Pehea e hoʻohana ai i ka lāʻau Saroten?

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

Nā palapala ʻano:

hoalohaha mau hoʻokūkū lōʻihi.

ʻO ke ʻano waiwai - amitriptyline hydrochloride 56.55 mg (e pili ana i ka 50 mg o ka amitriptyline).

Nā mea kūʻai - ka puna kōpū 123.074 mg, stearic acid 0.123 mg, shellac (non-waxed shellac) 8.480-14.140 mg, talcum 16.016-29.610 mg, povidone 0.724-1.086 mg.

Ka hoʻopaʻa ʻana o kahi pahu pale piha - gelatin 65.0 mg, kahe hao hao kahe hao (E 172) 0.98 mg, titanium dioxide (E 171) 0.33 mg.

paakiki, nā gelatin capsules, opaque, body and tutup red-brown. Uku nui Capsule No. 2.

Kākoʻo Kiʻi - nā palaki mai kahi keʻokeʻo a keʻokeʻo i ka melemele.

ʻO nā waiwai Pharmacological

ʻO Amitriptyline kahi antidepressant tricyclic. ʻO Amitriptyline kahi amine mākaʻikaʻi kūloko, e noho ana ma kahi o ke kikowaena waena o nā antidepresi tricyclic, no ka mea he like ia me ka hana like. i vivo me ka mea e pale ai i ka piʻi ʻana o ka serotonin a me nā norepinephrine e ka hopena o ka nerve presynaptic. ʻO ka metabolite koʻikoʻi o ka hoʻohui nortriptyline he mea paʻa i ka hoʻoneʻe o ka norepinephrine uptake, akā ua poloka nō hoʻi i ka hiʻona o ka serotonin. Amitriptyline ikaika ikaika anticholinergic, antihistaminergic a me sedative waiwai a potentiates kekahi hopena o nā catecholamines.

Ke hōʻike nei i ka wikiwiki o ka wikiwiki o ka maka (BDG) i manaʻo ʻia he hōʻailona o ka hana antidepressant. Tricyclic antidepressants, a me ka serotonin selectivee a me ka MAOI reuptake inhibitors, kāohi i ke ʻano o ka BDH a hoʻonui i ka hiamoe lohi i ka lōʻihi.

Hoʻonui ka Amitriptyline i kahi kahena o ka pathologically i hōʻemi ʻia.

Ma muli o kona hopena hopena, he mea koʻikoʻi ka amitriptyline i ka mālamaʻana i ke kaumaha, i hele pū me ka hopohopo, ke kaumaha, ka hopohopo a me nā wahi hiamoe.

ʻAʻole pili i ka hopena analgesic o ka lāʻau me ka antidepressant, no ka mea he nui ʻoi aku ka analgesia ma mua o nā ʻano hoʻololi ʻē aʻe, a ʻo ka hopena ma muli o ka lawe ʻana i ka haʻahaʻa haʻahaʻa ma mua o ka mea e pono ai e hōʻoia i nā loli like.

Hiki ke mālama pono i ka nocturnal enuresis.

Hoʻopau Hoʻolaha waha i ka lāʻau i loko o nā papa i hoʻoholo ai i ka loaʻa ʻana o ka pae kiʻekiʻe ma ka serum koko ma hope o 4:00 (t _max = 3.89 ± 1.87 hola, ʻauʻau 1.03-7.98 hola. Ma hope o ka lawe iā 50 mg, ka nui o ka waiwai o C _max = 30.95 ± 9.61 ng / ml, mūahi 10.85-45.70 ng / ml (111.57 ± 34.64 nmol / L, nāhele 39.06-164, 52 nmol / L). ʻO ka pīhoihoi kūlohelohe waha he 53% (F _abs = 0.527 ± 0.123, wahele 0.219-0.756). Kahele. ʻO ka pilina o ka protein plasma e pili ana i ka 95%. Amitriptyline a me kāna metabolite koʻikoʻi - nortriptyline - komo i loko o ka pale placental. Hāpai. ʻO ka metabolism Amitriptyline e hana nui ana ma ka demethylation (CYP2C19, CYP3A) a me ka hydroxylation (CYP2D6), i ukali ʻia e ka hui kulu me ka acidur o ka glucuronic. Eia kekahi, ʻikeia ka hana metabolism i ka genetically determin polymorphism. ʻO ka metabolite koʻikoʻi e pili ana i ka lua amine nortriptyline. ʻO Nortriptyline ka mea paʻa hou aku i ka hoʻihoʻi ʻana o ka hānai norepinephrine ma mua o ka serotonin, ʻoiai ke amitriptyline e kūleʻa maikaʻi ana i ka piʻi ʻana o nā neurotransmitters ʻelua. ʻO nā metabolites hou aʻe (cis a trans-10-hydroxyamitriptyline, a me cis a me ka trans-10-hydroxyinortriptyline) ke ʻano like me kahi kiʻi e like me ka nortriptyline, me ka hapa haʻahaʻa. Aia ʻo Demethylnortriptyline a me amitriptyline-N-oxide i loko o ke kaila plasma wale nō i loko o nā helu liʻiliʻi, ʻo ka hope loa o ka hana.

Hoʻopilikia nui ka excretion me ka urine. Kuhi ʻia ka hopena o ka amitriptyline e nā keiki (ma kahi o 2%).

I nā makuahine e hānai ana i nā pēpē hānai, ʻo amitriptyline a me nā nortriptyline i loko o ka waiū umauma ma nā liʻiliʻi liʻiliʻi. ʻO ka hoʻohālikelike o ka neʻe ʻana o ka waiū a me ka serum koko i loko o nā wahine he 1: 2. ʻO ka nui o ka nui o kēlā me kēia lā (amitriptyline + nortriptyline) i hāʻawi ʻia i ka pēpē e pili ana i ka 2% o ka nui o ka papa amitriptyline a ka makuahine, pili i ke kaumaha o ke kino o ka pēpē (ma mg / kg).

Loaʻa ka nui o nā pae plasma nui o ka amitriptyline a me ka nortriptyline i loko o ka hapa nui o nā mea maʻi ma loko o ka hebedoma. I kēia moku'āina, ʻo ka pae ma ka plasma koko i loko o ke ao e like me ka nui o ka amitriptyline a me nortriptyline i ka wā i mālama ʻia me nā papa papaʻaʻehā 3 mau lā i ka lā.

ʻOi aku ka lōʻihi o ka poʻe maʻi ʻoi aku ka hapalua-ola ma muli o ka emi haʻahaʻa loa.

Hiki i ka poʻokela i ka aʻa o kekahi ʻano aʻeha hiki ke hoʻopulapula i ka lawe ʻana o ka hepatic, ke alakaʻi nei i ke kiʻekiʻe kiʻekiʻe o ka lāʻau i ka plasma koko.

ʻAʻole hoʻopilikia ka hana a Renal i ka kinetics o ka lāʻau.

Hoʻololi Ka metabolism o ka lāʻau e pili ana i ka genetic polymorphism (isoenzymes CYP2D6 a me CYP2C19). Hoʻopili / Pharmacokinetic / pili paʻa. ʻO ka puna wai plasma paʻa no ka maʻi kaumaha loa he 100-250 ng / ml (≈370-925 nmol / l) (me ka amitriptyline a me nortriptyline).

ʻO ke kaumaha kaumaha, ʻo ia hoʻi me nā hiʻohiʻona hiʻona o ka hopohopo, ke kaumaha, a me nā hiamoe hiamoe.

ʻO nā kūlana kaumaha ma nā maʻi me ka schizophrenia i hui pū me nā antipsychotics e pale ai i ka exacerbation o hallucinations a me paraniaid mania.

ʻEha nā maʻi eha.

Hoʻolaha ʻo Nocturnal i ka haʻalele ʻana o nā patologi organik.

Nā Hoʻohui

Hypersensitivity i amitriptyline a i ʻole kekahi o nā mea pono o ka lāʻau.

ʻO ka wā hou i loaʻa i ka myocardial infarction. ʻO kēlā me kēia ʻano blockade a i ʻole arrhythmias cardiac, a me ka mea e loaʻa ai ka artery coronary.

Hoʻohui ʻia ka hoʻomaʻamaʻa ʻana me ka hoʻohana ʻana o MAOI (MAO inhibitors) (e ʻike i ka Māhele "Hoʻohālikelike i nā lāʻau lapaʻau a me nā ʻano ʻano ʻē aʻe").

Hiki i ka lawelawe ʻōhola o ka amitriptyline a me MAOI ka mea e hoʻoulu ai i ka serotonin syndrome (ka hui pū ʻana o nā hōʻailona, ​​ka mea e pili ana i ka hopohopo nui, nā haunaele, ka nui, myoclonus a me hyperthermia).

Hiki i ka hoʻouluulu ʻana me ka amitriptyline 14 mau lā ma hope o ke kāpae ʻana i ka hoʻohana ʻana i nā MAOI nonopili ʻole i koho ʻole ʻia, a ʻaʻole hoʻi e emi iho i ka 1 lā ma hope o ka hoʻihoʻi ʻana o nā lāʻau lapaʻau moclobemide a me selegiline.

Hiki i ka hoʻomaʻamaʻa ʻana me ka hoʻohana ʻana o MAOI hiki ke hoʻomaka i nā lā 14 ma hope o ka hoʻopaʻa ʻana i ka amitriptyline.

ʻO ka launa pū me nā lāʻau lapaʻau a me nā ʻano ʻē aʻe ʻē aʻe

ʻO MAO inhibitors (non-selective, a me ka selektif A moclobemide a me B selegiline) - ka hopena o ka "serotonin syndrome" (e nānā i ka ʻāpana "Contraindications").

Sympathomimetics: hiki i ka amitriptyline ke hoʻoikaika i nā hopena cardiovascular o ka adrenaline, ephedrine, isoprenaline, norepinephrine, phenylephrine a me phenylpropanolamine.

Nā blockers neuron Adrenergic: hiki ke hoʻopili i nā antidepresi tricyclic i nā hopena antihypertensive o ka guanethidine, betanidine, reserpine, clonidine, a me methyldopa.

Anticholinergics: hiki i nā antidepresi tricyclic ke hoʻoikaika i nā hopena o nā lāʻau lapaʻau e pili ana i ka maka, ke kalima, nā nīnū, nā ʻōpū a me nā ʻoloka, ʻo ka hoʻohana like ʻana iā lākou no ka hoʻonui nui ʻana o ka pēpē paralytic, pono e pale ʻia ka hyperpyrexia.

ʻO nā lāʻau lapaʻau e hoʻolōʻihi i ka palena QT o ka electrocardiograms, me ka lāʻau antiarrhythmic (quinidine), antihistamines (astemizole a terfenadine), kekahi mau lāʻau antipsychotic (i ka pimozide a me ka sertindole), cisapride, halofantrine a me nā sotalol e hoʻonui i ka hopena o ka hanana o ka ventricular o me nā antidepressants tricyclic.

ʻO nā hui antifungal, e like me ka fluconazole a me terbinafine, e hoʻonui i ka ʻike o ka antidepressants tricyclic i loko o ka serum o ke koko a me ka nui o ka hoʻonaninani concomitant. Aia nā hihia i nāwaliwali a me nā arrhythmias e like me torsade de pointes.

Nā hui e koi ana i ka mālama kūikawā

Nā mea hōʻeha i ka CNS: hiki i ka amitriptyline ke hoʻomaikaʻi i nā hopena sedative o ka waiʻona, barbiturates, a me nā mea hoʻonāukiuki waena o nā nūna.

ʻO ka hopena o nā lāʻau lapaʻau'ē aʻe i ka pharmacokinetics o nā tridlic antidepressants

ʻO ka antidepressants Tricyclic, me ka amitriptyline, e hoʻololi ʻia e ka cytochrome P450 isoenzyme CYP2D6. Hōʻike ʻia ka CYP2D6 e ka polymorphism i ka heluna kanaka a me kāna hana e hiki ke keʻa ʻia e nā psychotropic nui e like me nā lāʻau ʻē aʻe, e like me ka antipsychotics, serotonin reuptake inhibitors me ka hoʻokaʻawale ʻana o citalopram (he mea palupalu isoenzyme inhibitor), ʻokiʻoki β-adrenergic, a me nā lāʻau antiarrhythmic. . ^ E Ha yM. ʻO nā isoenzymes CYP2C19 a me CYP3A i komo pū i ka hana o ka metabolism ʻo amitriptyline.

ʻO nā Barbiturates, e like me nā stimulants enzim, rifampicin a me carbamazepine, hiki ke hoʻoikaika i ka metabolism a ma laila e hōʻemi ai i kahi kiko o nā antidepresan tricyclic i loko o ke koko koko a me ka hoʻēmi ʻana i ka hopena antidepressant.

ʻO Cimetidine a me methylphenidate, a me nā mākaukau o nā palaka saluran kalaleka, e hoʻonui i nā pae o nā pūpū tricyclic i loko o ke kō koko a me nā meaʻala e kau pū ana.

ʻO nā antidepresants o Tricyclic a me nā antipsychotics e pili pono i ka metabolism o kēlā me kēia, hiki i kēia ke kahe i ka paepae hopu a me ka nānā ʻana i nā kuʻe.

Nā mālamuhina Antifungal e like me ka fluconazole a me terbinafine i hoʻonui i ka serum pae o ka amitriptyline a me nā nortriptyline. Ma ke alo o ka eʻololo, ua hoʻonui ʻia ka kukuna plasma manuahi ʻole o ka amitriptyline a me nā ʻaina o nortriptyline.

Nā hiʻohiʻona noi

ʻAʻole i ʻōlohelohe ʻia ʻo Amitriptyline me ka pale ʻana o MAO (e ʻike i nā Māhele "Contraindications" a me "Interaction me nā lāʻau lapaʻau a me nā ʻano ʻē aʻe".

Ke hoʻohana nei i nā papa kiʻekiʻe o ka lāʻau lapaʻau, hiki i ka nui o ke kūkulu ʻana i ka hana hōʻeha naʻau a me ka nui o ka hypotension arterial. Hiki ke hoʻomohala ʻia ke ʻano o ia ʻano me ka hoʻohana ʻana i nā dosis maʻamau i nā maʻi me nā maʻi naʻau e noho nei.

ʻO Amitriptyline e pono e kuhikuhi me ka mālama ʻana i nā poʻe maʻi me ka hoʻomanawanui, mālama i ka urinary, hypertrophy prostatic, hyperthyroidism, i mua o nā hōʻailona paranoid, me nā maʻiʻeha a i ʻole nā ​​maʻi cardiovascular.

ʻO ka hopohopo e pili ana i ka nui o ka pilikia o ka pepehi kanaka. Hiki ke loaʻa i kēlā pilikia a hiki i ka wā e loaʻa ai ke kala mau a kū mai i ka wā o ka hōʻola. Ma muli o ka hiki ʻole o ka hoʻomaʻamaʻa ʻana i nā hebedoma mua o ka mālama ʻana a i ʻole ke lōʻihi, pono e nānā pono nā mea maʻi a hiki i ka hiki ʻana mai o ka hoʻomaikaʻi ʻana. Mai ka mākaukau o ka maʻi maʻamau, ʻike ʻia ka piʻi ʻana o ka hoʻoulu a pepehi ʻia i nā hoʻomaka mua o ka hoʻōla. ʻO ka poʻe maʻi me ka mōʻaukala o nā hanana suicidal a i ʻole he nui koʻikoʻi o nā manaʻo suicidal ma mua o ka ʻike ʻia o ka mālama ʻana e ʻoi aku ka nui o ka pepehi ʻana o ka pepehi ʻana a i ʻole ʻia, a pono e loaʻa ke nānā kokoke i ka wā mālama. Ua hōʻike ʻia ka meta-analilo o nā hoʻokolohua lapaʻau e mālama ʻia e nā antidepresi i nā maʻi pākeke me nā maʻi noʻonoʻo e hōʻike ana i ka nui o ka hoʻoulu ʻana i ka hana suicidal i ka wā e hoʻohana ai ka antidepressants i hoʻohālikelike ʻia me ka placebo i nā mea maʻi ma lalo o 25 mau makahiki o kona mau makahiki.

Pono ka nānā nui ʻana i ka wā e kuhikuhi ana i ka amitriptyline i nā mea maʻi me ka hyperthyroidism a i ʻole ka poʻe e lawe ana i ka hoʻomākaukau ʻana i ka hormone thyroid, ʻoiai hiki ke hiki i ka hoʻomohala ʻana o ka arrhythmias cardiac.

Hoʻomaʻamaʻa pinepine nā poʻe maʻi i ka hoʻomohala ʻana i ka hypotension postural i ka wā e mālama ai me ka amitriptyline.

I loko o nā mea maʻi e hoʻomanawanui nei i ka maʻi manic-depressive, hiki i ka hoʻololi o ka maʻi i loko o ka manic manawa, mai ka hoʻomaka ʻana o ka manic o ka maʻi o ka mea maʻi, pono e hoʻōla ʻia ka lāʻau amitriptyline.

Ke hoʻohana nei i ka amitriptyline no ka mea kaumahaʻole o ka schizophrenia, hiki i ka nui o nā maʻi psychotic. Pono ke ʻano o Amitriptyline i hui pū me nā antipsychotics.

I ka poʻe maʻi me ka loaʻa ʻole o ka papa pāpaku a me ka kiki ʻāwili o ke keʻena anterior o ka maka, e hoʻoweliweli ʻia ka hōʻeha ʻana o nā huaole ma muli o ka hoʻoweliweli ʻana o ka haumāna.

ʻO ka hoʻohana ʻana o ka anesthetics i ka wā o ka maʻi me ka tri- / tetracyclic antidepressants e hoʻonui i ka hiki i ka arrhythmias a me kahi hypotension arterial. Inā hiki, oki e hoʻohana i ka amitriptyline i kekahi mau lā ma mua o ka hoʻomaʻamaʻa ʻana. Inā ʻaʻole hiki ke hoʻokolohua pilikia, e hōʻike ana i ka mea pili e pili ana i ka hana amitriptyline.

E like me nā lāʻau mālama psychotropic, hiki i ka amitriptyline ke hoʻololi i ka naʻau o ke kino i ka insulin a me ka glucose, e koi ai i ka hoʻoponopono ʻana o ka antidiabetic therapy i nā poʻe maʻi me ka maʻi mellitus, a me ke ʻano he maʻi kaumaha, ʻo ka mea maoli paha e hōʻike iā ia iho i nā loli i ke koena o ka glucose i ke kino o ka mea maʻi.

ʻO nā hihia o ka hyperpyrexia me ka hoʻohanaʻana i nā antidepresi tricyclic i hōʻike ʻia i ka hihia o ke kuʻina i ka manawa like me nā anticholinergic a i ʻole nā ​​antipsychotic lāʻau, ka mea nui i ka wā wela.

Hiki ke hōʻeha ʻia o ka maʻi ma hope o ka mālama lōʻihi ʻana i nā hōʻailona hōʻemi i ke ʻano o ke poʻo o ka poʻo, malaise, insomnia a me ka huhū.

Pono e hoʻohana ʻia ʻo Amitriptyline me ka mālama ʻana i nā maʻi i lawe i ka SSRI.

Nā mea hoʻoweliweli: papa hua o ka lāʻau i loko o ka lactose monohydrate. ʻO nā mea maʻi me nā maʻi hoʻohemo maʻamau i ke ʻano o ka naʻau o ka galactose, ka nele o ka lactase a i ʻole ka malabsorption o glucose-galactose e lawe i kēia lāʻau.

Hoʻohana i ka wā hāpai a me ka lactation

ʻAʻole ʻae ʻia ʻo Amitriptyline i ka wā hāpai, inā ʻaʻole ʻoi aku ka pōmaikaʻi o ka mea maʻi i ʻoi aku ma mua o ka pilikia theoretical i ka pūpū. ʻO ka lawelawe ʻana o nā dosis kiʻekiʻe o nā antidepresi tricyclic i ke kolu o ka hapalua o ka hapai hiki ke alakaʻi i nā hoʻopiʻi neurovascular i nā pēpē. I ka poʻe hānau hou, e like me nā hōʻike, ua hoʻokumu wale ʻia nā hihia o ka ʻeha ma muli o nā hopena o ka hopena amitriptyline a me ka mālama ʻana i ka urinary ma muli o ka hōʻike ʻana i ka nortriptyline (kahi metabolite amitriptyline), inā ua kauoha ʻia ka lāʻau lapaʻau i nā wahine hāpai i mua o ka hānau ʻana.

Ke make nei ka lāʻau lapaʻau i ka umauma waiū i nā liʻiliʻi liʻiliʻi, no laila ʻo ka hopena ma ke pēpē i ka wā e lawe ʻole ai i nā dosis therapeutic. ʻO ka ʻōlelo i loaʻa ʻia e ke keiki ma kahi o 2% o ka nui o ka makuahine, e pili ana i ke kaumaha o ke keiki (ma mg / kg). Inā pono i nā ʻoihana maʻi, hiki ke hoʻomau i ka ʻōpiopio ma ka wā ʻoihana amitriptyline, akā e mālama ʻia ka mālama ʻana i ke pēpē, ʻoi aku ka 4 mau pule mua ma hope o ka hānau ʻana.

Nā hōʻailona no ka hoʻohana ʻana

ʻO ke kaumaha (me ka hopohopo nui, ke kaumaha, a me nā pilikia hiamoe, e komo pūi ka wā kamaliʻi, endogenous, involutional, reactive, neurotic, drug, with organic brain damage, hoʻihoʻi ʻawaʻawa), psychizophrenic psychoses, mix emosyonal mix, ʻoluʻolu hana (hana a me ka nānā aku), nocturnal enuresis (koe wale nō nā mea maʻi me ka pōpoki papau). bulimia nervosa, ʻehaʻeha hōʻeha o ke kanikani (ʻo ke kaumaha mau loa i nā maʻi maʻi, migraine, maʻi maʻi rheumatic, nā hōʻeha atypical i ke alo, postherpetic neuralgia, post-traumatic neuropathy ia, maʻi kuʻi a i ʻole nā ​​peripheral neuropathy), ʻehaʻeha, migraine (pale), ulia peptic o ka ʻōpū a me ka duodenum.

Pehea e hoʻohana ai: dosis a me ke ʻano o ka mālama ʻana

I loko, me ka ʻaihue ʻole ʻana, ma hope koke o ka ʻai ʻana (e hōʻemi i ka huhū o ka mucosa o ka ʻōpū). ʻO ka inikua mua no nā pākeke he 25-50 mg i ka pō, a laila hoʻonui ka nui ma luna o nā lā 5-6 a hiki i 150-200 mg / lā ma 3 mau pona (ʻo ka hapa nui o ka nui ma ka lā i lawe ʻia i ka pō). Inā ʻaʻohe holomua i loko o nā hebedoma 2, e hoʻonui ʻia ka nui o kēlā me kēia lā i 300 mg. Inā nalowale nā ​​hōʻailona o ke kaumaha, ua hoʻemi ʻia ka nui o ka lāʻau ma 50-100 mg / lā a hoʻomau ʻia ka lāʻau no ka liʻiliʻi o 3 mau mahina. I ka wā ʻelemakule, me ka maʻi ʻehaʻeha, kahi pona o 30-100 mg / lā (i ka pō) i kuhikuhi ʻia, ma hope o ka hiki ʻana i ka hopena therapeutic, ua huli lākou i ka hopena haʻahaʻa loa - 25-50 mg / lā.

Intramuscularly a iv (i hoʻoluhi lohi ʻia) ma kahi pānaʻi o 20-40 mg 4 mau manawa i ka lā, e hoʻololi lōloi ʻia me ke kau ʻana. ʻAʻoleʻoi aku ka lōʻihi o ka mālamaʻana i nā mahina 6 mahina.

Me nā enuresis nocturnal i nā keiki 6-10 mau makahiki - 10-20 mg / lā i ka pō, 11-16 makahiki mau makahiki - 25-50 mg / lā.

ʻO nā keiki ma kahi antidepressant: mai 6 a 12 mau makahiki - 10-30 mg a i ʻole 1-5 mg / kg / lā i kahi hapa, i ka wā kamaliʻi - 10 mg 3 mau manawa i kahi lā (inā pono, a hiki i 100 mg / lā).

No ka pale ʻana i ka migraine, me nā maʻi maʻamau o kahi ʻano neurogen (me ke poʻo o ke poʻo lōʻihi) - mai ka 12.5-25 a 100 mg / lā (ka nui loa o ka nui i ka pō).

Ka hana lāʻau lapaʻau

Antidepressant (tricyclic antidepressant). Loaʻa kekahi i kekahi analgesic (waena kumu), H2-histamine-blocking a me ka hana antiserotonin, kōkua ia e hoʻopau i ka urinary incontinence a hōʻemi i ka makemake.

Loaʻa ia i kahi hopena peripheral ikaika a me ka waena anticholinergic, ma muli o ka pilina kiʻekiʻe no ka poʻe m-cholinergic receptors, kahi hopena sedative ikaika e pili ana i ka pilina me ka H1-histamine receptors, a me nā alpha-adrenergic blocking hopena. Loaʻa ia nā waiwai o nā lāʻau antiarrhythmic o subgroup Ia, e like me ka quinidine in therapeutic doses, hoʻohaʻahaʻa i ka condricular conduction (inā paha he overdose, hiki iā ia ke hoʻoulu i ka intraventricular block).

Hoʻopili ʻia nā hana o ka hana antidepressant me ka hoʻonui i ka neʻe ʻana o ka norepinephrine i nā synapses a me / a i ʻole serotonin i loko o ka papa launa waena (a me ka hoʻēmi ʻana i ko lākou hōihoʻi hou ʻana). ʻO ka hōʻiliʻili ʻana o kēia mau neurotransmitters e hele mai ma muli o ke kaomi ʻana o ko lākou hopu hou ʻia e nā membranes o nā neurons presynaptic. Me ka lōʻihi o ka hoʻohana ʻana, e hōʻemi ana i ka hana hana o nā mea hoʻokomo beta-adrenergic a me serotonin i loko o ka lolo, hoʻomaʻamaʻa i ka hoʻoiho adrenergic a me serotonergic, a hoʻihoʻi hou i ka pae kaulike o kēia mau ʻōnaehana, ka mea i haki ʻia ma nā wahi kaumaha. I nā hopohopo-kaumaha kaumaha, e hōʻemi ana i ka hopohopo, ke kuuhū a me nā hōʻailona kaumaha.

ʻO ka hana o ka hana antiulcer ma muli o ka hiki ke kāohi ʻia ka hopena o nā ʻalapela H2-histamine i nā ʻāpana parietal o ka ʻōpū, me ka puʻupuʻu i ka hopena sedative a me ka m-anticholinergic (i ke ʻano o ka ulia peptic o ka ʻōpū a me ka ʻōpū duodenal, e hōʻoluʻolu i ka hōʻeha, a me ka hoʻōla i ka hoʻōla ʻana i nā ʻeha)

ʻO ka hoʻomaʻamaʻa ʻana i ka wā o ka moena moe ke ʻike ʻia ma muli o ka hana anticholinergic, ke alakaʻi nei i ka hoʻonui i ka hiki ke kīlei i ka pālahalaha ʻana, hoʻopuka pololei ana ʻo beta-adrenergic, hana o nā agonists alpha-adrenergic, i hoʻopili ʻia e ka piʻi ʻana o ka leo sphincter, a me kahi poloka waena o ka serotonin uptake.

Loaʻa ia i kahi hopena analgesic kikowaena, i manaʻoʻiʻo ia na ka loli o ka neʻe ʻana o ka monoamines i loko o nā kinipōpō o ke kikowaena, ka nui o ka serotonin, a me ka hopena o nā pūnaehana opogenid endogenous.

ʻOka ke ʻano o ka hana no ka bulimia nervosa ka mea maopopo ʻole (like paha me ia no ke kaumaha). Ka hopena ʻokoʻa o ka lāʻau lapaʻau i ka bulimia i nā poʻe maʻi me ka ʻole o ke kaumaha a me kona neʻe ʻana i hōʻike ʻia, ʻoiai ke ʻike ʻia ka emi ʻana o ka bulimia me ka nāwaliwali ʻole o ka pohō.

Ke hana nei i ka anesthesia ākea, e hoʻohaʻahaʻa ia i ke koko a me ke ʻano wela o ke kino. ʻAʻole ke keʻakeʻa iā MAO.

Hoʻokomo ka hopena antidepressant i loko o nā hebedoma 2-3 ma hope o ka hoʻomaka ʻana o ka hoʻohana.

Nā hopena hopena

Nā hopena Anticholinergic: nā hiʻona blurred, paralysis of accommodation, mydriasis, piʻi intraocular pressure (wale nō i nā poʻe me kahi predicposition anatomical kūloko - kahi kuʻikiʻu liʻiliʻi o ka keʻena anterior), tachycardia, waha maloʻo, hilahila, delirium a hallucinations, constipation, paralytic intestinal bara, paʻakikī urinating ʻānō ka hanu ʻana.

Mai ka pūnaehana nūhou: ka ʻeha, ka asthenia, nāwaliwali, nā hopohopo, ke kaumaha, hallucitions (ʻoi aku hoʻi i nā poʻe maʻi maʻi a me nā mea maʻi me ka maʻi Parkinson) nā hopohopo, nā hopohopo, nā hopohopo motor, ka ʻāina manic, hoʻokaumaha hypomanic, hoʻonāukiuki, hōʻeha o ka hoʻomanaʻo ʻana, depersonalization , hoʻonui i ka manaʻo, hoʻohaʻahaʻa i hiki ke kāohi, ʻāina, "pōʻeleʻele" moeʻuhane, aʻokiʻō, asthenia, hoʻōla i nā hōʻailona o ka psychosis, ʻeha, myoclonus, dysarthria, tremor Paina nāʻiʻo, ka oi aku i ka lima, lima, ke poo a me na olelo,ʻike ākea neuropathy (paresthesia), myasthenia gravis, myoclonus, ataxia, extrapyramidal maʻi pale, hoʻonui a me intensification o kāʻili 'ana, EEG hoʻololi.

Mai CCC: tachycardia, palpitations, dizziness, orthostatic hypotension, nonspecific ECG loli (ST interval a T wave) i nā poʻe maʻi me ka ʻole o ka maʻi puʻuwai, arrhythmia, ka hana i ke koko (hōʻemi a hoʻonui i ke kaomi koko), hoʻopiʻi intraventricular (hoʻoulu ʻia o ka paʻakikī QRS, hoʻololi i ka PQ interval, blockade o nā wāwae o ka pūpū o kāna).

Mai ka pūnaehana ʻana: ka hanu, paʻa ka maʻi hepatitis (e komo pū ana i ka hana aho pehu a me ka jaundice cholestatic), ka ʻulaʻī, ka luaʻi, ka gastralgia, nui ka momona a me ke kaumaha o ke kino a i ʻole ka hoʻēmi ʻana i ka makemake a me ke kaumaha o ke kino, stomatitis, hoʻololi i ka maʻi, ʻeha a me ka pouli o ka ʻōlelo.

Mai ka pūnaehana endocrine: ka nui o ka nui (edema) o nā testicles, gynecomastia, he nui i ka nui o nā momona mummary, galactorrhea, kahi hōʻemi a hoʻonui paha i ka libido, he kahe nui o ka potency, hyp- or hyperglycemia, hyponatremia (he hōʻemi i ka hana o ka vasopressin), he mea waiwai ʻole o ka ADH.

Mai nā lālā hemopoietic: agranulocytosis, leukopenia, thrombocytopenia, purpura, eosinophilia.

He maʻi kūlohelohe: ʻāwili i ka ʻili, ke kau ʻana o ka ʻili, urticaria, photosensitivity, ka huehue o ka maka a me ka alelo.

ʻO nā mea'ē aʻe: nā lauoho lauoho, tinnitus, edema, hyperpyrexia, nā nīnū lymph nūnū, mālama i ka urinary, pollakiuria, hypoproteinemia.

Ka hoʻihoʻi ʻana i nā hōʻailona: me ka hoʻokuʻu koke ʻana ma hope o ka lōʻihi o ka mālama ʻana - ka maʻi iki, ka luaʻi, ka ʻeha, ka ʻeha, ka ʻeha, ka hiamoe ʻana, nā moeʻuhane kūlohelohe, ke ʻano kūlohelohe, me ka wehe ʻana o ka hana lōʻihi - ka huhū, ka hopohopo hopohopo, ke hiamoe ʻole, nā moeʻuhane maʻamau.

ʻAʻole paʻa i ka pilina me ka ʻoihana hoʻomalu: nā pua like-like ʻo lupus (like me ka melratory arthritis, ka ʻike ʻana i nā antibi antinuclear a me ka hopena rheumatoid maikaʻi), hana i ka puʻuwai hemahema, ageusia.

ʻO nā hopena kūloko i ke kulekele iv: thrombophlebitis, lymphangitis, ke puhi ʻana i ka sensation, a me ke ʻano kūlohelohe. Overdose. Nā Hoʻomaka Mai ka ʻaoʻao o ka lawelawe o ka pūnaehana kūloko: mau ka hiamoe, stupor, coma, ataxia, hallucinations, hopohopo, psychomotor agitation, hoʻemi i ka hiki ke kāohi, disorientation, confingth, dysarthria, hyperreflexia, uaua paʻakikī, choreoathetosis, epileptic syndrome.

Mai CCC: hoʻemi kahe koko, tachycardia, arrhythmia, ka hoʻopilikia ʻana i ka intracardiac conduction, hoʻololi ʻia ʻo ECG (ʻoi aku hoʻi ia QRS), nāwīlū, puʻuwai puʻuwai, ʻohiʻohi i ka hoʻonaninani antidepresan tricyclic, pīhoihoi, hōʻeha i ka naʻau ma nā hihia loaʻa pinepine ʻole.

ʻO nā mea'ē aʻe: ke ake o nā mea hanu, pōkole o ka hanu, cyanosis, luaʻi, hyperthermia, mydriasis, hoʻonui nui loa, oliguria a anuria.

Kūkulu nā ʻōhumu i nā hola 4 ma hope o ka overdose, hiki i ka lōʻihi ma hope o 24 mau hola a i nā lā 4-6 mau lā. Inā kānalua kekahi overdose, ʻoi aku hoʻi i nā keiki, pono ke mālama ʻia ka mea maʻi.

Hanaʻi: me ka waha o ka ihu: lavage gastric, hoʻokele ʻana i ka ulana i hoʻōla ʻia, hōʻailona a me ke kākoʻo kākoʻo, me nā hopena anticholinergic kino (hōʻemi i ke kahe koko, arrhythmias, coma, hoʻokuʻi myoclonic) - ka hoʻomalu ʻana i nā inhibitor cholinesterase (ʻaʻole i ʻōlelo ʻia ka physostigmine no ka hoʻonui nui ʻana o ka hopu. ), ka mālama ʻana i ke koko a me ke kaulike wai-electrolyte. Hōʻike nā mana o nā hana CCC (me ka ECG) no 5 mau lā (hiki i ka hoʻomaha ke hiki i loko o 48 mau hola a i hope paha), mea lapaʻau anticonvulsant, ventilation mechanical, a me nā hana resuscitation ʻē aʻe. ʻO Hemodialysis a me nā diuresis hoʻoikaika i mea ʻole ia.

Nā ʻōlelo kikoʻī

Ma mua o ka hoʻomaka ʻana i ka mālama ʻana, pono e mālama ʻia ke koko (i loko o nā mea maʻi me ka hoʻokahe koko haʻahaʻa a hiki ke emi iho i nā mea hou aʻe), i ka wā mālama ʻia pono e mālama i ke koko peripheral (i kekahi mau hihia, hiki i ka agranulocytosis ke hoʻomohala, a no laila e ʻōlelo ʻia e nānā i ke kiʻi koko, me ka nui o hoʻonui i ke kino o ke kino, ke kūkulu ʻana i nā hōʻailona like-like me nā ʻehaʻeha koʻikoʻi), me ka hoʻomehana lōʻihi - ka hoʻomohala i nā hana o ka CVS a me ka puʻuwai. I ka poʻeʻelemakule a me nā mea maʻi me nā maʻi CCC, kāohi i ka nui o ka naʻau, ke koko, ke hōʻike ʻia ka ECG. Hiki ke loli paha nā loli i ka ʻoihana ʻē aʻe ma ka ECG (hoʻoliʻiliʻi i ka nalu T, hōʻeha i ka māhele S-T, hoʻonui i ka paʻakikī QRS).

Hiki i ka hoʻohana makua wale nō ma o kahi hale mālama, ma lalo o ka mākaʻi o ke kauka, me ka hoʻomaha ʻana o ka moena i nā lā mua o ka maʻi maʻi.

Pono e nānā mua aku i ka neʻe koke ʻana i kahi kūlana kūʻē mai kahi noho a noho ʻole paha.

I ka wā mālama, pono ke haʻalele ʻia ka ethanol.

E hāʻawi i ʻole ma mua o 14 mau lā ma hope o ka hemo ʻana o ko MAO inhibitors, e hoʻomaka me nā dosis liʻiliʻi.

Me kahi hikiʻole o ka hoʻokele ʻana ma hope o ka mālama lōʻihi, hiki i ka hoʻomohala ʻana o ka maʻi "withdrawal".

ʻO ka Amitriptyline i nā papa ma luna o 150 mg / lā e hōʻemi ana i ka paepae o ka hana hoʻomanawanui (ʻo ka loaʻa ʻana o nā meaʻawaʻawa epileptic i nā mea maʻi predisposed, me ka hiki ʻana o nā mea ʻē aʻe i hoʻomaka i ka hanana ʻana o ka maʻi hoʻomanaki, no ka laʻana, ka hoʻowalewale ʻana o ka lolo o kekahi etiology, ʻoiai e noʻonoʻo pono ai ka hoʻohana ʻana o nā lāʻau antipsychotic (antipsychotics). i ka hōʻole ʻana o ka ethanol a i ʻole ka haʻalele ʻana i nā lāʻau lapaʻau me nā mea anticonvulsant, e like me benzodiazepines).

Hōʻike ka maʻi kaumaha i ka hopena o nā hana suicidal, ka mea hiki ke kiʻi a hiki i ka loaʻa ʻana o ke kala koʻikoʻi. Ma kēia noʻonoʻo, i ka hoʻomaka ʻana o ka mālama ʻana, hiki i ka hui pū me nā lāʻau lapaʻau mai ka hui benzodiazepine a i ʻole nā ​​mea kanu antipsychotic a me ka mālama mau ʻana i nā lāʻau lapaʻau.

I loko o nā mea maʻi me ka maʻi pākuʻi cyclic, i ka manawa o ka manawa kaumaha, hiki i ka manic a i ʻole hypomanic kūlana hoʻomohala i ka wā o ka maʻi (hōʻemi ʻia i ka hoʻoneʻe ʻana a hoʻolilo paha i nā lāʻau lapaʻau antipsychotic pono). Ma hope o ke kau ʻana i kēia mau kūlana, inā loaʻa nā hōʻailona, ​​hiki ke hoʻomau ʻia ka mālama ʻana i nā dosis haʻahaʻa.

Ma muli o nā hopena cardiotoxic hiki loa, e koi ʻia ka mālama ʻana i ka wā e mālama ai i nā maʻi maʻi thyrotoxicosis a i nā mea maʻi e loaʻa ana i ka hoʻomākaukau ʻana i ka hormone thyroid.

I ka hui pū ʻana me ka hoʻolaʻa electroconvulsive, e kuhikuhi pū ʻia me ka mālama ʻana o ka maʻi lapaʻau.

I nā mea maʻi predisposed a me nā maʻi maʻi, hiki iā ia ke hoʻonāukiuki i ka hoʻomohala ʻana i nā maʻi psychoses, ʻoi loa ia i ka pō (ma hope o ka hōʻea o ka lāʻau lapaʻau, nalo lākou i loko o kahi mau lā).

Hiki i ka ʻalopili i ka palaki poloka paralytic, ka mea nui i nā mea maʻi me ka maʻi constipation, ʻo ka mea makua a i ʻole nā ​​mea maʻi e koi ʻia e mālama i ka hoʻomaha moe.

Ma mua o ka alakaʻi ʻana i ka anesthesia ākea a i ʻole kūloko, pono e hoʻomanaʻo ʻia he ʻano anesthesiologist e lawe ana ka mea maʻi i ka amitriptyline.

Ma muli o ka hana anticholinergic, kahi i hoʻohaʻahaʻa i ka lacrimation a me ka hoʻonui pinepine ʻana i ka nui o ka huehue i ka pūnaehana o ka waimaka ʻā hiki, hiki iā ia ke hana i ka hōʻino i ka epitheli corneal i loko o nā mea maʻi e hoʻohana ana i nā leʻaleʻa hoʻopili.

Me ka hoʻohana mau ʻana, ʻike ʻia kahi mahuahua o nā pilikia o nā niho niho. Hiki ke hoʻonui ʻia ka pono no ka riboflavin.

Ua hōʻike ʻia kahi hōʻike no ka hoʻopiʻi ʻana i nā holoholona i hopena maikaʻi loa i ka maʻi ʻana, a ʻaʻole i mālama ʻia nā haʻawina kūpono i hoʻopaʻa ʻia i nā wahine hāpai. I nā wahine hāpai, pono ke hoʻohana ʻia ka lāʻau inā pono ka manaʻo nui i ka makuahine i ʻoi loa i ka hopena o ka wahine hāpai.

Komo ʻia i loko o ka waiū umauma a e hōʻeha paha i ka hiamoe i nā pēpē.

I mea e pale aku ai i ka hoʻomohala ʻana o ka maʻi "withdrawal" i nā keiki hou (i hōʻike ʻia e ka pōkole o ka hanu, ka hiamoe, ka colinal intestinal, nui ka huhū a me ka hopohopo, hypotension a hypertension, tremor a spastic phenomena), amitriptyline e hoʻopau iki ʻia a ma kahi o 7 mau hebedoma ma mua o ka hānau ʻana i manaʻo ʻia.

Hoʻopili loa nā keiki i ka overdose aʻa, kahi e noʻonoʻo ai i ka mea weliweli a me ka hōʻeha ʻana iā lākou.

I ka wā o ka mālama ʻana, pono e mālama ʻia i ka wā e alakaʻi ana i nā kaʻa a komo i nā hana ʻē aʻe ʻē aʻe e koi ai i ka nui o ka neʻe ʻana a me ka wikiwiki o ka hopena psychomotor.

Me ka mālama pono

ʻO nā maʻi hoʻohālikelike, ka noho ʻana o ka urinary, ka hyperplasia prostatic, ka maʻi palupalu a me nā maʻi cardiovascular, ka nui ʻana o ka momona thyroid gland, hōʻailona paranoid, bipolar affective disorder (ma hope o ke waiho ʻana i kahi palupalu), intraocular hypertension (ma ke kanaka me kahi predisposition anatomical - kahi kihi kūleʻa

keʻena anterior), nā waiʻona maʻi maʻi, ka mālama ʻana i ka hematopoiesis pumehana o ka iwi, hypotension o ka pāheʻe, ʻōpū o bronchial, i hoʻemi ka hana o ka ʻeha gastrointestinal (hopena o ka leʻo paralytic), ka hui pū me ka selotonin reuptake inhibitors (SSRIs), ka makahiki kahiko, ka hapai.

ʻLoe a me ke kākele

Ke lawe nei i kahi mau kapika a Saroten Retard, ʻoi aku ia e inu me ka wai. Akā, hiki ke wehe ʻia nā Capsules a hiki ke lawe ʻia ka manaʻo me nā wai a lākou i nā mea (pellets). ʻAʻole kaʻili ʻia nā peni.

Hōʻike Depresive. ʻO nā kūlana kaumaha ma schizophrenia. Ua kuhikuhi ʻia i hoʻokahi manawa ma kahi o 3-4 mau hola ma mua o ka hiamoe.

Pono e mālama ʻia me ka Saroten Retard me hoʻokahi capsule e 50 mg i ke ahiahi. Inā pono, ma hope o ka hebedoma e hiki ke hoʻonui iki ʻia ka nui o ka lā ma 2 - 3 mau pūleʻa i ke ahiahi (100-150 mg). Ma hope o ka loaʻa ʻana o ka hoʻomaikaʻi ʻana i ka hōʻailona, ​​hiki ke hōʻemi ʻia ka nui o kēlā me kēia lā i ka hopena haʻahaʻa, ʻoi aku a hiki i ka 1-2 capsules (50-100 mg / lā).

Hoʻohala pinepine ka hopena antidepressant ma hope o 2 a 4 mau pule.Hoʻomaʻamaʻa ka lāʻau lapaʻau no ke kaumaha, no laila, ʻoi aku e hoʻomau i ka hoʻohana ʻana i nā antidepressants, e like me Saroten Retard, ma hope o ka loaʻa ʻana o kahi hopena i haʻi ʻia no kahi manawa kūpono - a hiki i 6 mau mahina e pale ai i ka hoʻi hou ʻana. I nā mea maʻi me ka hoʻihoʻi hou ʻana (unipolar), kahi alakaʻi lōʻihi o Saroten Retard e koi ʻia, a hala a hala i kekahi mau makahiki, i ka mālama ʻana i nā hōʻaiho i nā hopena anti-relaps.

Ka poʻe maʻi ma mua (ma mua o 65 mau makahiki) ʻO 50 mg capsule i ke ahiahi.

Hōʻemi ka hana o kaʻili

Hiki i nā Amitriptyline ke kuhikuhi i nā maʻi maʻamau no nā maʻi me nā pilikia ʻole.

Hōʻemi ka hana o ka ate

Pono e mālama pono i ka wā e hoʻohana ana i ka lāʻau lapaʻau i nā mea maʻi me ka hana aho lēwa, ka ʻōpala ʻo amitriptyline e nānā ʻia ma nā manawa he hiki.

Ma ka hoʻopau ʻana o ka lāʻau, ʻike ʻia ka hōʻaila ʻana e mālama ʻia me nā manawa he nui i hala mau hebedoma e pale ai i ke kūkulu hou ʻana o ka "hoʻihoʻi ʻia" hopena (ʻike i ka ʻāpana "ʻaoʻao hopena").

Hoʻohana i ka wā hāpai a lactation

ʻAʻole ʻae ʻia ʻo Amitriptyline i ka wā hāpai, inā ʻaʻole ʻoi aku ka pōmaikaʻi o ka mea maʻi i ʻoi aku ma mua o ka pilikia theoretical i ka pūpū. ʻO ka lawelawe ʻana o nā dosis kiʻekiʻe o nā antidepresi tricyclic i ke kolu o ka hapalua o ka hapai hiki ke alakaʻi i nā hoʻopiʻi neurovascular i nā pēpē. I nā keiki hou, e like me nā hōʻike, ua hoʻokumu wale ʻia nā hihia o ka ʻeha ma muli o nā hopena o ka hopena o ka amitriptyline a me ka mālama ʻana i ka urinary ma muli o nā hopena o ka nortriptyline (kahi metabolite o amitriptyline), inā ua kauoha ʻia ka lāʻau lapaʻau i nā wahine hāpai i mua o ka hānau ʻana.

Ke make nei ka lāʻau lapaʻau i ka umauma waiū i nā liʻiliʻi liʻiliʻi, no laila ʻo ka hopena ma ke pēpē i ka wā e lawe ʻole ai i nā dosis therapeutic. ʻO ka ʻōlelo i loaʻa ʻia e ke keiki ma kahi o 2% o ka nui o ka makuahine, e pili ana i ke kaumaha o ke keiki (ma mg / kg). Inā pono i nā ʻoihana maʻi, hiki ke hoʻomau i ka ʻōpiopio ma ka wā ʻoihana amitriptyline, akā e mālama ʻia ka mālama ʻana i ke pēpē, ʻoi aku ka 4 mau pule mua ma hope o ka hānau ʻana.

Ke keu

Nā hōʻailona Cardiac: arrhythmias (tachyarrhythmias ventricular, flutter-flicker, ventricular fibrillation). Hōʻike maʻamau ka ECG i kahi lōʻihi o ka PR PR, hoʻonui i ka paʻakikī QRS, hoʻonui i ka QT, hoʻonui a i ʻole ka hoʻowali ʻana o ka neʻe ʻana o ka T, hōʻalo o ka māhele o ST, a me nā ʻano like ʻole o ka poloka puʻuwai a hiki i ka hopu ʻana i ka cardiac. ʻO ka hoʻonuiʻana i ka paʻakikī QRS e hoʻomaʻamaʻa pinepine ʻia me ka nui o ka maʻi o ka pakanā ma hope o nā palaho. ʻO ka nele o ka puʻuwai, ka hypotension arterial, ulu ʻia ka hopena cardiov. Ke hoʻonui nui nei nā Metabolic acidosis a me ka hypokalemia. Ma hope o ke ala ʻana aʻe hiki ke hilahila, piʻi ka hopohopo, nā ʻalemona a me nā ataxia.

Kāohi: hoʻokipaʻi (ma ka hui mālama mālama koʻikoʻi). Hoʻomaʻamaʻa ʻia ka hoʻomaʻamaʻa ʻana a kākoʻo. Ke hoka nei ke Gastric o ka ʻōpū a me ka lavage, ʻoi aku ma hope o ke kaʻina hana ma hope o ka hoʻokele ʻana, a me ka hoʻōla ʻana o ka carbon carbon i hōʻike ʻia. Pono e nānā pono pono ai i ke kūlana, ʻoiai me kahi hihia maʻalahi. E nānā i ke kūlana o ka hoʻomaopopo ʻana, ke ʻano o ka pulse, ka waiwai o ke koko a me nā hana ʻana i ka hanu, ma nā manawa pōkole e pono e hoʻoholo i nā kiko o nā electrolytes a me nā poho koko. E hōʻoia i ke ala ʻokoʻa inā pono e ka intubation. I ka holoʻokoʻa, kuhikuhi ʻia ka mālama ʻia me ka hoʻowalewale ʻana i ka hopu ʻana i ka hopu ʻana i ka hanu. E hoʻomau ʻia ka mālama mau ʻana i ka ECG ma loko o 3-5 mau lā. Me ka hoʻonui ʻana o ka manawa QRS, ka hiki ʻole o ka naʻau, a me ka arrhythmias ventricular, hiki ke hoʻololi ʻia ka pH neʻe i ke koko i ka ʻaoʻao alkaline (hoʻopōmaikaʻi ʻana o kahi hopena bicarbonate a hyperventilation) me ka wikiwiki wikiwiki o kahi hopena hypertonic o ka sodium klorida (100-200 mmol Na +). Me nā arrhythmias ventricular, hiki ke hoʻohana i nā lāʻau lapaʻau antiarrhythmic kūlohelohe, e like me 50-100 mg o ka lidocaine (1-1.5 mg / kg) intravenously, ukali ʻia e ka infusion ma ka wikiwiki o 1-3 mg / min.

Inā pono, e kau i cardioversion a me defibrillation. Kuhi i ka pīhoihoi ʻana o ke kaila me ke kōkua o nā mea pili i ka plasma, a i nā pilikia koʻikoʻi, ma ka hoʻonāukiuki ʻana o ka dobutamine (mua ma ka pae o 2-3 μg / kg i hoʻokahi mau minuke) me ka hoʻonui o ka maʻa, e pili ana i ka hopena. Hiki ke pani ʻia ka hoʻokūkū a me nā hoʻokūkū e ka luna o ka diazepam.

ʻO ka naʻau nui loa i nā paukū he nui ka pilikino. I ka manawa like, ʻike pinepine nā keiki i ka ulu ʻana o nā mea cardiotoxicity phenola a me ka ʻaha.

I nā pākeke, nā dosis o 500 mg e hiki ke hōʻeha i ka hoʻohālikelike kaumaha, aʻo nā dosis he emi iki ma mua o 1000 mg he lethal.

ʻO nā hopena ʻino

Hiki i Amitriptyline ke hōʻeha i nā hopena ʻaoʻao e like me ka mea e kū ana i ka wā e lawe ai i nā antidepresi tricyclic. ʻO kekahi o nā hopena hopena i hōʻike ʻia ma lalo (ʻo ke poʻo, ka haʻalulu, ka nānā ʻana o ka manaʻo, constipation, a me ka hoʻohaʻawale i ka libido) kekahi mau hōʻailona paha i ke kaumaha a me ka haʻahaʻa o ka neʻe ʻana o ke kūlana kaumaha.

Hoʻohana ʻia nā ʻaha kūkā e pili ana i ka papa inoa ma lalo nei. ʻO WHO makemake nui i nā huaʻōlelo MedDRA no nā papa ʻōnaehana o ka papa: pinepine (> 1/10), pinepine (> 1/100, 1/1000, 1/10 000,

Hoʻopili ʻana me nā lāʻau lapaʻau ʻē aʻe:

Hiki i ka Amitriptyline ke hoʻoikaika i ka hopena o ka waiʻona, nā barbiturates a me nā mea ʻē aʻe e hōʻeha ana i ka pūnaehana neʻe.

Hiki i ka hoʻohana like me nā MAO inhibitors ke alakaʻi i ka pilikia hypertensive. No ka mea e hoʻonui ʻo amitriptyline i ka hana o nā anticholinergics, pono e pale ʻia ka hoʻoku like ʻana me lākou.

Hoʻopili i ka hana o ka sympathomimetics o adrenaline, norepinephrine, etc., ma muli o kēia, ʻo ka ʻona e pili ana i kēia mau mea e pono ai e hoʻohana pū ʻia me ka amitriptyline.

Hiki i ka hōʻemi i ka hopena antihypertensive o ka clonidine, betanidine, a me ka guanethidine.

Ke hoʻonohonoho pono ʻia me nā antipsychotics, pono e noʻonoʻo i ka tricyclic antidepressants a me nā antipsychotics a hui pū kekahi i ka metabolism o kēlā me kēia, e hoʻohaʻahaʻa ana i ka paepae no ka mākaukau paʻa.

Me ka hoʻohana like me ka cimetidine, hiki ke hoʻolōʻihi i ka metabolism o ka amitriptyline, hoʻonui i kona kao ʻana i loko o ke koko koko a me ka hoʻomohala ʻana i nā hopena o nā mea make.

Lapaʻau lāʻau

ʻO Amitriptyline kahi mahele o ka hui tricyclic. ʻO ia kahi amine type tertiary, ʻo ia ke kumu nui i loko o ka tricyclic Category, no ka mea aneane like ka hana ma vivo ma ke ʻano he lipi lau o ka serotonin a me nā norepinephrine uptake e ka presynaptic nerve receptors.

ʻO ka huahana decomposition nui, nortriptyline, he mea paʻa ikaika loa o ka upepake norepinephrine, akā hiki iā ia ke kālai i ka serotonin uptake. Loaʻa nā Amitriptyline i nā waiwai anticholinergic, sedative a me nā waiwai antihistaminergic, a ma kahi'ē aʻe, hiki iā ia ke hoʻokaʻawale i nā hopena o nā catecholamines.

ʻO ka manaʻo o ka DBD o ka wā hiamoe, he hōʻailona ia o nā hopena ikaika o nā antidepressants. Tricyclics, a me ka mea no lākou i koho selotonin reuptake inhibitors, pū kekahi me MAOs, pale i ke kaʻina o ka hana BDH, a hoʻomaikaʻi hou i ke ʻano o ka hiamoe hohonu (lohi-alon).

Hoʻomaikaʻi ʻo Amitriptyline i kahi maʻi moʻi o ka moʻo.

ʻO nā hopena hopena o ka amitriptyline kahi mea nui i ka mālama ʻana i ke kaumaha i loko o laila ka mea i hoʻonui nui ai i ka hauʻoli, hopohopo, hopohopo, a me nā pilikia hiamoe. Hoʻomaka nā hopena antidepressant e hele mai ma hope o 2 mau hebedoma mai ka hoʻomaka ʻana o ke mālama ʻana, ʻoiai ʻaʻole i emi ka hopena sedative.

ʻAʻole pili nā mea analgesic o nā lāʻau lapaʻau me nā lāʻau antidepressant, ʻoiai e hoʻomaka mua ana ka analgesia ma mua o nā loli i ka ʻano. ʻO ka manawa pinepine, ʻoi aku ka haʻahaʻa haʻahaʻa haʻahaʻa e loaʻa ai kēia hopena ma mua o ka hoʻolako ʻana i nā loli i loko o ke ʻano o ka mea maʻi.

Lapaʻau lāʻau

Ma hope o ka lawelawe o loko, ʻo ka hōʻailona o ka bioavailability o ka amitriptyline e like me 60%. ʻO ka pilina o ka protein plasma e pili ana i ka 95%. ʻO ka ʻike koʻikoʻi ma loko o ka serum o ke koko o ka mea hana a hōʻea e pili ana i ka hola 4-10 ma hope o ka hoʻohana a noho mau hoʻi mau.

ʻO ke kaʻina o ka hana metabolism o ka hana hana e ala ʻia e ka hydroxylation, a me ka demethylation. ʻO ka huahana decomposition nui loa.

ʻO ka hapa hapalua o ka amitriptyline i ka waena o 16-40 mau hola (awelika he 25 mau hola), a ʻo ka hapalua hoʻi o ka nortriptyline ma kahi o 27 hola. Hoʻomoe ʻia ka manaʻo no ka hana o ka therapeutic ma hope o 1-2 mau pule.

Hoʻopau nui ʻia ka hoʻōla ʻana o ka amitriptyline me ka urine, a ma ke ʻano heʻuʻuku liʻiliʻi, excreted i loko o nā feces.

Amitriptyline, a me ka nortriptyline, hiki ke hele i ka plasenta a komo i loko o ka waiū umauma ma nā liʻiliʻi liʻiliʻi.

Loaʻa ka hopena

Hiki i Amitriptyline ke hopena i nā hopena o nā hopena e like me nā mea i hoʻoiho ʻia e nā antidepresi tricyclic. ʻO kekahi o nā hopena hopena i hōʻike ʻia ma lalo nei, e like me ke poʻo, ka haʻalulu, ka nui o ka nānā ʻana, constipation, a me ka hoʻohaʻahaʻa i ka libido, hiki nō hoʻi i nā hōʻailona o ke kaumaha a hemo i ka hoʻemi me ka hoʻomaikaʻi ʻana i ke kaumaha.

Hōʻike ʻia ka hopena o nā hopena ʻaoʻao e:

pinepine mau (> 1/10), pinepine (mai> 1/100 a 1/1000 a 1/10000 a