"Methotrexate" iri dzinonzi rheumatoid arthritis: wongororo. Mirayiridzo yokushandisa, rondedzero rekugadzirira

Dzinonzi rheumatoid arthritis, kana zvashandurwa chaizvoizvo pamwe chiGiriki, rinoreva ezvinhu kuzvimba. Mubvunzo zvipi kutsamwisa kukura chirwere ichi haisi kujekeswa. mashoko zvisina kunanga kuti anowedzera uwandu leukocytes muropa uye ikawanda erythrocyte sedimentation mwero (ESR), zvinoita kugumisa kuti muitiro kusimukira chirwere kunoitawo kuti vamwe vashingaire hunhu. Zvinonzi vaidavira kuti riwedzere nekuda kukura chirwere chiri chirwere, Nokumukira kuvhiringidzika kushanda zvirwere. Zvisinei, pasi ichi, kwete zvose asi avo chete vane nhoroondo yemhuri. Mugumisiro kudzidzisa utachiona kuva Muviri womunhu paumbwe masoja zvivako (kubva nemavhairasi, antibodies, uye zvichingodaro. P.), Iyo uchingounganidza munyama uye kukonzera kwemajoini kukuvara.

Kazhinji, vabatwe ichi chirwere chakaipisisa Kurwadziwa Kuderedza, tava kuderera unyatsoshanda chirwere kwacho uye kudzorera kukuvadza (sezvo zvinogoneka mumwe nyaya) kushandisa zvomusejari nzira.

Zvapanzvimbo kurapwa aripo parizvino zvakawanda. Chimwe chaizvozvi ndiyo "Methotrexate". In dzinonzi rheumatoid arthritis (wongororo vashandi utano uye varwere zvinoratidza ruzivo urwu) vakati medicament unoshanda zvakakwana, migumisiro yacho kuchabatsira kuti akanzwa kwenguva refu.

Kuronga uye mashandiro

The chikuru vanoshingaira wemafuta zvinodhaka ndiko methotrexate. nitostatik ichi, imwe antagonist pamusoro folic acid. Pari nokuti tava kuderera kuchiita dzinonzi rheumatoid arthritis kurapwa kwacho "methotrexate" rinoshandiswa kakawanda kupfuura dzimwe nzira. Chaizvoizvo iyi antitumor chinodhaka, munhu cytostatic mumiririri, kuchititadzisa mitosis (sero nokupesana zvisina kunanga) kuchititadzisa kukura vachishingaira kuwedzera munyama, kuchititadzisa kukura anomera.

Maererano nenhamba, kubudirira zvinodhaka riri kuchengetwa 80% wevarwere, zvakanaka zvinooneka pashure 2-6 mavhiki pashure kutanga kurapa. Shure kwenguva yakareba kurapwa (anosvika 5 years) kurapa "Metotraksatom" kukanzura shoma zvikuru pane zvimwe inoshandiswa kuderedza chitange dzinonzi rheumatoid arthritis.

Release chimiro zvinodhaka

mishonga Self rinoenderana Russian pamusoro yeAustria "Methotrexate Ebewe". The yepakutanga mushonga mugadziri anopa vatengi ayo dzakasiyana siyana kugadzirwa. Mahwendefa vari kutengeswa muna dosages matatu 2.5 MG, 5 MG uye 10 MG huru vanoshingaira zvinoriumba. Vose vari kugara mu polypropylene ndiro 50 zvidimbu nerimwe. Uyezve, "Methotrexate" (Austria - mugadziri) inogona kutengwa panguva dose 50 MG / 5 Rine mamiririta mune mhinduro jekiseni. Ampoules dzakagadzirwa murima negirazi uye rakazara mune makadhibhokisi bhokisi.

Zvinogonekawo kuti kutenga medicament ari muchimiro Kuisa pfungwa pachinhu achigadzirira infusions (droppers). Chipimo chemushonga - 100 MG / 1 Rine mamiririta. In chimiro akadaro, "Methotrexate" anotengeswa munyika ndiro 5, 10, 50 Rine mamiririta. Mune kabhodhi bhokisi yakazara mumwe chinu.

Zvairatidza kuti pakugamuchira "methotrexate"

Zvairatidza kuti kushandiswa kwezvinodhaka rakanyatsojeka, sezvo chinangwa chawo chikuru - pakurwisa namamota. Zvinokurudzirwa kutora "Methotrexate" muzviitiko apo murwere kutambura kubva chakasimba lymphoblastic neleukemia uye lymphomas nehodzhinskimi. Uyewo, zviri nachiremba trophoblast mapundu howa Mycosis uye psoriasis (mu kwazvo mumatanho).

Uyewo, kana zvimwe dzokurapa uye zvinodhaka havana kuti munhu zvazvinoita akashandisa "MTX" nokuti dzinonzi rheumatoid arthritis. Anodzokorora rheumatologists nyanzvi pamusoro mishonga asi zvakanaka.

Zvairatidza kuti negashiro "Methotrexate Ebewe" zvishoma richingokura. Vanachiremba varayire kana murwere malignancies siyana gadziriro uye nhengo: kenza yemapapu uye kenza yemazamu, osteosarcoma uye munyoro zvinyama sarcomas, testicular uye ovarian namamota, Kaposi Jung, retinoblastoma uye autoimmune zvirwere.

Ndiani anofanira kutora mishonga?

Hazvina kunaka kutora mushonga kuvanhu hypersensitivity kune huru vanoshingaira chirungiso. Contraindicated kugamuchira "methotrexate" vakadzi vane pamuviri navanoyamwisa mums. Not prescribers vane yaivapo zvarakasiya chiropa uye itsvo, hematological zvirwere hunhu (kupererwa, thrombocytopenia, leukopenia). Hazvibviri kutanga kurapwa nemishonga varwere vari rikwanise chokutambudzika chero zvirwere, Immune Deficiency Syndrome kutambura. Sezvo Russian rinoenderana, uye chepakutanga "Methotrexate" (Austria) haabvumirwi kupa vana vavo kusvikira makore matatu.

Kana nhamba zvirwere zvinodhaka anopiwa nokunyatsongwarira. matambudziko aya anosanganisira nemaronda mudumbu uye 12 duodenal urikanwi, maronda colitis, uye kupera mvura mumuviri. In nemavhairasi, fungal uye zvirwere zvinokonzerwa noutachiona vanofanira chaizvo nokungwarira. To boka iri ndezvaJehovha nenyaya vasati radiotherapy kana mishonga.

Possible nemishonga

"Methotrexate" iri ampoules, mapiritsi, kana infusions zvinogona kukonzera zvinoverengeka nemishonga. Quite zvinetso zvakakomba angamuka hematopoietic system (leukopenia, thrombocytopenia, uye zvichingodaro. P.) Uye gastrointestinal (dyspepsia, kudya chiropa toxicity, pfungwa nomuviri zvemwana asati). Tsinga anogona kupindura musoro, hope, paresis, pfari. High mishonga zvinodhaka kungamutsawo kukura encephalopathy. Zvarakasiya kubva ziso mapazi uye kumwoyo (hypotension, pericardial effusion, thromboembolism).

Zvingamuka kufema kukundikana, chisingaperi obstructive pulmonary chirwere, kupfupika mweya, akaoma, nonproductive chikosoro, fivhiri. Tiine genitourinary hurongwa, pane mukana chakakomba cheitsvo kana itsvo kukundikana. Possible nokuvhiringidzirwa spermatogenesis uye oogenesis, ungaderedza libido, kushaya mbereko, kusabetsera.

Kana mukadzi ane pamuviri, "Methotrexate" (majekiseni, mapiritsi, inodonha) anogona kukonzera pamuviri, malformations kana fetus rufu.

mahwendefa dosing zvaiitwa

In pakurapa nyanyisa neoplasms zvaiitwa kuti mapiritsi nomumwe akagadzirirwa uye zvinoenderana redunhu mishonga muzvirongwa. Kana totaura pokushandisa medicament "MTX" nokuti dzinonzi rheumatoid arthritis (Patient mhinduro uine hunhu), kwokutanga dose iri yemanyorero 7.5 MG kamwe pavhiki. Unogona kutora yose dose kamwe, uye iwe unogona kuiganhura vachiita 3 mishonga nenguva 12 awa zvikamu.

Mune zvimwe zviitiko (kuzadzisa ane Zvakanyanya Kunaka Panguva Yepamuviri mugumisiro) dose pavhiki kunogona ngazviwedzerwe. Zvisinei, haufaniri kupfuura 20 MG. Apo aida kurapwa zvazviri kunokwanisika, kuti chipimo chemushonga inofanira zvishoma nezvishoma wakaderedzwa kushoma. The Zvakanyanya Kunaka Panguva Yepamuviri nguva kurapwa kosi hakusi akaora chirwere.

Majekiseni "methotrexate"

Uye sei kuita jekiseni pamwe zvinodhaka "Methotrexate"? Majekiseni nokuti dzinonzi rheumatoid arthritis kutanga kuita chipimo chemushonga kuti 7.5 MG pavhiki. Izvi zvinogona kuitwa subcutaneously, intramuscularly kana nomutsinga. Kana mushonga zvakanaka kuzoregwa murwere, kuti dose inogona kuwedzera zvishoma nezvishoma kwevhiki pa 2,5 MG asi kwete kupfuura 25 MG. Kana mishonga mugumisiro zvasvika (kazhinji 1-2 mwedzi pashure mharuro kurapwa), kuti dose inofanira zvishoma nezvishoma airarama shoma zvakakodzera. Nokuti murwere mumwe nomumwe dzinonzi rheumatoid arthritis, chipimo chemushonga anogona zvishoma nezvishoma kugadziridzwa kuti Zvakanyanya Kunaka Panguva Yepamuviri mugumisiro kurapwa. Ongororo Clinical dzakaratidza kuti "Methotrexate" raisangoita nani uye anopa usingashandi divi mhinduro, kana jekiseni subcutaneously kana intramuscularly.

Tiine chichiitwa negashiro "methotrexate" kutanga zvakanaka kuchirapa kushanda zvikaramba kwemakore maviri. Kana iwe kukanzura dzinonzi rheumatoid arthritis zvinodhaka ane kushanda muna mavhiki 3-6.

Kunwisa mishonga

Kunwisa mishonga Russian medicament kana zvinodhaka "Methotrexate Ebewe" (Mahwendefa, majekiseni, infusions) hakuratidzwi chaiwo zviratidzo. ovhadhozi chokwadi kunogona kuva chechetere methotrexate wevasungwa muropa plasma.

Treatment iri pakarepo (optimally munguva rokutanga) kuti mushonga chikumbiro, unova karusiyamu folinate. Bhuku injectate anofanira akaenzana kana kupfuura dose akagamuchira "methotrexate". Zvimwe mishonga calcium folinate kungadiwa nachiremba sezvinodiwa. Usati kupinda mumwe unozotevera dose, uye ipapo ose 6 maawa yose muitiro kubvisa zviratidzo ane ovhadhozi kushandisa mushonga zvinokosha kuona ph kuti weti. matanho akadaro kuderedza mukana wokuti dzichiri nephropathy.

Uyewo ari pasuru zviyero vaifanira kubvisa migumisiro ovhadhozi kurapwa kunosanganisira hydration weti uye alkalinization. Matanho aya achaita rikurumidze excretion kuti methotrexate.

Kudyidzana nevamwe zvinhu uye kugadzirira

Kana murwere ane gout, uye kugadzwa "Methotrexate" mishonga kana "Methotrexate Ebewe" dose arthrifuge zvinodhaka zvinofanira kugadziriswa. Pamunhu yaizoshanda panguva kushandisa salicylates, phenylbutazone, fenitoiona, sulfonamides, vanoverengeka zvimwe nemishonga (tetracycline, kuti penicillin, chloramphenicol), anticoagulants kunanga kushanda uye mishonga hypolipidemic kungaita kuti zvikuru toxicity, kunyange rufu.

uwandu "methotrexate" iri kufanana NSAIDs Large kunogona kukonzera rufu kubva zvikuru hematologic uye gastrointestinal toxicity. Tikafunga NSAIDs nemishonga yakaderera-dose pamberi pedu anogona kuderedza excretion okupedzisira nokuda renal tubules.

Hepatotoxic zvinodhaka (kwakavakirwa sulfasalazine, azathioprine, panyaya iyi) kuwedzera ngozi hepatotoxicity, gematotoksicheskim - gematotoksichnosti "methotrexate". Pamunhu yaizoshanda panguva kushandiswa kwezvinodhaka uye mwaranzi mushonga kurapa kunogona kukonzera mwongo depression.

mirayiridzo Special

Usati watanga kurapwa mishonga "Methotrexate" (jekiseni, kana zvinoshanda mapiritsi - hazvina basa), zvinokosha kuti kuitisa kwakakwana ropa count (kuziva huwandu maplatelet), nemakemikari omuviri (kuona zvinokosheswa chiropa makemikari, sealbumin, bilirubin), kuita chipfuva X-ray. Uyezve, zvinokosha kuongorora itsvo, mune zvimwe zviitiko, kwete kuva okushamisira miedzo nokuda nehepatitis uye TB.

Kuti varege kutadza kwekanguva kudhaka, zvakafanira kudzora Kuronga peripheral ropa (nhamba leukocytes uye maplatelet), renal basa, hepatic transaminase basa, pamwero uric asidhi mu serum. Asati neimwe Kushandiswa "methotrexate" nomumukanwa mucosa uye pharynx zvinofanira kuongororwa kuti kuvapo nemaronda. Pfungwa mwongo hematopoiesis zvinofanira kuongororwa kumavambo yokurapa, kamwe munguva kurapwa uye namarudzi kuvhara.

mutengo dungwerungwe

kusunungura chimiro (piritsi, jekiseni) uye dose - huru zvikonzero kukanganisa mari "Methotrexate" chinodhaka.

Price kavha mahwendefa (50 hrs.) Aine 2,5 MG dose Ingasiyana kubva 240 kusvika 250 rubles. Zvakafanana 5 MG dose Mahwendefa inogona kutengwa ive mari 390 kusvika 420 rubles. Kavha zvinodhaka pamwe chepamusoro dose (10 MG) achaita mari 530-550 rubles.

Kuitwa jekiseni zvakawanda zvinodhura, uye mutengo kupararira kuri vakwanise zvikuru. Somuenzaniso, 5 ampoules medicament ane chipimo chemushonga 50 MG / 5 Rine mamiririta mune dzimwe Pharmacies hungada anenge 1200-1300 rubles, apo vamwe - 4900 rubles.

mutengi pfungwa

Kune vose zvakanaka uye pfungwa wevarwere pamusoro mishonga "Methotrexate". In dzinonzi rheumatoid arthritis, asi wongororo zvikurukuru akanyorwa zvakanaka kuitika (anenge 80% wevarwere noruzivo efficacy ari 1-1.5 mwedzi yokutanga kurapwa). Zvisinei, mumwe anogona kazhinji kunzwa pamusoro akaipa zvinokonzerwa mushonga uri murwere, kukura nemishonga kunosiyana kwokuomerwa pamusoro chikamu siyana hurongwa nenyere.

Kurerutsa inokanganisa, "Methotrexate" rinofanira vanogadzwa chete kubudikidza kupinda chiremba, uye anewo kutanga kurapwa kuronga uye sarudza zvinobudirira dose.