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აციპრექსი / Aciprex | მედიკამენტები | vidal.ge
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იხილეთ აფთიაქების ჩამონათვალი

აციპრექსი / Aciprex

ფარმაკოლოგიური მოქმედება:
ესციტალოპრამი სეროტონინის  სელექტიური უკუმიტაცების ინჰიბიტორია. 5HT რეცეპტორების უკუმიტაცების ინჰიბირება განაპირობებს ესციტალოპრამის ფარმაკოლოგიურ და კლინიკურ ეფექტებს.

ესციტალოპრამი პრაქტიკულად არ ურთიერთქმედებს სეროტონინის 5-HT1A, 5-HT2A და დოპამინის D1 და D2, ადრენერგულ α1, α2, და β, ჰისტამინურ H1, მუსკარინულ, ბენზოდიაზეპინურ და ოპიოიდურ რეცეპტორებთან.

აციპრექსის  ანტიდეპრესიული მოქმედების მექანიზმი დაკავშირებულია ცენტრალურ ნერვულ სისტემაში სეროტონინერგული აქტივობის პოტენცირებასთან. კვლევების მიხედვით აციპრექსი არის სეროტონინის უკუმიტაცების მძლავრი სელექტიური ინჰიბიტორი, რომელსაც ახასიათებს მინიმალური ზეგავლენა ნორეპინეფრინის და დოპამინის ნეირონალურ უკუმიტაცებაზე.  

აციპრექსი ასევე არ უკავშირდება ან თითქმის არ უკავშირდება Na+, K+, CI+ და Ca++ არხებს.

ფარმაკოკინეტიკა:
აციპრექსის ორალური ბიოშეღწევადობა დაახლოებით 100%-ია და მის აბსორბციაზე საკვები არ ახდენს გავლენას. კონცენტრაციის პიკი პლაზმაში მიიღწევა 4 საათში. აციპრექსის ძირითადი მეტაბოლიტების ცილებთან კავშირის მაჩვენებელი 80%-ზე ნაკლებია. ესციტალოპრამი მეტაბოლიზდება ღვიძლში დემეთილციტალოპრამად და დიდემეთილციტალოპრამად. ორივე მეტაბოლიტი ფარმაკოლოგიურად აქტიურია. შეუცვლელი ესციტალოპრამი არის დომინანტური სტრუქტურა პლაზმაში. მას ახასიათებს ხაზოვანი კინეტიკა. პლაზმაში სტაბილური კონცენტრაცია მიიღწევა დაახლოებით ერთ კვირაში.

აციპრექსის ნახევარგამოყოფის პერიოდი შეადგენს 30 საათს და კლირენსი არის დაახლოებით 0.6 ლ/წთ. 

გამოყოფა უმთავრესად ხორციელდება შარდით და განავლით.

ხანდაზმულ პაციენტებში (65 წლის ან მეტი) ესციტალოპრამი შედარებით ნელა ელიმინირდება.

ღვიძლის მსუბუქი ან საშუალო სიმძიმის დარღვევების მქონე პაციენტებში ესციტალოპრამის ნახევარდაშლის პერიოდი არის დაახლოებით ორჯერ ხანგრძლივი. თირკმლის ფუნქციის დარღვევისას  ესციტალოპრამის ნახევარგამოყოფის პერიოდი ორმაგდება.

ჩვენებები:
ü  დიდი დეპრესიული აშლილობა;
ü  პანიკური აშლილობა აგორაფობიით ან მის გარეშე;
ü  სოციალური შფოთვითი აშლილობა.

დოზირების რეჟიმი:
აციპრექსის მიღება ხდება დღეში ერთხელ, დღის ნებისმიერ დროს საკვების მიღებისგან დამოუკიდებლად.

დიდი დეპრესიული აშლილობა: 10 მგ დღეში ერთხელ, დღიური დოზა შეიძლება გაიზარდოს 20 მგ-მდე  პაციენტის ინდივიდუალური საჭიროებისა და დეპრესიის სიმძიმის შესაბამისად.

შფოთვითი აშლილობა აგორაფობიით და აგორაფობიის გარეშე: ესციტალოპრამით მკურნალობა იწყება 5 მგ-ით დღეში პირველი კვირის განმავლობაში და როგორც წესი იზრდება 10 მგ-მდე დღეში. მოგვიანებით დღიური დოზა შეიძლება გაიზარდოს 20 მგ-მდე. მაქსიმალური ეფექტი მიიღწევა 3 თვეში. მკურნალობა გრძელდება რამდენიმე თვე.

სოციალური შფოთვითი აშლილობა: ჩვეულებრივ ინიშნება 10 მგ დღეში. სიმპტომთა შესამსუბუქებლად საჭიროა 2-4 კვირიანი მკურნალობის პერიოდი. პაციენტის ინდივიდუალური საჭიროების მიხედვით შეიძლება დოზის შემცირება 5 მგ-მდე ან გაზრდა მაქსიმალურ რეკომენდებულ დოზა - 20 მგ-მდე.

გენერალიზებული შფოთვითი აშლილობა: ჩვეულებრივ ინიშნება 10 მგ დღეში. პაციენტის ინდივიდუალური საჭიროების მიხედვით შეიძლება დოზის გაზრდა მაქსიმუმ - 20 მგ-მდე.

ხანდაზმული პაციენტები (>65 წელი): მკურნალობის საწყის ეტაპზე ინიშნება რეკომენდებული დოზის ნახევარი, ხოლო თერაპიის შესანარჩუნებლად - ყველაზე დაბალი მაქსიმალური დოზა.

ბავშვები და მოზარდები (<18 წელი):

პრეპარატის გამოყენება ბავშვებში არ არის რეკომენდებული, რადგან უცნობია მისი უსაფრთხოება და ეფექტურობა.

დოზის რეგულირება არ არის აუცილებელი მსუბუქი და საშუალო სიმძიმის თირკმლის უკმარისობის დროს.

ღვიძლის ფუნქციის დარღვევისას: მკურნალობის პირველი ორი კვირის განმავლობაში რეკომენდებულია აციპრექსის 5 მგ საწყისი დოზა. შემდეგ დღიური დოზა შეიძლება გაიზარდოს 10 მგ-მდე პაციენტის ინდივიდუალური საჭიროების მიხედვით.

მკურნალობის შეწყვეტა: აბსტინენციის შესაძლო რეაქციების პრევენციის მიზნით მკურნალობის დასრულებისას პრეპარატის დოზის კლება უნდა მოხდეს თანდათანობით 1-2 კვირის განმალობაში.

გვერდითი მოვლენები:
არასასურველი გვერდითი ეფექტები აციპრექსის გამოყენების დროს მსუბუქია და დროებით ხასიათს ატარებს. ისინი გვხვდება მკურნალობის დაწყებიდან პირველი 1-2 კვირის განმავლობაში.

უკუჩვენებები:
მომატებული მგრძნობელობა ესციტალოპრამის ან სხვა ნებისმიერი ინგრედიენტის მიმართ. აციპრექსის  გამოყენება უკუნაჩვენებია მონოამინოოქსიდაზას (მაო) ინჰიბიტორებთან ერთად

ორსულობა და ლაქტაცია:
ესციტალოპრამის უსაფრთხოება ორსულობისა და ლაქტაციის პერიოდში უცნობია.

სხვა წამლებთან ურთიერთქმედება:
ესციტალოპრამი ფრთხილად უნდა გამოვიყენოთ ცნს-ზე მოქმედ სხვა წამლებთან ერთად.

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