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კეტოროლაკი - APO / Ketorolac - APO | მედიკამენტები | vidal.ge
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იხილეთ აფთიაქების ჩამონათვალი

კეტოროლაკი - APO / Ketorolac - APO

ათქ კოდი: M01AB

 

შემადგენლობა:

კეტოროლაკი-APO-ს თითოეული შემოუგარსავი დისპერსირებადი ტაბლეტი შეიცავს: კეტოროლაკის ტრომეთამინის 10 მგ-ს

 

ფარმაკოთერაპიული ჯგუფი:

არასტეროიდული, ანთების საწინააღმდეგო და ანტირევმატული პრეპარატი.

 

ფარმაკოლოგიური თვისებები:

ფარმაკოკინეტიკა

კეტოროლაკის ტრომეთამინი შეიწოვება კუჭ-ნაწლავის ტრაქტიდან  პერორალური გზით მიღების შემდეგ. მაქსიმალური კონცენტრაცია პლაზმაში მიიღწევა 40-50 წუთში როგორც პერორალური, ასევე პარენტერალური მიღების შემდეგ. საკვების მიღება არ მოქმედებს აბსორბციაზე. პლაზმის ცილებთან კავშირი სეადგენს 99%. ნახევრად გამოყოფის პერიოდი შეადგენს 4-6 საათს. მიღებული დოზის 90% გამოიყოფა შარდთან ერთად (60% უცვლელი სახით), ხოლო დანარჩენი განავალთან ერთად. 

ღვიძლის დარღვევის მქონე და ხანდაზმულ პაციენტებში  პრეპარატის გამოყოფის სიჩქარე მცირდება და ნახევრად გამოყოფის პერიოდი იზრდება.

 

ფარმაკოდინამიკა:

კეტოროლაკი-APO არასტეროიდული, ანთების საწინააღმდეგო პრეპარატი, პიროლიზინ-კარბოქსილის მჟავის წარმოებულია. გააჩნია გამოხატული ანალგეზიური მოქმედება, ნაკლებად ახასიათებს ანთების საწინააღმდეგო და სიცხის დამწევი ეფექტი. მოქმედების მექანიზმი დაკავშირებულია ცოგ-ის აქტივობის დათრგუნვასთან. ცოგ-ი გახლავთ არაქიდონის მჟავის მეტაბოლიზმის ძირითადი ფერმენტია. არაქიდონის მჟავა კი- ანთების, ტკივილისა და ცხელების ძირითადი მედიატორების- პროსტაგლანდინების- წინამორბედია. 

 

გამოყენების ჩვენებები:

კეტოროლაკი-APO გამოიყენება  საშუალო და  მძიმე  მწვავე ტკივილის ხანმოკლე მკურნალობიასთვის, როდესაც საჭიროა ძლიერი, ოპიოიდების დოზის ანალგეზია. მწვავე, ძლიერი  ტკივილისას მკურნალობა იწყება პარენტერალური გამოყენებით, ხოლო შემდგომ ხდება ტაბლეტირებულ ფორმაზე გადასვლა. ტაბლეტირებული ფორმა ასევე გამოიყენება რეგულარული მიღებისას.  კეტოროლაკის მიღების ხანგრძლივობა არ უნდა აღემატებოდეს 5 დღეს არასასურველი რეაქციების სიხშირისა და სიმწვავის გაზრდის შესაძლებლობის გამო. შემდგომ რეკომენდებულია სხვა ანალგეზიური საშუალებების გამოყენება. 

 

დოზირება და მიღების წესი:

მოზრდილები: პირველი დოზა 2 ტაბლეტი (20 მგ), შემდეგ 1 ტაბლეტი (10 მგ) ყოველ 4-6 საათში. არ შეიძლება დღეში 4-ზე მეტი ტაბლეტის (40 მგ) მიღება. მკურნალობის ხანგრძლივობა არ უნდა აღემატებოდეს 5 დღეს.

ბავშვები: კეტოროლაკის უსაფრთხოება და ეფექტიანობა 16 წლამდე ასაკის ბავშვებში დადგენილი არ არის.

კეტოროლაკი ყველაზე სწრაფად მოქმედებს უზმოზე მიღებისას, თუმცა, ამ შემთხვევაში რეკომენდებულია  ანტაციდის წინასწაარი მიღება, კუჭის გაღიზიანების თავიდან აცილების მიზნით. არ შეიძლება დაწოლა მიღებიდან 20 წუთის განმავლობაში. ეს ხელს შეუწყობს ზემო კუჭ-ნაწლავის ტრაქტის გაღიზიანების პროფილაქტიკას.

 

გვერდითი ეფექტები:

კუჭ-ნალწავის ტრაქტის მხრივ:

პეპტიური წყლული, კუჭ-ნაწლავიდან სისხლდენა და/ან პერფორაცია. ამიტომ, კეტოროლაკის ტრომეთამინი უკუნაჩვენებია აქტიური პეპტიკური წყლულის, ცოტა ხნის წინ გადატანილი კუჭ-ნაწლავური სისხლდენის ან პერფორაციის მქონე პაციენტებში, აგრეთვე ანამნეზში პეპტიკური წყლულოვანი დაავადების ან კუჭ-ნაწლავური სისხლდენის მქონე პაციენტებში. 

შარდგამომყოფი სისტემის მხრივ:

კეტოროლაკი უკუნაჩვენებია  პროგრესირებადი თირკმლის უკმარისობის და ჰიპოვოლემიის  მქონე პაციენტებში. 

სისხლდენის რისკი:

კეტოროლაკი აინჰიბირებს თრომბოციტულ ფუნქციას და ამიტომ უკუნაჩვენებია ინტრაცერებრული სისხლდენის მქონე, ჰემორაგიული დიათეზის, არასრული ჰემოსტაზის და სისხლდენის რისკის მქონე პაციენტებში.

კეტოროლაკი უკუნაჩვენებია ქირურგიული ჩარევის წინ პროფილაქტიკური ანალგეზიის სახით, აგრეთვე ინტრაოპერაციულად, სისხლდენის მომატებული რისკის გამო. 

ჰიპერმგრძნობელობა:

შესაძლებელია ჰიპერმგრძნობელობის რეაქციების, ბრონქოსპაზმიდან ანაფილაქსურ შოკამდე განვითარება.

კეტოროლაკი უკუნაჩვენებია იმ პაციენტებში, რომლებშიც მანამდე გამოვლინდა ჰიპერმგრძნობელობა კეტოროლაკის  მიმართ ან ალერგიული რეაქციები სხვა არასტეროიდულ ანთების საწინააღმდეგო საშუალებებზე. 

 

უკუჩვენებები:

• აქტიური პეპტიური წყლული, ახლო წარსულში გადატანილი კუჭ-ნაწლავიდან სისხლდენა ან პერფორაციის მქონე პაციენტები, აგრეთვე ანამნეზში პეპტიური წყლულის ან კუჭ-ნაწლავიდან სისხლდენის მქონე პაციენტები. 

• პროგრესირებადი თირკმლის ფუნქციის დარღვევის და ჰიპოვოლემიის მქონე პაციენტები. 

• მშობიარობის დროს, ვინაიდან პროსტაგლანდინის სინტეზის ინჰიბიციის გამო,  შეიძლება უარყოფითი გავლენა მოახდინოს ნაყოფის სისხლის მიმოქცევაზე და გაიზარდოს საშვილოსნოსმიერი ჰემორაგიები. 

• მეძუძურ დედებში ახალშობილებზე პროსტაგლანდინ-მაინჰიბირეელი არასასურველი მოქმედების გამო.

• ჰიპერმგრძნობელობა კეტოროლაკის  მიმართ ან ალერგიული რეაქციები სხვა არასტეროიდულ ანთების საწინააღმდეგო საშუალებებზე. 

• ოპერაციის წინ პროფილაქტიური ანალგეტიკის სახით, აგრეთვე ინტრაოპერაციულად, სისხლდენის მომატებული რისკის გამო.

• კეტოროლაკი აინჰიბირებს თრომბოციტულ ფუნქციას და ამიტომ, უკუნაჩვენებია ინტრაცერებრული სისხლჩაქცევის, ჰემორაგიული დიათეზის, არასრული ჰემოსტაზის და სისხლდენის რისკის მქონე პაციენტებში. 

• აცეტილსალიცილის მჟავასთან ან/და არასტეროიდულ ანთების საწინააღმდეგო საშუალებებთან ერთად, არასასურველი მოვლენების კუმულაციის გამო. 

• პრობენეციდთან  ერთდროული გამოყენება.

 

ურთიერთქმედება სხვა სამკურნალო საშუალებებთან:

სხვა აასს-თან ერთად გამოყენებისას შესაძლებელია ადიტიური გვერდითი მოვლენების განვითარება.

პენტოქსიფილინი, ანტიკოაგულანტები (ჰეპარინის ჩათვლით)- სისხლდენის განვითარების რისკი;

აგფ-ინჰიბიტორები- თირკმლის უკმარისობის განვითარების რისკი

პრობენიციდი- კეტოროლაკის კონცენტრაციისა და ნახევრად გამოყეფის პერიოდის გაზრდა

ლითიუმის პრეპარატები- ლითიუმის თირკმლისმიერი კლირენსის დაქვეითება და მისი კონცენტრაციის ზრდა

ფუროსემიდი- შარდმდენი მოქმედების შემცირება.

კეტოროლაკთან ერთდროული გამოყენებისას მცირდება ოპიოიდური ანალგეტიკების გამოყენების აუცილებლობა. 

მეთოტრექსატი- ერთდროული გამოყენებისას აღინიშნა მეთოტრექსატის კლირენსის შემცირება, რაც აძლიერებს მეთოტრექსატის ტოქსიკურობას. მეთოტრექსატის კლოირენსზე კეტოროლაკის  მოქმედება შესწავლილი არ არის.

 

სპეციალური გაფრთხილებები:

კეტოროლაკის  ხანგრძლივი გამოყენებას შეუძლია  სხვადასხვა სახის ჰიპერმგრძნობელობის რეაქციების გამოწვევა (კანზე გამონაყარი, ჭინჭრის ციება, რინიტი, ანგიოშეშუპება, ბრონქოკონსტრიქცია და ანაფილაქსური შოკი) მგრძნობიარე პირებში. 

 

ჭარბი დოზირება:

კეტოროლაკის გამოყენებისას არ გამოვლენილა მწვავე ზედოზირება. სიმპტომები და მათი მართვა ხდება ისევე, როგორც სხვა არასტეროიდული ანთების საწინააღმდეგო საშუალებების შემთხვევაში. პაციენტებს შეიძლება აღენიშნოთ ძილიანობა,  ტკივილი ეპიგასტრიუმის არეში, გულისრევა, ღებინება, თავის ტკივილი, კუნთების სპაზმი ან კუჭ-ნაწლავური სისხლდენა. მიღებიდან პირველი რამდენიმე საათის განმავლობაში უნდა მოხდეს კუჭის ამორეცხვა ან ღებინების გამოწვევა.

მიიღება აქტივირებული ნახშირი და H2 ბლოკატორი. მკურნალობა სიმპტომურია. 

შეფუთვა 500 ტაბ შეფუთვაში

 

შენახვა:

ინახება არაუმეტეს 25◦C ტემპერატურაზე, ბნელ და მშრალ და ბავშვებისაგან მიუწვდომელ ადგილას. 

 

გაცემის პირობები

ფარმაცევტული პროდუქტის ჯგუფი II, გაიცემა ფორმა N3 რეცეპტით.

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