Mankhwala Oletsa Kuteteza Ambiri Amachotsa Mitsempha Yosakaniza Mankhwala a Edzi
Tamoxifen ndi mankhwala omwe amachititsidwa ndi amayi ambiri omwe amayamba kumwa mankhwalawa pambuyo poti atha kuchiza matenda a kansa ya m'mawere yotchedwa estrogen. Pofuna kuthana ndi zotsatira za tamoxifen (monga kutentha kwa moto) komanso kuthandizira kuvutika maganizo, madokotala amapereka mankhwala opatsirana. Komabe zambiri zowonongeka zimatha kusokoneza, kapena kuchotsa kwathunthu, ubwino wa tamoxifen.
Kodi aliyense ayenera kutenga tamoxifen chiyani?
Ntchito za Tamoxifen ndi Khansa ya m'mimba
Mkazi akamaliza mankhwala opatsirana khansa ya m'mawere, ndi mankhwala monga opaleshoni , chemotherapy , ndi mankhwala othandizira , amatha kutenga tamoxifen. Kwa amayi omwe ali ndi zotupa zotchedwa estrogen, ma ARV amachepetsa chiopsezo cha khansa kubwerera (mobwerezabwereza) pozungulira 50 peresenti.
Kusankhidwa kwa mankhwala kumadalira pa vuto la menopausal. Ngati mayi ali ndi matenda amodzi, tamoxifen nthawi zambiri ndi mankhwala osankhidwa. (Kwa omwe ali pambuyo poopa, kapena omwe ali ammenopausus koma adalandira mankhwala ochotsera ovarian, mankhwala a aromatase amagwiritsidwa ntchito mmalo mwake).
Maselo a khansa ya pachifuwa omwe ali estrogen receptor positive amachotsedwa ndi estrogen. Estrogen yomwe ilipo mu thupi (yopangidwa ndi mazira ochuluka) imamangiriza kuti maselo a khansa apange kukula. Tamoxifen amagwira ntchito mwakumangiriza kulandira mankhwalawa kuti estrogen isathe, makamaka njala ya maselo a khansa ya chakudya chawo.
Zotsatira za tamoxifen zikuphatikizapo zizindikiro za mtundu wa menopausal monga kutentha kwa moto, low libido, ndi kuyanika kwa amayi. Kwa amayi omwe sanakwanitse kusamba, kutentha kotentha kumakhala kokhumudwitsa kwambiri, koma taphunzira m'zaka zaposachedwapa kuti mankhwala ena oponderezedwa angachepetse kutentha uku.
Mwatsoka, ena mwa mankhwalawa amathandizanso kuchepetsa mphamvu ya tamoxifen.
Khansa ya m'mawere ndi Kusokonezeka maganizo
N'zosadabwitsa kuti amayi ambiri omwe athandizidwa pa khansa ya m'mawere amayamba kuvutika maganizo. Kuphatikizidwa kwa matenda opatsirana, zotsatira za chithandizo, ndi kusintha kwa chithunzi cha thupi chomwe chimaperekedwa ndi chithandizo chonse kumapangitsa kuti pakhale vuto lalikulu. Mwamwayi, atsikana ambiri omwe ali ndi khansa ya m'mawere ankapatsidwa mankhwala (pafupifupi kawirikawiri m'madera ena) ndi antidepressants, zinawoneka kuti mankhwala othetsera nzeru ambiri angachepetse zotsatira za tamoxifen. Kodi izi zimachitika bwanji?
Tamoxifen ndi Drug Interactions
Kugwiritsira ntchito mankhwala a Tamoxifen ndi mankhwala ndi ofala, ndipo izi zimaphatikizapo mankhwala ambiri kuphatikizapo mankhwala olepheretsa kugwiritsira ntchito mankhwala. Popeza ambiri mwa mankhwalawa amagwiritsa ntchito mankhwala osokoneza bongo, kuphatikizapo mankhwala osokoneza bongo monga Benadryl, ndikofunika kulankhula ndi dokotala wanu ndi wamankhwala za mankhwala aliwonse, kukonzekera-kukonza, kapena zakudya zowonjezera zomwe mukuziganizira, pamene muli pa mankhwala. Popeza anthu ambiri amatenga tamoxifen kwa zaka 5 mpaka 10, izi ndi zofunika kwambiri. Kumbukirani kuti si madokotala onse omwe amawadziwa bwino izi (ndipo tikuphunzira zambiri nthawi zonse).
Izi zikutanthawuza kuti ngati mupita kuchipatala mwamsanga, mwachitsanzo, ndi matenda, lankhulani ndi oncologist wanu kapena wamankhwala musanayambe kumwa mankhwala alionse omwe atchulidwa.
Tamoxifen imagwiritsidwa ntchito mopangidwira thupi m'thupi kuti ithetse. Endoxifen ili ndi mphamvu 30 mpaka 100 kuposa tamoxifen, ndipo imayambitsa zotsatira zambiri za matenda. Tamoxifen imasweka mpaka endoxifen ndi puloteni ya cytochrome P450 CYP2D6 (kuphatikizapo ena omwe sali ofunika kwambiri). Mankhwala alionse omwe amachepetsa ntchito ya CYP2D6 (ndipo alipo ambiri) akhoza kuchepetsa kusweka kwa ndondomeko kotero kuti, kuchuluka kwa endoxifen komwe kumapangidwa.
Tamoxifen ndi Antidepressants: Kuyanjana
Tikuphunziranso za anti-depressants ndi zotsatira zake pa ma tamoxifen mu thupi, koma pakalipano tawona kuti zovuta zowonjezereka zimatha kugwira tamoxifen m'njira zosiyanasiyana. Zina zoterezi (monga Prozac ndi Paxil) zimatsutsa kwambiri zotsatira za tamoxifen. Pankhaniyi, zingakhale ngati osatenga tamoxifen nkomwe (komanso osakhala ndi phindu la kuchepetsa chiopsezo).
Ndi zina zolimbitsa thupi pali kugwirizana moyenera, ndipo ndi ena, kugwirizana pang'ono. Mosiyana ndi zimenezi, zakudya zina zowonjezera zakudya zingathe kuwonjezeranso zotsatira za tamoxifen (komanso zotsatirapo), ngakhale kuti kafukufuku wina wasonyeza zosiyana.
Pansipa pali gome lomwe limafotokozera mwachidule zomwe timakhulupirira ndizowona zokhudzana ndi zovuta zambiri masiku ano. Iyi ndi gawo la kufufuza mwakhama, ndipo mwinamwake tidzakhala tikuphunzira zambiri posachedwa. Ngati mukuganiza za mankhwala opatsirana pogonana, kambiranani mosamala ndi dokotala, komanso nthawi ndi nthawi funsani ngati chirichonse chasintha.
Kudetsa nkhawa ndi momwe amachitira ndi Tamoxifen
| Mankhwala Osokoneza Maganizo | Kuyanjana ndi Tamoxifen | Chitetezo |
Paxil (paroxetine) Prozac (fluoxetine) | Kuteteza antiestrogen kumapindula | Pewani Kugwiritsa Ntchito |
Cymbalta (duloxetine) Wellbutrin (bupropion) Zoloft (sertraline) | Kusokonezeka kwapakatikati ndi kupindula kwa antiestrogen Zindikirani: Zofufuza zimatsimikizira kuti Zoloft amasokoneza Tamoxifen. | Kuwonjezera Mowopsa |
| Chovala cha Yohane Woyera (hypericum) | Kudziletsa kwambiri kwa antiestrogen | Mowonjezereka |
Celexa (citalopram) Lexapro (escitalopram) Pristiq (desvenlafaxine) Remeron (mirtazapine) | Kulankhulana kosavuta Zindikirani: Pristiq ndi Remeron sanaphunzire bwino pakuyanjana ndi Tamoxifen. | Sungani Zoopsa |
| Black Cohosh (Actaea) | Pewani kapena kupititsa patsogolo antiestrogen phindu potsatira phunziro. Zindikirani: Pali maphunziro owerengeka chabe okhudzana ndi Tamoxifen, ndipo ambiri achita "in vitro" (mu labu osati mwa anthu). | Sungani Zoopsa |
Effexor (venlafaxine) | Pafupifupi palibe kugwirizana ndi Tamoxifen | Kusankha Kwakukulu |
Pansi pa Tamoxifen ndi Antidepressants
Kudziwa za momwe mungagwiritsire ntchito mgwirizano pakati pa tamoxifen ndi mankhwala opatsirana kwambiri ngati mukuganizira za mankhwalawa. Matenda ena otetezera maganizo amadana kwambiri ndi zotsatira za tamoxifen, ndipo akuganiza kuti kugwirizana ndi chifukwa cha kuwonjezeka kwa imfa ya amayi omwe ali ndi khansa ya m'mawere omwe anatenga Paxil. Pakali pano, njira yabwino kwambiri yotentha ndi kutaya mtima kumawoneka kuti ndi Effexor, komabe n'kofunika kuzindikira kuti izi ndi gawo logwira ntchito kapena kufufuza, ndipo tikhoza kuphunzira zambiri posachedwa. Popeza cohosh wakuda amadziwika ndi kuthandizira ndi kutentha kwa kansalu kofanana ndi khansa ya m'mawere, komabe angayanjanenso ndi tamoxifen, ndikofunika kulankhula ndi oncologist wanu za mankhwala aliwonse, kukonzekera-kukonza, kapena kuwonjezera zakudya zomwe mukuziganizira.
> Zotsatira:
> Haque, R., Shi, J., Schottinger, J. et al. Tamoxifen ndi Kugonana kwa Mankhwala Osokoneza Maganizo Ogwiritsira Ntchito Mankhwala Osokoneza Bongo m'gulu la anthu 16,887 Otsatira za khansa ya m'mawere. Journal of National Cancer Institute . 2015. 108 (3): djv337.
> Juurlink, D. Kuyambiranso Kuyanjana kwa Mankhwala Pakati pa Tamoxifen ndi SSRI Oponderezedwa. British Medical Journal . 2016. 354: i5309.
> Li, J., Godecke, T., Chen, S. ndi al. Kuphatikizana kwa Vitamini Metabolic Pakati pa Black Cohosh (Cimicifuga Racemosa) ndi Tamoxifen Kupyolera Muyeso wa Cytochromes P450 2D6 ndi 3A4. Xenobiotica . 2011 Aug 9. (Epub patsogolo pa kusindikiza).