Kodi Mungatani Kuti Musagwiritse Ntchito Tamoxifen?
Ngati mwauzidwa tamoxifen kwa khansa ya m'mawere , mwinamwake munamva kuti ikhoza kuyanjana ndi mankhwala ena. Popeza kuyanjana kumeneku kumakhudza mankhwala omwe amagwiritsidwa ntchito mobwerezabwereza komanso kumaphatikizapo zowonjezereka komanso zakudya zowonjezera, izi ndi zofunika kwambiri. Kuwonjezera pamenepo, mwinamwake mukumwa mankhwalawa kwa zaka 5 mpaka 10, mukudziwitse za kuyanjana kosatheka osati kanthawi kochepa chabe.
Palinso anthu ena omwe, chifukwa cha kusiyana kwa majini, samapindula pokhapokha ngati mankhwalawa akugwiritsidwa ntchito kwambiri. Kodi muyenera kudziwa chiyani?
Ntchito za Tamoxifen
Tamoxifen amagwiritsa ntchito katatu:
- Nthawi zambiri amagwiritsidwa ntchito ngati chithandizo cha adjuvant kwa amayi omwe ali ndi kansa ya m'mawere oyambirira omwe ali estrogen receptor zabwino ndi omwe ali ammopaopausal. Pachifukwa ichi, zingachepetse chiopsezo cha kubwereza ndi 50 peresenti. Zimachepetsanso mwayi wokhala khansa yachiwiri m'matumbo anu okhudzidwa (ngati muli ndi lumpectomy) kapena m'thupi lanu.
- Tamoxifen imagwiritsidwa ntchito kwa amayi ndi abambo omwe ali ndi khansa ya m'mawere yomwe imakhala yotetezeka ndi estrogen komanso omwe sagonjetsedwa ndi mankhwala.
- Tamoxifen ingagwiritsidwe ntchito ngati njira yothandizira amayi omwe ali ndi chiopsezo chachikulu chokhala ndi khansa ya m'mawere. Pachifukwa ichi, zingachepetse chiopsezo cha amai kuti azikhala ndi khansa ya m'mawere ndi theka.
Mlingo wofala kwambiri ndi 20 mg tsiku lililonse kwa zaka 5 mpaka 10.
(Amene amayamba kukhala amodzi kapena amalandira mankhwala ochotsera ovari angasinthidwe ku aromatase inhibitor mmalo mwake).
Phunzirani zambiri za ntchito ya estrogen mu kansa ya m'mawere ndi njira zamakono zomwe zimapezeka.
Momwe Tamoxifen Amayendera Mthupi Lanu
Tamoxifen iyenera kuthyoledwa mu thupi lanu mu mawonekedwe ake.
Izi "metabolite" ndi endoxifen ndipo ndilo makina omwe amathandiza kupewa kubwereza.
Tamoxifen imasweka mpaka endoxifen ndi cytochrome P450 enzyme CYP2D6. (Palinso enzyme zina monga CYP3A4 ndi zina, koma CYP2D6 ndizofunika kwambiri). Chilichonse chomwe chimachepetsa ntchito ya enzyme iyi (CYP2D6) ikhoza kubweretsa kuchepa kwa mphamvu ya metabolite, ndipo motero, kupindula pang'ono. Ntchito yochepetsetsa ya enzyme ikhoza kuchitika ngati mukugwiritsa ntchito mankhwala ena kapena ngati muli ndi mitundu yosiyanasiyana ya mavitamini yomwe imachititsa kuti tizilombo toyambitsa matenda tisagwire ntchito.
Endoxifen, mankhwala owonongeka, ndi nthawi 30 mpaka 100 yothandiza kwambiri kuthetsa kusuntha kwa selojeni ya selojeni kuposa tamoxifen, ndipo ndilo maziko omwe amachititsa zotsatira za tamoxifen. Mutha kumva tamoxifen amatchedwa "pro-mankhwala" pa chifukwa ichi.
Chifukwa Chakuchita Mankhwala Osokoneza Bongo Angakhalepo
Chifukwa chomwe kumvetsetsa mphamvu ya kuchepa kwa tamoxifen ndikofunika kuti pali mankhwala ena ambiri omwe amakhudza nayenso mazira a CYP2D6. Mankhwala ena amaletsa kwambiri tizilombo toyambitsa matenda kuti tizilombo toyambitsa matenda tizilombo toyambitsa matenda tizilombo toyambitsa matenda tizilombo toyambitsa matenda tizilombo toyambitsa matenda tizilombo toyambitsa matenda. Mwachidziwikire, zidzakhala ngati inu simunatenge mankhwala.
Mankhwala omwe amakhudza mavitaminiwa ndi awa omwe amagwiritsidwa ntchito makamaka kwa amayi omwe ali ndi kansa ya m'mawere monga matenda ambiri otetezera matenda komanso ngakhale chimfine ndi mankhwala ozunguza bongo.
Zomwe zimagwirizanitsidwa ndi izi ndi zatsopano (tamoxifen inavomerezedwa mu 1998, koma kuyanjana sikukudziwikiratu mpaka panthawi ina) ndipo maphunziro akupitiriza kuyang'ana nkhaniyi mozama kwambiri. Zindikirani kuti, kafukufuku waposachedwapa apeza kuti mlingo wanu wa vitamini D ukhoza kugwirizanitsidwa ndi mphamvu ya tamoxifen ndi kuti mapulogalamu a endoxifen amayamba kukhala oposa kwambiri m'miyezi ya chilimwe. Popeza pakhala pali maphunziro omwe amasonyeza kuti vitamini D ingathandize kuthana ndi khansa ya m'mawere , ichi ndi chikumbutso kuti a oncologist azifufuza mlingo wanu wa vitamini D ngati simunachite izi.
Kuyanjana kwa Mankhwala Osokoneza Bongo pa Tamoxifen
M'munsimu tilembere mankhwala angapo omwe angagwirizane ndi tamoxifen. Chodziwika n'chakuti mankhwalawa angachepetse mphamvu ya tamoxifen koma azichita madigiri osiyana. Mankhwala ena ali amphamvu kwambiri mu tizilombo toyambitsa matenda a CYP2D6, pamene ena amaletsa tizilombo toyambitsa matenda. Mndandandawu suli wokwanira ndipo mankhwala ena osagwiritsidwa ntchito ambiri angagwirizane ndi tamoxifen. Chonde lankhulani ndi oncologist wanu ndi mankhwala pa mankhwala aliwonse a mankhwala, mankhwala owonjezera, kapena zakudya zowonjezera zomwe mukuziganizira mukakhala pa tamoxifen. Zindikirani kuti pangakhale nthawi zomwe phindu la kugwiritsa ntchito limodzi mwa mankhwalawa lingapangitse pangozi yochepetsera mayendedwe anu a endoxifen. Kuzindikira, komabe, kungakuthandizeni kufunsa dokotala mafunso abwino.
Mankhwala omwe ayenera kupewa ndi tamoxifen ndi awa:
- Kusankha serotonin uptake inhibitors (SSRIs) : Prozac (fluoxetine) ndi Paxil (paroxetine) ali ndi mphamvu zowononga za CYP2D6. Luvox (fluvoxamine), Celexa (citalopram), Lexapro (escitalopram). ndipo Zoloft (sertraline) amalepheretsanso enzyme. N'zosakayikitsa kuti mgwirizano umenewu ndi umene umayambitsa chiopsezo cha imfa chomwe amayi amapeza pa Paxil.
- Kusankha serotonin / norepinephrine reuptake inhibitors (SNRIs) : Effexor (venlafaxine), Pristiq (desvenlafaxine)
- Wellbutrin ndi Zyban (bupropion) : Amagwiritsidwa ntchito popuma ndi kusuta fodya
- Matenda a Tricyclic: Anafranil (clomipramine) ndi Norpramin (desipramine)
- Mankhwala a Endocrine : Sensipar (cinacalcet), Parlodel (bromocriptine), ndi Parnate (tranlcypromine)
- Matenda osiyanasiyana monga Mellaril (thioridazine), Trilafon (perphenazine), Orap (pimozide), Thorazine (chlorpromazine), ndi antipychotic antiyytics monga Risperdal (risperidone), Clozaril (clozapine), Geodon (ziprasidone), ndi Seroquel (quetiapine)
- Mankhwala a mtima : Cardioquin (quinidine), Ticlid (ticlopidine), Cardene (nicardipine)
- Antihistamines : Benadryl (diphenhydramine)
- Maantibayotiki : Rifampin akhoza kuchepetsa kwambiri tamoxifen, isoniazid (yogwiritsidwa ntchito kwa TB).
- Mankhwala a Reflux : Tagamet (cimetidine)
- Antifungals : Kaŵirikaŵiri amagwiritsidwa ntchito pa zochitika kuchokera pa phazi la wothamanga, kuti apepetse poizoni, kuti awonetsere bowa, Lamisil mankhwala kapena Terbinex (terbinafine) sayenera kugwiritsidwa ntchito ndi tamoxifen, ngakhale mankhwalawa sali nawo pamndandanda wa mankhwala omwe amapewa.
- Mankhwala a shuga: Actos (proglitazone)
- Mankhwala a Parkinson : Requip (ropinirole)
- Mankhwala a HIV / AIDS : Ambiri
- Zina : Neurontin (gabapentin)
- Mavitamini : Mankhwala othamanga kwambiri a vitamini E amatha kugwirizana ndi tamoxifen
- Zakudya zowonjezera zakudya : Sitikupeza maphunziro akuluakulu akuyang'ana kuyanjana kwa zitsamba zoonjezera ndi tamoxifen. Zowonjezera zomwe zili ndi mphamvu zolimba za CYP2D6 mu labu zikuphatikizapo skullcap, mandimu, mandimu, echinacea, ndi ginseng. Zambirimbiri, tizilombo tomwe timatulutsa tizilombo tingapangitse kuchuluka kwa tamoxifen m'magazi, koma izi sizikukwanira kuchititsa zizindikiro za kuchipatala. Ngati mukukonzekera kugwiritsa ntchito mankhwala aliwonse owonjezera amathandiza kuti muyankhule ndi oncologist wanu.
Njira Zina: Mankhwala Amene Angagwiritsidwe Ntchito M'malo mwake
Mwinamwake mukudabwa zomwe mungatenge ngati mukugwiritsa ntchito tamoxifen:
- Matenda oterewa amasiyana malinga ndi momwe amakhudzira CYP2D6 ya enzyme. Cymbalta (duloxetine) ikuwoneka kuti iwononge ma chiwerengero cha CYP2D6 pansi pa zowonjezera zambiri zowonongeka. Mankhwala omwe tatchulidwa pamwambapa akuti "mankhwala osokoneza bongo" amasiyana kwambiri ndi momwe amalepheretsa mavitaminiwa. Kafukufuku waposachedwapa amasonyeza kuti zina zoterezi zingakhale zotetezeka kuti zigwiritsidwe ntchito ndi tamoxifen, koma maphunziro panthawi ino sali osakwanira ngati izi zingakhale ndi zotsatira za kuchipatala.
- Mankhwala osokoneza bongo ndi ozizira: Mankhwala ambiri ozizira amakhala ndi zinthu zambiri, choncho ndi bwino kuwerenga malemba. Chiwerengero chochulukirapo chokonzekera chimfine ndi chimfine chiri ndi Benadryl. Mankhwala osokoneza bongo monga Zyrtec ndi Claritin akuganiziridwa kuti ndi otetezeka kugwiritsidwa ntchito ndi tamoxifen.
- Mankhwala a reflux achulukidwe omwe ali ophatikizapo Zantac (ranitidine) ndi ena.
Nthawi zonse timaphunzira zambiri za mankhwala omwe timagwiritsira ntchito mankhwala ndipo ndizofunikira kulankhula ndi odziwa za mankhwala anu komanso mankhwala omwe mumakonda kugwiritsa ntchito limodzi ndi tamoxifen.
QT Prolongation
Ngati mwayang'ana pa phukusi yanu yolembapo mutha kuwona kuti tamoxifen sayenera kugwiritsidwa ntchito ndi mankhwala ena omwe amapititsa nthawi ya QT. Nthawi ya QT imatanthawuza kuchuluka kwa nthawi pakati pa mafunde awiri omwe amawoneka pa electrocardiogram. Zimaganizidwa kuti ngati nthawi ya QT ikhale yotalika kwambiri, imayambitsa chiopsezo cha mtima wachilendo, ndipo mwina, imfa yadzidzidzi.
Zolembazo zimachenjeza kuti tamoxifen ingayambitse QT prolongation pamene imagwiritsidwa ntchito limodzi ndi mankhwala ena omwe angayambitse QT prolongation. Kupenda kafukufuku wa 2017, komabe, akuti pakhoza kukhala chiopsezo chachikulu cha kuchipatala chofunika kwambiri cha Pulogalamuyi, makamaka pa 20 mg tsiku lililonse.
Genetics ya Tamoxifen ndi CYP2D6 Kuyeza
Pali ntchito zambiri za CYP2D6, ndipo izi zimapangitsa kusiyana kwa kagayidwe kabwino ka mankhwala. Kafukufuku wa kafukufuku adawonetsa kuti zowonongeka kwambiri zimakhala ndi zotsatira zabwino kusiyana ndi kuchepetsa magetsi. Pafupifupi, pafupifupi 20 peresenti ya anthu akhala akuchepetsetsa mankhwalawa.
Ndiye mungadziwe bwanji ngati mungakhale osauka? Pali njira zamagetsi zogwirira ntchito zomwe zimapezeka kuti zikhale zogonana ndi CYP2D6, koma kuyesa sikuchitika makamaka kwa amayi pa tamoxifen mankhwala a khansa ya m'mawere ya estrogen. Mwa kuyankhula kwina, mwina simukudziwa. Izi ndizonso zotsutsana, ndipo ena ofufuza amakhulupirira kuti kukhalapo kwa enzyme yina, CYP3A4 * 22 ikhoza kuthetsa kuchepa kwa malingaliro a endoxifen okhudzana ndi ntchito yochepa ya CYP2D6.
Apanso, tiyenera kuzindikira kuti ntchito ya CYP2D6 imakhala yotsika kwambiri m'miyezi ya chilimwe (yodalira vitamini D pa mlingo wina), komanso kuyesa kwa vitamini D n'kofunika kwa amayi omwe amakhala ndi khansa ya m'mawere.
Pansi pa Tamoxifen Mankhwala Osokoneza Bongo
Tamoxifen ndi mankhwala omwe amayi amawatenga tsiku ndi tsiku kwa nthawi yayitali atatha kupeza matenda a kansa ya m'mawere. Mukatengedwera monga momwe mwalembedwera, ikhoza kuchepetsa chiopsezo cha kubwereranso (ndiyeno, imfa). Mwachidziwitso, kumvetsetsa kotheka kuyanjana ndikofunikira kwambiri.
Njira zina zothandizira mankhwala zingakhale zofewa, pamene mankhwala ena amatha kunyalanyaza zotsatira za tamoxifen pamene atengedwa nthawi imodzi. Izi zakhala zikuwonetsedwa osati labu loyang'ana mthupi la mankhwalawa, koma likuwonedwa ku chipatala kuwonjezeka kwa imfa ya amayi omwe anatenga Paxil pamodzi ndi tamoxifen.
Zatsopano zimabwera pamwamba (monga mavitamini D zomwe tatchula pamwambapa). Kupita patsogolo mofulumira kwa mankhwala a khansa kumapangitsa kukhala kofunika kwambiri kusiyana ndi kale kukhala wothandizira nokha pa chisamaliro chanu cha khansa . Kafukufuku omwe amasonyeza mfundo iyi ndi imodzi yomwe inkawoneka amayi omwe amatenga tamoxifen nthawi ya 2005 ndi 2010 (titatha kuzindikira za zina zoterezi). Pa nthawiyi, Paxil ndi imodzi mwa mankhwala omwe amadzitetezera kwambiri pa amayi omwe ali pa tamoxifen. Komabe, ngakhale kudandaula kwakukulu, ndikuti kukonzekera kwambiri kumagwirizanitsidwe ndi tamoxifen, kusiya anthu okha kuti adziŵe kuyanjana kwa mankhwala.
> Zotsatira:
> Antunes, M., Timm, T., de Oliveira, V. et al. Mphamvu ya CYP2D6 ndi CYP3A4 Phenotypes, Drug Interactions, ndi Vitamin D Chikhalidwe pa Tamoxifen Biotransformation. Kuwunika Mankhwala Ochepetsa Mankhwala . 2015. 37 (6): 733-44.
> Juurlink, D. Kuyambiranso Kuyanjana kwa Mankhwala Pakati pa Tamoxifen ndi SSRI Oponderezedwa. BMJ . 2016. 354: i5309.