Kawirikawiri Amalembedwa Ngati Methotrexate Siliyikwanitsa
Arava (yotchedwa lefilunomide) amadziwika ngati mankhwala osokoneza bongo (DMARD) omwe amachititsa matenda. Mankhwalawa, omwe amavomerezedwa ndi US FDA pa September 11, 1998, amagwiritsidwa ntchito pofuna kuchiza matenda a nyamakazi akuluakulu. Amagwiritsidwa ntchito kuchepetsa zizindikiro za nyamakazi ya nyamakazi, kuti ateteze kuwonongeka kwa thupi (mwachitsanzo, umboni wa x-ray wa zowonongeka ndi malo ophatikizira), ndi kusintha ntchito ya thupi.
Arava kawirikawiri imalembedwa pamene ma DMARD ena, makamaka methotrexate , sangathe kulekerera kapena kupereka yankho lokwanira (mwachitsanzo, kulephera kulamulira zizindikiro).
Kupezeka ndi Kusankha
Arava ikupezeka mu mapiritsi ophimba mafilimu 10 mg ndi 20 mg (mabotolo owerengeka 30). Arava imapezekanso mu paketi 100 mg 3-count blister. Chifukwa cha moyo wautali wa Arava omwe ali ndi matenda a nyamakazi komanso nthawi yomwe maola 24 akuyenera kuti adziwe, ndibwino kuti Arava ayambe ndi mlingo wa piritsi imodzi ya 100 mg pa tsiku kwa masiku atatu. Pambuyo pa mlingo wothandizira wathunthu, mlingo wa tsiku ndi tsiku wa 20 mg Arava umalimbikitsidwa kuchiza matenda a nyamakazi. Pulogalamu ya 10 mg imapezeka kwa odwala omwe amafunika mlingo wochepa chifukwa cha zotsatira zovuta ndi mlingo wapamwamba. Zitha kutenga masabata angapo musanayambe kuwoneka bwino pakumapweteka pamodzi kapena kupumphura. Zopindulitsa zambiri sizingatheke mpaka masabata 6 mpaka 12 pambuyo pa Arava.
Momwe Ikugwirira Ntchito
Arava ndi isoxazole immunomodulatory agent amene amaletsa dihydroorotate dehydrogenase, puloteni yomwe imagwiritsidwa ntchito mu pyrimidine. Pyrimidines ndikumanga nucleic acid. Arava imagwirizanitsidwa ndi ntchito yopewera mphamvu (kutanthauza, imalepheretsa kufalikira kwa maselo) komanso m'mayesero, yasonyeza zotsatira zotsutsana ndi zotupa.
Zimalepheretsa mapangidwe a DNA omwe amafunikira kuti apange maselo, monga maselo a m'thupi. Pochita zimenezi, zimadwalitsa chitetezo cha mthupi . Momwe zimagwiritsira ntchito makamaka pofuna kuthetsa nyamakazi ya nyamakazi sizimvetsetsedwa bwino.
Zotsatira Zotsatira ndi Zochitika Zoipa
Zomwe zimachitika kwambiri ndi Arava zikuphatikizapo kutsegula m'mimba, kunyowa, kupweteka mutu, kupuma kwa mpweya, mavitamini amphamvu a chiwindi (ALT ndi AST), alopecia, ndi kutupa. Kukwera kwa mavitamini a chiwindi kumakhudza odwala osachepera 10% omwe amagwiritsa ntchito Arava, koma chifukwa akhoza kuvulaza chiwindi, makamaka chifukwa cha mowa kapena mankhwala ena, kuyesedwa kwa magazi nthawi zonse kumafunika kuyang'anira chiwindi.
Zochitika zambiri zovulaza zinawonetsedwa kuti zidzakhudza 1% mpaka zosachepera 3% za odwala nyamakazi a nyamakazi omwe adayesedwa mu mayesero a chipatala ku Arava. Mavuto a mapuloteni, kuphatikizapo chifuwa kapena mpweya wochepa, amaonedwa kuti ndizovuta. Odwala ayenera kudziŵa zizindikiro zoyambirira za matenda a m'mapapo ndi kufotokoza zizindikirozo ngati ali nazo.
Matenda otsekula, omwe amawoneka bwino, amakhudza odwala 20 peresenti omwe amachitira ndi Arava. Kutsekula m'mimba chifukwa cha ntchito ya Arava nthawi zambiri kumakhala bwino ndi nthawi kapena kumwa mankhwala kuti athetse kutsekula m'mimba.
Nthawi zina, mlingo wa Arava ungafunike kuchepa.
Machenjezo ndi Zotsutsana
Arava sayenera kugwiritsidwa ntchito ndi amayi apakati kapena amayi omwe angathe kutenga mimba ndipo sakugwiritsa ntchito njira zobereka. Mimba iyenera kupeŵa panthawi ya mankhwala ndi Arava komanso isanathe kukonzanso mankhwala osokoneza bongo pambuyo pa chithandizo ndi Arava.
Kuvulala kwakukulu kwa chiwindi, kuphatikizapo kufala kwa chiwindi, kwakhala kwa odwala ena omwe anachitidwa ndi Arava. Odwala omwe ali ndi matenda aakulu a chiwindi omwe sakhalapo kale sayenera kuchitidwa ndi Arava.
Arava sichivomerezedwa kwa odwala omwe ali ndi matenda akuluakulu a m'magazi, mafupa a dysplasia, kapena matenda akuluakulu osalimba.
Nkhani zambiri za pancytopenia, agranulocytosis, ndi thrombocytoplenia zafotokozedwa. Kuwerengera kwa magazi kuyenera kuchitidwa kawirikawiri kuti awonetsere zachilendo.
Matenda ambiri a matenda a Stevens-Johnson ndi poizoni epidermal necrolysis, ndi DRESS (mankhwala osokoneza bongo ndi eosinophilia ndi zizindikiro zowonongeka) akhala akufotokozedwa kwa odwala omwe ali ndi Arava. Ngati izi zikuchitika, Arava iyenera kuyimitsidwa ndipo njira yothetsera mankhwala ingayambe.
Matenda a m'mimba amavomerezedwa kwa odwala ena omwe amatenga Arava. Ngakhale nthawi zambiri, zizindikiro zimagonjetsedwa ndi kutha kwa Arava, odwala ena anali ndi zizindikiro zosalekeza.
Zotsatira:
Arava Mapiritsi. Kufotokozera Information. Sanofi-Aventis US Yosinthidwa November 2014.
Leflunomide (Arava). American College of Rheumatology. Kusinthidwa May May 2015.