Valproic acid (sodium valproate) belongs rau ib pab pawg tshiab ntawm cov tshuaj tiv thaiv kab mob uas txawv ntawm cov tshuaj tiv thaiv kab mob yav dhau los ob qho tib si hauv cov qauv tshuaj thiab hauv cov ntsiab lus ntawm kev ua.
Kev piav qhia ntawm cov khoom
Cov tshuaj no tau tsim tawm hauv xyoo 1882 ua ib qho analog ntawm valeric acid los ntawm Dr. W. Barton. Nws muaj 2 pawg propyl. Tau ntau xyoo lawm, valproic acid tsuas yog siv nyob rau hauv lub chaw soj nstuam raws li ib tug inert hnyav rau ntau yam organic tebchaw. Nws cov khoom anticonvulsant tau tshawb pom los ntawm hmoov zoo.
Valproic acid yog ntshiab thiab kua ntawm chav tsev kub. Txawm li cas los xij, nws muaj peev xwm cuam tshuam nrog lub hauv paus, xws li sodium lossis magnesium hydroxide, los tsim cov ntsev ntawm valproate, uas yog cov khoom siv. Cov tshuaj no, qhov tseeb, yog 2-propylvaleric acid thiab nws cov ntsev ntsev. Tsis zoo li lwm cov tshuaj antiepileptic, nws yog ib qho tsis muaj nitrogen. Lub mechanism ntawm kev txiav txim ntawm no acid thiab nwsntsev yog txuam nrog ib qho kev cuam tshuam tshwj xeeb ntawm cov metabolism ntawm gamma-aminobutyric acid, uas yog ib qho inhibitor ntawm transferase enzyme.
Tshuaj muaj valproic acid txo qhov excitatory thiab convulsive teb ntawm lub cev muaj zog ntawm lub hlwb. Qhov no yog vim qhov tseeb tias cov tshuaj no nce cov ntsiab lus ntawm gamma-aminobutyric acid nyob rau hauv cov qauv ntawm lub paj hlwb. Valproic acid, tshuaj xyuas uas qhia txog nws cov txiaj ntsig hauv kev kho mob ntawm cov kab mob anticonvulsant, belongs rau pab pawg ntawm fatty acid derivatives.
yam ntxwv ntawm valproic acid, nws cov analogues
Valproic acid, cov lus qhia uas piav txog nws txoj kev cuam tshuam rau tib neeg, muaj nyob hauv ntau lub npe. Cov tshuaj nto moo tshaj plaws uas suav nrog cov tshuaj no yog Depakin, Konvuleks, Konvulsofin, Orfilin, Deprakin, Epilim, Everiden, Enkorat, Apilepsin, Valparin XP", "Dipromal". Hauv cov ntawv ua tiav, nws tuaj yeem ua rau hauv daim ntawv ntawm cov kua qaub lossis nws cov ntsev ntsev, hu ua sodium valproate. Cov kev ua ntawm cov tshuaj tsis txo qis los ntawm qhov no. Valproic acid, cov analogues uas tau teev tseg saum toj no, tau noj qhov ncauj tam sim ntawd tom qab noj mov. Tag nrho cov kev npaj uas muaj nws yog absorbed sai heev. Tom qab 2 teev, cov kua qaub no tshwm sim hauv cov ntshav plasma. Nws nkag mus zoo los ntawm cov ntaub so ntswg barriers. Cov kab seem ntawm cov khoom no tau txiav txim siab hauv cov kua cerebrospinal thiab hauv ntauLwm qhov chaw sab hauv ntawm lub cev. Nws kuj tseem pom muaj nyob hauv cov kua dej amniotic (kua amniotic) hauv cov poj niam cev xeeb tub.
Txoj Cai Ua Haujlwm
Valproic acid ua haujlwm li cas? Cov lus qhia rau cov tshuaj no tsis muab cov lus teb meej rau cov lus nug ntawm dab tsi yog lub tshuab ntawm nws cov txiaj ntsig kho. Qhov no yog vim qhov tseeb tias cov kws tshaj lij tseem tsis tau kawm tag nrho nws cov txiaj ntsig ntawm kev hloov cov khoom ntawm sodium channels. Tib lub sijhawm, valproic acid suav nrog hauv cov npe tshuaj uas tseem ceeb thiab tseem ceeb rau tib neeg.
Kev ua rau tus neeg
Valproic acid tsis yog siv rau kev qaug dab peg xwb. Cov lus qhia rau kev siv cov tshuaj no qhia tau hais tias nws tsis tau tsuas yog ib tug anticonvulsant nyhuv. Nws txhim kho txoj kev xav zoo li lub siab lub ntsws ntawm tus neeg. Cov kws tshaj lij hais tias cov kua qaub no muaj cov tshuaj tiv thaiv tranquilizing. Tsis zoo li lwm yam tshuaj ntawm hom no, nws txo qis lub xeev ntawm kev ntshai yam tsis muaj myoleraxant lossis sedative nyhuv. Qhov no yog vim nws qhov kev ua ntawm postsynaptic membranes. Tib lub sijhawm, cov txheej txheem ntawm kev sib kis ntawm cov hlab ntsha impulses yog suppressed.
Hauv cov ntawv me me ntawm kev qaug dab peg, feem ntau lawv txwv kom noj ib qho valproic acid lossis nws cov analogues. Hauv cov xwm txheej hnyav dua, cov tshuaj no tau ua ke nrog lwm cov tshuaj tiv thaiv kab mob.
Valproic acid rau qaug dab peg
Cov tshuaj no yog siv ntau hom mob vwm. Hauv qhov no, nws qhov kev txais tos yog nyob ntawm tus kws kho mob tsimtswv yim. Valproic acid, cov lus qhia rau kev siv uas qhia tau hais tias nws cov hauj lwm zoo nyob rau hauv ntau hom kab mob no, yog siv nyob rau hauv tej rooj plaub nyob rau hauv sib txawv koob tshuaj. Nws kuj yog feem ntau sau rau kev qaug dab peg.
siv tshuaj
Valproic acid, cov lus qhia uas yuav tsum tau muab tshuaj los ntawm tus kws kho mob uas tuaj koom thiab ua raws li kev kho mob nruj, yog siv rau hauv cov xwm txheej zoo li no:
• tiv thaiv ntau yam teeb meem ntawm qaug dab peg;
• convulsive tej yam kev mob uas tshwm sim nrog tej yam kab mob ntawm lub hauv paus paj hlwb;
• Ntxim qab heev;
• manic-depressive disorder tsis teb rau lithium tshuaj;
• convulsive mob uas tshwm sim thaum yau.
Valproic acid thiab cov kev npaj uas muaj nws tsuas yog yuav tsum tau ua raws li kev saib xyuas ntawm tus kws kho mob. Tsuas yog tom qab ua tiav tag nrho cov kev tshawb fawb tsim nyog thiab ntsuas tus neeg mob tus mob, tus kws kho mob tshwj xeeb yuav tuaj yeem xaiv qhov kev nyab xeeb thiab siv tau zoo ntawm cov tshuaj no.
Ib daim foos
Valproic acid, daim ntawv tso tawm uas txawv, yog ntim los ntawm cov tuam txhab sib txawv hauv daim ntawv hauv qab no:
• ntsiav tshuaj, coated, soluble nyob rau hauv txoj hnyuv. Lawv muaj 150, 200, 300, 500 mg ntawm valproic acid (sodium valproate).
• Capsules 150, 300 mg.
• Tshuaj (syrup) muaj 50 lossis 300 ml ntawm cov tshuaj hauv 1 ml.
Kev sib raug zoo nrog lwm tustshuaj
Valproic acid tuaj yeem txhim kho cov nyhuv ntawm lwm cov tshuaj tiv thaiv kab mob thiab tshuaj tiv thaiv kab mob, neuroleptics, tshuaj tiv thaiv kev puas siab ntsws, tshuaj tiv thaiv kev ntxhov siab, thiab cawv. Tsis txhob haus cawv thaum noj cov tshuaj no. Valproic acid, analogues ntawm cov tshuaj no, salicylic acid thiab anticoagulants muaj cov nyhuv inhibitory ntawm platelet aggregation (kev sib xyaw). Thaum noj, cov tshuaj no sai sai absorbed rau hauv cov hlab ntsha. Nyob rau tib lub sijhawm, kev siv valproic acid ib txhij nrog cov zaub mov me ntsis txo nws cov txiaj ntsig.
Side effects
Cov tshuaj no qee zaum ua rau muaj kev phiv xws li xeev siab, ntuav, tsis qab los noj mov, hnyav thiab mob plab, raws plab. Txhawm rau tshem tawm cov xwm txheej no, siv cov hnab ntawv lossis cov tshuaj antispasmodic. Valproic acid tuaj yeem ua rau muaj kev nyuaj siab thiab qaug zog, yog li nws tsis tshua muaj tshuaj rau cov neeg koom nrog kev ua haujlwm ntawm lub cev thiab lub hlwb. Kev noj cov tshuaj no qee zaum ua rau muaj kev puas tsuaj rau lub paj hlwb, uas tshwm sim los ntawm kev tshee tshee, ob lub dluab thiab pom kev cuam tshuam, tsaug zog, mob taub hau, kiv taub hau, psychomotor agitation, kev nyuaj siab thiab apathy.
Qee zaum, noj cov tshuaj no ua rau muaj qhov tshwm sim hauv qab no: txo qis thiab nce hauv lub cev hnyav, pom kev tsis haum tshuaj, plaub hau poob ib ntus, kev coj khaub ncaws tsis zoo, hloov pauv hauv hemogram. Tsis tshua muaj tab sis mob hnyav heevQhov kev kho no suav hais tias yog kev ua txhaum ntawm kev ua haujlwm ntawm lub siab lossis txiav txiav, txo qis hauv cov ntshav txhaws. Cov nyhuv hepatotoxic feem ntau yog thaum noj cov tshuaj no ib txhij nrog clonazepam, phenobarbital.
Thaum siv valproic acid, nws yuav tsum nco ntsoov tias hauv cov neeg mob ntshav qab zib, nws tuaj yeem cuam tshuam qhov tshwm sim ntawm kev kuaj zis, ua kom cov ntsiab lus ntawm ketone lub cev hauv nws. Txhawm rau tiv thaiv ntau yam teeb meem thaum kho, qib ntshav bilirubin, daim siab enzymes, thiab platelet suav tau txiav txim siab tsis tu ncua.
YContraindications
Valproic acid, uas nws cov kev npaj tau muag hauv khw muag tshuaj yam tsis muaj tshuaj, muaj contraindications hnyav. Cov no suav nrog:
• ua txhaum ntawm txiav txiav thiab daim siab;
• porphyria;
• hemorrhagic diathesis;
• idiosyncrasy;
• thawj peb lub hlis twg ntawm cev xeeb tub;
• lub sij hawm lactation (tshuaj tshuaj nkag mus rau hauv niam lub mis).
Thaum lub caij cev xeeb tub thib ob thiab thib peb ntawm cev xeeb tub, cov tshuaj no tau muab tshuaj me me thiab tsuas yog siv rau qhov tshwm sim loj, vim tias nws hla cov placenta thiab tuaj yeem cuam tshuam rau tus menyuam hauv plab.
Thaum noj valproic acid, nws yuav tsum ua tib zoo saib xyuas lub siab ua haujlwm, tswj cov ntshav txhaws thiab platelet aggregation. Thaum kho nrog cov tshuaj no, cov poj niam uas muaj kev sib deev yuav tsum sivtxoj kev txhim khu kev qha tshaj plaws ntawm kev tiv thaiv kom tsis txhob muaj menyuam.
Daim ntawv thov qauv
Kev npaj uas muaj cov kua qaub no tau noj raws li cov txheej txheem sib txawv. Cov koob tshuaj zoo tshaj yog xaiv tus kheej. Kev xaiv ntawm kev tswj hwm yog nyob ntawm tus mob ntawm tus neeg mob, nws qhov hnyav thiab hnub nyoog. Feem ntau, thaum pib ntawm chav kawm, cov neeg laus thiab cov menyuam yaus uas qhov hnyav tshaj 25 kg raug muab 10-15 mg / kg ib hnub. Nyob rau hauv lub neej yav tom ntej, txhua txhua lub lis piam koob tshuaj yog nce los ntawm 5-10 mg / kg, coj nws mus rau qhov siab tshaj plaws ntawm 30 mg / kg. Cov koob tshuaj txhua hnub rau cov menyuam yaus yog 20-50 mg / kg. Thaum hloov mus rau kev kho mob nrog valproic acid, kev noj tshuaj ntawm lwm cov tshuaj tiv thaiv tau maj mam txo. Qhov siab tshaj plaws ntawm valproic acid yuav tsum tsis pub tshaj 50 mg / kg ib hnub twg.
Muaj ntau hom tshuaj no. Kev tswj hwm txoj hlab ntshav suav nrog kev noj 400-800 mg ntawm sodium valproate ib hnub. Thaum lub sijhawm kho, nws yog ib qho tsim nyog los txiav txim siab qib ntawm cov tshuaj no hauv cov ntshav. Raws li kev txheeb xyuas, kev hloov kho tuaj yeem ua rau kev kho mob.
Indicative Application Charts:
• Cov menyuam yaus hnub nyoog qis dua 3 xyoos: thawj lub lim tiam lawv haus 150 mg 1 r. ib hnub, thib ob - 150 mg, 2 r. ib hnub, thiab peb - 150 mg 3 r. ib hnub.
• Cov menyuam hnub nyoog 3-10 xyoo: 450 mg hauv thawj lub lim tiam, 600 mg nyob rau lub lim tiam thib ob, thiab 900 mg nyob rau lub lim tiam thib peb. Raws li lwm cov tswv yim, lawv noj 300, 450, 600, 900 mg ib hnub, feem, ntawm 1, 2, 3 thiab 4 lub lis piam.
• Tom qab 10 xyoo: thawj lub lim tiam lawv haus 600 mg, nyob rau hauv lub thib ob - 900, nyob rau hauv lub thib peb - 1200 mg ib hnub twg. Raws li lwm txoj kev, lawv noj 300, 600, 900, 1200 mg ib hnub.raws li ntawm 1, 2, 3 thiab 4 lub lis piam.
Rau cov neeg mob uas yav tas los tau noj lwm cov tshuaj tiv thaiv kab mob, valproic acid tau muab tshuaj hauv cov tshuaj txo qis. Tib lub sijhawm, tus lej ntawm lwm cov nyiaj raug txo. Kev saib xyuas koob tshuaj rau cov neeg laus yog 900-1200 mg. Valproic acid, ntsiav tshuaj thiab tshuaj ntsiav tshuaj tsuas yog tom qab 10 xyoo, tau noj hauv 2-4 koob. Rau cov menyuam yaus, cov kua qab zib lossis sib tov nrog cov tshuaj no feem ntau yog sau.
"Depakine" (valproic acid)
Muaj ntau yam kev npaj nrog cov kua qaub no ntawm kev muag, tab sis ib qho nrov tshaj plaws yog Depakine. Hauv khw muag tshuaj muaj ntau hom tshuaj no: "Chrono", "300 Enteric", "Chronosphere granules" thiab lwm yam. Tag nrho cov ntawm lawv txawv me ntsis nyob rau hauv cov ntsiab lus ntawm active tshuaj thiab daim ntawv ntawm kev tso tawm. "Depakine" yog tshuaj raws li ib tug anticonvulsant thiab mus ob peb vas-stabilizing tshuaj. Nws tau ua pov thawj nws tus kheej hauv kev kho mob qaug dab peg, kev puas siab puas ntsws bipolar, tonic-clonic qaug dab peg, myoclonus, kev nyuaj siab, mob taub hau migraine. Nws kuj yog siv los kho mob neuropathic. Tsis ntev los no, cov tshuaj no tau raug tshuaj xyuas raws li cov tshuaj rau qee hom mob qog noj ntshav thiab kab mob HIV.
Valproic acid ntev ua haujlwm
Nrog valproic acid npaj, Depakine thiab nws cov analogues yog nyob rau hauv siab thov. Qhov no yog vim qhov tseeb tias nws muaj kev cuam tshuam ntev. Kev siv cov tshuaj noua rau txo qhov zaus ntawm qaug dab peg. Nws kuj txo lawv qhov hnyav thiab pab txhawb kev kawm. "Depakine" txo qhov kev pheej hmoo ntawm cov teeb meem hnyav dua.
Valproic acid yog metabolized los ntawm daim siab hlwb. Thaum noj cov tshuaj tsis tu ncua, ib nrab-lub neej yog li 6-8 teev. Cov kev npaj niaj hnub no tso cai rau kev tswj hwm kev kho mob ntawm cov tshuaj nquag hauv lub cev txog li 16 teev. Tus nqi ntawm excretion ntawm valproic acid nyob ntawm ntau yam ntawm lub siab ua haujlwm. Valproic acid, tshuaj xyuas uas feem ntau zoo, cuam tshuam rau txhua tus neeg mob hauv nws txoj kev. Qhov no yog vim qhov tseeb tias txhua lub cev muaj qhov tshwj xeeb thiab tuaj yeem pom cov khoom no nrog qee qhov sib txawv ntawm cov qauv.
