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X ning yarim tabletkasi X/2 tabletkasini almashtiradimi?

X ning yarim tabletkasi X/2 tabletkasini almashtiradimi?



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Bu anekdot bo'lishi mumkin.

Ilgari dorixonada retsept bo'yicha maqsadli kimyoviy moddaning X mg bo'lgan dori talab qilingan. Biroq, dorixonada faqat bir xil brendning yuqori quvvati mavjud edi.

Masalan, Retsept bo'yicha 25 mg ma'lum bir kimyoviy modda talab qilinishi mumkin, dorixona esa faqat ushbu kimyoviy moddaning 50 mg so'roviga xizmat qilishi mumkin. bir xil brend.

Farmatsevt va shifokorning fikriga ko'ra, xuddi shu markadagi yuqori ta'sirga ega dorining proportsional qismi past kuch bilan almashtirilishi mumkin. Shunday qilib, yuqoridagi misolda 50 mg lik yarim tabletka 25 mg lik bitta tabletka o'rniga xizmat qilishi mumkin.

Belgilangan brend uchun

  • X ning yarim tabletkasi to'liq X/2 tabletkasini almashtiradimi?
  • Natija ham yuqoriga qarab o'zgaradimi?

Rad etish: bularning barchasi tibbiy maslahat emas, balki umumiy tushuntirishdir. Dori-darmonlarni qabul qilish kerakmi yoki qanday dozalash kerakligi haqida har bir holatda shifokoringiz va/yoki farmatsevtingiz bilan gaplashishingiz kerak.


Ko'pgina farmatsevtik shakllar ikkita asosiy komponentdan iboratligini hisobga olishimiz kerak: faol moddalar (lar) va yordamchi moddalar.

The faol farmatsevtika moddasi bu:

farmatsevtik preparat tarkibidagi modda yoki biologik faol bo'lgan pestitsid.

Ya'ni, dorining haqiqatda "ishni bajaradigan" qismi. E'tibor bering, paketdagi dozalar tabletkaning og'irligiga emas, balki bunga tegishli! Masalan, 500 mg aspirin 500 mg faol moddani (atsetilsalitsil kislotasi) o'z ichiga oladi, ammo tabletkaning o'zi 500 mg dan oshadi.

An yordamchi moddasi bu:

kuchli faol moddalarni o'z ichiga olgan dori vositalarining faol moddasi ("API") bilan birga ishlab chiqarilgan faol bo'lmagan modda (shuning uchun ko'pincha "to'ldiruvchi", "to'ldiruvchi" yoki "suyultiruvchi" deb ataladi) .

Bu, odatda, biologik ta'sirga ega emas, lekin, masalan, qo'lingizga olish oson bo'lishi uchun etarli hajmdagi tabletkalarni olish imkonini beradi.

Bir tabletkani yarmiga bo'lganingizda Siz har bir yarmida bir xil miqdordagi faol moddalar mavjud deb taxmin qilyapsiz.

Bu Farmakopeya* tomonidan tartibga solinadi. Xususan, planshetlar uchun monografiyani ko'rib chiqsak, biz o'qiymiz (qalin meniki):

Tabletkalar qattiq dozalash shakllari bo'lib, odatda kukunlar yoki granulalarni bir yoki bir nechta siqish orqali olinadi. Ba'zi hollarda planshetlar qoliplash yoki ekstruziya usullari bilan olinishi mumkin. Ular qoplanmagan yoki qoplangan.

Planshetlar odatda to'g'ri dumaloq qattiq silindrlar bo'lib, ularning uchlari tekis yoki qavariq va qirralari qiyshiq bo'lishi mumkin. Ularda chiziqlar yoki tanaffus belgilari bo'lishi mumkin (ball), belgilar yoki boshqa belgilar.

Agar tanaffus belgisi (lar) bir yoki bir nechta to'liq tabletkalardan iborat dozani yutish qulayligi uchun planshetni sindirish uchun mo'ljallangan bo'lsa, baholash muhim emas. Biroq, Agar tanaffus belgisi(lar)i bitta tabletkadan kamroq dozani ta'minlash uchun planshetni to'g'ri bo'linish imkonini beradigan bo'lsa, baholash juda muhimdir. Dar terapevtik oynaga ega bo'lgan faol moddalarni o'z ichiga olgan planshetlar, odatda, bo'linish belgilari bilan taqdim etilmasligi kerak. Funktsional bo'lmagan buzilish belgilaridan qochish kerak.

Terapevtik oyna haqidagi nuqta nima uchun tabletkalarni ajratish xavfli bo'lishi mumkinligini ko'rsatadi. Terapevtik oyna - bu kasallikni davolovchi dori kontsentratsiyasi diapazoni, shu bilan birga xavfsizlik chegarasida qoladi.

Agar bu oyna tor bo'lsa, dozadagi minimal o'zgarishlar davolash samarasiz bo'lishiga olib kelishi mumkin - agar faol modda juda oz bo'lsa- yoki toksik - agar juda ko'p bo'lsa.

Farmakopeya shuningdek, planshetlarda bajarilishi kerak bo'lgan bir nechta testlarni sanab o'tadi. Xususan, buzilish belgilari mavjud bo'lganda, ishlab chiqaruvchi kerak

Kerakli hollarda bo'lingan qismlarning massasi yoki tarkibining bir xilligiga nisbatan tanaffus belgilarining samaradorligini ta'minlash, shunda bemor mo'ljallangan dozani oladi.

Rivojlanish jarayonida massaning bir xilligini baholash uchun mos test quyidagicha:

Tasodifiy ravishda 30 ta planshetni oling. Har bir planshetni qo'l bilan sindirib, bir qismini sinov uchun oling va boshqa qismini (qismlarini) rad qiling. Olingan 30 ta qismning har birini torting va o'rtacha massani hisoblang. Hech qanday individual massa 75% dan 125% gacha bo'lgan chegaradan tashqarida emas va bir nechta individual massa o'rtacha massaning 85% dan 115% gacha bo'lgan chegarasidan tashqarida emas.

Men qo'shimcha tafsilotlarga kirmayman, lekin, masalan, planshetdan planshetga massa va tarkibning bir xilligini, shuningdek, ularning jismoniy barqarorligini ta'minlash uchun boshqa sinovlar ham mavjud (ya'ni: ular bir-biridan ajralib chiqmasligi kerak. quti).

Esda tutingki, qadoqda odatda planshetni bo'lish xavfsizmi yoki ishlatilmagan qismlarni qanday saqlash (va qancha vaqt) haqida ko'rsatmalar bo'lishi kerak.

Bu planshetlarni ajratish uchun. Qarama-qarshi vaziyat ham paydo bo'lishi mumkin. 2x2mg tabletkalar 1x4mg tabletkaga tengmi (planshetdagi faol moddaning og'irligi haqida gapirganda, planshetning og'irligi emas)? Yuqoridagi kabi mulohazalar amal qiladi, ammo planshetlar bir xil bo'lishi kerak va hech qanday sinishi yo'qligi sababli, bu avvalgi holatdan ko'ra xavfsizroqdir.

Bularning barchasi preparatning bitta dozasiga nisbatan qo'llaniladi. Endi men takroriy dozalar haqida bir so'z qo'shmoqchiman. Men buni etarlicha ta'kidlay olmayman: har doim dori dozasi haqida shifokoringizga murojaat qiling. Ertalab va kechqurun bitta tabletka olish ertalab ikkitasini qabul qilish va kechqurun hech kimni qabul qilish yoki kun davomida to'rtta yarmini olish bilan bir xil emas. O'z-o'zidan dozalash xavfli va hech qachon qilmaslik kerak.

Dozaning yarmini qabul qilish preparatning optimal konsentratsiyasiga olib kelishi mumkin (shuning uchun u kutilganidek ishlamaydi). Dozani ikki marta qabul qilish zaharli kontsentratsiyaga olib kelishi mumkin, bu siz xohlagan narsa emas.


* E'tibor bering, bir nechta farmakopeya mavjud va aniq ko'rsatmalar farq qilishi mumkin. Oddiylik uchun men Jahon sog'liqni saqlash tashkiloti tomonidan nashr etilgan va Internetda mavjud bo'lgan Xalqaro farmakopeya, 4-nashr, 3-ilovaga murojaat qilaman. Boshqalar ham bor, masalan, Evropa farmakopeyasi (ko'rinishidan, erkin mavjud emasmi?) yoki Yaponiya farmakopeyasi, lekin menimcha, bu javob doirasidan tashqarida.


Ushbu veb-sayt go'zal umumiy ma'lumot beradi, jumladan, FDA tupurish bo'lishini kutgan dorilarni qanday tasdiqlashi va tabletkalarni kesishning ba'zi amaliy masalalari.

Ha, yarim tabletka (2x doza), boshqa muammolar bo'lmasa, bitta buzilmagan tabletka (1x) dozaga teng. Asosiy istisnolar amaliy holatlardir... bunda planshetni osongina kesib bo'lmaydi; dozasi shunchalik o'ziga xoski, dozaning ozgina o'zgarishi (tabletkaning notekis bo'laklari) muhim bo'lsa yoki doza kapsulada bo'lsa yoki maxsus qoplamaga ega bo'lsa, parchalanish preparatning tanaga chiqishini o'zgartirishi mumkin.

Ha, dozalash shkalasi yuqoriga ko'tariladi. Ikki tabletka bitta tabletkaning umumiy dozasini ikki baravar oshiradi.

Barcha retseptlar preparatning tanadagi samarali kontsentratsiyasiga etib borishini ta'minlash uchun maxsus dozalash rejimlari (ya'ni, siz qancha va qachon qabul qilishingiz) bilan tarqatiladi. Dori-darmonlarni qabul qilish orqali samaradorlikni oshirishga harakat qilmaslik kerak ko'proq dori, yoki olish tez-tez dori shifokoringiz buyurganidan ko'ra. Yuqoridagi veb-havolada ta'kidlanganidek, agar sizning dori shishangizda butun va kesilgan tabletkalar bo'lsa, dozalash va vaqtni kuzatish qiyin bo'lishi mumkin. (ya'ni, "har NN soatda bitta tabletka olish" nimani anglatadi?).

Bu TIBBIY MASLAHAT EMAS . Sizning holatingiz uchun har doim shifokoringiz va/yoki farmatsevtingiz bilan maslahatlashing.


Deksametazon yallig'lanishni kamaytirish va tananing immunitet reaktsiyasini bostirish (pastlash) uchun foydalanish uchun tasdiqlangan.

Deksametazon saratonning quyidagi turlarini davolash uchun boshqa dorilar bilan birgalikda qo'llaniladi:

  • Leykemiya.
  • Lenfoma.
  • Ko'p miyelom.
  • Qo'ziqorin mikozi (T-hujayrali teri limfomasining bir turi).

Deksametazon, shuningdek, saraton bilan bog'liq quyidagi holatlarning oldini olish yoki davolash uchun alohida yoki boshqa dorilar bilan birgalikda qo'llaniladi:

  • Anemiya.
  • Miya shishi (miyadagi suyuqlik to'planishi) miya shishi bilan bog'liq.
  • Dori vositalariga yuqori sezuvchanlik (allergik reaktsiyalar).
  • Giperkalsemiya (qonda kaltsiyning yuqori darajasi).
  • Trombotsitopeniya (past trombotsitlar darajasi).

Deksametazon ko'plab boshqa kasalliklar va sharoitlarni davolash uchun yolg'iz yoki boshqa dorilar bilan ham qo'llaniladi. Preparat ko'plab saraton turlarini va boshqa sharoitlarni davolashda o'rganishni davom ettirmoqda.


Retseptni 4 qismga qanday yozish kerak

  1. Bemorning ismi va boshqa identifikator, odatda tug'ilgan sanasi.
  2. Dori va quvvat, qabul qilinadigan miqdor, uni qabul qilish yo'li va chastotasi.
  3. Dorixonada berilishi kerak bo'lgan miqdor va to'ldirishlar soni.
  4. NPI yoki DEA raqamlari kabi imzo va shifokor identifikatorlari.

Bu retseptni qanday yozishning asosiy sxemasi. Biz quyida har bir qadamning tafsilotlarini ko'rib chiqamiz. Lekin birinchi navbatda, keling, nima uchun bu mahoratni to'g'ri olish juda muhimligini ko'rib chiqaylik.


Dell XPS 13 2-in-1

Dell XPS 13 2-in-1

Dell kompaniyasi o'zining taniqli XPS seriyali noutbukining yangi konvertatsiya qilinadigan versiyasi 999 dollardan boshlanadi. Hozircha bu 13 dyuymli displeyni yig'ishga muvaffaq bo'lgan eng ixcham 2-in-1 qurilmasi. U juda yupqa ramkalar va jozibali fanatsiz tuzilishi bilan faxrlanadi. Qo‘shimcha 49 dollar evaziga siz Surface Book’ga kiritilgan Surface Penga o‘xshash stilus tajribasi uchun mos keluvchi Dell Active Penni sotib olishingiz mumkin.

Dell tomonidan ham qiziqish: Latitude 7285 2-in-1, may oyida chiqarilishi kutilayotgan shunga o'xshash Surface Book raqibi.

Dell XPS 13 2-in-1 qurilmasini sotib oling Dell.com


Yon effektlar

Diareya, ko'ngil aynishi / qusish yoki bosh og'rig'i paydo bo'lishi mumkin. Agar ushbu ta'sirlardan birortasi davom etsa yoki yomonlashsa, darhol shifokor yoki farmatsevtga xabar bering.

Yodda tutingki, sizning shifokoringiz ushbu dori-darmonlarni buyurgan, chunki u sizga foyda nojo'ya ta'sirlar xavfidan kattaroq deb hisoblagan. Ushbu dorini ishlatadigan ko'p odamlar jiddiy yon ta'sirga ega emas.

Agar ushbu nojo'ya, ammo jiddiy nojo'ya ta'sirlardan biri yuzaga kelsa, darhol shifokoringizga xabar bering: to'piqlar/oyoqlarning shishishi, charchoq, yurak urishi tezlashi, nafas olish qiyinlishuvi, infektsiyaning yangi belgilari (masalan, isitma, doimiy tomoq og'rig'i), qoraygan siydik, doimiy ko'ngil aynishi / qusish, sarg'aygan ko'zlar / teri, oson ko'karish / qon ketish, buyrak muammolari belgilari (masalan, siydik miqdori o'zgarishi).

Agar ushbu kamdan-kam uchraydigan, ammo juda jiddiy yon ta'sirlardan biri yuzaga kelsa, darhol tibbiy yordamga murojaat qiling: ko'rish o'zgarishi, nutqning buzilishi, aqliy/kayfiyat o'zgarishi (masalan, chalkashlik).

Ushbu dori kamdan-kam hollarda bir turdagi chidamli bakteriyalar tufayli og'ir ichak holatini (Clostridium difficile bilan bog'liq diareya) keltirib chiqarishi mumkin. Bu holat davolanish paytida yoki davolanishni to'xtatgandan keyin haftalar yoki oylar o'tgach paydo bo'lishi mumkin. Agar rivojlanayotgan bo'lsangiz, darhol shifokoringizga xabar bering: doimiy diareya, qorin yoki oshqozon og'rig'i / kramp, axlatda qon / shilimshiq. Agar sizda ushbu alomatlardan biri bo'lsa, diareyaga qarshi yoki opioid preparatlarini ishlatmang, chunki bu mahsulotlar ularni yomonlashtirishi mumkin.

Ushbu preparatni uzoq yoki takroriy muddatlarda qo'llash og'iz bo'shlig'i yoki yangi vaginal xamirturush infektsiyasiga olib kelishi mumkin. Og'izda oq dog'lar, vaginal oqindi o'zgarishi yoki boshqa yangi alomatlarni sezsangiz, shifokoringizga murojaat qiling.

Ushbu preparatga juda jiddiy allergik reaktsiya kam uchraydi. Ammo, agar siz jiddiy allergik reaktsiyaning quyidagi alomatlarini sezsangiz, darhol shifokorga murojaat qiling: toshma, qichishish / shish (ayniqsa, yuz / til / tomoq), kuchli bosh aylanishi, nafas olish qiyinlishuvi.

Bu mumkin bo'lgan yon ta'sirlarning to'liq ro'yxati emas. Yuqorida sanab o'tilmagan boshqa ta'sirlarni sezsangiz, shifokor yoki farmatsevt bilan bog'laning.

Yon ta'siri haqida tibbiy maslahat olish uchun shifokoringizga murojaat qiling. Nojo'ya ta'sirlar haqida FDAga 1-800-FDA-1088 yoki www.fda.gov/medwatch manzilida xabar berishingiz mumkin.

Kanadada - Nojo'ya ta'sirlar haqida tibbiy maslahat olish uchun shifokoringizga qo'ng'iroq qiling. Siz 1-866-234-2345 raqamiga nojo'ya ta'sirlar haqida Kanada Health'ga xabar berishingiz mumkin.


Plaket bilan qanday kelishuv bor?

Blyashka - bu tishlaringizni qoplaydigan yopishqoq plyonka. Xo'sh, nega blyashka muammoli? Blyashka tarkibida shakar mavjud bo'lgan ovqatdan keyin kislotalarni chiqaradigan bakteriyalar mavjud. Ushbu kislotalar tish emaliga ta'sir qiladi. Takroriy hujumlar bilan sizning emalingiz parchalanishi mumkin, natijada bo'shliqlar, shuningdek, tish karies sifatida ham tanilgan.

Blyashka to'plansa va muntazam ravishda cho'tka bilan olib tashlanmasa, u oxir-oqibat tish toshiga aylanishi mumkin. Tish toshlari tish go'shti atrofida to'plansa, tish go'shti shishishi mumkin. Bu milk kasalligining dastlabki bosqichi.


Ativan

Ativan - anksiyete kasalliklarining alomatlarini davolash uchun ishlatiladigan retsept bo'yicha dori. Ativan alohida yoki boshqa dorilar bilan birgalikda ishlatilishi mumkin.

Ativan antianksiyete agentlari, anksiyolitiklar, benzodiazepinlar, antikonvulsanlar, benzodiazepin deb ataladigan dorilar sinfiga kiradi.

Ativanning mumkin bo'lgan yon ta'siri qanday?

Ativan jiddiy yon ta'sirga olib kelishi mumkin, jumladan:

  • qattiq uyquchanlik,
  • o'z joniga qasd qilish yoki o'zingizga zarar etkazish haqidagi fikrlar,
  • kayfiyat yoki xatti-harakatlardagi g'ayrioddiy o'zgarishlar,
  • chalkashlik,
  • tajovuz,
  • gallyutsinatsiyalar,
  • yomonlashgan uyqu muammolari,
  • to'satdan bezovtalik hissi yoki hayajon,
  • mushaklar kuchsizligi,
  • osilgan ko'z qovoqlari,
  • yutish muammosi,
  • ko'rish o'zgarishlari,
  • yuqori oshqozon og'rig'i,
  • qoramtir siydik, va
  • terining yoki ko'zning sarg'ayishi (sariqlik)

Yuqorida sanab o'tilgan alomatlardan biri bo'lsa, darhol tibbiy yordamga murojaat qiling.

Ativanning eng keng tarqalgan yon ta'siri quyidagilardan iborat:

  • bosh aylanishi,
  • uyquchanlik,
  • zaiflik,
  • noto'g'ri nutq,
  • muvozanat yoki muvofiqlashtirishning etishmasligi,
  • xotira muammolari va
  • beqaror his qilish

Agar sizni bezovta qiladigan yoki yo'qolmaydigan biron bir nojo'ya ta'sir bo'lsa, shifokorga ayting.

Bu Ativanning barcha mumkin bo'lgan yon ta'siri emas. Qo'shimcha ma'lumot olish uchun shifokoringiz yoki farmatsevtingizdan so'rang.

Yon ta'siri haqida tibbiy maslahat olish uchun shifokoringizga murojaat qiling. 1-800-FDA-1088 da FDAga nojo'ya ta'sirlar haqida xabar berishingiz mumkin.

Ta'rif

Ativan (lorazepam), anksiyetega qarshi vosita, kimyoviy formulaga ega, 7-xloro-5-(o-xlorofenil)-1,3-dihidro-3-gidroksi-2H-1,4-benzodiazepin-2-bir:

Bu suvda deyarli erimaydigan deyarli oq kukun. Og'iz orqali qabul qilinadigan har bir Ativan (lorazepam) planshetida 0,5 mg, 1 mg yoki 2 mg lorazepam mavjud. Mavjud faol bo'lmagan moddalar laktoza monohidrat, magniy stearati, mikrokristalin tsellyuloza va polakrilin kaliydir.

Ko'rsatkichlar

Ativan (lorazepam) anksiyete kasalliklarini davolash yoki depressiya belgilari bilan bog'liq tashvish yoki tashvish belgilarini qisqa muddatli bartaraf etish uchun ko'rsatiladi. Kundalik hayotdagi stress bilan bog'liq tashvish yoki kuchlanish odatda anksiyolitik bilan davolanishni talab qilmaydi.

Ativan (lorazepam) ning uzoq muddatli, ya'ni 4 oydan ortiq foydalanishda samaradorligi tizimli klinik tadqiqotlar bilan baholanmagan. Shifokor vaqti-vaqti bilan individual bemor uchun preparatning foydaliligini qayta ko'rib chiqishi kerak.

Dozaj va boshqaruv

Ativan (lorazepam) og'iz orqali yuboriladi. Optimal natijalarga erishish uchun dozani, qabul qilish chastotasini va terapiya davomiyligini bemorning javobiga qarab individual ravishda tanlash kerak. Buni osonlashtirish uchun 0,5 mg, 1 mg va 2 mg planshetlar mavjud.

Odatdagi diapazon kuniga 2 dan 6 mg gacha bo'lingan dozalarda beriladi, eng katta doza yotishdan oldin olinadi, ammo sutkalik dozasi kuniga 1 dan 10 mg gacha o'zgarishi mumkin.

Anksiyete uchun bemorlarning ko'pchiligi kuniga ikki marta yoki kuniga uch marta 2 dan 3 mg gacha bo'lgan boshlang'ich dozani talab qiladi.

Anksiyete yoki vaqtinchalik vaziyatli stress tufayli uyqusizlik uchun, odatda, yotishdan oldin, kuniga 2 dan 4 mg gacha bo'lgan yagona doz berilishi mumkin.

Keksa yoki zaif bemorlar uchun boshlang'ich dozani kuniga 1 dan 2 mg gacha bo'lgan dozalarga bo'lish tavsiya etiladi, agar kerak bo'lsa va toqat qilinadi.

Noqulay ta'sirlardan qochish uchun kerak bo'lganda, Ativan (lorazepam) dozasini asta-sekin oshirish kerak. Yuqori dozalar ko'rsatilganda, kechki dozani kunduzgi dozadan oldin oshirish kerak.

Ativanni to'xtatish yoki dozasini kamaytirish

Chiqib ketish reaktsiyalari xavfini kamaytirish uchun, Ativanni to'xtatish yoki dozani kamaytirish uchun asta-sekin kamaytiring. Agar bemorda olib tashlash reaktsiyalari paydo bo'lsa, kamaytirishni to'xtatib turish yoki dozani avvalgi toraytirilgan dozalash darajasiga oshirish haqida o'ylab ko'ring. Keyinchalik, dozani sekinroq kamaytiring (qarang OGOHLANTIRISH: Qaramlik va chekinish reaktsiyalari va Giyohvandlik va giyohvandlik: Qaramlik).

QANDAY TA'MINLANILGAN

Ativan ® (lorazepam) planshetlari Quyidagi dozalarda mavjud:

0,5 mg, oq rangli, besh qirrali (qalqon shaklidagi) planshetning bir tomoni ko‘tarilgan "A", orqa tomonida "BPI" va "63" tasviri bor.

NDC 0187-0063-01 -100 tabletkali shishalar.

1 mg, oq rangli, besh qirrali (qalqon shaklidagi) planshetning bir tomoni yuqoriga ko‘tarilgan "A", orqa tomonida esa "BPI" va "64" tasvirlangan.

NDC 0187-0064-01 -100 tabletkali shishalar.
NDC 0187-0064-10 -1000 tabletkali shishalar.

2 mg, oq rangli, besh qirrali (oddiy beshburchak) planshet, bir tomoni ko‘tarilgan "A" va tasvirlangan "2", orqa tomonida "BPI" va "65" tasvirlangan.

NDC 0187-0065-01 -100 tabletkali shishalar.

Shishalarni mahkam yopiq holda saqlang.

Bolalar qo'li etmaydigan joyda saqlang.

25 ° C (77 ° F) haroratda saqlang, 15 ° dan 30 ° C gacha (59 ° dan 86 ° F gacha) ruxsat beriladi (USP tomonidan boshqariladigan xona haroratiga qarang).

Qattiq idishga soling.

Ishlab chiqaruvchi: Bausch Health Companies Inc. Steinbach, MB R5G 1Z7, Kanada. Qayta ko'rib chiqilgan: 2021 yil fevral

SAVOL

YON EFFEKTLAR

Benzodiazepinlarga nisbatan ko'pgina nojo'ya reaktsiyalar, shu jumladan CNS ta'siri va nafas olish depressiyasi dozaga bog'liq bo'lib, yuqori dozalarda jiddiyroq ta'sir ko'rsatadi.

Anksiyete uchun davolangan 3500 ga yaqin bemorning namunasida Ativan (lorazepam) ga eng ko'p uchraydigan salbiy reaktsiya sedasyon (15,9%), keyin bosh aylanishi (6,9%), zaiflik (4,2%) va beqarorlik (3,4%) edi. Yoshi bilan sedasyon va beqarorlik holatlari ortib bordi.

Benzodiazepinlarga boshqa nojo'ya reaktsiyalar, shu jumladan lorazepam: charchoq, uyquchanlik, amneziya, xotira buzilishi, chalkashlik, disorientatsiya, depressiya, depressiya niqobini ochish, disinhibisyon, eyforiya, o'z joniga qasd qilish g'oyalari / urinishlari, ataksiya, asteniya, ekstrapiramidal simptomlar, kramplar, konvulsiyalar. vertigo, ko'z funktsiyasi / ko'rishning buzilishi (shu jumladan diplopiya va loyqa ko'rish), dizartriya / nutqning buzilishi, libidoning o'zgarishi, iktidarsizlik, orgazmning pasayishi bosh og'rig'i, koma respirator depressiya, apnea, uyqu apnoesining yomonlashishi, obstruktiv o'pka testi kasalliklarining yomonlashishi , ishtahaning o'zgarishi, ich qotishi, sariqlik, bilirubinning ko'payishi, jigar transaminazalarining ko'payishi, ishqoriy fosfataza yuqori sezuvchanlik reaktsiyalari, anafilaktoid reaktsiyalar dermatologik simptomlar, allergik teri reaktsiyalari, noto'g'ri antidiuretik gormon (SIADH) alopesiya sindromi (SIADH), trombotsitopeniya, giponatsitoz hipotermiya va aut onomik ko'rinishlar.

Paradoksal reaktsiyalar, jumladan, tashvish, qo'zg'alish, qo'zg'alish, dushmanlik, tajovuz, g'azab, uyqu buzilishi / uyqusizlik, jinsiy qo'zg'alish va gallyutsinatsiyalar paydo bo'lishi mumkin. Qon bosimi va gipotenziyada kichik pasayishlar bo'lishi mumkin, lekin odatda klinik ahamiyatga ega emas, ehtimol Ativan (lorazepam) tomonidan ishlab chiqarilgan tashvishlarni bartaraf etish bilan bog'liq.

Shubhali salbiy reaktsiyalar haqida xabar berish uchun Bausch Health US, LLC 1-800-3214576 yoki FDA 1-800-FDA-1088 yoki www.fda.gov/medwatch orqali bog'laning.

Giyohvand moddalarning o'zaro ta'siri

Benzodiazepinlar va opioidlarni bir vaqtda qo'llash nafas olishni nazorat qiluvchi markaziy asab tizimining turli retseptorlari joylarida ta'sir qilish tufayli nafas olish depressiyasi xavfini oshiradi. Benzodiazepinlar GABAA joylarida va opioidlar asosan mu retseptorlarida o'zaro ta'sir qiladi. Benzodiazepinlar va opioidlar birlashtirilganda, benzodiazepinlarning opioid bilan bog'liq nafas olish depressiyasini sezilarli darajada yomonlashtirishi mumkin. Benzodiazepinlar va opioidlarni bir vaqtda qo'llashning dozasi va davomiyligini cheklang va bemorlarni nafas olish depressiyasi va sedasyon uchun diqqat bilan kuzatib boring.

Benzodiazepinlar, shu jumladan Ativan (lorazepam) markaziy asab tizimining boshqa depressantlari, masalan, alkogol, barbituratlar, antipsikotiklar, sedativlar/hipnotiklar, anksiyolitiklar, antidepressantlar, giyohvandlik analjeziklari, sedativ antigistaminlar, analjeziklar, analjeziklar, analjeziklar, analjeziklar, analjeziklar, analjeziklar, antikonvulsantlar bilan birgalikda qo'llanilganda markaziy asab tizimining depressant ta'sirini kuchaytiradi.

Klozapin va lorazepamni bir vaqtda qo'llash sezilarli sedasyon, haddan tashqari tupurik, gipotenziya, ataksiya, deliryum va nafas olishni to'xtatishga olib kelishi mumkin.

Lorazepamni valproat bilan bir vaqtda qo'llash plazma kontsentratsiyasining oshishiga va lorazepamning klirensining pasayishiga olib keladi. Lorazepamning dozasini valproat bilan bir vaqtda qo'llashda taxminan 50% gacha kamaytirish kerak.

Lorazepamni probenetsid bilan bir vaqtda qo'llash yarimparchalanish davrining oshishi va umumiy klirensining pasayishi tufayli lorazepamning tezroq boshlanishi yoki uzoq davom etishiga olib kelishi mumkin. Lorazepamning dozasini probenetsid bilan bir vaqtda qo'llashda taxminan 50% ga kamaytirish kerak.

Probenetsid va valproatning lorazepamga ta'siri glyukuronidlanishni inhibe qilish bilan bog'liq bo'lishi mumkin.

Teofillin yoki aminofilinni qo'llash benzodiazepinlarning, shu jumladan lorazepamning sedativ ta'sirini kamaytirishi mumkin.

Giyohvandlik va giyohvandlik

Boshqariladigan modda

Ativan tarkibida lorazepam mavjud bo'lib, u IV jadvalga kiritilgan boshqariladigan moddadir.

Suiiste'mol

Ativan benzodiazepin va suiiste'mollik va giyohvandlik potentsialiga ega bo'lgan CNS depressantidir. Suiiste'mol qilish - bu giyohvand moddalarni bir marta bo'lsa ham, uning kerakli psixologik yoki fiziologik ta'siri uchun ataylab, terapevtik bo'lmagan holda qo'llash. Noto'g'ri foydalanish - bu dori vositasini tibbiy yordam ko'rsatuvchi provayder tomonidan ko'rsatilmagan yoki u tayinlanmagan shaxs tomonidan terapevtik maqsadlarda qasddan ishlatish. Giyohvandlik - bu giyohvand moddalarni iste'mol qilishga bo'lgan kuchli istak, giyohvand moddalarni iste'mol qilishni nazorat qilishdagi qiyinchiliklar (masalan, zararli oqibatlarga qaramay, giyohvand moddalarni iste'mol qilishni davom ettirish, giyohvand moddalarni iste'mol qilishga boshqa faoliyat turlaridan ko'ra ko'proq ustunlik berish va giyohvand moddalarni iste'mol qilishni davom ettirish) o'z ichiga olgan xulq-atvor, kognitiv va fiziologik hodisalar to'plami. majburiyatlar) va mumkin bo'lgan tolerantlik yoki jismoniy qaramlik. Hatto benzodiazepinlarni retsept bo'yicha qabul qilish bemorlarni dori-darmonlarni suiiste'mol qilish va noto'g'ri ishlatish xavfiga olib kelishi mumkin. Benzodiazepinlarni suiiste'mol qilish va suiiste'mol qilish giyohvandlikka olib kelishi mumkin.

Benzodiazepinlarni suiiste'mol qilish va suiiste'mol qilish ko'pincha (lekin har doim ham emas) tavsiya etilgan maksimal dozadan kattaroq dozalarni qo'llashni o'z ichiga oladi va odatda boshqa dorilar, spirtli ichimliklar va/yoki noqonuniy moddalarni bir vaqtda qo'llashni o'z ichiga oladi, bu jiddiy salbiy oqibatlarning ko'payishi bilan bog'liq. , jumladan, nafas olish depressiyasi, dozani oshirib yuborish yoki o'lim. Benzodiazepinlarni ko'pincha giyohvand moddalar va boshqa moddalarni suiiste'mol qiladigan shaxslar va giyohvandlik kasalliklari bo'lgan shaxslar qidiradi (qarang. OGOHLANTIRISH: Suiiste'mollik, noto'g'ri foydalanish va giyohvandlik).

Benzodiazepinni suiiste'mol qilish va/yoki noto'g'ri qo'llash bilan quyidagi nojo'ya reaktsiyalar yuzaga keldi: qorin og'rig'i, amneziya, anoreksiya, tashvish, tajovuz, ataksiya, loyqa ko'rish, tartibsizlik, depressiya, disinhibisyon, disorientatsiya, bosh aylanishi, eyforiya, konsentratsiya va xotiraning buzilishi, asabiylashish. , mushaklarning og'rig'i, nutqning buzilishi, titroq va vertigo.

Benzodiazepinni suiiste'mol qilish va/yoki suiiste'mol qilish bilan quyidagi jiddiy nojo'ya reaktsiyalar yuzaga keldi: deliryum, paranoyya, o'z joniga qasd qilish fikri va xatti-harakati, tutilishlar, koma, nafas olish qiyinlishuvi va o'lim. O'lim ko'pincha ko'p moddalarni iste'mol qilish bilan bog'liq (ayniqsa, benzodiazepinlar, opioidlar va alkogol kabi markaziy asab tizimining boshqa depressantlari bilan).

Qaramlik

Ativan davomiy terapiyadan jismoniy qaramlikni keltirib chiqarishi mumkin. Jismoniy qaramlik - giyohvand moddalarni qayta-qayta iste'mol qilishga javoban fiziologik moslashish natijasida rivojlanadigan holat bo'lib, u keskin to'xtatilgandan yoki preparatning dozasi sezilarli darajada kamaytirilgandan keyin olib tashlash belgilari va belgilari bilan namoyon bo'ladi. Benzodiazepinlarni to'satdan to'xtatish yoki dozasini tezda kamaytirish yoki benzodiazepin antagonisti flumazenilni qo'llash hayot uchun xavfli bo'lishi mumkin bo'lgan tutilishlarni o'z ichiga olgan o'tkir olib tashlash reaktsiyalarini keltirib chiqarishi mumkin. Benzodiazepinni qabul qilishni to'xtatgandan keyin yoki dozani tezda kamaytirgandan so'ng, olib tashlashning nojo'ya reaktsiyalari xavfi yuqori bo'lgan bemorlarga yuqori dozalarni (ya'ni, yuqori va/yoki ko'proq dozalarni) qabul qilganlar va undan uzoqroq foydalanish muddati bo'lgan bemorlar kiradi (qarang. OGOHLANTIRISH: Qaramlik va chekinish reaktsiyalari).

Bekor qilish reaktsiyalari xavfini kamaytirish uchun, Ativanni to'xtatish yoki dozani kamaytirish uchun asta-sekin kamaytiring (qarang. Dozaj va boshqaruv: Ativanni to'xtatish yoki dozasini kamaytirish va OGOHLANTIRISH).

O'tkir olib tashlash belgilari va belgilari

Benzodiazepinlar bilan bog'liq bo'lgan o'tkir olib tashlash belgilari va alomatlariga g'ayritabiiy beixtiyor harakatlar, tashvish, loyqa ko'rish, depersonalizatsiya, depressiya, derealizatsiya, bosh aylanishi, charchoq, oshqozon-ichak traktining salbiy reaktsiyalari (masalan, ko'ngil aynishi, qusish, diareya, vazn yo'qotish, bosh og'rig'i) kiradi. giperakuziya, gipertoniya, asabiylashish, uyqusizlik, xotira buzilishi, mushaklarning og'rig'i va qattiqligi, vahima hujumlari, fotofobi, bezovtalik, taxikardiya va tremor. O'tkir olib tashlashning yanada og'ir belgilari va belgilari, jumladan, hayot uchun xavfli reaktsiyalar: katatoniya, konvulsiyalar, deliryum tremens, depressiya, gallyutsinatsiyalar, maniya, psixoz, tutilish va o'z joniga qasd qilish.

Uzoq muddatli olib tashlash sindromi

Benzodiazepinlar bilan bog'liq cho'zilgan olib tashlash sindromi bezovtalik, kognitiv buzilishlar, depressiya, uyqusizlik, shakllanish, vosita belgilari (masalan, zaiflik, tremor, mushaklarning siqilishi), paresteziya va tinnitus bilan tavsiflanadi, ular bendradiazepinni qabul qilganidan keyin 4-6 haftadan keyin ham davom etadi. Uzoq muddatli olib tashlash belgilari haftadan 12 oygacha davom etishi mumkin. Natijada, olib tashlash alomatlarini benzodiazepin qo'llanilgan simptomlarning potentsial qayta paydo bo'lishi yoki davom etishidan farqlashda qiyinchiliklar paydo bo'lishi mumkin.

Davomli terapiya natijasida Ativanga tolerantlik rivojlanishi mumkin. Tolerantlik - bu preparatni takroriy qo'llashdan keyin javobning pasayishi bilan tavsiflangan fiziologik holat (ya'ni, bir marta pastroq dozada olingan bir xil ta'sirni yaratish uchun preparatning yuqori dozasi talab qilinadi). Ativanning terapevtik ta'siriga tolerantlik rivojlanishi mumkin, ammo benzodiazepinlar keltirib chiqaradigan amnestik reaktsiyalar va boshqa kognitiv buzilishlarga nisbatan kam tolerantlik rivojlanadi.

OGOHLANTIRISH

Opioidlar bilan bir vaqtda foydalanish xavfi

Benzodiazepinlarni, shu jumladan Ativanni va opioidlarni bir vaqtda qo'llash chuqur sedasyon, nafas olish depressiyasi, koma va o'limga olib kelishi mumkin. Ushbu xavflar tufayli, muqobil davolash usullari etarli bo'lmagan bemorlarga ushbu dori-darmonlarni bir vaqtda buyurish kerak.

Kuzatuv tadqiqotlari shuni ko'rsatdiki, opioid analjeziklari va benzodiazepinlarni bir vaqtda qo'llash faqat opioidlarni qo'llash bilan solishtirganda giyohvand moddalar bilan bog'liq o'lim xavfini oshiradi. Agar Ativanni opioidlar bilan bir vaqtda buyurish to'g'risida qaror qabul qilingan bo'lsa, eng past samarali dozalarni va bir vaqtda qo'llashning minimal davomiyligini belgilang va bemorlarni nafas olish depressiyasi va sedasyon belgilari va alomatlari uchun diqqat bilan kuzatib boring. Allaqachon opioid analjezikini olgan bemorlarga Ativanning boshlang'ich dozasini opioid yo'qligida ko'rsatilganidan pastroq qilib tayinlang va klinik javobga qarab titrlang. Agar allaqachon Ativanni qabul qilgan bemorda opioid boshlangan bo'lsa, opioidning pastroq boshlang'ich dozasini tayinlang va klinik javobga qarab titrlang.

Ativan opioidlar bilan birgalikda qo'llanganda, bemorlarga ham, parvarish qiluvchilarga ham nafas olish depressiyasi va sedasyon xavfi haqida maslahat bering. Bemorlarga opioid bilan bir vaqtda qo'llash oqibatlari aniqlanmaguncha mashinani boshqarish yoki og'ir mexanizmlar bilan ishlashni tavsiya eting (qarang. Giyohvand moddalarning o'zaro ta'siri).

Suiiste'mollik, noto'g'ri foydalanish va giyohvandlik

Benzodiazepinlardan, shu jumladan Ativandan foydalanish foydalanuvchilarni suiiste'mol qilish, noto'g'ri ishlatish va giyohvandlik xavfiga duchor qiladi, bu esa dozani oshirib yuborish yoki o'limga olib kelishi mumkin. Benzodiazepinlarni suiiste'mol qilish va suiiste'mol qilish ko'pincha (lekin har doim ham emas) tavsiya etilgan maksimal dozadan kattaroq dozalarni qo'llashni o'z ichiga oladi va odatda boshqa dorilar, spirtli ichimliklar va/yoki noqonuniy moddalarni bir vaqtda qo'llashni o'z ichiga oladi, bu jiddiy salbiy oqibatlarning ko'payishi bilan bog'liq. nafas olish depressiyasi, dozani oshirib yuborish yoki o'limni o'z ichiga oladi (qarang Giyohvandlik va giyohvandlik: Suiiste'mol).

Ativanni buyurishdan oldin va davolanish davomida har bir bemorning suiiste'mol, noto'g'ri foydalanish va giyohvandlik xavfini baholang (masalan, standartlashtirilgan skrining vositasidan foydalanish). Ativandan foydalanish, ayniqsa yuqori xavf ostida bo'lgan bemorlarda, xavflar va Ativandan to'g'ri foydalanish bo'yicha maslahat berish, shuningdek, suiiste'mollik, noto'g'ri foydalanish va giyohvandlik belgilari va alomatlarini kuzatishni talab qiladi. CNS depressantlarini va suiiste'mol qilish, noto'g'ri foydalanish va giyohvandlik bilan bog'liq bo'lgan boshqa moddalarni (masalan, opioid analjeziklari, stimulyatorlar) bir vaqtning o'zida qo'llashning oldini olish yoki minimallashtirish va bemorlarga foydalanilmagan preparatni to'g'ri yo'q qilish bo'yicha maslahat berish. Agar giyohvand moddalarni iste'mol qilish buzilishidan shubha qilingan bo'lsa, bemorni baholang va kerak bo'lganda erta davolanishni boshlang (yoki ularga murojaat qiling).

Qaramlik va chekinish reaktsiyalari

Chiqib ketish reaktsiyalari xavfini kamaytirish uchun, Ativanni to'xtatish yoki dozani kamaytirish uchun asta-sekin kamaytirishdan foydalaning (dozani kamaytirish uchun bemorga xos rejadan foydalanish kerak) (qarang DOZA VA QO'YILIShI: Ativanni to'xtatish yoki dozasini kamaytirish).

Benzodiazepinni qabul qilishni to'xtatgandan so'ng yoki dozani tezda kamaytirgandan so'ng, olib tashlashning nojo'ya reaktsiyalari xavfi yuqori bo'lgan bemorlarga yuqori dozalarni qabul qilganlar va uzoqroq foydalanish muddati bo'lgan bemorlar kiradi.

O'tkir olib tashlash reaktsiyalari

Benzodiazepinlardan, shu jumladan Ativandan doimiy foydalanish klinik jihatdan ahamiyatli jismoniy qaramlikka olib kelishi mumkin. Davomiy foydalanishdan keyin Ativanni keskin to'xtatish yoki dozasini tezda kamaytirish yoki flumazenilni (benzodiazepin antagonisti) qo'llash hayot uchun xavfli bo'lishi mumkin bo'lgan o'tkir olib tashlash reaktsiyalarini (masalan, tutilishlar) rivojlanishiga olib kelishi mumkin (qarang. Giyohvandlik va giyohvandlik: Qaramlik).

Uzoq muddatli olib tashlash sindromi

Ba'zi hollarda, benzodiazepinni iste'mol qiluvchilar bir necha haftadan 12 oygacha davom etadigan olib tashlash belgilari bilan uzoq davom etadigan olib tashlash sindromini rivojlantirdilar (qarang. Giyohvandlik va giyohvandlik: Qaramlik).

Benzodiazepinlarni, shu jumladan lorazepamni qo'llash paytida oldingi depressiya paydo bo'lishi yoki kuchayishi mumkin. Ativan (lorazepam) birlamchi depressiv buzilish yoki psixoz bilan og'rigan bemorlarda foydalanish tavsiya etilmaydi.

Benzodiazepinlarni, shu jumladan lorazepamni yolg'iz qo'llash va markaziy asab tizimining boshqa depressantlari bilan birgalikda qo'llash potentsial o'limga olib keladigan respirator depressiyaga olib kelishi mumkin (qarang. Giyohvand moddalarning o'zaro ta'siri).

Markaziy asab tizimini susaytiruvchi dori-darmonlarni qabul qilgan barcha bemorlarda bo'lgani kabi, lorazepamni qabul qilgan bemorlar xavfli mexanizmlar yoki transport vositalarini ishlatmasliklari va spirtli ichimliklar va markaziy asab tizimining boshqa depressantlariga nisbatan tolerantligi pasayishi haqida ogohlantirilishi kerak.

EHTIYOT CHORALARI

Depressiya bilan og'rigan bemorlarda o'z joniga qasd qilish ehtimoli borligini yodda tutish kerak, bunday bemorlarda benzodiazepinlar etarli antidepressant terapiyasisiz qo'llanilmasligi kerak.

Lorazepamni nafas olish funktsiyasi buzilgan bemorlarda (masalan, KOAH, uyqu apnesi sindromi) ehtiyotkorlik bilan qo'llash kerak.

Keksa yoshdagi yoki zaiflashgan bemorlar lorazepamning sedativ ta'siriga ko'proq moyil bo'lishi mumkin. Shuning uchun bunday bemorlarni tez-tez kuzatib borish va ularning dozasini bemorning javobiga qarab ehtiyotkorlik bilan sozlash kerak, boshlang'ich dozasi 2 mg dan oshmasligi kerak.

Ba'zida benzodiazepinni qo'llash paytida paradoksal reaktsiyalar qayd etilgan. Bunday reaktsiyalar bolalar va qariyalarda ko'proq sodir bo'lishi mumkin. Agar ular yuzaga kelsa, preparatni qo'llash to'xtatilishi kerak.

Buyrak yoki jigar funktsiyasi buzilgan bemorlarni davolashda odatiy ehtiyot choralariga rioya qilish kerak. Barcha benzodiazepinlar singari, lorazepamni qo'llash jigar ensefalopatiyasini yomonlashtirishi mumkin, shuning uchun lorazepamni og'ir jigar etishmovchiligi va/yoki ensefalopatiyasi bo'lgan bemorlarda ehtiyotkorlik bilan qo'llash kerak. Dosage for patients with severe hepatic insufficiency should be adjusted carefully according to patient response lower doses may be sufficient in such patients.

In patients where gastrointestinal or cardiovascular disorders coexist with anxiety, it should be noted that lorazepam has not been shown to be of significant benefit in treating the gastrointestinal or cardiovascular component.

Esophageal dilation occurred in rats treated with lorazepam for more than 1 year at 6 mg/kg/day. The no-effect dose was 1.25 mg/kg/day (approximately 6 times the maximum human therapeutic dose of 10 mg/day). The effect was reversible only when the treatment was withdrawn within 2 months of first observation of the phenomenon. The clinical significance of this is unknown. However, use of lorazepam for prolonged periods and in geriatric patients requires caution, and there should be frequent monitoring for symptoms of upper GI disease.

Safety and effectiveness of Ativan (lorazepam) in children of less than 12 years have not been established.

Information For Patients

Advise the patient to read the FDA-approved patient labeling (Medication Guide).

Risks From Concomitant Use With Opioids

Advise both patients and caregivers about the risks of potentially fatal respiratory depression and sedation when Ativan is used with opioids and not to use such drugs concomitantly unless supervised by a health care provider. Advise patients not to drive or operate heavy machinery until the effects of concomitant use with the opioid have been determined (see OGOHLANTIRISH: Risks From Concomitant Use Of Opioids va Giyohvand moddalarning o'zaro ta'siri).

Abuse, Misuse, and Addiction

Inform patients that the use of Ativan even at recommended doses, exposes users to risks of abuse, misuse, and addiction, which can lead to overdose and death, especially when used in combination with other medications (e.g., opioid analgesics), alcohol, and/or illicit substances. Inform patients about the signs and symptoms of benzodiazepine abuse, misuse, and addiction to seek medical help if they develop these signs and/or symptoms and on the proper disposal of unused drug (see OGOHLANTIRISH: Abuse Misuse, And Addiction va Drug Abuse And Dependence).

Inform patients that the continued use of Ativan may lead to clinically significant physical dependence and that abrupt discontinuation or rapid dosage reduction of Ativan may precipitate acute withdrawal reactions, which can be life-threatening. Inform patients that in some cases, patients taking benzodiazepines have developed a protracted withdrawal syndrome with withdrawal symptoms lasting weeks to more than 12 months. Instruct patients that discontinuation or dosage reduction of Ativan may require a slow taper (see OGOHLANTIRISH: Dependence And Withdrawal Reactions va Drug Abuse And Dependence).

Essential Laboratory Tests

Some patients on Ativan (lorazepam) have developed leukopenia, and some have had elevations of LDH. As with other benzodiazepines, periodic blood counts and liver function tests are recommended for patients on long-term therapy.

Carcinogenesis And Mutagenesis

No evidence of carcinogenic potential emerged in rats during an 18-month study with Ativan (lorazepam). No studies regarding mutagenesis have been performed.

Homiladorlik

Reproductive studies in animals were performed in mice, rats, and two strains of rabbits. Occasional anomalies (reduction of tarsals, tibia, metatarsals, malrotated limbs, gastroschisis, malformed skull, and microphthalmia) were seen in drug-treated rabbits without relationship to dosage. Although all of these anomalies were not present in the concurrent control group, they have been reported to occur randomly in historical controls. At doses of 40 mg/kg and higher, there was evidence of fetal resorption and increased fetal loss in rabbits which was not seen at lower doses.

The clinical significance of the above findings is not known. However, an increased risk of congenital malformations associated with the use of minor tranquilizers (chlordiazepoxide, diazepam, and meprobamate) during the first trimester of pregnancy has been suggested in several studies. Because the use of these drugs is rarely a matter of urgency, the use of lorazepam during this period should be avoided. The possibility that a woman of childbearing potential may be pregnant at the time of institution of therapy should be considered. Patients should be advised that if they become pregnant, they should communicate with their physician about the desirability of discontinuing the drug.

In humans, blood levels obtained from umbilical cord blood indicate placental transfer of lorazepam and lorazepam glucuronide. Infants of mothers who ingested benzodiazepines for several weeks or more preceding delivery have been reported to have withdrawal symptoms during the postnatal period. Symptoms such as hypoactivity, hypotonia, hypothermia, respiratory depression, apnea, feeding problems, and impaired metabolic response to cold stress have been reported in neonates born of mothers who have received benzodiazepines during the late phase of pregnancy or at delivery.

Emizikli onalar

Lorazepam has been detected in human breast milk therefore, it should not be administered to breastfeeding women, unless the expected benefit to the woman outweighs the potential risk to the infant.

Sedation and inability to suckle have occurred in neonates of lactating mothers taking benzodiazepines. Infants of lactating mothers should be observed for pharmacological effects (including sedation and irritability).

Geriatric Use

Clinical studies of Ativan generally were not adequate to determine whether subjects aged 65 and over respond differently than younger subjects however, the incidence of sedation and unsteadiness was observed to increase with age (see QARSHI REAKSIYALAR).

Age does not appear to have a significant effect on lorazepam kinetics (see Klinik farmakologiya).

Clinical circumstances, some of which may be more common in the elderly, such as hepatic or renal impairment, should be considered. Greater sensitivity (e.g., sedation) of some older individuals cannot be ruled out. In general, dose selection for an elderly patient should be cautious, and lower doses may be sufficient in these patients (see Dozaj va boshqaruv).

Dozani oshirib yuborish

In postmarketing experience, overdose with lorazepam has occurred predominantly in combination with alcohol and/or other drugs. Therefore, in the management of overdosage, it should be borne in mind that multiple agents may have been taken.

Alomatlar

Overdosage of benzodiazepines is usually manifested by varying degrees of CNS depression ranging from drowsiness to coma. In mild cases, symptoms include drowsiness, mental confusion, paradoxical reactions, dysarthria, and lethargy. In more serious cases, and especially when other drugs or alcohol were ingested, symptoms may include ataxia, hypotonia, hypotension, cardiovascular depression, respiratory depression, hypnotic state, coma, and death.

Boshqaruv

General supportive and symptomatic measures are recommended vital signs must be monitored and the patient closely observed. When there is a risk of aspiration, induction of emesis is not recommended. Gastric lavage may be indicated if performed soon after ingestion or in symptomatic patients. Administration of activated charcoal may also limit drug absorption. Hypotension, though unlikely, usually may be controlled with norepinephrine bitartrate injection. Lorazepam is poorly dialyzable. Lorazepam glucuronide, the inactive metabolite, may be highly dialyzable.

The benzodiazepine antagonist flumazenil may be used in hospitalized patients as an adjunct to, not as a substitute for, proper management of benzodiazepine overdose. The prescriber should be aware of a risk of seizure in association with flumazenil treatment, particularly in long-term benzodiazepine users and in cyclic antidepressant overdose. The complete flumazenil package insert including CONTRAINDICATIONS, WARNINGS, va EHTIYOT CHORALARI sections should be consulted prior to use.

QO'SHILMALARI

Ativan (lorazepam) is contraindicated in patients with:

  • hypersensitivity to benzodiazepines or to any components of the formulation
  • acute narrow-angle glaucoma.

Klinik farmakologiya

Studies in healthy volunteers show that in single high doses Ativan (lorazepam) has a tranquilizing action on the central nervous system with no appreciable effect on the respiratory or cardiovascular systems.

Ativan (lorazepam) is readily absorbed with an absolute bioavailability of 90%. Peak concentrations in plasma occur approximately 2 hours following administration. The peak plasma level of lorazepam from a 2 mg dose is approximately 20 ng/mL.

The mean half-life of unconjugated lorazepam in human plasma is about 12 hours and for its major metabolite, lorazepam glucuronide, about 18 hours. At clinically relevant concentrations, lorazepam is approximately 85% bound to plasma proteins. Ativan (lorazepam) is rapidly conjugated at its 3-hydroxy group into lorazepam glucuronide which is then excreted in the urine. Lorazepam glucuronide has no demonstrable central nervous system (CNS) activity in animals.

The plasma levels of lorazepam are proportional to the dose given. There is no evidence of accumulation of lorazepam on administration up to 6 months.

Studies comparing young and elderly subjects have shown that advancing age does not have a significant effect on the pharmacokinetics of lorazepam. However, in one study involving single intravenous doses of 1.5 to 3 mg of Ativan Injection, mean total body clearance of lorazepam decreased by 20% in 15 elderly subjects of 60 to 84 years of age compared to that in 15 younger subjects of 19 to 38 years of age.

Bemor haqida ma'lumot

ATIVAN
(AT-ivan)
(lorazepam) Tablets

What is the most important information I should know about ATIVAN?

Do not drive or operate heavy machinery until you know how taking ATIVAN with opioids affects you.

  • ATIVAN is a benzodiazepine medicine. Taking benzodiazepines with opioid medicines, alcohol, or other central nervous system depressants (including street drugs) can cause severe drowsiness, breathing problems (respiratory depression), coma and death. Get emergency help right away if any of the following happens:
    • shallow or slowed breathing
    • breathing stops (which may lead to the heart stopping)
    • excessive sleepiness (sedation)
    • Serious side effects including coma and death have happened in people who have abused or misused benzodiazepines, including ATIVAN. These serious side effects may also include delirium, paranoia, suicidal thoughts or actions, seizures, and difficulty breathing. Call your healthcare provider or go to the nearest hospital emergency room right away if you get any of these serious side effects.
    • You can develop an addiction even if you take ATIVAN exactly as prescribed by your healthcare provider.
    • Take ATIVAN exactly as your healthcare provider prescribed.
    • Do not share your ATIVAN with other people.
    • Keep ATIVAN in a safe place and away from children.
    • Do not suddenly stop taking ATIVAN. Stopping ATIVAN suddenly can cause serious and life-threatening side effects, including, unusual movements, responses or expressions, seizures, sudden and severe mental or nervous system changes, depression, seeing or hearing things that others do not see or hear, an extreme increase in activity or talking, losing touch with reality, and suicidal thoughts or actions. Call your healthcare provider or go to the nearest hospital emergency room right away if you get any of these symptoms.
    • Some people who suddenly stop benzodiazepines have symptoms that can last for several weeks to more than 12 months, including anxiety, trouble remembering, learning, or concentrating, depression, problems sleeping, feeling like insects are crawling under your skin, weakness, shaking, muscle twitching, burning or prickling feeling in your hands, arms, legs or feet, and ringing in your ears.
    • Physical dependence is not the same as drug addiction. Your healthcare provider can tell you more about the differences between physical dependence and drug addiction.
    • ATIVAN is a prescription medicine used:
      • to treat anxiety disorders
      • for the short-term relief of the symptoms of anxiety or anxiety that can happen with symptoms of depression

      Do not take ATIVAN if you:

      • are allergic to lorazepam, other benzodiazepines, or any of the ingredients in ATIVAN. See the end of this Medication Guide for a complete list of ingredients in ATIVAN.

      Before you take ATIVAN, tell your healthcare provider about all of your medical conditions, including if you:

      • have or have had depression, mood problems, or suicidal thoughts or behavior
      • have a history of drug or alcohol abuse or addiction
      • have lung disease or breathing problems (such as COPD, sleep apnea syndrome)
      • have liver or kidney problems
      • have or have had seizures
      • are pregnant or plan to become pregnant. ATIVAN may harm your unborn baby. You and your healthcare provider should decide if you should take ATIVAN while you are pregnant.
      • are breastfeeding or plan to breastfeed. ATIVAN passes into your breast milk and may harm your baby. Talk to your healthcare provider about the best way to feed your baby if you take ATIVAN. You should not breastfeed while taking ATIVAN.

      Tell your healthcare provider about all the medicines you take, including prescription and overthe-counter medicines, vitamins, and herbal supplements.

      Taking ATIVAN with certain other medicines can cause side effects or affect how well ATIVAN or the other medicines work. Do not start or stop other medicines without talking to your healthcare provider.

      How should I take ATIVAN?

      • Take ATIVAN exactly as your healthcare provider tells you to take it. Your healthcare provider will tell you how much ATIVAN to take and when to take it.
      • If you take too much ATIVAN, call your healthcare provider or go to the nearest hospital emergency room right away.

      What are the possible side effects of ATIVAN?

      ATIVAN may cause serious side effects, including:

      • See &ldquoWhat is the most important information I should know about ATIVAN?&rdquo
      • ATIVAN can make you sleepy or dizzy and can slow your thinking and motor skills.
        • Do not drive, operate heavy machinery, or do other dangerous activities until you know how ATIVAN affects you.
        • Do not drink alcohol or take other drugs that may make you sleepy or dizzy while taking ATIVAN without first talking to your healthcare provider. When taken with alcohol or drugs that cause sleepiness or dizziness, ATIVAN may make your sleepiness or dizziness much worse.

        The most common side effects of ATIVAN include:

        How should I store ATIVAN?

        • Store ATIVAN in a tightly closed container at room temperature between 68°F to 77°F (20°C to 25°C).
        • Keep ATIVAN and all medicines out of the reach of children.

        General information about the safe and effective use of ATIVAN

        Medicines are sometimes prescribed for purposes other than those listed in a Medication Guide. Do not use ATIVAN for a condition for which it was not prescribed. Do not give ATIVAN to other people, even if they have the same symptoms that you have. It may harm them. You can ask your pharmacist or healthcare provider for information about ATIVAN that is written for health professionals.

        What are the ingredients in ATIVAN?

        Active ingredient: lorazepam

        Inactive ingredients: lactose monohydrate, magnesium stearate, microcrystalline cellulose, and polacrilin potassium.


        Dizziness and Edema

        Amlodipine besylate causes vasodilation, or dilation of the blood vessels. The increased blood flow to the arms and legs can lead to side effects. The most common side effect with the 5 mg dose is dizziness. You may feel dizzy or faint upon standing up quickly after sitting or lying down. According to the Norvasc prescribing information as revised in January 2013, about 3 percent of people taking this dose report dizziness. Equally common with the 5 mg dose is swelling, called edema, due to excess collection of fluid. Edema usually is peripheral, or most noticeable in the legs and ankles.


        Factors that influence Effexor XR withdrawal include:

        1. Time Span

        How long have you taken Effexor? Did you take it for a couple months? Years? Have you taken it for over a decade? The amount of time you have taken this medication means your body has become reliant on this medication for everyday functioning.

        2. Dosage

        What dosage did you take? The dosage of Effexor that is commonly prescribed is 75 mg/day. However, some people may start at 37.5 mg, while others may fall between the range of 75 mg and 150 mg. The higher the dosage of the drug you were taking, the more difficulty you will have withdrawing.

        3. Individual Physiology

        Individual factors play a huge role in withdrawal. If you naturally aren’t really affected from antidepressant withdrawal symptoms, you may not be hit as hard with Effexor. On the other hand if you are very sensitive to medication, you may have a tougher time coping with the withdrawal.

        4. Cold Turkey vs. Tapering

        Do you plan on stopping Effexor XR cold turkey? Or have you set up a tapering protocol with your doctor? These are some questions to ask. Obviously cold turkey is much tougher on your body and brain’s readjustment compared to a gradual taper.


        See SINGULAR related publications especially A Singular Introduction to Commutative Algebra by Gert-Martin Greuel and Gerhard Pfister.

        There are quite numerous communities using these packages. Programming in the both systems is closely related to that of C langauage (they are written in C as well). Mathematica users however can miss all the graphics and visualisation capabilities. Nonetheless in the field of algebra they are even more useful.

        Adding to the mobile solutions: MathScript for Android

        Based on SymPy this is a CAS system and also a full-fledged python programming suite. There are two versions available - freeware and commercial.

        I was a long time user and used it for its linear algebra capabilities - reducing, matrix equations, etc.

        Those whom interested in java based API solution there is open source project called jscience It includes:

        • Implementation of Units of Measurement services.
        • A coordinates module compliant with OGC/ISO specifications for the development and deployment of geographic applications.
        • A rigourous mapping of mathematical structures (e.g. Group, Ring, Field, VectorSpace ) to Java interfaces.
        • A linear algebra module, which includes a first (and I believe unique) parameterized matrix class capable of resolving linear system of equations involving any kind of elements (e.g. Complex, ModuloInteger, RationalFunctions)
        • A functions module for symbolic calculations and analysis.
        • Different types of numbers such as real numbers of arbitrary and guaranteed precision, or the always exact rational numbers.
        • Support for exact or arbitrary precision measurements (also strongly typed).
        • Support for Standard , Relativistic , High-Energy , Quantum and Natural physical models.
        • A monetary module for precision-guaranteed calculations and currencies conversions.

        R is also an option. Easy to download just 48 Mb and install. Free ware and add those adds on which you required.

        R is the most comprehensive statistical analysis package available. It incorporates all of the standard statistical tests, models, and analyses, as well as providing a comprehensive language for managing and manipulating data. New technology and ideas often appear first in R.

        R is a programming language and environment developed for statistical analysis by practising statisticians and researchers. It reflects well on a very competent community of computational statisticians. R is now maintained by a core team of some 19 developers, including some very senior statisticians.

        The graphical capabilities of R are outstanding, providing a fully programmable graphics language that surpasses most other statistical and graphical packages. The validity of the R software is ensured through openly validated and comprehensive governance as documented for the US Food and Drug Administration (R Foundation for Statistical Computing, 2008). Because R is open source, unlike closed source software, it has been reviewed by many internationally renowned statisticians and computational scientists.

        R is free and open source software, allowing anyone to use and, importantly, to modify it. R is licensed under the GNU General Public License, with copyright held by The R Foundation for Statistical Computing.

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        Anyone is welcome to provide bug fixes, code enhancements, and new packages, and the wealth of quality packages available for R is a testament to this approach to software development and sharing.

        R has over 4800 packages available from multiple repositories specializing in topics like econometrics, data mining, spatial analysis, and bio-informatics.

        R is cross-platform. R runs on many operating systems and different hardware. It is popularly used on GNU/Linux, Macintosh, and Microsoft Windows, running on both 32 and 64 bit processors.

        R plays well with many other tools, importing data, for example, from CSV les, SAS, and SPSS, or directly from Microsoft Excel, Microsoft Access, Oracle, MySQL, and SQLite. It can also produce graphics output in PDF, JPG, PNG, and SVG formats, and table output for LATEX and HTML.

        R has active user groups where questions can be asked and are often quickly responded to, often by the very people who developed the environment. New books for R (the Springer Use R! series) are emerging, and there is now a very good library of books for using R. The coding of R is smiler to Mathematica , new user of R which is frequent in Mathematica easily pick and under stand the codes of R.