Mankhwala "Klayra": ndemanga madokotala, ubwino, kuipa, malangizo, mavuto. Reviews gynecologists za miyala "Klayra" chifukwa endometriosis, kusamba

Posachedwapa, nthawi zambiri madokotala masiku ano matenda ena mankhwala mankhwala "Klayra". Reviews madokotala, ubwino, kuipa kwa chida ichi - zonsezi ayankhidwa pansipa.

Kodi ntchito?

Izi mankhwala ndi kuphatikiza m'kamwa kulera zosiyanasiyanazi, ozikidwa pa ntchito mogwirizana kwa zinthu zingapo. Zofunika kwambiri pakati pawo ndi yimitsira wa ovulation, komanso kusintha kwa katundu wa ntchofu khomo lachiberekero - pa izi ndi zochokera kanthu "Klayra" mankhwala. Reviews madokotala (ubwino, kuipa akatswiri nthaŵi zonse ganizirani) amanena kuti ndi chida chapadera mwa zotsatira zake zofanana.

Kuwonjezera popewa kutenga mimba zapathengo mankhwala losiyana lonse mndandanda wa katundu zina zothandiza zomwe, ngakhale kutenga nkhani makhalidwe oipa amakulolani kusankha njira yabwino ya kulera. contraindications zonse mankhwala limafotokoza "Klayra" malangizo. Reviews madokotala mulinso nkhani amene kutenga mankhwala osafunika.

N'chiyani chimachititsa yokumana?

Kuchepetsa mphamvu ya ululu ndi menstrualnopodobnoe magazi, zomwe mapeto kuchepetsa kwambiri chiopsezo akusowa chitsulo magazi m'thupi. Kuti ndi mmene waukulu, umene amapereka "Klayra". Reviews madokotala (ubwino / kuipa kwa masentimita mankhwala. Mmunsimu) kuti zonsezi amaperekedwa mokwanira, mogwirizana ndi zimene medicament ndi kulengeza ntchito kawirikawiri. Komanso, nthawi zambiri anaona ndiponso kuti phwando chida amapereka kuchepetsa kwambiri kuthekera khansa endometrial. Komanso, mankhwala kuchepetsa chiopsezo cha khansa yamchiberekero.

Kodi madokotala kuti?

Ponena za mankhwala "Klayra" ayankhe madokotala zambiri kuunikila chakuti ali zotsatira zopindulitsa kwambiri pa endometrium, mu mogwirizana ndi chomwe ntchito mankhwalawa nthawi yaitali kapena amphamvu kwambiri kusamba magazi popanda kudwala organic. zizindikiro izi ndi zina osokonekera uterine magazi. Zimenezi kuonetsetsa zokhudza mankhwala "Klayra" ayankhe madokotala. Mu endometriosis ntchito yake komanso dera.

kafukufuku

Chitetezo ndi mphamvu ya kugwiritsira ntchito mapiritsi estradiol valerate / dienogest mankhwalawa zizindikiro za osokonekera magazi uterine akhala anazindikiritsidwa mu njira ya maphunziro awiri matenda.

yemweyo ma CD kapangidwe ndi kusanthula dongosolo ankagwiritsa ntchito maphunziro onse. Potsilizira pake, 269 odwala anasankhidwa kuti "Klayra" mankhwala. Reviews madokotala (ubwino / kuipa zafotokozedwa mwatsatanetsatane), kutenga nawo mbali mu kafukufukuyu, ananena kuti powonjezera wakhala nawo kuphunzira odwala 152, amene anayesedwa zotsatira za placebo. Mu maphunziro awa, padatsimikiza kuti mankhwala anali aluso poyerekeza placebo mankhwalawa zizindikiro, ndipo Dziwani chakuti endpoint poyankha mankhwala "Klayra" ndi oposa 40% aliyense maphunziro.

Komanso, aliyense wa maphunziro poyera ndi powerengera ndi kukomoka kwambiri kuchepetsa imfa kusamba magazi, ndiponso kuti anali limodzi ndi kuwonjezeka kwambiri mu chitsulo magawo kagayidwe kuti panopa nthawi zambiri awonetse njira "ndemanga Klayra 'madokotala (ubwino ndi kuipa mankhwala tiganizire) .

Monga esitirojeni pokonzekera zimawathandiza variat estradiol, umene ndi kalambulabwalo chilengedwe cha anthu 17β-estradiol. Estrogenic chigawo ntchito m'bukuli zikutanthauza yosiyana kwambiri ku estrogens amene amagwiritsidwa kwambiri kulera kuphatikiza m'kamwa, ndiwo muyezo kupanga esitirojeni, monga mestranol kapena ethinyl, omwe muli gulu methyl mu malo 17α. gulu zimenezi zimachititsa kwambiri kagayidwe kachakudya bata, koma pa nthawi yomweyo limachita zambiri kutchulidwa pa chiwindi, chimene chiri chofunika kwambiri komanso.

Pofotokoza lokonzekera "Klayra" ayankhe madokotala nthawi zambiri zinkakambidwa chakuti cholanda amapereka kuli kutchulidwa zimakhudzanso chiwindi poyerekeza ndi ena PDAs atatu gawo, yomwe ndi levonorgestrel ndi ethinyl estradiol. Pa kafukufuku padatsimikiza kuti zotsatira za ndende ya globulin lakonzedwa kuti amange mahomoni, sichidziwika kutchulidwa. Mothandizana ndi dienogest estradiol valerate chikusonyeza kuwonjezeka kwambiri HDL, pamene ndende okwana LDL mafuta yafupika.

Dienogest - ndi progestogen, ntchito mu nkhani ya utsogoleli m'kamwa. Iwo amakhala ndi zina zotsatira tsankho odana ndi androgenic, pamene odana estrogenic, androgenic ndi estrogenic katundu zonyozeka. Chifukwa wapadera kapangidwe mankhwala zimatheka ndi sipekitiramu lonse kanthu pharmacological, chomwe ndi ubwino kwambiri 19-kapena-progestogen, komanso ena ofanana zosiyanasiyana progesterone, amene nthawi zambiri ndemanga za njira zilipo "Klayra 'ndemanga (ubwino / kuipa nkhani zotsatirazi).

China deta chisanadze matenda amene analandira m'kupita kwa kawopsedwe maphunziro wamba pambuyo dosing angapo, komanso genotoxicity ndi kuthekera carcinogenic chida, osati anasonyeza, pali ena kwambiri chiopsezo yeniyeni anthu. Komabe, pofotokoza mankhwala "Klayra" amakambirana gynecologists amanena kuti sitiyenera kuiwala zokhuza kuthekera zolimbikitsa angapo zimakhala timadzi amadalira ndi zotupa kugonana mahomoni. Mu nkhani ya ntchito olondola a otchedwa Pearl Index (a muyezo umene Mzimuyo pafupipafupi mimba akazi pa zaka zana limodzi ntchito mankhwala a) ali ndi phindu zosakwana 1, koma mu nkhani ya mapiritsi anaphonya kapena kugwiritsa ntchito kukula.

Kenako pharmacokinetics "Klayra" mankhwala tidzakambirana. Reviews gynecologists pafupifupi mwathunthu kutsimikizira mfundo mwachindunji ndi Mlengi, mogwirizana ndi zimene chida ndipo anatumizidwa ku odwala ambiri.

dienogest

• Mayamwidwe. Zotsatirazi makonzedwe m'kamwa zinthu mwamsanga ndipo pafupifupi atamezedwa kotheratu. C _Max mu seramu magazi umalandira chizindikiro 90,5 ng / ml ya pambuyo pa ola limodzi pambuyo piritsi akutengedwa (muli 3 mg wa dienogest ndi 2 mg wa estradiol variat). Bioavailability Pankhaniyi umalandira chandamale 91%. Tikumbukenso kuti pharmacokinetics wa dienogest mu mlingo osiyanasiyana kuchokera 1 mg mpaka 8 yodziwika kudalira mwachindunji pa mlingo. Ngati lokonzekera ntchito imodzi ndi kudya, sayambitsa aliyense zotsatira kukomoka chidwi digiri kapena mlingo wa mayamwidwe mchitidwe uwu.

• Kufalitsa. Mbali yaikulu ya dienogest kufalitsidwa (10%) ndi mu maonekedwe unbound, pamene yotsala ndi osakhala enieni kwambiri kuti albumin. Dienogest pakokha mwachindunji ndi globulin aliyense kortikosteroidsvyazyvayuschim, kapena SHBG ndi. Ndi chifukwa chake testosterone kwathunthu inathetsedwa chiopsezo kusamutsidwa mgwirizano ndi SHBG kapena tochepa ku kulankhulana kwa zinthu ndi DRG lapansi. Chitsanzo makamaka pa njira zosiyanasiyana zokhudza thupi kusuntha mankhwala amkati, motero, ndiye sizingatheke. Pamene mgwirizano ndende ndi 46 V _D L chifukwa cha dongosolo mtsempha wa 85 mg wa dienogest zimalembedwa tritium.

• Kagayidwe. mchitidwe Dienogest pafupifupi kwathunthu zimapukusidwa kugwilizana zonse ndi njira pakalipano a kagayidwe mahomoni steroid, komanso mapangidwe metabolites ali mu ambiri a milandu hormonally kulalikira. metabolites awa excreted mofulumira kwambiri kotero lalikulu kagulu kamene mu madzi a m'magazi waima zikutsatiridwa dienogest. Total chilolezo pambuyo makonzedwe mtsempha wa tritiated dienogest ndi 5.1 L / h.

• Kucotsa. Chifukwa cha alandira mchitidwe m'kamwa mlingo wa 0.1 mg wa / kg kwathunthu dienogest monga metabolites amene excreted ndi impso ndi matumbo mu chiŵerengero pafupifupi 3: 1. Pambuyo makonzedwe m'kamwa pafupifupi 42% ya mlingo kwathunthu kuchotsedwa pa tsiku loyamba, pamene 63% - pa 6 masiku ndi excretion aimpso. Komanso, patapita masiku 6 mwa intestine ndi impso anachokera za 86% ya mlingo.

• The mgwirizano ndende. Mu nkhani iyi, pharmacokinetics wa dienogest si malinga ndi ndende ya SHBG. Chizindikiro C _SS zimatheka atatha pafupi masiku atatu pambuyo ntchito mlingo yemweyo, amene ali 3 mg wa dienogest osakaniza 2 mg wa Estradiol valerate.

estradiol valerate

• Mayamwidwe. Chifukwa cha kutenga estradiol mankhwala zitsanzo zabwino mofulumira ndi atamezedwa kotheratu. Pogawanikana pamawere pa asidi valeric ndi estradiol yokha mwachindunji ikuchitika pa suction wa amafotokozera mu m'mimba thirakiti mucosa kapena pa ndimeyi choyamba kudzera chiwindi, potero kuoneka estradiol ndi metabolites ake. Ngati wothandizila watengedwera pamodzi ndi chakudya, palibe zotsatira kukomoka kwambiri pati kapena mlingo wa mayamwidwe mchitidwe uwu.

• Kagayidwe. Valeric asidi losiyana kagayidwe mofulumira kwambiri. Pambuyo makonzedwe m'kamwa pafupifupi 3% ya mlingo, kumakhaladi kwathunthu bioavailable monga estradiol koyera likufa tima koyamba zotsatira kudutsa chiwindi, kuti gawo zochuluka mlingo kutumikiridwa zimapukusidwa kale akuyamba mu mucosa pa mundawo m'mimba. Mothandizana ndi presystemic kagayidwe mu chiwindi mwachindunji za 95% ya mlingo m'kamwa pamapeto pake zimapukusidwa isanapite mu makope zokhudza zonse. The metabolites chachikulu apa zinthu estrone sulphate estrone ndi estrone glucuronide.

• Kufalitsa. Mu seramu 38% ya estradiol mwachindunji zokhudzana SHBG, pamene 60% - ndi albumin ndi% okha 2-3 ndi mosalekeza akufalitsa m'chigawo unbound. Dziwani chakuti estradiol mwina insignificantly kuwonjezera ndende okwana SHBG ku seramu magazi, ndipo amenewa ndi mwachindunji amadalira kuvomereza mlingo. Pa tsiku 21, phwando kukonzekera izi ndende okwana SHBG anali pafupifupi 146% ya pachiyambi, pamene tsiku 28, ndiwo mapeto gawo la ntchito mapiritsi anafooka akhala kusanduka 141%.

• Kucotsa. Chifukwa dziwe mokwanira lalikulu kufalitsidwa glucuronides ndi sulfates, komanso chifukwa cha hepato-enteric recirculation T _1/2 estradiol pambuyo ntchito m'kamwa mu gawo akayakaya ndi mbali zovuta, mwachindunji amadalira njira zonse izi.

• The mgwirizano ndende. Pharmacokinetics estradiol mwachindunji zimadalira ambiri SHBG. Mu akazi, anthu ambiri estradiol mu madzi a m'magazi ndi zovuta za amkati estradiol, ndi kuti estradiol amene akulowa ndondomeko ya kulandira mankhwala. Pa phwando mapiritsi gawo, amene ali 3 mg wa dienogest ndi 2 mg wa estradiol valerate, ndi zikutanthauza ndende ya estradiol mu seramu magazi pa boma ravnomestnom ndi 51,6 PG / mL.

Pamene mankhwala ntchito?

Atasankhidwa "Klayra" nthawi ya kusintha kwa thupi. Reviews madokotala kuti izi ndi kusankha bwino zochizira amai amene akudwala katundu kapena yaitali kusamba magazi, pakalibe kudwala aliyense organic.

Komanso, mankhwala naye ntchito njira zolera m'kamwa.

contraindications

Pa yokonza "Klayra" ayankhe madokotala (zotsatira zoyipa - yowadzudzulira) si nthawi zonse zabwino. Mwachitsanzo, kuonetsetsa ena contraindications. Taonani zinthu zochepa zimene chida ichi sayenera kugwiritsidwa ntchito, chotero phwando ndi kwathunthu zimafika ngati mmodzi wa iwo akuyamba kukhala pa mankhwala:

• tilinazo kwambiri kuti aliyense wa mankhwala yogwira kapena ena a kummwera kwa chigawo;
• embolism kapena thrombosis tsopano kapena mbiri;
• boma, lomwe ndi chisanadze thrombosis onse mu mbiri ndi ntchito imene;
• anasonyeza cholowa kapena kugula kutengera za kwa zikamera wa wolumikizira kapena venous thrombosis, kuphatikizapo komanso akusowa wa antithrombin III, mapuloteni C ndi S akusowa, chitetezo kwa phospholipids ndi gipergomotsistsinemiya;
• pamaso pa wolumikizira okwera kapena thrombosis venous;
• pamaso pa migraine ndi zizindikiro zilizonse focal ubongo ngati pa mphindi, ndi mbiri;
• shuga, yodziwika ndi mavuto osiyanasiyana mtima;
• kapamba, hypertriglyceridemia aakulu ndi nthawi yogwira kapena mbiri;
• matenda aakulu chiwindi kapena chiwindi kulephera kupezeka;
• timadzi amadalira khansa anasonyeza kapena kukayikitsa asayembekezere;
• chiwindi zotupa;
• mimba kapena kukayikitsa izo;
• magazi kumaliseche kwa mkazi chiyambi sakudziwika;
• pamaso pa tsankho lactose, klyukozo-galactose malabsorption kapena akusowa lactase.

Komanso, Dziwani umodzi zambiri zimene sangathe ntchito mankhwala olera "Klayra". Reviews madokotala kuti iwo sayenera kumwedwa pa nthawi yoyamwitsa.

machenjezo wapadera

Ngati matenda ena, zinthu kapena mfundo zoopsa otchulidwa pansipa ali anaona anthu pa nthawi ino, tifunika kukhala bwino kuganizira lingathe kuopsa ndi ubwino kutenga mankhwala pa nkhani iliyonse payekha. Makamaka zimenezi zikugwira ntchito kwa zinthu zotsatirazi:

• zinthu chiopsezo cha chitukuko wotsatira wa thromboembolism ndi thrombosis;
• matenda ena omwe Tingaone zotumphukira matenda osiyana magazi;
• hypertriglyceridemia;
• pamaso pa cholowa angioneurotic edema;
• matenda osiyanasiyana, amene choyamba anaonekera kapena anakula pa mimba kapena pa ntchito yapita mahomoni kugonana.

sayenera kumwedwa "Klayra" miyala mu nthawi zonsezi. Reviews madokotala imeneyi kuthandiza kukhala ndi thanzi.

Mimba ndi kuyamwitsa

Kugwiritsa ntchito mankhwala ndi contraindicated pa mimba. Pankhaniyi, pali zoterezi pamene mimba kumachitikita odwala amene amalandira limanenanso mankhwala "Klayra" malangizo Buku. Reviews madokotala kuti mu nkhani iyi mufunika kuleka yomweyo akutsatiridwa ndi phwando a. Komabe, m'kupita kukwaniritsa maphunziro zikuluzikulu kuchuluka chiopsezo vuto lililonse kubadwa mwa ana sichinayambe mtima, anabadwa kwa akazi amene anatenga CPC monga kale mimba ndi pa phwando awo wamba pa chiyambi cha mimba.

CPC nthawi zina zimakhudza mkaka wa m'mawere, monga iwo zingathe kusokoneza kuchuluka kwa mkaka kapena kusintha kapangidwe kake, amene amatchulidwa za lokonzekera "Klayra" ayankhe madokotala. pachifukwa ichi, ntchito yake osavomerezeka makamaka zaka 40.