Abin da Kuna iya kuma baza ku iya amfani yayin amfani da Tamoxifen ba
Idan an umurce ka da takaddama don ciwon nono , tabbas ka ji cewa zai iya hulɗa tare da wasu magunguna. Tun da waɗannan hulɗar sun haɗa da magungunan da aka yi amfani dashi da yawa kuma sun hada da kariyan da kayan abinci mai gina jiki, wannan yana da mahimmanci. Bugu da ƙari, za ku iya shan magani don akalla shekaru 5 zuwa 10, da sanin yadda za a iya hulɗa da juna ba kawai dan damuwa na dan lokaci ba.
Akwai kuma wasu mutane waɗanda, saboda bambance-bambancen jinsin, ba su amfana sai dai idan an yi amfani da wani kashi mafi girma na wannan magani. Me kuke bukatar ku sani?
Tamoxifen Yana amfani
Tamoxifen yana da amfani na uku:
- An fi amfani da shi azaman maganin adjuvant ga matan da ke da ciwon daji na farko da ke da karfin maganin ciwon isrogen kuma wadanda suke da premenopausal. A cikin wannan wuri, zai iya rage haɗarin komawar kashi 50 cikin 100. Har ila yau, yana rage yiwuwar bunkasa ciwon daji na biyu a cikin ƙirjinka wanda ya shafa (idan kana da wani lumendomy) ko a cikin nono.
- Ana amfani da Tamoxifen ga mata da maza wanda ke da ciwon ƙwayar ƙwayar nono wanda shine mai karɓar mai jijiyoyin isrogen kuma wadanda basu da tsayayya ga miyagun ƙwayoyi.
- Tamoxifen za'a iya amfani dasu a matsayin maganin rigakafi a cikin mata waɗanda ke da mummunan hadarin bunkasa ciwon nono. A cikin wannan wuri, zai iya rage haɗarin mata na bunkasa ciwon nono ta hanyar rabi.
Mafi yawan kwayar cutar ita ce 20 MG kowace rana don shekaru 5 zuwa 10.
(Wadanda suka zama magoya bayan mata ko kuma sun sami magungunan yarinya na iya canzawa zuwa wani mai hana aromatase maimakon haka).
Ƙara koyon muhimmancin ciwon estrogen a cikin ciwon nono da kuma hanyoyin zaɓin hormonal da suke samuwa.
Ta yaya aka gyara Tamoxifen a jikinka
Tamoxifen yana buƙatar karya shi cikin jikinka cikin nauyin aiki.
Wannan "ƙa'ida" ita ce endoxifen kuma ita ce fili wanda ke aiki don hana sake komawa.
Tamoxifen ya rushe shi zuwa cikin CYP2D6 enzyme cytochrome P450. (Akwai kuma sauran enzymes irin su CYP3A4 da sauransu, amma CYP2D6 yana da mahimmanci). Duk wani abin da ya rage aikin wannan enzyme (CYP2D6) zai iya haifar da adadin yawan aiki mai aiki, sabili da haka, rashin amfani. Rage aikin aiki na enzyme na iya faruwa idan kana shan wasu magunguna ko kuma idan kana da wasu kwayoyin bambancin da ke sa enzyme kasa aiki.
Endoxifen, abin da ya ɓacewa, yana da sau 30 zuwa 100 sau da yawa wajen kawar da ciwon kwayoyin halitta mai yaduwar ciwon estrogen wanda yafi tamoxifen, kuma shine sashin da ke da alhakin sakamakon tamoxifen. Kuna iya jin tamoxifen ake kira "pro-drug" saboda wannan dalili.
Me yasa Damag Interactions May Dama
Dalilin da fahimtar metabolism na tamoxifen yana da mahimmanci shi ne cewa akwai wasu magunguna masu yawa wadanda suke shafar maganin CYP2D6. Wasu kwayoyi suna hana ƙin enzyme sosai don haka kadan idan an kawo karshen wani abu lokacin da aka dauki su tare da tamoxifen. A hakika, zai zama kamar ba ku dauki magungunan ba.
Magunguna da ke shafar wannan enzyme sun hada da waɗanda aka saba amfani da ita a cikin mata masu fama da ciwon nono kamar su masu yawan antidepressants har ma magungunan sanyi da rashin lafiya.
Bayanai game da waɗannan hulɗar sune sababbin (an yarda da takaddama a shekarar 1998, amma ba a lura dasu ba har sai daga bisani) kuma karatun suna gudana a halin yanzu suna kallon wannan batu a zurfin zurfi. Bayanan lura, shi ne binciken binciken na baya-bayan nan da aka gano cewa za a iya danganta batun bitamin D tare da tasirin tamoxifen kuma matakan endoxifen sun fi girma a cikin mata a cikin watanni na rani. Tun da akwai binciken da aka nuna cewa bitamin D zai iya taimakawa wajen magance ciwon nono , wannan tunatarwa ce don likitanku su duba tsarin bitamin D idan ba a taba yin hakan ba.
Amfani da Drug Amfani a kan Tamoxifen
A ƙasa za mu lissafa magunguna da dama waɗanda zasu iya hulɗa da tamoxifen. Na lura cewa wadannan kwayoyi na iya rage tasirin tamoxifen amma yin haka zuwa digiri daban-daban. Wasu kwayoyi suna da karfi masu hana CYP2D6, yayin da wasu sun hana enzyme zuwa ƙananan digiri. Wannan jerin ba cikakke ba kuma wasu magungunan da ba su da amfani da ita sun iya yin hulɗa da tamoxifen. Don Allah a yi magana da likitan ilimin likitancin ku da likitan magungunan likita game da duk wani magani na magungunan magani, over-counter-medication, ko abincin abincin da kake la'akari yayin da kake kan tamoxifen. Bayanin kulawa akwai cewa lokuta da amfani da amfani da waɗannan daga cikin kwayoyi zai iya ƙetare haɗarin rage ƙananan matakanka. Samun fahimta, duk da haka, zai iya taimaka maka ka tambayi likitanka tambayoyi masu dacewa.
Magunguna da ya kamata a kauce masa da tamoxifen sun hada da:
- Masu sukar maganin serotonin masu zabi (SSRIs) : Prozac (fluoxetine) da Paxil (paroxetine) masu karfi ne na CYP2D6. Luvox (fluvoxamine), Celexa (citalopram), Lexapro (escitalopram). da Zoloft (sertraline) kuma sun hana inzyme zuwa wani mataki. Wataƙila wannan hulɗa yana da alhakin ƙara yawan mutuwa na mutuwa da aka samu a cikin mata da ke ɗaukar Paxil.
- Serotonin mai zaɓi sérotonin / norepinephrine regetake inhibitors (SNRIs) : Effexor (venlafaxine), Pristiq (desvenlafaxine)
- Wellbutrin da Zyban (bupropion) : An yi amfani dasu don ciwo da shan taba
- Magunguna masu amfani da tricyclic: Anafranil (clomipramine) da Norpramin (desipramine)
- Endocrine magunguna : Sensipar (cinacalcet), Parlodel (bromocriptine), da kuma Parnate (tranlcypromine)
- Magunguna irin su Mellaril (thioridazine), Trilafon (perphenazine), Orap (pimozide), da Thorazine (chlorpromazine), da kuma maganin maganin cutar daji irin su Risperdal (risperidone), Clozaril (clozapine), Geodon (ziprasidone), da Seroquel (quetiapine)
- Magunguna cardiac : Cardioquin (quinidine), Ticlid (ticlopidine), Cardene (nicardipine)
- Anthistamines : Benadryl (diphenhydramine)
- Magunguna masu guba: Rifampin zai iya rage matakan tamoxifen, isoniazid (amfani da TB).
- Reflux magunguna : Tagamet (cimetidine)
- Magunguna : Ana amfani dasu don halaye daga ƙafafun wasa, zuwa tinea versicolor, don yaduwa naman gwari, Lamisil ko Terbinax (Terbinafine) bazaiyi amfani dashi tare da tamoxifen ba, duk da cewa wannan kwayar ba a kunshe a yawancin jerin sunayen kwayoyi don kaucewa ba.
- Magunguna masu ciwon sukari: Actos (proglitazone)
- Kwayoyin magani na Parkinson : Requip (ropinirole)
- Magunguna HIV / AIDs : Da dama
- Misc : Neurontin (gabapentin)
- Vitamin : Haɗin bitamin E mai yawa zai iya hulɗa tare da tamoxifen
- Abubuwa na gina jiki : Ba mu da wani babban nazari da ke kallon hulɗar abubuwan da ake ci da ita tare da tamoxifen. Ƙarin abin da ke da karfi CYP2D6 aiki a cikin lab sun hada da skullcap, lemun tsami balm, echinacea, da ginseng. A yawancin yawa, tsire-tsire mai shayi na iya kara yawan matakin tamoxifen cikin jini, amma wannan mai yiwuwa bai isa ya haifar da bayyanar cututtuka ba. Idan kun shirya akan yin amfani da duk wani nau'i na kayan lambu yana da muhimmanci a yi magana da likitanku.
Alternatives: Magunguna da Za a Yi Amfani A maimakon haka
Kuna iya mamaki abin da zaka iya dauka idan kana amfani da tamoxifen:
- Magungunan antitpressants sun bambanta a cikin digiri wanda suke rinjayar enzyme CYP2D6. Cymbalta (duloxetine) ya bayyana cewa ya kawar da matakan CYP2D6 kasa da sauran antidepressants. Magunguna da aka jera a sama a ƙarƙashin "kwayoyi don kaucewa" sun bambanta ƙwarai a cikin digiri wanda suke kawar da enzyme. Binciken da aka yi kwanan nan ya nuna cewa wasu daga cikin masu ƙanƙantar da ƙananan ƙanƙara zasu iya zama lafiya don amfani da tamoxifen, amma nazarin a wannan lokaci ba shi da tabbas ko wannan zai iya samun magungunan asibiti.
- Magunguna marasa lafiya da magungunan sanyi: Yawancin magungunan sanyi sun ƙunshi abubuwa fiye da ɗaya, don haka yana da muhimmanci a karanta alamu. Yawancin shirye-shirye na kan-da-counter na sanyi da mura yana dauke da Benadryl. Magunguna marasa lafiya kamar su Zyrtec da Claritin suna da tsammanin zasu yi amfani da tamoxifen lafiya.
- Magunguna masu magungunan Acid wadanda suka dace sun hada da Zantac (ranitidine) da sauransu.
Muna koya koyaushe game da hulɗar magani kuma yana da mahimmanci muyi magana da masu likitan ilimin likitancinka da magunguna game da kowane magungunan da kake son amfani tare da tamoxifen.
QT Tsarin
Idan ka dubi lakabin kunshin ku da kuka iya lura cewa kada a yi amfani da tamoxifen tare da wasu magunguna da za su tsawanta lokacin QT. Hanya na QT tana nufin lokacin lokaci tsakanin raƙuman ruwa biyu da aka gani a kan electrocardiogram. Ana tsammanin cewa idan tsangwama na QT yana da tsawo sosai, zai haifar da hadarin mummunan zuciya, kuma yiwuwar mutuwa ta kwatsam.
Bayanan martaba yayi gargadin cewa tamoxifen zai iya haifar da hawan QT lokacin amfani tare da sauran kwayoyi wanda zai iya haifar da QT tsawo. Bincike na binciken 2017, duk da haka, ya yi iƙirari cewa akwai yiwuwar ƙananan haɗari na QT a cikin wannan wuri, musamman a 20 mg kowace rana.
Genetics na Tamoxifen da CYP2D6 Gwaji
Akwai nau'i na aikin CYP2D6 enzyme, wannan yana haifar da bambance-bambance a cikin metabolism na kwayoyi. Wani bita na binciken ya gano cewa mai yawa metabolizers sun bayyana sun sami sakamako mafi kyau fiye da matalauta matakan metabolizers. Yawanci, kimanin kashi 20 cikin dari na mutane sun rage aikin wannan enzyme.
Don haka ta yaya ka san idan za ka iya zama matashi maras kyau? Akwai gwaje-gwajen samfurori na samfurori na samfurori na CYP2D6, amma wannan gwaji ba a saba saba wa mata a kan maganin tamoxifen ba don ciwon ciwon ƙirjin mai ciwon estrogen. A wasu kalmomi, ba za ku sani ba. Wannan kuma wani yanki ne na rikici, kuma wasu masu bincike sun yi imanin cewa kasancewar wani enzyme, CYP3A4 * 22 na iya ramawa ga rage yawan ƙananan ƙarewa da suka shafi aikin CYP2D6 kadan.
Bugu da ƙari, yana da daraja cewa aikin CYP2D6 yana da girma a cikin watanni na rani (dogara da bitamin D zuwa wani digiri), kuma gwajin bitamin D yana da mahimmanci ga matan da ke zaune tare da ciwon nono.
Gaba na Ƙasa akan Tamaxifen Damag Interactions
Tamoxifen magani ce da mata suke yi kowace rana don tsawon lokaci bayan bayanan asibiti na ciwon nono. Lokacin da aka dauka kamar yadda aka umarce shi, zai iya rage hadarin komawa (kuma bayan haka, mutuwa). Saboda haka, fahimtar fahimtar juna yana da mahimmanci.
Wasu hulɗar miyagun ƙwayoyi na iya zama m, yayin da wasu kwayoyi zasu iya kusan dukkanin lalata tasirin tamoxifen lokacin da aka ɗauka akai-akai. An nuna wannan ba wai kawai a cikin labaran da ke kallon metabolism na waɗannan kwayoyi ba, amma ana gani a asibiti a cikin yawan yawan mata da suka dauki Paxil tare da tamoxifen.
Sabuwar bayani yana zuwa a ƙasa (kamar bayanin bitamin D da aka ambata a sama). Wadannan ci gaba da sauri a maganin maganin ciwon daji ya sa ya fi muhimmanci fiye da kasancewa mai ba da shawara a cikin kulawar ciwon daji , Nazarin da ya nuna wannan batu shine kallon da ke kallo mata suna daukar tamoxifen a cikin lokaci daga 2005 zuwa 2010 (bayan da muka sani wasu daga cikin waɗannan hulɗar). A lokacin, Paxil yana daya daga cikin maganin tallafi ga mata a kan tamoxifen. Amma, mafi mahimmancin damuwa shi ne, yawancin shirye-shirye na kan-da-counter na iya yin hulɗa tare da tamoxifen, da barin mutane a kan kansu don gane hulɗar miyagun kwayoyi.
> Sources:
> Antunes, M., Timm, T., de Oliveira, V. et al. Hanyoyin CYP2D6 da CYP3A4 Phenotypes, Drug Interactions, da kuma yanayin Vitamin D akan Tamoxifen Biotransformation. Kulawa da maganin ƙwayar cuta . 2015. 37 (6): 733-44.
> Juurlink, D. Sauke Harkokin Drug tsakanin Tamoxifen da SSRI Antidepressants. BMJ . 2016. 354: i5309.