Chii Chaunogona uye Usingakwanisi Kutora Paunenge Uchishandisa Tamoxifen
Kana iwe wakarayirwa tamoxifen nokuda kwekenza yemazamu , iwe unogona kunge wakanzwa kuti inogona kuwirirana nemimwe mishonga. Sezvo kushamwaridzana uku kunosanganisira kushandiswa kwezvinodhaka zvinoshandiswa uye kunosanganisira kupfuura-the-counter uye nutritional supplements, izvi zvakakosha zvikuru. Mukuwedzera, iwe ungangodaro uri kutora mishonga kwemakore anosvika mashanu kusvika kune gumi, uchiita ruzivo rwekugonekana kusangana kwete kungova nehanya kwenguva pfupi.
Kunewo vamwe vanhu avo, zvichienderana nemararamiro akasiyana-siyana, haabatsiri kunze kwekuti chikwata chakakwirira chechirwere ichi chinoshandiswa. Chii chaunoda kuziva?
Tamoxifen Uses
Tamoxifen ine zvinhu zvitatu zvinoshandiswa zvikuru:
- Inonyanya kushandiswa sehutachiwana hwemadhiyabhorosi ane kenza yepabonde yepakutanga iyo ndiyo estrogen receptor yakanaka uye ndeye premenopausal. Munzvimbo iyi, inogona kuderedza ngozi yekudzoka ne50 muzana. Iko kunoderedzawo mikana yekuvandudza kenza yechipiri mubamu rako rakavhiringidzika (kana iwe une lumpectomy) kana mune imwe yepamu.
- Tamoxifen inoshandiswa kune vose vakadzi nevarume vane kenza yemasitamende yemasitendi iyo ndiyo estrogen receptor yakanaka uye iyo isingakonzerwi nemishonga.
- Tamoxifen inogonawo kushandiswa sechirongwa chekudzivirira muvakadzi vane ngozi yakakwirira yekutengesa kenza yemvere. Mumamiriro ezvinhu aya, inogona kuderedza dambudziko revakadzi rekudzivirira kenza yepamu nehafu.
Mhedzisiro yakawanda ndeye 20 mg zuva nezuva kwemakore mashanu kusvika kune gumi.
(Avo vanova postmenopausal kana vakagamuchira ovarian suppression therapy vangashandurwa kune anromatase inhibitor pane).
Dzidza zvakanyanya basa reestrogen mukenza yemazamu uye hormonal therapy nzira dziripo.
Iyo Tamoxifen Yakagadziriswa Muviri Wako
Tamoxifen inofanira kuputsika mumuviri wako kuva maitiro ayo.
Iyi "metabolite" ndeye endoxifen uye inhengo inobatsira kudzivirira kudzokorora.
Tamoxifen yakaputsika kusvika endoxifen ne cytochrome P450 enzyme CYP2D6. (Kunewo mamwe emakemikari akadai seYP3A4 nevamwe, asi CYP2D6 inogona kunge yakakosha zvikuru). Chinhu chipi nechipi chinoderedza basa re enzyme iyi (CYP2D6) inogona kuguma nehuwandu hwemagetsi anoshanda, uye naizvozvo, zvishoma kubatsirwa. Basa rakaderera re enzyme rinogona kuitika kana iwe uri kutora mamwe mishonga kana kana iwe une mararamiro akasiyana-siyana anoita kuti enzyme isanyanya kushanda.
Endoxifen, chibereko chinoparara, chinokwana makumi matatu kusvika ku100 chinonyanya kubudirira mukudzvinyirira isrogen-yakabatana nesero kukura kupfuura tamoxifen, uye iyo inogadziriswa inokonzerwa nemigumisiro ye tamoxifen. Iwe unogona kunzwa tamoxifen inonzi "pro-drug" nekuda kwechikonzero ichi.
Chikonzero nei Kubatana Kwemishonga Kunogona Kuitika
Chikonzero chinonzwisisa kushandiswa kwemasabolism tamoxifen kunokosha ndechokuti pane mamwe mishonga yakawanda iyo inokanganisawo inonzi CYP2D6 enzyme. Mimwe mishonga inonyanya kuvhiringidza enzyme kuitira kuti zvishoma kana chero endoxifen inogadzirwa apo inotorwa ne tamoxifen. Muchidimbu, zvingave zvakaita iwe usina kutora mushonga zvachose.
Mishonga inobata enzyme iyi inosanganisira iyo inowanzoshandiswa kuvakadzi vane kenza yemazamu yakawanda sekurwisa zvinodhaka uye kunyange kutonhora kunowanzoitwa uye kurwisa mishonga.
Izvo ruzivo rwekubatana uku ndewutsva (tamoxifen yakagamuchirwa muna 1998, asi kushamwaridzana kwakanga kusingazivikanwi kusvikira gare gare) uye zvidzidzo zviripo zvino zvichienderera mberi kutarisa nyaya iyi zvakadzama. Nhoroondo, ndeyekuti zvidzidzo zvenguva pfupi zvakawana kuti vitamin D yako yezinga inogona kuenzaniswa nekubudirira kwe tamoxifen uye kuti mazinga e endoxifen anowanzove akakwirira chaizvo kuvakadzi mumwedzi yezhizha. Sezvo pave pane zvidzidzo zvichiratidza kuti vitamini D inogona kubatsira kurwisa kenza yemazamu , ichi chiyeuchidzo chekuti oncologist yako ione uwandu hwevhitamini D kana iwe usati waita izvi.
Zvinogona Kuita Zvinodhaka Zvinodhaka paTamoxifen
Pazasi tinonyora mishonga yemishonga inogona kuwirirana ne tamoxifen. Chinyorwa ndechekuti mishonga iyi inogona kuderedza kushanda kwetamoxifen asi iite saizvozvo kune zvidimbu zvakasiyana. Mimwe mishonga yakaoma zvikuru inhibitor yeYP2D6, asi dzimwe dzinodzivisa enzyme kudarika madhigirii. Urongwa urwu harusi huwandu uye mamwe maitiro asingawanzoshandiswa anoshandiswa anogona kuwirirana ne tamoxifen zvakare. Ndapota taurirai oncologist wenyu uye mhizha nezvemishonga ipi neipi yemishonga, mishonga ye-anti-counter, kana mishonga yekuwedzera iyo uri kufunga iwe uri pa tamoxifen. Nyaya ndeyokuti pane nguva inogona kubatsirwe kushandisa imwe yemishonga iyi inogona kupfuudza njodzi yekuderedza mafungiro ako endoxifen. Kuva nekuziva, zvakadaro, kunogona kukubatsira kubvunza chiremba wako mibvunzo yakarurama.
Mishonga inofanira kudziviswa ne tamoxifen inosanganisira:
- Kusarudza serotonin uptake inhibitors (SSRIs) : Prozac (fluoxetine) uye Paxil (paroxetine) vane simba inhibitor yeYP2D6. Luvox (fluvoxamine), Celexa (citalopram), Lexapro (escitalopram). uye Zoloft (sertraline) inodzivisawo enzyme pane imwe nguva. Zvichida kuti kubatana uku kunokonzera kuwedzera kwengozi yekufa inowanika kuvakadzi vanotora Paxil.
- Kusarudza serotonin / norepinephrine reuptake inhibitors (SNRIs) : Effexor (venlafaxine), Pristiq (desvenlafaxine)
- Wellbutrin naZyban (bupropion) : Vanoshandiswa kuora mwoyo nekurega kusvuta
- Tricyclic vanodzvinyirira: Anafranil (clomipramine) uye Norpramin (desipramine)
- Mishonga yeMidocrine: Sensipar (cinacalcet), Parlodel (bromocriptine), uye Parnate (tranlcypromine)
- Zvimwe zvinorwisa antipsychotics zvakadai seMellaril (thioridazine), Trilafon (perphenazine), Orap (pimozide), uye Thorazine (chlorpromazine), uye atypical antipsychotics dzakadai seChaperperdal (risperidone), Clozaril (clozapine), Geodon (ziprasidone), uye Seroquel (quetiapine)
- Mishonga yemwoyo: Cardioquin (quinidine), Ticlid (ticlopidine), Cardene (nicardipine)
- Antihistamines : Benadryl (diphenhydramine)
- Antibiotics : Rifampin inogona kuderedza zvikuru tamoxifen mazinga, isoniazid (anoshandiswa kuTB).
- Reflux mishonga : Tagamet (cimetidine)
- Antifungals : Kazhinji inoshandiswa pamamiriro ezvinhu kubva patsoka dzevatambi, kuti tinea versicolor, kudonha fungus, iyo Ramisil yemishonga kana Terbinex (terbinafine) haifaniri kushandiswa ne tamoxifen, kunyange zvazvo ichi chirwere chisina kubatanidzwa pane zvakawanda zvezvinodhaka zvekudzivirira.
- Dhiyabhorosi mishonga: Actos (proglitazone)
- Mishonga yePalinson's disease : Requip (ropinirole)
- Mishonga yeHIV / AIDS : Zviverengeka
- Misc : Neurontin (gabapentin)
- Mavhitamini : Kuwedzera kwemavhitamini E zvinowedzera zvinogona kuwirirana ne tamoxifen
- Nutritional Supplement : Hatina dzidzo dzakawanda dzinotarisa kusangana kwemishonga inowedzera pamwe ne tamoxifen. Zvimwe zvizere izvo zvine simba CYP2D6 inhibitory basa mubasa rinosanganisira skullcap, lemon balm, echinacea, uye ginseng. Muhuwandu hwakawanda, ruvara rwehutayiti rehuti rinogona kuwedzera huwandu hwetamoxifen muropa, asi izvi zvichida hazvikwani kukonzera zviratidzo zvemakiriniki. Kana ukaronga kushandisa chero mishonga yemishonga inowedzera zvakakosha kutaurirana neoncologist yako.
Zvimwe Zvimwe: Mishonga Inogona Kushandiswa Panzvimbo
Iwe unogona kunge uri kushamisika kuti chii chaunogona kutora kana uri kushandisa tamoxifen:
- Anodzvinyirira anowanzosiyana nehuwandu hwavanoshandisa nayo enzyme CYP2D6. Cymbalta (duloxetine) inoratidzika kuvhara mazinga eYP2D6 pasi pemamwe akawanda evanhu vanodzvinyirira. Mishonga iri pamusoro apa pasi pe "madhiragi ekudzivisa" inopesana zvakanyanya muhuwandu hwavanodzivisa nayo enzyme. Zvidzidzo zvemazuva ano zvinoratidza kuti mamwe emadhora ekudzivirira angave akachengetedzeka kushandiswa ne tamoxifen, asi zvidzidzo panguva ino hazvisati zvisinganzwisisiki kana izvi zvingave zvine kliniki yehutano zvakare.
- Kurwarisa nemishonga inotonhora: Mishonga yakawanda inotonhorera ine zvigadzirwa zvinopfuura rimwe chete, saka zvakakosha kuverenga mavara. Nhamba yakawanda ye-over-the-counter yekugadzirira zvirwere uye chirwere chinosanganisira Benadryl. Zvimwe zvinodhaka zvinoshandiswa seZyrtec naClaritin zvinofungidzirwa kuti zvakachengeteka kushandiswa ne tamoxifen.
- Acid reflux mishonga inenge yakakodzera inosanganisira Zantac (ranitidine) nevamwe.
Tiri kugara tichinyanya kudzidza nezvemishonga yekurapa uye zvakakosha kutaura nemumwe wako oncologist uye wemasimine pamusoro pemishonga ipi zvayo yaunoda kushandisa pamwe ne tamoxifen.
QT Prolongation
Kana iwe wakatarisa pahomwe yako pakuratidzira iwe unogona kunge wakacherechedza kuti tamoxifen haifaniri kushandiswa nemimwe mishonga inowedzera nguva yeKT. Nguva yeKT inoreva nguva yakawanda pakati pemafungu maviri akaonekwa pane electrocardiogram. Zvinofungidzirwa kuti kana nguva yeKT ichiwedzerwa zvakanyanya, inomutsa dambudziko rekusava nemwoyo yenguva, uye zvichida, kufa kamwe kamwe.
Ikokuvhara kwemashoko inonyevera kuti tamoxifen inogona kukonzera QT kuwedzerwa kana yakashandiswa pamwe nemamwe mishonga inogona kukonzera QT kuwedzerwa. A 2017 kudzokorora zvidzidzo, zvisinei, inotaura kuti pane inogona kuva nengozi yakanyanya yekliniki inokosha QT prolongation munharaunda iyi, kunyanya pa 20 mg chete zuva rega rega.
The Genetics of Tamoxifen uye CYP2D6 Kuedza
Pane mhando yebasa reYP2D6 enzyme, uye izvi zvinoguma nekusiyana mune metabolism yemishonga. Kuongororwa kweongororo kwakawanikwa kuti maitiro akawanda emagetsi anoita seanova nemigumisiro iri nani kudarika varombo vemajini. Kakawanda, vanenge 20 muzana yevanhu vakapedza basa re enzyme iyi.
Saka iwe unoziva sei kana iwe ungave uri murombo wemagetsi? Iko kune zvekutengesa genotyping chikwata chekutsvaga chinowanikwa ku genotyping yeYP2D6, asi kuongororwa hakusi kuitirwa vakadzi pa tamoxifen therapy nokuda kweerogen receptor-positive chenza chepamu. Mune mamwe mazwi, zvichida hauzombozivi. Iyi inzvimbo yepikisano pamwe chete, uye vamwe vatsvakurudzi vanodavira kuti kuvapo kweimwe enzyme, CYP3A4 * 22 inogona kubhadhara kuderedza kwekupedzisira kwe-endoxifen yakabatana nechepasi CYP2D6 basa.
Zvakare, zvakakosha kuziva kuti basa reYP2D6 rinowanzova rakakwirira mumazhizha ezhizha (zvichienderana ne vitamini D kune imwe nguva), uye kuongorora kwevhitamini D kunokosha kune vakadzi vanorarama nekenza yemazamu.
Pasi Pasi paTamoxifen Drug Interactions
Tamoxifen imishonga iyo vakadzi vanotora zuva nezuva kwenguva yakareba mushure mekuongororwa kwekenza yemazamu. Kana inotorwa sezvinotungamirirwa, inogona kuderedza dambudziko rekudzoka (uyezve, rufu). Sezvo zvakadaro, kunzwisisana kunogona kuwirirana kunokosha zvikuru.
Zvimwe zvinoshandiswa pakushandisa zvinodhaka zvinogona kuva zvinyoro, asi mamwe mishonga inogona kunge yakanyanyisa zvachose migumisiro ye tamoxifen kana yakatorwa panguva imwe chete. Izvi zvakaratidzirwa kwete chete murabhu iri kutarisa metabolism yemishonga iyi, asi inoonekwa kliniki mune kuwedzera kwekufa kwevakadzi vakadzi vakatora Paxil pamwe ne tamoxifen.
Mashoko matsva ari kuuya kumusoro (kufanana nehutamende D ruzivo rwakataurwa pamusoro). Kufambira mberi kwakakurumidza mune mishonga yekenza kunoita kuti zvive zvakakosha kudarika kare kuti uve mutevereri wako mukuchengetedzwa kwekenza , Chidzidzo chinoratidzira pfungwa iyi ndiyo yakatarisa vakadzi vachitora tamoxifen munguva yegore kubva muna 2005 ne2010 (mushure mekunge taziva pane zvimwe zvekubatana). Panguva iyoyo, Paxil yaiva imwe yezvinowanzozivikanwa zvinodzvinyirirwa zvevakadzi kune tamoxifen. Zvimwe kunyanya kunetseka, zvakadaro, ndezvokuti vazhinji vanopfuura-the-counter kugadzirira vanogona kuwirirana ne tamoxifen, vachisiya vanhu voga kuti vaone kubatana kwemishonga.
> Sources:
> Antunes, M., Timm, T., de Oliveira, V. et al. Kuchinja kweYP2D6 neYP3A4 Phenotypes, Drug Interactions, uye Vitamin D Mamiriro eTamoxifen Biotransformation. Kurapa Drug Monitoring . 2015. 37 (6): 733-44.
> Juurlink, D. Kudzokorora Kudyidzana Kwemishonga Pakati peTamoxifen uye SSRI Antidepressants. BMJ . 2016. 354: i5309.