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Numune Saglik Dergisi RAMAZAN SAYISI

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Numune Saglik Dergisi RAMAZAN SAYISI 
Ankara Numune Eğitim ve Araştırma Hastanesi yayınıdır
ISSN 1309-9213
TEMMUZ-AĞUSTOS 2013
RAMAZAN ve SAĞLIK
ÖZEL SAYISI
Ramazan Ayında Beslenme
Oruç İbadeti ve
Gastro-İntestinal Sistem Sorunları
Ramazanda Diyabet Yönetimi İçin Öneriler
Kronik Böbrek Hastalığı ve Ramazan
Çalışan Annenin Ramazan Ayına Bakışı
Ramazanın ve Orucun Hikmetleri
Orucu Bozan ve Bozmayan
Muayene ve Tedavi Yöntemleri
Ramazan ve Kalp Sağlığı
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Referanslar:
1. Bauer M et al. A pooled analysis of two randomised, placebo-controlled studies of extended release quetiapine fumarate adjunctive to antidepressant therapy in patient with major depressive disorder. J Affect DB 2010; 127:19-30 2. Seroquel XR Ürün Bilgisi.
Seroquel XR 50 mg, 200 mg, 300 mg, 400 mg
11
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TKECTKØTØPØPCFČ5GTQSWGNŠ:4OIOIOIOI7\CVČNOČĵ5CNČONČ6ablet
Etkin madde: ketiapin (ketiapin fumarat olarak) Her tablette: 5ČTCUČ[NC50 mg, 200 mg, 300 mg, 400 mg ketiapin (ketiapin fumarat olarak) içerir. Ticari formun, CODCNCLČPKÃGTKüKPVC+PCTFE/alüminyum blisterde, 30,60 ve 90 tablet içeren kutularda. Endikasyon: 5'4137'.XR ĵK\QHTGPKtedavisinde, orta-ileri derece mani CVCMNCTČPČPtedavisinde, bipolar DQ\WMNWüCGĵNKMeden depresif aVCMNCTČPtedavisinde ve bipolar DQ\WMNWMVCMKmanik veya depresif CVCMNCTČ
ketiapin tedavisine cevap XGTOKĵhastalarda rekürrenslerin önlenmesinde, majör depresif nöbet tedavisinde, FKüGTantidepresan tedavilere cevap CNČPCOC[CPdurumlarda endikedir. &Q\CLČve uygulama yöntemi: 5'4137'.XR, günde bir defa MWNNCPČNOCNČFČT, yemeklerle beraber MWNNCPČNOCOCNČFČT. Tabletler bütün olarak [WVWNOCNČbölünmemeli, ÃKüPGPOGOGNKya da G\KNOGOGNKFKT. ĴK\QHTGPKtedavisinde ve bipolar DQ\WMNWüCGĵNKMeden orta - ileri derece manik
CVCMNCTČPtedavisinde: 5'4137'.XR yemeklerden en C\1 saat önce verilmelidir. Tedavi DCĵNCPIČEČPFCMKgünlük FQ\NCTbirinci gün 300 mg, ikinci gün 600 OIoFČTÖnerilen günlük FQ\600 mg QNOCUČPCTCüOGPGüGTklinik olarak gerekli ise günlük FQ\ 800 mg’a ÃČMČNCDKNKT. -WNNCPČNCPFQ\CNČPCPklinik [CPČVCve JCUVCPČPtolerabilitesine DCüNČolarak, günde 400-800 mg CTCUČPFCFGüKĵGP etkili FQ\UČPČTNCTČCTCUČPFCkalacak ĵGMKNFGC[CTNCPOCNČFČT. ĴK\QHTGPKFGMK
KFCOGVGFCXKUKPFGFQ\C[CTNCPOCUČPCKJVK[CÃ[QMVWT$KRQNCTDQ\WMNWüCGĵNKMGFGPFGRTGUKHCVCMNCTČPVGFCXKUKPFG5'4137'.:4yCVCTMGPCNČPOCNČFČT. TGFCXKPKPKNMIØPØPFGCNČPCECMVQRNCOIØPNØMFQ\NCTIØPOIIØPOIIØPOIXGIØ POIoFČT²PGTKNGPIØPNØMFQ\OIoFČT-NKPKMÃCNČĵOCNCTFCOIITWDWKNGMCTĵČNCĵVČTČNFČüČPFCOIITWDWPFCKNCXGDKTHC[FCIÒ\NGPOGOKĵVKT
DCMČPČ\DÒNØO$KTG[UGNQNCTCMJCUVCNCT
600 mg FQ\FCPfayda görebilir. 300 mg’dan yüksek FQ\NCT, bipolar DQ\WMNWMkonusunda deneyimli doktorlar VCTCHČPFCPDCĵNCVČNOCNČFČT. Bireysel olarak hastalarda, toleransla ilgili olaylar QNOCUČdurumunda, klinik ÃCNČĵOCNCTFCminimum 200 mg’a kadar FQ\C\CNVČNOCUČPČPFGüGTNGPFKTKNGDKNGEGüKDGNKTVKNOKĵVKT. Bipolar DQ\WMNWMVCnükslerin önlenmesi tedavisinde: Akut tedavide 5'4137'.XR’ye cevap XGTOKĵhastalarda, bipolar DQ\WMNWüWPmanik, karma veya
depresif ataklardaki rekürrenslerin önlenmesi tedavisinde, yatmadan önce C[PČFQ\FC5'4137'.XR W[IWNCPOCUČPCdevam edilmelidir. 5'4137'.XR FQ\Wher bir JCUVCPČPklinik EGXCDČPCve VQNGTCPUČPCDCüNČolarak günde 300-800 OIoNČMFQ\CTCNČüČPFCFGüKĵGDKNKr. ċFCOGtedavisi için en FØĵØMetkin FQ\WPMWNNCPČNOCUČönemlidir. Majör depresif DQ\WMNWüWPtedavisinde: 5'4137'.XR CMĵCOkuNNCPČNOCNČFČT. $CĵNCPIČÃFQ\Wolarak 1. ve 2. gün 50 mg ile
DCĵNCPOCNČXGKNGIØPOIoCÃČMČNOCNČFČT&CJCUQPTCJGTDKTJCUVCPČPMNKPKMEGXCDČPCXGVQNGTCPUČPCDCüNČQNCTCMiNCOIoNČMFQ\CTCNČüČPFCCĵCüČXG[C[WMCTČDCĵMCC[CTNCOCNCT[CRČNCDKNKT5'4137'.ÃCDWMUCNČONČVCDNGVNGTFGPIGÃKĵ5'4137'.ƂNOVCDNGVMWNNCPCTCMVGFCXKNGTKFGXCOGFGPJCUVCNCTFCMWNNCPFČMNCTČIØPNØMVQRNCOFQ\MCFCT5'4137'.:4XGTKNGTGMVGFCXKNGrine devam edilebilir$KTG[UGNFQ\C[CTNCOCNCTČPCKJVK[CÃFW[WNCDKNKT. Böbrek/
MCTCEKüGT[GVOG\NKüKBöbrek [GVOG\NKüKolan hastalarda FQ\C[CTNCPOCUČPCihtiyaç yoktur. Ketiapin, [C[IČPolarak MCTCEKüGTFGmGVCDQNK\Gedilir. Bu nedenle 5'4137'.XR, MCTCEKüGT[GVOG\NKüKQNFWüWbilinen hastalarda, Ò\GNNKMNGtedavinin DCĵNCPIČÃdöneminde dikkatli MWNNCPČNOCNČFČT. -CTCEKüGT[GVOG\NKüKolan hastalarda tedaviye, günde 50 mg ile DCĵNCPOCNČFČT. Daha sonra FQ\CNČPan klinik [CPČVCve JCUVCPČPtolerabilitesine DCüNČolarak, günde 50 OIoNČM
CTVČĵNCTNCGVMKNKFQ\C[ØMUGNVKNGDKNKT%KFFKMCTCEKüGT[GVOG\NKüKPFGMWNNCPČNOCOCNČFČT2GFK[CVTKMRQRØNCU[QP5'4137'.:4oPKPIØXGPNKNKMXGGVMKPNKüKÃQEWMNCTFCXGCFQNGUCPNCTFCFGüGTNGPFKTKNOGOKĵVKT[CĵČPCNVČPFCMKNGTFGMWNNCPČOČÒPGTKNOG\)GTK[atrik popülasyon: YCĵNČNCTFCÒ\GNNKMNGVGFCXKPKPDCĵNCPIČÃFÒPGOKPFGFKMMCVNGMWNNCPČNOCNČFČT$CĵNČEC[CPGVMKNGTXGCNČPOCUČIGTGMGPÒPNGONGT£QM[C[IČP$CĵFÒPOGUKUQOPQNCPUDCĵCüTČUČCüČ\MWTWOCUČ
serum trigliserid FØ\G[NGTKPFGCTVČĵtotal kolesterol (genellikle .&.kolesterol) FØ\G[NGTKPKPCTVOCUČyoksunluk UGORVQONCTČ *&.kolesterol FØ\G[KPFGC\CNOCkilo CTVČĵČhemoglobinde C\CNOCYC[IČP.ÒMQRGPKhiperprolaktinemi, KĵVCJCTVČĵČanormal rüyalar ve kabuslar, W[WTIG\GTNKMve FKüGTKNKĵMKNKolaylar, senkop, ekstrapiramidal semptomlar, disartri, VCĵKMCTFKÃCTRČPVČ DWNCPČMgörme, ortostatik hipotansiyon, rinit, dispne, MCDČ\NČMdispepsi, JCƂf asteni,
periferik ödem, FW[CTNČNČMkilo CTVČĵČserum VTCPUCOKPC\
#.T, AST) FØ\G[NGTKPFGyükselme, PÒVTQƂl UC[ČUČPČPC\CNOCUČkan ĵekerinin hiperglisemik FØ\G[Gyükselmesi, serum prolaktin FØ\G[KPFGCTVČĵtotal T4’de C\CNOCserbest T4’de C\CNOCtotal T3’de C\CNOCTSH’da CTVČĵYC[IČPolmayan: 'Q\KPQƂli, trombositopeni, CĵČTČFW[CTNČNČMkonvülsiyon, JW\WTUW\bacak sendromu, FK\atri, nöbet, )COOC)6FØ\G[NGTKPKPyükselmesi, platelet UC[ČUČPČPC\CNOCUČserbest
T3’ de C\CNOCSeyrek: 5CTČNČMRTKCRK\Ogalaktorea, nötroleptik malign sendrom, kan kreatin HQUHQMKPC\seviyelerinde CTVČĵÇok seyrek: #PCƂlaktik reaksiyon, Hiperglisemi, Diabetes Mellitus, tardif FKUMKPG\Kdisfaji, hepatit, anjiyoödem, Stevens-Johnson sendromu. Bilinmiyor: Nötropeni. $CĵNČECGVMKNGĵKONGTKIGÃKOUK\NKMNGTKKetiapin öncelikle OGTMG\Ksinir sisteminde etkili bir ilaç QNFWüWPFCP5'4137'.XR, yine OGTMG\Ksinir sitemini etkileyen FKüGTilaÃNCTNCXGCNMQNNGDKTNKMVGFKMMCVNGMWNNCPČNOCNČFČT5KVQMTQO2
%;2#MGVKCRKPKPUKVQMTQO2GP\KOUKUVGOKCTCEČNČüČ[NCIGTÃGMNGĵGPOGVCDQNK\OCUČPFCPUQTWONWDCĵNČECGP\KOFKT5CüNČMNČIÒPØNNØNGTFGMKGVMKNGĵKOÃCNČĵOCNCTČPFCOIMGVKCRKPKPbKT%;2#KPJKDKVÒTØQNCPMGVQMQPC\QNKNGDKTNKMVGMWNNCPČNOCUČMGVKCRKP'##FGüGTKPKPMCVCTVOCUČ[NCUQPWÃNCPOČĵVČT. KetiCRKPKP%;2#KPJKDKVÒTNGTK[NGDKTNKMVGMWNNCPČNOCUČDWPGFGPNGMQPVTGPFKMGFKT.
Ketiapinin C[TČECgreyfurt suyuyla CNČPOCUČda önerilmemektedir. #\QNUČPČHČantifungal ilaçlar, klaritromisin, diklofenak, doksisiklin, eritromisin, imatinib, K\QPKC\KFPGHC\QFQPnikardipin, propofol, RTQVGC\inhibitörleri kinidin, telitromisin ve verapamil gibi güçlü CYP3A4 inhibitörleri ile birlikte MWNNCPČNCPketiapinin RNC\OCMQPUCPVTCU[QPNCTČklinik ÃCNČĵOCNCTUČTCUČPFChastalarda IÒ\NGPGPFGPönemli ölçüde daha yüksek olabilir. Böyle bir durumda daha FØĵØM
5'4137'.XR FQ\NCTČMWNNCPČNOCNČFČT. YCĵNČNCT ve Ƃ\KMUGNdurumu iyi olamayan JCUVCNCTČ Ò\GNNKMNGFØĵØPOGMgerekir. Risk- fayda QTCPČher hasta için C[TČ FGüGTNGPFKTKNOGNKFKT. Bilinen bir MCTCEKüGTGP\KOindüktörü olan MCTDCOC\GRKPtedavisi öncesinde ve UČTCUČPFCverilen ketiapin HCTOCMQMKPGVKüKPKPFGüGTNGPFKTKNFKüKçok FQ\NWÃCNČĵOCFCMCTDCOC\GRKPNGbirlikte MWNNCPČOČPketiapin klerensini önemli ölçüde CTVČTFČüČIÒTØNOØĵVØT. Klerensteki bu CTVČĵNCEAA
FGüGTK[NGÒNÃØNGPUKUVGOKMMGVKCRKPGVMKUKPQTOCNMGVKCRKPW[IWNCOCUČPCIÒTGMCTDCOG\KPKNGDKTNKMVGMWNNCPČNCPMGVKCRKPFGoTVCNCOCoGFØĵGTCPECMDWFØĵØĵDC\ČJCUVCNCTFCÃQMFCJC[ØMUGMQTCPFCIGTÃGMNGĵOKĵVKT$WGVMKNGĵKOKPDKTUQPWEWQNCTCMRNC\OCFCMKMGVKCRKPMQPUCPVTCU[QPNCTČC\CNCDKNKTXG5'4137'.:4VGFCXKUKPKPGVMKPNKüKC\CNCDKNKT-GVKCRKPKPDKTFKüGTOKMTQ\QOCNGP\KOKPFØMVÒTØQNCPHGPKVQKPNGDKTNKMVGXGTKNOGUKMGVKCRKPMNGTGPUKPKPÃQM
yüksek oranda (% 450) CTVOCUČPCsebep QNOWĵVWT. -CTCEKüGTGP\KOindüktörü kullanmakta olan hastalarda 5'4137'.XR tedavisine baĵNCPOCUČsadece hekimin, 5'4137'.XR tedavisinin HC[FCNCTČPČP MCTCEKüGTGP\KOindüktörü tedavisine son verilmesinden FQüCECM risklerden HC\NCQNFWüWPWFØĵØPFØüØtakdirde DCĵNCPOCNČFČT. ċPFØMVÒTilaçta [CRČNCECMherhangi bir FGüKĵKMNKM[CXCĵ[CXCĵgerÃGMNGĵVKTKNOGNKve gerekirse bunun yerine, MCTCEKüGTGP\KOindüktörü olmayan bir ilaca ÒTPGüKPsodyum valproata) geçilmelidir DM\Bölüm 4.4 ). Ketiapin HCTOCMQMKPGVKüKbilinen bir CYP 2D6 inhibitörü olan antidepresan imipramin veya bilinen bir CYP 3A4 ve CYP 2D6 inhibitörü olan ƃuoksetinle birlikte XGTKNFKüinde, önemli ölçüde FGüKĵOGOKĵVKT. Birer antipsikotik olan risperidon veya haloperidol ile birlikte MWNNCPČNOCUČketiapinin faTOCMQMKPGVKüKPFGönemli FGüKĵKMNKMNGTGneden QNOCOČĵVČT. Ketiapin ve VK[QTKFC\KPKP
DKTNKMVGMWNNCPČNOCUČMGVKCRKPMNGTGPUKPK[CMNCĵČMQTCPČPFCCTVVČTOČĵVČT5KOGVKFKPKNGDKTNKMVGMWNNCPČOČVCMKDGPMGVKCRKPKPHCTOCMQMKPGVKüKPFGFGüKĵKMNKMQNOCOČĵVČT-GVKCRKPNGDKTNKMVGMWNNCPČNFČüČPFCNKV[WOWPHCTOCMQMKPGVKüKFGüKĵOGOKĵVKT. OrtCKNGTKFGTGEGOCPKCVCMNCTČPFCMGVKCRKPKPFKXCNRTQGMUNGXG[CNKV[WONCDKTNKMVGMWNNCPČNOCUČPCCKVXGTKNGTUČPČTNČFČTCPECMDW MQODKPGVGFCXKNGTK[KVQNGTGGFKNOKĵVKT
DM\DÒNØOXG8eriler, üçüncü haftada aditif
GVMKQNFWüWPWIÒUVGTOKĵVKTċMKPEKDKTÃCNČĵOCFCCNVČPEČJCHVCFCJGTJCPIKDKTCFKVKHGVMKIÒTØNOGOKĵVKT$KTNKMVGMWNNCPČNCPUQF[WOXCNRTQCVXGMGVKCRKPKPHCTOCMQMKPGVKMNGTKMNKPKMVGÒPGOVCĵČ[CECMĵGMKNFGFGüKĵOGOKĵVKT. Hipotansiyonu indükleme potansiyGNKQNFWüWPFCPMGVKCRKPDC\ČCPVKJKRGTVCPUKHKNCÃNCTČPGVMKNGTKPKCTVČTCDKNKT-GVKCRKPGNGMVTQNKVFGPIGUK\NKüKPGXG[C36c CTCNČüČPČPW\COCUČPCUGDGRQNFWüWDKNKPGPKNCÃNCTNCDKTNKMVGFKMMCVNGMWNNCPČNOCNČFČT. Ketiapin
CNCPJCUVCNCTFCOGVCFQPXGVTKUKMNKMCPVKFGRTGUCPNCTKÃKPGP\KOKOOØPQCPCNK\NGTKPFG[CNCPEČRQ\KVKHUQPWÃNCTTCRQTGFKNOKĵVKT. 7[IWPDKTMTQOCVQITCƂMVGMPKMKNGĵØRJGNKKOOØPQCPCNK\VCTCOCUQPWÃNCTČPČPFQüTWNCPOCUČVCXUK[GGFKNOGMVGFKT. Ketiapinin, karbCOC\GRKP[CFCHGPKVQKPIKDKIØÃNØMCTCEKüGTGP\KOKPFØMVÒTNGTK[NGDKTNKMVGMWNNCPČNOCUČMGVKCRKPRNC\OCFØ\G[NGTKPKÒPGONKöNÃØFGC\CNVCTCMMGVKCRKPVGFCXKUKPKPGVMKPNKüKPKC\CNVCDKNKT$KTMCTCEKüGTG\KOKP
düktörü kullanmakta olan hastalarda 5'4137'.XR tedavisine sadece hekim, 5'4137'.XR’den beklenen [CTCTNCTČPMCTCEKüGTGP\KOindüktörü tedavisine son verilmesinden FQüCECMrisklerden HC\NCQNFWüWPWFØĵØPFØüØtakdirde DCĵNCOCNČFČT. ċPFØMVÒTilaçta [CRČNCcak herhangi bir FGüKĵKMNKM[CXCĵ[CXCĵIGTÃGMNGĵVKTKNOGNKve gerekirse bunun yerine, MCTCEKüGTGP\KOindüktörü olmayan bir ilaca ÒTPGüKPsodyum valproat) geçilmelidir. Kontrendikasyonlar,
W[CTČNCTve ürün MWNNCPČNČTMGPdikkat edilmesi gereken durumlar: 5'4137'.XR, formülasyonunda bulunan etkin maddeye veya [CTFČOEČmaddelerden herhangi birine MCTĵČCĵČTČFW[CTNČNČMFCciddi santral sinir sistemi depresyonunda, kemik KNKüKDCUMČNCPOCUČkan FKUMTC\KNGTKciddi MCTCEKüGTJCUVCNČüČkoma durumunda, HIVRTQVGC\inhibitörleri, C\QNUČPČHČantifungal ilaçlar, eritromisin, klaritromisin ve PGHC\QFQPgibi, sitokrom P450 3A4 inhibitörleriyle birNKMVGMWNNCPČNOCUČMQPVTGPFKMGFKTċPVKJCTKNGKNIKNKQNC[Ò[MØUØQNCPJCUVCNCTČPXG[CVGFCXK[GDCĵNCOCFCPÒPEGÒPGONKFGTGEGFe intihar ƂMTKUGTIKNG[GPJCUVCNCTČPKPVKJCTFØĵØPEGUKXG[CKPVKJCTIKTKĵKOKCÃČUČPFCPDØ[ØMTKUMCNVČPFCQNFWMNCTČDKNKPOGNK ve bu hastalar tedavi boyunca dikkatle takip edilmelidir. Ketiapin tedavisi sedasyon gibi somnolans ve ilgili semptomlarla iliĵMKNGPFKTKNOKĵVKT$KRQNCTFGRTGU[QPNWJCUVCNCTČPVGFCXKUKKÃKP[CRČNCPMNKPKMÃCNČĵOCNCTFC
DCĵNCPIČÃgenellikle tedavinin ilk 3 gününde olur ve DCUMČPolarak JCƂf ila orta [QüWPNWMVCFČT. ĴKFFGVNK[QüWPNWMVCsomnolans deneyimleyen bipolar depresyon JCUVCNCTČUQOPQNCPUČPDCĵNCPIČEČPFCPitibaren minimum 2 hafta veya semptomlar K[KNGĵGPGkadar daha UČMtemasa gerek duyabilir ya da tedavinin kesilmesinin FGüGTNGPFKTKNOGUKgerekebilir. Antipsikotik KNCÃNCTČPMWNNCPČONCTČUČTCUČPFCXGPÒ\VTQODQGODQNK\O(VTE) XCMCNCTČTCRQTNCPOČĵVČT. Antipsikotikler
KNGVGFCXKGFKNGPJCUVCNCTČPÃQüWMG\86'KÃKPTKUMHCMVÒTNGTKVCĵČOCNCTČPFCPÒVØTØMGVKCRKPKNGVGFCXKÒPEGUKPFGXGUČTCUČPFa86'KÃKPQNCUČVØOTKUMHCMVÒTNGTKDGNKTNGPOGNKXGIGTGMNKÒPNGONGTCNČPOCNČFČT$KNKPGPMCTFK[QXCUMØNGTJCUVCNČüČUGTGDTQXCUMØNGTJCUVCNČüČXG[CJKRQVCPUK[QPC\GOKPJC\ČTNC[CPFKüGTMQĵWNNCTČDWNWPCPJCUVCNCTFCFKMMCVNGMWNNCPČNOCNČFČT. Konvülsiyon anCOPG\KQNCPJCUVCNCTČPVGFCXKUKPFGFKMMCVNKQNWPOCUČÒPGTKNOGMVGFKT. TCTFKHFKUMKPG\KDG
lirtileri ve UGORVQONCTČIGNKĵKTUG5'4137'.XR FQ\WPWPC\CNVČNOCUČveya MWNNCPČOČPCson verilmesi FØĵØPØNOGNKFKT. Hipertermi, mental durum FGüKĵKMNKüKkas rijiditesi, otonom instabilite ve kreatinin HQUHQMKPC\FØ\G[NGTKPKPyükselmesi gibi, bu sendroma ait klinik belirtiler IGNKĵKTUG5'4137'.XR tedavisi FWTFWTWNOCNČve gereken VČDDKtedavi W[IWNCPOCNČFČT. Ciddi nötropeni vakaUČgeçiren hastalar, enfeksiyon belirti ve UGORVQONCTČCÃČUČPFCPFGüGTNGPFKTKNOGNK
ve PÒVTQƂl UC[ČOČtakip edilmelidir (1,5 x .’yi CĵCPCkadar). Ketiapinin, MCTDCOC\GRKPya da fenitoin gibi, güçlü MCTCEKüGr GP\KOindüktörleriyle birlikte MWNNCPČNOCUČketiapin RNC\OCFØ\G[NGTKPKönemli ölçüde C\CNVCTCMketiapin tedavisinin etkinliüKPKC\CNVCDKNKT. Ketiapin tedavisi UČTCUČPFChiperglisemi IGNKĵOGUKveya önceden mevcut diyabetin ĵKFFGVNGPOGUK DKNFKTKNOKĵVKr. Aspirasyon pnömonisi riski bulunan hastalarda 5'4137'.XR ve FKüGTantipsikotik
KNCÃNCTFKMMCVNKĵGMKNFGMWNNCPČNOCNČFČT. TTKINKUGTKFXGMQNGUVGTQNFØ\G[NGTKPKP[ØMUGNOGUKMGVKCRKPKNG[ØTØVØNGPMNKPKMÃCNČĵOCNCTFCIÒ\NGPOKĵVKT-NKPKMÃCNČĵOCNCTFCIÒ\NGPGPMKNQMCPĵGMGTK
DCMČPČ\JKRGTINKUGOKXGNKRKFFGüKĵKMNKMNGTKFGüGTNGPFKTKNFKüKPFGDKTG[UGNQNCTCMJCUVCNCTFCOGVCDQNKMTKUMRTQƂNKPFGMÒVØNGĵOGQNCDKNGEGüKFKMMCVGCNČPOCNČXGMNKPKMNGW[WONWQNCTCM tedavi edilmelidir5GTWOVTCPUCOKPC\NCTČPFC
DCĵVC#.6QNOCMØ\GTGCUGORVQOCVKMIGÃKEK
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ilaç CNOČĵQNCDKNGEGüKde FØĵØPØNOGNKve [QüWPDCMČOW[IWNCPOCNČFČT. #ÃČMbir hava yolunun UCüNCPČRdevam ettirilmesi, yeterli oksijenasyon ve ventilasyon UCüNCPOCUČkardiyovasküler sistemin K\NGPOGUKve desteklenmesi, bu gibi vakalarda CNČPOCUČgereken önlemlerdir. &Q\CĵČOČPFCemilimin önlenmesi KPEGNGPOGOKĵVKTama ciddi \GJKTNGPOGdurumunda mide [ČMCPOCNČ ve GüGTmümkünse bu CNČPČOFCPsonraki bir saat içinde W[IWNCPOCNČFČT. Aktif VČDDK
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(127/19 - 26.03.2009), 400 mg W\CVČNOČĵUCNČONČtablet: 30 ve 60 tablet (127/20 - 26.03.2009). Daha IGPKĵbilgi için ƂTOCOČ\CDCĵXWTWPW\Reçete ile UCVČNČT. KDV dahil perakende UCVČĵƂ[CVČ50 mg 30 tablet: (54.75 6.200 mg 30 tablet: (70.77 6.200 mg 60 tablet: (141.57 6.300 mg 30 tablet: (112.75 6.300 mg 60 tablet: (225.54 6.400 mg 30 tablet: (174.58 6.400 mg 60 tablet: (326.32 6.)ØPEGNKÜB’ün 5CüNČM$CMCPNČüČVCTCHČPFCPonay
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18
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20
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†‡º‡”Ž‡†‹”‹Ž†‹º‹†‡ǡ‰Úœ†ƒŽƒ•Ç‘”—…—
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21
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22
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25
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27
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•‡”‡•›‘——ƒœƒŽƒ•Çƒ•‡„‡’
‘Žƒ–ƒ†Ç”Ǥ›Çœƒƒ†ƒ‰Ž—ƒ‰‘˜‡
ƒ–‡‘Žƒ‹•‡˜‹›‡Ž‡”‹ƒ”–ƒ”ǡ‰Ž—‘Œ‡‹
›ÇÇÇ—›ƒ”ÇŽÇ”˜‡‰Ž—‘‡‘‰‡‡œ
ƒ”–ƒ”ȋ͜ȌǤ­ŽÇ˜‡‘”—­•ò”‡•‹—œƒ†Ç­ƒǡ
‰Ž—‘Œ‡†‡’‘Žƒ”Ç„‹–‡›‡„ƒçŽƒ”˜‡
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ƒ”––ǔǔǤƒºƒ•‹–Ž‡”‹‹‘•‹†ƒ•›‘—‹Ž‡
‹•‡Ž‡–ǦƒŽ’ƒ•Çǡƒ”ƒ…‹º‡”ǡ„Ú„”‡˜‡
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†—”——†ƒ‘”—­œƒƒÇƒ‰‡­‹ç‹͗
ƒçƒƒ›ƒ„ÚŽòç–ò”ǣ
͕Ȍ ‹Ž‹•‘”ƒ•ÇˆƒœÇǡ‘”—­„ƒçŽƒ†Ç–ƒ
͚Ǧ͖͘•ƒƒ–•‘”ƒ
y ˜ƒ–‘”†ƒ—œƒŽÇŽƒ”ǐ‡†‡‹›Ž‡
ƒƒœƒƒ›Ç†ƒǡڜ‡ŽŽ‹Ž‡›ƒœ
ƒ›Žƒ”ljò‹­‹͕͜•ƒƒ––‡ˆƒœŽƒ‘”—­
–—–ƒò•ŽòƒŽƒ”ǐ†—”——›Žƒ
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„‡Ž‡‡–‡†‹”Ȍ
–ƒŠ‹‹͔͛Ǧ͔͜‰‰—Ž‘Œ‡„‡›‹˜‡
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•ƒƒ–ƒ”çǎƒ›ƒ„‹Ž‹”ȋ͕͔ȌǤ‹›ƒ„‡–‹‘Žƒ›ƒ
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ƒ”ƒŽÇ–ƒ–—–ƒ›ƒ­ƒŽÇ烐†‘ŽƒçǏ†ƒ‹
‹•—Ž‹˜‡–‡”•‡–‹Ž‹ƒ–‡‘Žƒ‹˜‡
‰Ž—ƒ‰‘‰‹„‹Š‘”‘Žƒ”ǐŠƒ••ƒ•
‘”ƒÇ‹Ž‡†òœ‡Ž‡‡–‡†‹”Ǥ——
›ƒÇ†ƒ†‹›ƒ„‡–‹Šƒ•–ƒŽƒ”†ƒǡ‰Ž—‘œ
Š‡‘•–ƒœÇƒŽ––ƒ›ƒ–ƒ’ƒ–‘ˆ‹œ›‘Ž‘Œ‹
†—”—˜‡‹•—Ž‹•‡”‡•›‘——ƒ”––Ç”ƒ
ˆƒ”ƒ‘Ž‘Œ‹ƒŒƒŽƒ”‹Ž‡„‘œ—Žƒ–ƒ†Ç”Ǥ
‹’͕†‹›ƒ„‡–‹Šƒ•–ƒŽƒ”†ƒŠ‹’‘‰Ž‹•‡‹›‡
…‡˜ƒ’‘Žƒ”ƒ—›‰—‰Ž—‘‰ƒ‘ƒ”–ÇçÇ
‘Žƒ›ƒ„‹Ž‹”Ǥ‹‡„ƒœÇ–‹’͕†‹›ƒ„‡–‹
Šƒ•–ƒŽƒ”†ƒ‡’‹‡ˆ”‹•ƒŽÇÇÇ•‘”—Ž—†—”
­òò‘–‘‘‹Ú”‘’ƒ–‹˜‡–‡”ƒ”Žƒ›ƒ
Š‹’‘‰Ž‹•‡‹Ž‡”‡„ƒºŽÇ‘Žƒ”ƒ†‡‰‡
„‘œ—Ž—ç–—”ȋ͜ȌǤ‹††‹‹•—Ž‹‡•‹Ž‹º‹
‘ŽƒŠƒ•–ƒŽƒ”†ƒ›‡–‡”Ž‹‹•—Ž‹‘Žƒ†ƒ
͖Ȍ Ž—‘‡‘‰‡‡œˆƒœÇǡ‘”—…—͖Ǧ͕͔Ǥ
‰òŽ‡”‹ƒ”ƒ•Ç
͗Ȍ ”‘–‡‹‘”—ƒˆƒœÇǡ‘”—…—͕͔Ǥ
‰òò†‡•‘”ƒ
.‘º—†‹†‡‹‘”—­Žƒ”ƒ†‹”‡͖͘•ƒƒ–‹
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y ƒ’Ç•ƒŽ‡º‹–‹˜‡‰ò˜‡Ž‹‘”—­
ˆ‹œ›‘Ž‘Œ‹…‡˜ƒ’Žƒ”ƒ•‡„‡’‘Žƒ„‹Ž‹”Ǥ—
‹­‹†‡•–‡º‹‡–‹•‹‹ƒ”ƒç–ǔǎ†ÇºÇ
­ƒŽÇ珃Žƒ”ǐ†ƒ†ƒŠ‹Ž‘Ž†—º—›‡‹­Çƒ †‡º‹ç‹Ž‹•ƒ›‡•‹†‡„ƒœÇ­ƒŽÇ珃Žƒ”†ƒ
–‹’͕†‹›ƒ„‡–‹Šƒ•–ƒŽƒ”†ƒ„‹Ž‡—œƒÇç
Ž‹–‡”ƒ–ò”ò›‡‹†‡‹…‡Ž‡‡–‡†‹”Ǥ
‘”—…——›‰—Žƒƒ„‹”Ž‹º‹ƒ­ÇŽƒƒ„‹Ž‹”ȋ͕͕ȌǤ
y G”‡–‹„ƒœŽÇ–‡†ƒ˜‹Ž‡”‰‹„‹†ƒŠƒƒœ
‹”‰‡…‡Ž‹ƒ­ŽÇ–ƒ•‘”ƒǡ•ƒºŽÇŽÇ„‹”
Š‹’‘‰Ž‹•‡‹”‹•‹‘Žƒ›‡‹‹Žƒ­Žƒ”ǐ
‹•ƒ†ƒ‘”–ƒŽƒƒ‰Ž—‘œ—ŽŽƒÇÇ
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›‡‹„‹Ž‰‹Ž‡”•ƒºŽƒƒ–ƒ†Ç”Ǥ
31
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ƒ›Ç†ƒ‘”—­–—–ƒÇŠƒ•–ƒ‡›‡›ƒ–Çç
‰‡”‡–‹”‡…‡…‹††‹Š‹’‘‰Ž‹•‡‹”‹•‹‹–‹’
͕†‹›ƒ„‡–‹Ž‡”†‡͘ǡ͛ƒ–ȋ͗Ȃ͕͘‘Žƒ›Ȁ͕͔͔
‹•ƒȀ͕ƒ›Ȍǡ–‹’͖†‹›ƒ„‡–‹Šƒ•–ƒŽƒ”†ƒ͛ǡ͙
ƒ–ȋ͔ǡ͘Ȃ͗‘Žƒ›Ȁ͕͔͔‹•ƒȀ͕ƒ›Ȍƒ”–Ç”†ÇºÇ
‰Ú•–‡”‡­ƒŽÇ珃•Ç„—‘—†ƒ‹
‡‰‡‹çƒ’•ƒŽÇ˜‡”‹Ž‡”‡•ƒŠ‹’–‹”ȋ͚ȌǤ
—­ƒŽÇ珃†ƒ…‹††‹Š‹’‘‰Ž‹•‡‹‹•‹†ƒ•Ç
—Š–‡‡Ž‡–ƒŠ‹‡†‹Ž†‹º‹†‡†ƒŠƒ
ƒœ„—Ž——ç–—”­òòŠ‘•’‹–ƒŽ‹œƒ•›‘
‹Š–‹›ƒ…Ç‘Žƒ†ƒ–‡†ƒ˜‹‡†‹Ž‡˜ƒƒŽƒ”
­ƒŽÇ珃›ƒ†ƒŠ‹Ž‡†‹Ž‡‹ç–‹”Ǥ—
Šƒ•–ƒŽƒ”ǐ‘”–ƒŽƒƒ„ƒ͕…†‡º‡”Ž‡”‹
ƒƒœƒǯǐ„ƒçŽƒ‰Ç…ǐ†ƒ˜‡”‹Ž‡‡•‹
•‡„‡„‹›Ž‡„—­ƒŽÇ珃›ƒƒ–ÇŽƒŽƒ”ǐ‹›‹
‰Ž‹•‡‹‘–”‘Ž‡•ƒŠ‹’‘Ž—’‘Žƒ†ÇºÇ
„‹Ž‹‡‡–‡†‹”Ǥ‹††‹Š‹’‘‰Ž‹•‡‹
‘”ƒŽŠ‹’‘‰Ž‹•‡‹‹Žƒ­˜‡›ƒ‹•—Ž‹
†‘œ—†‡º‹ç‡Ž‡”†‡˜‡„‡Ž‹”‰‹›ƒçƒ
–ƒ”œÇ†‡º‹ç‹Ž‹º‹›ƒ’ƒŽƒ”†ƒ†ƒŠƒˆƒœŽƒ
‰Ú”òŽòç–ò”ȋ͚ȌǤ
32
‰Ú•–‡”‡„‹”­ƒŽÇ珃›‘–—”Ǥƒƒœƒ
ƒ›Ç†ƒ‘”—­–—–ƒ†‹›ƒ„‡–‹Ž‡”†‡
‰Ž‹•‡‹‘–”‘ŽòòÚ–òŽ‡ç†‹º‹ǡ
‹Ž‡”Ž‡†‹º‹˜‡›ƒŠ‹­„‹”†‡º‹çŽ‹Ž‹‘Žƒ†ÇºÇ
”ƒ’‘”ŽƒÇç–Ç”ȋ͖͕Ȃ͖͙ȌǤ­ƒŽÇ珃•Ç
Šƒ•–ƒ‡›‡›ƒ–Ç片”‡–‹”‡Š‹’‡”‰Ž‹•‡‹
”‹•‹†‡–‹’͖†‹›ƒ„‡–‹Ž‡”†‡͙ƒ–ȋ͕Ǧ͙
‘Žƒ›Ȁ͕͔͔‹•ƒȀ͕ƒ›Ȍƒ”–Ç瑎†—º——
‰Ú•–‡”‹ç–‹”Ǥ‹’͕†‹›ƒ„‡–‹Ž‡”†‡‹•‡
‡–‘ƒ•‹†‘œ—‡çŽ‹‡––‹º‹˜‡›ƒ‡–‡†‹º‹
…‹††‹Š‹’‡”‰Ž‹•‡‹”‹•‹†‡›ƒŽƒçǍ
͗ƒ–ȋ͙Ǧ͕͛‘Žƒ›Ȁ͕͔͔‹•ƒȀ͕ƒ›Ȍƒ”–Çç
•ƒ’–ƒÇç–Ç”Ǥ‹’‡”‰Ž‹•‡‹ǡŠ‹’‘‰Ž‹•‡‹›‹
ڐŽ‡‡‹­‹—ŽŽƒÇŽƒ‹Žƒ­†‘œŽƒ”ǐǐ
ƒœƒŽ–ÇŽƒ•Çƒ„ƒºŽÇ‘Žƒ”ƒ†ƒ‰‡Ž‹ç‡„‹Ž‹”Ǥ
ƒœŽƒ‹–ƒ”†ƒ›‡‡˜‡›ƒç‡‡”–ò‡–‡
Šƒ•–ƒŽƒ”†ƒ…‹††‹Š‹’‡”‰Ž‹•‡‹”‹•‹„‡Ž‹”‰‹
‘Žƒ”ƒ†ƒŠƒ›ò•‡„—Ž——ç–—”ȋ͚ȌǤ
‹›ƒ„‡–‹‡–‘ƒ•‹†‘œ
‹›ƒ„‡–‹Šƒ•–ƒŽƒ”ǡڜ‡ŽŽ‹Ž‡ƒƒœƒ
ƒ›Ç†ƒ‘”—­–—–ƒ˜‡ƒƒœƒƒ›Ç†ƒ
ڐ…‡Ú–ò‰Ž‹•‡‹‘–”‘Žò‘Žƒ–‹’
͕†‹›ƒ„‡–Ž‹Ž‡”ǡ†‹›ƒ„‡–‹‡–‘ƒ•‹†‘œ
‰‡Ž‹ç‹‹‹­‹›ò•‡”‹•ƒŽ–ǐ†ƒ†Ç”Žƒ”ȋ͚ȌǤ
—ƒ‡‘Žƒ”ƒǡƒ›„‘›—…ƒƒœ›‡‡
›‡‡›‡’ƒ”ƒŽ‡Ž‘Žƒ”ƒ‹•—Ž‹†‘œŽƒ”ǐǐ
ƒœƒŽ–ÇŽƒ•Ç†‹›ƒ„‡–‹‡–‘ƒ•‹†‘œ”‹•‹‹
†ƒŠƒˆƒœŽƒƒ”––Ç”ƒ–ƒ†Ç”Ǥ
‰Ú•–‡”‹Ž‹ç–‹”ȋ͖͙ȌǤ——›ƒÇ†ƒ
ƒƒœƒƒ›Ç„‘›—…ƒ‘”‘‡”‘Žƒ›Žƒ”ƒ
˜‡›ƒ‹‡›‡„ƒºŽÇŠ‘•’‹–ƒŽ‹œƒ•›‘†ƒ
ƒ”–Ç畃’–ƒƒÇç–Ç”ȋ͖͚ȌǤ‹›ƒ„‡–‹‘Žƒ
˜‡‘Žƒ›ƒŠƒ•–ƒŽƒ”†ƒ‘”—…—‘”–ƒŽ‹–‡
òœ‡”‹†‡‹‡–‹•‹‹‰Ú•–‡”‡„‹”­ƒŽÇ珃
›‘–—”Ǥ
”—­•Ç”ƒ•Ç†ƒ•Ç˜ÇƒŽÇÇÇÇ•Ç–Žƒƒ•Ç
†‡Š‹†”ƒ–ƒ•›‘—„‹”•‡„‡„‹†‹”Ǥ
‡Š‹†”ƒ•–ƒ›‘•Ç…ƒ‹Ž‹Ž‡”†‡
„—Ž—ƒŽƒ”†ƒ˜‡›ƒ•Ç…ƒ–ƒ˜‡ˆ‹œ‹•‡Ž
ƒ–‹˜‹–‡‰‡”‡–‹”‡œ‘”‹çŽ‡”†‡
­ƒŽÇ烐Žƒ”†ƒ†ƒŠƒˆƒœŽƒ‰Ú”òŽ‡„‹Ž‹”Ǥ—ƒ
‡‘Žƒ”ƒǡŠ‹’‡”‰Ž‹•‡‹‘œ‘–‹†‹ò”‡œ
‘Ž—ç–—”ƒ”ƒ†ƒŠƒˆƒœŽƒ•Ç˜Ç˜‡‡Ž‡–”‘Ž‹–
ƒ›„ǐƒ•‡„‡’‘Žƒ–ƒ†Ç”ǤYœ‡ŽŽ‹Ž‡
†ƒŠƒÚ…‡†‡‘–‘‘‹Ú”‘’ƒ–‹•‹
‘ŽƒŠƒ•–ƒŽƒ”†ƒ‘”–‘•–ƒ–‹Š‹’‘–ƒ•‹›‘
‰Ú”òŽ‡„‹Ž‹”Ǥ‹’‘˜‘Ž‡‹˜‡‡çŽ‹‡†‡
Š‹’‘–ƒ•‹›‘•‡‘’ǡ†ò珇˜‡„—ƒ
„ƒºŽÇ›ƒ”ƒŽƒƒŽƒ”ƒ•‡„‡’‘Žƒ„‹Ž‹”Ǥ
—ƒ‡‘Žƒ”ƒ‹–”ƒ˜ƒ•òŽ‡”„‘玗º—
†ƒ”ƒŽƒ•Çœƒ–‡†‹›ƒ„‡–‹Ž‡”†‡‹›‹
–ƒÇŽƒÇ瑎ƒŠ‹’‡”‘ƒ‰—Žƒ„‹Ž‹–‡›‹
ƒ”––Ç”ƒ„‹Ž‹”ȋ͖͗ȌǤ‡Š‹†”ƒ–ƒ•›‘ƒ„ƒºŽÇ
ƒ”–Ç獃˜‹•‘•‹–‡•‹–”‘„‘œ˜‡
‹‡”‹•‹‹ƒ”––Ç”ƒ–ƒ†Ç”ȋ͖͘ȌǤ——†‹
”ƒ„‹•–ƒǯ†ƒ›ƒ’ÇŽƒ„‹”­ƒŽÇ珃†ƒǡ
ƒƒœƒƒ›Ç†ƒ‘”—­–—–ƒŽƒ”†ƒ”‡–‹ƒŽ
˜‡–”‘„‘œ—‹•‹†ƒ•ÇÇƒ”––ǺÇ
‹›ƒ„‡–Ž‹Šƒ•–ƒŽƒ”ǐ‘”—­–—–ƒ•ÇÇǡ
†‹‹‹ƒ­Žƒ”ǐÇçǺǃŽ–ǐ†ƒ˜‡‹Ž‰‹Ž‹
•ƒºŽÇ‰Ú”‡˜Ž‹•‹‹‘Žƒ•Ç‹Ž‹ç‹Ž‹”‹•Ž‡”‹
†‡º‡”Ž‡†‹”‡•‹‹Ž‡˜‡”‹Ž‡„‹Ž‡…‡
ڐ‡Ž‹‹ç‹•‡Ž„‹”ƒ”ƒ”‘Ž†—º—–‡”ƒ”
˜—”‰—ŽƒÇç–Ç”Ǥ.‘º—œƒƒ–Ç„„‹Ú‡”‹
Šƒ•–ƒÇ‘”—­–—–ƒƒ•ÇŽ‡Š‹‡†‹”Ǥ
——›ƒÇ†ƒǡ‘”—­–—–ƒ–ƒÇ•”ƒ”‡†‡
Šƒ•–ƒŽƒ”ǐ‘”—­–—–ƒÇ‘Žƒ•Ç”‹•Ž‡”‹
ŠƒÇ†ƒ—›ƒÇ‘Žƒ•Ç˜‡„—”‹•Ž‡”‹
ƒœƒŽ–ƒ‹­‹‡Ž‡”›ƒ’ƒ…ƒºÇÇ„‹Ž‡•‹
‰‡”‡‡–‡†‹”Ǥƒ•–ƒŽƒ””‹•ˆƒ–Ú”Ž‡”‹‹
•ƒ›Ç•Ç˜‡•ò”‡•‹‹Ž‡ƒŽƒƒŽÇ‘Žƒ”ƒ‘”—…ƒ
„ƒºŽÇ”‹•Ž‡”‹­‹†òçò˜‡›ƒ›ò•‡”‹•‡
•ƒŠ‹’‘Žƒ„‹Ž‹”Ž‡”Ǥ‹’͕˜‡–‹’͖†‹›ƒ„‡–‹
Šƒ•–ƒŽƒ”†ƒƒƒœƒƒ›Ç†ƒ‘”—­–—–ƒ›ƒ
„ƒºŽÇ‰Ú”òŽ‡„‹Ž‡…‡‘Žƒ•Ç›ƒ‡–‹Ž‡”Dz­‘
›ò•‡dzǡDz›ò•‡dzǡDz‘”–ƒdz˜‡Dz†òçòdz
”‹•‘Žƒ”ƒ„‡Ž‹”Ž‡‹ç˜‡ƒ„Ž‘͖ǯ†‡
Ž‹•–‡Ž‡‹ç–‹”Ǥ
.‘›ò•‡”‹•ǣƒƒœƒÚ…‡•‹†‡‹
•‘͗ƒ›‹­‡”‹•‹†‡…‹††‹Š‹’‘‰Ž‹•‡‹ǡ
‡ò””‡Š‹’‘‰Ž‹•‡‹Š‹ƒ›‡•‹ǡ
‹’‘‰Ž‹•‡‹‹ˆƒ”Ç†ƒ‘Žƒƒƒǡ
œƒÇçÚ–òŠ‹’‘‰Ž‹•‡‹‘–”‘Žǡ
ƒƒœƒ†ƒÚ…‡‹•‘͗ƒ›†ƒ
‡–‘ƒ•‹†‘œǡ‹’͕†‹›ƒ„‡–ǡ—–Šƒ•–ƒŽÇǡ
‘͗ƒ›‹­‡”‹•‹†‡Š‹’‡”‘œ‘Žƒ”
Š‹’‡”‰Ž‹•‡‹‘ƒǡçǔLj‹œ‹•‡Ž
ƒ–‹˜‹–‡‰‡”‡–‹”‡„‹”‹ç–‡­ƒŽÇ烐Žƒ”ǡ
ƒ‹Ž‡Ž‹ǡ”‘‹†‹›ƒŽ‹œ
ò•‡”‹•ǣ”–ƒ†‡”‡…‡Š‹’‡”‰Ž‹•‡‹
ȋ‘”–ƒŽƒƒƒç‡‡”‹͕͙͔Ǧ͔͔͗‰Ȁ
†Ž˜‡›ƒ„ƒ͕…†‡º‡”‹Ψ͛Ǥ͙Ǧ͝ƒ”ƒ•ÇȌǡ
‡ƒŽ›‡–‡œŽ‹ǡGŽ‡”‹ƒ”‘˜ƒ•òŽ‡”
‘’Ž‹ƒ•›‘Žƒ”ǡƒŽÇœ›ƒçƒ›ƒŽƒ”˜‡
‹•—Ž‹˜‡›ƒ•—Žˆ‘ò”‡‹Ž‡–‡†ƒ˜‹‘ŽƒŽƒ”ǡ
”‹•ˆƒ–Ú”ò‘Žƒ„‹Ž‡…‡‘Ǧ‘”„‹†
Šƒ•–ƒŽÇŽƒ”Ç‘ŽƒŽƒ”ǡŠƒ•–ƒŽÇºÇ‘Žƒ
›ƒçŽÇŠƒ•–ƒŽƒ”ǡ‡–ƒŽ†—”——‡–‹Ž‡›‡
‹Žƒ­—ŽŽƒƒŽƒ”
33
òçò”‹•ǣƒçƒ–ƒ”œÇ‘†‹ˆ‹ƒ•›‘—ǡ
‡–ˆ‘”‹ǡƒƒ”„‘œǡ–‹ƒœ‘Ž‹†‹†‹‘Žƒ”
˜‡›ƒ‹”‡–‹„ƒœŽÇ‹Žƒ­Žƒ”Žƒ†‹›ƒ„‡–‹
‘–”‘ŽƒŽ–ǐ†ƒ‘Žƒ˜‡‰‡‡Ž‘Žƒ”ƒ
•ƒºŽÇ†—”——‹›‹‘ŽƒŠƒ•–ƒŽƒ”
‡†ƒ˜‹
ƒ„Ž‘͖Ǧƒƒœƒ„‘›—…ƒ‘”—­–—–ƒ
–‹’͕˜‡–‹’͖†‹›ƒ„‡–‹Šƒ•–ƒŽƒ”†ƒ”‹•
ƒ–‡‰‘”‹Ž‡”‹
‡Š‹†”ƒ–ƒ•›‘˜‡–”‘„‘œ
”–ƒ”‹•ǣǕƒ‡–‹Ž‹‹•—Ž‹
•‡”ƒ–ƒ‘‰Žƒ”Ç‹Ž‡–‡†ƒ˜‹ƒŽ–ǐ†ƒ‘Žƒ‹›‹
‘–”‘Ž‡†‹Ž‹ç†‹›ƒ„‡–
‘–ǣ—•ÇÇˆŽƒƒ—œƒ‰Ú”òçò‡†ƒ›ƒŽÇ„‹”
•ÇÇˆŽƒƒ†Ç”˜‡Ž‹‹­ƒŽÇ珃Žƒ”†ƒ‡Ž†‡‡†‹Ž‹ç
˜‡”‹Ž‡”‡†ƒ›ƒƒƒ–ƒ†Ç”Ǥ
‡‡ŽÚŽ‡Ž‡”
.‘•ƒ›Ç†ƒÚ‡Ž‹‘—Úœ‡Ž†‹ƒ–
‹•–‡‡–‡†‹”Ǥ
‹ç‹•‡ŽŽ‡ç–‹”‡ǣ—Š–‡‡Ž‡‡
ڐ‡Ž‹˜‡”‹–‹‘—Šƒ•–ƒ„ƒÇ˜‡
†‡º‡”Ž‡†‹”‡•‹‹‹ç‹•‡ŽŽ‡ç–‹”‹Ž‡•‹
˜‡–‡†ƒ˜‹’ŽƒÇÇŠ‡”Úœ‡ŽŠƒ•–ƒ‹­‹
ڜ‡ŽŽ‡ç–‹”‹Ž‡•‹‰‡”­‡º‹†‹”Ǥ
Ž‹•‡‹‹­‹•Çƒ”ƒŽÇŽƒ”Žƒ‘–”‘Žǣ Bu
‘—†ƒ‹Šƒ•–ƒŽƒ”ǐ‰ò‹­‡”‹•‹†‡
­‘•ƒ›Ç†ƒƒç‡‡”‹ÚŽ­òò›ƒ’ƒ•Ç
‰‡”‡Ž‹†‹”Ǥ—‘—Úœ‡ŽŽ‹Ž‡–‹’͕
†‹›ƒ„‡–‹˜‡‹•—Ž‹—ŽŽƒƒ–‹’͖
†‹›ƒ„‡–‹Šƒ•–ƒŽƒ”‹­‹”‹–‹Ú‡‡
•ƒŠ‹’–‹”Ǥ
‡•Ž‡‡ǣƒƒœƒƒ›Ç†ƒ›ÇŽÇ†‹º‡”
ƒ›Žƒ”ǐƒ‰Ú”‡„‡•Ž‡‡ƒŽÇ獃ŽÇºÇ†ƒ
ƒŒÚ”†‡º‹ç‹Ž‹Ž‡”˜ƒ”†Ç”Ǥ.‘º—•ƒºŽÇ
’”‘„Ž‡‹—›‰—•—œ†‹›‡–˜‡›ƒ­‘
›‡‡˜‡ƒƒ„‹†‡›‡–‡”•‹œ—›—›ƒ
„ƒºŽÇ‘Žƒ”ƒ‰‡Ž‹ç‡–‡†‹”Ǥ—‡†‡Ž‡
ƒƒœƒƒ›Ç†ƒ†‹›ƒ„‡–‹Šƒ•–ƒŽƒ”‹­‹
†‹›‡–ǡ•ƒºŽÇŽÇ˜‡†‡‰‡Ž‹„‹”†‹›‡––‡
„‡Ž‹”‰‹‘Žƒ”ƒˆƒ”ŽÇŽÇ‰Ú•–‡”‡‡Ž‹†‹”Ǥ
‡•Ž‡‡‹Ž‡‹Ž‰‹Ž‹–ƒ˜•‹›‡Ž‡”Šƒ•–ƒŽƒ”ǐ
ڜ‡Ž‹Š–‹›ƒ­Žƒ”ǐƒ˜‡–Ç„„‹’”‘„Ž‡Ž‡”‹‡
„ƒºŽÇ‘Žƒ”ƒ†òœ‡Ž‡‡Ž‹†‹”Ǥƒ„‹–
„‹”˜ò…—–‹–Ž‡•‹‹†‡˜ƒ‡––‹”‡
ƒƒ­ŽƒƒŽÇ†Ç”Ǥ.‘º—­ƒŽÇ珃ǡŠƒ•–ƒŽƒ”ǐ
Ψ͙͔Ǧ͚͔ǯǐǐ‘”—­–—––—Žƒ”ǃ›„‘›—…ƒ
˜ò…—–ƒºÇ”ŽÇŽƒ”ǐǍ‘”—†—º—ƒƒ„——
›ƒÇ†ƒΨ͖͔Ǧ͖͙ǯŽ‹„‹”Ç•Ç‹•‡‹Ž‘
ƒŽ†ÇºÇÇ˜‡›ƒ˜‡”†‹º‹‹‰Ú•–‡”‹ç–‹”ȋ͚ȌǤ
Yœ‡ŽŽ‹Ž‡‹ˆ–ƒ”†ƒ›ƒ‹ƒçƒ›‡‡º‹
•Ç”ƒ•Ç†ƒƒ”„‘Š‹†”ƒ–˜‡›ƒº†ƒœ‡‰‹
­‘‹–ƒ”†ƒ›‡‡›‡‡•‹†‡
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34
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45
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46
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2UXFXQ+LNPHWOHUL
—ƒŽÇǥ
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‹–ƒ’Žƒ”ÇǥƒœÇŽƒŽƒ”ǡ„‹œŽ‡”‹­‹Ǣ
‹­‹†‡‹ƒƒŽƒ”ǡƒÇŽ•ƒŠ‹’Ž‡”‹‹­‹ǥ
—ƒŽÇǥòòǡ„—‰òòǥŽ—ç—ǡ
‘Žƒ–ƒ‘ŽƒÇǥƒ†‹•‡Ž‡”‹ǡŠƒ––ƒŸ‹ƒ–Ç
‘—ƒŽÇǥ‹”ƒŸ‹ƒ–‹–ƒ„ǐǐ†ƒ
Š‡”•ƒ–ǔǐ†ƒ†òçò‡Ž‡”‹­‹†‡”•Ž‡”ǡ
•ƒ›ˆƒŽƒ”ǐ†ƒ‹„”‡–Ž‡”˜ƒ”ǤŽƒçǎƒ•Ç
‰‡”‡‡Ž‡”˜ƒ”ǡƒŽƒƒ•Ç‰‡”‡‡Ž‡”˜ƒ”Ǥ
Y”‡º‹ǥ
Fenlerle makro
†ò›ƒ›Çǡ‹”‘
†ò›ƒ›Ç‘—ƒŽÇǥ
ƒŽƒ•‹Ž‡”†‡ǡ
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‰‡œ‡‰‡Ž‡”†‡ǡ
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Š‹‡–Ž‹˜‡ƒƒ­ŽÇǥŽ„‡––‡‹•ƒÇ
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ڔ‡Ž‹‹‘Žƒ”ȋˆ‡Ž‡”Ȍ‡
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ڎ­ò›òǡ†òœ‡‹ǡƒŠ‡‰‹ƒŽƒ–ƒ–ƒǢ–ƒ‹’
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G„ƒ†‡–Ž‡”ǥ
‹­òòò†ò”‹ǣ„‹”—•–ƒǡ„‹”
ƒ‹‡›‹ò‡‡Ž›ƒ’•ÇǡŠ‡”
’ƒ”­ƒ•Çƒ„‹”•ƒƒ–˜‡ƒƒ­–ƒ•Çǡ
„‹”ÚŽ­ò˜‡†òœ‡‹­‹†‡­ƒŽÇç–Ç”•Ç†ƒǢ
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˜‡„‡Ž‡†‹º‹„‹”‡–‹…‡‘Žƒ•ÇǨǫ
‡›ƒ„‹”‹‰ÚœòòœÚò†‡
„‹”Šƒ•–ƒ‡›‹‹çƒ‡–•‹Ǣ
„‹ƒ•Ç†ƒ„ÚŽòŽ‡”‡ǡ
‡‹’ƒ†ƒ’‡”•‘‡Ž‡ǡ
Šƒ•–ƒ•Ç†ƒŠ‡‹‹‡Š‡”燛‹
›‡”Ž‹›‡”‹…‡˜‡ÚŽ­òŽòǡƒƒ­ŽÇ˜‡
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‡†‹•‹ƒƒ­•Çœǡ‡–‹…‡•‹œƒŽ•Çǡ
Š‡”燛˜‡–ò‰ƒ›‡Ž‡”Š‹­‡‹•‹ǡ„‘çǡ
ƒ„‡•˜‡‹•”ƒˆ‘Ž•—ǤŽƒƒœǤŽ„‡––‡
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˜‡‰‡Ž‹ç‡ǡ
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G•Žƒ„‹œ‡„‹”­‘ƒŽ‹ǡƒ–Ǎ‹˜‡ƒŽ‹
†‡Ž‹ŽŽ‡„‹Ž†‹”‹›‘”‹ǣf—‹•ƒƒ‹‡•‹‹
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˜‡‹•ƒÇ›ƒ’Ç盃”ƒ–ÇçǢ‡Ž„‡––‡
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ƒƒœƒ˜‡”—­ǥ
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˜ƒ”Ǥ‡•‡Žƒ‹ƒƒŽƒ”ƒƒƒœƒƒ›Ç†ƒ
‘”—…—‡”‡–‹çǤ”—…—Š‹‡–Ž‡”‹‡
†ƒ‹”„‹”­‘ç‡›Ž‡”„‹Ž†‹”‹çǤ‡—”ƒǦÇ
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Š‹‡–Ž‡”‹‹›ƒœÇ玃”Ǥ
ƒƒœƒ”‹•ƒŽ‡•‹ǥ
Y”‡º‹
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„‡›ƒ‡†‡„‹”­‘‡•‡”†‡„‹”‹‹
‹…‡Ž‡›‡Ž‹Ǥ‡†‹òœœƒƒƒ‹†—”•‹ǯ‹
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‹•ƒŽ‡•‹ǥ
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…ƒ•ÇœŽƒ”†ƒ…ƒŽÇŽƒ”ƒǥ
Š‡”„‹”’ƒ”­ƒ•Ç†ƒǡ
­ƒ”Ç†ƒ‡†‹…‡„‹”­‘
Š‹‡–Ž‡”˜ƒ”ǤŽ„‡––‡Ÿ‹ƒ–ǐǡ
Š‡’•‹†‡†ƒŠƒ„ò›ò„‹”
1XPXQH6DðOÜN'HUJLVL7(008=$ï86726
‹œç‹†‹„‹”ƒ­ƒŽÇ–Ç›ƒ’Ç’ǡ†‡˜ƒÇÇ˜‡
‹œƒŠÇƒ”œ—‡†‡Ž‡”‡‡•‡”‹„‹”‡œ‘—ƒ›Ç
–ƒ˜•‹›‡‡†‹›‘”—œǤ
52
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›ƒ”†ÇÇ›ƒ’ƒƒœǢ›ƒ’•ƒ†ƒ–ƒ‘ŽƒƒœǤ
.ò‹Šƒ‹Á‘ŠƒŽ‡–‹‡†‹‡ˆ•‹†‡
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”—…—ò‡‡Ž‹ǥ
DzƒƒœƒǦÇf‡”‹ˆ–‡‹‘”—…—­‘
Š‹‡–Ž‡”‹ǢŠ‡‡ƒ„Ǧǃ̵ǐ
”—„—„‹›‡–‹‡ǡŠ‡‹•ƒÇŠƒ›ƒ–ǦÇ
‹­–‹ƒ‹›‡•‹‡ǡŠ‡Šƒ›ƒ–ǦÇ烊•‹›‡•‹‡ǡ
Š‡‡ˆ•‹–‡”„‹›‡•‹‡ǡŠ‡‹ƒǦÇ
GŽƒŠ‹›‡‹çò”ò‡„ƒƒ”Š‹‡–Ž‡”‹˜ƒ”Ǥdz
Dz‡‘‘”—…—‡‡Ž‹‹•‡ǣ‹†‡‰‹„‹„ò–ò
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‰‹„‹…‹Šƒœƒ–ǦNj•ƒ‹›‡›‡†ƒŠ‹„‹”‡˜‹
‘”—­–—––—”ƒ–Ç”Ǥƒ‹ǣ—Šƒ””‡ƒ––ƒǡ
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‰ƒŽ‹œ–ƒ„‹”Ž‡”†‡ƒ›Ç”ƒŽƒ‘ƒ‘”—­
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ڜòò
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燛Ž‡”‹‹ç‹–‡–‡‡̵‡†‹’ǡ‰Úœòò
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‘ƒ–ƒ̵–‹ŽǦ‹‡ç‰ƒŽ‡––‹”‹Ž•‡ǡ„ƒçƒò­ò
–‡œ‰ŸŠŽƒ”‘Žƒ›…ƒ‘ƒ‹––‹„ƒ‡––‹”‹Ž‡„‹Ž‹”Ǥdz
fò”òƒŠ–ƒ”Çǥ
DzǥƒƒœƒǦÇf‡”‹ˆ̵–‡‹‘”—­ǡŠƒ‹Á
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ƒŽ„—‹‹ˆ–ƒ”˜ƒ–‹†‡‘—”—‡‡ǡ
„‹”ò̵‹‹ƒœƒ”ǐ†ƒ­‘Ç›‡–†ƒ”
„‹”‹‡–Ǧ‹GŽƒŠ‹›‡‘Ž†—º—ƒ—˜˜‡Ǧ‹
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ˆ—ƒ”ƒ›ƒƒ†ƒ”Š‡”‡•ǡƒƒœƒǦÇf‡”‹ˆ–‡
‘‹‡–Ž‡”‹Ç›‡–Ž‡”‹‹ƒŽƒƒŽƒ„‹”
çò”Ǧòƒ‡˜Á›‡ƒœŠƒ”‘Ž—”ǤǥG疇„—
•—”‡–Ž‡‘”—­ǡ­‘…‹Š‡–Ž‡”Ž‡Šƒ‹Á˜ƒœ‹ˆ‡Ǧ‹
‹•ƒ‹›‡‘Žƒçò”òƒƒŠ–ƒ”ÇŠòò‡
‰‡­‡”Ǥdz
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‹­‹ƒÇŽ˜‡ç‡”‹ƒ––ƒ‰‡Ž‡‡”‹
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Dzƒ†Á•‹”‹˜ƒ›‡–Ž‡”‹†‡˜ƒ”†Ç”‹ǣ‡ƒ„ǦÇ
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ƒŠÁ̵‹•‹ǡ„‡•‡‹Ÿ…‹œ„‹”ƒ„†‹‹Ǥdz
DzG•ƒƒ‡òŠ‹„‹”‹ŽŸ­‡˜̵‹†‡
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DzǥG•ƒŽƒ”ǡƒ‹ç‡–…‹Š‡–‹†‡—Š–‡Ž‹ˆ
„‹”•—”‡––‡ŠƒŽ‡†‹Ž‹çŽ‡”Ǥ‡ƒ„Ǧǃ‘
‹Š–‹Žƒˆƒ„‹ƒ‡ǡœ‡‰‹Ž‡”‹ˆ—ƒ”ƒŽƒ”ǐ
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ŠƒŽŽ‡”‹‹˜‡ƒ­ŽÇŽƒ”ǐÇǡ‘”—­–ƒ‹
ƒ­ŽÇŽƒ–ƒŠ‹••‡†‡„‹Ž‹”Ž‡”Ǥº‡”‘”—­
‘Žƒœ•ƒǡ‡ˆ‹•’‡”‡•–­‘œ‡‰‹Ž‡”
„—Ž—ƒ„‹Ž‹”‹ǡƒ­ŽÇ˜‡ˆƒ‹”Ž‹‡
ƒ†ƒ”‡ŽÁ˜‡‘Žƒ”燈ƒ–‡‡ƒ†ƒ”
—Š–ƒ­‘Ž†—º——‹†”ƒ‡†‡‡œǤ—
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KOMPL‹KE
deri ve yumuflak doku
infeksiyonlarının tedavisini
BAS‹TLEfiT‹R‹N:
1
MRSA dahil Stafilokoklara,
ESBL(+) sufllar dahil
Enterobakterilere,
dahil Anaeroblara
2
etkilidir.
TYGACIL® ‹ntravenöz infüzyon çözeltisi için konsantre toz, steril FORMÜL: Her 5 ml TYGACIL® flakonu intravenöz infüzyon için 50 mg liyofilize Tigesiklin tozu içerir. FARMAKOLOJ‹K ÖZELL‹KLER: Etki mekanizmas›: Bir glisilsiklin antibiyotik olan TYGACIL®, bakterilerde ribozomlar›n 30S
altünitesine ba¤lanarak amino-acyl tRNA moleküllerinin ribozomun A bölgesine girmesini bloke eder ve protein translasyonunu inhibe eder. TYGACIL®, ribozomal korunma ve efluks gibi iki önemli tetrasiklin direnç mekanizmas›na karfl› gelme özelli¤ine sahiptir. Bu nedenle TYGACIL®'in, genifl
bir bakteriyel patojen spektrumuna karfl› in vitro ve in vivo etkinlik gösterdi¤i ortaya konmufltur. TYGACIL® ile di¤er antibiyotikler aras›nda çapraz direnç gözlemlenmemifltir. In vitro çal›flmalarda, TYGACIL® ile s›k kullan›lan di¤er antibiyotikler aras›nda hiçbir antagonist etkiye rastlan›lmam›flt›r.
Emilim: TYGACIL® intravenöz yolla uygulan›r, dolay›s›yla biyoyararlan›m› %100'dür. Da¤›l›m: Klinik çal›flmalarda gözlemlenen konsantrasyonlarda TYGACIL®'in in vitro plazma proteinlerine ba¤lanma oran› ortalama %71-89 aras›ndad›r. Hayvan ve insanlar üzerinde yap›lan çal›flmalar TYGACIL®'in
dokulara h›zl› bir flekilde da¤›ld›¤›n› ortaya koymufltur. Metabolizma: TYGACIL® yo¤un flekilde biyotransformasyona u¤ramaz. Eliminasyon: Genel olarak TYGACIL®'in primer at›l›m yolu ve flekli, de¤iflmemifl TYGACIL® halinde safra yolu ile at›l›md›r. De¤iflmemifl haldeki TYGACIL®'in
glukuronidasyonu ve idrarla at›l›m› sekonder yollard›r. ‹laç Etkileflimleri: TYGACIL®'in digoxin ile birlikte kullan›ld›¤› durumlarda herhangi bir doz ayarlamas›na gerek yoktur. TYGACIL®'in varfarin ile birlikte uyguland›¤› hallerde, protrombin zaman› ya da uygun olan bir baflka antikoagulasyon
testi ile monitorizasyon yap›lmas› uygun olur. ‹nsan karaci¤er mikrozomlar› ile yap›lan in vitro çal›flmalarda, sitokrom P450(CYP) izoformlar›ndan 1A2, 2C8, 2C9, 2C19, 2D6 ve 3A4 arac›l›¤›yla gerçekleflen metabolizmalar›n TYGACIL® ile inhibe edilmedi¤i gösterilmifltir. Bu nedenle TYGACIL®'in,
bu enzimlerle metabolize olan di¤er ilaçlar›n metabolizmalar›n› de¤ifltirmesi beklenmez. Ayr›ca, TYGACIL® yo¤un bir biyotransformasyona u¤ramad›¤› için, bu izoformlar› inhibe eden ya da uyaran ilaçlar›n TYGACIL®'in klirensini etkilemeleri de beklenmemektedir. Özel hasta gruplar›: Karaci¤er
Yetmezli¤i: TYGACIL®'in farmakokinetik profiline dayanarak, hafif ve orta derecede karaci¤er yetmezli¤i olanlarda (Child Pugh A ve B) herhangi bir doz ayarlamas›na gerek yoktur. Buna karfl›l›k ileri derecede karaci¤er yetmezli¤i olanlarda (Child Pugh C), TYGACIL® dozu 100mg bafllang›ç
dozunu takiben her 12 saatte bir 25mg fleklinde olmal›d›r. ‹leri derecede karaci¤er yetmezli¤i olanlarda (Child Pugh C) tedavi dikkatle izlenmeli ve tedaviye yan›t monitorize edilmelidir. Böbrek Yetmezli¤i: Böbrek yetmezli¤i olan hastalarda ve hemodiyaliz uygulanmakta olan hastalarda TYGACIL®
dozunun ayarlanmas›na gerek yoktur. Yafll› Hastalar: Yafll› hastalarda doz ayarlamas› yap›lmas›na gerek yoktur. END‹KASYONLAR: TYGACIL® yetiflkinlerde Metisiline dirençli Staphylococcus Aureus (MRSA) da dahil komplike deri ve deri yap›s› enfeksiyonlar›n›n, komplike intraabdominal
enfeksiyonlar›n ve bakteriyeminin efllik etti¤i vakalar dahil Streptococcus pneumoniae (penisiline duyarl› izolatlar), Haemophilus influenza (beta laktamaz negatif izolatlar) ve Legionella pneumophila’n›n neden oldu¤u toplum kökenli bakteriyel pnömoni tedavisinde endikedir. KONTREND‹KASYONLAR:
TYGACIL®, tigesikline afl›r› duyarl›l›¤› oldu¤u bilinen hastalarda kullan›lmamal›d›r. UYARILAR/ÖNLEMLER: Glisilsiklin s›n›f› antibiyotikler, yap›sal olarak tetrasiklin s›n›f› antibiyotiklere benzerler. Bu nedenle tetrasiklin s›n›f› antibiyotiklere afl›r› duyarl›l›¤› olan hastalarda dikkatli kullan›lmal›d›r.
Hemen hemen tüm antibakteriyel ajanlarla, hafif tablolardan yaflam› tehdit edecek dereceye varabilen fliddetli psödomembanöz kolit vakalar› bildirilmifltir. Bu nedenle herhangi bir antibiyotik tedavisinden sonra diyare yak›nmas› ile gelen hastalarda bu tablonun düflünülmesi önemlidir. Di¤er
antibiyotik preparatlar›nda oldu¤u gibi, bu ilac›n kullan›m› ile mantarlar dahil duyarl› olmayan organizmalar›n afl›r› ço¤almas› söz konusu olabilir. Hastalar tedavi süresince dikkatli bir flekilde izlenmelidir. Süperenfeksiyonun geliflmesi durumunda uygun tedavi yap›lmal›d›r. S›çanlarda yap›lan
TYGACIL® çal›flmalar›n›n sonuçlar›nda, kemikte renk de¤iflmesi gözlemlenmifltir. TYGACIL®, insanlarda difl geliflimi s›ras›nda uyguland›¤›nda difllerde kal›c› renk de¤iflimi ile iliflkili olabilir. Gebelikte kullan›m: Gebelik kategorisi: D Gebelerde uygun ve kontrollü çal›flmalar yap›lmam›flt›r. Hayvan
deneylerinin sonuçlar›, TYGACIL®'in gebelikte uygulanmas› durumunda fetusa zararl› olabilece¤ini göstermektedir. Laktasyonda kullan›m: Bu ilac›n insan sütüne geçip geçmedi¤i bilinmemektedir. Pediyatrik kullan›m: Güvenirlilik ve etkinli¤i belirlenmemifltir. Bu nedenle 18 yafl›n alt›ndaki
çocuklarda kullan›m› önerilmemektedir. Araba ve makine kullan›m›na etkisi: TYGACIL® bafldönmesine yol açabilir ve bu nedenle araç veya makine kullan›m yetene¤ini bozabilir. YAN ETK‹LER / ADVERS ETK‹LER: TYGACIL® tedavisi s›ras›nda en s›k bildirilen acil tedavi gerektiren advers
reaksiyonlar bulant› (%26) ve kusma (%18) olmufltur. Bulant› ve kusma genellikle tedavinin bafllang›c›nda (1.-2. günlerde) ortaya ç›km›flt›r. Tedavinin kesilmesi en s›k olarak bulant› (%1.1) ve kusma (%1.1) ile iliflkili olarak gündeme gelmifltir. GEÇ‹MS‹ZL‹KLER‹: Afla¤›da belirtilen ilaçlar,
TYGACIL® ile ayn› setten eflzamanl› olarak verilmemelidir: Amfoterisin B, Amfoterisin B likit kompleks, diazepam, esomeprazol, omeprazol. Uygun intravenöz solüsyonlar› flunlard›r: enjeksiyon için 9 mg/ml (%0.9) sodyum klorür solüsyonu (USP), enjeksiyon için 50 mg/ml (%5) dekstroz
solüsyonu (USP) ve Laktatl› Ringer enjeksiyonu (USP). TYGACIL®, afla¤›da belirtilen ilaç ya da çözeltiler ile ayn› setten verilebilir: Amikasin, dobutamin, dopamin HCl, gentamisin, haloperidol, Laktakl› Ringer solüsyonu, lidokain HCI, metoklopramid,
morfin, norepinefrin, piperasilin/tazobaktam (EDTA formülasyonu), potasyum HCI, propofol, raniditin HCI, teofilin, tobramisin. KULLANMA fiEKL‹ VE DOZU: Intravenöz yol ile uygulan›r; 100 mg bafllang›ç dozundan sonra 12 saatte bir 50
mg fleklinde kullan›l›r. TYGACIL® intravenöz infüzyon yoluyla uygulan›r. ‹nfüzyon süresi yaklafl›k 30-60 dakika aras›nda olmal›d›r. Tedavinin süresi, enfeksiyonun fliddeti ve bulundu¤u vücut bölgesi ile hastan›n klinik ve
bakteriyolojik seyrine göre belirlenmelidir. Önerilen tedavi süresi 5-14 gündür. Haz›rlama ve kullan›m bilgileri: Liyofilize toz, 5.3 ml, 9 mg/ml (%0.9)’luk enjeksiyon için sodyum klorür solüsyonu veya 50 mg/ml
(%5)’lik enjeksiyon için dekstroz solüsyonu veya Laktatl› Ringer enjeksiyonu (USP) ile kar›flt›r›larak, 10 mg/ml konsantrasyonunda TYGACIL® elde edilir. Flakon, ilac›n tamamen erimesini sa¤lamak
amac›yla hafifçe döndürülmelidir. Daha sonra derhal haz›rlanm›fl solüsyondan flakon içerisinden 5 ml çekilir ve infüzyon için 100 ml i.v. infüzyon torbas›na aktar›l›r. 100 mg'l›k doz için, 2 flakon
ilaç haz›rlanarak 100 ml i.v. torbas›na aktar›lmal›d›r. (Not: flakonda %6'l›k bir fazlal›k bulunmaktad›r, bu nedenle haz›rlanan solüsyonun 5 ml'si 50 mg ilaca eflde¤erdir). Haz›rlanan
solüsyon sar›-turuncu renkte olmal›d›r, de¤ilse solüsyon kullan›lmay›p at›lmal›d›r. Parenteral ürünler, uygulama öncesinde renk de¤iflikli¤i (ör. yeflil veya siyah) ve partikül aç›s›ndan
mutlaka incelenmelidir. TYGACIL®, tek bafl›na ayr› bir i.v. hattan veya ortak i.v. hat üzerinden uygulanabilir. Ayn› i.v. hatt›n peflpefle birkaç ilaç infüzyonu için kullan›ld›¤›
durumlarda, TYGACIL® uygulamas›ndan önce ve sonra damar hatt› 9 mg/ml (%0.9)'luk enjeksiyon için sodyum klorür solüsyonu veya 5 mg/ml (%5)'lik enjeksiyon
için dekstroz solüsyonu ile temizlenmelidir. TYGACIL® ile uyumlu bir infüzyon solüsyonu kullan›lmal› ve ayn› damar hatt›ndan uygulanan ilaç (ilaçlar›n) TYGACIL®
ile geçimli olmas›na dikkat edilmelidir. DOZ AfiIMI: Doz afl›m› durumunda uygulanacak tedavi ile ilgili spesifik bir bilgi yoktur. TYGACIL®'in sa¤l›kl› gönüllülerde
tek doz olarak 300 mg (60 dakika içinde, intravenöz) fleklinde uygulanmas›, bulant› ve kusman›n artmas›na yol açm›flt›r. TYGACIL®'in hemodiyaliz ile
anlaml› miktarda at›l›m› mümkün de¤ildir. SAKLAMA KOfiULLARI: 25°C'nin alt›ndaki oda s›cakl›¤›nda saklay›n›z. Rekonstitüe edilmifl solüsyon
sar›-turuncu renkte olmal›d›r; bu renk oluflmam›flsa solüsyon kullan›lmay›p at›lmal›d›r. TYGACIL® oda s›cakl›¤›nda (25°C) 24 saate kadar,
buzdolab›nda ise (2-8°C) 48 saat süreyle saklanabilir. T‹CAR‹ TAKD‹M fiEKL‹: TYGACIL® 10 flakonluk ambalajlarda sunulur. 10 flakonunun
KDV dahil PSF ve onay tarihi: 933,27 TL.-(Aral›k 2009) Ruhsat Tarihi ve No.: 05.02.2007 - 121/89. Üretim yeri: Wyeth-Ayerst
Lederle, Inc., Carolina, Porto Riko. Ruhsat sahibi: Pfizer ‹laçlar› Ltd. fiti. Muallim Naci Cad. No:55 34347 Ortaköy-‹STANBUL
Telefon no: (212) 310 70 00 - Faks no: (212) 310 70 58 Reçete ile sat›l›r. Daha fazla bilgi için firmam›za baflvurunuz.
1XPXQH6DðOÜN'HUJLVL7(008=$ï86726
56
TGC 10-22 (Eylül 2010)
Referanslar: 1. Ellis-Grosse EJ, et al. The efficacy and safety of tigecycline in the treatment of skin and skin-structure infections: results of 2 double-blind phase 3 comparison studies with vancomycin-aztreonam. Clinical infectious diseases: an official publication of the Infectious
Diseases Society of America. 2005; 41 Suppl 5: S341-53. 2. Zhanel GG, et al. Tigecycline: a novel glycylcycline antibiotic. Expert review of anti-infective therapy. 2006;4(1): 9-25.
57
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Y…‡‹–ƒ”‹ŠŽ‡”†‡òŽ‡‡‘‘‹›Ú†‡
†ƒ”„‘ºƒœƒ‰‹”‹…‡†‡‹”›‘Ž—˜‡–”‡Ž‡”‹
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†—”—›‘”Ǥ‡›•‡‹‡•Ž‡‘—Ž—‘Žƒ”ƒ
†‡º‡”Ž‡†‹”‹çŽ‡”Ǥ
͕͙͖͘ǯ–‡—”—Žƒ
”ƒƒ†ƒç‡Š”‹†‡ƒƒ–
—Ž‡•‹‡­Ç–ǍǤ
ڎǡ˜‘ŽƒŽƒ”˜‡ç‡Š”‹
ƒœƒ”ƒ•Ç‘Žƒºƒò•–ò‰òœ‡Ž†‹Ǥ͚͙͗
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†ƒŽƒ”†ƒ›ƒçƒ˜ƒ”Ǥ‡‰‹ǡˆƒ‹”‡˜Ž‡”‹ǡ
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ƒ›—Žƒ”ǡŽ‡›Ž‡Ž‡”ǡƒ‰‘ƒºƒ­Žƒ”ǘǤ•Ǥ
ڐ…‡•‹†Ú‡†‡Žƒ˜Žƒ”ƒŽ–ǐ†ƒƒŽƒ
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—†ƒºƒ‡”‹ƒǯÇ‘’‡‹ǯ•‹†‡‹›‘”Ǥ
ǔƒ
—ƒ–‡ƒŽƒǯ›ƒ‰‡Ž†‹Ǥƒ”ƒ›‘Ž—›Žƒ
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„—”ƒ†ƒ—”—Ž—›‘”ǤŽ‹çŽ‡‡Ž‡”‹„—”ƒ†ƒ
•ƒ–ÇŽÇ›‘”Ǥȋ‡•‹͙Ȍƒº—””ƒŠƒ–
„Ç”ƒÇ›‘”„‹œ‹Ǥ —ƒ–‡ƒŽƒǯ†ƒ͕͝
‡–‹‰”—’˜ƒ”Ǥƒ›ƒŽƒ”†‹Ž‡”‹‹†‡˜ƒ
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˜‡’‘”–”‡ƒ„ƒ”–ƒŽƒ”ǐǐ‡‰òœ‡Ž
ڔ‡Ž‡”‹„—”ƒ†ƒǤȋ‡•‹͗Ȍ—”‹œ
‰‡Ž‹”Ž‡”‹˜ƒ”Ǥ
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‹”‹Ž‹•‡‹‹ƒ”‹•‹­‘†‡º‹ç‹–‹Ǥ
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ƒŽ˜ƒ†‘”ƒŠ˜‡•‹‹—ŽŽƒÇ›‘”—çǤ
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77
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78
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