Ọgwụ "Klayra": reviews nke dọkịta, Uru, cons, ntuziaka, mmetụta. Nyocha gynecologists banyere mbadamba "Klayra" maka endometriosis, na menopause

Nso nso a, ezi mgbe oge a dọkịta ọrịa ụfọdụ idepụta ọgwụ "Klayra". Nyocha nke dọkịta, Uru, cons nke ngwá ọrụ a - a nile ga-atụle n'okpuru.

Olee otú ha na-arụ ọrụ?

A ọgwụ bụ a jikọrọ ọnụ na ogwu, nke dabeere na na mmekọrịta nke ọtụtụ ihe. Ihe kacha mkpa n'etiti ha bụ ndị na suppression nke ovulation, nakwa dị ka ukpụhọde nke Njirimara nke cervical imi - na nke a na ndị dabeere edinam "Klayra" ọgwụ ọjọọ. Nyocha nke dọkịta (Uru, cons ọkachamara-atụle mgbe nile) mgbe na-ekwu na ọ bụ ngwá ọrụ na-anọchi si n'etiti ya mmetụta yiri.

Ke adianade na-egbochi na-achọghị ime nke a ọgwụ ọjọọ dị iche a dum usoro nke ọzọ bara uru Njirimara na, ọbụna na-ewere n'ime akaụntụ ọ bụla na-adịghị mma àgwà-ekwe ka ị na-ahọrọ ndị kasị mma nhọrọ nke igbochi afọ. All contraindications ọgwụ na-akọwa "Klayra" ntụziaka. Nyocha dọkịta na-agụnye ihe ọmụma banyere onye na-a ọgwụ ekwesighi.

Gịnị na-eme na otu oge atọrọ?

Mbenata ike nke mgbu na menstrualnopodobnoe agba ọbara, nke n'ikpeazụ na-eduga ná a dị ịrịba ama Mbelata ke ize ndụ nke ígwè erughi anaemia. Nke bụ isi mmetụta, nke na-enye a "Klayra". Nyocha nke dọkịta (Uru / cons nke ọgwụ cm. N'okpuru ebe) na-ekwu na ihe niile a na-nyere na zuru, na njikọ na nke agwọ ọrịa na ike ikwu na ojiji nke ya mgbe niile. Ke adianade do, ezi mgbe hụrụ na na n'ikuku nke ngwá ọrụ na-enye a ịrịba gụnyere ya ná ekwe omume nke na-emepe emepe endometrial cancer. Ọzọkwa, ọgwụ na-ebelata ihe ize ndụ nke ovarian cancer.

Gịnị dọkịta na-ekwu?

Banyere ọgwụ "Klayra" omume na dọkịta na-egosipụtakarị eziokwu na ọ nwere nnọọ mmetụta bara uru na endometrium, na njikọ na nke ọ na-eji na ọgwụgwọ nke ogologo oge ma ọ bụ kwa ike ịhụ nsọ ọbara ọgbụgba enweghị organic daa ọrịa. Ndị a mgbaàmà ndị ụfọdụ dysfunctional eriri akpa nwa ọbara ọgbụgba. Eziokwu a na-igbunye dị banyere ọgwụ ọjọọ, "Klayra" omume na-dibia. Na endometriosis ya iji nwekwara ike-kenyere.

research

The nchekwa na irè nke eji mbadamba estradiol valerate / dienogest na ọgwụgwọ nke mgbaàmà nke dysfunctional eriri akpa nwa ọbara ọgbụgba e kwuru na N'ezie nke abụọ Clinical ọmụmụ.

otu nkwakọ imewe na analysis plan-eji ma ọmụmụ. Mee elu mee ala, 269 ọrịa na-ahọrọ maka "Klayra" ọgwụ ọjọọ. Nyocha nke dọkịta (Uru / cons na-kọwara n'ụzọ zuru ezu), na-ewere akụkụ na-amụ ihe, kwuru na na mgbakwunye na nke a ọ na-e abuana ke ọmụmụ nke 152 ọrịa, nke na-anwale mmetụta nke placebo. Na omumu ndia, a chọpụtara na ọgwụ bụ ihe ndị ọzọ dị irè tụnyere placebo na ọgwụgwọ nke a mgbaàmà, na ọ bụ uru arịba ama na eziokwu ahụ bụ na endpoint omume ọgwụ "Klayra" bụ ihe karịrị 40% na onye ọ bụla nke ọmụmụ.

Ke adianade do, onye ọ bụla nke ọmụmụ doro anya na owụt a statistically na clinically ịrịba gụnyere ya ná ịhụ nsọ ọbara ọgbụgba, na n'ihu ya a na-enwekarị ịrịba ama mmụba na ígwè metabolism parameters na ugbu mgbe akara a nke iji "Klayra 'reviews nke dọkịta (uru na ọghọm nke ngwaahịa a anyị na-atụle) .

Ka estrogen na a nkwadebe na-eje ozi variat estradiol, nke bụ a eke precursor mmadụ 17β-estradiol. Estrogenic akụrụngwa na-eji n'ime ebe a pụtara dị nnọọ iche budata si estrogens na ọtụtụ ndị na-eji na-jikọrọ ọnụ na gbochie afọ, nke na-ọkọlọtọ sịntetik estrogen, dị ka mestranol ma ọ bụ ethinyl, ọ bụla nke nwere a methyl otu na 17α ọnọdụ. Otu a na-akpata a nnọọ ukwuu metabolic kwụsie ike, ma n'otu oge nwere a ọzọ akpọ utịp ke imeju, nke bụkwa ezi mkpa.

Na nkọwa nke nkwadebe "Klayra" omume na dọkịta na-ezo aka n'eziokwu ahụ bụ na-ewere ọ na-enye ọtụtụ obere akpọ utịp ke imeju tụnyere ndị ọzọ atọ-adọ PDAs, nke na-agụnye levonorgestrel na ethinyl estradiol. N'oge nnyocha a chọpụtara na mmetụta nke ịta nke globulin e mere ka ha kee homonụ, bụ obere akpọ. Nchikota na dienogest estradiol valerate egosi a dị ịrịba ama mmụba na HDL, mgbe ngụkọta ịta nke LDL cholesterol dị ntakịrị.

Dienogest - a progestogen, na-arụ ọrụ na ihe banyere onu ochichi. Ọ e ji ọzọ ele mmadụ anya n'ihu mgbochi androgenic mmetụta, mgbe ya mgbochi estrogenic, androgenic na estrogenic Njirimara na-adịghị mkpa. N'ihi na pụrụ iche chemical Ọdịdị na-enweta site a dum ụdịdị dị iche iche nke pharmacological-eme ihe, nke bụ ihe kasị dị ịrịba ama uru nke 19-ma ọ bụ-progestogen, yana dị iche iche nkwekọrịta nke progesterone, nke a na-ezi mgbe ikwu banyere n'aka dị "Klayra 'reviews (Uru / cons ga-atụle mgbe e mesịrị).

Ọzọ tupu adakarị data na e nwetara na N'ezie nke nkịtị toxicity ọmụmụ mgbe multiple dosing, nakwa dị ka genotoxicity na carcinogenic nwere nke a na ngwá ọrụ, ọ bụghị ka e gosiri, na e nwere ụfọdụ dị ịrịba ama kpọmkwem n'ihe ize ndụ ụmụ mmadụ. Otú ọ dị, na-akọwa ọgwụ "Klayra" reviews gynecologists mgbe ekwu na anyị na-ekwesịghị ichefu banyere ekwe omume nke na-akpali akpali a ọnụ ọgụgụ nke hormone-ndabere na nsụkọrọ na etuto ahụ mmekọahụ homonụ. N'ihe banyere ndị ziri ezi iji nke a na-akpọ Pearl Index (a ezu na-ekpebi ugboro nke ime ndị inyom karịrị otu narị afọ nke na ngwa nke a ọgwụ) nwere a bara uru na-erughị 1, kama n'okwu nke Agbaghara mbadamba ma ọ bụ n'ụzọ nke ya nwere ike na-eto eto.

Next pharmacokinetics "Klayra" ọgwụ ga-atụle. Nyocha gynecologists fọrọ nke nta kpamkpam na-akwado ozi kpọmkwem site na emeputa, na njikọ na nke ngwá ọrụ na kenyere ọtụtụ ndị ọrịa.

dienogest

• Absorption. Ịgbaso onu ochichi mmewere ngwa ngwa na fọrọ nke nta kpamkpam etinye obi gị dum. C _max n'ime ọbara ọbara esịmde egosi 90,5 and / ml mgbe banyere otu awa mgbe mbadamba-e (ya dere 3 mg nke dienogest na 2 mg estradiol variat). Bioavailability na nke a esịmde lekwasịrị nke 91%. Ọ ga-kwuru na pharmacokinetics nke dienogest na a onunu ogwu nso si 1 mg ka 8 ji kpọmkwem dabeere na dose. Ọ bụrụ na nkwadebe na-eji n'otu oge na-eri, ọ na-adịghị eme ka ọ bụla clinically ịrịba utịp ke ogo ma ọ bụ ọnụego nke absorption nke a mmewere.

• Nkesa. A ukwuu nke ndị na-ekesa dienogest (10%) bụ na unbound ụdị, mgbe ndị fọdụrụnụ bụ ndị na-abụghị kpọmkwem nkekọ na-albumin. Dienogest onwe ya na-adịghị na-ejikọta ya na ihe ọ bụla kortikosteroidsvyazyvayuschim globulin, ma ọ bụ SHBG na. Ọ bụ n'ihi na nke a mere na testosterone kpamkpam tutu amama ihe ize ndụ nke Ndahie nke njikọ na SHBG ma ọ bụ cortisol si nkwurịta okwu nke mmewere na DRG. A akpan akpan mmetụta dị iche iche n'ahụ Filiks akpali endogenous Steroid, karị, bụ fọrọ agaghị ekwe omume. Mgbe ịha ịta bụ 46 V _d L dị ka a n'ihi nke igba ogwu n'akwara ochichi nke 85 mg dienogest kpọrọ na tritium.

• Metabolism. Dienogest mmewere na fọrọ nke nta kpamkpam metabolized na zuru nnabata ya na ugbu a mara ụzọ nke metabolism nke steroid homonụ, nakwa dị ka e guzobere metabolites na na-na nnukwu ọtụtụ nke ikpe hormonally-adịghị ejekwa ozi. Ndị a metabolites na-anyụpụ ngwa ngwa otú achị òtù ọbara plasma guzo agbanweghi agbanwe dienogest. Total nwechapụ mgbe igba ogwu n'akwara ochichi nke tritiated dienogest bụ 5.1 l / h.

• Mkpochapu. N'ihi nke na-anata a mmewere onu dose of 0,1 mg / n'arọ kpamkpam dienogest ka metabolites na-anyụpụ site akụrụ na eriri afọ na ndika ruru nke 3: 1. Mgbe onu ochichi nke dị 42% nke dose kpamkpam wepụrụ n'oge ụbọchị mbụ, mgbe 63% - n'elu 6 ụbọchị site gbasara akụrụ excretion. Ke adianade do, mgbe 6 ụbọchị site na eriri afọ na akụrụ ewepụtara banyere 86% nke dose.

• The ịha ịta. Na nke a, na pharmacokinetics nke dienogest na-adịghị dabere na ịta nke SHBG. Egosi C _SS a na-enweta mgbe banyere ụbọchị atọ mgbe iji otu dose, nke bụ 3 mg dienogest na Nchikota na 2 mg Estradiol valerate.

estradiol valerate

• Absorption. N'ihi nke na-ewere ọgwụ estradiol kacha mma samples ngwa ngwa kpam etinye obi gị dum. Cleavage na valeric acid na estradiol onwe ya ozugbo na rụrụ n'oge mmiri nke mmewere na digestive tract mucosa ma ọ bụ n'oge mbụ Itie site imeju, si otú na-egosi estradiol na ya metabolites. Ọ bụrụ na ndị gị n'ụlọnga-e concurrently nri, o nweghị clinically ịrịba mmetụta n'ókè ma ọ bụ ọnụego nke absorption nke a mmewere.

• Metabolism. Valeric acid dị iche nnọọ ngwa ngwa metabolism. Mgbe onu ochichi nke mkpokọta 3% nke dose, ọ na-aghọ kpamkpam bioavailable dị ọcha estradiol n'ịnwụ kpụ ọkụ n'ọnụ mbụ mmetụta agafe imeju, nke mere na a ọkpụrụkpụ akụkụ nke ndinọ dose metabolized ama amalite na mucosa nke eriri afọ tract. Nchikota na presystemic metabolism na imeju na ihe 95% nke ihe onu dose n'ikpeazụ metabolized tupu ya na-aga n'ime systemic mgbasa. Isi metabolites ebe a na-eme estrone sulfate, estrone na estrone glucuronide.

• Nkesa. Na ọbara 38% of estradiol na-na metụtara SHBG, mgbe 60% - na albumin na naanị 2-3% na-nọgidere ekesa na unbound ala. Ọ bụ uru na-arịba ama eziokwu na estradiol nwere ike insignificantly dịkwuo ngụkọta ịta nke SHBG na ọbara ọbara, nke a pụrụ isi kwuo ya bụ na dabere na nabata dose. On ụbọchị 21, n'ikuku nke a nkwadebe ngụkọta ịta nke SHBG ahụ bụ ihe dị 146% nke mbụ, mgbe 28th ụbọchị, nke bụ njedebe adọ nke ngwa nke na-adịghị ejekwa mbadamba e belata ka 141%.

• Mkpochapu. N'ihi na a zuru ezu nnukwu ọdọ mmiri nke-ekesa glucuronides na sulfates, nakwa dị ka n'ihi na nke hepato-enteric recirculation T _1/2 estradiol mgbe onu were na ọnụ na-adọ bụ a mgbagwoju mma, ozugbo dabere na a niile Filiks.

• The ịha ịta. Pharmacokinetics estradiol ozugbo na-adabere na ịta nke SHBG. Na ndị inyom, ịta nke estradiol ọbara plasma bụ a mgbagwoju nke endogenous estradiol, na na estradiol nke abatakwa usoro nke na-anata a ọgwụ. N'oge n'ikuku na-adọ mbadamba, nke nwere 3 mg nke dienogest na 2 mg estradiol valerate, nke pụtara ịta nke estradiol n'ime ọbara ọbara na ravnomestnom ala bụ 51,6 Ntuziaka Nne na Nna / ml.

Mgbe a ọgwụ na-eji?

First họpụtara "Klayra" n'oge menopause. Nyocha nke dọkịta na-ekwu na nke a bụ ihe kasị mma nhọrọ maka ọgwụgwọ nke ndị inyom na-ata ahụhụ site na arọ ma ọ bụ ruo ogologo oge ịhụ nsọ na-agba ọbara na-anọghị nke ọ bụla organic daa ọrịa.

Ọzọkwa, a ọgwụ ẹka iji onu igbochi afọ.

contraindications

On nkwadebe "Klayra" omume na dọkịta (mmetụta - na-ata ụta) bụghị ziri ezi mgbe nile. Ka ihe atụ, igbunye ụfọdụ contraindications. Rịba ama a ole na ole ọnọdụ nke ngwá ọrụ a na-ekwesịghị-eji, ma si otú ahụ n'ikuku bụ na-kpamkpam kagbuo ma ọ bụrụ na otu n'ime ha na-amalite ịzụlite n'oge ọgwụ:

• oké uche ọ bụla nke-arụ ọrụ bekee ma ọ bụ ụfọdụ sub-akụrụngwa;
• embolism ma ọ bụ thrombosis ugbu a ma ọ bụ na akụkọ ihe mere eme;
• ala, nke na-tupu thrombosis ma n'akụkọ ihe mere eme na na ugbu;
• owụt butere n'aka ma ọ bụ enwetara pụrụ ịrịa ntoputa nke ọbara ma ọ bụ venous thrombosis, gụnyere ndị erughi nke antithrombin III, protein C na S erughi,-alụso ọrịa ọgụ na phospholipids na gipergomotsistsinemiya;
• ọnụnọ nke elu ọbara ma ọ bụ venous thrombosis;
• ọnụnọ nke migraine na ihe ọ bụla Baịbụl hiwere isi n'ebe akwara ozi mgbaàmà dị ka n'oge, na akụkọ ihe mere eme;
• ọrịa shuga, ji dị iche iche vaskụla nsogbu;
• pancreatitis, oké hypertriglyceridemia enwe ifịk oge ma ọ bụ akụkọ ihe mere eme;
• oké ọrịa imeju ma ọ bụ mmebi imeju nnweta;
• hormone-ndabere ọrịa cancer egosipụta ma ọ bụ enyo nke ha omume;
• imeju etuto ahụ;
• ime ma ọ bụ na-enyo ya;
• mmamiri ọbara ọgbụgba nke na-amaghị si;
• ọnụnọ nke lactose ekweghị ibe nọrọ, klyukozo-galactose malabsorption ma ọ bụ lactase erughi.

Ke adianade do, ọ bụ uru na-arịba ama onye ọzọ ikpe na nke ike-eji ime na mkpụrụ ọgwụ "Klayra". Nyocha nke dọkịta na-ekwu na ha na-ekwesịghị iwere n'oge ara.

pụrụ iche ịdọ aka ná ntị

Ọ bụrụ na ọrịa ụfọdụ, ọnọdụ ma ọ bụ ihe ize ndụ ihe e kwuru n'okpuru ebe na-hụrụ ụmụ mmadụ na ugbu a, ga na-nnọọ nlezianya tụlee nwere ize ndụ na abamuru nke na-ewere a ọgwụ na onye ọ bụla ikpe. Karịsịa, a na-emetụta ndị na-esonụ ọnọdụ:

• ihe ize ndụ ihe maka ụdi mmepe nke thromboembolism na thrombosis;
• Ọrịa ndị ọzọ nke nwere ike hụrụ dị iche iche elu ọbara ọrịa;
• hypertriglyceridemia;
• ọnụnọ nke butere n'aka angioneurotic edema;
• ọrịa dị iche iche, nke mbụ pụtara ma ọ bụ na-aka njọ n'oge ime ma ọ bụ n'oge gara aga iji mmekọahụ homonụ.

ghara iwere "Klayra" mbadamba na ndị a niile ikpe. Nyocha nke dọkịta na ọnọdụ a na-enyere ịnọgide na-enwe ahụ ike.

Pregnancy na ara

The ojiji nke a ọgwụ na-contraindicated n'oge ime. Na nke a, e nwere ọnọdụ ndị dị otú mgbe a tụụrụ ime ya pụtara na ọrịa na-anata na-na-na-ezo aka ọgwụ "Klayra" ntụziaka ntuziaka. Nyocha nke dọkịta na-ekwu na nke a dị mkpa ka ị kwụsị ozugbo sochiri a n'ikuku. Otú ọ dị, na N'ezie nke-arụ nnukwu-ọnụ ọgụgụ ọmụmụ n'ihe ize ndụ nke ọ bụla nwa ntụpọ na ụmụaka ka e kpebisiri ike, mụụrụ inyom bụ onye na-CPC dị ka tupu a tụrụ ime na n'oge ha ukporo n'ikuku na mmalite nke afọ ime.

CPC mgbe ụfọdụ na-emetụta lactation, dị ka ha nwere ike imetụta ego nke mmiri ara ehi na-emepụta ma ọ bụ ọbụna ịgbanwe ya mejupụtara, nke a na-e kwuru okwu banyere nkwadebe "Klayra" omume na-dibia. n'ihi nke a, na ya iji na-adịghị na-atụ aro karịsịa mgbe afọ 40.