Doxorubicin Ebewe 10mg/5ml pengobatan tumor keras, hematuria lan limfoma (5ml)

Bentuk sediaan Kotak x 5 ml
Spesifikasi Doxorubicin
Komposisi EBewe

Komposisi

Informasi komposisi	Isi
Doxorubicin	2 mg/ml

Migunakake

Indikasi

Tumor pekat, hematuria lan sistem limfatik, kalebu:

Granulosit lan limfosit, kayata limfoma Hodgkin lan ora ana Hodgkin.

Karsinoma (karsinoma) payudara, kandung kemih, bronkial, uterus, serviks, ovarium, prostat, pankreas, lambung, tiroid, testis, ati; Tumor neuromuskular;

Jaringan jaringan lunak, balung (Sarkoma Ewing); Tumor Wilms, sirah-sirah, tumor sumsum balung.

Doxorubicin bisa dipompa langsung menyang kandung kemih ing kasus kanker kandung kemih cethek non-invasif - sawise prosedur pemotongan endoskopik (Tur) lan kanggo nyegah jaringan kanker.

Farmakokologi

mǎ ATC: L01D B01

Doxorubicin wis nuduhake aktivitas anti-alien ing sawetara kewan lan efektif ing manungsa nanging ora ana persetujuan babagan carane doxorubicin lan anthracycline liyane duwe efek anti-kanker. Ana 3 mekanisme biokimia utama sing diwenehake: impact ing DNA, nempel ing membran sel lan ngaktifake metabolisme liwat Natal.

Penyebab penting kegagalan perawatan karo doxorubicin lan antrasiklin liyane yaiku pangembangan resistensi obat. Kanggo ngatasi resistensi sel karo doxorubicin, panggunaan antagonis kalsium kayata Verapamil dianggep minangka target utama membran sel; Verapamil nyegah transportasi kalsium saluran alon lan bisa nambah sel kanggo nambah panyerepan Doxorubicin. Chang et al, 1989 nuduhake yen efek sitotoksik doxorubicin mundhak kanthi verapamil ing in vitro nalika digunakake kanggo 3 baris sel kanker pankreas.

Uga wis nliti peran sing ana ing plasma plasma Doxorubicinol, metabolit utama Doxorubicin, nanging nyimpulake yen ora ana hubungane karo akumulasi Doxorubicin. Perlu dicathet yen koordinasi doxorubicin lan verapamil wis nuduhake yen digabungake karo efek beracun sing abot ing kewan (Sridhar et al, 1992).

Farmakokinetik dinamis

Sawise nggunakake Doxorubicin intravena, ana reresik plasma cepet (t) / 2 = 10 menit) lan nempel banget ing jaringan. Wektu adol sampah pungkasan kira-kira 30 jam. Doxorubicin sebagian dimetabolisme, utamane dadi doxorubicinol lan jumlah sing luwih cilik dadi Aglycon, lan disambung karo glukuronida lan sulfat. Eliminasi utamane liwat empedu lan pupuk. Kira-kira 10% saka dosis diilangi liwat ginjel. Doxorubicin ditempelake ing protein plasma kira-kira 50-85%. Volume distribusi 800-3.500 l/m2.

doxorubicin ora diserap dening lisan; Obat kasebut ora ngliwati alangi aliran getih.

Ing pasien kanthi fungsi ati sing cacat, doxorubicin lan metabolit bisa mudhun.

Sadurunge njupuk Doxorubicin Ebewe 10mg/5ml pengobatan tumor keras, hematuria lan limfoma (5ml)

How to use doxorubicin can be used intravenously, artery, intravenous infusion for 48-96 hours or pump into the bladder. The drug is not allowed to be taken into the spinal cord, intramuscularly, injected subcutaneously or drink. Absolutely should be avoided from blood vessels because it can cause vascular inflammation and necrosis. Prolonged drug transmission should only be indicated for special cases. Aortic injection achieved the high level of medication. Wide necrosis can occur in the tissue spread. Because this injection is dangerous, it is necessary to consider carefully. There should be accurate operation when injected directly (Bolus injection) and/ or injecting in a short time. It is necessary to make sure the needle has entered the right position by testing about 5ml of standard transmission solution (isotonic saline solution) before transmitting medicine. Should clamp the transmission lock above the end of the line of the line, then pump Doxorubicin into the line at the position below the lock to avoid Doxorubicin from the upstream transmission in the infusion cord. Slowly inject the entire amount of Doxorubicin solution into the vein (10-20 minutes). Then unlock the infusion cord to transmit the drug to push the drug into the vein to avoid the risk of embolism. In case of bladder injection, avoid the condition in urine. To reduce the amount of urine to approximately 50ml/hour, patients should not drink liquid 12 hours before the treatment procedure is conducted. Patients should change the position lying every 15 minutes while transmitting dripping into the bladder. Usually the transmission time is 1 hour. Next, patients should urinate. Before pulling out the drug from the vial and injecting the drug, Doxorubicin should be stored at room temperature. To dilute Doxorubicin solution should use physiological saline. Dissolve 50ml doxorubicin with 30-50 ml of physiological saline solution to transmit bladder drip. If Doxorubicin is exposed to the skin, mucosa, you should wash the contact with water, soap immediately. Dosage doxorubicin dose depends on the corresponding treatment cycle, the patient's general condition and the patient's previous treatment. So the following data is just instructions. Treatment of distance with a dose of 75 mg/m2 body skin every 3 weeks taking a single dose or divided into several doses smaller than injected for 2-3 consecutive days. Treatment of distance with a dose of 60 mg/m body skin every 3 weeks in patients with impaired bone marrow function due to age or a history of bone marrow failure or newly invaded bone marrow Treatment of 25 mg/m2 of body skin per day (equivalent to 0.6mg/kg of body weight) within 3 days or 35 mg/m body skin (equivalent to 0.8 mg/kg body weight) within 2 days for cancer treatment of hematopathy, should not stop the drug less than 10 days. In children: 10-20 mg/m2 body skin, once a week or every 2 weeks, total dose not exceeding 500 mg/m2 body skin. For patients who cannot treat enough dose of some reasons (age, bone marrow inhibitor, immunosuppressive inhibition, relative contraindications) The following treatment cycle is recommended for monomers or multi -chemotherapy). transmitted for a long period of 60 mg/m within 48-96 hours. 20 mg/m2 The body skin used for 3 consecutive days, every 3 weeks. 20 mg/m2 body skin once a week, replacing treatment at a dose of 60 mg/m2 body skin every 3 weeks. Because there may be unwanted side effects on the heart, the total accumulation dose must not exceed 500-550 mg/m2 of the body. The total dose should be reduced to 400 mg/m2 of the body skin in the following cases: Patients who have been far away from the previous mediastinum, have been used before or are taking simultaneously toxic drugs (such as cyclophosphamide, mitoxantron) or related substances (daughterubicin). In the case of stomatitis or mucositis, therapy should only continue when the lesions have healed at a decrease to about 50%. In case of changes in blood formula, with liver and kidney dosage disorders, the dose should be reduced corresponding to the following test results: The number of white blood cells 4000/mm³ ≥100,000/mm³ D> 50% leukocytes less than 2000 and platelets less than 50,000/mm3 stop using doxorubicin. Bilirubin 1.2-3 mg/100 ml: 50%dose bilirubin> 3 mg/100 ml: 25%dose Creatinin serum 1,2-2 mg/100 ml: 50%dose What to do when overdose? 24 -hour round) as well as inhibition of bone marrow that peaks within 14 days. Treatment recommends is the treatment of mucositis symptoms. Heart symptoms due to toxicity are largely recovered and temporarily and can lead to nonspecific changes on the center of electrocardiogram (reducing the difference of ST, sinus tachycardia, extracellular fall). may need infection reserve (including antibiotics) as well as supplements to replace the affected urine ingredients in cases of bone marrow failure. Chronic poisoning occurs as a myocardial disease (left heart failure) especially when accumulating more than 500 mg/m2 of body skin, and need symptom treatment. It is necessary to perform an echocardiogram, measure the systolic time and nuclear arterial angiography to diagnose myocardial toxicity due to accumulation.

Efek sisih

Gagal sumsum balung sing abot biasane pulih sing bisa kedadeyan sawise perawatan 10-14 dina. Proporsi pasien anemia, trombositopenia, leukopenia gumantung saka dosis sing tambah mengko. Aktivitas gagal sumsum balung mundhak nalika digabungake karo obat anti-kanker liyane (sitostatik) utawa kanthi radiasi, utamane yen dosis sing luwih gedhe yaiku 550 mg / m2 awak lan 400 mg / m2 awak. Mulane, perlu kanggo ngontrol rumus sel getih putih, sel getih abang. Kanthi dosis kasebut, leukopenia kedadeyan lan sing paling abot sawise 10-14 dina. Umumé, kondisi iki pulih nganti dina kaping 21.

Uga obat Anthracycline liyane, perawatan karo doxorubicin bisa nyebabake lesi jantung. Risiko keracunan miokardium mundhak nalika dosis akumulasi total ngluwihi 500 mg / m2 awak ing wong diwasa lan 400 mg / m2 saka kulit awak ing bocah-bocah. Ngindhari obat-obatan tingkat dhuwur sing asring kedadeyan sawise infus intravena dosis dhuwur bisa nyuda keracunan ing jantung.

Tahap akut: Paling ing 24 jam sawise wiwitan perawatan, sing pisanan yaiku owah-owahan elektrokardiogram sing ora gumantung ing dosis kayata nyuda dawa St, sinus tachycardia, ventricular tachycardia lan ventricular tachycardia. Umume gejala ing jantung bisa pulih utawa bisa diobati kanthi anti-arrhyths. Ana laporan kasus langka saka patients gerah saka arrhythmia jantung sing ngancam nyawa ing sawetara menit. Sawise pasien ngalami aritmia bisa diterusake.

Fase pungkasan: keracunan jantung amarga akumulasi obat lan gumantung dosis. Komplikasi pungkasan biasane gagal jantung kongestif (gagal jantung kiwa) sajrone perawatan utawa bisa uga sawise pirang-pirang wulan utawa gangguan sawise perawatan rampung (sesak ambegan, tangan lan sikil).

Anthracyclin disebabake anthracyclin digabungake karo nyuda QRS, ndawakake wektu centrifugal lan ngurangi total serat sampel saka ventrikel kiwa. Manifestasi kasebut bisa tuwuh kanthi cepet lan angel dideteksi liwat elektrokardiogram biasa. Penyakit miokard nanggapi kanthi apik kanggo perawatan nanging bisa uga ora pulih lan nyebabake pati yen ora dideteksi luwih awal. Kesulitan ambegan, lengen lan sikil bisa nyebabake penyakit otot jantung anthracyclin. Sadurunge perawatan karo doxorubicin kudu nindakake tes electrocardiogram, echocardiograms lan nemtokake emulsi getih ventrikel kiwa. Fungsi jantung kudu dipantau kanthi rutin sajrone lan sawise perawatan.

Rambut rontog wis pulih udakara 85% pasien.

Mual, anorexia, kontraksi lambung, diare minangka efek samping sing ora dikarepake nanging gampang pulih.

Gastritis lan esophagitis biasane rata-rata suwene 5-10 dina lan arang nyebabake borok. Lesi inflamasi gastrointestinal (jarang nyebabake ulkus).

Urine pasien dadi abang nalika wiwitan perawatan nanging bali menyang normal sawise 48 jam lan ora ana gejala sing penting.

Arang kasus hiperurisemia, penyakit ginjel amarga obat-obatan sing paling akeh kedadeyan ing wiwitan perawatan ing pasien leukemia utawa limfoma ganas amarga karusakan kanthi cepet saka akeh sel sing nyebabake tambah asam urat serum.

Ruam abang, gatal, urtikaria, mriyang, tremor, anafilaksis sing arang kaget. Arang kasus pasien sing kuku rusak, hiperpigmentasi, inflamasi vena amarga trombosis, kaca epidermis, nyeri sendi, kekurangan imun.

Diamati kanthi hiperurisemia ing penyakit karo leukemia lan mbutuhake perawatan karo inhibitor xanthinoxidase.

Pasien sing wis utawa perawatan radioaktif bisa uga duwe risiko tambah reaksi lokal ing area iradiasi (fenomena regresi): Maneh, lesi radiasi sadurunge wis waras luwih awal nalika nggunakake doxorubicin.

Pangobatan kolaboratif karo cytarabine bisa nyebabake kolitis kolitis kadhangkala kanthi infeksi abot.

Diamati menstruasi lan sperma ing kombinasi karo obat sel liyane.

Kombinasi radioterapi bisa nyebabake dermatitis lan mucositis ing area radiasi. Uga ora dikecualekake kanggo tumor sekunder sing disebabake dening obat.

Efek samping sing ora dikarepake sing ana gandhengane karo panggunaan obat: Sawise infus ing vena cilik utawa injeksi diulang ing vena sing bisa nyebabake sclerosis. Yen injeksi doxorubicin ditinggalake saka obat kasebut, bakal nyebabake nekrosis jaringan lokal sing abot ing situs injeksi. Resiko trombosis bisa dikurangi ing situs injeksi nalika rute medis obat kasebut ditindakake.

* Arang arang katon ing sadawane injeksi intravena (yen injeksi intravena cepet banget).

Kabar menyang dhokter babagan efek sing ora dikarepake ing perawatan.

Pènget

Sadurunge nggunakake obat kasebut, sampeyan kudu maca instruksi kasebut kanthi teliti lan deleng informasi ing ngisor iki.

Kontraindikasi

alergi kanggo bahan obat.

doxorubicin ora digunakake kanggo pasien sing gagal sumsum balung sing abot.

doxorubicin ora digunakake kanggo pasien sing duwe riwayat penyakit jantung (angina ora stabil, gagal jantung progresif, gagal jantung tahap IV, gangguan transmisi lan aritmia jantung sing abot, infark miokard 6 sasi sadurunge, penyakit miokard).

Pasien diobati kanthi obat saka klompok anthracyclin (epirubicin, idarubicin, daunorubicin) nganti dosis kumulatif maksimal sing cocog karo doxorubicin.

Ora ana perawatan karo doxorubicin ing kasus gagal ginjel abot, gagal ati sing abot, infeksi sing ora bisa dikontrol lan pendarahan.

Kontraindikasi nggunakake doxorubicin langsung ing kandung kemih yen ana cystitis.

Aja nggunakake doxorubicin sing disuntikake langsung ing kandung kemih yen tumor wis nyerang tembok kandung kemih. Ati-ati kudu ati-ati ing kasus pasien sing duwe utawa lagi iradiasi pasien mediastinum, pericardial utawa post-treatment kanthi pil beracun kanggo jantung uga pasien sing duwe kahanan klinis khusus amarga penyakit kayata anemia, pericarditis lan / utawa miokarditis. Ana paningkatan risiko keracunan ing jantung nalika nggunakake doxorubicin ing kasus kasebut.

Aja nuduhake doxorubicin kanggo wanita ngandhut lan lactating.

Ati-ati nalika digunakake

Pangobatan obat ing klompok Anthracycline mung ditindakake dening spesialis kanker sing berpengalaman. Injeksi aorta mung ditindakake dening dokter sing duwe pengalaman khusus. Kahanan sing penting/kahanan medis utawa kahanan medis kudu diwenehake kanggo efek sing ora dikarepake. Sampeyan perlu kanggo mesthekake infus intravena sing aman, yen ora bisa necrotic lan trombosis. Pasien kudu dipantau kanthi teliti sadurunge, sajrone lan sawise perawatan. Monitor parameter hematologi: rumus getih, granulosit, sel getih abang lan trombosit. Perawatan awal pendarahan abot lan/utawa infeksi uga nyumbang kanggo perawatan sing sukses.

Priksa fungsi ati lan ginjel kayata bilirubin, kreatinin serum lan panyesuaian dosis sing penting.

Konsentrasi hemoragik: Perawatan sing cocog dibutuhake kanggo kasus hiper urea.

Monitor parameter jantung: EKG, ekokardiografi, indra ventrikel kiri. Diagnosis awal lan perawatan cepet dibutuhake kanggo perawatan sing sukses.

Kontrol infeksi: Infeksi sistemik kudu dikontrol sadurunge miwiti perawatan.

Penyakit pra-jantung, perawatan sadurunge karo keracunan jantung kayata anthracycline kanthi dosis kumulatif sing dhuwur nambah risiko keracunan ing jantung. Rasio keuntungan/resiko kudu dianggep nalika njupuk obat kanggo pasien saka klompok iki.

Sampeyan kudu takon karo ahli genetik yen pasien pengin meteng sawise mandheg perawatan.

Cathetan: Doxorubicin ora bisa ditaksir.

Pandhuan manipulasi safety kanggo tenaga kesehatan. Kaya bahan kimia anti-kanker liyane, ati-ati nalika nggarap doxorubicin. Yen obat kasebut tumpah, langsung cuci nganggo sabun lan banyu. Aja nganti wanita ngandhut kena doxorubicin.

doxorubicin ora aktif:

700 derajat C

larutan natrium hipoklorosis natrium diencerake kanthi 10 bagean banyu.

Efek obat kasebut ing kemampuan nyopir lan ngoperasikake mesin

doxorubicin bisa nyuda kemampuan nyopir lan ngoperasikake mesin, mula kudu ati-ati yen nindakake kegiatan kasebut nalika njupuk obat kasebut.

Gunakake obat kanggo wanita nalika meteng lan lactation

ora nuduhake Doxorubicin kanggo wanita ngandhut lan lactating. Doxorubicin wis diwujudake beracun kanggo keracunan, nyebabake teratogen ing kewan eksperimen, saengga ora digunakake kanggo wanita ngandhut. Perlu kanggo mesthekake kontrasepsi sing ketat kanggo pasien lan uga wanita ing wektu sadurunge lan paling ora 3 wulan sawise terapi doxorubicin. Amarga doxorubicin disekresi menyang ASI, pasien sing nyusoni kudu mandheg tanpa nyusoni.

Obat interaktif

Obat interaktif dumadi karo kabeh obat sing nyebabake inhibitor sumsum balung, pil beracun karo jantung, racun karo ati. Amarga doxorubicin bisa nyebabake tingkat asam urat mundhak lan mulane bisa uga kudu ditanggapi kanthi nyetel dosis sajrone wektu kombinasi kanggo nambani asam urat. Koordinasi karo cyclosporin bisa nyebabake neuropati utawa kekacauan. Doxorubicin padha karo heparin lan solusi alkali. Umumé, doxorubicin ora kudu dicampur karo solusi transmisi liyane. Fenobarbital bisa nyebabake peningkatan reresik doxorubicin. Doxorubicin bisa nyuda bioavailabilitas Digoxine (oral).

Sajrone perawatan doxorubicin, aja nggunakake vaksin kanggo ngetung pasien (pasien kudu ngindhari kontak karo wong sing lagi wae lumpuh vaksin). Resistensi silang dumadi karo Doxorubicin lan Daunorubicin.

Panyimpenan

Ninggalake papan sing adhem, aja nganti cahya, suhu ngisor 30⁰C.

Supaya ora bisa digayuh bocah, waca manual pangguna kanthi teliti sadurunge digunakake.

Obat liyane

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