I-Dabigatran

I-Dabigatran

Amahlule egazi abeka engcupheni enkulu yezempilo ezigidini zabantu emhlabeni wonke. I-Dabigatran umuthi obalulekile kunqolobane yezokwelapha yesimanje ngokumelene nengozi amahlule igazi. Lesi sihloko sichaza konke okudingekile iziguli mayelana ne-dabigatran, okuhlanganisa ukusetshenziswa kwayo okufanele, imiphumela engemihle engase ibe khona, izinyathelo zokuphepha ezidingekayo, nolwazi olubalulekile lokudosa.

Iyini i-Dabigatran?

I-Dabigatran umuthi onamandla we-anticoagulant ekilasini lama-thrombin inhibitors aqondile. Lo muthi owunikezwa ngudokotela uyindlela esebenzayo kwezinye izinto zendabuko zokunciphisa igazi njenge-warfarin, enikeza inzuzo yokungadingi ukuhlolwa kwegazi njalo.

Umuthi uthole ukugunyazwa yiziphathimandla ezilawulayo futhi uqashelwa ohlwini Lwemithi Ebalulekile Yenhlangano Yezempilo Yomhlaba. Kusukela yavunywa yi-FDA ngo-2010, i-dabigatran isibaluleke kakhulu ekwelashweni.

Umuthi utholakala ngezindlela ezimbili: amaphilisi omlomo awabantu abadala kanye namaphilisi omlomo eziguli zezingane.

Ngokungafani nezinto ezinciphisa igazi zendabuko, i-dabigatran ikhombisa imiphumela ebikezelwayo ye-anticoagulant emzimbeni. Lokhu kubikezela kuqeda isidingo sokuhlolwa kwegazi njalo ukuze kuqashwe ukusebenza kwalo, okwenza kube lula ezigulini ezidinga ukwelashwa kwe-anticoagulation yesikhathi eside.

Ukusetshenziswa kwethebhulethi ye-Dabigatran

Ukusetshenziswa okuyinhloko kwe-dabigatran kuhlanganisa:

• Ukuvimbela Ukushaywa unhlangothi: Yehlisa ubungozi bokushaywa unhlangothi ezigulini ezine-nonvalvular atrial fibrillation
• Ukwelashwa kwehlule legazi: Yelapha i-deep vein thrombosis (DVT) & pulmonary embolism (PE) ezigulini ezithole ukwelashwa kokuqala ngezithako zegazi ezijovwa
• Ukuvikelwa Kwangemva Kokuhlinzwa: Ivimbela amahlule egazi ngemva ukuhlinzeka ukuhlinzwa esikhundleni.
• Ukuvimbela Amahlule Okuphindaphindayo: Yehlisa ingozi yokuphindaphinda kwehlule legazi ezigulini ezithintekile ngaphambilini.
• Ukwelashwa Kwezingane: Yelapha amahlule egazi ezinganeni ezinezinyanga ezi-3 nangaphezulu

Indlela yokusebenzisa i-Dabigatran Tablet

Ukuphathwa ngendlela efanele kwe-dabigatran kubalulekile ekusebenzeni kwayo nokuphepha. Iziguli kufanele zilandele lezi ziqondiso ezibalulekile zokuphatha:

• Thatha ama-capsules wonke ngengilazi yamanzi agcwele
• Ungalokothi uphule, uchoboze, noma uvule amaphilisi
• Ingathathwa ngokudla noma ngaphandle kokudla
• Thatha ngesikhathi esifanayo usuku ngalunye
• Ngomthamo ophindwe kabili ngosuku, imithamo yesikhala cishe amahora ayi-12 ngokuhlukana
• Thatha imithamo egejiwe phakathi kwamahora ayi-6 wesikhathi esihleliwe
• Yeqa umthamo ogejiwe uma ngaphansi kwamahora angu-6 kuze kufike umthamo olandelayo ohleliwe

Imiphumela Emibi ye-Dabigatran Tablet

Imiphumela emibi evamile ye-dabigatran iziguli ezingayithola ihlanganisa:

• Ukuqunjelwa nokungakhululeki kwesisu
• isilungulela
• I-nausea nokuhlanza
• Ubuhlungu besisu
• Uhudo
• Ukukhathala nokuntuleka kwamandla

Imiphumela Emibi Kakhulu: Ukopha kuyingozi ebaluleke kakhulu ehambisana ne-dabigatran. Iziguli kufanele ngokushesha zithintane nodokotela wazo owelaphayo uma zibona:

• Umchamo opinki noma onsundu
• Izihlalo ze-tarry ezibomvu noma ezimnyama
• Ukulimala okungalindelekile
• Ukopha isikhathi eside ngokusikeka
• Ukukhwehlela igazi
• Ukuhlanza okubukeka njengezindawo zekhofi

Ukunakekelwa kwezokwelapha okuphuthumayo kuyadingeka uma iziguli ziba nokuvuvukala ebusweni, ezindebeni, olimini, noma ngaphakathi emphinjeni, ziba nobunzima bokuphefumula, noma ziba nokungezwani okukhulu kwesikhumba.

Ukuqapha

Ukuphepha kwesiguli kudinga ukunakwa ngokucophelela ezinyathelweni ezibalulekile lapho uthatha i-dabigatran. 

Izinyathelo ezibalulekile zokuqapha ukusetshenziswa kwe-dabigatran zihlanganisa:

• Gwema ukuphuza utshwala njengoba kwandisa ingozi yokopha
• Yazisa odokotela mayelana nokuhlinzwa okuzayo noma izinqubo zamazinyo
• Ukuqapha ukusebenza kwezinso okuvamile kubalulekile
• Gcina amashejuli omthamo angaguquki
• Phatha isixwayiso sezokwelapha
• Ungalokothi uyeke ukwelashwa ngaphandle kokubonisana nodokotela

Izimo Zezokwelapha: I-Dabigatran ayizilungele iziguli ezinamavalvu enhliziyo ayimishini, ukukhubazeka okukhulu kwezinso, noma izimo ukopha okusebenzayo. Labo abanobuchopho bamuva, umgogodla, noma ukuhlinzwa kweso zidinga ukuhlolwa okukhethekile kwezokwelapha ngaphambi kokuqala ukwelashwa. 

Isebenza kanjani ithebhulethi ye-Dabigatran

I-Dabigatran isebenza ngokubophezela ngokuhlehla ku-thrombin. I-Thrombin iyi-enzyme ebalulekile ekwakhiweni kwegazi. Lokhu kubopha kuvimbela i-thrombin ukuthi isebenze izici ezihlukahlukene zokujiyisa egazini. Ngokungafani nezinye izinto ezinciphisa igazi, i-dabigatran ingavimbela i-thrombin entantayo mahhala kanye ne-thrombin kakade eboshwe emahluleni egazi, ikwenze kusebenze ngokukhethekile.

Umuthi ubonisa imiphumela eminingana ebalulekile emzimbeni:

• Ivimbela i-thrombin ekuguquleni i-fibrinogen ibe yi-fibrin
• Yehlisa ikhono le-thrombin lokwenza amaplatelet asebenze
• Ivimbela ukwakheka kwamahlule egazi amasha
• Kungase kuthuthukise inqubo yemvelo yokuwohloka kwehlule

Uma ithathwa ngomlomo, i-dabigatran etexilate (ifomu elingasebenzi) iba noshintsho esibindini ukuze ibe yi-dabigatran esebenzayo. Le nqubo iqinisekisa ukumuncwa okuthembekile nokusebenza okungaguquki. 

Ngingakwazi Ukuthatha I-Dabigatran Ngeminye Imithi?

Imithi eminingana ingathinta kakhulu indlela i-dabigatran esebenza ngayo emzimbeni. Iziguli kufanele zazise odokotela bazo ngayo yonke imithi yamanje, ikakhulukazi:

• Imithi ehlobene negazi:
  • Ezinye izinto ezinciphisa igazi (warfarin, enoxaparin)
  • Imithi ye-antiplatelet (i-clopidogrel, i-prasugrel)
  • aspirin kanye nemikhiqizo equkethe i-aspirin
• Okunye Ukusebenzisana Okubalulekile:
  • Imithi ye-Antifungal (ketoconazole)
  • Imithi yesigqi senhliziyo (i-dronedarone)
  • Ukwelashwa kwesifo sofuba (phumlani)
  • Ama-NSAID (ibuprofen, naproxen)

Ulwazi Lomthamo

Umthamo ofanelekile we-dabigatran uncike ezicini eziningana, okuhlanganisa isimo sezempilo elashwayo, ukusebenza kwezinso, kanye neminyaka yesiguli. 

Umthamo Ojwayelekile Wabantu Abadala

• Ukuvimbela i-stroke ku-fibrillation ye-atrial: 150 mg kabili ngosuku
• Ukwelashwa kwe-vein thrombosis ejulile: 150 mg kabili ngosuku ngemuva kwezinsuku ezi-5-10 zokujova okokunciphisa igazi
• Ukuvimbela ukuhlinzwa esikhundleni se-hip: 110 mg ngosuku lokuqala, bese kuba ngu-220 mg kanye ngosuku

Ukucatshangelwa komsebenzi wezinso: Umuthi udinga ukulungiswa komthamo okususelwa ku-creatinine clearance (CrCl):

• Ukusebenza kwezinso okuvamile (CrCl>30 mL/min): Kusebenza umthamo ojwayelekile
• Ukonakala okumaphakathi (CrCl 15-30 mL/min): 75 mg kabili ngosuku
• Ukonakala okukhulu (CrCl <15 mL/min): Akunconyelwe

Abantu Abakhethekile: Umthamo wezingane uyahlukahluka ngesisindo:

• 11-16kg: 75 mg kabili ngosuku
• 16-26kg: 110 mg kabili ngosuku
• 26-41kg: 150 mg kabili ngosuku
• 41-61kg: 185 mg kabili ngosuku

Isiphetho

I-Dabigatran ime njengethuluzi elinamandla ekulweni nemithi yesimanje ngokumelene namahlule egazi ayingozi. Odokotela bayawazisa lo muthi ngemiphumela yawo ebikezelwayo kanye nesidingo esincishisiwe sokuqapha njalo uma kuqhathaniswa nezinciphisi zegazi zendabuko. Iziguli ziyazuza ekusebenzisaneni kwayo ngezindlela ezihlukahlukene ekwelapheni izimo ezihlukahlukene, kusukela ekuvimbeleni ukushaywa unhlangothi ku-atrial fibrillation kuya ekwelashweni kwehlule legazi ngemva kokuhlinzwa. Ukutholakala komuthi ngezindlela ezihlukene kuwenza ulungele kokubili abantu abadala kanye neziguli zezingane, okunweba ukufinyelela kwawo kokwelapha kuwo wonke amaqembu obudala.

Imibuzo Evame Ukubuzwa

1. Ingabe i-dabigatran inemiphumela emibi?

Imiphumela emibi evamile ukungaphatheki kahle kwesisu, isilungulela, nesicanucanu. Imiphumela emibi kakhulu ingabandakanya izinkinga zokopha. Iziguli kufanele zibheke:

• Ukulimala noma ukopha okungajwayelekile
• Umchamo opinki noma onsundu
• Igazi esitokisini noma ekuhlanzeni

2. Kufanele ngithathe kanjani i-dabigatran?

Iziguli kufanele ziphuze i-dabigatran ngendlela ebekiwe, ngokuvamile kabili ngosuku ngamanzi. I-capsule kufanele igwinywe iphelele futhi ingalokothi ichotshozwe noma ivuleke. Ukuyithatha kanye nokudla kungavimbela ukuvela kwesisu.

3. Ubani odinga i-dabigatran?

I-Dabigatran inqunyelwe iziguli ezine-fibrillation ye-atrial ukuvimbela imivimbo, lezo ezidinga ukwelashwa kwehlule legazi, kanye nabantu abanomlando wokuhlinzwa esikhundleni se-hip.

4. Zingaki izinsuku ongazithatha i-dabigatran?

Ubude besikhathi sokwelashwa buhluka kuye ngesimo sezempilo. Ezinye iziguli zingase ziyidinge emasontweni ambalwa ngemva kokuhlinzwa, kuyilapho ezinye ezinezimo ezingapheli zingase zidinge ukwelashwa isikhathi eside ngaphansi kokuqondisa kodokotela.

5. Ingabe i-dabigatran iphephile ukuyisebenzisa nsuku zonke?

Yebo, i-dabigatran iphephile ukusetshenziswa nsuku zonke uma ithathwa njengoba kushiwo. Ukuqapha njalo odokotela kuqinisekisa ukuphepha nokusebenza ngempumelelo okuqhubekayo.

6. Ubani okungafanele athathe i-dabigatran?

Iziguli ezinama-valve enhliziyo ayimishini, izinkinga ezinkulu zezinso, noma ukopha okusebenzayo akufanele zithathe i-dabigatran. Futhi ayifaneleki kulabo abanenkinga ethile yokopha noma ukuhlinzwa okukhulu kwakamuva.

7. Ingabe i-dabigatran ingcono kune-aspirin?

Ucwaningo lubonisa ukuthi i-dabigatran ingasebenza kangcono kune-aspirin ekuvimbeleni ukushaywa unhlangothi ezigulini ezinezimo ezithile. Nokho, ukukhetha phakathi kwemithi kuncike ezicini zesiguli ngasinye.

8. Kungani i-dabigatran inqunyelwe ukuthi iphuzwe kabili ngosuku?

I-dosing kabili ngosuku igcina amazinga egazi aqinile omuthi. Lolu hlelo lusiza ukunikeza ukuvikeleka okungaguquki kumahlule egazi usuku lonke.

9. Ukumisa nini i-dabigatran?

Iziguli akufanele neze ziyeke i-dabigatran ngaphandle kokubonisana nodokotela wazo. Ngokuhlinzwa okuhleliwe, ngokuvamile kuyamiswa ezinsukwini ezingu-1-5 ngaphambi kwenqubo, kuye ngokusebenza kwezinso nobungozi bokopha.

10. Yisiphi isikhathi esingcono kakhulu sokuthatha i-dabigatran?

Indlela engcono kakhulu ukuthatha imithamo amahora ayi-12 ngokuhlukana ngesikhathi esifanayo usuku ngalunye. Lokhu kuqinisekisa amazinga egazi angaguquki omuthi ukuze asebenze kahle.