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Rivaroxaban

Ama-clots egazi kuthinta izigidi zabantu emhlabeni wonke futhi kungaholela ezinkingeni zempilo ezibulalayo uma kungelashwa. I-Rivaroxaban iye yavela njengomuthi obalulekile ekuvimbeleni nasekwelapheni la mahlule egazi angaba yingozi. Lo mhlahlandlela ophelele uhlola konke okudingwa yiziguli mayelana nokusetshenziswa kwe-rivaroxaban, ukuphatha okufanele, imiphumela emibi engaba khona, kanye nezinyathelo zokuphepha ezidingekayo. 

Iyini i-Rivaroxaban?

I-Rivaroxaban imithi enamandla ye-anticoagulant esiza ukuvimbela nokwelapha amahlule egazi. Kungokweqembu elithile lemithi ebizwa ngokuthi i-factor Xa inhibitors. Ngokungafani nama-blood thinners wendabuko, i-rivaroxaban isebenza ngokuqondile ngokuvimbela izinto ezithile zemvelo ezibangela ukuba amahlule egazi akheke.

Okwenza i-rivaroxaban ihluke ukuphatha kwayo ngomlomo kanye nokusebenza kahle kwayo. Nazi izici zayo ezihlukile:

  • Ayidingi i-antithrombin III ukuze isebenze ngempumelelo
  • Ingathathwa ngomlomo, ngokungafani nezinye izinto eziningi ezinciphisa igazi ezidinga umjovo
  • Ifinyelela ukusebenza okuphezulu emahoreni angama-2-4 ngemuva kokuyithatha
  • Igcina i-bioavailability ephezulu engaphezu kuka-80% kumthamo we-10 mg

Ukusetshenziswa kwe-Rivaroxaban 

I-Rivaroxaban isetshenziselwa:

  • Ukwelashwa kwezifo ezifana i-vein thrombosis ejulile (DVT) & i-pulmonary i-embolism (PE)
  • Ukuvimbela imivimbo kubantu abadala abane-fibrillation ye-atrial engabangelwa isifo se-valve yenhliziyo
  • Ukuvimbela ukuthuthukiswa kwehlule legazi ngemva kokuhlinzwa kwedolo noma i-hip esikhundleni
  • Ukunciphisa izenzakalo ezinkulu zenhliziyo nemithambo yegazi lapho kuhlanganiswe ne-aspirin
  • Ukuvinjelwa kwamahlule egazi ezigulini ezisesibhedlela ezinokuhamba okulinganiselwe
  • Ezigulini ezishintshwa idolo nokuhlinzwa inqulu 
  • Ukuphatha isifo se-peripheral artery. 

Ungayisebenzisa kanjani ithebhulethi yeRivaroxaban

  • Iziguli kufanele zithathe i-rivaroxaban kanye ngosuku ngesidlo sazo sakusihlwa ezimweni eziningi. Lesi sikhathi sisiza umzimba ukuba umunce wonke umthamo ngempumelelo. 
  • Thatha ithebhulethi ngamanzi ngesikhathi esifanayo nsuku zonke
  • Ezinye iziguli, ikakhulukazi lezo ezelaphayo I-DVT noma i-PE, ingase idinge ukuyiphuza kabili ngosuku emasontweni ambalwa okuqala ngemva kokuhlinzwa.
  • Ungayeki ukuthatha noma ushintshe umthamo wakho we-rivaroxaban ngaphandle komyalelo kadokotela wakho.
  • Ungayihlukanisi noma uyichoboze ithebhulethi.
  • Uma isixazululo somlomo sinqunyiwe, sebenzisa amathuluzi okulinganisa afanelekile anikezwe umenzi; ungasebenzisi izinkezo zasendlini.

Imiphumela Emibi ye-Rivaroxaban Tablets

Imiphumela Emibi Evamile:

  • Ukopha okuncane ngenxa yokusikeka okuthatha isikhathi eside ukuyeka
  • Ukopha noma ukopha izinsini ngenkathi uxubha amazinyo
  • Ukulimaza ngokushesha kunokujwayelekile
  • Ubuhlungu besisu noma ukungakhululeki kokugaya ukudla
  • Ukuzizwa unesiyezi noma unekhanda elilula
  • Ukuphathwa yikhanda
  • Ukushisa isikhumba esincane

Imiphumela Emibi Kakhulu:

  • Igazi emchameni noma ezindle
  • Ukukhwehlela igazi
  • Ikhanda elibuhlungu noma isiyezi
  • Imihuzuko engajwayelekile noma amabala ansomi esikhumbeni
  • Ukopha okuqhubekayo ngenxa yokusikeka noma amanxeba

Ukuqapha

Abantu abathile badinga ukunakwa okwengeziwe lapho bethatha i-rivaroxaban. 

Isimo Sezempilo: 

  • Umuthi awunqunyelwe iziguli ezinezinkinga ezinkulu zezinso noma lezo eziku-dialysis ezinemvume ye-creatinine engaphansi kwama-30 mL/ngomzuzu. 
  • Abantu abanezinkinga ezinkulu zesibindi, ikakhulukazi labo abanezimo ze-Child-Pugh Class B no-C, kufanele bakugweme ukusebenzisa rivaroxaban.
  • Iziguli ezinamavalvu enhliziyo yokwenziwa noma lezo ezinezimo zokopha okungavamile zidinga ukuhlolwa ngokucophelela ngaphambi kokuqala ukwelashwa.
  • Abantu abanesisindo esingaphezu kuka-120 kg bangadinga ukuqapha okukhethekile
  • Abantu abane-antiphospholipid syndrome (APS) kufanele bagweme i-rivaroxaban

Abadala: Iziguli ezineminyaka engu-75 nangaphezulu zidinga ukuqashwa eduze ngenxa yokwanda kwezingozi zokopha

Izinqubo: Yazisa udokotela wakho ngalesi sidakamizwa ngaphambi kwanoma yiziphi izinqubo zokuhlinzwa, ukwelashwa kwamazinyo, noma ezinye izinqubo zezokwelapha.

Ukukhulelwa Nokuncelisa: Yazisa udokotela wakho uma uhlela ukukhulelwa noma abakhulelwe. I-Rivaroxaban ingase yandise ingozi yokopha kumama nengane engakazalwa. Lo muthi ungadlulela obisini lwebele, ngakho yazisa udokotela wakho uma kunjalo ibele.

Isebenza kanjani ithebhulethi yeRivaroxaban

Emgogodleni wayo, i-rivaroxaban isebenza ngokuvimbela into ebizwa ngokuthi i-Factor Xa, edlala indima ebalulekile ekujiyiseni kwegazi. Uma i-Factor Xa ivinjiwe, ivimbela ukwakheka kwe-thrombin, ekugcineni inciphise ikhono lomzimba lokwenza amahlule egazi.

Okwenza i-rivaroxaban iphumelele ikakhulukazi:

  • Ukubophezela okuqondile ku-Factor Xa ngokukhetha okuphezulu (izikhathi eziyi-10,000 ezikhethwa kakhulu kunamanye amaprotheni afanayo)
  • Ukumuncwa okusheshayo, kufinyelela ukusebenza okuphezulu emahoreni angama-2-4
  • Strong amaprotheni amandla okubopha angama-92-95% egazini
  • Amandla okusebenza ngaphandle kokudinga i-antithrombin III

Umuthi usebenza ngokushesha emzimbeni, usiza ukuvimba amahlule akhona ukuthi angakhuli kanye namahlule ukuthi akheke. Isebenza ngokukhomba i-Factor Xa ngezindlela ezintathu ezihlukene: lapho intanta mahhala, lapho iyingxenye yenqubo yokujiyisa, nalapho isivele iboshelwe kumahlule akhona.

I-Rivaroxaban inciphisa ukukhiqizwa kwe-thrombin egazini ngokuvimbela kokubili izindlela ze-intrinsic & extrinsic coagulation. Lesi senzo esikabili siyenza isebenze ngokukhethekile ekuvimbeleni amahlule egazi angafuneki kuyilapho ivumela umzimba ukuthi wakhe amahlule lapho kudingeka, njengangemuva kokulimala.

Ngingakwazi Ukuthatha I-Rivaroxaban Ngeminye Imithi?

Imithi ebalulekile okufanele uyigweme noma uyisebenzise ngokuqapha:

  • Izidakamizwa ze-Antiepileptic njenge-carbamazepine
  • Izidakamizwa zokulwa ne-Antiarrhythmic
  • aspirin
  • Ama-antibiotic athile, okuhlanganisa i-erythromycin ne-rifampicin
  • Imithi ye-HIV efana ne-ritonavir
  • Ama-NSAID afana ne-ibuprofen (ngaphandle uma kugunyazwe ngokuqondile udokotela)
  • Ezinye izinto ezinciphisa igazi noma ama-anticoagulants
  • I-serotonin reuptake inhibitor ekhethiwe (SSRI), efana ne-sertraline, i-fluoxetine
  • Eminye imithi ye-antifungal, kuhlanganise ne-fluconazole

Ulwazi Lomthamo

I-dosing efanele ye-rivaroxaban incike esimweni esithile sokwelashwa kanye nezici zesiguli ngasinye. Umuthi uza ngamandla ahlukene ukuze uhambisane nezidingo ezahlukene zokwelapha.

Ukuvimbela i-stroke ku-fibrillation ye-atrial:

  • I-20 mg kanye ngosuku ngokudla kwakusihlwa ezigulini ezijwayelekile izinso umsebenzi
  • 15 mg kanye ngosuku ngokudla kwakusihlwa uma ukusebenza kwezinso kuncipha

Lapho ukwelapha amahlule egazi (DVT/PE):

  • Ukwelashwa kokuqala: 15 mg kabili ngosuku ngezinsuku zokuqala ezingama-21
  • Umthamo wesondlo: 20 mg kanye ngosuku ngemuva kosuku 21

Ukuvimbela amahlule egazi ngemva kokuhlinzwa:

  • Ukushintshwa kwe-Hip: 10 milligrams kanye ngosuku izinsuku ezingamashumi amathathu nanhlanu
  • Ukushintsha idolo: 10 milligrams kanye ngosuku izinsuku eziyishumi nambili

Isiphetho

I-Rivaroxaban ime njengomuthi obalulekile wokuvimbela nokwelapha amahlule egazi kuzo zonke izimo zezokwelapha ezihlukahlukene. Odokotela bayayethemba le anticoagulant ngokusebenza kwayo ekwelapheni i-vein thrombosis ejulile, ukuvimbela ukushaywa unhlangothi, nokulawula izingozi zangemva kokuhlinzwa.

Ukwelashwa okuphumelelayo nge-rivaroxaban kuncike ekusetshenzisweni okufanele nokunaka ngokucophelela imihlahlandlela yokuphepha. Iziguli kufanele zilandele isimiso sazo somthamo esinqunyiwe, ziphuze umuthi nokudla lapho kudingeka, futhi zihlale ziqaphile nganoma yikuphi ukopha okungajwayelekile noma imiphumela engemihle.

Ukuphepha kuhlala kubalulekile uma usebenzisa i-rivaroxaban. Ukuxhumana okuvamile nodokotela kusiza ekuqinisekiseni umthamo ofanele, ukuphatha ukusebenzisana kwezidakamizwa okungase kube khona, nokubhekana nanoma yikuphi ukukhathazeka phakathi nokwelashwa. Iziguli akufanele neze zilungise umthamo wazo noma ziyeke ukuthatha i-rivaroxaban ngaphandle kwesiqondiso sikadokotela wazo, njengoba lokhu kungaholela ezinkingeni ezinkulu.

Ukugadwa kwezokwelapha kudlala indima ebalulekile kulo lonke uhambo lokwelashwa. Odokotela bangaqapha ukusebenza kwezinso, balungise imithamo lapho kudingeka, futhi basize iziguli zibhekane nezinselele ngesikhathi sokwelashwa kwazo i-rivaroxaban.

Imibuzo Evame Ukubuzwa

1. Ingabe i-rivaroxaban umuthi onobungozi obukhulu?

Nakuba i-rivaroxaban ngokuvamile iphephile uma ithathwa njengoba kushiwo, ithwala izingozi ezithile. Ukukhathazeka okuyinhloko ukopha, okungaba kubi kakhulu ezimweni ezingavamile. Njengazo zonke izinto ezinciphisa igazi, kudinga ukuqapha ngokucophelela nokusetshenziswa ngendlela efanele.

2. I-rivaroxaban ithatha isikhathi esingakanani ukusebenza?

I-Rivaroxaban iqala ukusebenza ngokushesha emzimbeni. Ifinyelela ekusebenzeni okuphezulu phakathi kwamahora angama-2-4 ngemuva kokuthatha ithebhulethi.

3. Kwenzekani uma ngiphuthelwa umthamo?

Ngemithamo kanye ngosuku, iziguli kufanele zithathe umthamo ogejiwe ngokushesha nje lapho zikhumbula ngalolo suku. Ngokusebenzisa umthamo ophindwe kabili ngosuku (15mg), iziguli zingaphuza amaphilisi amabili ngesikhathi esisodwa ukuze zigcine imfuneko yansuku zonke. Ungalokothi uthathe imithamo eyengeziwe ukuze wenzele abaphuthelwe.

4. Kwenzekani uma ngiphuza ngokweqile?

Ukuthatha i-rivaroxaban ngokweqile kwandisa ingozi yokopha. Iziguli ezisebenzisa ngokweqile kufanele zifune usizo lwezokwelapha ngokushesha. Ukwelashwa kungase kuhlanganise amalahle acushiwe kanye nezinyathelo zokusekela.

5. Ubani ongakwazi ukuthatha i-rivaroxaban?

I-Rivaroxaban ayifanele:

  • Iziguli ezinezinkinga ezinkulu zezinso (imvume ye-creatinine ngaphansi kwe-15 mL/min)
  • Labo abanenzuzo isifo sesibindi
  • Okhulelwe noma ibele abesifazane
  • Abantu abanamavalvu enhliziyo okwenziwa

6. Zingaki izinsuku okufanele ngithathe i-rivaroxaban?

Ubude besikhathi sokwelashwa kuyehluka:

7. Ungamisa nini i-rivaroxaban?

Iziguli akufanele neze ziyeke ukuthatha i-rivaroxaban ngaphandle kokubonisana nodokotela wazo. Ukuma kungazelelwe kwandisa ingozi yamahlule egazi.

8. Kungani uthatha i-rivaroxaban ebusuku?

Ukudla kwakusihlwa kwe-rivaroxaban kuholela emiphumeleni engcono futhi ehlala isikhathi eside. Kuyasiza ukugcina isivikelo emahlulekeni phakathi namahora asekuseni.

9. Ingabe i-rivaroxaban iphephile ezinso?

Nakuba ngokuvamile iphephile, i-rivaroxaban idinga ukuqapha ngokucophelela ezigulini ezinezinkinga zezinso. Labo abanesifo sezinso ezinzima kufanele bagweme imithi.

10. Ngingakwazi ukuthatha i-rivaroxaban nsuku zonke?

Yebo, i-rivaroxaban ingathathwa nsuku zonke njengoba kunqunyiwe. Isheduli yomthamo we-rivaroxaban izoncika esimweni, kodwa ngokuvamile ithathwa kanye noma kabili ngosuku.

11. Ingabe i-rivaroxaban ithinta i-BP?

Ucwaningo lubonisa ukuthi i-rivaroxaban ingase icindezele umfutho wegazi kwezinye izimo. Nokho, kokubili umfutho wegazi ophakeme nophansi akuyona imiphumela emibi evamile.