Imikoranire myinshi y'imiti ya Paxlovid irashobora gucungwa, ntabwo ivunira igihe kure. Ritonavir, agace ka kabiri mu biryane, ihagarika cyane CYP3A kandi yongera urugero rw'indi miti mu maraso, ku buryo umuganga wawe ashobora guhitamo kimwe mu bikorwa bitatu: kureka undi muti, kugabanya dose yawo, cyangwa kugukurikira iminsi itanu. Hariho urutonde ngufi rw'ibishobora gutera ikibazo gikomeye.

TL;DR: Ibintu by'ingenzi ugomba kwibuka

  • Ritonavir yongera urugero rw'ibiyobyabwenge byinshi. Uburyo busanzwe ni ugukura, kugabanyamo kabiri, cyangwa kugukurikirana iminsi itanu.
  • Bihambaye rwose ko ugomba kwirinda: bimwe mubihindura umuvuduko w'umutima, imiti y'uburwayi bwo mu mutwe ya ergot, lovastatin, simvastatin, hamwe na ba "CYP3A inducer" bikomeye.
  • Kureka lovastatin cyangwa simvastatin amasaha 12 mbere ya dose ya mbere, kongera kuyifata nyuma y'iminsi 5 uretse iheruka.
  • Ba "calcium channel blockers" bagira imikoranire. ACE inhibitors, ARBs, beta-blockers na diuretics ntibagiraho ikibazo gikomeye.
  • Ntuzahagarike Paxlovid cyangwa umuti w'igihe kirekire wenyine.

Imikoranire myinshi y'imiti ya Paxlovid ni ikibazo cy'iminsi itanu, ntabwo ari uguhagarikwa burundu

Imikoranire y'imiti ya Paxlovid ituruka kuri ritonavir, agace ka kabiri mu biryane. Ni ihagarika rikomeye rya CYP3A, ku buryo byongera urugero rw'indi miti myinshi mu maraso. Amabwiriza ya FDA abwira abaganga ko bagomba gusuzuma buri muti ufata, harimo ibyo wirondera, ibyo wifashisha ku bihingwa, n'ibiyobyabwenge bikoreshwa mu buryo budakurikiza amategeko, hanyuma bagahitamo guhindura dose, guhagarika igihe gito, cyangwa kugukurikirana kenshi. Imikoranire myinshi iboneka iracungwa, ntabwo ihagarikwa.

Icyo gice cy'ibintu bitatu ni cyo kishingiro cy'uru rupapuro. Ubushakashatsi bwakorewe ku bihingo mu kinyamakuru CMAJ bugaragaza uko bikorwa mu buryo bwa nyabwo: guhagarika atorvastatin no kuyisubizamo nyuma y'iminsi ibiri cyangwa itatu uretse dose ya nirmatrelvir-ritonavir, cyangwa kugabanya dose ya amlodipine kabiri (cyangwa kuyifata buri munsi), mu gihe ugikurikiranira umuvuduko w'amaraso. Nta murwayi numwe wahagaritswe kuvurwa COVID.

Bityo, ntukahagarike resepte, kandi ntukahagarike umuti w'igihe kirekire, kubera ko urutonde rusanzwe rwavuze "wirinda." Ikibazo cy'imikoranire ni ikintu cy'umuti wawe, ntabwo ari ivy'ibiyobyabwenge by'abaganga bose hamwe, ni yo mpamvu oseltamivir ifite urutonde ruto rw'imikoranire. Umuntu ugomba gufata iki cyemezo ni umuganga ufite urutonde rwawe rwose rw'imiti.

Bimwe mu bihingo bivuguruzwa burundu, ariko urwo rutonde ni rugufi

Inyandiko ya FDA ivuga ko ibiyobyabwenge bikoresha cyane CYP3A kugirango bikore neza kandi bigahinduka bibi mu rugero rwo hejuru:

  • Antiarrhythmics: amiodarone, dronedarone, flecainide, propafenone, quinidine
  • Ibihingwa bya ergot: dihydroergotamine, ergotamine, methylergonovine
  • Statins: lovastatin na simvastatin
  • Sildenafil (Revatio) iyo itewe indwara y'umuvuduko mu bihaha, kandi ntabwo isa na dose yo mu kuboneza urubyaro (iyo niyo biganirwa n'umuganga, ntibihagarikwa burundu)
  • Ba "CYP3A inducer" bikomeye, bibujijwe ku mpamvu yo kwirinda: bigabanya urugero rwa nirmatrelvir bihagije kugirango bibyare intege nke mu kuvura no kwirinda kwiyongera kw'ibirwanya virusi

Iri rutonde ritandukanye n'itsinda ry'ibiyobyabwenge bisaba umuhanga kuruta kwanga. Tacrolimus na cyclosporine ni imiti isanzwe itera ibibazo bikomeye ku bakoresha Paxlovid, ikurikirwa na ba "calcium channel blockers," nk'uko bivugwa na FDA Fact Sheet for Healthcare Providers. Abimukiwe bashobora kuvurwa rimwe na rimwe, ariko bafashijwe n'ikipe y'abavuzi babasanzwe.

Dosi ebyiri za statin zigomba kureka; izindi nyinshi zikeneye dose ntoya

Ikibazo cy'imiti ya statin na Paxlovid gifite igisubizo gisobanutse ku mpande zose. Lovastatin na simvastatin ntibizihanganirwa burundu, kandi igikoresho cy'abajyamo cy'abakora imiti itanga window y'igihe yihariye: kureka imwe mu minota 12 mbere ya dose ya mbere ya Paxlovid, kandi ntukayisubizemo kugeza nyuma y'iminsi 5 uretse iheruka.

Atorvastatin na rosuvastatin bafatwa ukundi. Byafata cyangwa bikagabanywa ku gihe cyose cy'ivuriro, bikongerwa nyuma y'iminsi ibiri kugeza itatu uretse kwishyura, nk'uko bivugwa mu bushakashatsi bwa CMAJ. Statins zikoreshwa mu buryo butinyitse binyuze muri CYP3A zifite akaga gato; IDSA interaction table izivuga kumwe kumwe hamwe n'igihe cyo guhagarika no kongera kuzikoresha, kandi ibyo ni byo ugomba kureba aho kuvuga ibyo wibuka.

Ibi ni bimwe abantu benshi batasobanurira: guhagarika iminsi itanu ya statin ntabwo bigarura imyaka myinshi yo kugenzura kolesteroli. Iminsi itanu yo guhagarika ntabwo ari ikibazo. Ikibazo ni ugukoresha statin itemewe, bityo rero reba kubabara bikomeye cyangwa intege nke mu ngingo, cyangwa inkari zisa na cola irabura, ishobora kugaragaza rhabdomyolysis kandi bikaba ngombwa kwihutira kwa muganga mu gihe gito.

Kubuvuduko bw'amaraso, ikibazo ni ba "calcium channel blockers," ntabwo ari lisinopril yawe

Iyo abantu babaza ku miti y'umuvuduko w'amaraso na Paxlovid, itsinda rimwe ryonyine rigize akazi kanini: ba "calcium channel blockers," harimo amlodipine, nifedipine, felodipine, diltiazem na verapamil. Ni yo itsinda rikoreshwa kenshi cyane mu bibazo bikomeye bivugwa na FDA. Uburyo busanzwe ni kugabanya dose ya amlodipine kabiri cyangwa kuyifata buri munsi mu gihe cy'ivuriro, hamwe n'umuvuduko w'amaraso ugenzurwa mu rugo.

Abantu benshi bafata imiti y'umuvuduko ntibari mu itsinda ry'akaga na gato. ACE inhibitors, ARBs, beta-blockers na thiazide diuretics ntibagiraho ikibazo gikomeye, kandi ubushakashatsi bwa CMAJ ntibwashyizeho ikibazo gikomeye na ramipril. Niba lisinopril ariwo muti wawe w'umutima wenyine, ushobora kureka kwibaza kuri iyi ngingo.

Niba dose igomba guhinduka, tangaza ibyuya iyo uhagaze, kwumva ubunebwe cyangwa kwirara bikabije. Kuvunagurika ni ikibazo gikomeye. kandi ntukahindure cyangwa usibure umuti w'umuvuduko w'amaraso utabimaze amakuru na muganga wawe.

Amanywa, imiti y'ihangayika n'ibyongerwa bikwiye kuba ku rutonde rw'ibyo uhana

Paxlovid n'amanywa ni igihangano abantu bagenda bipfuza kuvuga, kandi ni ikintu gikomeye. Konti ya Warfarin irashobora guhinduka, ku buryo INR igomba gukurikiranwa cyane. Amapilisi ya Apixaban na rivaroxaban ashobora kuzamuka, kongera akaga ko kwiruka, kandi muganga wawe ashobora guhagarika, kuyihindura, cyangwa guhitamo undi muti wa COVID. Clopidogrel na ticagrelor barahindura imbaraga zabo zo kurwanya kwiruka. Uburyo bwa buri kimwe bushitswe mu nyandiko ya FDA n'urubuga rwa IDSA; umuntu wese uzaba avuga dose runaka agomba kuba ashoboye kukwereka aho yakuye amakuru.

Mu miti y'ihangayika, trazodone na bupropion ni ibiri bimenyeshwa kenshi. Muri SSRIs na SNRIs, benshi baracungwa badahagaritswe. Kimwe na interactions za levofloxacin, igisubizo kiba kireba igihe n'ibyo ureba, ntabwo ari uguhagarika.

Ibyongerwa ni ikibazo gikomeye. St. John's wort ni "CYP3A inducer" ikomeye, bityo rero ibihingwa bikaba bidashoboka. Zana amabuburu maze usomere amabwiriza hamwe na farumasi. Kwibabara mu maso, kwiruka cyane, cyangwa amaraso mu nkari cyangwa imyanda bikwiye kugirwa igihe kimwe.

Umugenzuzi w'imikoranire amenyesha ikibazo; ntabwo ashobora kukubwira icyo ukora

Umugenzuzi w'imikoranire ya Paxlovid ni intambwe ya mbere nziza kandi ni intambwe ya nyuma mbi. Igikoresho cya Drugs.com nirmatrelvir-ritonavir kigaragaza ibyago bigera kuri 732 mu byiciro by'ingenzi, byo hagati na bike, kandi ni ingenzi mu kumenya ibibazo. Nta mugenzuzi w'imikoranire ya Paxlovid ushobora gutandukanya ibyemewe burundu n'ibishobora gukemurwa n'igihe, kandi icyo gitandukanya ni cyo cyemezo gikomeye. Farumasi ni uburyo bwihuse kandi budahenze bwo kumenya ikibazo, kuko amakuru yawe yose y'imiti aba ari kuri ecran imwe.

Niba umaze gufata zombi, ntuzahagarike Paxlovid utararangiza wenyine. Hamagara umuganga wawe cyangwa farumasi ku munsi ubwo ari bwo bwose, ufite amazina y'ibiryane, dose, n'igihe cy'umwanya wa nyuma, kandi wigendere kugeza icyo gihe.

Niba utashobora kugera ku muganga wawe, August's $39 online urgent care visit iguha umuganga wemewe muri Amerika washobora gusuzuma urutonde rwawe rw'imiti kandi akemeza niba kuvura bibaho. Gusura kuri terefone ntishobora gusimbura kugenzura imiti ya transplant cyangwa cardiologiya, kandi ntishobora gukora INR ya buri gihe cyangwa ibizamini by'urugero rw'ibiyobyabwenge.

Menya ibimenyetso by'imikoranire bisaba kwihutira kwa muganga kandi ibya bisaba guhamagara

Hamagara 911 cyangwa jya mu cyumba cy'ibitaro byihutirwa ubu niba:

  • Intoki, ibirenge cyangwa amaguru bikonja, bibijijwe, bivunagura cyangwa bifite ibara ry'ubururu, cyangwa ubabara cyane mu ngingo (birashobora kuba ergotism)
  • Uvunagura, cyangwa ufite ububabare mu gatuza, ibyuya bikabije, cyangwa umutima ugenda gahoro cyane, cyane, cyangwa udafite gahunda
  • Uri ku muti wo gukongeza amaraso kandi ufite kwiruka bikabije cyangwa byinshi, kwibabara, cyangwa amaraso mu nkari cyangwa imyanda
  • Urababara bikomeye mu ngingo cyangwa ufite intege nke, cyangwa inkari zisa na cola zirabura
  • Ufata tacrolimus cyangwa cyclosporine kandi ufite umushyitsi mushya, urujijo, kugabana bikabije kwa kuvunagura cyangwa kwiyongera
  • Imbavu zawe cyangwa ijosi byiyongera, cyangwa ugize uruhu rushushye cyangwa ubura cyane cyane

Gusaba kwivuza mu cyumweru gitaha niba:

  • Imitsi ibabaza ikomeza nyuma y'ivuriro riheruka
  • Ukeneye kongera gufata statin wahagaritse cyangwa kwemeza dose yahinduwe
  • Ibisubizo bya INR cyangwa urugero rw'ibiyobyabwenge bigomba gukorwa
  • Ibyuya bikomeza nyuma yo guhindura dose y'umuvuduko w'amaraso

Ganira n'umuganga mbere yo gutangira niba:

  • Ufata umuti w'umutima, umuti w'ibigize ibihingwa, umuti wo kwiruka amaraso, cyangwa umuti wo mu mutwe wa ergot
  • Ufata umuti wo guhagarika ibinya, rifampin, cyangwa St. John's wort
  • Waba utwite, uronsa, cyangwa uzewe mu buryo bwo kuboneza urubyaro

Bimwe mu bibazwa kenshi

Paxlovid iragabanya imbaraga za kontraseptif?

Yego. MedlinePlus ivuga ko imiti ya kontraseptif, harimo pifuri, ibirango, impeta, ibikoresho, inshinge, n'ibikoresho by'ibitsina by'abagore, bishobora kudakora neza mu gihe cyo kuvura. Ibi bitandukanye n'imikoranire y'uburozi hejuru, kandi biroroshye kwibagirwa. Koresha uburyo bwo kwirinda kandi wumve muganga wawe igihe cyo gukomeza kubikora.

Ndasabwa kwirinda imbuto za grapefruit mu gihe nkoresha Paxlovid?

Yego, birakwiye kwirinda. Grapefruit ihagarika inzira imwe ya CYP3A nk'iyo ritonavir ihagarika, bityo byongera imbaraga aho kubyara ikindi gishya. Iyo nzira imwe ni na yo mpamvu ibihingwa byose byitwa "ibyonsa" cyangwa "iby'ibinyobwa byo mu gifu" bikwiye gusuzumwa na farumasi mbere uko ubifata hamwe n'igihe cy'ivuriro.

Ndasabwa kureka imiti yanjye ya HIV cyangwa hepatitis C mu gihe nkoresha Paxlovid?

Oya. MedlinePlus y'abantu basanzwe bafata imiti irimo ritonavir cyangwa cobicistat ivuga ko bagomba gukomeza nk'uko bitegetswe aho guhagarika bonyine. Guhagarika imiti y'abagabo bikomeza akaga gasanzwe. Bwira muganga ibyo ufata kugirango urugero rwa ritonavir ruzashyirwa mu mwanya wawe.

Imiti isanzwe nk'imiti ya metformin, ibuprofen n'ibinyobwa by'abaganga ni ngiza na Paxlovid?

Mubusanzwe. Ubushakashatsi bwa CMAJ ntibwashyizeho ikibazo gikomeye na metformin, ibuprofen, methotrexate, aside ya folic, cyangwa ramipril. Imiti y'abaganga itandukanye ku buryo, bityo vuga imiti runaka. Ingingo rusange irakomeza: akaga gashyirwa ku miti runaka, ntabwo ku byiciro by'imiti isanzwe.

Imikoranire irahagarara ku munsi mbahoze ivuriro ry'iminsi itanu?

Ntabwo mbere. Ihagarikwa rya CYP3A ryinjira mu minsi mike kugirango ricike, ni yo mpamvu statins zafashwe zigasubizwa mu minsi ibiri cyangwa itatu kandi lovastatin cyangwa simvastatin zigategereza iminsi itanu yose nyuma yo gufata iheruka. Koresha itariki yo gusubizamo wahawe aho gusubizamo byose mu gitondo gikurikira.

Niba imiti yanjye idashobora guhagarikwa, hari undi muti wa COVID?

Rimwe na rimwe. Hari izindi mbaraga za antiviruses kandi ntibagabana ikibazo cya CYP3A cya ritonavir, ni yo mpamvu umuti udashobora guhagarikwa ari impamvu yo guhamagara muganga aho gusiba ivuriro burundu. Ubushobozi bishingiye ku gihe kuva mu ntangiriro y'ibimenyetso, imikorere y'impyiko, n'urwego rw'akaga kawe.

Igihe byose bishingiyeho

Imikoranire y'imiti ya Paxlovid ikunze kuba akazi ko gushyira mu gihe. Dosi ebyiri za statin n'urubuga ngufi rw'ibitemerwa ni ibihagarara burundu; hafi y'ibindi byose birafashwe, byagabanyijwe kabiri, cyangwa birarebwa iminsi itanu. Zana urutonde rwawe rwose rw'imiti, harimo ibyongerwa, kuri muganga wawe cyangwa farumasi, kandi ubabwire gufata icyemezo.

Ikimenyetso: Inyandiko iyi ni iy'amakuru gusa kandi ntabwo igize inama z'ubuvuzi. Hambara uhite umuganga ufite ubushobozi kugirango ugire ibyemezo byo kwirinda no kuvura. Niba ufite ikibazo cyihutirwa cy'ubuvuzi, hamagara 911 cyangwa jya mu bitaro byihutirwa hafi yawe.