µ²ºc¦¡ |
|
Carvedilol (¡Ó)-1-(Carbazol-4-yloxy)-3-[[2-(o-methoxyphenoxy)ethyl]amino]-2-propanol
|
UpToDate |
UpToDate ³sµ²
|
ÃIJz§@¥Î |
|
Carvedilol ¬°¨ã¦³¦hºØ§@¥ÎªºµÇ¤W¸¢¯À±µ¨ü¾¹ªýÂ_¾¯§t¦³£\1¡B£]1 ©M £]2-µÇ¤W¸¢¯À±µ¨ü¾¹ªýÂ_©Ê½è¡CCarvedilol ¨ã¦³«OÅ@¾¹©xªº§@¥Î¡CCarvedilol ¬O¤@Ó±j¤Oªº§Ü®ñ¤Æ¾¯©M¬¡©Ê®ñ¤Æ°ò(reactive oxygen radicals)ªº²M¹D¤Ò¡CCarvedilol ¬O®ø±Û©Ê¡A¥B¨âÓ R(+)©M S(-)Ãè¹³²§ºcª«¦³¬Û¦Pªº£\-µÇ¤W¸¢¯À±µ¨ü¾¹ªýÂ_©Ê½è©M§Ü®ñ¤Æ¾¯©Ê½è¡CCarvedilol ¹ï¤HÃþ¦åºÞ¥·Æ¦Ù²ÓM¦³§Ü¼W´Þªº§@¥Î¡C
|
¾AÀ³¯g |
|
°ª¦åÀ£¡BÆ{¦å©Ê¤ßŦ°IºÜ¡C
|
¥Îªk¥Î¶q |
|
1. ªvÀøªº´Á¶¡¡JªA¥ÎCarvedilol»Ýªø´Á©ÊªºªvÀø¡C¤£À³¬ðµM°±¤îªvÀø¦ÓÀ³¥H¬P´Á¬°¶¡¹j³vº¥´î¤ÖªvÀø¡A¦¹¹ï¨Ö¦³«aª¬¤ßŦ¯e¯fªº¯f¤H¤×¨ä«n¡C 2. ¥»ºA©Ê°ª¦åÀ£¡J¶}©lªvÀø«e¨â¤Ñªº«Øij¾¯¶q¬°12.5MG¡A¤@¤Ñ¤@¦¸¡C¤§«á¡A«Øij¾¯¶q¬°25MG¡A¤@¤Ñ¤@¦¸¡C¥²n®É¡A±µµÛ¥H¦Ü¤Ö¨â¶g¤§¶¡¹j¡A±N¾¯¶q¼W¥[¦Ü¨C¤é³Ì¤j«Øij¾¯¶q50MG¡A¤@¤Ñ¤@¦¸©Î¤À¦¸ªA¥Î(¤@¤Ñ¨â¦¸)¡C 3. ¦³¯gª¬¡Béw¡BºC©Ê¤§¤ßŦ°IºÜ¡J°_©lªvÀøªº«Øij¾¯¶q¬°3.125MG¡A¤@¤Ñ¨â¦¸¡A¬°´Á2¶g¡C¦pªG¯f±w¥i§Ô¨ü¦¹¾¯¶q¡A¥i±µµÛ±N¾¯¶q¥H¦Ü¤Ö¨â¶g¤§¶¡¹j¼W¥[¬°6.25MG¡B12.5MG©M25MG¡A¤@¤Ñ¨â¦¸¡C¾¯¶qÀ³½Õ¾ã¨ì¯f±w¯à§Ô¨üªº³Ì¤j¾¯¶q¡C ¦³ÄY«¤ßŦ°IºÜªº©Ò¦³¯f¤H©M¦³»´«×¦Ü¤¤«×¤ßŦ°IºÜ¤ÎÅ髧C©ó85¤½¤ç(187½S)ªº¯f¤H³Ì¤j«Øij¾¯¶q¬°25MG¡A¤@¤Ñ¨â¦¸¡C¦³»´«×©Î¤¤«×¤ßŦ°IºÜ¤ÎÅé«°ª©ó85¤½¤çªº¯f¤H³Ì¤j«Øij¾¯¶q¬°50MG¡A¤@¤Ñ¨â¦¸¡C
|
ÃİʤO¾Ç |
|
§l¦¬ °·±d¨ü¸ÕªÌ¤fªA 25 mg carvedilol ªº½¦Ån¡A¥i§Ö³t©ó¤j¬ù 1.5 ¤p®É (tmax)«á¡A¹F¨ì 21 mg/L ªº¦å¤¤³Ì°ª¿@«×(Cmax)¡CCmax È»P¾¯¶q§e½u©ÊÃö«Y¡C°·±d¨k©Ê¨ü¸ÕªÌ¤fªA carvedilol «á¡Acarvedilol ·|¤j¶q¶i¦æº´ç¥NÁ¡A¨Ïµ´¹ï¥ÍÅé¥i¥Î²v¬ù¬° 25%¡C ¤À§G Carvedilol ¬O°ª«×¿Ë¯×©Ê¤Æ¦Xª«¡A¬ù 95%·|»P¦å¼ß³J¥Õ½èµ²¦X¡C¤À§GÅé¿n¤¶©ó 1.5 ¦Ü 2 ¤½¤É/¤½¤ç¡C ¥NÁ ¦b¤HÅ餤¡Acarvedilol ¦b¨xŦÂǥѮñ¤Æ»Pµ²¦X¼sªx¦a³Q¥NÁ¦¨¦hºØ¥NÁª«¡A¨ä¥Dn±Æ°£©óÁx¥Ä¤¤¡C ±Æ°£ ¤fªA³æ¾¯ 50 mg carvedilol ¤§«á¡A11 ¤Ñ¤§¤º¬ù¦³ 60%ªº carvedilol ¥Dn¥H¥NÁª«ªº§Î¦¡¸g¥ÑÁT«K±Æ°£¡C¤fªA³æ¾¯ carvedilol ¤§«á¡A¶È¬ù 16%ªºÃĪ«·|¥H carvedilol ©Î¨ä¥NÁª«ªº§Î¦¡¶i¤J§¿²G¤¤¡C§¿²G¤¤¥¼¸g¥NÁªºÃĪ«§t¶q§C©ó 2%¡C
|
°Æ§@¥Î |
|
暈¯t¡BÀYµh¡A³q±`¬O»´·Lªº¥B¤×¨ä©óªv療ªºªì´Á¡Cµê®z(¥]¬A¯hÂ)¤]«D±`±`見¡C
|
¥æ¤¬§@¥Î |
|
Carvedilol ¹ï¨ä¥LÃĪ«ªºÃĪ«°Ê¤O¾Ç³y¦¨ªº¼vÅT Carvedilol ¬O P-ÁÞ³J¥Õªº¨ü½è¥H¤Î§í¨î¾¯¡C¦]¦¹§Q¥Î P-ÁÞ³J¥Õ¹B¿éªºÃĪ«¨Ö¥Î carvedilol ®É¡A¸ÓÃĪ«ªº¥ÍÅé¥i¥Î²v¥i¯à·|´£°ª¡C¦Ó¥B carvedilol ªº¥ÍÅé¥i¥Î²v¤]·|¨ü P-ÁÞ³J¥Õªº»¤¾É¾¯©Î§í¨î¾¯©Ò¼vÅT¡C
|
¸T§Ò |
|
¤@¡BCarvedilol ¸T¥Î©ó¤U¦C¯f±w¡G 1. ¹ïcarvedilol ©Î¦¹ÃĪ«ªº¥ô¦ó¦¨¹L±Ó 2. ¤£Ã©w/ ¥NÀv¾÷¯à´î°h¤§¤ßŦ°IºÜ 3. Á{§É¤W©úÅã¨x¥\¯à¨ü·l ¤G¡B¦p¦P¨ä¥L£]- ªýÂ_¾¯¡Acarvedilol ¸T¥Î©ó¤U¦C¯f±w¡G 1. ¤G¯Å©M¤T¯Å¤§©Ð«Ç¶Ç¾ÉªýÂ_(Atrioventricular block, AV block) ( °£¤F¦³©ñ¸m¥Ã¤[©Ê¤ß«ß½Õ¾ã¾¹¤§¥~) 2. ÄY«¤ß¸õ¹LºC(bradycardia)(<50 bpm) 3. ¯fºA©ÊÄu©Ð¯gÔ¸s( ¥]¬AÄu©Ð¶Ç¾ÉªýÂ_) 4. ÄY«§C¦åÀ£( ¦¬ÁYÀ£<85 mmHg) 5. ¤ß¦]©Ê¥ð§J 6. ¦³¤ä®ðºÞµjÅ˩ήð³Ý¯f¥v
|
ª`·N¨Æ¶µ |
|
Æ{¦å©Ê¤ßŦ°IºÜ¯f±w¦bcarvedilol ¦V¤W½Õ¾ã¾¯¶q®É¡A¥i¯àµo¥Í¤ßŦ°IºÜ´c¤Æ©ÎÅé²Gº¢¯dªº±¡§Î¡CY²£¥Í³o¨Ç¯gª¬®É¡AÀ³¼W¥[§Q§¿¾¯ªº¾¯¶q¦Ó¤£À³¦A¼W¥[carvedilol ªº¾¯¶q¡Aª½¨ìÁ{§É¯gª¬«ì´_©w¬°¤î¡C¦³¤ä®ðºÞµjÅ˪ººC©Êªý¶ë©ÊªÍ¯f(COPD) ¦ý¥¼ªA¤fªA©Î§l¤J©ÊÃĪ«ªº±wªÌ¡AÀ³¤p¤ß¨Ï¥Îcarvedilol¡A¥B¶È·íªvÀø®Ä¯q¤j©ó¦MÀI©Ê®É¤è¥i¨Ï¥Î¡C
|
¹L¶q³B²z |
|
¹L¶qªº¯gª¬©M¼x¥ü ¾¯¶q¹L¶q®É¡A¥i¯à¦³ÄY«§C¦åÀ£¡B¤ß¸õ¹LºC¡B¤ßŦ°IºÜ¡B¤ß¦]©Ê¥ð§J©M¤ßŦ°±¤î¡C¤]¥i¯à¦³©I§l°ÝÃD¡B¤ä®ðºÞµjÅË¡B¹Ã¦R¡B·NÃѲV¶Ã©M¥þ¨©ÊµjÅ˵o§@¡C ¹L¶qªºªvÀø °£¤F¤@¯ë³B²zªº¨BÆJ¡A¥²¶·ºÊµø¨Ã×¥¿¥Í©R¸ñ¶H°Ñ¼Æ¡A¦p»ÝnÀ³¥[±j¬ÝÅ@¡C¥i¥H¨Ï¥Î¤U¦C¤ä«ù©ÊÀøªk¡G ¯f¤H¶·¥õª×¡C Atropine¡GÀR¯ßª`®g 0.5 ¦Ü 2 ²@§J(¬°¤FÄY«¤ß¸õ¹LºC)¡C Glucagon¡G¶}©lÀR¯ßª`®g 1 ¦Ü 10 ²@§J¡A¤§«áªø®É¶¡¿éª` 2 ¦Ü 5 ²@§J/¤p®É(¬°¤F¤ä«ù¤ß¦åºÞ¥\¯à)¡C ®Ú¾ÚÅé«©M®ÄªGµ¹¤©ÀÀ¥æ·P¯«¸g¿³¾Ä¾¯¡Gdobutamine¡Bisoprenaline¡Borciprenaline ©Î adrenaline¡C¦p»Ýn¥¿¦V¦¬ÁY©Ê§@¥Î¡AÀ³¦Ò¼{µ¹¤© phosphodiesterase(PDE)§í¨î¾¯¦p milrinone¡C ¦p¤¤¬rªº²{¶H¬O¥Ñ©PÃä¦åºÞÂX±i©Ò§e²{¡AÀ³µ¹¤© norfenephrine ©Î noradrenaline ¥B«ùÄòºÊµø¨ä´`Àô±¡§Î¡C Y¬OÃĪ«©è§Ü©Êªº¤ß¸õ¹LºC¡AÀ³¶}©l¤ß«ß½Õ¸`¾¹ªºÀøªk¡C ¤ä®ðºÞµjÅ˪ºªvÀø ªvÀø¤ä®ðºÞµjÅˮɡAÀ³µ¹¤© £]-ÀÀ¥æ·P¯«¸g¿³¾Ä¾¯(©ó¼QÃú¾¯©ÎÀR¯ßª`®g)©Î aminophylline ÀR¯ßª`®g¡C µjÅ˵o§@ªºªvÀø ¦bµjÅ˵o§@®É¡A«Øij½wºCÀR¯ßª`®g diazepam ©Î clonazepam¡C «n³Æ§Ñ¿ý Y««×¤¤¬r®Éµo¥Í¥ð§J¡A¦]¹w´Á carvedilol ªº±Æ°£¥b°I´Á©µªø¥B±q²`³¡²Õ´ÄÀ¥Xªº carvedilol ·|¦A¤À§G¡A¥²¶·«ùÄò¨¬°÷ªø®É¶¡ªº¤ä«ù©ÊÀøªk¡C¤ä«ù©Ê/¸Ñ¬rªvÀøªº®É¶¡¨Ì¹L¶qªºÄY«µ{«×©w¡C¦]¦¹À³«ùÄò¤ä«ù©ÊÀøªkª½¨ì¯f¤Hª¬ªpéw¡C
|
ÃÄ«~«O¦s¤è¦¡ |
|
¥»«~À³¶J¦s©ó 25¢J¤U¤Î¨àµ£¦ù¤â不¤Î¤§³B¡C
|