#1
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Èíòåðåñíî ìíåíèå êîëëåã îòíîñèòåëüíî ïðåïàðàòà ôèòîêîäåëàê.
Óâàæàåìûå êîëëåãè, õîòåëîñü áû óñëûøàòü âàøå ìíåíèå îòíîñèòåëüíî ýòîãî íîó-õàó))) Ñîáñòâåííî, ïî÷åìó çàäàþ ýòîò âîïðîñ -êàê â îäíîì ïðåïàðàòå ìîãóò áûòü âçàèìîèñêëþ÷àþùèå, ïî ëîãèêå, êîìïîíåíòû?!
ß ïîïðîáîâàëà, ñêàæó ÷åñòíî, ýôôåêò î÷åíü îáðàäîâàë, íî ìåäèöèíñêèé óì êàòåãîðè÷åñêè ïðîòèâèòñÿ, íåïðàâèëüíî ýòî Ó ìîåé äî÷êè 2,9 ã. ìåñÿö íàçàä áûë òðàõåîáðîíõèò, ïåðâûå 5 äíåé ñòîè÷åñêè òåðïåëà, æäàëà, ÷òî ñàìî ïðîéäåò, èíãàëèðîâàëà ôèçðàñòâîðîì, îòïàèâàëà ÷àÿìè-ìîðñàìè, êàøåëü îñòàâàëñÿ ìàëîïðîäóêòèâíûì, à â îäíó èç íî÷åé ÂÎÎÁÙÅ ðåáåíîê íå ñïàë, ñ 11 íî÷è äî 6 óòðà êàøëÿë áåç ïåðåðûâà, íå ñîìêíóëà ãëàç íè íà ìèíóòó, â 6 óòðà ìóæ ïñèõàíóë, ÷òî ÿ ìàòü-èçâåðã, áåñïîíòîâûé ïåäèàòð,íå äàþ ðåáåíêó ëåêàðñòâ, ÷òî ÿ íå ïåäèàòð, à ôàøèñò, ÷òî ìåäèöèíà ó íàñ ...... è óì÷àëñÿ â àïòåêó, îòòóäà ïðèâåç ïðåïàðàò è äàë äî÷êå, êàê âñåãäà ÿ âîçìóùàëàñü, íî áåñïîëåçíî))) ×åðåç ïîë÷àñà îíà óñíóëà, ïðåïàðàò äàâàëè 5 äíåé, êàøåëü ñòàë ïðîäóêòèâíûì, ñîñòîÿíèå ðåáåíêà óëó÷øàëîñü íà ãëàçàõ. Íà îñíîâàíèè ýòîãî îïûòà è èíòåðåñóþñü)))Òàïêàìè íå êèäàòüñÿ, çíàþ, êàê ÏÐÀÂÈËÜÍÎ ëå÷èòü, íî ýòî ïðàâèëüíî èçìàòûâàëî ðåáåíêà)) Çû-â ñâîåé ïðàêòèêå ìàëåíüêèì äåòêàì ïðîòèâîêàøëåâûå ïðàêòè÷åñêè íèêîãäà íå íàçíà÷àþ. Èñêëþ÷èòåëüíî ïî ïîêàçàíèÿì. |
#2
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Âî-ïåðâûõ çà÷åì äàâàòü íåïîéìè ÷òî ? Åñòü ñóõîé èçìàòûâàþùèé êàøåëü, ìåøàþùèé ñïàòü, îáñòðóêöèè Âû óâåðåíû ÷òî íåò - äàåòå çàêîííî ñèíåêîä. Ñîãëàñíà ñ Âàøèì ìóæåì ÷òî èçäåâàòüñÿ íà äåòüìè íå íàäî.
Âî-âòîðûõ- ìîè äåòè òîæå ìåñÿö íàçàä áîëåëè êàøëåì, îäíó íî÷ü- äåéñòâèòåëüíî èçíóðèòåëüíî . Íî ÿ ëåíèâà, ìíå â íî÷íóþ àïòåêó õîäèòü áûëî âëîì. Íè÷åãî íå äàâàëà. Çà ïÿòü äíåé íè÷åãîíåäàâàíèÿ êàøåëü ñòàë ïðîäóêòèâíûì è òîæå ñîøåë íà íåò . Ïð÷ÿìî íà ãëàçàõ. |
#3
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 òîì-òî è äåëî, ÷òî äèíàìèêà íà ñëåä. äåíü ïîÿâèëàñü î÷åíü çàìåòíàÿ)))
À Âàì ñèíåêîä íðàâèòñÿ áîëüøå? ß â òåõ ðåäêèõ ñëó÷àÿõ, êîãäà íåîáõîäèìî íàçíà÷èòü ïðîòèâîêàøëåâîé ïðåïàðàò, ìó÷èòåëüíî äóìàþ, ÷òî ëó÷øå- ñèíåêîä, ñòîïòóññèí, êîäåëàê?  îäíîì òîëüêî áóòàìèðàò, â äðóãîì áóòàìèðàò è ãâàéôåíåçèí, â òðåòüåì êîäåèí.... |
#4
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Ïðè ñóõîì íàâÿç÷èâîì êàøëå ïðîòèâîêàøëåâûå ïðåïàðàòû â ïðèíöèïå îïðàâäàíû.
Ãëàâíîå íå äàâàòü äåêñòðîìåòàðôàíîâ âñÿêèõ. |
#5
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Ñâîþ äî÷ü âèæó ÷àùå ÷åì ïàöèåíòîâ, ïîýòîìó èç æèçíè îïûò â îñíîâíîì íà íåé. Ïðè ìó÷èòåëüíîì íàâÿç÷èâîì ñóõîì êàøëå øâåéöàðñêèé ñèíåêîä íå ïîìîãàë, çàòî ñ íàøåãî ñòîïòóññèíà ýôôåêò ñ ïåðâîé êàïëè. êîäåëàê ôèòî ñòàëà íàçíà÷àòü íåäàâíî, ïðî÷èòàâ â æ"Ïåäèàòðèÿ" ÷òî óæ áîëüíî õîðîø. Íà 3-4 äíÿ äî ïîÿâëåíèÿ âëàæíîãî êàøëÿ, êàê è ðåêîìåíäîâàíî. Áîëüíûå íå æàëóþòñÿ.
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#7
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Ïîïðîáóþ ñäåëàòü ìàëåíüêèé îáçîð.
Ïðîáëåìà äåéñòâèòåëüíî àêòóàëüíà. Ñóòü åå ñîñòîèò â òîì, ÷òî â ÐÔ èìååòñÿ â àðñåíàëå ïåäèàòðîâ, ïî áîëüøîìó ñ÷åòó, òîëüêî 2 ïðîòèâîêàøëåâûõ ïðåïàðàòà. Ýòî butamirate (ñèíåêîä) è codeine. Áóòàìèðàò, ÿâëÿÿñü ïî ïðîèñõîæäåíèþ ñâîåìó íåíàðêîòè÷åñêèì ñðåäñòâîì, íå îêàçûâàåò âûðàæåííîãî óãíåòàþùåãî äåéñòâèÿ íà äûõàòåëüíûé öåíòð, ïîòîìó ðàçðåøåí ñ 2 ìåñ, îäíàêî è âûðàæåííîñòü ïðîòèâîêàøëåâîãî ýôôåêòà åãî âåñüìà íåâåëèêà. Êîäåèí, ÿâëÿÿñü àëêàëîèäîì îïèÿ ôåíàíòðåíîâîãî ðÿäà, óãíåòàåò äûõàòåëüíûé öåíòð, ïîòîìó íå ðåêîìåíäîâàí ó äåòåé ðàíüøå 2õ ëåò. Ñ ïîçèöèé ÅÁÌ ñëîæíî ïðåäñòàâèòü ñåáå ñèòóàöèþ â ïåäèàòðèè, êîãäà ïîòðåáóåòñÿ ïðèìåíåíèå êîìáèíèðîâàííîãî ïðåïàðàòà (ïðîòèâîêàøëåâîãî+îòõàðêèâàþùåãî èëè ìóêîëèòèêà). Íî åñëè ñ áóòàìèðàòîì ó ïåäèàòðîâ åñòü âûáîð, åñòü ìîíîïðåïàðàòû (ñèíåêîä) è êîìáèíèðîâàííûå ïðåïàðàòû (ñòîïòóññèí è ïðî÷.), òî ñ êîäåèíîì òàêîãî âûáîðà íåò. Ìîíîïðåïàðàòà êîäåèíà â ÐÔ íåò (íàñêîëüêî ìíå èçâåñòíî). Ðàáîòàÿ â èíôåêöèîííîé êëèíèêå è ïîñòîÿííî íàáëþäàÿ äåòåé ñ êîêëþøåì, ÿ âèæó ðàçíèöó ýôôåêòîâ êîäåèíà è ñèíåêîäà. Ïðè òÿæåëîì êîêëþøíîì êàøëå çà÷àñòóþ ïîëíàÿ äîçà ïðåïàðàòà íå äàåò ñêîëüêî-íèáóäü îùóòèìîãî ýôôåêòà. Ñ êîäåèíîì òàêèå äåòè ÷óâñòâóþò ñåáÿ êóäà ëó÷øå, è äà, ó íàñ ýòî êîäåëàê-ôèòî. Ñîâñåì íåäàâíî åùå ìû ëîìàëè òàáëåòêè, ÷òî âî-ïåðâûõ âñåãäà íåïðàâèëüíî ñ òî÷êè çðåíèÿ äîçèðîâêè, à âî-âòîðûõ, îïÿòü æå ñîäåðæèò ìàññó òðàâÿíûõ äîáàâîê. Âûõîä äåòñêîé ôîðìû - ñ ýòîãî ðàêóðñà, áåçóñëîâíûé ïðîãðåññ. Îäíàêî, åñëè ïðè êîêëþøå ñ åãî âÿçêîé ìîêðîòîé ïðèìåíåíèå îòõàðêèâàþùèõ ñðåäñòâ õîòü êàê òî ìîæíî îïðàâäàòü, ïðè äðóãèõ ñîñòîÿíèÿõ, ñîïðîâîæäàþùèõñÿ ñóõèì íàäñàäíûì êàøëåì (ïëåâðèò, òðàõåèò, áðîíõèò...) ïðèìåíåíèå åãî âûçûâàåò ñîìíåíèÿ. Ó ñòàðøèõ äåòåé åñòü åùå âàðèàíò ñ ëèáåêñèíîì, îäíàêî äåòñêîé ôîðìû íåò (îïÿòü ëîìàòü è áåç òîãî êðîõîòíóþ òàáëåòêó). Ýôôåêò åãî ñðàâíèâàþò ñ êîäåèíîì, îòðèöàþò óãíåòåíèå äûõàòåëüíîãî öåíòðà, îäíàêî ïðè òàêèõ ïàðàìåòðàõ âîò ïî÷åìó òî âñå æå íåò äåòñêîé ôîðìû. Íåñïðîñòà (ñ).  èòîãå - çàÿâëåííûé ïðåïàðàò - ýòî ñàìîå ñèëüíîå ïðîòèâîêàøëåâîå ñðåäñòâî, èç èìåþùèõñÿ ó ïåäèàòðà. Îäíàêî, êîíå÷íî, î÷åíü áû õîòåëîñü èìåòü îôèöèíàëüíûé ìîíîïðåïàðàò êîäåèíà äëÿ äåòåé. NB Ïåäèàòðó âàæíî ïîìíèòü î êàòåãîðè÷åñêîì çàïðåòå ãðóäíîãî âñêàðìëèâàíèÿ ïðè ïðèìåíåíèè êîäåèíà ìàòåðüþ (êîäåèí ñîäåðæèòñÿ âî ìíîãèõ êîìáèíèðîâàííûõ ëåêàðñòâàõ äëÿ âçðîñëûõ, íàïðèìåð íóðîôåí ïëþñ è ïðî÷), íåñìîòðÿ íà äàííûå î íèçêîì ïðîíèêíîâåíèè êîäåèíà â ãðóäíîå ìîëîêî,FDA ïðåäóïðåæäàåò: [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ] Åñòü åùå ìàññà êîìáèíèðîâàííûõ ïðåïàðàòîâ, òàêèõ êàê àñêîðèë, áðîìãåêñèí è ïðî÷. Îíè ìîãóò áûòü ïîëåçíû â îòäåëüíûõ ñëó÷àÿõ, îäíàêî íåñìîòðÿ íà ïðèñóòñòâèå â èõ ñîñòàâå ïðîòèâîêàøëåâûõ êîìïîíåíòîâ, ýôôåêò ïîäàâëåíèÿ êàøëÿ âåñüìà ñëàá.
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Òîëüêî ïîìíèòå: ôîðóì - íå çàìåíà î÷íîìó âðà÷ó, à ëå÷åíèå ïî èíòåðíåòó - ÷ðåâàòî ñìåðòüþ îò îïå÷àòêè. Ñ óâàæåíèåì, Ñåðãåé Àëåêñàíäðîâè÷. |
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#8
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ß íàøåë ñêîëüêî-íèáóäü êà÷åñòâåííûå ñðàâíèòåëüíûå èññëåäîâàíèÿ êîäåèíà êàê ïðîòèâîêàøëåâîãî ïðåïàðàòà òîëüêî ñ äåêñòðîìåòîðôàíîì (ìîíîïðåïàðàòîâ â Ðîññèè âðîäå áû íåò, íî ñîäåðæèòñÿ â "Òóññèíå ïëþñ" è ìíîãèõ äðóãèõ êîìáèíèðîâàííûõ). Äåêñòðîìåòîðôàí - ïðîèçâîäíîå ìîðôèíà, íî, êàê ñ÷èòàåòñÿ, íå îáëàäàþùåå ýôôåêòàìè îïèàòîâ (õì-õì, âñïîìèíàþ ñâîé îïûò ðàáîòû â äåòñêîé òîêñèêîëîãèè... Íå îáëàäàþùåå, ãîâîðèòå?). Ýôôåêòèâíîñòü áûëà ñõîäíîé, ïîáî÷íûõ ýôôåêòîâ áîëüøå ó êîäåèíà. Îäíàêî äîçû êîäåèíà, ïðèìåíÿåìûå äëÿ ïðîòèâîêàøëåâîãî ýôôåêòà, äîâîëüíî áåçîïàñíû.
SUMMARY: Codeine and dextromethorphan have comparable efficacy in reducing cough frequency. Dextromethorphan is more effective than codeine in reducing cough intensity. Dextromethorphan produces fewer CNS and gastrointestinal side effects. b) A double-blind crossover comparison of codeine and dextromethorphan, using both an objective and subjective assessment of efficacy in 16 patients with chronic, stable cough, was undertaken. Both preparations, at a dose of 20 mg, were similarly effective in reducing cough frequency. Dextromethorphan lowered cough intensity to a greater degree than codeine and was considered the better antitussive by the majority of patients. Compared to codeine, dextromethorphan produces fewer CNS and gastrointestinal side effects. Potential problems with this study not mentioned by the investigators are the assumptions that the pathological cough response is similar among disease states and that cough patterns during sleep are comparable to those during the day. Another point is that cough frequency and intensity were not recorded before the study period to allow comparison with the treatment period. Thus, "chronic stable" cough was not defined (Matthys et al, 1983). The 1976 U.S. Food and Drug Administration review panel found no reports of fatalities, even with doses in excess of 100 times the normal adult dose (Committee on Drugs, 1978); (FDA, 1976). c) A well-conducted trial compared dose relationships, plasma pharmacokinetics, and antitussive effects of codeine and dextromethorphan in 8 bronchitic patients. These patients were similar in age, during of illness, and repetitive nonproductive cough. Patients received single oral doses ranging from 7.5 milligrams to 60 milligrams of codeine and placebo or dextromethorphan and placebo randomly administered to patients for 5 days. The following week patients crossed over to the opposite drug for another 5 days. Doses of 7.5 milligrams and 15 milligrams of either drug were not different from placebo. Only 30 milligrams of codeine and 60 milligrams of dextromethorphan were better than placebo. Peak cough suppression occurred 5 to 6 hours after the dose. No relationship was apparent between instantaneous plasma concentration of either drug and antitussive response. Adverse reactions included profound nausea in all patients after a 60 milligrams dose of codeine and in 2 patients after a 30 milligrams dose of codeine. Fatigue, lethargy, and mild constipation were also reported with codeine. No adverse reactions occurred with dextromethorphan (Aylward et al, 1984). d) Antitussive doses of codeine are associated with a much lower incidence of adverse reactions than with analgesic doses. Potential effects include nausea, drowsiness, lightheadedness, and constipation. Although respiratory depression can occur with codeine, it is seldom a problem with antitussive doses. Chronic codeine therapy can cause physical dependence. Because codeine may have a drying effect on respiratory mucosa as well as suppression of the cough reflex, it should be used with caution in patients with asthma or emphysema. Acute overdoses can cause excitement, seizures, hypotension, tachycardia, circulatory collapse, and respiratory paralysis. Adverse reactions with dextromethorphan rarely occur. Reported effects include drowsiness, nausea, and dizziness. It is associated with little or no respiratory depression although it can occur with extremely high doses. Toxicity can lead to stupor and disturbances in gait. Rapid recovery often occurs after emesis. Physical dependence has not been associated with its use (Reynolds, 1998; Bryant & Cormier, 1982). Ïî ïîâîäó áðîìãåêñèíà - ïîõîæå, ïðîèçîøëà ïóòàíèöà. Â ìèðå åñòü ðàçíûå áðîìãåêñèíû, è ïîëä íåêîòîðûìè êðîþòñÿ ïðîòèâîêàøëåâûå ïðåïàðàòû. Òîò áðîìãåêñèí, ÷òî áðîìãåêñèí ïî ÌÍÍ, ýòî ìóêîëèòèê |
#9
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Òîëüêî ïîìíèòå: ôîðóì - íå çàìåíà î÷íîìó âðà÷ó, à ëå÷åíèå ïî èíòåðíåòó - ÷ðåâàòî ñìåðòüþ îò îïå÷àòêè. Ñ óâàæåíèåì, Ñåðãåé Àëåêñàíäðîâè÷. |
#10
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Âîò åùå
[Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ] |
#11
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Íå òàê óæ è ñëîæíî äîçèðîâàòü ëèáåêñèí- 10 ìã\êã âåñà, ïðè âåñå â 10 êã- ýòî êàê ðàç òàáëåòêà 100ìã. Åñëè íóæíî ïîëîâèíó äîçû, òàê íåò ïðîáëåì- âñ¸ ðàâíî ìàëåíüêèå äåòè òðåáóþò äðîáëåíèÿ òàáëåòêè â ïîðîøîê. Íàñêîëüêî ÿ ïîìíþ- òàáëåòêà áåç îáëàòêè, ñòàëî áûòü, îñîáî íå ðàçäðàæàåò ñëèçèñòûå ( ñîáñòâåííî, è íà ïðàêòèêå ýòî âèäíî).
Âû åù¸ çàáûëè èíãàëÿöèè ïóëüìèêîðòà ïðè íàëè÷èè ñóõîãî èçíóðÿþùåãî êàøëÿ ñ ïðèçíàêàìè ãèïåððåàêòèâíîñòè ñëèçèñòîé.  ïîñëåäíåå âðåìÿ èñïîëüçîâàíèå åãî ñ÷èòàåòñÿ âïîëíå îïðàâäàíûì, äàæå ïðè îòñóòñòâèè ÁÀ. |
#12
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Òîëüêî ïîìíèòå: ôîðóì - íå çàìåíà î÷íîìó âðà÷ó, à ëå÷åíèå ïî èíòåðíåòó - ÷ðåâàòî ñìåðòüþ îò îïå÷àòêè. Ñ óâàæåíèåì, Ñåðãåé Àëåêñàíäðîâè÷. |
#13
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"Ïðèîáðåëà" ýòî çíàíèå íà ÔÏÊ. Âàøó ïðîñüáó ïîíèìàþ êàê çàìå÷àíèå. Óøëà çà ññûëêîé- âåðíóñü íå ñêîðî Âåðîÿòíî, îíà ïðèìåðíî òàì æå, ãäå è ññûëêà íà èñïîëüçîâàíèå ïðè êàøëå àñêîðèëà
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#14
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Ïåðå÷èòàë àííîòàöèþ ê áóäåñîíèäó â UpToDate - íå íàøåë òàêèõ ïîêàçàíèé.
Ðîññèéñêèå ðåêîìåíäàöèè æãóò. Ïî÷èòàéòå íàø ôîðóì, íàéäåòå åùå ìíîãî íåñòûêîâîê ñ ÔÏÊ.  êà÷åñòâå ïðèìåðà: http://forums.rusmedserv.com/showthr...F4%E5%F0%EE%ED [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ] http://forums.rusmedserv.com/showthr...E8%F0%EE%E7%E0 [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ]
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Òîëüêî ïîìíèòå: ôîðóì - íå çàìåíà î÷íîìó âðà÷ó, à ëå÷åíèå ïî èíòåðíåòó - ÷ðåâàòî ñìåðòüþ îò îïå÷àòêè. Ñ óâàæåíèåì, Ñåðãåé Àëåêñàíäðîâè÷. |
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Ê ïóëüìèêîðòó êàêèå-òî çàîáëà÷íî ðàñøèðåííûå ïîêàçàíèÿ.  òîì ÷èñëå è çà ñ÷åò ôàíòàçèé.
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