Kugwirizana kwa Methylene Blue ndi Mankhwala Ena ndi Vuto la Serotonin Yochuluka

Methylene blue ingayambitse kugwirizana koopsa ndi mankhwala omwe amakhudza serotonin. Malangizo operekera PROVAYBLUE kudzera mumtsempha ali ndi chenjezo m'bokosi lokhudza vuto la serotonin yochuluka (serotonin syndrome) lomwe lingaphe munthu ikagwiritsidwa ntchito limodzi ndi mankhwala okhudza serotonin kapena ma opioid. Chinthu chomwedwa sichimangokhala chopanda chiopsezo chimenechi chifukwa choti chimamwedwa.

Musanawonjezere methylene blue, pemphani katswiri wa mankhwala kapena wopereka mankhwala kuti aunike mndandanda wonse wa mankhwala anu, kuphatikizapo omwe mumamwa nthawi ndi nthawi, mankhwala a chifuwa, zowonjezera zakudya, ndi mtundu wa methylene blue womwe mukufuna kugwiritsa ntchito. Musasiye mankhwala omwe mukugwiritsa ntchito kale kuti muyambe methylene blue. Funso lofunika ndi lakuti ngati kuphatikiza mankhwala amenewo n'koyenera kwa munthuyo, osati ngati munthu wina pa intaneti adayesapo.

Chifukwa chake utoto umagwirizana ndi mankhwala ochepetsa kukhumudwa

Serotonin ndi mankhwala a m'thupi onyamula mauthenga. Mmene imagwirira ntchito zimadalira, mwa zina, liwiro limene maselo amaitenganso ndi kuiphwanya. Mankhwala otchedwa selective serotonin reuptake inhibitors, kapena SSRIs, amachepetsa kutengedwanso kwake. Monoamine oxidase A, yomwe imafupikitsidwa kuti MAO-A, ndi puloteni yothandiza kuphwanya serotonin. Kulepheretsa njira zonse ziwirizi kungapangitse kuti serotonin igwire ntchito mopitirira muyeso.

Mu kafukufuku wa ma enzyme wa Ramsay, Dunford, ndi Gillman wa 2007, methylene blue inalepheretsa kwambiri MAO-A ya munthu yomwe inali itayeretsedwa. Mtengo wokhazikika woyezera kulepheretsa umene unanenedwa unali pafupifupi 27 nanomolar. MAO-B inkafuna kuchuluka kwakukulu kwambiri. Uku kunali kuyesa mu labotale, osati kuyesa kokhazikitsa kuchuluka kovomerezeka komwedwa kapena kuyeza mwayi woti kugwirizana kwa mankhwala kungachitike.

Kulepheretsako kunali kotheka kubwerera m'mbuyo. Izi zikufotokoza mmene methylene blue imagwirira ntchito ndi enzyme; sizikutanthauza kuti zotsatira zovulaza zingakhale zochepa kapena kuti zingakhale zotetezeka kuzisamalira kunyumba. Zomwe zinapezeka mu labotale zimafotokoza njira imodzi yomwe imathandiza kumvetsa malipoti a zachipatala, koma sizimapereka malire otetezeka kwa munthu payekha.

Tebulo la kugwirizana: gulu, njira yolowera m'thupi, ndi umboni

Tebuloli limasiyanitsa chenjezo la zachipatala, njira yomwe ingathe kufotokoza kugwirizanako, ndi kusowa kwa umboni wachindunji wokwanira. Zitsanzozi sizikuphatikiza mankhwala onse a m'gulu lililonse. Gawo la njira yolowera m'thupi likunena za methylene blue, pokhapokha ngati njira ina yatchulidwa.

Gulu la mankhwala kapena funso	Umboni wosiyana malinga ndi njira yolowera m'thupi	Tanthauzo la zomwe zapezeka
Mankhwala ochepetsa kukhumudwa omwe amakhudza serotonin: SSRIs, SNRIs, ndi clomipramine	Malangizo a IV, operekera kudzera mumtsempha, amachenjeza kuti zisagwiritsidwe ntchito limodzi. Malipoti a zachipatala omwe afalitsidwa akuphatikiza methylene blue yoperekedwa popanda kudutsa m'mimba; palinso lipoti la chinthu chomwedwa chokhala ndi mankhwala angapo.	Ichi ndi chiopsezo chodziwika cha kugwirizana koopsa, osati funso la ngati mankhwalawo angagwiritsidwe ntchito limodzi longotengera lingaliro.
Mankhwala olepheretsa MAO, kuphatikizapo MAOIs a matenda a maganizo ndi linezolid	Malangizo a IV amatchula mankhwalawa pakati pa omwe sayenera kuphatikizidwa nayo.	Methylene blue imawonjezera kulepheretsedwa kwa MAO; ntchito yodziwika ya mankhwala siimasonyeza zoopsa zake zonse akaphatikizidwa ndi ena.
Bupropion, kuphatikizapo Wellbutrin	Malangizo a bupropion amatchula mwachindunji methylene blue ya IV ndi zotsatira za kukwera kwa kuthamanga kwa magazi.	Kusakhala m'gulu la SSRIs sikutsimikizira kuti mankhwalawa angagwiritsidwe ntchito limodzi.
Mankhwala olimbikitsa ubongo a amphetamine, kuphatikizapo Adderall XR	Malangizo amakono a amphetamine amaphatikiza methylene blue ya IV pa zoletsa zake zokhudza MAOIs chifukwa cha chiopsezo cha kukwera koopsa kwa kuthamanga kwa magazi.	Kuvulazidwa kwa mtima ndi mitsempha n'kofunika, limodzi ndi kuvulazidwa chifukwa cha serotonin. Mawu amenewa okhudza IV satsimikizira kuti kuwagwiritsa ntchito limodzi pomwa n'kovomerezeka.
Ma opioid, kuphatikizapo buprenorphine/naloxone kapena Suboxone	Malangizo a SUBOXONE amatchula methylene blue ya IV pakati pa mankhwala okhudza serotonin omwe angagwirizane nayo, ndipo amafotokoza kuvulazidwa ndi ma opioid kokhudzana ndi MAOIs.	Mankhwala omwe amayambitsa pang'ono ntchito ya malo olandirira ma opioid amafunikabe kuunikidwa pa kugwirizana kwawo ndi mankhwala ena. Chenjezoli silikutanthauza kuti opioid iliyonse ili ndi chiopsezo chofanana.
Mankhwala ena okhudza serotonin, kuphatikizapo buspirone ndi dextromethorphan	Malangizo a methylene blue ya IV amatchula mankhwalawa mwachindunji.	Mankhwala a nkhawa kapena chosakaniza cha mankhwala a chifuwa ogulidwa popanda chilolezo cha dokotala chingakhale chofunika mofanana ndi mankhwala ochepetsa kukhumudwa.
Gabapentin ndi mafunso okhudzana ndi mankhwala ena oletsa kukomoka	Pabwalo lokambirana pali kufotokoza kwa zizindikiro pambuyo pogwiritsa ntchito mankhwalawa limodzi. Uwu si kafukufuku wotsimikizidwa wa zachipatala wa kugwirizana kwa mankhwala malinga ndi njira yolowera m'thupi.	Zotsatira zomwe zanenedwa ziyenera kuunikidwa; sizitsimikizira kuti gabapentin inayambitsa vuto la serotonin yochuluka.
Mankhwala olepheretsa PDE5, kuphatikizapo sildenafil kapena Viagra	Zomwe zapezeka poyesa njira ya nitric oxide zimathandiza kufotokoza mmene mankhwalawa angagwirire ntchito, osati kuyesa chitetezo cha anthu omwa mankhwalawa limodzi.	Njira yogwirira ntchitoyo yokha sitsimikizira kusintha komwe kwayembekezeredwa kwa zotsatira kapena mfundo yakuti mankhwalawa angagwiritsidwe ntchito limodzi.
Ivermectin ndi kuphatikiza kwina kwa mankhwala komwe sikunaphunziridwe mokwanira	Palibe kafukufuku wa kugwirizana kwa mankhwala mwa anthu wokhala ndi gulu loyerekezera amene anapezeka m'magwero omwe anaunikidwa pa nkhaniyi.	Kuphatikizaku sikunafotokozedwe mokwanira. Kusapeza zambiri pofufuza kugwirizana kwa mankhwala si umboni wa chitetezo.

Gawo la malangizo a IV lokhudza kugwirizana kwa mankhwala limatchulanso mirtazapine ndi bupropion. Mndandanda wongokhala ndi mankhwala omwe mayina awo amatha ndi mayina odziwika a malonda a mankhwala ochepetsa kukhumudwa ungasiye mankhwala ena ofunika.

N'chiyani chimasintha methylene blue ikamezedwa?

Njira yolowera m'thupi imasintha mmene thupi limakumana ndi mankhwalawo, choncho lipoti la IV silingapereke chiwerengero cha chiopsezo cha mankhwala amadzimadzi omwedwa. Kugwiritsa ntchito mfundo imeneyi mosinthanitsa nakonso sikugwira ntchito: kuchepa kwa malipoti a kumwa sikutsimikizira kuti kuphatikiza mankhwala omwedwa n'kotetezeka.

Lipoti la Zuschlag ndi anzake la 2018 limafotokoza kukayikira vuto la serotonin yochuluka pambuyo poyambitsa mankhwala omwedwa ochepetsa ululu wa m'njira ya mkodzo okhala ndi methylene blue kwa wodwala yemwe ankamwa mankhwala angapo okhudza serotonin. Kuunika kwawo komwe kunatsagana ndi lipotilo kunapeza milandu 50 ya m'mbuyomo yokhudza methylene blue yoperekedwa popanda kudutsa m'mimba pamodzi ndi mankhwala ochepetsa kukhumudwa omwe amakhudza serotonin.

Kusiyanitsa kumeneku n'kothandiza. Mlandu wa kumwawo unakhudza mankhwala osakaniza, osati kuyesa koyendetsedwa bwino kwa mankhwala amadzimadzi a ogula okhala ndi chosakaniza chimodzi chokha. Sungatiuze kuti botolo linalake limayambitsa kugwirizana ndi mankhwala ena kangati. Komabe, umatsutsa mfundo yakuti kumeza methylene blue kumapangitsa kuti kuvulazidwa chifukwa cha serotonin kusatheke. Malipoti a milandu amasonyeza zoopsa; popanda kudziwa chiwerengero ndi makhalidwe a anthu onse amene analandira mankhwalawo, samayeza mmene vutolo limachitikira.

Wellbutrin, mankhwala olimbikitsa ubongo, ndi Suboxone zimafunika kuunikidwa payokha

Wellbutrin ndi bupropion, osati SSRI. Malangizo ake operekera mankhwala amatchula chiopsezo cha kukwera kwa kuthamanga kwa magazi ikagwiritsidwa ntchito ndi methylene blue ya IV. Choncho, kunena kuti “sikuti imagwira ntchito makamaka kudzera mu serotonin” sikokwanira kuyankha funso la kuiphatikiza ndi mankhwala ena.

Pa mankhwala olimbikitsa ubongo, malangizo a ADDERALL XR amaphatikiza mwachindunji methylene blue ya IV pa zoletsa zake zokhudza MAOIs. Kukwera kwakukulu kwa kuthamanga kwa magazi ndi chiopsezo chosiyana ndi njira ya serotonin yomwe yafotokozedwa pamwambapa. Mankhwala osiyanasiyana olimbikitsa ubongo amafunikabe kuunikidwa lililonse payokha.

Suboxone ili ndi buprenorphine ndi naloxone. Tebulo lake la kugwirizana kwa mankhwala limafotokoza vuto la serotonin yochuluka ndi kuvulazidwa ndi ma opioid kokhudzana ndi MAOIs, kuphatikizapo kuchepa kwa kupuma kapena chikomokere. Kukhalapo kwa naloxone sikutsimikizira kuti kugwirizana kulikonse ndi mankhwala ena n'kovomerezeka. Anthu omwe akulandira chithandizo cha vuto la kugwiritsa ntchito ma opioid ayenera kukambirana ndi gulu lawo la chithandizo asanawonjezere methylene blue.

Gabapentin: lipoti la zotsatira si kutsimikizira matenda

Funso pabwalo la Phoenix Rising lokhudza gabapentin ndi methylene blue limafotokoza kusokonezeka maganizo ndi kulimbikitsidwa mopitirira muyeso kwa mphamvu za kuzindikira monga kuona ndi kumva. Wolembayo ankadzifunsa ngati vuto la serotonin yochuluka ndilo linayambitsa izi. Funso limenelo silingayankhidwe kuchokera pa zomwe analembazo: palibe kuunikidwa ndi katswiri wa zachipatala kapena kufotokoza kotsimikizidwa kwa zizindikirozo.

Mmene gabapentin imagwirira ntchito m'thupi n'kosiyana ndi SSRI. Malangizo ake amafotokoza kuti imamangirira ku gawo la alpha-2-delta la njira zolowetsa calcium zomwe zimatsegulidwa ndi kusintha kwa mphamvu yamagetsi, pamene amavomereza kuti njira yeniyeni yomwe imathandizira pochiza sinadziwike bwino. Kusiyanitsa kumeneku kumathandiza kupewa kuika mankhwalawo m'gulu lolakwika; sikutsimikizira kuti kuwonjezera methylene blue sikungavulaze. Musatsanzire chithandizo chopulumutsa chomwe chanenedwa pabwalo lokambirana pofuna kuyesa chimene chinayambitsa zotsatirazo.

Sildenafil ndi ivermectin: njira yogwirira ntchito sitsimikizira ngati zingagwiritsidwe ntchito limodzi

Sildenafil imathandiza njira ya nitric oxide/cyclic GMP mwa kulepheretsa PDE5. Kufotokoza kwa sayansi kwa EMA kokhudza Viagra kumafotokoza njira imeneyi ndi kugwiritsidwa ntchito kwa methylene blue poyesa. Mu mayeso a mitsempha yochotsedwa m'thupi ndi ma enzyme oyeretsedwa, methylene blue inasokoneza kutumizidwa kwa mauthenga ndi nitric oxide, ndipo zotsatira zake zinasiyana malinga ndi malo omwe inakhudza ndi kuchuluka kwake.

Zomwe zinawonedwazi zimathandiza kumvetsa, kuchokera ku sayansi ya zamoyo, mfundo yakuti zotsatira za sildenafil zingasinthe. Sizitsimikizira zotsatira zodziwikiratu mwa munthu, kuphatikiza kotetezeka, kapena njira yogwiritsira ntchito mankhwala amodzi polinganiza zotsatira za ena. Mafunso okhudza mankhwala olepheretsa PDE5 ali m'gawo la mmene mankhwala amagwirira ntchito pa mtima ndi mitsempha, osati kuti amangokhala m'gulu limodzi la umboni ndi kugwirizana kwa SSRI ndi mankhwala ena.

Pa ivermectin, kusapezeka kwa kafukufuku wa kugwirizana ndi mankhwala ena wokhala ndi gulu loyerekezera m'zinthu zomwe zinapezeka kumasiya kusowa kwa umboni. Zolemba za labotale zomwe zimatchula mankhwala onse awiri zingakhale zikuyerekezera mankhwalawo kapena kugwiritsa ntchito limodzi ngati choyerekezera pa kuyeza. Umenewo si kafukufuku wa anthu omwe akumamwa limodzi. Momwemonso, zokambirana zosakhazikika za zomwe anthu anakumana nazo sizipereka mbiri ya mankhwala ndi kutsatira zotsatira mwadongosolo zomwe zimafunika kutsimikizira kuti kuphatikiza mankhwalawo n'kovomerezeka.

Zizindikiro zomwe zimafunika kuunikidwa mwamsanga

Kuvulazidwa chifukwa cha serotonin kungaphatikize kusakhazikika kapena kusokonezeka maganizo, kutentha thupi kapena kutuluka thukuta kwambiri, kugunda kwa mtima mofulumira, kunjenjemera, kuuma kwa minofu, ndi kugwedezeka kodzichitikira. Zizindikirozi zili mu chenjezo la vuto la serotonin yochuluka m'malangizo a amphetamine. Sizili mndandanda wodzitsimikizira matenda kunyumba.

Pambuyo pogwiritsa ntchito mankhwala omwe mukukayikira kuti agwirizana movulaza, zizindikiro zatsopano zimafunika uphungu wa zachipatala mwamsanga. Kusokonezeka maganizo kwambiri, kutentha thupi kwambiri, kukomoka ndi kugwedezeka, kugwa mwadzidzidzi, kapena kuvutika kupuma zimafunika chithandizo chadzidzidzi nthawi yomweyo. Perekani chidebe kapena zolemba za mankhwalawo, mndandanda wa mankhwala, njira yomwe analowera m'thupi, kuchuluka kwake, ndi nthawi yomwe anagwiritsidwa ntchito; musagwiritsenso ntchito methylene blue pamene mukufuna uphungu.

Ngati mukukonzekera kuunikidwa kwa mankhwala anu, gwiritsani ntchito mafunso oti mufunse katswiri wa zachipatala okhudza methylene blue. Malangizo ambiri a chitetezo cha methylene blue amafotokoza zoopsa zina kupatula kugwirizana ndi mankhwala ena, kuphatikizapo nkhani yapadera ya kusowa kwa G6PD ndi kuwonongeka kwa maselo ofiira a magazi. Kuunika kokwanira kumafunika mndandanda wa mankhwala komanso mbiri yoyenera ya thanzi la munthuyo.