Ukusebenzisana kwe-Methylene Blue Nemithi kanye ne-Serotonin Syndrome

I-methylene blue ingabangela ukusebenzisana okuyingozi kakhulu nemithi ethinta i-serotonin. Imininingwane yokunquma i-PROVAYBLUE efakwa emthanjeni inesexwayiso esigqanyiswe ebhokisini nge-serotonin syndrome engabangela ukufa lapho isetshenziswa nemithi ethinta i-serotonin kanye nama-opioid. Umkhiqizo ophuzwa ngomlomo awukhululeki ngokuzenzakalela kulokhu kukhathazeka.

Ngaphambi kokwengeza i-methylene blue, cela usokhemisi noma uchwepheshe onquma imithi ukuba ahlole uhlu oluphelele lwemithi, okuhlanganisa imithi esetshenziswa ngezikhathi ezithile, imikhiqizo yokukhwehlela, izithasiselo, kanye nokwakheka komkhiqizo we-methylene blue ohlongozwayo. Ungayeki umuthi osuvele uwusebenzisa ukuze uvule indawo yayo. Umbuzo owusizo uwukuthi leyo nhlanganisela ethile imfanele yini lowo muntu, hhayi ukuthi ukhona yini umuntu oku-inthanethi oseke wayizama.

Kungani udayi usebenzisana nemithi elwa nokucindezeleka

I-serotonin iyikhemikhali ethumela imiyalezo. Imiphumela yayo incike ngokwengxenye ekutheni amangqamuzana ashesha kangakanani ukuyibuyisela ngaphakathi nokuyiguqula ngamakhemikhali. Imithi ekhetha ukuvimbela ukubuyiselwa kwe-serotonin emangqamuzaneni, noma ama-SSRI, inciphisa lokho kubuyiselwa. I-monoamine oxidase A, efushaniswa ngokuthi MAO-A, iyi-enzayimu ehilelekile ekubhidlizweni kwe-serotonin. Ukuvimbela zombili lezi zinqubo kungabangela ukusebenza kwe-serotonin okweqile.

Ocwaningweni lwama-enzayimu luka-Ramsay, Dunford, no-Gillman lwango-2007, i-methylene blue yavimbela kakhulu i-MAO-A yomuntu ehlanziwe. Isilinganiso sokuvimbela esibikiwe sasicishe sibe ngu-27 nanomolar. I-MAO-B yayidinga amazinga okujiya aphakeme kakhulu. Lokhu kwakuwukuhlola kwaselabhorethri, hhayi ukuhlolwa okusungula umthamo owamukelekayo ophuzwa ngomlomo noma okulinganisa amathuba okusebenzisana kwemithi.

Lokhu kuvimbela kwakungahlehleka. Lokho kuchaza ukusebenzisana ne-enzayimu; akusho ukuthi ukusabela okubi kuzoba buthaka noma kuphephe ukukulawula ekhaya. Okutholwe elabhorethri kuchaza indlela esebenza ngemuva kwemibiko yezokwelapha, kodwa akunikezi umkhawulo wokuphepha womuntu ngamunye.

Ithebula lokusebenzisana: isigaba, indlela yokufakwa emzimbeni, nobufakazi

Ithebula lihlukanisa isexwayiso sezokwelapha endleleni engase ibe khona yokusebenzisana kanye nokuntuleka kobufakazi obuqondile obanele. Izibonelo azihlanganisi yonke imithi esigabeni ngasinye. Ikholomu yendlela yokufakwa emzimbeni ibhekisela ku-methylene blue, ngaphandle uma kuchazwe enye indlela.

Isigaba somuthi noma umbuzo	Ubufakazi obuqondene nendlela yokufakwa emzimbeni	Okushiwo yilokho okutholakele
Imithi elwa nokucindezeleka ethinta i-serotonin: ama-SSRI, ama-SNRI, ne-clomipramine	Imininingwane ye-IV ixwayisa ngokusetshenziswa ndawonye. Imibiko yezokwelapha eshicilelwe ihlanganisa ukuyifaka emzimbeni ngaphandle kokudlula emgudwini wokugaya ukudla; kukhona futhi umbiko wesigameko somkhiqizo ohlanganisa imithi ophuzwa ngomlomo.	Lokhu kuwukukhathazeka okuqinisekisiwe ngokusebenzisana okuyingozi kakhulu, hhayi nje umbuzo ocatshangelwayo ngokuhambisana kwemithi.
Imithi evimbela i-MAO, okuhlanganisa ama-MAOI ezifo zengqondo ne-linezolid	Imininingwane ye-IV ibala le mithi phakathi kwezinhlanganisela okufanele zigwenywe.	I-methylene blue yengeza ukuvinjelwa kwe-MAO; injongo evamile yomuthi ayivezi zonke izingozi zokusebenzisana kwawo.
I-bupropion, okuhlanganisa i-Wellbutrin	Imininingwane ye-bupropion ikhuluma ngokuqondile nge-methylene blue ye-IV kanye nokusabela okubangela umfutho wegazi ophakeme.	Ukungabi sesigabeni sama-SSRI akuqinisekisi ukuhambisana.
Izikhuthazi ze-amphetamine, okuhlanganisa i-Adderall XR	Imininingwane yamanje ye-amphetamine ihlanganisa i-methylene blue ye-IV ekwenqatshelweni kokusetshenziswa nama-MAOI ngenxa yengozi yokukhuphuka komfutho wegazi okuyingozi kakhulu.	Ubuthi obuthinta inhliziyo nemithambo yegazi bubalulekile kanye nobuthi be-serotonin. Lawo mazwi aphathelene ne-IV awaqinisekisi ukuphepha kokusetshenziswa ndawonye ngomlomo.
Ama-opioid, okuhlanganisa i-buprenorphine/naloxone noma i-Suboxone	Imininingwane ye-SUBOXONE ibala i-methylene blue ye-IV phakathi kwemithi ethinta i-serotonin esebenzisana nayo, futhi ichaza ubuthi bama-opioid obuhlobene nama-MAOI.	I-agonist ye-opioid esebenza ngokwengxenye isadinga ukuhlolwa kokusebenzisana. Lesi sexwayiso asisho ukuthi wonke ama-opioid anengozi efanayo.
Eminye imithi ethinta i-serotonin, okuhlanganisa i-buspirone ne-dextromethorphan	Imininingwane ye-methylene blue ye-IV ibala ngokuqondile lezi zinto.	Umuthi wokukhathazeka noma isithako somuthi wokukhwehlela othengwa ngaphandle kwencwadi kadokotela singabaluleka njengomuthi olwa nokucindezeleka.
I-gabapentin nemibuzo ehlobene nemithi evimbela ukuquleka	Inkundla yezingxoxo ichaza izimpawu ezavela ngemva kokusetshenziswa ndawonye. Lokhu akulona ucwaningo lwezokwelapha oluqinisekisiwe lokusebenzisana oluqondene nendlela yokufakwa emzimbeni.	Ukusabela okubikiwe kufanele kuhlolwe; akufakazeli ukuthi i-gabapentin yabangela i-serotonin syndrome.
Imithi evimbela i-PDE5, okuhlanganisa i-sildenafil noma i-Viagra	Okutholwe ekuhloleni indlela yokusebenza kwe-nitric oxide kunikeza umongo wendlela yokusebenza, hhayi ukuhlolwa kokuphepha kubantu kwenhlanganisela ephuzwa ngomlomo.	Indlela yokusebenza iyodwa ayiqinisekisi ushintsho olubikezelwe emphumeleni noma isimangalo sokuhambisana.
I-ivermectin nezinye izinhlanganisela ezingakacwaningwa ngokwanele	Akutholakalanga ucwaningo olulawulwayo lokusebenzisana kubantu emithonjeni ehloliwe yale ndatshana.	Le nhlanganisela isalokhu ingachazwa ngokwanele. Ukungatholi lutho lapho kuseshwa ukusebenzisana akubona ubufakazi bokuphepha.

Isigaba sokusebenzisana semininingwane ye-IV siphinde sibale i-mirtazapine ne-bupropion. Uhlu olukhawulelwe emithini egcina ngamagama emikhiqizo ejwayelekile yemithi elwa nokucindezeleka luzoshiya ngaphandle imithi efanele ukubhekwa.

Yini eshintshayo lapho i-methylene blue igwinywa?

Indlela yokufakwa emzimbeni ishintsha ukuchayeka kuyo, ngakho umbiko we-IV awukwazi ukunikeza isilinganiso senombolo sengozi yesixazululo esiphuzwa ngomlomo. Ukucabanga okuphambene nakho akusebenzi: ukuba nemibiko embalwa yokusetshenziswa ngomlomo akuqinisekisi ukuthi inhlanganisela ephuzwa ngomlomo iphephile.

Umbiko ka-Zuschlag nozakwabo wango-2018 uchaza i-serotonin syndrome eyayisolwa ngemva kokwengezwa komuthi ophuzwa ngomlomo wokudambisa ubuhlungu bomgudu womchamo owawune-methylene blue esigulini esasithatha imithi eminingana ethinta i-serotonin. Ukubuyekezwa abakwenza okuhambisana nalowo mbiko kwathola izigameko zangaphambilini ezingu-50 ezazihilela i-methylene blue efakwe emzimbeni ngaphandle kokudlula emgudwini wokugaya ukudla kanye nemithi elwa nokucindezeleka ethinta i-serotonin eyayisetshenziswa ngesikhathi esifanayo.

Lokho kuhlukanisa kuyasiza. Isigameko sokusetshenziswa ngomlomo sasihilela umuthi ohlanganisa izithako, hhayi ukuhlola okulawulwayo kwesixazululo sesithako esisodwa esithengiselwa abathengi. Asikwazi ukusitshela ukuthi ibhodlela elithile libangela ukusebenzisana kangaki. Nokho, siyaphikisana nesimangalo sokuthi ukugwinya i-methylene blue kwenza ubuthi be-serotonin bungenzeki. Imibiko yezigameko ikhomba izingozi; ngaphandle kwenani nezici zabo bonke abachayeke kuyo, ayilinganisi izinga lokuvela kwezigameko.

I-Wellbutrin, izikhuthazi, ne-Suboxone kudinga ukucatshangelwa ngokwehlukana

I-Wellbutrin iyi-bupropion, hhayi i-SSRI. Imininingwane yayo yokunquma umuthi iveza ingozi yokusabela okubangela umfutho wegazi ophakeme lapho isetshenziswa ne-methylene blue ye-IV. Ngakho-ke, “ayisebenzi kakhulu nge-serotonin” akuyona impendulo eyanele embuzweni wenhlanganisela.

Mayelana nezikhuthazi, imininingwane ye-ADDERALL XR ihlanganisa ngokusobala i-methylene blue ye-IV ekwenqatshelweni kokusetshenziswa nama-MAOI. Ukusabela okubangela ushintsho olukhulu lomfutho wegazi kuwukukhathazeka okuhlukile endleleni yokusebenza kwe-serotonin echazwe ngenhla. Imithi ehlukene yezikhuthazi isadinga ukuhlolwa ngamunye.

I-Suboxone iqukethe i-buprenorphine ne-naloxone. Ithebula layo lokusebenzisana lichaza i-serotonin syndrome nobuthi bama-opioid obuhlobene nama-MAOI, okuhlanganisa ukucindezeleka kokuphefumula noma ikhoma. Ukuba khona kwe-naloxone akuqinisekisi ngokujwayelekile ukuthi akukho ngozi yokusebenzisana. Abantu abathola ukwelashwa kokuphazamiseka okubangelwa ukusetshenziswa kwama-opioid kufanele baxoxe nethimba labo lokwelapha ngaphambi kokwengeza i-methylene blue.

I-Gabapentin: umbiko wokusabela awukona ukuxilongwa

Umbuzo enkundleni ye-Phoenix Rising nge-gabapentin ne-methylene blue uchaza ukudideka mayelana nendawo noma isikhathi kanye nokushukunyiswa kwezinzwa ngokweqile. Umbhali wayezibuza ukuthi kwakubangelwa yini i-serotonin syndrome. Lowo mbuzo awukwazi ukuxazululwa ngokuthunyelwe lapho: akukho ukuhlolwa kwezokwelapha noma incazelo eqinisekisiwe yezimpawu.

I-gabapentin isebenza ngendlela ehlukile kune-SSRI. Imininingwane yayo ichaza ukubopha kwayo engxenyeni ye-alpha-2-delta yemigudu ye-calcium evulwa ushintsho lwamandla kagesi, kodwa ivuma ukuthi indlela yayo eqondile yokwelapha ayiqinisekile. Lo mehluko uvimbela ukuhlukaniswa ngokwesigaba okungalungile; awufakazeli ukuthi ukwengeza i-methylene blue akunabungozi. Ungaphindi ukwelashwa kokuhlenga okuhlongozwa enkundleni yezingxoxo ukuze uzame ukuthola ukuthi yini ebangele ukusabela.

I-Sildenafil ne-ivermectin: izindlela zokusebenza aziqinisekisi ukuhambisana

I-sildenafil isekela indlela ye-nitric oxide/cyclic GMP ngokuvimbela i-PDE5. Ingxoxo yesayensi ye-EMA nge-Viagra ichaza le ndlela kanye nokusetshenziswa kwe-methylene blue ekuhloleni. Ekuhloleni kwemithambo ehlukanisiwe nama-enzayimu ahlanziwe, i-methylene blue yaphazamisa ukudluliswa kwemiyalezo kwe-nitric oxide, yaba nemiphumela ehlukene ezindaweni eziqondiswe kuzo nasemazingeni ahlukene okujiya.

Lokhu okubonakele kwenza izimangalo ngoshintsho olungaba khona emphumeleni we-sildenafil ziqondakale ngokwesayensi yokuphila. Akuqinisekisi umphumela obikezelwayo kubantu, inhlanganisela ephephile, noma indlela yokulinganisa umuthi owodwa ngomunye. Imibuzo ngemithi evimbela i-PDE5 ingeyocwaningo lokusebenza kwemithi enhliziyweni nasemithanjeni yegazi, hhayi ngokuzenzakalela eyesigaba sobufakazi esifanayo nokusebenzisana kwe-SSRI.

Mayelana ne-ivermectin, ukungabikho kocwaningo olulawulwayo lokusebenzisana emibhalweni etholakele kushiya igebe ebufakazini. Amaphepha ocwaningo lwaselabhorethri akhuluma ngazo zombili lezi zinhlanganisela zamakhemikhali angase aziqhathanise noma asebenzise eyodwa njengento yokulawula ekuhloleni. Lokho akulona ukuhlolwa kwabantu abazithatha ndawonye. Ngokufanayo, izingxoxo ezingahlelekile ngalokho abantu abahlangabezane nakho azinikezi imilando yemithi nokulandelelwa okuhlelekile okudingekayo ukuze kuqinisekiswe ukuphepha kwenhlanganisela.

Izimpawu ezidinga ukuhlolwa ngokuphuthumayo

Ubuthi be-serotonin bungahlanganisa ukungahlaliseki noma ukudideka, imfiva noma ukujuluka kakhulu, ukushaya kwenhliziyo ngokushesha, ukuthuthumela, ukuqina kwemisipha, nokunyakaza komzimba okungazelelwe okungazikhethelwe. Lezi zimpawu zivela esexwayisweni se-serotonin syndrome emininingwaneni ye-amphetamine. Azilona uhlu lokuzixilonga ekhaya.

Ngemva kokuchayeka okusolakala ukuthi kubangele ukusebenzisana, izimpawu ezintsha zidinga iseluleko sezokwelapha ngokushesha. Ukudideka okukhulu, imfiva ephezulu, ukuquleka, ukuwa, noma ubunzima bokuphefumula kudinga usizo lwezokwelapha oluphuthumayo ngokushesha. Nikeza ukupakishwa komkhiqizo, uhlu lwemithi, indlela ofakwe ngayo emzimbeni, inani, nesikhathi sokusetshenziswa; ungathathi enye i-methylene blue ngesikhathi ufuna iseluleko.

Uma uhlela ukuhlolwa kwemithi, sebenzisa imibuzo ongayibuza uchwepheshe wezokwelapha nge-methylene blue. Umhlahlandlela obanzi wokuphepha kwe-methylene blue uhlanganisa izingozi ezingaphezu kokusebenzisana, okuhlanganisa udaba oluhlukile lokushoda kwe-G6PD nokubhidlika kwamangqamuzana abomvu egazi. Ukuhlolwa okuphelele kudinga kokubili uhlu lwemithi nomlando wezempilo ofanele walowo muntu.