2023-03-11 23:13
Tadalafil (他達拉非) 犀利士膜衣錠, 有兩種劑型. 分別是 10mg 及 20 mg (犀利士仿單)犀利士使用方式. 每12小時吃 10 mg. 到達高海拔再開始吃藥. 持續吃 3-5 天. 目前相關的醫學研究不夠多, 所以沒有將犀利士列為 HAPE 的治療選項. 但美國CDC黃皮書提到, 也可用犀利士做為高海拔肺水腫的治療選項 : Tadalafil, 10 mg twice a day during ascent, can prevent HAPE; it may also have use as a treatment.
Sildenafil(西地那非) 威而鋼 100mg/tablet (每一錠含量是 100mg)
威而鋼預防 HAPE. 可行的使用方式是每八小時吃半顆(50mg)(最佳劑量目前尚無定論) , . 到達高海拔再開始吃藥. 持續吃 3-5 天.
下面是uptodate上的資料.
威而鋼. 血中濃度的半衰期是 17 小時, 在不同的醫學研究使用各種不同劑量. 最佳劑量目前並無定論. 有些研究是使用單一劑量, 例如一次 50mg(半顆) 或 100mg (一顆). 也有研究使用每次 40mg, 每八小時吃一次, 一天三次的使用方式.
犀利士, 血中濃度半衰期是 4-5 小時. 因此建議八小時吃一次. 一天三次的使用方式.
Tadalafil and sildenafil — In small studies, the PDE-5 inhibitors sildenafil and tadalafil prevented hypoxic pulmonary hypertension and the development of HAPE [49-51]. Optimal doses have not been established. Regimens for sildenafil have varied from a single dose of 50 or 100 mg just prior to exposure for acute ascent, to 40 mg three times per day for individuals who spend two to six days at high altitude; we give 50 mg every eight hours. For tadalafil, 10 mg every 12 hours is the usual dose. These drugs are potentially safer than nifedipine because there is less risk of hypotension, but they are more expensive and carry the risk of severe headaches. Sildenafil has shorter dosing intervals because its half-life is four to five hours; tadalafil's half-life is 17 hours. These drugs can be started the day of ascent and continued for three to five days after reaching maximal altitude; they can be extended for up to seven days or until start of descent in individuals who ascend faster than recommended.
tadalafil = Cialis FC Tablet 犀利士膜衣錠. 5毫克/錠
dexamethasone 底下直接翻譯為類固醇(類固醇很多種, 不僅這一種)
http://www.ncbi.nlm.nih.gov/pubmed/17015867
(備註 2014 WMS 指引, 類固醇不建議單獨用於預防 HAPE. HAPE 如果需藥物預防, 首選還是 nifedipine)
(類固醇預防HAPE研究目前仍很缺乏, 數量太少)
這篇是 2003 年的實驗. 在 2006 年發表於內科醫學雜誌.
在29名先前曾經發生過 HAPE 的成人. 分成三組. 預防性吃藥. 一組吃 tadalafil (10 mg) 一天兩次, 一組吃 dexamethasone (8 mg) 一天兩次, 一組吃安慰劑一天兩次, 從海拔 490 公尺上升至海拔 4559 公尺, 待兩天.
下面是 google 中文翻譯
背景：高原肺水腫 (HAPE) 是由與肺部一氧化氮生物利用度降低和肺泡液重吸收受損相關的過度缺氧肺血管收縮引起的。目的：研究地塞米鬆或他達拉非是否能降低有 HAPE 病史的成年人的 HAPE 和急性高山病 (AMS) 的發生率。
設計：2003 年夏季進行的隨機、雙盲、安慰劑對照研究。設置：24 小時內從 490 米上升，並在 4559 米處停留 2 晚。患者：29 名既往有 HAPE 的成人。干預：預防性使用他達拉非 (10 mg)、地塞米松 (8 mg) 或安慰劑，在上升和停留在 4559 m 的過程中每天兩次。
吃犀利士的一組共 10 人, 兩名在海拔 4559 公尺發生嚴重 AMS,. 從實驗退出. 但這兩位沒有發生 HAPE. 其他 8 個人有一個發生HAPE. 7 名發生 AMS.
吃安慰劑的九個人, 有七個人發生 HAPE. 8名發生 AMS.
吃 dexamethasone 的10 個人, 沒有人發生 HAPE. 3 名發生 AMS.
吃犀利士和 dexamethasone 的兩組. 肺動脈壓力比較低. (肺動脈高壓是 HAPE 成因)
結果：兩名接受他達拉非治療的參與者在到達海拔 4559 米時出現嚴重的 AMS，並退出了研究；他們當時沒有 HAPE。接受安慰劑的 9 名參與者中有 7 名和接受他達拉非的其餘 8 名參與者中有 1 名出現高原肺水腫，但接受地塞米鬆的 10 名參與者均未出現（他達拉非與安慰劑相比 P = 0.007；地塞米鬆與安慰劑相比 P < 0.001） . 接受安慰劑的 9 名參與者中有 8 名，接受他達拉非的 10 名參與者中有 7 名，接受地塞米鬆的 10 名參與者中有 3 名患有 AMS（他達拉非與安慰劑相比 P = 1.0；地塞米鬆與安慰劑相比 P = 0.020）。在高海拔地區，接受地塞米松（16 毫米汞柱 [95% CI，9 至 23 毫米汞柱]）和他達拉非（13 毫米汞柱 [CI，6 至 20 mm Hg]）比接受安慰劑的患者（28 mm Hg [CI，20 至 36 mm Hg]）（他達拉非與安慰劑相比 P = 0.005；地塞米鬆與安慰劑相比 P = 0.012）。組間鼻電位變化和白細胞鈉轉運蛋白信使 RNA 表達無統計學差異。
局限性：該研究涉及一小部分有 HAPE 病史的成年人。
結論：地塞米松和他達拉非均可降低肺動脈收縮壓，並可降低有 HAPE 病史的成人 HAPE 的發生率。地塞米松預防也可以降低這些成人 AMS 的發生率。
ClinicalTrials.gov 標識符：NCT00274430。
Both tadalafil and dexamethasone may reduce the incidence of high-altitude pulmonary edema: a randomized trial.
Ann Intern Med. 2006; 145(7):497-506 (ISSN: 1539-3704)
Maggiorini M; Brunner-La Rocca HP; Peth S; Fischler M; Böhm T; Bernheim A; Kiencke S; Bloch KE; Dehnert C; Naeije R; Lehmann T; Bärtsch P; Mairbäurl H
University Hospital Zürich, Zürich, Switzerland; Université de Bruxelles, Brussels, Belgium. klinmax@usz.unizh.ch
BACKGROUND: High-altitude pulmonary edema (HAPE) is caused by exaggerated hypoxic pulmonary vasoconstriction associated with decreased bioavailability of nitric oxide in the lungs and by impaired reabsorption of alveolar fluid. OBJECTIVE: To investigate whether dexamethasone or tadalafil reduces the incidence of HAPE and acute mountain sickness (AMS) in adults with a history of HAPE.
DESIGN: Randomized, double-blind, placebo-controlled study performed in summer 2003.
SETTING: Ascent from 490 m within 24 hours and stay for 2 nights at 4559 m.
PATIENTS: 29 adults with previous HAPE.
INTERVENTION: Prophylactic tadalafil (10 mg), dexamethasone (8 mg), or placebo twice daily during ascent and stay at 4559 m.
MEASUREMENTS: Chest radiography was used to diagnose HAPE. A Lake Louise score greater than 4 defined AMS. Systolic pulmonary artery pressure was measured by using Doppler echocardiography, and nasal potentials were measured as a surrogate marker of alveolar sodium transport.
吃犀利士的一組共 10 人, 兩名在海拔 4559 公尺發生嚴重 AMS,. 從實驗退出. 但這兩位沒有發生 HAPE. 其他 8 個人有一個發生HAPE. 7 名發生 AMS.
吃安慰劑的九個人, 有七個人發生 HAPE. 8名發生 AMS.
吃 dexamethasone 的10 個人, 沒有人發生 HAPE. 3 名發生 AMS.
吃犀利士和 dexamethasone 的兩組. 肺動脈壓力比較低. (肺動脈高壓是 HAPE 成因)
RESULTS: Two participants who received tadalafil developed severe AMS on arrival at 4559 m and withdrew from the study; they did not have HAPE at that time. High-altitude pulmonary edema developed in 7 of 9 participants receiving placebo and 1 of the remaining 8 participants receiving tadalafil but in none of the 10 participants receiving dexamethasone (P = 0.007 for tadalafil vs. placebo; P < 0.001 for dexamethasone vs. placebo). Eight of 9 participants receiving placebo, 7 of 10 receiving tadalafil, and 3 of 10 receiving dexamethasone had AMS (P = 1.0 for tadalafil vs. placebo; P = 0.020 for dexamethasone vs. placebo). At high altitude, systolic pulmonary artery pressure increased less in participants receiving dexamethasone (16 mm Hg [95% CI, 9 to 23 mm Hg]) and tadalafil (13 mm Hg [CI, 6 to 20 mm Hg]) than in those receiving placebo (28 mm Hg [CI, 20 to 36 mm Hg]) (P = 0.005 for tadalafil vs. placebo; P = 0.012 for dexamethasone vs. placebo). No statistically significant difference between groups was found in change in nasal potentials and expression of leukocyte sodium transport protein messenger RNA.
LIMITATIONS: The study involved a small sample of adults with a history of HAPE.
CONCLUSIONS: Both dexamethasone and tadalafil decrease systolic pulmonary artery pressure and may reduce the incidence of HAPE in adults with a history of HAPE. Dexamethasone prophylaxis may also reduce the incidence of AMS in these adults.
ClinicalTrials.gov identifier: NCT00274430
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