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a.index_btn{}.other_runlin_search{}.runlin_box{}.HJZF_Z__innerContent{}.HJZF_Z__inner_product_categroy5_title{}.HJZF_Z__Breadcrumbs{}body > div:nth-child(5) > div.container > div.HJZF_Z__Breadcrumbs > div > div{}.runlin_banner_right{}.main_newslist3 .newslist_img{}.inner_pro_info{}.inner_pro_info:after{}.runlin_left_inner > div > ul:hover{}.runlin_left_inner{}.runlin_left{}.runlin_left_inner > div > ul:hover span h3{}.index_wrapper{}body > div:nth-child(5) > div.runlin_banner > div.runlin_box > div > div > div > div > div.runlin_banner_right > a{}#HJZF_Z__innerBanner{}body > div.HJZF_Z__innerBanner.HJZF_Z__innerBanner2{}#HJZF_Z__wrapper > div.HJZF_Z__innerBanner.HJZF_Z__innerBanner2{}.zq_contactus>#HJZF_Z__wrapper>#HJZF_Z__innerBanner{}#payment > div > section.hidden-xs.hidden-sm.hidden-md.col-lg-3.HJZF_Z__inner--left > div > div.HJZF_Z__inner--left__content > div.InsidePages_left_content-main > ul{}body > div:nth-child(5) > div.runlin_banner > div.runlin_box > div > div > div > div > div.runlin_banner_right > h2:nth-child(1){}.aboutus_37_t b{}.index_title{}.aboutus_37_t b{}.hjzf_news_44_wrapper > li:first-child{}.news_44_list_con > div.news_44_list_con_box > div.index_text{}.other_184{}.aboutus_37_right li{}.aboutus_37_t b{}.aboutus_37_right li:before{}.aboutus_37_con> p{}.index_sub_title{}#bottom-35_1891 > section > div > div > div > div.hjzf_bottom_35_wrapper > div.foot_contact.text-center > h2{}.products_52_wrapper_img{}.products_52_wrapper li{}.products_52_wrapper li a{}#products-52_1891 > section > div > div > div > ul > li > a > h2{}.products_52_wrapper li p{}.mobiles_sidebar{}.foot_contact:before{}.index_sub_title a{}.other_184_right{}.HJZF_contact_inquiry{}.hj_navbar_nav > li > a > h2:before{}.nav_li.on>a h2{}.container-fluid{}.other_184_right{}.other_184_right>.index_sub_title{}#news-44_1891 > section > div > div > div > ul > li > div > div.index_text{}.other_184_right>.con{}.other_184_pagination{}.banner_27_zyzfw{}#aboutus-23_1891 > section > div > div > div > ul > li:nth-child(4){}.main_page{}body > div:nth-child(10) > div > div > section.hidden-xs.hidden-sm.hidden-md.col-xs-12 > div > ul > li:nth-child(2) > a{}body > div:nth-child(10) > div > div > section.hidden-xs.hidden-sm.hidden-md.col-xs-12 > div > ul > li > a{}body > div:nth-child(10) > div > div > section.hidden-xs.hidden-sm.hidden-md.col-xs-12 > div > ul > li:nth-child(3) > a{}body > div:nth-child(10) > div > div > section.hidden-xs.hidden-sm.hidden-md.col-xs-12 > div > ul > li:nth-child(4) > a{}body > div:nth-child(10) > div > div > section.hidden-xs.hidden-sm.hidden-md.col-xs-12 > div > ul > li:nth-child(5) > a{}body > div:nth-child(10) > div > div > section.hidden-xs.hidden-sm.hidden-md.col-xs-12 > div > ul > li:nth-child(7) > a{}body > div:nth-child(10) > div > div > section.hidden-xs.hidden-sm.hidden-md.col-xs-12 > div > ul > li:nth-child(8) > a{}body > div:nth-child(10) > div > div > section.hidden-xs.hidden-sm.hidden-md.col-xs-12 > div > ul > li:nth-child(9) > a{}body > div:nth-child(10) > div > div > section.hidden-xs.hidden-sm.hidden-md.col-xs-12 > div > ul > li:nth-child(6) > a{}body > div:nth-child(10) > div > div > section.hidden-xs.hidden-sm.hidden-md.col-xs-12 > div > ul > li:nth-child(1) > a{}.HJZF_Z__inner_product_categroy5 ul li:nth-child(3).on a, .HJZF_Z__inner_product_categroy5 ul li:nth-child(3):hover a{}.HJZF_Z__inner_product_categroy5 ul li:nth-child(2).on a, .HJZF_Z__inner_product_categroy5 ul li:nth-child(2):hover a{}.HJZF_Z__inner_product_categroy5 ul li:nth-child(4).on a, .HJZF_Z__inner_product_categroy5 ul li:nth-child(4):hover a{}.HJZF_Z__inner_product_categroy5 ul li:nth-child(5).on a, .HJZF_Z__inner_product_categroy5 ul li:nth-child(5):hover a{}.HJZF_Z__inner_product_categroy5 ul li:nth-child(6).on a, .HJZF_Z__inner_product_categroy5 ul li:nth-child(6):hover a{}.HJZF_Z__inner_product_categroy5 ul li:nth-child(7).on a, .HJZF_Z__inner_product_categroy5 ul li:nth-child(7):hover a{}.HJZF_Z__inner_product_categroy5 ul 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img{}.runlin_banner{}.runlin_banner_left{}.runlin_banner_right{}.runliin_top_email{}.runlin_email.first{}.runlin_des + .more{}.runlin_left li{}.runlin_yiji > span h3{}.submit_runlin_search{}.nav_drop{}body > div:nth-child(5) > div.runlin_banner > div.runlin_box > div > div > div > div > div.runlin_banner_right > div.runlin_des > b{}.hjzf2_z_products_list_left a.index_btn{}.other_runlin_search{}.runlin_box{}.HJZF_Z__innerContent{}.HJZF_Z__inner_product_categroy5_title{}.HJZF_Z__Breadcrumbs{}body > div:nth-child(5) > div.container > div.HJZF_Z__Breadcrumbs > div > div{}.runlin_banner_right{}.main_newslist3 .newslist_img{}.inner_pro_info{}.inner_pro_info:after{}.runlin_left_inner > div > ul:hover{}.runlin_left_inner{}.runlin_left{}.runlin_left_inner > div > ul:hover span h3{}.index_wrapper{}body > div:nth-child(5) > div.runlin_banner > div.runlin_box > div > div > div > div > div.runlin_banner_right > a{}#HJZF_Z__innerBanner{}body > div.HJZF_Z__innerBanner.HJZF_Z__innerBanner2{}#HJZF_Z__wrapper > div.HJZF_Z__innerBanner.HJZF_Z__innerBanner2{}.zq_contactus>#HJZF_Z__wrapper>#HJZF_Z__innerBanner{}#payment > div > section.hidden-xs.hidden-sm.hidden-md.col-lg-3.HJZF_Z__inner--left > div > div.HJZF_Z__inner--left__content > div.InsidePages_left_content-main > ul{}body > div:nth-child(5) > div.runlin_banner > div.runlin_box > div > div > div > div > div.runlin_banner_right > h2:nth-child(1){}.aboutus_37_t b{}.index_title{}.aboutus_37_t b{}.hjzf_news_44_wrapper > li:first-child{flex:0 0 100%}.news_44_list_con > div.news_44_list_con_box > div.index_text{}.other_184{}.aboutus_37_right li{}.aboutus_37_t b{}.aboutus_37_right li:before{}.aboutus_37_con> p{}.index_sub_title{}#bottom-35_1891 > section > div > div > div > div.hjzf_bottom_35_wrapper > div.foot_contact.text-center > h2{}.products_52_wrapper_img{}.products_52_wrapper li{}.products_52_wrapper li a{}#products-52_1891 > section > div > div > div > ul > li > a > 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section.hidden-xs.hidden-sm.hidden-md.col-xs-12 > div > ul > li:nth-child(4) > a{}body > div:nth-child(10) > div > div > section.hidden-xs.hidden-sm.hidden-md.col-xs-12 > div > ul > li:nth-child(5) > a{}body > div:nth-child(10) > div > div > section.hidden-xs.hidden-sm.hidden-md.col-xs-12 > div > ul > li:nth-child(7) > a{}body > div:nth-child(10) > div > div > section.hidden-xs.hidden-sm.hidden-md.col-xs-12 > div > ul > li:nth-child(8) > a{}body > div:nth-child(10) > div > div > section.hidden-xs.hidden-sm.hidden-md.col-xs-12 > div > ul > li:nth-child(9) > a{}body > div:nth-child(10) > div > div > section.hidden-xs.hidden-sm.hidden-md.col-xs-12 > div > ul > li:nth-child(6) > a{}body > div:nth-child(10) > div > div > section.hidden-xs.hidden-sm.hidden-md.col-xs-12 > div > ul > li:nth-child(1) > a{}.HJZF_Z__inner_product_categroy5 ul li:nth-child(3).on a, .HJZF_Z__inner_product_categroy5 ul li:nth-child(3):hover a{}.HJZF_Z__inner_product_categroy5 ul li:nth-child(2).on a, 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右美沙芬被禁卖,以后还能用哪些止咳药?
  2024/06/07| 阅读次数:1894

今年5月,国家药监局等部门联合发布了公告,宣布自2024年7月1日起,将右美沙芬等一批药品纳入第二类精神药品目录。


这意味着,对镇咳药右美沙芬的“限制”又升级了——


所谓的第二类精神药品,必须凭盖有医疗单位公章的医生处方才能按剂量购买,不得向未成年人出售,且医药门市部需将处方保存两年备查。


为什么大家熟知的右美沙芬管控更严格了?以后还能用吗?今天就跟着小编一起来了解。


01
为什么要禁卖右美沙芬?


右美沙芬为中枢性止咳药物,属于吗啡衍生物,其活性代谢产物通过和位于髓质的阿片样受体结合,抑制延脑的咳嗽中枢,起到止咳作用。常用于治疗感冒、急慢性支气管炎、咽喉炎等上呼吸道感染引起的少痰咳嗽,是止咳药中的“明星产品”。


右美沙芬在治疗剂量下(60-120mg/d,分次服用)不显现出来明确的中枢药理毒理作用(如痛觉丧失、呼吸抑制、成瘾性等),但在高剂量下(标签剂量的5-10倍)可表现出解离性[1]。


服用剂量100-200mg时,会出现躁动和欣快感;剂量200-500mg时,出现夸大的听觉和视觉感受、幻觉、失衡;剂量500-1000mg,出现视听紊乱、意识改变、反应迟钝、狂躁、恐慌、部分分离;剂量>1000mg,出现幻觉、妄想、运动失调、完全分离[2]。


看似与成瘾性或依赖性毫无关系的镇咳药,却因滥用成风,导致严重的不良后果。


近20余年来,国外关于青少年右美沙芬滥用的报道逐年增多,年龄段多集中在15-16岁,并且存在多例青少年过量服用右美沙芬胶囊或大剂量注射右美沙芬中毒死亡的案例[3]。


所以,这次右美沙芬被严管,并不是因为它作为止咳药规范使用有什么安全问题,而是为了合理使用,避免滥用。


02
以后咳嗽了,该怎么办?


以下是一些常见的止咳化痰药物,但患者适合使用哪一种,应遵循医生及药学专业人士建议,以避免不当使用情况。


如果是各种原因引起的剧烈咳嗽,常使用镇咳药,主要分为中枢性镇咳药和外周性镇咳药两类。中枢性镇咳药物(如可待因、福尔可定、喷托维林等)主要通过抑制延髓咳嗽中枢而发挥镇咳作用,但由于具有呼吸抑制、成瘾性等不良反应,不适用于长期治疗;


外周性镇咳药(如苯作那酯、那可丁等)通过抑制咳嗽反射弧中感受器、传入神经、传出神经中任何一个或多个环节而发挥镇咳作用,其镇咳作用相较于中枢镇咳药更温和,因而常作为辅助用药。


如果是各种原因引起的痰液不易咳出,常使用祛痰药,主要分为黏痰稀释药、黏痰溶解药以及黏痰调节药。黏痰稀释药(如愈创甘油醚、氯化铵、碘化钾)可通过迷走神经反射性促进支气管腺体分泌增加;黏痰溶解药(如乙酰半胱氨酸、羧甲司坦,厄多司坦)适用于痰液粘稠引起的咳痰困难和呼吸困难者;


黏痰调节药代表药物则为氨溴索(临床上常用其盐酸盐,即盐酸氨溴索)是临床上应用较为广泛的一类祛痰药物。


其主要作用是使粘液溶解,促进肺表面活性物质分泌,激活粘液纤毛毯净化功能,降低痰液与纤毛的粘着力,使痰液易于咳出。盐酸氨溴索在国内外用于临床治疗呼吸系统疾病多年,临床效果优良,安全,几乎无毒副作用。


研究结果显示,用药后患者的痰液性质、痰量、咳嗽和咳痰难易程度评分均较治疗前明显降低,痰液性质、痰量和咳痰难易程度等症状的消失率均在60%左右,有较高的临床价值,值得推广使用。[4]


总而言之,咳嗽的发病机制和原因复杂且涉及面广泛,具体该如何用药还应该在医生的指导下进行,规范全流程用药才能够药到病除。


参考文献:
[1]邹羽真,韩菲,梅丹.右美沙芬在神经系统应用的研究新进展[J].中国医院药学杂志, 2019(3):5.DOI:10.13286/j.cnki.chinhosppharmacyj.2019.03.21.
[2]Antoniou T,Juurlink DN.Dextromethorphan abuse[J].CMAJ,2014,186(16):631-632.
[3]张小波 . 右美沙芬滥用的成瘾风险与防治策略[J]. 中国药物滥用防治杂志,2020,26( 5) : 283-285.
[4]施毅,肖永营,苏欣,宋勇,赵蓓蕾,曹鄂洪,肖鑫武,杨炯,孙丽华.注射用盐酸氨溴索粘痰溶解与祛痰作用的多中心临床随机对照研究[J].临床内科杂志,2005,22(9):598-600.DOI:10.3969/j.issn.1001-9057.2005.09.007.

【声明】文章内容不作为临床诊疗依据,仅供交流、学习。


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