s********e
发帖数: 340 | 1 妈妈年纪大了，睡眠不好，感觉总是睡不实。妈妈有高血压，但是吃药控制的还不错，
就是失眠。妈妈年轻的时候睡眠很好。请问国外有没有比较好的相关的保健药？我想买
好了，给妈妈寄回去。
谢谢大家的帮助！！！
今天是3.8妇女节，祝女同胞节日快乐！：）
谢谢大家的帮助！！！ | f******k
发帖数: 5329 | 2 melatonin or valerian, make sure you bur from reputable brands. | s********e
发帖数: 340 | 3 melatonin 是褪黑素的意思吧？这个不就是脑白金么？我妈不想吃脑白金。
请问valerian是什么？
【在 f******k 的大作中提到】
: melatonin or valerian, make sure you bur from reputable brands.
| f******k
发帖数: 5329 | | M***e
发帖数: 40 | 5 Valerian root 是缬草根，也是一种草药，这边当保健品治失眠的
melatonin 是褪黑素，其实保健品都差不多的，
你妈妈吃的抗高血压的药中有没有叫“XX洛尔”的药（看药品说明书中的药品名，不是
商品名），这种药有时会有夜间做梦的副作用。 | b**o
发帖数: 5769 | 6 XX洛尔是什么class的？
【在 M***e 的大作中提到】
: Valerian root 是缬草根，也是一种草药，这边当保健品治失眠的
: melatonin 是褪黑素，其实保健品都差不多的，
: 你妈妈吃的抗高血压的药中有没有叫“XX洛尔”的药（看药品说明书中的药品名，不是
: 商品名），这种药有时会有夜间做梦的副作用。
| m*****o
发帖数: 165 | 7 应该是beta-blocker吧
【在 b**o 的大作中提到】
: XX洛尔是什么class的？
| s********e
发帖数: 340 | | M***e
发帖数: 40 | 9 药的副作用只是一种可能，还有可能是情绪或年龄的原因。老年人本来睡眠就不太好。
XX洛尔是一大类抗高血压的药，有很多，应用也广，你妈妈吃的什么高血压的药，也许
这样容易些 | s********e
发帖数: 340 | 10 谢谢啊！药名字叫“苯磺酸左旋氨氯地平缓释片” 该药的商品名叫“施惠达”。这个
药如何呢？国外有没有更好的药呢？ | | | b**o
发帖数: 5769 | 11 有没有试过做瑜珈之类的呢？多锻炼会有帮助哦。
人年纪大了睡得本来就少。我妈妈也说有时候半夜起来就睡不着，不过她就打开电视，
过一会儿又睡了。 | f******k
发帖数: 5329 | 12 只吃这一种降压药么？
【在 s********e 的大作中提到】
: 谢谢啊！药名字叫“苯磺酸左旋氨氯地平缓释片” 该药的商品名叫“施惠达”。这个
: 药如何呢？国外有没有更好的药呢？
| b**o
发帖数: 5769 | 13 It's a calcium channel blocker.
为什么翻译的英文名字前面还要加lev呢？
Levamlodipine Besylate
【批准文号】 国药准字H20083362 【中文名称】 苯磺酸左旋氨氯地平片 【产品英文
名称】 Levamlodipine Besylate Tablets 【生产企业】 江西施美制药有限公司 【功
效主治】 1高血压(单独或与其他药物合并使用)。
2心绞痛：尤其自发性心绞痛 【化学成分】 本品主要成份及其化学名称为：(-)3-乙基
-5-甲基-2-（2-氨乙氧甲基）-4-（2-氯苯基）-1，4-二氢-6-甲基-3，5-吡啶二羧酸酯
苯磺酸盐 【药理作用】 苯磺酸氨氯地平是二氢吡啶类钙拮抗剂(钙离子拮抗剂或慢通
道阻滞剂)。心肌和平滑肌的收缩依赖于细胞外钙离子通过特异性离子通道进入细胞。
本品选择性抑制钙离子跨膜进入平滑肌细胞和心肌细胞，对平滑肌的作用大于心肌。其
与钙通道的相互作用决定于它和受体位点结合和解离的渐进性速率，因此药理作用逐渐
产生。本品是外周动脉扩张剂，直接作用于血管平滑肌，降低外周血管阻力，从而降低
血压。治疗剂量下，体外实验可观察到负性肌力作用，但在整体动物实验中未见。本品
不影响血浆钙浓度。15项随机双盲、安慰剂对照的临床试验证实了本品的抗高血压作
patient handout: (Amlodipine)
Possible side effects of this medicine:
All medicines may cause side effects, but many people have no, or minor,
side effects. Check with your doctor if any of these most COMMON side
effects persist or become bothersome:
Dizziness; drowsiness; fatigue; flushing; headache; muscle cramps; nausea;
stomach pain; weakness.
Seek medical attention right away if any of these SEVERE side effects occur:
Severe allergic reactions (rash; hives; itching; difficulty breathing;
tightness in the chest; swelling of the mouth, face, lips, or tongue); dark
urine; fainting; fast, slow, or irregular heartbeat; pounding in the chest;
severe or persistent dizziness; shortness of breath; swelling of the feet or
legs; symptoms of heart attack (eg, chest, jaw, or left arm pain; numbness
of an arm or leg; sudden, severe headache or vomiting); tender, bleeding, or
swollen gums; worsening angina pain (eg, longer, more often, more severe);
yellowing of the eyes or skin. | f******k
发帖数: 5329 | 14 左旋体，active isomer
【在 b**o 的大作中提到】
: It's a calcium channel blocker.
: 为什么翻译的英文名字前面还要加lev呢？
: Levamlodipine Besylate
: 【批准文号】 国药准字H20083362 【中文名称】 苯磺酸左旋氨氯地平片 【产品英文
: 名称】 Levamlodipine Besylate Tablets 【生产企业】 江西施美制药有限公司 【功
: 效主治】 1高血压(单独或与其他药物合并使用)。
: 2心绞痛：尤其自发性心绞痛 【化学成分】 本品主要成份及其化学名称为：(-)3-乙基
: -5-甲基-2-（2-氨乙氧甲基）-4-（2-氯苯基）-1，4-二氢-6-甲基-3，5-吡啶二羧酸酯
: 苯磺酸盐 【药理作用】 苯磺酸氨氯地平是二氢吡啶类钙拮抗剂(钙离子拮抗剂或慢通
: 道阻滞剂)。心肌和平滑肌的收缩依赖于细胞外钙离子通过特异性离子通道进入细胞。
| l******t
发帖数: 115 | 15 我的妈妈一样的症状，她说吃了这个对她的睡眠有效，而且减少了降压药的剂量：
http://www.amazon.com/L-arginine-Plus-000mg-L-citrulline-servin
Amazon review 有好有坏，估计每个人情况不同。
大量的话可以直接去官网买，便宜很多：http://www.l-arginine.com/
【在 s********e 的大作中提到】
: 妈妈年纪大了，睡眠不好，感觉总是睡不实。妈妈有高血压，但是吃药控制的还不错，
: 就是失眠。妈妈年轻的时候睡眠很好。请问国外有没有比较好的相关的保健药？我想买
: 好了，给妈妈寄回去。
: 谢谢大家的帮助！！！
: 今天是3.8妇女节，祝女同胞节日快乐！：）
: 谢谢大家的帮助！！！
| l******k
发帖数: 27533 | 16 你妈妈现在吃的降压药是calcium channel blocker(CCB)
CCB may cause insomnia, but beta blocker(楼上提到的）may cause
hypersomnia.
这个版上不少专业人士，还是把reference列出了吧：）
Reference: Dopheide J, Stimmel G. Sleep Disorders. In: Koda-Kimble,
et al.
Applied Therapeutics: The Clinical Use of Drugs, Ninth Edition.
Lipppincott
Williams & Wilkins, 2009:77-1 to 77-23
要推荐OTC，最有效的应该是antihistamine (first generation).
benadryl用得比较多，但我推荐Chlorphenamine，very underused. 半衰期短4到5小时
，第二天比较少的residual effect。第二天不容易头晕嗜睡。
melatonin,kava, valerian都是limited evidence,没有很多实验证明真正有效。
我妈妈用过melatonin,没有效果，但我朋友的妈妈用就很有效。所以不妨试试。
不过OTC只推荐短期失眠，antihistamine最好不要连续使用超过14天。如果长期失眠，
还是看医生开处方ambien, lunesta,rozerem...
其实可以试着换换降压药。我家人有用CCB发生过腿抽筋的情况，现在换成lisinopril
后血压控制得很好，而且再也没出现过抽筋的情况，而且对肾有益，在美国应该是对大多数高血压
病人的首选降压药，特别是糖尿病人，和伴随其他心血管疾病的病人(Heart failure, MI...)
国内有lisinorpil卖，不过你要去药房问，听说价格还好。
版上牛人多，还请高手更正指点：）
【在 s********e 的大作中提到】
: 妈妈年纪大了，睡眠不好，感觉总是睡不实。妈妈有高血压，但是吃药控制的还不错，
: 就是失眠。妈妈年轻的时候睡眠很好。请问国外有没有比较好的相关的保健药？我想买
: 好了，给妈妈寄回去。
: 谢谢大家的帮助！！！
: 今天是3.8妇女节，祝女同胞节日快乐！：）
: 谢谢大家的帮助！！！
| f****o
发帖数: 2770 | 17 antihistamine (first generation) is not recommended for older people due to
increased risk of anticholinergic side effect and confusion.
ask for prescription
low dose trazodone or nortriptyline or desipramine will do the trick | b******8
发帖数: 1251 | 18 多锻炼身体。还有我高中的时候睡不着，就看政治书，看不到几分钟就想睡觉了。还是
找医生开药吧。 | l******k
发帖数: 27533 | 19 First generation antihistamine is the most effective OTC.
The key is the short term use.
Are you sure tricyclic antidepressants like nortriptyline or
desipramine have fewer anticholinergic effects than antihistamine?
Antidepressants is usually used to treat insomnia for the patients
having comorbidities like depression,anxiety,and etc.
Nonbenzodiazepine is usually recommended as first line therapy for most
people.
Trazodone is a good one though.
due
to
【在 f****o 的大作中提到】
: antihistamine (first generation) is not recommended for older people due to
: increased risk of anticholinergic side effect and confusion.
: ask for prescription
: low dose trazodone or nortriptyline or desipramine will do the trick
| f****o
发帖数: 2770 | 20 1st gen anti-histamine is the most effective OTC but they are not
recommended for elderly. Based on the information given, the mother is
likely to use chronically.
TCA nortriptyline and desipramine do not have active metabolites and have
the least anticholinergic effect compared to other TCAs.
1st gen antihistamines are on the Beer's list, nortriptyline and desipramine
are listed as preferred alternatives on the Beer's list.
Low dose TCA is not reserved for depressed patients who have insomnia. The
sleeping dose of TCA will not do anything to their depression, maybe some
placebo effect. Depression dose is much higher than sleeping dose.
Often times, those low dose TCA is also good for neuropathic pain dosed at
bedtime.
I agree non-BZD is usually recommended as first line.
If the mother is not old, I would go with benadryl as well, but since she is
old, although I don't know how old she really is, I would shy away from it.
..
hope that clarify my points.
【在 l******k 的大作中提到】
: First generation antihistamine is the most effective OTC.
: The key is the short term use.
: Are you sure tricyclic antidepressants like nortriptyline or
: desipramine have fewer anticholinergic effects than antihistamine?
: Antidepressants is usually used to treat insomnia for the patients
: having comorbidities like depression,anxiety,and etc.
: Nonbenzodiazepine is usually recommended as first line therapy for most
: people.
: Trazodone is a good one though.
:
| | | l******k
发帖数: 27533 | 21 nice search from Beer's list.
I don't look at it, but I believe the first generation antihistamine is not
contraindicated in the elderly. Reference is black and white, but the
patient is specific, the appropriate recommendation should be made based on
the patient's situation. Antihistamine is not the best drug for the elderly
insomnia, but for the healthy and the elderly in their sixties, we do
recommend first generation antihistamine especially the short half one like
chlorphenamine in the pharmacy. For the short half life one, the residual
and anticholinergic effects are transient and usually don't affect patients
function every much.
If the patient can not tolerate the first generation antihistamine bc of
anticholinergic AE, and she needs RX, I don't think it's appropriate to
recommend the second worst reagent TCA. The anticholingeric, antihistamine,
NE effects to increase cardiovascular are class side effects in TCA. These
risks are present in nortriptyline and desipramine though they have the
least anticholinergic effects. TCA has fell out of favor bc of its dirty AE.
Non-BZD is the drug of choice is the pt needs a sleep aid RX, and there
are FDA indicated long term use Non-BZDs.
Also, when we choose a drug to treat insomnia, the onset of action and the
duration are the major factors to consider. Before you recommended
nortriptyline, did you check its half life? I found its half life is more
than 16 hours. The sedation time is too long, the patient will have bad
residual effects, which will increase the fall risk of the elderly.
Do you still recommend TCA bc of that sentence you extracted from Beer's
list?:)
Again, short half life 1st generation antihistamine is not bad to be tried
firstly as occasional and short term use. If need long term therapy, refer
her to the doctor for Non-BZD, BZD, or antidepressants if the pt has
depression component.
Nice discussion with you:)
desipramine
【在 f****o 的大作中提到】
: 1st gen anti-histamine is the most effective OTC but they are not
: recommended for elderly. Based on the information given, the mother is
: likely to use chronically.
: TCA nortriptyline and desipramine do not have active metabolites and have
: the least anticholinergic effect compared to other TCAs.
: 1st gen antihistamines are on the Beer's list, nortriptyline and desipramine
: are listed as preferred alternatives on the Beer's list.
: Low dose TCA is not reserved for depressed patients who have insomnia. The
: sleeping dose of TCA will not do anything to their depression, maybe some
: placebo effect. Depression dose is much higher than sleeping dose.
| f****o
发帖数: 2770 | 22 nice discussion~we don't know the entire patient profile, I agree with your
recommendations and I was also just giving options.
The TCA recommendation was not based on the Beer's list.
Antidepressants have been used for insomnia for long time, and TCAs have
been most rigorously studied compared to the other antidepressants. There
are a lot of review articles available for search through PubMed if you are
interested. TCAs are definitely appropriate options using at low dose and
they are very cost-effective as well.
(Mayers AG, Baldwin DS. Antidepressants and their effect on sleep.Hum
Psychopharmacol. 2005 Dec;20(8):533-59.
Gursky, JT.; Krahn, LE. “The effects of antidepressants on sleep: a review.
” Harvard Review of Psychiatry, v. 8 issue 6, 2000, p. 298-306.)
Regarding your comment on half life, the sleeping dose of TCAs are extremely
low compared to depression dose, eg. nortriptyline 25mg, the tiny sleeping
dose generally does not cause a 16 hour of sleep/sedation...
I think I confused myself earlier, nortriptyline/desipramine are preferred
TCAs for neuropathic pain and are used along with gabapentine as first line
in the practice I have seen. I apologize for having my thoughts mixed up. I
agree with you that TCA is usually not the first line for sleep, but it is
an option.
Antihistamine:
I'm not saying 1st gen antihistamine is contraindicated in the elderly, it
is just not preferred. For younger healthy adults, I have no problems
recommending that. For elderly, there are high potential of anticholingergic
effects, possible mental status changes, and residual daytime drowsiness/
excessive somnolence, I would avoid 1st gen anti-H in the elderly population
, again, it's also depend on their health status. (1. Bloom HG, Ahmed I,
Alessi CA, et al. Evidence-based recommendations for the assessment and
management of sleep disorders in older person. J Am Geriatr Soc. 2009;57:761
-789. 2. Basu R, Dodge H, Stoehr GP, et al. Sedative hypnotic use of
diphenhydramine in a rural, older adult, community-based cohort. Geriatr
Psychiatry. 2003;11:205-213.)
I personally like trazodone as 1st line for elderly, it's affordable and I
see that in practice a lot (the medicine practice varies based on region, it
may not be the most common agent at where you practice). Low dose remeron
is a good option if they have poor appetite. TCAs: I would not use
amitriptyline in the elderly, I only stick with nortriptyline/desipramine if
physicians want to try TCAs.
I agree with you that non-BZD GABA receptor agonists is drug of choice. I
was trained that ambien has shorter duration ~5hrs despite what is listed in
Lexi-Comp, otherwise the drug company would not introduce Ambien CR...Those
non-BZDs are brand name/controlled/relatively expensive and have potential
to cause complex sleep-related behaviors. I have personal bias against using
those as the first line. Again, this is just my personal preference.
I think what you recommended are totally appropriate. Since neither of us
know the exact medical condition of the patient, we can discuss this forever
and won't be able to reach a conclusion.
Have a nice night~ | s********e
发帖数: 340 | 23 谢谢你啊，我也想买一瓶让我妈试试。您能说一下每天服用量么？
我在网上看不到相关的说明，我妈也不懂英语，这个药每天怎么吃啊？
多谢！
【在 l******t 的大作中提到】
: 我的妈妈一样的症状，她说吃了这个对她的睡眠有效，而且减少了降压药的剂量：
: http://www.amazon.com/L-arginine-Plus-000mg-L-citrulline-servin
: Amazon review 有好有坏，估计每个人情况不同。
: 大量的话可以直接去官网买，便宜很多：http://www.l-arginine.com/
| s********e
发帖数: 340 | 24 谢谢你啊，你真是个大好人！写了这么多的建议！真是感谢。
lisinopril 这个药我在amazon上没有找到，您能发个网上的链接么？中国有卖的话，
您知道在中国这个药叫什么名字么？
【在 l******k 的大作中提到】
: 你妈妈现在吃的降压药是calcium channel blocker(CCB)
: CCB may cause insomnia, but beta blocker(楼上提到的）may cause
: hypersomnia.
: 这个版上不少专业人士，还是把reference列出了吧：）
: Reference: Dopheide J, Stimmel G. Sleep Disorders. In: Koda-Kimble,
: et al.
: Applied Therapeutics: The Clinical Use of Drugs, Ninth Edition.
: Lipppincott
: Williams & Wilkins, 2009:77-1 to 77-23
: 要推荐OTC，最有效的应该是antihistamine (first generation).
| s********e
发帖数: 340 | 25 谢谢啊，我妈60出头了。您有推荐的药么？呵呵，我不懂医，看完后，不知道该怎么选
择。：）
desipramine
【在 f****o 的大作中提到】
: 1st gen anti-histamine is the most effective OTC but they are not
: recommended for elderly. Based on the information given, the mother is
: likely to use chronically.
: TCA nortriptyline and desipramine do not have active metabolites and have
: the least anticholinergic effect compared to other TCAs.
: 1st gen antihistamines are on the Beer's list, nortriptyline and desipramine
: are listed as preferred alternatives on the Beer's list.
: Low dose TCA is not reserved for depressed patients who have insomnia. The
: sleeping dose of TCA will not do anything to their depression, maybe some
: placebo effect. Depression dose is much higher than sleeping dose.
| b**o
发帖数: 5769 | 26 lisinopril是处方药，amazon当然没有了。
中文是
赖诺普利
Lisinopril
中文别名：
赖诺普利、苯丁赖脯酸、苯丁赖普酸、赖脯酸
英文别名：
Acerbon、Carace、Liprene、Prinivil、Prinizil、Tersil
生产企业：
药品类别：
抗高血压病药
本篇信息来源于 健康站(WWW.JKZHAN.COM)原文地址：http://www.jkzhan.com/ypcx/200706/17353.html
【在 s********e 的大作中提到】
: 谢谢你啊，你真是个大好人！写了这么多的建议！真是感谢。
: lisinopril 这个药我在amazon上没有找到，您能发个网上的链接么？中国有卖的话，
: 您知道在中国这个药叫什么名字么？
| f****o
发帖数: 2770 | 27 你妈妈是难以入睡，还是入睡容易但是睡了几个小时之后就醒？这个都是有区别的。。
人年纪大，睡眠减少是正常的现象。。她晚上几点睡，早上几点起来？白天午睡么？
为什么不愿意吃脑白金？吃过副作用强烈么？睡眠不好多久了，具体怎么过不好发？第
二天精神差还是精神还是可以？
你给的信息不足，我们很难做出最好的推荐。
高血压药要坚持吃，不能自己随便加减，换药要问医生先
【在 s********e 的大作中提到】
: 谢谢啊，我妈60出头了。您有推荐的药么？呵呵，我不懂医，看完后，不知道该怎么选
: 择。：）
:
: desipramine
| s********e
发帖数: 340 | 28 正常时间入睡不是很难，但是一般都是几个小时后回醒。 晚上9点半以后睡觉，早晨6
点起床，醒了就在床上躺着。中午一般不午睡，时间太短了。以前吃过，她说效果不是
很好。而且最主要是我妈对脑白金有抵触情绪，可能觉得不喜欢他们的广告吧。
【在 f****o 的大作中提到】
: 你妈妈是难以入睡，还是入睡容易但是睡了几个小时之后就醒？这个都是有区别的。。
: 人年纪大，睡眠减少是正常的现象。。她晚上几点睡，早上几点起来？白天午睡么？
: 为什么不愿意吃脑白金？吃过副作用强烈么？睡眠不好多久了，具体怎么过不好发？第
: 二天精神差还是精神还是可以？
: 你给的信息不足，我们很难做出最好的推荐。
: 高血压药要坚持吃，不能自己随便加减，换药要问医生先
| f****o
发帖数: 2770 | 29 找医生要处方药吧，保健品不管用的~
常用的催眠药国内都有的 | f****o
发帖数: 2770 | 30 你妈妈的失眠是sleep maintenance不好
要有long lasting 的催眠药
而不是针对sleep latency入睡的催眠药
微量trazodone25-100mg, ambien CR, Lunesta, Rozerem, Sonata, 都可以去试试，就
看价格问题了 |
|
