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Tratamiento del dolor neuropático en el enfermo con infección por el VIH
Treatment of neuropathic pain in HIV-infected patients
Raquel Lanaa,
Corresponding author
jmendozah@meditex.es

Dra. R. Lana Soto. Gaztambide, 33, bajo E. 28015 Madrid. España.
, Ana Isabel Léridab, Juan Luis Mendozac
a Servicio de Medicina Interna. Hospital Clínico San Carlos. Madrid. Barcelona. España
b Servicio de Medicina Interna. Hospital de Viladecans. Viladecans. Barcelona. España
c Servicio de Aparato Digestivo. Hospital Clínico San Carlos. Madrid. Barcelona. España
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          "en" => "<p id="sp0010" class="elsevierStyleSimplePara elsevierViewall">Algoritmo de tratamiento del dolor neurop&#225;tico&#46; VIH&#58; virus de la inmunodeficiencia humana&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="s0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0020">Introducci&#243;n</span><p id="p0260" class="elsevierStylePara elsevierViewall">La infecci&#243;n por el virus de la inmunodeficiencia humana &#40;VIH&#41; fue considerada una de las mayores plagas del siglo XX y contin&#250;a siendo un importante problema de salud p&#250;blica en el siglo XXI&#46; Los f&#225;rmacos antirretrovirales han conseguido controlar la infecci&#243;n&#44; fundamentalmente en los pa&#237;ses desarrollados&#44; hasta el punto de que muchos enfermos con VIH se transforman en enfermos cr&#243;nicos con una larga expectativa de vida&#46; En este contexto&#44; surgen nuevos problemas en cuanto al tratamiento cl&#237;nico de estos pacientes en los que el dolor constituye un s&#237;ntoma frecuente y muy molesto ya que afecta de forma importante a la calidad de vida y es dif&#237;cil de tratar&#46;</p><p id="p0265" class="elsevierStylePara elsevierViewall">En un trabajo publicado en 1997&#44; la prevalencia del dolor en los enfermos con VIH variaba entre el 30 y el 60&#37; de los pacientes ambulatorios y hasta el 97&#37; en los pacientes con enfermedad avanzada<a class="elsevierStyleCrossRef" href="#bb0010"><span class="elsevierStyleSup">1</span></a>&#44; aunque actualmente estas cifras han disminuido considerablemente&#46; Aun as&#237;&#44; muchas veces es un s&#237;ntoma infradiagnosticado e infratratado&#46; La mayor&#237;a de estos pacientes presentan m&#225;s de un tipo de dolor diferente y en varias localizaciones&#44; lo que dificulta un adecuado tratamiento&#44; ya que el tratamiento del dolor depende de su etiolog&#237;a&#44; caracter&#237;sticas y localizaci&#243;n&#46; El dolor neurop&#225;tico est&#225; presente en el 25-50&#37; de los pacientes con infecci&#243;n por VIH que consultan por dolor y est&#225; considerado cl&#225;sicamente como uno de los m&#225;s dif&#237;ciles de tratar<a class="elsevierStyleCrossRefs" href="#bb0015"><span class="elsevierStyleSup">2&#44;3</span></a>&#59; por esta raz&#243;n&#44; con este trabajo pretendemos dar unas pautas de tratamiento de este tipo de dolor&#46;</p></span><span id="s0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0025">Etiolog&#237;a</span><p id="p0270" class="elsevierStylePara elsevierViewall">El dolor neurop&#225;tico se produce como consecuencia de una lesi&#243;n en el sistema nervioso central o perif&#233;rico&#46; En el paciente infectado por el VIH el dolor puede ser causado por la propia enfermedad&#44; por infecciones concomitantes&#44; por efectos secundarios de los f&#225;rmacos antirretrovirales o por procesos no relacionados con el VIH como el consumo de sustancias t&#243;xicas y otras entidades nosol&#243;gicas&#46; La combinaci&#243;n de un tratamiento antirretroviral de gran actividad &#40;TARGA&#41;&#44; un incremento en la supervivencia de estos enfermos que son sometidos de manera continua a un gran n&#250;mero de f&#225;rmacos y su exposici&#243;n a diferentes agentes infecciosos ha originado un aumento en el riesgo de desarrollar neuropat&#237;a&#46; Aunque se han postulado varias teor&#237;as para explicar el origen del dolor neurop&#225;tico&#44; es posible que en su producci&#243;n intervengan varios mecanismos&#46;</p><p id="p0275" class="elsevierStylePara elsevierViewall">Las principales causas conocidas de dolor neurop&#225;tico en los pacientes infectados por VIH son&#58;<ul class="elsevierStyleList" id="l0025"><li class="elsevierStyleListItem" id="o0260"><span class="elsevierStyleLabel">1&#46;</span><p id="p0280" class="elsevierStylePara elsevierViewall">Neuropat&#237;a producida por el propio VIH&#58; se han descrito al menos 6 patrones distintos de presentaci&#243;n&#58; polineuropat&#237;a distal sim&#233;trica&#44; polineuropat&#237;a inflamatoria desmielinizante&#44; polirradiculopat&#237;a progresiva&#44; mononeuropat&#237;a m&#250;ltiple&#44; neuropat&#237;a auton&#243;mica y s&#237;ndrome linfocitario infiltrativo difuso<a class="elsevierStyleCrossRefs" href="#bb0015"><span class="elsevierStyleSup">2&#8211;4</span></a>&#46; La afectaci&#243;n m&#225;s frecuente es la polineuropat&#237;a axonal&#44; distal y sim&#233;trica&#44; de predominio sensitivo y aparece con mayor frecuencia en pacientes con inmunodepresi&#243;n grave&#46; La anatom&#237;a patol&#243;gica muestra desmielinizaci&#243;n y degeneraci&#243;n axonal&#44; as&#237; como infiltraci&#243;n perivascular por linfocitos y macr&#243;fagos&#46; La polirradiculopat&#237;a progresiva y la neuropat&#237;a auton&#243;mica se presentan tambi&#233;n en pacientes con inmunodepresi&#243;n severa&#44; mientras que la polineuropat&#237;a inflamatoria desmielinizante y la mononeuropat&#237;a m&#250;ltiple pueden presentarse en estadios m&#225;s precoces de la enfermedad&#46;</p></li><li class="elsevierStyleListItem" id="o0265"><span class="elsevierStyleLabel">2&#46;</span><p id="p0285" class="elsevierStylePara elsevierViewall">F&#225;rmacos antirretrovirales&#58; los antirretrovirales que m&#225;s se relacionan con el desarrollo de neuropat&#237;a perif&#233;rica son la estavudina &#40;D4T&#41;&#44; la didanosina &#40;ddI&#41; y la zalcitabina &#40;ddC&#41; y&#44; adem&#225;s&#44; su administraci&#243;n simult&#225;nea potencia la toxicidad neurol&#243;gica<a class="elsevierStyleCrossRefs" href="#bb0030"><span class="elsevierStyleSup">5&#44;6</span></a>&#46; Por este motivo se ha dejado de utilizar la ddC&#44; y en las &#250;ltimas gu&#237;as de Estados Unidos de 20 06<a class="elsevierStyleCrossRef" href="#bb0040"><span class="elsevierStyleSup">7</span></a> y de GESIDA de enero de 2007<a class="elsevierStyleCrossRef" href="#bb0045"><span class="elsevierStyleSup">8</span></a>&#44; tanto la D4T como la ddI han pasado a segunda l&#237;nea de tratamiento por su toxicidad mitocondrial&#44; que&#44; entre otros efectos&#44; engloba el desarrollo de neuropat&#237;a perif&#233;rica&#46; El patr&#243;n t&#237;pico de afectaci&#243;n es la polineuropat&#237;a distal sim&#233;trica&#46; El estudio histol&#243;gico muestra alteraciones en las mitocondrias en las c&#233;lulas de Schwann&#44; tanto en el nervio perif&#233;rico como en los ganglios de las ra&#237;ces dorsales<a class="elsevierStyleCrossRefs" href="#bb0050"><span class="elsevierStyleSup">9&#44;10</span></a>&#46;</p></li><li class="elsevierStyleListItem" id="o0270"><span class="elsevierStyleLabel">3&#46;</span><p id="p0290" class="elsevierStylePara elsevierViewall">Infecciones oportunistas&#58; la infecci&#243;n por citomegalovirus &#40;CMV&#41; es la que con m&#225;s frecuencia produce afectaci&#243;n neurop&#225;tica<a class="elsevierStyleCrossRef" href="#bb0060"><span class="elsevierStyleSup">11</span></a>&#46; Se observa en pacientes con inmunodepresi&#243;n grave con cifras de linfocitos CD4 por debajo de 100&#47;&#956;l&#44; en los que se produce una reactivaci&#243;n de la infecci&#243;n latente previamente adquirida&#46; La presentaci&#243;n puede ser en forma de polineuropat&#237;a distal sim&#233;trica&#44; polineuropat&#237;a inflamatoria desmielinizante&#44; polirradiculopat&#237;a progresiva o mononeuropat&#237;a m&#250;ltiple&#46; La anatom&#237;a patol&#243;gica muestra desmielinizaci&#243;n y degenaraci&#243;n axonal&#44; as&#237; como infiltraci&#243;n por polimorfonucleares&#46; Con microscopia electr&#243;nica se pueden observar viriones en las c&#233;lulas endoteliales y mononucleares&#46;</p><p id="p0295" class="elsevierStylePara elsevierViewall">La infecci&#243;n por el virus de la varicela-z&#243;ster que da lugar a la neuralgia postherp&#233;tica<a class="elsevierStyleCrossRef" href="#bb0060"><span class="elsevierStyleSup">11</span></a> es otra de las causas de dolor neurop&#225;tico en estos pacientes&#46; Puede aparecer en cualquier estadio de la infecci&#243;n por VIH&#44; pero es m&#225;s frecuente en pacientes inmunodeprimidos&#44; en quienes&#44; adem&#225;s&#44; son frecuentes las formas diseminadas&#46;</p></li><li class="elsevierStyleListItem" id="o0275"><span class="elsevierStyleLabel">4&#46;</span><p id="p0300" class="elsevierStylePara elsevierViewall">Otras causas de dolor neurop&#225;tico&#58; se trata de procesos que no son espec&#237;ficos de los enfermos con infecci&#243;n VIH pero se observan con frecuencia en la pr&#225;ctica cl&#237;nica asociados a estos pacientes&#46; Entre ellos destacan la polineuropat&#237;a por d&#233;ficit vitam&#237;nico &#40;vitamina B<span class="elsevierStyleInf">12</span>&#41; en estados de desnutrici&#243;n y la polineuropat&#237;a por alcohol o el uso de otros f&#225;rmacos con neurotoxicidad &#40;vincristina&#44; isoniacida&#44; linezolid&#44; hidroxiurea o talidomida&#41;&#46; Un factor importante es el progresivo envejecimiento de la poblaci&#243;n infectada por el VIH&#44; ya que se ha demostrado que la edad avanzada se asocia con un mayor grado de inmunodepresi&#243;n y un aumento de las complicaciones neurol&#243;gicas<a class="elsevierStyleCrossRef" href="#bb0070"><span class="elsevierStyleSup">13</span></a>&#46;</p></li></ul></p></span><span id="s0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0030">Tratamiento</span><p id="p0305" class="elsevierStylePara elsevierViewall">El tratamiento del dolor neurop&#225;tico en el enfermo infectado por VIH constituye actualmente un aut&#233;ntico reto por la dificultad de tratamiento que supone&#44; fundamentalmente por las posibles interacciones farmacol&#243;gicas con los antirretrovirales&#46; Exige un abordaje multidisciplinario e individualizado que comienza por un an&#225;lisis exhaustivo de las caracter&#237;sticas del dolor&#44; los posibles mecanismos fisiopatol&#243;gicos implicados&#44; las diferentes etiolog&#237;as&#44; la situaci&#243;n global del enfermo y los f&#225;rmacos que consume habitualmente&#46; Debemos hacer un tratamiento combinado del dolor basado en aspectos psicosociales&#44; dieta y ejercicio&#59; etiol&#243;gico siempre que sea posible&#59; farmacol&#243;gico sintom&#225;tico&#59; utilizar t&#233;cnicas intervencionistas&#44; e incluso recurrir a nuevos tratamientos&#44; algunos todav&#237;a en fase experimental &#40;<a class="elsevierStyleCrossRef" href="#f0010">fig&#46; 1</a>&#41;<a class="elsevierStyleCrossRefs" href="#bb0015"><span class="elsevierStyleSup">2&#44;14&#8211;16</span></a>&#46;</p><elsevierMultimedia ident="f0010"></elsevierMultimedia><span id="s0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0035">Tratamiento basado en aspectos psicosociales&#44; dieta y ejercicio</span><p id="p0310" class="elsevierStylePara elsevierViewall">El estado de &#225;nimo influye en todas las manifestaciones de dolor&#44; especialmente en el dolor neurop&#225;tico&#44; el estr&#233;s&#44; la ansiedad y los trastornos del sue&#241;o&#44; que pueden ser consecuencia de un dolor cr&#243;nico pero tambi&#233;n influyen en el empeoramiento del mismo<a class="elsevierStyleCrossRef" href="#bb0090"><span class="elsevierStyleSup">17</span></a>&#46; Los pacientes infectados por el VIH presentan una incidencia elevada de trastornos psiqui&#225;tricos primarios y secundarios y problemas de adaptaci&#243;n social&#46; Por todos estos motivos&#44; es fundamental una evaluaci&#243;n psiqui&#225;trica&#44; psicol&#243;gica y social de estos enfermos para tratar las situaciones de ansiedad&#44; depresi&#243;n y los trastornos del sue&#241;o asociados&#46; Se pueden utilizar t&#233;cnicas de relajaci&#243;n&#44; terapia cognitiva&#44; programas de tratamiento del estr&#233;s&#44; psicoterapia&#44; hipnosis o incluso recurrir a f&#225;rmacos<a class="elsevierStyleCrossRefs" href="#bb0095"><span class="elsevierStyleSup">18&#8211;21</span></a>&#46; En los enfermos con dolor neurop&#225;tico e infecci&#243;n por VIH&#44; la combinaci&#243;n de ambos tratamientos &#40;farmacol&#243;gico y psicosocial&#41; aumenta los beneficios terap&#233;uticos de manera considerable&#46;</p><p id="p0315" class="elsevierStylePara elsevierViewall">Otro aspecto importante es mantener una dieta adecuada que permita un buen estado nutricional&#44; evitando carencias de sustancias que pueden influir en la existencia de neuropat&#237;a&#46; Debemos evitar el consumo de alcohol y otras sustancias t&#243;xicas que producen toxicidad neurol&#243;gica y pueden desencadenar o agravar un dolor neurop&#225;tico&#46; En este sentido&#44; la pr&#225;ctica de ejercicio f&#237;sico adecuado a la situaci&#243;n del paciente ha demostrado su eficacia en el control de este tipo de dolor&#44; al igual que la fisioterapia&#46;</p></span><span id="s0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0040">Tratamiento etiol&#243;gico</span><p id="p0320" class="elsevierStylePara elsevierViewall">Siempre que sea posible debemos identificar las causas que causan el dolor neurop&#225;tico para prevenirlas o para iniciar un tratamiento etiol&#243;gico cuando ya se ha instaurado el dolor&#46; En el caso de la infecci&#243;n por el VIH&#44; es fundamental un tratamiento precoz y potente de la misma que permita una carga viral indetectable &#40;supresi&#243;n virol&#243;gica&#41; y una buena respuesta inmunol&#243;gica&#46; Tambi&#233;n hay que tratar de forma precoz otras infecciones asociadas como el citomegalovirus y el herpes z&#243;ster y evitar el uso de sustancias neurot&#243;xicas y las asociaciones que pueden potenciar esta toxicidad&#46;</p></span><span id="s0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0045">Tratamiento farmacol&#243;gico</span><p id="p0325" class="elsevierStylePara elsevierViewall">El tratamiento farmacol&#243;gico del dolor neurop&#225;tico debe de ser individualizado y escalonado&#44; teniendo en cuenta las posibles interacciones medicamentosas&#44; sobre todo en los enfermos con VIH que reciben habitualmente mucha medicaci&#243;n de forma simult&#225;nea &#40;<a class="elsevierStyleCrossRefs" href="#t0010">tablas 1&#8211;3</a>&#41;&#46; Es importante recordar que el dolor neurop&#225;tico responde mal a los analg&#233;sicos convencionales como los antiinflamatorios no esteroideos y los opioides&#44; por lo que cl&#225;sicamente se ha recurrido a sustancias que se dise&#241;aron para otros usos como los antidepresivos o anticomiciales<a class="elsevierStyleCrossRef" href="#bb0115"><span class="elsevierStyleSup">22</span></a>&#46; En la actualidad no existe evidencia de que sean necesarias estrategias de control diferentes para el dolor neurop&#225;tico en funci&#243;n de cu&#225;l sea su etiolog&#237;a espec&#237;fica ni en funci&#243;n de su presentaci&#243;n semiol&#243;gica&#46; Tampoco se ha establecido un consenso en cuanto a una pauta de administraci&#243;n escalonada de f&#225;rmacos para el tratamiento de este tipo de dolor&#46; En la <a class="elsevierStyleCrossRef" href="#t0025">tabla 4</a> se especifican las dosis aconsejadas de los f&#225;rmacos m&#225;s utilizados en el tratamiento del dolor neurop&#225;tico y que son considerados medicamentos de primera l&#237;nea&#46;</p><elsevierMultimedia ident="t0010"></elsevierMultimedia><elsevierMultimedia ident="t0015"></elsevierMultimedia><elsevierMultimedia ident="t0020"></elsevierMultimedia><elsevierMultimedia ident="t0025"></elsevierMultimedia><span id="s0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0050">Antidepresivos tric&#237;clicos</span><p id="p0330" class="elsevierStylePara elsevierViewall">Los m&#225;s eficaces en el tratamiento del dolor neurop&#225;tico son los que inhiben la recaptaci&#243;n de noradrenalina y serotonina como la amitriptilina&#44; clomipramina&#44; desimipramina y la doxepina&#46; Todas han demostrado una eficacia similar&#44; aunque la amitriptilina se considera el f&#225;rmaco de elecci&#243;n en el tratamiento del dolor neurop&#225;tico&#46; Por eso&#44; se aconseja iniciar el tratamiento con amitriptilina y sustituirla si aparece intolerancia&#44; efectos secundarios graves o es ineficaz&#46; Se inicia el tratamiento con dosis bajas y se aumenta progresivamente durante 2 semanas<a class="elsevierStyleCrossRefs" href="#bb0120"><span class="elsevierStyleSup">23&#8211;28</span></a>&#46; No afectan a las concentraciones de antirretrovirales pero &#233;stos pueden modificar la concentraci&#243;n de los antidepresivos&#44; por lo que hay que vigilar su eficacia y toxicidad &#40;<a class="elsevierStyleCrossRefs" href="#t0010">tablas 1-3</a>&#41;&#46;</p></span><span id="s0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0055">Antiepil&#233;pticos</span><p id="p0335" class="elsevierStylePara elsevierViewall">Los f&#225;rmacos anticomiciales son especialmente &#250;tiles en el tratamiento del dolor neurop&#225;tico con paroxismos lancinantes como en la neuralgia del trig&#233;mino o la neuralgia postherp&#233;tica&#46; Pueden utilizarse solos o combinados&#44; y los m&#225;s utilizados son la carbamazepina&#44; fenito&#237;na&#44; &#225;cido valproico&#44; clonazepam&#44; gabapentina&#44; lamotrigina y topiramato<a class="elsevierStyleCrossRefs" href="#bb0130"><span class="elsevierStyleSup">25&#8211;27</span></a>&#44;<a class="elsevierStyleCrossRef" href="#bb0150"><span class="elsevierStyleSup">29&#8211;34</span></a>&#46; La gabapentina y la lamotrigina son antiepil&#233;pticos de nueva generaci&#243;n que cada vez se est&#225;n utilizando m&#225;s para el control del dolor neurop&#225;tico&#44; especialmente en pacientes con pluripatolog&#237;a y polimedicaci&#243;n como los enfermos infectados por el VIH&#46; Recientemente&#44; se han publicado dos estudios en los que demuestran su eficacia con un buen perfil de seguridad<a class="elsevierStyleCrossRefs" href="#bb0170"><span class="elsevierStyleSup">33&#44;34</span></a>&#46; Los de menor riesgo de interacciones con los antirretrovirales son lamotrigina&#44; gabapentina y &#225;cido valproico&#46;</p></span><span id="s0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0060">Opioides</span><p id="p0340" class="elsevierStylePara elsevierViewall">Existe controversia en cuanto al uso de opioides para tratar el dolor neurop&#225;tico&#44; ya que en muchos estudios no ha demostrado su eficacia&#46; Sin embargo&#44; el tramadol&#44; que act&#250;a activando los receptores opioides mu con moderada afinidad e inhibiendo la recaptaci&#243;n de serotonina y noradrenalina produce analgesia en el dolor neurop&#225;tico y es considerado un f&#225;rmaco de segunda l&#237;nea para el tratamiento de este tipo de dolor<a class="elsevierStyleCrossRefs" href="#bb0180"><span class="elsevierStyleSup">35&#44;36</span></a>&#46; El tramadol es tambi&#233;n el opioide con menos interacciones con los antirretrovirales&#59; &#250;nicamente conviene recordar que el ritonavir puede disminuir su eficacia&#46;</p></span><span id="s0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0065">Tratamiento t&#243;pico</span><p id="p0345" class="elsevierStylePara elsevierViewall">El uso de crema de capsaicina&#44; parches de lidoca&#237;na al 5&#37; y EMLA &#40;mezcla de anest&#233;sicos en crema&#41; aplicados de forma t&#243;pica han demostrado su eficacia en el tratamiento de la alodinea y el dolor local que muchas veces acompa&#241;an al dolor neurop&#225;tico&#46; Tienen la ventaja de ser muy bien toleradas y presentar pocos efectos secundarios&#44; por lo que son f&#225;cilmente aceptadas por los enfermos<a class="elsevierStyleCrossRefs" href="#bb0190"><span class="elsevierStyleSup">37&#8211;39</span></a>&#46;</p></span><span id="s0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0070">Anest&#233;sicos locales por v&#237;a sist&#233;mica</span><p id="p0350" class="elsevierStylePara elsevierViewall">En algunos casos de dolor neurop&#225;tico rebelde a otros tratamientos se puede utilizar lidoca&#237;na por v&#237;a intravenosa empezando con dosis diarias de 100 mg en 250 ml de suero fisiol&#243;gico que pase en 2 h&#44; y aumentando posteriormente hasta alcanzar una dosis m&#225;xima de 5 mg&#47;kg o hasta que aparezcan signos de toxicidad&#46; La dosis m&#225;xima se mantiene durante 7 d&#237;as&#46; Si el tratamiento es eficaz se sustituye por mexiletina&#44; un an&#225;logo de la lidoca&#237;na que puede administrarse por v&#237;a oral y tiene una semivida de 10-12 h&#46; Otro anest&#233;sico que se puede utilizar por v&#237;a subcut&#225;nea o por v&#237;a oral es la ketamina&#44; evitando la v&#237;a intravenosa por su efecto anest&#233;sico general de recuperaci&#243;n lenta&#46; Es muy importante vigilar la aparici&#243;n de posibles efectos secundarios<a class="elsevierStyleCrossRef" href="#bb0205"><span class="elsevierStyleSup">40</span></a>&#46; Actualmente&#44; tres antirretrovirales &#40;efavirenz&#44; ritonavir y nelfinavir&#41; aumentan la concentraci&#243;n de ketamina potenciando su toxicidad&#46;</p></span></span><span id="s0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0075">Tratamiento no farmacol&#243;gico</span><p id="p0355" class="elsevierStylePara elsevierViewall">Se pueden utilizar distintas t&#233;cnicas para el tratamiento del dolor neurop&#225;tico en el paciente con infecci&#243;n por VIH&#44; desde la acupuntura al uso de estimulaci&#243;n el&#233;ctrica&#44; la realizaci&#243;n de bloqueos nerviosos o la magnetoterapia&#46; Son tratamientos &#250;tiles tanto como coadyuvantes como a modo de monoterapia&#46;</p><span id="s0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0080">Acupuntura</span><p id="p0360" class="elsevierStylePara elsevierViewall">Podr&#237;a ser &#250;til en un alto porcentaje de enfermos con dolor neurop&#225;tico&#46; Sin embargo&#44; todos los estudios con acupuntura para el control del dolor cr&#243;nico tienen limitaciones metodol&#243;gicas y en alguno realizado en enfermos con VIH y neuropat&#237;a perif&#233;rica no se ha observado ventajas frente a placebo<a class="elsevierStyleCrossRefs" href="#bb0210"><span class="elsevierStyleSup">41&#44;42</span></a>&#46; Se suelen pautar entre 1 y 3 sesiones por semana&#44; aunque hay grandes variaciones entre individuos&#46; No existe ninguna contraindicaci&#243;n y las &#250;nicas complicaciones que pueden aparecer son un m&#237;nimo riesgo de sangrado o de infecci&#243;n cut&#225;nea<a class="elsevierStyleCrossRefs" href="#bb0085"><span class="elsevierStyleSup">16&#44;41&#44;42</span></a>&#46;</p></span><span id="s0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0085">Estimulaci&#243;n el&#233;ctrica</span><p id="p0365" class="elsevierStylePara elsevierViewall">Existen diversos sistemas que aplican la corriente el&#233;ctrica como t&#233;cnica analg&#233;sica&#46; El alivio sintom&#225;tico se produce fundamentalmente en dolores rebeldes considerados resistentes a opioides&#46; No hay estudios publicados en enfermos con VIH&#46;</p><span id="s0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0090">Estimulaci&#243;n el&#233;ctrica transcut&#225;nea &#40;TENS&#41;</span><p id="p0370" class="elsevierStylePara elsevierViewall">Es muy utilizada para el control del dolor neurop&#225;tico&#44; aunque su eficacia est&#225; debatida porque tiene una alta variabilidad en los diferentes estudios publicados&#46; Produce una analgesia transitoria y son necesarias sesiones diarias durante varias semanas para lograr un efecto beneficioso&#46; No se puede utilizar si el enfermo tiene una alodinia intensa y esta contraindicada en personas obesas y en portadores de marcapasos<a class="elsevierStyleCrossRefs" href="#bb0085"><span class="elsevierStyleSup">16&#44;43&#44;44</span></a>&#46; No es efectivo en dolores de origen central&#46;</p></span><span id="s0085" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0095">Estimulaci&#243;n el&#233;ctrica medular &#40;EEM&#41;</span><p id="p0375" class="elsevierStylePara elsevierViewall">Su uso est&#225; menos extendido y se reserva para los casos de dolor refractario a los tratamientos convencionales&#46; Se hace un tratamiento de prueba durante unos d&#237;as empleando un generador externo conectado al electrodo&#59; si se confirma que existe respuesta favorable&#44; se sustituye el estimulador externo inicial por un electrodo epidural permanente que se implanta subcut&#225;neamente en el abdomen&#46; El generador se programa por telemetr&#237;a mediante un ordenador&#46; En el dolor neurop&#225;tico el 62&#37; de los pacientes obtiene alg&#250;n beneficio&#46;</p></span><span id="s0090" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0100">Estimulaci&#243;n el&#233;ctrica percut&#225;nea &#40;PENS&#41;</span><p id="p0380" class="elsevierStylePara elsevierViewall">Combina las ventajas de la estimulaci&#243;n transcut&#225;nea y de la electroacupuntura&#46; Se realizan 3 sesiones durante una semana insertando en las zonas doloridas unas agujas similares a las de la acupuntura conectadas a una corriente el&#233;ctrica de baja frecuencia&#46; Hasta el momento s&#243;lo se ha estudiado su efecto a corto plazo<a class="elsevierStyleCrossRef" href="#bb0230"><span class="elsevierStyleSup">45</span></a>&#46;</p></span></span><span id="s0095" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0105">Magnetoterapia</span><p id="p0385" class="elsevierStylePara elsevierViewall">Utiliza la actividad el&#233;ctrica a trav&#233;s de campos magn&#233;ticos logrando una mayor penetraci&#243;n y selectividad sobre los tejidos por tratar&#46; No existen datos suficientes para garantizar su eficacia en el tratamiento del dolor neurop&#225;tico&#59; tiene la ventaja de ser f&#225;cil de aplicar&#44; y es bien tolerado&#44; ya que no tiene contraindicaciones de uso ni efectos secundarios&#46;</p></span><span id="s0100" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0110">Bloqueos nerviosos</span><p id="p0390" class="elsevierStylePara elsevierViewall">Los bloqueos simp&#225;ticos regionales con f&#225;rmacos anest&#233;sicos han sido utilizados con &#233;xito en diferentes tipos de dolor neurop&#225;tico como la neuralgia postherp&#233;tica o las neuropat&#237;as perif&#233;ricas&#46; En general&#44; no se debe considerar el bloqueo analg&#233;sico una medida terap&#233;utica definitiva&#44; sino un m&#233;todo adyuvante&#46; Los m&#225;s utilizados son el bloqueo neurol&#237;tico intradural&#44; el del ganglio estrellado y el del plexo cel&#237;aco&#46; Exist&#237;a controversia en cuanto a su uso en el dolor neurop&#225;tico de los pacientes infectados por VIH&#44; puesto que en muchas ocasiones est&#225;n inmunodeprimidos&#44; con infecciones sist&#233;micas y trastornos de la coagulaci&#243;n que aumentan el riesgo de desarrollar complicaciones con estas t&#233;cnicas&#46; Estudios recientes indican que siempre que se realice una adecuada evaluaci&#243;n de la situaci&#243;n general del enfermo y se eliminen aquellos casos con contraindicaciones para la realizaci&#243;n del procedimiento&#44; se pueden realizar los bloqueos regionales y ejercer un efecto analg&#233;sico muy beneficioso&#46;</p></span></span><span id="s0105" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0115">Nuevos tratamientos</span><p id="p0395" class="elsevierStylePara elsevierViewall">Todav&#237;a queda mucho camino por recorrer en el tratamiento del dolor neurop&#225;tico&#44; ya que a pesar del amplio arsenal terap&#233;utico del que disponemos y del tratamiento combinado que se emplea habitualmente&#44; son muchos los enfermos que escapan a nuestro control y padecen un dolor cr&#243;nico e incapacitante que influye negativamente en su calidad de vida&#46; De manera paralela al mayor conocimiento sobre los mecanismos fisiopatol&#243;gicos de producci&#243;n de este tipo de dolor se van desarrollando nuevas sustancias que prometen ofrecer una alternativa al tratamiento del dolor neurop&#225;tico&#46;<ul class="elsevierStyleList" id="l0030"><li class="elsevierStyleListItem" id="u0010"><span class="elsevierStyleLabel">&#8211;</span><p id="p0400" class="elsevierStylePara elsevierViewall">Venlafaxina es un antidepresivo que inhibe la recaptaci&#243;n de la serotonina y la noradrenalina&#46; En dosis altas es capaz de inhibir la recaptaci&#243;n noradren&#233;rgica&#46; Es mejor tolerado que los antidepresivos tric&#237;clicos<a class="elsevierStyleCrossRefs" href="#bb0230"><span class="elsevierStyleSup">45&#8211;47</span></a>&#44; aunque se debe realizar un seguimiento del electrocardiograma&#44; ya que hasta en el 5&#37; de pacientes que tomaban este f&#225;rmaco aparecieron cambios electrocardiogr&#225;ficos significativos&#46;</p></li><li class="elsevierStyleListItem" id="u0015"><span class="elsevierStyleLabel">&#8211;</span><p id="p0405" class="elsevierStylePara elsevierViewall">Duloxetina es un antidepresivo que inhibe de forma equilibrada la recaptaci&#243;n de la serotonina y la noradrenalina&#46; Presenta un perfil favorable de efectos secundarios&#44; demuestra eficacia tras una semana de tratamiento y constituye un antidepresivo efectivo para los pacientes con dolor neurop&#225;tico&#46; Hasta el momento&#44; s&#243;lo se ha estudiado en la neuropat&#237;a diab&#233;tica con muy buenos resultados&#44; ya que los pacientes refieren mejor control del dolor&#44; mejor calidad de vida y menos efectos adversos que con otros f&#225;rmacos como gabapentina&#44; amitriptilina o venlafaxina<a class="elsevierStyleCrossRef" href="#bb0245"><span class="elsevierStyleSup">48</span></a>&#46;</p></li><li class="elsevierStyleListItem" id="u0020"><span class="elsevierStyleLabel">&#8211;</span><p id="p0410" class="elsevierStylePara elsevierViewall">Pregabalina&#44; un agente anticonvulsivo que se est&#225; utilizando por su efecto gaba&#233;rgico y su buena tolerabilidad<a class="elsevierStyleCrossRef" href="#bb0250"><span class="elsevierStyleSup">49</span></a>&#44; posee un efecto superior a la gabapentina&#46; Alcanza concentraciones plasm&#225;ticas de equilibrio entre el primer y el segundo d&#237;a despu&#233;s de su administraci&#243;n&#44; por lo que permite un r&#225;pido ajuste de dosis&#46; Se puede tomar en ayunas o con alimentos sin que se modifique su absorci&#243;n&#46;</p></li><li class="elsevierStyleListItem" id="u0025"><span class="elsevierStyleLabel">&#8211;</span><p id="p0415" class="elsevierStylePara elsevierViewall">Oxcarbazepina es un bloqueante de los canales de sodio que tiene una acci&#243;n similar a la carbamazepina en el tratamiento del dolor neurop&#225;tico pero con menos riesgo de interacciones medicamentosas<a class="elsevierStyleCrossRef" href="#bb0235"><span class="elsevierStyleSup">46</span></a>&#46;</p></li><li class="elsevierStyleListItem" id="u0030"><span class="elsevierStyleLabel">&#8211;</span><p id="p0420" class="elsevierStylePara elsevierViewall">Memantina&#44; act&#250;a como antagonista de los receptores N-metil-D-aspartato &#40;NMDA&#41; y es efectiva en el control de la hiperalgesia<a class="elsevierStyleCrossRef" href="#bb0235"><span class="elsevierStyleSup">46</span></a>&#46; Es bastante bien tolerado&#44; pero hay que tener cuidado con las interacciones medicamentosas &#40;ketamina&#44; agonistas dopamin&#233;rgicos&#44; anticolin&#233;rgicos&#44; barbit&#250;ricos y neurol&#233;pticos&#41;&#46;</p></li><li class="elsevierStyleListItem" id="u0035"><span class="elsevierStyleLabel">&#8211;</span><p id="p0425" class="elsevierStylePara elsevierViewall">Tizanidina es otra de las sustancias de nuevo uso<a class="elsevierStyleCrossRef" href="#bb0255"><span class="elsevierStyleSup">50</span></a>&#46; Es un miorrelajante de acci&#243;n en segunda motoneurona cuya principal indicaci&#243;n es el tratamiento de la espasticidad&#46;</p></li></ul></p></span></span></span>"
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        "resumen" => "<p id="sp0080" class="elsevierStyleSimplePara elsevierViewall">El dolor neurop&#225;tico en los pacientes con infecci&#243;n por VIH es un s&#237;ntoma frecuente y de etiolog&#237;a m&#250;ltiple que suele estar infradiagnosticado e infratratado&#46; Exige un abordaje multidisciplinario e individualizado&#46; Debemos hacer un tratamiento combinado del dolor basado en aspectos psicosociales&#44; dieta y ejercicio&#44; tambi&#233;n tratamiento etiol&#243;gico siempre que sea posible y tratamiento farmacol&#243;gico sintom&#225;tico e incluso recurrir a t&#233;cnicas intervencionistas&#46; El tratamiento farmacol&#243;gico del dolor neurop&#225;tico debe de ser individualizado y escalonado&#44; teniendo en cuenta las posibles interacciones medicamentosas&#44; sobre todo en los enfermos con VIH que reciben habitualmente mucha medicaci&#243;n de forma simult&#225;nea&#46; Responde mal a los analg&#233;sicos convencionales como los antiinflamatorios no esteroideos y los opioides&#44; y son los antidepresivos tric&#237;clicos y los anticomiciales los f&#225;rmacos de elecci&#243;n&#46; Antes de instaurar un tratamiento analg&#233;sico hay que descartar las posibles interacciones medicamentosas&#44; fundamentalmente con los antirretrovirales&#46;</p>"
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                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Antiepil&#233;pticos</span></td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Carbamazepina&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="center" valign="\n
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                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="center" valign="\n
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                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Fenito&#237;na&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="center" valign="\n
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                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#193;cido valproico&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Clonazepam&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="center" valign="\n
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                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="center" valign="\n
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                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="center" valign="\n
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                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Gabapentina&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
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                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Lamotrigina&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="center" valign="\n
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                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="center" valign="\n
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                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="center" valign="\n
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                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Topiramato&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
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                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="center" valign="\n
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                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
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                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="center" valign="\n
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                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Pregabalina&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Oxcarbazepina&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
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                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab243329.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="sp0015" class="elsevierStyleSimplePara elsevierViewall">Interacciones entre los ITIAN y los f&#225;rmacos utilizados para el dolor</p>"
        ]
      ]
      2 => array:7 [
        "identificador" => "t0015"
        "etiqueta" => "Tabla 2"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
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          "leyenda" => "<p id="sp0040" class="elsevierStyleSimplePara elsevierViewall">-&#58; no descrito&#46;<ul class="elsevierStyleList" id="l0015"><li class="elsevierStyleListItem" id="o0030"><span class="elsevierStyleLabel">1&#46;</span><p id="p0030" class="elsevierStylePara elsevierViewall">Puede disminuir la concentraci&#243;n de amitriptilina&#44; por lo que se debe monitorizar la eficacia de amitriptilina&#46;</p></li><li class="elsevierStyleListItem" id="o0035"><span class="elsevierStyleLabel">2&#46;</span><p id="p0035" class="elsevierStylePara elsevierViewall">Puede aumentar o disminuir la concentraci&#243;n de amitriptilina&#44; monitorizar eficacia&#47;toxicidad de amitriptilina&#46;</p></li><li class="elsevierStyleListItem" id="o0040"><span class="elsevierStyleLabel">3&#46;</span><p id="p0040" class="elsevierStylePara elsevierViewall">Puede disminuir la concentraci&#243;n de clomipramina&#44; monitorizar la eficacia de clomipramina&#46;</p></li><li class="elsevierStyleListItem" id="o0045"><span class="elsevierStyleLabel">4&#46;</span><p id="p0045" class="elsevierStylePara elsevierViewall">Puede aumentar o disminuir la concentraci&#243;n de clomipramina&#44; monitorizar eficacia&#47;toxicidad de clomipramina&#46;</p></li><li class="elsevierStyleListItem" id="o0050"><span class="elsevierStyleLabel">5&#46;</span><p id="p0050" class="elsevierStylePara elsevierViewall">Pueden disminuir las concentraciones de ambos&#44; monitorizar la concentraci&#243;n de carbamazepina y la eficacia de ambos f&#225;rmacos&#46; Asociar con precauci&#243;n&#46;</p></li><li class="elsevierStyleListItem" id="o0055"><span class="elsevierStyleLabel">6&#46;</span><p id="p0055" class="elsevierStylePara elsevierViewall">Puede reducirse la concentraci&#243;n de ambos&#44; se desaconseja esta asociaci&#243;n&#59; valorar otras alternativas terap&#233;uticas&#46;</p></li><li class="elsevierStyleListItem" id="o0060"><span class="elsevierStyleLabel">7&#46;</span><p id="p0060" class="elsevierStylePara elsevierViewall">Pueden disminuir los niveles de nevirapina&#44; monitorizar niveles de fenito&#237;na&#46;</p></li><li class="elsevierStyleListItem" id="o0065"><span class="elsevierStyleLabel">8&#46;</span><p id="p0065" class="elsevierStylePara elsevierViewall">Pueden disminuir los niveles de efavirenz y aumentar la concentraci&#243;n de fenito&#237;na&#44; monitorizar niveles de fenito&#237;na&#44; y si es posible&#44; los de efavirenz&#46; Utilizar con precauci&#243;n&#46;</p></li><li class="elsevierStyleListItem" id="o0070"><span class="elsevierStyleLabel">9&#46;</span><p id="p0070" class="elsevierStylePara elsevierViewall">Puede disminuir la concentraci&#243;n de clonazepam&#44; monitorizar la eficacia de clonazepam&#46;</p></li><li class="elsevierStyleListItem" id="o0075"><span class="elsevierStyleLabel">10&#46;</span><p id="p0075" class="elsevierStylePara elsevierViewall">Puede aumentar o disminuir la concentraci&#243;n de clonazepam&#44; monitorizar eficacia&#47;toxicidad de clonazepam&#46;</p></li><li class="elsevierStyleListItem" id="o0080"><span class="elsevierStyleLabel">11&#46;</span><p id="p0080" class="elsevierStylePara elsevierViewall">Puede disminuir la concentraci&#243;n de lidoca&#237;na&#44; monitorizar la concentraci&#243;n y la eficacia de lidoca&#237;na&#46;</p></li><li class="elsevierStyleListItem" id="o0085"><span class="elsevierStyleLabel">12&#46;</span><p id="p0085" class="elsevierStylePara elsevierViewall">Puede aumentar o disminuir la concentraci&#243;n de lidoca&#237;na&#44; monitorizar eficacia&#47;toxicidad de lidoca&#237;na&#46; Administrar con precauci&#243;n&#46;</p></li><li class="elsevierStyleListItem" id="o0090"><span class="elsevierStyleLabel">13&#46;</span><p id="p0090" class="elsevierStylePara elsevierViewall">Puede aumentar la concentraci&#243;n de ketamina&#46; Utilizar con mucha precauci&#243;n monitorizando s&#237;ntomas de toxicidad por ketamina &#40;depresi&#243;n respiratoria&#44; p&#233;rdida de conciencia y alucinaciones&#41;&#46;</p></li></ul></p><p id="sp0045" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">Nota</span>&#58; se pueden consultar las interacciones en la p&#225;gina web <span class="elsevierStyleInterRef" id="ir0015" href="http://www.interaccioneshiv.com">www&#46;interaccioneshiv&#46;com</span></p><p id="sp0050" class="elsevierStyleSimplePara elsevierViewall">EFV&#58; efavirenz&#59; ITINN&#58; inhibidores de la transcriptasa inversa no nucle&#243;sidos&#59; NVP&#58; nevirapina&#46;</p>"
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                  \t\t\t\t\tvoid\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
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                  \t\t\t\t">NVP&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">EFV&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="3" align="left" valign="\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Amitriptilina&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Clomipramina&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
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                  \t\t\t\t">3&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="center" valign="\n
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                  \t\t\t\t">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Desimipramina&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="center" valign="\n
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                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="center" valign="\n
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                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Doxepina&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
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                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
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                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Venlafaxina&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
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                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Duloxetina&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="3" align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleBold">Antiepil&#233;pticos</span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Carbamazepina&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
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                  \t\t\t\t">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Fenito&#237;na&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#193;cido valproico&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Clonazepam&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Gabapentina&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Lamotrigina&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Topiramato&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Pregabalina&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Oxcarbazepina&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Opioides</span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Tramadol&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Code&#237;na&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Anest&#233;sicos</span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Lidoca&#237;na&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
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                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab243331.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="sp0035" class="elsevierStyleSimplePara elsevierViewall">Interacciones entre los ITINN y los f&#225;rmacos utilizados para el dolor</p>"
        ]
      ]
      3 => array:7 [
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        "etiqueta" => "Tabla 3"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
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          "leyenda" => "<p id="sp0060" class="elsevierStyleSimplePara elsevierViewall">-&#58; interacci&#243;n no descrita o sin relevancia cl&#237;nica&#46;</p><p id="sp0065" class="elsevierStyleSimplePara elsevierViewall">APV&#58; amprenavir&#59; ATV&#58; atazanavir&#59; fAPV&#58; fosamprenavir&#59; IDV&#58; indinavir&#59; IP&#58; inhibidores de la proteasa&#59; LPV&#58; lopinavir&#59; NFV&#58; nelfinavir&#59; RTV&#58; ritonavir&#59; SQV&#58; saquinavir&#59; TPV&#58; tipranavir&#46;</p><p id="sp0070" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">Nota</span>&#58; se pueden consultar las interacciones en la p&#225;gina web <span class="elsevierStyleInterRef" id="ir0020" href="http://www.interaccioneshiv.com">www&#46;interaccioneshiv&#46;com</span></p>"
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            0 => array:2 [
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Clonazepam&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Gabapentina&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="center" valign="\n
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                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Topiramato&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
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                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
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                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Pregabalina&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
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                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
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                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
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                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
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                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Oxcarbazepina&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
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                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t"><span class="elsevierStyleBold">Opioides</span></td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Tramadol&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
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                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">27&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="center" valign="\n
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                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="center" valign="\n
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                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="center" valign="\n
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                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="center" valign="\n
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                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="center" valign="\n
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                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Code&#237;na&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">28&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">28&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t  " colspan="10" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Anest&#233;sicos</span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Lidoca&#237;na&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">29&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">29&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">29&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="center" valign="\n
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                  \t\t\t\t">29&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">29&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">29&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">29&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="center" valign="\n
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                  \t\t\t\t">29&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Mexiletina&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="center" valign="\n
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                  \t\t\t\t">30&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="center" valign="\n
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                  \t\t\t\t">31&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="center" valign="\n
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                  \t\t\t\t">30&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="center" valign="\n
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                  \t\t\t\t">30&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">30&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">30&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
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                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ketamina&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
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                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">32&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">33&nbsp;\t\t\t\t\t\t\n
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              "nota" => "<p class="elsevierStyleNotepara" id="np0010">Los estudios de interacciones est&#225;n realizados con dosis plenas de ritonavir&#44; pero se infiere que puesto que es un potente inhibidor enzim&#225;tico&#44; tambi&#233;n pueden producirse interacciones a dosis de potenciaci&#243;n&#46;<ul class="elsevierStyleList" id="l0020"><li class="elsevierStyleListItem" id="o0095"><span class="elsevierStyleLabel">1&#46;</span><p id="p0095" class="elsevierStylePara elsevierViewall">Puede aumentar la concentraci&#243;n de amitriptilina&#44; monitorizar la toxicidad de amitriptilina&#46;</p></li><li class="elsevierStyleListItem" id="o0100"><span class="elsevierStyleLabel">2&#46;</span><p id="p0100" class="elsevierStylePara elsevierViewall">Puede aumentar la concentraci&#243;n de clomipramina&#44; monitorizar la toxicidad de clomipramina&#46;</p></li><li class="elsevierStyleListItem" id="o0105"><span class="elsevierStyleLabel">3&#46;</span><p id="p0105" class="elsevierStylePara elsevierViewall">Puede aumentar la concentraci&#243;n de desimipramina&#44; monitorizar la toxicidad de desimipramina&#46;</p></li><li class="elsevierStyleListItem" id="o0110"><span class="elsevierStyleLabel">4&#46;</span><p id="p0110" class="elsevierStylePara elsevierViewall">Puede aumentar la concentraci&#243;n de desimipramina&#44; monitorizar la toxicidad de desimipramina&#46; Usar la menor dosis de desimipramina posible&#46;</p></li><li class="elsevierStyleListItem" id="o0115"><span class="elsevierStyleLabel">5&#46;</span><p id="p0115" class="elsevierStylePara elsevierViewall">Puede aumentar la concentraci&#243;n de doxepina&#44; monitorizar la toxicidad de doxepina&#46;</p></li><li class="elsevierStyleListItem" id="o0120"><span class="elsevierStyleLabel">6&#46;</span><p id="p0120" class="elsevierStylePara elsevierViewall">Pueden reducirse los niveles de indinavir&#44; monitorizar la eficacia de indinavir&#46;</p></li><li class="elsevierStyleListItem" id="o0125"><span class="elsevierStyleLabel">7&#46;</span><p id="p0125" class="elsevierStylePara elsevierViewall">Puede aumentar la concentraci&#243;n de venlafaxina&#44; monitorizar la toxicidad de venlafaxina &#40;elevaci&#243;n de la presi&#243;n arterial&#44; confusi&#243;n&#44; fatiga&#44; dolor de cabeza&#41;&#46;</p></li><li class="elsevierStyleListItem" id="o0130"><span class="elsevierStyleLabel">8&#46;</span><p id="p0130" class="elsevierStylePara elsevierViewall">Asociaci&#243;n contraindicada&#44; puede producirse fracaso del tratamiento antirretroviral&#46;</p></li><li class="elsevierStyleListItem" id="o0135"><span class="elsevierStyleLabel">9&#46;</span><p id="p0135" class="elsevierStylePara elsevierViewall">Puede aumentar la concentraci&#243;n de carbamazepina&#44; monitorizar los niveles de carbamazepina y los signos de toxicidad &#40;n&#225;useas&#44; somnolencia&#44; confusi&#243;n&#44; ataxia&#44; debilidad&#44; dolor de cabeza&#41;&#46; Pueden reducirse los niveles de ritonavir&#44; monitorizar la eficacia de ritonavir&#46;</p></li><li class="elsevierStyleListItem" id="o0140"><span class="elsevierStyleLabel">10&#46;</span><p id="p0140" class="elsevierStylePara elsevierViewall">Puede aumentar la concentraci&#243;n de carbamazepina&#44; monitorizar los niveles de carbamazepina y los signos de toxicidad &#40;n&#225;useas&#44; somnolencia&#44; confusi&#243;n&#44; ataxia&#44; debilidad&#44; dolor de cabeza&#41;&#46; Pueden reducirse los niveles de saquinavir&#44; monitorizar la eficacia de saquinavir&#46;</p></li><li class="elsevierStyleListItem" id="o0145"><span class="elsevierStyleLabel">11&#46;</span><p id="p0145" class="elsevierStylePara elsevierViewall">Puede aumentar la concentraci&#243;n de carbamazepina&#44; monitorizar los niveles de carbamazepina y los signos de toxicidad &#40;n&#225;useas&#44; somnolencia&#44; confusi&#243;n&#44; ataxia&#44; debilidad&#44; dolor de cabeza&#41;&#46; Pueden reducirse los niveles de nelfinavir&#44; monitorizar la eficacia de nelfinavir&#46;</p></li><li class="elsevierStyleListItem" id="o0150"><span class="elsevierStyleLabel">12&#46;</span><p id="p0150" class="elsevierStylePara elsevierViewall">Puede aumentar la concentraci&#243;n de carbamazepina&#44; monitorizar los niveles de carbamazepina y los signos de toxicidad &#40;n&#225;useas&#44; somnolencia&#44; confusi&#243;n&#44; ataxia&#44; debilidad&#44; dolor de cabeza&#41;&#46; Pueden reducirse los niveles de amprenavir&#44; monitorizar la eficacia de amprenavir&#46;</p></li><li class="elsevierStyleListItem" id="o0155"><span class="elsevierStyleLabel">13&#46;</span><p id="p0155" class="elsevierStylePara elsevierViewall">Puede aumentar la concentraci&#243;n de carbamazepina&#44; monitorizar los niveles de carbamazepina y los signos de toxicidad &#40;n&#225;useas&#44; somnolencia&#44; confusi&#243;n&#44; ataxia&#44; debilidad&#44; dolor de cabeza&#41;&#46; Pueden reducirse los niveles de fosamprenavir&#44; monitorizar la eficacia de fosamprenavir&#46;</p></li><li class="elsevierStyleListItem" id="o0160"><span class="elsevierStyleLabel">14&#46;</span><p id="p0160" class="elsevierStylePara elsevierViewall">Puede aumentar la concentraci&#243;n de carbamazepina&#44; monitorizar los niveles de carbamazepina y los signos de toxicidad &#40;n&#225;useas&#44; somnolencia&#44; confusi&#243;n&#44; ataxia&#44; debilidad&#44; dolor de cabeza&#41;&#46; Pueden reducirse los niveles de lopinavir&#44; monitorizar la eficacia de lopinavir&#46;</p></li><li class="elsevierStyleListItem" id="o0165"><span class="elsevierStyleLabel">15&#46;</span><p id="p0165" class="elsevierStylePara elsevierViewall">Puede aumentar la concentraci&#243;n de carbamazepina&#44; monitorizar los niveles de carbamazepina y los signos de toxicidad &#40;n&#225;useas&#44; somnolencia&#44; confusi&#243;n&#44; ataxia&#44; debilidad&#44; dolor de cabeza&#41;&#46; Pueden reducirse los niveles de atazananavir&#44; monitorizar la eficacia de atazananavir&#46;</p></li><li class="elsevierStyleListItem" id="o0170"><span class="elsevierStyleLabel">16&#46;</span><p id="p0170" class="elsevierStylePara elsevierViewall">Pueden reducirse los niveles de indinavir&#44; monitorizar la eficacia de indinavir&#46; Monitorizar los niveles plasm&#225;ticos de fenito&#237;na&#46;</p></li><li class="elsevierStyleListItem" id="o0175"><span class="elsevierStyleLabel">17&#46;</span><p id="p0175" class="elsevierStylePara elsevierViewall">Pueden reducirse los niveles de ritonavir&#44; monitorizar la eficacia de ritonavir&#46; Puede aumentar la concentraci&#243;n de fenito&#237;na&#44; monitorizar los niveles y toxicidad de fenito&#237;na &#40;ataxia&#44; nistagmus&#44; temblor&#44; hiperreflexia&#41;&#46;</p></li><li class="elsevierStyleListItem" id="o0180"><span class="elsevierStyleLabel">18&#46;</span><p id="p0180" class="elsevierStylePara elsevierViewall">Pueden reducirse los niveles de saquinavir&#44; monitorizar la eficacia de saquinavir&#44; monitorizar niveles plasm&#225;ticos de fenito&#237;na&#46;</p></li><li class="elsevierStyleListItem" id="o0185"><span class="elsevierStyleLabel">19&#46;</span><p id="p0185" class="elsevierStylePara elsevierViewall">Puede reducirse la concentraci&#243;n de fenito&#237;na&#44; monitorizar las concentraciones de fenito&#237;na&#46; Pueden reducirse los niveles de nelfinavir&#44; monitorizar la eficacia de nelfinavir&#46;</p></li><li class="elsevierStyleListItem" id="o0190"><span class="elsevierStyleLabel">20&#46;</span><p id="p0190" class="elsevierStylePara elsevierViewall">Pueden reducirse los niveles de amprenavir&#44; monitorizar la eficacia de amprenavir&#44; monitorizar los niveles de fenito&#237;na&#46;</p></li><li class="elsevierStyleListItem" id="o0195"><span class="elsevierStyleLabel">21&#46;</span><p id="p0195" class="elsevierStylePara elsevierViewall">Pueden reducirse los niveles de fosamprenavir&#44; monitorizar la eficacia de fosamprenavir&#44; monitorizar los niveles de fenito&#237;na&#46;</p></li><li class="elsevierStyleListItem" id="o0200"><span class="elsevierStyleLabel">22&#46;</span><p id="p0200" class="elsevierStylePara elsevierViewall">Pueden reducirse los niveles de lopinavir y la concentraci&#243;n de fenito&#237;na&#44; monitorizar niveles de ambos f&#225;rmacos&#46; Aumento de la toxicidad hep&#225;tica&#46;</p></li><li class="elsevierStyleListItem" id="o0205"><span class="elsevierStyleLabel">23&#46;</span><p id="p0205" class="elsevierStylePara elsevierViewall">Puede reducirse la concentraci&#243;n de &#225;cido valproico&#44; monitorizar niveles de &#225;cido valproico&#46;</p></li><li class="elsevierStyleListItem" id="o0210"><span class="elsevierStyleLabel">24&#46;</span><p id="p0210" class="elsevierStylePara elsevierViewall">Puede aumentar la concentraci&#243;n de clonazepam&#44; monitorizar los signos de toxicidad clonazepam &#40;sedaci&#243;n excesiva&#44; confusi&#243;n&#41;&#46;</p></li><li class="elsevierStyleListItem" id="o0215"><span class="elsevierStyleLabel">25&#46;</span><p id="p0215" class="elsevierStylePara elsevierViewall">Puede reducirse la concentraci&#243;n de lamotrigina&#44; monitorizar la eficacia lamotrigina&#46;</p></li><li class="elsevierStyleListItem" id="o0220"><span class="elsevierStyleLabel">26&#46;</span><p id="p0220" class="elsevierStylePara elsevierViewall">Puede reducirse la concentraci&#243;n de lamotrigina&#44; se recomienda duplicar la dosis de lamotrigina&#46;</p></li><li class="elsevierStyleListItem" id="o0225"><span class="elsevierStyleLabel">27&#46;</span><p id="p0225" class="elsevierStylePara elsevierViewall">Puede aumentar la concentraci&#243;n de tramadol&#44; monitorizar la toxicidad tramadol&#46;</p></li><li class="elsevierStyleListItem" id="o0230"><span class="elsevierStyleLabel">28&#46;</span><p id="p0230" class="elsevierStylePara elsevierViewall">Puede reducirse la concentraci&#243;n de code&#237;na&#44; monitorizar la eficacia de la code&#237;na&#46;</p></li><li class="elsevierStyleListItem" id="o0235"><span class="elsevierStyleLabel">29&#46;</span><p id="p0235" class="elsevierStylePara elsevierViewall">Puede aumentar la concentraci&#243;n de lidoca&#237;na&#44; monitorizar concentraci&#243;n y los signos de toxicidad de lidoca&#237;na &#40;hipotensi&#243;n&#44; arritmias card&#237;acas&#41;&#46;</p></li><li class="elsevierStyleListItem" id="o0240"><span class="elsevierStyleLabel">30&#46;</span><p id="p0240" class="elsevierStylePara elsevierViewall">No hay demostrada una interacci&#243;n relevante&#44; pero se recomienda su uso con precauci&#243;n&#46;</p></li><li class="elsevierStyleListItem" id="o0245"><span class="elsevierStyleLabel">31&#46;</span><p id="p0245" class="elsevierStylePara elsevierViewall">Puede aumentar la concentraci&#243;n de mexiletina&#44; monitorizar la toxicidad de mexiletina &#40;n&#225;useas&#44; confusi&#243;n&#44; arritmias card&#237;acas&#41;&#46;</p></li><li class="elsevierStyleListItem" id="o0250"><span class="elsevierStyleLabel">32&#46;</span><p id="p0250" class="elsevierStylePara elsevierViewall">Puede aumentar la concentraci&#243;n de ketamina&#44; monitorizar la concentraci&#243;n y los signos de toxicidad de ketamina &#40;depresi&#243;n respiratoria&#44; p&#233;rdida de conciencia y alucinaciones&#41;&#46; Incremento del riesgo de hepatitis&#46;</p></li><li class="elsevierStyleListItem" id="o0255"><span class="elsevierStyleLabel">33&#46;</span><p id="p0255" class="elsevierStylePara elsevierViewall">Puede aumentar la concentraci&#243;n de ketamina&#44; monitorizar la concentraci&#243;n y los signos de toxicidad de ketamina &#40;depresi&#243;n respiratoria&#44; p&#233;rdida de conciencia y alucinaciones&#41;&#46;</p></li></ul></p>"
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                  \t\t\t\t\tvoid\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="center" valign="\n
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                  \t\t\t\t  " align="center" valign="\n
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                  \t\t\t\t  " align="center" valign="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10-25 mg&#47;24 h&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">50-100 mg&#47;8 h&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Clomipramina&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Oral&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10-30 mg&#47;noche&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">150-300 mg&#47;24 h&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Desipramina&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Oral&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10-20 mg&#47;noche&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">75-150 mg&#47;24 h&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Carbamazepina&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Oral&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">100-200 mg&#47;24 h&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">200-400 mg&#47;8 h&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Fenito&#237;na&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Oral&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">100-200 mg&#47;24 h&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">100 mg&#47;8 h&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">A&#46; valproico&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Oral&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">200 mg&#47;8-12 h&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">400-800 mg&#47;8 h&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Clonazepam&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Oral&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;5-1 mg&#47;24 h&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1-2 mg&#47;6-12 h&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Gabapentina&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Oral&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">100-300 mg&#47;8 h&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">300-1200 mg&#47;8 h&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Lamotrigina&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Oral&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">25 mg&#47;noche o cada 12 h&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">100-200 mg&#47;12 h&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Topiramato&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Oral&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">25-50 mg&#47;noche&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">100-200 mg&#47;12 h&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Mexiletina&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Oral&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">150 mg&#47;24 h&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">150-300 mg&#47;8 h&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Code&#237;na&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Oral&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15-30 mg&#47;8 h&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15-30 mg&#47;4-6 h&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Tramadol&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Oral&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15 mg&#47;8 h&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">50-100 mg&#47;6-8 h&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ketamina&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Oral&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Dosis de prueba 13 mg i&#46;v&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">200 mg&#47;8 h&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Venlafaxina&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Oral&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">37&#44;5 mg&#47;24 h&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">75 mg&#47;12 h&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Pregabalina&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Oral&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">150 mg&#47;24 h&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">150-300 mg&#47;12 h&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab243332.png"
              ]
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        ]
        "descripcion" => array:1 [
          "en" => "<p id="sp0075" class="elsevierStyleSimplePara elsevierViewall">Dosis aconsejadas de los f&#225;rmacos utilizados en el tratamiento del dolor neurop&#225;tico</p>"
        ]
      ]
    ]
    "lecturaRecomendada" => array:1 [
      0 => array:3 [
        "vista" => "all"
        "titulo" => "<span class="elsevierStyleSectionTitle" id="st0120">Bibliograf&#237;a</span>"
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          0 => array:1 [
            "bibliografiaReferencia" => array:50 [
              0 => array:3 [
                "identificador" => "bb0010"
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                      0 => array:2 [
                        "titulo" => "Pain syndromes and etiologies in ambulatory AIDS patients"
                        "autores" => array:1 [
                          0 => array:2 [
                            "etal" => false
                            "autores" => array:6 [
                              0 => "E&#46;J&#46; Hewitt"
                              1 => "M&#46; McDonald"
                              2 => "R&#46;K&#46; Portenoy"
                              3 => "B&#46; Rosenfeld"
                              4 => "S&#46; Passik"
                              5 => "W&#46; Bretbart"
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                      0 => array:1 [
                        "Revista" => array:6 [
                          "tituloSerie" => "Pain"
                          "fecha" => "1997"
                          "volumen" => "70"
                          "paginaInicial" => "117"
                          "paginaFinal" => "123"
                          "link" => array:1 [
                            0 => array:2 [
                              "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9150284"
                              "web" => "Medline"
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                "identificador" => "bb0015"
                "etiqueta" => "2&#46;"
                "referencia" => array:1 [
                  0 => array:2 [
                    "contribucion" => array:1 [
                      0 => array:2 [
                        "titulo" => "HIV-associated peripheral neuropathy&#58; epidemiology&#44; pathophysiology and treatment"
                        "autores" => array:1 [
                          0 => array:2 [
                            "etal" => false
                            "autores" => array:3 [
                              0 => "E&#46;A&#46; Wulff"
                              1 => "A&#46;K&#46; Wang"
                              2 => "D&#46;M&#46; Simpson"
                            ]
                          ]
                        ]
                      ]
                    ]
                    "host" => array:1 [
                      0 => array:1 [
                        "Revista" => array:6 [
                          "tituloSerie" => "Drugs"
                          "fecha" => "2000"
                          "volumen" => "59"
                          "paginaInicial" => "1251"
                          "paginaFinal" => "1260"
                          "link" => array:1 [
                            0 => array:2 [
                              "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10882161"
                              "web" => "Medline"
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              2 => array:3 [
                "identificador" => "bb0020"
                "etiqueta" => "3&#46;"
                "referencia" => array:1 [
                  0 => array:2 [
                    "contribucion" => array:1 [
                      0 => array:2 [
                        "titulo" => "Epidemiology and clinical features of HIV-1 associated neuropathies"
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es en pt

¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

Are you a health professional able to prescribe or dispense drugs?

Você é um profissional de saúde habilitado a prescrever ou dispensar medicamentos