Yuav siv Telmista 40 li cas? > Kev khomob thiab kev tiv thaiv

Daim ntawv koob tshuaj Telmists - ntsiav tshuaj: yuav luag dawb lossis dawb, ntawm ib koob 20 mg - puag ncig, 40 mg - biconvex, oval, 80 mg - biconvex, tshuaj ntsiav-txoj hauv kev (hauv cov hlwv ntawm cov khoom siv sib xyaw ua ke 7 pcs., Hauv ib daim duab los qhia lub thawv 2, 4, 8 , 12 lossis 14 hlwv, hauv lub hlwv 10 pcs., Hauv daim duab los qhia 3, 6 lossis 9 hlwv).

Muaj pes tsawg leeg ib ntsiav tshuaj:

cov tshuaj nquag: telmisartan - 20, 40 lossis 80 mg,
kev zam: sodium hydroxide, lactose monohydrate, magnesium stearate, meglumine, povidone K30, sorbitol (E420).

Cov Tshuaj Hauv Tshuaj

Telmisartan, qhov tseem ceeb tshuaj ntawm Telmista, muaj cov khoom lag luam antihypertensive, yog tus kabmob angiotensin II receptor antagonist (AT blocker)₁cov txais). Txom cov tshuaj mob angiotensin II los ntawm qhov sib txuas nrog cov receptor, nws tsis muaj qhov kev txiav txim ntawm agonist nrog kev hwm txog qhov receptor no. Telmisartan xaiv zoo thiab tau ntev ntev tsuas tuaj yeem khi rau angiotensin II receptor subtype AT₁Cov. Nws tsis muaj kev sib raug zoo rau lwm tus neeg mob angiotensin, qhov tseem ceeb ntawm kev ua haujlwm thiab qhov txiaj ntsig ntawm qhov ntau dhau (vim yog siv telmisartan) lub hwj chim ntawm angiotensin II rau lawv tsis tau kawm.

Telmisartan txo qis kev mloog zoo ntawm aldosterone hauv cov ntshav ntshav, tsis cuam tshuam rau cov concentration ntawm renin thiab tsis thaiv cov ion ion. Cov tshuaj muaj zog tsis tiv thaiv ACE (angiotensin-hloov enzyme), uas kuj rhuav tshem bradykinin, yog li tsis muaj kev phiv tshuaj los ntawm bradykinin tau sau tseg.

Telmisartan, noj ntawm ib koob ntawm 80 mg, ua tag nrho cov txiaj ntsig kev ntxim siab ntawm angiotensin II. Tom qab txhaj thawj koob tshuaj rau 3 teev, qhov pib ntawm lub siab hypotensive raug sau tseg, cov nyhuv mob tsawv rau ib hnub thiab tseem ceeb rau txog li ob hnub. Cov nyhuv hypotensive ruaj khov feem ntau tsim tom qab 4-8 lub lis piam los ntawm kev pib kho mob nrog kev tswj hwm niaj hnub ntawm telmisartan.

Nrog rau kev mob ntshav siab, cov tshuaj pabcuam pab txo qis ntshav qis systolic thiab diastolic (BP). Telmisartan tsis muaj kev cuam tshuam cov leeg plawv (lub plawv dhia).

Hauv cov neeg mob uas muaj kev tshem tawm sai ntawm telmisartan, ntshav siab maj mam rov qab mus rau nws tus nqi qub, qhov kev tshem tawm mob tsis pom.

Cov Tshuaj Pharmacokinetics

kev nqus: thaum noj tau, nws nqus tau sai hauv lub plab zom mov. Bioavailability yog 50%. Thaum noj nrog zaub mov, qhov txo qis hauv AUC (thaj chaw hauv qab qhov nkhaus pharmacokinetic) yog nyob rau thaj tsam li ntawm 6% mus rau 19% ntawm koob tshuaj 40 thiab 160 mg, feem. 3 teev tom qab noj cov tshuaj telmisartan, nws qhov kev mob siab hauv cov ntshav plasma ntau ntau tawm (tsis yog nyob ntawm lub sijhawm noj mov). AUC thiab cov plasma ntshav siab tshaj plaws (C_max) nyob rau hauv cov poj niam yog kwv yees li 2 thiab 3 zaug siab dua, feem, dua li tus txiv neej. Tsis muaj qhov cuam tshuam rau kev ua haujlwm tau zoo,
kev faib tawm thiab cov metabolism: 99.5% ntawm cov khoom sib txuas rau cov ntshav plasma protein (feem ntau alpha-1 glycoprotein thiab albumin). Cov pom pom tseeb ntawm kev faib tawm hauv qhov sib npaug ntawm cov tsom xam yog nyob rau nruab nrab 500 l. Kev mob ntshav siab tshwm sim los ntawm kev sib txuas nrog glucuronic acid nrog kev tsim cov tshuaj pharmacologically tsis muaj zog,
kev tshem tawm: T_1/2 (tshem tawm ib nrab-lub neej) - ntau dua 20 teev. Qhov tshuaj ntawd yog tsuas yog tawm tsis pauv ntawm txoj hnyuv, nrog zis - tsawg dua 2%. Tag nrho cov ntshav ua kom huv si tau zoo heev piv nrog hepatic ntshav txaus (kwv yees li 1500 ml / min) thiab muaj kwv yees li 900 ml / min.

Lub ntsiab tshuaj pharmacokinetic ntawm telmisartan thaum siv rau cov menyuam yaus thiab cov tub ntxhais hluas txij li 6 txog 18 xyoo rau 4 lub hlis ntawm ib koob ntawm 1 lossis 2 mg / kg feem ntau piv nrog rau cov neeg mob hauv cov neeg laus thiab paub meej tias tsis yog-cov tshuaj pharmacokinetics ntawm cov tshuaj yeeb yam, tshwj xeeb tshaj yog kev hwm C_max.

Cov Yuav Tsum Tau Ua

cov foos tsis zoo ua rau lub siab ua haujlwm (raws li kev faib tawm Tus Menyuam - Pugh - chav C),
kua tsib leeg tav kev,
ua ke siv nrog aliskiren hauv cov neeg mob uas mob hnyav los sis mob raum tsis ua haujlwm (lub quag ua kua tsawg dua 60 ml / min / 1.73 m 2) lossis mob ntshav qab zib mellitus,
lactase / sucrose / isomaltase deficiency, fructose intolerance, qabzib-galactose malabsorption,
cev xeeb tub thiab lub sijhawm lactation,
hnub nyoog txog 18 xyoo
cov tib neeg cov tshuaj tiv thaiv tsis haum rau telmisartan lossis ib yam ntawm cov tshuaj ntu ntawm cov tshuaj.

Tus txheeb ze (kab mob / mob uas siv Telmista yuav tsum ceeb toom):

ua rau lub raum thiab / lossis lub siab ua haujlwm,
ob leeg lub raum leeg mob stenosis los yog leeg ntshav ntawm ib raum,
tej yam mob tom qab lub raum hloov chaw (vim tsis muaj kev paub txog kev siv),
hyperkalemia
kev npau suav,
mob plawv tsis ua hauj lwm
nqaim ntawm cov mitral thiab / lossis aortic valve,
GOKMP (hypertrophic obstructive cardiomyopathy),
txo qis hauv bcc (ntim ntawm cov ntshav) vim yog kev kho mob yav dhau los nrog kev siv tshuaj diuretics, kev noj tsawg ntsev, ntuav lossis raws plab,
thawj hyperaldosteronism (kev nyab xeeb thiab kev ua tau zoo tsis tsim).

Cov lus qhia rau kev siv Telmista: txoj kev thiab ntau npaum li cas

Cov ntsiav tshuaj Telmist tau noj ntawm qhov ncauj, tsis hais lub sijhawm noj mov.

Nrog rau kev mob ntshav siab, nws pom zoo kom pib noj nrog 20 lossis 40 mg ntawm cov tshuaj 1 zaug nyob rau ib hnub. Hauv qee tus neeg mob, nws yog ua tau kom ua tiav qhov hypotensive nyhuv ntawm koob tshuaj 20 mg / hnub. Thaum tsis muaj kev kho mob txaus, koj tuaj yeem nce lub koob tshuaj rau qhov ntau tshaj plaws ib hnub twg ntawm 80 mg. Nrog rau kev nce ntxiv hauv qhov koob tshuaj, nws yuav tsum coj mus rau hauv tus account tias qhov siab tshaj plaws ntawm kev xav ntawm Telmista feem ntau ua tiav tom qab 4-8 lub lis piam los ntawm qhov pib ntawm txoj kev kho.

Txhawm rau txo qis kev mob plawv thiab tuag, nws pom zoo kom noj 80 mg ntawm cov tshuaj 1 zaug hauv ib hnub.

Thaum pib theem ntawm kev kho mob, yuav tsum muaj txoj hauv kev ntxiv rau kev ntsuas ntshav siab ib txwm xav tau.

Nws tsis tas yuav kho cov tshuaj ntau npaum li cas rau cov neeg mob raum tsis ua haujlwm, suav nrog cov neeg mob hemodialysis.

Rau lub siab ua haujlwm lub siab ua haujlwm ntawm qhov mob me lossis mob hnyav (raws li kev faib cov menyuam yaus-Pugh - Chav Kawm A thiab B), qhov tshuaj tiv thaiv txhua hnub ntawm Telmista yog 40 mg.

Hauv cov neeg mob laus, cov pharmacokinetics ntawm telmisartan tsis hloov, yog li tsis tas yuav kho qhov tshuaj ntau npaum li cas rau lawv.

Sab sij huam

Thaum siv Telmists, Cov kev mob tshwm sim hauv qab no los ntawm cov kab ke thiab kabmob yog ua tau:

lub plawv: tachycardia, bradycardia,
cov hlab ntsha: orthostatic hypotension, ib qho tseem ceeb txo cov ntshav siab,
lub plab zom mov: raws plab, mob plab, dyspepsia, lub plab tsis xis nyob, pom tsis tau, ntuav, ua tsis tau pa (tsis nco qab), ua paug ntawm lub qhov ncauj, ua rau lub siab ua haujlwm / mob siab,
cov ntshav thiab cov lymphatic system: thrombocytopenia, eosinophilia, anemia, sepsis (suav nrog rau qhov mob ua rau tuag),
cov kab mob hauv lub cev: insomnia, ntxhov siab vim, kev nyuaj siab, txhaj tshuaj, tsaus muag,
kev tiv thaiv kab mob: kev tiv thaiv kab mob ua kom mob ntsws (urticaria, erythema, angioedema), anaphylactic kev ua xua, pruritus, eczema, tawv nqaij pob khaus (suav nrog tshuaj), hyperhidrosis, angioedema (txog thaum tuag), ua kom tawv nqaij ua paug,
yam ntawm lub zeem muag: pom kev txawv txav,
cov kab mob ua pa, hauv siab thiab mediastinal plab hnyuv siab: hnoos, ua tsis taus pa, mob ntsws sab sauv, kab mob ntsws interstitial (cov kev sib raug zoo nrog kev siv telmisartan tsis tau tsim),
musculoskeletal thiab cov nqaij mob sib txuas: mob nraub qaum, mob caj dab, mob leeg nqaij (mob plab rau cov leeg), myalgia, mob ceg, mob hauv cov leeg (cov tsos mob zoo ib yam li cov tsos mob thiab o ua rau cov leeg nqaij)
raum thiab mob txeeb zig: lub raum tsis ua haujlwm (suav nrog mob raum tsis ua haujlwm), mob txeeb zig (nrog rau mob cystitis),
lub cev tag nrho: kev ua kom tsis muaj zog, khaub thuas zoo li mob khaub thuas, mob hauv siab,
cov kev kawm ua haujlwm thiab kev kuaj ntshav kuaj mob: ib qho kev nce ntawm cov ntsiab lus ntawm uric acid, creatinine hauv ntshav ntshav, txo qis ntawm hemoglobin, kev nce siab hauv kev ua haujlwm ntawm hepatic transaminases, CPK (creatine phosphokinase) hauv ntshav plasma, hypoglycemia (hauv cov neeg mob ntshav qab zib mellitus), hyperkalemia.

Cov kev sib raug zoo ntawm qhov sib txawv ntawm qhov tshwm sim ntawm cov kev mob tshwm sim nrog lub hnub nyoog, tub los ntxhais lossis haiv neeg ntawm cov neeg mob tsis tau tsim.

Cov lus qhia tshwj xeeb

Kev siv tib lub sijhawm Telmista thiab ACE inhibitors lossis cov tshuaj tiv thaiv ncaj qha ntawm renin, aliskiren, vim qhov kev coj ua ob zaug ntawm RAAS (renin-angiotensin-aldosterone system) cuam tshuam kev ua haujlwm ntawm lub raum (nrog rau kev ua rau lub raum tsis ua haujlwm), thiab tseem yuav muaj kev pheej hmoo ntawm hypotension thiab hyperkalemia. Cov. Yog tias qhov kev sib koom tes sib txuas yog qhov tsim nyog tiag, nws yuav tsum tau ua nrog kev saib xyuas zoo, nrog rau kev tshuaj xyuas lub raum kev ua haujlwm, ntshav siab thiab cov ntshav hauv ntshav ntau ntxiv hauv cov ntshav ntshav.

Hauv cov neeg mob uas mob ntshav qab zib nephropathy, telmisartan thiab ACE inhibitors tsis pom zoo.

Nyob rau hauv rooj plaub uas vascular suab nrov thiab lub raum ua haujlwm feem ntau yog nyob ntawm qhov kev ua si ntawm RAAS (piv txwv li, hauv cov neeg mob raum, nrog rau ob leeg lub raum mob hlwb los yog ua rau lub raum mob ntawm lub raum, lossis nrog mob plawv tsis zoo), kev siv tshuaj uas cuam tshuam rau RAAS tuaj yeem ua rau kev txhim kho hyperazotemia, mob hlab ntaws ceev ntshav, muaj kab mob oliguria thiab mob raum tsis zoo (muaj qee zaus).

Thaum siv cov tshuaj potassium-sparing diuretics, cov ntsev ntxiv ntsev muaj txiaj ntsig, tshuaj ntxiv thiab lwm yam tshuaj uas ua rau kom muaj cov potassium ntau hauv cov ntshav ntshav ua ke nrog Telmista, nws yog qhov tsim nyog los tswj qib ntawm cov poov tshuaj hauv ntshav.

Txij li thaum telmisartan raug nthuav tawm feem ntau nrog cov kua tsib, nrog cov kab mob uas cuam tshuam ntawm txoj hlab plab los yog ua rau lub siab ua haujlwm, qhov txo qis hauv kev tshem tawm ntawm cov tshuaj yog ua tau.

Nrog rau cov ntshav qab zib thiab ntxiv kev pheej hmoo mob plawv, piv txwv li, mob plawv (mob plawv), Kev Siv Telmista tuaj yeem ua rau tuag taus myocardial infarction thiab mob plawv tuag sai. Hauv cov neeg mob uas mob ntshav qab zib mellitus, kev mob plawv tsis tuaj yeem kuaj mob, vim tias nws cov tsos mob hauv qhov no tsis tshwm sim tas li. Yog li, ua ntej pib siv tshuaj kho, nws yog qhov yuav tsum tau ua qhov kev kuaj mob kom tsim nyog, suav nrog kev sim nrog kev ua haujlwm ntawm lub cev.

Hauv cov neeg mob ntshav qab zib tau txais kev kho mob los ntawm insulin lossis tshuaj noj ntshav qab zib hauv qhov ncauj, hypoglycemia yuav tshwm sim thaum kho nrog Telmista. Cov neeg mob zoo li no yuav tsum tswj hwm qhov concentration ntawm cov piam thaj hauv cov ntshav, vim tias nyob ntawm qhov ntsuas no, cov koob tshuaj insulin lossis hypoglycemic yuav tsum kho.

Hauv cov thawj hyperaldosteronism, kev siv tshuaj tiv thaiv kabmob - RAAS inhibitors - feem ntau tsis muaj txiaj ntsig. Cov neeg mob zoo li no tsis pom zoo siv Telmista.

Kev siv cov tshuaj muaj peev xwm ua ke nrog thiazide diuretics, txij li ib qho kev sib xyaw no muab ib qho kev txo qis ntxiv hauv cov ntshav siab.

Cov kev tshawb fawb pom tau tias Telmista tsis ua haujlwm zoo rau cov neeg mob ntawm cov haiv neeg Negroid. Kev tsis ua haujlwm ntawm lub siab ua haujlwm nrog kev siv telmisartan tau pom muaj feem ntau ntawm cov neeg nyob hauv Nyij Pooj.

Cev xeeb tub thiab lactation

Raws li cov lus qhia, Telmista yog contraindicated thaum cev xeeb tub. Yog tias kev kuaj mob thaum cev xeeb tub, cov tshuaj yuav tsum nres tam sim ntawd. Yog tias tsim nyog, tshuaj tiv thaiv kabmob ntawm lwm cov chav kawm uas tau pom zoo rau kev siv thaum cev xeeb tub yuav tsum yog cov kws kho mob. Cov poj niam npaj ua cev xeeb tub kuj tseem qhia kom siv lwm txoj kev kho.

Hauv kev tshawb nrhiav preclinical ntawm cov tshuaj, teratogenic cov teebmeem tsis tau pom. Tab sis nws tau pom tias kev siv cov angiotensin II receptor antagonists hauv kev txiav tawm thib ob thiab thib peb ntawm cev xeeb tub ua rau fetotoxicity (oligohydramnios, lub raum tsis zoo, txo qis ossification ntawm cov pob txha ntawm pob txha taub hau) thiab neonatal toxicity (arterial hypotension, raum tsis ua haujlwm, hyperkalemia).

Cov menyuam mos uas lawv niam noj Telmista thaum cev xeeb tub yuav tsum muaj kev saib xyuas kev noj qab haus huv vim muaj peev xwm txhim kho txoj hlab ntshav hauv txoj hlab ntshav tshiab.

Txij li tsis muaj cov ntaub ntawv hais txog kev nkag mus ntawm telmisartan mus rau niam mis, cov tshuaj no yog sib kis thaum pub niam mis.

Nrog lub siab ua haujlwm tsis zoo

Nws tsis pom zoo kom noj cov tshuaj hauv cov neeg mob uas muaj lub siab tsis ua hauj lwm zoo (raws li Child-Pugh kev faib tawm - chav C).

Nrog me me mus rau me ntsis tsis txaus siab hepatic tsis txaus (raws li kev faib tawm rau menyuam yaus-Pugh - Chav A thiab B), kev siv ntawm Telmista yuav tsum ceev faj. Qhov siab tshaj plaws qhov koob tshuaj txhua hnub hauv qhov no yuav tsum tsis pub tshaj 40 mg.

Yeeb tshuaj sib cuam tshuam

Kev siv telmisartan ib txhij nrog qee cov tshuaj yuav ua rau kev txhim kho cov teebmeem hauv qab no:

antihypertensive tshuaj: muaj zog antihypertensive nyhuv,
warfarin, digoxin, ibuprofen, glibenclamide, hydrochlorothiazide, paracetamol, amlodipine thiab simvastatin: tsis muaj kev cuam tshuam tseem ceeb hauv tsev kho mob. Hauv qee kis, kev nce ntxiv ntawm plasma digoxin cov ntsiab lus los ntawm qhov nruab nrab ntawm 20% yog ua tau. Thaum ua ke nrog digoxin, nws raug nquahu kom saib xyuas nws lub plasma cov ntshav tsis tu ncua,
potassium-sparing diuretics (piv txwv li, spironolactone, amiloride, triamteren, eplerenone), potassium hloov pauv, ACE inhibitors, angiotensin II receptor antagonists, NSAIDs (tsis siv tshuaj tiv thaiv tshuaj tiv thaiv kab mob), suav nrog rau xaiv cyclooxygenase-hemporin-2-azimonodipromenph, 2-azimonodipromenph, 2-azimonodipromenph, 2-azimonodipromenph thiab trimethoprim: kev pheej hmoo siab ntawm hyperkalemia (vim muaj cov nyhuv synergistic),
ramipril: 2,5-fold hauv C ntsuas_max thiab AUC_0-24 ramipril thiab ramiprilat,
kev npaj lithium: kev thim rov qab ua kom rov qab nyob rau hauv cov concentration ntawm lithium hauv cov ntshav (tau qhia tawm hauv qee qhov tsis tshua muaj) nrog cov tshuaj lom. Nws raug nquahu kom koj nquag xyuas qib plasma lithium,
NSAIDs (suav nrog acetylsalicylic acid, tsis xaiv tshuaj NSAIDs thiab cyclooxygenase-2 inhibitors): txo cov nyhuv hypotensive ntawm telmisartan, ua rau muaj kev pheej hmoo ntawm lub raum tsis ua haujlwm thaum lub cev qhuav dej. Thaum pib ntawm kev sib xyaw ua ke nrog telmisartan thiab NSAIDs, nws yog qhov tsim nyog los them rau bcc thiab kuaj xyuas lub raum kev ua haujlwm,
amifostine, baclofen: potentiation ntawm kev ua haujlwm hypotensive ntawm telmisartan,
barbiturates, haus dej cawv, tshuaj tiv thaiv kab mob thiab tshuaj: aggravation ntawm orthostatic hypotension.

Telmista lub analogues yog: Mikardis, Teseo, Telmisartan-Richter, Telmisartan-SZ, Telpres, Telsartan thiab lwm yam.

Dosage daim ntawv

Ib ntsiav tshuaj muaj

Telmista®H40

yam tshuaj: Telmisartan 40mg

hydrochlorothiazide 12,5 mg

tus zam: meglumine, sodium hydroxide, povidone K30, lactose monohydrate, sorbitol, magnesium stearate, mannitol, hlau oxide liab (E172), hydroxypropyl cellulose, anhydrous colloidal silicon dioxide, sodium stearyl fumarate

Telmista®H80

yam tshuaj: Telmisartan 80mg

hydrochlorothiazide 12,5 mg

Telmista®ND 80

yam tshuaj: telmisartan 80 mg

hydrochlorothiazide 25 mg

tus zam: meglumine, sodium hydroxide, povidone K30, lactose monohydrate, sorbitol, magnesium stearate, mannitol, hlau oxide daj (E172) hydroxypropyl cellulose, anhydrous colloidal silicon dioxide, sodium stearyl fumarate

Oval ntsiav tshuaj, biconvex, bilayer, los ntawm dawb mus rau yuav luag dawb lossis pinkish-dawb hauv xim ntawm ib sab thiab liab-marble rau sab nraud (rau kev siv 40 mg / 12.5 mg thiab 80 mg / 12.5 mg).

Cov ntsiav tshuaj dawb, biconvex, ob-txheej, los ntawm xim dawb mus rau daj-dawb hauv cov xim ntawm ib sab thiab daj-marble ntawm sab nraud (rau ntau npaum li 80 mg / 25 mg).

Cov chaw muag tshuaj

Cov Tshuaj Pharmacokinetics

Qhov siab tshaj plaws ntawm telmisartan nrog qhov ncauj tswj hwm tau tiav tom qab 0.5-1.5 teev tom qab kev tswj hwm. Qhov tsis txaus ntseeg ntawm biomailability ntawm telmisartan nyob rau hauv koob tshuaj 40 mg thiab 160 mg yog 42% thiab 58%, feem. Kev noj zaub mov ib txhij tsis muaj peev xwm txo qis kev noj qab haus huv ntawm telmisartan, txo thaj tsam hauv qhov siab tshaj plaws ntawm cov tshuaj hauv cov ntshav ntshav (AUC) li ntawm 6% thaum noj 40 mg thiab los ntawm kwv yees li 19% tom qab noj 160 mg. Kev poob qis me ntsis hauv kev siab tshaj plaws tsis cuam tshuam rau kev kho kom zoo ntawm cov tshuaj. Lub chaw muag tshuaj ntawm telmisartan thaum muab cov tshuaj ntawm 20-160 mg yog cov tsis haum, Cmax thiab AUC feem ntau nce nrog cov tshuaj ntau dua. Nrog kev siv tas li, telmisartan me ntsis accumulates hauv ntshav ntshav.

Telmisartan khi tau zoo rau cov ntshav plasma protein (> 99.5%), feem ntau albumin thiab alpha L-acid glycoproteins. Qhov pom meej ntim ntawm kev faib tawm ntawm telmisartan yog kwv yees li 500 L, uas qhia tau cov ntaub so ntswg ntxiv.

Ntau tshaj li 97% ntawm cov tshuaj thaum muab tshuaj ntawm qhov ncauj yog tso rau hauv cov quav los ntawm txoj kev tso tawm biliary. Ib co kua nplaum muaj nyob hauv zis. Telmisartan yog metabolized los ntawm kev sib txuas rau cov tshuaj sib xyaw ua ke pharmacologically tsis muaj zog - acetyl glucuronides. Glucuronides tsuas yog cov metabolites ntawm cov khoom pib uas tau pom muaj hauv tib neeg.

Tom qab ib koob tshuaj telmisartan, cov ntsiab lus ntawm glucuronides hauv cov ntshav ntshav yog kwv yees li 11%. Telmisartan tsis yog metabolized los ntawm isoenzymes ntawm cytochrome P450 system. Tus nqi tshem tawm ntawm cov ntshav ntshav yog ntau dua 1500 ml / min. Lub davhlau ya nyob twg ib nrab-lub neej ntawm ntau tshaj 20 teev

Nrog kev tswj hwm qhov ncauj ntawm kev sib xyaw ua ke ntawm telmisartan / hydrochlorothiazide, qhov siab tshaj plaws ntawm hydrochlorothiazide tau mus txog hauv 1.0-3.0 teev tom qab kev tswj hwm. Xav txog tias hydrochlorothiazide tuaj yeem tsim tawm thaum lub sijhawm ua kom lub raum ua haujlwm, qhov tshwj xeeb bioavailability yog 60%.

Hydrochlorothiazide yog 68% ua txhua yam rau cov ntshav plasma protein thiab nws qhov kev faib tawm kom pom tseeb yog 0.83-1.14 l / kg.

Hydrochlorothiazide tsis yog metabolized thiab yog yuav luag txhua yam hloov pauv tsis dhau lub raum nrog zis. Li ntawm 60% ntawm qhov ncauj noj yog kho tsis muaj qhov hloov hauv 8 teev

Lub davhlau ya nyob twg ib nrab-lub neej ntawm hydrochlorothiazide yog 10-15 teev.

Cov Tshuaj Hauv Tshuaj

Kev sib xyaw ua ke ntawm telmisartan / hydrochlorothiazide yog kev sib txuas ntawm cov tshuaj mob angiotensin II receptor antagonist, telmisartan thiab thiazide diuretic, hydrochlorothiazide, uas muab cov qib siab ntawm cov nyhuv tshuaj tiv thaiv ntau dua li siv txhua yam ntawm cov khoom sib cais. Thaum noj cov tshuaj sib xyaw ua ke ntawm telmisartan / hydrochlorothiazide ib hnub ib zaug, qhov ua tau zoo thiab txo qis hauv cov ntshav siab nyob rau hauv txoj kev kho kom zoo.

Telmisartan siv tau thaum noj ntawm qhov ncauj thiab yog qhov tshwj xeeb (xaiv tau) tshuaj thaiv cov kabmob ntawm angiotensin II receptor subtype 1 (AT1). Telmisartan hloov chaw angiotensin II, vim tias nws muaj kev sib koom siab siab rau AT1 receptors ntawm cov ntawv cog lus xaib, uas yog lub luag haujlwm rau cov teeb meem tsim los ntawm angiotensin II. Telmisartan xaiv zoo thiab txuas mus txuas rau AT1 receptors thiab tsis muaj kev cuam tshuam rau lwm cov receptors, suav nrog AT2 thiab lwm cov receptors AT. Lub luag haujlwm ua haujlwm ntawm cov receptors tseem tsis tau tsim, ntxiv rau lawv cov kev cuam tshuam thaum muaj peev xwm ua hyperstimulation ntawm angiotensin II, qib uas nce ntxiv nyob rau hauv kev cuam tshuam ntawm telmisartan. Telmisartan txo plasma aldosterone ntau ntau thiab tsis inhibit kev ua ntawm angiotensin-hloov enzyme (kininase II), nrog kev koom tes ntawm uas muaj qhov txo qis hauv synthesis ntawm bradykinin, yog li kev muaj zog ntawm qhov tsis zoo ntawm bradykinin tsis tshwm sim.

Kev txwv tsis pub cov tshuaj angiotensin II tawm tsam keeb kwm ntawm telmisartan kav ntau dua 24 teev thiab kav ntev txog 48 teev.

Tom qab noj cov tshuaj telmisartan, cov haujlwm tiv thaiv kev tsis txaus ntseeg tau ua tiav hauv 3 teev. Qhov siab tshaj plaws nyob rau hauv cov ntshav siab feem ntau ua tiav 4-8 lub lis piam tom qab pib kho thiab txuas ntxiv thaum kho mob ntev. Cov nyhuv antihypertensive tau raug tswj nyob ntawm theem ib txwm rau 24 teev.

Hauv cov neeg mob ntshav siab, telmisartan txo qis ob qho systolic thiab diastolic ntshav siab tsis cuam tshuam rau lub plawv dhia.

Nrog kev tsis ua tiav ntawm kev kho mob nrog telmisartan, ntshav siab maj mam rov qab mus rau nws qib dhau los li ob peb hnub yam tsis muaj "kev rov ua mob" (nce siab hauv ntshav siab).

Thiazides cuam tshuam rau kev rov qab siv cov roj hauv electrolytes hauv cov tubules ntawm ob lub raum, ncaj qha nce ntxiv qhov tsis pom ntawm sodium thiab chlorides nyob hauv kwv yees sib npaug. Cov nyhuv diuretic ntawm hydrochlorothiazide ua rau txo cov ntshav plasma ntau npaum li cas, nce ntxiv ntawm plasma renin qib, kev nce siab ntawm aldosterone secretion, uas ua rau muaj kev nce ntxiv ntawm cov zis tsis tuaj yeem ntawm cov poov tshuaj thiab bicarbonates thiab, raws li, txo qis hauv poov tshuaj qib potassium. Qhov thaiv ntawm lub renin-angiotensin ntawm aldosterone system nrog kev siv sib xyaw ua ke ntawm telmisartan nrog diuretics ua rau muaj kev cuam tshuam rov qab poob ntawm cov poov tshuaj los ntawm lub cev. Thaum noj hydrochlorothiazide, diuresis pib tom qab 2 teev, qhov siab tshaj plaws diuretic nyhuv tau tiav 4 teev tom qab kev tswj hwm, qhov kev txiav txim kav ntev li 6-12 teev.

Kev ntsuas rau siv

- kev kho mob ntawm txoj hlab ntshav siab

Telmista®H40 thiab Telmista®H80 yog qhia rau cov neeg mob uas tsis tuaj yeem tswj hwm cov ntshav siab los ntawm kev siv telmisartan lossis hydrochlorothiazide nyob rau hauv daim ntawv ntawm monotherapy.

Telmista® ND80 yog qhia rau cov neeg mob cov neeg laus uas nws tsis tuaj yeem tswj hwm qhov ntshav siab los ntawm kev siv Telmista® N80 lossis hauv leej twg lub siab tau ua yav tas los tswj hwm siv telmisartan thiab hydrochlorothiazide cais.

Tsuas tshuaj thiab tswj hwm

Telmista®N40, Telmista®N80 lossis Telmista®ND80 yuav tsum tau siv ib hnub ib zaug, ntxuav tawm nrog cov dej me me, tsis hais txog qhov ua zaub mov noj.

Ua ntej kev kho mob nrog telmisartan / hydrochlorothiazide ua ke yuav tsum tau ua

xaiv koob tshuaj nyob rau keeb kwm ntawm monotherapy nrog telmisartan. Yog tias tsim nyog, koj tuaj yeem hloov tam sim ntawd los ntawm kev kho kab mob rau kev kho mob nrog kev sib txuas ntawm cov koob tshuaj ruaj khov.

Telmista®H40 tuaj yeem kho mob rau cov neeg mob uas ntshav siab tsis txaus tswj los ntawm telmisartan 40 mg.

Telmista® H80 tuaj yeem kho mob rau cov neeg mob uas ntshav siab tsis txaus tswj los ntawm 80 mg telmisartan.

Telmista® ND80 tuaj yeem kho rau cov neeg mob hauv cov ntshav siab tsis txaus tswj los ntawm Telmista® N80 lossis tus neeg lub siab tau ua yav tas los tswj los ntawm kev siv telmisartan thiab hydrochlorothiazide cais.

Tom qab pib txoj kev kho mob nrog kev sib xyaw ntawm telmisartan / hydrochlorothiazide, cov txiaj ntsig siab tshaj plaws tiv thaiv tau ua tiav nyob rau thawj 4-8 lub lis piam. Yog tias tsim nyog, Telmista®H40, Telmista®H80 lossis Telmista®ND80 tuaj yeem kho nrog lwm cov tshuaj tiv thaiv kabmob ntshav.

Cov neeg mob raum tsis ua haujlwm

Peb nquahu kom kuaj xyuas lub raum ua haujlwm tsis tu ncua.

Cov neeg mob mob siab tsis ua haujlwm

Hauv cov neeg mob uas muaj mob me me mus rau mob hepatic, lub koob tshuaj yuav tsum tsis pub tshaj 1 ntsiav tshuaj Telmista®N40 (telmisartan 40 / hydrochlorothiazide 12.5 mg) ib hnub ib zaug.

Cov neeg laus yuav tsum tsis txhob hloov kho ntxiv.

Pharmacological kev txiav txim

Cov ntsiav tshuaj Telmista - cov tshuaj zoo rau lub siab, muaj tus nqi pheej yig.

Nws qhov kev ua yog tsom rau kev thaiv cov receptors ntawm hom AT1, thaum nws tsis cuam tshuam rau lwm hom receptors.

Qhov siab tshaj qhov ua rau siab ntawm kev noj Telmista yog pom tom qab ib hlis ntawm kev kho, uas qhia qhov cuam tshuam ntev ntawm cov tshuaj.

Cov yam ntxwv ntawm cov tshuaj yog raws li kev sib txuam ua ke ntawm telmisartan nrog cov khoom siv hydrochlorothiazide, uas yog diuretic. Cov tshuaj yog xaiv hom antagonist uas siv rau kev txiav txim ntawm angiotensin ii. Cov tshuaj tiv thaiv muaj zog ua rau muaj kev sib raug zoo ntev nrog AT1 receptor.

Cov tshuaj txo cov aldosterone hauv cov ntshav ntshav ntau npaum li cas. Cov tshuaj txo cov aldosterone hauv cov ntshav ntshav ntau npaum li cas. Tsis muaj cuam tshuam dab tsi rau ntawm cov channel ion thiab renin. Qhov kev cuam tshuam ntawm kininase II tshuaj, uas muaj cov nyhuv zuj zus ntawm bradykinin, kuj tseem tsis tuaj.

Kuv yuav tsum tso ntshav dab tsi ntxiv?

Txhawm rau txo cov ntshav siab, 40 mg Telmista tau sau tseg hauv ib hnub. Hauv qee tus neeg mob, txawm tias qhov hno tshuaj 20 mg ib hnub twg, ib cov txiaj ntsig txaus tuaj yeem ua tiav. Yog hais tias lub hom phiaj txo qis ntshav siab tsis tiav, tus kws kho mob yuav nce qhov ntxiv rau 80 mg rau ib hnub.

Cov tshuaj muaj peev xwm muab tau ua ke nrog tus neeg sawv cev dehydrating los ntawm pawg thiazide (piv txwv li, hydrochlorothiazide). Ua ntej txhua qhov nce hauv koob, tus kws kho mob yuav tos txij plaub mus rau yim lub lis piam, txij li ntawd los cov nyhuv siab tshaj plaws ntawm cov tshuaj tau tshwm sim.

Txhawm rau tiv thaiv vascular kev puas tsuaj nyob rau hauv kev mob ua ntej, cov koob tshuaj pom zoo yog 80 mg ntawm telmisartan ib zaug ib hnub. Thaum pib kho, nquag xyuas ntshav tawm ntshav pom zoo. Yog tias tsim nyog, tus kws kho mob yuav hloov cov tshuaj kom ua tiav cov ntshav siab. Cov ntsiav tshuaj raug pom zoo kom noj nrog kua lossis tsis hais txog kev noj zaub mov.

Telmista H80

Cov tshuaj tau noj ntawm qhov ncauj 1 zaug / hnub, tsis hais txog ntawm cov zaub mov noj. Cov ntsiav tshuaj yuav tsum tau muab ntxuav nrog qhov me me ntawm cov dej.

Telmista H80 tuaj yeem tsim kho rau cov neeg mob uas siv cov tshuaj telmisartan hauv ib koob ntawm 80 mg tsis ua rau muaj kev tswj hwm ntshav txaus.

Nyeem kuj cov lus no: Lasix: 40 mg ntsiav tshuaj thiab hno

Ua ntej pib kev kho mob, kev xaiv koob tshuaj yuav tsum tau ua rau kev kho mob telmisartan monotherapy. Yog tias tsim nyog, koj tuaj yeem hloov tam sim ntawd los ntawm telmisartan monotherapy rau kev kho mob nrog Telmista H80.

Yog tias tsim nyog, cov tshuaj tuaj yeem raug sau nrog lwm cov tshuaj tiv thaiv antihypertensive.

Sab sij huam

Kev siv Telmista, zoo li lwm cov tshuaj tiv thaiv kev tiv thaiv, tuaj yeem ua rau ntau yam kev tsis zoo rau lub cev.

Ntawm cov kev phiv, cov lus qhia rau kev siv qhov txawv hauv qab no:

ua txhaum ntawm ob lub raum thiab lub chaw tso zis,
mob npaws nrog kub taub hau thiab malaise,
hnoos, mob sib kis ntawm cov pa sab saud thiab qis, ua pa nyuaj,
tsis khov ntawm cov cuab yeej siv qhov muag pom,
mob plawv atherosclerosis mob, tiv thaiv uas tachycardia thiab bradycardia tshwm sim,
mob plab thiab plab hnyuv, uas tau pom tias zawv plab, xeev siab, mob tsis xwm yeem thiab mob plab,
tsaus muag, pw tsaug zog, nkees,
hypersensitivity rau ntau yam sab nraud cuam tshuam, uas ua tau nws tus kheej hauv daim ntawv ntawm daim tawv nqaij khaus thiab urticaria, anaphylactic ceeb thiab hyperhidrosis,
anemia thiab kev hem thawj ntawm tuag taus sepsis,
cov txiaj ntsig tsis zoo ntawm kev tshawb nrhiav qhov tseeb ntawm tus neeg mob biomaterial, uas tau qhia nyob rau hauv lub siab ntawm uric acid, creatinine hauv cov ntshav, hypoglycemia thiab hemoglobin txo qis.

Ib qho kev mob tshwm sim no tuaj yeem tshwm sim ib leeg lossis hauv kev sib xyaw nrog lwm tus. Rau cov tsos mob tsis txaus ntseeg, yuav tsum tau saib xyuas kev kho mob sai sai uas yuav tsum kho cov kev kho mob kom zoo.

Cov menyuam yaus, thaum cev xeeb tub thiab lactation

Qhov kev nyab xeeb thiab ua haujlwm ntawm kev siv telmisartan hauv kev kho mob rau cov menyuam yaus tsis tau tsim, yog li ntawd, Telmista ntsiav tshuaj 40 mg, 80 mg thiab 20 mg yuav tsum tsis txhob raug rau cov menyuam yaus thiab cov hluas hnub nyoog qis dua 18 xyoo.

Raws li cov lus qhia, Telmista yog contraindicated thaum cev xeeb tub. Yog tias kev kuaj mob thaum cev xeeb tub, cov tshuaj yuav tsum nres tam sim ntawd.

Txij li tsis muaj cov ntaub ntawv hais txog kev nkag mus ntawm telmisartan mus rau niam mis, cov tshuaj no yog sib kis thaum pub niam mis.