Hartil Amlo: cov lus qhia rau kev siv

Cov tshuaj ntsiav 5 mg + 5 mg, tawv tawv, gelatin, CONI-SNAP 3, tsis kaw, kaw nws tus kheej, nrog lub ntsiab lus opaque nyob rau hauv lub teeb burgundy thiab ib qho opaque npog hauv lub teeb burgundy.

PRING crospovidone (E-1202), hypromellose (E-464), microcrystalline cellulose (E-460), glycerol dibehenate.

Cov lus sib xyaw ntawm cov tshuaj ntsiav CONI-SNAP 3: ci ntsa iab xiav (E-133), liab ntxim nyiam (E-129), titanium dioxide (E-171), gelatin.

7 Pcs - cov hlwv ua los ntawm PVC / Polyamide / Aluminium (4) - pob khoom los ntawm cardboard.
7 Pcs - cov hlwv ua los ntawm PVC / Polyamide / Aluminium (8) - pob khoom los ntawm cardboard.
10 Pcs - cov hlwv ua los ntawm PVC / Polyamide / Aluminium (3) - pob cov duab los qhia.
10 Pcs - cov hlwv ua los ntawm PVC / Polyamide / Aluminium (9) - pob khoom los ntawm cardboard.

Pharmacological kev txiav txim

Tus txheej txheem ntawm kev ua ntawm ramipril

Ramiprilat, ib qho ua kom tawv nqaij ntawm lub ramipril prodrug, tiv thaiv cov enzyme dipeptidyl carboxypeptidase I (txhais: angiotensin-hloov enzyme, kininase II). Hauv cov ntshav thiab cov nqaij mos, qhov enzyme catalyzes hloov dua siab tshiab ntawm angiotensin Kuv mus rau hauv cov tshuaj vasoconstrictor nquag - angiotensin II, thiab tseem ua rau muaj kev cuam tshuam ntawm lub vasodilator yam muaj zog - bradykinin. Txo cov tsim ntawm angiotensin II thiab inhibiting qhov kev ua tsis zoo ntawm bradykinin ua rau vasodilation.

Txij li thaum angiotensin II tseem txhawb cov kev tso tawm ntawm aldosterone, ramiprilat txo kev zais cia ntawm aldosterone. Cov lus teb nruab nrab rau kev kho mob monotherapy nrog ACE inhibitor yog qhov tsawg dua ntawm cov neeg dub (Afro-Caribbean) cov neeg mob ntshav liab (cov neeg mob ntawm cov neeg mob ntshav siab thiab, raws li txoj cai, nrog cov ntsiab lus qis qis) dua li cov neeg mob uas muaj xim tawv nqaij sib txawv.

Kev siv cov ramipril tau nrog ua ke los ntawm lub cim txo qis hauv peripheral arterial tsis kam. Raws li txoj cai, cov tshuaj tsis hloov pauv lub plawv tso ntshav txaus thiab tus nqi glomerular pom. Kev siv cov ramipril yog nrog los ntawm cov nyhuv antihypertensive, ob qho tib si nyob rau hauv txoj haujlwm sawv ntawm tus neeg mob thiab hauv txoj hauj lwm dag, thiab cov tshuaj tsis ua rau kom muaj kev tiv thaiv tachycardia.

Tom qab ib qho kev tswj hwm ntawm qhov ncauj ntawm ramipril, nws cov nyhuv antihypertensive raug pom nyob rau hauv 1-2 teev, nce mus txog qhov siab tshaj plaws tom qab 3-6 teev thiab kav rau 24 teev. Nrog rau kev noj txhua hnub ntawm ramipril, nws cov nyhuv antihypertensive maj nce dhau 3-4 lub lis piam thiab mob tsawv nrog rau kev kho mob ntev.

Kev tshem tawm sai ntawm ramipril tsis nrog ua ke los ntawm ntshav nce siab sai sai.

Tus txheej txheem ntawm kev ua ntawm amlodipine

Amlodipine inhibits qhov transmembrane tau txais cov calcium ions hauv cardiomyocytes thiab cov leeg ntshav ntawm cov leeg nqaij ("qeeb" calcium channel blocker lossis calcium ion antagonist).

Lub tshuab ntawm nws cov txiaj ntsig antihypertensive yog vim muaj cov nyhuv so ncaj qha rau cov leeg ntawm cov leeg ntshav, ua rau txo qis rau cov hlab ntshav tsis kam.

Cov ncauj lus ntxaws ntxaws ntawm cov txheej txheem uas nws ua kom ua tiav chav kawm ntawm angina pectoris tseem tsis tau tsim, tab sis tus txheej txheem no tuaj yeem ua haujlwm hauv ob txoj kev qhia:

1) kev nthuav dav ntawm cov hlab ntsha ntsig (peripheral arterioles), thiab, yog li, qhov txo qis ntawm tag nrho cov kab mob leeg tawm tsam (tom qab dhau los).

Txij li cov tshuaj tsis ua rau mob reflex tachycardia, lub zog noj ntawm myocardium thiab nws cov kev xav tau cov pa oxygen yuav txo qis.

2) kev nthuav dav ntawm cov hlab ntsha loj ntawm cov hlab ntsha thiab cov hlab ntsha txhaws, ob qho tib si hauv kev hloov pauv thiab hauv thaj chaw ischemic ntawm lub plawv mob, nce qhov khiav ntawm oxygen mus rau myocardium.

Cov txheej txheem piav qhia saum toj no ua rau muaj myocardial oxygen tso nrog txawm tias muaj qhov txha nqaj qaum ntawm lub cev txhaws (cov hlab ntsha txhaws lossis Prinzmetal angina).

Hauv cov neeg mob uas muaj mob ntshav tawm ntawm txoj hlab ntshav liab, ib koob tshuaj txhua hnub ntawm amlodipine ua rau muaj kev txo qis ntshav siab ntau dhau 24 teev (hauv tus neeg mob "dag" thiab "sawv" chaw). Vim tias muaj kev kawm tshwm sim zuj zus thiab kev ua kom ntev, cov tshuaj tsis ua rau muaj kev tiv thaiv ntshav siab.

Hauv cov neeg mob uas muaj tus kab mob angina pectoris, ib koob tshuaj txhua hnub nce kev tawm dag zog ua haujlwm, ncua kev tsim tawm ntawm lwm qhov kev tawm tsam ntawm angina pectoris thiab "ischemic" kev nyuab siab ntawm ntu ntu ST, thiab txo cov zaus ntawm angina tawm tsam thiab noj nitroglycerin. Cov tshuaj tsis ua rau muaj kev phom sij hauv lub cev: nws tsis cuam tshuam rau cov ntshav lipids, ntshav qab zib thiab ntshav uric acid thiab tuaj yeem raug kho rau cov neeg mob hawb pob.

Kev Kawm Kev Nyab Xeeb Preclinical

Hais txog ramipril:

Nrog lub qhov ncauj tswj hwm ntawm ramipril rau cov nas thiab dev, nws tau pom tias cov tshuaj tsis ua rau mob lom hauv tsiaj. Cov kev tshawb fawb siv kev tswj hwm qhov ncauj ntawm cov tshuaj pab tau ua nyob rau hauv nas, dev, thiab liab. Hauv tag nrho peb hom tsiaj, kev hloov pauv ntawm kev nqus ntawm cov ntshav electrolytes thiab kev hloov pauv hauv cov ntshav cov ntshav tau sau tseg.

Raws li cov ntaub ntawv pov thawj ntawm cov chaw muag tshuaj muaj txiaj ntsig ntawm ramipril, kev txhim kho lub raum juxtaglomerular complex hypertrophy tau pom nyob hauv cov dev thiab cov liab ntawm ib koob tshuaj 250 mg / kg / hnub. Nas, dev, thiab liab tau zam txhua hnub ntawm 2, 2.5, thiab 8 mg / kg (hnyav lub cev) / hnub, ntsig txog, yam tsis muaj kev cuam tshuam tsis zoo.

Cov kev tshawb fawb ntawm cov tshuaj lom cuam tshuam rau cov tshuaj ntawm kev ua me nyuam nyob rau hauv cov nas, luav thiab liab tau tsis qhia txog cov nyhuv teratogenic ntawm ramipril. Nees txiv neej thiab poj niam nas tsis pom muaj kev pauv hloov yug me nyuam.

Kev qhia ntawm ramipril rau cov poj niam nas thaum lub sijhawm xeeb menyuam thiab lub sijhawm lactation hauv ib hnub ntawm 50 mg / kg lub cev hnyav (lossis siab dua) tau nrog kev tsis tuaj yeem ua rau lub raum puas tsuaj (nthuav ntawm lub raum lub raum) ntawm tus me nyuam hauv plab.

Hauv cov kev tshawb fawb loj uas siv ntau lub tshuab ntsuas, tsis muaj cov cim ntawm mutagenicity lossis genotoxicity ntawm ramipril tau pom.

Hauv kev sib raug zoo rau amlodipine:

Cov nas thiab cov nas uas tau ntxiv nrog amlodipine maleate hauv pub ntau txog li ob xyoos ntawm kev siv ntau uas sib xws rau cov koob tshuaj txhua hnub ntawm 0.5, 1.25 thiab 2.5 mg ntawm amlodipine / kg (lub cev hnyav) / hnub, tsis pom muaj cov nyhuv carcinogenic. Qhov koob tshuaj siab tshaj plaws hauv cov nas (hais txog mg / m 2) piv rau qhov siab tshaj plaws pom zoo rau tib neeg koob tshuaj (MHD) ntawm 10 mg amlodipine ib hnub. Qhov siab tshaj plaws nyob rau hauv cov nas (hais txog mg / m 2) yog kwv yees li ob zaug ntau dua MPD.

Hauv kev kawm ntawm amlodipine maleate, tsis muaj cov cim ntawm mutagenicity tshwm sim los ntawm kev siv cov tshuaj, ob leeg nyob rau qib noob thiab ntawm qib ntawm cov chromosomes.

Qoj ib ce hauv cov nas uas muab qhov ncauj amlodipine maleate ntawm koob tshuaj txog 10 mg / kg (qhov hnyav hauv lub cev) / hnub (uas, ntawm mg / m 2, yog 8 zaug ntau dua li MPD ntawm 10 mg / hnub) tsis raug mob.

Yeeb tshuaj sib cuam tshuam

Hais txog ramipril:

Cov txheej txheem ua haujlwm ntxiv nrog rau cov ntshav sib chwv nrog cov chaw tsis zoo, xws li hemodialysis los ntawm cov kab mob siab (xws li daim nyias nyias ua los ntawm polyacrylonitrile tebchaw), hemofiltration lossis apheresis ntawm tsawg lipoproteins siv cov dextran sulfate, vim tias muaj kev pheej hmoo ntawm kev tsim cov tshuaj tiv thaiv tsis zoo lossis cov tshuaj tiv thaiv anaphylactoid. Yog tias kev kho mob yog qhov tsim nyog, tom qab ntawd siv cov tshuaj sib txawv ntawm daim nyias nyias rau kev lim ntshav lossis tshuaj tiv thaiv kabmob ntshav ntawm ntau pawg yuav tsum tau txiav txim siab.

Cov kev ceev faj rau kev siv

Nrog rau kev tswj hwm tib lub sijhawm nrog cov poov tshuaj npaj, capi-khaws cia diuretics thiab lwm yam tshuaj lom neeg uas ua rau kom plasma ntau ntau qib (suav nrog nrog angiotensin II receptor antagonists, trimethoprim, tacrolimus, cyclosporine): kev txhim kho hyperkalemia muaj peev xwm ua tau, yog li nws yuav tsum ua tib zoo saib xyuas qib ntawm cov poov tshuaj hauv ntshav ntshav.

Cov tshuaj tiv thaiv kab mob siab (piv txwv li, diuretics) thiab lwm yam tshuaj uas tuaj yeem txo cov ntshav siab (piv txwv, nitrates, tricyclic antidepressants, tshuaj mob plab, haus cawv, baclofen, alfuzosin, doxazosin, prazosin, tamsulosin, terazosin): kev pheej hmoo ntawm hypotension tuaj yeem muaj hwj chim.

Vasopressor sympathomimetics thiab lwm yam tshuaj (piv txwv, isoproterenol, dobutamine, dopamine, adrenaline) tuaj yeem txo cov nyhuv antihypertensive ntawm ramipril: tshuaj xyuas ntshav siab pom zoo.

Allopurinol, immunosuppressants, corticosteroids, procainamide, cytostatics thiab lwm yam tshuaj uas tuaj yeem hloov cov ntshav ntawm cov ntshav: ib qho kev ntxim nyiam ntawm kev tsim hematological tshua.

Lithium ntsev: thaum noj ACE inhibitors nrog lithium npaj, nws yog ib qho ua tau kom txo qis nws cov zis thiab, raws li, nce qhov kev nce qib ntawm lithium hauv cov ntshav nrog kev nce ntxiv hauv nws cov tshuaj lom. Kev tshuaj xyuas tas li ntawm cov qib lithium yog qhov yuav tsum tau ua.

Cov tshuaj tiv thaiv kab mob, nrog rau cov insulin: hypoglycemic tshua yuav tshwm sim. Nws raug nquahu kom tswj nruj txog qib hauv piam thaj hauv ntshav.

Cov tshuaj nonsteroidal anti-inflammatory thiab acetylsalicylic acid: qhov txo qis hauv cov nyhuv antihypertensive ntawm ramipril yog ua tau. Ntxiv rau, kev siv sib xyaw ua ke ntawm ACE inhibitors thiab NSAIDs tuaj yeem ua rau kev txhim kho hyperkalemia thiab ua rau muaj kev pheej hmoo ntawm kev ua haujlwm tsis zoo rau lub raum.

Hauv kev sib raug zoo rau amlodipine:

Cov tshuaj muaj kev nyab xeeb sib xyaw nrog thiazide diuretics, beta-blockers, ntev li ntawm nitrates, sublingual ntau npaum ntawm cov tshuaj nitroglycerin, cov tshuaj tsis-steroidal anti-inflammatory tshuaj, tshuaj tua kab mob thiab tshuaj noj ntawm qhov ncauj hypoglycemic.

Cov nyhuv ntawm lwm cov tshuaj ntawm amlodipine

- CYP3A4 inhibitors: thaum siv cov tshuaj CYP3A4 inhibitor, erythromycin hauv cov neeg mob hluas thiab diltiazem hauv cov neeg laus, ntsig txog, ntshav plasma concentration ntawm amlodipine nce, ntsig txog 22% thiab 50%. Txawm li cas los xij, kev kho mob tseem ceeb ntawm qhov xwm txheej no tseem tsis meej. Nws tsis tuaj yeem tshem tawm tias muaj zog CYP3A4 inhibitors (piv txwv li ketoconazole, itraconazole, ritonavir) tuaj yeem nce ntshav ntau dua ntawm amlodipine rau ntau dua li diltiazem. Amlodipine yuav tsum siv nrog kev ceev faj thaum sib koom tes nrog CYP3A4 inhibitors. Txawm li cas los xij, tseem tsis tau muaj kev qhia txog kev mob tshwm sim los ntawm qhov kev sib txuam no.

- CYP3A4 inducers: tsis muaj pov thawj qhia txog cov nyhuv ntawm CYP3A4 inducers ntawm amlodipine. Kev siv tshuaj ua ke nrog CYP3A4 inducers (piv txwv li, rifampicin lossis St. John lub wort) tuaj yeem txo cov ntshav plasma concentration ntawm amlodipine. Amlodipine yuav tsum siv nrog ceev faj thaum siv ua ke nrog CYP3A4 inducers.

Hauv kev tshawb nrhiav kev soj ntsuam ntawm kev sib cuam tshuam yeeb tshuaj, kev sib xyaw ua ke ntawm amlodipine nrog kua txiv kab ntxwv qaub, cimetidine, aluminium / magnesium (antacids) thiab sildenafil tsis cuam tshuam rau pharmacokinetics ntawm amlodipine.

Cov nyhuv ntawm amlodipine rau lwm yam tshuaj

Kev siv tshuaj amlodipine nrog lwm cov tshuaj tiv thaiv kab mob nce siab ua rau lawv txoj kev kho kom zoo dua qub.

Hauv kev tshawb nrhiav kev kho mob ntawm kev sib cuam tshuam tshuaj, amlodipine tsis cuam tshuam rau pharmacokinetics ntawm atorvastatin, digoxin, ethanol (ethanol), warfarin, lossis cyclosporine.

Tsis muaj cov nyhuv ntawm amlodipine ntawm kev hloov pauv hauv kev kuaj sim tau tsim.

Kev noj tshuaj ntxiv

Cov koob pom zoo noj txhua hnub yog 1 tshuaj ntsiav nrog ib qho tshuaj noj. Hartil-Amlo yuav tsum noj txhua hnub, tib lub sijhawm ntawm hnub, ua ntej lossis tom qab noj mov. Capsules yuav tsum tsis txhob zuaj lossis ntxo.

Cov koob tshuaj sib txuam ua ke tsis haum rau thawj theem ntawm kev kho. Yog tias muaj qhov xav tau ntau npaum li cas ntawm kev hloov kho tshuaj, tom qab ntawd nws yuav tsum tau nqa tawm tsuas yog kev pab ntawm monocomponents thiab tsuas yog tom qab xws li tsim nyog koob tshuaj tuaj yeem peb tuaj yeem hloov mus rau ib daim ntawv tshiab ntawm cov tshuaj nrog cov tshuaj ntawm Hartil ® Amlo.

Cov neeg laus: nws raug nquahu kom muab tshuaj rau noj nrog ceev faj rau cov neeg mob noj tshuaj diuretics, vim tias hauv cov neeg mob no ua txhaum cai ntawm cov dej-electrolyte tshuav yuav tshwm sim. Nws yog ib qho tsim nyog yuav tsum kawm txog lub raum kev ua haujlwm thiab txiav txim siab txog qib poov tshuaj hauv ntshav cov ntshav.

Hauv cov neeg mob uas lub siab ua tsis tau haujlwm, kev tshem tawm amlodipine tuaj yeem ua rau ntev dua. Cov lus qhia meej meej txog kev noj cov tshuaj amlodipine tsis tau txiav txim siab, tab sis cov tshuaj yuav tsum tau muab rau cov neeg mob no nrog kev ceev faj heev. Hauv cov neeg mob uas muaj lub siab tsis ua haujlwm, kev kho mob ramipril yuav tsum tsuas yog pib los ntawm kev saib xyuas kev noj qab haus huv, thiab qhov siab tshaj plaws txhua hnub yuav tsum yog 2.5 mg ntawm ramipril.

Nws raug nquahu tias Khartil ® Amlo tsuas yog raug rau cov neeg mob uas tau hloov mus rau 2.5 mg ntawm ramipril raws li kev saib xyuas zoo tshaj plaws thaum xaiv cov tshuaj ntawm ramipril.

Txhawm rau txiav txim siab ua kom zoo tshaj plaws ntawm kev pib thiab kev saib xyuas cov koob tshuaj nyob rau hauv cov neeg mob uas lub raum tsis ua haujlwm, qhov ntau ntawm cov tshuaj yuav tsum tau xaiv los ntawm tus kheej los txiav txim siab qhov ntau npaum ntawm ramipril thiab amlodipine.

Tsis tas yuav kho qhov tshuaj amlodipine ntau hauv cov neeg mob uas tsis ua hauj lwm lub raum.

Amlodipine tsis raug tawm nyob thaum lim ntshav. Cov neeg mob ua rau lim ntshav, amlodipine yuav tsum tau sau ntawv nrog kev ceev faj heev.

Cov koob tshuaj txhua hnub ntawm ramipril hauv cov neeg mob uas lub raum tsis ua haujlwm yuav tsum tau tsim los ua tus lej creatinine tshem tawm.

- Yog tias creatinine tshem tawm yog ≥60 ml / min, tom qab ntawd thawj koob tsis tas yuav tsum kho, qhov siab tshaj plaws niaj hnub noj yog 10 mg.

- Yog tias creatinine tshem tawm yog ® Amlo, nws raug nquahu kom muab tshuaj yog tias tus neeg mob tau hloov mus rau ramipril noj tshuaj ntawm 2.5 mg lossis 5 mg raws li kev tswj hwm kev noj tshuaj zoo tshaj (tsim thaum lub sijhawm noj tshuaj ramipril). Cov neeg mob ua rau mob hemodialysis yuav tsum tau noj cov tshuaj no ntau teev tom qab mob hemodialysis.

Hauv cov txheej txheem ntawm kev kho nrog tshuaj Hartil ® Amlo, kev muaj peev xwm ua haujlwm ntawm lub raum thiab cov ntsiab lus hauv poov tshuaj hauv cov ntshav cov ntshav yuav tsum raug tswj. Thaum lub cev tsis zoo ntawm lub raum kev ua haujlwm, kev siv tshuaj Hartil ® Amlo yuav tsum tau txiav tawm, thiab nws cov khoom siv yuav tsum tau sau tseg rau hauv cov koob tshuaj uas tau kho kom haum.

Cov neeg laus yuav siv ib qho tshuaj amlodipine ib txwm, txawm li cas los xij, yuav tsum tau ceev faj kom qhov koob tshuaj ntau ntxiv.

Thawj koob tshuaj ramipril yuav tsum qis dua li ib txwm, thiab kev kho tshuaj tom qab txuas ntxiv yuav tsum softer, vim tias qhov pheej hmoo ntawm cov teebmeem tsis xav tau.

Nws tsis pom zoo xaiv Hartil ® Amlo rau cov neeg laus thiab cov neeg tsis muaj zog.

Nws tsis pom zoo kom muab tshuaj Hartil ® Amlo rau cov menyuam yaus thiab cov hluas hnub nyoog qis dua 18 xyoo, vim tias qhov kev nyab xeeb thiab siv tshuaj nyob hauv pawg neeg mob no tseem tsis tau txiav txim siab.

Kev ntsuas rau kev xeeb tub

Hais txog ramipril

Kev siv IPF inhibitors tsis pom zoo thaum thawj peb lub hlis thaum cev xeeb tub, thiab thaum lub sijhawm thib ob thiab zaum thib peb ntawm cev xeeb tub, kev siv IPF inhibitors yog sib kis.

Epidemiological cov pov thawj ntawm kev pheej hmoo ntawm teratogenicity tom qab kis nrog ACE inhibitors thaum thawj peb lub hlis ntawm cev xeeb tub tsis txaus ntseeg, tab sis me ntsis ntawm qhov kev pheej hmoo no tsis tuaj yeem txiav txim siab. Yog tias xav tau kev kho mob txuas ntxiv nrog kev siv ACE / ARAT II cov tshuaj tiv thaiv, tom qab ntawd cov neeg mob npaj lub cev xeeb tub yuav tsum hloov lawv txoj kev kho mob rau lwm txoj kev kho mob tiv thaiv kab mob uas ua tau raws li kev nyab xeeb rau nws siv thaum cev xeeb tub. Thaum kev xeeb tub yog paub tseeb, kev kho mob nrog ACE inhibitors yuav tsum nres tam sim ntawd thiab, yog tias tsim nyog, yuav tsum tau kho lwm txoj kev kho mob.

Raug rau ACE inhibitors thaum lub sijhawm thib ob thiab thib peb lub hauv paus yog paub tias ua rau fetotoxicity hauv tib neeg (kev tsis zoo hauv lub raum ntawm cov me nyuam hauv plab, oligohydramnios, qeeb ntawm ossification ntawm lub pob txha taub hau) thiab neonatal toxicity (lub raum tsis ua haujlwm, hypotension, hyperkalemia). Yog tias raug rau ACE inhibitors tshwm sim thaum lub hlis thib ob ntawm cev xeeb tub, nws raug nquahu kom ua qhov ntsuas ntawm lub raum ua haujlwm thiab kev txhim kho pob txha taub hau. Cov menyuam mos uas lawv niam coj ACE inhibitors yuav tsum tswj xyuas zoo kom tau kev txhim kho hypotension, oliguria thiab hyperkalemia.

Hauv kev hais txog amlodipine

Kev nyab xeeb ntawm amlodipine thaum cev xeeb tub hauv cov poj niam tsis tau tsim. Cov kev tshawb fawb ntawm cov chaw tu tub tu kiv hauv cov nas pom tias tsis muaj cov cim ntawm kev mob toxicity, tsuas yog dhau ntawm kev ua haujlwm tom qab thiab nyob ntev dua, nrog koob tshuaj 50 zaug qhov kev xav tau ntau tshaj plaws rau cov tib neeg. Kev siv cov tshuaj thaum cev xeeb tub yog pom zoo tsuas yog thaum tsis muaj lwm txoj kev nyab xeeb thiab thaum tus kab mob ua rau muaj kev phom sij rau tus niam thiab tus menyuam hauv plab.

Hais txog ramipril

Txij li thaum tsis muaj cov ntaub ntawv tsis txaus txog kev siv ramipril thaum pub mis niam, kev siv ramipril nyob rau lub sijhawm no tsis pom zoo, thiab nws yog qhov zoo dua los xaiv lwm txoj kev kho mob nrog ntau cov ntsiab lus kev nyab xeeb lub sijhawm pub niam mis, tshwj xeeb tshaj yog thaum pub mis rau cov menyuam mos thiab cov menyuam yug ua ntej.

Hauv kev hais txog amlodipine

Tsis muaj ntaub ntawv hais txog kev faib cov amlodipine nrog rau niam mis. Qhov kev txiav txim siab txuas ntxiv / nres kev pub mis niam lossis kom txuas ntxiv / nres kev kho mob nrog amlodipine yuav tsum txiav txim siab txog cov txiaj ntsig ntawm kev pub mis niam rau tus menyuam thiab cov txiaj ntsig ntawm amlodipine txoj kev kho rau leej niam.

Cov lus qhia tshwj xeeb

Hais txog ramipril:

Cov Pab Pawg Tshwj Xeeb Patent

ACE inhibitors yuav tsum tsis txhob noj thaum cev xeeb tub. Yog tias xav tau kev kho mob txuas ntxiv nrog kev siv tshuaj ACE inhibitors, tom qab ntawd cov neeg mob npaj lub cev xeeb tub yuav tsum hloov cov tshuaj kho mob hloov mus rau lwm txoj kev kho mob, uas ua tau raws li kev nyab xeeb rau nws siv thaum cev xeeb tub. Thaum kuaj pom kev xeeb tub ntawm kev paub meej, kev kho mob nrog kev siv tshuaj ACE inhibitors yuav tsum nres tam sim ntawd thiab, yog tias tsim nyog, yuav tsum pib siv lwm txoj kev kho mob.

Cov neeg mob uas muaj kev pheej hmoo siab ntawm hypotension:

- Cov neeg mob uas muaj lub luag haujlwm ua ntau-txawv tus neeg ua haujlwm ntau:
cov neeg mob uas muaj lub zog ua haujlwm dhau los yog muaj lub siab ua rau muaj kev pheej hmoo loj hauv cov ntshav siab thiab lub raum tsis ua haujlwm vim ACE inhibition, tshwj xeeb tshaj yog thaum ACE inhibitors lossis concomitant diuretics raug kho rau thawj zaug lossis lawv cov tshuaj tau tsa thawj zaug.

Yog tias pom ntawm hyperactivation ntawm renin-angiotensin-aldosterone system zoo li ua tau, tom qab ntawd, yog tias tsim nyog, npaj kev saib xyuas kev kho mob, suav nrog saib xyuas ntshav siab:

- hauv cov neeg mob uas mob ntshav siab,

- hauv cov neeg mob uas decompensated congestive lub plawv tsis ua hauj lwm,

- nyob rau hauv cov neeg mob hemodynamically qhia obstructed ntws lossis ntws tawm los ntawm sab laug ventricle (piv txwv li, stenosis ntawm aorta lossis mitral valve),

- nyob rau hauv cov neeg mob uas muaj unilateral stenosis ntawm lub raum leeg nrog ua haujlwm thib ob lub raum,

- hauv cov neeg mob uas muaj (lossis ua tau) cuam tshuam kev cuam tshuam hauv cov dej-electrolyte tshuav nyiaj (nrog rau cov neeg mob noj tshuaj diuretics),

- hauv cov neeg mob uas muaj kab mob siab thiab / lossis ascites,

- nyob rau hauv cov neeg mob uas tau ua haujlwm phais mob nyuaj, lossis cov neeg ua haujlwm ua haujlwm tsis nco qab nrog kev siv cov tshuaj uas ua rau hypotension,

Feem ntau, nws pom zoo tias lub cev qhuav dej, hypovolemia, lossis ntsev tsis raug kho ua ntej kev kho mob (hauv cov neeg mob plawv tsis ua hauj lwm, txawm li cas los xij, txhua qhov zoo thiab qhov tsis zoo ntawm cov kev ntsuas yuav tsum ua tib zoo ntsuas, ntsuas qhov kev pheej hmoo ntawm ntim ntau dhau).

- hauv cov neeg mob uas tsis hloov (hloov chaw) lossis lub plawv tsis ua haujlwm tom qab MI,

- hauv cov neeg mob uas muaj kev pheej hmoo ntawm kev mob plawv lossis mob hlwb ischemia lossis hauv cov neeg mob hypotension mob ceev.

Nyob rau theem pib ntawm kev kho, kev kho mob tshwj xeeb yuav tsum tau ua.

Nws raug nquahu kom koj tsum tsis txhob siv cov tshuaj angiotensin-hloov mus rau enzyme inhibitors, xws li ramipril, ib hnub ua ntej kev phais mob, yog tias ua tau.

Kev kuaj xyuas lub raum

Cov haujlwm raum yuav tsum tau kuaj ua ntej thiab thaum kho, thiab qhov ntau ntawm cov tshuaj tau hloov kho, tshwj xeeb tshaj yog nyob rau thawj lub lim tiam ntawm kev kho mob. Rau cov neeg mob raum tsis txaus, yuav tsum tau saib xyuas tshwj xeeb. Muaj kev pheej hmoo ntawm lub raum tsis ua haujlwm, tshwj xeeb tshaj yog nyob rau cov neeg mob uas muaj lub plawv tsis ua haujlwm siab lossis tom qab hloov raum.

Qhov tshwm sim ntawm angioedema hauv cov neeg mob noj ACE inhibitors, suav nrog ramipril, tau tshaj tawm.

Yog hais tias mob siab tshwm sim, ramipril yuav tsum tsis ua mus ntxiv. Txoj kev thiab cov hau kev ntawm kev kho mob xwm txheej ceev yog qhia tam sim ntawd. Tus neeg mob yuav tsum tau saib xyuas tsawg kawg 12-24 teev, thiab tso tawm los ntawm kev tswj hwm tsuas yog tom qab tus tsos mob tau kho tas.

Qhov tshwm sim ntawm kev mob plab hnyuv tau tshaj tawm hauv cov neeg mob noj ACE inhibitors, suav nrog ramipril.

Cov neeg mob no yws yws vim mob plab (nrog lossis tsis muaj cov tsos mob ntawm xeev siab lossis ntuav).

Kev siv cov tshuaj ACE inhibitors tsub kom muaj qhov tsis nco qab thiab anaphylactoid (thiab mob hnyav) rau cov tshuaj lom cov kab mob thiab lwm yam kev ua xua. Kom txog rau thaum desensitization tiav, yuav tsum tau muab rau kev txiav tawm ib ntus ramipril.

Hyperkalemia tau pom nyob hauv qee cov neeg mob noj tshuaj ACE inhibitors, suav nrog ramipril. Cov pab pawg ntawm cov neeg mob uas muaj kev pheej hmoo siab ntawm hyperkalemia suav nrog cov neeg mob raum tsis ua haujlwm, cov neeg laus laus (laus dua 70 xyoo), cov neeg mob ntshav qab zib tsis tuaj yeem tswj hwm, lossis cov neeg mob uas noj ntsev ntxiv, potassium-muaj diuretics thiab lwm yam tshuaj ua kom muaj ntshav ntau ntau ntxiv ntshav, nrog rau cov neeg mob uas mob lub cev qhuav dej, lub plawv tsis ua haujlwm, lossis mob plab metabolic acidosis. Yog tias kev siv ua ke nrog cov tshuaj saum toj saud pom tau tias tsim nyog, nws raug nquahu kom kuaj xyuas tsis tu ncua ntawm cov poov tshuaj hauv cov ntshav cov ntshav.

Muaj cov ntaub ntawv tsis tshua muaj tshwm sim ntawm tus neeg mob neutropenia / agranulocytosis, mob thrombocytopenia thiab ntshav liab, nrog rau kev mob hlwb pob txha. Rau qhov pom tau sai tshaj plaws ntawm cov leukopenia, nws pom zoo kom tswj cov leukocytes. Kev tshuaj xyuas ntau zaus nyob rau theem pib ntawm kev kho yog pom zoo ntawm cov neeg mob uas lub raum tsis ua haujlwm, nrog rau cov neeg mob uas pom tus mob collagenoses (piv txwv, lupus erythematosus lossis scleroderma), thiab hauv txhua tus neeg mob noj lwm yam tshuaj uas yuav ua rau muaj kev hloov pauv hauv cov ntshav ntshav.

ACE inhibitors nce cov xwm txheej ntawm tus mob angioedema hauv cov neeg mob dub piv nrog cov neeg mob uas muaj xim tawv nqaij sib txawv.

Zoo li lwm cov tshuaj ACE inhibitors, ramipril yuav ua tsis tau zoo dua ntawm kev txo cov ntshav siab hauv cov neeg mob dub piv rau cov neeg mob uas muaj xim sib txawv. Tej zaum qhov no yog vim muaj qhov muaj ntau ntawm cov hlab ntsha txhaws nrog qhov qis qis qis hauv cov neeg nyob ntawm cov neeg mob dub mob ntshav siab.

Muaj cov ntawv tshaj tawm txog kev hnoos tom qab siv ACE inhibitors. Cov yam ntxwv ntawm tus cwj pwm hnoos yog nws qhov dryness thiab qhov tawm mus ntev li cas, nrog rau ploj ntawm nws cov kev qhia tom qab kev tsis ua tiav ntawm kev kho. Kev hnoos tshwm sim los ntawm kev noj cov tshuaj ACE inhibitors yuav tsum raug xam tias yog ib feem ntawm kev kuaj pom muaj qhov sib txawv ntawm hnoos.

Hauv kev sib raug zoo rau amlodipine:

Qhov kev nyab xeeb thiab ua haujlwm ntawm amlodipine hauv kev kub ntxhov tsis tau teeb tsa.

Siv rau hauv cov neeg mob lub plawv tsis ua haujlwm

Nws yuav tsum siv nrog ceev faj hauv cov neeg mob plawv. Hauv kev tshawb nrhiav qhov chaw ntev ntev uas muaj feem cuam tshuam nrog cov neeg mob lub plawv tsis ua haujlwm tsis zoo (NYHA chav kawm III thiab IV ua haujlwm chav kawm), cov xwm txheej ntawm pulmonary edema tau sau tseg, qhov xwm txheej ntawm uas tau siab dua hauv pawg nrog amlodipine, piv nrog pab pawg placebo, tab sis qhov no tsis yog nrog muaj ntau lub plawv dhia tsis ua haujlwm.

Siv rau hauv cov neeg mob uas lub siab tsis ua hauj lwm zoo

Hauv cov neeg mob uas muaj lub siab tsis ua hauj lwm zoo, ib nrab ntawm lub neej ntawm amlodipine yog lengthened, tsis muaj kev pom zoo rau kev hloov cov tshuaj ntau dua. Cov neeg mob hauv pab pawg no yuav tsum noj tshuaj amlodipine nrog kev ceev faj.

Siv rau cov neeg mob laus

Cov neeg laus yuav tsum noj tshuaj amlodipine nrog kev ceev faj.

Siv rau hauv cov neeg mob uas lub raum tsis ua haujlwm

Cov neeg mob uas lub raum tsis ua haujlwm yuav siv cov tshuaj amlodipine hauv ib zaug. Kev hloov pauv hauv plasma ntau ntau ntawm amlodipine ntau tsis ruaj rau feem cuam ntawm cov qog ua tsis zoo. Amlodipine tsis raug tawm nyob thaum lim ntshav.

Hauv cov tshuaj pliav pliav 5 mg / 5 mg thiab 10 mg / 5 mg yog ntxim nyiam liab (allura liab AC-FD & C Liab 40 E-129, thiab hauv tshuaj ntsuab plhaub 5 mg / 10 mg thiab 10 mg / 10 mg muaj azorubine (carmuazine) ( E-122). Cov xim xoos no tuaj yeem ua rau ua xua.

Cuam tshuam rau kev muaj peev xwm tsav tsheb thiab tswj cov tshuab

Qee qhov kev mob tshwm sim (piv txwv, cov tsos mob tshwm sim ntawm ntshav qis, xws li kiv taub hau) tuaj yeem ua rau tus neeg mob lub peev xwm mloog thiab teb sai, thiab yog li ua rau muaj kev pheej hmoo hauv cov xwm txheej uas cov peev xwm no tseem ceeb tshwj xeeb (piv txwv, thaum tsav tsheb lossis kev pabcuam) tshuab thiab tshuab).

Hauv qee qhov, qhov no tuaj yeem tshwm sim thaum pib kho lossis thaum hloov lwm yam tshuaj. Tom qab noj thawj koob ntawm cov tshuaj lossis qhov nce ntxiv hauv nws cov koob tshuaj, nws tsis pom zoo rau tsav tsheb lossis tswj xyuas cov tshuab thiab cov txheej txheem rau ob peb teev.

Cov Tshuaj Pharmacokinetics

Xuas thiab faib khoom

Tom qab kev tswj hwm ntawm qhov ncauj, ramipril nrawm nrawm los ntawm lub plab zom mov. C_max ramipril nyob rau hauv cov ntshav tau txog li 1 teev. Kev ntsuas mus rau hauv lub tso zis tsis tso zis, cov theem nqus yuav tsawg kawg yog 56% thiab tsis yog nyob ntawm kev noj zaub mov. Lub bioavailability ntawm lub metabolite ntawm ramiprilat tom qab qhov ncauj tswj hwm ntawm 2.5 mg thiab 5 mg ntawm ramipril yog 45%.

C_max ramiprilat, tsuas yog ua kom tiav metabolite ntawm ramipril, tau mus txog 2-4 teev tom qab noj ramipril. C_ss ramiprilat plasma concentration tau mus txog, kwv yees li, nyob rau hnub 4 ntawm kev noj ramipril hauv kev kho mob koob tshuaj. Kev khi ntawm ramipril rau cov tshuaj protein yog li 73%, thiab ramiprilat yog li ntawm 56%.

Kev ntsuas phoo thiab nthuav tawm

Ramipril yuav luag txhua qhov ua tiav rau ramiprilat thiab kom diketopiperazinovy ​​ether, diketopiperazinovy ​​acid thiab mus rau ramipril thiab ramiprilat glucuronides. Kev nthuav tawm ntawm metabolites yog nqa tawm tsuas yog los ntawm ob lub raum. Plasma cov ntsiab lus ntawm ramiprilat raug txo hauv polyphase hom. Vim tias nws txoj kev khi ruaj khov rau ACE thiab tsis muaj zog kev cuam tshuam nrog cov enzyme, ramiprilat cov khoom pov thawj theem ntev ntev ntawm kev tshem tawm ntawm qhov qis heev ntawm cov tshuaj hauv plasma. Tom qab rov ua dua coj ntawm ramipril hauv ib qho tshuaj 1 zaug /, zoo T_1/2 ramiprilat yog 13-17 teev (ntawm ib koob ntawm 5-10 mg), thiab tom qab txo qhov koob tshuaj rau 1.25-2.5 mg T_1/2 ntev. Qhov sib txawv no yog vim qhov muaj peev xwm txaus ntawm qhov enzyme, uas khi rau ramiprilat.

Tom qab ib koob nkaus ntawm ramipril, tsis muaj cov cim qhia ntawm ramipril thiab nws cov metabolites hauv niam mis. Txawm li cas los xij, qhov tsis pom zoo ntawm ramipril nrog rau lub mis niam nrog kev tswj hwm rov qab ntawm cov tshuaj no tseem tsis tau paub meej.

Pharmacokinetics hauv cov chaw kuaj mob tshwj xeeb

Ramiprilat lub raum tsis zoo yog txo hauv cov neeg mob nrog tsis hnov ​​mob raum muaj nuj nqi, thiab lub raum tshem tawm ntawm ramiprilat yog muaj feem cuam tshuam nrog QC. Qhov no ua rau muaj kev nce plasma ntau ntxiv ntawm ramiprilat, uas ua rau qeeb qeeb dua li cov neeg mob uas lub raum tsis ua haujlwm.

Hauv cov neeg mob nrog ua rau lub siab ua haujlwm tsis zoo, qhov kev hloov pauv hauv cov roj av ntawm ramipril rau ramiprilat poob qis vim tias qhov txo qis ntawm kev ua haujlwm ntawm hepatic esterases, thiab cov ntshav ntshav ntawm ramipril hauv cov neeg mob no nce ntxiv. C_max ramiprilata hauv cov neeg mob no, txawm li cas los xij, tsis txawv li ntawm cov neeg mob hauv lub siab ua haujlwm rau lub siab.

Xuas thiab faib khoom

Tom qab cov tshuaj qhov ncauj, amlodipine maj mam nqus tawm ntawm cov hnyuv. C_max hauv cov ntshav muaj kev saib xyuas tom qab 6-12 teev. Kev noj haus tsis cuam tshuam rau qhov kev tsis haum xeeb ntawm amlodipine. Kev tsis raug cai ntawm bioavailability yog 64-80%.

V_d ua 21 l / kg ntawm lub cev hnyav. C_ss hauv cov ntshav plasma (5-15 ng / ml) tau tiav tom qab 7-8 hnub ntawm kev siv tshuaj txhua hnub. Hauv cov kev tshawb fawb hauv vitro pom tau tias 93–98% ntawm amlodipine ncig hauv cov hlab ntshav khi rau cov ntshav protein.

Kev ntsuas phoo thiab nthuav tawm

Amlodipine yog cov tshuaj tiv thaiv sai (kwv yees li 90%) hauv lub siab los ua cov tshuaj metabolites tsis muaj zog.

Kwv yees li 10% ntawm qhov pib qhov pib thiab 60% ntawm cov tshuaj tiv thaiv kab mob ua rau tsis tso zis, 20-25% nrog quav. Qhov txo qis hauv ntshav cov ntshav yog biphasic. Thaum kawg tshem tawm T_1/2 los ntawm cov ntshav ntshav yog li ntawm 35-50 teev thaum noj 1 zaug / Kev tshem tag nrho yog 7 ml / min / kg (nrog tus neeg mob lub cev hnyav txog 60 kg - 25 l / teev).

Pharmacokinetics hauv cov chaw kuaj mob tshwj xeeb

Cov tshuaj pharmacokinetics ntawm amlodipine tsis hloov pauv tseem ceeb hauv lub raum tsis ua haujlwm thiab nrog lub hnub nyoog nce ntawm cov neeg mob.

Lub sijhawm mus txog C_max amlodipine nyob rau hauv ntshav rau cov neeg laus thiab cov neeg mob hluas yog qhov qub. Ntawm cov neeg laus laus Kev tshem tag nrho ntawm amlodipine yog 19 l / h. Amlodipine tshem tawm tsis tu ncua feem ntau yog txo nrog nce AUC thiab T_1/2hauv cov neeg laus cov neeg mob.

AUC thiab T nce ntxiv_1/2 hauv cov neeg mob uas muaj lub plawv tsis ua hauj lwm zoo ib yam li cov neeg laus.

Amlodipine yog feem ntau hloov kho los tsim cov kev hloov pauv hauv lub cev. 10% ntawm qhov pib sib txuas yog tawm tsis hloov pauv hauv zis. Kev hloov pauv ntshav ntau ntawm amlodipine tsis cuam tshuam nrog qhov degree lub raum tsis ua hauj lwmCov. Cov neeg mob zoo li no tuaj yeem siv tshuaj amlodipine ua ntu zus. Kev lim ntshav ntawm amlodipine yog qhov tsis muaj txiaj ntsig.

T_1/2 amlodipine hauv cov neeg mob nrog ua rau lub siab ua haujlwm tsis zoo lengthens.

Cov Yuav Tsum Tau Ua

muaj cov keeb kwm ntawm kev mob puas siab puas ntsws (kab mob hlwb, idiopathic, lossis yav dhau los ua rau mob los ntawm kev siv ACE inhibitors lossis angiotensin II receptor antagonists),

- kev kho mob sab nrauv, nrog rau kev sib chwv ntawm ntshav nrog qhov chaw tsis zoo,

- hais ob tog raum leeg txoj hlab ntsha hlwb raum lossis lub raum leeg ntshav stenosis ntawm lub raum nquag xwb,

- Kev mob ntshav siab los yog tsis ruaj khov lub xeev (ramipril yuav tsum tsis txhob raug tshuaj),

- ib daim ntawv hnyav ntawm hypotension,

- kev poob siab (suav nrog cardiogenic),

- kev sib tw ntawm cov hlab ntsha, tiv thaiv cov ntshav ntawm cov hlab ntsha sab laug (piv txwv li, mob aortic stenosis),

- hemodynamically tsis khov lub plawv tsis ua haujlwm tom qab mob myocardial infarction,

- Kev ua haujlwm tsis haum rau ramipril (lossis ACE inhibitors), amlodipine, dihydropyridine derivatives, thiab / lossis ib qho ntawm excipients ntawm cov tshuaj.

Cev xeeb tub thiab lactation

Epidemiological cov ntaub ntawv qhia tias muaj kev pheej hmoo ntawm teratogenicity tom qab kis nrog ACE inhibitors thaum thawj peb lub hlis ntawm cev xeeb tub tsis tau ntseeg, tab sis me ntsis ntawm qhov kev pheej hmoo no tsis tuaj yeem txiav tawm.

Raug rau ACE inhibitors thaum lub sijhawm thib ob thiab thib peb lub cev xeeb tub yog paub tias ua rau fetotoxicity hauv tib neeg (kev tsis zoo ntawm lub raum ntawm cov me nyuam hauv plab, oligohydramnios, ncua ossification ntawm pob txha taub hau) thiab mob neonatal toxicity (lub raum tsis ua haujlwm, hypotension, hyperkalemia). Yog tias raug rau ACE inhibitors tshwm sim thaum lub hlis thib ob ntawm cev xeeb tub, nws raug nquahu kom ua qhov ntsuas ntawm lub raum ua haujlwm thiab kev txhim kho pob txha ntawm pob txha taub hau. Cov menyuam mos uas lawv niam coj ACE inhibitors yuav tsum tswj xyuas zoo kom tau kev txhim kho hypotension, oliguria thiab hyperkalemia.

Txij li thaum muaj cov ntaub ntawv tsis txaus ntawm kev siv ramipril thiab amlodipine thaum lactation, lawv siv nyob rau lub sijhawm no yog contraindicated, thiab nws yog qhov zoo dua los xaiv lwm txoj kev kho mob nrog ntau qhov tshwj xeeb kev nyab xeeb, tshwj xeeb tshaj yog thaum lub sijhawm lactation.

Tsuas tshuaj thiab tswj hwm

Cov tshuaj yuav tsum raug siv nruj me ntsis raws li kws kho mob tau sau tseg.

Hartil-Amlo yuav tsum tau noj tib lub sijhawm ntawm ib hnub, txhua txhua hnub thaum kho mob, ua ntej thiab tom qab noj mov tas. Tsis txhob zuaj lossis zom khoom noj.

Qhov pom zoo kom noj txhua hnub yog 1 tshuaj ntsiav ntawm qee qhov tshuaj.

Cov tshuaj sib xyaw nrog qee yam muab tshuaj tsis haum rau thawj theem ntawm kev kho.

Yog tias xav tau koob tshuaj hloov kho qhov tshuaj, koob tshuaj Hartil ® Amlo tuaj yeem hloov pauv lossis cov koob tshuaj ntawm cov khoom siv kho mob ib leeg tuaj yeem hloov kho nrog lawv cov tshuaj dawb.

Nws raug nquahu kom muab tshuaj los ntawm kev ceev faj. cov neeg mob noj tshuaj diuretics, vim tias nyob hauv cov neeg mob no ua txhaum cai ntawm cov dej-electrolyte tshuav yuav tshwm sim. Nws yog ib qho tsim nyog yuav tsum kawm txog lub raum kev ua haujlwm thiab txiav txim siab txog qib poov tshuaj hauv ntshav cov ntshav.

Siv rau hauv cov neeg mob lub siab ua tsis tau haujlwm

Hauv cov neeg mob uas muaj lub siab ua haujlwm tsis zoo, kho mob ramipril yuav tsum tau tsuas yog pib nyob rau hauv kev saib xyuas kev noj qab haus huv, nrog kev siv ntau tshaj plaws txhua hnub ntawm 2.5 mg ramipril.

Hartil ® Amlo ntsiav tshuaj muaj 2.5 mg ramipril + 2.5 mg amlodipine raug pom zoo rau cov neeg mob uas tau hloov mus rau ib koob tshuaj 2.5 mg ntawm ramipril, raws li kev saib xyuas zoo tshaj plaws thaum xaiv cov tshuaj ntawm ramipril.

Thaum lub siab ua haujlwm tsis ua haujlwm, ncua sijhawm amlodipine tej zaum yuav loj tuaj. Tsis muaj cov lus qhia meej rau kev noj tshuaj txog amlodipine, yog li, cov tshuaj hauv cov neeg mob no yuav tsum tau ceev faj nrog kev ceev faj.

Siv rau hauv cov neeg mob uas lub raum tsis ua haujlwm

Txhawm rau txiav txim siab zoo ua ke ntawm kev pib thiab txij nkawm koob tshuaj nyob rau hauv cov neeg mob uas muaj lub raum tsis zoo, kev noj cov tshuaj yog xaiv los ntawm ib leeg zuj zus txiav txim siab qhov tsuas ntawm ramipril thiab amlodipine.

Cov koob tshuaj txhua hnub ramipril hauv cov neeg mob mob raum tsis ua haujlwm, nws yuav tsum tau tsim tsim los ua tus lej QC:

- hauv cov neeg mob nrog CC ≥ 60 ml / min, qhov yuav tsum tau txhaj tshuaj kho thawj zaug, qhov siab tshaj plaws ib hnub yog 10 mg,

- hauv cov neeg mob nrog KK ® Amlo nws raug nquahu kom muab tshuaj yog tias tus neeg mob tau hloov mus rau ramipril ntau npaum li cas kev noj tshuaj ntawm 2.5 mg lossis 5 mg raws li kev tswj hwm kev noj tshuaj zoo tshaj (tsim thaum lub sijhawm noj tshuaj ramipril). Cov neeg mob ua rau mob hemodialysis yuav tsum tau noj cov tshuaj no ntau teev tom qab mob hemodialysis.

Tsis tas yuav tsum kho npaum li cas amlodipine cov neeg mob uas lub raum tsis ua haujlwm.

Amlodipine tsis raug tawm nyob thaum lim ntshav. Cov neeg mob ua rau lim ntshav, amlodipine yuav tsum tau sau ntawv nrog kev ceev faj heev.

Thaum kho nrog Hartil ® Amlo, kev tswj hwm kev muaj peev xwm ua haujlwm ntawm lub raum thiab poov tshuaj ntsiab lus hauv cov ntshav cov ntshav yuav tsum muaj. Thaum lub cev tsis zoo ntawm lub raum kev ua haujlwm, kev siv tshuaj Hartil ® Amlo yuav tsum tau txiav tawm, thiab nws cov khoom siv yuav tsum tau sau tseg rau hauv cov koob tshuaj uas tau kho kom haum.

Siv rau hauv cov neeg laus laus

Thawj koob tshuaj ramipril yuav tsum qis dua li ib txwm, thiab kev kho tshuaj tom ntej yuav tsum tau ua mentsis qis dua, vim qhov pheej hmoo ntawm kev phiv. Nws tsis pom zoo xaiv Hartil ® Amlo rau cov neeg laus thiab cov neeg tsis muaj zog.

Cov neeg laus yuav siv ib qho tshuaj amlodipine ib txwm, txawm li cas los xij, yuav tsum tau ceev faj kom qhov koob tshuaj ntau ntxiv.

Siv rau hauv cov menyuam yaus thiab cov tub ntxhais hluas hnub nyoog qis dua 18 xyoo

Nws tsis pom zoo kom muab tshuaj Hartil ® Amlo rau cov menyuam yaus thiab cov tub ntxhais hluas hnub nyoog qis dua 18 xyoo, vim tias qhov kev nyab xeeb thiab kev siv tshuaj hauv pawg neeg mob no tseem tsis tau tsim.

Noj ntau dhau

Cov tsos mob nyob ntawm seb qhov kev noj ntau dhau heev dhau lawm, kev tso pa tawm ntawm lub cev ntau npaum li cas (nrog rau kev ua mob ntshav siab thiab duab tsawv), bradycardia, hluav taws xob tsis txaus thiab lub raum tsis ua haujlwm.

Kev Kho Mob: tus neeg mob yuav tsum tau saib xyuas tas li, thiab cov kev kho mob kws kho mob yuav tsum pom zoo thiab txhawb nqa. Cov kev ntsuas pom muaj xws li thawj qhov kev tshem tawm (pais plab lav, cov khoom noj adsorbent) thiab ntsuas kom rov ua kom ruaj ntseg ntawm hemodynamic tsis xws li, suav nrog alpha cob₁-adrenomimetics lossis angiotensin II (angiotensinamide). Ramiprilat ua tsis zoo los ntawm hemodialysis los ntawm cov ntshav dav dav. Thaum hais txog kev kho tus mob hypotension tshwm sim los ntawm kev noj tshuaj ntau dua ntawm amlodipine, tus neeg mob yuav tsum tau muab txoj hauj lwm tav toj nrog qhov chaw nce ntawm ob txhais ceg, thiab siv cov kev ntsuas los tswj cov kev ua haujlwm ntawm cov hlab plawv, nrog rau kev saib xyuas tsis tu ncua ntawm lub luag haujlwm ntawm lub plawv thiab lub ntsws ua pa, BCC thiab tus nqi ntawm cov zis tawm. Thaum tsis muaj contraindications, nws muaj peev xwm siv (nrog ceev faj) vasoconstrictors los rov qab vascular suab thiab ntshav siab. Hauv / hauv kev qhia txog calcium gluconate tuaj yeem ua tau zoo hauv kev tshem tawm cov kev thaiv ntawm calcium calcium. Hauv qee kis, kev mob plab zom mov tuaj yeem muaj txiaj ntsig zoo. Hauv kev tshawb fawb txog cov neeg ua haujlwm pab dawb noj qab haus huv, tau pom tias kev siv cov roj carbon activated thaum 2 teev tom qab noj 10 mg ntawm amlodipine txo qis nws txoj kev nqus. Txij li thaum amlodipine cuam tshuam nrog cov protein ntau, hemodialysis ua tsis tau dab tsi.

Kev cuam tshuam nrog lwm yam tshuaj

Hartil ® Amlo yuav tsum tsis txhob koom ua ke nrog cov txheej txheem ua yeeb yaj kiab ntxiv nrog rau kev sib chwv cov ntshav nrog qhov chaw tsis zoo, xws li hemodialysis los ntawm cov kab mob siab (piv txwv li, cov qog ua los ntawm polyacrylonitrile tebchaw), hemofiltration lossis apheresis ntawm tsawg lipoproteins siv dextran sulfate, vim muaj ntau ntxiv kev phom sij ntawm kev tsim cov tshuaj tiv thaiv tsis hnyav lossis tshuaj tiv thaiv anaphylactoid. Yog tias kev kho mob yog qhov tsim nyog, tom qab ntawd siv cov tshuaj sib txawv ntawm daim nyias nyias rau kev lim ntshav lossis tshuaj tiv thaiv kabmob ntshav ntawm ntau pawg yuav tsum tau txiav txim siab.

Nrog rau kev tswj hwm tib lub sijhawm nrog cov tshuaj potassium npaj, potassium-sparing diuretics thiab lwm yam tshuaj lom neeg uas ua rau kom plasma ntau ntau qib (suav nrog nrog angiotensin II receptor antagonists, trimethoprim, tacrolimus, cyclosporine), hyperkalemia yuav tsim kho, yog li ntawd, nws yog qhov yuav tsum tau ua tib zoo saib xyuas theem ntawm cov poov tshuaj potassium.

Thaum noj ib txhij nrog cov tshuaj antihypertensive (piv txwv li, diuretics) thiab lwm yam tshuaj uas tuaj yeem txo cov ntshav siab (piv txwv, nitrates, tricyclic antidepressants, analgesics, ethanol, baclofen, alfuzosin, doxazosin, prazosin, tamsulosin, terazosin risk), nws yog qhov ua tau.

Nrog rau kev tswj hwm ib txhij nrog vasopressor sympathomimetics thiab lwm yam tshuaj (piv txwv, isoproterenol, dobutamine, dopamine, adrenaline), cov nyhuv antihypertensive ntawm ramipril yuav txo, yog li ntawd, soj ntsuam ntshav siab yog qhov pom zoo.

Nrog rau kev tswj hwm tib lub sijhawm nrog allopurinol, cov tshuaj tiv thaiv kab mob, corticosteroids, procainamide, cytostatics thiab lwm yam tshuaj uas tuaj yeem hloov cov ntshav ntawm cov ntshav, qhov ntau dua ntawm kev txhim kho hematological nce.

Nrog rau kev tswj fwm ntawm ACE cov tshuaj tiv thaiv nrog cov roj ntsha lithium, nws muaj peev xwm txo qis nws cov kev tshem tawm thiab, raws li, nce qhov siab ntawm lithium hauv cov ntshav nrog kev nce ntxiv hauv nws cov tshuaj lom. Kev tshuaj xyuas tas li ntawm cov qib lithium yog qhov yuav tsum tau ua.

Thaum noj nrog cov tshuaj tiv thaiv kab mob (nrog rau insulin) yuav ua kom lub cev tsis muaj teeb meem dab tsi. Nws raug nquahu kom tswj nruj txog qib hauv piam thaj hauv ntshav.

Thaum noj nrog NSAIDs (suav nrog acetylsalicylic acid) tuaj yeem txo cov nyhuv antihypertensive ntawm ramipril. Ntxiv rau, kev siv sib xyaw ua ke ntawm ACE inhibitors thiab NSAIDs tuaj yeem ua rau kev txhim kho hyperkalemia thiab ua rau muaj kev pheej hmoo ntawm kev ua haujlwm tsis zoo rau lub raum.

Cov tshuaj muaj kev nyab xeeb sib xyaw nrog thiazide diuretics, beta-blockers, ntev-tso cov nitrates, sublingual ntau npaum cov tshuaj nitroglycerin, NSAIDs, tshuaj tua kab mob, thiab tshuaj qhov ncauj hypoglycemic.

Thaum tau noj tshuaj nrog CYP3A4 inhibitor erythromycin hauv cov neeg hluas thiab diltiazem hauv cov neeg mob laus, feem, cov ntshav plasma concentration ntawm amlodipine nce ntxiv 22% thiab 50%, feem. Txawm li cas los xij, kev kho mob tseem ceeb ntawm qhov xwm txheej no tseem tsis meej. Nws tsis tuaj yeem tshem tawm tias muaj zog CYP3A4 inhibitors (piv txwv li ketoconazole, itraconazole, ritonavir) tuaj yeem nce ntshav ntau dua ntawm amlodipine rau ntau dua li diltiazem. Amlodipine yuav tsum siv nrog kev ceev faj thaum sib koom tes nrog CYP3A4 inhibitors. Txawm li cas los xij, tseem tsis tau muaj kev qhia txog kev mob tshwm sim los ntawm qhov kev sib txuam no.

Neeg kho mob CYP3A4: cov ntaub ntawv hais txog cov nyhuv ntawm CYP3A4 inducers ntawm amlodipine tsis muaj. Kev siv sib xyaw ua ke ntawm cov tshuaj nrog inducers ntawm CYP3A4 (piv txwv li, rifampicin lossis St. John's wort perforated) tuaj yeem txo cov ntshav plasma concentration ntawm amlodipine. Amlodipine yuav tsum siv nrog ceev faj thaum siv ua ke nrog CYP3A4 inducers.

Hauv kev tshawb nrhiav kev kho mob ntawm kev sib cuam tshuam yeeb tshuaj, kev siv amlodipine tib si nrog kua txiv kab ntxwv qaub, cimetidine, aluminium / magnesium (antacids) thiab sildenafil tsis cuam tshuam rau pharmacokinetics ntawm amlodipine.

Siv tib lub sijhawm ntawm amlodipine nrog rau lwm cov tshuaj tiv thaiv kev tiv thaiv kab mob pab kho lawv cov kev ua kom zoo.

Hauv kev tshawb nrhiav kev kho mob ntawm kev sib cuam tshuam tshuaj, amlodipine tsis cuam tshuam rau lub khw muag tshuaj ntawm vvastatin, digoxin, ethanol (ethanol), warfarin, lossis cyclosporine.

Cov nyhuv ntawm amlodipine ntawm kev hloov pauv hauv chav kuaj sim tsis tau tsim.

Tso tawm daim ntawv thiab muaj pes tsawg leeg

Cov tshuaj Hartil muaj nyob rau hauv daim ntawv ntawm cov ntsiav tshuaj rau qhov ncauj tswj hwm ntawm lub teeb txiv kab ntxwv, oval, tiaj. Cov ntsiav tshuaj tau ntim rau hauv cov hlwv ntawm 7 daim (1-4) hauv daim ntawv thawv ntawv, cov lus qhia ntxaws nrog cov lus piav qhia tau txuas nrog tshuaj.

Txhua ntsiav tshuaj muaj 5 mg lossis 10 mg ntawm cov tshuaj nquag Ramipril, ntxiv rau cov naj npawb ntawm cov khoom siv pabcuam, suav nrog lactose monohydrate.

Tseem tsim cov ntsiav tshuaj 2.5 mg + 12.5 mg, 5 mg + 25 mg Hartil D nrog diuretic hydrochlorothiazide. Cov nkauj muaj xws li ramipril, hydrochlorothiazide thiab excipients (Hartil D).

Tso cov ntaub ntawv thiab cov nyob ua ke

Cov tshuaj muaj nyob rau hauv daim ntawv ntawm gelatin tsiav tshuaj ntawm 5 mg thiab 10 mg ntawm active active ingredient. Cov tshuaj phiv yog ramipril (Ramiprilum). Qhov no yog tshuaj lom neeg cov tshuaj lom neeg uas yog cov hmoov dawb soluble hauv kev daws teeb meem thiab cov kuab tshuaj organic. Cov neeg qheb - amlodipine, microcellulose, crospovidone, hypromellose.

Kev ntsuas rau siv

Cov tshuaj ntsiav muaj qhov dav dav ntawm kev ua ntawm ramipril thiab raug kho raws li cov cim hauv qab no:

• arterial hypertension - ib qho kev mob siab ntsig txog ntshav siab,
• mitral valve prolapse,
• siv rau kev ua mob hyperthermia rau txo tus mob,
• lub siab tsis ua haujlwm, hauv kev ua haujlwm ntawm tag nrho lub cev muaj kev cuam tshuam vim kev ntshav tsis txaus thiab oxygen txaus siab ntawm cov kabmob thiab cov tshuab,
• angina pectoris, ischemia,
• qhov tshwm sim ntawm myocardial infarction, kom tiv thaiv tau tus thib ob nres thiab txo lub nra ntawm lub plawv mob,
• kev tiv thaiv tus mob stroke nyob rau hauv kab mob plawv.

Lub plab zom mov

Stomatitis, xeev siab, ntuav, kub siab, pancreatitis, mob plab hnyuv, mob raws plab, mob plab hnyuv thiab txiav, ua rau tsis qab los noj mov.

Los ntawm kev mob plab hnyuv, Hartil tuaj yeem ua rau xeev ntuav.

Cuam tshuam rau lub peev xwm los tswj cov tshuab

Cov tshuaj muaj peev xwm cuam tshuam rau lub hauv nruab nrab lub paj hlwb, ua rau lub cev poob dej, txo qis. Hauv qhov no, koj yuav tsum nyob deb ntawm kev ua haujlwm ntawm cov khoom siv tsis siv neeg lossis tsav tsheb.

Hartil Amlo yuav cuam tshuam koj lub peev xwm tsav tsheb.

Siv thaum cev xeeb tub thiab lactation

Hauv xyoo II thiab III peb lub hlis, cov tshuaj no txwv tsis pub siv. Hauv thawj peb lub hlis, koj tuaj yeem siv Hartil tsuas yog thaum muaj xwm txheej ceev. Thaum kho thaum lub sijhawm lactation, nws raug nquahu kom hloov mus rau qhov khoom pub noj mis nyuj.

Rau cov menyuam yaus hnub nyoog qis dua 15 xyoos, kev haus cov tshuaj txwv tsis pub nruj, vim kev tshawb fawb tsis tau tshawb nrhiav.

Kev cuam tshuam nrog lwm yam tshuaj

Nrog rau kev tswj hwm tib lub sij hawm nrog cov tshuaj diuretics thiab lwm yam tshuaj mob ntshav siab, kev txo qis hauv cov ntshav siab yog tau.

Yog tias koj muab cov tshuaj antihypertensive nrog cov tshuaj tsis-tshuaj steroidal los tiv thaiv cov tshuaj, cov nyhuv raug txo kom tsawg, thiab yuav muaj qhov tsis muaj txiaj ntsig los ntawm cov tshuaj.

Thaum noj cov tshuaj lithium uas muaj tshuaj sib xyaw nrog Hartil, cov tshuaj ntawm cov roj ntsha lithium hauv cov ntshav nce ntxiv.

Nws tsis pom zoo kom siv ua ke nrog cov nyiaj muaj cov poov tshuaj nyob hauv cov lus muaj pes tsawg leeg, yog li kom tsis pub dhau qib ntawm cov poov tshuaj hauv lub cev.

Yog tias vim qee lub laj thawj tsis muaj peev xwm nqa tawm, koj tuaj yeem hloov lawv nrog tshuaj Hungarian, Asmeskas lossis Lavxias ntawm cov nyhuv zoo sib xws:

• raws li ramipril thiab amlodipine: tsiav tshuaj Bi-Ramag, Sumilar, Tritace-A,
• raws li amlodipine thiab lisinopril: Amapil-L ntsiav tshuaj, Amlipin, Kev Qhia Khoom Ncaj,
• raws perindopril: Amlessa, Bi-Prestarium, Viacoram,
• raws li lercanidipine thiab enalapril: Coriprene, Lerkamen, Enap L Combi.

Cov tshuaj tiv thaiv ntawm cov tshuaj Harty Amlo yog Amlessa. Cov tshuaj noj ntawm cov tshuaj Hartil Amlo yog Coripren.Cov tshuaj noj ntawm cov tshuaj Hartil Amlo yog Lerkamen.

Cov kws tshaj lij tsis pom zoo kom hloov cov tshuaj ntawm lawv tus kheej, kom tsis txhob muaj kev phom sij rau kev noj qab haus huv. Ua ntej hloov nws yog qhov yuav tsum tau sab laj nrog tus kws kho mob.

Kev kho plawv

Alexander Ivanovich, Moscow

Cov tshuaj yog ib qho zoo tshaj plaws rau kev kho mob thiab tiv thaiv kab mob plawv thiab rov qab los ntawm cov ntshav siab. Yog tias tsis muaj contraindications, Kuv ib txwm sau ntawv txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau kis myocardial infarction thiab mob stroke.

Cov lus qhia rau kev siv Hartil-Amlo Cov tshuaj twg txhawm rau txhawm rau yog qhov zoo tshaj plaws

Tamara Nikolaevna, 70 xyoo, Krasnodar

Ob leeg kuv tus txiv thiab kuv raug kev mob plawv. Tau ntau xyoo, peb tau haus Hartil chav kawm ib xyoos ob zaug nyob ua ke. Cov tshuaj siv tau zoo, tsis ua rau muaj kev phiv, sai sai txo qis ntshav siab, txo qis mob taub hau, o. Lub siab ua haujlwm yam tsis muaj kev cuam tshuam, peb xav tias 20 xyoo yau dua.

Hartil Ntsiav Tshuaj

Nws yog noj ntawm qhov ncauj tsis tas yuav zom, ntxuav nrog ntau cov kua (li 1 iav), tsis hais lub sijhawm noj mov.

Qhov muab tshuaj yuav tsum tau tsim rau txhua tus neeg mob ib tus zuj zus, noj rau hauv cov txiaj ntsig kho thiab ua siab ntev. Cov ntsiav tshuaj tuaj yeem muab faib ua ib nrab, tawg thaum muaj teeb meem.

• Mob plawv nres. Qhov pom zoo kom pib lub koob tshuaj yog 1.25 mg ib hnub ib zaug (1/2 ntsiav tshuaj ntawm Hartil 2.5 mg txhua hnub). Nyob ntawm qhov siv tshuaj kho kom haum, qhov koob tshuaj tuaj yeem nce ntxiv los ntawm qhov muab tshuaj rau ob zaug txhua txhua 2-3 lub lis piam. Yog tias koj xav tau ntau dua li 2.5 mg ntawm cov tshuaj, cov tshuaj no tuaj yeem siv tam sim ntawd lossis faib ua 2 koob. Qhov siab tshaj plaws rau kev noj tshuaj txhua hnub yuav tsum tsis pub tshaj 10 mg.
• Arterial tawg. Qhov pom zoo kom pib noj yog 2.5 mg ib hnub ib zaug (1 ntsiav tshuaj ntawm Hartil 2.5 mg txhua hnub). Nyob ntawm qhov siv tshuaj kho kom haum, qhov koob tshuaj tuaj yeem nce ntxiv los ntawm qhov muab tshuaj rau ob zaug txhua txhua 2-3 lub lis piam. Cov koob tshuaj saib xyuas ib txwm yog 2.5-5 mg ib hnub (1 ntsiav tshuaj ntawm Hartil 2.5 mg lossis 1 ntsiav tshuaj ntawm 5 mg). Qhov siab tshaj plaws rau kev noj tshuaj txhua hnub yuav tsum tsis pub tshaj 10 mg.
• Kev tiv thaiv ntawm myocardial infarction, mob stroke, lossis tuag los ntawm kev mob plawv. Qhov pom zoo kom pib noj tshuaj yog 2.5 mg ib hnub ib zaug. Nyob ntawm qhov kam rau ntawm cov tshuaj, tom qab 1 lub lis piam ntawm kev tswj hwm, qhov tshuaj yuav tsum tau muab ob npaug piv rau thawj zaug. Cov koob tshuaj no yuav tsum tau txuas ntxiv ob zaug ntxiv tom qab 3 lub lim tiam ntawm kev tswj hwm. Qhov pom zoo txij nkawm cov koob tshuaj yog 10 mg ib hnub ib zaug.
• Tsis-mob ntshav qab zib lossis ntshav qab zib nephropathy. Qhov pom zoo kom pib koob tshuaj yog 1.25 mg ib hnub ib zaug (1/2 ntsiav tshuaj ntawm Hartil 2.5 mg txhua hnub). Nyob ntawm qhov siv tshuaj kho kom haum, qhov koob tshuaj tuaj yeem nce ntxiv los ntawm qhov muab tshuaj rau ob zaug txhua txhua 2-3 lub lis piam. Yog tias koj xav tau ntau dua li 2.5 mg ntawm cov tshuaj, cov tshuaj no tuaj yeem siv tam sim ntawd lossis faib ua ob zaug. Qhov pom zoo ntau kawg rau txhua hnub koob yog 5 mg.
• Kev kho mob tom qab myocardial infarction. Nws raug nquahu kom pib noj cov tshuaj ntawm 3-10 hnub tom qab mob myocardial infarction. Cov koob tshuaj pom zoo thawj zaug, nyob ntawm tus neeg mob lub sijhawm thiab lub sijhawm dhau los tom qab kis myocardial infarction, yog 2.5 mg 2 zaug hauv ib hnub (1 ntsiav tshuaj ntawm Hartil 2.5 mg 2 zaug hauv ib hnub). Ua raws li cov tshuaj kho tau, qhov kev pib yuav muab tau ob npaug txog 5 mg (2 ntsiav tshuaj ntawm Hartil 2.5 mg lossis 1 ntsiav tshuaj ntawm Hartil 5 mg) 2 zaug hauv ib hnub. Qhov siab tshaj plaws rau kev noj tshuaj txhua hnub yuav tsum tsis pub tshaj 10 mg. Yog tias cov tshuaj tsis qaug rau, cov tshuaj yuav tsum raug txo kom tsawg.

Cov pab pawg neeg tshwj xeeb

Cov neeg laus cov neeg mob. Kev siv cov ramipril rau cov neeg laus laus noj cov tshuaj diuretics thiab / lossis nrog lub plawv tsis ua haujlwm, ntxiv rau ua kom lub siab lossis lub raum tsis ua haujlwm, yuav tsum tau tshwj xeeb. Cov koob tshuaj yuav tsum tsim los ntawm cov tib neeg xaiv koob tshuaj nyob ntawm cov tshuaj tiv thaiv cov tshuaj.

Lub siab ua haujlwm tsis zoo. Yog tias muaj lub siab ua haujlwm tsis txaus siab, qhov txo qis lossis nce ntxiv ntawm kev siv tshuaj Hartil tuaj yeem sib txig sib luag, vim li no, thaum ntxov ntawm kev kho mob, cov neeg mob uas lub siab tsis ua haujlwm yuav tsum tau ua tib zoo saib xyuas kev kho mob. Qhov siab tshaj plaws qhov siab txhua hnub hauv cov xwm txheej zoo li no yuav tsum tsis pub tshaj 2.5 mg.

Hauv cov neeg mob uas tau txais kev kho mob diuretic, vim tias qhov pheej hmoo ntawm kev txo ntshav siab ntau, qhov tseem tuaj yeem tshem tawm ib ntus lossis tsawg kawg ntawm qhov txo qis ntawm cov tshuaj kho mob yuav tsum tau txiav txim siab yam tsawg kawg 2-3 hnub (lossis ntev dua, nyob ntawm lub sijhawm ntawm kev txiav txim ntawm diuretics) ua ntej noj tshuaj Hartil. Rau cov neeg mob ua ntej kho nrog tshuaj diuretics, feem ntau yog tso rau thawj zaug yog 1.25 mg.

Sab sij huam

Cov tshuaj kho mob ntawm Hartil nco ntsoov qhov ntxim nyiam ntawm cov kev mob tshwm sim. Lawv cov npe yog qhov dav heev thiab yuav tsum muaj kev kawm ntxaws ntxaws. Nws raug nquahu kom koj paub koj tus kheej zoo txog cov kev mob tshwm sim tsis zoo tshaj plaws ua ntej noj cov tshuaj:

• urticaria, khaus, tawv nqaij ua pob, ua pob txha,
• tsis qab los noj mov, xeev siab, cem quav / raws plab, pancreatitis, lub qhov ncauj qhuav, ntuav,
• nrhav, hyperthermia, alopecia, tawm hws,
• hyperkalemia, hypercreatininemia, nce kev ua si ntawm hepatic transaminases thiab urea nitrogen qib, hyponatremia,
• thrombocytopenia, ua haujlwm ntshav qis, ntshav tsis txaus thiab hemoglobin concentration, thrombocytopenia, neutropenia, leukocytopenia, agranulocytosis, hemolytic anemia, pancytopenia,
• tsis muaj zog, mob taub hau, tsaug zog, tshee tshee, tshee tshee, npau taws, ntxhov siab, mob leeg, cuam tshuam rau hauv qhov pom (hnov ntxhiab tsw, hnov, saj, tsis pom kev) thiab vestibular ntshawv siab,
• nce proteinuria, lub raum tsis ua haujlwm, txo qis libido, tso zis ntim tsawg dua,
• orthostatic hypotension, txo cov ntshav siab. Hauv qee qhov tsis tshua muaj tshwm sim - arrhythmia, cov tsos ntawm circulatory mob ntawm plab hnyuv siab raum, myocardial ischemia thiab lub hlwb,
• txog siav ua pa, bronchospasm, rhinorrhea, sinusitis, rhinitis, mob ntsws, hnoos qhuav.

Kev siv Hartil thaum cev xeeb tub tuaj yeem ua rau muaj kev phiv rau tus me nyuam hauv plab: ntau yam kev ua txhaum ntawm kev txhim kho thiab kev ua haujlwm ntawm lub raum, txo cov ntshav nyob rau hauv tus menyuam, hypoplasia ntawm lub ntsws thiab pob txha taub hau, kev cog lus ntawm nqaj, thiab deformation ntawm lub pob txha taub hau.

Cov lus so thiab nqe

Tus nqi nruab nrab ntawm Hartil (5 ntsiav tshuaj mg, 28 daim) hauv Moscow yog 400 rubles. Cov tshuaj no tau faib tawm los ntawm cov khw muag tshuaj los ntawm cov tshuaj noj.

Qhov zoo tshaj plaws khaws cia kub ntawm cov tshuaj yog 25 degrees. Lub txee lub neej ntawm cov ntsiav tshuaj tau qhia tau rau ntawm pob thiab yog 4 xyoos txij li hnub tsim khoom lag luam. Hartil pom zoo kom siv cov ntsiav tshuaj yuav tsum tau muab cia rau hauv qhov chaw ncav cuag rau menyuam yaus, kom deb ntawm kev tshav ntuj.

Kev Sib Sau thiab daim ntawv ntawm tso tawm

Hartil muaj nyob hauv daim foos. Cov tshuaj ntim rau hauv cov hlwv rau 7 ntsiav tshuaj. Lub thawv ntawv thawv yuav muaj 14 thiab 28 chav nyob ntawm daim foos noj tshuaj.

Cov khoom ua kom nquag plias yog ramipril.

Ntsiav tshuaj 1.25 mg, 2.5 mg, 5 mg thiab 10 mg (Hartil).

5 mg ntsiav tshuaj: lub teeb liab nrog lub txiv kab ntxwv zas, oval, tiaj tus nrog cov kab sib faib, chamfer thiab kos "R3" ntawm ib sab.

10 mg ntsiav tshuaj: dawb lossis yuav luag dawb oval, tiaj tus nrog paub kab, chamfer thiab kos "R4" ntawm ib sab.

• Hartil D ntsiav tshuaj nrog diuretic hydrochlorothiazide 2.5 mg + 12.5 mg, 5 mg + 25 mg.
• Hartil Amlo Ramipril. Xws li amlodipine ntxiv. Muab rau nce rau hauv cov ntshav siab yog hais tias noj cov khoom xyaw dhia (ib leeg lossis ib leeg) muab txoj hauv kev zoo.

Dab tsi pab Hartil?

Kev qhia rau kev siv cov cuab yeej no muaj raws li hauv qab no:

• lub plawv tsis ua haujlwm tom qab mob myocardial infarction nrog hemodynamics ruaj khov,
• mob plawv tsis ua hauj lwm
• leeg ntshav siab
• ntshav qab zib nephropathy,
• tus mob raum diffuse,
• qhov xav tau kom txo tau tus mob myocardial infarction, "kev tuag rau txoj kev tuag" rau cov neeg muaj mob ua rau cov hlab ntshav txhaws,
• qhov xav kom txo tau kev pheej hmoo mob hlab ntsha hauv cov neeg muaj mob plawv.

Nrog rau kev mob ntshav siab, Hartil Amlo kuj tseem siv tau, yog tias ua ntej hloov mus rau cov tshuaj no, ntshav siab tau tswj los ntawm kev siv txho ib txwm muaj ramipril thiab amlodipine hauv kev siv tshuaj tib yam li hauv cov tshuaj.

Tseem Ceeb! Tus kws kho mob yuav tsum txiav txim siab txog qhov xav tau ntawm chav kawm ntawm txoj kev kho mob tshuaj. Kev noj tshuaj rau tus kheej yog qhov tsis lees txais.

Cov lus qhia rau kev siv

Cov koob tshuaj ntawm cov tshuaj Hartil tau tsim los ntawm tus kws kho mob nruj me ntsis ntawm tus kheej. Kev kho mob ntawm txoj kev mob ntshav siab pib nrog kev siv tshuaj tsawg kawg - 2.5 mg ib hnub ib zaug.

Nrog cov tshuaj kho tsis txaus lossis tsis muaj txiaj ntsig, qhov koob tshuaj tuaj yeem nce tsis pub tshaj 1 zaug hauv ib lub lis piam los ntawm 2.5 mg, qhov tshuaj ntau tshaj rau ib tus neeg mob hnub nyoog yog 10 mg. Yog tias qhov tshuaj no tsis txaus los txo cov ntshav siab rau cov txiaj ntsig ib txwm, tom qab ntawd Hartil ntsiav tshuaj yog kho raws li ib feem ntawm txoj kev kho mob nrog lwm tus neeg sawv cev antihypertensive.

Yog tias tsim nyog, cov neeg mob yuav tsum tau txais kev saib xyuas ntawm 2.5-5 mg ntawm Hartil ib hnub.

Kev kho mob ntawm cov kev mob tshwm sim tom qab kev mob siab rau lub siab yuav tsum yog 3 hnub, koob tshuaj thawj zaug yog 2.5 mg, cov tshuaj yog noj 2 zaug hauv ib hnub, qhov tshuaj ntau tshaj plaws rau ib tus neeg mob hnub nyoog yog 10 mg.

Txog kev kho mob ntshav qab zib lossis tsis mob ntshav qab zib nephropathy, cov tshuaj Hartil tau sau tseg hauv tshuaj ntau npaum li cas ntawm 1.25 mg ib hnub ib zaug. Lub sijhawm tiv thaiv yog 3 lub lis piam.

Txhawm rau tiv thaiv txoj kev loj hlob ntawm myocardial infarction, cov neeg mob angina pectoris thiab mob hauv cov hlab ntsha tau tshaj tawm cov tshuaj Hartil ntawm koob tshuaj 2.5 mg ib hnub ib zaug rau 3 lub lis piam, tom qab ntawd cov koob tshuaj tau nce rau 5 mg ib hnub twg thiab tseem txuas ntxiv siv tshuaj yaj yeeb rau 3 lub lis piam.

Cov neeg mob raum lossis lub plawv tsis ua haujlwm ntev yuav tsum xaiv ib koob tshuaj ib leeg zuj zus, kev kho mob nrog Hartil yog tau kho los ntawm thaj tsam ntawm 1,25 mg rau ib hnub, yog tias tsim nyog thiab nrog kev muaj peev xwm tiv taus, maj mam nce ntxiv.

Cov teeb meem Pharmacological

Txij li thaum cov tshuaj thaiv cov khoom lag luam ntawm ACE, nws cov txiaj ntsig feem ntau yuav yog hypotension, uas yog, txo qis siab los ntawm ntau dua 20% ntawm thawj zaug tus nqi. Hauv qhov no, cov mem tes yuav nyob tib yam nkaus li ua ntej txais tos, yam tsis muaj los them rau tus poob.

Txij li nws txwv cov angiotensin, kev tsim tawm ntawm aldosterone yog txo qis, nrog rau kev ua haujlwm ntau ntxiv hauv cov ntshav ntawm renin. Cov nyhuv ntawm cov tshuaj txuas ntxiv tsis tsuas yog rau ACE uas muaj nyob rau hauv cov hlab ntshav, tab sis kuj rau cov uas tau tsim hauv cov vascular phab ntsa thiab lwm cov ntaub so ntswg uas nyob ib sab.

Lwm cov chaw muag tshuaj:

• Kev txwv tsis pub cov raum muaj mob cuam tshuam nrog kev tshaj tawm cov ntshav qab zib hauv lub xeev - microalbuminuria, piv txwv.
• Kev ua rau cov proteinuria tsawg zuj zus thiab ua kom cov creatinine nce siab, uas ua rau muaj kev txhim kho ntxiv rau lub raum tsis ua haujlwm.
• Yuav txo tau kev kub siab hypertrophied lub plawv mob, pab txhawm rau txhav qhov ntswg.
• Kev tawg ntawm bradykinin, uas ua rau ntawm cov hlab ntshav, tso prostacyclin thiab divalent nitric oxide rau hauv cov ntshav.
• Kev txo qhov siab ntawm lub portal txoj hlab ntsha yog tias pom qhov kub siab.
• Txo qhov tshwm sim ntawm arrhythmias yog tias tus neeg mob underwent myocardial reperfusion, qhov kev pheej hmoo ntawm kev txhim kho ntxiv ntawm lub plawv nres, tiv thaiv, cov ntshav tau muab rov ua dua.

Tej yam kev mob tshwj xeeb

Txoj kev kho yog ua tiav los ntawm kev saib xyuas kev noj qab haus huv tas li.

Tom qab noj thawj koob Hartil, tus neeg mob yuav tsum nyob hauv kev saib xyuas ntawm tus kws kho mob txhawm rau kom zam dhau qhov kev tiv thaiv tsis ua haujlwm hypotensive. Yuav tsum ntsuas ntsuas ntshav ntsuas qhov ntshav siab.

Ramipril yuav tsum tsis txhob noj tshuaj kom txog thaum ntsuas kom tiv thaiv kom tsis txhob muaj ntshav siab thiab lub raum khiav tsis zoo. Yog tias ua tau, kev txhim kho lub cev qhuav dej, hypovolemia, txo qis hauv cov ntshav liab yog tau coj ua ntej noj cov tshuaj. Yog tias cov kev tsis zoo no loj heev, ramipril yuav tsum ncua sijhawm.

Cov neeg mob raum ua rau lub plawv mob raum, lub raum khiav tsis zoo, ua rau cov ntshav nce siab, thiab cov neeg mob plawv tsis ua haujlwm thiab tom qab lub raum hloov ntshav, yuav tsum tau saib xyuas zoo.

Tawm tsam keeb kwm yav dhau los ntawm kev noj cov tshuaj, qhov txo qis ntawm sodium thiab nce qib ntawm cov poov tshuaj muaj peev xwm, uas yog ntau dua nrog kev ua haujlwm tsis zoo hauv lub raum lossis thaum noj nws nrog cov tshuaj potassium-sparing diuretics.

Yog hais tias noj cov tshuaj ua rau muaj kev txo qis hauv siab, tus neeg mob yuav tsum tau pw hauv txoj hauj lwm nrog ceg tsa ceg, kev kho mob, nrog rau kev qhia txog kua, tej zaum yuav tsim nyog.

Yog tias muaj mob raum ua haujlwm thiab pom cov kab mob ntawm cov nqaij mos sib txuas, thaum noj lwm yam tshuaj uas cuam tshuam rau cov ntshav hematopoietic thiab cov tshuaj tiv thaiv kab mob, kev hloov ntshav yuav tshwm sim.

Nrog rau kev tswj hwm tib txhij ntawm cov tshuaj diuretics, ua tib zoo soj ntsuam cov qib ntawm sodium hauv cov ntshav, nrog rau cov leukocytes, yog qhov tsim nyog.

Hauv cov neeg mob ntawm hemodialysis siv daim nyias nyias nrog qhov siab hydraulic permeability nrog kev tswj hwm tib txhij ntawm ACE cov tshuaj tiv thaiv kab mob, ua rau muaj kev phom sij txog kev tiv thaiv lub cev muaj peev xwm ua tau. Tib qho xwm txheej raug pom hauv cov neeg mob niaj hnub LDL apheresis nrog kev nqus ntawm dextran sulfate.

ACE cov tshuaj tiv thaiv yuav tsum tsis txhob muab rau cov neeg mob uas tau txais kev kho mob vim tias muaj kev pheej hmoo ntawm kev tsim cov kev mob hnyav tsis nco qab.

Nws yuav tsum tau yug nyob rau hauv lub siab tias Hartil ntsiav tshuaj nrog ib yam tshuaj muaj zog ntawm 5 mg suav nrog 96.47 mg ntawm lactose, 10 mg - 193,2 mg.

Cov kev paub nrog ramipril nyob rau hauv cov menyuam yaus uas mob raum tsis zoo thiab lub sijhawm lim ntshav tsawg tsawg.

Ua rau txo qis ntshav siab, uas yuav cuam tshuam lub peev xwm tswj hwm. Hauv qhov no, kev tsav tsheb thiab kev koom tes hauv cov kev ua si uas muaj kev phom sij tsis zoo.