Cov tshuaj Ramipril C3: cov lus qhia rau kev siv > Kev khomob thiab kev tiv thaiv

Ntawm nws qhov tseem ceeb, Ramipril yog ib qho tshuaj muaj feem xyuam ACE inhibitors (angiotensin hloov enzyme), i.e. rau ib pawg ntawm cov tebchaw uas nquag siv hauv kev kho mob lub plawv tsis ua hauj lwm. Vim tias qhov tshwm sim zoo ntawm cov tshuaj hauv tib neeg lub cev pib tsim tawm ramiprilat, uas nyob rau hauv lem qeeb qeeb hloov dua siab tshiab angiotensin Kuv mus rau angiotensin II, thiab tseem cuam tshuam nrog kev sib txuas ntawm tom kawg hauv cov ntaub so ntswg.

Raws li qhov tshwm sim ntawm kev ua ntawm cov tshuaj sib txuas, cov tshuaj lom hauv lub cev tsawg dua angiotensin IIuas hais txog cov muaj hwj chim txaus vasoconstrictor tshuajCov. Los ntawm kev tshem tawm cov lus tsis zoo thaum tso tawm reninzais cia tsawg aldosteroneyog li txo tag nrho peripheral vascular tsis kam.

Nyob rau tib lub sijhawm, load kam rau ua nce vim muaj qhov nce ntawm lub plawv ntim ib feeb thiab ua rau cov hlab ntsha ntawm lub ntswsCov. Cov tshuaj muaj cov nyhuv cuam tshuam rau raum hlabthiab kuj tseem pib txheej txheem kev kho lub plawv kom rov qab losCov. Ramipril txo cov kev tawm tsam tag nrholub dag zogcov hlab ntsha ntawm lub raum, cov leeg, nplooj siab, tawv nqaij thiab lub hlwbua kom zoo dua cov ntshav khiav hauv nruab nrog cev.

Antihypertensive nyhuv cov tshuaj pib tsis dhau ob peb teev tom qab nws tswj. Nrog kev siv cov tshuaj tsis tu ncua rau 4 lub lis piam, maj mam nce antihypertensive kev ua si, qib qub uas tau tswj nrog kev kho mob ntev rau ntau xyoo.

Cov tshuaj yuav txo tau qhov tshwm sim ntawm kev pheej rov ua dua tus cwj nrag, myocardial infarctionhauv cov neeg mob tom qab kev qaug dab peg dhau los lossis kev txom nyem los ntawm cov kab mob ntu hlab ntshali qub Ischemic mob plawvCov. Tsis tas li ntawd, cov tshuaj yuav pab kom tsis txhob muaj kev loj hlob. mob ntshav qab zib mellitushauv cov neeg mob uas muaj keeb kwm muaj kev pheej hmoo txaus ntshai xws li ntshav siab, microalbuminuria, cov roj (cholesterol) thiab HDL tsawg (cov lipoproteins ntau ntom).

Ramipril yog nqus los ntawm 60% hauv lub cev, thiab zaub mov noj tsis cuam tshuam rau qib ntawm kev nqus ntawm cov tshuaj. Rau cov tshuaj muaj txiaj ntsig zoo ntawm cov tshuaj, tus neeg mob yuav tsum tau ua haujlwm kom raug mob siab, nyob rau hauv uas cov etheric bonds raug rhuav tshem, thiab tsimramiprilatceev txoj kev kawm txuj ci metabolites.

Tom qab 2 teev tom qab noj cov tshuaj hauv lub cev, qhov siab tshaj plaws ntawm cov tshuaj sib txuam tau mus txog, uas yog tawm tag nrho tom qab 17 teev nrog quav thiab tso zis.

Kev ntsuas rau siv

Kev siv cov tshuaj yog pom zoo rau:

lub plawv tsis ua hauj lwmmuaj mob
ntshav qab zib nephropathy,hnav raum diffuse xwm (tsis mob ntshav qab zib nephropathy),
leeg ntshav siab,
txo qhov tshwm sim myocardial infarction, mob stroke, kev tuag leeg.

Ntxiv rau, Ramipril yog siv rau hauv kev kho mob ntawm cov neeg mob lub cev plawv nres, mob stroke, li qub qhov tseeb angioplastythiabtxoj hlab ntshav khiav hla txoj leeg.

Cov Yuav Tsum Muaj

Nws tsis pom zoo kom siv cov tshuaj thaum twg kev tiv thaiv tsis haum rau ACE inhibitorsntawm hypotension, hyperkalemia, lub raum tsis ua hauj lwmli cas los thaum cev xeeb tub thiab hauvlactation lub sijhawm.Ib qho ntxiv, nws raug nquahu kom tsis txhob Ramipril hauv kev khomob rau cov menyuam yaus hnub nyoog qis dua 18 xyoo thiab cov neeg laus laus.

Txo qhov kev siv tshuaj ntau ntxiv yog tias muaj keeb kwm ntawm angioedema, kev tsuj tawm, mob hnyav ntawm lub cev ua kom tsis taus, ntshav tsis zoo, atherosclerosis, mob hlwb, tom qab hloov raum, nrog ntshav qab zibthiab qee qhov kab mob ntsws, hyponatremia, lim ntshav.

Sab sij huam

Thaum noj cov tshuaj, phiv xws li: lub plawv tsis ua hauj lwmhypotension, angina pectoris, myocardial infarction, syncope, vertigo, arrhythmia, vasculitis, thrombocytopenia, xeev ntuav thiab ntuav, raws plab, txawv, txhawm, cem quav, pancreatitis, dysgraphia, ua kom lub siab ua haujlwm tsis zoo, daj ntseg, ua kom muaj qaub ncaug, dias taub hau thiab mob taub hau, mob ntsws, tej yam kev mob, nkees nkees, mob neuropathy, tshee tshee, pw tsaug zog, hnov lus tsis txaus, daim siab necrosis, plooj tsis pom kev, hnoos, ua tsis taus pa, mob ntsws, mob pharyngitis, rhinitis, laryngitis, photosensitivity, nrog rau poob phaus, mob taub hau, ua npaws.

Cov lus qhia rau kev siv Ramipril (Txuj ci thiab ntau npaum li cas)

Raws li cov lus qhia rau kev siv Ramipril, cov tshuaj pib noj ntawm qhov ncauj tsis ntau tshaj 2.5 mg. ib hnub. Cov hom kev siv ntawm cov tshuaj, nrog rau qhov ntau npaum li cas, tuaj yeem sib txawv raws li cov tshuaj ntawm tus kws kho mob tuaj koom, nrog rau qhov cuam tshuam ntawm cov kabmob thiab tus neeg mob lub cev.

Noj ntau dhau

Yog tias dhau ntawm kev noj ntau dhau, cov tsos mob hauv qab no yog pom hauv cov neeg mob: hypotension, angioedema, mob ntshav siab, lub plawv nres nrog lub txim hnyav ntawm lub plawv.

Rau kev kho mob ntawm qhov tshwm sim ntawm kev siv tshuaj tsis raug ntxuav lub plabnqa tawm cov haujlwm kom nce qib ntim ncig saib ntshav, nrog rau tag nrho nres los yog txo qhov koob tshuaj Ramipril.

Kev sib txuam

Kev kho mob ntawm qhov tshuaj tau zoo dua qub antihypertensivesCov. Yuav kom zam ntshav qog, hyperaldosteronismnce txoj kev pheej hmoo ntawm txoj kev loj hlob neutropeniacov tshuaj tsis yog siv nrog hauv tshuaj tiv thaiv kab mob, tshuaj kho mobraws li tau txhais tau tias myelosuppressive cuam tshuam, poov tshuaj pab thiab ntsev hloov.

Cov lus qhia tshwj xeeb

Ua ntej siv cov tshuaj, xws li thaum kho nws tus kheej, rau cov neeg mob (tshwj xeeb tshaj yog muaj kab mob sib txuas cov nqaij ntawm qhov sib txawv ntawm qhovkuj yog tus tswv tsev thiab Allopurinol thiab txhaj tshuaj tiv thaiv kab mob) Nws raug nquahu kom yauv kuaj mob tas li raum thiab ntshav electrolyte muaj pes tsawg leegsuav nrog lub dag zog.

Mob nrog sodium tsis muaj ua ntej pib txoj kev kho mob yuav tsum ua kom rov zoo li qub dej-electrolyte ntsuas. Lub sijhawm ntawm lub sijhawm siv cov tshuaj yog txwv tsis pub hemodialysis nrog kev pab ntawm polyacrylonitrile ua ke.

Kev txheeb xyuas ntawm Ramipril

Cov neeg mob feem ntau siv cov tshuaj qub, thiab tsis raug nqi ntau dua, nrog rau cov tuam ntxhab hauv tsev, tawm cov lus pom zoo txog Ramipril. Txawm li cas los xij, ntau tus neeg nco ntsoov yog qhov tsis zoo uas cov tshuaj muaj npe ntau dhau ntawm kev phiv.

Cov yam ntxwv ntawm cov tshuaj

"Ramipril", tshuaj tiv thaiv kab mob, nrog rau cov tshuaj ua cov tshuaj tiv thaiv yog cov tshuaj tiv thaiv kab mob siab. Ramipril nws tus kheej yog ib yam tshuaj uas muaj nyob hauv ntau cov tshuaj. Nws yog ACE inhibitor uas tuaj yeem tiv thaiv qhov enzyme thiab txo qis ntshav siab. Nws tso cai rau koj txhawm rau txhim kho kev ntsuas ntawm qhov kev kawm ntawm tus kab mob hauv cov neeg laus.

Cov kev tshawb fawb soj ntsuam tau pom tias ramiprilat, lub cev siv tshuaj tiv thaiv ntawm Ramipril, inhibits cov tshuaj angiotensin hloov mus rau enzyme ntau zog. Vim tias qhov no, Ramipril, analogues thiab cov kev npaj ua nyuaj yog txoj kev xaiv rau kev nyuaj tswj ntshav siab.

Txij li thaum cov tshuaj muaj peev xwm tiv thaiv ACE khov kho thiab pab tswj ntshav siab, Ramipril muaj ntau cov duab analogues. Txhua tus ntawm lawv tau ua tiav zoo siv hauv kev kho ntshav siab. Ntxiv mus, thawj ramipril yog cov tshuaj "Tritace". Txhua tus so yog nws cov generics, cov kev ua tau zoo uas yuav tsum tau muab piv nrog nws. Qhov pub nkag mus muag yuav tsum muaj kev lees paub los ntawm kev sib luag ntawm cov tshuaj Tritace.

Lub sijhawm no, cov npe ntawm cov analogues yog raws li nram no: Amprilan, Vazolong, Dilaprel, Korpril, Pyramil, Ramepress, Ramigamma, Ramicardia, Tritace, Hartil. Ramipril tseem ua los ntawm cov tuam txhab Lavxias Tathimpharmpreparaty, Biokom thiab Severnaya Zvezda. Cov khoom lag luam ntawm tom kawg yog hu ua Ramipril SZ.

Cov qauv tshuaj thiab cov khoom siv npaj ua nyuaj

Cov tshuaj antihypertensive Ramipril yog qhov yooj yim rau kev txhaj tshuaj thiab noj. Nws cov haujlwm ua rau peb cais peb tus qauv tshuaj. Cov no yog 2.5 mg, 10 thiab 5 mg. Cov ntsiav tshuaj ntawm qhov loj no npaum li cas noj ob zaug ib hnub. Nws kuj tseem muaj cov tshuaj uas muaj cov tshuaj ramipril thiab hydrochlorothiazide: Amprilan ND, Amprilan NL, Vazolong N, Remazid, Triapin, Tritace Plus, Hartil D, Egypt. Ntawm no, tus nqi ntawm ramipril yog li ntawm 2.5 mg txog 10, thiab qhov koob tshuaj hydrochlorothiazide yog li ntawm 12.5 txog 25 mg hauv ib ntsiav tshuaj.

Hom tshuaj thib ob ntawm cov tshuaj muaj zog yog kev sib xyaw ntawm Ramipril thiab calcium antagonist, Amlodipine. Ib qho piv txwv ntawm cov tshuaj yog Egipress, uas muaj nyob hauv ob qhov qauv tshuaj: 10 mg ramipril thiab 5 mg amlodipine, thiab tseem nyob ntawm koob tshuaj 10/10 mg. Ntxiv rau kev sib xyaw ua ke no, tseem muaj lwm hom tshuaj muaj ACE inhibitor Ramipril thiab calcium antagonist Felodipine. Qhov no yog Triapin, uas muaj 2.5 mg ntawm ramipril thiab 2.5 mg ntawm felodipine.

Cov lus qhia siv

Ntxiv nrog rau kev pom zoo ntawm tus kws kho mob, tus neeg mob yuav tsum coj mus rau hauv tus account cov lus qhia rau kev siv. Nws muaj cov ntaub ntawv hais txog cov cim, cov kev mob tshwm sim, kev noj tshuaj thiab cov cai tswj hwm, contraindications thiab kev ceev faj. Tsis tas li ntawd, cov lus qhia rau kev siv txuas nrog rau kev npaj Ramipril piav qhia txog qhov yuav tsum tsis lees haus cawv thaum kho ntshav siab.

Ramipril, cov tshuaj sib piv ntawm cov tshuaj thiab cov generic Tritace yog qhia rau:

tawg siab tseem ceeb,
raws li ib feem ntawm cov kev ua ntau txoj kev kho ntawm kev mob plawv tsis ua hauj lwm,
mob ntshav qab zib thiab lwm yam mob nephropathy nyob rau chaw kho mob lossis subclinical theem, tsis cuam tshuam nrog lub raum leeg ntshav hlab ntsha,
nrog cov tsos mob arterial tawg siab,
rau kev tiv thaiv ntawm myocardial infarction, kev tuag ntawm cov neeg mob uas muaj mob plawv, nrog rau kev kho mob ntshav siab nrog lub siab tag nrho cov kev pheej hmoo.

Lub ntsiab tseem ceeb yog txoj hlab ntshav tawg. Qhov no yog cov kabmob ntawm cov hnub nyoog nruab nrab thiab hnub nyoog laus, xav tau kho. Tsis tas li, cov tshuaj "Ramipril" lossis lwm ACE inhibitor yuav tsum tau muab rau cov neeg mob hauv thawj 2-9 hnub txij li lub sijhawm mob myocardial infarction. Cov koob tshuaj ntawm cov tshuaj yuav tsum ua siab ntev li sai tau txawm tias thaum tus neeg mob tsis kub siab. Qhov no yog vim muaj zog cardioprotective zoo ntawm ACE inhibitors.

Kev noj tshuaj ntxiv

Daim ntawv noj tshuaj lub ntsiab ntawm Ramipril yog ntsiav tshuaj. Hauv cov tshuaj ntsiav, nws yog qhov tsawg dua. Hauv qhov no, kev pom zoo pom zoo thawj zaug yog 1.25 mg. Qhov noj tshuaj tsawg tshaj plaws yog 2.5 mg, uas yuam nws faib ua ob. Muaj txoj kab ntawm cov ntsiav tshuaj ua rau qhov no yooj yim.

Nrog rau ib qho twg ntawm kev kub siab, kev pib koob tshuaj yog 1.25 mg ib hnub ib zaug. Tom qab ntawd, nrog kev ua siab ntev zoo, cov tshuaj maj mam ntxiv ob npaug. Koob tshuaj titration yog ua kom txog thaum ntsuas ntshav siab tau ruaj khov. Cov txheej txheem rau kev kho kom zoo ntawm kev mob ntshav siab yog cov ntshav tawm tsis tu ncua, uas tsis tshua nce ntawm lub sijhawm so.

Kev tiv thaiv kev nyab xeeb

Cov tshuaj yuav tsum nyob rau hauv kev tswj siab, tshwj xeeb yog rau thawj zaug teem tseg. Nws yog ib qho tseem ceeb tias systolic ntshav siab yog txo tsis qis dua 90 hli. Hg. Kos duab. Yog tias ntshav siab poob qis dua qhov theem no, nws raug nquahu tias koj nrhiav kev pab ntawm cov neeg ua haujlwm kho mob. Txhawm rau tiv thaiv cov ntshav siab poob, nws tsis pom zoo kom siv Ramipril ua ke nrog nitrates, chav kawm I antiarrhythmics (Procainamide) thiab alpha-1 blockers (Alfuzosin, Tamsulozin).

Cov tshuaj yuav tsum tau ua kom tsis tu ncua thiab nyiam dua nyob rau tib lub sijhawm. Qhov no tso cai rau koj hloov kho lub renin-angiotensin-aldosterone system, uas tswj ntshav siab. Ntxiv thiab, tsis txhob hla kev noj tshuaj, uas tuaj yeem hais tawm los ntawm kev mob kub siab ntau. Kev tsis kam lees qhov tseeb yuav ua rau mob stroke, qhov txaus ntshai uas yuav nce ntxiv hauv lub sijhawm no.

Tus neeg mob tshuaj xyuas txog cov tshuaj

Tritace thiab nws cov generics yog cov tshuaj zoo uas tswj ntshav siab. Txog rau hnub no, cov tshuaj no yog cov tshuaj tiv thaiv uas muaj zog tshaj plaws. Ua tsaug rau qhov no, kev xyuas tus neeg mob txog nws feem ntau zoo. Lawv tus xeeb ceem nws yog cov tshuaj uas muaj kev ntseeg siab thiab muaj zog uas tswj hwm ntshav siab. Tseem ceeb tshwj xeeb yog kev tshuaj xyuas ntawm cov neeg mob uas tau ua yav dhau los siv lwm cov tshuaj hauv pawg no.

Cov neeg mob tau sau tseg tias qee qhov tshwm sim tsis zoo nrog kev haus tshuaj lom. Qib siab ntawm kev sib raug zoo rau ACE, nrog rau qhov sib zog me me ntawm cov tshuaj, neutralize ntau cov teebmeem ntawm cov teeb meem metabolic uas tsis xav tau nrog kev siv tas li. Nws yog ib qho tseem ceeb uas cov lej ntawm cov kev ntsoog thaum siv tas li ntawm Ramipril yog qhov txo qis. Txawm li cas los xij, lawv txoj kev cais tawm tsis yog ua tiav nrog kev kho mob monotherapy.

Kev tshuaj xyuas ntawm cov kws khomob txog cov tshuaj

Kev ntsuas cov ntshav siab yog qhov kev nyuab siab. Nws tau lees tias qhov tseem ceeb ntawm tus kabmob no rau kev siv tshuaj tshiab. Nws tseem yog ib qho tseem ceeb uas cov kab mob hais txog kev txo lub neej muaj sia. Tawg nce vim kev overproduction ntawm renin, uas ua rau cov ntshav angiotensin ntau ntau. Kev txwv tsis pub cov enzyme no ua rau txo qis hauv siab. Qhov no yog qhov tsim nyog los tiv thaiv sclerosis ntawm lub nkoj phab ntsa thiab cov tsos ntawm formidable cov teeb meem kub siab.

Raws li kev rov qab saib mob cov kev tshawb fawb pom tias, ntau yam atrial fibrillations thiab mob ntawm cov hlab plawv tawm tsam tom qab tus neeg mob twb muaj ntshav siab rau qee lub sijhawm. Yog li ntawd, qhov tseem ceeb ntawm nws txoj kev kho yog loj heev. Thiab qhov tseem ceeb dua, nws muaj peev xwm tshem tawm cov kev mob nkeeg ua tsaug rau ACE inhibitors. Ntawm lawv, Ramipril yog nyob deb ntawm cov muaj zog tshaj plaws thiab muaj txiaj ntsig zoo.

Kev tshuaj xyuas ntawm cov kws kho mob hais txog nws ua pov thawj nws qhov zoo. Cov tshuaj yooj yim siv, muaj ob peb qhov tsis zoo thiab yog qhov siv tau zoo. Txawm li cas los xij, txawm hais tias cov kev ua tau zoo no, nws kuj yuav tsis txaus los kho kev mob ntshav siab ntau. Qhov no yuav luag 40-50% kev kuaj mob.

Lawv cov kev kho mob yuav tsum muaj kev sib txuas nrog tshuaj xws li ACE inhibitor, diuretic, calcium antagonist, thiab qee zaum qee qhov beta blocker. Raws li inhibitor ntawm angiotensin-hloov pauv enzyme, Ramipril tau zoo haum. Yog li ntawd, nws muaj peev xwm ib txwm coj nws qhov chaw hauv kev kho mob ntshav siab, thaum tso cai. Txawm hais tias ntau tus neeg mob xav txog nws tus nqi kuj pheej yig rau qhov tsis muaj.

Kev sib xyaw rau ib ntsiav tshuaj 10.00 mg:

Yam tshuaj muaj sia: ramipril - 10.00 mg.
Cov muaj tswv yim: lactose monohydrate (mis nyuj qab zib) - 174.00 mg, sodium bicarbonate - 10.00 mg, croscarmellose sodium - 4.00 mg, sodium stearyl fumarate - 2.00 mg.

ntsiav tshuaj nrog qhov ntau npaum ntawm 2.5 mg - puag ncig biconvex ntsiav tshuaj ntawm cov xim dawb lossis yuav luag dawb nrog kev pheej hmoo.
Cov ntsiav tshuaj nrog qhov ntau npaum li cas ntawm 5 mg thiab 10 mg yog puag ncig lub thauv-cylindrical ntsiav tshuaj ntawm xim dawb lossis yuav luag xim dawb nrog lub ntsej muag thiab pheej hmoo.

Cov chaw muag tshuaj

Cov Tshuaj Hauv Tshuaj
Lub ramipril nquag metabolite tsim nyob rau hauv cawv ntawm "daim siab" enzymes, ramiprilat, yog ACE inhibitor ntev ntev (cov ntsiab lus ntawm ACE: kininase II, dipeptidyl carboxy dipeptidase I), uas yog peptidyl dipeptidase. ACE hauv cov ntshav thiab cov nqaij mos ua kom muaj kev hloov pauv ntawm angiotensin I mus rau angiotensin II, uas muaj cov vasoconstrictor effect, thiab tawg ntawm bradykinin, uas muaj cov nyhuv vasodilating.
Yog li no, thaum noj cov ramipril sab hauv, qhov tsim ntawm angiotensin II poob qis thiab bradykinin ntau zuj zus, uas ua rau vasodilation thiab txo cov ntshav siab (BP). Tsa los ntawm ramipril, kev nce ntxiv hauv cov kev ua haujlwm ntawm kallikrein-kinin cov ntshav hauv cov ntshav thiab cov ntaub so ntswg nrog kev ua haujlwm ntawm cov kab mob prostaglandin thiab qhov nce ntawm cov synthesis ntawm prostaglandins, uas txhawb kev tsim ntawm nitric oxide hauv endotheliocytes, ua rau nws cov cardioprotective thiab endothelioprotective effect. Angiotensin II stimulates zus ntawm aldosterone, yog li noj ramipril ua rau txo qis ntawm kev tso cai ntawm aldosterone thiab nce cov ntsiab lus ntawm cov potassium ions hauv cov ntshav cov ntshav.
Nrog rau kev poob qis hauv kev ua haujlwm ntawm angiotensin II hauv cov ntshav, nws cov nyhuv inhibitory ntawm kev zais ntawm renin los ntawm hom kev tawm tsam tsis zoo yog tshem tawm, uas ua rau muaj kev nce ntxiv ntawm cov kev ua ntawm renin hauv ntshav ntshav.
Nws xav tias qhov kev txhim kho ntawm qee qhov xwm txheej tsis zoo (tshwj xeeb, "qhuav" hnoos) kuj yog cuam tshuam nrog kev nce ntawm cov kev ua ntawm bradykinin.
Hauv cov neeg mob uas mob ntshav liab, noj ramipril ua rau txo qis ntshav siab hauv txoj haujlwm "dag" thiab "sawv", yam tsis muaj kev cuam tshuam rau lub plawv dhia (HR). Ramipril txo qis tag nrho peripheral vascular tsis kam (OPSS), suab tsis ua rau muaj kev hloov pauv ntawm cov ntshav raum thiab cov ntshav txhaws. Cov nyhuv antihypertensive pib tsim tawm 1-2 teev tom qab noj ib koob ntawm cov tshuaj, nce mus txog tus nqi siab tshaj plaws tom qab 3-6 teev, thiab mob siab rau 24 teev. Nrog cov chav kawm ntawm ramipril, cov nyhuv antihypertensive yuav maj mam nce ntxiv, feem ntau yuav ruaj khov los ntawm 3-4 lub lim tiam ntawm niaj zaus noj cov tshuaj thiab tom qab ntawd tas li rau lub sijhawm ntev. Kev tsis tu ncua tam sim ntawd ntawm cov tshuaj tsis ua rau muaj kev cuam tshuam sai thiab tseem ceeb rau cov ntshav siab (tsis muaj "tshem tawm" syndrome),
Hauv cov neeg mob uas mob ntshav tawm tsam, ramipril qeeb txoj kev txhim kho thiab kev hloov kho ntawm myocardial hypertrophy thiab leeg ntshav phab ntsa.
Hauv cov neeg mob uas muaj lub plawv tsis ua hauj lwm ntev, ramipril txo OPSS (txo qis tom qab lub siab), ua kom lub peev xwm ntawm txoj hlab xaib thiab txo qhov txhaws ntawm sab laug ventricle, uas, raws li, ua rau txo qis hauv kev thauj khoom hauv lub plawv. Hauv cov neeg mob no, thaum noj cov tshuaj ramipril, muaj qhov nce ntxiv hauv cov hlab plawv, tso tawm feem thiab ua kom lub cev muaj zog dua. Hauv kev mob ntshav qab zib thiab tsis mob ntshav qab zib, noj ramipril ua rau qeeb tus nqi ntawm qhov muaj mob ntawm lub raum tsis ua haujlwm thiab qhov pib ntawm qhov kawg ntawm lub raum tsis ua haujlwm thiab, yog li, txo qhov xav tau hemodialysis lossis hloov raum. Hauv cov theem pib ntawm tus mob ntshav qab zib lossis mob ntshav qab zib nephropathy, ramipril txo qhov tshwm sim ntawm albuminuria. Hauv cov neeg mob uas muaj kev pheej hmoo siab los ntawm kev mob hlab plawv vim yog voos txhab (kuaj mob plawv, keeb kwm ntawm kab mob txha caj qaum, keeb kwm ntawm mob hlab ntsha tawg) lossis ntshav qab zib mellitus muaj tsawg kawg yog ib qho kev pheej hmoo ntxiv (microalbuminuria, mob ntshav nce ntshav, nce siab ntawm tag nrho cov roj (OX), kev txo qis ntawm cov khoom ntawm cov ntshav qab zib lipoprotein ntau (roj HDL-C), haus luam yeeb) qhov sib ntxiv ntawm ramipril rau cov kev kho mob txhais tau tias Nws thim txo qhov tshwm sim ntawm myocardial infarction, mob stroke, thiab kev tuag ntawm cov kab mob plawv. Ntxiv rau, ramipril txo tag nrho cov neeg tuag, nrog rau kev xav kom rov ua haujlwm ntawm cov hlab ntsha thiab ua rau qhov pib qeeb lossis mob zuj zus ntawm lub plawv tsis ua haujlwm.
Hauv cov neeg mob uas lub plawv tsis ua haujlwm thiab kev soj ntsuam uas tau tsim hauv thawj hnub ntawm tus mob myocardial infarction (2-9 hnub), ramipril, uas tau pib txij hnub 3 mus rau 10 hnub ntawm tus mob myocardial infarction, txo kev tuag (los ntawm 27%), kev pheej hmoo ntawm kev tuag sai (los ntawm 30 %), qhov pheej hmoo ntawm kev vam meej ntawm lub plawv tsis ua haujlwm kom tsis txhob mob loj (NYHA chav kawm III-IV ua haujlwm chav kawm) / kho-tiv taus (23%), qhov yuav ua rau tsev kho mob txuas ntxiv vim yog kev txhim kho lub plawv tsis ua haujlwm (26%).
Hauv cov neeg mob dav dav, nrog rau cov neeg mob ntshav qab zib mellitus, ob qho tib si nrog txoj hlab ntshav siab thiab nrog cov ntshav siab li qub, ramipril txo txoj kev pheej hmoo ntawm nephropathy thiab qhov tshwm sim ntawm microalbuminuria.

Cov Tshuaj Pharmacokinetics
Tom qab kev tswj hwm ntawm qhov ncauj, ramipril yog nqus tau sai sai ntawm txoj hnyuv (50-60%). Tib lub sij hawm ua noj ua haus qeeb qeeb nws nqus, tab sis tsis cuam tshuam rau qhov ua tiav ntawm kev nqus. Ramipril yauv ua rau lub cev muaj zog presystemic metabolism / ua kom zoo (feem ntau yog nyob hauv daim siab los ntawm hydrolysis), uas ua rau nws tsuas yog siv cov metabolite, ramiprilat, uas nws ua haujlwm nrog hwm ACE inhibition yog kwv yees li 6 npaug siab dua qhov kev ua haujlwm ntawm ramipril. Tsis tas li ntawd, raws li kev tshwm sim ntawm ramipril metabolism, diketopiperazine, uas tsis muaj pharmacological kev ua si, yog tsim, uas yog tom qab ntawd ua rau kev sib txuas nrog glucuronic acid, ramiprilat kuj tseem glucuronated thiab metabolized rau diketopiperazic acid.
Txhua qhov tsim tawm metabolites, tshwj tsis yog ramiprilat, tsis muaj kev ua haujlwm pharmacological.
Lub bioavailability ntawm ramipril tom qab kev tswj hwm ntawm qhov ncauj li ntawm 15% (rau ib koob tshuaj 2.5 mg) txog 28% (rau ib koob tshuaj 5 mg). Lub bioavailability ntawm lub nquag metabolite, ramiprilat, tom qab noj ntawm 2.5 mg thiab 5 mg ntawm ramipril yog kwv yees li 45% (piv nrog nws cov bioavailability tom qab kev tswj hwm hauv tib cov tshuaj).
Tom qab noj ramipril sab hauv, qhov siab tshaj plaws ntshav plasma ntawm ramipril thiab ramiprilat tau mus txog tom qab 1 thiab 2-4 teev, feem. Kev poob qis hauv lub plasma concentration ntawm ramiprilat tshwm sim nyob rau hauv ntau theem: kev faib khoom thiab kev nthuav tawm theem nrog ib nrab-lub neej (T_1/2) ramiprilat, kwv yees li 3 teev, tom qab ntawd theem nrab nrog T_1/2 ramiprilat, suav nrog kwv yees li 15 teev, thiab theem kawg nrog kev siv qis heev ntawm ramiprilat hauv ntshav thiab T_1/2 ramiprilat, kwv yees li 4-5 hnub. Qhov theem kawg no yog vim qhov qeeb tawm ntawm ramiprilat los ntawm kev sib raug zoo nrog ACE receptors. Txawm hais tias tau ua kom tiav lub sijhawm ntev nrog ib zaug muab tshuaj ntawm ramipril qhov ncauj ntawm koob tshuaj 2.5 mg lossis ntau dua, qhov sib luag ntawm cov ntshav ntshav ntawm ramiprilat tau mus txog tom qab kwv yees li 4 hnub ntawm kev kho mob. Nrog rau txoj kev siv ntawm cov tshuaj "zoo" T_1/2 nyob ntawm seb qhov koob tshuaj yog 13-17 teev.
Kev sib txuas nrog cov ntshav plasma protein yog kwv yees li 73% rau ramipril, thiab 56% rau ramiprilat.
Tom qab kev tswj hwm ntawm cov dej khov, qhov ntim ntawm ramipril thiab ramiprilat yog kwv yees li 90 L thiab kwv yees li 500 L, feem.
Tom qab noj, ramipril (10 mg), sau npe nrog cov xov tooj cua isotope, 39% ntawm radioactivity tau tawm ntawm txoj hnyuv thiab li 60% los ntawm lub raum. Tom qab tso cov tshuaj ramipril, 50-60% ntawm cov koob tshuaj yog pom hauv cov zis hauv daim ntawv ntawm ramipril thiab nws cov tshuaj tiv thaiv. Tom qab kev tso cov tshuaj ramiprilat, kwv yees li 70% ntawm cov koob tshuaj tau pom nyob hauv cov zis hauv daim ntawv ntawm ramiprilat thiab nws cov metabolites, hauv lwm cov lus, nrog kev tswj hwm ntawm ramipril thiab ramiprilat, ib feem tseem ceeb ntawm cov koob tshuaj tau tawm hauv cov hnyuv nrog bile, hla lub raum (50% thiab 30%, feem). Tom qab lub qhov ncauj tswj hwm ntawm 5 mg ntawm ramipril nyob rau hauv cov neeg mob nrog cov kua tsib lub raj dej, yuav luag tus nqi ntawm ramipril thiab nws cov metabolites yog txaws los ntawm lub raum thiab dhau los ntawm txoj hnyuv hauv thawj 24 teev tom qab kev coj.
Kwv yees li 80-90% ntawm cov metabolites hauv cov zis thiab bile tau pom tias yog ramiprilat thiab ramiprilat metabolites. Ramipril glucuronide thiab ramipril diketopiperazine tus account rau kwv yees li 10-20% ntawm tag nrho cov nyiaj, thiab cov ntsiab lus tsis muaj npe ntawm ramipril nyob hauv cov zis yog kwv yees li 2%.
Cov kev tshawb fawb tsiaj tau pom tias ramipril ua rau tawm hauv niam cov kua mis.
Yog tias muaj teeb meem lub raum tsis ua hauj lwm nrog kev tshem tawm creatinine (CC) tsawg dua 60 ml / min. excretion ntawm ramiprilat thiab nws cov metabolites los ntawm lub raum poob qis. Qhov no ua rau muaj qhov nce ntxiv ntawm plasma concentration ntawm ramiprilat, uas ua rau qeeb qeeb qeeb dua li cov neeg mob uas lub raum tsis ua haujlwm.
Thaum noj ramipril hauv siab (10 mg), lub siab ua haujlwm tsis zoo ua rau cov qeeb qeeb hauv presystemic metabolism ntawm ramipril kom nquag ua haujlwm ramiprilat thiab qeeb qeeb ntawm ramiprilat.
Hauv cov neeg tuaj yeem noj qab haus huv thiab nyob rau hauv cov neeg mob mob ntshav liab, tom qab ob lub lis piam los kho mob nrog ramipril hauv ib koob tshuaj 5 mg txhua hnub, tsis muaj qhov tseem ceeb hauv kev kho mob ntawm ramipril thiab ramiprilat. Hauv cov neeg mob uas muaj lub plawv tsis ua hauj lwm ntev, tom qab kho ob lub lis piam nrog ramipril nyob rau hauv ib koob tshuaj 5 mg txhua hnub, 1.5-1.8-lub sij hawm nce hauv plasma cov ntsiab lus ntawm ramiprilat thiab thaj chaw hauv qab qhov tsom mus rau-lub sij hawm pharmacokinetic nkhaus (AUC) tau pom.
Hauv cov neeg laus noj qab haus huv cov neeg ua haujlwm dawb (65-76 xyoo), pharmacokinetics ntawm ramipril thiab ramiprilat tsis txawv dua li cov tub ntxhais hluas ua haujlwm pab dawb.

Nrog saib xyuas

Kev siv ib txhij ntawm cov tshuaj Ramipril nrog cov tshuaj muaj aliskiren lossis angiotensin II receptor antagonists (nrog ob qhov kev thaiv ntawm cov renin-angiotensin-aldosterone system (RAAS) muaj qhov pheej hmoo ntawm kev txo qis hauv cov ntshav siab, kev txhim kho ntawm hyperkalemia thiab lub cev tsis zoo los ua kom zoo li piv nrog kev kho mob hlwb (saib ntshav) (saib Tshooj lus "Cov Lus Qhia Tshwj Xeeb").
Cov mob uas ua rau cov ntshav siab poob qis yog qhov txaus ntshai tshwj xeeb (nrog cov leeg mob ntawm cov leeg ntshav thiab txoj hlab hlwb).
Cov mob uas muaj nrog los ntawm kev nce siab hauv RAAS kev ua haujlwm, uas, thaum ACE raug tiv thaiv, muaj kev pheej hmoo ntawm cov ntshav siab nrog lub hlwb ua haujlwm tsis zoo:

kev mob ntshav siab tshwj xeeb tshaj plaws, tshwj xeeb tshaj yog malignant arterial tawg,
mob plawv tsis ua hauj lwm, tshwj xeeb tshaj yog mob hnyav, lossis rau lwm yam tshuaj tiv thaiv kab mob ntshav siab,
hemodynamically tseem ceeb unilateral stenosis ntawm lub raum artery (nyob rau hauv muaj ob lub raum) - nyob rau hauv cov neeg mob, txawm tias nce me ntsis nyob rau hauv lub concentration ntawm creatinine nyob rau hauv cov ntshav cov ntshav tuaj yeem yog ib qho kev cuam tshuam ntawm unilateral tsis zoo ntawm lub raum muaj nuj nqi,
yav dhau los kom tsawg ntawm diuretics,
kev ntxhov siab hauv cov dej-electrolyte sib npaug los ntawm kev nqus dej tsis txaus thiab sodium chloride, raws plab, ntuav, thiab tawm hws.

Kev ua tsis zoo ntawm daim siab ua haujlwm (tsis muaj kev paub nrog kev siv: nws muaj peev xwm ua tau ob qho tib si ua kom nrov nrov thiab tsis muaj zog ntawm cov teebmeem ntawm ramipril muaj peev xwm ua tau, hauv cov neeg mob uas muaj lub siab ua rau daim siab nrog ascites thiab edema, kev ua haujlwm tseem ceeb ntawm RAAS yog ua tau)
Lub raum khiav tsis zoo (CC ntau dua 20 ml / min / 1.73 m² ntawm lub cev nqaij daim tawv thaj tsam) vim qhov pheej hmoo ntawm kev txhim kho hyperkalemia thiab leukopenia.
Mob tom qab hloov raum.
Cov kab mob ntawm cov kab mob sib txuas, nrog rau cov kab mob lupus erythematosus, scleroderma, kev kho qhov muag nrog cov tshuaj uas tuaj yeem ua rau muaj kev hloov pauv hauv daim duab ntawm cov ntshav txhaws (tej zaum yuav txwv cov leeg ntshav hematopoiesis, kev txhim kho neutropenia lossis agranulocytosis) (saib ntu "Kev cuam tshuam nrog lwm cov tshuaj").
Ntshav qab zib mellitus (kev pheej hmoo ntawm hyperkalemia).
Cov neeg laus (muaj kev pheej hmoo ntawm cov nyhuv antihypertensive).
Hyperkalemia

Siv thaum cev xeeb tub thiab thaum pub niam mis

Ramipril yog contraindicated nyob rau hauv cev xeeb tub, vim nws tuaj yeem muaj qhov tsis zoo ntawm lub cev hauv plab: kev txhim kho lub raum ntawm lub cev, poob qis ntawm cov ntshav ntawm lub cev thiab cov menyuam yug tshiab, kev ua haujlwm tsis zoo rau lub raum, hyperkalemia, hypoplasia ntawm cov pob txha pob txha taub hau, oligohydramnios, kev cog lus ntawm cov nqaj, kev hloov ntawm cov pob txha ntawm lub pob txha taub hau, hypoplasia.
Yog li, ua ntej siv cov tshuaj rau hauv cov poj niam ntawm lub hnub nyoog yug menyuam, cev xeeb tub yuav tsum raug cais tawm.
Yog tias tus poj niam tab tom npaj kho cev xeeb tub, tom qab ntawv kho nrog ACE inhibitors yuav tsum tsis ua ntxiv.
Yog tias pom tseeb qhov tseeb ntawm cev xeeb tub thaum kho nrog Ramipril, koj yuav tsum tsum tsis noj sai thiab hloov tus neeg mob mus noj lwm yam tshuaj, thaum siv uas qhov pheej hmoo rau tus menyuam yuav tsawg tshaj plaws.
Yog tias kev kho mob nrog Ramipril yog qhov tsim nyog thaum lactation, kev pub mis niam yuav tsum tsis ua mus ntxiv.

Tsuas tshuaj thiab tswj hwm

Cov ntsiav tshuaj yuav tsum tau noj tsis hais txog lub sijhawm noj mov (uas yog, ntsiav tshuaj tuaj yeem noj ua ntej thiab thaum lossis tom qab noj mov) thiab haus dej ntau (1/2 khob). Tsis txhob zom lossis zom cov ntsiav tshuaj ua ntej siv.
Cov koob tshuaj tau xaiv nyob ntawm kev kho mob kom haum thiab ua siab ntev rau cov neeg mob rau cov tshuaj. Txoj kev kho yog feem ntau ntev, thiab nws lub sijhawm nyob rau hauv txhua kis tau txiav txim los ntawm tus kws kho mob.
Tshwj tsis yog muaj kev cai tshwj xeeb, tom qab ntawd nrog lub raum ua haujlwm thiab lub siab ua haujlwm, kev noj tshuaj hauv qab no raug pom zoo.
Nrog rau cov hlab ntsha o
Feem ntau, cov tshuaj thawj zaug yog 2.5 mg ib hnub ib zaug thaum sawv ntxov. Yog tias thaum noj cov tshuaj hauv qhov tshuaj no 3 lub lis piam lossis ntau dua, nws tsis tuaj yeem ua kom ntshav siab, ces qhov koob tshuaj yuav raug nce ntxiv rau 5 mg ntawm ramipril ib hnub. Yog tias qhov koob tshuaj 5 mg yuav siv tsis tau txaus, tom qab 2-3 lub lis piam nws tuaj yeem tau ob npaug rau qhov siab tshaj qhov xav tau ntawm 10 mg ib hnub twg.
Raws li lwm txoj hauv kev ntxiv cov tshuaj rau 10 mg rau ib hnub nrog qhov tsis muaj txiaj ntsig antihypertensive ntawm ib koob tshuaj txhua hnub ntawm 5 mg, nws muaj peev xwm ntxiv lwm cov tshuaj tiv thaiv kab mob rau kev kho mob, tshwj xeeb, diuretics lossis "qeeb" calcium channel blockers.
Hauv lub plawv tsis ua haujlwm
Qhov pom zoo pib koob ntawm 1.25 mg (1/2 ntsiav tshuaj ntawm 2.5 mg) 1 zaug hauv ib hnub. Nyob ntawm cov lus teb los ntawm tus neeg mob txoj kev kho, qhov koob tshuaj yuav nce ntxiv. Nws raug nquahu kom txhaj koob tshuaj ob zaug nrog ib nrab sijhawm 1-2 asthiv. Yog tias koj yuav tsum tau noj tshuaj txhua hnub ntawm 2.5 mg lossis siab dua, nws tuaj yeem muab ib zaug ib hnub, lossis faib ua 2 zaug.
Qhov siab tshaj plaws kev pom zoo txhua hnub koob tshuaj yog 10 mg.
Nrog mob ntshav qab zib lossis tsis mob ntshav qab zib nephropathy
Qhov pom zoo kom tau txhaj thawj zaug ntawm 1.25 mg ib hnub ib zaug (1/2 ntsiav tshuaj ntawm 2.5 mg). Qhov koob tshuaj yuav nce ntxiv rau 5 mg ib hnub ib zaug. Nrog rau cov mob no, cov koob tshuaj ntau dua 5 mg ib hnub ib zaug hauv kev tswj cov chaw kho mob tsis tau tshawb fawb txaus.
Txo txoj hauv kev pheej hmoo ntawm myocardial infarction, mob hlab ntsha tawg, lossis lub plawv kev tuag ntawm cov neeg mob ntshav siab
Qhov pom zoo pib koob tshuaj 2.5 mg 1 zaug nyob rau ib hnub. Nyob ntawm seb cov neeg mob ua siab ntev li cas, cov koob tshuaj tuaj yeem raug maj mam nce ntxiv. Nws raug nquahu kom txhaj ob npaug tom qab 1 lub lim tiam ntawm kev kho mob, thiab nyob rau 3 lub lis piam tom qab ntawm kev kho mob, nce nws mus rau kev tswj hwm ib txwm li ntawm 10 mg ib hnub ib zaug.
Cov koob tshuaj ntau tshaj 10 mg tsis tau muaj kev kawm txaus hauv kev tswj xyuas cov neeg mob. Kev siv cov tshuaj hauv cov neeg mob CC ntau dua 0.6 ml / sec tsis nkag siab zoo.
Nrog lub plawv tsis ua haujlwm nrog cov kev kuaj mob tshwm sim thaum thawj ob peb hnub (los ntawm hnub thib 2 mus rau hnub 9) tom qab mob myocardial infarction
Qhov pom zoo kom muab thawj zaug yog 5 mg rau ib hnub, muab faib ua ob zaug tshuaj 2.5 mg, uas tau noj ib tag kis thiab thib ob thaum yav tsaus ntuj. Yog tias tus neeg mob tsis zam lub koob tshuaj no thaum pib (saib ntshav siab txaus), nws raug nquahu kom noj 1.25 mg (1/2 ntsiav tshuaj ntawm 2.5 mg) 2 zaug hauv ib hnub rau ob hnub.
Tom qab ntawd, nyob ntawm kev tawm tsam los ntawm tus neeg mob, cov koob tshuaj yuav raug nce ntxiv. Nws raug nquahu tias cov koob tshuaj nrog nws nce ob npaug nrog ib nrab ntawm 1-3 hnub. Tom qab ntawd, tag nrho cov koob tshuaj txhua hnub, uas tau muab faib ua thawj zaug, muab tau ib zaug. Qhov koob tshuaj ntau tshaj plaws yog 10 mg.
Tam sim no, cov kev paub hauv kev kho cov neeg mob uas muaj mob plawv tsis zoo (III-IV chav kawm ua haujlwm raws li NYHA kev faib tawm), uas tau tshwm sim sai sai tom qab mob myocardial infarction, tsis txaus. Yog tias cov neeg mob zoo li no txiav txim siab mus kho mob nrog Ramipril, nws raug nquahu tias kev kho mob pib nrog kev siv qis tshaj - 1.25 mg (1/2 ntsiav tshuaj ntawm 2.5 mg) ib hnub ib zaug, thiab yuav tsum tau saib xyuas tshwj xeeb nrog txhua qhov nce koob tshuaj.
Kev siv cov tshuaj Ramipril hauv qee pawg ntawm cov neeg mob
Cov neeg mob uas lub raum tsis ua hauj lwm zoo
Nrog CC los ntawm 50 txog 20 ml / min, qhov kev pib rau thawj hnub feem ntau yog 1.25 mg (1/2 ntsiav tshuaj ntawm 2.5 mg). Qhov nyiaj pab ntau tshaj rau niaj hnub noj yog 5 mg.
Cov neeg mob uas ua tsis tiav kho cov kua dej thiab electrolytes, cov neeg mob ntshav siab heev, nrog rau cov neeg mob ntshav siab ua rau muaj kev phom sij ntau (piv txwv li, muaj cov leeg mob atherosclerotic ntau dua ntawm cov hlab ntshav hlab ntshav thiab hlab hlwb)
Thawj koob tshuaj yog txo kom tsawg rau 1.25 mg / hnub (1/2 ntsiav tshuaj ntawm 2.5 mg).
Cov neeg mob nrog kev kho mob ua ntej
Nws yog qhov tsim nyog, yog tias ua tau, kom tshem tawm cov tshuaj diuretics 2-3 hnub (nyob ntawm lub sijhawm ntawm kev ua ntawm diuretics) ua ntej pib kev kho mob nrog Ramipril lossis, tsawg kawg, txo cov koob tshuaj diuretics noj. Kev kho mob ntawm cov neeg mob zoo li no yuav tsum pib nrog qhov qis tshaj ntawm 1.25 mg ntawm ramipril (1/2 ntsiav tshuaj ntawm 2.5 mg), noj ib hnub ib zaug, thaum sawv ntxov. Tom qab noj thawj koob thiab txhua lub sijhawm tom qab nce lub koob tshuaj ramipril thiab (lossis) diuretics, tshwj xeeb tshaj yog "voj" diuretics, cov neeg mob yuav tsum tau nyob hauv kev saib xyuas kev kho mob tsawg kawg yog 8 teev txhawm rau kom zam dhau qhov kev tiv thaiv tsis tuaj yeem tswj tau.
Cov neeg laus (laus dua 65 xyoos)
Thawj koob tshuaj yog txo kom tsawg dua 1.25 mg rau ib hnub (1/2 ntsiav tshuaj ntawm 2.5 mg).
Cov neeg mob uas muaj lub siab ua haujlwm tsis zoo
Cov tshuaj tiv thaiv ntawm cov ntshav siab rau noj Ramipril tuaj yeem ua rau nce ntxiv (vim qhov ua kom qeeb ntawm ramiprilat excretion), lossis ua kom tsis muaj zog (vim ua kom qeeb ntawm qhov hloov pauv tsis ua haujlwm mus rau ramiprilat kom nquag ua haujlwm ramiprilat). Yog li, thaum pib kho yuav tsum muaj kev saib xyuas mob nkeeg. Qhov siab tshaj plaws tau tso cai rau noj txhua hnub yog 2.5 mg.

Yuav siv li cas: noj ntau thiab hom tshuaj kho

Cov ntsiav tshuaj tau nqos tag nrho (tsis txhob zom), ntxuav nrog qhov dej txaus (1/2 khob) ntawm cov dej, tsis hais txog kev noj mov (li cas, cov ntsiav tshuaj tuaj yeem noj ua ntej thiab thaum lossis tom qab noj mov). Cov koob tshuaj tau xaiv nyob ntawm kev kho mob kom haum thiab ua siab ntev rau cov neeg mob rau cov tshuaj.

Kev kho mob nrog Ramipril-SZ feem ntau yog ntev, thiab nws lub sijhawm hauv txhua kis tau txiav txim los ntawm tus kws kho mob.

Tshwj tsis yog muaj lwm qhov sau tseg, tom qab ntawd nrog lub raum thiab cov hlab ntsws ua haujlwm, kev noj tshuaj hauv qab no raug pom zoo.

Nrog rau qhov kub siab tseem ceeb, feem ntau yog pib ntawm thawj zaug yog 2.5 mg 1 zaug hauv ib hnub thaum sawv ntxov. Yog tias thaum noj cov tshuaj hauv qhov tshuaj no 3 lub lis piam lossis ntau dua, nws tsis tuaj yeem ua kom ntshav siab, ces qhov koob tshuaj yuav raug nce ntxiv rau 5 mg ntawm ramipril ib hnub. Yog tias qhov koob tshuaj 5 mg yuav siv tsis tau txaus, tom qab 2-3 lub lis piam nws tuaj yeem tau ob npaug rau qhov siab tshaj qhov xav tau ntawm 10 mg ib hnub twg.

Raws li lwm txoj hauv kev ntxiv cov tshuaj rau 10 mg rau ib hnub nrog qhov tsis txaus antihypertensive siv tau los ntawm kev noj tshuaj txhua hnub ntawm 5 mg, nws muaj peev xwm ntxiv lwm cov tshuaj tiv thaiv kab mob rau kev kho mob, tshwj xeeb cov tshuaj diuretics lossis "qeeb" calcium channel blockers.

Hauv kev mob plawv tsis ua hauj lwm ntev, pom zoo kom pib koob: 1.25 mg ib hnub ib zaug (1/2 ntsiav tshuaj 2.5 mg). Nyob ntawm tus neeg mob cov lus teb rau txoj kev kho mob, cov koob tshuaj yuav nce ntxiv. Nws raug nquahu kom txhaj koob tshuaj ob zaug nrog ib nrab sijhawm 1-2 asthiv. Yog tias koj xav noj cov tshuaj 2.5 mg los sis ntau dua, nws tuaj yeem muab ib zaug ib hnub, lossis faib ua 2 zaug.

Qhov siab tshaj plaws kev pom zoo txhua hnub koob tshuaj yog 10 mg.

Rau cov ntshav qab zib lossis tsis mob ntshav qab zib rau cov ntshav qab zib, kev pom zoo pib koob: 1.25 mg ib hnub ib zaug (1/2 ntsiav tshuaj 2.5 mg). Qhov koob tshuaj yuav nce ntxiv rau 5 mg ib hnub ib zaug. Nrog rau cov xwm txheej no, cov koob tshuaj ntau dua 5 mg ib hnub ib zaug hauv kev tswj cov chaw kho mob tsis tau tshawb fawb txaus.

Txo txoj kev pheej hmoo ntawm myocardial infarction, mob hlab ntsha tawg, lossis lub plawv kev tuag hauv cov neeg mob uas muaj kev pheej hmoo siab ntshav siab, qhov kev xav pom zoo thawj zaug ntawm Ramipril-SZ yog 2.5 mg ib hnub ib zaug. Nyob ntawm seb cov neeg mob ua siab ntev li cas, cov koob tshuaj tuaj yeem raug maj mam nce ntxiv. Nws raug nquahu kom txhaj koob tshuaj ob zaug ntxiv tom qab 1 lub lim tiam ntawm kev kho mob, thiab nyob rau 3 lub lis piam tom qab ntawm kev kho mob, nce nws mus rau kev saib xyuas li niaj zaus noj 10 mg ib hnub ib zaug.

Cov koob tshuaj ntau tshaj 10 mg tsis tau muaj kev kawm txaus hauv kev tswj xyuas cov neeg mob.

Kev siv cov tshuaj rau cov neeg mob nrog creatinine tshem tawm tsawg dua 0.6 ml / s tsis tau kawm txaus.

Nrog rau lub plawv tsis ua haujlwm uas tau tsim nyob rau thawj ob peb hnub (txij li hnub thib 2 mus rau 9 hnub) tom qab mob myocardial infarction, qhov kev xav pom zoo thawj zaug yog 5 mg ib hnub, muab faib ua ob zaug tshuaj 2.5 mg, uas noj ib tag kis sawv ntxov, thiab zaum ob thaum yav tsaus ntuj. Yog hais tias tus neeg mob tsis zam lub koob tshuaj no thaum pib (ntshav siab dhau heev yog kuaj), ces nws raug pom zoo kom nws muab 1.25 mg 2 zaug hauv ib hnub (1/2 ntsiav tshuaj 2.5 mg). Tom qab ntawd, nyob ntawm kev tawm tsam los ntawm tus neeg mob, cov koob tshuaj yuav raug nce ntxiv. Nws raug nquahu tias cov koob tshuaj nrog nws nce ob npaug nrog ib nrab ntawm 1-3 hnub. Tom qab ntawd, tag nrho cov koob tshuaj txhua hnub, uas tau muab faib ua thawj zaug, muab tau ib zaug.

Qhov koob tshuaj ntau tshaj plaws yog 10 mg.

Tam sim no, cov kev paub hauv kev kho cov neeg mob uas muaj lub plawv tsis zoo (III-IV chav kawm ua haujlwm raws li NYHA kev faib tawm), uas tshwm sim tam sim ntawd tom qab mob myocardial infarction, tsis txaus. Yog tias cov neeg mob zoo li no txiav txim siab mus kho mob nrog Ramipril-SZ, nws raug nquahu tias kev kho mob pib nrog kev siv qis tshaj - 1.25 mg ib hnub ib zaug (1/2 ntsiav tshuaj 2.5 mg) thiab kev saib xyuas tshwj xeeb yuav tsum tau noj nrog txhua qhov nce koob tshuaj.

Kev siv Ramipril-SZ hauv qee pab pawg ntawm cov neeg mob

Cov neeg mob uas lub raum tsis zoo: thaum creatinine tshem tawm yog los ntawm 50 txog 20 ml / min rau 1.73 m2 ntawm lub cev, qhov pib thawj hnub feem ntau yog 1.25 mg (1/2 ntsiav tshuaj 2.5 mg). Qhov nyiaj pab ntau tshaj rau niaj hnub noj yog 5 mg.

Cov neeg mob uas muaj qee qhov kho tsis tau kua thiab roj ntsha, cov neeg mob ntshav siab ntau ntxiv, nrog rau cov neeg mob uas cov ntshav siab ntau dhau los ua qee yam kev pheej hmoo (piv txwv li, muaj qhov tsis txaus ntshav atherosclerotic ntawm cov hlab ntshav tawm thiab hlab hlwb): cov koob tshuaj thawj zaug raug txo mus rau 1.25 mg / hnub (1/2 ntsiav tshuaj 2.5 mg).

Cov neeg mob nrog kev kho mob diuretic yav dhau los: yog tias ua tau, diuretics yuav tsum tso tseg nyob rau hauv 2-3 hnub (nyob ntawm lub sijhawm ntawm kev ua ntawm diuretics) ua ntej pib kho nrog Ramipril-SZ lossis, tsawg kawg, txo qhov koob tshuaj diuretics noj. Kev kho mob ntawm cov neeg mob no yuav tsum tau pib nrog kev noj tshuaj qis dua 1.25 mg ntawm ramipril (1/2 ntsiav tshuaj ntawm 2.5 mg), noj ib hnub ib zaug, thaum sawv ntxov. Tom qab noj thawj koob thiab txhua lub sijhawm tom qab nce lub koob tshuaj ramipril thiab (lossis) "voj" diuretics, cov neeg mob yuav tsum tau nyob hauv kev saib xyuas kev kho mob tsawg kawg yog 8 teev txhawm rau kom zam dhau qhov kev tiv thaiv tsis tuaj yeem tswj tau.

Cov neeg laus muaj hnub nyoog (laus dua 65 xyoos): thawj koob yuav tsum tau txo kom txog 1.25 mg rau ib hnub (1/2 ntsiav tshuaj 2.5 mg).

Cov neeg mob uas muaj lub siab ua haujlwm tsis txaus siab: cov tshuaj tiv thaiv ntshav siab rau kev noj cov tshuaj Ramipril-SZ tuaj yeem nce ntxiv (los ntawm kev txo qis ramiprilat excretion) lossis ua kom tsis muaj zog (vim txo qis kev hloov pauv ntawm cov tsis muaj zog ramipril kom nquag ua haujlwm ramiprilat). Yog li, thaum pib kho yuav tsum muaj kev saib xyuas mob nkeeg. Qhov siab tshaj plaws tau tso cai rau noj txhua hnub yog 2.5 mg.

Pharmacological kev txiav txim

Cov tshuaj nquag ntawm Ramipril-SZ nyob rau hauv kev cuam tshuam ntawm "daim siab" enzymes tau hloov mus rau hauv lub cev nquag metabolite ramiprilat, uas muaj kev cuam tshuam lub sijhawm ntev ntawm ACE. ACE hauv cov ntshav thiab cov nqaij ua rau kev hloov pauv ntawm angiotensin I mus rau angiotensin II thiab kev tawg ntawm bradykinin. Yog li no, thaum noj cov ramipril sab hauv, qhov tsim ntawm angiotensin II poob qis thiab bradykinin ntau zuj zus, uas ua rau vasodilation thiab txo cov ntshav siab (BP).

Kev nce ntxiv hauv cov haujlwm ntawm kallikrein-kinin lub cev nyob rau hauv cov ntshav thiab cov ntaub so ntswg txiav txim siab cardioprotective thiab endothelioprotective nyhuv ntawm ramipril vim kev ua haujlwm ntawm prostaglandin system thiab, raws li, kev nce ntxiv hauv cov synthesis ntawm prostaglandins, uas txhawb kev tsim cov nitric oxide (TSIS) nyob rau hauv endotheliocytes.

Angiotensin II stimulates zus ntawm aldosterone, yog li noj ramipril txo cov kev zais ntawm aldosterone thiab nce cov ntsiab lus ntawm poov tshuaj ions.

Nrog rau kev txo qis hauv kev ua haujlwm ntawm angiotensin II hauv cov ntshav, nws cov nyhuv inhibitory rau renin secretion los ntawm cov lus tsis zoo raug tshem tawm, uas ua rau muaj kev nce ntxiv hauv cov ntshav plasma renin kev ua si. Nws tau suav hais tias kev txhim kho ntawm qee qhov kev tsis haum (tshwj xeeb, "qhuav" hnoos) kuj yog cuam tshuam nrog kev nce ntawm cov kev ua ntawm bradykinin.

Hauv cov neeg mob uas mob ntshav liab, noj ramipril ua rau txo qis ntshav siab hauv txoj haujlwm "dag" thiab "sawv", yam tsis muaj kev cuam tshuam rau lub plawv dhia (HR). Ramipril txo qis tag nrho peripheral vascular tsis kam (OPSS), suab tsis ua rau muaj kev hloov pauv ntawm cov ntshav raum thiab cov ntshav txhaws. Cov nyhuv antihypertensive pib tshwm sim li 1-2 teev tom qab noj ib koob ntawm cov tshuaj, nce mus txog nws tus nqi siab tshaj plaws tom qab 3-9 teev, thiab kav ntev li 24 teev. Nrog chav kawm koob tshuaj, cov nyhuv antihypertensive yuav maj mam nce ntxiv, feem ntau yuav ruaj khov li ntawm 3 txog 4 asthiv ntawm kev tswj hwm ib txwm ntawm cov tshuaj thiab tom qab ntawd tawm tsam mus ntev. Cov tshuaj tsis muaj "tawm tsam" qhov mob, i.e. kev txiav tawm sai sai ntawm cov neeg saib xyuas tshuaj tsis ua rau muaj kev cuam tshuam ntshav siab sai thiab tseem ceeb.

Hauv cov neeg mob uas mob ntshav tawm tsam, ramipril qeeb txoj kev txhim kho thiab kev hloov kho ntawm myocardial hypertrophy thiab leeg ntshav phab ntsa.

Hauv cov neeg mob uas muaj lub plawv tsis ua hauj lwm ntev, ramipril txo OPSS (txo qis hauv lub siab tom qab lub siab), ua rau muaj peev xwm ntawm txoj hlab xaib thiab txo qhov txhaws ntawm sab laug ventricle, uas, raws li, ua rau txo qis hauv kev thauj khoom hauv lub plawv. Hauv cov neeg mob no, thaum noj cov tshuaj ramipril, muaj qhov nce ntxiv hauv cov hlab plawv, tso tawm feem thiab ua kom lub cev muaj zog dua.

Hauv kev mob ntshav qab zib thiab tsis mob ntshav qab zib, ramipril ua rau qeeb tus nqi ntawm qhov muaj mob ntawm lub raum tsis ua haujlwm thiab qhov pib ntawm qhov kawg ntawm lub raum tsis ua haujlwm thiab, yog li, txo qhov xav tau hemodialysis lossis hloov raum. Hauv cov theem pib ntawm tus mob ntshav qab zib lossis mob ntshav qab zib nephropathy, ramipril txo qhov hnyav ntawm albuminuria.

Hauv cov neeg mob uas muaj qhov pheej hmoo loj ntawm kev mob plawv vim los yog voos txhab (kuaj mob rau cov hlab plawv, keeb kwm ntawm kab mob txha caj qaum, keeb kwm ntawm mob hlab ntsha tawg), lossis mob ntshav qab zib mellitus nrog tsawg kawg ib qho kev pheej hmoo ntxiv (microalbuminuria, ntshav siab, nce ntxiv) qhov kev txiav txim siab ntawm cov roj (OX) tag nrho, qhov kev txo qis hauv cov concentration ntawm cov roj (cholesterol) ntawm cov lipoproteins uas ntau (HDL-C), haus luam yeeb) ntxiv ntawm ramipril rau cov kev kho mob txo qhov tshwm sim ntawm myocardial infarction, mob hlab ntsha tawg thiab tuag los ntawm kev mob plawv. Ntxiv rau, ramipril txo cov ntsiab lus ntawm kev tuag tag nrho, nrog rau cov kev xav ua kom rov ua haujlwm, thiab ua rau qeeb ntawm qhov pib lossis mob zuj zus ntawm lub plawv tsis ua haujlwm.

Hauv cov neeg mob uas lub plawv tsis ua haujlwm uas tau tsim hauv thawj hnub ntawm tus mob myocardial infarction (2-9 hnub), noj ramipril pib ntawm 3 mus rau 10 hnub ntawm tus mob myocardial infarction txo txoj kev pheej hmoo ntawm lub neej kev tuag (los ntawm 27%), kev pheej hmoo ntawm kev tuag sai (los ntawm 30 %), qhov pheej hmoo ntawm lub plawv tsis ua hauj lwm hnyav mus rau qhov hnyav (NYHA chav kawm III-IV ua haujlwm chav kawm) / kho-tiv taus (27%), qhov yuav ua rau muaj tsev kho mob ntxiv vim yog lub plawv tsis ua haujlwm (26%).

Hauv cov neeg mob dav dav, nrog rau cov neeg mob ntshav qab zib mellitus, ob qho tib si nrog txoj hlab ntshav siab thiab nrog cov ntshav siab li qub, ramipril txo txoj kev pheej hmoo ntawm nephropathy thiab qhov tshwm sim ntawm microalbuminuria.

Tso tawm daim ntawv thiab muaj pes tsawg leeg

Daim ntawv txiav tshuaj - ntsiav tshuaj: yuav luag dawb lossis dawb, puag ncig ncaj qha-cylindrical, nrog cov kab ua haujlwm thiab faib kab (hauv blister sawb ntim: 10 pcs., 3 ntim hauv ib daim ntawv thawv ntawv, 14 pcs. Hauv ib lub thawv, 1 lossis 2 ntim rau hauv ib lub thawv ntawv) Cov.

Cov tshuaj nquag ntawm Ramipril yog ramipril, hauv 1 ntsiav tshuaj - 2.5 mg, 5 mg lossis 10 mg.

Ntu cov khoom siv: lactose, microcrystalline cellulose, aerosil (colloidal silicon dioxide), magnesium stearate, primogel (sodium carboxymethyl starch).

Cov Tshuaj Pharmacokinetics

Nrog kev tswj hwm ntawm qhov ncauj, kev nqus mus txog 50-60%. Kev noj tsis cuam tshuam rau qib ntawm kev nqus, tab sis txo tus nqi ntawm kev nqus. Qhov siab tshaj plaws ntawm cov ramipril tau mus txog tom qab 2-4 teev tom qab kev tswj hwm. Hauv daim siab, qhov sib xyaw ua ke yog metabolized, tsim cov nquag metabolite ramiprilat (ACE inhibition tus nqi yog 6 npaug ntau dua qhov ntawd rau ramipril) thiab lub zog metabolite diketopiperazine. Tom qab ntawd ramipril undergoes glucuronidation. Nrog rau kev zam ntawm ramiprilat, tag nrho cov metabolites tsim tsis pom kev ua si pharmacological.

Ramipril khi rau cov ntshav plasma ntau npaum li 73%, thiab ramiprilat - los ntawm 56%. Lub bioavailability tom qab lub qhov ncauj tswj hwm ntawm 2.5-5 mg ntawm cov tshuaj yog 15-28%, nyob rau hauv cov ntaub ntawv ntawm ramiprilat - 45%. Nrog rau qhov koob tshuaj txhua hnub ntawm 5 mg rau ib hnub, qhov theem ruaj khov ntawm ramiprilat hauv cov ntshav ntshav tau mus txog thaum hnub 4 lawm.

Ib nrab-lub neej ntawm ramipril yog 5.1 teev. Qhov kev nkag siab ntawm ramiprilat hauv cov ntshav cov ntshav txo qis hauv kev faib thiab tshem tawm theem nrog ib nrab-lub neej ntawm 3 teev, nyob rau theem hloov pauv, ib nrab-lub neej yog 15 teev thiab nyob rau theem ntev kawg, uas yog tus cwj pwm los ntawm cov ntsiab lus tsawg heev ntawm ramiprilat hauv ntshav - 4-5 hnub. Kev tshem tawm ib nrab-lub neej nce ntxiv hauv cov neeg mob uas mob raum tsis ua haujlwm.

Qhov faib khoom ntawm ramipril yog 90 litres, ramiprilata yog 500 litres. Cov tshuaj no dhau los ntawm lub raum hauv qhov nyiaj ntawm 60% ntawm qhov kev noj tshuaj, thiab los ntawm cov hnyuv - hauv qhov nyiaj ntawm 40% (feem ntau yog siv tshuaj tiv thaiv metabolites). Nrog lub raum tsis ua haujlwm, tus nqi ntawm kev nthuav tawm ntawm ramipril thiab nws cov metabolites poob qis hauv qhov sib piv rau qhov txo qis ntawm creatinine, nrog daim siab ua tsis tiav, nws hloov mus rau ramiprilat yog inhibited, thiab hauv plawv tsis ua haujlwm, cov ntsiab lus ntawm ramiprilat nce li ntawm 1.5-1.8 lub sijhawm.

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

Cov ntsiav tshuaj tau noj ntawm qhov ncauj ua ntej lossis tom qab noj mov, nqos tag nrho nrog dej.

Tus kws kho mob tau sau ntawv rau noj rau lub hauv paus ntawm kev ntsuas kev ntsuas, coj mus rau hauv tus neeg lub siab ntev thiab kev kho mob ntawm cov tshuaj.

Arterial hypertension: thawj koob tshuaj yog 2.5 mg 1 zaug hauv ib hnub (sawv ntxov) lossis 2 koob tshuaj. Yuav kom ua tiav qhov kev xav ua kom zoo, ntau txoj kev txhaj tshuaj muaj peev xwm ua tau tom qab 2-3 lub lis piam ntawm kev kho mob. Qhov kev saib xyuas ib txwm muaj li ntawm 2,5-5 mg, qhov ntau tshaj yog 10 mg rau ib hnub. Nrog kev kho mob diuretic dhau los, lawv yuav tsum tau tso tseg lossis cov koob tshuaj yuav tsum tau txiav tawm tsis pub dhau 3 hnub ua ntej pib Ramipril.Thawj koob tshuaj rau cov neeg mob noj tshuaj diuretics, cov neeg mob lub raum tsis ua haujlwm lossis mob hlab ntaws thiab lub siab tsis ua hauj lwm zoo yog 1.25 mg ib hnub ib zaug. Daim ntawv thov yuav tsum tau pib hauv kev tswj hwm nruj ntawm tus kws kho mob. Rau cov neeg mob uas muaj kev cuam tshuam nrog dej-electrolyte tshuav lossis qhov kev pheej hmoo ntawm cov tshuaj tiv thaiv tshuaj tiv thaiv kab mob, koob tshuaj rau txhua hnub yuav tsum tsis pub tshaj 1.25 mg,
Mob plawv tsis ua hauj lwm: thawj zaug tshuaj yog 1.25 mg ib zaug, yog tias tsim nyog, cov koob tshuaj tuaj yeem muab ob npaug ntxiv tom qab 1-2 asthiv. Qhov koob tshuaj txhua hnub yuav tsum tsis pub tshaj 10 mg. Nrog rau kev tswj hwm tib si ntawm cov tshuaj diuretics, lawv cov koob tshuaj yuav tsum tau txo ua ntej pib txoj kev kho,
Lub plawv tsis ua haujlwm uas tau tshwm sim tsis pub dhau 2-9 hnub tom qab mob myocardial infarction: koob tshuaj thawj zaug - 2.5 mg 2 zaug hauv ib hnub (sawv ntxov thiab yav tsaus ntuj) thiab tom qab ob hnub kev kho mob - 5 mg 2 zaug hauv ib hnub. Txij nkawm koob tshuaj - 2.5-5 mg 2 zaug ib hnub. Yog tias cov tshuaj tsis tshua zoo (kev mob ntshav qis), thawj koob yuav tsum tau txo qis rau 1.25 mg 2 zaug hauv ib hnub, tom qab ntawd 2 hnub nws tuaj yeem nce ntxiv rau 2.5 mg, thiab tom qab 2 hnub txog 5 mg 2 zaug ib hnub. Qhov koob tshuaj txhua hnub yuav tsum tsis pub tshaj 10 mg. Yog tias qhov tshuaj tsis zoo txaus, 2,5 mg 2 zaug hauv ib hnub yuav tsum tsis ua mus ntxiv. Vim kev paub tsis txaus nrog kev siv Ramipril hauv cov neeg mob uas muaj lub plawv tsis ua haujlwm ntawm chav III-IV ua haujlwm (raws li NYHA kev faib tawm) uas tau tshwm sim tam sim ntawd tom qab mob myocardial infarction, koob tshuaj thawj rau pawg neeg mob no yuav tsum tsis pub ntau dua 1.25 mg ib hnub ib zaug. Qhov koob tshuaj nce ntxiv yuav tsum tau ua nyob rau hauv kev saib xyuas ntawm kws kho mob,
Tus mob neopropathy nyob rau txoj kev mob loj ntawm lub raum, mob ntshav qab zib nephropathy: pib koob - 1.25 mg ib zaug. Nrog rau kev tiv thaiv zoo ntawm cov tshuaj, cov koob tshuaj tuaj yeem muab ob npaug rau txhua 2 lub lis piam kom txog thaum kev saib xyuas txij nkawm ntawm 5 mg tau mus txog ib zaug ib hnub,
Txo txoj kev pheej hmoo ntawm mob hlab ntsha tawg, myocardial infarction, lossis kev mob plawv tuag rau hauv cov neeg mob uas muaj kev pheej hmoo mob plawv ntau: thawj koob yog 2.5 mg ib zaug. Kev nce qib hauv koob tshuaj yog pom tias: tom qab 1 lub lis piam, tom qab ntawd tom qab 2-3 lub lis piam - txog kev saib xyuas txij nkawm ntawm 10 mg ib hnub ib zaug.

Cov tshuaj pom zoo kom noj tshuaj ntawm Ramipril rau cov neeg mob raum tsis ua haujlwm:

CC tsawg dua 30 ml / min: thawj koob - 1.25 mg ib hnub, ntau kawg - 5 mg,
KK 30-60 ml / feeb: thawj qhov hno - 2.5 mg ib hnub, ntau kawg - 5 mg,
CC ntau dua 60 ml / min: thawj qhov muab tshuaj yog 2.5 mg rau ib hnub, qhov ntau tshaj yog 10 mg.

Nrog daim siab ua haujlwm, cov koob tshuaj thawj zaug yuav tsum tsis pub tshaj 1.25 mg, qhov siab tshaj - 2.5 mg ib zaug.

Thawj koob tshuaj rau cov neeg mob laus yog 1.25 mg rau ib hnub.

Kev tswj tshwj xeeb yog yuav tsum muaj rau cov neeg mob uas muaj hnub nyoog 65 xyoos noj tshuaj diuretics, rau cov neeg mob plawv tsis ua haujlwm nrog lub raum thiab lub siab tsis ua haujlwm. Cov koob tshuaj yog xaiv raws li qib hom phiaj ntawm ntshav siab.

Yeeb tshuaj sib cuam tshuam

Thaum teem caij Ramipril, tus kws kho mob yuav tsum ceeb toom rau tus neeg mob txog qhov xav tau kev sib tham ua ntej ua ntej pib siv cov tshuaj ib txhij.

Cov yeeb yaj kiab ntawm Ramipril yog: Ramipril-SZ, Wazolong, Amprilan, Dilaprel, Hartil, Korpril, Pyramil, Ramigamma, Tritace, Ramicardia.