Pyramil ntxiv: cov lus qhia rau kev siv

Cov lus qhia phau ntawv
rau kev siv cov khoom lag luam tshuaj rau kev siv kho mob

Nyeem cov lus qhia no kom zoo zoo ua ntej koj pib noj / siv cov tshuaj no.
• Khaws phau ntawv; nws kuj xav tau ntxiv.
• Yog koj muaj lus nug, sab laj nrog kws kho mob.
• Cov tshuaj no tau sau rau koj tus kheej thiab yuav tsum tsis txhob faib rau lwm tus, vim tias nws tuaj yeem tsim kev puas tsuaj rau koj txawm tias koj muaj tib co tsos mob zoo li koj.

Daim ntawv noj tshuaj:

khoom xyaw ua si: ramipril - 2.50 / 5.00 / 10.00 mg, tus zam: microcrystalline cellulose - 296.10 / 293.60 / 289.00 mg, pregelatinized hmoov txhuv nplej siab - 18.00 / 18.00 / 18.00 mg, precipitated silicon dioxide - 32.00 / 32.00 / 32.00 mg, glycine hydrochloride - 3.00 / 3.00 / 3.00 mg, glyceryl dibehenate - 8.00 / 8.00 / 8.00 mg, hlau zas xim oxide daj (E-172) 0.40 / - / - mg, zas hlau oxide liab (E-172) - / 0.40 / - mg.

Kev piav qhia:

2.5 mg ntsiav tshuaj: oblong, biconvex ntsiav tshuaj ntawm lub teeb daj xim nrog lub qhov ntxhib, nrog thaj tsis tshua muaj xim tsaus thiab muaj kev pheej hmoo ntawm ib sab.
5.0 mg ntsiav tshuaj: oblong, biconvex ntsiav tshuaj ntawm lub teeb liab xim nrog lub qhov ntxhib, nrog thaj tsis tshua muaj xim tsaus nti thiab muaj kev pheej hmoo ntawm ib sab.
10.0 mg ntsiav tshuaj: oblong, biconvex ntsiav tshuaj ntawm cov xim dawb lossis yuav luag xim dawb nrog lub ntsej muag ntxhib thiab muaj kev pheej hmoo ntawm ib sab.

Cov chaw muag tshuaj

Cov Tshuaj Hauv Tshuaj
Ramipril nrawm nrawm rau lub plab hnyuv plab thiab yauv ua kom lub cev hydrolysis nyob hauv daim siab ua lub cev nquag ntawm ramiprilat. Ramiprilat yog lub zog ua haujlwm ntev ntawm ACE - ib qho enzyme uas catalyzes hloov dua siab tshiab ntawm angiotensin I rau angiotensin II.
Ramipril ua rau txo qis ntawm theem ntawm angiotensin II hauv ntshav ntshav, nce ntxiv hauv kev ua si ntawm renin thiab txo qis hauv kev tso tawm aldosterone.
Txhawb kev tiv thaiv kininase II qib, cuam tshuam nrog kev rhuav tshem ntawm bradykinin, txhim kho cov synthesis ntawm prostaglandins. Raws li lub zog ntawm ramipril, cov hlab ntsha peripheral nthuav dav thiab tag nrho peripheral vascular tsis kam (OPSS) poob qis.
Arterial tawg
Nws muaj cov nyhuv hypotensive hauv txoj hauj lwm ntawm tus neeg mob "dag" thiab "sawv".
Nws txo OPSS (tom qab ua haujlwm), jamming siab nyob rau hauv cov hlab ntsws capillaries tsis muaj nyiaj them rov qab ntawm lub plawv dhia (HR).
Txhim kho txoj hlab ntshav siab thiab lub raum khiav ntshav yam tsis muaj kev cuam tshuam ntawm tus nqi glomerular filtration.
Qhov pib ntawm cov nyhuv hypotensive yog 1-2 teev tom qab noj, cov nyhuv siab tshaj plaws tsim tawm 3-6 teev tom qab kev tswj hwm. Qhov kev txiav txim kav tsawg kawg yog 24 teev.
Mob plawv tsis ua hauj lwm thiab lub plawv tsis ua haujlwm vim qhov mob myocardial infarction
Ramipril txo OPSS thiab, thaum kawg, ntshav siab.
Tsub ntxiv cov zis tshwm sim thiab ua kom tawm dag zog. Nrog rau siv ntev, nws ua rau muaj kev thim rov qab ntawm myocardial hypertrophy nyob rau hauv cov neeg mob uas lub plawv tsis ua haujlwm ntawm chav kawm ua haujlwm I thiab II raws li NYHA kev faib tawm, txhim kho cov ntshav muab rau ischemic myocardium.
Ramipril nce kev muaj sia nyob ntawm cov neeg mob uas muaj cov tsos mob tshwm sim los yog mob plawv sai tom qab myocardial infarction. Nws muaj cov nyhuv cardioprotective, tiv thaiv cov mob hlab ntsha ischemic ntu, txo qhov ntxim nyiam ntawm kev tsim myocardial infarction thiab txo lub sijhawm mus pw hauv tsev kho mob.
Ntshav qab zib thiab tsis mob ntshav qab zib nephropathy
Hauv cov neeg mob uas mob ntshav qab zib thiab mob ntshav qab zib nephropathy, ramipril 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 ntawd, txo qhov xav tau hemodialysis lossis lub raum hloov. Hauv cov theem pib ntawm tus mob ntshav qab zib lossis mob ntshav qab zib nephropathy, ramipril txo qhov hnyav ntawm albuminuria.
Cov Neeg Mob Ntawm Cov Qib Siab Tshaj Plaws Muaj Kab Mob
vim vascular lesions (kuaj mob rau cov hlab plawv txha caj qaum (CHD), mob ntshav nruab nrog ntshav txhaws lossis keeb kwm ntawm mob hlab ntsha tawg), ntshav qab zib mellitus muaj tsawg kawg yog ib qho kev pheej hmoo ntxiv (microalbuminuria, mob ntshav tawm tsam, ntshav ntau ntxiv ntawm tag nrho cov roj (OX), ntshav plasma ntau ntau high-density lipoprotein cholesterol (HDL-C), haus luam yeeb) qhov sib ntxiv ntawm ramipril mus rau cov kev kho mob tseem ceeb txo cov xwm txheej ntawm myocardial infarction, ins. lta thiab kev tuag los ntawm kev mob plawv ua rau.
Cov Tshuaj Pharmacokinetics
Ramipril nrawm rau lub plab zom mov tom qab kev tswj hwm qhov ncauj. Kev tsis haum yog nyob ywj pheej ntawm kev ua zaub mov.
Tom qab kev nqus, ramipril sai sai thiab yuav luag hloov mus rau hauv kev siv tshuaj metabolite ntawm ramiprilat raws li kev ua ntawm daim siab esterase enzyme. Ramiprilat yog kwv yees li 6 npaug ntau zog hauv kev txwv ACE dua li ramipril. Lwm lub tshuaj tiv thaiv kev tsis haum tshuaj kuj tau kuaj pom.
Hauv cov neeg mob uas lub raum tsis ua haujlwm, qhov hloov ntawm ramipril rau hauv ramiprilat qeeb vim tias lub sijhawm luv luv ntawm esterase, yog li ntawd, qib ntawm ramipril hauv cov ntshav plasma hauv cov neeg mob no tau nce.
Qhov siab tshaj plaws ntawm ramipril hauv plasma tau tiav hauv ib teev tom qab kev tswj hwm, ramiprilat - hauv 2-4 teev tom qab noj cov tshuaj.
Lub bioavailability ntawm ramipril yog 60%. Kev sib txuas lus nrog cov ntshav plasma nce mus txog 73% rau ramipril thiab 56% rau ramiprilat. Tom qab noj 5 mg, lub raum tshem tawm ntawm ramipril yog 10-55 ml / min, kev tshem tawm ntxiv mus txog 750 ml / min. Rau ramiprilat, cov nqi no yog 70-120 ml / min thiab li 140 ml / min, feem. Ramipril thiab ramiprilat tsuas yog feem ntau raug nteg tawm los ntawm lub raum (40-60%). Nrog lub raum tsis ua haujlwm, lawv txoj kev tshem tawm qis qis dua.
Ib nrab-lub neej ntawm ramiprilat nrog lub caij nyoog siv ntawm koob tshuaj 5-10 mg ib hnub ib zaug yog 13-17 teev.

Kev ntsuas rau siv

• cov leeg ntshav siab,
• mob plawv tsis ua hauj lwm (ua ib feem ntawm txoj kev kho ua ke),
• mob ntshav qab zib lossis tsis mob ntshav qab zib nephropathy, ua ntej pw thiab chaw kuaj mob, nrog rau cov proteinuria ntau, tshwj xeeb yog thaum sib koom nrog cov leeg ntshav siab thiab muaj microalbuminuria,
• txo qis myocardial infarction, mob hlab ntsha tawg, lossis lub plawv tuag rau cov neeg mob uas muaj kev pheej hmoo siab ntawm cov kab mob plawv:
- nyob rau hauv cov neeg mob uas paub tseeb txog cov hlab ntsha txoj hlab ntshav, myocardial infarction nrog lossis tsis muaj keeb kwm ntawm cov neeg mob, suav nrog cov neeg mob uas tau txiav txim siab txhawm rau txhawm rau lub plawv txha caj qaum, mob ntshav hlab ntsha
- hauv cov neeg mob muaj keeb kwm mob stroke,
- hauv cov neeg mob uas muaj qhov txhab txhab ntawm cov hlab ntsha txhaws,
- hauv cov neeg mob ntshav qab zib uas muaj tsawg kawg yog ib qho kev pheej hmoo ntxiv (microalbuminuria, ntshav siab, nce ntshav ntau dhau ntawm OX, txo ntshav ntshav ntau ntawm HDL-C, haus luam yeeb),
• lub plawv tsis ua haujlwm uas tau tsim nyob rau thawj ob peb hnub (txij li 2 txog 9 hnub) tom qab mob myocardial infarction.

Cov Yuav Tsum Muaj

• Ua rau lub plab hlaub tsis haum, lwm yam ACE inhibitors lossis tshuaj tiv thaiv cov tshuaj,
• kev mob siab los yog mob ntsws idiopathic angioedema Quincke's edema (suav nrog coj ACE inhibitors hauv keeb kwm),
• hemodynamically tseem ceeb stenosis ntawm lub raum hlab ntsha (ob leeg los sis tsis sib haum thaum muaj ib lub raum),
• cardiogenic poob siab,
• thawj hyperaldosteronism,
• Cov mob ntshav liab hnyav (systolic ntshav siab dua 90 hli Hg) lossis tej yam mob tsis xwm yeem,
• cev xeeb tub
• lub sijhawm pub niam mis,
• hnub nyoog txog 18 xyoo (qhov ua tau zoo thiab kev nyab xeeb ntawm kev siv tsis tau kawm),
• lub raum mob tsis zoo (ua kom lub siab zoo (tshem tawm qhov tsis zoo (CC) tsawg dua 20 ml / min / 1.73 m²),
• mob rau daim siab ua haujlwm tsis zoo (tsis muaj kev kuaj mob),
• hemodialysis lossis hemofiltration siv qee qhov puas nrog lub ntsej muag tsis zoo (lub siab polyacrylonitrile daim nyias nyias (qhov txaus ntshai ntawm kev txhim kho qhov tsis haum lub zog),)
• apheresis uas tsis muaj cov lipoproteins uas siv dextran sulfate (kev phom sij ntawm kev txhim kho qhov tsis haum lub zog),
• siv nyob rau hauv cov qib mob myocardial infarction: mob hnyav lub plawv tsis ua haujlwm (CHF) (NYHA chav IV ua haujlwm chav ua haujlwm), tsis khov kho lub plawv tsis khov, lub neej tuag ventricular mob plawv dhia tsis ua hauj lwm, "mob ntsws" lub plawv,
• zoo li nrog rau lwm tus ACE inhibitors, kev siv tshuaj sib xyaw ua ke thiab tshuaj muaj aliskiren yog sib xyaw rau cov neeg mob ntshav qab zib mellitus lossis mob qis qis los yog mob raum tsis zoo (CC tsawg dua 60 ml / min / 1.73 m²),
• siv tib txhij ua cov angiotensin II receptor antagonists rau cov neeg mob ntshav qab zib nephropathy,
• nephropathy, uas tau kho nrog glucocorticosteroids, cov tshuaj tsis haum steroidal anti-inflammatory (NSAIDs), immunomodulators thiab / lossis lwm yam tshuaj cytotoxic (kev paub hauv chaw kho mob tsis txaus ntseeg),
• hemodynamically tseem ceeb aortic lossis mitral stenosis (kev pheej hmoo ntawm kev txo qis hauv cov ntshav siab ntxiv los ntawm kev ua haujlwm tsis zoo hauv lub raum (CC ntau dua 20 ml / min / 1.73 m²), hypertrophic obstructive cardiomyopathy.

Nrog saib xyuas

Siv tib lub sij hawm nrog cov tshuaj muaj aliskiren, los yog nrog angiotensin II receptor antagonists, ua rau muaj kev cuam tshuam ob zaug ntawm cov renin-angiotensin-aldosterone system (RAAS), hyperkalemia, hyponatremia (suav nrog tiv thaiv keeb kwm ntawm diuretics thiab noj zaub mov nrog kev txwv kev noj ntsev), mob ntshav qab zib mellitus (kev pheej hmoo ntawm hyperkalemia), mob plawv tsis ua hauj lwm, tshwj xeeb tshaj yog mob hnyav lossis rau lwm yam tshuaj nrog cov nyhuv antihypertensive raug noj, mob hnyav rau lub plawv thiab mob hlwb. cov hlab ntsha (kev pheej hmoo ntawm cov ntshav tsawg nrog lub cev txo qis), hemodynamically tseem ceeb unilateral stenosis ntawm lub raum leeg ntshav (nyob rau ntawm ob lub raum), tej yam kev mob los ntawm kev poob qis hauv lub ntim ntawm cov ntshav (suav nrog rau mob raws plab, ntuav), siv tib lub sijhawm ntawm lithium npaj, immunosuppressants thiab saluretics, mob rau cov nqaij mob sib kis (nrog rau cov kab mob lupus erythematosus, scleroderma - muaj kev pheej hmoo ntawm neutropenia lossis agranulocytosis), kev kho kab mob tsis zoo, muaj hnub nyoog dhau los (tshaj 65 xyoo) (nce th kev pheej hmoo ntawm concomitant tsis ua hauj lwm ntawm daim siab thiab / lossis ob lub raum thiab lub plawv tsis ua haujlwm), mob tom qab hloov raum, mob siab.

Siv thaum cev xeeb tub thiab thaum pub niam mis

Kev siv cov tshuaj Pyramil ® thaum cev xeeb tub thiab pub niam mis yog contraindicated, vim hais tias kev siv ramipril tuaj yeem muaj qhov tsis zoo ntawm cov menyuam hauv plab: kev txhim kho tsis zoo ntawm lub raum ntawm lub cev, poob qis ntshav ntawm lub zog ntawm cov menyuam yaus thiab cov neeg yug menyuam tshiab, lub raum tsis ua haujlwm, hyperkalemia, hypoplasia ntawm cov pob txha pob txha taub hau, hypoplasia ntawm lub ntsws. Pyramil ® tsis pom zoo rau cov poj niam npaj cev xeeb tub. Yog tias cev xeeb tub thaum kho nrog kev siv tshuaj Pyramil ®, koj yuav tsum tsis txhob noj tshuaj sai li sai tau thiab saib xyuas kev loj hlob ntawm lub me nyuam hauv plab.
Cov poj niam ntawm kev ua me nyuam hnub nyoog tau txais kev kho mob nrog ACE inhibitors yuav tsum siv txoj kev tswj kom zoo.
Yog tias cov poj niam thaum yug menyuam muaj hnub nyoog nrog txoj kev hloov ntshav liab coj ACE inhibitors, tom qab ntawd nws yuav tsum nco ntsoov tias thaum muaj menyuam cev xeeb tub, hloov mus rau tus neeg mob mus noj tshuaj hypotensive los ntawm lwm pab pawg. Hauv txhua kis, kev saib xyuas mob nkeeg yog qhov yuav tsum tau ua.
Tsis muaj pov thawj dab tsi txog seb puas yog ramipril ua tawm hauv niam cov kua mis.
Cov kev tshawb fawb tsiaj pom tias ramipril yog cov tawm hauv cov mis ntawm lactating nas. Kev siv cov tshuaj Pyramil ® thaum pub mis niam yog contraindicated. Yog tias nws yog qhov tsim nyog los sau tshuaj Pyramil ® rau ib tus niam saib xyuas mob, qhov teeb meem ntawm kev txwv tsis pub mis niam yuav tsum txiav txim siab.

Tsuas tshuaj thiab tswj hwm

Sab hauv, tsis hais txog kev noj zaub mov ntau, tsis muaj kev zom, haus dej ntau (1/2 khob).
Cov koob tshuaj tau xaiv nyob ntawm kev kho mob kom haum thiab ua siab ntev rau cov neeg mob rau cov tshuaj.
Arterial tawg
Qhov pom zoo kom pib koob tshuaj Pyramil ® rau cov neeg mob uas tsis mob plawv tsis noj tshuaj uas tsis noj tshuaj noj yog 2.5 mg ib hnub. Cov koob tshuaj tuaj yeem raug maj mam nce txhua 2-3 lub lis piam nyob ntawm cov nyhuv thiab kam rau ua. Qhov tshuaj ntau ntau yog 10 mg ib hnub ib zaug.
Feem ntau, kev saib xyuas txij nkawm yog 2.5-5 mg ib hnub ib zaug.
Thaum tsis muaj qhov ua tau zoo ntawm kev siv tshuaj thaum noj 10 mg ib hnub twg ntawm cov tshuaj Pyramil ®, kev teem sij hawm ntawm kev siv tshuaj kho mob pom zoo.
Yog tias tus neeg mob noj cov tshuaj diuretics, lawv yuav tsum tsis txhob noj lawv lossis txo lawv qhov hno 2-3 hnub ua ntej pib kho nrog Pyramil ®. Rau cov neeg mob zoo li no, pom zoo kom pib noj tshuaj yog 1.25 mg (1/2 ntsiav tshuaj ntawm 2.5 mg) ib hnub ib zaug.
Mob plawv nres
Qhov pom zoo thawj koob tshuaj Pyramil ® yog 1.25 mg (1/2 ntsiav tshuaj ntawm 2.5 mg) ib hnub ib zaug.
Cov koob tshuaj tuaj yeem raug maj mam nce ntxiv nyob ntawm seb cov txiaj ntsig thiab kam rau ua, muab ob npaug rau nws txhua 1-2 asthiv. Kev noj tshuaj ntawm 2.5 mg rau ib hnub thiab siab dua tuaj yeem nqa tau hauv ib lossis ob zaug.
Qhov tshuaj ntau ntau yog 10 mg ib hnub ib zaug.
Rau cov neeg mob noj cov tshuaj diuretics siab ntau, lawv cov koob tshuaj yuav tsum tau txo qis ua ntej pib kho nrog Pyramil ® txhawm rau txo kev pheej hmoo ntawm kev tsim cov tsos mob ntawm lub ntsej muag hypotension.
Txo txoj hauv kev pheej hmoo ntawm myocardial infarction, mob hlab ntsha tawg, lossis lub plawv kev tuag ntawm cov neeg mob ntshav siab
Pom zoo kom pib koob tshuaj: 2.5 mg ib hnub ib zaug. Nyob ntawm qhov ua siab ntev, cov koob tshuaj tuaj yeem muab ob npaug ntxiv tom qab 1 lub lim tiam ntawm kev kho mob, thiab dhau 3 lub lim tiam tom qab kev kho mob, nce nws mus rau kev saib xyuas ib txwm li ntawm 10 mg ib hnub ib zaug.
Lub plawv tsis ua haujlwm vim yog mob myocardial infarction
Kev kho mob pib 3-10 hnub tom qab mob myocardial infarction.
Thawj koob tshuaj Pyramil ® yog 5 mg rau ib hnub (2.5 mg ob zaug thaum sawv ntxov thiab yav tsaus ntuj), tom qab ob hnub qhov tshuaj tau nce ntxiv rau 5 mg ob zaug ib hnub.
Nrog kev tiv thaiv tsis zoo ntawm thawj zaug ntawm 2.5 mg ob zaug ib hnub, koob tshuaj 1.25 mg (1/2 ntsiav tshuaj ntawm 2.5 mg) yuav tsum tau txhaj tshuaj ib hnub ob zaug, tom qab ntawd nce lub koob tshuaj rau 2.5 mg thiab 5 mg ob zaug ib hnub. Cov koob tshuaj saib xyuas ntawm Pyramil ® yog 2.5-5 mg ob zaug ib hnub. Qhov nyiaj pab ntau tshaj txhua hnub yog 10 mg.
Ntshav qab zib thiab tsis-mob ntshav qab zib nephropathy
Qhov pom zoo pib koob tshuaj Pyramil ® yog 1.25 mg (1/2 ntsiav tshuaj ntawm 2.5 mg) 1 zaug hauv ib hnub.
Nyob ntawm qhov ua siab ntev, cov koob tshuaj tuaj yeem muab ob npaug ntawm kev ncua sijhawm 2-3 lub lis piam mus txog qhov siab kawg ntawm 5 mg ib hnub twg.
Yog tias tus neeg mob noj cov tshuaj diuretics, lawv yuav tsum tsis txhob noj lawv lossis txo qhov hno 2-3 hnub ua ntej pib kho nrog Pyramil ®, qhov no qhov pom zoo thawj zaug ntawm Pyramil ® yog 1.25 mg (1/2 ntsiav tshuaj ntawm 2.5 mg) ib ib hnub.
Cov neeg mob uas lub raum tsis ua hauj lwm zoo
Rau cov neeg mob uas lub raum tsis ua haujlwm (kev tsim lub peev xwm (cleinine clearance (CC) 20-50 ml / min / 1.73 m²), qhov pom zoo thawj zaug ntawm Pyramil ® yog 1.25 mg (1/2 ntsiav tshuaj ntawm 2.5 mg) ib hnub ib zaug , thiab qhov siab tshaj plaws yuav tsum tsis pub tshaj 5 mg ib hnub. Hauv kev mob raum tsis zoo (CC qis dua 20 ml / min / 1.73 m²), qhov pom zoo thawj zaug ntawm Pyramil ® yog 1.25 mg (1/2 ntsiav tshuaj ntawm 2.5 mg) ib hnub ib zaug, yog tias tsim nyog, qhov koob tshuaj yuav raug nce ntxiv txog li 2.5 mg ib hnub twg.
Cov neeg mob uas muaj lub siab ua haujlwm tsis zoo
Hauv cov neeg mob uas muaj lub siab tsis ua haujlwm, ob qho kev nce thiab qhov ua kom tsis muaj zog ntawm cov tshuaj kho Pyramil ® tuaj yeem pom. Kev kho mob yuav tsum tau pib nyob rau hauv kev saib xyuas ntawm kws kho mob nrog koob tshuaj 1.25 mg (1/2 ntsiav tshuaj ntawm 2.5 mg). Qhov siab tshaj plaws yuav tsum tsis pub tshaj 2.5 mg ib hnub.
Cov neeg laus (tshaj 65 xyoo)
Ceev faj yuav tsum tau siv thaum kho cov tshuaj Pyramil ® rau cov neeg mob ntawm cov hnub nyoog laus zog yog tias lawv lub raum lossis lub siab tsis ua haujlwm, nrog rau lub plawv tsis ua haujlwm thiab / lossis siv cov tshuaj diuretics.
Cov koob tshuaj yuav tsum tau xaiv ib tus zuj zus nyob ntawm hom phiaj ntawm cov ntshav siab. Qhov muab tshuaj thawj zaug yog txo kom tsawg rau 1.25 mg rau ib hnub.

Sab sij huam

Raws li Lub Koom Haum Ntiaj Teb Kev Noj Qab Haus Huv (WHO), tsis xav tau cov dej num yog cais raws li lawv cov kev loj hlob raws li hauv qab no: feem ntau (≥ 1/10), feem ntau (≥1 / 100, los ntawm cov kab mob plawv
feem ntau: cim txo nyob rau hauv cov ntshav siab, impaired orthostatic kev cai ntawm vascular laus (orthostatic hypotension), syncope,
pheej: orthostatic cev qhuav dej, myocardial ischemia, suav nrog kev txhim kho ntawm ib qho kev tawm tsam ntawm angina pectoris lossis myocardial infarction, cerebrovascular raug mob (vim tias poob ntawm cov ntshav siab hauv cov neeg mob uas muaj kev pheej hmoo), tachycardia, arrhythmia, peripheral edema, palpitation, flushing ntawm cov ntshav mus rau daim tawv nqaij ntawm lub ntsej muag,
tsis tshua muaj: qhov tshwm sim los yog kev sib zog ntawm cov mob ntshav khov ntawm keeb kwm ntawm stenotic vascular lesions, vasculitis,
tsis paub zaus: Raynaud's syndrome.
Los ntawm cov kabmob hemopoietic
pheej: eosinophilia
tsis tshua muaj: leukopenia, suav nrog neutropenia thiab agranulocytosis (neutropenia thiab agranulocytosis yog qhov thim rov qab thiab ploj thaum ACE inhibitors yuav tso tseg), ua rau ntshav khov, thrombocytopenia, lymphadenopathy, tsawg dua hemoglobin,
tsis paub zaus: inhibition ntawm cov pob txha mob hematopoiesis, pancytopenia, ntshav tsawg tsis txaus.
Los ntawm lub paj hlwb tawg
feem ntau: tsis muaj zog, mob taub hau,
pheej: mus ob peb vas lability, ntxhov siab vim, poob siab, mob caj dab, kiv taub hau, pw tsaug zog, pw tsaug zog, lub cev muaj zog,
tsis tshua muaj: tshee hnyo, kev tsis txaus, tsis meej pem,
tsis paub zaus: cerebral ischemia, nrog rau mob stroke thiab lub sijhawm cuam tshuam kev puas hlwb ntawm lub hlwb, parosmia (tsis hnov ​​tsw ntawm tsis hnov ​​tsw), tsis hnov ​​qab cov kev xav psychomotor, kev tsis hnov ​​qab.
Los ntawm cov kabmob hauv nruab nrog
pheej: pom kev tsis xws luag, suav nrog cov duab zim zuag, saj yam ntxhov,
tsis tshua muaj: pom pob ntseg, pob ntseg tsis hnov ​​lus, mob hlwb (hnov ntawm lub suab nrov, tinnitus).
Los ntawm lub tshuab ua pa
feem ntau: “Qhuav” hnoos, mob ntsws, mob ntsws, ua pa siav,
pheej: bronchospasm, suav nrog kev ua phem ntawm cov chav kawm ntawm bronchial hawb pob, mob ntswg.
Los ntawm lub plab zom mov
feem ntau: mob tshwm sim hauv lub plab thiab cov hnyuv, lub plab zom mov, tsis xis nyob hauv plab, ua tsis taus pa, raws plab, xeev siab, ntuav,
pheej: mob caj dab, muaj ntau ntxiv rau "mob siab" transaminases thiab ntshav sib xyaw ua ke bilirubin concentration, kev ua rau lub siab ntxiv rau lub cev, mob plab hnyuv, mob plab, mob plab, mob plab, quav, qhov ncauj qhuav,
tsis tshua muaj: glossitis, cholestatic daj ntseg daj ntseg, hepatocellular txhab,
tsis paub zaus: aphthous stomatitis (kev kis mob ntawm lub qhov ncauj mucosa), mob siab ua haujlwm rau lub siab, mob cholestatic lossis cytolytic mob siab, nrog rau neeg tuag taus.
Los ntawm qhov mob txeeb zig
tsis tshua muaj: lub raum khiav tsis zoo, nrog rau kev txhim kho ntawm lub raum tsis ua haujlwm, nce zis ntawm cov zis, muaj proteinuria ntau dua ua ntej, muaj zog ntawm urea thiab creatinine hauv cov ntshav.
Ntawm ib feem ntawm daim tawv nqaij thiab cov qog ua kua
feem ntau: daim tawv nqaij ua pob xoo, tshwj xeeb maculopapular,
pheej: Mob caj dab, nrog rau kev ua rau tuag taus (ua pa tawm hauv lub plab tuaj yeem ua rau txhaws ua rau ua rau tuag), tawv nqaij ua pob khaus, hyperhidrosis (nce tawm hws),
tsis tshua muaj: exfoliative dermatitis, urticaria, onycholysis (exfoliation ntawm tus ntsia thawv los ntawm cov nqaij mos ntawm cov ntiv tes),
Tsis tshua muaj: kev tshua tshua dhau los,
tsis paub zaus: tshuaj lom neeg mob ua paug, cov mob Stevens-Johnson syndrome, erythema multiforme, pemphigus (mob pob khaus), ua rau mob psoriasis, mob psoriasis zoo li dermatitis, pemphigoid lossis lichenoid exanthema lossis enanthema, alopecia.
Los ntawm cov leeg musculoskeletal
feem ntau: mob leeg, myalgia,
pheej: arthralgia.
Los ntawm ib sab ntawm cov metabolism
feem ntau: nce poov tshuaj nyob rau hauv cov ntshav,
pheej: anorexia, qab los noj mov,
tsis paub zaus: ua kom cov ntsev hauv cov ntshav tsawg zuj zus.
Los ntawm lub cev tiv thaiv kab mob
tsis paub zaus: anaphylactic lossis anaphylactoid tshua, nce titer ntawm cov tshuaj tiv thaiv kev tiv thaiv kev tsis haum.
Endocrine system
tsis paub zaus: cov tshuaj tsis txaus ntawm cov tshuaj tiv thaiv antidiuretic (SNA ADH).
Los ntawm kev yug me nyuam
pheej: transient impotence vim yog erectile kawg, txo qis libido,
tsis paub zaus: gynecomastia.
Kev cuam tshuam dav dav thiab cuam tshuam ntawm qhov chaw txhaj tshuaj
feem ntau: mob hauv siab, qaug zog,
pheej: npaws
tsis tshua muaj: asthenia.

Noj ntau dhau

Cov tsos mob ntev li ntawm peripheral vasodilation nrog kev txhim kho ntawm cov lus tshaj tawm nyob rau hauv cov ntshav siab (BP), poob siab, bradycardia, ua tsis taus dej-electrolyte tshuav nyiaj li cas, poob siab, mob raum tsis ua haujlwm, ua tsis taus pa.
Kev Kho Mob: hauv kev mob me ntawm kev noj ntau dhau: mob plab zom mov, kev tswj hwm ntawm adsorbents, sodium sulfate (nyiam dua hauv thawj 30 feeb tom qab muab tshuaj). Kev ua haujlwm ntawm cov kabmob tseem ceeb yuav tsum tau saib xyuas. Hauv ntau qhov xwm txheej loj, kev ntsuas tswj kev ua kom lub ntshav ruaj khov: kev tswj hwm ntawm 0.9% kev daws teeb meem ntawm sodium chloride, ntshav hloov chaw, kev teeb tsa ntawm cov khoom siv hluav taws xob ib ntus nrog cov tshuaj tiv thaiv bradycardia, hemodialysis. Nrog lub cim txo qis hauv cov ntshav siab, cov lus qhia ntawm α-adrenergic agonists (norepinephrine, dopamine) tuaj yeem muab ntxiv rau kev kho mob kom rov ua cov ntim ntawm cov ntshav ncig thiab rov qab ua kom cov dej-electrolyte tshuav nyiaj li cas. Yog hais tias bradycardia, kev teem caij ntawm atropine lossis kev teeb tsa ntawm cov tshuab hluav taws xob ib ntus tau pom zoo.
Nws yog ib qho tsim nyog los ua tib zoo saib xyuas ntshav siab, lub raum kev ua haujlwm thiab ntshav dej electrolytes.
Tsis muaj kev paub dhau los ntawm kev siv lub zog diuresis, kev hloov pauv ntawm cov zis pH, hemofiltration lossis lim ntshav kom nrawm tshem tawm ntawm ramipril los ntawm lub cev. Hemodialysis yog qhia nyob rau hauv kis ntawm kev loj hlob ntawm lub raum tsis ua haujlwm.

Kev cuam tshuam nrog lwm yam tshuaj

Contraindicated kev sib txuas ua ke
Kev siv qee qhov ua kom lub siab muaj qhov tsis zoo ntawm lub ntsej muag (piv txwv li polyacryl-nitrile daim nyias nyias) thaum lub sijhawm hemodialysis lossis hemofiltration, kev siv dextran sulfate thaum apheresis ntawm tsawg lipoproteins tuaj yeem ua rau muaj kev pheej hmoo ntawm kev phiv tshuaj tsis zoo, yog tias tus neeg mob xav tau cov txheej txheem no, lwm yam kev voos yuav tsum tau siv (nyob rau hauv cov ntaub ntawv ntawm plasmapheresis thiab hemofiltration) lossis hloov tus neeg mob mus rau lwm cov tshuaj antihypertensive.
Ib yam li lwm tus ACE inhibitors, kev sib xyaw ua ke ntawm kev siv tshuaj ramipril nrog aliskiren thiab aliskiren-cov tshuaj muaj qhov cuam tshuam rau cov neeg mob ntshav qab zib mellitus lossis nruab nrab lossis mob raum tsis ua haujlwm (CC tsawg dua 60 ml / min / 1.73 m²).
Siv cov tshuaj tsis haum nrog lwm cov tshuaj ACE inhibitors ua rau muaj kev pheej hmoo ntau ntxiv (nrog rau mob raum tsis ua haujlwm), hyperkalemia.
Kev siv ib txhij ntawm cov tshuaj thiab angiotensin II receptor antagonists hauv cov neeg mob ntshav qab zib nephropathy yog contraindicated thiab tsis pom zoo rau lwm cov neeg mob.
Kev sib xyaw ua ke kom siv nrog ceev faj
Concomitant siv nrog ntsev cov ntsev, poov tshuaj-sparing diuretics (piv txwv li, amiloride, triamteren, spironolactone), zoo li tshuaj, nrog txhawb kev nce ntxiv hauv cov poov tshuaj poov tshuaj (suav nrog trimethoprim, tacrolimus, cyclosporine, angiotensin II receptor antagonists) tuaj yeem ua rau kom muaj cov poov tshuaj ntau ntau ntxiv (yuav tsum muaj kev soj ntsuam cov poov tshuaj ntau ntxiv).
Cov tshuaj antihypertensive (alfuzosin, doxazosin, prazosin, tamsulosin, terazosin), baclofen, diuretics, nitrates, tricyclic antidepressants, antipsychotics, tshuaj tsaug zog, narcotic analgesics, tus sawv cev rau cov tshuaj loog dav dav thiab hauv zos. txhim kho cov nyhuv antihypertensive ntawm ramipril.
Vasopressor sympathomimetics thiab lwm yam tshuaj uas ua rau cov nyhuv antihypertensive (piv txwv, isoproterenol, dobutamine, dopamine, epinephrine) txo cov nyhuv antihypertensive ntawm ramipril, thiab kev soj ntsuam cov ntshav siab yog ib qho yuav tsum tau ua.
Concomitant siv nrog allopurinol, procainamide, cytostatics, immunosuppressants, corticosteroids (glucocorticosteroids thiab mineralocorticosteroids) thiab lwm yam txhais tau tias yuav cuam tshuam rau hematological tsis, nce qhov kev pheej hmoo ntawm kev tsim leukopenia.
Tsis tas siv cov tshuaj ramipril nrog corticosteroids tsis pom zoo.
Lithium ntsev ua rau kom muaj kev nce ntxiv hauv cov concentration ntawm lithium hauv cov ntshav cov ntshav thiab nce ntxiv ntawm cov kev mob plawv thiab neurotoxic ntawm lithium.
Ramipril ua kom cov nyhuv ntshav qab zib tsawg cov kab mob hypoglycemic (insulin, hypoglycemic cov neeg sawv cev rau kev tswj hwm qhov ncauj (sulfonylurea derivatives)) txog kev txhim kho ntawm hypoglycemia. Kev tswj cov qabzib yog xav tau.
Vildagliptin ua rau muaj kev nce ntxiv ntawm qhov tshwm sim ntawm angioedema.
Concomitant siv nrog ramipril nrog mTOR (mammalian Lub hom phiaj ntawm Rapamycin - lub hom phiaj ntawm rapamycin hauv hlwb mammalian), piv txwv li, nrog temsirolimus, tuaj yeem ua rau nce ntxiv hauv qhov tshwm sim ntawm angioedema.
Kev sib txuas ua ke los txiav txim siab
Nonsteroidal anti-inflammatory tshuaj (NSAIDs) (piv txwv li, acetylsalicylic acid (ntau dua 3 g / hnub), cyclooxygenase-2 inhibitors (COX2) tuaj yeem ua rau cov nyhuv antihypertensive ntawm ramipril, zoo li ua rau lub raum tsis ua haujlwm, qee zaum ua rau kev txhim kho lub raum tsis ua haujlwm. Heparin tej zaum yuav nce cov poov tshuaj poov xab.
Sodium Chloride tuaj yeem ua kom tsis muaj zog ntawm cov nyhuv ntawm ramipril.
Yuav tsum tsis txhob tau haus ethanol thaum kho nrog ramipril (qhov cuam tshuam ntawm ethanol ntawm lub hauv nruab nrab cov hlab hlwb (CNS) tau nce siab).
Estrogens tsis muaj zog tiv thaiv cov nyhuv antihypertensive (ua kua dej khaws cia).
Kev kho kom zoo nrog cov kev ua kom mob siab rau cov tshuaj lom cov kab. ACE inhibitors, suav nrog ramipril, ua rau kom muaj kev phiv tshuaj lossis khaus khaus zoo rau cov tshuaj lom cov kab.

Cov lus qhia tshwj xeeb

Ua ntej pib kho nrog Pyramil ®, nws yog ib qhov tsim nyog los tshem tawm hyponatremia thiab hypovolemia. Hauv cov neeg mob uas tau noj tshuaj diuretics yav dhau los, nws yog qhov yuav tsum tso tseg lawv los yog txo lawv qhov hno 2-3 hnub ua ntej pib siv tshuaj Pyramil ®. Hauv qhov xwm txheej no, qhov xwm txheej ntawm cov neeg mob uas muaj lub plawv tsis ua haujlwm ntev yuav tsum tau ua tib zoo saib xyuas vim muaj peev xwm tsim decompensation hauv cov neeg mob uas muaj ntshav ntau ntxiv.
Tom qab noj thawj koob tshuaj, nrog rau kev nce ntxiv ntawm koob tshuaj diuretic thiab / lossis Pyramil ®, cov neeg mob yuav tsum tau nyob hauv kev saib xyuas kev noj qab haus huv rau 8 teev vim tias tseem muaj peev xwm tsim orthostatic hypotension.
Kev hloov pauv ntawm cov roj ntsha tsis yog qhov sib txuam rau kev kho mob txuas ntxiv nrog Pyramil ®, txij li thaum rov kho lub ntim ntawm cov ntshav ncig thiab ua kom ntshav nce siab, noj tom ntej ntawm cov tshuaj feem ntau tsis ua rau muaj tsos mob ntsig txog txoj hlab ntshav hypotension.
Yog tias rov tshwm sim ntau zaus ntawm cov kev mob ntshav dhau los, yuav tsum txo qhov koob tshuaj lossis cov tshuaj yuav tsum tsis ua haujlwm ntxiv. Cov neeg mob uas muaj cov hlav ntshav ntau dua los yog lub plawv tsis ua haujlwm, tshwj xeeb tshaj yog nyob rau theem mob myocardial infarction, yuav tsum pib kho xwb hauv tsev kho mob lub chaw teeb tsa.
Hauv cov neeg mob uas muaj lub plawv tsis ua haujlwm ntev, noj Pyramil ® tuaj yeem ua rau txo ntshav siab, uas qee qhov mob nrog oliguria lossis azotemia thiab tsis tshua muaj kev loj hlob ntawm cov mob raum tsis zoo.
Cov neeg mob uas muaj RAAS ntau ntxiv uas tau noj cov tshuaj no thawj zaug los yog noj ntau dua yuav tsum tau saib xyuas ntshav siab thiab lub raum kev ua haujlwm, tshwj xeeb tshaj yog thaum pib kho, vim tias cov neeg mob no muaj kev pheej hmoo ntau ntxiv ntawm cov ntshav siab thiab kev tsis hnov ​​qab lub plawv ua haujlwm los ntawm ACE.
Kev ceev faj yuav tsum tau siv rau hauv kev kho mob ntawm cov neeg laus, vim tias lawv yuav tshwj xeeb rau ACE inhibitors.
Kev ceev faj yuav tsum tau tawm dag zog thaum tawm dag zog lub cev thiab / lossis huab cua kub vim muaj kev pheej hmoo tawm hws thiab lub cev qhuav dej nrog txoj kev loj hlob ntawm cov hlab ntsha hypotension vim qhov txo qis hauv cov dej ntawm cov ntshav ncig thiab txo qis ntawm sodium cov ntsiab lus hauv cov ntshav.
Ua ntej thiab thaum kho nrog Pyramil ®, nws yog ib qho yuav tsum tau saib xyuas lub raum muaj nuj nqi (creatinine, urea), plasma potassium, ib qho kev suav cov ntshav, hemoglobin, thiab kuaj lub siab ua haujlwm.
Nrog rau kev txhim kho cholestatic jaundice lossis lub cim nce rau hauv cov kev ua ntawm "mob siab" transaminases, koj yuav tsum tsis txhob noj ACE inhibitors.
Cov kev pheej hmoo rau cov mob hyperkalemia yog tsim los ntawm cov neeg mob lub raum tsis ua haujlwm, mob ntshav qab zib mellitus, nrog rau cov uas noj cov tshuaj potassium ntau ntxiv, cov tshuaj potassium los yog cov ntsev ntxiv ntsev thiab tshuaj muaj zog ntxiv cov ntsiab lus poov tshuaj potassium (piv txwv li, heparin).
Hauv cov neeg mob uas muaj kev pheej hmoo ntau ntxiv ntawm neutropenia (nrog lub raum tsis ua haujlwm, cov kab mob ntawm cov nqaij sib txuas), thaum tswj cov tshuaj Pyramil ®, kuaj ntshav feem ntau yuav tsum tau saib xyuas ib hlis ib zaug thaum thawj 3-6 lub hlis ntawm kev kho, nrog rau thawj cov cim ntawm tus mob. Yog tias neutropenia raug kuaj pom (tus naj npawb ntawm neutrophils tsawg dua 2000 / μl), kev kho mob nrog ACE inhibitors yuav tsum tsis ua mus ntxiv.
Muaj qee zaus, thaum kho nrog ACE inhibitors, suav nrog ramipril, angioedema ntawm lub ntsej muag, nqua, daim di ncauj, tus nplaig, lub suab thiab / lossis mob taub hau yog sau tseg. Yog tias muaj edema uas tuaj yeem tsim dheev hauv lub sijhawm twg los ntawm kev kho mob, koj yuav tsum tsis txhob noj tshuaj tam sim ntawd, saib xyuas kev kho mob xwm txheej ceev thiab saib xyuas tus neeg mob kom txog thaum tus tsos mob ploj tag thiab mus tas li.
Hauv cov neeg mob uas tau txais ACE inhibitors, cov mob ntawm txoj hnyuv angioedema tau pom, uas tau pom los ntawm kev mob plab nrog lossis tsis hnov ​​xeev siab thiab ntuav, thiab qee qhov mob angioedema ntawm lub ntsej muag tau saib ib txhij. Yog tias tus neeg mob pib txhim kho cov tsos mob saum toj no nrog kev kho mob ntawm ACE inhibitors, kev kuaj mob txawv yuav tsum xav txog qhov ua tau ntawm kev tsim muaj txoj hnyuv mob hlwb ntawm lawv.
Kev siv cov tshuaj ACE inhibitors, suav nrog ramipril, hauv cov neeg mob niaj hnub phais kev siv tshuaj loog dav dav tuaj yeem ua rau txoj kev loj hlob ntawm txoj kev mob ntshav ntawm lub plawv.
Nws raug nquahu kom tsis txhob noj cov tshuaj Pyramil ® ib hnub ua ntej kev phais mob.
Kev siv qee qhov ua kom lub siab lub zog nrog qhov tsis zoo ntawm lub ntsej muag (piv txwv li, polyacrylonitrile daim nyias nyias) yuav tsum zam, piv txwv, rau kev kho mob sai lossis hemofiltration nrog ACE inhibitors (vim tias muaj kev phiv tshuaj tsis zoo rau cov neeg mob). Muaj qee zaus, nrog kev ua apheresis ntawm tsawg lipoproteins (LDL) nrog dextran sulfate thiab kev tswj hwm ntawm ACE inhibitors tib lub sij hawm, anaphylactoid tshua yuav tsim.
Yog li, hom no yuav tsum tsis txhob siv rau hauv cov neeg mob uas tau txais ACE inhibitors.
Antihypertensive cov neeg sawv cev uas tiv thaiv RAAS feem ntau tsis ua hauj lwm zoo rau kev kho cov neeg mob nrog tus thawj hyperaldosteronism, yog li kev siv ramipril hauv cov xwm txheej zoo li no tsis pom zoo.
Ib yam li lwm tus ACE inhibitors, kev sib xyaw ua ke ntawm kev siv tshuaj ramipril nrog aliskiren thiab aliskiren-cov tshuaj muaj qhov cuam tshuam rau cov neeg mob ntshav qab zib mellitus lossis nruab nrab lossis mob raum tsis ua haujlwm (CC tsawg dua 60 ml / min / 1.73 m²).
Siv tib lub sijhawm nrog cov tshuaj muaj aliskiren, lossis nrog angiotensin II receptor antagonists, ua rau muaj kev thaiv ob zaug ntawm RAAS, tsis pom zoo vim muaj kev pheej hmoo ntawm kev txo qis hauv cov ntshav siab, kev txhim kho hyperkalemia thiab lub plawv tsis zoo los ua haujlwm piv nrog kev kho mob hlwb.
Siv tib lub sijhawm ntawm angiotensin II receptor antagonists hauv cov neeg mob ntshav qab zib nephropathy yog contraindicated (saib ntu "Contraindications").

Cuam tshuam rau kev muaj peev xwm tsav tsheb, tshuab

Tsis muaj cov ntaub ntawv hais txog qhov tsis zoo ntawm Pyramil ® kev npaj rau cov koob tshuaj pom zoo ntawm kev muaj peev xwm tsav tsheb lossis ua haujlwm nrog cov txheej txheem. Txawm li cas los xij, vim muaj qhov ntxim nyiam ntawm cov kev mob tshwm sim, xws li txo qis ntshav siab thiab qaug zog, nws raug nquahu kom tsis txhob koom ua cov haujlwm uas muaj feem yuav ua rau muaj kev cuam tshuam ntau ntxiv thiab ceev ntawm psychomotor cov kev cuam tshuam, suav nrog kev tsav tsheb, tshwj xeeb yog tom qab noj thawj koob, hloov mus rau lwm yam tshuaj thaum noj cov tshuaj diuretics thiab haus dej cawv.

Kev tiv thaiv kev nyab xeeb

Ceev faj yog qhia nyob rau hauv cov neeg mob tau txais concomitant diuretic txoj kev kho, vim muaj qhov tsis muaj peev xwm ntawm cov kua thiab (lossis) cov roj ntsha hauv lub cev, thiab soj ntsuam cov raum kev ua haujlwm thiab cov qib potassium nyob hauv cov ntshav.

Cov ntaub ntawv ntawm ramipril
Ob chav thaiv ntawm lub renin-angiotensin-aldosterone system (RAAS)
Kev sib xyaw ntawm Pyramil® Ntxiv thiab aliskiren tsis pom zoo vim tias qhov kev pheej hmoo ntawm kev npau taws, kev mob ntshav hauv lub cev, thiab kev hloov pauv ntawm lub raum ua haujlwm. Kev siv Pyramil® Ntxiv nrog rau aliskiren yog contraindicated rau cov neeg mob ntshav qab zib mellitus lossis lub raum tsis ua haujlwm (GFR 2) (saib "Kev cuam tshuam nrog lwm cov tshuaj").
Cov neeg mob ntawm Kev Raug Mob Hlav Hlav Hypotension
Cov neeg mob uas tau ua kom muaj lub zog ntawm renin-angiotensin-aldosterone system
Cov neeg mob uas tau ua haujlwm loj ntawm RAAS yog qhov muaj feem yuav ua rau muaj ntshav nce siab ntau ntxiv thiab ua rau lub raum khiav tsis zoo vim ACE inhibition, tshwj xeeb tshaj yog thawj zaug tswj hwm ntawm ACE inhibitor (lossis concomitant diuretic) lossis nce ntxiv.
Cov lus tshaj tawm ntawm RAAS, xav tau kev tswj hwm los ntawm cov neeg ua haujlwm kho mob, suav nrog kev saib xyuas ntshav siab, kev cia siab los ntawm pawg neeg hauv qab no:
- cov neeg mob uas mob ntshav dhau los,
- cov neeg mob uas decompensated congestive lub plawv tsis ua hauj lwm,
- cov neeg mob hemodynamically cuam tshuam loj heev ntawm kev ntws tawm lossis tawm ntawm cov ntshav tawm ntawm sab laug ventricle (piv txwv, stenosis ntawm aortic lossis mitral valve),
- cov neeg mob uas mob raum ntshav tsis sib luag thiab mob raum zaum ob,
- cov neeg mob uas muaj lossis yuav ua rau lub cev tsis muaj dej txaus thiab (lossis) electrolytes (suav nrog cov neeg mob noj tshuaj diuretics),
- cov neeg mob ntsws thiab (lossis) ascites,
- Cov neeg mob niaj hnub ua txoj kev phais mob lossis tshuaj loog nrog cov tshuaj uas ua rau hypotension.
Ua ntej pib kev kho mob, nws raug nquahu tias lub cev qhuav dej, hypovolemia, lossis electrolyte tsis raug kho (txawm li cas los xij, hauv cov neeg mob plawv tsis ua hauj lwm 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 nyob rau hauv cov kis mob ntawm hypotension mob ceev.
Nyob rau theem pib ntawm kev kho, kev kho mob tshwj xeeb yuav tsum tau ua.
Cov neeg laus cov neeg mob
Thawj cov koob tshuaj ntawm ramipril yuav tsum qis dua, nrog lawv cov kev ceev faj ntxiv tom qab, vim tias qhov tshwm sim ntau dua qhov tsis xav tau. Amlodipine / ramipril tsis pom zoo rau cov neeg laus thiab cov neeg muaj mob ntau.
Kev phais mob
Yog tias ua tau, nws raug nquahu kom thim ACE inhibitors ib hnub ua ntej kev phais mob.
Kev kuaj xyuas lub raum
Cov haujlwm raum yuav tsum raug ntsuas ua ntej thiab thaum kho thiab cov koob yuav tsum kho, tshwj xeeb tshaj yog nyob rau thawj lub lim tiam ntawm kev kho. Tshwj xeeb kev saib xyuas tshwj xeeb yog qhov tsim nyog hauv cov neeg mob uas lub raum tsis ua haujlwm. 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.
Hauv cov neeg mob uas mob raum tsis zoo (GFR

Tsuas tshuaj thiab tswj hwm

Koob tshuaj
Pyramil® Ntxiv yuav tsum tsis txhob siv rau kev pib kho kev mob ntshav ntawm txoj hlab ntshav. Cov koob tshuaj ntawm txhua feem yuav tsum tau xaiv ib tus zuj zus raws li tus neeg mob cov ntaub ntawv thiab qib kev tswj ntshav siab tau ua tiav.
Yog tias nws yuav tsum tau hloov cov koob tshuaj, qhov ntau dua kev noj tshuaj yuav raug xaiv ib qho zuj zus rau txhua qhov sib xyaw ntawm cov tshuaj cais - ramipril thiab amlodipine, thiab tsuas yog tom qab txiav txim siab cov koob tshuaj tsim nyog, kev tswj hwm ntawm cov tshuaj tiv thaiv ib leeg tuaj yeem hloov nrog kev tswj hwm ntawm cov tshuaj Pyramil® Ntxiv.
Cov koob tshuaj pom zoo: ib qho tshuaj ntsiav ib hnub. Qhov siab noj ib hnub ntau: ib qho tshuaj ntsiav ntawm 10 mg / 10 mg.
Cov pab pawg neeg tshwj xeeb
Cov neeg mob es lub raum khiav tsis zoo: qhov zoo tshaj plaws thaum pib thiab txij nkawm koob tshuaj yog txiav txim siab ib leeg los ntawm titrating koob tshuaj ntawm txhua feem ntawm cov tshuaj (amlodipine thiab ramipril) cais.
Ramipril yog qee tawm hauv qee qhov kev lim ntshav, yog li cov tshuaj yuav tsum noj ob peb teev tom qab hemodialysis.
Amlodipine tsis raug ntiab tawm los ntawm lim ntshav. Rau cov neeg mob rau kev lim ntshav, nws yog kws kho nrog ceev faj.
Thaum kho nrog Pyramil® Ntxiv, raum kev ua haujlwm thiab cov qib poov tshuaj hauv ntshav yuav tsum tau saib xyuas. Yog tias muaj teeb meem lub raum tsis ua haujlwm, Pyramil® Ntxiv yuav tsum tau txiav thiab hloov los ntawm kev noj cov tshuaj zoo txaus ntawm cov feem cais.
Cov neeg mob uas lub siab ua tsis taus haujlwm: qhov siab tshaj plaws txhua hnub koob ntawm ramipril yog 2.5 mg. Cov tshuaj Pyramil® Ntxiv rau hauv cov neeg mob uas muaj lub siab ua haujlwm tsis zoo yog siv tsis tau.
Cov neeg laus: kev kho mob raug pom zoo kom pib nrog kev pib siv tshuaj qis dua, tom qab ntawd qhov nce ceev faj.
Cov menyuam yaus thiab cov hluas: kev nyab xeeb thiab ua haujlwm ntawm Pyramil® Ntxiv rau cov menyuam yaus tseem tsis tau tsim. Nws tsis tuaj yeem muab lus pom zoo muab tshuaj.

Txoj kev ntawm daim ntawv thov
Txog kev tswj hwm qhov ncauj. Noj tib lub sijhawm ntawm hnub, tsis hais noj zaub mov.

Nosological kev faib tawm (ICD-10)

Kev piav qhia ntawm daim ntawv tshuaj

5 mg ntsiav tshuaj: oblong, biconvex, lub teeb xim liab dawb hauv cov xim nrog qhov ntxhib, nrog thaj tsis tshua muaj xim tsaus thiab xim tha xim ntawm ib sab.

Ntsiav tshuaj, 10 mg: oblong, biconvex, xim dawb lossis yuav luag xim dawb nrog xim nrog lub qhov ntxhib ntxoo thiab thais ntawm ib sab.

Cov Tshuaj Hauv Tshuaj

Ramipril nrawm nrawm hauv lub plab zom mov thiab yauv ua kom muaj cov kua dej hauv lub siab nrog rau kev tsim cov khoom noj nquag ntawm ramiprilat. Ramiprilat yog ACE inhibitor ua ntu zus ntev, ib qho enzyme uas catalyzes hloov dua siab tshiab ntawm angiotensin I rau angiotensin II.

Ramipril ua rau txo qis ntawm theem ntawm angiotensin II hauv ntshav ntshav, nce ntxiv hauv kev ua si ntawm renin thiab txo qis hauv kev tso tawm aldosterone. Txhawb nqa qib ntawm kinase II, txwv tsis pub tawg ntawm bradykinin, txhim kho kev sib txuas ntawm PG. Raws li qhov kev txiav txim ntawm ramipril, cov hlab ntsha peripheral nthuav dav thiab OPSS txo.

Nws muaj qhov ntsuas tsis zoo thaum tus neeg mob dag thiab sawv. Txo OPSS (tom qab ua haujlwm), txhaws siab nyob rau hauv cov hlab ntsws tsis muaj txhaum nyob rau hauv lub plawv dhia. Txhim kho txoj hlab ntshav siab thiab lub plawv raum ntws yam tsis muaj kev cuam tshuam rau GFR.

Thaum pib ntawm cov nyhuv hypotensive yog 1-2 teev tom qab noj, cov nyhuv siab tshaj plaws tsim tawm 3-6 teev tom qab kev tswj hwm. Qhov kev txiav txim kav tsawg kawg yog 24 teev.

Lub plawv tsis ua haujlwm thiab lub plawv tsis ua haujlwm vim yog mob myocardial infarction

Ramipril txo OPSS thiab thaum kawg ntshav siab. Tsub ntxiv cov zis tshwm sim thiab ua kom tawm dag zog. Nrog rau siv ntev, nws ua rau muaj kev thim rov qab ntawm myocardial hypertrophy hauv cov neeg mob uas lub plawv tsis ua haujlwm ntawm chav kawm I thiab II raws li kev faib tawm NYHA, txhim kho cov ntshav cov ntshav mus rau ischemic myocardium.

Ramipril nce kev muaj sia nyob ntawm cov neeg mob uas muaj cov tsos mob tshwm sim los yog CHF tom qab myocardial infarction. Nws muaj cov nyhuv cardioprotective, tiv thaiv cov mob hlab ntsha ischemic ntu, txo qhov ntxim nyiam ntawm kev tsim myocardial infarction thiab txo lub sijhawm mus pw hauv tsev kho mob.

Ntshav qab zib thiab tsis-mob ntshav qab zib nephropathy

Hauv cov neeg mob ntshav qab zib thiab tsis mob ntshav qab zib nephropathy, ramipril 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 ntawd txo qhov kev xav rau hemodialysis lossis lub raum hloov. 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 kev pheej hmoo siab tshaj plaws ntawm cov hlab plawv vim yog voos txhab (raug mob rau cov hlab ntshav txhaws, mob ntshav tawm ntawm cov leeg ntshav lossis keeb kwm ntawm cov hlab ntsha ntshav qab zib), ntshav qab zib mellitus muaj tsawg kawg yog ib qho kev pheej hmoo ntxiv (microalbuminuria, ntshav siab, nce ntshav ntau ntawm tag nrho cov roj, poob ntshav qhov kev nkag siab ntawm HDL-C, haus luam yeeb) qhov sib ntxiv ntawm ramipril mus rau kev kho mob txheem txo cov xwm txheej ntawm myocardial infarction, mob stroke thiab lub plawv tuag. leeg leeg ua.

Cov Tshuaj Pharmacokinetics

Ramipril nrawm rau lub plab zom mov tom qab kev tswj hwm qhov ncauj. Kev tsis haum yog nyob ywj pheej ntawm kev ua zaub mov.

Tom qab kev nqus, ramipril sai thiab yuav luag hloov mus rau hauv kev siv tshuaj metabolite ntawm ramiprilat nyob rau hauv kev cuam tshuam ntawm esterase enzyme hauv daim siab. Ramiprilat yog kwv yees li 6 npaug ntau zog hauv kev txwv ACE dua li ramipril. Lwm cov tshuaj tiv thaiv lub cev tsis muaj zog sib xyaw ua ke kuj tau tshawb pom.

Hauv cov neeg mob uas lub raum tsis ua haujlwm, qhov hloov ntawm ramipril rau hauv ramiprilat qeeb vim tias lub sijhawm luv luv ntawm esterase, yog li ntawd, qib ntawm ramipril hauv cov ntshav plasma hauv cov neeg mob no tau nce.

C_max ramipril hauv plasma tau mus txog hauv ib teev tom qab kev tswj hwm, ramiprilata - hauv 2-4 teev tom qab noj cov tshuaj. Lub bioavailability ntawm ramipril yog 60%. Plasma protein khi tau ncav cuag 73% rau ramipril thiab 56% rau ramiprilat. Tom qab noj 5 mg, lub raum tshem tawm ntawm ramipril yog 10-55 ml / min, kev tshem tawm ntxiv mus txog 750 ml / min. Rau ramiprilat, cov nqi no yog 70-120 ml / min thiab kwv yees li 140 ml / min, raws li. Ramipril thiab ramiprilat tsuas yog feem ntau raug nteg tawm los ntawm lub raum (40-60%). Nrog lub raum tsis ua haujlwm, lawv txoj kev tshem tawm qis qis dua.

T_1/2 ramiprilata nrog lub caij nyoog siv hauv qhov koob tshuaj 5-10 mg 1 zaug hauv ib hnub yog 13-17 teev.

Kev taw qhia ntawm cov tshuaj Pyramil ®

mob plawv tsis ua hauj lwm (raws li ib feem ntawm txoj kev kho ua ke),

mob ntshav qab zib thiab tsis mob ntshav qab zib nephropathy, kev kho mob thiab chaw kuaj mob qhia nyob rau theem, suav nrog nrog cov proteinuria hnyav, tshwj xeeb tshaj yog thaum ua ke nrog cov leeg ntshav thiab muaj cov microalbuminuria,

txo qis kev pheej hmoo ntawm myocardial infarction, mob hlab ntsha tawg, lossis lub plawv tuag rau cov neeg mob uas muaj kev pheej hmoo siab ntawm cov kab mob plawv (cov neeg mob uas paub tseeb txog cov hlab ntshav txha caj qaum, cov keeb kwm ntawm myocardial infarction lossis tsis muaj nws, suav nrog cov neeg mob percutaneous transluminal coronary angioplasty, mob ntshav hlab plawv los ntawm kev sib tsoo, cov neeg mob stroke peripheral arterial occlusion lesions, ntshav qab zib mellitus nrog tsawg kawg ib qho kev pheej hmoo ntxiv (microalbuminuria, mob ntshav siab, nce ntshav ntxiv) x tag nrho cov roj uas txhaws ntau, tsis ntshav ntau ntawm LDL-roj HDL, haus luam yeeb)

lub plawv tsis ua haujlwm uas tau tsim nyob rau thawj ob peb hnub (txij li 2 txog 9 hnub) tom qab mob myocardial infarction.

Cev xeeb tub thiab lactation

Kev siv cov tshuaj Pyramil ® thaum cev xeeb tub thiab pub niam mis yog contraindicated, vim hais tias tej zaum yuav muaj qhov tsis zoo ntawm tus me nyuam: tsis hnov ​​qab txoj kev loj hlob ntawm lub raum ntawm lub cev, txo cov ntshav siab ntawm cov me nyuam hauv plab thiab cov menyuam yug tshiab, lub raum tsis ua haujlwm, hyperkalemia, hypoplasia ntawm cov pob txha pob txha taub hau, hypoplasia ntawm lub ntsws. Pyramil ® tsis pom zoo rau cov poj niam npaj cev xeeb tub. Yog tias cev xeeb tub thaum kho nrog kev siv tshuaj Pyramil ®, koj yuav tsum tsis txhob noj tshuaj sai li sai tau thiab saib xyuas kev loj hlob ntawm lub me nyuam hauv plab.

Cov poj niam ntawm kev ua me nyuam hnub nyoog tau txais kev kho mob nrog ACE inhibitors yuav tsum siv txoj kev tswj kom zoo. Yog tias cov poj niam thaum yug menyuam muaj hnub nyoog nrog txoj kev hloov ntshav liab coj ACE inhibitors, tom qab ntawd nws yuav tsum nco ntsoov tias thaum muaj menyuam cev xeeb tub, hloov tus neeg mob mus rau kev noj tshuaj hypotensive los ntawm lwm pab pawg. Hauv txhua kis, kev saib xyuas mob nkeeg yog qhov yuav tsum tau ua.

Tsis muaj pov thawj dab tsi txog seb puas yog ramipril ua tawm hauv niam cov kua mis.

Cov kev tshawb fawb tsiaj pom tias ramipril yog cov tawm hauv cov mis ntawm lactating nas. Kev siv cov tshuaj Pyramil ® thaum pub mis niam yog contraindicated. Yog tias nws yog qhov tsim nyog los sau tshuaj Pyramil ® rau ib tus niam saib xyuas mob, qhov teeb meem ntawm kev txwv tsis pub mis niam yuav tsum txiav txim siab.

Sab sij huam

Cov kev ua tsis tau zoo raug muab raws li WHO kev faib tawm raws li lawv lub zog ntawm kev loj hlob raws li hauv qab no: ntau zaus (> 1/10), feem ntau (> 1/100, 1/1000, 1/10000, ntshav siab, tsis hnov ​​lus orthostatic txoj cai ntawm vascular laus (orthostatic hypotension) , syncopal tej yam kev mob, tsis xws luag - orthostatic cev qhuav dej, myocardial ischemia, suav nrog kev txhim kho ntawm ib qho kev tawm tsam ntawm angina pectoris lossis myocardial infarction, cerebrovascular kev sib tsoo (vim yog poob siab hauv cov ntshav siab hauv cov neeg mob ntawm kev pheej hmoo), tachycardia, arrhythmia, peripheral edema, palpitation, flushing los cov tawv nqaij ntawm lub ntsej muag, tsis tshua muaj tshwm sim - kev tshwm sim lossis kev sib zog ntawm cov mob ntshav khov ntawm cov keeb kwm yav dhau los ntawm voos voos voos, vasculitis, qhov zaus tsis paub meej - Raynaud's syndrome.

Los ntawm cov kabmob hemopoietic: ua tsis tau - eosinophilia, tsis tshua muaj - leukopenia, suav nrog neutropenia thiab agranulocytosis (neutropenia thiab agranulocytosis yog qhov thim rov qab thiab ploj thaum ACE inhibitors raug tso tseg), ntshav txhaws, thrombocytopenia, lymphadenopathy, tsawg dua hemoglobin, tsis paub ntau zaus - txhawm rau txha ntawm pob txha, hemorrosis.

Los ntawm lub paj hlwb: feem ntau - tsis muaj zog, mob taub hau, ua tsis tau - mob lub siab, ntxhov siab, poob siab, mob plab, kiv taub hau, pw tsaug zog, pw tsaug zog, mob lub cev, tsis tshua muaj - tshee, tsis txaus, tsis meej pem, tsis paub ntau zaus - cerebral ischemia, suav nrog mob stroke thiab hloov chaw lub hlwb ncig, parosmia (hnov tsis pom tsw ntawm tsw), tsis hnov ​​qab lub hlwb kev xav, kev ua tsis tau zoo.

Ntawm qhov txhia chaw: nkag tsis meej - pom kev tsis meej, nrog rau cov duab plooj, ua txhaum ntawm qhov hnov ​​tsw, tsis tshua pom - mob pob ntseg, tsis hnov ​​lus, tsis hnov ​​lus (hnov ntawm lub suab, tinnitus).

Los ntawm tus txheej txheem ua pa: feem ntau - hnoos qhuav, mob ntsws, mob ntsws, ua pa luv, tsis txaus ntseeg - bronchospasm, suav nrog kev ua tsis ncaj ntawm bronchial hawb pob, txhaws ntswg.

Los ntawm lub plab zom mov: feem ntau - muaj kev hloov pauv hauv lub plab thiab cov hnyuv, lub plab zom mov, tsis xis nyob hauv plab, dyspepsia, raws plab, xeev siab, ntuav, ua tsis tiav - ntuav, mob ntxiv ntawm hepatic transaminases thiab concentration ntawm conjugated bilirubin nyob rau hauv cov ntshav ntshav, nce kev ua haujlwm ntawm pancreatic enzymes, plab hnyuv taum. o, mob nyob rau hauv plab, mob plab, cem quav, qhov ncauj qhuav, tsis tshua muaj glossitis, cholestatic daj ntseg, mob txhab nqaij, ntau qhov tsis paub - af ozny stomatitis (inflammatory cov tshuaj tiv thaiv ntawm lub qhov ncauj mucosa), mob siab tsis ua hauj lwm, los yog cytolytic thiab cholestatic kab mob siab, xws li neeg tuag taus.

Los ntawm cov mob txeeb zig: tsis tshua muaj - lub raum lub raum tsis ua haujlwm, suav nrog kev txhim kho ntawm lub raum tsis ua haujlwm, kev nce ntawm cov zis, nce ntxiv ntawm cov proteinuria uas twb muaj lawm, kev nce siab ntawm urea thiab creatinine hauv cov ntshav.

Los ntawm cov tawv nqaij thiab hnoos qeev: feem ntau - tawv nqaij ua pob, tshwj xeeb maculopapular, ua tsis xws luag - angioneurotic edema, suav nrog tuag taus (laryngeal edema tuaj yeem ua rau txhaws ua rau ua rau tuag taus), tawv nqaij ua pob khaus, hyperhidrosis (nce tawm hws), tsis tshua muaj - exfoliative dermatitis, urticaria, onycholysis (tev tawm ntawm cov ntsia hlau los ntawm cov nqaij mos ntawm cov ntiv tes), tsis tshua muaj tshwm sim - ua rau lub ntsej muag ua kom zoo nkauj, tsis paub qhov tsis tu ncua - muaj mob lom rau daim tawv nqaij tsis haum, Stevens-Johnson syndrome, erythema multiforme, pemphigus (ua pob liab vog), zuj zus ntawm psoriasis, psoriasis zoo li dermatitis, pemphigoid lossis lichenoid exanthema lossis ena ntsiab, alopecia.

Los ntawm cov leeg musculoskeletal: feem ntau - mob leeg, myalgia, ua ncus - arthralgia.

Los ntawm sab ntawm cov metabolism: feem ntau - cov poov tshuaj ntau ntxiv hauv cov ntshav, tsis tu ncua - tsis xav noj mov, tsis qab los, tsis paub ntau zuj zus - tsis muaj ntsev ntau nyob hauv cov ntshav.

Los ntawm lub nruab zog: zaus tsis paub - anaphylactic lossis anaphylactoid tshua, nce titer ntawm cov tshuaj tiv thaiv kev tawm tsam.

Los ntawm cov kab ke endocrine: zaus tsis paub - ADHD secretion syndrome.

Los ntawm kev muaj me nyuam: ua tsis tau - hloov chaw tsis muaj zog vim kev ua tsis zoo erectile, txo qis libido, ntau zaus tsis paub - gynecomastia.

Kev cuam tshuam dav dav thiab cuam tshuam ntawm qhov chaw txhaj tshuaj: feem ntau - mob hauv siab, nkees, tsis txaus ntseeg - ua npaws, tsis tshua muaj - asthenia.

Kev sib txuam

Kev siv qee qhov ua kom lub siab muaj qhov tsis zoo ntawm lub ntsej muag (piv txwv li polyacrylonitrile daim nyias nyias) thaum lub sijhawm hemodialysis lossis hemofiltration, kev siv dextran sulfate thaum lub sijhawm LDL apheresis tuaj yeem ua rau muaj kev pheej hmoo ntawm qhov mob tshwm sim tsis zoo, yog tias tus neeg mob xav tau cov txheej txheem no, lwm hom qog yuav tsum tau siv (thaum plasmapheresis thiab hemofiltration) lossis hloov tus neeg mob mus rau lwm cov tshuaj tiv thaiv kabmob ntshav.

Ib yam li lwm tus ACE inhibitors, kev siv tshuaj sib xyaw nrog ramipril nrog aliskiren thiab aliskiren-muaj cov tshuaj yog contraindicated rau cov neeg mob ntshav qab zib mellitus lossis mob hnyav los yog mob raum tsis ua haujlwm (Cl creatinine 2).

Siv cov tshuaj tsis haum nrog lwm cov tshuaj ACE inhibitors tsub kom muaj kev pheej hmoo ntau ntxiv ntawm lub raum (nrog rau mob), mob hyperkalemia. Kev siv ib txhij tshuaj thiab ARA II hauv cov neeg mob ntshav qab zib nephropathy yog contraindicated thiab tsis pom zoo rau lwm cov neeg mob.

Kev sib xyaw ua ke kom siv nrog ceev faj

Kev siv ib txhij nrog cov ntsev ntsev, potassium-sparing diuretics (piv txwv li, amiloride, triamteren, spironolactone), nrog rau cov tshuaj uas ua rau kom nce qib ntawm cov potassium nyob hauv cov ntshav ntshav (suav nrog trimethoprim, tacrolimus, cyclosporine, ARA II) tuaj yeem ua rau muaj kev nce qib ntxiv ntawm cov potassium hauv cov ntshav ntshav (yuav tsum muaj ib txwm saib xyuas cov poov tshuaj nyob rau hauv cov ntshav ntshav).

Cov tshuaj tiv thaiv kev tsis haum tshuaj (alfuzosin, doxazosin, prazosin, tamsulosin, terazosin), baclofen, diuretics, nitrates, tricyclic antidepressants, antipsychotics, hypnotics, narcotic analgesics, tus neeg sawv cev rau cov tshuaj loog dav dav thiab hauv zej zog txhawb cov antihypertensive nyhuv ntawm ramipri.

Vasopressor sympathomimetics thiab lwm yam tshuaj uas ua rau muaj kev tiv thaiv kabmob (xws li isoproterenol, dobutamine, dopamine, epinephrine) txo cov nyhuv antihypertensive ntawm ramipril, thiab kev soj ntsuam ntsuas ntshav siab yog qhov yuav tsum tau ua.

Kev siv tib txhij ntawm allopurinol, procainamide, cytostatics, immunosuppressants, corticosteroids (GCS thiab mineralocorticosteroids) thiab lwm yam tshuaj uas tuaj yeem cuam tshuam hematological tsis txaus yuav ua rau muaj kev pheej hmoo ntawm kev tsim leukopenia. Tsis tas siv cov tshuaj ramipril nrog corticosteroids tsis pom zoo.

Lithium ntsev ua rau muaj kev nce ntxiv ntawm cov ntshiab lithium thiab kev nce hauv cardio- thiab cov teebmeem neurotoxic ntawm lithium.

Ramipril txhim kho cov nyhuv ntawm cov kab mob hypoglycemic (insulin, hypoglycemic cov neeg sawv cev rau kev tswj hwm qhov ncauj (sulfonylurea derivatives) mus txog rau kev txhim kho hypoglycemia. Nws yog qhov tsim nyog los tswj cov ntshav qab zib.

Vildagliptin ua rau muaj kev nce ntxiv ntawm qhov tshwm sim ntawm angioedema.

Yeem siv cov ramipril nrog mTOR inhibitors (mammalian lub hom phiaj ntawm rapamycin - lub hom phiaj ntawm rapamycin hauv hlwb qog hlwb) kinases, piv txwv li nrog temsirolimus, tuaj yeem ua rau muaj ntau ntxiv ntawm cov zaus ntawm kev txhim kho angioedema.

Kev sib txuas ua ke los txiav txim siab

NSAIDs (piv txwv li, acetylsalicylic acid (ntau dua 3 g / hnub), COX2 inhibitors) tuaj yeem ua kom cov nyhuv tsis muaj zog ntawm ramipril, nrog rau ua rau lub raum ua kom tsis zoo, qee zaum ua rau kev txhim kho lub raum tsis ua haujlwm.

Heparin tuaj yeem nce cov poov tshuaj poov hlau.

Sodium chloride tuaj yeem ua kom tsis muaj zog ntawm cov nyhuv ramipril.

Ethanol yuav tsum tsis txhob noj lub sijhawm kho mob nrog ramipril (cov nyhuv inhibitory ntawm ethanol ntawm lub hauv nruab nrab cov hlab ntsha yog kho kom zoo). Estrogens ua rau cov nyhuv antihypertensive (muaj dej tuav cia).

Kev kho kom zoo rau lub cev tsis haum rau cov tshuaj lom kab

ACE inhibitors, suav nrog ramipril, ua rau kom muaj kev phiv tshuaj lossis khaus khaus zoo rau cov tshuaj lom cov kab.

Pharmacological kev txiav txim

Tom qab kev tswj hwm ntawm qhov ncauj, ramipril yog nqus tawm sai sai ntawm lub plab zom mov: ntshav siab kawg ntshav ntawm ramipril tau mus txog hauv ib teev. Qhov ntsuas nqus tau yog li ntawm 56% ntawm qhov kev noj tshuaj thiab yog kev ywj pheej ntawm kev noj zaub mov. Lub bioavailability ntawm lub nquag metabolite ntawm ramiprilat tom qab lub qhov ncauj ntawm 2.5 mg thiab 5 mg yog 45%, cov ntsiab lus siab kawg tau nce mus txog 2 txog 4 teev tom qab kev tswj hwm.

Pab txhawb cov ntshav muaj zog ntawm ramiprilat tom qab ib koob nkaus xwb ntawm ib txwm hno ramipril tau mus txog rau hnub 4.

Plasma protein khi yog kwv yees li 73% rau ramipril thiab 56% rau ramiprilat.

Ramipril yuav luag txhua qhov ua tiav rau ramiprilat, diketopiperazinovy ​​ester, diketopiperazinovy ​​acid thiab glucuronides ntawm ramipril thiab ramiprilat.

Kev nqhis cov tshuaj metabolites, feem ntau yog los ntawm ob lub raum. Plasma ntau ntawm ramiprilat deviate polyphase. Vim nws lub zog muaj txiaj ntsig ua rau ACE thiab qeeb kev cuam tshuam los ntawm cov enzyme, ramiprilat ua kom pom qhov kev tshem tawm ntev ntev ntawm qhov ntshav tsawg heev. Tom qab noj cov tshuaj ramipril ib zaug ib zaug, qhov zoo ib nrab-lub neej ntawm ramiprilat ntau yog 13-17 teev rau kev txhaj tshuaj ntawm 5-10 mg thiab ntev dua rau kev txhaj tshuaj qis dua ntawm 1.25-2.5 mg. Qhov txawv yog vim qhov muaj peev xwm zaum ntawm qhov enzyme nrog rau kev sib khi ntawm ramiprilat.

Ib qho tshuaj qhov ncauj ntawm 10 mg ntawm ramipril tsis tau ua rau pom qhov ntau ntawm ramipril lossis nws cov metabolite hauv cov kua mis. Txawm li cas los xij, cov txiaj ntsig ntawm ntau koob tsis tau paub.

Hauv cov neeg mob uas lub raum tsis txaus, qhov kev tshem tawm ntawm ramiprilat yog qhov txo qis, txij li lub raum tshem tawm ntawm ramiprilat yog ncaj qha cuam tshuam nrog creatinine clearance. Qhov no ua rau muaj kev nce ntxiv ntawm ntshav ramiprilat concentration, uas ua rau qeeb qeeb dua hauv kev kawm nrog lub raum kev ua haujlwm.

Hauv cov neeg mob uas tsis muaj kabmob hepatic, kev ua kom muaj zog ntawm ramipril hauv ramiprilat raug ncua vim txo qis kev ua haujlwm ntawm hepatic esterases. Xws li cov neeg mob ua rau muaj qib ntshav plasma ramipril ntau ntau. Txawm li cas los xij, kev mob ntshav plasma ramiprilat ntau yog zoo tib yam rau cov neeg mob hauv lub siab ua haujlwm.

Ramiprilat yog lub zog metabolite ntawm ramipril, inhibits qhov enzyme dipeptidyl carboxypeptidase Kuv (tseem hu ua angiotensin-hloov enzyme lossis kininase II). Hauv cov ntshav thiab cov nqaij mos, qhov enzyme catalyzes hloov dua siab tshiab ntawm angiotensin I rau hauv vasoconstrictor (vasoconstrictor) angiotensin II, nrog rau kev rhuav tshem ntawm vasodilator active bradykinin. Txo cov tsim ntawm angiotensin II thiab kev txwv tsis pub kom tawg ntawm bradykinin ua rau kev nthuav dav ntawm cov hlab ntshav. Txij li thaum angiotensin II tseem txhawb qhov kev tso tawm ntawm aldosterone, kev zais cia ntawm aldosterone yog txo vim yog ramiprilat. Cov lus teb nruab nrab rau kev kho mob monotherapy nrog ACE inhibitor hauv cov neeg mob ntawm cov haiv neeg Negroid (feem ntau nyob hauv cov pejxeem uas muaj ntshav siab thiab tsis tshua muaj siab ntawm renin) tau qis dua piv rau cov sawv cev ntawm lwm haiv neeg.

Ramipril txo tag nrho peripheral vascular tsis kam (OPSS), suab tsis ua rau muaj kev hloov pauv ntawm cov ntshav raum thiab cov ntshav txhaws.

Hauv cov neeg mob uas mob ntshav liab, noj Pyramil® ua rau txo qis ntshav siab thaum dag thiab sawv ntsug, yam tsis muaj nyiaj cheem nce ntxiv hauv lub plawv (HR). Feem ntau ntawm cov neeg mob, cov nyhuv antihypertensive tom qab kev tswj hwm qhov ncauj ntawm ib koob nkaus li tshwm tom qab 1-2 teev. Qhov siab tshaj plaws ntawm kev siv ib zaug feem ntau ua tiav tom qab 3-6 teev thiab feem ntau kav 24 teev.

Qhov siab tshaj plaws cov nyhuv antihypertensive nrog kev siv lub sijhawm ntev ntawm ramipril yog pom tom qab 3-4 lub lis piam. Nrog kev kho mob ntev, nws mob siab rau 2 xyoos.

Kev tshem tawm tsis sai ntawm ramipril tsis ua rau muaj kev cuam tshuam sai thiab ntau dhau ntawm cov ntshav siab.

Ntxiv nrog rau kev kho mob nrog cov diuretics thiab mob glycosides (raws li kws kho mob tau sau tseg), Pyramil ua tau zoo rau cov neeg mob plawv tsis ua haujlwm qib II-IV raws li kev tso cai kev faib tawm ntawm NYHA (New York Cardiology Association).

Pyramil txo OPSS (txo qis tom qab tawm ntawm 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 siab. Thaum noj cov ramipril, muaj qhov nce ntxiv hauv cov txiaj ntsig ntawm lub plawv, lub ntsej muag tawm thiab qhov kev txhim kho hauv kev ua kom lub cev ua kom zoo dua thiab muaj kev txhim kho hauv lub plawv ua pa. Ramipril kuj txo qis neuroendocrine ua kom ua haujlwm.

Kev Sau Ua ke ntawm Pyramil ntsiav tshuaj

Cov tshuaj no yog tsim los ntawm cov tuam txhab los ntawm Poland thiab Switzerland. Muaj nyob hauv ntsiav tshuaj daim ntawv.

Rooj 1. Cov ntawv sib xyaw ntawm pob zeb.

Mechanism ntawm kev ua

Cov txiaj ntsig Pyramil yog vim yog cov tshuaj nquag - ramipril. Nws pab txhawb kom:

1. Kev ua kom qeeb ntawm kev sib txuas ntawm cov tshuaj angiotensin hauv cov ntshav thiab cov ntaub so ntswg. Nws yog qhov tshuaj no uas muaj cov nyhuv vasoconstrictor thiab ua rau kev nce ntxiv hauv siab.
2. Nws pab ua rau hauv kev txwv tsis pub cov menyuam plab lub luag haujlwm txhawm rau nce ntshav siab hauv cov nqaij thiab hlab ntsha.
3. Kev ua kom qeeb qeeb tso tawm ntawm norepinephrine, uas ua rau koom nrog nce siab hauv lub plawv. Tsis tas li, cov tshuaj muaj cov vasoconstrictor nyhuv thiab txo cov nyhuv pressor.
4. Txo cov aldosterone ntau lawm. Mineralocorticoid hormone ua rau kom cov ntshav ntau ntxiv thiab ua kom lub siab nce ntxiv.
5. Tsub ntxiv ntawm kev tawm tsam ntawm bradykinin kom lwj. Cov tshuaj muaj cov nyhuv antihypertensive (txo qis).
6. Txhawb txoj kev nthuav dav ntawm cov hlab ntshav hauv ob lub raum.
7. Nws muaj cov txiaj ntsig zoo rov qab los ntawm sab laug ventricle thiab hlab plawv system raws li tag nrho.
8. Rov qab cov ntaub so ntswg myocardial los ntawm kev ua kom cov synthesis ntawm nitric oxide.
9. Txo kom tag nrho cov kev tawm tsam mob vascular nyob rau hauv cov plab hnyuv siab raum thiab cov kab mob.
10. Ua kom cov ntshav ntxiv rau cov kabmob thiab cov kab ke.
11. Txhawb nqa qhov kev pab cuam ntawm cov ntshav txhaws.

Cov lus qhia rau kev siv

Txhua pob Pyramil muaj cov ntaub ntawv txais tos.Ua ntej siv, nws yog qhov yuav tsum tau paub txog koj tus kheej nrog cov khw muag cov lus qhia.

Hauv particular, Pyramil, cov lus qhia rau kev siv uas muaj cov npe ua tiav ntawm cov cim qhia, muaj txiaj ntsig zoo rau:

1. Ua rau cov ntshav siab ntxiv.
2. Mob plawv nres.
3. Ntshav qab zib / tsis mob ntshav qab zib nephropathy.
4. Txhawm rau tiv thaiv kev pheej hmoo ntawm kev tsim cov myocardial infarction lossis lwm yam kev mob plawv hauv plawv uas tuaj yeem ua rau tuag taus.
5. Nrog rau cov kab mob plawv, suav nrog tom qab kev phais mob ntawm cov mob plawv.
6. Nrog mob stroke.
7. Thaum fusion lossis kaw ntawm cov hlab ntsha loj.
8. Ntshav qab zib muaj teeb meem los ntawm ntau yam.
9. Raws li kev kho mob tom qab myocardial infarction thaum muaj kev pheej hmoo ntawm lub plawv tsis ua haujlwm.

Cov ntsiav tshuaj Pyramil muaj qhov biconvex oblong puab. Ntawm ib sab yog kev thais - kev pheej hmoo. Cov ntsiav tshuaj yog ntxhib mus rau qhov kov, tsaus plooj pub rau ntawm lub plhaub. Pyramil muaj nyob hauv kev siv tshuaj hauv qab no:

1. 2.5 mg Them nrog lub qhov txhab txiv kab ntxwv daj plhaw sib xyaw.
2. 5 mg Lawv muaj lub teeb plooj pinkish.
3. 10 mg Lawv pleev xim dawb lossis yuav luag dawb tsis muaj kev cuam tshuam.

Cov koob tshuaj Pyramil nyob ntawm qhov ntsuas rau kev siv thiab kam rau ua hauv ib tus neeg mob.

Cov teeb meem tshwm sim los ntawm ntshav siab

Rooj ntawv 2. Muab noj thiab tshuaj Pyramil.

Pyramids tsis tuaj yeem zom thiab yuav tsum tau ntxuav nrog dej kom ntau (qhov tsawg kawg - 100 ml).

Cov yam ntxwv ntawm kev siv

Pyramids, kev qhia ntawm uas muaj ntau tus lej kev txwv, yuav tsum tau siv nrog ceev faj hauv qee kis. Muaj ib tug xov tooj ntawm cov lus qhia tshwj xeeb, ntawm lawv:

1. Ua tib zoo nws tsim nyog ua ke ntawm Pyramils ​​nrog diuretics. Nws raug nquahu kom txo qhov koob tshuaj lossis tsis kam lees qhov kev noj tshuaj.
2. Kev siv Pyramil thawj zaug yuav tsum tshwm sim nyob rau hauv kev saib xyuas ntawm tus kws tshaj lij. Qhov tsawg kawg yog kev soj ntsuam lub sijhawm yog 8 teev.
3. Hauv kev mob plawv tsis ua haujlwm, Pyramylls tuaj yeem ua rau txo qis ntshav siab ntau dua.
4. Nrog kev ua haujlwm siab ntawm renin-angiotensin system, nws raug nquahu kom kuaj xyuas ntshav siab thiab lub raum kev ua haujlwm.
5. Nrog kev ua kom lub cev muaj zog lossis muaj cua kub ntau, nws yog qhov tsim nyog kom tsis txhob muaj lub cev qhuav dej. Ua ke nrog Pyramil, nws yuav ua rau muaj kev tshem tawm ntau dhau.
6. Ua ntej kev phais mob, Pyramil tsis suav 24 teev ua ntej, thiab lwm yam.

Raws li cov ntaub ntawv muaj, Pyramil tsis muaj qhov cuam tshuam ncaj qha rau qhov muaj peev xwm tsav tsheb. Txawm li cas los xij, cov kev mob tshwm sim xws li tsis muaj zog thiab tsaug zog yuav cuam tshuam kev tsav tsheb nyab xeeb.

Thaum cev xeeb tub lossis pub niam mis, noj Pyramil yog txwv tsis pub muaj. Qhov no tuaj yeem ua rau menyuam tsis muaj zog ntawm kev loj hlob lossis kev tshwm sim ntawm ntau lub pathologies. Thaum npaj kev cev xeeb tub, koj yuav tsum tsis kam noj cov tshuaj ua ntej.

Pyramids yog txwv tsis pub coj:

• Cov neeg tsis tau muaj 18 xyoo
• nrog Quincke's edema,
• raum / nplooj siab tsis ua haujlwm,
• muaj lub cev tsis haum rau lub tshuaj,
• ua ke nrog cov piam thaj steroids lossis cov tshuaj uas tsis yog tshuaj steroidal,
• nrog qhov kev pheej hmoo ntawm kev txo qis hauv cov ntshav siab hauv tus neeg mob (tshwj xeeb hauv cov neeg mob hypotensive),
• nrog cardiogenic poob siab, thiab lwm yam.

Analogs thiab cov lus txhais

Muaj ntau cov tshuaj uas hloov Pyramil, uas tuaj yeem faib ua ob pawg:

1. Txhais ntawm Pyramil. Txhais tau tias muaj cov tib yam khoom muaj nyob hauv cov muaj pes tsawg leeg, tab sis txawv los ntawm cov npe lag luam.
2. Cov Lus Qhia Pyramil. Kev npaj uas sib txawv hauv cov muaj pes tsawg leeg tab sis muaj kev kho zoo sib xws.

Pyramil, nws cov lus zoo li kuj tuaj yeem tau txais hauv cov khw muag tshuaj, nws zoo sib xws rau:

Pyramil, cov analogues ntawm uas muaj cov nyhuv zoo ib yam, tuaj yeem hloov los ntawm: