Telzap - cov lus qhia rau kev siv, tshuaj xyuas, tshuaj sib piv thiab ntau npaum li cas (cov ntsiav tshuaj 40 mg, 80 mg, Ntxiv 80 mg 12, 5 mg nrog diuretic hydrochlorothiazide) tshuaj rau kev kho mob ntshav siab thiab txo ntshav siab hauv cov neeg laus, menyuam yaus thiab cev xeeb tub

Hauv tsab xov xwm no, koj tuaj yeem nyeem cov lus qhia rau kev siv tshuaj yaj yeeb TelzapCov. Muab cov lus pom zoo los ntawm cov neeg tuaj saib rau ntawm thaj chaw - cov neeg tau txais kev pab ntawm cov tshuaj no, nrog rau kev xav ntawm cov kws kho mob tshwj xeeb txog kev siv Telzap hauv lawv qhov kev coj ua. Qhov kev thov loj yog nquag ntxiv kev tshuaj xyuas koj ntawm cov tshuaj: cov tshuaj tau pab lossis tsis pab ua kom tshem tawm ntawm tus kabmob, muaj dab tsi tshwm sim thiab cov kev mob tshwm sim, tejzaum nws tsis tshaj tawm los ntawm tus tsim khoom hauv cov lus piav qhia. Cov qauv ntawm Telzap nyob rau hauv muaj cov qauv txheej txheem qauv. Siv rau kev kho mob ntawm kev kub siab tseem ceeb thiab txo qis qis hauv cov neeg laus, menyuam yaus, nrog rau thaum cev xeeb tub thiab lactation. Cov tshuaj muaj pes tsawg leeg.

Telzap - Cov tshuaj antihypertensive.

Telmisartan (cov tshuaj ua haujlwm ntawm Telzap) yog cov tshuaj thaiv kev tsis haum ntawm angiotensin 2 receptors (hom AT1), uas siv tau thaum noj ntawm qhov ncauj. Nws muaj qhov kev cuam tshuam zoo heev rau AT1 receptor subtype, los ntawm qhov kev txiav txim ntawm angiotensin 2 tau pom. Telmisartan hloov chaw angiotensin 2 los ntawm qhov khi rau receptor, tsis muaj kev cuam tshuam ntawm agonist nyob rau hauv kev sib raug zoo nrog cov receptor no, khi nkaus xwb rau AT1 receptor subtype ntawm angiotensin 2. Kev khi yog ruaj khov. Telmisartan tsis muaj kev sib nyiam rau lwm tus txais, incl. rau AT2 receptors thiab lwm qhov tsawg kawm angiotensin receptors. Lub luag haujlwm tseem ceeb ntawm cov receptors, nrog rau cov txiaj ntsig ntawm lawv qhov kev xav tau dhau los nrog angiotensin 2, qhov kev cia siab ntawm uas nce nrog kev teem sijhawm telmisartan, tseem tsis tau kawm. Telmisartan txo qis kev mloog zoo ntawm aldosterone hauv cov ntshav ntshav, tsis txo cov haujlwm ntawm renin, thiab tsis thaiv cov ion ion. Telmisartan tsis inhibit ACE (kininase 2), uas kuj tseem catalyzes rhuav tshem bradykinin. Qhov no zam txoj kev phiv cuam tshuam nrog kev ua ntawm bradykinin (piv txwv li, hnoos qhuav).

Telzap hauv ib koob ntawm 80 mg ua rau tag nrho cov txiaj ntsig ntawm kev mob siab ntawm angiotensin 2. Qhov pib ntawm qhov kev txiav txim siab tiv thaiv kab mob tsis pub dhau 3 teev tom qab thawj koob tshuaj telmisartan. Cov nyhuv ntawm cov tshuaj no kav rau 24 teev thiab tseem qhov chaw kuaj mob tseem ceeb kom txog 48 teev. Tshaj tawm qhov teebmeem antihypertensive feem ntau pib 4-8 lub lis piam tom qab siv tas.

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

Thaum tsis muaj kev txiav txim siab ntawm kev noj tshuaj Telzap, cov ntshav siab maj mam rov qab los rau nws qib qub dhau ob peb hnub yam tsis muaj kev txhim kho ntawm kev tshem tawm tus mob.

Raws li cov txiaj ntsig ntawm kev sib piv hauv cov chaw kho mob tau qhia, cov nyhuv ntawm cov tshuaj telmisartan piv rau cov txiaj ntsig antihypertensive ntawm cov tshuaj ntawm lwm cov chav kawm (amlodipine, atenolol, enalapril, hydrochlorothiazide thiab lisinopril).

Qhov tshwm sim ntawm hnoos qhuav tau qis dua nrog telmisartan piv rau ACE inhibitors.

Kev Tiv Thaiv Kab Mob Tiv Thaiv Kab Mob

Cov neeg mob hnub nyoog 55 xyoos thiab laus dua nrog mob hlab ntsha txhaws, mob stroke, hloov ischemic nres, peripheral hlab ntsha puas tsuaj, lossis nrog cov teeb meem ntawm cov ntshav qab zib hom 2 (xws li, retinopathy, sab laug ventricular hypertrophy, macro- lossis microalbuminuria) muaj keeb kwm mob plawv ntawm cov xwm txheej, Telzap muaj cov txiaj ntsig zoo xws li cov nyhuv ntawm ramipril ntawm kev txo cov kev sib txuam ua ke: kev mob plawv tuag los ntawm myocardial infarction yam tsis muaj kev ploj tuag, mob stroke tsis muaj lub txiaj ntsig tuag thiab lub xeev Khoom noj khoom haus vim mob plawv tsis ua haujlwm.

Telmisartan tau ua haujlwm zoo li ramipril hauv kev txo cov zaus ntawm cov ntsiab lus thib ob: kev mob plawv tuag, tsis muaj mob ntshav tuag ntau, lossis mob tsis tuag.

Cov hnoos qhuav thiab mob caj dab tsis tshua tau piav qhia feem ntau nrog telmisartan piv nrog ramipril, thaum arterial hypotension feem ntau tshwm sim nrog telmisartan.

Hydrochlorothiazide ua ib feem ntawm Telzap Plus yog thiazide diuretic. Thiazides cuam tshuam rau kev rov qab siv cov roj ntsha hauv cov hlab ntsws, kom qhov ntau ntxiv ntawm kev tso dej ntawm sodium thiab chloride ide kwv yees li qhov sib npaug. Cov nyhuv diuretic ntawm hydrochlorothiazide ua rau txo qis hauv BCC, kev nce hauv cov kev ua ntawm plasma renin, kev nce ntawm aldosterone ntau ntxiv, tom qab los ntawm kev nce ntxiv hauv cov ntsiab lus ntawm cov potassium thiab bicarbonates hauv cov zis thiab txo qis hauv cov ntsiab lus ntawm potassium hauv cov ntshav ntshav. Kev siv tib lub sijhawm ua haujlwm ntawm telmisartan pab txo qis cov poov tshuaj los ntawm cov diuretic no, tej zaum vim yog RAAS thaiv. Tom qab noj hydrochlorothiazide, diuresis mob siab ntxiv tom qab 2 teev, cov nyhuv siab tshaj plaws tshwm sim tom qab txog 4 teev, cov nyhuv ntev li 6-12 teev.

Kev tshawb fawb tawm tsam pom tias kev kho mob ntev ntev hydrochlorothiazide kho txo cov kev pheej hmoo ntawm cov hlab plawv mob thiab tuag nrog.

Muaj pes tsawg leeg

Telmisartan + excipients.

Telmisartan + Hydrochlorothiazide + Cov Neeg Muaj Peev Xwm (Telzap Plus).

Cov Tshuaj Pharmacokinetics

Thaum noj ntawm qhov ncauj, Telzap nrawm nrawm los ntawm lub plab zom mov. Bioavailability yog 50%. Telmisartan muaj zog khi rau cov ntshav plasma protein, feem ntau nrog albumin thiab alpha-1 acid glycoprotein. Nws yog metabolized los ntawm kev sib txuas nrog glucuronic acid. Lub conjugate tsis muaj pharmacological kev ua si. Nws yog tawm los ntawm txoj hnyuv tsis hloov, nthuav tawm los ntawm ob lub raum - tsawg dua 1%.

Hydrochlorothiazide tsis yog metabolized hauv tib neeg. Nws yog tawm yuav luag tsis hloov pauv hlo ntawm cov zis. Li ntawm 60% ntawm qhov koob tshuaj noj ntawm qhov ncauj yog kho tsis hloov tsis pub dhau 48 teev. Kev hlais tawm huv yog 250-300 ml / min.

Pharmacokinetics hauv cov pab pawg neeg mob tshwj xeeb

Muaj qhov sib txawv ntawm plasma ntau ntawm telmisartan hauv cov txiv neej thiab poj niam. Cmax thiab AUC tau kwv yees li 3 thiab 2 npaug feem ntau hauv cov poj niam piv nrog cov txiv neej tsis muaj qhov cuam tshuam txog kev ua tau zoo.

Rau cov poj niam, muaj qhov nyiam kev nyoos ntau dua ntawm hydrochlorothiazide hauv cov ntshav ntshav, qhov no tsis yog qhov tseem ceeb hauv tsev kho mob.

Cov kws tshuaj ntawm telmisartan hauv cov neeg laus laus dua 65 xyoo tsis txawv ntawm cov neeg mob hluas. Koob tshuaj yuav tsis haum.

Hauv cov neeg mob uas muaj me me mus rau lub raum lub raum lub raum kev ua haujlwm, kev kho tshuaj telmisartan tsis tas yuav tsum ua. Cov neeg mob uas lub raum tsis ua haujlwm loj thiab cov neeg mob rau mob hemodialysis pom zoo kom txo qis qis ntawm 20 mg rau ib hnub. Telmisartan tsis raug ntiab tawm los ntawm hemodialysis.

Hauv cov neeg mob uas muaj me me mus txog qib qog ua lub siab ua haujlwm (chav A thiab B raws li kev faib menyuam yaus-Pugh), koob tshuaj txhua hnub yuav tsum tsis pub tshaj 40 mg.

Cov Khoom Qhia

tawg siab tseem ceeb,
ib qho kev txo qis kev tuag thiab kev mob plawv hauv cov neeg mob cov neeg laus uas muaj cov kab mob plawv ntawm atherothrombotic keeb kwm (IHD, mob stroke lossis keeb kwm ntawm tus kab mob peripheral artery) thiab hom 2 mob ntshav qab zib mellitus nrog phiaj ua rau lub cev puas tsuaj.

Tso Tawm Cov Ntawv

Cov ntsiav tshuaj 40 mg thiab 80 mg.

Ntsiav tshuaj 80 mg + 12.5 mg (Telzap Plus).

Cov lus qhia rau kev siv thiab ntau npaum li cas

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

Thawj koob tshuaj pom zoo ntawm Telzap yog 40 mg (1 ntsiav tshuaj) ib hnub ib zaug. Hauv qee tus neeg mob, noj cov tshuaj ntawm ib koob tshuaj 20 mg rau ib hnub yuav ua tau zoo. Qhov koob tshuaj 20 mg tuaj yeem muab tau los ntawm kev faib 40 mg ntsiav tshuaj hauv ib nrab ntawm qhov pheej hmoo. Nyob rau hauv rooj plaub uas qhov kev kho mob ua tsis tiav, qhov koob tshuaj pom zoo ntawm Telzap tuaj yeem raug nce txog qhov ntau kawg ntawm 80 mg ib hnub ib zaug.

Raws li lwm txoj kev xaiv, Telzap tuaj yeem nqa ua ke nrog thiazide diuretics, piv txwv li, hydrochlorothiazide, uas, thaum siv ua ke, muaj cov nyhuv antihypertensive ntxiv. Thaum txiav txim siab tias yuav nce qhov ntau npaum li cas, nws yuav tsum raug coj mus rau hauv tus account tias qhov siab tshaj plaws antihypertensive feem ntau ua tiav tsis pub dhau 4-8 lub lis piam tom qab pib kho.

Txo cov neeg tuag thiab mob plawv

Qhov pom zoo koob tshuaj ntawm Telzap yog 80 mg ib hnub ib zaug. Hauv thawj lub sijhawm ntawm kev kho mob, kev pom zoo ntsuas ntshav siab; kev kho ntawm antihypertensive kev kho mob yuav tsum tau.

Cov kev paub nrog telmisartan hauv cov neeg mob uas mob raum tsis zoo los sis cov neeg mob ntawm cov mob hemodialysis muaj tsawg. Cov neeg mob no tau pom zoo kom txhaj tshuaj qis dua li 20 mg rau ib hnub. Rau cov neeg mob mentsis mus txog qib qis muaj lub raum khiav tsis zoo, tsis tas yuav hloov kho dua.

Kev siv yooj yim ntawm Telzap nrog aliskiren yog contraindicated rau cov neeg mob raum tsis ua haujlwm (GFR tsawg dua 60 ml / min / 1.73 m2 ntawm lub cev nqaij daim tawv hauv cheeb tsam).

Kev siv tib lub sijhawm ntawm Telzap nrog ACE inhibitors yog contraindicated rau cov neeg mob uas mob ntshav qab zib.

Cov neeg mob uas mob me mus txog rau daim siab tsis ua hauj lwm (hoob A thiab B raws li kev faib menyuam yaus-Pugh) yuav tsum muaj kev ceeb toom, qhov koob tshuaj yuav tsum tsis pub tshaj 40 mg ib hnub ib zaug. Telzap yog contraindicated rau hauv cov neeg mob uas muaj mob rau cov kabmob hepatic hnyav (chav kawm C raws li menyuam-Pugh kev faib tawm).

Hauv cov neeg laus cov neeg mob, tsis tas yuav txhaj tshuaj.

Sab hauv, ib hnub ib zaug, ntxuav nrog kua, tsis hais txog ntawm cov khoom noj.

Cov neeg mob uas nws lub BP tsis tuaj yeem tswj hwm tau zoo nrog kev kho mob monotherapy nrog telmisartan lossis hydrochlorothiazide yuav tsum siv Telzap Plus. Ua ntej hloov mus rau qhov sib xyaw-koob tshuaj sib txuam, pom zoo koob tshuaj ib feem ntawm ib qho twg. Hauv qee qhov xwm txheej hauv tsev kho mob, kev hloov ncaj qha los ntawm monotherapy mus rau kev kho mob nrog kev sib txuam nrog koob tshuaj yuav suav tau.

Cov tshuaj Telzap Plus, tuaj yeem siv ib hnub ib zaug rau cov neeg mob uas tsis tuaj yeem tswj ntshav siab thaum noj telmisartan ntawm koob ntawm 80 mg rau ib hnub.

Sab sij huam

mob txeeb zig, suav nrog cystitis,
sab sauv ntawm txoj hlab ua pa, nrog rau pharyngitis thiab sinusitis,
sepsis, suav nrog neeg tuag taus
anemia, eosinophilia, thrombocytopenia,
tshuaj tiv thaiv anaphylactic,
kev tiv thaiv tsis haum
hyperkalemia
hypoglycemia (hauv cov neeg mob ntshav qab zib mellitus),
insomnia
kev nyuaj siab
ntxhov siab
tsaus muag
tsaug zog
pom kev tsis sib to taub
ntsug
bradycardia
ntev li ntawm txo nyob rau hauv cov ntshav siab,
orthostatic hypotension,
tachycardia
txog siav
hnoos
interstitial mob ntsws
mob plab
zawv plab
dyspepsia
flatulence
ntuav
qhov ncauj qhuav
tsis xis nyob hauv plab
ua txhaum ntawm saj
ua rau daim siab ua haujlwm tsis zoo / ua rau lub siab puas,
khaus tawv
hyperhidrosis
ua pob
Mob hlwb (kuj ua rau neeg tuag taus)
eczema
erythema
urticaria
tshuaj pob khaus
ua kom tawv nqaij ua pob
sciatica
mob leeg
myalgia
arthralgia,
tes taw mob
leeg zoo li mob syndrome,
Mob raum tsis ua haujlwm, suav nrog mob raum tsis ua haujlwm,
nce ntshav creatinine,
hemoglobin txo,
nce ntshav uric acid,
nce kev ua si ntawm daim siab enzymes thiab CPK,
mob hauv siab
asthenia
khaub thuas zoo li mob aws.

Cov Yuav Tsum Muaj

obstructive biliary huam kab mob,
mob siab rau daim siab tsis ua haujlwm (Menyuam-Pugh chav C),
ua ke siv nrog aliskiren hauv cov neeg mob ntshav qab zib mellitus lossis mob raum tsis zoo (GFR tsawg dua 60 ml / min / 1.73 m2 ntawm lub cev nqaij daim tawv hauv cheeb tsam),
siv tib txhij nrog ACE inhibitors hauv cov neeg mob ntshav qab zib nephropathy,
hereditary fructose intolerance (vim muaj sorbitol hauv tshuaj muaj pes tsawg leeg),
cev xeeb tub
lub sij hawm pub niam mis,
hnub nyoog txog 18 xyoo (qhov ua tau zoo thiab kev nyab xeeb tsis tau tsim tsa),
hypersensitivity rau cov tshuaj nquag los yog ib qho kev zam ntawm cov tshuaj.

Cev xeeb tub thiab lactation

Tam sim no, cov ntaub ntawv txhim khu kev qha ntawm kev nyab xeeb ntawm telmisartan hauv cov poj niam cev xeeb tub tsis muaj. Hauv kev tshawb fawb tsiaj, kev ua me nyuam muaj mob toxicity ntawm cov tshuaj tau txheeb xyuas. Kev siv Telzap yog contraindicated thaum cev xeeb tub.

Yog tias koj xav tau kev kho mob mus ntev nrog Telzap, cov neeg mob npaj lub cev xeeb tub yuav tsum xaiv lwm txoj kev tiv thaiv tshuaj tiv thaiv uas muaj ntaub ntawv pov thawj kev nyab xeeb rau kev siv thaum cev xeeb tub. Tom qab tsim qhov tseeb ntawm cev xeeb tub, kev kho mob nrog Telzap yuav tsum nres tam sim ntawd thiab, yog tias tsim nyog, lwm txoj kev kho yuav tsum tau pib.

Raws li kev soj ntsuam hauv kev soj ntsuam, kev siv cov tshuaj angiotensin 2 receptor antagonists hauv kev txiav tawm thib 2 thiab 3 ntawm cev xeeb tub muaj lub cev tsis zoo rau lub plab (mob raum ua haujlwm, oligohydramnios, ncua ossification ntawm pob txha taub hau) thiab tus menyuam yug tshiab (lub raum tsis ua haujlwm, ntshav siab thiab ntshav qab zib). Thaum siv cov tshuaj angiotensin 2 receptor antagonists hauv 2 lub hlis ntawm cev xeeb tub, ultrasound ntawm ob lub raum thiab pob txha taub hau ntawm tus me nyuam yog pom zoo. Cov menyuam yaus uas lawv niam tau txais tus mob angiotensin 2 receptor antagonists thaum cev xeeb tub yuav tsum tau saib zoo kom pom cov hlab ntsha hypotension.

Cov ntaub ntawv hais txog kev siv telmisartan thaum pub mis niam tsis muaj. Kev siv cov tshuaj Telzap thaum pub mis niam yog contraindicated. Lwm txoj kev siv tshuaj tiv thaiv kab mob nrog ntau qhov kev nyab xeeb tshaj plaws yuav tsum tau siv, tshwj xeeb tshaj yog thaum pub mis rau cov menyuam tshiab lossis menyuam yug ntxov.

Siv rau menyuam yaus

Kev siv cov tshuaj Telzap uas muaj hnub nyoog qis dua 18 xyoo yog qhov tsis pom zoo (qhov ua tau zoo thiab kev nyab xeeb tsis tau tsim).

Siv rau cov neeg mob laus

Hauv cov neeg laus cov neeg mob, tsis tas yuav txhaj tshuaj.

Cov lus qhia tshwj xeeb

Lub siab ua haujlwm tsis zoo

Kev siv Telzap yog contraindicated nyob rau hauv cov neeg mob cholestasis, thaiv tus kab mob biliary lossis mob siab rau lub siab ua haujlwm (Menyuam-Pugh chav C), txij li telmisartan yog qhov tseem ceeb hauv cov kua tsib. Nws ntseeg tau tias cov neeg mob zoo li no tau txo qis hepatic tshem ntawm telmisartan. Hauv cov neeg mob uas muaj me me los sis me me ntawm lub siab tsis ua hauj lwm (chav kawm A thiab B raws li kev faib menyuam yaus-Pugh), Telzap yuav tsum siv nrog ceev faj.

Cov neeg mob uas muaj ob sab raum leeg mob stenosis los yog txoj hlab ntshav tawm ntawm lub raum kev ua haujlwm ib lub raum ua rau muaj kev pheej hmoo mob ntshav siab ntau thiab lub raum tsis ua haujlwm thaum kho nrog cov tshuaj yeeb yam ntawm RAAS.

Lub raum khiav tsis zoo thiab lub raum hloov

Thaum siv Telzap hauv cov neeg mob uas lub raum tsis ua haujlwm, kev saib xyuas lub sijhawm ntawm cov ntsiab lus ntawm cov poov tshuaj thiab creatinine hauv ntshav ntshav pom zoo. Tsis muaj kev sim kho mob nrog Telzap hauv cov neeg mob uas nyuam qhuav hloov raum.

Cov tsos mob ntawm txoj hlab ntshav liab, tshwj xeeb tshaj yog tom qab thawj zaug thawj coj ntawm Telzap, tej zaum yuav tshwm sim hauv cov neeg mob uas txo BCC thiab / lossis sodium hauv cov ntshav plasma tiv thaiv keeb kwm yav dhau los ntawm kev kho mob yav dhau los nrog diuretics, txwv kev noj ntsev, raws plab, lossis ntuav. Xws li cov mob (kua thiab / lossis ntsev sodium tsis txaus) yuav tsum tau muab tshem tawm ua ntej siv Telzap.

Ob chav thaiv ntawm RAAS

Yooj yim siv telmisartan nrog aliskiren yog contraindicated rau cov neeg mob ntshav qab zib mellitus lossis lub raum tsis ua haujlwm (GFR tsawg dua 60 ml / min / 1.73 m2 ntawm lub cev nqaij daim tawv hauv cheeb tsam).

Kev siv tib lub sijhawm ntawm Telzap thiab ACE inhibitors yog contraindicated rau cov neeg mob uas mob ntshav qab zib.

Raws li kev txiav txim siab ntawm RAAS, kev mob ntshav ntawm lub plawv, syncope, hyperkalemia, thiab lub raum tsis ua haujlwm (suav nrog mob raum tsis ua haujlwm) tau sau tseg hauv cov neeg mob uas tsis zoo rau qhov no, tshwj xeeb tshaj yog thaum ua ke nrog ntau cov tshuaj uas tseem ua rau cov kab ke no. Yog li no, txwv tsis pub muab RAAS ob zaug (piv txwv, thaum noj telmisartan nrog lwm tus RAAS cov thaiv kev ua haujlwm) tsis pom zoo.

Thaum muaj kev vam khom rau lub suab vascular thiab lub raum kev ua haujlwm feem ntau ntawm RAAS kev ua si (piv txwv, hauv cov neeg mob uas muaj lub plawv tsis ua haujlwm ntev los yog mob raum, suav nrog nrog lub raum leeg mob stenosis lossis mob ntawm lub raum leeg lub raum), kev siv tshuaj uas cuam tshuam rau cov kab mob no nrog los ntawm kev txhim kho ntawm cov mob ntsig txog txoj kev mob voos, hyperazotemia, oliguria, thiab qee zaus, mob raum tsis ua haujlwm.

Hauv cov neeg mob uas muaj hyperaldosteronism thawj zaug, kho nrog cov tshuaj tiv thaiv kabmob, qhov tshwm sim ntawm kev ua tiav los ntawm inhibiting RAAS, feem ntau tsis ua haujlwm. Hauv qhov no, kev siv tshuaj Telzap tsis pom zoo.

Aortic thiab mitral valve stenosis, hypertrophic obstructive cardiomyopathy

Ib yam li lwm cov vasodilators, cov neeg mob aortic lossis mitral stenosis, as Well as hypertrophic obstructive cardiomyopathy, yuav tsum tau ceev faj tshwj xeeb thaum siv Telzap.

Cov neeg mob ntshav qab zib uas tau txais cov tshuaj insulin lossis hypoglycemic rau kev tswj hwm qhov ncauj

Tawm tsam keeb kwm ntawm kev kho mob nrog Telzap, cov neeg mob no tuaj yeem ntsib kev mob ntshav qab zib. Kev tswj hwm Glycemia yuav tsum ua kom muaj zog, raws li tej zaum yuav xav tau koob tshuaj insulin lossis tus neeg sawv cev hypoglycemic.

Kev siv cov tshuaj yeeb yam ntawm RAAS tuaj yeem ua rau hyperkalemia. Hauv cov neeg mob laus, cov neeg mob lub raum tsis ua haujlwm lossis ntshav qab zib mellitus, cov neeg mob noj tshuaj uas nce plasma ntau ntau, thiab / lossis cov neeg mob uas muaj kab mob concomitant, hyperkalemia tuaj yeem ua rau neeg tuag taus.

Thaum txiav txim siab qhov tsis txaus ntseeg ntawm kev siv yeeb tshuaj uas ua yeeb yam ntawm RAAS, nws yog qhov tsim nyog los ntsuas qhov piv ntawm kev pheej hmoo thiab cov txiaj ntsig. Cov kev pheej hmoo tseem ceeb rau hyperkalemia uas yuav tsum tau txiav txim siab yog:

mob ntshav qab zib mellitus, lub raum tsis ua hauj lwm, lub hnub nyoog (cov neeg mob laus dua 70 xyoo),
ua ke nrog ib los yog ntau cov tshuaj yeeb yam ua yeeb yam rau RAAS, thiab / los yog cov tshuaj noj muaj yees ntxiv. Tshuaj los yog kev kawm kho mob ntawm cov tshuaj uas tuaj yeem ua rau hyperkalemia yog ntsev hloov pauv muaj cov poov tshuaj, potassium-sparing diuretics, ACE inhibitors, angiotensin 2 receptor antagonists, tsis siv tshuaj tiv thaiv tsis haum tshuaj (NSAIDs) (suav nrog rau COX-2 inhibitors), heparin, immunosuppressants (cyclosporine lossis tacrolimus) thiab trimethoprim,
cov kab mob intercurrent, tshwj xeeb tshaj yog lub cev qhuav dej, lub siab tsis ua hauj lwm, metabolic acidosis, lub raum khiav tsis zoo, cytolysis syndrome (xws li, mob caj dab ischemia, mob rhabdomyolysis, mob hnyav heev).

Cov neeg mob uas pheej hmoo yuav tsum tau ua tib zoo saib xyuas cov poov tshuaj ntsiab lus hauv cov ntshav ntshav.

Telzap muaj cov sorbitol (E420). Cov neeg mob uas muaj kab mob tsis tshua muaj keeb txaus fructose intolerance yuav tsum tsis txhob noj cov tshuaj.

Raws li tau sau tseg rau ACE inhibitors, telmisartan thiab lwm cov angiotensin 2 receptor antagonists zoo li txo cov ntshav siab tsis tshua muaj txiaj ntsig hauv cov neeg mob ntawm cov haiv neeg Negroid dua li lwm qhov kev sib tw, tej zaum vim muaj kev cuam tshuam ntau dua rau txo qis kev ua si hauv cov neeg mob.

Ib yam li lwm cov tshuaj tiv thaiv kabmob ntshav, kev txo ntshav siab rau hauv cov neeg mob ischemic cardiomyopathy lossis mob plawv tuaj yeem ua rau txoj kev loj hlob ntawm myocardial infarction lossis mob hlab ntsha tawg.

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

Kev tshawb nrhiav tshwj xeeb los kawm txog kev cuam tshuam ntawm cov tshuaj ntawm kev muaj peev xwm tsav lub tsheb thiab cov tshuab tseem tsis tau ua. Thaum tsav tsheb thiab ua haujlwm nrog cov txheej txheem uas yuav tsum muaj kev saib xyuas ntau ntxiv, kev saib xyuas yuav tsum ua, vim yog kiv tob hau thiab tsaug zog tsis tshua muaj tshwm sim nrog kev siv Telzap.

Yeeb tshuaj sib cuam tshuam

Ob chav thaiv ntawm RAAS

Kev siv yooj yim ntawm Telzap nrog aliskiren yog contraindicated rau cov neeg mob ntshav qab zib mellitus lossis lub raum tsis ua haujlwm (GFR tsawg dua 60 ml / min / 1.73 m2 ntawm lub cev nqaij daim tawv hauv cheeb tsam) thiab tsis pom zoo rau lwm cov neeg mob.

Kev siv tib lub sijhawm ntawm telmisartan thiab ACE inhibitors yog contraindicated nyob rau hauv cov neeg mob uas mob ntshav qab zib nephropathy.

Cov kev tshawb fawb soj ntsuam pom tau tias ob zaug thaiv RAAS vim yog kev sib xyaw ua ke ntawm ACE inhibitors, angiotensin 2 receptor antagonists, lossis aliskiren cuam tshuam nrog kev muaj mob tshwm sim tsis zoo ntxiv xws li arterial hypotension, hyperkalemia, thiab lub plawv tsis zoo (nrog rau mob raum tsis ua haujlwm) piv rau kev siv tsuas yog ib qho tshuaj yeeb tshuaj ua yeeb yam rau RAAS.

Txoj kev pheej hmoo ntawm kev mob hyperkalemia yuav nce ntxiv thaum siv ua ke nrog lwm cov tshuaj uas tuaj yeem ua rau hyperkalemia (cov poov tshuaj muaj cov khoom noj ntxiv thiab ntsev hloov pauv muaj cov poov tshuaj, potassium-sparing diuretics (piv txwv li spironolactone, eplerenone, triamterene lossis amiloride), NSAIDs (suav nrog xaiv COX-2 inhibitors) , heparin, immunosuppressants (cyclosporine lossis tacrolimus) thiab trimethoprim). Yog tias tsim nyog, tawm tsam keeb kwm yav dhau los ntawm cov ntawv sau tseg hypokalemia, kev siv tshuaj ua ke yuav tsum tau nqa nrog ceev faj thiab soj ntsuam cov ntsiab lus ntawm cov poov tshuaj hauv ntshav plasma.

Nrog kev siv ua ke ntawm telmisartan nrog digoxin, qhov nce nruab nrab ntawm Cmax ntawm digoxin hauv plasma los ntawm 49% thiab Cmin los ntawm 20% tau sau tseg. Thaum pib ntawm kev kho mob, thaum xaiv cov koob tshuaj thiab txiav tawm kev kho mob nrog telmisartan, cov concentration ntawm digoxin hauv cov ntshav plasma yuav tsum tau ua tib zoo saib xyuas kom nws nyob hauv qhov kev kho mob kom ntau.

Poov tshuaj-sparing diuretics los yog poov tshuaj uas muaj cov tshuaj pab noj haus

Angiotensin 2 receptor antagonists, xws li telmisartan, txo cov diuretic-vim cov kab mob plam ploj. Potassium-sparing diuretics (piv txwv li, spironolactone, eplerenone, triamteren, lossis amiloride), cov tshuaj ntxiv poov tshuaj, lossis ntsev hloov pauv tuaj yeem ua rau muaj qhov nce ntxiv ntawm plasma potassium. Yog tias kev pom zoo siv tau qhia tau, txij li muaj cov ntaub ntawv sau tseg hypokalemia, lawv yuav tsum siv nrog kev ceev faj thiab tiv thaiv keeb kwm ntawm kev saib xyuas cov poov tshuaj tsis tu ncua hauv cov ntshav ntshav.

Nrog rau kev siv cov tshuaj lithium nrog ACE inhibitors thiab cov tshuaj tiv thaiv angiotensin 2 receptor antagonists, suav nrog telmisartan, qhov thim rov nce ntxiv hauv cov concentration ntawm lithium hauv cov ntshav ntshav thiab nws cov nyhuv ua kom muaj kuab lom. Yog tias koj xav siv cov tshuaj sib xyaw no, nws raug nquahu kom koj ua tib zoo saib xyuas cov kua roj lithium hauv cov ntshav ntshav.

NSAIDs (i.e., acetylsalicylic acid hauv koob tshuaj siv rau kev kho mob tiv thaiv, COX-2 inhibitors thiab tsis xaiv tshuaj NSAIDs) tuaj yeem ua rau lub zog tiv thaiv kev puas siab ntsws ntawm angiotensin 2 receptor antagonists. Hauv qee cov neeg mob uas lub cev tsis muaj peev xwm ua lub raum (piv txwv li, cov neeg mob lub cev qhuav dej, cov neeg laus uas muaj mob lub raum tsis ua haujlwm) ua ke siv cov tshuaj angiotensin 2 receptor antagonists thiab tshuaj uas cuam tshuam rau COX-2 tuaj yeem ua rau muaj kev tsis zoo ntawm lub raum ua haujlwm ntxiv, suav nrog kev txhim kho ntawm lub raum tsis ua haujlwm. tatochnosti, uas yog feem ntau yog reversible. Yog li, kev siv tshuaj sib xyaw ua ke yuav tsum ua nrog ceev faj, tshwj xeeb tshaj yog nyob rau cov neeg laus laus. Yuav tsum ua kom ntseeg tau cov kua dej txaus, ntxiv rau, thaum pib ntawm kev sib koom tes thiab tsis tseg nyob rau yav tom ntej, cov ntsuas kev ua haujlwm lub raum yuav tsum raug saib xyuas.

Diuretics (thiazide lossis ntxees)

Cov kev kho mob ua ntej nrog cov koob tshuaj diuretics, xws li furosemide (ib qho "voj" diuretic) thiab hydrochlorothiazide (thiazide diuretic), tuaj yeem ua rau hypovolemia thiab qhov kev pheej hmoo ntawm hypotension thaum pib kho mob telmisartan.

Lwm cov tshuaj tiv thaiv antihypertensive

Cov nyhuv ntawm Telzap tuaj yeem ua kom zoo dua los ntawm kev siv ua ke ntawm lwm cov tshuaj tiv thaiv kabmob ntshav siab.

Raws li cov tshuaj pharmacological ntawm baclofen thiab amifostine, nws tuaj yeem xav tias lawv yuav txhim kho cov kev ua kom zoo ntawm txhua yam tshuaj tiv thaiv kab mob, nrog rau telmisartan. Ntxiv rau, orthostatic hypotension tuaj yeem ua kom hnyav ntxiv los ntawm kev siv cov cawv cawv (haus cawv), barbiturates, tshuaj yeeb tshuaj lossis tshuaj tiv thaiv kab mob.

Corticosteroids (rau kev siv tshuaj muaj yees)

Corticosteroids ua kom cov nyhuv ntawm telmisartan tsis muaj zog.

Cov tshuaj ntawm cov tshuaj Telzap

Cov qauv ntawm cov qauv ua haujlwm:

Mikardis,
Mikardis Ntxiv,
Tshuab luam ntawv
Tanidol
Cov no,
Telzap Ntxiv,
Telmisartan
Telmista
Telpres
Telpres Ntxiv,
Telsartan
Telsartan N.

Cov tshuaj tiv thaiv hauv cov pab pawg tshuaj (angiotensin 2 receptor antagonists):

Aprovask,
Aprovel
Artinova,
Atacand
Blocktran
Brozaar
Vasotens,
Valz
Valz N,
Valsartan
Valsacor
Vamloset
Gizaar
Hyposart,
Diovan
Duopress,
Zisakar
Ibertan
Irbesartan
Irsar
Tus Cwj Pwm,
Candesartan
Cardomin
Cardos,
Cardosal
Cardosten
Karzartan
Co-Exforge,
Coaprovel
Cozaar
Xarten
Lozap,
Lozap Ntxiv,
Lozarel
Losartan
Losartan n
Lorista
Losacor
Mikardis,
Naviten
Nortian
Olimestra
Hloov
Tshuab luam ntawv
Tubkawm Presartan
Los Tsuas
Sartavel
Tanidol
Tareg
Tweensta
Teveten
Telmisartan
Telpres
Telsartan
Khov Siab
Edarby
Tshuas
Exfotans,
Eprosartan Mesylate.

Nosological kev faib tawm (ICD-10)

Zaj duab xis-coated ntsiav tshuaj	1 tab.
cov tshuaj nquag:
telmisartan	40/80 mg
tus zam: meglumine - 12/24 mg, sorbitol - 162,2 / 324,4 mg, sodium hydroxide - 3.4 / 6.8 mg, povidone 25 - 20/40 mg, magnesium stearate - 2.4 / 4.8 mg

Cov Tshuaj Hauv Tshuaj

Telmisartan yog kev qhia tshwj xeeb ntawm ARA II (AT subtype₁), siv tau thaum noj ntawm qhov ncauj. Telmisartan muaj kev cuam tshuam zoo heev rau AT₁-txoj kev txais mus uas qhov kev txiav txim ntawm angiotensin II yog pom tau hais. Nws tshem tawm cov kabmob angiotensin II los ntawm txoj kev sib cog lus nrog cov receptor, tsis yog muaj kev txiav txim ntawm agonist hauv kev sib raug zoo nrog cov khoom no. Telmisartan khi nkaus xwb rau qhov AT subtype₁receptors ntawm angiotensin II. Kev sib txuas lus yog kev ruaj khov. Telmisartan tsis muaj kev sib nyiam rau lwm tus txais, incl. AT₂receptors thiab lwm qhov tsis tshua kawm txog angiotensin receptors. Lub luag haujlwm tseem ceeb ntawm cov receptors, nrog rau cov txiaj ntsig ntawm lawv qhov kev xav tau dhau los nrog angiotensin II, qhov kev tsub zuj zus uas nce nrog kev teem sijhawm ntawm telmisartan, tsis tau kawm. Telmisartan txo qis kev mloog zoo ntawm aldosterone hauv cov ntshav ntshav, tsis txo cov haujlwm ntawm renin, thiab tsis thaiv cov ion ion. Telmisartan tsis inhibit ACE (kininase II), uas kuj catalyzes rhuav tshem bradykinin. Qhov no zam txoj kev phiv cuam tshuam nrog kev ua ntawm bradykinin (piv txwv li, hnoos qhuav).

Qhov tseem ceeb tawg. Hauv cov neeg mob, telmisartan ntawm ib koob ntawm 80 mg ua rau tag nrho cov kev cuam tshuam ntawm kev mob siab ntawm angiotensin II. Qhov pib ntawm kev tawm tsam qhov kev tiv thaiv tau sau tseg tsis pub dhau 3 teev tom qab thawj thawj coj ntawm telmisartan. Cov nyhuv ntawm cov tshuaj no kav rau 24 teev thiab tseem qhov chaw kuaj mob tseem ceeb kom txog 48 teev. Tshaj tawm qhov teebmeem antihypertensive feem ntau pib 4-8 lub lis piam tom qab siv tas.

Hauv cov neeg mob mob ntshav lub plawv, telmisartan txo cov ntshav siab thiab txiv tsis muaj teebmeem rau lub plawv dhia.

Thaum tsis muaj xov tooj ntawm telmisartan, qhov ntshav siab dhau ob peb hnub maj mam rov qab los rau nws qib tseem tsis muaj kev txhim kho ntawm kev tshem tawm cov tsos mob.

Kev tiv thaiv cov kab mob plawv. Cov neeg mob hnub nyoog 55 xyoos thiab laus dua nrog mob hlab ntsha txhaws, mob stroke, hloov ischemic nres, peripheral txog hlab ntsha puas tsuaj, lossis mob ntawm hom 2 mob ntshav qab zib mellitus (piv txwv li retinopathy, sab laug ventricular hypertrophy, macro- lossis microalbuminuria) muaj keeb kwm mob plawv, telmisartan muaj cov txiaj ntsig zoo ib yam li ramipril hauv kev txo cov kev sib txuam ua ke: kev mob plawv tuag, tsis muaj mob ntshav tuag myocardial infarction, tsis mob ntshav siab thiab kev nyob rau hauv kev twb kev txuas nrog CHF.

Telmisartan tau ua haujlwm zoo li ramipril hauv kev txo cov zaus ntawm cov ntsiab lus thib ob: kev mob plawv tuag, tsis muaj mob ntshav tuag ntau, lossis mob tsis tuag. Cov hnoos qhuav thiab mob caj dab tsis tshua tau piav qhia feem ntau nrog telmisartan piv nrog ramipril, thaum arterial hypotension feem ntau tshwm sim nrog telmisartan.

Cov neeg mob ntawm cov menyuam yaus thiab thaum tiav hluas. Cov kev nyab xeeb thiab ua haujlwm ntawm telmisartan hauv cov menyuam yaus thiab cov tub ntxhais hluas hnub nyoog qis dua 18 xyoo tsis tau teeb tsa.

Cov Tshuaj Pharmacokinetics

Xuas. Thaum muab tshuaj, telmisartan nrawm nrawm los ntawm lub plab zom mov. Bioavailability yog 50%. Thaum noj ib txhij nrog cov zaub mov, qhov txo qis hauv AUC yog li ntawm 6% (ntawm koob 40 mg) txog 19% (ntawm ib koob ntawm 160 mg). Tom qab 3 teev tom qab kev coj noj coj ua, kev saib xyuas hauv cov ntshav plasma yog leveled tsis hais tias telmisartan tau noj tib lub sijhawm cov zaub mov lossis tsis. Muaj qhov sib txawv ntawm ntshav ntau nyob rau hauv cov txiv neej thiab poj niam. C_max thiab AUC tau kwv yees li ntawm 3 thiab 2 npaug feem ntau hauv cov poj niam piv nrog cov txiv neej uas tsis muaj qhov cuam tshuam ntawm kev ua tau zoo.

Tsis muaj txoj kab sib txuas ntawm qhov tshuaj ntawm cov tshuaj thiab nws cov plasma concentration. C_max thiab, rau qhov tsawg dua, AUC nce ntau ntawm cov koob tshuaj ntau ntxiv thaum siv koob tshuaj ntau dua 40 mg / hnub.

Kev xa Khoom. Telmisartan muaj zog khi rau cov ntshav plasma nqaij (> 99.5%), mas nrog albumin thiab alpha₁-acid glycoprotein.

Thaj V_ss yog kwv yees li 500 litres.

Kev zom zaub mov. Nws yog metabolized los ntawm kev sib txuas nrog glucuronic acid.

Lub conjugate tsis muaj pharmacological kev ua si.

Chaw Sau Ntawv. T_1/2 yog ntau tshaj 20 teev.Nws tau tawm los ntawm txoj hnyuv tsis hloov, nthuav tawm los ntawm lub raum - tsawg dua 1%. Tag nrho cov ntshav hauv lub plasma yog qhov siab (txog 1000 ml / min) piv nrog hepatic ntshav txaus (li 1500 ml / min).

Cov neeg mob tshwj xeeb

Laus lub caij nyoog. Tus kws tshuaj ntawm telmisartan hauv cov neeg mob uas muaj hnub nyoog 65 xyoos tsis txawv dua li cov neeg mob hluas. Koob tshuaj yuav tsis haum.

Lub raum khiav tsis zoo. Hauv cov neeg mob uas muaj me me mus rau lub raum lub raum lub raum kev ua haujlwm, kev kho tshuaj telmisartan tsis tas yuav tsum ua.

Cov neeg mob uas mob raum tsis zoo thiab cov neeg mob hemodialysis raug pom zoo kom txhaj qis dua 20 mg / hnub (saib "Cov Lus Qhia Tshwj Xeeb"). Telmisartan tsis raug ntiab tawm los ntawm hemodialysis.

Lub siab ua haujlwm tsis zoo. Hauv cov neeg mob uas muaj me me mus txog qib qog ua lub siab ua haujlwm (chav A thiab B raws li kev faib menyuam yaus-Pugh), koob tshuaj txhua hnub yuav tsum tsis pub tshaj 40 mg.

Dosage daim ntawv

Ib ntsiav tshuaj muaj

yam tshuaj: telmisartan 40,000 lossis 80,000 mg, feem,

hydrochlorothiazide 12.500 mg lossis 25.000 mg, feem,

tus zam: sorbitol, sodium hydroxide, povidone 25, magnesium stearate

Lub sijhawm ntev dua cov ntsiav tshuaj nrog lub ntsej muag biconvex los ntawm dawb mus rau xim daj, nrog tus lej extruded "41" ntawm ib sab ntawm lub ntsiav tshuaj, txog 12 hli ntev thiab txog 6 hli dav (rau qhov ntau npaum 40 mg / 12.5 mg).

Cov ntsiav tshuaj zoo li ntev ntev nrog lub ntsej muag biconvex los ntawm dawb mus rau xim daj, nrog tus lej extruded “81” ntawm ib sab ntawm lub ntsiav tshuaj, ntev txog 16.5 hli ntev, txog 8.3 mm dav (rau qhov ntau npaum ntawm 80 mg / 12.5 mg).

Cov ntsiav tshuaj zoo li ntev ntev nrog lub ntsej muag biconvex los ntawm dawb mus rau xim daj, nrog tus lej extruded “82” ntawm ib sab ntawm lub ntsiav tshuaj, ntev txog 16 hli ntev, txog 8 hli dav (rau qhov ntau npaum ntawm 80 mg / 25 mg).

Cov Lus Qhia Telzap ®

kev txo qis kev tuag thiab kev mob plawv hauv cov neeg mob cov neeg laus:

- nrog cov kab mob plawv ntawm atherothrombotic keeb kwm (mob plawv, mob hlab ntsha hlwb los yog keeb kwm ntawm cov hlab ntsha txhaws),

- nrog hom 2 mob ntshav qab zib mellitus nrog phiaj hloov khoom nruab nrog.

Cov Yuav Tsum Muaj

hypersensitivity rau cov nquag yam tshuaj los yog ib tug tshaj lij ntawm cov tshuaj,

cev xeeb tub thiab lactation,

obstructive biliary huam kab mob,

mob siab rau daim siab tsis ua haujlwm (Menyuam-Pugh chav C),

ua ke siv nrog aliskiren hauv cov neeg mob ntshav qab zib mellitus lossis mob raum tsis zoo (GFR tsawg dua 60 ml / min / 1,73 m 2) (saib "Kev Sib Tham" thiab "Cov Lus Qhia Tshwj Xeeb"),

cov kab mob fructose tsis haum (vim muaj sorbitol hauv ntsiav tshuaj),

siv tib txhij nrog ACE inhibitors hauv cov neeg mob ntshav qab zib nephropathy (saib "Kev Sib Tham" thiab "Cov lus qhia tshwj xeeb"),

hnub nyoog txog 18 xyoo (qhov ua tau zoo thiab kev nyab xeeb tsis tau tsim).

Nrog saib xyuas: Ob leeg lub raum artery stenosis los yog txoj hlab ntsha tsis zoo ntawm ib lub raum ua haujlwm, lub raum tsis zoo, mob me me mus rau lub cev tsis muaj zog, txo qis BCC piv nrog kev noj cov tshuaj diuretics yav dhau los, kev txwv kev noj ntawm sodium chloride, raws plab lossis ntuav, hyponatremia, hyperkalemia, mob tom qab lub raum hloov ntshav (kev ua haujlwm dhau los tsis tuaj), mob ua rau lub plawv tsis ua haujlwm tsis txaus, aortic thiab mitral valve stenosis, hypertrophic obstructive cardiomyopathy, thawj hyperaldosta onizm (miv nyuas siv zug thiab kev nyab xeeb tsis tau tsim), kev kho mob ntawm dub neeg mob.

Cev xeeb tub thiab lactation

Yog tias kev kho mob mus ntev nrog Telzap ® yog qhov tsim nyog, cov neeg mob npaj lub cev xeeb tub yuav tsum xaiv lwm cov tshuaj tiv thaiv kev tiv thaiv mob nrog kev tiv thaiv kev nyab xeeb rau kev siv thaum cev xeeb tub. Tom qab tsim qhov tseeb ntawm cev xeeb tub, kev kho mob nrog Telzap ® yuav tsum nres tam sim ntawd thiab, yog tias tsim nyog, kev kho mob lwm yam yuav tsum tau pib.

Raws li pom los ntawm cov kev soj ntsuam hauv kev soj ntsuam, kev siv tshuaj ARA II hauv II thiab III trimesters cev xeeb tub muaj lub cev tsis zoo rau lub plab (mob raum tsis ua haujlwm, oligohydramnios, ncua ossification ntawm pob txha taub hau) thiab cov menyuam yug tshiab (lub raum tsis ua haujlwm, ntshav tawm ntshav thiab hyperkalemia). Thaum siv tshuaj ARA II nyob rau lub sijhawm peb lub hlis thib ob ntawm cev xeeb tub, ultrasound ntawm lub raum thiab pob txha taub hau ntawm tus me nyuam yog tau pom zoo.

Cov menyuam yaus uas lawv niam siv ARA II thaum cev xeeb tub yuav tsum ua tib zoo saib kom muaj ntshav tsis xwm yeem.

Cov ntaub ntawv hais txog kev siv telmisartan thaum pub mis niam tsis muaj. Noj Telzap ® thaum pub niam mis yog contraindicated (saib "Contraindications"), lwm txoj kev tiv thaiv tshuaj tiv thaiv nrog ntau qhov kev nyab xeeb tshaj plaws yuav tsum tau siv, tshwj xeeb tshaj yog thaum pub mis rau cov menyuam mos lossis cov menyuam yug ntxov.

Sab sij huam

Raws li WHO, cov teebmeem tsis xav tau raug faib raws li lawv qhov muaj ntawm kev loj hlob raws li hauv qab no: feem ntau (/1 / 10), feem ntau (txij li ≥1 / 100 txog rau suav txog kev tuag taus).

Ntawm ib feem ntawm cov ntshav thiab cov lymphatic system: ua tsis tau - mob ntshav liab, tsis tshua muaj - eosinophilia, thrombocytopenia.

Los ntawm lub nruab zog: tsis tshua muaj - tshuaj tiv thaiv anaphylactic, kev ua haujlwm tsis txaus ntseeg.

Los ntawm sab ntawm cov metabolism thiab khoom noj khoom haus: tsis ncau - hyperkalemia, tsis tshua muaj - hypoglycemia (hauv cov neeg mob ntshav qab zib mellitus).

Los ntawm ib sab ntawm lub psyche: ncaw - insomnia, kev nyuaj siab, tsis tshua muaj - ntxhov siab vim.

Los ntawm lub paj hlwb: pheej - fainting, tsis tshua muaj - nkees.

Los ntawm ob sab ntawm cov khoom hauv nruab nrog tsis tshua pom: pom kev tsis sib to taub.

Ntawm ib feem ntawm cov hnov lus thiab cov labyrinth cuam tshuam: ncaw - vertigo.

Ntawm lub plawv: nkag tsis tau - bradycardia, tsis tshua muaj - tachycardia.

Los ntawm cov hlab ntsha: tsis ncau - ua cim txo nyob rau hauv cov ntshav siab, orthostatic hypotension.

Los ntawm lub tshuab ua pa, hauv siab thiab mediastinal kabmob: ua tsis tau - ua tsis taus pa, hnoos, tsis tshua muaj - kab mob ntsws interstitial.

Los ntawm cov hnyuv: ua tsis tau yooj yim - mob plab, raws plab, dyspepsia, flatulence, ntuav, tsis tshua - lub qhov ncauj qhuav, tsis xis nyob hauv plab, ua txhaum ntawm saj hnov.

Nyob rau ib feem ntawm daim siab thiab kais plab: tsis tshua muaj - poob siab ntawm daim siab ua haujlwm / daim siab puas.

Ntawm ib feem ntawm daim tawv nqaij thiab cov nqaij mos subcutaneous: tsis ncau - khaus daim tawv, hyperhidrosis, tawm pob, tsis tshua muaj - angioedema (tseem ua rau neeg tuag taus), eczema, erythema, urticaria, tshuaj pob tawv nqaij, ua pob tawv nqaij lom.

Los ntawm cov leeg musculoskeletal thiab cov leeg mob: tsis xws luag - mob nraub qaum (sciatica), mob leeg nqaij, myalgia, tsis tshua muaj - mob caj dab, mob nqaj, mob leeg (leeg ntshav-zoo li syndrome).

Los ntawm ob lub raum thiab mob txeeb zig: tsis xws luag - qias neeg raum tsis ua haujlwm, suav nrog mob raum tsis ua haujlwm.

Kev cuam tshuam dav dav thiab cuam tshuam ntawm qhov chaw txhaj tshuaj: tsis nkag siab - mob hauv siab, asthenia (tsis muaj zog), tsis tshua muaj - xws li mob khaub thuas.

Cuam tshuam rau cov txiaj ntsig ntawm kev tshawb nrhiav thiab twj: ua tsis tau - kev nce siab ntawm kev tsim ntawm creatinine hauv ntshav ntshav, tsis tshua muaj - txo qis hauv cov ntsiab lus ntawm Hb, kev nce hauv cov ntsiab lus ntawm uric acid hauv cov ntshav ntshav, kev nce siab hauv kev ua haujlwm ntawm daim siab enzymes thiab CPK.

Kev sib txuam

Ob chav thaiv ntawm RAAS. Kev siv cov tshuaj telmisartan nrog aliskiren yog qhov ua rau cov neeg mob ntshav qab zib mellitus lossis lub raum tsis ua haujlwm (GFR tsawg dua 60 ml / min / 1.73 m 2) thiab tsis pom zoo rau lwm cov neeg mob.

Siv tib lub koob tshuaj ntawm telmisartan thiab ACE inhibitors yog qhov tsis sib haum xeeb hauv cov neeg mob uas mob ntshav qab zib nephropathy (saib "Contraindications").

Cov kev tshawb fawb soj ntsuam tau pom tias ob zaug thaiv ntawm RAAS vim kev siv tshuaj los ntawm ACE inhibitors, ARA II, lossis aliskiren yog cuam tshuam nrog kev muaj mob tshwm sim ntau ntxiv xws li arterial hypotension, hyperkalemia, thiab lub raum tsis zoo (suav nrog kev mob raum tsis ua haujlwm), piv nrog kev siv ntawm ib qho tshuaj xwb Ua yeeb yam rau RAAS.

Txoj kev pheej hmoo ntawm kev mob hyperkalemia yuav nce ntxiv thaum siv ua ke nrog lwm cov tshuaj uas tuaj yeem ua rau hyperkalemia (cov poov tshuaj muaj cov khoom noj ntxiv thiab ntsev hloov pauv muaj cov poov tshuaj, potassium-sparing diuretics (piv txwv li spironolactone, eplerenone, triamterene lossis amiloride), NSAIDs, suav nrog xaiv COX-2 inhibitors, hepari , immunosuppressants (cyclosporine lossis tacrolimus) thiab trimethoprim.Yog hais tias tsim nyog, tawm tsam keeb kwm yav dhau los ntawm cov ntaub ntawv hypokalemia, kev siv tshuaj ua ke yuav tsum tau nqa tawm yuav tsum ceev faj thiab soj ntsuam cov ntsiab lus ntawm potassium nyob hauv ntshav ntshav.

Digoxin. Nrog kev tswj hwm ntawm telmisartan nrog digoxin, qhov nruab nrab nce hauv C tau sau tseg_max ntshav digoxin ntawm 49% thiab C_min los ntawm 20%. Thaum pib ntawm kev kho mob, thaum xaiv cov koob tshuaj thiab txiav tawm kev kho mob nrog telmisartan, cov concentration ntawm digoxin hauv cov ntshav plasma yuav tsum tau ua tib zoo saib xyuas kom nws nyob hauv qhov kev kho mob kom ntau.

Poov tshuaj-sparing diuretics los yog poov tshuaj uas muaj cov tshuaj pab noj haus. ARA II, xws li telmisartan, txo cov poob poov tshuaj los ntawm lub diuretic. Potassium-sparing diuretics, piv txwv li spironolactone, eplerenone, triamteren lossis amiloride, cov tshuaj ntxiv potassium los yog cov zaub mov hloov ntsev tuaj yeem ua rau nce siab ntxiv hauv potassium hauv cov ntshav ntshav. Yog tias kev pom zoo siv tau qhia tau, txij li muaj cov ntaub ntawv sau tseg hypokalemia, lawv yuav tsum siv nrog kev ceev faj thiab tiv thaiv keeb kwm ntawm kev saib xyuas cov poov tshuaj tsis tu ncua hauv cov ntshav ntshav.

Kev npaj lithium. Thaum cov roj ntsha lithium tau noj ua ke nrog ACE thiab ARA II inhibitors, suav nrog telmisartan, qhov thim rov nce ntxiv hauv plasma cov ntau ntawm lithium thiab nws cov kev ua kom muaj kuab lom. Yog tias koj xav siv cov tshuaj sib xyaw no, nws raug nquahu kom koj ua tib zoo saib xyuas cov kua roj lithium hauv cov ntshav ntshav.

NSAIDs. NSAIDs (i.e., acetylsalicylic acid hauv koob tshuaj siv rau kev kho mob tiv thaiv kab mob, COX-2 inhibitors thiab tsis xaiv tshuaj NSAIDs) tuaj yeem ua kom tsis muaj zog tiv thaiv kev tiv thaiv ntawm ARA II. Hauv qee tus neeg mob uas lub raum tsis zoo (piv txwv, lub cev qhuav dej, cov neeg laus uas lub raum tsis ua haujlwm), kev siv tshuaj tiv thaiv ntawm ARA II thiab tshuaj uas cuam tshuam COX-2 tuaj yeem ua rau muaj kev cuam tshuam ntawm lub raum ntxiv, nrog rau kev txhim kho ntawm lub raum tsis ua haujlwm, uas, raws li txoj cai, yog reversible. Yog li, kev siv tshuaj sib xyaw ua ke yuav tsum ua nrog ceev faj, tshwj xeeb tshaj yog nyob rau cov neeg laus laus. Nws yog ib qho tsim nyog kom ntseeg tau tias cov kua dej txaus, ntxiv rau, thaum pib sib koom tes thiab tsis tseg nyob rau yav tom ntej, cov ntsuas kev ua haujlwm lub raum yuav tsum raug saib xyuas.

Diuretics (thiazide lossis ntxig). Cov kev kho mob dhau los nrog cov koob tshuaj diuretics, xws li furosemide (loop diuretic) thiab hydrochlorothiazide (thiazide diuretic), tuaj yeem ua rau hypovolemia thiab muaj kev pheej hmoo ntawm hypotension thaum pib kho mob nrog telmisartan.

Lwm cov tshuaj tiv thaiv antihypertensive. Cov nyhuv ntawm telmisartan tuaj yeem txhim kho nrog kev siv ua ke ntawm lwm cov tshuaj tiv thaiv antihypertensive. Raws li cov tshuaj pharmacological ntawm baclofen thiab amifostine, nws tuaj yeem xav tias lawv yuav txhim kho cov kev ua kom zoo ntawm txhua yam tshuaj tiv thaiv kab mob, nrog rau telmisartan. Ntxiv rau, orthostatic hypotension yuav nce ntxiv nrog cawv, barbiturates, tshuaj, lossis antidepressants.

Corticosteroids (rau kev siv tshuaj muaj txiaj ntsig). Corticosteroids ua kom cov nyhuv ntawm telmisartan tsis muaj zog.

Tsuas tshuaj thiab tswj hwm

Sab hauv, ib hnub ib zaug, ntxuav tawm nrog kua, tsis hais txog ntawm cov khoom noj.

Arterial kub siab. Cov koob tshuaj pom zoo thawj zaug ntawm Telzap ® yog 1 ntsiav tshuaj. (40 mg) ib hnub ib zaug. Qee tus neeg mob yuav tau txais kev pab zoo txog 20 mg / hnub. Qhov koob tshuaj 20 mg tuaj yeem muab tau los ntawm kev faib 40 mg ntsiav tshuaj hauv ib nrab ntawm qhov pheej hmoo. Hauv qhov xwm txheej qhov kev kho mob tsis ua tiav, qhov koob tshuaj pom zoo ntawm Telzap ® tuaj yeem nce ntxiv mus txog 80 mg ib zaug ib hnub. Raws li lwm txoj kev xaiv, Telzap ® tuaj yeem coj los ua ke nrog thiazide diuretics, piv txwv li, hydrochlorothiazide, uas, thaum siv ua ke, muaj cov nyhuv antihypertensive ntxiv.

Thaum txiav txim siab tias yuav nce qhov ntau npaum li cas, nws yuav tsum raug coj mus rau hauv tus account tias qhov siab tshaj plaws antihypertensive feem ntau ua tiav tsis pub dhau 4-8 lub lis piam tom qab pib kho.

Txo cov neeg tuag thiab zaus ntawm cov kab mob plawv. Cov koob tshuaj pom zoo ntawm Telzap ® yog 80 mg ib hnub ib zaug. Hauv thawj lub sijhawm ntawm kev kho mob, kev pom zoo ntsuas ntshav siab; kev kho ntawm antihypertensive kev kho mob yuav tsum tau.

Cov neeg mob tshwj xeeb

Lub raum khiav tsis zoo. Cov kev paub nrog telmisartan hauv cov neeg mob uas mob raum tsis zoo los sis cov neeg mob ntawm cov mob hemodialysis muaj tsawg. Cov neeg mob no tau pom zoo kom txhaj tshuaj qis dua 20 mg / hnub (saib. "Kev khomob tshwj xeeb"). Rau cov neeg mob mentsis mus txog qib qis muaj lub raum khiav tsis zoo, tsis tas yuav hloov kho dua. Kev siv yooj yim ntawm Telzap ® nrog aliskiren yog contraindicated rau cov neeg mob raum tsis ua haujlwm (GFR tsawg dua 60 ml / min / 1,73 m 2) (saib. "Contraindications").

Kev siv tib lub sijhawm ntawm Telzap ® nrog ACE inhibitors yog contraindicated nyob rau hauv cov neeg mob uas mob nephropathy (saib "Contraindications").

Lub siab ua haujlwm tsis zoo. Telzap ® yog pom qhov tsis zoo rau cov neeg mob uas muaj mob tsis haum hnyav (Me-Pugh chav C) (saib "Contraindications"). Hauv cov neeg mob uas tsis tshua mob mus rau me ntsis hepatic tsis txaus (chav A thiab B raws li menyuam-Pugh kev faib tawm, feem), cov tshuaj tau raug txiav txim nrog ceev faj, qhov tshuaj yuav tsum tsis pub tshaj 40 mg ib hnub ib zaug (saib "Nrog ceev faj").

Laus lub caij nyoog. Rau cov neeg mob laus, tsis tas yuav hloov cov tshuaj.

Menyuam yaus thiab tub ntxhais hluas. Kev siv Telzap ® rau cov menyuam yaus thiab cov neeg hluas hnub nyoog qis dua 18 xyoo yog qhov tsis pom zoo vim tsis muaj cov ntaub ntawv kev nyab xeeb thiab ua tau zoo (saib "Contraindications").

Noj ntau dhau

Cov tsos mob Cov kev mob tshwm sim ntau tshaj plaws ntawm kev txhaj tshuaj tshaj yog qhov tshaj tawm ntawm cov ntshav siab thiab tachycardia, thiab bradycardia, kiv taub hau, qhov nce ntawm cov ntshav creatinine concentration thiab mob raum tsis ua haujlwm kuj tau qhia.

Kev Kho Mob: Telmisartan tsis raug ntiab tawm los ntawm hemodialysis. Cov neeg mob yuav tsum tau ua tib zoo saib xyuas thiab muaj tsos mob zoo li kev txhawb nqa kom zoo. Cov hau kev rau kev kho yog nyob ntawm lub sijhawm dhau los tom qab siv cov tshuaj, thiab qhov hnyav ntawm cov tsos mob. Cov kev ntsuas pom zoo suav nrog kev ntxias lub cev ntuav thiab / lossis lub plab zom zaub mov, thiab kev siv lub tshuab hluav ncaig hluav taws xob yog kev pom zoo. Plasma electrolytes thiab creatinine yuav tsum tau saib xyuas tsis tu ncua. Yog tias qhov cim tseg poob rau hauv cov ntshav siab tshwm sim, tus neeg mob yuav tsum tuav txoj haujlwm tav toj nrog sawv ceg nce, thaum nws yuav tsum tau ua sai sai ntawm qhov bcc thiab electrolytes.

Cov lus qhia tshwj xeeb

Lub siab ua haujlwm tsis zoo. Kev siv Telzap ® yog sib kis rau cov neeg mob cholestasis, kev cuam tshuam ntawm txoj hlab pas lossis mob siab rau lub siab ua haujlwm (Me-Pugh chav C) (saib "Contraindications"), txij li telmisartan tsuas yog raug tawm hauv cov kua tsib. Nws ntseeg tau hais tias nyob rau hauv cov neeg mob zoo li no, kab mob pob txha kho kabmob ntawm telmisartan yog txo qis. Hauv cov neeg mob mob siab me lossis hnyav daim siab tsis ua hauj lwm (chav A thiab B raws li kev faib tawm Me-Pugh), Telzap ® yuav tsum siv nrog ceev faj (saib Nrog saib xyuas).

Renovascular tawg. Hauv kev kho cov tshuaj ua yeeb yam rau RAAS hauv cov neeg mob uas muaj ob leeg lub raum mob ntshav siab los yog txoj hlab ntshav ntawm lub raum kev ua haujlwm ib lub raum, qhov kev pheej hmoo ntawm cov ntshav liab ntau heev thiab raum tsis ua haujlwm ntxiv.

Lub raum khiav tsis zoo thiab lub raum hloov. Thaum siv Telzap ® hauv cov neeg mob uas lub raum tsis ua haujlwm, kev saib xyuas lub sijhawm ntawm cov ntsiab lus ntawm cov poov tshuaj thiab creatinine hauv cov ntshav ntshav tau pom zoo. Tsis muaj kev sim kho mob nrog Telzap ® hauv cov neeg mob uas nyuam qhuav hloov raum.

Txo hauv BCC. Cov tsos mob ntawm txoj hlab ntshav liab, tshwj xeeb tshaj yog tom qab thawj zaug thawj coj ntawm Telzap ®, tej zaum yuav tshwm sim rau cov neeg mob uas tsis tshua muaj BCC thiab / lossis sodium hauv cov ntshav plasma tiv thaiv keeb kwm yav dhau los ntawm kev kho mob yav dhau los nrog diuretics, txwv tsis pub ntsev, raws plab lossis ntuav.

Cov mob no (kua thiab / los yog sodium tsis txaus) yuav tsum tau muab tshem tawm ua ntej noj Telzap ®.

Ob chav thaiv ntawm RAAS. Kev siv qhov tseeb ntawm telmisartan nrog aliskiren yog contraindicated rau cov neeg mob ntshav qab zib mellitus lossis lub raum tsis ua haujlwm (GFR tsawg dua 60 ml / min / 1.73 m 2) (saib. "Contraindications").

Siv tib lub koob tshuaj ntawm telmisartan thiab ACE inhibitors yog qhov tsis sib haum xeeb hauv cov neeg mob uas mob ntshav qab zib nephropathy (saib "Contraindications").

Raws li kev txiav txim siab ntawm RAAS, kev mob ntshav hauv lub cev, tsaus muag, mob hyperkalemia, thiab lub raum tsis ua haujlwm (suav nrog mob raum tsis ua haujlwm) tau sau tseg hauv cov neeg mob predisposed rau qhov no, tshwj xeeb tshaj yog thaum ua ke nrog ntau cov tshuaj uas tseem ua rau cov kab ke no. Yog li no, txwv tsis pub muab RAAS ob zaug (piv txwv, thaum noj telmisartan nrog lwm tus RAAS cov thaiv kev ua haujlwm) tsis pom zoo.

Thaum muaj kev vam khom rau lub suab vascular thiab lub raum kev ua haujlwm feem ntau ntawm RAAS kev ua si (piv txwv li, hauv cov neeg mob uas lub plawv tsis ua haujlwm lossis lub raum mob, suav nrog lub raum leeg mob stenosis los yog mob qog ntawm lub raum tib leeg), kev tswj hwm ntawm cov tshuaj uas cuam tshuam rau cov kab mob no yuav nrog kev loj hlob ntawm tus mob zoo. arterial hypotension, hyperazotemia, oliguria thiab tsis tshua muaj mob, mob raum tsis ua haujlwm.

Thawj Hyperaldosteronism. Hauv cov neeg mob uas muaj hyperaldosteronism thawj zaug, kho nrog cov tshuaj tiv thaiv kabmob, qhov tshwm sim ntawm kev ua tiav los ntawm inhibiting RAAS, feem ntau tsis ua haujlwm. Hauv qhov no, kev siv tshuaj Tezap ® tsis pom zoo.

Stenosis ntawm aortic thiab mitral li qub, hypertrophic obstructive cardiomyopathy. Ib yam li lwm cov vasodilators, cov neeg mob aortic lossis mitral stenosis, as Well as hypertrophic obstructive cardiomyopathy, yuav tsum tau ceev faj tshwj xeeb thaum siv Telzap ®.

Cov neeg mob ntshav qab zib uas tau txais cov tshuaj insulin lossis hypoglycemic rau kev tswj hwm qhov ncauj. Tawm tsam keeb kwm ntawm kev kho mob nrog Telzap ®, cov neeg mob no tuaj yeem ntsib kev mob ntshav qab zib. Hauv cov neeg mob zoo li no, glycemic tswj yuav tsum ua kom muaj zog, li tej zaum yuav xav tau koob tshuaj insulin lossis tus neeg sawv cev hypoglycemic.

Hyperkalemia Txais tos ntawm cov tshuaj yeeb yam rau ntawm RAAS tuaj yeem ua rau hyperkalemia. Hauv cov neeg mob laus, cov neeg mob raum tsis ua haujlwm lossis ntshav qab zib mellitus, cov neeg mob noj tshuaj uas tseem nce plasma ntau dua, thiab / lossis cov neeg mob uas muaj kabmob sib kis, hyperkalemia tuaj yeem ua rau neeg tuag taus.

Thaum txiav txim siab qhov tsis txaus ntseeg ntawm kev siv yeeb tshuaj uas ua yeeb yam ntawm RAAS, nws yog qhov tsim nyog los ntsuas qhov kev pheej hmoo-txiaj ntsig. Cov kev pheej hmoo tseem ceeb rau hyperkalemia uas yuav tsum tau txiav txim siab yog:

- mob ntshav qab zib mellitus, lub raum tsis ua haujlwm, hnub nyoog (cov neeg mob laus dua 70 xyoo),

- kev sib xyaw nrog ib los yog ntau cov tshuaj ua yeeb yam ntawm RAAS, thiab / los yog cov tshuaj noj muaj yees ntxiv. Tshuaj los yog kev kho mob chav kawm ntawm cov tshuaj uas tuaj yeem ua rau hyperkalemia yog ntsev hloov pauv muaj cov poov tshuaj, potassium-sparing diuretics, ACE inhibitors, ARA II, NSAIDs, suav nrog xaiv COX-2 inhibitors, heparin, immunosuppressants (cyclosporin lossis tacrolimus) thiab trimethoprim,

- mob / kis cuam tshuam, tshwj xeeb yog lub cev qhuav dej, lub plawv tsis ua haujlwm, metabolic acidosis, lub raum khiav tsis zoo, cytolysis syndrome (piv txwv, mob caj dab ntev ischemia, rhabdomyolysis, mob hnyav heev).

Cov neeg mob uas pheej hmoo pom zoo kom ua tib zoo saib xyuas cov ntsiab lus ntawm potassium nyob hauv ntshav ntshav (saib "Kev sib cuam tshuam").

Sorbitol. Cov tshuaj no muaj sorbitol (E420). Cov neeg mob uas tsis tshua muaj kab mob siab tsis haum fructose yuav tsum tsis txhob noj Telzap ®.

Haiv neeg sib txawv. Raws li tau sau tseg rau ACE inhibitors, telmisartan thiab lwm yam ARA II zoo li txo qis ntshav siab tsis muaj txiaj ntsig zoo rau cov neeg mob ntawm cov haiv neeg Negroid dua li cov neeg sawv cev ntawm lwm haiv neeg, tej zaum vim muaj kev cuam tshuam ntau dua rau txo qis kev ua si hauv cov neeg ntawm cov neeg mob no.

Txawv. Ib yam li lwm cov tshuaj tiv thaiv kabmob ntshav, kev txo ntshav siab rau hauv cov neeg mob ischemic cardiomyopathy lossis CHD tuaj yeem ua rau muaj kev txhim kho myocardial infarction lossis mob stroke.

Cuam tshuam rau kev muaj peev xwm tsav tsheb, tshuab. Kev tshawb nrhiav tshwj xeeb los kawm txog kev cuam tshuam ntawm cov tshuaj ntawm kev muaj peev xwm tsav lub tsheb thiab cov tshuab tseem tsis tau ua. Thaum tsav tsheb thiab ua haujlwm nrog cov txheej txheem uas yuav tsum muaj kev saib xyuas ntau ntxiv, kev saib xyuas yuav tsum ua, vim yog kiv tob hau thiab tsaug zog yuav tsis pom tshwm sim thaum noj Telzap ®.

Chaw tsim tshuaj paus

Zentiva Saalyk Yurunleri Sanayi ve Tijaret A.Sh., Qaib ntxhw.

Koog Tsev Kawm Kucukkaryshtyran, st. Merkez, No. 223 / A, 39780, Buyukkaryshtyran, Luleburgaz, Kırklareli, Qaib Cov Txwv.

Tuav nrog daim ntawv pov thawj rau npe. Sanofi Russia JSC. 125009, Russia, Moscow, ul. Tverskaya, 22.

Kev thov rau qhov zoo ntawm cov tshuaj yuav tsum raug xa mus rau qhov chaw nyob ntawm Sanofi Russia JSC: 125009, Russia, Moscow, ul. Tverskaya, 22.

Xov Tooj: (495) 721-14-00, fev: (495) 721-14-11.

Tso tawm daim ntawv thiab muaj pes tsawg leeg

Telzap muaj nyob rau hauv daim ntawv ntawm cov ntsiav tshuaj coated nrog ib zaj duab xis txheej ntawm 40 mg thiab 80 mg. 10 daim raug muag hauv cov hlwv, hauv pob ntawv cardboard muaj 3, 6 lossis 9 hlwv thiab cov lus qhia rau kev siv Telzap.

1 ntsiav tshuaj muaj cov tshuaj nquag: telmisartan - 40 mg lossis 80 mg thiab ntu sib xyaw: povidone 25, meglumine, sodium hydroxide, sorbitol, magnesium stearate.

Tseem tsim cov ntsiav tshuaj Telzap Ntxiv 80 mg + 12.5 mg, muaj 80 mg ntawm telmisartan thiab 12.5 mg ntawm hydrochlorothiazide - ib lub diuretic.

Pharmacological kev txiav txim

Cov tshuaj lom neeg telmisartan muaj cov khoom tshwj xeeb ntawm angiotensin II receptor antagonists. Thaum noj, cov tshuaj yeeb yaj kiab tuaj yeem tshem cov tshuaj angiotensin II los ntawm nws cov kev sib txuas nrog cov receptor. Ntxiv mus, nyob rau hauv kev sib raug zoo nrog no receptor, nws tsis yog agonist. Telmisartan tsuas cuam tshuam nrog cov tshuaj mob angiotensin II ATl. Cov tshuaj yeeb dej caw tsis ua kom pom cov khoom zoo ib yam li AT2 receptor thiab qee yam.

Hauv qab ntawm cov tshuaj nyob rau hauv cov ntshav ntshav, cov ntsiab lus ntawm aldosterone poob tsawg. Tib lub sijhawm, cov kev ua si renin tseem nyob rau tib theem thiab raws li ion channel tsis thaiv.

Angiotensin-hloov pauv enzyme uas catalyzes qhov kev puas tsuaj ntawm bradykinin tsis yog inhibited. Cov yeeb yam no tso cai rau koj kom tshem tawm qhov kev pheej hmoo ntawm kev tsim cov kev mob tshwm sim xws li hnoos qhuav.

Thaum siv ntau npaum ntawm 80 mg rau hauv cov neeg mob, qhov kub siab ua haujlwm ntawm angiotensin II txhaws. Cov nyhuv tau tiav 3 teev tom qab thawj koob. Qhov kev txiav txim kav rau 24 teev. Nws suav hais tias yog kev siv tshuaj zoo rau 48 teev. Kev nquag noj cov ntsiav tshuaj rau 4-8 lub lis piam ua rau muaj txiaj ntsig antihypertensive.

Kev siv Telzap hauv cov neeg mob ntshav siab tuaj yeem txo qis cov ntshav diastolic thiab systolic. Lub caij no, lub plawv hloov tsis hloov.

Cov tshuaj yog siv los kho cov kab mob plawv. Hauv cov neeg mob laus uas muaj cov kab mob ntawm cov hlab plawv cov ntshav, cov ntsiav tshuaj tau muaj cov nyhuv tsawg zuj zus:

tus mob stroke
myocardial infarction
kev ploj tuag vim yog kab mob plawv.

Kev ntsuas rau siv

Dab tsi pab Telzap? Cov cim tseem ceeb rau kev siv cov ntsiav tshuaj:

IHD rau cov neeg mob hnub nyoog tshaj 55 xyoos.
Kev tiv thaiv kab mob ntawm cov kab mob plawv.
Kev tiv thaiv kev ploj tuag vim kev mob plawv hauv cov neeg mob uas muaj kev pheej hmoo (rau kev tiv thaiv lub plawv nres, mob hlab ntsha tawg, plawv tsis ua hauj lwm nrog rau cov neeg tuag taus).
Kev tiv thaiv ntawm cov teeb meem los ntawm lub siab thiab cov hlab ntsha hauv hom 2 ntshav qab zib.
Yuav tsum muaj ntshav siab - siab dua 140/90 rau qhov tseem ceeb thiab qee yam tsos mob siab ntsig.
Raws li ib feem ntawm cov kev kho mob nyuaj tom qab mob stroke lossis ischemic nres.

Arterial tawg

Kev siv yooj yim ntawm Telzap nrog aliskiren yog contraindicated rau cov neeg mob raum tsis ua haujlwm (GFR tsawg dua 60 ml / min / 1.73 m2 ntawm lub cev nqaij daim tawv hauv cheeb tsam).

Kev siv tib lub sijhawm ntawm Telzap nrog ACE inhibitors yog contraindicated rau cov neeg mob uas mob ntshav qab zib.

Hauv cov neeg laus cov neeg mob, tsis tas yuav txhaj tshuaj.

Telzap Ntxiv

Siv ncauj, ib hnub ib zaug, ntxuav nrog kua, tsis hais noj mov dabtsi.

Cov neeg mob uas nws lub BP tsis tuaj yeem tswj hwm tau zoo nrog kev kho mob monotherapy nrog telmisartan lossis hydrochlorothiazide yuav tsum siv Telzap Plus.

Ua ntej hloov mus rau qhov sib xyaw-koob tshuaj sib txuam, pom zoo koob tshuaj ib feem ntawm ib qho twg. Hauv qee qhov xwm txheej hauv tsev kho mob, kev hloov ncaj qha los ntawm monotherapy mus rau kev kho mob nrog kev sib txuam nrog koob tshuaj yuav suav tau.

Nyeem kuj cov ntawv no: ntawm dab tsi lub siab kom haus Corinfar: cov lus qhia, nqe thiab tshuaj xyuas

Cov tshuaj Telzap Plus, tuaj yeem siv ib hnub ib zaug rau cov neeg mob uas tsis tuaj yeem tswj ntshav siab thaum noj telmisartan ntawm koob ntawm 80 mg rau ib hnub.

Sab sij huam

Hauv qee cov neeg mob, noj Telzap tuaj yeem ua rau pom kev tshwm sim ntawm kev phiv.

Dyspnea thiab hnoos tsawg zaus. Tsis tshua muaj, kev mob ntsws los ntawm lub cev tshwm sim.
Qee cov neeg mob yws ntawm insomnia, kev nyuaj siab, ntxhov siab ntxiv. Nyob rau hauv tsawg zaus, muaj tsaus muag.
Rau cov poj niam, cov kab mob ua mob ntawm kev yug me nyuam tuaj yeem tshwm sim, qee qhov tsis tshua muaj tshwm sim, pom muaj kev coj khaub ncaws tsis coj khaub ncaws. Hauv cov txiv neej, ua kom tiav erectile kuj ua tau.
Muaj cov pov thawj ntawm kev txhim kho thrombocytopenia, eosinophilia thiab ntshav tsawg tsawg.
Hauv cov npe ntawm cov kev mob tshwm sim no yuav tsum tau hu ua hyperhidrosis, tawv nqaij khaus, ua pob. Eczema, angioedema, erythema, tshuaj lom cov tawv nqaij thiab tshuaj lom yog tsis tshua kuaj pom.
Ntawm cov kev mob tshwm sim hu ua impaired raum muaj nuj nqi. Ntawm cov pathologies yog lub raum tsis ua haujlwm.
Los ntawm lub plab zom mov, raws plab, mob plab, ntuav, pom kev thiab dyspepsia tshwm sim ntau dua li lwm tus. Saj tsis zoo nyob rau hauv thaj chaw epigastric, hnoos qeev hauv lub qhov ncauj kab noj hniav yog qhov tsis tshua pom tshwm sim.

Txoj hlab plawv tsis tshua muaj rau cov kev tshwm sim tsis zoo nrog Telzap txoj kev kho. Lub caij no, cov neeg mob ua tau:

txo qis ntshav siab nrog kev hloov chaw hauv lub cev,
kev npau taws kev tsaus muag
txo lossis nce siab hauv plawv.

Kev tsis txaus siab ntawm lub qog thiab lub siab yog qhov tsis tshua muaj neeg pom.

Siv cov tshuaj tuaj yeem ua rau txo cov ntshav qab zib thiab ntshav qab zib hauv lub cev.

Ntawm kev fab tshuaj ua xua, cov hauv qab no yog ua tau:

Cov chaw muag tshuaj

Cov Tshuaj Pharmacokinetics

Kev siv tib lub sij hawm ntawm hydrochlorothiazide thiab telmisartan tsis cuam tshuam rau pharmacokinetics ntawm cov tshuaj no.

Telmisartan: Tom qab kev tswj hwm ntawm qhov ncauj, qhov siab tshaj plaws ntawm telmisartan tau mus txog tom qab 0.5 - 1.5 teev. Qhov tsis txaus ntseeg ntawm telmisartan ntawm koob tshuaj 40 mg thiab 160 mg yog 42% thiab 58%, feem. Thaum noj cov tshuaj telmisartan ib txhij nrog zaub mov noj, qhov txo qis hauv AUC (thaj chaw hauv qab qhov xav txog lub sijhawm nkhaus) yog li ntawm 6% (ntawm ib koob 40 mg) txog 19% (ntawm koob tshuaj 160 mg). 3 teev tom qab noj, qhov kev nkag siab hauv cov ntshav ntshav tawm ntau, tsis hais cov pluas noj dab tsi. Qhov kev txo qis hauv AUC tsis ua rau txo qis kev kho kom zoo. Cov tshuaj pharmacokinetics ntawm qhov ncauj telmisartan yog nonlinear ntawm koob tshuaj ntawm 20-160 mg nrog ntau dua ntawm cov xwm txheej nce ntxiv hauv plasma ntau (Cmax thiab AUC) nrog kev nce siab. Tsis pom qhov kev sib txuam tseem ceeb hauv cov tshuaj telmisartan.

Hydrochlorothiazide: Tom qab qhov ncauj tswj hwm ntawm Telzap Plus, cov ntsiab lus ntau ntawm hydrochlorothiazide tau mus txog kwv yees li 1.0 mus rau 3.0 teev tom qab noj cov tshuaj. Raws li kev ua kom lub raum khiav tawm ntawm hydrochlorothiazide, qhov tseeb txog kev nyab xeeb yog li 60%.

Telmisartan qhov tseem ceeb khi rau cov ntshav plasma protein (ntau dua 99.5%), feem ntau nrog albumin thiab alpha-1-acid glycoprotein. Qhov kev xa khoom faib tawm yog kwv yees li 500 L, uas qhia tau tias yuav tsum muaj ntaub so ntswg ntxiv.

Hydrochlorothiazide 68% ua txhua yam rau cov plasma protein thiab qhov ntim ntawm kev faib tawm yog 0.83 - 1.14 l / kg.

Telmisartan metabolized los ntawm kev sib txuas nrog kev tsim cov pharmacologically tsis nquag acylglucuronide. Cov glucuronide ntawm leej niam leej txiv lub cev tsuas yog cov metabolite uas tau txheeb pom hauv tib neeg. Tom qab ib koob nkaus xwb ntawm 14C-sau npe telmisartan, glucuronide yog kwv yees li 11% ntawm kev ntsuas ntshav ntshav radioactivity. Cytochrome P450 thiab isoenzymes tsis koom nrog hauv cov metabolism ntawm telmisartan.

Hydrochlorothiazide tsis metabolized hauv tib neeg

Telmisartan: Tom qab tso ntshav lossis tswj lub qhov ncauj ntawm 14C-daim ntawv qhia hu ua telmisartan, feem ntau ntawm kev siv tshuaj (> 97%) tau tawm hauv cov quav los ntawm cov kua tso tawm. Cov kua me me tau pom nyob hauv cov zis.

Tag nrho cov ntshav pliav tshem tawm ntawm telmisartan tom qab kev tswj hwm ntawm qhov ncauj yog> 1500 ml / min. Lub davhlau ya nyob twg ib nrab-lub neej yog> 20 teev.

Hydrochlorothiazide cia tawm yuav luag tsis hloov pauv ntawm cov zis.Li ntawm 60% ntawm qhov ncauj noj tau tawm hauv 48 teev. Kev kho lub raum yog li 250 - 300 ml / min. Lub davhlau ya nyob twg ib nrab-lub neej yog 10 mus rau 15 teev.

Cov neeg laus cov neeg mob

Cov chaw muag tshuaj ntawm telmisartan tsis txawv hauv cov neeg laus thiab cov neeg mob hnub nyoog qis dua 65 xyoos.

Plasma cov ntsiab lus ntawm telmisartan yog 2-3 zaug siab dua hauv poj niam ntau dua li txiv neej. Hauv qhov kev tshawb fawb soj ntsuam, tsis muaj ib qho tseem ceeb ntxiv hauv cov lus teb ntawm ntshav siab lossis ntau zaus ntawm orthostatic hypotension rau cov poj niam. Koob tshuaj yuav tsis haum. Ib tug nyiam mus rau qhov ntshav siab ntau dua ntawm hydrochlorothiazide tau pom hauv cov poj niam dua li tus txiv neej. Nws tsis muaj qhov tseem ceeb hauv tsev kho mob.

Cov neeg mob raum tsis ua haujlwm

Kev tsis pom lub pob zeb tsis cuam tshuam rau telmisartan tshem tawm. Raws li cov txiaj ntsig ntawm kev paub me me nrog Telzap Plus hauv cov neeg mob uas tsis tshua mob mus rau lub raum tsis ua hauj lwm (kev tshem tawm ntawm 30-60 ml / min, qhov nqi nruab nrab ntawm kwv yees li 50 ml / min), kev kho kom haum yog tsis tsim nyog rau cov neeg mob uas txo lub raum. Telmisartan tsis raug tshem tawm los ntawm cov ntshav los ntawm hemodialysis. Hauv cov neeg mob uas lub raum lub raum tsis ua haujlwm, tus nqi ntawm kev tshem tawm ntawm hydrochlorothiazide yog txo. Hauv kev tshawb nrhiav hauv cov neeg mob uas muaj qhov nruab nrab creatinine tshem tawm ntawm 90 ml / min, qhov kev siv ib nrab ntawm lub neej ntawm hydrochlorothiazide tau nce ntxiv. Hauv cov neeg mob uas lub raum tsis ua haujlwm, kev tshem tawm ib nrab-lub neej yog li 34 teev.

Cov neeg mob mob siab tsis ua haujlwm

Hauv cov neeg mob uas muaj mob hepatic tsis txaus, qhov tiag ntawm bioavailability ntawm telmisartan nce txog 100%. Ib nrab-lub neej rau daim siab ua tsis hloov.

Yawg Nom Loobodinamika

Telzap Plus yog qhov sib xyaw ntawm cov tshuaj mob angiotensin II receptor antagonist (ARAII), telmisartan, thiab thiazide diuretic, hydrochlorothiazide. Kev sib xyaw ua ke ntawm cov cheebtsam no muaj qhov ua haujlwm ntxiv los tiv thaiv kabmob, txo cov ntshav siab rau ntau dua li ib ntu tivthaiv ib leeg. Telzap Plus thaum noj ib hnub ib zaug ua rau muaj kev txo qis zoo thiab txo qis cov ntshav siab.

Telmisartan yog qhov ua tau zoo thiab tshwj xeeb (xaiv tau) angiotensin II receptor antagonist (hom AT1) rau kev tswj hwm qhov ncauj. Telmisartan nrog qhov zoo sib xws siab hloov chaw angiotensin II los ntawm nws cov chaw khi hauv receptors ntawm subtype 1 (AT1), uas yog lub luag haujlwm rau paub txog cov nyhuv ntawm angiotensin II. Telmisartan tsis nthuav tawm ib qho kev ua kom muaj kev ua phem ntawm AT1 receptor. Telmisartan xaiv yeem khi rau AT1 receptor. Kev khi yog lub sijhawm ntev. Telmisartan tsis qhia txog kev sib raug zoo rau lwm cov receptors, suav nrog AT2 receptor thiab lwm yam, tsis tshua tau kawm txog AT receptors.

Lub luag haujlwm tseem ceeb ntawm cov receptors, nrog rau cov txiaj ntsig ntawm lawv qhov kev xav tau dhau los nrog angiotensin II, qhov kev tsub zuj zus uas nce nrog kev teem sijhawm ntawm telmisartan, tsis tau kawm.

Telmisartan txo cov ntshav plasma aldosterone ntau ntau, tsis thaiv cov renin hauv tib neeg ntshav thiab ion channels.

Telmisartan tsis thaiv qhov kev mob angiotensin-hloov pauv enzyme (kinase II), uas txo cov khoom ntawm bradykinin ntau lawm. Yog li no, tsis muaj suab nrov nrov ntawm kev phiv cuam tshuam nrog kev txiav txim ntawm bradykinin.

Ib 80 mg koob tshuaj ntawm telmisartan, muab rau cov neeg tuaj yeem noj qab haus huv, yuav luag tag nrho qhov kev tiv thaiv qhov nce siab uas tshwm sim los ntawm kev chwv cov tshuaj angiotensin II. Cov nyhuv inhibitory tseem nyob ntev dua 24 teev (mus txog 48 teev).

Tom qab noj thawj koob ntawm telmisartan, ntshav siab poob qis tom qab 3 teev. Qhov siab tshaj plaws nyob rau hauv cov ntshav siab, raws li txoj cai, ua tiav 4-8 lub lis piam tom qab pib kho thiab mob siab rau kev kho mob mus ntev.

Cov nyhuv antihypertensive kav rau 24 teev tom qab noj cov tshuaj, suav nrog 4 teev ua ntej noj cov koob tshuaj txuas ntxiv, uas tau paub tseeb los ntawm kev ntsuas ntshav siab, nrog rau cov neeg mob nyob sab nraud (saum 80%) ntawm qhov tsawg kawg thiab ntau qhov ntau ntawm cov tshuaj tom qab noj 40 thiab 80 mg ntawm telmisartan nyob rau hauv qhov chaw tswj hwm. kev tshawb fawb soj ntsuam.

Hauv cov neeg mob ntshav siab, telmisartan txo qis ob qho systolic thiab diastolic ntshav siab tsis cuam tshuam rau lub plawv dhia. Qhov ua tau zoo ntawm telmisartan piv nrog cov neeg sawv cev ntawm lwm cov chav kawm ntawm cov tshuaj tiv thaiv kabmob (zoo li pom hauv kev tshawb fawb soj ntsuam cov sib piv ntawm telmisartan nrog amlodipine, atenolol, enalapril, hydrochlorothiazide, thiab lisinopril).

Hauv ob lub qhov muag dig, tswj kev soj ntsuam (N = 687 cov neeg mob uas tau raug soj ntsuam rau qhov ua tau zoo), cov tib neeg tsis teb rau 80 mg / 12.5 mg kev sib xyaw ua kom pom kev txo qis ntshav siab ntawm 80 mg / 25 mg sib xyaw piv nrog kev kho mob mus ntev nrog cov koob tshuaj 80 mg / 12.5 mg 2.7 / 1.6 mmHg (SBP / DBP) (qhov sib txawv ntawm kev hloov pauv qhov nruab nrab hauv kev txheeb tus kwv tij). Hauv kev kawm nrog kev sib xyaw ntawm 80 mg / 25 mg, ntshav siab poob qis, uas ua rau muaj kev txo qis tag nrho ntawm 11.5 / 9.9 mmHg. (VAJTSWV / DBP).

Kev ntsuam xyuas dav dav ntawm ob qhov zoo sib xws ntawm 8 lub lis piam ob zaug dig muag, cov tshuaj placebo tshuaj soj ntsuam sib piv valsartan / hydrochlorothiazide 160 mg / 25 mg (N = 2121 cov neeg mob uas tau raug soj ntsuam rau qhov ua tau zoo) pom tias muaj txiaj ntsig ntau dua ntawm kev txo ntshav siab 2.2 / 1.2 hli Hg Cov. (SBP / DBP) (qhov sib txawv ntawm kev hloov kho txhais tau hloov los ntawm lub hauv paus, ib feem) nyob rau hauv kev pom zoo ntawm kev sib xyaw ntawm telmisartan / hydrochlorothiazide 80 mg / 25 mg.

Tom qab qhov kev tso tseg tsis zoo ntawm kev kho mob nrog telmisartan, ntshav siab maj mam rov qab los rau nws cov nqi pib ntau hnub dhau los uas tsis muaj cov cim qhia "rov mob" tawg.

Hauv cov kev tshawb fawb soj ntsuam ncaj qha piv rau ob txoj kev kho, qhov tshwm sim ntawm kev hnoos qhuav tau qis dua hauv cov neeg mob uas tau txais telmisartan dua li cov uas tau txais angiotensin-hloov enzyme inhibitors.

Kev soj ntsuam PRoFESS tau ua nyob rau hauv cov neeg mob hnub nyoog qis dua 50 xyoo uas nyuam qhuav muaj mob stroke tam sim no pom tias muaj qhov sib luag ntawm sepsis nrog telmisartan piv nrog cov placebo, 0.70% piv nrog 0.49% LOSSIS 1.43 (95% kev cog qoob loo nyob nruab nrab 1.00 - 2.06), qhov ntau zaus ntawm kev tuag los ntawm sepsis yog ntau dua rau cov neeg mob noj telmisartan (0.33%) piv nrog cov neeg mob noj placebo (0.16%) LOSSIS 2.07 (95% kev ntseeg siab ib ntus 1.14 - 3.76). Qhov pom tau nce ntxiv ntawm qhov tshwm sim ntawm sepsis cuam tshuam nrog kev siv telmisartan tej zaum yuav yog ib qho kev tshwm sim random lossis yuav cuam tshuam nrog lub tshuab uas tsis tau paub tam sim no.

Qhov tshwm sim ntawm telmisartan ntawm kev tuag thiab cov mob plawv yog cov tseem tsis tau paub. Hydrochlorothiazide yog thiazide diuretic. Tus txheej txheem ntawm cov nyhuv los tiv thaiv thiazide diuretics tsis tau paub meej. Thiazides cuam tshuam rau lub raum kev rov ua haujlwm ntawm kev rov tsim cov roj ntsha hauv cov tub ntxhais, ncaj qha nce cov kev tsis haum ntawm sodium thiab chloride nyob hauv kwv yees li ntau dua. Cov nyhuv diuretic ntawm hydrochlorothiazide txo plasma ntim ntau dua, nce plasma renin kev ua si, nce zais pa ntawm aldosterone, tom qab kev nce poov tshuaj ntau ntxiv hauv cov zis, poob ntawm bicarbonate thiab txo qis hauv poov tshuaj potassium. Tej zaum dhau ntawm qhov thaiv ntawm cov renin-angiotensin-aldosterone system, kev sib koom tes ntawm telmisartan, raws li txoj cai, txwv tsis pub cov pa roj carbon ntau txuam nrog cov diuretics. Thaum siv hydrochlorothiazide, qhov pib ntawm diuresis tshwm sim tom qab 2 teev, thiab cov nyhuv siab tshwm sim tom qab li 4 teev, thaum cov nyhuv cuam tshuam txog li 6-12 teev.

Kev tshawb fawb tawm tsam pom tau tias kev kho mob ntev nrog hydrochlorothiazide txo txoj kev pheej hmoo ntawm lub plawv kev tuag thiab kev qoj ib ce.

Cov menyuam yaus, thaum cev xeeb tub thiab lactation

Tsis muaj ntaub ntawv txaus ntseeg txog kev nyab xeeb ntawm cov tshuaj no thaum cev xeeb tub. Yog tias tus neeg mob npaj lub cev xeeb tub, thiab nws yuav tsum noj tshuaj kom txo qis, nws pom zoo kom siv lwm txoj hauv kev ntxiv.

Kev siv cov tshuaj los ntawm cov pab pawg ntawm inhibitors, angiotensin antagonists hauv qib thib 2 thiab thib 3 ua rau muaj kev txhim kho kev puas tsuaj rau lub raum, mob siab, ncua ossification ntawm lub pob txha taub hau hauv plab, oligohydramnion (txo qis hauv cov kua tshuaj amniotic kua).

Kev siv cov tshuaj thaum lub sijhawm pub niam mis yog nruj me ntsis.

Yeeb tshuaj sib cuam tshuam

Telzap feem ntau yog siv los ua ib feem ntawm cov kev kho mob nyuaj, yog li koj yuav tsum xav txog qhov sib xyaw ntawm cov ntsiav tshuaj nrog rau lwm cov tshuaj.

Cov neeg mob uas muaj ntshav qab zib hom 2 tsis raug tso cai coj telmisartan nrog lwm cov tshuaj tiv thaiv ACE tib lub sijhawm. Feem ntau, qhov no ua rau ua rau lub plawv tsis muaj ntshav.

Cov tshuaj tsis pom zoo rau kev siv: