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

Cov tshuaj antihypertensive, inhibitor ACECov. Tus txheej txheem ntawm kev txiav txim yog vim yog kev sib xyaw ACE thiab thaiv qhov kev hloov pauv hloov kho angiotensin Kuv hauv angiotensin II, uas ua rau txoj kev txhim kho ntawm cov nyhuv hypotensive, uas ua tau nws tus kheej tsis hais qhov chaw ntawm tus neeg mob (dag / sawv), thaum lub sij hawm tsim kho ntxiv Lub plawv dhia tsis yog muaj tshwm sim. Cov tshuaj txo cov kev yoo mov thiab thau khoom, txo ntau lawm aldosterone, kev tawm tsam hauv cov hlab ntsha ntawm lub ntsws, nce lub cev kev nkag siab kom thauj khoom thiab feeb ntawm cov ntshav, txhim kho cov ntshav rau myocardium. Thaum siv rau lub sijhawm ntev hauv cov neeg mob leeg ntshav siab qhov thim rov qab tshwm sim rau kev txhim kho ntawm myocardial hypertrophy, qhov tsawg dua tuaj arrhythmiashloov pauv ntawm cov leeg endothelium tshwm sim nyob rau hauv qhov kev txiav txim ntawm siab cov zaub mov roj, nce raum thiab mob ntshav siab.

Cov nyhuv antihypertensive tom qab noj cov tshuaj sab hauv tshwm sim tom qab 1.5-2 teev, cov nyhuv siab tshaj plaws tau pom tom qab 6-9 teev, lub sijhawm ua haujlwm yog txog ib hnub, tsis muaj kev tshem tawm cov tsos mob. Hauv cov neeg mob mob myocardial infarction nrog txhim kho lub plawv tsis ua haujlwm hauv thawj hnub, noj cov tshuaj pab ua rau txo qis kev tuag thiab txo kev pheej hmoo ntawm qhov ua tau mob CHFCov. Txais tos ramipril nrog cov uas tsis mob ntshav qab zib / ntshav qab zib nephropathy qeeb zuj zus lub raum tsis ua hauj lwm.

Cov Tshuaj Pharmacokinetics

Cov tshuaj cuam tshuam sai sai los ntawm Kev kho mob txoj hnyuvtxawm li cas los xij, kev nkag ntawm cov zaub mov tsis cuam tshuam rau qhov ua tiav ntawm kev nqus, tab sis cov txheej txheem nqus tau qeeb. Kev sib txuas lus nrog cov ntshav protein ntawm theem ntawm 75%. Cmax ua tiav ntawm nruab nrab tom qab 1.5 teev. Kev txiav txim siab ua rau daim siab, uas ua rau muaj kev tsim kho cov tshuaj noj tshuaj metabolite ramiprilat thiab tsis nquag - ramipril glucuronides, ether thiab diketopiperazinic acidCov. Nws raug tawm hauv daim ntawv ntawm kev tsim tshwj xeeb los ntawm kev tso zis thiab quav. T1 / 2 - 5-6 teev.

Cov chaw muag tshuaj

Cov Tshuaj Hauv Tshuaj

Lub nquag metabolite ntawm ramipril tsim nyob rau hauv cawv ntawm daim siab enzymes - ramiprilat - yog qhov ua haujlwm ntev ACE inhibitor, uas yog peptidyldipeptidase. ACE hauv cov ntshav thiab cov nqaij ua rau kev hloov pauv ntawm angiotensin I mus rau angiotensin II thiab kev tawg ntawm bradykinin. Yog li no, thaum noj cov ramipril sab hauv, qhov tsim ntawm angiotensin II poob qis thiab bradykinin ntau zuj zus, uas ua rau vasodilation thiab txo cov ntshav siab (BP). Kev nce ntxiv hauv kev ua haujlwm ntawm kallikrein-kinin lub cev nyob rau hauv cov ntshav thiab cov ntaub so ntswg txiav txim siab cov txiaj ntsig cardioprotective thiab endothelioprotective ntawm ramipril vim kev ua haujlwm ntawm prostaglandin system thiab, raws li, kev nce ntxiv hauv cov synthesis ntawm prostaglandins, uas txhawb kev tsim ntawm nitric oxide (TSIS) nyob rau hauv endotheliocytes. Angiotensin II stimulates zus tau ntawm aldosterone, yog li noj ramipril ua rau txo qis ntawm aldosterone secretion thiab nce ntxiv ntawm cov ntshav ntxim rau renin zais cia los ntawm hom kev tsis zoo, uas ua rau muaj kev nce plasma renin kev ua si.

Nws tau suav hais tias kev txhim kho ntawm qee qhov tsis xav tau (tshwj xeeb, hnoos qhuav) tseem cuam tshuam nrog kev nce hauv cov kev ua ntawm bradykinin. Hauv cov neeg mob uas muaj mob ntshav lub plawv, noj ramipril ua rau txo qis ntshav siab thaum dag thiab sawv ntsug yam tsis muaj txiaj ntsig ntawm kev mob plawv (HR). Ramipril txo qis tag nrho peripheral vascular tsis kam (OPSS), suab tsis ua rau muaj kev hloov pauv ntawm cov ntshav raum thiab cov ntshav txhaws. Cov nyhuv antihypertensive pib tshwm sim 1-2 teev tom qab noj ib koob ntawm cov tshuaj, nce mus txog nws tus nqi ntau tshaj plaws tom qab 3-9 teev, thiab kav ntev li 24 teev.

Nrog cov tshuaj tiv thaiv ib zaug, cov nyhuv antihypertensive tuaj yeem maj mam nce, feem ntau yuav ruaj khov nyob rau ntawm 3-4 lub lim tiam ntawm kev siv cov tshuaj tsis tu ncua thiab tom qab ntawd txuas ntxiv mus ntev. Kev txiav tu ncua tsis siv tshuaj tam sim tsis ua rau muaj ntshav nce siab thiab ceev ntxiv (tsis tuaj yeem tshem tawm mob).

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

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

Hauv cov ntshav qab zib thiab tsis mob ntshav qab zib nephropathy, noj ramipril txo tus nqi ntawm kev muaj mob ntawm lub raum tsis ua haujlwm thiab qhov pib ntawm lub davhlau ya nyob twg ntawm kev mob raum tsis ua haujlwm thiab, yog li, txo qhov kev xav rau hemodialysis thiab lub raum hloov. Hauv cov theem pib ntawm tus mob ntshav qab zib thiab tsis mob ntshav qab zib nephropathy, ramipril txo qhov hnyav ntawm albuminuria.

Hauv cov neeg mob uas muaj kev pheej hmoo siab los ntawm kev mob hlab plawv vim yog viav vias txhab (kuaj mob plawv, keeb kwm ntawm cov leeg ntshav txha caj qaum, keeb kwm ntawm mob hlab ntsha tawg), lossis mob ntshav qab zib mellitus muaj tsawg kawg yog ib qho kev pheej hmoo ntxiv (microalbuminuria, ntshav siab, nce ntxiv) qhov kev txiav txim siab ntawm cov roj (OX) tag nrho, qhov kev txo qis hauv cov concentration ntawm high-density lipoprotein cholesterol (OX-HDL), haus luam yeeb) qhov sib ntxiv ntawm ramipril rau cov qauv kev kho mob ho thiaj li cov xwm txheej ntawm myocardial infarction, mob stroke thiab tuag los ntawm kev mob plawv ua rau. Ntxiv rau, ramipril txo cov ntsiab lus ntawm kev tuag tag nrho, nrog rau cov kev xav ua kom rov ua haujlwm, thiab ua rau qeeb ntawm qhov pib lossis mob zuj zus ntawm lub plawv tsis ua haujlwm.

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

Hauv cov neeg mob dav dav, nrog rau cov neeg mob ntshav qab zib mellitus (ob qho tib si nrog cov leeg ntshav thiab nrog cov ntshav siab), ramipril txo qhov pheej hmoo ntawm nephropathy thiab qhov tshwm sim ntawm microalbuminuria.

Cov Tshuaj Pharmacokinetics

Tom qab kev tswj hwm ntawm qhov ncauj, ramipril yog nqus tau sai sai ntawm txoj hnyuv (50-60%). Noj noj kom tsawg nws nqus, tab sis tsis cuam tshuam rau qhov ua tiav ntawm kev nqus.

Nws yog cov tshuaj tiv thaiv hauv lub siab nrog kev tsim cov tshuaj metabolite ntawm ramiprilat (nws yog 6 zaug ntau dua hauv kev tiv thaiv ACE dua li ramipril) thiab cov roj ntsha tsis ua haujlwm - diketopiperazinovoy ether, diketopiperazinovoy acid, zoo li ramiprilat glucuronides thiab ramiprilat. Txhua qhov tsim tawm metabolites, tshwj tsis yog ramiprilat, tsis muaj kev ua haujlwm pharmacological. Kev sib txuas lus nrog plasma protein rau ramipril - 73%, ramiprilata - 56%.

Tom qab noj ramipril sab hauv, qhov siab tshaj plaws ntshav plasma ntawm ramipril thiab ramiprilat tau mus txog tom qab 1 thiab 2-4 teev, feem. Lub bioavailability rau ramipril tom qab kev tswj hwm ntawm qhov ncauj ntawm 2.5-5 mg yog 15-28%, rau ramiprilat - 45%. Tom qab kev noj haus txhua hnub ntawm 5 mg / hnub, kev saib xyuas ruaj khov ntawm ramiprilat hauv cov ntshav ntshav tau mus txog rau hnub 4. Ib nrab-lub neej (T_1/2) rau ramipril - 5.1 teev, nyob rau theem ntawm kev faib tawm thiab kev tshem tawm, qhov kev txo qis ntawm cov concentration ntawm ramiprilat hauv cov ntshav cov ntshav tshwm sim nrog T_1/2 sib npaug txog 3 teev, ua raws li kev hloov theem nrog T_1/2 sib npaug zos rau 15 teev thiab qhov ntev ntev kawg nrog kev siv ntau heev ntawm ramiprilat hauv ntshav thiab T_1/2 sib npaug li 4-5 hnub T_1/2 nce nyob rau hauv mob raum tsis ua hauj lwm (CRF). Qhov faib khoom ntawm ramipril yog 90 l, ramiprilat yog 500 l.

Cov kev tshawb fawb tsiaj tau pom tias ramipril ua rau tawm hauv niam cov kua mis.

Nws yog tawm los ntawm lub raum - 60%, los ntawm txoj hnyuv - 40% (feem ntau yog nyob rau hauv daim ntawv ntawm metabolites). Nrog kev ua haujlwm tsis zoo hauv lub raum, qhov kev nthuav tawm ntawm ramipril thiab nws cov metabolites qeeb qeeb hauv qhov sib piv rau qhov txo qis ntawm creatinine tshem tawm (CC), nrog lub siab ua haujlwm tsis txaus, hloov mus rau ramiprilat qeeb qeeb, thiab hauv plawv tsis ua haujlwm, qhov siab ntawm ramiprilat nce 1.5-1.8 zaug.

Hauv cov neeg laus noj qab haus huv cov neeg ua haujlwm dawb (65-76 xyoo), pharmacokinetics ntawm ramipril thiab ramiprilat tsis txawv dua li cov tub ntxhais hluas ua haujlwm pab dawb noj qab haus huv.

Cov Yuav Tsum Muaj

Arterial hypotension, angioedema ntau yam etiologies, raum leeg hlab ntsha stenosis, obstructive cardiomyopathy nrog hypertrophic hloov, hais tawm lub raum tsis ua hauj lwmkev pub mis hemodialysis, cev xeeb tubthawj hyperaldosteronismhnub nyoog txog 18 xyoo CHF nyob rau hauv theem ntawm decompensation, lactose intolerance, siab rhiab heev rau cov tshuaj, mob plawv tsis xwm yeem, tsis khov angina pectorisLactase tsis txaus.

Siv nrog ceev faj thaum atherosclerotic txhab cerebral thiab hlab ntshav hlab ntsha.

Kev ntsuas rau siv

tawg siab tseem ceeb,
mob plawv tsis ua hauj lwm (raws li ib feem ntawm kev sib xyaw ua ke, tshwj xeeb hauv kev sib xyaw nrog tshuaj diuretics),
mob ntshav qab zib lossis tsis mob ntshav qab zib nephropathy, ua ntej pw hauv tsev kho mob los yog chaw kuaj mob, nrog rau cov proteinuria ntau heev, tshwj xeeb tshaj yog thaum ua ke nrog cov leeg ntshav siab,
txo txoj kev pheej hmoo ntawm kev tsim myocardial infarction, mob hlab ntsha tawg, lossis lub plawv kev tuag ntawm cov neeg mob uas muaj kev pheej hmoo mob plawv:
- nyob rau hauv cov neeg mob uas paub tseeb txog cov mob plawv mob plawv, keeb kwm ntawm myocardial infarction lossis tsis muaj nws, suav nrog cov neeg mob uas tau txiav txim siab txhawm rau txhawm rau mob hlab ntsha plawv, mob ntshav txha caj qaum txoj hlab ntshav mob
- hauv cov neeg mob uas muaj keeb kwm ntawm mob hlab ntsha tawg,
- hauv cov neeg mob uas muaj qhov txhab txhab ntawm cov hlab ntsha txhaws,
- nyob rau hauv cov neeg mob ntshav qab zib mellitus nrog tsawg kawg ib qho kev pheej hmoo ntxiv (microalbuminuria, mob ntshav siab, nce ntshav ntau 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 (los ntawm hnub thib ob mus rau cuaj hnub) tom qab mob myocardial infarction (saib ntu "Pharmacodynamics").

Sab sij huam

Tshaj tawm los poob HUAB TAISmob hauv siab orthostatic hypotension, myocardial ischemia, arrhythmias, lub plawv dhia, plhws, peripheral edema, lub raum tsis ua haujlwm, nce siab neeg tsim tswv thiab urea nyob rau hauv cov ntshav, txo qis libido, erectile kawg, gynecomastia, mob taub haumloog zoo li nkees, ntxhov siab, lub cev muaj zog, muaj kev ntxhov siab, pw tsaug zog, tsaus muag thiab pom tus ntxhiab tsw, myalgiamob leeg plab, kem plab, ntuav, zawv plabmob hauv plab dyspepsiahnoos qhuav txog siav, mob hlab ntsws, mob ntswsdaim tawv nqaij ua pob hyperhidrosiskhaus tawv nqaij, ua xua tuaj, eosinophiliance lub concentration ntawm cov poov tshuaj nyob rau hauv cov ntshav.

Tsuas tshuaj thiab tswj hwm

Arterial tawg
Sab hauv, qhov pib tshuaj yog 2.5 mg, ib zaug, thaum sawv ntxov. Yog tias thaum noj cov tshuaj hauv cov tshuaj no 3 lub lis piam lossis ntau dua, nws tsis tuaj yeem ua kom ntshav siab, ces cov koob tshuaj yuav nce ntxiv rau 5 mg ntawm tshuaj Dilaprel ® ib hnub. Yog tias qhov koob tshuaj 5 mg yuav siv tsis tau txaus, tom qab 2-3 lub lis piam nws tuaj yeem tau ob npaug rau qhov siab tshaj qhov xav tau ntawm 10 mg ib hnub twg. Raws li lwm txoj hauv kev ntxiv cov koob tshuaj rau 10 mg rau ib hnub nrog qhov tsis txaus los tiv thaiv kev mob ntshav siab ntawm cov tshuaj txhua hnub ntawm 5 mg, lwm cov tshuaj tiv thaiv kab mob siab, tshwj xeeb hauv diuretics lossis "qeeb" calcium channel blockers, yuav ntxiv rau kev kho mob.

Mob plawv nres
Qhov hno thawj zaug yog 1.25 mg / hnub *. Nyob ntawm tus neeg mob cov lus teb rau txoj kev kho mob, cov tshuaj tuaj yeem nce ntxiv. Nws raug nquahu kom ua ob zaug ntxiv ntawm 1-2 lis piam. Cov koob tshuaj ntawm 2.5 mg lossis ntau dua yuav tsum noj ib zaug lossis faib ua 2 zaug. Qhov nyiaj pab ntau tshaj txhua hnub yog 10 mg.

Nrog lub plawv tsis ua haujlwm uas tau tsim nyob rau thawj ob peb hnub (txij hnub ob mus txog cuaj hnub) tom qab mob myocardial infarction
Qhov tshuaj thawj zaug yog 5 mg, muab faib ua 2 koob tshuaj, 2.5 mg thaum sawv ntxov thiab yav tsaus ntuj. Yog tias tus neeg mob tsis ua siab ntev rau thawj zaug li no (pom qhov ntsuas ntshav siab ntau dhau), ces nws raug nquahu kom muab 1,25 mg 2 zaug hauv ib hnub * rau ob hnub.
Tom qab ntawd, nyob ntawm kev tawm tsam los ntawm tus neeg mob, cov koob tshuaj yuav raug nce ntxiv.
Nws raug nquahu tias cov koob tshuaj nrog nws nce ob npaug nrog nruab nrab ntawm 1-3 hnub. Tom qab ntawd, tag nrho cov koob tshuaj txhua hnub, uas tau muab faib ua thawj zaug, muab tau ib zaug.
Qhov siab tshaj plaws kev pom zoo txhua hnub koob tshuaj yog 10 mg.
Tam sim no, cov kev paub hauv kev kho cov neeg mob uas muaj mob plawv tsis zoo (III-IV ua haujlwm chav kawm raws li NYHA kev faib tawm), uas tau tshwm sim sai sai tom qab mob myocardial infarction, yog qhov tsis txaus.
Yog tias cov neeg mob zoo li no txiav txim siab mus kho nrog Dilaprel ®, nws raug nquahu tias kev kho mob pib nrog kev siv qis tshaj - 1.25 mg ib hnub ib zaug *. Qhov tshwj xeeb yuav tsum ceev faj nrog txhua qhov nce ntxiv.

Nrog mob ntshav qab zib lossis tsis mob ntshav qab zib nephropathy
Thawj qhov tshuaj yog 1.25 mg ib hnub ib zaug *. Qhov koob tshuaj yuav nce ntxiv rau 5 mg ib hnub ib zaug.
Qhov nyiaj pab ntau tshaj txhua hnub yog 5 mg.

Kev siv Dilaprel ® hauv qee pawg

Cov neeg mob uas lub raum tsis ua hauj lwm zoo
Nrog CC los ntawm 50 txog 20 ml / min rau 1.73 m² ntawm lub cev, qhov pib siv tshuaj txhua hnub feem ntau yog 1.25 mg *.
Qhov nyiaj pab ntau tshaj txhua hnub yog 5 mg.

Cov neeg mob uas ua tsis tiav kho cov kua dej thiab electrolytes, cov neeg mob ntshav siab heev, nrog rau cov neeg mob ntshav siab ua rau muaj qee qhov kev pheej hmoo (piv txwv li, muaj qhov mob loj atherosclerotic ntawm cov hlab ntshav hlab ntshav thiab hlab hlwb)
Qhov hno koob thawj zaug tau raug txo mus rau 1.25 mg / hnub *.

Cov neeg mob nrog kev kho mob ua ntej
Yog tias ua tau, nws yog qhov yuav tsum tau tso tseg cov tshuaj diuretics hauv 2-3 hnub (nyob ntawm lub sijhawm ntawm kev ua ntawm diuretics) ua ntej pib kho nrog Dilaprel ® lossis, tsawg kawg, txo qhov kev txhaj tshuaj ntawm diuretics noj. Kev kho mob ntawm cov neeg mob no yuav tsum pib nrog qhov qis tshaj ntawm 1.25 mg ntawm ramipril * noj ib hnub ib zaug thaum sawv ntxov. Tom qab noj thawj koob thiab txhua lub sijhawm tom qab nce cov koob tshuaj ramipril thiab (lossis) lub voj diuretics, cov neeg mob yuav tsum tau nyob hauv kev saib xyuas kev kho mob tsawg kawg yog 8 teev kom tsis txhob muaj kev tiv thaiv kev tiv thaiv hypotensive.

Cov neeg laus (laus dua 65 xyoos)
Qhov hno koob thawj zaug tau raug txo mus rau 1.25 mg / hnub *.

Cov neeg mob uas muaj lub siab ua haujlwm tsis zoo
Cov tshuaj tiv thaiv ntawm cov ntshav siab rau noj Dilaprel ® tuaj yeem nce ntxiv (vim tias qhov ua haujlwm qeeb hauv ramiprilat excretion) lossis txo qis (vim kev ua haujlwm qeeb ntawm qhov hloov pauv tsis ua haujlwm mus rau ramiprilat kom nquag ua haujlwm ramiprilat). Yog li, thaum pib kho yuav tsum muaj kev saib xyuas mob nkeeg.
Qhov siab tshaj plaws tau tso cai rau noj txhua hnub yog 2.5 mg.

* Hauv qhov no, koj tuaj yeem siv cov tshuaj ramipril hauv lwm daim ntawv tshuaj: 2.5 mg ntsiav tshuaj nrog kev pheej hmoo.

Sab sij huam

Los ntawm cov kab mob plawv:
feem ntau - ntau dhau txo nyob rau hauv cov ntshav siab, orthostatic hypotension, syncope, mob hauv siab,
ua tsis tiav - myocardial ischemia, nrog rau kev txhim kho ntawm kev tawm tsam ntawm angina pectoris lossis myocardial infarction, tachycardia, arrhythmias (tsos lossis ntxiv mus), palpitations, peripheral edema, yaug ntawm lub ntsej muag.

Los ntawm genitourinary system:
tsis xws luag - lub raum tsis ua haujlwm, suav nrog kev txhim kho ntawm lub raum tsis ua haujlwm, kev tso zis ntau ntxiv, cov zis muaj txig nce ntxiv, muaj kev nce ntxiv ntawm cov zis ntawm urea thiab creatinine hauv cov ntshav, tsis hloov pauv vim yog erectile kawg, txo qis libido,
zaus tsis paub - gynecomastia.

Los ntawm lub hauv nruab nrab hauv lub paj hlwb:
feem ntau mob taub hau, zoo nkaus li "pom kev zoo" nyob hauv taub hau, zoo nkaus li nkees,
tsis xws luag - kiv taub hau, agevzia (poob ntawm saj tsis hnov tsw), mob tsis txaus ntseeg (ua txhaum ntawm saj tsis tau), muaj kev ntxhov siab, ntxhov siab, nce ntxiv kev npau taws, lub cev muaj zog, pw tsaug zog, nrog rau kev tsaug zog,
tsis tshua muaj - tshee, kev txhim kho lossis kev sib zog ntawm cov mob ntshav khov ntau ntawm cov keeb kwm yav dhau los ntawm voos voos txhab, vasculitis, asthenia, tsis txaus, tsis meej,
zaus tsis paub - Raynaud's syndrome, cerebral ischemia, suav nrog ischemic stroke thiab hloov cerebrovascular, mob puas hlwb psychomotor, tsis nco qab cov caj dab (mob ncus), parosmia (hnov tsis hnov tsw ntawm tsw), hnov tsis zoo, kev nyuaj siab.

Ntawm qhov txhia chaw:
nkag tsis meej - pom kev tsis txaus ntseeg, suav nrog pom kev plooj plooj, tsis tshua pom - qhov txham, hnov lus tsis zoo, tsis hnov dab tsi,

Los ntawm cov leeg musculoskeletal:
feem ntau mob ib ce mob, myalgia,
nkag siab - arthralgia.

Los ntawm lub plab zom mov:
feem ntau - muaj qhov tsis haum rau hauv plab thiab hnyuv, kem plab, tsis xis nyob hauv plab, dyspepsia, raws plab, xeev siab, ntuav,
tso tsis tau - txiav txim siab, nrog rau cov txiaj ntsig ua rau tuag taus, kev ua haujlwm ntau ntxiv ntawm pancreatic enzymes hauv cov ntshav ntshav, mob plab hnyuv, mob plab, mob plab, mob plab, ua rau lub qhov ncauj qhuav, ntxiv kev ua haujlwm ntawm daim siab enzymes (ALT, AST aminotransferases) thiab concentration of conjugated bilirubin nyob rau hauv cov ntshav ntshav, anorexia, tsis qab los,
tsis tshua muaj - glossitis, cholestatic jaundice, kab mob siab hepatocellular, qhov ntau zaus tsis paub meej - aphthous stomatitis, mob siab tsis ua haujlwm, mob cholestatic lossis mob cytolytic (kev tuag yog yam tsis tshua muaj).

Los ntawm tus txheej txheem ua pa:
feem ntau - hnoos qhuav (zuj zus thaum hmo ntuj pw), mob ntsws, mob ntsws, ua pa nyuaj,
pheej - bronchospasm, suav nrog kev ua phem ntawm cov chav kawm ntawm bronchial hawb pob, mob ntswg.

Ntawm feem ntawm daim tawv nqaij:
feem ntau - tawm pob ntawm daim tawv nqaij, tshwj xeeb maculopapular, tsis tshua muaj - angioedema, suav nrog kev ua kom tuag taus (ua pa lary yuav ua rau txhaws qa ua rau tuag), tawv nqaij ua pob khaus, hyperhidrosis (tawm hws ntau dhau), tsis tshua muaj - exfoliative dermatitis, urticaria, onycholysis,
tsis tshua muaj heev - kev hloov ua qhov muag,
tsis paub qhov tsis tu ncua - muaj tshuaj lom rau cov mob ua paug, Stevens-Johnson syndrome, erythema multiforme, pemphigus, psoriasis zuj zus ntxiv, kab mob psoriasis zoo li dermatitis, pemphigoid lossis lichenoid (lichenoid) exanthema lossis enanthema, alopecia, anaphylactic lossis anaphylactic anaphylactic tshua ntau ntxiv rau cov tshuaj lom kab), muaj zog ntxiv ntawm cov tshuaj tiv thaiv kev tawm tsam.

Los ntawm cov kabmob hemopoietic:
ua tsis tiav - eosinophilia, tsis tshua muaj - leukopenia, suav nrog neutropenia thiab agranulocytosis, qhov tsawg ntawm cov ntshav liab hauv cov ntshav nruab nrog cev, txo qis hauv hemoglobin concentration, thrombocytopenia, qhov ntau zaus tsis paub txog - kev txwv tsis pub cov leeg ntshav liab, ntshav tsis txaus, ntshav tsis txaus.

Lwm yam:
nkag siab - hyperthermia.

Kev ntsuas ntsuas:
feem ntau - kev nce poov tshuaj hauv cov ntshav, ntau zaus tsis paub txog - kev txo ntsev hauv cov ntshav. Cov neeg mob ntshav qab zib tau raug tshaj tawm hauv cov neeg mob ntshav qab zib uas tau noj tshuaj insulin thiab tshuaj tiv thaiv ntshav qab zib hauv qhov ncauj.

Noj ntau dhau

Kev cuam tshuam nrog lwm yam tshuaj

Kev siv qee qhov ua tau siab ntawm daim nyias nyias nrog qhov tsis zoo ntawm lub ntsej muag (piv txwv li, polyacrylonitrile daim nyias nyias) thaum lub sijhawm hemodialysis lossis hemofiltration thiab siv cov dextran sulfate thaum lub sijhawm apheresis ntawm tsawg lipoproteins nce qhov kev pheej hmoo ntawm kev phiv tshuaj tsis zoo.

Tsis pom zoo kev sib txuas ua ke
Nrog cov ntsev ntsev ntawm cov ntsev, potassium-sparing diuretics (piv txwv li amiloride, triamteren, spironolactone), ntau tshaj tawm hauv cov ntshiab poov tshuaj muaj peev xwm (nrog kev sib txig siv, kev soj ntsuam tas li ntawm poov tshuaj potassium yuav tsum).

Kev sib xyaw ua ke kom siv nrog ceev faj
Nrog cov tshuaj tiv thaiv kab mob siab (tshwj xeeb yog diuretics) thiab lwm yam tshuaj uas txo cov ntshav siab (nitrates, tricyclic antidepressants), lub hwj chim ntawm cov nyhuv antihypertensive raug sau tseg, hauv kev sib xyaw nrog diuretics, cov dej ntsiab lus sodium yuav tsum tau saib xyuas.

Lub ntsej muag hyperemia, xeev siab, ntuav, hypotension tsis tshua muaj nrog kev txhaj tshuaj kub.

Nrog rau kev noj tshuaj tsaug zog, narcotic analgesics, tus neeg sawv cev rau cov tshuaj loog thiab tshuaj pleev ib ce, nce ntxiv hauv cov nyhuv antihypertensive yog ua tau. Nrog vasopressor sympathomimetics (epinephrine), qhov txo qis hauv cov nyhuv antihypertensive ntawm ramipril yog sau tseg, yuav tsum tau soj ntsuam cov ntshav siab tas li.

Nrog rau cov allopurinol, procainamide, cytostatics, immunosuppressants, cov kab mob glucocorticosteroids thiab lwm yam tshuaj uas tuaj yeem cuam tshuam rau hematological tsis, qhov kev pheej hmoo ntawm kev tsim leukopenia nce.

Nrog cov roj ntsha lithium, ib qho kev nce ntxiv hauv cov dej ntawm cov lithium thiab qhov nce ntxiv ntawm cov kev mob plawv thiab neurotoxic ntawm lithium tau sau tseg.

Nrog hypoglycemic cov neeg sawv cev rau kev tswj hwm qhov ncauj (sulfonylurea derivatives, biguanides), insulin, nyob rau hauv kev sib txuas nrog qhov txo qis ntawm insulin tsis kam nyob rau hauv cawv ntawm ramipril, qhov ua rau lub ntsej muag hypoglycemic ntawm cov tshuaj no tuaj yeem txhim kho kev txhim kho hypoglycemia.

Kev sib txuas ua ke los txiav txim siab

Nrog rau cov tshuaj tsis-steroidal anti-inflammatory (indomethacin, acetylsalicylic acid), ua rau lub cev tsis muaj zog, ua rau muaj kev pheej hmoo ntawm lub raum tsis ua haujlwm thiab nce qib poov tshuaj ntau ntau yog ua tau.

Nrog rau cov tshuaj heparin, kev nce ntshav ntau ntxiv yog ua tau.

Nrog sodium chloride, nws muaj peev xwm ua kom tsis muaj zog antihypertensive nyhuv ntawm ramipril thiab kev kho mob tsis tshua muaj txiaj ntsig rau cov tsos mob ntawm mob plawv tsis ua haujlwm.

Nrog ethanol, qhov nce ntawm cov tsos mob ntawm vasodilation yog sau tseg. Ramipril tuaj yeem nce cov kev mob tshwm sim tsis zoo ntawm ethanol ntawm lub cev.

Nrog estrogens, cov nyhuv antihypertensive ntawm ramipril ua kom tsis muaj zog (cov kua dej khaws cia).

Kev kho kom zoo rau lub cev tsis ua haujlwm rau cov tshuaj lom kab: ACE inhibitors, suav nrog ramipril, ua rau muaj kev phiv tshuaj lossis tshuaj tiv thaiv kab mob rau cov tshuaj lom kab.

Tawm tsam keeb kwm ntawm kev kho mob nrog ACE inhibitors, tshuaj tiv thaiv tsis haum rau cov kab lom (piv txwv li, muv, nkawj) txhim kho sai thiab nyuaj dua. Yog tias desensitization rau cov kab ua paug tsim nyog, ACE inhibitor yuav tsum tau hloov ib ntus nrog cov tshuaj sib thooj ntawm cov chav kawm sib txawv.

Cov lus qhia tshwj xeeb

Ua ntej pib kho nrog Dilaprel ®, nws yog ib qho tsim nyog yuav tsum tshem tawm hyponatremia thiab hypovolemia. Hauv cov neeg mob uas tau noj cov tshuaj diuretics yav dhau los, nws yog qhov yuav tsum tau tso tseg lossis tsawg kawg los txo lawv cov koob tshuaj 2-3 hnub ua ntej noj Dilaprel ® (hauv qhov no, qhov mob ntawm cov neeg mob uas muaj lub plawv tsis ua haujlwm yuav tsum tau ua tib zoo saib vim muaj peev xwm tsim decompensation vim yog nce rau hauv cov ntshav ncig).

Tom qab noj thawj koob ntawm cov tshuaj, nrog rau kev nce ntxiv thiab / lossis koob tshuaj diuretics (tshwj xeeb tshaj yog voj), nws yog ib qho tsim nyog yuav tsum tau ua tib zoo saib xyuas kev kho mob ntawm tus neeg mob tsawg kawg 8 teev kom ntsuas kev tsim nyog thaum muaj ntshav siab ntau dhau.

Yog tias Dilaprel used tau siv thawj zaug lossis ntau dua nyob rau hauv cov neeg mob uas muaj ntau RAAS kev ua haujlwm, tom qab ntawd lawv yuav tsum ua tib zoo saib xyuas ntshav siab, tshwj xeeb tshaj yog thaum pib kho, vim tias cov neeg mob no muaj feem yuav ua rau muaj ntshav siab ntau ntxiv (saib nqe lus "Ceev Faj") Cov.

Thaum muaj mob tshwm sim ntawm txoj hlab ntshav siab thiab lub plawv tsis ua haujlwm, tshwj xeeb tshaj yog nyob rau theem mob myocardial infarction, kev kho mob nrog Dilaprel ® yuav tsum tau pib hauv tsev kho mob nkaus xwb.

Hauv cov neeg mob uas muaj lub plawv tsis ua haujlwm ntev, noj cov tshuaj tuaj yeem ua rau muaj kev txhim kho qhov ua rau txo qis ntshav siab, uas qee zaum muaj tus mob oliguria lossis azotemia thiab tsis tshua muaj los ntawm kev txhim kho ntawm lub raum tsis ua haujlwm. Kev ceev faj yuav tsum tau siv rau kev kho mob rau cov neeg laus, vim tias lawv yuav nkag siab tshwj xeeb rau ACE cov tshuaj tiv thaiv. Hauv thawj theem kev kho mob, nws raug nquahu los soj ntsuam cov cim ua haujlwm raum (saib ntu “Noj thiab tswj hwm”)

Hauv cov neeg mob uas tus mob ntshav nce qis yuav ua rau muaj kev pheej hmoo (piv txwv, hauv cov neeg mob atherosclerotic txoj hlab ntshav lossis hlab ntsha txhaws), kev kho mob yuav tsum pib los ntawm kev saib xyuas zoo. 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 kev txhim kho cov hlab ntsha hypotension vim muaj qhov txo qis hauv cov dej ntawm cov ntshav ncig thiab txo qis ntawm cov tshuaj sodium hauv cov ntshav.

Thaum kho nrog Dilaprel ®, haus cawv tsis pom zoo.

Kev hloov pauv ntawm cov hlab ntsha tsis yog qhov sib txuam rau txoj kev kho mob txuas ntxiv tom qab tswj kev tswj ntshav khov.

Yog tias pheej rov qab txhim kho ntawm txoj kev mob ntshav dhau los, kev noj tshuaj yuav tsum raug txo kom tsawg lossis cov tshuaj yuav tsum tau tsum mus txuas ntxiv.

Hauv cov neeg mob kho nrog ACE inhibitors, raug mob ntawm lub ntsej muag angioedema ntawm lub ntsej muag, nqua, daim di ncauj, tus nplaig, pharynx lossis larynx tau pom. Yog tias o o tshwm sim thaj tsam ntawm lub ntsej muag (daim di ncauj, tawv muag) lossis tus nplaig, tsis hnov qab nqos lossis ua pa, tus neeg mob yuav tsum tsis txhob noj cov tshuaj tam sim ntawd.

Angioneurotic edema, ua rau thaj chaw hauv tus nplaig, pharynx lossis larynx (cov tsos mob tshwm sim: tsis hnov qab nqos lossis ua pa), tuaj yeem ua rau muaj kev phom sij rau lub neej thiab xav tau kev ntsuas kom nres nws sai: kev tswj hwm ntawm 0.3-0.5 mg lossis tso dej txau ntawm 0.1 mg ntawm adrenaline (nyob rau hauv kev tswj hwm ntshav siab, lub plawv dhia thiab ECG), tom qab ntawd siv glucocorticosteroids (iv, i / m lossis sab hauv), tso ntshav tshuaj saib xyuas cov tshuaj antihistamines (blockers ntawm H1 thiab H2 histamine receptors) kuj pom zoo, thiab yog tias tsis muaj dab tsi tiv thaiv, ua liaj ua teb nta C1-esterase tuaj yeem xav txog qhov xav tau ntawm kev qhia ntxiv ntxiv rau adrenaline inhibitors ntawm enzyme C1-esterase. Tus neeg mob yuav tsum tau pw hauv tsev kho mob, thiab kev soj ntsuam yuav tsum ua kom txog thaum tus mob zoo sai, tab sis tsis pub tsawg dua 24 teev.

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 nrog ACE inhibitors, kev kuaj mob txawv yuav tsum xav txog qhov ua tau ntawm kev mob hnyuv angioedema.

Kev kho mob txhawm rau ua kom cov kab mob tsis haum (cov muv, nqaim) thiab noj ACE inhibitors tib lub sijhawm tuaj yeem ua tus mob anaphylactic thiab anaphylactoid tshua (piv txwv, txo ntshav siab, ua tsis taus pa, ntuav, ua xua ntawm daim tawv nqaij), uas qee zaum muaj kev phom sij txog lub neej. Tawm tsam keeb kwm ntawm kev kho mob nrog ACE inhibitors, tshuaj tiv thaiv tsis haum rau cov kab lom (piv txwv li, muv, nkawj) txhim kho sai thiab nyuaj dua. Yog tias desensitization rau cov kab ua paug tsim nyog, ACE inhibitor yuav tsum tau hloov ib ntus nrog cov tshuaj sib thooj ntawm cov chav kawm sib txawv.

Thaum siv ACE inhibitors, lub neej tsis muaj teeb meem, txhim kho cov teeb meem anaphylactoid ntau tau piav qhia, qee zaum txog kev txhim kho ntawm kev poob siab thaum hemodialysis lossis plasma lim siv qee yam muaj kuab muaj zog (piv txwv li, polyacrylonitrile daim nyias nyias) (saib cov lus qhia ua kua membrane). Nws yog ib qho tsim nyog kom tsis txhob muaj kev sib xyaw ua ke ntawm kev siv tshuaj Dilaprel ® thiab xws li cov qog ua pa, piv txwv, rau kev kho mob sai sai lossis hemofiltration. Hauv qhov no, kev siv lwm tus daim nyias nyias lossis qhov tshem tawm ntawm ACE inhibitors yog qhov xav tau. Cov kev cuam tshuam zoo sib xws tau pom nrog apheresis ntawm cov qog lipoproteins uas siv cov dextran sulfate. Yog li, hom no yuav tsum tsis txhob siv rau hauv cov neeg mob uas tau txais ACE inhibitors.

Ua ntej kev phais mob (suav nrog kws kho hniav), nws yog qhov yuav tsum ceeb toom rau tus neeg siv tshuaj loog txog kev siv tshuaj ACE inhibitors.

Ua ntej thiab thaum kho nrog ACE inhibitors, nws yog qhov yuav tsum tau suav tag nrho cov leukocytes thiab txiav txim siab cov mis leukocyte.

Cov kev nyab xeeb thiab ua haujlwm ntawm Dilaprel ® rau cov menyuam yaus thiab cov tub ntxhais hluas hnub nyoog qis dua 18 xyoo tsis tau teeb tsa.

Nws raug nquahu kom ua tib zoo saib xyuas cov menyuam mos uas tau nphav raug tshuaj ACE inhibitors txhawm rau txhawm rau txhawm rau kuaj kev mob ntshav hypotension, oliguria thiab hyperkalemia. Hauv oliguria, nws yog qhov tsim nyog los tswj cov ntshav siab thiab lub raum zoo nkauj los ntawm kev qhia cov kua dej kom tsim nyog thiab vasoconstrictors. Cov menyuam mos yug tshiab muaj kev pheej hmoo ntawm tus mob oliguria thiab hlab ntsha hlwb, tej zaum yuav ua rau lub raum thiab ntshav hlwb khiav qis vim qhov ntshav nce siab los ntawm ACE inhibitors (tau los ntawm cov poj niam cev xeeb tub thiab tom qab yug menyuam).

Hauv cov neeg mob uas muaj lub plawv tsis ua haujlwm ntev, noj Dilaprel ® tuaj yeem ua rau kev loj hlob ntawm cov cim ntshav tsawg, uas qee qhov mob nrog oliguria lossis azotemia, thiab tsis tshua muaj, kev txhim kho ntawm lub raum tsis ua haujlwm. Cov neeg mob uas mob ntshav tawm tsam los yog ua kom lub siab tsis ua hauj lwm yuav tsum tau pib kho hauv tsev kho mob.

Hauv cov neeg mob uas muaj lub siab ua haujlwm tsis zoo, kev tawm tsam los kho nrog Dilaprel ® tuaj yeem txhim kho lossis tsis muaj zog. Tsis tas li ntawd, nyob rau hauv cov neeg mob uas muaj mob ntshav siab nrog edema thiab / lossis ascites, kev ua haujlwm tseem ceeb ntawm renin-angiotensin-aldosterone system (RAAS) yog ua tau, yog li ntawd, kev saib xyuas tshwj xeeb yuav tsum tau coj los kho cov neeg mob no.

Saib xyuas cov ntsuas kom paub ua ntej thiab thaum kho nrog Dilaprel ® (txog 1 zaug hauv ib hlis hauv thawj 3-6 lub hlis ntawm kev kho mob)
tshwj xeeb yog qhov tseem ceeb hauv cov neeg mob uas muaj kev pheej hmoo siab neutropenia - nrog lub raum lub raum tsis ua haujlwm, cov kab mob ntawm cov nqaij sib txuas lossis hauv cov neeg mob tau txais cov tshuaj ntau dua, nrog rau thawj cov cim ntawm kev kis mob. Thaum neutropenia tau paub tseeb (tus naj npawb ntawm neutrophils tsawg dua 2000 / μl), ACE inhibitor txoj kev kho yuav tsum tsis ua mus ntxiv.

Hauv kev kho ntawm ACE inhibitors hauv thawj lub lis piam ntawm kev kho thiab tom qab ntawd tau pom zoo raum kev tswj xyuas. Kev tshuaj xyuas tshwj xeeb yog yuav tsum muaj rau cov neeg mob lub siab thiab mob plawv tsis ua haujlwm, lub raum tsis ua haujlwm, tom qab lub raum hloov pauv, cov neeg mob uas muaj kev kho mob tshiab, suav nrog cov neeg mob hemodynamically tseem ceeb unilateral renal artery stenosis nyob rau hauv muaj ob lub raum (hauv cov neeg mob ntawd, txawm tias nce me ntsis hauv cov ntshav creatinine concentration tuaj yeem yuav qhov taw qhia ntawm lub raum tsis zoo ua haujlwm).

Kev tswj xyuas hluav taws xob tsom: Peb nqua hu kom ntsuas cov ntshiab poov tshuaj. Tshwj xeeb tshaj yog saib xyuas cov ntshiab poov tshuaj yog yuav tsum muaj nyob rau hauv cov neeg mob uas lub raum tsis zoo, ua rau lub cev tsis muaj dej txaus, thiab lub plawv tsis ua haujlwm ntev.

Pom zoo kom tswj ntshav suav los txheeb xyuas cov mob leukopenia. Kev tshuaj xyuas ntau tas li raug pom zoo thaum pib kev kho mob thiab hauv cov neeg mob uas lub raum tsis ua haujlwm, nrog rau cov neeg mob cov nqaij mob sib kis lossis cov neeg mob uas tau txais lwm cov tshuaj uas tuaj yeem hloov cov duab ntawm cov ntshav nruab nrog cev (saib ntu "Kev cuam tshuam nrog lwm cov tshuaj") Cov. Kev tswj hwm ntawm tus lej ntawm cov leukocytes yog qhov tsim nyog rau kev tshawb pom thaum ntxov ntawm leukopenia, uas yog qhov tshwj xeeb tshaj yog nyob rau hauv cov neeg mob uas muaj kev pheej hmoo ntawm nws txoj kev loj hlob, zoo li ntawm thawj cov cim ntawm kev kis mob. Thaum cov tsos mob cuam tshuam nrog cov mob leukopenia tshwm sim (piv txwv, ua npaws, mob rau cov qog ntshav, tonsillitis), yuav tsum tau soj ntsuam ceev cov duab peripheral ntshav yog qhov tsim nyog. Thaum muaj cov cim los ntshav (me tshaj petechiae, pob liab liab daj rau ntawm daim tawv nqaij thiab cov qog ua kua), nws tseem yuav tsum tswj hwm cov platelets hauv cov ntshav ib puag ncig.

Yog tias qhov daj ntseg lossis qhov nce siab hauv kev ua haujlwm ntawm lub siab enzymes (aminotransferase ALT, AST) tshwm sim, kev kho mob nrog Dilaprel ® yuav tsum tsis ua haujlwm ntxiv thiab kev saib xyuas kev kho mob ntawm tus neeg mob yuav tsum tau ua kom zoo.

Tso tawm daim ntawv thiab muaj pes tsawg leeg

Dilaprel daim ntawv tsuas tshuaj - tsiav tshuaj: gelatin nyuaj, qhov loj me No. 3, ntawm koob tshuaj 2.5 mg - lub cev dawb thiab lub hau daj, ntawm kev noj ntau npaum li 5 mg - lub cev daj thiab lub hau, ntawm ntau npaum li 10 mg - lub cev dawb thiab cap, muab tub lim - hmoov loj yuav luag dawb lossis dawb, txau lossis ua kom pom tseeb, ua kom tsis sib haum thaum nias (hauv cov hlwv ntim: 7 pcs., hauv ib daim ntawv cardboard 2 lossis 4 pob, 10 pcs., hauv ib daim ntawv cardboard 1, 2, 3, 5 lossis 6 pob) , 14 pcs., Hauv daim thawv ntawv thawv 1, 2 lossis 4 ntim).

Cov nyob ua ke ntawm ib cov tshuaj ntsiav:

cov tshuaj nquag: ramipril - 2.5, 5 lossis 10 mg,
Cov khoom siv pabcuam: calcium stearate, aerosil (colloidal silicon dioxide), lactose (lactose monohydrate - rau 10 mg tsiav tshuaj),
rooj plaub thiab lub hau: gelatin, titanium dioxide, zaub mov xim hlau oxide daj (rau cov tshuaj ntsiav 2.5 mg thiab 5 mg).

Dilaprel: cov lus qhia rau kev siv (noj thiab hom)

Dilaprel tsiav tshuaj noj qhov ncauj tsis noj ntxo nrog cov dej txaus (1 /₂ khob). Qhov ua tau zoo ntawm cov tshuaj tsis yog nyob ntawm kev tau txais khoom noj.

Cov koob tshuaj yog xaiv tau ib tus zuj zus, coj mus rau hauv tus account kev soj ntsuam qhia, kho nyhuv thiab ua siab ntev rau cov tshuaj. Lub sijhawm kho yog feem ntau ntev, nws lub sijhawm nyob rau hauv txhua tus neeg mob txiav txim los ntawm tus kws kho mob.

Pom zoo Dilaprel Muab Kev Tso Cai (tshwj tsis yog muaj kev txwv tsis pub siv):

arterial hypertension: thawj koob tshuaj yog 2.5 mg 1 zaug ib hnub twg thaum sawv ntxov. Yog tias nyob hauv 3 lub lis piam cov ntshav siab tsis rov qab zoo li qub, koj tuaj yeem nce cov tshuaj txhua hnub rau 5 mg. Yog tias qhov kev siv tshuaj ntawm 5 koob tshuaj txhua hnub tsis txaus, nws yuav muab ob npaug rau hauv 2-3 lub lis piam mus txog qhov siab tshaj ntawm 10 mg rau ib hnub, lossis lwm cov tshuaj tiv thaiv kab mob tuaj yeem ntxiv rau kev kho mob, tshwj xeeb tshaj yog qeeb calcium channel blockers lossis diuretics,
daim ntawv uas muaj mob plawv sai: thawj koob - 1.25 mg ib hnub twg. Raws li cov txiaj ntsig ntawm txoj kev kho thiab nrog kev zam zoo, nws raug nquahu kom maj mam nce cov koob tshuaj, ob zaug nws nyob ntawm ncua sijhawm ntawm 1-2 lub lis piam, tab sis tsis pub tshaj 10 mg ib hnub. Cov koob tshuaj saum toj no 2.5 mg tuaj yeem noj ib zaug ib hnub lossis faib ua ob zaug,
lub plawv tsis ua haujlwm nrog cov kev mob tshwm sim uas tau tsim muaj 2–9 hnub tom qab mob myocardial infarction: koob tshuaj thawj zaug yog 2.5 mg 2 zaug hauv ib hnub (sawv ntxov thiab yav tsaus ntuj). Nrog rau kev txo ntshav siab ntau dhau, nws yog ib qho tsim nyog yuav tsum txo qis thawj zaug rau 1,25 mg 2 zaug hauv ib hnub. Tom qab ntawd, nyob ntawm tus mob ntawm tus neeg mob, lub koob tshuaj tuaj yeem muab ob npaug nrog ib lub sijhawm ntawm 1-3 hnub. Hauv qhov no, qhov ntau zaus ntawm kev noj tshuaj txhua hnub tuaj yeem txo mus rau 1 zaug hauv ib hnub. Qhov pom zoo kom zoo tshaj plaws txhua hnub koob tshuaj yog 10 mg,
kev mob ntshav siab hnyav ntawm lub plawv tsis ua haujlwm (NYHA chav kawm III - IV chav kawm ua haujlwm), uas tau tshwm sim sai sai tom qab mob myocardial infarction: koob thawj zaug - 1.25 mg ib hnub ib zaug, yav tom ntej, nrog txhua qhov nce ntawm koob tshuaj, ceev faj yuav tsum siv. Qhov tshuaj tiv thaiv thaum xub thawj thiab txuas ntxiv tsuas yog kho los ntawm tus kws kho mob nkaus xwb,
kev tiv thaiv mob stroke, myocardial infarction, lossis kev tuag los ntawm CVD (hauv cov neeg mob uas muaj kev pheej hmoo mob plawv ntau): pib koob - 2.5 mg ib hnub ib zaug. Nrog rau kev tiv thaiv zoo ntawm cov tshuaj, nws raug nquahu kom maj mam nce cov koob tshuaj. Tom qab 1 lub lim tiam ntawm kev kho mob, nws tuaj yeem kho ob npaug, tom qab ntawd tsis pub dhau 3 lub lis piam mus rau kev saib xyuas txij nkawm li 10 mg ib hnub ib zaug,
cov mob ntshav qab zib uas tsis yog mob ntshav qab zib lossis mob ntshav qab zib uas tsis muaj mob ntshav qab zib: thawj koob yog 1.25 mg ib hnub ib zaug, tom qab ntawd nws yuav nce ntxiv mus txog ntau kawg yog 5 mg / hnub, noj ib zaug.

Pom zoo Dilaprel ntau npaum kev kho rau qee yam kab mob / mob:

mob ntshav tawm hauv cov ntshav siab (qib III), ua kom cov dej ntsev-metabolism hauv lub cev tsis txaus thiab ua rau muaj ntshav siab txaus yog qhov txaus ntshai (piv txwv, nrog kev mob atherosclerotic ntau ntawm lub paj hlwb thiab cov hlab ntshav txhaws): kev pib noj - 1.25 mg ib hnub,
lub raum tsis ua haujlwm nrog CC ntawm 50–20 ml / min nrog thaj tsam ntawm 1,73 m 2: thawj koob yog 1.25 mg / hnub, qhov siab tshaj plaws niaj hnub noj yog 5 mg,
cov hnub nyoog laus dua 65 xyoo: pib siv tshuaj - 1.25 mg ib hnub,
daim siab ua haujlwm: qhov ntau kawg yog 2.5 mg ib hnub twg. Thaum pib theem ntawm kev kho, kev siv tshuaj yuav tsum tau ua nyob rau hauv kev saib xyuas kev noj qab haus huv, txij li theem ntawm cov ntshav siab tuaj yeem sib txawv rau hauv ib qho kev taw qhia lossis lwm yam.
kev kho mob yav dhau los nrog tshuaj diuretics: thawj koob tshuaj yog 1.25 mg ib hnub ib zaug thaum sawv ntxov (nws raug nquahu kom tso cov tshuaj diuretics lossis txo lawv cov tshuaj 2-3 hnub ua ntej pib Dilaprel). Thaum txhaj thawj koob tshuaj, nrog rau lub sijhawm nce ntxiv ntawm koob tshuaj ramipril thiab / lossis diuretics, txhawm rau zam kom tsis txhob muaj qhov tsis haum lub cev tsis zoo, ua tib zoo saib xyuas kev kho mob ntawm tus neeg mob lub sijhawm tsawg kawg 8 teev yog qhov tsim nyog.

Cev xeeb tub thiab lactation

Raws li cov lus qhia, Dilaprel yog contraindicated rau hauv kev xeeb tub thiab thaum pub niam mis.

Ua ntej kev kho mob, cev xeeb tub yuav tsum raug cais tawm. Yog tias muaj kev cuam tshuam tshwm sim thaum lub sijhawm noj cov tshuaj, nws yog ib qho tsim nyog yuav tsum tau muab nws tshem tawm sai li sai tau thiab muab tshuaj ntxiv

Noj Dilaprel thaum cev xeeb tub (tshwj xeeb tshaj yog nyob rau thawj peb lub hlis) tuaj yeem ua rau txo qis ntshav hauv lub cev thiab tus menyuam yug tshiab, kev loj hlob tsis zoo ntawm lub raum ntawm lub cev, kev ua haujlwm tsis zoo ntawm lub raum, hypoplasia ntawm cov pob txha pob txha taub hau, hyperkalemia, kev ua haujlwm ntawm qhov kawg, hypoplasia ntawm lub ntsws, thiab hloov kho ntawm pob txha taub hau. Rau cov menyuam yug tshiab raug rau lub cev raug rau ACE inhibitors, nws yog qhov yuav tsum tau ua tib zoo saib xyuas rau oliguria, hyperkalemia thiab arterial hypotension, ntxiv rau, lawv muaj kev pheej hmoo ntawm cov hlab ntsha tsis zoo.

Yog tias xav tau kev kho mob nrog Dilaprel thaum pub mis, kev noj niam mis yuav tsum tau tsum.

Dilaprel, cov lus qhia rau kev siv (Txoj kev thiab ntau npaum li cas)

Kev noj tshuaj ntau npaum li cas yog coj mus rau hauv cov tshuaj tiv thaiv ntawm tus neeg mob lub cev, qhov hnyav ntawm cov txheej txheem pathological. Nqos quav ntses tag nrho yam tsis ntxo thiab haus nrog dej. Qhov ntau tshaj txhua hnub qhov ntau ntawm cov tshuaj yog 10 milligrams.

Ntawm leeg ntshav siab Dilaprel pib noj nrog kev noj ntau npaum li 2.5 mg 1 zaug nyob rau ib hnub. Nrog cov tshuaj kho kom tsis muaj zog lossis nws qhov qhaj rau 21 hnub, ntau npaum li cas tau nce rau 5 mg. Hauv kev kho mob CHF qhov kev pib noj tshuaj yog 1.25 mg / hnub thiab tom qab ntawd, yog tias tsim nyog, cov tshuaj kho tau raug kho.

Nrog lub raum tsis ua haujlwm

Dilaprel yog contraindicated rau cov mob raum loj (nrog CC tsawg dua 20 ml / min nrog thaj tsam ntawm lub cev ntawm 1,73 m 2), cov neeg mob nephropathy tau kho nrog cov tshuaj tsis-steroidal anti-inflammatory (NSAIDs), glucocorticosteroids (GCS), immunomodulators thiab / lossis lwm cov neeg ua hauj lwm cytotoxic.

Nrog ceev faj, Dilaprel yuav tsum tau noj rau lub raum tsis ua haujlwm (CC ntau dua 20 ml / min nrog thaj tsam ntawm lub cev ntawm 1,73 m 2) - vim tias muaj kev pheej hmoo ntawm kev tsim mob hyperkalemia thiab leukopenia, nrog hemodynamically tseem ceeb unilateral renal leeg leeg mob (nyob rau hauv ob lub raum), thiab tom qab hloov raum.

Kev sib txuam

Tsis pom zoo rau kev sib xyaw ua ke ntawm Dilaprel nrog cov tshuaj potassium-sparing diuretics thiab cov ntsev ntsev (vim muaj kev pheej hmoo ntawm cov lus tshaj tawm ntawm cov poov tshuaj hauv cov ntshav). Kev sib xyaw ua ke kom siv nrog ceev faj.

Qhia txog Dilaprel nrog kev ceev faj:

nrog rau cov tshuaj tiv thaiv kab mob siab, tshwj xeeb yog diuretics, nrog rau cov tshuaj tiv thaiv kev ua kom tsaug zog, tshuaj tsaug zog, tshuaj kho mob vim yog lub hwj chim tshaj tawm ntawm cov nyhuv hypotensive,
nrog vasopressor sympathomimetics vim tias qhov kev pheej hmoo ntawm kev txo qis hauv cov nyhuv hypotensive ntawm cov tshuaj,
nrog procainamidetxhaj tshuaj tiv thaiv kab mob allopurinolkaw lus GKS, cytostatics thiab lwm yam tshuaj uas cuam tshuam rau hematological tsis vim muaj kev pheej hmoo ntawm txoj kev loj hlob leukopenia,
nrog hypoglycemic tshuaj rau qhov ncauj tswj hwm, vim tias qhov ua tau nce hauv hypoglycemic cov tshuaj no nrog kev pheej hmoo ntawm kev loj hlob ntshav qog,
nrog lithium ntsev ntxiv: nce neuro- thiab cardiotoxic cov teebmeem ntawm cov roj ntsha lithium,
nrog tshuaj estrogen: vim qhov muaj pheej hmoo ua kom tsis muaj zog ntawm hypotensive nyhuv tshuaj,
nrog heparin vim qhov kev pheej hmoo ntawm kev nce siab ntawm cov poov tshuaj hauv cov ntshav.

Nrog lub siab ua haujlwm tsis zoo

Hauv cov neeg mob uas lub siab tsis ua haujlwm, ob qho kev nce thiab txo qis hauv cov nyhuv ntawm ramipril tuaj yeem pom. Vim tias tsis muaj kev paub nrog kev siv, Dilaprel yuav tsum muaj ntawv ceeb toom nrog ceev faj rau cov neeg mob zoo li no.

Kev saib xyuas tshwj xeeb yuav tsum tau saib xyuas nrog kev mob hnyav ntawm lub siab nrog edema thiab / lossis ascites vim tias muaj cov haujlwm tseem ceeb ntawm RAAS.

Yeeb tshuaj sib cuam tshuam

Kev siv Dilaprel ib txhij nrog qee cov tshuaj tuaj yeem ua rau kev txhim kho ntawm cov teebmeem hauv qab no:

poov tshuaj ntsev thiab potassium-sparing diuretics (spironolactone, triamteren, amiloride), lwm yam tshuaj uas ua rau kom cov ntshav poov tshuaj ntau ntxiv (cyclosporine, tacrolimus, trimethoprim): cov plasma cov ntsiab lus ntau ntxiv,
telmisartan: ua rau muaj qhov ua rau lub raum ua rau lub raum khiav tsis zoo, ua kom tus mob ntshav tawm, ua kom lub plawv o, dias taub hau,
cov tshuaj muaj aliskiren, ntxiv rau AT1 receptor blockers (angiotensin II receptor antagonists): vim qhov ob zaug thaiv ntawm RAAS, kev pheej hmoo ntawm kev tsim hyperkalemia, kev tsis zoo hauv lub raum, kev poob siab hauv cov ntshav siab,
antihypertensive tshuaj (piv txwv li diuretics) thiab lwm yam tshuaj uas txo cov ntshav siab (tricyclic antidepressants, nitrates, tshuaj loog hauv zos thiab dav dav, alfuzosin, baclofen, prazosin, doxazosin, terazosin, tamsulosin): potentiation ntawm cov nyhuv antihypertensive,
kev npaj kub (sodium aurothiomalate) rau kev tswj hwm: ntsej muag hyperemia, ntshav tawm ntshav hypotension, xeev siab, ntuav,
Cov tshuaj noj kom tsaug zog, tshuaj tua mob thiab tshuaj yeeb: nce ntxiv cov nyhuv antihypertensive,
vasopressor sympathomimetics (isoproterenol, epinephrine, dopamine, dobutamine): qhov txo qis hauv cov nyhuv antihypertensive ntawm ramipril,
cov tshuaj tiv thaiv kab mob, corticosteroids (mineralocorticosteroids, glucocorticoids), cytostatics, allopurinol, procainamide thiab lwm yam tshuaj uas cuam tshuam rau cov tsis muaj hematological: muaj kev pheej hmoo ntawm kev tsim hematological,
lithium ntsev: ua kom cov ntshav plasma concentration ntawm lithium thiab txhim kho nws cov neuro- thiab cov teebmeem cardiotoxic,
hypoglycemic agents (suav nrog insulins, hypoglycemic cov neeg sawv cev rau kev tswj hwm ntawm qhov ncauj, sulfonylureas): muaj cov nyhuv hypoglycemic ntau ntxiv ntawm cov tshuaj no mus txog rau kev txhim kho hypoglycemia,
vildagliptin: nce ntxiv ntawm Quincke edema,
NSAIDs (acetylsalicylic acid ntawm ib koob ntawm ntau dua 3 g ib hnub, cyclooxygenase-2 inhibitors, indomethacin): kev txwv tsis pub ramipril, muaj kev pheej hmoo ntawm lub raum tsis ua haujlwm thiab nce ntxiv ntawm cov poov tshuaj hauv ntshav ntshav,
sodium chloride: kev ua kom lub zog ntawm cov nyhuv ua kom tsis muaj zog ntawm ramipril,
heparin: ntshiab si poov tshuaj kom sov,
ethanol: cov tsos mob nce ntxiv ntawm vasodilation, nce ntxiv tsis zoo ntawm ethanol rau lub cev,
estrogens: kev txo qis hauv cov nyhuv hypotensive ntawm ramipril,
lwm cov ACE inhibitors: muaj kev pheej hmoo ntawm kev txhim kho lub raum tsis ua haujlwm (suav nrog cov ntaub ntawv mob), hyperkalemia,
kev npaj muaj nyob hauv kev kho txoj kev ua kom zoo rau cov kab hymenoptera: ua rau muaj kev phiv tshuaj lossis tshuaj tiv thaiv kev tsis haum hymenoptera paum.

Cov qauv ntawm Dilaprel yog: Prenesa, Diroton, Enap, Lipril, Renipril.

Kev txheeb xyuas ntawm Dilaprel

Kev txheeb xyuas txog Dilaprel muaj tsawg thiab feem ntau zoo. Cov tshuaj ua haujlwm tau zoo thaum nws tsim nyog los ua kom ntshav siab ob leeg ntawm nws tus kheej thiab hauv kev sib xyaw nrog lwm cov tshuaj. Cov kev xav tsis zoo muaj qhov tsis tshua muaj neeg. Txawm li cas los xij, nws tau sau tseg tias nrog kev siv lub caij nyoog ntev, kev muaj yees thiab ua kom lub zog ntawm cov nyhuv tshwm sim.

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

Dilaprel tsiav tshuaj noj qhov ncauj, nqos tag nrho thiab ntxuav nrog qhov dej txaus (100 ml), ua ntej, thaum lossis tom qab noj mov.

Tus kws kho mob sau cov tshuaj thiab lub sijhawm rau kev kho mob ib tus zuj zus, suav txog qhov ntsuas kev kuaj mob, kev muaj peev xwm ntawm cov tshuaj thiab cov nyhuv kho. Lub sijhawm siv yog feem ntau ntev.

Pom zoo Dilaprel Noj:

arterial hypertension: thawj koob tshuaj yog 2.5 mg ib zaug thaum sawv ntxov. Yog tias ntshav siab tsis zoo li qub tom qab 21 hnub ntawm kev kho, qhov tshuaj txhua hnub yuav raug nce ntxiv rau 5 mg. Thaum tsis muaj kev kho mob txaus los ntawm kev siv tshuaj ntau dua, tus neeg mob tuaj yeem ntxiv lwm qhov kev siv tshuaj tiv thaiv kab mob (nrog rau cov diuretics lossis qeeb calcium channel blockers), lossis tom qab 14-21 hnub ntawm kev siv, nce nws kom ntau kawg ntawm 10 mg ib hnub twg,
mob plawv tsis ua haujlwm: thawj koob - 1,25 mg ib hnub twg. Nrog rau kev tiv thaiv zoo ntawm cov tshuaj, cov koob tshuaj tuaj yeem hloov zuj zus, nrog lub sijhawm 7-14 hnub, rau ib koob tshuaj uas muab kev tswj txaus tus kabmob, tabsis tsis pub ntau tshaj 10 mg rau ib hnub. Ib koob tshuaj saum toj no 2.5 mg tuaj yeem faib ua 2 koob tshuaj,
soj ntsuam lub plawv tsis ua haujlwm, tsim los ntawm 2 txog 9 hnub tom qab mob myocardial infarction: koob tshuaj thawj zaug - 2.5 mg 2 zaug hauv ib hnub (sawv ntxov thiab yav tsaus ntuj). Thaum muaj ntshav nce siab ntau, qhov yuav tsum tau txo rau thawj zaug rau 1.25 mg 2 zaug ib hnub. Tom qab ntawd, muab cov xwm txheej ntawm tus neeg mob, cov koob tshuaj tuaj yeem muab ob npaug nrog ib lub sijhawm ntawm 1-3 hnub. Tom qab ntawd tus neeg mob tuaj yeem hloov mus rau ib koob tshuaj txhua hnub. Cov koob tshuaj txhua hnub yuav tsum tsis pub tshaj 10 mg,
lub siab mob plawv tsis ua haujlwm sai (NYHA chav kawm III - IV ua haujlwm hauv chav kawm) uas tau tshwm sim sai sai tom qab mob myocardial infarction: koob thawj zaug - 1.25 mg ib hnub ib zaug, tom qab ntawd yuav tsum tau saib xyuas tshwj xeeb ntawm txhua qhov koob tshuaj nce,
tsis mob ntshav qab zib lossis ntshav qab zib nephropathy: thawj koob yog 1.25 mg ib hnub ib zaug. Ntxiv mus, nws tuaj yeem raug nce siab rau qhov siab tshaj plaws txhua hnub koob tshuaj 5 mg thiab noj ib zaug,
ib qho kev txo qis ntawm qhov muaj feem yuav tsim muaj myocardial infarction, mob hlab ntsha tawg, lossis lub plawv tuag rau cov neeg mob uas muaj kev pheej hmoo mob plawv ntau: thawj koob yog 2.5 mg ib hnub ib zaug. Nrog kev tiv thaiv zoo ntawm cov tshuaj, nws pom zoo kom muab ob npaug rau koob tshuaj tom qab 7 hnub ntawm kev kho mob, tom qab ntawd li 21 hnub ntawm kev kho mob, nce nws mus rau 10 mg - koob tshuaj txij nkawm.

Pom zoo kev hloov kho ntawm Dilaprel ntau npaum cov neeg mob tshwj xeeb:

lub raum tsis ua hauj lwm zoo (CC 50 ml20 ml / min rau 1.73 m 2 lub cev saum npoo): kev txhaj tshuaj txhua hnub - 1.25 mg. Qhov siab tshaj plaws yog 5 mg rau ib hnub,
ua txhaum ntawm cov dej-electrolyte tshuav, lossis ntshav tawm ntawm cov ntshav ntau heev, lossis cov leeg mob atherosclerotic ntau dua ntawm cov hlab ntshav tawm thiab cov hlab ntsha hauv lub cev: qhov pib koob yog 1.25 mg ib hnub,
cov neeg mob hnub nyoog 65 xyoos: koob tshuaj pib - 1.25 mg ib hnub,
lub siab ua haujlwm tsis txaus siab: qhov siab tshaj plaws niaj hnub noj yog 2.5 mg. Cov tshuaj yuav tsum tau noj thaum pib ntawm kev kho mob nyob rau hauv kev saib xyuas mob nkeeg, txij li ntshav siab tuaj yeem txo qis lossis nce ntxiv.

Rau cov neeg mob uas kho cov diuretic ua ntej, kev siv tshuaj Dilaprel tsuas yog qhia ob peb hnub tom qab tshem tawm lossis txo qis cov tshuaj txhaj ntawm diuretics thaum pib noj tshuaj txhua hnub ntawm 1.25 mg. Tom qab siv tshuaj thawj zaug thiab ntawm txhua qhov nce, tus neeg mob yuav tsum tau txais kev saib xyuas kev noj qab haus huv rau 8 teev kom tiv thaiv kev txhim kho ntawm cov tshuaj tiv thaiv tsis haum hypotensive.

Dilaprel, cov lus qhia rau kev siv (qauv thiab ntau npaum li cas)

Dilaprel tsiav tshuaj yog noj ntawm qhov ncauj, tsis hais txog ntawm cov khoom noj, ntxuav nrog ib nrab khob dej.

Cov koob tshuaj ntawm cov tshuaj tau xaiv ib tus zuj zus, suav txog qhov nws ua tau siab ntev thiab ua tiav cov txiaj ntsig kho. Cov kev kho mob feem ntau yog siv sijhawm ntev.

Cov tshuaj pom zoo ntau npaum rau cov neeg mob siab thiab lub raum ua haujlwm:

nce ntshav siab: 2.5 mg ib hnub ib zaug (thaum sawv ntxov), tom qab 3 lub lis piam ntawm kev noj tshuaj ntawm qhov tshuaj no thiab qhov tsis tshwm sim zoo, nws muaj peev xwm nce qhov koob tshuaj ntau dua 5 mg rau ib hnub, tom qab lwm 2-3 lub lis piam ntawm kev noj tshuaj ntawm koob tshuaj 5 mg nyob rau hauv cov ntaub ntawv ntawm nws qhov tsis muaj txiaj ntsig, qhov kev noj tshuaj txhua hnub tuaj yeem nce mus txog qhov siab tshaj plaws ntawm 10 mg, lwm txoj kev xaiv kuj tseem muaj peev xwm - kev siv Dilaprel ntawm koob tshuaj 5 mg ib hnub thiab ntxiv ntawm lwm cov tshuaj tiv thaiv kab mob rau kev kho mob, piv txwv li, qeeb calcium channel blockers lossis diuretics,
mob plawv tsis ua hauj lwm: 1.25 mg ib hnub ib zaug thaum pib kho, tom qab ntawd, coj mus rau hauv tus neeg mob qhov tshuaj tiv thaiv, nws muaj peev xwm ua ob npaug koob tshuaj nyob rau txhua 1-2 lub lis piam mus txog qhov siab tshaj plaws txhua hnub noj 10 mg,
lub plawv tsis ua hauj lwm uas tsim tawm tom qab mob myocardial infarction nyob rau lub sijhawm txij hnub 2 mus rau hnub 9: 5 mg ib hnub hauv ob koob (thaum sawv ntxov thiab yav tsaus ntuj) thaum pib kho, nrog kev tsis haum rau thawj koob rau ob hnub yuav tsum noj 1 , 25 mg ntawm ramipril ob zaug hauv ib hnub, yav tom ntej, coj mus rau hauv tus neeg mob qhov tshuaj tiv thaiv, nws yog ua tau rau ob zaug koob tshuaj txhua 1-3 hnub kom txog thaum qhov siab tshaj plaws txhua hnub ntawm 10 mg tau mus txog, qhov ntau zaus ntawm kev siv tshuaj ntawm lub sijhawm dhau los tuaj yeem txo mus rau ib hnub ib zaug,
Mob raum (nephropathy): 1,25 mg ib hnub ib zaug thaum pib kho, yav tom ntej, ntau npaum li cas yuav nce ntxiv rau 5 mg ib hnub ib zaug (ntau tshaj ib hnub ib zaug),
kev txo qis hauv txoj kev pheej hmoo ntawm mob hlab ntsha tawg, plawv nres lossis muaj kev pheej hmoo ntawm cov hlab plawv tuag hauv cov neeg mob los ntawm cov pab pawg mob plawv ntau: 2.5 mg ntawm ramipril ib zaug ib hnub thaum pib kho, ntau npaum li cas ntawm cov tshuaj yuav tsum tau ob npaug tom qab 1 lub lis piam, thiab dhau 3 lub lis piam tom ntej qhov kev txhaj tshuaj ntawm Dilaprel tuaj yeem nce ntxiv txog 10 mg ib hnub ib zaug.

Yog tias tsis ua haujlwm li lub raum (kev tsim kho lub peev xwm ntawm 50–20 ml / min), cov tshuaj yuav tsum siv nyob rau hauv thawj hnub ntawm 1.25 mg, thiab qhov siab tshaj plaws hauv cov neeg mob ntawd yuav tsum tsis pub ntau tshaj 5 mg ib hnub.

Hauv kev mob ntshav siab heev, hauv cov neeg mob uas tsis muaj dej-electrolyte tshuav nyiaj li cas thiab hauv cov neeg mob rau cov ntshav siab tseem ceeb yog qhov cuam tshuam nrog qee qhov kev pheej hmoo, qhov pib ntawm ramipril yog 1.25 mg rau ib hnub.

Cov neeg mob uas tau txais kev kho mob ua ntej pib kho nrog Dilaprel yuav tsum, yog tias ua tau, tsum tsis txhob noj 2-3 hnub ua ntej pib kho lossis txo lawv cov koob tshuaj. Kev kho mob Ramipril yuav tsum tau pib nrog ib koob tshuaj 1.25 mg ib hnub ib zaug. Tom qab noj cov tshuaj thawj zaug, nrog rau txhua qhov nce ntawm cov tshuaj thiab / lossis cov tshuaj diuretics, ua tib zoo tshuaj xyuas tus neeg mob yuav tsum muaj tsawg kawg yog 8 teev, uas yuav pab kom tsis txhob muaj kev tswj hwm cov ntshav siab.

Cov neeg mob uas muaj hnub nyoog 65 xyoos yuav tsum tau txais Dilaprel nyob rau hauv thawj zaug ntawm 1.25 mg rau ib hnub.

Yog tias ua rau lub siab tsis ua haujlwm, qhov yuav tsum tau txhaj ntau tshaj plaws ntawm lub hnub yuav tsum tsis pub tshaj 2.5 mg.

Tus nqi ntawm Dilaprel hauv cov chaw muag tshuaj

Tus nqi ntawm Dilaprel hauv cov khw muag tshuaj sib txawv nws txawv me ntsis thiab muaj ntau dua ntawm kev haus thiab ntim. Kwv yees tus nqi ntawm cov tshuaj hnub no: 2.5 mg tsiav tshuaj (28 pcs. Hauv ib pob) - 149 rubles, 5 mg tsiav tshuaj (28 pcs. Hauv ib pob) - 227-266 rubles, 10 mg tsiav tshuaj (28 pcs. Hauv ib pob) - 267-315 rubles.

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