Yuav siv cov tshuaj Telsartan N li cas?

Kev piav qhia ntawm daim ntawv tshuaj

Ntsiav tshuaj 12,5 mg + 40 mg. Oval, biconvex, ob-txheej, ib txheej los ntawm lub teeb liab dawb mus rau xim liab, lwm txheej los ntawm dawb mus rau yuav luag dawb nrog cov ua tau sib xyaw xim liab. Nyob rau saum npoo dawb ntawm cov ntsiav tshuaj muaj qhov pheej hmoo thiab lub ntsej muag "T" thiab "1" nyob rau sab nraud ntawm nws.

Ntsiav tshuaj 12,5 mg + 80 mg. Oval, biconvex, ob-txheej, ib txheej los ntawm lub teeb liab dawb mus rau xim liab, lwm txheej los ntawm dawb mus rau yuav luag dawb nrog cov ua tau sib xyaw xim liab. Nyob rau saum npoo dawb ntawm cov ntsiav tshuaj muaj qhov pheej hmoo thiab lub pob "T" thiab "2" nyob rau sab nraud ntawm nws.

Dosage daim ntawv

Qhov yooj yim lub cev thiab tshuaj:

cov ntsiav tshuaj los ntawm dawb rau yuav luag dawb, tsis muaj lub plhaub, lub plhaw-lub ntsej muag, nrog cov ntawv luam tawm "T" thiab "L" ntawm ob sab ntawm cov kab ua txhaum ntawm ib sab thiab sau "40" (rau cov ntsiav tshuaj ntawm 40 mg) lossis xav txog "80" ( rau cov ntsiav tshuaj ntawm 80 mg) ntawm lwm sab.

Cov Yuav Tsum Muaj

Cov tshuaj tiv thaiv kab mob siab (nrog rau lwm cov sulfonamide derivatives, cholestasis, mob siab tsis ua hauj lwm, mob raum tsis ua haujlwm (CC tsawg dua 30 ml / min), mob hypokalemia, hyponatremia, hypercalcemia, mob ntshav qab zib fructose intolerance (muaj sorbitol), cev xeeb tub, lactation, lub hnub nyoog txog 18 xyoo (qhov ua tau zoo thiab kev nyab xeeb tsis tau tsim) C ceev faj: Lub siab ua haujlwm lossis mob siab rau daim siab (muaj kev pheej hmoo ua rau mob hepatic vim muaj teeb meem hluav taws xob tsis zoo), ob tog lub raum. txoj hlab ntsha hauv plab los yog ua kom qhov ncauj tawm ntawm lub raum ib leeg, lub raum tsis ua haujlwm, mob tom qab lub raum hloov, txo qis bcc (kev kho mob diuretic dhau los, kev noj haus nrog kev txwv ntsev, raws plab lossis ntuav), lub plawv tsis ua haujlwm, aortic lossis mitral stenosis, GOKMP, ntshav qab zib mellitus, CHD, SLE mob gout.

Yuav siv li cas: noj ntau thiab hom tshuaj kho

Sab hauv, tsis hais txog ntawm cov khoom noj, 1 zaug hauv ib hnub.

Cov ntsiav tshuaj nrog qhov sib piv ntawm telmisartan / hydrochlorothiazide 40 / 12.5 mg thiab 80 / 12.5 mg tuaj yeem muab rau cov neeg mob uas siv cov tshuaj telmisartan ntawm koob tshuaj 40 lossis mg lossis hydrochlorothiazide ntawm koob tshuaj 12,5 mg tsis ua rau muaj kev tswj ntshav siab txaus.

Koob tshuaj hloov kho rau lub raum tsis ua hauj lwm los ntawm mob sib khuav thiab me, nrog rau cov neeg laus, tsis tas yuav.

Nrog rau daim siab ua haujlwm ntawm qhov mob me mus rau mob hnyav, cov koob yuav tsum tsis pub tshaj 40 / 12,5 mg rau ib hnub.

Pharmacological kev txiav txim

Telmisartan yog tus paub tab ntawm kev tiv thaiv ntawm angiotensin II receptors (hom AT1). Txom cov tshuaj angiotensin II los ntawm qhov sib txuas nrog cov receptor, tsis muaj cov kev ua ntawm agonist nyob rau hauv kev sib raug zoo nrog cov receptor no. Nws tsim kev sib raug zoo mus ntev tsuas yog AT1 subtype ntawm angiotensin II receptors. Nws tsis muaj kev sib txuam rau lwm tus txais, suav nrog AT2 receptor thiab lwm tus, tsawg dua kawm angiotensin receptors. Telmisartan ua rau kev txo qis hauv kev suav ntawm aldosterone hauv cov ntshav ntshav. Tsis muaj kev cuam tshuam dab tsi rau kev ua haujlwm ntawm plasma renin thiab ion channels, ACE, tsis cuam tshuam rau bradykinin.

Ntawm ib koob ntawm 80 mg, qhov cuam tshuam ntawm lub siab ntawm angiotensin II yog tag sim. Cov nyhuv ntawm cov tshuaj no ntev dua li 24 teev, suav nrog 4 teev kawg ua ntej noj dua ntxiv. Qhov pib ntawm kev ua yeeb yam tsis zoo yog sau tseg tsis pub dhau 3 teev tom qab txhaj thawj. Qhov siab tshaj plaws nyob rau hauv cov ntshav siab feem ntau pom 4 lub lis piam tom qab pib ntawm kev kho mob.

Nrog rau cov hlab ntsha o, nws txo systolic thiab diastolic ntshav siab, tsis cuam tshuam rau lub plawv dhia. Nyob rau hauv cov ntaub ntawv ntawm kev tshem tawm sai ntawm telmisartan, ntshav siab maj mam rov qab los rau nws thawj qib tsis muaj kev txhim kho ntawm "tshem tawm" syndrome.

Hydrochlorothiazide yog thiazide diuretic. Nws tsis cuam tshuam rau qhov rov tsim cov roj hluav taws xob hauv cov hlaus rov qab, ncaj qha nce kev nthuav dav ntawm Na + thiab Cl- (kwv yees nyob rau hauv tus nqi sib npaug). Cov nyhuv diuretic ua rau txo qis hauv bcc, kev nce rau hauv cov kev ua ntawm plasma renin, ib qho kev zais ntawm aldosterone thiab muaj kev cuam tshuam nrog cov ntsiab lus ntawm K + thiab bicarbonates hauv cov zis, ntxiv rau hypokalemia. Nrog tib lub sijhawm tswj hwm ntawm telmisartan, qhov txo qis hauv K + vim los ntawm hydrochlorothiazide raug sau tseg, txawm tias yog qhov thaiv ntawm cov renin-angiotensin-aldosterone system. Tom qab noj hydrochlorothiazide, diuresis siv zog ntxiv tom qab 2 teev, cov nyhuv siab tshaj plaws yog pom tom qab txog 4 teev. Cov diuretic effect tseem muaj txog li 6-12 teev.

Qhov siab tshaj plaws ntawm cov tshuaj antihypertensive feem ntau ua tiav 4 lub lis piam tom qab pib ntawm kev kho mob.

Sab sij huam

Los ntawm cov txheej txheem ua pa: sab saud mob ntsws (suav nrog rau mob ntsws, pharyngitis, hlab ntsws), ua pa luv, ua pa, mob ntsws ua pa (nrog rau mob ntsws thiab mob ntsws).

Los ntawm CCC: bradycardia, tachycardia, arrhythmia, cim txo nyob rau hauv cov ntshav siab, orthostatic hypotension, necrotic angiitis (vasculitis), mob hauv siab.

Los ntawm sab hauv lub hauv nruab nrab ntawm cov hlab ntsha hauv lub cev: nce siab kev npau taws, paub txog kev ntshai, kev nyuaj siab, ntxhov siab, kiv taub hau, tsaus muag, pw tsaug zog, tsis khov thaum taug kev, paresthesia.

Los ntawm lub plab zom mov: mob plab, raws plab, dyspepsia, mob plab, tsis nco qab, tsis qab los, mob sialadenitis, lub qhov ncauj qhuav, plooj, ntuav, cem quav, pancreatitis, daj ntseg (hepatocellular lossis cholestatic).

Los ntawm cov kab mob endocrine: hyperglycemia, glucosuria, mob tsis hnov ​​lus qab zib.

Los ntawm ib sab ntawm cov metabolism: hypercholesterolemia, hyperuricemia, hypokalemia, hyponatremia, poob qis BCC, cuam tshuam cov roj ntsha electrolyte metabolism, hypercalcemia.

Los ntawm cov ntshav hemopoietic plab hnyuv siab raum: eosinophilia, aplastic anemia, hemolytic anemia, myelodepression, leukopenia, neutropenia / agranulocytosis, thrombocytopenia.

Los ntawm cov kab mob ntawm lub tso zis: kis kab mob ntawm cov mob txeeb zig, mob interstitial nephritis, ua kom lub raum khiav tsis zoo.

Los ntawm qhov system musculoskeletal: mob pob txha, mob pob txha, mob nraub qaum, mob ceg qis dua, mob leeg nqaij, txhaws ntswg ntawm cov leeg plab (pob txha), cov tsos mob zoo li mob leeg, leeg tsis muaj zog, mob leeg.

Ua xua: anaphylactic kev ua xua, eczema, erythema, tawv nqaij khaus, tawv nqaij zoo li tawv nqaij, tawv nqaij ua xua, ua kom tawv nqaij, tawv nqaij ua pob, SLE exacerbation, tshuaj lom epidermal necrolysis, angioedema, urticaria.

Los ntawm cov plab hnyuv siab tuaj ntawm lub cev: qhov pom ntawm lub qhov muag tsis meej, qhov muag pom kev pom (hloov chaw), xanthopsia, vertigo.

Los ntawm cov muaj yug me nyuam: txo potency.

Qhov ntsuas pom: txo qis hauv Hb, hypercreatininemia, kev ua haujlwm ntau ntxiv ntawm "daim siab" hloov pauv, hypertriglyceridemia.

Lwm yam: zoo li khaub thuas xws li mob khaub thuas, kub taub hau, tawm hws ntau dhau. Cov tsos mob (telmisartan): cim txo hauv cov ntshav siab, tachycardia thiab / lossis bradycardia.

Cov tsos mob (hydrochlorothiazide): hypokalemia (mob leeg, nce ntau ntawm lub cev los ntawm tib lub sijhawm siv plawv mob los yog tshuaj tiv thaiv kab mob), hypochloremia, lub cev qhuav dej vim ntau yam diuresis, xeev siab, qaug zog.

Kev Kho Mob: induction ntuav, pais plab lav, ua pa hluav taws, tshuaj lom thiab txhawb kev saib xyuas, tshuaj xyuas cov tshuaj electrolytes thiab creatinine nyob rau hauv cov ntshav cov ntshav. Nyob rau hauv cov ntaub ntawv ntawm cov cim txo nyob rau hauv cov ntshav siab, tus neeg mob yuav tsum muab tso rau hauv txoj hauj lwm tav toj, rov qab ua rau qhov tsis muaj electrolytes, bcc.

Telmisartan tsis raug tshem tawm los ntawm hemodialysis. Cov theem ntawm tshem tawm ntawm hydrochlorothiazide thaum hemodialysis tseem tsis tau tsim.

Cov lus qhia tshwj xeeb

Hauv cov neeg mob uas muaj ob lub raum mob raum ua rau lub plawv los yog txoj hlab ntshav tawm ntawm lub raum tsuas ua haujlwm lub raum thaum siv cov tshuaj uas cuam tshuam rau renin-angiotensin-aldosterone system, txoj kev pheej hmoo ntawm lub suab txo qis thiab lub raum tsis ua haujlwm nce.

Tsis muaj kev paub txog kev npaj hauv cov neeg mob uas lub raum tsis ua haujlwm loj lossis tom qab tau hloov raum. Nrog cov mob me me lossis mob hnyav ntawm lub raum tsis ua haujlwm, kev txiav txim siab lub sijhawm ntawm kev txiav txim siab ntawm K +, creatinine hauv ntshav cov ntshav tau pom zoo. Kev siv ntawm thiazide diuretics hauv cov neeg mob uas lub raum tsis ua haujlwm tuaj yeem ua rau azotemia. Pom zoo sij hawm saib xyuas lub raum ua haujlwm yog qhov pom zoo.

Hauv cov neeg mob uas txo qis hauv BCC thiab / lossis hyponatremia (vim kev kho mob diuretic, txwv tsis pub ntsev ntau, raws plab lossis ntuav), qhov chaw kho mob tau txo qis ntshav siab yuav tshwm sim, tshwj xeeb yog tom qab noj thawj koob ntawm cov tshuaj. Ua ntej pib siv cov tshuaj, kev kho ntawm cov kev tsis sib haum xeeb yog qhov tsim nyog.

Hauv cov neeg mob uas muaj mob CHF ntau heev, lub raum mob hlab ntsha hlwb, kev siv cov tshuaj uas cuam tshuam rau lub xeev ntawm renin-angiotensin-aldosterone system tuaj yeem nrog kev txhim kho kev txo qis hauv cov ntshav siab, hyperazotemia, oligouria, lossis, tsis tshua muaj mob, mob raum tsis ua haujlwm.

Hauv cov neeg mob uas muaj cov thawj hyperaldosteronism, cov tshuaj tiv thaiv kev tiv thaiv kab mob, qhov kev hloov pauv ntawm qhov kev tiv thaiv uas yog los tiv thaiv qhov kev ua ntawm renin-angiotensin-aldosterone system, feem ntau tsis muaj txiaj ntsig. Hauv cov xwm txheej zoo li no, kev teem sij hawm tshuaj tsis pom zoo.

Hauv cov neeg mob ntshav qab zib, yuav tsum tau txhaj tshuaj insulin los yog tshuaj hauv lub qhov ncauj hypoglycemic kom tsim nyog. Thaum kho nrog thiazide diuretics, ib hom mob ntshav qab zib tuaj yeem tshwm sim.

Qee qhov xwm txheej, kev siv cov thiazide diuretics tuaj yeem txhim kho hyperuricemia thiab gout.

Thaum lub sijhawm kev kho mob, kev saib xyuas txhua lub sijhawm ntawm kev saib xyuas cov electrolytes hauv cov ntshav cov ntshav yog tsim nyog.

Txoj kev pheej hmoo ntawm hypokalemia nce nyob rau hauv cov neeg mob qog mob ntshav nce ntshav, nrog cov diuresis ntau dua, muaj qhov ncauj tsis txaus ntawm cov electrolytes, zoo li nyob rau hauv rooj plaub ntawm kev siv GCS lossis ACTH tib lub sijhawm.

Telmisartan, uas yog ib feem ntawm cov tshuaj, tuaj yeem ua rau hyperkalemia. Txawm hais tias thaj chaw kho mob tseem ceeb hyperkalemia tsis tau tshaj tawm nrog kev siv ntawm kev npaj, nws yuav tsum raug sau tseg tias muaj kev pheej hmoo rau nws txoj kev loj hlob muaj xws li lub raum thiab / lossis lub plawv tsis ua haujlwm thiab ntshav qab zib mellitus.

Tsis muaj pov thawj qhia tias qhov tshuaj tuaj yeem txo lossis tiv thaiv hyponatremia tshwm sim los ntawm cov tshuaj diuretic. Hypochloremia feem ntau yog hais me ntsis thiab tsis tas yuav tsum tau kho.

Hydrochlorothiazide tuaj yeem txo Ca2 + kev tsis pom zoo thiab ua rau (thaum tsis paub Ca2 + metabolic cuam tshuam) tsis hloov thiab muaj me me hypercalcemia. Ntau dua hypercalcemia tseem ceeb yuav yog ib qho kev mob latent hyperparathyroidism. Ua ntej txiav txim siab txoj haujlwm ntawm cov qog parathyroid, cov tshuaj yuav tsum tau tshem tawm.

Hauv cov neeg mob uas muaj mob ua mob rau cov hlab ntshav ntawm lub cev, qhov kev poob qis ntawm cov ntshav siab tuaj yeem ua rau myocardial infarction lossis mob stroke.

Qhov pom zoo txhua hnub koob ntawm 40 / 12.5 lossis 80 / 12.5 muaj 169 lossis 338 mg ntawm sorbitol, ua ntu zus.

Txoj kev pheej hmoo ntawm kev tsim kev tsis haum tshuaj rau qhov muaj mob hydrochlorothiazide yog nce ntxiv hauv cov neeg mob uas muaj keeb kwm kev ua xua lossis ua pa hawb pob.

Muaj cov ntawv tshaj tawm txog kev nthuav dav ntawm SLE siv thiazide diuretics.

Cov tshuaj muaj peev xwm, yog tsim nyog, siv nrog lwm cov tshuaj tiv thaiv antihypertensive.

Thaum lub sijhawm kho mob, yuav tsum tau ceev faj thaum xyaum ua tej yam ua rau muaj kev phom sij (suav nrog kev tsav tsheb) uas yuav tsum muaj kev saib xyuas ntau dua thiab ceev ntawm cov kev xav psychomotor (muaj peev xwm tsim kiv taub hau thiab qaug zog thaum siv tshuaj tiv thaiv tshuaj tiv thaiv).

Telmisartan tsis muaj teratogenic effect, tab sis muaj cov nyhuv fetotoxic. Xws li thaum lub sijhawm cev xeeb tub, cov tshuaj yuav tsum tau hloov nrog lwm cov tshuaj uas pom zoo rau siv thaum cev xeeb tub. Yog tias muaj menyuam hauv plab, koj yuav tsum tsum tsis txhob noj cov tshuaj tam sim ntawd.

Hauv lub sijhawm thib II thiab III, kev siv tshuaj yaj yeeb tuaj yeem ua rau xaim hluav taws xob hauv cov menyuam hauv plab. Kev loj hlob ntawm neonatal thrombocytopenia, jaundice (nyob rau hauv tus menyuam lossis tus menyuam yug tshiab) tus niam noj thiazide diuretics tau tshaj tawm. Nws tsis paub meej tias telmisartan tau nkag mus rau hauv niam mis, thiazide diuretics dhau mus rau hauv niam cov kua mis thiab tuaj yeem tiv thaiv lactation.

Kev sib txuam

Nrog tib lub sijhawm siv ntawm Li + thiab angiotensin II receptor antagonists, qhov nce ntawm cov concentration ntawm Li + hauv cov ntshav cov ntshav thiab nce ntxiv hauv kev ua kom muaj kuab lom. Kev siv hydrochlorothiazide txo cov kev tshem tawm ntawm Li +. Kev saib xyuas zoo yog qhov tsim nyog, saib xyuas qhov tob ntawm Li + hauv ntshiab.

Cov nyhuv hypokalemic ntawm hydrochlorothiazide yog pab txhawb los ntawm cov ntsiab lus ntawm potassium-sparing ntawm telmisartan. Txawm li cas los xij, kev tiv thaiv hypokalemic ntawm hydrochlorothiazide tuaj yeem txhim kho los ntawm lwm cov tshuaj uas ua rau hypokalemia (suav nrog rau lwm cov tshuaj diuretics, laxatives, GCS, ACTH, amphotericin, carbenoxolone, penicillin G sodium, salicylic acid thiab nws cov neeg raug mob).

Kev siv cov pa tshuaj hu ua potassium-sparing diuretics, K + kev npaj, thiab lwm yam tshuaj uas tuaj yeem ua kom muaj ntshav ntau ntau cov ntsiab lus K + (suav nrog sodium heparin), K +-tsis muaj tshuaj noj muaj txiaj ntsig zoo tuaj yeem ua rau hyperkalemia.

Nrog rau kev siv tshuaj nrog cov mob glycosides, tshuaj tiv thaiv kab mob thiab lwm yam tshuaj uas ua rau lub plawv dhia tsis xws luag xws li pirouette, kev soj ntsuam ib zaug ib zaug ntawm cov concentration ntawm K + hauv cov ntshav ntshav tau pom zoo.

Telmisartan ua rau kev kho mob hypotensive ntawm lwm cov tshuaj tiv thaiv kabmob ntshav.

Cov tshuaj muaj peev xwm ua kom muaj kev nce siab ntau ntawm digoxin (txog 39%), yog li ntawd, kev saib xyuas ntshav plasma ntau ntawm digoxin yuav tsum tau ua.

Kev siv cov tshuaj hydrochlorothiazide nrog ethanol, barbiturates, narcotic analgesics - qhov kev pheej hmoo ntawm kev txhim kho orthostatic hypotension, nrog cov tshuaj hypoglycemic (ob qho tib si ntawm qhov ncauj thiab insulin) - kev siv tshuaj ntau dua ntawm cov tshuaj hypoglycemic tej zaum yuav tsum tau, nrog metformin - qhov kev pheej hmoo ntawm lactic acidosis, nrog rau cov tshuaj hypoglycemic (ob qho tib si ntawm qhov ncauj thiab insulin) nrog mob glycosides - txoj kev pheej hmoo ntawm hypokalemia los yog hypomagnesemia (arrhythmias), nrog NSAIDs - txo qis hauv diuretic, natriuretic thiab antihypertensive cuam tshuam hydrochlorothiazide, nrog pressor amines (suav nrog norepinephrine - qhov ua kom tsis muaj zog ntawm cov nyhuv ntawm pressor amines, nrog cov tsis-depolarizing nqaij relaxants (suav nrog tubocurarine) - kev nce hauv kev ua ntawm cov nqaij leeg, nrog antigout - kev kho kom haum ntawm uricosuric tshuaj yuav tsum tau, vim (vim tias hyper tshwm sim los ntawm hydrochlorothiazide), nrog allopurinol - ib qho kev nce ntawm cov zaus muaj qhov tsis haum siab rau allopurinol, nrog Ca2 + ntsev - qhov kev pheej hmoo ntawm kev tsim hypercalcemia (vim los ntawm nws qhov txo qis), nrog beta-adrenergic blockers thiab diazok noob - kev pheej hmoo ntawm nce hyperglycemia, nrog m-anticholinergics (suav nrog atropine, biperiden) - ib qho kev nce ntxiv hauv kev siv lub cev ntawm hydrochlorothiazide (vim tias lub plab hnyuv plab tsis tuaj yeem).

Cov tshuaj muaj peev xwm nce kev pheej hmoo ntawm kev phiv ntawm amantadine, txo qis raum tsis ua haujlwm ntawm cov tshuaj cytotoxic (suav nrog cyclophosphamide, methotrexate) thiab txhim kho lawv cov nyhuv myelosuppressive.

Cov Tshuaj Hauv Tshuaj

Hydrochlorothiazide yog thiazide diuretic. Thiazide diuretics cuam tshuam rau kev rov qab cov roj hluav taws xob hauv cov hlab ntsws, rov nce ncaj qha rau qhov tsis pom kev ntawm sodium thiab chlorides (kwv yees li qhov sib npaug). Cov nyhuv diuretic ntawm hydrochlorothiazide ua rau txo bcc, kev nce rau hauv cov kev ua ntawm plasma renin, nce ntxiv ntawm kev tso cai ntawm aldosterone, tom qab kev nce hauv cov zis potassium thiab hydrocarbonates thiab, raws li lub txiaj ntsig, txo cov poov tshuaj hauv ntshav plasma.Nrog rau kev tswj hwm tib lub sijhawm nrog telmisartan, muaj lub siab nyiam kom tsis txhob muaj cov poov tshuaj los ntawm cov diuretics, piv txwv vim yog RAAS thaiv.

Tom qab kev tswj hwm ntawm qhov ncauj, diuresis nce ntxiv tom qab 2 teev, thiab cov txiaj ntsig siab tshaj plaws tau pom tom qab 4 teev. Cov diuretic nyhuv ntawm cov tshuaj tseem nyob ntev li 6-12 teev.

Kev siv lub sijhawm ntev ntev ntawm hydrochlorothiazide txo cov kev pheej hmoo ntawm cov teeb meem ntawm cov kab mob plawv thiab kev tuag ntawm lawv.

Telmisartan - Tshwj xeeb ARA II (Hom AT₁), siv tau thaum noj ntawm qhov ncauj. Muaj qhov khoom plig zoo rau lub sub subpepe₁receptors ntawm angiotensin II, dhau los ntawm qhov kev txiav txim ntawm angiotensin II yog pom tau hais. Txom cov tshuaj angiotensin II los ntawm qhov sib txuas nrog cov receptor, yam tsis qhia tus yam ntxwv ntawm agonist in relation to no receptor. Telmisartan tsuas khi rau AT subtype₁receptors ntawm angiotensin II. Cov kev sib txuas tas mus li. Nws tsis muaj kev sib raug zoo rau lwm tus txais, incl. rau AT₂receptor thiab lwm yam 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 II, qhov kev tsub zuj zus uas nce nrog kev teem sijhawm ntawm telmisartan, tseem tsis tau kawm.

Telmisartan txo qis kev mloog zoo ntawm aldosterone hauv ntshav ntshav, tsis inhibit renin hauv ntshav ntshav thiab tsis thaiv cov ion ion. Telmisartan tsis inhibit ACE (kininase II), uas kuj tseem catalyzes qhov kev puas tsuaj ntawm bradykinin. Yog li, kev nce qib hauv kev phiv los ntawm bradykinin tsis yog kev cia siab.

Hauv cov neeg mob uas muaj mob ntshav tawm, 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 qhov kev txiav txim siab tawm tsam yog pom nyob hauv 3 teev tom qab thawj qhov ncauj ntawm telmisartan. Cov nyhuv ntawm cov tshuaj no kav rau 24 teev thiab tseem ceeb txog li 48 teev. Tshaj tawm cov nyhuv antihypertensive feem ntau muaj 4 lub lis piam tom qab siv cov tshuaj tsis tu ncua.

Hauv cov neeg mob uas muaj mob ntshav nce hlwb, telmisartan txo qis SBP thiab DBP yam tsis cuam tshuam rau lub plawv dhia.

Thaum muaj kev tshem tawm sai ntawm telmisartan, cov ntshav siab maj mam rov qab los rau nws qib tseem tsis muaj kev txhim kho ntawm kev tshem tawm tus mob.

Hauv kev tshawb fawb nrog telmisartan, cov mob ntawm lub plawv kev tuag, kev tsis mob ntshav qab zib, tsis mob ntshav siab, lossis pw hauv tsev kho mob vim lub plawv tsis ua haujlwm raug soj ntsuam. Ib qho kev txo qis ntawm cov hlab plawv txhaws thiab tuag nyob hauv cov neeg mob uas muaj kev pheej hmoo mob plawv (mob ntshav hlab plawv, mob hlab ntsha tawg, mob leeg ntshav lossis ntshav qab zib mellitus nrog concomitant kev puas tsuaj rau lub hom phiaj ntawm lub cev xws li retinopathy, sab laug ventricular hypertrophy, macro- lossis microalbuminuria hauv keeb kwm) tau muaj pov thawj. hnub nyoog 55 xyoos.

Cov nyhuv siab tshaj plaws ntawm cov tshuaj Telsartan ® N feem ntau ua tiav 4 lub lis piam tom qab pib kho.

Cov Tshuaj Pharmacokinetics

Kev siv sib xyaw ua ke ntawm telmisartan thiab hydrochlorothiazide tsis cuam tshuam rau pharmacokinetics ntawm txhua qhov sib xyaw ntawm cov tshuaj.

Tom qab cov tshuaj ntawm qhov ncauj Telsartan ® N C_max plasma hydrochlorothiazide ncav cuag li 1-3 teev. Kev ua kom lub neej tsis txaus ntseeg yog li 60% (raws li txhua lub raum tsis ua haujlwm). Plasma proteins khi 64% ntawm hydrochlorothiazide, thiab V_d yog (0.8 ± 0.3) l / kg. Hydrochlorothiazide tsis yog metabolized hauv lub cev thiab tawm los ntawm lub raum yuav luag tsis hloov. Li ntawm 60% ntawm qhov kev siv tshuaj yog muab tshem tawm hauv 48 teev. Kev kho kom zoo nkauj yog li 250-300 ml / min. T_1/2 hydrochlorothiazide yog 10-15 teev.

Muaj qhov sib txawv ntawm ntshav ntau nyob rau hauv cov txiv neej thiab poj niam. Rau cov poj niam, qhov concentration ntawm telmisartan hauv ntshav yog 2-3 npaug ntau dua li cov txiv neej, thiab cov poj niam kuj nyiam ua qhov kev kuaj mob tsis tseem ceeb hauv plasma cov ntsiab lus ntawm hydrochlorothiazide.

Tsis hlauv. Hauv cov neeg mob uas lub raum lub raum tsis ua haujlwm, tus nqi ntawm kev tshem tawm ntawm hydrochlorothiazide yog txo. Kev tshawb fawb hauv cov neeg mob nrog 90 ml / min creatinine Cl pom tias T_1/2 hydrochlorothiazide tsub kom. Hauv cov neeg mob uas lub raum tsis zoo ua haujlwm T_1/2 txog 34 teev

Thaum noj sai sai nqus tau los ntawm Lub plab zom mov. Bioavailability yog kwv yees li 50%. Qhov siab tshaj tawm tau tshwm sim tom qab kwv yees li 0.5-1.5 teev. Thaum noj ib txhij nrog zaub mov, qhov txo qis hauv AUC yog li ntawm 6 txog 19% (thaum noj ib koob 40 thiab 160 mg, ntsig txog). 3 teev tom qab noj, qhov xav tau nyob hauv cov ntshav ntshav yog qib yog tsis hais noj mov dab tsi.

Muaj qhov sib txawv ntawm cov concentration ntawm telmisartan hauv plasma hauv cov txiv neej thiab poj niam. C_max hauv ntshav, txog li 3 zaug thiab AUC txog 2 npaug siab dua hauv cov poj niam piv nrog cov txiv neej tsis muaj qhov cuam tshuam txog kev ua tau zoo. Txawm li cas los xij, ib qho kev nce hauv cov nyhuv hypotensive tsis pom hauv cov poj niam.

Koom siab tseem ceeb nrog cov plasma protein (ntau dua li 99.5%), feem ntau nrog albumin thiab alpha₁-acid glycoprotein. V_d kwv yees li 500 litres

Telmisartan yog metabolized los ntawm kev sib txuas nrog glucuronic acid. Metabolites yog tus tsis muaj tshuaj nyob hauv tsev muag tshuaj. T_1/2 yog ntau tshaj 20 teev

Nws yog tawm los ntawm txoj hnyuv tsis hloov, nthuav tawm los ntawm ob lub raum - tsawg dua 2%. Tag nrho cov ntshav ntawm lub plasma tshem tawm ntau yog siab (li 900 ml / min).

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

Tsis hlauv. Hloov cov koob tshuaj telmisartan hauv cov neeg mob uas lub raum tsis ua haujlwm, tsis suav nrog, cov neeg mob ntawm hemodialysis. Telmisartan tsis raug tshem tawm los ntawm hemodialysis.

Daim siab ua haujlwm. Cov kev tshawb fawb ntawm pharmacokinetics hauv cov neeg mob uas lub siab tsis ua hauj lwm pom tias muaj kev nyab xeeb txog ntawm kev tsis txaus ntseeg txog kev yuav luag txog 100%. Nrog daim siab ua haujlwm T_1/2 tsis hloov (saib. "Dosage thiab kev tswj hwm").

Cev xeeb tub thiab lactation

Kev siv cov tshuaj Telsartan ® N yog contraindicated thaum cev xeeb tub.

Cov kev paub nrog hydrochlorothiazide thaum cev xeeb tub, tshwj xeeb tshaj yog thaum thawj peb hlis, muaj tsawg.

Hydrochlorothiazide hla lub teeb meem ntawm thaj chaw. Muab cov tshuaj pharmacological ntawm kev ua ntawm hydrochlorothiazide, nws xav tias nws siv thaum lub sijhawm thib ob thiab thib peb lub cev xeeb tub tuaj yeem cuam tshuam lub fetoplacental perfusion thiab ua rau muaj kev hloov pauv ntawm lub cev thiab menyuam, xws li mob daj ntseg, cuam tshuam hauv dej-electrolyte tshuav thiab thrombocytopenia.

Hydrochlorothiazide yuav tsum tsis txhob siv los kho qhov kub siab tseem ceeb hauv cov poj niam cev xeeb tub, tshwj tsis yog nyob rau qhov xwm txheej tsis tshua muaj lwm txoj kev kho mob.

Kev siv tshuaj ntawm ARA II thaum cev xeeb tub yog contraindicated.

Thaum kuaj pom kev xeeb tub, cov tshuaj yuav tsum nres tam sim ntawd.

Yog tias tsim nyog, yuav tsum siv lwm txoj kev kho (lwm cov chav kawm ntawm cov tshuaj tiv thaiv mob ntshav qis uas pom zoo siv thaum cev xeeb tub).

Kev Kho Mob nrog Telsartan ® H yog qhov sib xyaw thaum lub sijhawm pub mis.

Hauv kev tshawb nrhiav tsiaj, qhov tshwm sim ntawm telmisartan thiab hydrochlorothiazide ntawm kev muaj me nyuam tsis tau pom. Cov kev tshawb fawb txog cov kev cuam tshuam rau tib neeg kev muaj peev xwm tsis tau ua.

Tsuas tshuaj thiab tswj hwm

Sab hauv tsis hais txog ntawm cov noj mov.

Telsartan ® N yuav tsum noj 1 zaug nyob rau ib hnub.

Telsartan ® N (12.5 mg + 40 mg) tuaj yeem kho rau cov neeg mob uas kev kho mob monotherapy nrog telmisartan ntawm kev noj tshuaj 40 mg lossis monotherapy nrog hydrochlorothiazide tsis ua rau muaj kev tswj ntshav siab txaus.

Telsartan ® N (12.5 mg + 80 mg) tuaj yeem kho rau cov neeg mob uas kev kho mob monotherapy nrog telmisartan ntawm koob ntawm 80 mg lossis tshuaj Telsartan (N (12.5 mg + 40 mg) tsis ua rau muaj kev tswj ntshav siab txaus.

Hauv cov neeg mob uas mob ntshav liab ntau dhau, qhov ntau tshaj plaws niaj hnub noj tshuaj ntawm telmisartan yog 160 mg / hnub. Cov koob tshuaj no tau pom zoo zoo thiab ua tau haujlwm zoo.

Cov pab pawg neeg tshwj xeeb

Lub raum khiav tsis zoo. Tsawg qhov kev paub nrog kev siv kev sib xyaw ua ke ntawm hydrochlorothiazide thiab telmisartan hauv cov neeg mob uas tsis muaj mob me los yog mob raum tsis xav tau hloov cov koob hauv cov kis no. Hauv cov neeg mob li no, lub raum kev ua haujlwm yuav tsum raug saib xyuas (nrog Cl creatinine tsawg dua 30 ml / min, saib "Contraindications").

Lub siab ua haujlwm tsis zoo. Hauv cov neeg mob uas muaj me me mus rau lub cev tsis ua haujlwm zoo (Me-Pugh kev faib tawm A thiab B), koob tshuaj Telsartan daily N txhua hnub yuav tsum tsis pub tshaj 12,5 mg + 40 mg ib hnub (saib Pharmacokinetics).

Laus lub caij nyoog. Qhov ntau npaum ntawm qhov tshuaj tsis tas yuav hloov pauv.

Noj ntau dhau

Tsis muaj cov tsos mob ntawm kev haus ntau tshaj tau pom. Cov tsos mob tau tshwm sim ntawm kev haus ib ce ntau dhau ntawm cov tsos mob tshwm sim los ntawm cov tshuaj sib txuas ntawm cov tshuaj.

Cov tsos mob ntawm kev overdose ntawm hydrochlorothiazide: kev cuam tshuam hauv cov dej-electrolyte sib npaug ntawm cov ntshav (hypokalemia, hypochloremia), qhov txo qis hauv BCC, uas tuaj yeem ua rau cov leeg mob thiab / lossis cov mob tsis zoo los ntawm CCC: arrhythmias tshwm sim los ntawm kev siv tib lub sijhawm ntawm lub plawv glycosides lossis qee cov tshuaj tiv thaiv kab mob.

Cov tsos mob ntawm kev overdose ntawm telmisartan: cim txo nyob rau hauv cov ntshav siab, tachycardia, bradycardia.

Kev Kho Mob: kev kho mob, kev hloov kho kho tsis tau zoo. Cov theem ntawm tshem tawm ntawm hydrochlorothiazide thaum hemodialysis tseem tsis tau tsim. Kev soj ntsuam tas li ntawm cov electrolyte cov ntsiab lus thiab ntshav dej creatinine concentration yuav tsum tau ua.

Chaw tsim tshuaj paus

Dr. Reddy lub chaw soj nstuam Ltd., Is Nrias teb. Dr. Reddy's Lub chaw soj nstuam Ltd., Is Nrias teb. Tsim Qauv Tsev-III, Sy. No. 41, Bachupally Village, Qutubullapur Mandal, Cheeb Tsam Ranga Reddy, Telangana, Is Nrias teb.

Cov ntaub ntawv hais txog kev tsis txaus siab thiab cov tshuaj tsis tsim nyog yuav tsum raug xa mus rau qhov chaw nyob nram qab no: Dr. Reddy's Laboratories Ltd. chaw sawv cev. 115035, Moscow, Ovchinnikovskaya nab., 20, p. 1.

Xov Tooj: (495) 795-39-39, fev: (495) 795-39-08.

Cov chaw muag tshuaj

Telmisartan yog tus neeg paub tseeb txog kev tiv thaiv kabmob ntawm angiotensin II receptor (hom AO 1), ua haujlwm ntawm kev tswj hwm qhov ncauj. Muaj kev sib raug zoo, telmisartan hloov chaw angiotensin II ntawm nws qhov kev sib tshuam nrog AO 1 subtype receptor, uas yog lub luag haujlwm rau kev ua haujlwm ntawm angiotensin II. Telmisartan tsis qhia txog qee qhov haujlwm ntawm AO 1 receptor uas yog agonist. Telmisartan xaiv zoo khi rau AO 1 receptor ntev. Cov tshuaj tsis ua rau muaj kev sib nyiam rau lwm tus txais, suav nrog AO 2 thiab lwm tus neeg tsis tshua muaj nyob ntawm AT receptors. Lub luag haujlwm ua haujlwm ntawm cov receptors tsis paub, nrog rau cov txiaj ntsig ntawm lawv qhov kev xav tau dhau los nrog angiotensin II, qib uas nce telmisartan. Telmisartan txo cov ntshav plasma aldosterone ntau ntau. Telmisartan tsis yog inhibited los ntawm tib neeg plasma renin, tsis yog nws thaiv cov ion ion. Telmisartan tsis inhibit ACE (kinase II), uas kuj rhuav tshem bradykinin. Yog li, ib qho yuav tsum tsis txhob cia siab tias muaj kev nce ntxiv hauv kev phiv tshuaj txuam nrog bradykinin.

Rau tib neeg, telmisartan ntawm ib koob ntawm 80 mg yuav luag tag nrho cov nyhuv ntawm angiotensin II rau nce ntshav siab.

Cov chaw kuaj mob tau zoo thiab Kev Nyab Xeeb

Kev kho mob ntawm kev mob ntshav siab

Tom qab thawj koob tshuaj telmisartan, cov nyhuv antihypertensive maj mam pib tshwm li ntawm 3:00. Qhov siab tshaj plaws nyob rau hauv cov ntshav siab feem ntau ua tiav 4-8 lub lis piam tom qab pib kho thiab mob siab rau kev kho mob ntev.

Cov nyhuv antihypertensive tseem nyob twj ywm rau ntau tshaj ib hnub tom qab noj cov tshuaj, suav nrog 4:00 ua ntej koob tshuaj ntxiv, raws li pom nyob rau sab nraud ntsuas ntsuas ntshav siab. Qhov no yog qhov ua pov thawj pom tseeb los ntawm qhov sib piv ntawm cov seem mus rau qhov siab tshaj plaws, uas yog ntau tshaj 80% tom qab kev siv koob tshuaj 40 thiab 80 mg ntawm telmisartan nyob rau hauv cov chaw tso tshuaj kho mob. Muaj qhov kev paub tseeb ntawm cov koob tshuaj thiab lub sijhawm rov qab los ntawm kev pib mob ntshav systolic (SBP). Cov ntaub ntawv hais txog diastolic ntshav siab (DBP) yog qhov tsis sib xws.

Hauv cov neeg mob uas mob ntshav liab, telmisartan txo qis ob qho systolic ntshav siab thiab ntshav siab diastolic, thaum nws tsis cuam tshuam rau cov mem tes dhia. Qhov kev pub rau ntawm diuretic thiab natriuretic los ntawm cov tshuaj rau nws kev ua haujlwm hypotensive tseem tsis tau txiav txim siab. Qhov ua tau zoo ntawm telmisartan hauv kev txo cov ntshav siab yog piv rau lwm cov tshuaj sawv cev rau lwm cov chav kawm ntawm cov tshuaj tiv thaiv kabmob (kev kho mob los sib piv telmisartan nrog amlodipine, atenolol, enalapril, hydrochlorothiazide thiab lisinopril).

Nrog rau qhov tsis muaj ntshav tawm ntawm kev kho mob telmisartan, cov ntshav siab maj mam rov qab los rau theem uas tau ua ntej kev kho mob rau ob peb hnub yam tsis muaj kev cuam tshuam ntawm kev rov qab tawg.

Hauv kev sim tshuaj, los ntawm kev sib piv ncaj qha ntawm ob cov tshuaj tiv thaiv kab mob, cov neeg mob hnoos qhuav tau tsawg dua li tus kabmob telmisartan dua li nrog ACE inhibitors.

Telmisartan nrawm nrawm, txawm hais tias qhov nyiaj nqus tau pauv txawv. Qhov nruab nrab txog kev txiav txim siab nruab nrab ntawm telmisartan yog kwv yees li 50%. Thaum siv telmisartan nrog zaub mov noj, thaj chaw hauv qab qhov chaw cia rau lub sijhawm concentration (AUC 0-∞) poob qis hauv qhov ntau ntawm 6% (ntawm koob tshuaj 40 mg) txog 19% (ntawm koob tshuaj 160 mg). 3:00 tom qab daim ntawv thov, qhov concentration ntawm telmisartan hauv cov ntshav plasma yeej zoo ib yam thaum noj rau hauv lub plab khoob lossis thaum noj nrog zaub mov.

Qhov tshuaj kho me ntsis hauv AUC yog cia siab kom txo cov nyhuv kho mob. Tsis muaj kab sib txuas ntawm koob tshuaj thiab ntshav plasma concentration ntawm tshuaj. C max thiab, rau qhov tsawg dua, AUC nce tsis sib luag ntawm ib koob ntawm 40 mg.

Telmisartan yog qhov tseem cuam tshuam rau cov ntshav plasma protein (> 99.5%), mas nrog albumin thiab alpha-1 acid glycoprotein. Qhov nruab nrab ntawm qhov ntim faib (V dss) hauv kev sib npaug yog kwv yees li 500 L.

Telmisartan yog metabolized los ntawm kev sib txuas ntawm niam txiv cov tub ntxhais hluas mus rau glucuronide, lub conjugate tsis muaj kev ua haujlwm ntawm pharmacological.

Telmisartan yog lub cim tsim los ntawm kev txiav txim siab bi-exponential pharmacokinetic nrog lub davhlau ya nyob hauv tshem tawm ib nrab-lub neej ntawm ntau tshaj 20 teev. Qhov siab tshaj plaws ntshav plasma concentration (C max) thiab, kom tsawg dua li ntawd, thaj chaw hauv qab qhov ntsuas-lub sijhawm nkhaus (AUC) nce tsis raws cai rau cov koob tshuaj. Tsis muaj pov thawj dab tsi ntawm kev sib xyaw ua mob loj hauv telmisartan thaum siv cov koob tshuaj pom zoo. Rau cov poj niam, plasma ntshav ntau dua cov txiv neej tsis muaj qhov cuam tshuam tseem ceeb ntawm kev ua tau zoo.

Tom qab kev tswj hwm ntawm qhov ncauj, telmisartan yog yuav luag txhua tus nyob hauv cov quav, feem ntau tsis hloov pauv. Tag nrho cov kev tawm ntawm cov tshuaj nrog zis yog 70 xyoo. Ua ke nrog lwm cov tshuaj cuam tshuam rau renin-angiotensin-aldosterone system, thiab / lossis kev siv cov tshuaj potassium uas muaj cov tshuaj ntxiv.

Pom zoo saib xyuas cov poov tshuaj ntau ntau hauv cov neeg mob uas muaj qhov pheej hmoo pom zoo.

ACE inhibitors, telmisartan, thiab lwm yam angiotensin II receptor antagonists tsis tshua muaj kev txo qis ntshav siab hauv cov neeg mob ntawm cov haiv neeg Negroid dua li lwm qhov kev sib tw, tej zaum vim qhov tseeb tias cov neeg mob ntshav siab tsis zoo ntawm Negroid haiv neeg feem ntau muaj qis ntshav qis dua.

Thaum siv cov tshuaj tiv thaiv kabmob ntshav ntau dhau los, kev txo cov ntshav siab ntau hauv cov neeg mob ischemic cardiopathy lossis ischemic mob plawv tuaj yeem ua rau myocardial infarction lossis mob stroke.

Siv thaum cev xeeb tub lossis lactation

Tsis muaj ntaub ntawv cuam tshuam txog kev siv Telmisartan rau cov poj niam cev xeeb tub.

Kev mob tshwm sim rau kev pheej hmoo ntawm teratogenicity vim kev siv tshuaj ACE inhibitors thaum thawj peb lub hlis thaum cev xeeb tub tsis txaus ntseeg, tab sis qhov kev pheej hmoo me ntsis tsis tuaj yeem txiav tawm.

Angiotensin II receptor antagonists yuav tsum tsis txhob pib thaum cev xeeb tub. Yog tias kev txuas ntxiv ntawm kev kho mob nrog angiotensin II antagonists yog suav tias yog tsim nyog, thiab tus neeg mob tau npaj siab cev xeeb tub, nws raug nquahu kom hloov txoj kev kho mob nrog antihypertensive kev kho nrog qhov tsim kom muaj kev nyab xeeb thaum cev xeeb tub. Yog tias cev xeeb tub raug tsim, kev kho mob nrog angiotensin II receptor antagonists yuav tsum tau tsum tsis ua sai sai thiab kev kho tsim nyog yuav tsum tau pib.

Nws paub tias kev siv cov angiotensin II receptor antagonists thaum lub sijhawm II thiab III txiav tawm hauv cev xeeb tub ua rau fetotoxicity hauv tib neeg (qog ua haujlwm tsis zoo, oligohydramniosis, qeeb tsim cov pob txha cranial) thiab mob neonatal toxicity (lub raum tsis ua haujlwm, ntshav siab, hyperkalemia). Yog tias siv cov angiotensin II receptor antagonists tau pib txij li zaum thib ob ntawm cev xeeb tub, nws raug nquahu kom ua qhov kev kuaj mob ultrasound ntawm lub raum thiab cov pob txha ntawm lub pob txha taub hau ntawm tus menyuam. Cov xwm txheej ntawm cov menyuam mos uas lawv niam coj angiotensin II receptor antagonists yuav tsum tau ua tib zoo saib kom muaj ntshav liab ntawm lub ntsej muag (saib Ntu "Contraindications" thiab "Nta ntawm kev siv").

Telmisartan tsis pom zoo thaum pub mis niam, vim nws tsis paub tseeb tias nws tawm hauv neeg cov kua mis. Lwm txoj kev kho mob nrog daim ntawv qhia txog kev nyab xeeb zoo dua yog qhov zoo dua, tshwj xeeb tshaj yog thaum pub niam mis rau ib tus menyuam mos lossis menyuam yug ntxov.