Noliprel A Fort > Chithandizo ndi kupewa

Dzina lachi Latin: Noliprel A forte

Code ya ATX: C09BA04

Chithandizo chogwira: perindopril arginine (perindopril arginine) + indapamide (indapamide)

Wopanga: Laboratories Servier Viwanda (France), Serdix, LLC (Russia)

Sinthani mafotokozedwe ndi chithunzi: 11/27/2018

Mitengo muma pharmacies: kuchokera pa ma ruble 564.

Noliprel A forte ndi mankhwala ophatikiza antihypertensive, kuphatikizapo angiotensin osintha enzyme inhibitor (ACE) ndi okodzetsa.

Kutulutsa mawonekedwe ndi kapangidwe kake

Mankhwala amapezeka mu mawonekedwe a mapiritsi okhala ndi filimu: oblong, oyera (mu mabotolo a polypropylene ndi dispenser: 14 kapena 29 ma PC.,) Pabokosi kamatoni okhala ndi batani loyambirira lotsegulira 1, 30 ma PC., Pabokosi la makatoni okhala ndi chiwongolero choyamba Mabotolo a 1 kapena atatu, m'mapaketi azachipatala - mabotolo 30 m'makatoni, makatoni 1 makatoni ndi malangizo ogwiritsira ntchito Noliprel A forte).

Piritsi limodzi lili:

zinthu zogwira: perindopril arginine - 5 mg (ofanana ndi zomwe 3,395 mg perindopril), indapamide - 1.25 mg,
othandizira: lactose monohydrate, colloidal silicon dioxide anhydrous, maltodextrin, sodium carboxymethyl starch (mtundu A), magnesium stearate,
makina otengera mafilimu: premix ya filmoyera wa filimu SEPIFILM 37781 RBC hypromellose, macrogol 6000, glycerol, titanium dioxide (E171), magnesium stearate, macrogol 6000.

Mankhwala "Noliprel forte": kapangidwe ndi mawonekedwe a kumasulidwa

Mankhwalawa amapezeka mu mawonekedwe a mapiritsi okhala ndi filimu yoteteza. Mankhwalawa amaphatikiza zinthu zingapo zogwira ntchito nthawi imodzi, zomwe zimapereka mphamvu zake. Makamaka, piritsi lililonse lili ndi 10 mg perindopril arginine (kuchuluka kumeneku kumafanana ndi 6.79 mg perindopril) ndi 2.5 ml indapamine.

Popanga mankhwalawa, zinthu monga magnesium stearate, colloidal anhydrous silicon dioxide, lactose monohydrate, maltodextrin, hypromellose, macrogol 6000, glycerol ndi ena enanso amagwiritsidwa ntchito ngati othandizira.

Pharmacological zimatha mankhwala

Inde, zomwe mankhwala a "Noliprel forte" amagwiritsidwa ntchito zimakhudzana makamaka ndi momwe thupi lake limagwirira ntchito. Koma poyambira, ndikofunikira kudziwa kuti mankhwalawa ali ndi tanthauzo lotsogolera, ndipo amakhudza kupindika komanso ma systolic. Kukula kwa mavutowo pamatengera mlingo. Zotsatira zolimbitsa thupi zimawonekera osapitirira mwezi umodzi atayamba chithandizo.

Perindopril ndi imodzi mwamagawo akuluakulu a mankhwalawa. Izi ndizoletsa mtundu wina wa enzyme. Imafinya m'mitsempha yamagazi ndikubwezeretsa kapangidwe ka malinga awo. Kafukufuku wambiri awonetsa kuti perindropril imachepetsa kuthamanga kwa magazi, ndipo kusiya mankhwala sikubweretsa kudumphira lakuthwa. Chinthu china chomwe chimagwira, indapamide, ndi chofanana mu katundu wake ndi thiazide diuretics. Izi zimalepheretsa mayamwidwe a potaziyamu mu nephron, zomwe zimabweretsa kuwonjezeka kwa diuresis ndi chotsekemera cha chlorine ndi sodium ion ndi mkodzo.

Perindopril amamuchotsa mkodzo. Pazitali zake ndende zimawonedwa patatha maola 3-4 mutatha kukhazikitsa. Nkhani ya indapamide, imayamba kugwira ntchito mwachangu kwa ola limodzi, ndipo imatulutsidwa limodzi ndi mkodzo komanso ndowe.

Mankhwala

Noliprel A forte ndi mankhwala osokoneza bongo, zotsatira zake zomwe zimachitika chifukwa cha antihypertensive katundu wa perindopril ndi indapamide, omwe amawonjezera chifukwa cha kuphatikiza kwawo.

Perindopril ndi zoletsa za ACE zomwe zimayambitsa kusintha kwa angiotensin I kukhala vasoconstrictor chinthu angiotensin II. Kuphatikiza apo, ACE (kapena kininase II) amasintha bradykinin kukhala heptapeptide yosagwira. Bradykinin m'thupi lili ndi vasodilating. Chifukwa cha kulepheretsa kwa ACE, kubisala kwa aldosterone kumachepa, njira yolakwika yotsutsa imayamba, yomwe imapangitsa ntchito ya renin m'madzi a m'magazi. Chifukwa cha kutsitsa komanso kutsitsa, ntchito yam'makutu imakhala yofanana. Kugwiritsidwa ntchito kwa nthawi yayitali kwa perindopril kumathandizira kuchepetsa zotumphukira zamitsempha zosagonjetseka (OPSS), zomwe zimachitika makamaka chifukwa cha mphamvu yake m'matumbo ndi impso. Zotsatira zimachitika popanda kuchedwa kwa sodium ndi ion yamadzimadzi kapena kukula kwa Refx tachycardia.

Zakhazikitsidwa kuti ngati vuto la mtima likulephera (CHF), perindopril imapereka kuchepa kwakudzaza kuzungulira kwa mtima kumanzere ndi kumanja kwamtima, kuchepa kwa mtima, kuwonjezeka kwa mtima komanso kuwonjezeka kwamitsempha yamagazi.

Indapamide ndi sulfonamide amene mankhwala ake ofanana ndi thiazide diuretics. Zimalepheretsa kuyambiranso kwa ayoni a sodium mu gawo la gawo la Henle, ndikukulitsa chimbudzi cha chloride, sodium, komanso kuchepera kwa magnesium ndi potonium ion kudzera mu impso. Izi zimawonjezera diuresis ndikupangitsa kuchepa kwa kuthamanga kwa magazi (BP).

Mphamvu ya antihypertensive ya Noliprel A forte imadalira mlingo muyezo, kuyimirira ndikunama imawonetsedwa chimodzimodzi pokhudzana ndi kuthamanga kwa magazi kwa diastoli ndi systolic. Pambuyo kumwa mapiritsi, mphamvu ya mankhwalawa imapitilira maola 24. The achire zotsatira ukufika okhazikika pambuyo masiku 30 chithandizo.

Kuchira kwa mankhwala sikumayendera limodzi ndi matenda achire.

Pogwiritsa ntchito Noliprel A forte, pali kuchepa kwa OPSS, kuchepa kwa milingo yamanzere yamitsempha yamitsempha yamagazi (GTL), komanso kusinthika pakukula kwa mitsempha. Mankhwalawa sakukhudza kagayidwe ka lipids komanso zomwe zili mu cholesterol yathunthu, cholesterol, high density lipoprotein (HDL) ndi otsika kachulukidwe lipoprotein (LDL) kapena triglycerides.

Ndi ochepa matenda oopsa komanso GTL, pankhani yophatikiza perindopril ndi indapamide, kuchepa kwakukulu kwa lamanzere yamitsempha yama cell (LVMI) ndi antihypertensive zotsatira zimawonedwa poyerekeza ndi enalapril.

Kafukufuku wokhudzana ndi zotsatira za Noliprel A Forte pa zovuta zazikulu za macro- komanso microvascular kwa odwala omwe ali ndi mtundu wa 2 matenda a shuga adachitika ngati chowonjezera pa njira zonse ziwiri zamankhwala olimbana ndi glycemic control komanso glycemic control (IHC) njira (chandamale HbA_1c zosakwana 6.5%). Gulu la odwala lidatenga nawo mbali phunziroli, zizindikiritso zapakati pazaka 66, kuthamanga kwa magazi - 145 / 8mm Hg, kulemera kwa index - 28 kg pa 1 m 2 ya thupi, HbA1c (glycosylated hemoglobin) - 7.5%. Odwala ambiri anali pa hypoglycemic ndi concomitant mankhwala (kuphatikizapo antihypertensive, hypolipidemic, antiplatelet agents).

Zotsatira zakufufuza (kutalika kwa zaka pafupifupi 5) zikuwonetsa kuchepa kwa 10% pangozi ya kuphatikizika kwamavuto azachuma komanso apakati pa gulu la IHC (pafupifupi HbA_1c 6.5%) poyerekeza ndi gulu lolamulira wamba (sing'anga HbA_1c 7,3%).

Kuchepetsa kwakukulu kwa chiopsezo chapakati kumachitika chifukwa cha kuchepa kwa 14% pamavuto akulu am'magazi, 21% mwadzidzidzi ndi kufalikira kwa nephropathy, 9% ya microalbuminuria, 30% ya macroalbuminuria, ndi 11% yopanga zovuta zama impso.

Ubwino wa mankhwala a antihypertensive sizidalira phindu lomwe limapezeka ndi IHC.

Mphamvu ya antihypertensive ya perindopril imatsimikiziridwa pochiza matenda oopsa a matenda oopsa. Pambuyo pakukonzekera kamlomo kamodzi, mphamvu yayikulu ya Noliprel A Forte imatheka pambuyo pa maola 4-6 ndipo imatha kwa maola 24. Zotsalira (pafupifupi 80%) zoletsa za ACE zimawonedwa patatha maola 24 pambuyo pa kuperekedwa.

Perindopril amakhala ndi vuto lochita kupanikizika ndi ntchito yotsika ya plasma.

Kuphatikizidwa ndi thiazide diuretics kumawonjezera zovuta za antihypertensive kwambiri, kuchepetsa chiopsezo cha hypokalemia chifukwa cha kuchuluka kwa okodzetsa.

Kuphatikiza mankhwala omwe ali ndi ACE inhibitor ndi angiotensin II receptor antagonist (ARA II) odwala omwe ali ndi mbiri ya matenda amtima kapena matenda a mtima, odwala omwe ali ndi matenda a shuga 2 (omwe atsimikizika kuwonongeka kwa ziwalo), mtundu 2 wa matenda a shuga ndi nephropathy sanakhale nawo kuchipatala zotsatira zabwino pakumveka kwa impso ndi / kapena zochitika za mtima kapena ziwopsezo za kufa. Koma nditayifanizira ndi monotherapy, zidapezeka kuti mosagwirizana ndi kuphatikizika kwa ACE inhibitor ndi ARA II, chiopsezo chokhala ndi hyperkalemia, kulephera kwa aimpso komanso / kapena kuchepa kwa hypotension.

Poganizira kuti intragroup pharmacodynamic katundu a ACE inhibitors ndi ARA II ndi ofanana, zotsatira izi zitha kuyembekezedwa ndikuphatikizidwa kwa perindopril ndi ARA II.

Sitikulimbikitsidwa kugwiritsa ntchito nthawi yomweyo ACE inhibitors ndi ARA II odwala omwe ali ndi matenda ashuga.

Kuphatikizika kwa aliskiren kuti mulembe matenda ashuga a 2 a shuga ndi matenda a impso komanso / kapena matenda amtundu wokhazikika ku ACE kapena ARA II inhibitor Therapy kumawonjezera chiopsezo cha zotsatila, kuphatikizapo mtima wamitsempha, stroko, kukula kwa hyperkalemia, ochepa hypotension .

Kugwiritsa ntchito indapamide mu Mlingo wokhala ndi mphamvu yayikulu yotsitsa kumapangitsa kuchepa kwa OPSS, kusintha magawo otanuka a mitsempha yayikulu, yomwe imawupatsa antihypertensive. Popanda kukhudza kuchuluka kwa lipids mu madzi am'magazi (triglycerides, cholesterol yathunthu, LDL, HDL) ndi metabolism ya carbo (kuphatikizapo odwala matenda a shuga mellitus), indapamide imathandizira kuchepetsa GTL.

Pharmacokinetics

Makhalidwe a pharmacokinetic omwe amapezeka mu monotherapy ndi mankhwala aliwonse samasintha ndikusakanikirana kwa perindopril ndi indapamide.

Pambuyo pakukonzekera pakamwa, kupopera kwa perindopril kumachitika mwachangu, kuphatikiza kwake bioavailability kumatha kuyambira 65 mpaka 70%. Pafupifupi 20% ya kuchuluka kwa gawo la mankhwalawa imapangidwa biotransformed mu metabolite perindoprilat. Kuzungulira kwake kwakukulu (C_max) m'magazi a m'magazi mumatha maola 3-4. Kugundika panthawi yomweyo kumachepetsa kutembenuka kwa perindopril kukhala perindoprilat popanda zotsatira zazikulu zamatenda.

Pambuyo mayamwidwe mofulumira a indapamide kuchokera m'mimba thirakiti kwathunthu pa mlingo womwe watenga, C_max mu madzi am'magazi amafikira 1 ora kuchokera nthawi yolowa.

Madzi a protein a plasma: perindopril - osakwana 30%, indapamide - 79%.

Kulekanitsa kwa perCEoprilat yokhudzana ndi ACE kumachepetsedwa, motero, theka la moyo (T_1/2) perindopril - maola 25. Dera lofanana lakafika patatha maola 96.

Perindopril amadutsa chotchinga chachikulu.

Kugwiritsa ntchito pafupipafupi kwa Noliprel A forte sikuti kumapangitsa kuti thupi lizigwira bwino ntchito.

Perindoprilat amachotseredwa ndi impso, T_1/2 Ndi maola 3-5.

T_1/2 kuchuluka kwa maola 19. Amayikidwa mu mawonekedwe a metabolites osagwira: kudzera mu impso - 70% ya mlingo wotengedwa, kudzera m'matumbo - 22%.

Kuwonekera kwa perindoprilat pa dialysis ndi 70 ml / min.

Ndi aimpso ndi mtima kulephera, komanso mwa okalamba odwala, mawonekedwe a perindoprilat amachepetsa.

Ndi cirrhosis ya chiwindi, chiwonetsero cha hepatic cha perindopril chimachepetsedwa nthawi 2, koma izi sizikhudza kuchuluka kwa perindoprilat, kotero kusintha kwa mankhwalawa sikofunikira.

Odwala omwe ali ndi vuto la impso, pharmacokinetics ya indapamide sasintha.

Contraindication

kulephera kwambiri kwa chiwindi, kuphatikiza ndi zovuta za encephalopathy,
kulephera kwambiri kwaimpso ndi creatinine chilolezo (CC) zosakwana 30 ml / min,
bilteryal aimpso mtsempha wamagazi,
kupezeka kwa impso imodzi,
kugwiritsa ntchito hemodialysis,
hypokalemia
kulephera kwa mtima kugundika,
chithandizo chogwirizana ndimankhwala omwe amakulitsa nthawi ya QT,
kuphatikiza ndi antiarrhythmic mankhwala omwe angayambitse ma ventricular arrhythmias monga "pirouette",
munthawi yomweyo kugwiritsa ntchito mankhwala okhala ndi aliskiren odwala omwe ali ndi matenda osokoneza bongo kapena matenda a impso (GFR osakwana 60 ml / mphindi pa 1.73 m2 ya thupi pamalo),
shuga-galactose malabsorption syndrome, galactosemia, kuchepa kwa lactase,
cholowa kapena idiopathic angioedema,
chisonyezo cha mbiri ya angioedema, kuphatikiza kugwiritsa ntchito zoletsa za ACE,
nthawi yapakati
yoyamwitsa
wazaka 18
anakhazikitsa hypersensitivity ena ACE zoletsa kapena sulfonamides,
tsankho limodzi ndi zigawo zikuluzikulu za mankhwala.

Mochenjera, tikulimbikitsidwa kuti Noliprel A forte apatsidwe odwala omwe ali ndi vuto la mtima la kalasi yothandizira ya IV malinga ndi gulu la NYHA (New York Heart Association), angina pectoris, kukonzanso kwa matenda oopsa, aortic valve stenosis, matenda oopsa a mtima (kuphatikizapo chifukwa chodyetsa mafuta, kutsatira zakudya zopanda mchere, kusanza, kutsegula m'mimba kapena hemodialysis) abolevaniyami, shuga, chiwindi kulephera, zokhudza zonse connective matenda minofu (kuphatikizapo matendawa, zokhudza zonse lupus erythematosus), ndi lability wa magazi, hyperuricemia (makamaka limodzi urate gout ndi nephrolithiasis), okalamba, komanso Akatswiri ndi odwala akuda.

Kuphatikiza apo, kusamala kumalangizidwa pakugwiritsa ntchito ma immunosuppressants, kukonzekera kwa lithiamu, hemodialysis pogwiritsa ntchito ma membrane otaya kwambiri, desensitization, pamaso pa LDL apheresis process, anesthesia, ndi kupatsirana kwa impso.

Zotsatira zoyipa

Kuchokera pakati: Mitsempha, Vertigo, chizungulire, asthenia, paresthesia, pafupipafupi - kulimbitsa thupi, kusokonezeka kwa tulo, kawirikawiri - chisokonezo, pafupipafupi osakhazikitsidwa - kukomoka,
Kuchokera kwamankhwala am'mimba otupa ndi ozungulira: kawirikawiri - leukopenia, neutropenia, thrombocytopenia, agranulocytosis, kuchepa magazi kwa magazi, kuchepa kwa magazi, kuchepa kwa magazi, magazi m'thupi (pambuyo pa kupatsirana kwa impso, hemodialysis),
Kuchokera pamtima dongosolo: Nthawi zambiri - kuchepa kwa kuthamanga kwa magazi (kuphatikizapo orthostatic hypotension), kawirikawiri - mtima wa arrhythmias (kuphatikizapo bradycardia, ventricular tachycardia, atrial fibrillation), angina pectoris, infarction ya mtima, pafupipafupi kupha
Kuchokera ziwalo zam'maganizo: nthawi zambiri - tinnitus, masoka operewera,
Kuchokera pakapumidwe, m'chifuwa komanso pakatikati mwa ziwalo: pafupipafupi - chifuwa chosakhalitsa (chifukwa chogwiritsa ntchito kwa nthawi yayitali), kupuma movutikira, mosapumira - bronchospasm, kawirikawiri - rhinitis, chibayo, eosinophilic,
Kuchokera kumimba: Nthawi zambiri - kuphwanya kulawa, pakamwa pang'ono, kuchepa kwa chakudya, mseru, kusanza, kupweteka kwam'mimba, kudzimbidwa, kutsegula m'mimba, kusowa kwa magazi, kawirikawiri - kapamba, angioedema, cholestatic jaundice, cytolytic kapena cholestatic hepatitis, pafupipafupi sakhazikitsidwa - kwa chiwindi encephalopathy (ndi kulephera kwa chiwindi),
thupi lawo siligwirizana: pafupipafupi - urticaria, angioedema a nkhope, milomo, lilime, miyendo, mucous nembanemba wa mawu khola ndi / kapena larynx, vuto la bronchial kutsekeka ndi thupi lawo siligwirizana - hypersensitivity reaction,
dermatological zimachitika: Nthawi zambiri - kuyabwa, zotupa pakhungu, zotupa za maculopapular, kawirikawiri - kukulira kwa mawonekedwe owopsa a systemic lupus erythematosus, purpura, kawirikawiri - poizoni wa epermermal necrolysis, erythema multiforme, Stevens-Johnson syndrome, photosensitivity,
Kuchokera kwamankhwala am'mimbidwe: Nthawi zambiri - minyewa yam'mimba,
kuchokera ku kubereka: mosalekeza - kusabala,
Kuchokera kwamikodzo dongosolo: pafupipafupi - kulephera kwa impso, kawirikawiri - kulephera kwaimpso,
Zizindikiro zasayansi: kawirikawiri - hypercalcemia, pafupipafupi sizinakhazikitsidwe - kuchuluka kwa gawo la QT pa electrocardiogram, kuchuluka kwa glucose ndi uric acid m'magazi, kuwonjezeka kwa ntchito ya michere ya chiwindi, hypokalemia, hyponatremia, hypovolemia, hyperkalemia, kuchuluka kwa kuchuluka kwa magazi ndi kuchuluka kwa magazi m'thupi
zimachitika kawirikawiri: kawirikawiri - asthenia, pafupipafupi - thukuta likukula.

Bongo

Zizindikiro: kuchepa kwakukulu kwa kuthamanga kwa magazi, komwe kumayendetsedwa ndi nseru, kusanza, chizungulire, kugona, kusokonekera, oliguria, nthawi zina kutembenukira ku anuria chifukwa cha hypovolemia, kuchepa kwa madzi m'magazi a electrolyte (hyponatremia ndi hypokalemia).

Chithandizo: chapamimba pompopompo, kukhazikitsidwa kwa kaboni yokhazikitsidwa, kubwezeretsa bwino kwa-electrolyte. Ndi hypotension yayikulu, wodwalayo ayenera kuyikiridwa kumbuyo kwake ndi miyendo yake ndikukweza. Kuonetsetsa bwino momwe wodwalayo alili, ndi hypovolemia - kuchita iv (kulowetsedwa) kulowetsedwa kwa 0.9% sodium chloride solution.

Mwina ntchito dialysis.

Malangizo apadera

Kugwiritsa ntchito kwa Noliprel A forte kumayendera limodzi ndi zotsatira zoyipa za monotherapy ndi perindopril ndi indapamide pamtengo wochepetsetsa wa achire. Odwala omwe sanalandire chithandizo cham'mbuyomu ndi mankhwala awiri a antihypertensive, pali chiopsezo chowonjezereka cha idiosyncrasy, chifukwa chake kuyang'anira mosamala ndikofunikira kuti muchepetse ngozizi.

Ngati zasayansi zochizira kulephera kwaimpso zikupezeka munthawi yamankhwala, chithandizo ndi mankhwalawa ziyenera kusiyidwa. Kuti muyambenso kugwiritsa ntchito mankhwala othandizira, tikulimbikitsidwa kugwiritsa ntchito Mlingo wochepa uliwonse wa mankhwala kapena kupereka imodzi mwazomwezo. Pankhaniyi, odwala amafunikira kuwunika ma seramu potaziyamu ndi ma protein a creatinine. Kafukufuku amachitika masiku 14 atayamba chithandizo ndipo nthawi 1 m'masiku 60.

Odwala omwe ali ndi vuto lalikulu la mtima komanso matenda aimpso oyamba, kuphatikizira aimpso.

Kukula mwadzidzidzi kwa ochepa hypotension makamaka ndi hyponatremia koyamba, makamaka kwa odwala aimpso. Chifukwa chake, mutatha kutsekula m'mimba kapena kusanza, ndikofunikira kuganizira kuthanso kwa madzi m'thupi ndi kuchepa kwa zinthu zamagetsi m'magazi a m'magazi. Ndi ochepa ochepa hypotension, iv makonzedwe a 0,9% sodium kolorayidi njira akuwonetsedwa.

Kutsika kwakanthawi kochepa sikutanthauza chifukwa chosiya kuchira. Pambuyo pobwezeretsa BCC ndi kuthamanga kwa magazi, chithandizo chitha kuyambiranso pogwiritsa ntchito milingo yochepa ya zigawo ziwiri kapena imodzi mwazomwezo.

Kuchiza kuyenera kumayendetsedwa ndikuwunika kwa potaziyamu m'magazi am'magazi, makamaka ndi matenda a shuga komanso kulephera kwa aimpso.

Kugwiritsa ntchito kwa Noliprel A Fort kuyenera kuyimitsidwa maola 24 asanafike pakuyamba kudzipereka.

Pamaso pa njira iliyonse ya LDL ya apheresis yogwiritsira ntchito dextran sulfate, kuyendetsa kwa ACE inhibitor kuyenera kuyimitsidwa kwakanthawi.

Odwala omwe akupezeka ndi mankhwala a perindopril, zotupa zomwe zimayenda kwambiri sizingagwiritsidwe ntchito pa hemodialysis. Iyenera kulowetsedwa ndi michere ina kapena njira ina yothandizira antihypertensive iyenera kuyikidwa kwa wodwala pogwiritsa ntchito mankhwala a gulu lina la pharmacotherapeutic.

Pozindikira kutsokomola kouma komwe kumakhalapo munthawi yamankhwala, ziyenera kukumbukiridwa kuti kugwiritsidwa ntchito kwa ACE inhibitor kungakhale chifukwa cha mawonekedwe ake.

Chifukwa cha chiopsezo chotenga matenda a neutropenia, agranulocytosis, thrombocytopenia, ndi magazi m'thupi, kusamalidwa kwapadera kuyenera kuchitika popereka mankhwala kwa perindopril kwa odwala omwe ali ndi matenda a minyewa yodziwika yomwe amatenga onse a immunosuppressants, procainamide kapena allopurinol, makamaka ndi vuto la impso loyambirira. Odwala awa ali pachiwopsezo chachikulu chotenga matenda owopsa, omwe nthawi zambiri amalimbana ndi maantibayotiki ambiri. Kugwiritsa ntchito kwa Noliprel A Forte mu gulu ili la odwala akulimbikitsidwa kuti azitsatira pang'onopang'ono kuwunika kwa leukocytes m'magazi. Ayenera kudziwitsidwa za kufunika kofunsa dokotala ngati pali zilonda zapakhosi, kutentha thupi ndi zizindikiro zina za matenda opatsirana.

Ndi kuchepa kwa ma electrolyte a plasma ndi hypovolemia yayikulu, poyambira kuthamanga kwa magazi, kupweteka kwa minyewa ya m'mimba, kulephera kwa mtima, kapena matenda ena a chiwindi omwe ali ndi edema ndi ascites, kutsegulira kwakukulu kwa renin-aldosterone-angiotensin system (RAAS) kumatha kuchitika chifukwa cha kutsekeka kwa dongosolo lino ndi perindopril. Mkhalidwe wa wodwalayo umatha kutsagana ndi kuchepa kwambiri kwa kuthamanga kwa magazi, kuwonjezeka kwa creatinine m'madzi am'magazi, kukulitsa kwa aimpso kulephera. Nthawi zambiri, zochitika izi zimawonedwa masiku 14 oyambirira a mankhwala. Ndikulimbikitsidwa kuti muyambenso kumwa mankhwalawa ndi mlingo wotsikirapo.

Kwa matenda oopsa kwa odwala omwe ali ndi matenda a mtima (CHD), kuchepa kwa magazi m'thupi, kulephera kwamtima kwambiri komanso / kapena matenda a shuga 1, chithandizo chiyenera kuyambitsidwa ndi milingo yotsika. Odwala omwe ali ndi vuto la mitsempha ya m'magazi ayenera kutenga zoletsa za ACE limodzi ndi beta-blockers.

Chifukwa cha chiwopsezo chotenga magazi m'thupi mwa odwala omwe akuwonjezeka kapena kupatsidwa hemodialysis, chithandizo chikuyenera kuyendetsedwa ndi mayeso a hematological.

Asanachite opaleshoni yayikulu, Noliprel A Fort iyenera kutayidwa maola 24 asanafike opaleshoni yayikulu.

Tiyenera kukumbukira kuti odwala a mpikisano wa Negroid, mphamvu ya antihypertensive ya perindopril imatchulidwa kochepa.

Panthawi ya chiwindi ntchito, indapamide angayambitse kukula kwa chiwindi, kwa nthawi yomweyo kusiya mankhwala.

Kukhazikitsidwa kwa Noliprel A forte kuyenera kuchitika pazotsatira zotsatira za kafukufuku wamagetsi amagetsi am'madzi (kuphatikiza zomwe zili ndi sodium, potaziyamu ndi calcium ions mu plasma) wa wodwalayo, pambuyo pake kuwunika kwawoko kwa ma laboratori ndikofunikira.

Hypokalemia mwa odwala okalamba, operewera kwa zakudya m'thupi, odwala mtima, matenda amtima, cirrhosis (yokhala ndi edema kapena ascites) imawonjezera kuwopsa kwa mtima wa glycosides wamtima ndipo umawonjezera chiopsezo cha arrhythmias.

Pa mankhwala a diuretic, kuchuluka kwa plasma uric acid kumatha kukulitsa zovuta za gout.

Kuchita bwino kwa mankhwala othandizira odwala ndi thiazide ndi thiazide ngati diuretics kumatha kutsimikiziridwa kokha ndi ntchito yabwinobwino kapena pang'ono. Masautso a plasma creatinine mwa odwala akuluakulu ayenera kukhala ochepera 2,5 mg / dL kapena 220 μmol / L. Kwa odwala okalamba, amasinthidwa malinga ndi zaka, jenda, ndi kulemera pogwiritsa ntchito njira ya Cockcroft. Chizindikiro chodziwika cha kuchuluka kwa plasma creatinine mwa amuna chimatsimikiziridwa ndikuchulukitsa kusiyana (zaka zosapindulitsa zana limodzi ndi theka) ndi kulemera kwa wodwala pama kilogalamu ndi kugawa zotsatira zake ndi plasma creatinine concentration (μmol / L), yochulukitsidwa ndi 0.814. Kuti mudziwe chizindikiro ichi kwa akazi, zotsatira zomaliza ziyenera kuchulukitsidwa ndi 0.85.

Kwa odwala omwe ali ndi vuto lofanana ndi aimpso, kuwoneka kwa kulephera kwa ntchito kwaimpso si kowopsa. Ndi kulephera koyambirira kwa impso, kuchepa kwa GFR, kuchuluka kwa urea ndi creatinine mu plasma ya magazi kumatha kukhala ndi machitidwe otchulidwa komanso zotsatira zoyipa.

Chifukwa cha chiwopsezo cha zochita za photosensitivity pakagwiritsidwe ntchito ka Noliprel A Forte, tikulimbikitsidwa kuti tisayang'ane ndi kuwala kwa dzuwa kapena ma radiation oyipa a ultraviolet.

Tizikumbukira kuti popanga ma doping control mu othamanga, indapamide imatha kupereka zotsatira zabwino.

Kukopa pa kuthekera koyendetsa magalimoto ndi njira zowerengeka

Noliprel A forte samayambitsa kuphwanya kwa psychomotor reaction. Komabe, chifukwa cha chiwopsezo chomwe chilipo pakupangitsa zochitika zoyipa zomwe zimachitika motsutsana ndi maziko a kuchepa kwa kuthamanga kwa magazi kapena pakukonzanso chithandizo, kusamala kumalangizidwa mukamayendetsa magalimoto ndi zida zovuta, makamaka kumayambiriro kwa chithandizo.

Mimba komanso kuyamwa

Kugwiritsa ntchito kwa Noliprel A Forte kumakhudzana pakamwa ndi poyamwitsa.

Pokonzekera kutenga pakati kapena ngati mukulandira pakati pa mankhwala, mankhwalawa ayenera kusiyidwa ndipo wogwirizira wovomerezedwa kuti agwiritsidwe ntchito pa nthawi yapakati ayenera kulembedwa.

Kugwiritsa ntchito zoletsa za ACE mu II - ma trimesters achitatu am'mimba kungayambitse kusokonezeka kwakukulu kwa chitukuko cha fetal (kuchepa kwa ntchito yaimpso, kuchedwa kuchepa kwa mafupa a chigaza, oligohydramnios) ndi kukula kwa zovuta pakubadwa kwatsopano (aimpso, arterial hypotension ndi / kapena hyperkalemia).

Kuphatikiza apo, chithandizo cha nthawi yayitali ndi thiazide diuretics mu III trimester ya mimba imakhudza kayendedwe ka magazi a utero-placental, ndikuyambitsa hypovolemia mwa amayi.

Ndi mkhutu aimpso ntchito

Kugwiritsa ntchito kwa Noliprel A Forte kumaphatikizidwa ndikulephera kwambiri kwaimpso (CC ochepera 30 ml / min).

Polephera kwa aimpso odwala CC 30-60 ml / min, kuikidwa kwa mankhwala ophatikizira kuyenera kuchitidwa pambuyo pa monotherapy yoyambirira ndi gawo lililonse lazogwira ntchito. Ndikofunikira kugwiritsa ntchito Mlingo womwe umalola kuti zitheke.

Pakulephera kwa impso ndi CC ya 60 ml / mphindi ndi kupitilira apo, mulingo woyenera wa Noliprel A umapangidwa, motsatana ndi chithandizo chowunika cha plasma creatinine ndi milingo ya potaziyamu.

Kuyanjana kwa mankhwala osokoneza bongo

Kukonzekera kwa lithiamu: kuphatikiza kwa ACE inhibitor ndi kukonzekera kwa lithiamu kumawonjezera chiopsezo chowonjezereka cha kuchuluka kwa lithiamu m'madzi a m'magazi komanso kukula kwa zotsatira zoyipa. Kukhalapo kwa thiazide diuretics kumangowonjezera zomwe zikutuluka. Chithandizo chothandizirana ndi kukonzekera kwa lithiamu sikulimbikitsidwa. Ngati kuli koyenera kuchitira mankhwala osakanikirana, kuwunika pafupipafupi zamadzimadzi a m'magazi kumafunikira,
baclofen: kumawonjezera hypotensive zotsatira. Kwa kusintha kwa mlingo kwakanthaŵi kwa mankhwala, ntchito ya impso ndi kuthamanga kwa magazi kuyenera kuyang'aniridwa.
non-steroidal anti-yotupa mankhwala (NSAIDs) (kuphatikizapo tsiku ndi tsiku mlingo wa acetylsalicylic acid wokwera kuposa 3 g): cycloo oxygenase-2 inhibitors (COX-2), NSAIDs zosasankha komanso mankhwala osokoneza bongo a acetylsalicylic acid amachepetsa mphamvu ya antihypertensive ya perindopril ndikuwonjezera chiwopsezo cha matenda aimpso. onjezerani potaziyamu ya potaziyamu (makamaka poyambira kuchepa kwa impso)
tricyclic antidepressants, antipsychotic (antipsychotic): Ndi munthawi yomweyo kugwiritsa ntchito Noliprel A forte, amalimbikitsa kuchititsa chidwi, kukulitsa chiopsezo cha orthostatic hypotension,
corticosteroids, tetracosactide: zimayambitsa kuchepa kwa antihypertensive kwenikweni. Zochita za corticosteroids zimathandizira kuti madzi asungidwe amadzimadzi ndi sodium,
Mankhwala ena a antihypertensive ndi vasodilators: akhoza kupititsa patsogolo mphamvu ya mankhwala. Nitroglycerin, nitrate ndi vasodilators amatha kupititsa magazi,
potaziyamu osunga diuretics (kuphatikizapo amiloride, spironolactone, eplerenone, triamteren), kukonzekera kwa potaziyamu, m'malo mwa mchere wa potaziyamu: zoterezi zimatha kuyambitsa chidwi chochuluka cha kuchuluka kwa potaziyamu mu seramu yamagazi, kuphatikiza ndi omwe amafa. Pamenepa, ndi hypokalemia yotsimikizika, kuphatikiza kwawo ndi mankhwalawa kuyenera kutsagana ndikuwunika kawirikawiri zomwe zili mu potaziyamu yamagazi ndi magawo a ECG,
estramustine: chiopsezo chokhala ndi angioedema ndi zochitika zovuta ngati izi zimakulitsidwa
insulin ndi sulfonylurea zotumphukira (mkamwa hypoglycemic othandizira): odwala matenda a shuga, hypoglycemic zotsatira za insulin ndi zotumphukira za sulfonylurea zimatha kulimbikitsidwa,
allopurinol, immunosuppressing ndi cytostatic othandizira, corticosteroids ogwiritsira ntchito mwadongosolo, procainamide: kuphatikiza ndi othandizawa kungakulitse mwayi wokhala ndi leukopenia,
General opaleshoni mankhwala: kugwiritsa ntchito mankhwala ambiri opaleshoni kumapangitsa antihypertensive zotsatira,
thiazide ndi "loop" okodzetsa: kuchuluka kwamphamvu kwa okodzetsa kungayambitse hypovolemia ndi ochepa hypotension,
linagliptin, sitagliptin, vildagliptin, saxagliptin (gliptins): kuwonjezera ngozi ya angioedema,
sympathomimetics: kufooketsa kwa antihypertensive zotsatira,
Kukonzekera kwa golide: motsutsana ndi maziko a iv pokonzekera golide, kukonzekera kwa nitrate kungayambike (nkhope yamkhungu, kukwiya, kusanza),
quinidine, disopyramide, hydroquinidine (antiarrhythmic mankhwala a kalasi IA), ibutilide, amiodarone, dofetilide, bretilia tosylate (antiarrhythmic mankhwala a gulu lachitatu), sotalol, chlorpromazine, ciamemazine, levomepromazine, thioridideide, trideidrideideide, trideidridiide, trideidridiide, trideidridiide, trideidridiide, trideidridiide, trupidridiide, trupidridiazidi, trideidridiide, trideidrideide, trideidine, trideidridiide, trideidrideide, trideidine. droperidol, haloperidol, pimozide, bepridil, diphenyl methyl sulfate, cisapride, erythromycin ndi vincamine (iv), misolastine, moxifloxacin, pentamidine, halofantrine, sparfloxacin, methadone, terfenadine, astemizole: indapamide imatha kuthandizira kuchepa kwa potaziyamu m'magazi am'magazi komanso kupezeka kwa mitundu ya pirouette arrhythmias. Ngati pakufunika kupereka ndalama izi, chisamaliro chapadera chiyenera kuthandizidwa kuti azilamulira zomwe zili m'madzi a m'magazi komanso nthawi ya QT,
amphotericin B (iv), systemic glucocorticoids ndi mineralocorticoids, tetracosactides ndi mankhwala ofewetsa thupi omwe amachititsa kuti matumbo asamayende: kuonjezera ngozi ya hypokalemia,
mtima glycosides: ziyenera kukumbukiridwa kuti hypokalemia ikhoza kupititsa patsogolo poizoni wa mtima glycosides, motero, tikulimbikitsidwa kuwongolera potaziyamu m'magazi a magazi ndi magawo a ECG ndikupanga kukonza koyenera kwamankhwala.
metformin: kupezeka kwa kulephera kwa aimpso komwe kunachitika pakudya diuretic, yomwe ikaphatikizidwa ndi metformin, kumawonjezera chiopsezo cha lactic acidosis, kuyenera kuganiziridwanso. Ngati kuchuluka kwa plazma m'magazi kwa amuna kukupitirira 15 mg / l, ndipo mwa akazi - 12 mg / l, metformin sayenera kutumikiridwa,
Mulingo wokhala ndi ayodini: mitundu yayikulu ya ayodini yomwe imakhala ndi mitundu yosiyanitsa ndi maziko am'madzi (chifukwa cha kupezeka kwa mankhwala okodzetsa) ya thupi imakulitsa chiopsezo cha kulephera kwa impso, komwe kumafunikira chipukuta misozi chifukwa cha madzi am'mimba musanagwiritse ntchito mankhwala okhala ndi ayodini.
mchere wamchere: kuchepa kwa ma impion a calcium ndi impso ndikotheka, komwe kumawonjezera mwayi wokhala ndi hypercalcemia,
cyclosporine: kuchuluka kwa cyclosporine m'madzi a m'magazi sikusintha, koma nkotheka kuonjezera creatinine m'madzi a m'magazi, kuphatikiza ndi madzi ndi sodium ion.

Zofanizira za Noliprel A forte ndizo: Noliprel, Noliprel A Bi-forte, Perindopril PLUS Indapamide, Co-Parnavel, Indapamide / Perindopril-Teva, Co-Perineva, Co-Preness, Perindapam, Perindide, Perindopril-Indapamide Richter.

Kufotokozera kwamapiritsi

Kuphatikizika kwa mapiritsiwa kumaphatikizapo Perindopril ndi Indapamide. Zinthu zonsezi zili ndi tanthauzo la antihypertensive, koma tsitsani tomu m'njira zosiyanasiyana.

Perindopril ndi ACE inhibitor, ndipo Indapamide ndi m'gulu la sulfonamide diuretics. Kuphatikiza apo, izi zimathandizira kuchitirana.

Lemberani mankhwala othandizira kuchepetsa kupanikizika. Nthawi zambiri, dokotala amaphatikiza Noliprel pa matenda a matenda oopsa.

Kuchuluka kwa hypotensive kumachitika pambuyo pa mwezi wopereka chithandizo ndipo kumapitilira kwa nthawi yayitali. Mankhwalawa amagwira ntchito ngakhale mankhwala ena a antihypertgency sathandizira.

Nthawi yomweyo, mtengo wamapiritsi ndi wotsika mtengo. Anthu ambiri amagula Noliprel, koma sakudziwa momwe angatengere. Chifukwa cha izi, zodandaula nthawi zambiri zimatuluka kuti malonda ake sagwira ntchito kapena amachepetsa tonometer kwambiri.

Ndemanga pa Noliprel A Fort

Ndemanga za Noliprel A Fort ndi zabwino. Odwala odziwa chithandizo cha matenda oopsa onena kuti kusintha kwa Noliprel A forte kunawathandiza kuti azichulukitsa magazi, ndipo kudya nthawi zonse kumapangitsa kuti pakhale bata. Pozindikira kuthandizira kwa mankhwalawa, ogwiritsa ntchito amalangizidwa kuti asayambe kumwa mankhwalawa popanda kufunsa dokotala.

Mlingo wa Noliprel

Noliprel amamasulidwa mumitundu ingapo. Ndikofunika kwa odwala komanso madokotala kuti amvetse izi.

Noliprel A Bi-Forte

Mitundu yotsatirayi ya mapiritsi ophatikizika imasiyanitsidwa:

Noliprel (ili ndi 2 mg perindopril ndi 0,625 mg diuretic),
Noliprel Forte (Mlingo wa indapamide ndi 1.25 mg, ndipo perindopril ndi 4 mg),
Noliprel A Forte (indapamide - 1.25 mg, perindopril - 5 mg),
Noliprel A Bi-Forte (perindopril amapezeka mu 10 mg, ndi okodzetsa - 2,5 mg),
Noliprel A (2,5 mg perindopril ndi 0,625 mg indapamide).

Noliprel A Bi-Forte amadziwika nthawi zambiri chifukwa cha kuchuluka kwa mankhwalawa. Ngati pali mlingo wambiri wa mankhwalawa, adokotala amasankha mapiritsi okhala ndi zochepa za perindopril ndi indapamide.

Mankhwala Noliprel A, Bi-Forte ndi A Forte ali ndi amino acid arginine, omwe ali ndi phindu pa kachitidwe ka mtima.

Chifukwa chake, ngati pali mavuto a mtima, ndikofunikira kugwiritsa ntchito mankhwalawa pamwambapa. Kwa wodwala aliyense, mulingo wake umasankhidwa payekhapayekha, poganizira zovuta za msinkhu, zaka. Odwala odwala matenda okalamba amalimbikitsidwa kuti ayambe kulandira chithandizo piritsi limodzi.

Momwe mungamwe mapiritsi a noliprel?

Mankhwala ophatikizidwa amatengedwa kamodzi patsiku. Ndi yabwino kwambiri, makamaka kwa anthu otanganidwa komanso osokonezeka.

Ngati dotolo adayambitsa Noliprel, momwe mungamwe mankhwalawa musanadye kapena mutatha kudya ndizovuta kwambiri kwa odwala ambiri.

Malangizo a boma sayankha. Zikungowonetsedwa kuti mankhwalawo amayenera kuledzera m'mawa.

Madokotala amalimbikitsa kugwiritsa ntchito mankhwalawa musanadye chakudya cham'mawa. Ndikofunika kuti mutenge mapiritsi nthawi yomweyo. Kenako mphamvu ya mankhwalawa idzatchulidwanso ndipo palibe mavuto omwe adzachitike.

Ponena za mlingo, dokotala amayamba kutumiza piritsi limodzi patsiku. Koma, ngati patatha mwezi umodzi chiyambi cha chithandizo zotsatira zake sizikupezeka, Noliprel Forte adayikidwa ndi mulingo wa 4 mg perindopril ndi 1.25 indapamide. Nthawi zina madokotala amatipatsa mankhwala ena. Mwachitsanzo, olimbana ndi calcium amawonjezeredwa. Poterepa, Mlingo wa antihypertensive wothandizidwa umachepetsedwa pang'ono.

Ngati mlingo uli wokwera kwambiri, zizindikiro zotsatirazi zimawonedwa:

kusanza ndi kusanza
kugona
mphwayi
chizungulire
kufooka
bradycardia
kukokana
kukomoka
thukuta lozizira
kutsika kwamphamvu kwa kuthamanga kwa magazi,
kuleka kwamkodzo kapena kukodza pafupipafupi.

Ngati zizindikiro zotere zikuwoneka, muyenera kuyimbira ambulansi nthawi yomweyo. Ndipo mukakhala kuti mukumva bwino, muyenera kupanga nthawi yokumana ndi dokotala kuti musinthe.

Chithandizo pa mimba

Pakukonzekera kutenga pakati, kubereka mwana sikulimbikitsidwa kuti atenge Noliprel.

Ngati mayi adagwiritsapo ntchito kale mapiritsi otere, maphunzirowa ayenera kumaliza ndi kufunsa dokotala kuti akupatseni mankhwala ena.

Kafukufuku wokhudzana ndi zotsatira za zoletsa za ACE pa amayi oyembekezera sizinachitike. Sizikudziwika kwenikweni momwe mankhwalawa amakhudzira kukula kwa mwana wosabadwayo.

Chifukwa chake, chisamaliro chiyenera kumwedwa. Kupatula apo, pali chiopsezo chakuti zinthu zofunikira za mankhwalawa zimatha kukhudza mapangidwe a mafupa chigaza, ntchito ya impso za akhanda. Komanso kumawonjezera mwayi wa ochepa hypotension.

Mankhwalawa amalekananso kuyamwitsa, chifukwa amalepheretsa kuyamwa ndikuchepetsa kuchuluka kwa mkaka wa m'mawere mwa amayi achichepere. Poganizira zakumwa mankhwala ngati amenewa, mwana amatha kukhala ndi hypokalemia, jaundice.

Kutalika kwa mankhwala

Noliprel nthawi zambiri amakhala mankhwala akuluakulu ogwiritsidwa ntchito pochiza matenda oopsa.

Mapiritsi amaloledwa kwa nthawi yayitali, koma ndikofunikira kuti mupumule nthawi yayifupi. Kupanda kutero, mankhwalawa angakhudze ntchito ya impso ndi chiwindi.

Kutalika kwa kumwa Noliprel, Mlingo - zonsezi ayenera kusankha dokotala, malinga ndi momwe wodwalayo alili.

Mankhwalawa ali contraindicated kwa odwala kwambiri aimpso kulephera. Ndi kulephera kwapakati kwakhungu, mulingo sayenera kupitilira piritsi limodzi patsiku.

Odwala ena omwe ali ndi vuto laimpso akumwa mankhwalawa, zizindikiro zakulembedwera zauma zimawonekera. Pankhaniyi, mankhwalawa amasiya. M'tsogolomu, amaloledwa kuyambiranso kuphatikiza mankhwala, koma pamlingo wotsika kwambiri komanso njira yochepa.

Kuchiza kwa nthawi yayitali ndi Noliprel sikulimbikitsidwa chifukwa cha matenda otere:

angina pectoris ,,
scleroderma,
Hyperuricemia
matenda ashuga
systemic lupus erythematosus,
hypertrophic cardiomyopathy,
aortic valve stenosis,
kulephera kwa mtima kosalephera.

Mankhwalawa amathandizira kukhala ndi kukakamizidwa pamlingo wa 130-140 / 80-90 mm. Hg. Art. ndi pansipa.

Chifukwa chake, chiwopsezo cha kubaya, kugunda kwa mtima komanso kulephera kwaimpso kumachepetsedwa. Kuchita bwino kwa mankhwalawa kumatsimikiziridwa ndi madokotala.

Madokotala amawona kuti chidacho chimakupatsani mwayi wokhazikika kwa kayendetsedwe kazinthu ndipo nthawi zambiri samayambitsa zovuta. Mavuto ambiri omwe amabwera mwa odwala omwe ali ndi matenda oopsa pamene akumwa Noliprel akukhudzana ndikuti odwala satenga mapiritsi molondola, musatsatire malangizo a dokotala.

Odwala omwe ali ndi vuto lozindikira kuti Noliprel ndi yokwera mtengo, angagulidwe ku pharmacy iliyonse. Koma nthawi zina mapiritsi sagulitsidwa. Pankhaniyi, analogu amaloledwa. Mwachitsanzo, Co-perineva, Prestarium, Perindopril ndi Indapamide Forte, Co-prenes, Quinard, Mipril, Lysopres, Capotiazide, Iruzid. Komanso cholowa mmalo choyenera ndi Ena sandoz, choyenera pochiza matenda oopsa, kulephera kwamtima, komanso kupewa myocardial infarction.

Makanema okhudzana nawo

Kanemayu akuwatsimikizira kuchiritsa kwa matenda oopsa a matenda a m'mimba Noliprel. Amauza amene adalembedwa komanso zomwe atengedwa?

Chifukwa chake, imodzi mwa zida zamakono zophatikiza antihypertensive ndi Noliprel. Mankhwala mofatsa koma mwachangu amakhala okhazikika pazovuta. Amapezeka mu mitundu yosiyanasiyana. Chifukwa cha izi, ndikosavuta kusankha mlingo woyenera kwambiri. Koma kudzipereka nokha sikungachitike. Dokotala amayenera kukulemberani mapiritsi ndipo pokhapokha ngati wodwalayo atamupima kwathunthu.

Amachotsa zoyambitsa zovuta
Imachepetsa kupanikizika mkati mwa mphindi 10 pambuyo pa kutsata

Noliprel Forte: kapangidwe ndi mawonekedwe a kumasulidwa

Kuti muchepetse kupanikizika, mankhwala osokoneza bongo osiyanasiyana amagwiritsidwa ntchito. Kwenikweni, awa ndi ma diuretics - okodzetsa omwe amachotsa madzi ochulukirapo ndi mchere wa sodium kuchokera m'magazi, amachepetsa kuchuluka kwake ndikusintha magazi. Amaphatikizidwanso ndi zinthu zomwe zochita zawo zimayang'ana poletsa ntchito ya enzyme yomwe imatembenuza angiotensin I kuti angiotensin II.

Ndi kuchepa kwa kuthamanga kwa impso, prorenin imapangidwa, yomwe, ikalowa m'magazi a magazi, imasinthidwa kukhala renin, imangiriza kwa angiotensinogen, ndikupanga angiotensin I. Pulogalamuyi imayendetsedwa ndi angiotensin II pakuchitika kwa michere ya magazi. Nthawi yomweyo, mitsempha yamagazi imacheperachepera, kugunda kwa mtima kumachepa, mtima wamanjenje wachifundo, womwe umayambitsa kukakamizidwa, umakhala wokondwa, aldosterone imapangidwa, yomwe imasungabe mchere ndi madzi, ndikuwonjezeranso katundu pamagetsi. Njirayi imakukakamizani kuti mumwe mankhwala mobwerezabwereza.

Noliprel A Forte (Noliprel Forte) - chida chamakono chophatikiza: diuretic ndi zoletsa zochitika za angiotensin-kutembenuza enzyme. Kuonjezera mphamvu ya mankhwala, kumachepetsa mavuto ndi zovuta.

Mankhwalawa amapezekanso pochepetsedwa ndimisempha yogwira ya Noliprel A. Amawonetsedwa kwa odwala omwe ndizosatheka kuchitira chithandizo chokwanira.

Mankhwala ali ndi magawo awiri omwe amagwira ntchito:

indapamide (1.25 mg),
perindopril arginine (5 mg).

sodium carboxymethyl wowuma (2.7 mg),
silika (0,27 mg),
lactose ngati monohydrate (71.33 mg),
magnesium stearate (0.45 mg),
maltodextrin (9 mg).

Mankhwala amapangidwa mwa mawonekedwe a convex chowulungika mapiritsi oyera. Atanyamula m'mabotolo apulasitiki okhala ndi dispenser ndi chivindikiro chinyezi cha 14 kapena 30 ma PC.

Zochita zamankhwala

Indapamide ndi Perindopril ndi mankhwala a antihypertensive a magulu osiyanasiyana, koma ophatikizidwa bwino mu zovuta mankhwala. Zinthu zake ndizogwirizana, zimathandizira zochita za wina ndi mnzake, zimathandizira kuchepetsa Mlingo komanso kuchepetsa mavuto.

Zophatikiza ndi sulfonamides, ndi mankhwala okodzetsa. Mwa kuletsa mayamwidwe a sodium m'magazi, amawachotsa mwachangu kwa impso pamodzi ndi plasma yambiri, ndikuwonjezera kukodza. Kuchita kotereku kumatha kuchepetsa kuthamanga kwamadzi m'matumbo, kukonza magazi, ndikuchepetsa kugunda kwa mtima.

Indapamide amachepetsa chiwopsezo cha makoma a mtima kuti angiotensin II. Kuphatikiza apo, mankhwalawa amachepetsa kuchuluka kwa calcium m'magazi chifukwa cha kuphipha kwake mu mkodzo, komwe kumachepetsa% ya mankhwala ake omwe amalowa m'minyewa yam'mimba.

Kashiamu imapangitsa kuti minofu ikhale yolimba, zomwe zimapangitsa kuti mtima ukhale wawonjezeka komanso chiwopsezo chowonjezeka.

Indapamide imachepetsa m'badwo wama radicals a oxygen aulere, omwe amachititsa kukalamba kwa thupi komanso mawonekedwe a neoplasms.

Thupi limatengedwa mwachangu ndikumanga mapuloteni a plasma, minofu elastin. Imapukutidwa makamaka ndi impso. Pafupifupi 30% imachotsedwa ndi chiwindi mu mawonekedwe a metabolites kapena momwe zimakhalira.

Indapamide imakhala ndi mankhwala omwe amadalira mlingo wa mankhwala, motero, amaikidwa panjira ya mankhwalawa.

Perindopril

Gawo lomwe limaletsa mawonekedwe a angiotensin II - vasoconstrictor wamphamvu. Ilinso ndi zotulukapo zina zomwe zimakhudza mayendedwe azitsulo zamagazi okhazikika:

amachepetsa kupanga aldosterone,
kuonjezera ntchito renin,
amachepetsa kugunda kwa mtima popanda kusintha mawonekedwe awo.

Perindopril amasintha kayendedwe ka magazi, amachepetsa katundu pa minofu ya mtima, kuchepetsa chiopsezo cha kugunda kwa mtima, kuletsa kukulitsa kwa hyperplasia kapena hypertrophy ya minofu minofu ya mtima, kugwiritsa ntchito cardio- ndi angioprotective.

Kuti muchepetse kuthamanga kwa magazi, chinthucho chimatengedwa nthawi imodzi - zotsatira zimachitika pambuyo maola 4 ndikutsalira kwa tsiku - ndi maphunzirowo. Ndi kugwiritsa ntchito tsiku ndi tsiku, kutchulidwa kochiritsa kumawonekera pakatha mwezi umodzi ndipo kumapitirira kwa nthawi yayitali.

Kufunsira kwa miyezi isanu ndi umodzi kapena kupitirira apo kumachepetsa katundu pamtima ndi m'mitsempha yamagazi ndikuwonjezera kupirira kwa odwala omwe ali ndi vuto la mtima. Perindopril siosokoneza.

Ikatengedwa, imakamizidwa mwachangu, yomangika pang'onopang'ono pamapuloteni amwazi, omwe amapikisidwa ndi chiwindi, amachotsa impso ndi ndowe.

Mankhwala amatchulidwa zochizira matenda oopsa - mwatsatanetsatane (3-4 kawiri pa tsiku) kukhathamira kwa 140/90. Nthawi zambiri amapezeka odwala azaka 35 mpaka 40 ndipo alibe chifukwa.

Wokhazikika maphunziro makonzedwe a "Noliprel Forte" kumayambiriro kwa matenda amatha kuphatikiza kukakamiza. Mu gawo lovuta kwambiri, lachitatu, magazi akakwera kufika pa 180/110, amakhala ndi otsika kwambiri, kuchepetsa chiopsezo chotaya magazi ndi mtima.

Mankhwala akuwonetsedwa kuti agwiritse ntchito odwala omwe ali ndi nthawi yomweyo matenda oopsa a shuga 2, ngati njira yotchinjirizira ku zovuta zamagulu olowa.

Mapiritsi a Noliprel Forte

Mankhwala ndi othandiza kwambiri polimbana ndi matenda oopsa. Chifukwa chopangidwa mosiyanasiyana ndi mankhwalawa, kuphatikiza bwino kwa zigawo zikuluzikulu (perindopril, indapamide), Noliprel imakhazikika kuthamanga kwa magazi ndikuchotsa madzi ochulukirapo m'thupi. Njira yokhazikika yothandizidwa ndi Noliprel imachitika pakatha masabata atatu kuyambira chiyambi chamankhwala ndipo samatsagana ndi tachycardia. Mankhwalawa amathandizidwa kuti azilandira kunyumba, kuwunika kwa nthawi ndi nthawi ndi dokotala kuti asinthe.

Kapangidwe ka Noliprel

Mankhwalawa amapezeka m'magome oyera oyera. Noliprel ali ndi mitundu ingapo yomwe ili ndi mulingo wosiyanasiyana wa zinthu zazikulu: perindopril, indapamide. Zomwe zikuchokera mankhwala zimaperekedwa pagome:

Ndende ya Perindopril, mg

The kuchuluka kwa indapamide, mg

lactose monohydrate, microcrystalline cellulose, hydrophobic colloidal silicon, arginine (wophatikizidwa ndi fomu yotulutsidwa ndi prefix "A")

Noliprel A Bi-Forte

Noliprel A Forte

Zotsatira za pharmacological

Mankhwala Noliprel ndi kuphatikiza zinthu ziwiri zazikulu zomwe zimakhala ndi zawo komanso zimakhala ndi zotsatirapo zosiyanasiyana:

Perindopril. Imachepetsa kuthamanga kwa magazi kukhala mulingo wabwinobwino, kumachepetsa kukana m'mitsempha yamagazi, kumapangitsa kuti makoma amitsempha, kukhazikika m'mitsempha ya mtima, kuchepetsa kuchepa kwamitsempha yamanzere yam'manja, kumachepetsa mwamphamvu kuchuluka kwa minofu yamtima.
Indapamide. Amachotsa madzi ochulukirapo kudzera mu impso, amakhala ndi diuretic ndi vasoconstrictor.

Zizindikiro zogwiritsidwa ntchito

Mapiritsi a kukakamiza Noliprel amagwiritsidwa ntchito pongowonetsa chithandizo - chofunikira (chachikulu) cha matenda oopsa. Matendawa amayamba chifukwa cha matenda a chithokomiro. Komabe, mogwirizana ndi malangizo, mankhwalawa amatha kupatsidwa mankhwala a prophylactic pochizira odwala a m'magazi a magulu apadera (matenda oopsa, mtundu II matenda a shuga).

Mayendedwe Noliprel Forte

Mbali yabwino ya mankhwalawa ndikuti iyenera kumwa kamodzi patsiku. Izi ndizothandiza kwa okalamba, omwe nthawi zambiri amavutika ndi kuyiwalika. Nthawi yabwino kumwa mankhwalawa ndi m'mawa. Piritsi limodzi liyenera kumeza (musatafuna, musagawike ma Mlingo awiri) musanadye, imwani madzi ambiri. Zochita za mapiritsi zimawonetsedwa maola 2-5 mutatha kugwiritsa ntchito ndipo zimatha kwa maola 24. Pakatha mwezi umodzi ndi theka kumwa mankhwalawo, adotolo amasintha.

Pa nthawi yoyembekezera

Kugwiritsa ntchito mankhwala Noliprel motsutsana ndi kukakamiza kumaletsedwa mosamala pakubala ndi poyamwitsa. Mukakonzekera kapena kukhala ndi pakati, mankhwala a antihypertensive ayenera kuyimitsidwa nthawi yomweyo. The yogwira zinthu za Noliprel zingasokoneze kukula kwa mwana wosabadwayo, kuyambitsa:

kulephera kwa aimpso
amniotic fluid voliyumu,
Kuchepa kwa impso kwa mwana,
kuchedwa kwa chitukuko cha fetus chokhudzana ndi fetotoxicity,
Kuchepetsa mapangidwe a mafupa a chigaza cha mwana,
ochepa matenda oopsa.

Panthawi yoyamwitsa, Noliprel iyenera kusiyidwa. Zomwe zimagwiritsidwa ntchito ndi mankhwalawa zimachepetsa kuchuluka kwa mkaka wa m'mawere ndi kuyamwa. Kuphatikiza apo, Noliprel imatha kusokoneza thanzi la mwana, kuchititsa jaundice kapena hypokalemia. Ngati mankhwalawa ndi ofunikira thanzi la mayi ndipo palibe chomwe chitha kusintha, mwana ayenera kusinthidwa kwakanthawi ku zakudya zopangidwa mwakudya.

Muubwana

Noliprel osavomerezeka kuti azichitira ana ndi achinyamata ochepera zaka 18. Zotsatira zake, zoyipa zake ndi kugwiritsa ntchito bwino kwa mankhwalawo m'thupi la ana sizinakhazikitsidwe. Kunyalanyaza kubedwa kumeneku kumatha kuwononga thanzi la wodwala komanso kuchipatala kuti abwezeretse zizindikilo zofunika za wodwalayo.

Migwirizano yogulitsa ndikusunga

Mankhwalawo amagulitsidwa ndi mankhwala. Palibe malo osungirako apadera, muyenera kuti Noliprel asamathe ana pa kutentha kosaposa madigiri 30. Alumali moyo wa mankhwala si zoposa 3 zaka.

Popeza mtengo wapamwamba wa Nolirel ndi mndandanda wambiri wa contraindication, chithandizo chitha m'malo mwake ndi ma analogu ena. Lingaliro losankha chida chochepetsera kuthamanga kwa magazi liyenera kuchitika ndi dokotala. Kuphatikiza kopambana kwa indapamide ndi perindopril kumagwiritsidwa ntchito mwachangu mu mankhwalawa:

Ko-Perineva,
Perindopril-Indapamide Richter,
Perindapam,
Co Parnawel
Perindid
Noliprel A
Indapamide Perindopril-Teva,
Aigupto
Iruzid,
Ikweta
Dalneva.

Malangizo ogwiritsira ntchito mankhwalawa

Mwachilengedwe, mulingo woyenera pankhaniyi uyenera kukhala payekha, chifukwa zimatengera zaka komanso wodwala, komanso matenda omwe amapezeka mwa iye. Komabe, pali malamulo oyendetsedwa bwino komanso malamulo othandiza. Mapiritsi a Noliprel amatengedwa bwino m'mawa - motere zotsatira zake zimawoneka mwachangu komanso zimatenga nthawi yayitali, ndipo kukakamizidwa sikungasokoneze chizolowezi chamasana.

Ponena za kuchuluka kwake, akuluakulu amalangizidwa kuti atenge piritsi limodzi patsiku. Ngati ndi kotheka, dokotala, inde, angasinthe mlingo kapena mankhwalawa.

Mankhwala "Noliprel forte": contraindication

Kuphatikiza apo, kulephera kwambiri kwa chiwindi ndi hypokalemia kumagwiranso ntchito pa contraindication. Odwala omwe ali ndi matenda oopsa a impso amaletsedwanso. Ndipo, ndithudi, mankhwalawa saloledwa kwa ana ochepera zaka 18. Ndipo popeza mankhwalawo ali ndi lactose monohydrate, sinafotokozeredwe anthu omwe ali ndi vuto la kuchepa kwa lactose komanso matenda ena okhudzana ndi kupindika kwa kagayidwe kazakudya.

Ichi ndichifukwa chake simuyenera kuiwala kuti mankhwalawa amatha kuperekedwa ndi adokotala atalandira zotsatira zonse za mayeso ndi maphunziro. Ngati pali contraindication, zotsatira za mankhwala zimatha kukhala zowopsa thanzi komanso ngakhale moyo.

Zotheka zimachitika

Nthawi zina, mankhwala amabweretsa kuphwanya kwamphamvu dongosolo la kupuma - chifuwa chowuma, bronchospasm, rhinorrhea kumatha kuchitika. Nthawi zina, kugwiritsa ntchito mankhwalawa kungayambitse angina pectoris, arrhythmias, stroke, kugunda kwa mtima, kulephera kwaimpso.

Nthawi zina pamakhala mseru, kusanza, kusokonezeka kwa pakamwa, pakamwa pouma. Osowa kwambiri, chithandizo chimabweretsa kukula kwa kapamba kapena jaundice.

Zowonjezera

Ndikofunika kudziwa kuti mlingo woyamba wa mankhwalawa ungayambitse kuchepa kwambiri kwa magazi - palibe chifukwa choopera, izi ndizabwinobwino, makamaka m'masiku ochepa. Koma wodwala wotere ayenera kuyang'aniridwa ndi antchito azachipatala nthawi zonse.

Kuphatikiza apo, ndikofunikira kuyesedwa nthawi ndi nthawi pamankhwala - izi zimathandizira kuwunika kuchuluka kwa creatinine ndi potaziyamu m'magazi, popeza kupatuka kuzizolowereka kumatheka motsogozedwa ndi mankhwalawa.

Madokotala samalimbikitsanso kuyendetsa galimoto mukamachiza, gwiritsani ntchito njira zosiyanasiyana zomwe zimafunikira kuti muzitha kuyang'anitsitsa komanso kuchitapo kanthu mofulumira. Musanayambe chithandizo, onetsetsani kuti mwauza dokotala za mankhwalawa omwe mumamwa, chifukwa mankhwalawa a Noliprel Forte ophatikizana ndi mankhwala ena akhoza kukhala owopsa.

Ndemanga za Makasitomala

Komabe, mankhwalawa "Noliprel forte" ali ndi zovuta zina. Poyamba, ndikofunikira kuzindikira mtengo wake - mtengo uwu sioyenera aliyense, makamaka pankhani ya chithandizo chanthawi yayitali. Kuphatikiza apo, odwala ena omwe amamwa mankhwalawa kwa nthawi yayitali (miyezi 2-3) adakhala ndi vuto m'malo - kusowa kwa tsitsi. Pamaso pa kuphwanya koteroko, muyenera kufunsa dokotala: mungafunike analogue ya Noliprel (mwachitsanzo, Enap N). Mwa njira, mutha kugula zogulitsa zomwe zili ndi zigawo zikuluzikulu zomwe zimagwiritsidwa ntchito ndi mankhwala (perindopril ndi indapamide) - kuzitenga zingathandize kukwaniritsa zofanana, koma chiopsezo chamawonekedwe a dazi chimakhala chochepa kwambiri.

Malangizo

Ndi bwino kumwa piritsi limodzi m'mawa musanadye chakudya cham'mawa. Mlingo umodzi wa Noliprel Forte ndi wokwanira kuchiritsa tsiku lonse.

Odwala omwe ali ndi matenda a shuga, aimpso kapena a hepatic insuffuffence akuwonetsedwa kuti ayambe kuchira ndi mankhwalawa "Noliprel A".

Mlingo weniweni ndi malingaliro a kumwa mankhwalawa amaperekedwa ndi adokotala. Ngati malangizo onse atsatiridwa, chiwopsezo cha zovuta ndi zovuta zimatsika kwambiri, ndipo mphamvu ya chithandizo ndi yokwanira.

Nthawi zina, ngati kuli kotheka kusankha mlingo, mankhwalawa amasinthidwa ndi mankhwala osokoneza bongo a monocomponent ndi indapamide ndi perindopril amaperekedwa malinga ndi kuchuluka kwake.

Zotsatira zoyipa

Zotsatira zoyipa za thupi siziyenera kutsatira njira yochizira. Ngati kusintha kwa zinthu kukuyambitsa kusasangalala kwambiri kapena kuwopseza moyo ndi thanzi, onetsetsani kuti mwadziwitsa dokotala. Amasintha mlingo wake kapena amwe mankhwalawo.

Madandaulo odziwika kwambiri kwa odwala ndi awa:

ululu wamkati, chizungulire,
mawonetseredwe akunja a ziwengo - hyperemia, urticaria, kuyabwa, kupendama,
mawonekedwe a tinnitus, zosokoneza zowoneka,
kupezeka kwa orthostatic hypotension ndi zosiyana,
kuchuluka kwauma kwa mucous nembanemba mkamwa ndi pakhosi, kutsokomola,
kufooka wamba, minyewa kukokana.

Kusokonezeka monga kugona tulo, arrhythmia, tachycardia, edema, mawonekedwe amtundu wazovuta, kutuluka thukuta sikofala.

Chifukwa cha kusintha kwa ndende yamagazi, mankhwalawa amatha kusintha magwiridwe amunthu. Chifukwa chake, kuyesedwa kwa labotale kayendedwe kake kumalimbikitsidwa.

Mankhwala "Noliprel Forte" ali ndi chitsimikiziro chowona pochiza matenda oopsa.

Odwala omwe amamwa mankhwalawa, amadziwika kuti:

achire zotsatira pambuyo masabata 2-3 utsogoleri,
kutsitsa kukula kwa hypertrophied kumanzere kwamitseko,
Kusintha kwazinthu zina
wathunthu matenda a magazi mankhwalawa koyambirira kwa matenda oopsa.

Mwambiri, Noliprel amalekerera mosavuta, ndipo pakakhala tsankho amaloledwa ndi mankhwala ena omwe adachitanso chimodzimodzi.

Mutha kugula mankhwalawo ku pharmacy. Amangotulutsidwa pokhapokha ngati akuwapatsa mankhwala. Kulandilako kumaloledwa pambuyo poyankhulana ndi katswiri. Mtengo wapakati wa mankhwala ndi ma ruble 680 pa paketi imodzi ya 30 ma PC.