Tsatirani malangizo ogwiritsira ntchito, contraindication, mavuto, ndemanga

Mankhwala a antihypertensive, ACE inhibitor
Mankhwala: TRITACE
The yogwira mankhwala: ramipril
ATX Encoding: C09AA05
KFG: ACE inhibitor
Reg. nambala: P No. 016132/01
Tsiku lolembetsa: 12.29.04
Mwini reg. acc.: AVENTIS PHARMA Deutschland GmbH

Kutulutsa mawonekedwe Tritace, ma CD ndikuphatikizira ndi mankhwala.

Mapiritsiwo ndi owala, achikasu owoneka bwino okhala ndi chilembo chogawana mbali zonse ndipo olembedwa "2,5 / chithunzi chosemedwa cha zilembo h" ndi "2,5 / HMR" mbali inayo.
1 tabu
ramipril
2,5 mg

Omwe amathandizira: Hypromellose, pregelatinized starch, microcrystalline cellulose, sodium stearyl fumarate, chikasu chachitsulo.

14 ma PC. - mapepala otumphukira (2) - mapaketi a makatoni.

Mapiritsiwa ndi owota, opepuka pinki okhala ndi chilembo chogawana mbali zonse ndipo amalemba "5 / chithunzi chosemedwa cha zilembo h" ndi "5 / HMR" mbali inayo.

1 tabu
ramipril
5 mg

Omwe amathandizira: Hypromellose, pregelatinized starch, microcrystalline cellulose, sodium stearyl fumarate, iron utoto wofiyira.

14 ma PC. - mapepala otumphukira (2) - mapaketi a makatoni.

Kufotokozera kwa mankhwalawa kumatengera malangizo ovomerezeka omwe angagwiritsidwe ntchito.

Tracace ya pharmacological

Mankhwala a antihypertensive, ACE inhibitor. Ramiprilat, metabolite wogwira wa ramipril, ndi ACE inhibitor wautali. Mu plasma ndi minofu, enzyme iyi imathandizira kusintha kwa angiotensin I ku angiotensin II (vasoconstrictor yogwira) komanso kuwonongeka kwa vasodilator bradykinin. Kuchepetsa mapangidwe a angiotensin II ndikuwonjezera ntchito ya bradykinin kumabweretsa vasodilation ndipo kumapangitsa kuti mtima ndi ramotril uwoneke.

Angiotensin II imalimbikitsa kutulutsa kwa aldosterone, pankhaniyi, ramipril imayambitsa kuchepa kwa secretion ya aldosterone.

Kutenga ramipril kumabweretsa kuchepa kwakukulu mu OPSS, makamaka popanda kuyambitsa kusintha kwa magazi a impso komanso kuchuluka kwa kusefedwa kwa glomerular. Kutenga ramipril kumayambitsa kuchepa kwa kuthamanga kwa magazi ponse pa supine komanso m'malo oyimilira popanda kuchuluka kwa mtima. Mphamvu ya antihypertensive imayamba patatha maola awiri atatha kumwa kamodzi pa mankhwalawa ndikulimbikira kwa maola 24. Mphamvu ya antihypertensive ya Tritace imakonda kuchitika pakadutsa masabata 3-4 a kupitiliza kuyendetsedwa kwa mankhwalawa ndipo imakhala kwa nthawi yayitali. Kusiyidwa kwadzidzidzi kwa mankhwalawa sikupangitsa kuti magazi azithamanga mofulumira komanso mwamphamvu.

Kugwiritsa ntchito mankhwalawa kumachepetsa kufa (kuphatikizapo kufa mwadzidzidzi), chiwopsezo cha mtima wosalephera, kumachepetsa kuchuluka kwa odwala omwe ali ndi matenda amisempha yodwala pambuyo pakulowerera kwaposachedwa.

Odwala omwe ali ndi matenda ashuga komanso osadwala omwe amakhala ndi matenda osokoneza bongo, mankhwalawa amachepetsa kukula kwa impso, komanso panthawi ya matenda ashuga komanso osadwala a shuga, ramipril amachepetsa albuminuria.

Mankhwala amakhudzanso kagayidwe kazakudya komanso mbiri ya lipid, imayambitsa kuchepa kwambiri kwa myocardial hypertrophy ndi khoma la mtima.

Pharmacokinetics wa mankhwala.

Pambuyo pakukonzekera pakamwa, imatengedwa mwachangu kuchokera ku m'mimba thirakiti (50-60%). Zakudya sizikhudzana ndi mayamwa athunthu, koma zimachepetsa mayamwidwe.

Cmax ya ramipril ndi ramiprilat imafikira m'madzi a m'magazi pambuyo pa maola 1 ndi 3, motero.

Kugawa komanso kagayidwe

Pokhala mankhwala osokoneza bongo, ramipril amakumana ndi kagayidwe kakang'ono kwambiri (makamaka m'chiwindi ndi hydrolysis), chifukwa chomwe metabolite yokhayo, ramiprilat, imapangidwa. Kuphatikiza pakupangidwe kwa metabolite yogwira iyi, glucuronidation ya ramipril ndi mitundu ya ramiprilat yosagwira metabolites - ramipril diketopiperazine ndi ramiprilat diketopiperazine. Ramiprilat ali pafupifupi 6 nthawi zambiri wogwira ntchito poletsa ACE kuposa ramipril.

Kumangidwa kwa ramipril kumapuloteni a plasma ndi 73%, ramiprilata - 56%.

Vd ya ramipril ndi ramiprilat pafupifupi 90 malita ndi 500 malita.

Pambuyo pakukonzekera tsiku lililonse, kamodzi patsiku la mankhwalawa 5 mg Css mu plasma, imafikiridwa ndi tsiku 4. Kuchulukitsidwa kwa plasma kwa ramiprilate kumachepera magawo angapo: magawo oyamba ndi kuwachotsa kwa ramiprilat ndi T1 / 2 pafupifupi maola atatu, ndiye gawo loyambira ndi ramiprilat T1 / 2 nthawi pafupifupi maola 15 ndipo gawo lomaliza ndi ramiprilat yotsika kwambiri mu plasma ndi T1 / 2 ramiprilata pafupifupi 4-5 masiku. Gawo lotsiriza limalumikizidwa ndi kudzipatula pang'onopang'ono kwa ramiprilat chifukwa chogwirizana ndi ACE receptors. Ngakhale nthawi yayitali yomaliza ndi gawo limodzi la ramipril pa 2,5 mg kapena kuposerapo, kuchuluka kwa ramiprilat mu plasma kumachitika pambuyo masiku pafupifupi anayi a chithandizo.

Ndi nthawi ya mankhwala T1 / 2 ndi maola 13 mpaka 17.

Mukamamwa, pafupifupi 60% ya mankhwala omwe amapezeka mumkodzo ndi 40% ya ndulu, yotsika osachepera 2%.

Kutulutsa mawonekedwe ndi kapangidwe kake

Tritace imapezeka mu mawonekedwe a piritsi:

Mapiritsi a 2,5 mg: opepuka achikasu, oblong, mbali zonse ziwiri zokhala ndi chizindikiritso (mbali imodzi - "2,5" ndi zilembo zosasunthika h, mbali inayo - "2,5" ndi HMR) (zidutswa 14) .matuza, pamakatoni okhala ndi matuza awiri),
Mapiritsi a 5 mg: opepuka pinki okhala ndi zopepuka kapena zopepuka zakuda, mbali zonse ziwiri zokhala ndi chizindikiro ndi zolemba (mbali imodzi - "5" ndi zilembo zosasunthika h, mbali inayo - "5" ndi HMR) (14 iliyonse) ma PC mu matuza, mu carton matuza awiri),
Mapiritsi a 10 mg: pafupifupi oyera kapena oyera, oblong, mbali zonse ziwiri ndi notch ndi "constituion" kumbali zomwe zili pachiwopsezo, cholembedwa mbali imodzi (HMO / HMO) (ma PC 14 mu matuza, mu katoni chithuza).

Piritsi limodzi:

yogwira mankhwala: ramipril - 2,5, 5 kapena 10 mg,
othandizira: microcrystalline cellulose, hypromellose, sodium stearyl fumarate, pregelatinized starch, yellow iron oxide utoto (mapiritsi a 2.5 mg), utoto wofiira wa oxide (mapiritsi a 5 mg).

Zizindikiro zogwiritsidwa ntchito

CHF (kulephera kwamtima kosalekeza) - mankhwalawa, kuphatikizapo molumikizana ndi okodzetsa,
kulephera kwa mtima komwe kunayamba kuchokera masiku awiri mpaka 9 kuchokera pakhungu lachiwembu,
zofunika matenda oopsa
kuchuluka kwa chiwopsezo cha mtima (odwala omwe ali ndi mbiri ya kuwonongeka kwa mtima, komanso matenda amtima wotsimikizika komanso mbiri ya kupunduka kwamatenda am'mimba, zotupa zokhala ndi zotumphukira, zotupa za matenda a shuga komanso vuto limodzi mwanjira ina) - - chiopsezo chotenga stroko kapena myocardial infaration,
nephropathy (odwala matenda ashuga kapena osachiritsika), kuphatikiza ndi proteinuria yayikulu.

Contraindication

kuthamanga kwa magazi (magazi a systolic osakwana 90 mm Hg), komanso mikhalidwe yomwe ili ndi mawonekedwe osakhazikika a hemodynamic,
CHF ikuyenera kubwezera (popeza pali zosakwanira pakugwiritsa ntchito pachipatala),
hypertrophic obstriers cardiomyopathy kapena hemodynamically stenosis ya mitral kapena aortic valve,
unilateral (wokhala ndi impso imodzi) kapena mbali ziwiri zikuluzikulu za hemodynamically a renal stenosis,
nephropathy (mankhwalawa amagwiritsa ntchito ma immunomodulators, mankhwala osokoneza bongo a anti-yotupa, glucocorticosteroids ndi / kapena mankhwala ena a cytotoxic, popeza mulibe deta yakwanira yachipatala),
hemodialysis (chifukwa cha kusowa nzeru zakuchipatala),
kulephera kwambiri kwa aimpso,
hemofiltration kapena hemodialysis pogwiritsa ntchito mphamvu zamphamvu zam'mimba za polyacrylonitrile (chifukwa cha chiopsezo cha zochita za hypersensitivity),
mbiri ya angioedema,
hyposensitizing mankhwala a hypersensitivity zimachitikira mavu ndi njuchi njoka,
apheresis of LDL (otsika kachulukidwe lipoproteins), amene amagwiritsa ntchito dextran sulfate (chifukwa cha chiopsezo cha hypersensitivity reaction),
chachikulu hyperaldosteronism,
ana ndi achinyamata ochepera zaka 18 (chifukwa cha kusowa nzeru zakuchipatala),
nthawi ya pakati komanso yoyamwitsa,
Hypersensitivity gawo lililonse la mankhwala kapena zoletsa zina za ACE.

Mu gawo lowawa la myocardial infarction, Tritace imaphatikizidwanso zotsatirazi:

mtima wa m'mapapo
angina wosakhazikika,
kulephera kwamtima kwambiri
moyo wowopsa wamitsempha yamagazi.

Wachibale (Tritace imagwiritsidwa ntchito mosamala):

chiwindi ntchito (mwina kufooka kapena kuchuluka kwa ramipril),
aimpso kuwonda ntchito pang'ono kufatsa,
postoperative nthawi pambuyo kupatsirana kwa impso,
matenda ashuga
Hyperkalemia
matenda a chiwindi ndi edema ndi ascites,
nyengo yomwe kuchepa kwa kuthamanga kwa magazi kumalumikizidwa ndi chiwopsezo chowonjezereka (mwachitsanzo, ndi zotupa za atherosrance
matenda a minofu yolumikizira (scleroderma, systemic lupus erythematosus, komanso chithandizo chothandizirana ndi mankhwala omwe angapangitse kusintha kwa chithunzi cha magazi).
machitidwe omwe ntchito ya RAAS (renin-angiotensin-aldosterone system) imachulukira, ndipo ACE ikatsekereza, pamakhala chiopsezo chakuchepa kwambiri kwa kuthamanga kwa magazi komanso kuwonongeka kwaimpso (kufooka kwa mtima, kuchepa kwamphamvu kwa magazi, kusungunuka kwa magazi, kugwiritsa ntchito mankhwala osokoneza bongo, etc. .)
ukalamba (chifukwa cha chiwopsezo chowonjezeka cha hypotensive zotsatira).

Mlingo ndi makonzedwe

Mapiritsi a Tritace amatengedwa pakamwa popanda kutafuna ndikumwa madzi ambiri. Kumwa mankhwalawa sikudalira nthawi yakudya. Mlingo amasankhidwa payekha poganizira kulekerera kwa mankhwala ndi zotsatira achire zotsatira. Chithandizo chake nthawi zambiri chimakhala chachitali, ndipo nthawi yake imatsimikiziridwa ndi dokotala.

Malangizo a dosing oyenera a Tritace omwe ali ndi chiwindi komanso impso ntchito:

CHF: mlingo woyamba ndi 1.25 mg kamodzi patsiku, m'tsogolomo, poganizira kulekerera kwa mankhwalawa, ndizotheka kuphatikiza mlingo uliwonse pakadutsa milungu iwiri, mlingo wa tsiku ndi tsiku womwe walandila, ngati wopitilira 2,5 mg, utha kugawidwa Mlingo wambiri, 10 mg tsiku,
Kulephera kwa mtima komwe kumachitika patangotha masiku ochepa pambuyo povunditsidwa ndi mkodzo: matendawo koyamba - 5 mg patsiku kawiri magawo awiri m'mawa ndi madzulo), osagwirizana ndi koyamba mlingo (kuchepa kwambiri kwa magazi), tikulimbikitsidwa kuti muchepetse magazi ndikupatsa wodwalayo masiku awiri , 5 mg ya mankhwala patsiku kawiri. M'masiku otsatirawa, mudwala momwe wodwalayo angachitire, mutha kuwonjezera kuchuluka kwa mankhwalawa masiku onse atatu, mlingo waukulu ndi 10 mg patsiku,
kofunika ochepa matenda oopsa: woyamba mankhwalawa 2,5 mg kamodzi patsiku (m'mawa), ngati mkati mwa 3 kapena kuposa milungu ya chithandizo koyamba mlingo wa kuthamanga magazi sizinachitike, n`zotheka kuwonjezera mlingo mpaka 5 mg patsiku, pambuyo wina 2-3 milungu ya mankhwala, vuto la osakwanira kuchuluka kwa 5 mg tsiku lililonse, mlingo wa Tritace umachulukitsidwa kawiri pazomwe zikukulimbikitsidwa, zomwe ndi 10 mg patsiku, kapena kusiya zomwezo, koma othandizira ena amawonjezera mankhwalawo.
Kuchepetsa kufa kwa mtima ndi chiopsezo chodwala kapena kupweteka kwamtima mwa odwala omwe ali ndi chiwopsezo cha mtima: 2,5 mg kamodzi patsiku kumayambiriro kwa mankhwala, ndikutsatira kuwonjezeka kwapang'onopang'ono kwa mlingo, poganizira kulolera kwa mankhwala, kuwirikiza kawiri mlingo pambuyo pa sabata la 1, ndi masabata atatu otsatira, bweretsani mlingo wokonzanso womwe umakhala 10 mg patsiku limodzi,
nephropathy ndi matenda ashuga kapena nondiabetic: mlingo woyambirira ndi 1.25 mg kamodzi patsiku, m'tsogolomu ndikotheka kuwonjezera mlingo mpaka 5 mg kamodzi patsiku, kugwiritsa ntchito Tritace mu Mlingo wapamwamba pamikhalidwe iyi sikumveka bwino.

Panthawi ya kuphwanya impso (creatinine chilolezo cha 50-20 ml / mphindi) ndi chiwindi, odwala omwe adalandira chithandizo cham'mbuyomu, okalamba odwala, odwala matenda ochepa owopsa, osakonzedwa kwathunthu ndi kuwonongeka kwa ma elekitirodiya ndi madzi, komanso omwe kuchepa kwambiri kwa magazi kuthamanga kwa magazi kumaika chiopsezo china, mlingo woyambirira wa Tritace sayenera kupitirira 1.25 mg patsiku.

Mu vuto la aimpso, mulingo woyenera tsiku lililonse sayenera kupitirira 5 mg, komanso chiwindi ntchito - osaposa 2.5 mg.

Zotsatira zoyipa

kupukusa m'mimba: pafupipafupi - kupukusa m'mimba, kusanza, kusanza, m'mimba, kutupika m'matumbo ndi m'mimba, kutsekula m'mimba, dyspepsia, nthawi zina - kupweteka kwamlomo wamkamwa, kapamba, gastritis, kupweteka kwam'mimba, kudzimbidwa, matumbo angioedema, kuchuluka pancreatic enzyme ntchito, kawirikawiri - kutupa kwa lilime, pafupipafupi - aphthous stomatitis,
mtima dongosolo: pafupipafupi - orthostatic hypotension, kuchepa kwambiri kwa magazi, kukomoka, nthawi zina - mawonekedwe kapena kuchuluka kwa arrhythmias yomwe ilipo, zotumphukira edema, myocardial ischemia, palpitations, kutupa kwa nkhope, tachycardia, kawirikawiri - vasculitis, kusokonezeka kwa mitsempha, pafupipafupi sikudziwika Matenda a Raynaud
kupuma dongosolo: Nthawi zambiri - kufupika, bronchitis, chifuwa chowuma, sinusitis, nthawi zina - kuchulukana kwammphuno, bronchospasm (kuphatikizapo kuphatikizika kwa mphumu wa bronchial),
pakati mantha dongosolo: Nthawi zambiri - kumverera kwa kupepuka m'mutu, kupweteka mutu, nthawi zina - kuphwanya kapena kutaya chidwi cha kukoma, kugona tulo, nkhawa, kugona, chizungulire, nkhawa, nkhawa yamagalimoto, mantha, kawirikawiri - chisokonezo, kusayenda bwino, kugwedezeka, pafupipafupi. osadziwika - kusokonezeka kwa mafungo, paresthesia, kusokonezeka kwa chidwi ndi psychomotor zimachitika, matenda ischemia,
ziwalo zamawonedwe ndi kumva: nthawi zina - zosokoneza zowonekera, kuphatikizapo zithunzi zosakhudzika, kawirikawiri - tinnitus, kuchepa kwamva, conjunctivitis,
dongosolo la minofu ndi mafupa: Nthawi zambiri - kupweteka kwa minofu, kukokana kwa minofu, nthawi zina - kupweteka kwapawiri,
Njira zoberekera ndi mabere am'mimba: Nthawi zina - kuchepa kwa libido, kusakhalitsa, kusadziwika pafupipafupi - gynecomastia,
kwamikodzo dongosolo: nthawi zina - polyuria, kuchuluka proteinuria, mkhutu aimpso, kuchuluka kwaini a creatinine ndi urea m'magazi,
hepatobiliary dongosolo: nthawi zina - kuchuluka kwa michere ya chiwindi, kawirikawiri - zotupa za hepatocellular, jaundice ya cholestatic, kufupika sikudziwika - cytolytic kapena hepatitis ya cholestatic, kulephera kwa chiwindi,
hematopoietic dongosolo: nthawi zina - eosinophilia, kawirikawiri - thrombocytopenia, leukopenia, kuchepa kwa hemoglobin, kuchepa kwa maselo ofiira amwazi, kufupika sikudziwika - pancytopenia, kuletsa kwa hematopoiesis m'mafupa, hemolytic anemia,
metabolism ndi ma labotale magawo: nthawi zambiri - kuwonjezeka kwa kuchuluka kwa potaziyamu m'magazi, nthawi zina - kuchepa kwa chilakolako cha kudya, anorexia, pafupipafupi sikudziwika - kuchepa kwa kuchuluka kwa sodium,
chitetezo chamthupi: pafupipafupi osadziwika - anaphylactoid kapena anaphylactic zimachitika, kuchuluka kwa antibodies a antiinuclear,
khungu ndi mucous nembanemba: pafupipafupi - chotupa pakhungu, nthawi zina - kuyabwa, magazi a Quincke, hyperhidrosis, kawirikawiri - urticaria, dermatitis exfoliative, exfoliation ya msomali mbale, kawirikawiri - photosensitivity zimachitika, pafupipafupi - erythema multiforme, psoriasis-like dermatitis. , pemphigus, alopecia, matenda a Stevens-Johnson, lichen-like kapena pemphigoid zidzolo, kukulira kwa psoriasis,
zimachitika kawirikawiri: kawirikawiri - kumva kutopa, kupweteka pachifuwa, nthawi zina - kutentha thupi, kawirikawiri - asthenic syndrome.

Malangizo apadera

Musanagwiritse ntchito Tritace, hypovolemia ndi hyponatremia ziyenera kuthetsedwa. Ngati wodwala amatenga okodzetsa, ayenera kuchotsedwa kapena mlingo utachepetsedwa masiku 2-3 asanayambe mankhwala a ramipril.

Mutatenga mlingo woyamba wa Tritace ndi kuchuluka kulikonse kwa mlingo wake komanso / kapena diuretics yomwe imatengedwa nthawi yomweyo, kuyang'anira wodwalayo mosamala kuyenera kuthandizidwa kwa maola osachepera 8, kuti ngati magazi achepetsedwa kwambiri, njira zoyenera zimachitika nthawi yake.

Ndi kuthamanga kwambiri kwa magazi komanso kulephera kwa mtima, makamaka ndi infarction yovuta kwambiri, chithandizo cha ramipril chiyenera kuyamba kokha kuchipatala chodziwika bwino.

Odwala omwe ali ndi vuto la mtima, kutenga Tritace kungayambitse kuchepa kwambiri kwa magazi, nthawi zina limodzi ndi azotemia kapena oliguria, ndipo nthawi zina, kulephera kwa impso.

Mu nyengo yotentha komanso / kapena pakulimbitsa thupi, chiwopsezo cha kuchepa madzi ndi thukuta lomwe limachulukitsa, zomwe zingayambitse kuchepa kwa kuchuluka kwa sodium m'magazi komanso kuchepa kwa magazi ozungulira, ndipo, chifukwa chake, kukulitsa kwa hypotension yovunda.

Pa chithandizo, sikulimbikitsidwa kumwa zakumwa zoledzeretsa.

Pankhani ya kukula kwa angioedema, komwe kumachitika larynx, pharynx ndi lilime, kutenga Tritace kuyimitsidwa nthawi yomweyo ndikuchitapo kanthu mwachangu kuti muchepetse kutupa.

Pamaso pa opareshoni, kuphatikizapo opaleshoni yamano, ndikofunikira kuchenjeza madotolo pakugwiritsa ntchito ACE inhibitors.

Makanda obadwa kumene obwera chifukwa cha kuwonekera kwa ramipril amayenera kuyang'aniridwa mosamala kuti azindikire oliguria, hyperkalemia, ndi ochepa hypotension.

M`nthawi ya miyezi isanu ndi umodzi ya 6 ndi chithandizo cha Tritace, ndikofunikira kuyang'anira ntchito ya impso, electrolyte, magawo a hematological, chiwindi cha enzyme yogwira ntchito komanso magazi a bilirubin m'magazi.

Pakumwa mankhwala, munthu ayenera kupewa kuyendetsa galimoto ndi kuchita zinthu zina zomwe zingakhale zoopsa, chifukwa chizungulire, kusowa chidwi, komanso kuthamanga kwa malingaliro a psychomotor kumatha kuchitika mutatenga Tritace.

Kuyanjana kwa mankhwala osokoneza bongo

Mankhwala osavomerezeka amatengedwa nthawi yomweyo ndi potaziyamu wotsekemera okodzetsa ndi mchere wa potaziyamu.

Akaphatikizidwa ndi mankhwala omwe amachepetsa kuthamanga kwa magazi (tricyclic antidepressants, diuretics, nitrate, ndi zina), kuwonjezereka kwa hypotensive zotsatira kumawonedwa.

Ma narcotic, ma pinkiller ndi mapiritsi ogona angayambitse kuchepa kwa magazi.

Vasopressor sympathomimetics amachepetsa hypotensive zotsatira za Tritace.

Immunosuppressants, cytostatics, systemic glucocorticosteroids, procainamide, allopurinol ndi mankhwala ena omwe amakhudza magawo a hematological amawonjezera mwayi wokhala ndi leukopenia.

Pogwiritsa ntchito munthawi yomweyo mankhwala a insulin ndi pakamwa hypoglycemic, ndizotheka kuwonjezera kuchuluka kwa hypoglycemic kwa mankhwalawa.

Kuphatikizidwa ndi mchere wa lithiamu kumabweretsa kuwonjezeka kwa kuchuluka kwa seramu lifiyamu komanso kuwonjezeka kwa neurotoxic ndi mtima ndi zotsatira za lithiamu.

Mankhwala osagwirizana ndi antisteroidal amatha kufooketsa Tritace, komanso kuonjezera kuchuluka kwa potaziyamu ndikuwonjezera mwayi wa kuwonongeka kwa impso.

Ndi munthawi yomweyo kugwiritsa ntchito Mowa, vasodilation ndi zotsatira zoyipa za Mowa pa thupi zimatheka.

Ma estrogens ndi sodium chloride amachepetsa mphamvu ya ramipril.

Kuphatikizidwa ndi heparin kungayambitse kuwonjezeka kwa ndende ya serum potaziyamu.

Mafanizo a Tritace ndi awa: Amprilan, Dilaprel, Ramipril, Ramipril-SZ, Pyramil, Khartil.

Mlingo ndi njira ya mankhwala.

Mankhwala amatengedwa pakamwa. Mapiritsi ayenera kumezedwa lonse (osafuna kutafuna) musanadye, musanadye kapena mukatha kudya ndikusambitsidwa ndi madzi okwanira (1/2 chikho) chamadzi. Mlingo amawerengedwa kutengera zomwe achiyembekezeredwa achire komanso kulekerera kwa odwala onse.

Ngati wodwala alandila okodzetsa, ndiye kuti ayenera kuchotsedwa masiku awiri atatu (kutengera nthawi ya kukodzetsa) asanayambe chithandizo ndi Tritace, kapena kuchepetsa mlingo wa okodzetsa omwe atengedwa.

Panthawi ya kuwonongeka kwa impso (CC 50-20 ml / mphindi / 1.73 m2 ya thupi), mlingo woyambayo ndi 1.25 mg. Mlingo wambiri watsiku ndi tsiku ndi 5 mg.

Ngati chiwindi chayamba kugwira ntchito, muyezo wapamwamba wa tsiku lililonse ndi 2,5 mg.

Odwala omwe kale amatenga diuretics, mlingo woyambirira ndi 1.25 mg.

Ngati nkosatheka kuthetseratu kuphwanya kwamiyeso yamagetsi yamagetsi pamavuto okhudzana kwambiri ndi matenda oopsa, komanso kwa omwe wodwalayo angatenge chiwopsezo china (mwachitsanzo, kuchepa kwa magazi chifukwa chakuchepa kwa mitsempha ya mtima kapena mitsempha ya ubongo), mlingo woyambayo ndi 1.25 mg.

CC itha kuwerengedwa pogwiritsa ntchito zizindikiro za serum creatinine malinga ndi njira yotsatira (Cockcroft equation):

Kulemera kwa thupi (kg) x (140 - zaka)

72 x serum creatinine (mg / dl)

kwa akazi: chulukitsani zotsatirazo zomwe zapezedwa pamwambapa ndi 0.85.

Chithandizo cha tritace nthawi zambiri chimakhala chachitali komanso kutalika kwake muzochitika zonse zimatsimikiziridwa ndi adokotala.

Pochiza matenda oopsa, mankhwalawa amaperekedwa nthawi 1 / tsiku, mlingo woyambira ndi 2,5 mg, ngati pangafunike, mlingo umachulukitsidwa pambuyo pa masabata awiri ndi atatu, kutengera momwe wodwalayo amvera, mankhwalawa tsiku lililonse ndi 2,5-5 mg, ndipo mlingo wambiri watsiku ndi tsiku ndi 10 mg

Mankhwalawa aakulu mtima kulephera, woyamba tsiku mlingo - 1.25 mg 1 nthawi / tsiku. Kutengera momwe wodwalayo amayankhira, mlingo umatha kuchuluka. Ndikulimbikitsidwa kuti muwonjezere mlingo kawiri pa masabata a 1-2. Mlingo kuchokera ku 2.5 mg kapena kupitilira uyenera kutengedwa kamodzi kapena kugawidwa pawiri. Pazipita tsiku mlingo 10 mg.

Mankhwalawa aakulu mtima kulephera pambuyo m`mnyewa wamtima infarction, koyamba mlingo 5 mg mu 2 waukulu - 2,5 mamawa ndi madzulo. Ngati mulingo wolekerera, uyenera kuchepetsedwa kukhala 1.25 mg 2 nthawi / tsiku kwa masiku awiri. Pofuna kuwonjezera mlingo, tikulimbikitsidwa kuti tiziigawa mu 2 Mlingo woyamba 3 masiku. Pambuyo pake, mlingo wa tsiku ndi tsiku, womwe umagawidwa pakawiri, utha kumwedwa ngati gawo limodzi la tsiku. Pazipita tsiku mlingo 10 mg.

Mu matenda osalephera a mtima (IV digiri molingana ndi gulu la NYHA) pambuyo pa kulowerera kwa myocardial, mankhwalawa ndi mankhwala a 1.25 mg 1 nthawi / tsiku. Mu gulu ili la odwala, kuwonjezera mlingo uyenera kukhala wosamala kwambiri.

Mankhwalawa odwala matenda ashuga komanso osadwala matenda a shuga, mankhwalawa koyamba ndi 1.25 mg 1 nthawi / tsiku. Mlingo wokonza ndi 2,5 mg. Ndi kuchuluka kwa kuchuluka kwa mankhwalawa, kuyenera kuchulukitsidwa kawiri ndi masabata awiri kapena atatu. Mlingo wambiri watsiku ndi tsiku ndi 5 mg.

Pofuna kupewa kulowerera kwa myocardial, stroke kapena "kufa kwa coronary", mlingo woyambira ndi 2.5 mg 1 nthawi / tsiku. Mlingo uyenera kuchulukitsidwa pakubwezeretsa pambuyo pa sabata 1 la mankhwala. Pambuyo pa milungu itatu, mlingo umatha kuwonjezeka nthawi 2, mlingo waukulu ndi 10 mg.

Zotsatira zoyipa za Tritace:

Kuchokera kwamikodzo dongosolo: kuchuluka kwa seramu urea, hypercreatininemia (makamaka ndi munthawi yomweyo okodzetsa), kuwonongeka kwaimpso, kulephera kwaimpso, kawirikawiri - hyperkalemia, proteinuria, hyponatremia, kuchuluka kwa proteinuria kapena kuchuluka kwa mkodzo.

Pa mbali ya mtima dongosolo: kawirikawiri - kuchepa kwa kuthamanga kwa magazi, postural hypotension, myocardial kapena ubongo ischemia, myocardial infarction, arrhythmia, syncope, ischemic stroke, kufupika kwa ubongo ischemia, tachycardia, zotumphukira edema (mu mafupa a ankolo).

Thupi lawo siligwirizana: angioedema a nkhope, milomo, eyelids, lilime, glottis ndi / kapena larynx, redness pakhungu, kumva kutentha, conjunctivitis, kuyabwa, urticaria, zotupa zina pakhungu kapena mucous membrane (maculopapular exanthema ndi enanthema, erythema multiforme (kuphatikizapo Stevens-Johnson syndrome), pemphigus (pemphigus), serositis, kuchuluka kwa psoriasis, poyizoni epermosis necrolysis (matenda a Lyell), onycholysis, photosensitivity, nthawi zina alopecia, kukula kwa matenda a Raynaud, kuchuluka kwa antibodies a antiinodar , eosinophilia, vasculitis, myalgia, arthralgia, nyamakazi.

Kuchokera pamachitidwe opumira: nthawi zambiri - chifuwa chowuma chowuma, usiku pamene wodwala ali pamalo opingasa, nthawi zambiri zimachitika mwa azimayi komanso osasuta (nthawi zina, kuchotsa ACE inhibitor ndikugwira ntchito). Pofuna kutsokomola kosalekeza, kusiya mankhwala kungafunike. N`zotheka - catarrhal rhinitis, sinusitis, bronchitis, bronchospasm, dyspnea.

Kuchokera pamimba: kukhumudwa, kupweteka kwa epigastric, kuwonjezeka kwa chiwindi ndi michere ya kapamba, bilirubin, kawirikawiri cholestatic jaundice, kugaya chakudya, kusanza, kutsekula m'mimba, kudzimbidwa komanso kusowa chilala, kusintha kwa kukoma ("zitsulo"), kuchepa kulawa zamadzimadzi ndipo nthawi zina ngakhale kutaya kukoma, kukamwa kowuma, stomatitis, glossitis, kapamba, kawirikawiri - kutupa kwamkamwa, m'mimba, kutsekeka, chiwindi ntchito, ndikukula kwa chiwindi ochnosti.

Kuchokera ku hemopoietic dongosolo: kawirikawiri - kuchepa kwa maselo ofiira am'magazi komanso kuchepa kwa hemoglobin kuchokera kufupipafupi mpaka ku kwambiri, thrombocytopenia ndi leukopenia, nthawi zina neutropenia, agranulocytosis, pancytopenia, hemolytic anemia.

Kuchokera kumbali ya chapakati mantha dongosolo ndi zotumphukira mantha dongosolo: kusasamala, kupweteka mutu, mantha, kugwedezeka, kugona kugona, kufooka, chisokonezo, nkhawa, nkhawa, paresthesia, minofu kukokana.

Kuchokera pazinthu zam'maganizo: zovuta za vestibular, kulawa kwamkati, kununkhiza, kumva ndi masomphenya, tinnitus.

Zina: kuchepa kwa ma erection ndi kuyendetsa kugonana, kutentha thupi.

Gwiritsani ntchito pa nthawi yoyembekezera komanso mkaka wa m`mawere.

Mankhwala Tritace ali contraindicated pa mimba. Chifukwa chake, musanayambe chithandizo, onetsetsani kuti palibe kutenga pakati.

Ngati wodwala adatenga pakati pa nthawi ya chithandizo, ndikofunikira kusintha Tritace ndi mankhwala ena momwe angathere. Kupanda kutero, pali chiopsezo cha kuwonongeka kwa fetal, makamaka panthawi yoyamba kutenga pakati. Zinakhazikitsidwa kuti mankhwalawa amachititsa kuti impso za mwana wosabadwayo zisamayende bwino, kuchepa kwa magazi a mwana wosabadwa komanso wakhanda, kuwonongeka kwa impso, hyperkalemia, chigaza hypoplasia, oligohydramnios, kufooka kwa miyendo, chifuwa.

Kwa ana akhanda omwe adakumana ndi vuto la intrauterine ku zoletsa za ACE, tikulimbikitsidwa kuyang'anira bwino kuwunika kwa ochepa hypotension, oliguria ndi hyperkalemia. Mu oliguria, ndikofunikira kukhalabe ndi kuthamanga kwa magazi komanso kupatsanso impso poyambitsa madzi abwino ndi vasoconstrictors. Mu makanda obadwa kumene ndi makanda, pali chiopsezo cha matenda a oliguria ndi mitsempha, mwina chifukwa chakuchepa kwa magazi a impso ndi matenda am'mimba chifukwa cha kuchepa kwa kuthamanga kwa magazi komwe kumachitika chifukwa cha ACE inhibitors (opezedwa ndi amayi apakati komanso atabereka mwana). Kuyang'anira kuyenera ndikulimbikitsidwa.

Ngati kuli kofunikira kuti mupeze Tritace panthawi yoyamwitsa, yoyamwitsa iyenera kutha.

Malangizo apadera ogwiritsira ntchito Tritace.

Chithandizo cha tritace nthawi zambiri chimakhala chachitali, kutalika kwake muzochitika zonse zomwe dokotala amafunsa. Zimafunikanso kuyang'aniridwa nthawi zonse kuchipatala, makamaka kwa odwala omwe ali ndi vuto la chiwindi ndi impso. Nthawi zambiri amavomerezedwa kuti kuchepa kwa madzi m'thupi, Hypovolemia, kapena kuchepa kwa mchere usanapangidwe.

Ngati mwadzidzidzi, chithandizo ndi mankhwalawa chitha kuyamba kapena kupitilizidwa pokhapokha ngati pakufunika kusamala mosamala kuti magazi achepetse kwambiri komanso kuti aimpso ntchito.

Ndikofunikira kuwongolera ntchito yaimpso, makamaka masabata oyamba a chithandizo. Odwala aimpso mtima matenda (mwachitsanzo, ndi aimpso mtsempha wamagazi stenosis akadali kwambiri achire, kapena unilateral hemodynamically kwambiri aimpso mtsempha wamagazi stenosis) milandu aimpso kuwonongeka ntchito, komanso odwala amene akuchoka impso, kuyang'anira mosamala ndikofunikira.

Serum potaziyamu ndi kuzungulira kwa sodium ziyenera kuyang'aniridwa nthawi zonse. Odwala omwe ali ndi vuto laimpso, kuwunika pafupipafupi izi kukufunika.

Ndikofunikira kuwongolera kuchuluka kwa leukocytes (matenda a leukopenia). Makamaka kuwunikira nthawi zonse kumalimbikitsidwa kumayambiriro kwa chithandizo, komanso odwala omwe ali pachiwopsezo - mpaka nthawi 1 pamwezi mu miyezi yoyamba ya 6 - 6 ya chithandizo kwa odwala omwe ali ndi chiopsezo cha neutropenia - ndi vuto laimpso, matenda a matenda a minyewa yolumikizidwa kapena kulandira waukulu. okodzetsa, komanso pazizindikiro zoyambirira za matenda.

Potsimikizira za neutropenia (kuchuluka kwa neutrophil ochepera 2000 / )l), mankhwala a ACE inhibitor ayenera kusiyidwa.

Ngati pali zizindikiro za kusayenda bwino kwa magazi chifukwa cha leukopenia (mwachitsanzo, malungo, zotupa zam'mimba, tonillitis), kuwunika mwachangu kwa chithunzi cha magazi ofunikira ndikofunikira. Pakakhala zizindikiro zakutuluka magazi (tating'onoting'ono tating'onoting'ono, totupa totuwa) pakhungu ndi kofunikanso kuwongolera mapulogalamu ambiri m'magazi oyipa.

Pamaso pathu ndi chithandizo, kuwongolera kuthamanga kwa magazi, kugwira ntchito kwa impso, hemoglobin m'magazi othandizira, creatinine, urea, ndende ya electrolyte ndi zochitika za michere ya chiwindi m'magazi ndikofunikira.

Chenjezo liyenera kuthandizidwa popereka mankhwala kwa odwala omwe amamwa mchere wochepa kapena wopanda mchere (chiwopsezo chowonjezereka cha hypotension). Odwala omwe ali ndi BCC yafupika (chifukwa cha kukodzetsa kwa mkodzo) ukuletsa kuchepa kwa sodium, kutsegula m'mimba ndi kusanza kumatha kukhala chizindikiro cha ochepa hypotension.

Osakhalitsa ochepa hypotension si kuphwanya lamulo kwa kupitiriza mankhwala pambuyo kukhazikika kwa magazi. Ngati mwachitika mobwerezabwereza kwambiri hypotension, mlingo uyenera kuchepetsedwa kapena mankhwala atha.

Ngati mbiri ili ndi zisonyezo zakukula kwa angioneurotic edema, osagwirizanitsidwa ndi ntchito ya ACE inhibitors, ndiye kuti odwala oterewa ali ndi chiopsezo chowonjezeka cha chitukuko chake akamatenga Tritace.

Chenjezo liyenera kuchitika mukamachita masewera olimbitsa thupi komanso / kapena nyengo yotentha chifukwa cha chiwopsezo cha kuchepa madzi m'thupi komanso kuchepa kwa magazi chifukwa chakuchepa kwa kuchuluka kwa madzimadzi.

Kumwa mowa sikulimbikitsidwa.

Pamaso pochita opaleshoni (kuphatikizapo mano), ndikofunikira kuchenjeza wopanga maopaleshoni / opaleshoni yokhudza kugwiritsa ntchito ACE inhibitors.

Ngati edema imachitika, mwachitsanzo kumaso (milomo, eyelids) kapena lilime, kapena ngati kumeza kapena kupuma kumalephera, wodwalayo ayenera kusiya kumwa mankhwalawo. Angioedema m'dera la lilime, pharynx, kapena larynx (zizindikiro zomwe zingatheke kumeza kapena kumeza kupuma) zitha kukhala pachiwopsezo cha moyo ndikupangitsa kuti pakufunika chisamaliro chodzidzimutsa.

Zomwe zimachitika pogwiritsa ntchito Tritace mwa ana, odwala omwe ali ndi vuto la impso (CC pansi 20 ml / mphindi yokhala ndi 1.73 m2), komanso kwa odwala omwe amalandila chithandizo cha hemodialysis, sikokwanira.

Atamwa mlingo woyamba, komanso kukulitsa kuchuluka kwa okodzetsa ndi / kapena ramipril, odwala ayenera kuyang'aniridwa ndi achipatala kwa maola 8 kuti apewe kusintha kosagwirizana ndi hypotensive. Odwala ndi mtima Kulephera, kumwa mankhwalawa kungayambitse kukula kwambiri ochepa hypotension, amene nthawi zina amakhala ndi oliguria kapena azotemia, ndipo nthawi zambiri, kukula kwa aimpso kulephera.

Odwala omwe ali ndi vuto losakanizira matenda oopsa kapena kufooka kwamtima kwambiri ayenera kuyamba kuchipatala.

Odwala omwe amalandila ACE, zimawopseza, zomwe zimapangitsa kuti anaphylactoid azigwirizana, nthawi zina mpaka zimachitika podzidzimutsa, pochita hemodialysis pogwiritsa ntchito ziwalo zina zotulutsa kwambiri (mwachitsanzo, polyacrylonitrile). Potengera momwe mankhwalawo amathandizira ndi Tritace, kugwiritsa ntchito michere yamtunduwu kuyenera kupewedwa mwachitsanzo, chifukwa cha hemodialysis kapena hemofiltration. Ngati pakufunika kuchita izi, ndikofunikira kugwiritsa ntchito ziwalo zina kapena kuletsa mankhwalawo. Maganizo omwewo adawonedwa ndi LDL apheresis ogwiritsa ntchito dextran sulfate. Chifukwa chake, njirayi siyenera kugwiritsidwa ntchito mwa odwala omwe amalandila ACE inhibitors.

Kugwiritsa Ntchito Kwa Ana

Chitetezo ndikuyenda bwino kwa mankhwalawa kwa ana ndi achinyamata osakwana zaka 18 sizinakhazikitsidwe, chifukwa chake, kuyimbidwa kumatsutsana.

Kukopa pa kuyendetsa magalimoto ndi kayendedwe kazinthu

Munthawi ya chithandizo, wodwalayo ayenera kupewa kuchita zinthu zomwe zingakhale zoopsa zomwe zimafunikira kuti azikhala ndi chidwi komanso kuthamanga kwa zochitika zama psychomotor, popeza chizungulire n`kotheka, makamaka pambuyo koyamba mlingo wa Tritace kuti atengere okodzetsa.

Mankhwala osokoneza bongo:

Zizindikiro: kuchepa kwakukulu kwa kuthamanga kwa magazi, kugwedezeka, bradycardia yayikulu, kusokonezeka muyezo wamagetsi wamagetsi, kulephera kwaimpso, stupor.

Chithandizo: chapamimba, kudya adsorbents, sodium sodium (ngati nkotheka mkati mwa mphindi 30). Pankhani ya kukula kwa ochepa hypotension, kukhazikitsidwa kwa alpha1-adrenostimulants (norepinephrine, dopamine) ndi angiotensin II (angiotensinamide) kungawonjezeke pamankhwala kuti kubwezeretsanso bcc ndikubwezeretsanso mchere.

Kuchita kwa Tritace ndi mankhwala ena.

Ndi munthawi yomweyo kugwiritsa ntchito potaziyamu mchere, potaziyamu wolekerera okodzetsa (mwachitsanzo, amiloride, triamteren, spironolactone) ndi Tritace, hyperkalemia imadziwika (serum potaziyamu ndiyofunikira).

Kugwiritsa ntchito nthawi yomweyo kwa Tritace ndi antihypertensive agents (makamaka, ndi okodzetsa) ndi mankhwala ena omwe kuthamanga kwa magazi kumayambitsa kuwonjezeka kwa ramipril.

Pogwiritsa ntchito munthawi yomweyo ndi hypnotics, opioids ndi analgesics, kuchepa kwambiri kwa magazi kumatheka.

Mankhwala a Vasopressor sympathomimetic (epinephrine) ndi estrogens angayambitse kufooka kwa ramipril.

Pogwiritsa ntchito munthawi yomweyo Tritace ndi allopurinol, procainamide, cytotoxic mankhwala, immunosuppressants, systemic corticosteroids ndi mankhwala ena omwe angasinthe chithunzi cha magazi, kuchepa kwa chiwerengero cha maselo oyera m'magazi ndikotheka.

Pogwiritsa ntchito munthawi yomweyo kukonzekera kwa lithiamu, kuwonjezereka kwa kuchuluka kwa lithiamu mu plasma ndikotheka, komwe kumabweretsa kuwonjezeka kwa Cardio- ndi neurotic zotsatira za lithiamu.

Ndi ntchito munthawi yomweyo Tritace yokhala ndi pakamwa hypoglycemic wothandizila (sulfonylureas, biguanides), insulin, hypoglycemia imakulirakulira.

NSAIDs (indomethacin, acetylsalicylic acid) itha kuchepa mphamvu ya ramipril.

Ndi munthawi yomweyo kugwiritsa ntchito heparin, kuchuluka kwa potaziyamu mu seramu yamagazi ndikotheka.

Mchere umachepetsa mphamvu ya ramipril.

Ethanol timapitiriza hypotensive zotsatira za ramipril.

Chofunikira pa matenda oopsa

Mlingo woyambira wokhazikika ndi 2.5 mg kamodzi tsiku lililonse m'mawa (mapiritsi a ½ 5 mg ndivomerezeka). Ngati mankhwalawa agwiritsidwa ntchito kwa masabata atatu pamlingo wopatsidwa ndipo kuthamanga kwa magazi sikunabwerere mwakale, mlingo waukulu wa tsiku lililonse umakulitsidwa mpaka 5 mg. Ndi osakwanira pambuyo masabata 2-3, pazipita mlingo tsiku lililonse amaloledwa kuti 10 mg.

Njira yina yochiritsira yolowa ndi mankhwala osakwanira a antihypertensive ya mankhwalawa imaphatikizanso kugwiritsa ntchito mankhwala ena a antihypertensive (mwachitsanzo, osachepera calcium calcium blockers kapena okodzetsa).

Mlingo

5 mg ndi 10 mg mapiritsi

Piritsi limodzi la 5 mg lili

ntchito yogwira - ramipril 5 mg

obwera: hypromellose, pregelatinized starch, microcrystalline cellulose, iron oxide ofiira (E 172), sodium stearyl fumarate

Piritsi limodzi la 10 mg lili

ntchito yogwira - ramipril 10 mg

obwera: Hypromellose, pregelatinized starch, microcrystalline cellulose, sodium stearyl fumarate

Mapiritsi Oval ndi ofiira, ali ndi chiopsezo chophwanya mbali zonse ziwiri za piritsi, olembedwa "logo 5 / kampani" mbali imodzi ndi "5 / HMP" mbali inayo

Mapiritsi Oval a oyera kapena pafupifupi oyera, okhala ndi chiopsezo chophwanya mbali zonse ziwiri za piritsi, cholembedwa "HMO / HMO" mbali imodzi.

Kulephera kwamtima kosalekeza

Pa 1.25 mg kamodzi patsiku (gwiritsani ntchito mapiritsi a ½ a 2 mg). Kutengera momwe amathandizira kulandira chithandizo, kuchuluka kwa mlingo kumaloledwa. Mlingo uyenera kuwonjezeredwa kawiri, ndikukhalitsa pakadutsa milungu iwiri. Ngati mlingo wa tsiku ndi tsiku uli ndi 2,5 mg kapena kupitilira, utha kutengedwa onse kamodzi kapena magawo awiri. Sitikulimbikitsidwa kupitilira muyeso ya tsiku lililonse ya 10 mg.

Kuchepetsa chiopsezo cha kufa ndi mtima, kugundidwa, kapena kuphwanya kwamtima kwa odwala omwe ali ndi vuto la matenda amtima

Chithandizo cha mankhwalawa chimayamba ndi 2,5 mg kamodzi patsiku (piritsi limodzi 2,5 mg kapena ½ piritsi 5 mg). Kutengera momwe thupi limaperekera mankhwala, kuwonjezeka kwapang'onopang'ono kwa tsiku ndi tsiku kumaloledwa. Pakatha sabata limodzi la mankhwalawa, tikulimbikitsidwa kuti muwonjezere kuchuluka kwa mankhwalawa, ndipo masabata atatu otsatira, muwonjezere kwa mlingo wokwanira tsiku lililonse wa 10 mg, womwe umatengedwa kamodzi.

Kugwiritsa ntchito mankhwalawa muyezo woposa 10 mg, ndipo mwa odwala CC ochepera 0.6 ml / min, amaphunziridwa mosakwanira.

Kulephera kwa mtima kunayamba kuchokera pa 2 mpaka 9th patatha masiku osokoneza bongo

Chithandizo chimayamba ndi mlingo wa tsiku lililonse wa 5 mg, magawo awiri a 2.5 mg, omwe amamwa m'mawa ndi madzulo (mapiritsi a 2.5 mg kapena mapiritsi a mg 5 mg). Ndi kuchepa kwakukulu kwa kuthamanga kwa magazi kwa wodwala masiku awiri, Tritace imayikidwa 1.25 mg 2 kawiri pa tsiku (½ mapiritsi 2,5 mg). Kenako, moyang'aniridwa ndi dokotala, mlingo umakulitsidwa pang'onopang'ono, ndikuwonjeza katatu tsiku lililonse. Pambuyo pake, mlingo wa tsiku ndi tsiku, womwe unagawidwa pawiri, utha kuperekedwa kamodzi. Sitikulimbikitsidwa kupitilira muyeso ya tsiku lililonse ya 10 mg.

Kugwiritsa ntchito kwa Tritace pochiza odwala omwe ali ndi vuto lalikulu la kufooka kwa mtima (III - IV yogwira ntchito mkalasi malinga ndi gulu la NYHA) sikumveka bwino, chifukwa chake, muzochizira odwala otere, mlingo wotsika kwambiri umayikidwa: 1.25 mg kamodzi patsiku (½ mapiritsi a 2 mg). Onjezani mlingo mosamala kwambiri.

Gwiritsani ntchito odwala omwe ali ndi vuto laimpso

Ndi CC kuchokera 50 mpaka 20 ml / min, Tritace amalembedwa koyamba mlingo wa 1.25 mg (½ mapiritsi 2,5 mg). Mlingo wovomerezeka tsiku lililonse ndi 5 mg. Njira yofananayo ya mankhwalawa imagwiritsidwa ntchito kwa odwala omwe ali ndi vuto lalikulu kwambiri lamankhwala osakanikirana, omwe sangathe kuwongolera chifukwa cha kuchepa kwa magazi ndi kuchepa kwa madzi m'mimba, komanso mwa odwala omwe kuchepa kwambiri kwa magazi amadzala ndi zovuta (mwachitsanzo, ndi zotupa za ubongo ndi mitsempha ya mitsempha).

Gwiritsani ntchito odwala omwe ali ndi diuretic chithandizo

Masiku atatu isanayambike chithandizo ndi Tritace, kutengera kuchuluka kwa nthawi yayitali pakukodzetsa, ndikofunikira kusiya kumwa mankhwalawa kapena kuchepetsa kumwa. Odwala oterewa amalimbikitsidwa kuti ayambe kulandira chithandizo chamankhwala ochepa kwambiri a 1.25 mg (½ mapiritsi a 2,5 mg), omwe amatengedwa nthawi imodzi patsiku m'mawa. Atamwa mlingo woyamba, kukulitsa mlingo wa Tritace ndi / kapena loop-mtundu okodzetsa, odwala ayenera kuyang'aniridwa ndi achipatala kwa maola osachepera a 8 kupewa kupewa kusakhazikika kwa hypotensive.

Gwiritsani ntchito odwala omwe ali ndi vuto la chiwindi

Mu gulu la odwala, kumwa mankhwalawa kumapangitsa kuwonjezeka kwambiri komanso kuchepa kwa kuthamanga kwa magazi. Chifukwa chake, chithandizo cha Tritace chikuyenera kuchitika moyang'aniridwa ndi dokotala. Ndikulimbikitsidwa kuti musadutse mlingo wa 2,5 mg wa tsiku lililonse (piritsi 1,5 mg kapena ½ piritsi 5 mg).

Zizindikiro za bongo ndi aimpso kulephera, kuchuluka kwa vasodilation ndi zimachitika mantha ndi kuchepa magazi, kusokonezeka kwa madzi-electrolyte kagayidwe, bradycardia, stupor. Pankhaniyi, m'mimba mumatsukidwa ndipo sodium sodium imayikidwa (ngati kuli kotheka, iyenera kutengedwa mu mphindi 30 mutatha kumwa kwambiri mankhwala) ndi adsorbents. Ndi kuchepa kwa magazi, angiotensinamide (angiotensin II) ndi alpha amatumizidwa₁-adrenergic agonists (dopamine, norepinephrine). Pankhani ya bradycardia kukana kugwiritsa ntchito mankhwala osokoneza bongo, pacemaker yochita kupanga nthawi zina imakhazikitsidwa kwakanthawi. Mu nkhani ya bongo, kuwunika ma seramu mozungulira ma elekitirodi ndi creatinine tikulimbikitsidwa.

Mankhwala

Pharmacokinetics

Pambuyo pakukonzekera kwa pakamwa, ramipril imatengedwa mwachangu kuchokera kumimba: m'mimba mwa malezala amodzi amapezeka mkati mwa ola limodzi. Mlingo wa mayamwidwe osachepera 56% ya mlingo wotengedwa ndipo osadalira zakudya. Ili ndi mapangidwe okhathamira kwathunthu (makamaka m'chiwindi) ndikupanga kwa metabolite yogwira - ramiprilat (ndi nthawi 6 yogwira kwambiri ya ACE-angiotensin-yotembenuza enzyme kuposa ramipril). The bioavailability wa ramiprilat ndi 45%.

Kuchuluka kwa ramiprilat mu plasma kumachitika pambuyo maola 2-4. Wokhazikika plasma woipa wa ramiprilat pambuyo limodzi mlingo wa mwachizolowezi wa ramipril zimatheka pa 4 tsiku.

Kumanga mapuloteni a Plasma pafupifupi 73% kwa ramipril ndi 56% kwa ramiprilat.

Ramipril ali pafupi kupangika kwathunthu ku ramiprilat, diketopiperazinovy ester, diketopiperazinovy acid ndi glucuronides a ramipril ndi ramiprilat.

Mafuta a metabolites makamaka kudzera mu impso. The plasma woipa wa ramiprilat yafupika polyphase. Chifukwa cha kuchuluka kwake komwe kumamangirira ku ACE komanso kudzipatula pang'onopang'ono kuchokera ku enzyme, ramiprilat imawonetsa gawo lotalikirana kwambiri pamagawo ochepa a plasma. Hafu ya moyo wa ramiprilat imachokera ku maola 13 mpaka 17 pa Mlingo wa 5 ndi 10 mg.

Mphamvu ya antihypertensive imayamba patatha maola awiri atatha kumwa kamodzi pa mankhwalawa, mphamvu yake imayamba pambuyo pa maola a 6 ndi 6 pambuyo pa kukhazikitsa ndipo imatha maola 24. Pogwiritsa ntchito tsiku ndi tsiku, ntchito za antihypertensive zimayamba kupitilira sabata zingapo.

Zinawonetsedwa kuti antihypertensive zotsatira zimatha zaka 2 ndikuchiritsa kwa nthawi yayitali. Kusokonezeka kambiri potenga ramipril sikupangitsa kuti magazi azitha kwambiri ("rebound").

Magulu apadera a odwala

Odwala ndi mkhutu aimpso ntchito Aimpso excretion wa ramiprilat yafupika, impso chilolezo cha ramiprilat mwachindunji mogwirizana ndi creatinine chilolezo. Izi zimabweretsa kuwonjezeka kwa plasma ramiprilat ndende, komwe kumachepetsa kwambiri pang'onopang'ono kuposa maphunziro omwe ali ndi vuto laimpso.

Odwala ndi mkhutu chiwindi ntchito kagayidwe ka ramipril mu ramiprilat imachedwa chifukwa cha kuchepa kwa ntchito ya hepatic esterases. Odwala oterewa amawonetsa kuchuluka kwa plasma ramipril. Komabe, nsonga za plasma ramiprilat ndizofanana ndi omwe ali ndi odwala omwe ali ndi chiwindi chokwanira.

Mlingo umodzi wa ramipril utatenga pakamwa, mankhwalawo ndi metabolite sanapezeke mkaka wa m'mawere. Komabe, kuchuluka kwa milingo yambiri sikudziwika.

Mankhwala

The angiotensin-converting enzyme ACE, yomwe imadziwikanso kuti dipeptidyl carboxypeptidase I), yomwe imathandizira kutembenuka kwa angiotensin I kupita ku angiotensin II, vasoconstrictor wogwira, komanso imapangitsa kutsekeka kwa bradykinin, vasodilator, wapezeka kuti ndi wofunikira pakukweza kwa matenda oopsa.

Ramiprilat, metabolite yogwira ya Tritace®kuletsa ACE mu plasma ndi zimakhala, incl. khoma lamitsempha, limalepheretsa kupangika kwa angiotensin II ndi kuwonongeka kwa bradykinin, komwe kumabweretsa vasodilation komanso kutsika kwa magazi.

Ndi kuchepa kwa kuchuluka kwa angiotensin II m'magazi, mphamvu yake yolepheretsa kubisala kwa renin ndi mtundu wa mayankho olakwika amachotsedwa, zomwe zimapangitsa kuti ntchito ya plinma ikonzeke.

Kuwonjezeka kwa ntchito ya kallikrein-kinin system m'magazi ndipo zimakhala ndizomwe zimayambitsa mtima ndi endothelioprotective mphamvu ya ramipril chifukwa cha kuyambitsa kwa dongosolo la prostaglandin ndipo, motero, kuwonjezeka kwa kaphatikizidwe ka prostaglandins, komwe kumalimbikitsa mapangidwe a nitric oxide (NO) mu endotheliocytes.

Angiotensin II imalimbikitsa kupanga aldosterone, motero kutenga Tritace® kumabweretsa kuchepa kwa katulutsidwe ka aldosterone ndi kuchuluka kwa seramu wozungulira wa potaziyamu ayoni.

Odwalandi matenda oopsa Chinsinsi® kumabweretsa kutsika kwa kuthamanga kwa magazi pomwe mukugona ndi kuyimirira, popanda kukakamiza kowonjezera kuchuluka kwa mtima (HR). Tsata® Amachepetsa kwathunthu zotumphukira mtima kukana (OPSS), popanda kuchititsa kusintha kwa magazi aimpso ndi kuchuluka kwa kusefera.

Odwala ochepa matenda oopsa, ramipril imachedwetsa kukula ndi kupitilira kwa myocardial hypertrophy ndi mtima wall.

Kuphatikiza ndi diuretics ndi mtima glycosides (malinga ndi dokotala) Tritace® ogwira odwala omwe ali ndi mtima wolephera II-IV malinga ndi gulu la NYHA (New York Cardiology Association).

Tsata® imakhala ndi zotsatira zabwino pa hemodynamics ya mtima - imachepetsa OPSS (kuchepetsa katundu pambuyo pamtima), imachepetsa kukhuta kwa mbali zamanzere ndi zamanja, kumawonjezera kutulutsa kwamtima, ndikuwongolera mtima wa mtima1.

Ndi matenda ashuga komanso osadwala Chinsinsi® Imachepetsa kuchepa kwa impso kulephera komanso kuyambika kwa gawo lothana ndi vuto la impso, motero, kumachepetsa kufunika kwa hemodialysis kapena kupatsirana kwa impso. Kwa odwala matenda ashuga kapena omwe alibe shuga® amachepetsa kuopsa kwa proteinuria.

Odwala omwe ali pachiwopsezo chachikulu chotenga matenda a mtima chifukwa cha zotupa zam'mimba (matenda a mtima, matenda a mtima), matenda am'mimba-HDL, kusuta), kutenga ramipril molumikizana ndi chithandizo chamankhwala ambiri kapena monotherapy kumachepetsa kwambiri kubadwa kwa myocardial infarction, stroke, ndi kufa chifukwa cha mtima. Kuphatikiza apo, Tritace® Imachepetsa ziwengo zonse zakufa, komanso kufunikira kwa njira zopitirizira kusintha, ndikuchepetsa kuyambika kapena kupitilira kwa matenda olephera a mtima.

Odwala ndi kulephera kwa mtima komwe kumayamba m'masiku ochepa pachimake myocardial infarction (2-9 masiku), mutatenga Tritace®Kuyambira kuyambira pa 3 mpaka tsiku la 10 la kuphwanya kwakhungu pachimake, chiopsezo chakufa chatsika ndi 5.7%, chiwopsezo cha 27%.

Mwa odwala ambiri, komanso odwala matenda a shuga, onse omwe ali ndi matenda oopsa ndipo ali ndi magazi abwinobwino Tsata® Amachepetsa kwambiri vuto la nephropathy komanso kupezeka kwa microalbuminuria.

Mlingo ndi makonzedwe

Zokhudza pakamwa.

Tritace ndikulimbikitsidwa® tsiku ndi tsiku.

Tsata® Amatha kumwa kapena wopanda chakudya, popeza bioavailability palokha popanda kudya. Tsata® ayenera kumwedwa ndi madzi okwanira. Simungathe kutafuna kapena kuphwanya piritsi.

Odwala Kulandila Mankhwala Olimbitsa Thupi

Kumayambiriro kwa mankhwala ndi Tritace® Hypotension ikhoza kuchitika, izi zimachitika kwambiri mwa odwala omwe amalandila okodzetsa. Pankhaniyi, kusamala kuyenera kuchitidwa, popeza mwa odwala otayika amadzimadzi kapena mchere umatha kuchitika.

Ngati ndi kotheka, okodzetsa ayenera kuchotsedwa masiku awiri kapena atatu asanayambike mankhwala a Tritace.®.

Odwala matenda oopsa popanda kusiya okodzetsa, mankhwala ndi Tritace® akuyenera kuyamba ndi Mlingo wa 1.25 mg. Ndikofunikira kuyang'anira kuchuluka kwa seramu potaziyamu ndi diuresis. Mlingo wotsatira wa Tritace® ziyenera kusinthidwa molingana ndi gawo la kuthamanga kwa magazi.

Matenda oopsa

Mlingo umasankhidwa payekha malinga ndi mbiri ya wodwalayo komanso kuchuluka kwa kuthamanga kwa magazi. Tsata® itha kugwiritsidwa ntchito ngati monotherapy kapena kuphatikiza ena othandizira.

Chithandizo cha Tritace® ziyenera kuyamba magawo. Mlingo woyambira wopendekera ndi 2.5 mg tsiku lililonse.

Odwala omwe akuwonjezera ntchito ya renin-angiotensin-aldosterone, kuchepa kwakukulu kwa zovuta kumatha kuchitika mutatha kumwa koyamba. Kwa odwala otere, mlingo woyambirira ndi 1.25 mg. Chithandizo chiyenera kuyang'aniridwa ndi dokotala.

Mlingo wokhudzana ndi kukonzanso

Ngati ndi kotheka, muthilidwe wakewo ungathe kuwirikiza kawiri kwa milungu iwiri kapena inayi, kotero kuti kuthana ndi zomwe mukufuna zitheke. Mlingo Wapamwamba® ndi 10 mg patsiku. Mankhwalawa amatengedwa kamodzi patsiku.

Mtima Kupewa matenda

Mlingo woyambira wothandiza ndi 2.5 mg Tritace® kamodzi patsiku.

Mlingo wokhudzana ndi kukonzanso

Kutengera kulolera kwazomwe zimagwiritsidwa ntchito, mlingo umakulitsidwa pang'onopang'ono. Ndikulimbikitsidwa kuti muwonjezere kuchuluka kwa mankhwala mu masabata 1-2 pambuyo pa kuyamba kwa mankhwalawa ndipo pakatha milungu iwiri iwiri (2) kuti mukwaniritse momwe muliri wa 10 mg® patsiku.

Onaninso dosing ya odwala omwe amatenga okodzetsa.

Chithandizo cha Matenda a Impso

Odwala omwe ali ndi matenda ashuga komanso microalbuminuria

Mlingo woyambira wopendekera ndi 1.25 mg Tritace patsiku.

Mlingo wokhudzana ndi kukonzanso.

Kutengera kulolera kwa mankhwalawa, mlingo umakulitsidwa pang'onopang'ono. Kubwereza muyeso wa 2.5 mg tsiku lililonse pakapita milungu iwiri kenako mpaka 5 mg patsiku patadutsa milungu iwiri.

Odwala omwe ali ndi shugashuga komanso osacheperachimodzi chowonjezera chowopsa

Mlingo woyambira wothandiza ndi 2.5 mg Tritace® patsiku.

Mlingo wokhudzana ndi kukonzanso

Kutengera kulolera kwazomwe zimagwiritsidwa ntchito, mlingo umakulitsidwa pang'onopang'ono. Ndikulimbikitsidwa kuti muwonjezere mlingo kwa 5 mg tsiku lililonse pakapita milungu iwiri kenako 10 mg tsiku lililonse pakapita milungu iwiri kapena itatu. Pazipita lililonse tsiku lililonse ndi 10 mg tsiku.

Odwala omwe alibe diabetesic nephropathy ndi macroproteinuria oposa 3 g / tsiku

Mlingo woyambira wopendekera ndi 1.25 mg Tritace® patsiku.

Mlingo wokhudzana ndi kukonzanso

Kutengera kulolera kwazomwe zimagwiritsidwa ntchito, mlingo umakulitsidwa pang'onopang'ono. Ndikulimbikitsidwa kuti muwonjezere kuchuluka kwa 2,5 mg tsiku lililonse pakapita milungu iwiri, kenako 5 mg tsiku lililonse pakapita milungu iwiri.

Zizindikiro za mtima kulephera

Kwa odwala omwe ali ndi diuretic mankhwala, mlingo woyambira ndi 1.25 mg Tritace® patsiku.

Mlingo wokhudzana ndi kukonzanso

Kusuntha kuyenera kuchitidwa pobwereza Mlingo wa Tritace® Sabata iliyonse kapena awiri mpaka mlingo waukulu wa 10 mg. Kugawa muyezo Mlingo iwiri patsiku tikulimbikitsidwa.

Prophylaxis yachiwiri pambuyo kuphwanya kwamphamvu kwa myocardial ndi kulephera kwa mtima

Mlingo woyambirira ndi 2,5 mg kawiri tsiku lililonse kwa masiku atatu, ndipo umayamba kugwiritsidwa ntchito patatha maola 48 kuchokera pakubadwa kwa myocardial infiration mwa odwala komanso okhazikika a hemodynamically. Ngati mulingo woyambira wa 2,5 mg wosavomerezeka bwino, ndiye kuti mlingo umagawidwa pawiri. 1.25 mg kwa masiku awiri mpaka mulingo wokwanira mpaka 2,5 mg ndi 5 mg kawiri pa tsiku. Ngati mulingo sangathe kuchuluka kwa 2,5 mg kawiri pa tsiku, chithandizo chikuyenera kutha.

Onaninso mlingo pamwambapa kwa odwala omwe akutenga okodzetsa.

Mlingo wokhudzana ndi kukonzanso

Mlingo wa tsiku ndi tsiku umachulukana modabwitsa pakubwereza kwa masiku 1 mpaka atatu mpaka pamlingo wowonjezera wa 5 mg kawiri pa tsiku. Ngati ndi kotheka, Mlingo wa kukonza uyenera kugawidwa pawiri.

Ngati mulingo sangathe kuchuluka kwa 2,5 mg kawiri pa tsiku, chithandizo chikuyenera kutha. Pankhani ya chithandizo cha odwala omwe ali ndi vuto lalikulu la mtima (NYHA kalasi IV) atangolowa myocardial infarction, zochitika zimatha. Ngati lingaliro lingachitike pazamankhwala a odwala otere, ndikulimbikitsidwa kuti muyambe ndi mlingo wa 1.25 mg kamodzi patsiku, ndikuwonetsetsa mosamala kwambiri.

Magulu Opatsa Odwala

Odwala ndi mkhutu aimpso ntchito

Mlingo wa tsiku ndi tsiku wa odwala omwe ali ndi vuto la impso uyenera kutsimikizika malinga ndi chilolezo cha creatinine:

- ngati creatinine chilolezo ≥ 60 ml / min, kusintha kwa gawo loyambirira (2,5 mg / tsiku) sikufunika, mulingo woyenera watsiku ndi tsiku ndi 10 mg.

- ngati creatinine chilolezo chili m'magawo 30-60 ml / min, mulingo woyambirira sunasinthidwe (2,5 mg / tsiku), mlingo waukulu tsiku lililonse ndi 5 mg.

- ngati creatinine chilolezo chili mndandanda wa 10-30 ml / min, muyeso woyamba ndi 1.25 mg / tsiku, mlingo waukulu tsiku lililonse ndi 5 mg.

- odwala omwe ali ndi matenda oopsa omwe amachitika ndi hemodialysis: ramipril imachotsedwa bwino ndi dialysis, mlingo woyambirira ndi 1.25 mg / tsiku, mlingo waukulu wa tsiku ndi tsiku ndi 5 mg. Mankhwala ayenera kumwedwa patatha maola angapo atamaliza kukonzekera kwa dialysis.

Odwala omwe ali ndi vuto la chiwindi

Odwala omwe ali ndi vuto la chiwindi, Tritace mankhwala® Iyenera kuyamba kuyang'aniridwa ndi achipatala okhawo, mlingo woyenera wa tsiku ndi tsiku wa Tritace® ndi 2,5 mg.

Mlingo woyambirira wa gulu ili la odwala uyenera kukhala wotsika momwe mungathere, komanso kuthana nawo kwa mankhwalawo mosatalikirapo, popeza pali zovuta zina za odwala okalamba ndi ofooka. Mlingo woyambira wotsika wa 1.25 mg wa ramipril uyenera kukumbukiridwa.

Tsata® osavomerezeka kuti azigwiritsidwa ntchito mwa ana ndi achinyamata ochepera zaka 18 chifukwa cha kuchuluka kwa chitetezo chokwanira. Pali zochepa zomwe zimachitika ndi ana a ramipril.

Kutulutsa mafomu ndi kapangidwe kake

Mutha kugula mankhwalawo molimba. Chofunikira kwambiri pakuphatikizidwacho ndi ramipril. Piritsi limodzi, mankhwalawa amapezeka mu 2.5 mg. Pali njira zina za mankhwalawa: 5 ndi 10 mg. M'matembenuzidwe onse, zigawo zing'onozing'ono ndizofanana. Zinthu izi sizikuwonetsa ntchito za antihypertensive. Izi zikuphatikiza:

hypopellose,
pregelatinized wowuma
cellcrystalline mapadi,
sodium walaryl fumarate,
utoto.

Piritsi limodzi, mankhwalawa amapezeka mu 2.5 mg.

Mutha kugula mankhwalawa mumapaketi okhala ndi matuza awiri, mapiritsi 14 aliwonse.

Zomwe zimayikidwa

Zisonyezo zingapo zogwiritsira ntchito mankhwalawa:

matenda oopsa oopsa (aakulu komanso pachimake),
Kulephera kwa mtima, pamenepa, mankhwalawa amatchulidwa ngati gawo la zovuta,
Matenda aimpso owonongeka chifukwa cha matenda ashuga,
kupewa matenda a mtima dongosolo (stroko, myocardial infarction, ndi zina) odwala omwe ali pachiwopsezo cha zovuta zotere,
mtima ischemia, makamaka, mankhwalawa ndi ofunikira kwa anthu omwe atha kudwala matenda opha ziwalo zam'mnyewa wamatumbo, corteryary artery bypass grafting, orterial angioplasty,
pathological zinthu zomwe zimayambitsa kusintha kwa kapangidwe ka malinga a zotumphukira.

Chizindikiro chachikulu cha kumwa mankhwalawa ndi ochepa matenda oopsa.
Tritace amalembera kuphwanya aimpso, oyambitsa matenda a shuga.
Tritace imapangidwira infarction ya myocardial.

Ndi chisamaliro

Zoyipa zingapo zaumbanda zadziwika:

kusintha kwa atherosulinotic m'makoma a mitsempha,
kulephera kwa mtima
matenda oopsa owopsa
Kuchepetsa kuwala kwa mitsempha mu mphamvu, bola kuti izi zichitike mbali imodzi yokha,
ntchito masiku ochepa okodzetsa
kusowa kwamadzi mthupi motsutsana ndi kusanza, kutsekula m'mimba ndi zina zokhudzana ndi matenda,
Hyperkalemia
matenda ashuga.

Mankhwalawa sanatchulidwe kulephera kwamtima komanso kosalekeza.
Mankhwalawa ali ophatikizika chifukwa cha kulephera kwa impso.
Mosamala, mankhwalawa amagwiritsidwa ntchito posowa madzi m'thupi popewa kusanza.

Momwe mungatenge Tritace

Mapiritsi a kutafuna sayenera kukhala. Njira yochiritsira mankhwalawa imasankhidwa chifukwa cha matenda. Nthawi zambiri, mlingo wa yogwira ntchito umachulukitsidwa pang'onopang'ono. Nthawi zambiri zotchulidwa 1.25-2.5 mg wa chinthu 1 nthawi patsiku. Pakapita kanthawi, kuchuluka kwa mankhwalawo kumawonjezeka. Pankhaniyi, mlingo umatsimikiziridwa payekhapayekha kwa wodwala aliyense, potengera mphamvu za matendawa. Pafupipafupi, maphunziro a mankhwalawa amayamba ndi 5 mg ya mankhwalawa.

Ndi matenda ashuga

Chidachi chimagwiritsidwa ntchito kuchuluka kosaposa 1.25 mg patsiku. Ngati ndi kotheka, mlingo ukuwonjezeka. Komabe, mankhwalawa adapangidwanso pambuyo pa masabata 1-2 atatha kuyambitsa makonzedwe.

Ndi matenda a shuga, mankhwalawa amagwiritsidwa ntchito kuchuluka osaposa 1.25 mg patsiku.

Pakati mantha dongosolo

Mutu, chizungulire, kugunda kwa malekezero, kuchepa mphamvu, kuwonongeka koyenera pamalo owongoka, matenda amitsempha yamagazi, limodzi ndi zovuta zamagazi.

Kuchokera kumbali ya dongosolo lamanjenje lamkati, pamatha kupweteka mutu mutatha Tritace.

Dongosolo la Endocrine

Kuphwanya njira zamankhwala amuzolengedwa: kumachepa kapena kuwonjezeka komwe kumachitika zinthu zosiyanasiyana (sodium, potaziyamu, magnesium, calcium).

Kuchokera mu minculoskeletal system, pakhoza kukhala minofu kukokana mutatenga Tritace.

Kuchokera ku chitetezo chamthupi

Zomwe ma antiinodar antibodies amakula, zimachitika ndi anaphylactoid.

Sitikulimbikitsidwa kuyendetsa galimoto chifukwa choopsa kwambiri chifukwa chosagwirizana ndi zoyipa.

Urticaria, yotsatana ndi kuyabwa, zotupa, kufupika kwa magawo ena amtundu wakunja ndi kutupa.

The ntchito aimpso kuwonongeka

Contraindication ndi kwambiri pathologies a limba. Mankhwala sinafotokozedwe ndi kuchepa kwa chilolezo cha creatinine 20 ml / min.

Mukakalamba, kusamala kuyenera kuchitidwa, popeza pamakhala chiopsezo chocheperako kwambiri mavuto.

Kuchita ndi mankhwala ena

Popeza mphamvu ya mankhwalawo yomwe ikufunsidwa, muyenera kusamala posankha mankhwala osokoneza bongo.

Ngati bongo wambiri, nkhawa zamtima zimayamba.

Kuphatikiza komwe kumafunikira kusamala

Gululi limaphatikizapo mankhwala omwe amatsogolera kuchepa kwa kukakamizidwa. Ndikofunikira kuyang'ana momwe thupi limagwirira ntchito heparin, ethanol ndi sodium chloride.

Kumwa zakumwa zokhala ndi zakumwa zoledzeretsa limodzi ndi zomwe mukufunsazo sizikulimbikitsidwa.

Kuyenderana ndi mowa

Kumwa zakumwa zokhala ndi zakumwa zoledzeretsa limodzi ndi zomwe mukufunsazo sizikulimbikitsidwa.

Ndikofunikira kusankha mankhwala omwe amadziwika ndi zovuta zochepa, koma nthawi yomweyo amathandizira ku matenda oopsa ndipo amatsogolera kukonzanso kwamtima.

Ndemanga za Tritac

Ndikulimbikitsidwa kuti mupeze chidziwitso chambiri momwe mungagwiritsire ntchito mankhwalawa. Izi zimathandiza kuwunika kwa ogula ndi akatswiri.

Zafiraki V.K., katswiri wazamtima, wazaka 39, Krasnodar

Ndi ankalamulira pathologies a mtima dongosolo, mankhwalawa amagwira ntchito bwino: amachepetsa kuthamanga kwa magazi ndipo samayambitsa mavuto. Komabe, mwa odwala ambiri, matenda oyanjana amadziwika, chifukwa chake zimakhala zovuta kupereka mankhwala - kuyang'anira mkhalidwe wa thupi kumafunika.

Alanina E. G., wochita zamatsenga, wazaka 43, Kolomna

Mankhwala ayenera kumwedwa, simungathe kuwonjezera kuchuluka kwa tsiku lililonse, muyenera kuyang'anira thanzi lanu. Zizindikiro zoyipa zoyambirira zikaonekera, njira yolandirayo imasokonekera. Sindingatsutse kuchuluka kwa mankhwalawa, koma ndimayesetsa kuti ndiziwapatsa mankhwala pafupipafupi, chifukwa pamakhala chiwopsezo chachikulu chokhala ndi mavuto akulu.

Maxim, wazaka 35, Pskov

Nthawi zina ndimamwa mankhwalawa, chifukwa ndakhala ndikuvutika ndi matenda oopsa kwa nthawi yayitali. Amachitapo kanthu mwachangu. Adotolo adandiuza kuti atenge mlingo wocheperako, chifukwa sindili wovuta. Pazifukwa izi, zoyipa sizinachitikebe.

Veronika, wazaka 41, Vladivostok

Chifukwa cha zovuta ndi zotengera, kupanikizika kumadumpha nthawi zambiri. Nthawi zina ndimasintha antihypertensive mankhwala pazovomerezeka za dokotala. Ndidayesa kumwa mankhwala osiyanasiyana. Mankhwala omwe amafunsidwa ndi othandiza kwambiri, chifukwa zotsatira zake zimawoneka mwachangu. Koma ichi ndi chida chankhanza. Ndimagwiritsa ntchito pafupipafupi kuposa ma analogues.