Momwe mungagwiritsire ntchito mankhwala Hartil Amlo?

Makapisozi 5 mg + 5 mg, yolimba, gelatin, CONI-SNAP 3, yopanda chidwi, yodzitseka yokha, yokhala ndi opaque base mu kuwala burgundy ndi chivundikiro cha opaque mu kuwala burgundy.

1 zisoti.

ramipril	5 mg
amlodipine (mawonekedwe a besylate)	5 mg

PRING crospovidone (E-1202), hypromellose (E-464), microcrystalline cellulose (E-460), glycerol dibehenate.

Kapangidwe ka kapisozi CONI-SNAP 3: buluu wonyezimira (E-133), wofiira wokongola (E-129), titanium dioxide (E-171), gelatin.

7 ma PC - matuza opangidwa ndi PVC / Polyamide / Aluminium (4) - mapaketi a makatoni.
7 ma PC - matuza opangidwa ndi PVC / Polyamide / Aluminium (8) - mapaketi a makatoni.
Ma PC 10 - matuza opangidwa ndi PVC / Polyamide / Aluminium (3) - mapaketi a makatoni.
Ma PC 10 - matuza opangidwa ndi PVC / Polyamide / Aluminium (9) - mapaketi a makatoni.

Zotsatira za pharmacological

Limagwirira a ramipril

Ramiprilat, metabolite yogwira ya ramipril prodrug, imalepheretsa enzyme dipeptidyl carboxypeptidase I (masinthidwe: angiotensin-akatembenuza enzyme, kininase II). Mu plasma ndi minofu, enzyme iyi imathandizira kusintha kwa angiotensin I kukhala yogwira vasoconstrictor chinthu - angiotensin II, komanso imathandizira pakuwonongeka kwa chinthu cha vasodilator - bradykinin. Kuchepetsa mapangidwe a angiotensin II ndikuletsa kuwonongeka kwa bradykinin kumabweretsa vasodilation.

Popeza angiotensin II imathandizanso kumasulidwa kwa aldosterone, ramiprilat imachepetsa kubisika kwa aldosterone. Kuyankha kwapakati pa monotherapy yokhala ndi ACE inhibitor kunali kotsika mu chiwerengero cha odwala akuda (Afro-Caribbean) omwe ali ndi matenda oopsa (kuchuluka kwa odwala omwe ali ndi matenda oopsa ndipo, monga lamulo, okhala ndi zotsalira za renin) kuposa kwa odwala omwe ali ndi khungu losiyana.

Kugwiritsidwa ntchito kwa ramipril kumayendera limodzi ndi kuchepa kwapadera kwa ziwopsezo zapakati. Monga lamulo, mankhwalawa sasintha kwambiri magazi aimpso komanso kusefukira kwa gawo la khungu. Kugwiritsidwa ntchito kwa ramipril kumayendera limodzi ndi antihypertensive kwambiri, ponse paudindo wa wodwala komanso malo abodza, ndipo mankhwalawa samayambitsa kupweteka kwa tachycardia.

Pambuyo pakukonzekera kamodzi pamlomo wa ramipril, mphamvu yake ya antihypertgency imawonedwa mkati mwa maola 1-2, imafikira pambuyo pa maola 3-6 ndipo imatha kwa maola 24. Pokhala ndi ramipril tsiku lililonse, mphamvu yake ya antihypertensive imayamba kuwonjezeka masabata 3-4 ndipo imapitirira ndi chithandizo cha nthawi yayitali.

Kutsetsereka mwadzidzidzi kwa ramipril sikuyenda ndi kukwera msanga kwa magazi.

Limagwirira zake amlodipine

Amlodipine imalepheretsa transmembrane kudya calcium calcium mu Cardiomyocyte ndi minyewa yosalala minofu ("wosakwiya" calcium njira blocker kapena calcium ion antagonist).

Limagwirira ake antihypertensive kwenikweni imachitika chifukwa kupuma mwachindunji minofu yosalala yamitsempha yamagazi, kupangitsa kuchepa kwa zotumphukira zamitsempha.

Kufotokozera mwatsatanetsatane kamangidwe kamene amayendetsedwera njira ya angina pectoris sikunakhazikitsidwe, koma makinawa amatha kugwira ntchito mbali ziwiri:

1) kukulitsa kwa zotumphukira za arterioles, ndipo, motero, kuchepa kwamphamvu yonse ya zotumphukira za mtima (pambuyo pake).

Popeza mankhwalawa samayambitsa reflex tachycardia, kugwiritsa ntchito mphamvu kwa myocardium ndi kufunika kwake kwa mpweya woperewera kumachepa.

2) kukulira kwa mitsempha yayikulu yam'mimba ndi ma arterioles a coronary, onse osasinthika komanso magawo a ischemic a minofu ya mtima, kumawonjezera kutuluka kwa mpweya mu myocardium.

Makina omwe tafotokozawa akuwonjezera mpweya wa okosijeni wam'magazi ngakhale m'mitsempha ya m'mitsempha yama coronary (angina kapena Prinzmetal angina).

Odwala ochepa matenda oopsa, kumwa kamodzi kwa tsiku ndi tsiku kwa amlodipine kumachepetsa kwambiri kuthamanga kwa magazi kwakanthawi kokwanira maola 24 (wodwalayo "atagona" ndi "ataimirira"). Chifukwa cha kuwonekera pang'onopang'ono kwa chochitikacho komanso kuchuluka kwa nthawi yayitali, mankhwalawa samayambitsa kupweteka kwambiri.

Odwala a angina pectoris, limodzi tsiku lililonse mlingo kumawonjezera kulolerako, kuchedwa kukula kwa matenda ena angina pectoris ndi "ischemic" kukhumudwa kwa gawo la ST, ndikuchepetsa pafupipafupi angina kuukira ndi kumwa nitroglycerin. Mankhwalawa sayambitsa zovuta zilizonse zama metabolic: sizikhudza lipids ya plasma, shuga ndi magazi a seramu uric acid ndipo amatha kupatsidwa odwala omwe ali ndi mphumu.

Maphunziro Otetezeka

Ponena za ramipril:

Ndi mkamwa makonzedwe a ramipril ku makoswe ndi agalu, zidapezeka kuti mankhwalawa sayambitsa poopsa pachinyama. Kafukufuku wogwiritsa ntchito mankhwala opaka pakamwa amachitika m makoswe, agalu, ndi nyani. M'mitundu yonse itatu yamtunduwu, kusintha kwa kuchuluka kwa ma plasma electrolyte ndi kusintha kwa chithunzi cha magazi kunalembedwa.

Monga umboni wa pharmacodynamic ntchito ya ramipril, kukula kwa aimpso juxtaglomerular tata hypertrophy kumawonedwa mu agalu ndi anyani tsiku lililonse la 250 mg / kg / tsiku. Makoswe, agalu, ndi anyani analekerera tsiku lililonse 2, 2,5, ndi 8 mg / kg (thupi) / tsiku, mosasamala kanthu.

Kafukufuku wokhudzana ndi zakumwa zoopsa za mankhwala omwe amapezeka pang'onopang'ono mu makoswe, akalulu ndi nyani sizinawululidwe za mtundu wina wa ramipril. Palibe amuna kapena makoswe achikazi omwe anasintha chonde.

Kukhazikitsa kwa ramipril ku makoswe achikazi munthawi ya fetal komanso nthawi yotsekemera tsiku lililonse la 50 mg / kg kulemera kwa thupi (kapena kuposa pamenepo) kumayendetsedwa ndi kuwonongeka kwa impso (kukula kwa impso).

M'maphunziro apamwamba ogwiritsa ntchito mitundu ingapo yoyesera, palibe chizindikiro cha mutagenicity kapena genotoxicity ya ramipril yomwe yapezeka.

Pokhudzana ndi amlodipine:

Mu makoswe ndi mbewa zomwe zimaphatikizidwa ndi amlodipine malete mu zakudya za kwa zaka ziwiri pamakina omwe amagwirizana ndi kuchuluka kwa masiku onse a 0.5, 1.25 ndi 2.5 mg a amlodipine / kg (thupi) / tsiku, palibe carcinogenic zotsatira. Mlingo wapamwamba kwambiri mbewa (monga mg / m 2) anali wofanana ndi mlingo wapamwamba wa anthu (MHD) wa 10 mg amlodipine patsiku. Mlingo wapamwamba kwambiri m'makola (molingana ndi mg / m 2) anali pafupifupi kawiri kuposa MPD.

M'maphunziro a amlodipine maleate, panalibe zisonyezo za mutagenicity zomwe zimachitika chifukwa chogwiritsa ntchito mankhwalawa, ponse pa jini komanso pamtunda wa chromosomes.

Chonde mu makoswe omwe amapatsidwa pakamwa amlodipine menate pa mlingo wa 10 mg / kg (kulemera kwa thupi) / tsiku (lomwe, malinga ndi mg / m 2, linali lokwera kokwana 8 kuposa MPD ya 10 mg / tsiku) silinali lolemala.

Kuyanjana kwa mankhwala osokoneza bongo

Ponena za ramipril:

Njira zina zowonjezera magazi zomwe zimakhudzana ndi malo osasakanika bwino, monga hemodialysis kudzera m'mitsempha yambiri (mwachitsanzo, zotupa zopangidwa ndi polyacrylonitrile complication), hemofiltration kapena apheresis ya otsika osalimba a lipoproteins amagwiritsa ntchito dextran sulfate, chifukwa chowonjezera chiopsezo chokhala ndi anaphylactic kapena anaphylacic. Ngati chithandizo choterocho nchofunikira, ndiye kuti kugwiritsa ntchito mitundu ina ya ulalo wamtundu wa dialysis kapena antihypertensive mankhwala ena ayenera kuganiziridwanso.

Njira zopewera kugwiritsa ntchito

Ndi munthawi yomweyo makonzedwe a potaziyamu, capi-kusunga okodzetsa ndi zinthu zina zomwe zimapangitsa kuchuluka kwa plasma potaziyamu (kuphatikiza ndi angiotensin II receptor antagonists, trimethoprim, tacrolimus, cyclosporine): Kukula kwa hyperkalemia ndikotheka, chifukwa chake ndikofunikira kuyang'anira kuchuluka kwa potaziyamu.

Mankhwala a antihypertensive (mwachitsanzo, okodzetsa) ndi zinthu zina zomwe zimachepetsa kuthamanga kwa magazi (mwachitsanzo, nitrate, antidepressants, painkillers, mowa, baclofen, alfuzosin, doxazosin, prazosin, tamsulosin, terazosin): chiopsezo cha hypotension chingakhalepo.

Vasopressor sympathomimetics ndi zinthu zina (mwachitsanzo, isoproterenol, dobutamine, dopamine, adrenaline) zomwe zimatha kuchepetsa mphamvu ya antihypertensive ya ramipril: kuwunika kwa magazi kumalimbikitsa.

Allopurinol, immunosuppressants, corticosteroids, procainamide, cytostatics ndi mankhwala ena omwe amatha kusintha kuchuluka kwa maselo amwazi: mwayi wokulira kwa kusintha kwa ma hematological.

Mchere wa Lithium: mutenga ma inhibitors a ACE okhala ndi kukonzekera kwa lithiamu, mutha kuchepetsa kuchepa kwake, motero, kuwonjezera kuchuluka kwa lithiamu m'magazi ndikuwonjezereka kwa kawopsedwe ake. Kuwunikira pafupipafupi kwamiyezo ya lithiamu kumafunika.

Othandizira odwala matenda ashuga, kuphatikiza ndi insulin: ma hypoglycemic angakhudzidwe. Ndikulimbikitsidwa kutsimikiza mosamala kuchuluka kwa shuga m'magazi.

Mankhwala osapatsirana omwe amaletsa kutupa ndi acetylsalicylic acid: kuchepa kwa mphamvu ya antihypertensive ya ramipril ndikotheka. Kuphatikiza apo, kugwiritsidwa ntchito kophatikizana kwa ACE inhibitors ndi NSAIDs kungayambitse kukula kwa hyperkalemia ndikuchulukitsa chiopsezo cha vuto laimpso.

Pokhudzana ndi amlodipine:

Mankhwala amagwirizana ndi thiazide diuretics, beta-blockers, nitrate wautali, mankhwalawa amtundu wa nitroglycerin, mankhwala osokoneza bongo omwe amaletsa kutupa, mankhwala opha ma antioxotic komanso mankhwala opaka pakamwa.

Zotsatira za mankhwala ena amlodipine

- CYP3A4 zoletsa: pamene mankhwalawa amagwiritsidwa ntchito ndi CYP3A4 inhibitor, erythromycin mwa odwala achinyamata ndi diltiazem odwala okalamba, motero, kuchuluka kwa plasma kwa amlodipine kumawonjezeka, 22% ndi 50%. Komabe, momwe matendawo amafananira ndi izi sizikudziwika bwinobwino. Sizingatengedwe kuti mphamvu zamtundu wa CYP3A4 zoletsa (mwachitsanzo, ketoconazole, itraconazole, ritonavir) zitha kukulitsa kuchuluka kwa plasma kwa amlodipine pamlingo wokulirapo kuposa diltiazem. Amlodipine akuyenera kugwiritsidwa ntchito mosamala mukamathandizana ndi CYP3A4 inhibitors. Komabe, palibe malipoti azotsatira zoyipa zilizonse zomwe zimagwirizanitsidwa ndi kuyanjana uku.

- CYP3A4 inducers: palibe umboni wazomwe zimapangitsa CYP3A4 inducers pa amlodipine. Kugwiritsa ntchito mankhwalawa ndi CYP3A4 inducers (mwachitsanzo, rifampicin kapena St. John wa wort) kungachepetse ndende ya plasma ya amlodipine. Amlodipine ayenera kugwiritsidwa ntchito mosamala akamagwiritsa ntchito limodzi ndi CYP3A4 inducers.

M'maphunziro azachipatala omwe amachitika ndi mankhwala osokoneza bongo, kuphatikiza kwa amlodipine ndi madzi a mphesa, cimetidine, aluminium / magnesium (antacid) ndi sildenafil sizinakhudze pharmacokinetics ya amlodipine.

Zotsatira za amlodipine pa mankhwala ena

Kuphatikiza kwa amlodipine ndi othandizira ena antihypertgency kumawonjezera luso lawo lachifundo.

M'maphunziro azachipatala omwe amachitika ndi mankhwala, amlodipine sanakhudze pharmacokinetics ya atorvastatin, digoxin, ethanol (ethanol), warfarin, kapena cyclosporine.

Palibe mphamvu ya amlodipine pakusintha kwa mayeso a labotale.

Mlingo

Mlingo wovomerezeka tsiku lililonse ndi 1 kapisozi yodziwika bwino. Hartil ® Amlo ayenera kumwedwa tsiku lililonse, nthawi yomweyo patsiku, asanadye kapena atadya. Makapisozi sayenera kuphwanyidwa kapena kutafunidwa.

Mankhwala osakanikirana ndi mankhwalawa sayenera gawo loyambirira la mankhwala. Ngati pakufunika kusintha kwa mlingo, ndiye kuti uyenera kuchitika mothandizidwa ndi oyang'anira anzawo ndipo pokhapokha mlingo wokwanira utakhazikitsidwa titha kusintha mtundu wina wa mankhwalawo ndi Hartil ® Amlo.

Akuluakulu: tikulimbikitsidwa kupaka mankhwalawa mosamala kwa odwala omwe ali ndi zodwala, chifukwa mwa izi odwala akhoza kuphwanya muyezo wamagetsi wamadzi. Ndikofunikira kuphunzira ntchito yaimpso ndikuwona mulingo wa potaziyamu mu seramu yamagazi.

Odwala omwe ali ndi vuto la chiwindi, amlodipine amayamba nthawi yayitali. Malangizo enieni okhudza mlingo wa amlodipine sanatsimikizidwe, koma mankhwalawa amayenera kuperekedwa kwa odwala mosamala kwambiri. Odwala omwe ali ndi vuto la chiwindi, mankhwala a ramipril amayenera kuyambitsidwa moyang'aniridwa ndi achipatala, ndipo mlingo wambiri watsiku ndi tsiku uyenera kukhala 2,5 mg wa ramipril.

Ndikulimbikitsidwa kuti Khartil ® Amlo adangoperekedwa kwa okhawo omwe atumizidwa ku 2,5 mg ya ramipril ngati mlingo woyenera kwambiri posamalira mlingo wa ramipril.

Pofuna kudziwa mulingo woyenera kwambiri woyambira ndi kukonzanso Mlingo wa odwala omwe ali ndi vuto la impso, mlingo wa mankhwalawa umayenera kusankhidwa ndi aliyense payekha kudziwa kuchuluka kwa ramipril ndi amlodipine.

Palibe chifukwa chosinthira kuchuluka kwa amlodipine mwa odwala omwe ali ndi vuto laimpso.

Amlodipine samachotsedwanso panthawiyi. Odwala omwe akupita dialysis, amlodipine ayenera kuikidwa mosamala kwambiri.

Mlingo wa tsiku ndi tsiku wa ramipril mu odwala aimpso ayenera kukhazikitsidwa poganizira chilolezo cha creatinine.

- Ngati creatinine chilolezo ndi ≥60 ml / mphindi, ndiye kuti mlingo woyambirira sukusunthika, mlingo waukulu wa tsiku ndi tsiku ndi 10 mg.

- Ngati creatinine chilolezo ndi ® Amlo, tikulimbikitsidwa kupereka mankhwala pokhapokha ngati wodwala wasintha kuti akhale ndi ramipril dosing ya 2,5 mg kapena 5 mg ngati mlingo woyenera wokwanira (womwe unakhazikitsidwa pa ramipril dosing). Odwala akudwala hemodialysis ayenera kumwa mankhwala patatha maola angapo kuchokera hemodialysis.

Mukafuna chithandizo cha mankhwala ndi Hartil ® Amlo, mphamvu yogwira impso komanso zomwe zili mu seramu yamagazi ziyenera kuwongoleredwa. Ngati kuwonongeka kwa impso, kugwiritsidwa ntchito kwa mankhwala Hartil ® Amlo kuyenera kusiyidwa, ndipo zigawo zake ziyenera kufotokozedwa mu Mlingo womwe umasinthidwa moyenera.

Odwala okalamba amatha kumwa mwachizolowezi amlodipine, komabe, kusamala kuyenera kutengedwa kuti muwonjezere mlingo wa mankhwalawa.

Mlingo woyambirira wa ramipril uyenera kukhala wotsika kuposa masiku onse, ndipo kusintha kwa mlingo wotsatira uyenera kukhala wofewa, chifukwa cha chiwopsezo chachikulu cha zotsatira zoyipa.

Sikulimbikitsidwa kusankha Hartil ® Amlo kukhala odwala okalamba kwambiri komanso ofooka.

Sitikulimbikitsidwa kupereka Hartil ® Amlo kwa ana ndi achinyamata osakwana zaka 18, popeza chitetezo ndi kugwiritsa ntchito mankhwalawa m'gulu la odwala sikunatsimikizidwe.

Zisonyezo za pakati

Ponena za ramipril

Kugwiritsira ntchito IPF zoletsa sikuti ndikulimbikitsidwa panthawi yoyambirira ya kubereka, ndipo panthawi yachiwiri komanso yachitatu ya kutenga pakati, kugwiritsa ntchito IPF zoletsa kumatsutsana.

Umboni wa Epidemiological wa chiopsezo cha teratogenicity pambuyo povumbulutsidwa ndi ma inhibitors a ACE panthawi yoyamba ya mimba siwokhutiritsa, koma kuwonjezeka pang'ono pangozi imeneyi sikungatsimikizike. Ngati pakufunika kupitiliza chithandizo chamankhwala pogwiritsa ntchito ACE / APAT II zoletsa, ndiye kuti odwala omwe akukonzekera kutenga pakati asintha njira zawo zochiritsidwazo ku njira ina yothandizira antihypertensive yomwe ikukwaniritsa zofunikira pakugwiritsa ntchito panthawi yomwe ali ndi pakati. Mimba ikatsimikiziridwa, chithandizo ndi zoletsa za ACE ziyenera kuyimitsidwa nthawi yomweyo ndipo ngati kuli koyenera, njira zina zochiritsira ziyenera kuyambitsidwa.

Kuwonetsedwa kwa ma inhibitors a ACE panthawi yachiwiri ndi yachitatu ya trimesters kumadziwika kuti kumapangitsa kuti mwana akhale ndi chiberekero. Ngati kukhudzana ndi ACE zoletsa kumachitika nthawi yachiwiri ya kubereka, tikulimbikitsidwa kuti tichite ntchito ya impso ndi kukula kwamafupa. Makanda obadwa kumene omwe amayi awo adatenga zoletsa za ACE ayenera kuyang'aniridwa bwino kuti athe kukhala ndi hypotension, oliguria ndi hyperkalemia.

Pokhudzana ndi amlodipine

Chitetezo cha amlodipine pa nthawi yapakati mwa amayi sichinakhazikitsidwe. Kafukufuku wokhudzana ndi kubereka mu makoswe akuwonetsa kusapezeka kwa chizindikiro cha poizoni, kupatula kugwiranso ntchito kwa nthawi yayitali komanso kutalika kwakutali, ndi Mlingo wowirikiza kawiri mlingo womwe anthu amapereka. Kugwiritsa ntchito mankhwalawa panthawi yapakati kumalimbikitsidwa pokhapokha ngati pali njira zina zotetezeka komanso ngati matendawa ali pachiwopsezo chachikulu kwa mayi ndi mwana wosabadwayo.

Ponena za ramipril

Popeza palibe chidziwitso chokwanira chokhudza kugwiritsa ntchito ramipril pa nthawi yoyamwitsa, kugwiritsa ntchito ramipril panthawiyi sikulimbikitsidwa, ndipo ndikofunika kusankha njira zina zamankhwala zomwe zimafotokozedwera mwatsatanetsatane pa chitetezo cham'mawere, makamaka pakudyetsa ana akhanda ndi masiku osakwana.

Pokhudzana ndi amlodipine

Palibe deta pakugawidwa kwa amlodipine mkaka wamawere. Lingaliro la kupitiriza / kusiya kuyamwitsa kapena kupitiliza / kusiya kumwa mankhwala ndi amlodipine liyenera kuchitika poganizira zabwino za kuyamwitsa khanda ndi mapindu a amlodipine chithandizo cha mayi.

Malangizo apadera

Ponena za ramipril:

Magulu Apadera a Patent

ACE zoletsa sayenera kumwedwa panthawi yoyembekezera. Ngati pakufunika kupitiliza chithandizo chamankhwala pogwiritsa ntchito zoletsa za ACE, ndiye kuti odwala omwe akukonzekera kutenga pakati asintha njira zina zochiritsira zosagwiritsidwa ntchito masiku onse, zomwe zimakwaniritsa chitetezo chazomwe zimagwiritsidwa ntchito panthawi yapakati. Pakupezeka kwazindikiritso wam'mimba, chithandizo chogwiritsa ntchito ACE zoletsa ziyenera kuyimitsidwa nthawi yomweyo ndipo ngati kuli koyenera, kugwiritsa ntchito njira zina zochiritsira kuyenera kuyambitsidwa.

Odwala omwe ali ndi chiopsezo chowonjezereka:

- Odwala omwe ali ndi renin-angiotensin-aldosterone kwambiri:
odwala omwe ali ndi renin-angiotensin-aldosterone yodwala kwambiri ali pachiwopsezo chachikulu cha kutsika kwamphamvu kwa magazi komanso kuwonongeka kwaimpso chifukwa cha kuletsa kwa ACE, makamaka pamene ACE inhibitors kapena concomitant diuretics adalembedwa koyamba kapena mlingo wawo ukakwezedwa kwa nthawi yoyamba.

Ngati chiwonetsero cha hyperactivation cha renin-angiotensin-aldosterone chikuwoneka ngati chotheka, ngati kuli koyenera, konzani kuyang'aniridwa kwa achipatala, kuphatikizapo kuwunika kwa magazi:

- odwala matenda oopsa,

Odwala omwe ali ndi mtima wofundidwa,

- odwala hemodynamically akuwonetsa kulowetsedwa kulowetsedwa kapena kutuluka kuchokera kumanzere kwamitseko (mwachitsanzo, stenosis ya msempha kapena mitral valavu),

- odwala ndi unilateral stenosis a impso mtsempha wamagazi kugwira ntchito impso yachiwiri,

- odwala omwe ali ndi kusokonezeka komwe (kapena kotheka) muyezo wamagetsi wamagetsi (kuphatikiza odwala akutenga okodzetsa),

- odwala cirrhosis ndi / kapena ascites,

- odwala omwe anachitidwa opareshoni yovuta, kapena amene anachitidwa opaleshoni yokhudzana ndi mankhwala omwe amachititsa hypotension,

Pafupifupi, tikulimbikitsidwa kuti kuchepa kwa madzi m'thupi, kuchepa kwa magazi, kapena kuchepa kwa mchere usanachitike chithandizo (odwala omwe ali ndi vuto la mtima, komabe, zabwino ndi zovuta zonse za zinthu zotere ziyenera kuyesedwa mosamala, poganizira chiopsezo cha kuchuluka kwambiri).

- odwala omwe ali ndi kusakhalitsa (osachedwa) kapena kulephera kwamtima kosatha pambuyo pa MI,

- odwala omwe ali pachiwopsezo cha kukhala ndi mtima kapena chodabwitsa cha ischemia kapena chifukwa cha kupweteka kwambiri.

Pa gawo loyambirira la chithandizo, kuyang'aniridwa kwapadera kwachipatala kumafunika.

Ndikulimbikitsidwa kuti musiye kugwiritsa ntchito angiotensin-converting enzyme inhibitors, monga ramipril, tsiku limodzi musanachite opaleshoni, ngati zingatheke.

Impso ntchito kuwunika

Ntchito yeniyeni iyenera kuyesedwa musanayambe komanso chithandizo, ndipo muyezo wa mankhwalawa umasinthidwa, makamaka masabata oyamba a chithandizo. Kwa odwala omwe ali ndi vuto la impso, makamaka kuwunika mosamala ndikofunikira. Pali chiopsezo cha matenda aimpso, makamaka mwa odwala omwe ali ndi vuto la mtima kapena pambuyo pake.

Zomwe zimachitika ndi angioedema mwa odwala omwe amatenga zoletsa za ACE, kuphatikizapo ramipril, akuti.

Ngati angioedema ingachitike, ramipril iyenera kuyimitsidwa. Njira ndi njira zochizira mwadzidzidzi zimalembedwa nthawi yomweyo. Wodwala amayenera kuyang'aniridwa kwa maola osachepera 12-24, ndikuwamasulidwa kuulamuliro pokhapokha zizindikiro zitatha.

Kupezeka kwa matumbo angioedema kunanenedwa mwa odwala omwe amatenga zoletsa za ACE, kuphatikizapo ramipril.

Odwala awa adadandaula za kupweteka kwam'mimba (ndi kapena popanda zizindikiro za mseru kapena kusanza).

Kugwiritsa ntchito zoletsa za ACE kumawonjezera mwayi wa anaphylactic komanso anaphylactoid zimachitika (ndi kuopsa kwawo) kuzilombo zankhondo ndi zina zoyipa. Mpaka kufika pansi pa kukakamira, kulingalira kuyenera kuperekedwa kwa kusiya kwa nthawi yochepa ramipril.

Hyperkalemia inaonedwa mwa odwala ena omwe amatenga ma ACE zoletsa, kuphatikizapo ramipril. Gulu la odwala omwe ali ndi chiopsezo chowonjezeka cha hyperkalemia limaphatikizapo odwala omwe amalephera kupezekanso impso, okalamba (zaka zopitilira 70), odwala matenda osakhazikika a shuga, kapena odwala omwe amamwa mchere wa potaziyamu, okodzetsa wa potaziyamu komanso zinthu zina zomwe zimapangitsa kuchuluka kwa plasma potaziyamu magazi, komanso odwala omwe ali ndi vuto la kufooka kwa madzi, kusowa kwa mtima, kapena metabolic acidosis. Ngati kugwiritsa ntchito munthawi yomweyo mankhwala omwe ali pamwambawa akuwoneka kuti ndi oyenera, tikulimbikitsidwa kuti kuwunika pafupipafupi kuchuluka kwa potaziyamu mu seramu yamagazi ndikulimbikitsidwa.

Pakhala lipoti losowa kwambiri la milandu ya neutropenia / agranulocytosis, thrombocytopenia ndi kuchepa kwa magazi, komanso kupsinjika kwa m'mafupa. Kuti mupeze leukopenia woyamba kwambiri, tikulimbikitsidwa kuwongolera kuchuluka kwamaselo oyera. Kuwunikira pafupipafupi kumayambiriro kwa mankhwalawa kumalimbikitsidwa pakati pa odwala omwe ali ndi vuto laimpso, komanso odwala omwe ali ndi vuto la collagenoses (mwachitsanzo, lupus erythematosus kapena scleroderma), komanso mwa odwala onse omwe amamwa mankhwala ena omwe amachititsa kuti magazi asinthe.

Zoletsa za ACE zimachulukitsa zochitika za angioedema mwa odwala akuda poyerekeza ndi odwala omwe ali ndi khungu losiyana.

Monga zoletsa zina za ACE, ramipril imatha kukhala yosagwira pakumachepetsa kuthamanga kwa magazi mwa odwala akuda poyerekeza ndi odwala omwe ali ndi khungu losiyana. Mwina izi zikuchitika chifukwa cha kuchuluka kwa magazi ochepa omwe ali ndi vuto lotsika la renin kuchulukitsa kwa anthu akuda omwe akudwala matenda oopsa.

Pali mbiri ya kutsokomola itatha kutenga ACE inhibitors. Chizindikiro cha chifuwa ndi kuuma ndi kulimbikira, komanso kutha kwa mawonetsedwe ake atasiya kugwiritsa ntchito mankhwala. Khunyu lomwe limayamba chifukwa cha kutenga ACE inhibitors liyenera kuganiziridwa ngati mbali imodzi yodziwitsa za chifuwa.

Pokhudzana ndi amlodipine:

Chitetezo ndi mphamvu ya amlodipine pamavuto oopsa kwambiri sichinakhazikitsidwe.

Gwiritsani ntchito odwala omwe ali ndi vuto la mtima

Iyenera kugwiritsidwa ntchito mosamala odwala omwe ali ndi vuto la mtima. Pakufufuzidwa kwakutali kwa placebo komwe kumakhudza odwala omwe ali ndi vuto lalikulu la mtima (kalasi ya NYHA III ndi kalasi yothandizira IV), milandu ya edema ya m'mapapu idalembedwa, zomwe zimachitika kuti zinali zambiri pagululi ndi amlodipine, poyerekeza ndi gulu la placebo, koma izi sizoyenera limodzi ndi kulephera mtima kwambiri.

Gwiritsani ntchito odwala omwe ali ndi vuto la chiwindi

Odwala omwe ali ndi vuto la chiwindi, theka la moyo wa amlodipine limakulitsidwa, palibe malingaliro osinthira mlingo. Odwala omwe ali mgululi ayenera kumwa mosamala amlodipine.

Gwiritsani ntchito odwala okalamba

Odwala okalamba ayenera kumwa amlodipine mosamala.

Gwiritsani ntchito odwala omwe ali ndi vuto laimpso

Odwala omwe ali ndi vuto laimpso amatha kutenga amlodipine muyezo wamba. Kusintha kwa plasma wozungulira amlodipine woipa sakukwanirana ndi kuchuluka kwa aimpso kulephera. Amlodipine samachotsedwanso panthawiyi.

Mu kapisozi 5 mg / 5 mg ndi 10 mg / 5 mg ndi ofiira owoneka bwino (allura red AC-FD & C Red 40 E-129, ndipo mu kapisozi 5 mg / 10 mg ndi 10 mg / 10 mg pali azorubine (carmuazine)). E-122) Utoto uwu umatha kuyambitsa thupi.

Kukopa pa kuyendetsa magalimoto ndi kayendedwe kazinthu

Zotsatira zina zoyipa (mwachitsanzo, Zizindikiro zakuchepa kwa kuthamanga kwa magazi, monga chizungulire) zimatha kudodometsa chidwi cha wodwalayo kuti aziganiza mozama komanso kuchitapo kanthu mwachangu, motero zimawonjezera chiopsezo pamavuto omwe maluso amenewa ali ofunikira makamaka (mwachitsanzo, poyendetsa galimoto kapena kutumikira) makina ndi makina).

Makamaka, izi zimatha kuyamba kumayambiriro kwa mankhwalawa kapenanso kusintha mankhwala ena. Mukamwa mlingo woyamba wa mankhwalawa kapena kuwonjezeka kwa mlingo wake, osavomerezeka kuyendetsa magalimoto kapena kukonza makina ndi zida zingapo kwa maola angapo.

Pharmacokinetics

Zogulitsa ndi kugawa

Pambuyo pakukonzekera pakamwa, ramipril imatengedwa mwachangu kuchokera mumimba. C_max ramipril mu plasma imafikiridwa mkati mwa ola limodzi. Poganizira kuchuluka kwa mkodzo, kuchuluka kwa mayamwidwe kumachepera 56% ndipo sikudalira chakudya. The bioavailability wa yogwira metabolite wa ramiprilat pambuyo m`kamwa makonzedwe a 2,5 mg ndi 5 mg wa ramipril ndi 45%.

C_max ramiprilat, metabolite yokhayo yomwe imagwira ramipril, imafikiridwa patatha maola 2-4 mutatha ramipril. C_ss ramiprilat plasma ndende zimafikiridwa, pafupifupi, pa 4 tsiku lotenga ramipril mu achire mlingo. Kumangidwa kwa ramipril ku mapuloteni a seramu kuli pafupi 73%, ndipo ramiprilat ili pafupifupi 56%.

Kutetemera ndi chimbudzi

Ramipril ali pafupi kupangika kwathunthu ku ramiprilat ndi diketopiperazinovy ether, diketopiperazinovy acid komanso ramipril ndi ramiprilat glucuronides. Kukula kwa metabolites kumachitika makamaka kudzera mu impso. Kuzama kwa plasma kwa ramiprilat kumachepetsedwa model polyphase. Chifukwa chogwirizanitsa kwa ACE komanso kufooka kocheperako ndi enzyme, ramiprilat imawonetsa gawo limodzi lomaliza lothana ndi mankhwala ambiri a plasma. Pambuyo mobwerezabwereza makonzedwe a ramipril limodzi mlingo 1 nthawi /, T_1/2 ramiprilat anali maora 13-17 (pa mlingo wa 5-10 mg), ndipo atachepetsa mlingo wa 1.25-2.5 mg T_1/2 kutalika. Kusiyana kumeneku kumachitika chifukwa cha kukhathamiritsa kwa mphamvu ya enzyme, yomwe imamangiriza ku ramiprilat.

Pambuyo pa limodzi la ramipril, panalibe umboni wa ramipril ndi metabolites ake mkaka wa m'mawere. Komabe, kupukusa kwa ramipril mkaka wa m'mawere ndikukhazikika kwa mankhwalawa kumadziwika.

Pharmacokinetics mu milandu yapadera yamankhwala

Ramiprilat aimpso excretion amachepetsa odwala matenda aimpso, kuvomerezeka kwa impso kwa ramiprilat kumadalira QC. Izi zimabweretsa kuwonjezeka kwa plasma woipa wa ramiprilat, womwe umachepetsa pang'onopang'ono kuposa odwala omwe ali ndi vuto laimpso.

Odwala chiwindi ntchito, kutembenuka kwa kagayidwe ka ramipril kukhala ramiprilat kumachepa chifukwa cha kuchepa kwa ntchito ya hepatic esterases, ndipo kuchuluka kwa madzi a ramipril mwa odwala kumawonjezereka. C_max ramiprilata mwa odwala, Komabe, sasiyana ndi omwe ali ndi odwala omwe ali ndi chiwindi chokwanira.

Zogulitsa ndi kugawa

Pambuyo pakukonzekera pakamwa, amlodipine imatengeka pang'onopang'ono kuchokera m'mimba. C_max mu seramu umawonedwa pambuyo maola 6-12. Kudya sikukhudza bioavailability wa amlodipine. Mtheradi bioavailability ndi 64-80%.

V_d zimapangitsa 21 l / kg ya thupi. C_ss mu madzi am'magazi (5-15 ng / ml) zimatheka pambuyo masiku 7-8 ogwiritsa ntchito mankhwalawa tsiku lililonse. Kafukufuku wa in vitro awonetsa kuti 93-98% ya amlodipine yozungulira m'magazi imamangiriza mapuloteni a plasma.

Kutetemera ndi chimbudzi

Amlodipine imapangidwa mofulumira (pafupifupi 90%) m'chiwindi kuti apange metabolites osagwira.

Pafupifupi 10% ya phula loyambira ndi 60% yama metabolites osagwira amatsitsidwa mkodzo, 20-25% ndi ndowe. Kutsika kwa plasma ndende ndi biphasic. Kuchotsa komaliza T_1/2 kuchokera ku madzi am'magazi ndi pafupifupi 35-50 maola pamene amatengedwa 1 nthawi / Chilolezo chonse ndi 7 ml / min / kg (ndi thupi la wodwala 60 kg - 25 l / h).

Pharmacokinetics mu milandu yapadera yamankhwala

Ma pharmacokinetics a amlodipine satenga kusintha kwakukulu kwa kulephera kwa impso komanso kukula kwa odwala.

Nthawi yoti mufikire C_max amlodipine mu plasma mwa okalamba ndi achinyamata odwala ndi omwewo. At odwala okalamba chilolezo chonse cha amlodipine ndi 19 l / h. Chilolezo cha Amlodipine nthawi zambiri chimachepetsa ndikukula kwa AUC ndi T_1/2mwa okalamba.

AUC ndi T akuwonjezeka_1/2 Odwala omwe mtima wawo uli ndi vuto lodzikongoletsa anali chimodzimodzi ndi odwala okalamba.

Amlodipine imapangidwa kwambiri kuti apange ma metabolites osagwira. 10% yazomwe zimayambira zimapukusidwa mu mkodzo. Zosintha mu plasma wozungulira amlodipine sizigwirizana ndi digirii kulephera kwa aimpso. Odwala otere amatha kumwa Mlingo wa amlodipine nthawi zonse. Kujambula kwa amlodipine sikugwira ntchito.

T_1/2 amlodipine odwala chiwindi ntchito kutalika.

Contraindication

kukhalapo kwa mbiri ya angioedema (cholowa, idiopathic, kapena angioedema wam'mbuyomu chifukwa cha ntchito ya ACE inhibitors kapena angiotensin II receptor antagonists),

- chithandizo chakumwa kunja, limodzi ndi kukhudzana ndi magazi okhala ndi mawonekedwe oyipa,

- akuti aimpso mtsempha wamagazi wamanjenje kapena a impso a stenosis a impso yokhayo,

- hypotension kapena hemodynamically wosakhazikika boma (ramipril sayenera kutumizidwa),

- mawonekedwe oopsa a hypotension,

- mantha (kuphatikizapo Cardiogenic),

- Kuchepetsa mitsempha ya magazi, kuteteza kutuluka kwa magazi kuchokera kumanzere kwamitsempha (mwachitsanzo, kukokomeza kwakukulu kwa aortic),

- hemodynamically kusakhazikika kwa mtima pambuyo pachimake khunyu wamtima,

- Hypersensitivity to ramipril (kapena ACE inhibitors), amlodipine, zotumphukira zochokera m'zakudya, komanso / kapena ena mwa omwe amapereka mankhwala.

Mimba komanso kuyamwa

Dongosolo la epidemiological lomwe likuwonetsa chiopsezo cha teratogenicity pambuyo povumbulutsidwa ndi ma inhibitors a ACE panthawi yoyamba ya kubereka sakukhutiritsa, koma kuwonjezeka pang'ono pangozi imeneyi sikungadziwike.

Kuwonetsedwa kwa ma inhibitors a ACE panthawi yachiwiri komanso yachitatu yamatenda oyembekezera kumadziwika kuti kumapangitsa kuti mwana akhale ndi chiberekero (chitukuko cha impso za mwana wosabadwayo, oligohydramnios, kuchepa kwa khungu la chifuwa) ndi neonatal poizoni (kulephera kwa impso, hyperkalemia). Ngati kukhudzana ndi ACE zoletsa kumachitika nthawi yachiwiri ya kubereka, tikulimbikitsidwa kuti tichite ntchito ya impso ndi kukula kwamafupa. Makanda obadwa kumene omwe amayi awo adatenga zoletsa za ACE ayenera kuyang'aniridwa bwino kuti athe kukhala ndi hypotension, oliguria ndi hyperkalemia.

Popeza palibe chidziwitso chokwanira pakugwiritsidwa ntchito kwa ramipril ndi amlodipine panthawi yotsekera, kugwiritsa ntchito panthawiyi ndikotsutsana, ndipo ndikofunikira kusankha njira zina zamankhwala zomwe zili ndi mbiri yayikulu yachitetezo, makamaka panthawi yotseka.

Mlingo ndi makonzedwe

Mankhwalawa ayenera kugwiritsidwa ntchito mosamalitsa monga adanenera dokotala.

Hartil ® Amlo ayenera kumwedwa nthawi yomweyo, tsiku lililonse munthawi ya chithandizo, musanadye komanso mutadya. Osaphwanya kapena kutafuna makapisozi.

Mlingo wovomerezeka tsiku lililonse ndi 1 kapisozi ya mlingo wina.

Mankhwala osakanikirana ndi mulingo woyenera sayenera gawo loyambirira la mankhwala.

Ngati pakufunika kusintha kwa mlingo, mlingo wa mankhwalawo Hartil ® Amlo ungasinthidwe kapena Mlingo wa zomwe munthu akuchita payokha akhoza kusinthidwanso ndi kuphatikiza kwawo kwaulere.

Ndikulimbikitsidwa kupereka mankhwala mosamala. odwala akutenga okodzetsa, popeza mwa odwalawa kuphwanya kwamagetsi kosakanikirana kwamadzi kumachitika. Ndikofunikira kuphunzira ntchito yaimpso ndikuwona mulingo wa potaziyamu mu seramu yamagazi.

Gwiritsani ntchito Odwala omwe ali ndi vuto la chiwindi

Odwala ndi mkhutu chiwindi ntchito, mankhwalawa ramipril ziyenera kuyamba kokha moyang'aniridwa ndi achipatala, ndi mlingo wambiri watsiku ndi tsiku wa 2,5 mg.

Mapiritsi a Hartil ® Amlo okhala ndi 2.5 mg ya ramipril + 2,5 mg wa amlodipine akulimbikitsidwa kwa odwala omwe asamutsidwa kuti amwe mankhwala a 2,5 mg wa a ramipril, ngati mlingo woyenera kwambiri posankha mlingo wa ramipril.

Pankhani ya kufooka kwa chiwindi, nthawi ya kuchotsa amlodipine zitha kuchuluka. Palibe malingaliro enieni a dosing okhudza amlodipine, chifukwa chake, mankhwalawa ayenera kudwala mosamala kwambiri.

Gwiritsani ntchito odwala ndi mkhutu aimpso ntchito

Kuti mupeze kuphatikiza bwino koyambirira ndi kukonzanso Mlingo wa odwala omwe ali ndi vuto laimpso, Mlingo wa mankhwalawa umasankhidwa payekhapayekha kudziwa Mlingo wa ramipril ndi amlodipine.

Tsiku lililonse ramipril odwala ndi aimpso kulephera, ayenera kukhazikitsidwa kuganizira QC:

- odwala CC ≥ 60 ml / min, kusintha koyamba kwa mankhwala sikofunikira, mlingo waukulu watsiku ndi tsiku ndi 10 mg,

- mwa odwala KK ® Amlo tikulimbikitsidwa kuti tizingolemba pokhapokha ngati wodwala watumizidwa ku mtundu wa ramipril wa 2,5 mg kapena 5 mg ngati mlingo woyenera wokwanira (womwe unakhazikitsidwa nthawi ya ramipril dosing). Odwala akudwala hemodialysis ayenera kumwa mankhwala patatha maola angapo kuchokera hemodialysis.

Palibe kusintha kwa mlingo womwe ukufunika amlodipine odwala ndi mkhutu aimpso ntchito.

Amlodipine samachotsedwanso panthawiyi. Odwala omwe akupita dialysis, amlodipine ayenera kuikidwa mosamala kwambiri.

Pa chithandizo ndi Hartil ® Amlo, kuyang'anira mphamvu ya impso komanso zomwe zili potaziyamu mu seramu yamagazi ndizofunikira. Ngati kuwonongeka kwa impso, kugwiritsidwa ntchito kwa mankhwala Hartil ® Amlo kuyenera kusiyidwa, ndipo zigawo zake ziyenera kufotokozedwa mu Mlingo womwe umasinthidwa moyenera.

Gwiritsani ntchito odwala okalamba

Mlingo woyambirira wa ramipril uyenera kukhala wotsika kuposa masiku onse, ndipo kusintha kwa mlingo wotsatira uyenera kukhala wofatsa, chifukwa cha chiwopsezo chachikulu cha mavuto. Sikulimbikitsidwa kusankha Hartil ® Amlo kukhala odwala okalamba kwambiri komanso ofooka.

Odwala okalamba amatha kumwa mwachizolowezi amlodipine, komabe, kusamala kuyenera kutengedwa kuti muwonjezere mlingo wa mankhwalawa.

Gwiritsani ntchito ana ndi achinyamata ochepera zaka 18

Sikulimbikitsidwa kupereka Hartil ® Amlo kwa ana ndi achinyamata osakwana zaka 18, popeza chitetezo ndi kugwiritsa ntchito mankhwalawa m'gulu la odwala sikunakhazikitsidwe.

Bongo

Zizindikiro kutengera kuchuluka kwa mankhwala osokoneza bongo osokoneza bongo (vasodilation ochuluka) (okhala ndi vuto lalikulu kwambiri komanso chithunzi chodabwitsa), bradycardia, electrolyte kusalingani, komanso kulephera kwa aimpso kungachitike.

Chithandizo: Wodwala ayenera kuyang'aniridwa pafupipafupi, ndipo chithandizo chamankhwala chiyenera kukhala chothandizira komanso chothandizira. Njira zomwe akuyembekezerazi zimaphatikizapo detoxization yoyamba (chapamimba cham'mimba, kudya kwa adsorbent) komanso njira zobwezeretsanso magawo a hemodynamic, kuphatikiza ntchito za alpha₁-adrenomimetics kapena angiotensin II (angiotensinamide). Ramiprilat samachotsedwa bwino ndi hemodialysis kuchokera kumagazi ambiri. Pankhani ya kukokomeza kwamankhwala komwe kumachitika chifukwa cha kuchuluka kwa amlodipine, wodwalayo ayenera kupatsidwa mpata woyang'ana ndi miyendo, ndikuwonetsetsa kuti ntchito ya mtima ndi kupuma kwamphamvu, BCC komanso kuchuluka kwa mkodzo wambiri. Popanda contraindication, ndizotheka kugwiritsa ntchito (mosamala) vasoconstrictors kubwezeretsa kamvekedwe ka mtima ndi kuthamanga kwa magazi. Mu / pakubweretsa calcium gluconate ingakhale yothandiza kuthetsa kufalikira kwa njira za calcium. Nthawi zina, kutsuka kwa m'mimba kumatha kukhala kopindulitsa. Pakafukufuku wokhudza odzipereka athanzi labwino, zidawonetsedwa kuti kugwiritsa ntchito kaboni yokhoma mkati mwa maola awiri mutatenga 10 mg ya amlodipine kunachepetsa mayamwidwe ake. Popeza amlodipine amagwirizana kwambiri ndi mapuloteni, hemodialysis siyothandiza.

Kuchita ndi mankhwala ena

Hartil ® Amlo sayenera kuphatikizidwa ndi njira zina zakunja zomwe zimakhudzana ndi magazi mosavomerezeka, monga hemodialysis kudzera m'mitsempha yolowera kwambiri (mwachitsanzo, michere yopangidwa kuchokera kuphatikiza kwa polyacrylonitrile), hemofiltration kapena apheresis ya lowensensens lipoproteins pogwiritsa ntchito dextran sulfate, chifukwa chowonjezeka chiopsezo chokhala ndi anaphylactic kapena anaphylactoid zimachitika. Ngati chithandizo choterocho nchofunikira, ndiye kuti kugwiritsa ntchito mitundu ina ya ulalo wamtundu wa dialysis kapena antihypertensive mankhwala ena ayenera kuganiziridwanso.

Ndi munthawi yomweyo makonzedwe a potaziyamu, potaziyamu wambiri okodzetsa komanso zinthu zina zomwe zimapangitsa kuchuluka kwa plasma potaziyamu (kuphatikiza ndi angiotensin II receptor antagonists, trimethoprim, tacrolimus, cyclosporine), hyperkalemia ikhoza kukhazikitsidwa, motero, ndikofunikira kuyang'anira kuchuluka kwa seramu potaziyamu.

Mukamamwa pamodzi ndi antihypertensive mankhwala (mwachitsanzo, okodzetsa) ndi zinthu zina zomwe zimachepetsa kuthamanga kwa magazi (mwachitsanzo, nitrate, antidepressants, trgesclic antidepressants, analgesics, ethanol, baclofen, alfuzosin, doxazosin, prazosin, tamsulosin, terazosin chiopsezo), ndizotheka.

Ndi munthawi yomweyo makonzedwe a vasopressor sympathomimetics ndi mankhwala ena (mwachitsanzo, isoproterenol, dobutamine, dopamine, adrenaline), mphamvu ya antihypertensive ya ramipril imatha kuchepa, chifukwa chake, kuyang'anira magazi kumalimbikitsa.

Ndi munthawi yomweyo makonzedwe a allopurinol, immunosuppressants, corticosteroids, procainamide, cytostatics ndi mankhwala ena omwe amatha kusintha kuchuluka kwa maselo amwazi, mwayi wokhala ndi kusintha kwa hematological ukuwonjezeka.

Ndi makonzedwe omwewo a ACE zoletsa okhala ndi kukonzekera kwa lithiamu, ndizotheka kuchepa kwake, motero, kuwonjezera kuchuluka kwa lithiamu m'magazi ndikuwonjezereka kwa kawopsedwe ake. Kuwunikira pafupipafupi kwamiyezo ya lithiamu kumafunika.

Mukutenga ndi othandizira odwala matenda a shuga (kuphatikiza insulin) amatha kukhala ndi vuto la hypoglycemic. Ndikulimbikitsidwa kutsimikiza mosamala kuchuluka kwa shuga m'magazi.

Mukutenga NSAIDs (kuphatikizapo acetylsalicylic acid) itha kuchepetsa mphamvu ya antihypertensive ya ramipril. Kuphatikiza apo, kugwiritsidwa ntchito kophatikizana kwa ACE inhibitors ndi NSAIDs kungayambitse kukula kwa hyperkalemia ndikuchulukitsa chiopsezo cha vuto laimpso.

Mankhwalawa amagwirizana ndi thiazide okodzetsa, ma beta-blockers, omasulidwa a nthawi yayitali, mitundu yofanana ya nitroglycerin, NSAIDs, maantibayotiki, komanso mankhwala amkamwa a hypoglycemic.

Mukumwa mankhwalawo ndi CYP3A4 inhibitor erythromycin mwa odwala achinyamata diltiazem mu okalamba odwala, plasma ndende ya amlodipine ukuwonjezeka ndi 22% ndi 50%, motero. Komabe, momwe matendawo amafananira ndi izi sizikudziwika bwinobwino. Sizingatengedwe kuti mphamvu zamtundu wa CYP3A4 zoletsa (mwachitsanzo, ketoconazole, itraconazole, ritonavir) zitha kukulitsa kuchuluka kwa plasma kwa amlodipine pamlingo wokulirapo kuposa diltiazem. Amlodipine akuyenera kugwiritsidwa ntchito mosamala mukamathandizana ndi CYP3A4 inhibitors. Komabe, palibe malipoti azotsatira zoyipa zilizonse zomwe zimagwirizanitsidwa ndi kuyanjana uku.

Zolozera CYP3A4: Zambiri pa zotsatira za CYP3A4 inducers pa amlodipine sizipezeka. Kugwiritsa ntchito mankhwalawa ndi CYP3A4 inducers (mwachitsanzo, rifampicin kapena St. wort perforated) kungachepetse ndende ya plasma ya amlodipine. Amlodipine ayenera kugwiritsidwa ntchito mosamala akamagwiritsa ntchito limodzi ndi CYP3A4 inducers.

M'maphunziro azachipatala omwe amachitika ndi mankhwala, kugwiritsa ntchito pamodzi kwa amlodipine ndi madzi a mphesa, cimetidine, aluminium / magnesium (antacids) ndi sildenafil sizinakhudze pharmacokinetics ya amlodipine.

Kugwiritsa ntchito munthawi yomweyo amlodipine ndi othandizira ena othandizira kupititsa patsogolo ntchito kumathandizira kuwongolera.

M'maphunziro azachipatala omwe amachitika ndi mankhwala osokoneza bongo, amlodipine sizinakhudze pharmacokinetics ya hugeatin, digoxin, ethanol (ethanol), warfarin, kapena cyclosporine.

Zotsatira za amlodipine pakusintha kwa mayeso a labotale sizinakhazikitsidwe.

Kutulutsa mawonekedwe ndi kapangidwe kake

Mankhwala Hartil amapezeka mu mawonekedwe a mapiritsi a pakamwa makonzedwe a kuwala lalanje, chowulungika, lathyathyathya. Mapiritsi amaikidwa m'matumba a zidutswa 7 (1-4) pabokosi lamakatoni, malangizo atsatanetsatane ofotokozera ali ndi mankhwalawa.

Piritsi lililonse lili ndi 5 mg kapena 10 mg ya mankhwala othandizira a Ramipril, komanso magawo ena othandiza, kuphatikizapo lactose monohydrate.

Ndipatseni mapiritsi 2.5 mg + 12,5 mg, 5 mg + 25 mg Hartil D ndi diuretic hydrochlorothiazide. Kuphatikizikako kumaphatikizapo ramipril, hydrochlorothiazide ndi maipi (Hartil D).

Kutulutsa mafomu ndi kapangidwe kake

Mankhwala amapezeka mu mawonekedwe a gelatin makapisozi a 5 mg ndi 10 mg yogwira mtima pophika. Zomwe zimagwiritsidwa ntchito ndi ramipril (Ramiprilum). Awa ndi mankhwala omwe ali oyera ufa osungunuka mumayankho a buffer ndi ma organic sol sol. Omwe amathandizira - amlodipine, microcellulose, crospovidone, hypromellose.

Zizindikiro zogwiritsidwa ntchito

Makapisozi ali ndi mawonekedwe osiyanasiyana a ramipril ndipo amawonetsedwa molingana ndi izi:

ochepa matenda oopsa - vuto la kuthamanga kwa magazi,
mitral valve prolapse,
ntchito hyperthermia yoyipa kuti athetse vuto,
kulephera kwa mtima, komwe ntchito ya thupi yonse imasokonezeka chifukwa cha kusakwanira kwa magazi ndi kuchuluka kwa mpweya wa ziwalo ndi machitidwe,
angina pectoris, ischemia,
Zotsatira za kulowetsedwa kwa myocardial, kuti mupewe kuchitika kwachiwiri ndikuchepetsa katundu pa minofu ya mtima,
kupewa matenda a mtima.

Matumbo

Stomatitis, nseru, kusanza, kutentha kwa mtima, kapamba, matumbo edema, matenda am'mimba, kupweteka m'matumbo ndi kapamba, kunachepetsa chilimbikitso.

Kuchokera m'mimba, Hartil amatha kuyambitsa nseru.

Zokhudza mphamvu pakuwongolera njira

Mankhwala amatha kukhudza chapakati mantha dongosolo, chifukwa kugona, kuchepetsa ndende. Pankhaniyi, muyenera kukhala kuti mulibe ntchito pa zida zamagetsi kapena magalimoto oyendetsa.

Hartil Amlo angakhudze luso lanu kuyendetsa galimoto.

Gwiritsani ntchito pa nthawi yoyembekezera komanso mkaka wa m`mawere

Mu II ndi III trimester, mankhwalawa saloledwa kumwa. Mukakhala trimester yoyamba, mutha kugwiritsa ntchito Hartil pokhapokha mwadzidzidzi. Mukamachiritsa munthawi ya mkaka wa m'mawere, tikulimbikitsidwa kusinthana ndi kudya kwachilendo.

Kwa ana ochepera zaka 15, kumwa mankhwalawo ndizoletsedwa, chifukwa maphunziro sanachitike.

Kuchita ndi mankhwala ena

Ndi munthawi yomweyo makonzedwe a okodzetsa ndi mankhwala ena oopsa, kuchepa kwambiri kwa magazi kumatheka.

Ngati muphatikiza mankhwala a antihypertensive ndi mankhwala omwe si a anti -idalidal anti-yotupa, zotsatira zake zimachepetsedwa, ndipo palibe phindu lililonse la mankhwalawo.

Mukamamwa mankhwala a lithiamu omwe ali ndi Hartil, kuchuluka kwa maamuamu m'magazi kumawonjezeka.

Sitikulimbikitsidwa kugwiritsa ntchito limodzi ndi ndalama zomwe zili ndi potaziyamu pakukonzekera, kuti musapitirire kuchuluka kwa potaziyamu m'thupi.

Ngati makapisozi pazifukwa zina sangatengedwe, mutha kusintha m'malo mwa mankhwalawa aku Hungary, America kapena Russian ofanana:

kutengera ndi ramipril ndi amlodipine: makapisozi Bi-Ramag, Sumilar, Tritace-A,
kutengera amlodipine ndi lisinopril: mapiritsi a Amapil-L, Amlipin, Equator,
kutengera perindopril: Amlessa, Bi-Prestarium, Viacoram,
kutengera lercanidipine ndi enalapril: Coriprene, Lerkamen, Enap L Combi.

Analogue ya mankhwala Harty Amlo ndi Amlessa. Analogue ya mankhwala Hartil Amlo ndi Coripren.Analogue ya mankhwala Hartil Amlo ndi Lerkamen.

Akatswiri salimbikitsa kuti asinthe mankhwalawo pawokha, kuti musavulaze thanzi. Musanalowe m'malo ndikofunikira kukaonana ndi dokotala.

Omvera zamtima

Alexander Ivanovich, Moscow

Mankhwala ndi imodzi mwothandiza kwambiri pochiza komanso kupewa matenda a mtima komanso kubwezeretsa magazi. Ngati palibe contraindication, ine nthawi zonse ndimapereka kuti tipewe kubwerezabwereza myocardial infarction ndi stroke.

Malangizo ogwiritsira ntchito Hartil-Amlo Omwe mapiritsi azovuta ndi abwino kwambiri

Tamara Nikolaevna, wazaka 70, Krasnodar

Ine ndi mwamuna wanga tonse timavutika ndi mtima. Kwa zaka zingapo, takhala tikumwa maphunziro a Hartil kawiri pachaka limodzi. Mankhwala ndi othandizadi, samayambitsa mavuto, amachepetsa kuthamanga kwa magazi, amachepetsa mutu, kutupa. Mtima umagwira popanda kusokonekera, timamverera zaka 20.

Mapiritsi a Hartil

Amatengedwa pakamwa popanda kutafuna, kutsukidwa ndi madzi ambiri (pafupifupi kapu imodzi), osasamala nthawi yakudya.

Mlingo uyenera kukhazikitsidwa kwa wodwala aliyense payekhapayekha, poganizira chithandizo ndi kulekerera. Mapiritsi amatha kugawanika pakati, kuswa pachiwopsezo.

Kulephera kwamtima kosalekeza. Mlingo woyambira wopendekera ndi 1.25 mg kamodzi tsiku lililonse (piritsi 1 la Hartil 2.5 mg tsiku lililonse). Kutengera kuthekera kwa chithandiziro, mlingo umatha kuchulukitsidwa pochulukitsa kawiri tsiku lililonse masabata awiri ndi atatu. Ngati mukufuna kumwa mankhwala opitirira 2.5 mg, mankhwalawa atha kumwa mankhwalawa kapenanso kugawidwa mu 2 waukulu. Pazipita tsiku mlingo sayenera upambana 10 mg.
Matenda oopsa. Mlingo woyambira wothandiza ndi 2.5 mg kamodzi tsiku lililonse (piritsi limodzi la Hartil 2.5 mg tsiku lililonse). Kutengera kuthekera kwa chithandiziro, mlingo umatha kuchulukitsidwa pochulukitsa kawiri tsiku lililonse masabata awiri ndi atatu. Mulingo wokhazikika wokonza ndi 2.5-5 mg patsiku (piritsi limodzi la Hartil 2.5 mg kapena piritsi limodzi la 5 mg). Pazipita tsiku mlingo sayenera upambana 10 mg.
Kupewa infarction ya myocardial, stroko, kapena kufa chifukwa cha matenda amtima. Mlingo woyambira wothandiza ndi 2.5 mg kamodzi tsiku lililonse. Kutengera kulekerera kwa mankhwalawa, pambuyo pa sabata 1 yotsata, mlingo uyenera kuwonjezeredwa kawiri kuyerekeza ndi koyambirira. Mlingo uwu uyenera kubwerezedwanso pambuyo pa milungu itatu ya makonzedwe. Mulingo woyenera wokonzedwa ndi 10 mg kamodzi tsiku lililonse.
Osati matenda ashuga kapena matenda ashuga nephropathy. Mlingo woyambirira wovomerezeka ndi 1.25 mg kamodzi tsiku lililonse (piritsi limodzi la 2/2 la Hartil 2.5 mg tsiku lililonse). Kutengera kuthekera kwa chithandiziro, mlingo umatha kuchulukitsidwa pochulukitsa kawiri tsiku lililonse masabata awiri ndi atatu. Ngati mukufuna kumwa mankhwala opitirira 2.5 mg, mankhwalawa atha kumwa mankhwalawa kapenanso kugawidwa pawiri. Mlingo woyenera tsiku lililonse ndi 5 mg.
Chithandizo pambuyo myocardial infarction. Ndi bwino kuyamba kumwa mankhwalawa tsiku la 3-10 patatha kulowetsedwa kwachimake. Mlingo woyambirira wotsimikizika, kutengera momwe wodwalayo alili ndi nthawi yomwe adadutsa pambuyo poti wapezeka m'matumbo amodzi, ndi 2.5 mg kawiri pa tsiku (piritsi limodzi la Hartil 2.5 mg 2 kawiri pa tsiku). Kutengera ndi mankhwalawa, mlingo woyambira ukhoza kuchulukitsidwa mpaka 5 mg (mapiritsi 2 a Hartil 2,5 mg kapena piritsi limodzi la Hartil 5 mg) kawiri pa tsiku. Pazipita tsiku mlingo sayenera upambana 10 mg. Mosalolera mankhwala, mlingo uyenera kuchepetsedwa.

Magulu apadera a odwala

Odwala okalamba. Kugwiritsidwa ntchito kwa ramipril mu odwala okalamba omwe amathandizira okodzetsa ndi / kapena kulephera kwa mtima, komanso kuwonongeka kwa chiwindi kapena impso, kumafunikira chisamaliro chapadera. Mlingo uyenera kukhazikitsidwa ndi kusankha kwa mankhwalawa malinga ndi momwe mankhwalawo amvera.

Kuwonongeka kwa chiwindi. Mu vuto la chiwindi ntchito, kuchepetsedwa kapena kuwonjezeka kwa kugwiritsa ntchito mankhwalawa Hartil kumawonedwa mofananamo, chifukwa chake magawo oyambira, odwala omwe ali ndi vuto la chiwindi amafunikira kuyang'aniridwa mosamala. Mlingo wambiri watsiku ndi tsiku pazinthu zoterezi sayenera kupitilira 2.5 mg.

Odwala omwe amalandila mankhwala okodzetsa, chifukwa chakuchepa kwambiri kwa kuthamanga kwa magazi, kuthekera kwa kuchepetsedwa kwakanthawi kapena kuchepa kwa kuchuluka kwa okodzetsa kuyenera kuganiziridwa osachepera masiku atatu kapena atatu, kutengera nthawi yomwe ma diuretics asanafike pa mankhwala Hartil. Kwa odwala omwe kale amathandizidwa ndi okodzetsa, nthawi zambiri mlingo woyambira ndi 1.25 mg.

Zotsatira zoyipa

Ndemanga zamankhwala za Hartil zimawerengera za zovuta zina. Mndandanda wawo ndiwowonjezera ndipo amafunikira kuti awerenge mwatsatanetsatane. Ndikulimbikitsidwa kuti mudziwe bwino za zovuta zoyambira musanamwe mankhwala:

urticaria, kuyabwa, zotupa pakhungu, conjunctivitis,
kudya kwakachepa, nseru, kudzimbidwa / kutsekula m'mimba, kapamba, pakamwa pouma, kusanza,
zopweteka, Hyperthermia, alopecia, thukuta,
Hyperkalemia, hypercreatininemia, kuchuluka kwa hepatic transaminases ndi urea nayitrogeni, hyponatremia,
thrombocytopenia, kuchepa magazi, kuchepa kwa hematocrit ndi hemoglobin, thrombocytopenia, neutropenia, leukocytopenia, agranulocytosis, hemolytic anemia, pancytopenia,
kufooka, kupweteka mutu, kugona, mantha amkati, kunjenjemera, kusokonezeka kwa mitsempha, nkhawa, kupsinjika kwa minofu, kusokonezeka kwa kuzindikira (kununkhiza, kumva, kulawa, masomphenya) ndi zovuta zam'mimba.
kuchuluka kwa proteinuria, kulephera kwa impso, kutsika libido, kuchepa mkodzo,
orthostatic hypotension, kuchepa kwa magazi. Nthawi zina - arrhythmia, maonekedwe a kuzungulira kwa ziwalo, myocardial ischemia ndi ubongo,
kufupika kwa mpweya, bronchospasm, rhinorrhea, sinusitis, rhinitis, bronchitis, chifuwa chowuma.

Kugwiritsa ntchito Hartil pa nthawi ya pakati kumatha kubweretsa zovuta pa mwana wosabadwayo: kuyanʻanila kosiyanasiyana kwa chitukuko ndi ntchito ya impso, kutsika kwa magazi kwa mwana, hypoplasia yamapapu ndi chigaza, mgwirizano wamanja, ndi kupindika kwa chigaza.

Maholide ndi mtengo

Mtengo wapakati wa Hartil (mapiritsi a 5 mg, zidutswa 28) ku Moscow ndi ma ruble 400. Mankhwala amaperekedwa ku pharmacies mwa mankhwala.

Kutentha kwambiri kwa mankhwalawa ndi 25 madigiri. Moyo wa alumali wa mapiritsi akuwonetsedwa phukusi ndipo ndi zaka 4 kuyambira tsiku lopangidwa. Hartil amalimbikitsa kugwiritsa ntchito mapiritsi kuti asungidwe m'malo osavomerezeka ndi ana, kutali ndi dzuwa.

Kupanga ndi mawonekedwe a kumasulidwa

Hartil amapezeka piritsi. Mankhwalawa amadzaza m'matumba a mapiritsi 7. Bokosi la makatoni limatha kukhala ndi zigawo 14 ndi 28 za fomu.

Zomwe zimagwira ndi ramipril.

Mapiritsi 1.25 mg, 2.5 mg, 5 mg ndi 10 mg (Hartil).

Mapiritsi a 5 mg: pinki yopepuka yokhala ndi tint ya malalanje, chowulungika, chopindika ndi mzere wogawa, chamfer ndikulemba "R3" mbali imodzi.

Mapiritsi a 10 mg: oyera kapena pafupifupi oyera ovunda, osyanjika ndi mzere wogawa, chamfer ndikulemba "R4" mbali imodzi.

Mapiritsi a Hartil D ndi diuretic hydrochlorothiazide 2,5 mg + 12,5 mg, 5 mg + 25 mg.
Hartil Amlo Ramipril. Mulinso ndi amlodipine wowonjezera. Gawani ndi kukwera kwa magazi ngati mutenga zosakaniza (aliyense payekhapayekha kapena palimodzi) zimapereka zabwino.

Kodi chimathandiza Hartil ndi chiyani?

Zizindikiro zakugwiritsa ntchito chida ichi ndi motere:

kulephera kwa mtima pambuyo pathupi kwamatumbo amawonongeka ndi hemodynamics yokhazikika,
kulephera kwa mtima
ochepa matenda oopsa
matenda ashuga nephropathy,
matenda osokoneza bongo a impso,
kufunikira kuchepetsa chiopsezo cha kulowerera m'mitsempha, "kufa kwa coronary" mwa anthu omwe ali ndi matenda amitsempha yamagazi,
Kufunika kochepetsera chiopsezo cha matenda a sitiroko.

Ndi ochepa matenda oopsa, Hartil Amlo angagwiritsidwenso ntchito, ngati musintha mankhwalawa, kuthamanga kwa magazi kumayendetsedwa ndikugwiritsidwa ntchito munthawi yomweyo ndi ramipril ndi amlodipine pazomwezo monga mankhwala.

Zofunika! Dokotala ayenera kusankha pakufunikira kwa maphunziro a pharmacotherapy. Kudzichitira nokha mankhwala ndikosavomerezeka.

Malangizo ogwiritsira ntchito

Mlingo wa mankhwala Hartil amakhazikitsidwa ndi adokotala mosasamala. Mankhwalawa ochepa matenda oopsa amayamba ndi osachepera ogwira mlingo - 2,5 mg kamodzi patsiku.

Ndi osakwanira achire zotsatira kapena kuchepa mphamvu, mlingo akhoza kuchuluka osapitiliza 1 pa sabata ndi 2.5 mg, pazipita tsiku lililonse kwa munthu wamkulu ndi 10 mg. Ngati mulingo wokwanira sangachepetse kuthamanga kwa magazi kukhala amtundu wabwinobwino, ndiye kuti mapiritsi a Hartil amawonetsedwa monga gawo la zovuta za mankhwala ndi antihypertensive othandizira ena.

Ngati ndi kotheka, odwala ayenera kupatsidwa muyeso wa 2,5-5 mg wa Hartil patsiku.

Mankhwalawa pambuyo zovuta pachaka matenda a mtima ayenera mankhwala kwa masiku atatu, woyamba mankhwalawa ndi 2,5 mg, mankhwala akutengedwa 2 pa tsiku, pazipita mlingo tsiku lililonse kwa munthu wamkulu 10 mg.

Zochizira matenda ashuga kapena osachiritsika nephropathy, Hartil mankhwala zotchulidwa mlingo wa 1,25 mg kamodzi patsiku. Kutalika kwa chithandizo ndi masabata atatu.

Poletsa kukula kwa kulowetsedwa kwa myocardial, odwala omwe ali ndi vuto la angina pectoris ndi zovuta zamagazi m'matumbo amapatsidwa mankhwala Hartil pa 2,5 mg kamodzi patsiku kwa masabata atatu, pambuyo pake, mankhwalawa amawonjezeredwa mpaka 5 mg patsiku komanso kupitilizabe kumwa kwa milungu itatu.

Odwala omwe ali ndi matenda a impso kapena matenda a mtima osakhazikika ayenera kusankha mlingo payekhapayekha, chithandizo ndi Hartil ndi mankhwala ochokera kwa 1.25 mg tsiku lililonse, ngati kuli kotheka komanso ndi kulolera kwawamba, pang'onopang'ono kuonjezera.

Zotsatira zamatsenga

Popeza mankhwalawa amaletsa kupanga ACE, zotsatira zake zowoneka kwambiri ndizochita hypotension, ndiye kuti, kuchepa kwa kukakamizidwa ndi zoposa 20% ya mtengo woyambirira. Potere, zomwe zimachitika ndizomwe zimakhala momwe ziliri kale zisanalandire, popanda kulipirira kutaya.

Popeza chimalepheretsa angiotensin, kupanga aldosterone kumachepetsedwa, komanso kuwonjezera ntchito mu plasma ya renin. Zotsatira za mankhwalawa sizimangopita ku ACE yomwe ili m'magazi, komanso kwa iwo omwe amapanga khoma la mtima komanso ziwalo zina zoyandikana.

Zina zama pharmacodynamic:

Kuletsa kwa aimpso njira yolumikizana ndi matenda a matenda ashuga - mwachitsanzo, microalbuminuria.
Kuchepetsa proteinuria ndikuwonjezera milingo ya creatinine, yomwe imayambitsa chitukuko cha impso.
Kuchepetsa minofu ya mtima, kuthandiza ndi matenda oopsa.
Kuwonongeka kwa bradykinin, komwe kumagwira m'mitsempha yamagazi, kumatulutsa uhule wa prostacyclin ndi nitrate oxide m'magazi.
Kupanikizika kwa mitsempha ya portal ngati matenda oopsa awonedwa.
Kuchepetsa zochitika za arrhythmias ngati wodwalayo adakhudzidwanso ndi myocardial reprfusion, chiopsezo chowonjezereka cha vuto la mtima chimapewedwa, magazi enieni amabwezeretsedwa.

Mikhalidwe yapadera

Chithandizo chikuchitidwa moyang'aniridwa ndi achipatala pafupipafupi.

Mutatenga mlingo woyamba wa Hartil, wodwalayo amayenera kuyang'aniridwa ndi dokotala kuti apewe kusachita bwino. Nthawi zonse kuyeza kwa magazi kumafunika.

Ramipril sayenera kufotokozedwa mpaka zitatengedwa kuti muchepetse kuthamanga kwa magazi komanso kuwonongeka kwa impso. Ngati ndi kotheka, kukonza kwam'madzi, hypovolemia, kuchepa kwa maselo ofiira am'magazi kumachitika musanamwe mankhwalawa. Ngati matendawa ndi oopsa, ramipril iyenera kuchedwa.

Odwala omwe ali ndi vuto la impso, kuwonongeka kwa impso, kuchepa kwa magazi, komanso odwala omwe ali ndi vuto la mtima komanso pambuyo pakupatsirana kwa impso, amafunikira kuwunika mosamala.

Kutengera komwe kumamwa mankhwalawa, kuchepa kwa sodium komanso kuchuluka kwa potaziyamu ndikotheka, komwe kumakhala kofala kwambiri ndi kuwonongeka kwa impso kapena mukamamwa ndi potaziyamu osagwiritsa ntchito diuretics.

Ngati kumwa mankhwalawa kumapangitsa kutsika kwakukulu, wodwalayo ayenera kuyikidwa pamalo okhala ndi miyendo yokwezeka, mankhwala othandizira, kuphatikizapo kuyambitsa madzimadzi, kungakhale kofunikira.

Ngati aimpso ntchito ndi matenda a concomitant matenda, pamene mukumwa mankhwala ena omwe amakhudza hematopoietic ndi chitetezo cha m'thupi, kusintha kwa magazi kumakhala kotheka.

Ndi munthawi yomweyo makonzedwe a okodzetsa, kuwunika pafupipafupi kuchuluka kwa sodium mu seramu yamagazi, komanso kuchuluka kwa leukocytes, ndikofunikira.

Odwala hemodialysis ntchito nembanemba wapamwamba hydraulic permeability ndi munthawi yomweyo makonzedwe ACE zoletsa, pangozi anaphylactoid zimachitika. Zomwezo zimawonedwa mwa odwala omwe akupezeka ndi LDL apheresis omwe amakhala ndi dextran sulfate.

ACE zoletsa sayenera kuperekedwa kwa odwala kulandira desensitizing chithandizo chifukwa choopsa kwambiri anaphylactoid zimachitika.

Tiyenera kukumbukira kuti mapiritsi a Hartil omwe ali ndi mphamvu yogwira ntchito ya 5 mg akuphatikizapo 96.47 mg wa lactose, 10 mg - 193.2 mg.

Zochitika ndi ramipril mwa ana omwe ali ndi vuto lalikulu laimpso komanso nthawi ya dialysis ndizochepa.

Zimayambitsa kuchepa kwa kuthamanga kwa magazi, zomwe zingakhudze kuthekera kwambiri. Pankhani imeneyi, kuyendetsa galimoto ndi kuchita zinthu zomwe sizingachitike bwino sikulimbikitsidwa.