Telmista 40 mg - malangizo ogwiritsira ntchito

Telmista 40 mg - mankhwala a antihypertensive, angiotensin II receptor antagonist (mtundu wa AT1).

Piritsi 1 40 mg:

Zogwira pophika: Telmisartan 40.00 mg

Omwe amathandizira: meglumine, sodium hydroxide, povidone-KZO, lactose monohydrate, sorbitol (E420), magnesium stearate.

Oval, mapiritsi a biconvex a zoyera kapena pafupifupi zoyera.

Mankhwala

Telmisartan ndi angiotensin II receptor antagonist (ARA II) (mtundu wa AT1), wogwira ntchito mukamamwa. Ili ndi kuyanjana kwakukulu kwa AS1 subtype ya angiotensin II receptors, kudzera momwe zochita za angiotensin II zimadziwika. Kuyika angiotensin II kulumikizana ndi cholandilira, osakhala ndi zochita za agonist mokhudzana ndi cholandilira ichi. Telmisartan imamangiriza kokha ku AT1 subtype ya angiotensin II receptors. Kulankhulana kumatenga nthawi yayitali. Ilibe chiyanjano ndi ma receptor ena, kuphatikizapo AT2 receptors ndi zina zochepa zomwe amaphunzira angiotensin receptors. Kufunikira kwa magwiritsidwe awa a ma receptor, komanso momwe mphamvu zawo zimakhudzira kwambiri ndi angiotensin II, kugwiritsidwa ntchito kwa zomwe zimawonjezeka ndi telmisartan, sikunaphunzire. Amachepetsa ndende ya aldosterone m'madzi am'magazi, samalepheretsa renin m'magazi am'magazi komanso ns block ma ion. Telmisartan sichimalepheretsa angiotensin kutembenuza enzyme (ACE) (kininase II) (enzyme yomwe imawononganso bradykinin). Chifukwa chake, kuwonjezeka kwa zoyipa zoyambitsidwa ndi bradykinin sikuyembekezeredwa.

Odwala, telmisartan pa mlingo wa 80 mg kwathunthu limalepheretsa hypertensive zotsatira za angiotensin II. Kukhazikika kwa antihypertensive kanthu kumadziwika mkati mwa maola atatu itatha konzedwe ka telmisartan. Mphamvu ya mankhwalawa imapitilira maola 24 ndipo imakhalabe yofunikira mpaka maola 48. Ananena kuti antihypertensive zotsatira zimachitika pambuyo 4-8 milungu yochitika pafupipafupi telmisartan.

Odwala omwe ali ndi matenda oopsa, telmisartan lowers systolic and diastolic magazi (BP) osakhudza kugunda kwa mtima (HR).

Pankhani yakuchotsedwa kwadzidzidzi kwa telmisartan, kuthamanga kwa magazi pang'onopang'ono kumabwereranso ku gawo lake loyambirira popanda chitukuko cha "kusiya" matenda.

Pharmacokinetics

Ikamamwa pakamwa, imatengedwa mwachangu kuchokera m'matumbo am'mimba (GIT). Bioavailability ndi 50%. Kuchepa kwa AUC (dera lomwe lili pansi pa nthawi yokhazikika) ndi kugwiritsa ntchito munthawi yomweyo telmisartan yomwe imachokera ku 6% (pa 40 mg) mpaka 19% (pa mlingo wa 160 mg). Pakadutsa maola atatu atatha kumwa, ndende ya m'madzi am'magazi imayendetsedwa, ngakhale nthawi yakudya. Pali kusiyana pamaganizidwe a plasma mwa amuna ndi akazi. Kuchuluka kwa ndende (Cmax) mu madzi am'magazi ndi AUC mwa akazi poyerekeza ndi abambo kunali pafupifupi 3 ndi 2 nthawi, motero (popanda kuchitapo kanthu).

Kuyankhulana ndi mapuloteni am'madzi am'magazi - 99,5%, makamaka ndi albumin ndi alpha-1 glycoprotein.

Mtengo wapakati wamawonekedwe ogajirika m'ndende zofanana ndi 500 malita. Zimapangidwa ndi kuphatikizika ndi glucuronic acid. Ma metabolabolites ndi opanga ma pharmacologic. Hafu ya moyo (T1 / 2) ndi wopitilira maola 20. Amapukusidwa kudzera m'matumbo mu mawonekedwe osasinthika komanso impso - zosakwana 2% ya mlingo wotengedwa. Chilolezo chonse cha plasma ndi chachikulu (900 ml / min), koma kuyerekeza ndi magazi a "hepatic" (pafupifupi 1500 ml / min).

Kugwiritsa ntchito kwa ana

Zizindikiro zazikulu za pharmacokinetics za telmisartan mwa ana a zaka 6 mpaka 18 atatenga telmisartan pa mlingo wa 1 mg / kg kapena 2 mg / kg kwa masabata 4 nthawi zambiri amafanana ndi deta yomwe imapezeka mu chithandizo cha odwala akuluakulu ndikutsimikizira kusawonekera pharmacokinetics of telmisartan, makamaka pokhudzana ndi Cmax.

Contraindication

Zotsatira pa Telemista:

Hypersensitivity ku yogwira mankhwala kapena excipients ya mankhwala.
Mimba
Nthawi ya kuyamwitsa.
Matenda owopsa a m'mimba.
Zowopsa za hepatic kuwonongeka (Gulu Lopanda Ana).
Kugwiritsira ntchito limodzi ndi aliskiren kwa odwala omwe ali ndi matenda osokoneza bongo kapena ochepa kwambiri aimpso kulephera (glomerular filtration rate (GFR)

Zotsatira zoyipa

Milandu yomwe idawonedwako idakhudzana ndi chikhalidwe, zaka kapena mtundu wa odwala.

Matenda opatsirana komanso ma parasitic: sepsis, kuphatikizapo matenda oopsa a sepsis, matenda amkodzo thirakiti (kuphatikizapo cystitis), matenda opatsirana am'mimba kwambiri.
Kusokonezeka kwa magazi ndi dongosolo la lymphatic: kuchepa magazi, eosinophilia, thrombocytopenia.
Kusokonezeka kwa chitetezo chathupi: anaphylactic reaction, hypersensitivity (erythema, urticaria, angioedema), eczema, kuyabwa, zotupa pakhungu (kuphatikizapo mankhwala), angioedema (wokhala ndi zotsatira zakupha), hyperhidrosis, zotupa pakhungu.
Kuphwanya kwamanjenje: nkhawa, kusowa tulo, kukhumudwa, kukomoka, vertigo.
Kusokonezeka kwa ziwalo zamasomphenya: Kusokonezeka kowoneka.
Kusweka kwa mtima: bradycardia, tachycardia.
Kuphwanya Mitsempha yamagazi: kuchepa kwamphamvu kwa kuthamanga kwa magazi, orthostatic hypotension.
Kusokonezeka kwa dongosolo la kupuma, ziwalo zam'mimba ndi Mediastinum: kufupika, kupuma, matenda am'mapapo * (* munthawi yogulitsa pambuyo pake, milandu yokhudzana ndi matenda am'mimba yofotokozedwa, ndi ubale wapakanthawi ndi telmisartan. Komabe, palibe kuyanjana kwa ntchito ndi telmisartan yaikidwa).
Matenda am'mimba: kupweteka kwam'mimba, kutsegula m'mimba, kupweteka kwamlomo wam'mimba, kukomoka, kuphwanya m'mimba, kusokonezeka kwa m'mimba, kusanza, kulakwitsa kosokoneza (dysgeusia), chiwindi ntchito / matenda a chiwindi * (* malinga ndi zotsatira zakuwonetsa pambuyo pakutsatsa. milandu ya chiwindi ntchito / chiwindi matenda awonekera mu okhala Japan).
Kusokonezeka kwa minculoskeletal ndi minofu yolumikizana: arthralgia, kupweteka kwa msana, kupindika kwa minofu (kukokana kwa minofu ya ng'ombe), kupweteka m'munsi, myalgia, tendon ululu (Zizindikiro zofanana ndi chiwonetsero cha tendonitis).
Kusokonezeka kwa impso ndi kwamikodzo thirakiti: kuwonongeka kwaimpso, kuphatikizapo kupweteka kwaimpso.
Zovuta ndi zovuta zina pamalo a jakisoni: kupweteka pachifuwa, matenda ofanana ndi chimfine, kufooka wamba.
Zolemba zasayansi ndi othandizira: kuchepa kwa hemoglobin, kuwonjezeka kwa kuchuluka kwa uric acid, creatinine m'magazi am'magazi, kuwonjezeka kwa ntchito ya "chiwindi" michere, creatine phosphokinase (CPK) m'magazi am'magazi, hyperkalemia, hypoglycemia (odwala matenda a shuga).

Kuyanjana kwa mankhwala osokoneza bongo

Telmisartan imachulukitsa mphamvu ya antihypertensive ya mankhwala ena a antihypertensive. Mitundu ina ya zochitika zamatenda azachipatala sizinadziwikebe.

Kugwiritsa ntchito ndi digoxin, warfarin, hydrochlorothiazide, glibenclamide, ibuprofen, paracetamol, simvastatin ndi amlodipine sikuti kumabweretsa mgwirizano wamphamvu pakadutsa. Kuwonjezeka kwakukulu kwa kuchuluka kwa digoxin m'madzi am'magazi ndi pafupifupi 20% (munthawi imodzi, ndi 39%). Ndi munthawi yomweyo kugwiritsa ntchito telmisartan ndi digoxin, ndikofunikira kuti nthawi zina azindikire kuchuluka kwa digoxin m'madzi a m'magazi.

Monga mankhwala ena omwe amagwiritsa ntchito renin-angiotensin-aldosterone system (RAAS), kugwiritsa ntchito telmisartan kungayambitse hyperkalemia (onani gawo "Malangizo apadera"). Chiwopsezochi chikuwonjezeka ngati mugwiritsidwa ntchito nthawi yomweyo ndimankhwala ena, omwe angayambitsenso kukulitsa kwa hyperkalemia (zotulutsa mchere wa potaziyamu, mankhwala osokoneza bongo a potaziyamu, zoletsa za ACE, AA II, osagwiritsa ntchito mankhwala a anti-yotupa a NSAIDs, kuphatikizapo kusankha kwa cycloo oxygenase-2 | TsOGG-2 | immunosuppressants cyclosporine kapena tacrolimus ndi trimethoprim.

Kukula kwa hyperkalemia kumadalira zochitika zangozi. Chiwopsezochi chimakulanso ngati mukugwiritsa ntchito zomwezi pamwambapa. Makamaka, chiwopsezo chimakhala chachikulu kwambiri ngati chikugwiritsidwa ntchito nthawi imodzi ndi potaziyamu ochepera okodzetsa, komanso m'malo mwa mchere wa potaziyamu. Mwachitsanzo, kugwiritsa ntchito limodzi ndi ACE inhibitors kapena NSAID sikumakhala pachiwopsezo chochepa kwambiri ngati machitidwe osamala akutengedwa. ARA II, monga telmisartan, amachepetsa kuchepa kwa potaziyamu nthawi ya mankhwala a diuretic. Kugwiritsa ntchito potaziyamu posungira diuretics, mwachitsanzo, spironolactone, eplerenone, triamteren kapena amiloride, zina zowonjezera potaziyamu kapena zotulutsa mchere wa potaziyamu zitha kubweretsa kuwonjezeka kwakukulu kwa seramu potaziyamu. Kugwiritsira ntchito nthawi yomweyo kwa hypokalemia zolembedwa kuyenera kugwiritsidwa ntchito mosamala komanso kuyang'anira potaziyamu yambiri m'magazi a magazi. Ndi kugwiritsa ntchito pamodzi kwa telmisartan ndi ramipril, kuwonjezeka kwa 2,5 kwa AUC0-24 ndi Cmax ya ramipril ndi ramipril kunawonedwa. Kufunika kwamankhwala pazinthu izi sikunakhazikitsidwe. Pogwiritsa ntchito munthawi yomweyo ACE zoletsa ndi kukonzekera kwa lifiyamu, kuwonjezereka kwa zinthu za m'magazi a plasma kumawonedwa, limodzi ndi zotsatira zoyipa. Nthawi zina, zosintha zoterezi zidanenedwa ndi ARA II ndi kukonzekera kwa lithiamu. Pogwiritsa ntchito munthawi yomweyo lifiyamu ndi ARA II, tikulimbikitsidwa kuti tidziwe zomwe zili mu lithiamu m'madzi a m'magazi. Kuchiza kwa NSAIDs, kuphatikizapo acetylsalicylic acid, COX-2, komanso NSAIDs yosasankha, kungayambitse kulephera kwa impso kwa odwala omwe alibe madzi m'thupi. Mankhwala omwe amagwiritsidwa ntchito pa RAAS amatha kukhala ndi synergistic. Odwala omwe alandila NSAIDs ndi telmisartan, bcc iyenera kulipidwa poyambira chithandizo ndikuwonetsa kuyinso. Kugwiritsa ntchito pamodzi ndi aliskiren kwa odwala omwe ali ndi matenda osokoneza bongo kapena kuchepa kwapakati komanso kupweteka kwambiri kwa chiwindi (GefRular filtration rate GFR) Mtengo wamba wa Telmista 40 mg ku malo ogulitsa mankhwala ku Moscow ndi:

Mapiritsi 28 pa paketi iliyonse - ma ruble 300-350.
Mapiritsi 84 pa paketi iliyonse - 650-700 rubles.

Kutulutsa mawonekedwe ndi kapangidwe kake

Mlingo wa mawonekedwe a Telmists - mapiritsi: pafupifupi oyera kapena oyera, pamtunda wa 20 mg - kuzungulira, 40 mg - biconvex, chowulungika, 80 mg - biconvex, kapangidwe kake ka kapangidwe kake (mu chithuza cha zinthu zophatikizika 7 ma PC., Pabokosi la 2, 4, 8 , Matuza 12 kapena 14, m'matumba 10,. M'katoni 3, 6 kapena matuza 9.

Piritsi limodzi:

yogwira mankhwala: telmisartan - 20, 40 kapena 80 mg,
zotuluka: sodium hydroxide, lactose monohydrate, magnesium stearate, meglumine, povidone K30, sorbitol (E420).

Malangizo ogwiritsira ntchito Telmista: njira ndi mlingo

Mapiritsi a Telmist amatengedwa pakamwa, mosasamala nthawi yakudya.

Ndi ochepa matenda oopsa, tikulimbikitsidwa kuyamba kumwa 20 mg kapena 40 mg ya mankhwalawa kamodzi patsiku. Mwa odwala ena, ndizotheka kukwaniritsa hypotensive zotsatira za 20 mg / tsiku. Ngati osakwanira achire kwenikweni, mutha kuwonjezera mlingo waukulu tsiku lililonse wa 80 mg. Ndi kuchuluka kwa mankhwalawa, ziyenera kukumbukiridwa kuti kuchuluka kwapamwamba kwambiri kwa Telmista nthawi zambiri kumachitika pambuyo pa masabata 4-8 kuyambira pakuyamba kwa chithandizo.

Kuti muchepetse vuto la mtima ndi kufa, tikulimbikitsidwa kumwa mankhwalawa 80 mg 1 pa tsiku.

Pakumayambiriro kwa chithandizo, njira zowonjezerapo zamagazi zingafunike.

Sikoyenera kusintha mtundu wa odwala omwe ali ndi vuto la impso, kuphatikizanso omwe ali ndi hemodialysis.

Kwa chiwindi chobisalira ntchito yofatsa kapena yolimbitsa thupi (malinga ndi gulu la ana-Pugh - Gulu A ndi B), mlingo waukulu wa tsiku ndi tsiku wa Telmista ndi 40 mg.

Odwala okalamba, pharmacokinetics ya telmisartan sasintha, motero palibe chifukwa chosinthira mlingo wa mankhwalawo.

Kufotokozera kwamapangidwe a kuchitapo kanthu: pharmacodynamics and pharmacokinetics

Telmisartan ndi mtundu 1 angiotensin receptor antagonist. Monga mankhwala onse omwe ali mkalasi iyi, telmisartan imachotsa malo osokoneza bongo kwambiri a angiotensin II kuchokera kumalo omangirira a AT1 receptor. Telmisartan imachepetsa mitsempha yamagazi ndikuchepetsa kuthamanga kwa magazi.

Telmisartan

Malinga ndi kafukufuku watsopano, telmisartan imathandiziranso maselo ena apadera am'mafuta m'thupi. Ma Receptors amawongolera kusintha kwa mafuta kukhala mafuta ndikuwonjezera mphamvu ya maselo am'madzi kuti apange insulin. Odwala ambiri oopsa amakhalanso ndi vuto la magazi lipid komanso malamulo a shuga wamagazi (metabolic syndrome). Kwa odwala awa, telmisartan ali ndi mwayi wochepetsera kuchuluka kwa shuga ndi insulin, komanso kuchuluka kwa triglycerides m'mwazi momwe kuchuluka kwa HDL kumawonjezeka.

Telmisartan nthawi zambiri imalekeredwa. Mphamvu ya antihypertgency imatha pafupifupi maola 24 pambuyo pakamwa. Mankhwala amakhala ataphatikizidwa kwathunthu m'chiwindi. Ndi chithandizo chathanzi, telmisartan imayamba kugwira ntchito patatha milungu isanu ndi umodzi mpaka isanu ndi itatu.

Pambuyo pakukonzekera kwa telmisartan, plasma moyikirapo imafikiridwa mkati mwa maola 0,5-1. Pa mlingo wa 40 mg, bioavailability 40% imatheka. Pa mlingo wa 160 mg, 58% bioavailability imatheka, omwe amangodalira pang'ono chakudya. Matenda amkati samalepheretsa kuchulukana kwa telmisartan, chifukwa chake, kuchepetsa kwa mankhwalawa sikofunikira kwa odwala omwe ndi ofatsa kapena olimbitsa aimpso. Mankhwala sakhala ndi vuto lililonse pamtima.

Popeza cytochrome P450 isoenzymes (CYP) simuphatikizidwa mu metabolism ya telmisartan, kuyanjana ndi mankhwala omwe amalepheretsa kapena kupangidwanso ndi CYP sikuyembekezeredwa. Telmisartan imachulukitsa mozama komanso mosachepera digoxin mozungulira ndi 49% ndi 20%, motero. Mankhwalawa samakhudza kugwira ntchito kwa warfarin, chifukwa chake, angagwiritsidwe ntchito mosamala pa mankhwala a anticoagulant.

Warfarin

Poyerekeza kapangidwe ka mankhwala a sartani, munthu amatha kuzindikira kuti telmisartan mu kapangidwe kake kamafanana ndi molekyulu ya thiazolidatediones - ozindikira za insulin receptors pioglitazone ndi rosiglitazone. Telmisartan ndiyo sartan yokha yomwe imasintha bwino metabolism ya lipid ndi shuga. Kuphatikiza pakupanga kofanana ndi thiazolidatediones, telmisartan ili ndi buku yayikulu kwambiri yogawa kuposa ma sartan ena, ndikuwonetsa kugawa kwambiri chinthucho. Chifukwa cha nyumbazi, zimayesedwa ngati chinthu chokhala ndi zotsatira za mtima.

Zowonjezera zothandizira pakuyambitsa kwa PPAR zaphunziridwa pogwiritsa ntchito agonist yosankha monga chitsanzo. Zochitika zamankhwala zam'mbuyomu zikuwonetsa kuti telmisartan sayenera kuyambitsa zovuta zoyambitsidwa ndi kusankha kwa activation ya PPAR-g. Ngati izi zidziwitso zoyambirira zamankhwala, zotsimikiziridwa pamayeso akuluakulu azachipatala, zimatsimikiziridwa, telmisartan ikhoza kukhala chida chofunikira kwambiri popewa komanso kuchiza matenda a metabolic syndrome, matenda a shuga komanso matenda atherosulinosis.

Kutulutsa mafomu ndi kapangidwe kake

Mankhwalawa ali ngati mapiritsi oyera.Mawonekedwe awo amatha kusiyanasiyana: 20 mg ya yogwira mankhwala mozungulira, 40 mg - chowzungulira chowoneka mbali zonse, 80 mg - makapisozi ofanana ndi mawonekedwe a convex mbali ziwiri. Zitha kupezeka m'matumba, makatoni.

Chothandizira chake ndi telmisartan. Kuphatikiza apo, malembawa amaphatikizapo: sodium hydroxide, sorbitol, povidone K30, meglumine, magnesium stearate, lactose monohydrate.

Zotsatira za pharmacological

Mankhwalawa ali ndi mphamvu ya antihypertensive. Chosakaniza chophatikizacho ndi angiotensin II receptor antagonist. Gawo limodzi la mankhwalawa limasamutsa angiotensin 2, pomwe siwothandiza kwa receptor. Kuphatikiza apo, zimapanga aldosterone yochepa mu plasma. Amathandizira kutsika kwa magazi, kugunda kwa mtima kumakhalabe chimodzimodzi.

Ndi chisamaliro

Chenjezo liyenera kuwonedwa ngati pali kuwonongeka kwa chiwindi ntchito zolimbitsa mwamphamvu. Chithandizo cha kuyang'aniridwa ndi dokotala ndikofunikira kwa awiri aimpso yamitsempha yamagazi. Ngati impso imodzi yachotsedwa ndipo a impso artery stenosis ikuyang'aniridwa, mankhwala ayenera kumwedwa mosamala. Nthawi yomweyo, ntchito ya impso imayang'aniridwa.

Chenjezo pa chithandizo cha mankhwalawa liyenera kuchitika kwa anthu omwe ali ndi hyperkalemia, sodium owonjezera, hypertrophic insulin Cardiomyopathy, mawonekedwe osakhazikika a mtima kulephera, kupindika kwa aortic kapena mitral, kuchepa kwa magazi, komanso kuchuluka kwa hyperaldosteronism.

Chenjezo liyenera kuwonedwa ngati pali kuwonongeka kwa chiwindi ntchito zolimbitsa mwamphamvu.

Momwe mungatenge Telmista

Funsani dokotala kuti mudziwe mtundu woyenera wa mankhwala ndi mtundu wa chithandizo. Mapiritsi amatengedwa pakamwa. Kugwiritsa ntchito mankhwala sikumagwirizanitsidwa ndi kudya zakudya.

Akuluakulu nthawi zambiri amamwa kumwa 20 mg mg kamodzi patsiku. Odwala ena amafunika 80 mg kuti awonetse kuchuluka kwa telmisartan. Okalamba ndi odwala omwe ali ndi matenda a impso safuna kusintha kwa Mlingo.

Ndi matenda a chiwindi, mlingo wa tsiku ndi tsiku ndi 40 mg. Kuphatikiza apo, m'migawo yoyambirira yamankhwala, mungafunike kumwa mankhwala omwe amateteza kuthamanga kwa magazi.

Gwiritsani ntchito pa nthawi yoyembekezera komanso mkaka wa m`mawere

Mankhwalawa sanalembedwe ngati ali ndi pakati komanso amayamwa: amayambitsa vuto la neonatal. Ngati mayi adamwa mankhwalawa panthawi yoyembekezera, ndi kotheka kuti khanda limakhala ndi vuto lochita kusokonekera kwa magazi.

Mankhwalawa sanalembedwe ngati ali ndi pakati komanso amayamwa: amayambitsa vuto la neonatal.

Kuchita ndi mankhwala ena

Ndi makonzedwe a munthawi yomweyo ndi mankhwala ena a antihypertensive, mphamvu ya mankhwalawa imalimbikitsidwa.

Pali kuwonjezeka kwa ndende ya lithiamu m'madzi am'magazi komanso poizoni wake akamagwiritsa ntchito mankhwala omwe ali ndi chinthu chofunikira.

Mukamamwa ndi zoletsa za ACE, zoletsa potaziyamu, komanso mankhwala osintha a potaziyamu, chiopsezo cha zinthu zochulukirapo mu thupi zimakulirakulira.

Ndi makonzedwe a munthawi yomweyo ndi mankhwala ena a antihypertensive, mphamvu ya mankhwalawa imalimbikitsidwa.

Mukamagwiritsidwa ntchito ndi NSAIDs, mphamvu ya mankhwalawo imacheperachepera.

Mankhwalawa ali ndi ma syonyms ambiri. Zofunikira: Teseo, Telpres, Mikardis, Telzap, Prirator. Valz, Lorista, Edbari, Tanidol amagwiritsidwanso ntchito.

Ndemanga za Telmistar

Chifukwa cha kuthamanga kwa mankhwala a antihypertensive, mankhwalawa adalandira ndemanga zambiri zabwino.

Diana, wazaka 44, Kaluga: “Ndimapereka mankhwala kwa odwala nthawi zambiri. Kugwiritsa ntchito bwino, kumayamba kuchitapo kanthu mwachangu, zotsatira zoyipa sizipezeka kawirikawiri. "

Malangizo a Telmista Mapiritsi apamwamba kwambiri

Alisa, wazaka 57, ku Moscow: “Dokotala analamula kuti Telmist amwe chifukwa cha kuthamanga kwa magazi. Mankhwalawa amathandizira kuchepetsa kuthamanga kwa magazi. Ndimamva bwino ndikamwa mankhwalawo. ”

Dmitry, wazaka 40, Penza: "Mankhwalawa ndiwotsika mtengo, amathandiza kuchepetsa kuthamanga kwa magazi, zotsatira zake zimawoneka mwachangu. Koma chifukwa cha kudya, mavuto a impso adayamba. Ndinayenera kukaonana ndi dokotala, kuti ndikalandire njira yatsopano. ”

Malangizo apadera

Kugwiritsa ntchito nthawi yomweyo kwa Telmista ndi ACE zoletsa kapena inhibitor ya renin, aliskiren, chifukwa chakuchita kawiri pa RAAS (renin-angiotensin-aldosterone system) kumawonjezera kugwira ntchito kwa impso (kuphatikizapo kungayambitse kusokonezeka kwa impso), komanso kumawonjezera chiopsezo cha hypotension ndi hyperkalemia . Ngati chithandizo cholandirachi ndichofunika kwambiri, chikuyenera kuchitika moyang'aniridwa ndi achipatala, komanso ngati mumayang'ananso ntchito ya impso, kuthamanga kwa magazi komanso kuchuluka kwa ma electrolyte m'madzi a m'magazi.

Odwala odwala matenda ashuga nephropathy, telmisartan ndi ACE zoletsa sizabwino.

Mu milandu yomwe mtima wamatumbo ndi impso zimadalira ntchito ya RAAS (mwachitsanzo, odwala omwe ali ndi matenda a impso, kuphatikizapo kuphatikizika kwa impso kapena stenosis ya mtsempha wama impso, kapena ndi vuto la mtima), kugwiritsa ntchito mankhwala omwe amakhudza RAAS kungayambitse kukula kwa hyperazotemia, pachimake ochepa hypotension, oliguria ndi pachimake aimpso kulephera (nthawi zina).

Mukamagwiritsa ntchito potaziyamu osagwiritsa ntchito mankhwala a potaziyamu, mchere wotsekemera wokhala ndi potaziyamu, mankhwala ena othandizira komanso mankhwala ena omwe amalimbikitsa kuchuluka kwa potaziyamu m'madzi a m'magazi limodzi ndi Telmista, ndikofunikira kuwongolera potaziyamu m'magazi.

Popeza telmisartan amachotseredwa ndi ndulu, ndimatenda ofooketsa a biliary thirakiti kapena ntchito ya chiwindi, kuchepa kwa chidziwitso cha mankhwalawa ndikotheka.

Ndi matenda a shuga ndi chiwopsezo chowonjezera cha mtima, mwachitsanzo, matenda a mtima (matenda a mtima), kugwiritsidwa ntchito kwa Telmista kungayambitse kuphedwa kwa myocardial infarction ndi kufa mwadzidzidzi kwamtima. Odwala omwe ali ndi matenda a shuga, matenda am'mitima ya coronary sangawonekere, chifukwa nthawi zambiri matendawa amapezeka. Chifukwa chake, musanayambe mankhwala osokoneza bongo, ndikofunikira kuchita mayeso oyenerera, kuphatikiza kuyesedwa kochita masewera olimbitsa thupi.

Odwala omwe ali ndi matenda a shuga amalandiridwa ndi mankhwala a insulin kapena mankhwala a mkamwa. Odwala otere amafunika kuwongolera kuchuluka kwa shuga m'magazi, chifukwa malinga ndi chizindikiro ichi, mankhwala a insulin kapena hypoglycemic ayenera kusintha.

Mu hyperaldosteronism yoyamba, kugwiritsa ntchito mankhwala a antihypertensive - RAAS inhibitors - nthawi zambiri sagwira ntchito. Odwala oterewa saloledwa kutenga Telmista.

Kugwiritsira ntchito mankhwalawa ndizotheka pamodzi ndi thiazide diuretics, popeza kuphatikiza koteroko kumapereka kuchepa kwa kuthamanga kwa magazi.

Kafukufuku akuwonetsa kuti Telmista sili yothandiza kwambiri kwa odwala a liwiro la Negroid. Kuchuluka kwa chiwindi pogwiritsa ntchito telmisartan kumaonekera kwambiri pakati pa anthu okhala ku Japan.

Zizindikiro zogwiritsidwa ntchito

pamaso pa matenda oopsa,
mankhwalawa matenda amitundu iwiri, omwe ziwalo zamkati zimakhudzidwa.
monga prophylaxis waimfa pamaso pa matenda a mtima dongosolo wodwala wazaka zopitilira 50.

Kwa prophylactic, mankhwalawa amagwiritsidwa ntchito ngati wodwala ali ndi mbiri yakale ya matenda ndi matenda monga kugwidwa, kupatuka mu ntchito ya zotumphukira zamagazi zomwe zimayamba chifukwa cha kuzungulira kwa magazi kapena chifukwa cha matenda a shuga. Kukhazikitsidwa kwakanthawi kwa mankhwalawa kumachepetsa chiopsezo cha matenda a mtima komanso sitiroko.

Kwa prophylactic, mankhwalawa amagwiritsidwa ntchito ngati akumenya.

Matumbo

Zotsatira zoyipa monga kupweteka m'mimba, kusokonezeka kwa chopondapo m'mimba, kukula kwa dyspepsia, kutulutsa thukuta kosalekeza, komanso zovuta zamatsenga sizimachitika kawirikawiri. Ndiwosowa kwambiri, koma kupezeka kwa zizindikiro monga kufinya pamlomo wamkamwa, kusapeza bwino pamimba, komanso kusokoneza kukoma sikumayikidwa pambali.

Zotsatira zoyipa monga kupweteka m'mimba sizimachitika kawirikawiri.

Kuchokera minofu ndi mafupa

Kukula kwa sciatica (mawonekedwe a ululu pamimba), kupindika kwa minofu, kupweteka kwa tendon.

Zotsatira zoyipa pakhungu ndiko kuyabwa ndi redness, urticaria, kukula kwa erythema ndi eczema. Si kawirikawiri, kumwa mankhwalawa kumayambitsa kukhumudwa kwa anaphylactic.

Si kawirikawiri, kumwa mankhwalawa kumayambitsa kukhumudwa kwa anaphylactic.

Zokhudza mphamvu pakuwongolera njira

Palibe zoletsa kuyendetsa galimoto ndi kugwira ntchito ndi zovuta kupanga. Koma ndikofunikira kudziwa kuti chifukwa cha kugwiritsidwa ntchito kwa mankhwalawa, chiopsezo chokhala ndi vuto loyambitsa chizungulire sichimaletseka.

Palibe zoletsa kuyendetsa galimoto ndi kugwira ntchito ndi zovuta kupanga.

The ntchito aimpso kuwonongeka

Kawirikawiri analamula odwala aimpso kukanika. Muzochitika zoterezi, ndikofunikira kukhazikitsa kuyang'anira kuchuluka kwa potaziyamu m'magazi ndi kupanga zinthu.

Zogwiritsa ntchito zimapukusidwa ndi bile, ndipo izi, zimayambitsa kuchuluka kwa chiwindi ndi kufalikira kwa matenda.

Kugwiritsa ntchito kwa vuto la chiwindi

Kugwiritsa ntchito mankhwalawa ndi odwala omwe ali ndi matenda ngati cholestasis, matenda oletsa kupatsirana kapena matenda a impso ndi oletsedwa. Zogwiritsa ntchito zimapukusidwa ndi bile, ndipo izi, zimayambitsa kuchuluka kwa chiwindi ndi kufalikira kwa matenda.

Amaloledwa kumwa mankhwalawo pokhapokha ngati wodwala ali ndi matenda aimpso ofatsa komanso olimbitsa. Koma mlingo pazinthu zoterezi uyenera kukhala wocheperako, ndipo mankhwalawa amayenera kumwedwa kokha moyang'aniridwa ndi dokotala.

Bongo

Milandu yama bongo osokoneza bongo sichipezeka kawirikawiri. Zizindikiro zoyipa zomwe zimachitika ndi kugwiritsa ntchito mankhwalawa mopitilira muyeso ndi kuleka kwa tachycardia ndi bradycardia, hypotension.

Chithandizo cha mankhwala pamene vutoli likukula kwambiri. Hemodialysis sagwiritsidwa ntchito chifukwa cha kuthekera kochotsa zigawo za mankhwala m'magazi.

Ndemanga pa Telmista 80

Malingaliro a odwala ndi madotolo okhudzana ndi mankhwalawa nthawi zambiri ndiabwino. Chipangizocho, ngati chikugwiritsidwa ntchito moyenera, sichimakhumudwitsa kukula kwa zizindikiro zam'mbali. Mankhwalawa adziwonetsanso ngati prophylactic, kuchepetsa zoopsa zomwe zimayambika mwadzidzidzi matenda a mtima ndi stroko mwa anthu azaka 55 zakubadwa.

Cyril, wazaka 51, yemwe ndi dokotala wamtima: “Njira yokhayo yomwe Telmista 80 imabweretsa ndiyopeza, pomwe odwala ambiri amafuna athetse vuto lawo nthawi yomweyo. Ndimapereka mankhwala kwa anthu achikulire omwe ali ndi mbiri yokhudza kugunda kwa mtima. "Chidacho chimapulumutsa pamavuto ambiri ndikuchepetsa ngozi zaimfa, monga zikuwonekeranso pakuwona kwa nthawi yayitali."

Marina, wazaka 41, yemwe ndi dokotala wamkulu: "Telmista 80 imatha kuchitira bwino matenda oopsa a matenda oyamba, ndipo kuphatikiza pamodzi kumathandizanso pochiza matenda oopsa a 2nd degree. Ndi kugwiritsa ntchito mankhwalawa pafupipafupi, zotsatira zabwino zimachitika pambuyo pa masabata 1-2, ndikuchotsa chizindikiro chosasangalatsa ngati kupanikizika kosalekeza. Zotsatira zake zimakhala zosowa kwambiri. ”

Maxim, wazaka 45, Astana: “Dokotala wasankha Telmist kuti athandize matenda oyamba ndi matenda oopsa. Izi zisanachitike ndidayesera zinthu zambiri, koma njira zina zomwe zidabweretsa zovuta kapena sizinathandize konse. Panalibe mavuto ndi mankhwalawa. Pakatha milungu iwiri kuchokera pomwe amayamba kudya, kupanikizika kumakhala kwabwinobwino komanso kumakhalabe komweko, popanda kudumpha kosasangalatsa. ”

Ksenia, wazaka 55, Berdyansk: "Nditayamba kuchita izi chifukwa chosiya kusamba, chifukwa kupsinjika kunazunza kwathunthu. Mankhwala anathandizira kusintha zizindikilo bwino. Ngakhale kudumpha kumachitika, sikuthandiza ndipo sikukubweretsa nkhawa zambiri. ”

Andrei, wazaka 35, ku Moscow: “Dotolo adapatsa bambo anga a Telmist 80, anali ndi zaka 60, ndipo anali ndi vuto la mtima. Popeza kuti nthawi zambiri amalumpha kukakamizidwa, pali kuthekera kwakukulu kwakuti vuto lachiwiri la mtima lidzachitike. Zinatenga pafupifupi mwezi kuti mankhwalawo ayambe kugwira ntchito, koma abambowo anakonda kuigwiritsa ntchito, mankhwalawo abwinanso. ”

Momwe mungatengere ndi kukakamiza, mulingo

Anthu ambiri amafunsa kuti: Kodi wopeza matendawa amayenera kutenga magazi ati? Kuti achepetse kuthamanga kwa magazi, opanga ma 40 mg amalembedwa patsiku. Odwala ena, ngakhale ndi 20 mg 20 mg tsiku lililonse, zotsatira zokwanira zimatheka. Ngati kuchepetsa kufalikira kwa magazi sikukwaniritsidwa, dokotala akhoza kuwonjezera mlingo mpaka 80 mg patsiku.

Mankhwalawa amatha kuperekedwa limodzi ndi wothandizila kupha madzi m'gulu la thiazide (mwachitsanzo, hydrochlorothiazide). Mlingo uliwonse usanonjezeke, dokotala amayembekeza milungu inayi mpaka isanu ndi itatu, kuyambira pamenepo mphamvu ya mankhwalawo imawonetsedwa.

Pofuna kupewa kuwonongeka kwa mtima m'masiku omwe analipo, mlingo woyenera wa 80 mg wa telmisartan kamodzi patsiku. Kumayambiriro kwa chithandizo, kuwongolera pafupipafupi magazi kumalimbikitsa. Ngati ndi kotheka, dokotala amasintha mlingo kuti akwaniritse kutsata kwa magazi. Mapiritsi akulimbikitsidwa kuti amwe ndi madzi kapena osasamala zakudya.

Mlingo

40 mg ndi 80 mg mapiritsi

Piritsi limodzi lili

ntchito yogwira - telmisartan 40 kapena 80 mg, motero,

zokopa: meglumine, sodium hydroxide, povidone, lactose monohydrate, sorbitol, magnesium stearate

Mapiritsi Oval okhala ndi biconvex pamtundu wakuda kapena pafupi ndi mtundu (wa 40 mg).

Mapiritsi okhala ndi mawonekedwe a Capsule okhala ndi biconvex pamtundu wa zoyera kapena pafupifupi zoyera (kwa mulingo wa 80 mg)

Kuchita ndi mankhwala ena

Popeza telmisartan sikuti ndi biotransformed ndi cytochrome P-450, imakhala ndi chiopsezo chocheperako. Sizikhudzanso zochita za metabolic za P-450 isoenzymes mu maphunziro a vitro, kupatula kufatsa kofatsa kwa CYP2C19 isoenzyme.

Pharmacokinetic zimatha telmisartan sizimakhudza concomitant makonzedwe a warfarin. Chiwerengero chochepa kwambiri cha warfarin (Cmin) chidachepa pang'ono, koma izi sizinachitike pakuyesedwa kwa magazi. Pakufufuza kwa kulumikizana ndi odzipereka 12 athanzi, telmisartan adaonjezera AUC, Cmax, ndi Cmin digoxin ndi 13%. Izi mwina ndi chifukwa cha kufutukukanso kwa digoxin, popeza nthawi mpaka ndende ya plasma (Tmax) yachepa kuchokera 1 mpaka 0.5 maola. Mukasintha mlingo wa digoxin osakanikirana ndi telmisartan, mulingo wa chinthu ichi uyenera kuyang'aniridwa.

Kafukufuku wina wogwirizana wa pharmacokinetic awonetsa kuti telmisartan ikhoza kuphatikizidwa mosamala ndi simvastatin (40 mg), amlodipine (10 mg), hydrochlorothiazide (25 mg), glibenclamide (1.75 mg), ibuprofen (3x400 mg) kapena paracetamol (1000 mg).

Hydrochlorothiazide

Uphungu! Musanagwiritse ntchito mankhwala aliwonse, muyenera kufunsa dokotala. Sizikulimbikitsidwa kuti muthe kumwa nokha mankhwala amphamvu popanda kuonana ndi dokotala.

Mankhwala

Pharmacokinetics

Telmisartan imatengedwa mwachangu, kuchuluka kwake komwe kumamwa kumasiyana. The bioavailability wa telmisartan pafupifupi 50%.

Mukamamwa telmisartan nthawi yomweyo ndi chakudya, kuchepa kwa AUC (dera lozunguliridwa ndi nthawi yopondera) kumachokera ku 6% (pa 40 mg) mpaka 19% (pa mlingo wa 160 mg). Pakadutsa maola atatu atatha kumwa, kuchuluka kwa madzi am'magazi kumatha, ngakhale chakudya. Kutsika pang'ono kwa AUC sikupangitsa kuti mankhwalawa athe kuchepa.

Pali kusiyana pamaganizidwe a plasma mwa amuna ndi akazi. Cmax (ndende yozungulirapo) ndi AUC anali okwera pafupifupi katatu ndi kawiri mwa akazi poyerekeza ndi abambo popanda phindu lalikulu.

Kuyankhulana ndi mapuloteni a plasma oposa 99.5%, makamaka ndi albumin ndi alpha-1 glycoprotein. Voliyumu yogawa ndi pafupifupi 500 malita.

Telmisartan imapangidwa poyanjanitsa zinthu zoyambira ndi glucuronide. Palibe pharmacological ntchito ya conjugate yomwe idapezeka.

Telmisartan ali ndi chikhalidwe chodziwika bwino cha pharmacokinetics ndikuchotsa kupatula kwa theka-moyo> maola 20. Cmax ndi - mochepera - AUC ichulukane mosasamala ndi mlingo. Palibe kondwerero yofunika kwambiri ya telmisartan yomwe yapezeka.

Pambuyo pakumwa pakamwa, telmisartan imangotsala kwathunthu kudzera m'matumbo osasinthika. Kutulutsa kwathunthu kwamkodzo kumachepera 2% ya mlingo. Chilolezo chonse cha plasma ndi chachikulu (pafupifupi 900 ml / min) poyerekeza ndi magazi a hepatic (pafupifupi 1500 ml / min).

Odwala okalamba

Ma pharmacokinetics a telmisartan mwa odwala okalamba sasintha.

Odwala omwe ali ndi vuto la impso

Odwala omwe ali ndi vuto la impso akukumana ndi hemodialysis, kutsika kwa plasma kumawonedwa. Odwala omwe amalephera kupweteka kwa impso, telmisartan imagwirizanitsidwa kwambiri ndi mapuloteni a plasma ndipo samachotsa pakhungu. Ndi kulephera kwa aimpso, kusiyidwa hafu ya moyo sikusintha.

Odwala omwe ali ndi vuto la chiwindi

Odwala ndi hepatic kusowa, kutsimikizika bioavailability wa telmisartan ukuwonjezeka mpaka 100%. Hafu ya moyo wa chiwindi kulephera sasintha.

Mankhwala

Telmista ® ndi othandiza komanso yosankha (yosankha) ya angiotensin II receptor antagonist (mtundu wa AT1) wochita pakamwa. Telmisartan yokhala ndi ogwirizana kwambiri imasamutsa angiotensin II kuchokera m'malo ake omangiramo malo a AS1 subtype receptors, omwe ali ndi udindo wothandizira angiotensin II. Telmista® ilibe agonist pa receptor ya AT1. Telmista® imasankha mosamala ku ma receptors a AT1. Kulankhulana kumatenga nthawi yayitali. Telmisartan siziwonetsa kuyanjana kwa receptor ena, kuphatikizapo AT2 receptor ndi ena, sanaphunzire kwambiri AT receptors.

Kufunika kwa magwiridwe antchito izi, komanso momwe zimakhalira ndikulimbikitsa kwakukulu ndi angiotensin II, kugwiritsidwa ntchito kwa zomwe zimawonjezeka poika telmisartan, sikunaphunzire.

Telmista® imachepetsa ma pldma aldosterone, sikulepheretsa renin m'magulu am'magazi a anthu ndi ma ion.

Telmista ® sikulepheretsa kusintha kwa eniotensin (kinase II), yomwe imawononga bradykinin. Chifukwa chake, palibe kukonzekera kwa mavuto omwe amabwera chifukwa cha bradykinin.

Mwa anthu, mlingo wa 80 mg wa telmisartan pafupifupi umalepheretsa kuthamanga kwa magazi (BP) chifukwa cha angiotensin II. Mphamvu ya inhibitory imasungidwa kwa maola opitilira 24 ndipo imatsimikiziridwabe pambuyo pa maola 48.

Chithandizo cha ochepa matenda oopsa

Mutatenga mlingo woyamba wa telmisartan, kuthamanga kwa magazi kumachepa pambuyo pa maola atatu. Kutsika kwakukulu kwa kuthamanga kwa magazi kumatheka pang'onopang'ono masabata 4 pambuyo poyambira chithandizo ndikusungidwa kwanthawi yayitali.

Mphamvu ya antihypertgency imatha kwa maola 24 mutatha kumwa mankhwalawa, kuphatikiza maola 4 musanamwe mlingo wotsatira, womwe umatsimikiziridwa ndi kuchuluka kwa kuthamanga kwa magazi, komanso kukhazikika (kopitilira 80%) pazakuchepera komanso kuzama kwa mankhwalawa mutatenga 40 ndi 80 mg ya telmisartan pakuyesedwa kwachipatala. .

Odwala omwe ali ndi matenda oopsa, Telmista® imachepetsa kuthamanga kwa magazi kwa systolic ndi diastolic popanda kusintha kugunda kwa mtima.

Mphamvu ya antihypertensive ya telmisartan ikufanizidwa ndi oimira magulu ena a antihypertensive mankhwala, monga: amlodipine, atenolol, enalapril, hydrochlorothiazide, losartan, lisinopril, ramipril ndi valsartan.

Pankhani ya telmisartan yodzidzimutsa, magazi amayenda pang'onopang'ono pamankhwala osafunikira kwa masiku angapo popanda zizindikiro za kuyambiranso kwamankhwala oopsa (palibe "rebound").

Kafukufuku wachipatala awonetsa kuti telmisartan imagwirizanitsidwa ndi kuchepa kwakukulu kwa kuchuluka kwamanzere kwamitsempha yamanzere yamanzere yamanzere yamitsempha yamagazi kwa odwala omwe ali ndi matenda oopsa komanso osagwirizana ndi hypertrophy yamanzere.

Odwala omwe ali ndi matenda oopsa komanso odwala matenda ashuga nephropathy amawonetsedwa ndi telmisartan akuwonetsa kuchepa kwakukulu kwa proteinuria (kuphatikizapo microalbuminuria ndi macroalbuminuria).

M'mayesero azachipatala apadziko lonse lapansi, zinawonetsedwa kuti panali owerengeka ochepa odwala omwe adwala telmisartan kuposa odwala omwe amalandila angiotensin-converting enzyme inhibitors (ACE inhibitors).

Kupewa matenda a mtima komanso kufa

Odwala azaka za 55 wazaka zopitilira apo omwe ali ndi mbiri ya matenda amitsempha yamagazi, matenda opha ziwalo, zotupa za m'mitsempha, kapena matenda a shuga. kulephera kwa mtima ndi kuchepetsa kufa kwa matenda amtima.

Mlingo ndi makonzedwe

Chithandizo cha ochepa matenda oopsa

Mulingo woyamwa wabwino ndi 40 mg kamodzi tsiku lililonse.

Mwa odwala ena, tsiku lililonse 20 mg imatha kukhala yothandiza.

Muzochitika zomwe kuthamanga kwa magazi sikukwaniritsidwa, mlingo wa Telmista® ukhoza kuwonjezeka mpaka kufika pa 80 mg kamodzi patsiku.

Mukachulukitsa mlingo, muyenera kukumbukiranso kuti mphamvu yotsalira ya antihypertgency nthawi zambiri imakwaniritsidwa patatha milungu inayi mpaka isanu ndi itatu mutayamba chithandizo.

Telmisartan ikhoza kugwiritsidwa ntchito limodzi ndi thiazide diuretics, mwachitsanzo, hydrochlorothiazide, yomwe kuphatikiza ndi telmisartan imakhala ndi chowonjezera chama hypotensive.

Odwala omwe ali ndi matenda oopsa kwambiri, mlingo wa telmisartan anali 160 mg / tsiku ndipo osakanikirana ndi hydrochlorothiazide 12,5-25 mg / tsiku anali wololera komanso wogwira ntchito.

Kupewa matenda a mtima komanso kufa

Mlingo womwe umalimbikitsa ndi 80 mg kamodzi tsiku lililonse.

Sizinatsimikizike ngati Mlingo womwe uli pansi pa 80 mg ndiwothandiza kuchepetsa kuchepa kwa mtima ndi kufa.

Poyamba kugwiritsidwa ntchito kwa telmisartan popewa kuchepa kwa mtima ndi kufa kwa magazi, kuyang'aniridwa kwa magazi kumalimbikitsidwa, ndipo kuwongolera kwa BP kungafunikenso ndi mankhwala omwe amachepetsa kuthamanga kwa magazi.

Telmista® imatha kuchitika mosayang'anira zakudya.

Kusintha kwa odwala omwe ali ndi vuto la aimpso sikofunikira, kuphatikiza odwala pa hemodialysis. Telmisartan samachotsedwa m'magazi panthawi ya kuwonongeka kwa magazi.

Odwala omwe ali ndi chiwindi chochepa kwambiri, ntchito ya tsiku ndi tsiku sayenera kupitirira 40 mg kamodzi patsiku.

Kusintha kwa Mlingo sikofunikira.

Chitetezo ndikuyenda bwino kwa telmisartan mwa ana ochepera zaka 18 sizinakhazikitsidwe.

Mimba komanso kuyamwa

Malinga ndi malangizo, Telmista imapangidwa nthawi yapakati. Pofuna kuzindikira kuti ali ndi pakati, mankhwalawa amayenera kuyimitsidwa nthawi yomweyo. Ngati ndi kotheka, mankhwala a antihypertensive amakalasi ena omwe amavomerezedwa kuti agwiritsidwe ntchito pa nthawi ya pakati ayenera kufotokozedwa. Amayi omwe akukonzekera kukhala ndi pakati amalangizidwanso kuti agwiritse ntchito njira zina.

Mu maphunziro oyamba a mankhwalawa, zotsatira za teratogenic sizinapezeke. Koma kunapezeka kuti kugwiritsa ntchito angiotensin II receptor antagonists mu wachiwiri ndi wachitatu wozungulira matendawa kumayambitsa fetotoxicity (oligohydramnios, kuchepa kwa impso, kuchepa kwa mafupa a khungu la fetal ndi neonatal toxity (arterial hypotension, renal kulephera, hyperkalemia).

Makanda obadwa kumene omwe amayi awo adatenga Telmista panthawi yoyembekezera amafunika kuyang'aniridwa kuchipatala chifukwa chotheka cha kusintha kwa ubongo.

Popeza palibe chidziwitso chokhudza kulowa kwa telmisartan mkaka wa m'mawere, mankhwalawa amatsutsana panthawi yoyamwitsa.

Ndi chiwindi ntchito

Sichikulimbikitsidwa kumwa mankhwalawa odwala omwe ali ndi vuto la chiwindi kwambiri (malinga ndi gulu la ana-Pugh - gulu C).

Ndi kufatsa pang'ono kwa hepatic kosakwanira (malinga ndi gulu la ana-Pugh - Gulu A ndi B), kugwiritsa ntchito kwa Telmista kumafuna kusamala. Mulingo woyenera wa tsiku lililonse wa mankhwalawa sayenera kupitirira 40 mg.