Mankhwala Ramipril C3: malangizo ntchito

Pakatikati pake, Ramipril ndi mankhwala okhudzana ndi ACE zoletsa (angiotensin akatembenuka enzyme), i.e. ku gulu la mankhwala omwe amagwiritsidwa ntchito mochizira kulephera kwa mtima. Chifukwa cha mankhwalawa mankhwala omwe amapezeka mthupi la munthu amayamba kupanga ramiprilat, yomwe imachepetsa kutembenuka angiotensin I angiotensin II, komanso zimasokoneza kaphatikizidwe kamatchulidwe kameneka.

Chifukwa cha zomwe amapanga mankhwala, kuphatikiza thupi kumachepa angiotensin IIzomwe zimatanthawuza zamphamvu zokwanira vasoconstrictor zinthu. Mwa kuthetsa mayankho olakwika atamasulidwa reninkatulutsidwe amachepetsa aldosteronepotero amachepetsa chonse zotumphukira mtima kukana.

Nthawi yomweyo, kulekerera katundu kumawonjezeka chifukwa cha kuwonjezeka kwa voliyumu ya mtima mphindi ndi kukana kwa ziwiya zam'mapapo. Mankhwalawa ali ndi mphamvu zotengera impsondikuyambitsanso njirayi kukonzanso kwamtima dongosolo. Ramipril amachepetsa kukana konsezotumphukiraziwiya za impso, minofu, chiwindi, khungu ndi ubongozimapangitsa kuthamanga kwa magazi mu ziwalo.

Antihypertensive zotsatira mankhwalawa amayamba patangopita maola ochepa atakhazikitsa. Ndi kugwiritsa ntchito mankhwalawa pafupipafupi kwa milungu 4, kuwonjezeka kwapang'onopang'ono kumadziwika antihypertensive ntchito, mulingo wabwinobwino womwe umakhala ndi chithandizo cha nthawi yayitali.

Mankhwalawa amachepetsa kubwereza stroko, myocardial infarctionodwala atadwala koyamba kapena akudwala matenda zotengera zangozikomanso Matenda a mtima wa Ischemic. Kuphatikiza apo, mankhwalawa amathandizira kupewa chitukuko. matenda ashugaOdwala omwe ali ndi mbiri ya chiopsezo monga matenda oopsa, microalbuminuria, cholesterol yayikulu komanso otsika HDL (lipensitroteins yapamwamba).

Ramipril amalowetsedwa ndi 60% mthupi, ndipo zakudya sizimakhudza kuchuluka kwa mankhwalawa. Kuti mankhwala azigwira bwino ntchito, wodwala ayenera kugwira ntchito moyenera chiwindi, momwe ma setireti amawonongeka, ndikupangidwansoramiprilatkufulumizitsa njira yophunzitsira metabolites.

Pambuyo maora 2 mutatha kumwa mankhwalawo mthupi, pazotheka ambiri pazogwira ntchito, zomwe zimachotsedwa pakatha maola 17 ndi ndowe ndi mkodzo.

Zizindikiro zogwiritsidwa ntchito

Kugwiritsa ntchito mankhwalawa tikulimbikitsidwa:

kulephera kwa mtimachikhalidwe chovuta
matenda ashuga nephropathy,matenda a impso ovala kusokoneza chilengedwe (non-diabetesic nephropathy),
ochepa matenda oopsa,
kuchepa kwa kuthekera myocardial infaration, sitiroko, imfa ya coronary.

Kuphatikiza apo, Ramipril amagwiritsidwa ntchito pochiza odwala omwe akupita kugunda kwamtima, kugunda, komanso translateiioplastyndichotupa cham'madzi chodutsa.

Contraindication

Sivomerezeka kugwiritsa ntchito mankhwalawa pamene Hypersensitivity kuti ACE zoletsaat hypotension, Hyperkalemia, kulephera kwa aimpsokomanso nthawi mimba ndiNthawi yonyamula mkaka.Kuphatikiza apo, ndikulimbikitsidwa kupewa Ramipril pochiza ana osaposa zaka 18 ndi odwala okalamba.

Chepetsani kugwiritsa ntchito mankhwalawa ngati pali mbiri ya angioedema, kuponderezana, matenda oopsa a autoimmune, kufalitsa bwino, matenda a atherosclerosis, stenosis, pambuyo pothira impso, ndimatenda a shugandi ena matenda a m'mapapo, hyponatremia, dialysis.

Zotsatira zoyipa

Mukumwa mankhwalawo, mavuto monga: kulephera kwa mtimahypotension, angina pectoris, myocardial infarction, syncope, vertigo, arrhythmia, vasculitis, thrombocytopenia, nseru, kusanza, matendawa, kusokonekera, kapamba, kukomoka, chizungulire ndi kupweteka mutu, asthenia, magawo, kugona, neuropathy, kunjenjemera, kusowa kwa tulo, kusamva makutu, kuperewera kwa chiwindi, kusawona bwino, kutsokomola, kupuma movutikira, sinusitis, pharyngitis, rhinitis, laryngitis, photosensitivity, komanso kuchepa kwa thupi, angioedema, malungo.

Malangizo ogwiritsira ntchito Ramipril (Njira ndi Mlingo)

Malinga ndi malangizo a Ramipril ogwiritsira ntchito mankhwalawa, mankhwalawa amayamba kutengedwa pakamwa osapitilira 2.5 mg. patsiku. Njira yogwiritsira ntchito mankhwalawa, komanso mlingo, zimatha kusiyanasiyana malinga ndi mankhwala omwe adokotala amapeza, komanso zovuta za matendawo ndi momwe wodwalayo alili.

Bongo

Ngati bongo, mankhwala otsatirawa amawonetsedwa mwa odwala: hypotension, angioedema, kusokonezeka kwa magazi, vuto la mtima limodzi ndi zovuta za thromboembolic.

Zochizira zotsatira za mlingo woyenera wa mankhwalawa kuchapa m'mimbapangani zochitika kuti muwonjezere voliyumu magazi ozungulira, komanso kusiya kapena kuchepetsa mlingo wa Ramipril.

Kuchita

Achire zotsatira za mankhwala bwino antihypertensives. Kupewa hypoglycemia, hyperaldosteronismkuwonjezera chiwopsezo cha chitukuko neutropeniamankhwalawa sagwiritsidwa ntchito molumikizana ndi mankhwala antidiabetes, okodzetsakomanso njira myelosuppressive zotsatira, potaziyamu zowonjezera ndi m'malo amchere.

Malangizo apadera

Musanagwiritse ntchito mankhwalawa, monga pa chithandizo chokha, kwa odwala (makamaka ndi matenda minofu yolumikizira yachilengedwekomanso wolandila Allopurinol ndi immunosuppressants) ndikulimbikitsidwa kukayezetsa nthawi zonse impso ndi magazi electrolytekuphatikiza zotumphukira.

Odwala kusowa kwa sodium Musanayambe chithandizo chamankhwala chiyenera kubweretsanso mwakale Zizindikiro zamagetsi amadzi. Munthawi yogwiritsira ntchito mankhwalawa ndizoletsedwa hemodialysis ndi thandizo polyacrylonitrile zimagwira.

Ndemanga za Ramipril

Odwala ambiri omwe amagwiritsa ntchito mankhwala oyambirirawo, osagwiritsa ntchito ndalama zambiri, kuphatikizapo opanga zoweta, amasiya ndemanga zabwino za Ramipril. Komabe, anthu ambiri amawona kuti ndi chinthu chosalimbikitsa kuti mankhwalawa ali ndi mndandanda wazotsatira zoyipa zambiri.

Zokhudza zonse zokhudza mankhwala

"Ramipril", fanizo la mankhwala, komanso zovuta mankhwala ndi othandizira antihypertensive. Ramipril yokha ndi chinthu chogwira ntchito chomwe chimapezeka mu mankhwala ambiri. Ndi choletsa ACE chomwe chitha kutsekereza enzyme komanso kutsitsa magazi. Zimakupatsani mwayi wokulitsa zakutsogolo kwamaphunziro a matenda okalamba.

Kafukufuku wazachipatala awonetsa kuti ramiprilat, metabolite yogwira ya Ramipril, amalepheretsa angiotensin kutembenuza enzyme mwamphamvu kwambiri. Chifukwa cha izi, Ramipril, analogues ndi kukonzekera kovuta ndi njira yosankhira matenda olembetsedwa kwambiri.

Popeza mankhwalawa amatha kuletsa ACE mwamphamvu ndikuthandizira kuthamanga kwa magazi, Ramipril ali ndi mitundu yambiri. Zonsezi zimagwiritsidwa ntchito bwino pochiza matenda oopsa. Kuphatikiza apo, ramipril woyambirira ndi mankhwala "Tritace". Ena onse ndi zida zake zamagetsi, kuyenera kwake kuyenera kufaniziridwa ndi iye. Kuvomereza kugulitsa kuyenera kutsimikiziridwa ndi bioequivalence kwa mankhwala a Tritace.

Pakadali pano, mndandanda wazofanizira ndi motere: Amprilan, Vazolong, Dilaprel, Korpril, Pyramil, Ramepress, Ramigamma, Ramicardia, Tritace, Hartil. Ramipril amapangidwanso ndi makampani aku Russia a Tathimpharmpreparaty, Biokom ndi Severnaya Zvezda. Zopangira izi zimatchedwa Ramipril SZ.

Mlingo wambiri komanso kukonzekera kovuta

Mankhwala a antihypertensive Ramipril ndiosavuta kumwa komanso kutenga. Zochita zake zimakuthandizani kusiyanitsa mitundu yayikulu ya mankhwala. Awa ndi 2.5 mg, 10 ndi 5 mg. Mapiritsi a izi amatengedwa kawiri patsiku. Palinso mankhwala ovuta omwe ali ndi ramipril ndi hydrochlorothiazide: Amprilan ND, Amprilan NL, Vazolong N, Remazid, Triapin, Tritace Plus, Hartil D, Egypt. Apa, kuchuluka kwa ramipril kumachokera ku 2,5 mg mpaka 10, ndipo mlingo wa hydrochlorothiazide umachokera pa 12,5 mpaka 25 mg piritsi limodzi.

Gulu lachiwiri la mankhwala ovuta ndi kuphatikiza kwa Ramipril ndi wotsutsana ndi calcium, Amlodipine. Chitsanzo cha mankhwala ndi Egipress, omwe amapezeka pamiyeso iwiri: 10 mg ramipril ndi 5 mg amlodipine, komanso mlingo wa 10/10 mg. Kuphatikiza pa kuphatikiza uku, pali mtundu wina wa mankhwala omwe ali ndi ACE inhibitor Ramipril ndi Felodipine wa calcium. Ili ndi Triapin, lomwe lili ndi 2,5 mg ya ramipril ndi 2,5 mg wa felodipine.

Mayendedwe ogwiritsa ntchito

Kuphatikiza pa malingaliro omwe adotolo adalandira, wodwalayo ayenera kuganizira malangizo omwe angagwiritsidwe ntchito. Ili ndi chidziwitso cha zomwe zikuwonetsa, mavuto, Mlingo ndi makina othandizira, zotsutsana ndi njira zopewera. Komanso, malangizo omwe angagwiritsidwe ntchito pokonzekera Ramipril amafotokoza kufunika kokana mowa panthawi ya matenda oopsa.

Ramipril, fanizo la mankhwala ndi genit Tritace akuwonetsedwa:

matenda oopsa,
Monga gawo la zovuta zamankhwala ambiri osokoneza bongo omwe amalephera,
odwala matenda ashuga ndi nephropathy ena kuchipatala kapena subclinical siteji, osagwirizana ndi aimpso mtsempha wamagazi,
ndi matenda oopsa oopsa,
popewa kulowetsedwa kwa myocardial infarction, kuchepetsa kufa kwa odwala omwe ali ndi matenda amtima, komanso zochizira matenda oopsa omwe ali ndi chiwopsezo chachikulu cha mtima.

Chizindikiro chachikulu ndi matenda oopsa. Ili ndi matenda ofala kwambiri a zaka zapakati komanso zakale, omwe amafunikira kukonza. Komanso, mankhwalawa "Ramipril" kapena inhibitor wina wa ACE ayenera kutumizidwa kwa odwala masiku 2-9 kuyambira nthawi yovuta kwambiri ya infarction ya myocardial. Mlingo wa mankhwalawa uyenera kukhala wololera ngakhale pamene wodwala alibe matenda oopsa. Izi ndichifukwa champhamvu pamtima zotsatira za ACE zoletsa.

Mlingo regimens

Fomu yayikulu ya Ramipril ndi miyala. M'mapiritsi, sizachilendo. Pankhaniyi, mlingo woyambira ndi 1.25 mg. Mlingo wochepetsetsa wa mankhwalawo ndi 2.5 mg, womwe umawakakamiza kuti agawidwe pawiri. Kukhala ndi mzere piritsi kumapangitsa izi kukhala zosavuta.

Ndi mtundu uliwonse wa matenda oopsa, muyeso woyamba ndi 1.25 mg kamodzi patsiku. Kenako, ndi kulolerana kwabwino, mlingo umapitirira pang'onopang'ono. Mlingo titration umachitika mpaka chiwonetsero cha magazi chikukhazikika. Choyimira pothandiza matenda oopsa ndicho kuthamanga kwa magazi, komwe sikumapumula nthawi yopuma.

Njira zopewera kupewa ngozi

Mankhwalawa amayenera kumwedwa poyesedwa, makamaka oyamba. Ndikofunikira kuti magazi a systolic achepetse osachepera 90 mm. Hg. Art. Ngati kuthamanga kwa magazi kumagwera pansi pamlingo uwu, ndikulimbikitsidwa kuti mufunse thandizo la ogwira ntchito kuchipatala. Pofuna kupewa kuthamanga kwa magazi, sizikulimbikitsidwa kuti mugwiritse ntchito Ramipril limodzi ndi nitrate, antiarrhythmics (Procainamide) ndi alpha-1 blockers (Alfuzosin, Tamsulozin).

Mankhwalawa amayenera kumwedwa nthawi zonse komanso makamaka nthawi yomweyo. Izi zimakuthandizani kuti muzolowere dongosolo la renin-angiotensin-aldosterone, lomwe limayendetsa kuthamanga kwa magazi. Komanso, musadumphe kumwa mankhwala, omwe atha kuwonetsedwa ndi mavuto akulu kwambiri. Kukana kwambiri kutenga kumatha kubweretsa mikwingwirima, zoopsa zomwe zimawonjezeka nthawi imeneyi.

Ndemanga za wodwala zamankhwala

Tritace ndi ma generics ake ndi mankhwala apamwamba kwambiri omwe amalamulira bwino kuthamanga kwa magazi. Mpaka pano, mankhwalawa ndi mankhwala amphamvu kwambiri a antihypertensive. Chifukwa cha izi, ndemanga zodwala za iye nthawi zambiri zimakhala zabwino. Amadziona ngati mankhwala odalirika komanso amphamvu omwe amayendetsa magazi bwino. Chofunika kwambiri ndikuwunika kwa odwala omwe adamwa mankhwalawo m'gululi.

Odwala adazindikira zingapo zoyipa zomwe zimakhudzana ndi kawopsedwe. Kuyanjana kwakukulu kwa ACE, komanso mlingo wochepa wa mankhwalawa, kusokoneza zotsatira zingapo za metabolic zomwe mwina sizoyenera kugwiritsa ntchito mosalekeza. Ndikofunikira kuti kuchuluka kwa zovuta komwe kumagwiritsidwa ntchito nthawi zonse ndi Ramipril kumachepetsedwa kwambiri. Komabe, kupatula kwathunthu sikungatheke ndi monotherapy.

Ndemanga za madotolo zamankhwala

Chiwerengero cha matenda oopsa chikufooketsa. Zimatsimikizira kufunikira kwa matendawa kwa mankhwala amakono. Ndikofunikanso kuti matenda a zamatsenga amachepetsa kwambiri kukhala ndi moyo. Hypertension imayamba chifukwa cha kuchuluka kwa renin, komwe kumawonjezera kuchuluka kwa magazi a angiotensin. Kuletsa kwa enzymeyi kumabweretsa kuchepa kwa mavuto. Izi ndizofunikira kupewa sclerosis ya chotengera chotengera ndi mawonekedwe a zovuta zoopsa za matenda oopsa.

Monga momwe kafukufuku wofufuzira wophunzirayo akuwonetsera, ma fibrillations ambiri oyamba ndi matenda a mtima wam'mimba amayamba pambuyo poti wodwala wayamba kale kukhala ndi matenda oopsa. Chifukwa chake, kufunikira kwake kwamankhwala ndikofunika. Ndipo koposa zonse, ndikotheka kuthetsa kuthokoza chifukwa cha zoletsa ACE. Pakati pawo, Ramipril ndiye wamphamvu kwambiri komanso wothandiza kwambiri.

Kuwona madotolo za iye kumatsimikizira zopindulitsa zake. Mankhwalawa ndi osavuta kugwiritsa ntchito, ali ndi zovuta zochepa ndipo amagwira ntchito bwino. Komabe, ngakhale ali ndi izi, mwina sizingakhale zokwanira kuchiza matenda oopsa. Izi pafupifupi 40-50% ya milandu yamankhwala.

Chithandizo chawo chimafunikira njira yophatikizira ya ACE inhibitor, okodzetsa, okonda calcium, ndipo nthawi zina amabweretsa beta. Monga choletsa cha angiotensin-kutembenuza enzyme, Ramipril ali woyenera. Chifukwa chake, nthawi zonse zimatha kukhala m'malo ake mankhwalawa matenda oopsa, chikavomerezeka. Ngakhale odwala ambiri amawona kuti ndi mtengo wokwera mtengo chifukwa chosowa.

Muli piritsi 10,00 mg:

Chithandizo: ramipril - 10,00 mg.
Othandizira: lactose monohydrate (mkaka wa shuga) - 174,00 mg, sodium bicarbonate - 10,00 mg, croscarmellose sodium - 4,00 mg, sodium stearyl fumarate - 2.00 mg.

mapiritsi okhala ndi muyeso wa 2.5 mg - mapiritsi a biconvex ozungulira a zoyera kapena pafupifupi zoyera ndi ngozi.
Mapiritsi okhala ndi mulingo wa 5 mg ndi 10 mg ndi mapiritsi ozungulira amiyala yoyera kapena pafupifupi yoyera ndi mawonekedwe ndi chiwopsezo.

Mankhwala

Mankhwala
Meripril yogwira metabolite yopangidwa ndi michere ya "chiwindi", ramiprilat, ndi ACE inhibitor yemwe amagwira ntchito nthawi yayitali (masinthidwe a ACE: kininase II, dipeptidyl carboxy dipeptidase I), yomwe ndi peptidyl dipeptidase. ACE mu plasma ndi zimakhala zimathandizira kutembenuka kwa angiotensin II, yemwe ali ndi vasoconstrictor kwenikweni, ndi kuwonongeka kwa bradykinin, yomwe imapangitsa Vasodilating.
Chifukwa chake, mutenga ramipril mkati, mapangidwe a angiotensin II amachepetsa ndipo bradykinin imadziunjikira, yomwe imayambitsa vasodilation ndi kuchepa kwa kuthamanga kwa magazi (BP). Ramipril-wonjezera kuwonjezeka kwa ntchito ya kallikrein-kinin dongosolo m'magazi ndipo zimakhala ndi kutsegula kwa dongosolo la prostaglandin komanso kuwonjezeka kaphatikizidwe ka prostaglandins, kamene kamapangitsa mapangidwe a nitric oxide mu endotheliocytes, amachititsa mtima wake ndi mapangidwe a endothelioprotective. Angiotensin II imathandizira kupanga aldosterone, kotero kutenga ramipril kumabweretsa kuchepa kwa secretion ya aldosterone ndi kuwonjezeka kwa zomwe zili mu potaziyamu ions mu seramu yamagazi.
Ndi kuchepa kwa kuchuluka kwa angiotensin II m'mwazi, mphamvu yake yoletsa kukhudzidwa kwa renin ndi mtundu wa mayankho olakwika amachotsedwa, zomwe zimayambitsa kuwonjezeka kwa ntchito ya renin m'madzi a m'magazi.
Amaganiziridwa kuti kukulitsa zochitika zina zovuta (makamaka, chifuwa "chowuma") zimaphatikizidwanso ndikuwonjezereka kwa ntchito ya bradykinin.
Odwala omwe ali ndi matenda oopsa, kutenga ramipril kumayambitsa kutsika kwa magazi m'magawo a "kunama" ndi "kuyimirira", popanda kuchuluka kwa mtima (HR). Ramipril amachepetsa kwambiri zotumphukira zotupa (OPSS), popanda kuchititsa kusintha kwa magazi aimpso komanso kuchuluka kwa kusefera kwa mafuta. Mphamvu ya antihypertensive imayamba kupanga pakatha maola 1-2 mutangolowa muyezo umodzi wa mankhwalawo, kufikira mtengo wofunikira kwambiri pambuyo pa maola 3-6, ndipo umapitirira kwa maola 24. kumwa mankhwalawa ndikulimbikira kwa nthawi yayitali. Kusiyidwa kwadzidzidzi kwa mankhwalawa sikupangitsa kuti magazi azitha mofulumira (kusowa kwa "achire"),
Odwala ochepa matenda oopsa, ramipril imachedwetsa kukula ndi kupitilira kwa myocardial hypertrophy ndi mtima wall.
Odwala omwe ali ndi vuto la mtima wosalephera, ramipril amachepetsa OPSS (imachepetsa kutsitsa pamtima), imawonjezera mphamvu ya venous channel ndikuchepetsa kuzaza kwa ventricle yamanzere, yomwe, motero, imabweretsa kutsika kwa preload pamtima. Mwa odwalawa, mukamamwa ramipril, pamakhala kuwonjezeka kwa kutulutsa kwamtima, kachigawo kakang'ono ka thupi ndi kuwongolera zolimbitsa thupi. Mu matenda a diabetes komanso osadwala matenda a shuga, kutenga ramipril imachepetsa kuchepa kwa impso komanso kuyambika kwa kulephera kwa aimpso chifukwa chake, kumachepetsa kufunika kwa hemodialysis kapena kupatsirana kwa impso. M'magawo oyamba a matenda ashuga kapena nondiabetesic nephropathy, ramipril amachepetsa vuto la albinuria. Odwala omwe ali ndi chiopsezo chokhala ndi mtima wam'mimba chifukwa cha zotupa zam'matumbo (matenda a mtima ofunikira, mbiri ya zotumphukira zam'magazi, mbiri ya sitiroko) kapena matenda osokoneza bongo omwe ali ndi vuto limodzi lowonjezera (microalbuminuria, matenda oopsa, chiwopsezo cha kuchuluka cholesterol (OX), kuchepa kwa kuchuluka kwa anthu osalimba kwambiri a lipoprotein cholesterol (HDL-C), kusuta fodya) kuwonjezera kwa ramipril ku mankhwala ena onse Amachepetsa kwambiri kubadwa kwa myocardial infarction, stroke, ndi kufa chifukwa cha matenda amtima. Kuphatikiza apo, ramipril imachepetsa chiwerengero cha anthu omwalira, komanso kufunikira kwa njira zowunikiranso ndikuchepetsa kuyambika kapena kupitirira kwa vuto la mtima.
Odwala omwe ali ndi vuto la mtima komanso mawonetseredwe azachipatala omwe amapezeka masiku oyamba a infarction ya pachimake (2-9 masiku), ramipril, yomwe idayamba kuyambira tsiku la 3 mpaka 10 la infaration yokhala pachimake, yochepetsa kufa (pofika 27%), chiopsezo cha kufa mwadzidzidzi (pofika 30) %), chiwopsezo cha kupita patsogolo kwa kulephera kwa mtima kukhala kwambiri (NYHA kalasi ya III-IV yogwira ntchito mkalasi) / mankhwala osagwira ntchito (23%), mwayi wakugonekedwa m'chipatala chifukwa cha chotupa cha mtima (26%).
Mwa odwala ambiri, komanso odwala matenda a shuga, omwe amakhala ndi matenda oopsa komanso kuthamanga kwa magazi, ramipril imachepetsa kwambiri vuto la nephropathy komanso kupezeka kwa microalbuminuria.

Pharmacokinetics
Pambuyo pakukonzekera kwa pakamwa, ramipril imatengedwa mwachangu kuchokera ku m'mimba thirakiti (50-60%). Zakudya zomwezi munthawi yomweyo zimachepetsa kuyamwa, koma sizimakhudza mayamwidwe athunthu. Ramipril amakhala ndi mphamvu yayikulu ya metabolism / activation (makamaka m'chiwindi ndi hydrolysis), zomwe zimapangitsa kuti metabolite wokhayo azigwira, ramiprilat, yemwe ntchito yake mokhudzana ndi kuletsa kwa ACE imakhala yokwera kwambiri maulendo 6 kuposa zochita za ramipril. Kuphatikiza apo, chifukwa cha ramipril metabolism, diketopiperazine, yomwe ilibe zochitika zamankhwala, imapangidwa, pomwe imayanjanitsidwa ndi glucuronic acid, ramiprilat imaphatikizidwanso glucuronated ndikupanga mankhwala a diketopiperazinic acid.
Ma metabolites onse opangidwa, kupatulapo ramiprilat, alibe zochitika zokhudzana ndi mankhwala.
The bioavailability wa ramipril pambuyo m`kamwa makonzedwe kuyambira 15% (kwa 2,5 mg) mpaka 28% (kwa 5 mg). The bioavailability wa yogwira metabolite, ramiprilat, pambuyo ingestion wa 2,5 mg ndi 5 mg wa ramipril pafupifupi 45% (poyerekeza ndi bioavailability pambuyo mtsempha wamagulu Mlingo womwewo).
Pambuyo potenga ramipril mkati, plasma wozama wa ramipril ndi ramiprilat umafikiridwa pambuyo pa maola 1 ndi 2-4, motsatana. Kuchepa kwa plasma ndende ya ramiprilat kumachitika m'magawo angapo: magawidwe ndi chimbudzi ndi theka la moyo (T_1/2) ramiprilat, pafupifupi maola atatu, ndiye gawo lapakatikati ndi T_1/2 ramiprilat, wopangidwa pafupifupi maola 15, ndipo gawo lomaliza lokhala ndi ramiprilat yochepa kwambiri mu plasma ndi T_1/2 ramiprilat, pafupifupi masiku 4-5. Gawo lomaliza ili chifukwa chakumasulidwa kwapang'onopang'ono kwa ramiprilat kuchokera ku chomangira cholimba ndi ACE receptors. Ngakhale gawo lomaliza lomaliza lokhala ndi pakamwa limodzi la ramipril pakamwa pa 2,5 mg kapena kuposerapo, kuchuluka kwa madzi a ramiprilat kumachitika patadutsa masiku pafupifupi anayi a chithandizo. Mothandizidwa ndi mankhwalawa “ogwira” T_1/2 kutengera mlingo ndi maola 13 mpaka 17.
Kulumikizana ndi mapuloteni ammadzi am'magazi ndi pafupifupi 73% ya ramipril, ndi 56% ya ramiprilat.
Pambuyo pamakina othandizira, kuchuluka kwa ramipril ndi ramiprilat kuli pafupifupi 90 L ndi pafupifupi 500 L, motsatana.
Pambuyo pakumeza, ramipril (10 mg), wolembedwa ndi radioot isotope, 39% yama radioac imachotsedwa m'matumbo ndipo pafupifupi 60% ndi impso. Pambuyo pakukonzekera kwamitsempha kwa ramipril, 50-60% ya mankhwalawa imapezeka mkodzo mu mawonekedwe a ramipril ndi metabolites. Pambuyo pokonzekera kulowetsedwa kwa ramiprilat, pafupifupi 70% ya mankhwalawa imapezeka mkodzo mu mawonekedwe a ramiprilat ndi metabolites, mwanjira ina, ndi intravenous ya ramipril ndi ramiprilat, gawo lofunikira la mankhwalawa limatulutsidwa m'matumbo ndi bile, kudutsa impso (50% ndi 30%, motero). Pambuyo pakamwa makonzedwe a 5 mg a ramipril mwa odwala a kukhetsa kwa ma draina, pafupifupi kuchuluka komweko kwa ramipril ndi metabolites ake kumatsitsidwa ndi impso komanso m'matumbo mu maola 24 atangotha.
Pafupifupi 80-90% ya metabolites mu mkodzo ndi bile adadziwika kuti ndi ramiprilat ndi ramiprilat metabolites. Mankhwala a Ramipril glucuronide ndi ramipril diketopiperazine pafupifupi 10-20% ya kuchuluka kwathunthu, ndipo zinthu zosakhudzidwa ndi ramipril mumkodzo ndi pafupifupi 2%.
Kafukufuku wazinyama awonetsa kuti ramipril imachotsedwanso mkaka wa m'mawere.
Panthawi ya kuwonongeka kwaimpso ndi creatinine chilolezo (CC) zosakwana 60 ml / min. kuchuluka kwa ramiprilat ndipo ma metabolites ake ndi impso amayamba kuchepa. Izi zimabweretsa kuwonjezeka kwa plasma ndende ya ramiprilat, yomwe imachepetsa pang'onopang'ono kuposa odwala omwe ali ndi vuto laimpso.
Mukatenga ramipril muyezo waukulu (10 mg), chiwindi chimagwira ntchito zimayendetsa pang'onopang'ono mu kagayidwe ka ramipril ndikuyamba kuchepa kwa ramiprilat.
Odzipereka athanzi komanso odwala omwe ali ndi matenda oopsa oopsa, atatha kumwa kwa milungu iwiri ndi ramipril tsiku lililonse la 5 mg, palibe kuchuluka kwakukulu kwa ramipril ndi ramiprilat. Odwala omwe ali ndi vuto la mtima wosakhazikika, atatha kumwa kwa milungu iwiri ndi ramipril mu tsiku lililonse la 5 mg, kuwonjezeka kwa 1.5-1.8-plasma kwa ramiprilat ndi dera lomwe lili pansi pa nthawi ya pharmacokinetic curve (AUC).
Mwa odzipereka okalamba athanzi (zaka 65-76), pharmacokinetics of ramipril ndi ramiprilat siosiyana kwambiri ndi za achinyamata odzipereka athanzi labwino.

Ndi chisamaliro

Kugwiritsa ntchito munthawi yomweyo mankhwala a Ramipril omwe ali ndi mankhwala okhala ndi aliskiren kapena angiotensin II receptor antagonists (wokhala ndi njira yochepetsera ya renin-angiotensin-aldosterone system (RAAS) pali chiopsezo chowonjezeka kwambiri cha kuthamanga kwa magazi, kakulidwe ka hyperkalemia ndi matenda opatsirana aimpso poyerekeza ndi monotherapy (onani. .Gawo "Malangizo Apadera").
Zomwe zimachepetsa kwambiri kuthamanga kwa magazi ndizowopsa zake (zotupa za mitsempha ya mitsempha ndi mitsempha ya m'magazi).
Zomwe zimaphatikizidwa ndi kuwonjezeka kwa ntchito ya RAAS, momwe, AID ikapumira, pamakhala chiwopsezo cha kuchepa kwambiri kwa magazi ndi vuto laimpso:

kwambiri matenda oopsa, makamaka oopsa oopsa
Kulephera kwa mtima, makamaka koopsa, kapena komwe mankhwala ena a antihypertgency amatengedwa,
hemodynamically kwambiri unilateral stenosis a impso (pamaso pa impso zonse) - mwa odwala, ngakhale kuwonjezeka pang'onopang'ono kwa ndende ya magazi mu seramu ya magazi kumatha kuwonetsa kuwonongeka kwa impso.
Zakudya zam'mbuyomu,
Kusokonezeka kwa kuchuluka kwa ma electrolyte chifukwa chosakwanira kudya kwamadzi ndi sodium chloride, kutsegula m'mimba, kusanza, ndi thukuta kwambiri.

Kuwonongeka kwa ntchito ya chiwindi (kusowa kwa chidziwitso ndi kugwiritsa ntchito: ndikotheka zonse kuwongolera ndi kufooketsa zovuta za ramipril, ngati odwala ali ndi matenda a chiwindi ndi ascites ndi edema, kutsegula kwakukulu kwa RAAS ndikotheka).
Kuwonongeka kwa impso (CC zoposa 20 ml / mphindi / 1.73 m²) m'dera lamunthu) chifukwa cha chiwopsezo cha kukhala ndi vuto la mtima ndi leukopenia.
Mkhalidwe pambuyo kupatsirana kwa impso.
Matenda a matenda a minofu yolumikizika, kuphatikizapo systemic lupus erythematosus, scleroderma, concomitant therapy ndi mankhwala omwe angapangitse kusintha kwa chithunzi cha zotumphukira za magazi (mwina kuletsa mafupa hematopoiesis, chitukuko cha neutropenia kapena agranulocytosis) (onani gawo "Kulumikizana ndi mankhwala ena").
Matenda a shuga mellitus (chiopsezo cha hyperkalemia).
Okalamba (chiopsezo cha kuchuluka kwa antihypertensive).
Hyperkalemia

Gwiritsani ntchito pa nthawi yoyembekezera komanso nthawi yoyamwitsa

Ramipril amatsutsana ndi pakati, monga momwe amathandizira mwana wosabadwayo: kufooka kwa impso za mwana wosabadwayo, kuchepa kwa magazi a mwana wosabadwayo komanso wakhanda, kusokonekera kwa impso, hyperkalemia, hypoplasia ya mafupa a chigaza, mafupa a mafupa.
Chifukwa chake, musanamwe mankhwala azimayi a msinkhu wobereka, mimba sayenera kupatula.
Ngati mayi akukonzekera kutenga pakati, ndiye kuti chithandizo ndi zoletsa za ACE ziyenera kusiyidwa.
Pofuna kutsimikizira kuti mayi ali ndi pakati pa nthawi ya mankhwala ndi a Ramipril, muyenera kusiya kumwa mankhwalawo ndikusintha wodwalayo kuti amwe mankhwala ena, mukamagwiritsa ntchito zomwe zingakhale zowopsa kwambiri kwa mwana.
Ngati chithandizo ndi Ramipril ndikofunikira panthawi yoyamwa, kuyamwitsa kuyenera kutha.

Mlingo ndi makonzedwe

Mapiritsi amayenera kumwedwa mosaganizira nthawi yakudya (ndiye kuti, mapiritsi amatha kumwedwa musanadye kapena nthawi ya chakudya) ndikumwa madzi ambiri (1/2 chikho). Musamamwetafuna kapena kumeza miyala musanayambe kugwiritsa ntchito.
Mlingo amasankhidwa malinga ndi achire zotsatira ndi kulolera kwa wodwala mankhwala. Chithandizo nthawi zambiri chimakhala chachitali, ndipo nthawi yake imapangidwa ndi dokotala.
Pokhapokha ngati tinafotokozeredwe mwanjira ina, kenako ndi aimpso ndi chiwindi ntchito, mulingo wambiri womwe uli pansipa ukulimbikitsidwa.
Ndi ochepa matenda oopsa
Nthawi zambiri, mlingo woyambirira ndi 2.5 mg kamodzi tsiku lililonse m'mawa. Ngati mukumwa mankhwalawa kwa milungu itatu kapena kupitilira apo, sizotheka kutulutsa magazi, ndiye kuti mankhwalawa akhoza kuwonjezeka mpaka 5 mg wa ramipril patsiku. Ngati mlingo wa 5 mg sugwira ntchito mokwanira, pakatha milungu iwiri itha kuyerekezera kawiri mpaka 10 mg pa tsiku.
Ngati njira ina yowonjezera mlingo mpaka 10 mg patsiku osakwanira antihypertensive mphamvu ya tsiku ndi tsiku ya 5 mg, ndikotheka kuwonjezera othandizira ena othandizira kulandira chithandizo, makamaka, okodzetsa kapena oletsa "calcium" blockers.
Kulephera kwa mtima kosatha
Mankhwala oyamba a 1.25 mg (1/2 piritsi 2,5 mg) kamodzi pa tsiku. Kutengera ndi momwe wodwalayo amathandizira, mankhwalawa akhoza kuchuluka. Ndikulimbikitsidwa kuti muwonjezere kawiri mlingo ndi masabata a 1-2. Ngati mukufunika kumwa tsiku lililonse la 2,5 mg kapena kupitilira, liperekedwe kamodzi patsiku, kapena magawo awiri.
Pazipita lililonse tsiku lililonse ndi 10 mg.
Ndi matenda ashuga kapena osadwala
Mankhwala oyamba a 1.25 mg kamodzi patsiku (piritsi 1/2 la 2 mg). Mlingo umatha kuchuluka mpaka 5 mg kamodzi patsiku. Ndi mikhalidwe imeneyi, Mlingo wokwera kuposa 5 mg kamodzi patsiku pazoyesedwa zachipatala sizinaphunzire bwino.
Kuchepetsa chiopsezo cha kufa ndi matenda am'mimba, matenda opha ziwalo, kapena mtima mwa odwala omwe ali ndi chiwopsezo chachikulu cha mtima.
Analimbikitsa koyamba mlingo wa 2.5 mg 1 nthawi patsiku. Kutengera kulekerera kwa wodwala, mlingo umatha kupitilizidwa. Ndikulimbikitsidwa kuti muwonjezere kawiri mlingo pambuyo pa sabata limodzi la chithandizo, ndipo mkati mwa milungu itatu yamankhwala, muonjezeni kwa njira yokhayo yokonzera 10 mg kamodzi patsiku.
Mlingo wowonjezera wa 10 mg sunaphunziridwe mokwanira m'mayesero azachipatala olamulidwa. Kugwiritsa ntchito mankhwalawa kwa odwala omwe ali ndi CC ochepera 0.6 ml / sec sikumveka bwino.
Ndi kulephera kwa mtima ndi mawonetseredwe azachipatala omwe amapezeka masiku angapo oyambira (kuyambira pa 2 mpaka tsiku la 9) atatha kulowetsedwa pachimake
Mlingo woyambirira wovomerezeka ndi 5 mg patsiku, womwe umagawidwa awiri Mlingo 2,5 mg, omwe amatengedwa m'mawa ndi wachiwiri madzulo. Ngati wodwalayo salola mlingo woyambayo (kuchepa kwambiri kwa magazi kumawonedwa), ndiye kuti akulimbikitsidwa kumwa mapiritsi a 1.25 mg (1/2 a 2 mg mg) kawiri pa tsiku kwa masiku awiri.
Kenako, kutengera zomwe wodwalayo achita, muyezo utha kuchuluka. Ndikulimbikitsidwa kuti mlingo ndi kuwonjezeka kwake kawiri ndi gawo la masiku 1-3. Pambuyo pake, mlingo wathunthu wa tsiku ndi tsiku, womwe poyamba udagawidwa pawiri, utha kuperekedwa kamodzi. Mlingo woyenera kwambiri ndi 10 mg.
Pakadali pano, zomwe tikukumana nazo pochiza odwala omwe ali ndi vuto lalikulu la mtima (kalasi ya IV-IV yogwira ntchito molingana ndi gulu la NYHA), yomwe idayambika pambuyo poti infernate myocardial infarction, sikokwanira. Ngati odwala oterowo asankha kulandira chithandizo cha mankhwala ndi a Ramipril, tikulimbikitsidwa kuti chithandizo chitha kuyamba ndi mlingo wotsika kwambiri - 1.25 mg (piritsi 1/2 la 2 mg) kamodzi patsiku, ndipo chisamaliro chapadera chikuyenera kuthandizidwa ndikukula kulikonse Mlingo.
Kugwiritsa ntchito mankhwala Ramipril m'magulu ena a odwala
Odwala ndi mkhutu aimpso ntchito
Ndi CC kuchokera 50 mpaka 20 ml / min, muyeso woyamba wa tsiku ndi tsiku nthawi zambiri umakhala 1.25 mg (1/2 piritsi ya 2,5 mg). Mulingo wovomerezeka tsiku lililonse ndi 5 mg.
Odwala omwe ali ndi vuto losakwanira lamadzimadzi ndi ma elekitiroma, odwala omwe ali ochepa kwambiri matenda oopsa, komanso odwala omwe kuchepa kwambiri kwa magazi kumakhala ndi chiwopsezo china (mwachitsanzo, ndi zotupa zam'magazi a mitsempha ndi mitsempha)
Mlingo woyamba umachepetsedwa kukhala 1.25 mg / tsiku (piritsi 1/2 la 2 mg).
Odwala ndi isanachitike diuretic mankhwala
Ndikofunikira, ngati kungatheke, kuletsa kukodzetsa masiku awiri ndi atatu (kutengera nthawi yomwe okodzetsa amakhala nawo) musanayambe chithandizo ndi Ramipril kapena, kuchepetsa kuchuluka kwa okodzetsa omwe atengedwa. Chithandizo cha odwala chotere chiyenera kuyamba ndi mlingo wochepa kwambiri wa 1.25 mg wa ramipril (piritsi 1/2 la 2 mg), amatengedwa kamodzi patsiku, m'mawa. Mutatenga mlingo woyamba komanso nthawi iliyonse mukakulitsa kuchuluka kwa ramipril ndi (kapena) okodzetsa, odwala ayenera kuyang'aniridwa ndi achipatala kwa maola osachepera 8 kuti apewe kusagwirizana ndi hypotensive.
Okalamba okalamba (woposa zaka 65)
Mlingo woyambirira umachepetsedwa kukhala 1.25 mg patsiku (piritsi 1/2 la 2 mg).
Odwala omwe ali ndi vuto la chiwindi
Zomwe magazi akupanga kuti atenge Ramipril zitha kukulira (chifukwa kuchepa kwa ramiprilat excretion), kapena kufooketsa (chifukwa chakuchepetsa kutembenuka kwa ramipril kukhala yogwira ramiprilat). Chifukwa chake, kumayambiriro kwa chithandizo amafunika kuyang'aniridwa mosamala kuchipatala. Mulingo wovomerezeka tsiku lililonse ndi 2,5 mg.

Momwe mungagwiritsire ntchito: Mlingo ndi njira ya chithandizo

Mapiritsiwo amameza lonse (osafuna kutafuna), kutsukidwa ndi madzi okwanira (1/2 chikho) chamadzi, mosasamala kanthu ndi chakudyacho (ndiye kuti, mapiritsi amatha kumwedwa nthawi yonse isanayambe komanso isanayambe kapena itatha). Mlingo amasankhidwa malinga ndi achire zotsatira ndi kulolera kwa wodwala mankhwala.

Kuchiza ndi Ramipril-SZ nthawi zambiri kumakhala kwa nthawi yayitali, ndipo nthawi yake muzochitika zonse zimatsimikiziridwa ndi adokotala.

Pokhapokha pofotokozedwa mwanjira ina, kenako ndi aimpso ndi chiwindi ntchito, njira zotsatirazi zikulimbikitsidwa.

Ndi matenda oopsa kwambiri, nthawi zambiri mlingo woyambira ndi 2,5 mg 1 nthawi patsiku. Ngati mukumwa mankhwalawa kwa milungu itatu kapena kupitilira apo, sizotheka kutulutsa magazi, ndiye kuti mankhwalawa akhoza kuwonjezeka mpaka 5 mg wa ramipril patsiku. Ngati mlingo wa 5 mg sugwira ntchito mokwanira, pakatha milungu iwiri itha kuyerekezera kawiri mpaka 10 mg pa tsiku.

Ngati njira ina yowonjezera mlingo mpaka 10 mg patsiku osakwanira antihypertensive mphamvu ya tsiku ndi tsiku ya 5 mg, ndikotheka kuwonjezera othandizira ena othandizira kuchipatala, makamaka okodzetsa kapena "odekha" calcium blockers.

Kulephera kwa mtima kosalekeza, mankhwala oyamba: 1.25 mg kamodzi patsiku (1/2 piritsi 2,5 mg). Kutengera momwe wodwalayo amamuthandizira, mankhwalawa akhoza kuchuluka. Ndikulimbikitsidwa kuti muwonjezere kawiri mlingo ndi masabata a 1-2. Ngati mukufunika kumwa tsiku ndi tsiku 2,5 mg kapena kuposerapo, mutha kupatsidwa kamodzi patsiku, kapena magawo awiri.

Pazipita lililonse tsiku lililonse ndi 10 mg.

Kwa odwala matenda ashuga kapena omwe alibe matenda a shuga, mankhwalawa oyambira: 1.25 mg kamodzi patsiku (1/2 piritsi 2,5 mg). Mlingo umatha kuchuluka mpaka 5 mg kamodzi patsiku. Ndi mikhalidwe imeneyi, Mlingo wokwera kuposa 5 mg kamodzi patsiku pazoyesedwa zachipatala sizinaphunzire bwino.

Kuti muchepetse chiopsezo cha kufa kwa myocardial, stroko, kapena mtima wamtima mwa odwala omwe ali ndi chiopsezo cha mtima, mtima woyenera wa Ramipril-SZ ndi 2.5 mg kamodzi patsiku. Kutengera kulekerera kwa wodwala, mlingo umatha kupitilizidwa. Ndikulimbikitsidwa kuwonjezereka kawiri pambuyo pa sabata 1 la chithandizo, ndipo mkati mwa milungu itatu yamankhwala, muonjezeni kwa njira yokhayo yokonzera 10 mg kamodzi patsiku.

Mlingo wowonjezera wa 10 mg sunaphunziridwe mokwanira m'mayesero azachipatala olamulidwa.

Kugwiritsa ntchito mankhwalawa odwala omwe ali ndi creatinine chilolezo chochepera 0.6 ml / s sikunaphunzire kokwanira.

Ndi vuto la mtima lomwe lidayamba m'masiku ochepa oyambira (kuyambira pa 2 mpaka tsiku la 9) pambuyo poti mwayamba kupindika, mlingo woyambirira ndi 5 mg tsiku lililonse, ndipo umagawidwa pawiri. ndi wachiwiri madzulo. Ngati wodwala salola mlingo woyambayo (kuchepa kwambiri kwa magazi kumawonedwa), ndiye kuti amalimbikitsidwa kuti apatsidwe 1.25 mg 2 kawiri pa tsiku (1/2 piritsi 2,5 mg) masiku awiri. Kenako, kutengera zomwe wodwalayo achita, muyezo utha kuchuluka. Ndikulimbikitsidwa kuti mlingo ndi kuwonjezeka kwake kawiri ndi gawo la masiku 1-3. Pambuyo pake, mlingo wathunthu wa tsiku ndi tsiku, womwe poyamba udagawidwa pawiri, utha kuperekedwa kamodzi.

Mlingo woyenera kwambiri ndi 10 mg.

Pakadali pano, zomwe takumana nazo pochiritsa odwala omwe ali ndi vuto lalikulu la mtima (kalasi yogwira ntchito ya IV-IV malinga ndi gulu la NYHA), yomwe idachitika mwadzidzidzi pambuyo poyambitsa myocardial infarction, sikokwanira. Ngati odwala oterowo asankha kulandira chithandizo chamankhwala ndi Ramipril-SZ, tikulimbikitsidwa kuti chithandizo chitha kuyamba ndi mlingo wotsika kwambiri - 1.25 mg kamodzi patsiku (1/2 piritsi 2,5 mg) ndi chisamaliro chapadera ziyenera kumwedwa ndi kuchuluka kulikonse Mlingo.

Kugwiritsa ntchito kwa Ramipril-SZ m'magulu ena a odwala

Odwala ndi mkhutu aimpso ntchito: pamene creatinine chilolezo kuchokera 50 mpaka 20 ml / mphindi pa 1,73 m2 thupi, nthawi yoyamba tsiku lililonse 1.25 mg (1/2 piritsi 2.5 mg). Mulingo wovomerezeka tsiku lililonse ndi 5 mg.

Odwala omwe ali ndi vuto losintha pang'ono lamadzimadzi ndi ma elekitiroma, odwala omwe ali ochepa kwambiri matenda oopsa, komanso odwala omwe kuchepa kwambiri kwa magazi kumabweretsa chiwopsezo china (mwachitsanzo, ndi zotupa zam'magazi a mitsempha ndi mitsempha ya m'magazi): mlingo woyambira umachepetsedwa mpaka 1.25 mg / tsiku (1/2 piritsi 2,5 mg).

Odwala omwe ali ndi diuretic yapita: ngati kungatheke, okodzetsa ayenera kuthetsedweratu pakapita masiku atatu (kutengera nthawi yokhudza kukodzetsa) asanayambe chithandizo ndi Ramipril-SZ kapena, makamaka, kuchepetsa okodzetsa otengedwa. Chithandizo cha odwala awa chiyenera kuyamba ndi mlingo wochepa kwambiri wa 1.25 mg wa ramipril (1/2 piritsi ya 2,5 mg), wotengedwa kamodzi patsiku, m'mawa. Atamwa mlingo woyamba komanso nthawi iliyonse mukachulukitsa mlingo wa ramipril ndi (kapena) “okhuthala” okodzetsa, odwala amayenera kuyang'aniridwa ndi achipatala kwa maola osachepera 8 kuti apewe kusagwirizana ndi hypotensive.

Odwala okalamba (opitilira 65): mlingo woyambirira uyenera kuchepetsedwa mpaka 1.25 mg patsiku (1/2 piritsi 2,5 mg).

Odwala omwe ali ndi vuto la chiwindi ntchito: kuthamanga kwa magazi chifukwa chotenga Ramipril-SZ kumatha kuwonjezeka (chifukwa cha kutsika kwa ramiprilat excretion), kapena kufooka (chifukwa chakuchepa kwa kutembenuka kwa ramipril kuti asagwire ntchito) Chifukwa chake, kumayambiriro kwa chithandizo amafunika kuyang'aniridwa mosamala kuchipatala. Mulingo wovomerezeka tsiku lililonse ndi 2,5 mg.

Zotsatira za pharmacological

Chithandizo chogwira ntchito cha Ramipril-SZ mothandizidwa ndi "chiwindi" cha ma enzymes chimasinthidwa kukhala yogwira metabolite ramiprilat, yomwe imalepheretsa nthawi yayitali ku ACE. ACE mu plasma ndi zimakhala zimathandizira kusintha kwa angiotensin I ku angiotensin II ndi kuwonongeka kwa bradykinin. Chifukwa chake, mutenga ramipril mkati, mapangidwe a angiotensin II amachepetsa ndipo bradykinin imadziunjikira, yomwe imayambitsa vasodilation ndi kuchepa kwa kuthamanga kwa magazi (BP).

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

Angiotensin II imalimbikitsa kupanga aldosterone, kotero kutenga ramipril kumachepetsa kubisalira kwa aldosterone ndikuwonjezera zomwe seramu imakhala ndi potonium ion.

Ndi kuchepa kwa kuchuluka kwa angiotensin II m'mwazi, mphamvu yake yoletsa kukonzanso kwa renin kutengera kwa mayankho olakwika amachotsedwa, zomwe zimapangitsa kuti chiwonetsero cha magazi a plasma renin chiwonjezeke. Amaganiziridwa kuti kukulira kwa zinthu zina zosasangalatsa (makamaka, chifuwa "chowuma") zimaphatikizidwanso ndikuwonjezereka kwa ntchito ya bradykinin.

Odwala omwe ali ndi matenda oopsa, kutenga ramipril kumayambitsa kutsika kwa magazi m'magawo a "kunama" ndi "kuyimirira", popanda kuchuluka kwa mtima (HR). Ramipril amachepetsa kwambiri zotumphukira zotupa (OPSS), popanda kuchititsa kusintha kwa magazi aimpso komanso kuchuluka kwa kusefera kwa mafuta. Mphamvu ya antihypertensive imayamba kuwonekera pakangotha maola 1-2 mutatha kumwa kamodzi pa mankhwalawa, mpaka kufika pakatha maola 3-9, ndipo kumatha maola 24. Ndi mlingo wa mankhwalawa, mphamvu ya antihypertgency imatha kukula pang'onopang'ono, ndipo nthawi zambiri imakhala yolimba pakadutsa masabata atatu mpaka anayi pakukhazikika kwa mankhwalawa ndikulimbikira kwa nthawi yayitali. Mankhwala alibe "achire" matenda, i.e. kusiyidwa kwadzidzidzi kwa mankhwala osokoneza bongo sikuti kumapangitsa kuti magazi azithamanga mosavuta.

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

Odwala omwe ali ndi vuto la mtima wosalephera, ramipril amachepetsa OPSS (kuchepa kwa katundu pamtima), imawonjezera mphamvu ya venous channel ndikuchepetsa kuzaza kwa ventricle yamanzere, yomwe, motero, imabweretsa kutsika kwa preload pamtima. Mwa odwalawa, mukamamwa ramipril, pamakhala kuwonjezeka kwa kutulutsa kwamtima, kachigawo kakang'ono ka thupi ndi kuwongolera zolimbitsa thupi.

Mu matenda a diabetes komanso osadwala matenda a shuga, ramipril amachepetsa kuchepa kwa impso komanso kuyambika kwa kulephera kwa impso, motero, amachepetsa kufunika kwa hemodialysis kapena kupatsirana kwa impso. M'magawo oyamba a matenda ashuga kapena nondiabetesic nephropathy, ramipril amachepetsa kuopsa kwa albuminuria.

Odwala omwe ali ndi chiopsezo chokhala ndi mtima wam'mimba chifukwa cha zotupa zam'mitsempha kapena matenda am'mitsempha. (Matenda am'mitima yamatumbo, mbiri ya matenda otumphukira, mbiri ya sitiroko), kapena matenda osokoneza bongo omwe ali ndi vuto limodzi lowonjezera (microalbuminuria, matenda ochepa) kuchuluka kwa cholesterol yathunthu (OX), kuchepa kwa kuchuluka kwa cholesterol yapamwamba kachulukidwe lipoproteins (HDL-C), kusuta) kuwonjezera kwa ramipril ku chithandizo chamankhwala Amachepetsa kwambiri kuchulukana kwa myocardial infarction, stroke ndi kufa chifukwa cha mtima. Kuphatikiza apo, ramipril imachepetsa chiwerengero cha anthu omwalira, komanso kufunika kosinthira kayendedwe ka zinthu, ndikuchepetsa kuyambika kapena kupitilira kwa matenda olephera a mtima.

Odwala omwe ali ndi vuto la mtima lomwe linayamba m'masiku oyamba kupweteka kwamatumbo (masiku 2-9), kutenga ramipril kuyambira 3 mpaka 10 masiku obadwa nako pachimake amachepetsa chiopsezo cha kufa (mwa 27%), chiopsezo cha kufa mwadzidzidzi (pofika 30) %), chiopsezo cha matenda osalephera a mtima opita patsogolo kwambiri (NYHA kalasi ya III-IV yogwira ntchito mkalasi) / othandizira odwala (27%), mwayi wokhala kuchipatala chotsatira chifukwa cha kulephera kwa mtima (26%).

Mwa odwala ambiri, komanso odwala matenda a shuga, omwe amakhala ndi matenda oopsa komanso kuthamanga kwa magazi, ramipril imachepetsa kwambiri vuto la nephropathy komanso kupezeka kwa microalbuminuria.

Kutulutsa mawonekedwe ndi kapangidwe kake

Fomu ya Mlingo - mapiritsi: pafupifupi oyera kapena oyera, ozungulira-osalimba, okhala ndi kolfer komanso yolowera (mu chosakanizira cholongedza: ma PC 10., Mapaketi atatu muthumba la makatoni, ma PC 14. Mu katoni katoni, 1 kapena 2 mapaketi) .

Mphamvu ya Ramipril yogwira ndi ramipril, piritsi limodzi - 2,5 mg, 5 mg kapena 10 mg.

Zothandiza: lactose, microcrystalline cellulose, aerosil (colloidal silicon dioxide), magnesium stearate, primogel (sodium carboxymethyl starch).

Pharmacokinetics

Ndi makamwa, mayamwidwe ukufika 50-60%. Kudya sikumakhudza kuchuluka kwa mayamwidwe, koma kumachepetsa kuyamwa. Pazitali zambiri za ramipril zimafikiridwa pambuyo pa maola 2-5 pambuyo pa kukhazikitsa. Mu chiwindi, phula limapangidwa, ndikupanga metabolite ramiprilat yogwira ntchito (chiwopsezo chopinga cha ACE ndi 6 kutalika kuposa 6 kwa ramipril) ndi yogwira metabolite diketopiperazine. Kenako ramipril amakumana ndi glucuronidation. Kupatula kwa ramiprilat, ma metabolites onse omwe amapangidwa samawonetsa zochitika za pharmacological.

Ramipril amamangidwa ndi mapuloteni a plasma ndi 73%, ndi ramiprilat - ndi 56%. The bioavailability pambuyo m`kamwa makonzedwe a 2-5-5 mg wa mankhwala ndi 15-27%, pankhani la ramiprilat - 45%. Ndi mlingo wa 5 mg tsiku lililonse, mlingo wokhazikika wa ramiprilat mu plasma umafikiridwa ndi tsiku la 4.

Hafu ya moyo wa ramipril ndi maola 5.1. Kuchuluka kwa ramiprilat mu seramu yamagazi kumachepa pogawa ndikuchotsa gawo limodzi ndi theka la moyo wa maola atatu, pakusintha kwa gawo, theka la moyo ndi maola 15 ndipo gawo lomaliza lomaliza, lomwe limadziwika ndi zambiri za ramiprilat mu plasma - masiku 4-5. Kuchotsa hafu ya moyo kumawonjezeka kwa odwala omwe ali ndi vuto laimpso.

Kuchulukitsidwa kwama ramipril ndi malita 90, ramiprilata ndi 500 malita. Thupi limapukusidwa kudzera mu impso mu 60% ya mankhwala omwe atengedwa, ndipo matumbo - 40% (makamaka mwa metabolites). Ndi kukanika kwa aimpso, kuchuluka kwa ramipril ndi ma metabolites ake kumachepera molingana ndi kuchepa kwa chilolezo cha creatinine, ndi kuperewera kwa chiwindi, kutembenuka kwake ku ramiprilat kumalepheretsedwa, ndipo mu mtima kulephera, zomwe zili mu ramiprilat zimachulukitsa nthawi 1.5-1.8.

Malangizo a Ramipril: njira ndi mlingo

Mapiritsi amatengedwa pakamwa musanadye kapena mutatha kudya, kumeza lonse ndi madzi.

Dokotala amamufotokozera za mankhwalawa malinga ndi momwe matendawa amathandizira, makamaka chifukwa cha kulolerana komanso chithandizo cha mankhwala.

Matenda oopsa: Mankhwala oyamba ndi 2,5 mg 1 nthawi patsiku (m'mawa) kapena mu 2 waukulu. Kukwaniritsa kufunika kwa achire, kuwonjezereka kwa mankhwalawa kumatheka pambuyo pa milungu iwiri ya chithandizo. Mlingo wokonzanso mwachizolowezi ndi 2.5-5 mg, upamwamba ndi 10 mg patsiku. Ndi mankhwala a diuretic am'mbuyomu, ayenera kuchotsedwa kapena kuti mankhwalawo athetsedwe osapitirira masiku atatu musanayambe Ramipril.Mlingo woyamba wa odwala omwe ali ndi okodzetsa, odwala omwe ali ndi vuto la impso kapena ochepa matenda oopsa ndi mtima kulephera ndi 1.25 mg patsiku kamodzi. Kugwiritsa ntchito kuyenera kuyambika kuyang'aniridwa ndi dokotala. Kwa odwala omwe ali ndi vuto losakanikirana ndi ma electrolyte kapena chiopsezo cha antihypertensive, mankhwala oyamba tsiku lililonse sayenera kupitirira 1.25 mg,
Kulephera kwa mtima kosatha: mlingo woyamba ndi 1.25 mg kamodzi, ngati kuli kotheka, muyezowo ungathe kuchulukitsidwa pambuyo pa masabata 1-2. Mlingo watsiku ndi tsiku sayenera kupitilira 10 mg. Ndi munthawi yomweyo makonzedwe a okodzetsa, mlingo wawo uyenera kuchepetsedwa asanayambe chithandizo,
Kulephera kwa mtima komwe kunachitika mkati mwa 2-9 patatha masiku osokoneza bongo: kuyambirira kwa mankhwalawa - 2,5 mg kawiri patsiku (m'mawa ndi madzulo) ndipo patatha masiku awiri a chithandizo - 5 mg 2 kawiri pa tsiku. Kukonza mlingo - 2,5-5 mg 2 kawiri pa tsiku. Ngati mankhwalawa salekerera bwino (ochepa ochepa), mlingo woyambayo uyenera kuchepetsedwa kukhala 1.25 mg kawiri pa tsiku, ndiye kuti pambuyo pa masiku awiri utha kuwonjezereka mpaka 2,5 mg, ndipo pambuyo masiku 2 mpaka 5 mg 2 kawiri pa tsiku. Mlingo watsiku ndi tsiku sayenera kupitilira 10 mg. Ngati mulingo wolekerera bwino, 2,5 mg 2 pa tsiku ziyenera kusiyidwa. Chifukwa chosakwanira ndi kugwiritsa ntchito kwa Ramipril mwa odwala omwe ali ndi vuto lalikulu la mtima la kalasi yothandizira ya IV-IV (malinga ndi gulu la NYHA) zomwe zimachitika atangomaliza kupweteka kwa myocardial, mlingo woyambirira wa gulu ili la odwala suyenera kupitirira 1.25 mg kamodzi patsiku. Kuchulukitsa kwa mankhwalawa kuyenera kuchitika moyang'aniridwa ndi dokotala,
Nephropathy aakulu mawonekedwe a impso, matenda ashuga nephropathy: koyamba mlingo - 1.25 mg kamodzi. Ndi kulekerera bwino kwa mankhwalawa, muyezo mutha kuwirikiza kawiri pakatha milungu iwiri kufikira mutapeza mlingo wa 5 mg kamodzi patsiku,
Kuchepetsa chiopsezo cha stroke, myocardial infarction, kapena mtima wamatenda omwe ali ndi chiwopsezo chachikulu cha mtima: mlingo woyambirira ndi 2.5 mg kamodzi. Kuwonjezeka kwapang'onopang'ono kwa mlingo kumawonetsedwa: pambuyo pa sabata 1, kenako pakatha milungu iwiri - mpaka kukonzekera mlingo wa 10 mg kamodzi patsiku.

Mlingo woyenera wa Ramipril kwa odwala omwe ali ndi vuto la impso:

CC ochepera 30 ml / mphindi: mlingo woyambirira - 1.25 mg wa patsiku, pazipita - 5 mg,
KK 30-60 ml / min: muyeso woyamba - 2,5 mg patsiku, pazipita - 5 mg,
CC oposa 60 ml / mphindi: mlingo woyambira ndi 2,5 mg patsiku, upamwamba ndi 10 mg.

Ndi kulephera kwa chiwindi, muyeso woyamba sayenera kupitirira 1.25 mg, pazokwanira - 2,5 mg kamodzi.

Mlingo woyambirira wa odwala okalamba ndi 1.25 mg patsiku.

Kuwongolera kwapadera kumafunikira kwa odwala azaka zopitilira 65 omwe amatenga okodzetsa, kwa odwala omwe ali ndi vuto la mtima losalekeza komanso aimpso. Mlingo umasankhidwa kutengera mulingo wamavuto a magazi.