Lisinopril (10 mg, Himfarm AO) Lisinopril

5 mg, 10 mg ndi 20 mg mapiritsi

Piritsi limodzi lili

ntchito yogwira - lisinopril dihydrate 5.5 mg, 11.0 mg kapena 22.0 mg

(zofanana ndi lisinopril 5.0 mg, 10,0 mg kapena 20.0 mg)

zokopa: lactose monohydrate, microcrystalline cellulose, sodium starch glycolate, calcium stearate.

Mapiritsiwo ndi oyera kwa kirimu utoto woterera-wozungulira, mbali ina ya piritsiyo pali chamfer, mbali inayo - chamfer ndi logo yamakampani mu mawonekedwe a mtanda (pamiyeso ya 5 ndi 20 mg).

Mapiritsiwo ndi oyera kwa kirimu utoto wonyezimira, mbali ina ya piritsi pali chamfer ndi chiwopsezo, mbali inayo - chamfer ndi logo yamakampani mu mawonekedwe a mtanda (pa mulingo wa 10 mg).

Gulu la Pharmacotherapeutic

Mankhwala osokoneza bongo omwe amakhudza dongosolo la renin-angiotensin. Angiotensin-converting enzyme (ACF) zoletsa. Lisinopril.

Code ATX C09AA03

Fzida zankhondo

Pharmacokinetics

Kudya sizikhudzana ndi mayamwa. Kwambiri ndende ya madzi am`magazi amafikira pafupifupi maola 6 pambuyo m`kamwa makonzedwe a lisinopril. Bioavailability ndi 29%. Kuphatikiza pa mgwirizano wake ndi puloteni ya angiotensin, sizigwirizana ndi mapuloteni ena a plasma. Sipangaphatikizidwe, imapukusidwa kwathunthu ndi impso osasinthika. Hafu ya moyo ndi maola 12.6. Lisinopril amadutsa chotchinga.

Mankhwala

Lisinopril ndi wa gulu la angiotensin-otembenuza enzyme zoletsa. Kuponderezedwa kwa ACF kumabweretsa kufupika kwa mapangidwe a angiotensin II (ndi vasoconstrictor athari) ndi kuchepa kwa secretion ya aldosterone. Lisinopril amaletsanso kuwonongeka kwa bradykinin, peptide yamphamvu ya vasodepressor. Zotsatira zake, amachepetsa kuthamanga kwa magazi, kupuma kwamitsempha yamagazi, kukonzekera komanso kutsekemera pamtima, kumawonjezera kuchuluka kwa miniti, kutulutsa kwamtima, kumathandizira kulolerana kwazinthu zamkati komanso kumapangitsa magazi kupita ku ischemic myocardium. Odwala omwe ali ndi kupweteka kwam'mnyewa wamtima wam'mimba, lisinopril pamodzi ndi nitrate amachepetsa mapangidwe amanzere amitsempha yama mtima kapena mtima.

Amathandizira kubwezeretsa kwa endothelial yowonongeka kwa odwala omwe ali ndi hyperglycemia.

Kuchepa kwa kuthamanga kwa magazi kumayambira ola limodzi mutatha kumwa mankhwalawo mkati ndikufika pazokwanira pambuyo maola 6. Kutalika kwa zochita za lisinopril kumadalira mlingo ndipo pafupifupi maola 24, omwe amakupatsani mwayi kugwiritsa ntchito mankhwalawa 1 patsiku. Ndi chithandizo chakanthawi, mphamvu ya mankhwalawa sikuchepa. Ndi kutha kwakanema kwa chithandizo, kusintha kwakukulu mu kuthamanga kwa magazi (matenda olekana) sikuchitika.

Ngakhale mphamvu yayikulu ya lisinopril imalumikizidwa ndi renin-angiotensin-aldosterone dongosolo, mankhwalawa amagwiranso ntchito pazovuta zamankhwala ocheperako okhala ndi renin.

Kuphatikiza kutsika kwatsiku ndi magazi, lisinopril imachepetsa albuminuria chifukwa cha kusintha mu histology ndi hemodynamics ya zida zamafuta a impso.

Mlingo ndi makonzedwe

Lisinopril amatengedwa pakamwa, ngakhale zakudya, 1 nthawi patsiku, makamaka nthawi imodzi.

Lisinopril angagwiritsidwe ntchito ngati monotherapy kapena kuphatikiza ndi mankhwala ena a antihypertensive.

Ndi ochepa matenda oopsa, mwachizolowezi mlingo woyambirira wa mankhwalawa ndi 10 mg. Odwala omwe ali ndi vuto lalikulu la renin-angiotensin-aldosterone system (makamaka, ndi kukonzanso kwamitsempha, vuto la mtima, kapena matenda oopsa), kuchepa kwambiri kwa magazi pambuyo pakuchitika kwa magazi koyamba. Chifukwa chake, odwala oterewa amalimbikitsidwa muyeso woyamba wa 2,5-5 mg woyang'aniridwa ndi dokotala.

Kuchiza kuyenera kuyamba ndi 5 mg tsiku lililonse m'mawa. Kutalika kwa nthawi pakati pa kuchuluka kwake kuyenera kukhala milungu itatu. Mulingo woyenera wokonza ndi 10-20 mg wa Lisinopril 1 nthawi patsiku, ndipo pazipita tsiku lililonse ndi 40 mg 1 nthawi patsiku. Kuti muchepetse kuthamanga kwa magazi, Lisinopril ayenera kuphatikizidwa ndi mankhwala ena a antihypertensive.

Nthawi zambiri, pafupifupi achire mlingo 20 mg kamodzi patsiku. Ngati kufunika kwa achire zotsatira sizingachitike mkati mwa masabata a 2-4, mlingowo ungakulidwe.

Mankhwala a diuretic ayenera kusiyidwa masiku atatu isanayambe kumwa Lisinopril. Ngati palibe kuchotsera okodzetsa, ndiye kuti ndikulimbikitsidwa kuti muyambe mankhwala a Lisinopril ndi 5 mg patsiku. Ndikofunikira kuwongolera ntchito yaimpso ndi kuchuluka kwa seramu potaziyamu.

Lisinopril adapangidwira kuwonjezera pa mankhwala omwe alipo ndi okodzetsa, mtima glycosides kapena beta-blockers. Pankhaniyi, zoyambirira, momwe zingathekere, mlingo wa okodzetsa uyenera kuchepetsedwa. Mlingo woyamba ndi 2,5 mamawa. Njira yokonzanso imakhazikitsidwa m'magawo ndi kuwonjezeka kwa 2,5 mg ndi nthawi ya masabata awiri. Mulingo woyenera wokonza ndi 520 mg kamodzi tsiku lililonse. Sitikulimbikitsidwa kupitirira 35 mg patsiku.

Pa mankhwala, muyenera kuyang'anira kuthamanga kwa magazi, ntchito yaimpso, kuchuluka kwa potaziyamu ndi sodium mu seramu yamagazi kuti mupewe kukula kwa hypotension komanso kugwirizana kwa kuwonongeka kwa aimpso.

Pachimake m`mnyewa wamtima infaration odwala khola hemodynamics

Kuchiza ndi lisinopril kumatha kuyamba patadutsa maola 24 pambuyo poti khansa ya m'magazi iwonongeke kwambiri (100stHH), popanda zizindikiro za vuto la impso), kuwonjezera pa mankhwalawa amtundu wa infarction ya myocardial (othandizira a thrombolytic, acetylsalicylic acid, beta-blockers, nitrate mu monga mafupa amkati ndi transdermal).

Mlingo woyambirira ndi 5 mg, pambuyo maola 24 - wina 5 mg, pambuyo maola 48 - 10 mg wa Lisinopril. Ndiye kuti mlingo ndi 10 mg 1 nthawi patsiku.

Odwala omwe ali ndi vuto lochepa kwambiri wamagazi (≤ 120 mm Hg) ayenera kupatsidwa chithandizo chochepa cha Lisinopril, 2,5 mg, asanayambe mankhwala kapena masiku atatu oyamba atadwala matenda a mtima.

Kuchiza kuyenera kupitilizidwa kwa milungu 6. Mlingo wokonza mankhwalawa ndi 10 mg patsiku. Odwala omwe ali ndi vuto la mtima akulephera amalimbikitsidwa kuti apitilize mankhwala ndi Lisinopril.

Zomwe zimagwiritsidwa ntchito pakuchepa kwa impso

Popeza kuthetsa kwa lisinopril kudutsa impso, muyeso woyambirira umadalira kuvomerezeka kwa creatinine, njira yokonza imadalira mayankho azachipatala, ndipo amasankhidwa ndikuwunika kawirikawiri aimpso, serum potaziyamu ndi kutsata kwa sodium.

Chilolezo cha Creatinine (ml / min)

Mlingo woyambirira (mg / tsiku)

3 g / tsiku, amatha kuchepetsa kuchuluka kwa ma ACF zoletsa. Kugwiritsa ntchito pamodzi kwa ma NSAIDs ndi ma ACF zoletsa kungayambitse hyperkalemia, yomwe imayipa ntchito ya impso. Izi zimakonda kusinthidwa, ndipo mawonekedwe ake ndiwotheka, choyambirira, mwa odwala omwe ali ndi vuto laimpso. Kuphatikiza kwa ACF inhibitors ndi NSAID kuyenera kuyikidwa mosamala, makamaka kwa achikulire kapena anthu otopa. Odwala ayenera kukhala ndi madzi okwanira, pambuyo pa maphunziro ndikofunikira kuti ayang'ane ntchito ya impso.

Ngati zoletsa za ACF ndi kukonzekera kwa golide zimaperekedwa ngati jakisoni (mwachitsanzo sodium aurothiomalate), mawonekedwe amtundu wa nitrate (zizindikiro za vasodilation, kuphatikiza kuyimba, nseru, chizungulire komanso hypotension, zomwe nthawi zina zimakhala zovuta kwambiri) zimatha kukhazikika.

Kugwiritsa ntchito munthawi yomweyo mankhwala ena a antihypertensive kungakulitse kuchuluka kwa chidwi cha lisinopril. Kuphatikizidwa kwa lisinopril ndi nitroglycerin, nitrate ena, kapena ma vasodilators ena amathanso kutsitsa magazi.

Mosamala, onani mankhwala osakanikirana ndi munthawi yomweyo kugwiritsa ntchito mankhwala oletsa kupha, osokoneza bongo antidepressants ndi ma antipsychotic omwe ali ndi ACF zoletsa chifukwa cha kuchuluka kwa hypotensive.

Sympathomimetics ingachepetse kuchuluka kwa ma ACF zoletsa.

Kugwiritsidwa ntchito mosiyanasiyana kwa mankhwala a Lisinopril ndi antidiabetic (insulin, mankhwala a hypoglycemic)

limbitsani mphamvu ya hypoglycemic yotsirizira ndi chiopsezo cha hypoglycemia. Izi zimachitika makamaka mkati mwa masabata oyambilira ophatikiza ndi odwala omwe ali ndi vuto la aimpso.

Lisinopril angagwiritsidwe ntchito nthawi imodzi ndi acetylsalicylic acid (mu milingo yopereka antiplatelet athari), thrombolytics, beta-blockers ndi / kapena nitrate.

Malangizo apadera

Pchitukukoowonetsa ochepahypotension n`zotheka kwa odwala omwe ali ndi hyponatremia komanso / kapena kuchepetsedwa magazi kuzungulira magazi chifukwa chamankhwala othandizira kugaya, kugwiritsa ntchito zakudya zapadera kapena kuchepa kwa thupi pazifukwa zina (kutukwana thukuta, kusanza mobwerezabwereza, kutsekula m'mimba, dialysis) komanso ndi kulephera kwa mtima. Chithandizo cha hypotension chimakhala mpumulo wa bedi, ndipo ngati ndi kotheka, mankhwala a kulowetsedwa. Kutsika kwapang'onopang'ono kwa kuthamanga kwa magazi sikukulepheretsa kulandira chithandizo ndi Lisinopril, komabe, kusiya kwa nthawi yochepa kwa mankhwalawa kapena kuchepetsa mankhwala kungafunike.

Mankhwalawa ndi Lisinopril ayenera kuperekedweratu ndi vuto la kusalinganika kwa madzi ndi electrolyte ndikuchotsa kufooka kwa magazi, komanso, ndikofunikira kuyang'anira kusintha kwa kuthamanga kwa magazi mutatha kumwa koyamba.

Mu matenda a cerebrovascular and coronary heart heart, ziyenera kukumbukiridwa kuti kuchepa kwakukulu kwa kuthamanga kwa magazi kungayambitse kukula kwa stroko kapena myocardial infarction.

Mu pachimake myocardial infarction mankhwalawa lisinopril ali osavomerezeka kuti ayambe odwala omwe ali ndi vuto la impso, omwe amatsimikiza ndi serum creatinine ndende yomwe ili pamwamba pa 177 μmol / L ndi / kapena proteinuria yoposa 500 mg / 24 h. 265 μmol / l), ndiye kuti kuthetsedwa kwake ndikofunikira.

Chithandizo ndi lisinopril chimaphatikizidwa milandu Cardiogenic mantha ndi pachimake myocardial infarationNgati kupezeka kwa vasodilator kumatha kuwononga kwambiri hemodynamics, mwachitsanzo, kupanikizika kwa systolic sikupitirira 100 mm Hg

Ndi kupanikizika kwa systolic kosaposa 120 mm Hg, Mlingo wocheperako wa Lisinopril amadziwika mu masiku atatu oyamba a infarction ya 2 - 2 mg / tsiku. Ndi ochepa hypotension, mlingo wokonza umachepetsedwa mpaka 5 mg / tsiku kapena kwakanthawi mpaka 2.5 mg / tsiku. Ndi hypotension ya nthawi yayitali, ndi kupanikizika kwa systolic pansi pa 90 mm Hg, mankhwalawa adatha.

Ndia impso artery tenosis (mayiko awiri kapena osagwirizana ndi amodziimpso)

Odwala ena omwe ali ndi vuto la impso a stenosis kapena stenosis ya mtsempha wama impso amodzi, kuikidwa kwa Lisinopril kumakulitsa kuchuluka kwa urea ndi creatinine mu seramu yamagazi, yomwe, monga lamulo, imasinthanso pambuyo pakuchotsa chithandizo. Izi ndizofala kwambiri kwa odwala omwe ali ndi vuto la impso.

AtMatenda a renovascular Palinso chiopsezo chokhala ndi ochepa owopsa komanso kulephera kwaimpso. Odwala awa, chithandizo ndi lisinopril iyenera kuyambitsidwa moyang'aniridwa mosamala ndi madokotala ochepa, ndikutsatira.

Aortic, mitral valve stenosis, hypertrophic cardiomyopathy

Monga zoletsa zina za ACF, lisinopril iyenera kugwiritsidwa ntchito mosamala odwala omwe ali ndi mitral valve stenosis, aortic valve valve, kapena hypertrophic Cardiomyopathy.

Angioedema ndi osowa kwa odwala omwe amalandira ma ACF inhibitors. Zikatero, mankhwalawa amayenera kuyimitsidwa nthawi yomweyo ndipo chithandizo choyenera chikuyenera kuperekedwa mpaka zizindikiro za edema zitathetsedwa.

Opaleshoni yayikulu kapena mankhwala osokoneza bongo omwe ali ndi hypotensive zotsatira, Lisinopril amatchinga kutembenuza kwa renin yothandizira kuti angiotensin-II. Hypotension, yomwe ingakhale chifukwa chamapangidwe omwe ali pamwambapa, imatha kuthetsedwa mwa kubwezeretsanso kuchuluka kwa magazi.

Hemodialysis/ LDLlipid apheresis / desensitization mankhwala

Ndi munthawi yomweyo makonzedwe a Lisinopril ndi dialysis ndi polyacryl-nitrile membrane kapena LDL (otsika kachulukidwe lipoprotein) apheresis yokhala ndi dextran sulfate kapena desensitization motsutsana ndi ziphe (njuchi, mavu), anaphylactic.

Ndikulimbikitsidwa kuti mugwiritse ntchito mawonekedwe amtundu wina wa dialysis kapena m'malo mwakanthawi Lisinopril ndi mankhwala ena a antihypertensive (osati ACF inhibitors).

Asanatsimikizike, lisinopril liyenera kuletsedwa.

Neutropenia, agranulocytosis, thrombocytopenia ndi kuchepa kwa magazi m'thupi amawonedwa kawirikawiri odwala omwe amalandila ACF zoletsa. Izi zimasinthika pambuyo pakuchotsedwa kwa Lisinopril. Mankhwala ayenera kugwiritsidwa ntchito mosamala kwambiri odwala omwe ali ndi matenda a autoimmune omwe amalandila immunosuppressants, allopurinol, kapena procainamide. Mukamagwiritsa ntchito lisinopril mwa odwala, kuyang'anira momwe leukocytes m'magazi amalimbikitsidwa.

Ncholowaaytsankhogalactose akusowa Lapp lactase,shuga malabsorption syndrome - galactose

Lisinopril sayenera kutumizidwa kwa odwala omwe samadziwika kawirikawiri cholowa cha galactose, Lapp lactase akusowa kapena vuto la kufooka kwa glucose - galactose chifukwa cha kupezeka kwa lactose monohydrate mu kapangidwe kake.

Zomwe zimachitika chifukwa cha mankhwalawa amatha kuyendetsa galimoto kapena njira zoopsa

Mukutenga Lisinopril, osavomerezeka kuyendetsa galimoto ndikugwira ntchito ndi njira zoopsa, chifukwa cha kuthekera kwazomwe zimachitika poyambira (chizungulire).

Bongo

Zizindikiro kwambiri hypotension mpaka kugwedezeka boma, Hyperkalemia, bradycardia, tachycardia, kufupika, kulephera kwaimpso, kutsokomola, chizungulire, nkhawa.

Chithandizo: chapamimba, kudya kwa adsorbents ndi sodium sodium pambuyo mutatenga mapiritsi a Lisinopril mkati. Ndikofunikira kuwongolera moyenera-electrolyte bwino komanso ndende ya serum creatinine.

Syndrome Syntomatic mankhwala zotchulidwa, intravenous makonzedwe a 0,9% sodium kolorayidi yankho, adrenergic agonists woopsa hypotension. Ndi bradycardia, atropine imayendetsedwa, ngati kuli kofunikira, ndizotheka kulingalira za pacemaker. Lisinopril amachotseredwa ndi hemodialysis.

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