Amlodipine Lisinopril > Chithandizo ndi kupewa

Dzina lachi Latin: Amlodipine + Lisinopril

Code ya ATX: C09BB03

Chithandizo chogwira: amlodipine (Amlodipine) + lisinopril (Lisinopril)

Wopanga: Severnaya Zvezda CJSC (Russia)

Kusintha malongosoledwe ndi chithunzi: 07/10/2019

Amlodipine + Lisinopril ndi mankhwala ophatikiza antihypertensive okhala ndi pang'onopang'ono calcium blockchain ndi angiotensin kutembenuza enzyme (ACE) inhibitor.

Kutulutsa mawonekedwe ndi kapangidwe kake

Mankhwalawa amapezeka mu mawonekedwe a mapiritsi: ozungulira, osalala, oyera kapena oyera, okhala ndi chamfer ndi mzere wogawanika (10 iliyonse mumapaketi osakanikirana, pamakatoni a 3, 5 kapena 6 mapaketi, 30 zidutswa m'mitsuko kapena mabotolo, mu bokosi la makatoni 1 amatha kapena botolo. Paketi iliyonse ilinso ndi malangizo ogwiritsira ntchito Amlodipine + Lisinopril.

Piritsi limodzi lili:

zosakaniza: amlodipine (mu mawonekedwe a amlodipine besilate) + lisinopril (mawonekedwe a lisinopril dihydrate) - 5 mg (6.95 mg) + 10 mg (10.93 mg), 10 mg (13.9 mg) + 20 mg (21 , 86 mg) kapena 5 mg (6.95 mg) + 20 mg (21.86 mg),
othandizira zigawo zikuluzikulu: wowuma wa sodium carboxymethyl, anerrous aerosil (silicon dioxide colloidal anhydrous), cellcosestalline cellulose, magnesium stearate.

Mankhwala

Amlodipine + Lisinopril ndi mankhwala ophatikiza antihypertensive, kapangidwe kake kamene kamachitika chifukwa cha zinthu zomwe zimagwira - amlodipine ndi lisinopril.

Amlodipine ndi calcium blockchain, omwe amachokera ku dihydropyridine. Ili ndi hypotensive komanso antianginal effect. Kuchita kwake kwa antihypertgency kumachitika chifukwa chopumula kumachitika mwachindunji pa maselo osalala a khoma lamitsempha. Thupi limalepheretsa kusintha kwa transmembrane kwa calcium ayoni kuti minyewa yosalala ya mtima khoma komanso mtima wamitsempha. Mphamvu ya antiquinal ya amlodipine imatsimikiza kukulira kwa ma coronary ndi zotumphukira zama cell ndi arterioles. Ndi angina pectoris, izi zimathandiza kuchepetsa zovuta za myocardial ischemia. Kukula kwa zotumphukira za arterioles kumabweretsa kuchepa kwa OPSS (okwana zotumphukira zamitsempha), kuchepa kwa katundu pambuyo pamtima ndi myocardial oxygen akufuna. Kukula kwa mitsempha yama coronary ndi ma arterioles m'malo a ischemic komanso osasinthika a myocardium kumapereka kuwonjezeka kwa okosijeni omwe amalowa myocardium (makamaka ndi vasospastic angina pectoris). Amlodipine imalepheretsa kuphipha kwamitsempha yama coronary, yomwe imatha kupezeka, kuphatikizapo kusuta.

Kukhalitsa kwa nthawi yayitali kumadalira mlingo. Ndi ochepa matenda oopsa, kutenga amlodipine kamodzi patsiku kumathandizira kutsika kwamphamvu kwa kuthamanga kwa magazi (BP) kwa maola makumi awiri ndi awiri.

Kwa amlodipine, kupezeka kwa pachimake ochepa hypotension sikuchitika chifukwa cha kuyambukira kwa pang'onopang'ono kwa mphamvu ya antihypertensive. Ndi khola la angina pectoris, tsiku limodzi mlingo umakulitsa kulimbitsa thupi, kumathandizira kuchepa kwa vuto la angina ndi kukhumudwa kwa gawo la ischemic, ndikuchepetsa pafupipafupi kuukira kwa angina ndi kufunika kotenga nitroglycerin kapena nitrate ena.

Amlodipine sasokoneza myocardial contractility ndi momwe amapangira, amachepetsa mphamvu ya kumanzere kwamitsempha yamagazi. Imalepheretsa kuphatikiza kwa maselo a m'magazi, sikumapangitsa kuchuluka kwa mtima (HR), kumachulukitsa kuchuluka kwa kusefukira kwa magazi (GFR), komanso kufooka.

Akuluakulu kuchepa kwa magazi kuthamanga pambuyo 6-10 maola, zotsatira kumatenga maola 24. Odwala odwala matenda ashuga nephropathy, kumwa mankhwalawa sayambitsa kuchuluka kwa microalbuminuria. Palibe zotsatira zoyipa za amlodipine pa metabolism kapena plasma lipid concentration. Kugwiritsidwa ntchito kwake kumawonetsedwa kwa odwala omwe ali ndi concomitant pathologies monga mphumu ya bronchial, shuga mellitus, gout.

Kugwiritsa ntchito amlodipine mu angina pectoris, carotid atherosulinosis, kuchokera ku kuwonongeka kwa chotengera chimodzi kupita ku stenosis yamitsempha itatu kapena kuposerapo (matenda amitsempha yamagazi) komanso odwala ena omwe ali ndi vuto la mtima kapena kulowerera kwa coronary angioplasty. makanema ogwiritsira ntchito mitsempha ya carotid, amathandizira kuchepetsa chiwerengero cha anthu amafa chifukwa cha matenda amitsempha yam'mimba, sitiroko, zotupa za mitsempha yodutsa m'mitsempha kapena galimotoyi yodutsa. anary angioplasty. Kuphatikiza apo, kuchuluka kwa zipatala chifukwa cha kuchuluka kwa matenda a mtima osakhazikika komanso angina osakhazikika kumachepetsedwa, ndipo pafupipafupi kuchitapo kanthu kubwezeretsanso magazi ake kumachepa.

Odwala omwe ali ndi vuto la mtima losagwirizana ndi gulu la IV - IV yogwira ntchito molingana ndi gulu la NYHA (New York Cardiac Association), kugwiritsa ntchito nthawi yomweyo kwa amlodipine ndi digoxin, ACE inhibitors kapena diuretics sikukuonjezera ngozi ndi kufa.

Ndi etiology yopanda-ischemic yodwala matenda a mtima olephera (kalasi la NYHA III - kalasi yothandizira IV), amlodipine imawonjezera chiopsezo cha pulmonary edema.

Lisinopril, wokhala ACE inhibitor, amachepetsa mapangidwe a angiotensin II kuchokera ku angiotensin I, omwe amatsogolera kuchepa kwa ndende ya angiotensin II komanso kuchepa mwachindunji kwa secretion ya aldosterone. Mothandizidwa ndi lisinopril, kuchepa kwa bradykinin kumachepa, ndipo kuphatikizika kwa ma prostaglandins kumawonjezeka. Pakuchepetsa OPSS, preload, kuthamanga kwa magazi ndi kukakamira kwa m'mapapo m'mapapo, chinthucho chimakulitsa kuchuluka kwa magazi ndikuwonjezera kulolerana kwa myocardial kulimbitsa thupi kwakuthupi kosalephera. Mitsempha yamagazi imakulitsa mpaka kukula kwambiri kuposa misempha. Zina mwa zotsatira za lisinopril zimafotokozedwa ndi momwe minofu renin-angiotensin imathandizira. Poyerekeza ndi chithandizo cha nthawi yayitali, pali kuchepa kwa matenda oopsa a m'mitsempha komanso makoma a mitsempha yotulutsa.

Lisinopril amasintha magazi kupita ku ischemic myocardium.

Kugwiritsa ntchito zoletsa za ACE mwa odwala omwe ali ndi vuto la mtima kulephera kumatenga nthawi yayitali, ndipo odwala omwe adwala matenda amisala popanda kuwonekera kwa chiperewere, mtima wawo umachepa.

Pambuyo pakukonzekera pakamwa, lisinopril imayamba kuchita pambuyo pa ola limodzi, mphamvu yayikulu yotsika imachitika pambuyo pa maola 6-7 ndipo imatha kwa maola 24. Odwala ochepa matenda oopsa, chithandizo cha mankhwalawa chimawonedwa pakangotha masiku ochepa chiyambireni chithandizo, ndikukwaniritsa bwino mankhwala, nthawi zonse makonzedwe amafunika masiku 30-60. Kuchoka mwadzidzidzi sikupangitsa kuchuluka kwa magazi. Kuphatikiza pa antihypertensive zotsatira, lisinopril imathandizira kuchepetsa albuminuria, yokhala ndi hyperglycemia, imasintha ntchito ya glomerular endothelium. Odwala omwe ali ndi matenda a shuga, sizimakhudza kuchuluka kwa shuga m'magazi komanso kuchuluka kwa hypoglycemia.

Chifukwa cha kuphatikiza kwa zigawo ziwiri zogwira ntchito mu mankhwala amodzi, Amlodipine + Lisinopril amakupatsani mwayi wofanana ndikuwongolera kuthamanga kwa magazi ndikuletsa kupezeka kwa zotsatira zoyipa.

Pharmacokinetics

Mutatenga Amlodipine + Lisinopril mkati, mayamwidwe azinthu zogwira ntchito amapezeka m'matumbo am'mimba (GIT): amlodipine amalowetsedwa pang'onopang'ono ndipo pafupifupi kwathunthu, lisinopril

25% ya mlingo wotengedwa. Zakudya zomwezi munthawi yomweyo sizikhudza mayamwidwe awo. Kuzindikira kwakukulu (C_max) mu plasma ya amlodipine imatheka pambuyo maola 6-12, lisinopril - atatha maola 6 - 6 ataperekedwa. Ambiri mwamtheradi bioavailability: amlodipine - 64-80%, lisinopril - 25-29%.

Gawo Logawa (V_d) amlodipine pafupifupi 21 l pa 1 makilogalamu amalemu amthupi, izi zikuwonetsa kugawa kwake kofunikira mu minofu.

Kumangidwa kwa amlodipine ku mapuloteni a plasma ndi 97,5% ya gawo m'magazi. Ndende yake yolingana (C_ss) mu plasma yamagazi imatheka pambuyo masiku 7-8 a kudya pafupipafupi.

Lisinopril wokhala ndi mapuloteni a plasma amamangika pofooka.

Zinthu zonse ziwiri zotere zimatha kuthana ndi magazi ndi ubongo.

Amlodipine imapangidwa pang'onopang'ono koma imapangidwa molimba mtima m'chiwindi ndikupanga ma metabolites omwe alibe zofunika pa pharmacological. Zotsatira za "gawo loyambayo" kudzera m'chiwindi sizikudziwika.

Lisinopril m'thupi silinapangidwe, imathandizidwa kudzera mu impso osasinthika. Hafu ya moyo (T_1/2) lisinopril ndi maola 12.

T_1/2 Amlodipine pambuyo pa limodzi mlingo amatha kuchoka pa 35 mpaka 50 maola, motsutsana ndi maziko ogwiritsidwa ntchito mobwerezabwereza - pafupifupi maora 45. Mpaka 60% ya mlingo wovomerezeka umachotsedwa kudzera mu impso: 10% - osasinthika, ena onse - munthawi ya metabolites. Kudzera m'matumbo ndi bile, 20-25% ya mankhwala imachotsedwa. Chilolezo chonse cha amlodipine ndi 0.116 ml / s / kg, kapena 7 ml / min / kg. Ndi hemodialysis, amlodipine samachotsedwa.

Ndi kulephera kwa chiwindi T_1/2 Amlodipine amatalika mpaka maola 60, ndi chithandizo chazitali ndi mankhwalawa, akuyembekezeka kuwonjezera kuchuluka kwake mthupi.

Kulephera kwa mtima kosatha, kuchepa kwa mayamwidwe ndi chilolezo cha lisinopril, bioavailability sichidutsa 16%.

Kulephera kwa aimpso ndi creatinine chilolezo (CC) chochepera 30 ml / min, mulingo wa lisinopril m'madzi am'magazi ndi wokwanira kangapo kuposa kwa odwala omwe ali ndi vuto laimpso. Izi zimawonjezera nthawi yofika C_max m'magazi am'magazi ndi T_1/2.

Odwala okalamba, kuchuluka kwa lisinopril mu madzi a m'magazi kumawonjezereka ndi 60%, AUC (dera lomwe limakhala nthawi yokhazikika kwa ndende) imakhala yotalika maulendo awiri kuposa ya achinyamata.

The bioavailability wa lisinopril ndi matenda enaake amachepetsa 30%, ndipo chilolezo - ndi 50% yazomwezo mwa odwala omwe ali ndi chiwindi chokwanira.

Kuyanjana pakati pa amlodipine ndi lisinopril sikunakhazikitsidwe, pharmacokinetics ndi pharmacodynamics pazomwe zimagwiritsidwa ntchito za mankhwala sizikuphwanyidwa poyerekeza ndi zomwe zimapezeka palokha.

Kutalika kwa nthawi yayitali kwa mankhwala mthupi kumakupatsani mwayi wolingana ndi kachipatala kofunikira kamodzi pa tsiku.

Contraindication

mbiri ya angioedema, kuphatikizapo milandu yokhudzana ndi kugwiritsa ntchito zoletsa za ACE,
cholowa kapena idiopathic angioedema,
mantha, kuphatikizapo Cardiogenic,
angina wosakhazikika (kupatula Prinzmetal angina),
kwambiri ochepa ochepa hypotension (systolic magazi osakwana 90 mmHg),
hemodynamically yofunika mitral stenosis, hypertrophic insulin cardiomyopathy, kwambiri stenosis wa machitidwe orortice ndi zina hemodynamically yofunika kutsekeka kwa kutuluka kwa gawo lamanzere lamitsempha,
hemodynamically kusakhazikika kwa mtima pambuyo pachimake khunyu wamtima,
kuphatikiza ndi mankhwala omwe amatsutsana ndi angiotensin II receptors kwa odwala omwe ali ndi matenda ashuga nephropathy,
chithandizo chamankhwala omwe ali ndi aliskiren kapena aliskiren okhala ndi odwala omwe ali ndi matenda a shuga komanso / kapena omwe ali ndi vuto laimpso kapena lochepa kwambiri (CC osakwana 60 ml / min),
nthawi yapakati
yoyamwitsa
wazaka 18
Hypersensitivity ena ACE zoletsa kapena dihydropyridine zotumphukira,
tsankho limodzi ndi zigawo zikuluzikulu za mankhwala.

Mochenjera, tikulimbikitsidwa kugwiritsa ntchito mapiritsi a Amlodipine + Lisinopril chifukwa cha kuphwanya kwambiri kwaimpso, momwe mungagwiritsire impso, chotupa cham'mimba, kapena chiwindi chimodzi chaimpso, matenda a chiwindi, azotemia, hyperkalemia, chachikulu aldosteronism, matenda a mtima ochepa hypotension, matenda a mtima, sinus node kufooka kwa tachycardia, bradycardia kwambiri, coronary chikwaniritso, mtima kulephera kwa non-ischemic chiyambi (NYHA kalasi III - IV yogwira kalasi), aortic kapena mitral stenosis, pachimake myocardial infarction ndipo mkati mwa masiku 30 itatha, kuletsa mafupa hematopoiesis, autoimmune matenda a connective minofu (kuphatikizapo systemic lupus erythematosus, scleroderma) Kutsatira zakudya zomwe zimaletsa sodium chloride, hemodialysis wogwiritsa ntchito ma membalatits oyenda kwambiri (monga AN69), kusanza, kutsegula m'mimba, ndi zina zomwe zimapangitsa kuchepa CC (magazi buku) odwala okalamba.

Mankhwala

Amlodipine imatseka njira pang'onopang'ono za calcium, ili ndi antianginal, komanso antihypertensive effect. Mothandizidwa ndi chinthu ichi, kuchuluka kwa Ca ions mu maselo a minofu yosalala ndikulunjika melocardial cell kumachepetsedwa kwambiri, kutsitsa magazi ndi zotumphukira zamitsempha. Amlodipine amawonetsa katundu wakapangidwe wam'mbuyo chifukwa cha kukulitsa kwa osati arterioles okha, komanso mitsempha, ndikuchepetsa pambuyo pake. Okosijeni a okosijeni am'deralo myocardial dera, komanso madera ake a ischemic, amawonedwa. Ndizofunikira kudziwa kuti Amlodipine imalepheretsa kupangika kwa ischemic ST, popanda kupatsa chidwi kwa Reflex tachycardia, ndipo palibe zomwe zimapangitsa kuti ma myocardium akhale ndi chidwi. Chifukwa chodziwikiratu ndi chinthuchi, kufunikira kwa nitroglycerin kumachepetsedwa, ndipo pafupipafupi kufupika kwa ziwiya zomwe zimadyetsa minofu ya mtima kumachepetsedwa. Kukhalitsa kwa mphamvu kwa nthawi yayitali kumawonetsedwa, zomwe zimatengera mlingo wa mankhwala omwe wodwala amatenga. Pankhani ya matenda a ischemic, zotchulidwa za mtima komanso anti-atherosulinotic zimawonedwa.

Ndi amlodipine, kuphatikizika kwa maselo a m'magazi kumachepetsa. Kusefera kwa glomerular kumathandizidwa, osatchulika mokwanira natriuretic zotsatira amalemba. Kugwiritsa ntchito mankhwalawa ndi anthu omwe akudwala gout, shuga, komanso mphumu ya bronchial. Zotsatira zakuchiritsa zimalandiridwa pambuyo pa maola 2-4, zimapitirira tsiku lotsatira.

Lisinopril ndi imodzi mwazinthu za ATP inhibitor, amachepetsa mapangidwe a aldosterone, komanso angiotensin 2, pomwe akuwonjezera kupanga kwa bradykinin palokha. Zotsatira za lisinopril sizimangopita pakugwira ntchito kwa machitidwe a renin-angiotensin-aldosterone. Mothandizidwa ndi lisinopril, kutsika kwa magazi, kuthamanga mkati mwa ma pulmonary capillaries kumawonedwa, pre-ndi pambuyo pake amachepetsa, limodzi ndi izi, magazi a impso amawonjezeka. Katunduyu amathandizira kukulitsa mitsempha, amatulutsa magaziwo kupita ku myocardium, yomwe yachitika ischemia. Ngati ntchito kwa nthawi yayitali, kuuma kwa matenda oopsa a m'mitsempha yamitsempha yamagazi kumachepa. Mothandizidwa ndi lisinopril, kukomoka kumanzere kwamitseko, komwe nthawi zambiri kumakhala kojambulidwa pambuyo poyambitsa myocardial, kumalepheretsa.

Lisinopril amatha kuchepetsa albuminuria, imagwira kwambiri kuthamanga kwa magazi, komwe mumakhala kuchepa kwa renin.Mphamvu ya antihypertensive ya lisinopril imawonedwa ola limodzi mutatha kugwiritsa ntchito, m'maola 6 otsatira kwambiri mankhwala omwe amalembedwa amapitilira maola 24. Ndizofunikira kudziwa kuti pomaliziratu mwadzidzidzi kayendetsedwe ka lisinopril, chitukuko cha zomwe zimatchedwa kuti kudzipatula sichinalembedwe.

Kuphatikizika kwa zinthu monga lisinopril ndi amplodipine kumathandizira kuti pasamachitike zotulukapo zoipa zomwe zimatsutsidwa ndi kutsutsa kwa magawo omwe amagwira ntchito. Kuphatikiza kumeneku kumayendetsedwa kuti mugwiritse ntchito pokhapokha ngati mankhwalawa agwiritsa ntchito mankhwalawa okha alibe njira zochizira.

Chifukwa cha kufalikira kwazitali m'magazi awa mankhwalawa amatha kugwiritsidwa ntchito kamodzi patsiku. Lisinopril ndi amplodipine samalumikiza.

Zizindikiro zogwiritsidwa ntchito

Kuthandiza kuphatikiza mankhwala othandizira matenda oopsa.

Njira yoyendetsera amlodipine ndi lisinopril

Mankhwalawa onse amapangidwa pakamwa. Kwa anthu omwe amamwa mankhwala a antihypertensive, kugwiritsa ntchito mankhwalawa amalembedwa piritsi limodzi patsiku.

Ngati mukutenga ma diuretics, ndiye kuti pafupifupi masiku awiri. musanagwiritse ntchito amlodipine ndi lisinopril, mankhwala a diuretic adzafunika kuti aletsedwe.

Kuti mudziwe kuchuluka kwa mankhwalawa komanso momwe mungagwiritsire ntchito kukonza mankhwalawa kwa odwala omwe ali ndi vuto la impso, mulingo wofunikira umayenera kupatsidwa gawo limodzi ndikumupeza payekhapayekha, kumwa mtundu wina wa amlodipine ndi lisinopril.

Mankhwala pa mlingo wa 10 mg / 5 mg ndi kwa anthu omwe ali ndi yokonza mlingo wa titten mpaka 10 mg ndi 5 mg. Kulandila kwa Mlingo wambiri kumachitika molingana ndi chiwembu chomwe madokotala amakupatsani.

Pa nthawi ya chithandizo, mudzafunika kuwunika zochitika zaimpso, ma seramu ambiri a K ndi Na. Ntchito ya aimpso ikaipira, mankhwala amasiya, mlingo wa mankhwalawo umachepetsedwa.

Tiyenera kukumbukira kuti pakhoza kukhala kuchepa kwapadera kwa amlodipine mwa anthu omwe ali ndi chiwindi cha ma cell.

Zotsatira zoyipa

Mankhwalawa amalekeredwa bwino, koma nthawi zina, kumwa kuphatikiza kwa mankhwalawa kumatha kubweretsa kuphwanya izi:

NS: ulesi, kupweteka mutu, asthenia, kusakhazikika kwa malingaliro, kusungunuka kwa kuganiza ndi kusokonezeka, kugona.
Dongosolo lothandizira: chifuwa chosabereka
CVS: palpitations, tachycardia, orthostatic hypotension, kukula kwa arrhasmia
M`mimba thirakiti: kudziwa kuchuluka kwa m`kamwa, kupweteka kwa epigastric, kuwonongeka kwamatumbo, chiwindi
Genitourinary dongosolo: mkhutu aimpso ntchito, mkodzo kukodza, kusabala
Dongosolo la hematopoietic: Zizindikiro za agranulocytosis, kuchepa kwa hemoglobin ndi hematocrit, kukula kwa erythropenia, leukopenia, thrombocytopenia, ndi neutropenia
Musculoskeletal system: kutupa kwa ankolo, Zizindikiro za arthralgia, zizindikiro za ziwengo
Laborator Zizindikiro: kuchuluka ESR, hyperbilirubinemia, kuchuluka kwa chiwindi michere, hypercreatininemia, kuchuluka urea nayitrogeni, hyperkalemia, kukhalapo kwa antinuclear antibodies
Khungu: zotupa za mtundu wa urticaria, kutuluka thukuta kwambiri, kuyabwa kwambiri, kupezeka kwa erythema, Hyperemia ya khungu la nkhope, alopecia
Ena: kupezeka kwa boma lanthete, kupweteka kumbuyo kwa sternum, kukula kwa myalgia.

Zochita zamankhwala osokoneza bongo

Mukamayikidwa limodzi ndi ma microsomal hepatic enzymes, kuchepa kwa plasma ndende ya amlodipine kumatha kuchitika, ndipo pakugwiritsa ntchito microsomal oxidation inhibitors, kutsika kwakukulu kumachitika.

Kugwiritsa ntchito munthawi yomweyo mankhwala osokoneza bongo a potaziyamu komanso mankhwala ena a K (potaziyamu) kungapangitse matenda a hyperkalemia. Pankhani imeneyi, kudya mankhwalawa kuyenera kuchitika pokhapokha ngati pakuwunika njira zochizira zomwe zingayembekezeredwe komanso kuopsa kwa thanzi, ndikofunikanso kuwunika kuchuluka kwa K m'magazi ndikuwunika magwiridwe antchito aimpso.

Ma diuretics ena amachepetsa kuthamanga kwa magazi, pomwe mukumwa mankhwala a antihypertensive, kuwonjezerapo chidwi kungawonedwe.

Mankhwala okhala ndi estrogen, NSAIDs, sympathomimetics, komanso ma adrenostimulants angapo amatha kuchepetsa kuchiritsa kwa kuphatikiza kwa amlodipine ndi lisinopril.

Maantacid okhala limodzi ndi colestyramine amathandizira kuti muchepetse kuyamwa kwa zigawo za mapiritsi ndi mucosa wam'mimba.

Ma antipsychotic, amiodarone, α1-blockers, ndi quinidine amalimbikitsa chidwi chochitika.

Kuchotsa zinthu zomwe zimapangidwa ndi lifiyamu kumatha kuchepetsedwa, ndipo plasma moyikirapo ya lifiyamu ifunika kuyang'aniridwa.

Procainamide, quinidine imatha kutalikitsa nthawi ya QT.

Ndizofunikira kudziwa kuti lisinopril imachepetsa "kuchekeka" kwa K pamene ikuchita othandizira okodzetsa.

Mankhwala omwe akuphatikizapo Ca amatha kuchepetsa kutha kwa ma calcium blockers.

Cimetidine imagwirizana ndi amlodipine ndi lisinopril, njira yabwino kwambiri yotsatirira ndikuwonana ndi dokotala.

Bongo

Pankhani ya bongo, zotumphukira vasodilation, tachycardia, komanso kuchepa kwamphamvu kwa magazi kumachitika.

Popeza kuti amlodipine imatengeka pang'onopang'ono, palibe chifukwa chogwiritsira ntchito m'mimba; tikulimbikitsidwa kuti muyambe kumwa mankhwala a enterosorbent. Ndi kuchepa kwa kuthamanga kwa magazi, iv dopamine ndi calcium gluconate amasonyezedwa. Mtsogolomo, zidzakhala zofunikira kuwongolera kuthamanga kwa magazi, diuresis, hydro-electrolyte bwino. Ndikofunika kuyang'anitsitsa kuti njira ya hemodialysis pankhaniyi ikhale yopanda tanthauzo.

Kukonzekera kwa Amlodipine ndi lisinopril

Mpaka pano, mankhwala angapo amapangidwa, omwe amaphatikizapo amlodipine ndi lisinopril: Lisinopril Plus, Equator, Equator, Equapril. Mankhwalawa ali ndi gawo lokhazikika la chilichonse. Musanayambe chithandizo, ndikofunika kumuyesa mokwanira, funsani dokotala kuti mudziwe mtundu woyenera wa matendawa. Ngati ndi kotheka, munthawi ya chithandizo, mudzatha kusintha mtundu wa mankhwala omwe amwe.

Kodi amlodipine amatengedwa liti?

Mayina Ogulitsa: Amlothop.

Zili pagulu la oyambitsa calcium calcium blockers. Mankhwala othandizira ali ndi zotsutsana ndi ischemic, antihypertensive, vasodilating (vasodilating).

Amagwiritsidwa ntchito popanga matenda oopsa kuti achepetse kuthamanga kwa magazi, angina pectoris, matenda a Raynaud ndi zina zomwe zimayenderana ndi angiospasm.

Mphamvu ya amlodipine imakhazikitsidwa ndi kutsekeka kwa njira za calcium, kuchepa kwa kupendekeka kwa minofu yosalala ya mitsempha yamagazi ndi katundu wa vasodilating.

Mankhwala amachepetsa kukana kwa hemodynamic kwamitsempha, kuchepetsa kuthamanga kwa magazi komwe kumachitika chifukwa cha kuchuluka kwa vasoconstrictors - adrenaline, vasopressin, renin renin.

Ndi matenda am'mtima, mankhwalawa amachepetsa katundu pamtima, amathandizira kuphipha kwamitsempha yama coronary yomwe imadyetsa myocardium, ndikuyenda bwino kwa magazi.

Pharmacology

Kuphatikiza komwe kuli lisinopril ndi amlodipine.

Lisinopril - inhibitor ya ACE, imachepetsa mapangidwe a angiotensin II kuchokera ku angiotensin I. Kutsika kwa zomwe angiotensin II kumabweretsa kutsika kwachindunji kumatulutsidwa kwa aldosterone. Amachepetsa kuchepa kwa bradykinin ndikuwonjezera kaphatikizidwe ka PG. Amachepetsa OPSS, kuthamanga kwa magazi, kutsitsa, kupanikizika m'mapapo m'mimba, kumapangitsa kuchuluka kwa magazi kwa miniti ndikukulitsa kulolerana kwa mtima ndi nkhawa kwa odwala omwe ali ndi vuto la mtima. Imakulitsa mitsempha pamlingo wokulirapo kuposa mitsempha. Zotsatira zina zimayamba chifukwa cha RAAS ya minofu. Pogwiritsa ntchito nthawi yayitali, hypertrophy ya myocardium ndi makhoma amitsempha ya mtundu wotsalira amachepa. Amasintha magazi kupita ku ischemic myocardium.

ACE inhibitors imakulitsa chiyembekezo cha moyo kwa odwala omwe ali ndi vuto la mtima, osachedwa kupitilira kwa vuto lamanzere kwa odwala pambuyo pa kulowetsedwa kwa myocardial popanda chiwonetsero cha matenda a mtima kulephera.

Mchitidwewo umayamba ola limodzi mutatha kumwa. Mulingo wambiri wa antihypertensive umatsimikizika pambuyo maola 6 ndipo umangokhalira maola 24. Ngati matenda oopsa, mphamvu ya antihypertgency imawonedwa m'masiku oyambira pambuyo pa kuyamba kwa mankhwala, zotsatira zokhazikika zimayamba pambuyo pa miyezi 1-2. Ndi kuthetseratu lakuthwa kwa lisinopril, kuchuluka kwakukulu kwa magazi sikunadziwike.

Ngakhale mphamvu yayikulu ya RAAS, lisinopril imathandizanso ku matenda oopsa kwambiri ochita kuchepa. Kuphatikiza pakuchepetsa kuthamanga kwa magazi, lisinopril imachepetsa albuminuria. Lisinopril samakhudzanso kuchuluka kwa shuga m'magazi mwa odwala matenda a shuga ndipo sikuti zimawonjezera kuchuluka kwa matenda a hypoglycemia.

Amlodipine - kuchokera ku dihydropyridine, BKK, imakhala ndi antianginal and antihypertensive effect. Imalepheretsa mayendedwe a calcium, imachepetsa kusintha kwa ma ioni a calcium kulowa mu khungu (kwambiri kwa maselo osalala amitsempha yamagazi kuposa mtima wamtima).

Mphamvu ya antianginal imatheka chifukwa cha kukulira kwa mitsempha ya m'mimba ndi zotumphukira: Kukula kwamitsempha yama coronary ndi arterioles m'malo osasinthika komanso ischemic ya myocardium, kumawonjezera kuperekera kwa oksijeni ku myocardium (makamaka ndi vasospastic angina), kumalepheretsa kupindika kwa mitsempha ya m'mimba (kuphatikizapo yomwe imayamba ndi kusuta). Odwala okhala ndi khola la angina, tsiku limodzi la amlodipine limathandizira kulolerana, amachepetsa kukula kwa matenda a angina pectoris ndi ischemic kukhumudwa kwa gawo la ST, ndikuchepetsa pafupipafupi kuzunzidwa kwa angina ndi kumwa kwa nitroglycerin ndi ena nitrate.

Amlodipine ali ndi nthawi yayitali-amadalira antihypertensive kwenikweni. Mphamvu ya antihypertensive imachitika chifukwa cha kusuntha mwachindunji kwa minofu yosalala yamitsempha yamagazi. Ngati matenda oopsa azikhala ochepa, kumwa kamodzi kumapereka kuchepa kwambiri kwa magazi kwakanthawi kokwanira maola 24 (wodwalayo atagona komanso atayimirira). Orthostatic hypotension poika amlodipine ndiyosowa. Sichimapangitsa kuchepa kwa kulolerako zolimbitsa thupi, kachigawo kakang'ono ka minyewa yamanzere. Amachepetsa mulingo wamanzere wamitsempha yamagazi wamitsempha yamagazi. Zilibe kukhudzika kwa myocardial contractility ndi kuperekera, sizimapangitsa kuchuluka kwa mtima, kumalepheretsa kuphatikiza kwa ma protein, kuonjezera GFR, komanso kufooka kwa mphamvu ya natriuretic. Ndi matenda a shuga a nephropathy samachulukitsa kukula kwa microalbuminuria. Zilibe zovuta pa kagayidwe ka magazi ndi kuchuluka kwa ma lipids a m'magazi ndipo zitha kugwiritsidwa ntchito pothandizira odwala omwe ali ndi mphumu ya bronchial, matenda a shuga komanso gout. Kutsika kwakukulu kwa kuthamanga kwa magazi kumawonedwa pambuyo pa maola 6-10, kutalika kwa zotsatirazi ndi maola 24.

Amlodipine + lisinopril. Kuphatikizika kwa lisinopril ndi amlodipine kungalepheretse kukula kwa zotsatira zosafunikira zoyambitsidwa ndi imodzi mwazinthu zomwe zimagwira. Chifukwa chake, BKK, kukulitsa ma arterioles mwachindunji, kungayambitse kuchepa kwa sodium ndi madzimadzi m'thupi, chifukwa chake, imatha kuyambitsa RAAS. ACE inhibitor imaletsa njirayi.

Zogulitsa. Pambuyo pakukonzekera pakamwa, lisinopril imatengedwa kuchokera kumimba yotsekemera, mayamwidwe ake amasiyanasiyana kuchokera 6 mpaka 60%. Bioavailability ndi 29%. Kudya sizikhudzana ndi mayamwa.

Kugawa. Pafupifupi sizigwirizana ndi mapuloteni a plasma. C_max m'magazi am'magazi - 90 ng / ml, itakwaniritsidwa pambuyo pa maola 6-7. Chilolezo kudzera mu BBB ndi chotchinga chachikulu ndi chotsika.

Kupenda. Lisinopril samapangidwa mwachilengedwe m'thupi.

Kuswana. Imafufutidwa ndi impso zosasinthika. T_1/2 ndi maola 12.6

Pharmacokinetics m'magulu odwala

Ukalamba. Odwala okalamba, kuchuluka kwa lisinopril mu plasma yamagazi ndi AUC ndikwambiri kuposa kawiri kuposa kwa achinyamata.

CHF. Odwala omwe ali ndi vuto la mtima, mayamwidwe ndi kutsimikizika kwa lisinopril kumachepetsedwa.

Kulephera kwina. Odwala omwe amalephera kupezeka ndi aimpso, kuchuluka kwa lisinopril kumakhala kangapo kuposa kuchuluka kwa plasma mu odzipereka athanzi, ndikuwonjezeka kwa T_max mu plasma ndikukulitsa T_1/2 .

Lisinopril amachotseredwa ndi hemodialysis.

Zogulitsa. Pambuyo pakukonzekera pakamwa, amlodipine imayamba pang'onopang'ono ndipo pafupifupi kwathunthu (90%) yotengedwa kuchokera m'mimba. The bioavailability wa amlodipine ndi 64-80%. Kudya sikumakhudza kuyamwa kwa amlodipine.

Kugawa. Ambiri mwa amlodipine m'magazi (95-98%) amamangidwa ndi mapuloteni a plasma. C_max mu seramu amawonedwa pambuyo 6-10 maola C_ss akwaniritsa pambuyo 7-8 masiku a mankhwala. Pakati V_d ndi 20 l / kg, zomwe zikuwonetsa kuti ambiri mwa amlodipine amakhala m'matupi, ndipo gawo laling'ono limakhala m'magazi.

Kupenda. Amlodipine amadutsa pang'onopang'ono koma amagwira kagayidwe kake popanda chiwonetsero chofunikira choyamba. Ma metabolabol alibe gawo lalikulu la pharmacological.

Kuswana. Excretion imakhala ndi magawo awiri, T_1/2 gawo lomaliza ndi maola 30-50. Pafupifupi 60% ya mankhwala omwe adalowetsedwa ndi impso amuchotsa mu mawonekedwe a metabolites, 10% osasinthika, ndipo 20-25% mu mawonekedwe a metabolites kudzera m'matumbo ndi bile. Chilolezo chonse cha amlodipine ndi 0.116 ml / s / kg (7 ml / min / kg, 0.42 l / h / kg).

Pharmacokinetics m'magulu odwala

Ukalamba. Odwala okalamba (zaka zopitilira 65), zotupa za amlodipine zimachepetsedwa (T_1/2 - 65 h) poyerekeza ndi odwala achichepere, kusiyana kumeneku kulibe tanthauzo lachipatala.

Kulephera kwa chiwindi. Odwala omwe ali ndi vuto la chiwindi, kuchuluka kwa T_1/2 zikusonyeza kuti kugwiritsa ntchito kwa nthawi yayitali, kuchuluka kwa amlodipine mthupi kudzakhala kwakukulu (T_1/2 - mpaka maola 60).

Kulephera kwina sizikhudza kwambiri pharmacokinetics ya amlodipine.

Amlodipine amawoloka BBB. Ndi hemodialysis samachotsedwa.

Kuyanjana pakati pa zinthu zomwe zimapanga kuphatikiza kwa amlodipine + lisinopril ndizokayikitsa. Mfundo AUC, T_max ndi C_max , T_1/2 musasinthe poyerekeza ndi momwe munthu aliyense amagwirira ntchito. Kudya sikukhudza kuyamwa kwa zinthu zomwe zimagwira.

Zoletsa ntchito

Kulephera mwamphamvu kwaimpso, kukokoloka kwa minyewa yamitsempha kapena kukokoloka kwa minyewa imodzi ya msana ndi azotemia, vuto pambuyo pa kupatsirana kwa impso, azotemia, hyperkalemia, hyperaldosteronism, matenda a chiwindi, kuwonongeka kwa chiwindi, matenda amitsempha yamagazi. matenda a mtima, kuperewera kwa mtima, matenda a sinus node kufooka (kwambiri bradycardia, tachycardia) gulu la etiology ya III - kalasi yogwira ntchito ya IV malinga ndi gulu NYHA, aortic stenosis, mitral stenosis, pachimake myocardial infarction (ndipo patatha mwezi umodzi pambuyo panjira ya infarction), autoimmune systemic matenda a minyewa (kuphatikizapo scleroderma, systemic lupus erythematosus). zamchere, hypovolemic states (kuphatikizapochifukwa cha kutsegula m'mimba, kusanza), kukalamba, hemodialysis pogwiritsa ntchito ma membalatits am'mimba okhathamira omwe ali ndi vuto lalikulu lowonongeka (AN69 ®), kupweteka kwa LDL, kukomoka kwa njuchi kapena mavu.

Mimba komanso kuyamwa

Kugwiritsa ntchito sikulimbikitsidwa pakakhala pakati. Pozindikira kuti muli ndi pakati, kuphatikiza kuyenera kuyimitsidwa nthawi yomweyo.

Kulandila kwa zoletsa za ACE mu II ndi III trimesters ya mimba kumakhala ndi zovuta pa mwana wosabadwayo (kutchulidwa kwa kuchepa kwa kuthamanga kwa magazi, kulephera kwa impso, hyperkalemia, hypoplasia ya mafupa a chigaza, kufa kwa intrauterine ndikotheka). Palibe umboni uliwonse wosakhudza mwana wosabadwayo ngati agwiritsidwa ntchito nthawi yoyamba ya mimba. Kwa makanda ndi makanda omwe amakhala ndi intrauterine kukhudzana ndi ma inhibitors a ACE, tikulimbikitsidwa kuyang'anira mosamala kuti mupeze nthawi yake yomwe kuchepa kwa magazi, oliguria, hyperkalemia.

Chitetezo cha amlodipine pa nthawi ya pakati sichinakhazikitsidwe, chifukwa chake, kugwiritsa ntchito amlodipine sikulimbikitsidwa panthawi yapakati.

Lisinopril amawoloka chikhodzodzo ndipo amatha kuchotseredwa mkaka wa m'mawere. Palibe umboni wotulutsa amlodipine mkaka wa m'mawere. Komabe, zimadziwika kuti ma BCC ena - omwe amapezeka mu dihydropyridine, amawachotsa mkaka wa m'mawere.

Kugwiritsa ntchito kuphatikiza pa mkaka wa msambo sikulimbikitsidwa. Ngati ndi kotheka, gwiritsani ntchito mkaka wa m'mawere, yoyamwitsa iyenera kutha.

Kuchita

Ma blockade apawiri a RAAS angiotensin receptor blockers, ACE inhibitors kapena aliskiren imalumikizidwa ndi chiopsezo chowonjezereka cha hypotension, hyperkalemia ndi mkhutu waimpso (kuphatikiza kuperewera kwaimpso) poyerekeza ndi monotherapy ndi mankhwalawa. Ndikofunikira kuwunika mosamala kuthamanga kwa magazi, ntchito ya impso ndi electrolyte moyenera kwa odwala omwe amalandila lisinopril nthawi imodzi ndi mankhwala ena omwe amakhudza RAAS.

Mankhwala omwe amakhudza madzi a potaziyamu m'madzi a m'magazi: potaziyamu yosunga diuretics (mwachitsanzo spironolactone, amiloride, triamteren, eplerenone), potaziyamu wokhala ndi zowonjezera zakudya, zotsekemera za potaziyamu, ndi zina zilizonse zomwe zimapangitsa serum potaziyamu (mwachitsanzo heparin) zingayambitse hyperkalemia ikagwiritsidwa ntchito pamodzi ndi zoletsa za ACE, makamaka Odwala omwe ali ndi mbiri yolephera aimpso ndi matenda ena a impso. Mukamagwiritsa ntchito mankhwala omwe amakhudza zinthu za potaziyamu, mawonekedwe a seramu potaziyamu amayenera kuyang'aniridwa nthawi yomweyo ndi lisinopril. Chifukwa chake, kugwiritsa ntchito munthawi yomweyo kuyenera kukhala kolondola komanso kupangidwa mosamala kwambiri ndikuwunika zonse za seramu potaziyamu ndi ntchito yaimpso. Potaziyamu yosalekerera okodzetsa imatha kumwedwa nthawi imodzi ndi kuphatikiza kwa amlodipine + lisinopril pokhapokha ngati akuyang'aniridwa mosamala ndi madokotala.

Zotsatira: pankhani yogwiritsa ntchito diuretics pochiza ndi kuphatikiza kwa amlodipine + lisinopril, mphamvu ya antihypertensive nthawi zambiri imatheka. Kugwiritsa ntchito pamodzi kuyenera kuchitidwa mosamala. Lisinopril amachepetsa potaziyamu-okodzetsa mphamvu ya okodzetsa.

Mankhwala ena a antihypertensive: munthawi yomweyo kugwiritsa ntchito mankhwalawa kumathandizanso kuti antihypertensive akhale osakanikirana amlodipine + lisinopril. Ntchito munthawi yomweyo ndi nitroglycerin, ma nitrate ena kapena ma vasodilator angayambitse kuchepa kwa magazi.

Tricyclic antidepressants / antipsychotic / opaleshoni wamba / narcotic analgesics: Kugwiritsa ntchito limodzi ndi ACE zoletsa kungayambitse kuchepa kwa magazi.

Ethanoli timapitiriza antihypertensive kwenikweni.

Allopurinol, procainamide, cytostatics kapena immunosuppressants (systemic corticosteroids) zimatha kubweretsa chiwopsezo chowonjezeka cha leukopenia pamene mukugwiritsa ntchito ACE inhibitors.

Maantacid ndi colestyramine mukutenga ndi zoletsa za ACE kumachepetsa bioavailability wa ACE zoletsa.

Sympathomimetics itha kuchepetsa antihypertensive mphamvu ya ACE zoletsa, ndikofunikira kuyang'anitsitsa bwino momwe mungakwaniritsire zotsatira zomwe mukufuna.

Hypoglycemic mankhwala: mukumwa mankhwala a ACE zoletsa komanso mankhwala a hypoglycemic (insulin ndi hypoglycemic othandizira pakamwa), mwayi wochepetsa kuchuluka kwa shuga mu seramu yamagazi ndi chiopsezo cha hypoglycemia ungakulitse. Nthawi zambiri, izi zimachitika mkati mwa sabata loyamba la mankhwala ophatikizika komanso kwa odwala omwe ali ndi vuto la impso.

NSAIDs (kuphatikizapo COX-2 inhibitors yosankha): Kugwiritsa ntchito nthawi yayitali kwa NSAIDs, kuphatikizapo kuchuluka kwa acetylsalicylic acid woposa 3 g / tsiku, kungachepetse antihypertensive zotsatira za ACE zoletsa. Mphamvu yowonjezereka mukamatenga ma NSAIDs ndi ACE zoletsa ndikuwonetseredwa pakuwonjezeka kwa seramu potaziyamu ndipo kungayambitse kuwonongeka kwa impso. Zotsatira izi nthawi zambiri zimakhala zosinthika. Sikovuta kwambiri kukhala ndi vuto laimpso kwambiri, makamaka kwa okalamba ndi odwala omwe atha magazi.

Mankhwala okhala ndi Lithium: excretion ya lithiamu ikhoza kuchepetsedwa pamene mukutenga ndi zoletsa za ACE, chifukwa chake, kuyika kwa lithiamu mu seramu yamagazi kuyenera kuyang'aniridwa panthawiyi. Pogwiritsa ntchito munthawi yomweyo kukonzekera kwa lifiyamu, ndikotheka kuwonjezera mawonekedwe awowonjezera a neurotoxicity (nseru, kusanza, kutsegula m'mimba, ataxia, kugwedeza, tinnitus).

Mankhwala okhala ndi Golide: ndi munthawi yomweyo kugwiritsa ntchito ACE zoletsa komanso kukonzekera golide (sodium aurothiomalate) iv, chizindikiro chafotokozeredwa, kuphatikizira kutulutsa nkhope, nseru, kusanza, ndi kuchepa kwa thupi.

Dantrolene (iv): Mu nyama, pambuyo pa ntchito ya verapamil ndi iv yoyendetsedwa ndi dantrolene, milandu yakupha yamitsempha yamagazi yotupa ndi kulephera kwamtima komwe kumayenderana ndi hyperkalemia. Popeza kuti mungathe kukhala ndi hyperkalemia, kugwiritsa ntchito BCC nthawi yomweyo kuyenera kupewedwa, kuphatikizapo odwala amlodipine, odwala amakonda kukula koipa hyperthermia, komanso mankhwalawa zoopsa hyperthermia.

CYP3A4 isoenzyme zoletsa: Kafukufuku mu odwala okalamba awonetsa kuti diltiazem inhibits amlodipine metabolism, mwina kudzera mu CYP3A4 isoenzyme (plasma / seramu concentration ikuwonjezeka pafupifupi 50% ndipo zotsatira za amlodipine zimawonjezeka). Kuthekera sikungadziwike kuti zoletsa zamphamvu za CYP3A4 isoenzyme (mwachitsanzo, ketoconazole, itraconazole, ritonavir) zitha kukulitsa kuchuluka kwa amlodipine mu seramu yamagazi kwakukulu kwambiri kuposa diltiazem. Kugwiritsa ntchito pamodzi kuyenera kuchitidwa mosamala.

Zizindikiro za isoenzyme CYP3A4: kugwiritsa ntchito munthawi yomweyo ndi antiepileptic mankhwala (mwachitsanzo, carbamazepine, phenobarbital, phenytoin, fosphenytoin, primidone), rifampicin, mankhwala okhala ndi wort ya St. John, angayambitse kuchepa kwa kuchuluka kwa amlodipine m'madzi a m'magazi. Kuwongolera kumawonetsedwa ndi kusintha kwa mlingo wa amlodipine pamankhwala omwe amachititsa kuti CYP3A4 isoenzyme itathe. Kugwiritsa ntchito pamodzi kuyenera kuchitidwa mosamala.

Monga monotherapy, amlodipine pamodzi thiazide ndi kuzungulira okodzetsa, wothandizira kwa mankhwala ochititsa dzanzi ambiri, beta-blockers, Ace zoletsa, kuleza kumachita ku feteleza, nitroglycerin, digoxin, warfarin, atorvastatin, sildenafil, Mankhwalawa ayenera kumwedwa (zotayidwa hydroxide, magnesium hydroxide), simethicone, cimetidine NSAIDs, mankhwala ndi wothandizila hypoglycemic pakamwa.

Ndikotheka kuwonjezera antianginal ndi antihypertensive zotsatira za CCB ndikugwiritsa ntchito munthawi yomweyo thiazide ndi loop diuretics, verapamil, zoletsa za ACE, beta-blockers, nitrate ndi ma vasodilators ena, komanso kukulitsa mphamvu yawo ya antihypertensive mukamagwiritsa ntchito alpha adrenoblockers, antipsychotic.

Chenjezo liyenera kuchitika mukamagwiritsa ntchito nitroglycerin, ma nitrate ena, kapena ma vasodilator ena, chifukwa kuchepa kwapadera kwa magazi kumatheka.

Mlingo umodzi wa 100 mg sildenafil Odwala ofunika matenda oopsa sichikhudza pharmacokinetics ya amlodipine.

Mobwerezabwereza ntchito amlodipine pa 10 mg ndi atorvastatin pa mlingo wa 80 mg si limodzi ndi kusintha kwakukulu mu pharmacokinetics of atorvastatin.

Baclofen: mwina kuchuluka antihypertensive kwenikweni. Kuthamanga kwa magazi ndi ntchito ya impso kuyenera kuyang'aniridwa; ngati kuli kotheka, sinthani mlingo wa amlodipine.

Corticosteroids (mineralocorticosteroids ndi corticosteroids), tetracosactide: kuchepa kwa antihypertensive zotsatira (kusungunuka kwa madzimadzi ndi ma ayoni a sodium chifukwa cha zochita za corticosteroids).

Amifostine: imathandizira antihypertensive mphamvu ya amlodipine.

Tricyclic antidepressants: kuchuluka antihypertensive mphamvu ya amlodipine ndi chiwopsezo cha orthostatic hypotension.

Erythromycin: pamene kugwiritsa ntchito kumawonjezera C_max amlodipine mwa odwala achinyamata ndi 22%, mwa okalamba odwala - ndi 50%.

Ma antiviral (ritonavir) onjezani kuchuluka kwa plasma ya BKK, kuphatikiza amlodipine.

Ma antipsychotic ndi isoflurane - kuchuluka antihypertensive zotsatira dihydropyridine zotumphukira.

Amlodipine sichikhudza kwambiri pharmacokinetics Mowa.

Kukonzekera kwa calcium itha kuchepetsa zotsatira za BCC.

Ndi munthawi yomweyo kugwiritsa ntchito amlodipine Mankhwala okhala ndi lithiamu kuwonjezeka chiwonetsero cha neurotoxicity (nseru, kusanza, kutsegula m'mimba, ataxia, kugwedeza, tinnitus).

Zilibe kukhudzana seramu ndende digoxin ndi mawonekedwe ake a impso.

Palibe tanthauzo lalikulu pazochitikazo warfarin (PV).

Cimetidine sizikhudzanso pharmacokinetics ya amlodipine.

Kuchepetsa kwa antihypertensive momwe kuphatikizira kwa amlodipine + lisinopril mukamagwiritsira ntchito estrogens, sympathomimetics.

Procainamide, quinidine ndi mankhwala ena omwe amakulitsa nthawi ya QT, imathandizira pakukulitsa kofunikira.

M'maphunziro mu vitro amlodipine sichikhudza plasma yomanga digoxin, phenytoin, warfarin ndi indomethacin.

Kutenga amlodipine ndi msuzi wa mphesa osavomerezeka, monga mwa odwala ena izi zimatha kuwonjezeka mu bioavailability ya amlodipine, zomwe zimapangitsa kuti chiwonetsero chake chikule.

Tacrolimus: kugwiritsa ntchito munthawi yomweyo ndi amlodipine, pali chiopsezo chowonjezera kuchuluka kwa tacrolimus m'madzi a m'magazi, koma mapangidwe a pharmacokinetic pamalumikizidwe awa sanaphunzire kwathunthu. Pofuna kupewa kuwopsa kwa tacrolimus pogwiritsa ntchito amlodipine, kuwunika kwa tacrolimus m'madzi a m'magazi kuyenera kuyang'aniridwa ndikufunika kwa tacrolimus ngati pakufunika.

Clarithromycin: clarithromycin ndi choletsa CYP3A4 isoenzyme. Ndi munthawi yomweyo kugwiritsa ntchito amlodipine ndi clarithromycin, mwayi wokhala ochepa hypotension ukuwonjezeka. Kusamalidwa mosamala kwa odwala omwe amalandila amlodipine mogwirizana ndi clarithromycin akulimbikitsidwa.

Cyclosporin: maphunziro ogwiritsira ntchito cyclosporine ndi amlodipine mu odzipereka athanzi kapena magulu ena a odwala sanachite nawo, kupatula kwa odwala omwe adatsekeredwa impso, momwe osasinthika ochepera ozungulira (pafupifupi mfundo: 0–40%) ya cyclosporine. Ndi munthawi yomweyo kugwiritsa ntchito amlodipine mwa odwala omwe akuwonjezeka impso, kuyang'aniridwa kwa cyclosporin m'madzi a m'magazi kuyenera kuyang'aniridwa, ndipo ngati ndi kotheka, muchepetse mlingo wake.

Simvastatin: munthawi yomweyo kugwiritsa ntchito amlodipine pa 10 mg ndi simvastatin pa mlingo wa 80 mg kumawonjezera kukhudzidwa kwa simvastatin ndi 77% poyerekeza ndi simvastatin monotherapy. Odwala omwe amalandila amlodipine akulimbikitsidwa kuti agwiritse ntchito simvastatin muyezo wosaposa 20 mg / tsiku.

Bongo

Zizindikiro chizindikiro kuchepa kwa kuthamanga kwa magazi ndi kuphatikizika kwa Reflex tachycardia ndi zotumphukira kwambiri zotumphukira (chiwopsezo cha kupanikizika kwakanthawi kwa hypotension, kuphatikizapo kukula kwa mantha ndi kufa).

Chithandizo: gastric lavage, kudya kwa activated kaboni, kusunga ntchito yamtima ndi kupuma, kupatsa wodwalayo malo oyimirira ndi miyendo yokwezeka, kuwongolera kwa bcc ndi mkodzo potulutsa. Kubwezeretsa kamvekedwe ka mtima - kugwiritsa ntchito ma vasoconstrictors (osagwiritsa ntchito contraindication kuti agwiritse ntchito), kuti athetse mavuto omwe amabwera chifukwa cha kutsekeka kwa mayendedwe a calcium - kudzera pakukonzekera kwa calcium gluconate. Hemodialysis siyothandiza.

Zizindikiro Kuchepa kwa kuthamanga kwa magazi, kuwuma kwa mucosa wamlomo, kugona, mkodzo posungira, kudzimbidwa, nkhawa, kuchuluka kwa kusokonekera.

Chithandizo: gastric lavage, kutenga activated makala, kupatsa wodwalayo malo opingasa ndi miyendo yokwezeka, kubwezeretsanso bcc - mu / kuyambitsa njira yothetsera plasma, chidziwitso chamankhwala, kuyang'anira ntchito zamtima ndi kupuma, bcc, urea ndende, creatinine ndi serum electrolyte, komanso diuresis. Lisinopril amachotsedwa m'thupi kudzera pa hemodialysis.

Zokhudza ukadaulo

Pamodzi, lisinopril ndi amlodipine akupezeka mu kukonzekera kwa Equator. Palinso mankhwala ena, osatchuka pamsika. Amawonetsedwa pansi pa dzina la "Lisinopril Plus", ndi piritsi lokhala ndi 10 mg wa chinthu chimodzi ndi 5 mg yachiwiri. Amlodipine amaika ndalama zochepa. Phukusi limodzi lili ndi makaponi atatu mpaka sikisi. Chilichonse chojambulidwa choyera, chili ndi mawonekedwe ozungulira a mtundu wothinikizidwa. Ziwopsezo zowopsa, chamfer. Piritsi limodzi, amlodipine imawonetsedwa ngati besylate, yachiwiri yophatikizira imaphatikizidwa mu mawonekedwe a dihydrate. Wopanga adagwiritsa ntchito cellulose, wowuma, magnesium ndi zinthu za silicon ngati mankhwala ena owonjezera.

Mapiritsi a equator, omwe amakhalanso ndi zida ziwiri izi, amapangidwa mwa mawonekedwe a bwalo lathyathyathya. Chamfer, zoopsa zimadziwikiratu. Hue - yoyera kapena pafupi nayo momwe ndingathere. Chimodzi mwazo zili ndi luso lolemba. Pali njira zingapo. Amlodipine amaphatikizidwa ndi mankhwalawa mu mawonekedwe a besylate, lisinopril amayimilidwa ndi dihydrate. Pali njira zosankha: 5 ndi 10, 5 ndi 20, 10 ndi 10, 10 ndi 20 mg motsatana. Kuphatikiza pa amlodipine ndi lisinopril, kaphatikizidwe kamakhala ndi wowuma, cellulose, mamolekyulu a magnesium momwe akuwonekera. Phukusi limodzi lili ndi magome 10 mpaka 60. Kuchuluka kwake kwatchulidwa kunja kwa phukusi. Apa, mulingo wa zosakaniza zonse zomwe zimagwira pakopi iliyonse umafotokozedwa.

Amlodipine: mawonekedwe

Nthawi zambiri, odwala mankhwala mankhwala kuphatikiza pamodzi ndi amlodipine, indapamide ndi lisinopril mu pulogalamu. Katundu woyamba kuchokera pamndandandawu umatha kugwira ntchito (mphamvu zake zimatengera mlingo) pakukakamizidwa. Ichi ndi chifukwa cha vasodilating mphamvu pa minofu makoma a mtima dongosolo. Pakakhala vuto la kuthamanga kwa magazi, muyeso umodzi wa voliyumu yokwanira umatsimikizira kuti matendawa amatsika tsiku limodzi. Izi ndizokhazikika ndikuyimirira, ndikugona.

Orthostatic hypotension mwa odwala omwe akuchita maphunziro ndi kuphatikizika kwa amlodipine sichijambulidwa kwenikweni.Mankhwala sikuchepetsa chiwopsezo zolimbitsa thupi. Ndi kugwiritsidwa ntchito kwake, kuopsa kwa njira zama hypertrophic mumitseko yamtima kumanzere kumachepa. Pankhaniyi, conduction, contractility ya mtima minofu sizikuwonongeka, palibe Reflex kukula kwa mtima. Kukhazikitsidwa kwa mapiritsi a amlodipine ndi lisinopril kumapangitsa kuchuluka kwa impso kukuchepetsa komanso kuchepa kwa kuphatikiza kwa maselo ambiri. Pali zosasinthika natriuretic zotsatira. Palibe vuto lililonse pa kagayidwe, mafuta pamagazi. Amlodipine ndiolandiridwa ndi matenda ashuga, gout, mphumu. Mphamvu yotamandika yolembedwa pambuyo pa maola 6 mpaka 10, imapitirira tsiku limodzi.

Lisinopril: mawonekedwe

Monga momwe mungaphunzirire ndi mankhwala omwe akuphatikizidwa omwe ali ndi lisinopril ndi amlodipine, malangizo ogwiritsira ntchito, chophatikizidwacho choyamba chimawonetsa tanthauzo pambuyo pakatha ola limodzi pakulowetsa. Zochita pazambiri zimalembedwa pafupifupi maola 6.5 pambuyo pa mfundo iyi. Kutalika kwa kusunga bwino kumafika tsiku. Ndi kuthamanga kwa magazi, zotsatira zake zimawonedwa masiku angapo atangoyamba kumene maphunzirowo, patatha mwezi umodzi kapena iwiri mkhalidwewo umakhazikika.

Milandu yakufunika kwachotsedwa kwadzidzidzi kwa chinthu kwawonedwa. Panalibe kuwonjezeka kwakukulu kwa kupanikizika komwe kudachitika. Mothandizidwa ndi lisinopril, kupanikizika kumatsika, zotsatira za kuchepa kwa albuminuria. Ndi hyperglycemia, mankhwalawa amathandizira kusintha matenda osokoneza bongo a gloterular endothelium. Mu shuga, sizimakhudzidwa ndi zomwe zimakhala m'magazi. Kugwiritsidwa ntchito kwa lisinopril sikukulitsa chiwopsezo cha hypoglycemia.

Kuphatikiza kwa zinthu

Popeza lisinopril ndi amlodipine ndizogwirizana, othandizira ophatikiza amapangidwa. Chimodzi mwazinthuzi chimaperekedwa pansi pa dzina la "Equator". Thupi limakhala ndi zosakaniza zonse ziwiri. Kuphatikiza uku kumakuthandizani kuti muchepetse chiopsezo cha zovuta zina mwazinthu zilizonse payekhapayekha. Zachidziwikire, kugwiritsa ntchito wothandizirana kophatikizidwa kumaloledwa mosamalidwa ndi katswiri, popeza zoopsa zake zidakalipobe, koma mankhwalawo amavomerezedwa ndi odwala kuposa mtundu uliwonse wa mankhwalawo mosiyana.

Zimafunika liti?

Monga momwe tinganenere kuti, "Amlodipine" ndi "Lisinopril" nthawi zambiri amaperekedwa kwa anthu omwe amafunikira mankhwala kuti akonze matenda oopsa. M'mbuyomu, adotolo amafotokoza kufotokozera koyenera kwa maphunzirowa. Gwiritsani ntchito mankhwalawa molingana ndi zisonyezo. Kudzilamulira nokha ndi mwayi wambiri kumapangitsa kuti pakhale zovuta. Hypertension ndiyo chisonyezo chokhacho chomwe chatchulidwa mu malangizo omwe atsatiridwa ndi mankhwala.

Kuphatikiza: ndizowopsa?

Anthu omwe adalembedwera chinthu chophatikizira kuthana ndi zowunikira nthawi zina amakhala ndi chidwi ndi kuwopsa kwake komwe kumachitika chifukwa cha kuthekera kwa kusakanikirana kwa zosakanikirana wina ndi mnzake. Monga momwe mayesero asonyezera, chiopsezo cha kulumikizana kwamankhwala chotere ndi chochepa kwambiri. Kudalira kwa theka la moyo, kuzungulira kwakukulu kapena kugawa zinthu m'thupi kumayendera. Kuwongolera kwa magawo awa sikukhazikitsidwa ndikugwiritsa ntchito ndalama mophatikiza kapena payokha. Osadalira nthawi yakudya. Chakudya sichisintha kuchuluka kwa mayamwidwe. Kutalikirana kwanthawi yayitali kwa zosakaniza m'thupi kumakulolani kugwiritsa ntchito mankhwalawa kamodzi patsiku.

Momwe mungagwiritsire ntchito?

Mankhwala ophatikiza omwe ali ndi amlodipine ndi lisinopril ayenera kumwedwa pakamwa. Kulandila sikudalira chakudya. Zimafunikira kumwa mankhwala omwe amapezeka ndi madzi oyera popanda zina zowonjezera. Mulingo wokhazikika wa tsiku ndi tsiku ndi kapisozi imodzi. Ndikofunika kugwiritsa ntchito mankhwalawa tsiku lililonse panthawi yokhazikika. Piritsi limodzi siligwiritsidwa ntchito patsiku.

Mankhwala ena ophatikizika amayenera kumwedwa ngati kuchuluka kwa zosakaniza zogwirizana kumagwirizana ndi kuchuluka kokwanira kwa aliyense wa iwo pa vuto linalake. Choyamba, adotolo amawona Mlingo wokhazikika wa wodwala wina, kenako amawafanizira ndi mitundu yosiyanasiyana ya mankhwala ophatikizidwa. Kutulutsidwa kwa mankhwala a Equator ndi Lisinopril Plus kwasonyezedwa pamwambapa. Ngati sizotheka kupeza mawonekedwe aliwonse abwino otulutsira, muyenera kupatsa wodwalayo gawo lina la mankhwala awa.

The kusiyanasiyana kwamankhwala

Ngati dotolo adayikapo mankhwala osakanikirana, omwe akuphatikizapo amlodipine ndi lisinopril, koma kumayambiriro kwa mankhwalawa magazi atagwa kwambiri, wodwalayo atenge malo apamwamba ndi kusiya kumwa. Ndikofunikira kufunafuna thandizo kuchokera kwa dotolo wothandizira. Nthawi zambiri chochitika cha transistor sichikakamiza kusiya njira yochizira, koma nthawi zina kuyeza mlingo kumafunika. Ngati pakufunika kusankha mwayeso, mankhwalawa amalembedwera mankhwala ena munthawi yopanga maphunzirowa.

Nthawi zina wodwalayo amapatsidwa maphunziro osiyanasiyana (mwachitsanzo, munthawi yomweyo amlodipine, lisinopril rosuvastatin). Monga momwe masewera amasonyezera, zinthu zambiri za pulogalamuyi zomwe wodwala amafunikira, ndizomwe zimapangitsa kuti ataye chinthu. Ngati wodwala wasowa nthawi yogwiritsira ntchito "Equator", muyenera kuyembekezera nthawi ina. Nthawi iliyonse pamakhala kugwiritsa ntchito kamodzi. Ngati mlingo wapambuyo watuluka, sikofunikira kubwereza wotsatira. Simufunikanso kubweza ndalama zomwe zadutsa.

Kutsutsana kwambiri pa kutenga "Equator" ndikuthekera kowonjezereka kwa chilichonse chophatikizidwa ndi mankhwala. Izi zimagwiranso ntchito pazinthu zazikulu ndi zina zothandizira. Simungagwiritse ntchito chinthucho ngati thupi la munthu limadziwika ndi chiwopsezo chowonjezeka cha chilichonse chopanga dihydropyridine kapena ACE inhibitors. Ngati wodwalayo adagwiritsa kale ntchito ya ACE inhibitor ndipo izi zidakwiyitsa edema ya Quincke, ngati izi zidawonedwa pazifukwa zina, "Equator" singagwiritsidwe ntchito. Ndi zoletsedwa kumwa mankhwalawa ndi angioedema wa mawonekedwe a idiopathic kapena chifukwa cha chibadwa, komanso mkhalidwe wakunjenjemera, ndi mantha a cardiogenic. Mankhwala sakhazikitsidwa kwa angina wosakhazikika. Mlandu wapadera ndi mtundu wa matenda omwe amadziwika kuti Prinzmetal matenda. Simungathe kupereka yankho loti mupeze mawonekedwe osakanikirana am'mitsempha, pomwe zizindikirozo ndizochepera 90, komanso ngati mtima suyenda bwino mu mtundu wosakhazikika wa hemodynamic ngati vuto la mtima lovuta lidasamutsidwa kale. Mankhwalawa sagwiritsidwa ntchito ngati pakufunika kumwa aliskiren kapena mankhwala ena aliwonse omwe amapezeka ndi mankhwalawa, omwe ali ndi matenda a shuga, osakhazikika kapena aimpso.

"Equator", "Equamer" (mankhwala omwe ali ndi amlodipine, lisinopril rosuvastatin) sagwiritsidwa ntchito panthawi yapakati. Simungagwiritse ntchito mankhwala ophatikizira mkaka wa m`mawere ndi unyamata, ngati mukufuna olimbana nawo a receptor dongosolo la kuzindikira kwa mtundu wachiwiri wa angiotensin wa nephropathy chifukwa cha matenda ashuga. Zofooka zimakhazikitsidwa ndi kutsekeka kwa linanena bungwe lamanzere yamitsempha yama mtima ya hemodynamically yofunika mtundu, komanso mitral stenosis.

Mutha kutero, koma mosamala kwambiri

Nthawi zina kuphatikiza kwa mankhwala kumapangidwira kwa aortic stenosis, mitundu ina ya myopathy, cerebrovascular pathologies. Zinthu ngatizi zimafunikira chisamaliro chowonjezereka. Ndikofunikira nthawi zonse kuwunika momwe wodwalayo alili, kuwunika momwe magwiridwe antchito amkati ndi ziwalo. Kulondola kumafunikira milanduyo ngati wodwalayo amakakamizidwa kugwiritsa ntchito potaziyamu-poteteza okonza, potaziyamu kukonzekera, m'malo mwa mchere wa potaziyamu. Makamaka makamaka ndi anthu omwe ali ndi potaziyamu yambiri mthupi, kusowa kwa sodium, komanso odwala matenda a myelosuppression, matenda ashuga, komanso symmetric aimpso arterial stenosis.

Mankhwala ophatikizidwa mosamala kwambiri a kuthamanga kwa magazi amaperekedwa ngati munthu wadwala impso, amakakamizidwa kuti apite ndi hemodialysis, yemwe ali ndi matenda a aldosteronism oyambira kapena kudya chakudya chopatsa mphamvu kwambiri mchere. Kufunika kugwiritsa ntchito zinthu zomwe zimalepheretsa puloteni CYP3A4, olowetsa ensa iyi amafunikira kuwunika momwe wodwalayo alili.

Zosafunika

Kumwa mankhwala osakanikirana, omwe amaphatikizapo amlodipine ndi lisinopril, angayambitse kuchepa kwa hemoglobin, hematocrit m'magazi. Pali chiopsezo chopinga cha hematopoietic ntchito. Pali chiopsezo chosagwirizana, kuchuluka kapena kuchepa kwa shuga wamagazi. Hypertonicity ya minofu, neuropathy, matenda amtundu wa extrapyramidal ndi osowa kwambiri. Pali ngozi yamavuto amaso, kugona, kuzindikira. Matenda ovutitsidwa, nkhawa, lability ndizotheka. Ena amati tinnitus. Nthawi zambiri vuto la mtima silinajambulidwe. Pali chiopsezo chophwanya pafupipafupi komanso kuthamanga kwa kugunda kwa mtima, atrive fibrillation. Hypotension imatheka, pamakhala ngozi yoti kusokonekera kwa magazi kutuluka mu ubongo. Matenda a Raynaud amatha.

Milandu ya chibayo, kapamba, hepatitis amalembedwa. Pali chiopsezo chakulephera kwa chiwindi, kusokonezeka kwa chopondapo, kupweteka pamimba. Ena anali ndi chifuwa, kufupika, komanso pakamwa pouma. Kuyesedwa kumawonetsa kuwonjezeka kwa ntchito ya enzyme ya chiwindi.

Kodi lisinopril limaperekedwa kuti?

Mankhwalawa ndi a gulu la mankhwala omwe amalepheretsa ntchito ya eniotensin-kutembenuza enzyme. Amagwiritsidwa ntchito poyerekeza matenda oopsa, kuphipha kwa mitsempha ya m'mimba (angina pectoris, infarction ya myocardial).

Imakhala ndi vasodilating, imachepetsa mphamvu ya mtima kamvekedwe ka angiotensin II, ndikuwonjezera zomwe zimapangidwa ndi bradykinin, yomwe imachepetsa mitsempha.

Kuchulukitsa kupirira kwa minofu ya mtima munthawi yamavuto am'mthupi komanso m'maganizo, kumapangitsa kuti magazi azikhala ochepa, komanso kukulitsa mitsempha ya mitsempha. Amachepetsa kukana kwa mtima, kuchepetsa nkhawa pamtima.

Momwe mungatenge amlodipine ndi lisinopril palimodzi?

Amlodipine amagwiritsidwa ntchito pa 5 mg patsiku chifukwa cha matenda amitsempha yamagazi ndi matenda oopsa.

Lisinopril mu monotherapy amatchulidwa 5 mg kamodzi. Ngati mphamvu yakutenga kulibe, mlingo umakulitsidwa. Mlingo wokonza ndi 20 mg patsiku.

Mlingo umapangidwa payekhapayekha ndi mtima.

Mawonekedwe a Amlodipine

Mankhwala ndi a gulu la othandizira calcium calcium. Dzinali ndi Amlodipine. Amathandizira kuthamanga kwa magazi komanso kupewa ma angina. Mankhwalawa amachepetsa mitsempha ndipo amachepetsa katundu pamitsempha ya mtima, komanso imathandizira kutumiza kwa oksijeni ku minofu yam'mimba. Mankhwalawa amathandiza kupewetsa kuphipha kwam'mimba, komwe nthawi zambiri kumapezeka mwa anthu omwe amasuta.

Mukamwa mankhwalawa, kusinthasintha kwa minofu yamtima ndikuchita zolimbitsa thupi kumatha.

Kuphatikiza apo, mankhwalawa amakulitsa kuthandizira kwamitsempha yamagazi, ndikupangitsa kuti magazi azithamanga. Mankhwalawa amathandizira kuchepetsa kukhathamiritsa kwa mapulateleti, koma samakhudza njira zoyipa za thupi.

Pambuyo pa kayendetsedwe, gawo logwira limamangiriza mapuloteni amadzi a m'magazi ndi 95%, zomwe zimapangitsa kuchepetsa kukakamira kwakanthawi. Mphamvu ya antihypertensive imawonekera pambuyo pa mphindi 30-60. Kuzindikira kwakukulu mu seramu kumafikira maola 6.

Kodi lisinopril imagwira ntchito bwanji?

Mankhwalawa ndi a gulu la zoletsa za ACE, zomwe zimakhudza katulutsidwe ka aldosterone. Mayina apadziko lonse - Lisinopril. Mankhwala amachepetsa kuthamanga kwa magazi ndi kukakamiza kwa ma pulmonary capillaries. Mankhwalawa amagwiritsidwa ntchito pochiza odwala omwe ali ndi vuto la mtima, chifukwa bwino myocardial kuzolowera zolimbitsa thupi.

Chidacho chimathandizira kukulitsa mitsempha ndikuthandizira kuthamanga kwa magazi m'dera la ischemia. Mankhwala amachepetsa kupitilira kwa kufalikira kwa minyewa yamanzere yamitsempha yamanzere. Mankhwalawa amatha kutalikitsa moyo wa odwala omwe ali ndi mawonekedwe osatha a mtima olephera.

Momwe mungatenge amlodipine ndi lisinopril?

Amlodipine amayamba kumwa ndi 5 mg kamodzi patsiku, mosasamala kanthu ndi chakudya (m'mawa kapena madzulo). Woopsa milandu, madokotala mankhwala 2 kawiri mlingo - 10 mg. Lisinopril amatengedwa nthawi 1 patsiku kuyambira 10 mg, osasamala chakudya (makamaka m'mawa). Njira yamankhwala imatsimikiziridwa ndi adokotala.

Kuchokera pamavuto

Ndi kuthamanga kwa magazi, Amlodipine amayikidwa 1 mg patsiku, 5 mg, ndi Lisinopril 10-20 mg patsiku.

Ndi kuthamanga kwa magazi, Amlodipine amatchulidwa 1 mg patsiku.

Malingaliro a madotolo

Pavel Anatolyevich, wothandizira, Novosibirsk

Ndimapereka mankhwala onse ali ndi kuthamanga kwa magazi komanso chiwopsezo chodwala mtima. Chifukwa cha zovuta, kuthekera kwa zovuta kumachepetsedwa. Nthawi zina, kuphatikiza uku kumateteza ku kukha mwazi kwa ubongo, komwe nthawi zina kumadzaza ndi imfa.

Evgenia Alexandrovna, katswiri wamtima, Penza

Kuphatikiza kwa mankhwalawa kwagwiritsidwa ntchito pochita kwakanthawi yayitali, chifukwa Amathandizira kukonza mkhalidwe wa wodwala wokhala ndi matenda oopsa komanso matenda a mtima. Ndimayamwa mapiritsi ochepetsetsa Mlingo wochepetsedwa kuti muchepetse chiopsezo chodwala. Ndikofunikira kudziwitsa wodwalayo kuti okodzetsa ayenera kuchotsedwa masiku 2 asanayambe chithandizo.

Tamara Sergeevna, katswiri wamtima, Ulyanovsk

Mankhwalawa nthawi zambiri amaphatikizidwa kuti akwaniritse zotsatira zabwino pochiza odwala omwe ali ndi matenda a mtima ndi mitsempha yamagazi. Ndisanapereke mankhwala, ndimalimbikitsa kuti odwala aziyang'aniridwa ndi ziwalo za X-ray ndikuwapititsa mayeso ofunikira kuti adziwe zoyipa.

Ndemanga za Odwala Amlodipine ndi Lisinopril

Peter, wazaka 62, Kiev

Anatenga kuphatikiza kwa mankhwalawa atatha kulowerera m'mnyewa kuti asadzayambenso. Kupanikizika kunali kosasunthika pakumwa, koma atangosiya chithandizo, matendawo adakula kwambiri. Tsopano ndimatenganso mapiritsi ndipo sindinyalanyaza malangizo aukatswiri wamtima.

Igor, wazaka 55, Otradny

Ndi matenda oopsa, mankhwalawa onse adalembedwa kamodzi, chifukwa kupanikizika kunali kosalekeza. Pa tsiku lachiwiri chiyambireni chithandizo, ndinamva bwino, mutu wanga unasiya kupweteka ndipo nseru idasoweka. Imwani mankhwalawa pafupipafupi.

Elena, wazaka 49, Salavat

Ndakhala ndikulimbana ndi kuthamanga kwa magazi kwa nthawi yayitali. Palibe ndalama zomwe zinathandiza. Kenako adotolo adatulutsa kuphatikiza kwa mankhwalawa. Zotsatira sizinatenge nthawi kubwera ndipo tsiku lotsatira ndinayamba kusintha.