Mankhwala a Telzap: malangizo ogwiritsira ntchito

Mankhwala amapezeka mu mawonekedwe a mapiritsi okhala ndi filimu: kuchokera ku chikasu mpaka pafupifupi oyera, oblong, biconvex, 40 mg iliyonse ndi mzere wogaula mbali iliyonse, 80 mg aliyense - wolemba "80" (10 ma PC. m'matumba, pamatoni okhala ndi matuza 3, 6 kapena 9 ndi malangizo ogwiritsira ntchito Telzap).

Piritsi limodzi lili:

yogwira mankhwala: telmisartan - 40 mg kapena 80 mg,
othandizira zigawo: povidone 25, meglumine, sodium hydroxide, sorbitol, magnesium stearate.

Mankhwala

Telzap ndi mankhwala osokoneza bongo a antihypertgency, omwe amagwira ntchito ndi telmisartan - wotsutsa wina wa angiotensin II receptors (subtype AT₁) Telmisartan ali ndi ubale wapamwamba kwambiri wa AT₁ (angiotensin) -mabungwe omwe zochita za angiotensin II zimadziwika. Kulephera kuchitapo kanthu kwa munthu wothandizidwa ndi agonist povomereza, kumachotsa angiotensin II pazolumikizano zake ndikumangofika ku subtype ya AT₁zolandila za angiotensin II. Kupita kuma receptors ena a angiotensin (kuphatikizapo AT₂receptors) telmisartan alibe ubale. Kufunika kwawo kwamachitidwe ndi momwe zimapangitsa kuti pakhale kukondoweza kwambiri ndi angiotensin II sikunaphunzire. Telmisartan imachepetsa plasma aldosterone miyezo, saletsa mayendedwe a ion, sikuchepetsa ntchito ya renin, ndipo siziletsa zochita za angiotensin-converting enzyme (kininase II), yomwe imathandizira kuwonongeka kwa bradykinin. Izi zimapewa kukula kwa chifuwa chouma ndi zotsatira zina chifukwa cha bradykinin.

Ndi chofunikira matenda oopsa, kutenga Telzap muyezo wa 80 mg kumapangitsa kutsekeka kwa matenda oopsa a angiotensin II. Mphamvu ya antihypertensive pambuyo koyamba kwa telmisartan imachitika mkati mwa maola atatu ndipo imangokhalira maola 24, kutsalira kwakanthawi mpaka maola 48. Ananena kuti antihypertensive zotsatira zimachitika pambuyo masiku 28-56 a pafupipafupi mankhwala.

Mu ochepa matenda oopsa, telmisartan lowers systolic and diastolic magazi (BP) osakhudza kugunda kwa mtima (HR).

Kuletsa kwakukulu kwa kutenga Telzap sikuyenda ndi chitukuko cha matenda obwera, kuthamanga kwa magazi pang'onopang'ono kumabweza msana wake masiku ambiri.

Mphamvu ya antihypertensive ya telmisartan imafanana ndi zomwe antihypertensive othandizira monga amlodipine, enalapril, hydrochlorothiazide, atenolol, ndi lisinopril, koma kugwiritsa ntchito telmisartan pali mwayi wocheperako wa chifuwa chowuma mosiyana ndi angiotensin kutembenuzira kwa enzyme.

Kugwiritsidwa ntchito kwa telmisartan popewa matenda amtima wamkati mwa odwala akuluakulu (azaka 55 ndi akulu) omwe amakhala ndi vuto lotchedwa ischemic, matenda a mtima, kuchepa kwamitsempha, kuwonongeka kapena mavuto a matenda a shuga 2, kuphatikiza retinopathy, kusowa kwamitsempha yamagazi, macro- kapena mbiri yakale ya microalbuminuria) idathandizira kuchepetsa kuphatikizika kwa matumizidwe ophatikizidwira: kuchipatala chifukwa cha kugundika kwa mtima, kufa kwa mtima, kufa kwa myocar kapena osakhala amapha sitiroko. Zotsatira za telmisartan ndizofanana ndi ramipril pochepetsa kufupika kwa mfundo zachiwiri: kufa kwa mtima, infarction yamtima, kapena sitiroko yopanda chifukwa. Mosiyana ndi ramipril, wokhala ndi telmisartan, kuchuluka kwa chifuwa chouma ndi angioedema kumakhala kotsika, ndipo ochepa hypotension amakhala apamwamba.

Pharmacokinetics

Pambuyo pakukonzekera pakamwa, mayamwidwe a telmisartan kuchokera m'matumbo am'mimba amachitika mwachangu, bioavailability ndi 50%. Kudya panthawi yomweyo kumayambitsa kuchepa kwa AUC (kuchuluka kwa plasma ndende), koma patatha maola atatu kuchuluka kwa telmisartan m'madzi a m'magazi kumafanana.

Poyerekeza ndi Amuna mwa Akazi, C_max (kuchuluka kwa kuchuluka kwa madzi am'magazi) kumakhala katatu, ndipo AUC - pafupifupi kawiri, koma izi sizikhudza kwambiri mphamvu ya Telzap.

Pali kusowa kwa ubale wapakati pakati pa kumwa ndi plasma ndende ya mankhwalawa. Mukamagwiritsa ntchito tsiku ndi tsiku 40 mg C_max ndipo AUC amasiyanasiyana mosiyanasiyana ndi kuchuluka kwa mankhwalawa.

Kumangiriza kumapulogalamu amadzi a m'magazi (makamaka albin ndi alpha₁glycoprotein wa asidi - oposa 99.5%.

Kukula kwakukulu komwe kumaoneka ndi magawo 500.

Kagayidwe ka Telmisartan kumachitika ndi kulumikizana ndi glucuronic acid; conjugate ilibe zochitika za pharmacological.

T_1/2 (kuchotsa theka-moyo) - oposa 20 maola. Amayamwa osasinthika makamaka (99%) m'matumbo, osakwana 1% omwe impso zimamufukula.

Chilolezo chonse cha plasma ndi pafupifupi 1000 ml / min, magazi a hepatic - mpaka 1500 ml / min.

Ndiofatsa pang'ono pang'ono aimpso ntchito, komanso odwala azaka zopitilira 65, pharmacokinetics ya telmisartan sikuti akuwonongeka, kotero kusintha kwa mankhwalawa sikofunikira.

A kwambiri kulephera aimpso ndi hemodialysis odwala, koyamba mlingo sayenera upambana 20 mg patsiku.

Telmisartan siwotsimikizika ndi hemodialysis.

Kuti muchepetse kuchepa kwa hepatic (zolimbitsa thupi kwa ana A ndi B), muyeso wa tsiku ndi tsiku mpaka 40 mg uyenera kugwiritsidwa ntchito.

Zizindikiro zogwiritsidwa ntchito

matenda oopsa,
kuchepa kwa pafupipafupi kwamatenda amtima komanso kufa kwa anthu okalamba omwe ali ndi matenda amtima wamatenda a atherothrombotic etiology (matenda a mtima, kuwonongeka kwakanthawi kapena mbiri yam'mimba) komanso ndikuloweka kwa chiwopsezo cha mtundu wa matenda ashuga.

Contraindication

kusokonekera kwamphamvu kwa chiwindi (Gulu Lopanda C),
matenda opatsirana a biliary thirakiti, cholestasis,
munthawi yomweyo kugwiritsa ntchito aliskiren kwambiri aimpso kuwonongeka GFR (glomerular kusefera gawo) zosakwana 60 ml / mphindi / 1,73 mamita 2 a thupi kapena vuto la matenda a shuga;
Mankhwala othandizirana ndi angiotensin-converting enzyme (ACE) zoletsa odwala matenda ashuga nephropathy,
cholowa m'malo obadwa nacho,
nthawi yapakati
yoyamwitsa
wazaka 18
Hypersensitivity pamagawo a mankhwala.

Telzap iyenera kugwiritsidwa ntchito mosamala ngati vuto la mtima lakulephera, matenda oopsa a mtima, aortic ndi mitral valve stenosis, kusokonezeka kwa impso, bilteral artery stenosis, artery stenosis yokhala ndi impso imodzi, yofatsa kuti magazi azingokhala ochepa (BCC). ) poyerekeza ndi kuchepa pang'ono kwa sodium mankhwala enaake, kutsekula m'mimba, kusanza kapena kumwa okodzetsa, hyperkalemia, hyponatremia, hyperaldost yoyamba ronism munthawi ya pambuyo opatsirana impso, kugwiritsa ntchito odwala a Negroid mpikisano.

Telzap, malangizo ogwiritsira ntchito: njira ndi mlingo

Mapiritsi a Telzap amatengedwa pakamwa ndi madzi okwanira, mosasamala kanthu ndi chakudyacho.

Kuchulukana kwa kumwa mankhwalawa ndi 1 nthawi patsiku.

Mlingo wovomerezeka watsiku ndi tsiku:

ochepa matenda oopsa: woyamba mlingo ndi 2040 mg. Pokhapokha wokwanira hypotensive pambuyo 28-56 masiku a mankhwala, koyamba mlingo akhoza kuchuluka. Mlingo wapamwamba tsiku lililonse ndi 80 mg. Njira ina, kuphatikiza kwa Telzap ndi thiazide diuretics (kuphatikizapo hydrochlorothiazide) kukuwonetsedwa,
kuchepa kwaimfa komanso kuchuluka kwa matenda amtima: 80 mg, kumayambiriro kwa chithandizo ndikofunikira kuwongolera kuthamanga kwa magazi. Ngati ndi kotheka, mankhwala a antihypertensive ayenera kuwongoleredwa.

Woopsa aimpso kulephera kapena hemodialysis odwala tikulimbikitsidwa kugwiritsa ntchito koyamba tsiku lililonse osaposa 20 mg.

Kuti muchepetse matenda aimpso pang'ono, kusintha sikofunikira.

Pofatsa kwambiri kwa hepatic insufficiency (Child-Pugh gulu la magulu A ndi B), tsiku lililonse mlingo wa Telzap suyenera kupitirira 40 mg.

Zotsatira zoyipa

zovuta zapakati: pafupipafupi - asthenia, kupweteka pachifuwa, kawirikawiri - matenda ngati chimfine,
matenda opatsirana ndi parasitic: pafupipafupi - matenda amkodzo thirakiti (kuphatikizapo cystitis), matenda am'mimba opatsirana pamatumbo (kuphatikizapo sinusitis, pharyngitis), osowa - sepsis (kuphatikizapo imfa),
Kuchokera pamtima dongosolo: pafupipafupi - bradycardia, orthostatic hypotension, kuchepa kwamphamvu kwa magazi, kawirikawiri - tachycardia,
Kuchokera kumitsempha yamagazi ndi magazi: kawirikawiri - kuchepa magazi, osowa - thrombocytopenia, eosinophilia,
kuchokera ku chitetezo chathupi: kawirikawiri - hypersensitivity zimachitika, anaphylactic zimachitika,
kuchokera ku psyche: pafupipafupi - kukhumudwa, kusowa tulo, kawirikawiri - nkhawa,
mbali ya kagayidwe ndi zakudya: pafupipafupi - hyperkalemia, osowa - hypoglycemia motsutsana ndi matenda osokoneza bongo,
Kuchokera m'mimba thirakiti: pafupipafupi - kupweteka kwam'mimba, kusanza, kukomoka, kutsekemera, kutsegula m'mimba, kawirikawiri - pakamwa youma, kulawa kwamkamwa, kusapeza bwino m'mimba.
Kuchokera ku hepatobiliary system: kawirikawiri - kuwonongeka kwa chiwindi, zovuta zamatenda a chiwindi,
kuchokera ku dongosolo lamanjenje: pafupipafupi - kukomoka, kawirikawiri - kugona,
mbali ya kumva, mavuto a labyrinth: pafupipafupi - vertigo,
mbali ya gawo la masomphenya: zosokoneza zowoneka,
Kuchokera pakapumidwe, m'chifuwa komanso mkati mwa ziwalo zam'mimba: pafupipafupi - kutsokomola, kupuma movutikira, kawirikawiri - matenda apamapapo ochepa,
dermatological zimachitika: pafupipafupi - kuyabwa, zotupa pakhungu, hyperhidrosis, osowa - zotupa za mankhwala, uritisaria, erythema, chikanga, poyipa pakhungu, angioedema (kuphatikizapo wakupha)
Kuchokera kwamikodzo dongosolo: pafupipafupi - kuwonongeka kwaimpso, kulephera kwaimpso,
Kuchokera kwamankhwala am'mimba komanso minyewa yolumikizana: pafupipafupi - kukokana kwa minofu, kupweteka kumbuyo (sciatica), myalgia, kawirikawiri - kupweteka kwa miyendo, arthralgia, kupweteka kwa tendon (tendon-like syndrome),
Laborator zizindikiro: pafupipafupi - kuchuluka plasma creatinine, kawirikawiri - kuchepa kwa hemoglobin m'madzi am'magazi, kuwonjezeka kwa ntchito ya hepatic michere ndi creatine phosphokinase, kuwonjezeka kwa kuchuluka kwa uric acid m'madzi a m'magazi.

Bongo

Zizindikiro: kuchepa kwa kuthamanga kwa magazi, tachycardia, chizungulire, bradycardia, kuchuluka kwa serum creatinine, kulephera kwaimpso.

Chithandizo: chapamimba pompopompo, kusanza kochita kupanga, ndikuthira makala. Kukula kwa zizindikiro zake komanso momwe wodwalayo akuyenera kuwunikira. Lemberani zothandizira komanso zothandizira. Ndikofunikira kuonetsetsa kuyesa kwa magazi pafupipafupi kwa ma plrma electrolyte ndi creatinine. Ndi kuchepa kwakukulu kwa kuthamanga kwa magazi, wodwalayo amayenera kuyikidwa pakukweza miyendo yake. Chitani zochitika kuti mubwezere bcc ndi ma elekitirodi.

Kugwiritsa ntchito hemodialysis ndikosatheka.

Malangizo apadera

Poika Telzap kwa odwala omwe ali ndi mafupa am'mimbamo a stenosis kapena ochepa a stenosis, ziyenera kukumbukiridwa kuti kumwa mankhwalawa kungayambitse chiopsezo chachikulu cha matenda oopsa komanso aimpso.

Yambani kulandira mankhwala pokhapokha mutachotsa kuperewera kwa bcc ndi / kapena sodium m'madzi a m'magazi.

Kugwiritsa ntchito kwa Telzap odwala omwe ali ndi vuto laimpso kumalimbikitsidwa kuti azitsatira limodzi ndi kuwunika kwa potaziyamu ndi creatinine m'madzi a m'magazi.

Kuletsa kwa RAAS (renin-aldosterone-angiotensin system) kumatha kuchitika m'magulu omwe ali ndi izi ndipo amatenga telmisartan ndi ena otsutsa RAAS. Amatha kuyambitsa ochepa hypotension, kukomoka, kukhazikika kwa hyperkalemia, komanso matenda operewera aimpso (kuphatikizapo kuperewera kwaimpso).

Kulephera kwa mtima, matenda a impso, kapena ma pathologies ena omwe amadalira kwambiri ntchito ya RAAS, kuyang'anira kwa Telzap kungayambitse kukula kwa vuto loti silinachitike, hyperazotemia, oliguria, ndipo nthawi zina, kulephera kwaimpso.

Ndi hyperaldosteronism yoyamba, kugwiritsa ntchito mankhwalawa sikuthandiza.

Mankhwalawa telmisartan odwala matenda a shuga amalandila insulin kapena m`kamwa hypoglycemic wothandizila, hypoglycemia angachitike, chifukwa chake kuyangʻanitsitsa misempha ya shuga amafunika. Ngati ndi kotheka, kusintha kwa insulin kapena hypoglycemic wothandizila kuyenera kuchitika.

Kusamalidwa makamaka kuyenera kuchitika ndipo chisamaliro chapadera chiyenera kuthandizidwa popereka mankhwala kwa Telzap kwa odwala omwe ali ndi vuto longa kuperewera kwa impso, matenda a shuga, odwala omwe amathandizidwanso munthawi yomweyo ndi mankhwala omwe amachititsa kuchuluka kwa potaziyamu m'madzi am'magazi, odwala okalamba (opitilira zaka 70), popeza izi magulu a odwala ali pachiwopsezo chachikulu cha kukhala ndi hyperkalemia, kuphatikizapo imfa.

Munthawi ya mankhwala ndi mankhwala, munthawi yomweyo mankhwala ena amayenera kuchitika pokhapokha ngati akuwuzani dokotala.

Kuchepa kwambiri kwa kuthamanga kwa magazi pa ischemic cardiomyopathy kapena matenda a mtima kungayambitse kukulitsa kwa myocardial infarction kapena stroke.

Kwa odwala a mpikisano wa Negroid, kuchepa kwapang'onopang'ono kwa kuthamanga kwa magazi kumadziwika.

Mimba komanso kuyamwa

Kugwiritsidwa ntchito kwa mapiritsi a Telzap munthawi ya gestation ndi kuyamwitsa kumatsutsana.

Pambuyo podziwa kuti mayi ali ndi pakati, odwala omwe atenga chithandizo cha Telzap ayenera kuyimitsa chithandizo cha telmisartan mwachangu ndikusintha mankhwalawa pogwiritsa ntchito mankhwala ena a antihypertensive omwe ali ndi mbiri yoyenera ya chitetezo panthawi yomwe ali ndi pakati komanso mkaka wa m`mawere.

Mu vuto laimpso

Poika Telzap imapikisidwa kwa odwala omwe amalephera kupweteka kwa impso (GFR osakwana 60 ml / mphindi / 1.73 m 2) akupanga mankhwala olumikizana ndi aliskiren.

Mochenjera, Telzap iyenera kutumikiridwa kuti iwononge matenda a impso, zamitsempha zamitsempha zamagazi zam'mitsempha, chotupa cha minyewa ya impso.

Woopsa aimpso kulephera ndi hemodialysis odwala tikulimbikitsidwa kugwiritsa ntchito koyamba tsiku lililonse osaposa 20 mg.

Kuti muchepetse matenda aimpso pang'ono, kusintha sikofunikira.

Ndi chiwindi ntchito

Kukhazikitsidwa kwa Telzap pochiza odwala omwe ali ndi vuto lochepa kwambiri kwa chiwindi (kalasi C malinga ndi gulu la ana-Pugh) latsutsana.

Mosamala, mapiritsi amayenera kumwedwa mofatsa kuti azikhala osakwanira (mapangidwe a Ana ndi Pugh A ndi B). Mlingo wa tsiku ndi tsiku wa telmisartan sayenera kupitirira 40 mg.

Kuyanjana kwa mankhwala osokoneza bongo

Pogwiritsa ntchito nthawi yomweyo Telzap:

aliskiren: odwala aimpso kulephera kapena matenda ashuga, kuphatikiza mankhwala ndi telmisartan ndi aliskiren kumabweretsa blockade pawiri wa RAAS, zomwe zimapangitsa kuwonjezeka pafupipafupi kwa zochitika zosagwirizana ndi ochepa hypotension, hyperkalemia ndi vuto laimpso.
ACE zoletsa: mwa odwala matenda ashuga nephropathy, munthawi yomweyo mankhwala ACE zoletsa amayambitsa iwiri blockade wa RAAS, kotero kuphatikiza telmisartan ndi ACE zoletsa amalephera.
potaziyamu yosalekerera okodzetsa (kuphatikizapo spironolactone, eplerenone, amiloride, triamteren), potaziyamu wokhala ndi zakudya zowonjezera zomwe zimakhala ndi potaziyamu wamchere, non-steroidal anti-kutupa mankhwala (NSAIDs), heparin, cyclosporine, tacrolimus, trimethoprim. Ngati kugwiritsidwa ntchito kophatikizana ndikofunikira, kuchuluka kwa ndende ya potaziyamu m'magazi a magazi kuyenera kuyang'aniridwa nthawi zonse,
digoxin: pali kuchuluka kwapakati pa digoxin m'madzi a m'magazi (C_max - 49%, C_mphindi - pofika 20%), posankha mtundu wa telmisartan kapena kusiya ntchito yake, mlingo wa digoxin m'magazi a magazi uyenera kuyang'aniridwa, kupewa kupyola malire a njira zake zochizira
Kukonzekera kwa lithiamu: ziyenera kudziwidwa kuti mosiyana ndi maziko a mankhwala ophatikiza ndi angiotensin II receptor antagonists ndi ACE inhibitors, kuchuluka kwa maamu m'magazi a m'magazi kungaonjezere mpaka kufika poizoni.
NSAIDs zosasankha, acetylsalicylic acid (Mlingo womwe amagwiritsidwa ntchito pochiza chotupa), cycloo oxygenase-2 inhibitors (COX-2): zimathandizira kufooka kwa mphamvu ya hypotensive ya telmisartan. Ngati vuto laimpso lawonongeka, kuphatikiza ndi COX-2 zoletsa kungayambitse kuwonongeka kwina mu ntchito yaimpso.
diuretics: isanafike mankhwalawa isanachitike kuchuluka kwa thiazide ndi kuwonda okodzetsa kumawonjezera chiopsezo cha hypovolemia ndi ochepa hypotension koyambirira kwa mankhwala ndi telmisartan,
Mankhwala ena a antihypertensive: onjezerani mphamvu za telmisartan,
antidepressants, ethanol, barbiturates, narcotic mankhwala: kuonjezera chiopsezo cha orthostatic hypotension,
corticosteroids chifukwa chogwiritsidwa ntchito mwazinthu: zimayambitsa kufooka kwa hypotensive zotsatira za Telzap.

Ma Analogs a Telzap ndi: Telmista, Mikardis, Telsartan, Telpres.

Gulu la Nosological (ICD-10)

Mapiritsi okhala ndi mafilimu	1 tabu.
ntchito:
telmisartan	40/80 mg
zokopa: meglumine - 12/24 mg, sorbitol - 162.2 / 324.4 mg, sodium hydroxide - 3,4 / 6.8 mg, povidone 25 - 20/40 mg, magnesium stearate - 2.4 / 4.8 mg

Zisonyezo Telzap ®

Kuchepetsa imfa ndi mtima matenda odwala akulu:

- ndi matenda amitsempha ya atherothrombotic chiyambi (matenda a mtima, stroko kapena mbiri ya zotumphukira mitsempha),

- ndi mtundu 2 matenda a shuga ndi chiwopsezo cha ziwalo.

Mimba komanso kuyamwa

Pakadali pano, zidziwitso zodalirika za chitetezo cha telmisartan mwa amayi apakati sizikupezeka. Mu maphunziro a nyama, poizoni wa mankhwala adadziwika. Kugwiritsa ntchito kwa Telzap ® kumaphatikizidwa panthawi yapakati (onani "Contraindication").

Ngati chithandizo cha nthawi yayitali ndi Telzap ® ndikofunikira, odwala omwe akukonzekera kutenga pakati ayenera kusankha njira ina yotsatsira antihypertensive yokhala ndi mbiri yotsimikizika yotetezeka yogwiritsidwa ntchito panthawi yapakati. Pambuyo pokhazikitsa chowonadi chokhala ndi pakati, chithandizo ndi Telzap ® ziyenera kuyimitsidwa nthawi yomweyo ndipo ngati kuli koyenera, chithandizo chamankhwala chiyenera kuyambitsidwa.

Monga tawonera zotsatira za kuwunika kwachipatala, kugwiritsidwa ntchito kwa ARA II mu II ndi III trimesters pamimba kumakhala ndi poizoni pa mwana wosabadwa (kuwonongeka kwa impso, oligohydramnios, kuchedwa kwa msana kwa chigaza) ndi wakhanda (kulephera kwa impso, kusintha kwina ndi hyperkalemia). Mukamagwiritsa ntchito ARA II panthawi yachiwiri ya kubereka, ndikulimbikitsidwa kwa impso ndi chigaza cha mwana wosabadwayo.

Ana omwe amayi awo adatenga ARA II panthawi yapakati amayenera kuwunikira mosamala kuti asachite kunjenjemera.

Zambiri pakugwiritsa ntchito telmisartan panthawi yoyamwitsa sizipezeka. Kutenga Telzap ® mukamayamwa kumayesedwa (onani "Contraindication"), mankhwala othandizira omwe ali ndi mbiri yabwino yachitetezo ayenera kugwiritsidwa ntchito, makamaka podyetsa mwana wakhanda kapena asanabadwe.

Kuchita

Ma blockade apawiri a RAAS. Kugwiritsidwa ntchito kwa telmisartan ndi aliskiren kumatsutsana mwa odwala omwe ali ndi matenda osokoneza bongo kapena kulephera kwa aimpso (GFR ochepera 60 ml / min / 1.73 m 2) ndipo osavomerezeka kwa odwala ena.

Kugwiritsa ntchito pamodzi kwa telmisartan ndi ACE zoletsa kumapangidwa kwa odwala omwe ali ndi matenda ashuga nephropathy (onani "Contraindication").

Kafukufuku wachipatala adawonetsa kuti blockade iwiri ya RAAS chifukwa cha kuphatikiza kwa ACE inhibitors, ARA II, kapena aliskiren imalumikizidwa ndikuwonjezereka kwa zochitika zovuta monga arterial hypotension, hyperkalemia, ndi vuto laimpso (kuphatikizapo kuperewera kwaimpso), poyerekeza ndi kugwiritsa ntchito mankhwala amodzi okha kutsatira RAAS.

Chiwopsezo cha kukhala ndi hyperkalemia chitha kuchuluka ngati agwiritsidwa ntchito limodzi ndi mankhwala ena omwe angayambitse hyperkalemia (potaziyamu-zakudya zowonjezera ndi mchere wogwirizira womwe amakhala ndi potaziyamu, potaziyamu woteteza (e.g. spironolactone, eplerenone, triamterene kapena amiloride), NSAIDs, kuphatikiza kusankha COX-2 inhibiti , immunosuppressants (cyclosporine kapena tacrolimus) ndi trimethoprim.Ngati ndikofunikira, motsutsana ndi mbiri yakale ya hypokalemia, kugwiritsa ntchito mankhwala paliponse kuyenera kuchitika samalani ndikuwonetsetsa zochitika za potaziyamu m'madzi a m'magazi.

Digoxin. Ndi mgwirizano wa telmisartan ndi digoxin, kuwonjezeka kwapakati pa C kunadziwika_max plasma digoxin pa 49% ndi C_mphindi ndi 20%. Kumayambiriro kwa chithandizo, posankha mtundu wa mankhwala ndi kusiya kumwa mankhwala ndi telmisartan, kuchuluka kwa digoxin m'madzi a m'magazi kuyenera kuyang'aniridwa mosamala kuti pakhale njira yochizira.

Potaziyamu yosawononga okodzetsa kapena potaziyamu wokhala ndi zopatsa thanzi. ARA II, monga telmisartan, amachepetsa kutaya kwa potaziyamu chifukwa cha okodzetsa. Potaziyamu yosawononga diuretics, mwachitsanzo spironolactone, eplerenone, triamteren kapena amiloride, potaziyamu zomwe zimakhala ndi zakudya kapena zowonjezera mchere zimatha kuyambitsa kuchuluka kwa potaziyamu m'madzi a m'magazi. Ngati zikugwiritsidwa ntchito mosiyanasiyana, chifukwa pali zolembedwa kuti: hypokalemia, ziyenera kugwiritsidwa ntchito mosamala komanso motsutsana ndi kuyang'anira potaziyamu nthawi zonse m'magazi a magazi.

Kukonzekera kwa Lithium. Pamene kukonzekera kwa lithiamu kumachitika limodzi ndi ACE ndi ARA II zoletsa, kuphatikiza telmisartan, kuwonjezereka kosintha kwa plasma wozungulira wa lithiamu ndi poizoni wake kunayamba. Ngati mukufuna kugwiritsa ntchito mitundu yosiyanasiyana ya mankhwalawa, tikulimbikitsidwa kuti muwunike mosamala kuchuluka kwa lifiyamu m'madzi a m'magazi.

NSAIDs. NSAIDs (i.e., acetylsalicylic acid mu Mlingo wogwiritsidwa ntchito pakuthana ndi zotupa, COX-2 inhibitors komanso NSAIDs zosasankha) zitha kufooketsa mphamvu ya antihypertensive ya ARA II. Odwala ena omwe ali ndi vuto la impso (mwachitsanzo, kuchepa madzi m'thupi, odwala okalamba omwe ali ndi vuto laimpso), kugwiritsidwa ntchito kophatikizana kwa ARA II ndi mankhwala omwe amalepheretsa COX-2 kungayambitse kuwonongeka kwa ntchito yaimpso, kuphatikizapo kukula kwa aimpso kulephera, komwe, monga lamulo, ndikosintha. Chifukwa chake, kugwiritsa ntchito mankhwala paliponse kuyenera kuchitika mosamala, makamaka odwala okalamba. Ndikofunikira kuti zitsimikizire kuchuluka koyenera kwamadzimadzi, kuphatikiza, kumayambiriro kwa kugwiritsidwa ntchito molumikizana komanso nthawi ndi nthawi mtsogolo, zidziwitso zantchito ya aimpso ziyenera kuyang'aniridwa.

Diuretics (thiazide kapena loop). Chithandizo cham'mbuyomu chokhala ndi kuchuluka kwa okodzetsa, monga furosemide (loop diuretic) ndi hydrochlorothiazide (thiazide diuretic), zimatha kubweretsa hypovolemia ndi chiopsezo cha hypotension koyambirira kwa chithandizo ndi telmisartan.

Mankhwala ena a antihypertensive. Mphamvu ya telmisartan imatha kupitilizidwa ndi kugwiritsa ntchito mankhwala ena a antihypertensive. Kutengera ndi mankhwalawa a baclofen ndi amifostine, titha kuganiza kuti apititsa patsogolo mankhwala othandizira onse antihypertensive mankhwala, kuphatikizapo telmisartan. Kuphatikiza apo, orthostatic hypotension imatha kuchuluka ndi mowa, barbiturates, mankhwala osokoneza bongo, kapena antidepressants.

Corticosteroids (yogwiritsidwa ntchito mwadongosolo). Corticosteroids imafooketsa mphamvu ya telmisartan.

Mlingo ndi makonzedwe

Mkati, kamodzi patsiku, kutsukidwa ndimadzimadzi, mosasamala kanthu za kudya.

Matenda oopsa. Mlingo woyamba wa Telzap ® ndi piritsi limodzi. (40 mg) kamodzi patsiku. Odwala ena amatha kudya 20 mg / tsiku limodzi. Mlingo wa 20 mg ungapezeke mwa kugawa piritsi la 40 mg pakati pangozi. Muzochitika zomwe achire samakwaniritsa, muyezo wa Telzap ® mutha kupititsidwa mpaka 80 mg kamodzi patsiku. Njira ina, Telzap ® imatha kuthandizidwa ndi thiazide diuretics, mwachitsanzo, hydrochlorothiazide, yomwe, ikagwiritsidwa ntchito palimodzi, imakhala ndi mphamvu yowonjezera ya antihypertensive.

Mukafuna kudziwa kuchuluka kwa mankhwalawa, ziyenera kukumbukiridwa kuti mphamvu yayitali kwambiri ya antihypertgency nthawi zambiri imatheka mkati mwa masabata 4-8 pambuyo poyambira chithandizo.

Kuchepetsa imfa ndi pafupipafupi matenda a mtima. Mlingo wovomerezeka wa Telzap ® ndi 80 mg kamodzi patsiku. Munthawi yoyambirira ya chithandizo, kuyang'anira magazi kumalimbikitsidwa; kusintha kwa antihypertensive mankhwala kungafunike.

Ambiri odwala

Matenda aimpso. Zomwe zimachitika ndi telmisartan kwa odwala omwe amalephera kwambiri aimpso kapena odwala hemodialysis ndi ochepa. Odwala awa amalimbikitsidwa kuti ayambe kutsika 20 mg / tsiku (onani. "Chithandizo chapadera"). Kwa odwala omwe ali ndi vuto laimpso lokwanira zolimbitsa thupi, kusintha kwa mankhwala sikofunikira. Kugwiritsa ntchito kwa Telzap ® ndi aliskiren kumapangidwa mwa odwala omwe amalephera kuwonongeka kwa impso (GFR osakwana 60 ml / min / 1.73 m 2) (onani. "Contraindication").

Kugwiritsa ntchito nthawi yomweyo kwa Telzap ® ndi ACE zoletsa kumapangidwa kwa odwala omwe ali ndi matenda ashuga nephropathy (onani "Contraindication").

Kuwonongeka kwa chiwindi. Telzap ® imaphatikizidwa kwa odwala omwe amawonongeka kwambiri kwa chiwindi (Child-Pugh class C) (onani "Contraindication"). Odwala omwe ali ndi vuto lochepa kwambiri kwa hepatic (kalasi A ndi B malinga ndi gulu la ana-Pugh, motsutsana), mankhwalawa amadziwitsidwa mosamala, mankhwalawa sayenera kupitilira 40 mg kamodzi patsiku (onani. "Mochenjera").

Ukalamba. Kwa odwala okalamba, kusintha kwa mankhwalawa sikofunikira.

Ana ndi unyamata. Kugwiritsa ntchito kwa Telzap ® mwa ana ndi achinyamata ochepera zaka 18 kumayesedwa chifukwa chosowa chitetezo ndi chidziwitso chokwanira (onani "Contraindication").

Wopanga

Zentiva Saalyk Yurunleri Sanayi ve Tijaret A.Sh., Turkey.

District Kucukkaryshtyran, st. Merkez, No. 223 / A, 39780, Buyukkaryshtyran, Luleburgaz, Kırklareli, Turkey.

Wokhala ndi satifiketi yolembetsa. Sanofi Russia JSC. 125009, Russia, Moscow, ul. Tverskaya, 22.

Zofunsa pamtundu wa mankhwalawa ziyenera kutumizidwa ku adilesi ya Sanofi Russia JSC: 125009, Russia, Moscow, ul. Tverskaya, 22.

Tele. ((495) 721-14-00, fakisi: (495) 721-14-11.

Kutulutsa mafomu ndi kapangidwe kake

Amapezeka mu piritsi. Piritsi lililonse lili ndi 0,04 kapena 0,08 g wa telmisartan yogwira mankhwala.

Kuphatikiza apo, chipangizochi chimaphatikizapo zinthu monga izi:

meglumine
sorbitol
sodium hydroxide
povidone
mchere wakuwotcha wa magnesium.

Mapiritsi amaikidwa m'matumba a zidutswa 10.

Zotsatira za pharmacological

Mankhwalawa ndi a okonda ma angiotensin receptors ept. Imagwiritsidwa ntchito ngati njira yothandizira pakamwa. Imaika angiotensin ΙΙ, siyimalola kuyanjana ndi ma receptors. Amamangidwa ku AT I angiotensin рецеп receptor, ndipo kulumikizaku kumafotokozedwera mosalekeza.

Mankhwalawa amachepetsa kuchuluka kwa aldosterone mu plasma popanda kuchepetsa mphamvu ya renin. Siletsa kutsata ma ion. Sipondera njira ya kaphatikizidwe ka ACE. Zinthu zotere zimathandiza kupewa zovuta pa kumwa mankhwalawa.

Kumwa mankhwala osokoneza bongo a 0,88 g kumayimitsa ntchito ya angiotensin ΙΙ. Chifukwa cha izi, mankhwalawa atha kumwa mankhwala oletsa kuchepa kwa magazi. Komanso, kuyambika kwa zinthu zotere kumayamba patatha maola atatu mutangomamwa.

Pharmacological zotsatira zimapitirira kwa tsiku likamatha, zikuwonekeranso masiku ena awiri.

Hypotensive yokhazikika imayamba pakatha masabata anayi atayamba chithandizo.

Mankhwala atatha, zisonyezo zimangobwerera pang'onopang'ono kwa zomwe zinali kale popanda kuwonetsa zizindikiro zochoka.

Matenda oopsa

Mlingo woyamba wa Telzap ndi 40 mg (piritsi 1) kamodzi patsiku. Odwala ena, kumwa mankhwala 20 mg patsiku kungakhale kothandiza. Mlingo wa 20 mg ungapezeke mwa kugawa piritsi la 40 mg pakati pangozi. Muzochitika zomwe achire samakwaniritsa, muyezo wa Telzap mutha kupititsidwa mpaka 80 mg kamodzi patsiku.

Njira ina, Telzap imatha kuthandizidwa ndi thiazide diuretics, mwachitsanzo, hydrochlorothiazide, yomwe, ikagwiritsidwa ntchito limodzi, inali ndi mphamvu yowonjezera ya antihypertensive. Mukafuna kudziwa kuchuluka kwa mankhwalawa, ziyenera kukumbukiridwa kuti mphamvu yayitali kwambiri ya antihypertgency nthawi zambiri imatheka mkati mwa masabata 4-8 pambuyo poyambira chithandizo.

Zomwe zimachitika ndi telmisartan kwa odwala omwe amalephera kwambiri aimpso kapena odwala hemodialysis ndi ochepa. Odwala akulimbikitsidwa kuchepetsedwa koyamba kwa 20 mg patsiku. Kwa odwala omwe ali ndi vuto laimpso lokwanira zolimbitsa thupi, kusintha kwa mankhwala sikofunikira.

Kugwiritsidwa ntchito kwa Telzap ndi aliskiren kumayikidwa kwa odwala omwe amalephera kupweteka kwa impso (GFR osakwana 60 ml / mphindi / 1.73 m2 yamalo olimbitsa thupi).

Kugwiritsa ntchito nthawi yomweyo kwa Telzap ndi ACE zoletsa kumapangidwa kwa odwala omwe ali ndi matenda ashuga.

Odwala omwe ali ndi vuto lochepa kwambiri la chiwindi (kalasi A ndi B malinga ndi gulu la ana-Pugh) ayenera kuikidwa mosamala, mlingo sayenera kupitirira 40 mg kamodzi patsiku. Telzap imaphatikizidwa kwa odwala omwe ali ndi vuto loopsa la hepatic (kalasi C malinga ndi gulu la Mwana-Pugh).

Kwa odwala okalamba, kusintha kwa mankhwala sikofunikira.

Telzap Plus

Tengani pakamwa, kamodzi patsiku, kutsukidwa ndi madzi, osasamala chakudyacho.

Odwala omwe BP yawo singayende moyenera ndi monotherapy ndi telmisartan kapena hydrochlorothiazide ayenera kutenga Telzap Plus.

Musanafike pophatikizira ndi gawo limodzi la mankhwala, munthu aliyense amalimbikitsidwa pakamwa. Mu zochitika zina zamankhwala, kusintha kwachindunji kuchokera ku monotherapy kupita ku chithandizo cha mankhwala osakanikirana kungaganizidwe.

Mankhwala a Telzap Plus, angagwiritsidwe ntchito kamodzi patsiku kwa odwala omwe magazi awo sangathe kuwongolera bwino akamamwa telmisartan pa mlingo wa 80 mg patsiku.

Kupanga ndi mawonekedwe a kumasulidwa

Zogulitsa lero ndi mitundu iwiri ya mankhwala omwe ali osiyana mu kapangidwe kake ndi zinthu zina.

Zomwe mapiritsi a Telzap amaphatikizira ndizochita: telmisartan 40 ndi 80 mg.

Zomwe mapiritsi a Telzap Plus akuphatikizira:

yogwira pophika: telmisartan - 80 mg, hydrochlorothiazide - 12,5 mg,
zina zowonjezera: sorbitol - 348.3 mg, sodium hydroxide - 6.8 mg, povidone - 25.4 mg, magnesium stearate - 4.9 mg.

Kodi chimathandiza ndi chiyani Telzap?

Malinga ndi malangizo ogwiritsira ntchito, mankhwalawa amaperekedwa kwa anthu omwe ali ndi matenda ochepa ochepa.

Zizindikiro zazikulu zogwiritsira ntchito mankhwalawa:

IHD mwa odwala azaka zopitilira 55.
Monga mbali ya zovuta mankhwala pambuyo sitiroko kapena ischemic kuukira.
Kupewa matenda a mtima ndi mitsempha yamagazi mu mtundu 2 wa shuga.
Kuthamanga kwambiri kwa magazi - pamwambapa pa 140/90 pakufunika kofunikira komanso mitundu ina ya matenda oopsa.
Kupewa matenda a mtima dongosolo.
Kupewa kufa chifukwa cha kugunda kwamtima kwa odwala omwe ali pachiwopsezo (choteteza mtima, kugunda, kulephera kwa mtima ndi zotsatira zakupha).

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

Matenda oopsa

Mlingo wa mankhwalawa amatchulidwa malinga ndi kupezeka kwa mankhwalawa. Ndi bwino kuti chithandizo cha matenda oopsa chiyambire kumwa piritsi limodzi patsiku (40 mg). Odwala ena amatha kupeza mphamvu akatha kudya 20 mg / tsiku. Kulandira mlingo wa 20 mg, ndikokwanira kugawa piritsi la 40 mg magawo awiri.

Ngati zotsatira zoyenerera sizingatheke ngakhale mutatenga 40 mg, dokotala amatha kudziwa kuchuluka kwa mankhwalawa kwa wodwala, i.e 80 mg.

Ngati mukufuna, mankhwalawa amatha kuphatikizidwa ndi thiazide diuretics, omwe ali ndi antihypertensive kwambiri mwachitsanzo, hydrochlorothiazide.

Mukafuna kusankha kuchuluka, muyenera kuganizira: kuchuluka kwa zochita za antihypertensive zimayamba pambuyo pa miyezi iwiri ya chithandizo.

Kuchepa kwaimfa, matenda a mtima

Pankhaniyi, mankhwalawa amalimbikitsidwa kuti amwe pa 80 mg / tsiku. Kumayambiriro kwa chithandizo, muyenera kuwunika kuthamanga kwa magazi ndipo ngati kuli kotheka, musinthe ma regimen.

Zomwe tikugwiritsa ntchito Telzap mwa anthu omwe ali ndi hemodialysis kapena akuvutika kwambiri ndi impso ndizochepa. Mlingo woyambirira wa odwala wotere siwapitilira 20 mg / tsiku. Ngati munthu ali ndi kuwonongeka kwakanthawi kapena kufinya kwa impso, mulingo wake sukuchepetsedwa.

Ndi kulephera kwa aimpso ndi matenda a shuga a nephropathy, kugwiritsidwa ntchito kwa Telzap ndi Aliskiren kumatsutsana.
Kulephera kwambiri kwa chiwindi, mankhwala sawunikidwa. Kugwiritsa ntchito kwa Telzap modekha komanso kufatsa kwa chiwindi kumatheka muyezo wa 40 mg / tsiku.

Akuluakulu safuna kusintha kwa mlingo.

Zotsatira zamatsenga

Mankhwala a Telzap ndi othandiza makamaka. Mwa kulumikizana ndi olandirira thupi, mankhwalawa amaletsa omaliza, kuletsa zinthu zina zomwe zimayambitsa kuthamanga kwa magazi (BP) "pochita ntchito yawo."

Odwala omwe ali ndi kuthamanga kwa magazi, mapiritsi amapereka kuchepa kwapang'onopang'ono kwa kuthamanga kwa magazi, onse a diastolic ndi systolic. Poterepa, mankhwalawa samakhudza kugunda kwa mtima.

Kwa mapiritsi, syndrome yodziwikiratu si yachilendo. Ndi kusiyidwa kwakanema kwa mankhwala okhala ndi mapiritsi, zizindikiro za kuthamanga kwa magazi zimabweza m'magawo awo am'mbuyomu masiku angapo otsatira.

Kuchita kwa Telzap ndikofanizira ndi antihypertensive zotsatira zamankhwala ena, machitidwe ofanana kuchokera m'makalasi ena - Enalapril, Lisinopril, etc.

Zotsatira zoyipa

Ngakhale imagwira ntchito kwambiri, mankhwalawa a Telzap ali ndi zovuta zingapo:

kusintha kwa impso ndi chiwindi.
kugona
chizungulire, kusowa kwa chikumbumtima kwakanthawi,
kutsika kwa hemoglobin ndi kuchuluka kwa ma protein
kuchuluka kwa potaziyamu m'magazi,
kupweteka kwa minofu ndi molumikizana
zovuta zam'mimba, kusintha kwa kukoma, kuchuluka kwa mpweya,
kutsitsa kwa mtima,
zilonda zamkati, khungu, kuyabwa
kuvutika mumtima,
kutsika kwa kuchuluka kwa shuga,
kumva kuwonongeka.

Wodwalayo ayenera kuwunika bwino matenda ake. Maonekedwe osintha mthupi mwanjira iliyonse atha kuwonetsa kusayenda bwino kwa mankhwalawa.

Analogs a mankhwala Telzap

Zochizira, analogues zotchulidwa mankhwala:

Wotsogolera
Telsartan
Telsartan H,
Telmisartan
Telpres
Pano,
Telmista
Tanidol
Telpres Plus,
Mikardis,
Mikardis Kuphatikiza,
Telzap Plus.

Angiotensin 2 receptor antagonists akuphatikizapo analogues:

Sartavel
Presartan
Mikardis,
Lozarel
Pakati
Artinova,
Exfotans,
Kuthekera
Firmast
Irbesartan
Lorista
Telmisartan
Blocktran
Valz N,
Ibertan
Cozaar
Renicard
Cardosten
Losartan
Naviten
Brozaar
Coaprovel
Lozap Plus,
Valz
Lozap,
Telsartan
Aprovel
Cardomin
Tareg
Telpres
Ordiss
Olimestra
Nortian
Wogwirizira
Mphepete,
Vasotens,
Irsar
Gizaar
Zisakar
Edarby
Valsacor
Hyposart,
Losartan n
Aprovask,
Wotsogolera
Makandulo
Diovan
Muziyamwa
Eprosartan Mesylate,
Cardos,
Cardosal
Kuphatikiza,
Karzartan
Xarten
Losacor
Valsartan
Tanidol
Atacand
Vamloset.

Mikhalidwe yapadera

Pamaso pa zinthu zotsatirazi, katswiri wodziwa bwino yekha ndi amene angamwetse mankhwalawa ndikuwerengera kuchuluka kwake:

Kuwonongeka kwakukulu kwa impso. Kwa odwala omwe ali ndi chiwonetsero cholimba cha impso, sikuyenera kusintha kwapadera. Komabe, vuto lalikulu la aimpso, mlingo uyenera kuchepetsedwa 20 mg. Ngati wodwala ali ndi hemodialysis, Telzap sayenera kumwedwa.
Matenda a shuga Mankhwalawa amachepetsa shuga wamagazi, motero odwala ayenera kuyang'anitsitsa kuchuluka kwa shuga.
Cardiomyopathy, kupendekera kwa maonekedwe aortic kapena mitral. Telzap idzakulitsa lumen ya ziwiya, motero odwala omwe ali ndi matenda otere amafunika kuwongolera kwapadera pakumwa mankhwala.
Ma blockade apawiri a RAAS. Kuletsa kwa RAAS kumapangitsa kutsika kwamphamvu kwa kuthamanga kwa magazi, kuchuluka kwa potaziyamu komanso kuletsa kugwira ntchito kwa aimpso.
Kukonzanso kwamphamvu kwamphamvu. Pathology imawoneka ngati magazi atasokonezeka chifukwa cha stenosis yamitsempha yama impso. Mukamagwiritsa ntchito mankhwalawa, kulephera kwa impso kumatha kuchitika.
Ntchito chiwindi ntchito. Kwa chiwindi cholimbitsa chiwindi, kusintha kwa mankhwalawa sikofunikira. Ndi pathologies zazikulu, kumwa mapiritsi ndi koletsedwa.

Mtengo ndi tanthauzo la tchuthi

Phukusi wamba la Telzap 40 mg ku Moscow limawononga ma ruble 380. Kuti mupeze mankhwala omwe amapezeka mu Mlingo wa mankhwala awiri, muyenera kulipira ma ruble 435. Mapiritsi amatha kugulidwa kuchokera ku pharmacies ndi mankhwala.

Mankhwala a Telzap malangizo ogwiritsira ntchito akutsimikiza kuti musamagwire ana kwa zaka ziwiri. Kuti mapiritsi asatayike katundu wawo, muyenera kuyang'anira kutentha kwa mpweya m'chipindacho. Sizingadutse 25 digiri.

Kapangidwe kake ndi mafotokozedwe ake

Mapiritsi 80 mg: mapiritsi oblong, a biconvex kuchokera pafupifupi oyera mpaka achikaso achikuda ndi olemba "80" mbali imodzi.

Piritsi lililonse la 80 mg limakhala ndi:

yogwira mankhwala: telmisartan - 80,000 mg,
zotuluka: meglumine - 24,000 mg, sorbitol - 324,400 mg, sodium hydroxide - 6,800 mg, povidone 25 - 40,000 mg, magnesium stearate - 4,800 mg.

Zofunikira pa Hypertension

Odwala, telmisartan pa mlingo wa 80 mg kwathunthu limalepheretsa hypertensive zotsatira za angiotensin II. Kukhazikika kwa antihypertensive kanthu kumadziwika mkati mwa maola atatu itatha konzedwe ka telmisartan. Mphamvu ya mankhwalawa imatha kwa maola 24 ndipo imakhalabe yovuta mpaka maola 48. Mankhwala otchulidwa kuti antihypertensive nthawi zambiri amakula masabata 4,8 pambuyo pakudya.

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

Ngati telmisartan itatha, kuthamanga kwa magazi pang'onopang'ono kumatha kubwerera m'masiku angapo popanda matenda oti "achotse".

Zotsatira zakuyerekeza kwamafukufuku azachipatala zawonetsa, zotsatira za antihypertensive za telmisartan zikufanana ndi mphamvu ya antihypertensive ya mankhwala am'makalasi ena (amlodipine, atenolol, enalapril, hydrochlorothiazide ndi lisinopril.

Zomwe zimachitika kuti chifuwa chouma chikhale chotsika kwambiri ndi telmisartan poyerekeza ndi ACE inhibitors.

Mtima Kupewa matenda

Odwala azaka za 55 kapena kuposerapo omwe ali ndi matenda amtima wodwala, stroko, kuchepa kwa kanthawi kochepa, kuwonongeka kwamitsempha, kapena zovuta za mtundu 2 - zochitika zaposachedwa, telmisartan anali ndi vuto lofanana ndi la ramipril pakuchepetsa magawo ophatikizana: kufa kwa mtima kuchokera ku infa ya myocardial popanda zotsatira zakupha, sitiroko popanda imfa kapena m'chipatala chifukwa cholephera aakulu mtima.

Telmisartan inali yothandiza ngati ramipril pakuchepetsa pafupipafupi mfundo zachiwiri: kufa kwa mtima, kufa kosagwirizana ndi myocardial infarction, kapena kupha anthu omwe sanaphe. Kukhosomola kouma ndi angioedema sikuti sikufotokozedwa kwenikweni ndi telmisartan poyerekeza ndi ramipril, pomwe ochepa hypotension nthawi zambiri amakhala ndi telmisartan.

Zogulitsa

Ikaperekedwa, telmisartan imatengedwa mwachangu kuchokera m'mimba. Bioavailability ndi 50%. Mukamamwa pamodzi nthawi yomweyo ndi chakudya, kuchepa kwa AUC (dera lomwe limakhala ndende nthawi yayitali) kumachokera ku 6% (pa 40 mg) mpaka 19% (pa mlingo wa 160 mg). Pambuyo pa maola atatu pambuyo pa utsogoleri, ndende ya m'magazi imayendetsedwa, palokha, telmisartan idatengedwa panthawi yomweyo ngati chakudya kapena ayi. Pali kusiyana pamaganizidwe a plasma mwa amuna ndi akazi. Stach (ndende yayitali) ndi AUC inali pafupifupi 3 ndi 2 nthawi, motero, yayitali mwa azimayi poyerekeza ndi abambo popanda phindu lalikulu.

Panalibe ubale wamzera pakati pa mlingo wa mankhwalawo ndi ndende yake ya plasma. Phula ndi, pocheperapo, AUC imachulukitsa mosasamala kuti ichulukitse mlingo wake pogwiritsa ntchito Mlingo wapamwamba wa 40 mg patsiku.

Kupenda

Zimapangidwa ndi kuphatikizika ndi glucuronic acid. Conjugate ilibe zochitika zamankhwala.

Hafu ya moyo (T. / 2) ndi wopitilira maola 20. Amapukusidwa kudzera m'matumbo osasinthika, zotupa za impso - zosakwana 1%. Chilolezo chonse cha plasma ndi chachikulu (pafupifupi 1000 ml / min) poyerekeza ndi magazi a "hepatic" (pafupifupi 1500 ml / min).

Zisonyezero zogwiritsira ntchito mapiritsi a Telzap 80 mg ndi:

matenda oopsa,
Kuchepetsa kufedwa ndi matenda amtima mu akulu okalamba omwe ali ndi matenda amtundu wa atherothrombotic chiyambi (IHD, stroke kapena mbiri ya zotumphukira mitsempha) ndi mtundu 2 matenda a shuga ndi vuto lachiberekero

Ndi chisamaliro

Mankhwala a Telzap ayenera kuthandizidwa mosamala pazinthu zotsatirazi:

Mgwirizano wamitsempha wamagazi wamanjenje kapena matenda am'mimba a impso imodzi,
kuwonongeka kwaimpso,
zofatsa pang'ono zolimbitsa chiwindi,
kutsika kwa magazi mozungulira magazi (BCC) potengera zakumayambiriro kwa okodzetsa, kuletsa kumwa kwa sodium mankhwala enaake, kutsekula m'mimba kapena kusanza,
hyponatremia,
Hyperkalemia
kusintha pambuyo pa kupatsirana kwa impso (osagwiritsa ntchito),
kulephera kwamtima kwambiri,
stenosis wa msempha wa msempha ndi mitral valavu,
hypertrophic obstriers cardiomyopathy,
chachikulu hyperaldosteronism (mphamvu ndi chitetezo sichinakhazikitsidwe)

Odwala ndi mkhutu aimpso ntchito

Zomwe zimachitika ndi telmisartan kwa odwala omwe amalephera kwambiri aimpso kapena odwala hemodialysis ndi ochepa. Odwala awa amalimbikitsidwa kuti azikhala ndi 20 mg ochepa patsiku (onani gawo "chisamaliro chapadera"). Kwa odwala omwe ali ndi vuto laimpso lokwanira zolimbitsa thupi, kusintha kwa mankhwala sikofunikira.

Kugwiritsa ntchito kwa Telzap ndi aliskiren kumatsutsana mwa odwala omwe ali ndi vuto la impso.

Kugwiritsa ntchito nthawi yomweyo kwa Telzap ndi ACE zoletsa kumapangidwa kwa odwala omwe ali ndi matenda ashuga.

Odwala omwe ali ndi vuto la chiwindi

Telzap imaphatikizidwa kwa odwala omwe ali ndi vuto loopsa la hepatic (kalasi C malinga ndi gulu la Mwana-Pugh). Odwala omwe ali ndi vuto lochepa la chiwindi cholimbitsa thupi (kalasi A ndi B malinga ndi gulu la ana-Pugh, motero), mankhwalawa amaperekedwa mosamala, mankhwalawa sayenera kupitilira 40 mg kamodzi patsiku.

Mimba

Pakadali pano, zidziwitso zodalirika za chitetezo cha telmisartan mwa amayi apakati sizikupezeka. Mu maphunziro a nyama, poizoni wa mankhwala adadziwika. Kugwiritsa ntchito kwa Telzap kumapangidwa pakubadwa (onani gawo "Contraindication").

Ngati chithandizo cha nthawi yayitali ndi Telzap ndichofunikira, odwala omwe akukonzekera kutenga pakati ayenera kusankha njira ina yotsatsira antihypertensive yokhala ndi mbiri yotsimikizika yotetezeka yogwiritsidwa ntchito panthawi yapakati. Pambuyo pokhazikitsa mfundo yokhudza kukhala ndi pakati, chithandizo ndi Telzap ziyenera kuyimitsidwa nthawi yomweyo ndipo ngati kuli kotheka, chithandizo chamankhwala chiyenera kuyamba.

Monga tawonera zotsatira za kuwunika kwachipatala, kugwiritsidwa ntchito kwa ARAP panthawi yachiwiri komanso yachitatu yamatenda oyembekezera kumakhala ndi poizoni pa mwana wosabadwa (ntchito yolakwika yaimpso, oligohydramnios, kuchedwa kwa msana kwa chigaza) ndi wakhanda (kulephera kwa impso, kusintha kwina ndi hyperkalemia). Mukamagwiritsa ntchito ARAN panthawi yachiwiri ya kubereka, ndikulimbikitsidwa kuyesa impso ndi chigaza cha mwana wosabadwayo.

Ana omwe amayi awo anatenga ARAP panthawi yoyembekezera ayenera kuwunikiridwa mosamala kuti awoneke bwino.

Nthawi yoyamwitsa

Zambiri pakugwiritsa ntchito telmisartan panthawi yoyamwitsa sizipezeka. Kutenga Telzap mukamayamwa kumapangidwa, njira yothandizira antihypertgency yokhala ndi mbiri yabwino yachitetezo iyenera kugwiritsidwa ntchito, makamaka pakudyetsa mwana wakhanda kapena asanabadwe.

Zotsatira zoyipa

Pogwiritsa ntchito mankhwala Ordiss, zovuta zimatheka:

Matenda opatsirana komanso parasitic: pafupipafupi - matenda amkodzo thirakiti, kuphatikiza cystitis, matenda am'mimba opatsirana kupuma, kuphatikizapo pharyngitis ndi sinusitis, osowa - sepsis.
Kuchokera ku hemopoietic system: pafupipafupi - kuchepa magazi, osowa - eosinophilia, thrombocytopenia.
Kuchokera ku chitetezo chamthupi: kawirikawiri - anaphylactic reaction, hypersensitivity.
Kuchokera kumbali ya kagayidwe: kawirikawiri - hyperkalemia, kawirikawiri - hypoglycemia (odwala matenda a shuga a mellitus).
Matenda am'malingaliro: pafupipafupi - kusowa tulo, kukhumudwa, kawirikawiri - nkhawa.
Kuchokera ku dongosolo lamanjenje: pafupipafupi - kukomoka, kawirikawiri - kugona.
Kuchokera kumbali ya gawo la masomphenya: kawirikawiri - zosokoneza zowoneka.
Kumbali ya chiwalo cha makutu ndi labyrinth: pafupipafupi - vertigo.
Kuchokera pamtima dongosolo: pafupipafupi - bradycardia, kuchepa kwakukulu kwa kuthamanga kwa magazi, orthostatic hypotension, kawirikawiri - tachycardia.
Kuchokera kupuma dongosolo: pafupipafupi - kupuma movutikira, kutsokomola, kawirikawiri - matenda am'mapapo ochepa.
Kuchokera m'mimba thirakiti: pafupipafupi - kupweteka kwam'mimba, kutsegula m'mimba, kukomoka, kugona, kusanza, kawirikawiri - pakamwa pouma, kusapeza bwino m'mimba, kuphwanya kwa zomverera zamkati.
Kuchokera ku chiwindi ndi ma biliary thirakiti: kawirikawiri - kuwonongeka kwa chiwindi / kuwonongeka kwa chiwindi.
Pa khungu ndi subcutaneous zimakhala: pafupipafupi - khungu kuyabwa, hyperhidrosis, zotupa pakhungu, kawirikawiri - angioedema (komanso wakupha), chikanga, erythema, urticaria, zotupa pakhungu.
Kuchokera ku minculoskeletal system: pafupipafupi - kupweteka kumbuyo (sciatica), kukokana kwa minofu, myalgia, kawirikawiri - arthralgia, kupweteka kwa miyendo, kupweteka kwa tendons (zizindikiro ngati tendon).
Kuchokera kwamikodzo dongosolo: mokwanira - mkhutu aimpso ntchito, kuphatikizapo pachimake aimpso kulephera.
Mbali ya labotale ndi yowunikira maphunziro: pafupipafupi - kuwonjezeka kwa kuchuluka kwa creatinine m'madzi a m'magazi, kawirikawiri - kuchepa kwa zomwe zili hemoglobin, kuchuluka kwa uric acid mu plasma yamagazi, kuwonjezeka kwa ntchito ya michere ya chiwindi ndi CPK.
Zina: pafupipafupi - kupweteka pachifuwa, asthenia, kawirikawiri - matenda ngati chimfine.

Ma blockade apawiri a RAAS

Kugwiritsa ntchito pamodzi kwa telmisartan ndi aliskiren kapena mankhwala okhala ndi aliskiren kumapangidwa mwa odwala omwe ali ndi matenda osokoneza bongo komanso / kapena odziletsa komanso aimpso kulephera (GFR osakwana 60 ml / min / 1.73 m2 ya thupi pamtunda) ndipo salimbikitsidwa kwa odwala ena.

Kugwiritsa ntchito pamodzi kwa telmisartan ndi ACE zoletsa kumapangidwa kwa odwala omwe ali ndi matenda ashuga ndipo samalimbikitsidwa kwa odwala ena.

Kafukufuku wachipatala adawonetsa kuti blockade yowirikiza kawiri ya RAAS chifukwa cha kuphatikiza kwa ACE inhibitors, angiotensin II receptor antagonists, kapena aliskiren imalumikizidwa ndikuwonjezereka kwa zochitika zovuta monga arterial hypotension, hyperkalemia, ndi kuwonongeka kwa aimpso (kuphatikiza ndi vuto limodzi laimpso) mankhwala ochita ku RAAS.

Hyperkalemia

Chiwopsezo cha kukhala ndi hyperkalemia chitha kuchuluka ngati agwiritsidwa ntchito limodzi ndi mankhwala ena omwe angayambitse hyperkalemia (potaziyamu-zakudya zowonjezera komanso zosakaniza zamchere zomwe zimakhala ndi potaziyamu, potaziyamu yotulutsa potaziyamu, mwachitsanzo, spironolactone, eplerenone, triamterene kapena amiloride), NSAIDs (kuphatikiza kusankha COX-2) , heparin, immunosuppressants (cyclosporine kapena tacrolimus) ndi trimethoprim).

Kuchuluka kwa hyperkalemia kumadalira ndi zomwe zimayambitsa ngozi. Chiwopsezochi chimakulitsidwa mukamagwiritsa ntchito kuphatikiza pamwambapa, ndipo chimakhala chokwera kwambiri ngati chikugwiritsidwa ntchito nthawi imodzi ndi potaziyamu osasamala okodzetsa komanso mchere wotsekera wokhala ndi potaziyamu. Kugwiritsa ntchito ma telmisartan osakanikirana ndi ACE inhibitors kapena NSAID sikukhala pachiwopsezo chochepa kwambiri ngati machitidwe osamala akutsatiridwa.

Kuwonongeka kwa chiwindi

Kugwiritsa ntchito kwa Telzap kumaphatikizidwa kwa odwala omwe ali ndi cholestasis, kufooka kwa biliary kapena chiwopsezo chachikulu cha chiwindi (Child-Pugh kalasi C), popeza telmisartan imapezedwa kwambiri mu ndulu. Amakhulupirira kuti mwa odwala oterowo, chiwopsezo cha telmisartan chimachepetsedwa. Odwala omwe ali ndi vuto la chiwindi chofatsa kapena zolimbitsa thupi (kalasi A ndi B malinga ndi gulu la ana-Pugh), Telzap iyenera kugwiritsidwa ntchito mosamala.

Kutsika kwamagazi kozungulira (BCC)

Zizindikiro zamitsempha yamagazi, makamaka pambuyo koyamba kwa mankhwalawa, zimatha kupezeka mwa odwala omwe ali ndi BCC yochepa komanso / kapena sodium mu plasma yamagazi motsutsana ndi maziko a chithandizo cham'mbuyomu ndi okodzetsa, zoletsa pakudya mchere, kutsegula m'mimba kapena kusanza.

Mikhalidwe yofananira (kuchepa kwa madzi ndi / kapena sodium) ziyenera kuchotsedwa musanatenge Telzap.

Zina zomwe zimagwirizana ndi kukondoweza kwa RAAS

Odwala omwe kamvekedwe ka minyewa ndi impso zimadalira ntchito ya RAAS (mwachitsanzo, odwala omwe ali ndi vuto la mtima kapena matenda a impso, kuphatikizanso ndi aimpso a stenosis kapena stenosis yamitsempha yama impso imodzi, kugwiritsa ntchito mankhwala omwe amakhudza dongosolo lino. akhoza limodzi ndi chitukuko cha pachimake ochepa hypotension, hyperazotemia, oliguria, ndipo nthawi zina, pachimake aimpso kulephera.

Zotsatira pa kuthekera koyendetsa magalimoto

Maphunziro apadera azachipatala kuti aphunzire momwe mankhwalawo amathandizira kuyendetsa galimoto ndi njira sizinachitike. Mukamayendetsa ndikugwira ntchito zamagetsi zomwe zimafuna kuti chidwi chioneke, muyenera kusamala, popeza chizungulire komanso kugona sikungachitike kawirikawiri mutatenga Telzap.

Ana, pa mimba ndi mkaka wa m`mawere

Palibe chidziwitso chodalirika cha mankhwalawa panthawi yapakati. Ngati wodwala akukonzekera kutenga pakati, ndipo akuyenera kumwa mankhwala kuti achepetse zovuta, tikulimbikitsidwa kuti atenge njira zina.

Kugwiritsa ntchito mankhwala kuchokera ku gulu la zoletsa, angiotensin antagonists mu 2nd ndi 3 trimesters kumathandizira kukulitsa kuwonongeka kwa impso, chiwindi, kuchedwa kwa msana kwa chigaza mu fetus, oligohydramnion (kuchepa kwa kuchuluka kwa amniotic fluid).

Kugwiritsa ntchito mankhwalawa nthawi yoyamwitsa kumatsutsana.