Pyramil yowonjezera: malangizo ogwiritsira ntchito

Buku lamalangizo
kugwiritsa ntchito mankhwala omwe mumagwiritsidwa ntchito ngati mankhwala

Werengani malangizo awa mosamala musanayambe kumwa / kugwiritsa ntchito mankhwalawa.
Sungani bukuli, lingafunenso.
• Ngati muli ndi mafunso, funsani dokotala.
• Mankhwalawa amaperekedwa kwa inu panokha ndipo sayenera kugawana ndi ena, popeza amathanso kuwavulaza ngakhale mutakhala ndi zofanana ndi inu.

Fomu ya Mlingo:

yogwira pophika: ramipril - 2.50 / 5.00 / 10.00 mg, zokopa: microcrystalline cellulose - 296.10 / 293.60 / 289.00 mg, pregelatinized wowuma - 18.00 / 18.00 / 18,00 mg, mpweya wambiri wa silicon - 32.00 / 32.00 / 32,00 mg, glycine hydrochloride - 3.00 / 3.00 / 3.00 mg, glyceryl dibehenate - 8.00 / 8.00 / 8.00 mg, utoto wazitsulo utayidi wachikasu (E-172) 0,40 / - / - mg, utoto red oxide ofiira (E-172) - / 0.40 / - mg.

Kufotokozera:

Mapiritsi a 2.5 mg: mapiritsi oblong, a biconvex amtundu wachikaso chopepuka ndi malo owuma, okhala ndi mitundu yakuda kwambiri ndi chiopsezo mbali imodzi.
Mapiritsi a 5.0 mg: mapiritsi oblong, a biconvex amtundu wopepuka wa pinki wokhala ndi mawonekedwe osalala, okhala ndi ziphuphu zakuda kwambiri ndi chiopsezo mbali imodzi.
Mapiritsi a 10,0 mg: mapiritsi oblong, a biconvex azungu kapena pafupifupi oyera okhala ndi mawonekedwe oyipa komanso owopsa mbali imodzi.

Mankhwala

Mankhwala
Ramipril amatengeka mwachangu m'mimba ndipo amatsitsidwa ndi hydrolysis mu chiwindi kuti apange metabolite yogwira ya ramiprilat. Ramiprilat ndi wakale wa ACE inhibitor, enzyme yomwe imathandizira kusintha kwa angiotensin I kukhala angiotensin II.
Ramipril amachititsa kuchepa kwa kuchuluka kwa angiotensin II m'madzi am'magazi, kuwonjezeka kwa ntchito ya renin komanso kuchepa kwa kutulutsa kwa aldosterone.
Imapendekera kininase II mulingo, imasokoneza kuwonongeka kwa bradykinin, imathandizira kapangidwe ka prostaglandins. Mothandizidwa ndi ramipril, zotumphukira zotumphukira zimakulitsidwa ndipo zotumphukira zonse zotsekemera (OPSS) zimachepa.
Matenda oopsa
Imakhala ndi vuto loti wodwalayo "aname" ndi "ataimirira".
Amachepetsa OPSS (kutsitsa), kuthinana kwamankhwala m'matumbo am'mapapu popanda kukakamira kuchuluka kwa mtima (HR).
Imawonjezera kuyenda kwa magazi ndi impso popanda kukhudza kuchuluka kwa kusefedwa kwa glomerular.
Kukhazikika kwa hypotensive zotsatira ndi 1-2 mawola ingestion, mphamvu pazomwe zimachitika pambuyo pa maola 3-6 pambuyo pa kuperekedwa. Chochitikacho chimatha pafupifupi maola 24.
Kulephera kwa mtima kosalekeza komanso kulephera kwa mtima chifukwa chakupupuluma kwa myocardial
Ramipril amachepetsa OPSS ndipo, pamapeto pake, kuthamanga kwa magazi.
Zimawonjezera kutulutsa kwamtima ndi kulolerana zolimbitsa thupi. Kugwiritsa ntchito nthawi yayitali, kumathandizira kukonzanso kwa myocardial hypertrophy kwa odwala omwe mtima walephera kugwira ntchito kwa kalasi yoyamba I ndi II malinga ndi gulu la NYHA, limapangitsa kuti magazi azikhala ndi ischemic myocardium.
Ramipril imawonjezera kupulumuka kwa odwala omwe ali ndi zizindikiro zakuchepa kapena kuperewera kwa mtima pambuyo pakuwonekera kwa myocardial. Ili ndi mtima wogwira mtima, imalepheretsa ma epicode a ischemic, amachepetsa mwayi wokhala ndi infarction ya myocardial komanso imachepetsa nthawi yayitali yogonekedwa m'chipatala.
Matenda a shuga komanso odwala matenda ashuga
Odwala omwe ali ndi matenda ashuga komanso a nondiabetic nephropathy, ramipril amachepetsa kuchepa kwa impso komanso kuyambika kwa kulephera kwa impso, motero, amachepetsa kufunika kwa hemodialysis kapena kupatsirana kwa impso. M'magawo oyamba a matenda ashuga kapena nondiabetesic nephropathy, ramipril amachepetsa kuopsa kwa albuminuria.
Odwala omwe Ali pachiwopsezo chachikulu cha Matenda Amtima Wonse
chifukwa cha zotupa zam'matumbo (matenda a mtima waponseponse) (CHD), kuwonongera kwa zotumphukira za m'mitsempha kapena mbiri ya matenda opha ziwopsezo), matenda osokoneza bongo omwe ali ndi vuto limodzi lowonjezera (microalbuminuria, matenda oopsa), kuchuluka kwa plasma kwa cholesterol yathunthu, high-density lipoprotein cholesterol (HDL-C), kusuta) kuwonjezerapo kwa ramipril ku chithandizo chamankhwala kumachepetsa kwambiri kuperewera kwa myocardial, lta ndi imfa ndi matenda a mtima.
Pharmacokinetics
Ramipril amalowerera msanga m'mimba thirakiti pambuyo pakamwa. Mafuta osungirako zakudya popanda kudya.
Pambuyo mayamwidwe, ramipril mwachangu ndipo pafupifupi kwathunthu amasintha kukhala yogwira metabolite wa ramiprilat mothandizidwa ndi encyme ya chiwindi. Ramiprilat ndiwofatsa kwambiri kuwirikiza kawiri pakulepheretsa ACE kuposa ramipril. Ma metabolac ena omwe sanachite bwino atulukanso.
Odwala omwe ali ndi vuto la impso, kusintha kwa ramipril ku ramiprilat kumachepetsa chifukwa cha kutalika kwa nthawi ya esterase, motero, mlingo wa ramipril mu plasma yamagazi mwa odwala awa ukuwonjezeka.
Kuchuluka kwa ramipril mu plasma kumatheka patatha ola limodzi makonzedwe, ramiprilat - mkati mwa maola 2-4 mutatha kumwa mankhwalawa.
The bioavailability wa ramipril ndi 60%. Kuyankhulana ndi mapuloteni a plasma kumafika 73% kwa ramipril ndi 56% kwa ramiprilat. Mutatenga 5 mg, chilolezo cha ramipril ndi 10-55 ml / min, chilolezo chowonjezera chimafika pa 750 ml / min. Kwa ramiprilat, izi ndi 70-120 ml / min ndi pafupifupi 140 ml / min, motsatana. Ramipril ndi ramiprilat makamaka amawonetsedwa ndi impso (40-60%). Ndi vuto laimpso, kutsika kwawo kumachepa.
Hafu ya moyo wa ramiprilat wogwiritsidwa ntchito nthawi yayitali pa 5-10 mg kamodzi pa tsiku ndi maola 13 mpaka 17.

Zizindikiro zogwiritsidwa ntchito

• ochepa matenda oopsa,
• Kulephera kwa mtima (monga gawo la mankhwala othandizira),
• diabetes kapena non-diabetesic nephropathy, preclinical and clinical expression, kuphatikizapo proteinuria yayikulu, makamaka ikaphatikizidwa ndi matenda oopsa komanso kukhalapo kwa Microalbuminuria,
• Kuchepetsa chiopsezo cha kufa kwamtima, kugwidwa, kapena matenda amtima mwa odwala omwe ali ndi chiwopsezo chachikulu cha matenda amtima:
- Odwala omwe ali ndi vuto la mitsempha yovomerezeka, kulowetsedwa kwa myocardial kapena osakhala ndi mbiri yakale ya odwala, kuphatikiza odwala omwe adakumana ndi zovuta kuzimasulira za coronary angioplasty, coronary artery bypass grafting,
- odwala omwe ali ndi mbiri yakusowa kwa matenda,
- odwala ndi occlusive zotupa za zotumphukira mitsempha,
- odwala omwe ali ndi matenda a shuga omwe ali ndi chiopsezo chimodzi chowonjezera (microalbuminuria, matenda oopsa, kuchuluka kwa plasma kwa OX, kutsika kwa plasma kwa HDL-C, kusuta),
• Kulephera kwa mtima komwe kumayamba masiku ochepa (kuyambira masiku 2 mpaka 9) pambuyo panjira yodziwika bwino.

Contraindication

• Hypersensitivity kwa ramipril, zoletsa zina za ACE kapena zigawo zothandizira za mankhwala,
• cholowa kapena ediquathic angioedema Quincke edema (kuphatikizapo kutenga zoletsa za ACE m'mbiri),
• hemodynamically yofunika stenosis yamitsempha yamafungo (yamkati kapena yothandizirana ngati impso imodzi),
• kugwedezeka kwa mtima,
• chachikulu hyperaldosteronism,
• kwambiri ochepa ochepa hypotension (systolic kuthamanga kwa magazi zosakwana 90 mm Hg) kapena zikhalidwe ndi hemodynamics yosakhazikika,
• pakati
• nthawi yoyamwitsa,
• amakhala ndi zaka zakubadwa zofika 18 (kuthekera kophunziridwa ndi kutetezedwa kwa zinthu sizinaphunzire),
• Kulephera kwakukulu kwa aimpso (creatinine chilolezo (CC) zosakwana 20 ml / mphindi / 1.73 m²,
• Kulephera kwamphamvu kwa chiwindi (popanda kukumana ndi zamankhwala),
• hemodialysis kapena hemofiltration pogwiritsa ntchito ziwalo zina zomwe sizinayende bwino (zotuluka za polyacrylonitrile membrane (ngozi yakupanga hypersensitivity reaction),
• apheresis ya otsika kachulukidwe lipoproteins ntchito dextran sulfate (ngozi kukhala hypersensitivity zimachitikira),
• gwiritsani ntchito gawo lowopsa la kuchepa kwa mtima: kuchepa kwamtima kwambiri (CHF) (NYHA kalasi yothandizira IV), kusakhazikika kwa angina, moyo wowopsa wamitsempha yamagazi, mtima wa "pulmonary",
• Monga momwe ziliri ndi zoletsa zina za ACE, kuphatikiza kwa mankhwala a ramipril ndi mankhwala okhala ndi aliskiren kumayikidwa mwa odwala omwe ali ndi matenda a shuga kapena kulephera kwapakati kapena koopsa (CC osakwana 60 ml / min / 1.73 m²),
• munthawi yomweyo kugwiritsa ntchito angiotensin II receptor okonda odwala matenda ashuga nephropathy,
• nephropathy, yomwe imathandizidwa ndi glucocorticosteroids, mankhwala osapweteka a antiidal (NSAIDs), immunomodulators ndi / kapena mankhwala ena a cytotoxic (zomwe munakumana nazo kuchipatala sizokwanira),
• hemodynamically kwambiri aortic kapena mitral stenosis (chiwopsezo kuchepa kwambiri kwa magazi kutsatiridwa ndi mkhutu aimpso (CC oposa 20 ml / mphindi / 1.73 m²), hypertrophic obstriers Cardiomyopathy.

Ndi chisamaliro

Kugwiritsa ntchito munthawi yomweyo ndi mankhwala okhala ndi aliskiren, kapena ndi angiotensin II receptor antagonists, zomwe zimayambitsa kubwereza kwapawiri kwa renin-angiotensin-aldosterone system (RAAS), hyperkalemia, hyponatremia (kuphatikizapo motsutsana ndi maziko a okodzetsa komanso zakudya zoperewera). shuga mellitus (chiopsezo cha hyperkalemia), mtima wosalephera, makamaka kapena mankhwala ena omwe ali ndi antihypertensive zotsatira amatengedwa, zilonda zam'mimba kwambiri ndi matenda mitsempha (chiwopsezo cha kuchepa kwa magazi ndi kuchepa kwakukulu kwa magazi), hemodynamally yofunika stilosis yamitsempha yamafungo (pamaso pa impso zonse), mikhalidwe yotsatana ndi kuchepa kwa kuchuluka kwa magazi ozungulira (kuphatikiza kutsegula m'mimba, kusanza), kugwiritsa ntchito munthawi yomweyo mankhwala a lithiamu, immunosuppressants ndi saluretics, matenda ogwirizana a minofu (kuphatikizapo zokhudza zonse lupus erythematosus, scleroderma - chiwopsezo cha neutropenia kapena agranulocytosis), desensitizing chithandizo, ukalamba (wopitilira zaka 65) (kuchuluka Chiwopsezo cha kusokonezeka kwa chiwindi ndi / kapena impso ndi mtima), vuto pambuyo pakupatsirana kwa impso, chiwindi.

Gwiritsani ntchito pa nthawi yoyembekezera komanso nthawi yoyamwitsa

Kugwiritsa ntchito mankhwala Pyramil ® pa nthawi ya pakati komanso yoyamwitsa kumatsutsana, chifukwa Kugwiritsidwa ntchito kwa ramipril kungakhale ndi vuto pa mwana wosabadwayo: kusokonezeka kwa impso za mwana wosabadwayo, kuchepa kwa magazi a mwana wosabadwayo ndi akhanda, mkhutuimpso, Hyperkalemia, hypoplasia yamafupa. Pyramil ® siyikulimbikitsidwa kwa amayi omwe akukonzekera kutenga pakati. Ngati muli ndi pakati pa mankhwala a Pyramil ®, muyenera kusiya kumwa mankhwalawo momwe mungathere ndikuyang'anira kukula kwa mwana wosabadwayo.
Amayi azaka zobereka omwe amalandila chithandizo ndi zoletsa zoletsa za ACE ayenera kugwiritsa ntchito njira zolerera.
Ngati amayi a msinkhu wobereka wokhala ndi ochepa matenda oopsa amatenga zoletsa za ACE, ndiye kuti ziyenera kukumbukiridwa kuti mukakhala ndi pakati, pititsani wodwala kuti atenge mankhwala ena oopsa kuchokera pagulu lina. Nthawi zonse, kuyang'aniridwa mosamala kuchipatala ndikofunikira.
Palibe umboni kuti ramipril wachotsedwa mkaka wa m'mawere.
Kafukufuku wazinyama adawonetsa kuti ramipril imapukusidwa mkaka wa makoswe onyentchera. Kugwiritsa ntchito mankhwala Pyramil ® nthawi yoyamwitsa kumatsutsana. Ngati kuli koyenera kupereka mankhwala Pyramil ® kwa mayi woyamwitsa, nkhani yosiya kuyamwitsa iyenera kuganiziridwa.

Mlingo ndi makonzedwe

Mkati, osasamala chakudya, osafuna kutafuna, kumwa madzi ambiri (1/2 chikho).
Mlingo amasankhidwa malinga ndi achire zotsatira ndi kulolera kwa wodwala mankhwala.
Matenda oopsa
Mlingo woyambira wa Pyramil ® wa odwala osagwirizana ndi mtima omwe sakumwa okodzetsa ndi 2.5 mg patsiku. Mlingo umatha kuwonjezeka pang'onopang'ono masabata onse a 2-3 kutengera mphamvu ndi kulolerana. Mlingo waukulu kwambiri ndi 10 mg kamodzi patsiku.
Nthawi zambiri, mlingo wokonza ndi 2,5-5 mg kamodzi tsiku lililonse.
Pokhapokha wodwala achire zotsatira kumwa 10 mg patsiku la mankhwala Pyramil ®, poika mankhwala ophatikiza pamodzi akulimbikitsidwa.
Ngati wodwala akutenga okodzetsa, ayenera kusiya kumwa kapena kuchepetsa mlingo wawo masiku awiri 2-3 asanayambe chithandizo ndi Pyramil ®. Kwa odwala oterewa, muyeso woyenera wa mankhwalawa ndi 1.25 mg (1/2 piritsi ya 2,5 mg) kamodzi patsiku.
Kulephera kwamtima kosalekeza
Mlingo woyamba wa Pyramil ® ndi 1.25 mg (piritsi limodzi la 2/2 mg) kamodzi patsiku.
Mlingo utha kuchulukitsidwa pang'onopang'ono kutengera mphamvu ndi kulolera, ndikuchulukitsa masabata awiri aliwonse. Mlingo wa 2,5 mg wa patsiku ndi kupitilira ungatengedwe mu umodzi kapena iwiri.
Mlingo waukulu kwambiri ndi 10 mg kamodzi patsiku.
Kwa odwala omwe ali ndi kuchuluka kwa okodzetsa, milingo yawo iyenera kuchepetsedwa asanayambe chithandizo ndi Pyramil ® kuti muchepetse chiopsezo chokhala ndi vuto la hypotension.
Kuchepetsa chiopsezo cha kufa ndi matenda am'mimba, matenda opha ziwalo, kapena mtima mwa odwala omwe ali ndi chiwopsezo chachikulu cha mtima.
Mlingo woyambira: 2,5 mg kamodzi tsiku lililonse. Kutengera kulekerera, mlingo umatha kuwonjezeredwa pambuyo pa sabata 1 la chithandizo, ndipo pakatha milungu 3 yotsatira ya mankhwalawa, muwonjezere mpaka muyeso wambiri wa 10 mg kamodzi patsiku.
Kulephera kwa mtima chifukwa cha kuphwanya kwakhungu kwam'mutu
Kuchiza kumayamba masiku 3-10 patatha masiku osokoneza bongo.
Mlingo woyambirira wa Pyramil ® ndi 5 mg patsiku (2,5 mg kawiri m'mawa komanso madzulo), atatha masiku awiri mlingo umakulitsidwa mpaka 5 mg kawiri patsiku.
Ndi kulekerera kosayenera kwa koyamba mlingo wa 2,5 mg kawiri pa tsiku, mlingo wa 1.25 mg (1/2 piritsi ya 2,5 mg) uyenera kutumikiridwa kawiri pa tsiku, ndikuwonjezera mlingo wa 2,5 mg ndi 5 mg kawiri tsiku lililonse. Mlingo wokonza Pyramil ® ndi 2.5-5 mg kawiri patsiku. Pazipita tsiku mlingo 10 mg.
Matenda a shuga komanso odwala matenda ashuga
Mlingo woyamba wa Pyramil ® ndi 1.25 mg (piritsi limodzi la 2/2 mg) kamodzi patsiku.
Kutengera kulekerera, kumwa mankhwalawa kumatha kuwirikiza kawiri pakapita masabata awiri ndi atatu mpaka muyeso wa 5 mg tsiku lililonse.
Ngati wodwala akutenga okodzetsa, ayenera kusiya kumwa kapena kutsitsa mlingo wa mankhwala masiku awiri asanayambe chithandizo ndi Pyramil ®, mulingo woyenera wa Pyramil ® ndi 1.25 mg (piritsi limodzi la 2,5 mg) imodzi kamodzi patsiku.
Odwala ndi mkhutu aimpso ntchito
Kwa odwala omwe ali ndi vuto la impso (creatinine chilolezo (CC) 20-50 ml / mphindi / 1.73 m²), piritsi loyambirira la Pyramil ® ndi 1.25 mg (piritsi limodzi la 2,5 mg) kamodzi patsiku. , ndipo mlingo waukulu kwambiri sayenera kupitirira 5 mg patsiku. Kulephera kwakukulu kwa aimpso (CC pansi 20 ml / mphindi / 1.73 m²), muyezo woyambirira wa Pyramil ® ndi 1.25 mg (piritsi limodzi la 2,5 la 2 mg) kamodzi patsiku, ngati kuli kotheka, muyezo utha kuchuluka. mpaka 2,5 mg pa tsiku.
Odwala omwe ali ndi vuto la chiwindi
Odwala omwe ali ndi vuto la chiwindi, kuwonjezeka komanso kufooka kwa njira zochiritsira za Pyramil ® zitha kuonedwa. Chithandizo chiyenera kuyambitsidwa moyang'aniridwa ndi dokotala wokhala ndi mlingo wa 1.25 mg (piritsi 1/2 la 2 mg). Mlingo waukulu kwambiri sayenera kupitirira 2,5 mg patsiku.
Okalamba okalamba (woposa zaka 65)
Chenjezo liyenera kuthandizidwa popereka mankhwala a Pyramil ® kwa odwala okalamba ngati ali ndi vuto la impso kapena chiwindi, komanso kulephera kwa mtima komanso / kapena kugwiritsa ntchito okodzetsa.
Mlingo uyenera kusankhidwa payekha kutengera mulingo wamagazi. Mlingo woyambirira umachepetsedwa mpaka 1.25 mg patsiku.

Zotsatira zoyipa

Malinga ndi World Health Organisation (WHO), zotsatira zosafunikira zimagawidwa malinga ndi kuchuluka kwa chitukuko motere: kawirikawiri (≥ 1/10), nthawi zambiri (≥1 / 100, kuchokera ku mtima wamatsenga
Nthawi zambiri: chizindikiro kuchepa kwa kuthamanga kwa magazi, kutsekeka kwa orthostatic malamulo a mtima (orthostatic hypotension), syncope,
kawirikawiri: kugwa kwa orthostatic, myocardial ischemia, kuphatikizapo kukulira kwa chiwopsezo cha angina pectoris kapena myocardial infarction, ngozi ya m'magazi (chifukwa cha kutsika kwakukulu kwa kuthamanga kwa magazi mwa odwala omwe ali pachiwopsezo), tachycardia, arrhythmia, zotumphukira za edema, khungu, nkhope
osati kawirikawiri: mwadzidzidzi kapena kukula kwa kuzungulira kwa matenda obisika a zotupa zam'mimba, vasculitis,
maulendo osadziwika: Matenda a Raynaud.
Kuchokera ku ziwalo za hemopoietic
kawirikawiri: eosinophilia
osati kawirikawiri: leukopenia, kuphatikizapo neutropenia ndi agranulocytosis (neutropenia ndi agranulocytosis zimasinthika ndikusowa pomwe ACE zoletsa zaletsedwa), kuchepa magazi, thrombocytopenia, lymphadenopathy, kuchepa hemoglobin,
maulendo osadziwika: chopinga wa m`mafupa hematopoiesis, pancytopenia, hemolytic magazi.
Kuchokera ku dongosolo lamanjenje
Nthawi zambiri: kufooka, mutu,
kawirikawiri: kutopa, nkhawa, mantha, kupweteka, chizungulire, kugona tulo, kusowa tulo, nkhawa zamagalimoto,
osati kawirikawiri: kugwedezeka, kusasamala, chisokonezo,
maulendo osadziwika: matenda ischemia, kuphatikizapo sitiroko ndi kusokonezeka kwa kufalikira kwa ubongo, parosmia (kusokonezeka kwa malingaliro a mafungo), kusokonezeka kwa ma psychomotor, kusokonezeka kwa ndende.
Kuchokera kumankhwala akumva
kawirikawiri: zosokoneza zowoneka, kuphatikizapo zithunzi zopanda pake, chisokonezo cha kukoma,
osati kawirikawiri: conjunctivitis, kuchepa kwa makutu, tinnitus (kugunda kwa kulira, tinnitus).
Kuchokera ku kupuma
Nthawi zambiri: "Kuuma" chifuwa, bronchitis, sinusitis, kufupika kwa mpweya,
kawirikawiri: bronchospasm, kuphatikizapo kuwonjezeka kwa chifuwa cha bronchial, mphuno.
Kuchokera m'mimba
Nthawi zambiri: zotupa zotupa m'mimba ndi matumbo, matenda am'mimba, kusokonezeka m'mimba, dyspepsia, kutsegula m'mimba, kunyansidwa, kusanza,
kawirikawiri: kapamba, kuchuluka kwa "chiwindi" transaminases ndi plasma conjugated bilirubin ndende, kuchuluka kwa pancreatic enzyme, matumbo angioedema, kupweteka kwam'mimba, gastritis, kudzimbidwa, pakamwa lowuma,
osati kawirikawiri: glossitis, cholestatic jaundice, zotupa za hepatocellular,
maulendo osadziwika: aphthous stomatitis (yotupa ya mucosa wamlomo), chiwindi chimakanika, cholestatic kapena cytolytic hepatitis, kuphatikizapo zakupha.
Kuchokera pamimba
osati kawirikawiri: aimpso kuwonongeka, kuphatikizapo kukula kwa pachimake aimpso kulephera, kuchuluka kwa mkodzo, kuchuluka pre-alipo proteinuria, kuchuluka ndende ya urea ndi creatinine m'magazi.
Pa khungu ndi mucous nembanemba
Nthawi zambiri: zotupa pakhungu, makamaka maculopapular,
kawirikawiri: angioedema, kuphatikizapo wakupha (laryngeal edema imatha kuyambitsa kutsekeka kwa mpweya kupita kumwalowo)
osati kawirikawiri: dermatitis, exoticative dermatitis, urticaria, onycholysis (kutulutsa msomali kuchokera kuzinthu zofewa za chala),
kawirikawiri kusintha kwa zithunzi,
maulendo osadziwika: epidermal necrolysis yoopsa, Stevens-Johnson syndrome, erythema multiforme, pemphigus (cystic rash), kukulira kwa psoriasis, psoriasis-ngati dermatitis, pemphigoid kapena licentiid exanthema kapena enanthema, alopecia.
Kuchokera ku minculoskeletal system
Nthawi zambiri: minofu kukokana, myalgia,
kawirikawiri: arthralgia.
Kuchokera kumbali ya kagayidwe
Nthawi zambiri: kuchuluka kwa potaziyamu m'magazi,
kawirikawiri: matenda a anorexia, kuchepa kwa chakudya,
maulendo osadziwika: kuchepa kwa sodium m'magazi.
Kuchokera ku chitetezo chamthupi
maulendo osadziwika: anaphylactic kapena anaphylactoid zimachitika, kuchuluka titer wa antinuclear antibodies.
Dongosolo la Endocrine
maulendo osadziwika: matenda osakwanira katulutsidwe wa mankhwala a antidiuretic (SNA ADH).
Kuchokera ku kubereka
kawirikawiri: kusayenda kwakanthawi chifukwa cha kukanika kwa erectile, kuchepa kwa libido,
maulendo osadziwika: gynecomastia.
Zovuta ndi zovuta zina pamalo a jakisoni
Nthawi zambiri: kupweteka pachifuwa, kutopa,
kawirikawiri: malungo
osati kawirikawiri: asthenia.

Bongo

Zizindikiro kwambiri zotumphukira vasodilation ndi chitukuko cha kutchulidwa kuchepa kwa magazi (BP), mantha, bradycardia, mkhutu wamagetsi-electrolyte bwino, mantha, pachimake aimpso kulephera, stupor.
Chithandizo: osachepera milandu bongo: chapamimba kukonzanso, adsorbents, sodium sulfate (makamaka mkati 30 mphindi pambuyo makonzedwe). Ntchito yamagulu ofunikira iyenera kuyang'aniridwa. Woopsa milandu, miyeso umalimbana kuthamanga kwa magazi: intravenous makonzedwe a 0,9% yankho la sodium kolorayidi, plasma m'malo, kukhazikitsa pachipala kwakanthawi kokhala ndi bradycardia osagwiritsa ntchito mankhwala, hemodialysis. Ndi kuchepa kwakukulu kwa kuthamanga kwa magazi, kukhazikitsidwa kwa α-adrenergic agonists (norepinephrine, dopamine) kungawonjezeke ku chithandizo chobwezeretsanso kuchuluka kwa magazi ndikubwezeretsani mulingo wamagetsi am'magazi. Pankhani ya bradycardia, kusankha atropine kapena kukhazikitsa pacemaker kwakanthawi ndikulimbikitsidwa.
Ndikofunikira kuyang'anitsitsa kuthamanga kwa magazi, ntchito ya impso ndi ma seramu electrolyte.
Palibe zokuchitikirani pakugwiritsa ntchito kukakamiza diuresis, kusintha kwamkodzo pH, hemofiltration kapena dialysis kutiathandizire kuchotsedwa kwa ramipril kuchokera mthupi. Hemodialysis akuwonetsedwa milandu chitukuko cha aimpso.

Kuchita ndi mankhwala ena

Kuphatikiza kophatikizidwa
Kugwiritsa ntchito michere ina yamphamvu kwambiri yomwe ili ndi mawonekedwe osasokoneza bwino (mwachitsanzo, polyacryl-nitrile membranes) pa hemodialysis kapena hemofiltration, kugwiritsa ntchito dextran sulfate panthawi ya kupanikizika kwa lipoproteins yotsika kwambiri kungayambitse chiopsezo cha anaphylactic reaction, ngati wodwala akuyenera kugwiritsa ntchito njirazi (pankhani ya plasmapheresis ndi hemofiltration) kapena kusamutsa wodwala kuti atenge mankhwala ena a antihypertensive.
Monga ma ACE enhibitors ena, kugwiritsa ntchito kwa ramipril ndi aliskiren ndi mankhwala okhala ndi aliskiren kumatsutsana mwa odwala omwe ali ndi matenda osokoneza bongo kapena olephera kapena aimpso kwambiri (CC osakwana 60 ml / min / 1.73 m²).
Kugwiritsa ntchito limodzi ndi zoletsa zina za ACE kumawonjezera mwayi wokhala ndi kulephera kwa aimpso (kuphatikizapo pachimake aimpso), hyperkalemia.
The munthawi yomweyo kugwiritsa ntchito mankhwala ndi angiotensin II receptor okonda odwala matenda ashuga nephropathy ali contraindicated ndipo osavomerezeka ena odwala.
Kuphatikiza kugwiritsidwa ntchito mosamala
Ntchito mogwirizana mchere wa potaziyamu, poteteza wina poteteza mphamvu zina (mwachitsanzo, amiloride, triamteren, spironolactone), komanso mankhwala osokoneza bongo, zimathandizira pakuwonjezeka kwa seramu potaziyamu (kuphatikizapo trimethoprim, tacrolimus, cyclosporine, angiotensin II receptor antagonists) zitha kutsogolera kuchuluka kwa seramu potaziyamu (kumafunikira kuwunika pafupipafupi kuchuluka kwa serum potaziyamu).
Mankhwala a antihypertensive (alfuzosin, doxazosin, prazosin, tamsulosin, terazosin), baclofen, diuretics, nitrate, tridclic antidepressants, antipsychotic, mapiritsi ogona, narcotic analgesics, othandizira opaleshoni wamba sinthani mphamvu ya antihypertensive ya ramipril.
Vasopressor sympathomimetics ndi mankhwala ena omwe amachititsa antihypertensive zotsatira (mwachitsanzo, isoproterenol, dobutamine, dopamine, epinephrine) amachepetsa mphamvu ya antihypertensive ya ramipril, ndikuwunika kawirikawiri magazi amafunika.
Ntchito mogwirizana allopurinol, procainamide, cytostatics, immunosuppressants, corticosteroids (glucocorticosteroids ndi mineralocorticosteroids) ndi njira zina zomwe zingakhudze magawo a hematological, zimawonjezera mwayi wokhala ndi leukopenia.
Kugwiritsa ntchito nthawi imodzi ya ramipril ndi corticosteroids sikulimbikitsidwa.
Mchere wamchere wa Lithium kumabweretsa kuwonjezeka kwa ndende ya lithiamu m'magazi seramu ndi kuwonjezereka kwa mtima ndi neurotoxic zotsatira za lifiyamu.
Ramipril imapititsa patsogolo hypoglycemic othandizira a hypoglycemic (insulin, hypoglycemic wothandizila kukakamiza pakamwa (zotumphukira za sulfonylurea) mpaka kukula kwa hypoglycemia. Kuwongolera glucose ndende ndikofunikira.
Vildagliptin kumabweretsa chiwopsezo cha angioedema.
Kugwiritsa ntchito ramipril ndi MTOR (Cholinga cha rapamycin - chiyembekezo cha rapamycin mu maselo aku mamalia), mwachitsanzo, ndi temsirolimus, zingayambitse kuwonjezereka kwa angioedema.
Kuphatikiza kwa kulingalira
Mankhwala omwe amaletsa kutupa (NSAIDs) (mwachitsanzo, acetylsalicylic acid (kuposa 3 g / tsiku), cycloo oxygenase-2 inhibitors (COX2) imatha kufooketsa mphamvu ya antihypertensive ya ramipril, komanso imapangitsa kuti ntchito yaimpso ikhale yovuta. Heparin achuluke seramu potaziyamu.
Sodium Chloride itha kufooketsa mphamvu ya ramipril.
Sayenera kudyedwa Mowa Pa mankhwala a ramipril (inhibitory zotsatira za Mowa mu chapakati mantha dongosolo (CNS) kumatheka.
Ma estrogens Kuchepetsa mphamvu ya antihypertensive (kusungidwa kwamadzi).
Kuchotsa mankhwala ndi chidwi chochulukirapo cha tizilombo. Zoletsa za ACE, kuphatikiza ndi ramipril, zimawonjezera mwayi wokhala ndi anaphylactic kapena anaphylactoid zimachitika poizoniyu.

Malangizo apadera

Musanayambe chithandizo ndi Pyramil ®, ndikofunikira kuthetsa hyponatremia ndi hypovolemia. Odwala omwe adamwa diuretics m'mbuyomu, ndikofunikira kusiya kapena kuchepetsa mlingo wawo masiku awiri 2-3 asanayambe kumwa mankhwala a Pyramil ®. Pankhaniyi, mkhalidwe wa odwala omwe ali ndi vuto la mtima wosakhazikika uyenera kuyang'aniridwa mosamala chifukwa chotheka kukulira kuwonongeka kwa odwala omwe ali ndi magazi ochulukirapo.
Mutatenga mlingo woyamba, komanso kuwonjezera kuchuluka kwa okodzetsa komanso / kapena Pyramil ®, odwala ayenera kuyang'aniridwa ndi achipatala kwa maola 8 chifukwa atha kukhala ndi orthostatic hypotension.
Kutsika kwakanthawi kochepa kwa magazi sikukulepheretsa kupitiliza chithandizo ndi Pyramil ®, popeza mukabwezeretsa kuchuluka kwa magazi ndi kufalikira kwa magazi, mutatenga mlingo wotsatira wa mankhwalawa sikuti kumayambitsa hypotension.
Ngati mwachitika mobwerezabwereza kwambiri hypotension, mlingo uyenera kuchepetsedwa kapena mankhwalawo ayenera kusiyidwa. Odwala omwe ali ndi vuto losakanizira matenda oopsa kapena kulephera kwa mtima, makamaka chifukwa cha kupweteka kwambiri kwa mtima. kokha kuchipatala.
Odwala omwe ali ndi vuto la mtima wosalekeza, kutenga Pyramil ® kungayambitse kuchepa kwamphamvu kwa magazi, komwe nthawi zina kumayendetsedwa ndi oliguria kapena azotemia ndipo nthawi zambiri sikukukula kwa impso kulephera.
Odwala omwe ali ndi ntchito ya RAAS yowonjezera omwe amamwa mankhwalawa koyamba kapena mlingo waukulu amayenera kuwunika magazi ndi kugwiranso ntchito kwa impso, makamaka kumayambiriro kwa chithandizo, popeza odwalawa ali ndi chiopsezo chakuchepa kwa kuthamanga kwa magazi komanso kuwonongeka kwa aimpso chifukwa chokomera ACE.
Chenjezo liyenera kuchitidwa pochiza odwala okalamba, popeza amatha kukhala osamala makamaka ndi ACE inhibitors.
Chenjezo liyeneranso kuchitika pakulimbikira thupi komanso / kapena nyengo yotentha chifukwa choopsa cha kutuluka thukuta ndi madzi am'mimba chifukwa cha kuchepa kwa kuchuluka kwa magazi ndi kuchepa kwa zinthu za sodium m'magazi.
Asanachitike komanso atagwiritsidwa ntchito ndi Pyramil ®, ndikofunikira kuyang'anira ntchito ya aimpso (creatinine, urea), potaziyamu m'madzi am'magazi, kuchuluka kwa magazi, hemoglobin, ndi mayesero a chiwindi.
Ndi chitukuko cha cholestatic jaundice kapena kuwonjezeka kwakukulu kwa ntchito za "chiwindi", muyenera kusiya kumwa zoletsa ACE.
Gulu lomwe lili pachiwopsezo cha hyperkalemia limapangidwa ndi odwala omwe amalephera kupweteka kwa minyewa, matenda a shuga, komanso omwe amamwa mankhwala osokoneza bongo a potaziyamu, kukonzekera kwa potaziyamu kapena mankhwala osokoneza bongo a potaziyamu omwe amalimbikitsa zomwe zili ndi serum potaziyamu (mwachitsanzo, heparin).
Odwala omwe ali ndi chiopsezo chowonjezeka cha neutropenia (omwe ali ndi vuto laimpso), matenda a minyewa yolumikizira), popereka mankhwala Pyramil ®, kuyesedwa kwa magazi kuyenera kuyang'aniridwa kamodzi pamwezi m'miyezi itatu yoyambirira ya chithandizo, komanso poyambira matenda. Ngati neutropenia yapezeka (kuchuluka kwa ma neutrophils ndi ochepera 2000 / μl), chithandizo ndi zoletsa za ACE ziyenera kusiyidwa.
Nthawi zina, mukamalandira mankhwala a ACE zoletsa, kuphatikizapo ramipril, angioedema ya nkhope, miyendo, milomo, lilime, larynx ndi / kapena pharynx amadziwika. Ngati pali edema yomwe imatha kuyamba mwadzidzidzi munthawi iliyonse yamankhwala, muyenera kusiya kumwa mankhwalawo, kulandira chithandizo chamankhwala mwadzidzidzi ndikuwonetsetsa kuti wodwalayo ayang'aniridwa mpaka zizindikirazo zitatha.
Odwala omwe amalandila zoletsa za ACE, milandu ya angioedema yam'mimba imayang'aniridwa, yomwe imawonetsedwa ndi kupweteka kwam'mimba ndi kapena kusanza ndi kusanza, ndipo nthawi zina angioedema ya nkhope imawonedwa nthawi yomweyo. Wodwala akakhala ndi zomwe zili pamwambapa mothandizidwa ndi zoletsa za ACE, kuwunika koyenerako kuyeneranso kulingalira za momwe angakhalire matumbo angioedema mwa iwo.
Kugwiritsa ntchito zoletsa za ACE, kuphatikiza ndi ramipril, mu odwala omwe akuchita opaleshoni ya opaleshoni wamba kungayambitse kukula kwa ochepa hypotension.
Ndikulimbikitsidwa kusiya kumwa mankhwala Pyramil ® tsiku limodzi musanachite opareshoni.
Kugwiritsa ntchito michere yamphamvu kwambiri yomwe ili ndi mawonekedwe osayenera (mwachitsanzo, michere ya polyacrylonitrile) iyenera kupewedwa, mwachitsanzo, chifukwa chofunikira hemodialysis kapena hemofiltration pamodzi ndi ACE inhibitors (chifukwa cha kutheka kwa anaphylactoid mu odwala). Nthawi zina, ndi apheresis of lowensens lip liprrinsin (LDL) wokhala ndi dextran sulfate komanso munthawi yomweyo makonzedwe a ACE zoletsa, anaphylactoid zimachitika.
Chifukwa chake, njirayi siyenera kugwiritsidwa ntchito mwa odwala omwe alandila ACE inhibitors.
Ma antihypertensive othandizira omwe amalepheretsa RAAS nthawi zambiri sagwira ntchito moyenera pochiza odwala omwe ali ndi vuto lalikulu la hyperaldosteronism, kotero kugwiritsa ntchito ramipril pazinthu zoterezi sikulimbikitsidwa.
Monga ma ACE enhibitors ena, kugwiritsa ntchito kwa ramipril ndi aliskiren ndi mankhwala okhala ndi aliskiren kumatsutsana mwa odwala omwe ali ndi matenda osokoneza bongo kapena olephera kapena aimpso kwambiri (CC osakwana 60 ml / min / 1.73 m²).
Kugwiritsa ntchito munthawi yomweyo ndi mankhwala okhala ndi aliskiren, kapena angiotensin II receptor antagonists, zomwe zimayambitsa kutsekeka kwapawiri kwa RAAS, sikulimbikitsidwa chifukwa chakuchepa kwambiri kwa kuthamanga kwa magazi, kukulitsa kwa hyperkalemia ndi vuto laimpso poyerekeza ndi monotherapy.
Kugwiritsira ntchito nthawi yomweyo kwa angiotensin II receptor antagonists mwa odwala omwe ali ndi matenda ashuga nephropathy amatsutsana (onani gawo "Contraindication").

Kukopa pa kuyendetsa magalimoto, machitidwe

Palibe zambiri pazakuipa kwa kukonzekera kwa Pyramil ® mu Mlingo wolimbikitsidwa pazomwe zimayendetsa magalimoto kapena magwiridwe antchito. Komabe, chifukwa cha zovuta zoyipa, monga kuchepetsa magazi ndi kugona, tikulimbikitsidwa kuti tisamachite nawo zinthu zoopsa zomwe zimafunikira chidwi chachikulu komanso kuthamanga kwa zochitika zama psychomotor, kuphatikizapo kuyendetsa galimoto, makamaka mutatha kumwa koyamba mlingo mukumwa mankhwala okodzetsa ndi mowa.

Njira zopewera kupewa ngozi

Chenjezo limaperekedwa kwa odwala omwe amalandila othandizira okodzetsa, chifukwa cha kuchepa kwamadzi ndi (kapena) ma elekitirogirisi m'thupi, komanso kuwunika ntchito yaimpso ndi kuchuluka kwa potaziyamu m'magazi.

Zambiri pa ramipril
Blockade iwiri ya renin-angiotensin-aldosterone system (RAAS)
Kuphatikizidwa kwa Pyramil® Owonjezera ndi aliskiren sikulimbikitsidwa chifukwa chowonjezera chiopsezo cha hypotension, hyperkalemia, ndi kusintha kwa ntchito yaimpso. Kugwiritsira ntchito kwa Pyramil® kowonjezera kuphatikiza ndi aliskiren kumatsutsana mwa odwala omwe ali ndi matenda osokoneza bongo kapena kulephera kwa aimpso (GFR 2) (onani "Kuyanjana ndi mankhwala ena").
Odwala Pangozi Yambiri ya Arterial Hypotension
Odwala ovuta kwambiri a renin-angiotensin-aldosterone dongosolo
Odwala omwe ali ndi activation yovuta ya RAAS ali pachiwopsezo chambiri cha kutsika kwambiri kwa magazi komanso kuwonongeka kwa impso chifukwa cha kuletsa kwa ACE, makamaka ndi oyang'anira a ACE inhibitor (kapena concomitant diuretic) kapena kuwonjezeka kwa mlingo.
Ntchito yokhazikitsidwa ndi RAAS, yomwe ikufuna kuwongoleredwa ndi ogwira ntchito kuchipatala, kuphatikizapo kuwunika kwa magazi, ikuyembekezeka m'magulu otsatirawa a anthu:
- odwala kwambiri ochepa matenda oopsa,
- odwala mtima kuwonongeka mtima,
- odwala omwe ali ndi vuto la hemodynamically lalikulu la kulowerera kapena kutuluka kwa magazi kuchokera kumanzere kwamitsempha yamagetsi (mwachitsanzo, stenosis ya aortic kapena mitral valve),
- odwala a unilateral aimpso artery stenosis ndi yachiwiri impso,
- odwala omwe ali ndi vuto la kuchepa kwamadzi kapena (kapena) ma electrolyte (kuphatikiza odwala omwe atenga ma diuretics),
- odwala cirrhosis ndi (kapena) ascites,
- Odwala omwe akuchita opaleshoni yovuta kapena mankhwala oletsa kupweteka omwe amachititsa kuti munthu azingokhala ndi hypotension.
Asanayambe chithandizo, tikulimbikitsidwa kuti kuchepa kwa madzi m'thupi, kuchepa kwa magazi, kapena kuchepa kwa electrolyte (Komabe, odwala omwe ali ndi vuto la mtima onse pazabwino ndi zovuta za zinthu zotere ziyenera kuyesedwa mosamala, poganizira kuopsa kwa kuchuluka kwakukulu):
- odwala omwe ali ndi kusakhalitsa (osachedwa) kapena kulephera kwamtima kosatha pambuyo pa MI,
- odwala omwe ali pachiwopsezo cha kukhala ndi mtima kapena chodabwitsa cha ischemia, kapena ngati ali ndi vuto la pachimake.
Pa gawo loyambirira la chithandizo, kuyang'aniridwa kwapadera kwa zamankhwala kumafunika.
Odwala okalamba
Mlingo woyamba wa ramipril uyenera kutsikira, ndikuwonjezereka kwawo mosamala, chifukwa chakuwonjezereka kwa zotsatira zosayenera. Amlodipine / ramipril osavomerezeka mu odwala kwambiri okalamba komanso odwala.
Opaleshoni
Ngati ndi kotheka, tikulimbikitsidwa kuletsa zoletsa za ACE tsiku lisanafike opaleshoni.
Impso ntchito kuwunika
Ntchito yeniyeni iyenera kuyesedwa isanachitike komanso munthawi ya chithandizo ndipo mankhwalawa akuyenera kuwongoleredwa, makamaka masabata oyamba a mankhwala. Makamaka kuwunika mosamala ndikofunikira kwa odwala omwe ali ndi vuto laimpso. Pali chiopsezo cha matenda aimpso, makamaka mwa odwala omwe ali ndi vuto la mtima kapena pambuyo pake.
Odwala kwambiri aimpso kulephera (GFR

Mlingo ndi makonzedwe

Mlingo
Pyramil® yowonjezera sayenera kugwiritsidwa ntchito poyambitsa chithandizo cha matenda oopsa. Mlingo wa gawo lililonse uyenera kusankhidwa payekha malinga ndi mbiri ya wodwalayo komanso kuchuluka kwa kayendedwe ka magazi komwe kamapezeka.
Ngati pakufunika kusintha mlingo, Mlingo wa mankhwalawa amasankhidwa payekhapayekha pachidutswa chilichonse cha mankhwalawa - ramipril ndi amlodipine, pokhapokha pokhazikitsa mlingo woyenera, kuyang'anira kwa zigawo za munthu payekha kungathe kusinthidwa ndi kuperekedwa kwa mankhwala a Pyramil® owonjezera.
Mlingo woyenera: kapisozi imodzi patsiku. Mulingo wambiri tsiku lililonse: kapisozi imodzi ya 10 mg / 10 mg.
Magulu apadera a odwala
Odwala ndi mkhutu aimpso ntchito: mulingo woyenera kwambiri woyambira ndi kukonzanso mlingo umapangidwa mosiyanitsa ndi gawo la gawo lililonse la mankhwala (amlodipine ndi ramipril) payokha.
Ramipril amachotsedwa pang'ono panthawi ya dialysis, kotero, mankhwalawa amayenera kutengedwa patatha maola angapo atatha hemodialysis.
Amlodipine samachotsedwanso ndi dialysis. Kwa odwala pa dialysis, amatchulidwa mosamala kwambiri.
Mukamalandira mankhwala a Pyramil® owonjezera, ntchito ya impso ndi milingo ya potaziyamu m'magazi iyenera kuyang'aniridwa. Pankhani ya kuwonongeka kwa impso, Pyramil® yowonjezera iyenera kuyimitsidwa ndikusinthidwa ndikutenga utoto wokwanira wa ziwalozo mosiyana.
Odwala omwe ali ndi vuto la chiwindi: pazipita tsiku lililonse ramipril ndi 2,5 mg. Pyramil® yowonjezera kwa odwala omwe ali ndi vuto la chiwindi sichikugwira ntchito.
Odwala okalamba: Chithandizo tikulimbikitsidwa kuti ndiyambe ndi ochepa madontho oyambira, kenako ndikuwonjezeka mosamala.
Ana ndi achinyamata: chitetezo ndi kugwira ntchito kwa Pyramil® Owonjezera mu ana sichinakhazikitsidwe. Sizotheka kupereka malingaliro.

Njira yogwiritsira ntchito
Zokhudza pakamwa. Tengani pa nthawi yomweyo patsiku, mosasamala kanthu za kudya.

Gulu la Nosological (ICD-10)

Kufotokozera za mtundu wa kipimo

Mapiritsi a 5 mg: oblong, biconvex, pinki wopepuka wautoto wokhala ndi mawonekedwe owuma, wokhala ndi ziphuphu zakuda kwambiri ndi notch mbali imodzi.

Mapiritsi, 10 mg: oblong, biconvex, yoyera kapena pafupifupi yoyera ndi utoto woyipa mbali imodzi.

Mankhwala

Ramipril amatengeka mwachangu mumimba ndipo amatsitsa hydrolysis mu chiwindi ndikupanga metabolite yogwira ya ramiprilat. Ramiprilat ndi wakale wa ACE inhibitor, enzyme yomwe imathandizira kusintha kwa angiotensin I kukhala angiotensin II.

Ramipril amachititsa kuchepa kwa kuchuluka kwa angiotensin II m'madzi am'magazi, kuwonjezeka kwa ntchito ya renin komanso kuchepa kwa kutulutsa kwa aldosterone. Imachepetsa mulingo wa kinase II, imalepheretsa kuwonongeka kwa bradykinin, imathandizira kapangidwe ka PG. Mothandizidwa ndi ramipril, zotumphukira zotumphukira zimakulitsidwa ndipo OPSS imachepa.

Zimakhala ndi vuto loti wodwalayo atagona ndikuyimirira. Amachepetsa OPSS (katundu pambuyo pake), kuthinana kwamankhwala m'matumbo am'mapapu popanda kukakamira kuchuluka kwa mtima. Zimalimbikitsa kuyenda kwa magazi ndi ziphuphu popanda kukhudza GFR.

Chiyambireni cha hypotensive zotsatira ndi maola 1-2 mutatha kumwa, pazomwe zimachitika pambuyo pake patapita maola atatu ndi atatu atatha kumwa. Chochitikacho chimatha pafupifupi maola 24.

Kulephera kwa mtima ndi kulephera kwa mtima chifukwa chakuphwa kwambiri kwa myocardial

Ramipril amachepetsa OPSS ndipo pamapeto pake kuthamanga kwa magazi. Zimawonjezera kutulutsa kwamtima ndi kulolerana zolimbitsa thupi. Kugwiritsa ntchito nthawi yayitali, kumathandizira kuti chitukuko cha matenda obwera chifukwa cha matenda ochitika m'mitsempha chodwala chikhale mwa odwala omwe mtima walephera kugwira ntchito kwa kalasi I ndi II molingana ndi gulu NYHA, imasintha magazi kupita ku ischemic myocardium.

Ramipril amachulukitsa kupulumuka kwa odwala omwe ali ndi zizindikiro zakufupika kapena CHF pambuyo panjira ya myocardial. Ili ndi mtima wogwira mtima, imalepheretsa ma epicode a ischemic, amachepetsa mwayi wokhala ndi infarction ya myocardial komanso imachepetsa nthawi yayitali yogonekedwa m'chipatala.

Matenda a shuga komanso odwala matenda ashuga

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

Odwala omwe ali ndi chiwopsezo chachikulu cha matenda amtima chifukwa cha zotupa zam'mitsempha (matenda am'mitsempha yamagazi kuchuluka kwa HDL-C, kusuta) kuwonjezeranso kwa ramipril ku chithandizo chamankhwala kumachepetsa kwambiri kubadwa kwa myocardial infarction, stroke ndi mtima kufa zimayambitsa mtima.

Pharmacokinetics

Ramipril amalowerera msanga m'mimba thirakiti pambuyo pakamwa. Mafuta osungirako zakudya popanda kudya.

Pambuyo mayamwidwe, ramipril mwachangu ndipo pafupifupi kwathunthu amasintha kukhala yogwira metabolite wa ramiprilat mothandizidwa ndi esterase enzyme m'chiwindi. Ramiprilat ndiwofatsa kwambiri kuwirikiza kawiri pakulepheretsa ACE kuposa ramipril. Ma metabolites ena osagwira ntchito za mankhwala apezekanso.

Odwala omwe ali ndi vuto la impso, kusintha kwa ramipril ku ramiprilat kumachepetsa chifukwa cha kutalika kwa nthawi ya esterase, motero, mlingo wa ramipril mu plasma yamagazi mwa odwala awa ukuwonjezeka.

C_max ramipril mu plasma imafikiridwa patangotha ​​ola limodzi makonzedwe, ramiprilata - mkati mwa maola 2-4 atatha kumwa mankhwalawa. The bioavailability wa ramipril ndi 60%. Mapuloteni a Plasma omwe amafika 73% a ramipril ndi 56% a ramiprilat. Mutatenga 5 mg, chilolezo cha ramipril ndi 10-55 ml / mphindi, chilolezo chowonjezera chimafika pa 750 ml / min. Kwa ramiprilat, izi ndi 70-120 ml / min ndi pafupifupi 140 ml / min, motsatana. Ramipril ndi ramiprilat makamaka amawonetsedwa ndi impso (40-60%). Ndi vuto laimpso, kutsika kwawo kumachepa.

T_1/2 Ramiprilata yaitali ntchito mlingo wa 5-10 mg wa 1 nthawi patsiku ndi 13-17 maola.

Zisonyezero za Pyramil ®

Kulephera kwamtima kwakanthawi (monga gawo la chithandizo chophatikiza),

odwala matenda ashuga komanso odwala matenda ashuga nephropathy, preclinical komanso matenda magawo, kuphatikizapo ndi proteinuria yayikulu, makamaka ikaphatikizidwa ndi matenda oopsa komanso kukhalapo kwa microalbuminuria,

Kuchepetsa chiopsezo cha kufa kwa myocardial, kugwidwa, kapena kufa kwa mtima mwa odwala omwe ali ndi chiwopsezo chachikulu cha matenda amtima (odwala matenda amitsempha yamaitsempha yamagazi, mbiri yakale ya myocardial kapena popanda iyo, kuphatikiza odwala omwe ali ndi vuto lozungulira la coronary angioplasty, zotupa zokhudzana ndi zotupa zam'mimba, zotupa za shuga ndi chimodzi chokha chowonjezera (microalbuminuria, ochepa matenda oopsa, kuchuluka kwa plasma × okwana mafuta woipa, utachepa woipa plasma wa LDL-HDL mafuta m'thupi, kusuta)

Kulephera kwa mtima komwe kumayamba masiku ochepa (kuyambira masiku 2 mpaka 9) pambuyo poti pachimake pakhungu layamba kuchepa.

Mimba komanso kuyamwa

Kugwiritsa ntchito mankhwala Pyramil ® pa nthawi ya pakati komanso yoyamwitsa kumatsutsana, chifukwa akhoza kukhala ndi vuto pa mwana wosabadwayo: kusokonezeka kwa impso za mwana wosabadwayo, kuchepa magazi a mwana wosabadwayo ndi akhanda, mkhutu aimpso, hyperkalemia, hypoplasia mafupa a chigaza, hypoplasia yamapapu. Pyramil ® siyikulimbikitsidwa kwa amayi omwe akukonzekera kutenga pakati. Ngati muli ndi pakati pa mankhwala a Pyramil ®, muyenera kusiya kumwa mankhwalawo momwe mungayang'anire ndikuwunika momwe mwana akukula.

Amayi azaka zobereka omwe amalandila chithandizo ndi zoletsa za ACE ayenera kugwiritsa ntchito njira zolerera. Ngati amayi a msinkhu wobereka wokhala ndi matenda oopsa amatenga zoletsa za ACE, ndiye kuti ziyenera kukumbukiridwa kuti mukakhala ndi pakati, pititsani wodwala kuti atenge mankhwala ena oopsa kuchokera pagulu lina. Nthawi zonse, kuyang'aniridwa mosamala kuchipatala ndikofunikira.

Palibe umboni kuti ramipril wachotsedwa mkaka wa m'mawere.

Kafukufuku wazinyama adawonetsa kuti ramipril imapukusidwa mkaka wa makoswe onyentchera. Kugwiritsa ntchito mankhwala Pyramil ® nthawi yoyamwitsa kumatsutsana. Ngati kuli koyenera kupereka mankhwala Pyramil ® kwa mayi woyamwitsa, nkhani yosiya kuyamwitsa iyenera kuganiziridwa.

Zotsatira zoyipa

Zotsatira zosafunikira zimaperekedwa molingana ndi gulu la WHO malinga ndi kuchuluka kwa chitukuko motere: pafupipafupi (> 1/10), nthawi zambiri (> 1/100, 1/1000, 1/10000, kuthamanga kwa magazi, kusokonekera kwa mafupa a orthostatic regression (orthostatic hypotension) , syncopal mamiriro, infrequently - orthostatic kugwa, myocardial ischemia, kuphatikizapo kukulira kwa chiwopsezo cha angina pectoris kapena myocardial infarction, cerebrovascular ngozi (chifukwa cha kutsika kwakukwera kwa kuthamanga kwa magazi mwa odwala omwe ali pachiwopsezo), tachycardia, arrhasmia, zotumphukira edema, palpation. khungu lamaso, kawirikawiri - kupezeka kapena kuwonjezereka kwa zovuta zamagazi pamasamba a zotupa zam'mimba, vasculitis, pafupipafupi ndikosadziwika - matenda a Raynaud.

Kuchokera ku ziwalo za hemopoietic: pafupipafupi - eosinophilia, kawirikawiri - leukopenia, kuphatikizapo neutropenia ndi agranulocytosis (neutropenia ndi agranulocytosis zimasinthika ndikusowa pomwe ACE inhibitors yachotsedwa), kuchepa kwa magazi, kuchepa kwa magazi, kuchepa kwa hemog hemin, kuchepa kwa mafupa, hemorr hemia, hemorr hemia.

Kuchokera ku dongosolo lamanjenje: Nthawi zambiri - kufooka, kupweteka mutu, pafupipafupi - kusinthasintha kwa mitsempha, nkhawa, mantha, kugona, nkhawa yamagalimoto, kawirikawiri - kunjenjemera, kusowa kwa chisokonezo, chisokonezo, kusadziwika pafupipafupi - matenda a ischemia matenda kufalitsidwa, parosmia (kusokonezeka kwa mafungo), kuphwanya psychomotor zimachitika, kusokonezeka ndende.

Kuchokera pamalingaliro: pafupipafupi - zosokoneza zowonekera, kuphatikizapo zithunzi zopanda pake, kuphwanya kwa zomverera, kawirikawiri - conjunctivitis, kuchepa kwa makutu, tinnitus (kumva kulira, tinnitus).

Kuchokera pakapumidwe: Nthawi zambiri - chifuwa chowuma, bronchitis, sinusitis, kupuma movutikira, pafupipafupi - bronchospasm, kuphatikizapo kuphatikizika kwa mphumu wa bronchial, mphuno.

Kuchokera m'mimba: Nthawi zambiri - zotupa mu m'mimba ndi matumbo, m'mimba, kusokonezeka m'mimba, dyspepsia, kutsegula m'mimba, mseru, kusanza, pafupipafupi - kapamba, kuchuluka kwa hepatic transaminases ndi ndende ya conjugated bilirubin mu plasma, kuchuluka kwa ziwonetsero zam'mimba. kutupa, kupweteka pamimba, gastritis, kudzimbidwa, pakamwa youma, kawirikawiri glossitis, cholestatic jaundice, hepatocellular zotupa, pafupipafupi osadziwika - af ozny stomatitis (yotupa anachita mucosa m'kamwa), pachimake kulephera chiwindi, kapena cytolytic ndi cholestatic chiwindi, kuphatikizapo zakupha.

Kuchokera pamtsempha wa kwamikodzo: kawirikawiri - kuwonongeka kwaimpso, kuphatikizapo kukula kwa impso kulephera, kuwonjezeka kwa kuphipha kwamkodzo, kuwonjezeka kwa proteinuria yomwe ilipo, kuwonjezeka kwa ndende ya urea ndi creatinine m'magazi.

Kuchokera pakhungu ndi mucous nembanemba: Nthawi zambiri - zotupa pakhungu, makamaka maculopapular, ochepa - angioneurotic edema, kuphatikizapo kupha (laryngeal edema kungayambitse kutsekeka kwa mpweya kufikitsa kumaliro), kuyabwa pakhungu, hyperhidrosis (kutuluka thukuta), kawirikawiri - dermatitis, exoticative dermatitis, urticaria, onycholysis (kukhomoka kwa msomali kuchokera kumiyendo yofewa ya chala), kawirikawiri - mawonekedwe a photosensitivity, pafupipafupi osadziwika - poyizoni epermhema necrolysis, Stevens-Johnson syndrome, erythema multiforme, pemphigus (cystic rash), kukulira kwa psoriasis, psoriasis-ngati dermatitis, pemphigoid kapena lichenoid exanthema kapena ena mutu, alopecia.

Kuchokera ku minculoskeletal system: Nthawi zambiri - minyewa kukokana, myalgia, pafupipafupi - arthralgia.

Kuchokera kumbali ya kagayidwe: Nthawi zambiri - kuchuluka kwa potaziyamu m'magazi, pafupipafupi - anorexia, kuchepa kwa chakudya, pafupipafupi sikudziwika - kutsika kwa sodium m'magazi.

Kuchokera ku chitetezo chamthupi: pafupipafupi osadziwika - anaphylactic kapena anaphylactoid zimachitika, kuchuluka titer wa antiinodar antibodies.

Kuchokera ku endocrine system: pafupipafupi osadziwika - ADHD secretion syndrome.

Kuchokera pakubala: infrequently - osakhalitsa chifukwa chosokonekera kwa erectile, kuchepa libido, pafupipafupi osadziwika - gynecomastia.

Zovuta ndi zovuta zina pamalo opangira jakisoni: Nthawi zambiri - kupweteka pachifuwa, kutopa, kawirikawiri - malungo, kawirikawiri - asthenia.

Kuchita

Kugwiritsa ntchito michere ina yamphamvu kwambiri yomwe ili ndi mawonekedwe osasokoneza bwino (mwachitsanzo, polyacrylonitrile membranes) pa hemodialysis kapena hemofiltration, kugwiritsa ntchito dextran sulfate panthawi ya LDL apheresis kungayambitse chiopsezo cha anaphylactic reaction, ngati wodwala afunikira njirazi, mitundu ina ya nembanemba ifunika kugwiritsidwa ntchito ndi hemofiltration) kapena kusamutsa wodwala ku mankhwala ena a antihypertensive.

Monga ma ACE enhibitors ena, kugwiritsa ntchito kwa ramipril ndi aliskiren ndi mankhwala okhala ndi aliskiren kumatsutsana mwa odwala omwe ali ndi matenda osokoneza bongo kapena olephera kapena aimpso kwambiri (Cl creatinine 2).

Kugwiritsa ntchito mosagwirizana ndi zoletsa zina za ACE kumawonjezera mwayi wokhala ndi kulephera kwa aimpso (kuphatikizapo pachimake), hyperkalemia. Kugwiritsa ntchito munthawi yomweyo mankhwala ndi ARA II odwala omwe ali ndi matenda ashuga nephropathy ndi contraindicated ndipo osavomerezeka ena odwala.

Kuphatikiza kugwiritsidwa ntchito mosamala

Kugwiritsa ntchito munthawi yomweyo ndi potaziyamu amchere, potaziyamu wochepetsa diuretics (mwachitsanzo, amiloride, triamteren, spironolactone), komanso mankhwala omwe amalimbikitsa kuchuluka kwa potaziyamu mu seramu yamagazi (kuphatikiza trimethoprim, tacrolimus, cyclosporine, ARA II) kungayambitse kuchuluka kwa potaziyamu yambiri kuyang'anira kawirikawiri potaziyamu mu seramu yamagazi).

Mankhwala a antihypertensive (alfuzosin, doxazosin, prazosin, tamsulosin, terazosin), baclofen, diuretics, nitrate, tridclic antidepressants, antipsychotic, hypnotics, narcotic analgesics, othandizira ambiri ndi antesthesia am'deralo amathandizira antihypertensive zotsatira za ramipri.

Vasopressor sympathomimetics ndi mankhwala ena omwe amachititsa zotsatira za antihypertensive (mwachitsanzo isoproterenol, dobutamine, dopamine, epinephrine) amachepetsa mphamvu ya antihypertensive ya ramipril, ndikuwunika pafupipafupi magazi.

Kugwiritsa ntchito nthawi yomweyo kwa allopurinol, procainamide, cytostatics, immunosuppressants, corticosteroids (GCS ndi mineralocorticosteroids) ndi mankhwala ena omwe angakhudze magawo a hematological kumawonjezera mwayi wokhala ndi leukopenia. Kugwiritsa ntchito nthawi imodzi ya ramipril ndi corticosteroids sikulimbikitsidwa.

Mchere wa Lithium umabweretsa kuwonjezeka kwa seramu lithiamu ndende ndikuwonjezeka kwa Cardio- ndi neurotoxic zotsatira za lithiamu.

Ramipril imawonjezera mphamvu ya othandizira a hypoglycemic (insulin, hypoglycemic othandizira pakamwa. (Sulfonylurea derivatives) mpaka pakukula kwa hypoglycemia.

Vildagliptin imabweretsa kuwonjezeka kwa chiwopsezo cha angioedema.

Kugwiritsa ntchito kwa ramipril ndi ma MTOR zoletsa (mamiliyoni chandamale cha rapamycin - chandamale cha rapamycin mu maselo a mamalia) kinases, mwachitsanzo ndi temsirolimus, zitha kutsogola kukula kwa chitukuko cha angioedema.

Kuphatikiza kwa kulingalira

NSAIDs (mwachitsanzo acetylsalicylic acid (oposa 3 g / tsiku), ma COX2 inhibitors) amatha kufooketsa mphamvu ya antihypertensive ya ramipril, komanso kuyambitsa vuto laimpso, nthawi zina zomwe zimayambitsa kukula kwa impso.

Heparin imatha kuwonjezera seramu potaziyamu.

Sodium chloride imatha kufooketsa mphamvu ya ramipril.

Ethanol sayenera kumwa pakhungu la ramipril (chotupa cha ma ethanol pamkati wamanjenje oyendetsedwa bwino). Estrogens imafooketsa antihypertensive zotsatira (kusungidwa kwamadzi).

Kutsimikiza mtima kwa hypersensitivity kupha tizirombo

Zoletsa za ACE, kuphatikiza ndi ramipril, zimawonjezera mwayi wokhala ndi anaphylactic kapena anaphylactoid zimachitika poizoniyu.

Zotsatira za pharmacological

Pambuyo pakukonzekera kwa pakamwa, ramipril imatengedwa mwachangu kuchokera kumimba: m'mimba mwa malezala amodzi amapezeka mkati mwa ola limodzi. Mlingo wa mayamwidwe uli pafupifupi 56% ya mlingo wotengedwa ndipo osadalira chakudya. The bioavailability wa yogwira metabolite wa ramiprilat pambuyo m`kamwa makonzedwe a 2,5 mg ndi 5 mg ndi 45%, nsonga poipa zimafikiridwa 2 mpaka 4 mawola kukhazikitsa.

Wokhazikika plasma woipa wa ramiprilat pambuyo limodzi mlingo wa mwachizolowezi wa ramipril zimatheka pa 4 tsiku.

Kumanga mapuloteni a Plasma pafupifupi 73% kwa ramipril ndi 56% kwa ramiprilat.

Ramipril ali pafupi kupangika kwathunthu ku ramiprilat, diketopiperazinovy ​​ester, diketopiperazinovy ​​acid ndi glucuronides a ramipril ndi ramiprilat.

Mkulu wa metabolites, makamaka kudzera impso. Plasma woipa wa ramiprilat kupatuka polyphase. Chifukwa cha kuchuluka kwake komwe kumamangirira ku ACE komanso kudzipatula pang'onopang'ono kuchokera ku enzyme, ramiprilat imawonetsa gawo lotalikirana kwambiri pamagawo ochepa a plasma. Mutatenga Mlingo wa ramipril tsiku lililonse mobwerezabwereza, nthawi yayitali ya moyo wa ramiprilat ndi maola 13 mpaka 17 Mlingo wa 5-10 mg komanso kutalika kwa milingo ya 1.25-2.5 mg. Kusiyanaku kumachitika chifukwa cha kuthekera kwakutsogolo kwa enzyme pankhani yomangika kwa ramiprilat.

Mlingo umodzi wamkamwa wa 10 mg wa ramipril sizinachititse kuti azindikire kuchuluka kwa ramipril kapena metabolite yake mkaka wa m'mawere. Komabe, kuchuluka kwa milingo yambiri sikudziwika.

Odwala omwe ali ndi vuto la impso, chindapusa cha ramiprilat chimachepetsedwa, chifukwa mawonekedwe a ramiprilat amafanizidwa mwachindunji ndi chilolezo chain. Izi zimabweretsa kuwonjezeka kwa plasma ramiprilat ndende, komwe kumachepetsa kwambiri pang'onopang'ono kuposa maphunziro omwe ali ndi vuto laimpso.

Odwala omwe ali ndi hepatic kusowa, kutsegula kwa ramipril mu ramiprilat kumachedwetsedwa chifukwa chochepetsedwa ndi zochitika za hepatic esterases. Odwala oterewa amawonetsa kuchuluka kwa plasma ramipril. Komabe, nsonga za plasma ramiprilat ndizofanana ndi omwe ali ndi odwala omwe ali ndi chiwindi chokwanira.

Ramiprilat ndi metabolite yogwira ya ramipril, imalepheretsa enzyme dipeptidyl carboxypeptidase I (yemwe amadziwikanso kuti angiotensin-akatembenuza enzyme kapena kininase II). Mu plasma ndi minofu, enzyme iyi imathandizira kusintha kwa angiotensin I kukhala yogwira vasoconstrictor chinthu (vasoconstrictor) angiotensin II, komanso kuwonongeka kwa vasodilator bradykinin. Kuchepetsa mapangidwe a angiotensin II ndikulepheretsa kuwonongeka kwa bradykinin kumabweretsa kukulitsa kwamitsempha yamagazi. Popeza angiotensin II imathandizanso kumasulidwa kwa aldosterone, kubisala kwa aldosterone kumachepetsedwa chifukwa cha ramiprilat. Kuyankha kwapakati pa monotherapy yokhala ndi ACE inhibitor mwa odwala a mtundu wa Negroid (omwe nthawi zambiri amakhala ndi anthu omwe ali ndi matenda oopsa komanso kuchuluka kwa renin) kunachepetsedwa poyerekeza ndi oimira mafuko ena.

Ramipril amachepetsa kutulutsa kwamitsempha yamagazi kukana (OPSS), popanda kuchititsa kusintha kwa magazi aimpso komanso kuchuluka kwa kusefera kwa mafuta.

Odwala omwe ali ndi matenda oopsa, kutenga Pyramil ® kumabweretsa kutsika kwa magazi pamene akugona ndikuyimirira, popanda kuchuluka kwa mtima (HR). Odwala ambiri, mphamvu ya antihypertensive pambuyo pakamwa pakumwa mlingo umodzi imawonekera pambuyo pa maola 1-2.Ukuluku wambiri wa mlingo umodzi umatheka pambuyo pa maola 3-6 ndipo nthawi zambiri umatha maola 24.

Mulingo wapamwamba wa antihypertensive wogwiritsidwa ntchito kwa nthawi yayitali wa ramipril umawonedwa pambuyo pa masabata 3-4. Ndi chithandizo chazitali, chimapitilira zaka ziwiri.

Kuchepetsa mwadzidzidzi kwa ramipril sikumapangitsa kuti magazi azithamanga komanso azithamanga.

Kuphatikiza pa chithandizo chamankhwala chokhala ndi diuretics ndi mtima glycosides (monga momwe adokotala adanenera), Pyramil amagwira ntchito bwino kwa odwala omwe ali ndi vuto la mtima grade II-IV molingana ndi gulu la NYHA (New York Cardiology Association).

Pyramil imachepetsa OPSS (kuchepetsa katundu pambuyo pamtima), imakulitsa mphamvu ya venous channel ndikuchepetsa kuzaza kwa ventricle yamanzere, yomwe, motero, imabweretsa kutsika kwa preload pamtima. Mukatenga ramipril, pali kuwonjezeka kwa kutulutsa kwamtima, kachigawo kakang'ono ka mutu komanso kusintha kwa kulolerako kochita masewera olimbitsa thupi ndi kusintha kwa molozera wamtima. Ramipril amachepetsa kutsegula kwa neuroendocrine.

Kuphatikizika kwa mapiritsi a Pyramil

Mankhwalawa amapangidwa ndi makampani ochokera ku Poland ndi Switzerland. Amapezeka piritsi.

Gome 1. Mapangidwe ake a piramidi.

Njira yamachitidwe

Zotsatira za Pyramil zimachitika chifukwa cha zomwe zimagwira - ramipril. Zimathandizira:

1. Kuchepetsa kaphatikizidwe ka angiotensin m'magazi ndi zimakhala. Ndi mahomoni awa omwe ali ndi vasoconstrictor zotsatira ndipo amatsogolera pakuwonjezeka kwa kukakamizidwa.
2. Zimathandizira kutsitsa kwa mahomoni amomwe amayendetsa kuthamanga kwa magazi mu minofu ndi ziwiya.
3. Imachepetsa kumasulidwa kwa norepinephrine, zomwe zimapangitsa kuti chiwonetsero cha mtima chiwonjezeke. Kuphatikiza apo, thunthu limakhala ndi vasoconstrictor zotsatira ndipo limachepetsa mphamvu ya Pressor.
4. Imachepetsa kupanga kwa aldosterone. Hormone ya Mineralocorticoid imachulukitsa kuchuluka kwa magazi ndi kuzungulira.
5. Kuchulukitsa kukana kwa bradykinin kuwola. Thupi limakhala ndi antihypertensive zotsatira (zimachepetsa kupsinjika).
6. Imalimbikitsa kukula kwa mitsempha yamagazi mu impso.
7. Imakhala ndi njira yobwezeretserani mphamvu kumanzere kwamitsempha yamagetsi komanso mtima ndi zonse.
8. Amabwezeretsa minofu yamkati mwa kukonzanso kapangidwe ka nitric oxide.
9. Kuchepetsa kwathunthu zotumphukira mtima kukana mu ziwalo ndi ziwalo.
10. Kuchulukitsa kwa magazi ku ziwalo ndi machitidwe awo.
11. Imalimbikitsa mpumulo wamagazi.

Malangizo ogwiritsira ntchito

Phukusi lililonse la Pyramil lili ndi chidziwitso cholandirira.Musanagwiritse ntchito, ndikofunikira kudziwa bwino zomwe wopanga amapanga.

Makamaka, Pyramil, malangizo ogwiritsa ntchito omwe ali ndi mndandanda wathunthu wazidziwitso, ndiwothandiza:

1. Kuchulukitsa kwa magazi.
2. Kulephera kwamtima kosalekeza.
3. Diabetes / non-diabetes nephropathy.
4. Pofuna kupewa ngozi yokhala ndi myocardial infarction kapena mtima zina zomwe zingayambitse imfa.
5. Ndi matenda a mtima, kuphatikiza pa opareshoni ya matenda a mtima.
6. Ndi stroke.
7. Mukasakaniza kapena kutsekeka kwamitsempha yayikulu yamagazi.
8. Ndi matenda a shuga ophatikizika ndi zinthu zosiyanasiyana.
9. Monga mankhwala pambuyo myocardial infaration muopseza mtima.

Mapiritsi a pyramil ali ndi mawonekedwe a biconvex oblong. Mbali imodzi ndi notch - chiwopsezo. Mapiritsiwo ndiwokwiya kukhudza, zofunda zakuda zimaloledwa pa chipolopolo. Pyramil imapezeka mu mitundu yotsatirayi:

1. 2,5 mg Wophatikizidwa ndi chipolopolo chachikulu cha mandimu achikasu.
2. 5 mg Ali ndi chipolopolo chopepuka.
3. 10 mg Amapakidwa zoyera kapena pafupifupi zoyera popanda splashes.

Mlingo wa Pyramil zimatengera zomwe zikuwoneka kuti zingagwiritsidwe ntchito komanso kulolera mwa wodwala wina.

Mavuto obwera chifukwa cha kuthamanga kwa magazi

Gome 2. Mlingo ndi regimens Pyramil.

Ma piramidi sangathe kutafunidwa ndipo ayenera kutsukidwa ndi madzi ambiri (osachepera - 100 ml).

Mawonekedwe akugwiritsidwa ntchito

Ma piramidi, malangizo omwe ali ndi zoletsa zingapo, ayenera kugwiritsidwa ntchito mosamala nthawi zina. Pali malangizo apadera angapo, mwa iwo:

1. Mosamala ndikofunikira kuphatikiza Mapiramidi ndi diuretics. Ndikulimbikitsidwa kuti muchepetse kwambiri kapena musamwe kumwa mankhwalawo.
2. Kugwiritsa ntchito Pyramil koyamba kuyenera kuchitika motsogozedwa ndi katswiri. Nthawi yowonera kochepa ndi maola 8.
3. Kulephera kwamtima kosalekeza, ma Pyramylls angayambitse kuchepa kwambiri kwa magazi.
4. Ndi ntchito yayikulu ya renin-angiotensin, timalimbikitsidwa kuyang'anira kuthamanga kwa magazi ndi impso.
5. Ndi kuchuluka kwa masewera olimbitsa thupi kapena kutentha kwambiri kwa mpweya, ndikofunikira kupewa kuchepa kwa madzi m'thupi. Kuphatikiza ndi Pyramil, zingayambitse kuchepa kwambiri kwa kupanikizika.
6. Asanachitidwe opareshoni, Pyramil sapatula maola 24 kale, etc.

Malinga ndi deta yomwe ikupezeka, Pyramil ilibe vuto lililonse poyendetsa galimoto. Komabe, zoyipa monga kufooka komanso kugona zimatha kuthana ndikuyendetsa bwino.

Pa nthawi ya pakati kapena yoyamwitsa, kutenga Pyramil koletsedwa kotheratu. Izi zimatha kubweretsa kusokonezeka kwa fetus kapena kutuluka kwa ma pathologies angapo. Pokonzekera kukhala ndi pakati, muyenera kukana kumwa mankhwalawo pasadakhale.

Ma piramidi saloledwa kutenga:

• Anthu ochepera 18
• ndi edema ya Quincke,
• aimpso / chiwindi kulephera
• Hypersensitivity pamagawo a mankhwala,
• pamodzi ndi mankhwala a shuga a glucose kapena mankhwala omwe si a steroidal,
• ndi chiwopsezo cha kuchepa kwambiri kwa magazi mwa odwala (makamaka odwala hypotensive),
• ndi kugunda kwa mtima ndi zina, etc.

Analogi ndi zophatikizira

Pali mankhwala angapo omwe amalocha Pyramil, omwe amatha kugawidwa m'magulu awiri:

1. Ma Synonyms a Pyramil. Zimatanthawuza kukhala ndi chinthu chofananacho pakapangidwe, koma mosiyana ndi dzina la malonda.
2. Analogs Pyramil. Kukonzekera komwe kumasiyana mosiyanasiyana koma kumathandizanso.

Pyramil, omwe maulumikizidwe ake amathanso kupezeka m'mafakisi, ndi ofanana ndi:

Pyramil, zomwe zimafanana zomwe zikufanana, zitha kusintha: