Momwe mungagwiritsire ntchito mankhwala a Mikardis 80?

Mikardis imapangidwa ngati mapiritsi: obala, pafupifupi oyera kapena oyera, mbali imodzi pali zolemba "51N" kapena "52N" (40 kapena 80 mg, motsatana), inayo - chizindikiro cha kampani (ma 7 ma PC. M'matumba, chilichonse 2, 4, 8 kapena 14 matuza okhala ndi kabokosi katoni).

Piritsi limodzi lili ndi:

Zogwira ntchito: telmisartan - 40 kapena 80 mg,
Zothandiza monga (40/80 mg iliyonse): magnesium stearate - 4/8 mg, sodium hydroxide - 3.36 / 6.72 mg, meglumine - 12/250 mg, polyvidone (collidone 25) - 12/250 mg, sorbitol - 168.64 / 337.28 mg.

Kutulutsa Fomu

Mankhwalawa ndi mapiritsi oyera okhala ndi mawonekedwe a 51H olembedwa m'mphepete mwake ndi logo yamakampani mbali inayo.

Mapiritsi 7 oterewa ali ndi mulingo wa 40 mg mu chithuza; 2 kapena 4 matuza oterowo mu katoni. Pafupifupi mapiritsi 7 oterewa omwe ali ndi mulingo wa 80 mg wa chithuza, 2, 4 kapena 8 matuza oterowo mu katoni

Pharmacodynamics ndi pharmacokinetics

Mankhwala

Telmisartan - kusankha receptor blocker angiotensin II. Ali ndi kutentha kwakukulu AT1 cholandilira subtype angiotensin II. Kupikisana ndi angiotensin II mu ma receptor osakhala ndi zofanana. Kumangiriza ndikupitiliza.

Siziwonetsa kutenthedwa kwa ma subtypes ena a receptors. Imachepetsa zomwe zili aldosterone m'magazi, sikumachepetsa plasma renin ndi njira za ion m'maselo.

Yambani Hypotensive zotsatira Amadziwika m'maola atatu oyambilira atatha kukhazikitsa telmisartan. Mchitidwewu ukupitilira kwa tsiku limodzi kapena kupitilira apo. Mphamvu yotchulidwa imayamba mwezi umodzi wokhazikika.

Mwa anthu okhala ndi ochepa matenda oopsatelmisartan amachepetsa kuthamanga kwa magazi kwa systolic ndi diastolic, koma sasintha kuchuluka kwa mtima.

Sizimayambitsa kusiya achiwerewere.

Pharmacokinetics

Ikamamwa pakamwa, imatengedwa mwachangu kuchokera m'matumbo. Bioavailability ikuyandikira 50%. Pambuyo maola atatu, ndende ya plasma imakhala yokwanira. 99.5% ya chinthu chomwe chimagwira ndimapuloteni amwazi. Kupangidwa poyankha ndi glucuronic acid. Ma metabolites a mankhwalawa sagwira ntchito. Kuthetsa theka-moyo woposa maola 20. Amachotseredwa kudzera m'mimba, chimbudzi cha mkodzo ndizosakwana 2%.

Contraindication

Mapiritsi a Micardis amatsutsana mwa anthu omwe ali nawo chifuwa pazigawo za mankhwala, zolemetsa matendachiwindi kapena impso, fructose tsankho, pa mimba ndi nyere, ana osakwana zaka 18.

Zotsatira zoyipa

Kuchokera ku dongosolo lamanjenje lalikulu: kukhumudwachizungulire mutukutopa, kuda nkhawa, kusowa tulo, kukokana.
Kuchokera kupuma dongosolo: matenda a chapamwamba kupuma thirakiti (sinusitis, pharyngitis, bronchitis), chifuwa.
Kuchokera kwamuzungulire: kutchulidwa kuchepa kwa mavuto, tachycardia, bradycardiakupweteka pachifuwa.
Kuchokera kugaya chakudya: nseru, kutsegula m'mimba, dyspepsiakuchuluka kuchuluka kwa chiwindi michere.
Kuchokera ku minculoskeletal system: myalgiakupweteka kumbuyo arthralgia.
Kuchokera ku genitourinary system: edema, matenda a genitourinary system, hypercreatininemia.
Hypersensitivity Reaction: Khungu Zotupa, angioedema, urticaria.
Zizindikiro zasayansi: kuchepa magazi, Hyperkalemia.
Zina: erythemakuyabwa dyspnea.

Mikardis, malangizo ogwiritsira ntchito

Malinga ndi malangizo ogwiritsira ntchito Mikardis, mankhwalawa amatengedwa pakamwa. Chalangizidwa kwa akulu mlingo 40 mg kamodzi patsiku. Mu odwala angapo, achire zotsatira zimawonedwa kale akamamwa mankhwala 20 mg patsiku. Ngati kuchepa kwa kukakamizidwa pamlingo wofunidwa sikunawonedwe, ndiye kuti mlingowo ungathe kuwonjezeka mpaka 80 mg patsiku.

Kuchuluka kwa mankhwalawa kumatheka patadutsa masabata asanu atayamba chithandizo.

Odwala ovuta mitundu ochepa matenda oopsa kugwiritsa ntchito 160 mg mankhwala patsiku.

Kuchita

Telmisartan yambitsa Hypotensive zotsatira njira zina zochepetsera kupanikizika.

Mukamagwiritsa ntchito limodzi telmisartan ndi digoxin Nthawi ndi nthawi kuganizira za ndende ndikofunikira digoxin m'magazi, chifukwa amatha kuwuka.

Mukamamwa mankhwala limodzi lifiyamu ndi ACE zoletsa kuwonjezeka kwakanthawi kawonedwe lifiyamu m'magazi, owonetsedwa ndi zoyipa.

Chithandizo mankhwala osapweteka a antiidal Pamodzi ndi Mikardis odwala omwe alibe madzi am'mimba amatha kutsogolera kukula kwa impso.

Malangizo apadera

Chifukwa odwala osowa madzi m'thupi (kuletsa mchere, chithandizo okodzetsa, kutsegula m'mimba, kusanza) kuchepa kwa mlingo wa Mikardis ndikofunikira.

Mosamala, sankhani anthu omwe stenosis mwa onse mitsempha ya impso, mitral valve stenosis kapena aortic hypertrophic cardiomyopathy yotupa, yayikulu impso, kwa chiwindi kapena mtima kulephera, matenda am'mimba.

Ndi zoletsedwa kugwiritsa ntchito liti chachikulu aldosteronism ndi fructose tsankho.

Ndi mimba yomwe mwakonza, muyenera kupeza kaye malo a Mikardis ndi enanso antihypertensive mankhwala.

Gwiritsani ntchito mosamala mukamayendetsa.

Pogwiritsa ntchito mankhwala osokoneza bongo lifiyamu kuyang'anira zinthu za lithiamu m'magazi akuwonetsedwa, chifukwa kuwonjezeka kwakanthawi pamlingo wake ndizotheka.

Mtengo wa Mikardis

Ku Russia, phukusi la 80 mg No. 28 lidzawononga ndalama kuchokera pa 830 mpaka 980 rubles. Ku Ukraine, mtengo wa Mikardis mu mtundu womwewo wa nkhani ukuyandikira 411 hhucnias.

Munkhaniyi, mutha kuwerengera malangizo ogwiritsira ntchito mankhwalawa Mikardis. Amapereka ndemanga kuchokera kwa alendo omwe amabwera patsamba lino - ogula mankhwalawa, komanso malingaliro a akatswiri azachipatala pakugwiritsa ntchito Mikardis pochita zawo. Chopempha chachikulu ndikuti muwonjezere ndemanga zanu za mankhwalawa: mankhwalawo adathandizira kapena sanathandizire kuchotsa matendawa, ndizovuta ziti zomwe zimawoneka ndi zotsatirapo zake, zomwe mwina sizinalengezedwe ndi wopanga. Mikardis analogi pamaso paopezeka mawonekedwe. Gwiritsani ntchito pochizira matenda oopsa komanso kutsitsa magazi mu akulu, ana, komanso pa nthawi ya bere. The zikuchokera mankhwala.

Mikardis - antihypertensive mankhwala.

Telmisartan (chinthu chomwe chimagwiritsidwa ntchito ngati mankhwala a Mikardis) ndiwotsutsa wina wa receptors wa angiotensin 2. Imakhala ndi mgwirizano wapamwamba wa AT1 receptor subtype wa angiotensin 2, kudzera momwe angiotensin 2 amachokera. Zimapanga kulumikizana kokha ndi AT1 receptor subtype ya angiotensin 2. Kumangiraku ndikupitirirabe. Telmisartan ilibe chiyanjano ndi ma receptors ena (kuphatikizapo AT2 receptors) ndi zina zochepa zomwe zimaphunzitsidwa ndi angiotensin receptors. Kufunikira kwa magwiritsidwe awa a ma receptor, komanso momwe mphamvu zawo zimakhudzira kwambiri ndi angiotensin 2, kuchuluka kwa zomwe zimawonjezeka ndikusankhidwa kwa telmisartan, sikunaphunzire. Amachepetsa ndende ya aldosterone m'magazi, samalepheretsa renin m'magazi am'magazi ndipo saletsa njira ya ion. Sizingalepheretse ACE (kininase 2), puloteni yomwe imawonongeranso bradykinin, chifukwa chake, kuwonjezeka kwa zotsatira zoyambitsidwa ndi bradykinin sikuyembekezeredwa.

Mikardis pa mlingo wa 80 mg kwathunthu umatchinga matenda oopsa a angiotensin 2. Kuyamba kwa hypotensive zochita kumadziwika mkati mwa maola atatu itatha konzedwe ka telmisartan. Mphamvu ya mankhwalawa imatha kwa maola 24 ndipo imakhalabe yofunikira mpaka maola 48. Kutchulidwa kotsimikiza kumachitika pambuyo pa masabata 4-8 ogwiritsidwa ntchito pafupipafupi.

Odwala omwe ali ndi matenda oopsa, telmisartan imachepetsa kuthamanga kwa magazi ndi magazi, popanda kukhudza kugunda kwa mtima.

Panthawi yomwe Mikardis akhazikitsidwa, mwapang'onopang'ono AD imabweranso pamlingo wake woyambira popanda chitukuko cha matenda obwera nawo.

Hydrochlorothiazide (mankhwala omwe amagwiritsidwa ntchito ndi mankhwala a Mikardis Plus) ndi thiazide diuretic. Liazide diuretics imakhudzanso kubwezeretsanso kwa ma electrolyte mu impso tubules, kukulitsa zowonjezera zotulutsa za sodium ndi chloride (pafupifupi zofanana). Mphamvu ya diuretic ya hydrochlorothiazide imabweretsa kuchepa kwa bcc, kuwonjezeka kwa ntchito ya plasma renin, kuchuluka kwa secretion ya aldosterone ndipo kumayendetsedwa ndi kuwonjezeka kwa potaziyamu ndi bicarbonates, ndipo chifukwa chake, kutsika kwa potaziyamu m'madzi a m'magazi. Pogwiritsa ntchito munthawi yomweyo telmisartan, pali chizolowezi choletsa kutaya kwa potaziyamu chifukwa cha zotupa zotere, mwina chifukwa cha RAAS blockade.

Pambuyo pa kutenga hydrochlorothiazide, diuresis imawonjezeka pambuyo pa maola awiri, ndipo mphamvu yakeyo imawonekera patatha pafupifupi maola 4.

Kugwiritsa ntchito nthawi yayitali hydrochlorothiazide kumachepetsa chiopsezo cha matenda amtima komanso kufa kwa iwo.

Mankhwala odziwika bwino a antihypertensive a mankhwala a Mikardis Plus nthawi zambiri amakwaniritsidwa masabata 4-8 pambuyo poyambira chithandizo.

Kupanga

Omwe amachokera ku Telmisartan + (Mikardis).

Telmisartan + hydrochlorothiazide + Excipients (Mikardis Plus).

Pharmacokinetics

Ikaperekedwa, telmisartan imatengedwa mwachangu kuchokera mumimba. Bioavailability ndi 50%. Mukamamwa pamodzi nthawi yomweyo ndi chakudya, kutsika kwa mfundo za AUC kumachokera ku 6% (mukamagwiritsa ntchito mlingo wa 40 mg) mpaka 19% (mukamagwiritsa ntchito mlingo wa 160 mg). Pambuyo pakatha maola atatu pambuyo pa kupangika, magazi omwe amapezeka m'magazi amayambitsidwa mosasamala nthawi yakudya. Zimapangidwa ndi kuphatikizika ndi glucuronic acid. Ma metabolabol siogwiritsa ntchito mankhwala. Amafukusidwa kudzera m'matumbo osasinthika, impso ndi impso - osachepera 2% ya mlingo womwe umatenge.

Pali kusiyana pakukhazikika pakati pa amuna ndi akazi. Mwa akazi, Cmax ndi AUC anali pafupifupi 3 ndi 2 nthawi motsatana kuposa mwa abambo (popanda phindu lalikulu).

Ma pharmacokinetics a telmisartan mwa odwala okalamba samasiyana ndi pharmacokinetics mwa odwala achinyamata. Kusintha kwa Mlingo sikofunikira.

Kusintha kwa odwala omwe ali ndi vuto la aimpso sikofunikira, kuphatikiza odwala pa hemodialysis. Telmisartan samachotsedwa ndi hemodialysis.

Odwala omwe ali ndi vuto la chiwindi ntchito yofatsa kwa digiri yochepa (kalasi A ndi B pa Child-Pugh), tsiku lililonse mankhwalawa sayenera kupitilira 40 mg.

Zizindikiro zazikulu za pharmacokinetics za telmisartan mwa ana ndi achinyamata azaka 6 mpaka 18 atatenga telmisartan pa mlingo wa 1 mg / kg kapena 2 mg / kg kwa masabata 4 nthawi zambiri amafananizidwa ndi deta yomwe imapezeka mu chithandizo cha akuluakulu ndikutsimikizira kusagwirizana kwa pharmacokinetics telmisartan, makamaka polemekeza Cmax.

Pambuyo pakukonzekera pakamwa, Mikardis Plus Cmax hydrochlorothiazide imafikiridwa mkati mwa maola 1-3. Mtheradi wa bioavailability akuyerekeza ndi kuchuluka kwa impso kwa hydrochlorothiazide ndipo pafupifupi 60%. Amamangidwa ndi mapuloteni am'madzi am'magazi ndi 64%. Siphatikidwanso m'thupi la munthu ndipo timatulutsa mkodzo pafupifupi osasinthika. Pafupifupi 60% ya mankhwala omwe amamwa pakamwa amathetsedwa mkati mwa maola 48.

Pali kusiyana pamaganizidwe a plasma mwa amuna ndi akazi. Mwa azimayi, mumakhala vuto lotere la hydrochlorothiazide.

Odwala ndi mkhutu aimpso ntchito, mlingo wa kuthetsedwa kwa hydrochlorothiazide amachepetsa.

Zizindikiro

matenda oopsa oopsa (kuchepa kwa mavuto),
Kuchepetsa kuchepa kwa mtima ndi kufa kwa odwala azaka 55 ndi akulu omwe ali ndi chiwopsezo cha matenda amtima.

Kutulutsa Mafomu

Mapiritsi 40 mg ndi 80 mg.

Mapiritsi 40 mg + 12.5 mg ndi 80 mg + 12.5 mg (Mikardis Plus).

Malangizo ogwiritsira ntchito ndi mlingo

Mankhwala ndi mankhwala pakamwa, ngakhale kudya zakudya.

Ndi matenda oopsa oopsa, mankhwala oyamba a Mikardis ndi piritsi limodzi la 40 mg kamodzi patsiku. Muzochitika zomwe achire samakwaniritsa, mlingo wa mankhwalawa ukhoza kuwonjezeka mpaka 80 mg kamodzi patsiku. 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 kuchepa kwa matenda a mtima ndi kufa, mlingo womwe umalimbikitsidwa ndi piritsi limodzi (80 mg) kamodzi patsiku. Mu nthawi yoyamba ya chithandizo, kuwongolera kowonjezereka kwa magazi kungafunike.

Odwala omwe ali ndi vuto la aimpso (kuphatikiza omwe ali ndi hemodialysis) kusintha kwa mankhwalawa sikufunika.

Odwala omwe ali ndi vuto la chiwindi ntchito yofatsa kwa digiri yochepa (kalasi A ndi B pa Child-Pugh), tsiku lililonse mankhwalawa sayenera kupitilira 40 mg.

Mlingo wothandizira odwala okalamba sufuna kusintha.

Mikardis Plus iyenera kumwedwa pakamwa kamodzi patsiku, mosasamala kanthu za kudya.

Mikardis Plus 40 / 12,5 mg imatha kuperekedwa kwa odwala omwe kugwiritsa ntchito mankhwalawa Mikardis pa 40 mg kapena hydrochlorothiazide sikupangitsa kuti magazi azithamanga.

Mikardis Plus 80 / 12,5 mg imatha kutumikiridwa kwa odwala omwe kugwiritsa ntchito mankhwalawa Mikardis pa mlingo wa 80 mg kapena Mikardis Plus 40 / 12,5 mg sikuti kumayambitsa kuthamanga kwa magazi.

Odwala omwe ali ochepa matenda oopsa, kuchuluka kwa tsiku lililonse kwa telmisartan ndi 160 mg patsiku. Mlingo uwu unali wothandiza komanso wololera bwino.

Zotsatira zoyipa

kupuma pamavuto (kuphatikiza chibayo ndi pulmonary edema),
kupuma movutikira
arrhythmias,
tachycardia
bradycardia
kuchepa kwakukulu kwa kuthamanga kwa magazi (kuphatikiza orthostatic hypotension),
kukomoka
paresthesia
zosokoneza tulo
kusowa tulo
chizungulire
nkhawa
kukhumudwa
kusakhazikika
mutu
kutsegula m'mimba, kudzimbidwa,
mucosa wowuma mkamwa,
chisangalalo
kupweteka m'mimba
kusanza
gastritis
kuchepa kwamtima
kukomoka
hyperglycemia
hypercholesterolemia,
kapamba
chiwindi ntchito,
jaundice (hepatocellular kapena cholestatic),
dyspepsia
kutuluka thukuta kwambiri
kupweteka kumbuyo
minofu kukokana
myalgia
arthralgia,
nyama yamatumbo yamatumbo,
arthrosis,
ngati tendonitis ngati zizindikiro
kupweteka pachifuwa
kuchepa kwa magazi m'thupi, kuchepa kwa magazi m'thupi, kuchepa magazi m'thupi, kuchepa kwa magazi, kuchepa kwa magazi, kuchepa kwa magazi, kuchepa kwa magazi, kuchepa kwa magazi,
Kulephera kwaimpso, kuphatikizapo kulephera kwaimpso,
interstitial nephritis,
glucosuria
kuwonongeka kwamawonekedwe
masomphenya osakhalitsa
pachimake-kutsekeka glaucoma,
kusabala
sepsis, kuphatikizapo milandu yakupha,
chapamwamba kupuma thirakiti matenda (bronchitis, pharyngitis, sinusitis),
matenda a kwamkodzo thirakiti (kuphatikizapo cystitis),
kutupa kwa tiziwalo tating'ono,
kuchuluka kwa michere ya chiwindi,
kuchuluka kwa ntchito za CPK,
kuchuluka kwa uric acid m'magazi,
hypertriglyceridemia,
hypokalemia, hyperkalemia,
hyponatremia,
Hyperuricemia
hypoglycemia (odwala matenda a shuga),
kulolerana kwa shuga,
kuchepa kwa hemoglobin m'magazi,
angioedema (kuphatikizapo milandu yakupha),
erythema
Khungu
zotupa
anaphylactic reaction,
chikanga
zidzolo
toxic epidermal necrolysis,
zimachitika lupus
kuchuluka kapena kukulitsa kwa zizindikiro za systemic lupus erythematosus,
necrotic vasculitis,
zokhudza zonse vasculitis
makonda azithunzi
kubwereranso kwa dongosolo la lupus erythematosus,
vasculitis
chimfine ngati matenda
malungo
kufooka.

Contraindication

matenda olepheretsa biliary thirakiti
chiwindi cholakwika kwambiri (Gulu Lopanda Ana),
kukanika kwambiri kwaimpso (CC zosakwana 30 ml / min),
Hypokalemia, hypercalcemia,
ntchito munthawi yomweyo ndi aliskiren odwala matenda a shuga ndi kulephera kwaimpso (GFR osakwana 60 ml / min / 1.73 m2),
cholowa m'malo obadwa nacho (mankhwalawa ali ndi sorbitol),
kufupika kwa lactase, tsankho lactose, shuga-galactose malabsorption syndrome,
zaka mpaka zaka 18 (chitetezo ndi kukhazikika)
mimba
mkaka wa pachiwopsezo (mkaka wa m'mawere),
Hypersensitivity kwa yogwira mankhwala kapena othandizira zigawo zikuluzikulu za mankhwala kapena zotumphukira zina za sulfonamide.

bilteryal aimpso mtsempha wamagazi kapena stenosis ya impso imodzi,
kuwonongeka kwa chiwindi kapena matenda a chiwindi oyenda pang'onopang'ono (kalasi A ndi B pa kukula kwa Mwana-Prag),
kuchepa kwa BCC chifukwa cha m'mbuyomu diuretiki yoletsa, kuletsa kudya mchere, kutsekula m'mimba kapena kusanza,
Hyperkalemia
kusintha pambuyo pa kupatsirana kwa impso (osagwiritsa ntchito),
kulephera kwamtima kwa mtima kwa FC FC malinga ndi gulu la New York Heart Association,
stenosis wa msempha wa msempha ndi mitral valavu,
idiopathic hypertrophic subaortic stenosis,
hypertrophic obstriers cardiomyopathy,
matenda ashuga
aldosteronism yoyamba,
gout
kutsekeka kwa khungu (chifukwa cha kupezeka kwa hydrochlorothiazide pamagulu).

Mimba komanso kuyamwa

Kugwiritsa ntchito kwa Mikardis ndi Mikardis Plus kumatsutsana panthawi ya pakati.

Kugwiritsa ntchito angiotensin 2 receptor antagonists mu 1 trimester ya mimba sikulimbikitsidwa, mankhwalawa sayenera kutumikiridwa panthawi yapakati. Mimba ikachitika, mankhwalawa amayenera kuyimitsidwa nthawi yomweyo. Ngati ndi kotheka, njira zina zochiritsira ziyenera kutumizidwa (magulu ena a antihypertensive mankhwala ovomerezeka kuti agwiritsidwe ntchito pa nthawi yapakati).

Kugwiritsa ntchito angiotensin 2 receptor antagonists mu 2 ndi 3 trimesters ya mimba ndi contraindicated. Mu maphunziro oyamba a telmisartan, zotsatira za teratogenic sizinawonekere, koma fetotoxicity idakhazikitsidwa. Amadziwika kuti zotsatira za angiotensin 2 receptor antagonists mu 2 and 3 trimesters of mimba zimayambitsa kufalikira kwa munthu (kuchepa kwa ntchito yaimpso, oligohydramnios, kuchedwa kwa ossization kwa chigaza), komanso neonatal toxity (renal kulephera, hypotension, hyperkalemia). Odwala omwe akukonzekera kutenga pakati ayenera kupatsidwanso njira zina zochiritsira. Ngati mankhwala a angiotensin 2 receptor antagonists adachitika mu 2nd trimester ya kutenga pakati, kupweteka kwa impso ndi chigaza mafupa a mwana wosabadwayo tikulimbikitsidwa.

Makanda obadwa kumene omwe amayi awo adalandira angiotensin 2 receptor antagonists amayenera kuyang'aniridwa kwambiri kuti asachitire hypotension.

Zomwe zimachitika ndi hydrochlorothiazide pa nthawi yapakati, makamaka trimester yoyamba, ndizochepa. Hydrochlorothiazide imawoloka chotchinga. Poganizira njira yogwiritsira ntchito ya hydrochlorothiazide, amaganiza kuti kugwiritsa ntchito kwake kwa 3 ndi 3 pomwe amatenga pathupi kumatha kusokoneza kufooka kwa fetoplacental ndikupangitsa kusintha kwa mluza komanso fetus, monga jaundice, kusalinganika kwa elekitirodi, ndi thrombocytopenia. Hydrochlorothiazide sayenera kugwiritsidwa ntchito ngati edema ya amayi apakati, amayi apakati omwe ali ndi matenda oopsa, kapena pa preeclampsia, ngati pali chiopsezo chakuchepa kwa kuchuluka kwa plasma ndi kuchepa kwa placental perfusion, ndipo palibe zotsatira zabwino muzochitika zamankhwala.

Hydrochlorothiazide sayenera kugwiritsidwa ntchito pochiza matenda oopsa mu azimayi oyembekezera, pokhapokha ngati nthawi zina pomwe mankhwala ena sangagwiritsidwe ntchito.

Mankhwala omwe amapezeka ndi mankhwala a Mikardis ndi Mikardis Plus amatsutsana pakamwa.

Pakafukufuku wazinyama, zotsatira za telmisartan ndi hydrochlorothiazide pa chonde sizinawoneke.

Kafukufuku wokhudza chonde chaumunthu sanachitike.

Gwiritsani ntchito ana

Mankhwalawa Mikardis ndi Mikardis Plus amalephera kugwiritsidwa ntchito mwa ana ndi achinyamata ochepera zaka 18, chifukwa Zambiri pankhani yothandiza ndi chitetezo m'gululi sizipezeka.

Gwiritsani ntchito odwala okalamba

Kusintha kwa muyezo wachipatala mwa okalamba sikufunika.

Malangizo apadera

Zinthu zomwe zimachulukitsa ntchito ya RAAS

Odwala ena, chifukwa cha kuponderezedwa kwa ntchito ya RAAS, makamaka ndi munthawi yomweyo mankhwala omwe amapezeka munthawi imeneyi, ntchito yaimpso (kuphatikizapo kuperewera kwaimpso) imalephera. Chifukwa chake, chithandizo chothandizirana ndi mawonekedwe awiri ofanana a RAAS (mwachitsanzo, ndi kuwonjezera kwa ACE inhibitor kapena renin inhibitor, aliskiren, kuti angiotensin 2 receptor antagonist blockers), ziyenera kuchitidwa mosamalitsa komanso kuwunikira ntchito ya aimpso pafupipafupi. serum creatinine).

Kugwiritsa ntchito thiazide okodzetsa odwala omwe ali ndi vuto laimpso kungayambitse azotemia. Kuyang'anira ntchito za impso kumalimbikitsidwa.

Odwala omwe ali ndi vuto limodzi la impso a stenosis kapena ochepa a stenosis, omwe amagwiritsidwa ntchito ndi mankhwala omwe amakhudza RAAS, chiopsezo chokhala ndi ochepa owopsa komanso kulephera kwa aimpso ukuwonjezeka.

Kuwonongeka kwa chiwindi

Odwala omwe ali ndi vuto la chiwindi kapena matenda a chiwindi omwe akupita patsogolo, a MikardisPlus ayenera kugwiritsidwa ntchito mosamala, chifukwa ngakhale kusintha kochepa muyezo wamagetsi wamagetsi kumatha kuthandizira kukulira kwa chiwindi.

Zokhudza kagayidwe ndi kagwiridwe ka endocrine

Odwala omwe ali ndi matenda ashuga, kusintha kwa muyezo wa insulin kapena hypoglycemic wothandizila pakamwa kungafunike. Mankhwalawa ndi thiazide diuretics, matenda a shuga a m'mbuyo amatha kuwonekera.

Nthawi zina, kugwiritsa ntchito thiazide diuretics kumatha kukhala ndi hyperuricemia ndikuchulukitsa njira ya matenda otupa.

Odwala omwe ali ndi matenda osokoneza bongo komanso chiwopsezo chowonjezera cha mtima, mwachitsanzo, odwala omwe ali ndi matenda a shuga komanso matenda a mtima, kugwiritsa ntchito mankhwala omwe amachepetsa kuthamanga kwa magazi, monga angiotensin 2 receptor antagonists kapena ACE inhibitors, angakulitse chiopsezo cha kuphedwa kwa myocardial infarction komanso mtima wamtima mwadzidzidzi. imfa ya mtima. Odwala omwe ali ndi matenda ashuga, matenda a mtima amatha kukhala asymptomatic motero sangadziwike. Musanayambe kugwiritsa ntchito mankhwala a Mikardis ndi Mikardis Plus kuti mupeze ndi kulandira matenda a mtima, muyenera kuwunika matenda ena, kuphatikizira kuyesa ndi zolimbitsa thupi.

Pachimake myopia ndi yachiwiri angle-kutsekedwa glaucoma

Hydrochlorothiazide, wokhala wochokera ku sulfonamide, imatha kuyambitsa zotsatira za maidiidi amisimu yacute yokhazikika komanso yovuta kwambiri. Zizindikiro za matendawa ndi kuchepa mosayembekezereka kwa kupweteka kwakhungu kapena kupweteka kwa maso, komwe nthawi zambiri kumachitika patangopita maola ochepa mpaka milungu ingapo atayamba kumwa mankhwalawa. Ngati sanalandire, khungu lotsekeka kwambiri limatha kuyambitsa masomphenya. Chithandizo chachikulu ndikuchotsa hydrochlorothiazide mwachangu. Tiyenera kukumbukira kuti ngati mavuto a intraocular sangakhale osalamulirika, ayenera kuwonetsetsa mwachangu kapena kuchitidwa opaleshoni. Zowopsa zomwe zimapangitsa kuti khungu lizitha kutsekeka kwambiri limaphatikizaponso mbiri ya ziwopsezo za sulfonamides kapena penicillin.

Kuphwanya mphamvu yamagetsi yamagetsi

Mukamagwiritsa ntchito mankhwala a Mikardis Plus, monga momwe amathandizira okodzetsa, muyenera kuwunika pafupipafupi zomwe zili mu mauramu am'magazi.

Thiazide okodzetsa, incl. hydrochlorothiazide, ikhoza kuyambitsa chisokonezo pamagetsi a electrolyte ndi acid-base state (hypokalemia, hyponatremia ndi hypochloremic alkalosis). Zizindikiro za matendawa zimaphatikizira kufinya kwa pakamwa, ludzu, kufooka, kugona, nkhawa, myalgia kapena kupindika kwa minofu ya ng'ombe (crumpi), kufooka kwa minofu, kuchepa kwa kuthamanga kwa magazi, oliguria, tachycardia, komanso m'mimba zoterezi kusokonezeka m'matumbo ngati mseru kapena kusanza.

Mankhwala a thiazide diuretics akagwiritsidwa ntchito, hypokalemia imatha kupanga, koma telmisartan wogwiritsidwa ntchito nthawi yomweyo amatha kuwonjezera zomwe zili m'magazi a potaziyamu. Chiwopsezo cha hypokalemia ndichulukirachulukirachulukirachulukira odwala omwe ali ndi matenda acirrhosis, okhala ndi diuresis yowonjezereka, wopanda chakudya chopanda mchere, komanso munthawi yomweyo kugwiritsa ntchito gluco- ndi mineralocorticosteroids kapena corticotropin. Telmisartan, yomwe ndi gawo la kukonzekera kwa Mikardis ndi Mikardis Plus, m'malo mwake, imatha kuyambitsa Hyperkalemia chifukwa chotsutsana ndi angiotensin 2 receptors (subtype AT1). Ngakhale Hyperkalemia yofunika kwambiri pakadali pano sanafotokozedwe pogwiritsa ntchito Mikardis Plus, zomwe zimayambitsa chiwopsezo chake zimaphatikizira aimpso ndi / kapena kulephera kwa mtima ndi matenda a shuga.

Palibe umboni kuti mankhwalawo Mikardis Plus amatha kuchepetsa kapena kupewa hyponatremia yoyambitsidwa ndi okodzetsa. Hypochloremia nthawi zambiri imakhala yaying'ono ndipo sifunikira chithandizo.

Liazide diuretics imatha kuchepetsa kuwononga kwa calcium kwa impso ndikuyambitsa (pakakhala kusokonezeka kwodziwika mu calcium metabolism) kuchepa kwapang'onopang'ono komanso kuwonjezeka pang'ono kwa calcium ya seramu. Hypercalcemia yoopsa kwambiri ikhoza kukhala chizindikiro cha hypentparathyroidism yam'mbuyo. Musanayese magwiridwe amtundu wa parathyroid, ma diaztics a thiazide ayenera kusiyidwa.

Zawonetsedwa kuti thiazide diuretics imachulukitsa kuchulukitsidwa kwa magnesium ndi impso, zomwe zingayambitse hypomagnesemia.

Odwala omwe ali ndi matenda a mtima, kugwiritsidwa ntchito kwa mankhwala aliwonse a antihypertensive, ngati kuchepa kwambiri kwa magazi, kungayambitse kuphwanyidwa kwa myocardial kapena stroke.

Pali malipoti a kakulidwe ka systemic lupus erythematosus ndi thiazide diuretics.

Mikardis ndi Mikardis Plus, ngati pakufunika kuthandizira, ingagwiritsidwe ntchito nthawi imodzi ndi othandizira ena a antihypertensive.

Kutha kwa chiwindi poika telmisartan nthawi zambiri kunawonedwa mwa okhala ku Japan.

Kukopa pa kuyendetsa magalimoto ndi kayendedwe kazinthu

Maphunziro apadera azachipatala kuti athe kuwunika momwe mankhwalawa a Mikardis Plus pa kuyendetsa magalimoto ndikugwirira ntchito ndi zida zomwe zimafunikira chidwi chochulukirapo sizinachitike. Komabe, mukamayendetsa galimoto ndikuchita zina zomwe zingakhale zovulaza, mwayi wokhala ndi chizungulire ndi kugona kuyenera kukumbukiridwa, zomwe zimafunikira kusamala.

Kuyanjana kwa mankhwala osokoneza bongo

Ndi munthawi yomweyo telmisartan ndi:

othandizira ena antihypertgency angalimbikitse mphamvu ya antihypertensive. Phunziro limodzi, kugwiritsa ntchito telmisartan ndi ramipril, kuwonjezeka kwa 2,5 kwa AUC0-24 ndi Cmax ya ramipril ndi ramipril. Kufunika kwachipatala pakuyanjanaku sikunakhazikike. Kafukufuku wokhudzana ndi zochitika zoyipa zomwe zimayambitsa kuleka kwa chithandizo ndikuwunika zochitika zoyipa zomwe zimapezeka panthawi yachipatala kudawonetsa kuti kutsokomola ndi angioedema kumachitika kwambiri ndi ramipril, pomwe ochepa hypotension amakhala ponseponse ndi telmisartan. Milandu ya hyperkalemia, kulephera kwaimpso, kusintha kwazowopsa ndi syncope kunawonedwa kwambiri nthawi zambiri pogwiritsa ntchito munthawi yomweyo telmisartan ndi ramipril,
Kukonzekera kwa lithiamu kumawonjezera kuwonjezereka kwa kuchuluka kwa lithiamu m'magazi, limodzi ndi zovuta za poizoni pogwiritsa ntchito ACE zoletsa. Nthawi zina, kusintha kotereku kunanenedwa ndi utsogoleri wa angiotensin 2 receptor antagonists, makamaka telmisartan. Pogwiritsa ntchito munthawi yomweyo kukonzekera kwa lifiyamu ndi angiotensin 2 receptor antagonists, tikulimbikitsidwa kudziwa zomwe zili m'magazi,
nonsteroidal anti-yotupa mankhwala (NSAIDs), kuphatikizapo acetylsalicylic acid mu Mlingo womwe amagwiritsidwa ntchito ngati anti-yotupa, COX-2 inhibitors komanso NSAIDs zosasankha, zimatha kulephera kwaimpso kwa odwala omwe ali ndi BCC yochepetsedwa. Mankhwala omwe amakhudza RAAS amatha kukhala ndi synergistic. Odwala omwe alandila NSAIDs ndi telmisartan, BCC iyenera kulipidwa koyambirira kwa chithandizo ndipo maphunziro a impso ayenera kuchitidwa. Kutsika kwa mphamvu ya ma antihypertensive othandizira, monga telmisartan, kudzera mu chopinga cha vasodilating zotsatira za prostaglandins amadziwika ndi mankhwala ophatikizika ndi NSAIDs. Ndi munthawi yomweyo kugwiritsa ntchito telmisartan ndi ibuprofen kapena paracetamol, palibe zotsatira zazikulu zamankhwala zomwe zapezeka,
digoxin, warfarin, hydrochlorothiazide, glibenclamide, simvastatin ndi amlodipine sizinawululire mgwirizano wachipatala. Kuwonjezeka kwakukulu kwa kuchuluka kwa digoxin m'madzi am'magazi ndi pafupifupi 20% (munthawi imodzi, ndi 39%). Ndi munthawi yomweyo makonzedwe a telmisartan ndi digoxin, ndikofunikira kuti nthawi zina azindikire kuchuluka kwa digoxin m'magazi.

Kugwiritsa ntchito nthawi imodzi ndi:

ethanol (mowa), barbiturates kapena opioid analgesics, pali chiopsezo chokhala ndi orthostatic hypotension,
Hypoglycemic mankhwala akumwa pakamwa ndi insulin ingafune kusintha kwa ma hypoglycemic wothandizila pakamwa ndi insulin,
metformin pali chiopsezo cha lactic acidosis,
kolestiraminom ndi kolestipolom - pamaso pa anionic kusinthana kumapangitsa kuyamwa kwa hydrochlorothiazide kusokonekera,
mtima glycosides amawonjezera chiopsezo cha hypokalemia kapena hypomagnesemia chifukwa cha thiazide diuretics, kukula kwa arrhythmias yoyambitsidwa ndi mtima glycosides,
ma Pressor amines (mwachitsanzo norepinephrine) amatha kufooketsa mphamvu za mabungwe a Pressor,
hydrochlorothiazide yosakhumudwitsa ya minofu (mwachitsanzo tubocurarine chloride) hydrochlorothiazide ingalimbikitse zotsatira za anthu omwe samachepetsa minofu,
antigout othandizira achulukitse kuchuluka kwa uric acid mu seramu yamagazi, motero, kusintha kwa uricosuric wothandizila kungafunike. Kugwiritsa ntchito thiazide diuretics kumawonjezera pafupipafupi kukula kwa hypersensitivity zimachitikira allopurinol,
Kukonzekera kwa kashiamu - thiazide diuretics imatha kukulitsa zowonjezera calcium za seramu chifukwa cha kuchepa kwa zotuluka zake ndi impso. Ngati mukufuna kugwiritsa ntchito kashiamu, muyenera kuyang'anira kuchuluka kwa calcium m'magazi ndipo, ngati kuli kotheka, musinthe makonzedwe a calcium,
beta-blockers ndi diazoxide thiazide diuretics amatha kupititsa patsogolo hyperglycemia yoyambitsidwa ndi beta-blockers ndi diazoxide,
m-anticholinergics (mwachitsanzo, atropine, biperidine) - kuchepa kwa m'mimba motility, kuwonjezeka kwa bioavailability wa thiazide diuretics,
amantadine thiazide okodzetsa achulukitse chiopsezo chosavomerezeka chifukwa cha amantadine,
cytotoxic othandizira (mwachitsanzo, cyclophosphamide, methotrexate) - kuchepa kwa impso excretion wa othandizira a cytotoxic ndi kuwonjezeka kwa mphamvu yanga ya myelosuppressive.
NSAIDs - kuphatikiza ndi thiazide okodzetsa kungayambitse kuchepa kwa diuretic ndi antihypertensive zotsatira,
mankhwala omwe amatsogolera pakutha kwa potaziyamu ndi hypokalemia (mwachitsanzo, okodzetsa omwe amachotsa potaziyamu, mankhwala othandizira, gluco- ndi mineralocorticosteroids, corticotropin, amphotericin B, carbenoxolone, benzylpenicillin, zotumphukira za acetylsalicylic acid) - kuchuluka kwa hypokalemic. Hypokalemia yoyambitsidwa ndi hydrochlorothiazide imathetsedwa ndi mphamvu ya potaziyamu yotulutsa telmisartan,
Kukula kwa hyperkalemia ndikotheka ndi potaziyamu woleketsa okodzetsa, kukonzekera kwa potaziyamu, njira zina zomwe zimatha kuwonjezera zomwe zili mu seramu potaziyamu (mwachitsanzo, heparin) kapena m'malo mwa sodium kolorayidi ndi potaziyamu wamchere. Kuwunikira kwa potaziyamu nthawi zonse m'magazi a m'magazi kumalimbikitsidwa panthawi yomwe mankhwalawa Mikardis Plus amagwiritsidwa ntchito nthawi yomweyo ndi mankhwala omwe angayambitse hypokalemia, komanso mankhwala omwe amatha kuonjezera serum potaziyamu.

Mndandanda wa mankhwala Mikardis

Zofanana muzochitika zamagulu:

Analogs mu pharmacological group (angiotensin 2 receptor antagonists):

Angiakand
Aprovel
Atacand
Blocktran
Vasotens,
Valz
Valsartan
Ma Valsafors,
Valsacor
Hyposart,
Diovan
Zisakar
Ibertan
Irbesartan
Irsar
Wogwirizira
Makandulo
Cardosal
Cardosten
Cardostin
Karzartan
Cozaar
Xarten
Nyanja
Lozap,
Lozarel
Losartan
Lorista
Losacor
Lotor
Mikardis Kuphatikiza,
Naviten
Nortian
Olimestra
Ordiss
Wotsogolera
Presartan
Renicard
Sartavel
Tanidol
Tantordio
Tareg
Muziyamwa
Pano,
Telzap
Telmisartan
Telmista
Telsartan
Firmast
Edarby.

Nambala yolembetsa: P N015387 / 01

Zina zamalonda zamankhwala: Mikardis ®

Dzinalo Lopanda Ntchito Padziko Lonse: telmisartan

Mlingo: mapiritsi

KupangaPiritsi 1 ili:
Zogwira ntchito: - Telmisartan 40 mg kapena 80 mg,
Othandizira: - sodium hydroxide 3.36 mg / 6.72 mg, polyvidone (Kollidon 25) 12 mg / 24 mg, meglumine 12 mg / 24 mg, sorbitol 168.64 mg / 337.28 mg, magnesium stearate 4 mg / 8 mg

Kufotokozera
40 mg mapiritsi
Mapiritsi oyera kapena pafupifupi oyera oblong, mbali imodzi yolembedwa "51H", mbali inayo - chizindikiro cha kampani.
Mapiritsi a 80 mg
Mapiritsi oyera kapena pafupifupi oyera owoneka oyera, mbali imodzi yolemba "52H", mbali inayo - chizindikiro cha kampani.

Gulu la Pharmacotherapeutic: angiotensin II receptor antagonist.
Code ya ATX C09CA07

Mankhwala
Mankhwala
Telmisartan ndi chiwopsezo cha angiotensin II receptor antagonist (mtundu wa AT1), chogwira ntchito ngati chimwedwa pakamwa. Ili ndi kuyanjana kwakukulu kwa AS1 subtype ya angiotensin II receptors, kudzera momwe zochita za angiotensin II zimadziwika. Kuyika angiotensin I kuchokera kulumikizana ndi cholandilira, osakhala ndi zochita za agonist mokhudzana ndi cholandilira ichi.
Telmisartan imamangiriza kokha ku AT1 subtype ya angiotensin II receptors. Kulumikizana ndikupitiliza. Ilibe chiyanjano ndi ma receptor ena, kuphatikizapo AT2 receptor ndi zina zochepa zomwe amaphunzira angiotensin receptors. Kufunika kwa magwiridwe antchito izi, komanso momwe zimakhalira ndikulimbikitsa kwakukulu ndi angiotensin II, kugwiritsidwa ntchito kwa zomwe zimawonjezeka poika telmisartan, sikunaphunzire. Amachepetsa ndende ya aldosterone m'magazi, samalepheretsa renin m'magazi am'magazi ndipo saletsa njira ya ion. Telmisartan sichimalepheretsa angiotensin kutembenuza enzyme (kininase II) (enzyme yomwe imawononganso bradykinin). Chifukwa chake, kuwonjezeka kwa zoyipa zoyambitsidwa ndi bradykinin sikuyembekezeredwa.
Odwala, telmisartan pa mlingo wa 80 mg kwathunthu limalepheretsa hypertensive zotsatira za angiotensin II. Kuyamba kwa hypotensive kanthu kumadziwika mkati mwa maola atatu itatha konzedwe ka telmisartan. Mphamvu ya mankhwalawa imapitilira maola 24 ndipo imakhalabe yofunikira 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).
Pankhani yakuchotsedwa kwadzidzidzi kwa telmisartan, kuthamanga kwa magazi pang'onopang'ono kumabwereranso ku msika wake wopanda chitukuko cha matenda a "kuchoka".

Pharmacokinetics
Ikamamwa pakamwa, imatengedwa mwachangu kuchokera m'mimba. Bioavailability - 50%. Mukamamwa pamodzi nthawi yomweyo ndi chakudya, kuchepa kwa AUC (dera lozunguliridwa ndi nthawi yayitali) kumachokera ku 6% (pa 40 mg) mpaka 19% (pa mlingo wa 160 mg). Pakadutsa maola atatu atatha kumwa, kuchuluka kwa madzi am'magazi kumatha, ngakhale chakudya. Pali kusiyana pamaganizidwe a plasma mwa amuna ndi akazi. Cmax (kuchuluka ndende) ndi AUC anali pafupifupi 3 ndi 2 nthawi, motero, apamwamba mwa akazi poyerekeza ndi abambo popanda phindu lalikulu.
Kuyankhulana ndi mapuloteni am'madzi am'magazi - 99,5%, makamaka ndi albumin ndi alpha-1 glycoprotein.
Mtengo wapakati wamawonekedwe ogajirika m'ndende zofanana ndi 500 malita. Zimapangidwa ndi kuphatikizika ndi glucuronic acid. Ma metabolabolites ndi opanga ma pharmacologic. Kuthetsa theka-moyo (T½) kupitilira maola 20. Amayamwa kudzera m'matumbo osasinthika, zotupa za impso - zosakwana 2%. Chilolezo chonse cha plasma ndichokwera (900 ml / min.) Poyerekeza ndi magazi a "hepatic" (pafupifupi 1500 ml / min.).
Odwala okalamba
Ma pharmacokinetics a telmisartan mwa odwala okalamba samasiyana ndi achinyamata achinyamata. Kusintha kwa Mlingo sikofunikira.
Odwala omwe ali ndi vuto la impso
Kusintha kwa odwala omwe ali ndi vuto la aimpso sikofunikira, kuphatikiza odwala pa hemodialysis.
Telmisartan samachotsedwa ndi hemodialysis.
Odwala omwe ali ndi vuto la chiwindi
Odwala omwe ali ndi chiwindi chochepa komanso chochepa zolimbitsa thupi (kalasi A ndi B pa kukula kwa Mwana), mlingo wa tsiku ndi tsiku sayenera kupitilira 40 mg.
Mu ana
Zizindikiro zazikulu za pharmacokinetics za telmisartan mwa ana a zaka zapakati pa 6 mpaka 18, mwanjira zambiri, zimafananizidwa ndi deta yomwe idapezedwa pochiritsa akuluakulu, ndikutsimikizira kusakhala kwina kwa pharmacokinetics ya telmisartan, makamaka pokhudzana ndi Cmax.

Zizindikiro zogwiritsidwa ntchito

Matenda oopsa.
Kuchepetsa kuchepa kwa mtima ndi kufa kwa odwala azaka 55 ndi akulu omwe ali ndi chiwopsezo chachikulu cha matenda amtima.

Contraindication

Hypersensitivity kwa yogwira mankhwala kapena othandizira zigawo za mankhwala
Mimba
Nthawi yochepetsetsa
Matenda oletsa kuponderezana
Zowopsa za hepatic kuwonongeka (Gulu Lopanda Ana)
Herederal fructose tsankho (lili ndi sorbitol)
Zofika zaka 18 (mphamvu ndi chitetezo sizinakhazikitsidwe)

Ndi chisamaliro

Mgwirizano wamitsempha wamatsenga kapena matenda am'mimba a impso imodzi,
Kuwonongeka kwa chiwindi ndi / kapena impso (onaninso malangizo apadera),
Kutsika kwamagazi kozungulira (BCC) chifukwa cha m'mbuyomu mankhwala othandizira, kutsekeka kwa mchere, kutsegula m'mimba, kapena kusanza
Hyponatremia,
Hyperkalemia
Zokhudza kupatsirana kwa impso (osagwiritsa ntchito),
Kulephera kwamtima kosalekeza
Stenosis wa msempha wa msempha,
Idiopathic hypertrophic subaortic stenosis,
Kuphatikiza kwakukulu kwa aldosteronism (mphamvu ndi chitetezo sichinakhazikitsidwe)

Mlingo ndi makonzedwe
Mkati, ngakhale zakudya.
Matenda oopsa
Mlingo woyamba wovomerezeka wa mankhwala a Mikardis ® ndi 1 tabu. (40 mg) kamodzi patsiku. Muzochitika zomwe achire samakwaniritsa, mulingo woyenera kwambiri wa mankhwalawo Mikardis ® utha kuwonjezeka mpaka 80 mg kamodzi patsiku. 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 kuchepa kwa mtima ndi kufa
Mlingo woyenera ndi piritsi limodzi la mankhwala a Mikardis ® 80 mg, kamodzi patsiku.
Mu nthawi yoyamba ya chithandizo, kuwongolera kowonjezereka kwa magazi kungafunike.
Matenda aimpso
Odwala omwe ali ndi vuto la impso, kuphatikizapo odwala omwe akudwala hemodialysis, kusintha kwa dosing sikofunikira.
Kuwonongeka kwa chiwindi
Odwala omwe ali ndi vuto la chiwindi chochepa kwambiri (kalasi A ndi B pa Child-Pugh, motero), mlingo wa tsiku lililonse wa Mikardis ® sayenera kupitilira 40 mg.
Odwala okalamba
Mlingo wa mankhwalawa sufuna kusintha.

Zotsatira zoyipa
Milandu yomwe idawonedwako idakhudzana ndi chikhalidwe, zaka kapena mtundu wa odwala.
Matenda:
Sepsis, kuphatikizapo kupha sepsis, matenda amkodzo thirakiti (kuphatikizapo cystitis), matenda am'mimba opatsirana kudzera m'mapapo.
Kuchokera kuzomwe zimayendera;
Matendawa, eosinophilia, thrombocytopenia.
Kuchokera ku dongosolo lamanjenje lalikulu:
Kuda nkhawa, kusowa tulo, kukhumudwa, kukomoka.
Kuchokera ziwalo zamawonedwe ndi kumva:
Zosokoneza zowoneka, chizungulire.
Kuchokera pamtima:
Bradycardia, tachycardia, chizindikiro cha kuchepa kwa magazi, orthostatic hypotension
Kuchokera pakapumidwe:
Kupuma pang'ono.
Kuchokera m'mimba:
Kupweteka kwam'mimba, kutsegula m'mimba, kukamwa kowuma, dyspepsia, kusefukira kwam'mimba, kusapeza bwino m'mimba, kusanza, chiwindi ntchito.
Zotsatira zoyipa:
Anaphylactic zimachitika, hypersensitivity kwa yogwira mankhwala kapena wothandiza zigawo za mankhwala, angioedema (wakupha), chikanga, erythema, kuyabwa pakhungu, kuphatikizapo mankhwala), hyperhidrosis, urticaria, poizoni.
Kuchokera ku minculoskeletal system:
Arthralgia, kupweteka kwa msana, kukokana kwa minofu (kukokana kwa minofu ya ng'ombe), kupweteka m'munsi, myalgia, kupweteka kwa tendons (Zizindikiro zofanana ndi chiwonetsero cha tendonitis).
Kuchokera ku impso ndi kwamkodzo thirakiti:
Matenda aimpso, kuphatikizapo kupweteka kwaimpso.
Zambiri:
Kupweteka pachifuwa, matenda ofanana ndi chimfine, asthenia (kufooka), hyperkalemia, hypoglycemia (odwala matenda a shuga).
Zizindikiro zasayansi:
Kuchepa kwa kuchuluka kwa hemoglobin, kuwonjezeka kwa kuchuluka kwa uric acid, creatinine m'magazi, kuchuluka kwa michere ya "chiwindi", kuwonjezeka kwa kuchuluka kwa creatine phosphokinase (CPK).

Bongo
Palibe milandu ya bongo yomwe yapezeka.
Zizindikiro: kuchepa kwa magazi, tachycardia, bradycardia.
Chithandizo: Chithandizo cha ma cell, hemodialysis sichothandiza.

Kuchita ndi mankhwala ena
Telmisartan imatha kuonjezera mphamvu ya ena othandizira. Mitundu ina ya zochitika zamatenda azachipatala sizinadziwikebe. Ntchito zophatikizidwa ndi digoxin, warfarin, hydrochlorothiazide, glibenclamide, ibuprofen, paracetamol, simvastatin ndi amlodipine sizitengera mgwirizano wamphamvu. Kuwonjezeka kwakukulu kwa kuchuluka kwa digoxin m'madzi am'magazi ndi pafupifupi 20% (munthawi imodzi, ndi 39%). Ndi munthawi yomweyo makonzedwe a telmisartan ndi digoxin, ndikofunikira kuti nthawi zina azindikire kuchuluka kwa digoxin m'magazi.
Pogwiritsa ntchito munthawi yomweyo telmisartan ndi ramipril, kuwonjezeka kwa AUC0-24 ndi Cmax ya ramipril ndi ramiprilat kumawonetsedwa nthawi 2.5. Kufunika kwamankhwala pazinthu izi sikunakhazikitsidwe.
Ndi munthawi yomweyo makonzedwe a angiotensin otembenuka enzyme (ACE) zoletsa ndi kukonzekera ma lifiyamu, kuwonjezeranso kusintha kwa ndende ya magaziamu kunawonedwa, limodzi ndi poyizoni. Nthawi zina, zosintha zoterezi zidanenedwa ndi makonzedwe a angiotensin II receptors. Ndi munthawi yomweyo makonzedwe a lithiamu ndi angiotensin II receptor antagonists, tikulimbikitsidwa kudziwa kuchuluka kwa lithiamu m'magazi.
Kuchiza ndi mankhwala osapweteka a anti-yotupa (NSAIDs), kuphatikizapo acetylsalicylic acid, cycloo oxygenase-2 inhibitors (COX-2) ndi NSAIDs zosasankha, zingayambitse kulephera kwa impso kwa odwala opanda madzi. Mankhwala osokoneza bongo omwe amagwiritsa ntchito renin-angiotensin-aldosterone system (RAAS) amatha kukhala ndi synergistic. Odwala omwe alandila NSAIDs ndi telmisartan, bcc iyenera kulipidwa poyambira chithandizo ndikuwonetsa kuyinso.
Kutsika kwa mphamvu ya ma antihypertensive othandizira, monga telmisartan, kudzera mu chopinga cha vasodilating zotsatira za prostaglandins kwawonedwa ndi mgwirizano wa NSAIDs.

Malangizo apadera
Odwala ena, chifukwa cha kuponderezedwa kwa RAAS, makamaka akamagwiritsa ntchito mankhwala osakanikirana ndi dongosololi, ntchito yaimpso (kuphatikizapo kuperewera kwaimpso) imalephera. Chifukwa chake, mankhwalawa ophatikizidwa ndi magawo awiri amtundu wa RAAS amayenera kuchitidwa mosamalitsa komanso kuyang'anira kuwonekera kwa ntchito yaimpso (kuphatikizapo kuwunika kwa serum potaziyamu ndi ma protein a creatinine).
Pankhani yodalira mtima wamatumbo ndi impso ntchito makamaka pa ntchito ya RAAS (mwachitsanzo, odwala omwe ali ndi vuto la mtima, kapena matenda a impso, kuphatikizapo aimpso, a stenosis, kapena artery stenosis a impso imodzi), kusankha mankhwala omwe amakhudza dongosolo lino. akhoza limodzi ndi chitukuko cha pachimake ochepa hypotension, hyperazotemia, oliguria, ndipo, kawirikawiri, kulephera kwambiri aimpso.
Kutengera ndi luso logwiritsa ntchito mankhwala ena omwe amakhudza RAAS, pogwiritsa ntchito mankhwala a Mikardis ® komanso okhathamiritsa osakaniza a potaziyamu, zina za mchere wa potaziyamu, mankhwala ena omwe amalimbikitsa kuchuluka kwa potaziyamu m'magazi (mwachitsanzo, heparin), chizindikirochi chikuyenera kuyang'aniridwa mwa odwala.
Mwinanso, Mikardis ® ikhoza kugwiritsidwa ntchito limodzi ndi thiazide diuretics, monga hydrochlorothiazide, yomwe imathandizanso kwambiri (mwachitsanzo, Mikardis Plus ® 40 mg / 12.5 mg, 80 mg /) 2.5 mg).
Odwala omwe ali ochepa matenda oopsa, mlingo wa telmisartan wa 160 mg / tsiku komanso osakanikirana ndi hydrochlorothiazide 12,5-25 mg anali wololera komanso wogwira ntchito. Mikardis ® ndi yothandiza kwambiri kwa odwala a liwiro la Negroid.

Kukopa pa kuyendetsa galimoto ndikugwira ntchito ndi zinthu
Kafukufuku wapadera wazachipatala wokhudzana ndi momwe mankhwalawo amathandizira poyendetsa galimoto ndi njira sizinachitike. Komabe, mukamayendetsa ndikugwira ntchito zamagetsi, mwayi wokhala ndi chizungulire ndi kugona kuyenera kukumbukiridwa, zomwe zimafunikira kusamala.

Kutulutsa Fomu
Mapiritsi 40 mg ndi 80 mg.
Mapiritsi 7 pa chithuza chilichonse chopangidwa ndi polyamide / aluminium / PVC. 2 kapena 4 matuza okhala ndi malangizo ogwiritsira ntchito pabokosi lamakatoni (pa 40 mg). Kwa matuza a 2, 4 kapena 8 omwe ali ndi malangizo ogwiritsira ntchito pabokosi lamakatoni (pa mulingo wa 80 mg).

Malo osungira
Mndandanda B.
Sungani kutentha osapitirira 30 ° C pamalo otetezedwa ku chinyezi.
Pewani patali ndi ana!

Tsiku lotha ntchito
Zaka 4 Osagwiritsa ntchito tsiku lanu litatha.

Mankhwala Okhala Pamalo a Pharmacy
Ndi mankhwala.

Tchulani ndi adilesi ya bungwe lalamulo lomwe chikalata chake cholembedwa chikuperekedwa
Beringer Ingelheim International GmbH Bingsr Strasse 173,
55216, Ingelheim am Rhein, Germany

Wopanga
Beringer Ingelheim Pharma GmbH & Co.KG
Bingerstrasse 173, 55216 Ingelheim am Rhein, Germany

Mutha kupeza zowonjezera zokhudzana ndi mankhwalawa, komanso kutumiza madandaulo anu ndi zambiri zokhudzana ndi zochitika zotsutsana ndi adilesi yotsatira ku Russia
Beringer Ingelheim LLC 125171, Moscow, 16A Leningradskoye Shosse

Mlingo

Mapiritsi 80 mg / 12,5 mg, 80 mg / 25 mg

Piritsi limodzi lili

ntchito: telmisartan 80 mg

hydrochlorothiazide 12,5 mg kapena 25 mg, motero

zokopa: sodium hydroxide, polyvidone K 25 (povidone), meglumine, sorbitol, magnesium stearate, lactose monohydrate, microcrystalline cellulose, starch, iron (III) red oxide (E172) (Mlingo 80 / 12,5), chitsulo (ІІІ) oxide chikasu (Е172) (Mlingo 80/25), sodium wowuma glycolate (mtundu A).

80 mg / 12,5 mg: mapiritsi okhala ndi mawonekedwe owumbika okhala ndi biconvex, yokhala ndi mbali ziwiri: gawo limodzi ndi loyera ndi "H8" chosindikizidwa ndi logo yamakampani, yovomerezeka yofiyira, ina ndi ya pinki.

80 mg / 25 mg: mapiritsi okhala ndi mawonekedwe ozungulira okhala ndi biconvex, yokhala ndi mbali ziwiri: gawo limodzi loyera ndi pepala la "H9" ndi logo ya kampani, yokhala ndi chikaso chovomerezeka chachikasu, gawo lina ndilachikaso.

Mankhwala

Pharmacokinetics

Kugwiritsa ntchito nthawi imodzimodziyo kwa hydrochlorothiazide ndi telmisartan sikukukhudza pharmacokinetics a mankhwalawa.

Telmisartan: pambuyo pakamwa, telmisartan imatengedwa mwachangu, kuchuluka kwakukulu kwa telmisartan kumafikira maola 0.5-1,5.

Pafupifupi mtheradi bioavailability wa telmisartan pafupifupi 50%. Kudya pang'ono kumachepetsa bioavailability wa telmisartan ndi kuchepa kwa dera pansi pa mapindikira "plasma concentration-time" (AUC) kuchokera 6% mukamamwa mlingo wa 40 mg mpaka 19% mukamamwa mlingo wa 160 mg. Patatha maola atatu mutatenga telmisartan, kuchuluka kwa madzi am'magazi kumakhazikika ndipo sikudalira chakudya. Kutsika pang'ono kwa AUC sikuyambitsa kuchepa kwamankhwala othandizira.

The pharmacokinetics of telmisartan pamene akutengedwa pakamwa si mzere mu Mlingo kuyambira 20 mg mpaka 160 mg ndi kuchuluka kochulukira kopitilira muyeso wa plasma (Cmax ndi AUC) ndi mlingo wowonjezereka. Telmisartan simadziunjikira mumadzi am'magazi kwakukulu ndikugwiritsa ntchito mobwerezabwereza.

Hydrochlorothiazide: Pambuyo pakukonzekera pakamwa, pazipita kuchuluka kwa hydrochlorothiazide kumatheka pafupifupi maola 1,3,3.0 pambuyo pa kuperekedwa. Mtheradi bioavailability wa hydrochlorothiazide pafupifupi 60%.

Telmisartan: ali ndi milingo yambiri yomanga mapuloteni a plasma (> 99.5%), makamaka okhala ndi albumin ndi alpha-1 acid glycoprotein. Kuchuluka kwa magawo ndi 500 malita.

Hydrochlorothiazide: 64% yomangidwa kumapuloteni a plasma ndipo kuchuluka kwake kogawika ndi 0.80.3 l / kg.

Kutetemera ndi chimbudzi

Telmisartan: Pambuyo pakukonzekera kwa pakamwa kwa 14C yokhala ndi telmisartan, ambiri mwa mankhwalawo (> 97%) anathiridwa mu ndowezo pogwiritsa ntchito chimbudzi, ndipo ochepa kwambiri amapezeka mkodzo. Zimapangidwa poyanjanitsa zinthu zoyambira ndi mankhwala osokoneza bongo acylglucuronide, glucuronide yekhayo amene amadziwika ndi anthu.

Pambuyo pa kumwa kamodzi pa 14C yolembedwa telmisartan, glucuronide imapezeka pafupifupi 11% ya placma radioactivity. Ma cytochrome P450 isoenzymes satenga nawo mbali mu metabolism ya telmisartan. Kuchuluka kwa plasma chilolezo cha telmisartan pafupifupi 1500 ml / mphindi, theka la moyo wopitilira maola 20.

Hydrochlorothiazide: mwa anthu, silinapangidwe ndipo limapukusidwa pafupifupi osasinthika mkodzo. Pafupifupi 60% ya mankhwala amkamwa amachotseredwa ngati mankhwala osasintha mkati mwa maola 48. Kuchotsa chilolezo ndi pafupifupi 250-300 ml / min. Hafu yotsiriza ya moyo wa hydrochlorothiazide ndi maola 10-15.

Odwala okalamba: pharmacokinetics ya telmisartan mwa okalamba odwala komanso ochepera zaka 65 sizosiyana.

Okwatirana: plasma ndende ya telmisartan mwa akazi ndi yayitali katatu kuposa amuna. Komabe, m'maphunziro azachipatala kunalibe kuwonjezeka kwakukulu kwa kuthamanga kwa magazi kapena kuchuluka kwa orthostatic hypotension mwa azimayi. Palibe chifukwa chosinthira mlingo. Panali chizolowezi chambiri cha kuchuluka kwa hydrochlorothiazide m'madzi a m'magazi mwa akazi poyerekeza ndi amuna.

Palibe kondwerero yofunika kwambiri ya telmisartan yomwe yapezeka.

Odwala omwe ali ndi vuto la impso

Kuchotsera kwamkati sikukhudza chilolezo cha telmisartan. Kutengera luso la kugwiritsa ntchito mankhwalawa odwala omwe ali ofatsa pang'ono komanso aimpso kulephera (kulengedwa kwa creatinine 30-60 ml / min, pafupifupi 50 ml / min), adawonetsedwa kuti kusintha kwa mlingo sikofunikira kwa odwala omwe ali ndi kuchepa kwa aimpso. Telmisartan sichimapukusidwa panthawi ya hemodialysis. Odwala ndi mkhutu aimpso ntchito, mlingo wa kuthetsedwa kwa hydrochlorothiazide amachepetsa.

Pakufufuza kwa odwala omwe ali ndi chilengedwe cha creatinine chilolezo cha 90 ml / min, theka la moyo wa hydrochlorothiazide lidakulitsidwa. Odwala omwe ali ndi impso yosagwira ntchito, kuchotsa hafu ya moyo kumakhala pafupifupi maola 34.

Odwala omwe ali ndi vuto la chiwindi

Odwala omwe ali ndi vuto la chiwindi, pali kuwonjezeka kwathunthu kwa bioavailability mpaka 100%. Hafu ya moyo sikusintha ndi kulephera kwa chiwindi.

Mankhwala

MIKARDIS Plus ndi kuphatikiza kwa angiotensin II receptor antagonist - telmisartan ndi thiazide diuretic - hydrochlorothiazide. Kuphatikiza kwa zinthuzi kumapereka mphamvu ya antihypertensive kwambiri kuposa kutenga gawo lililonse palokha. Kulandila kwa MIKARDIS Plus kamodzi patsiku la mankhwala othandizira kumathandizira kutsika kwamphamvu kwa magazi.

Telmisartan: Ndi othandizira komanso osankhika (amasankha) angiotensin II receptor antagonist (mtundu wa AT1). Telmisartan yokhala ndi digiri yapamwamba kwambiri yopanga mgwirizano imangokhala ndi AT1 subtype, angiotensin II receptors. Telmisartan ilibe chiyanjano ndi ma receptor ena, kuphatikizapo AT2 - angiotensin receptors, ndi ena, osaphunzira kwambiri, AT receptors. Kufunika kwa magwiridwe antchito izi, komanso momwe zimakhalira ndikulimbikitsa kwakukulu ndi angiotensin II, kugwiritsidwa ntchito kwa zomwe zimawonjezeka poika telmisartan, sikunaphunzire.

Telmisartan imatsogolera kuchepa kwa milingo ya aldosterone. Telmisartan siimaletsa renin mu plasma ya anthu ndipo siimaletsa mayendedwe a ion. Telmisartan sikuletsa ntchito ya angiotensin kutembenuza enzyme (kinase II), ndi kutenga nawo gawo komwe kumachepa kaphatikizidwe ka bradykinin. Chifukwa chake, palibe kuwonjezereka pazotsatira zoyambitsidwa ndi bradykinin.

Odwala, telmisartan pa mlingo wa 80 mg pafupifupi kwathunthu limalepheretsa hypertensive zotsatira za angiotensin II. Mphamvu yoletsa kupitirira imatha maola 24 ndipo imakhalabe yofunikira mpaka maola 48.

Mutatenga mlingo woyamba wa telmisartan, ntchito ya antihypertgency imayamba kuonekera pakapita maola atatu. Kutsika kwakukulu kwa kuthamanga kwa magazi kumatheka pang'onopang'ono masabata 4 pambuyo poyambira chithandizo ndikusungidwa kwanthawi yayitali.

Odwala omwe ali ndi matenda oopsa, telmisartan amachepetsa kuthamanga kwa magazi ndi diastolic popanda kusintha kugunda kwa mtima.

Mphamvu ya antihypertensive ya telmisartan imafanana ndi magulu ena a antihypertensive mankhwala (monga momwe akuwonetsera mu maphunziro azachipatala kuyerekezera telmisartan ndi amlodipine, atenolol, enalapril, hydrochlorothiazide, losartan, lisinopril, ramipril, ndi valsartan).

Pankhani ya telmisartan yadzidzidzi, magazi amayenda pang'onopang'ono pamankhwala osafunikira kwa masiku angapo popanda chizindikiro cha kuyambiranso kwa matenda oopsa (palibe "kuchoka").

M'maphunziro azachipatala ndikuyerekeza mwachindunji mitundu iwiri ya chithandizo cha antihypertensive, kuchuluka kwa chifuwa chouma mwa odwala omwe akutenga telmisartan kunali kotsika kwambiri poyerekeza ndi omwe amalandira angiotensin-converting enzyme inhibitors.

Hydrochlorothiazide: ndi thiazide okodzetsa. Makina a antihypertensive zotsatira za thiazide diuretics sakudziwika kwathunthu. Thiazides amachita mogwirizana ndi aimpso tachulukidwe ka electrolyte reabsorption, kukulitsa zowonjezera zotulutsa za sodium ndi chloride pafupifupi zofanana. Mphamvu ya diuretic ya hydrochlorothiazide imachepetsa kuchuluka kwa plasma, kumawonjezera ntchito ya plasma, kumawonjezera katemera wa aldosterone, kutsatiridwa ndi kuwonjezeka kwa potaziyamu ndi bicarbonate mu mkodzo ndi kuchepa kwa seramu potaziyamu. Kutha kutsirizika-kutsika-blockade kwa renin-angiotensin-aldosterone dongosolo mukaphatikizidwa ndi telmisartan kumapangitsa kuti kutembenuka kwa potaziyamu kosakanikirana ndi ma diuttics.

Mukamamwa hydrochlorothiazide, kuwonjezeka kwa diuresis kumawonedwa pambuyo pa maola awiri, mphamvu yayikulu imachitika pambuyo pa maola pafupifupi 4, pomwe nthawi yakuchita ili pafupifupi maola 6-12.

Kafukufuku wa Epidemiological awonetsa kuti chithandizo cha nthawi yayitali ndi hydrochlorothiazide chimachepetsa chiopsezo cha kuchepa kwamtima ndi kufa kwa iwo.

Mlingo ndi makonzedwe

MIKARDIS Plus imatengedwa kamodzi patsiku ndi madzi pang'ono.

Mukasintha kuchokera ku telmisartan kupita ku MIKARDIS Plus, mlingo wa telmisartan ukhoza kuchulukiratu. Kusintha kwachindunji kuchokera ku monotherapy kupita ku kuphatikiza mankhwala ndikotheka.

MIKARDIS Plus 80 mg / 12.5 mg imatha kuperekedwa kwa odwala omwe kugwiritsa ntchito telmisartan (MIKARDIS) 80 mg sikuchepetsa kuthamanga kwa magazi.

MIKARDIS Plus 80 mg / 25 mg imatha kuperekedwa kwa odwala omwe kugwiritsa ntchito MIKARDIS Plus 80 mg / 12,5 mg sikuthandizira kuthamanga kwa magazi kapena kwa odwala omwe chikhalidwe chawo kale chimakhazikika ndi telmisartan kapena hydrochlorothiazide akamagwiritsa ntchito mosiyana.

Mulingo wambiri wa antihypertensive nthawi zambiri umatheka mkati mwa masabata 4-8 pambuyo poyambira chithandizo.

Ngati ndi kotheka, MIKARDIS Plus ikhoza kuphatikizidwa ndi mankhwala ena a antihypertensive.

Odwala omwe ali ndi vuto lalikulu kwambiri lamankhwala oopsa, telmisartan mu Mlingo mpaka 160 mg tsiku lililonse (makapisozi awiri a MIKARDIS 80 mg) kapena osakanikirana ndi hydrochlorothiazide 12,5-25 mg patsiku (makapisozi awiri a MIKARDIS Plus 80 mg / 12,5 mg kapena 80 mg / 25 mg) anali wololera bwino komanso wogwira ntchito.

MIKARDIS Plus imatha kutengedwa mosasamala kanthu za chakudya.

Chifukwa cha kukhalapo kwa MIKARDIS Plus hydrochlorothiazide pakukonzekera, sikuyenera kutumizidwa kwa odwala omwe amalephera kwambiri aimpso