Mankhwala a Telzap 40: malangizo ogwiritsira ntchito

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

Piritsi limodzi lili:

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

Mankhwala

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

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

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

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

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

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

Pharmacokinetics

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

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

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

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

Kukula kwakukulu komwe kumaoneka ndi magawo 500.

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

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

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

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

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

Telmisartan siwotsimikizika ndi hemodialysis.

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

Zizindikiro zogwiritsidwa ntchito

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

Contraindication

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

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

Telzap, malangizo ogwiritsira ntchito: njira ndi mlingo

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

Kuchulukana kwa kumwa mankhwalawa ndi 1 nthawi patsiku.

Mlingo wovomerezeka watsiku ndi tsiku:

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

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

Kuti muchepetse matenda aimpso pang'ono, kusintha sikofunikira.

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

Zotsatira zoyipa

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

Bongo

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

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

Kugwiritsa ntchito hemodialysis ndikosatheka.

Malangizo apadera

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

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

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

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

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

Ndi hyperaldosteronism yoyamba, kugwiritsa ntchito mankhwalawa sikuthandiza.

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

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

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

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

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

Mimba komanso kuyamwa

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

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

Mndandanda wamalingaliro ndi kufanana kwa Telzap

Telpres (mapiritsi) → mawu ofanana: 29 Pamwamba

Analogue ndiotsika mtengo kuchokera ku ma ruble a 77.

Wopanga: -
Kutulutsa Mafomu:

Mapiritsi, 20 mg, No. 28

Mtengo wa Telpres m'masitolo ogulitsa: kuyambira 187 rubles. mpaka 855 rub. (Zopereka 795)
Telpres (tanthauzo) - yopangidwa ku Spain ndi Kupro. Ili ndi chinthu chomwe chikugwiranso ntchito ngati telzap. Amagwiritsidwa ntchito kwa odwala omwe ali ndi matenda oopsa, komanso kwa anthu omwe ali pachiwopsezo cha mtima wamatenda a atherothrombotic chiyambi (ischemic stroke, chosakhalitsa kuwukira, kuchepa kwamitsempha, matenda am'mitsempha yam'munsi yam'mphepete) awo oyambira pakuletsa, kuchepetsa kulumala ndi kufa kwa matenda awa. Amagwiritsidwa ntchito popewa kupanikizika kwachiwiri kwa mtima komanso kukula kwa ischemia yachiwiri kwa odwala omwe ali ndi intracerebral hemorrhage. Zochitika zoyipa zimatha kukhala ngati zotupa pakhungu ndi kuyabwa, angioedema, anaphylactic zimachitika, chifuwa chowuma, mseru, kusanza, mkamwa, kupweteka komanso m'mimba, kutsika magazi, chizungulire, kufooka, kuchuluka kwa transaminases, urea ndi creatinine, kuchepa magazi, thrombocytopenia. Singagwiritsidwe ntchito kulekerera, kutsekeka kwa biliary thirakiti, hypotension, impso ndi chiwindi, kulephera kwamkati, anthu osakwana zaka 18, azimayi amene ali ndi mwana ndi amayi oyamwitsa.

Analogue ndiotsika mtengo kuchokera ku ma ruble 70.

Lorista ndi analogue, wopanga ndi kampani ya Slovenia KRKA ndi ofesi yoyimira Russia ku KRKA-RUS. Amapangidwa ngati mapiritsi mu chipolopolo cha 12.5 mg (No. 30), 25 mg (No. 30), 50 mg (No. 30, 60 ndi 90) ndi 100 mg (No. 30, 60 ndi 90). Imalepheretsa zolandilira za AT1 za angiotensin-2, kuletsa mapangidwe a angiotensin-2 kuchokera ku angiotensin-1, potero kutsekeka kwa vasoconstrictor mphamvu ya angiotensin a mtundu wachiwiri. Mankhwalawa amachepetsa kuthamanga kwa magazi, osakhudza kugunda kwa mtima. Amagwiritsidwa ntchito popangira matenda oopsa, komanso kuchepetsa chiopsezo cha matenda amtima komanso atherothrombotic subtype ya ischemic stroke mwa anthu omwe akuyembekezeka kupezeka ndi matenda awa, okhala ndi chotupa cha intracranial hemorrhage kuti atseke kuphipha kwa mitsempha, yomwe imatsogolera kukula kwa mkhalidwe wa wodwalayo. Imwani mankhwalawa kamodzi patsiku. Zitha kuyambitsa ziwopsezo, kukomoka, kukomoka, kuperewera ndi chiwindi, kufooka, chizungulire, kusintha kwamkati wamagazi, hyperkalemia, kupweteka kwa minofu. Contraindicated vuto la tsankho, hypotension, kwambiri matenda a chiwindi ndi impso, ana, amayi apakati ndi mkaka wa m`mawere.

Telsartan (mapiritsi) → mawu ofanana: 17 Up

Analogue ndiyotsika mtengo kuchokera ku ma ruble 14.

Wopanga: -
Kutulutsa Mafomu:

Mapiritsi, 40 mg, No. 30

Mtengo wa Telsartan m'masitolo ogulitsa: kuchokera ku 232 rubles. mpaka 556 rub. (Zopereka 577)
Telsartan ndi mawu ofanana achimwenye otanthauza telzap. Kutulutsa mawonekedwe - mapiritsi a 40 ndi 80 mg (No. 30). Ndi osokoneza okonda a angiotensin-2 receptors. Amagwiritsidwa ntchito kwa odwala omwe ali ndi matenda oyamba (ofunika) ochepa matenda oopsa, komanso anthu azaka zopitilira 55 omwe ali ndi chiopsezo chachikulu cha zovuta zamtima zamatenda a atherothrombotic chifukwa choteteza kuwonongeka koyambirira komanso mobwerezabwereza kwa kubadwa kwa myocardial infarction ndi ischemic, kuukira kwakanthawi kochepa, matenda owopsa malekezero apansi, kuchepetsa mwayi wa kulumala ndi kufa kwa matenda awa. Amagwiritsidwa ntchito kwambiri mu machitidwe a minyewa ndi mitsempha yopanga mozungulira patali komanso zowopsa m'mitsempha yoteteza matumbo a chithokomiro, zomwe zimatsogolera kukula kwa mkhalidwe wa wodwalayo. Kugwiritsa ntchito mankhwala kumatsutsana pokhapokha ngati hypersensitivity ikupanga, magawo omwe amatsutsana ndi hypotension, a revenue artery stenosis kapena a impso artery stenosis a impso imodzi, ndi aimpso komanso a hepatic insuffence, kutsekeka kwa chotupa, panthawi ya pakati ndi poyamwitsa, kwa ana ndi achinyamata.

Analogue ndiokwera mtengo kwambiri kuchokera ku ma ruble 6.

Telmista (mawu ofanana ndi Telzap) - amapangidwa ku Slovenia pamapiritsi a 40 mg (No. 28 ndi 30) ndi 80 mg (No. 28). Zomwe zimagwiranso ntchito ndi telmisartan. Makina ochitapo kanthu ali ofanana ndi omwe ali pamwambapa. Piritsi limodzi amatengedwa kamodzi patsiku pamaphunziro atali. Amagwiritsidwa ntchito mwa odwala omwe ali ndi vuto lalikulu kwambiri la matenda oopsa komanso mwa anthu omwe ali pachiwopsezo cha matenda amtima (atagundidwa ndi mtima, sitiroko, matenda owonongera a ziwiya zam'munsi) chifukwa cha kupewera kwawo koyambirira komanso kwachiwiri, kuchepetsa kulumala ndi kufa kwa matenda awa. Amagwiritsidwa ntchito mwa odwala omwe ali ndi matenda am'mimba kuti ateteze yachiwiri vasoconstriction m'derali komanso necrosis yamitsempha yamaubongo kuzungulira hemorrhage. Mukamamwa mankhwalawa, thupi limatulutsa, chifuwa, matenda ngati chimfine, kukomoka, kufooka, chizungulire, kufooka, kusokonezeka kwa magazi, kupweteka kwaimpso komanso chiwindi, edema imatha kuchitika.

Analogue ndiokwera mtengo kwambiri kuchokera ku ma ruble 227.

Edarbi - analogue ya Telzap, imapangidwa ku Denmark, Japan, Ireland ndi USA pamapiritsi a 40 ndi 80 mg (No. 28). Chomwe chimagwira ndi azilsartan. Imalepheretsa ma angiotensin-2 receptors, kuletsa ntchito ya renin-angiotensin-aldosterone, yomwe imayambitsa mphamvu ya antihypertensive. Amagwiritsidwa ntchito mwa odwala omwe ali ndi matenda oopsa (ofunikira), anthu omwe ali ndi vuto lalikulu la mtima chifukwa chopewa koyambirira komanso kwachiwiri, komanso kuchepetsa chiopsezo cha kulumala ndi kufa kwa matendawa. Amagwiritsidwa ntchito chifukwa cha hemorrhagic stroke komanso zoopsa zamitsempha yamagazi yoteteza kutulutsa kwachiwiri kwa chotupa cha ziwongo. Zotsatira zoyipa (nthawi zambiri zimakhala zofatsa kapena zolimbitsa thupi) zimatha kukhala ngati thupi siligwirizana, kuperewera kwa chizungulire, chizungulire, kufooka, kuchuluka kwa CPK kwa magazi, hypotension, edema ya m'miyendo, ntchito yowonjezera ya chiwindi, urea, ndi creatinine transaminases. Chotsutsana pa kugwiritsa ntchito mankhwalawa ndi tsankho lake, makonzedwe a aliskiren ndi ACE zoletsa odwala omwe ali ndi matenda osokoneza bongo, ubwana ndi unyamata, kutenga pakati komanso kuyamwa.

Analogue ndiokwera mtengo kwambiri kuchokera ku ma ruble 249.

Mikardis (mawu ofanana ndi Telzap) ndi mankhwala achi Germany opangidwa m'mapiritsi a 40 mg (No. 14 ndi 28) ndi 80 mg (No. 28). Ili ndi chinthu chofanana ndi telzap komanso magwiritsidwe ofanana. Amagwiritsidwa ntchito pochiza matenda oopsa a m'magazi, komanso kuchepetsa chiopsezo cha matenda amtima (monga mtima wamatenda, matenda amitsempha, kuphulika kwa matenda ashericrombotic, matenda opatsirana a minyewa, ndi zina zotere). kulemala ndi kufa kwa matenda. Amagwiritsidwanso ntchito ngati hemorrhagic stroke, spontaneous subarachnoid hemorrhage komanso traumatic intracranial hemorrhage popewa yachiwiri ya vasospasm, yomwe imayambitsa kupangika kwa gawo la necrosis m'deralo pafupi ndi hemorrhagic kuyang'ana ndikupangitsa kuwonjezeka kwa kuchepa kwa mitsempha ndi kuwonjezereka kwa mkhalidwe wa wodwalayo. Simungagwiritse ntchito mankhwalawa chifukwa cha tsankho lake, kusokonezeka kwamitsempha yama mtima, matenda a chiwindi ndi impso, mayiko omwe ali ndi vuto la impso, komanso kuwonongeka kwa matenda a shuga komanso Aisk inhibitors ndi aliskiren, osalolera, ana ndi achinyamata.

Mlingo

Piritsi limodzi lili

ntchito: telmisartan 40,000 kapena 80,000 mg, motero,

hydrochlorothiazide 12.500 mg kapena 25,000 mg, motero,

zokopa: sorbitol, sodium hydroxide, povidone 25, magnesium stearate

Mapiritsi okhala ndi mawonekedwe okhala ndi biconvex kuyambira oyera mpaka achikasu, ndipo nambala yowerengeka "41" mbali imodzi ya piritsi, pafupi 12 mm kutalika ndi pafupi 6 mm mulifupi (Mlingo wa 40 mg / 12,5 mg).

Mapiritsi okhala ndi mawonekedwe olimbirana ndi biconvex kuchokera oyera mpaka achikasu, ndipo mbali imodzi ya phale, kutalika kwa 16.5 mm, pafupi 8.3 mm mulifupiMlingo wa 80 mg / 12,5 mg).

Mapiritsi okhala ndi mawonekedwe okongola ndipo ali ndi biconvex kuyambira oyera mpaka achikasu, ndipo dzina lake limakhala ngati "82" mbali imodzi ya phale, pafupi 16 mm kutalika, pafupifupi 8 mm mulifupi (Mlingo wa 80 mg / 25 mg).

Mankhwala

Pharmacokinetics

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

Telmisartan: Pambuyo pakukonzekera kwa pakamwa, kutsikira kwa telmisartan kumachitika pambuyo pa maola 0.5 - 1.5. Mtheradi wa bioavailability wa telmisartan pa mlingo wa 40 mg ndi 160 mg ndi 42% ndi 58%, motero. Mukamamwa telmisartan nthawi yomweyo ndi chakudya, kuchepa kwa AUC (dera lozunguliridwa ndi nthawi yoponderezedwa) 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. Kutsika pang'ono kwa AUC sikuyambitsa kuchepa kwamankhwala othandizira. The pharmacokinetics ya telmisartan ya pakamwa silinelinear pa Mlingo wa 20-160 mg ndi kuchuluka kopitilira muyeso wama plasma (Cmax ndi AUC) omwe ali ndi mlingo wowonjezeka. Palibe kondwerero yofunika kwambiri ya telmisartan yomwe yapezeka.

Hydrochlorothiazide: Pambuyo pakumwa kwa Telzap Plus, kuchuluka kwa kutsika kwa hydrochlorothiazide kumafika pafupifupi maola 1.0 mpaka 3.0 mutamwa mankhwalawo. Kutengera ndi kuchuluka kwa aimpso a hydrochlorothiazide, mtheradi wa bioavailability ndi pafupifupi 60%.

Telmisartan imagwira mapuloteni a plasma (ochulukirapo 99.5%), makamaka okhala ndi albumin ndi alpha-1-acid glycoprotein. Voliyumu yogawa ndi pafupifupi 500 L, zomwe zikuwonetsa kuti zomangamanga zina zimangiriza.

Hydrochlorothiazide 68% yomangidwa kumapuloteni a plasma ndipo kuchuluka kwa magawo ndi 0.83 - 1.14 l / kg.

Telmisartan zimapukusidwa ndi kuphatikizika kwa mapangidwe a cellacologic acylglucuronide. Glucuronide wa gulu la makolo ndiye metabolite yokhayo yomwe yadziwika mwa anthu. Pakupanga kamodzi kwa 14C yokhala ndi telmisartan, glucuronide ili pafupifupi 11% ya placma radioactivity. Cytochrome P450 ndi isoenzymes satenga nawo mbali mu metabolism ya telmisartan.

Hydrochlorothiazide osati zimapukusidwa mwa anthu

Telmisartan: Pambuyo pakutsatira kapena pakamwa makonzedwe a 14C olembedwa telmisartan, kuchuluka kwa mankhwalawo (> 97%) kumathandizidwa mu ndowe kudzera mwa biliary excretion. Ma voliyumu ang'onoang'ono anapezeka mumkodzo.

Kuchuluka kwa plasma chilolezo cha telmisartan pambuyo pakamwa kwamlomo ndi> 1500 ml / min. The terminal half-life ndi> maola 20.

Hydrochlorothiazide chakumwirira osasinthika mkodzo. Pafupifupi 60% ya mankhwala amkamwa amatulutsidwa mkati mwa maola 48. Kuchotsa chilolezo ndi pafupifupi 250 - 300 ml / min. The theka-terminal moyo ndi maola 10 mpaka 15.

Odwala okalamba

Ma pharmacokinetics a telmisartan siosiyana mwa anthu okalamba komanso odwala ochepera zaka 65.

Plasma wozungulira telmisartan ndi okwera 2-3 kuposa akazi kuposa amuna. M'maphunziro azachipatala, panalibe kuwonjezeka kwakukulu pakuyankha kwa kuthamanga kwa magazi kapena kuchuluka kwa orthostatic hypotension mwa azimayi. Kusintha kwa Mlingo sikofunikira. Njira yodziwika yozama kwambiri ya plasma ya hydrochlorothiazide imawonedwa mwa akazi kuposa amuna. Zilibe tanthauzo la chipatala.

Odwala omwe ali ndi vuto la impso

Kuchotsera kwamkati sikukhudza chilolezo cha telmisartan. Malinga ndi zotsatira za kusadziwa pang'ono ndi Telzap Plus mwa odwala omwe amachepetsa kwambiri aimpso (creatinine chilolezo cha 30-60 ml / mphindi, pafupifupi mtengo wa pafupifupi 50 ml / min), kusintha kwa mankhwalawa sikofunikira kwa odwala omwe ali ndi kuchepa kwa aimpso. Telmisartan samachotsedwa magazi ndi 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 ndi hepatic kusowa, kutsimikizika bioavailability wa telmisartan ukuwonjezeka mpaka 100%. Hafu ya moyo wa chiwindi kulephera sasintha.

Farmakodinamika

Telzap Plus ndi kuphatikiza kwa angiotensin II receptor antagonist (ARAII), telmisartan, ndi thiazide diuretic, hydrochlorothiazide. Kuphatikizidwa kwa zinthuzi kumakhala ndi mphamvu yowonjezera ya antihypertensive, kutsitsa kuthamanga kwa magazi kwakukulu kwambiri kuposa gawo lirilonse lokha. Telzap Plus ikagwiritsidwa kamodzi patsiku imabweretsa kutsika kwamagazi koyenda bwino komanso kosavuta.

Telmisartan ndi wogwira mtima komanso wosankha (wosankha) angiotensin II receptor antagonist (mtundu wa AT1) wowongolera pakamwa. Telmisartan yokhala ndi mawonekedwe ofanana kwambiri angiotensin II kuchokera m'malo ake omangika mu subtype 1 (AT1), omwe ali ndi chifukwa cha angiotensin II. Telmisartan siziwonetsa zochitika zilizonse zogwirizana ndi AT1 receptor. Telmisartan mosankha imamangirira ku receptor ya AT1. Kumangirira ndikutalika. Telmisartan siziwonetsa kuyanjana kwa receptor ena, kuphatikizapo AT2 receptor ndi ena, sanaphunzire 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 imachepetsa plasma aldosterone, sichiletsa renin mu plasma ya anthu ndi njira za ion.

Telmisartan sikulepheretsa puloteni ya angiotensin (kinase II), yomwe imachepetsa kupanga bradykinin. Chifukwa chake, palibe kukonzekera kwa mavuto omwe amabwera chifukwa cha bradykinin.

Mlingo wa 80 mg wa telmisartan, woperekedwa kwa odzipereka athanzi, pafupifupi amalepheretsa kuchuluka kwa mavuto omwe amabwera chifukwa cha angiotensin II. Mphamvu ya inhibitory imapitilira maola opitilira 24 (mpaka maola 48).

Mutatenga mlingo woyamba wa telmisartan, kuthamanga kwa magazi kumachepa pambuyo pa maola atatu. Kutsika kwakukulu kwa kuthamanga kwa magazi, monga lamulo, kumakwaniritsidwa masabata 4-8 pambuyo poyambira mankhwalawa ndikupitilira chithandizo cha nthawi yayitali.

Mphamvu ya antihypertgency imatha kwa maola 24 mutatha kumwa mankhwalawa, kuphatikiza maola 4 musanamwe mlingo wotsatira, womwe umatsimikiziridwa ndi kuchuluka kwa magazi, komanso kukhazikika kwa mankhwala (pamwamba 80%) pazakuchepera komanso kuzama kwa mankhwala mutatenga 40 ndi 80 mg ya telmisartan maphunziro azachipatala.

Odwala omwe ali ndi matenda oopsa, telmisartan imachepetsa kuthamanga kwa magazi kwa systolic ndi diastolic popanda kukhudza kugunda kwa mtima. Mphamvu ya antihypertensive ya telmisartan imafanana ndi oimira magulu ena a mankhwala a antihypertensive (monga momwe akuwonetsera mu maphunziro azachipatala kuyerekezera telmisartan ndi amlodipine, atenolol, enalapril, hydrochlorothiazide, ndi lisinopril).

M'mayeso azachipatala owongoleredwa kawiri (N = 687 omwe adayesedwa kuti agwire bwino ntchito), anthu omwe sanayankhe pazomwe 80 mg / 12.5 mg adawonetsa pang'onopang'ono kutsitsa kuthamanga kwa magazi kwa kuphatikiza kwa 80 mg / 25 mg poyerekeza ndi chithandizo cha nthawi yayitali ndi mlingo. 80 mg / 12.5 mg 2.7 / 1.6 mmHg (SBP / DBP) (kusiyana kwakasintha kwaposachedwa koyambira). Pakafukufuku wophatikizidwa wa 80 mg / 25 mg, kuthamanga kwa magazi kunachepa, zomwe zimapangitsa kuchepa kwathunthu kwa 11.5 / 9.9 mmHg. (GARDEN / DBP).

Kuwunikira kwakukulu kwa masabata awiri ofanana a 8-masabata awiri, akhungu oyesedwa ndi placebo poyerekeza valsartan / hydrochlorothiazide 160 mg / 25 mg (N = 2121 odwala omwe adawunikidwa kuti agwire bwino ntchito) adawonetsa kuwongolera kuthamanga kwa magazi a 2.2 / 1,2 mm Hg . (SBP / DBP) (kusiyana kosinthika kumatanthauza kusintha kochokera pamizere, motsatana) m'malo mwa kuphatikiza kwa telmisartan / hydrochlorothiazide 80 mg / 25 mg.

Pambuyo pakuchotsa lakuthwa kwa mankhwalawa ndi telmisartan, kuthamanga kwa magazi pang'onopang'ono kumabwereranso ku mtengo wake woyamba masiku angapo popanda chizindikiro cha "rebound" matenda oopsa.

M'maphunziro azachipatala kuyerekezera mwachindunji chithandizo chachiwiri, kuchuluka kwa chifuwa chouma kunachepetsedwa kwambiri mwa odwala omwe amalandila telmisartan kuposa omwe amalandila eni

Kafukufuku wa PRoFESS wochitidwa mwa odwala omwe ali ndi zaka zopitilira 50 omwe ali ndi matenda opha ziwonetsero akuwonetsa kuchuluka kwa sepsis ndi telmisartan poyerekeza ndi placebo, 0.70% poyerekeza ndi 0.49% OR 1.43 (95% chidule pakudzikhulupirira 1.00 - 2.06), kufala kwa ma sepsis kunali kokwanira kwambiri kwa odwala omwe amatenga telmisartan (0.33%) poyerekeza ndi odwala omwe akutenga placebo (0.16%) AU 2.07 (95% chidaliro chopitilira 1.14 - 3.76). Kuwonjezeka kwa chiwonetsero cha sepsis komwe kumagwiritsidwa ntchito ndi telmisartan kungakhale kwachilendo kapena kungagwirizanitsidwe ndi makina omwe sakudziwika pakali pano.

Mavuto a telmisartan paimfa ndi matenda a mtima sizikudziwika mpaka pano. Hydrochlorothiazide ndi thiazide okodzetsa. Makina a antihypertensive zotsatira za thiazide diuretics sakudziwika kwathunthu. Thiazides amakhudzanso impso njira za kupatsanso ma elekitiroma mu ma tubules, kukulitsa zowonjezera zotulutsa za sodium ndi chloride m'njira zofanana. Mphamvu ya diuretic ya hydrochlorothiazide imachepetsa kuchuluka kwa plasma, kumawonjezera ntchito ya plasma, kumawonjezera katulutsidwe ka aldosterone, kenako ndikuwonjezereka kwa potaziyamu mumkodzo, kutayika kwa bicarbonate ndi kuchepa kwa seramu potaziyamu. Mwina kudzera mu blockade ya renin-angiotensin-aldosterone system, mgwirizano wa telmisartan, monga lamulo, kumalepheretsa kutayika kwa potaziyamu komwe kumakhudzana ndi okodzetsa awa. Mukamagwiritsa ntchito hydrochlorothiazide, kuyambika kwa diuresis kumachitika pambuyo pa maola awiri, ndipo kupendekera kumachitika pambuyo pa maola pafupifupi 4, pomwe mphamvuyo imapitirira pafupifupi maola 6-12.

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

Mlingo ndi makonzedwe

Mapiritsi a Telzap Plus amapangidwira kuti azigwiritsidwa ntchito pakamwa, ngakhale atamwa kwambiri, amatengedwa kamodzi patsiku ndipo amayenera kutsukidwa ndi madzi.

Telzap Plus imaperekedwa kwa odwala omwe kuthamanga kwa magazi ake sikuwongolera mokwanira ndi telmisartan monotherapy. Kutengeka kwa gawo limodzi la magawo awiriwa kumalimbikitsidwa musanayambe kuphatikiza kwa mankhwala osakanikirana. Potengera kuchipatala, kusintha kwachindunji kuchokera ku monotherapy kupita ku kuphatikiza kokhazikika kungaganizidwe.

Telzap Plus 40 mg / 12.5 mg imatha kutengedwa kamodzi patsiku kwa odwala omwe magazi awo samayendetsedwa mokwanira ndi 40 mg telmisartan monotherapy.

Telzap Plus 80 mg / 12.5 mg imatha kutengedwa kamodzi patsiku kwa odwala omwe magazi awo samayendetsedwa mokwanira ndi telmisartan monotherapy 80 mg.

Telzap Plus 80 mg / 25 mg imatha kutengedwa kamodzi patsiku kwa odwala omwe magazi awo samayendetsedwa moyenera akamagwiritsa ntchito Telzap Plus 80 / 12,5 mg kapena kwa odwala omwe magazi awo atakhazikika kale pa telmisartan ndi hydrochlorothiazide padera.

Gwiritsani ntchito mwa okalamba

Kusintha kwa Mlingo sikofunikira.

Odwala omwe ali ndi vuto la impso

Kuyang'anira ntchito za impso kumalimbikitsidwa (onani "Malangizo Apadera")

Odwala omwe ali ndi vuto la chiwindi

Odwala omwe ali ndi vuto lochepa kwambiri la hepatic, mulingo sayenera kupitirira Telzap Plus 40 mg / 12,5 mg kamodzi patsiku. Telzap Plus sichisonyezedwa kwa odwala omwe ali ndi vuto la chiwindi kwambiri. Thiazides ayenera kugwiritsidwa ntchito mosamala odwala omwe ali ndi vuto la chiwindi (onani gawo "Malangizo apadera").

Chitetezo ndi kuyendetsa bwino kwa Telzap Plus mwa ana ndi achinyamata ochepera zaka 18 sizinakhazikitsidwe. Zambiri sizipezeka

Mu vuto laimpso

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

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

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

Kuti muchepetse matenda aimpso pang'ono, kusintha sikofunikira.

Zofunikira pa Hypertension

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

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

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

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

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

Mtima Kupewa matenda

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

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

Zogulitsa

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

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

Kupenda

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

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

Ndi chisamaliro

Mankhwala a Telzap ayenera kuthandizidwa mosamala pazinthu zotsatirazi:

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

Matenda oopsa

Mlingo woyamba wa Telzap ndi piritsi 1 (40 mg) kamodzi patsiku. Mwa odwala ena, 20 mg patsiku imatha kukhala yothandiza. Mlingo wa 20 mg ungapezeke mwa kugawa piritsi la 40 mg pakati pangozi. Muzochitika zomwe achire samakwaniritsa, muyezo wa Telzap mutha kupititsidwa mpaka 80 mg kamodzi patsiku.

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

Odwala ndi mkhutu aimpso ntchito

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

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

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

Odwala omwe ali ndi vuto la chiwindi

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

Mimba

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

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

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

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

Nthawi yoyamwitsa

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

Zotsatira zoyipa

Pogwiritsa ntchito mankhwala Ordiss, zovuta zimatheka:

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

Kuyanjana kwa mankhwala osokoneza bongo

Ndi kugwiritsa ntchito pamodzi kwa telmisartan ndi digoxin, kuchuluka kwa Cmax kwa digoxin m'madzi amwazi ndi 49% ndi Cmin ndi 20%. Kumayambiriro kwa chithandizo, posankha mtundu wa mankhwala ndi kusiya kumwa mankhwala ndi telmisartan, kuchuluka kwa digoxin m'madzi a m'magazi kuyenera kuyang'aniridwa mosamala kuti pakhale njira yochizira.

Ma blockade apawiri a RAAS

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

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

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

Hyperkalemia

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

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

Kuwonongeka kwa chiwindi

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

Kutsika kwamagazi kozungulira (BCC)

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

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

Zina zomwe zimagwirizana ndi kukondoweza kwa RAAS

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

Ndi chiwindi ntchito

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

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

Zotsatira pa kuthekera koyendetsa magalimoto

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