Momwe mungagwiritsire ntchito Tritace Plus?

Mankhwala Ramiprilat, metabolite yogwira ya ramipril, amalepheretsa pulotidyl carboxypeptidase I ya enzyme (ma syonms: angiotensin kutembenuza enzyme, kininase II). Mu plasma ndi minofu, enzyme iyi imathandizira kusintha kwa angiotensin I kukhala yogwira vasoconstrictor chinthu (vasoconstrictor) angiotensin II, komanso kuwonongeka kwa vasodilator bradykinin. Kuchepetsa mapangidwe a angiotensin II ndikulepheretsa kuwonongeka kwa bradykinin kumabweretsa kukulitsa kwamitsempha yamagazi.
Popeza angiotensin II imathandizanso kumasulidwa kwa aldosterone, kubisala kwa aldosterone kumachepetsedwa chifukwa cha ramiprilat. Kuwonjezeka kwa ntchito ya bradykinin, mwachiwonekere, kumatsimikiza mtima ndi zotsatira za endothelioprotective zomwe zimawonedwa poyeserera nyama. Lero sizikudziwika momwe izi zimakhudzira kukhazikitsidwa kwa zovuta zina (mwachitsanzo, chifuwa chosasangalatsa).
ACE inhibitors ndi othandiza ngakhale kwa odwala omwe ali ndi matenda oopsa, omwe kuchuluka kwa renin m'madzi a m'magazi kumakhala kotsika. Kuyankha kwapakati pa ACE inhibitor monotherapy kwa odwala omwe ali ndi mtundu wa Negroid (omwe nthawi zambiri amakhala ndi anthu omwe amakhala ndi matenda oopsa komanso oyerekeza a renin) anali ochepa poyerekeza ndi oimira mafuko ena.
Kutenga ramipril kumayambitsa kuchepa kwakukulu kwa kukana kwa mitsempha. Mwambiri, kusintha kwa impso komanso kuchuluka kwa kusefera kwa madzi sikukusintha kwenikweni.
Kukhazikitsidwa kwa ramipril kwa odwala omwe ali ndi matenda oopsa kumabweretsa kuchepa kwa kuthamanga kwa magazi mu supine ndi maimidwe, popanda kukula kochokera pamtima.
Odwala ambiri, mphamvu ya antihypertensive pambuyo pakumwa limodzi pakanthawi kochepa imawonekera pambuyo pa maola 1-2.Ukuluku wambiri wa mlingo umodzi umatheka pambuyo pa maola 3 mpaka 6 ndipo nthawi zambiri umatha maola 24.
Upamwamba wa antihypertensive kwambiri ndi chithandizo cha nthawi yayitali ndi ramipril umawonedwa pambuyo pa masabata 3-4. Zinawululidwa kuti ndi chithandizo cha nthawi yayitali chimapitilira zaka ziwiri.
Poyankha kufinya kwamphamvu kwa ramipril, palibe kuwonjezeka kwadzidzidzi kwa magazi.
Kafukufuku wa AIRE adawonetsa kuti odwala omwe ali ndi matenda a mtima ofooka, chithandizo chomwe adayamba patatha masiku atatu mpaka 10 pambuyo poti pachimake chikuwoneka bwino, ramipril adachepetsa chiopsezo cha kufa ndi 27% poyerekeza ndi placebo. Subanalysis idawonekeranso kuchepa kwa ngozi zina, kuphatikizapo chiwopsezo cha kufa mwadzidzidzi (pofika 30%) komanso chiwopsezo cha matenda kupitilira kukula kwa kugunda kwamtima / kosalekeza (mwa 23%). Kuphatikiza apo, kufunikira kwa kugonekedwa m'chipatala pambuyo pake chifukwa cha kulephera kwa mtima kumachepa ndi 26%.
Odwala omwe alibe odwala matenda ashuga kapena matenda ashuga nephropathy, ramipril amachepetsa kukula kwa impso ndi kuyambika kwa gawo lotsiriza la impso, ndipo chifukwa chake, kufunika kwa dialysis kapena kupatsirana kwa impso. Odwala omwe alibe shuga kapena matenda ashuga oyamba ndi nephropathy, ramipril amachepetsa kuchulukitsidwa kwa albumin.
Kafukufuku wolembedwa ndi a HOPE wolumikizidwa ndi placebo (Pulogalamu Yoteteza Mtima pa Zotsatira za Kuteteza Mtima), womwe wakhala zaka 5, anali ndi odwala azaka 55 ndi akulu omwe anali ndi chiwopsezo cha mtima chifukwa cha matenda amitsempha (monga matenda a m'matumbo a coronary artery, mbiri ya matenda otupa kapena matenda otumphukira) kapena matenda a shuga, okhala ndi vuto limodzi lowonjezera (microalbuminuria, matenda oopsa, kuchuluka kwambiri Cholesterol, cholesterol yotsika HDL, kusuta). Odwala 4645 kuwonjezera pa mankhwala omwe amagwiritsidwa ntchito ndi ramipril pazolinga za prophylactic. Kafukufukuyu adawonetsa kuti ramipril, yokhala ndi kuchuluka kwakukulu kwa mawerengero, adachepetsa kupezeka kwa myocardial infarction, stroko, kapena kufa mtima. Kuphatikiza apo, ramipril imachepetsa kufa kwathunthu komanso kutuluka kwa kufunikira kwa kusinthanso, komanso kuchedwetsa kuyambira ndi kupitilira kwa mtima wongogundika. Ramipril amachepetsa chiopsezo chokhala ndi nephropathy mwa anthu ambiri komanso odwala matenda ashuga. Ramipril amachepetsa kwambiri kuchuluka kwa microalbuminuria. Zotsatira zotere zimawonedwa kwa odwala omwe ali ndi matenda oopsa komanso a standardotension.
Pharmacokinetics A presystemic metabolism of the prodrug, ramipril, amapezeka m'chiwindi, chifukwa chomwe metabolite ramiprilat imodzi imapangidwa (ndi hydrolysis, yomwe imachitika makamaka m'chiwindi). Kuphatikiza pa kutsegulidwa kotereku ndikupanga kwa ramiprilat, ramipril imadutsa glucuronidation ndikusintha kukhala ramipril diketopiperazine (ether). Ramiprilat imapangidwanso glucuronidated ndikusinthidwa kukhala ramiprilat diketopiperazine (acid).
Zotsatira za kutseguka / kagayidwe kazakumwa, pafupifupi 20% ya ramipril yomwe imayamwa pakanapezekanso bioavava.
The bioavailability wa ramiprilat pambuyo m`kamwa makonzedwe a 2,5 ndi 5 mg wa ramipril pafupifupi 45%, poyerekeza kupezeka pambuyo iv makonzedwe omwewo.
Pambuyo pakamwa 10 mg ya ramipril cholembedwa chokhala ndi ma radioactive, pafupifupi 40% ya cholembera yonse imachotsedwamo ndowe ndipo pafupifupi 60% mumkodzo. Pambuyo m`kamwa makonzedwe a 5 mg a ramipril kwa odwala a kukhetsa kwa ndulu ducts, pafupifupi ofanana kuchuluka kwa ramipril ndi metabolites ake anapatsidwa woyamba maola 24 ndi mkodzo ndi bile.
Pafupifupi 80 mpaka 90% ya metabolites mu mkodzo ndi bile ndi ramiprilat kapena ramiprilat metabolites. Ramipril glucuronide ndi ramipril diketopiperazine akaunti pafupifupi 10 mpaka 20% ya kuchuluka, ndi unmetabolised ramipril pafupifupi 2%.
M'maphunziro a nyama, ramipril adapezeka kuti akupita mkaka wa m'mawere.
Ramipril amatengeka mwachangu pambuyo pakukonzekera pakamwa. Monga momwe adakhazikitsira poyesa kuchuluka kwa cholembera mu mkodzo, chomwe chimangowonetsa njira imodzi yothetsera, mayamwidwe a ramipril si ochepera 56%. Kutenga ramipril ndi chakudya sikunawonetse phindu lalikulu la mayamwidwe.
Kuchuluka kwa plasma ndende ya ramipril kumatheka 1 ora pambuyo pakamwa. Hafu ya moyo wa ramipril imakhala pafupifupi ola limodzi. Kuchuluka kwa ramiprilat mu plasma kumachitika pakati pa 2 ndi 4 mawola atamwa.
Kuchepa kwa kuchuluka kwa ramiprilat mu plasma kumachitika m'njira zingapo. Nthawi yoyamba magawo oyamba kugawa ndikuchotsa ndi pafupifupi maola 3. Zitatha izi, pali gawo losinthika (lomwe limakhala ndi pafupifupi maola 15), kenako gawo lomaliza, pomwe magwiridwe a madzi a ramiprilat ndi otsika kwambiri, ndi nthawi pafupifupi masiku 4-5.
Kukhalapo kwa gawo lotsiriza chifukwa chodzipatula pang'onopang'ono kwa ramiprilat kuchokera ku ubale wapafupi koma wokhazikika ndi ACE.
Ngakhale gawo lomaliza lomaliza, atatha kumwa kamodzi pa ramipril pa 2,5 mg kapena kuposerapo, malo osasunthika (pomwe plasma ndende ya ramiprilat imakhalabe yofikira) imatha pambuyo pafupifupi masiku anayi. Pambuyo mobwerezabwereza makonzedwe, theka la moyo, kutengera mlingo, ndi maola 13 mpaka 17.
Kafukufuku wa in vitro awonetsa kuti kuletsa kosalekeza kwa ramiprilat ndi 7 mmol / L, ndipo nthawi yakusagwirizana ndi ramiprilat ndi ACE ndi maola 10.7, omwe akuwonetsa ntchito yayikulu.
Kumangidwa kwa ramipril ndi ramiprilat ku mapuloteni a seramu kuli pafupi 73 ndi 56%, motsatana.
Mwa anthu athanzi azaka zapakati pa 65-76, kinetics za ramipril ndi ramiprilat ndi zofanana ndi zomwe zimachitika mwa achinyamata athanzi.
Ndi mkhutu waimpso, mawonekedwe a ramiprilat ndi impso amachepa, chilolezo cha impso cha ramiprilat chimachepa molingana ndi chilolezo cha creatinine. Izi zimapangitsa kukulira kwa plasma ya ramiprilat, yomwe imachepetsa pang'onopang'ono kuposa anthu omwe ali ndi vuto laimpso.
Ndi kuyambitsidwa kwa Mlingo wambiri (10 mg) ndi kuchepa kwa chiwindi, kutembenuka kwa ramipril kukhala ramiprilat kumachitika pambuyo pake, kuchuluka kwa madzi a ramipril kumawonjezeka ndipo kuwonjezeka kwa ramiprilat kumachepetsa.
Monga mwa anthu athanzi labwino komanso odwala matenda oopsa, pambuyo pakukonzekera kwa 5 mg ya ramipril kamodzi patsiku kwa masabata awiri odwala omwe ali ndi vuto la mtima wosakhazikika, palibe chidwi chachikulu cha ramipril ndi ramiprilat.
Zambiri zotetezera. Zotsatira za mayeso oyesa mayeso zimawonetsa kusapezeka kwa ngozi iliyonse kwa anthu malinga ndi maphunziro omwe amapezeka paziwopsezo zamankhwala otetezedwa, poyizoni wokhala ndi Mlingo wambiri, genotoxicity, carcinogenicity.

Zisonyezero zogwiritsira ntchito mankhwala Tritace

AH (ochepa matenda oopsa), ndi cholinga chochepetsera kuthamanga kwa magazi monga monotherapy kapena kuphatikiza othandizira ena a antihypertensive, mwachitsanzo, okodzetsa ndi odana ndi calcium.
Kulephera kwa mtima kwamphamvu, komanso kuphatikiza okodzetsa.
Kulephera kwamtima kwambiri masiku owerengeka atayamba kupweteka kwambiri.
Kusagwirizana ndi matenda ashuga kapena matenda ashuga kapena poyambirira nephropathy.
Kuchepetsa chiopsezo cha kupha misempha yam'mimba, matenda amisempha, kapena mtima wamtima mwa odwala omwe ali ndi chiwopsezo cha mtima chifukwa cha matenda amtima (ndi chiwopsezo cha mtima (microalbuminuria, matenda oopsa, cholesterol okwanira, cholesterol yotsika ya HDL, kusuta).

Kugwiritsa ntchito mankhwala Tritace

Mlingo umakhazikitsidwa molingana ndi mphamvu ndi kulolerana kwa mankhwalawa kwa odwala ena.
Mapiritsi a Tritace ayenera kumezedwa ndi madzi okwanira (pafupifupi 1/2 chikho). Mapiritsi sayenera kutafunidwa kapena kuphwanyidwa.
Chakudya sichikhudza kwambiri mayamwidwe a ramipril. Chifukwa chake, Tritace imatha kudyedwa musanadye chakudya.
Chithandizo cha matenda oopsa (ochepa matenda oopsa).
Mlingo woyenera wokhazikitsidwa kwa akuluakulu: 2.5 mg Tritace kamodzi patsiku.
Kutengera kutengera kwa wodwala, mlingo umatha kuchuluka. Ndikulimbikitsidwa kuti mukulitse mlingowo pochulukitsa milungu iwiri iliyonse.
Mulingo woyenera wokonza: 2.5 mpaka 5 mg Tritace patsiku.
Mulingo wololedwa tsiku lililonse kwa akulu: 10 mg Tritace.
Njira ina yowonjezerera mlingo wa oposa 5 mg wa Tritace patsiku imakhala njira yowonjezerapo, mwachitsanzo, okodzetsa kapena okodzetsa calcium.
Chithandizo cha mtima kulephera.
Mlingo woyambira wokhazikitsidwa ndi akuluakulu: 1.25 mg Tritace 1 nthawi patsiku.
Kutengera ndikuyankha kwa wodwalayo, mlingowo ungakulidwe ndikuwuchulukitsa pakadutsa milungu iwiri iliyonse. Ngati mlingo wofunikira uli 2,5 mg wa Tritace kapena kupitilira apo, utha kutengedwa ngati gawo limodzi kapena logawidwa pawiri.
Pazipita tsiku mlingo: 10 mg Tritace.
Chithandizo pambuyo myocardial infarction.
Mlingo woyenera wopangidwira: 5 mg Tritace patsiku, wogawika mu 2 Mlingo wa 2,5 mg, mlingo umodzi umatengedwa m'mawa ndi enawo madzulo. Ngati wodwalayo salola mlingo woyambirira, mlingo wa 1.25 mg 2 kawiri pa tsiku kwa masiku awiri umalimbikitsidwa.
Kenako, kutengera kutengera kwa wodwalayo, mlingowo ungakulidwe. Ndikulimbikitsidwa kuti mukulitse mlingowo pochulukitsa masiku 1 mpaka atatu.
M'tsogolomu, mlingo wa tsiku ndi tsiku, womwe umagawidwa pawiri, utha kumwa kamodzi.
Pazipita tsiku mlingo: 10 mg Tritace.
Zochitika pothandiza odwala omwe ali ndi vuto lalikulu (kalasi IV, NYHA - New York Heart Association) kulephera kwa mtima pambuyo pokhazikika kwa myocardial sikokwanira. Pankhani yogwiritsa ntchito Tritace ya mankhwala, tikulimbikitsidwa kuti muyambitse mankhwala omwe ali ndi mankhwala ochepetsa kwambiri tsiku ndi tsiku (1.25 mg wa Tritace kamodzi patsiku) ndipo kuwonjezeraku kulikonse kuyenera kuchitika mosamala kwambiri.
Chithandizo cha matenda ashuga kapena omwe alibe matenda ashuga.
Mlingo woyambira wokhazikitsidwa ndi akuluakulu: 1.25 mg Tritace 1 nthawi patsiku.
Kutengera kulolera kwa wodwalayo ku mankhwalawo, mlingo umatha kupitilira muyeso wokonzanso, womwe ndi 5 mg wa Tritace 1 nthawi patsiku.
Mlingo pamwambapa 5 mg wa Tritace kamodzi patsiku sunaphunziridwe mokwanira panthawi yoyesedwa.
Pofuna kuchepetsa chiopsezo cha kufa myocardial infrction, stroke, kapena mtima.
Mlingo woyenera wokhazikitsidwa ndi akuluakulu: 2,5 mg Tritace 1 nthawi patsiku.
Kutengera kulolera kwa wodwala kwa mankhwalawo, mlingo umatha kuwonjezeka pang'onopang'ono. Ndikulimbikitsidwa kuwonjezeranso kawiri mlingo pambuyo pa sabata limodzi la chithandizo, ndipo pakatha milungu itatu - muonjezere mpaka muyeso wa 10 mg Tritace kamodzi patsiku.
M'mayeso azachipatala olamulidwa, kugwiritsa ntchito mlingo wa 10 mg wa Tritace kamodzi patsiku sikunaphunzire kokwanira.
Kugwiritsa ntchito kwa odwala omwe ali ndi vuto lalikulu laimpso ndi creatinine chilolezo cha ≤36 ml / min sikunaphunziridwe mokwanira.
Ambiri odwala.
Odwala ndi mkhutu aimpso ntchito.
Ngati creatinine chilolezo chimakhala 50-20 ml / mphindi pa 1.73 mamilimita awiri m'thupi, nthawi yayitali munthu wamkulu wa 1.25 mg wa Tritace amagwiritsidwa ntchito. Mlingo wapamwamba tsiku lililonse pamenepa ndi 5 mg Tritace.
Odwala omwe sanapatsidwe ma elekitirodi osachepera thupi, odwala matenda oopsa oopsa (ochepa matenda oopsa), komanso odwala omwe lingaliro loopsa lingayambitse chiwopsezo china (mwachitsanzo, ndi stenosis yofunika kwambiri yamitsempha yamagazi kapena chithokomiro, njira yochepetsera yoyambirira iyenera kugwiritsidwa ntchito 1 , 25 mg Tritace patsiku.
Odwala kale ankachitira ndi okodzetsa.
Ndikofunika kusiya kumwa okodzetsa m'masiku awiri mpaka atatu kapena, kutengera nthawi yomwe okonzanso aukodzetsa, ngakhale kale, asanayambe chithandizo ndi Tritace, kapena kuchepetsa mlingo wa okodzetsa. Mlingo woyambirira wa tsiku ndi tsiku wa odwala akuluakulu omwe adagwiritsa ntchito diuretic nthawi zambiri amakhala 1.25 mg Tritace.
Odwala omwe ali ndi vuto la chiwindi.
Kuyankha kwa chithandizo kumatha kuwonjezera kapena kuchepetsedwa. Chifukwa chake, chithandizo cha odwala awa chiyenera kuyambitsidwa moyang'aniridwa mosamala ndi madokotala. Mlingo wapamwamba wa tsiku lililonse kwa akulu ndi 2.5 mg Tritace.
Anthu okalamba.
Mlingo woyambirira uyenera kukhala wotsika - 1.25 mg Tritace patsiku.

Zotsatira pa kugwiritsa ntchito mankhwala Tritace

Hypersensitivity to ramipril, inhibitor wina wa ACE kapena aliyense mwa omwe amapanga mankhwala,
mbiri ya angioedema,
a impso artery stenosis (mayiko kapena a m'mitsempha stenosis ya impso imodzi),
hypotensive kapena hemodynamically zinthu zosakhazikika,
chachikulu hyperaldosteronism,
nthawi yapakati
Nthawi yonyamula mkaka
zaka za ana.

Pewani kugwiritsa ntchito Tritace kapena zoletsa zina za ACE kuphatikiza njira zochiritsira zakunja, zomwe zingayambitse kulumikizana kwa magazi ndi mawonekedwe olakwika, chifukwa pamakhala chiopsezo chokhala ndi anaphylactoid reaction, yomwe nthawi zina imatha kudzetsa kwambiri anaphylactic.
Chifukwa chake, mukatenga Tritace, ndizosatheka kuchita dialysis kapena hemofiltration pogwiritsa ntchito polyacrylonitrile, sodium-2-methylsulfonate nembanemba yokhala ndi zochitika zapamwamba kwambiri (mwachitsanzo, "AN 69") ndi njira ya LDL apheresis pogwiritsa ntchito dextran sulfate.

Zotsatira zoyipa za Tritace ya mankhwala

Popeza Tritace ndi antihypertensive othandizira, zotsatira zake zoyipa ndizotsatira zake zowonjezera, zomwe zimapangitsa kukonzanso kusintha kwa adrenergic kapena organ hypoperfusion. Zotsatira zina zambiri (mwachitsanzo, kuchuluka kwa ma elekitirodi, ma anaphylactoid kapena zotupa zochokera mucous membrane) zimayambitsidwa ndi ACE zoletsa kapena zotsatira zina zamankhwala za kalasi iyi yamankhwala.
Mtima ndi mantha machitidwe.
Pafupipafupi, zingayambitse kuchepa kwake, zimayamba kuchitika, monga kupweteka mutu, kusayenda bwino, kufooka, kugona, kugona, chizungulire, kapena kuchepa kwa mayankho.
Kutengeka modekha ndi zizindikiro, monga zotumphukira za edema, kuzimiririka, chizungulire, kusinja kwa thukuta, kutopa, kusakhazikika, kupsinjika, kupsinjika, kuda nkhawa, kusawona bwino, kuvutika kugona, chisokonezo, kuda nkhawa, kudutsa kuchepa kwa thupi, kumva Kuchita thukuta, thukuta kwambiri, kuwonongeka kwa makutu, kugona, kapena mawonekedwe a orthostatic, komanso zimachitika zambiri monga angina pectoris, arrhythmias yamtima komanso kusazindikira.
Hypotension yayikulu imachitika kawirikawiri, ischemia ya myocardial kapena chithokomiro, kuchepa kwaposachedwa kwa ischemic, ischemic stroke, kuwonjezereka kwa kusokonezeka kwa mitsempha komwe kumachitika chifukwa cha mtima wa stenosis, kuwonjezeka kwa chiwonetsero chazachipatala cha zochitika za Raynaud kapena paresthesia zimawonedwa padera.
Impso ndi electrolyte bwino.
Nthawi zina pamakhala kuchuluka kwa urea ndi serum creatinine (kuthekera kumawonjezeka ndi kugwiritsa ntchito ma okosijeni) komanso kuwonongeka mu ntchito ya impso, munthawi zina kungayambike - kukulitsa kulephera kwa impso.
Nthawi zina, seramu potaziyamu ndende ikhoza kuchuluka. Pazinthu zokhazokha, kuchuluka kwa seramu sodium kumatha kuchepa, komanso proteinuria yomwe ilipo imatha kuwonjezeka (ngakhale kuti ACE inhibitors nthawi zambiri imayambitsa kutsika kwa proteinuria) kapena kuwonjezeka kwa mkodzo (chifukwa cha ntchito yamtima yabwino).
Machitidwe opatsirana, anaphylactic / anaphylactoid ndi khungu.
Nthawi zambiri pamakhala chifuwa chowuma (chosabereka). Khunyu ili limakonda kuvuta usiku komanso nthawi yopuma (mwachitsanzo, ikagona), ndipo nthawi zambiri imapezeka mwa azimayi ndi anthu omwe sasuta.
Pafupipafupi, kuchulukana kwammphuno, sinusitis, bronchitis, bronchospasm, ndi dyspnea zimayamba.
Nthawi zambiri, mapiritsi a apacquologic angatedurotic angawonedwe (angioedema oyambitsidwa ndi ACE inhibitors amapezeka pafupipafupi kwa odwala a liwiro la Negroid poyerekeza ndi odwala amitundu ina). Zotsatira zamtunduwu ndi zina zosakhudzana ndi mankhwala anaphylactic kapena anaphylactoid zimachitika ku ramipril kapena mbali zina zilizonse ndizosowa kwambiri.
Zimachitika pakhungu kapena mucous nembanemba, monga totupa, kuyabwa, kapena ming'oma sikuchita bwino. Nthawi zina, kugunda kwa maculopapular chikhalidwe, pemphigus, kuchulukitsa kwa psoriasis, psoriasiform, pemphigoid kapena licentiid exanthema ndi enanthema, erythema multiforme, Stevens-Johnson syndrome, poermal necrolysis, alopecia, onycholysis kapena chithunzicholism.
Momwe zimachitikira komanso kuopsa kwa anaphylactic ndi anaphylactoid zimachitika poizoni waukali panthawi yaoletsa kukula kwa ACE. Amakhulupirira kuti zoterezi zimatha kuonedwa poyerekeza ndi mitundu ina yonse ya matendawa.
M'mimba, chiwindi.
Nthawi zambiri, nseru, kuchuluka kwa ma seramu michere ya chiwindi ndi / kapena bilirubin, komanso cholestatic jaundice. Nthawi zina, pakamwa pouma, kusokoneza, kusokoneza m'mimba, kupweteka kwa epigastric, kugaya chakudya m'mimba, kudzimbidwa, kutsegula m'mimba, kusanza, ndi kuchuluka kwa michere ya pancreatic. Nthawi zina, kapamba kapena kuwonongeka kwa chiwindi (kuphatikizapo kuperewera kwa chiwindi) kumayamba.
Hematologic zimachitikira.
Nthawi zina, pamatha kuchepa - muzochitika zina zazikulu - kuchepa kwa maselo ofiira am'magazi ndi hemoglobin, kuchuluka kwa maselo oyera am'magazi kapena mapulateleti. Nthawi zina, agranulocytosis, pancytopenia ndi kupsinjika kwa m'mafupa zimawonedwa.
Hematological zochita za zochita za ACE zoletsa zambiri amapezeka odwala omwe ali ndi vuto laimpso, makamaka ndi concomitant collagenoses (mwachitsanzo, systemic lupus erythematosus kapena scleroderma), kapena odwala omwe amagwiritsa ntchito mankhwala ena omwe angayambitse kusintha kwa magazi.
Nthawi zina, hemolytic anemia imayamba.
Zotsatira zina zoyipa.
Nthawi zambiri, conjunctivitis imatha kuchitika, komanso nthawi zina minyewa yam'mimba, kutsika kwa libido, kusowa kwa chilimbikitso ndi kununkhika kwakamaso (mwachitsanzo, kulawa kwazitsulo mkamwa) kapena pang'ono, nthawi zina kwathunthu, kutaya kulawa.
Nthawi zina, vasculitis, myalgia, arthralgia, malungo ndi eosinophilia, komanso kuchuluka kwa ma antibodies a antiinodar.

Malangizo apadera ogwiritsira ntchito mankhwala a Tritace

Tritace iyenera kugwiritsidwa ntchito moyang'aniridwa ndi dokotala.
Odwala omwe amathandizidwa ndi ACE zoletsa, milandu ya angioedema ya nkhope, miyendo, milomo, lilime, glottis kapena pharynx. Chithandizo chodzidzimutsa cha angioedema chowopseza moyo chimaphatikizapo kuyendetsa kwapadera kwa epinephrine (sc kapena pang'onopang'ono iv) motsatana ndi ECG komanso kuwongolera kuthamanga kwa magazi. Kugonekedwa kuchipatala kumalimbikitsidwa, kuyang'anira wodwala kwa maola osachepera 12 mpaka 24, mpaka zizindikirocho zitatha.
Odwala omwe amathandizidwa ndi ACE zoletsa, milandu ya angioedema yamatumbo imawonedwa. Odwala awa adadandaula za kupweteka kwam'mimba (ndi kusanza kapena kusanza), ndipo nthawi zina angioedema a nkhope amapezekanso. Zizindikiro za angioedema wamatumbo zinazimiririka atasiya kuyimitsa ACE.
Palibe chithandizo chokwanira ndi Tritace cha ana, odwala omwe ali ndi vuto la impso (creatinine chilolezo pansipa 20 ml / mphindi pa 1.73 m2 ya thupi padziko), komanso odwala omwe ali ndi dialysis.
Odwala omwe akuwonjezera ntchito ya renin-angiotensin. Mankhwala a odwala omwe akuwonjezera ntchito ya renin-angiotensin, kusamalidwa kwapadera kuyenera kuchitika. Mwa odwala, pamakhala chiwopsezo cha kuchepa kwadzidzidzi komanso kwakukulu kwa kuthamanga kwa magazi komanso kuwonongeka kwa impso chifukwa cha kuletsa kwa ACE, makamaka ngati ACE inhibitor kapena concomitant diuretic imalembedwa koyamba kapena koyamba pa mlingo wapamwamba. Kumayambiriro kwa mankhwala osokoneza bongo kapena kuwonjezeka kwa mlingo, kuyang'anira magazi moyenera kuyenera kuchitika mpaka pakuwopseza kuchepa kwambiri kwa magazi.
Ntchito yowonjezera ya renin-angiotensin ingayembekezeredwe, makamaka:

Odwala kwambiri, makamaka oopsa matenda oopsa. Mu gawo loyambirira la chithandizo, chithandizo chapadera chachipatala chimafunikira,
Odwala omwe ali ndi vuto lalikulu la mtima kapena ngati amathandizidwa ndi mankhwala ena omwe amachepetsa kuthamanga kwa magazi. Ngati vuto la mtima lakulephera koyambirira kwamankhwala, kuyang'aniridwa kwachipatala ndikofunikira,
Odwala omwe ali ndi hemodynamically kwambiri zovuta mu kulowerera kapena kutuluka kwa magazi kuchokera kumanzere kwamitsempha yamafuta (mwachitsanzo, aortic stenosis kapena mitral valve stenosis kapena hypertrophic cardiomyopathy). Mu gawo loyambirira la chithandizo, muyenera kuyang'aniridwa mosamalitsa,
Odwala hemodynamically kwambiri aimpso mtsempha wamagazi stenosis. Mu gawo loyambirira la chithandizo, kuyang'aniridwa kwakanthawi kachipatala ndikofunikira.

Pangakhale kofunikira kuti muimitse mankhwala oyamba ndi diuretics:

odwala omwe kale anali okodzetsa. Ngati discontinuation kapena kuchepetsedwa kwa okodzetsa sikutheka, kuyang'aniridwa kwakanthawi kachipatala ndikofunikira pakumayambiriro kwa chithandizo,
Odwala omwe ali ndi vuto kapena osakwanira mu electrolyte bwino (chifukwa chosakwanira kudya kwamadzi kapena mchere, kapena chifukwa cha kutaya kwawo - kutsegula m'mimba, kusamba kapena thukuta lowonjezera, m'malo omwe kubwezeredwa chifukwa chosowa madzi ndi mchere sikokwanira).

Kuwongolera mkhalidwe wamatenda am'madzi, Hypovolemia kapena kuchepa kwa electrolyte musanalandire chithandizo (komabe, kwa odwala omwe ali ndi vuto la mtima, njira zowongolera zotere ziyenera kuwunikiridwa mosamala pokhudzana ndi chiopsezo cha kuchuluka kwambiri). M'mikhalidwe yofunika kwambiri yachipatala, chithandizo cha Tritace chitha kuyamba kapena kupitilizidwa kwinaku mukuchita zoyenera kuti muchepetse kuthamanga kwa magazi ndi kuchepa kwa impso.
Odwala omwe ali ndi vuto la chiwindi.
Odwala omwe ali ndi vuto la chiwindi, mayankho ku chithandizo cha Tritace akhoza kuchuluka kapena kuchepetsedwa. Kuphatikiza apo, mwa odwala omwe ali ndi vuto lalikulu la chiwindi ndi edema ndi / kapena ascites, zochitika za renin-angiotensin dongosolo zimatha kuwonjezeka kwambiri, chifukwa chake, chisamaliro chapadera chiyenera kuchitidwa panthawi ya odwala.
Odwala omwe kuchepa kwakukulu kwa kuthamanga kwa magazi kumabweretsa chiopsezo (mwachitsanzo, odwala omwe ali ndi vuto la mitsempha ya mitsempha kapena mitsempha ya m'magazi), kuyang'aniridwa kwamankhwala kofunikira ndikofunikira pakuyamba kwa chithandizo,
Okalamba.
Mu okalamba, momwe machitidwe a ACE zoletsa angatchulidwire. Kumayambiriro kwa chithandizo chawo, kuyesedwa kwa aimpso kumalimbikitsidwa.
Ndikulimbikitsidwa kuwunikira ntchito yaimpso, makamaka masabata oyamba omwe mumalandira chithandizo ndi ACE inhibitor. Kuyang'anira makamaka ndikofunikira kwa odwala omwe ali ndi:

kulephera kwa mtima
matenda a vasorenal, kuphatikiza odwala hemodynamical kwambiri unilateral aimpso mtsempha wamagazi. Mu gulu lomaliza la odwala, ngakhale kuwonjezeka pang'ono kwa serum creatinine kungasonyeze kuchepa kwa ntchito yaimpso,
kuchepa kwa impso,
anaika impso.

Kuwongolera moyenera electrolyte.
Ndikulimbikitsidwa kuti kuwunika pafupipafupi kuchuluka kwa potaziyamu mu seramu ya magazi kuchitike. Kuwunikira pafupipafupi kwa kuchuluka kwa seramu potaziyamu kumafunika kwa odwala omwe ali ndi vuto laimpso.
Kuwunikira kwa hematologic.
Ndikulimbikitsidwa kuwunikira kuchuluka kwa leukocytes kuti mupeze nthawi yomwe mungathe leukopenia. Kuwunikira pafupipafupi kumalimbikitsidwa pakadali koyambirira kwa odwala omwe ali ndi vuto la impso, ndi concomitant collagenosis (systemic lupus erythematosus kapena scleroderma) kapena odwala omwe amalandila chithandizo ndi mankhwala ena omwe amakhudza hemogram.
Gwiritsani ntchito pa nthawi yoyembekezera komanso mkaka wa m`mawere.
Pa nthawi ya pakati, ndizoletsedwa kutenga Tritace (onani gawo CONTRAINDICATIONS). Chifukwa chake, musanamwe mankhwala azimayi amisinkhu yobala, ndikofunikira kupatula pakati. Amayi azaka zoyambira kubereka azigwiritsa ntchito njira zodalirika zakulera pamene akutenga Tritace. Ngati mayi akufuna kukhala ndi pakati, siyani kugwiritsa ntchito mankhwalawa ndikusintha ndi mankhwala ena aliwonse (kupatula ACE zoletsa). Ngati chithandizo ndi zoletsa za ACE sichitha kuyimitsidwa, mimba iyenera kupewa. Pochitika kuti pakati pokhazikitsidwa ndi chithandizo cha Tritace, ndikofunikira kusintha posachedwa (kuyang'aniridwa ndi dokotala) kupita kwina mankhwala othandizira omwe amaika pachiwopsezo chochepa kwambiri kwa mwana wosabadwa (kupatula ACE inhibitors).
Kafukufuku wazinyama awonetsa kuti ramipril imadutsa mkaka wa m'mawere. Popeza sizikudziwika ngati ramipril adalowa mkaka wa m'mawere a anthu, kugwiritsa ntchito Tritace panthawi yoyamwitsa kumatsutsana.
Ana. Chifukwa cha kusowa kwachipatala chokwanira, Tritace sayenera kuperekedwa kwa ana.
Kutha kusinthitsa kuchuluka kwa zochita mukamayendetsa kapena kugwiritsa ntchito njira zina.Zotsatira zina zoyipa (mwachitsanzo, zizindikiro za kuchepa kwa kuthamanga kwa magazi, makamaka nseru, chizungulire) zimatha kudodometsa chidwi cha wodwalayo komanso kuchuluka kwa malingaliro a psychomotor.

Njira Zogwiritsira Ntchito Mankhwala Osokoneza bongo

Kuphatikiza komwe kumatsutsana.
Njira zochizira kunja, zomwe zimapangitsa kuti magazi azigwira pamalo osasokoneza bwino, monga dialysis kapena hemofiltration pogwiritsa ntchito ziwalo zina zokhala ndimatayimidwe ambiri (mwachitsanzo, polyacrylonitrile nembanemba) ndi Ldl apheresis ogwiritsa ntchito dextrin sulfate.
Kuphatikiza komwe sikulimbikitsidwa.
Mchere wa potaziyamu, okonza potaziyamu wambiri: kuwonjezereka kwa kuchuluka kwa seramu potaziyamu kuyenera kuyembekezeredwa. Ndi chithandizo munthawi yomweyo ndi ramipril wokhala ndi potaziyamu wolekerera okodzetsa (mwachitsanzo, spironolactone) kapena mchere wa potaziyamu, kuyang'anira ndende ya seramu potaziyamu ndikofunikira.
Gwiritsani ntchito mosamala.
Mankhwala a antihypertensive (mwachitsanzo, okodzetsa) ndi mankhwala ena amachepetsa kuthamanga kwa magazi (mwachitsanzo, nitrate, antidepressants, anesthetics): kuwonjezeka kwa mphamvu ya antihypertensive ya ramipril kungachitike. Ndikulimbikitsidwa kuwunika nthawi zonse ma seramu sodium ndende odwala omwe amalandira chithandizo nthawi yomweyo ndi okodzetsa.
Vasoconstrictive sympathomimetics: ingafooketse mphamvu yochepetsa kuthamanga kwa magazi a Tritace. Ndikulimbikitsidwa kuwunika kuyang'anira magazi makamaka mosamala. Allopurinol, immunosuppressants, glucocorticosteroids, procainamide, cytostatics ndi mankhwala ena omwe angayambitse kusintha kwa hemograms: amatha kukulitsa mwayi wazokhudzana ndi hematological mukamagwiritsa ntchito limodzi ndi ramipril.
Mchere wa Lithium. Kutulutsa kwa lithiamu ndi ACE zoletsa kungachepe. Kutsika koteroko kumatha kubweretsa kuwonjezeka kwa seramu lifiyumu ndende ndikuwonjezera kawopsedwe wa lithiamu. Pankhaniyi, ndikofunikira kuwongolera ndende ya lithiamu mu seramu yamagazi.
Othandizira odwala matenda ashuga (mwachitsanzo, insulin ndi zotumphukira za sulfonylurea). ACE inhibitors amatha kuwonjezera mphamvu ya insulin. Nthawi zina, izi zimatha kubweretsa kukula kwa hypoglycemia mwa odwala omwe nthawi yomweyo amagwiritsa ntchito mankhwala antidiabetes. Kumayambiriro kwa chithandizo, makamaka kuyang'anira kuchuluka kwa shuga m'magazi tikulimbikitsidwa.
Chakudya sichisintha kwenikweni mayamwidwe a ramipril.
Ayenera kukumbukiridwa.
NSAIDs (mwachitsanzo, indomethacin ndi acetylsalicylic acid). Mwina akuchepetsa mphamvu yochepetsera kuthamanga kwa magazi pansi pa zochita za Tritace. Kuphatikiza apo, kugwiritsa ntchito nthawi yomweyo ndi ACE inhibitors ndi NSAIDs kumatha kuyambitsa chiwopsezo cha kuchepa kwa ntchito ya impso komanso kuchuluka kwa seramu potaziyamu.
Heparin. Mwina kuwonjezeka kwa kuchuluka kwa potaziyamu mu seramu yamagazi.
Mowa: umawonjezera vasodilation. Kufufuza kumatha kuwonjezera zovuta za mowa.
Mchere Kuchuluka kwa mchere kumatha kufooketsa mphamvu ya antihypertensive ya Tritace.
Njira yotsatsira hyposensitization. Chifukwa cha kuletsa kwa ACE, kuthekera ndi kuopsa kwa anaphylactic ndi anaphylactoid zimachitika poizoni waziphuphu ukuwonjezeka.Amanenanso kuti zoterezi zitha kuonedwanso ndi ma allergen ena.

Mankhwala osokoneza bongo Tritace, Zizindikiro ndi mankhwala

Zizindikiro za kuledzera. Mankhwala osokoneza bongo amatha kuyambitsa kufalikira kwa ziwiya zotumphukira (ndi kufooka kwambiri, mantha), bradycardia, kusagwirizana mu electrolyte bwino komanso kulephera kwa aimpso.
Chithandizo cha impoxication. Detoxization yoyamba, mwachitsanzo, posamba m'mimba, kugwiritsa ntchito adsorbents, sodium thiosulfate (ngati zingatheke, pa mphindi 30 zoyambirira). Pakachitika hypotension, kuphatikiza muyeso womwe cholinga chake ndi kubwezeretsa kuchuluka kwa madzimadzi ndi kuchuluka kwa mchere, ndikofunikira kugwiritsa ntchito agonists a α1-adrenergic receptors (mwachitsanzo, norepinephrine, dopamine) kapena angiotensin II (angiotensinamide), omwe, monga lamulo, amapezeka pofufuza pawokha labotale.
Palibe chidziwitso pakugwiritsa ntchito kukakamiza diuresis, kusintha kwamkodzo poyankha, hemofiltration kapena dialysis pofotokozera kufalikira kwa ramipril kapena ramiprilat. Komabe, kuthekera kwa dialysis kapena hemofiltration kukuganiziridwa.

Mlingo

Zofunikira zathupi:

Tritace PLUS ® 5 mg / 12.5 mg ndi mapiritsi apinki okhala ndi mzere mbali zonse ziwiri. Sitampu yapamwamba: 41 / AV.

Tritace PLUS ® 10 mg / 12.5 mg piritsi lalanje lalanje ndi mzere mbali zonse ziwiri. Sitampu yapamwamba 42 / AV.

Kuyanjana ndi mankhwala ena ndi mitundu ina yoyanjana

Chakudya. Zakudya zomwezi munthawi yomweyo sizikhudza mayamwidwe a ramipril.

Njira zochizira kunja, zomwe zimayambitsa kukhudzana ndi magazi omwe ali ndi malo olakwika, monga dialysis kapena hemofiltration pogwiritsa ntchito ziwalo zina zokhala ndi mayendedwe okwera (mwachitsanzo, polacrylonitrile membrane) ndi apheresis ya otsika osalimba a lipoprotein ogwiritsa ntchito dextran sulfate - chifukwa chowonjezera chiopsezo chokhala ndi anaphylactic machitidwe (onani

Kugwiritsa ntchito mosiyanasiyana ndi mankhwala omwe ali ndi aliskiren amatsutsana kuti agwiritse ntchito odwala omwe ali ndi matenda ashuga kapena odwala omwe ali ndi vuto lochepa kwambiri laimpso (creatinine chilolezo

Kugwiritsira ntchito nthawi yomweyo kwa angiotensin II receptor antagonists omwe ali ndi mankhwala amatsutsana kuti agwiritse ntchito odwala matenda ashuga koma osavomerezeka kuti agwiritsidwe ntchito ndi odwala ena onse.

Kuphatikiza komwe kumafunikira kusamala kwambiri.

Mchere wamchere wa potaziyamu, heparin, potaziyamu wambiri komanso zinthu zina zomwe zimapangitsa kuti potaziyamu akhale m'magazi am'magazi (kuphatikizapo angiotensin II okonda, trimethoprim, tacrolimus, cyclosporine). Hyperkalemia imatha kuchitika, chifukwa chake muyenera kuyang'anira mosamala mulingo wa potaziyamu m'magazi a magazi.

Mankhwala a antihypertensive (mwachitsanzo diuretics) ndi zinthu zina zomwe zimatha kuchepetsa kuthamanga kwa magazi (mwachitsanzo, nitrate, antidepressants, anesthetics, mowa, baclofen, alfuzosin, doxazosin, prazosin, tamsulosin, terazosin). Pakhoza kukhala chiwopsezo cha ochepa hypotension (onani gawo "Njira ya makonzedwe ndi mlingo" wa okodzetsa).

Vasopressor sympathomimetics ndi zinthu zina zogwira ntchito (mwachitsanzo epinephrine), zomwe zimatha kuchepetsa antihypertensive zotsatira za ramipril. Ndikulimbikitsidwa kuwunika magazi pafupipafupi.

Allopurinol, immunosuppressants, corticosteroids, procainamide, cytostatics ndi zinthu zina zomwe zingayambitse kusintha kwa chithunzi cha magazi. Kuchulukitsa kwa mayendedwe a hematological (onani gawo "Zomwe zimagwiritsidwa ntchito").

Mchere wa Lithium. Popeza ACE inhibitors ikhoza kuchepetsa lithiamu excretion, izi zingapangitse kuti chiwopsezo cha lithiamu chidziwike.

Othandizira odwala matenda ashuga, kuphatikiza insulin. Hypoglycemic zimachitika. Hydrochlorothiazide imatha kufooketsa mphamvu ya mankhwala a antidiabetes. Chifukwa chake, kumayambiriro kwa kugwiritsa ntchito mankhwalawa mankhwalawa, ndikofunikira kuyang'anitsitsa kuchuluka kwa shuga m'magazi. Metformin iyenera kugwiritsidwa ntchito mosamala, chifukwa cha chiwopsezo cha lactic acidosis chifukwa chotheka kugwira ntchito mwamphamvu chifukwa cha hydrochlorothiazide.

Mankhwala osokoneza bongo a nonsteroidal (NSAIDs) ndi acetylsalicylic acid. Kutsika kwa antihypertensive zotsatira za Tritace Plus ® kuyembekezeredwa. Komanso, munthawi yomweyo kugwiritsa ntchito ACE zoletsa ndi ma NSAIDs kumatha kukhala limodzi ndi chiwopsezo cha matenda aimpso komanso kuwonjezeka kwa potaziyamu m'magazi.

Ma anticoagulants amlomo . Pogwiritsa ntchito munthawi yomweyo ndi hydrochlorothiazide, mphamvu ya anticoagulant itha kufooka.

Corticosteroids, ACTH, amphotericin B, carbenoxolone, kugwiritsa ntchito kuchuluka kwa licorice, mankhwala amphumphu (ogwiritsira ntchito nthawi yayitali) ndi mankhwala ena okhazikika kapena zinthu zina zomwe zimachepetsa kuchuluka kwa potaziyamu m'madzi a m'magazi. Chiwopsezo chowonjezereka cha hypokalemia.

Kukonzekera kwa Digitalis, zinthu zomwe zimatha kuwonjezera nthawi ya QT, antiarrhythmic mankhwala. Pamaso pa electrolyte kusalinganika (mwachitsanzo, hypokalemia, hypomagnesemia), zotsatira za proarrhythmic zitha kuchuluka, ndipo zotsatira za antiarrhythmic zitha kufooka.

Mankhwala omwe zotsatira zake zimakhudzidwa ndikusintha kwa seramu potaziyamu

Kuwunikira kwa pang'onopang'ono kwa kuchuluka kwa seramu potaziyamu ndikuwunikira kwa ECG ndikulimbikitsidwa ngati hydrochlorothiazide imatengedwa nthawi yomweyo ndimankhwala omwe zotsatira zake zimakhudzidwa ndi kusintha kwamankhwala a serum potaziyamu (mwachitsanzo, digitalis glycosides ndi antiarrhythmic mankhwala ndi mankhwala otsatirawa omwe amachititsa polymorphic pirouette mtundu tachycardia ( ventricular tachycardia) (kuphatikiza mankhwala ena a antiarrhythmic), popeza hypokalemia imapangitsa kuti pirouette tachycardia ipangidwe:

mankhwala a Ia antiarrhythmic (quinidine, hydroquinidine, disopyramide)
mankhwala a antiarrhythmic a kalasi III (amiodarone, sotalol, dofetilide, ibutilide)
ma antipsychotic (mwachitsanzo, thioridazine, chlorpromazine, levomepromazine, trifluoroorazine, ciamemazine, sulpiride, sultopride, amisulpiride, thiapride, pimozide, haloperidol, droperidol)
mankhwala ena (mwachitsanzo, bepridil, chisapride, difemanil, erythromycin kwa mtsempha wamkati, halofantrine, misolastine, pentamidine, terfenadine, vincamine kwa intravenous management.

Methyldopa. Nkhani zina za hemolytic anemia zimanenedwa ndi kugwiritsa ntchito nthawi yomweyo kwa hydrochlorothiazide ndi methyldopa.

Cholestyramine kapena ma ion ena ion omwe amapangidwira pakamwa. Kuyamwa kwa hydrochlorothiazide. Suffonamide diuretics iyenera kumwedwa osachepera 1:00 asanafike kapena maola 4-6 mutatha kugwiritsa ntchito mankhwalawa.

Ma curariform minyewa yopuma. Zitha kuwonjezera ndikuchulukitsa nthawi ya opuma minofu.

Mchere wa calcium ndi mankhwala omwe amalimbitsa calcium. Pogwiritsa ntchito munthawi yomweyo ndi hydrochlorothiazide, kuwonjezereka kwa calcium ya plasma kungayang'anitsidwe, chifukwa chake, ndikofunikira kuyang'anira kuchuluka kwa calcium m'madzi a m'magazi.

Carbamazepine. Pali chiopsezo cha hyponatremia chifukwa cha kuchuluka kwa hydrochlorothiazide.

Osiyanasiyana othandizira okhala ndi ayodini. Pankhani yakusowa kwamadzi chifukwa chogwiritsa ntchito ma diuretics, kuphatikiza hydrochlorothiazide, pamakhala chiwopsezo chokhala ndi kulephera kwa impso, makamaka mukapatsidwa mankhwala osokoneza bongo omwe ali ndi ayodini.

Penicillin. Hydrochlorothiazide excretion imachitika mu distal tubules ya nephron, chifukwa chomwe kutulutsa kwa penicillin kumachepetsedwa.

Quinine. Hydrochlorothiazide amachepetsa quinine excretion.

Vildagliptin. Kuwonjezeka kwa zochitika za angioneurotic edema zimawonedwa mwa odwala omwe nthawi yomweyo amatenga ACE inhibitors ndi vildagliptin.

MTOR zoletsa (mwachitsanzo. Temsirolimus) . Panali kuwonjezeka kwa chiwopsezo cha angioedema mwa odwala omwe amatenga nthawi yomweyo ACE inhibitors ndi mTOR inhibitors (chandamale cha rapamycin mwa zolengedwa).

Heparin. Kuchuluka kwa seramu potaziyamu.

Mukamagwiritsa ntchito mankhwala a salicylates okwanira, hydrochlorothiazide imatha kuwongolera zovuta zawo pakatikati kwamanjenje.

Pogwiritsa ntchito munthawi yomweyo cyclosporine, hyperuricemia imatha kuwonjezeka ndipo chiwopsezo cha zovuta monga gout chikhoza kuchuluka.

Mowa Ramipril angayambitse kuchuluka kwa vasodilation ndipo zimawonjezera mphamvu ya mowa.

Mowa, barbiturates, mankhwala osokoneza bongo kapena antidepressants. Zitha kupititsa patsogolo hypotension ya orthostatic.

Mchere Kuchepetsa mphamvu ya antihypertensive ya mankhwala ndi kuwonjezeka kwa mchere wambiri m'zakudya.

Beta blockers ndi diaxoside. Kugwiritsa ntchito pamodzi kwa thiazide diuretics, kuphatikizapo hydrochlorothiazide, yokhala ndi beta-blockers kungakulitse chiopsezo cha hyperglycemia.

Amantadine. Thiazides, kuphatikizapo hydrochlorothiazide, amatha kukulitsa chiopsezo cha zotsatira zoyipa za amantadine.

Ma Pressor amines (mwachitsanzo adrenaline). Ndizotheka kufooketsa mphamvu za mabotolo a Pressor, koma osafikira pamomwe angapangitse kuti azigwiritsidwa ntchito.

Mankhwala othandizira gout (probenecid, sulfinpyrazone ndi allopurinol). Kusintha kwa mlingo wa uricosuric othandizira kungafunike, popeza hydrochlorothiazide ingakulitse kuchuluka kwa seramu uric acid. Zingakhale kuti pakufunika kuwonjezeredwa mlingo wa phenenecid kapena sulfinpyrazone. Ndi munthawi yomweyo kugwiritsa ntchito thiazides, kuwonjezeka pafupipafupi kwa hypersensitivity zimachitika ku allopurinol ndikotheka.

Anticholinergics (mwachitsanzo, atropine, biperiden). Chifukwa chakuchepa mphamvu ya matumbo am'mimba komanso kuchepa kwa kuthamangitsidwa m'mimba, kukhudzana kwa zakudya zamtundu wa thiazide kukuchulukirachulukira.

Zotsatira zamankhwala pazotsatira zoyeserera zasayansi

Chifukwa cha momwe kagayidwe ka calcium kamaperekera, thiazides amatha kuthana ndi zotsatira za kuwunika kwa magwiridwe amtundu wa parathyroid (onani gawo "Zogwiritsira ntchito").

Hypersensitivity yapadera. Chifukwa cha kuletsa kwa ACE, kuthekera ndi kuopsa kwa anaphylactic ndi anaphylactoid zimachitika poizoni waziphuphu ukuwonjezeka. Amakhulupirira kuti izi zitha kuonedwanso kwa allergen ena.

Zolemba ntchito

Magulu apadera a odwala

Mimba Chithandizo cha ACE inhibitors kapena angiotensin II receptor antagonists sayenera kuyambitsidwa pakakhala pakati. Pokhapokha kupitiriza kwa chithandizo ndi ACE inhibitor / angiotensin II receptor antagonist ndikofunikira, odwala omwe akukonzekera kukhala ndi pakati ayenera kusamutsidwira ku mankhwala ena a antihypertensive, kugwiritsa ntchito komwe kumawoneka kotetezeka panthawi yapakati.

Blockade iwiri ya renin-angiotensin- (RAAS) pogwiritsa ntchito mankhwala omwe ali ndi aliskiren

Kuphatikizika kwapawiri kwa renin-angiotensin ndi kuphatikiza kwa mankhwala a Tritace Plus ® ndi aliskiren osavomerezeka, chifukwa pali chiwopsezo cha hypotension, hyperkalemia ndi kusintha kwa impso.

Kwa odwala matenda a shuga a mellitus kapena aimpso ntchito (GFR 60 ml / min), kugwiritsa ntchito kwa Tritace Plus ® ndi aliskiren kumatsutsana (onani gawo "Contraindication").

Odwala omwe ali pachiwopsezo chachikulu cha ochepa hypotension

Odwala okhala ndi renin-angiotensin-ntchito. Odwala omwe akuwonjezera ntchito ya renin-angiotensin-pali chiopsezo chochepetsa kwambiri magazi komanso kuwonongeka kwa impso chifukwa chopewera ACE. Izi ndizowona makamaka muzochitika zomwe ACE inhibitor kapena conquitant diuretic adalembedwa koyamba kapena kuti mlingo ukuwonjezeka kwa nthawi yoyamba. Kuwonjezeka kwa ntchito ya renin-angiotensin-kufunsa kuthandizidwira kuchipatala, kuphatikizapo kuwunika kwambiri magazi, kungayembekezeredwe, mwachitsanzo, mwa odwala:

ndi matenda oopsa kwambiri
Ndi mtima wopunduka,
ndi hemodynamically yofunika kutsekeka kwa njira kulowa kapena kutuluka kwa magazi kuchokera kumanzere kwamitsempha (mwachitsanzo, stenosis ya msempha kapena mitral valavu)
Ndi unilateral aimpso mtsempha wamagazi stenosis pamaso pa yachiwiri kugwira ntchito impso
ndi kusowa kwambiri kwamadzi kapena kotenthera (kapena odwala omwe amalandila zotupa),
ndi matenda amitsempha ndi / kapena ascites,
omwe amachitidwa opaleshoni yayikulu kapena panthawi ya mankhwala oletsa kupweteka omwe angayambitse ochepa hypotension.

Asanayambe chithandizo, nthawi zambiri amalimbikitsa kuti kuchepa kwa madzi m'thupi, Hypovolemia, kapena electrolyte kucheperachepera (Komabe, mwa odwala omwe ali ndi vuto la mtima, njira zothetsera zotere ziyenera kuyesedwa mosamala poyerekeza ndi kuchuluka kwa kuchuluka kwambiri.

Kwa odwala omwe ali ndi vuto la chiwindi, mayankho omwe amathandizidwa ndi Tritace Plus ® akhoza kupitilizidwa kapena kuchepetsedwa. Kuphatikiza apo, mwa odwala omwe ali ndi vuto lalikulu la chiwindi, lomwe limayendetsedwa ndi edema ndi / kapena ascites, ntchito ya renin-angiotensin dongosolo imatha kuchuluka kwambiri, chifukwa chake, chisamaliro chapadera chiyenera kuchitidwa panthawi ya odwala.

Kuthandizira opaleshoni. Ngati ndi kotheka, chithandizo ndi zoletsa za ACE, monga ramipril, ziyenera kuyimitsidwa tsiku 1 lisanachitike opaleshoni.

Odwala omwe ali pachiwopsezo cha mtima kapena matenda a ischemia atha kukhala owopsa. Mu gawo loyambirira la chithandizo, wodwalayo amafunika kuyang'aniridwa mosamala ndi madokotala.

Hyperaldosteronism yoyamba. Kuphatikiza kwa ramipril + hydrochlorothiazide si mankhwala osankhidwa pochiza matenda oyamba a hyperaldosteronism. Komabe, ngati ramipril + hydrochlorothiazide imagwiritsidwa ntchito mwa wodwala yemwe ali ndi hyperaldosteronism yoyamba, ndikofunikira kuyang'anira bwino kuchuluka kwa potaziyamu m'madzi a m'magazi.

Odwala okalamba. Onani gawo "Mlingo ndi Kapangidwe".

Odwala omwe ali ndi matenda a chiwindi. Odwala omwe ali ndi matenda a chiwindi, kukanika kwa elexandrolyte chifukwa cha mankhwala omwe ali ndi hydrochlorothiazide diuretics kungayambitse kukula kwa hepatic encephalopathy.

Pankhani ya zovuta za hepatic komanso odwala omwe akudwala matenda a chiwindi omwe akupita patsogolo, ma thiazides ayenera kugwiritsidwa ntchito mosamala, chifukwa mankhwalawa amatha kuyambitsa cholestasis ya intrahepatic, komanso kusintha kochepa muyezo wamchere wamchere womwe ungayambitse kukula kwa chiwindi cha hepatic. Hypothiazide imaphatikizidwa kwa odwala omwe ali ndi vuto lolemera la hepatic (onani gawo "Contraindication").

Kuyang'anira ntchito ya impso. Ntchito yeniyeni iyenera kuyang'aniridwa musanayambe komanso pakumwa ndipo mankhwalawa amayenera kusinthidwa moyenera, makamaka masabata oyamba a chithandizo. Odwala omwe ali ndi vuto la impso (onani Gawo "Mlingo ndi Kapangidwe") amafunikira kuwunikira mosamala.

Odwala ndi mkhutu aimpso ntchito. Odwala omwe ali ndi matenda a impso, thiazides amatha kuyambitsa uremia mwadzidzidzi. Odwala ndi mkhutu aimpso ntchito, kuchuluka kwa yogwira zinthu zitha kuchitika.Ngati kufalikira kwa impso kuwonekera, monga momwe chiwonetsero chikuwonjezeka cha kuchuluka kwa zotsalira za nayitrogeni, lingaliro lakuwonjezera chithandizo liyenera kulemedwa mosamala. Kuganizira kuyenera kuperekedwa pakuletsa chithandizo ndi diuretic (onani gawo "Contraindication").

Electrolyte kusalinganika. Monga odwala onse omwe amalandira chithandizo cha mankhwala okodzetsa, ndikofunikira kuti azitha kuyeza kuchuluka kwa ma electrolyte m'madzi am'magazi nthawi yoyenera. Thiazides, kuphatikizapo hydrochlorothiazide, imatha kuyambitsa kuphwanya kwamiyeso yamagetsi yamagetsi (hypokalemia, hyponatremia ndi hypochloremic alkalosis).

Ngakhale hypokalemia imatha kukhala ndi thiazide diuretics, kugwiritsa ntchito nthawi imodzi kwa ramipril kumatha kuchepetsa hypokalemia yoyambitsidwa ndi okodzetsa. Chiwopsezo cha hypokalemia ndichulukwi kwambiri kwa odwala omwe ali ndi matenda a cirrhosis, odwala omwe ali ndi diuresis yowonjezereka, odwala omwe amalandira ma elekitirodi osakwanira, komanso odwala omwe akulandira chithandizo nthawi yomweyo ndi corticosteroids ndi ACTH (onani Gawo "Kuyanjana ndi mankhwala ena ndi mitundu ina ya mitundu zochita "). Mkati mwa sabata yoyamba ya chithandizo, milingo ya potaziyamu yoyambirira iyenera kutsimikizika. Ngati mapiritsi a potaziyamu apezeka, kuwongolera ndikofunikira.

Kuchepetsa kwa hyponatremia kumatha kuchitika. Mchere wochepa wa sodium poyamba ungakhale wa asymptomatic, kotero kutsimikiza kwakanthaŵi kuchuluka kwake ndikofunikira. Kwa odwala okalamba komanso odwala matenda a cirrhosis, kuyesedwa koteroko kumayenera kuchitika pafupipafupi.

Thiazides adawonetsedwa kuti akuwonjezera kukodza kwa magnesium, komwe kungayambitse hypomagnesemia.

Hyperkalemia Mwa odwala ena omwe adalandira zoletsa za ACE, monga Tritace Plus ®, kumachitika kwa hyperkalemia. Gulu lomwe lili pachiwopsezo cha hyperkalemia limaphatikizapo odwala omwe ali ndi vuto la impso, okalamba (wazaka zopitilira 70), odwala omwe sanayesedwe kapena salangidwa bwino ndi matenda a shuga, kapena iwo omwe amamwa mchere wa potaziyamu, zotupa za potaziyamu, ndi zinthu zina zomwe zimapangitsa kuchuluka kwa plasma potaziyamu magazi, kapena odwala omwe ali ndi vuto lakusowa madzi m'thupi, mtima kuwonongeka, kapena metabolic acidosis. Ngati kugwiritsa ntchito mankhwala omwe ali pamwambawa akuwonetsedwa, tikulimbikitsidwa kuwunika kawirikawiri mulingo wa potaziyamu wam'magazi (onani Gawo "Kuyanjana ndi mankhwala ena ndi mitundu ina yoyanjana").

Hepatic encephalopathy. Odwala omwe ali ndi matenda a chiwindi, electrolyte kusalinganika chifukwa cha chithandizo cha okodzetsa, kuphatikizapo hydrochlorothiazide, kungayambitse kukula kwa hepatic encephalopathy. Ngati chiwopsezo cha hepatic encephalopathy, chithandizo chiyenera kuyimitsidwa nthawi yomweyo.

Hypercalcemia. Hydrochlorothiazide imathandizira kubwezeretsanso kwa calcium mu impso, zomwe zingayambitse hypercalcemia. Izi zitha kupotoza zotsatira za mayeso omwe amachitidwa kuti aphunzire ntchito ya gathy ya parathyroid.

Angioneurotic edema. Odwala omwe amalandila zoletsa za ACE, monga ramipril, angioedema adawonedwa (onani Gawo "Zosiyana '). Ngati angioedema, chithandizo ndi Tritace Plus ® ziyenera kusiyidwa pomwepo ndipo chithandizo chamankhwala chiyenera kuyamba. Wodwalayo amayenera kuyang'aniridwa ndi achipatala kwa maola osachepera 12-24 ndipo amangotulutsidwa pambuyo poti zizindikirizo zitatheratu.

Odwala omwe amalandila zoletsa za ACE, monga Tritace Plus ®, pakhala pali milandu ya angioedema wamatumbo (onani gawo "Zotsatira zosiyana"). Odwala awa adadandaula za kupweteka kwam'mimba (ndi kusanza kapena kusanza).

Anaphylactic zimachitika pa hyposensitization. Pogwiritsa ntchito zoletsa za ACE, kutha kwa kukhalapo ndi kuopsa kwa anaphylactic ndi anaphylactoid zimachitika poizoni wazakudya ndipo zina zimachulukana.

Neutropenia / agranulocytosis. Milandu ya neutropenia / agranulocytosis yakhala yosowa kwambiri. Kulepheretsa kwa kugwirira kwa mafupa kwatchulidwanso. Kuti muwone zotheka leukopenia, tikulimbikitsidwa kuwongolera kuchuluka kwama cell oyera m'magazi. Kuwunikira pafupipafupi kumakhala koyenera kumayambiriro kwa chithandizo cha odwala omwe ali ndi vuto laimpso, odwala omwe ali ndi vuto la collagenosis (mwachitsanzo, systemic lupus erythematosus kapena scleroderma) ndi iwo omwe amamwa mankhwala ena omwe angayambitse kusintha kwa chithunzi cha magazi (onani Magawo " kulumikizana ndimankhwala ena ndi mitundu ina yolumikizirana ”ndi" Kusintha Kosiyanasiyana ").

Mitundu yosiyanasiyana. Ma Ahibuloseti a ACE amakonda kupangitsa angioedema odwala omwe amathamanga mu mpikisano wa Negroid kuposa oyimira mafuko ena. Monga zoletsa zina za ACE, zotsatira za ramipril zitha kutchulidwa pang'ono m'magulu amtundu wa Negroid poyerekeza ndi oimira mafuko ena. Izi zitha kuchitika chifukwa chakuti odwala akuda omwe alibe matenda oopsa, matenda oopsa oopsa kwambiri omwe amakhala ndi ntchito yotsikitsitsa amawonedwa nthawi zambiri.

Ochita masewera Hydrochlorothiazide imatha kupereka zotsatira zabwino mukamayesa mayeso obera.

Zotsatira za metabolism ndi endocrine. Mankhwala a Thiazide amatha kusokoneza kulolera kwa shuga. Nthawi zina, odwala matenda ashuga angafunikire kusintha kwa mankhwala a insulin komanso mankhwala amkamwa. Mukalandira mankhwala a thiazides, mtundu wamtunduwu wa shuga umatha kukhala wowonekera.

Thiazide diuretic mankhwala amatha kuphatikizidwa ndi cholesterol yokwezeka komanso triglycerides. Odwala ena, kugwiritsa ntchito thiazide diuretics kumatha kupangitsa kuti chiwopsezo cha hyperuricemia kapena chiwopsezo chachikulu cha gout.

Kutsokomola. Mukamagwiritsa ntchito zoletsa za ACE, kutsokomola kwanenedwa. Monga lamulo, chifuwa ichi sichiberekanso, chimatenga nthawi yayitali ndipo chimazimiririka atatha kulandira chithandizo. Pozindikira kuti muli ndi chifuwa, muyenera kukumbukira ngati pali kuthekera kwa chifuwa chifukwa cha zoletsa ma ACE.

Pachimake myopia ndi yachiwiri pachimake glaucoma. Hydrochlorothiazide ndi sulfonamide kukonzekera. Sulfanilamides ndi sulfonamide zotumphukira zimatha kuyambitsa ma idiosyncrasies omwe amatsogolera ku myopia yochepa komanso kutsekeka kwapakati-kutsekeka kwa glaucoma. Zizindikiro zimaphatikizira kuyambitsa kwamphamvu kwa kuchepa kwa mawonekedwe owoneka kapena kupweteka kwa maso ndipo nthawi zambiri kumachitika patatha maola angapo mpaka milungu ingapo mutayamba mankhwalawa.

Glaucoma yopanda mawonekedwe imatha kuyambitsa masomphenya. Chithandizo chachikulu cha izi ndi kusiya kumwa mankhwalawo mwachangu momwe mungathere. Kuthandizidwa mwadzidzidzi kapena kuchitidwa opaleshoni kungafunike ngati kupanikizika kwapakati pakokha sikungakhale kosalamulirika. Zomwe zimayambitsa kukulira glaucoma yovuta kwambiri ikhoza kukhala ndi mbiri ya sulfonamide kapena penicillin allergy.

Dr. Odwala, ngakhale atakhala kuti ali ndi mbiri yakale ya alla

Kutulutsa Fomu

Tritace Plus imapezeka piritsi.

Mapiritsi ndi ofiira pinki pamtundu, mbali iliyonse pamakhala chiopsezo chogawanitsa. Pamwamba pali sitampu 41 / AV. Makonda amodzi okha amaloledwa.

Mapiritsi ndi lalanje wamtundu, mbali zonse ziwiri pali chiopsezo chogawanitsa. Pamwamba pali sitampu 42 / AY. Makonda amodzi okha amaloledwa.

Mapiritsi amakhala oyera, oyera-kirimu okhala ndi chiopsezo, mawonekedwe. Mbali zonse ziwiri pali logo yamakampani ndi sitampu ya HNW.

Mapiritsi a pinki oblong. Pali chiopsezo chogawanitsa mbali zonse ziwiri. Sitampu yapamwamba 39 / AV. Malo amdima amodzi amaloledwa.

Zotsatira za pharmacological

Kuphatikizidwa antihypertensive wothandizira, yomwe ili ndi zigawo ziwiri zogwira ntchito.

Gawo lomwe lili pano ACE enzyme inhibitor. Mfundo zoyendetsera zimakhazikitsidwa popewa kusintha kwa mawonekedwe amodzi angiotensin (I) kwa wina (II).

Poterepa, palibe kuwonjezeka kwa kugunda kwa mtima ndi chipangizo chothandizira, kupanga sikuchepetsedwa aldosterone, kuthamanga kwa ma capillaries a pulmonary system sasintha, sikukula magazi, kuchuluka kwa kusefa m'minyewa ya impso sikusintha, ndipo kukana kwa zotengera zam'mapapo mwanga kumakhalabe koyamba.

Kafukufuku wazachipatala awonetsa kuti chithandizo cha nthawi yayitali chimayambitsa kutsika kwamphamvu myocardial hypertrophy odwala ovutika matenda oopsa. Mu ischemic myocardium Ramipril amathandizira kutsika kwa magazi, amachepetsa pafupipafupi kubwezeretsanso kwanyengo ndi chiopsezo chotukuka arrhythmias.

Cardioprotective (mtima + chitetezo) zimachitika chifukwa cha zovuta zomwe zimachitika ma prostaglandinskomanso chifukwa cha kupangidwa kwa mapangidwe a nitric oxide mu maselo a endotheliocyte. Chosakaniza chophatikizika chimatha kuchepetsa kuphatikizana kwa mapulosi

Hydrochlorothiazide

Gawo lomwe lili pano thiazide okodzetsandipo imatha kusintha kubwezeretsanso kwa potaziyamu, chlorine, sodium, ion ya magnesium. Zinthu zomwe zikuchedwa zikuchedwa uric acid mu thupi, amachepetsa njira yochulukirapo ya calcium ion, amasintha kusinthanso kwa madzi mu nephrons (gawo lachigawo).

Mphamvu ya antihypertensive imakwaniritsidwa ndikuwonjezera kukhumudwitsa motsutsana ndi ganglia, kuchepetsa kuwuma kwa Pressor zotsatira norepinephrine, adrenaline ndi maini ena a vasoconstrictor, chifukwa cha kuchepa kwa BCC. Pansi pazabwino kuthamanga kwa magazi Hypotensive zotsatira sizikuwonetsedwa.

Ramipril ndi hydrochlorothiazide amadziwika ndi chowonjezera. Hydrochlorothiazide imapereka potaziyamu m'thupi, ndipo Ramipril amachotsa izi, kupewa kutayika kwa K +.

Pharmacodynamics ndi pharmacokinetics

Mphamvu ya antihypertensive ya Ramipril imawerengedwa mphindi 90 mutamwa mapiritsi, ndipo zotsatira zake zazikulu zimawonedwa pambuyo pa maola 5-9. Zotsatira zimapitilira tsiku lonse. Mukamaliza chithandizo, matendawa amayamba. Mphamvu ya diuretic ya hydrochlorothiazide imawonekera patatha maola 1-2.

Zotsatira zazikulu zimawonedwa pambuyo maola 4 ndipo zimatha mpaka maola 12. Mphamvu ya antihypertensive imawonedwa pakatha masiku 3-4, komabe, ndizotheka kukwaniritsa zoyenera kwambiri pambuyo pa masabata 3-4.

Zotsatira zoyipa

Matenda a mtima:

Matendawa:

yafupika libido
proteinuria
Kutulutsa kwamkodzo,
kuchuluka kwa zizindikiro za aimpso Kulephera.

Machitidwe amanjenje:

chisangalalo chamanjenje
Kusintha kwa ischemic muubongo,
chizungulire,
kufooka
paresthesia
kugona kwambiri
nkhawa
nkhawa
zovuta zosowa tulo, kugona tulo,
kusakhazikika mtima,
kukomoka
chisokonezo,
kukhumudwa
miyendo.

Zosangalatsa:

Sinthani kaonedwe ka kukoma,
kusawona bwino,
Vuto lama vestibular
tinnitus.

Matumbo:

Machitidwe opatsirana:

Mayankho oyipa:

angioedema lilime, milomo, larynx kapena kutsogolo kwa mutu,
zotupa pakhungu,
angioedema of the phele,
serositis
pemphigus
Matenda a Lyell
zithunzi,
vasculitis
dermatitis exfoliative,
Khungu
urticaria
myositis
nyamakazi
onycholysis,
eosinophilia.

Ziwalo za Hematopoietic:

pancytopenia
kuchepa kwa hemoglobin,
agranulocytosis,
thrombocytopenia
kuchepa magazi m'thupi,
erythropenia.

Zotheka kuchitika pa mwana wosabadwa:

mafupa a chigaza,
Hyperkalemia
kuzindikira ma antibodies a antiinuclear,
hyponatremia,
miyendo
Hyperazotemia,
kusintha kwa kayendedwe ka impso,
dontho mu kuthamanga kwa magazi
oligohydramnios
mafupa a khungu.

Zochita zasayansi:

kuzindikira ma antibodies a antiinuclear,
Hyperkalemia
Hyperazotemia,
hypercreatininemia,
hyperbilirubinemia,
kuchuluka ALT, AST, bilirubin.

Zotsatira zina:

Zotsatira zoyipa za hydrochlorothiazide:

arrhasmia,
kusakhazikika
chisokonezo,
kulimbana kwa psyche ndi chisangalalo,
Hypochloremic alkalosis,
matenda am'mimba
cholecystitis
tachycardia,
anemia (aplastic, hemolytic),
orthostatic hypotension,
kupweteka kwa epigastric
sialadenitis
kapamba
kukomoka
Hyperuricemia
hyperglycemia
kuchuluka kwa gout,
necrotizing vasculitis,
zotupa pakhungu,
chibayo
pulmonary edema ya non-cardiogenic.

Malangizo pa Tritac Plus (Njira ndi Mlingo)

Dosing ikuchitika mukuganizira umunthu. Nthawi yolandilidwa ndi nthawi yam'mawa. Kutalika kwakukulu komwe kumaloledwa patsiku kumatenga mapiritsi awiri pa mapiritsi a 5 + 25 kapena 4 pamlingo wa 2,5 + 12,5, womwe umafanana ndi 50 mg ya hydrochlorothiazide ndi 10 mg ya Ramipril.

Pakulumpha mlingo, amayesetsa kumwa mwachangu momwe angathere. Kudzilimbitsa pokha pa mlingo wa mankhwala sikuloledwa. Mapiritsi ayenera kutsukidwa ndi madzi, kuswa ndi kutafuna sikuloledwa. Kudya sikukhudza kuwonongeka kwa njira zochizira za Tritace Plus.

Gwiritsani ntchito pa nthawi yoyembekezera komanso nthawi yoyamwitsa

Tritace ® Plus sayenera kugwiritsidwa ntchito panthawi yapakati. Chifukwa chake, musanamwe mankhwalawa azimayi amisinkhu yosabereka, kutenga pakati sikuyenera kuperekedwa, ndipo panthawi ya chithandizo akuyenera kugwiritsa ntchito njira zodalirika zakulera. Zikatere pakakhala pakati pa mankhwala ndi mankhwalawa, muyenera kusiya kumwa mosachedwa ndikusintha wodwalayo kuti amwe mankhwala ena a antihypertensive, omwe chiopsezo cha mwana chingakhale chochepa.

Chifukwa cha chiwopsezo cha zotsatira zoyipa za ramipril ndi hydrochlorothiazide pa mwana wosabadwa, tikulimbikitsidwa kuti amayi omwe sangasamutsidwe ku chithandizo china cha matenda oopsa (opanda ACE inhibitors ndi diuretics) amalangizidwa kuti asatenge mimba.

Sizikudziwika ngati mphamvu ya mankhwalawa Tritace ® Plus mu trimester yoyamba ya kubereka ikhoza kukhala ndi vuto pa kukula kwa mwana wosabadwayo. Kugwiritsa ntchito zoletsa za ACE mu nthawi yachiwiri komanso yachitatu ya kutenga pakati kumayikidwa limodzi ndi zovuta zomwe zimatha kukhalanso kwa mwana wosabadwa komanso wakhanda, kuphatikizapo kuchepa kwa kuthamanga kwa magazi, cranial bone hypoplasia, anuria, kulephera kusintha kwa impso, komanso kufa.

Kukula kwa oligohydramnios kunanenedwanso, makamaka chifukwa cha kuwonongeka kwa ntchito ya impso za mwana wosabadwayo, oligohydramnios mu zochitika zoterezi zimayendetsedwa ndi chitukuko cha kulera kwa malekezero a mwana wosabadwayo, kusokonezeka kwa craniofacial, kubadwa pasadafike, kubadwa kwa intrauterine kubwezeretsedwa komanso kusakhala kotsekera sikunachitike. izi ndizotsatira za ACE inhibitor.

Ndikulimbikitsidwa kuwunikira mosamala ana akhanda omwe amawonetsedwa ndi intrauterine kuwonetsedwa kwa ACE inhibitors kuti adziwe kuchepa kwa kuthamanga kwa magazi, oliguria ndi hyperkalemia. Mu oliguria, ndikofunikira kukhalabe ndi kuthamanga kwa magazi komanso kupatsanso impso poyambitsa madzi oyenera ndi mankhwala a vasoconstrictor. Achichepere oterewa ali ndi chiopsezo chokhala ndi vuto la oliguria ndi mitsempha, chifukwa cha kuchepa kwa magazi ndi impso chifukwa cha kuchepa kwa kuthamanga kwa magazi komwe kumachitika chifukwa cha ACE inhibitors. Amaganiza kuti pogwiritsa ntchito hydrochlorothiazide mu nyengo yachiwiri yapakati ya kubereka, kukulitsa kwa thrombocytopenia mu akhanda ndikotheka.

Nthawi yoyamwitsa

Popeza ramipril ndi hydrochlorothiazide amuchotseredwa mkaka wa m'mawere, ngati pakufunika kugwiritsa ntchito mankhwala Tritace kuphatikiza pa mkaka wa m`mawere, kuyamwitsa kuyenera kuyimitsidwa.

Mlingo ndi makonzedwe

Njira yogwiritsira ntchito

Mapiritsiwo ayenera kumezedwa lonse ndi madzi okwanira (1/2 chikho). Mapiritsi sangathe kuphwanyika ndi kutafuna. Kudya sikumanganso kukhudza kwa bioavailability wa mankhwalawa, chifukwa chake amatha kumwedwa musanadye chakudya. Nthawi zambiri amalimbikitsidwa kuti kumwa kwa tsiku ndi tsiku kumayenera kutengedwa kamodzi nthawi yomweyo, makamaka m'mawa.

Mlingo Wovomerezeka ndi Sharp Dosing

Mlingo wa mankhwala amasankhidwa payekha. Kusankhidwa kwa Mlingo kumachitika ndi dokotala molingana ndi kuopsa kwa matenda oopsa komanso kupezeka kwa zinthu zomwe zingayambitse chiopsezo, komanso kulolera kwa mankhwalawa.

Mlingo wa Tritace kuphatikiza mankhwala umasankhidwa ndi kuchepa kwapang'onopang'ono kapena, ngati kuli koyenera, kuchepetsa) Mlingo wa mankhwala a ramipril komanso kukonzekera kwa hydrochlorothiazide.

Wodwala atasankhidwa Mlingo wa ramipril ndi hydrochlorothiazide, pofuna kuthandiza odwala, kudya kwawo kungathe kulowa m'malo mwa kutenga Tritace ya mankhwala kuphatikizapo mlingo woyenera, kuonetsetsa kuti mankhwalawa a ramipril ndi hydrochlorothiazide amatengedwa piritsi limodzi.

Mulingo woyambira: 2.5 mg ramipril ndi 12.5 mg hydrochlorothiazide kamodzi tsiku lililonse. Ngati ndi kotheka, kumwa mankhwalawa akhoza kuchuluka pakadutsa masabata awiri ndi atatu.
Odwala omwe sangathe kukwaniritsa kuthamanga kwa magazi ndi kupanikizika kwa ramipril monotherapy pa 10 mg, kapena kwa odwala omwe amachepetsa kuthamanga kwa magazi komwe kumachitika ndi ramipril pa 10 mg ndi hydrochlorothiazide pa Mlingo wa 12,5 mg -25 mg monga kukonzekera padera, ndikotheka kugwiritsa ntchito mankhwala Tritace ® kuphatikiza 12,5 mg + 10 mg ndi 25 mg + 10 mg.

Nthawi zambiri, kuthamanga kwa magazi kumachepa mokwanira mukamatenga Tritace ® Plus mu Mlingo wa 2,5 mg wa ramipril ndi 12,5 mg wa hydrochlorothiazide mpaka 5 mg wa ramipril ndi 25 mg ya hydrochlorothiazide. Mlingo woyenera ndi mtundu wa Mlingo wapadera pamankhwala ena

Chithandizo cha odwala kulandira okodzetsa
Odwala omwe alandila chithandizo cham'mbuyomu ndi okodzetsa, musanamwe mankhwala Tritace kuphatikiza, ngati nkotheka kwa masiku awiri kapena kuposerapo (kutengera kutalika kwa nthawi ya kukodzetsa), ayenera kuthetsedwa kapena kuchepetsa mlingo.
Ngati sikutheka kusiya kukodzetsa, tikulimbikitsidwa kuti muyambe kulandira mankhwala omwe ali ndi zotsika kwambiri za ramipril (1.25 mg patsiku) pophatikizana, kumwa mankhwala osiyana a ramipril ndi hydrochlorothiazide. Ndikulimbikitsidwa kuti mtsogolomo, kusamutsa kutenga Tritace ® kuphatikiza kuyenera kuchitika mwanjira yoti mlingo woyambira tsiku ndi tsiku usapitirire 2,5 mg wa ramipril ndi 12,5 mg wa hydrochlorothiazide. Chithandizo cha odwala mkhutu aimpso ntchito
Ngati creatinine chilolezo kuyambira 30 mpaka 60 ml / mphindi pa 1.73 m2 wa thupi padziko, mankhwala akuyamba ndi ramipril monotherapy tsiku lililonse mlingo wa 1,25 mg.
Pambuyo pang'onopang'ono kuchuluka kwa ramipril, mankhwala osakanikirana ndi mankhwalawa amayamba ndi 2,5 mg ya ramipril ndi 12,5 mg wa hydrochlorothiazide. Mulingo wovomerezeka womwe umaloledwa tsiku lililonse kwa odwala ndi aimpso ndi 5 mg ramipril ndi 25 mg hydrochlorothiazide. Odwala otere sayenera kumwa mapiritsi a Tritace ® kuphatikiza 12,5 mg + 10 mg ndi 25 mg + 10 mg.

Chithandizo cha odwala omwe ali ofatsa (ma point 5-6 pamlingo wa Mwana-Pyo) kapena olimbitsa (7-16 point on the Child-Pyo wadogo) chiwindi chodwala
Kuchiza ndi Tritace ® kuphatikiza kuyenera kuyang'aniridwa ndi achipatala ndipo mlingo wambiri wa tsiku ndi tsiku wa oxipril uyenera kukhala 2 mg.
Mwa odwala, mapiritsi a Tritace ® sangathe kugwiritsidwa ntchito, kuphatikiza 25 mg + 5 mg, 12,5 + 10 mg 25 mg + 10 mg.

Chithandizo cha odwala okalamba
Kuchiza kuyenera kuyamba ndi Mlingo wocheperako, komanso kuchuluka kwa msambo kuyenera kukhala pang'ono pang'onopang'ono (ndi kuwonjezereka kwa Mlingo) chifukwa chakuwonjezereka kwa zovuta, makamaka mwa odwala ofooka.

Mlingo

Mukadumpha mlingo wotsatira, mlingo womwe mwasowa uyenera kumwedwa mwachangu. Komabe, ngati izi zipezeka pafupi kwambiri ndi nthawi yotsatira, muyenera kulumpha mulingo womwe wasowayo ndikubwerera kwakanthawi kochepa, kupewa kupewa kuwonongera kawiri munthawi yochepa.

Zotsatira zoyipa

Otsatirawa ndi zotsatira zosafunikira zomwe zimatha kugwiritsidwa ntchito ndi Tritace ® kuphatikiza, zinthu zake zogwira ntchito (ramipril ndi hydrochlorothiazide), zina za ACE inhibitors, kapena zotulutsa zina ngati hydrochlorothiazide, zomwe zimaperekedwa molingana ndi kusintha pang'onopang'ono kwa pafupipafupi kwa zomwe zimachitika:
nthawi zambiri (≥ 10%), nthawi zambiri (≥ 1% - Mavuto a mtima
Nthawi zambiri: myocardial ischemia, kuphatikizapo kukula kwa angina pectoris, tachycardia, mtima arrhythmias, palpitations, zotumphukira edema.
Maulendo osadziwika: myocardial infaration.

Kusokonezeka kwa magazi ndi dongosolo la lymphatic
Nthawi zambiri: kuchepa kwa kuchuluka kwa leukocytes m'mitsempha yamagazi, kuchepa kwa chiwerengero cha maselo ofiira m'magazi a zotumphukira, kuchepa kwa hemoglobin, hemolytic anemia, kuchepa kwamapulatifomu m'magazi otumphukira.
Maulendo osadziwika: kuphwanya mafupa a hematopoiesis, kuphatikizapo agranulocytosis (kuchepa kwambiri kapena kuchepa kwa granulocytes kuchokera m'magazi otumphukira), pancytopenia, eosinophilia, hemoconcentration chifukwa kuchepa kwa madzimadzi m'thupi, kuphatikiza magazi.

Kusokonezeka kwamanjenje
Nthawi zambiri: mutu, chizungulire (kumverera kwa "kupepuka" m'mutu).
Nthawi zambiri: vertigo, paresthesia, kugwedeza, kusalingalira, kutentha kwa khungu, dysgeusia (kuphwanya kukoma), Agegezia (kutaya kukoma).
Maulendo osadziwika: ischemia ya ubongo, kuphatikiza kusokonezeka kwa ischemic ndi kusokonezeka kwapang'onopang'ono kwa kufalikira kwa ubongo, kusokonezeka kwa ma psychomotor, parosmia (kufooka kwa mkodzo, kuphatikizapo kuphatikizika kwa kununkhira kulikonse pakakhala kuti kulibe).

Kuphwanya gawo la masomphenyawo
Nthawi zambiri: zosokoneza zowoneka, kuphatikiza mawonekedwe a chithunzi chowoneka, conjunctivitis.
Maulendo osadziwika: xantopsia, kuchepa pakupanga kwamadzi akumwa (chifukwa cha kupezeka kwa hydrochlorothiazide pokonzekera).

Kumva kuwonongeka ndi labyrinthine
Nthawi zambiri: kulira m'makutu.
Maulendo osadziwika: kusamva.

Zovuta zamkati mwa kupuma, chifuwa ndi ziwalo zapakati
Nthawi zambiri: chifuwa chosapangidwa ("chowuma"), bronchitis.
Nthawi zambiri: sinusitis, kupuma movutikira, kuchulukana kwammphuno.
Maulendo osadziwika: bronchospasm, kuphatikizapo kuchuluka kwa mphumu ya bronchial, allergic alveolitis (pneumonitis), non-cardiogenic pulmonary edema (chifukwa cha kukhalapo kwa hydrochlorothiazide pokonzekera).

Matenda am'mimba
Nthawi zambiri: zotupa za mucous nembanemba zam'mimba, matenda am'mimba, kusokonezeka pamimba, dyspepsia, gastritis, nseru, kudzimbidwa, gingivitis (chifukwa cha kupezeka kwa hydrochlorothiazide pokonzekera).
Si kawirikawiri: kusanza, aphthous stomatitis, glossitis, kutsegula m'mimba, kupweteka kwa epigastric, mucosa wowuma mkamwa.
Maulendo osadziwika: kapamba (pokhapokha, potenga zoletsa za ACE, kupha kwamankhwala kumaonekera), kuchuluka kwa michere yamatumbo m'magazi, angioedema wamatumbo ang'ono, sialadenitis (chifukwa cha kupezeka kwa hydrochlorothiazide pokonzekera).

Kuphwanya impso ndi kwamikodzo thirakiti
Nthawi zambiri: kuwonongeka kwaimpso, kuphatikiza pachimake kukanika kwa mkodzo, kuwonjezeka kwa kuchuluka kwa mkodzo m'magazi, kuwonjezeka kwa kuchuluka kwa uini m'magazi (ngakhale kuwonjezeka pang'ono pang'onopang'ono kwa creatinine ndi unilateral aimpso artery stenosis kungawonetse ntchito yaimpso.
Maulendo osadziwika: kuchuluka kwa proteinuria, interstitial nephritis (chifukwa cha kupezeka kwa hydrochlorothiazide pokonzekera).

Kusokonezeka kwa khungu ndi minofu yolowerera
Nthawi zambiri: angioedema: mwapadera, kutsekeka kwa ma airways chifukwa cha angioedema kumatha kubweretsa imfa, dermatitis ya psoriasis, kuchuluka kwa thukuta, zotupa pakhungu, makamaka, zotupa pakhungu la pakhungu, pruritus, dazi.
Maulendo osadziwika: toxic epidermal necrolysis, Stevens-Johnson syndrome, erythema multiforme, pemphigus, kuchuluka kwa psoriasis, exfoliative dermatitis, photosensitization reaction, onycholysis, pemphigoid kapena licentiid exanthema kapena enanthema, urticaria, systemic lupus erythematosus (chifukwa cha kupezeka kwa mankhwala).

Kusokonezeka kwa minofu ndi mafupa
Nthawi zambiri: myalgia.
Maulendo osadziwika: arthralgia, kupindika kwa minofu ya minyewa, kufooka kwa minofu, minyewa, kufinya (chifukwa cha kupezeka kwa hydrochlorothiazide pokonzekera).

Kusokonezeka kwa dongosolo la endocrine
Maulendo osadziwika: matenda osakwanira katulutsidwe wa mankhwala a antidiuretic (SNA ADH).

Matenda a metabolism komanso zakudya
Nthawi zambiri: kuwonongeka kwa shuga mellitus, kutsika kwa shuga m'magazi, kuchuluka kwa glucose m'magazi, kuchuluka kwa uric acid m'magazi, kuchuluka kwa gout, kuchuluka kwa cholesterol ndi triglycerides m'magazi (chifukwa cha kupezeka kwa hydrochlorothiazide pamagulu).
Nthawi zambiri: kudya kwa anorexia, kuchepa kwa chakudya, kuchepa kwa potaziyamu m'magazi, ludzu (chifukwa cha kupezeka kwa hydrochlorothiazide pokonzekera).
Zosowa: kuchuluka kwa potaziyamu m'magazi (chifukwa cha kupezeka kwa ramipril pakukonzekera).
Maulendo osadziwika: kuchepa kwa sodium, glucosuria, metabolic alkalosis, hypochloremia, hypomagnesemia, hypercalcemia, kuchepa kwa madzi m'mimba (chifukwa cha kupezeka kwa hydrochlorothiazide pokonzekera).

Vuto la mtima
Nthawi zambiri: kuchepa kwambiri kwa kuthamanga kwa magazi, orthostatic hypotension (kukomoka kwa mafupa a minyewa yamitsempha), kukomoka, kuthina kwa magazi pankhope.
Maulendo osadziwika: thrombosis kwambiri kuchepa kwa madzimadzi, mtima stenosis, kupezeka kapena kulimbitsa kwa magazi kuzungulira maziko a stenotic mtima zotupa, a raynaud's syndrome, vasculitis.

Zovuta ndi zovuta zina pamalo a jakisoni
Nthawi zambiri: kutopa, asthenia.
Nthawi zambiri: kupweteka pachifuwa, kutentha thupi.

Kusokonezeka Kwa Magazi
Maulendo osadziwika: anaphylactic kapena anaphylactoid zimachitika ku ramipril (ndi chopinga wa ACE achuluke kwambiri anaphylactic kapena anaphylactoid zimachitika poizoni kapena) anaphylactic zimachitika hydrochlorothiazide, kuchuluka titer a antiinodar antibodies.

Kuphwanya chiwindi ndi njira ziwiri
Nthawi zambiri: cholestatic kapena cytolytic hepatitis (pazochitika zapadera), kuwonjezeka kwa ntchito ya "chiwindi" michere ndi / kapena kuwonjezeka kwa kuchuluka kwa bilirubin wamwazi m'magazi, kuwerengera cholecystitis (chifukwa cha hydrochlorothiazide pokonzekera).
Maulendo osadziwika: pachimake chiwindi kulephera, cholestatic jaundice, hepatocellular zotupa.

Kuphwanya maliseche ndi nyamakazi
Nthawi zambiri: kusakhazikika kwa erectile kukanika.
Maulendo osadziwika: yafupika libido, gynecomastia.

Mavuto amisala
Nthawi zambiri: kukhumudwa, kuda nkhawa, nkhawa, mantha, kusokonezeka kwa kugona (kuphatikizapo kugona.
Maulendo osadziwika: chisokonezo, nkhawa, kusokonezeka kwa chidwi (kuchepa kwa ndende).

Zotsatira zoyipa

Mbiri ya chitetezo cha a Ramipril imaphatikiza chifuwa chowuma komanso zochita zake chifukwa cha kunjenjemera. Zovuta zoyipa zimaphatikizapo stroko, myocardial infarction, angioedema, hyperkalemia, mkhutu aimpso kapena kwa chiwindi ntchito, kapamba, pakhungu, ndi neutropenia / agranulocytosis.

Njira zomwe zimanenedwapo kwambiri pa mankhwala a amlodipine ndi kugona, chizungulire, kupweteka kwa mutu, tachycardia, hyperemia, kupweteka kwam'mimba, nseru, kutupa m'mitsempha yamafupa, kutupa, ndi kutopa kwambiri.

Zomwe zimachitika poyipa zimagawidwa motere: kawirikawiri (≥ 1/10), nthawi zambiri (Kamutu 1/100 mpaka