Presartan N

Mankhwala omwe ali ndi antihypertensive kwenikweni, amatanthauza mankhwala, omwe ali blocker enieni. angiotensin zolandila (mtundu AT1) Sichiletsa enzyme (kinase II) zomwe zimawononga bradykinin. Presartan amachepetsa magazi aldosterone ndi norepinephrine, OPSS, HERE, amachepetsa kulongedza pambuyo, kukakamizidwa mu kuzungulira kwa "magazi" ochepa, kumakhudzanso diuretic. Imalepheretsa kukula kwa myocardial hypertrophy. Odwala CHF kumawonjezera kukana zolimbitsa thupi.

Pambuyo pa limodzi lokha la Presartan, mphamvu ya antihypertgency imafika pakufunika kwake pambuyo pa maola 6, ndipo amayamba kuchepa tsiku lotsatira. Pazipita hypotensive zotsatira zimawonetsedwa pafupifupi mwezi umodzi chiyambireni chithandizo ndi mankhwalawa.

Presartan, malangizo ogwiritsira ntchito (Njira ndi Mlingo)

Presartan amatengedwa mosasamala zakudya, 1 nthawi patsiku. Mankhwalawa ochepa matenda oopsa Mulingo watsiku lililonse wa 50 mg, womwe, ngati ndi kotheka, utha kuwonjezeka mpaka 100 mg. Ngati wodwala atenga kuchuluka kwa okodzetsa, mlingo uyenera kuchepetsedwa mpaka 25 mg tsiku lililonse.

Mankhwala CHF Mlingo woyamba wa tsiku ndi tsiku ndi 12,5 mg, amatengedwa nthawi imodzi, kenako, pakadutsa sabata, mankhwalawa amawonjezeka nthawi ziwiri (12.5, 25, 50 mg). Mlingo wokonza ndi 50 mg patsiku. Kupititsa patsogolo kwa hypotensive kwambiri, tikulimbikitsidwa kupatsa Presartan N (Losartan ndi wothandizirana ndi antihypertensive).

Kuchita

Kugwiritsa ntchito mosokoneza bongo mankhwala omwe ali ndi potaziyamu (kukonzekera kwa potaziyamu, potaziyamu wothandiza okodzetsa) kumawonjezera mwayi wakukula Hyperkalemia. Kuphatikizidwa kwa kumwa mankhwalawa ndi okodzetsa kumatha kuponya pansi HERE. Kulandila kwa Presartan ndi NSAIDs amathandizira kuchepetsa kukhathamiritsa kwa mankhwala. Ndi munthawi yomweyo makonzedwe a mankhwala ena antihypertensive mankhwala, onse Hypotensive zotsatira.

Kutulutsa mawonekedwe ndi kapangidwe kake

Mlingo wa Presartan ndi mapiritsi okhala ndi filimu: pamiyeso ya 25 ndi 50 mg - round biconvex, pinki, 25 mg mapiritsi okhala ndi mzere mbali imodzi, pamlingo wa 100 mg - wopindika, biconvex, yoyera kapena pafupi yoyera " 100 "mbali imodzi ndi" BL "mbali inayo (ma PC 10. Pamutu, matuza atatu m'bokosi lamakatoni, ma PC 14. Pachimake, matuza awiri mu bokosi la makatoni).

Piritsi 1 25/50 mg:

• yogwira mankhwala: losartan potaziyamu - 25/50 mg,
• othandizira zigawo zikuluzikulu: wowuma wowuma, microcrystalline cellulose, kuyeretsa talc, colloidal silicon dioxide, sodium starch glycolate, magnesium stearate, isopropyl mowa, methylene chloride, opadry OY-55030, utoto wofiirira.

Piritsi 1 100 mg:

• yogwira mankhwala: losartan potaziyamu - 100 mg,
• othandizira: chimanga wowuma, microcrystalline cellulose, talc, colloidal silicon dioxide, sodium carboxymethyl starch, magnesium stearate, hypromellose, titanium dioxide, talc, macrogol.

Pharmacokinetics

Presartan imatengedwa mwachangu kuchokera kumatumbo a m'mimba (GIT). Wopangidwa ndi kudutsa chiwindi koyamba. Mlingo womangiriza mapuloteni a plasma a losartan ndi metabolites ndi 92-99%. Bioavailability - 33% (kudya zakudya kulibe mphamvu). Mankhwala osokoneza bongo samalowa mu zotchinga magazi. Sichikundikira m'thupi, chimbudzi chimachitika ndi mkodzo ndi ndulu. Hafu ya moyo wa losartan ndi ma 2 maola.

Zizindikiro zogwiritsidwa ntchito

• ochepa matenda oopsa ndipo lamanzere yamitsempha yamagazi (kuchepetsa chiopsezo cha matenda a mtima ndi kufa),
• lembani matenda a shuga a II II mellitus ndi proteinuria (kuchepetsa chiopsezo cha proteinuria ndi hypercreatininemia),
• Kulephera kwa mtima kwamphamvu kumagwiritsidwa ntchito ngati gawo la mankhwala osakanikirana pomwe sikutheka kugwiritsa ntchito angiotensin kutembenuza enzyme (ACE) zoletsa.

Contraindication

• kulephera kwamphamvu kwa chiwindi ˃ 9 mfundo pamiyeso ya Mwana-Pugh (mapiritsi 100 mg),
• Mimba ndi kuyamwa
• wazaka 18
• kuchuluka kwa chidwi cha zigawo za Presartan.

Contraindication wothandizirana (mapiritsi 100 mg):

• gout
• Hyperuricemia
• Thupi lawo siligwirizana nthawi yapitali ya mankhwala ndi ACE zoletsa kapena mankhwala ena,
• Mphumu ya bronchial,
• zamagazi matenda
• kuchepa kwamagazi (BCC),
• ochepa hypotension,
• kugwirira ntchito limodzi ndi mankhwala osapweteka a antiidal (NSAIDs),
• matenda a mtima
• ukalamba.

Malangizo ogwiritsira ntchito Presartan: njira ndi mlingo

Mapiritsi a Presartan amatengedwa pakamwa kamodzi patsiku, mosasamala kanthu za kudya.

Mlingo wofotokozedwa:

• ochepa matenda oopsa: mlingo woyambirira ndi 25 mg / tsiku, avareji ya 50 mg / tsiku, ngati kuli kotheka, akhoza kuonjezereka mpaka 100 mg / tsiku, pamene kumwa mankhwalawa kawiri patsiku ndikuloledwa,
• Kulephera kwa mtima: koyamba mlingo wa 12,5 mg / tsiku, kusinthanitsa kwa mlingo kumachitika limodzi ndi sabata. Mlingo wapakati wokonza ndi 50 mg / tsiku,
• kupewa matenda a mtima ndi kufa kwa odwala omwe ali ndi vuto lalikulu kwambiri lamanzere am'mitsempha yamagazi: mankhwalawo oyambira ndi 50 mg / tsiku, ndiye kuti amawonjezeredwa mpaka 100 mg / tsiku, kapena kuphatikiza kwa hydrochlorothiazide kotsimikizika,
• mtundu II matenda a shuga ndi proteinuria: mlingo woyambirira ndi 50 mg / tsiku, ndiye umakulitsidwa mpaka 100 mg / tsiku.

Magulu apadera a odwala:

• Kulephera kwa chiwindi (˂ 9 peresenti ya mwana-Pugh), kutenga kuchuluka kwa okodzetsa, hemodialysis, zaka zoposa 75: mlingo woyambirira wa mankhwalawa sayenera kupitilira 25 mg / tsiku,
• chiwindi kuwonongeka ntchito: m'munsi Mlingo wa mankhwala ayenera kugwiritsidwa ntchito.

Zotsatira zoyipa

Presartan mu gawo la 25 ndi 50 mg nthawi zambiri amaloledwa. Zotsatira zoyipa zimatha kuchitika m'mimba, kukomoka, kupweteka kwa minofu, kutupa, mutu, chizungulire, kusokonezeka kwa kugona, hyperkalemia (potaziyamu ndende> 5.5 meq / l), kawirikawiri, kutsokomola, kulephera kupuma, tachycardia, angioedema ( milomo, nkhope, pharynx ndi / kapena lilime), urticaria, kuchuluka kwa chiwindi michere, serum bilirubin.

Zotsatira zoyipa zoyenera mukamamwa mapiritsi a Presartan mu mlingo wa 100 mg:

• mtima dongosolo: tachycardia, palpitations, nosebleeds, okhudzana ndi orthostatic hypotension, arrhythmias, bradycardia, vasculitis, angina pectoris, infarction ya myocardial,
• kugaya chakudya dongosolo: kutsegula m'mimba, kupweteka kwam'mimba, nseru, kukomoka, kupweteka kwa pakamwa, kugona, kusanza, kupweteka mano, kudzimbidwa, gastritis, flatulence, hepatitis, kuphwanya chiwindi ntchito.
• minofu: mafupa a minofu ya ng'ombe, kupweteka kwam'mbuyo ndi mwendo, nyamakazi, kupweteka kwa phewa, bondo, fibromyalgia,
• khungu: erythema, khungu lowuma, ecchymosis, photosensitivity, alopecia, kuchuluka thukuta,
• thupi lawo siligwirizana: zotupa pakhungu, kuyabwa, urticaria, angioedema (kuphatikizapo edema ya larynx, lilime),
• hematopoiesis: thrombocytopenia, eosinophilia, cholinga cha Schoenlein - Genoch, kuchepa pang'ono kwa hemoglobin ndi hematocrit,
• dongosolo lamanjenje: mutu, chizungulire, kugona, nkhawa, kugona, kusokonezeka kwa kukumbukira, kusokonezeka kwa kukumbukira, kupsinjika, kupsinjika kwa mitsempha, kunjenjemera, ataxia, kupsinjika, tinnitus, kukomoka, kusokonezeka kwa zowawa, migraine, conjunctivitis, kuwonongeka kwa mawonekedwe,
• kupuma dongosolo: chifuwa, pharyngitis, chifuwa, mphuno, sinusitis, chapamwamba kupuma thirakiti matenda,
• genitourinary system: kwamikodzo thirakiti matenda, kukodza kwamkodzo, matenda aimpso, kutsika kwa libido, kusabala,
• zina: asthenia, kupweteka pachifuwa, kutopa, zotumphukira edema, kukokomeza njira ya matenda amtundu,
• labotale magawo: hyperuricemia, kuchuluka kwa kuchuluka kwa urea, zotsalira za nayitrogeni ndi creatinine mu seramu yamagazi, kuwonjezeka kwa ntchito ya hepatic transaminases (zolimbitsa), hyperbilirubinemia.

Malangizo apadera

Inde, mukayamba kumwa Presartan, muyenera kukonza madzi obwera chifukwa cha mankhwalawa, mwachitsanzo, mutamwa mankhwala okodzetsa pamiyeso yambiri, ngati sizotheka kusintha BCC, kulandira chithandizo kuyenera kuyamba ndi mlingo wotsika wa mankhwalawa.

Mankhwala osokoneza bongo omwe amakhudza RAAS (renin-angiotensin-aldosterone system) amatha kuonjezera kuchuluka kwa urea m'magazi ndi seramu creatinine mwa odwala omwe ali ndi vuto la impso.

Kukopa pa kuthekera koyendetsa magalimoto ndi njira zowerengeka

Kafukufuku wapadera wazokhudzana ndi Presartan pakutha kuyendetsa magalimoto ndi njira zina zovuta sizinachitike. Komabe, kuganiziridwaku kuyenera kuthandizidwa pokonzekera zotsatira zoyipa, monga kugona ndi chizungulire, zomwe zimafunikira chisamaliro chowonjezereka mukamachita ntchito zomwe zingakhale zoopsa.

Kuyanjana kwa mankhwala osokoneza bongo

• potaziyamu wothandiza okodzetsa, kukonzekera kwa potaziyamu: chiopsezo chotenga hyperkalemia,
• okodzetsa: chiopsezo cha kutsika kwakukulu kwa kuthamanga kwa magazi,
• beta-blockers ndi sympatholytics: zimawonjezera zotsatira zawo,
• rifampicin, flucanazole: kuchepetsa kuchuluka kwa yogwira metabolite wa losartan m'magazi,
• lifiyamu: kuwonjezeka kwa kuchuluka kwake m'magazi ndikotheka,
• NSAIDs: kuchuluka kwa mankhwalawa kumachepetsa,
• Mankhwala ena a antihypertensive: mphamvu zawo zonsezo zimakhala zowonjezera.

Zofanizira za Prezartan ndi Brozaar, Blocktran, Vazotens, Zisakar, Kozaar, Lozap, Cardomin-Sanovel, Lozartan, Renikard, Lakea, Vero-Lozartan, Lorista.

Momwe mungagwiritsire ntchito: Mlingo ndi njira ya chithandizo

Mapiritsi a Presartan N amatengedwa pakamwa, ngakhale atamwa kwambiri.

Mlingo woyamba ndi kukonza ndi piritsi limodzi 12,5 mg + 50 mg 1 nthawi patsiku. Mulingo wapamwamba wa antihypertensive umatheka mkati mwa milungu itatu yamankhwala. Kuti mukwaniritse kutchulidwa kokwanira, ndizotheka kuwonjezera kuchuluka kwa mankhwalawa m'mapiritsi awiri pa mlingo wa 12,5 mg + 50 mg kamodzi patsiku. Pazipita tsiku lililonse mapiritsi awiri a Presartan N.

Kwa odwala omwe ali ndi magazi ochulukirapo (mwachitsanzo, mutamwa mankhwala ambiri), mlingo woyambira wa osartan wodwala ndi 25ovolemia ndi 25 mg kamodzi patsiku. Pankhaniyi, chithandizo ndi Presartan N ziyenera kuyambitsidwa atatha kuthetsedwa kwa okodzetsa ndi kukonza kwa hypovolemia.

Odwala okalamba ndi odwala omwe ali ndi vuto laimpso lokwanira, kuphatikizira omwe ali pa dialysis, palibe kusintha koyamba kwa mankhwala kofunikira.

Kuchepetsa chiopsezo cha kuchepa kwa mtima ndi kufa kwa odwala omwe ali ndi vuto losakanizira kwa magazi ndi kumanzere kwamitsempha yamagazi

Muyezo woyambira wa losartan ndi 50 mg 1 nthawi patsiku. Odwala omwe sakanakwanitsa kukhala ndi vuto la kuthamanga kwa magazi pomwe akumatenga losartan 50 mg / tsiku amafunikira chithandizo chophatikizana ndi losartan yokhala ndi Mlingo wochepa wa hydrochlorothiazide (12,5 mg), ndipo ngati pangafunike, onjezani mlingo wa losartan mpaka 100 mg kuphatikiza ndi hydrochlorothiazide pa mlingo wa 12,5 mg / tsiku, m'tsogolo - kuwonjezereka kwa mapiritsi 2 a mankhwala pa 50 / 12,5 mg wokwanira (100 mg ya losartan ndi 25 mg ya hydrochlorothiazide patsiku kamodzi).

Zotsatira za pharmacological

Presartan H ili ndi kuphatikiza kwa losartan ndi hydrochlorothiazide, zigawo zonse ziwiri zimakhala ndi mphamvu yowonjezera antihypertensive, kutsitsa kuthamanga kwa magazi (BP) kwakukulu kwambiri kuposa gawo lililonse palokha.

Losartan ndi angiotensin II receptor antagonist (subtype AT1) wowongolera pakamwa. Losartan ndi metabolacologic yogwira metabolite (E 3174) onse mu vitro komanso mu vivo amatseka zotsatira zonse za thupi za angiotensin II, posatengera magwero kapena njira ya kaphatikizidwe. Losartan amamangirira ku ma receptors a AT1 ndipo samamanga kapena kutseka ma receptor a mahomoni ena ndi ma njira a ion, omwe amathandiza kwambiri pakuwonetsa ntchito ya mtima. Kuphatikiza apo, losartan sichimalepheretsa enzyme yotembenuza (ACE) - kininase II, ndipo, motero, sichiletsa kuwonongeka kwa bradykinin, chifukwa chake zotsatira zoyipa zomwe zimagwirizanitsidwa ndi bradykinin (mwachitsanzo, angioedema) ndizosowa kwenikweni.

Mukamagwiritsa ntchito losartan, kusowa kwa chidwi cha mayankho olakwika pa renin secretion kumapangitsa kukulitsa kwa plasma renin. Kuwonjezeka kwa ntchito za renin kumabweretsa kuwonjezeka kwa angiotensin II m'madzi a m'magazi. Komabe, ntchito ya antihypertensive ndi kuchepa kwa kuchuluka kwa aldosterone m'magazi a magazi kumapitirira, zomwe zikuwonetsa kutsekeka kwothandiza kwa angiotensin II receptors. Losartan ndi metabolite yake yogwira amakhala ndi mgwirizano waukulu wa angiotensin I receptors kuposa angiotensin P. receptors. Metabolite yogwira imakhala yogwira kwambiri nthawi 10-5 kuposa losartan.

Pambuyo pakukonzekera kamodzi pamlomo, antihypertensive zotsatira (kuchepa kwa magazi a systolic ndi diastolic) zimafika pazitali pambuyo pa maola 6, kenako zimayamba kuchepa mkati mwa maola 24. Mulingo wambiri wa antihypertensive umayamba masabata 3-6 pambuyo pa kuyamba kwa mankhwalawa.

Hydrochlorothiazide - thiazide okodzetsa, amasokoneza kubwezeretsanso kwa sodium, chlorine, potaziyamu, ion ya magnesium mu distal nephron, kuchedwa kwa excretion ya calcium, uric acid. Kuwonjezeka kwa impso kuchulukitsa kwa ma ion amenewa kumayendera limodzi ndi kuchuluka kwa mkodzo (chifukwa cha kumanga kwa osmotic). Amachepetsa kuchuluka kwa madzi am'magazi, kumawonjezera ntchito ya plasma renin ndi secretion ya aldosterone. Mukamamwa mlingo waukulu, hydrochlorothiazide imawonjezera kuchuluka kwa ma bicarbonates, pomwe kugwiritsidwa ntchito nthawi yayitali kumachepetsa mphamvu ya calcium.

Mphamvu ya antihypertensive imayamba chifukwa cha kuchepa kwa kuchuluka kwa magazi ozungulira (BCC), kusintha kosinthika kwa khoma lamitsempha, kuchepa kwa mapanikizidwe a vasoconstrictor amines (adrenaline, norepinephrine) ndikuwonjezereka kwa kukhumudwitsa kwa ganglia. Sizikhudza kuthamanga kwa magazi. Mphamvu ya diuretic imawonedwa pambuyo pa maola 1-2, imafika pakatha maola 4 ndipo imatha maola 6-12. Antihypertensive zotsatira zimachitika m'masiku 3-4, koma masabata 3-4 amafunikira kuti akwaniritse bwino achire.

Mafunso, mayankho, ndemanga pa mankhwala a Presartan N

Zomwe zimaperekedwa zimakonzekera akatswiri azamankhwala komanso zamankhwala. Chidziwitso chokwanira chokhudza mankhwalawa chili m'malangizo omwe aphatikizidwa ndi wopanga. Palibe chidziwitso chomwe chatumizidwa patsamba lino kapena tsamba lililonse la tsamba lathu chomwe chingagwire ntchito ngati cholowa m'malo mwapadera kwa katswiri.

Kutulutsa mawonekedwe, ma CD ndi mawonekedwe a Presartan N

Mapiritsi, omwe amakhala achikaso chachikaso, ndi oval biconvex, pamtanda: pakati pake ndi kuyambira oyera mpaka oyera.

Othandizira: lactose monohydrate 111.50 mg, microcrystalline cellulose 58 mg, pregelatinized wowonda 3 mg, chimanga wowuma 12 mg, colloidal silicon diabetes 1 mg, magnesium stearate 2 mg.

Ma Shell:
hypromellose 2.441 g, titanium dioxide 0,60 mg, talc 1.50 mg, macrogol-6000 0.40 mg, quinoline chikasu utoto 0,058 mg.

14 ma PC. - matumba otumphuka (2) - mapaketi a makatoni.

Mlingo ndi makonzedwe

Ndi ochepa matenda oopsa, woyamba tsiku lililonse 25 mg, pafupifupi tsiku lililonse 50 mg, pafupipafupi makonzedwe ndi 1 nthawi / tsiku.

Kuzindikira kwakukulu kumayamba masabata 3-6 pambuyo pa kuyamba kwa mankhwalawa. Ngati ndi kotheka, mlingo wa mankhwalawa utha kuwonjezereka mpaka 1 00 mg patsiku. Pankhaniyi, n`zotheka kumwa mankhwala 2 pa tsiku.

Mlingo woyamba wa odwala omwe ali ndi vuto la mtima ndi 12,5 mg 1 nthawi / tsiku. Mwachizolowezi, mankhwalawa amakhala ochepa pakatikati pa sabata (mwachitsanzo 12,5 mg / tsiku, 25 mg / tsiku. 50 mg / tsiku) kwa pafupifupi makonzedwe a 50 mg 1 nthawi / tsiku, kutengera momwe wodwalayo amalolera.

Popereka mankhwala kwa odwala omwe amalandira kuchuluka kwa okodzetsa, muyeso woyamba uyenera kuchepetsedwa mpaka 25 mg 1 nthawi / tsiku.

Odwala omwe ali ndi vuto la chiwindi amayenera kupatsidwa mankhwala ochepa a losartan,

Okalamba odwala, komanso odwala mkhutu aimpso ntchito, kuphatikizapo odwala hemodialysis, palibe chifukwa chosinthira koyamba mlingo wa mankhwalawa.

Presartan imatha kutumizidwa molumikizana ndi mankhwala ena a antihypertensive. Losartan ikhoza kugwiritsidwa ntchito mosasamala kanthu zakudya.

Zotsatira zoyipa

Presartan nthawi zambiri imalekeredwa. Itha kuchitika: kutsekula m'mimba, kukomoka, kupweteka kwa minofu, kutupa, chizungulire, kusowa tulo, kupweteka mutu, hyperkalemia (potaziyamu m'magazi oposa 5.5 meq / l). Nthawi zina pamatha kukhala chifuwa, kulephera kupuma, tachycardia, angioedema (kuphatikizapo kutupa kwa nkhope, milomo, pharynx ndi / kapena lilime), urticaria, kuchuluka kwa transilase ya "chiwindi", bilirubin m'magazi.

Zolemba ntchito

Odwala kuchepa kwa madzi m'thupi (mwachitsanzo, kulandira chithandizo chokhala ndi kuchuluka kwa okodzetsa), kuwonetseredwa kwa chizindikiro chitha kuchitika kumayambiriro kwa chithandizo ndi Presartan. Ndikofunikira kukonza madzi osafunikira mkati musanayambitse chithandizo chamankhwala kapena kuyamba ndi mankhwala ochepa.

Zotsatira za pharmacological zimawonetsa kuti kuchuluka kwa losartan mu plasma pamisempha ya odwala omwe ali ndi matenda enaake a cirrhosis kumawonjezeka kwambiri, chifukwa chake, odwala omwe ali ndi mbiri ya matenda a chiwindi amayenera kupatsidwa mankhwala ochepa.

Mankhwala ena omwe amakhudza kipinapgiotensin dongosolo amatha kuwonjezera urea ndi serum creatinine mwa odwala omwe ali ndi vuto laimpso.

Sizikudziwika ngati losachedwa limapukusidwa mkaka wa m'mawere. Pokhazikika pokhazikitsidwa ndi mkaka wa msambo, lingaliro liyenera kuperekedwa poyimitsa kuyamwa kapena kusiya kumwa mankhwala.