The mankhwala Ibertan: malangizo ntchito

Mayina apadziko lonse lapansi - ibertan kuphatikiza

Kupanga ndi mawonekedwe a kumasulidwa.

Mapiritsi okhala ndi mafilimu, piritsi limodzi lili ndi hydrochlorothiazide - 12,5 mg, irbesartan - 150 mg.

Mapale zokutira filimu, 12,5 mg + 150 mg: 28 kapena 30 ma PC.

7 ma PC - matuza (4) - mapaketi a makatoni.
Ma PC 10 - matuza (3) - mapaketi a makatoni.
14 ma PC. - matuza (2) - mapaketi a makatoni.
15 ma PC. - matuza (2) - mapaketi a makatoni.

Zotsatira za pharmacological.

Ibertan Plus ndi mankhwala ophatikiza ndi antihypertensive kwenikweni. Kuphatikizikako ndikuphatikizapo angiotensin II receptor antagonist ndi thiazide diuretic. Kuphatikiza kwa mankhwalawa kumakhala ndi mphamvu yowonjezera ya antihypertensive, kumachepetsa kuthamanga kwa magazi kwakukulu kuposa mtundu uliwonse wa mankhwalawo mosiyana.

Irbesartan ndiwotsutsa wosankha wa angiotensin II receptors (mtundu wa AT1) woperekera pakamwa. Irbesartan imalepheretsa zovuta zonse zamapangidwe amtundu wa angiotensin II wolumikizidwa ndi receptors a AT1, mosasamala kanthu za gwero kapena njira ya kaphatikizidwe wa angiotensin II. Kusankha kosagwirizana ndi angiotensin II (AT1) zolandilira kumabweretsa kuwonjezeka kwa plasma kwa renin ndi angiotensin II komanso kuchepa kwa kuchuluka kwa aldosterone m'madzi a m'magazi. Zambiri za seramu potaziyamu nthawi zambiri sizisintha mukamayamwa irbesartan pa milingo yolimbikitsidwa; irbesartan sichimaletsa kininase II. Irbesartan sikufuna kagayidwe kachakudya. Amachepetsa kuthamanga kwa magazi ndi kusintha kocheperako pamtima.

Hydrochlorothiazide ndi thiazide okodzetsa. Zimakhudzanso kubwezeretsanso kwa ma electrolyte mu aimpso tubules, kukulitsa zowonjezera za zotumphukira zama sodium ndi chlorine mu pafupifupi zofanana. Mphamvu ya diuretic ya hydrochlorothiazide imabweretsa kuchepa kwamagazi am'magazi, kuwonjezereka kwa ntchito za renin m'magazi am'magazi, kuwonjezereka kwa secretion ya aldosterone komanso kuwonjezeka kwa zomwe zili mu potaziyamu ayoni ndi ma bicarbonate mkodzo ndi hypokalemia. Kuyendetsa munthawi yomweyo ndi irbesartan kumabweretsa kuchepa kwa kutayika kwa potonium ion, makamaka chifukwa cha blockade ya renin-angiotensin-aldosterone system. Mankhwala a hydrochlorothiazide amatengedwa pakamwa, kuwonjezeka kwa diuresis kumachitika pambuyo pa maola 2 ndikufika pazofunikira pambuyo maola 4. Kuchita kwa hydrochlorothiazide kumatha pafupifupi maola 6-12.

Kutsika kwa kuthamanga kwa magazi popanga mankhwala a irbesartan osakanikirana ndi hydrochlorothiazide kumawonekera kale mutayamba kumwa mankhwalawo mkati ndikukhala kwa masabata 1-2, ndikutsatira ndikuwonjezereka kwake pang'onopang'ono komanso kukula kwa mphamvu kwambiri pamasabata a 6-8.

Pharmacokinetics.

The munthawi yomweyo hydrochlorothiazide ndi irbesartan sizikhudza pharmacokinetics aliyense mankhwala.

Zogulitsa. Pambuyo pakukonzekera pakamwa, mtheradi wa bioavailability wa irbesartan ndi 60-80%, hydrochlorothiazide 50-80%. Kudya sikuwakhudza bioavailability wawo. Cmax ya irbesartan m'madzi a m'magazi amafikira pambuyo 1.5-2 mawola kukonzekera pakamwa, hydrochlorothiazide - pambuyo maola 1-2,5.

Kugawa. Irbesartan ndi 96% womanga mapuloteni a plasma. Voliyumu yogawa (Vd) ya irbesartan ndi malita 53-93. Ma paracokinetic magawo a irbesartan ali ofanana komanso olingana muyezo kuyambira 10 mg mpaka 600 mg. Pa Mlingo wapamwamba wa 600 mg (muyezo womwe umalimbikitsa mlingo wambiri), pharmacokinetics ya irbesartan imakhala yopanda ulalo (kuchepa kwa mayamwidwe).

Hydrochlorothiazide ndi 68% yomanga mapuloteni a plasma, V d - 0.83-1.14 l / kg.

Kupenda. Irbesartan imapangidwa mu chiwindi ndi conjugation ndi glucuronic acid ndi oxidation. Metabolite yake yayikulu yozungulira m'magazi ndi irbesartan g.tukuronid (pafupifupi 6%). Kafukufuku wa Invitro awonetsa kuti irbesartan imadutsa oxidation makamaka kudzera mu CYP2C9 isoenzyme ya cytochrome P450. Zotsatira za CYP3A4 isoenzyme ndizosatheka.

Hydrochlorothiazide sanapangidwe. Imalowa mkati mwa chotchinga ndikuyamwa mkaka wa m'mawere. Samadutsa chotchinga-magazi chotchinga magazi.

Kuswana. Chilolezo chokwanira ndi impso ndi 157-176 ndi 3.0-3.5 ml / min, motsatana. T1 / 2 ya irbesartan ndi maola 11-15. Irbesartan ndi metabolites ake amuchotsa m'matumbo (80%) komanso impso (20%). osakwana 2% ya mlingo wa irbesartan wotengedwa ndi impso osasinthika.

T 1/2 hydrochlorothiazide - maola 5 mpaka 5. Amatulutsidwa ndi impso. Peresenti ya 61 peresenti ya kamwa yakamwa simumasinthidwa mkati mwa maola 24.

Pharmacokinetics mu milandu yapadera yamankhwala. Pazitali zapamwamba za plasma za irbesartan zimawonedwa mwa amayi. Komabe, kusiyana kwa T1 / 2 kukondoweza kwa irbesartan sikunapezeke. Kusintha kwa mlingo wa Irbesartan mwa odwala wamkazi sikufunika.

Mfundo zake zinali pansi pa nthawi yopondera (AUC) ndi C max ya irbesartan m'magazi am'magazi anali ochepa kwambiri odwala okalamba (azaka zoposa 65) kuposa odwala ang'onoang'ono (osakwana zaka 65). T 1/2 irbesartan sizinasiyane kwambiri. Mlingo kusintha kwa irbesartan mwa okalamba odwala safunika.

Kuwonongeka kwa impso: odwala omwe ali ndi vuto la impso kapena akudwala hemodialysis, magawo a pharmacokinetic a irbesartan amasintha pang'ono.

Kuchepa kwa chiwindi ntchito: odwala omwe ali ndi vuto la chiwindi chofatsa kapena zovuta, mapiritsi a pharmacokinetic a irbesartan amasintha pang'ono. Odwala omwe ali ndi vuto la chiwindi kwambiri, palibe maphunziro omwe adachitidwa.

Matenda oopsa a arterial (mankhwalawa odwala omwe akuwonetsedwa kuphatikiza mankhwala).

Mlingo komanso njira yogwiritsira ntchito Ibertan kuphatikiza.

Mkati, kamodzi patsiku, osasamala za chakudya. Ibertan Plus 12.5 / 150 mg (mapiritsi okhala ndi hydrochlorothiazide / irbesartan 12. 5/150 mg, motsatana) angathe kutumizidwa kwa odwala omwe magazi awo samayendetsedwa mokwanira ndikusankhidwa kwa hydrochlorothiazide okha (12.5 mg / tsiku) kapena irbesartan ( 150 mg / tsiku) mu monotherapy. Ibertan Plus 12,5 / 300 mg (mapiritsi okhala ndi hydrochlorothiazide / nrbesartan 12. 5/300 mg, motsatana) atha kutumizidwa kwa odwala ngati magazi sayendetsedwa mokwanira ndi irbesartan (300 mg / tsiku) kapena Ibertan Plus (12, 5/150 mg).

Ibertan Plus 25-300 mg (mapiritsi okhala ndi hydrochlorothiazide / irbesartan 25/300 mg, motsatana) atha kupatsidwa mankhwala ngati magazi sayendetsedwa mokwanira ndi kayendetsedwe ka Ibertan Plus (12. 5/300 mg). Poika Mlingo woposa 25 mg wa hydrochlorothiazide / 300 mg wa irbesartan 1 nthawi patsiku osavomerezeka. Ngati ndi kotheka, mankhwala Ibertan Plus angathe kuthandizidwa molumikizana ndi mankhwala ena a antihypertensive.

Kuwonongeka kwa impso: chifukwa chakuti mankhwala a Ibertan Plus amaphatikiza hydrochlorothiazide. Mankhwala sakuvomerezeka kwa odwala omwe ali ndi vuto la kuchepa kwa impso (creatinine chilolezo cha 30 ml / min. Kuwonongeka kwa chiwindi: Ibertan Plus) silivomerezeka kwa odwala omwe ali ndi vuto lalikulu la chiwindi. Mlingo wa Ibertan Plus sufunikanso .. Okalamba okalamba: kusintha kwa Ibertan Plus sikofunikira kwa odwala okalamba. Ndi Ibertan Plus, ndikofunikira kusintha kuchuluka kwa magazi ndi / kapena zinthu za sodium.

Zotsatira zoyipa ibertana kuphatikiza.

Zotsatira zoyipa zotsatirazi zimaperekedwa molingana ndi kutsatizanatsatizana kwatsatanetsatane wa zomwe zimachitika: nthawi zambiri (> 1/10), nthawi zambiri /> 1/100, 1/1 000, 1/10 000, 30 ml / min.

Kugwiritsa ntchito mankhwala kwa ana.

Odwala ana osakwana zaka 18.

Gwiritsani ntchito odwala okalamba.

Palibe kusintha kwa mlingo wa Ibertan Plus mwa okalamba odwala.

Malangizo apadera a kuvomerezedwa ibertana kuphatikiza.

Odwala ochepa ochepa hypotension ndi kuchepetsedwa magazi magazi: Odwala ochepa matenda oopsa, Ibertan Plus samakonda kuyambitsa ochepa hypotension. Zizindikiro zamitsempha yamagazi zimatha kuwonetsedwa mwa odwala omwe ali ndi magazi ochepa kapena ochepa sodium panthawi ya diuretic mankhwala, ndikudya komwe kumachepetsa mchere, ndimatumbo kapena kusanza. Zinthu ngati izi ziyenera kukonzedwa musanayambe mankhwala ndi Ibertan Plus.

Zotsatira za metabolism ndi endocrine. Liazardic diuretics imatha kuchepetsa kulolera kwa glucose. Odwala omwe ali ndi matenda ashuga, kusintha kwa mankhwala a insulin kapena hypoglycemic kwa pakamwa kungafunike. Pogwiritsa ntchito thiazide diuretics, kukulitsa kwa matenda abwinobwino a shuga kumatha.

Pa mankhwala ndi thiazide okodzetsa, hyperuricemia kapena kuchulukitsa kwa gout kumatha kuchitika mwa odwala ena.

Kuphwanya mulingo wamagetsi wamadzi. Thiazide okodzetsa, kuphatikizapo hydrochlorothiazide. zimatha kuyambitsa kuphwanya kwamanja-electrolyte bwino (hypokalemia, hyponatremia ndi hypochloremic alkalosis). Ngakhale kukula kwa hypokalemia ndikotheka ndi thiazide diuretics, kugwiritsa ntchito limodzi ndi irbesartan kungachepetse hypokalemia yoyambitsidwa ndi diuretic. Chiwopsezo cha hypokalemia chimachulukitsidwa mwa odwala omwe amalandira glucocorticosteroids kapena adrenocorticotropic mahomoni. Osatengera izi, chifukwa cha irbesartan, yomwe ndi gawo la Ibertan Plus kukonzekera, Hyperkalemia ndiyotheka, makamaka pakakhala kulephera kwa impso komanso / kapena kulephera kwa mtima kapena matenda ashuga. Kuwunikira pafupipafupi kwa seramu potaziyamu odwala omwe ali pachiwopsezo akulimbikitsidwa.

Thiazide okodzetsa amachepetsa kuchulukitsidwa kwa calcium ion ndi impso ndikuyambitsa kuchepa kwa hypercalcemia chifukwa chosagwirizana ndi kuwonongeka kwa calcium. Hypercalcemia yayikulu ikhoza kuwonetsa latent hyperparathyroidism. Liazide diuretics iyenera kuyimitsidwa isanachitike maphunziro a parathyroid ntchito.

Zawonetsedwa kuti thiazide diuretics imatha kuwonjezera kuchuluka kwa ma impion a magnesium ndi impso, zomwe zingayambitse kukula kwa hypomagnesemia.

Kukonzanso kwamphamvu kwamphamvu. Odwala omwe ali ndi vuto limodzi lokhala ndi mafupa a stenosis kapena ochepa a stenosis, akamwa mankhwala omwe amakhudza RAAS, pamakhala chiwopsezo chokhala ndi ochepa owopsa komanso aimpso kulephera. Ngakhale zambiri zotere sizinapezeke mukutenga Ibertan Plus, zotsatira zofananazi zimatha kuyembekezeredwa pakugwiritsa ntchito angiotensin II receptor antagonists.

Kulephera kwamkati ndi momwe pambuyo pakuwonekera kwa impso. Pankhani ya kugwiritsa ntchito mankhwala Ibertan Plus odwala mkhutu aimpso ntchito, kuwunika kwa potaziyamu, creatinine ndi uric acid mu magazi seramu. Palibe zokuchitikirani pakugwiritsa ntchito Ibertan Plus mwa odwala pambuyo pakuwonjezera impso kwaposachedwa.

Aortic kapena mitral valve stenosis, hypertrophic obstriers cardiomyopathy. Monga momwe zimakhalira ndi ma vasodilator ena, kusamala ndikofunikira popereka Ibertan Plus kwa odwala aortic kapena mitral stenosis kapena hypertrophic obstriers Cardiomyopathy.

Hyperaldosteronism yoyamba. Mankhwala a antihypertensive ochita kudzera mwa kulepheretsa kwa dongosolo la renin-angiotensin-aldosterone nthawi zambiri amakhala osagwira ntchito kwa odwala omwe ali ndi hyperaldostronism yoyamba. Chifukwa chake, kugwiritsa ntchito mankhwala a Ibertan Plus pazinthu zoterezi ndizopanda tanthauzo.

Kuyeserera: hydrochlorothiazide ikhoza kuyambitsa zotsatira zabwino pakuwongolera.

Zina. Monga mankhwala ena a antihypertensive omwe amakhudza dongosolo la renin-angiotensin-aldosterone, kuchepa kwakukulu kwa kuthamanga kwa magazi kwa odwala omwe ali ndi matenda a mtima komanso / kapena atherosulinosis ya mitsempha yaubongo kungayambitse kukulira kwa myocardial infarction kapena stroke. Chithandizo cha odwala chotere chikuyenera kuchitika ndi ayodini ndi kayendetsedwe ka magazi.

Pali malipoti akuwonjezereka kapena kuchulukitsa kwa makina a systemic lupus erythematosus poika ma thiazide okodzetsa.

Zokhudza mphamvu pakutha kuyendetsa magalimoto ndikugwira ntchito ndi njira

Zotsatira za Ibertan Plus pa luso loyendetsa magalimoto ndi kugwira ntchito yofunika chidwi sizinaphunziridwe. Komabe, munthawi yakumwa mankhwalawa, muyenera kusamala mukamayendetsa magalimoto ndikugwiritsa ntchito zida, chifukwa nthawi yozizira komanso kufinya kumatheka.

Bongo.

Zizindikiro (akuganiziridwa): irbesartan - kuchepa kwa magazi, tachycardia, bradycardia. Hydrochlorothiazide - hypokalemia, hyponatremia, kuchepa madzi m'thupi chifukwa cha kupukusa kwambiri kwa thupi. Mawonekedwe ambiri a bongo ndi mseru ndi kugona. Hypokalemia imatha kuyambitsa kukhudzidwa ndi / kapena kukulira kwa mtima wamagulu omwe amaphatikizidwa ndi kugwiritsidwa ntchito kwa mtima wama glycosides ndi mankhwala a antiarrhythmic.

Chithandizo: zimatengera nthawi yomwe idadutsa kuyambira nthawi yoyang'anira ndi kutha kwa chizindikirocho. Njira zomwe akuyembekezerazi zimaphatikizira kutsuka komanso / kapena kupukusa kwam'mimba, kugwiritsa ntchito kaboni yokhazikitsidwa, kuyang'anira mosamala mkhalidwe wa wodwalayo, komanso kuthandizira pochiza odwala. Ndikofunikira kuwongolera kuchuluka kwa ma electrolyte ndi creatinine m'madzi a m'magazi. Pofuna kukhazikika kwa kuthamanga kwa magazi, wodwalayo azigoneka kumbuyo kwake ndikutukuka pang'ono komanso kuti athe kubwezeretsa mchere ndi madzi. Irbesartan samatulutsidwa panthawi ya hemodialysis.

Kuchita ndi mankhwala ena.

Mankhwala ena a antihypertensive: mphamvu ya antihypertensive ya mankhwala Ibertan Plus ingalimbikitsidwe ndi kugwiritsidwa ntchito kwa mankhwala ena a antihypertensive. Hydrochlorothiazide ndi irbesartan (muyezo mpaka 25 mg wa hydrochlorothiazide / 300 mg wa irbesartan) atha kugwiritsidwa ntchito mosagwirizana ndi mankhwala ena a antihypertensive, kuphatikizapo "pang'onopang'ono" calcium blockers ndi beta-blockers. M'mbuyomu ankalandiridwa ndi Mlingo wambiri wokodzetsa umatha kusokoneza msana ndipo zimawonjezera chiopsezo cha kuchepa kwa mtima.

Lithium: Pali malipoti akuwonjezeranso kusintha kwa kuchuluka kwa ma seramu ndi kuwonongeka kwa mankhwalawa pogwiritsa ntchito kukonzekera kwa lithiamu ndi angiotensin-kutembenuza ma enzyme inhibitors. Kwa irbesartan, zotsatira zofananazi sizinakhalepo kwambiri mpaka pano. Kuphatikiza apo, chiwonetsero chaimpso cha lithiamu chimatsika ndikugwiritsidwa ntchito kwa thiazide diuretics, kotero pamene Ibertan Plus ikafotokozedwa, pamakhala chiwopsezo chokhala ndi zotsatira za poizoni. Ngati cholinga cha kuphatikiza uku ndikofunikira, tikulimbikitsidwa kuwunika mosamala pazomwe zili mu seramu yamagazi.

Mankhwala omwe amakhudza potaziyamu m'magazi: Hypokalemic mphamvu ya hydrochlorothiazide imafooketsedwa ndi potaziyamu woteteza mphamvu ya irbesartan.Komabe, izi za hydrochlorothiazide zitha kupitilizidwa ndi mankhwala ena, cholinga chomwe chimalumikizidwa ndi kuchepa kwa potaziyamu ndi gnococalpemia (mwachitsanzo, diuretics, laxatives, amphotericin, carbenoxolone, penicillin G sodium, zotumphukira za asidi wa salicelic acid) M'malo mwake, potengera zomwe zimachitika pochepetsa ntchito. Angiotensin-aldosterone dongosolo, wogwiritsa ntchito potaziyamu wochepa. x dpureshkov. oiologically yogwira zina, potaziyamu amchere othandizira, kapena mankhwala ena omwe angapangitse kuchuluka kwa seramu potaziyamu (monga heparin sodium) kungayambitse kuchuluka kwa serum Katya. Ndikulimbikitsidwa kuti kuwunika koyenera kwa seramu potaziyamu mu odwala omwe ali ndi vuto la hyperkalemia.

Mankhwala omwe amakhudzidwa ndi kuphwanya kwa potaziyamu mu seramu yamagazi: Ndikulimbikitsidwa kuti kuwunikira mosamala zomwe zili mu seramu yamagazi zipangidwe pomwe Ibertan Plus imayikidwa limodzi ndi mankhwala omwe amakhudzidwa ndikuphwanya kwa potaziyamu mu seramu yamagazi (mwachitsanzo, glycosides ya mtima, antiarrhythmic mankhwala.

Mankhwala osokoneza bongo oletsa kuponderezana: Mukamapereka mankhwala othandizira kupikisana ndi angotensin II receptor motsutsana ndi mankhwala osagwiritsa ntchito mankhwala osokoneza bongo (mwachitsanzo, osankha ma cycloo oxygenase-2 inhibitors (COX-2), acetylsalicylic acid (> 3 g / tsiku) komanso osagwiritsa ntchito mankhwala osokoneza bongo omwe amaletsa kusintha kwa antihypertgent. Monga ntchito ndi angiotensin potembenuza enzyme zoletsa ndi angiotensin II receptor antagonists osakanikirana ndi NSAIDs, pali chiwopsezo chowonjezeka chaimpso ntchito, mpaka kukulira kwa kupweteka kwa impso, kuchuluka kwa potaziyamu, makamaka makamaka kwa odwala omwe ali ndi vuto la impso. Kuphatikiza kwa mankhwalawa kuyenera kuyikidwa mosamala, makamaka kwa okalamba. Odwala sayenera kuchepetsedwa madzi. Kuwunika ntchito kwamkati kumayenera kuchitika pambuyo poyambira kuphatikiza mankhwalawa komanso mtsogolo.

Zambiri pazokhudzana ndi mankhwala a irbesartan: hydrochlorothiazide sichikhudza pharmacokinetics ya irbesartan. Popanga mankhwala a irbesartan osakanikirana ndi warfarin, omwe amapangidwa ndi oyambitsa a CYP2C9 isoenzyme, palibe kuphatikizana kwakukulu kwa pharmacokinetic ndi pharmacodynamic komwe kunapezeka. Zotsatira za CYP2C9 isoenzyme inducers, monga rifampicin, pa pharmacokinetics of irbesartan sizinawunikidwe. Ndi kusankha kwa irbesartan kuphatikiza ndi digoxin, ma pharmacokinetics omaliza sanasinthe.

Zambiri pazokhudzana ndi mankhwala a hydrochlorothiazide:

Mankhwala otsatirawa amatha kuyanjana ndi thiazide diuretics pamene akupereka:

Ethanol, barbiturates kapena mankhwala osokoneza bongo: kuchuluka kwa orthostatic hypotension kumawonedwa.

Catecholamines (mwachitsanzo, norepinephrine): mphamvu ya mankhwalawa itha kuchepetsedwa.

Kupuma kosakhumudwitsa minofu (mwachitsanzo tubocurarine): hydrochlorothiazide imatha kuyambitsa mavuto obwera chifukwa chosapondereza minofu.

Hypoglycemic mankhwala (omwe amakamwa pakamwa ndi insulin): mlingo kusintha kwa hypoglycemic wothandizila angafunike.

Colestyramine ndi colestipol: pamaso pa anion kusinthana mains, mayamwidwe a hydrochlorothiazide amasokonezeka. The pakati pakati kumwa mankhwalawa ayenera kukhala osachepera 4 maola.

Glucocorticosteroids, adrenocorticotropic timadzi: kuphwanya kwamphamvu kwa-electrolyte bwino, makamaka, kuchuluka kwa hypokalemia.

Mankhwala opha gout: kukonza mankhwala ochulukirapo omwe amagwiritsidwa ntchito pochiritsa gout kungafunike, popeza hydrochlorothiazide imatha kuonjezera uric acid m'madzi a m'magazi. Kuwonjezeka kwa kuchuluka kwa phenenenide kapena sulfinpyrazone kungafunike. Kugwirizana ndi thiazide okodzetsa kungawonjezere zochitika za hypersensitivity zimachitika ku allopurinol.

Mchere wa calcium thiazide diuretics imatha kuwonjezera calcium calcium chifukwa cha kuchepa kwa kutulutsa kwake. Ngati kuli kofunikira kupatsa mankhwala othandizira calcium kapena mankhwala omwe amakhudza calcium (mwachitsanzo, vitamini D), ndikofunikira kusintha mlingo wa mankhwalawa moyenera ndikuwongolera calcium zomwe zili m'madzi a m'magazi.

Mitundu ina yamagulu osokoneza bongo: thiazide diuretics imatha kupititsa patsogolo hyperglycemic ya beta-blockers ndi diazoxide. Anticholinergics (mwachitsanzo, atropine) amatha kuwonjezera kukhudzika kwa diazture wa thiazide pochepetsa m'mimba komanso kuchepa kwa m'mimba. Liazide diuretics imatha kukulitsa chiopsezo chosinthana ndi amantadine. Thiazide diuretics imatha kuchepetsa kuchuluka kwa mankhwala a cytotoxic ndi impso (mwachitsanzo, cyclophosphamide, methotrexate) ndikuwonjezera mphamvu yanga ya myelosuppressive.

Malo opumulira ochokera ku malo ogulitsa mankhwala.

Migwirizano ndi magwiritsidwe akusungidwa.

Kutentha kopitilira 25 ° C. Pewani kufikira ana. Moyo wa alumali ndi zaka 2.

Kugwiritsa ntchito ibertan ya mankhwala kuphatikiza pokhapokha ngati dokotala angafotokozere, malongosoledwe amaperekedwa kuti awathandize!

Contraindication

- Hypersensitivity kwa irbesartan kapena zigawo zina za mankhwala,

- cholowa galactose tsankho, kuchepa kwa lactase kapena malabsorption a shuga ndi galactose,

- zaka mpaka 18 (kuchita bwino ndi chitetezo sizinakhazikitsidwe).

Hyponatremia, kudya komwe kumaletsa kuchuluka kwa mchere, mgwirizano wamitsempha wamitsempha kapena kupindika kwamitsempha imodzi yothandizirana impso, kuchepa kwa magazi (kuphatikizapo kutsekula m'mimba, kusanza), chithandizo cham'mbuyomu, kuperewera kwa impso, kusowa kwa hemodialysis kwambiri kulephera kwa chiwindi (kusowa kwa zachipatala), hyperkalemia, kugwiritsa ntchito limodzi ndi kukonzekera kwa lithiamu, stenosis yamitsempha yamagetsi ndi mitral, gy pertrophic obstriers cardiomyopathy (GOKMP), hyperaldosteronism yayikulu, kusakhazikika kwa mtima (NYHA kalasi yachitatu-IV kalasi yogwira ntchito), matenda a mtima (CHD) ndi / kapena atherosranceotic cerebrovascular matenda, odwala okulirapo kuposa zaka 75.

Kufotokozera kwamachitidwe a pharmacological

Antihypertensive wothandizira, angiotensin II receptor antagonist. Imatseka ma receptors a AT1, omwe amatsogolera kuchepa kwa zotsatira zoyipa za angiotensin II, kuphatikizapo vasoconstrictor kwenikweni, zolimbikitsa kwambiri kutulutsidwa kwa aldosterone ndi kutsegula kwa mtima wachifundo dongosolo. Zotsatira zake, kuthamanga kwa magazi kumachepa.

Kuchepetsa OPSS, kumachepetsa pambuyo. Amachepetsa kuthamanga kwa magazi (kusintha pang'ono pamlingo wamtima) komanso kuthamanga kwa magazi m'mapapo, ndipo kuchepa kwa kuthamanga kwa magazi kumadalira mlingo.

Zilibe kukhudzana ndi kuchuluka kwa triglycerides, zomwe zimakhala za cholesterol, glucose, uric acid m'madzi am'magazi kapena zotupa za uric acid mkodzo.

Mankhwala

Makulidwe kwambiri komanso osasinthika otsekera angiotensin II receptors (subtype AT1).

Amathetsa vasoconstrictor mphamvu ya angiotensin II, amachepetsa kuchuluka kwa aldosterone mu plasma, amachepetsa OPSS, pambuyo pake pa mtima, zokhudza zonse magazi ndi kuthamanga kwa magazi m'mapapo.

Zisakhudze kinase II (ACE), yomwe imawononga bradykinin ndipo ikuphatikizidwa ndikupanga angiotensin II.

Imagwira pang'onopang'ono, pakadutsa kamodzi, mphamvu kwambiri imayamba pambuyo pa maola 3-6.

Antihypertensive effect imapitilira maola 24.

Ndi kugwiritsa ntchito nthawi zonse mkati mwa masabata 1-2, zotsatira zake zimakhala zolimba ndikufikira patatha masabata 4-6.

Pharmacokinetics

Pambuyo pakukonzekera pakamwa, imatengedwa bwino kwambiri kuchokera m'mimba. Cmax ya irbesartan m'madzi am'magazi imatheka 1.5-2 maola atatha kumwa. Bioavailability ndi 60-80%. Kudya panthawi imodzi sikukhudza kuyanjana kwa irbesartan.

Kuphatikiza kwa mapuloteni a Plasma kuli pafupifupi 96%. Vd - malita 53-93. Css imafikiridwa patatha masiku atatu mutangoyamba kutenga irbesartan 1 nthawi / Ndi Mlingo wobwereza wa 1 nthawi / pali kuchuluka kwa irbesartan mu plasma (osachepera 20%).

Pambuyo pakulowetsa 14C-irbesartan, 80-85% ya radioacaction m'magazi oyendayenda imagwera pa irbesartan yosasinthika.

Irbesartan imapangidwa mu chiwindi ndi conjugation kuti apange glucuronide ndi oxidation. Metabolite yayikulu ndi irbesartan glucuronide (pafupifupi 6%).

Mothandizidwa ndi kuchuluka kwa mankhwalawa, irbesartan imadziwika ndi ozungulira a pharmacokinetics, pomwe T1 / 2 m'magawo okonzekera amakhala maola 11 mpaka 15. Chilolezo chokwanira ndi kupezekanso kwa impso ndi 157-176 ml / min ndi 3-3.5 ml / min, motsatana. Irbesartan ndi metabolites ake amuchotsa mu ndulu ndi mkodzo.

Odwala omwe ali ndi vuto la impso, zolimbitsa thupi, mapiritsi a pharmacokinetic a irbesartan sanasinthe kwambiri.

Zotsatira zoyipa

Kuchokera kumachitidwe amanjenje ndi ziwalo zam'maganizo: ≥1% - mutu, chizungulire, kutopa, nkhawa / kusangalala.

Kuchokera pamtima ndi magazi (hematopoiesis, hemostasis): ≥1% - tachycardia.

Kuchokera pakapumidwe: ≥1% - matenda amtundu wa kupuma pamatenda (malungo, zina), sinusopathy, sinusitis, pharyngitis, rhinitis, chifuwa.

Kuchokera pamimba yokhudza kugaya chakudya: ≥1% - kutsegula m'mimba, kusanza, kusanza, zizindikiro zam'mimba, kutentha kwa mtima.

Kuchokera ku minculoskeletal system: ≥1% - ululu wamphongo (kuphatikizapo myalgia, kupweteka m'mafupa, pachifuwa).

Zotsatira zoyipa: ≥1% - zidzolo.

Zina: ≥1% - kupweteka pamimba, matenda amkodzo.

Mlingo ndi makonzedwe

Mlingo woyambirira ndi 150 mg, ngati kuli kotheka, onjezani mlingo mpaka 300 mg. Nthawi zina (hypochloride zakudya, mankhwala okodzetsa ena, mankhwala asanakwane kusanza kapena kutsegula m'mimba, hemodialysis), pang'onopang'ono mlingo woyambirira umagwiritsidwa ntchito.

Irbesartan amatengedwa pakamwa nthawi 1 / tsiku, makamaka nthawi yomweyo.

Kuchita ndi mankhwala ena

Pogwiritsa ntchito munthawi yomweyo mankhwala osokoneza bongo a potaziyamu, kukonzekera kwa potaziyamu, kuchuluka kwa potaziyamu m'magazi a m'magazi ndikotheka.

Pogwiritsa ntchito munthawi yomweyo ndi hydrochlorothiazide, mawonekedwe owonjezera a hypotensive zotsatira amawonekera.

Pogwiritsa ntchito munthawi yomweyo ndi lithiamu carbonate, kuwonjezereka kwa ndende ya lithiamu m'madzi a m'magazi ndikotheka.

Ndi munthawi yomweyo kugwiritsa ntchito fluconazole kungalepheretse kagayidwe ka irbesartan.

Njira zopewera kugwiritsa ntchito

Amagwiritsidwa ntchito mosamala odwala omwe ali ndi hyponatremia (mankhwala othandizira okodzetsa, kutsekeka kwa mchere wambiri ndi zakudya, kutsegula m'mimba, kusanza), mwa odwala hemodialysis (kukulitsa kwa hypotension ya dalili ndikotheka), komanso kwa odwala omwe alibe madzi m'thupi.

Chenjezo liyenera kuchitika kwa odwala omwe akukonzanso matenda oopsa chifukwa cha mtima wamitsempha. Matenda a impso imodzi (chiwopsezo chachikulu cha kufooka kwa magazi komanso kulephera kwa aimpso), aortic kapena mitral stenosis, hypertrophic cardiomyopathy, kugunda kwamtima kwambiri (gawo III - IV NYHA) ndi matenda a mtima (chiwopsezo chowonjezereka cha myocardial infarction, angina pectoris).

Malinga ndi maziko aimpso kuwonongeka, kuyanʻanila serum potaziyamu ndi creatinine wambiri akulimbikitsidwa.

Sizikulimbikitsidwa kwa odwala omwe ali ndi vuto lalikulu la hyperaldosteronism, omwe ali ndi vuto lalikulu la impso (palibe chokumana nacho chachipatala), mwa odwala omwe akuwonjezeka impso (osadziwa zamankhwala).

Malangizo apadera a kuvomerezedwa

Pakafukufuku woyeserera wa nyama yothandizira, mutagenic, clastogenic, ndi carcinogenic zotsatira za irbesartan sizinakhazikitsidwe.

Kukopa pa kuyendetsa magalimoto ndi kayendedwe kazinthu

Palibe zomwe zikuwonetsa kuti irbesartan imayendetsa bwanji magalimoto ndikugwiritsa ntchito makina.

Mankhwala ofanana:

• Mapale a Berlipril (Berlipril)
• Mapiritsi a Moxogamm (Moxogamm) Oral
• Diacordin 60 (Diacordin 60) mapiritsi amlomo
• Captopril-AKOS (Captopril-AKOS) mapiritsi amlomo
• Moxonitex (Moxonitex) Mapale amlomo
• Adelphan-Esidrex (Adelphane-Es> Mapiritsi
• Captopril (Captopril) Mapiritsi amlomo
• Valz (mapiritsi amkamwa)
• Mapiritsi a Orz H H (Valz H)
• Moxonidine (Moxon> Mapiritsi a Oral

** Maupangiri a Mankhwala ndi a zidziwitso zokha. Kuti mumve zambiri, chonde onani zomwe akupanga. Osadzilimbitsa nokha, musanayambe kugwiritsa ntchito Ibertan, muyenera kufunsa dokotala. EUROLAB sikuti ali ndi vuto pazotsatira zomwe zimadza chifukwa chogwiritsa ntchito chidziwitso chomwe chatumizidwa pa tsamba. Zomwe zili patsamba lililonse sizilowa m'malo mwa upangiri waudokotala ndipo sizingakhale chitsimikizo cha mankhwala.

Chidwi cha Ibertan? Kodi mukufuna kudziwa zambiri kapena muyenera kukaonana ndi dokotala? Kapena mukufuna kuyesedwa? Mutha kutero pangana ndi adokotala - Euro yachipatala labu nthawi zonse pantchito yanu! Madotolo abwino amayeserera, kukulangizani, kukupatsani chithandizo choyenera ndikupanga matenda. Mukhozanso Itanani dokotala kunyumba. Chipatala cha Euro labu tsegulani kwa inu nthawi yonse yoyandikira.

** Tcheru! Zomwe zawonetsedwa mu bukhuli zamankhwala ndizothandiza akatswiri azachipatala ndipo siziyenera kukhala chifukwa chodzidziwira nokha. Kufotokozera kwa mankhwala Ibertan amaperekedwa kuti amve zambiri ndipo sanapangidwe kuti akupatseni mankhwala popanda kutenga dokotala. Odwala amafunikira upangiri waluso!

Ngati mukufunabe mankhwala ndi mankhwala ena aliwonse, mafotokozedwe awo ndi malangizo ogwiritsira ntchito, chidziwitso cha kapangidwe ndi mawonekedwe amamasulidwe, zikuwonetsa ntchito ndi zovuta zake, njira zogwiritsira ntchito, mitengo ndi kuwunika kwa mankhwala, kapena kodi muli ndi mafunso ena ndi malingaliro - tilembereni, tiyesetsa kukuthandizani.

Kutulutsa mafomu ndi kapangidwe kake

Mutha kugula othandizira antihypertensive m'mapiritsi okhala ndi filimu. Ntchito yogwira ntchito ndi irbesartan. Chipangizocho ndi chimodzi chimodzi, zomwe zikutanthauza kuti zida zotsalira sizikuwonetsa ntchito ya antihypertensive. The kuchuluka kwa irbesartan piritsi 1: 75, 150 ndi 300 mg. Mutha kugula mankhwalawo m'matumba (14 ma PC.). Bokosi lamatoni lili ndi mapepala awiri a cell.

Zotsatira za pharmacological

Mankhwala amapereka hypotensive kwenikweni. Chopanga chachikulu pakuphatikizika kwake chimagwira ngati wogwirizira wa receptor. Izi zikutanthauza kuti irbesartan imasokoneza machitidwe a angiotensin II receptors, omwe amathandizira kuti makhoma azigawo amitsempha yamagazi (amachepetsa chilolezo cha mitsempha, mitsempha). Zotsatira zake, kuchuluka kwa magazi kumatsika pang'ono.

Ntchito ya mtundu 2 angiotensin sikuti kuchepa kwamitsempha yamagazi kokha komanso kuwonjezeka kwa kukakamiza, komanso malamulo a kuphatikiza kwa maselo ndi kutsatira kwawo. Kugwirizana kwa ma receptor ndi timadzi timeneti timalepheretsa kupanga kwa nitric oxide, yomwe ndi chinthu champhamvu kwambiri. Mothandizidwa ndi Ibertan, njira zomwe zafotokozedwazo zimachepetsa.

Kuphatikiza apo, pali kuchepa kwa kuchuluka kwa aldosterone. Awa ndi mahomoni a gulu la mineralocorticoid. Zimapangidwa ndi adrenal cortex.Ntchito yake yayikulu ndikuwongolera mayendedwe a sodium ndi potaziyamu cations ndi anyezi a chlorine. Hormoni iyi imathandizira katundu wamtunduwu monga hydrophilicity. Aldosterone imapangidwa ndi kutenga mtundu wa angiotensin wa 2. Chifukwa chake, ndi kuchepa kwa ntchito yotsirizira, kugwira ntchito kwa mahomoni oyambilira kumachepetsa.

Mankhwala amapereka hypotensive kwenikweni.

Komabe, palibe zoyipa zilizonse pa kinase II, zomwe zimakhudzidwa ndikuwonongeka kwa bradykinin ndikuthandizira kupanga mtundu wa 2 angiotensin. Irbesartan ilibe gawo lalikulu pamlingo wamtima. Zotsatira zake, chiopsezo cha zovuta kuchokera ku mtima sichikukula. Zadziwika kuti chida chomwe chikufunsidwa sichikhudza kupanga kwa triglycerides, cholesterol.

Ndi chisamaliro

Zowerengeka zingapo zawonedwa, momwe ndikofunikira kuwonetsa chidwi, kuphatikiza:

• kuphwanya kayendedwe ka sodium cato,
• Zakudya zopanda mchere
• aimpso ntchito, makamaka, kuchepetsa kwa lumen mtsempha wamagazi,
• Kuchulukitsa kwamadzi kuchokera mthupi, kuphatikiza matenda, limodzi ndi kusanza, kutsekula m'mimba,
• kugwiritsidwa ntchito kwaposachedwa kwa thiazide diuretics,
• kuchira pambuyo kufalitsa impso,
• Kuchepetsa kudutsa kwa magazi kudzera ma mitral, ma aligilamu aortic, omwe amatha chifukwa cha stenosis,
• Kugwiritsa ntchito nthawi imodzi ndi kukonzekera kokhala ndi lifiyamu,
• matenda endocrine amagwirizana ndi kuwonongeka kwa aldosterone kaphatikizidwe,
• kusintha kwa ma atherosulinotic
• matenda a mtima dongosolo: ischemia, kuchepa kwa ntchito ya thupilo.

Mochenjera, mankhwalawa amapatsidwa matenda a mtima.

Kutenga Ibertan?

Pa gawo loyamba la mankhwalawa, mlingo wa irbesartan ndi wocheperako (150 mg). Kuchulukitsa kuvomerezeka - 1 nthawi patsiku. Mankhwalawa amatha kumwa pamimba yopanda kanthu, nthawi yakudya kapena itatha. Komabe, nthawi zina, kuchepetsa wamphamvu kwamphamvu kwambiri kumafunikira - mpaka 75 mg patsiku. Chizindikiro cha izi ndi kusowa kwamadzi, kuchepa kwa kuchuluka kwa magazi oyendayenda, kumwa mankhwala omwe amalimbikitsa kutulutsa kwa madzi, ndi chakudya chopanda mchere.

Ngati thupi siligwirizana bwino, ndiye kuti kuchuluka kwa irbesartan kumakulitsidwa mpaka 300 mg patsiku. Amadziwika kuti kumwa Mlingo wowonjezera wa 300 mg sikukula mphamvu ya antihypertensive. Posintha kuchuluka kwa mankhwalawo, mapumidwe amayenera kupitilizidwa (mpaka milungu iwiri).

Chithandizo cha nephropathy: mankhwala mankhwala 150 mg tsiku. Ngati ndi kotheka, muyeso wa zomwe zimagwiritsidwa ntchito umakulitsidwa mpaka 300 mg (osapitilira 1 nthawi patsiku).

Momwe mungagwiritsire ntchito: Mlingo ndi njira ya chithandizo

Mkati, 1 nthawi patsiku, mosasamala za kudya, kutsukidwa ndi madzi.

Nthawi zambiri mlingo woyambira ndi kukonza ndi 150 mg kamodzi tsiku lililonse. Odwala otaya madzi m'thupi, omwe amachepetsa magazi ochulukitsa (BCC) (kuphatikiza kutsegula m'mimba, kusanza), ndi hyponatremia, munthawi ya chithandizo cha diuretics kapena zakudya zamafuta ochepa a sodium chloride, kapena hemodialysis, kapena odwala opitirira zaka 75 akuvomerezeka - 75 mg patsiku.

Ndi osakwanira zovuta achire zotsatira, mlingo ukuwonjezeka mpaka 300 mg patsiku. Kuwonjezeka kwina kwa gawo limodzi ndi masabata a 1-2 (zoposa 300 mg patsiku) sikumawonjezera zovuta za hypotensive. Ngati palibe zotsatira pa monotherapy, kuphatikiza ndi antihypertensive mankhwala ena, mwachitsanzo, ndi otsika Mlingo wa okodzetsa (hydrochlorothiazide), ndizotheka.

Zochizira nephropathy, odwala ochepa matenda oopsa ndi mtundu 2 matenda a shuga amalimbikitsidwa mlingo woyambira wa Ibertan 150 mg kamodzi patsiku, ngati chithandizo chokwanira sichikwanira, mlingo umatha kuchuluka (ndi masabata awiri) mpaka 300 mg kamodzi patsiku.

Odwala ndi mkhutu aimpso ntchito safuna kusintha kwa mlingo.

Odwala ndi mkhutu chiwindi ntchito wofatsa kuti azikhala wamphamvu kusintha mlingo safunika. Palibe zochitika zachipatala ndi odwala omwe ali ndi vuto la chiwindi kwambiri.

Ibertan - malangizo ogwiritsira ntchito, mitengo, ndemanga

Musanadziwe zambiri za Ibertan ya mankhwala - malangizowo amaperekedwa mwakutanthauzira kwaulere ndipo amayikidwa kuti awonenso. Zofotokozedwera patsamba lathu sizoyenera kudzidziwitsa nokha.

Opanga: Polpharma S.A. Zaklady Farmaceutyczne SA, PL

Zinthu zogwira ntchito
Gulu la matenda

• Chofunikira Pazowopsa Hypertension
• Matenda oopsa

Zachipatala ndi gulu la mankhwala

• Zosatchulidwa. Onani malangizo

Zotsatira za pharmacological
Gulu la mankhwala

• Angiotensin II receptor antagonists (AT1 subtype)

Kuchita ndi mankhwala ena

Pogwiritsa ntchito munthawi yomweyo mankhwala osokoneza bongo a potaziyamu, kukonzekera kwa potaziyamu, kuchuluka kwa potaziyamu m'magazi a m'magazi ndikotheka.

Pogwiritsa ntchito munthawi yomweyo ndi hydrochlorothiazide, mawonekedwe owonjezera a hypotensive zotsatira amawonekera. Pogwiritsa ntchito munthawi yomweyo ndi lithiamu carbonate, kuwonjezereka kwa ndende ya lithiamu m'madzi a m'magazi ndikotheka.

Ndi munthawi yomweyo kugwiritsa ntchito fluconazole kungalepheretse kagayidwe ka irbesartan.

Amagwiritsidwa ntchito mosamala odwala omwe ali ndi hyponatremia (mankhwala othandizira okodzetsa, kutsekeka kwa mchere wambiri ndi zakudya, kutsegula m'mimba, kusanza), mwa odwala hemodialysis (kukulitsa kwa hypotension ya dalili ndikotheka), komanso kwa odwala omwe alibe madzi m'thupi.

Chenjezo liyenera kuchitika kwa odwala omwe akukonzanso matenda oopsa chifukwa cha mtima wamitsempha. Matenda a impso imodzi (chiwopsezo chachikulu cha kufooka kwa magazi komanso kulephera kwa aimpso), aortic kapena mitral stenosis, hypertrophic cardiomyopathy, kugunda kwamtima kwambiri (gawo III - IV NYHA) ndi matenda a mtima (chiwopsezo chowonjezereka cha myocardial infarction, angina pectoris). Malinga ndi maziko aimpso kuwonongeka, kuyanʻanila serum potaziyamu ndi creatinine wambiri akulimbikitsidwa.

Sizikulimbikitsidwa kwa odwala omwe ali ndi vuto lalikulu la hyperaldosteronism, omwe ali ndi vuto lalikulu la impso (palibe chokumana nacho chachipatala), mwa odwala omwe akuwonjezeka impso (osadziwa zamankhwala).

Irbesartan: analogues, malangizo ogwiritsira ntchito, mitengo ndi malingaliro

Kuthamanga kwambiri kwa magazi, apo ayi matenda oopsa ndi limodzi mwa matenda ofala kwambiri m'nthawi yathu ino. Alibe zaka kapena jenda. Matendawa ali ndi magawo anayi a chitukuko, chilichonse chomwe chimafanana ndi chithandizo chake. Irbesartan ndi amodzi mwa mankhwala omwe amathandiza kuthana ndi matenda oopsa komanso kukhala ndi thanzi.

Malangizo ogwiritsira ntchito, mitengo ndi ndemanga pakusintha Irbesartan ndi analogues zotsika mtengo, werengani pansipa.

The ntchito aimpso kuwonongeka

Kulephera kwamkati si chifukwa chosiya chithandizo. Ngakhale kumwa mankhwalawa motsutsana ndi matendawa, tiyenera kusamala.

Kukula kwa pathologies ofiira a chiwindi si chifukwa chosiya mankhwala.

Overdose wa Ibertan

Nthawi zambiri, odwala amachepetsa kuthamanga kwa magazi, nthawi zambiri amachepetsa tachycardia. Nthawi zina, zizindikiro za bradycardia zimachitika. Kuchepetsa kukula kwa mawonekedwe owoneka bwino kungathandize kupuma kwamatumbo, kuyika kwa sorbents (bola mankhwala atangotengedwa). Pofuna kuthetsa zizindikiro za munthu aliyense, mankhwala opatsidwa mankhwala apadera amalembedwa, mwachitsanzo, kusintha mtundu wa mtima, kuthamanga kwa mavuto.

Kuyenderana ndi mowa

Popeza ethanol imathandizira kukulitsa mitsempha yamagazi, sikulimbikitsidwa kuti mugwiritse ntchito zakumwa zoledzeretsa zam'kati pochita ndi Ibertan. Pankhaniyi, ntchito ya antihypertgency ya mankhwala imawonjezeka.

Popeza ethanol imathandizira kukulitsa mitsempha yamagazi, sikulimbikitsidwa kuti mugwiritse ntchito zakumwa zoledzeretsa zam'kati pochita ndi Ibertan.

Zosankha zovomerezeka zosinthira mankhwalawa:

• Irbesartan
• Irsar
• Aprovel
• Telmisartan.

Njira yoyamba ndiyotengera malo a Iberta. Chida ichi chili ndi chophatikizira chimodzi chomwechi. Mlingo wake ndi 150 ndi 300 mg piritsi limodzi. Malinga ndi magawo akuluakulu, Irbesartan siwosiyana ndi Ibertan.

Irsar ndi analogue ina yamankhwala omwe amafunsidwa. Sizisintha pakupanga, kuchuluka kwa yogwira mankhwala, zikuwonetsa ndi zotsutsana. Ndalama izi zili m'gulu lomwelo. Wotsalira wina (Aprovel) amawononga ndalama zochepa (600-800 rubles). Kutulutsa mawonekedwe - mapiritsi. Mu 1 pc ili ndi 150 ndi 300 mg ya irbesartan. Chifukwa chake, mankhwalawo amathanso kuikidwa m'malo mwa mankhwalawo omwe mukufunsidwa.

Telmisartan ili ndi gawo la dzina lomweli. Kuchuluka kwake ndi 40 ndi 80 mg piritsi limodzi. Mfundo zoyenera kuchitira mankhwalawa zimakhazikika pakuletsa ntchito ya ma receptors omwe amalumikizana ndi angiotensin II. Zotsatira zake, kuchepa kwa kukakamiza kumadziwika. Chifukwa chake, malinga ndi limagwirira ntchito, Telmisartan ndi mankhwala omwe amafunsidwawa ndi ofanana. Zisonyezero ntchito: matenda oopsa, kupewa kukula kwa zovuta (kuphatikizapo kufa) matenda a mtima dongosolo.

Telmisartan imakhala ndi zotsutsana zambiri. Kuletsa kugwiritsa ntchito mankhwalawa panthawi yapakati, kuyamwa, muubwana, ndikuphwanya khunyu, kumadziwika kuti chiwindi chimadziwika. Sikulimbikitsidwa kuti muziphatikiza ndi mankhwala ochokera ku gulu la angiotensin-akatembenuka enhibme enzyme. Mwa ndalama zomwe zaganiziridwa, Telmisartan ndi okhawo omwe angagwiritsidwe ntchito m'malo mwa Ibertan, malinga ngati tsankho la gawo lomwe likugwira, irbesartan, limayamba.

Kuphatikizika ndi katundu

Mphamvu ya antihypertensive ya mankhwalawa imapereka gawo lalikulu la mankhwala. Irbesartan ndi choletsa mahomoni angiotensin, omwe amachititsa kupindika kwamitsempha.

Ntchito ya irbesartan ndiyo kupondereza vasoconstrictor zotsatira ndikuchepetsa katundu pamtima. Mankhwalawa adapangira kuti azigwiritsa ntchito kwa nthawi yayitali. Kuphatikizika kwa mankhwalawa kumachitika patatha maola 4-5 mutamwa mankhwalawa.

Zotsatira zimapitilira tsiku lonse. Pambuyo masiku 10-14 akudya pafupipafupi, kukhazikika kumatheka.

Mankhwalawa amatengedwa mwachangu ndi thirakiti la m'mimba. Kuchuluka kwa mankhwala osokoneza bongo omwe amafikira pomwepo akuchitikira kumafika 80%. Kuphazikika kwakukulu m'magazi kumawonedwa patatha maola awiri mutamwa mankhwalawa. Irbesartan sisonkhana m'thupi, njira yochotsera imachitika ndi chiwindi mpaka 80%, zotsalazo zimatsitsidwa ndi impso.

Zizindikiro ndi contraindication

Mankhwalawa amagwiritsidwa ntchito pochiza matenda oopsa (aakulu) oopsa. Mankhwala ogwira mankhwalawa matenda oopsa kuphatikiza aimpso mtima matenda a shuga (diabetesic nephropathy).

Chithandizo cha Irbesartan sichinafotokozedwe motere:

• nthawi yobala mwana ndi kuyamwitsa,
• chidwi chachikulu ndi zosakaniza za mankhwala,
• cholowa cholowa cha kuperewera kwa monosaccharides m'matumbo (glucose-galactose malabsorption),
• zaka zazing'ono (mpaka zaka 18).

Kusamala ndikofunikira pakumwa mankhwala ngati wodwala ali ndi matenda otsatirawa:

• kuchepa kwa lumen (stenosis) kwa vala yamitsempha,
• kuvunda kwamtima,
• kusowa kwamadzi
• kuchuluka kwa sodium m'thupi,
• kufinya kwamtsempha wama impso,
• kugaya chakudya.

Kwa odwala azaka za 75+, palibe mankhwala omwe amapereka.

Sikoyenera kugwiritsa ntchito mankhwalawa kuti muwonongeke kwa hepatic, popeza palibe zambiri zamankhwala.

Kutulutsa mawonekedwe ndi mlingo

Mankhwalawa amapezeka mu mawonekedwe a piritsi pa 75, 150, 300 mg.

Muyezo chithandizo amayamba ndi mlingo wa 150 mg. Kutengera momwe wodwalayo alili, mlingo ungathe kuwonjezeka mpaka 300 mg, kapena kutsitsidwa mpaka 75 mg. Kwa odwala omwe ali ndi matenda a impso, kusintha kwa mankhwalawa kumayamba pa 75 mg.

Mankhwalawa amayang'aniridwa pafupipafupi magazi.

Mawonekedwe

Mankhwalawa ali ndi mavuto, omwe amawonetsedwa ndi zizindikiro zotsatirazi:

Normodipine ndi fanizo la mankhwala.

• kutopa ndi chizungulire,
• kuda nkhawa kosafunikira,
• kuchuluka kwa mtima (tachycardia),
• paroxysmal chifuwa
• kugaya chakudya m'mimba (kutsegula m'mimba, chimbudzi chopweteka),
• thupi lawo siligwirizana
• minofu kukokana
• kuphwanya ntchito kwa erectile mwa amuna.

Odwala odwala matenda ashuga nephropathy, kutsika kwa hemoglobin m'magazi ndikotheka.

Mphamvu ya mankhwalawa imatheka komanso kugwiritsa ntchito kofananira kwa okodzetsa ndi mankhwala ena omwe amachepetsa kuthamanga kwa magazi.

Mukatengedwa ndi zowonjezera za potaziyamu, chiopsezo chokhala ndi hyperkalemia chimakulanso.

Kuchita ndi mankhwala osagwiritsa ntchito mankhwala a anti-yotupa kumawononga ntchito ya impso.

Mankhwala osokoneza bongo owopsa amakhala owopsa pakhungu la mtima. (tachycardia, bradycardia).

Irbesartan amapangidwa ndi Kern Pharma S.L. (Spain). Mtengo wa ma CD ndi ma ruble 350.

Kuthandizira pang'onopang'ono kumatha kuchitidwa mosiyana ndi irbesartan. Popeza malangizo ogwiritsa ntchito ndi omwewo, nthawi zambiri mankhwala ndi mankhwala otere amlodipine amagwiritsidwa ntchito.

Amapezeka piritsi. Zosakaniza zothandizira ndi izi: mchere wa magnesium ndi stearic acid, silicon dioxide, lactose, cellulose, croscarmellose sodium, hypromellose. Mankhwala ali ndi zofanana ndi za Irbesartan.

Amagwiritsidwa ntchito pochiza matenda oyamba komanso achiwiri, komanso pochiza matenda oopsa mwa anthu odwala matenda ashuga. Chithandizo cha mankhwalawa chimayamba ndi mlingo wocheperako wa 150 mg, osapatsa mphamvu zoyenera, mulingo wambiri.

Analogue imasiyana ndi yoyambayo mwa iyo odwala matenda a impso safuna kusintha kwa mlingo. Wopanga ndi kampani yaku France ya Sanofi-Winthrop Industrie. Mtengo wake umachokera ku ma ruble 350 mpaka 700, kutengera ma CD.

Mankhwala aku Russia, analogue mtheradi wa Ibersartan.

Ili ndi zofananira, ma contraindication ndi zoyipa. Amasankhidwa muyezo womwewo monga woyamba. Yopangidwa ndi Canonfarm Production CJSC.

Mtengo wa mankhwalawo ndi ma ruble 250.

Mankhwalawa samasiyana mu mankhwala a Irbesartan.

Amapezeka piritsi. Mapiritsi 75 mg Kukhazikitsidwa ndi kuchuluka kwake kumafanana ndi zoyambirira.

Mankhwalawa amapangidwa ku Poland, pogwiritsa ntchito mankhwala a Polpharma S.A. Mtengo wake ndi pafupifupi ma ruble 200.

Ma pharmacokinetics ndi zotsatira za mankhwalawa ndizofanana ndi zoyambirira. Amatchulidwa muyezo wa 150 mg. Palibe achire zotsatira, mlingo ukuwonjezeka 300 mg. Odwala omwe ali ndi aimpso amathandizidwa kuti ayambe kulandira mankhwala ndi 75 mg. Mankhwalawa amapangidwa ndi KRKA d.d. (Slovenia). Mapiritsi a 150 mg

Irbesartan ndi analogues ake nthawi zambiri amaloledwa ndi odwala. Ngati mulingo wovomerezeka ndi dokotala umawonedwa, mavuto omwe samachitika kawirikawiri. Mankhwalawa amagwiritsidwa ntchito pochiritsa ndi mtima.

Amayi ali ndi zaka 60. Wakhala akuvutika ndi kuthamanga kwa magazi kwazaka pafupifupi 10. Ndidayesa kumwa mankhwala osiyanasiyana, koma zovuta zake zimawonekera nthawi zonse. Dotolo adayikira Irbesartan, koma adachenjeza kuti mankhwalawa amayenera kumwedwa nthawi yayitali. Chida ichi chinali chabwino kwa amayi. Palibe mavuto. Zakhala zikuchitika kwa miyezi iwiri, kupanikizika kwakhazikika.

Ndili ndi zaka, ndinayamba kumva kupanikizika, ndikulira m'makutu mwanga, ndipo mutu wanga unkandipweteka. Dokotala adalangiza Aprovel wa ku France.Mankhwalawa adandithandiza bwino, koma mtengo wake ndi wokwera kwambiri. Popeza kuti ndikofunikira kumwa, mosalekeza, ndinapempha kuti ndisiyenso wina waku Russia. Tsopano ndimamwa Irsar. Palibe kusiyana m'malingaliro, koma kumawononga ndalama zochepa.

Irbesartan m'magulu sanandigwirizire. Pambuyo pa phwando, mtima wanga unayamba kugunda. Zinthu sizinakhale bwino, koma zinaipiraipira. Ndinasinthanitsa ndi mankhwala ena, othandiza kwambiri kwa ine.

Ibertan Plus

Mankhwala ena a antihypertensive: mphamvu ya antihypertensive ya mankhwala Ibertan Plus ingalimbikitsidwe ndi kugwiritsidwa ntchito kwa mankhwala ena a antihypertensive.

Hydrochlorothiazide ndi irbesartan (muyezo mpaka 25 mg wa hydrochlorothiazide / 300 mg wa irbesartan) atha kugwiritsidwa ntchito mosagwirizana ndi mankhwala ena a antihypertensive, kuphatikizapo "pang'onopang'ono" calcium blockers ndi beta-blockers.

M'mbuyomu ankalandiridwa ndi Mlingo wambiri wokodzetsa umatha kusokoneza msana ndipo zimawonjezera chiopsezo cha kuchepa kwa mtima.

Lithium: Pali malipoti akuwonjezeranso kusintha kwa kuchuluka kwa ma seramu ndi kuwonongeka kwa mankhwalawa pogwiritsa ntchito kukonzekera kwa lithiamu ndi angiotensin-kutembenuza ma enzyme inhibitors. Kwa irbesartan, zotsatira zofananazi sizinakhalepo kwambiri mpaka pano.

Kuphatikiza apo, chiwonetsero chaimpso cha lithiamu chimatsika ndikugwiritsidwa ntchito kwa thiazide diuretics, kotero pamene Ibertan Plus ikafotokozedwa, pamakhala chiwopsezo chokhala ndi zotsatira za poizoni.

Ngati cholinga cha kuphatikiza uku ndikofunikira, tikulimbikitsidwa kuwunika mosamala pazomwe zili mu seramu yamagazi.

Mankhwala omwe amakhudza potaziyamu m'magazi: Hypokalemic mphamvu ya hydrochlorothiazide imafooketsedwa ndi potaziyamu woteteza mphamvu ya irbesartan.

Komabe, izi za hydrochlorothiazide zitha kupitilizidwa ndi mankhwala ena, cholinga chomwe chimalumikizidwa ndi kuchepa kwa potaziyamu ndi gnococalpemia (mwachitsanzo, diuretics, laxatives, amphotericin, carbenoxolone, penicillin G sodium, zotumphukira za asidi wa salicelic acid) M'malo mwake, potengera zomwe zimachitika pochepetsa ntchito. Angiotensin-aldosterone dongosolo, wogwiritsa ntchito potaziyamu wochepa. oiologically yogwira zina, potaziyamu amchere othandizira, kapena mankhwala ena omwe angapangitse kuchuluka kwa seramu potaziyamu (monga heparin sodium) kungayambitse kuchuluka kwa serum Katya. Ndikulimbikitsidwa kuti muziyang'anira bwino seramu potaziyamu mwa odwala omwe ali pachiwopsezo cha kukhala ndi hyperkalemia.

Mankhwala omwe amakhudzidwa ndi kuphwanya kwa potaziyamu mu seramu yamagazi: tikulimbikitsidwa kuti kuwunikira mosamala zomwe zili potaziyamu zomwe zili mu seramu ya magazi ziperekedwe popereka Ibertan Plus molumikizana ndi mankhwala omwe amakhudzidwa ndikuphwanya kwa potaziyamu mu seramu yamagazi (mwachitsanzo, glycosides ya mtima, mankhwala a antiarrhythmic.

Mankhwala osokoneza bongo oletsa kuponderezana: mukamapereka mankhwala ochepetsa chidwi cha angotensin II receptor osakanikirana ndi mankhwala omwe si a steroidal komanso anti-inflammatory (mwachitsanzo, osankha cycloo oxygenase-2 inhibitors (COX-2), acetylsalicylic acid (> 3 g / tsiku) komanso osagwiritsa ntchito mankhwala osagwiritsa ntchito anti-antiidal. Monga ntchito ndi angiotensin potembenuza enzyme zoletsa ndi angiotensin II receptor antagonists osakanikirana ndi NSAIDs, pali chiwopsezo chowonjezeka chaimpso ntchito, mpaka kukulira kwa kupweteka kwa impso, kuchuluka kwa potaziyamu, makamaka makamaka kwa odwala omwe ali ndi vuto la impso. Kuphatikiza kwa mankhwalawa kuyenera kuyikidwa mosamala, makamaka kwa okalamba. Odwala sayenera kuchepetsedwa madzi. Kuwunika ntchito kwamkati kumayenera kuchitika pambuyo poyambira kuphatikiza mankhwalawa komanso mtsogolo.

Zambiri pazokhudzana ndi mankhwala a irbesartan: hydrochlorothiazide sichikhudza pharmacokinetics ya irbesartan.

Popanga mankhwala a irbesartan osakanikirana ndi warfarin, omwe amapangidwa ndi oyambitsa a CYP2C9 isoenzyme, palibe kuphatikizana kwakukulu kwa pharmacokinetic ndi pharmacodynamic komwe kunapezeka.

Zotsatira za CYP2C9 isoenzyme inductors, monga rifampicin, pa pharmacokinetics ya irbesartan sizinayesedwe. Ndi kusankha kwa irbesartan kuphatikiza ndi digoxin, ma pharmacokinetics omaliza sanasinthe.

Zambiri pazokhudzana ndi mankhwala a hydrochlorothiazide:

Mankhwala otsatirawa amatha kuyanjana ndi thiazide diuretics pamene akupereka:

Ethanol, barbiturates kapena mankhwala osokoneza bongo: kuchuluka kwa orthostatic hypotension kumawonedwa.

Hypoglycemic mankhwala (omwe amakamwa pakamwa ndi insulin): mlingo kusintha kwa hypoglycemic wothandizila angafunike.

Colestyramine ndi colestipol: pamaso pa anion kusinthana mains, mayamwidwe a hydrochlorothiazide amasokonezeka. The pakati pakati kumwa mankhwalawa ayenera kukhala osachepera 4 maola.

Glucocorticosteroids, adrenocorticotropic timadzi: kuphwanya kwamphamvu kwa-electrolyte bwino, makamaka, kuchuluka kwa hypokalemia.

Catecholamines (mwachitsanzo, norepinephrine): mphamvu ya mankhwalawa itha kuchepetsedwa.

Kupuma kosakhumudwitsa minofu (mwachitsanzo tubocurarine): hydrochlorothiazide imatha kuyambitsa mavuto obwera chifukwa chosapondereza minofu.

Mankhwala opha gout: kukonza mankhwala ochulukirapo omwe amagwiritsidwa ntchito pochiritsa gout kungafunike, popeza hydrochlorothiazide imatha kuonjezera uric acid m'madzi a m'magazi. Kuwonjezeka kwa kuchuluka kwa phenenenide kapena sulfinpyrazone kungafunike. Kugwirizana ndi thiazide okodzetsa kungawonjezere zochitika za hypersensitivity zimachitika ku allopurinol.

Mchere wa calcium thiazide diuretics imatha kuwonjezera calcium calcium chifukwa cha kuchepa kwa kutulutsa kwake. Ngati kuli kofunikira kupatsa mankhwala othandizira calcium kapena mankhwala omwe amakhudza calcium (mwachitsanzo, vitamini D), ndikofunikira kusintha mlingo wa mankhwalawa moyenera ndikuwongolera calcium zomwe zili m'madzi a m'magazi.

Mitundu ina yamagulu osokoneza bongo: thiazide diuretics imatha kupititsa patsogolo hyperglycemic ya beta-blockers ndi diazoxide.

Anticholinergics (mwachitsanzo, atropine) amatha kuwonjezera kukhudzika kwa diazture wa thiazide pochepetsa m'mimba komanso kuchepa kwa m'mimba. Liazide diuretics imatha kukulitsa chiopsezo chosinthana ndi amantadine.

Thiazide diuretics imatha kuchepetsa kuchuluka kwa mankhwala a cytotoxic ndi impso (mwachitsanzo, cyclophosphamide, methotrexate) ndikuwonjezera mphamvu yanga ya myelosuppressive.

Kufotokozera, malangizo:

Malangizo ogwiritsira ntchito Ibertan tabu. 150mg No. 28 Gulani Ibertan tabu. 150mg No. 28

Mlingo Wamitundu

Opanga

Polfa SA (Poland)

Kupanga ndi mawonekedwe a kumasulidwa

Ibertan mapiritsi okhala ndi mafilimu

1 tabu ili ndi irbesartan (mu mawonekedwe a hydrochloride) 75, 150 ndi 300 mg, mu phukusi la 28 ma PC.

Zotsatira za pharmacologicalIbertan ndi othandizira ochititsa chidwi, angiotensin II (mtundu AT1) receptor blocker.

Amachepetsa ndende ya aldosterone mu plasma (samachepetsa kinase II, yemwe amawononga bradykinin), amachotsa mphamvu ya vasoconstrictor ya angiotensin II, amachepetsa OPSS, amachepetsa pambuyo pake, magazi ndi kukakamiza kwazungulira "zazing'ono" zamagazi.

Sizikhudzanso kuchuluka kwa TG, cholesterol, glucose, uric acid mu plasma ndi excretion ya uric acid mkodzo.

Kuchuluka kwake kumachitika pambuyo pa maola 3-6 patatha nthawi yokhayo limodzi, kutalika kwa maola 24, pambuyo pa masabata 1-2, pokhapokha ngati mugwire ntchito yolimbitsa thupi pang'onopang'ono.

Zizindikiro
Matenda oopsa a magazi, kuphatikiza mukaphatikizidwa ndi matenda a shuga a 2.

ContraindicationHypersensitivity, kutenga pakati, kuyamwa, zaka mpaka 18.

Mosamala. CHF, GOKMP, stenosis ya aortic kapena mitral valavu, kuchepa kwa madzi, hyponatremia, hemodialysis, hypo-salt zakudya, kutsegula m'mimba, kusanza, unilateral kapena billetal renal aren stenosis, aimpso kulephera.

Mlingo ndi makonzedweIbertan amatengedwa pakamwa, pakudya kapena pamimba yopanda kanthu, piritsi limamezedwa lonse, kutsukidwa ndi madzi.

Mlingo woyambirira ndi wokonza ndi 150 mg / tsiku limodzi mu mlingo umodzi, ngati kuli kotheka, mlingo umakulitsidwa mpaka 300 mg / tsiku (kuwonjezereka kwa kuchuluka kwa mankhwalawa sikungowonjezera zovuta za hypotensive zotsatira).

Ngati palibe zotsatira pa monotherapy, Mlingo wochepa wa okodzetsa (hydrochlorothiazide) amawonjezeranso.

Mlingo woyambirira wa odwala omwe ali ndi vuto losowa madzi mthupi, hyponatremia (chifukwa cha chithandizo cha okodzetsa, kuletsa kwamchere chifukwa cha zakudya, kutsegula m'mimba, kusanza) pa hemodialysis ndi 75 mg.

Zotsatira zoyipaKuchepa kwambiri kwa kuthamanga kwa magazi (mu 0.4% ya milandu) - mutu, chizungulire, nseru, kusanza, kufooka.

M'milandu yotsatsa, m'malo osowa - asthenia, dyspepsia (kuphatikizapo matenda am'mimba), chizungulire, kupweteka kwa mutu, hyperkalemia, myalgia, nseru, tachycardia, chiwindi ntchito

hepatitis) ndi impso (kuphatikizapo kulephera kwaimpso kwa odwala omwe ali pachiwopsezo chachikulu).

Irbesartan siothandiza kwenikweni mu aldosteronism (kugwiritsa ntchito sikololedwa)

Malangizo apaderaChithandizo chiyenera kuyang'aniridwa ndi kuthamanga kwa magazi.

Odwala omwe ali ndi madzi osowa, komanso chifukwa cha kuchepa kwa Na + (chifukwa chothira mankhwala okodzetsa, kutsegula m'mimba kapena kusanza, kutsekeka kwa mchere wambiri ndi chakudya) komanso mwa odwala hemodialysis, hypotension yodziwika bwino imatha kupezeka, makamaka mutatha kumwa mankhwala oyamba.

Odwala omwe ali ndi vuto la aimpso, kuwunika kwa ndende ya K + ndi creatinine mu plasma kuyenera kuchitika. Kulephera kwamtima kwambiri, matenda a impso (kuphatikizapo impso artery stenosis), chiwopsezo cha kuchepa kwambiri kwa magazi, azotemia, oliguria, mpaka kulephera kwa impso, kumawonjezera ndi ischemic cardiomyopathy - chiopsezo cha angina pectoris ndi kulowerera kwa mtima.

Munthawi ya chithandizo, chisamaliro chikuyenera kuchitika poyendetsa magalimoto ndikuchita zinthu zoopsa zomwe zimafuna kuti chidwi ndi kuthamanga kwa malingaliro a psychomotor (chizungulire komanso kutopa kwambiri zitheke).

Kuyanjana kwa mankhwala osokoneza bongoMa diuretics ndi mankhwala ena a antihypertensive amalimbikitsa zotsatira. Pamaso chithandizo chisanachitike ndi diuretics mu Mlingo wambiri kumatha kubweretsa vuto lakumadzi ndipo kumawonjezera kuchepa kwamphamvu kwa magazi.

Kuthandizidwanso munthawi yomweyo ndi heparin, potaziyamu woleketsa okodzetsa, kapena mankhwala ena okhala ndi K + kungayambitse kuchuluka kwa K + m'madzi a m'magazi. Kafukufuku wa in vitro awonetsa kuthekera kwa metabolism ya mankhwala a irbesartan omwe amaphatikizika ndi CYP2C9 isoenzyme kapena ma inhibitors.

Zotsatira za CYP2C9 isoenzyme (kuphatikizapo rifampicin) sizinaphunzire. Kuchita ndi mankhwala, kagayidwe kamene kamatengera isoenzymes CYP1A1, CYP1A2, CYP2A6, CYP2B6, CYP2D6, CYP2E1, CYP3A4, mu vitro sanapezeka.

Zotheka, kuwonjezereka kwa plasma Li + ndende ndizotheka (kuwunika ndikofunikira). Sizikhudza magawo a pharmacokinetic a digoxin.

Hydrochlorothiazide, nifedipine sichikhudza magawo a pharmacokinetic a irbesartan.

Bongo Zizindikiro: tachy- kapena bradycardia, kuchepa kwambiri kwa magazi, kugwa.

Chithandizo: chapamimba cha m'mimba, kuyikitsidwa kwa kaboni yodziyimira, yodziwika bwino, hemodialysis siyothandiza.

Malo osungira
Pamalo amdima pakutentha kosaposa + 25 ° C.

Kupezeka ndi mitengo ku Stolichki Pharmacies:

Zinthu zomwe sizipezeka m'mafakitoreti a Stolichki. Komabe, muyenera kuyesa kulumikizana ndi tel. 8 (495) 215-5-215 kuti mumve zambiri za kupezeka kwa katundu m'mafakisi ku Moscow. Zambiri patsamba lino sizingakhale ndi nthawi yoti zisinthidwe.

Kutulutsa mawonekedwe, ma CD ndi mawonekedwe a Ibertan Plus

7 ma PC - matuza (4) - mapaketi a makatoni.
Ma PC 10 - matuza (3) - mapaketi a makatoni.
14 ma PC. - matuza (2) - mapaketi a makatoni.
15 ma PC. - matuza (2) - mapaketi a makatoni.

7 ma PC - matuza (4) - mapaketi a makatoni.
Ma PC 10 - matuza (3) - mapaketi a makatoni.
14 ma PC. - matuza (2) - mapaketi a makatoni.
15 ma PC. - matuza (2) - mapaketi a makatoni.

7 ma PC - matuza (4) - mapaketi a makatoni.
Ma PC 10 - matuza (3) - mapaketi a makatoni.
14 ma PC. - matuza (2) - mapaketi a makatoni.
15 ma PC. - matuza (2) - mapaketi a makatoni.

Mlingo

Mkati, kamodzi patsiku, osasamala za chakudya.

Ibertan Plus 12.5 / 150 mg (mapiritsi okhala ndi hydrochlorothiazide / irbesartan 12.5 / 150 mg, motsatana) atha kutumizidwa kwa odwala omwe kuthamanga kwa magazi awo sikuwongolera mokwanira ndikukhazikitsidwa kwa hydrochlorothiazide kokha (12,5 mg / tsiku) kapena irbesartan (150 mg / tsiku) mu monotherapy.

Ibertan Plus 12.5 / 300 mg (mapiritsi okhala ndi hydrochlorothiazide / nrbesartan 12.5 / 300 mg, motsatana) atha kutumizidwa kwa odwala ngati magazi sayendetsedwa mokwanira ndi irbesartan (300 mg / tsiku) kapena Ibertan Plus (12.5 / 150 mg).

Ibertan Plus 25-300 mg (mapiritsi okhala ndi hydrochlorothiazide / irbesartan 25/300 mg, motsatana) atha kupatsidwa mankhwala ngati magazi sayendetsedwa mokwanira ndi kayendetsedwe ka Ibertan Plus (12.5 / 300 mg). Poika Mlingo woposa 25 mg wa hydrochlorothiazide / 300 mg wa irbesartan 1 nthawi patsiku osavomerezeka.

Ngati ndi kotheka, mankhwala Ibertan Plus angathe kuthandizidwa molumikizana ndi mankhwala ena a antihypertensive.

Kuwonongeka kwa impso: chifukwa chakuti mankhwala a Ibertan Plus amaphatikiza hydrochlorothiazide. The mankhwala osavomerezeka chifukwa odwala kwambiri aimpso kuwonongeka (creatinine chilolezo cha 30 ml / mphindi.

Kuwonongeka kwa chiwindi: Ibertan Plus siyikulimbikitsidwa kwa odwala omwe ali ndi vuto lalikulu la chiwindi. Odwala omwe ali ndi kufatsa pang'ono kwa hepatic osakwanira, kusintha kwa mankhwala a Ibertan Plus sikofunikira.

Okalamba okalamba: kusintha kwa Ibertan Plus sikofunikira kwa okalamba.

Kuchuluka kwamagazi kwamagazi: Musanafotokoze Ibertan Plus, ndikofunikira kusintha kuchuluka kwa magazi ndi / kapena zinthu za sodium.

Zotsatira zoyipa

Zotsatira zoyipa zotsatirazi zimaperekedwa molingana ndi kutsatizanatsatizana kwatsatanetsatane wa zomwe zimachitika: nthawi zambiri (> 1/10), nthawi zambiri>> 1/100, 1/1 000, 1/10 000, Kuphatikiza kwa hydrochlorothiazide / irbesartan:

Kuchokera kumbali ya chapakati mantha dongosolo: Nthawi zambiri - chizungulire, kawirikawiri orthostatic chizungulire.

Kumbali yamtima dongosolo: syncope yocheperako, kuchepa kwa magazi, tachycardia, zotumphukira edema, "mafunde" amkati pagazi la nkhope.

Kuchokera mmimba: kawirikawiri - nseru, kusanza, kutsegula m'mimba kambiri.

Kuchokera kwamikodzo dongosolo: Nthawi zambiri - kuphwanya kwamikodzo.

Kuchokera ku genitourinary system: mokwanira - kusowa kwa kugonana, kuphwanya kwa libido.

Zina: nthawi zambiri - kutopa.

Zowonetsa zasayansi: kawirikawiri - kuwonjezeka kwa kuchuluka kwa urea nayitrogeni, creatinine ndi plasma creatine phosphokinase, modabwitsa - kuchepa kwa zomwe potaziyamu ndi sodium mumagazi seramu. Kusintha kumeneku kwa ma labotale sikunakhale kofunika kwambiri pakubala.

Zotsatira zoyipa zomwe zapezeka mukutenga kuphatikiza kwa hydrochlorothiazide / irbesartan, zomwe zidanenedwa nthawi yakutsatsa:

Thupi lawo siligwirizana: kawirikawiri - zotupa pakhungu, urticaria, angioedema.

Kuchokera kumbali ya kagayidwe: kawirikawiri - hyperkalemia.

Kuchokera kwa chapakati mantha dongosolo: kawirikawiri - mutu.

Kuchokera ku chida chamalingaliro: kawirikawiri - kulira kumakutu.

Kuchokera pakupuma dongosolo: kawirikawiri - chifuwa.

Kuchokera pamimba yogaya chakudya: osowa kwambiri - dyspepsia, dysgeusia, chifuwa chamlomo cham'mimba, chiwindi, chiwindi ntchito.

Kuchokera ku minculoskeletal system: kawirikawiri kwambiri arthralgia, myalgia.

Kuchokera kwamikodzo dongosolo: kawirikawiri - kusokonezeka kwa impso, kuphatikiza milandu ya aimpso kulephera kwa odwala omwe ali pachiwopsezo chachikulu.

Zowonjezera pazamankhwala amodzi:

Kuphatikiza pazotsatira zomwe zawoneka kale, zovuta zina zomwe zidanenedwapo kale pankhani iliyonse mwazomwe zimapangidwira, zomwe zimatha kukhala zotsatirapo pakugwiritsa ntchito mankhwala Ibertan Plus, zalembedwa pansipa.

Zina: pafupipafupi - kupweteka pachifuwa.

Hydrochlorothiazide (popanda kuwonetsa pafupipafupi)

Hematopoietic ziwalo: aplastic anemia, kufooka kwa mafupa, kuchepa kwa magazi, leukopenia, neutropenia / agranulocytosis, thrombocytopenia.

Kuchokera ku dongosolo lalikulu lamanjenje: kukhumudwa, kusokonezeka kwa kugona, chizungulire, paresthesia, nkhawa.

Kuchokera kumbali ya chida chamalingaliro: kuwona kwakanthawi, xantopsia.

Kuchokera pamtima dongosolo: arrhythmias, postural hypotension.

Kuchokera kupuma dongosolo: kupuma mavuto syndrome (kuphatikizapo pneumonitis ndi pulmonary edema).

Kuchokera m'mimba: jaundice (intrahepatic cholestatic jaundice).

Thupi lawo siligwirizana: anaphylactic zimachitika, poizoni epermermal necrolysis, lupus ngati matenda, necrotizing angiitis (vasculitis, khungu vasculitis), photosensitivity zimachitika, zotupa pa khungu, kuchuluka kwa zokhudza zonse lupus erythematosus, urticaria.

Kuchokera ku minculoskeletal system: minofu kukokana, kufooka.

Kuchokera kwamikodzo dongosolo: interstitial nephritis, aimpso kukanika.

Zina: kutentha thupi.

Zizindikiro zasayansi: Kusokonezeka kwa kuchuluka kwa ma electrolyte (kuphatikizapo hypokalemia ndi hyonatremia), glucosuria, hyperglycemia, hyperuricemia, kuchuluka kwa cholesterol ndi triglycerides.

Mimba komanso kuyamwa

Kutenga Ibertan Plus kumayesedwa panthawi yomwe muli ndi pakati, popeza kukhudzana ndi mwana wosabadwayo wa mankhwala omwe amakhudzanso renin-angiotensin-aldosterone dongosolo kungayambitse kuwonongeka ndi kufa kwa mwana wosabadwayo. Thiazide diuretics amadutsa chotchinga ndipo amapezeka m'mwazi wama chingwe. Nthawi zambiri, kugwiritsa ntchito mankhwala okodzetsa mwa amayi apakati athanzi sikulimbikitsidwa ndikuwonetsa mayi ndi mwana wosabadwayo pachiwopsezo chosafunikira, kuphatikizapo kukulira kwa fetal kapena neonatal jaundice, thrombocytopenia ndipo, mwinanso, zovuta zina zomwe zimawonedwa mwa akulu. Hydrochlorothiazide osavomerezeka mu trimester yoyamba ya mimba. Mankhwalawa amatsutsana mu II ndi III trimesters a mimba. Ngati amayi apezeka kuti ali ndi pakati, ndiye kuti Ibertan Plus iyenera kusiyidwa posachedwa. Ngati wodwalayo adatenga mankhwalawa ku nthawi yachiwiri ya mimba, ndikofunikira kuyesa kuyesa kwa chigaza ndi impso. Mankhwala Ibertan Plus amatsutsana nthawi yonse ya mkaka wa mkaka.

Kuyanjana kwa mankhwala osokoneza bongo

Mankhwala ena a antihypertensive: mphamvu ya antihypertensive ya mankhwala Ibertan Plus imatha kupitilizidwa ndi kugwiritsidwa ntchito kwa mankhwala ena a antihypertensive. Hydrochlorothiazide ndi irbesartan (muyezo mpaka 25 mg wa hydrochlorothiazide / 300 mg wa irbesartan) atha kugwiritsidwa ntchito mosagwirizana ndi mankhwala ena a antihypertensive, kuphatikizapo "pang'onopang'ono" calcium blockers ndi beta-blockers. M'mbuyomu ankalandiridwa ndi Mlingo wambiri wokodzetsa umatha kusokoneza msana ndipo zimawonjezera chiopsezo cha kuchepa kwa mtima.

Lithium: pali malipoti a kuchuluka kosinthika kwa kuchuluka kwa ma seramu ndi kuwopsa kwa kuphatikiza kwa kuphatikizika kwa lithiamu ndikukonzekera ndi angiotensin-kutembenuza ma enzyme inhibitors. Kwa irbesartan, zotsatira zofananazi sizinakhalepo kwambiri mpaka pano. Kuphatikiza apo, chiwonetsero chaimpso cha lithiamu chimatsika ndikugwiritsidwa ntchito kwa thiazide diuretics, kotero pamene Ibertan Plus ikafotokozedwa, pamakhala chiwopsezo chokhala ndi zotsatira za poizoni. Ngati cholinga cha kuphatikiza uku ndikofunikira, tikulimbikitsidwa kuwunika mosamala pazomwe zili mu seramu yamagazi.

Mankhwala omwe amakhudza potaziyamu m'magazi: mphamvu ya hydrochlorothiazide imakhala yofooka chifukwa cha mphamvu ya potaziyamu ya irbesartan. Komabe, izi za hydrochlorothiazide zitha kupitilizidwa ndi mankhwala ena, cholinga chomwe chimalumikizidwa ndi kuchepa kwa potaziyamu ndi gnococalpemia (mwachitsanzo, diuretics, laxatives, amphotericin, carbenoxolone, penicillin G sodium, zotumphukira za asidi wa salicelic acid) M'malo mwake, potengera zomwe zimachitika pochepetsa ntchito. Angiotensin-aldosterone dongosolo, wogwiritsa ntchito potaziyamu wochepa. oiologically yogwira zina, potaziyamu amchere othandizira, kapena mankhwala ena omwe angapangitse kuchuluka kwa seramu potaziyamu (monga heparin sodium) kungayambitse kuchuluka kwa serum Katya. Ndikulimbikitsidwa kuti muziyang'anira bwino seramu potaziyamu mwa odwala omwe ali pachiwopsezo cha kukhala ndi hyperkalemia.

Mankhwala omwe amakhudzidwa ndikuphwanya mulingo wa potaziyamu mu seramu yamagazi: tikulimbikitsidwa kuti kuwunikira mosamala zomwe zili mu potaziyamu yamagazi zimaperekedwa popereka Ibertan Plus molumikizana ndi mankhwala omwe amakhudzidwa ndikuphwanya kwa potaziyamu mu seramu yamagazi (mwachitsanzo, glycocryiment ya mtima.

Mankhwala osokoneza bongo oletsa kuponderezana: mukamapereka mankhwala othana ndi angotensin II receptor osakanikirana ndi mankhwala omwe si a antiidal komanso anti-yotupa (mwachitsanzo, kusankha cycloo oxygenase-2 inhibitors (COX-2), acetylsalicylic acid (> 3 g / tsiku) komanso osagwiritsa ntchito mankhwala omwe amaletsa anti-kutupa machitidwe. Monga ntchito ndi angiotensin potembenuza enzyme zoletsa ndi angiotensin II receptor antagonists osakanikirana ndi NSAIDs, pali chiwopsezo chowonjezeka chaimpso ntchito, mpaka kukulira kwa kupweteka kwa impso, kuchuluka kwa potaziyamu, makamaka makamaka kwa odwala omwe ali ndi vuto la impso. Kuphatikiza kwa mankhwalawa kuyenera kuyikidwa mosamala, makamaka kwa okalamba. Odwala sayenera kuchepetsedwa madzi. Kuwunika ntchito kwamkati kumayenera kuchitika pambuyo poyambira kuphatikiza mankhwalawa komanso mtsogolo.

Zambiri pazokhudzana ndi mankhwala a irbesartan: hydrochlorothiazide sichikhudza pharmacokinetics ya irbesartan. Popanga mankhwala a irbesartan osakanikirana ndi warfarin, omwe amapangidwa ndi oyambitsa a CYP2C9 isoenzyme, palibe kuphatikizana kwakukulu kwa pharmacokinetic ndi pharmacodynamic komwe kunapezeka. Zotsatira za CYP2C9 isoenzyme inductors, monga rifampicin, pa pharmacokinetics ya irbesartan sizinayesedwe. Ndi kusankha kwa irbesartan kuphatikiza ndi digoxin, ma pharmacokinetics omaliza sanasinthe.

Zambiri pazokhudzana ndi mankhwala a hydrochlorothiazide:

Mankhwala otsatirawa amatha kuyanjana ndi thiazide diuretics pamene akupereka:

Ethanol, barbiturates kapena mankhwala osokoneza bongo: kuchuluka kwa orthostatic hypotension kumawonedwa.

Hypoglycemic mankhwala (othandizira pakamwa ndi insulin): Kusintha kwa mankhwala a hypoglycemic kungafunike.

Colestyramine ndi colestipol: pamaso pa anion osinthika ma cell, kuyamwa kwa hydrochlorothiazide kumasokoneza. The pakati pakati kumwa mankhwalawa ayenera kukhala osachepera 4 maola.

Glucocorticosteroids, adrenocorticotropic timadzi: kuphwanya kwamtundu wamagetsi amagetsi, makamaka, kuchuluka kwa hypokalemia.

Catecholamines (mwachitsanzo, norepinephrine): mphamvu ya mankhwalawa itha kuchepetsedwa.

Kupuma kosakhumudwitsa kwa minofu (mwachitsanzo, tubocurarine): hydrochlorothiazide imatha kuyambitsa mavuto obwera chifukwa chosasokoneza minofu.

Mankhwala a anti-gout: angafune kukonza mankhwala ambiri omwe amagwiritsidwa ntchito pochiritsa gout, popeza hydrochlorothiazide imatha kukulitsa zomwe zili uric acid m'madzi am'magazi. Kuwonjezeka kwa kuchuluka kwa phenenenide kapena sulfinpyrazone kungafunike. Kugwirizana ndi thiazide okodzetsa kungawonjezere zochitika za hypersensitivity zimachitika ku allopurinol.

Mchere waku calcium: thiazide diuretics imatha kuwonjezera calcium calcium chifukwa chakuchepa kwa kuphipha kwake. Ngati kuli kofunikira kupatsa mankhwala othandizira calcium kapena mankhwala omwe amakhudza calcium (mwachitsanzo, vitamini D), ndikofunikira kusintha mlingo wa mankhwalawa moyenera ndikuwongolera calcium zomwe zili m'madzi a m'magazi.

Mitundu ina yogwiritsira ntchito mankhwalawa: thiazide diuretics imatha kukulitsa mphamvu ya hyperglycemic ya beta-blockers ndi diazoxide. Anticholinergics (mwachitsanzo, atropine) amatha kuwonjezera kukhudzika kwa diazture wa thiazide pochepetsa m'mimba komanso kuchepa kwa m'mimba. Liazide diuretics imatha kukulitsa chiopsezo chosinthana ndi amantadine. Thiazide diuretics imatha kuchepetsa kuchuluka kwa mankhwala a cytotoxic ndi impso (mwachitsanzo, cyclophosphamide, methotrexate) ndikuwonjezera mphamvu yanga ya myelosuppressive.