Telzap - malangizo, ntchito, ndemanga > Chithandizo ndi kupewa

Munkhaniyi, mutha kuwerengera malangizo ogwiritsira ntchito mankhwalawa Telzap. Amapereka ndemanga kuchokera kwa alendo omwe amabwera patsamba lino - ogula mankhwalawa, komanso malingaliro a akatswiri azachipatala pakugwiritsa ntchito kwa Telzap machitidwe awo. Chopempha chachikulu ndikuti muwonjezere ndemanga zanu za mankhwalawa: mankhwalawo adathandizira kapena sanathandizire kuchotsa matendawa, ndizovuta ziti zomwe zimawoneka ndi zotsatirapo zake, mwina sizinalengezedwe ndi wopanga. Analogs a Telzap pamaso pa maumbulidwe apangidwe omwe alipo. Gwiritsani ntchito pochizira matenda oopsa komanso kuchepetsa kupanikizika kwa akulu, ana, komanso panthawi yoyembekezera komanso mkaka wa m'mawere. The zikuchokera mankhwala.

Telzap - antihypertensive mankhwala.

Telmisartan (chinthu chogwira ntchito cha Telzap) ndiwotsutsa wina ndi mnzake wa angiotensin 2 receptors (mtundu wa AT1), womwe umagwira pakamwa. Ili ndi mgwirizano wapamwamba kwambiri wa AT1 receptor subtype, kudzera momwe zochita za angiotensin 2 zimadziwika .Thermisartan imayendetsa malo angiotensin 2 kuchokera kumangiriza kupita ku receptor, popanda zochita za agonist pokhudzana ndi receptor iyi, amangomanga kokha ku AT1 receptor subtype ya angiotensin 2. Kumangiriza ndikokhazikika. Telmisartan ilibe chiyanjano ndi ma receptor ena, incl. kupita ku receptors a AT2 ndi ma receptors ena osaphunzira a angiotensin. Kufunikira kwa magwiritsidwe awa a ma receptor, komanso momwe mphamvu zawo zimakhudzira kwambiri ndi angiotensin 2, kuchuluka kwa zomwe zimawonjezeka ndikusankhidwa kwa telmisartan, sikunaphunzire. Telmisartan amachepetsa kuchuluka kwa aldosterone m'magazi am'magazi, sikuchepetsa ntchito ya renin, ndipo satseka njira za ion. Telmisartan sikuletsa ACE (kininase 2), yomwe imathandizanso kuwonongedwa kwa bradykinin. Izi zimapewa zoyipa zomwe zimakhudzana ndi zochita za bradykinin (mwachitsanzo, chifuwa chowuma).

Telzap muyezo wa 80 mg kwathunthu umalepheretsa kupanikizika kwamphamvu kwa angiotensin 2. Kuyamba kwa antihypertensive zochita kumadziwika mkati mwa maola atatu itatha yoyamba ya telmisartan. Mphamvu ya mankhwalawa imatha kwa maola 24 ndipo imakhalabe yofunikira mpaka maola 48. Njira yodziwika bwino ya antihypertgency nthawi zambiri imatha masabata 4-8 pambuyo povomerezeka.

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

Pakakhala kutha kwakumwa kwa kutenga Telzap, kuthamanga kwa magazi pang'onopang'ono kumabwereranso ku nthawi yake yoposa masiku angapo popanda chitukuko cha matenda obwera nawo.

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

Mtima Kupewa matenda

Odwala azaka za 55 wazaka zopitilira apo omwe ali ndi matenda amitsempha yamagazi, matenda opha ziwopsezo, kuchepa kwakanthawi, kuwonongeka kwa mtima, kapena zovuta za mtundu 2 shuga mellitus (mwachitsanzo, retinopathy, lamanzere lamitsempha yamagazi, micro- kapena microalbuminuria Zochitika, Telzap anali ndi zofanana ndi zovuta za ramipril pakuchepetsa kuphatikizika: kupha kwamtima kuchokera ku infa ya myocardial popanda zotsatira zakupha, sitiroko popanda chifukwa ndi boma Chakudya chopatsa thanzi chifukwa cha kulephera kwa mtima.

Telmisartan inali yothandiza ngati ramipril pakuchepetsa pafupipafupi mfundo zachiwiri: kufa kwa mtima, kufa kosagwirizana ndi myocardial infarction, kapena kupha anthu omwe sanaphe.

Kukhosomola kouma ndi angioedema sizimafotokozedwa kawirikawiri poyerekeza ndi telmisartan, pomwe ochepa hypotension amatenga ndi telmisartan.

Hydrochlorothiazide monga gawo la Telzap Plus ndi thiazide diuretic. Thiazides amakhudzanso kukonzanso kwa ma elekitiroma mu reum tubules, mwakutero kuwonjezera kuchuluka kwa sodium ndi chloride ion pafupifupi zofanana. Mphamvu ya diuretic ya hydrochlorothiazide imabweretsa kuchepa kwa BCC, kuwonjezeka kwa ntchito ya plasma renin, kuwonjezeka kwa kupanga kwa aldosterone, kutsatiridwa ndi kuwonjezeka kwa potaziyamu ndi bicarbonates mkodzo ndi kuchepa kwa zomwe zili potaziyamu m'madzi a m'magazi. Kugwiritsa ntchito pamodzi kwa telmisartan kumathandizira kuchepetsa kutaya kwa potaziyamu chifukwa cha diuretic iyi, mwina chifukwa cha RAAS blockade. Pambuyo potenga hydrochlorothiazide, diuresis imakulirakulira pambuyo pa maola awiri, mphamvu yayikulu imapangika pambuyo pafupifupi maola 4, zotsatira zimatha pafupifupi maola 6-12.

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

Kupanga

Omwe amachokera ku Telmisartan.

Telmisartan + Hydrochlorothiazide + Excipients (Telzap Plus).

Pharmacokinetics

Mukamamwa pakamwa, Telzap imatengedwa mwachangu kuchokera mumimba. Bioavailability ndi 50%. Telmisartan imamangidwa kwambiri ndi mapuloteni a plasma, makamaka ndi albumin ndi alpha-1 acid glycoprotein. Zimapangidwa ndi kuphatikizika ndi glucuronic acid. Conjugate ilibe zochitika zamankhwala. Amayamwa kudzera m'matumbo osasinthika, zotupa za impso - zosakwana 1%.

Hydrochlorothiazide samapangidwira mwa anthu. Imapakidwa pafupifupi osasinthika mkodzo. Pafupifupi 60% ya mankhwalawa omwe amwedwa pakamwa samachotsedwa mkati mwa maola 48. Chilolezo chotsimikizika ndi 250-300 ml / min.

Pharmacokinetics pamagulu apadera a odwala

Pali kusiyana kwa ma plasma oyang'ana kwa telmisartan mwa amuna ndi akazi. Cmax ndi AUC anali pafupifupi 3 ndi 2 nthawi kwambiri mu akazi poyerekeza ndi abambo popanda chidwi chokwanira.

Mwa azimayi, mumakonda kupezeka kwa hydrochlorothiazide m'madzi am'magazi, izi sizofunika kwambiri pamankhwala.

Ma pharmacokinetics a telmisartan odwala okalamba azaka zopitilira 65 samasiyana ndi achinyamata. Kusintha kwa Mlingo sikofunikira.

Odwala omwe ali ndi vuto laimpso lokwanira, sayenera kusintha njira ya telmisartan. Odwala kwambiri aimpso kulephera ndi odwala hemodialysis akulimbikitsidwa apansi koyamba mlingo wa 20 mg patsiku. Telmisartan siwotsimikizika ndi hemodialysis.

Odwala omwe ali ndi vuto la chiwindi chochepa kwambiri (kalasi A ndi B malinga ndi gulu la ana-Pugh), mlingo wa tsiku ndi tsiku sayenera kupitilira 40 mg.

Zizindikiro

matenda oopsa,
kuchepa kwaimfa ndi matenda amtima mu akulu okalamba omwe ali ndi matenda amtundu wa atherothrombotic chiyambi (IHD, sitiroko kapena mbiri yakale ya zotumphukira matenda a mtsempha wamagazi) ndikulemba mtundu wa matenda ashuga a 2 omwe ali ndi chida chowonongeka.

Kutulutsa Mafomu

Mapiritsi 40 mg ndi 80 mg.

Mapiritsi 80 mg + 12,5 mg (Telzap Plus).

Malangizo ogwiritsira ntchito ndi mlingo

Mankhwala amatengedwa pakamwa, 1 kamodzi patsiku, mosasamala kanthu za kudya, mapiritsi ayenera kutsukidwa ndi madzi.

Mlingo woyamba wa Telzap ndi 40 mg (piritsi 1) kamodzi patsiku. Odwala ena, kumwa mankhwala 20 mg patsiku kungakhale kothandiza. Mlingo wa 20 mg ungapezeke mwa kugawa piritsi la 40 mg pakati pangozi. Muzochitika zomwe achire samakwaniritsa, muyezo wa Telzap mutha kupititsidwa mpaka 80 mg kamodzi patsiku.

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

Kuchepetsa imfa ndi pafupipafupi matenda a mtima

Mlingo woyenera wa Telzap ndi 80 mg kamodzi patsiku. Munthawi yoyambirira ya chithandizo, kuyang'anira magazi kumalimbikitsidwa; kusintha kwa antihypertensive mankhwala kungafunike.

Zomwe zimachitika ndi telmisartan kwa odwala omwe amalephera kwambiri aimpso kapena odwala hemodialysis ndi ochepa. Odwala akulimbikitsidwa kuchepetsedwa koyamba kwa 20 mg patsiku. Kwa odwala omwe ali ndi vuto laimpso lokwanira zolimbitsa thupi, kusintha kwa mankhwala sikofunikira.

Kugwiritsidwa ntchito kwa Telzap ndi aliskiren kumayikidwa kwa odwala omwe amalephera kupweteka kwa impso (GFR osakwana 60 ml / mphindi / 1.73 m2 yamalo olimbitsa thupi).

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

Odwala omwe ali ndi vuto lochepa kwambiri la chiwindi (kalasi A ndi B malinga ndi gulu la ana-Pugh) ayenera kuikidwa mosamala, mlingo sayenera kupitirira 40 mg kamodzi patsiku. Telzap imaphatikizidwa kwa odwala omwe ali ndi vuto loopsa la hepatic (kalasi C malinga ndi gulu la Mwana-Pugh).

Kwa odwala okalamba, kusintha kwa mankhwala sikofunikira.

Mkati, kamodzi patsiku, kutsukidwa ndimadzimadzi, mosasamala kanthu za kudya.

Odwala omwe BP yawo singayende moyenera ndi monotherapy ndi telmisartan kapena hydrochlorothiazide ayenera kutenga Telzap Plus. Musanafike pophatikizira ndi gawo limodzi la mankhwala, munthu aliyense amalimbikitsidwa pakamwa. Mu zochitika zina zamankhwala, kusintha kwachindunji kuchokera ku monotherapy kupita ku chithandizo cha mankhwala osakanikirana kungaganizidwe.

Mankhwala a Telzap Plus, angagwiritsidwe ntchito kamodzi patsiku kwa odwala omwe magazi awo sangathe kuwongolera bwino akamamwa telmisartan pa mlingo wa 80 mg patsiku.

Zotsatira zoyipa

matenda a kwamkodzo thirakiti, kuphatikizapo cystitis,
chapamwamba kupuma thirakiti matenda, kuphatikizapo pharyngitis ndi sinusitis,
sepsis, kuphatikizapo zakupha
anemia, eosinophilia, thrombocytopenia,
anaphylactic reaction,
Hypersensitivity
Hyperkalemia
hypoglycemia (odwala matenda a shuga),
kusowa tulo
kukhumudwa
nkhawa
kukomoka
kugona
zosokoneza zowoneka
vertigo
bradycardia
kuchepa kwambiri kwa magazi,
orthostatic hypotension,
tachycardia
kupuma movutikira
kutsokomola
matenda am`mapapo matenda
kupweteka kwam'mimba
kutsegula m'mimba
dyspepsia
chisangalalo
kusanza
kamwa yowuma
kusasangalala m'mimba
kuphwanya kukoma
chiwindi ntchito / chiwindi kuwonongeka,
Khungu
hyperhidrosis
zotupa
angioedema (komanso wakupha)
chikanga
erythema
urticaria
zidzolo
zotupa pakhungu
sciatica
minofu kukokana
myalgia
arthralgia,
kupweteka kwa miyendo
ngati matenda a tendon,
aimpso kuwonongeka, kuphatikizapo pachimake aimpso kulephera,
kuchuluka kwa plasma creatinine,
kuchepa kwa hemoglobin,
kuchuluka kwa plasma uric acid,
kuchuluka kwa chiwindi michere ndi CPK,
kupweteka pachifuwa
asthenia
chimfine ngati matenda.

Contraindication

matenda olepheretsa biliary thirakiti
kukanika kwambiri kwa chiwindi (kalasi la ana a Pugh),
kuphatikiza pamodzi ndi aliskiren odwala omwe ali ndi matenda osokoneza bongo kapena matenda a impso (GFR ochepera 60 ml / min / 1.73 m2) m'thupi ()
munthawi yomweyo kugwiritsa ntchito ACE zoletsa odwala matenda ashuga nephropathy,
cholowa m'malo obadwa nacho (chifukwa cha kukhalapo kwa sorbitol mu mankhwala)
mimba
nthawi yoyamwitsa,
zaka mpaka 18 - (kuchita bwino ndi chitetezo sizinakhazikitsidwe),
Hypersensitivity kwa yogwira thunthu kapena zilizonse zokondweretsa.

Mimba komanso kuyamwa

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

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

Malinga ndi kuunika kwachipatala, kugwiritsidwa ntchito kwa angiotensin 2 receptor antagonists mu 2 ndi 3 trimesters ya mimba imakhala ndi poizoni pa mwana wosabadwa (ntchito yaimpso, oligohydramnios, kuchepa kwa msana kwa chigaza) ndi wakhanda (kulephera kwa impso, hypotension ndi hyperkalemia). Mukamagwiritsa ntchito angiotensin 2 receptor antagonists mu 2 trimester ya kutenga pakati, kupatsirana kwa impso ndi chigaza cha mwana wosabadwayo kumalimbikitsidwa. Ana omwe amayi awo adalandira angiotensin 2 receptor antagonists panthawi yoyembekezera ayenera kuyang'aniridwa bwino kuti awone ochepa hypotension.

Zambiri pakugwiritsa ntchito telmisartan panthawi yoyamwitsa sizipezeka. Kugwiritsa ntchito kwa mankhwala a Telzap panthawi yoyamwitsa kumatsutsana. Mankhwala ena okhala ndi antihypertensive omwe ali ndi mbiri yabwino yotetezeka amayenera kugwiritsidwa ntchito, makamaka podyetsa mwana wakhanda kapena asanabadwe.

Gwiritsani ntchito ana

Kugwiritsa ntchito kwa mankhwala a Telzap osakwana zaka 18 kuli ndi zotsutsana (kufunikira ndi chitetezo sizinakhazikitsidwe).

Gwiritsani ntchito odwala okalamba

Kwa odwala okalamba, kusintha kwa mankhwala sikofunikira.

Malangizo apadera

Kuwonongeka kwa chiwindi

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

Odwala omwe ali ndi vuto limodzi la impso a stenosis kapena ochepa a stenosis omwe amagwira ntchito limodzi amapangitsa kuti chiwopsezo cha matenda osakanikirana aimpso ndi kulephera kwaimpso akathandizidwe ndi mankhwala osokoneza bongo a RAAS.

Kuwonongeka kwa impso ndi kupatsirana kwa impso

Mukamagwiritsa ntchito Telzap odwala omwe ali ndi vuto la impso, nthawi ndi nthawi mumayang'aniridwa ndi potaziyamu ndi creatinine m'madzi am'magazi. Palibe zovuta zakuchipatala ndi Telzap mwa odwala omwe atulutsidwa kumene impso.

Zizindikiro zamitsempha yamagazi, makamaka pambuyo koyamba kwa Telzap, imatha kupezeka mwa odwala omwe amachepetsa BCC ndi / kapena sodium mu plasma yamagazi motsutsana ndi maziko a chithandizo cham'mbuyomu ndi okodzetsa, kuletsa kudya mchere, kutsegula m'mimba, kapena kusanza. Zinthu zotere (kuchepa kwa madzi ndi / kapena sodium) ziyenera kuchotsedwa musanatenge Telzap.

Ma blockade apawiri a RAAS

Kugwiritsanso ntchito kwa telmisartan ndi aliskiren kumayikidwa kwa odwala omwe ali ndi matenda osokoneza bongo kapena kulephera kwa aimpso (GFR osakwana 60 ml / min / 1.73 m2 ya thupi padziko).

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

Zotsatira za kulepheretsa kwa RAAS, ochepa hypotension, syncope, hyperkalemia, ndi vuto laimpso (kuphatikizapo kuperewera kwaimpso) zimadziwika mu odwala omwe adaganizira izi, makamaka akaphatikizana ndi mankhwala angapo omwe amathandizanso pa dongosolo ili. Chifukwa chake, kuyimitsidwa kwapawiri kwa RAAS (mwachitsanzo, mutatenga telmisartan ndi otsutsana ndi ena a RAAS) sikulimbikitsidwa.

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

Odwala omwe ali ndi vuto loyambira la hyperaldosteronism, mankhwala omwe ali ndi antihypertensive mankhwala, zomwe zimachitika popewa RAAS, nthawi zambiri sizothandiza. Pamenepa, kugwiritsa ntchito mankhwala a Telzap sikulimbikitsidwa.

Aortic ndi mitral valve stenosis, hypertrophic obstriers cardiomyopathy

Monga ndi vasodilators ena, odwala aortic kapena mitral stenosis, komanso hypertrophic obstriers Cardiomyopathy, ayenera kusamala makamaka akamagwiritsa ntchito Telzap.

Odwala omwe ali ndi matenda a shuga omwe adalandira insulin kapena ma hypoglycemic othandizira pakamwa

Poyerekeza ndi momwe mankhwalawo amathandizira ndi Telzap, odwala otere amatha kukumana ndi hypoglycemia. Glycemia yoyang'anira iyenera kulimbikitsidwa, monga pakhoza kufunikira kusintha kwa mlingo wa insulin kapena wothandizira wa hypoglycemic.

Kugwiritsa ntchito mankhwala osokoneza bongo ku RAAS kungayambitse hyperkalemia. Odwala okalamba, odwala omwe amalephera aimpso kapena matenda a shuga, odwala omwe amamwa mankhwala omwe amalimbikitsa kuchuluka kwa plasma potaziyamu, komanso / kapena odwala omwe ali ndi matenda opatsirana, hyperkalemia imatha kupha.

Mukamaganiza za kugwiritsa ntchito mankhwala mogwirizana ndi RAAS, ndikofunikira kuyesa kuchuluka kwa ngozi ndi phindu. Zowopsa zazikuluzikulu za hyperkalemia zomwe ziyenera kuganiziridwa ndi:

matenda a shuga, kulephera kwa impso, zaka (odwala okulirapo kuposa zaka 70),
kuphatikiza ndi mankhwala amodzi kapena zingapo akuchita pa RAAS, ndi / kapena zakudya zopezeka potaziyamu. Mankhwala osokoneza bongo kapena magulu azachipatala omwe angayambitse hyperkalemia ndi malo amchere omwe ali ndi potaziyamu, zoteteza potaziyamu, ACE inhibitors, angiotensin 2 receptor antagonists, non-steroidal anti-kutupa mankhwala (NSAIDs) (kuphatikiza kusankha COX-2 inhibitors), heparin, immunosuppressants (cyclosporine kapena tacrolimus) ndi trimethoprim,
Matenda ophatikizika, makamaka kuchepa kwa madzi m'mimba, kuperewera kwa mtima, metabolic acidosis, matenda aimpso, cytolysis syndrome (mwachitsanzo, miyendo ya pachimake, ischemia, rhabdomyolysis, kuvulala kwambiri).

Odwala omwe ali pachiwopsezo amalangizidwa kuti aziyang'anira mosamala pazomwe zili mu potaziyamu yamagazi.

Telzap ili ndi sorbitol (E420). Odwala osowa cholowa fructose tsankho sayenera kumwa mankhwala.

Monga tafotokozera kwa ACE inhibitors, telmisartan ndi ena angiotensin 2 receptor antagonists amawoneka kuti amachepetsa kuthamanga kwa magazi mokwanira kwa odwala a liwiro la Negroid kuposa amitundu ina, mwina chifukwa chakuwongolera kwakukulu kwa kuchepa kwa ntchito ya renin mwa odwala.

Monga mankhwala ena a antihypertensive, kuchepa kwambiri kwa kuthamanga kwa magazi kwa odwala omwe ali ndi ischemic cardiomyopathy kapena matenda a mtima angayambitse kukulitsa kwa myocardial infarction kapena stroke.

Kukopa pa kuyendetsa magalimoto ndi kayendedwe kazinthu

Maphunziro apadera azachipatala kuti aphunzire momwe mankhwalawo amathandizira kuyendetsa galimoto ndi njira sizinachitike. Mukamayendetsa komanso kugwiritsa ntchito njira zomwe zimafuna kuti anthu azikumbukira, chisamaliro chikuyenera kuchitika, chifukwa chizungulire ndi kugona sikumachitika kawirikawiri ndi ntchito ya Telzap.

Kuyanjana kwa mankhwala osokoneza bongo

Ma blockade apawiri a RAAS

Kugwiritsidwa ntchito kwa Telzap ndi aliskiren kumayikidwa kwa odwala omwe ali ndi matenda osokoneza bongo kapena kulephera kwa aimpso (GFR osakwana 60 ml / min / 1.73 m2 ya malo owonekera mthupi) ndipo osavomerezeka kwa odwala ena.

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

Kafukufuku wachipatala adawonetsa kuti blockade yowirikiza kawiri ya RAAS chifukwa cha kuphatikiza kwa ACE inhibitors, angiotensin 2 receptor antagonists, kapena aliskiren imalumikizidwa ndi zochitika zowonjezereka monga zochitika zamagulu ochepa (hyperkalemia), vuto la aimpso poyerekeza ndikugwiritsa ntchito imodzi yokha mankhwala ochita ku RAAS.

Chiwopsezo cha kukhala ndi hyperkalemia chitha kuchuluka ngati agwiritsidwa ntchito limodzi ndi mankhwala ena omwe angayambitse hyperkalemia (potaziyamu-zakudya zowonjezera komanso zosakaniza zamchere zomwe zimakhala ndi potaziyamu, potaziyamu yotulutsa potaziyamu, mwachitsanzo, spironolactone, eplerenone, triamterene kapena amiloride), NSAIDs (kuphatikiza kusankha COX-2) , heparin, immunosuppressants (cyclosporine kapena tacrolimus) ndi trimethoprim). Ngati ndi kotheka, malinga ndi zomwe zalembedwa pa hypokalemia, kugwiritsa ntchito mankhwala osakanikirana kuyenera kuchitika mosamala ndikuwunika zonse za potaziyamu m'madzi a m'magazi.

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

Potaziyamu yosawononga okodzetsa kapena potaziyamu wokhala ndi zopatsa thanzi

Angiotensin 2 receptor antagonists, monga telmisartan, amachepetsa kuwonongedwa kwa potaziyamu. Potaziyamu yosawononga diuretics (mwachitsanzo, spironolactone, eplerenone, triamteren, kapena amiloride), potaziyamu yazakudya zomwe zili ndi potaziyamu, kapena mchere wotsekemera ungapangitse kuchuluka kwakukulu kwa potaziyamu ya plasma. Ngati zikugwiritsidwa ntchito mosiyanasiyana, chifukwa pali zolembedwa kuti: hypokalemia, ziyenera kugwiritsidwa ntchito mosamala komanso motsutsana ndi kuyang'anira potaziyamu nthawi zonse m'magazi a magazi.

Ndi kuphatikiza kwa lithiamu kukonzekera ndi ACE inhibitors ndi angiotensin 2 receptor antagonists, kuphatikizapo telmisartan, kuwonjezereka kosinthika kwa ndende ya lithiamu m'madzi a m'magazi ndipo poizoni wake adayamba. Ngati mukufuna kugwiritsa ntchito mitundu yosiyanasiyana ya mankhwalawa, tikulimbikitsidwa kuti muwunike mosamala kuchuluka kwa lifiyamu m'madzi a m'magazi.

NSAIDs (i.e., acetylsalicylic acid mu Mlingo womwe umagwiritsidwa ntchito pofuna kuthana ndi kutupa, COX-2 inhibitors komanso osasankha NSAIDs) imatha kufooketsa mphamvu ya antihypertensive zotsatira za angiotensin 2 receptor antagonists. Ena mwa odwala omwe ali ndi vuto la impso (mwachitsanzo, odwala omwe ali ndi vuto la kuchepa magazi, okalamba odwala ntchito aimpso ntchito pamodzi ndi angiotensin 2 receptor antagonists ndi mankhwala omwe amalepheretsa COX-2 kungapangitse kuwonongeka kwina kwaimpso, kuphatikizapo kukula kwa aimpso kulephera. tatochnosti, amene nthawi zambiri kusintha. Chifukwa chake, kugwiritsa ntchito mankhwala paliponse kuyenera kuchitika mosamala, makamaka odwala okalamba. Zakudya zokwanira zamadzimadzi ziyenera kuperekedwa, kuphatikiza, kumayambiriro kwa kugwiritsidwa ntchito molumikizana komanso mtsogolo.

Diuretics (thiazide kapena loop)

Asanalandire chithandizo chamankhwala okodzetsa kwambiri, monga furosemide (a "loop" diuretic) ndi hydrochlorothiazide (a thiazide diuretic), zimatha kubweretsa hypovolemia komanso chiopsezo cha hypotension koyambirira kwa chithandizo cha telmisartan.

Mankhwala ena a antihypertensive

Zotsatira za Telzap zitha kupitilizidwa ndi kugwiritsa ntchito mankhwala ena a antihypertensive.

Kutengera ndi mankhwalawa a baclofen ndi amifostine, titha kuganiza kuti apititsa patsogolo mankhwala othandizira onse antihypertensive mankhwala, kuphatikizapo telmisartan. Kuphatikiza apo, orthostatic hypotension imatha kukula ndikugwiritsa ntchito ethanol (mowa), barbiturates, mankhwala osokoneza bongo kapena antidepressants.

Corticosteroids (yogwiritsidwa ntchito mwatsatanetsatane)

Corticosteroids imafooketsa mphamvu ya telmisartan.

Analogs a mankhwala a Telzap

Zofanana muzochitika zamagulu:

Mikardis,
Mikardis Kuphatikiza,
Wotsogolera
Tanidol
Pano,
Telzap Plus,
Telmisartan
Telmista
Telpres
Telpres Plus,
Telsartan
Telsartan N.

Analogs mu pharmacological group (angiotensin 2 receptor antagonists):

Aprovask,
Aprovel
Artinova,
Atacand
Blocktran
Brozaar
Vasotens,
Valz
Valz N,
Valsartan
Valsacor
Vamloset
Gizaar
Hyposart,
Diovan
Mphepete,
Zisakar
Ibertan
Irbesartan
Irsar
Wogwirizira
Makandulo
Cardomin
Cardos,
Cardosal
Cardosten
Karzartan
Kuphatikiza,
Coaprovel
Cozaar
Xarten
Lozap,
Lozap Plus,
Lozarel
Losartan
Losartan n
Lorista
Losacor
Mikardis,
Naviten
Nortian
Olimestra
Ordiss
Wotsogolera
Presartan
Renicard
Sartavel
Tanidol
Tareg
Pakati
Muziyamwa
Telmisartan
Telpres
Telsartan
Firmast
Edarby
Kuthekera
Exfotans,
Eprosartan Mesylate.

Gulu la Nosological (ICD-10)

Mapiritsi okhala ndi mafilimu	1 tabu.
ntchito:
telmisartan	40/80 mg
zokopa: meglumine - 12/24 mg, sorbitol - 162.2 / 324.4 mg, sodium hydroxide - 3,4 / 6.8 mg, povidone 25 - 20/40 mg, magnesium stearate - 2.4 / 4.8 mg

Mankhwala

Telmisartan ndi mtundu wina wa ARA II (AT subtype₁), yogwira mtima mukamamwa. Telmisartan ali ndiubwenzi wapamwamba kwambiri wa AT₁- olemba omwe ntchito ya angiotensin II imadziwika. Imasiyanitsa angiotensin II kuchoka pachibwenzi ndi cholandilira, osakhala ndi zochita za agonist mokhudzana ndi cholandilira ichi. Telmisartan imamangiriza kokha ku subtype ya AT₁zolandila za angiotensin II. Kulumikizana ndikokhazikika. Telmisartan ilibe chiyanjano ndi ma receptor ena, incl. AT₂ma receptor ndi zina zochepa zomwe amaphunzira angiotensin receptors. Kufunika kwa magwiridwe antchito izi, komanso momwe zimakhalira ndikulimbikitsa kwakukulu ndi angiotensin II, kugwiritsidwa ntchito kwa zomwe zimawonjezeka poika telmisartan, sikunaphunzire. Telmisartan amachepetsa kuchuluka kwa aldosterone m'magazi am'magazi, sikuchepetsa ntchito ya renin, ndipo satseka njira za ion. Telmisartan sikuletsa ACE (kininase II), yomwe imathandizanso kuwonongedwa kwa bradykinin. Izi zimapewa zoyipa zomwe zimakhudzana ndi zochita za bradykinin (mwachitsanzo, chifuwa chowuma).

Chofunikira pa matenda oopsa. Odwala, telmisartan pa mlingo wa 80 mg kwathunthu limalepheretsa hypertensive zotsatira za angiotensin II. Kukhazikika kwa antihypertensive kanthu kumadziwika mkati mwa maola atatu itatha konzedwe ka telmisartan. Mphamvu ya mankhwalawa imatha kwa maola 24 ndipo imakhalabe yofunikira mpaka maola 48. Njira yodziwika bwino ya antihypertgency nthawi zambiri imatha masabata 4-8 pambuyo povomerezeka.

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

Pankhani yakutha kwa telmisartan, kuthamanga kwa magazi kwa masiku angapo pang'onopang'ono kumatha kubwerera ku chiyambi chake popanda chitukuko cha kusiya.

Zotsatira zakuyerekeza kwamafukufuku azachipatala zawonetsa, zotsatira za antihypertensive za telmisartan zikufanana ndi mphamvu ya antihypertensive ya mankhwala am'makalasi ena (amlodipine, atenolol, enalapril, hydrochlorothiazide ndi lisinopril. Zomwe zimachitika kuti chifuwa chouma chikhale chotsika kwambiri ndi telmisartan poyerekeza ndi ACE inhibitors.

Kupewa matenda a mtima. Odwala azaka zapakati pa 55 ndi kupitilira apo omwe ali ndi matenda amitsempha yamagazi, matenda opha ziwopsezo, kuchepa kwakanthawi, kuwonongeka kwamitsempha, kapena zovuta za mtundu 2 shuga mellitus (mwachitsanzo, retinopathy, lamanzere lamitsempha yamagazi, macro- kapena microalbuminuria telmisartan anali ndi vuto lofanana ndi la ramipril pakuchepetsa magawo ophatikizidwira: kufa kwa mtima, kufa kosagwirizana ndi myocardial infarction, soni wa mogwirizana ndi CHF.

Telmisartan inali yothandiza ngati ramipril pakuchepetsa pafupipafupi mfundo zachiwiri: kufa kwa mtima, kufa kosagwirizana ndi myocardial infarction, kapena kupha anthu omwe sanaphe. Kukhosomola kouma ndi angioedema sizimafotokozedwa kawirikawiri poyerekeza ndi telmisartan, pomwe ochepa hypotension amatenga ndi telmisartan.

Odwala aubwana ndi unyamata. Chitetezo ndi luso la telmisartan mwa ana ndi achinyamata ochepera zaka 18 sizinakhazikitsidwe.

Pharmacokinetics

Zogulitsa. Ikaperekedwa, telmisartan imatengedwa mwachangu kuchokera mumimba. Bioavailability ndi 50%. Mukamamwa nthawi yomweyo ndi chakudya, kuchepa kwa AUC kumachokera 6% (pa 40 mg) mpaka 19% (pa mlingo wa 160 mg). Pambuyo pa maola atatu pambuyo pa utsogoleri, ndende ya m'magazi imayendetsedwa mosasamala kanthu kuti telmisartan idatengedwa nthawi yomweyo ngati chakudya kapena ayi. Pali kusiyana pamaganizidwe a plasma mwa amuna ndi akazi. C_max ndipo AUC anali pafupifupi 3 ndi 2 nthawi motsatana mwa azimayi poyerekeza ndi abambo popanda phindu lalikulu.

Panalibe ubale wamzera pakati pa mlingo wa mankhwalawo ndi ndende yake ya plasma. C_max ndipo, pocheperapo, AUC imakulitsa mosawerengeka kuti mankhwalawa amawonjezeka mukamagwiritsa ntchito mankhwala oposa 40 mg / tsiku.

Kugawa. Telmisartan imamangiriza kwambiri mapuloteni a plasma (> 99.5%), makamaka ndi albumin ndi alpha₁-acid glycoprotein.

Kutanthauza Zowoneka V_ss pafupifupi malita 500.

Kupenda. Zimapangidwa ndi kuphatikizika ndi glucuronic acid.

Conjugate ilibe zochitika zamankhwala.

Kuswana. T_1/2 amapitilira maola 20. Amatulutsidwa m'matumbo osasinthika, zotupa za impso - zosakwana 1%. Chilolezo chonse cha plasma ndichokwera (pafupifupi 1000 ml / min) poyerekeza ndi magazi a hepatic (pafupifupi 1500 ml / min).

Ambiri odwala

Ukalamba. Ma pharmacokinetics a telmisartan mwa odwala opitilira zaka 65 sasiyana ndi achinyamata. Kusintha kwa Mlingo sikofunikira.

Matenda aimpso. Odwala omwe ali ndi vuto laimpso lokwanira, sayenera kusintha njira ya telmisartan.

Odwala omwe amalephera kwambiri aimpso komanso omwe ali ndi hemodialysis amalimbikitsidwa kuti azigwiritsa ntchito 20 mg / tsiku (onani "Maupangiri apadera"). Telmisartan siwotsimikizika ndi hemodialysis.

Kuwonongeka kwa chiwindi. Odwala omwe ali ndi vuto la chiwindi chochepa kwambiri (kalasi A ndi B malinga ndi gulu la ana-Pugh), mlingo wa tsiku ndi tsiku sayenera kupitilira 40 mg.

Mlingo

Piritsi limodzi lili

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

hydrochlorothiazide 12.500 mg kapena 25,000 mg, motero,

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

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

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

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

Zisonyezo Telzap ®

Kuchepetsa imfa ndi mtima matenda odwala akulu:

- ndi matenda amitsempha ya atherothrombotic chiyambi (matenda a mtima, stroko kapena mbiri ya zotumphukira mitsempha),

- ndi mtundu 2 matenda a shuga ndi chiwopsezo cha ziwalo.

Contraindication

Hypersensitivity kwa yogwira mankhwala kapena chilichonse okonda mankhwala,

Mimba ndi kuyamwa

matenda olepheretsa biliary thirakiti

kukanika kwambiri kwa chiwindi (kalasi la ana a Pugh),

kuphatikiza pamodzi ndi aliskiren kwa odwala omwe ali ndi matenda a shuga kapena aimpso kwambiri (GFR ochepera 60 ml / min / 1.73 m 2) (onani "Kulumikizana" ndi "Malangizo Apadera"),

cholowa m'malo obadwa nacho (chifukwa cha sorbitol piritsi),

Kugwiritsa ntchito pamodzi ndi ACE zoletsa odwala omwe ali ndi matenda ashuga nephropathy (onani "Kuchita" ndi "Malangizo apadera"),

zaka mpaka 18 (Kuchita bwino komanso chitetezo sichinakhazikitsidwe).

Ndi chisamaliro: Mgwirizano wamitsempha wamagazi wamanjenje kapena kupindika kwamankhwala amkati, kugwira ntchito kwa impso. kulibe), mtima wosalephera, aortic ndi mitral valve stenosis, hypertrophic obstriers Cardiomyopathy, hyperalosta yoyamba onizm (efficacy ndi chitetezo sizinachitike anakhazikitsa), chithandizo cha odwala akuda.

Mimba komanso kuyamwa

Ngati chithandizo cha nthawi yayitali ndi Telzap ® ndikofunikira, odwala omwe akukonzekera kutenga pakati ayenera kusankha njira ina yotsatsira antihypertensive yokhala ndi mbiri yotsimikizika yotetezeka yogwiritsidwa ntchito panthawi yapakati. Pambuyo pokhazikitsa chowonadi chokhala ndi pakati, chithandizo ndi Telzap ® ziyenera kuyimitsidwa nthawi yomweyo ndipo ngati kuli koyenera, chithandizo chamankhwala chiyenera kuyambitsidwa.

Monga tawonera zotsatira za kuwunika kwachipatala, kugwiritsidwa ntchito kwa ARA II mu II ndi III trimesters pamimba kumakhala ndi poizoni pa mwana wosabadwa (kuwonongeka kwa impso, oligohydramnios, kuchedwa kwa msana kwa chigaza) ndi wakhanda (kulephera kwa impso, kusintha kwina ndi hyperkalemia). Mukamagwiritsa ntchito ARA II panthawi yachiwiri ya kubereka, ndikulimbikitsidwa kwa impso ndi chigaza cha mwana wosabadwayo.

Ana omwe amayi awo adatenga ARA II panthawi yapakati amayenera kuwunikira mosamala kuti asachite kunjenjemera.

Zambiri pakugwiritsa ntchito telmisartan panthawi yoyamwitsa sizipezeka. Kutenga Telzap ® mukamayamwa kumayesedwa (onani "Contraindication"), mankhwala othandizira omwe ali ndi mbiri yabwino yachitetezo ayenera kugwiritsidwa ntchito, makamaka podyetsa mwana wakhanda kapena asanabadwe.

Zotsatira zoyipa

Malinga ndi WHO, zotsatira zosafunikira zimagawidwa malinga ndi kuchuluka kwa chitukuko motere: pafupipafupi (≥1 / 10), nthawi zambiri (kuyambira ≥1 / 100 mpaka kupha kumene.

Mbali ya magazi ndi zamitsempha yamagazi: pafupipafupi - kuchepa magazi, osowa - eosinophilia, thrombocytopenia.

Kuchokera ku chitetezo chamthupi: kawirikawiri - anaphylactic reaction, hypersensitivity.

Kuchokera kumbali ya kagayidwe ndi zakudya: pafupipafupi - hyperkalemia, kawirikawiri - hypoglycemia (odwala matenda a shuga).

Kuchokera kumbali ya psyche: pafupipafupi - kusowa tulo, kukhumudwa, kawirikawiri - nkhawa.

Kuchokera ku dongosolo lamanjenje: pafupipafupi - kukomoka, kawirikawiri - kugona.

Kuchokera kumbali yathu zosokoneza zowoneka.

Mbali ya vuto lakumva ndi vuto la labyrinth: pafupipafupi - vertigo.

Kuchokera pamtima: pafupipafupi - bradycardia, kawirikawiri - tachycardia.

Kuchokera pazombo: pafupipafupi - kuchepa kwa magazi, orthostatic hypotension.

Kuchokera pakapumidwe, m'chifuwa ndi ziwalo zam'mimba: pafupipafupi - kupuma movutikira, kutsokomola, kawirikawiri - matenda am'mapapo.

Kuchokera m'mimba: pafupipafupi - kupweteka kwam'mimba, kutsegula m'mimba, kukomoka, kusanza, kusanza, kawirikawiri - pakamwa youma, kusapeza bwino m'mimba, kuphwanya kwamvedwe kabwino.

Pa mbali ya chiwindi ndi biliary thirakiti: osowa - kuwonongeka kwa chiwindi / kuwonongeka kwa chiwindi.

Pa khungu ndi subcutaneous minofu: pafupipafupi - khungu loyenda, hyperhidrosis, zotupa, osowa - angioedema (komanso wowopsa), chikanga, erythema, urticaria, chotupa cha mankhwala, zotupa pakhungu.

Kuchokera minofu ndi mafupa ofunikira: pafupipafupi - kupweteka kumbuyo (sciatica), kukokana kwa minofu, myalgia, kawirikawiri - arthralgia, kupweteka kwa miyendo, kupweteka kwa tendon (tendon-like syndrome).

Kuchokera ku impso ndi kwamkodzo thirakiti: pafupipafupi - mkhutu waimpso, kuphatikizapo kupweteka kwaimpso.

Zovuta ndi zovuta zina pamalo opangira jakisoni: pafupipafupi - kupweteka pachifuwa, asthenia (kufooka), kawirikawiri - matenda ngati chimfine.

Kukhudzidwa pazotsatira za labotale ndi zothandiza: pafupipafupi - kuwonjezeka kwa kuchuluka kwa creatinine m'madzi a m'magazi, kawirikawiri - kuchepa kwa zomwe zili mu Hb, kuchuluka kwa uric acid m'madzi am'magazi, kuwonjezeka kwa ntchito ya michere ya chiwindi ndi CPK.

Kuchita

Ma blockade apawiri a RAAS. Kugwiritsidwa ntchito kwa telmisartan ndi aliskiren kumatsutsana mwa odwala omwe ali ndi matenda osokoneza bongo kapena kulephera kwa aimpso (GFR ochepera 60 ml / min / 1.73 m 2) ndipo osavomerezeka kwa odwala ena.

Kugwiritsa ntchito pamodzi kwa telmisartan ndi ACE zoletsa kumapangidwa kwa odwala omwe ali ndi matenda ashuga nephropathy (onani "Contraindication").

Kafukufuku wachipatala adawonetsa kuti blockade iwiri ya RAAS chifukwa cha kuphatikiza kwa ACE inhibitors, ARA II, kapena aliskiren imalumikizidwa ndikuwonjezereka kwa zochitika zovuta monga arterial hypotension, hyperkalemia, ndi vuto laimpso (kuphatikizapo kuperewera kwaimpso), poyerekeza ndi kugwiritsa ntchito mankhwala amodzi okha kutsatira RAAS.

Chiwopsezo cha kukhala ndi hyperkalemia chitha kuchuluka ngati agwiritsidwa ntchito limodzi ndi mankhwala ena omwe angayambitse hyperkalemia (potaziyamu-zakudya zowonjezera ndi mchere wogwirizira womwe amakhala ndi potaziyamu, potaziyamu woteteza (e.g. spironolactone, eplerenone, triamterene kapena amiloride), NSAIDs, kuphatikiza kusankha COX-2 inhibiti , immunosuppressants (cyclosporine kapena tacrolimus) ndi trimethoprim.Ngati ndikofunikira, motsutsana ndi mbiri yakale ya hypokalemia, kugwiritsa ntchito mankhwala paliponse kuyenera kuchitika samalani ndikuwonetsetsa zochitika za potaziyamu m'madzi a m'magazi.

Digoxin. Ndi mgwirizano wa telmisartan ndi digoxin, kuwonjezeka kwapakati pa C kunadziwika_max plasma digoxin pa 49% ndi C_mphindi ndi 20%. Kumayambiriro kwa chithandizo, posankha mtundu wa mankhwala ndi kusiya kumwa mankhwala ndi telmisartan, kuchuluka kwa digoxin m'madzi a m'magazi kuyenera kuyang'aniridwa mosamala kuti pakhale njira yochizira.

Potaziyamu yosawononga okodzetsa kapena potaziyamu wokhala ndi zopatsa thanzi. ARA II, monga telmisartan, amachepetsa kutaya kwa potaziyamu chifukwa cha okodzetsa. Potaziyamu yosawononga diuretics, mwachitsanzo spironolactone, eplerenone, triamteren kapena amiloride, potaziyamu zomwe zimakhala ndi zakudya kapena zowonjezera mchere zimatha kuyambitsa kuchuluka kwa potaziyamu m'madzi a m'magazi. Ngati zikugwiritsidwa ntchito mosiyanasiyana, chifukwa pali zolembedwa kuti: hypokalemia, ziyenera kugwiritsidwa ntchito mosamala komanso motsutsana ndi kuyang'anira potaziyamu nthawi zonse m'magazi a magazi.

Kukonzekera kwa Lithium. Pamene kukonzekera kwa lithiamu kumachitika limodzi ndi ACE ndi ARA II zoletsa, kuphatikiza telmisartan, kuwonjezereka kosintha kwa plasma wozungulira wa lithiamu ndi poizoni wake kunayamba. Ngati mukufuna kugwiritsa ntchito mitundu yosiyanasiyana ya mankhwalawa, tikulimbikitsidwa kuti muwunike mosamala kuchuluka kwa lifiyamu m'madzi a m'magazi.

NSAIDs. NSAIDs (i.e., acetylsalicylic acid mu Mlingo wogwiritsidwa ntchito pakuthana ndi zotupa, COX-2 inhibitors komanso NSAIDs zosasankha) zitha kufooketsa mphamvu ya antihypertensive ya ARA II. Odwala ena omwe ali ndi vuto la impso (mwachitsanzo, kuchepa madzi m'thupi, odwala okalamba omwe ali ndi vuto laimpso), kugwiritsidwa ntchito kophatikizana kwa ARA II ndi mankhwala omwe amalepheretsa COX-2 kungayambitse kuwonongeka kwa ntchito yaimpso, kuphatikizapo kukula kwa aimpso kulephera, komwe, monga lamulo, ndikosintha. Chifukwa chake, kugwiritsa ntchito mankhwala paliponse kuyenera kuchitika mosamala, makamaka odwala okalamba. Ndikofunikira kuti zitsimikizire kuchuluka koyenera kwamadzimadzi, kuphatikiza, kumayambiriro kwa kugwiritsidwa ntchito molumikizana komanso nthawi ndi nthawi mtsogolo, zidziwitso zantchito ya aimpso ziyenera kuyang'aniridwa.

Diuretics (thiazide kapena loop). Chithandizo cham'mbuyomu chokhala ndi kuchuluka kwa okodzetsa, monga furosemide (loop diuretic) ndi hydrochlorothiazide (thiazide diuretic), zimatha kubweretsa hypovolemia ndi chiopsezo cha hypotension koyambirira kwa chithandizo ndi telmisartan.

Mankhwala ena a antihypertensive. Mphamvu ya telmisartan imatha kupitilizidwa ndi kugwiritsa ntchito mankhwala ena a antihypertensive. Kutengera ndi mankhwalawa a baclofen ndi amifostine, titha kuganiza kuti apititsa patsogolo mankhwala othandizira onse antihypertensive mankhwala, kuphatikizapo telmisartan. Kuphatikiza apo, orthostatic hypotension imatha kuchuluka ndi mowa, barbiturates, mankhwala osokoneza bongo, kapena antidepressants.

Corticosteroids (yogwiritsidwa ntchito mwadongosolo). Corticosteroids imafooketsa mphamvu ya telmisartan.

Mlingo ndi makonzedwe

Mkati, kamodzi patsiku, kutsukidwa ndimadzimadzi, mosasamala kanthu za kudya.

Matenda oopsa. Mlingo woyamba wa Telzap ® ndi piritsi limodzi. (40 mg) kamodzi patsiku. Odwala ena amatha kudya 20 mg / tsiku limodzi. Mlingo wa 20 mg ungapezeke mwa kugawa piritsi la 40 mg pakati pangozi. Muzochitika zomwe achire samakwaniritsa, muyezo wa Telzap ® mutha kupititsidwa mpaka 80 mg kamodzi patsiku. Njira ina, Telzap ® imatha kuthandizidwa ndi thiazide diuretics, mwachitsanzo, hydrochlorothiazide, yomwe, ikagwiritsidwa ntchito palimodzi, imakhala ndi mphamvu yowonjezera ya antihypertensive.

Mukafuna kudziwa kuchuluka kwa mankhwalawa, ziyenera kukumbukiridwa kuti mphamvu yayitali kwambiri ya antihypertgency nthawi zambiri imatheka mkati mwa masabata 4-8 pambuyo poyambira chithandizo.

Kuchepetsa imfa ndi pafupipafupi matenda a mtima. Mlingo wovomerezeka wa Telzap ® ndi 80 mg kamodzi patsiku. Munthawi yoyambirira ya chithandizo, kuyang'anira magazi kumalimbikitsidwa; kusintha kwa antihypertensive mankhwala kungafunike.

Ambiri odwala

Matenda aimpso. Zomwe zimachitika ndi telmisartan kwa odwala omwe amalephera kwambiri aimpso kapena odwala hemodialysis ndi ochepa. Odwala awa amalimbikitsidwa kuti ayambe kutsika 20 mg / tsiku (onani. "Chithandizo chapadera"). Kwa odwala omwe ali ndi vuto laimpso lokwanira zolimbitsa thupi, kusintha kwa mankhwala sikofunikira. Kugwiritsa ntchito kwa Telzap ® ndi aliskiren kumapangidwa mwa odwala omwe amalephera kuwonongeka kwa impso (GFR osakwana 60 ml / min / 1.73 m 2) (onani. "Contraindication").

Kugwiritsa ntchito nthawi yomweyo kwa Telzap ® ndi ACE zoletsa kumapangidwa kwa odwala omwe ali ndi matenda ashuga nephropathy (onani "Contraindication").

Kuwonongeka kwa chiwindi. Telzap ® imaphatikizidwa kwa odwala omwe amawonongeka kwambiri kwa chiwindi (Child-Pugh class C) (onani "Contraindication"). Odwala omwe ali ndi vuto lochepa kwambiri kwa hepatic (kalasi A ndi B malinga ndi gulu la ana-Pugh, motsutsana), mankhwalawa amadziwitsidwa mosamala, mankhwalawa sayenera kupitilira 40 mg kamodzi patsiku (onani. "Mochenjera").

Ukalamba. Kwa odwala okalamba, kusintha kwa mankhwalawa sikofunikira.

Ana ndi unyamata. Kugwiritsa ntchito kwa Telzap ® mwa ana ndi achinyamata ochepera zaka 18 kumayesedwa chifukwa chosowa chitetezo ndi chidziwitso chokwanira (onani "Contraindication").

Bongo

Zizindikiro mawonetseredwe ambiri a bongo anali kuchepa kwa kuthamanga kwa magazi ndi tachycardia, ndi bradycardia, chizungulire, kuchuluka kwa serum creatinine ndende ndi kulephera kwa aimpso kunanenedwanso.

Chithandizo: Telmisartan siwotsimikizika ndi hemodialysis. Odwala ayenera kuyang'aniridwa mosamala ndikuwonetsa chizindikiro komanso chisamaliro chothandizira chikuyenera kuthandizidwa. Njira yothandizira matendawa imadalira nthawi yomwe umatha kumwa mankhwalawo, komanso kuopsa kwa zizindikiro. Njira zomwe zingalimbikitsidwe zimaphatikizira kutsuka komanso / kapena kuphwanya m'mimba; kugwiritsa ntchito kaboni yokhazikitsidwa ndikofunika. Ma electrolyte a plasma ndi creatinine ayenera kuyang'aniridwa pafupipafupi. Ngati kuchepa kwakukulu kwa magazi kumachitika, wodwalayo ayenera kuyimilira ndi miyendo yokwezeka, pomwe ndikofunikira kubwezeretsa mwachangu bcc ndi ma elekitirodi.

Malangizo apadera

Kuwonongeka kwa chiwindi. Kugwiritsa ntchito kwa Telzap ® kumaphatikizidwa kwa odwala omwe ali ndi cholestasis, bile duct obstruction kapena chiwopsezo chachikulu cha chiwindi (Mwana-Pugh kalasi C) (onani "Contraindication"), chifukwa telmisartan imapukusidwa kwambiri mu bile. Amakhulupirira kuti mwa odwala oterowo, chiwopsezo cha telmisartan chimachepetsedwa. Odwala omwe ali ndi vuto lochepa kapena lakuthwa kwa hepatic (gulu la ana-Pugh A ndi gulu la B), Telzap ® iyenera kugwiritsidwa ntchito mosamala (onani. Ndi chisamaliro).

Kukonzanso kwamphamvu kwamphamvu. Mankhwalawa akamagwiritsa ntchito RAAS odwala omwe ali ndi vuto la mtima lamitsempha limodzi la mtima kapena minyewa ya m'mimba ya impso yokhayo, chiopsezo cha matenda owopsa komanso aimpso chikuwonjezeka.

Kuwonongeka kwa impso ndi kumuika impso. Mukamagwiritsa ntchito Telzap ® odwala omwe ali ndi vuto la impso, nthawi zina mumayang'aniridwa ndi potaziyamu ndi creatinine m'madzi am'magazi. Palibe chokuchitikirani ndi Telzap ® mwa odwala omwe atulutsidwa kumene impso.

Kuchepetsa mu BCC. Zizindikiro zamitsempha yamagazi, makamaka pambuyo koyamba kwa Telzap ®, imatha kupezeka mwa odwala omwe ali ndi BCC yotsika komanso / kapena sodium m'magazi am'magazi motsutsana ndi maziko a chithandizo cham'mbuyomu ndi okodzetsa, zoletsa pakudya mchere, kutsegula m'mimba kapena kusanza.

Zinthu zotere (kuchepa kwa madzi ndi / kapena sodium) ziyenera kuchotsedwa musanatenge Telzap ®.

Ma blockade apawiri a RAAS. Kugwiritsanso ntchito kwa telmisartan ndi aliskiren kumatsutsana mwa odwala omwe ali ndi matenda osokoneza bongo kapena kulephera kwa aimpso (GFR osakwana 60 ml / min / 1.73 m 2) (onani. "Contraindication").

Kugwiritsa ntchito pamodzi kwa telmisartan ndi ACE zoletsa kumapangidwa kwa odwala omwe ali ndi matenda ashuga nephropathy (onani "Contraindication").

Zotsatira za kulepheretsa kwa RAAS, ochepa hypotension, kukomoka, hyperkalemia, ndi vuto laimpso (kuphatikizapo kuperewera kwaimpso) zimadziwika mu odwala omwe adaloseredwa izi, makamaka akaphatikizidwa ndi mankhwala angapo omwe amagwiranso ntchito pa dongosololi. Chifukwa chake, kuyimitsidwa kwapawiri kwa RAAS (mwachitsanzo, mutatenga telmisartan ndi otsutsana ndi ena a RAAS) sikofunikira.

Pankhani yodalira mtima kamvekedwe ka minyewa ndi ntchito yaimpso makamaka pa ntchito ya RAAS (mwachitsanzo, odwala omwe ali ndi vuto la mtima kapena matenda a impso, kuphatikizapo aimpso mtsempha wamagazi kapena stenosis yamitsempha yama impso imodzi, kayendetsedwe ka mankhwala omwe amakhudzana ndi dongosolo lino akhoza kukhala limodzi ndi kukula kwa pachimake. ochepa hypotension, hyperazotemia, oliguria ndipo nthawi zina, pachimake aimpso kulephera.

Hyperaldosteronism yoyamba. Odwala omwe ali ndi vuto loyambira la hyperaldosteronism, mankhwala omwe ali ndi antihypertensive mankhwala, zomwe zimachitika popewa RAAS, nthawi zambiri sizothandiza. Pankhaniyi, kugwiritsa ntchito mankhwala a Tezap ® sikulimbikitsidwa.

Stenosis ya maortic ndi mitral maalves, hypertrophic obstriers cardiomyopathy. Monga ndi vasodilators ena, odwala aortic kapena mitral stenosis, komanso hypertrophic obstriers Cardiomyopathy, ayenera kusamala makamaka mukamagwiritsa ntchito Telzap ®.

Odwala omwe ali ndi matenda a shuga omwe adalandira insulin kapena ma hypoglycemic othandizira pakamwa. Poyerekeza ndi chithandizo cha mankhwalawa ndi Telzap ®, odwalawa amatha kukumana ndi hypoglycemia. Mwa odwala, glycemic control iyenera kulimbikitsidwa, monga pakhoza kufunikira kusintha kwa mlingo wa insulin kapena wothandizira wa hypoglycemic.

Hyperkalemia Kulandila kwa mankhwala ochita ku RAAS kungayambitse matenda oopsa. Odwala okalamba, odwala omwe ali ndi vuto la impso kapena matenda a shuga, odwala omwe amamwa mankhwala omwe amathandizanso plasma potaziyamu, komanso / kapena odwala omwe ali ndi matenda opatsirana, hyperkalemia imatha kupha.

Mukamaganiza za kugwiritsa ntchito mankhwalawo mogwirizana ndi RAAS, ndikofunikira kuyesa kuchuluka kwa mapangidwe ake. Zowopsa zazikuluzikulu za hyperkalemia zomwe ziyenera kuganiziridwa ndi:

- matenda a shuga, matenda a impso, zaka (odwala okalamba zaka 70),

- kuphatikiza ndi mankhwala amodzi kapena zingapo wogwiritsa ntchito RAAS, ndi / kapena zakudya zopezeka ndi potaziyamu. Mankhwala osokoneza bongo kapena magulu azachipatala omwe angayambitse hyperkalemia ndi malo amchere omwe ali ndi potaziyamu, potaziyamu osasamala okodzetsa, ACE inhibitors, ARA II, NSAIDs, kuphatikizapo kusankha COX-2 zoletsa, heparin, immunosuppressants (cyclosporin kapena tacrolimus) ndi trimethoprim,

- Matenda ofanana / matenda, makamaka kuchepa kwa madzi, kupweteka mtima, metabolic acidosis, matenda aimpso, cytolysis syndrome, mwachitsanzo, miyendo ya pachimake, ischemia, rhabdomyolysis, kuvulala kwambiri.

Odwala omwe ali pachiwopsezo amalimbikitsidwa kuti awunikire mosamala zomwe zili mu potaziyamu yamagazi (onani "Kuchita").

Sorbitol. Mankhwalawa ali ndi sorbitol (E420). Odwala omwe ali ndi mafupa osowa mwanjira ya chiberekero sayenera kutenga Telzap ®.

Mitundu yosiyanasiyana. Monga taonera kwa ACE inhibitors, telmisartan ndi ena a ARA II amawoneka kuti amachepetsa kuthamanga kwa magazi kwa odwala omwe amathamanga mu liwiro la Negroid kuposa oyimira mafuko ena, mwina chifukwa chakuwongolera kwakukulu kwa kuchepa kwa ntchito ya renin mwa kuchuluka kwa odwala.

Zolakwika Monga mankhwala ena a antihypertgency, kuchepa kwambiri kwa kuthamanga kwa magazi kwa odwala omwe ali ndi ischemic cardiomyopathy kapena CHD kungayambitse kukula kwa myocardial infarction kapena stroke.

Kukopa pa kuyendetsa magalimoto, machitidwe. Maphunziro apadera azachipatala kuti aphunzire momwe mankhwalawo amathandizira kuyendetsa galimoto ndi njira sizinachitike. Mukamayendetsa komanso kugwiritsa ntchito njira zomwe zimafuna kuti anthu azikumbukira, chisamaliro chikuyenera kuchitika, chifukwa chizungulire ndi tulo sizitha kuchitika kawirikawiri mutatenga Telzap ®.

Wopanga

Zentiva Saalyk Yurunleri Sanayi ve Tijaret A.Sh., Turkey.

District Kucukkaryshtyran, st. Merkez, No. 223 / A, 39780, Buyukkaryshtyran, Luleburgaz, Kırklareli, Turkey.

Wokhala ndi satifiketi yolembetsa. Sanofi Russia JSC. 125009, Russia, Moscow, ul. Tverskaya, 22.

Zofunsa pamtundu wa mankhwalawa ziyenera kutumizidwa ku adilesi ya Sanofi Russia JSC: 125009, Russia, Moscow, ul. Tverskaya, 22.

Tele. ((495) 721-14-00, fakisi: (495) 721-14-11.

Kutulutsa mawonekedwe ndi kapangidwe kake

Telzap imapezeka mu mawonekedwe a mapiritsi ophimbidwa ndi filimu yophimba ya 40 mg ndi 80 mg. Zidutswa 10 zimagulitsidwa m'matumba, pamakatoni okhala ndi matuza 3, 6 kapena 9 ndi malangizo ogwiritsa ntchito Telzap.

Piritsi 1 imakhala ndi yogwira: telmisartan - 40 mg kapena 80 mg ndi othandizira: povidone 25, meglumine, sodium hydroxide, sorbitol, magnesium stearate.

Tipange mapiritsi a Telzap Plus 80 mg + 12,5 mg, okhala ndi 80 mg ya telmisartan ndi 12.5 mg wa hydrochlorothiazide - okodzetsa.

Zotsatira za pharmacological

The yogwira mankhwala telmisartan ali ndi mphamvu ya enieni angiotensin II receptor antagonists. Mukamwetsa, mankhwalawa amatha kuthamangitsa angiotensin II kuchokera pakulumikizana ndi receptor. Kuphatikiza apo, polankhula ndi receptor uyu, sikuti amangokhalira kukangana. Telmisartan imangolumikizana ndi angiotensin II ATl receptors. Zomwe zimagwira sizikuwonetsa zofanana ndi AT2 receptor ndi zina.

Mothandizidwa ndi mankhwalawa m'magazi am'magazi, kuchuluka kwa aldosterone kumachepa. Nthawi yomweyo, ntchito za renin zimakhalabe pamlingo womwewo ndipo mayendedwe a ion satsekedwa.

Angiotensin-akatembenuza enzyme yomwe imathandizira kuwonongeka kwa bradykinin sikuletsa. Izi zimakupatsani mwayi kuti muchepetse chiopsezo chokhala ndi zotsatira zoyipa monga chifuwa chowuma.

Mukamagwiritsa ntchito mulingo wa 80 mg mu odwala, chiwopsezo cha angiotensin II chatsekedwa. Zotsatira zake zimatheka patadutsa maola atatu itatha yoyamba mlingo. Kuchitikaku kumatenga maola 24. Amamuwona ngati wothandiza kwa maola 48. Kudya mapiritsi pafupipafupi kwa masabata a 4-8 kumabweretsa zotsatira zabwino za antihypertensive.

Kugwiritsa ntchito kwa Telzap odwala omwe ali ndi matenda oopsa kwambiri kungachepetse kuthamanga kwa magazi kwa diastoli ndi systolic. Pakadali pano, kugunda kwa mtima sikusintha.

Mankhwalawa amagwiritsidwa ntchito pochiza matenda amtima. Odwala okalamba odwala matenda a mtima dongosolo, mapiritsi anali ndi kuchepetsa kutsika kwa:

mikwingwirima
myocardial infaration
kufa chifukwa cha matenda amtima.

Zizindikiro zogwiritsidwa ntchito

Kodi chimathandiza ndi chiyani Telzap? Zizindikiro zazikulu pakugwiritsa ntchito mapiritsi:

IHD mwa odwala azaka zopitilira 55.
Kupewa matenda a mtima dongosolo.
Kupewa kufa chifukwa cha kugunda kwamtima kwa odwala omwe ali pachiwopsezo (choteteza mtima, kugunda, kulephera kwa mtima ndi zotsatira zakupha).
Kupewa matenda a mtima ndi mitsempha yamagazi mu mtundu 2 wa shuga.
Kuthamanga kwambiri kwa magazi - pamwambapa pa 140/90 pakufunika kofunikira komanso mitundu ina ya matenda oopsa.
Monga mbali ya zovuta mankhwala pambuyo sitiroko kapena ischemic kuukira.

Matenda oopsa

Kugwiritsidwa ntchito kwa Telzap ndi aliskiren kumayikidwa kwa odwala omwe amalephera kupweteka kwa impso (GFR osakwana 60 ml / mphindi / 1.73 m2 yamalo olimbitsa thupi).

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

Kwa odwala okalamba, kusintha kwa mankhwala sikofunikira.

Telzap Plus

Tengani pakamwa, kamodzi patsiku, kutsukidwa ndi madzi, osasamala chakudyacho.

Odwala omwe BP yawo singayende moyenera ndi monotherapy ndi telmisartan kapena hydrochlorothiazide ayenera kutenga Telzap Plus.

Musanafike pophatikizira ndi gawo limodzi la mankhwala, munthu aliyense amalimbikitsidwa pakamwa. Mu zochitika zina zamankhwala, kusintha kwachindunji kuchokera ku monotherapy kupita ku chithandizo cha mankhwala osakanikirana kungaganizidwe.

Werengani komanso nkhaniyi: Pa kukakamizidwa kumwa Korintofar: malangizo, mtengo, ndi ndemanga

Mankhwala a Telzap Plus, angagwiritsidwe ntchito kamodzi patsiku kwa odwala omwe magazi awo sangathe kuwongolera bwino akamamwa telmisartan pa mlingo wa 80 mg patsiku.

Zotsatira zoyipa

Mwa odwala ena, kutenga Telzap kumatha kupangitsa kuti muzindikire mavuto.

Dyspnea ndi chifuwa sizimachitika kawirikawiri. Pafupipafupi, pamakhala matenda amkati wamapapo.
Odwala ena amadandaula za kusowa tulo, kukhumudwa, nkhawa zambiri. Nthawi zina, amakomoka.
Mwa azimayi, matenda otupa a kubereka amatha kuchitika, nthawi zina, vuto lakusamba kwa msambo limawonedwa. Mwa amuna, kukanika kwa erectile ndikotheka.
Pali umboni wa kakulidwe ka thrombocytopenia, eosinophilia ndi hemoglobin wotsika.
Mndandanda wazotsatira zoyenera zotchedwa hyperhidrosis, kuyabwa pakhungu, zotupa. Eczema, angioedema, erythema, poizoni wakhungu ndi mankhwala osokoneza bongo samapezeka kawirikawiri.
Mwa zina zoyipa zotchedwa aimpso ntchito. Chimodzi mwazomwezi ndi kuperewera kwa impso.
Kuchokera m'mimba, m'mimba, kupweteka kwam'mimba, kusanza, kugona ndi matenda osokoneza bongo zimachitika kawirikawiri kuposa ena. Mavuto amakomedwe, kusapeza bwino mu gawo la epigastric, mucosa wowuma pamlomo wamkati samadziwika.

Matenda a mtima nthawi zambiri samayankha pazomwe zimachitika ndi chithandizo cha Telzap. Pakadali pano, odwala ndi otheka:

kutsitsa kuthamanga kwa magazi ndikusintha kwa maonekedwe a thupi
kukomoka kwa hypotension
kuchepa kapena kuchuluka kwa kugunda kwa mtima.

Mavuto a ndulu ndi chiwindi ndi osowa kwambiri.

Kugwiritsa ntchito mankhwalawa kungayambitse kuchepa kwa shuga m'magazi ndi metabolic acidosis.

Pazonse zomwe sizigwirizana, izi ndizotheka:

Mankhwala

Pharmacokinetics

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

Telmisartan: Pambuyo pakukonzekera kwa pakamwa, kutsikira kwa telmisartan kumachitika pambuyo pa maola 0.5 - 1.5. Mtheradi wa bioavailability wa telmisartan pa mlingo wa 40 mg ndi 160 mg ndi 42% ndi 58%, motero. Mukamamwa telmisartan nthawi yomweyo ndi chakudya, kuchepa kwa AUC (dera lozunguliridwa ndi nthawi yoponderezedwa) kumachokera ku 6% (pa 40 mg) mpaka 19% (pa mlingo wa 160 mg). Pakadutsa maola atatu atatha kumwa, kuchuluka kwa madzi am'magazi kumatha, ngakhale chakudya. Kutsika pang'ono kwa AUC sikuyambitsa kuchepa kwamankhwala othandizira. The pharmacokinetics ya telmisartan ya pakamwa silinelinear pa Mlingo wa 20-160 mg ndi kuchuluka kopitilira muyeso wama plasma (Cmax ndi AUC) omwe ali ndi mlingo wowonjezeka. Palibe kondwerero yofunika kwambiri ya telmisartan yomwe yapezeka.

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

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

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

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

Hydrochlorothiazide osati zimapukusidwa mwa anthu

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

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

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

Odwala okalamba

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

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

Odwala omwe ali ndi vuto la impso

Kuchotsera kwamkati sikukhudza chilolezo cha telmisartan. Malinga ndi zotsatira za kusadziwa pang'ono ndi Telzap Plus mwa odwala omwe amachepetsa kwambiri aimpso (creatinine chilolezo cha 30-60 ml / mphindi, pafupifupi mtengo wa pafupifupi 50 ml / min), kusintha kwa mankhwalawa sikofunikira kwa odwala omwe ali ndi kuchepa kwa aimpso. Telmisartan samachotsedwa magazi ndi hemodialysis. Odwala ndi mkhutu aimpso ntchito, mlingo wa kuthetsedwa kwa hydrochlorothiazide amachepetsa. Pakufufuza kwa odwala omwe ali ndi chilengedwe cha creatinine chilolezo cha 90 ml / min, theka la moyo wa hydrochlorothiazide lidakulitsidwa. Odwala omwe ali ndi impso yosagwira ntchito, kuchotsa hafu ya moyo kumakhala pafupifupi maola 34.

Odwala omwe ali ndi vuto la chiwindi

Odwala ndi hepatic kusowa, kutsimikizika bioavailability wa telmisartan ukuwonjezeka mpaka 100%. Hafu ya moyo wa chiwindi kulephera sasintha.

Farmakodinamika

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

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

Kufunika kwa magwiridwe antchito izi, komanso momwe zimakhalira ndikulimbikitsa kwakukulu ndi angiotensin II, kugwiritsidwa ntchito kwa zomwe zimawonjezeka poika telmisartan, sikunaphunzire.

Telmisartan imachepetsa plasma aldosterone, sichiletsa renin mu plasma ya anthu ndi njira za ion.

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

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

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

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

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

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

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

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

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

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

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

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

Ana, pa mimba ndi mkaka wa m`mawere

Palibe chidziwitso chodalirika cha mankhwalawa panthawi yapakati. Ngati wodwala akukonzekera kutenga pakati, ndipo akuyenera kumwa mankhwala kuti achepetse zovuta, tikulimbikitsidwa kuti atenge njira zina.

Kugwiritsa ntchito mankhwala kuchokera ku gulu la zoletsa, angiotensin antagonists mu 2nd ndi 3 trimesters kumathandizira kukulitsa kuwonongeka kwa impso, chiwindi, kuchedwa kwa msana kwa chigaza mu fetus, oligohydramnion (kuchepa kwa kuchuluka kwa amniotic fluid).

Kugwiritsa ntchito mankhwalawa nthawi yoyamwitsa kumatsutsana.

Kuyanjana kwa mankhwala osokoneza bongo

Telzap nthawi zambiri imagwiritsidwa ntchito ngati gawo la chithandizo chovuta, kotero muyenera kuganizira momwe mapiritsi amaphatikizira ndi mankhwala ena.

Odwala omwe ali ndi matenda a shuga a mtundu wachiwiri samaloledwa kutenga telmisartan ndi zoletsa zina za ACE nthawi imodzi. Nthawi zambiri, izi zimayambitsa hypoglycemia.

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