Dilaprel mankhwala: malangizo ntchito > Chithandizo ndi kupewa

Mankhwala a antihypertensive, inhibitor ACE. Limagwirira ntchito chifukwa cha zoletsa ACE ndikuletsa ntchito yosintha angiotensin I mu angiotensin II, zomwe zimabweretsa kukula kwa hypotensive zotsatira, zomwe zimadziwonetsera mosasamala udindo wa wodwala (kunama / kuyimirira), pomwe chiwonjezerocho chikuwonjezeka Kufika pamtima sizikuchitika. Mankhwala amachepetsa kusala komanso kutsitsa, kutsitsa kupanga aldosterone, kukana m'mitsempha yamapapu, kumawonjezera kulolerana kwa thupi kuti muthe komanso kuchuluka kwa magazi, kumapangitsa kuti magazi azikhala ndi myocardium. Mukamagwiritsidwa ntchito kwakanthawi odwala ochepa matenda oopsa kusinthaku kumachitika pakukula kwa myocardial hypertrophy, pafupipafupi amachepetsa arrhythmiaskusintha kwa mtima endothelium chifukwa cha mkulu chakudya cholesterol, kuchuluka kwaimpso ndi magazi.

Mphamvu ya antihypertensive mutatha kumwa mankhwalawa mkati imawonekera pambuyo pa maola 1.5-2, mphamvu kwambiri imawonedwa pambuyo pa maola 6-9, nthawi yochitapo kanthu ili pafupi tsiku, palibe kutulutsa matenda. Odwala ndi pachimake myocardial infaration ndi mtima kulephera m'masiku oyamba, kumwa mankhwalawa kumathandizira kuchepetsa ziwengo komanso kuchepetsa chiopsezo chopita patsogolo CHF. Phwando ramipril osakhala ndi diabetes / diabetes nephropathy amachepetsa kupita patsogolo kulephera kwa aimpso.

Pharmacokinetics

Mankhwala amatengedwa mwachangu Matumbokomabe, kudya kwambiri sikukukhudzira kukwana kwathunthu kwa mayamwa, koma mayendedwe amachepetsa. Kuyankhulana ndi mapuloteni amwazi pamlingo wa 75%. Cmax akwaniritsa pafupifupi pambuyo 1.5 maola. Zimapukusidwa mu chiwindi, zomwe zimapangitsa kupangika kwa metabolacologically yogwira metabolite ramiprilat komanso wogwira ntchito - ramipril glucuronides, ether ndi diketopiperazinic acid. Imafufutidwa mu mawonekedwe a metabolites kudzera mkodzo ndi ndowe. T1 / 2 - maola 5-6.

Mankhwala

Mankhwala

Metabolite yogwira ya ramipril yopangidwa mchikakamizo cha michere ya chiwindi - ramiprilat - ndimtundu wa ACE inhibitor, womwe ndi peptidyldipeptidase. ACE mu plasma ndi zimakhala zimathandizira kusintha kwa angiotensin I ku angiotensin II ndi kuwonongeka kwa bradykinin. Chifukwa chake, mutenga ramipril mkati, mapangidwe a angiotensin II amachepetsa ndipo bradykinin imadziunjikira, yomwe imayambitsa vasodilation ndi kuchepa kwa kuthamanga kwa magazi (BP). Kuwonjezeka kwa ntchito ya kallikrein-kinin system m'magazi ndipo zimakhala ndizomwe zimayambitsa mtima ndi endothelioprotective mphamvu ya ramipril chifukwa cha kuyambitsa kwa dongosolo la prostaglandin ndipo, motero, kuwonjezeka kwa kaphatikizidwe ka prostaglandins, komwe kumalimbikitsa mapangidwe a nitric oxide (NO) mu endotheliocytes. Angiotensin II imathandizira kupanga aldosterone, kotero kutenga ramipril kumabweretsa kutsika kwa secretion ya aldosterone ndi kuwonjezeka kwa seramu kumapangitsa renin katulutsidwe ndi mtundu wa mayankho osalimbikitsa, omwe amatsogolera pakuwonjezeka kwa ntchito ya plasma renin.

Amaganiziridwa kuti kukulira kwina kosakhumudwitsa (makamaka, chifuwa chowuma) kumagwirizananso ndi kuwonjezeka kwa ntchito ya bradykinin. Odwala omwe ali ndi matenda oopsa, kutenga ramipril kumabweretsa kuchepa kwa magazi atagona ndikuyima popanda chiwopsezo cha kuchuluka kwa mtima (HR). Ramipril amachepetsa kwambiri zotumphukira zotupa (OPSS), popanda kuchititsa kusintha kwa magazi aimpso komanso kuchuluka kwa kusefera kwa mafuta. Mphamvu ya antihypertensive imayamba kuwonekera patatha maola 1-2 atatha kumwa kamodzi pa mankhwalawa, mpaka imakhala yofunikira kwambiri pambuyo pa maola 3-9, ndipo imakhala kwa maola 24.

Ndi mlingo wa mankhwalawa, mphamvu ya antihypertensive imatha kukula pang'onopang'ono, ndipo nthawi zambiri imakhala yolimba pakapita masabata atatu ndikugwiritsa ntchito mankhwalawa kenako ndikupitilira kwa nthawi yayitali. Kusiyidwa kwadzidzidzi kwa mankhwalawa sikupangitsa kuti magazi azikulirakulira komanso kusakhalapo (kusakhalapo kwina).

Odwala ochepa matenda oopsa, ramipril imachedwetsa kukula ndi kupitilira kwa myocardial hypertrophy ndi mtima wall.

Odwala omwe ali ndi vuto la mtima wosalephera, ramipril amachepetsa OPSS (kuchepa kwa katundu pamtima), imawonjezera mphamvu ya venous channel ndikuchepetsa kuzaza kwa ventricle yamanzere, yomwe, motero, imabweretsa kutsika kwa preload pamtima. Mwa odwalawa, mukamamwa ramipril, pamakhala kuwonjezeka kwa kutulutsa kwamtima, kachigawo kakang'ono ka thupi ndi kuwongolera zolimbitsa thupi.

Mu matenda a diabetes komanso osadwala matenda a shuga, kutenga ramipril kumachepetsa kufalikira kwa impso komanso kuyambika kwa gawo loti matendawa amalephera, chifukwa chake, amachepetsa kufunika kwa hemodialysis ndi kupatsirana kwa impso. M'magawo oyamba a matenda ashuga komanso nondiabetesic nephropathy, ramipril amachepetsa kuopsa kwa albuminuria.

Odwala omwe ali ndi chiopsezo chotenga matenda a mtima chifukwa cha zotupa zam'mitsempha (matenda amtima wapezeka, mbiri ya zotumphukira za m'magazi, mbiri ya sitiroko), kapena matenda osokoneza bongo omwe ali ndi vuto limodzi lowonjezera (microalbuminuria, matenda oopsa a ubongo) kuchuluka kwa cholesterol yathunthu, OX, kuchepa kwa kuchuluka kwa osalimba lipoprotein cholesterol (OX-HDL), kusuta) kuwonjezera kwa ramipril ku mankhwala kwambiri kumachepetsa zochitika za m'mnyewa wamtima infarction, sitiroko ndi imfa ndi matenda a mtima. Kuphatikiza apo, ramipril imachepetsa chiwerengero cha anthu omwalira, komanso kufunika kosinthira kayendedwe ka zinthu, ndikuchepetsa kuyambika kapena kupitilira kwa matenda olephera a mtima.

Odwala omwe ali ndi vuto la mtima lomwe linayamba m'masiku oyamba kupweteka kwamatumbo (masiku 2-9), kutenga ramipril kuyambira 3 mpaka 10 masiku obadwa nako pachimake amachepetsa ngozi yakufa (mwa 27%), chiopsezo cha kufa mwadzidzidzi (mwa 30%) , chiwopsezo cha kupitirira kwa mtima kosalephereka kwakukulu (III-IV yogwira ntchito malinga ndi gulu la NYHA) / kugonjetsedwa ndi chithandizo (27%), mwayi wakugonekedwa m'chipatala chifukwa cha kukhumudwa kwa mtima (mwa 26%).

Mwa kuchuluka kwa odwala, komanso odwala omwe ali ndi matenda osokoneza bongo (onse omwe ali ndi vuto losakanikirana kwa magazi komanso kuthamanga kwa magazi), ramipril amachepetsa kwambiri vuto la nephropathy komanso kupezeka kwa microalbuminuria.

Pharmacokinetics

Pambuyo pakukonzekera kwa pakamwa, ramipril imatengedwa mwachangu kuchokera ku m'mimba thirakiti (50-60%). Kudya kumachepetsa mayamwidwe, koma sikukhudza kuperewera kwa mayamwa.

Amapukusidwa mu chiwindi ndikupanga metabolite yogwira ya ramiprilat (imakhala 6 nthawi yogwira kwambiri poletsa ACE kuposa ramipril) komanso metabolites - diketopiperazinovoy ether, diketopiperazinovoy acid, komanso ramiprilat glucuronides ndi ramiprilat. Ma metabolites onse opangidwa, kupatulapo ramiprilat, alibe zochitika zokhudzana ndi mankhwala. Kuyankhulana ndi mapuloteni a plasma a ramipril - 73%, ramiprilata - 56%.

Pambuyo potenga ramipril mkati, plasma wozama wa ramipril ndi ramiprilat umafikiridwa pambuyo pa maola 1 ndi 2-4, motsatana. The bioavailability wa ramipril pambuyo m`kamwa makonzedwe a 2,5-5 mg ndi 15-28%, kwa ramiprilat - 45%. Pambuyo tsiku lililonse kudya 5 mg / tsiku, khola la ramiprilat mu plasma yamagazi limafikiridwa ndi tsiku 4. Hafu ya moyo (T_1/2) kwa ramipril - maola 5.1, pagawo logawa komanso kuchotsa, kuchepa kwa ramiprilat mu seramu yamagazi kumachitika ndi T_1/2 wofanana ndi maola atatu, ndikutsatiridwa ndi gawo la kusintha ndi T_1/2 ofanana ndi maola 15 ndi gawo lomaliza lomaliza ndi magawo ochepa kwambiri a ramiprilat mu plasma ndi T_1/2 zofanana ndi masiku 4-5.T_1/2 kuchuluka kwa aimpso kulephera (CRF). Kuchulukitsidwa kwama ramipril ndi 90 l, ramiprilat ndi 500 l.

Kafukufuku wazinyama awonetsa kuti ramipril imachotsedwanso mkaka wa m'mawere.

Amadzipukusa ndi impso - 60%, kudzera m'matumbo - 40% (makamaka mwa ma metabolites). Ndi vuto laimpso, kuwonongeka kwa ramipril ndi metabolites yake kumachepa mogwirizana ndi kuchepa kwa creatinine chilolezo (CC), ndi vuto la chiwindi, kusinthika kwa ramiprilat kumachepetsa, ndipo mu mtima kulephera, kukhazikika kwa ramiprilat kumawonjezera nthawi 1.5-1.8.

Mwa odzipereka okalamba athanzi (zaka 65-76), pharmacokinetics of ramipril ndi ramiprilat siosiyana kwambiri ndi za achinyamata odzipereka athanzi labwino.

Contraindication

Matenda ogwirizana, angioedema osiyanasiyana etiology, aimpso mtsempha wamagazi, mtima wowononga ndi kusintha kwa hypertrophic, kofotokozedwa kulephera kwa aimpsonyere hemodialysis, mimbachoyambirira hyperaldosteronismmpaka zaka 18 CHF mu gawo la kuwongolera, lactose tsankho, chidwi cha mankhwala, mtima arrhythmias, wosakhazikika angina pectorisLactase akusowa.

Gwiritsani ntchito mosamala pamene zotupa za atherosulinotic zombo zamatumbo ndi zamatsenga.

Zizindikiro zogwiritsidwa ntchito

matenda oopsa,
Kulephera kwamtima kwakanthawi (monga gawo la mankhwala othandizira, makamaka kuphatikiza ndi okodzetsa),
matenda ashuga kapena osadwala matenda a shuga, osasintha kapena owoneka bwino, kuphatikiza ndi proteinuria yayikulu, makamaka akaphatikizidwa ndi matenda oopsa oopsa,
kuchepetsa chiopsezo chokhala ndi infracation ya myocardial, sitiroko, kapena mtima mwa odwala omwe ali ndi chiwopsezo cha mtima:
- Odwala omwe ali ndi matenda amtima wotsimikizika, mbiri yakale ya m'mitsempha yamagazi kapena popanda iwo, kuphatikiza odwala omwe adakumana ndi zovuta zam'madzi za coronary angioplasty, aorto-coronary artery bypass grafting,
- odwala omwe ali ndi mbiri yakusowa kwa matenda,
- odwala ndi occlusive zotupa za zotumphukira mitsempha,
- Odwala omwe ali ndi matenda osokoneza bongo omwe ali ndi vuto limodzi lodziwika (microalbuminuria, matenda oopsa, kuchuluka kwa plasma OX, kuchepa kwa plasma kwa HDL-C, kusuta),
kulephera kwa mtima komwe kunayamba m'masiku ochepa oyambira (kuyambira lachiwiri mpaka tsiku lachisanu ndi chinayi) pambuyo panjira yolakwika yamatumbo (onani gawo "Pharmacodynamics").

Zotsatira zoyipa

Akutchulidwa kukana HEREkupweteka pachifuwa orthostatic hypotension, myocardial ischemia, arrhythmias, kugunda kwa mtima, flashing, zotumphukira edema, matenda aimpso, kuwonjezeka creatinine ndi urea m'magazi, utachepa libido, kukanika kwa erectile, gynecomastia, mutukumva kutopa, kuda nkhawa, nkhawa yamagalimoto, kusokonezeka maganizo, kusokonezeka kwa tulo, kusawona bwino komanso kuzindikira kununkhira. myalgiaminofu kukokana, kudzimbidwa, kusanza, kutsegula m'mimbakupweteka m'mimba dyspepsiachifuwa chowuma kupuma movutikira, sinusitis, bronchitiszotupa pakhungu hyperhidrosisKhungu loyera, mawonekedwe am thupi lawo, eosinophiliakukulitsa kuchuluka kwa potaziyamu m'magazi.

Mlingo ndi makonzedwe

Matenda oopsa
Mkati, mlingo woyambira ndi 2,5 mg, kamodzi, m'mawa. Ngati mukumwa mankhwalawa kwa milungu itatu kapena kupitilira apo, sizotheka kutulutsa magazi, ndiye kuti mankhwalawa akhoza kuchuluka mpaka 5 mg ya mankhwala Dilaprel ® patsiku. Ngati mlingo wa 5 mg sugwira ntchito mokwanira, pakatha milungu iwiri itha kuyerekezera kawiri mpaka 10 mg pa tsiku. Ngati njira ina yowonjezera mlingo mpaka 10 mg patsiku osakwanira odana ndi matenda oopsa tsiku lililonse la 5 mg, othandizira ena othandizira, makamaka okodzetsa kapena "odekha" calcium blockers, atha kuwonjezeredwa ku chithandizo.

Kulephera kwamtima kosalekeza
Mlingo woyamba ndi 1.25 mg / tsiku *. Kutengera momwe wodwalayo amamuthandizira, mankhwalawa amatha kuchuluka. Ndikulimbikitsidwa kuichulukitsa kamodzi pakadutsa masabata a 1-2. Mlingo kuchokera ku 2.5 mg kapena kupitilira uyenera kutengedwa kamodzi kapena kugawidwa pawiri. Pazipita tsiku mlingo 10 mg.

Ndi kulephera kwa mtima komwe kudayamba masiku ochepa (kuyambira lachiwiri mpaka tsiku lachisanu ndi chinayi)
Mlingo woyambirira ndi 5 mg, wogawidwa mu 2 Mlingo, 2,5 mamawa ndi madzulo. Ngati wodwala salola mlingo woyambayo (kuchepa kwambiri kwa magazi kumawonedwa), ndiye kuti amalimbikitsidwa kupereka 1.25 mg kawiri pa tsiku * kwa masiku awiri.
Kenako, kutengera zomwe wodwalayo achita, muyezo utha kuchuluka.
Ndikulimbikitsidwa kuti mlingo ndi kuwonjezeka kwake kawiri ndi gawo la masiku 1-3. Pambuyo pake, mlingo wathunthu wa tsiku ndi tsiku, womwe poyamba udagawidwa pawiri, utha kuperekedwa kamodzi.
Pazipita lililonse tsiku lililonse ndi 10 mg.
Pakadali pano, zomwe tikukumana nazo pochiza odwala omwe ali ndi vuto lalikulu la mtima (III-IV magawo olimbitsa thupi malinga ndi gulu la NYHA), lomwe linayambika nthawi yomweyo pambuyo pakuphatikizika kwachidziwikire, sikokwanira.
Ngati odwala oterowo asankha kulandira chithandizo ndi Dilaprel ®, ndikulimbikitsidwa kuti chithandizo chamankhwala chiyambe ndi mlingo wotsika kwambiri - 1.25 mg kamodzi patsiku *. Kusamala makamaka kuyenera kuonedwa ndi kuwonjezeka kwa mlingo uliwonse.

Ndi matenda ashuga kapena osadwala
Mlingo woyambirira ndi 1.25 mg kamodzi patsiku *. Mlingo umatha kuchuluka mpaka 5 mg kamodzi patsiku.
Mlingo wambiri watsiku ndi tsiku ndi 5 mg.

Kugwiritsa ntchito mankhwala Dilaprel ® m'magulu ena a odwala

Odwala ndi mkhutu aimpso ntchito
Ndi CC kuchokera 50 mpaka 20 ml / mphindi pa 1.73 mamilimita thupi, mankhwalawa tsiku lililonse nthawi zambiri amakhala 1.25 mg *.
Mlingo wambiri watsiku ndi tsiku ndi 5 mg.

Odwala omwe ali ndi vuto losakwanira lamadzimadzi ndi ma elekitiroma, odwala omwe ali ochepa kwambiri matenda oopsa, komanso odwala omwe kuchepa kwambiri kwa magazi kumakhala ndi chiwopsezo china (mwachitsanzo, ndi zotupa zam'magazi a mitsempha ndi mitsempha)
Mlingo woyamba umachepetsedwa kukhala 1.25 mg / tsiku *.

Odwala ndi isanachitike diuretic mankhwala
Ngati ndi kotheka, ndikofunikira kuletsa kukodzetsa m'masiku atatu (kutengera nthawi yomwe okonza amadzimadzi) musanayambe chithandizo ndi Dilaprel ® kapena, kuchepetsa kuchuluka kwa okodzetsa omwe atengedwa. Chithandizo cha odwala chotere chiyenera kuyamba ndi mankhwala ochepera 1.25 mg a ramipril * omwe amatengedwa kamodzi patsiku m'mawa. Mutatenga mlingo woyamba komanso nthawi iliyonse mukakulitsa kuchuluka kwa ramipril ndi (kapena) okodzetsa, odwala ayenera kuyang'aniridwa ndi achipatala kwa maola osachepera a 8 kuti apewe kusagwirizana ndi hypotensive.

Okalamba okalamba (woposa zaka 65)
Mlingo woyamba umachepetsedwa kukhala 1.25 mg / tsiku *.

Odwala omwe ali ndi vuto la chiwindi
Zomwe magazi akupanga kuti atenge Dilaprel ® zitha kukulira (chifukwa chakuchepa kwa ramiprilat excretion) kapena kuchepa (chifukwa chakuchepa kwa kutembenuka kwa ramipril kukhala yogwira ramiprilat). Chifukwa chake, kumayambiriro kwa chithandizo amafunika kuyang'aniridwa mosamala kuchipatala.
Mulingo wovomerezeka tsiku lililonse ndi 2,5 mg.

* Pankhaniyi, mutha kugwiritsa ntchito mankhwala a ramipril mu mtundu wina waukulu: mapiritsi a 2,5 mg omwe ali pachiwopsezo.

Zotsatira zoyipa

Kuchokera pamtima:
Nthawi zambiri - kuchepa kwambiri kwa kuthamanga kwa magazi, hypotension ya orthostatic, syncope, kupweteka pachifuwa.
pafupipafupi - myocardial ischemia, kuphatikizapo kukula kwa kuukira kwa angina pectoris kapena myocardial infarction, tachycardia, arrhythmias (mawonekedwe kapena kukulira), palpitations, edema yodutsa, kuwonetsa nkhope.

Kuchokera ku genitourinary system:
infrequent - kusokonezeka kwa impso, kuphatikizapo kukula kwa impso kulephera, kuwonjezeka kwa kuchuluka kwa mkodzo, kuwonjezeka kwa proteinuria, kuwonjezeka kwa kuchuluka kwa urea ndi creatinine m'magazi, kusakhazikika kwina chifukwa cha kukokoloka, kuchepa kwa libido,
pafupipafupi osadziwika - gynecomastia.

Kuchokera ku dongosolo lamanjenje lalikulu:
Nthawi zambiri mutu, kumva "kupepuka" m'mutu, kumva kutopa,
pafupipafupi - chizungulire, Agevzia (kusowa kwa kukhudzika kwa kukoma), dysgeusia (kuphwanya mphamvu ya kukoma), kukhumudwa, nkhawa, kuchuluka kwa mkwiyo, nkhawa zamagalimoto, kusokonezeka kwa kugona, kuphatikizapo kugona.
kawirikawiri - kunjenjemera, kutukuka kapena kulimbitsa kwa magazi kuzungulira kwa zilonda zam'mimba zotupa, vasculitis, asthenia, kusalinganika, chisokonezo,
pafupipafupi osadziwika - a Raynaud's syndrome, matenda a ischemia, kuphatikizapo ischemic stroke komanso kufupika kwa vuto la ubongo; kusokonezeka kwa ma psychomotor, paresthesia (kutentha moto), parosmia (kuzindikira kwa fungo), kusokonezeka kwa chidwi, kukhumudwa.

Kuchokera pamalingaliro:
pafupipafupi - zosokoneza zowonekera, kuphatikizapo kusawona bwino, kawirikawiri - conjunctivitis, kuchepa kwa makutu, tinnitus,

Kuchokera ku minculoskeletal system:
Nthawi zambiri minofu kukokana, myalgia,
pafupipafupi - arthralgia.

Kuchokera m'mimba:
Nthawi zambiri - zotupa m'mimba ndi matumbo, kudzimbidwa, kusokonezeka m'mimba, kukomoka, kutsegula m'mimba, kusanza, kusanza,
pafupipafupi - kapamba, kuphatikiza ndi kupha, kuchuluka kwa michere yamapazi mu madzi am'magazi, matumbo angioedema, kupweteka kwam'mimba, gastritis, kudzimbidwa, kupweteka kwapakamwa kwamkamwa, kuwonjezeka kwa michere ya chiwindi (ALT, AST aminotransferases) ndi kuchuluka kwa bilirubin wophatikizika wamadzi am'magazi, anorexia, kuchepa kwamtima,
kawirikawiri - glossitis, cholestatic jaundice, hepatocellular zotupa, kufupikiratu sikudziwika - aphthous stomatitis, kuperewera kwa chiwindi, cholestatic kapena cytolytic hepatitis (imfa inali yosowa kwambiri).

Kuchokera pakapumidwe:
Nthawi zambiri - chifuwa chowuma (koyipa kwambiri kugona pansi), sinusitis, bronchitis, kufupika kwa mpweya,
pafupipafupi - bronchospasm, kuphatikizapo kuwonjezeka kwa mphumu ya bronchial, mphuno.

Pa khungu:
Nthawi zambiri - zotupa pakhungu, makamaka maculopapular, kawirikawiri - angioedema, kuphatikizapo kupha (laryngeal edema imatha kuyambitsa kulowetsedwa kwa mpweya kumayambitsa imfa), kuyabwa pakhungu, hyperhidrosis (kutuluka thukuta kwambiri), kawirikawiri - exfoliative dermatitis, urticaria, onycholysis,
osati kawirikawiri - mawonekedwe a photosensitivity,
pafupipafupi osadziwika - poizoni wa epermermal necrolysis, poizoni wa Johnson kupha tizirombo), kuchuluka kwa ma antibodies othandizira.

Kuchokera ku ziwalo za hemopoietic:
pafupipafupi - eosinophilia, kawirikawiri - leukopenia, kuphatikizapo neutropenia ndi agranulocytosis, kuchepa kwa maselo ofiira amwazi m'mitsempha yamagazi, kuchepa kwa hemoglobin ndende, thrombocytopenia, pafupipafupi sikudziwika - kuletsa kwa mafupa a hematopoiesis, pcytopenia.

Zina:
pafupipafupi - hyperthermia.

Zizindikiro zasayansi:
Nthawi zambiri - kuchuluka kwa potaziyamu m'magazi, kusadziwika pafupipafupi - kuchepa kwa sodium m'magazi. Milandu ya hypoglycemia idanenedwa mwa odwala omwe ali ndi matenda ashuga omwe amamwa mankhwala a insulin komanso mkamwa a hypoglycemic.

Bongo

Kuchita ndi mankhwala ena

Kugwiritsidwa ntchito kwa ziwalo zina zotulutsa kwambiri zomwe zimakhala ndi malo osasakanizira bwino (mwachitsanzo, polyacrylonitrile membranes) pa hemodialysis kapena hemofiltration komanso kugwiritsa ntchito dextran sulfate panthawi ya kuphatikizana kwa lipoproteins yotsika kumawonjezera chiopsezo cha anaphylactic reaction.

Osavomerezeka kuphatikiza
Ndi mchere wa potaziyamu, potaziyamu wochepetsa diuretics (mwachitsanzo, amiloride, triamteren, spironolactone), kuwonjezeka kotchulidwa kwa serum potaziyamu ndikotheka (ndikugwiritsa ntchito munthawi yomweyo, kuyang'anira seramu potaziyamu ndikofunikira).

Kuphatikiza kugwiritsidwa ntchito mosamala
Ndi othandizira a antihypertensive (makamaka okodzetsa) ndi mankhwala ena omwe amachepetsa kuthamanga kwa magazi (ma nitrate, ma tridclic antidepressants), kuthekera kwa antihypertensive zotsatira kumadziwika, kuphatikiza ndi okodzetsa, zomwe zili mu seramu sodium ziyenera kuyang'aniridwa.

Nkhope hyperemia, nseru, kusanza, hypotension nthawi zina sizingatheke ndi kukonzedwa golide.

Ndi mapiritsi ogona, analcics ya narcotic, othandizira opaleshoni yodwala ndi ma pinkiller, kuchuluka kwa antihypertensive kumatha. Ndi vasopressor sympathomimetics (epinephrine), kuchepa kwa mphamvu ya antihypertensive ya ramipril kumadziwika, kuwunika kawirikawiri magazi kumafunika.

Ndi allopurinol, procainamide, cytostatics, immunosuppressants, systemic glucocorticosteroids ndi mankhwala ena omwe angakhudze magawo a hematological, chiopsezo chokhala ndi leukopenia chikuwonjezeka.

Ndi mchere wa lithiamu, kuwonjezereka kwa kuchuluka kwa seramu ndi kuwonjezereka kwa mtima ndi zotsatira za neurotoxic zimadziwika.

Ndi othandizira a hypoglycemic operekera pakamwa (sulfonylurea derivatives, biguanides), insulin, pokhudzana ndi kuchepa kwa insulin kukakamizidwa ndi ramipril, mphamvu ya hypoglycemic ya mankhwalawa imatha kupititsidwa patsogolo mpaka pakukula kwa hypoglycemia.

Kuphatikiza kwa kulingalira

Ndi mankhwala omwe si a steroidal anti-yotupa (indomethacin, acetylsalicylic acid), ofooketsa zotsatira za ramipril, zomwe zimapangitsa kuti chiwopsezo cha matenda aimpso ndikuwonjezeka ndi kuchuluka kwa seramu potaziyamu ndizotheka.

Ndi heparin, kuwonjezeka kwa seramu potaziyamu ndikotheka.

Ndi sodium chloride, ndizotheka kufooketsa mphamvu ya antihypertensive ya ramipril ndi chithandizo chochepa kwambiri chazovuta za matenda a mtima osalephera.

Ndi Mowa, kuwonjezeka kwa zizindikiro za vasodilation kumadziwika. Ramipril angakulitse zovuta zoyipa za ethanol m'thupi.

Ndi estrogens, mphamvu ya antihypertensive ya ramipril imakhala yofooka (kusungidwa kwamadzi).

Kutsimikiza mtima kwa hypersensitivity kupha tizilombo: ACE zoletsa, kuphatikizapo ramipril, kuwonjezera mwayi woopsa wa anaphylactic kapena anaphylactoid zimachitika ndi tizilombo tambiri.

Poyerekeza ndi momwe mankhwalawo amathandizira ndi ACE zoletsa, hypersensitivity reaction to sumu (mwachitsanzo, njuchi, mavu) zimakula mwachangu ndipo ndizovuta. Ngati kufunitsitsa kwa chiphe chaudzu ndikofunikira, a ACE inhibitor iyenera kusintha kwa kanthawi ndi mankhwala ofanana ndi gulu lina.

Malangizo apadera

Musanayambe chithandizo ndi Dilaprel ®, ndikofunikira kuthetsa hyponatremia ndi hypovolemia. Odwala omwe adamwa diuretics m'mbuyomu, ndikofunikira kuti aiwale kapena kuti muchepetse mlingo wawo masiku awiri - 2 asanatenge Dilaprel ® (pankhani iyi, odwala omwe ali ndi vuto la mtima ayenera kuyang'aniridwa mosamala chifukwa chofuna kubwezerera chifukwa kuchuluka kwa magazi ozungulira).

Pambuyo pa kumwa koyamba kwa mankhwalawo, komanso kuwonjezera kuchuluka kwake ndi / kapena diuretics (makamaka kuzungulira), ndikofunikira kuonetsetsa kuwunika kwa wodwala kwa maola osachepera a 8 kuti athe kuchitapo kanthu poyenera kuchepa kwambiri kwa magazi.

Ngati Dilaprel ® imagwiritsidwa ntchito kwa nthawi yoyamba kapena mlingo waukulu mwa odwala omwe ali ndi zochita za RAAS zowonjezereka, ndiye kuti ayenera kuyang'anira magazi mosamala, makamaka kumayambiriro kwa chithandizo, popeza odwalawa ali ndi chiopsezo chakuchepa kwambiri kwa kuthamanga kwa magazi (onani gawo la "Chenjerani") .

Pankhani ya matenda oopsa a hypertension ndi vuto la mtima, makamaka munthawi ya kulowetsedwa kwa myocardial, chithandizo ndi Dilaprel ® ziyenera kuyambitsidwa kuchipatala chokha.

Odwala matenda a mtima Kulephera, kumwa mankhwalawa kungayambitse kuchepa kwa magazi, komwe nthawi zina kumayendetsedwa ndi oliguria kapena azotemia ndipo sikuti kumachitika chifukwa cha kulephera kwaimpso. Chenjezo liyenera kuchitidwa pochiza odwala okalamba, makamaka chifukwa chogwiritsa ntchito zoletsa za ACE. Mu gawo loyambirira la mankhwalawa, tikulimbikitsidwa kuyang'anira mawonekedwe a impso (onaninso gawo la "Mlingo ndi Ulamuliro").

Odwala omwe kuchepa kwa kuthamanga kwa magazi kungakhale pachiwopsezo china (mwachitsanzo, odwala omwe ali ndi vuto la kuchepa kwa mitsempha kapena mitsempha), chithandizo chiyenera kuyang'aniridwa ndi achipatala. Chenjezo liyenera kuchitika pakulimbitsa thupi komanso / kapena nyengo yotentha chifukwa chakuwonjezeka thukuta ndi kuchepa mphamvu kwa thupi chifukwa cha kuchepa kwa kuchuluka kwa magazi ndi kuchepa kwa kuchuluka kwa sodium m'magazi.

Mukamalandira mankhwala a Dilaprel ®, mowa sukulimbikitsidwa.

Osakhalitsa ochepa hypotension si kuphwanya lamulo kwa kupitiriza mankhwala pambuyo kukhazikika kwa magazi.

Ngati kukula mobwerezabwereza kwambiri hypotension, mlingo uyenera kuchepetsedwa kapena mankhwalawo ayenera kusiyidwa.

Odwala omwe amathandizidwa ndi ACE zoletsa, milandu ya angioedema ya nkhope, miyendo, milomo, lilime, pharynx kapena larynx. Ngati kutupa kumachitika m'dera la nkhope (milomo, eyelids) kapena lilime, kumeza kumeza kapena kupuma, wodwalayo ayenera kusiya kumwa mankhwalawo.

Angioneurotic edema, yodziwika kutulutsa lilime, pharynx kapena larynx (Zizindikiro zotheka: kumeza kapena kupuma), ikhoza kukhala pachiwopsezo cha moyo ndipo imafunikira kuchitapo kanthu kuti muimitse: makina osapumira a 0,3-0,5 mg kapena kukomoka kwa mtsempha wa 0.1. mg wa adrenaline (moyang'aniridwa ndi kuthamanga kwa magazi, kugunda kwa mtima ndi ECG) ndi kugwiritsidwa ntchito kwotsatira kwa glucocorticosteroids (iv, i / m kapena mkati), intravenous management of antihistamines (blockers of H1- and H2-histamine receptors) amavomerezedwanso, ndipo vuto la kuchepa kwa inactivator nta C1-esterase imatha kuganizira kufunika koyambitsa kuwonjezera pa adrenaline zoletsa za enzyme C1-esterase. Wodwala amayenera kupita kuchipatala, ndipo kuwunika kuyenera kuchitika mpaka zizindikirozo zitatsitsimuka kwathunthu, koma osachepera maola 24.

Odwala omwe amalandila zoletsa za ACE, milandu ya angioedema yam'mimba imayang'aniridwa, yomwe imawonetsedwa ndi kupweteka kwam'mimba ndi kapena kusanza ndi kusanza, ndipo nthawi zina angioedema ya nkhope imawonedwa nthawi yomweyo. Wodwala akakhala ndi zizindikiro zakumwambazi mothandizidwa ndi ACE zoletsa, kuzindikira koyenerako kuyeneranso kuganizira kuthekera kwa kukulira matumbo angioedema.

Kuchiza komwe kumayambitsa kupweteka kwa tizilombo toyambitsa matenda (njuchi, mavu komanso kugwiritsa ntchito ma ACE zoletsa nthawi imodzi kumatha kuyambitsa kusintha kwa anaphylactic ndi anaphylactoid (mwachitsanzo, kuchepa kwa magazi, kufupika, kusanza, kusintha kwa khungu), komwe nthawi zina kumakhala koopsa. Poyerekeza ndi momwe mankhwalawo amathandizira ndi ACE zoletsa, hypersensitivity reaction to sumu (mwachitsanzo, njuchi, mavu) zimakula mwachangu ndipo ndizovuta. Ngati kufunitsitsa kwa chiphe chaudzu ndikofunikira, a ACE inhibitor iyenera kusintha kwa kanthawi ndi mankhwala ofanana ndi gulu lina.

Mukamagwiritsa ntchito zoletsa za ACE, zowopsa m'moyo, zomwe zimachitika pang'onopang'ono ma anaphylactoid zimafotokozedwa, nthawi zina mpaka kukulira kwa nkhawa panthawi ya hemodialysis kapena kusefa kwa plasma pogwiritsa ntchito ziwalo zina zotulutsa kwambiri (mwachitsanzo, polyacrylonitrile membranes) (onaninso malangizo a omwe amapanga nembanemba). Ndikofunikira kuti musagwiritse ntchito mankhwala osakanikirana a Dilaprel ® ndi ziwalo zoterezi, mwachitsanzo, chifukwa chofunikira hemodialysis kapena hemofiltration. Pankhaniyi, kugwiritsa ntchito michere ina kapena kupatula ACE inhibitors ndikofunikira. Kufanana komweko kunawonedwa ndi apheresis otsika kachulukidwe lipoproteins ntchito dextran sulfate. Chifukwa chake, njirayi siyenera kugwiritsidwa ntchito mwa odwala omwe alandila ACE inhibitors.

Pamaso pakuchita opaleshoni (kuphatikizapo mano), ndikofunikira kuchenjeza opaleshoni ya kagwiritsidwe ntchito ka ACE inhibitors.

Asanachitike komanso atagwiritsidwa ntchito ndi ACE zoletsa, ndikofunikira kuwerengetsa kuchuluka kwa leukocytes ndikuzindikira formula ya leukocyte.

Chitetezo ndi ntchito ya Dilaprel ® mwa ana ndi achinyamata ochepera zaka 18 sizinakhazikitsidwe.

Ndikulimbikitsidwa kuyang'anitsitsa ana akhanda omwe adakumana ndi vuto la intrauterine ku ACE inhibitors kuti azindikire ochepa hypotension, oliguria ndi hyperkalemia. Mu oliguria, ndikofunikira kukhalabe ndi kuthamanga kwa magazi komanso kupatsanso impso poyambitsa madzi abwino ndi vasoconstrictors. Mu makanda atsopano, pamakhala chiwopsezo cha matenda a oliguria ndi mitsempha, mwina chifukwa cha kuchepa kwa magazi a impso ndi matenda am'mimba chifukwa cha kuchepa kwa kuthamanga kwa magazi komwe kumachitika chifukwa cha ACE inhibitors (opezedwa ndi amayi apakati komanso atabereka mwana).

Odwala omwe ali ndi vuto la mtima, kugwiritsidwa ntchito kwa mankhwalawa Dilaprel ® kungayambitse kuchepa kwa magazi, komwe nthawi zina kumayendetsedwa ndi oliguria kapena azotemia, ndipo kawirikawiri, kulephera kwaimpso. Odwala omwe ali ndi vuto losakanizira matenda oopsa kapena operewera mtima wosakhazikika ayenera kuyamba kulandira chithandizo kuchipatala.

Odwala omwe ali ndi vuto la chiwindi, zomwe amathandizira pochita ndi Dilaprel ® akhoza kupitilizidwa kapena kufooka. Kuphatikiza apo, mwa odwala omwe ali ndi vuto lalikulu la cirrhosis ndi edema ndi / kapena ascites, kutseguka kwakukulu kwa renin-angiotensin-aldosterone system (RAAS) ndikotheka, motero, chisamaliro chapadera chimayenera kuthandizidwa pochiza odwala.

Kuwunikira magawo a ma laboratori isanachitike komanso munthawi ya chithandizo ndi Dilaprel ® (mpaka nthawi 1 pamwezi m'miyezi yoyambirira ya 3-6)
Chofunika kwambiri kwa odwala omwe ali ndi chiopsezo cha neutropenia - ndi vuto laimpso, matenda a minyewa yodwala kapena odwala omwe alandila mlingo waukulu wa mankhwalawo, komanso poyambira matenda. Pamene neutropenia imatsimikiziridwa (kuchuluka kwa neutrophils ndizosakwana 2000 / μl), mankhwala a ACE inhibitor ayenera kusiyidwa.

Mankhwala a ACE zoletsa m'milungu yoyamba ya mankhwala ndipo pambuyo pake amalimbikitsidwa kuwunika ntchito ya impso. Makamaka kuwunika kosamalitsa kumafunika kwa odwala omwe ali ndi vuto lalikulu la mtima komanso matenda a mtima, kuwonongeka kwa impso, pambuyo pakupatsika kwa impso, odwala omwe ali ndi matenda okonzanso, kuphatikiza odwala omwe ali ndi hemodynamically kwambiri a unalateral aimpso stenosis pamaso pa impso ziwiri (mwa odwala, ngakhale kuwonjezeka kwapang'onopang'ono kwa seramu ya creatinine. Chizindikiro cha kuchepa kwa impso).

Electrolyte ndende yoyang'anira: kuwunika pafupipafupi seramu potaziyamu ndikulimbikitsidwa. Makamaka kuwunika kwa seramu potaziyamu kumafunikira odwala omwe ali ndi vuto laimpso, kuwonongeka kwakukulu kwa madzi ndi electrolyte, komanso kulephera kwa mtima.

Analimbikitsa kuti azilamulira kuchuluka kwa magazi kudziwa zotheka leukopenia. Kuwunikira pafupipafupi kumalimbikitsidwa kumayambiriro kwa chithandizo komanso kwa odwala omwe ali ndi vuto laimpso, komanso kwa odwala omwe ali ndi vuto la minofu kapena odwala omwe amalandila mankhwala ena omwe angasinthe chithunzi cha magazi otumphukira (onani gawo "Kuyanjana ndi mankhwala ena") . Kuwongolera kwa chiwerengero cha leukocytes ndikofunikira kuti chizindikiritso cha leukopenia chizindikirike, chomwe ndichofunikira kwambiri kwa odwala omwe ali pachiwopsezo cha chitukuko chake, komanso pazizindikiro zoyambirira za matenda. Zizindikiro zophatikizana ndi leukopenia zikuwonekera (mwachitsanzo, kutentha thupi, kutupa kwa m'mimba, totillitis), kuwunika mwachangu kwa chithunzi cha magazi ofunikira ndikofunikira. Pakakhala zizindikiro zakutuluka magazi (tating'onoting'ono tating'onoting'ono, totupa tofiirira pakhungu ndi mucous membrane), ndikofunikira kuwongolera mapulogalamu ambiri m'magazi otumphukira.

Ngati jaundice kapena kuwonjezeka kwakukulu kwa ntchito ya michere ya chiwindi (aminotransferase ALT, AST) pakachitika, chithandizo ndi Dilaprel ® ziyenera kusiyidwa ndipo kuyang'aniridwa kwa wodwala kuyenera kuthandizidwa.

Kutulutsa mawonekedwe ndi kapangidwe kake

Dilaprel Mlingo wa mankhwalawa - makapisozi: gelatin yolimba, kukula kwake 3, pa mlingo wa 2,5 mg - thupi loyera ndi kapu yachikasu, pa mlingo wa 5 mg - thupi lachikaso ndi kapu, pamlingo wa 10 mg - thupi loyera ndi chipewa, filler - misa yochulukirapo pafupifupi yoyera kapena yoyera, yowoneka bwino kapena yopindika, yosungunuka ikapanikizidwa (mumapaketi otumphukira: ma PC 7.., katoni kamatoni 2 kapena 4 mapaketi, ma PC 10., pabokosi la makatoni 1, 2, 3, 5 kapena 6 , 14 ma PC., Pabokosi la makatoni 1, 2 kapena 4).

Kapangidwe ka kapisozi kamodzi:

yogwira mankhwala: ramipril - 2,5, 5 kapena 10 mg,
othandizira: calcium stearate, aerosil (colloidal silicon dioxide), lactose (lactose monohydrate - 10 mg makapisozi),
mlandu ndi chivindikiro: gelatin, titanium dioxide, chakudya utoto wachitsulo oxide chikasu (makapisozi 2,5 mg ndi 5 mg).

Dilaprel: malangizo ogwiritsira ntchito (Mlingo ndi njira)

Makapisozi a Dilaprel amatengedwa pakamwa popanda kutafuna ndi madzi okwanira (1 /₂ makapu). Kuchita bwino kwa mankhwalawa sikudalira chakudya.

Mlingo amasankhidwa payekhapayekha, poganizira zomwe zikuwonetsa kuthandizira, achire komanso kulolerana ndi mankhwalawa. Nthawi ya chithandizo nthawi zambiri imakhala yayitali, kutalika kwake mu vuto lililonse kumatsimikiziridwa ndi dokotala.

Malangizo Othandizira a Dilaprel (pokhapokha ngati akuwalamula):

ochepa matenda oopsa: mlingo woyamba ndi 2,5 mg wa 1 nthawi patsiku. Ngati mkati mwa masabata atatu magazi atakhala kuti sanatchulike, mutha kuwonjezera kuchuluka kwa tsiku lililonse mpaka 5 mg. Ngati achire mphamvu ya tsiku lililonse ya 5 mg ndi yosakwanira, imatha kuwirikiza kawiri pakapita masabata atatu mpaka 10 mg tsiku lililonse, kapena mankhwala ena a antihypertensive atha kuwonjezeredwa ku chithandizo chamankhwala, makamaka pang'onopang'ono calcium blockers kapena diuretics,
aakulu mawonekedwe a mtima kulephera: koyamba mlingo - 1.25 mg wa patsiku. Kutengera mphamvu ya mankhwalawo komanso kulekerera bwino, kumalimbikitsidwa kuwonjezera pang'onopang'ono mlingo wa mankhwalawa, pakadutsa masabata 1-2, koma osapitilira 10 mg patsiku. Mlingo pamtunda wa 2.5 mg utha kutengedwa kamodzi patsiku kapena ugawidwe pawiri.
kulephera kwa mtima ndi mawonetseredwe azachipatala omwe amapezeka pakatha masiku 2 - 9 atatha kulowetsedwa kwam'mnyewa: njira yoyamba ndi 2,5 mg 2 kawiri patsiku (m'mawa ndi madzulo). Ndi kuchepa kwambiri kwa kuthamanga kwa magazi, ndikofunikira kuchepetsa koyamba kwa 1.25 mg 2 kawiri pa tsiku. Kenako, malingana ndi momwe wodwalayo alili, muyezowo umatha kuwirikiza kawiri ndi masiku atatu. Pankhaniyi, pafupipafupi kumwa tsiku ndi tsiku mlingo ungathe kuchepetsedwa 1 nthawi patsiku. Mlingo woyenera tsiku lililonse ndi 10 mg,
kwambiri aakulu mawonekedwe a mtima kulephera (NYHA kalasi III - IV magwiridwe antchito), amene zinachitika yomweyo pambuyo pachimake myocardial infaration: koyamba mlingo - 1.25 mg kamodzi patsiku, m'tsogolo, ndi kuchuluka kulikonse, muyenera kusamala kwambiri. Mlingo woyambirira komanso wotsatira umangotchulidwa ndi dokotala wokhazikika,
kupewa matenda a stroko, myocardial infarction, kapena kufa kwa CVD (odwala omwe ali ndi chiwopsezo cha mtima): koyamba mlingo - 2,5 mg kamodzi patsiku. Ndi kulekerera bwino kwa mankhwalawa, tikulimbikitsidwa kuti pang'onopang'ono muwonjezere mlingo. Pambuyo pa sabata limodzi la chithandizo, imatha kuonjezeredwa, kenako pakapita milungu itatu pitani pa njira yokonzanso 10 mg kamodzi patsiku,
non-diabetes kapena diabetesic nephropathy: mlingo woyambayo ndi 1.25 mg kamodzi patsiku, ndiye kuti utha kuwonjezereka mpaka 5 mg / tsiku, kamodzi.

Mlingo woyenera wa Dilaprel regimen wowongoletsa wa matenda / mikhalidwe ina:

kwambiri arterial matenda oopsa (giredi III), kuchepa kwamchere kwamchere amchere ndi mikhalidwe momwe kuchepa kwakukulu kwa kuthamanga kwa magazi kumakhala koopsa (mwachitsanzo, ndi zotupa zam'mimba kwambiri mu ubongo ndi mitsempha ya mitsempha): mlingo woyambirira - 1.25 mg patsiku,
Kulephera kwaimpso ndi CC ya 50-20 ml / mphindi yokhala ndi malo osambira 1.73 mamita 2: muyeso woyamba ndi 1.25 mg / tsiku, mlingo waukulu tsiku lililonse ndi 5 mg,
okalamba wazaka zopitilira 65: mlingo woyambirira - 1.25 mg wa patsiku,
Kulephera kwa chiwindi: mlingo waukulu ndi 2,5 mg tsiku lililonse. Pa gawo loyambirira la mankhwalawa, kugwiritsa ntchito mankhwalawa kuyenera kuchitika moyang'aniridwa ndi achipatala, popeza kuchuluka kwa kuthamanga kwa magazi kumatha kusiyanasiyana mbali imodzi.
chithandizo cham'mbuyomu ndi okodzetsa: koyamba mlingo ndi 1.25 mg kamodzi patsiku (ndikulimbikitsidwa kuletsa kukodzetsa kapena kuchepetsa mlingo wawo masiku atatu mpaka 33 musanayambe Dilaprel). Nthawi yoyamba, komanso pakukweza kulikonse kwa mankhwala a ramipril ndi / kapena okodzetsa, pofuna kupewa kuyipa kosafunikira, kuyang'aniridwa mosamala kwa wodwala kwa pafupifupi maola 8 ndikofunikira.

Mimba komanso kuyamwa

Malinga ndi malangizo, Dilaprel amadzipaka pakati komanso nthawi yoyamwitsa.

Pamaso pa chithandizo, mimba iyenera kupatula. Ngati kutenga pakati kumachitika panthawi yomwe mukumwa mankhwalawa, ndikofunikira kusiya kaye ndikupereka mankhwala ena.

Kutenga Dilaprel pa nthawi ya pakati (makamaka pa trimester yoyamba) kungayambitse kuchepa kwa magazi a mwana wosabadwayo komanso wobadwa kumene, kusokonekera kwa impso za mwana wosabadwa, kuwonongeka kwa impso, hypoplasia ya mafupa a chigaza, hyperkalemia, mapangidwe a malekezero, hypoplasia yamapapu, ndi kusokonezeka kwa chigaza. Kwa ana akhanda omwe amawonetsedwa ndi intrauterine kuwonetsedwa kwa ma inhibitors a ACE, ndikofunikira kuyang'anitsitsa mosamala ma oliguria, hyperkalemia ndi ochepa hypotension, kuwonjezera apo, ali ndi chiopsezo cha matenda amitsempha.

Ngati pakufunika chithandizo ndi Dilaprel panthawi yoyamwa, kuyamwitsa kuyenera kuyimitsidwa.

Dilaprel, malangizo ogwiritsira ntchito (Njira ndi Mlingo)

Mlingo wa mankhwalawa amatengedwa poganizira momwe thupi la wodwalayo limakhudzidwira, zovuta za pathological process. Swapsow makapisozi kwathunthu popanda kutafuna ndi kumwa ndi madzi. Mlingo wapamwamba tsiku lililonse wa mankhwalawa ndi mamiligalamu 10.

At ochepa matenda oopsa Dilaprel imayamba kumwa ndi mlingo wa 2,5 mg 1 nthawi patsiku. Ndi ofooka othandizira kwenikweni kapena kusakhalapo kwa masiku 21, mlingo umawonjezereka mpaka 5 mg. Mankhwalawa CHF Mlingo woyambirira ndi 1.25 mg / tsiku ndipo, ngati kuli kotheka, mlingo umasintha.

Mu vuto laimpso

Dilaprel imatsutsana ndi kuwonongeka kwambiri kwa impso (ndi CC yochepera 20 ml / mphindi yokhala ndi malo a 1.73 m 2), odwala a nephropathy omwe amathandizidwa ndi mankhwala omwe si a anti -idalidal-NSAIDs, glucocorticosteroids (GCS), immunomodulators ndi / kapena othandizira ena a cytotoxic.

Mosamala, Dilaprel iyenera kumwedwa chifukwa cha kuwonongeka kwa impso (CC zoposa 20 ml / mphindi yokhala ndi malo a 1.73 m 2) - chifukwa chokhala ndi vuto la matenda amitsempha yamagazi ndi leukopenia. pambuyo kupatsirana kwa impso.

Kuchita

Osavomerezeka kuphatikiza kwa mankhwala a Dilaprel okhala ndi potaziyamu osasiya mchere komanso potaziyamu mchere (chifukwa cha chiwopsezo cha kuchuluka kwa potaziyamu wa seramu yamagazi). Kuphatikiza kugwiritsidwa ntchito mosamala.

Fotokozani Dilaprel mosamala:

Mankhwala osokoneza bongo a antihypertensive, makamaka okodzetsa, okhala ndi mankhwala osokoneza bongo, mapiritsi ogona, ma pinkiller chifukwa cha kutanthauzira kwa hypotensive zotsatira,
ndi vasopressor sympathomimetics chifukwa choopsa cha kuchepa kwa hypotensive zotsatira za mankhwala,
ndi procainamideimmunosuppressants allopurinolkachitidwe GKS, cytostatics ndi mankhwala ena omwe amakhudza magawo a hematological chifukwa cha chiwopsezo chowonjezeka leukopenia,
Mankhwala a hypoglycemic a pakamwa, chifukwa cha kuchuluka kwa mankhwalawa kwa hypoglycemic. hypoglycemia,
Mchere wa lithiamu: kuchuluka kwa neuro- ndi mtima pazovuta za lithiamu,
ndi estrogen: chifukwa chiopsezo cha kufooketsa mphamvu ya mankhwala
ndi heparin chifukwa choopsa chowonjezera kuchuluka kwa potaziyamu m'magazi.

Ndi chiwindi ntchito

Odwala omwe ali ndi vuto la chiwindi, kuwonjezeka ndi kuchepa kwa mphamvu ya ramipril kumatha kuonedwa. Chifukwa chosadziwa zambiri ndi ntchito, Dilaprel iyenera kuyikidwa mosamala kwa odwalawo.

Kusamalidwa makamaka kuyenera kuchitika ndi matenda owopsa a chiwindi ndi edema ndi / kapena ascites chifukwa cha kuthandizira kwakukulu kwa RAAS.

Kuyanjana kwa mankhwala osokoneza bongo

Kugwiritsa ntchito Dilaprel nthawi yomweyo ndi mankhwala ena kumatha kubweretsa zotsatirazi:

mchere wa potaziyamu komanso potaziyamu wolekerera okodzetsa (spironolactone, triamteren, amiloride), mankhwala ena omwe amachulukitsa potaziyamu ya plasma (cyclosporine, tacrolimus, trimethoprim): kuchuluka kwa potaziyamu wa plasma,
telmisartan: kuchuluka kwa vuto laimpso, kuchepa kwamitsempha, kuwonekera kwa hypotension, chizungulire,
Mankhwala okhala ndi aliskiren, komanso AT1 receptor blockers (angiotensin II receptor antagonists): chifukwa cha blockade ya RAAS, chiopsezo chokhala ndi hyperkalemia, vuto laimpso, kutsika kowopsa kwa magazi,
mankhwala a antihypertensive (mwachitsanzo, okodzetsa) ndi mankhwala ena omwe amachepetsa kuthamanga kwa magazi (ma tricyclic antidepressants, nitrate, anesthesia wamba, alfuzosin, baclofen, prazosin, doxazosin, terazosin, tamsulosin): mphamvu ya antihypertensive zotsatira,
Kukonzekera kwa golide (sodium aurothiomalate) kwa mtsempha wamitsempha: nkhope yamitsempha, kusintha kwa thupi, kusanza, kusanza,
mapiritsi ogona, ma pinkiller ndi mankhwala osokoneza bongo: kuchuluka kwa antihypertensive,
vasopressor sympathomimetics (isoproterenol, epinephrine, dopamine, dobutamine): kuchepa kwa antihypertensive zotsatira za ramipril,
immunosuppressants, corticosteroids (mineralocorticosteroids, glucocorticoids), cytostatics, allopurinol, procainamide ndi mankhwala ena omwe amakhudza magawo a hematological: chiwopsezo chokhala ndi ma hematological reaction.
Mchere wa lithiamu: kukulitsa kuchuluka kwa plasma ya lithiamu ndikuwonjezera mphamvu zake za neuro- ndi mtima,
othandizira a hypoglycemic (kuphatikiza ma insulin, othandizira pakamwa, sulfonylureas): kuchuluka kwa mankhwalawa kwa hypoglycemia,
vildagliptin: kuchuluka kwa Quincke edema,
NSAIDs (acetylsalicylic acid pa mlingo woposa 3 g patsiku, cycloo oxygenase-2 inhibitors, indomethacin): chopinga cha ramipril, chiwopsezo cha kulephera kwa impso ndi kuwonjezeka kwa potaziyamu yambiri m'madzi a m'magazi,
sodium chloride: kufooketsa antihypertensive mphamvu ya ramipril,
heparin: kuchuluka kwa seramu potaziyamu,
Mowa: kuchuluka kwa vasodilation, kuchuluka kwa zotsatira zoyipa za ethanol m'thupi,
estrogens: kuchepa kwa mphamvu ya ramipril,
zoletsa zina za ACE: chiwopsezo chotenga matenda aimpso (kuphatikizapo mitundu ya pachimake), hyperkalemia,
Kukonzekera akuphatikizidwa ndi kufooketsa tizilombo ta hymenoptera tizilombo: kuwonjezera zovuta anaphylactic kapena anaphylactoid zimachitika mafupa a hymenoptera.

Mafanizo a Dilaprel ndi awa: Prenesa, Diroton, Enap, Lipril, Renipril.

Ndemanga za Dilaprel

Ndemanga za Dilaprel ndizochepa komanso zabwino. Mankhwalawa amagwira ntchito bwino ngati pakufunika kuthandizanso kuthamanga kwa magazi palokha komanso mophatikizana ndi mankhwala ena. Zotsatira zoyipa ndizosowa kwambiri. Komabe, zimadziwika kuti kugwiritsa ntchito nthawi yayitali, kuzolowera komanso kufooka kwa zotsatira kumachitika.

Malangizo ogwiritsira ntchito Dilaprel: njira ndi mlingo

Makapisozi a Dilaprel amatengedwa pakamwa, kumezedwa kwathunthu ndikutsukidwa ndi madzi okwanira (100 ml), isanachitike, isanayambe kapena itatha kudya.

Dokotala amafotokozera kuchuluka kwa chithandizo komanso nthawi yayitali ya chithandizo, pozindikira zomwe zikuwonetsa kuchipatala, kulolera kwa mankhwalawa ndi njira yothandizira. Nthawi yofunsira nthawi zambiri imakhala yayitali.

Mlingo Wovomerezeka wa Dilaprel:

ochepa matenda oopsa: woyamba mankhwalawa ndi 2.5 mg kamodzi m'mawa. Ngati kuthamanga kwa magazi sikwabwinobwino pambuyo pa masiku 21 ochizira, mlingo wa tsiku ndi tsiku ungathe kuchuluka mpaka 5 mg. Pokhapokha ngati pali chithandizo chokwanira cha kuchuluka kwa odwala, wodwalayo angathe kuikidwa mankhwala ena a antihypertensive (kuphatikizapo okodzetsa kapena osachepera calcium calcium blockers), kapena pambuyo masiku 14 mpaka 14, muwonjezere kwa mlingo waukulu wa 10 mg patsiku,
aakulu mtima kulephera: koyamba mlingo - 1.25 mg patsiku. Ndi kulekerera bwino kwa mankhwalawa, mlingo umatha kuwonjezeka pang'onopang'ono, ndi masiku 7-14, pamtengowo womwe umawongolera mokwanira matenda, koma osapitirira 10 mg patsiku. Mlingo pamwamba 2,5 mg utha kugawidwa mu 2 Mlingo,
matenda a mtima kulephera, anayamba 2 mpaka 9 pambuyo pachimake myocardial infarction: koyamba mlingo - 2,5 mg kawiri pa tsiku (m'mawa ndi madzulo). Pankhani ya kuchepa kwambiri kwa magazi, mlingo woyambirira uyenera kuchepetsedwa mpaka 1,25 mg kawiri pa tsiku. Kenako, malinga ndi momwe wodwalayo alili, muyezowo ungathe kuwirikiza kawiri ndi masiku atatu kapena atatu. Kenako wodwalayo amatha kusamutsidwa pamodzinso tsiku lililonse. Mlingo watsiku ndi tsiku sayenera kupitilira 10 mg,
kuperewera kwamtima kwambiri (NYHA kalasi III - kalasi yogwira ntchito ya IV) yomwe imachitika nthawi yomweyo pambuyo poti chithokomiro chowopsa: mlingo woyambirira - 1.25 mg kamodzi patsiku, ndiye kuti chisamaliro chapadera chiyenera kuchitika pakulimbikitsa kwa mlingo uliwonse.
non-diabetes kapena diabetesic nephropathy: mlingo woyamba ndi 1.25 mg kamodzi patsiku. Kupitilira apo, imatha kuwonjezeredwa mpaka mlingo waukulu tsiku lililonse wa 5 mg ndi kumwa kamodzi,
kuchepa kwa mwayi wokhala ndi vuto la kuchepa kwa mtima, matenda opha ziwalo, kapena mtima mwa odwala omwe ali ndi chiwopsezo chachikulu cha mtima: mlingo woyamba ndi 2,5 mg kamodzi patsiku. Ngati mankhwalawa amalekeredwa bwino, tikulimbikitsidwa kuti muwonjezere kuchuluka kwa mankhwalawa patatha masiku 7, ndiye kuti muonjezere mpaka 10 mg pasanathe masiku 21 chithandizo - njira yokhazikika yokonzera.

Malangizo oyenera a Dilaprel regimen yamagulu apadera a odwala:

aimpso kuwonongeka (CC 50-20 ml / mphindi pa 1.73 mamita 2 thupi): tsiku koyamba mlingo - 1.25 mg. Mlingo waukulu kwambiri ndi 5 mg patsiku,
kuphwanya mulingo wamadzi-electrolyte, kapena ochepa matenda oopsa, kapena chotupa chachikulu cha chotupa ndi mitsempha ya mitsempha: gawo loyamba ndi 1.25 mg patsiku,
odwala opitirira zaka 65: mlingo woyambirira - 1.25 mg wa patsiku,
kuwonongeka kwa chiwindi ntchito: pazipita tsiku lililonse ndi 2,5 mg. Mankhwalawa amayenera kumwedwa kumayambiriro kwa mankhwalawa moyang'aniridwa ndi achipatala, chifukwa kuthamanga kwa magazi kumatha kuchepa kapena kuwonjezeka.

Kwa odwala omwe ali ndi diuretic yapita, kugwiritsa ntchito Dilaprel kukuwonetsedwa patangotha masiku ochepa atachotsa kapena kuchepetsa mlingo wa okodzetsa koyamba mlingo wa 1.25 mg. Mutatenga mlingo woyamba komanso pakukula kulikonse, wodwalayo ayenera kuyang'aniridwa ndi achipatala kwa maola 8 kuti ateteze vuto losalamulira.

Dilaprel, malangizo ogwiritsira ntchito (njira ndi Mlingo)

Makapisozi a Dilaprel amatengedwa pakamwa, mosasamala kanthu za kudya, kutsukidwa ndi theka la kapu ya madzi.

Mlingo wa mankhwalawa amasankhidwa payekhapayekha, poganizira kulekerera kwake komanso zotsatira zake achire. Mankhwalawa nthawi zambiri amakhala aatali.

Mlingo wolimbikitsidwa wa odwala omwe ali ndi chiwindi chokwanira ndi ntchito ya impso:

kuthamanga kwa magazi: 2,5 mg kamodzi patsiku (m'mawa), pambuyo pa masabata atatu atamwa mankhwalawa komanso osakhalapo chifukwa choyembekezeredwa, zimatha kuwonjezera mlingo mpaka 5 mg tsiku lililonse, pakatha milungu iwiri itatha kumwa mankhwalawa pa 5 mg ngati sagwira bwino ntchito, mlingo wa tsiku ndi tsiku umatha kuchuluka mpaka 10 mg, njira ina ndiyothekanso - kugwiritsa ntchito Dilaprel pa mlingo wa 5 mg patsiku ndi kuwonjezera kwa othandizira ena othandizira mankhwalawa, mwachitsanzo, othandizira pang'onopang'ono a calcium calcium blockers kapena okodzetsa,
Kulephera kwa mtima kosatha: 1.25 mg patsiku kumayambiriro kwa chithandizo, mtsogolo, poganizira mayankho a wodwalayo, ndizotheka kubwereza kawiri pamasabata 1-2 mpaka mlingo waukulu wa tsiku lililonse wa 10 mg,
Kulephera kwa mtima komwe kumachitika pambuyo pobwera chifukwa cha kuchepa kwa magazi m'thupi kuyambira pa 2 mpaka tsiku la 9: 5 mg patsiku kawiri pamankhwala (m'mawa ndi madzulo) kumayambiriro kwa chithandizo, osagwirizana ndi koyamba kwa masiku awiri ayenera kumwedwa 1 , 25 mg ya ramipril kawiri pa tsiku, mtsogolomo, poganizira zomwe wodwalayo akuchita, ndizotheka kubwereza kawiri pamasiku onse mpaka magawo a 10 mg okwanira atakwanira, kuchuluka kwa mankhwala kwa nthawi pakanthawi kungathe kuchepetsedwa kamodzi patsiku,
aimpso nephropathy: 1.25 mg kamodzi patsiku kumayambiriro kwa mankhwala, mtsogolo, mlingo utha kuwonjezeka mpaka 5 mg kamodzi patsiku (mlingo waukulu wa tsiku lililonse),
Kuchepetsa mwayi wokhala ndi stroke, kugunda kwa mtima kapena chiopsezo cha kufa kwa mtima mwa odwala omwe ali pachiwopsezo cha mtima: 2,5 mg wa ramipril kamodzi patsiku kumayambiriro kwa mankhwalawa, mlingo wa mankhwalawa ukhoza kuwonjezeredwa pambuyo pa sabata 1, komanso masabata atatu otsatira Mlingo wa Dilaprel ukhoza kuwonjezeka mpaka 10 mg kamodzi patsiku.

Mu vuto la impso (creatinine chilolezo cha 50-20 ml / min), mankhwalawa ayenera kugwiritsidwa ntchito koyamba mlingo wa 1.25 mg, ndipo mlingo waukulu mwa odwala sayenera kupitirira 5 mg patsiku.

Mu ochepa matenda oopsa, odwala omwe ali ndi vuto lamagetsi am'magetsi komanso odwala omwe kuchepa kwambiri kwa magazi kumayenderana ndi chiwopsezo, mlingo woyamba wa ramipril ndi 1.25 mg patsiku.

Odwala omwe amalandila diuretics asanayambe kulandira chithandizo ndi Dilaprel ayenera, ngati kuli kotheka, kusiya kumwa masiku awiri asanayambe chithandizo kapena kuchepetsa kumwa. Chithandizo cha Ramipril ziyenera kuyamba ndi mlingo wa 1.25 mg kamodzi patsiku. Mutatha kumwa koyamba, komanso mukuwonjezeka kwa kuchuluka kwa mankhwalawa komanso / kapena okodzetsa, kuyang'anira wodwala mosamala kumafunikira kwa maola osachepera 8, omwe amathandiza kupewa kuchepa kwa magazi.

Odwala a zaka zopitilira 65 ayenera kulandira Dilaprel mu koyamba mlingo wa 1.25 mg wa patsiku.

Ngati chiwindi ntchito, opeza tsiku lililonse mankhwala sayenera upambana 2,5 mg.

Mtengo wa Dilaprel m'masitolo ogulitsa mankhwala

Mtengo wa Dilaprel m'masitolo osiyanasiyana amasiyana pang'ono ndipo umadalira kwambiri Mlingo ndi ma CD. Mtengo woyenerana ndi mankhwalawa masiku ano: makapisozi a 2,5 mg (ma 28 ma PC. Phukusi) - ma ruble 149, makapisozi 5 mg (ma PC 28. Phukusi) - 227-26 ruble, 10 mg makapisozi (ma 28 ma PC. Phukusi) - 267-315 rubles.

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