Mtundu wa Aprovel ndi mapiritsi okhala ndi mafilimu: ozungulira, biconvex, oyera kapena pafupifupi oyera, mbali yomweyo amalemba chithunzi cha mtima, mbali inayo, manambala 2872 (mapiritsi a 150 mg) kapena 2873 (mapiritsi a 300 mg).

• yogwira mankhwala: irbesartan - 150 kapena 300 mg,
• othandizira: microcrystalline cellulose, lactose monohydrate, hypromellose, colloidal silicon dioxide, magnesium stearate, croscarmellose sodium,
• kujambula kwama film: carnauba wax, oyera a Opadry (macrogol-3000, hypromellose, lactose monohydrate, titanium dioxide E 171).

Mankhwala

Ntchito yogwira ya Aprovel ndi irbesartan - kusankha wotsutsana ndi angiotensin II receptors (mtundu wa AT₁), pofuna kupezeka kwa pharmacological ntchito yomwe metabolic ya activation siyofunikira.

Angiotensin II ndi gawo lofunikira la renin-angiotensin-aldosterone system (RAAS). Amagwira nawo pathogenesis ya ochepa matenda oopsa komanso sodium homeostasis.

Irbesartan imalepheretsa zovuta zonse za thupi za angiotensin II, mosatengera njira kapena magwero ake, kuphatikiza zomwe aldosterone-secreting komanso vasoconstrictive zotsatira zomwe zimachitika kudzera pa ma receptors a AT₁ili mu adrenal cortex komanso pamwamba pa maselo osalala a minyewa.

Irbesartan alibe ntchito ya agonist₁-ngowalandira, koma ali ndi ubale wopambana kwambiri (> kuposa 8500-fold) poyerekeza ndi AT₂- zomvera zomwe sizikugwirizana ndi kayendedwe ka mtima.

Mankhwala samaletsa enzyme za RAAS monga angiotensin kutembenuza enzyme (ACE) ndi renin. Kuphatikiza apo, sizikhudza ma receptor a mahomoni ena ndi ma njira a ion, omwe akukhudzidwa ndi kayendetsedwe ka sodium homeostasis ndi kuthamanga kwa magazi.

Chifukwa chakuti irbesartan imaletsa AT₁-receptors, mayendedwe olowera mu renin - angiotensin dongosolo limasokonezeka, chifukwa chomwe plasma wozungulira wa renin ndi angiotensin II ukuwonjezeka. Mukamwa mankhwala othandizira, mankhwalawa amathandizira kuchepetsa kuchuluka kwa aldosterone, osakhala ndi gawo lalikulu la potaziyamu mu seramu yamagazi (chizindikiro ichi chimawonjezeka pafupifupi ndi osapitirira 0,1 mEq / l). Komanso, mankhwalawa alibe phindu lililonse la seramu wozungulira wa triglycerides, glucose ndi cholesterol, kuchuluka kwa uric acid mu seramu komanso kuchuluka kwa excretion ya uric acid ndi impso.

Mphamvu ya Aprovel imawonekera kale mutatenga mlingo woyamba, imakhala yofunikira mkati mwa masabata 1-2, imakwanitsa pambuyo pake pakatha milungu 6. Mu maphunziro azachipatala a nthawi yayitali, kulimbikira kwa zochita za antihypertensive kunadziwika kwa nthawi yoposa chaka chimodzi.

Mukamwa mankhwala kamodzi patsiku Mlingo wa 900 mg, Hypotensive zotsatira zake zimadalira mlingo. Ngati mulingo wolembedwa pakati pa 150 mpaka 300 mg, magazi a irbesartan amachepetsa kuthamanga kwa magazi (BP), omwe amayeza atagona ndikukhala kumapeto kwa gawo la interdose (ndiko kuti, musanamwe mlingo wotsatira, pambuyo pa maola 24) poyerekeza ndi placebo: kuthamanga kwa magazi kwa systolic ( CAD) - avareji ya 8-13 mm Hg. Art., Diastolic magazi (DBP) - 5-8 mm RT. ct Kumapeto kwa kupendekera kwapakati pa interdose, mphamvu ya antihypertensive imawonetsedwa ndi 60-70% ya kuchuluka kwakukulu kwa kuchepa kwa SBP ndi DBP. Kutsika kwakukulu kwa kuthamanga kwa magazi mkati mwa maola 24 kumatheka chifukwa chotenga Aprovel kamodzi patsiku.

Kutsika kwa kuthamanga kwa magazi m'magonedwe abodza ndi oyimilira amawonedwa pafupifupi ofanana.

Zotsatira za Orthostatic ndizosowa. Komabe, mwa odwala omwe ali ndi hypovolemia ndi / kapena hyponatremia, kuchepa kwambiri kwa magazi kumatheka, limodzi ndi mawonetsedwe azachipatala.

Kulimbitsa mphamvu ya antihypertensive kumawonedwa mukamamwa irbesartan kuphatikiza ndi thiazide diuretics. Chifukwa chake, ngati vuto lakachepera kuthamanga kwa magazi kwa odwala omwe amalandila irbesartan monotherapy, kuphatikiza, hydrochlorothiazide ndi mankhwala ochepa (12,5 mg) kamodzi patsiku. Mukatenga kuphatikiza uku, kuchepa kwapadera kwa magazi a systolic ndi diastolic ndi 7-10 ndi 3-6 mm RT. Art. mogwirizana, poyerekeza ndi odwala omwe adalandira placebo ku irbesartan.

Jenda komanso zaka za wodwalayo sizikhudza kuopsa kwa machitidwe a Aprovel. Zotsatira zake zimachepetsedwa kwambiri odwala a liwiro la Negroid. Komabe, ma hydrochlorothiazide ochepa akawonjezeredwa ku irbesartan, kuyankha kotsutsa kwa oyimira mpikisanowu kumayandikira kwa odwala a mpikisano wa Caucasian.

Pambuyo pakuchotsa chithandizo, kuthamanga kwa magazi pang'onopang'ono kumabwereranso mumlingo wake woyambirira. Mankhwala sayambitsa kukula kwa achire matenda.

Mu multicenter yokhazikika yolamulidwa yokhala ndi maso akhungu awiri>

Opaleshoni ya multicenter, yosasinthika, yolamulidwa ndi placebo, yowona kawiri-kawiri idachitidwanso komwe kunayesa zotsatira za irbesartan pa microalbuminuria (20-200 μg / min, 30-300 mg / tsiku) odwala omwe ali ndi matenda oopsa komanso mtundu wokhudzana ndi matenda a shuga 2 mellitus (IRMA 2). Kafukufukuyu adakhudzana ndi odwala 590 omwe ali ndi matendawa komanso ntchito yachibadwa ya impso (serum creatinine concentration mwa amuna - 9 point on the Child-Pugh wadogo)

• matenda a mtima ndi / kapena kwambiri matenda amitsempha yamagazi (pakakhala kuchepa kwambiri kwa kuthamanga kwa magazi, vuto la ischemic lingaonjezeke, mpaka pakulimbikitsidwa kwa stroko ndi chithokomiro chachikulu cha myocardial),
• hypertrophic obstriers cardiomyopathy,
• aortic / mitral valve stenosis,
• hypovolemia / hyponatremia chifukwa cha hemodialysis kapena ntchito okodzetsa,
• kutsatira zakudya zomwe zimachepetsa kuchuluka kwa mchere, kapena kutsegula m'mimba, kusanza (mwina kutsika kwambiri kwa magazi),
• kupatsirana kwatsopano kwa impso,
• Kulephera kwa aimpso (mulingo wa potaziyamu ndi ndende ya creatinine ayenera kuyang'aniridwa),
• ntchito yaimpso kutengera RAAS, kuphatikizapo matenda oopsa omwe ali ndi mphamvu ya mtima komanso matenda ena amodzi a mtima wa III - IV malinga ndi gulu la NYHA,
• kugwiritsa ntchito munthawi yomweyo aliskiren kapena ACE zoletsa (chifukwa chakuchepa kwambiri kwa kuthamanga kwa magazi, kukula kwaimpso ndi kuwonda kwambiri),
• munthawi yomweyo makina osapatsirana omwe amaletsa kutupa, kuphatikiza kusankha ma inhibitors a COX-2 (chiwopsezo chaimpso zoyipa, kuphatikiza kuchuluka kwa seramu calcium ndi kukula kwa kulephera kwaimpso, makamaka achikulire, ndi hypovolemia, ndi vuto laimpso).

Malangizo ogwiritsira ntchito Aprovel: njira ndi mlingo

Aprovel ayenera kumwedwa pakamwa, kumeza mapiritsiwo ndi madzi okwanira. Nthawi ya chakudya ilibe kanthu.

Kumayambiriro kwa mankhwalawa, 150 mg nthawi zambiri amapatsidwa kamodzi patsiku. Ngati vutoli silikwanira, onjezani mlingo ku 300 mg kapena kuwonjezera pa okodzetsa (mwachitsanzo, hydrochlorothiazide pa mlingo wa 12,5 mg) kapena mankhwala ena a antihypertensive (mwachitsanzo, wogwira ntchito pang'onopang'ono wa calcium calcium blocker kapena beta-blocker.

Ndi nephropathy, odwala omwe ali ndi matenda oopsa komanso mtundu wachiwiri wa matenda a shuga nthawi zambiri amafunikira mankhwala okwanira 300 mg kamodzi patsiku.

Odwala omwe ali ndi vuto lalikulu la hypovolemia komanso / kapena hyponatremia asanaikidwe Aprovel ayenera kuwongolera kuphwanya kwa mulingo wamadzi-electrolyte.

Kuyanjana kwa mankhwala osokoneza bongo

Kuphatikizidwa kwa Aprovel ndi aliskiren kapena ACE inhibitors kumabweretsa kubwereza kwapawiri kwa RAAS. Kugwiritsa ntchito kuphatikiza koteroko sikulimbikitsidwa, popeza chiwopsezo cha kuchepa kwambiri kwa kuthamanga kwa magazi, kuwonongeka kwa impso ndi kukula kwa hyperkalemia kumakulitsidwa. Kugwiritsa ntchito Aprovel munthawi yomweyo ndi aliskiren kumatsutsana mwa odwala omwe ali ndi matenda osokoneza bongo komanso kulephera kwa aimpso (glomerular filtration rate 2 body). Kugwiritsa ntchito Aprovel kuphatikiza ndi ACE inhibitors kumatsutsana kwambiri ndi odwala omwe ali ndi matenda ashuga nephropathy, osavomerezeka kwa odwala ena onse.

Irbesartan imatha kuwonjezera kuchuluka kwa lithiamu mu seramu yamagazi ndikuwonjezera kawopsedwe ake.

Odwala omwe adalandira kuchuluka kwa okodzetsa asanafike Aprovel, hypovolemia ikhoza kukhala, chiwopsezo cha kuchepa kwambiri kwa magazi kumayambiriro kwa irbesartan ukuwonjezeka.

Mankhwala osagwirizana ndi nonsteroidal anti-kutupa (NSAIDs), kuphatikizapo kusankha ma inhibitors a COX-2, amatha kufooketsa mphamvu ya hypotensive zotsatira za angiotensin II receptor antagonists, zomwe zimaphatikizapo irbesartan. Okalamba, odwala hypovolemia komanso odwala mkhutu aimpso, NSAIDs ikhoza kuyambitsa kuwonongeka kwa impso, mpaka kukulira kwaimpso kulephera. Nthawi zambiri, izi zimatha kusintha. Pankhaniyi, kugwiritsa ntchito kuphatikiza koteroko kumafunikira kuwunikira ntchito yaimpso.

Pali chokuchitikira ndi kugwiritsa ntchito mankhwala ena omwe amakhudza RAAS, komanso potaziyamu oteteza pakudya, potaziyamu wokhala ndi mchere, m'malo mwa potaziyamu, ndi othandizira ena omwe angakulitse kuchuluka kwa plasma (mwachitsanzo, heparin). Pali malipoti osiyana akuwonjezeka kwa seramu potaziyamu ndende. Poganizira momwe irbesartan imakhudzira RAAS mukamagwiritsa ntchito Aprovel, tikulimbikitsidwa kuwunika ma seramu potaziyamu.

Ndi munthawi yomweyo kugwiritsa ntchito ma antihypertensive othandizira ena, kuwonjezeka kwa hypotensive zotsatira ndikotheka. Irbesartan popanda zovuta zosagwiritsidwa ntchito adagwiritsidwa ntchito limodzi ndi thiazide diuretics, beta-blockers komanso osakhalitsa ochita pang'onopang'ono calcium blockers.

Ma Analogs a Aprovel ndi Firmast, Irbesartan, Ibertan, Irsar.

Ndemanga za Aprovel

Ndemanga za Aprovel ndizabwino. Odwala amadziwa mphamvu ya mankhwalawa, kuchepa kwa magazi ndi kuthamanga kwa magazi - 1 nthawi patsiku, chifukwa antihypertensive effect imapitilira maola 24. Zotsatira zoyipa, malinga ndi ndemanga, ndizosakhalitsa m'chilengedwe. Ubwino wowonjezereka wa mankhwalawa ndi kusapezeka kwa zoyipa zomwe zimachitika ndi angiotensin-kutembenuza enzyme zoletsa (kuphatikizapo chifuwa). Choyipa chachikulu cha Aprovel chimawonetsedwa ngati mtengo wokwera mtengo.

Momwe mungagwiritsire ntchito mankhwalawa Aprovel?

Aprovel ndi mankhwala othandizira zochizira matenda oopsa komanso nephropathy. Amaloledwa kugwiritsa ntchito mankhwala a shuga. Pankhaniyi, mankhwalawa sayambitsa achire matenda atasiya ntchito. Mankhwalawa amapezeka mu mawonekedwe a mapiritsi, omwe amalola madokotala kuti asamalamulire mankhwalawo. Odwala pawokha amatha kusintha njira zina zochizira mankhwalawa panthawi yoyenera.

Kutulutsa mafomu ndi kapangidwe kake

Mankhwalawa amapezeka m'mapiritsi otsekemera olimbitsa thupi. Gawo lamankhwala lili ndi 150, 300 mg yogwira ntchito - irbesartan. Monga zida zothandizira popanga zimagwiritsidwa ntchito:

• shuga mkaka
• hypopellose,
• colloidal dehydrate silicon dioxide,
• magnesium wakuba,
• croscarmellose sodium.

Utoto wamafilimuwo umakhala ndi sera wa carnauba, macrogol 3000, hypromellose, titanium dioxide ndi shuga mkaka. Mapiritsiwo ali ndi mawonekedwe owuma a biconvex ndipo amapaka utoto woyera.

Amaloledwa kugwiritsa ntchito mankhwala a shuga.
Ndi kumwa kamodzi kwa 300 mg ya mankhwalawa, kutsika kwa magazi kuthamanga mwachindunji kumatengera mlingo womwe umamwa.
Kuchuluka kwa hypotensive kwambiri kumawonedwa patatha maola 3-6 mutamwa mapiritsi.

Kufotokozera za mankhwalawa

Aprovel ndi mankhwala omwe ali m'gulu la angiotensin II receptor antagonists. Zogwira ntchito mankhwala ndi irbesartan. Aprovel imaphatikizanso zothandizira:

• Lactose Monohydrate.
• Wowuma chimanga.
• Silica colloidal hydrate.
• Microcrystalline mapadi.
• Magnesium wakuba.
• Poloxamer 188.
• Croscarmellose sodium.

Kutulutsa mawonekedwe - mapiritsi okhala ndi 75, 150 ndi 300 mg ya irbesartan.

Njira yamachitidwe

Aprovel ndi othandizira antihypertensive (hypotensive) omwe amasintha machitidwe a renin-angiotensin-aldosterone chifukwa chosankha kutsekedwa kwa 1 subtype ya mtundu II angiotensin receptors. Mwa kutsekereza ma receptors omwe ali pamwambawa, kumangiriza kwa angiotensin II kwa iwo sikuchitika, ndipo kuzungulira kwake ndi renin mu plasma kumawonjezeka, ndikuchepetsa kuchuluka kwa aldosterone yomwe imamasulidwa. Mphamvu ya Aprovel imakhala yachindunji komanso yofunikira pakukhazikitsa kwa hypotensive zotsatira.

Komanso, mankhwalawa ali ndi vuto lapakati. Zimachitika chifukwa cha kulumikizana ndi angiotensin I-receptors, omwe amakhala pambale ya presynaptic pafupifupi neuron yomvera chisoni. Kulumikizidwa kuzinthu izi kumabweretsa kutsika kwa plasma zomwe zili norepinephrine, zomwe, monga adrenaline ndi angiotensin, zimayambitsa kuchuluka kwa magazi.

Aprovel amakhalanso ndi hypotensive zotsatira zosakhudzidwa, zomwe zimagwirizanitsidwa ndi kuchulukitsidwa kwazomwe zimachitika ndi mankhwala a AT-2, AT-3, AT-4 ndi receptors a AT, malinga ndi momwe ma receptors amtundu woyamba amakhala otsekeka. Zotsatira zake, timalandira kuchuluka kwa ziwiya zamagetsi ndikuchulukanso kwa zotupa za sodium ndi madzi mu mkodzo.

Zotsatira zazikulu zamankhwalachifukwa cha Aprovel:

1. Kuchepetsa kwathunthu kwamphamvu mtima.
2. Kuchepetsa pambuyo pamtima.
3. Matenda a systolic magazi mu m'mapapo capillaries a m'mapapo.

Aprovel ali ndi bioavailability yapamwamba, yomwe ili pamtunda wa 60-80%. Mankhwala atalowa m'thupi la munthu kudzera munjira yolowera, pamakhala mphamvu yomweyo komanso yolumikizira mapuloteni a plasma, omwe amalowa m'chiwindi. Mkati mwa thupi, mankhwalawa amatha kugwiritsidwa ntchito ndi makutidwe ndi okosijeni omwe amapangitsa kuti metabolite akhazikike - irbesartan-glucuronide.

Mutatha kumwa mankhwalawa, mphamvu ya antihypertensive yambiri imachitika pambuyo pa maola 3-6 ndipo imatha maola opitilira 24. Patsiku limodzi, zotsatira za hypotensive zidzakhala zitasankhidwa pang'ono 30%% poyerekeza ndi tsiku loyamba. Irbesartan, monga metabolite yake yogwira, imapukusidwa mu ndulu ndi mkodzo.

Malamulo ogwiritsira ntchito

Aprovel imapezeka m'mapiritsi a pakamwa (peros), omwe safunika kutafuna. Mukatha kumwa, mumangofunika kumwa mawonekedwe a mankhwalawo ndi madzi okwanira.

Kumayambiriro kwa chithandizo, zosaposa 150 mg za Aprovel nthawi zambiri zimayikidwa patsiku. Gwiritsani ntchito mlingo womwe umayesedwa nthawi yoyamba musanadye kapena mutatha kudya.

Popeza pali mapiritsi okhala ndi zinthu zosiyanasiyana zogwira ntchito, mutha kuwongolera kuthamanga kwa magazi ndi mphamvu ya antihypertensive mankhwala.Mwachitsanzo, ngati wodwalayo ndi wokalamba kapena akudwala hemodialysis, mulingo woyenera wa Aprovel ndi 75 mg patsiku.

Kwa anthu omwe ali ndi mtundu wa shuga wachiwiri kapena matenda oopsa, kuchuluka kwa mankhwalawa kwa 150 mg ndi koyenera, komwe kumatha kuonjezereka mpaka 300 ngati simungakwanitse kapena pazifukwa zina.

Mlingo wokhazikika wa Aprovel pa 300 mg patsiku ndiye chizoloŵezi kwa odwala omwe ali ndi nephropathy.

Ngati wodwalayo ali ndi vuto lina la impso, mwina la virus kapena bakiteriya, kusintha kwa mankhwalawa kungakhudze mkhalidwe wa wodwalayo komanso kugwiritsa ntchito bwino kwa mankhwalawo (chomaliza chitha kuphatikizidwa ndi kuwonongeka kwa zinthu zomwe zimagwira ndi ma metabolites).

Kugwiritsa ntchito mankhwalawa kwa ana, amayi oyembekezera komanso oyamwitsa

Mankhwala aliwonse omwe amakhudza dongosolo la renin-angiotensin-aldosterone, kuphatikiza Aprovel, amaletsedwa kugwiritsa ntchito nthawi ya bere, mosasamala kanthu za trimester. Ngati mayi woyembekezerayo adagwiritsa ntchito mankhwalawa amayi asanakhazikitsidwe, mankhwalawo amachotsedwa ndipo amachenjezedwa za zomwe zingachitike (makamaka zowopsa panthawi yomwe mimba imakhazikitsidwa mochedwa).

Chifukwa chakuti kulephera kwa irbesartan ndi ma metabolites kulowa m'matumbo a mammary, ndipo kudzera mwa iwo mumkaka, sikumatsimikiziridwa mwanjira iliyonse, Aprovel amaletsedwanso kuti azigwiritsa ntchito pa mkaka wa mkaka.

Kwa anthu osakwana zaka 18, mankhwalawa amakwiriridwa.

Zizindikiro zogwiritsidwa ntchito

Aprovel amagwiritsidwa ntchito pochiza:

• Nephropathy, yomwe imayamba motsutsana ndi maziko a matenda ashuga.
• Chofunikira komanso chachiwiri matenda oopsa.

Tiyeneranso kukumbukiranso kuti pakuwonjezereka kwa magazi, Aprovel amagwiritsidwa ntchito ngati gawo la zovuta mankhwala, popeza mankhwala a magulu omwe amagwirizana amayenera kugawidwa kuti athetse matenda.

Ndi nephropathy, mankhwalawa amagwiritsidwa ntchito chifukwa cha zotsatira zabwino za impso, akuvutika kwambiri ndi matenda a shuga.

Contraindication

Mankhwala saloledwa kugwiritsa ntchito:

• Anthu omwe ali ndi hypersensitive ku mankhwalawo, zida zake.
• Amayi oyembekezera komanso oyembekezera.
• Ana.
• Ndi cholowa galactose tsankho, kuchepa kwa lactose kapena malabsorption a shuga ndi galactose.

Kuphatikiza apo, motsogozedwa mwamphamvu, Aprovel amagwiritsidwa ntchito kupangira matenda ndi ma pathological monga:

• Hypertrophic obstriers Cardiomyopathy.
• Kuthetsa madzi m'thupi.
• Hyponatremia.
• Hyperkalemia
• Dyspepsia
• Bilateral aimpso mtsempha wamagazi.
• Unilateral stenosis yokhayo impso ntchito.
• Kulephera kwamtima kosalekeza.
• Matenda a mtima.
• Atherosulinotic zotupa za ochepa ziwiya za ubongo.
• Kulephera kwina.
• Hemodialysis
• Kulephera kwa chiwindi.

Zotsatira zoyipa

Aprovel amakhalanso ndi zovuta, zomwe nthawi zambiri zimachitika ndi Mlingo wosayenera wa mankhwalawa kapena kugwiritsa ntchito mosalamulika pazinthu zomwe zili pamwambapa. Mankhwala angayambitse:

• Kuthamanga kwamphamvu kumaso, komwe kumayendetsedwa ndi mawonekedwe a edema a gawo lolingana la thupi.
• Chizungulire
• Mutu.
• Tinnitus.
• Matenda a mtima, kupweteka kwambiri sternum.
• Hyperkalemia
• Youma chifuwa.
• Kuphwanya kukoma.
• Kutopa.
• Kukanika kwa Erectile.
• Kulephera kwina.
• The ziwengo.
• Kusokonezeka kwa ziwalo zam'mimba, zomwe zimawonekera: kusanza, nseru, kutentha mtima.
• Zowonongeka za m'magazi pachiwindi zimagwirizanitsidwa ndi kuphwanya kwamphamvu thupi (jaundice, hepatitis ndi matenda ena).

Kuphatikiza apo, mu labotale odwala omwe amagwiritsa ntchito Aprovel mu achire, chiwonetsero chachikulu cha plasma creatine kinase chikuwoneka. Kuphatikiza apo, mkhalidwe wa pathologicalwu sunayambitse chiwonetsero chilichonse chazachipatala mwa anthu. Zochitika za hyperkalemia ndizodziwika kwambiri mwa odwala a nephropathy. Momwemonso gulu la odwala, chizungulire cha orthostatic, hypotension, ululu wokhudza mafupa amawonedwa. Ndi nephropathy ndi matenda a shuga, 2% ya anthu nthawi zina amakhala ndi hemoglobin wochepa m'magazi.

Kuyanjana ndi mankhwala ena ndi mowa

Ganizirani momwe Aprovel amagwiritsidwira ntchito ndi mankhwala ena:

1. Ma diuretics ndi othandizira ena othandizira. Mukamagwiritsa ntchito antihypertensive mankhwala limodzi, kuthekera kwa zochita zawo kumawonedwa. Ngakhale izi, Aprovel imagwiritsidwa ntchito ndi beta-blockers, block-calcium calcium blockers okhalitsa komanso thiazides. Ngati tikulankhula za mankhwala a magulu omwe ali pamwambapa, ndiye kuti simungathe kuchita popanda hydrochlorothiazide, Amlodipine, Nifedipine, Verapamil, Diltiazem, Anaprilin.
2. Potaziyamu zowonjezera ndi potaziyamu wolekerera okodzetsa. Kugwiritsa ntchito mankhwala am'maguluwa, komanso mankhwala omwe amalimbikitsa kuchuluka kwa potaziyamu mu seramu yamagazi pamodzi ndi Aprovel ndi mankhwala ena omwe amakhudza dongosolo la renin-angiotensin-aldosterone, kungayambitse kuchuluka kwambiri kwa ions ya potaziyamu mu seramu. Mwa mankhwalawa, omwe amagwiritsidwa ntchito kwambiri ndi awa: Spironolactone, Heparin, omwe amachokera ku molekyulu.
3. Mankhwala osokoneza bongo oletsa kuponderezana. Mukamagwiritsa ntchito Aprovel ndi mankhwala a gululi, kuchepa kwa mphamvu ya antihypertgency kumawonedwa. Ma NSAID odziwika kwambiri: Lornoxicam, Meloxicam, Nimesulide, Celecoxib.
4. Kukonzekera kwa Lithium. Pogwiritsa ntchito mankhwala a gululi limodzi ndi angiotensin-converting enzyme inhibitors, kuwonjezereka kwa kuwopsa kwa mankhwala opangidwa ndi zitsulo kunadziwika. Nthawi zina, kuwonjezeka kwa mavuto kumawonedwanso mukamagwiritsa ntchito kukonzekera kwa lithiamu palimodzi ndi Aprovel, chifukwa cha iwo amagwiritsa ntchito kuphatikiza pokhapokha pokhapokha ndikulamulidwa mwamphamvu kwa mulingo wazitsulo mu seramu yamagazi.

Kugwiritsa ntchito pamodzi kwa Aprovel ndi mowa, narcotic ndi zinthu zina zoyipa ndizoletsedwa. Izi ndichifukwa choti mankhwalawa ali ndi mphamvu ya antihypertensive, ndipo mowa komanso ndalama pamwambapa zimachita mosiyana ndikumapangitsa kuchuluka kwa magazi.

Kodi ndingamupeze kuti Aprovel?

Mutha kugula mankhwalawo ku pharmacy kapena kupanga lamulo pa intaneti. Malo wamba ogulira ndalama:

Mtengo mankhwalawa amasiyanasiyana m'dera la 323-870 rubles.

Ngakhale kuti mankhwalawa ali ndi zovuta zingapo, amatha kutchedwa imodzi mwazisankho zabwino pochiza matenda oopsa, monga matenda oopsa kapena nephropathy yokhala ndi matenda osokoneza bongo. Kuphatikiza apo, mankhwalawa amatha kuyanjana ndi mankhwala ena.

The zikuchokera mankhwala

Izi zimapangidwa makamaka m'mapiritsi ozungulira. Palinso njira za Aprovel pamsika wa kulowetsedwa kwamkati. Chofunikira chachikulu cha mankhwalawa ndi irbesartone. The zikuchokera mankhwala mulinso:

lactose monohydrate,
wowuma chimanga
sodium croscarmellose,
silika
poloxamer 188,
madzi achikondwerero
cellcrystalline mapadi,
magnesium wakuba.

Mapiritsi aprovel amalemera 150 mg aliyense. Mutha kuwazindikira polemba - mtima mbali imodzi ndikuwerenga 2772 mbali inayo. Komanso pamsika nthawi zina mapiritsi Aprovel 300 mg aliyense.

Zotsatira za pharmacological

Kamodzi m'thupi la wodwalayo, mankhwalawa "Aprovel" amayamba kukopa ma receptors a mtundu 2 angiotensin. Zotsirizazo ndizomwe zimayambitsa kukhoma kwa chotengera cha chotengera. Mukakumana nawo, enzyme ya angiotensin imapangitsa kufinya kwa mitsempha. Zotsatira zake, kuthamanga kwa magazi kumachepa.

Chofunikira cha mankhwalawa Aprovel, poyerekeza ndi zina, ndikuti sizilumikizana ndi ma enzymes ena mthupi konse. Chifukwa cha izi, wodwala amene amamwa mankhwalawa samawonetsa kusintha m'magazi. Makamaka, madzi a m'magazi samachulukitsa kuchuluka kwa calcium komanso zinthu zina zomwe zingasokoneze zochita za mtima.

Mankhwalawa amayamba kugwira ntchito pafupifupi maola 5-6 atalowa m'mimba. Mphamvu ya antihypertensive mukamamwa Aprovel imayamba kukula mkati mwa masiku 7 mpaka 14. Imafika pachimake pafupifupi milungu 6 chichitikireni chithandizo.

Popeza mankhwalawa ndi othandiza, madokotala nthawi zambiri amapereka Aprovel kwa odwala awo. Kugwiritsidwa ntchito kwake kumawonetsedwa ngati matenda monga:

matenda oopsa,
nephropathy mu mtundu 2 matenda a shuga ndi matenda oopsa.

Potsirizira pake, "Aprovel" imayikidwa ndi madokotala nthawi zambiri ngati gawo limodzi la mankhwala othandizira antihypertensive. Madotolo awona kuti mankhwalawa amatha kupindulitsa moyenera machitidwe a odwala omwe ali ndi matenda ashuga.

Mitu ya mankhwalawa

Mankhwala a Odwala Aprovel amayenera kuwunikiridwa bwino. Ambiri amakhulupirira kuti lero ndi chida chabwino kwambiri m'gululi. Koma mwatsoka, simungapeze nthawi zonse mufamu. Popeza mankhwalawa palibe pa malonda, ndiye kuti muyenera kugwiritsa ntchito zina. Ngati ndi kotheka, mutha kumwa analog m'malo mwa mankhwalawa Aprovel:

Ibertan.
Irsar.
"Converium".
Firmast.

Nthawi zina m'malo mwa mankhwalawa, odwala amalembanso "Lozap" kapena "Valz." Wodziwika bwino wa mankhwalawa "Irbesartan" (omwe ali ndi mawonekedwe omwewo, koma osati chizindikiro) akugulanso masiku ano.

Uku ndi kuyendera bwino bwino kwa Aprovel 150 mg ndi 300 mg. Chofunikira chachikulu pazomwe zimapangidwanso ndi irbesartan. Ibertan amapezeka pamapiritsi a 75, 150 ndi 300 mg. Imakhalanso ndi mankhwala omwewo pamthupi la wodwalayo monga Aprovel. Ndi Ibertan yekha amene amasiyana ndi mankhwalawa chifukwa mumakhala zinthu zina zowonjezera.

Mankhwala "Irsar"

Irbesartan imaphatikizidwanso pakuphatikizidwa kwa mankhwalawa monga chinthu chachikulu chogwira ntchito. Irsar amapezeka pamapiritsi. Mukamamwa, wodwalayo amapatsidwa chakudya chapadera (ndi malire a kuchuluka kwa mchere womwe umamwetsa). Monga Aprovel, mnzake wa Irsar amachepetsa kuthamanga kwa magazi bwino. Kuphatikiza apo, alibe zotsatira pa mtima wa wodwala.

Kutanthauza "Lozap" ndi "Valz"

Mankhwala Firmasta, Converium, Irsar, ndi Ibertan amafanana ndi Aprovel, chifukwa ali ndi mawonekedwe ofanana. Mankhwala "Valz" ndi "Lozap", kwenikweni, ndiofananira kwawo. Zomwe zimagwiritsidwa ntchito ndizosiyana kwa iwo. "Valz" imapangidwa pamaziko a valsartan, ndi "Lozap" - losartan potaziyamu. Komabe, mankhwalawa amachepetsa kupanikizika bwino monga Aprovel.

Opanga ndi mitengo

Mankhwalawa "Aprovel" amapangidwa ndi makampani opanga mankhwala aku France Sanofi winthrop industrie ndi Sanofi-Aventis. Ndikofunika kulongedza mankhwala ngati amenewo kuchokera pamapiritsi 14 a 150 mg m'chigawo cha 320-350 p. kutengera wopereka. Paketi yokhala ndi tsamba la 14. 300 mg pama pharmacies nthawi zambiri amafunsa pafupifupi 450 r.
Nthawi zina mankhwalawa amagulitsidwa m'matumba a 28 ma PC. Pankhaniyi, mtengo wake ndi 600 p. (mapiritsi a 150 mg) ndi 850 r. (300 mg).

Inde, odwala ambiri omwe ali ndi vuto la kuthamanga kwa magazi akufuna kudziwa ngati Aprovel ali ndi fanizo lililonse la ku Russia. Mwa zina zomwe tazifotokoza pamwambapa, Irsar yekha ndi amene amapangidwa m'dziko lathu. Zimapangidwa ndi kampani yaku Russia ya CanonFarma Production. Mankhwalawa ndi ofunika pafupifupi 100 p. kwa zidutswa 22 za 150 mg.

Mutha kudziwa kuti ndi makampani ati omwe amapanga mankhwala ena omwe atchulidwa patebulopo.
Awa ndi makampani omwe amatulutsa ma Aprovel. Zofananira za Russia, monga mukuwona, sizambiri. Zabwino kwambiri mwa izo ndi Irsar. Komabe, mtengo wamalo achilendo pachida ichi ndiwotsika kwambiri.

Malangizo apadera

Madokotala samapereka mankhwalawa kuti "Aprovel" kwa odwala, mwa zina, ndipo ngati mawonekedwe amagetsi amagetsi asokonekera. Musanagwiritse ntchito mankhwalawa, mavuto onsewa ayenera kuwongoleredwa pogwiritsa ntchito mankhwala ena.

Ngati mankhwalawa amathandizidwa ndi odwala omwe amalephera kupweteka aimpso, dokotala amayenera kuwunika nthawi zonse seramu ya creatine ndi potaziyamu m'magazi ake. Zomwezi zimagwiranso kwa anthu omwe ali ndi hyperkalemia.

Chithandizo cha odwala omwe ali ndi matenda a mtima kapena atherosclerosis ogwiritsa ntchito wothandizirawa kapena ma analogues ake amayenera kuchitika mosamala kwambiri pakayikidwa magazi.

Mankhwala "Aprovel": malangizo ogwiritsira ntchito

Mapiritsiwa amawerengedwa kwa odwala, nthawi zambiri amodzi nthawi imodzi (150 mg) patsiku. Ngati ndi kotheka, Mlingo ungathe kuwonjezeka mpaka 300 mg. Mochulukitsa, mankhwalawa samatchulidwa ngati osagwira ntchito. Ngati, ndi kuwonjezeka kwa mlingo mpaka 300 mg, kufunika kwake sikapezeka, wodwalayo amapatsidwa mankhwala ena kuchokera ku gulu la okodzetsa.

Odwala okhala ndi kuchepa mphamvu kwa thupi kapena hyponatremia nthawi zambiri amalembedwa osati 150 mg ya mankhwalawa, koma 75 mg. Komanso, odwala okalamba nthawi zambiri amathandizidwa ndi mankhwalawa.

Pharmacokinetics

Pambuyo pakukonzekera pakamwa, mankhwalawa amalowetsedwa m'matumbo ang'onoang'ono ndi 60-80% ya mlingo wotengedwa. Ikalowa m'magazi, chinthu chogwira ntchito chimamangiriza mapuloteni a plasma ndi 96% ndipo, chifukwa cha zovuta zomwe amapanga, chimagawidwa minofu yonse.

Zofunikira kwambiri pazakuchiritsira kwa Aprovel zimawonedwa patatha milungu isanu ndi umodzi ya kuyendetsedwa kwake.
Kulandila kwa Aprovel amalembedwa kwa nephropathy pamtundu wa matenda a shuga a 2, limodzi ndi matenda oopsa.
Mankhwala ali osavomerezeka lactose tsankho, lactase.
Komanso contraindication kutenga Aprovel kwambiri chiwindi kukanika.

The yogwira thunthu ukufika pazipita plasma ndende pambuyo 1.5-2 mawola.

Kutha kwa theka-moyo kumapangitsa maola 11-15. Osakwana 2% ya gawo lomwe limagwira mu mawonekedwe ake oyambirira limapukusidwa kudzera mu kwamikodzo.

Mlingo ndi makonzedwe

Mlingo woyambirira komanso wokonza ndi 150 mg kamodzi tsiku lililonse ndi chakudya kapena pamimba yopanda kanthu. Aprovel ® pa mlingo wa 150 mg kamodzi patsiku nthawi zambiri imawongolera kuthamanga kwa magazi kwa maola 24 kuposa mlingo wa 75 mg. Komabe, kumayambiriro kwa mankhwalawa, mlingo wa 75 mg ungagwiritsidwe ntchito, makamaka kwa odwala pa hemodialysis, kapena kwa odwala omwe ali ndi zaka zopitilira 75.

Kwa odwala omwe magazi awo samayendetsedwera mokwanira pa mlingo wa 150 mg kamodzi patsiku, mlingo wa Aprovel ® ukhoza kuwonjezeka mpaka 300 mg kamodzi patsiku, kapena mankhwala ena a antihypertensive angathe kuikidwa. Makamaka, zidawonetsedwa kuti kuwonjezera kwa okodzetsa, monga hydrochlorothiazide, ku mankhwalawa ndi Aprovel ® kumakhala ndizowonjezera.

Kwa odwala omwe ali ndi matenda oopsa komanso mtundu 2 shuga, mankhwalawa amayenera kuyamba ndi 150 mg ya irbesartan kamodzi patsiku, ndiye kuti abweretseni 300 mg kamodzi patsiku, yomwe ndi njira yabwino kwambiri yothandizira odwala pochiza matenda a impso.

Zotsatira zabwino za aprovel ® pa impso mwa odwala omwe ali ndi matenda oopsa komanso mtundu II matenda a shuga adawonetsedwa m'maphunziro pomwe irbesartan adagwiritsidwa ntchito ngati adjunct ndi mankhwala ena a antihypertensive, ngati pakufunika, kuti akwaniritse gawo lomwe likufunika la kuthamanga kwa magazi.

Kulephera kwina Kwa odwala omwe ali ndi vuto laimpso, kusintha kwa mankhwalawa sikofunikira.Kwa odwala pa hemodialysis, mlingo woyambira wotsika (75 mg) uyenera kugwiritsidwa ntchito.

Kuchepetsa mu BCC. Kuchepa kwamadzi / kuchuluka kwa magazi ndi / kapena kuchepa kwa sodium kuyenera kuwongoleredwa musanagwiritse ntchito Aprovel ®.

Kulephera kwa chiwindi. Kwa odwala omwe ali ndi kufatsa pang'ono kwa hepatic osakwanira, kusintha kwa mankhwalawa sikofunikira. Palibe zovuta zokhudzana ndi mankhwalawa pogwiritsa ntchito mankhwalawa odwala omwe ali ndi vuto lalikulu la chiwindi.

Odwala okalamba. Ngakhale chithandizo cha odwala opitirira zaka 75 chiyenera kuyamba ndi mlingo wa 75 mg, nthawi zambiri kusintha kwa mankhwalawa sikofunikira.

Gwiritsani ntchito ana. Irbesartan silivomerezeka kuti athandizire ana ndi achinyamata chifukwa chosakwanira chifukwa cha chitetezo chake.

Zotsatira zoyipa

Kusintha kovutikira kotsatidwa pansipa kumatsimikiziridwa motere: zofala kwambiri (³1 / 10), zofala ((1 / 100, 2% odwala kuposa omwe amalandira placebo.

Kuphwanya kwamanjenje. Chizungulire wamba.

Vuto la mtima Hypotension wamba.

Matenda a musculoskeletal, kusokonezeka kwa minofu yolumikizana ndi mafupa. Ululu wamba wamphongo.

Kafukufuku wa Laborator. Hyperkalemia imatha kupezeka mwa odwala matenda a shuga omwe amalandila irbesartan kuposa placebo. Odwala omwe ali ndi matenda a shuga oopsa, omwe anali ndi microalbuminuria komanso aimpso ntchito, hyperkalemia (³ 5.5 mEq / mol) amawonetsedwa mu 29.4% (zotsatira zoyipa kwambiri) za odwala omwe amalandira

300 mg ya irbesartan, ndipo mu 22% ya odwala omwe akulandira placebo. Odwala a shuga omwe ali ndi matenda oopsa, anali ndi vuto la impso ndi proteinuria yayikulu, hyperkalemia (³ 5.5 mEq / mol) adaonedwa mu 46.3% (zotsatira zoyipa kwambiri) za odwala omwe amalandila irbesartan komanso 26.3% ya odwala omwe amalandila placebo.

Kutsika kwa hemoglobin, komwe sikunali kofunika kwambiri m'mankhwala, kunawonedwa mu 1.7% (zotsatira zoyipa) za odwala oopsa komanso odwala matenda ashuga othamanga omwe amathandizidwa ndi irbesartan.

Zotsatira zowonjezera zotsatirazi zanenedwa nthawi yakufufuza pambuyo pakutsatsa. Popeza izi zimapezeka kuchokera ku mauthenga okhazikika, sizingatheke kudziwa kuchuluka kwa zomwe zimachitika.

Matenda a chitetezo chamthupi. Monga ndi ena angiotensin II olandilira okokana, hypersensitivity reaction, monga zotupa, urticaria, angioedema, sizinanenedwe kuti.

Kuphwanya kagayidwe kachakudya ndi mayamwidwe michere. Hyperkalemia

Kuphwanya kwamanjenje. Mutu.

Kumva kuwonongeka ndi zida zapamwamba. Tinnitus.

Matenda Am'mimba. Dysgeusia (kusintha kukoma).

Machitidwe a heepatobiliary. Hepatitis, chiwindi ntchito.

Matenda a musculoskeletal, kusokonezeka kwa minofu yolumikizana ndi mafupa. Arthralgia, myalgia (nthawi zina amagwirizana ndi kuchuluka kwa ma seramu CPK), kukokana kwa minofu.

Matenda aimpso ndi mkodzo dongosolo. Kuwonongeka kwa impso, kuphatikizapo kulephera kwa aimpso kwa odwala omwe ali pachiwopsezo chachikulu (onani "Makhalidwe Ogwiritsira Ntchito").

Pa khungu ndi subcutaneous minofu. Leukocytoclastic vasculitis.

Gwiritsani ntchito ana. Mu kafukufuku wosasankhidwa pamasabata atatu owona kawiri m'magulu a ana 318 ndi achinyamata azaka 6 mpaka 16 ndi matenda oopsa, zotsatirapo zoyipa zinaonedwa: mutu (7.9%), hypotension (2.2%), chizungulire (1.9%), chifuwa (0.9%). Munthawi yamaphunziro a sabata osatseguka a 26, kupatuka kuzizindikiro za labotale nthawi zambiri kumawonedwa: kuwonjezeka kwa creatinine (6.5%) komanso kuwonjezeka kwa CPK (SC) mu 2% ya ana omwe amalandila.

Bongo

Zochitika kugwiritsa ntchito mankhwalawa mankhwalawa achikulire mu Mlingo mpaka 900 mg pa tsiku kwa masabata 8 sizinawonetse kuchuluka kwa mankhwalawa. Kuwonetseredwa kwakukulu kwa bongo kungathe kufotokozedwa mu hypotension ndi tachycardia, bradycardia ikhoza kukhalanso chiwonetsero cha bongo. Palibe chidziwitso chokwanira pokhudzana ndi mankhwala osokoneza bongo a Aprovel ®. Odwala ayenera kuyang'aniridwa mosamala; chithandizo chikuyenera kukhala chazizindikiro komanso chothandizira. Zochita zomwe zaperekedwa ndi monga kusanza ndi / kapena kuphwanya kwam'mimba. Mankhwalawa bongo, kugwiritsa ntchito kaboni yokhazikika kungakhale kothandiza. Irbesartan samatulutsidwa panthawi ya hemodialysis.

Gwiritsani ntchito pa nthawi yoyembekezera kapena mkaka wa m'mawere

Kugwiritsa ntchito kwa mankhwalawa "Aprovel ®" kwatsutsana mu II ndi III trimesters ya mimba. Mu gawo lachiwiri komanso lachitatu la mimba, othandizira omwe amakhudza mwachindunji dongosolo la renin-angiotensin angayambitse kulephera kwa impso kapena wakhanda, hypoplasia ya chigaza cha fetal, ndipo ngakhale kufa.

Pofuna kusamala, osavomerezeka kugwiritsa ntchito munthawi yoyambirira ya mimba.

M'pofunika kusinthira ku njira ina yothandizira musanakhale ndi pakati. Ngati amayi apezeka kuti ali ndi pakati, a irbesartan ayenera kusiyidwa posachedwa komanso

onani momwe chigaza cha fetal ndi impso zimagwirira ntchito ndi ultrasound, ngati chithandizo chosagwiritsika ntchito chinatenga nthawi yayitali.

Kugwiritsa ntchito mankhwalawa "Aprovel ®" kumapangidwa panthawi yoyamwitsa. Sizikudziwika ngati irbesartan yachotsedwa mkaka wa m'mawere. Irbesartan amachotseredwa mkaka wa tchuthi pa mkaka wa mkaka.

Irbesartan adawerengeredwa pagulu la ana azaka za 6 mpaka 16, koma zomwe zikupezeka lero sizokwanira kuwonjezera ziwonetsero zake kuti zigwiritsidwe ntchito mwa ana mpaka idatha yowonjezera itapezeka.

Zolemba zogwiritsira ntchito

Kuchepetsa mu BCC.Zizindikiro zamitsempha yama hypotension, makamaka mutatenga koyamba mlingo, zimatha kupezeka kwa odwala omwe ali ndi BCC yochepa komanso / kapena otsika sodium chifukwa chodukitsa kwambiri mankhwala, zakudya zokhala ndi mchere wochepa, kutsegula m'mimba, kapena kusanza. Zizindikiro izi ziyenera kubwezeretsedwanso masiku onse musanagwiritse ntchito mankhwala "Aprovel ®".

Arterial Renovascular Hypertension.Mukamagwiritsa ntchito mankhwala omwe amakhudzanso renin-angiotensin-aldosterone, pamakhala ngozi yowonjezereka yoopsa kwambiri komanso kulephera kwaimpso kwa odwala omwe ali ndi vuto la impso. Ngakhale milandu ngati imeneyi sinachitike ndi kugwiritsa ntchito mankhwala a Aprovel ®, pogwiritsa ntchito angiotensin I receptor antagonists, zotsatira zofananira zitha kuyembekezeredwa.

Kulephera kwamkati ndi kupatsirana kwa impso.Mukamagwiritsa ntchito Aprovel ® pochiza odwala omwe ali ndi vuto la Impso, tikulimbikitsidwa kuwunika pafupipafupi kuchuluka kwa potaziyamu ndi creatinine mu seramu. Palibe zokuchitikirani ndi kugwiritsa ntchito Aprovel ® pochiza odwala omwe akuwonjezeka impso posachedwapa.

Odwala omwe ali ndi matenda oopsa, matenda a impso, ndi matenda a shuga II . Zotsatira za irbesartan pa impso ndi mtima ndi zina sizinali zofanana m'magulu onse omwe adawunikidwa pakupenda kwa odwala omwe ali ndi matenda ovuta a impso. Makamaka, zidapezeka kuti sizabwino kwa azimayi komanso omvera omwe siwoyera.

HyperkalemiaMonga mankhwala ena omwe amakhudza renin-angiotensin-aldosterone, hyperkalemia imatha kupezeka pakumwa mankhwala ndi Aprovel ®, makamaka pakakhala kulephera kwa impso, proteinuria yayikulu chifukwa cha matenda a shuga ndi / kapena kulephera kwa mtima. Kusamalitsa mosamala kwa seramu potaziyamu mozama mwa odwala omwe ali pachiwopsezo akulimbikitsidwa.

Lithium.Nthawi yomweyo, lithiamu ndi Aprovel ® sizikulimbikitsidwa.

Stenosis ya msempha ndi mitral valavu, hypertrophic cardiomyopathy.Monga vasodilators ena, ndikofunikira kugwiritsa ntchito mankhwalawa mosamala kwambiri odwala omwe ali ndi aortic kapena mitral valve stenosis, oletsa hypertrophic Cardiomyopathy.

Kuphatikiza kwakukulu kwa aldosteronism.Odwala omwe ali ndi aldosteronism oyamba nthawi zambiri samayankha mankhwalawa omwe amaletsa kukonzanso kwa renin-angiotensin. Chifukwa chake, kugwiritsa ntchito Aprovel ® pochizira odwala oterewa sikulimbikitsidwa.

Zambiri.Odwala omwe mtima wawo wamatsempha ndi aimpso ntchito zimadalira ntchito ya renin-angiotensin-aldosterone (mwachitsanzo, odwala omwe ali ndi vuto lalikulu la mtima kapena matenda a impso, kuphatikizapo aimpso artery stenosis), chithandizo ndi ACE inhibitors kapena angiotensin-II receptor antagonists, zomwe zimakhudza dongosololi zimagwirizanitsidwa ndi hypotension yacute, azotemia, oliguria, ndipo nthawi zina kulephera kwa impso. Monga china chilichonse cha antihypertensive wothandizira, kuchepa kwambiri kwa kuthamanga kwa magazi kwa odwala omwe ali ndi ischemic cardiopathy kapena ischemic mtima matenda angayambitse infarction ya myocardial kapena stroke. Monga zoletsa za angiotensin-akatembenuka enzyme, ma irbesartan ndi ena okana angiotensin mwachiwonekere sangakhale othandiza kuchepetsa kuthamanga kwa magazi mwa oyimira amtundu wakuda kuposa oyimira mafuko ena, mwina chifukwa chakuti malo okhala ndi renin otsika amapezeka kwambiri pakati pa odwala a mtundu wakuda omwe ali ndi matenda oopsa .

Amadzipaka kuti agwiritse ntchito mankhwalawa mankhwalawa odwala omwe ali ndi mavuto osowa mwabadwa - galactose tsankho, kuperewera kwa lappase kapena glucose-galactose malabsorption.

Kutha kukopa momwe zinthu zikuyendera mukamayendetsa magalimoto kapena njila zina

Zotsatira zakutha kuyendetsa galimoto ndikugwira ntchito yofunika chidwi sizinaphunzire. Ma pharmacokinetic katundu a irbesartan amawonetsa kuti ndizokayikitsa kuti zingayambitse izi.

Mukamayendetsa galimoto kapena pogwiritsira ntchito makina, ziyenera kukumbukiridwa kuti chizungulire komanso kutopa kumatha kuchitika pakumwa.

Kuyanjana ndi mankhwala ena ndi mitundu ina yoyanjana

Ma diuretics ndi othandizira ena othandizira. Othandizira ena a antihypertensive amatha kupititsa patsogolo zotsatira za irbesartan, ngakhale izi zili choncho, Aprovel ® yakhala ikugwiritsidwa ntchito mosamala ndi othandizira ena othandizira, monga beta-blockers, othana ndi calcium calcium blockers ndi thiazide diuretics. Chithandizo choyambirira ndi kuchuluka kwa okodzetsa kumatha kubweretsa vuto lakumadzi ndipo zimawonjezera chiopsezo cha hypotension kumayambiriro kwa chithandizo ndi Aprovel ®.

Potaziyamu zowonjezera komanso ma diuretics omwe amasunga potaziyamu. Zomwe zidapezeka ndikugwiritsa ntchito mankhwala ena omwe amakhudzanso renin-angiotensin-aldosterone dongosolo limawonetsa kuti kugwiritsa ntchito nthawi imodzi kwamankhwala othandizira omwe amasunga potaziyamu, zowonjezera zam potaziyamu, cholowa m'malo mwa potaziyamu, kapena mankhwala ena omwe angakulitse serum potaziyamu (i.e., heparin) akhoza kuwonjezera seramu potaziyamu. Chifukwa chake, sikulimbikitsidwa kugwiritsa ntchito nthawi yomweyo mankhwalawa ndi mankhwala "Aprovel ®".

Lithium. Kuwonjezeka kosasinthika kwa seramu lifiyumu ndende yake ndikuwopsa kwake kunawonedwa ndikugwiritsa ntchito munthawi yomweyo lifiyamu ndi ACE zoletsa. Nthawi zina, zotsatira zofananazi zimawonedwa ndi irbesartan. Chifukwa chake, kuphatikiza uku sikulimbikitsidwa. Ngati kuli kofunikira, kuwunikira mosamala kuchuluka kwa maamu a seramu ndikulimbikitsidwa.

Mankhwala osokoneza bongo oletsa kuponderezana. Pogwiritsa ntchito munthawi yomweyo mankhwala a angiotensin II omwe ali ndi mankhwala osagwiritsa ntchito mankhwala osokoneza bongo (mwachitsanzo, kusankha ma COX-2 zoletsa, acetylsalicylic acid (> 3 g patsiku) komanso osagwiritsa ntchito mankhwala osokoneza bongo omwe amaletsa kutupa (antihypertensive) amatha kufooka.

Monga ACE zoletsa, kugwiritsa ntchito munthawi yomweyo za angiotensin II antagonists ndi NSAIDs kungakulitse chiopsezo cha vuto laimpso, kuphatikiza mwayi wokhala ndi kulephera kwa impso, ndikuwonjezera kuchuluka kwa seramu potaziyamu, makamaka kwa odwala omwe ali ndi vuto laimpso. Kuphatikiza uku kuyenera kugwiritsidwa ntchito mosamala, makamaka odwala okalamba. Ndikofunikira kuchita machulukidwe amadzimadzi ndikuwunikira ntchito ya impso poyambira kuphatikiza mankhwalawa ndipo nthawi zina pambuyo pake.

Zambiri pazokhudzana ndi irbesartan. M'maphunziro azachipatala, hydrochlorothiazide sizinakhudze pharmacokinetics ya irbesartan. Irbesartan imapangidwa ndi CYP2C9 ndipo, pang'ono, mwa glucuronidation. Palibe zochitika zamtundu wa pharmacokinetic kapena pharmacodynamic zomwe zinagwiritsidwa ntchito ndi nthawi yomweyo ya irbesartan ndi warfarin, yomwe imapangidwira ndi CYP2C9. Zotsatira za CYP2C9 inducers, monga rifampicin, pa pharmacokinetics ya irbesartan sizinaphunzire. Mankhwala a digoxin osasinthika pomwe amagwiritsidwa ntchito ndi irbesartan.

Mankhwala

Mankhwala. Irbesartan ndi wamphamvu, wogwira pakamwa, kusankha angiotensin II receptor antagonist (mtundu wa AT 1). Amakhulupirira kuti imalepheretsa zotsatira zonse za thupi za angiotensin II zolumikizidwa kudzera mu 1 1 receptor, mosasamala za magwero kapena njira ya kapangidwe ka angiotensin II. Kusankha kosagwirizana ndi angiotensin II receptors (AT 1) kumabweretsa kuwonjezeka kwa kuchuluka kwa renin ndi angiotensin II m'madzi a plasma ndikuchepa kwa kuchuluka kwa aldosterone mu plasma. Ikagwiritsidwa ntchito pazovomerezeka, seramu potaziyamu sasintha kwambiri. Irbesartan sikuletsa ACE (kininase II) - puloteni yomwe imapanga angiotensin II, kuchepa kwa metabolism kwa bradykinin ndikupanga ma metabolites osagwira. Kuti awonetse mphamvu yake, irbesartan sikufuna kagayidwe kazinthu.

Mphamvu yamankhwala mu matenda oopsa. Irbesartan amachepetsa kuthamanga kwa magazi ndikusintha kocheperako kwamtima. Kutsika kwa kuthamanga kwa magazi mukamamwa kamodzi patsiku kumadalira mankhwalawa, mwanjira yofikira pagome pamiyeso yoposa 300 mg. Mlingo wa 150-300 mg pamene atengedwa kamodzi patsiku amachepetsa kuthamanga kwa magazi komwe kumayikidwa mu supine kapena kukhala kumapeto kwa chochitikacho (ndiye kuti, maora 24 mutatha kumwa mankhwalawa) mwa pafupifupi 8-13 / 5-8 mm RT. Art. (systolic / diastolic) kuposa placebo.

Kutsika kwakukulu kwa kuthamanga kwa magazi kumatheka ndi maola 3-6 mutatha kumwa mankhwalawa, antihypertensive effect imapitilira maola 24.

Maola 24 mutatenga Mlingo wovomerezeka, kuchepa kwa kuthamanga kwa magazi ndi 60-70% poyerekeza ndi kuchepetsedwa kwakukulu kwa diastolic ndi systolic magazi. Kumwa mankhwalawa muyezo wa 150 mg kamodzi patsiku kumapereka zotsatira (osachepera kuchitapo kanthu komanso maola 24), zofanana ndi zomwe zimapezeka pogawa tsiku ndi tsiku Mlingo iwiri.

Mphamvu ya antihypertensive ya mankhwalawa "Aprovel ®" imawonekera mkati mwa masabata 1-2, ndipo kutchulidwa kokwanira kumakwaniritsidwa masabata a 4-6 kuyambira pachiyambireni chithandizo. Mphamvu ya antihypertensive imapitirira ndi chithandizo cha nthawi yayitali. Pambuyo pakuleka kulandira chithandizo, kuthamanga kwa magazi pang'onopang'ono kumabwereranso ku mtengo wake woyambirira. Withrawal syndrome mu mawonekedwe a kuchuluka kwa matenda oopsa pambuyo kuchoka kwa mankhwalawa sichinawoneke.

Irbesartan ndi thiazide-mtundu diuretics amapereka zowonjezera zowonjezera.Kwa odwala omwe irbesartan yekha sanapereke zotsatira zomwe amafunikira, kugwiritsa ntchito nthawi yomweyo hydrochlorothiazide (12.5 mg) ndi irbesartan kamodzi patsiku kunapangitsa kuchepa kwa kuthamanga kwa magazi ndi osachepera 7-10 / 3-6 mm Hg. Art. (Systolic / diastolic) poyerekeza ndi placebo.

Kugwiritsa ntchito bwino kwa mankhwalawa "Aprovel ®" sikukutengera zaka kapena jenda. Odwala a mtundu wakuda omwe akudwala matenda oopsa amakhala ndi yankho lofooka kwambiri ku monotherapy yokhala ndi irbesartan, komanso mankhwala ena omwe amakhudza dongosolo la renin-angiotensin. Panthawi yomweyo kugwiritsa ntchito irbesartan ndi hydrochlorothiazide muyezo wotsika (mwachitsanzo, 12.5 mg patsiku), kuyankha kwa odwala amtundu wakuda kunafika pakuyankha kwa odwala amtundu woyerawo. Palibe kusintha kwakukulu pamankhwala a seramu uric acid kapena kwamikodzo ya uric acid.

Mu 318 ana ndi achinyamata a zaka zapakati pa 6 mpaka 16, anali ndi matenda oopsa kapena chiwopsezo chotenga chake (matenda ashuga, kupezeka kwa odwala oopsa m'mabanja), adaphunzira kuchepa kwa kuthamanga kwa magazi pambuyo pa kuperewera kwa mitsempha ya irbesartan - 0,5 mg / kg (otsika), 1 , 5 mg / kg (pafupifupi) ndi 4.5 mg / kg (mkulu) kwa masabata atatu. Pamapeto pa sabata lachitatu, kuchepa kwa magazi kwa systolic m'malo okhala (SATSP) kunatsika kuchoka pamlingo woyambira ndi 117 mm RT. Art. (Mlingo wotsika), 9.3 mmHg. Art. (Mlingo waukulu), 13.2 mmHg. Art. (Mlingo wapamwamba). Palibe kusiyana kwakukulu pakati pazotsatira za mankhwalawa. Kusintha kotanthauza kusinthika kwakukhalabe pansi kwa magazi a magazi a diastolic (DATSP) anali 3.8 mmHg. Art. (Mlingo wotsika), 3.2 mmHg. Art. (Mlingo waukulu), 5.6 mmHg. Art. (Mlingo wapamwamba). Pambuyo pa milungu iwiri, odwala adasinthidwanso mosintha kuti agwiritse ntchito mankhwala kapena placebo. Odwala

placebo idagwiritsidwa ntchito, SATSP ndi DATSP idakula ndi 2.4 ndi 2.0 mm Hg. Art., Ndi omwe adagwiritsa ntchito irbesartan mu Mlingo wosiyanasiyana, kusintha kofananira kunali 0.1 ndi -0.3 mm RT. Art.

Mphamvu yamankhwala odwala matenda oopsa, matenda a impso, ndi matenda a shuga II . Kafukufuku wa IDNT (irbesartan for diabetesic nephropathy) adawonetsa kuti irbesartan imachedwetsa kupitilira kwa kuwonongeka kwa impso kwa odwala omwe ali ndi vuto la aimpso kwambiri komanso proteinuria yayikulu.

IDNT inali yowonera kawiri, yowunikira yomwe ikufanizira kuchepa kwa thupi ndi kufa pakati pa odwala omwe adalandira chithandizo ndi Aprovel ®, amlodipine, ndi placebo. Adasankhidwa ndi odwala 1715 omwe ali ndi matenda oopsa ndipo amtundu wa II matenda ashuga, momwe mudali proteinuria ≥ 900 mg / tsiku ndi mulingo wa serum creatinine womwe uli pamtunda wa 1,3-3.0 mg / dl. Zotsatira zakutsogolo (pafupifupi zaka 2.6) zamankhwala zomwe zimagwiritsidwa ntchito ngati mankhwalawa "Aprovel ®" zidawerengedwa - zotsatira zakukula kwa matenda a impso komanso kufa kwathunthu. Odwala adalandira mlingo wa 75 mg mpaka 300 mg (mlingo wokonza) wa Aprovel ®, 2,5 mg mpaka 10 mg wa amlodipine kapena placebo, kutengera kulolerana. Pagulu lirilonse, odwala nthawi zambiri amalandira mankhwalawa a antihypertensive (mwachitsanzo, okodzetsa, opanga ma beta, alpha-blockers) kuti akwaniritse cholinga chomwe anakonzeratu - kuthamanga kwa magazi pamlingo wa 85 135/85 mm Hg. Art. kapena kuchepa kwa kuthamanga kwa systolic ndi 10 mm RT. Art., Ngati mulingo woyamba anali> 160 mm RT. Art. Mulingo wothamanga wamagazi unakwaniritsidwa kwa 60% ya odwala omwe ali mgululi la placebo, ndipo kwa 76% ndi 78% m'magulu omwe amalandila irbesartan ndi amlodipine, motsatana. Irbesartan amachepetsa kwambiri chiopsezo chokhala ndi gawo lalikulu, lomwe limaphatikizidwa ndi serum creatinine, matenda a impso, kapena kufa kwathunthu. Pafupifupi 33% ya odwala adakwanitsa kumapeto kwa gulu la irbesartan poyerekeza ndi 39% ndi 41% m'magulu a placebo ndi amlodipine; kutsika kwa 20% pangozi poyerekeza ndi placebo (p = 0.024) ndi kutsika kwa 23% chiopsezo poyerekeza ndi amlodipine (p = 0.006). Pamene magawo amodzi a malembawo adasanthula, zidapezeka kuti palibe chomwe chimapangitsa kufa kwathunthu, panthawi imodzimodzi, panali chidwi chofuna kuchepa milandu yomaliza ya matenda a impso komanso kuchepa kwakukulu kwa kuchuluka kwa milandu pobwereza seramu creatinine.

Kuunika kwa zotsatira zamankhwala kunachitika m'magulu osiyanasiyana, ogawidwa pamtundu wa jenda, mtundu, zaka, nthawi ya matenda ashuga, kuthamanga kwa magazi, serum creatinine ndende ndi kuchuluka kwa ma albumin. M'magulu azimayi ndi oyimira amtundu wakuda, omwe anali 32% ndi 26% ya anthu onse owerengera, motere, padalibe kusintha kwakukulu mu chikhalidwe cha impso, ngakhale kulimba mtima pakadapanda izi sikadapatula izi. Ngati tirikunena za gawo lachiwirilo - chochitika chamtima chomwe chatha (kuphedwa) kapena sichinathere (sichingachitike) imfa, ndiye kuti palibe kusiyana pakati pa magulu atatuwo pagulu lonselo, ngakhale kuti vuto la inffatal myocardial infarction (MI) linali lalikulu kwambiri mwa azimayi komanso ochepa mwa amuna ochokera ku gulu la irbesartan poyerekeza ndi gulu la placebo. Poyerekeza ndi gulu la amlodipine, kuchuluka kwa kuphwanya kwa mtima kosagwirizana ndi matenda osokoneza bongo kunali kwakukulu kwambiri mwa azimayi ochokera ku gulu la irbesartan, pomwe kuchuluka kwa milandu kuchipatala chifukwa cholephera kwamtima muanthu onse kunali kocheperako. Palibe chotsimikizika chotsimikizika chazotsatira zotere chidapezeka mwa akazi.

Kafukufuku "Zotsatira za irbesartan pa microalbuminuria mwa odwala omwe ali ndi mtundu II matenda a shuga komanso matenda oopsa" (IRMA 2) awonetsa kuti 300 mg irbesartan mwa odwala omwe ali ndi microalbuminuria amachepetsa kupita patsogolo ndikuwoneka ngati proteinuria. IRMA 2 ndi kafukufuku wowunika kawiri, wowongoleredwa ndi placebo yemwe amayesa kufa kwa odwala 590 omwe ali ndi mtundu II shuga mellitus wokhala ndi microalbuminuria (30-300 mg patsiku) ndi ntchito yachilendo ya impso (serum creatinine ≤ 1.5 mg / dL mwa amuna ndi 300 mg patsiku ndikuwonjezereka kwa SHEAS ndi 30% yokha yoyambira). Cholinga chokonzedweratu chinali kuthamanga kwa magazi pamlingo wa ≤135 / 85 mmHg. Art. Kuti muthandizire kukwaniritsa cholinga ichi

ngati kuli kotheka, othandizira owonjezera a antihypertensive adayambitsidwa (kupatula ACE inhibitors, angiotensin II receptor antagonists ndi calcium njira dihydropyridine blockers). M'magulu onse azithandizo, kuchuluka kwa kuthamanga kwa magazi komwe odwala amakumana kunali kofanana, koma mgululi limalandira 300 mg ya irbesartan, maphunziro ochepa (5.2%) kuposa omwe amalandira placebo (14.9%) kapena 150 mg ya irbesartan patsiku (9.7%), adafika pamapeto - proteinuria yowonekera. Izi zikuwonetsa kuchepa kwama 70% pachiwopsezo chochepa pambuyo pa mlingo waukulu poyerekeza ndi placebo (p = 0.0004). Kuchulukana munthawi yomweyo kwamisala yocheperako (GFR) m'miyezi itatu yoyambirira ya chithandizo sikunachitike. Kuchepetsa pang'onopang'ono maonekedwe a proteinuria otchulidwa bwino kunadziwika pambuyo pa miyezi itatu, ndipo izi zinatha ndi sitima yapamtunda wazaka ziwiri. Kukakamira ku normoalbuminuria (

Basic zida zachilengedwe

Mapiritsi 75 mg : mapiritsi oyera oyera kapena oyera ngati biconvex okhala ndi cholembedwa pamtima mbali imodzi ndi manambala “2771” mbali inayo

Mapiritsi a 150 mg : mapiritsi oyera oyera kapena oyera ngati biconvex okhala ndi cholembedwa pamtima mbali imodzi ndi manambala “2772” mbali inayo

300 mg mapiritsi : mapiritsi oyera oyera kapena oyera ngati biconvex okhala ndi cholembedwa pamtima mbali imodzi ndi manambala “2773” mbali inayo

Zotsatira zoyipa za mankhwalawa

Nayi malangizo ngati agwiritsidwe ntchito pokonzekera Aprovel. Ma analogi ake amatengedwa chimodzimodzi. Mankhwalawa alibe mphamvu iliyonse pa ntchito zamtima. Komabe, amayenera kukhala oledzera, kumene, amangoyang'aniridwa ndi adokotala. Nthawi zina, mankhwalawa amakhala ndi zovuta zina mthupi la wodwalayo. Mwachitsanzo, kupanikizika kwa wodwala kumatha kutsika kwambiri. Potere, wodwalayo azitha kuona ngati:

kufooka
kusanza ndi kusanza.

Kuphatikiza apo, kugwiritsa ntchito mankhwalawa mosasamala kungayambitse mavuto akulu monga chiwindi ntchito (kuphatikizapo hepatitis) kapena mavuto a impso.

Chizungulire chaching'ono ndizomwe zingachitike kwa wodwala pogwiritsa ntchito Aprovel. Analogue (pafupifupi iliyonse) nthawi zambiri imayambitsa zotsatira zomwezo. Chifukwa chake, munthawi ya chithandizo ndikugwiritsa ntchito ndalama zotere, muyenera kusamala kwambiri mukamayendetsa galimoto komanso mukamagwira ntchito yomwe imafuna chidwi chochulukirapo.

Ndi chisamaliro

Chenjezo tikulimbikitsidwa otsatirawa:

• stenosis ya msempha kapena mitral valavu, mafupa aimpso,
• kupatsidwa impso
• CHD (matenda a mtima)
• ndi kulephera kwa aimpso, ndikofunikira kuwongolera kuchuluka kwa potaziyamu ndi creatinine m'magazi,
• matenda amiseche,
• Zakudya zopanda mchere, limodzi ndi matenda am'mimba, kusanza,
• cardiomyopathy
• Hypovolemia, kusowa kwa sodium pazoyambira zamankhwala osokoneza bongo okodzetsa.

Ndikofunikira kuyang'anira mkhalidwe wa odwala pa hemodialysis.

Momwe mungatenge Aprovel

Mankhwala adapangira pakamwa. Nthawi yomweyo, kuthamanga ndi mphamvu ya mayamwidwe m'matumbo ang'onoang'ono ndizoyima pawokha pakudya. Mapiritsi ayenera kuledzera kwathunthu osafuna kutafuna. Mlingo wokhazikika pamlingo woyamba wa chithandizo ndi 150 mg patsiku. Odwala omwe matenda awo oopsa amafuna mankhwala owonjezera a antihypertensive amalandira 300 mg patsiku.

Ndi kuchepa kosakwanira kwa kuthamanga kwa magazi, kuphatikiza chithandizo ndi Aprovel, beta-blockers, othandizira a calcium ion amagwiritsidwa ntchito kuti akwaniritse zomwe akufuna.

Mapiritsi a Aprovel ayenera kukhala oledzera kwathunthu osafuna kutafuna.
Ndikofunika kukumbukira kuti mlingo ndi nthawi ya mankhwalawa imakhazikitsidwa ndi katswiri wazachipatala.
Mukatenga Aprovel mwa odwala matenda a shuga, chiopsezo chokhala ndi hyperkalemia chikuwonjezeka.

Ndikofunika kukumbukira kuti mulingo ndi nthawi yayitali ya mankhwalawa imakhazikitsidwa ndi katswiri wazachipatala pokhapokha pa zomwe wodwalayo akuchita, kuchuluka kwa ma data ndi kuwunika kwa thupi.

Kumwa mankhwala a shuga

Kulandila kwa matenda a shuga 1 kuyenera kukambidwa ndi dokotala, yemwe angaletse Aprovel kapena asinthe mlingo wa tsiku ndi tsiku. Mtundu 2 wa shuga wosadalira insulini, mulingo woyenera ndi 300 mg patsiku kamodzi.

Odwala omwe ali ndi matenda ashuga ali ndi chiopsezo chowonjezereka cha hyperkalemia.

Zotsatira zoyipa za Aprovel

Chitetezo cha mankhwalawo chidatsimikiziridwa m'mayesero azachipatala omwe odwala 5,000 adatenga nawo gawo. Othandizira 1300 adadwala matenda othamanga magazi ndipo adamwa mankhwalawa kwa miyezi 6. Kwa odwala 400, kutalika kwa mankhwalawa kunatha chaka. Zotsatira zoyipa sizidalira kuchuluka kwa odwala, jenda komanso msinkhu wa wodwala.

Mawonetsero osagwirizana ndi kugwiritsa ntchito mankhwalawa m'njira zam'mimba ndizotheka.
Monga zoyipa za Aprovel, kutentha kwa kutentha nkotheka.
Kuchokera ku chiwindi ndi njira yothandizira, chiwindi chimatha.

Phunziro lolamulidwa ndi placebo, odzipereka a 1965 adalandira chithandizo cha irbesartan kwa miyezi 1-3. Mu 3.5% ya milandu, odwala adakakamizidwa kusiya chithandizo cha Aprovel chifukwa cha magawo ena a labotale yoyipa. 4.5% anakana kutenga placebo, chifukwa sanamve kusintha.

Matumbo

Mawonekedwe olakwika m'mimba yamagaya amatulutsidwa ngati:

• kutsegula m'mimba, kudzimbidwa, kugonja,
• kusanza, kusanza,
• kukulitsa ntchito ya aminotransferases mu hepatocytes,
• dyspepsia
• kutentha kwa mtima.

Kuchokera kumbali ya chiwindi ndi matenda amanjenje, hepatitis imatha, kuwonjezeka kwa plasma ndende ya bilirubin, komwe kumabweretsa cholestatic jaundice.

Kuchokera ku kupuma

Zotsatira zoyipa zokha za kupuma kwamphamvu ndi kutsokomola.

Zotsatira zoyipa zokha za kupuma kwamphamvu ndi kutsokomola.
Odwala omwe ali pachiwopsezo chotenga kulephera kwa impso, vuto la impso limatha kukula.
Mwa mawonetsedwe amomwe thupi limagwirira, edema ya Quincke imasiyanitsidwa.

Kuchokera pamtima

Orthostatic hypotension nthawi zambiri imawonetsedwa.

Zina mwazomwe zimawonekera ndizomwe zimachitikira:

• Edincke's edema,
• anaphylactic shock,
• zotupa, kuyabwa, buluzi,
• urticaria
• angioedema.

Odwala omwe amakonda anaphylactic anachita amafunikira kuyesedwa. Ngati zotsatirapo zake zili zabwino, mankhwalawo ayenera kusinthidwa.

Zokhudza mphamvu pakuwongolera njira

Mankhwala samakhudza mwachindunji ntchito zamunthu. Nthawi yomweyo, zotsatira zoyipa zimatha kukhala pakati pa dongosolo lamkati komanso lamkati, chifukwa chake amalimbikitsidwa kukana kuyendetsa galimoto, kugwira ntchito ndi njira zovuta, komanso zochitika zina zomwe zimafuna kuyankhidwa mwachangu komanso kuzama panthawi yamankhwala.

Ndikulimbikitsidwa panthawi yamankhwala kuti musamayendetse.
Odwala omwe amagwira ntchito molakwika a mtima ali ndi chiopsezo chotukuka cha matenda oopsa.
Ndi kuchepa kwamphamvu kwa kuthamanga kwa magazi motsutsana ndi ischemia, kulowetsedwa kwa myocardial kumatha kuchitika.

Gwiritsani ntchito pa nthawi yoyembekezera komanso mkaka wa m`mawere

Mankhwalawa amaletsedwa kugwiritsidwa ntchito panthawi ya bere. Monga mankhwala ena omwe amakhudza dongosolo la renin-angiotensin-aldosterone, irbesartan imalowa mwaulere chotchingira. Gawo lolimbikira limatha kukhudza chitukuko cha intrauterine panthawi iliyonse ya bere. Pankhaniyi, irbesartan amachotseredwa mkaka wa m'mawere, chifukwa chake kuyenera kuyimitsidwa mkaka.

Kugwiritsa ntchito kwa vuto la chiwindi

Ngati vuto la hepatocyte layamba, mankhwalawa ali osavomerezeka.

2% yokha ya mankhwalawa imachoka m'thupi kudzera mu impso, chifukwa anthu omwe ali ndi matenda a impso safunika kuchepetsa mlingo.

Kuchita ndi mankhwala ena

Ndi munthawi yomweyo kugwiritsa ntchito Aprovel ndi mankhwala ena, zotsatirazi zimawonedwa:

1. Synergism (kukulitsa njira zochiritsira zomwe zimagwiritsidwa ntchito ndi mankhwalawa) kuphatikiza mankhwala a antihypertensive, calcium njira inhibitors, thiazide diuretics, beta-adrenergic blockers.
2. Serum potaziyamu ndende m'magazi amadzuka ndi heparin komanso mankhwala okhala ndi potaziyamu.
3. Irbesartan imachulukitsa kuwopsa kwa lithiamu.
4. Kuphatikiza ndi mankhwala omwe si a antiidal a antiidal.

Pali chiwopsezo chowonjezera cha Aprovel kuphatikiza ndi mankhwala a antihypertensive, calcium Channel inhibitors, ndi thiazide diuretics.
Ndi munthawi yomweyo makonzedwe a Aprovel ndi Heparin, seramu ndende ya potaziyamu m'magazi imakwera.
Gawo lazogwiritsa ntchito la Aprovel silikhudza zochizira za Digoxin.

Gawo lazogwiritsa ntchito la Aprovel silikhudza zochizira za Digoxin.

Kuyenderana ndi mowa

Wothandizila antihypertgency ndi oletsedwa kutengedwa nthawi yomweyo ndi zinthu zakumwa zoledzeretsa.Mowa wa Ethyl umatha kuyambitsa maselo ofiira am'magazi, kuphatikiza komwe kumatha kubisa lumen ya chotengera. Kutuluka kwa magazi kumakhala kovuta, komwe kumayambitsa kuchuluka kwa mtima komanso kuchuluka kwa mavuto. Potengera maziko a mankhwala, izi zimapangitsa kugwa kwamitsempha.

Mwa zina zomwe zimafananizira, zomwe zimapangidwa potengera irbesartan, pali mankhwala onse opangidwa ku Russia ndi akunja. Mutha kusintha mapiritsi a Aprovel ndi awa:

Ndikofunika kukumbukira kuti musanasinthane ndi mankhwala atsopano ndikofunikira kufunsa dokotala. Kudzilowetsa ndekha koletsedwa.

Wothandizila antihypertgency ndi oletsedwa kutengedwa nthawi yomweyo ndi zinthu zakumwa zoledzeretsa.
Mutha kusintha magome a Aprovel ndi Irbesartan.
Mankhwala amagulitsidwa ndi mankhwala.

Omvera zamtima

Olga Zhikhareva, katswiri wamtima, Samara

Njira yothandiza yochepetsera kuthamanga kwa magazi. Ndimagwiritsa ntchito kuchipatala monga monotherapy kapena chithandizo chovuta. Sindinawone chizolowezi. Odwala samalimbikitsa kuti atenge nthawi yopitilira 1 patsiku.

Antonina Ukravechinko, katswiri wa zamtima, Ryazan

Ubwino wa ndalama, koma ndikulimbikitsa kuchenjeza kwa iwo omwe ali ndi mitral kapena aortic valve stenosis. Ana ndi amayi oyembekezera saloledwa kumwa mapiritsi a Aprovel. Mwa zina zoyipa, matupi awo sagwirizana. Nthawi yomweyo, ngakhale panali zovuta zina mthupi, mankhwalawa adathandizira kuchepetsa kuthamanga kwa magazi.

Ngati mankhwalawa azachipatala atayamba kuonekera, ndiye kuti muyenera kupita kuchipatala.

Cairo Airam, wazaka 24, Kazan

Ndili ndi matenda oopsa oopsa. M'mawa limadzuka mpaka 160/100 mm Hg. Art. Anamwa mankhwala ambiri kutsitsa magazi, koma mapiritsi a Aprovel okha ndi omwe adathandiza. Pambuyo pakugwiritsa ntchito, nthawi yomweyo imakhala yosavuta kupuma, mkokomo wamagazi m'makachisi umadutsa. Chachikulu ndichakuti zotsatira pambuyo posiya mankhwala zimapitirira kwa nthawi yayitali. Muyenera kumwa maphunziro komanso kuyendera dokotala wanu pafupipafupi. Sindinazindikire mavuto aliwonse.

Anastasia Zolotnik, wazaka 57, Moscow

Mankhwalawa sanakwane ndi thupi langa. Pambuyo mapiritsi, zotupa, kutupa ndi kuyabwa kwambiri. Ndinayesa kuyanjanitsa kwa sabata limodzi, chifukwa kupanikizika kunachepa, koma ziwengo sizinathe. Ndinafunika kupita kwa dokotala kuti ndikasankhe mankhwala ena. Ndinkakonda kuti matenda obwera nawo sanatuluke, mosiyana ndi njira zina zochepetsera kuthamanga kwa magazi.

Ndi malamulo ati omwe amayenera kuwonetsedwa ndi wodwalayo

Mukamamwa mankhwalawa "Aprovel", ma fanizo ndi matchulidwe omwe ali ambiri, wodwalayo amayenera kupita kwa dokotala wokhazikika. Palibe chifukwa chomwe mungasinthire mlingo popanda kufunsa dokotala. Kusintha mankhwalawa ndi wina popanda kufunsa katswiri ndizachidziwikire, ndizoletsedwa.

Ndikofunika kuti mutenge mapiritsi a Aprovel nthawi yomweyo. Inde, simuyenera kumwa mankhwalawa ngati atha ntchito kapena ngati adasungidwa molakwika.

Mutha kumwa mapiritsi onsewa musanadye kapena pambuyo pake. Kukhalapo kapena kusapezeka kwa chakudya m'mimba kwenikweni sizikhudza mayendedwe awo m'magazi.

Mawonekedwe akugwiritsidwa ntchito mmalo

Ma fanizo a mankhwalawa, omwe timawaganizira pamwambapa, omwe amapangidwa pamaziko a chinthu chomwecho, ali ndi malangizo ofananawo kuti agwiritse ntchito. Koma ena a iwo amafunika kuti aledzere komabe mosiyana pang'ono kuposa Aprovel. Analogue ya mankhwalawa, Converium, mwachitsanzo, amalimbikitsidwa kumwa m'mawa asanadye.

Zachidziwikire, ali ndi malangizo osiyanasiyana oti agwiritse ntchito komanso m'malo mwa mankhwalawa "Lozap" ndi "Valz" ndi chinthu china chogwira ntchito. Pakati tsiku lililonse oyamba ndi 50 mg patsiku. Odwala omwe ali ndi vuto lalikulu la mtima, mankhwalawa nthawi zambiri amapatsidwa mankhwala osaposa 12 mg pa tsiku. Valz nthawi zambiri imatengedwa pa 80 mg patsiku.

Kulephera kwa mtima kosatha, mlingo uwu umachepetsedwa mpaka 40 mg patsiku.

Zomwe zinali zoyenera kuwerengera zamankhwala

Odwala, monga madokotala, nthawi zambiri amatamanda Aprovel. Ndemanga (mayendedwe ake nthawi zambiri sagwira ntchito bwino kwambiri) kuchokera kwa odwala, adapeza zabwino kwambiri. Mwachitsanzo, odwala ambiri amakhulupirira kuti ali ndi zovuta zochepa kuposa mankhwala a Lozap ndi Valz. Pogwiritsa ntchito chida ichi, odwala ambiri adakwanitsa kubwereza kumatha sabata imodzi.

Malamulo osungira mankhwala

Chifukwa chake, tazindikira zomwe kukonzekera kwa "Aprovel" kumaimira (malangizo ogwiritsira ntchito, ndemanga, analogues). Mankhwalawa, monga mukuwonera, ndiabwino kwambiri. Komabe, imagwira ntchito bwino, pokhapokha ngati itasungidwa bwino.

Sungani paketi ndi izi pokhapokha pouma. Nthawi yomweyo, kutentha m'chipindacho sikuyenera kupitirira 30 C. Inde, mapiritsi amayenera kusungidwa kuti ana asawafikire.

Wopanga

Udindo wofunikira kwa ambiri posankha mankhwala amasewera ndi wopanga. Aprovel amapangidwa ndi kampani yaku France ya Sanofi. Nkhani ya Sanofi idayamba mu 1973, pomwe idaganizidwa kuti ipange mankhwala osokoneza bongo pamaziko a kampani yopanga mafuta. Pambuyo pazaka 10, malonda adayamba kugulitsa m'misika ya United States ndi Japan.

Sanofi tsopano amatulutsa katemera, mankhwala a shuga, ndi mankhwala othandizira matenda amtima. Aprovel zida ziwiri - 150 ndi 300 mg.

Pali maofesi oyimirira pafupifupi zana omwe ali m'maiko osiyanasiyana. Mmodzi wa iwo ali ku Moscow. Adilesi yotumiza madandaulo ndi zofuna zikuwonetsedwa muzomwe mungagwiritse ntchito.

Kodi limayikidwa kuti?

Zizindikiro zotsatirazi zamankhwala othandizira zimasiyanitsidwa:

• chachikulu matenda oopsa,
• yachiwiri matenda oopsa,
• nephropathy.

Malinga ndi malangizo ogwiritsira ntchito, mankhwalawa Aprovel amagwira bwino kwambiri ku matenda ochepa owopsa. Matendawa amadziwika ndi kuwonjezeka kosasunthika kwa kupanikizika kwa 140-90 mm Hg. Art. Zoyambitsa zosiyanasiyana zimalumikizidwa ndi chitukuko chake, chosagwirizana ndi mawonekedwe awonetsero wina. Matenda oopsa oopsa amawononga mitsempha ya mtima, mtima ndi impso. Amalembetsedwa ndi anthu 9 miliyoni padziko lonse lapansi.

Mosiyana ndi mawonekedwe oyamba, matenda oopsa achiwonetsero ndi zotsatira za matenda ena a thupi. Kuti muchotse matendawa, gawo lofunikira limaseweredwa ndikukhazikitsa chifukwa chenicheni chomwe chinayambitsa kuyambika kwa matenda oopsa. Aprovel imagwiritsidwa ntchito mwachangu mu fomu yachiwiri, yomwe imayikidwa mu malangizo ogwiritsa ntchito.

Nephropathy imaphatikizidwanso mndandanda wazowonetsa. Matendawa amayambitsa matenda aimpso chifukwa cha kuwonongeka kwa zida zamagetsi komanso magwiridwe antchito a epithelial cell of the organ.

Kutenga?

Zochiritsira zam'mapiritsi a Aprovel ndizosavuta komanso ndizomveka kwa wodwala. Kuti mukwaniritse zotsatira zokhazikika, kudya kamodzi kokwanira tsiku lililonse ndikokwanira. Malangizo ogwiritsira ntchito amadziwitsa kuti mankhwalawa samayimitsidwa pakudya. Piritsi imatha kuledzera mutatha kudya. Mankhwala ayenera kutsukidwa ndi madzi okwanira.

Kuchuluka kwa mankhwalawa kumatengera kuzindikira kwake. Madokotala amalangiza kuyambira ndi 150 mg patsiku, mwapadera ndizotheka kuwonjezera kuchuluka ndi kutenga 300 mg ya Aprovel. Malangizo ogwiritsira ntchito kuti adziwe kuchuluka kwa kuchuluka kwa tsiku lililonse.

Nthawi zina ndi ochepa matenda oopsa, wodwalayo amapatsidwa mankhwala othandizira, monga momwe amafotokozera malangizo. Kuphatikiza pa mapiritsi a Aprovel, okodzetsa amawonjezeranso mankhwala. Izi ndi zida zomwe zimathandizira kuthamangitsa kuzimitsidwa kwa madzi m'thupi. Amathandizira kukulitsa lumen ya mitsempha yamagazi, chifukwa, kutsitsa magazi.

Tebulo 2. Mulingo woyenera wa magulu aanthu odwala.

Ndemanga za odwala omwe amamwa mankhwalawa

Malingaliro a anthu amagawanika. Pali ndemanga zabwino komanso zoipa. Aprovel amayamikiridwa chifukwa:

• ntchito yayikulu
• kuchitapo kanthu mwachangu (pambuyo pa mphindi 15-30),
• kuthekera kogula mosavuta ku malo ogulitsa mankhwala kumachitika ponseponse,
• limodzi mlingo
• kusowa kwa zolaula.

Komabe, palinso zovuta. Mwachitsanzo, mankhwalawa ali ndi mtengo wokwera kwambiri. Pali zida zina zotsika mtengo. Aprovel amasiyanitsidwa ndi mndandanda wochititsa chidwi wa malangizo apadera, chithandizocho chimatha kuyambitsa kukulitsa zovuta.

Kutengera ndi irbesartan, mankhwala otsatirawa alipo omwe atha kubwezeretsa Aprovel:

1. Irsar. Mtengo wa Irsar ndi wocheperapo ndi 2,5 kuposa mnzake waku France. Ndi block receptor blocker yomwe ili ndi magawo angapo owonjezera.
2. Irbesartan. Mankhwala aku Spain, omwe amadziwikanso chifukwa cha kusokonezeka kwamitsempha yamanzere ndi kulephera kwa mtima mwa mawonekedwe osakhazikika.
3. Irbesartan Canon (Russia).