Momwe mungagwiritsire ntchito mankhwala a Telsartan N?

Kufotokozera za mtundu wa kipimo

Mapiritsi 12.5 mg + 40 mg. Oval, biconvex, awiri-wosanjikiza, wosanjikiza umodzi kuchokera ku pinki wopepuka kupita pinki, wina wosanjika kuchokera oyera mpaka pafupi oyera ndi pinki wolowererapo. Pamiyeso yoyera ya mapiritsi pali chiopsezo ndipo muli ndi "T" ndi "1" pambali yake.

Mapiritsi 12.5 mg + 80 mg. Oval, biconvex, awiri-wosanjikiza, wosanjikiza umodzi kuchokera ku pinki wopepuka kupita pinki, wina wosanjika kuchokera oyera mpaka pafupi oyera ndi pinki wolowererapo. Pamiyeso yoyera ya mapiritsi pali chiopsezo ndipo chokhala ndi "T" ndi "2" pambali pake.

Mlingo

Zoyambira zathupi komanso mankhwala:

mapiritsi kuyambira oyera mpaka oyera, opanda chipolopolo, chopangidwa ndi kapisozi, okhala ndi matepi "T" ndi "L" mbali zonse za cholakwika mbali imodzi ndikulemba "40" (mapiritsi a 40 mg) kapena chosonyezera "80" ( mapiritsi a 80 mg) mbali inayo.

Contraindication

Hypersensitivity (kuphatikizapo mankhwala ena a sulfonamide, cholestasis, kufooka kwambiri kwa chiwindi, kulephera kwambiri kwaimpso (CC zosakwana 30 ml / min), hypokalemia, hyponatremia, hypercalcemia, cholowa cholowa m'malo mwake, zaka mpaka 18 (Kuchita bwino komanso chitetezo sizinakhazikitsidwe) C Chenjezo: Kulephera kwa chiwindi kapena matenda apafupipafupi a chiwindi (chiwopsezo cha hepatic chikomokere chifukwa cha kusokonezeka kwa elekitirodi), kupindika kwa impso Mitsempha yamitsempha kapena stenosis ya mtsempha wama impso, kulephera kwa impso, kuchepa kwa bc (chithandizo cham'mbuyomu), kudya ndi kutsekeka kwa mchere, kutsekula m'mimba kapena kusanza), kulephera kwa mtima, msempha kapena mitral stenosis, CHD, SLE gout.

Momwe mungagwiritsire ntchito: Mlingo ndi njira ya chithandizo

Mkati, ngakhale kudya zakudya, 1 nthawi patsiku.

Mapiritsi okhala ndi telmisartan / hydrochlorothiazide 40 / 12,5 mg ndi 80 / 12,5 mg angalembedwe kwa odwala omwe kugwiritsa ntchito telmisartan pa mlingo wa 40 kapena mg kapena hydrochlorothiazide pa mlingo wa 12,5 mg sikuti kumayambitsa kuthamanga kwa magazi.

Mlingo kusintha kwa aimpso kulephera kwambiri pang'ono, komanso okalamba odwala, sikufunika.

Ndi matenda a chiwindi osakhazikika kwenikweni kukula kwake, mlingo sayenera kupitirira 40 / 12,5 mg patsiku.

Zotsatira za pharmacological

Telmisartan ndi wotsutsa winawake wa angiotensin II receptors (mtundu wa AT1). Kuyika angiotensin II kulumikizana ndi cholandilira, osakhala ndi zochita za agonist mokhudzana ndi cholandilira ichi. Zimapanga ubale wokhalitsa pokhapokha ndi AT1 subtype ya angiotensin II receptors. Ilibe chiyanjano ndi ma receptor ena, kuphatikiza ndi AT2 receptor ndi ena, omwe sanaphunzire angiotensin receptors. Telmisartan imabweretsa kuchepa kwa kuchuluka kwa aldosterone m'madzi a m'magazi. Sichikukhudzana ndi ntchito ya plasma renin ndi njira za ion, ACE, sizikuyambitsa bradykinin.

Pa mlingo wa 80 mg, chiwopsezo cha angiotensin II chitha. Mphamvu ya mankhwalawa imatha maola opitilira 24, kuphatikiza maola 4 omaliza musanamwe mlingo wotsatira. Kuyamba kwa hypotensive kanthu kumadziwika mkati mwa maola atatu mutatha kumwa koyamba. Kutsika kwakukulu kwa kuthamanga kwa magazi nthawi zambiri kumawonedwa pakatha milungu 4 chiyambireni chithandizo.

Ndi matenda oopsa kwambiri, amachepetsa kuthamanga kwa magazi kwa systolic ndi diastolic, osakhudza kugunda kwa mtima. Pankhani yakuchotsedwa kwadzidzidzi kwa telmisartan, kuthamanga kwa magazi pang'onopang'ono kumabwereranso ku gawo lake loyambirira popanda chitukuko cha "kusiya" matenda.

Hydrochlorothiazide ndi thiazide okodzetsa. Sichikukhudzanso kukonzanso kwa ma elekitiroma mu reum tubules, kuwonjezera mwachindunji kutuluka kwa Na + ndi Cl- (pafupifupi zofanana). Mphamvu ya diuretic imabweretsa kuchepa kwa bcc, kuwonjezeka kwa ntchito ya plasma renin, kuwonjezeka kwa katulutsidwe ka aldosterone ndipo kumayendetsedwa ndi kuwonjezeka kwa zomwe zili K + ndi ma bicarbonates mkodzo, komanso hypokalemia. Ndi makonzedwe apakati a telmisartan, kuchepa kwa kutayika kwa K + komwe kumayambira ndi hydrochlorothiazide kumadziwika, mwina chifukwa chakutseka kwa dongosolo la renin-angiotensin-aldosterone. Pambuyo potenga hydrochlorothiazide, diuresis imakulirakulira pambuyo pa maola awiri, mphamvu kwambiri imawonedwa pambuyo pafupifupi maola 4. Mphamvu yotsekemera imapitilira pafupifupi maola 6-12.

Mulingo wambiri wa antihypertensive wa mankhwalawa nthawi zambiri umakwaniritsidwa masabata 4 atayamba chithandizo.

Zotsatira zoyipa

Kuchokera pamachitidwe opuma: matenda apamwamba a kupuma thirakiti (kuphatikizapo bronchitis, pharyngitis, sinusitis), kupuma movutikira, dyspnea, kupuma kwa vuto la kupuma (kuphatikizapo chibayo ndi edema ya m'mapapo).

Kuchokera ku CCC: bradycardia, tachycardia, arrhythmia, chizindikiro cha kuchepa kwa magazi, orthostatic hypotension, necrotic angiitis (vasculitis), kupweteka pachifuwa.

Kuchokera kumbali ya chapakati mantha dongosolo: kuchuluka irritability, mantha, nkhawa, chizungulire, kukomoka, tulo, kusakhazikika poyenda, paresthesia.

Kuchokera pamimba: kupweteka kwam'mimba, kutsegula m'mimba, kusowa kwa magazi, gastitis, matenda a anorexia, kusowa kwa chilimbikitso, sialadenitis, pakamwa pouma, kugona, kusefukira, kudzimbidwa, kapamba, jaundice (hepatocellular kapena cholestatic).

Kuchokera ku dongosolo la endocrine: hyperglycemia, glucosuria, kulolerana kwa shuga.

Kuchokera kumbali ya kagayidwe: hypercholesterolemia, hyperuricemia, hypokalemia, hyponatremia, yafupika BCC, kusokonekera kwa electrolyte metabolism, hypercalcemia.

Kuchokera ku ziwalo za hemopoietic: eosinophilia, aplasic anemia, hemolytic anemia, myelodepression, leukopenia, neutropenia / agranulocytosis, thrombocytopenia.

Kuchokera kwamikodzo dongosolo: matenda a kwamikodzo dongosolo, interstitial nephritis, matenda aimpso.

Kuchokera kwamankhwala am'mimba: arthralgia, arthrosis, kupweteka kwa m'mbuyo, kupweteka m'miyendo, myalgia, kupindika kwa minofu ya ng'ombe (crumpi), zizindikiro ngati tendonitis, kufooka kwa minofu, kuphipha kwa minofu.

Thupi lawo siligwirizana: anaphylactic zimachitika, chikanga, erythema, kuyabwa khungu, lupus-ngati khungu zimachitika, khungu vasculitis, photosensitivity, zotupa pa khungu, SLE exacerbation, poyizoni epermermal necrolysis, angioedema, urticaria.

Kuchokera pamalingaliro am'maganizo: kusokonezeka kwamaonedwe, kusokonezeka kowonera (mosakhalitsa), xanthopsia, vertigo.

Kuchokera pakubala: kuchepa kwa potency.

Zizindikiro zasayansi: kuchepa kwa Hb, hypercreatininemia, kuchuluka kwa "chiwindi" transaminases, hypertriglyceridemia.

Zina: matenda a chimfine, malungo, kuchuluka thukuta. Zizindikiro (telmisartan): kutsika kwa magazi, tachycardia ndi / kapena bradycardia.

Zizindikiro (hydrochlorothiazide): hypokalemia (kuphipha kwa minofu, kuwonjezeka kwa kusintha kwa mankhwalawa chifukwa cha munthawi yomweyo kugwiritsa ntchito mtima wa glycosides kapena mankhwala osokoneza bongo), hypochloremia, kuchepa thupi chifukwa cha kukokomeza kwakukulu, kusanza, kugona.

Chithandizo: kusanza, kutsuka kwa m'mimba, makala othandizira, othandizira komanso othandizira, kuyang'anira kuchuluka kwa ma electrolyte ndi creatinine mu seramu yamagazi. Pankhani ya kuchepa kwakukulu kwa kuthamanga kwa magazi, wodwalayo ayenera kuyikidwa pamalo opingasa, kukonzanso kutayika kwa ma elekitirodi, bcc.

Telmisartan samachotsedwa ndi hemodialysis. Mlingo wochotsa hydrochlorothiazide pa hemodialysis sunakhazikitsidwe.

Malangizo apadera

Odwala omwe ali ndi vuto limodzi la impso a stenosis kapena a stenosis a impso yokhayo yomwe amagwiritsa ntchito mankhwala omwe amakhudza dongosolo la renin-angiotensin-aldosterone, chiwopsezo cha kuchepa kotchulidwa komanso kulephera kwa aimpso kumawonjezeka.

Palibe zinachitikira ndi kukonzekera kwa odwala kwambiri aimpso kapena pambuyo kupatsirana kwa impso. Ndi kufatsa kapena kufatsa kwa aimpso kulephera, kutsimikiza kwa ndende ya K +, creatinine m'magazi seramu akulimbikitsidwa. Kugwiritsa ntchito thiazide diuretics kwa odwala omwe amalephera kupweteka kwa impso kungayambitse azotemia. Kuyang'anira ntchito za impso kumalimbikitsidwa.

Odwala omwe ali ndi kuchepa kwa BCC ndi / kapena hyponatremia (chifukwa cha kukodzetsa thupi, kuletsa kudya kwamchere, kutsekula m'mimba kapena kusanza), kuchepa kwa magazi kumaneneka kumatheka, makamaka mutatha kumwa koyamba kwa mankhwalawa. Musanayambe kugwiritsa ntchito mankhwalawa, kukonza izi ndikofunikira.

Odwala omwe ali ndi CHF yayikulu, a repat artery stenosis, kugwiritsa ntchito mankhwala omwe amakhudza boma la renin-angiotensin-aldosterone machitidwe akhoza kutsagana ndi chitukuko cha kuchepa kwambiri kwa kuthamanga kwa magazi, hyperazotemia, oligouria, kapena, kawirikawiri, kulephera kwaimpso.

Odwala omwe ali ndi matenda oopsa a hyperaldosteronism, mankhwala a antihypertensive, momwe amagwirira ntchito zomwe zimalepheretsa ntchito ya renin-angiotensin-aldosterone, nthawi zambiri sagwira ntchito. Zikatero, kuikidwa kwa mankhwala sikulimbikitsidwa.

Odwala omwe ali ndi matenda ashuga, kusintha kwa mankhwala a insulin kapena pakamwa a hypoglycemic kungafunike. Mankhwalawa ndi thiazide diuretics, mtundu wodwala wa matenda a shuga umatha kuonekera.

Nthawi zina, kugwiritsa ntchito thiazide diuretics kumatha kukhala hyperuricemia ndi gout.

Munthawi ya chithandizo, kuwunika kwa nthawi yayitali ya ma electrolyte mu seramu yofunikira ndikofunikira.

Chiwopsezo cha hypokalemia chikuwonjezereka mwa odwala ndi matenda amitsempha, okhala ndi kukokomeza, kuchuluka kwa pakamwa kosakwanira kwa ma elekitiroma, komanso pankhani yogwiritsidwa ntchito nthawi yomweyo kwa GCS kapena ACTH

Telmisartan, yomwe ndi gawo la mankhwalawa, imatha kubweretsa Hyperkalemia. Ngakhale matenda oopsa okhudzana ndi matendawa sananenedwe pogwiritsa ntchito kukonzekera, ziyenera kudziwika kuti zomwe zimayambitsa chitukuko chake zimaphatikizira aimpso ndi / kapena kulephera kwa mtima ndi matenda a shuga.

Palibe umboni kuti mankhwalawa amatha kuchepetsa kapena kupewa hyponatremia yoyambitsidwa ndi mankhwala okodzetsa. Hypochloremia nthawi zambiri imatchulidwa pang'ono ndipo safuna kuwongoleredwa.

Hydrochlorothiazide itha kuchepa Ca2 + chimbudzi ndi chifukwa (posakhala ndi zovuta za Ca2 + kagayidwe kachakudya) kosakhalitsa ndi hypercalcemia yaying'ono. Hypercalcemia yofunika kwambiri ikhoza kukhala chizindikiro cha hypentparathyroidism yam'mbuyo. Musanaganize ntchito ya zotupa za parathyroid, mankhwalawa ayenera kuthetsedwa.

Odwala omwe ali ndi matenda amitsempha yamagazi, kuchepa kwamphamvu kwa magazi kumatha kubweretsa kuphwanya pansi kwa mtima kapena sitiroko.

Mlingo wovomerezeka tsiku lililonse wa 40 / 12,5 kapena 80 / 12,5 uli ndi 169 kapena 338 mg wa sorbitol, motero.

Chiwopsezo chotenga thupi lawo siligwirizana ndi hydrochlorothiazide imachulukitsidwa mwa odwala omwe ali ndi mbiri ya matenda ofooketsa kapena chifuwa cha bronchial.

Pali malipoti a kakulidwe ka SLE pogwiritsa ntchito thiazide diuretics.

Mankhwala amatha, ngati pakufunika, angagwiritsidwe ntchito limodzi ndi mankhwala ena a antihypertensive.

Panthawi yamankhwala, muyenera kusamala mukamachita zinthu zoopsa (kuphatikizapo kuyendetsa galimoto) zomwe zimafunikira chidwi chachikulu komanso kuthamanga kwa zochitika zama psychomotor (kuthekera kotulutsa chizungulire ndi kugona pamene mukugwiritsa ntchito mankhwala a antihypertensive).

Telmisartan ilibe teratogenic kwenikweni, koma imakhala ndi mphamvu ya mwana. Pankhani ya mimba yomwe mwakonzekera, mankhwalawa amayenera kulowedwa m'malo ndi ena omwe amavomerezedwa kuti agwiritsidwe ntchito panthawi yomwe muli ndi pakati. Ngati mimba yakhazikitsidwa, muyenera kusiya kumwa mankhwalawo.

Mu II ndi III trimester, kugwiritsa ntchito mankhwalawa kumatha kuyambitsa chisokonezo cha elekitirasi mu fetus. Kukula kwa neonatal thrombocytopenia, jaundice (mwana wosabadwayo kapena wakhanda) pankhani ya mayi kutenga thiazide diuretics akuti. Sizikudziwika ngati telmisartan idutsa mkaka wa m'mawere, thiazide diuretics imadutsa mkaka wa m'mawere ndipo imatha kuletsa kuyamwa.

Kuchita

Pogwiritsa ntchito munthawi yomweyo Li + ndi angiotensin II receptor antagonists, kuchuluka kwa anthu ambiri a Li + mu seramu yamagazi ndi kuwonjezereka kwa poizoni. Kugwiritsa ntchito hydrochlorothiazide kumachepetsa chilolezo cha Li +. Kuyang'anira mosamala ndikofunikira, kuyang'anira kuchuluka kwa Li + mu seramu.

Hypokalemic mphamvu ya hydrochlorothiazide imatha ndi potaziyamu woteteza mphamvu ya telmisartan. Komabe, Hypokalemic mphamvu ya hydrochlorothiazide imatha kupitilizidwa ndi mankhwala ena omwe amatsogolera ku hypokalemia (kuphatikizapo ma diuretics, ma laxatives, GCS, ACTH, amphotericin, carbenoxolone, penicillin G sodium, salicylic acid ndi zotumphukira zake).

Kugwiritsa ntchito munthawi yomweyo mankhwala osokoneza bongo a potaziyamu, kukonzekera kwa K +, ndi mankhwala ena omwe angakulitse zomwe zili ndi seramu K + (kuphatikizapo sodium heparin), K + - kuphatikiza zakudya zopatsa thanzi kumatha kuyambitsa Hyperkalemia.

Pogwiritsa ntchito mtima ndi glycosides, mtima ndi mankhwala ena omwe amayambitsa mtima monga pirouette, kuyang'anira kuwunika kwa K + m'madzi a m'magazi kumalimbikitsidwa.

Telmisartan imapititsa patsogolo zotsatira za mankhwala ena a antihypertensive.

Mankhwala amatha kuonjezera kuchuluka kwa digoxin (mpaka 39%), chifukwa chake, kuyang'anira kuchuluka kwa plasma kwa digoxin kungafunike.

Kugwiritsira ntchito kwa hydrochlorothiazide ndi ethanol, barbiturates, narcotic analgesics - chiopsezo chokhala ndi orthostatic hypotension, omwe ali ndi hypoglycemic othandizira (onse pakamwa ndi insulin) - Mlingo wa mankhwala a hypoglycemic angafunike, ndi metformin - chiopsezo cha lactic acidosis, ndi colestyramine ndi cooleptyoline - ndi mtima glycosides - chiopsezo cha hypokalemia kapena hypomagnesemia (arrhythmias), ndi NSAIDs - kuchepa kwa okodzetsa, Natriuretic ndi antihypertensive zotsatira hydrochlorothiazide, ndi makina opanikizira (kuphatikiza norepinephrine - kufooketsa mphamvu ya mabatani a Pressor, osapondereza minofu omasuka (kuphatikiza tubocurarine) - kuwonjezeka kwa zochitika zopumitsa minofu, ndi antigout - kusintha kwa mankhwalawa kwa uricosuric mankhwala kungafunike, chifukwa (Hyper oyambitsidwa ndi hydrochlorothiazide), ndi allopurinol - kuchuluka kwa kuchuluka kwa mphamvu ya hypersensitivity ku allopurinol, wokhala ndi mchere wa Ca2 + - chiwopsezo chokhala ndi hypercalcemia (chifukwa cha kuchepa kwa kutulutsa kwake), ndi beta-adrenergic blockers ndi diazok mbewu - chiopsezo cha hyperglycemia, ndi m-anticholinergics (kuphatikizapo atropine, biperiden) - kuchuluka kwa bioavailability wa hydrochlorothiazide (chifukwa kuchepa kwa m'mimba motility).

Mankhwalawa amatha kuwonjezera zovuta za amantadine, amachepetsa impso za cytotoxic mankhwala (kuphatikizapo cyclophosphamide, methotrexate) ndikuwonjezera mphamvu yanga ya myelosuppression.

Mankhwala

Hydrochlorothiazide ndi thiazide okodzetsa. Liazide diuretics imakhudzanso kubwezeretsanso kwa ma electrolyte mu impso tubules, kukulitsa zowonjezera zotulutsa za sodium ndi chloride (pafupifupi zofanana). Mphamvu ya diuretic ya hydrochlorothiazide imabweretsa kuchepa kwa bcc, kuwonjezeka kwa ntchito ya plasma renin, kuchuluka kwa secretion ya aldosterone, kutsatiridwa ndi kuwonjezeka kwa potaziyamu ndi hydrocarbonates ndipo, chifukwa chake, kutsika kwa potaziyamu m'madzi a m'magazi.Ndi makonzedwe a munthawi yomweyo ndi telmisartan, pali chizolowezi choletsa kutaya kwa potaziyamu chifukwa cha zotupa izi, mwina chifukwa cha RAAS blockade.

Pambuyo pakukonzekera pakamwa, diuresis imawonjezeka pambuyo pa maola awiri, ndipo kuchuluka kwake kumawonedwa pambuyo pafupifupi maola 4. Mphamvu yokhudza kukodzetsa kwa mankhwalawa imapitirira pafupifupi maola 6-12.

Kugwiritsa ntchito nthawi yayitali hydrochlorothiazide kumachepetsa chiopsezo cha matenda amtima komanso kufa kwa iwo.

Telmisartan - Yotsimikizika ARA II (Mtundu AT₁), yogwira mtima mukamamwa. Ali ndi kuyanjana kwakukulu ndi AT subtype₁zolandilira za angiotensin II, pomwe zochita za angiotensin II zimadziwika. Ikuwonetsa angiotensin II kuchokera kulumikizano ndi cholandilira, osawonetsa mawonekedwe a agonist mokhudzana ndi cholandilira ichi. Telmisartan amangomanga ku AT subtype₁zolandila za angiotensin II. Kulumikizana ndikupitiliza. Ilibe chiyanjano ndi ma receptor ena, incl. kupita ku AT₂receptor ndi zina zochepa zomwe amaphunzira angiotensin receptors. Kufunika kwa magwiridwe antchito izi, komanso momwe zimakhalira ndikulimbikitsa kwakukulu ndi angiotensin II, kugwiritsidwa ntchito kwa zomwe zimawonjezeka poika telmisartan, sikunaphunzire.

Telmisartan amachepetsa kuchuluka kwa aldosterone m'magazi am'magazi, sikulepheretsa renin m'magazi am'magazi ndipo satchinga njira za ion. Telmisartan sikuletsa ACE (kininase II), yomwe imathandiziranso kuchepa kwa bradykinin. Chifukwa chake, kuwonjezeka kwa zoyipa zoyambitsidwa ndi bradykinin sikuyembekezeredwa.

Odwala ochepa matenda oopsa, telmisartan pa mlingo wa 80 mg kwathunthu limatchinga matenda oopsa a angiotensin II. Kukhazikika kwa antihypertensive kanthu kumadziwika mkati mwa maola atatu mutangomaliza kukonzekera kwa telmisartan. Mphamvu ya mankhwalawa imatha kwa maola 24 ndipo imakhalabe yofunikira mpaka maola 48. Njira yodziwika bwino ya antihypertgency nthawi zambiri imayamba masabata 4 mutatha kugwiritsa ntchito mankhwala.

Odwala omwe ali ndi matenda oopsa, telmisartan amachepetsa SBP ndi DBP popanda kukhudza kugunda kwa mtima.

Pankhani ya telmisartan yadzidzidzi, kuthamanga kwa magazi pang'onopang'ono kumabwereranso ku msana wake popanda kusintha kwa matenda obwera nawo.

Pakufufuza ndi telmisartan, milandu yakufa kwa mtima, kupha kwa mtima kosagwirizana ndi mtima, kugunda kwam'mimba, kapena kuchipatala chifukwa cha kulephera kwa mtima kunayesedwa. Kuchepa kwa kuchepa kwa mtima ndi kufa kwa odwala omwe ali ndi chiwopsezo chachikulu cha mtima (matenda amitsempha yamagazi, matenda opha ziwalo, zotupa za chiwopsezo kapena matenda a shuga. zaka zopitilira 55.

Mphamvu yayitali kwambiri ya antihypertensive ya mankhwala a Telsartan ® N nthawi zambiri imakwaniritsidwa patatha masabata 4 atayamba chithandizo.

Pharmacokinetics

Kugwiritsa ntchito kwa telmisartan ndi hydrochlorothiazide sikukhudza ma pharmacokinetics omwe aliwonse azigawo lamankhwala.

Pambuyo m`kamwa makonzedwe a mankhwala Telsartan ® N C_max plasma hydrochlorothiazide imafikiridwa mkati mwa maola 1-3. Mtheradi wa bioavailability pafupifupi 60% (kutengera kuchuluka kwathunthu kwa impso). Mapuloteni a Plasma amamanga 64% ya hydrochlorothiazide, ndi V_d ndi (0,8 ± 0.3) l / kg. Hydrochlorothiazide samapukusidwa mthupi ndipo amachotsa impso pafupifupi osasinthika. Pafupifupi 60% ya mankhwala omwe adalowetsedwa amathetsedwa mkati mwa maola 48. Chilolezo chokhudza pafupifupi 250-300 ml / min. T_1/2 hydrochlorothiazide ndi maola 10-15.

Pali kusiyana pamaganizidwe a plasma mwa amuna ndi akazi. Mwa azimayi, kuchuluka kwa telmisartan mu plasma kumakhala kochulukirapo kuposa kuposa kwa amuna, ndipo amayi nawonso amakhala ndi chiwopsezo chochepa kwambiri cha plasma wozungulira wa hydrochlorothiazide.

Kulephera kwina. Odwala ndi mkhutu aimpso ntchito, mlingo wa kuthetsedwa kwa hydrochlorothiazide amachepetsa. Kafukufuku wodwala wokhala ndi 90 ml / min creatinine Cl adawonetsa kuti T_1/2 hydrochlorothiazide imachuluka. Odwala ndi kuchepa aimpso ntchito T_1/2 pafupifupi 34 maola

Mukamwetsa mwachangu odzipereka ku Matumbo. Bioavailability pafupifupi 50%. Kuphatikizika kwa nsonga kumachitika pambuyo pa maola pafupifupi 0,5-1.5.Ngati mutengedwa nthawi yomweyo ndi chakudya, kuchepa kwa AUC kumachokera ku 6 mpaka 19% (mukamamwa mlingo wa 40 ndi 160 mg, motsatana). Pakadutsa maola atatu atatha kumwa, ndende ya m'madzi am'madzi imayikidwamo mosasamala chakudya.

Pali kusiyana pakumvekera kwa telmisartan mu plasma mwa amuna ndi akazi. C_max mu plasma, pafupifupi 3 nthawi ndi AUC pafupifupi 2 times akazi poyerekeza ndi abambo popanda phindu lalikulu. Komabe, kuwonjezeka kwa zotsatira za hypotensive sikuwonedwa mwa akazi.

Kuyanjana kwakukulu ndi mapuloteni a plasma (oposa 99,5%), makamaka ndi albumin ndi alpha₁-acid glycoprotein. V_d pafupifupi malita 500

Telmisartan imapangidwa ndi kuphatikizika ndi glucuronic acid. Ma metabolabolites ndi opanga ma pharmacologic. T_1/2 amapitilira maola 20

Amayamwa kudzera m'matumbo osasinthika, zotupa za impso - zosakwana 2%. Chilolezo chonse cha plasma ndichokwera (pafupifupi 900 ml / min).

Odwala okalamba. Ma pharmacokinetics a telmisartan mwa odwala okalamba samasiyana ndi achinyamata achinyamata. Kusintha kwa Mlingo sikofunikira.

Kulephera kwina. Kusintha kwa telmisartan mwa odwala ndi aimpso kulephera sikofunikira, kuphatikiza odwala pa hemodialysis. Telmisartan samachotsedwa ndi hemodialysis.

Kulephera kwa chiwindi. Kafukufuku wa pharmacokinetics mwa odwala omwe ali ndi vuto la chiwindi adawonetsa kuwonjezeka kwathunthu kwa pafupifupi pafupifupi 100%. Ndi kulephera kwa chiwindi T_1/2 sizisintha (onani. Mlingo ndi kasamalidwe ").

Mimba komanso kuyamwa

Kugwiritsa ntchito kwa mankhwala Telsartan ® N ndi contraindicated pa mimba.

Zomwe zimachitika ndi hydrochlorothiazide pa nthawi yapakati, makamaka nthawi ya trimester yoyamba, ndizochepa.

Hydrochlorothiazide imawoloka chotchinga. Poganizira njira yogwiritsira ntchito hydrochlorothiazide, amaganiza kuti kugwiritsidwa ntchito panthawi yachiwiri ndi yachitatu ya kutenga pakati kumatha kusokoneza kufooka kwa fetoplacental ndikupangitsa kusintha kwa mwana wosabadwayo komanso mwana wosabadwayo, monga jaundice, kusokonezeka pamawonekedwe amadzimadzi a electrolyte ndi thrombocytopenia.

Hydrochlorothiazide sayenera kugwiritsidwa ntchito pochiza matenda oopsa mu azimayi oyembekezera, pokhapokha ngati nthawi zina pomwe mankhwala ena sangagwiritsidwe ntchito.

Kugwiritsidwa ntchito kwa ARA II pa nthawi ya pakati kumapangidwa.

Pozindikira kuti muli ndi pakati, mankhwalawa amayenera kuyimitsidwa nthawi yomweyo.

Ngati ndi kotheka, njira zina zochiritsira zosagwiritsidwa ntchito ziyenera kugwiritsidwa ntchito (magulu ena a antihypertensive mankhwala ovomerezeka kuti agwiritsidwe ntchito pa nthawi yapakati).

Chithandizo cha mankhwala a Telsartan ® H chimapangidwa mu nthawi yoyamwitsa.

Mu maphunziro a nyama, zotsatira za telmisartan ndi hydrochlorothiazide pa chonde sizinawoneke. Kafukufuku wokhudza chonde chaumunthu sanachitike.

Mlingo ndi makonzedwe

Mkati ngakhale chakudyacho.

Telsartan ® N iyenera kutengedwa nthawi imodzi patsiku.

Telsartan ® N (12.5 mg + 40 mg) imatha kuperekedwa kwa odwala omwe amathandizidwa ndi telmisartan pa mlingo wa 40 mg kapena monotherapy yokhala ndi hydrochlorothiazide sikuti kumayendetsa bwino magazi.

Telsartan ® N (12.5 mg + 80 mg) imatha kuperekedwa kwa odwala omwe amathandizidwa ndi telmisartan pa mlingo wa 80 mg kapena mankhwala a Telsartan ® N (12.5 mg + 40 mg) samatsogolera pakuwongolera koyenera kwa kuthamanga kwa magazi.

Odwala omwe ali ndi ochepa matenda oopsa, tsiku lililonse mlingo wa telmisartan ndi 160 mg / tsiku. Mlingo anali wololera komanso wogwira ntchito.

Magulu apadera a odwala

Matenda aimpso. Kuperewera kokhazikika pakugwiritsa ntchito kuphatikiza kwa hydrochlorothiazide ndi telmisartan odwala omwe ali ndi vuto lochepa kwambiri laimpso sikutanthauza kusintha kwa mankhwalawa. Mu odwala oterowo, ntchito ya impso iyenera kuyang'aniridwa (ndi Cl creatinine osakwana 30 ml / min, onani "Contraindication").

Kuwonongeka kwa chiwindi. Odwala omwe ali ndi chiwindi chochepa komanso choperewera (chiwonetsero cha ana-Pugh A ndi B), mlingo wa Telsartan ® N wa tsiku lililonse sayenera kupitirira 12,5 mg + 40 mg patsiku (onani Pharmacokinetics).

Ukalamba. Mlingo wa mankhwalawa sufuna kusintha.

Bongo

Palibe milandu ya bongo yomwe yapezeka. Zizindikiro zotheka za bongo zimapangidwa ndi zizindikiritso zake zomwe zimagwiritsidwa ntchito ndi mankhwala.

Zizindikiro za bongo wa hydrochlorothiazide: Kusokonezeka m'magazi a electrolyte yamagazi (hypokalemia, hypochloremia), kuchepa kwa BCC, komwe kumatha kubweretsa minyewa ya m'mimba komanso / kapena kukokoloka kwa CCC: arrhythmias yoyambitsidwa ndi kugwirira ntchito limodzi kwamtima wamankhwala a glycosides kapena mankhwala ena a antiarrhythmic.

Zizindikiro za bongo wa telmisartan: kuchepa kwa kuthamanga kwa magazi, tachycardia, bradycardia.

Chithandizo: symptomatic chithandizo, hemodialysis sichothandiza. Mlingo wochotsa hydrochlorothiazide pa hemodialysis sunakhazikitsidwe. Kuwunikira pafupipafupi pazinthu zamagetsi ndi ma serum creatinine pamafunika.

Wopanga

Dr. Reddy's Laboratories Ltd., India. Dr. Reddy's Laboratories Ltd., India. Unit-III, Sy. No. 41, Mudzi wa Bachupally, Qutubullapur Mandal, Ranga Reddy District, Telangana, India.

Zambiri zokhudzana ndi madandaulo ndi mayendedwe osayenera a mankhwalawa ziyenera kutumizidwa ku adilesi iyi: ofesi yoyimira ya Dr. Reddy's Laboratories Ltd. 115035, Moscow, Ovchinnikovskaya nab., 20, p. 1.

Tele. ((495) 795-39-39, fakisi: (495) 795-39-08.

Mankhwala

Telmisartan ndi wotsutsa winawake wa angiotensin II receptor (mtundu wa AO 1), akuchita pakamwa. Pokhala ndi ubale wapamwamba, telmisartan imalowa m'malo mwa angiotensin II pamgwirizano wake ndi AO 1 subtype receptor, yomwe imayang'anira zochitika za angiotensin II. Telmisartan sikuwonetsa zochitika zilizonse pa AO 1 receptor ngati agonist. Telmisartan mosankha imangiriza kwa AO 1 receptor kwa nthawi yayitali. Mankhwalawa samawonetsa kuyanjana ndi ma receptor ena, kuphatikiza AO 2 ndipo ena samadziwika ndi receptors a AT. Ntchito yothandizirana ndi ma receptor awa sichikudziwika, komanso momwe mphamvu zawo zimakhudzira kwambiri ndi angiotensin II, omwe amawonjezera telmisartan. Telmisartan amachepetsa kuchuluka kwa plasma aldosterone. Telmisartan sikuletsedwa ndi plasma renin, komanso sikutchinga ma wayion ion. Telmisartan sikuletsa ACE (kinase II), yomwe imaphwanyanso bradykinin. Chifukwa chake, munthu sayenera kuyembekeza kuwonjezeka kwa zoyipa zomwe zimachitika chifukwa cha bradykinin.

Mwa anthu, telmisartan pa mlingo wa 80 mg pafupifupi umachepetsa mphamvu ya angiotensin II pakuwonjezera magazi.

Kuchita Mwachipatala ndi Chitetezo

Chithandizo cha matenda oopsa

Pambuyo pa mlingo woyamba wa telmisartan, mphamvu ya antihypertensive imayamba kuwonekera pakadutsa 3:00. Kutsika kwakukulu kwa kuthamanga kwa magazi nthawi zambiri kumakwaniritsidwa masabata 4-8 pambuyo poyambira kuchipatala ndikupitilira chithandizo cha nthawi yayitali.

Mphamvu ya antihypertgency imakhalabe yopitilira tsiku limodzi mutamwa, kuphatikizapo 4:00 isanachitike mlingo wotsatira, monga momwe magazi akuwonekera. Izi zimatsimikiziridwa mobwerezabwereza ndi kuchuluka kwa zotsalira kuti zitheke, zomwe zimaposa 80% pambuyo pakugwiritsa ntchito Mlingo wa 40 ndi 80 mg wa telmisartan pamavuto oyesedwa a placebo. Pali ubale womveka pakati pa mlingo komanso nthawi yobwezeretsa koyambirira kwa kuthamanga kwa magazi systolic (SBP). Zambiri zokhudzana ndi kuthamanga kwa magazi kwa diastolic (DBP) ndizosagwirizana.

Odwala omwe ali ndi matenda oopsa, telmisartan imachepetsa kuthamanga kwa magazi ndi kuthamanga kwa magazi, pomwe sikukhudza kugunda kwa mtima. Kukula kwa diuretic ndi natriuretic zotsatira za mankhwalawa pantchito yake yotsitsa sikunadziwikebe. Mphamvu ya telmisartan pakuchepetsa kuthamanga kwa magazi ikufanana ndi mankhwala ena omwe amaimira magulu ena a antihypertensive mankhwala (maphunziro azachipatala kuyerekezera telmisartan ndi amlodipine, atenolol, enalapril, hydrochlorothiazide ndi lisinopril).

Ndi kutha kwadzidzidzi kwa chithandizo cha telmisartan, kuthamanga kwa magazi pang'onopang'ono kumabweza mulingo womwe unalipo masiku angapo osalandira chithandizo chamankhwala.

M'mayesero azachipatala, poyerekeza mwachindunji mankhwala awiri a antihypertensive, milandu ya chifuwa chouma inali yochepa kwambiri kuposa telmisartan kuposa ACE inhibitors.

Telmisartan imatengedwa mwachangu, ngakhale kuchuluka kwake kumazisiyanasiyana. Pafupifupi mtheradi bioavailability wa telmisartan pafupifupi 50%. Mukamagwiritsa ntchito telmisartan ndi chakudya, dera lomwe limaponderezedwa (AUC 0-∞) limatsika pamtunda kuchokera 6% (pa 40 mg) mpaka 19% (pa mlingo wa 160 mg). 3:00 itatha ntchito, kuchuluka kwa telmisartan m'madzi am'magazi ndi chimodzimodzi mukamamwa pamimba yopanda kanthu kapena mukamamwa ndi chakudya.

Kutsika pang'ono kwa AUC kukuyembekezeka kuchepa kuchiritsa kochizira. Palibe chiyanjano pakati pa Mlingo ndi plasma ndende ya mankhwalawa. C max ndipo, mochepera, AUC imachulukana mosawerengeka pa 40 mg.

Telmisartan imamangidwa kwambiri ndi mapuloteni a plasma (> 99.5%), makamaka okhala ndi albumin ndi alpha-1 acid glycoprotein. Voliyumu yapakati yogawa (V dss) yofanana ndi 500 L.

Telmisartan imapangidwa ndi kuphatikizika kwa pawiri wa kholo kupita ku glucuronide, conjugate ilibe ntchito ya pharmacological.

Telmisartan amadziwika ndi bio-exponential pharmacokinetic curve ndi kupha kozungulira theka la moyo wopitilira maola 20. Kuchuluka kwa plasma ndende (C max) ndipo, pocheperako, dera lomwe lili pansi pa ndende (AUC) limakulirakulira mosagwirizana ndi mlingo. Palibe umboni wa kuchuluka kwa telmisartan pamavuto povomerezeka. Mwa azimayi, kutsata kwa plasma kunali kokwanira kuposa abambo popanda chidwi chokwanira.

Pambuyo pakamwa, telmisartan imatulutsidwa kwathunthu ndowe, makamaka osasinthika. Kuchuluka kwathunthu kwa mankhwala ndi mkodzo ndi zaka 70. Kuphatikiza ndi mankhwala ena omwe akukhudza dongosolo la renin-angiotensin-aldosterone, komanso / kapena kugwiritsa ntchito mankhwala ena a potaziyamu.

Kuwunikira mosamala kuchuluka kwa potaziyamu mu odwala omwe ali pachiwopsezo akulimbikitsidwa.

ACE inhibitors, telmisartan, and angiotensin II receptor antagonists sakhala ogwira ntchito pochepetsa kuthamanga kwa magazi kwa anthu othamanga mu mpikisano wa Negroid kuposa amitundu ina, mwina chifukwa chakuti odwala omwe ali ndi vuto lothamanga la mtundu wa Negroid amatha kukhala ndi zotsika kwambiri za renin.

Mukamagwiritsa ntchito mankhwala aliwonse a antihypertensive, kuchepa kwambiri kwa kuthamanga kwa magazi kwa odwala omwe ali ndi ischemic cardiopathy kapena ischemic mtima matenda kungayambitse infarction ya myocardial kapena stroke.

Gwiritsani ntchito pa nthawi yoyembekezera kapena mkaka wa m'mawere

Palibe zambiri zogwirizana ndi ntchito ya Telmisartan kwa amayi oyembekezera.

Zoyambitsa mliri wa chiopsezo cha teratogenicity chifukwa chogwiritsa ntchito zoletsa za ACE nthawi yoyamba ya pakati sizinali kukhudzika, koma kuwonjezeka pang'ono pangozi sikungadziwike.

Angiotensin II receptor antagonists sayenera kuyamba pomwe ali ndi pakati. Ngati kupitiliza kwa mankhwalawa ndi angiotensin II okondedwa akuwoneka kuti ndikofunikira, ndipo wodwalayo akukonzekera kutenga pakati, tikulimbikitsidwa kuti tichotse mankhwalawa ndi antihypertensive mankhwala okhala ndi mbiri yotetezeka panthawi yomwe muli ndi pakati. Ngati mimba yakhazikika, chithandizo cha angiotensin II receptor antagonists iyenera kusiyidwa pomwepo ndipo njira yoyenera yothandizira iyenera kuyambitsidwa.

Amadziwika kuti kugwiritsa ntchito angiotensin II receptor antagonists pa II ndi III trimesters ya mimba imayambitsa kufalikira kwa anthu (kuwonongeka kwa impso, oligohydramniosis, kuchedwa kwa mapangidwe a mafupa a cranial) komanso neonatal kawopsedwe (kulephera kwa impso, hypotension, hyperkalemia). Ngati kugwiritsa ntchito angiotensin II receptor antagonists adayamba mu nyengo yachiwiri ya kubereka, tikulimbikitsidwa kuti tichite kafukufuku wa impso ndi mafupa a chigoba cha fetal. Mkhalidwe wa akhanda omwe amayi awo adatenga angiotensin II receptor antagonists ayenera kuyang'aniridwa mosamala kuti pakhale kuwonongeka kwa hyperial hypotension (onani Magawo "Contraindication" ndi "Makhalidwe Ogwiritsira Ntchito").

Telmisartan siyikulimbikitsidwa pakuyamwitsa, chifukwa sizikudziwika ngati amathiridwa mkaka wa munthu. Njira zina zochiritsira zosagwiritsidwa ntchito ndi njira yophunziridwa bwino ndiyabwino, makamaka poyamwitsa mwana wakhanda kapena asanabadwe.