Kodi ndiyenera kumwa mapiritsi a Hartil komanso liti?

Hartil-D ndi antihypertensive mankhwala omwe amaperekanso okodzetsa machitidwe. Zachika machitidwe a zinthu zogwiritsidwa ntchito ndi mankhwala ndizothandiza, pomwe ramipril amachepetsa zachinyengo zotsatirahydrochlorothiazide.

Pharmacodynamics ndi pharmacokinetics

Zigawo zogwira ntchito za chida ichi zimagwiritsidwa ntchito kuthamanga kwa magazi.

Ramiprilat (yogwira ramipril metabolite) zokhumudwitsa ACE. Kuphatikiza apo, amachepetsa mpweya. aldosterone. Ramipril zimayambitsanso kuchepa zotumphukira mtima kukana.

Mwambiri antihypertensive chochitikacho chikuwonekera patatha maola 1-2. Imapitilira tsiku limodzi. Kukula kwakukulu kwa kuchitapo kanthu kumatheka pambuyo pa maola 3-6. Ndi chithandizo chazitali, mphamvu zambiri zimadziwika pambuyo pa milungu itatu. Ndi chithandizo cha nthawi yayitali, chimasungidwa kwa zaka ziwiri.

Hydrochlorothiazide zimapangitsa thiazide okodzetsa. Chotheka ndi chake antihypertensive Zochitazo zikuphatikiza kusintha mulingo wa sodium komanso kukana kwamitsempha, komanso kuchepetsa kuchepa kwa madzi amkati, plasma, komanso kusintha kwa zomwe angiotensin II ndi norepinephrine.

Kuchuluka kwake kumawonekera pambuyo pa maola 3-6 ndipo kumakhala mpaka maola 12. Zachika zotsatira zimatheka pambuyo masiku 3-4 a mankhwala ndipo zimatha sabata itatha maphunziro ake. Ndi chithandizo chazitali, kuchepa kuthamanga kwa magazi kukwaniritsidwa pogwiritsa ntchito Mlingo wocheperako kuposa momwe ungafunikire okodzetsa zotsatira. Chepetsani kuthamanga kwa magazi pali kuwonjezeka pang'ono pa liwiro kusefera kwamadziZochita renin m'madzi a m'magazi mtima kukana impso. Mukamagwiritsa ntchito hydrochlorothiazide muyezo waukulu, kuchuluka kwa plasma ndi kuthamanga kumachepa kusefera kwamadzi, amatanthauza kuthamanga kwa magazi ndi magazi aimpso. Ndi chithandizo chotenga nthawi yayitali, kuchuluka kwa madzi am'madzi, zokhudza zonse mtima kukana ndi amatanthauza kuthamanga kwa magazi khalani otsika mokwanira panthawi yomweyo kusefera kwamadzi ndipo voliyumu yamphindi imabwerera kumigawo yapitayi.

Contraindication

Chida ichi sichikulimbikitsidwa kuti mugwiritse ntchito ndi:

• cholestasis,
• Edema wa Quincke mu mbirikomanso cholowa / idiopathic,
• mavuto akulu ndi impso,
• anuria,
• chachikulu aldosteronism,
• hemodialysis,
• tsankho galactose,
• kuchepa kwa cholowa mkanda kapena vuto la malabsorption shuga galactose,
• yoyamwitsa,
• wa mimba,
• ubwana
• zonyansa zambiri mu chiwindi,
• ochepa hypotension,
• pambuyo kupatsirana kwa impso,
• tsankho kwa zigawo zikuluzikulu za mankhwala.

Mosamala, Hartil-D adasankhidwa kuti msempha ndi mitral stenosis, zokhudza matenda matenda a zotumphukira minofu, zotupa zamkati ndi ziwalo, mayiko awiriaimpso mtsempha wamagazi stenosis, gout, hyponatremia, hypercalcemia, kulephera kwa aimpso, matenda a chiwindizosakhazikika angina pectorisaakulu kulephera kwa mtima (gawo lachinayi), kuchepetsa Bcc, matenda ashugaukalamba hypertrophic obstriers cardiomyopathy, Hyperkalemia, mmodzi mtsempha wamagazi a stenosis, hypokalemia, Matenda a mtima wa Ischemic, kulephera kwa chiwindi.

Zotsatira zoyipa

Mukamamwa mankhwalawa kumayambiriro kwa mankhwala ndipo mutatha kuchuluka kwa mankhwalawa, kutchulidwa ochepa hypotension. Zizindikiro zake zingaphatikizeponso chizunguliremasomphenya osalala, kufooka kwathunthu, kukomoka. Kuphatikiza apo, milandu yatsoka yamphamvu yamphamvu yamphamvu yatsimbidwa, tachycardia, arrhythmias, myocardial infarationpalpitations anasonyezaochepa matenda oopsa, angina pectoris ndi mantha. Mukamagwiritsa ntchito ACE zoletsa at ochepa hypotension mwina zotupa m'mimba ndi ischemic stroke.

Zotsatira zotsatirazi zingakhale:

• kagayidwe - hyperglycemiakuchuluka kwa asidi hypokalemia, gout, Hyperkalemia, hypomagnesemia, hypercalcemia, hyponatremia, hyperchloremia,
• dongosolo lamanjenje - mphwayimantha mutukutopa, kumva kufooka, kugona,
• ziwalo zamawonedwe - conjunctivitis, blepharitis,
• mtima wamtima - kuchepa kwakukulu kuthamanga kwa magazi, kutupa maondo
• kupuma dongosolo - mawonekedwe a chifuwa chowuma, bronchitis,
• zam'mimba dongosolo - nseru, kusanza, kupweteka pamimba, dyspepsiacramping dera la epigastric, kudzimbidwakudya, ludzu, kutsegula m'mimba,
• khungu wopindika - urticaria, zithunzi, kuyabwa,
• kwamikodzo - proteinuria,
• kubereka - kuchepa libido.

Nthawi zina, izi ndizotheka:

• dongosolo lamagazi ndi zamitsempha - kuchepa kwa zinthu hematocrit ndi hemoglobin, thrombocytopenia, eosinophilia, leukopenia, pancytopenia, agranulocytosis,hemolytic anemia (pakuchepa shuga-6-phosphate dehydrogenase),
• kagayidwe ndi zakudya - moyenera mulingo wamagetsi wamagetsi, kagayidwe kachakudya matenda, hypochloremiakuchuluka kwazinthu triglycerides mu seramu ndi seramu ma amylase, hypercholesterolemiakubwezera matenda ashuga,
• dongosolo lamanjenje - nkhawa, kusasamala, kununkhiza, paresthesia,
• ziwalo zamawonedwe - kanthawi kochepa,
• ziwalo zamakutu - zikulira m'makutu,
• zamtima dongosolo - kuphwanya kwamphamvu kwa kufalitsa kwamkati, kukomoka, thromboembolic zovuta, vasculitis, thrombosiskuchuluka Matenda a Raynaudmatenda a mitsempha embolism,
• kupumira dongosolo - kufupika kwa mpweya, rhinitis, glossitismatupi awo onse chibayo, sinusitis, pharyngitis, bronchospasm, Edema wa Quinckepulmonary edema
• zotupa - zotumphukira matumbo, pakamwa pouma, kusokonezeka kwa kukoma, sialadenitiskusanza, kutukusira kwa mucous nembanemba, hemorrhagic kapamba,
• chiwindi - kuchuluka kwa ntchito bilirubin ndi michere ya chiwindi, cholestatic jaundice, cholecystitis, chiwindi, necrosis chiwindi
• khungu wopindika - zokhudza zonse lupus erythematosus, erythema multiforme, kusefukira kwa nkhope, zotupa zotuluka, kuchuluka thukuta, Matenda a Lyellkuchuluka psoriasis, Matenda a Stevens-Johnson, thupi lawo siligwirizana, alopecia, onycholysis,
• minofu ndi mafupa a minyewa - minofu yolumikizana, arthralgia, nyamakazi, myalgiakufooka kwa minofu ziwalo,
• kwamikodzo dongosolo - mkhutu aimpso ntchito, kuchepa kwa madzi m'thupi, kuchuluka kwatsalira a nayitrogeni ndipo serum creatinine, nephrotic syndromepachimake kulephera kwa aimpso, oliguria, interstitial nephritis,
• kubereka - kusabala,
• ena - anaphylactic zimachitika.

Edema wa Quincke nthawi zambiri amapezeka mwa odwala a liwiro la Negroid. Kuphatikiza apo, kagulu kakang'ono katero angioedema nkhope ndi oropharyngeal madera chifukwa chakumwa ACE zoletsa.

Ndi zovuta kutchulidwa khungu, muyenera kufunsa katswiri.

Kuyang'ana kuchipatala kumasonyezedwa liti jaundice ndi ntchito yowonjezereka michere ya chiwindi.

Malangizo ogwiritsa ntchito Hartil-D (Njira ndi Mlingo)

Mankhwalawa amapangidwira kuti azigwiritsidwa ntchito kamodzi m'mawa ndi madzi okwanira. Malangizo ogwiritsira ntchito Hartil-D akuti kudya sikukhudza zotsatira zake. Mapiritsi sangathe kugawidwa m'magawo awiri.

Tengani chida ichi pokhapokha ngati dokotala wasankha kuchuluka ndi mankhwala. Monga lamulo, 2.5 mg imayankhidwa kuti ayambe maphunziro ramiprilndi 12.5 mg hydrochlorothiazide. Mlingo wokonza ndikufanana kapena kawiri kukwera, motero, pa chinthu chilichonse yogwira ntchito. Mlingo ukuwonjezeka ngati pakufunika masabata atatu. Mlingo woyenera wambiri patsiku ndi 5 mg. ramipril ndi 25 mg hydrochlorothiazide.

Kwa anthu okalamba, komanso kwa iwo omwe asokonezeka kwa impso ndi chiwindi, milingo ya gawo lililonse imasankhidwa payekhapayekha asanasinthane ndi mankhwala ophatikizira Khartil-D. Mlingo wake uyenera kukhala wochepa.

Bongo

Mukamagwiritsa ntchito mankhwala osokoneza bongo kuposa momwe zimakhalira, zotsatirazi ndizotheka: kusungika kwamikodzo, kuchepa kwakukulu kuthamanga kwa magazikukokana arrhythmia, mawonekedwe amanjenje, chotupa cham'mimba, vuto la electrolyte, chikomokere, paresis, bradycardia, kulephera kwa aimpso.

Njira zochizira matendawa zimatengedwa payekhapayekha. Monga zochulukirapo, kufinya kwam'mimba, sodium sulfate ndi makala omwe adalowetsedwa amathanso kukonzekera. Kuphatikiza apo, othandizira othandizira amagwiritsidwa ntchito.

Ramipril kuchotsedwa m'thupi ndi dialysis.

Ndi kuchepa kwakukulu kuthamanga kwa magazi voliyumu yamadzimadzi imabwezeretsedwa ndi saline ya thupi. Ngati izi sizikutulutsa chifukwa chomwe chikufunikira, makonzedwe amkati amatha. angiotensin II, katekisimaamu. Ndikofunikira kuyang'anira Bcc, KShchS, diuresis, kuchuluka kwa ma electrolyte ndi shuga m'magazi. Ndi kwambiri bradycardia pacemaker yakhazikitsidwa. At hypokalemia milingo yabwinobwino ya potaziyamu iyenera kubwezeretsedwa.

Moyo wowopsa angioedema Njira zotsatirazi zikugwira ntchito:

• makatani subcutaneous mpaka 0,5 mg epinephrine kapena kulowetsa pang'onopang'ono adrenaline ndi ulamuliroECG ndi kuthamanga kwa magazi,
• kuyambitsa antihistamines mankhwala
• intravenous kapena mu mnofu makonzedwe glucocorticoids,
• adrenaline ikhoza kuthandizidwa C₁ inactivatorngati wodwala ali ndi vuto.

Kuchita

Kuphatikiza ramipril ndi okodzetsa zitha kuchuluka antihypertensive zotsatira. Kuphatikiza apo, kuchepetsa kwakukulu ndikotheka. kuthamanga kwa magazi. Chifukwa chake ndikofunika kupewa kuphatikiza koteroko.

Zachika mphamvu imatha kupititsidwa patsogolo ngati itengedwa ramipril nthawi yomweyo ndi organic nitrate kapena vasodilators. Kuphatikiza apo, amayamba kufooka akadyedwa. NSAIDs. Ndalamazi zimathandizanso kuphatikiza ramipril matenda aimpso. Nthawi zina, zimawonedwa kulephera kwa aimpso. Chiwopsezo cha chitukuko chake chimawonjezeka pamene akutenga Hartil-D ndi Allopurinol (itha kuwonekeranso leukopenia) ndi Cyclosporine. Kuthetsa komaliza komanso Lovastatinndi trimethoprim zimatha kuyambitsa Hyperkalemia. Leukopenia amakonzanso pamene Hartil-D iphatikizidwa Procainamide, immunosuppressants ndi cytostatics.

Kuchita ramipril Kukonzekera kwa lifiyamu kumabweretsa kuwonjezeka kwa milingo ya seramu lifiyamu, kukula kwa zovuta ndizotheka. Kuphatikiza kumeneku sikuloledwa, koma ngati kuli kosapeweka, kuwunika momwe wodwalayo amafunikira. Kuledzera kwa Lithium kumatha kuwonjezekathiazide okodzetsa.

Matenda ogwirizana kukulitsidwa ndi kulumikizana ramipril ndi ena opaleshoni, antipsychotic amatanthauza ndipo tridclic antidepressants.

Mkhalidwe wa wodwala uyeneranso kuyang'aniridwa pamene Hartil-D iphatikizidwa amphanomachul. Ndipo mukamacheza ndi hypoglycemic njira zitha kuwonjezera zotsatira zawo mpaka mawonekedwe hypoglycemia. Izi ndizotheka makamaka kumayambiriro kwa mankhwala komanso kuwonongeka kwaimpso.

Kuphatikiza dialysis ndi ACE zoletsa Kutsutsana, chifukwa izi zingayambitse anaphylactoid zimachitika.

Hydrochlorothiazide mukamacheza ndi Amphotericin B, GKSmankhwala othandizira Carbenoxolonekapena Corticotropin zingayambitse kusowa kwa electrolyte. Ndipo akaphatikizidwa ndi mchere wamchere, mawonekedwe a hypercalcemiandi mtima glycosides – kuledzera kwa digito ndi hypokalemiandi Sotalolom – arrhythmiandi salicylates - adawonjezera poizoni pazovuta zamanjenje.

Zogulitsa hydrochlorothiazide amachepetsa cholesterol amapuma ndi Colestipol. Chifukwa chake, pakati pa kuvomereza ndikofunikira kuti mupange mpata umodzi mpaka maola angapo.

Izi zimagwira Hartil-D zimathandiziranso zotsatira zake. osapondereza minofu.

Komanso antihypertensive mphamvu ya mankhwalawa amachepetsa akaphatikizidwa ndi sodium chloride.

Ndemanga za Hartil-D

Ndemanga ya Hartil-D ikuwonetsa kuwongolera kwa mankhwalawa. Zotsatira zake zimawonekera kuyambira koyambirira kwamaphunzirowa. Odwala ena, komabe, amafunikira kusintha kwa mankhwalawa, chifukwa kuchepa kwambiri kwa magazi kumatha. Chifukwa chake chida ichi chikuyenera kugwiritsidwa ntchito moyang'aniridwa ndi katswiri. Ngati atengedwa mogwirizana ndi malingaliro a dokotala, zimathandiza ndi ochepa matenda oopsa.

Mtengo, kuti mugule

Mtengo wa chida ichi pamapiritsi a 2,5 mgramipril ndi 12.5 mg hydrochlorothiazide - pafupifupi ma ruble 300. Mtengo wa mapiritsi omwe 5 mg ramipril ndi 25 mg hydrochlorothiazide - pafupifupi ma ruble 400.

Kapangidwe ndi kapangidwe ka zochita

Piritsi limodzi lili ndi kapangidwe kake ntchito yogwiramonga ramipril mu 5 mg kapena 10 mg. Zothandizirazigawo malo azachipatala ndi:

• sodium bicarbonate,
• sodium croscarmellose,
• sodium walaryl fumarate,
• pregelatinized wowuma
• lactose monohydrate,
• chitsulo
• chitsulo oxide chikasu.

Mankhwala amatha kukhala ndi zotsatira za mtima ndi angioprotective. Komanso, mankhwalawa amatha kuyambitsa njira zosinthira magazi m'magazi amitsempha yamagazi, kuwononga cholesterol plaque, kuonjezera kuchuluka kwa fibrinogen ndikuchepetsa njira ya maselo a gluing pamodzi, ndiko kuti, kuphatikiza ma cell.

Zotsatira zabwino za kumwa mapiritsi a Hartil zimayamba kuonekera pambuyo pa maola 1-2. Mphamvu ya mankhwalawa imapitilira maola 24. Mphamvu za antihypertensive za mankhwalawa sizimadalira jenda, kulemera ndi msinkhu wa wodwala amene akalandira.

Ndipo mwatsatanetsatane wazambiri za ramipril ndi mankhwala ake atha kupezeka pakuwona vidiyo yotsatira.

Kutulutsa Fomu

Mankhwala ali piritsi. M'masitolo ogulitsa mankhwalawa mutha kugula ma CD, omwe amaphatikizapo mapiritsi asanu ndi awiri a kuwala kwapinki kapena a lalanje-apinki m'matuza.

Mapiritsi omwewo ali ndi mawonekedwe osyanthika, pamaso pawo mutha kujambula "R3". Mankhwalawa ali ndi 5 mg yofunikira yogwiritsira ntchito - ramipril.

Komanso mumasitolo ogulitsa mutha kugula phukusi la mapiritsi oyera asanu ndi awiri amodzimodzi, koma ndi cholembedwa "R4", zomwe zikutanthauza kuti kukonzekera kuli ndi 10 mg yayikulu yothandizira.

Kodi mapiritsi a Hartil amatengedwa milandu iti?

Madokotala amapereka mankhwala kwa odwala omwe ali ndi matenda monga:

• ochepa matenda oopsa
• kulephera kwa mtima
• matenda ashuga nephropathy,
• kulephera kwamtima chifukwa cha vuto la mtima.

Cardiologists adazindikira kuti kumwa mapiritsi kumachepetsa chiopsezo cha matenda a mtima ndi stroko, ngakhale kwa odwala omwe amachitidwa opaleshoni yopitilira apo.

Mimba komanso kuyamwa

Mankhwala Hartil-D amaphatikizidwa pakatundu, kotero kukhalapo kwa pakati kuyenera kusiyidwa musanayambe. Ngati wodwalayo akufuna kukhala ndi pakati, ayenera kusiya kutenga ACE inhibitors ndi hydrochlorothiazide ndikusintha ndi mankhwala ena a antihypertensive. Mimba ikachitika mukumwa mankhwalawa Hartil-D, ndiye kuti iyenera kusinthidwa posachedwa (mulimonse, asanafike kumapeto kwa trimester yoyamba) ndi mankhwala omwe alibe ACE inhibitor kuti mupewe chiopsezo cha kuwonongeka kwa fetal.

Popeza ramipril ndi hydrochlorothiazide amachotsedwa mkaka wa m'mawere, kuyamwitsa mkaka wa mankhwalawa ndi Hartil-D sikuloledwa.

Mlingo ndi makonzedwe

Hartil-D iyenera kutengedwa tsiku lililonse kamodzi m'mawa. Mapiritsi amayenera kumeza popanda kutafuna ndikumwa madzi ambiri (osachepera theka lagalasi). Mapiritsi a Hartil-D amatha kumwedwa mosasamala chakudyacho: amatha kumwa pamimba yopanda kanthu, nthawi yakudya kapena itatha. Mapiritsi amatha kugawanika pakati, kuswa pachiwopsezo.

Tengani Hartil-D, kutsatira mosamalitsa zomwe dokotala wamupeza. Mulingo woyambira wokhazikika kwa achikulire ndi 2.5 mg wa ramipril ndi 12,5 mg wa hydrochlorothiazide. Mlingo umatha kuchuluka ndi masabata atatu. Mulingo wokhazikika wokonza ndi 2,5 mg wa ramipril ndi 12,5 mg wa hydrochlorothiazide kapena 5 mg wa ramipril ndi 25 mg ya hydrochlorothiazide. Mulingo wambiri watsiku ndi tsiku ndi 10 mg ramipril ndi 50 mg hydrochlorothiazide. Kutalika kwa nthawi ya mankhwala kutsimikiza ndi dokotala.

Mlingo wa odwala okalamba komanso odwala omwe ali ndi vuto la chiwindi kapena impso nthawi zambiri amakhala otsika kuposa masiku onse ndipo amayenera kusankhidwa payekha ndi dokotala, poganizira momwe impso ndi chiwindi zimagwirira ntchito.

Zotsatira zoyipa

Pa Mlingo woyenera, mankhwalawa nthawi zambiri amaloledwa. Nthawi zina, kuoneka kosakhudzika kosatheka ndikotheka, komwe nthawi zambiri sikutanthauza kuti mankhwalawa atha. Ngati mukukumana ndi zovuta kapena zovuta zomwe sizinatchulidwe mu bukuli, kafunseni kwa dokotala kapena wamankhwala.

Kumayambiriro kwa maphunzirowa komanso mutakulitsa mlingo, kuchepa kwambiri kwa magazi kumatha kuchitika - kukulani hypotensionkuwonetseredwa ndi zizindikiro monga chizungulire, kufooka wamba, kuwona kwamaso, nthawi zina kukomoka kapena kusazindikira. The mwayi wa kukhala hypotension ndi wamkulu mwa odwala mkhutu - electrolyte bwino, ndi mtima kulephera, ndi zinchito aimpso kulephera. Ndi kukula kwa hypotension, wodwalayo ayenera kusunthidwa, ngati kuli koyenera, apange kulowetsedwa kwamitsempha kuti muwonjezere magazi ozungulira. Osakhalitsa hypotensive anachita si kuphwanya kwa pambuyo pake mankhwala. Ndi hypotension yayitali komanso yayitali, kuchepa kwa mankhwalawa kapena kusiya chithandizo kungafunike.

Amadziwika kuti kutenga ACE inhibitors kumatha kutsagana ndi chifuwa chowuma, omwe umawonjezeka usiku komanso malo othinana, amakhala ochulukirapo mwa azimayi komanso osasuta fodya. Kukhosomola uku nthawi zonse kumatha mosakhalitsa pambuyo pongomwa mankhwalawo. Nthawi zina kutsokomola kumatha kuyimitsidwa pomwe wodwala wasamutsidwira ku ACE inhibitor yina.

Izi ndi zina mwazotsatira zoyipa zomwe zimanenedwa pakuyesa kwachipatala komanso kugwiritsa ntchito mankhwala a ACE inhibitors, kuphatikiza ramipril kuphatikiza ndi hydrochlorothiazide.

Matenda a metabolism: kuchepa kwakukulu kwa mulingo wa potaziyamu m'magazi, m'malo ogwidwa kwambiri kapena kufooka kwa minofu, kuchuluka kwa urea ndi creatinine m'magazi, gout, kuchuluka kwa glucose m'magazi, komanso kuchuluka kwachulukidwe ka potaziyamu m'magazi.

Kuphwanya kwamanjenje: chizungulire, kutopa, kupweteka mutu, kufooka, kugona.

Zovuta za pamtima: ochepa hypotension, nsapato edema.

Matumbo: nseru, kupweteka m'mimba, matenda am'mimba, kukokana m'mimba, ludzu, kudzimbidwa, kutsegula m'mimba, kusowa chilakolako cha chakudya.

Matenda opatsirana: chifuwa, bronchitis, rhinitis, sinusitis.

Matenda aimpso: kuwonongeka kwaimpso, kuchuluka kwa urea m'magazi ndi seramu creatinine, kusowa kwamadzi.

Chisoni: conjunctivitis, blepharitis, kuchepa kwa mawonekedwe owoneka, tinnitus.

General zimachitika thupi, thupi lawo siligwirizana, zotupa za pakhungu: thupi lawo siligwirizana, nthawi zambiri mu mawonekedwe a zotupa pakhungu pang'onopang'ono - kawirikawiri - urticaria, zotupa pakhungu loyendetsedwa ndi kuyabwa, maonekedwe a zotupa kapena malo otuluka, kutupa kwa khungu ndi mucous membrane, photosensitivity, thukuta kwambiri, kupweteka kwapawiri, kufalikira kwa psoriasis, zokhudza zonse lupus erythematosus, vasculitis.

Zolemba zogwiritsira ntchito

Pa mankhwala ndi Hartil-D kuyang'anira pafupipafupi. Kuphatikiza pa kuthamanga kwa magazi, ntchito ya impso, kuchuluka kwa magazi ndi magawo amomwe amawonedwe amayenera kuyang'aniridwa nthawi ndi nthawi. Kuphwanya madzi - electrolyte bwino iyenera kuthetsedwa musanamwe mankhwala.

Hartil-D ingayambitse kuchepa kwambiri kwa magazi, makamaka itatha yoyamba kumwa kapena mutangoyamba kumwa. Kuchepa kwa hypotension kumakulirakulira ndi kuchepa kwa magazi kuzungulira magazi chifukwa cha kutaya kwamadzi ndi mchere, komanso kwa odwala omwe ali ndi vuto la mtima omwe ali ndi vuto lotsogola kapena magazi ochepa. Ndi chitukuko cha hypotension, wodwalayo ayenera kusunthira pamalo opingasa ndipo ngati kuli kotheka, kulowetsedwa kwamkati mwa mchere kumafunika kuwonjezera kuchuluka kwa magazi. Kungosintha kwakanthawi kochepa sikutanthauza kuphwanya mankhwalawa. Ndi hypotension yayitali komanso yathanzi, kungakhale kofunikira kuti muchepetse mankhwalawa kapena muimire chithandizo nayo.

Pankhani zotsatirazi, chisamaliro chapadera chiyenera kuchitika mukamagwiritsa ntchito Hartil-D:

- odwala kusowa kwamadzipa vuto la m'mimba ndi kusanza,
- odwala akutenga okodzetsa,
- Odwala ndi kuchuluka chimbudzi ma adrenal cortex mahomoni (Matenda a Conn)
- mwa anthu ogwiritsa Zakudya zamchere zochepakutenga potaziyamu wokhala ndi chitetezo chamagulu kapenapotaziyamu mankhwala
- odwala matenda oopsa aimpsozolemetsa kulephera kwa mtima, hypertrophic cardiomyopathy,
- odwala matenda ashugaomwe ayenera kuyang'anira pafupipafupi kuchuluka kwa glycemia. Kungakhale kofunikira kuti aliyense payekha asankhe kuchuluka kwa mankhwala ochepetsa shuga kapena kusintha kuchokera pakukonzekera piritsi kupita ku insulin,
- odwala zokhudza zonse lupus erythematosus kapena psoriasis Kuchulukitsa kwa matendawa ndikotheka.

Iyenera kupewedwa hemodialysis motsutsana kumbuyo kwa mankhwala ndi Hartil-D. Ngati dialysis ikufunika, muyenera kusinthira kumwa mankhwala ena a antihypertensive omwe si ACE inhibitor.

Ndikofunikira kudziwitsa dokotala za kumwa mankhwalawa Hartil-D musanachite opareshoni komanso opaleshoni, kuphatikizapo mankhwala oletsa mano.

Mankhwala a Hartil-D angayambitse chifuwa chowumazomwe nthawi zonse zimatha atasiya kulandira chithandizo.

Hartil-D ili ndi lactose monohydrate. Izi zimayenera kukumbukiridwa pothandizira odwala omwe ali ndi kuchepa kwa lactase ndi zovuta zina zosowa za metabolic (galactosemia kapena glucose / galactose malabsorption syndrome).

Ngati mukuyiwala kutenga Hartil-D pa nthawi, tengani mankhwalawa msanga momwe mungathere, kenako imwani mankhwalawo monga momwe dokotala wakupangirani. Ngati mlingo wotsatira ukhala maola angapo kapena nthawi yakwana kuti mutenge mlingo wotsatira mukalandila mlingo, musatenge mlingo wachiwiri wa Hartil-D kuti mulipire mlingo womwe mwasowa. Poterepa, musaphonye mlingo womwe sunamwe nthawi ndikupitiliza kumwa mankhwalawa malinga ndi chizolowezi.

Osasokoneza kapena kusiya kutenga Hartil-D nokha! Kuchotsa kuvomereza Hartil-D kapena kusintha kwa mlingo zikuyenera kuchitika monga momwe zalembedwera ndikuwunika adotolo.

Njira zopewera kupewa ngozi

Zotsatira paULAMULIRA kuyendetsa magalimoto kapena makina owopsa

Hartil-D, kutengera zomwe zimachitika munthu akamamwa mankhwalawo, zitha kukhala ndi vuto chifukwa chogwira ntchito yomwe imafunika chidwi chochulukirapo. Kumayambiriro kwa chithandizo cha mankhwala ndi Hartil-D ndipo mutachulukitsa mlingo, sikulimbikitsidwa kuyendetsa magalimoto kapena kugwira ntchito ina yomwe imafuna chidwi chochulukirapo komanso kuthamanga kwa zochitika zama psychomotor. M'tsogolomu, kuthekera kochita ntchito yomwe tafotokozayi ndikuwonetsetsa kuti mlingo woyenera umachitika ndi dokotala.

Kutenga?

Mapiritsi a Hartil amatha kuledzera ngati kuli koyenera, ndiye kuti, musanadye kaye, musanadye kapena pambuyo pake. Mankhwala sangathe kutafunidwa, muyenera kumeza mapilitsi athunthu ndi madzi wamba.

Kuvutika mtima ochepa matenda oopsa, dokotala wamtima angalimbikitse kumwa mankhwalawa 2.5 mg kamodzi patsiku. Ngati ndi kotheka, ndiye kuti mankhwalawa amwedwa pang'onopang'ono. Ndikofunika kudziwa kuti kuchuluka kwa Hartil komwe amatengedwa patsiku sikuyenera kupitirira 10 mg.

Kuvutika mtima kulephera kwa mtima aakulu mawonekedwe, dokotala amaletsa kumwa mapiritsi 1.25 mg tsiku lililonse. Ngati ndi kotheka, dokotala wa mtima amawonjezera mlingo wa mankhwalawo. Chiwerengero chonse cha mankhwala omwe amamwa patsiku sayenera kupitirira 10 mg.

Munthu amene wavutika vuto la mtima, mankhwalawa amathandizidwa masiku 2-9. Wodwalayo amamwa 2,5 mg ya mankhwalawa kawiri pa tsiku. Ngati ndi kotheka, dokotala wamtima angalimbikitse kuchuluka kwa Hartil.

Iwo amene akudwala nephropathy, muyenera kumwa 1.25 mg ya mankhwalawa patsiku. Mwakamodzikamodzi ndi matendawa, mlingo umasinthidwa kukhala 5 mg patsiku.

Monga kupewa matenda a mtima kapena sitiroko ndi mtima matenda adokotala amatha kupatsa wodwala kumwa Hartil kuchuluka kwa 2,5 mg patsiku. Mlingo wake umathanso kukula ndipo pang'onopang'ono ufike 10 mg.

Kugwiritsa ntchito Hartil ana, pa nthawi ya pakati komanso mkaka wa m`mawere

Mankhwalawa aletsedwa kumwa pa nthawi yobala mwana ndi kuyamwitsa. Hartil amatha kupangitsa kuti pakhale kuphwanyidwa kwa mapangidwe a impso za mwana wosabadwa, kuchepetsa kuthamanga kwa magazi ake. Komanso, mankhwalawo ndi owopsa chifukwa amatha kuthandizira pakukula kwa hyperkalemia mu fetus, chigaza hypoplasia ndi kupindika kwake, mapapu hypoplasia, matenda am'miyendo.

Chitetezo chotenga Hartil ndi magwiridwe ake osakwanitsa zaka 18 sichinakhazikitsidwe. Pankhaniyi, simungathe kutenga.

Contraindication zotheka ndi mavuto

Hartil sayenera kumwedwa pazotsatirazi:

• mbiri ya angioedema,
• Hypersensitivity kwa zinthu zomwe zili ndimankhwala,
• mimba nthawi iliyonse
• nyere
• aimpso mtsempha wamagazi,
• chachikulu hyperaldosteronism,
• bilteryal aimpso mtsempha wamagazi,
• kulephera kwa aimpso
• hemodynamics wosakhazikika.

Kuphatikiza apo, mankhwalawa amatha kuyambitsa zosankha zoyipa thupi litengedwa, lomwe lingaphatikizepo:

• kutsitsa magazi
• arrhythmia
• thrombocytopenia
• orthostatic hypotension,
• kuchuluka proteinuria,
• chifuwa chowuma
• kusokonezeka kwa malingaliro
• zosokoneza m'magazi,
• kuchuluka aimpso kulephera
• kunjenjemera
• Rhinorrhea
• myocardial ischemia ndi ubongo
• yafupika libido
• mawonekedwe ofooka
• kugona
• chisangalalo chamanjenje
• Kuzindikira kwamaso mwa kumva, kununkhiza, kulawa ndi masomphenya.
• kukokana
• bronchospasm
• alopecia
• Vuto lama vestibular
• kuchepa kwa ndende ya hemoglobin ndi hematocrit,
• rhinitis, sinusitis,
• bronchitis
• minofu kukokana
• hyponatremia,
• kuchepa kwamtima
• conjunctivitis
• nseru, kutsegula m'mimba, kapena kudzimbidwa
• kupuma movutikira, kamwa yowuma,
• hemolytic anemia
• zotupa, kuyabwa pakhungu.

Chifukwa cha kuchuluka kwa zovuta zomwe zimachitika mukamamwa mapiritsi, muyenera kumwa iwo, ndikuwona chitetezo. Ndikofunika kumvetsetsa kuti pochiza ndi Hartil, kuyendetsedwa ndi adokotala ndikofunikira. Izi ndizofunikira makamaka munthawi yanthawi yotsatira mlingo wa mankhwalawo ukakulitsidwa. Pakupita maola asanu ndi atatu mutatha kutenga Hartil muyezo wowonjezereka, nthawi zambiri mumayenera kuyeza kuthamanga kwa magazi ndikuwunika zomwe zikuwonetsa.

Komanso, kuyang'anira dokotala pafupipafupi kumafunikira kwa odwala omwe ali ndi impso, zotupa, aimpso, omwe amapatsirana impso.

Zochita zosiyanasiyana zomwe zimafunikira chidwi chochulukirapo ziyenera kusiyidwa kwa nthawi yamankhwala.

Kugwirizana kwa Hartil ndi mankhwala ena ndi mowa

Kuphatikizika kwa mapiritsi okhala ndi mitundu yosiyanasiyana ya mankhwala ndikotheka pazifukwa zamankhwala. Koma panthawi imodzimodzi, ndikofunikira kuganizira kuti kugwiritsa ntchito mankhwalawa munthawi yomweyo komanso mankhwala osokoneza bongo a magulu am'magazi monga cytostatics ndi corticosteroids, zimathandizira kuwoneka kwa kusintha kwa kapangidwe ka magazi ndipo kungayambitse kusokonezeka kwamitundu yambiri m'magazi.

Komanso ndizowopsa kuphatikiza kugwiritsa ntchito mankhwalawa ndi insulin komanso mankhwala ena pofuna kuthana ndi matenda a shuga, chifukwa mu nkhani iyi mumachepa kwambiri shuga, motero kungakhale koopsa.

Akatswiri a Cardio amalimbikitsa mwamphamvu kuti zakumwa zoledzeretsa ziletsedwe panthawi yothiridwa ndi mapiritsi awa, chifukwa amathandizira kuwonjezera zotsatira za zakumwa zakumwa zoledzeretsa.

Mankhwalawa mu mawonekedwe oyenera amasulidwe amagulitsidwa pafupifupi m'magulu onse a mankhwala. Mutha kugulanso mankhwalawo m'mafakitare apakompyuta. Pogula mankhwala, mankhwala ochokera kwa adokotala amafunikira.

Mtengo wapakati wa mankhwala umayamba kuchokera ku ma ruble 370 m'masitolo ogulitsa mankhwala ku Moscow. Mumachiritsi azamalonda pa intaneti mutha kugula mankhwala otsika mtengo - mtengo wa mapiritsi umayamba pa ruble 297.

Mankhwala ofanana ndi mtengo wake

Mankhwala otsatirawa atengedwa kuti ali ndi fanizo la mankhwalawa:

• Amprilan - kuchokera ku ruble 220,
• Pyramil - kuchokera ku ruble 202,
• Tritace - kuchokera ma ruble 996,
• Dilaprel - kuchokera ku ma ruble 115,
• Ramimed - kuchokera ku 280 rubles.

Musanagule fanizo la mankhwala, muyenera kuonana ndi dokotala ngati angathe kusintha mankhwalawo kapena ayi.

Hartil ndi mankhwala amphamvu, motero, ndikofunikira kumwa kokha ngati dokotala wathandizira ndikutsatira mosamala. Kupanda kutero, mutha kukulitsa zovuta zoyipa.

Kupanga ndi kuchitapo kanthu

Chofotokozerachi chikuti Hartil ndi wa gulu la zoletsa zoletsa za ACE. Chomwe chimagwira ntchito zake ndi ramipiril. Chifukwa chakuletsa kwa eniotensin-kutembenuza enzyme, wothandizirayo ali ndi kutanthauzira kwakukulu.

Tcherani khutu! Mankhwala amayamba kuchepetsa kupanikizika mkati mwa maola 1.5-2 pambuyo pa kuperekedwa. A kutchulidwa matenda zotsatira amakula pambuyo 3.5-6 ndipo kumatenga maola 24. Hartil imafuna kugwiritsidwa ntchito pafupipafupi komanso kwanthawi yayitali, ndizosatheka kumwa mapiritsi nthawi ndi nthawi.

Kuphatikiza apo, ramipyril:

• amalimbikitsa kusintha kosinthika kwa hypertrophy ya minofu yamtima (ndikugwiritsa ntchito nthawi yayitali),
• Amayenda bwino ndi magazi pama myocardium,
• amachepetsa ma pafupipafupi a arrhythmias,
• imachepetsa kupsinjika kwamitsempha yama portal ndi matenda oopsa a portal,
• linalake ndipo tikulephera kuwonongeka aimpso ntchito odwala matenda ashuga.

Zizindikiro zogwiritsidwa ntchito

Popeza timvetsetsa momwe mankhwalawo amagwirira ntchito, timakambirana momwe angagwiritsire ntchito.

• ochepa matenda oopsa
• CHF,
• pachimake myocardial infarction, mbiri ya stroko m'mbiri (kuchepetsa chiopsezo cha kubwereza mtima kwa mtima)
• nephropathy, kuphatikizapo matenda ashuga.

Kutulutsa Mafomu

Hartil amapangidwa ndi kampani yopanga mankhwala ku Hungary EGIS Pharmaceuticals PLC. Njira yokhayo yotulutsira mapiritsi ndi mlingo wa 5 kapena 10 mg. Mu phukusi la makatoni, kuwonjezera pa mapiritsi 28 a pinki kapena oyera, malangizo atsatanetsatane ogwiritsidwira ntchito ali. Mtengo wapakatikati wa bokosi ndi 410 p. Mlingo wa 5 mg ndi 460 r kwa 10 mg.

Tcherani khutu! Ndizopindulitsa kwambiri kugula mapiritsi 10 milligram. Iliyonse yaiwo itha kugawidwa pakati, kuswa pachiwopsezo.

Kuphatikiza apo, mzere waopanga uli ndi mankhwala osakanikirana ogwirizana ndi ramipiril ndi mankhwala ena a antihypertensive:

• Hartil Amlo (AM) (ramipiril + amlodipine) 5 mg + 5 mg, 10 mg + 10 mg,
• Hartil D (ramipiril + hydrochlorothiazide) 2,5 mg + 12,5 mg, 5 mg + 25 mg.

Njira yogwiritsira ntchito

Hartil amatengedwa pakamwa popanda kutafuna, kutsukidwa ndi madzi (yambiri, pafupifupi 200-250 ml) yamadzi. Muyenera kumwa mankhwalawa tsiku lililonse, maola 24 aliwonse.

Dokotala amakhazikitsa muyeso ndi nthawi ya chithandizo payekha kwa wodwala aliyense. Malangizo ofunikira aperekedwa pansipa.

Gome 1: Malangizo oyenera pa kusankha kwa Hartil:

Zofunika! Chidwi chopatsa chidwi chimafunikira kusankha kuchuluka kwa Hartil kwa odwala okalamba omwe amatenga mafuta okodzetsa komanso akuvutika ndi matenda oyanjana (kulephera kwa mtima, matenda opuwala a ziwalo zina).

Chithandizo cha matenda oopsa mu odwala matenda ashuga

Kodi Hartil ndi woyenera kuchitira matenda oopsa kwa odwala okalamba omwe ali ndi matenda a shuga a 2?

Moni Mwambiri, inde: mankhwalawa ali ndi zotsatira zabwino pa matenda a shuga a macroangiopathy ndi nephropathy. Komabe, kwa wodwala aliyense payekha, mankhwala a antihypertensive ayenera kusankhidwa payekhapayekha.

Kuphatikiza apo, kuphatikiza kwa Hartil kophatikizidwa ndi majakisoni obanika a hypoglycemic amachititsa kuchepa kwamphamvu m'magazi a shuga. Chifukwa chake, nthawi zina, motsutsana ndi maziko a mankhwalawa, ndikofunikira kusintha mlingo wa insulin.

Pharmacokinetics wa mankhwala.

Ramipril
Zogulitsa
Pambuyo pakukonzekera pakamwa, ramipril imalowa mwachangu. Poyerekeza ndi radioactivity yomwe yapezeka mumkodzo pambuyo pakulowetsa mafupa a ramipril (kuchulukitsidwa ndi impso ndi njira imodzi yokha), osachepera 56% amamwa. Kudya nthawi imodzi sikukhudza kuyamwa.
Ramipril ndi mankhwala osokoneza bongo, amapanga metabolism mu "gawo loyambirira" kudzera m'chiwindi, chifukwa chokhacho chomwe limagwira metabolite ramiprilat (chifukwa cha hydrolysis, makamaka m'chiwindi). Kuphatikiza pa kukhala metabolite wogwira wa ramiprilat, ramipril imalumikizana ndi glucuronic acid ndipo imasandulika kukhala liketopiperazine ester ya ramipril. Ramiprilat imalumikizidwanso ndi glucuronic acid ndikusinthidwa kukhala diketopiperazine-ramiprilat (acid). Chifukwa cha kutseguka / kagayidwe ka ramipril, bioavailability pambuyo pakamwa makonzedwe pafupifupi 20%.
Cmax ya ramipril mu plasma imafikira mkati 1 ora pambuyo pakamwa. Cmax ya ramiprilat mu plasma imafikiridwa mkati mwa maola 2-4 atatha kumwa kwa ramipril.
Kugawa
Kumangiriza kwa mapuloteni a plasma a ramipril ndi ramiprilat kuli pafupifupi 73% ndi 56%, motsatana.
M'maphunziro oyesera, zidapezeka kuti ramipril imapukusidwa mkaka wa m'mawere.
Kuswana
T1 / 2 ya ramipril ndi pafupifupi ola limodzi. Kuchepa kwa kuchuluka kwa ramiprilat m'magazi am'magazi ndi michere yambiri. Gawo loyambira ndikuchotsa koyambirira limadziwika ndi T1 / 2 yofanana ndi maola pafupifupi 3. Kenako gawo lapakatikati (T1 / 2 pafupifupi maola 15) ndi gawo lomaliza, pomwe nthawi ya nthawi ya ramiprilat mu plasma yamagazi ndi yotsika kwambiri (T1 / 2 - masiku 4-5), amatsata. ) Gawo lomaliza ndilobwera chifukwa chodzipatula pang'onopang'ono kwa ramiprilat kuchokera ku maofesi olimba koma okhazikika ndi ACE. Ngakhale kutalika kwa gawo lotha, Css ya ramipril imafikiridwa pafupifupi masiku 4 ndikudya kwa 2,5 mg kapena kupitirirapo kwa ramipril. Kugwiritsa ntchito bwino T1 / 2 (chizindikiro chokhudzana ndi kusankha kwa mankhwalawa) ndi maola 13 mpaka 17 mutatenga kuchuluka kambiri.
Pambuyo pakamwa 10 mg yolembedwa ramipril, pafupifupi 40% ya radioactivity imatulutsidwa m'matumbo ndi 60% ndi impso. Pakadutsa maola 24 atatha kumwa 5 mg ya ramipril ndi odwala omwe ali ndi catheter yomwe ikuwonetsa bile, zotsatira zofananira za ramipril ndi metabolites ake ndi impso ndi bile zidapezeka. Pafupifupi 80-90% ya metabolites yotulutsidwa ndi impso ndipo bile limayimiriridwa ndi ramiprilat ndi mankhwala chifukwa cha metabolism yake yowonjezereka. Glucuronide ndi diketopiperazine zochokera ku ramipril zimapezeka pafupifupi 10-20%, ndipo ramipril wosagwirizana ndi pafupifupi 2% ya kuchuluka kwa ramipril.

Mlingo ndi njira ya mankhwala.

Mapiritsi ayenera kumwedwa 1 nthawi / tsiku tsiku lililonse m'mawa, kumwa madzi ambiri. Mankhwalawa atha kumwa mosasamala chakudya. Mapiritsi sanapangidwe kuti agawidwe magawo.
Akuluakulu, mankhwala Hartil-D amalimbikitsidwa kuti azingoikidwa pambuyo pokhapokha posankha Mlingo uliwonse pazigawo zilizonse. Mlingo umatha kuchuluka ndi masabata atatu. Mulingo wamba woyambira ndi 2.5 mg wa ramipril ndi 12.5 mg wa hydrochlorothiazide. Mulingo wokhazikika wokonza ndi 2,5 mg wa ramipril ndi 12,5 mg wa hydrochlorothiazide kapena 5 mg ya ramipril ndi 25 mg ya hydrochlorothiazide. Mlingo wovomerezeka tsiku lililonse ndi 5 mg wa ramipril ndi 25 mg ya hydrochlorothiazide.
Kwa odwala okalamba komanso odwala CC kuchokera 30 mpaka 60 ml / min, Mlingo wa chilichonse mwa zigawozi (ramipril ndi hydrochlorothiazide) ayenera kusankhidwa mosamala musanapite ku Hartil-D wophatikizira mankhwala.
Mlingo wa Hartil-D uyenera kukhala wotsika momwe ungathere. Mlingo wovomerezeka tsiku lililonse ndi 5 mg wa ramipril ndi 25 mg ya hydrochlorothiazide.
Hartil-D ndi contraindication kwa odwala mkhutu aimpso ntchito (CC zosakwana 30 ml / mphindi / 1.73 m2).
Asanasinthe kupita ku Hartil-D, odwala omwe ali ndi chiwindi chofatsa kapena cholimbitsa ayenera kupatsidwa mlingo wa ramipril.
Saloledwa kumwa mankhwala Hartil-D mwa odwala omwe ali ndi vuto la chiwindi ndi / kapena cholestasis.
Hartil-D siyikulimbikitsidwa kwa ana ndi achinyamata (osakwana zaka 18) chifukwa chosowa chitetezo ndi chidziwitso chokwanira cha gulu ili.