Zizindikiro Zakudya ndi malangizo atsatanetsatane

Mapiritsiwo ndi oyera, ozungulira, a biconvex okhala ndi bevel mbali imodzi ndi zojambula za digito mbali inayo, zomwe zimasiyana kutengera mlingo wa chophatikizira chachikulu. Kuchuluka 5 mg torasemidechimafanana ndi nambala 915, ndi 10 mg - 916 kumbuyo kwa piritsi.

Mankhwala amagulitsidwa mumatumba a chimbale cha filimu ya polymer ndi zojambulazo za aluminium, m'chigawo chilichonse chotere. Pali mbale ziwiri pabokosi lamatoni (zidutswa 20 pabokosi).

Zotsatira za pharmacological

Diuver (INN - Diuver) Ndi mankhwala okodzetsa, magulu kuzungulira kwamikodzo zinthu, ndiye kuti, tanthauzo lalikulu la mankhwalawo kuzungulira kwa Henle (imodzi mwazinthu zofunikira kwambiri pakupanga impso - nephron) Machitidwe azotsatira zamankhwala ambiri ali linalake ndipo tikulephera kusintha mayamwidwe wa sodium ndi chlorine ayoni mu bondo lokwera lomwe limaonekera, lomwe limawonetsedwa pakuchepa kwa magawo a osmotic amadzimadzi a intracellular fluid. Zotsatira zake, imalephereka kubwezeretsanso madzitsiku lililonse limachuluka diuresis ndipo madzi owonjezera amachotsedwa m'thupi.

Limagwirira a zochita za mankhwala kukonzekera ikuchitika kuletsa onyamula ma ion mu gawo lodziwika lakukwera (dzina lina lachigawo ndilotakata) gawo lakumalo la nephron. Ma receptor nawonso amatsekedwa aldosteroneili mu minofu ya mtima. Izi zimalola zowonjezerakuwonjezera madzi akumwa, popeza mahomoni amtundu wa adrenal samapangitsa kuti madzi asamabwerenso.

Zotsatira za mtima zimalolera sinthani diastolic myocardial ntchito, popeza kuchuluka kwambiri ndi voliyumu kumalephereka (chifukwa chachikulu cha kupweteka kwamtima chifukwa cha kufooka kwa mtima ndi matenda oopsa a mtima). Chifukwa cha kuchuluka kwa myocardium ndi diastole yayitali imachepa fibrosing ndi chifuwa minofu ya pampu yamkati.

Diuver amathanso kuchita ngati antihypertensive wothandizira, popeza kuchitapo kanthu kwa Torasemide, chopangira chachikulu, chimadziwika chifukwa chakuchepa kwa zotumphukira mtima kukana (chigawo chodzaza, zomwe zimapangitsa kuti mtima uziyenda bwino, motero, zimachuluka kuthamanga kwa magazi) Makina a izi kukondoweza kwa potaziyamu ion ntchito maselo osalala a minofu yosanjikiza, momwe khomalo limayankhira zotsatira za mabaniki azinthu amachepa (mwachitsanzo, zinthu, katekisimaamukapena vasopressinmahomoni am'mbuyo titu tizizungulira).

M'pofunika kudziwa kuti torasemidemonga thiazide okodzetsa, ili ndi maubwino angapo kuyerekeza ndi njira yayikulu yopangira mankhwala - Furosemide:

kufikira pang'ono, mkhalidwe wamakhalidwe monga hypokalemia,
ntchito mankhwala torasemide kukwera
mphamvu zomwe Diuver amagwiritsa ntchito zimatenga nthawi yayitali, zomwe zimathandiza kuti pakhale nthawi yayitali mankhwala osokoneza bongo.

Pharmacodynamics ndi pharmacokinetics

Diuver amavomerezedwa pakamwamwachangu komanso mwathunthu (bioavailabilitymankhwala ndi 80-90 peresenti, kutengera mawonekedwe a thupi) imalengezedwa kuchokera m'mimba. Kuchuluka kwa plasma ndende yogwira ntchito kumawonedwa pambuyo pa maola 1-2, mutatha mapiritsi. M'magazi torasemideimagwira mapuloteni a plasma, omwe amapereka okodzetsa zotsatira pazaka khumi ndi zisanu ndi zitatu. Pafupipafupi kukodza kumachulukana mosasamala panthawi yonse ya mankhwalawa, mosakayikira ndi gawo labwino la mankhwalawa (mosiyana ndi Furosemide, silikakamiza kuchepetsa ntchito ya wodwala mutangomwa mapiritsi).

Wopangidwiramankhwala mu chiwindi, pansi pa michere mu kachitidwe cytochrome P450. Chemical zimachitika mawonekedwe hydroxylated metabolitesomwe amamangirira mapuloteni a plasma ndi 85-97 peresenti (kupezeka kwa chomangira kumadalira kutengera kwachilengedwe kwa ziwalozo komanso momwe ma oxidation ndi mphete ya hydroxylation zimachitikira).

AkuwonetsedwaDiuver makamaka ndi impso (impso chilolezo torasemidendi 10 ml / min, motsutsana ndi kumbuyo kwa kuchuluka - 40 ml / min) mu mawonekedwe a metabolites osagwira, pafupifupi magawo makumi asanu ndi atatu a zana limodzi. Hafu ya moyo kukonzekera kwa mankhwala ndi pafupifupi maola 3-4 (vuto la kulephera kwa impso, chizindikiro sichisintha mwanjira iliyonse). Gawo laling'ono la metabolites torasemideImapukusidwa kudzera mu hemodialysis ndi hemofiltration.

Zowonetsa Diuver

Chizindikiro chokwanira chogwiritsira ntchito mankhwala okodzetsa pamutu torasemidendi edematous syndrome motsutsana ndi maziko a matenda osiyanasiyana. Momwemo ndi matenda a impso, chiwindi, mapapu mu zovuta mankhwala, ndikofunikira kuphatikiza mankhwala omwewo.

Kulephera kwamtima kosalekeza Ndiwothandiza kwambiri kuchiza ngati mugwiritsidwa ntchito zida zodulirakuthandiza kuchepetsa kudzikundikira kwamadzimadzi m'matumba ndi minofu.

Zizindikiro zogwiritsa ntchito Diuver ndi ochepa matenda oopsa siwotsimikizika, koma ambiri azachipatala amagwiritsa ntchito mankhwalawa m'njira yochiritsira mosamala, popeza imakhala ndi mphamvu komanso yosatha poyerekeza ndi ma diuretics ena. Chowoneka chosangalatsa pakugwiritsa ntchito kwa Diuver ndi luso lake la pharmacokinetic komanso mlingo amadalirakuloleza kukhazikitsa bwino kufunika kwa achire.

Contraindication

Hypersensitivity kapena tsankho kwa zigawo zikuluzikulu za mankhwala,
Kulephera kwaimpso kwa anuria,
kuchepa kwa lactase (ndi kulolera kwa lactose, monga chifukwa chake) kapena kusamwa kwa glucose ndi galactose,
kusowa kwamadzi, exicosismachitidwe
hepatic chikomokere,
nthawi nyere,
kuledzera mtima glycosides,
kutchulidwa hypokalemiakapena hyponatremia,
lakuthwa glomerulonephritis,
zolakwika mtima valavu zamtima (makamaka stenosis ya msempha ndi mawonekedwe a mitral),
kuchuluka kwapakati pa venous kuposa 10 mmHg,
gulu mpaka zaka 18.

Palinso zochitika zingapo zam'magazi pomwe mankhwalawa amayenera kumwedwa pokhapokha poyang'aniridwa ndi akatswiri odziwa bwino chithandizo chamankhwala (kuti pakhale zovuta zoyipa zamankhwala othandizira, thandizo liyenera kuperekedwa mwachangu). Izi ndi monga:

ochepa hypotension,
atherosulinosis (makamaka mitsempha yam'mimba),
makonzedwe owonjezera plasma ndende za urate,
kuphwanya kutuluka kwa mkodzo kuchokera ku urethra (choyambitsa matenda ambiri) chosaopsa Prostatic hyperplasia mwa amuna kapena njira zamankhwala zotupa mwa akazi),
pachimake gawo myocardial infaration (chiopsezo chokhala ndi nkhawa ya cardiogenic ndi kupita patsogolo kwa njira ya pathological ikukula),
matenda ashuga (amachepetsa kulolera kwa shuga m'maselo ndipo amachepetsa mphamvu ya hypoglycemic ya mankhwala),
kuchepa magazi,
hepatorenal syndrome.

Zotsatira zoyipa

Mankhwala angayambitse zotsatirazi zovuta pa mankhwala a edema syndrome:

Mwa mtima:pachimake circulatory kulepherakuchepa kwambiri kwa kuthamanga kwa magazi mpaka kugwa, arrhythmias (makamaka tachycardia), kuchepa kwa kuchuluka kwa magazi ozungulira.
Mwa kwamikodzo dongosolo: pachimake kwamikodzokuwonjezera kuchuluka kwa mchere wa uric acid m'madzi am'magazi, hematuria(magazi mkodzo) interstitial nephritis, hydronephrosis.
Mwa VEB ndi KSCHB: kuchepa kwa zinthu za plasma za sodium, potaziyamu, chlorine, magnesium, calcium, kagayidwe kachakudya matenda, hypovolemia, kusowa kwamadzi, exicosis, kuchuluka kwa magazindi kuchuluka kwa magazi m'maso.
Mwa kagayidwe: hypercholesterolemia, hypertriglyceridemia ndi atherosulinosisZotsatira zake, kuchuluka kwakukula kwa magazi muine, Matenda a gouty, kuchepa kwa kulolera kwa glucose (kupweteketsa kotheka mawonetseredwe a shuga).
Tizilombo timimba: Zizindikiro zam'maso (mseru, kusanza, kupweteka kwa epigastric, kutsegula m'mimba), kuphwanya ntchito ya michere ya chiwindi, kapamba (kwambiri zakuthwa).
Mwa dongosolo lamkati lamanjenje ndi ziwalo zamakutu: kusinthasintha makutu kumva, tinnitusmutu chizungulire, paresthesia.
Chiwonetsero cha khungu: urticaria, Khunguzotupa zoyambira, dermatitis, zithunzi, vasculitis, anaphylactic ndi anaphylactoid zimachitika (mpaka chitukuko mantha onse).
Mwa magazi aziphuphu: kuchepa kwa chiwerengero cha maselo othandiza magazi kuundana komanso maselo oyera (omalizawo akuwoneka ngati agranulocytosis), aplastic kapena hemolytic anemia.

Diuver, malangizo ogwiritsira ntchito (Njira ndi Mlingo)

Mapiritsi amatengedwa pakamwandi madzi pang'ono. Ndikulimbikitsidwa kugwiritsa ntchito mankhwalawa mukangotha kadzutsa, pomwe adsorption m'mimba imalimbikitsidwa ndi mtanda wazakudya.

Dongosolo la mankhwalawa ndi dokotala wopita, poganizira za momwe munthu akuonekera ndi zomwe akuwonetsa pakuwongolera, kawirikawiri ndi edematous syndrome achire Mlingo wa magwero osiyanasiyana ndi 5 mg torasemidekamodzi patsiku. Pang'onopang'ono, tsiku lililonse mlingo umatha kuwonjezeka mpaka 20 ngakhale 40 mg pa nthawi, ngati pathological mkhalidwe wa wodwala umafuna. Siyani chithandizo pokhapokha pakutha kwa edema (kutsimikizira zoyenera, kusamalira kulemera ndi Mayeso a McClure-Aldrich edema obisika).

Malangizo ogwiritsira ntchito Diuver ndi ochepa matenda oopsa chosiyana pang'ono. Mlingo woyamba ndi 2,5 mg, ndiye theka la piritsi limodzi ndi zochuluka torasemide5 mg (kapena kotala, motero, pa 10 mg ya mankhwala othandizira). Ngati ndi kotheka, kuonjezera achire zotsatira, tsiku lililonse mlingo akhoza kuchuluka kwa 5 mg.

Bongo

Kuchuluka kwa plasma ndende ndi kusalamulirika kwa mankhwalawa kumayambitsa zotsatirazi za kuledzera:

kukodza pafupipafupi kukoka kwapadera kwamikodzo
ochulukirapo kusowa kwa magazi,
kutchulidwa kuchepa kwa kuthamanga kwa magazi, mpaka orthostatic hypotension,
kuphwanya ma electrolyte ndi acid-base balance of the body,
m'mimba kukhumudwa,
kugona,
chisokonezo,
kugwa- Kulephera kuzungulira kwa magazi.

Zapadera mankhwala, zomwe zingathandize ndi kuledzera kwa Diuver pamsika wamankhwala, koma pali njira zochizira zomwe zimalipira momwe thupi limagwirira ntchito. Zambiri zimagwiritsidwa ntchito intravenous kulowetsedwa isotonic ndi crystalline njira zothetsera kutayika kwa bcc. Mothandizidwa ndi seramu wozungulira wa elekitirodi ndi hemocrit Oyang'anira a CBS ndi VIB. M'malo ovuta kwambiri amatha kugwiritsidwa ntchitom'malo mwa magazi ndi magazi.

Ngati poyizoni wa mankhwala adachitika motsutsana ndi maziko a mankhwalawa omwe adwedwa kumene, ndiye kuti ndi othandiza chapamimba, kusanza, kutulutsa zomwe zili m'mimba mwanjira zonse (pogwiritsa ntchito njira zosungira, kugwiritsa ntchito mankhwala, ndi njira za physiotherapy).

Kuchita

Torasemide- Chithandizo chogwira ntchito kwambiri chomwe chimatha kulumikizana ndi mndandanda waukulu wa mankhwala. Chifukwa chake diuretic imawonjezera ndende, ndipo chifukwa chake chiopsezo cha zotsatira zoyipa (makamaka oto- ndi nephrotoxicity) zamagulu monga ma antibayotiki magulu cephalosporinndi aminoglycosides, chloramphenicol, chisplatin, ethaconic acid, amphotericin B (gwiranani monga mpikisano wa impso).

Payokha, ndikofunikira kudziwa kuti Diuver amachepetsa mphamvuothandizira a hypoglycemic, komwe kumafunika kukonza koyenera kwa matenda ashuga. Kupanda kutero, chitukuko ndichotheka hyperglycemic kapena ketoacidotic chikomokere komanso kusintha kosasinthika mu microvasculature. Kupanga kwamankhwala kumapangidwanso. allopurinolngati chithandizo chovuta ndichophatikiza mankhwalawa ndi mankhwala a m'mimba a Torasemide.

Diuver amachepetsa kwambiri impso Kukonzekera kwa lifiyamu, popeza kuti mkodzo wambiri wofooka umatulutsidwa (ndimphamvu zowonjezera zotulutsa, zida zama glomerular zimagwira ntchito mofooka). Izi zimawopseza chitukuko kuledzera kwa lithiamu, zomwe zitha kuwoneka motere:

dyspeptic matenda (nseru, kusanza, ndi zina)
kuchuluka kwamitsempha wamkati,
khunyu,
ataxia,
chachikulu kunjenjemera,
chisokonezo, delirium,
kulephera kwa aimpso.

Mankhwala osokoneza bongo oletsa kuponderezana kwambiri kuchepetsa okodzetsa kwenikweni torasemide, popeza amaletsa kaphatikizidwe ma prostaglandins, yomwe imadziwonetsera kuti ikuphwanya zochita za chinthu chamoyo monga renin m'magazi amwazi. Zotsatira zake, magazi aimpso amachepa ndipo kukodza sikumagwira. Yemweyo limagwirira a NSAIDs timapitiriza hypotensive zotsatira diuretic mankhwala (renin- gawo lalikulu la aimpso magazi a magazi, kupereka Pressor kwambiri pa bedi lamankhwala.

Sayenera kuphatikizidwa mu zovuta mankhwala ndi mankhwala omwe amalepheretsa angiotensin-kutembenuza enzyme kapena angiotensin receptor agonists pamodzi ndi zida zodulira, chithandizo chotere chimatha kubweretsa kuchepa kwambiri kwa kuthamanga kwa magazi ndikukula kwa ziwopsezo zamagazi kwambiri. Ndi zodziwikiratu, tikulimbikitsidwa kuti chithandizo chokhwima chisamaliro chichepe kapena kusiya kwakanthawi torasemide pamenepo.

Odwala omwe ali pachiwopsezo chachikulu chotenga matenda a impso (nephropathyMitundu yosiyanasiyana) iyenera kupewa cyclosporine ndi torasemide, popeza izi zimatha kukhala chinthu choyambitsa matenda oopsa kwambiri. Zotsatira zoyipa za cyclosporine ndikuphwanya kuchuluka kwa mchere wa impricity wa impso, ndipo torasemide, imapangitsa kuwonjezereka kwawo kwamphamvu m'magazi. Kuchitapo kanthu koteroko kumadzetsa kutsimikizika kwamatenda kapena chitukuko cha Matenda a gouty.

Malangizo ogwiritsira ntchito Diuver, mlingo

Mankhwala adapangira pakamwa. Mapiritsi amatengedwa m'mawa mutatha kadzutsa ndi madzi pang'ono.

Zochizira edematous syndrome, piritsi limodzi la Diuver 5 mg 1 nthawi patsiku limayikidwa. Ngati ndi kotheka, mlingo umatha kukula mpaka 20-40 mg kamodzi patsiku. Mwapadera, mlingo wa tsiku ndi tsiku umatha kukhala 200 mg.

Zochizira matenda oopsa, theka la piritsi la Diuver 5 mg (2.5 mg) 1 nthawi patsiku limasankhidwa. Nthawi zina, mwakufuna kwa dokotala, mlingo ungakulidwe mpaka 5 mg tsiku lililonse.

Kulandila kwa oposa 5 mg patsiku sikuti kumayambitsa kuchepa kowonjezereka kwa magazi ndipo sikulangizidwa pakufunika kwa matenda oopsa. Tizikumbukira kuti kwambiri hypotensive zotsatira za torasemide zimatheka pakatha masabata 12 atayamba chithandizo.

Okalamba odwala ayenera kutsegula torasemide mu Mlingo wochepa kwambiri ndikusintha kwa mankhwala mosamala.

Diuretic Diuver

Chofunikira chachikulu pa mankhwalawa ndi torasemide, yomwe imagwira ntchito ngati okodzetsa mosakhalitsa. Zowonjezera - chimanga wowuma, lactose monohydrate, sodium carboxymethyl. Muli ndi magnesium stearate, anidrous silicon dioxide. Mankhwala a Diuver ali ndi zisonyezo zogwiritsidwa ntchito puffness, machitidwe ake amathandiza:

kutsika kwa osmotic kuthamanga mu impso.
kuchotsa madzi ochulukirapo ku minofu,
kukakamiza kuyamwa kwa madzi, ma ayoni a sodium,
sinthani ntchito zam'mtima,
Kuchepetsa potaziyamu,
chepetsa fibrosis.

Diuver - malangizo

Zisonyezero zogwiritsira ntchito mankhwalawa zimatsimikiziridwa ndi dokotala. Kugwiritsa ntchito mankhwala Diuver, ndikofunikira kuti muphunzire malangizo, omwe amawonetsa malamulo ovomerezeka, mlingo ndi malingaliro:

Ganizirani zovuta, zotsutsana,
pimani magazi pafupipafupi
nthawi yomweyo kudya Veroshpiron kusunga potaziyamu,
kutsatira zakudya zomwe zimagwiritsidwa ntchito kwa nthawi yayitali.

Malinga ndi malangizo ogwiritsira ntchito, ndikofunikira:

Musanagwiritse ntchito mankhwala, sinthani muyezo wamagetsi wamadzi,
onani shuga
gwiritsani ntchito malonda mosamala molumikizana ndi ATP inhibitors - kuchepetsa kwambiri kupanikizika,
pewani kuyendetsa galimoto,
kumwa potaziyamu zowonjezera,
osatengera ntchito ndi mayunitsi ovuta.

Diuver - umboni

Pambuyo powerenga malangizowa, mutha kumvetsetsa kuti Diuver - zikuwonetsa kugwiritsa ntchito zomwe zili zoona za edematous syndromes zamitundu yosiyanasiyana, zimakhudza madera ambiri azamankhwala. Mankhwalawa amalembedwa ndi akatswiri a zamankhwala komanso endocrinologists, nephrologists ndi mtima. Mapiritsi a Diuver amakhudzanso matenda:

impso
mapapu
chiwindi
matenda oopsa okalamba,
kulephera kwa mtima.

Diuver - mlingo

Mukasankha Diuver - zisonyezo zakugwiritsa ntchito zomwe zimatupa, dokotala woyamba amasankha mlingo wochepa. Mukamawona wodwala, chithandizo chimasinthidwa. Kudziyendetsa nokha kwa okodzetsa ndikosavomerezeka chifukwa cha kupezeka kwa zoyipa, contraindication. Mankhwalawa amamwetsedwa m'mawa, atatha kudya, kutsukidwa ndi madzi. Nthawi zina, kugwiritsa ntchito moyo wake wonse kumalimbikitsidwa. Mlingo woyambirira wa Diuver patsiku:

ndi matenda oopsa - 2.5 mg - theka la piritsi,
pa matenda am'mapapo, impso - 5 mg,
ndi vuto lalikulu la mtima - mpaka 40 mg.

Diuver - zotsutsana

Diyala iyenera kugwiritsidwa ntchito moyang'aniridwa ndi dokotala, osati chifukwa choti zinthu zofunika zimatsukidwa kuchokera m'thupi zomwe zimafunikira kuwunika. Pali zotsutsana Diuver:

Kulephera kwa impso, komwe mkodzo sukulowa mu chikhodzodzo,
hepatic chikomokere
Hyponatremia - kuchepa kwa masodium,
hypocalcemia,
kuchepetsedwa kupanikizika
lactose tsankho,
pachimake glomerulonephritis.

Kugwiritsa ntchito mankhwalawa panthawi yapakati, ana, achinyamata osakwana zaka 18, pomwe kuyamwitsa sikuvomerezeka. Mankhwalawa adalakwika ngati:

mtima glycoside kuledzera,
thupi lawo siligwirizana,
kuchuluka venous anzawo
glucose mayamwidwe,
gout
pachimake myocardial infaration,
matenda ashuga
kuchepa magazi
kuyang'aniridwa kwa kutuluka kwa mkodzo,
chamkati michere,
kutsegula m'mimba.

Madokotala, akudziwa kuti diuver - zikuwonetsa kuti amagwiritsidwa ntchito nthawi zonse mogwirizana ndi malangizo, imagwira ntchito pamankhwala, ayenera kuganizira zovuta. Pali nthawi zosasangalatsa zotere zamthupi;

zamkati - kuponya kukoka, kukomoka,
kwamikodzo - kusungika kwamikodzo, maonekedwe a magazi mkati mwake, kuchepa potency,
kugaya chakudya - kutsekula m'mimba, kusanza, kukondoweza kwa kapamba, kuchepa kwa chakudya,
wamanjenje - tinnitus, dzanzi la miyendo, kuchepa kwa mawonekedwe,
kuthamanga kwa magazi - kuchepa kwa maselo ofiira a m'magazi, kusagwira bwino kwa dongosolo.

Diuver - analogues

Kukhalapo kwa zoletsa zambiri kumakakamiza madokotala kuti apereke kwa odwala, akagwiritsidwa ntchito, ma syulumms a diuretics omwe ali ndi chinthu chofanana. Maupangiri wapa radar akuonetsa ma analogi a Diuver omwe ali ndi mawonekedwe ofananawo:

Maphiri,
Aldacton
Arifon Penga,
Britomar,
Brinerdin,
Brusniver,
Brinaldix,
Bufenox,
Isobar
Zokardis kuphatikiza,
Zopondera
Clopamide
Lorvas
Lespeflan
Lasix
Kubwereza
Nebilong N,
Trigrim
Triamtel
Spironolactone
Furosemide
Phytolysin.

Mtengo wa Dongosolo

Ma diuretics angagulidwe pa counter pa shopu yapafupi. Ingolowetsani mankhwalawa pamakalabu ndipo mugule malo ogulitsira. Mtengo umatengera kuchuluka kwa mapiritsi omwe ali muphukusili, wopanga. Mtengo wa Diuver ndi analogues:

Zogwira ntchito, mg

Kusweka kwamitengo, ma ruble

Kanefron H, ngalande

Ekaterina, wa zaka 48 Torasemid Canon adayikidwa ndi endocrinologist, zikuwonetsa kuti matendawa amagwiritsidwa ntchito kwambiri. Sindikudziwa zoyenera kuyenda - miyendo yake sinafanane ndi nsapato zilizonse. Ndinkakonda kuti mankhwalawa ndi ofatsa, palibe chikakamizo chambiri kuchimbudzi. Patsiku lachiwiri, kulimba mtima kunayamba kutha, ndipo patatha sabata imodzi - kuwonda kunayamba. Ndikumva bwino.

Eugenia, wazaka 58 Monga wodwala wodwalitsa mtima wodziwa zambiri, nthawi zonse ndimawonedwa ndi dokotala. Mwa mankhwala omwe ndalamulidwa kuti azigwiritsidwa ntchito tsiku ndi tsiku, pali ma diuretics. Poyamba ndimamwa Acetazolamide, koma ili ndi mtengo wokwera kwambiri kwa omwe amapuma penshoni, ndiye wochiritsirayo adadzichotsa ndi Indapamide. Mankhwala ndi otsika mtengo, amasunga kukakamira, palibe zopweteka kuchokera pakukakamizika.

Valentina, wazaka 52. Nditapezeka ndi matenda a mtima osakhazikika, adapereka mankhwala a Veroshpilakton. Dokotalayo adalongosola kuti mankhwalawa samangochotsa timadzi tomwe timayenda, komanso amateteza potaziyamu ku leaching, omwe ndiofunikira kwambiri kwa ziwalo. Chachikulu ndichakuti kutupira thupi lonse kudutsa, ngakhale maso pankhope adawoneka.

Pharmacokinetics

Pambuyo pakukonzekera pakamwa, torasemide imathamanga ndipo imatsala pang'ono kulowa m'matumbo. Mulingo wokulirapo wa torasemide m'madzi a m'magazi umawonedwa pakatha maola awiri pambuyo pudya. Bioavailability ndi 80-90% yocheperako mosiyanasiyana.

Mphamvu ya okodzetsa imatenga maola 18, yomwe imathandizira kulolerana kwa chithandizo chifukwa chosowa kukoka pafupipafupi m'maola atatha kumwa mankhwala mkati, kuchepetsa ntchito za odwala.

Kuyankhulana ndi mapuloteni a plasma oposa 99%. Voliyumu yomwe ikuwoneka ndi 16 malita.

Zimapangidwa m'chiwindi pogwiritsa ntchito isoenzymes ya cytochrome P450 system. Zotsatira za oxidation motsatizana, hydroxylation, kapena mphete ya hydroxylation, ma metabolites atatu amapangidwa (M1, M3, ndi M5), omwe amamangiriza mapuloteni a plasma ndi 86%, 95%, ndi 97%, motsatana.

Hafu ya moyo (T1 / 2) ya torasemide ndi ma metabolites ndi maola 3-4 ndipo sasintha pakulephera kwa aimpso. Chilolezo chonse cha torasemide ndi 40 ml / min, chilolezo cha impso - 10 ml / min. Pafupifupi, pafupifupi 83% ya mankhwalawa amatengedwa ndi impso: osasinthika (24%) komanso mawonekedwe a metabolites osagwira (Ml - 12%, M3 - 3%, M5 - 41%).

Pakulephera kwa aimpso, T1 / 2 sasintha, T1 / 2 ya metabolites M3 ndi M5 imachulukirachulukira. Torasemide ndi ma metabolites ake amachepetsa pang'ono ndi hemodialysis ndi hemofiltration.

Ndi kulephera kwa chiwindi, kuchuluka kwa torasemide m'madzi a m'magazi kumawonjezeka chifukwa cha kuchepa kwa kagayidwe ka mankhwala mu chiwindi. Odwala omwe ali ndi mtima kapena chiwindi amalephera T1 / 2 ya torasemide ndi M5 metabolite imachulukitsidwa pang'ono, kuchuluka kwa mankhwalawa sikungatheke.

Ndi chisamaliro

Arterial hypotension, stenosing atherosulinosis ya mitsempha, hypoproteinemia, chiyembekezo cha hyperuricemia, kuphwanya kwamkodzo potuluka (chosaopsa Prostatic hyperplasia, kuchepa kwa urethra kapena hydronephrosis), mbiri ya urethra kapena hydronephrosis; shuga mellitus (kulekerera kwa shuga), hepatorenal syndrome, gout, kuchepa magazi, kubereka.

Zotsatira zoyipa

Malinga ndi malangizo ogwiritsira ntchito, kuikidwa kwa Diuver (5/10 mg) atha kutsagana ndi zotsatirazi zoyipa:

kuchepa kwa madzi m'thupi ndi kuwonjezeka kwa kuchuluka kwa magazi a potaziyamu, magnesium, calcium, chlorine ndi sodium,
kuchepa kwakukulu kwa kuthamanga kwa magazi,
arrhythmias ndi tachycardia, osagwa,
kuchuluka kwa kuchuluka kwa urea ndi cholesterol m'mwazi,
interstitial nephritis kapena pachimake kwamikodzo posungira,
kapamba ndi vuto la dyspeptic,
paresthesia
kusamvana kwakanthawi
Kusintha kwa chithunzi cha magazi mpaka kukwera magazi m'magazi.
khungu lawo siligwirizana, komanso anaphylactic mantha.

Ngati zikuwoneka kuti zikuwonetsa kuyambanso kwa zoyipa, ndikofunikira kuti musiye kumwa mankhwalawo musanapite kwa dokotala.

The diuretic mphamvu ya mankhwala kumatenga mpaka maola 18, chifukwa chomwe, mu maora ake atangoyambika, palibe kukakamiza pafupipafupi kukodza, kuchepetsa zomwe wodwala akuchita.

Contraindication

Diuver amatsutsana m'magulu otsatirawa odwala:

Ndi chidwi chambiri pa torasemide ndi / kapena sulfonamides, komanso okonda mankhwala,
M'mikhalidwe yomwe imayenderana ndi kusowa kwa mkodzo mu chikhodzodzo,
Mu mkhalidwe wa hepatic chikomokere, wodziwika ndi kusokonezeka kwamitsempha yamitsempha yam'mimba, chifukwa cha kuletsa kwambiri ntchito ya chiwindi.
M'malo ovuta,
Ndi kulephera kwa aimpso, komwe kumayendetsedwa ndi zizindikiro za azotemia,
Ndi ochepa hypotension,
Ndi arrhasmia.

Chifukwa cha kuchepa kwa maphunziro azachipatala nthawi ya mkaka wa m'mawere, sizikulimbikitsidwa kwa amayi omwe akuyamwitsa. Komanso, mankhwalawa ali osavomerezeka kwa ana osakwana zaka 18, popeza chitetezo chake ndi magwiridwe ake a gulu lino sichinakhazikitsidwe.

Kuwunikira nthawi zonse za fetal ndikofunikira, popeza ndikulowa mu minofu yake, torasemide imayambitsa kusokonezeka kwa kagayidwe kazinthu kamadzi, komanso thrombocytopenia.

Bongo

Mukamamwa mankhwala ochulukirapo a Diuver mwa odwala, zimatha kusokoneza chisokonezo chamagetsi, kuthamanga kwambiri, kugona, kusowa hypotension, chisokonezo komanso kuperewera kwa mtima.

Kuphatikiza apo, kukulitsa matenda am'mimba.

Mankhwala enieniwo sakudziwika. Kuchotsera kwa mankhwalawa kapena kuchepetsa mankhwala kumasonyezedwa. Ndi zizindikiro zazikuluzikulu za mankhwala osokoneza bongo, mphamvu yamagetsi yamagetsi imakonzedwa ndipo chithandizo cha mankhwala chimayikidwa.

Gwiritsani ntchito pa nthawi yoyembekezera komanso mkaka wa m`mawere

Torasemide ilibe teratogenic kwenikweni ndi fetotoxicity, imalowa mu chotchinga, ndikuyambitsa kusokonezeka kwa madzi a electrolyte metabolism ndi thrombocytopenia mu fetus.

Piritsi la Dokotala pa nthawi ya bereka lingagwiritsidwe ntchito pokhapokha ngati phindu la amayi likupita patsogolo pazowopsa zomwe zimayang'aniridwa ndi dokotala komanso muyezo waukulu.

Sizikudziwika ngati torasemide idutsa mkaka wa m'mawere. Ngati ndi kotheka kugwiritsa ntchito mankhwala Diuver pa mkaka wa m`mawere, ndikofunikira kusiya kuyamwitsa.

Analogs of Diuver, mtengo pama pharmacies

Ngati ndi kotheka, Diuver akhoza m'malo ndi analogue yogwira - awa ndi mankhwala:

Posankha analogi, ndikofunikira kumvetsetsa kuti malangizo ogwiritsira ntchito Diuver, mtengo ndi kuwunika kwa mankhwala omwe ali ndi zotsatira zofananira sizikugwira ntchito. Ndikofunikira kupeza upangiri wa dokotala komanso kuti usasinthe popanda mankhwala.

Mtengo m'mafakitale aku Russia: Mapiritsi a Diuver 5 mg 20 ma PC. - kuyambira 335 mpaka 391 rubles, 10 mg 20 pcs. - kuchokera 425 mpaka 439 rubles.

Sungani pamatenthedwe mpaka 30 ºº. Pewani kufikira ana. Moyo wa alumali ndi zaka zitatu. Mankhwala amagulitsidwa ndi mankhwala.

Ndemanga zitatu za "Diuver"

Amachotsa edema ndikuchepetsa kupanikizika, koma pali zovuta zina zoyipa ((

Mosiyana ndi anzako okwera mtengo kwambiri, Diuver ali ndi zovuta zina.

Njira yabwino yothetsera. Diuver adatengedwa ndi abambo anga chifukwa chakutha kwa mtima kuti amuchotsere kudzikuza kwambiri (miyendo yake idatupa kwambiri, mpaka zidatha kusuntha yekha). Asanachitike, Diuver adayesa zonse, koma palibe chowoneka komanso choyembekezeredwa.

Diuver, malangizo ogwiritsira ntchito: njira ndi mlingo

Mapiritsi otsekemera amayenera kumwa pakamwa kamodzi pa tsiku (mukatha kudya m'mawa), kutsukidwa ndi madzi okwanira.

Mlingo woyenera wosakwatiwa (komanso tsiku lililonse nthawi yomweyo):

Edema syndrome: mlingo woyambirira ndi 5 mg, ngati zotsatira zake sizikwanira, mlingo umawonjezereka mpaka 20-40 mg, nthawi zina - mpaka 200 mg. Ndikofunikira kutenga Diuver mpaka edema ikasowa, chithandizo chotenga nthawi yayitali ndizotheka,
Matenda oopsa a arterial: mlingo woyamba ndi 2,5 piritsi (1/2 piritsi), ngati ndi kotheka, onjezani mlingo mpaka 5 mg.

Malangizo apadera

Diuver ayenera kumwedwa mosamalitsa monga adokotala adanenera.

Mphamvu ya diuretic ya Diuver imatha mpaka maola 18, chifukwa chomwe, m'maola angapo atangoyenda, palibe kukakamiza pafupipafupi kukodza, kuchepetsa zomwe wodwala akuchita.

Mukamwa mankhwala ambiri a Diuver kwa nthawi yayitali, chiopsezo chotenga matenda a hypokalemia, hyponatremia ndi metabolic alkalosis amawonjezereka, chifukwa chake amalimbikitsidwa kuti azitsatira zakudya zomwe zimakhala ndi calcium sodium yambiri ndikuphatikiza kukonzekera kwa potaziyamu.

Odwala ndi aimpso kulephera, chiopsezo chotenga madzi amagetsi-electrolyte bwino ukuwonjezeka, motero, pa mankhwala, ulamuliro wa kuchuluka kwa ma elekitiroma mu plasma ya magazi (kuphatikizapo sodium, potaziyamu, calcium ndi magnesium), acid-base state, yotsalira wa nayitrogeni, uric acid ndiyofunikira ndi creatinine. Nthawi zina, chithandizo choyenera chofunikira chingafunikire, makamaka kwa odwala omwe akusanza pafupipafupi kapena kulandira madzi amadzimadzi.

Pankhani ya kuwoneka kapena kulimbikitsa oliguria ndi azotemia mwa odwala omwe ali ndi vuto la impso lakukula, chithandizo ndi Diuver tikulimbikitsidwa kuti iyimitsidwe.

Kusankhidwa kwa muyezo wa Diuver kwa odwala omwe ali ndi ascites omwe amayamba chifukwa cha matenda amchiwindi amayenera kuchitika mchipatala, popeza kusokonezeka muyezo wamagetsi wamagetsi kumatha kubweretsa kukula kwa hepatic chikomokere. Kuphatikiza apo, m'gulu ili la odwala, ma electrolyte a plasma amayenera kuyang'aniridwa pafupipafupi.

Odwala omwe amachepetsa shuga ndi shuga, ndikofunikira kuyang'anitsitsa kuchuluka kwa shuga mumkodzo ndi magazi.

Chifukwa cha chiwopsezo cha kusungika kwamkodzo kwamkodzo, kuwongolera mkodzo ndikofunikira kwa odwala omwe amachepetsa ureters ndi hyperplasia ya prostate, komanso odwala omwe ali ndi vuto losazindikira.

Mimba komanso kuyamwa

Mimba
Kuchepetsa: mankhwala ndi contraindicated.

Kuyanjana kwa mankhwala osokoneza bongo

Aminoglycosides, cephalosporins, ethaconic acid, amphotericin B, chloramphenicol, cisplatin: kuthamangitsidwa kwawo ndi chiopsezo chokhala ndi oto- ndi nephrotoxic zotsatira zimawonjezeka
Theophylline, diazoxide, antihypertensive mankhwala: zotsatira zawo zimakhala bwino,
Zochita kupumula kwamankhwala (mwachitsanzo, suxamethonium): mitsempha yawo yolumikizira minofu imakulitsidwa,
Osaletsa olemekezeka a minofu (mwachitsanzo tubocurarine), allopurinol, othandizira a hypoglycemic: magwiridwe awo amachepa,
Torasemide, ma Pressor mabwalo: kuchepa kwa mphamvu kukuwonekera,
Mankhwala omwe amateteza katulutsidwe ka tubular: kuchuluka kwa seramu torasemide,
Kukonzekera kwa Lithium: chilolezo chawo cha impso ndi mwayi wopitilira kuledzera,
Cyclosporine: chiwopsezo chowonjezereka cha matenda a gouty,
Amphotericin B, glucocorticosteroids: kuchulukitsa mwayi wokhala ndi hypokalemia,
Cardiac glycosides: chiwopsezo chotenga glycoside kuledzera chifukwa cha hypokalemia ndi kutalikitsa theka la moyo,
Mankhwala osokoneza bongo a Sucralfate, omwe si a anti -idalidal: mphamvu ya diuretic ya Diuver yafupika,
Ma salicylates okwanira Mlingo wambiri:
Angiotensin-converting enzyme inhibitors, angiotensin II receptor antagonists: kuchepa kwamphamvu kwa magazi kumatheka,
Methotrexate, probenecid: Kuchotsa kwawo kwaimpso kumachepa, kugwira ntchito kwa torasemide kumachepa.

Odwala omwe ali ndi chiopsezo chotenga nephropathy omwe akutenga Diuver, pamene othandizira a radiopaque amathandizidwa, kukanika kwa aimpso kumakhala kofala kuposa kwa odwala omwe ali ndi chiopsezo chachikulu cha nephropathy omwe adalowa mkati mwa kulowetsedwa kwa radiopaque.

Ma Analogs a Diuver ndi awa: Torasemide, Torasemide-SZ, Torasemide Vertex, Trigrim, Trifas, Britomar.

Ndemanga za Diuver

Ndemanga za Diuver ndizabwino. Odwala amadziona kuti ndi okodzetsa kwa nthawi yayitali, pang'onopang'ono komanso pang'ono pang'onopang'ono amadzimadzi, zomwe zimabweretsa mpumulo wa edema ya m'miyendo komanso kuchepa pang'ono kwa magazi. Komanso, kuthekera kwa kugwiritsa ntchito mankhwalawa kwa nthawi yayitali kumawerengedwa kuti ndi koyenera. Mtengo wake umakhala wokwera.

Kupanga ndi mawonekedwe a kumasulidwa

Diuver imapezeka mu mawonekedwe a mapiritsi oyera a mawonekedwe a biconvex wozungulira, omwe ali ndi chiopsezo chogawana mbali imodzi ndikulemba mbali inayo. Chofunikira chachikulu cha mankhwalawa ndi torasemide, zomwe zili m'mapiritsi ndi zolemba:

Zachipatala ndi gulu la mankhwala: diuretic.

Kodi chimathandiza ndi chiyani Diuver?

Malinga ndi malangizo, Diuver amalimbikitsidwa kwa odwala omwe ali ndi chiwonetsero cha edema syndrome chifukwa cha vuto la mtima, matenda a impso, mapapu ndi chiwindi.

Zotsatira zoyipa

Kugwiritsa ntchito bwino mankhwalawa ndikuwonetsetsa kuti dokotala walimbikitsa Ndi hypersensitivity kapena kugwiritsidwa ntchito mosalamulira, zotsatirazi zingakhale ndi izi:

Kuchokera kumbali ya madzi-electrolyte ndi acid-base usawa: hyponatremia, hypochloremia, hypokalemia, hypomagnesemia, hypocalcemia, metabolism alkalosis. Zizindikiro zomwe zikuwonetsa kukula kwa electrolyte ndi asidi-pamunsi zimatha kuphatikizira kupweteka mutu, kusokonezeka, kukokana, kufooka, kufooka kwa minofu, kuchepa kwa mtima komanso kusokonekera kwa magazi, hypovolemia ndi kuchepa magazi (nthawi zambiri mwa odwala okalamba), zomwe zingayambitse hemoconcentration ndi chizolowezi cha thrombosis.
Kuchokera pamtima wamtima: kuchepa kwambiri kwa magazi, kuthamanga kwa magazi, kugwa, tachycardia, arrhythmias, kuchepa kwa kuchuluka kwa magazi.
Kuchokera kumbali ya kagayidwe: hypercholesterolemia, hypertriglyceridemia, kuchuluka pang'onopang'ono mu ndende ya creatinine ndi urea m'magazi, kuwonjezeka kwa kuchuluka kwa uric acid m'magazi, komwe kumatha kuyambitsa kapena kukulitsa mawonetseredwe a gout, kuchepa kwa kulolerana kwa shuga (kutulutsa chiwonetsero cha matenda a shuga).
Kuchokera kwamikodzo dongosolo: oliguria, kusungika kwamikodzo poyerekeza (mwachitsanzo, ndi prostatic hyperplasia, kuchepa kwa urethra, hydronephrosis), nephritis ya pakati, hematuria, kuchepa kwa potency.
Kuchokera mmimba thirakiti: nseru, kusanza, kutsegula m'mimba, intrahepatic cholestasis, kuchuluka kwa michere ya "chiwindi", chifuwa chachikulu.
Kuchokera pakatikati wamanjenje, kumva chiwalo: kuchepa kwa makutu, kusinthika, komanso / kapena tinnitus, makamaka kwa odwala omwe amalephera kupweteka aimpso kapena hypoproteinemia (nephrotic syndrome), paresthesia.
Pa khungu: kuyabwa pakhungu, uritisaria, mitundu ina ya totupa kapena zotupa pakhungu, polymorphic erythema, exfoliative dermatitis, purpura, fever, vasculitis, eosinophilia, photosensitivity, anaphylactic kapena anaphylactoid pambuyo mtsempha wa magazi makonzedwe.
Kuchokera kwa magazi othandizira: thrombocytopenia, leukopenia, agranulocytosis, aplastic kapena hemolytic anemia.

Nthawi zina, manenedwe a anaphylactic angayambe.

Mankhwala

Diuver ndi okodzetsa ndipo amatchulidwa kwambiri komanso okodzetsa mphamvu yakepi. The yogwira pophika mankhwala kwenikweni sayambitsa kukula kwa hypokalemia, mosiyana furosemide ndi ena fanizo mankhwala.

Pambuyo piritsi mkati, chinthu chogwira chimatengedwa m'magazi ambiri, zochizira zamankhwala zimawonedwa pambuyo pa maola awiri. Mankhwalawa amaloledwa ndi odwala, choncho amatha kugwiritsidwa ntchito kwa nthawi yayitali ngati pakufunika.

Pa nthawi yoyembekezera

Pa nthawi yoyembekezera, kugwiritsa ntchito Diuver kumakhala koyenera pokhapokha pakufunika mofulumira. Kuvomerezedwa kuyenera kuchitika mu milingo yocheperako, pansi pazoyimira komanso moyang'aniridwa ndi dokotala yemwe ali ndi mkazi wovala ntchito. Kuwunikira nthawi zonse za fetal ndikofunikira, popeza ndikulowa mu minofu yake, torasemide imayambitsa kusokonezeka kwa kagayidwe kazinthu kamadzi, komanso thrombocytopenia.