Diroton kapena Lisinopril - ndibwino? Zinsinsi zam'mbuyo!

Diroton - awa ndi mapiritsi omwe amachepetsa mapangidwe a angiotesin II kuchokera ku angiotensin I, omwe amachepetsa kuchepa kwa bradykinin ndikuwonjezera kapangidwe ka prostaglandins. Kusintha koteroko kwa mankhwala mthupi kumathandizira kuchepetsa OPSS, kuthamanga kwa magazi, kutsitsa komanso kupanikizika kwa m'mapapo. Kuphatikiza apo, mankhwalawa amatha kuyambitsa kuchuluka kwa magazi kwa miniti ndikukulitsa mitsempha.

Diroton, monga fanizo lake, amatha kuwonjezera moyo wa odwala omwe ali ndi vuto la mtima komanso kuchepetsedwa kukula kwa vuto lakumanzere kwa odwala atatha kulowetsedwa ndi myocardial.

Zomwe zimagwira popanga Diroton ndi lisinopril. Pali zambiri zofananira zamankhwala zomwe zimagwiritsidwa ntchito. Funso: "Chingalowe m'malo ndi Diroton ndi chani?" Nthawi zambiri pamakhala wodwala akakumana ndi zomwe amamwa mankhwalawo, ndiye tikambirana za olowa mmalo ake otchuka.

Lisinopril ndi Diroton ali ndizofanana zambiri. Amaperekedwa mu mawonekedwe omwewo - mapiritsi a 5 mg, 10 mg ndi 20 mg, ndipo amatengedwanso kamodzi patsiku, mosasamala za kudya. Koma kokha Diroton iyenera kudyedwa kuwirikiza kawiri - 10 mg kamodzi patsiku, ndipo Lisinopril yekha 5 mg. M'njira zonsezi, zonse zimakwaniritsidwa sabata yachiwiri kapena yachinayi.

Kusiyana kwakukulu ndikwakuphwanya, chifukwa Diroton amaletsedwa kwa odwala omwe ali ndi cholowa cha Quincke, ndi Lisinopril kwa odwala osalolera a lactose, omwe ali ndi vuto la lactose, komanso malabsorption a glucose-galactose. Zina zotsutsana pazomwa mankhwalawa ndizofanana:

• mimba
• kuyamwa
• mbiri ya angioedema,
• Hypersensitivity mankhwala.

Chithandizo chogwira ntchito mu enalapril ndi enalapril - ndiye kusiyana kwakukulu pakati pa mankhwalawa. Komanso, mankhwalawa ali ndi mawonekedwe ochepa, mosiyana ndi Diroton amangogwiritsidwa ntchito pamagulu awiri okha:

• ochepa matenda oopsa
• kulephera kwa mtima.

Sizingakhale zoletsedwa kugwiritsidwa ntchito ngati vuto laimpso liyambika, pambuyo pakuwonjezeka kwa impso ndi hyperalosteronism yoyamba. Zotsalira zotsalira ndizofanana ndi Diroton.

Diroton ndi Lozap amakhalanso osiyana siyana pazomwe zimagwira, popeza pankhani yachiwiri ndi Lozartan. Chifukwa cha chiyani, mankhwalawa amagwiritsidwanso ntchito pochiza kutali ndi matenda onse a mtima, koma kokha ndi matenda oopsa komanso kulephera kwa mtima. Pankhaniyi, zotsutsana za mankhwalawa ndizofanana. Chifukwa chake, Diroton amasinthidwa ndi Lozap pokhapokha pomwe wodwala ali ndi hypersensitive to lisinopril.

Mwachidule, tinganene kuti mankhwala aliwonse ali ndi mwayi wake. Ma analogi a Diroton amasiyanitsidwa ndi contraindication kapena chinthu chogwira ntchito, chomwe nthawi zambiri chimakhala chinthu chofunikira posankha mankhwala.

Malinga ndi gulu la mankhwala, Diroton ndi wa gulu la angiotensin-converting enzyme inhibitors, kapena ACE inhibitors mwachidule.

Amagwiritsidwa ntchito matenda osiyanasiyana, kuphatikizapo asymptomatic atherosulinosis, matenda opatsika aimpso, omwe akuwonetsedwa ndi albuminuria.

Koma zikuluzikulu zomwe zimayambitsa kupangika kwa mankhwalawa ndi matenda a mtima, omwe amaphatikizidwa ndi matenda oopsa omwe amawononga magazi.

Mosiyana ndi mankhwala ena opangidwa ndi akatswiri a mtima kuchiza matenda oterowo, Diroton, monga amafananitsa kunyumba ndi kwina kuchokera ku gulu la ACE inhibitors, samayambitsa hypoglycemia, chifukwa chake imatha kugwiritsidwa ntchito mosamala matenda ashuga.

Kuti timvetsetse momwe magwiritsidwe ntchito a mankhwalawa, tiyeni tizingoganizira ntchito ya renin-angiotensin-aldosterone dongosolo ndi udindo wake pakupereka magazi.

Monga dzina la gulu lazachipatala lomwe Diroton ali nalo, zigawo zake zogwiritsa ntchito lisinopril zimayambitsa kuchepa kwa ACE mu plasma ndi zimakhala ndipo zimalepheretsa kutembenuka kwa angiotensin I ku boma lakelo, angiotensin II, kusokoneza zochitika zapazomwe tafotokozazi.

Chifukwa chake, Diroton ali ndi chiwonetsero chofunikira chazinthu kuti achepetse kuwonetsa kwa matenda oopsa, matenda a mtima, kulephera kwamtima kosalekeza.

Dutu lake lisinopril limapereka zotsatirazi za mankhwala pthupi:

• Zachika.
• Vasodilating ndi pleiotropic. Diroton linalake ndipo limalepheretsa ntchito ya enaseti ya kinase II ndikuwonjezera kuchuluka kwa bradykinin. Izi zimathandizira kuti maselo amtundu wa endothelium azilimbitsa, ndikuwonjezera kapangidwe ka nitric oxide. Mankhwalawa amakhalanso ndi anti-kutupa, amachepetsa kuchuluka kwa mapuloteni a C-yogwira komanso fibrinogen.
• Kuwongolera magazi kuyenda mu mtima ndi ziwalo zina, amene amachepetsa kwambiri vuto la matenda oopsa.
• Mtima. ACE zoletsa amayambitsa kusintha kwa kumanzere kwamitsempha yamagazi kwamtima, ndipo chizindikiro ichi ndi chofunikira chotsimikizika cha matenda amtima. Diroton imawonjezeranso kuchuluka kwa magazi ndi miniti yaying'ono, kumachepetsa mphamvu yotsatsira komanso pambuyo pake pa myocardium, yomwe imathandizira kubwezeretsa mphamvu yake komanso mgwirizano wake popanda kuwonjezera kuchuluka kwa mtima. Izi zimachepetsa kupita patsogolo kwa matenda osakhazikika mtima mwa wodwala ndipo zimawonjezera kukana kuchita zolimbitsa thupi.
• Wodzikongoletsa. Diroton amachotsa madzimadzi owonjezera ndi sodium ion mthupi, amenenso ndi amodzi mwa njira zochepetsera kuthamanga kwa magazi.

Lisinopril ndi amodzi mwa odziwika bwino kwambiri komanso ophunziridwa bwino ndi ACE. Kupanga kwake, zomwe zili mgulu la carboxyl, kumatsimikiza kukhalitsa komanso kulekerera bwino poyerekeza ndi ena oimira gululi.

Malinga ndi kufotokozeredwa, kuphatikiza kwa bioavailability kwa Diroton kumachokera 25-50%, ndipo chakudya sichikhudzanso gawo ili. Peresenti ya kuchuluka kwa lisinopril mu plasma imachitika patatha maola 6. Kuchotsa impso kumachitika m'magawo awiri. Woyamba - pambuyo maola 12, wachiwiri - pambuyo maola 30, womwe umalumikizidwa ndi nthawi yolumikizana ndi eniotensin-yotembenuza enzyme.

Pankhaniyi, kuti mukwaniritse khola la hypotensive, Diroton ndi yokwanira kutenga 1 nthawi patsiku (izi zafotokozedwera malangizo a mankhwalawa). A osinopril okhazikika a magazi m'magazi limachitika pa 2 - 3 tsiku kumwa mapiritsi, ndi mosalekeza achire zotsatira - masabata awiri atayamba kugwiritsa ntchito.

Diroton amadutsa chotchinga ndi magazi ndipo amatha kukhudza malo opumira omwe ali mu ubongo. Zotsatira zoyipa monga kutsokomola zimakhudzana ndi mawonekedwe a mankhwalawa. Kuphatikiza apo, lisinopril imalowa m'magazi amtundu wa placental, womwe umachepetsa kugwiritsidwa ntchito kwake pathupi.

Popeza kuphatikiza kwa oimira awa a ACE zoletsa ndi okodzetsa, kuphatikiza kophatikizira Co-Diroton kunapangidwa. Kuphatikiza pa lisinopril, imaphatikizanso gawo la diuretic hydrochlorothiazide. Izi zimathandizira kulimbitsa mphamvu ya wina ndi mnzake.

Malinga ndi madotolo, sikuti gawo yaying'ono pakufalikira kwa Diroton imaseweredwa ndi mtengo wotsika. Izi zimakupatsani mwayi wophunzitsira popanda kuopa kuti wodwalayo azitha kusokoneza chithandizo chifukwa chosowa ndalama.

Mankhwala Diroton amapangidwa ndi kampani ya ku Hungary GEDEON RICHTER (Gideon Richter). Mankhwalawa amapangidwa mwanjira ya mapiritsi mu gawo la 2,5, 5, 10 ndi 20 mg. Pakhoza kukhala matuza angapo mu phukusi, kuchuluka kwa mapiritsi ndi 14, 28 kapena 56.

Zisonyezo za kupatsidwa kwa mapiritsi a Diroton ndizomwe zimayambitsa:

• ochepa matenda oopsa
• Kulephera kwa mtima, nthawi zambiri ndimatenda ofanana, mankhwalawa amagwiritsidwa ntchito limodzi ndi mankhwala ena.
• pachimake myocardial infarction, ndi khola hemodynamic magawo, kumwa mapiritsi kukakamiza Diroton amayamba tsiku loyamba pambuyo kuukira,
• kuwonongeka kwamkati ndi minofu ya impso (nephropathy) yoyambitsidwa ndi matenda ashuga.

Kugwiritsa ntchito lisinopril kumakhala kochepa pazochitika zotsatirazi:

• kukhalapo kwa matupi awo sagwirizana ndi lisinopril wokha kapena magawo ena a mapiritsi,
• mbiri ya angioedema wodwala iyemwini kapena cholowa m'mabadwa (dzina lodziwika bwino ndi lotchuka ndi Quincke's edema),
• Mgwirizano wamitsempha wamagazi wamanjenje kapena matenda am'mimba a impso imodzi,
• kwambiri hypotension,
• kwambiri aortic stenosis,
• hyperkalemia (potaziyamu ion ndende pamwamba 5.5 mmol / l).

Mochenjera, mapiritsi a kuponderezedwa Diroton amalembedwa pambuyo pa kupatsirana kwa impso, pamaso pa zilonda kapena mawonekedwe oopsa omwe amalepheretsa kutuluka kwa magazi kuchokera kumanzere kwamitsempha, leukopenia, kuchepa magazi. Kuwunika momwe wodwalayo alili pakufunika kwa matenda a minofu yolumikizika.

Kuwonetsetsa makamaka kwa odwala omwe ali ndi vuto laimpso. Atapereka mapiritsi a kukakamiza, Diroton nthawi zonse amayang'anira kuchuluka kwa creatinine ndi seramu potaziyamu. Ndi kuchepa kwa kuchuluka kwa kusefera kwa glomerular kosakwana 60 ml / mphindi, muyezo wa lisinopril umatheka, osakwana 30 ml / mphindi - wolemba ¾.

Ndi kuwonongeka kwina mu ntchito ya impso, tikulimbikitsidwa kusankha inhibitor ina ya ACE yomwe imapangidwa m'chiwindi. Tiyeneranso kudziwa kuti chifukwa cha vasodilator ndi hypotensive zotsatira za mapiritsi a Diroton, amatengedwa bwino osati m'mawa, koma madzulo, nthawi yomweyo.

Mlingo wa mankhwala Diroton ungasiyane kutengera matenda. Chifukwa chake, kuchuluka koyamba kwa matenda oopsa kwambiri ndi 10 mg tsiku lililonse. Ngati wodwalayo akulekerera lisinopril, ndiye kuti amachulukitsidwa mpaka 20 mg. Ndi kusakwanira kwenikweni kwa mankhwalawa, Diroton wa mankhwala amatengedwa pa 40 mg patsiku. Komabe, mulingo wake ndi wokwanira, owonjezera ake ndi owopsa.

Ngati m'mbuyomu wodwalayo adalandira chithandizo chamankhwala ena (makamaka, okodzetsa ndi vasodilators), ayenera kuyimitsidwa osachepera maola 24 (moyenera masiku 2-4) asanayambe lisinopril. Ngati izi ndizosatheka pazifukwa zilizonse, kuchuluka koyamba kwa Diroton sikuyenera kupitirira 5 mg patsiku.

Poterepa, ndikofunikira kuwongolera kuthamanga kwa magazi. Nthawi yowopsa kwambiri ndi maola 6 mutatha kumwa koyamba. Kenako, mlingo woyenera wa lisinopril kapena kuphatikiza koyenera kwa mankhwala amasankhidwa.

Monga tafotokozera pamwambapa, kutenga Diroton kuli bwino masanawa. Chifukwa chake, kuthamanga kwa magazi m'mawa kumatsika, zomwe zimachitika makamaka kwa okalamba.

Kugwiritsa ntchito mankhwala Diroton kwa matenda oopsa oopsa chifukwa cha kukanika kwa renin-angiotensin-aldosterone dongosolo kumayamba ndi kuchepa kwa 2,5-5 mg. Kamodzikamodzi masiku atatu, pang'onopang'ono imachulukitsidwa mpaka 10 mg patsiku kapena kulolera monga momwe kungathekere. Munthawi imeneyi, ntchito ya impso, kuthamanga kwa magazi, komanso kuchuluka kwa potaziyamu ndi sodium m'madzi am'magazi amayang'aniridwa.

Kulephera kwa mtima kosatha, Diroton amatengedwa ndi mlingo wa 2,5 mg, womwe umawonjezereka mpaka 5-20 mg masiku 5. Kusankhidwa kwa mulingo wa tsiku ndi tsiku wa odwala omwe ali ndi nephropathy mu matenda a shuga kumachitika chimodzimodzi. Mlingo wa kuthamanga kwa magazi kwa diastoli mu nkhani iyi sayenera kupitirira 85-90 mm Hg.

Kulemba Diroton pambuyo kuphwanya kwachiwiri kumawonetsedwa kwa odwala popanda zizindikiro za hypotension.Patsiku loyamba ndi lachiwiri pambuyo powaukira, kukonzekera kwa 5 mg kumayikidwa, ndiye 10 mg amatengedwa. Lisinopril amatengedwa kwa milungu isanu ndi umodzi. Ndi kuchepa kwa kuthamanga kwa magazi, mlingo wake umatheka.

Kuyenera kudziwika kuti mwina mankhwala a Diroton mankhwala a mtima dongosolo mwana. Malinga ndi madokotala, sipanakhalepo zoyesedwa zachipatala pazamankhwala a lisinopril pa mwana. Pankhani imeneyi, mankhwalawa saikidwa mpaka zaka 18, ngakhale pazifukwa zaumoyo.

Kugwiritsira ntchito mankhwala Diroton pa nthawi ya pakati kumatsutsana. Lisinopril amadutsa chotchinga chachikulu ndipo amatha kuyambitsa vuto la hypoplasia ndi impso mu fetus, kufooka kwa mafupa, komanso kusowa kwa madzi m'magazi a electrolyte. Ma pathologies amenewa nthawi zambiri sagwirizana ndi chitukuko chowonjezereka cha fetal.

Ngati mimba idadziwika pakumwa mankhwala a Diroton, mankhwala ayenera kusiyidwa posachedwa, ndipo atabadwa, kuyang'anira mkhalidwe wa mwana ndikofunikira. Komanso, akatswiri a mtima samakhala ndi chidziwitso pakutseka kwa lisinopril mkaka wa m'mawere. Komabe, kugwiritsidwa ntchito kwake motsutsana mkaka wa m'mawere sikuloledwa.

Zotsatira zoyipa za mankhwala Diroton mu5-6%chidziwitso cha odwala:

• mutu
• chizungulire
• youma, yayitali
• kuchepa kwakukulu kwa kuthamanga kwa magazi ndi kusintha kwa maonekedwe a thupi,
• kusanza kapena kusanza
• kupweteka pachifuwa
• zotupa pakhungu.

Zotsatira zina zoyipa zimaphatikizidwanso ndi vuto pa kupanga aldosterone ndipo ndizochepa.

Odwala amatha kudandaula za izi:

• arrhasmia,
• kamwa yowuma
• matenda a m'mimba osokoneza bongo (kusowa kwa chakudya, kusowa kwa tulo, kuwonongeka kwa chiwindi),
• kutuluka thukuta kwambiri
• kudziwa dzuwa.
• kugona, chisokonezo, zomwe ziyenera kulingaliridwa poyendetsa galimoto, etc.,
• kusinthasintha
• kupuma mavuto
• zimachitikira onse
• kuphwanya dongosolo la hematopoietic (dontho la leukocytes, hemoglobin, mapulateleti, neutrophils ndi zinthu zina zopangidwa ndi magazi),
• utachepa potency
• kukodza kwamkaka komwe kumayenderana ndi vuto laimpso,
• minofu, kupweteka kwa molumikizana, kuchulukitsa kwa gout.

Chifukwa cha zovuta zoterezi, mankhwalawo sangathetsedwe mwadzidzidzi chifukwa choopseza kufooka kwa mtima.

Kupitilira tsiku lililonse la mankhwala Diroton ndiwowopsa ndi kutsika kwamphamvu kwa magazi ndi kulephera kwa aimpso. Kuphatikiza pa chizindikiro cha mankhwala, kupweteka kwam'mimba ndi adsorbent, hemodialysis pa "impso yokuchitira" imathandizira kuchotsa ntchito yogwira mankhwala osokoneza bongo a lisinopril.

Mankhwala Diroton kumlingo wina kapena wina umakhudza ziwalo zonse ndi machitidwe, motero makonzedwe a mankhwala owonjezera ayenera kuvomerezedwa ndi adokotala. Chifukwa chake, ngati vuto laimpso lalembedwera wodwala, kusamala kwapadera ndikofunikira pophatikiza ma potaziyamu oteteza pakhungu (Veroshpiron, Aldacton) ndi lisinopril chifukwa choopsa cha hyperkalemia.

Mankhwala otsatirawa amalimbikitsa kukomoka kwa Diroton:

• beta blockers,
• odana ndi calcium
• okodzetsa
• barbiturates, antidepressants,
• vasodilators.

Kuphatikizidwa kwa Diroton ndi zakumwa zoledzeretsa kumatha kuyambitsa Hypotension yayikulu.

Yogwira pophika mankhwala Diroton lisinopril amataya mphamvu yake akamamwa mankhwala otsatirawa:

• mankhwala osapweteka a antiidal
• Kukonzekera kwa lifiyamu
• Maantacid (kuchepetsa mayamwidwe a lisinopril m'matumbo am'mimba).

Kuphatikiza apo, kusintha kwa mlingo wa hypoglycemic wothandizira ndikofunikira kwa odwala matenda a shuga.Amayi ayenera kudziwa kuti Diroton wa mankhwala amachepetsa mphamvu zakulera zomwe zimachitika m'magazi a mahomoni apakhomo popewa kutenga pakati.

Diroton yaku Hungary pamtengo siyosiyana kwambiri ndi anzawo apakhomo.

Mtengo wa kulongedza mapiritsi a zidutswa 28 zimatengera kuchuluka kwa magawo omwe amagwira ntchito:

• 2,5 mg - ma ruble 120,
• 5 mg - 215 ma ruble,
• 10 mg - 290 ma ruble.

The fanizo la mankhwala Diroton ndi Lisinopril, Lisinopril Teva, Iramed, Lisinoton, Diropress, Lysigamma, Lizoril, Listril, Liten.

Ndemanga za a mtima zimawonetsa kuti Diroton mankhwala amapereka antihypertensive kwenikweni ndi kuteteza ziwalo zovutika ndi mtima kulephera. Kuphatikiza apo, katundu wapadera wa mankhwalawa amalola kuti iyenera kulimbikitsidwa kwa odwala osiyanasiyana omwe ali ndi matenda oopsa ndi kunenepa kwambiri komanso kuwonongeka kwa chiwindi.

Wolemba mu magazine:
"Systemic matenda oopsa", 2010, No. 3, p. 46-50

A.A. Abdullaev, Z.Yu. Shahbieva, U.A.Islamova, R.M. Gafurova
Dagestan State Medical Academy, Makhachkala, Russia

A.A. Abdullaev, Z. J. Shahbieva, U. A. Islamova, R. M. Gafurova
Dagestan boma sukulu, Makhachkala, Russia

Chidule
Cholinga: kuyerekezera mphamvu, chitetezo ndi pharmaco-zachuma kulungamitsidwa kwa mankhwala ovomerezeka ndi generic ACE inhibitors lisinopril (Irume (Belupo) ndi Diroton (Gideon Richter) monga monotherapy komanso kuphatikiza ndi hydrochlorothiazide mwa odwala omwe ali ndi matenda a grade 1 ochepa.
Zida ndi njira: Odwala 50 omwe ali ndi AH a 1-2 tbsp adaphatikizidwa mu kafukufuku wotsogola wokhala ndi mwayi wodziwika bwino. (Amuna 22 ndi akazi 28) wazaka 35-75, ali ndi nthawi yayitali yoopsa kwambiri wazaka 7.1 ± 3.3. Odwala asanu ndi mmodzi adasiya kuphunzira: 2 kumbuyo kwa chithandizo cha mankhwala ndi Irume ndi 4 kumbuyo kwa chithandizo ndi Diroton. Kuwunikira tsiku ndi tsiku kuthamanga kwa magazi (BPM) kunachitika pogwiritsa ntchito zida SL90207 ndi 90202 (SpaceLabsMedical, USA).
Zotsatira: chithandizo ndi Iramed kunayambitsa kutsika kwakukulu kwa kuthamanga kwa magazi (-27.8 ± 8.6 / -15.1 ± 6.9 mm Hg) poyerekeza ndi Diroton (-21.1 ± 6.9 / -9.0 ± 5.9 mmHg), pMapeto: Kuchiza ndi Irume odwala omwe ali ndi AH ya 1-2 mwamphamvu amadziwika ndi antihypertensive kwambiri ndipo amadziwikanso kuposa mankhwala a Diroton.
Mawu osakira: ochepa matenda oopsa, lisinopril, Irumed, Diroton.

Cholinga: kuyerekezera mphamvu ndi kulolera kwa chiphaso cha mankhwala ndi generic ACE inhibitor lisinopril (Irumed, Belupo ndi Diroton, Gedeon Richter) mu monotherapy komanso kuphatikiza ndi hydrochlorothiazide kwa odwala omwe ali ndi matenda oopsa (AH).
Zida ndi njira: mwachisawawa woyembekezeredwa pang'onopang'ono anali ndi odwala 50 omwe ali ndi AH (amuna 22 ndi azimayi 28 azaka 35-75 azaka zapakati pazaka 7.1 ± 3.3 zaka. Odwala 6 asiya kuphunzira (Irume -2 ndi Diroton - 4). Kuthamanga kwa magazi (BP) kuyang'aniridwa kwa maola 24 ndi chipangizocho SL 90207 ndi 90202 (SpaceLabs Medical, USA).
Zotsatira: Ndidakhala ndikuchepetsa kwambiri BP yachipatala (-27.8 ± 8.6 / -15.1 ± 6.9 mm Hg) kuposa Diroton (-21.1 ± 6.9 / -9.0 ± 5.9 mm Hg ), pMapeto: Chithandizo cha Irume chodziwika bwino kwambiri komanso chotsika mtengo kuposa chithandizo cha Diroton mu odwala omwe ali ndi giredi 1 ochepa matenda oopsa.
Mawu ofunika: ochepa matenda oopsa, lisinopril, Irumed, Diroton

Zambiri za alembawo
Abdullaev Aligadzhi Abdullaevich - Dr. med. sayansi, mutu. Department of Outpatient Therapy, Cardiology ndi General Medical Practice
GOU VPO Dagestan State Medical Academy
Shakhbieva Zarema Yusupovna - womaliza maphunziro ku dipatimenti yomweyo
Islamova Ummet Abdulhakimovna - Chinsinsi. wokondedwa sayansi, wothandizira kudipatimenti yomweyo. 367030, RD, Makhachkala, I. Shamily Ave., 41, apt. 94.
Gafurova Raziyat Magomedtagirovna - Chinsinsi. wokondedwa sayansi, wothandizira kudipatimenti yomweyo. 367010, RD, mzinda wa Makhachkala, ul. Mendeleev, d.12.

Mawu Oyamba
Chithandizo cha odwala omwe ali ndi matenda oopsa (AH) ndi ntchito yofunikira mwachangu, monga momwe chiwonetsero chake pakufa kwa mtima (SS) chikufikira 40%, ndipo ndi chithandizo chokwanira komanso chothandiza, chimatanthauzanso zoopsa zomwe zingayambitse matenda a mtima. IHD) ndi matenda ena a SS. Zotsatira za kafukufuku wambiri zatsimikizira kuti monotherapy imangogwira gawo laling'ono (pafupifupi 30%) la odwala omwe ali ndi matenda oopsa. Kugwiritsa ntchito mankhwala awiriwa kumakupatsani mwayi wokwaniritsa kuthamanga kwa magazi (Nthawi yomwe ntchito yateteza patent, ntchito iliyonse yamankhwala ikhoza kupanga ndikugulitsa mankhwalawa. Zotsatira zake, mankhwala omwewo kuchokera kwa omwe amapanga angapo amatha kugulitsidwa m'masitolo ogulitsa) Komanso, mankhwalawa amatha kusiyanasiyana ndikuchita bwino. Mapindu onse a mankhwalawa, omwe amatsimikiziridwa m'mayesero akulu azachipatala omwe amagwiritsidwa ntchito mosiyanasiyana, amakhudzana ndi mankhwala oyambira. ndi mankhwala opangidwa pansi pa layisensi.Mankhwala opangidwa ndi mtundu wina ayenera kuthandizira pakuyesa kwachipatala akakufanizira mwachindunji ndi koyambirira. Pankhaniyi, titha kunena kuti mankhwalawo adzakhala othandiza komanso otetezeka monga oyambira, ndipo zomwe zapezeka pamankhwala oyambirirawa zitha kugawidwa kwa iwo. Tsoka ilo, ndi ochepa mankhwala okhawo, kafukufuku wofanana adachitidwapo.

M'zaka zaposachedwa, pakhala chidwi chachikulu kumbali yazachuma. Izi zimakhudzidwa ndi kuchepa ndalama kwa mabungwe azachipatala, ndipo, nthawi zambiri, zofunikira zothandizira wodwalayo. Kuti muthane ndi vutoli pakadali pano, ndikofunikira kuti mugwire ntchito osati chithandizo chamankhwala komanso chitetezo chamankhwala ena, komanso zovuta zake zachuma kwa wodwala komanso paumoyo. Rational pharmacotherapy ya matenda aliwonse ayenera kukhala ozikidwa pa pharmacoeconomics.

Cholinga cha kafukufuku - yerekezerani mphamvu ya chitetezo, chitetezo ndi pharmacoeconomic kulungamitsidwa ndi zovomerezeka ndi generic ACE inhibitors lisinopril (Irume (Belupo) ndi Diroton (Gideon Richter) mu mawonekedwe a monotherapy komanso kuphatikiza ndi hydrochlorothiazide mwa odwala omwe ali ndi kalasi yoyamba yachiwiri ya matenda oopsa.

Zida ndi njira: Phunziroli lidaphatikizapo odwala 50 omwe ali ndi matenda oopsa a 1-2 zovuta, omwe 6 odwala adatsika panthawi yopenyerera: 2 munthawi ya chithandizo ndi Irume ndi 4 munthawi ya chithandizo ndi Diroton. Odwala 44 anamaliza kafukufukuyu. Poyamba, maguluwa analibe kusiyana zaka, jenda, ndi machitidwe ena (Gome 1). Phunziroli lidaphatikizapo odwala azaka za 18-75 azaka zapakati kapena omwe sanamwe pafupipafupi mankhwala a antihypertensive m'mwezi watha. Panthawi yophatikizidwa, gulu lambiri la systolic magazi (kalasi) linali 158.5 ± 7.5 mm Hg. Art., Diastolic magazi (DBP) C. 97.5 ± 5.0 mmHg. Art., Kugunda kwamtima 74.7 ± 8.8 kumenyedwa / mphindi. Njira zochotsetsedwera zinali: mitundu yachiwiri ya matenda oopsa, kuwonongeka kwa pachimake kwa magazi, kupweteka kwapachaka koopsa m'miyezi 6 yapitayo, angina pectoris II-III FC, kuperewera kwa mtima, mtima arrhythmias, chiwindi ndi impso.

Tebulo 1. Makhalidwe oyamba azachipatala komanso a anthu komanso a labotale

Dongosolo Lophunzira: kafukufukuyu anali osasankhidwa, otseguka, oyembekezeredwa, ndipo adachitidwa molingana ndi malamulo a GCP (Zabwino Zazabwino) ndi 2000 Helsinki Declaration. Nthawi yowonera inali masabata 24-25. Asanaphatikizidwe mu phunziroli, mbiri yonse yachipatala idachitidwa mwa odwala onse, kuyezetsa thupi kunachitika, kuthamanga kwa magazi kunayesedwa ndi njira ya Korotkov, pambuyo pake odwala omwe adakumana ndi njira zophatikizira ndipo osakhala ndi kusiyanitsa adagawidwa mosazindikira m'magulu awiri ofanana, woyamba omwe adayamba chithandizo ndi Iramed ndipo wachiwiri ndi Diroton pa 10 mg / tsiku. Pambuyo pa masabata awiri, pomwe kuchuluka kwa kuthamanga kwa magazi sikunachitike (kuthamanga kwa magazi kunatanthauzidwa ngati kuchuluka kwa kuthamanga kwa magazi atatu ndi buku la sphygmomanometer m'malo okhala pambuyo pakupumula kwa mphindi 10-15, komanso kuyimirira, miniti imodzi musanamwe mankhwalawa patsiku la kuchezerako.) kwa ma cell am'magazi a AD, adachepetsa maselo a DBP ndi 10% kapena 10 mm Hg ndi maselo a GARDEN ndi 15 mm Hg kuchokera pamlingo woyamba. mapulogalamu phukusi Statistiсa 6.0 (Statsof t, USA), kuperekera mwayi wowunikira parametric komanso nonparametric.Mosiyanawa adawoneka kuti ndiofunika pa p.Zotsatira ndi zokambirana

Mankhwala onse omwe amaphunzirawa anali ndi antihypertensive zotsatira zabwino, zomwe zidawonjezera kusintha kwa odwala kuphatikiza chithandizo. Amaganizira kwambiri kutsika kwa magazi monga ma cl. HELL, komanso malinga ndi a Scad. Pambuyo pa masabata awiri atatenga lisinopril pa mlingo wa 10 mg / tsiku mu gulu la Irume, kuthamanga kwa magazi kunachepa kuyambira 158.4 4 7.4 / 98.2 ± 4.4 mm Hg. Art. mpaka 146.1 ± 9.1 / 93.1 ± 6.1 mmHg. Art. (tsaTebulo 2. Mphamvu ya kuthamanga kwa magazi. Pa mankhwala ndi Irume ndi Diroton.

Kodi lisinopril kapena binoton ndiwabwino? Kodi pali kusiyana kotani?

Kukonzekera komwe kumakhala ndi Lisinopril Lisinopril, code ya ATX ATC C09AA03 Nthawi zambiri amakumana ndi mafomu omasulira opitilira mankhwala opitilira 100 ku Moscow. Diroton Diroton.

Izi zili chimodzimodzi. Pali ma contraindication (kwambiri). Funsani dokotala musanatenge.
Kusiyana kwakukulu ndikwakuphwanya, chifukwa Diroton amaletsedwa kwa odwala omwe ali ndi cholowa cha Quincke, ndi Lisinopril kwa odwala osalolera a lactose, omwe ali ndi vuto la lactose, komanso malabsorption a glucose-galactose.

Awa ndi mankhwala ofanana.
Diroton ndi amodzi mwa mayina amalonda a lisinopril
Kusiyanaku kumangokhala wopanga ndi mtengo

Izi zimathandiza. Mankhwala osokoneza bongo amachita mosiyana ndi aliyense

Mawu ofunikira arterial hypertension, lisinopril, Irumed, Diroton.If monotherapy ndi lisinopril Irume kapena Diroton sanalole kufikira gawo lamagazi, ndiye pambuyo pa masabata awiri hydrochlorothiazide hydrochlorothiazide GCT idawonjezeredwa 12,5 mg patsiku monga kuphatikiza kwaulere.

Ineyo pandekha sindinayenerere chimodzi kapena chimzake ... sizinachitike

Maziko a mankhwalawa ndi lisinopril dihydrate, ndipo kusiyana kuli m'zigawo zowonjezerazo, lomwe ndilo dzinali ndi prefix ku Latin Teva, Actavis, Ratiopharm, Stada, komanso gulu la mitundu yosiyana ya kumasulidwa Indapamide, Diroton, Irumed, Dapril, Captopril, Sinopril ...

Inde, ndiwe wopusa. Tengani mwachitsanzo aspirin athu, ndi Asipirin ochokera ku USA ndi amodzi ofanana, ndipo kusiyana pamtengo ndikwabwino. Ndimagwira ntchito m'minda yama pharmacy, motero ndikudziwa zomwe zachitika

Diroton lisinopril amalamula Wopanga Richter Gedeon Ltd, Hungary. Ndani akuwonetsedwa Diroton. Matenda oopsa a arterial mu mawonekedwe a monotherapy kapena kuphatikiza ena othandizira.

Uko nkulondola. Tidagawidwa mopusa.
Timalipira zotsatsa, zapamwamba.

Ndikuganiza inde, kuno anthu achi China ndi anzeru, akhala akugwiritsa ntchito mankhwala achikhalidwe kwazaka zambiri, komabe sanawabwezeretse pansi !!

Onani. Pali mitundu itatu yamchere: gome, nyanja, ndiukadaulo. Fomula imodzi ndi sodium chloride. Koma zodetsa ndizosiyana ... kodi mumathira mchere waukadaulo mu msuzi wanu? Zilinso chimodzimodzi ndi mankhwala osokoneza bongo. choyambirira chimakhala chozizira nthawi zonse. Chifukwa limapatsa ulamuliro wamphamvu.

Pali mankhwala ngati awa. Duphaston amawononga ma ruble 500, pali analogue yaku Russia (dzina layiwalika) -120 rubles. - palibe kusiyana. Koma nthawi yomweyo, acyclovir yathu siyothandiza konse, ngakhale imakhala ndalama, ndipo mopanda tsankho-170p imathandiza nthawi yomweyo.

Sindinganene kuti acyclovir siyothandiza, koma pali matenda osiyanasiyana, amathandiza munthu nthawi yomweyo, ndipo wina osatero
Koma! Ndimalola diroton (kulowererapo), ndikusinthidwa ndi lisinopril (mankhwala omwe ndi othandizira ndi osinopril, mulingo wambiri) -pezeka 0. Pali kusiyana, ngakhale kusiyana kwa mtengo ndi 30%. Ndimayesetsa kutenga zoweta m'malo mwakuitanitsa

Ndipo ka ndiboton kapena prestarium, pali kusiyana kotani pakati pa mankhwalawa. Diroton lisinopril ndi m'modzi mwa zoletsa ACE. Prestarium perindopril ndi mankhwala ena ochokera ku gulu lomweli.

Nditha kunena za Acetylsalicylic acid wopanga kwathu komanso Bayer (sindikudziwa za USA): yathu ndi mtundu wosakanikirana (osakanikirana) wa 2- (Acetyloxy) benzoic acid ndi 4- (Acetyloxy) benzoic acid, ndipo wopanga waku Germany adayeretsedwa ndi 4- (Acetyloxy ) benzoic acid, motero bwino. (Chifukwa chake dotolo wathu wa sayansi ya mankhwala adandiuza).
Ndipo pali mankhwala a generic ndi eni eni eni (Generic atha kukhala ndi zokopa zina kuposa zoyambirira - ndipo mankhwalawa onse amakhala ndi zotulutsa zambiri zomwe zimakhudza zochitika zamankhwala omwe amapezeka mankhwalawa (kuchuluka kwa mankhwalawa (kuwonjezeka / kuchepa, ndi zina).
Mankhwala enieni: opangidwa, amapitilira kafukufuku wonse, wokhala ndi malipoti, ndi ena ... (zimawononga ndalama) .... ndipo generic imapangidwa nthawi yomweyo atamaliza patent yoyamba ndi / kapena atasintha Aux.
Chifukwa chake, timavina, zomwe zili bwino ....

Chizindikiro ndichofunika ndalamazo. Ndani azilipira ngati si ife?

Pakukakamizidwa kumeneku, muyenera kuyitanitsa ambulansi, apo ayi mutha kusuntha kavalo

Mndandanda wa mapiritsi Diroton. Mapiritsi a Diroton Kutalika kwamavoti 8. Wopanga ma fomu a George Richter Hungary Kutulutsira Ma mapiritsi a Diroton. Mapiritsi a Lisinopril Avereji yamavoti 18. Mndandanda wa analogue ndi wotsika mtengo kuchokera ku ma ruble 60.

Yesani LYSINOPRIL 10 kapena ngakhale 20 ngati simutenga 10. Imwani piritsi 1 usiku.

Chifukwa chake muyenera kumuuza dotoloyo ndikutola atsopano, kuphatikiza mukuyenera kumwa zakumwa

Ambulansi, apereka jakisoni. Kufunika mwachangu kuti muchepetse kukakamizidwa, chifukwa chake kudzithandiza nokha pamenepa si koyenera.

Chofunikira chachikulu cha Diroton ndi lisinopril. Mtengo wa Diroton 20 mg ndi ruble 600. Mitundu yotchipa ya Diroton yokhala ndi chinthu chachikulu lisinopril.

Kupsinjika kotereku kumagwetsedwa ndi Captopress (kapoten) - piritsi 1 komanso pansi pa lilime (lidzatengedwa mwachangu ndipo lidzachitapo kanthu. Ndipo pambuyo pa mphindi 30 kukakamizidwa kumayesedwa - ndipo kutengera ndi piritsi lina. kuti sachita zinthu mwachidule ndipo satenga nthawi yayitali.
Ngati muli ndi mankhwala, ndiye kuti amawunikira pambuyo pa masabata osachepera awiri, ndipo ambiri - pakadatha masabata anayi. Chifukwa chake musathamangire kunena.

Kwa adotolo, ndipo ngati mapiritsi sangathandize, ndiye kuti muyenera kuyesa ena. aliyense amachita!

Oooooh kapena bwanji! Mukangotanganidwa choncho mwachangu pansi pa lilime, volidol kapena nitroglycerin pansi pa lilime ndikuyitanitsa ambulansi mwachangu !! ! Muyenera kuyikidwa ku dipatimenti yochiritsa kapena ku dipatimenti yamtima! Koma pa msinkhu wanu izi siziri konse zokhazokha !! ! Ndikumvetsetsa ngati ndiwe mayi wamkulu !! ! Koma osati pa usinkhu umenewo

Pakukakamizidwa kumeneku, muyenera kubaya dibazole ndi papaverine (iyi ndi ambulansi) Ndipo mukuyenera kusankha mankhwalawa kuti muthandizidwe ndi okodzetsa ...

Ёёёёё….
Diroton nambala 10, mutha kudziwa nambala 5
m'malo osafunikira, kusamba m'manja otentha pachiwuno, koma osapitirira mphindi 5 - zombozo zidzafalikira msanga, kupsinjika kudzachepa pomwe ambulansi ikuyenda ....
Kodi mwayesedwa? muyenera kudziwa kuti vuto ndi chiyani.

Diroton sikuti amatchulidwa. A George Richter, omwe amapanga, ndi chomera ku Hungary, pomwe amatenga zinthu zomwe sindikuzidziwa. Ndikugwirizana kwathunthu ndi a Mikhail Yuryevich kuti kusiyanitsa atomu imodzi kapena awiri kungabise kusiyana kwakukulu!

Mndandanda wazofanana ndi mitengo

Diroton (Lisinopril) - malangizo osankhidwa kuti agwiritsidwe

Nkhani yolembedwa ndi wolemba malowa, wamtima, pamatenda a matenda oopsa

Zonse zokhudza tonometer

Pali zotsutsana. Funsani dokotala musanatenge.

Mayina azamalonda kumayiko ena (kunja) - Acebitor, Acemin, Acerbon, Acinopril, Carace, Cipril, Coric, Diotril, Hipril, Lanatin, Linoxal, Lipril, Lisihexal, Lisinostad, Lisitec, Lisodura, Lisotec, Nivant, Novatecos, Odace, , Prinivil, Ranopril, Renotens, Secubar, Sedotensil, Sinopren, Tensiphar, Tensopril, Tevalis, Tobicor, Trupril, Vivatec, Zestomax, Zestril.

Ma zoletsa ena a ACE ali pano.

Mankhwala onse omwe amagwiritsidwa ntchito mu mtima pano.

Mutha kufunsa funso kapena kusiya ndemanga yokhudza mankhwalawa (chonde musayiwale kufotokoza dzina la mankhwalawo m'lemba la meseji) apa.

Zokonzekera zomwe zili ndi lisinopril (Lisinopril, code ya ATX (ATC) C09AA03):

Kodi generic ndiyiti yabwino?

Zachipatala ndi gulu:

ACE Inhibitor (Angiotensin Kutembenuza Enzyme)

ACE inhibitor, amachepetsa kupangika kwa angiotensin II kuchokera ku angiotensin I. Kutsika kwa zomwe angiotensin II kumabweretsa kutsika kwachindunji kutulutsidwa kwa aldosterone. Amachepetsa kuchepa kwa bradykinin ndikuwonjezera kaphatikizidwe ka prostaglandins. Amachepetsa OPSS, kuthamanga kwa magazi, kutsitsa, kupanikizika m'mapapo m'mimba, kumapangitsa kuchuluka kwa magazi kwa miniti ndikukulitsa kulolerana kwa mtima ndi odwala omwe ali ndi vuto la mtima. Imakulitsa mitsempha pamlingo wokulirapo kuposa mitsempha. Zotsatira zina zimafotokozedwa ndi kuthana ndi machitidwe a minye renin-angiotensin. Pogwiritsa ntchito nthawi yayitali, hypertrophy ya myocardium ndi makhoma amitsempha ya mtundu wotsalira amachepa. Amasintha magazi kupita ku ischemic myocardium.

ACE inhibitors imakulitsa chiyembekezo cha moyo kwa odwala omwe ali ndi vuto losatha la mtima, achepetsa kudutsa kwamanzere kwamitsempha yamagazi kwa odwala pambuyo poyambitsa myocardial infarction popanda mawonekedwe a mtima olephera.

Kukhazikika kwa mankhwalawa - pambuyo pa ola limodzi, kumafika pazokwanira pambuyo pa maola 6-7 ndipo kumatha kwa maola 24. Kutalika kwa zotsatirazi kumatanthauzanso kukula kwa mlingo womwe umamwa. Ndi ochepa matenda oopsa, zotsatira zake zimadziwika m'masiku oyamba pambuyo pa kuyamba kwa mankhwalawa, mokhazikika umayamba pambuyo pa miyezi 1-2. Ndi kusiyiratu kwakumwa kwa mankhwalawo, kuchuluka kwakukulu kwa magazi sikunawonedwe.

Diroton ® imachepetsa albuminuria. Odwala omwe ali ndi hyperglycemia, zimathandizanso kuti mawonekedwe a glomerular endothelium awonongeke. Zilibe kukhudzanso kuchuluka kwa shuga wamagazi mwa odwala matenda a shuga ndipo sikuti zimawonjezera kuchuluka kwa hypoglycemia.

Pambuyo potenga lisinopril mkati, Cmax imafikiridwa pambuyo pa maola 7. Nthawi zambiri kuyamwa kwa lisinopril ndi pafupifupi 25%, ndikusiyana kwakukulu pakati (6-60%). Kudya sizikhudzana ndi mayamwa.

Lisinopril amamangiririka pamapuloteni a plasma. Chilolezo kudzera mu BBB ndipo chotchinga chachikulu ndi chotsika.

Lisinopril sanapangidwe.

Imaphatikizidwanso ndi impso zosasinthika. Pambuyo pa kutsata mobwerezabwereza, T1 / 2 yothandiza ndi maola 12.

Odwala omwe ali ndi vuto lalikulu la mtima, mayamwidwe ndi chilolezo cha lisinopril amachepetsa.

Ntchito yaimpso yolakwika imabweretsa kuwonjezeka kwa AUC ndi T1 / 2 ya lisinopril, koma kusintha kumeneku kumakhala kofunika kwambiri pokhapokha kuchuluka kwa kusefukira kwa glomerular kumakhala kochepera 30 ml / min.

Odwala okalamba, kuchuluka kwa mankhwalawa mu plasma ndi AUC ndikwambiri kuposa kawiri kuposa kwa achinyamata.

Lisinopril amachotseredwa ndi hemodialysis.

Mlingo

Mankhwalawa amatengedwa pakamwa kamodzi pa tsiku, pazomwe zikuwonetsedwa, mosasamala za kudya, makamaka nthawi yomweyo.

Ndi matenda oopsa, odwala osalandira mankhwala ena a antihypertensive amapatsidwa 10 mg kamodzi patsiku. Mulingo wamba wokonzanso tsiku lililonse ndi 20 mg. Mlingo wambiri watsiku ndi tsiku ndi 40 mg.

Zotsatira zonse zimayamba pambuyo pa masabata 2-4 kuyambira pa chiyambi cha mankhwala, zomwe zimayenera kukumbukiridwa pakukweza mlingo. Ndi matenda osakwanira azaumoyo, ndizotheka kuphatikiza mankhwalawa ndi mankhwala ena a antihypertensive.

Ngati wodwalayo alandila chithandizo choyambirira ndi okodzetsa, ndiye kuti phwando lawo liyenera kuyimitsidwa masiku awiri asanafike ntchito kwa Diroton. Ngati ndizosatheka kuletsa kukodzetsa, ndiye kuti mlingo woyambirira wa Diroton suyenera kupitirira 5 mg patsiku. Pankhaniyi, mutatenga mlingo woyamba, kuyang'anira kuchipatala kumalimbikitsidwa kwa maola angapo (mphamvu yayitali imatheka pambuyo pafupifupi maola 6), chifukwa kutsika kwamphamvu kwa magazi kungayambike.

Pankhani ya kukonzanso kwamitsempha yamagazi kapena zinthu zina zomwe zikuwonjezera ntchito ya RAAS, ndikofunikira kuperekanso mlingo wotsika wa 2,5-5 mg patsiku pansi pazowongolera zamankhwala (kuyang'anira kuthamanga kwa magazi, ntchito yaimpso, seramu potaziyamu). Mlingo wokonza uyenera kutsimikizika kutengera mphamvu ya kuthamanga kwa magazi.

Pakulephera kwa impso, chifukwa chakuti impso imafufutidwa ndi impso, mlingo woyambirira uyenera kutsimikiziridwa malinga ndi chilolezo cha KK, ndiye, malinga ndi zomwe zimachitika, mlingo wokonzanso uyenera kukhazikitsidwa pansi pazoyang'anira kawirikawiri aimpso, kuzungulira kwa potaziyamu ndi sodium m'magazi a seramu.

Kulephera kwamtima kosalekeza, mlingo woyambirira ndi 2,5 mg 1 nthawi patsiku, womwe umatha kuwonjezeredwa pang'onopang'ono masiku 3-5 mpaka masiku onse, kumathandizira tsiku lililonse la 5-20 mg. Mlingo sayenera kupitirira pazipita tsiku 20 mg. Pogwiritsa ntchito munthawi yomweyo ndi okodzetsa, mlingo wa okodzetsa uyenera kuchepetsedwa, ngati kuli kotheka. Musanayambe chithandizo ndi Diroton ® komanso pambuyo pake, munthawi ya chithandizo, kuthamanga kwa magazi, ntchito ya impso, potaziyamu ndi sodium m'magazi ziyenera kuyang'aniridwa nthawi zonse kuti mupewe kukula kwa hypotension yokhudzana ndi minyewa komanso kusagwirizana kwa aimpso.

Mu pachimake myocardial infarction (monga gawo la mankhwala osakanikirana), 5 mg ndi mankhwala tsiku loyamba, 5 mg tsiku lachiwiri, 10 mg tsiku lachitatu, ndi mlingo wokonza 10 mg kamodzi patsiku. Odwala omwe ali ndi kuphwanya kwakumwa kwa myocardial, mankhwala ayenera kugwiritsidwa ntchito kwa milungu 6. Ndi magazi ochepa a systolic (osakwana 120 mmHg), chithandizo chimayamba ndi mlingo wochepa (2,5 mg /). Pankhani ya kukula kwa ochepa hypotension, pamene magazi a systolic ndi ochepera 100 mm Hg. Art., Mlingo wokonza umachepetsedwa kukhala 5 mg patsiku, ngati kuli kotheka, mutha kusankha kwakanthawi 2,5 mg patsiku. Pankhani ya kuchepa kwakanthawi kwa kuthamanga kwa magazi (kuthamanga kwa magazi m'munsi mwa Hg 90 mm. Art. Kupitilira ola limodzi), ndikofunikira kusiya mankhwalawa.

Mu matenda a shuga a nephropathy odwala matenda a shuga omwe amadalira shuga, Diroton ® amagwiritsidwa ntchito pa 10 mg kamodzi patsiku.Ngati ndi kotheka, mlingowo umatha kuwonjezeka mpaka 20 mg kamodzi patsiku kuti akwaniritse kuthamanga kwa magazi m'munsi mwa 75 mm Hg. Art. m'malo okhala. Odwala omwe samadwala matenda a shuga omwe amadalira insulin, mankhwalawa amapatsidwa mankhwala omwewo, kuti akwaniritse kuthamanga kwa magazi m'magazi a diastoli 90 mm Hg. m'malo okhala.

Zotsatira zoyipa kwambiri ndiz chizungulire, kupweteka mutu (5-6%), kufooka, kutsekula m'mimba, chifuwa chowuma (3%), nseru, kusanza, orthostatic hypotension, zotupa pakhungu, kupweteka pachifuwa (1-3%).

Makulidwe azinthu zina zoyipa amakhala ochepera 1%.

Kuchokera pamtima dongosolo: kuchepa kwamphamvu kwa kuthamanga kwa magazi, kupweteka pachifuwa, osawerengeka - orthostatic hypotension, tachycardia, bradycardia, mawonekedwe a kulephera kwa mtima, kukomoka kwa AV conduction, kulowetsedwa kwa myocardial.

Kuchokera pamimba: kukhumudwa, kusanza, kupweteka kwam'mimba, mkamwa wowuma, kutsekula m'mimba, dyspepsia, anorexia, vuto la kukoma, kapamba, hepatitis (hepatocellular ndi cholestatic), jaundice (hepatocellular kapena cholestatic), hyperbilirubinemia, kuchuluka kwa chiwindi.

Pa khungu: urticaria, thukuta lamphamvu, photosensitivity, kuyabwa, tsitsi.

Kuchokera kumbali ya chapakati mantha dongosolo: kuvutikako, kusokonezeka ndende, paresthesia, kuchuluka kutopa, kugona, kusokonekera kwa minofu ya miyendo ndi milomo, kawirikawiri - asthenic syndrome, chisokonezo.

Kuchokera pakapumidwe: dyspnea, chifuwa chowuma, bronchospasm, ziphuphu.

Kuchokera ku hemopoietic dongosolo: leukopenia, thrombocytopenia, neutropenia, agranulocytosis, kuchepa kwa magazi (kuchepa kwa ndende ya hemoglobin, hematocrit, erythrocytopenia), ndimankhwala osakhalitsa, kuchepa pang'ono kwa hemoglobin ndi hematocrit.

Thupi lawo siligwirizana: angioedema a nkhope, miyendo, milomo, lilime, epiglottis ndi / kapena larynx, matumbo angioedema, vasculitis, zabwino zochita antibodies, kuchuluka ESR, eosinophilia, mu zosowa kwambiri - interstitial angioedema (pulmonary edema popanda interstitial minofu kutuluka kwa transudate kupita ku lumen ya alveoli).

Kuchokera ku genitourinary system: uremia, oliguria, anuria, mkhutu waimpso, kulephera kwa impso, kuchepa potency.

Zizindikiro zasayansi: Hyperkalemia ndi / kapena hypokalemia, hyponatremia, hypomagnesemia, hypochloremia, hypercalcemia, hyperuricemia, kuchuluka kwa plasma urea ndi creatinine, hypercholesterolemia, hypertriglyceridemia, kuchepa kwa shuga.

Zina: arthralgia, nyamakazi, myalgia, malungo, kukokomeza kwa gout.

Mochenjera, mankhwalawa akuyenera kupatsidwa kwa minyewa yamitsempha yamafupa kapena stenosis ya mtsempha wama impso, pambuyo pa kupatsirana kwa impso, kulephera kwa impso (CC zosakwana 30 ml / min), stenosis ya orortice oripice, hypertrophic obstriers Cardiomyopathy, matenda oopsa a hypertrophic, ochepa hypotension kuphatikizapo cerebrovascular insufficiency), matenda a mtima, mitundu yayikulu ya matenda a shuga, matenda oopsa a mtima, matenda a mtima minofu (kuphatikizapo scleroderma, systemic lupus erythematosus), chopinga cha marow hematopoiesis, matenda a hypovolemic (kuphatikiza chifukwa cha matenda otsekula m'mimba, kusanza), hyponatremia (odwala omwe ali ndi mchere wopanda mchere kapena wopanda mchere, ali pachiwopsezo chokhala ndi matenda ochepa) hypotension), odwala okalamba omwe ali ndi hemodialysis pogwiritsa ntchito ma flowal dialysis okwera kwambiri (AN69®).

Kugwiritsa ntchito Diroton pa nthawi ya pakati kumapangidwa. Lisinopril amadutsa chotchinga. Mimba ikakhazikitsidwa, mankhwalawo amayenera kusiyidwa posachedwa. Kulandila kwa zoletsa za ACE mu II ndi III trimesters ya mimba kumakhala ndi zovuta pa mwana wosabadwayo (kutchulidwa kwa kuchepa kwa kuthamanga kwa magazi, kulephera kwa impso, hyperkalemia, chigaza hypoplasia, kufa kwa intrauterine ndikotheka).Palibe zambiri pazotsatira zoyipa za mankhwala kwa mwana wosabadwayo ngati agwiritsidwa ntchito koyamba. Kwa makanda ndi makanda omwe amakhala ndi intrauterine kukhudzana ndi ma inhibitors a ACE, tikulimbikitsidwa kukhazikitsa kuwunikira mosamala kuti mupeze nthawi yake yomwe kuchepa kwa magazi, oliguria, hyperkalemia.

Palibe chidziwitso pakulowerera kwa lisinopril mkaka wa m'mawere. Ngati ndi kotheka, kuikidwa kwa mankhwalawa panthawi yoyamwa, kuyamwitsa kuyenera kuyimitsidwa.

Pakulephera kwa aimpso, chifukwa chakuti lisinopril imachotsedwa kudzera mu impso, mlingo woyambirira uyenera kutsimikiziridwa malinga ndi chilolezo cha creatinine, ndiye molingana ndi zomwe zimachitika, muyeso wokhazikitsidwa uyenera kukhazikitsidwa pokhapokha pakuwunikira ntchito ya aimpso, potaziyamu ndi kuchuluka kwa sodium.

Mochenjera, mankhwalawa ayenera kuyambitsa kuvulala kwambiri aimpso, aimpso mtsempha wamagazi kapena matenda am'mimba a impso limodzi ndi azotemia wofalikira, momwemo pambuyo pakupatsirana kwa impso, kulephera kwa impso, azotemia.

Nthawi zambiri, kutsika kwamphamvu kwa kuthamanga kwa magazi kumachitika ndi kuchepa kwamphamvu kwamadzimadzi amayamba chifukwa cha mankhwala a diuretic, kuchepa kwa mchere mu chakudya, dialysis, kutsegula m'mimba, kapena kusanza. Kulephera kwamtima kwakanthawi limodzi ndi kulephera kwaimpso kamodzi kapena popanda izi, kuchepa kwamphamvu kwa magazi kumatheka. Kuchepetsa kwambiri kwa kuthamanga kwa magazi kumapezeka mwa odwala omwe ali ndi vuto lalikulu la mtima, chifukwa chogwiritsa ntchito okodzetsa kwambiri, kapena kuchepa kwa impso. Odwala otere, chithandizo ndi Diroton ziyenera kuyamba kuyang'aniridwa ndi dokotala (mosamala, sankhani kuchuluka kwa mankhwalawa ndi okodzetsa).

Malamulo omwewo ayenera kutsatiridwa popereka Diroton kwa odwala omwe ali ndi matenda amitsempha yamagazi, kuchepa kwa magazi, komwe kuchepa kwambiri kwa magazi kungayambitse kuphwanya kwa myocardial kapena stroke.

Kuchepetsa mphamvu kwa nthawi yochepa sikukutsutsana pakumwa mlingo wotsatira wa mankhwalawa.

Musanayambe chithandizo ndi Diroton, ngati kuli kotheka, sinthani sodium ndende ndi / kapena mupangitse kuchuluka kwa madzi otayika, yang'anirani mosamala za zotsatira zoyambira za Diroton pamagazi a wodwalayo.

Chithandizo cha chizindikiro cha ochepa hypotension imakhala ndikupereka kupumula kwa bedi ndipo ngati kuli kotheka, iv fluid fluid (kulowetsedwa kwa saline). Kutsika kwakanthawi kwakanthawi kochulukitsa sikunyozetsa chithandizo kwa Diroton®, komabe, kungafune kuchotsedwa kwakanthawi, kapena kuchepetsa mlingo.

Mankhwala a Diroton ® amatsatiridwa chifukwa cha kugunda kwa mtima ndi kupunduka kwamkati, ngati kuikidwa kwa vasodilator kumatha kuvuta kwambiri hemodynamics, mwachitsanzo, ngati magazi a systolic sangadutse 100 mmHg. Art.

Odwala omwe ali ndi kupweteka kwambiri kwa myocardial infarction, kuchepa kwa impso (plasma creatinine ndende yoposa 177 μmol / L ndi / kapena proteinuria yoposa 500 mg / 24 h) ndi kutsutsana kwa kugwiritsa ntchito mankhwala Diroton ®. Pankhani ya kukula kwa aimpso kulephera mankhwalawa lisinopril (kuchuluka kwa creatinine mu madzi am'magazi ndi oposa 265 μmol / L kapena kawiri msinkhu woyambira), adotolo ayenera kusankha pakufunika kwa kusiya mankhwala.

Ndi awiri a impso artery stenosis ndi a impso a stenosis a impso imodzi, komanso ndi hyponatremia komanso / kapena kuchepa kwa bcc kapena kulephera kwa magazi, masinthidwe ena am'mimba omwe amayamba chifukwa cha kumwa mankhwala a Diroton ® kungayambitse kuchepa kwa impso poyambanso kusintha kwachulukidwe (pambuyo posiya mankhwala). kusakwanira. Kuwonjezeka kwakanthawi kochepa mu ndende ya urea m'magazi ndi creatinine kumatha kuwonetsedwa ngati kuwonongeka kwaimpso, makamaka motsutsana ndi maziko omwe amachitika nthawi yomweyo.Pankhani ya kuchepa kwakukulu kwa impso (CC zosakwana 30 ml / min), kusamala ndi kuwongolera kwa ntchito yaimpso ndikofunikira.

Angioedema ya nkhope, miyendo, milomo, lilime, epiglottis ndi / kapena larynx sichinkawonetsedwa kwambiri mwa odwala omwe ali ndi ACE zoletsa, kuphatikizapo mankhwala Diroton ®, omwe amatha kuchitika nthawi iliyonse panthawi yamankhwala. Pankhaniyi, chithandizo ndi Diroton® chiyenera kuyimitsidwa posachedwa ndipo wodwalayo ayenera kuyang'aniridwa mpaka zizindikirocho zikuyambiranso. Muzochitika pomwe panali kutupa ndi pakamwa pokhapokha, matendawa amatha nthawi zambiri popanda kuthandizidwa, komabe, amatha kupereka mankhwala a antihistamines. Angioneurotic edema yokhala ndi edema laryngeal imatha kupha. Lilime, epiglottis kapena larynx itaphimbidwa, kutsekeka kwa mpweya kungachitike, chifukwa chake, chithandizo choyenera chikuyenera kuchitika nthawi yomweyo (0.3-0.5 ml ya epinephrine (adrenaline) yankho la 1: 1000 s / c, makonzedwe a GCS, antihistamines) ndi / kapena njira zowonetsetsa kuti msewu usunthidwe. njira. Odwala omwe ali ndi mbiri ya angioedema yomwe siyinkagwirizanidwe ndi chithandizo cham'mbuyomu ndi ACE inhibitors, chiwopsezo cha chitukuko chake pakulandidwa ndi ACE inhibitor chitha kuchuluka.

Kuchita kwa anaphylactic kunadziwikanso mwa odwala omwe akudwala hemodialysis omwe amagwiritsa ntchito ma flowal dialysis membranes (AN69 ®) omwe amatenga Diroton ® nthawi yomweyo. Zikatero, ayenera kuganizira za mtundu wina wa dialysis membrane kapena antihypertensive agent.

Nthawi zina desensitization motsutsana arthropod allergen, chithandizo ndi ACE zoletsa limodzi ndi hypersensitivity zimachitikira. Izi zitha kupewedwa ngati mutasiya kaye kutenga ma ACE inhibitors.

Odwala omwe ali ndi opaleshoni yayikulu kapena nthawi yochita opaleshoni, ACE inhibitors (makamaka, lisinopril) atha kuletsa mapangidwe a angiotensin II. Kutsika kwa kuthamanga kwa magazi komwe kumalumikizidwa ndi kayendedwe kameneka kumakonzedwa ndikuwonjezeka kwa bcc. Pamaso pakuchita opaleshoni (kuphatikizapo mano), ndikofunikira kuchenjeza opaleshoni yokhudza kugwiritsa ntchito mankhwalawa Diroton ®.

Kugwiritsa ntchito Mlingo wa mankhwalawa mu odwala okalamba kungayende limodzi ndi kuwonjezeka kwa lisinopril m'magazi, kotero kusankha kwa mankhwalawa kumafunikira chisamaliro chapadera ndikuchitika molingana ndi vuto la impso la wodwalayo komanso kuthamanga kwa magazi. Komabe, mwa okalamba ndi achinyamata odwala, mphamvu ya antihypertensive ya mankhwala Diroton ® imatchulidwanso chimodzimodzi.

Mukamagwiritsa ntchito zoletsa za ACE, kutsokomola kunadziwika (kouma, kwakanthawi, komwe kumatha pambuyo pothandizidwa ndi ACE inhibitors kumatha. Pozindikira kuti pali chifuwa, kutsokomola komwe kumachitika chifukwa chogwiritsa ntchito ACE inhibitors kuyenera kuganiziridwanso.

Nthawi zina, Hyperkalemia adadziwika. Zomwe zimayambitsa vuto la hyperkalemia zimaphatikizapo kulephera kwa impso, matenda a shuga, mankhwala a potaziyamu, kapena mankhwala omwe amachulukitsa potaziyamu (monga heparin), makamaka kwa odwala omwe ali ndi vuto laimpso.

Munthawi ya mankhwala ndi mankhwala, kuyang'anira potaziyamu, shuga, urea, lipids mu madzi a m'magazi ndikofunikira.

Pa mankhwala, osavomerezeka kumwa zakumwa zoledzeretsa, monga mowa kumawonjezera hypotensive mphamvu ya mankhwala.

Chenjezo liyenera kuchitika mukamachita masewera olimbitsa thupi nyengo yotentha (chiwopsezo cha kuchepa madzi m'thupi komanso kuchepa kwambiri kwa magazi chifukwa chakuchepa kwa bcc).

Popeza chiopsezo cha agranulocytosis sichingathetsedwe, kuwunika kwa chithunzi cha magazi kumafunika.

Pakachitika zoyipa zamagetsi zamkati, sizikulimbikitsidwa kuyendetsa magalimoto kapena kugwira ntchito yolumikizana ndi chiwopsezo chowonjezeka.

Zizindikiro: kuchepa kwamphamvu kwa magazi, pakamwa pouma, kugona, kwamikodzo, kudzimbidwa, nkhawa, kuchuluka kwa kusokonekera.

Chithandizo: chapamimba, kugwiritsa ntchito makala othandizira, ndikupatsa wodwalayo malo oyimirira ndi miyendo yokwezeka, ndikudzudzulanso bcc (iv makonzedwe othandizira kusintha kwa plasma), chithandizo chamankhwala, kuyang'anira ntchito zamtima ndi kupuma, bcc, urea, creatinine ndi serum electrolytes komanso diuresis. Lisinopril amachotsedwa m'thupi kudzera pa hemodialysis.

Pogwiritsa ntchito munthawi yomweyo mankhwala osokoneza bongo a potaziyamu (spironolactone, triamteren, amiloride), kukonzekera kwa potaziyamu, m'malo mwa mchere womwe umakhala ndi potaziyamu, chiopsezo chokhala ndi hyperkalemia chikuwonjezeka, makamaka kwa odwala omwe ali ndi vuto laimpso. Chifukwa chake, kuphatikiza kophatikizana ndikotheka pokhapokha ngati lingaliro la dokotala payekhapayekha poonetsetsa kuti ntchito ya seramu ndi potaziyamu ikuwonekera.

Pogwiritsa ntchito nthawi yomweyo ndi beta-blockers, calcium pang'onopang'ono njira blockers, okodzetsa ndi zina antihypertensive mankhwala, kuwonjezeka kwa hypotensive zotsatira za mankhwala kumawonedwa.

Pogwiritsa ntchito munthawi yomweyo ACE zoletsa ndi kukonzekera golide (sodium aurothiomalate) iv, chizindikiro chafotokozeredwa, kuphatikizira kutulutsa nkhope, nseru, kusanza, ndi kuchepa kwa thupi.

Pogwiritsa ntchito munthawi yomweyo ma vasodilators, barbiturates, phenothiazines, ma tridclic antidepressants, Mowa, chidwi champhamvu cha mankhwala chimakulitsidwa.

Pogwiritsa ntchito nthawi yomweyo ndi NSAIDs (kuphatikizapo COX-2 inhibitors), estrogens, komanso adrenergic agonists, mphamvu ya antihypertensive ya lisinopril yafupika.

Pogwiritsa ntchito munthawi yomweyo kukonzekera kwa lifiyamu, kuthetseratu kwa lithiamu m'thupi kumachepa (kuwonjezereka kwa mtima ndi zotsatira za neurotoxic za lithiamu).

Pogwiritsa ntchito munthawi yomweyo maantacid ndi colestyramine, mayamwidwe m'mimba amachepetsa.

Mankhwalawa amathandizira minyewa ya salicylates, imafooketsa mphamvu ya othandizira a hypoglycemic pakumwa mankhwalawa, norepinephrine, epinephrine ndi anti-gout, amathandizira zotsatira zake (kuphatikizapo zotsatira zoyipa) za mtima glycosides, mphamvu ya zotumphukira za minofu, komanso kuchepetsa kutulutsa kwa quinidine.

Imachepetsa mphamvu ya njira zakulera zamkamwa.

Ndi makonzedwe apakati a methyldopa, chiwopsezo cha hemolysis chikuwonjezeka.

Mankhwala ndi mankhwala.

Mndandanda B. Mankhwala amayenera kusungidwa kuti ana asawatenthe kuchokera pa 15 ° mpaka 30 ° C. Tsiku lotha ntchito - zaka zitatu

Lisinopril ndi Diroton, pali kusiyana kotani?

Lisinopril ndi mankhwala omwe ali ndi natriuretic (kuchotsedwa kwa ma ayoni a sodium m'thupi ndi impso), mtima (zoteteza mtima minofu) ndi hypotensive (kutsitsa magazi).

Diroton ndi mankhwala okhala ndi zotumphukira (zakutali) za vasodilating (kumasuka kwa minofu yosalala ya makoma amitsempha yamagazi) komanso njira yotsatsira thupi.

• Lisinopril - chophatikiza chophatikizika mu mankhwalawa ndi lisinopril dihydrate. Kuphatikiza apo, kapangidwe kake kamaphatikizanso zinthu zofunika kuti mupatse mawonekedwe oyenera. Mankhwalawa amapangidwa ndi makampani azachipatala aku Russia.
• Diroton - chophatikiza chophatikizika mu mankhwalawa ndi lisinopril. Komanso, kupereka mawonekedwe abwino kwambiri azachipatala, zinthu zina zimaphatikizidwa. Mankhwalawa amapangidwa ndi gulu lachipatala lotchedwa Gideon Richter (Hungary).

Njira yamachitidwe

Lisinopril - chinthu chogwira ntchito cha mankhwalawa, chimachepetsa njira yotulutsa aldosterone (mahomoni a adrenal omwe amayang'anira madzi ndi ion moyenera, komanso kuchepetsedwa kwa ziwiya zotumphukira), zomwe zimachepetsa kuchuluka kwa ayoni a sodium omwe amakola madzi mthupi la munthu, zimapangitsa kuchuluka kwa bcc ( voliyumu yamadzi ozungulira), yomwe imakulitsa katundu pamtima. Komanso, lisinopril imatsitsimutsa minofu yosalala ya makoma amitsempha yamagazi, yomwe imachepetsa kuthamanga kwa magazi.

Diroton - popeza mu mankhwalawa, mankhwala omwe amagwira ntchito ndi lisinopril, momwe amagwirira ntchito ndi ofanana ndi mankhwala omwe ali pamwambawa.

• Matenda oopsa a magazi (matenda omwe amadziwika ndi kuwonjezereka kwa kuthamanga kwa magazi),
• Kulephera kwamtima kosalekeza
• Monga gawo la zovuta mankhwala, mankhwalawa pachimake myocardial infarction,
• Nephropathy (kuwonongeka kwa impso chifukwa cha matenda ashuga).

• Zizindikiro ndizofanana ndi mankhwala omwe ali pamwambapa.

Contraindication

• Hypersensitivity pamagawo a mankhwala,
• Lactose tsankho.

• Kusalolera payekhapayekha pazigawo za mankhwala,
• Mimba komanso kuyamwa,
• Kudzipereka kwa Quincke edema (pachimake ziwengo, kodziwika ndi edema ya chapamwamba kupumira thirakiti),
• Zaka (zosaperekedwa kwa ana osakwana zaka 18).

Zotsatira zoyipa

• Thupi lawo siligwirizana (redness, zotupa, ndi kuyabwa pakhungu),
• Zizindikiro zam'mimba (nseru, kusanza, kutsegula m'mimba kapena kudzimbidwa, kugona ndi kutulutsa, kupweteka m'mimba),
• Mutu, chizungulire,
• Kukula kwa myocardial infarction (ngati mulingo wambiri woperekedwa kwa odwala omwe ali ndi matenda a mtima),
• Kugona, kutopa,
• Ululu kumbuyo kwa sternum
• Kupuma pang'ono
• Youma chifuwa
• Tachycardia (kuchuluka kwa kugunda kwa mtima) kapena bradycardia (kuchepa kwa kugunda kwa mtima),
• Kuchepetsa chidwi
• Kuchulukitsa thukuta
• Kuchepetsa tsitsi
• Erectile dysfunction (chilakolako chogonana) mwa amuna,
• Kupweteka kwa minofu
• Photophobia.

• Zotsatira zoyipa ndizofanana ndi mankhwala omwe ali pamwambapa.

Tulutsani mafomu ndi mtengo

• Mapiritsi a 5 mg, ma PC 30, - "kuchokera 89 r",
• Mapiritsi a 10 mg, ma PC 30, - "kuchokera ku 115 r",
• Mapiritsi a 10 mg, ma PC 60, - "kuyambira 197 r",
• Mapiritsi a 20 mg, ma PC 30, - "kuyambira 181 p."

• Mapiritsi a 2.5 mg, ma pc 28, - "kuchokera pa 105 r",
• Mapiritsi a 5 mg, ma PC 28, - "kuchokera 217 r",
• Mapiritsi a 5 mg, ma PC 58, - "kuchokera 370 r",
• Mapiritsi a 10 mg, ma PC 28, - "kuchokera 309 r",
• Mapiritsi a 10 mg, ma PC 58, - "kuchokera pa 516 r",
• 20 mg mapiritsi, 28 ma PC, - "kuchokera 139 r",
• Mapiritsi a 20 mg, ma PC 56, - ​​"kuchokera pa 769 p."

Diroton kapena Lisinopril - ndibwino?

Kuti mudziwe kuti ndi mankhwala ati a antihypertensive omwe ali bwino, ndikofunikira kumvetsetsa kusiyana kwawo, popeza mankhwalawa ali ndi chinthu chimodzi chogwira ntchito, ndipo mogwirizana ndi momwe matchulidwe ndi zovuta zake zimakhala zofanana.

Anthu ambiri amaganiza molakwika kuti mankhwalawa ndi analogue (mankhwala omwe ali ndi zinthu zosiyanasiyana zogwira ntchito, koma zisonyezo zofananira), kungakhale kolondola kuwatcha ma genetic (chinthu chomwechi, mayina osiyanasiyana ogulitsa).

Mwambiri, kusiyana pakati pa mankhwalawo kuli mu contraindication. Lisinopril sayenera kugwiritsidwa ntchito kwa anthu omwe ali ndi vuto la lactose. Nawonso, Diroton amaletsedwa kwa anthu omwe amakonda chibadwa cha Quincke.

Lisinopril amapangidwa ndi makampani aku Russia, ndipo Diroton amapangidwa ku Hungary, chifukwa chake, mtengo wake umakhala wokwera kwambiri. Koma izi sizikhudza kutha.

Lisinopril kapena Diroton - ndibwino? Ndemanga

Kutengera ndemanga za mankhwalawa, mutha kupeza chithunzi chokwanira chomwe mankhwalawo ali bwino.

• Mtengo wotsika
• Kuthamanga kwa achire zotsatira.

• Osayenera kwa anthu omwe ali ndi lactose tsankho.

• Zotsutsa zochepa
• Kuchita bwino kwambiri.

Kuthandiza kwa chiphaso chamankhwala ndi genin lisinopril mu monotherapy komanso kuphatikiza ndi hydrochlorothiazide kwa odwala omwe ali ndi matenda oopsa

A.A. Abdullaev, Z. J. Shahbieva, U. A. Islamova, R. M. Gafurova
Dagestan boma sukulu, Makhachkala, Russia

Chidule
Cholinga: kuyerekezera mphamvu, chitetezo ndi pharmaco-zachuma kulungamitsidwa kwa mankhwala ovomerezeka ndi generic ACE inhibitors lisinopril (Irume (Belupo) ndi Diroton (Gideon Richter) monga monotherapy komanso kuphatikiza ndi hydrochlorothiazide mwa odwala omwe ali ndi matenda a grade 1 ochepa.
Zida ndi njira: Odwala 50 omwe ali ndi AH a 1-2 tbsp adaphatikizidwa mu kafukufuku wotsogola wokhala ndi mwayi wodziwika bwino. (Amuna 22 ndi akazi 28) wazaka 35-75, ali ndi nthawi yayitali yoopsa kwambiri wazaka 7.1 ± 3.3. Odwala asanu ndi mmodzi adasiya kuphunzira: 2 kumbuyo kwa chithandizo cha mankhwala ndi Irume ndi 4 kumbuyo kwa chithandizo ndi Diroton. Kuwunikira tsiku ndi tsiku kuthamanga kwa magazi (BPM) kunachitika pogwiritsa ntchito zida SL90207 ndi 90202 (SpaceLabsMedical, USA).
Zotsatira: chithandizo ndi Iramed kunayambitsa kuchepa kwakukulu kwa kuthamanga kwa magazi (-27.8 ± 8.6 / -15.1 ± 6.9 mm RT.Art.) Poyerekeza ndi Diroton (-21.1 ± 6.9 / -9.0 ± 5.9 mm Hg), p.Mapeto: Kuchiza ndi Irume odwala omwe ali ndi AH ya 1-2 mwamphamvu amadziwika ndi antihypertensive kwambiri ndipo amadziwikanso kuposa mankhwala a Diroton.
Mawu osakira: ochepa matenda oopsa, lisinopril, Irumed, Diroton.

Cholinga: kuyerekezera mphamvu ndi kulolera kwa chiphaso cha mankhwala ndi generic ACE inhibitor lisinopril (Irumed, Belupo ndi Diroton, Gedeon Richter) mu monotherapy komanso kuphatikiza ndi hydrochlorothiazide kwa odwala omwe ali ndi matenda oopsa (AH).
Zida ndi njira: mwachisawawa woyembekezeredwa pang'onopang'ono anali ndi odwala 50 omwe ali ndi AH (amuna 22 ndi azimayi 28 azaka 35-75 azaka zapakati pazaka 7.1 ± 3.3 zaka. Odwala 6 asiya kuphunzira (Irume -2 ndi Diroton - 4). Kuthamanga kwa magazi (BP) kuyang'aniridwa kwa maola 24 ndi chipangizocho SL 90207 ndi 90202 (SpaceLabs Medical, USA).
Zotsatira: Ndidakhala ndikuchepetsa kwambiri BP yachipatala (-27.8 ± 8.6 / -15.1 ± 6.9 mm Hg) kuposa Diroton (-21.1 ± 6.9 / -9.0 ± 5.9 mm Hg ), pMapeto: Chithandizo cha Irume chodziwika bwino kwambiri komanso chotsika mtengo kuposa chithandizo cha Diroton mu odwala omwe ali ndi giredi 1 ochepa matenda oopsa.
Mawu ofunika: ochepa matenda oopsa, lisinopril, Irumed, Diroton

Zambiri za alembawo
Abdullaev Aligadzhi Abdullaevich - Dr. med. sayansi, mutu. Department of Outpatient Therapy, Cardiology ndi General Medical Practice
GOU VPO Dagestan State Medical Academy
Shakhbieva Zarema Yusupovna - womaliza maphunziro ku dipatimenti yomweyo
Islamova Ummet Abdulhakimovna - Chinsinsi. wokondedwa sayansi, wothandizira kudipatimenti yomweyo. 367030, RD, Makhachkala, I. Shamily Ave., 41, apt. 94.
Gafurova Raziyat Magomedtagirovna - Chinsinsi. wokondedwa sayansi, wothandizira kudipatimenti yomweyo. 367010, RD, mzinda wa Makhachkala, ul. Mendeleev, d.12.

Mawu Oyamba
Chithandizo cha odwala omwe ali ndi matenda oopsa (AH) ndi ntchito yofunikira mwachangu, monga momwe chiwonetsero chake pakufa kwa mtima (SS) chikufikira 40%, ndipo ndi chithandizo chokwanira komanso chothandiza, chimatanthauzanso zoopsa zomwe zingayambitse matenda a mtima. IHD) ndi matenda ena a SS. Zotsatira za kafukufuku wambiri zatsimikizira kuti monotherapy imagwira ntchito pokhapokha (pafupifupi 30%) ya odwala omwe ali ndi matenda oopsa 2, 3. Kugwiritsa ntchito mankhwala awiri kungakwaniritse kuchuluka kwa kuthamanga kwa magazi (Pambuyo pa nthawi yoteteza patent, kampani iliyonse yamankhwala ikhoza kupanga ndikugulitsa mankhwalawo. Zotsatira zake, mankhwalawa omwewo opanga angapo amatha kugulitsidwa ku malo ogulitsa mankhwala, ndipo mankhwalawa amatha kusiyanasiyana kwambiri pakuchita bwino komanso chitetezo. Mphamvu ya mankhwala, yotsimikiziridwa pamayeso akulu oyendetsedwa mosasamala, kutanthauza za mankhwala oyamba ndi mankhwala omwe amapangidwa pansi pa layisensi. Mankhwala ofanana ayenera kutsimikizika poyerekeza ndi omwe amapezeka koyambirira. Pankhaniyi, titha kunena kuti mankhwalawo angagwire bwino ntchito ndiotetezeka, monga choyambirira, ndipo mutha kugawa zomwe zapezeka pamankhwala oyambirirawo. Tsoka ilo, ndi ochepa mankhwala okhawo, kafukufuku wofanana adachitidwapo.

M'zaka zaposachedwa, pakhala chidwi chachikulu kumbali yazachuma. Izi zimakhudzidwa ndi kuchepa ndalama kwa mabungwe azachipatala, ndipo, nthawi zambiri, zofunikira zothandizira wodwalayo. Kuti muthane ndi vutoli pakadali pano, ndikofunikira kuti mugwire ntchito osati chithandizo chamankhwala komanso chitetezo chamankhwala ena, komanso zovuta zake zachuma kwa wodwala komanso paumoyo. Rational pharmacotherapy a matenda aliwonse ayenera kukhala ozikidwa pa pharmacoeconomics 7, 8.

Cholinga cha kafukufuku - yerekezerani mphamvu ya chitetezo, chitetezo ndi pharmacoeconomic kulungamitsidwa ndi zovomerezeka ndi generic ACE inhibitors lisinopril (Irume (Belupo) ndi Diroton (Gideon Richter) mu mawonekedwe a monotherapy komanso kuphatikiza ndi hydrochlorothiazide mwa odwala omwe ali ndi kalasi yoyamba yachiwiri ya matenda oopsa.

Zida ndi njira: Phunziroli lidaphatikizapo odwala 50 omwe ali ndi matenda oopsa a 1-2 zovuta, omwe 6 odwala adatsika panthawi yopenyerera: 2 munthawi ya chithandizo ndi Irume ndi 4 munthawi ya chithandizo ndi Diroton. Odwala 44 anamaliza kafukufukuyu. Poyamba, maguluwa analibe kusiyana zaka, jenda, ndi machitidwe ena (Gome 1).Phunziroli lidaphatikizapo odwala azaka za 18-75 azaka zapakati kapena omwe sanamwe pafupipafupi mankhwala a antihypertensive m'mwezi watha. Panthawi yophatikizidwa, gulu lambiri la systolic magazi (kalasi) linali 158.5 ± 7.5 mm Hg. Art., Diastolic magazi (DBP) C. 97.5 ± 5.0 mmHg. Art., Kugunda kwamtima 74.7 ± 8.8 kumenyedwa / mphindi. Njira zochotsetsedwera zinali: mitundu yachiwiri ya matenda oopsa, kuwonongeka kwa pachimake kwa magazi, kupweteka kwapachaka koopsa m'miyezi 6 yapitayo, angina pectoris II-III FC, kuperewera kwa mtima, mtima arrhythmias, chiwindi ndi impso.

Tebulo 1. Makhalidwe oyamba azachipatala komanso a anthu komanso a labotale

Dongosolo Lophunzira: kafukufukuyu anali osasankhidwa, otseguka, oyembekezeredwa, ndipo adachitidwa molingana ndi malamulo a GCP (Zabwino Zazabwino) ndi 2000 Helsinki Declaration. Nthawi yowonera inali masabata 24-25. Asanaphatikizidwe mu phunziroli, mbiri yonse yachipatala idachitidwa mwa odwala onse, kuyezetsa thupi kunachitika, kuthamanga kwa magazi kunayesedwa ndi njira ya Korotkov, pambuyo pake odwala omwe adakumana ndi njira zophatikizira ndipo osakhala ndi kusiyanitsa adagawidwa mosazindikira m'magulu awiri ofanana, woyamba omwe adayamba chithandizo ndi Iramed ndipo wachiwiri ndi Diroton pa 10 mg / tsiku. Pambuyo pa masabata awiri, pomwe kuchuluka kwa kuthamanga kwa magazi sikunachitike (kuthamanga kwa magazi kunatanthauzidwa ngati kuchuluka kwa kuthamanga kwa magazi atatu ndi buku la sphygmomanometer m'malo okhala pambuyo pakupumula kwa mphindi 10-15, komanso kuyimirira, miniti imodzi musanamwe mankhwalawa patsiku la kuchezerako.) kwa ma cell am'magazi a AD, adachepetsa maselo a DBP ndi 10% kapena 10 mm Hg ndi maselo a GARDEN ndi 15 mm Hg kuchokera pamlingo woyamba. mapulogalamu phukusi Statistiсa 6.0 (Statsof t, USA), kuperekera mwayi wowunikira parametric komanso nonparametric.Mosiyanawa adawoneka kuti ndiofunika pa p.Zotsatira ndi zokambirana

Mankhwala onse omwe amaphunzirawa anali ndi antihypertensive zotsatira zabwino, zomwe zidawonjezera kusintha kwa odwala kuphatikiza chithandizo. Amaganizira kwambiri kutsika kwa magazi monga ma cl. HELL, komanso malinga ndi a Scad. Pambuyo pa masabata awiri atatenga lisinopril pa mlingo wa 10 mg / tsiku mu gulu la Irume, kuthamanga kwa magazi kunachepa kuyambira 158.4 4 7.4 / 98.2 ± 4.4 mm Hg. Art. mpaka 146.1 ± 9.1 / 93.1 ± 6.1 mmHg. Art. (tsaTebulo 2. Mphamvu ya kuthamanga kwa magazi. Pa mankhwala ndi Irume ndi Diroton.