Lozarel Plus > Jiyya da rigakafin

Lozarel Plus: umarnin don amfani da bita

Sunan Latin: Losarel Plus

Lambar ATX: C09DA01

Abunda yake aiki: hydrochlorothiazide (Hydrochlorothiazide) + losartan (Losartanum)

Mai masana'anta: LEK dd (LEK d.d.) (Slovenia)

Descriptionaukaka bayanin da hoto: 11.28.2018

Farashin kuɗi a cikin kantin magani: daga 120 rubles.

Lozarel Plus magani ne mai haɓaka.

Formaddamar da tsari da abun da ke ciki

Hanya sashi - allunan da aka shirya fim: zagaye, biconvex, a cikin wani farin rawaya mai haske, tare da farin daga farin tare da launin toka mai launin shuɗi zuwa fari (a cikin kwali na kwanson 3-6, 8, 10 ko 14 blister fakitoci dauke da 7 ko 10 Allunan, da umarnin don amfani da Lozarel Plus).

Abun da ke ciki na kwamfutar hannu 1 (12.5 mg + 50 mg) / (25 MG + 100 MG) ya hada da:

abubuwa masu aiki: hydrochlorothiazide - 12.5 / 25 mg, potassium losartan - 50/100 mg (ciki har da losartan - 45.8 / 91.6 mg da potassium - 4.24 / 8.48 mg),
abubuwan taimako (ainihin): microcrystalline cellulose - 60/120 mg, lactose monohydrate - 26.9 / 53.8 mg, sitacilatinized sitaci - 23.6 / 47.2 mg, colloidal silicon dioxide - 0.5 / 1 mg, stearate magnesium - 1.5 / 3 mg,
rufin fim: hyprolose - 1.925 / 3.85 mg, hypromellose - 1.925 / 3.85 mg, titanium dioxide - 1.13 / 2.26 mg, baƙin ƙarfe baƙin ƙarfe mai launin shuɗi - 0.02 / 0.04 mg.

Kayan magunguna

Lozarel Plus haɗuwa ne na losartan (antagonistin mai karɓar angiotensin II) da hydrochlorothiazide (thiazide diuretic). Haɗin waɗannan abubuwan yana da tasirin antihypertensive ƙari kuma yana rage hawan jini (saukar karfin jini) zuwa babban girma idan aka kwatanta da amfani da waɗannan abubuwan haɗin kamar monotherapy.

Sakamakon sakamako na Lozarel Plus yana ɗaukar sa'o'i 24, mafi girman tasirin warkewa galibi ana samun shi a cikin makonni huɗu na shiga.

Pharmacodynamics

Losartan shine ɗayan takamaiman magabatan masu karɓar angiotensin II (nau'in AT1). Bayan gudanarwarsa, angiotensin II yanada ɗaure wa masu karɓa na AT1 waɗanda ke cikin ƙwayoyin daban-daban (a cikin ƙwayoyin adrenal, ƙwayoyin tsoka mai santsi na jijiyoyin jini, zuciya da kodan), kuma ana yin ayyuka masu mahimmanci na halittu da yawa, ciki har da sakin aldosterone da vasoconstriction. Angiotensin II kuma yana karfafa haɓaka ƙwayoyin tsoka mai santsi.

Dangane da sakamakon binciken, losartan da E-3174 na metabolite, suna nuna aikin kimiyyar halittu, toshe duk tasirin ilimin halittar jiki na angiotensin II, ba tare da la’akari da asalin ko hanyar biosynthesis ba.

Losartan ACE (angiotensin wanda ke canza enzyme), wanda baya hana kininase II, kuma, gwargwadon hakan, baya hana lalacewar bradykinin. Sabili da haka, halayen da ba a sani ba waɗanda ke da alaƙa da alaƙa da bradykinin (musamman, angioedema) suna da wuya sosai. Losartan da metabolite mai aiki suna da kusanci sosai don masu karɓar angiotensin I fiye da masu karɓar angiotensin II. Metabolite mai aiki na losartan yana aiki fiye da abu, kusan sau 10-40. Plasma maida hankali ne na losartan da aiki metabolite a cikin jini, kazalika da antihypertensive sakamako na abu karuwa dangane da Losarel Plus. Tun da losartan da aiki na metabolite masu adawa da masu karɓar angiotensin II, duka biyun suna ba da gudummawa ga tasirin sakamako.

Babban tasirin losartan da metabolites dinsa E-3174:

raguwa a cikin karfin jini da hauhawar jini a cikin jijiyoyin kumburi, raguwa a cikin jimlar rabewar jijiyoyin jini da taro na aldosterone a cikin jini,
bayan saukarwa
samar da wani sakamako diuretic,
hana haɓakar hauhawar jini,
increasedara haƙuri da haƙuri a cikin marasa lafiya tare da raunin zuciya (rashin karfin zuciya),
karfafawar plasma maida hankali ne urea a cikin jini.

Dukkanin losartan da aiki na metabolite dinsu basa tasiri ga ciyawar ciyawa, basa da tasirin aiki na dogon lokaci a cikin aikin plasma na norepinephrine a cikin jini.

Sakamakon antihypertensive (a cikin nau'i na raguwa a cikin systolic da tashin jini na jini) bayan gudanarwa na baka guda ɗaya ya isa matsakaicin darajar shi a cikin awanni 6, sannan tasirin a hankali ya ragu sama da awanni 24. Matsakaicin sakamako na antihypertensive yana tasowa bayan makonni 3-6 na far.

Kamar yadda aka kafa shi a cikin gwaji na asibiti wanda aka haɗa da marasa lafiya tare da rauni mai sauƙi zuwa matsakaici na hauhawar jini na jijiyoyin jini, an lura da ƙididdigar ƙima a cikin systolic da tashin jini na jini sakamakon shan losartan sau ɗaya a rana. Lokacin da aka gwada karfin jini 5-6 da awanni 24 bayan shigo da kwayar guda daya ta Lozarel Plus, an gano cewa yayin da ake kula da yanayin kullun na yau da kullun, hawan jini ya kasance mara nauyi na awanni 24. A ƙarshen lokacin allura, raguwar hauhawar jini ya kusan kashi 70-80% na sakamakon da ake lura da sa'o'i 5-6 bayan sarrafa maganin na losartan.

Lokacin da aka dakatar da losartan ta hanyar marasa lafiya tare da hauhawar jijiyoyin jini, ba a lura da hauhawar hauhawar hauhawar jini (ciwon suga). Abun, dukda ragewar karfin jini, bashi da wani tasiri a kimin zuciya.

Sakamakon warkewa na losartan bai dogara da jinsi da shekarun haƙuri ba.

Hydrochlorothiazide

Hydrochlorothiazide mai lalata ne thiazide. Babban tasirin sa shine keta reabsorption na chlorine, sodium, magnesium da potassium ion a cikin farji, na taimakawa ga jinkirta fitarwar uric acid da alli. Tare da haɓaka haɓakar ƙwayar haɗi na waɗannan ion, an lura da haɓakar adadin fitsari (saboda ɗaukar ruwa na osmotic).

Abubuwan na rage girman plasma jini, yayin da aikin renin a cikin jini yana ƙaruwa kuma an inganta biosynthesis na aldosterone. Hydrochlorothiazide a cikin babban allurai yana ba da gudummawa ga haɓakar haɗarin bicarbonates, tare da tsawaita amfani - don raguwa a cikin haɓakar alli. Tasirin antihypertensive yana haɓakawa saboda raguwar ƙwayar jini, canje-canje a cikin sake kunnawar bango na jijiyoyin jini, raguwa a cikin tasirin tasirin vasoconstrictive amines (adrenaline, norepinephrine) da haɓaka sakamako mai banƙyama a cikin ganglia. Abun ba ya shafar hawan jini. Ana lura da sakamako na diuretic a cikin awanni 1-2, matsakaicin sakamako yana tasowa a cikin sa'o'i 4, tsawon lokacin tasirin diuretic yana daga 6 zuwa 12 hours.

Sakamakon warkewa yana faruwa bayan kwanaki 3-4 na gudanarwa, amma yana ɗaukar daga 3 zuwa 4 makonni don cimma sakamako mafi kyawu.

Pharmacokinetics

Bayan gudanar da baki, losartan yana da kyau daga ƙwayar gastrointestinal. An metabolized yayin farkon tafiya ta hanta ta hanyar carbonxylation tare da halartar cytochrome CYP2C9 isoenzyme, tare da ƙirƙirar metabolite mai aiki. Tsarin bioavailability na tsarin shine kusan 33%. Cin abinci baya tasiri wannan alamar. Lokaci don isa C_max (mafi girman maida hankali) na losartan da aiki metabolite a cikin jini bayan gudanarwar baka - awa 1 da 3-4, bi da bi.

Abubuwan da ake amfani dasu da metabolite mai aiki sun danganta ga furotin na plasma a matakin sama da kashi 99%, akasarinsu tare da albumin. V_d (distributionimar rarraba) shine lita 34. Losartan a zahiri ba ya shiga cikin shingen jini-kwakwalwa.

Canje-canje a cikin sigogin magunguna na abu da kuma metabolite mai aiki bayan ɗaukar har zuwa 200 mg na losartan yana cikin gwargwado layin gwargwado.

Tare da yawan gudanarwa na 1 sau ɗaya kowace rana, ba a lura da tara yawan losartan da metabolite na jini ba. Amfani guda ɗaya a cikin ma'aunin yau da kullun na 100 MG ba ya haifar da babban tarin kayan abu da kuma metabolite a cikin jini na jini.

Kusan 4% na kashi na losartan an canza shi zuwa metabolite mai aiki. Bayan shigowa da alama mai lamba 14 C tare da losartan, aikin rediyo yana motsa jini yana da alaƙa da farko tare da kasancewar abu da kuma ƙwayar aiki a ciki. A cikin kusan 1% na lokuta, an gano ƙananan matakan losartan metabolism.

Tabbatarwar Plasma da na koda shine (bi da bi): losartan - kimanin 600 da 74 ml / min, aiki mai aiki - kimanin 50 da 26 ml / min. Kusan 4% na kashi na losartan an cire shi ta hanyar kodan, kusan 6% - azaman metabolite mai aiki. Plasma maida hankali ne na abu da kuma aiki metabolite rage yawan tare da karshe T_1/2 (kawar da rabin rayuwa) kimanin awa 2 zuwa 6 - 9, bi da bi. Ana fitar da shakatawa ta hanyar kodan kuma tare da bile. Bayan samun alamar 14 C na losartan, kusan 58% na aikin rediyon ana samun su cikin feces, 35% a cikin fitsari.

A ƙarshen yanayin mai laushi zuwa matsakaici mai ƙarfi na rikicewar hanta na giya, idan aka kwatanta da lafiyar masu sa kai na maza, taro na losartan da metabolite mai aiki suna ƙaruwa sau 5 da 1.7 bi da bi.

Hulɗar da losartan a cikin jini na jini tare da CC (keɓaɓɓe na creatinine) sama da 10 ml / min bai bambanta da wannan a cikin rashin aiki na keɓaɓɓiyar aiki. A cikin marasa lafiya na hemodialysis, ƙimar AUC (yanki a ƙarƙashin lokutan tattara lokaci) ya ninka har sau 2 sama da rashin aiki na keɓaɓɓiyar aiki. Tare da maganin hemodialysis, losartan da metabolite mai aiki ba a cire su ba.

A cikin matan da ke fama da hauhawar jini, dabi'ar plasma maida hankali ne na losartan sun ninka darajar ma'aurata a cikin maza sau biyu, yayin da a cikin maza da mata yawan kwantar da tarzoma ba su bambanta. Wannan bambance-bambancen magani ba shi da mahimmancin asibiti.

Contraindications

mai tsanani gazawar koda (a cikin marasa lafiya tare da CC kasa da 30 ml / min),
matsanancin hanta (bisa ga --auna - sikelin Sha, fiye da maki 9),
rashin lafiya
karancin maganin lactase, cutar malabsorption da rashin rashin maganin lactose,
Cutar Addison
gout na bayyanar cututtuka da / ko hauhawar jini,
hyperkalemia, hyperkarelia, hypercalcemia, hyperpremia,
rashin ruwa, gami da hade da amfani da manyan allurai na diuretics,
wahalar sarrafa ciwon sukari
mai tsanani jijiya jini,
haɗuwa tare da maganin aliskiren da aliskiren da ke ƙunshe da magunguna a cikin marasa lafiya da ke fama da rauni na aikin ƙira (tare da ƙimar fillet na 2) da / ko ciwon sukari mellitus,
ciki da lactation,
shekaru zuwa shekaru 18
mutum ɗan haƙuri zuwa ga abubuwan da ke cikin miyagun ƙwayoyi, kazalika da kwayoyi waɗanda keɓaɓɓe na sulfonamide.

Kullawa (Lozarel Plus an wajabta shi a ƙarƙashin kulawar likita):

haɗuwa tare da maganin rashin amfani da steroidal anti-mai kumburi (ciki har da masu hana cyclooxygenase-2),
karancin rashin aiki,
keta rikice-rikicen ruwa na jini, alal misali, hade da zawo ko amai (hyponatremia, hypomagnesemia, hypochloremic alkalosis),
biyun koda na jijiya arte stenosis ko artery stenosis na koda daya,
gazawar renal (a cikin marasa lafiya tare da CC 30-50 ml / min),
nau'in tarihin rashin lafiyar da rashin lafiyar fuka,
cututtukan hanta na ci gaba da rauni mara nauyi (gwargwadon ma'aunin Yara-Pugh, ƙasa da maki 9),
cututtukan cututtukan cututtukan nama (haɗe da lupus erythematosus),
rashin karfin zuciya tare da arrhythmias na rayuwa,
stenosis na aorta ko mitral bawul,
myopia m da na kusurwa kusa-ƙulli glaucoma (hade da hydrochlorothiazide),
cututtukan zuciya da jijiyoyin jini
tsorataccen jini,
na farko hyperaldosteronism,
yanayi bayan dasawa koda (babu gogewa tare da amfani),
ciwon sukari mellitus
mallakar baƙar fata.

Side effects

A cikin gwaji na asibiti tare da losartan da hydrochlorothiazide, ba a lura da halayen da suka dace da wannan haɗin haɗin ba.

Abubuwan da ke haifar da illa an iyakance su ne kawai waɗanda aka riga aka bayar da rahoto yayin amfani da abubuwa masu aiki na Losarel Plus azaman maganin monotherapy. Gaba ɗaya, mitar tasirin sakamako wanda aka ruwaito tare da wannan haɗuwa ya kasance daidai da wancan tare da placebo.

Gabaɗaya, ana amfani da maganin haɗuwa tare da losartan da hydrochlorothiazide. A mafi yawan lokuta, raunin da ya faru ya kasance mai sauƙi, mai natsuwa a cikin yanayi kuma baya haifar da shafewa na Lozarel Plus.

Dangane da sakamakon gwaji na asibiti, a cikin lura da mahimmancin hauhawar jini, matakin da ba a so kawai wanda ke da alaƙa da gudanar da aikin Lozarel Plus, yawan abin da ya zarce hakan tare da raunin sama da 1%, ya kasance tsananin farin ciki.

Hakanan, yayin gudanar da nazari, an gano cewa a cikin marasa lafiya da hauhawar jini a cikin hagu da hauhawar jijiyoyin jini, mafi yawan rikice-rikice sun kasance: karuwa gajiya, rauni, tsari / rashin tsari.

A yayin gudanar da karatuttuka daban-daban, da suka hada da lura da ayyukan yin rijista, an rubuta tasirin sakamako masu zuwa> 10% - sau da yawa (> 1% da 0.1% da 0.01% da 5.5 mmol / L), a lokaci-lokaci - karuwa a cikin ƙwayar ƙwaƙwalwar ƙwaƙwalwa urea. / saura nitrogen da creatinine a cikin jini, mai saukin kamuwa da hyperbilirubinemia, matsakaiciyar karuwa a ayyukan hepatic transaminases (aspartate aminotransferase da alanine aminotransferase), tare da tazara mai iyaka - hyponatremia,

rikice-rikicen gaba ɗaya: sau da yawa - ƙara yawan gajiya, asthenia, naƙasa gefe, jin zafi a yankin kirji, maras-sau - zazzabi, kumburin fuska, tare da ƙarancin lokaci - alamomin kamar mura, malaise.

Matsalar da za a yi illa daga tsarin da gabobin saboda hydrochlorothiazide:

tsarin zuciya da jijiyoyin jini: akai-akai - yanayin kwanciyar hankali na orthostatic, arrhythmias, vasculitis,
tsarin narkewa: lokaci-lokaci - haushi na mucosa na ciki, cholestatic jaundice, intrahepatic cholestasis, cholecystitis ko pancreatitis, zawo, amai, tashin zuciya, gurguwa, maƙarƙashiya, sialadenitis, anorexia,
tsarin urinary: na lokaci-lokaci - nephritis na gaba-gaba, gazawar koda, aikin nakasa mai rauni,
tsarin juyayi: sau da yawa - ciwon kai, a kai-a kai - kishi, kashe kansa, rashin bacci,
tsarin rigakafi: na lokaci-lokaci - matsanancin damuwa na numfashi (wanda ya hada da rashin cututtukan zuciya da cututtukan zuciya), cututtukan mahaifa, cututtukan jijiyoyin jiki, purpura, cututtukan Stevens-Johnson, da wuya - halayen anaphylactic, mai yiwuwa su girgiza,
jini da tsarin lymphatic: akai-akai - thrombocytopenia, leukopenia, agranulocytosis, aplastic / hemolytic anemia,
sashin hangen nesa: akai-akai - xantopsia, hangen nesa mai rauni na ɗan lokaci, tare da tazara mai iyaka - m angle-rufe glaucoma,
fata da subcutaneous nama: akai-akai - mai guba epidermal necrolysis, daukar hoto, tare da mitar - lupus erythematosus,
metabolism da abinci mai gina jiki: na lokaci-lokaci - hypomagnesemia, hypokalemia, hyperglycemia, hyponatremia, glucosuria, hyperuricemia tare da haɓakar wani hari na gout, hypercalcemia da hypochloremic alkalosis (bayyana a cikin nau'in xerostomia, ƙishirwa, rashin daidaituwa na zuciya yanayi) tsoka, tashin zuciya, amai, gajiya baƙon abu ko rauni, hypochloremic alkalosis na iya haifar da ci gaban hepatic encephalopathy / hepatic coma), hyponatremia (wanda aka bayyana a matsayin rikicewa, raɗaɗi , Lethargy, m tunani tsari, excitability, gajiya, tsoka cramps) a lokacin far thiazide yiwu sosai glucose haƙuri, da gudãna iya bayyana latent ciwon sukari mellitus, a cikin hali na high allurai zai iya ƙara magani taro na lipids a cikin jini,
wasu: na lokaci-lokaci - sauƙaƙe tsoka, rage ƙarfin aiki.

Yawan abin sama da ya kamata

Babban bayyanar cututtuka na yawan abin sama da yakamata na abubuwan aiki na Lozarel Plus:

losartan: tachycardia, raguwar alama a cikin karfin jini, bradycardia (yana da alaƙa da tashin hankali vagal),
hydrochlorothiazide: asarar electrolytes (a cikin hanyar hypokalemia, hyperchloremia, hyponatremia), kazalika da bushewa, wanda ke haɓakawa saboda yawan diuresis, a cikin yanayin amfani da concoitant tare da glycosides na zuciya, hypokalemia na iya kara tasirin maganhythmias.

Farfesa: mai tallafawa da alamu. Idan ɗan lokaci kaɗan ya wuce tun lokacin liyafar, kuna buƙatar kurkura cikin, bisa ga alamu, ana aiwatar da gyaran hargitsi na ruwa. Losartan da metabolites dinsa masu aiki ba su cire shi ta hanyar amfani da shi ba.

Form sashi

Allunan da aka sanya fim-50 MG / 12.5 MG, 100 MG / 25 MG

Tabletaya daga cikin kwamfutar hannu ya ƙunshi

Abubuwan da ke aiki: losartan potassium 50 MG, hydrochlorothiazide 12.5 MG ko

losartan potassium 100 MG, hydrochlorothiazide 25 MG

magabatansu: lactose monohydrate, microcrystalline cellulose, sitaci sitiri, magnesium stearate, anhydrous colloidal silicon dioxide

kwaskwarimar kwaskwarima: hypromellose, hydroxypropyl cellulose, yellow iron oxide (E 172), titanium dioxide (E 171), macrogol (400) (don sashi na 100 mg / 25 mg), talc (don sashi na 100 mg / 25 mg).

Allunan da aka saka a fim, launin rawaya mai haske a launi, zagaye a tsari, tare da farfajiyar biconvex.

Sashi da gudanarwa

Ana iya ba da umarnin Lozarel Plus a hade tare da sauran jami'in antihypertensive.

Ya kamata a yi amfani da allunan a baka tare da gilashin ruwa, ba tare da la'akari da abincin ba.

Ba a karɓa da potassium ta amfani da hydrochlorothiazide azaman maganin na farko, amma an wajabta wa marassa lafiya waɗanda amfani da losartan potassium ko hydrochlorothiazide dabam ba zai haifar da isasshen ikon hawan jini ba.

Ana bayar da shawarar kashi ɗaya daga cikin abubuwan haɗin guda biyu (potassium losartan da hydrochlorothiazide).

Lokacin da ya cancanta ta asibiti, a cikin marasa lafiya waɗanda ba a kula da karfin jini daidai, za a iya yin la'akari da canjin kai tsaye na monotherapy zuwa haɗaka mai haɗaka.

Lozarel Plus 50 MG / 12.5 MG mai allunan ɗaukar hoto

Karancin kulawa na yau da kullun: 1 kwamfutar hannu 50 MG / 12.5 MG 1 lokaci kowace rana.

Ga marasa lafiya waɗanda basu da isasshen amsa, ana iya ƙara yawan zuwa 2 Allunan 50 na mg / 12.5 mg sau ɗaya a rana ko 1 kwamfutar hannu na 100 MG / 25 MG sau ɗaya a rana.

A matsayinka na mai mulkin, ana samun tasirin rigakafin a cikin makonni 3-4 bayan fara magani.

Lozarel Plus, allunan da aka rufe fim 100 MG / 25 MG Mafi girman maganin: 1 kwamfutar hannu 100 MG / 25 MG sau ɗaya a rana.

A matsayinka na mai mulkin, ana samun tasirin rigakafin a cikin makonni 3-4 bayan fara magani.

Yi amfani da shi a cikin marasa lafiya da ke fama da rauni na aikin haya kuma a cikin marasa lafiya akan hemodialysis.

A cikin marassa lafiya tare da matsakaici mai rauni aiki (i.e. keɓaɓɓen keɓantaccen shine 30-50 ml / min), ba a buƙatar daidaita sigar farko. Haɗin maganin losartan-hydrochlorothiazide ba a ba da shawarar a cikin marasa lafiya akan hemodialysis ba. Haɗin maganin losartan-hydrochlorothiazide bai kamata a wajabta shi ga marasa lafiya da ke fama da rauni na aikin keɓaɓɓen aiki

Yadda ake amfani: sashi da hanya na jiyya

A ciki, lokaci 1 kowace rana, ba tare da la'akari da yawan abinci ba.

Tare da hauhawar jini, tsohuwar farko da kuma maganin kulawa shine 1 shafin. LozarelR Plus 12.5 mg + 50 mg / rana.

A cikin rashin ingantaccen sakamako na warkewa a cikin makonni 3-4, ya kamata a ƙara yawan kashi zuwa allunan 2 na LozarelR Plus 12.5 mg + 50 mg ko 1 kwamfutar hannu na LozarelR Plus 25 mg + 100 mg (matsakaicin adadin yau da kullun).

A cikin marasa lafiya tare da rage yawan ƙwayar jini (alal misali, yayin ɗaukar manyan magungunan diuretics), shawarar da aka fara amfani da ita na losartan shine 25 MG sau ɗaya a rana. A wannan batun, ya kamata a fara amfani da maganin LozarelR Plus bayan an soke diuretics kuma an gyara hypovolemia.

A cikin tsofaffi marasa lafiya da marasa lafiya da gazawar ƙarancin koda, ciki har da waɗanda ke kan dialysis, ba a buƙatar daidaita sigar farko da ake buƙata.

Aikin magunguna

Lozarel Plus shine haɗin antagonistin II mai karɓar antagonist (losartan) da turezide diuretic (hydrochlorothiazide). Haɗin waɗannan abubuwan yana da tasirin antihypertensive ƙari kuma yana rage hawan jini (BP) zuwa mafi girma fiye da kowane ɗayan abubuwan haɗin.

Haɗa kai

Tare da yin amfani da thiazide diuretics lokaci guda tare da barbiturates, narcotic analgesics, ethanol, haɓakar haɗarin haɓakar orthostatic hypotension yana yiwuwa.

Abubuwan diuretics suna rage ƙwayar ɗan adam na lithium da ƙara haɗarin cutarwa mai guba, ba a bada shawarar yin amfani da maganin diuretics da shirye-shiryen lithium ba.

Tare da yin amfani da lokaci ɗaya tare da amines pressor (norepinephrine, epinephrine), raguwa kaɗan a cikin tasirin amines na pressor mai yiwuwa ne, wanda ba shi da tsangwama ga gudanarwar su, tare da rashin nutsuwa mai narkewar tsoka (tubocurarine) - karuwa ga tasirinsu.

Tare da yin amfani da glucocorticosteroids, hormone adrenocorticotropic (ACTH), yana yiwuwa a ƙara asarar ƙwaƙwalwar ƙwayoyin cuta, ta ƙaruwa da hypokalemia. Thiazides na iya rage haɓakar haɓakar ƙwayoyin ƙwayar cuta ta cytotoxic da kuma haɓaka tasirin tasirin tasirin maɗaukaki.

Umarni na musamman

Magunguna waɗanda ke da tasiri kan RAAS (tsarin renin-angiotensin-aldosterone) a cikin marasa lafiya da ke fama da jijiyoyin ƙwayar ƙwayar cutar mahaɗar mahaifa ko ƙwarƙwarar ƙwayar ƙwayar koda guda ɗaya na iya haɓaka urea da ƙwaƙwalwar ƙwayar ƙwayar cuta. An lura da irin wannan tasirin tare da losartan. Wadannan dysfunctions na yara sun juyawa kuma sun wuce bayan dakatar da ilimin. Akwai shaidu cewa a cikin wasu marasa lafiya da ke shan maganin, canje-canje masu canzawa a cikin aikin renal, gami da gazawar renal, ya faru ne saboda dakatar da aikin RAAS.

Kamar yadda yin amfani da wasu kwayoyi tare da sakamako mai banƙyama, a sakamakon raguwa mai yawa a cikin karfin jini a cikin cututtukan zuciya na zuciya na ischemic da cututtukan cerebrovascular, infarction myocardial da bugun jini na iya haɓaka.

A cikin marasa lafiya da raunin zuciya tare da / ba tare da aiki na keɓaɓɓen aiki ba, ƙarancin na koda da kuma rage karfin jini zai yiwu.

Kamar sauran masu adawa da karɓar angiotensin II, losartan ba shi da tasiri a cikin marasa lafiya na tseren Negroid, wanda ke da alaƙa da ƙananan aikin renin.

A cikin marasa lafiya bayan dasawa da koda, babu kwarewa tare da amfani da losartan.

1. Alamu don amfani

An wajabta maganin Lozarel idan akwai:

A bayyane alamun hauhawar jini.
Rage haɗarin kamuwa da cututtukan zuciya a cikin mutanen da ke fama da hauhawar jijiyoyi ko hauhawar jini a ventricular hagu, wanda aka nuna da raguwa a haɗewar yawan cututtukan zuciya, bugun jini da infarction na zuciya.
Bayar da kariya daga koda a cikin marassa lafiya da masu ciwon sukari na 2.
Bukatar rage furotin.
Rashin ƙarfin zuciya na rashin ƙarfi tare da gazawar magani daga masu hana ACE.

3. Hadin gwiwar Magunguna

Yin hulɗa da Lazorel tare da wasu kwayoyi:

Babu wata ma'amala tsakanin Lozarel da Hydrochlorothiazide da Digoxin, da sauran magunguna waɗanda suke da tasirin irinsu a jikin mutum. Wani lokacin hada shi da "Rifampicin" da "Fluconazole" yana haifar da raguwa a cikin matakin metabolite mai aiki a cikin jini na jini.
Haɗuwa tare da kwayoyi waɗanda ke hana enzyme na angiotensin II ko kuma aikinta, akwai karuwa mai girma a cikin haɗarin ci gaban haɓaka na hyperkalemia.
Magungunan rigakafin ƙwayar cuta marasa lalacewa na iya rage tasirin magungunan masu karɓa na angiotensin II.
Haɗakarwa tare da maganin antiotensin II antagonists da NSAIDs galibi suna haifar da matsalolin koda.
Haɗin maganin antiotensin II mai karɓar antagonists tare da shirye-shiryen lithium yana haifar da karuwa a cikin adadin lithium da ke cikin jini na jini.
Jiyya tare da "Losarel" lokaci guda tare da gabatarwar diuretics yana ba da sakamako mai ƙari. Sakamakon haka, an sami haɓakar juna game da tasiri na magungunan antihypertensive daban-daban.

6. Sharuɗɗa da yanayin ajiya

Adana a zazzabi da bai wuce 25 ° C. Kiyaye miyagun ƙwayoyi daga isa zuwa ƙananan yara.

Ranar karewa Magungunan shine shekaru 2.

Kada kuyi amfani da miyagun ƙwayoyi bayan ranar karewa.

Kudin magungunan Lazorel sun bambanta dangane da masana'anta da kuma kamfanonin kera magunguna, a Rasha a kan matsakaici yana biyan kuɗi daga 200 rubles.

A cikin Ukraine miyagun ƙwayoyi ba ta yaɗu ba kuma farashi kimanin 200 UAH.

Idan ya cancanta, zaka iya maye gurbin "Lozarel" tare da ɗayan waɗannan kwayoyi:

Brozaar
Bugawa
Vero-Losartan
Vazotens
Cardomin-Sanovel
Zisakar
Cozaar
Karzartan
Lozap,
Lakea
Losartan A,
Losartan Canon
"Fasahar Losartan",
Losartan Richter,
Losartan MacLeods,
Losartan Teva
"Lozartan-TAD",
Losacor
Lorista
Presartan
Karin
"Renicard."

Yin amfani da analogues don magani ana buƙatar musamman a cikin lokuta inda mai haƙuri yana da haƙurin mutum game da abubuwan da ke cikin miyagun ƙwayoyi. Koyaya, likita kawai zai iya ba da kowane irin magani.

Ana iya samun ra'ayoyi na miyagun ƙwayoyi a yanar gizo, alal misali, Anastasia ya rubuta: “Cutar sankarau tana haifar da azaba mai yawa. Ba da daɗewa ba, na fuskanci sabon bayyanar wannan cutar. An kuma kamu da cutar nephropathy. Likita ya ba da adadi da yawa na kwayoyi daban-daban, ciki har da Lozarel. Shi ne ya taimaka wajan hanzarta dawo da tsarin aikin kodan. Kafa kafafu ya ɓace. ”

Ana iya samun sauran bita a ƙarshen wannan labarin.

An san Lozarel na miyagun ƙwayoyi azaman magani mai tasiri wajen lura da hauhawar jini da raunin zuciya. Yana da jerin hanyoyin analogues tare da manyan abubuwan da aka yi kama da su, ba a bada shawara ba don matsalolin hanta da kodan, kazalika a lokacin daukar ciki da kuma kasa da shekaru 18. Don hana faruwar sakamako, ana bada shawarar a sha magani sosai kamar yadda likita ya umarta.

Allunan, farar fata mai santsi ko fari tare da launin shuɗi mai haske, zagaye, biconvex, tare da haɗari a gefe ɗaya.

Waɗanda suka ƙware: microcrystalline cellulose, lactose monohydrate, sitaci preculatinized, sitaci ana magana da silicon dioxide na anhydrous, magnesium stearate.

Abun da ke cikin membrane fim: hypromellose, hyprolose, macrogol 400, titanium dioxide (E171), talc.

10 inji mai kwakwalwa. - blister (3) - fakitoci na kwali.

Magungunan rigakafin ƙwayar cuta, zaɓin mai adawa da masu karɓar angiotensin II (nau'in AT 1). Angiotensin II yanada ɗaure wa masu karɓar AT 1 da aka samo a yawancin kyallen takarda (a cikin ƙyallen ƙwayar tsoka na jijiyoyin jini, ƙoshin adrenal, kodan da zuciya) kuma yana haifar da vasoconstriction da sakin aldosterone, ƙoshin lafiya mai santsi.

A cikin in vitro da kuma a cikin bincike na vivo sun nuna cewa losartan da ƙwaƙwalwar ƙwaƙwalwar ƙwaƙwalwar ta suna aiki duk toshe duk mahimmancin abubuwan da ake amfani da su na angiotensin II, ba tare da la’akari da asalin ko hanyar da ake yin sa ba. Ba ya hana kinase II - enzyme wanda ke lalata bradykinin.

Yana rage OPSS, maida hankali na jini na aldosterone, hawan jini, matsa lamba a cikin jijiyoyin bugun jini, yana rage bayan fitowar, yana da tasirin diuretic. Yana sa baki tare da haɓakar hauhawar jini na zuciya, yana ƙaruwa da haƙuri a cikin marasa lafiya tare da rauni na zuciya.

Bayan gudanar da maganin baka guda ɗaya, tasirin mai narkewa (systolic da diastolic pressure saukar jini) ya kai matsakaici bayan sa'o'i 6, sannan sannu a hankali ya rage a cikin sa'o'i 24. Matsakaicin sakamako mai ƙarfi yana tasowa 3-6 makonni bayan gudanar da magani na yau da kullun.

Hakan baya hana ACE kuma, sabili da haka, baya hana lalata bradykinin, sabili da haka, losartan bashi da tasirin sakamako kai tsaye da alaƙa da bradykinin (alal misali, angioedema).

A cikin marasa lafiya tare da hauhawar jini ba tare da conellitus na ciwon sukari mai narkewa tare da proteinuria (fiye da 2 g / rana), yin amfani da miyagun ƙwayoyi yana rage proteinuria, haɓakar albumin da immunoglobulins G.

Yana daidaita matakin urea a cikin jini na jini. Ba ya shafar tasirin ciyayi, kuma baya da tasiri mai inganci akan matakin norepinephrine a cikin jini.

A cikin adadin har zuwa 150 MG, lokaci 1 / rana ba ya shafar matakin triglycerides, jimlar cholesterol da HDL cholesterol (HD) a cikin jijiyoyin jini a cikin marasa lafiya tare da tashin hankali na jijiya. A daidai wannan matakin, losartan baya shafar glucose na jini.

Lokacin kulawa, losartan yana da kyau daga narkewa. Yana halakar da metabolism yayin “farkon hanyar” ta hanta ta hanyar carbonxylation tare da halartar CYP2C9 isoenzyme tare da samuwar metabolite mai aiki. Tsarin bioavailability na losartan shine kusan 33%. C max na losartan da aiki metabolite ana samun su cikin jijiyoyin jini bayan kimanin awa 1 da awa 3-4 bayan fitowar, bi da bi. Cin abinci baya tasiri bioavailability na losartan.

Lokacin shan miyagun ƙwayoyi ta bakin bakin a allurai har zuwa 200 MG, losartan da aiki metabolite suna nunawa ta hanyar magungunan layi.

Theaddamar da losartan da aiki na metabolite zuwa ƙwayoyin plasma (galibi tare da albumin) sun fi 99%. V d losartan - 34 l. Losartan a zahiri ba ya ratsa cikin BBB.

Aƙalla 14% na losartan da aka gudanar iv ko a baki ga mai haƙuri an canza shi zuwa aiki mai aiki.

Shafin ruwan plasma na losartan shine 600 ml / min, metabolite mai aiki shine 50 ml / min. Clearasar dangin na losartan da metabolite mai aiki shine 74 ml / min, da 26 ml / min, bi da bi. Lokacin da aka shiga ciki, kusan kashi 4% na kashin da aka dauka ana raba shi ne da kodan ba shi canzawa kuma kusan 6% na kodan ya kasance a cikin hanyar metabolite mai aiki. Bayan gudanar da baki, ƙwayar plasma na losartan da ƙwayar metabolite mai aiki suna raguwa tare da ƙarewar T 1/2 na losartan kimanin 2 hours, da kuma metabolite mai aiki game da sa'o'i 6-9. Lokacin shan maganin a kashi na 100 MG / rana, ba losartan ko aiki metabolite yana da mahimmanci cumulate a cikin jini jini.

Losartan da metabolites din an kebe su ta hanjin ciki da kodan.

Pharmacokinetics a cikin lokuta na musamman na asibiti

A cikin marasa lafiya da ke da laushi zuwa matsakaici guguwar cirkohosis, yawan losartan ya kasance sau 5, kuma metabolite mai aiki ya kasance sau 1.7 sama da na masu sa kai na maza masu lafiya.

Tare da CC fiye da 10 ml / min, taro na losartan a cikin jini na jini bai bambanta da wannan tare da aikin aikin koda.A cikin marasa lafiya waɗanda ke buƙatar hemodialysis, ƙimar AUC ta kusan sau 2 fiye da yadda take a cikin marasa lafiya da ke da aikin na al'ada.

Ba za a cire losartan ko metabolite dinsa mai aiki daga jiki ta hanyar motsa jini ba.

Haɗarin losartan da ƙwayar metabolite mai aiki a cikin jini na tsofaffi maza tare da hauhawar jijiyoyi ba su bambanta da mahimmancin waɗannan sigogi a cikin samari da ke fama da hauhawar jini.

Darajojin ma'aunin plasma na mata a cikin matan da ke fama da hauhawar jini, ya ninka 2 sau da yawa kan daidai wajan maza da ke fama da hauhawar jini. Ba a bambanta abubuwan da ke faruwa a cikin maza da mata ba. Wannan bambancin na pharmacokinetic bashi da mahimmancin asibiti.

- rashin lafiyar zuciya na kullum (tare da gazawar magani daga masu hana ta ACE),

- nephropathy a cikin nau'in ciwon sukari na 2 na mellitus (rage haɗarin haɓaka haɓakar hypercreatininemia da proteinuria),

- rage haɗarin rikicewar cututtukan zuciya da mace-mace a cikin marasa lafiya da hauhawar jini da jijiyoyin jini na hagu.

- lactation (nono),

- shekaru har zuwa shekaru 18 (ba a kafa ingantaccen aiki da aminci ba),

- rashin jituwa tsakanin lactose, galactosemia ko cutar glucose / galactose malabsorption syndrome,

- Rashin hankali ga abubuwan da ke tattare da maganin.

Tare da taka tsantsan, ya kamata a yi amfani da miyagun ƙwayoyi don maganin hepatic da / ko gazawar koda, raguwa a cikin bcc, daidaitawar ruwa-electrolyte, ƙayyadadden ƙwararrakin koda biyu na jijiya ko stenosis na hanta guda ɗaya.

An wajabta maganin a baki 1 sau / rana, ba tare da la'akari da yawan abinci ba.

Tare da hauhawar jini a jijiyoyin jiki a mafi yawan lokuta, matakin farko da tabbatarwa shine 50 MG 1 lokaci / rana. Idan ya cancanta, ana iya ƙara yawan ƙwayar zuwa 100 mg / rana a allurai 1 ko 2.

A kan tushen ɗaukar diuretics a cikin allurai masu yawa, ana bada shawara don fara jiyya tare da miyagun ƙwayoyi Lozarel tare da 25 MG (1/2 tab. 50 MG) 1 lokaci / rana.

A cikin rauni na zuciya, kashi na farko shine 12.5 mg / day, wanda ya biyo bayan sati daya na 2 sau zuwa 50 mg / day, gwargwadon juriya da miyagun ƙwayoyi. Lokacin amfani dashi a cikin kashi na farko na 12.5 MG, ana bada shawarar yin amfani da siffofin sashi tare da ƙananan abun ciki na abu mai aiki (Allunan 25 MG tare da haɗari).

A cikin nau'in 2 na ciwon sukari mellitus tare da proteinuria (rage haɗarin haɓakar hypercreatininemia da proteinuria), kashi na farko shine 50 mg 1 lokaci / rana a cikin kashi 1. A lokacin jiyya, dangane da hawan jini, zaku iya ƙara yawan kwayoyin yau da kullun zuwa 100 MG a cikin 1 ko 2 allurai.

Lokacin amfani da miyagun ƙwayoyi Lozarel don rage haɗarin rikice rikicewar jijiyoyin jini da mace-mace a cikin marasa lafiya da hauhawar jijiya da hauhawar jini ventricular hagu, kashi na farko shine 50 MG 1 lokaci / rana, idan ya cancanta, ana iya ƙara yawan zuwa 100 mg / rana.

Marasa lafiya da ke fama da rauni na aikin ƙirar ƙasa (CC ƙasa da 20 ml / min), tare da tarihin cutar hanta, rashin ruwa, yayin aikin dialysis, da kuma marasa lafiya waɗanda suka girmi shekaru 75 da haihuwa, ana ba da shawarar yin amfani da maganin a cikin ƙananan matakin farko - 25 mg (1/2 tab. 50 MG) 1 lokaci / rana.

Yawancin lokaci sakamako masu illa suna da laushi kuma na dindindin, basa buƙatar dakatar da magani.

Haihuwa da lactation

Ba a tsara Lozarel Plus lokacin daukar ciki / lactation ba.

Lokacin amfani da miyagun ƙwayoyi a cikin kwayoyin cuta na II - III na ciki, lalacewar tayin mai tasowa mai yiwuwa ne, a wasu halayen, jiyya na iya haifar da mutuwarsa. Hadarin da ke tattare da rikice-rikice masu zuwa a cikin tayin shima yana ƙaruwa: jaundice tayi da jaundice na jariri. Uwa na iya haɓakar thrombocytopenia. Ya kamata a soke Lozarel Plus nan da nan bayan tabbatar da ciki.

Lokacin da ake tantance fa'idodi da haɗarin yin amfani da Lozarel Plus, mata masu shayarwa ya kamata suyi la'akari da cewa thiazides sun fayyace a cikin madarar nono, kuma ba a yi nazarin bayanan kare lafiyar losartan ba. Idan ya zama dole don amfani da Lozarel Plus, ya kamata a daina shayar da jarirai nono.

Tare da nakasa aiki na koda

A cikin marasa lafiya da mummunan gazawar renal (CC kasa da 30 ml / min), maganin ƙwayoyi yana contraindicated.

Tare da gazawar matsakaita matsakaici (CC 30-50 ml / min), an wajabta Lozarel Plus da taka tsantsan.

Ba a buƙatar gyaran kashi na farko ga marasa lafiya da gazawar matsakaicin matsakaici, ciki har da waɗanda ke kan dialysis, ba a buƙatar.

Tare da aikin hanta mai rauni

Ga marasa lafiya da matsanancin karancin damuwa na hepatic (bisa ga sikelin Yara-Pugh na fiye da maki 9), maganin yana tare da wannan wakilin antihypertensive wanda aka haɗa.

Tare da cututtukan hanta na ci gaba da kuma rauni na aikin hepatic kasa da maki 9 akan ma'aunin Yara-Pugh Lozarel Plus, ana amfani dashi a karkashin kulawar likita.

Abun ciki da nau'i na saki

Ana siyar da maganin a cikin nau'i na biconvex, allunan zagaye, mai rufi tare da harsashi mai launin rawaya mai haske. Idan kun karya kwamfutar hannu zuwa sassan 2, a ciki zaku iya samun farin fari ko farin-yellow. Kowane fakitin ya ƙunshi allunan 30.

A matsayin abubuwan da ke aiki, ƙwayar na iya ƙunsar 12.5 MG na hydrochlorothiazide da 50 MG na potassium losartan ko 25 MG na hydrochlorothiazide da 100 MG na potassium losartan.

Tushen Lozarel Plus ya ƙunshi lactose monohydrate, sitaci pregelatinized, MCC, colloidal silicon dioxide, magnesium stearate.

Shell ɗin ya ƙunshi baƙin ƙarfe baƙin ƙarfe oxide (fenti), hyprolose, titanium dioxide, hypromellose.

Lozarel: umarnin don amfani, farashi, analogues

Lozarel wani lamunin rage karfin jini ne wanda ake amfani dashi sosai wajen kula da mutanen da ke fama da hauhawar jini, gajiyawar zuciya, da ciwon suga (don kare kodan). Kamar kowane magani, yana da wasu alamomi, contraindications da sakamako masu illa.

Yanayi, tsawon lokacin ajiya

Adana Lozarel Plus a zazzabi na +25 ba ya wuce shekaru biyu.

Ga mazaunan Russia shirya magani yana farashin 200-300 rubles.

An kiyasta farashin Lozarel Plus a cikin Ukraine - 240 hryvnia.

Analogues na maganin sune magungunan kamar Lozartan N, Simartan-N, Lozartan-N Canon, Presartan N, Lorista ND, Lorista N.

Yin hukunci da sake dubawa, Lozarel Plus yadda ya kamata yana rage karfin jini kuma yana da kyau yana tasiri yanayin tsarin jijiyoyin jini.

Likitoci sun ce maganin bai dace da duk masu cutar hawan jini ba, don haka kuna buƙatar shan shi bisa shawarar likita.

Kuna iya karanta sake dubawar da mutane na gaske suka bari a ƙarshen umarnin.

Umarnin don amfani

Daidai da umarnin don amfani, yawanci ana shan maganin sau ɗaya a rana. Kuma suna yin duka biyu a kan komai a ciki, da kuma bayan sun ci abinci.

A cikin lura da hauhawar jini, kashi na farko kuma mai zuwa shine 50 mg sau ɗaya a rana. Tare da rashin isasshen sakamako, ana ƙaruwa sashi zuwa 100 MG kowace rana (idan ana so, za'a iya kasu kashi biyu).

A cikin lura da rauni na zuciya, ƙwayar farko shine 12.5 MG (kwata na kwamfutar hannu) kowace rana, yana ƙaruwa da haɓaka (an ninka kashi biyu kowane mako). Kada a sha fiye da 50 MG kowace rana.

Don rage haɗarin haɓakar hypercreatininemia da furotin a cikin marasa lafiya da ke dauke da nau'in ciwon sukari na 2, magani tare da miyagun ƙwayoyi ya fara da 50 MG sau ɗaya a rana. Bayan haka, ana ƙaruwa da kullun kashi (tare da ingantaccen sakamako mai kyau) zuwa 100 MG da aka ɗauka a cikin allurai ɗaya ko biyu.

Don rage haɗarin cututtukan zuciya da mutuwa a cikin mutane da hauhawar jini da jijiyoyin jikin bango na hagu, ana fara jiyya tare da 50 MG sau ɗaya a rana. Idan ya cancanta, ƙara kashi zuwa 100 MG kowace rana.

Recommendedarancin magani (25 MG kowace rana) ana bada shawara ga mutane:

sama da shekaru 75 da haihuwa
fama da rashin ruwa, hanta da cututtukan koda,
kasancewa akan dialysis.

Ra'ayoyi akan Lozarel

“Na kamu da ciwon zuciya shekaru biyar da suka gabata. Na gwada kusan dukkanin masu hana ACE, amma kusan basu lura da wani canji mai kyau ba. Sannan likita ya umurce ni da Lozarel. Yayin da aka dauki maganin, sai ta fara lura da cewa ta gaji, sannan kumburi a kafafu da hannayenta ya ragu, sannan gajeruwar numfashi ya shuɗe. Magungunan ba zai fara aiki ba nan da nan, amma idan kuka ƙara ɗaukar sa, ƙarin lura zai zama sakamakon. Bayan watanni biyar na ɗauka, Na kawar da tari mai narkewa a cikin dare, kuma yanzu zan iya alfahari da rashin ƙarfi da kumburi. Haka ne, kuma gazawar numfashi baya bayyana ”