Hartil Amlo: umarnin don amfani

Kafurai 5 MG + 5 MG, mai wuya, gelatin, CONI-SNAP 3, mara ƙyalle, rufewar kai, tare da tushen opaque a cikin burgundy haske da murfin opaque a cikin burgundy mai haske.

PRING crospovidone (E-1202), hypromellose (E-464), celclose microcrystalline (E-460), glycerol dibehenate.

Abinda ke ciki na kwalliyar CONI-SNAP 3: shuɗi mai haske (E-133), ja mai kyau (E-129), titanium dioxide (E-171), gelatin.

7 inji mai kwakwalwa - blisters da aka yi da PVC / Polyamide / Aluminum (4) - fakitoci na kwali.
7 inji mai kwakwalwa - blisters da aka yi da PVC / Polyamide / Aluminum (8) - fakitoci na kwali.
10 inji mai kwakwalwa. - blisters da aka yi da PVC / Polyamide / Aluminum (3) - fakitoci na kwali.
10 inji mai kwakwalwa. - blisters da aka yi da PVC / Polyamide / Aluminum (9) - fakitoci na kwali.

Aikin magunguna

Hanyar aiwatar da ramipril

Ramiprilat, metabolite mai aiki na ramipril prodrug, yana hana enzyme dipeptidyl carboxypeptidase I (kalma: angiotensin-mai canza enzyme, kininase II). A cikin ƙwayar plasma da kyallen takarda, wannan enzyme yana ɗaukar juyar da juyawar angiotensin I cikin wani abu mai aiki na vasoconstrictor - angiotensin II, yana kuma ba da gudummawa ga lalata lalata abu na vasodilator - bradykinin. Rage samuwar angiotensin II da hana lalata lalata bradykinin yana haifar da vasodilation.

Tun da angiotensin II kuma yana ƙarfafa sakin aldosterone, ramiprilat yana rage ɓoyewar aldosterone. Matsakaicin martani ga maganin monotherapy tare da inhibitor na ACE ya kasance ƙasa cikin yawan fararen fata (Afro-Caribbean) da ke fama da hauhawar jijiya (yawan ƙwararrun marasa lafiya da hawan jini kuma, a matsayin mai mulkin, tare da ƙaramin abun ciki).

Yin amfani da ramipril yana tare da raguwar alama a cikin juriya na jijiyoyin jini. A matsayinka na mai mulkin, miyagun ƙwayoyi ba su canza yanayin hauhawar jini na jini da ƙimar tacewa na duniya. Yin amfani da ramipril yana haɗuwa da sakamako na antihypertensive, duka a matsayin tsaye ga mai haƙuri da matsayin kwance, kuma ƙwayar ba ta haifar da tachycardia rama.

Bayan kulawa guda ɗaya na ramipril, ana lura da tasirinsa na antihypertensive a cikin sa'o'i 1-2, ya kai matsakaici bayan sa'o'i 3-6 kuma yana ɗaukar tsawon sa'o'i 24. Tare da amfani da ramipril yau da kullun, tasirin antihypertensive yana ƙaruwa sama da makonni 3-4 kuma yana ci gaba tare da tsawan magani.

Rushewar kwatsam na ramipril ba tare da haɓaka hawan jini ba.

Tsarin aikin amlodipine

Amlodipine yana hana isharar ƙwayar ƙwayar calcium a cikin cardiomyocytes da ƙwayoyin tsoka mai santsi (mai “jinkirin” mai hana tashar alli ko maganin kalshin alli).

Hanyar tasirin sa na rashin inganci shine sakamakon tasirin natsuwa kai tsaye a kan mai santsi na jijiyoyin jijiyoyin jini, yana haifar da raguwar juriya na jijiyoyin jiki.

Cikakken bayanin hanyar wanda ta sauƙaƙa hanyar aikin angina pectoris ba a riga an kafa shi ba, amma wannan tsarin yana iya aiki ta hanyoyi biyu:

1) yaduwar cututtukan mahaifa, kuma, saboda haka, raguwa cikin jimlar jijiyoyin bugun jini (bayan saukarwa).

Tun da miyagun ƙwayoyi ba ya haifar da tlexycardia reflex, yawan kuzarin myocardium da buƙatarsa ​​don wadatar oxygen zai ragu.

2) yaduwar manyan jijiyoyin zuciya da jijiyoyin jini, duka a canzawa da kuma cikin bangarorin ischemic na ƙwayar zuciya, yana ƙaruwa kwararar iskar oxygen zuwa cikin myocardium.

Hanyar da aka fasalta a sama tana ƙara wadatar iskar oxygen sauyawa koda da jijiyoyin jijiyoyin zuciya (sananniyar angina ko Prinzmetal angina).

A cikin marasa lafiya tare da hauhawar jini, guda ɗaya na amlodipine yana samar da raguwa mai mahimmanci a cikin karfin jini a cikin tsawon awanni 24 (a cikin “kwance” da “matsayin” mai haƙuri). Saboda bayyanuwar hankali na aikin da kuma tsawan sakamako, ƙwayar ba ta haifar da matsananciyar damuwa.

A cikin marasa lafiya tare da angina pectoris, kashi ɗaya na yau da kullun yana ƙaruwa da haƙuri na motsa jiki, jinkirta ci gaba da wani harin na angina pectoris da "ischemic" ciki na rukunin ST, kuma yana rage yawan lokutan harin angina da kuma yawan nitroglycerin. Magungunan ba ya haifar da illa mai illa: ba ya shafar lipids na plasma, sukari jini da acid uric kuma ana iya tsara shi ga masu fama da cutar asma.

Karatun Tsaro na Lafiya

Game da ramipril:

Tare da maganin baka na ramipril zuwa rodents da karnuka, an gano cewa miyagun ƙwayoyi ba ya haifar da mummunan guba a cikin dabbobi. An gudanar da karatun ne ta amfani da maganin hana yaduwar maganin a cikin beraye, karnuka, da birai. A duk nau'ikan dabbobi uku, an yi canje-canje a cikin taro na ƙwayoyin plasma electrolytes da canje-canje a hoton jini.

Kamar yadda shaidar aikin pharmacodynamic na ramipril, an lura da haɓakar ƙwayar cutar ƙwaƙwalwar ƙwayar ƙwayar cuta a cikin karnuka da birai a kashi 250 na rana / kg / rana. Beraye, karnuka, da birai sun yi haƙuri da allurai kowace rana na 2, 2.5, da 8 mg / kg (nauyin jiki) / rana, bi da bi, ba tare da cutarwa ba.

Karatun game da sakamakon guba na miyagun ƙwayoyi akan ƙwayar haihuwa a cikin beraye, zomaye da birai ba su bayyana wani tasirin teratogenic na ramipril ba. Babu maza ko berayen da suka nuna canje-canje ga haihuwa.

Addamarwar ramipril ga berayen mace yayin lokacin tayi da kuma lokacin lactation a cikin kashi ɗaya na 50 mg / kg nauyin jiki (ko mafi girma) yana tare da lalacewa mai lalacewa ga ƙodan (faɗaɗa ƙashin ƙugu na tayi).

A cikin babban binciken da aka yi amfani da tsarin gwaji da yawa, ba a gano alamun mutagenicity ko genotoxicity na ramipril ba.

Dangane da amlodipine:

A cikin berayen da berayen da aka haɓaka tare da amlodipine maleate a cikin yawan haɗuwa har zuwa shekaru biyu a cikin yawan haɗuwa wanda ya dace da matakan allurai na yau da kullun na 0.5, 1.25 da 2.5 mg na amlodipine / kg (nauyin jiki) / rana, ba a lura da tasirin carcinogenic ba. Matsakaicin mafi girma a cikin mice (cikin sharuddan mg / m 2) ya kasance daidai da iyakar shawarar ɗan adam da aka ba da shawarar (MHD) na amlodipine 10 mg a kowace rana. Matsakaicin mafi girma a cikin berayen (dangane da mg / m 2) ya kusan sau biyu yana fi na MPD girma.

Yayin aiwatar da nazarin amlodipine maleate, babu alamun mutagenicity wanda ya haifar da amfani da miyagun ƙwayoyi, duka a matakin gene da kuma matakin chromosomes.

Amfanin haihuwa a cikin berayen da aka bayar da maganin amlodipine na maleres a kashi na kimanin 10 mg / kg (nauyin jiki) / rana (wanda, dangane da mg / m 2, ya kasance sau 8 ya fi na MPD na 10 mg / day).

Hulɗa da ƙwayoyi

Game da ramipril:

Hanyoyin wuce gona da iri da ke tattare da haɗuwa da jini tare da abubuwan da ba su da tushe, irin su hemodialysis ta hanyar membranes sosai (misali membranes da aka yi daga ƙwayoyin polyacrylonitrile), hawan jini ko ƙamshi na rashin ƙarfi mai yawa ta amfani da dextran sulfate, saboda haɓakar haɗarin haɓaka mai ƙima ko rashin lafiyar anaphylaid. Idan irin wannan magani ya zama dole, to amfani da wani nau'in membrane don maganin dialysis ko magungunan antihypertensive na wani fanni yakamata a yi la’akari.

Kariya don amfani

Tare da gudanarwa na lokaci guda tare da shirye-shiryen potassium, capi-tsare diuretics da sauran abubuwa masu aiki waɗanda ke haɓaka matakan ƙwayar cutar ta plasma (wanda ya haɗa da angiotensin II receptor antagonists, trimethoprim, tacrolimus, cyclosporine): haɓakar hyperkalemia mai yiwuwa ne, saboda haka wajibi ne don saka idanu sosai a kan matakin potassium a cikin jini.

Magungunan Antihypertensive (misali, diuretics) da sauran abubuwa waɗanda zasu iya rage karfin jini (misali, nitrates, tricyclic antidepressants, painkillers, barasa, baclofen, alfuzosin, doxazosin, prazosin, tamsulosin, terazosin): haɗarin hauhawar jini na iya kasancewa da ƙarfi.

Vasopressor sympathomimetics da sauran abubuwa (alal misali, isoproterenol, dobutamine, dopamine, adrenaline) waɗanda zasu iya rage tasirin antihypertensive na ramipril: Ana bada shawarar saka idanu akan hawan jini.

Allopurinol, immunosuppressants, corticosteroids, procainamide, cytostatics da sauran kwayoyi waɗanda zasu iya canza adadin ƙwayoyin jini: haɓaka alama na haɓaka halayen jini.

Gishirin lithium: yayin shan magungunan ACE tare da shirye-shiryen lithium, yana yiwuwa a rage ƙyalli kuma, a sakamakon haka, ƙara yawan haɗuwar lithium a cikin jini tare da ƙara yawan haɗarinsa. Ana buƙatar saka idanu akai-akai game da matakan lithium.

Antidiabeticic jami'ai, gami da insulin: maganganu na rashin ƙarfi da haɓaka na iya haɓaka. An ba da shawarar yin tsauraran matakan glucose a cikin jini.

Magungunan anti-kumburi marasa amfani da acetylsalicylic acid: raguwa a cikin tasirin antihypertensive na ramipril yana yiwuwa. Bugu da ƙari, haɗuwa da masu hana ACE da masu hana NSAIDs na iya haifar da haɓakar hyperkalemia da haɓaka haɗarin aikin ƙarancin haya.

Dangane da amlodipine:

Magungunan sun aminta da thiazide diuretics, beta-blockers, nitrates mai tsawo, nau'ikan sakin magunguna na nitroglycerin, magungunan anti-mai kumburi marasa amfani, maganin rigakafi da magunguna na tsoka.

Sakamakon wasu kwayoyi a kan amlodipine

- Inhibitors na CYP3A4: lokacin da ake amfani da miyagun ƙwayoyi tare da inhibitor na CYP3A4, erythromycin a cikin marasa lafiya matasa da diltiazemem a cikin tsofaffi marasa lafiya, bi da bi, yawan ƙwayar ƙwayar amlodipine yana ƙaruwa, bi da bi, da kashi 22% da 50%. Koyaya, mahimmancin yanayin wannan yanayin ya zama ba a bayyane ba. Ba za a iya cire shi ba cewa masu hana CYP3A4 masu ƙarfi (alal misali, ketoconazole, itraconazole, ritonavir) na iya haɓaka ƙwayoyin plasma na amlodipine zuwa mafi girma fiye da diltiazem. Ya kamata a yi amfani da Amlodipine tare da taka tsantsan lokacin da aka gudanar da shi tare da masu hana CYP3A4. Koyaya, babu rahoto game da wasu sakamako masu illa da ke tattare da wannan hulɗa.

- CYP3A4 inducers: babu wata shaida game da tasirin injinin CYP3A4 akan amlodipine. Haɗewar yin amfani da miyagun ƙwayoyi tare da masu amfani da CYP3A4 (alal misali, rifampicin ko St John's wort) na iya rage yawan ƙwayar cutar ta amlodipine. Ya kamata a yi amfani da Amlodipine tare da taka tsantsan lokacin amfani dashi tare da injinin CYP3A4.

A cikin nazarin asibiti game da hulɗa da miyagun ƙwayoyi, haɗin amlodipine tare da ruwan innabi, cimetidine, aluminium / magnesium (antacids) da sildenafil ba su shafi magungunan maganin amlodipine ba.

Tasirin amlodipine akan sauran kwayoyi

Haɗewar amfani da amlodipine tare da wasu wakilai masu amfani da ƙwayoyin cuta suna haɓaka ingancin warkewar su.

A cikin nazarin asibiti na hulɗa da magunguna, amlodipine bai tasiri kan magungunan likitancin atorvastatin, digoxin, ethanol (ethanol), warfarin, ko cyclosporine.

Babu wani sakamako na amlodipine akan canje-canje a cikin gwaje-gwajen gwaje-gwaje da aka tabbatar.

Sakawa lokacin

Thewarin da aka ba da shawarar yau da kullun shine capsule 1 tare da maganin da aka tsara. Hartil ® Amlo ya kamata a dauki kullun, a lokaci guda na rana, kafin ko bayan abincin. Kada a murƙushe capsules ko chewed.

Fixedarancin magunguna masu haɗuwa bai dace da matakin farko na maganin ba. Idan akwai buƙatar daidaitawar sashi, to yakamata a aiwatar da shi kawai tare da taimakon masu samar da abubuwa kuma kawai bayan an kafa irin wannan isasshen ƙwayar za mu iya canzawa zuwa wani sabon nau'in magani tare da ƙayyadadden ƙwayar magani da aka sanya wa Hartil ® Amlo.

Tsofaffi: an bada shawara don tsara magunguna tare da taka tsantsan ga marasa lafiya da ke shan diuretics, tunda a cikin waɗannan marasa lafiya ana iya samun daidaituwa game da ma'aunin ruwan-electrolyte na iya faruwa. Wajibi ne a yi nazarin aikin koda kuma a tantance matakin potassium a cikin jini.

A cikin marasa lafiya da ke fama da aikin hanta, kawar da amlodipine na iya zama tsawan lokaci. Tabbatattun shawarwari game da sigar amlodipine ba a ƙaddara su ba, amma ya kamata a tsara maganin ga waɗannan marasa lafiya tare da taka tsantsan. A cikin marasa lafiya da ke fama da rauni na hanta, ya kamata a fara amfani da magani na ramipril a karkashin kulawa ta kusa da likita, kuma mafi girman kullun ya kamata ya zama 2.5 mg na ramipril.

An ba da shawarar cewa a sanya Khartil ® Amlo kawai ga waɗanda aka tura su zuwa 2.5 MG na ramipril azaman ingantaccen matakin kulawa lokacin zaɓar sashi na ramipril.

Don ƙayyade mafi kyau duka na farko da kuma kula allurai a cikin marasa lafiya da nakasa aiki na koda, ya kamata a zabi sashi na miyagun ƙwayoyi da akayi daban-daban ƙayyade sashi na ramipril da amlodipine.

Babu buƙatar daidaita sashi na amlodipine a cikin marasa lafiya da ke fama da rauni na aikin koda.

Amlodipine ba a keɓe shi ba lokacin diyya. Marasa lafiya suna fuskantar dialysis, amlodipine ya kamata a wajabta shi tare da taka tsantsan.

Ya kamata a samar da maganin yau da kullun na ramipril a cikin marasa lafiya tare da gazawar koda

- Idan keɓantaccen creatinine shine ml60 ml / min, to kashi na farko baya buƙatar daidaitawa, matsakaicin adadin yau da kullun shine 10 MG.

- Idan keɓantaccen bayani na in Amlo, ana bada shawara don yin magani kawai idan an sauya mai haƙuri zuwa ramipril dosing regimen na 2.5 MG ko 5 MG a matsayin mafi kyawun kiyayewa na kariya (wanda aka kafa yayin ƙaddamar ramipril). Marasa lafiya da ke fuskantar hemodialysis yakamata su sha maganin a wasu sa'o'i bayan hemodialysis.

A cikin aiwatar da magani tare da miyagun ƙwayoyi Hartil ® Amlo, ikon aikin kodan da abubuwan da ke cikin potassium a cikin jijiyoyin jini ya kamata a sarrafa su. Idan lalacewar aikin koda, ya kamata a dakatar da amfani da miyagun ƙwayoyi il Amlo, kuma ya kamata a tsara abubuwan da ke cikin sa a allurai da aka daidaita sosai.

Tsofaffi marasa lafiya na iya ɗaukar allurai na amlodipine, kodayake, ya kamata a yi taka tsan-tsan don ƙara yawan ƙwayar.

Yankin farko na ramipril ya kamata ya zama ƙasa da yadda aka saba, kuma daidaitaccen sashi na gaba ya kamata ya zama mafi sauƙi, saboda haɗarin haɗari na tasirin da ba a so.

Ba da shawarar sanya Hartil ® Amlo ga tsoffin kuma marasa ƙarfi marasa lafiya.

Ba'a ba da shawarar yin amfani da Hartil ® Amlo don yara da matasa masu shekaru 18 ba, tunda ba a ƙaddara aminci da tasiri na miyagun ƙwayoyi a cikin wannan rukunin marasa lafiya ba.

Alamomi don daukar ciki

Game da ramipril

Ba'a bada shawarar yin amfani da IP inhibitors lokacin farkon watanni uku na ciki, kuma yayin watanni uku da na uku na ciki, yin amfani da allurar IPF.

Tabbacin cutar cututtukan ƙwayar cuta game da haɗarin teratogenicity bayan fallasawa ga masu hana ACE yayin farkon watanni na ciki ba tabbatacce bane, amma ƙara ƙarancin wannan haɗarin ba za'a iya yanke hukunci ba. Idan akwai buƙatar ci gaba da jiyya tare da yin amfani da inhibitors na ACE / ARAT II, ​​to marassa lafiyar da ke shirin ɗaukar ciki ya kamata su canza tsarin kulawar su zuwa wani zaɓi na rigakafin ƙwayar cuta wanda ya cika buƙatun aminci don amfanin sa yayin daukar ciki. Lokacin da aka tabbatar da ciki, magani tare da masu hana ACE ya kamata a dakatar da su nan da nan kuma, idan ya cancanta, ya kamata a fara wani magani.

Fitowa ga inhibitors na ACE a lokacin karo na biyu da na uku an san shi yana haifar da fetotoxicity a cikin mutane (nakasa ci gaban koda na tayin, oligohydramnios, jinkirin ossification na kwanyar) da cututtukan cututtukan ƙwayoyin cuta na ciki (gazawar renal, hypotension, hyperkalemia). Idan fallasawa ga inhibitors na ACE ya faru yayin watanni biyu na ciki, ana ba da shawarar yin wani duban dan tayi game da aikin koda da haɓaka ƙasusuwa. Ya kamata jarirai su kula da jarirai wanda uwayensu suka sha maganin ACE don yiwuwar ci gaban haihuwar jini, oliguria da hyperkalemia.

Dangane da amlodipine

Ba a tabbatar da amincin amlodipine lokacin daukar ciki a cikin mata ba. Nazarin wurare na haihuwa a cikin berayen sun nuna rashin alamun yawan guba, ban da na aiki daga baya da tsawon lokaci, tare da allurai sau 50 mafi girman shawarar da aka yiwa dan adam. Yin amfani da miyagun ƙwayoyi yayin daukar ciki ana bada shawarar ne kawai in babu wasu hanyoyin mafi aminci kuma idan cutar ta haifar da babban haɗari ga uwa da tayin.

Game da ramipril

Tunda babu isasshen bayani game da amfani da ramipril yayin shayarwa, ba a bada shawarar amfani da ramipril a wannan lokacin ba, kuma anfi so a zabi wasu hanyoyin magani tare da ingantattun bayanan bayanan martaba yayin shayarwa, musamman yayin ciyar da jarirai da jarirai.

Dangane da amlodipine

Babu bayanai game da rarraba amlodipine tare da madara. Ya kamata a yanke shawara don ci gaba / dakatar da shayarwa ko ci gaba / dakatar da magani tare da amlodipine tare da la’akari da fa'idodin shayar da jarirai ga jariri da fa'idodin maganin amlodipine ga mahaifiyar.

Umarni na musamman

Game da ramipril:

Ungiyoyin Patent na Musamman

Bai kamata a sha masu hana ACE lokacin ciki ba. Idan akwai buƙatar ci gaba da warkewa tare da yin amfani da masu hana ACE, to, marassa lafiyar da ke shirin ɗaukar ciki ya kamata su canza tsarin warkewa zuwa madadin maganin rigakafin ƙwayar cuta, wanda ya cika buƙatun aminci don amfanin sa yayin daukar ciki. Lokacin da aka tabbatar da bayyanar cutar ciki, magani tare da amfani da allurar ACE ya kamata a dakatar da shi nan da nan kuma, idan ya cancanta, ya kamata a fara amfani da madadin magani.

Marasa lafiya tare da ƙara haɗarin hauhawar jini:

- Marasa lafiya da ƙwayar renin-angiotensin-aldosterone mai saurin motsa jiki:
marasa lafiya da ke da tasirin gaske mai narkewa-angiotensin-aldosterone suna cikin hadarin matsanancin raguwa a cikin karfin jini da aikin nakasassun aiki saboda hanawar ACE, musamman idan aka tsara allurar ACE ko kuma abubuwan kwantar da hankali a karon farko ko kuma an tashe maganinsu a karon farko.

Idan bayyanar hyperactivation na tsarin renin-angiotensin-aldosterone da alama zai yiwu, to, idan ya cancanta, shirya duba likita, gami da saka idanu akan hawan jini:

- a cikin marasa lafiya da matsanancin hauhawar jini,

- a cikin marasa lafiya da decompensated ambaliyar zuciya,

- a cikin marasa lafiya da ke nuna rashin haɓakar bugun jini ko kwararar jini daga ventricle hagu (alal misali, stenosis na aorta ko mitral valve),

- a cikin marassa lafiya tare da wani abu guda daya na na koda na koda tare da aiki koda na biyu,

- a cikin marasa lafiya tare da data kasance (ko zai yiwu) hargitsi a cikin daidaituwar ruwa-mai wutan lantarki (gami da marasa lafiya suna shan diuretics),

- a cikin marasa lafiya da cirrhosis da / ko ascites,

- a cikin majinyacin da suka kamu da hadaddun tiyata, ko waɗanda suka sami maganin rashin daidaituwa ta hanyar amfani da magungunan da ke haifar da tashin hankali,

Gabaɗaya, ana bada shawara cewa za a gyara rashin ƙarfi, ƙwanƙwarar jini, ko ƙarancin gishiri kafin a fara jiyya (a cikin marasa lafiya da raunin zuciya, duk da haka, duk wadatar da ire iren waɗannan matakan ya kamata a auna su da kyau, yin la’akari da haɗarin hauhawar abin hawa).

- a cikin marasa lafiya tare da lokaci na lokaci-lokaci (lokaci-lokaci) ko rashin zuciya na dindindin bayan MI,

- a cikin marasa lafiya masu haɗarin haɓakar bugun zuciya ko ischemia na ciki ko cikin yanayin tashin zuciya mai zurfi.

A matakin farko na jiyya, ana buƙatar duba kulawa ta musamman.

An ba da shawarar ku daina amfani da angiotensin-juyar da inzyme enzyme, kamar ramipril, wata rana kafin tiyata, in ya yiwu.

Kulawa da aikin koda

Dole ne a bincika aikin azabtarwa kafin da lokacin jiyya, kuma ana daidaita sashi na magunguna, musamman a farkon makonni na jiyya. Ga marasa lafiya da ƙarancin na koda, musamman saka idanu sosai wajibi ne. Akwai haɗarin aiki na ƙarancin aiki, musamman a cikin marasa lafiya da cututtukan zuciya da ke faruwa ko bayan sakewar koda.

Hatsarin angioedema a cikin marasa lafiya da ke shan inhibitors na ACE, gami da ramipril, an ba da rahoto.

Idan angioedema ta faru, ya kamata a dakatar da ragewar ƙwayar ido. Hanyar da hanyoyin maganin gaggawa ana wajabta su nan da nan. Ya kamata a kula da mai haƙuri aƙalla awanni 12 zuwa 12, kuma a sake shi daga sarrafawa kawai bayan alamun bayyanar sun gama warwarewa.

Abin da ya faru na angioedema na hanji an ba da rahotonsa a cikin marasa lafiya waɗanda ke shan masu hana ACE ciki har da ramipril.

Wadannan marasa lafiya sun koka da ciwon ciki (tare da ko ba tare da alamun tashin zuciya ko amai ba).

Amfani da inhibitors na ACE yana kara yiwuwar kamuwa da kwayar cutar kwayar cutar kwayoyi (da kuma tsananin ƙarfinsu) ga ƙwayoyin kwari da wasu abubuwan ƙwayoyin cuta. Har sai lokacin hana haihuwa ya cika, ya kamata a ba da shawara don katse ɗan ramipril na ɗan lokaci.

An lura da Hyperkalemia a cikin wasu marasa lafiya da ke shan inhibitors na ACE, gami da ramipril. Rukunin marasa lafiya da haɓakar haɗarin hyperkalemia sun haɗa da marasa lafiya tare da gazawar koda, tsofaffi marasa lafiya (fiye da shekaru 70), marasa lafiya waɗanda ke fama da cututtukan ƙwayar cuta na marasa lafiya, ko marasa lafiya waɗanda ke ɗaukar salts na salma, abubuwan da ke dauke da sinadarin potassium da wasu abubuwa masu aiki waɗanda ke haɓaka matakan ƙwayar ƙwayar cutar ta plasma jini, kazalika da marasa lafiya da yanayi irin su bushewar zuciya, gazawar zuciya, ko kuma acidosis na rayuwa. Idan anyi la'akari da amfani da magungunan da aka yi amfani dasu a lokaci daya dace, ana bada shawarar kulawa da kullun matakin potassium a cikin jini.

Akwai rahotannin da ba a sani ba game da shari'o'in cututtukan neutropenia / agranulocytosis, thrombocytopenia da anemia, da kuma raunin ɓacin rai. Don farkon gano leukopenia, ana bada shawara don sarrafa adadin leukocytes. Ana ba da shawarar ƙarin sa ido akai-akai a matakin farko na magani a cikin marasa lafiya da ke fama da rauni na nakasassu, kazalika da marasa lafiya da ke da haɗin gwiwa (alal misali, lupus erythematosus ko scleroderma), kuma a duk marasa lafiya suna ɗaukar wasu magunguna waɗanda zasu iya haifar da canje-canje a hoton jini.

ACE inhibitors yana ƙara haɗarin angioedema a cikin marasa lafiya baƙar fata idan aka kwatanta da marasa lafiya da launi daban-daban na fata.

Kamar sauran masu hana ACE, ramipril na iya zama mai ƙarancin tasiri wajen rage karfin jini a cikin marasa lafiyar baƙi idan aka kwatanta da marasa lafiya da launi daban-daban na fata. Wataƙila wannan shi ne saboda yawan hauhawar jini a cikin jijiya tare da ƙaramin matakin renin a yawan baƙar fata marasa lafiya da ke fama da hauhawar jini.

Akwai rahotanni na tari bayan shan maganin ACE. Siffar halayyar tari shine bushewarsa da dorewarsa, da kuma ɓatar da bayyanuwarsa bayan yankewar magani. Kwantar da hankali ta hanyar shan inhibitors na ACE ya kamata a yi la'akari dashi azaman ɓangare na bambance banbancen maganin tari.

Dangane da amlodipine:

Babu aminci da tasiri na amlodipine a cikin tashin hankali na hauhawar jini.

Yi amfani da marasa lafiya tare da raunin zuciya

Ya kamata a yi amfani dashi tare da taka tsantsan a cikin marasa lafiya da raunin zuciya. A cikin dogon nazari da aka sarrafa mai karfi wanda ya shafi marasa lafiya da raunin zuciya (NYHA aji III da aji na aji), an yi rikodin lokuta na huhun ciki, wanda ya kasance mafi girma a cikin rukuni tare da amlodipine, idan aka kwatanta da kungiyar placebo, amma wannan ba tare da mafi tsananin rauni zuciya.

Yi amfani a cikin marasa lafiya da nakasa aikin hanta

A cikin marasa lafiya waɗanda ke fama da aikin hanta mai rauni, rabin rayuwar amlodipine yana da tsawo, babu shawarwari don canza sashi. Marasa lafiya a cikin wannan rukuni ya kamata su dauki amlodipine tare da taka tsantsan.

Yi amfani da shi a cikin tsofaffi marasa lafiya

Ya kamata tsofaffi marasa lafiya su ɗauki amlodipine tare da taka tsantsan.

Yi amfani da marasa lafiya da ke fama da rauni na aikin haya

Marasa lafiya da ke fama da rauni na aikin ƙirar na iya ɗaukar amlodipine a cikin matakan al'ada. Canje-canje a cikin yawan ƙwayar plasma na amlodipine ba su daidaita tare da matsayin ƙin renal. Amlodipine ba a keɓe shi ba lokacin diyya.

A cikin kwalin kwanson 5 mg / 5 mg da 10 mg / 5 mg shine ja mai kyau (allura red AC-FD & C Red 40 E-129, kuma a cikin kwanson kwanson 5 mg / 10 mg da 10 mg / 10 mg akwai azorubine (carmuazine) ( E-122) Waɗannan duwatsun na iya haifar da rashin lafiyan ƙwayar cuta.

Tasiri kan ikon tuka motoci da hanyoyin sarrafa abubuwa

Wasu sakamako masu illa (alal misali, alamu na raguwar hauhawar jini, kamar suma) na iya rage ƙarfin mai haƙuri wajen maida hankali da amsa da sauri, sabili da haka yana ƙara haɗarin yanayi a inda waɗannan damar ke da mahimmanci musamman (alal misali, yayin tuki ko aiki inji da injuna).

Musamman, wannan na iya faruwa a farkon jiyya ko lokacin maye gurbin wasu kwayoyi. Bayan shan kashi na farko na maganin ko kuma ƙaruwa mai zuwa na maganinsa, ba a ba da shawarar fitar da motoci ko riƙe injuna da injuna na awanni da yawa.

Pharmacokinetics

Tsotsa da rarrabawa

Bayan gudanar da bakin, ramipril yana dafe cikin hanzari daga narkewa. C_max Ramipril a cikin plasma an kai shi cikin awa 1. Yin la'akari da fitar fitsari, matakin sha aƙalla ya zama kashi 56% kuma baya dogaro da abincin. A bioavailability na aiki metabolite na ramiprilat bayan maganin baka na 2.5 mg da 5 MG na ramipril shine 45%.

C_max ramiprilat, kadai metabolite na ramipril, an kai shi awanni 2-4 bayan shan ramipril. C_ss An kai ga maida hankali ga ƙwayar plasma ramiprilat, kimanin, a ranar 4 na ɗaukar ramipril a cikin warkewa. Theulla ramipril ga ƙwayoyin serum kusan kashi 73%, kuma ramiprilat kusan kashi 56%.

Metabolism da excretion

Ramipril kusan kusan metabolized ne ga ramiprilat kuma zuwa diketopiperazinovy ​​ether, diketopiperazinovy ​​acid kuma zuwa ramipril da ramiprilat glucuronides. Ana motsa jijiyar metabolites, musamman ta hanyar kodan. Plasma maida hankali ne na ramiprilat a cikin yanayin polyphase. Sakamakon ɗaukar nauyin da ke tsakanin ACE da raunin rarrabuwa tare da enzyme, ramiprilat yana nuna ƙarshen lokacin ƙarshe na kawar da ƙwaƙwalwar ƙwayar cuta a cikin ƙananan ƙwayar cuta. Bayan sake maimaitawa na ramipril a cikin kashi ɗaya 1 lokaci /, T sosai_1/2 ramiprilat ya kasance awanni 13 zuwa 17 (a kaso na 5-10 mg), kuma bayan an rage kashi zuwa 1.25-2.5 mg T_1/2 tsawanta. Wannan bambanci yana faruwa ne ta hanyar ikon enzyme, wanda yake ɗaukar ramiprilat.

Bayan kashi daya na ramipril, babu alamun ramipril da metabolites a cikin madara. Koyaya, haɓakar ramipril tare da madara tare da madara tare da maimaita magunguna har yanzu ba a sani ba.

Pharmacokinetics a cikin lokuta na musamman na asibiti

Ramiprilat renal excretion an rage cikin marasa lafiya tare da lalataccen aikin na koda, da kuma keɓaɓɓen sikewar ramiprilat ya dogara gwargwadon QC. Wannan yana haifar da karuwa a cikin yawan ƙwayar plasma na ramiprilat, wanda ke ragewa a hankali fiye da marasa lafiya da ke da aikin na al'ada.

A cikin marasa lafiya tare da aikin lalata hanta, canjin metabolism na ramipril zuwa ramiprilat yana raguwa saboda raguwa a cikin ayyukan hepatic esterases, kuma matakan plasma na ramipril a cikin waɗannan marasa lafiya suna ƙaruwa. C_max ramiprilata a cikin waɗannan marasa lafiya, duk da haka, bai bambanta da waɗanda ke cikin marasa lafiya da aikin hanta na al'ada ba.

Tsotsa da rarrabawa

Bayan gudanar da baki, amlodipine a hankali yana daga cikin narkewar abinci. C_max a cikin magani yana lura ne bayan sa'o'i 6-12. Cin abinci baya shafar bioavailability na amlodipine. Cikakken bioavailability shine 64-80%.

V_d yana yin 21 l / kg na nauyin jiki. C_ss a cikin jini (5-15 ng / ml) an cimma shi ne bayan kwanaki 7-8 na amfani da maganin yau da kullun. Binciken in vitro ya nuna cewa kashi 93 zuwa 9% na amlodipine da ke yawo a cikin jijiyoyin jini na hade da kariyar plasma.

Metabolism da excretion

Amlodipine yana da sauri metabolized (kusan 90%) a cikin hanta don samar da metabolites marasa aiki.

Kimanin 10% na farawa da 60% na metabolites marasa aiki suna cikin fitsari, 20-25% tare da feces. Rage yawan plasma maida hankali ne biphasic. Kaya ta ƙarshe T_1/2 daga plasma jini shine kimanin sa'o'i 35 zuwa 50 lokacin da aka ɗauki 1 lokaci / totalididdigar yawan kuɗi shine 7 ml / min / kg (tare da nauyin jikin mai haƙuri na 60 kg - 25 l / h).

Pharmacokinetics a cikin lokuta na musamman na asibiti

Magungunan magunguna na amlodipine ba su fuskantar manyan canje-canje a cikin gazawar koda kuma tare da karuwar shekarun marasa lafiya.

Lokaci don isa C_max amlodipine a cikin plasma a cikin tsofaffi da matasa marasa lafiya iri ɗaya ne. A tsofaffi marasa lafiya jimlar amlodipine shine 19 l / h. Amlodipine yarda yawanci yana raguwa tare da haɓaka AUC da T_1/2a cikin tsofaffi marasa lafiya.

AUC da T haɓaka_1/2 iri ɗaya ne a cikin tsofaffi marasa lafiya.

Amlodipine yana da cikakken metabolized don samar da metabolites marasa aiki. 10% na farawa ba a canza shi a cikin fitsari. Canje-canje a cikin tattarawar plasma na amlodipine bashi da alaƙa da digiri na gazawar. Irin waɗannan marasa lafiya na iya ɗaukar allurai na amlodipine na yau da kullun. Binciken amlodipine ba shi da tasiri.

T_1/2 amlodipine a cikin marasa lafiya tare da aikin lalata hanta tsawaita.

Contraindications

kasancewar tarihin angioedema (hereditary, idiopathic, ko angioedema ta baya sakamakon amfani da ACE inhibitors ko angiotensin II antagonists),

- extracorporeal magani, tare da tuntuɓar jini tare da saman da caje saman,

- ƙira biyu na kyanwa arter Stenosis ko na koda arter stenosis na kawai aiki koda,

- hypotension ko hemodynamically m jihar (ramipril kada a wajabta shi),

- wani mummunan nau'in tashin hankali,

- rawar jiki (gami da cardiogenic),

- narrowuntata tasoshin jini, hana zubar jini daga ventricle hagu (alal misali, matsanancin aortic stenosis),

- rashin karfin zuciya a cikin damuwa bayan rashin karfin myocardial infarction,

- Hypersensitivity to ramipril (ko inhibitors na ACE), amlodipine, magungunan dihydropyridine, da / ko kowane daga cikin magungunan.

Haihuwa da lactation

Bayanan cututtukan cututtukan cututtukan da ke nuna haɗarin teratogenicity bayan fallasa su game da inhibitors na ACE a lokacin farkon farkon ciki ba su da tabbaci, amma ƙaramin haɓaka a cikin wannan haɗarin ba za a iya yankewa ba.

Fitowa ga inhibitors na ACE a lokacin karo na biyu da na uku na ciki ana san shi ne wanda ke haifar da fetotoxicity a cikin mutane (nakasar ci gaban kodan tayin, oligohydramnios, jinkirta ossification na kwanyar) da cututtukan cututtukan cututtukan ciki (gazawar koda, hauhawar jini, hyperkalemia). Idan fallasawa ga inhibitors na ACE ya faru yayin watanni biyu na ciki, ana ba da shawarar yin wani duban dan tayi game da aikin koda da haɓakar ƙasusuwa na kwanyar. Ya kamata jarirai su kula da jarirai wanda uwayensu suka sha maganin ACE don yiwuwar ci gaban haihuwar jini, oliguria da hyperkalemia.

Tunda babu isasshen bayani game da amfani da ramipril da amlodipine yayin lactation, amfani dasu yayin wannan lokacin yana da sabani, kuma ya fi dacewa a zabi madadin hanyoyin magani tare da ingantattun bayanan martaba, musamman a lokacin lactation.

Sashi da gudanarwa

Dole ne a yi amfani da miyagun ƙwayoyi kamar yadda likita ya umarta.

Hartil ® Amlo yakamata a sha a lokaci guda na rana, kowace rana yayin jinya, gaba da bayan abinci. Kar a murkushe ko tauna capsules.

A shawarar da aka bayar na yau da kullun shine capsule 1 na wani sashi.

Haɗin magani tare da takamaiman sashi ba ya dace da matakin farko na maganin.

Idan akwai buƙatar daidaitawar kashi, kashi na magani Hartil ® Amlo za'a iya canzawa ko kuma yawan abubuwan da aka gyara na mutum tare da haɗinsu kyauta.

Ana bada shawara don tsara magunguna tare da taka tsantsan. marasa lafiya suna shan diuretics, tunda a cikin wajan wadannan mara lafiyar ana iya samun daidaituwa game da daidaiton ruwan-lantarki Wajibi ne a yi nazarin aikin koda kuma a tantance matakin potassium a cikin jini.

Yi amfani da marasa lafiya da nakasa aikin hanta

A cikin marasa lafiya da nakasa aikin hanta, magani shamir yakamata a fara a karkashin kulawa ta hanyar likita, tare da matsakaicin maganin yau da kullun na 2.5 mg ramipril.

Hartil ® Allunan amlo wanda ke dauke da 2.5 mg ramipril + 2.5 mg amlodipine ana ba da shawarar ga marasa lafiya da aka canza su zuwa kashi na 2.5 mg na ramipril, a matsayin mafi kyawun kiyayewa lokacin zabar sashi na ramipril.

Game da gazawar hanta, lokacin cirewa amlodipine na iya karuwa. Babu takamaiman shawarwari don dosing game da amlodipine, sabili da haka, ya kamata a tsara magunguna a cikin waɗannan marasa lafiya tare da taka tsantsan.

Yi amfani da marasa lafiya tare da nakasa aiki na koda

Don tantance mafi kyawun haɗari na farawa da kiyaye allurai a cikin marasa lafiya da ke fama da rauni na aikin ƙirar, ana zaɓi sashi na maganin ta hanyar ƙayyade matakan ramipril da amlodipine.

Kwancen yau da kullun shamir a cikin marasa lafiya da gazawar koda, ya kamata a kafa shi yayin yin la'akari da QC:

- a cikin marasa lafiya tare da CC ≥ 60 ml / min, ba a buƙatar gyaran kashi na farko, mafi girman maganin yau da kullun shine 10 MG,

- a cikin marasa lafiya tare da KK ® Amlo an bada shawara don yin magani kawai idan an canza mai haƙuri zuwa tsarin maganin rage girman ƙwayar cuta na 2.5 mg ko 5 MG a matsayin mafi kyawun tabbatarwa na kulawa (wanda aka kafa yayin rabepril dosing). Marasa lafiya da ke fuskantar hemodialysis yakamata su sha maganin a wasu sa'o'i bayan hemodialysis.

Babu buƙatar daidaitawar sashi amlodipine marasa lafiya tare da nakasa aiki na koda.

Amlodipine ba a keɓe shi ba lokacin diyya. Marasa lafiya suna fuskantar dialysis, amlodipine ya kamata a wajabta shi tare da taka tsantsan.

Yayin jiyya tare da Hartil ® Amlo, ana buƙatar sarrafa ƙarfin aikin kodan da abun da ke cikin potassium a cikin ƙwayar jini. Idan lalacewar aikin koda, ya kamata a dakatar da amfani da miyagun ƙwayoyi il Amlo, kuma ya kamata a tsara abubuwan da ke cikin sa a allurai da aka daidaita sosai.

Yi amfani da tsofaffi marasa lafiya

Yankin na farko na ramipril ya kamata ya zama ƙasa da yadda aka saba, kuma daidaitaccen sashi na gaba ya kamata ya zama milder, saboda haɗarin haɗarin sakamako masu illa. Ba da shawarar sanya Hartil ® Amlo ga tsoffin kuma marasa ƙarfi marasa lafiya.

Tsofaffi marasa lafiya na iya ɗaukar allurai na amlodipine, kodayake, ya kamata a yi taka tsan-tsan don ƙara yawan ƙwayar.

Yi amfani da yara da matasa masu shekaru 18

Ba a ba da shawarar yin amfani da Hartil ® Amlo don yara da matasa masu shekaru 18 ba, tunda ba a kafa aminci da tasiri na miyagun ƙwayoyi a cikin wannan rukunin marasa lafiya ba.

Yawan abin sama da ya kamata

Kwayar cutar ya danganta da matakin yawan yawan zubar da ruwa, tashin zuciya mai wuce gona da iri (tare da matsanancin rashin damuwa da hoto mai tashe), bradycardia, rashin daidaituwa na lantarki da gazawar renal na iya faruwa.

Jiyya: Ya kamata a kula da yanayin mai haƙuri koyaushe, kuma maganin da aka tsara ya kamata ya zama alama da tallafi. Matakan da aka gabatar sun hada da samarda das hi na farko (lavage na ciki, adsorbent ci) da kuma matakan dawo da kwanciyar hankali sigogi, alfa aikin₁-adrenomimetics ko angiotensin II (angiotensinamide). Ramiprilat ba shi da kyau ta hanyar cire jini daga cikin jini gaba ɗaya. Idan akwai maganar zubar jini a cikin damuwa wanda ya haifar da yawan amlodipine, yakamata a bawa mara lafiyar a kwance tare da matsayin da ya hau a kafafu, kuma a dauki matakan aiki domin kula da ayyukan zuciya, gami da sanya idanu akai-akai kan aikin zuciya da tsarin numfashi, BCC da yawan fitsari da aka fitar. Idan babu contraindications, yana yiwuwa a yi amfani da (tare da taka tsantsan) vasoconstrictors don dawo da sautin jijiyoyin jini da hawan jini. A / a cikin gabatarwar glucose na alli na iya zama mai tasiri wajen kawar da katange tashoshin alli. A wasu halaye, lavage na ciki na iya zama da amfani. A cikin binciken da ya shafi masu ba da lafiya, an nuna cewa amfani da carbon mai aiki a cikin sa'o'i 2 bayan shan 10 mg na amlodipine yana rage yawan sha. Tunda amlodipine yana da alaƙa da sunadarai, hemodialysis ba shi da tasiri.

Yin hulɗa tare da wasu kwayoyi

Hartil ® Amlo bai kamata a haɗe shi da hanyoyin wuce gona da iri ba wanda ya shafi sadarwar jini tare da abubuwan da ba su dace ba, irin su hemodialysis ta hanyar membranes mai matuƙar mahimmanci (alal misali, membranes da aka yi daga ƙwayoyin polyacrylonitrile), hawan jini ko ƙamshi na rashin ƙarfi mai yawa na amfani da tsautsayi sulfate, saboda karuwar haɗarin haɓakar mummunan cutar anaphylactic ko halayen anaphylactoid. Idan irin wannan magani ya zama dole, to amfani da wani nau'in membrane don maganin dialysis ko magungunan antihypertensive na wani fanni yakamata a yi la’akari.

Tare da gudanarwa na lokaci guda tare da shirye-shiryen potassium, diuretics-poaring da sauran abubuwa masu aiki waɗanda ke haɓaka matakan ƙwayar ƙwayar plasma (wanda ya haɗa da angiotensin II antagonist antagonists, trimethoprim, tacrolimus, cyclosporine), hyperkalemia na iya haɓaka, sabili da haka, ya zama dole don kulawa da hankali a kan matakin ƙwayoyin potassium.

Lokacin da aka ɗauka lokaci guda tare da magungunan antihypertensive (misali, diuretics) da sauran abubuwa waɗanda zasu iya rage karfin jini (misali, nitrates, tricyclic antidepressants, analgesics, ethanol, baclofen, alfuzosin, doxazosin, prazosin, tamsulosin, hadarin terazosin), yana yiwuwa.

Tare da gudanarwa na lokaci daya tare da vasopressor sympathomimetics da sauran kwayoyi (alal misali, isoproterenol, dobutamine, dopamine, adrenaline), tasirin antihypertensive na ramipril na iya raguwa, saboda haka, ana bada shawarar saka idanu akan hawan jini.

Tare da gudanarwa na lokaci guda tare da allopurinol, immunosuppressants, corticosteroids, procainamide, cytostatics da sauran kwayoyi waɗanda zasu iya canza adadin ƙwayoyin jini, da alama haɓaka halayen cututtukan ƙwaƙwalwar ƙwaƙwalwa yana ƙaruwa.

Tare da gudanarwa na lokaci daya na masu hana ACE tare da shirye-shiryen lithium, yana yiwuwa a rage ƙyalli kuma, a sakamakon haka, ƙara yawan haɗuwar lithium a cikin jini tare da karuwa mai guba. Ana buƙatar saka idanu akai-akai game da matakan lithium.

Yayin shan tare da magungunan antidiabetic (gami da insulin) na iya haɓaka halayen da ke motsa jini. An ba da shawarar yin tsauraran matakan glucose a cikin jini.

Duk da yake shan tare da NSAIDs (gami da acetylsalicylic acid) na iya rage tasirin antihypertensive na ramipril. Bugu da ƙari, haɗuwa da masu hana ACE da masu hana NSAIDs na iya haifar da haɓakar hyperkalemia da haɓaka haɗarin aikin ƙarancin haya.

Magungunan sun aminta da thiazide diuretics, beta-blockers, nitred-release nitrates, nau'ikan sashi na magunguna na nitroglycerin, NSAIDs, maganin rigakafi, da magunguna na zub da jini.

Yayin shan magungunan tare da mai hana CYP3A4 karinda78 a cikin matasa marasa lafiya da diltiazem a cikin tsofaffi marasa lafiya, bi da bi, ƙwayar plasma na amlodipine yana ƙaruwa da 22% da 50%, bi da bi. Koyaya, mahimmancin yanayin wannan yanayin ya zama ba a bayyane ba. Ba za a iya cire shi ba cewa masu hana CYP3A4 masu ƙarfi (alal misali, ketoconazole, itraconazole, ritonavir) na iya haɓaka ƙwayoyin plasma na amlodipine zuwa mafi girma fiye da diltiazem. Ya kamata a yi amfani da Amlodipine tare da taka tsantsan lokacin da aka gudanar da shi tare da masu hana CYP3A4. Koyaya, babu rahoto game da wasu sakamako masu illa da ke tattare da wannan hulɗa.

Kayan cikin gida CYP3A4: bayanai a kan sakamakon CYP3A4 inducers a kan amlodipine babu su. Haɗewar yin amfani da miyagun ƙwayoyi tare da inginin CYP3A4 (alal misali, rifampicin ko St. John's wort perforated) na iya rage yawan ƙwayar ƙwayar cuta ta amlodipine. Ya kamata a yi amfani da Amlodipine tare da taka tsantsan lokacin amfani dashi tare da injinin CYP3A4.

A cikin nazarin asibiti na hulɗa da magunguna, yin amfani da amlodipine lokaci guda tare da ruwan innabi, cimetidine, aluminum / magnesium (antacids) da sildenafil ba su shafi magungunan magunguna na amlodipine ba.

Amfani da amlodipine a lokaci guda tare da wasu wakilai na antihypertensive suna haɓaka ingancin warkewar su.

A cikin nazarin asibiti na hulɗa da magunguna, amlodipine bai shafi magungunan likitancin vvastatin, digoxin, ethanol (ethanol), warfarin, ko cyclosporine ba.

Sakamakon amlodipine akan canje-canje a cikin gwaje-gwaje na dakin gwaje-gwaje ba a kafa shi ba.

Formaddamar da tsari da abun da ke ciki

Hartil din na magani yana samuwa a cikin nau'i na allunan don maganin baka na Orange, m, lebur. Allunan an shirya su a blisters na 7 guda (1-4) a cikin kwali na kwali, cikakkun bayanai tare da kwatancin an haɗe su da miyagun ƙwayoyi.

Kowane kwamfutar hannu yana da 5 MG ko 10 MG na kayan aiki mai aiki da Ramipril, kazalika da adadin abubuwan taimako, gami da lactose monohydrate.

Har yanzu samar da allunan 2.5 MG + 12.5 MG, 5 MG + 25 MG Hartil D tare da diuretic hydrochlorothiazide. Haɗin ya haɗa da ramipril, hydrochlorothiazide da kuma magabata (Hartil D).

Saki siffofin da abun da ke ciki

Ana samun magungunan a cikin nau'i na kwalliyar gelatin na 5 MG da 10 MG na kayan aiki mai aiki mai aiki. Abunda yake aiki shine ramipril (Ramiprilum). Wannan fili ne na sinadarai wanda yake farin farin foda mai narkewa ne a cikin hanyoyin magance abubuwan da ke tattare da aiki. Wadanda suka kware - amlodipine, microcellulose, crospovidone, hypromellose.

Alamu don amfani

Capsules suna da fitila iri-iri na aiki iri iri na ramipril kuma ana wajabta su bisa ga alamun da ke gaba:

• hauhawar jini - artabuwar cutar hawan jini,
• mitral bawul prolapse,
• anyi amfani da shi don cutar sankarar mahaifa don rage cutar,
• gazawar zuciya, wanda aikinsa yake rushewar jiki saboda rashin isasshen zagayarwar jini da jijiyoyin jijiyoyin jiki gabobi da tsarin,
• angina pectoris, ischemia,
• Sakamakon infarction na zuciya, don hana kai hari na biyu da rage nauyin akan ƙwayar zuciya,
• rigakafin bugun jini a cikin cututtukan zuciya.

Gastrointestinal fili

Stomatitis, tashin zuciya, amai, tashin zuciya, pancreatitis, na ciki hanji, zawo, jin zafi a cikin hanji da kuma pancreas, rage ci.

Daga cikin jijiyoyin mahaifa, Hartil na iya haifar da tashin zuciya.

Tasiri kan ikon sarrafa abubuwan inji

Magungunan zai iya shafar tsarin juyayi na tsakiya, haifar da nutsuwa, rage taro. A wannan batun, ya kamata ka nisanta daga aiki akan kayan aiki na atomatik ko fitar da motoci.

Hartil Amlo na iya shafar kwarewarku ta tuki.

Yi amfani da lokacin daukar ciki da lactation

A cikin watanni biyu na II da III, an haramta wannan maganin. A lokacin farkon lokacin, zaka iya amfani da Hartil kawai idan akwai gaggawa. Lokacin yin jiyya yayin lactation, ana bada shawara don canzawa zuwa ciyar da wucin gadi.

Yara kanana 'yan kasa da shekaru 15, shan haramtattun kwayoyi, haramun ne, tunda ba a gudanar da binciken ba.

Yin hulɗa tare da wasu kwayoyi

Tare da gudanarwa na lokaci daya tare da diuretics da sauran magungunan hauhawar jini, raguwar wuce kima a cikin karfin jini yana yiwuwa.

Idan kun haɗu da magungunan antihypertensive tare da magungunan anti -pertrosal anti-inflammatory, sakamakon yana raguwa, kuma kusan ba za a sami wata fa'ida ga magungunan ba.

Lokacin ɗaukar kwayoyi masu ɗauke da ƙwayoyin Lithium a haɗe da Hartil, haɗuwar lithium a cikin jini yana ƙaruwa.

Ba'a ba da shawarar yin amfani dashi tare da kudaden da ke ɗauke da potassium a cikin abun da ke ciki, don kar su wuce matakin potassium a jiki.

Idan ba a iya ɗaukar capsules saboda wasu dalilai ba, zaku iya maye gurbinsu da ƙwayoyin Hungaria, na Amurka ko na Rasha masu kama da wannan:

• dangane da ramipril da amlodipine: capsules Bi-Ramag, Sumilar, Tritace-A,
• dangane da amlodipine da lisinopril: Allunan Amapil-L, Amlipin, Equator,
• dangane da perindopril: Amlessa, Bi-Prestarium, Viacoram,
• dangane da lercanidipine da enalapril: Cori Loose, Lerkamen, Enap L Combi.

Misalin miyagun ƙwayoyi Harty Amlo shine Amlessa. Analogue na miyagun ƙwayoyi Hartil Amlo shine Coripren.Misalin magunguna Hartil Amlo shine Lerkamen.

Masana sun ba da shawarar canza magungunan da kansu, don kada a cutar da lafiya. Kafin maye gurbin ya zama dole a nemi likita.

Likitocin zuciya

Alexander Ivanovich, Moscow

Magungunan yana daya daga cikin mafi inganci don kulawa da rigakafin cututtukan zuciya da kuma dawo da hawan jini. Idan babu maganin contraindications, koyaushe na kebance shi don hana maimaita rauni na bugun zuciya da bugun jini.

Umarnin don amfani da Hartil-Amlo Wanne kwayoyin hana daukar ciki sune mafi kyau

Tamara Nikolaevna, dan shekara 70, Krasnodar

Ni da maigidana mun sha wahala daga bugun zuciya. Shekaru da yawa, mun kasance muna shan tafarkin Hartil sau biyu a shekara tare. Magungunan suna da tasiri, baya haifar da sakamako masu illa, da sauri yana rage karfin jini, yana sauƙaƙa ciwon kai, kumburi. Zuciya tana aiki ba tare da tsangwama ba, muna jin ɗan shekara 20.

Magungunan Hartil

Ana ɗauka ta baki ba tare da tauna ba, a wanke da ruwa mai yawa (kusan gilashin 1), ba tare da la'akari da lokacin cin abinci ba.

Ya kamata a saita sashi don kowane mai haƙuri daban-daban, la'akari da tasirin warkewa da haƙuri. Allunan za'a iya raba su a rabi, kuma a kakkarya cikin hadari.

• Ciwon zuciya mai rauni. Startingwarin da aka bada shawarar farawa shine 1.25 MG sau ɗaya kowace rana (1/2 kwamfutar hannu na Hartil 2.5 MG kowace rana). Dangane da tasirin warkewa, ana iya karuwa da kashi ɗaya ta hanyar ninka yawan amfanin yau da kullun kowane mako 2-3. Idan kana buƙatar shan fiye da 2.5 MG na miyagun ƙwayoyi, ana iya ɗaukar wannan kashi nan da nan ko kuma a raba shi zuwa allurai 2. Matsakaicin adadin yau da kullun kada ya wuce 10 MG.
• Hawan jini. Matsakaicin farawa shine 2.5 mg sau ɗaya kowace rana (1 kwamfutar hannu na Hartil 2.5 MG kowace rana). Dangane da tasirin warkewa, ana iya karuwa da kashi ɗaya ta hanyar ninka yawan amfanin yau da kullun kowane mako 2-3. Yankin kulawa da aka saba shine 2.5-5 MG kowace rana (1 kwamfutar hannu na Hartil 2.5 MG ko 1 kwamfutar hannu na 5 MG). Matsakaicin adadin yau da kullun kada ya wuce 10 MG.
• Yin rigakafin infarction na zuciya, bugun jini, ko mutuwa daga raunin zuciya. Matsarin da aka ba da shawarar farawa shine 2.5 mg sau ɗaya kowace rana. Dangane da haƙuri na miyagun ƙwayoyi, bayan mako 1 na gudanarwa, ya kamata a ninka kashi biyu idan aka kwatanta da na farkon. Ya kamata a ninka wannan kashi sau biyu bayan makonni 3 na gudanarwa. Girman da aka bada shawarar tabbatarwa shine 10 MG sau ɗaya kowace rana.
• Rashin ciwon sukari ko mai ciwon sukari. Maganin farko da aka ba da shawarar shine 1.25 MG sau ɗaya kowace rana (1/2 kwamfutar hannu na Hartil 2.5 MG kowace rana). Dangane da tasirin warkewa, ana iya karuwa da kashi ɗaya ta hanyar ninka yawan amfanin yau da kullun kowane mako 2-3. Idan kana buƙatar shan fiye da 2.5 MG na miyagun ƙwayoyi, ana iya ɗaukar wannan kashi nan da nan ko kuma ya kasu kashi biyu. Mafi girman shawarar yau da kullun shine 5 MG.
• Jiyya bayan infarction na zuciya. An bada shawara don fara shan miyagun ƙwayoyi a ranar 3-10-10th bayan marcardial infarction mai girma. Initialwarin da aka ba da shawarar farko, dangane da yanayin haƙuri da lokacin da ya ɓace bayan ɓoyewar myocardial infarction, shine 2.5 mg sau 2 a rana (1 kwamfutar hannu na Hartil 2.5 MG 2 sau a rana). Dangane da tasirin warkewa, ana iya ninka kashi na farko zuwa 5 MG (Allunan Allunan na Hartil 2.5 MG ko kuma kwamfutar hannu 1 na Hartil 5 MG) sau 2 a rana. Matsakaicin adadin yau da kullun kada ya wuce 10 MG. Tare da rashin haƙuri ga miyagun ƙwayoyi, yakamata a rage kashi.

Groupsungiyoyin haƙuri na musamman

Tsofaffi marasa lafiya. Yin amfani da ramipril a cikin tsofaffi marasa lafiya suna shan diuretics da / ko tare da raunin zuciya, da kuma hanta mai rauni ko aikin koda, yana buƙatar kulawa ta musamman. Sashi ya kamata a kafa ta mutum zaɓi na allurai dangane da amsawa ga miyagun ƙwayoyi.

Rashin aikin hanta. Idan akwai aiki na hanta mai lalacewa, raguwa ko ƙarin tasirin amfani da miyagun ƙwayoyi Hartil za a iya lura da shi sau da yawa, sabili da haka, a farkon matakan jiyya, marasa lafiya da ke fama da cutar hanta suna buƙatar kulawa da hankali na likita. Matsakaicin adadin yau da kullun a irin waɗannan lokuta kada ya wuce 2.5 MG.

A cikin marasa lafiya da ke karɓar maganin diuretic, saboda haɗarin raguwa mai yawa a cikin karfin jini, yiwuwar sakewa na ɗan lokaci ko aƙalla cikin kashi na diuretics ya kamata a yi la'akari da aƙalla kwanaki 2-3 (ko ya fi tsayi, gwargwadon tsawon lokacin aikin diuretics) kafin ɗaukar miyagun ƙwayoyi. Hartil. Ga marasa lafiya da aka bi da su tare da diuretics, yawanci farkon kashi shine 1.25 mg.

Side effects

Nazarin likita na Hartil ya lura da alama tasirin sakamako masu illa. Lissafinsu suna da faɗi sosai kuma yana buƙatar cikakken nazari. An ba da shawarar ku san kanku tare da yawancin tasirin sakamako kafin a sha magani:

• urticaria, itching, fatar fata, conjunctivitis,
• rage yawan ci, tashin zuciya, maƙarƙashiya / zawo, farjin huhu, bushe baki, amai,
• tashin zuciya, hauhawar jini, alopecia, sweating,
• hyperkalemia, hypercreatininemia, ƙara yawan ƙwayoyin hepatic transaminases da urea nitrogen matakin, hyponatremia,
• thrombocytopenia, anaemia, low low of hematocrit and haemoglobin, thrombocytopenia, neutropenia, leukocytopenia, agranulocytosis, hemolytic anemia, pancytopenia,
• rauni, ciwon kai, amai, tashin zuciya, tashin hankali, rikicewar yanayi, tashin hankali, tashin zuciya, damuwa a cikin fahimta (wari, ji, dandano, hangen nesa) da rikicewar yanayin,
• proteinarin furotin, rashin cin abinci na koda, rage libido, rage kiba,
• orthostatic hypotension, rage karfin jini. A cikin lokuta mafi wuya - arrhythmia, bayyanar rikicewar wurare dabam dabam na gabobin, ischemia myocardial da kwakwalwa,
• shortness na numfashi, bronchospasm, rhinorrhea, sinusitis, rhinitis, mashako, bushe tari.

Yin amfani da Hartil yayin daukar ciki yana iya haifar da sakamako masu illa ga tayin: cin zarafi daban-daban na ci gaba da aikin kodan, rage karfin jini a cikin yara, hauhawar huhu da kwanyar, yin kwancen kafa, da kuma lalata kwanyar.

Sharuɗɗan hutu da farashi

Matsakaicin farashin Hartil (5 MG Allunan, guda 28) a cikin Moscow shine 400 rubles. Ana bayar da maganin daga magunguna ta hanyar takardar sayan magani.

Mafi kyawun yanayin zafin jiki na magani shine digiri 25. An nuna rayuwar shiryayye daga allunan akan kunshin kuma shine shekaru 4 daga ranar da aka ƙera. Hartil ya ba da shawarar yin amfani da allunan don adana su a cikin wurin da ba a iya kaiwa ga yara, nesa da hasken rana kai tsaye.

Abun ciki da nau'i na saki

Hartil yana samuwa a cikin kwamfutar hannu. An tattara magungunan a cikin blisters don allunan 7. Akwatin kwali na iya ƙunsar raka'a 14 da 28 na sikari.

Abunda yake aiki shine ramipril.

Allunan 1.25 MG, 2.5 MG, 5 MG da 10 MG (Hartil).

Allunan 5m: ruwan hoda mai haske tare da tintin ruwan lemo, m, lebur tare da layin rarrabuwa, chamfer da sigar rubutu "R3" a gefe ɗaya.

Allunan 10 MG: farar fata ko kusan fararen oval, lebur tare da layin rarrabuwa, chamfer da zane-zanen "R4" a gefe ɗaya.

• Allunan Hartil D tare da diuretic hydrochlorothiazide 2.5 MG + 12.5 MG, 5 MG + 25 MG.
• Hartil Amlo Ramipril. Ya hada da ƙarin amlodipine. Sanya tare da haɓakar hawan jini idan shan abubuwa masu aiki (daban-daban ko tare) yana ba da tasiri mai kyau.

Me ke taimaka wa Hartil?

Alamu don amfanin wannan kayan aikin sune kamar haka:

• rashin karfin zuciya bayan mummunan myocardial infarction tare da tsayayyar hemodynamics,
• na kullum zuciya
• hauhawar jini
• mai ciwon sukari nephropathy,
• na kullum yaduwa cutar koda,
• da bukatar rage hadarin kamuwa da cutar sankara, "mutuwar zuciya" a cikin mutanen da ke fama da cututtukan hanji,
• bukatar rage hadarin bugun jini a cikin mutanen da ke fama da cututtukan hanji.

Tare da hauhawar jini, ana iya amfani da Hartil Amlo, idan kafin canzawa zuwa wannan magani, ana amfani da karfin hawan jini ta lokaci guda ta amfani da kwayoyi iri-iri da kuma amlodipine a cikin magunguna iri ɗaya kamar yadda yake a magani.

Mahimmanci! Dole ne likita ya yanke shawara game da buƙatar hanya na magani. Kai magani kai bashi yarda.

Umarnin don amfani

Yawan magani na likitan Hartil an saita shi da likita daban daban. Jiyya na hauhawar jijiya yana farawa da ƙarancin tasiri - 2.5 MG sau ɗaya a rana.

Tare da rashin isasshen sakamako na warkewa ko rashin sakamako, ana iya ƙara yawan kashi ba sau 1 ba a kowane mako ta 2.5 MG, matsakaicin adadin yau da kullun ga mai haƙuri shine 10 MG. Idan wannan matakin bai isa ya rage karfin jini zuwa dabi'u na yau da kullun ba, to an tsara allunan Hartil a matsayin wani ɓangare na hadaddun hanyoyin kwantar da hankali tare da sauran wakilai na antihypertensive.

Idan ya cancanta, ya kamata a ba marasa lafiya magani na kashi 2.5-5 mg na Hartil kowace rana.

Kulawa da rikitarwa bayan mummunan ciwon zuciya ya kamata a tsara shi don kwanaki 3, maganin farko na miyagun ƙwayoyi shine 2.5 MG, ana shan magani sau 2 a rana, mafi girman kullun ga mai haƙuri shine 10 MG.

Don lura da cututtukan ƙwayar cutar zazzabin cizon sauro ko wadanda ba su da ciwon sukari, an wajabta wa magani magani Hartil a sashi na 1.25 MG sau ɗaya a rana. Tsawon lokacin magani shine makonni 3.

Don hana haɓakar infarction na myocardial, marasa lafiya tare da angina pectoris da rikicewar jijiyoyin jini a cikin tasoshin ana wajabta su a cikin ƙwayar Hartil a cikin ƙwayar 2.5 mg sau ɗaya a rana don makonni 3, bayan wannan an ƙara adadin zuwa 5 MG kowace rana kuma har ila yau ci gaba da shan maganin har tsawon makonni 3.

Marasa lafiya da cututtukan koda ko raunin zuciya yakamata su zaɓi kashi ɗaya daban, an tsara magani tare da Hartil daga kashi na 1.25 MG kowace rana, idan ya cancanta kuma tare da haƙuri na al'ada, sannu a hankali yana ƙaruwa da shi.

Tasirin magunguna

Tun da miyagun ƙwayoyi sun hana samar da ACE, mafi kyawun tasirinsa zai zama hypotension, watau, raguwar matsin lamba sama da 20% na ƙimar farko. A wannan yanayin, bugun zai kasance daidai gwargwado kamar a gaban liyafar, ba tare da rama abin da ya ɓata ba.

Tunda yana hana angiotensin, ana rage yawan aikin aldosterone, haka kuma ana samun karuwar aiki a cikin plasma na renin. Tasirin miyagun ƙwayoyi yana gudana ba kawai ga ACE da ke cikin magudanar jini ba, har ma ga wannan da aka kafa a bango na jijiyoyin bugun gini da sauran ƙusoshin dabbobin kusa.

Sauran kayayyakin aikin:

• Hibarfin hanyoyin da na keɓaɓɓiyar alaƙa da ke da alaƙa da yanayin ciwon sukari - microalbuminuria, alal misali.
• Rage proteinuria da haɓaka matakan creatinine, waɗanda ke tsokani cigaban haɓaka rashin nasara na koda.
• Rage ƙwanƙwasa ƙwayar zuciya, taimakawa tare da hauhawar jini.
• Rushewar bradykinin, wanda yake aiki akan jijiyoyin jini, yana fitar da prostacyclin da sinadarin nitric oxide cikin jini.
• Rage matsin lamba a cikin jijiya ta bututun idan an lura hauhawar jini.
• Rage abin da ya faru na arrhythmias idan mai haƙuri ya sami rauni na damuwa, an hana haɗarin ci gaba da bugun zuciya, an sake dawo da jini na al'ada.

Yanayi na musamman

Ana gudanar da magani a karkashin kulawa ta yau da kullun.

Bayan shan kashi na farko na Hartil, mai haƙuri ya kamata ya kasance a ƙarƙashin kulawar likita don kauce wa halayen da ba a kulawa da shi ba. Ana buƙatar gwargwadon ƙarfin jini akai-akai.

Bai kamata a rubuta Ramipril ba har sai an dauki matakan don hana raguwar hauhawar jini a cikin jini da kuma aikin keɓaɓɓen aiki. Idan za ta yiwu, gyaran fitsari, hypovolemia, raguwar adadin ƙwayoyin jan jini ke faruwa kafin ɗaukar magani. Idan waɗannan rikice-rikice masu tsanani ne, ramipril ya kamata a jinkirta.

Marasa lafiya tare da lalacewar jijiyoyin koda, raunin aiki na koda, raguwa sosai a cikin karfin jini, haka kuma marasa lafiya da raunin zuciya da bayan jigilar koda, suna buƙatar sa ido sosai.

A kan tushen ɗaukar miyagun ƙwayoyi, raguwa a matakin sodium da haɓaka matakin potassium mai yiwuwa ne, wanda ya fi dacewa tare da aiki na keɓaɓɓen aiki ko yayin shan shi tare da daskararren ƙwayoyin potassium.

Idan shan miyagun ƙwayoyi yana haifar da raguwa mai wucewa a cikin matsin lamba, ya kamata a dage haƙuri a cikin matsayi tare da kafafu masu tasowa, maganin cututtukan alamomi, gami da gabatar da ruwa, na iya zama dole.

Idan akwai rauni na aiki na koda da kuma cututtukan haɗin haɗin ƙwayar cuta, lokacin ɗaukar wasu kwayoyi waɗanda ke shafar tsarin bashin da na rigakafi, to akwai yiwuwar canje-canje na jini.

Tare da gudanar da aikin kai-tsaye na diuretics, saka idanu na yau da kullun game da matakin sodium a cikin jijiyar jini, da kuma adadin leukocytes, ya zama dole.

A cikin marasa lafiya akan hemodialysis ta amfani da membranes tare da babban nauyin hydraulic tare da kulawa na lokaci daya na masu hana ACE, halayen anaphylactoid na barazanar rayuwa mai yiwuwa. An lura da yanayi iri ɗaya a cikin marasa lafiya masu fama da rashin lafiyar LDL tare da ɗaukar ma'adinin dextran sulfate.

Bai kamata a bai wa masu hana maganin ACE ga marasa lafiya da ke shan iskancin magani ba saboda haɗarin haɓaka halayen cutar anaphylactoid mai wahala.

Ya kamata a ɗauka a hankali cewa Allunan Hartil tare da abun aiki mai mahimmanci na 5 MG sun hada da 96.47 mg na lactose, 10 mg - 193.2 mg.

Kwarewa tare da ramipril a cikin yara tare da mummunan lalacewa na koda kuma yayin dialysis yana iyakance.

Yana haifar da raguwa a cikin karfin jini, wanda na iya shafan damar yin hankali. A wannan batun, ba da shawarar tuki da saka hannu cikin ayyukan haɗari.