Magungunan Ramipril C3: umarnin don amfani

A cikin asalin, Ramipril magani ne mai alaƙa da ACE masu hanawa (angiotensin yana canza enzyme), i.e. ga rukunin mahadi waɗanda ke amfani da karfi sosai wajen lura da bugun zuciya. Sakamakon sakamako na magani a cikin jikin mutum ya fara samarwa ramiprilat, wanda hakan ke rage jinkirin canzawar hakane dann angiotensin II, kuma yana ma'amala tare da ma'anar ƙarshen ta a kyallen takarda.

Sakamakon aikin ƙwayar ƙwayar cuta, maida hankali a cikin jiki yana raguwa karafarirani IIwanda yana nufin isa sosai abubuwa na vasoconstrictor. Ta hanyar kawar da martani mara kyau a yayin fitarwa reninɓoyewa yana raguwa aldosteroneda haka rage jimlar na gefe na jijiyoyin bugun jini.

A lokaci guda, haƙurin haƙuri yana ƙaruwa saboda haɓakar ƙarar zuciya a minti daya da juriya ga na huhu jirgi. Magani yana da tasiri koda tasoshinkuma yana fara aiwatarwa sake fasalin tsarin zuciya. Ramipril yana rage juriya gaba ɗayana gefetasoshin kodan, tsokoki, hanta, fata da kwakwalwainganta saukar jini a cikin gabobin.

Antihypertensive sakamako miyagun ƙwayoyi yana farawa a cikin 'yan sa'o'i bayan gudanarwarsa. Tare da yin amfani da miyagun ƙwayoyi na yau da kullun don makonni 4, an lura da karuwa a hankali antihypertensive aiki, matakin al'ada wanda aka kiyaye shi tare da tsawanta jiyya shekaru da yawa.

Magani na rage faruwar hakan shanyewar jiki, ta hanyar lalacewaa cikin marasa lafiya bayan raunin da ya gabata ko wahala daga cututtuka kewaye tasoshinkazalika Ciwon zuciya na Ischemic. Bugu da ƙari, ƙwayar tana taimakawa wajen guje wa ci gaba. ciwon sukari mellitusa cikin marasa lafiya tare da tarihin abubuwan haɗari kamar su hauhawar jini, microalbuminuria, babban cholesterol da ƙarancin HDL (babban yawan lipoproteins mai yawa).

Ramipril yana dauke da kashi 60% a cikin jikin mutum, kuma abinci baya shafar matakin ɗaukar ƙwayar. Don ingantaccen sakamako na magani, mai haƙuri dole ne yayi aiki daidai hanta, a cikin abin da etheric bonds aka lalata, kuma kafaramiprilathanzarta samar da ilimi metabolites.

Bayan sa'o'i 2 bayan shan miyagun ƙwayoyi a jiki, ana samun mafi girman yawan fili mai aiki, wanda aka cire shi gaba ɗaya bayan awanni 17 tare da jijiyoyi da fitsari.

Alamu don amfani

Ana bada shawarar amfani da miyagun ƙwayoyi don:

bugun zuciyana kullum
mai ciwon sukari nephropathy,cutar koda yaxuwa (yanayin rashin ciwon suga),
hauhawar jini,
raguwa cikin yiwuwa infarction na zuciya, bugun jini, mutuwar zuciya.

Bugu da kari, ana amfani da Ramipril wajen maganin marasa lafiyar da ke gudana bugun zuciya, bugun jini, kazalika transluminal angioplastydana jijiyoyin zuciya artery kewaye grafting.

Contraindications

Ba da shawarar amfani da miyagun ƙwayoyi lokacin da yawan tashin hankali zuwa ACE masu hanawaa tashin hankali, hyperkalemia, na gazawarkazalika a lokacin na ciki kuma a cikinlactation zamani.Bugu da kari, an bada shawara don gujewa Ramipril a cikin kulawa da yara a ƙarƙashin shekaru 18 da marasa lafiya tsofaffi.

Iyakance amfani da miyagun ƙwayoyi idan akwai tarihin angioedema, tashin hankali, cututtukan autoimmune mai tsanani, yaduwa mara kyau, atherosclerosis, stenosis, bayan kamuwa da koda, tare da cutar sankarakuma wasu cututtukan huhu, hyponatremia, dialysis.

Side effects

Lokacin shan magani, sakamako masu illa kamar: bugun zuciyahypotension, angina pectoris, infarction myocardial, syncope, vertigo, arrhythmia, vasculitis, thrombocytopenia, tashin zuciya da amai, gudawa, bambanci, maƙarƙashiya, cututtukan zuciya, dysgraphia, aikin lalata hanji, jaundice, ƙara yawan sinadi, danshi da ciwon kai, asthenia, yanayi, nutsuwa, neuropathy, rawar jiki, tashin hankali, rashin bacci, raunin jijiya, necrosis, hangen nesa, huhu, gazawar numfashi, sinusitis, pharyngitis, rhinitis, laryngitis, photoensitivity, kazalika da asarar nauyi, angioedema, zazzabi.

Umarnin don amfani da Ramipril (Hanyar da sashi)

A daidai da umarnin don amfani da Ramipril, an fara ɗaukar maganin ta baka a cikin kashi wanda bai wuce 2.5 MG ba. kowace rana. Halin yin amfani da miyagun ƙwayoyi, kazalika da sashi, na iya bambanta dangane da rubutaccen likitan halartar, da kuma kan hadaddiyar cutar da yanayin mai haƙuri.

Yawan abin sama da ya kamata

Game da yawan abin sama da ya kamata, ana lura da alamun masu zuwa a cikin marasa lafiya: hypotension, angioedema, rikicewar Sistem, bugun zuciya a hade tare da rikicewar thromboembolic.

Don lura da sakamakon sakamako mara kyau na miyagun ƙwayoyi wanke cikiaiwatar da ayyukan don kara girman kewaya jini, kazalika gaba daya dakatar ko rage yawan Ramipril.

Haɗa kai

An inganta aikin warkewa na maganin sosai karafarin. Don gujewa yawan haila, hyperaldosteronismyana kara hadarin ci gaba neutropeniaBa a yi amfani da maganin a tare tare ba maganin antidiabetic, kamuwa da cutakamar yadda yana nufin myelosuppressive effects, potassium kari da madadin gishiri.

Umarni na musamman

Kafin yin amfani da miyagun ƙwayoyi, kamar lokacin jiyya kanta, ga marasa lafiya (musamman tare da cututtuka haɗin nama na yanayi mai yaxuwakazalika da rundunar Allopurinol da immunosuppressants) yana da shawarar yin jarrabawar yau da kullun koda da abun ciki na jinigami da na gefe.

Marasa lafiya tare da rashi mai narkewa kafin fara maganin warkewa ya kamata ya dawo da al'ada ruwa mai nuna wutar lantarki. An haramtawa lokacin amfani da miyagun ƙwayoyi maganin hemodialysis tare da taimakon polyacrylonitrile membranes.

Nazarin Ramipril

Yawancin marasa lafiya da ke amfani da magani na asali, kuma ba ƙarin ƙimar analogues mai tsada ba, gami da masana'antun cikin gida, suna barin kyakkyawan ra'ayi game da Ramipril. Koyaya, mutane da yawa suna lura da matsayin mummunan sakamako cewa miyagun ƙwayoyi suna da jerin abubuwan sakamako masu illa.

Tsarin halayen magani

"Ramipril", analogues na miyagun ƙwayoyi, har da magunguna masu rikitarwa sune wakilai masu hana ƙwayoyin cuta. Ramipril kanta abu ne mai aiki wanda aka samo a cikin kwayoyi da yawa. Inhibitor ne na ACE wanda zai iya toshe enzyme da ƙananan karfin jini. Yana ba ku damar inganta mahimmancin yanayin cutar a cikin tsofaffi.

Nazarin asibiti ya nuna cewa ramiprilat, metabolite mai aiki na Ramipril, yana hana sinadarin angiotensin canza enzyme sosai. Saboda wannan, Ramipril, analogues da shirye-shirye masu rikitarwa sune hanyar zabi don hauhawar hauhawar wahalar wahalarwa.

Tun da maganin yana da ikon toshe ACE da ƙarfi kuma yana iya sarrafa hawan jini, Ramipril yana da magungunan analogues da yawa. Ana amfani da su duka cikin nasara don maganin hauhawar jini. Haka kuma, asalin ramipril shine magani "Tritace". Duk sauran abubuwan tarihinsa ne, tasirin abin da dole ne a kamanta shi da shi. Amincewa ga siyarwa dole ne ya tabbatar da rashin lafiya ta hanyar maganin Tritace.

A lokacin, jerin analogues kamar haka: Amprilan, Vazolong, Dilaprel, Korpril, Pyramil, Ramepress, Ramigamma, Ramicardia, Tritace, Hartil. Hakanan kamfanin Ramipril ne ya kera shi daga kamfanonin Rasha Tathimpharmpreparaty, Biokom da Severnaya Zvezda. Abubuwan samfuran ƙarshen ƙarshen ana kiran su Ramipril SZ.

Tabbatattun sigogi da shirye-shiryen hadaddun

Magungunan antihypertensive Ramipril yana da sauƙin kashi da ɗauka. Ayyukanta yana ba mu damar bambanta matakai guda uku na maganin. Waɗannan sune 2.5 mg, 10 da 5 mg. Allunan suna shan wannan allunan sau biyu a rana. Hakanan akwai magunguna masu rikitarwa waɗanda ke ɗauke da ramipril da hydrochlorothiazide: Amprilan ND, Amprilan NL, Vazolong N, Remazid, Triapin, Tritace Plus, Hartil D, Egypt. A nan, adadin ramipril yana daga 2.5 MG zuwa 10, kuma adadin hydrochlorothiazide yana daga 12.5 zuwa 25 MG a cikin kwamfutar hannu guda.

Rukuni na biyu na magungunan masu rikitarwa sune haɗin Ramipril da mai maganin antioxist, Amlodipine. Misalin magani shine Egipress, ana samun su ne a matakai guda biyu: 10 mg ramipril da 5 mg amlodipine, kuma a kashi 10/10 mg. Baya ga wannan haɗin, akwai wani nau'in magani wanda ya ƙunshi ACE inhibitor Ramipril da Felodipine antagonist. Wannan shi ne Triapin, wanda ya ƙunshi 2.5 mg na ramipril da 2.5 mg na felodipine.

Hanyoyi don amfani

Baya ga shawarar likita, mai haƙuri ya kamata yayi la'akari da umarnin don amfani. Ya ƙunshi bayanai game da alamomi, tasirin sakamako, sashi da kuma tsarin kulawa, contraindications da kuma kiyayewa. Hakanan, umarnin don amfani da aka haɗe zuwa shirye-shiryen Ramipril yana bayyana buƙatar ƙin barasa yayin lura da hauhawar jini.

Ramipril, analogues na miyagun ƙwayoyi da kwayoyin Tritace an nuna su:

hawan jini,
kamar yadda wani bangare na hadaddun hanyoyin kwantar da hankali na gawar zuciya,
masu ciwon sukari da sauran cututtukan nephropathy a matakin asibiti ko ƙananan ƙananan, ba a haɗa su da cutar sankara ba,
tare da cutar hawan jini,
don rigakafin infarction na cututtukan zuciya na zuciya, ragin mace-mace a cikin marasa lafiya da cututtukan zuciya, da kuma don magance hauhawar jini tare da haɗarin babban jijiyoyin jini.

Babban nuni shine hauhawar jini. Wannan shine cutar mafi yawan gama gari da tsufa, da ke buƙatar gyara. Hakanan, magunguna "Ramipril" ko wani inhibitor na ACE ya kamata a wajabta shi ga marasa lafiya a cikin kwanakin 2-9 na farko daga lokacin ɓoyewar ɓarna na ciki. Yawan maganin yana iya zama mai haƙuri kamar yadda zai yiwu koda lokacin da mara lafiya bashi da hauhawar jini. Wannan ya faru ne sakamakon tasirin cutar zuciya mai karfi na masu hana masu amfani da ACE.

Sashi magunguna

Babban nau'in sashi na Ramipril shine Allunan. A cikin capsules, ba shi da yawa. A wannan yanayin, maganin da aka ba da shawarar farko shine 1.25 mg. Smallestarancin mafi yawan magunguna shine 2.5 MG, wanda ke tilasta shi ya kasu biyu. Samun layi a kan kwamfutar hannu yana sanya wannan mai sauƙi.

Tare da kowane nau'i na hauhawar jini, kashi na farko shine 1.25 MG sau ɗaya a rana. Bayan haka, tare da haƙuri mai kyau, kashi a hankali ya ninka. Ana yin abin ɗorawa har sai lokacin da aka nuna alamar karfin jini. Bayani don ingantaccen jiyya shine hauhawar jini, wanda da wuya yakan tashi a hutawa.

Kariya da aminci

Ya kamata a sha miyagun ƙwayoyi a ƙarƙashin ikon matsa lamba, musamman ga alƙawarin farko. Yana da mahimmanci cewa an rage karfin jini na systolic ba kasa da 90 mm. Hg. Art. Idan saukar karfin jini ya fadi kasa da wannan matakin, yana da kyau a nemi taimakon ma’aikatan asibiti. Don hana zubar jini saukar jini, ba a ba da shawarar yin amfani da Ramipril tare da nitrates, aji I antiarrhythmics (Procainamide) da masu hana alpha-1 (Alfuzosin, Tamsulozin).

Ya kamata a sha magani a kai a kai kuma zai fi dacewa a lokaci guda. Wannan yana ba ku damar daidaita tsarin renin-angiotensin-aldosterone, wanda ke daidaita karfin jini. Hakanan, kar ku tsallake shan magunguna, wanda za'a iya bayyanawa ta hanyar rikice-rikice masu hauhawar jini. Sharpin yarda ka ɗauke shi zai iya haifar da shanyewar jiki, haɗarin hakan yana ƙaruwa yayin wannan lokacin.

Nazarin haƙuri game da magani

Tritace da kwayoyin halitta sune magunguna masu inganci waɗanda ke sarrafa hawan jini da kyau. Zuwa yau, wannan magani shine mafi kyawun magungunan antihypertensive. Godiya ga wannan, haƙuri game da shi duka tabbatacce ne. Suna danganta shi azaman magani mai aminci wanda yake da iko wanda ke sarrafa hawan jini da kyau. Musamman mahimmanci shine sake dubawa na waɗannan marasa lafiya waɗanda suka ɗauki wasu magunguna a cikin wannan rukuni.

Marasa lafiya sun lura da ƙaramin adadin halayen masu illa da ke haɗuwa da yawan guba. Babban darajar alaƙa da ACE, kazalika da ƙaramin ƙwayoyi na ƙwayar cuta, kawar da tasirin sakamako na rayuwa wanda ke da yiwuwar amfani da kullun. Yana da mahimmanci cewa yawan rikice-rikice a cikin yawan amfani da Ramipril yana raguwa da muhimmanci. Koyaya, cikakken wariyar su ba ta yiwu ba tare da maganin hana ƙwaƙwalwa.

Nazarin likitoci game da maganin

Statisticsididdigar hawan jini yana ta ɓacin rai. Ya tabbatar da mahimmancin wannan cuta ga maganin zamani. Hakan yana da mahimmanci cewa ilimin halayyar dan adam ya rage tsammanin rayuwa. Hauhawar jini yana tasowa ne saboda yawan renin, wanda ya haɓaka yawan ƙwayar angiotensin. Haramcin wannan enzyme yana haifar da raguwa a cikin matsin lamba. Wannan ya wajaba don hana sclerosis na bangon jirgin ruwa da kuma bayyanar da rikitarwa rikitarwa na hauhawar jini.

Kamar yadda bincike na asibiti ya nuna, yawancin maganganun atrial da kuma cututtukan cututtukan zuciya da jijiyoyin jini suna ci gaba bayan mai haƙuri ya riga ya sami hauhawar jini a wani lokaci. Saboda haka, mahimmancin jiyyarta yana da girma. Kuma mafi mahimmanci, yana yiwuwa a kawar da ciwo saboda godiya ga masu hana ACE. Daga cikinsu, Ramipril shine mafi tsananin iko da tasiri.

Binciken likitoci game da shi ya tabbatar da fa'idodi. Magungunan sun dace don amfani, yana da adan halayen marasa amfani kuma yana da tasiri sosai. Koyaya, duk da waɗannan halayen, bazai isa ba don magance cutar hawan jini. Wannan kusan 40-50% na lokuta na asibiti.

Jiyyarsu yana buƙatar tsari mai haɗuwa wanda ya ƙunshi wani mai hana ACE, mai diuretic, mai ƙin amsar alli, wani lokacin kuma mai hana beta. A matsayin mai hana inzali na angiotensin-mai canza enzyme, Ramipril ya dace sosai. Sabili da haka, koyaushe zai iya ɗaukar matsayinsa wurin lura da hauhawar jini, lokacin da ya halatta. Kodayake yawancin marasa lafiya suna la'akari da shi azaman babban tsada don rashin ƙarfi.

Abun ciki kowace kwamfutar hannu 10.00 MG:

Aiki mai aiki: ƙwayar cuta - 10.00 mg.
Fitowa: lactose monohydrate (sukari na madara) - 174.00 mg, sodium bicarbonate - 10.00 mg, croscarmellose sodium - 4.00 mg, sodium stearyl fumarate - 2.00 mg.

Allunan tare da sashi na 2.5 MG - allunan biconvex na farin fari ko kusan fararen launi tare da haɗari.
Allunan tare da sashi na 5 MG da 10 MG sune zagaye Allunan-cylindrical Allunan farin ko kusan fararen launi tare da facet da haɗari.

Kayan magunguna

Pharmacodynamics
Ramepril metabolite mai aiki yana aiki a ƙarƙashin rinjayar enzymes “hanta”, ramiprilat, mai hanawa ne mai ɗaukar nauyi na ACE (maganganun ACE: kininase II, dipeptidyl carboxy dipeptidase I), wanda shine peptidyl dipeptidase. ACE a cikin plasma da kyallen takarda suna ɗaukar juyowar juyawar angiotensin I zuwa angiotensin II, wanda ke da tasirin vasoconstrictor, da rushewar bradykinin, wanda ke da tasirin vasodilating.
Saboda haka, lokacin shan ramipril a ciki, samuwar angiotensin II yana raguwa kuma bradykinin ya tara, wanda ke haifar da vasodilation da raguwa a cikin karfin jini (BP). Tashi ta ramipril, karuwa a cikin aiki na tsarin kallikrein-kinin a cikin jini da kyallen takarda tare da kunna tsarin prostaglandin da haɓaka aikin prostaglandins, wanda ke motsa samuwar nitric oxide a cikin endotheliocytes, yana haifar da tsarin aikin zuciya da sakamako mai illa. Angiotensin II yana haɓaka samar da aldosterone, don haka ɗaukar ramipril yana haifar da raguwa a cikin ɓoyewar aldosterone da haɓaka abubuwan da ke cikin ions na potassium a cikin jijiyar jini.
Tare da raguwa a cikin taro na angiotensin II a cikin jini, an kawar da tasirin hanawar sa game da renin ta hanyar nau'in amsawar mara kyau, wanda ke haifar da karuwa a cikin aikin renin a cikin jini na jini.
An ɗauka cewa haɓakar wasu lamurra masu illa (musamman, "bushe" tari) kuma ana haɗuwa da haɓaka ayyukan bradykinin.
A cikin marasa lafiya tare da hauhawar jini, jijiyar ramipril yana haifar da raguwar hauhawar jini a cikin "kwance" da "tsayawa" matsayi, ba tare da karuwa mai raɗaɗin raunin zuciya ba (HR). Ramipril yana rage yawan juriya na jijiyoyin bugun jini (OPSS), a zahiri ba tare da haifar da canje-canje ba a cikin yanayin hauhawar jini da kuma yawan zubar duniya. Tasirin antihypertensive yana fara haɓaka 1-2 sa'o'i bayan farawa na adadin ƙwayoyi guda ɗaya, yana isa mafi girman darajar bayan sa'o'i 3-6, kuma ya ci gaba na tsawon awanni 24. Tare da yanayin ramipril, tasirin antihypertensive zai iya ƙaruwa a hankali, yawanci yana kwantar da hankali ta makonni 3-4 na yau da kullun shan maganin sannan ya dage tsawon lokaci. Kwantar da magunguna ba zato ba tsammani zai haifar da haɓakawa da haɓaka cikin hawan jini (rashin "cirewa" ciwo),
A cikin marasa lafiya da hauhawar jijiya, ramipril yana rage jinkirin ci gaba da hauhawar jini na jijiyoyin jini da bango na jijiyoyin jiki.
A cikin marasa lafiya tare da raunin zuciya, ramipril yana rage OPSS (yana rage nauyin bayan zuciya), yana ƙaruwa da damar tashar tasirin kuma yana rage matsin lamba na ventricle na hagu, wanda, a sakamakon haka, yana haifar da raguwa cikin preload akan zuciya. A cikin waɗannan marasa lafiya, lokacin ɗaukar ramipril, akwai karuwa a fitarwa na zuciya, ctionaukar jini da haɓaka haƙuri. A cikin masu ciwon sukari da wadanda ba su kamu da cutar kansa ba, shan ramipril yana rage jinkirin ci gaban lalacewa na dan adam da kuma faduwar kasa-kasa game da kasawa kuma, saboda haka, yana rage bukatar hawan jini ko juyawar koda. A cikin matakan farko na masu ciwon sukari ko nophiabetic nephropathy, ramipril yana rage haɗarin albuminuria. A cikin marasa lafiya da babban haɗarin ci gaba da cututtukan zuciya sakamakon cututtukan jijiyoyin bugun zuciya (cututtukan zuciya da ke fama da cutar, tarihin cutar mahaifa, tarihin bugun jini) ko cutar sankarar bargo tare da aƙalla ƙarin ƙarin haɗarin haɗari (microalbuminuria, hauhawar jijiyoyin jini, hauhawar yawan taro cholesterol (OX), raguwa a cikin yawan ƙwayar lipoprotein ƙwayoyin cuta (HDL-C), shan sigari) ƙari na ramipril zuwa daidaitaccen aikin likita yana nufin Ya rage abin da ke tattare da rauni na zuciya, bugun jini, da mace-mace daga cututtukan zuciya. Bugu da kari, ramipril yana rage yawan mace-mace, kazalika da bukatar farfadowa da hanyoyin rage karfin ciwan zuciya.
A cikin marasa lafiya da raunin zuciya da bayyanuwar asibiti wanda ya ɓullo a farkon kwanakin myocardial infarction (2-9 kwana), ramipril, wanda aka fara daga 3rd zuwa ranar 10 na myocardial infarction, rage mace-mace (by 27%), hadarin mutuwa kwatsam (by 30 %), haɗarin ci gaban zuciya ga mummunan rauni (aji na aikin aji na III-IV) / yiwuwar warkewar cutar (23%), da alama yiwuwar asibiti mai zuwa sakamakon ci gaban bugun zuciya (26%).
A cikin yawan haƙuri, har ma a cikin marasa lafiya da ciwon sukari mellitus, duka biyu tare da hauhawar jini kuma tare da hawan jini na yau da kullun, ramipril yana rage haɗarin nephropathy da kuma faruwa na microalbuminuria.

Pharmacokinetics
Bayan gudanar da baki, ramipril yana dafe cikin hanzari daga cikin gastrointestinal fili (50-60%). Abincin abinci na lokaci daya yana rage girman shan shi, amma baya tasiri cikar shanshi. Ramipril yana ɗaukar matakan metabolism / kunnawa mai ƙarfi (musamman a cikin hanta ta hanyar hydrolysis), sakamakon shi kawai metabolite mai aiki, ramiprilat, wanda aikinsa game da inhibition na ACE shine kusan sau 6 sama da ayyukan ramipril. Bugu da ƙari, sakamakon metabolism na ramipril, an kirkiro diketopiperazine, wanda ba shi da aikin maganin, wanda aka sanya shi a cikin haɗuwa tare da glucuronic acid, ramiprilat shima yana glucuronated da metabolized zuwa diketopiperazic acid.
Dukkanin metabolites da aka kirkira, ban da ramiprilat, basu da aikin magani.
A bioavailability na ramipril bayan maganin baka yana daga 15% (don kashi 2,5 mg) zuwa 28% (don kashi 5 MG). A bioavailability na aiki metabolite, ramiprilat, bayan ingestion na 2.5 MG da 5 MG na ramipril shine kimanin 45% (idan aka kwatanta da bioavailability dinsa bayan gudanarwar jijiyoyin jini a cikin allurai iri ɗaya).
Bayan ɗaukar ramipril a ciki, matsakaicin ƙwayar ƙwayar plasma na ramipril da ramiprilat ana kai su bayan sa'o'i 1 da 2-4, bi da bi. Rage yawan ƙwayar plasma na ramiprilat yana faruwa a cikin matakai da yawa: rarrabuwa da lokaci na shakatawa tare da rabin rayuwa (T_1/2) ramiprilat, kimanin sa'o'i 3, sannan tsaka tsaki tare da T_1/2 ramiprilat, wanda ya ƙunshi kimanin awanni 15, kuma ƙarshen zamani tare da raguwar ramiprilat a cikin plasma da T_1/2 ramiprilat, kimanin kwanaki 4-5. Wannan matakin na ƙarshe shine saboda jinkirin sakin ramiprilat daga ƙawance mai ƙarfi tare da masu karɓar ACE. Duk da dogon lokaci na ƙarshe tare da guda ɗaya na maganin ramipril a baki a kashi biyu na 2.5 mg ko sama da haka, daidaitawar plasma mai daidaitawa na ramiprilat ya isa bayan kimanin kwanaki 4 na magani. Tare da amfani da miyagun ƙwayoyi "ingantacce" T_1/2 Dogaro da maganin shine 13-17 hours.
Haɗin haɗin ginin furotin na jini shine kusan 73% don ramipril, da kuma 56% don ramiprilat.
Bayan gudanarwar cikin jijiya, rarraba ramipril da ramiprilat shine 90 L kuma kamar 500 L, bi da bi.
Bayan shigowa, ramipril (10 MG), wanda aka yi masa alama tare da nau'in rediyo na rediyo, 39% na aikin rediyo yana toshewa cikin hanji da kusan kashi 60% daga hanta. Bayan gudanarwar ƙwayar ciki na ƙwayar cuta, kashi 50-60% na kashi ana samunsa a cikin fitsari a cikin nau'in ramipril da metabolites. Bayan gudanarwar cikin ciki na ramiprilat, kusan kashi 70% na kashi ana samun shi a cikin fitsari a cikin nau'in ramiprilat da metabolites, a wasu kalmomin, tare da gudanarwar cikin ciki na ramipril da ramiprilat, wani sashi mai mahimmanci na kashi yana kwance ta cikin hanji tare da bile, kewaya kodan (50% da 30%, bi da bi). Bayan sarrafa bakin na 5 MG na ramipril a cikin marasa lafiya da bututun magudanar bile, kusan iri daya na ramipril da metabolites ke keɓewa da kodan da ta cikin hanji a cikin awanni 24 na farko bayan gudanarwa.
Kimanin kashi 80-90% na metabolites a cikin fitsari da bile an gano su azaman ramiprilat da ramiprilat metabolites. Ramipril glucuronide da asusun ramipril diketopiperazine na kimanin 10-20% na jimlar, kuma abubuwan da basu dace ba ke cikin fitsari a cikin fitsari kusan 2%.
Nazarin dabbobi sun nuna cewa ramipril an cire shi cikin madara.
Game da lalacewa aiki tare da izinin keɓaɓɓen da keɓantaccen izinin keɓaɓɓen (CC) ƙasa da 60 ml / min. excretion na ramiprilat da metabolites ta hanyar koda yana rage gudu. Wannan yana haifar da karuwa a cikin ƙwayar plasma na ramiprilat, wanda ke ragewa a hankali fiye da marasa lafiya da keɓaɓɓen aikin na koda.
Lokacin ɗaukar ramipril a cikin allurai masu yawa (10 mg), aikin hanta mai rauni yana haifar da raguwa a cikin tsarin metabolism na ramipril zuwa ramiprilat mai aiki da jinkirin kawar da ramiprilat.
A cikin masu ba da agaji da lafiya kuma a cikin marasa lafiya da hauhawar jini, bayan jiyya-mako biyu tare da ramipril a kashi na yau da kullun na 5 MG, babu wani gagarumin tarin tarin ƙwayar cuta da ramiprilat. A cikin marasa lafiya da raunin zuciya, bayan an shafe makonni biyu tare da ramipril a cikin kashi 5 na yau da kullun, an sami karuwar 1.5-1.8 a cikin yawan ƙwayar plasma na ramiprilat da yankin a ƙarƙashin tsarin kula da lokacin-inuwa (AUC).
A cikin tsofaffi masu lafiya masu lafiya (65-76 shekaru), kantin magunguna na ramipril da ramiprilat ba ya bambanta da na matasa masu sa kai na lafiya.

Tare da kulawa

Yin amfani da magungunan Ramipril na lokaci guda tare da kwayoyi dauke da aliskiren ko angiotensin II mai karɓar antagonists (tare da hanawa biyu na tsarin renin-angiotensin-aldosterone (RAAS)) akwai karuwar haɗarin raguwar hauhawar jini, haɓakar haɓaka hyperkalemia da kuma aiki na renal idan aka kwatanta da monotherapy) (duba) . Sashe "Umarni na Musamman").
Yanayin da raguwar hauhawar jini yake da haɗari musamman (tare da raunuka na atherosclerotic of the coronary and cerebral arteries).
Yanayi tare da haɓaka ayyukan RAAS, wanda, lokacin da aka hana ACE, to akwai haɗarin raguwa sosai a cikin hawan jini tare da aiki na keɓaɓɓen aiki:

matsanancin hauhawar jini, musamman cutar hawan jini,
rashin karfin zuciya, musamman mai tsanani, ko kuma wanda aka dauki wasu magungunan rigakafi,
hemodynamically muhimmanci dayantaka stenosis na koda na koda (a gaban duka kodan) - a cikin irin wannan marasa lafiya, ko da kadan karuwa a taro na creatinine a cikin jini magani na iya zama wata alama ta guda ɗaya ta rashin aiki na koda aiki,
kwatancen da ya gabata na maganin diure,
hargitsi a cikin daidaiton ruwa-electrolyte sakamakon karancin yawan shan ruwa da sinadarin sodium, zawo, amai, da kuma yawan gumi.

Rashin aiki na hanta (ƙwarewar amfani da amfani: yana yiwuwa duka ƙarfin magana da rauni na tasirin ramipril yana yiwuwa, a cikin marasa lafiya da ke fama da cutar hanta tare da ascites da edema, gagarumin kunna RAAS yana yiwuwa)
Paarancin aikin renal mai rauni (CC fiye da 20 ml / min / 1.73 m² na yankin farfajiyar jiki) saboda haɗarin haɓaka hyperkalemia da leukopenia.
Yanayi bayan sakewa koda.
Cututtukan cututtukan cututtukan nama masu haɗuwa, ciki har da systemic lupus erythematosus, scleroderma, concomitant therapy tare da kwayoyi waɗanda zasu iya haifar da canje-canje a cikin hoto na tsinkaye jini (yiwuwar hana ƙone kashi, ci gaban neutropenia ko agranulocytosis) (duba sashe "Haɗa tare da wasu kwayoyi").
Ciwon sukari mellitus (haɗarin hyperkalemia).
Tsofaffi (haɗarin ƙara yawan tasirin antihypertensive).
Hyperkalemia

Yi amfani da lokacin daukar ciki da lokacin shayarwa

Ramipril yana contraindicated a cikin ciki, kamar yadda zai iya yin mummunar illa ga tayin: nakasa ci gaban kodan tayi, rage karfin jini na tayin da jarirai, aikin nakasasshe, hyperkalemia, hypoplasia na kasusuwa, oligohydramnios, kwancen kafafu na hanji, nakasa da kasusuwa na huhu, hanji na huhu da ciwan hanji na hanji, na kasusuwa na huhu da hanji na hanji, da ciwan hanji na huhun hanji, da ciwan hanji na huhun hanji, da ciwan hanji na huhu da hanji na hanji, da na huhun ciwan kansa.
Don haka, kafin shan magani a cikin mata masu haihuwa, ya kamata a cire ciki.
Idan mace tana shirin daukar ciki, to ya kamata a dakatar da magani tare da masu hana ACE.
Game da tabbatar da gaskiyar yanayin ciki yayin jiyya tare da Ramipril, ya kamata ku daina shan shi da wuri-wuri kuma canja wurin mai haƙuri zuwa shan wasu kwayoyi, lokacin amfani da haɗarin yarinyar zai zama mafi ƙaranci.
Idan jiyya tare da Ramipril ya zama dole yayin lactation, ya kamata a daina shayar da jarirai.

Sashi da gudanarwa

Ya kamata a ɗauki Allunan ba tare da la'akari da lokacin cin abinci ba (shine, za'a iya ɗaukar allunan duka kafin da lokacin ko bayan abinci) kuma a sha ruwa mai yawa (1/2 kofin). Karka tauna ko niƙa Allunan kafin amfani.
An zaɓi kashi gwargwadon tasirin warkewa da haƙuri da magani. Jiyya yawanci yana da tsawo, kuma likita ne ya ƙaddara tsawon lokacinsa.
Sai dai idan ba a baiyane takamaiman ba, to tare da al'ada na koda da aikin hepatic, ana bada shawarar hanyoyin yin sashi na ƙasa.
Tare da hauhawar jini
Yawancin lokaci, kashi na farko shine 2.5 mg sau ɗaya kowace rana da safe. Idan lokacin shan miyagun ƙwayoyi a cikin wannan kashi na makonni 3 ko fiye, ba zai yiwu a daidaita jinin jini ba, to ana iya ƙara kashi zuwa 5 mg na ramipril a kowace rana. Idan kashi na 5 MG ba ya isa sosai, bayan makonni 2-3 ana iya ninka shi zuwa iyakar shawarar yau da kullun na 10 MG kowace rana.
A matsayin madadin ƙara yawan kashi zuwa 10 MG kowace rana tare da isasshen ƙwayar maganin rigakafi na ƙimar 5 na yau da kullun, yana yiwuwa a ƙara wasu wakilai na antihypertensive zuwa magani, musamman, diuretics ko "jinkiri" masu katangar alli.
A cikin raunin zuciya
Shawarar farko da aka ba da shawarar ta 1.25 MG (1/2 kwamfutar hannu na 2.5 MG) lokaci 1 a rana. Dogaro da martani ga maganin mara lafiya, kashi na iya karuwa. An ba da shawarar ninka kashi biyu tare da tazara tsakanin makonni 1-2. Idan kuna buƙatar ɗaukar magani na yau da kullum na 2.5 MG ko mafi girma, ana iya ba shi sau ɗaya a rana, ko kuma ya kasu kashi biyu.
Matsakaicin da aka bayar da shawarar kullun shine 10 MG.
Tare da ciwon sukari ko mai fama da ciwon sukari
Shawarar farko da aka ba da shawarar ta 1.25 MG sau ɗaya a rana (1/2 kwamfutar hannu na 2.5 MG). Yawan yana iya ƙaruwa zuwa 5 MG sau ɗaya a rana. Tare da waɗannan yanayin, allurai sama da 5 MG sau ɗaya a rana a cikin gwaji na asibiti ba a yi nazari sosai ba.
Don rage haɗarin infarction myocardial, bugun jini, ko mace-mace a cikin marasa lafiya da ke tattare da haɗarin cutar zuciya
Shafin farko da aka bayar na 2.5 MG 1 sau ɗaya kowace rana. Dangane da haƙuri mai haƙuri, ana iya ƙara yawan ƙwayar a hankali. An ba da shawarar ninka kashi biyu bayan mako 1 na magani, kuma a cikin makonni 3 na gaba na jiyya, kara shi zuwa ga maganin da aka saba da na 10 MG sau ɗaya a rana.
Allurar da ta wuce 10 MG ba a yi karatun tazarce ba a cikin gwaji na asibiti. Ba a fahimci amfani da miyagun ƙwayoyi a cikin marasa lafiya tare da CC kasa da 0.6 ml / sec.
Tare da gazawar zuciya tare da bayyanar cututtuka na asibiti waɗanda suka ɓullo a cikin fewan kwanakin farko (daga rana ta 2 zuwa rana ta 9) bayan raunin myocardial m.
Maganin farko da aka ba da shawarar shi ne 5 MG kowace rana, an kasu kashi biyu na 2.5 na ƙwayoyin cuta, waɗanda ake ɗauka ɗayan safe da na biyu da yamma. Idan mai haƙuri bai yarda da wannan kashi na farko ba (ana lura da raguwa mai yawa a cikin karfin jini), to an ba shi shawarar ya ɗauki 1.25 mg (1/2 kwamfutar hannu na 2.5 mg) sau 2 a rana don kwana biyu.
Sannan, gwargwadon aikin mara haƙuri, ana iya ƙara yawan kashi. An ba da shawarar cewa kashi tare da karuwa ya ninki tare da tazara tsakanin kwanaki 1-3. Daga baya, ana iya ba da kashi ɗaya na yau da kullun, wanda da farko an kasha kashi biyu. Matsakaicin shawarar da aka ba da shawarar ita ce 10 MG.
A halin yanzu, ƙwarewar jiyya ga marasa lafiya da mummunan rauni na zuciya (III-IV aji na aiki bisa ga rarrabuwa na NYHA), wanda ya tashi nan da nan bayan rashin ƙarfi na myocardial infarction, bai isa ba. Idan irin waɗannan marasa lafiya suka yanke shawarar yin magani tare da Ramipril, ana ba da shawarar cewa farawa ya fara da mafi ƙarancin yiwuwar - 1.25 MG (1/2 kwamfutar hannu na 2.5 mg) sau ɗaya a rana, kuma ya kamata a kula da kulawa ta musamman tare da kowane ƙaruwa allurai.
Yin amfani da miyagun ƙwayoyi Ramipril a wasu rukuni na marasa lafiya
Marasa lafiya tare da nakasa aiki na renal
Tare da CC daga 50 zuwa 20 ml / min, farkon kashi yau da kullun yawanci shine 1.25 MG (1/2 kwamfutar hannu na 2.5 MG). Matsakaicin izini na yau da kullun shine 5 MG.
Marasa lafiya tare da rashin daidaituwa mai yawa na asarar ruwa da electrolytes, marasa lafiya da matsanancin tashin hankali na jijiya, kazalika da marasa lafiya waɗanda raguwar matsanancin raunin hawan jini yana ba da haɗari (alal misali, tare da mummunan rauni na rauni na jijiyoyin zuciya da jijiyoyin zuciya)
An rage kashi na farko zuwa 1.25 mg / rana (1/2 kwamfutar hannu na 2.5 MG).
Marasa lafiya tare da maganin cutar ta farko
Wajibi ne, in ya yiwu, a sokeure sauure 2-3 kwana (gwargwadon tsawon lokacin aikin diuretics) kafin a fara jiyya tare da Ramipril ko, aƙalla, rage kashi na shan maganin. Kulawa da irin wannan marasa lafiya ya kamata ya fara da mafi ƙasƙanci kashi na 1.25 mg na ramipril (1/2 kwamfutar hannu na 2.5 mg), ana ɗauka sau ɗaya a rana, da safe. Bayan ɗaukar kashi na farko da kowane lokaci bayan ƙara yawan ƙwayar ramipril da (ko) diuretics, musamman "madauki" diuretics, marasa lafiya ya kamata su kasance a ƙarƙashin kulawa na likita na akalla awanni 8 don gujewa mummunan halin rashin kulawa.
Tsofaffi mara lafiya (fiye da 65 shekara)
An rage kashi na farko zuwa 1.25 MG kowace rana (1/2 kwamfutar hannu na 2.5 MG).
Marasa lafiya tare da nakasa aikin hanta
Halin hauhawar jini zuwa shan Ramipril na iya haɓaka ko da (saboda ragewa ramiprilat excretion), ko raunana (saboda ragewa da sauyawar ramipril mara aiki zuwa ramiprilat mai aiki). Sabili da haka, a farkon magani yana buƙatar kulawa da kulawa da hankali. Matsakaicin izini na yau da kullun shine 2.5 MG.

Yadda ake amfani: sashi da hanya na jiyya

Allunan an cinye Allunan (kar a ɗan tauna), a wanke su da isasshen adadin (1/2 kofin) na ruwa, ba tare da cin abinci ba (shine, za'a iya ɗaukar allunan biyu kafin da lokacin cin abinci ko bayan abinci). An zaɓi kashi gwargwadon tasirin warkewa da haƙuri da magani.

Jiyya tare da Ramipril-SZ yawanci yana da tsawo, kuma likita yana ƙaddara tsawon lokacinsa a kowane yanayi.

Sai dai idan ba a baiyane takamaiman ba, to tare da al'ada na koda da aikin hepatic, ana bada shawarar yin amfani da hanyoyin jinya masu zuwa.

Tare da hauhawar jini, mahimmancin farko shine 2.5 MG 1 sau ɗaya kowace rana da safe. Idan lokacin shan miyagun ƙwayoyi a cikin wannan kashi na makonni 3 ko fiye, ba zai yiwu a daidaita jinin jini ba, to ana iya ƙara kashi zuwa 5 mg na ramipril a kowace rana. Idan kashi na 5 MG ba ya isa sosai, bayan makonni 2-3 ana iya ninka shi zuwa iyakar shawarar da aka bayar na yau da kullun na 10 MG kowace rana.

A matsayin madadin kara yawan zuwa 10 MG a kowace rana tare da isasshen ingancin antihypertensive na maganin yau da kullun na 5 MG, yana yiwuwa a ƙara wasu wakilai na antihypertensive zuwa magani, musamman diuretics ko "jinkiri" masu katangar alli.

A cikin raunin zuciya, ƙwaƙwalwar farko da aka ba da shawarar: 1.25 mg sau ɗaya a rana (1/2 kwamfutar hannu 2.5 mg). Dogaro da amsar da mara lafiyar ya bayar game da maganin, kashi na iya karuwa. An ba da shawarar ninka kashi biyu tare da tazara tsakanin makonni 1-2. Idan kuna buƙatar ɗaukar magani na yau da kullum na 2.5 MG ko fiye, ana iya ba shi sau ɗaya a rana, ko kuma ya kasu kashi biyu.

Matsakaicin da aka bayar da shawarar kullun shine 10 MG.

Don mai ciwon sukari ko mai rashin ciwon sukari, wanda aka bayar da shawarar farko: 1.25 mg sau ɗaya a rana (1/2 kwamfutar hannu 2.5 mg). Yawan yana iya ƙaruwa zuwa 5 MG sau ɗaya a rana. Tare da waɗannan yanayin, allurai sama da 5 MG sau ɗaya a rana a cikin gwaji na asibiti ba a yi nazari sosai ba.

Don rage haɗarin infarction myocardial, bugun jini, ko mutuwar zuciya a cikin marasa lafiya da ke tattare da haɗarin zuciya, shawarar da aka bayar da farko ta Ramipril-SZ shine 2.5 MG sau ɗaya a rana. Dangane da haƙuri mai haƙuri, ana iya ƙara yawan ƙwayar a hankali. An ba da shawarar ninka kashi biyu bayan mako 1 na magani, kuma a cikin makonni 3 na gaba na jiyya, kara shi zuwa ga maganin da aka saba da na 10 MG sau ɗaya a rana.

Allurar da ta wuce 10 MG ba a yi karatun tazarce ba a cikin gwaji na asibiti.

Amfani da miyagun ƙwayoyi a cikin marasa lafiya tare da keɓantaccen izinin creatinine na ƙasa da 0.6 ml / s ba a yi nazarin isa ba.

Tare da raunin zuciya wanda ya ɓullo a cikin kwanakin farko na farko (daga rana ta 2 zuwa ta 9) bayan rashin ƙarfi na myocardial infarction, maganin da aka ba da shawarar farko shine 5 MG kowace rana, ya kasu kashi biyu na biyu na 2.5 MG, wanda aka ɗauka da safe, na biyun kuma da yamma. Idan mara lafiya bai yarda da wannan kashi na farko ba (ana lura da raguwar hauhawar jini a cikin jini), to an ba da shawarar a ba shi 1.25 MG 2 sau a rana (1/2 kwamfutar hannu 2.5 mg) na kwana biyu. Sannan, gwargwadon aikin mara haƙuri, ana iya ƙara yawan kashi. An ba da shawarar cewa kashi tare da karuwa ya ninki tare da tazara tsakanin kwanaki 1-3. Daga baya, ana iya ba da kashi ɗaya na yau da kullun, wanda da farko an kasha kashi biyu.

Matsakaicin shawarar da aka ba da shawarar ita ce 10 MG.

A halin yanzu, ƙwarewar jiyya ga marasa lafiya da rauni na zuciya (III-IV aji na aiki bisa ga tsarin NYHA), wanda ya faru nan da nan bayan mummunan rauni na myocardial, bai isa ba. Idan irin waɗannan marasa lafiya suka yanke shawarar yin magani tare da Ramipril-SZ, ana ba da shawarar cewa farawa ya fara da mafi ƙarancin yiwuwar magani - 1.25 MG sau ɗaya a rana (1/2 kwamfutar hannu 2.5 mg) kuma ya kamata a kula da musamman tare da kowane karuwa. allurai.

Amfani da Ramipril-SZ a wasu rukuni na marasa lafiya

Marasa lafiya tare da rauni na aikin ƙirar ƙira: lokacin da keɓancewar creatinine daga 50 zuwa 20 ml / min ta 1.73 m2 na farfajiyar jiki, farawa na yau da kullun yawanci shine 1.25 mg (1/2 kwamfutar hannu 2.5 mg). Matsakaicin izini na yau da kullun shine 5 MG.

Marasa lafiya tare da ɗan gyara asarar ruwa da electrolytes, marasa lafiya tare da matsanancin tashin hankali na jijiya, kazalika da marasa lafiya waɗanda raguwa mai yawa a cikin hawan jini yana ba da haɗarin haɗari (alal misali, tare da mummunan raunuka na atherosclerotic of the coronary and cerebral arteries): an rage kashi na farko zuwa 1.25 mg / day (1/2 kwamfutar hannu 2.5 MG).

Marasa lafiya da keɓaɓɓen magani na fitsari: in ya yiwu, ya kamata a soke diuretics kwana 2-3 daga baya (ya danganta da tsawon lokacin da masu aikin keɓaɓɓu) kafin a fara jiyya tare da Ramipril-SZ ko, aƙalla, rage ƙarancin cututtukan da ake ɗauka. Kulawa da waɗannan marasa lafiya ya kamata ya fara da mafi ƙarancin kashi na 1.25 mg na ramipril (1/2 kwamfutar hannu na 2.5 mg), ana ɗauka sau ɗaya a rana, da safe. Bayan ɗaukar kashi na farko da kowane lokaci bayan ƙara yawan ƙwayar ramipril da (ko) "madauki" diuretics, marasa lafiya ya kamata su kasance a ƙarƙashin kulawa na likita don aƙalla 8 hours don kauce wa amsawar rashin kulawa.

Marasa lafiyar tsofaffi (sama da 65): ya kamata a rage kashi na farko zuwa 1.25 MG kowace rana (1/2 kwamfutar hannu 2.5 mg).

Marasa lafiya tare da aikin hanta mai rauni: ƙaddamar da haɓakar jini don ɗaukar Ramipril-SZ na iya haɓaka ko (saboda raguwa a ramiprilat excretion), ko raunana (saboda raguwa a cikin juyawa na ramipril mara aiki zuwa ramiprilat mai aiki). Sabili da haka, a farkon magani yana buƙatar kulawa da kulawa da hankali. Matsakaicin izini na yau da kullun shine 2.5 MG.

Aikin magunguna

Abubuwan da ke aiki na Ramipril-SZ a ƙarƙashin rinjayar enzymes "hanta" an canza su zuwa ramiprilat mai aiki, wanda ke da tasiri mai hanawa na tsawon lokaci akan ACE. ACE a cikin ƙwayar plasma da kyallen takarda suna ɗaukar juyowar juyawar angiotensin I zuwa angiotensin II da rushewar bradykinin. Saboda haka, lokacin shan ramipril a ciki, samuwar angiotensin II yana raguwa kuma bradykinin ya tara, wanda ke haifar da vasodilation da raguwa a cikin karfin jini (BP).

Increaseara yawan ayyukan kallikrein-kinin a cikin jini da kyallen takarda yana ƙayyade tasirin cardioprotective da endothelioprotective na ramipril saboda kunnawa cikin tsarin prostaglandin kuma, a sakamakon haka, haɓaka aikin haɗin prostaglandins, wanda ke haɓaka samuwar nitric oxide (NO) a cikin endotheliocytes.

Angiotensin II yana haɓaka samar da aldosterone, don haka ɗaukar ramipril yana rage ɓoyewar aldosterone kuma yana haɓaka ƙwayoyin ƙwayoyin potassium ions.

Tare da raguwa a cikin taro na angiotensin II a cikin jini, an kawar da tasirinsa na hanawar renin ta hanyar nau'in amsawar mara kyau, wanda ke haifar da karuwa a cikin aikin aikin jini na jini. Ana tsammanin ci gaban wasu halayen da ba a so (musamman, “bushe” tari) kuma ana alaƙa da haɓaka ayyukan bradykinin.

A cikin marasa lafiya tare da hauhawar jini, jijiyar ramipril yana haifar da raguwar hauhawar jini a cikin "kwance" da "tsayawa" matsayi, ba tare da karuwa mai raɗaɗin raunin zuciya ba (HR). Ramipril yana rage yawan juriya na jijiyoyin bugun jini (OPSS), a zahiri ba tare da haifar da canje-canje ba a cikin yanayin hauhawar jini da kuma yawan zubar duniya. Tasirin antihypertensive ya fara bayyana a cikin sa'o'i 1-2 bayan shigowa da kashi daya na maganin, har ya kai ga darajar sa bayan sa'o'i 3 zuwa 9, kuma zai kai tsawon awanni 24. Tare da hanya, sakamako na antihypertensive na iya ƙaruwa a hankali, yawanci yana ƙarfafawa zuwa makonni 3 zuwa 4 na gudanarwar yau da kullun na miyagun ƙwayoyi sannan kuma ya dage tsawon lokaci. A miyagun ƙwayoyi ba shi da "karbo" ciwo, i.e. dakatarwar kwatsam na sarrafa magunguna ba ya haifar da saurin hauhawa da gagarumin ci gaba a hawan jini.

A cikin marasa lafiya da hauhawar jijiya, ramipril yana rage jinkirin ci gaba da hauhawar jini na jijiyoyin jini da bango na jijiyoyin jiki.

A cikin marasa lafiya da rauni na zuciya, ramipril yana rage OPSS (raguwa bayan saukarwa a kan zuciya), yana kara karfin tashar tashan kuma yana rage matsin lamba na ventricle na hagu, wanda, a sakamakon haka, yana haifar da raguwa cikin preload akan zuciya. A cikin waɗannan marasa lafiya, lokacin ɗaukar ramipril, akwai karuwa a fitarwa na zuciya, ctionaukar jini da haɓaka haƙuri.

A cikin masu ciwon sukari da wadanda ba su kamu da cutar kansa ba, ramipril yana rage jinkirin ci gaba na ƙarancin ƙwaƙwalwar ƙwayar cuta da kuma rashin cin nasara game da ƙaddamarwar ƙarewa kuma, sabili da haka, yana buƙatar rage buƙatar hawan jini ko juyawar koda. A cikin farkon matakai na masu ciwon sukari ko nophisathy na nephropathy, ramipril yana rage zafin albuminuria.

A cikin marasa lafiya da babban haɗarin haɓakar cututtukan zuciya saboda ko jijiyoyin bugun jini (cututtukan zuciya da ke fama da cutar, tarihin cutar mahaifa, tarihin bugun jini), ko ciwon sukari mellitus tare da aƙalla ƙarin ƙarin haɗarin haɗari (microalbuminuria, hauhawar jijiyoyin jini, ƙaruwar jini) taro na duka cholesterol (OX), raguwa a cikin taro na cholesterol na yawan yawa na lipoproteins (HDL-C), shan taba sigari) ƙari na ramipril zuwa daidaitaccen far da muhimmanci rage abin da ke faruwa a cikin rauni na zuciya, bugun jini da mace-mace daga sanadin cututtukan zuciya. Bugu da kari, ramipril yana rage yawan mace-mace, kazalika da bukatar farfadowa, kuma yana rage jinkiri kan ci gaban zuciya.

A cikin marasa lafiya tare da raunin zuciya wanda ya ɓullo a farkon kwanakin myocardial infarction (2-9 days), ɗaukar ramipril fara daga 3 zuwa 10 kwanakin myocardial infarction yana rage haɗarin mace-mace (ta 27%), haɗarin mutuwa kwatsam (by 30 %), haɗarin kamuwa da ciwon zuciya na ci gaba zuwa mummunan aiki (aji na aikin aji na III-IV) / jigilar maganin cutar (27%), da yiwuwar asibiti mai zuwa sakamakon gazawar zuciya (26%).

A cikin yawan haƙuri, har ma a cikin marasa lafiya da ciwon sukari mellitus, duka biyu tare da hauhawar jini kuma tare da hawan jini na yau da kullun, ramipril yana rage haɗarin nephropathy da kuma faruwa na microalbuminuria.

Formaddamar da tsari da abun da ke ciki

Fitar sashi - allunan: kusan fararen fari ne ko fari, silin-silin zagaye, tare da sashin layi da rarrabuwa (a cikin ɗaukar hoto mai ɗaukar hoto: inji 10., Fakitoci 3 a cikin kwali na kwali, guda guda 14. A cikin kundin kwali, fakiti 1 ko 2) .

Abubuwan da ke aiki na Ramipril shine ramipril, a cikin kwamfutar hannu 1 - 2.5 MG, 5 MG ko 10 MG.

Abubuwa masu taimako: lactose, microcrystalline cellulose, aerosil (sillofon silicon dioxide), magnesium stearate, primogel (sodium carboxymethyl sitaci).

Pharmacokinetics

Tare da gudanarwa na baka, ɗaukar ciki ya kai 50-60%. Cin abinci baya shafar matakin ɗaukar, amma yana rage ƙimar sha. Matsakaicin ƙwayar ramipril ya kai bayan sa'o'i 2-4 bayan gudanarwa. A cikin hanta, fili yana da metabolized, yana yin aiki ramiprilat mai aiki (ƙimar hanawar ACE ya ninka sau 6 fiye da hakan don ramipril) da diketopiperazine mai aiki marasa aiki. Sannan ramipril ya sha maganin glucuronidation. Bayan ban da ramiprilat, duk metabolites kafa ba su nuna aikin pharmacological ba.

Ramipril yana ɗaure sunadaran plasma ta hanyar 73%, da kuma ramiprilat - by 56%. A bioavailability bayan na baka kulawa na 2.5-5 MG na miyagun ƙwayoyi ne 15-28%, a yanayin saukan ramiprilat - 45%. Tare da kashi 5 na yau da kullun na 5, yau da kullun, matakin kwanciyar hankali na ramiprilat a cikin plasma yana zuwa ta 4th.

Rabin rayuwar ramipril shine 5.1 hours. Hankalin ramiprilat a cikin jijiyoyin jini yana raguwa a cikin rarrabawa da cirewa tare da rabin rayuwa na tsawon awanni 3, a cikin canjin lokaci, rabin-rayuwa shine sa'o'i 15 kuma a cikin lokaci na ƙarshe na ƙarshe, wanda aka nuna shi da ƙarancin abun ciki na ramiprilat a cikin plasma - 4-5 days. Cire rabin rayuwa yana ƙaruwa a cikin marasa lafiya da ke fama da gazawar koda na gazawa.

Yawan rarraba ramipril shine lita 90, ramiprilata shine lita 500. Abubuwan da aka keɓe ta hanyar kodan a cikin adadin 60% na kashi da aka dauka, kuma ta cikin hanji - a cikin adadin 40% (galibi a cikin hanyar metabolites). Tare da dysfunctions na koda, yawan hurawar ramipril da metabolites yana raguwa gwargwadon raguwa a cikin kyawun ƙirar creatinine, tare da lalata hanta, sauyawar shi zuwa ramiprilat, kuma tare da gazawar zuciya, ƙarancin ramiprilat yana ƙaruwa sau 1.5-1.8.

Umarnin don amfani da Ramipril: hanya da sashi

Ana ɗaukar allunan a baki kafin ko bayan abinci, suna haɗiye duka da ruwa.

Likita ya ba da allurar gwargwadon alamun alamun asibiti, an ba wa mutum haƙuri da warkewar cutar.

Hauhawar jijiyoyin jini: kashi na farko shine 2.5 MG 1 lokaci ɗaya kowace rana (da safe) ko a allurai 2. Don cimma sakamako na warkewa da ake so, ƙaruwa da yawa yana yiwuwa bayan makonni 2-3 na jiyya. Girman tabbatarwa na yau da kullun shine 2.5-5 MG, mafi girman shine 10 MG kowace rana. Tare da jiyya na baya tare da diuretics, yakamata a soke su ko kuma ya kamata a rage kashi ɗin a ƙarshen kwanaki 3 kafin fara Ramipril.Matsayi na farko don marasa lafiya suna shan diuretics, marasa lafiya da ke fama da rauni na aiki ko tare da hauhawar jijiya da gazawar zuciya shine 1.25 MG kowace rana sau ɗaya. Yakamata a fara aikace-aikacen a ƙarƙashin tsananin kulawar likita. Ga marasa lafiya da rikicewar ruwa-electrolyte ma'auni ko haɗarin amsawar antihypertensive, kashi na farko na yau da kullun ya kamata ya wuce 1.25 MG,
Rashin ciwon zuciya na yau da kullun: kashi na farko shine 1.25 MG sau ɗaya, idan ya cancanta, ana iya ninka kashi biyu bayan makonni 1-2. Yawancin yau da kullun kada ya wuce 10 MG. Tare da gudanar da aikin sau ɗaya na diuretics, ya kamata a rage yawan ƙwayoyin su kafin fara amfani da jiyya,
Rashin bugun zuciya wanda ya faru tsakanin kwanaki 2-9 bayan tsananin infarction myocardial: kashi na farko - 2.5 mg sau 2 a rana (safe da maraice) sannan bayan kwana biyu na maganin - 5 MG sau 2 a rana. Adadin kulawa - 2.5-5 mg sau 2 a rana. Idan magungunan ba su da haƙuri da haƙuri (artpot hypotension), ya kamata a rage kashi na farko zuwa 1.25 mg sau 2 a rana, to bayan kwanaki 2 ana iya ƙara zuwa 2.5 MG, kuma bayan kwanaki 2 zuwa 5 MG 2 sau a rana. Yawancin yau da kullun kada ya wuce 10 MG. Idan an yi haƙuri da ƙarancin ƙwayar cuta, 2.5 sau 2 a rana ya kamata a daina. Sakamakon ƙarancin ƙwarewa tare da amfani da Ramipril a cikin marasa lafiya da rauni na zuciya na aji na aikin III-IV (bisa ga rarrabuwa na NYHA) wanda ya faru nan da nan bayan rashin ƙarfi na myocardial infarction, kashi na farko na wannan rukuni na marasa lafiya kada ya wuce mgnin 1.25 sau ɗaya a rana. Ya kamata a aiwatar da karin kashi a karkashin kulawar likita,
Nephropathy a cikin yanayin yaduwar cututtukan ƙwayar cuta na kodan, cututtukan cututtukan cututtukan ƙwayar cuta: kashi na farko - 1.25 mg sau ɗaya. Tare da kyakkyawan haƙuri na miyagun ƙwayoyi, ana iya ninka kashi biyu a kowane sati 2 har sai an sami kashi na kiyayewa na 5 MG sau ɗaya a rana,
Rage haɗarin bugun zuciya, infarction na zuciya na zuciya, ko mutuwar jijiyoyin jini a cikin marasa lafiya da ke tattare da haɗarin cututtukan zuciya: kashi na farko shine 2.5 MG sau ɗaya. Ana nuna haɓaka mai sauƙi a cikin kashi: bayan mako 1, sannan bayan makonni 2-3 - zuwa adadin tallafi na 10 MG sau ɗaya a rana.

Shawarwarin sarrafa magunguna na Ramipril da aka ba da shawara ga marasa lafiya da gazawar koda

CC kasa da 30 ml / min: kashi na farko - 1.25 MG a rana, matsakaici - 5 MG,
KK 30-60 ml / min: na farko kashi - 2.5 MG kowace rana, matsakaici - 5 MG,
CC fiye da 60 ml / min: kashi na farko shine 2.5 MG a kowace rana, matsakaicin shine 10 MG.

Tare da gazawar hanta, kashi na farko kada ya wuce 1.25 MG, matsakaicin - 2.5 MG sau ɗaya.

Maganin farko na marasa lafiya tsofaffi shine 1.25 MG kowace rana.

Ana buƙatar kulawa ta musamman ga marasa lafiya da suka wuce shekaru 65 suna shan diuretics, don marasa lafiya tare da raunin zuciya tare da nakasa na koda da aikin hepatic. An zabi kashi gwargwadon matakin manufa da karfin jini.

Hulɗa da ƙwayoyi

Lokacin da yake rubuta Ramipril, likita ya kamata ya gargadi mara lafiya game da buƙatar yin shawarwari kafin fara amfani da lokaci guda na kowane kwayoyi.

Misalin Ramipril sune: Ramipril-SZ, Wazolong, Amprilan, Dilaprel, Hartil, Korpril, Pyramil, Ramigamma, Tritace, Ramicardia.