Amprilan® (Amprilan)

Lokacin toshe ACE yana raguwa angiotensin-2, renin aiki yana ƙaruwa, aiki yana ƙaruwa bradykininsamarwa yana ƙaruwa aldosterone. An bayarda maganin hemodynamic da antihypertensive na miyagun ƙwayoyi ta hanyar fadada ƙwayar jirgi, rage OPSS. Magungunan ba su da tasiribugun zuciya. Jiyya na dogon lokaci na iya haifar da tashin hankali na hauhawar jini ventricular hagu, wanda ke haɓaka tare da hauhawar jini. Ragewa hawan jini rajista 1-2 hours bayan shan miyagun ƙwayoyi, da antihypertensive sakamako ya ci gaba har kwana guda.

A cikin marasa lafiya tare da bugun zuciya rage hadarin bugun zuciya, mutuwa kwatsam, ci gaban cuta, adadin asibitocin gaggawa da lambar hauhawar jini. A cikin marasa lafiya tare da ciwon sukari akwai raguwa microalbuminuriarage hadari nephropathy. Wadannan tasirin suna ci gaba ba tare da la’akari da matakin karfin jini ba.

Alamu Amprilana

• bugun zuciya (na kullum
• hauhawar jini,
• na jijiyoyin zuciya jijiya cutazukata.

Alamu don amfani a cikin marasa lafiya tare da ciwon sukari: nephropathy.

Contraindications

• yawan tashin hankali ga abubuwanda aka gyara
• lahani na zuciya (na mitral, aortic, haɗe),
• nono,
• cardioyopathy,
• tsarin tsarin koda,
• hyperaldosteronism,
• ciki,
• shekaru zuwa shekaru 18.

Side effects

Mafi yawan lokuta, ana yin rikicewar matsewar hawan jini,maimaita, migraine-kamar ciwon kai, bushe tari, karin ƙarfefata mai rauni, fashewa ciwan ciki da maganin ciwon huhu tare da karuwa a cikin taro na enzymes, jin zafi a cikin gidajen abinci da tsokoki.

Kadan na kowa arrhythmiabugun zuciya angina pectorisrikitarwa ta hanyar infarction na zuciya daga myocardial Cutar Raynaud, vasculitis, cututtukan astheno-depression tare da rikicewar bacci, tashin hankali ischemic Attack da bugun jini, rashin ƙarfi, lalacewar tsarin na koda tare da kara maida hankali creatinia da urea a cikin fitsari halayen rashin lafiyan halayenwani canji a sigogi na dakin gwaje-gwaje a cikin hanyar neutropenia, erythropenia.

Tare da ci gaba da tsananin zafin halayen, ana bada shawara a nemi likita kuma a dakatar da shan maganin Amprilan na ɗan lokaci.

Formaddamar da tsari da abun da ke ciki

Babban aikin Amprilan shine ramipril.

Abubuwan taimako sun ƙunshi allunan: ssumum croscarmellose, sitaci pregelatinized, sodium stearyl fumarate, sodium bicarbonate, lactose monohydrate, dyes.

Samun magungunan: 1.25 MG, 2.5 MG, 5 MG da 10 MG na ramipril a cikin kwamfutar hannu guda.

Ana samar da Amprilan a cikin allunan (7 ko allunan 10 a cikin alkuki) oval tare da shimfiɗar lebur da farar fata. Launi na allunan sun bambanta dangane da matakin maganin: fararen fata ko kusan fararen fata (1.25 mg da 10 mg kowannensu), launin rawaya mai haske (2.5 mg kowace), ruwan hoda mai launi (5 MG kowace),

Aikin magunguna

Pharmacodynamics Amprilan mai aiki ne na ACE mai daukar dogon lokaci. Abubuwan da ke tattare da enzyme na Angiotensin suna haɓaka juyar da angiotensin II daga angiotensin I, daidai suke da kinase - enzyme wanda ke kara rushewar bradykinin. Sakamakon toshewar ACE ta Amprilan, maida hankali kan ƙwaƙwalwar angiotensin II yana ƙaruwa, ayyukan renin a cikin jini yana ƙaruwa, aikin bradykinin da samar da aldosterone yana ƙaruwa, wanda ke haifar da karuwa a cikin ƙwayoyin potassium a cikin jini.

Amprilan yana da tasirin antihypertensive da illolin hemodynamic saboda yaduwar tasoshin jini da rage yawan juriya. A wannan yanayin, raunin zuciya ba ya canzawa. Ragewar matsin lamba bayan kashi daya na Amprilan ana lura dashi bayan sa'o'i 1-2, bayan awanni 3-6 sakamakon warkewar cutar ya isa yakai tsawon sa'o'i 24.

Tare da tsawanta magani tare da miyagun ƙwayoyi, hauhawar jini na ventricular hagu yana raguwa, yayin da babu wani mummunan tasiri akan aikin zuciya.

Pharmacokinetics

Abubuwan da ke aiki suna saurin daga hanzarin narkewa (saurin baya dogaro da abincin). Sa'a guda bayan aikace-aikacen, ana samun mafi girman yawan abubuwan aiki a cikin jini. Kusan kashi 73% na ramipril suna ɗaure zuwa kariyar plasma.

Magungunan yana rushewa a cikin hanta, yana haifar da ramiprilat mai aiki (aikin ƙarshen shine sau 6 sama da aikin ramipril kanta) da diketopiperazine mai aiki mara aiki. Matsakaicin mafi girman ramiprilat a cikin jini an gano shi awanni 2-4 bayan amfani da miyagun ƙwayoyi, kwanciyar hankali da daidaituwa mai warkewa koyaushe a ranar 4 na magani. Kimanin kashi 56% na ramiprilat sun ɗauka zuwa sunadaran plasma.

Kusan kashi 60 na ramipril da ramiprilat sune kodan ke kwance a cikin hanyar metabolites, kasa da 2% na ramipril an cire shi daga jikin da bai canza ba. Rabin rayuwar ramiprilat daga 13 zuwa 17 ne, ramipril - 5 hours.

Tare da lalacewar aikin na koda, ragin cirewar ramipril da metabolites yana raguwa. A cikin marasa lafiya da rashin wadataccen hepatic, sauyawar ramipril zuwa ramiprilat yana raguwa, abubuwan da ke cikin ramipril a cikin ƙwayar jini yana ƙaruwa.

Sashi da gudanarwa

Ana ɗaukar allunan a baki, ba tare da la'akari da abinci ba, kada ku ci, ku sha ruwa mai yawa.

An zabi sashi na miyagun ƙwayoyi ta likita sau ɗaya daban-daban ga kowane mara lafiya, la'akari da alamun, haƙuri na miyagun ƙwayoyi, cututtukan haɗuwa da shekarun haƙuri. Lokacin zaɓin abu, dole ne a kula da alamar karfin jini. Matsakaicin izni na maganin don kowane nau'in cutar shine 10 MG kowace rana. A hanya mafi yawanci magani ne, kuma likita ta kafa.

Tare da hauhawar jini Maganin farko da aka bada shawarar sashi shine 2.5 mg sau daya a kullum. Idan ya cancanta, ana iya ninka kashi a cikin kwanaki 7-14.

A cikin raunin zuciya kashi na farko da aka bayar da shawarar magunguna shine 1.25 mg (ana iya ninka shi bayan makonni 1-2).

Tare da rashin zuciya, wanda ya faru kwanaki 2-9 bayan m infarinction na myocardial, ana bada shawara don shan 5 MG na Amprilan kowace rana - 2.5 MG da safe da maraice. Idan yayin jiyya matsa lamba ya ragu sosai, sashi zai ragu (1.25 mg sau biyu a rana). Bayan kwana 3, sai kashi ya sake tashi. Idan shan miyagun ƙwayoyi a cikin kashi na 2.5 mg sau biyu a rana yana sake haƙuri da haƙuri mara haƙuri, magani tare da Amprilan ya kamata a soke.

Nephropathy (tare da yaduwar cututtuka na kodan da masu ciwon sukari).Ganin farawa shine 1.25 MG kowace rana. Kowane kwanaki 14, da kashi sau biyu har sai an tabbatar da kashi 5 MG kowace rana.

Yin rigakafin faduwar zuciya bayan faduwar zuciya. A matakin farko na warkewa hanya, ana ba da Amprilan 2.5 MG a kowace kwamfutar hannu kowace rana. Bayan mako guda, sashi yana ƙaruwa zuwa 5 MG a kowace rana, bayan wani makonni 2-3 - zuwa kashi na goyon baya na 10 MG sau ɗaya a rana.

Tare da cirewar jijiya da kuma bayan tiyata Ana shan Amprilan 2.5 MG sau ɗaya a rana don kwanaki 7. Sannan, har tsawon makonni 2-3, ana shan maganin a 5 MG a kowace rana, bayan an ƙara yawan sashi sau biyu - har zuwa 10 MG kowace rana.

Umarni na musamman

1. Ga marasa lafiya da raunin aikin koda, raunin farko na Amprilan ya zama 1.25 MG, kuma matsakaicin adadin yau da kullun ya kamata ya zama 5 MG.
2. Ga marasa lafiya da gazawar hanta, kashi na farko shine 1.25 mg, matsakaicin adadin yau da kullun shine 2.5 mg.
3. Idan an wajabta Amprilan ga marasa lafiya da ke shan diuretics, ana buƙatar sokewa ko rage yawan sashi na diuretics. Hakanan yana buƙatar saka idanu akai-akai game da yanayin irin waɗannan marasa lafiya, musamman ma tsofaffi marasa lafiya (fiye da shekaru 65).
4. Ana ɗaukar Amprilan tare da taka tsantsan a cikin marasa lafiya da cututtukan cututtukan cututtukan nama, ƙwaƙwalwar mellitus, rashin lafiyar angina pectoris.
5. Magungunan suna da mummunar tasiri a tayin (hypoplasia na huhu da ƙasusuwa na kwanyar, hyperkalemia, aiki mara kyau na renal) kuma yana contraindicated a cikin mata masu juna biyu. Kafin zubar da Amprilan, yana da mahimmanci ga matan masu haihuwa su cire juna biyu.
6. Lokacin shan Amprilan yayin shayarwa, ya kamata a soke shan nono.

Sharuɗɗan da yanayin ajiya

Adana miyagun ƙwayoyi a zazzabi da bai wuce 25 ° C ba, a wani wuri mai kariya daga danshi da hasken rana, ga yara. Rayuwar shiryayye na allunan Amprilan shine shekaru 3. Bayan kwanan wata da aka nuna akan kunshin, ba za a iya ɗaukar magani ba.

Tsarin analogues na Amprilan (kwayoyi tare da irin wannan abu mai aiki) sune:

Hotunan 3D

Sashi da gudanarwa

A ciki ba tare da la’akari da lokacin cin abinci ba (ana iya ɗaukar allunan biyu kafin da lokacin ko bayan cin), shan ruwa mai yawa (1/2 kofin). Kar a tauna ko niƙa allunan kafin a ɗauka.

An zaɓi kashi gwargwadon tasirin warkewa da haƙuri da magani.

Jiyya tare da Amprilan ® yawanci yana da tsawo, kuma likita yana ƙaddara tsawon lokacin 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.

Yawancin lokaci farawa shine 2.5 mg / rana da safe. Idan lokacin shan Amprilan ® a wannan kashi na tsawon makonni 3 ko sama da haka, ba zai yiwu a daidaita jinin jini ba, to ana iya ƙara yawan zuwa 5 mg / 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.

A matsayin madadin ƙara yawan kashi zuwa 10 MG / rana tare da isasshen ingancin antihypertensive na maganin yau da kullun na 5 MG, yana yiwuwa a ƙara wasu wakilan antihypertensive zuwa magani, musamman diuretics ko BKK.

Maganin farko da aka ba da shawarar shine 1.25 mg / day. Dangane da amsawar mai haƙuri ga maganin, ƙimar na iya ƙaruwa.

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 amfani dashi sau ɗaya a rana, ko kuma ya kasu kashi biyu.

Matsakaicin da aka bayar da shawarar kullun shine 10 MG.

Ciwon sukari ko mai fama da ciwon sukari

Maganin farko da aka ba da shawarar shine 1.25 mg / day. Yawan yana iya ƙaruwa zuwa 5 MG / rana. Tare da waɗannan yanayin, allurai sama da 5 mg / rana ba a yi nazarinsu ba sosai a cikin gwaji na asibiti.

Rage haɗarin haɓakar infitar ƙarfin zuciya, bugun jini, ko mutuwar zuciya a cikin marasa lafiya da ke tattare da haɗarin cutar zuciya

Matsakaicin farawa shine 2.5 mg / rana.

Dangane da haƙuri haƙuri ga Amprilan ®, ana iya ƙara yawan ƙwayar a hankali.

An ba da shawarar ninka kashi biyu bayan makon 1 na jiyya, kuma a cikin makonni 3 masu zuwa, kara shi zuwa kashi na yau da kullun akan 10 mg / rana.

Yin amfani da kashi wanda ya wuce 10 MG / rana a cikin gwaji na asibiti ba a yi nazarin sosai ba. Ba a fahimci amfani da miyagun ƙwayoyi a cikin marasa lafiya tare da Cl creatinine kasa da 0.6 ml / sec.

Rashin bugun zuciya wanda ya bunkasa a cikin thean kwanakin farko (daga kwana 2 zuwa 9) bayan raunin myocardial infarction

Initialwarin da aka ba da shawarar farko shine 5 MG / rana, sun kasu kashi biyu kawai na 2.5 MG (wanda aka ɗauka da safe da maraice). Idan mara lafiya bai yarda da wannan kashi na farko ba (ana lura da raguwar hauhawar jini a cikin jini), to an ba shi shawarar ya dauki 1.25 mg sau 2 a rana don kwanaki 2.

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. Hakanan za'a iya amfani da jimlar yau da kullun, wanda aka fara raba shi zuwa allurai 2 a sau daya.

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

A halin yanzu, ƙwarewa a cikin lura da marasa lafiya da mummunan rauni na zuciya (III - III aikin aji bisa ga rarrabuwa NYHA) wanda ya faru nan da nan bayan mummunan rauni na infarction myocardial bai isa ba. Idan irin waɗannan marasa lafiya suka yanke shawarar yin magani tare da Amprilan ®, ana ba da shawarar cewa farawa ya fara da mafi ƙarancin kashi - 1.25 mg / day, kuma ya kamata a kula da kowace kulawa tare da kowane karuwa a kashi.

Groupsungiyoyin haƙuri na musamman

Paarancin aiki na haya. Tare da Cl creatinine daga 50 zuwa 20 ml / min / 1.73 m 2, kashi na farko na yau da kullun shine yawanci 1.25 mg. Matsakaicin izini na yau da kullun shine 5 MG.

Rashin ingantaccen gyara asarar ruwa da electrolytes, hauhawar jini mai jijiyoyi, har ila yau idan hauhawar jini ya yawaita cikin haɗarin (alal misali, tare da mummunan raunuka na jijiyoyin zuciya da jijiyoyin zuciya). An rage kashi na farko zuwa 1.25 mg / rana.

Na baya maganin fargaba. Idan za ta yiwu, ya kamata a soke diuretics kwanaki 2-3 (gwargwadon tsawon lokacin da masu aikin keɓaɓɓu) kafin a fara jiyya tare da Amprilan ® ko kuma a rage yawan maganin cutar diuretics. Kulawa da irin wannan marasa lafiya ya kamata ya fara da mafi ƙarancin kashi na Amprilan ® - 1.25 mg / rana da safe. Bayan ɗaukar kashi na farko da kowane lokaci bayan ƙara yawan ƙwayar Amprilan ® da / ko madauki diuretics, ya kamata marasa lafiya su kasance a ƙarƙashin kulawa na likita don aƙalla 8 hours don guje wa amsawar hypotensive.

Shekaru sama da 65. An rage kashi na farko zuwa 1.25 mg / rana.

Rashin aikin hanta. Halin hauhawar jini ga shan Amprilan ® na iya haɓaka (ta rage ramiprilat excretion), ko kuma ya raunana (saboda rage jinkirin 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.

Mai masana'anta

JSC “Krka, dd, Novo mesto”. Šmarješka cesta 6, 8501 Novo mesto, Slovenia.

Lokacin shirya da / ko marufi a cikin kamfanin kasuwanci na Rasha, za a nuna shi: "KRKA-RUS" LLC. 143500, Rasha, Yankin Moscow, Istra, ul. Moscow, 50.

Tẹli: (495) 994-70-70, fax: (495) 994-70-78.

Ofishin wakilci na Krka, dd, Novo mesto JSC a cikin Federationungiyar Rasha / ƙungiyar da ke karɓar korafin mabukaci: 125212, Moscow, Golovinskoye sh., 5, bldg. 1, bene 22.

Waya: (495) 981-10-95, fax (495) 981-10-91.

Pharmacokinetics

Bayan gudanar da baki na ramipril, Amprilan yana da sauri daga ƙwayar gastrointestinal (gastrointestinal fili) a matakin 50-60%. Yawan cin abinci a lokaci guda tare da abinci yana rage jinkirin sha, amma baya tasiri da adadin sinadarin da ya shiga cikin jini. Sakamakon tsarin biotransformation mai ƙarfi / kunnawa na ramipril, akasari a cikin hanta ta hanyar hydrolysis, ramiprilat (metabolite mai aiki, 6 sau mafi aiki fiye da ramipril tare da girmamawa ga ACE inhibition) da diketopiperazine (metabolite wanda ba shi da aikin magani) an kafa su. Bugu da ƙari, diketopiperazine yana haɗuwa da acid na glucuronic, kuma ramiprilat yana glucuronated da metabolized zuwa diketopiperazinic acid.

Amfani da bioravril na ramipril ya dogara da kashi na baka kuma ya bambanta daga 15% (don 2.5 mg) zuwa 28% (don 5 MG).A bioavailability na ramiprilat bayan maganin baka na 2.5 MG da 5 MG na ramipril ne

45% na wannan alamar da aka samo bayan gudanarwar jiyya guda ɗaya.

Bayan ɗaukar Amprilan a ciki, matsakaicin ƙwayar plasma na ramipril an kai shi ne bayan 1 h, ramiprilat - bayan sa'o'i 2-4. Raguwar matakin ramiprilat a cikin plasma yana faruwa a cikin matakai da yawa: mataki na rarrabawa da fitarwa tare da T_1/2 (rabin rayuwa)

3 h, matsakaici mataki tare da T_1/2

15 h kuma mataki na ƙarshe tare da ƙarancin abun ciki na ramiprilat a cikin plasma da T_1/2

4-5 days, wanda shine saboda jinkirin sakin ramiprilat daga ƙawance mai ƙarfi tare da masu karɓar ACE. Duk da wannan lokacin na ƙarshe na ƙarshe, ɗaukar ramipril na baka 2.5 mg ko fiye da sau ɗaya a rana a cikin ɗayan na iya cimma daidaituwa da ƙwaƙwalwar ƙwayar cuta ta ramiprilat bayan kwanaki 4 na shan miyagun ƙwayoyi. A gaskiya gudanar da Amprilan tasiri T_1/2 ya dogara da kashi kuma ya bambanta daga 13 zuwa 17 hours

Ramipril yana ɗaure wa furotin plasma a kusan 73%, ramiprilat - 56%.

Bayan sarrafawar bakin ramipril, wanda aka yi masa alama da ketope rediyo, a cikin kashi 10, har zuwa 39% na aikin rediyo yana fallasa ta cikin hanji, kusan kashi 60% daga cikin kodan ke fitar dashi. A cikin marasa lafiya da bututun mai keɓaɓɓe na biyu sakamakon shan 5mg na ramipril a cikin kodan kuma ta cikin hanji, kusan iri ɗaya na ramipril da metabolites an sake su a cikin sa'o'i 24 na farko bayan gudanarwa.

Kimanin kashi 80 zuwa 90% na abubuwan da aka ɗauka a fitsari da bile an gano su azaman ramiprilat da metabolites. Ramipril glucuronide da diketopiperazine sun haɗu

10-20% na jimlar, kuma ba a cika amfani da su ba -

A cikin binciken kwaskwarima a cikin dabbobi, an gano cewa ramipril ya shiga cikin madara mai nono.

A cikin marasa lafiya da ke fama da rauni na aiki na keɓaɓɓen aiki, keɓantaccen keɓantaccen abu (CC) na ƙasa da 60 ml / min yana kawar da ramiprilat da metabolites. Wannan yana haifar da karuwa a cikin ƙwayar plasma da raguwa a hankali idan aka kwatanta da marasa lafiya tare da aikin koda na al'ada.

Shan allurai masu yawa na ramipril (10 MG) idan ya zama bai dace da aikin hanta ba yana haifar da raguwa a tsarin magudin ramipril da kuma hankali a hankali wanda yake aiki da shi.

A cikin masu ba da agaji da lafiya kuma a cikin marasa lafiya da hauhawar jini, ba a lura da mahimmancin cutar ta ramipril da ramiprilat a sakamakon maganin mako biyu tare da Amprilan a kashi 5 MG kowace rana. Bayan makwanni biyu makamancin wannan, marasa lafiya da raunin zuciya sun sami karuwa 1.5-1.8 a matakin ramiprilat a cikin plasma jini da yankin a ƙarƙashin ɓoye lokaci-lokaci (AUC).

Abubuwan da aka kera na pharmacokinetic na ramipril da ramiprilat a cikin tsofaffi masu lafiya masu shekaru masu shekaru 65 zuwa 75 basu bambanta da waɗanda ke cikin masu sa kai na matasa masu lafiya.

Kayan magunguna

Pharmacodynamics

Tsarin aiki mai aiki na ramipril, wanda aka kirkiro ta hanyar aikin "hanta" enzymes, ramiprilat shine mai hana aiki na ACE mai ɗaukar hoto (kalmomin ACE: kininase II, dipeptidyl carboxy dipeptidase I). 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). Ramipril-induced ƙara yawan ayyukan kallikrein-kinin a cikin jini na jini da kyallen takarda tare da kunna tsarin prostaglandin da haɓaka aikin prostaglandins, wanda ke motsa samuwar nitric oxide (N0) a cikin endotheliocytes, yana haifar da tasirin aikin zuciya.

Angiotensin II yana haɓaka samar da aldosterone, don haka ɗaukar ramipril yana haifar da raguwa a cikin ɓoyewar ƙwayar aldosterone da haɓaka abun cikin potassium a cikin ƙwayar jini.

Tare da raguwa a cikin taro na angiotensin II a cikin jini na plasma, ana cire tasirinsa mai ƙonewa akan ɓoyewar renin ta hanyar nau'in amsawar mara kyau, wanda ke haifar da karuwa a cikin aikin renon plasma.

Ana tsammanin ci gaban wasu halayen masu illa (musamman, "bushe" tari) yana da alaƙa da haɓaka ayyukan bradykinin.

A cikin marasa lafiya tare da hauhawar jini shan ramipril yana haifar da raguwar hauhawar jini a cikin “kwance” da “tsayawa” matsayi ba tare da ragi mai 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 bayyana 1 zuwa 2 sa'o'i bayan shigowa da kashi daya na maganin, har ya kai ga darajar sa bayan sa'o'i 3-6, kuma ya kai tsawon awanni 24. Tare da shan Amprilan, tasirin antihypertensive zai iya ƙaruwa a hankali, yawanci yana kwantar da hankali ta makonni 3-4 na amfani yau da kullun sannan tsayawa na dogon 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 da raunin zuciya (CHF) ramipril yana rage OPSS (yana rage nauyin bayan zuciya), yana kara yawan tashar tasirin kuma yana rage matsin lamba na ventricle na hagu (LV), wanda, hakanan, yana haifar da raguwar preload akan zuciya. A cikin waɗannan marasa lafiya, lokacin ɗaukar ramipril, akwai karuwa a fitarwa na zuciya, LG ejection fraction (LVEF) da haɓakawa game da haƙuri.

Tare da masu ciwon sukari da kuma wadanda ba su da masu ciwon sukari ba shan ramipril yana ragewa ci gaban ci gaban na koda da kuma farkon lalacewa na kasawa kuma, saboda haka, yana rage buƙatar haɓakar hemodialysis ko dasawa 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 (OXc), rage rage yawan ƙwayar lipoprotein cholesterol (HDL-C), shan sigari) additionarin ramipril zuwa daidaitaccen maganin rage ƙwayar cuta Ya bayyana abin da ya faru na infarction na zuciya, bugun jini, da mutuwar zuciya. Bugu da kari, ramipril yana rage yawan mace-mace, kazalika da bukatar farfadowa daga hanyoyin da kuma rage gudu ko ci gaban zuciya.

A cikin marasa lafiya tare da raunin zuciya tare da bayyanar cututtuka na asibiti wanda ya ɓullo a farkon kwanakin myocardial infarction (2-9 kwana), yin amfani da ramipril, ya fara daga ranar 3 zuwa 10 na mummunan myocardial infarction, rage mace-mace (ta 27%), haɗarin kwatsam mutuwa (ta hanyar 30%), haɗarin mummunan rashin ci gaba na zuciya zuwa ƙarancin nauyi (aji na aiki na III-IV bisa ga ƙaddamarwar NYHA) / jigilar maganin (ta hanyar 23%), da alama yiwuwar asibiti mai zuwa sakamakon ci gaban bugun zuciya (ta 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 faruwar microalbuminuria.

Pharmacokinetics

Bayan gudanar da baki, ramipril yana dafe cikin hanzari daga cikin gastrointestinal fili (50-60%). Abinci yana rage jinkirin shanshi, amma baya tasiri cikar sha.

Ramipril yana ɗaukar ƙwayar tsoka mai aiki / kunnawa (galibi a cikin hanta ta hydrolysis), sakamakon shi kawai metabolite mai aiki, ramiprilat, wanda aikinsa game da hanawar ACE shine kusan sau 6 na ramipril. Bugu da ƙari, sakamakon metabolism na ramipril, an kirkiro diketopiperazine, wanda ba shi da aikin magani, wanda aka haɗa shi da acid ɗin glucuronic acid, shi ma ana amfani da sinadarin ramiprilat da metabolized zuwa diketopiperazinic acid.

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 1 da 2 zuwa 4 hours, bi da bi. Rage yawan ƙwayar plasma na ramiprilat yana faruwa a cikin matakai da yawa: rarrabuwa da ƙayyadaddun lokaci tare da rabi-rayuwa (T1 / 2) na ramiprilat na kimanin 3 hours, sannan tsaka-tsakin yanayi tare da T1 / 2 ramiprilat, kimanin awanni 15, kuma ƙarshen zamani tare da raguwar ramiprilat a cikin plasma da T1 / 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 cikin kashi biyu na 2.5 mg ko sama da haka, an daidaita yawan ƙwayar cutar plasma na ramiprilat bayan kimanin kwanaki 4 na magani. Tare da amfani da miyagun ƙwayoyi "tasiri" T1 / 2 Dogaro da maganin shine 13-17 hours.

Tattaunawa tare da sunadaran plasma jini kusan 73% ne na ramipril, kuma 56% na ramiprilat.

Bayan gudanarwar cikin jijiya, rarraba ramipril da ramiprilat shine 90 L kuma kamar 500 L, bi da bi.

Bayan shigowar ramipril (10 MG) wanda aka yiwa alama da wani nau'in rediyo, kamar kashi 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, wucewa da 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.

Kusan 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.

Idan akwai rauni na aiki da keɓaɓɓen aiki tare da keɓantaccen keɓantaccen ɗaukar hoto (CC) na ƙasa da 60 ml / min, ƙarar ramiprilat da ƙwayoyin jikinta ta hanjin ta sauka. 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 makonni biyu na jiyya tare da ramipril a cikin kashi na yau da kullum na 5 MG, an lura da karuwar 1.5-1.8 a cikin yawan ƙwayar plasma na ramiprilat da yankin a ƙarƙashin tsarin lokaci-lokaci (AUC).

A cikin tsofaffi masu lafiya masu lafiya (65-75 years), likitancin magunguna na ramipril da ramiprilat ba su bambanta da waɗanda ke cikin masu sa kai na matasa masu lafiya ba.

Yi amfani da lokacin daukar ciki da lokacin shayarwa

Amprilan yana contraindicated a lokacin daukar ciki, saboda yana iya yin illa ga tayin: gazawar ci gaban kodan tayi, rage karfin jini na tayin da jarirai, aikin nakasasshe, hyperkalemia, hypoplasia na kasusuwa kwancen, hypoplasia na huhu.

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 mai hana 'ACE inhibitor'.

A cikin yanayin samun ciki yayin jiyya tare da Amprilan, ya kamata ku daina shan shi da wuri-wuri kuma canja wurin mai haƙuri zuwa shan wasu kwayoyi, tare da yin amfani da abin da haɗarin ga yarinyar zai zama kaɗan.

Idan magani tare da Amprilan ya zama dole yayin shayarwa, ya kamata a daina shayar da jarirai.

Amprilan, umarnin don amfani (Hanyar da sashi)

An wajabta Ramipril a cikin 'yancin cin abinci. Allunan an bada shawarar shan ruwa mai yawa. An tsara maganin ne ta hanyar likita wanda ya zaɓi isasshen ƙwayar cuta ta la'akari da yanayin mai haƙuri da haƙurinsa ga abubuwan da ke cikin maganin. Ana bada shawara don fara ɗaukar Amprilan tare da ƙananan allurai na 2.5 MG, tare da yiwuwar karuwa zuwa matsakaicin adadi - 10 MG. Tsawon maganin yana ƙaddara ta likita dangane da gunaguni da bayanai, tarihin likita da aka tattara a hankali.

Umarnin amfani da Amprilan ND da NL: 1 kwamfutar hannu a rana. Zai yiwu a daidaita sikelin lokacin magani. Tsawon lokacin rashin lafiya bai iyakance ba.

Form sashi

Allunan 1.25 MG, 2.5 MG, 5 MG da 10 MG

Tabletaya daga cikin kwamfutar hannu ya ƙunshi

abu mai aiki - ramipril 1.25 mg, 2.5 MG, 5 MG, 10 MG,

magabata: sodium bicarbonate, lactose monohydrate, croscarmellose sodium, sitaci sitaci sitaci (sitaci 1500), sodium stearyl fumarate (don sashi na 1.25 MG, 2.5 MG, 5 MG da 10 MG),

don sashi 2.5 MG: cakuda launi PB22886 launin rawaya (lactose monohydrate, baƙin ƙarfe oxide yellow (E 172)),

don sashi na 5 MG: cakuda launi PB24899 ja (lactose monohydrate, baƙin ƙarfe baƙin ƙarfe (E 172), baƙin ƙarfe oxide (E 172)

Allunan farare, daga farare zuwa fari,

chamfered (don sashi na 1.25 MG da 10 MG)

Allon mara lafiya mai tsayi, launin rawaya mai haske, zazzabi (don sashi na 2.5 mg)

Flat allunan wani m siffar, ruwan hoda, tare da bevel da bayyane inclusions (don sashi na 5 MG)

Yawan abin sama da ya kamata

Bayyanar cututtuka na yawan shan magunguna sune bradycardia (karancin bugun jini), raguwar hauhawar jini, jihar bugawa tare da m renal gazawar. Matakan gaggawa na ababen hawa sun hada da na ciki lavage da aikace-aikacen lokacienzakarshin, kuma tare da barazanar girgizawa, gabatarwar magungunan da ke kara hawan jini.

Haɗa kai

Vasopressor tausayawa, rukuni na magungunan anti-mai kumburi, hodar iblis na corticosteroid na iya rage tsananin tasirin sakamako raminipril. Inganta tasirin sakamako na antipsychotics, magungunan antidepressant. Haɗin Amprilan tare da kwayoyi na rukunin lithium, zinari, daskararren-potassium, hypoglycemic jamiái, cytostatics, shirye-shiryen potassium, immunosuppressants ba da shawarar ba.

Fitar saki da kuma kwantena

Ana sanya allunan 7 ko 10 a cikin murfin kumburin firiji na fim na layin polyamide / aluminum / polyvinyl chloride da alumini na tsare.

An gabatar da kunshin da ke kunshe da allunan 7 a fannoni biyu, wanda ya bambanta akan tsarin allunan a cikin kunshin.

4, 12 ko 14 (Allunan 7 kowannensu) ko 2, 3 ko 5 (Allunan 10 kowannensu) fakitin kunshin tare da umarnin don amfani da lafiya a cikin jihar kuma an sanya harsunan Rashan a cikin fakitin kwali.