Kyaftin-Bayanai (Captopril-STI)

Captopril-STI: umarnin don amfani da bita

Sunan Latin: Captopril-STI

Lambar ATX: C09AA01

Abunda yake aiki: Captopril (Captoprilum)

Manufacturer: АВВА РУС, ОАО (Russia)

Ana ɗaukaka bayanin da hoto: 07/12/2019

Captopril-STI wani abu ne wanda yake jujjuya maganin inzyme (ACE).

Formaddamar da tsari da abun da ke ciki

Fitar sashi - allunan: biconvex, farar fata ko fari tare da turare mai kamshi, mai yuwuwar haske, ƙamshin halayyar, a gefe ɗaya - tare da haɗarin (a cikin fakitin kwali 1 filastik can ko kwalban dauke da allunan 60, ko 2, 3, 4, Fakitoci 5 ko 6 na fakitin bakin ciki dauke da allunan 10 kowannensu, da kuma umarnin amfani da Captopril-STI).

Abun ciki 1 kwamfutar hannu 25/50 mg:

• abubuwa masu aiki: captopril - 25/50 mg,
• abubuwan taimako: talc - 1/2 mg, povidone K-17 - 1.975 / 3.95 mg, microcrystalline cellulose - 6.97 / 13.94 mg, masara mai - 7.98 / 15.96 mg, magnesium stearate - 1 / 2 MG, lactose monohydrate - don samun kwamfutar hannu mai nauyin 100/200 MG.

Nau'i na saki, marufi da abun da ke ciki

10 inji mai kwakwalwa - fakitin bakin (2) - fakitoci na kwali.
10 inji mai kwakwalwa - fakiti mai bakin ciki (3) - fakitoci na kwali.
10 inji mai kwakwalwa - fakiti mai bakin ciki (4) - fakitoci na kwali.
10 inji mai kwakwalwa - fakitin bakin ciki (5) - fakitoci na kwali.
10 inji mai kwakwalwa - fakitin bakin (6) - fakitoci na kwali.

Pharmacodynamics

Captopril-STI shine inhibitor na ACE wanda ke rage samuwar angiotensin II daga angiotensin I, wanda ke haifar da raguwa kai tsaye a cikin sakin aldosterone. A kan wannan yanayin, post-da preload a kan zuciya, saukar karfin jini (BP), da jimamin jijiyoyin bugun jini suna raguwa.

Ayyukan magungunan magungunan, saboda ƙayyadadden kayan aikinsa (captopril), sun haɗa da:

• bazuwar arteries (zuwa mafi girma fiye da jijiya),
• increaseara yawan haɓakar kwayar cutar prostaglandin da raguwa da lalata lalacewar bradykinin,
• da yawa na koda kuma na jijiyoyin jini jini,
• raguwa a cikin tsananin tsananin hauhawar jini na ganuwar myocardium da arteries na nau'in resistive (tare da tsawan amfani da miyagun ƙwayoyi),
• Inganta jini zuwa ischemic myocardium,
• tarin rashi platelet,
• raguwa cikin Na + cikin buguwa na zuciya,
• rage karfin karfin jini ba tare da haɓaka tachycardia na reflex (sabanin kai tsaye zuwa ga vasodilators - minoxidil, hydralazine), yana haifar da raguwa a cikin bukatar oxygen na myocardial.

Sakamakon antihypertensive na Captopril-STI bai dogara da aikin renin plasma ba, kuma an sami raguwar hauhawar jini a bangon da aka yi amfani dashi a al'ada har ma da rage matakan hormone, wanda ke haifar da tasirin sakamako akan tsarin renin-angiotensin nama.

A cikin marasa lafiya da raunin zuciya, ɗaukar angiotensin-canza masu hana enzyme a cikin ƙimar da ya dace ba zai tasiri hauhawar jini ba.

Bayan gudanar da baki, ana lura da mafi girman raguwar hauhawar jini bayan sa'o'i 1.5.5. Tsawon lokacin sakamako mai ƙarfi yana dogara ne akan yawan ƙwaƙwalwar Captopril-STI kuma ya kai kyawawan dabi'u a cikin makonni da yawa.

Aikin magunguna

Wakili na antihypertensive, ACE inhibitor. Hanyar antihypertensive mataki yana da alaƙa da hanawar shiga ayyukan ACE, wanda ke haifar da raguwa cikin ƙayyadaddun juyawa na angiotensin I zuwa angiotensin II (wanda ke da tasirin vasoconstrictor mai ƙarfi kuma yana ƙarfafa ɓoyewar aldosterone a cikin cortex adrenal). Bugu da ƙari, captopril ya bayyana yana da tasiri a cikin tsarin kinin-kallikrein, yana hana rushewar bradykinin. Tasirin antihypertensive bai dogara da ayyukan plasma renin ba, an lura da rage karfin jini a al'ada har ma da rage yawan kuzarin hormone, wanda sakamakon sakamako ne akan nama RAAS. Yana sanya jijiyoyin jini da kuma koda.

Sakamakon tasirin vasodilating, yana rage OPSS (bayan saukarwa), matsin lamba a cikin ƙwayoyin huhun jini (preload) da juriya a cikin tasoshin huhun, yana haifar da fitowar zuciya da kuma haƙurin motsa jiki. Tare da yin amfani da tsawan lokaci, yana rage zafin cutar ventricular myocardial hauhawar jini, yana hana ci gaban zuciya kuma yana rage jinkirin ci gaban ventricular dilatation. Yana taimakawa rage sodium a cikin marasa lafiya da raunin zuciya. Yana faɗaɗa jijiyoyin jini har ya zuwa jijiyoyi. Yana inganta wadatarwar jini zuwa ischemic myocardium. Yana rage hadewar platelet.

Yana rage sautin da ke tattare da ƙwayar cutar sankara na hanta, da haɓakar hemodynamics na intracubular, kuma yana haɓaka haɓakar cutar sankara mai narkewa.

Pharmacokinetics

Bayan gudanar da baki, aƙalla kashi 75% cikin sauri yana narkewa daga narkewa. Cin abinci lokaci guda yana rage yawan zafin jiki ta hanyar 30-40%. C max a cikin jini na jini bayan minti 30-90. Abincin furotin, akasari tare da albumin, shine 25-30%. Cire cikin madara mai nono. Yana cikin metabolized a cikin hanta tare da kirkirar dimpleril disulfide dimer da kuma cututtukan ƙwaƙwalwar ƙwaƙwalwar ƙwaƙwalwar ƙwaƙwalwa. Metabolites ba su da magunguna.

T 1/2 kasa da sa'o'i 3 kuma yana ƙaruwa tare da gazawar renal (3.5-32 hours). Fiye da kashi 95% na ƙwaƙwalwar ƙwaƙwalwa sun ɓoye, 40-50% ba canzawa, sauran - a cikin hanyar metabolites.

A cikin gazawar na koda, yana tarawa.

Alamar magunguna

Side sakamako

Daga gefen tsarin juyayi na tsakiya da tsarin juyayi na farji: danshi, ciwon kai, gajiya, asthenia, paresthesia.

Daga tsarin zuciya: jijiyar jini orthostatic, da wuya - tachycardia.

Daga tsarin narkewa: tashin zuciya, rashin cin abinci, cin zarafin dandano, da wuya - ciwon ciki, zawo ko maƙarƙashiya, ƙaruwar aikin cutar hepatic, hyperbilirubinemia, alamun lalacewar hepatocellular (hepatitis), a wasu yanayi - cholestasis, a cikin yanayin da ya keɓe - pancreatitis.

Daga tsarin hemopoietic: da wuya - neutropenia, anemia, thrombocytopenia, da wuya cikin marasa lafiya da cututtukan autoimmune - agranulocytosis.

Daga gefen metabolism: hyperkalemia, acidosis.

Daga tsarin urinary: proteinuria, aikin nakasa mai aiki (ƙaruwar urea da creatinine a cikin jini).

Daga tsarin numfashi: bushe tari.

Harkokin halayen ƙwayar cuta: fatar fata, da wuya - edema na Quincke, bronchospasm, cututtukan serum, lymphadenopathy, a wasu yanayi - bayyanar cututtukan antinuclear a cikin jini.

Haihuwa da lactation

Ya kamata a ɗauka a cikin zuciya cewa yin amfani da ƙwaƙwalwar ƙwayoyin cuta a cikin watanni na II da III na ciki na iya haifar da rikicewar haɓaka da mutuwar tayi. Idan an kafa ciki, ya kamata a cire mashin din cikin gida kai tsaye.

An fitarda Captopril a cikin madara. Idan ya cancanta, yi amfani da lokacin lactation ya kamata ya yanke shawara game da dakatar da shayarwa.

Yi amfani da shi don aikin keɓaɓɓiyar aiki

Ya kamata a yi amfani da hankali a cikin yanayin bayan dasawa koda, gazawar koda.

Game da matsalar aiki na koda, ya kamata a rage kashi na yau da kullun.

Ya kamata a guji yin amfani da potassium-spure diuretics da shirye-shiryen potassium a cikin marasa lafiya tare da gazawar koda.

Umarni na musamman

Ya kamata a yi amfani da hankali lokacin da akwai tarihin angioedema a cikin marasa lafiya da ACE inhibitor far, hereditary ko idiopathic angioedema, tare da aortic stenosis, cerebro- da cututtukan zuciya (ciki har da rashin aiki na cerebrovascular insufficiency, cututtukan cututtukan zuciya, rashin wadataccen jijiyoyin zuciya), cututtukan autoimmune na ƙwayar haɗin haɗin gwiwa (ciki har da SLE, scleroderma), tare da hana cizon jini kashi, tare da ciwon sukari mellitus, hyperkalemia, biyun koda na jijiya arten stenosis, artery na koda guda ɗaya, jihar bayan jigilar koda, koda da / ko gazawar hanta, a kan rage cin abinci tare da ƙuntatawa sodium, yanayi tare da raguwa a cikin BCC (gami da zawo, amai), a cikin tsofaffi marasa lafiya.

A cikin marasa lafiya da rauni na zuciya, ana amfani da captopril a karkashin kulawa ta kusa da likita.

Ciwon jijiyoyin jiki wanda ke faruwa yayin tiyata yayin ɗaukar captopril an cire shi ta hanyar sake cika girman ruwan.

Dole ne a guji yin amfani da sauron-abu mai amfani da potassium-diuretics da kuma shirye-shiryen potassium, musamman a cikin marasa lafiya da gazawar koda da kuma ciwon sukari mellitus.

Lokacin ɗaukar captopril, ana iya lura da mummunan-tabbaci lokacin da ake nazarin fitsari don acetone.

Yin amfani da captopril a cikin yara zai yiwu ne kawai idan wasu kwayoyi ba su da tasiri.

Tasiri kan ikon tuka motoci da hanyoyin sarrafa abubuwa

Ana buƙatar taka tsantsan lokacin tuki motoci ko yin wasu aikin na buƙatar haɓakar hankali, as tsananin damuwa yana iya yiwuwa, musamman bayan kashi na farko na maganin kwakwalwa.

Hulɗa da ƙwayoyi

Tare da amfani da lokaci guda tare da immunosuppressants, cytostatics, haɗarin haɓaka leukopenia yana ƙaruwa.

Tare da yin amfani da lokaci ɗaya tare da diuretics na potassium-sparing (ciki har da spironolactone, triamteren, amiloride), shirye-shiryen potassium, kayan gishiri da kayan abinci don abinci wanda ke dauke da potassium, hyperkalemia na iya haɓaka (musamman a cikin marasa lafiya da keɓaɓɓen aikin na kiɗa), saboda ACE inhibitors yana rage abun ciki na aldosterone, wanda ke haifar da jinkiri a cikin potassium a cikin jikin sabanin tushen iyakance fitar da sinadarin potassium ko kuma karinsa.

Tare da yin amfani da inhibitors na ACE da NSAIDs a lokaci guda, haɗarin haɓakar lalata yara, ƙwararrun hyperkalemia ba wuya.

Tare da yin amfani da lokaci ɗaya tare da "madauki" diuretics ko thiazide diuretics, hypotension art akpọ na iya yiwuwa, musamman bayan ɗaukar kashi na farko na diuretic, a fili saboda hypovolemia, wanda ke haifar da karuwa a kan lokaci a cikin tasirin antihypertensive na captopril. Akwai haɗarin hypokalemia. Riskara hadarin haɓakar lalata koda.

Ta yin amfani da magunguna don magance cutar rashin ƙarfi, na cikin jijiya, na iya yiwuwa.

Tare da yin amfani da lokaci ɗaya tare da azathioprine, anaemia na iya haɓaka saboda hana ayyukan erythropoietin ƙarƙashin rinjayar ACE inhibitors da azathioprine. An bayyana hanyoyin haɓaka na leukopenia, waɗanda za a iya danganta su da hana ƙyalƙyalin aikin bargo.

Tare da yin amfani da lokaci ɗaya tare da allopurinol, haɗarin haɓakar haɓakar ƙwaƙwalwar ƙwayar cuta yana ƙaruwa, shari'o'in haɓaka halayen halayen rashin ƙarfi, ciki har da ciwo na Stevens-Johnson.

Tare da amfani da hydroxide aluminium a lokaci guda, magnesium hydroxide, magnesium carbonate, bioavailability na captopril an rage shi.

Acetylsalicylic acid a cikin manyan allurai na iya rage tasirin antihypertensive na captopril. Ba a tabbatar da shi ba ko acetylsalicylic acid yana iya rage ingancin warkewar cututtukan da ke haifar da cutar ACE a cikin marasa lafiya da cututtukan jijiyoyin zuciya da kuma gazawar zuciya. Yanayin wannan hulɗar ya dogara da cutar. Acetylsalicylic acid, yana hana sinadarin COX da prostaglandin kira, na iya haifar da vasoconstriction, wanda ke haifar da raguwar fitowar zuciya da lalacewa a cikin yanayin rashin lafiyar zuciya da ke karɓar masu hana ACE.

Akwai rahotannin karuwa a cikin taro na narkexin a cikin jini na jini tare da yin amfani da captopril na lokaci guda tare da digoxin. Rashin haɗarin hulɗa da miyagun ƙwayoyi yana ƙaruwa a cikin marasa lafiya waɗanda ke fama da rauni na aikin fyaɗe.

Tare da yin amfani da lokaci ɗaya tare da indomethacin, ibuprofen, tasirin antihypertensive na captopril yana raguwa, a fili saboda hanawar aikin prostaglandin a ƙarƙashin tasirin NSAIDs (waɗanda aka yi imanin zasu taka rawa a haɓakar tasirin hypeensive na ACE inhibitors).

Tare da yin amfani da lokaci guda tare da insulins, wakilai na hypoglycemic, abubuwan da suka samo asali na sulfonylurea, hypoglycemia na iya haɓaka saboda haɓakar glucose.

Ta yin amfani da inhibitors na ACE da interleukin-3 a lokaci guda, akwai haɗarin haɓakar jijiyoyin jini.

Tare da yin amfani da interferon alpha-2a na lokaci ɗaya ko beta na interferon, ana bayyana shari'o'in haɓaka girman granulocytopenia.

Lokacin juyawa daga shan clonidine zuwa captopril, tasirin antihypertensive na ƙarshen yana haɓaka hankali. Game da batun cirewar clonidine kwatsam a cikin marasa lafiya da ke karɓar ƙwaƙwalwar ƙwaƙwalwa, ƙaruwa mai yawa a cikin karfin jini yana yiwuwa.

Tare da amfani da carbonate na lithium a lokaci daya, maida hankali ne yawan daukar lithium a cikin jijiyoyin jini, tare da alamu na maye.

Tare da yin amfani da lokaci ɗaya tare da minoxidil, sodium nitroprusside, an inganta tasirin antihypertensive.

Tare da yin amfani da lokaci ɗaya tare da orlistat, captopril na iya zama ƙasa da tasiri, wanda zai haifar da hauhawar hauhawar jini, rikicin hauhawar jini, da kuma shari'ar cutar ƙwayar cuta.

Tare da yin amfani da inhibitors na ACE na lokaci guda tare da pergolide, haɓaka tasirin antihypertensive yana yiwuwa.

Tare da yin amfani da lokaci daya tare da probenecid, ƙaddamar da renal na captopril yana raguwa.

Ta hanyar amfani da procainamide a lokaci guda, haɓaka haɗarin haɓaka leukopenia mai yiwuwa ne.

Tare da yin amfani da lokaci ɗaya tare da trimethoprim, akwai haɗarin haɓaka hyperkalemia, musamman a cikin marasa lafiya da ke fama da rauni na aikin haya.

Tare da yin amfani da lokaci guda tare da chlorpromazine, akwai haɗarin haɓaka maganin orthostatic hypotension.

Tare da yin amfani da lokaci ɗaya tare da cyclosporine, akwai rahotanni na ci gaban lalacewa mara nauyi, oliguria.

An yi imani cewa raguwa a cikin tasirin magungunan antihypertensive yayin amfani da erythropoietins mai yiwuwa ne.

Side effects

Matsalar da za a iya yi da ita> 10% - sau da yawa, (> 1% da 0.1% da 0.01% da + a cikin jini .. Idan akwai cutar mellitus na ciwon sukari, gazawar renal, shan magungunan ƙwayar cutar potassium, magunguna dauke da potassium ko magunguna waɗanda ke haɓaka maida hankali kan potassium a cikin jini (alal misali, heparin) yana ƙara haɗarin haɓaka hyperkalemia. A wannan batun, ana bada shawara don kauce wa haɗuwa da ƙwayoyin potassium-spure da shirye-shiryen potassium.

A cikin yanayin cututtukan hemodialysis yayin gudanar da aikin Captopril-STI, yana da mahimmanci don hana amfani da membranes dialysis tare da babban iko (alal misali, AN69), tunda a cikin irin waɗannan yanayin yiwuwar haɓaka halayen anaphylactoid yana ƙaruwa.

Lokacin da angioneurotic edema ya bayyana, an soke angiotensin-wanda ke juya enzyme inhibitor, an kula da mai haƙuri kuma an tsara shi ta hanyar magani.

Ya kamata a ɗauka a cikin zuciya cewa sakamakon nazarin fitsari don acetone a lokacin ɗaukar captopril na iya zama tabbataccen ƙarya.

Marasa lafiya a kan rashin abinci mai ƙoshin-gishiri ko gishiri-gishiri yakamata su ɗauki Captopril-STI da taka tsantsan, saboda karuwar haɗarin jijiyoyin jini.

Contraindications

Hypersensitivity (ciki har da sauran masu hana ACE), angioedema (tarihin jiyya tare da ACE inhibitors ko hereditary), matsanancin na koda / hepatic insufficiency, hyperkalemia, biyun koda na jijiya artisen stenosis, stenosis na guda koda tare da ci gaba azotemia, yanayin bayan jigilar koda, IHSS, cututtuka da yanayi tare da wahalar zubar jini daga LV, ciki, lactation, shekaru a ƙarƙashin shekaru 18 (ba a kafa inganci da aminci ba).

Yadda ake amfani: sashi da hanya na jiyya

A ciki, awa 1 kafin cin abinci, tare da hauhawar jini, jiyya yana farawa da mafi ƙarancin tasiri na 12.5 MG 2 sau a rana. Idan ya cancanta, a hankali ana ƙaruwa da kashi tare da tazara tsakanin makonni 2-4 har sai an sami mafi kyawun kashi. Tare da hauhawar jini zuwa matsakaici na matsakaici, matsakaiciyar kulawa yawanci shine 25 mg sau 2 a rana, matsakaicin kashi shine 50 mg sau 2 a rana. A cikin matsanancin tashin hankali na jijiya, kashi na farko shine 12.5 mg sau 2 a rana, wanda a hankali ya ƙaru zuwa mafi girman kullun na 150 MG (50 mg sau 3 a rana).

A cikin CHF, kashi na farko na yau da kullun shine 6.25 mg sau 3 a rana, idan ya cancanta, ƙara kashi tare da tazara tsakanin akalla makonni 2. Matsakaicin matsakaiciyar kulawa shine 25 mg 2-3 sau a rana. Matsakaicin adadin yau da kullun shine 150 MG.

Idan akwai rauni na aiki na LV bayan fama da rauni na wucin gadi a cikin marasa lafiya a cikin yanayin kwanciyar hankali na asibiti, ana iya fara aikin captopril a farkon kwanaki 3 bayan infarction na ta myocardial. Kashi na farko shine 6.25 mg / rana, sannan ana iya ƙara adadin yau da kullun zuwa 37.5-75 MG cikin allurai 2-3 (gwargwadon haƙuri da miyagun ƙwayoyi) har zuwa iyakar 150 mg / rana.

A cikin cututtukan cututtukan cututtukan zuciya, ana sanya magani na 75-150 mg / rana a cikin kashi 2-3. A nau'in 1 mellitus na ciwon sukari tare da macroalbuminuria (30-300 mg / day) - 50 mg sau 2 a rana. Tare da wadataccen furotin na furotin fiye da 500 mg / rana - 25 MG sau 3 a rana.

Tare da matsakaici na matsakaici na aikin keɓaɓɓen aiki (CC aƙalla 30 ml / min / 1.73 sq.m) - 75-100 mg / rana. Tare da ƙarin ƙayyadadden matsayi na dysfunction na koda (CC kasa da 30 ml / min / 1.73 m), kashi na farko bai wuce 12.5 mg sau 2 a rana ba, to, idan ya cancanta, ana aiwatar da kashi na ƙwaƙwalwa a hankali tare da tsaka-tsaki har sai an sami sakamako na warkewa, amma ana amfani da maganin yau da kullun ya kamata ya zama ƙasa da yadda aka saba.

A cikin tsofaffi marasa lafiya, kashi na farko shine 6.25 mg sau 2 a rana.

Haɗa kai

Tasirin antihypertensive yana raunana ta hanyar indomethacin da sauran NSAIDs, ciki har da masu hana COX-2 masu hanawa (jinkirta Na + da raguwa a cikin ayyukan Pg), musamman a kan asalin karamin maida hankali, da estrogens (jinkirta Na +).

Haɗuwa tare da thiazide diuretics, vasodilators (minoxidil) yana haɓaka tasirin sakamako.

Haɗin mai amfani tare da diuretics-sparing na potassium, shirye-shiryen K +, kayan abinci na potassium, madadin gishiri (sun ƙunshi adadin K +) yana ƙara haɗarin hyperkalemia.

Yana rage gudu daga magungunan Li +, yana kara maida hankali cikin jini.

Tare da alƙawarin captopril yayin ɗaukar allopurinol ko procainamide, haɗarin haɓakar ciwo na Stevens-Johnson da cutar ta neutropenia suna ƙaruwa.

Tare da yin amfani da inhibitors na ACE na lokaci daya da shirye-shiryen zinare (sodium aurothiomalate), an bayyana hadaddun alamun, wanda ya haɗa da fuskata fuska, tashin zuciya, amai da raguwar hawan jini.

Insulin da sauran magunguna na baki hypoglycemic - haɗarin cutar hypoglycemia.

Yin amfani da captopril a cikin marasa lafiya da ke karɓar immunosuppressants (ciki har da azathioprine ko cyclophosphamide) yana ƙara haɗarin cututtukan cututtukan zuciya.

Saki siffofin da abun da ke ciki

Shiri wani farin abu ne, mai narkewa a cikin methyl, ethyl giya da ruwa, tare da warin sulfur mai rauni. Rashin ƙwayar maganin a cikin ethyl acetate da chloroform tsari ne na babban abu. Maganin ba ya narke a cikin ether.

Ana samfur ɗin a cikin allunan da aka lalata don gudanarwa na cikin gida ko na biyu.

Baya ga babban sashi mai aiki a cikin adadin 12.5-100 MG, kwamfutar hannu ta ƙunshi wasu abubuwa masu taimako: silicon dioxide, stearic acid, MCC, sitaci, da sauransu.

Yaya aiki?

Har yanzu ana ci gaba da nazarin aikin magungunan ƙwaƙwalwar ƙwayar cuta.

Ressionarfafa tsarin renin-angiotensin-aldosterone (PAA) tare da miyagun ƙwayoyi yana haifar da ingantaccen tasirinsa a cikin magance lalacewar zuciya da hawan jini.

Ayyukan Captopril shine ya raunana jimlar karfin jijiyoyin bugun jini (OPSS).

Raunin da kodan ya yi aiki a cikin jini a cikin jini na plasma, wanda ke haifar da haifar da rashin aiki mai rauni da kuma angiotensin. Sannan, a ƙarƙashin rinjayar ACE (angiotensin-mai canza enzyme), wani abu mai vasoconstrictor na endogenous, angiotensin l an canza shi zuwa angiotensin ll, wanda ke ƙarfafa haɗin aldosterone ta cortex adrenal. A sakamakon haka, ana riƙe da ruwa da kuma sodium a cikin kyallen takarda.

Ayyukan Captopril shine ya raunana jimlar karfin jijiyoyin bugun jini (OPSS). A wannan yanayin, fitowar zuciya ko yana ƙaruwa ko ba ya canzawa. Yawan tacewa a cikin duniyan koda shima baya canzawa.

Farkon tasirin sakamako na miyagun ƙwayoyi yana faruwa a cikin minti 60-90 bayan ɗaukar kashi ɗaya.

An wajabta magungunan na dogon lokaci, saboda hawan jini a cikin jiragen ruwa yana raguwa a hankali a ƙarƙashin rinjayar miyagun ƙwayoyi. Tare da yin amfani da haɗin gwiwar Captopril tare da thiazide diuretics, ana lura da ƙari. Yanayin aiki a hade tare da beta-blockers ba ya haifar da fadada sakamakon.

Matsin lamba na jini ya isa lambobi na al'ada a hankali, ba tare da haifar da ci gaban tachycardia da orthostatic hypotension. Babu saurin hauhawa a cikin karfin jini kuma tare da tsauraran maganin.

Ragewar bugun zuciya, raguwar hauhawar jini, nauyin zuciya, juriya bugun jini, haɓaka fitowar zuciya, da alamomi na gwajin haƙuri motsa jiki duk ana lura da su a cikin masu haƙuri da tsarin cututtukan zuciya yayin aikin jiyya. Haka kuma, ana gano waɗannan tasirin a cikin marasa lafiya bayan sun ɗauki kashi na farko, suna ɗorewa a duk jiyya.

Abubuwan da ke aiki suna narkewa a cikin ruwan 'ya'yan ciki kuma suna shiga cikin jini ta cikin hanjin. Matsakaicin maida hankali a cikin jini ya kai a cikin awa daya.

An shirya maganin ne don maganin hauhawar jini na koda.

Ta hanyar jini, sinadarin yana aiki akan sinadaran ACE a cikin huhu da ƙodan kuma yana lalata shi. An cire magungunan fiye da rabi a cikin yanayin canzawa. A cikin hanyar metabolite mara aiki, an keɓance ta ta hanyar kodan tare da fitsari. 25-30% na miyagun ƙwayoyi suna shiga cikin haɗin gwiwa tare da kariyar jini. Kashi 95% na kayan suna cirewa daga kodan bayan sa'o'i 24. Sa'o'i biyu bayan gudanarwa, maida hankali cikin jini ya ragu da kimanin rabi.

Rashin sakamako a cikin marasa lafiya da shan maganin yana haifar da jinkiri a cikin jiki.

Abinda ya taimaka

An yi nufin maganin ne don maganin:

1. Hauhawar jini na jijiya: ana amfani da sifar kwamfutar kamar maganin farko a cikin marasa lafiya da keɓaɓɓen aikin na koda. Marasa lafiya da ke fama da rauni na aikin ƙirar, musamman waɗanda ke da tsarin sihiri, bai kamata su yi amfani da shi ba idan an gano tasirin sakamako akan wasu kwayoyi. Za'a iya amfani da kayan aiki azaman maganin monotherapy ko a hade tare da sauran abubuwan magunguna.
2. Sakamakon bugun zuciya: Ana amfani da maganin kafatanin kwakwalwa a hade tare da Digitalis da diuretics.
3. Rashin ƙananan ƙwayar cuta bayan aikin aikin ventricular hagu: ƙimar rayuwar irin waɗannan marasa lafiya yana ƙaruwa saboda raguwa a cikin kayan fitarwa na zuciya zuwa kashi 40%.
4. Cutar cutar sankara ta rashin lafiya: ana bukatar rage yawan cututtukan cututtukan cututtukan zuciya da kamuwa da cutar ta hanyar rage ci gaban cututtukan nephrotic. Ana amfani dashi don insulin-dogara da ciwon sukari mellitus da nephropathy tare da proteinuria fiye da 500 mg / rana.
5. Rashin hauhawar jini.

A cikin lalacewar zuciya, ana amfani da wariyar hanyar Captopril a hade tare da digitalis da diuretics.

Yadda ake ɗaukar captopril

Tare da cutar hawan jini, ɗauki sublingally ko a baki bayan cin abinci.

Wajibi ne a sha maganin a awa daya kafin abinci, a matsayin abubuwan da ke cikin ciki na iya rage yawan abin da kashi 30-40%.

Dogon magani yana haɗuwa tare da shan maganin a ciki. Idan ana amfani da abu don kulawa ta gaggawa tare da haɓakar hawan jini da aka motsa ta hanyar motsa rai ko motsa jiki, ana ba da shi a ƙarƙashin harshe.

Tun tuni mintina 15 bayan maganin baka, sinadarin ya shiga cikin jini.

Tare da gudanar da sublingual, da bioavailability da kuma adadin abin da ya faru na sakamako karuwa.

Farkon maganin yana haɗuwa tare da gudanar da aikin magani wanda aka rarraba zuwa maraice da maraice na safiya.

Farkon maganin yana haɗuwa tare da gudanar da aikin magani wanda aka rarraba zuwa maraice da maraice na safiya.

Maganin rashin lafiyar zuciya ya ƙunshi amfani da magani sau uku a rana. Idan manufar Captopril kadai ba zai iya isa ya rage matsin lamba ba, an wajabta hydrochlorothiazide azaman antihypertensive na biyu. Akwai ma wani tsari na musamman wanda ya qunshi duka wadannan abubuwan guda biyu (Caposide).

Jiyya tare da matsanancin matsin lamba an fara shi da maganin yau da kullun na 25-50 MG. Sannan ana kara yawan kashi, kamar yadda likita ya umarta, a hankali har sai karfin jini ya zama al'ada. Koyaya, yakamata ya wuce matsakaicin darajar 150 MG.

Kulawa da lalacewar zuciya ya ƙunshi farawa ta yin amfani da magunguna guda na 6.5-12.5 MG tare da ƙarin haɓaka idan ya cancanta.

Kulawa da lalacewar zuciya ya ƙunshi farawa ta yin amfani da magunguna guda na 6.5-12.5 MG tare da ƙarin haɓaka idan ya cancanta.

Farkon shigarwar yana faruwa ne a rana ta uku bayan lalata lalacewar zuciya. Magungunan sun bugu bisa ga tsarin:

1. 6.25 mg sau biyu kullun don kwanakin 3-4 na farko.
2. A cikin mako, 12.5 mg sau 2 a rana.
3. Makonni 2-3 - MG 37.5, an kasu kashi uku.
4. Idan an yarda da miyagun ƙwayoyi ba tare da mummunan sakamako ba, ana daidaita adadin yau da kullun zuwa 75 MG, yana ƙaruwa kamar yadda ya wajaba ga 150 MG.

Captopril yana farawa a rana ta uku bayan lalacewar ƙwayar zuciya.

Ciwon sukari mai narkewa tare da babban abun ciki na albumin a cikin fitsari yana buƙatar yin amfani da kashi biyu na kayan magani a kowace rana, daidai yake da 50 MG. Idan adadin furotin ya wuce 500 MG cikin fitsari kullum - 25 MG sau uku.

Tare da raunin masu ciwon sukari mellitus l nephropathy, kashi 75-100 mg / rana ya kasu kashi biyu.

Yawan abin sama da ya kamata

Shan allurai fiye da shawarar da aka bada shawarar na iya haifar da raguwar karfin jini. Bugu da kari, ana iya samun rikice-rikice a cikin nau'in thromboembolism na manyan jijiyoyin jini, tasoshin jini na zuciya da kwakwalwa, wanda, bi da bi, na iya haifar da bugun zuciya da bugun jini.

Tare da yawan abin sha da yawa na Captopril, ana buƙatar hemodialysis.

Ana ɗaukar matakan masu zuwa azaman hanyar dabarar magani:

1. Kurkura ciki bayan soke ko rage sashi na magani.
2. Mayar da hawan jini, ba mai haƙuri shimfiɗa a kwance tare da kafafu da aka ɗaga, sannan kuma aiwatar da haɓakar ƙwayar ciki, Reopoliglyukin ko plasma.
3. Ceaddamar da Epinephrine cikin ciki ko subcutaneously don ƙara hauhawar jini. Kamar yadda wakilai masu dauke rai suke amfani da su, yi amfani da hydrocortisone da antihistamines.
4. Yi hemodialysis.

Yanayin hutu don maganin komputa daga kantin magani

Abin sani kawai bisa ga girke-girke da aka rubuta akan wani nau'i na musamman a Latin, misali:

1. Rp. Captoprili 0.025.
2. D.t.d. N 20 a cikin tabulettis.
3. S. 1 kwamfutar hannu rabin sa'a kafin abinci da safe da maraice.

Farashin miyagun ƙwayoyi ya bambanta daga 9-159 rubles.

Nazarin likitoci da marasa lafiya game da Captopril

Oksana Aleksandrovna, Pskov, likitan ilimin mahaifa: “Ina amfani da Captopril a matsayin motar asibiti don rikice-rikice. Sau da yawa ya kasa, saboda haka yana da kyau a kula: shin magani ne ko magani na asali. ”

Maria, 'yar shekara 45, Moscow: “Ina shan maganin ne bisa shawarar likitan zuciyar da ke da matsin lamba. Sakamakon ba mafi muni ba daga Moxonidine na yau da kullun. Yana yin aikinsa na "taimakon farko" daidai, kuma a wannan farashi mai kyau. "

Vitaliy Konstantinovich, Krasnodar, likitan zuciya: “Idan mara lafiyar na fuskantar zabi, tara da Kapoten ko Captopril, Zan ba da shawarar farko. Haka ne, abu mai aiki a cikin magungunan guda ɗaya ne, amma ɗayan shine na asali, na biyu kwafi ne. Marasa lafiya sau da yawa suna korafi game da rauni na miyagun ƙwayoyi, kodayake ana amfani dashi a cikin yanayi inda taimako yakamata ya kasance mai sauri da tasiri. Ina bayar da shawarar Kapoten ga marasa lafiya da ke fama da matsalar hauhawar jini, saboda ni kaina ma zan dauki wannan magani. Haka kuma, farashin ya ba shi damar. ”

Nazarin UKPDS

Ofaya daga cikin tabbacin farko na aminci da tasiri na amfani da BB a cikin nau'in ciwon sukari na 2 shine kammala binciken UKPDS, wanda ya kwatanta cututtukan zuciya da mace-mace, da kuma rikice-rikice na microvascular (MD, DR) a cikin marasa lafiya da ke fama da nau'in ciwon sukari na 2 tare da hauhawar jini wanda ya karɓi ko dai ACE inhibitor captopril a kashi na 25-50 mg sau 2 a rana (mutane 400), ko kuma zaɓi atenolol BB a cikin kashi 50-100 mg / rana (mutane 358).

Bayan lokacin lura (shekaru 8.4) a cikin duka bangarorin biyu, an cimma daidaitaccen matakin sarrafa karfin jini: 144/83 mmHg. Art. a cikin rukuni na captopril da 143/81 mm RT. Art. a rukunin atenolol. A lokaci guda, babu manyan bambance-bambance a cikin abubuwan da aka ƙaddara na ƙarshe (mutuwar da ke da alaƙa da ciwon sukari, yawan abubuwan da suka faru na zuciya da rikice-rikice, rikicewar microvascular) tsakanin ƙungiyoyin. A takaice dai, captopril da atenolol sun haifar da sakamako iri ɗaya na kariya akan rikicewar micro- da macrovascular rikice-rikice a cikin marasa lafiya da ke fama da ciwon sukari na 2.

A matsayin sharhi, Ina so in lura cewa binciken UKPDS ya fara a ƙarshen 1970s, lokacin da captopril shine kawai mai hana ACE a kasuwar duniya. A waɗancan shekarun, ana karɓar tsarin kulawa da ƙwaƙwalwar ƙwaƙwalwar ƙwayoyin cuta ta 25-100 mg sau 2 a rana. Koyaya, an gano cewa daga baya cewa irin wannan magungunan ba zai iya haifar da tasirin antihypertensive ba yayin rana, tunda wannan maganin yana da ɗan gajeren lokaci (awanni 4-6).

Don tabbataccen kulawar karfin jini, ana buƙatar karɓar ƙwayar 3-4 sau na kwayar cuta a cikin adadin yau da kullun na 150 MG. Sabili da haka, kwatancen mai amfani da aikin karamin aiki tare da atenolol mai aiki na yau da kullun ba daidai bane a cikin tsarin sashi. Ko ta yaya, magungunan biyu suna da irin wannan kariya. Bayan samun sakamakon binciken UKPDS, ya zama sananne cewa amfani da zaɓin BB a cikin marasa lafiya da ke fama da ciwon sukari na 2 kuma AT yana da aminci da tasiri.

Nazarin GEMINI (Sakamakon Cutar Glycemic a cikin Mellitus na Diabetes: Kwatanta Carvedilol-Metoprolol a cikin Hypertensives)

A cikin wannan binciken mai makafi biyu, makasudin shine a gudanar da kwatancen kai tsaye na BBs biyu a cikin lura da hauhawar jini a cikin marasa lafiya da ke dauke da ciwon sukari na 2: metoprolol, wani β1 mai zaɓin BB, da carvedilol, BB ba zaɓaɓɓu ba, wanda ke da ƙarin ikon toshe α1-AR. Masu binciken sun ba da shawarar cewa saboda toshewar α1-AR, carvedilol zai sami fa'ida a kan metoprolol ba wai kawai saboda aikin vasodilator da aka riga aka tabbatar da shi ba, har ma, mai yiwuwa, saboda tasirin da ya fi dacewa akan sigogin metabolism (dyslipidemia, IR), tunda α1-AR blockade increasedara yawan ayyukan lipoprotein lipase wanda ke rushe TG.

Binciken ya haɗa da marasa lafiya 1235 da ke fama da hauhawar jini da nau'in ciwon sukari na 2. Groupungiya guda (n = 737) ta karɓi metoprolol tartrate a cikin kashi 50-200 mg sau 2 a rana, na biyu (n = 498) ya karɓi carvedilol a cikin kashi 6.25-25 mg sau 2 a rana don makonni 35. A lokaci guda, duk marasa lafiya sun ci gaba da ɗaukar allurar RAS blockers (ACE inhibitors ko ARA) a baya. Lokacin da ake gwada alamun nuna ƙarfi na glycemic, ya juya cewa a lokacin jiyya a cikin rukunin carvedilol, matsakaicin ƙimar HbAlc bai canza ba, yayin da yake cikin ƙungiyar metoprolol sun haɓaka da 0.15%, ƙwarewar insulin (ƙaddarawar NOMA ta ƙididdigar) inganta akan carvedilol, amma ba akan metoprolol ( ƙididdigar ta ragu da 9.1 da 2, bi da bi). Hadarin UIA ya kasance mafi ƙaranci akan carvedilol fiye da akan metoprolol (6.4 da 10.3%, bi da bi).

Don haka, wannan binciken ya kawar da labarin tatsuniya game da haɗarin amfani da BB a cikin ciwon sukari kuma ya tabbatar da cewa carvedilol ba wai kawai yana hana sarrafa hanzari a cikin nau'in 2 na ciwon sukari ba, har ma yana inganta jijiyar nama zuwa insulin. Tabbas, ba za a iya canza sakamakon binciken wannan zuwa ga dukkanin rukunin na BB ba, tunda carvedilol yana da ƙarin kaddarorin α1-blocker, wanda ke bayanin tasirin metabolism da aka samu. A cikin wannan binciken, Hoffman - la Roche ya yi amfani da sassaka (Dilatrend).

BB da ciwon zuciya

Nazarin tasiri na BB a cikin raunin zuciya ya kasance batun darussan da yawa, ciki har daMERIT-HF (Metoprolol CR: XL Rikicin Tsarin Shiga ciki a cikin lalacewar Zuciya), CIBIS-II (Nazarin Inifficiency Bisoprolol Nazarin) da SENIORS (Nazarin Sakamakon Tasirin Nebivolol Shiga Sakamakon Sakamakon Sakamakon Binciken a cikin Tsofaffi tare da raunin zuciya).

Manufar binciken MERIT-HF shine don tantance aminci da inganci na BB a cikin marasa lafiya da rashin zuciya. 3991 marasa lafiya tare da matsakaicin shekaru na 63 sun kasance tare da HYHA aji II-IV rashin zuciya. Kimanin 25% na marasa lafiya da aka haɗa sun kasance marasa lafiya da masu ciwon sukari na type 2. Amfani da hanyar makanta biyu, marasa lafiya sun kasance bazuwar cikin rukuni biyu: suna karɓar metoprolol CR (aiki mai-tsayi) a kashi 25 zuwa 200 MG ko placebo. A lokaci guda, marasa lafiya sun ci gaba da shan diuretics (90%), ACE inhibitors (89%) da digitalis (63%). An dakatar da binciken ba daidai ba shekara guda bayan fara magani saboda alfanun amfani da metoprolol. Jimlar yawan ƙwayoyin cuta da jijiyoyin jini sun kasance ƙananan baya tare da metoprolol ta hanyar 34 da 38%.

An samo irin wannan sakamakon a cikin binciken CIBIS-II, wanda yayi nazarin bisoprolol na miyagun ƙwayoyi a cikin rukuni mai kama da marasa lafiya. A cikin wannan binciken, adadin marasa lafiya da ke dauke da ciwon sukari na 2 shine kashi 12%. Mutuwar zuciya a jikin bisoprolol ya ragu da kashi 34%.

Kwanan nan, an kammala nazarin CIBIS-III, wanda shine ya nuna cewa fara monotherapy tare da bisoprolol biyo bayan canja wurin marasa lafiya tare da raunin zuciya zuwa haɗuwa da BB bisoprolol da ACE inhibitors enalapril ba su da ƙaranci ga umarnin juyo na al'ada (ACE inhibitors enalapril bi hade da hana BB bisoprolo) yawan mutuwa da asibitoci. Sakamakon watanni 6 na monotherapy tare da kowane daga cikin kwayoyi, biyo baya ta hanyar canzawa zuwa haɗuwa da magani (watanni 18) a karo na farko ya tabbatar da hasashen cewa zaɓin fara magani don raunin zuciya (BB tare da bisoprolol ko ACE inhibitors enalapril) ba ya tasiri babban batun (jimlar mutuwa da asibiti a ƙarshen kallo. ) kuma ya kamata ya dogara da shawarar likita dangane da kowane takamaiman mai haƙuri.

A cikin bincike daban na ɓangaren marasa lafiya da masu ciwon sukari a cikin duka binciken, ya juya cewa haɗarin mace-mace a cikin marasa lafiya da ke da nau'in ciwon sukari na 2 wanda ya karɓi BD ya zama 46% ƙasa da marasa lafiya da ke fama da ciwon sukari da ba a bi da su tare da BD.

Nazarin makafi biyu, bazuwar, binciken sarrafawa ta hanyar SENIORS da nufin kimanta tasiri na nebivolol (zaɓin BB tare da aikin vasodilator) a cikin lura da raunin zuciya. Binciken ya haɗa da fiye da tsofaffi marasa lafiya 2,000 (> shekara 70), wanda 26% suna da ciwon sukari na nau'in 2. Lokacin lura yana kimanin shekaru 2. Sakamakon haka, nebivolol ya tabbatar da inganci da haƙuri mai kyau a cikin lura da wannan rukuni na marasa lafiya, ciki har da a cikin marasa lafiya da ke da nau'in ciwon sukari na 2: yawan mutuwar zuciya da ƙimar asibiti ya ragu sosai idan aka kwatanta da ƙungiyar placebo.

Don haka, binciken da aka gudanar ya tabbatar da tabbatattun fa'idodin amfani da BB a cikin marasa lafiya da masu ciwon sukari tare da raunin zuciya.

BB a cikin jiyya na lokacin-infarction

An yi nazarin yiwuwar yin amfani da BB a farkon lokacin bayan infarction a cikin binciken MIAMI (Metoprolol In Acute Myocardial Infarction), ISIS-1 (Nazarin farko na kasa da kasa a kan Infarct Survival), CAPRICORN (Gudanar da Tsira da Kulawa da Cutar Invect na Carvedilol Post infarct in LV Dysfunction).

A duk waɗannan karatun, an nuna cewa yin amfani da BB a cikin lokacin bayan infarction (watanni 3 na farko bayan tsananin infitarwar myocardial infarction) ya fi tasiri a cikin marasa lafiya da masu ciwon sukari fiye da marasa lafiya ba tare da ciwon sukari ba.

Don haka, duk waɗannan karatun suna tabbatar da fa'idar rashin amfani da amfani da BB a cikin marasa lafiya da masu ciwon sukari tare da cututtukan zuciya da ke cikin zuciya bayan lokacin infarction. Haka kuma, kamar yadda aka nuna a cikin binciken Bezafibrate Infarction Rigakafin (B1P), soke BD a cikin marasa lafiya da ke fama da cutar sankara tare da cututtukan zuciya da jijiyoyin jini ya ninka mace-mace.

Duk da tabbatattun fa'idodin amfani da BB a cikin ciwon sukari, har yanzu, kawai 40-50% na marasa lafiya da ke dauke da ciwon sukari suna karɓar BB a cikin lokacin bayan infarction. Wataƙila, wannan na iya yin bayani game da gaskiyar cewa, tare da gabaɗaya game da raguwar mace-mace a cikin jama'a gaba ɗaya, a cikin marasa lafiya da ke fama da cutar sankara a cikin 'yan shekarun nan, yawan bugun zuciya ba wai kawai ya ragu ba, har ma ya ƙaru.