Telzap - umarnin don amfani, sake dubawa, analogs da siffofin saki (Allunan 40 MG, 80 MG, 80arin 80 mg 12, 5 MG tare da diuretic hydrochlorothiazide) magunguna don maganin hauhawar jini da rage karfin jini a cikin manya, yara da ciki.

A cikin wannan labarin, zaku iya karanta umarnin don amfani da miyagun ƙwayoyi Telzap. Yana ba da ra'ayi daga baƙi zuwa rukunin yanar gizon - masu amfani da wannan magani, kazalika da ra'ayoyin kwararrun likitocin game da amfani da Telzap a cikin ayyukansu. Babban roƙon shine don ƙara haɓaka ra'ayoyinku game da miyagun ƙwayoyi: maganin ya taimaka ko bai taimaka kawar da cutar ba, menene rikice-rikice da sakamako masu illa da aka lura, mai yiwuwa ba sanar da mai ƙirar ba a cikin m. Analogs na Telzap a gaban tsoffin tsarin analogues. Amfani don kulawa da hauhawar hawan jini da rage matsin lamba a cikin manya, yara, harda lokacin daukar ciki da lactation. Abun da magani.

Telzap - magungunan antihypertensive.

Telmisartan (abu mai aiki na Telzap) takamaiman mai adawa ne na angiotensin 2 masu karɓa (nau'in AT1), wanda yake tasiri idan aka yi magana da baki. Yana da kusanci sosai ga nau'ikan mai karɓar mai karɓar AT1, wanda ta hanyar wanda an gano aikin angiotensin 2 Telmisartan ya kori angiotensin 2 daga ɗauri zuwa mai karɓa, ba tare da aikin ɗanɗanarwa dangane da wannan mai karɓa ba, yana ɗaure kawai ga sashin karɓar mai karɓar AT1 na angiotensin 2. Theaƙatar ta tabbata. Telmisartan bashi da alaƙa ga sauran masu karɓa, incl. ga masu karɓar AT2 da sauran masu karɓar angiotensin marasa ƙarancin karatu. Babban mahimmancin mahimmancin waɗannan masu karɓar, har ma da tasirin ƙwarin gwiwar da suka yiwu tare da angiotensin 2, wanda ya ƙara yawan haɗuwa tare da alƙawarin telmisartan, ba a yi nazari ba. Telmisartan yana rage maida hankali na aldosterone a cikin jini na jini, baya rage ayyukan renin, kuma baya hana tashoshin ion. Telmisartan baya hana ACE (kininase 2), wanda shima yake ɗaukar halakar bradykinin. Wannan yana guje wa sakamako masu illa da ke tattare da aikin bradykinin (alal misali, bushe tari).

Telzap a cikin kashi na 80 MG gaba daya yana toshe sakamakon tasirin hauhawar jini na angiotensin 2. An lura da fara aikin antihypertensive a cikin sa'o'i 3 bayan kashi na farko na telmisartan. Tasirin miyagun ƙwayoyi ya ɗauki tsawon awanni 24 yana ci gaba da kasancewa a asibiti har zuwa awanni 48. Sakamakon magani mai ƙoshin ƙwaƙwalwa yakan haifar da makonni 4-8 bayan amfani na yau da kullun.

A cikin marasa lafiya tare da hauhawar jini na jijiya, telmisartan yana rage karfin systolic da hauhawar jini, ba tare da shafi yawan zuciya ba.

Game da batun dakatar da shan Telzap, hauhawar jini a yayin da yake a wasu kwanaki sai ya koma kan matakin sa na asali ba tare da ci gaba da cire ciwo ba.

Halin bushewar tari ya kasance ƙasa da ƙarancin ƙwayar cuta tare da telmisartan idan aka kwatanta da masu hana ACE.

Rashin Cutar zuciya

Marasa lafiya shekaru 55 da haihuwa da tsufa tare da cututtukan jijiyoyin zuciya, bugun jini, rauni na iskemic na farko, lalacewar jijiya, ko kuma tare da rikice-rikice na nau'in ciwon sukari na 2 na jini (misali, retinopathy, hauhawar jini na ventricular, macro-ko microalbuminuria) tare da tarihin haɗarin cututtukan zuciya. na abubuwan da suka faru, Telzap yana da tasiri kama da sakamakon ramipril kan rage haɗakar haɗuwa: mutuwar zuciya da jijiyoyin jini daga lalacewa ta hanyar lalacewa ba tare da mummunan sakamako ba, bugun jini ba tare da mummunan sakamako ba. Rashin abinci mai gina jiki sakamakon raunin zuciya.

Telmisartan ya kasance mai tasiri kamar ramipril don rage yawan maki na sakandare: macewar zuciya, rashin ƙarfi mai rauni, ko rauni mai rauni.

Dry tari da angioedema ba a bayyana su sau da yawa tare da telmisartan idan aka kwatanta da ramipril, yayin da jijiyoyin jijiyoyin jini yafi sau da yawa tare da telmisartan.

Hydrochlorothiazide a matsayin wani ɓangare na Telzap Plus shine diuretic thiazide. Thiazides yana da tasiri ga tsarin rerosorption na electrolytes a cikin renal tubules, don haka yana ƙara haɓakar iskar sodium da ion loride a cikin daidai adadin. Sakamakon diuretic na hydrochlorothiazide yana haifar da raguwa a cikin BCC, karuwa a cikin aikin plasma renin, karuwa a cikin samar da aldosterone, biyo baya da haɓakar abun da ke cikin potassium da bicarbonates a cikin fitsari da kuma rage yawan abubuwan da ke cikin potassium a cikin jini na jini. Amfani da telmisartan lokaci guda yana taimakawa rage asarar potassium wanda wannan diuretic ke haifar dashi, mai yiwuwa saboda toshewar RAAS. Bayan ɗaukar hydrochlorothiazide, diuresis yana ƙaruwa bayan sa'o'i 2, matsakaicin sakamako yana tasowa bayan kimanin sa'o'i 4, sakamakon yana ɗaukar kimanin sa'o'i 6-12.

Nazarin cututtukan cututtukan cututtukan cuta sun gano cewa tsawon lokacin hydrochlorothiazide far na rage haɗarin cututtukan zuciya da mace-mace.

Abun ciki

Telmisartan + magabata.

Telmisartan + Hydrochlorothiazide + Masu cin nasara (Telzap Plus).

Pharmacokinetics

Idan ana amfani da shi a baki, ana saurin saukar da Telzap daga narkewa. Bioavailability shine 50%. Telmisartan an daure shi sosai ga furotin na plasma, akasarinsu tare da albumin da glycoprotein acid na alpha-1. Yana da metabolized ta conjugation tare da glucuronic acid. Conjugate bashi da aikin magunguna. An cire ta ta cikin hanji bai canzawa ba, excretion da kodan - kasa da 1%.

Hydrochlorothiazide ba a metabolized a cikin mutane ba. An cire ta kusan canzawa gaba daya cikin fitsari. Kimanin kashi 60% na kashin da aka sha da bakin ne ba a canza shi ba a cikin awanni 48. Rashin izini shine 250-300 ml / min.

Pharmacokinetics a cikin rukunin masu haƙuri na musamman

Akwai bambanci a cikin yawan ƙwayar plasma na telmisartan a cikin maza da mata. Cmax da AUC sun kasance kusan sau 3 da biyu bi da bi a mata idan aka kwatanta da maza ba tare da tasiri mai mahimmanci ba.

A cikin mata, akwai haɓakar haɓakar haɓakar hydrochlorothiazide a cikin jini, wannan ba mahimmanci bane a asibiti.

Magungunan magunguna na telmisartan a cikin tsofaffi marasa lafiya fiye da 65 shekara bai bambanta da matasa marasa lafiya. Ba a buƙatar gyaran gyaɗa.

A cikin marasa lafiya masu rauni zuwa ga matsakaici mai rauni aiki, ba a buƙaci daidaitawa na telmisartan. Marasa lafiya tare da mummunan gazawar koda da marasa lafiya akan hemodialysis ana bada shawarar ƙananan matakin farko na 20 MG kowace rana. Telmisartan ba a cire shi ta hanyar hanyar motsa jiki ba.

A cikin marasa lafiya masu rauni na wucin gadi zuwa matsakaici marasa aiki (aji A da B bisa ga rarrabuwa da Yara-Pugh), kashi na yau da kullun kada ya wuce 40 MG.

Alamu

hawan jini,
raguwa a cikin mace-mace da cututtukan zuciya a cikin tsofaffi marasa lafiya tare da cututtukan zuciya na asali na atherothrombotic (IHD, bugun jini ko tarihin cutar mahaifa) da nau'in ciwon sukari na 2 wanda ke da lalacewar ƙwayar cuta.

Sakin Fom

Allunan 40 MG da 80 MG.

Allunan 80 MG + 12.5 MG (Telzap Plus).

Umarnin don amfani da sashi

Ana ɗaukar miyagun ƙwayoyi a baki, lokaci 1 kowace rana, ba tare da la'akari da ci abinci ba, allunan ya kamata a wanke su da ruwa.

Maganin farko na shawarar Telzap shine 40 MG (kwamfutar hannu 1) sau ɗaya a rana. A wasu marasa lafiya, shan magani a kashi 20 na MG kowace rana na iya zama mai tasiri. Za'a iya samun kashi 20 na MG ta rarraba kwamfutar hannu 40 mg a cikin rabin haɗari. A cikin yanayin inda ba a cimma tasirin maganin warkewa ba, ana iya ƙara yawan shawarar da aka bayar na Telzap zuwa iyakar 80 MG sau ɗaya a rana.

Azaman madadin, za'a iya ɗaukar Telzap a hade tare da thiazide diuretics, alal misali, hydrochlorothiazide, wanda, lokacin amfani dashi tare, yana da ƙarin tasirin antihypertensive. Lokacin yanke shawara ko ƙara yawan ƙwayar, ya kamata a la'akari da cewa mafi girman tasirin antihypertensive ana samun mafi yawa a cikin makonni 4-8 bayan fara magani.

Ragewar mace-mace da yawan cututtukan zuciya

Matsakaicin shawarar Telzap shine 80 MG sau ɗaya a rana. A lokacin farko na magani, ana ba da shawarar lura da hawan jini; ana iya buƙatar gyaran farji mai guba.

Kwarewa tare da telmisartan a cikin marasa lafiya tare da gazawar na koda ko marasa lafiya akan hemodialysis yana iyakance. Ana ba da shawarar waɗannan marasa lafiya ƙananan kashi na 20 na MG kowace rana. Don marasa lafiya da ke da rauni zuwa matsakaici mai rauni aiki, ba a buƙatar daidaita sashi.

Amfani da kwanciyar hankali na Telzap tare da aliskiren yana contraindicated a cikin marasa lafiya tare da gazawar renal (GFR kasa da 60 ml / min / 1.73 m2 na yankin farfajiya na jiki).

Amfani da lokaci guda na Telzap tare da masu hana ACE an hana shi cikin marasa lafiya da ke fama da cutar sankarar hanta.

Marasa lafiya tare da gazawar hanta mai sassauci zuwa matsakaici (aji A da B bisa ga rabe-raben Yara-Pugh) ya kamata a tsara shi da taka tsantsan, kashi bai kamata ya wuce 40 MG sau ɗaya a rana ba. Telzap yana cikin contraindicated a cikin marasa lafiya da tsananin hepatic rashi (aji C bisa ga Child-Pugh rarraba).

A cikin marasa lafiya tsofaffi, ba a buƙatar daidaita sashi ba.

A ciki, sau ɗaya a rana, ana wanke shi da ruwa, ba tare da la'akari da ɗimbin abinci ba.

Marasa lafiya waɗanda BP ba za a iya sarrafa su da kyau tare da monotherapy tare da telmisartan ko hydrochlorothiazide ya kamata su ɗauki Telzap Plus. Kafin canjawa zuwa hadewar-matsakaicin hade, ana bada shawarar kowane bangare na kowane kashi. A wasu yanayi na asibiti, ana iya yin jujjuyawar canji kai tsaye daga monotherapy zuwa magani tare da haɗaɗɗen ƙwayar cuta.

Za a iya amfani da magani na Telzap Plus, sau ɗaya a rana don marasa lafiya waɗanda ba za a iya sarrafa haɓakar jininsu yadda yakamata lokacin shan telmisartan a kashi 80 a kowace rana.

Side sakamako

cututtukan urinary fili, gami da cystitis,
cututtukan mahaifa da babba, ciki har da cututtukan cututtukan zuciya,
sepsis, gami da m
anaemia, eosinophilia, thrombocytopenia,
anaphylactic dauki,
yawan tashin hankali
hyperkalemia
hypoglycemia (a cikin marasa lafiya da ciwon sukari mellitus),
rashin bacci
bacin rai
damuwa
suma
nutsuwa
rikicewar gani
vertigo
bradycardia
matsanancin raguwar hauhawar jini,
orthostatic hypotension,
samarin
karancin numfashi
tari
cutar huhun ciki
ciwon ciki
zawo
dyspepsia
rashin tsoro
amai
bushe bakin
rashin jin daɗi a ciki
take hakkin dandano
mai aiki mai hanta / lalata hanta,
fata mai ƙaiƙai
hyperhidrosis
kurji
angioedema (kuma m)
eczema
erythema
cututtukan mahaifa
miyagun ƙwayoyi
mai guba fata fatar jiki
sciatica
jijiyar wuya
myalgia
arthralgia
jin zafi
jijiya kamar-ciwo,
lalacewar aikin na koda, gami da gazawar ma'anar aiki,
ya karuwar plainma creatinine,
haemoglobin,
yawaitar uric acid,
activityara yawan aikin hanta enzymes da CPK,
ciwon kirji
asthenia
mura mai kama da cuta.

Contraindications

toshewar cutar biliary fili
matsanancin hanta (aji-Pugh aji C),
haɗewar amfani da aliskiren a cikin marasa lafiya da masu ciwon sukari mellitus ko raunin matsanancin ƙwayar cuta (GFR ƙasa da 60 ml / min / 1.73 m2 na yankin farfajiyar jiki),
Yin amfani da lokaci ɗaya tare da masu hana ACE a cikin marasa lafiya da masu fama da cutar sankara,
rashin jini fructose rashin haƙuri (saboda gaban sorbitol a cikin abun da ke ciki na miyagun ƙwayoyi),
ciki
lokacin shayarwa,
shekaru har zuwa shekaru 18 (ba a kafa ingantaccen aiki da aminci ba),
hypersensitivity ga aiki abu ko wani magabata na miyagun ƙwayoyi.

Haihuwa da lactation

A halin yanzu, amintaccen bayani kan amincin telmisartan a cikin mata masu juna biyu babu. A cikin nazarin dabbobi, an gano mai guba na ƙwayar cuta. Yin amfani da miyagun ƙwayoyi Telzap an contraindicated lokacin daukar ciki.

Idan kuna buƙatar magani na dogon lokaci tare da Telzap, marasa lafiya da ke shirin daukar ciki ya kamata su zabi wani madadin maganin rigakafin ƙwayar cuta tare da ingantaccen bayanin martaba na tsaro don amfani lokacin daukar ciki. Bayan tabbatar da gaskiyar daukar ciki, ya kamata a dakatar da magani tare da Telzap nan da nan kuma, idan ya cancanta, ya kamata a fara wani magani.

Dangane da lurawar asibiti, yin amfani da angiotensin 2 antagonist antagonists a cikin kashi na 2 da na uku na ciki yana da sakamako mai guba a tayin (nakasasshen aikin renal, oligohydramnios, jinkirta ossification na kwanyar) da jariri (gazawar renal, hypotension da hyperkalemia). Lokacin amfani da angiotensin 2 masu karɓar antagonists a cikin watanni na biyu na ciki, ana bada shawarar duban dan tayi tare da kwanyar tayin. Yaran da iyayensu mata sun karbi angiotensin 2 masu karɓar maganin tashin jijiyoyin ƙwayar cuta yayin ɗaukar ciki ya kamata a sa ido sosai don gano ƙwayar jijiya.

Ba a samun bayani game da amfani da telmisartan lokacin shayarwa. Yin amfani da miyagun ƙwayoyi Telzap yayin shayarwa yana da rauni. Ya kamata a yi amfani da wani magani na rigakafin rigakafi tare da ingantaccen bayanin martaba na aminci, musamman yayin ciyar da jariri ko wanda bai kai haihuwa ba.

Yi amfani da yara

Yin amfani da miyagun ƙwayoyi Telzap a karkashin shekara 18 yana contraindicated (inganci da aminci ba a kafa).

Yi amfani a cikin marasa lafiya tsofaffi

A cikin marasa lafiya tsofaffi, ba a buƙatar daidaita sashi ba.

Umarni na musamman

Rashin aikin hanta

Yin amfani da Telzap an contraindicated a cikin marasa lafiya da cholestasis, biliary toshewa ko mai rauni hanta aiki (Child-Pugh aji C), tun da telmisartan ne yafi excreted a cikin bile. An yi imani cewa irin waɗannan marasa lafiya sun rage zubar da hepatic na telmisartan. A cikin marasa lafiya da rauni mai laushi ko matsakaiciyar matsakaici (aji na A da B bisa ga rabe-raben Yara-Pugh), ya kamata a yi amfani da Telzap tare da taka tsantsan.

Marasa lafiya tare da jijiyoyin koda na akasi ko kuma na jijiya guda ɗaya na cutar koda na haɓaka haɗarin mummunan yanayin jijiyoyin jiki da gazawar koda yayin kula da magunguna waɗanda ke aiki akan RAAS.

Paarfin aikin na koda da jujin koda

Lokacin amfani da Telzap a cikin marasa lafiya da ke fama da rauni na aikin koda, ana bada shawarar saka idanu akan abubuwan da ke tattare da potassium da creatinine a cikin jini. Babu wani ƙwarewar asibiti tare da Telzap a cikin marasa lafiyar da suka yi fama da canjin koda.

Sympotomatic artpot hypotension, musamman bayan na farko na gudanarwar Telzap, na iya faruwa a cikin marasa lafiya da rage BCC da / ko sodium a cikin jini na jini a bango na jiyya na baya tare da diuretics, ƙuntatawa akan cin gishirin, zawo, ko amai. Irin waɗannan yanayi (raunin ruwa da / ko raunin sodium) ya kamata a cire su kafin su ɗauki Telzap.

Raka'o'i biyu na RAAS

Amintaccen amfani da telmisartan tare da aliskiren an contraindicated a cikin marasa lafiya da ciwon sukari mellitus ko na koda kasawa (GFR kasa da 60 ml / min / 1.73 m2 na jiki farfajiya na yanki).

Amfani da lokaci guda na Telzap da ACE inhibitors yana cikin contraindicated a cikin marasa lafiya da masu ciwon sukari nephropathy.

Sakamakon hanawa RAAS, jijiyoyin jijiyoyin jini jijiya, syncope, hyperkalemia, da rauni na aikin koda (ciki har da gazawar renal) an lura a cikin marasa lafiya da aka ƙaddara wannan, musamman idan aka haɗu da magunguna da yawa waɗanda suma suke aiki akan wannan tsarin. Saboda haka, ba a yarda da riɓi biyu na RAAS (alal misali, yayin ɗaukar telmisartan tare da sauran masu adawa da RAAS) ba da shawarar ba.

A cikin maganganu na dogaro da sautin jijiyoyin bugun gini da aikin koda na musamman a kan aikin RAAS (alal misali, a cikin marasa lafiya da raunin zuciya ko cutar koda, gami da ƙwayar cutar koda da ƙwaƙwalwar ƙwayar koda), yin amfani da magungunan da ke shafar wannan tsarin na iya tare da haɓakar rashin lafiyar jijiya mai ƙwanƙwasawa, hyperazotemia, oliguria, kuma a lokuta da dama, rashin lafiyar koda.

A cikin marasa lafiya tare da hyperaldosteronism na farko, magani tare da magungunan antihypertensive, sakamakon abin da aka samu ta hanyar hana RAAS, yawanci ba shi da tasiri. A wannan batun, ba a bada shawarar amfani da miyagun ƙwayoyi na Telzap ba.

Aortic da mitral valve stenosis, maganin bugun jini na zuciya

Kamar yadda yake da sauran masu bugun jini, marasa lafiya da ke fama da tasirin aortic ko na mitral stenosis, da kuma cututtukan zuciya na hypertrophic, suna iya yin taka tsantsan yayin amfani da Telzap.

Marasa lafiya tare da ciwon sukari waɗanda suka karbi insulin ko hypoglycemic jami'ai don maganin baka

A waje na tushen magani tare da Telzap, irin waɗannan marasa lafiya na iya fuskantar cutar sikari. Ya kamata a ƙarfafa ikon kulawar glycemia, kamar yadda ƙila akwai buƙatar daidaita sashin insulin ko wakili na ƙawan jini.

Yin amfani da kwayoyi masu aiki da RAAS na iya haifar da hyperkalemia. A cikin tsofaffi marasa lafiya, marasa lafiya da gazawar renal ko ciwon sukari mellitus, marasa lafiya suna shan magunguna waɗanda ke haɓaka matakan ƙwayar plasma, da / ko marasa lafiya da ke tattare da cututtukan haɗuwa, hyperkalemia na iya zama mai mutuwa.

Lokacin yanke shawara game da amfani da magungunan kwastomomi masu aiki da RAAS, ya zama dole don tantance rabo na haɗari da fa'ida. Babban abubuwan haɗarin cutar hyperkalemia da yakamata a yi la’akari da su sune:

ciwon sukari mellitus, gazawar koda, shekaru (marasa lafiya sun girmi shekaru 70),
haɗuwa tare da ɗaya ko fiye da kwayoyi masu aiki akan RAAS, da / ko kayan abinci mai ɗauke da potassium. Magunguna ko kuma warkewar azuzuwan magunguna waɗanda zasu iya haifar da hyperkalemia sune maye gurbin gishiri wanda ya ƙunshi potassium, potassium-sparing diuretics, ACE inhibitors, angiotensin 2 antagonists, magungunan anti-mai kumburi mai guba (NSAIDs) (ciki har da masu hana COX-2 inhibitors), heparin, immunosuppressants (cyclosporine ko tacrolimus) da kuma trimethoprim,
cututtukan cikin jiki, musamman rashin ruwa a jiki, gajiyawar zuciya, raunin acidosis, rauni na aikin koda, cututtukan cytolysis (misali, isheemah mai rauni, rhabdomyolysis, rauni mai yawa).

An shawarci marasa lafiya da ke cikin haɗarin yin hankali da sanya idanu a kan abubuwan da ke cikin potassium a cikin jini.

Telzap ya ƙunshi sorbitol (E420). Marasa lafiya da rashin saurin rashin jituwa na fructose kada su sha maganin.

Kamar yadda aka sani ga masu hana ACE, telmisartan da sauran angiotensin 2 antagonist masu alama suna rage karfin jini a ƙasa da kyau a cikin marasa lafiya na tseren Negroid fiye da sauran tsere, watakila saboda babban tsinkaya zuwa raguwar ayyukan renin a cikin yawan haƙuri.

Kamar yadda yake da sauran magungunan antihypertensive, raguwar wuce kima a cikin karfin jini a cikin marassa lafiya da cututtukan zuciya da cututtukan zuciya na zuciya na iya haifar da haɓaka infasshin myocardial ko bugun jini.

Tasiri kan ikon tuka motoci da hanyoyin sarrafa abubuwa

Karatuttukan asibiti na musamman don nazarin tasirin kwayoyi akan karfin tuƙin mota da hanyoyin da ba a gudanar dasu ba. Lokacin tuki da aiki tare da kayan aikin da ke buƙatar ƙara yawan kulawa, yakamata a kula, saboda rashin ruwa da nutsuwa da wuya su faru tare da amfani da Telzap.

Hulɗa da ƙwayoyi

Raka'o'i biyu na RAAS

Amfani da kwanciyar hankali na Telzap tare da aliskiren an contraindicated a cikin marasa lafiya da ciwon sukari mellitus ko na renal gazawar (GFR kasa da 60 ml / min / 1.73 m2 na yankin farfajiya na jiki) kuma ba a ba da shawarar ga sauran marasa lafiya ba.

Yin amfani da telemisartan da ACE inhibitors lokaci guda yana cikin contraindicated a cikin marasa lafiya tare da masu ciwon sukari na nephropathy.

Nazarin asibiti yana nuna cewa ninki biyu na RAAS saboda haɗakar masu amfani da ACE inhibitors, angiotensin 2 antagonist antagonist, ko aliskiren yana da alaƙa da haɓakar abubuwan da suka faru da damuwa kamar su yanayin tashin hankali, hyperkalemia, da kuma aiki mara nauyi (ciki har da rashin aiki na renal) idan aka kwatanta da amfani guda ɗaya kawai. miyagun ƙwayoyi aiki akan RAAS.

Hadarin haɓakar hyperkalemia na iya ƙaruwa lokacin da aka yi amfani da su tare da sauran magunguna waɗanda zasu iya haifar da hyperkalemia (abubuwan da ke kunshe da abinci mai guba da madadin gishiri) wanda ke kunshe da ƙwayoyin potassium, spredinolactone, eplerenone, triamterene ko amiloride, NSAIDs (gami da zaɓi COX-2 inhibitors) , heparin, immunosuppressants (cyclosporine ko tacrolimus) da trimethoprim). Idan ya cancanta, a kan asalin bayanan hypokalemia, hadewar magungunan ya kamata a aiwatar da su tare da taka tsantsan kuma a kai a kai suna lura da abun da ke cikin potassium a cikin jini.

Ta amfani da telmisartan tare da digoxin, an samu ƙaruwa a Cmax na digoxin a cikin plasma da kashi 49% kuma Cmin da kashi 20%. A farkon farawa, lokacin zabar magani da dakatar da jiyya tare da telmisartan, ya kamata a sa ido sosai game da ƙwaƙwalwar ƙwayar cuta a cikin jini don kulawa da shi a cikin kewayon warkewa.

Tsarin dasarin potassium ko kuma mai dauke da abubuwan gina jiki masu dauke da sinadarai

Angiotensin 2 antagonists, kamar telmisartan, yana rage asarar mai-mai-tozarta potassium. Abubuwan da ke tattare da daskararren potassium (misali, spironolactone, eplerenone, triamteren, ko amiloride), abubuwan da ke kunshe da abinci na potassium, ko maye gurbin gishiri suna iya haifar da hauhawar haɓakar potassium. Idan aka nuna amfani da concomitant, tun da akwai bayanan hypokalemia, ya kamata a yi amfani dasu da taka tsantsan kuma a kan tushen kulawa da potassium a kai a kai a cikin jini.

Tare da haɗuwa da shirye-shiryen lithium tare da masu hana ACE da masu hana antagonensin 2 masu karɓar antagonists, ciki har da telmisartan, ƙara ƙaruwa mai sauƙin ƙaruwa a cikin taro na lithium a cikin jini yana da tasirin sakamako mai guba. Idan kuna buƙatar amfani da wannan haɗin magunguna, ana bada shawara cewa ku kula da hankali da ƙwayar lithium a cikin jini.

NSAIDs (i.e., acetylsalicylic acid a cikin allurai da aka yi amfani da su don maganin hana kumburi, COX-2 inhibitors da kuma NSAIDs marasa zaɓi) na iya raunana tasirin magungunan antagonensin masu karɓa na angioensin 2 A cikin wasu marasa lafiya da ke fama da rauni na aikin ƙira (misali, marasa lafiya da rashin ruwa, tsofaffi marasa lafiya da lalacewar aikin na renal) haɗe da amfani da angiotensin 2 antagonists da kwayoyi waɗanda ke hana COX-2 na iya haifar da ci gaba da lalacewar aikin koda, gami da haɓaka rashin aiki na ƙasa tatochnosti, wanda shi ne yawanci reversible. Sabili da haka, ya kamata a aiwatar da haɗin magunguna tare da taka tsantsan, musamman ma a cikin tsofaffi marasa lafiya. Ya kamata a samar da isasshen abincin da ya dace, a additionari, a farkon amfani tare da lokaci-lokaci a nan gaba, ya kamata a sa ido kan alamun alamun aikin.

Diuretics (thiazide ko madauki)

Magunguna na gaba tare da cututtukan cututtukan ƙwayar cuta, irin su furosemide (“dip” diuretic) da hydrochlorothiazide (mai cutar thiazide diuretic), na iya haifar da hypovolemia da haɗarin tashin hankali a farkon maganin telmisartan.

Sauran magungunan antihypertensive

Ana iya inganta tasirin Telzap ta amfani da sauran magungunan antihypertensive.

Dangane da kayan aikin magunguna na baclofen da amifostine, ana iya ɗauka cewa za su inganta tasirin warkewar duk magungunan antihypertensive, ciki har da telmisartan. Bugu da kari, maganin orthostatic hypotension na iya rikitarwa ta hanyar amfani da ethanol (barasa), barbiturates, magunguna ko maganin antidepressants.

Corticosteroids (don amfani da tsari)

Corticosteroids ya raunana tasirin telmisartan.

Analogs na miyagun ƙwayoyi Telzap

Tsarin analogues na mai aiki abu:

Mikardis,
Mikardis Da,
Firimiya
Tanidol
Karin
Bayanin Karin
Telmisartan
Telmista
Labarun
Yana da
Telsartan
Telsartan N.

Analogs a cikin rukunin magungunan gargajiya (angiotensin 2 antagonists antagonists):

Afuwan,
Aprovel
Artinova,
Atacand
Bugawa
Brozaar
Vasotens,
Valz
Bayanai,
Valsartan
Valsacor
Vamloset
Gizaar
Hyposart,
Diovan
Duopress,
Zisakar
Ibertan
Irbesartan
Irsar
Candecor
Kayani
Cardomin
Cardos,
Cardosal
Cardosten
Karzartan
Co-Exforge,
Coaprovel
Cozaar
Xarten
Lozap,
Lozap Plus,
Lozarel
Losartan
Losartan n
Lorista
Losacor
Mikardis,
Naviten
Nortian
Olimestra
Ordiss
Firimiya
Presartan,
Maimaitawa
Sartavel
Tanidol
Tareg
Tweensta
Teveten
Telmisartan
Labarun
Telsartan
Firmast
Edarby
Exforge
'Yanfofi,
Eprosartan Mesylate.

Tsarin ilimin rayuwa (ICD-10)

Allunan mai rufe fim	Shafin 1.
abu mai aiki:
telmisartan	40/80 mg
magabata: meglumine - 12/24 mg, sorbitol - 162.2 / 324.4 mg, sodium hydroxide - 3.4 / 6.8 mg, povidone 25 - 20/40 mg, magnesium stearate - 2.4 / 4.8 mg

Pharmacodynamics

Telmisartan wani takamaiman ne na ARA II (AT subtype₁), mai tasiri idan aka sha shi da baki. Telmisartan yana da kusanci sosai ga AT₁-receptors ta hanyar wanda aikin angiotensin II ya tabbata. Yana kawar da angiotensin II daga haɗin tare da mai karɓa, ba da ikon ɗaukar aikin agonist dangane da wannan mai karɓa. Telmisartan ya ɗaura kawai da ƙirar AT₁masu karɓar angiotensin II. Sadarwa mai dorewa ce. Telmisartan bashi da alaƙa ga sauran masu karɓa, incl. AT₂masu karɓa da sauran masu karɓar angiotensin marasa ƙarancin karatu. Babban mahimmancin mahimmancin waɗannan masu karɓar, da kuma tasirin tasirin tasirinsu mai yawa tare da angiotensin II, wanda yake ƙaruwa wanda yake ƙaruwa tare da alƙawarin telmisartan, ba a yi nazari ba. Telmisartan yana rage maida hankali na aldosterone a cikin jini na jini, baya rage ayyukan renin, kuma baya hana tashoshin ion. Telmisartan baya hana ACE (kininase na II), wanda shima yake daukar nauyin lalata bradykinin. Wannan yana guje wa sakamako masu illa da ke tattare da aikin bradykinin (alal misali, bushe tari).

Mahimmancin hauhawar jini. A cikin marasa lafiya, telmisartan a kashi na 80 MG gaba daya yana toshe sakamakon tasirin hauhawar jini na angiotensin II. An lura da fara aikin rigakafi a cikin sa'o'i 3 bayan aiwatarwa na farko na telmisartan. Tasirin miyagun ƙwayoyi ya ɗauki tsawon awanni 24 yana ci gaba da kasancewa a asibiti har zuwa awanni 48. Sakamakon magani mai ƙoshin ƙwaƙwalwa yakan haifar da makonni 4-8 bayan amfani da kullun.

A cikin marasa lafiya tare da hauhawar jini, telmisartan yana rage hawan jini da baba ba tare da shafi yawan zuciya ba.

Game da katsewar kunne na telmisartan, hawan jini a wasu ranakun sannu a hankali ya dawo kan matakin sa na asali ba tare da cigaban ciwo ba.

Kamar yadda sakamakon nazarin karatun asibiti ya nuna, tasirin antihypertensive na telmisartan yana da kwatankwacin tasirin antihypertensive na kwayoyi na wasu azuzuwan (amlodipine, atenolol, enalapril, hydrochlorothiazide da lisinopril). Halin bushewar tari ya kasance ƙasa da ƙarancin ƙwayar cuta tare da telmisartan idan aka kwatanta da masu hana ACE.

Yin rigakafin cutar zuciya. Marasa lafiya shekaru 55 da haihuwa tare da cutar na jijiyoyin zuciya, bugun jini, tashin hankali ischemic attack, na waje lalacewa, ko rikitarwa na type 2 ciwon sukari mellitus (misali retinopathy, hagu ventricular hagu, macro- ko microalbuminuria) tare da tarihin abubuwan da suka faru na zuciya, telmisartan yana da tasirin kama da na ramipril a cikin rage mahaɗin ma'amala: macewar zuciya, rashin ƙarfi mai rauni mai rauni, bugun zuciya mai rauni. illolin dangane da CHF.

Telmisartan ya kasance mai tasiri kamar ramipril don rage yawan maki na sakandare: macewar zuciya, rashin ƙarfi mai rauni, ko rauni mai rauni. Dry tari da angioedema ba a bayyana su sau da yawa tare da telmisartan idan aka kwatanta da ramipril, yayin da jijiyoyin jijiyoyin jini yafi sau da yawa tare da telmisartan.

Marasa lafiya na ƙuruciya da samari. Babu aminci da tasirin telmisartan a cikin yara da matasa masu shekaru 18 da haihuwa.

Pharmacokinetics

Damuwa. Lokacin kulawa, ana amfani da telmisartan da sauri daga narkewa. Bioavailability shine 50%. Lokacin da aka dauki shi lokaci guda tare da abinci, raguwa a cikin AUC ya tashi daga 6% (a kashi 40 na MG) zuwa 19% (a kashi na 160 mg). Bayan sa'o'i 3 bayan gudanarwa, yawan shiga cikin plasma na jini ya kasance ba tare da la'akari da ko an karɓi telmisartan a lokaci ɗaya abinci ko ba. Akwai bambanci a cikin yawan ƙwayar plasma a cikin maza da mata. C_max kuma AUC ya kasance kusan sau 3 da biyu bi da bi a cikin mata idan aka kwatanta da maza ba tare da tasiri mai mahimmanci ba.

Babu wata alaƙar dangantaka tsakanin yawan maganin da ƙwayar cutar tasa. C_max kuma, zuwa mafi ƙarancin, Cungiyar ta AUC ta karu sosai zuwa kashi ɗaya lokacin ƙaruwa yayin amfani da allurai sama da 40 mg / rana.

Rarraba. Telmisartan ya daure sosai akan furotin na plasma (> 99.5%), akasari tare da albumin da alpha₁-acid glycoprotein.

A fili V_ss kusan lita 500 ne.

Tsarin rayuwa. Yana da metabolized ta conjugation tare da glucuronic acid.

Conjugate bashi da aikin magunguna.

Kiwo. T_1/2 Fiye da awanni 20. An fallasa shi ta cikin hanji bai canza ba, excretion da kodan - kasa da 1%. Gabaɗayan aikin plasma yana da girma (kusan 1000 ml / min) idan aka kwatanta da hawan jini na hepatic (kimanin 1500 ml / min).

Patientwararrun masu haƙuri

Tsufa. Magungunan magunguna na telmisartan a cikin marasa lafiya fiye da shekaru 65 ba ya bambanta da matasa marasa lafiya. Ba a buƙatar gyaran gyaɗa.

Paarancin aiki na haya. A cikin marasa lafiya masu rauni zuwa ga matsakaici mai rauni aiki, ba a buƙaci daidaitawa na telmisartan.

Marasa lafiya da ke fama da rauni na koda da waɗanda ke hemodialysis an bada shawarar ƙaramin matakin farko na 20 mg / rana (duba "Umarnin na Musamman"). Telmisartan ba a cire shi ta hanyar hanyar motsa jiki ba.

Rashin aikin hanta. A cikin marasa lafiya masu rauni na wucin gadi zuwa matsakaici marasa aiki (aji A da B bisa ga rarrabuwa da Yara-Pugh), kashi na yau da kullun kada ya wuce 40 MG.

Form sashi

Tabletaya daga cikin kwamfutar hannu ya ƙunshi

abubuwa masu aiki: telmisartan 40,000 ko 80,000 MG, bi da bi,

hydrochlorothiazide 12.500 MG ko 25,000 MG, bi da bi,

magabata: sorbitol, sodium hydroxide, povidone 25, magnesium stearate

Allunan masu launi iri daya mai dauke da farin biconvex daga fari zuwa rawaya, tare da lambar "41" a gefe daya daga cikin kwamfutar, kimanin 12 mm tsayi kuma kusan fadi 6 mm (don sashi na 40 mg / 12.5 mg).

Allunan masu siffofi masu launuka masu dumbin yawa tare da furucin biconvex daga fari zuwa launin ruwan hoda, tare da lambar “81” a gefe daya daga cikin kwamfutar, tsawon tsayin mm 16.5, kusan 8.3 mm fadi (don sashi na 80 MG / 12.5 MG).

Allunan masu siffofi masu launuka masu dumbin yawa tare da furen biconvex daga fari zuwa rawaya, tare da lambar “82” a gefe daya daga cikin kwamfutar, tsawonta mm 16, tsawonta mm 8don sashi na 80 MG / 25 MG).

Alamu na Telzap ®

raguwa a cikin mace-mace da cuta a cikin jijiyoyin jini:

- tare da cututtukan zuciya na asali na atherothrombotic (cututtukan zuciya na zuciya, bugun jini ko tarihin jijiyoyin mahaifa),

- tare da nau'in ciwon sukari na 2 na cutar siga tare da lalacewar ƙwayar cuta mai lalata.

Contraindications

hypersensitivity ga aiki abu ko wani magabata na miyagun ƙwayoyi,

ciki da lactation,

toshewar cutar biliary fili

matsanancin hanta (aji-Pugh aji C),

haɗe tare da aliskiren a cikin marasa lafiya da masu ciwon sukari mellitus ko raunin rauni na koda (GFR ƙasa da 60 ml / min / 1.73 m 2) (duba “Haɗin kai” da “Umarni na Musamman”),

rashin haƙuri na fructose (saboda gaban sorbitol a cikin kwamfutar hannu),

Amfani na lokaci daya tare da masu hana ACE a cikin marasa lafiya da masu fama da cutar sankarar jini (duba "Haɗin kai" da "Umarni na Musamman"),

shekaru har zuwa shekaru 18 (inganci da aminci ba kafa).

Tare da kulawa: hadin gwiwa na kashin asali na asali ko kuma na jijiya na koda guda daya na aiki, karancin aiki na koda, mai laushi ga matsakaita hepatic, raguwar BCC idan aka kwatanta da abubuwanda suka gabata na hana abinci, hanawar sodium chloride, zawo ko amai, hyponatremia, hyperkalemia, yanayin bayan dasawa koda rashi), mummunan rauni na zuciya, aortic da mitral valve stenosis, bugun jini na zuciya, bugun jini na farko, hyperaldosta onizm (inganci da kuma aminci ba a kafa), magani na baƙar fata marasa lafiya.

Haihuwa da lactation

A halin yanzu, amintaccen bayani kan amincin telmisartan a cikin mata masu juna biyu babu. A cikin nazarin dabbobi, an gano mai guba na ƙwayar cuta. An hana amfani da Telzap ® lokacin daukar ciki (duba "Contraindications").

Idan magani na dogon lokaci tare da Telzap ® ya zama dole, marasa lafiya da ke shirin daukar ciki ya kamata su zabi wani madadin maganin rigakafin tare da ingantaccen bayanin martaba na tsaro don amfani lokacin daukar ciki. Bayan tabbatar da gaskiyar daukar ciki, ya kamata a dakatar da magani tare da Telzap immediately nan da nan kuma, idan ya cancanta, ya kamata a fara wani magani.

Kamar yadda sakamakon binciken asibiti ya nuna, yin amfani da ARA II a cikin abubuwan ciki na II da III na ciki yana da sakamako mai guba a tayin (aikin nakal din yara, oligohydramnios, jinkirta ossification na kwanyar) da jariri (gazawar renal, rashin lafiyar jijiyoyin jini da hyperkalemia). Lokacin amfani da ARA II a cikin sati na biyu na ciki, ana bada shawarar duban dan tayi da kodan tayi.

Yaran da uwayensu suka dauki ARA II a lokacin daukar ciki ya kamata a sa ido a hankali don maganin tarin jini.

Ba a samun bayani game da amfani da telmisartan lokacin shayarwa. Amfani da Telzap ® yayin shayarwa yana da kariya (duba "Contraindications"), madadin antihypertensive magani tare da ingantaccen bayanin martaba na aminci, musamman lokacin ciyar da jariri ko wanda bai kai haihuwa ba.

Side effects

A cewar WHO, tasirin da ba a buƙata ana rarrabe shi gwargwadon yawan ci gaban su kamar haka: sau da yawa (≥1 / 10), sau da yawa (daga ≥1 / 100 zuwa ciki har da m.

A bangare na jini da tsarin lymphatic: sau da yawa - anaemia, da wuya - eosinophilia, thrombocytopenia.

Daga tsarin rigakafi: da wuya - anaphylactic dauki, hypersensitivity.

Daga gefen metabolism da abinci mai gina jiki: infrequently - hyperkalemia, da wuya - hypoglycemia (a cikin marasa lafiya da ciwon sukari mellitus).

Daga psyche: infrequently - rashin bacci, ciki, da wuya - damuwa.

Daga tsarin juyayi: sau da yawa - sanyin jiki, da wuya - nutsuwa.

Daga gefen gabar hangen nesa da wuya: rikicewar gani.

A ɓangaren ɓangaren ji da jiɓin labyrinth: sau da yawa - vertigo.

Daga zuciya: sau da yawa - bradycardia, da wuya - tachycardia.

Daga tasoshin: sau da yawa - raguwa alama a cikin karfin jini, hauhawar jini na orthostatic.

Daga tsarin numfashi, kirji da gabobin jiki: infrequently - shortness na numfashi, tari, da wuya - wuya cutar huhu.

Daga cikin jijiyoyin mahaifa: sau da yawa - zafin ciki, zawo, dyspepsia, flatulence, vomiting, da wuya - bushe bakin, rashin jin daɗi a cikin ciki, take hakkin dandano abin mamaki.

A ɓangaren hanta da ƙwayar biliary: da wuya - lalacewar aikin hanta / lalacewar hanta.

A bangare na fata da kasusuwa na jiki: sau da yawa - itching fata, hyperhidrosis, fitsari, da wuya - angioedema (kuma m), eczema, erythema, urticaria, fiska fata, fata guba fata.

Daga tsarin musculoskeletal da nama mai hadewa: infrequently - ciwon baya (sciatica), cramps muscle, myalgia, da wuya - arthralgia, reshe pain, pain tendon (ciwon tendon-kamar syndrome).

Daga kodan da urinary fili: sau da yawa - ba matsala aiki na koda, ciki har da m na koda gazawar.

Janar cuta da rikice-rikice a wurin yin allura: infrequently - zafi kirji, asthenia (rauni), da wuya - mura-kamar ciwo.

Tasiri kan sakamakon dakin gwaje-gwaje da na kayan aiki: akai-akai - karuwa a cikin taro na creatinine a cikin jini na jini, da wuya - raguwa a cikin abubuwan Hb, karuwa a cikin abun uric acid a cikin jini na jini, karuwa a cikin ayyukan hanta enzymes na hanta da kuma CPK.

Haɗa kai

Raka'o'i biyu na RAAS. Amfani da kwanon tebur na telmisartan tare da aliskiren an ba shi cikin marasa lafiya da ciwon sukari mellitus ko gazawar koda (GFR ƙasa da 60 ml / min / 1.73 m 2) kuma ba a ba da shawarar ga sauran marasa lafiya ba.

Amfani da lokaci ɗaya na telmisartan da ACE inhibitors an contraindicated a cikin marasa lafiya da masu ciwon sukari nephropathy (duba "Contraindications").

Nazarin asibiti ya nuna cewa ninki biyu na RAAS saboda haɗakar maganin ACE inhibitors, ARA II, ko aliskiren yana da alaƙa da haɓakar haɗarin abubuwan tashin hankali irin su hypotension, hyperkalemia, da kuma aiki mara girman aiki (gami da rashin aiki na ƙarancin renal), idan aka kwatanta da amfani da magani ɗaya kawai. aiki akan RAAS.

Hadarin bunkasa haɓaka hyperkalemia na iya ƙaruwa lokacin da aka yi amfani da su tare da sauran magunguna waɗanda zasu iya haifar da hyperkalemia (abubuwan da ke kunshe da abinci mai guba da madadin gishiri) dauke da sinadarin potassium, spredinolactone, eplerenone, triamterene ko amiloride, NSAIDs, gami da zaɓaɓɓen COX-2 inhibitors, hepari , immunosuppressants (cyclosporine ko tacrolimus) da kuma trimethoprim.Idan ya zama dole, a kan asalin bayanan hypokalemia da aka tattara, hadewar kwayoyi ya kamata a aiwatar da su. yi hankali kuma a kai a kai saka idanu akan abubuwan da ke cikin potassium a cikin jini.

Digoxin. Tare da haɗin gwiwar telmisartan tare da digoxin, an lura da karuwa a C_max plasma digoxin a 49% da C_min da kashi 20%. A farkon farawa, lokacin zabar magani da dakatar da jiyya tare da telmisartan, ya kamata a sa ido sosai game da ƙwaƙwalwar ƙwayar cuta a cikin jini don kulawa da shi a cikin kewayon warkewa.

Tsarin dasarin potassium ko kuma mai dauke da abubuwan gina jiki masu dauke da sinadarai. ARA II, kamar telmisartan, yana rage asarar potassium wanda diuretic ke haifar. Abubuwan da ke dauke da sinadarin potassium, misali spironolactone, eplerenone, triamteren ko amiloride, abubuwan da ke dauke da sinadarin potassium ko gishirin gishiri zasu iya haifar da karuwa a cikin potassium a cikin jini. Idan aka nuna amfani da concomitant, tun da akwai bayanan hypokalemia, ya kamata a yi amfani dasu da taka tsantsan kuma a kan tushen kulawa da potassium a kai a kai a cikin jini.

Shirye-shiryen Lithium. Lokacin da aka shirya shirye-shiryen lithium tare da masu hana ACE da ARA II, ciki har da telmisartan, wani koma-baya mai karuwa a cikin yawan ƙwayoyin plasma na lithium kuma sakamako mai guba ya tashi. Idan kuna buƙatar amfani da wannan haɗin magunguna, ana bada shawara cewa ku kula da hankali da ƙwayar lithium a cikin jini.

NSAIDs. NSAIDs (i.e., acetylsalicylic acid a cikin allurai da aka yi amfani dasu don maganin rigakafi, masu hana COX-2 da NSAIDs marasa zaɓi) na iya raunana tasirin antiRpertensive na ARA II. A cikin wasu marasa lafiya da ke fama da rauni na aiki (misali, rashin ruwa, tsofaffi marassa lafiya da ke fama da rauni na aiki), hada hadarin ARA II da magungunan da ke hana COX-2 na iya haifar da ci gaba da tabarbarewa aiki na renal, gami da haɓakar rashin aiki na ƙarancin ƙima, wanda, a matsayin mai mulki, mai juyawa ne. Sabili da haka, ya kamata a aiwatar da haɗin magunguna tare da taka tsantsan, musamman ma a cikin tsofaffi marasa lafiya. Wajibi ne a tabbatar da dacewa da shan ruwa, a Bugu da kari, a farkon amfani tare da lokaci-lokaci a gaba, ya kamata a sa ido kan alamun aikin.

Diuretics (thiazide ko madauki). Maganin da ya gabata tare da babban allurai na diuretics, kamar furosemide (loop diuretic) da hydrochlorothiazide (thiazide diuretic), na iya haifar da hypovolemia da haɗarin hypotension a farkon jiyya tare da telmisartan.

Sauran magungunan antihypertensive. Za'a iya inganta tasirin telmisartan tare da haɗakar amfani da sauran magungunan antihypertensive. Dangane da kayan aikin magunguna na baclofen da amifostine, ana iya ɗauka cewa za su inganta tasirin warkewar duk magungunan antihypertensive, ciki har da telmisartan. Bugu da kari, orthostatic hypotension na iya haɓaka tare da barasa, barbiturates, magunguna, ko maganin antidepressants.

Corticosteroids (don amfani da tsari). Corticosteroids ya raunana tasirin telmisartan.

Sashi da gudanarwa

A ciki, sau ɗaya a rana, a wanke da ruwa, ba tare da la’akari da yawan abincin ba.

Hawan jini. Yankin da aka bada shawarar farko na Telzap ® shine kwamfutar hannu 1. (40 MG) sau ɗaya a rana. Wasu marasa lafiya na iya samun ingantaccen ci na 20 MG / rana. Za'a iya samun kashi 20 na MG ta rarraba kwamfutar hannu 40 mg a cikin rabin haɗari. A cikin yanayin inda ba a cimma tasirin maganin warkewa ba, ana iya ƙara yawan shawarar da aka bayar na Telzap to zuwa iyakar 80 MG sau ɗaya a rana. Azaman madadin, za'a iya ɗaukar Telzap ® a hade tare da turezide diuretics, alal misali, hydrochlorothiazide, wanda, lokacin amfani dashi tare, yana da ƙarin tasirin antihypertensive.

Lokacin yanke shawara ko ƙara yawan ƙwayar, ya kamata a la'akari da cewa mafi girman tasirin antihypertensive ana samun mafi yawa a cikin makonni 4-8 bayan fara magani.

Ragewar mace-mace da yawan cututtukan zuciya. Matsakaicin shawarar Telzap ® shine 80 MG sau ɗaya a rana. A lokacin farko na magani, ana ba da shawarar lura da hawan jini; ana iya buƙatar gyaran farji mai guba.

Patientwararrun masu haƙuri

Paarancin aiki na haya. Kwarewa tare da telmisartan a cikin marasa lafiya tare da gazawar na koda ko marasa lafiya akan hemodialysis yana iyakance. Ana ba da shawarar waɗannan marasa lafiya ƙananan matakin farko na 20 MG / rana (duba. "Jiyya na musamman"). Don marasa lafiya da ke da rauni zuwa matsakaici mai rauni aiki, ba a buƙatar daidaita sashi. Amfani da kwanciyar hankali na Telzap ® tare da aliskiren an contraindicated a cikin marasa lafiya da gazawar renal (GFR kasa da 60 ml / min / 1.73 m 2) (duba. "Contraindications").

Amfani da lokaci guda na Telzap ® tare da masu hana ACE an hana su cikin marasa lafiya da ke fama da cutar sankarar mahaifa (duba “Contraindications”).

Rashin aikin hanta. Telzap ® yana cikin contraindicated a cikin marasa lafiya da mummunar cutar hepatic (Yara-Pugh aji C) (duba "Contraindications"). A cikin marasa lafiya tare da laushi zuwa matsakaici rashin daidaituwa na hepatic (aji A da B bisa ga rarrabuwa na Yara-Pugh, bi da bi), an tsara maganin tare da taka tsantsan, kashi bai kamata ya wuce 40 MG sau ɗaya a rana ba (duba "Tare da taka tsantsan").

Tsufa. Ga tsofaffi marasa lafiya, ba a buƙatar daidaita sashi ba.

Yara da samartaka. Amfani da Telzap ® a cikin yara da matasa a karkashin shekara 18 an contraindicated saboda rashin aminci da ingancin bayanai (duba "Contraindications").

Yawan abin sama da ya kamata

Kwayar cutar mafi yawan bayyanannun bayyanannu na yawan abin sama da ya faru sun kasance raguwa mai yawa a cikin karfin jini da tachycardia, da bradycardia, fitsari, haɓaka cikin ƙwaƙwalwar ƙwaƙwalwar ƙwaƙwalwar ƙwaƙwalwa da rashin lafiyar koda.

Jiyya: Telmisartan ba a cire shi ta hanyar hanyar motsa jiki ba. Ya kamata a kula da marasa lafiya a hankali kuma a alamu haka nan kuma ya kamata a kula da marasa lafiya. Hanya zuwa magani ya dogara da lokacin da bayan shan magani, da kuma tsananin alamun. Matakan da aka ba da shawarar sun hada da gabatar da amai da / ko lavage ciki, amfani da carbon da aka kunna da kyau ana bada shawara. Plasma electrolytes da creatinine ya kamata a sa ido akai-akai. Idan raguwar alama a cikin karfin jini ya faru, mara lafiya ya kamata ya ɗauki madaidaiciya tare da ƙafafu masu tsayi, yayin da ya zama dole a gaggauta sake buɗe bcc da electrolytes.

Umarni na musamman

Rashin aikin hanta. Yin amfani da Telzap ® an contraindicated a cikin marasa lafiya da cholestasis, toshewar hancin biliary fili ko aikin hanta mai rauni (Yara-Pugh aji C) (duba “Contraindications”), tun da telmisartan yafi birgeshi a cikin bile. An yi imani da cewa a cikin irin waɗannan marasa lafiya, an rage yawan maganin hepatic na telmisartan. A cikin marasa lafiya da rauni mai laushi ko matsakaiciyar matsakaici (Rashin aji na A da B), ya kamata a yi amfani da Telzap ® tare da taka tsantsan (duba Tare da kulawa).

Maganin tashin zuciya. A cikin lura da kwayoyi da ke aiki a kan RAAS a cikin marasa lafiya da keɓaɓɓiyar ƙwayar cutar koda na jijiya ko kuma jijiya ta hanji na koda guda ɗaya na aiki, haɗarin matsanancin jijiya da rashin ƙarfi na haɓaka yana ƙaruwa.

Imarfin aikin na koda da jujin koda. Lokacin amfani da Telzap ® a cikin marasa lafiya da ke fama da rauni na aikin ƙirar, ana bada shawarar saka idanu akan abubuwan da ke tattare da potassium da creatinine a cikin jini. Babu wani ƙwarewar asibiti tare da Telzap ® a cikin marasa lafiyar da suka yi fama da canjin koda.

Ragewa a cikin BCC. Sympotomatic artpot hypotension, musamman bayan na farko na gudanarwar Telzap ®, na iya faruwa a cikin marasa lafiya da ƙarancin BCC da / ko sodium a cikin jini na jini ta fuskar tushen jiyya da ta gabata tare da diuretics, ƙuntatawa akan cin gishirin, zawo ko amai.

Irin waɗannan yanayi (ragin ruwa da / ko rashi sodium) ya kamata a cire su kafin su ɗauki Telzap ®.

Raka'o'i biyu na RAAS. Amintaccen amfani da telmisartan tare da aliskiren an contraindicated a cikin marasa lafiya da ciwon sukari mellitus ko na koda kasawa (GFR kasa da 60 ml / min / 1.73 m 2) (duba. "Contraindications").

Amfani da lokaci ɗaya na telmisartan da ACE inhibitors an contraindicated a cikin marasa lafiya da masu ciwon sukari nephropathy (duba "Contraindications").

Sakamakon hanawa RAAS, jijiyoyin jijiyoyin jini, fitsari, hyperkalemia, da rauni na aikin koda (gami da ƙarancin kiɗa na yara) an lura dasu a cikin marasa lafiya da aka ƙaddara wannan, musamman idan aka haɗu da magunguna da yawa waɗanda suma suke aiki akan wannan tsarin. Saboda haka, ba a yarda da riɓi biyu na RAAS (alal misali, yayin ɗaukar telmisartan tare da sauran masu adawa da RAAS) ba da shawarar ba.

A cikin maganganun dogaro na sautin jijiyoyin bugun gini da na koda na aiki a kan aikin RAAS (alal misali, a cikin marasa lafiya da raunin zuciya ko cutar koda, gami da ƙwayar cutar koda da ƙwayar ƙwayar koda), gudanarwar kwayoyi waɗanda ke shafar wannan tsarin na iya kasancewa tare da haɓaka ƙoshin lafiya. hypotension, artperazotemia, oliguria kuma a lokuta da dama, gazawar cutar koda.

Primary hyperaldosteronism. A cikin marasa lafiya tare da hyperaldosteronism na farko, magani tare da magungunan antihypertensive, sakamakon abin da aka samu ta hanyar hana RAAS, yawanci ba shi da tasiri. A wannan batun, ba da shawarar yin amfani da miyagun ƙwayoyi Tezap ®.

Stenosis na aortic da mitral valves, cututtukan zuciya da ke haifar da tasirin jini. Kamar yadda yake da sauran masu bugun jini, marasa lafiya da ke fama da tasirin aortic ko na mitral stenosis, haka nan kuma masu ciwon zuciya na jini sunkamata a hankali musamman lokacin amfani da Telzap ®.

Marasa lafiya tare da ciwon sukari waɗanda suka karbi insulin ko hypoglycemic jami'ai don maganin baka. A waje na tushen magani tare da Telzap ®, waɗannan marasa lafiya na iya fuskantar matsalar rashin ƙarfi na hypoglycemia. A cikin irin waɗannan marasa lafiya, ya kamata a ƙarfafa ikon sarrafa glycemic, kamar yadda ƙila akwai buƙatar daidaita sashin insulin ko wakili na ƙawan jini.

Hyperkalemia Amincewa da kwayoyi masu aiki da RAAS na iya haifar da hyperkalemia. A cikin tsofaffi marasa lafiya, marasa lafiya da gazawar koda ko ciwon sukari na mellitus, marasa lafiya suna shan magunguna waɗanda suma suna haɓaka ƙwayar plasma, da / ko marasa lafiya da ke tattare da cututtukan haɗuwa, hyperkalemia na iya zama mai mutuwa.

Lokacin yanke shawara game da amfani da magunguna masu ɗaukar nauyin RAAS, ya zama dole don kimanta ragin-haɗarin haɗarin. Babban abubuwan haɗarin cutar hyperkalemia da yakamata a yi la’akari da su sune:

- ciwon sukari mellitus, gazawar koda, shekaru (marasa lafiya sun girmi shekaru 70),

- haɗuwa tare da ɗayan magunguna ɗaya ko fiye da ke aiki akan RAAS, da / ko kayan abinci mai ɗauke da potassium. Magunguna ko kuma magungunan warkewa na kwayoyi waɗanda zasu iya haifar da hyperkalemia sune maye gurbin gishiri da ke kunshe da potassium, sparing diuretics, ACE inhibitors, ARA II, NSAIDs, gami da mai zaɓar COX-2 inhibitors, heparin, immunosuppressants (cyclosporin ko tacrolimus) da kuma trimethoprim,

- yanayi na ciki / cututtuka, musamman rashin ruwa, gazawar zuciya, rashi acidosis, rashi aiki na koda, alamomin cytolysis (alal misali, isheemah babba, rhabdomyolysis, rauni mai yawa).

An ba da shawarar marasa lafiya da ke cikin haɗari don saka idanu sosai a kan abubuwan da ke cikin potassium a cikin jini (duba "Haɗin kai").

Sorbitol. Wannan magani yana dauke da sihiri (E420). Marasa lafiya tare da rashin haƙuri na fructose mai haƙuri bai kamata su ɗauki Telzap ® ba.

Banbancin kabilanci. Kamar yadda aka sani ga masu hana ACE, telmisartan da sauran ARA II suna da alama suna rage karfin jini a ƙasa da kyau a cikin marasa lafiya na tseren Negroid fiye da wakilan sauran jinsi, watakila saboda babban tsinkaya don raguwa a cikin ayyukan renin a cikin yawan waɗannan marasa lafiya.

Misc Kamar yadda yake tare da sauran magungunan rigakafin ƙwayar cuta, raguwar wuce kima a cikin karfin jini a cikin marasa lafiya tare da ischemic cardiomyopathy ko CHD na iya haifar da haɓaka infarction na zuciya ko bugun jini.

Tasiri kan iya tuka motoci, abubuwan aiki. Karatuttukan asibiti na musamman don nazarin tasirin kwayoyi akan karfin tuƙin mota da hanyoyin da ba a gudanar dasu ba. Lokacin tuki da aiki tare da kayan aikin da ke buƙatar ƙara yawan kulawa, yakamata a kula, saboda ƙoshin ruwa da nutsuwa na iya kasancewa da wuya su faru yayin ɗaukar Telzap ®.

Mai masana'anta

Zentiva Saalyk Yurunleri Sanayi ve Tijaret A.Sh., Turkiya.

Kucukkaryshtyran gundumar, st. Merkez, A'a 223 / A, 39780, Buyukkaryshtyran, Luleburgaz, Kırklareli, Turkey.

Mai riƙe da takardar rajista. Sanofi Russia JSC. 125009, Russia, Moscow, ul. Tverskaya, 22.

Ya kamata a aika da sanarwa game da ingancin miyagun ƙwayoyi zuwa adireshin Sanofi Russia JSC: 125009, Russia, Moscow, ul. Tverskaya, 22.

Waya: (495) 721-14-00, fax: (495) 721-14-11.

Formaddamar da tsari da abun da ke ciki

Ana samun Telzap a cikin nau'ikan allunan da aka rufe tare da fim mai nauyin 40 MG da 80 MG. Ana sayar da guda 10 cikin blisters, a cikin kwalin kwali akwai blister 3, 6 ko 9 da umarnin don amfani da Telzap.

1 kwamfutar hannu 1 ya ƙunshi abu mai aiki: telmisartan - 40 MG ko 80 MG da abubuwan taimako: povidone 25, meglumine, sodium hydroxide, sorbitol, magnesium stearate.

Duk da haka suna samar da allunan Telzap Plus 80 MG + 12.5 mg, wanda ya ƙunshi 80 MG na telmisartan da 12.5 MG na hydrochlorothiazide - mai diuretic.

Aikin magunguna

Aiki mai mahimmanci telmisartan yana da kaddarorin takamaiman angiotensin II mai karɓar antagonists. Lokacin da aka shigar da shi, miyagun ƙwayoyi suna iya kawar da angiotensin II daga haɗinsa tare da mai karɓa. Haka kuma, dangane da wannan mai karɓar, shi ba mai bincike bane. Telmisartan kawai yana hulɗa tare da masu karɓar angiotensin II ATl. Abunda yake aiki baya nuna kwatancen makamancin wannan ga mai karɓar AT2 da wasu.

A ƙarƙashin tasirin miyagun ƙwayoyi a cikin jini na jini, haɗuwa na aldosterone yana raguwa. A lokaci guda, aikin renin ya kasance a matakin daidai kuma ba a katange tashoshin ion ba.

Angiotensin-mai canza enzyme wanda ke daukar nauyin lalata bradykinin ba'a hana shi ba. Wannan fasalin yana ba ku damar kawar da haɗarin ci gaban sakamako kamar bushe tari.

Lokacin amfani da sashi na 80 MG a cikin marasa lafiya, an katange tasirin cutar angiotensin II. Ana samun tasirin sa'o'i 3 bayan kashi na farko. Wannan aikin ya dauki tsawon awanni 24. An dauke shi mai tasiri a asibiti na tsawon awanni 48. Allunan cin abinci na yau da kullun don makonni 4-8 yana haifar da sakamako mai lalacewa.

Amfani da Telzap a cikin marasa lafiya da hauhawar jini na jijiya na iya rage yawan tashin hankali da hauhawar jini na systolic. A halin yanzu, bugun zuciya baya canzawa.

Ana amfani da maganin don magance cututtukan zuciya. A cikin tsofaffi marasa lafiya da ke dauke da cututtukan cututtukan zuciya, allunan suna da tasirin rage yawan:

shanyewar jiki
infarction na zuciya
mace-mace saboda cutar zuciya.

Alamu don amfani

Me ke taimaka wa Telzap? Babban alamu don amfanin Allunan:

IHD a cikin marasa lafiya fiye da shekaru 55.
Yin rigakafin cututtuka na tsarin zuciya.
Yin rigakafin mace-mace sakamakon cututtukan zuciya a cikin marasa lafiya a cikin haɗari (don rigakafin bugun zuciya, bugun jini, gazawar zuciya tare da mummunan sakamako).
Yin rigakafin rikice-rikice daga zuciya da jijiyoyin jini a cikin nau'in ciwon sukari na 2.
Hawan jini sosai - sama da 140/90 don mahimmanci da wasu nau'in hawan jini.
A zaman wani yanki na hadadden jiyya bayan bugun jini ko harin ischemic.

Hawan jini

Amfani da kwanciyar hankali na Telzap tare da aliskiren yana contraindicated a cikin marasa lafiya tare da gazawar renal (GFR kasa da 60 ml / min / 1.73 m2 na yankin farfajiya na jiki).

Amfani da lokaci guda na Telzap tare da masu hana ACE an hana shi cikin marasa lafiya da ke fama da cutar sankarar hanta.

A cikin marasa lafiya tsofaffi, ba a buƙatar daidaita sashi ba.

Telzap Plus

Oauki bakin, sau ɗaya a rana, a wanke da ruwa, ba tare da la'akari da abincin ba.

Marasa lafiya waɗanda BP ba za a iya sarrafa su da kyau tare da monotherapy tare da telmisartan ko hydrochlorothiazide ya kamata su ɗauki Telzap Plus.

Kafin canjawa zuwa hadewar-matsakaicin hade, ana bada shawarar kowane bangare na kowane kashi. A wasu yanayi na asibiti, ana iya yin jujjuyawar canji kai tsaye daga monotherapy zuwa magani tare da haɗaɗɗen ƙwayar cuta.

Karanta wannan labarin: A wane matsin lamba ne ga shan Korinfar: umarni, farashi da bita

Za a iya amfani da magani na Telzap Plus, sau ɗaya a rana don marasa lafiya waɗanda ba za a iya sarrafa haɓakar jininsu yadda yakamata lokacin shan telmisartan a kashi 80 a kowace rana.

Side effects

A wasu marasa lafiya, shan Telzap na iya tayar da bayyanar tasirin sakamako.

Dyspnea da tari ba sa faruwa. Da wuya, cutar huhu na faruwa.
Wasu marasa lafiya suna koka da rashin bacci, rashin jin daɗi, ƙara damuwa. A lokuta da dama, akwai suma.
A cikin mata, cututtukan kumburi na tsarin haihuwa na iya faruwa, a lokuta mafi ƙaranci, ana lura da mummunan yanayin haila. A cikin maza, lalata daskararre mai yiwuwa ne.
Akwai wata shaida game da haɓakar thrombocytopenia, eosinophilia da ƙananan haemoglobin.
A cikin jerin irin waɗannan sakamako masu illa ya kamata a kira shi hyperhidrosis, itching fata, fatar. Eczema, angioedema, erythema, mai guba da cututtukan fata basuda wuya a gano su.
Daga cikin sakamako masu illa da ake kira lalacewa na aiki. Daga cikin wadannan cututtukan akwai gazawar koda.
Daga tsarin narkewa, zawo, ciwon ciki, amai, flatulence da dyspepsia suna faruwa sau da yawa fiye da wasu. Rashin jin daɗi, rashin jin daɗi a cikin yankin na epigastric, bushewar mucosa a cikin kogon bakin yana da wuya a lura.

Tsarin zuciya da jijiyoyin wuya ba da amsa ga al'amuran masu illa da jiyya na Telzap. A halin yanzu, marasa lafiya suna yiwuwa:

saukar da saukar karfin jini tare da canza matsayin mutum,
tashin hankali fainting
raguwa ko karuwa a yawan zuciya.

Rashin hankali na ƙwayar hanta da hanta suna da wuya sosai.

Yin amfani da maganin na iya haifar da raguwa cikin sukari jini da acidosis metabolic.

Daga halayen rashin lafiyan, masu yiwuwa suna da yiwuwar:

Kayan magunguna

Pharmacokinetics

Yin amfani da hydrochlorothiazide da telmisartan lokaci guda ba zai tasiri kan magungunan magungunan waɗannan magungunan ba.

Telmisartan: Bayan gudanar da baki, mafi girman tasirin telmisartan an kai shi ne bayan awa 0.5 - 1.5. cikakkiyar bioavailability na telmisartan a cikin kashi 40 mg da 160 mg shine 42% da 58%, bi da bi. Lokacin ɗaukar telmisartan lokaci guda tare da abinci, raguwa a cikin AUC (yanki a ƙarƙashin tsarin lokaci-lokaci) ya tashi daga 6% (a kashi 40 mg) zuwa 19% (a kashi na 160 mg). 3 hours bayan shigowa, maida hankali ne a cikin matakan jini na jini ya fita, ba tare da cin abincin ba. Decreasearamin ragewa a cikin AUC baya haifar da raguwa a cikin ingancin warkewar cutar. Magungunan magunguna na telmisartan na baka shine ba a kwance ba a allurai na 20-160 mg tare da karuwa gwargwadon yawan ƙwayar plasma (Cmax da AUC) tare da ƙaruwa da yawa. Babu wani muhimmin taro na telmisartan da aka gano.

Hydrochlorothiazide: Bayan gudanar da maganin baka na Telzap Plus, mafi girman yawan hydrochlorothiazide an kai shi zuwa awa 1.0 zuwa 3.0 bayan shan maganin. Dangane da tarawar koda na iskar gas na hydrochlorothiazide, cikakken bioavailability kusan kashi 60% ne.

Telmisartan yana da matukar mahimmanci ga garkuwar plasma (fiye da kashi 99.5%), akasarinsu tare da albumin da glycoprotein alpha-1-acid. Volumeimar rarraba kusan 500 L, wanda ke nuna ƙarin sashin nama.

Hydrochlorothiazide 68% an ɗaure su ne daga ƙwayoyin plasma kuma ƙarar rarraba shine 0.83 - 1.14 l / kg.

Telmisartan metabolized by conjugation tare da samuwar pharmacologically m acylglucuronide. Glucuronide na mahaifa shine kawai metabolite da aka gano a cikin mutane. Bayan kashi ɗaya na 14C mai suna telmisartan, glucuronide shine kusan 11% na aikin radiostivity da aka auna. Cytochrome P450 da isoenzymes basa shiga cikin metabolism na telmisartan.

Hydrochlorothiazide ba metabolized a cikin mutane

Telmisartan: Bayan gudanarwa na ciki ko na baka na 14C-wanda aka yiwa lakabi da telmisartan, mafi yawan magungunan da aka gudanar (> 97%) an kebe su a feces ta hanyar biliary excretion. An samo ƙananan kundin a cikin fitsari.

Jimlar fitar plasma na telmisartan bayan gudanar da maganin shine> 1500 ml / min. Rayuwar rabin rayuwar shine> awanni 20.

Hydrochlorothiazide excreted kusan gaba daya canzawa a cikin fitsari.Kusan kashi 60% na maganinn bakin cikin an cire shi cikin awoyi 48. Enaladdamar da hukunci shine kimanin 250 - 300 ml / min. M rabin rai ne 10 zuwa 15 hours.

Tsofaffi marasa lafiya

Magungunan likitancin telmisartan ba su da bambanci ga tsofaffi da marasa lafiya waɗanda shekarunsu ba su kai 65 ba.

Yawan Plasma na telmisartan sun ninka 2-3 sau na mata sama da na maza. A cikin karatun asibiti, babu wani gagarumin ƙaruwa a cikin martanin matsin lamba na jini ko kuma yawan tashin hankali na orthostatic a cikin mata. Ba a buƙatar gyaran gyaɗa. An lura da fifiko ga ƙwayoyin plasma na hydrochlorothiazide a cikin mata fiye da maza. Ba shi da mahimmanci a asibiti.

Marasa lafiya tare da gazawar koda

Gangaren rariya ba ya tasiri a kan keɓar telmisartan. Dangane da sakamakon ƙarancin ƙwarewa tare da Telzap Plus a cikin marasa lafiya tare da ƙarancin gazawar matsakaici (lalacewa na 30-60 ml / min, matsakaicin darajar kimanin 50 ml / min), daidaita sashi ba lallai ba ne a cikin marasa lafiya tare da rage aikin renal. Ba a cire Telmisartan daga jini ta hanyar hemodialysis ba. A cikin marasa lafiya da ke fama da rauni na aikin ƙirar, ana rage yawan kawar da hydrochlorothiazide. A cikin binciken a cikin marasa lafiya tare da matsakaiciyar karɓar creatinine na 90 ml / min, rabin rayuwar hydrochlorothiazide ya ƙaru. A cikin marasa lafiya tare da koda na rashin aiki, cire rabin rayuwa shine kusan awanni 34.

Marasa lafiya tare da raunin hanta

A cikin marasa lafiya da rashin isasshen hepatic, cikakken bioavailability na telmisartan yana ƙaruwa zuwa 100%. Rabin rayuwar don gazawar hanta baya canzawa.

Farmakodinamika

Telzap Plus shine haɗin maganin antagonistin II mai karɓar angiotensin II (ARAII), telmisartan, da thiazide diuretic, hydrochlorothiazide. Haɗin waɗannan abubuwan yana da tasirin antihypertensive ƙari, rage karfin jini zuwa mafi girma fiye da kowane bangaren shi kaɗai. Telzap Plus idan aka sha shi sau ɗaya a rana yakan haifar da ingantaccen raguwa da nagarta sosai a hawan jini.

Telmisartan ingantacce ne kuma takamaiman (mai zaɓa) angiotensin II receptor antagonist (nau'in AT1) don gudanar da maganin baka. Telmisartan mai kama da sikelin wanda ke canza yanayin angiotensin II daga rukunin sa da ke cikin masu karɓar subtype 1 (AT1), waɗanda ke da alhakin sanannen tasirin angiotensin II. Telmisartan bai nuna wani aikin agonist mai tsayayya da mai karɓar AT1 ba. Za a haɗa Telmisartan a cikin mai karɓar AT1. Yin linzami na dogon lokaci. Telmisartan bai nuna kusanci ga sauran masu karɓar ba, gami da karɓar AT2 da sauran su, ƙarancin masu karɓar AT karɓar.

Babban mahimmancin mahimmancin waɗannan masu karɓar, da kuma tasirin tasirin tasirinsu mai yawa tare da angiotensin II, wanda yake ƙaruwa wanda yake ƙaruwa tare da alƙawarin telmisartan, ba a yi nazari ba.

Telmisartan yana rage matakan plasma aldosterone, baya toshe renin a cikin tashoshin plasma na mutum da ion.

Telmisartan baya hana sinadarin enzyme agiotensin-mai canzawa (kinase II), wanda ke rage haɓakar bradykinin. Don haka, babu ƙara girman tasirin sakamako masu dangantaka da aikin bradykinin.

Kashi 80 na telmisartan, ana gudanar da shi ga masu ba da agaji lafiya, kusan gabaɗaya yana hana haɓakar matsin lamba ta hanyar haɗuwa da angiotensin II. Ingancin hana aiki na ci gaba sama da awanni 24 (har zuwa awanni 48).

Bayan shan kashi na farko na telmisartan, hawan jini yana raguwa bayan sa'o'i 3. Matsakaicin raguwa a cikin karfin jini, a matsayin mai mulkin, ana samun makonni 4-8 bayan farawar magani kuma yaci gaba da warkarwa na dogon lokaci.

Tasirin antihypertensive yana ɗaukar sa'o'i 24 bayan shan maganin, ciki har da awowi 4 kafin ɗaukar kashi na gaba, wanda aka tabbatar da shi ta hanyar ma'aunin jini, da kuma ƙwaƙƙwaran ƙwaƙwalwar ƙwayar cuta (sama da 80%) na mafi ƙarancin magunguna bayan shan 40 da 80 MG na telmisartan a cikin placebo-sarrafawa karatun asibiti.

A cikin marasa lafiya tare da hauhawar jini, telmisartan yana rage duka systolic da diastolic saukar jini ba tare da shafi yawan zuciya ba. Ingancin antihypertensive na telmisartan yana daidai da wakilan sauran azuzuwan magungunan antihypertensive (kamar yadda aka nuna a karatun asibiti yayin kwatanta telmisartan da amlodipine, atenolol, enalapril, hydrochlorothiazide, da lisinopril).

A cikin makafi biyu, gwajin asibiti mai sarrafawa (N = 687 marasa lafiya waɗanda aka kimanta su don inganci), daidaikun mutanen da basu amsa rakiyar 80 mg / 12.5 mg sun nuna sakamako na hankali na rage karfin jini na haɗuwa na 80 mg / 25 mg idan aka kwatanta da magani na dogon lokaci tare da kashi 80 MG / 12.5 mg 2.7 / 1.6 mmHg (SBP / DBP) (bambanci a cikin daidaitattun sauye-sauye masu daidaitawa a cikin abin da ya shafi yanayin). A cikin binciken tare da haɗakar 80 mg / 25 MG, hawan jini ya ragu, yana haifar da raguwar gaba ɗaya na 11.5 / 9.9 mmHg. (GARDEN / DBP).

Babban binciken da aka yi a kan makwanni biyu masu kama 8-mako biyu, makafi, gwajin asibiti mai sarrafa kansa yana kwatanta valsartan / hydrochlorothiazide 160 mg / 25 mg (N = 2121 marasa lafiya waɗanda aka kimanta su don inganci) sun nuna babban sakamako na rage karfin jini 2.2 / 1.2 mm Hg . (SBP / DBP) (bambanci a cikin daidaitattun ma'anar canje-canje daga tushe, bi da bi) a cikin goyon baya na haɗuwar telmisartan / hydrochlorothiazide 80 MG / 25 MG.

Bayan katsewa daga jiyya tare da telmisartan, hawan jini a hankali ya dawo zuwa ga darajar sa ta farko a cikin kwanaki da yawa ba tare da alamun “sake dawowa” hawan jini ba.

A cikin karatun asibiti kai tsaye idan aka kwatanta hanyoyin biyun, cutar bushewar ta ragu sosai a cikin marassa lafiyar da ke karɓar telmisartan fiye da waɗanda ke karɓar inzyitors na angiotensin-wanda ke jujjuyar inzyitors.

Nazarin PRoFESS da aka gudanar a cikin marasa lafiya waɗanda suka girmi shekaru 50 waɗanda suka sami rauni a kwanan nan sun nuna karuwa a cikin sepsis tare da telmisartan idan aka kwatanta da placebo, 0.70% idan aka kwatanta da 0.49% KO 1.43 (95% tazara tsakanin 1.00 - 2.06), yawan adadin mutuwar daga sepsis ya kasance mafi girma a cikin marasa lafiya suna shan telmisartan (0.33%) idan aka kwatanta da marasa lafiya suna shan placebo (0.16%) OR 2.07 (95% tsaka-tsakin amincewa 1.14 - 3.76). Observedarin da aka lura yana faruwa a cikin faruwar wani ɓarin ciki wanda ya danganta da amfani da telmisartan na iya zama ko dai wani lamari ne na asali ko kuma yana iya hadewa da wata hanyar da ba a san ta ba.

Ba a san illar telmisartan akan mace-mace da cututtukan zuciya a halin yanzu. Hydrochlorothiazide mai lalata ne thiazide. Ba'a san cikakken tsarin aikin antihypertensive na tasirin thiazide ba. Thiazides yana shafar hanyoyin keɓaɓɓen na reabsorption na electrolytes a cikin tubules, kai tsaye yana ƙara narkar da sodium da chloride daidai da adadin. Sakamakon diuretic na hydrochlorothiazide yana rage yawan ƙwayar plasma, yana ƙara yawan aikin renon plasma, yana ƙara ɓoyewar aldosterone, yana ƙaruwa da haɓakar potassium a cikin fitsari, asarar bicarbonate da raguwa a cikin ƙwayoyin ƙwayar ƙwayar ƙwayar magani. Mai yiwuwa ta hanyar toshewar tsarin renin-angiotensin-aldosterone, haɗin gwiwar telmisartan, a matsayin mai mulkin, yana hana asarar potassium da ke hade da waɗannan diuretics. Lokacin amfani da hydrochlorothiazide, farkon diureis yana faruwa bayan sa'o'i 2, kuma tasirin girma yana faruwa bayan kimanin sa'o'i 4, yayin da tasirin yaci gaba har zuwa awanni 6 zuwa 6.

Nazarin cututtukan cututtukan dabbobi sun nuna cewa tsawan magani tare da hydrochlorothiazide yana rage haɗarin mutuwar zuciya da cututtukan zuciya.

Yara, yayin ciki da lactation

Babu wani ingantaccen bayani game da amincin wannan magani yayin daukar ciki. Idan mara lafiya yana shirin daukar ciki, kuma tana buƙatar ɗaukar magani don rage matsin lamba, ana ba da shawarar shan magunguna madadin.

Yin amfani da kwayoyi daga rukuni na hanawa, angiotensin antagonists a cikin kashi na 2 da na 3 yana ba da gudummawa ga ci gaban lalacewar kodan, hanta, jinkirta ossification na kwanyar cikin tayin, oligohydramnion (raguwa a cikin adadin ƙwayar amniotic).

Amfani da miyagun ƙwayoyi yayin shayarwa yana da tsayayye.

Hulɗa da ƙwayoyi

Ana amfani da Telzap sau da yawa a matsayin wani ɓangare na kulawa mai wahala, saboda haka kuna buƙatar la'akari da jituwa na Allunan tare da wasu kwayoyi.

Ba a ba da haƙuri ga masu ciwon sukari na nau'in 2 don ɗaukar telmisartan tare da sauran masu hana ACE a lokaci guda. A mafi yawan lokuta, wannan yana haifar da hypoglycemia.

Magungunan ba da shawarar don amfani ba: