Ọgwụ Ramipril C3: ntuziaka maka ojiji

Na isi ya, Ramipril bụ ọgwụ metụtara Ihe mgbochi ACE (angiotensin na - agbanwe enzyme), i.e. nye ìgwè nke na - arụ ọrụ nke ọma na ọgwụgwọ nke obi obara. N'ihi mmetụta nke ọgwụ na ahụ mmadụ na-amalite imepụta ramiprilat, nke n’aka nke ya, na-eji nwayọ nwayọ nwayọ angiotensin I rue angiotensin II, na - etinyekwa aka na njikọ nke ikpeazụ na akwara.

N'ihi nsonaazụ nke ọgwụ ọgwụ, itinye uche na ahụ na-agbada angiotensin IInke negosi ike zuru oke vasoconstrictor bekee. Site na iwepu nzaghachi na-ezighi ezi mgbe ewepụtara ya reninizo ya ezo aldosteronesi otú a na-ebelata ngụkọta na -akpata akwara vaskụla.

N'otu oge, nnabata ndidi na-abawanye n'ihi mmụba nke olu obi kwa nkeji na iguzogide ya akwara arịa. Ọgwụ nwere mmetụta na ya arịa akụrụma bidokwa usoro ahụ ịrụzigharị usoro akụrụngwa. Ramipril na-ebelata nguzogide n'ozuzuakụkụarịa nke akụrụ, akwara, umeji, anụ ahụ na ụbụrụnkwalite ọbara na-erugharị n’arụ ahụ.

Antihypertensive utịp ọgwụ ahụ malitere n’ime awa ole na ole ọ nwesịrị nchịkwa. Site na ị regularụ ọgwụ ahụ oge niile maka izu 4, achọpụtala mmụba nwayọ antihypertensive ọrụ, Nke a na-ahụkarị nke kwesịrị ka ọ were ọgwụgwọ were ogologo oge ruo ọtụtụ afọ.

Ọgwụ na-ebelata omume nke ugboro ugboro ọrịa ụbụrụ, infarction myocardialn'ime ndị ọrịa mgbe ọdịnala gara aga ma ọ bụ na-arịa ọrịa arịa akụkụka Ọrịa ụbụrụ Ischemic. Na mgbakwunye, ọgwụ ahụ na-enyere aka izere mmepe. ọrịa shuga mellitusn’ebe ndị ọrịa nwere akụkọ ihe mere eme nke ihe dị ka ọbara mgbali elu, microalbuminuria, cholesterol dị elu na HDL dị ala (nnukwu npoproteins dị elu).

Ramipril na-abanye n'ime 60% n'ime ahụ, nri anaghịkwa emetụta ogo oriri ọgwụ. Maka mmetụta ọgwụ dị mma nke ọgwụ ahụ, onye ọrịa ahụ ga-arụ ọrụ n'ụzọ ziri ezi imeju, nke a na-emebi agbụ etheric ma kpụzieramiprilatna-eme ka usoro agụmakwụkwọ dị ngwa metabolites.

Mgbe awa 2 gachara ị takingụ ọgwụ ahụ n’ime ahụ, a na-enweta ntinye uche kachasị nke ogige dị ike, nke ewepụrụ kpamkpam ka awa 17 n’arụ na mmamịrị ya.

Ihe ngosi maka ojiji

A na-atụ aro iji ọgwụ ahụ eme ihe maka:

obi obaraọdịdị na-adịghị ala ala
ọrịa shuga,ọrịa akụrụ yi na-enye ụdị (ọrịa anaghị arịa ọrịa mamịrị),
ọbara mgbali ike,
ibelata n'ihe gbasara nke puru omume infarction myocardial, ọrịa strok, Coronary ọnwụ.

Na mgbakwunye, a na-eji Ramipril na ọgwụgwọ nke ndị ọrịa na-eme nkụchi obi, ọnya afọ, ka transiouminal angioplastynaakwara ọbara akwara hazie grafting.

Ihe ngbanwe

A naghị atụ aro ka ị theụ ọgwụ mgbe hypersensitivity ka Ihe mgbochi ACEna hypotension, hyperkalemia, gbasara akwaranakwa n'oge nke afọ ime na n’imeoge lactation.Na mgbakwunye, a na-atụ aro izere Ramipril n'ịgwọ ụmụaka n'okpuru afọ 18 na ndị ọrịa agadi.

Belata iji ọgwụ ọjọọ eme ihe ma ọ bụrụ na akụkọ ntolite angioedema, mwepu, ọrịa autoimmune siri ike, mgbasa na-adịghị mma, atherosclerosis, stenosis, mgbe ọ nwesịrị akụrụ, na-arịa ọrịa shuga.na ụfọdụ ọrịa ngụgụ, hyponatremia, dialysis.

Nsonaazụ

Mgbe ị na-a theụ ọgwụ ahụ, mmetụta ndị dị ka: obi obarahypotension, angina pectoris, infarction myocardial, syncope, vertigo, arrhythmia, vasculitis, thrombocytopenia, ọgbụgbọ na ọgbụgbọ, afọ ọsịsa, iche iche, afọ ntachi, akwara, dysgraphia, ọrụ imeju, ụdọ, ịba ụba mmanụ, ọgbụgbọ na isi ọwụwa, asthenia, ọnọdụ, ụra, neuropathy, mkpọtụ, nsogbu nke ihi ụra, ịnụ ụkwara, necrosis, ọria ihu, ụkwara, mkpụmkpụ ume, sinusitis, pharyngitis, rhinitis, laryngitis, photoensitivity, yana felata, angioedema, fever.

Ntụziaka maka iji Ramipril (Usoro na usoro onunu ogwu)

Dabere na ntuziaka maka ojiji nke Ramipril, a na-amalite ị oụ ọgwụ ahụ na ọgwụ erughi 2.5 mg. kwa ụbọchị. Ofzọ eji ọgwụ ahụ, yana usoro onunu ogwu, nwere ike ịdị iche iche site na ndenye dọkịta na-aga ya, yana n'ọrịa dị iche iche yana ọnọdụ onye ọrịa.

Dodoụbiga ya ókè

N'ihe banyere ịdoụbiga mmanya ókè, a na-ahụ ihe mgbaàmà ndị a na ndị ọrịa: hypotension, angioedema, nsogbu ọbara, nkụchi obi na njikọta thromboembolic.

Maka ọgwụgwọ nke nsonaazụ nke ọgwụ ezighi ezi sachara afona -eme ihe omume iji mee ka olu ha di elu ọbara na - ekusa, yana ịkwụsị kpam kpam ma ọ bụ belata ọgwụ Ramipril.

Mmekorita

Mmetụta ọgwụgwọ nke ọgwụ a na-emeziwanye ike antihypertensives. Iji zere hypoglycemia, hyperaldosteronismna-abawanye n'ihe ize ndụ nke mmepe neutropeniaEjighị ọgwụ ahụ na njikọta ọgwụ antidiabetic, diureticsyana uzo mmetụta myelosuppressive, potassium emeju na-eji dochie nnu.

Ntụziaka pụrụ iche

Tupu ị theụ ọgwụ ahụ, dị ka n'oge ọgwụgwọ n'onwe ya, nye ndị ọrịa (karịsịa nwere ọrịa njikọta anụ ahụ nke uwa na - agbasawanyeyana onye obia Allopurinol na immunosuppressants) a na-atụ aro ka ịnwale ya mgbe niile ihe mejupụtara akụrụ na ọbara electrolytegụnyere akụkụ.

Na-arịa Ọrịa sodium ụkọ tupu ịmalite usoro ọgwụgwọ kwesịrị ịmaliteghachi na nkịtị mmiri na - egosi mmiri. Amachibidoro iji oge iji ọgwụ eme ihe ịba ọcha n'anya site n'enyemaka polyacrylonitrile membranes.

Nyocha nke Ramipril

Imirikiti ndị ọrịa na-eji ọgwụ mbụ, ma ọ bụghị ọnụ ahịa ego dị oke ọnụ, gụnyere ndị na-emepụta ụlọ, na-ahapụ nzaghachi dị mma banyere Ramipril. Agbanyeghị, ọtụtụ ndị mmadụ na-ahụta dị ka ihe na-adịghị mma na ọgwụ ahụ nwere oke aha zuru oke nke nsonaazụ ndị ọ na-akpata.

Sistemu mara ọgwụ a

"Ramipril", analogues nke ọgwụ ahụ, yana ọgwụ ọgwụ dị mgbagwoju anya bụ ndị na - egbochi ọgwụ mgbochi. Ramipril n'onwe ya bụ ihe na-arụ ọrụ nke a na-ahụ n'ọtụtụ ọgwụ. Ọ bụ ihe mgbochi ACE nwere ike igbochi enzyme na obere ọbara mgbali. Ọ na - enyere gị aka ịkwalite prognosis nke ọrịa ọrịa na ndị agadi.

Ihe omumu ihe omumu gosiputara na ramiprilat, metabolism nke Ramipril na aru oru, na egbochi oria ndi mmadu itughari enzyme. N'ihi nke a, Ramipril, analogues na nhazi dị mgbagwoju anya bụ ụzọ a ga-ahọrọ maka ọbara mgbali elu na-achịkwa.

Ebe ọgwụ ahụ nwere ike igbochi ACE ma nyere aka ijikwa ọbara mgbali elu, Ramipril nwere ọtụtụ analogues. A na-eji ha niile mee ihe nke ọma na ọgwụgwọ ọbara mgbali elu. Ọzọkwa, ramipril mbụ bụ ọgwụ "Tritace". Ihe ndị ọzọ niile bụ agbụrụ ya, arụmọrụ nke ekwesịrị iji ya tụnyere ya. Ekwesịrị itinye nkwenye ire ga-enyocha ọgwụ sitere na ọgwụ Tritace.

N'oge a, ndepụta analogues dị ka ndị a: Amprilan, Vazolong, Dilaprel, Korpril, Pyramil, Ramepress, Ramigamma, Ramicardia, Tritace, Hartil. A na-emepụta Ramipril site na ụlọ ọrụ ndị Russia Tathimpharmpreparaty, Biokom na Severnaya Zvezda. A na-akpọ ngwaahịa nke ndị ikpeazụ a Ramipril SZ.

Usoro onunu ogwu na nkwadebe di omimi

Ọgwụ antihypertensive Ramipril dị mfe ị doseụ ọgwụ ma were. Ọrụ ya na-enye gị ohere ịmata ụzọ atọ dị n'usoro ọgwụ. Ndị a bụ 2.5 mg, 10 na 5 mg. Mbadamba ụrọ a na - ewere ugboro abụọ n'ụbọchị. E nwekwara ọgwụ ndị dị mgbagwoju anya nke nwere ramipril na hydrochlorothiazide: Amprilan ND, Amprilan NL, Vazolong N, Remazid, Triapin, Tritace Plus, Hartil D, Egypt. N'ebe a, ọnụọgụ ramipril sitere na 2.5 mg ruo 10, yana dose nke hydrochlorothiazide sitere na 12.5 ruo 25 mg na otu mbadamba.

Seconddị nke abụọ nke ọgwụ mgbagwoju anya bụ nchikota Ramipril na onye na-emegide calcium, Amlodipine. Ihe atụ nke ọgwụ bụ Egipress, nke dị na usoro ọkọlọtọ abụọ: 10 mg ramipril na 5 mg amlodipine, yana kwa 10/10 mg. Na mgbakwunye na ngwakọta a, enwere ụdị ọgwụ ọzọ nwere ACE inhibitor Ramipril na calcium antagonist Felodipine. Nke a bụ Triapin, nke nwere 2.5 mg nke ramipril na 2.5 mg nke felodipine.

Ntuziaka maka iji

Na mgbakwunye na ndụmọdụ dọkịta, onye ọrịa ahụ kwesịrị iburu ntuziaka maka ojiji. O nwere ihe omuma banyere ihe ngosi, nsogbu ndi ozo, usoro onunu ogwu na usoro ochichi, contraindications na akpachara anya. Ọzọkwa, ntuziaka maka ojiji agbakwunyere nkwadebe Ramipril na-akọwa mkpa ọ dị ịhapụ ị alcoholụ mmanya n'oge ọgwụgwọ ọbara mgbali elu.

Ramipril, analogues nke ọgwụ na ụdị Tritace gosipụtara maka:

ọbara mgbali elu,
dị ka akụkụ nke usoro ọgwụgwọ multiclass dị mgbagwoju anya nke ọrịa obi na-adịghị ala ala.
ọrịa shuga na ndị ọzọ nephropathy na clinical ma ọ bụ subclinical ogbo, ejikọghị ya na akwara akwara stenosis,
ya na obara obara otiti,
maka mgbochi nke infarction myocardial, mbelata onwu na ndị ọrịa nwere ọrịa obi, yana maka ọgwụgwọ ọbara mgbali elu nwere nnukwu ọrịa obi.

Ihe kachasị egosi bụ ọbara mgbali elu. Nke a bụ ọrịa kachasị n'etiti etiti na agadi, na-achọ mgbazi. Ọzọkwa, ọgwụ ahụ "Ramipril" ma ọ bụ ihe mgbochi ACE ọzọ ka a ga-enyerịrị ndị ọrịa na mkpụrụ ụbọchị abụọ mbụ ruo 9-9 site na oge nnukwu ọrịa myocardial infarction. ọgwụ dose kwesịrị karịa anabata ọbụna mgbe ọrịa anaghị ata ahụhụ site na ọbara mgbali. Nke a bụ n'ihi nsonaazụ dị egwu nke ndị na - egbochi ACE.

Usoro onunu ogwu

Maindị usoro ọgwụgwọ Ramipril dị mkpa bụ mbadamba ihe. Na capsules, ọ bụ ihe a na-ahụkarị. N'okwu a, usoro ọgwụgwọ akwadoro ka ọ bụrụ 1.25 mg. Obere usoro ọgwụ a bụ 2.5 mg, nke na-eme ka e kee ya abụọ. Linenweta ahịrị na mbadamba ụrọ na-eme ka nke a dị mfe.

Site na ụdị ọbara mgbali ọ bụla, ọgwụ mbụ bụ 1.25 mg otu ugboro n'ụbọchị. Mgbe ahụ, na ntachi obi dị mma, dose ahụ ji nke nta nke abụọ. A na-eme titotse dose ruo mgbe onye na - egosi ọbara ọbara kwụsiri ike. Ihe a ma ama maka ọgwụgwọ dị mma nke ọbara mgbali elu bụ ọbara mgbali elu, nke na-adịkarị ala na izu ike.

Nchedo nchekwa

Ekwesịrị ị drugụ ọgwụ ahụ n'okpuru nchịkwa nke nrụgide, karịsịa maka oge mbụ. Ọ dị mkpa na mbelata ọbara systolic adịghị ala karịa 90 mm. Hg. Art. Ọ bụrụ na ọbara mgbali dara n'okpuru ọkwa a, a na-atụ aro ka ị chọọ enyemaka nke ndị ọrụ ahụike. Iji gbochie ọbara mgbali elu, a naghị atụ aro iji Ramipril ọnụ na nitrates, klas I antiarrhythmics (Procainamide) na mgbochi alpha-1 (Alfuzosin, Tamsulozin).

Ekwesịrị ị Theụ ọgwụ ahụ mgbe niile ma ọkacha mma n'otu oge ahụ. Nke a ga - enyere gị aka ịmegharị usoro renin-angiotensin-aldosterone, nke na - edozi ọbara mgbali. Ọzọkwa, ahapụla ị takingụ ọgwụ, nke enwere ike ịkọwa ya site na nnukwu nsogbu mgbali elu. Sharpjụ iwe nke ọma nwere ike ibute ọrịa strok, ihe ọghọm a na-abawanye n'oge a.

Ndị ọrịa na-enyocha ọgwụ

Tritace na mkpụrụ ndụ ihe nketa ya bụ ọgwụ dị mma nke na-achịkwa ọbara mgbali nke ọma. Ruo ugbu a, ọgwụ a bụ ọgwụ kachasị ike nke antihypertensive. Site na nke a, nyocha ndị ọrịa gbasara ya na-adịkarị mma. Ha na-akọwa ya dị ka ọgwụ a pụrụ ịdabere na ma dị ike nke na-achịkwa ọbara mgbali nke ọma. Nyocha dị oke mkpa na nyocha nke ndị ọrịa ahụ were ọgwụ ndị ọzọ na otu a.

Ndị ọrịa hụrụ ọnụọgụ mmerụ ahụ metụtara nsi. Ogologo nmekorita di elu nke ACE, yana obere ogwu nke ogwu a, wepu otutu ihe mmetuta nke aru ike na-adighi nma site na iji ya mgbe niile. Ọ dị mkpa na ọnụ ọgụgụ nke ọgba aghara a na-ejigide Ramipril mgbe niile. Agbanyeghị, mwepu ha zuru oke agaghị ekwe omume na monotherapy.

Nyocha ndị dọkịta banyere ọgwụ

Ndekọ ọbara mgbali elu na-akụda mmụọ. Ọ na-egosi ịdị mkpa nke ọrịa a maka ọgwụ ọgbara ọhụrụ. Ọ dịkwa mkpa na pathology belata oge ịtụ anya ndụ. Ọbara mgbali elu na - ebilite n'ihi oke mmiri renin, nke na - abawanye oke nke angiotensin ọbara. Mmachi nke enzyme a na-eduga na mbelata nrụgide. Nke a dị mkpa iji gbochie sclerosis nke mgbidi arịa yana mpụta nsogbu siri ike ọbara mgbali elu.

Dika ihe omumu ihe banyere ileba anya na egosi, otutu oria ndi mmadu na onwonye n’aria obi na ebido mgbe onye obia nwechara obara n’iru nwa oge. N'ihi ya, mkpa ọ dị ịgwọ ọrịa buru ibu. Nke kachasị mkpa, enwere ike iwepụ ọrịa ahụ na-ekele ndị na-egbochi ACE. N'ime ha, Ramipril bụ nnọọ ike kachasị ike ma dị irè.

Nyocha ndị dọkịta kwuru banyere ya gosiri uru ọ bara. Ọgwụ dị mfe iji, ọ nwere mmeghachi omume ole na ole ma dịkwa irè. Agbanyeghị, n'agbanyeghị agwa ndị a, o nwere ike ọ gaghị ezu iji gwọọ ọbara mgbali elu. Nke a bụ ihe fọrọ nke nta ka 40-50% nke ọrịa.

Ọgwụgwọ ha chọrọ usoro ngwakọta nke mejupụtara ACE inhibitor, diuretic, onye na-egbochi calcium, yana oge ụfọdụ ihe mgbochi beta. Dịka onye na - egbochi enzyme angiotensin - na - agbanwegharị, Ramipril dabara nke ọma. Ya mere, enwere ike ibute ọnọdụ ya mgbe a na-agwọ ọbara mgbali elu, mgbe enwere ike. Ọ bụ ezie na ọtụtụ ndị ọrịa na-ahụta ya dị oke ọnụ maka enweghị ego.

Ihe mejupụtara nke mbadamba 10,00 mg:

Arụ Ọrụ: ramipril - 10.00 mg.
Ndị e mere: lactose monohydrate (shuga mmiri ara ehi) - 174.00 mg, sodium bicarbonate - 10.00 mg, croscarmellose sodium - 4.00 mg, sodium stearyl fumarate - 2.00 mg.

Mbadamba ụrọ nwere usoro ị ofụ ọgwụ nke 2,5 mg - mbadamba biconvex nke agba ọcha ma ọ bụ ihe fọrọ nke nta ka ọ bụrụ ụcha na-enwe ihe ize ndụ.
Mbadamba iji dots nke 5 mg na 10 mg bụ mbadamba nkume gbara gburugburu ma ọ bụ nke fọrọ nke nta ka ọ bụrụ nke na-acha ọcha na akụkụ na ihe ize ndụ.

Ngwongwo ogwu

Mlọ ọgwụ
Metabolite na-arụ ọrụ nke ramipril guzobere n'okpuru nduzi nke enzymes “imeju”, ramiprilat, bụ ihe na - arụ ọrụ ACE inhibitor (ACE okwu: kininase II, dipeptidyl carboxy dipeptidase I), nke bụ peptidyl dipeptidase. ACE na plasma na anụ ahụ na-ejikwa ntụgharị nke angiotensin nke m ka ọ bụrụ angiotensin nke II, nke nwere mmetụta vasoconstrictor, yana ndakpọ nke bradykinin, nke nwere mmetụta vasodilating.
Ya mere, mgbe ị na-ewere ramipril n'ime, nguzobe nke angiotensin II na-agbadata ma bradykinin na-agbakọ, nke na-eduga na vasodilation na mbelata ọbara mgbali (BP). Site na ramipril, mmụba na ọrụ nke sistemu kallikrein-kinin na ọbara na anụ ahụ na-eme ka arụ ọrụ nke usoro prostaglandin na mmụba na njikọta nke prostaglandins, nke na-akpali nguzobe nke nitric oxide na endotheliocytes, na-ebute akwara mbuzo ya na endothelioprotective. Angiotensin II na-akpali mmepụta nke aldosterone, yabụ, iji ramipril na-eduga n'ịbelata nzuzo nke aldosterone na mmụba nke ọdịnaya ion potassium na ọbara.
Site na mbelata nke mkpokọta angiotensin II na ọbara, a na-ewepụ mmetụta ya na nzuzo nke renin site na ụdị nzaghachi na-adịghị mma, nke na-eduga na mmụba nke ọrụ renin na plasma ọbara.
Echere na mmepe nke ụfọdụ ihe ọjọọ (akpan akpan, "ụkwara" ụkwara) jikọtara ya na mmụba nke ọrụ bradykinin.
N'ime ndị ọrịa nwere ọbara mgbali elu, ị raụ ramipril na-eduga n'ịbelata ọbara mgbali n'ọnọdụ "ụgha" na "kwụ ọtọ", na-enweghị mgbakwunye mmụba na obi obi (HR). Ramipril na –ebelata mkpụkọ akwara gbasara akwara, (OPSS), na - emeghi mgbanwe na ọbara gbasara akwara na ọnụego mmụba. Mmetụta antihypertensive na-amalite ịmalite 1-2 awa mgbe ị ofụsịrị ọgwụ otu ọgwụ, rute uru kachasị elu mgbe awa 3-6 gasịrị, ọ na-adịgide ruo awa 24. Site na usoro ramipril, mmetụta antihypertensive nwere ike jiri nwayọọ nwayọọ na-abawanye, na-ejikarị izu site na izu 3-4 nke oge niile. na-a theụ ọgwụ ahụ ma na-adịgide ruo ogologo oge. Contkwụsị ọgwụ ngwa ngwa anaghị ebute mmụba ọbara ngwa ngwa ma dị ịrịba ama (enweghị ọrịa "ndọrọ ego"),
N'ime ndị ọrịa nwere ọbara mgbali elu, ramipril na-ebelata mmepe na oganihu nke myocardial hypertrophy na mgbidi vaskụla.
N'ime ndị ọrịa nwere ọrịa obi na-adịghị ala ala, ramipril na-ebelata OPSS (belata mgbe ebuputara na obi), na-eme ka ikike nke venous dịkwuo ma belata mgbali nke ventricle ekpe, nke, n'ihi ya, na-eduga na mbelata preload na obi. N'ime ndị ọrịa a, mgbe ha na-ewere ramipril, enwere mmụba na mmepụta obi, ụmụ irighiri akwara ma nwekwa ohere ịnagide mmega ahụ ka mma. Na ọrịa mamịrị na-arịa ọrịa mamịrị na-arịa ọrịa mamịrị, na-ewere ramipril na-agbadata ọnụego nke ngụgụ nke ọdịda akụrụ na mmalite nke akwara gbasara njedebe akụrụngwa na, yabụ, na-ebelata mkpa ịba ama ma ọ bụ mmịnye akụrụ. N'ime mmalite nke ọrịa mamịrị ma ọ bụ nephropathy, ọrịa ramipril na-ebelata ọnọdụ albuminuria. N'ime ndị ọrịa nwere nnukwu ihe ibute ọrịa obi n'ihi akwara ọnya (ọrịa obi na-arịa ọrịa akwara, akụkọ banyere ọrịa akwara ozi, ọrịa strok) ma ọ bụ ọrịa shuga nwere obere ihe ize ndụ ndị ọzọ (microalbuminuria, ọbara mgbali akwara, mmụba nke mkpokọta nke mkpokọta cholesterol (OX), mbelata nke ịta nke nnukwu protein lipoprotein cholesterol (HDL-C), ị smokingụ sịga) mgbakwunye nke ramipril na usoro ọgwụgwọ pụtara Ọ belata nke ukwuu ọrịa infịction myocardial, ọrịa strok, na onwu site na ọrịa obi. Na mgbakwunye, ramipril na-ebelata ọnụ ọgụgụ mmadụ na-anwụ, yana mkpa maka usoro nyochaghachi ma na-ebelata mmalite ma ọ bụ ọganihu nke nkụda obi na-adịghị ala ala.
N'ime ndị ọrịa nwere nkụda mmụọ na ngosipụta nke ọrịa bidoro na ụbọchị mbụ nke nnukwu myocardial infarction (ụbọchị 2-9), ramipril, nke bidoro site na ụbọchị 3 ruo nke 10 nke nnukwu myocardial infarction, belata ọnwụ (site na 27%), ihe egwu ọnwụ mberede (site na 30 %), ihe ọghọm nke mmụba nke nkụda obi na oke njọ (NYHA klaasị III-IV klaasị arụ ọrụ) / na-egbochi ọgwụ (23%), ohere nke ụlọ ọgwụ na-esote n'ihi mmepe nke nkụda obi (26%).
N'ime ọha mmadụ n'ozuzu ya, yana ndị ọrịa nwere ọrịa mellitus, ha abụọ nwere ọbara mgbali elu yana ọbara mgbali nkịtị, ramipril na-ebelata ihe ize ndụ nke nephropathy na ntinye nke microalbuminuria.

Mlọ ọgwụ
Mgbe nchịkwa ọnụ gasịrị, ramipril na-abanye ngwa ngwa site na eriri afọ (50-60%). Nri oriri a na-eme n'otu oge ga-akwụsịlata ịmịcha ya, mana anaghị emetụta oke oke oriri. Ramipril nwere usoro metabolism dị omimi / na-arụ ọrụ (nke kachasị nke imeju site na hydrolysis), na-ebute naanị metabolite na-arụ ọrụ, ramiprilat, nke ọrụ ya n'ihe gbasara ACE inhibition dị ihe dị ka ugboro isii karịa ọrụ nke ramipril. Na mgbakwunye, n'ihi metabolism ramipril, a na-emepụta diketopiperazine, nke na-enweghị ọrụ ọgwụ, nke a na-eme ka conjugation na glucuronic acid, a na-agbanye ramiprilat ma metabolized na diketopiperazic acid.
All metabolites guzobere, ma e wezụga ramiprilat, enweghị ọrụ ọgwụ.
Bioavailability nke ramipril mgbe nchịkwa ọnụ sitere na 15% (maka ọgwụ nke 2,5 mg) ruo 28% (maka ọgwụ nke 5 mg). Ihe bioavailability nke metabolite nọ n'ọrụ, ramiprilat, mgbe ingestion nke 2.5 mg na 5 mg nke ramipril dị ihe dịka 45% (ma e jiri ya tụnyere bioavailability ya mgbe nchịkwa intravenous na otu usoro).
Mgbe iwere ramipril n'ime, pilosima kachasị nke ramipril na ramiprilat na-eru mgbe awa 1 na 2-4 gachara. Mbelata na mkpokọta plasma nke ramiprilat pụtara n'ọtụtụ nkebi: nkesa na ntụgharị aka yana ọkara ndụ (T_1/2) ramiprilat, ihe dị ka awa 3, mgbe ahụ etiti na T_1/2 ramiprilat, nwere ihe dị ka awa iri na ise, na ngwụcha ikpeazụ nke nwere ntakịrị ramiprilat na plasma na T_1/2 ramiprilat, ihe dịka 4-5 ụbọchị. Oge ikpeazu a bụ n'ihi nwayọ nke ramiprilat na nkekọ siri ike na ndị na-anabata ACE. Na agbanyeghi ogologo oge ikpeazụ nke iji otu mkpụrụ ọgwụ ramipril na ọnụego nke 2.5 mg ma ọ bụ karịa, e mejupụtara ọkwa plasma nke ramiprilat mgbe ihe dị ka ụbọchị anọ nke ọgwụgwọ gasịrị. Site n'iji ọgwụ ahụ “dị irè” T_1/2 dabere na dose bụ 13-17 awa.
Njikọ ya na protein protein plasma dị ihe dị ka 73% maka ramipril, yana 56% maka ramiprilat.
Mgbe nchịkwa intraven, olu nkesa ramipril na ramiprilat dị 90 L na ihe dịka 500 L, n'otu n'otu.
Mgbe abatasịrị, ramipril (10 mg), nke akara rediototo kpọrọ redirect, 39% nke redioaktivu na-apụ apụ na eriri afọ yana ihe dịka 60% akụrụ. Mgbe nhazi nchịkwa nke ramipril, a na-ahụ ihe dịka 50-60% nke mmamịrị na mmamịrị n'ụdị ramipril na metabolites ya. Mgbe nchịkwa intravenous nke ramiprilat, ihe dị ka pacenti 70 nke ọgwụ a na-ahụ na mmamịrị n'ụdị ramiprilat na metabolites ya, n'ụzọ ọzọ, site na nchịkwa intravenous nke ramipril na ramiprilat, akụkụ dị ukwuu nke ọgwụ ahụ na-apụta site na eriri afọ ya na agbanye na bile, na-agabiga akụrụ (50% na 30%, n'otu n'otu). Mgbe usoro nchịkwa nke 5 mg nke ramipril dị na ndị ọrịa nwere mmịpụta mmiri, ihe fọrọ nke nta ka ọ bụrụ otu ụdị ramipril na metabolites ya bụ akụrụ site na akwara ya na n'ime awa 24 mbụ ka nchịkwa gasịrị.
Ihe dị ka 80-90% nke metabolites dị na mmamịrị na bile ka amatapụtara dị ka ramiprilat na ramiprilat metabolites. Ramipril glucuronide na ramipril diketopiperazine na-ewe ihe dị ka 10-20% nke ngụkọta ego, ihe ramipril na-enweghị atụ na mmamịrị bụ ihe dịka 2%.
Nnyocha ụmụ anụmanụ egosila na ramipril dị na mmiri ara ara.
Bụrụ na arụrụ ọrụ ezigharị ọrụ ya na nwechapụ creatinine (CC) erughi 60 ml / min. excretion nke ramiprilat na metabolites ya site na akụrụ na-agbada. Nke a na-ebute mmụba na mkpokọta plasma nke ramiprilat, nke na-agbada nwayọ karịa ndị ọrịa nwere ọrụ ezumike nkịtị.
Mgbe ị na-ewere ramipril na usoro dị elu (10 mg), ọrụ imeju na-arụ ọrụ na-eduga n'ibelata usoro metabolism nke ramipril na ramiprilat na-arụ ọrụ ngwa ngwa na mkpochapu ramiprilat.
N'ime ndị ọrụ afọ ofufo ahụike na ndị ọrịa nwere ọbara mgbali elu, mgbe a gwọchara ya izu abụọ na ramipril na ọgwụ kwa ụbọchị nke 5 mg, enweghị nchịkọta ọgwụ ramipril na ramiprilat. N'ime ndị ọrịa nwere nkụchi obi na-adịghị ala ala, mgbe a gwọchara ya izu abụọ na ramipril na ntinye kwa ụbọchị nke 5 mg, mmụba 1.5-1.8 na plasma nke ramiprilat na mpaghara dị n'okpuru oge ịchekwa ọgwụ ọgwụ (AUC).
N'ime ndị ọrụ afọ ofufo mere agadi nwere ahụike (afọ 65-76), ọgwụ ọgwụ nke ramipril na ramiprilat adịghị iche na nke ndị ọrụ afọ ofufo siri ike.

Jiri nlezianya

N’otu oge a na-eji ọgwụ Ramipril nwere ọgwụ nwere aliskiren ma ọ bụ angiotensin II receptor antagonists (ya na mgbochi abụọ nke usoro renin-angiotensin-aldosterone (RAAS), enwere ọghọm nke mbelata ọbara mgbali elu, mmepe nke hyperkalemia na arụ ọrụ na-arụ ọrụ na-adịghị mma ma e jiri ya tụnyere monotherapy) (lee. Nkebi "Ntuziaka Pụrụ Iche").
Ọnọdụ nke mbelata ọbara mgbali elu dị oke njọ (yana ọnya ọnya na akwara akwara).
Ọnọdụ tinyere mmụba na ọrụ RAAS, nke, mgbe ejiri gbochie ACE, enwere ihe ọghọm nke mbelata ọbara mgbali elu na ọrụ ezigharị arụ ọrụ:

nnukwu ọbara ọgbụgba, ọkachasị ịba ụba ọbara ọgbụgba,
ọrịa obi ọgụ na-adịghị ala ala, nke ka njọ, ma ọ bụ nke ejiri ọgwụ ndị ọzọ na-egbochi ya,
hemodynamically dị mkpa jikọrọ akwara gbasara akwara akwara (ọnụnọ akụrụ abụọ) - na ụdị ndị ọrịa a, ọbụlagodi mmụba nke ịta nke creatinine n'ọbara ọbara nwere ike bụrụ ngosipụta nke ịdị n'otu na-emebi akwara nke akụrụngwa,
ihe oriri nke gara aga,
ọgba aghara dị na nguzo mmiri-electrolyte n'ihi erughị mmiri na sodium chloride, afọ ọsịsa, vomiting, na ịchafụ oke.

Mmetụta ọrụ nke imeju (enweghị ahụmịhe n'iji ya: ọ ga - ekwe omume na njupụta na adịghị ike nke mmetụta nke ramipril ga - ekwe omume, n'ime ndị ọrịa nwere ọrịa imeju nke ascites na edema, mmụba dị ukwuu nke RAAS ga - ekwe omume)
Ọrụ akụrụngwa arụrụala (CC karịrị 20 ml / min / 1.73 m² nke mpaghara elu ahụ) n'ihi ihe egwu nke ịbawanye hyperkalemia na leukopenia.
Ọnọdụ mgbe akụrụ gbasara akụrụ.
Ọrịa systemic nke anụ ahụ na - ejikọta, gụnyere sistemu lupus erythematosus, scleroderma, ọgwụgwọ concomitant na ọgwụ nwere ike ibute mgbanwe na ọbara nke oke (ikekwe mgbochi ụmị ọkpụkpụ), mmepe nke neutropenia ma ọ bụ agranulocytosis (lee mpaghara “Mmekọrịta na ọgwụ ndị ọzọ”).
Ọrịa shuga mellitus (ihe ize ndụ nke hyperkalemia).
Okenye (nsogbu nke mmerụ antihypertensive mmetụta).
Hyperkalemia

Jiri n’oge ime na n’oge a na-enye nwa ara

Ramipril bụ contraindicated na ime, dị ka o nwere ike na-enwe mmetụta ọjọọ na nwa ebu n'afọ: emebiwo akụrụ nke nwa ebu n'afọ, mbelata ọbara mgbali nke nwa ebu n'afọ na nwa amụrụ ọhụrụ, ọrụ ezumike nká, hyperkalemia, hypoplasia nke ọkpụkpụ nke okpokoro isi, oligohydramnios, contraure nke aka na ụkwụ, mbibi akwara nke ọwara.
N'ihi ya, tupu ị theụ ọgwụ ọjọọ n'ime ụmụ nwanyị ịmụ nwa, a ga-agụpụ afọ ime.
Ọ bụrụ na nwanyị na-eme atụmatụ ịtụrụ ime, aga-akwụsị ịkwụsị ịgwọ ndị na - egbochi ACE.
N'ihe banyere nkwenye nke afọ ime n’oge ọgwụgwọ na Ramipril, ị kwesịrị ịkwụsị iwere ya ozugbo enwere ike ma nyefee onye ọrịa ahụ ka ọ takingụọ ọgwụ ndị ọzọ, mgbe ị na-eji nke ahụ nwatakịrị ahụ ga-akacha.
Ọ bụrụ na ọgwụgwọ Ramipril dị mkpa n'oge a na-ara, a ga-akwụsị ịkwụsị inye ya ara.

Usoro onunu ogwu na nhazi

Ekwesịrị iwere mbadamba ihe n'agbanyeghị oge nri (ya bụ, a ga-eburu mbadamba ma tupu ma mgbe ma ọ bụ mgbe nri gasịrị) ma drinkụọ mmiri dị ukwuu (iko 1/2). Etala ma ọ bụ ghari nke mbadamba tupu i jiri ya.
A na-ahọrọ dose ahụ dabere na ọgwụgwọ ọgwụgwọ na ndidi na ndidi maka ọgwụ. Ọgwụgwọ na-adịkarị ogologo oge, ọ bụkwa dọkịta kpebiri ka oge ọ ga-adị n’okwu nke ọ bụla.
Ọ gwụla ma akọwapụtara ya, mgbe ahụ yana ọrụ ahaziri nkịtị na ọrụ ịba ọcha n'anya, a na-atụ aro usoro usoro usoro onunu ogwu n'okpuru.
Site na ọbara mgbali elu
Ọtụtụ mgbe, ọgwụ mbụ bụ 2.5 mg otu ugboro kwa ụtụtụ. Ọ bụrụ na mgbe ị na-a theụ ọgwụ a na dose a maka izu 3 ma ọ bụ karịa, ọ gaghị ekwe omume ịme ka ọ̀tụ̀tụ̀ ọbara ji erugharị, mgbe ahụ, a pụrụ ịbawanye ọgwụ ahụ gaa 5 mg nke ramipril kwa ụbọchị. Ọ bụrụ na ọgwụ nke 5 mg adịghị arụ ọrụ nke ọma, mgbe izu abụọ 2-3 gasịrị, a ga-agbakọ ya okpukpu abụọ nke kasịnụ akwadoro kwa ụbọchị 10 mg kwa ụbọchị.
Dika uzo ozo iji nwekwuo onodu ogwu na 10 mg kwa ubochi na enweghi ezigbo antihypertensive nke ihe ubochi ubochi 5 mg, o kwere omume igbakwunye ndi ozo antihypertensive na ọgwụgwọ, karie, diuretics ma obu “ngwa ngwa” ndi a na egbochi uzu.
Na nkụda mmụọ obi na-adịghị ala ala
Usoro akwadoro ọgwụ mbụ nke 1.25 mg (1/2 mbadamba nke 2.5 mg) 1 oge kwa ụbọchị. Dabere na nzaghachi na ọgwụgwọ ọrịa, ọgwụ ahụ nwere ike ịba ụba. Ọ na-atụ aro ka ị jiri okpukpu abụọ dị n’agbata 1-2 were okpukpu abụọ. Ọ bụrụ n’ịchọrọ ị doseụ ọgwụ kwa ụbọchị nke 2.5 mg ma ọ bụ karịa, enwere ike inye ya otu ugboro n’ụbọchị, ma ọ bụ ekewa abụọ.
Oke kachasị tụrụ aro kwa ụbọchị bụ 10 mg.
Na-arịa ọrịa shuga ma ọ bụ nephropathy na-arịa ọrịa mamịrị
Usoro akwadoro ọgwụ mbụ nke 1.25 mg otu ugboro kwa ụbọchị (1/2/2 / 2,5 mg). Ọgwụ ahụ nwere ike ịbawanye ọgwụ 5 ugboro otu ugboro n'ụbọchị. Site na ọnọdụ ndị a, usoro onunu ogwu dị elu karịa 5 mg otu ugboro kwa ụbọchị na ule ụlọ ọgwụ a na-achịbeghị nke ọma.
Iji belata ihe ize ndụ nke infarction myocardial, ọrịa strok, ma ọ bụ ọnwụ obi na ndị ọrịa nwere nnukwu ọrịa obi.
Ndụmọdụ akwadoro mbụ nke 2.5 mg 1 oge kwa ụbọchị. Dabere na ntachi obi na ndidi, enwere ike ịbawanye dose ahụ. Ọ na-atụ aro ka okpukpu abụọ gboo mgbe ọgwụgwọ izu 1 gachara, ma n’ime izu 3 na-esote ọgwụgwọ, bulie ya na usoro mmezi nke 10 mg otu ugboro n’ụbọchị.
A mụọbeghị usoro onyunyo karịa nke 10 mg nke ọma na ule nyocha a na-achịkwa. Nghọta eji ọgwụ eme ihe na ndị ọrịa nwere CC ihe na-erughị 0.6 ml / sec nke ọma.
Site na nkụchi obi na iji ngosipụta nke ụlọ ọgwụ bidoro n'ime ụbọchị ole na ole mbụ (site na ụbọchị nke abụọ ruo ụbọchị itoolu) mgbe nnukwu ọrịa myocardial infarction.
Usoro ọgwụgwọ akwadoro bụ 5 mg kwa ụbọchị, kewara abụọ n'ime ọgwụ ọ bụla nke 2.5 mg, nke a na-ewere otu n'ụtụtụ na nke abụọ na mgbede. Ọ bụrụ na onye ọrịa ahụ anabataghị ọgwụ izizi a (a na-achọpụta mbelata ọbara mgbali elu), mgbe ahụ, a na-atụ aro ka ọ were 1.25 mg (1/2 mbadamba 2.5 mg) ugboro abụọ kwa ụbọchị maka ụbọchị abụọ.
Mgbe ahụ, dabere na mmeghachi omume nke onye ọrịa, enwere ike ịbawanye dose ahụ. Ọ na-atụ aro ka usoro ya na mmụba ya okpukpu abụọ na nkeji nke ụbọchị 1-3. Emesia, enwere ike inye gi otu ugboro otu ubochi, nke e kewara ya ụzọ abuo ugboro abụọ. Ogo kachasị akwadoro bụ 10 mg.
Ugbu a, ahụmịhe n’imeso ndị ọrịa nwere nnukwu obi nkụchi (klas III-IV na-arụ ọrụ dị ka nhazi NYHA), nke bilitere ozugbo nnukwu nsogbu myocardial, ezughi oke. Ọ bụrụ na ndị ọrịa dị otú ahụ kpebiri ịgwọ Ramipril, a na-atụ aro ka ọgwụgwọ malite na nke kachasị dị ala - 1.25 mg (1/2 mbadamba 2.5 mg) otu ugboro kwa ụbọchị, a ga-elebara anya pụrụ iche na mmụba ọ bụla. doses.
Ojiji Ramipril nke ọgwụ na ụfọdụ ndị ọrịa
Ndị ọrịa nwere ọrụ mgbazinye nsogbu
Site na CC site na 50 ruo 20 ml / min, usoro mbụ kwa ụbọchị na-abụkarị 1.25 mg (1/2 mbadamba 2.5 mg). Ogo ị na-anabata kwa ụbọchị bụ 5 mg.
Ọrịa nwere ọghọm mmiri na akwara ozi na - ezighi ezi, ndị ọrịa nwere nnukwu ọbara ọgbụgba, yana ndị ọrịa maka oke ọbara mgbali elu na - ebute ihe egwu ụfọdụ (dịka ọmụmaatụ, yana nnukwu ọnya akwara akwara na akwara akwara)
A na-ebelata ọgwụ mbụ ka ọ bụrụ 1.25 mg / ụbọchị (1/2 mbadamba nke 2.5 mg).
Ọrịa nwere ọgwụgwọ diuretic tupu oge ya
Ọ dị mkpa, ma ọ bụrụ na ọ ga-ekwe omume, iji kagbuo mkpụrụ ọgwụ diuretchi ụbọchị abụọ (ọ dabere na oge nke ihe ọgbụgba) tupu ịmalite ọgwụgwọ na Ramipril ma ọ bụ, opekata mpe, belata dose nke ọgwụ ịre ahụ. Treatmentgwọ ndị ọrịa dị otú a kwesịrị ịmalite site na ntakịrị ọgwụ nke 1.25 mg nke ramipril (1/2 mbadamba nke 2.5 mg), na-ewere otu ugboro kwa ụbọchị, n'ụtụtụ. Mgbe ha takingụchara ọgwụ nke mbụ na oge ọ bụla mgbe ha nwesịrị ịba ụba nke ramipril na (ma ọ bụ) mkpụrụ ndụ, ọkachasị “akaghị” diuretics, ndị ọrịa kwesịrị ịnọ n'okpuru nlekọta ahụike ọbụlagodi 8 awa iji zere mmeghachi omume nchịkwa hypotensive.
Ndị okenye (ndị okenye karịrị afọ 65)
A na-ebelata ọgwụ mbụ ka ọ bụrụ 1.25 mg kwa ụbọchị (1/2 mbadamba nke 2.5 mg).
Ndị ọrịa nwere ọria imeju
Mmeghachi omume nke ọbara mgbali na iwere Ramipril nwere ike ịbawanye elu (n'ihi nkwụsị nke ramiprilat excretion), ma ọ bụ mee ka ike gwụ (n'ihi na ọ na-ebelata ntụgharị nke ramipril na-adịghị arụ ọrụ na ramiprilat nọ n'ọrụ). Ya mere, na mmalite ọgwụgwọ chọrọ nlezianya nlekọta ahụike. Oke kachasị anabata ụbọchị ọ bụla bụ 2.5 mg.

Etu esi eji: usoro onunu ogwu na usoro ọgwụgwọ

Miri mbadamba nkume nile (anaghị ata ata), were mmiri zuru ezu (1/2) mmiri sachaa, n'agbanyeghị nri (ya bụ, enwere ike ị were mbadamba ma tupu ma n'oge ma ọ bụ mgbe nri ahụ gasịrị). A na-ahọrọ dose ahụ dabere na ọgwụgwọ ọgwụgwọ na ndidi na ndidi maka ọgwụ.

Ọgwụgwọ na Ramipril-SZ na-abụkarị ogologo oge, ọ bụkwa dọkịta kpebiri ka oge ọ ga-eji nọọ n'ọnọdụ ọ bụla.

Ọ gwụla ma akọwapụtara ya nke ọma, mgbe ahụ yana ọrụ akwara dị iche iche yana ọrụ ịwa ahụ, a na-atụ aro usoro usoro usoro ọgwụgwọ ndị a.

Site n'ọbara mgbali elu, ọ na - abụkarị ọgwụ mbido bụ 2.5 mg 1 oge kwa ụbọchị n'ụtụtụ. Ọ bụrụ na mgbe ị na-a theụ ọgwụ a na dose a maka izu 3 ma ọ bụ karịa, ọ gaghị ekwe omume ịme ka ọ̀tụ̀tụ̀ ọbara ji erugharị, mgbe ahụ, a pụrụ ịbawanye ọgwụ ahụ gaa 5 mg nke ramipril kwa ụbọchị. Ọ bụrụ na ọgwụ nke 5 mg adịghị arụ ọrụ nke ọma, mgbe izu abụọ 2-3 gasịrị, a ga-agbakọ ya okpukpu abụọ nke kasịnụ a na-atụ aro kwa ụbọchị nke 10 mg kwa ụbọchị.

Dika uzo ozo ịbawanye ogwu rue 10 mg kwa ubochi na enweghi ezigbo ogwu ihe antihypertensive nke otu ubochi 5 mg, o kwere omume itinye ndi ozo na anakpo antihypertensive na ọgwụgwọ, karia ihe di omimi ma obu “ndi na ewepu ume”.

N’ewepu obi na-adịghị ala ala, usoro ọgwụgwọ a tụrụ aro ya: 1.25 mg otu ugboro n’ụbọchị (1/2 mbadamba 2.5 mg). Dabere na nzaghachi onye ọrịa na usoro ọgwụgwọ ahụ, ọgwụ ahụ nwere ike ịba ụba. Ọ na-atụ aro ka ị jiri okpukpu abụọ dị n’agbata 1-2 were okpukpu abụọ. Ọ bụrụ n’ịchọrọ iri ọgwụ kwa ụbọchị nke 2.5 mg ma ọ bụ karịa, enwere ike inye ya otu ugboro n’ụbọchị, ma ọ bụ ekewa ya abụọ.

Oke kachasị tụrụ aro kwa ụbọchị bụ 10 mg.

Maka diphropathy na-arịa ọrịa mamịrị ma ọ bụ ndị na-arịa ọrịa shuga, usoro ọgwụgwọ a tụrụ aro ka ọ bụrụ: 1.25 mg otu ugboro n'ụbọchị (1/2 mbadamba 2.5 mg). Ọgwụ ahụ nwere ike ịbawanye ọgwụ 5 ugboro otu ugboro n'ụbọchị. Site na ọnọdụ ndị a, usoro onunu ogwu dị elu karịa 5 mg otu ugboro kwa ụbọchị na ule ụlọ ọgwụ a na-achịbeghị nke ọma.

Iji belata ihe ize ndụ nke infarction myocardial, ọrịa strok, ma ọ bụ ọnwụ obi na ndị ọrịa nwere nnukwu ọrịa obi, usoro mbụ a tụrụ aro Ramipril-SZ bụ 2.5 mg otu ugboro n'ụbọchị. Dabere na ntachi obi na ndidi, enwere ike ịbawanye dose ahụ. Ọ na-atụ aro ka okpukpu abụọ gwọọ ya ka ọ gachara izu 1 nke ọgwụgwọ, ma n’izu izu atọ na-esochi ọgwụgwọ, bulie ya na usoro mmezi nke 10 mg otu ugboro n’ụbọchị.

A mụọbeghị usoro onyunyo karịa nke 10 mg nke ọma na ule nyocha a na-achịkwa.

Agụbeghị ọgwụ a na ndị ọrịa nwere ikike idozi creatinine nke erughị 0.6 ml / s agụbeghị nke ọma.

Site na nkụchi obi nke mepụtara n'ime ụbọchị ole na ole mbụ (site na ụbọchị nke abụọ ruo ụbọchị nke itoolu) mgbe ọ bụla na-arịa nnukwu myocardial infarction, ọgwụ mbụ a tụrụ aro bụ 5 mg kwa ụbọchị, kewara ya na abụọ otu 2.5 mg, nke a na-ewere n'otu ụtụtụ, nke-abua na anyasi. Ọ bụrụ na onye ọrịa ahụ anabataghị ọgwụ izizi a (a na-achọpụta mbelata ọbara mgbali elu), mgbe ahụ, a na-atụ aro ka enye ya 1.25 mg ugboro abụọ n'ụbọchị (1/2 mbadamba 2.5 mg) maka ụbọchị abụọ. Mgbe ahụ, dabere na mmeghachi omume nke onye ọrịa, enwere ike ịbawanye dose ahụ. Ọ na-atụ aro ka usoro ya na mmụba ya okpukpu abụọ na nkeji nke ụbọchị 1-3. Emesia, enwere ike inye gi otu ugboro otu ubochi, nke e kewara ya ụzọ abuo ugboro abụọ.

Ogo kachasị akwadoro bụ 10 mg.

Ugbu a, ahụmịhe n’imeso ndị ọrịa nwere nnukwu nkụchi obi (III-IV klas arụ ọrụ dị ka nhazi NYHA), nke mere ozugbo enwere nnukwu myocardial infarction, ezughi oke. Ọ bụrụ na ndị ọrịa dị otú ahụ kpebiri ịgwọ Ramipril-SZ, a na-atụ aro ka ọgwụgwọ malite na nke kachasị dị ala - 1.25 mg otu ugboro kwa ụbọchị (1/2 mbadamba 2.5 mg) na nlekọta pụrụ iche na mmụba ọ bụla. doses.

Ojiji Ramipril-SZ na ụfọdụ ndị ọrịa

Ndị ọrịa nwere ọrụ akwara ezighi ezi: mgbe nhichapụ ihe dị site na 50 ruo 20 ml / min kwa 1.73 m2 nke anụ ahụ, usoro mbụ kwa ụbọchị na-abụkarị 1.25 mg (1/2 mbadamba 2.5 mg). Ogo ị na-anabata kwa ụbọchị bụ 5 mg.

Ndị ọrịa nwere obere mmezi mmiri na electrolytes, ndị ọrịa nwere oke ọbara mgbali elu, yana ndị ọrịa maka oke mbelata ọbara mgbali elu na-eweta ụfọdụ ihe ize ndụ (dịka ọmụmaatụ, yana ọnya ọnya siri ike nke akwara na akwara akwara): a na-ebelata usoro izizi ruo 1.25 mg / ụbọchị (1/2 mbadamba 2,5 mg).

Ndị ọrịa nwere ọgwụgwọ ọrịa diuretic gara aga: ọ bụrụ na ọ ga-ekwe omume, ekwesịrị ịkagbuure diuretics n'ime ụbọchị 2-3 (dabere na oge nke ihe ndị metụtara diuretics) tupu ịmalite ọgwụgwọ na Ramipril-SZ ma ọ bụ, ma ọ dịkarịa ala, belata dose nke ọgwụ diuretics. Treatmentgwọ ndị ọrịa a kwesịrị ịmalite n ’ụzọ dị ala nke 1.25 mg nke ramipril (1/2 mbadamba 2.5 mg), nke a na-ewere otu ugboro n’ụbọchị. Mgbe ha takingụsịrị ọgwụ nke mbụ na oge ọ bụla mgbe ha nwetasịrị ọgwụ ramipril na (ma ọ bụ) “akaghị” diuretics, ndị ọrịa kwesịrị ịnọ n'okpuru nlekọta ahụike ọbụlagodi 8 awa iji zere mmeghachi omume nchịkwa nchịkwa.

Ndi oria okenye (karia iri isii na ise): a kwesiri iwetulata onye mbu rue 1.25 mg kwa ubochi (1/2 mbadamba 2.5 mg).

Ndị ọrịa nwere ọrụ imeju na-arụ ọrụ: mmeghachi omume ọbara mgbali na iwere Ramipril-SZ nwere ike ịbawanye elu (site na ibelata ramiprilat excretion) ma ọ bụ mee ka ike gwụ (n'ihi na ọ na-ebelata ntụgharị nke ramipril na-adịghị arụ ọrụ na ramiprilat nọ n'ọrụ). Ya mere, na mmalite ọgwụgwọ chọrọ nlezianya nlekọta ahụike. Oke kachasị anabata ụbọchị ọ bụla bụ 2.5 mg.

Omume ọgwụ

Arụ ọrụ nke Ramipril-SZ na-arụ ọrụ n'okpuru enzymes "imeju" na-arụ ọrụ n'ime metabolite ramiprilat, nke nwere mmetụta inhibitory ogologo oge na ACE. ACE na plasma na anụ ahụ na-egosipụta ntụgharị nke angiotensin nke m na angiotensin nke abụọ na ndakpọ nke bradykinin. Ya mere, mgbe ị na-ewere ramipril n'ime, nguzobe nke angiotensin II na-agbadata ma bradykinin na-agbakọ, nke na-eduga na vasodilation na mbelata ọbara mgbali (BP).

Mmụba na ọrụ nke usoro kallikrein-kinin dị n'ọbara na anụ ahụ na-ekpebi mmetụta cardioprotective na endothelioprotective nke ramipril n'ihi mmemme nke usoro prostaglandin na, n'ihi ya, mmụba na njikọ nke prostaglandins, nke na-akpali nguzobe nke nitric oxide (O nweghi) na endotheliocytes.

Angiotensin II na-akpali mmepụta nke aldosterone, yabụ, iji ramipril na-ebelata ihe nzuzo nke aldosterone ma na-abawanye mkpụrụ ndụ nke ion potassium.

Site na mbelata nke mkpokọta angiotensin II na ọbara, a na-ewepụ ihe mgbochi ya na mmiri mmiri renin site na ụdị nzaghachi na-adịghị mma, nke na-eduga n'ọbawanye na ọrụ plasma ọbara ọbara. A na-eche na mmepe nke ụfọdụ mmeghachi omume na-adịghị mma (karịchaa, ụkwara "akọrọ") jikọtara ya na mmụba nke ọrụ bradykinin.

N'ime ndị ọrịa nwere ọbara mgbali elu, ị raụ ramipril na-eduga n'ịbelata ọbara mgbali n'ọnọdụ "ụgha" na "kwụ ọtọ", na-enweghị mgbakwunye mmụba na obi obi (HR). Ramipril na –ebelata mkpụkọ akwara gbasara akwara, (OPSS), na - emeghi mgbanwe na ọbara gbasara akwara na ọnụego mmụba. Mmetụta antihypertensive malitere ịpụta n’ime 1-2 awa mgbe ị afterụsịrị ọgwụ otu ọgwụ, rute uru kachasị ya mgbe awa 3-9 gachara, ọ ga-adịgide ruo awa 24. Site na iji usoro ọgwụgwọ, mmetụta antihypertensive nwere ike jiri nwayọọ nwayọọ mụbaa, na-ejikarị izu atọ ruo izu anọ nke nchịkwa ọgwụ mgbe niile ma na-adịgide ruo ogologo oge. Ọgwụ ahụ enweghị ọrịa "ndọrọ ego", i.e. esskwụsị nchịkwa ọgwụ na mberede anaghị ebute mmụba ọbara ngwa ngwa ma dị ịrịba ama.

N'ime ndị ọrịa nwere ọbara mgbali elu, ramipril na-ebelata mmepe na oganihu nke myocardial hypertrophy na mgbidi vaskụla.

N'ime ndị ọrịa nwere ọrịa obi na-adịghị ala ala, ramipril na-ebelata OPSS (ibelata ibu na-ebugharị n'obi), na-eme ka ikike nke venous dịkwuo ma belata mgbali nke ventricle ekpe, nke, n'ihi ya, na-eduga na mbelata preload na obi. N'ime ndị ọrịa a, mgbe ha na-ewere ramipril, enwere mmụba na mmepụta obi, ụmụ irighiri akwara ma nwekwa ohere ịnagide mmega ahụ ka mma.

Na mamịrị nephropathy na-arịa ọrịa mamịrị na-arịa ọrịa mamịrị, ramipril na-agbadata ọnụego nke ngụgụ nke ọdịda akụrụ na mmalite nke ọdịda akụrụ oke, ma, ya mere, na-ebelata mkpa ịba ama ma ọ bụ mmịnye akụrụ. N'ime mmalite nke ọrịa mamịrị ma ọ bụ nephropathy, ọrịa ramipril na-ebelata ogo albuminuria.

N'ime ndị ọrịa nwere nnukwu ihe ibute ọrịa obi n'ihi ọrịa ma ọ bụ ọnya akwara (ọrịa obi na-arịa akwara, akụkọ banyere ọrịa ọgụ, ọrịa strok), ma ọ bụ ọrịa shuga na-arịa ma ọ dịkarịa ala otu ihe ize ndụ ndị ọzọ (microalbuminuria, ọbara mgbali elu, mụbara. ịta nke cholesterol mkpokọta (OX), mbelata nke ịta cholesterol nke ịdị elu lipoproteins (HDL-C), ị smokingụ sịga) mgbakwunye nke ramipril na ọgwụ ọkọlọtọ. na-ebelata oke ụbụrụ nke myocardial infarction, ọrịa strok na ọnwụ n'ihe kpatara ọrịa obi. Na mgbakwunye, ramipril na-ebelata ọnụ ọgụgụ mmadụ na-anwụ, yana mkpa maka usoro nyochaghachi, na-ebelata mmalite ma ọ bụ ọganihu nke ọdịda obi na-adịghị ala ala.

N'ime ndị ọrịa nwere ọrịa obi nke mepụtara na ụbọchị mbụ nke nnukwu myocardial infarction (ụbọchị 2-9), na-ewere ramipril malite na ụbọchị 3 ruo 10 nke nnukwu myocardial infarction na-ebelata ohere nke ịnwụ (na 27%), ihe egwu nke ọnwụ mberede (site na 30 %), ihe ọghọm nke ọrịa obi na-adịghị ala ala na-aga n’ihu na klaasị arụ ọrụ (NYHA klas III-IV na-arụ ọrụ) / na-egbochi ọgwụgwọ (27%), ohere nke ụlọ ọgwụ na-esote n'ihi mmepe nke nkụda obi (26%).

N'ime ọha mmadụ n'ozuzu ya, yana ndị ọrịa nwere ọrịa mellitus, ha abụọ nwere ọbara mgbali elu yana ọbara mgbali nkịtị, ramipril na-ebelata ihe ize ndụ nke nephropathy na ntinye nke microalbuminuria.

Mwepụta wepụtara ya na ihe mejupụtara

Mpempe usoro onodu ogwu - mbadamba: ihe fọrọ nke nta ka ọ bụrụ ọcha ma ọ bụ na-acha ọcha, na -eji cylindrical dị larịị, nke nwere kerfer na nkewa (na mpempe akwụkwọ ọnya: 10 p.., Ngwugwu 3 na igbe kaadi, pọọki 14. N’otu igbe, 1 ma ọ bụ 2 na ngwugwu igbe kaadi) .

Ihe na-arụ ọrụ nke Ramipril bụ ramipril, na mbadamba 1 - 2.5 mg, 5 mg ma ọ bụ 10 mg.

Ngwa inye aka: lactose, microcrystalline cellulose, aerosil (sillolọn silicon dioxide), magnesium stearate, primogel (sodium carboxymethyl stachi).

Mlọ ọgwụ

Site na nchịkwa ọnụ, mmịpụta ruru 50-60%. Iri nri anaghị emetụta ogo nke mmụba, kama ọ na -ebelata ọnụego nnabata. Oke nlebara anya nke ramipril eruola mgbe awa 2-4 gachara nchịkwa. N'ime imeju, a na-eme ka onyinye ahụ pụta anya, mepụta metabolite ramiprilat nke na-arụ ọrụ (ọnụego mgbochi ACE dị okpukpu 6 karịa nke ramipril) yana diketopiperazine metabolites na-adịghị arụ ọrụ. Mgbe ahụ, ramipril na-arịa glucuronidation. Ewezuga ramiprilat, ihe niile metabolites guzobere anaghị egosipụta ọrụ ọgwụ.

Ramipril na-ejikọ protein protein plasma site na 73%, na ramiprilat - ruru 56%. Bioavailability mgbe nchịkwa ọnụ nke 2.5-5 mg nke ọgwụ bụ 15-28%, n'ihe banyere ramiprilat - 45%. Site na iji 5 mg kwa ụbọchị, ọkwa ramiprilat dị na plasma ọbara ruru ụbọchị nke anọ.

Ndụ ọkara nke ramipril bụ 5.1 awa. Ntinye uche nke ramiprilat n’ime ọbara ọbara na-agbadata na nkesa na mkpochapu ya na ọkara ndụ nke awa 3, n’oge ntụgharị, ọkara ndụ bụ awa iri na ise na ogologo oge ikpeazụ, nke a na-eji ọdịnaya dị ala nke ramiprilat dị na plasma - 4-5 ụbọchị. Iwepu ọkara ndụ na-abawanye na ndị ọrịa na-arịa ụkọ akwara na-adịghị ala ala.

Olu nkesa ramipril bụ 90 lita, ramiprilata bụ lita 500. A na-ewepụta ihe ahụ site na akụrụ na ego nke 60% nke ọgwụ were, yana site na eriri afọ - na ọnụọgụ 40% (ọkachasị n'ụdị metabolites). Site dysfunctions gbasara akụrụ, mwepụ nke ramipril na metabolites ya na-agbadata n'ike n'ike na mkpochasị nke creatinine, yana nsị imeju, a na-egbochi ntụgharị ya na ramiprilat, ma na nkụchi obi, ọdịnaya ramiprilat na-abawanye site na 1.5-1.8 ugboro.

Ntụziaka maka iji Ramipril: usoro na usoro onunu ogwu

Ana mbadamba mbadamba ndị ahụ tupu e rie ma ọ bụ mgbe nri gachara, na-eji mmiri rijuo afọ.

Dọkịta na-edepụta ọgwụ ahụ dabere na ngosipụta nyocha nke ụlọ ọgwụ, na-eburu n'uche nnagide na ọgwụgwọ nke ọgwụ ahụ.

Ọbara ọgbụgba: ọnụọgụ mbido bụ 2.5 mg 1 oge kwa ụbọchị (n'ụtụtụ) ma ọ bụ na usoro onunu abụọ. Iji mezuo mmetụta ọgwụgwọ achọrọ, mmụba nke ọtụtụ ga-ekwe omume mgbe izu 2-3 gachara. Ọgwụ a na-arụkarị bụ 2.5-5 mg, ihe kachasị bụ 10 mg kwa ụbọchị. Site na usoro ọgwụgwọ oge gara aga nwere mgbatị ahụ, ekwesịrị ịkagbu ma ọ bụ belata dose ahụ na-erughị ụbọchị atọ tupu ịmalite Ramipril.Ọgwụ nke mbụ maka ndị ọrịa na-a diụ ọrịa dialtiiki, ndị ọrịa nwere ọrụ mkpali ezughị ezu ma ọ bụ mgbali elu akwara na nkụda obi bụ 1.25 mg kwa ụbọchị otu ugboro. Ekwesịrị ịmalite ngwa a n'okpuru nlekọta dọkịta. Maka ndị ọrịa nwere nsogbu nguzogide mmiri ma ọ bụ ihe nwere ike imeghachi omume, usoro izizi nke ụbọchị ekwesịghị gafere 1.25 mg,
Ọrịa obi na-adịghị ala ala: mbụ ọgwụ bụ 1.25 mg otu ugboro, ọ bụrụ na ọ dị mkpa, enwere ike ịgbatị okpukpu abụọ ka izu 1-2 gachara. Dosebọchị kwa ụbọchị ekwesịghị ịkarị 10 mg. Site na nhazi oge nke diuretics, ha kwesịrị belata ọgwụ ha tupu ịmalite ọgwụgwọ,
Ọdịda obi na-eme n’ime ụbọchị 2-9 ka ọ nwesịrị nnukwu myocardial infarction: ọgwụ mbụ - 2.5 mg ugboro abụọ n’ụbọchị (n'ụtụtụ na mgbede) na mgbe ụbọchị abụọ nke ọgwụgwọ gasịrị - 5 mg ugboro abụọ kwa ụbọchị. Gwọ mmezi - 2.5-5 mg ugboro abụọ n'ụbọchị. Ọ bụrụ na ọgwụ anabataghị ọgwụ ike (artpot hypotension), a ga-ebelata ọgwụ izizi ka ọ bụrụ 1.25 mg ugboro abụọ kwa ụbọchị, mgbe ọ gachara ụbọchị 2, enwere ike ịbawanye ya na 2.5 mg, yana mgbe ụbọchị 2 ruo 5 mg ugboro 2 kwa ụbọchị. Dosebọchị kwa ụbọchị ekwesịghị ịkarị 10 mg. Ọ bụrụ na anabataghị dose ahụ, 2.5 mg 2 ugboro kwa ụbọchị kwesịrị ịkwụsị. N'ihi ahụmịhe ezughi oke na iji Ramipril mee ihe na ndị ọrịa nwere nnukwu nkụda mmụọ nke klaasị arụ ọrụ III-IV (dịka nhazi ọkwa NYHA) mere na ozugbo infarction acyo dị oke njọ, usoro izizi maka ụdị ndị ọrịa a agaghị agafe 1.25 mg otu ugboro kwa ụbọchị. O kwesiri ka emee ihe nribata ya n’okpuru onye dibia,
Nehropathy na nsogbu na-adịghị ala ala nke akụrụ, nephropathy mamịrị: usoro mbụ - 1.25 mg otu ugboro. Site na ịnwe ezigbo ọgwụ, ọgwụ nwere ike okpukpu abụọ kwa izu ruo mgbe a ga-enweta ọgwụ a na-edozi 5 mg otu ugboro n'ụbọchị.
Mbelata ihe ize ndụ nke ọrịa strok, infarction myocardial, ma ọ bụ ọnwụ obi na ndị ọrịa nwere nnukwu ọrịa obi: usoro mbụ bụ 2.5 mg otu ugboro. Egosi-abawanye n’ime onodu ogwu: ka onwa ato gachara, emesia mgbe izu uka abuo – rue na mmezi nke 10 mg otu ugboro n ’ubochi.

Usoro a tụrụ aro ka usoro Ramipril na-atụ aro maka ndị ọrịa nwere ọdịda akụrụngwa:

CC erughi 30 ml / min: mbido mbụ - 1.25 mg kwa ụbọchị, kacha - 5 mg,
KK 30-60 ml / min: mbido mbụ - 2.5 mg kwa ụbọchị, kacha - 5 mg,
CC karịa 60 ml / min: ọgwụ mbụ bụ 2.5 mg kwa ụbọchị, kachasị bụ 10 mg.

Site na nkwarụ imeju, usoro izizi ekwesịghị ịgafe 1.25 mg, nke kachasị - 2.5 mg otu ugboro.

Ọgwụ izizi maka ndị ọrịa agadi bụ 1.25 mg kwa ụbọchị.

Achọrọ njikwa pụrụ iche maka ndị ọrịa gafere afọ 65 na-ewere diuretics, maka ndị ọrịa nwere ọrịa obi na-adịghị ala ala yana ọrụ akwara na arụ ọrụ ọria. A na-ahọrọ ọ̀gwụgwọ ahụ dabere na ọkwa mgbali ọbara.

Mkparịta ụka ọgwụ ọjọọ

Mgbe ị na-ahọpụta Ramipril, dọkịta ahụ aghaghị ịdọ onye ọrịa ahụ aka na ntị banyere mkpa ọ dị tupu ha amalite tupu ịmalite iji oge ọ bụla nke ọgwụ ọ bụla.

Ihe atụ nke Ramipril bụ: Ramipril-SZ, Wazolong, Amprilan, Dilaprel, Hartil, Korpril, Pyramil, Ramigamma, Tritace, Ramicardia.