Ọgwụ Dilaprel: ntuziaka maka ojiji > Ọgwụgwọ na mgbochi

Antihypertensive ọgwụ, inhibitor ACE. Usoro ihe eji eme ya bu ihe mgbochi ACE na igbochi usoro mgbanwe angiotensin I n'ime angiotensin II, nke na-eduga na mmepe nke mmetụta na-adịghị mma, nke na-egosipụta onwe ya n'agbanyeghị ọnọdụ onye ọrịa (ịgha ụgha / iguzo ọtọ), ebe mmụba na-akwụ ụgwọ Oku obi adighi eme. Ọgwụ na-ebelata ibu ọnụ na ibu, belata mmepụta aldosterone, nguzogide n’ime arịa nke akpa ume, na-eme ka nnabata nke anụ ahụ nwee ike ibute ibu na obere nkeji ọbara, na-eme ka ọbara myocardium dịkwuo mma. Mgbe ejiri ya ogologo oge na ndị ọrịa ọbara mgbali ike ihe ndọghachi azụ na-ebute mmepe nke hypertrophy myocardial, ugboro ole na-ebelata arrhythmiasmgbanwe na endothelium vaskụla na-ebilite n'okpuru ọrụ dị elu nri cholesterol, ịba ụba nke akụrụngwa ọbara na akwara ọbara.

Mmetụta antihypertensive mgbe ị takingụ ọgwụ ahụ na-apụta mgbe awa 1.5-2 gasịrị, a na-ahụ mmetụta kachasị mgbe awa 6-9 gachara, oge ọrụ ga-abụ ihe dị ka otu ụbọchị, enweghi ọrịa wepụ ya. Na ọrịa nwere nnukwu infarction myocardial site na nkụchi obi na-etolite n'ime ụbọchị mbụ, ị theụ ọgwụ ahụ na-enyere aka belata ọnụego ọnwụ na belata ihe ize ndụ nke inwe ọganihu CHF. N'ikuku ramipril na onye na-arịa ọrịa mamịrị / ọrịa mamịrị nephropathy na-akwụsị inwe ọganihu gbasara akwara.

Mlọ ọgwụ

A na-enweta ọgwụ ngwa ngwa site na Ọkpụkpụ afọagbanyeghị, iri nri anaghị emetụta izu oke, mana mmiri ịmịcha kwụsịlata. Nkwukọrịta na protein ndị dị n'ọbara dị larịị nke 75%. Cmax enweta na nkezi mgbe 1.5 awa. Metabolized n'ime imeju, na-ebute nguzobe ọgwụ ọgwụ na-arụ ọrụ ramiprilat anaghị arụ ọrụ - ramipril glucuronides, ether na diketopiperazinic acid. Edere ya n'ụdị metabolites site na mmamịrị na feces. T1 / 2 - 5-6 awa.

Ngwongwo ogwu

Mlọ ọgwụ

Metabolite na-arụ ọrụ nke ramipril guzobere n'okpuru nduzi nke enzymes imeju - ramiprilat - bụ onye na - eme ACE inhibitor dị ogologo, nke bụ peptidyldipeptidase. 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 nsonaazụ cardioprotective na endothelioprotective nke ramipril n'ihi mmemme nke usoro prostaglandin na, n'ihi ya, mmụba na njikọta nke prostaglandins, nke na-akpali nguzobe nke nitric oxide (O nweghi) na endotheliocytes. Angiotensin II na-akpali mmepụta nke aldosterone, yabụ, iji ramipril na-eduga na mbelata aldosterone secretion na mmụba na mmetụta serum na renin secretion site na ụdị nzaghachi adịghị mma, nke na-eduga n'ịba ụba na ọrụ plasma renin.

A na-eche na mmepe nke ụfọdụ mmeghachi omume na-adịghị mma (karịchaa, ụkwara akọrọ) na mmụba nke ọrụ bradykinin. N'ime ndị ọrịa nwere ọbara mgbali elu, ị raụ ramipril na-eduga n'ịbelata ọbara mgbali mgbe ịgha ụgha na iguzo na-enweghị mmụba na ọnụego obi (HR). Ramipril na –ebelata mkpụkọ akwara gbasara akwara, (OPSS), na - emeghi mgbanwe na ọbara gbasara akwara na ọnụego mmụba. Mmetụta antihypertensive na-apụta ịpụta 1-2 awa mgbe ị ofụ 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 na-abawanye, na-ejikarị izu site na izu 3-4 nke ị weeksụ ọgwụ ahụ mgbe niile wee na-adịgide ruo ogologo oge. Contkwụsị ọgwụ ahụ na mberede anaghị ebute mmụba ọbara ngwa ngwa ma dị ịrịba ama (enweghị ọrịa nkwụsị).

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 ọrịa mamịrị na-arịa ọrịa mamịrị na-arịa ọrịa mamịrị, ị raụ ramipril na-ebelata ọnụego ntughari nke ọdịda akwara na mmalite nke ọkwa ọnụ nke ọdịda akụrụngwa na, yabụ, na-ebelata mkpa maka ịba ọcha n'anya na akụrụ. N'ime mmalite nke ọrịa mamịrị na ọrịa nephropathy, ramipril na-ebelata ogo albuminuria.

N'ime ndị ọrịa nwere nnukwu ihe ibute ọrịa obi n'ihi ọrịa obi na-arịa (ọrịa obi na-arịa akwara, akụkọ ihe mere eme), ma ọ bụ ọrịa shuga, ma ọ dịkarịa ala otu ihe ize ndụ ọzọ (microalbuminuria, ọbara mgbali elu, mụbara. ịta nke cholesterol mkpokọta (OX), mbelata nke mkpokọta akwa protein lipoprotein (OX-HDL), ise anwụrụ). budata ebelata omume nke myocardial infarction, ọrịa strok na ọnwụ site obi na-akpata. 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 nkụda obi nke malitere na ụbọchị mbụ nke ọrịa 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 mmụba nke ọrịa obi na-adịghị ala ala na nnukwu ọrịa (klas arụ ọrụ III-IV dị ka nhazi NYHA) / na-eguzogide ọgwụ (site na 27%), ohere nke ụlọ ọgwụ na-esote n'ihi mmepe nke ọdịda obi (site na 26%).

N'ime ọha mmadụ n'ozuzu ya, yana ndị ọrịa nwere ọrịa mellitus (ha abụọ na - arịa ọbara mgbali elu na 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%). Iri nri na - eme ka mmata gi ghara ikwusi ike, ma o nweghi otutu ovu.

Ọ metabolized na imeju na oruru nke nọ n'ọrụ metabolite nke ramiprilat (ọ bụ 6 ugboro ọrụ ike na igbochi ACE karịa ramipril) na-adịghị arụ ọrụ metabolites - diketopiperazinovoy ether, diketopiperazinovoy acid, yana ramiprilat glucuronides na ramiprilat. All metabolites guzobere, ma e wezụga ramiprilat, enweghị ọrụ ọgwụ. Nkwukọrịta na protein plasma maka ramipril - 73%, ramiprilata - 56%.

Mgbe iwere ramipril n'ime, pilosima kachasị nke ramipril na ramiprilat na-eru mgbe awa 1 na 2-4 gachara. Ihe bioavailability maka ramipril mgbe nchịkwa ọnụ nke 2.5-5 mg bụ 15-28%, maka ramiprilat - 45%. Mgbe ị nweta ọgwụ kwa ụbọchị nke 5 mg / ụbọchị, ịta ọkwa ramiprilat na plasma ọbara na-eru ụbọchị 4. Ọkara ndụ (T_1/2) maka ramipril - 5,1 awa, na oge nkesa na mkpochapu, mbelata nke mkpo nke ramiprilat n'ọbara ọbara na-apụta na T._1/2 hara ka elekere atọ, sorokwa usoro ntụgharị ya na T_1/2 ha hà ka awa iri na ise na ogologo oge ikpeazụ nke nwere oke ala ramiprilat dị na plasma na T_1/2 ha ruru ụbọchị 4-5. T_1/2 na-abawanye na ọdịda akụrụ afọ (CRF). Olu nkesa ramipril bụ 90 l, ramiprilat bụ 500 l.

Nnyocha ụmụ anụmanụ egosila na ramipril dị na mmiri ara ara.

Ọ bụ ya bụ akụrụ - 60%, site na eriri afọ - 40% (ọkachasị n'ụdị metabolites). Site n'ịrụ arụ ọrụ na mkpị, na mwepu nke ramipril ya na metabolites na-adalata na mbelata na nsụpụta creatinine (CC), na arụ ọrụ imeju, ntụgharị ya na ramiprilat na-adalata, na nkụda obi, itinye uche nke ramiprilat na-abawanye ugboro 1.5-1.8.

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.

Ihe ngbanwe

Nnukwu ọgbụgba, angioedema dị iche iche etiologies, akụrụ akwara akwara stenosis, obi anakpo cardiomyopathy ya na mgbanwe mgbanwe hypertrophic gbasara akwaralactation ịba ọcha n'anya, tụụrụ imeisi hyperaldosteronismruo 18 afọ CHF na ogbo nke decompensation, ekweghị na lactose, uche dị elu maka ọgwụ, cardiac arrhythmias, edoghi anya angina pectorisEnweghị ntụpọ.

Jiri nlezianya mee ihe mgbe ọnya atherosclerotic ọnya arịa na eriri afọ.

Ihe ngosi maka ojiji

ọbara mgbali elu,
ọrịa obi na-adịghị ala ala (dị ka akụkụ nke ọgwụgwọ ịgwọ ọrịa, ọkachasị yana yana ọgwụ ịba ọcha),
ọrịa shuga ma ọ bụ ọrịa mamịrị, nke na-arịa ọrịa shuga, gụnyere ma ọ bụ proteinuria siri ike, ọkachasị mgbe enwere mgbali elu.
ọghọm nke ibute ọrịa myocardial infarction, ọrịa strok, ma ọ bụ ọnwụ obi na ndị ọrịa nwere nnukwu ọrịa obi:
- n'ime ndị ọrịa enwetara n'ọrịa obi na-arịa, akwara nke infarction myocardial infarction ma ọ bụ na-enweghị ya, gụnyere ndị ọrịa na-arịa ajọ ọrịa akwara na-agafe agafe, mkpụrụ okwu aorto-coronary artpass byft grafting,
- n'ime ndị ọrịa nwere ọrịa strok,
- n'ime ndị ọrịa nwere ọnya ọrịa anya nke akwara,
- n'ime ndị ọrịa nwere ọrịa mellitus nwere opekempe ihe egwu ọzọ (microalbuminuria, ọbara mgbali elu, ịba ụba plasma nke OX, belata plasma nke HDL-C, ị smokingụ sịga),
nkụda obi na toro n’ụbọchị ole na ole mbụ (site na nke abụọ ruo n’ụbọchị nke itoolu) mgbe nnukwu ọrịa myocardial infarction (lee ngalaba “Pharmacodynamics”).

Nsonaazụ

Mbelata ọdịda EGOobi mgbu orthostatic hypotension, ischemia myocardial, arrhythmias, nkuchi obi, ntopute, ụsọ ụsọ akwara, ọrụ ezigharị nsogbu, ịbawanye ụba creatinine na urea n'ime ọbara, mbelata libido, erectile dysfunction, gynecomastia, isi ọwụwaike gwụrụ, nchekasị, ụjọ moto, obi erughị ala, nsogbu ịrahụ ụra, ọhụhụ ụzọ na nghọta isi, myalgiamgbu afọ, afọ mgbu, vomiting, afọ ọsịsamgbu n'ime afọ dyspepsiaakọrọ ụkwara mkpụkpu ume, sinusitis, ọla kọpaakpukpo aru hyperhidrosisAkpukpu aru, isi oji, eosinophiliana-abawanye ịta nke potassium na ọbara.

Usoro onunu ogwu na nhazi

Ọbara ọbara
N'ime, ọgwụ izizi bụ 2.5 mg, otu ugboro, n'ụtụtụ. Ọ bụrụ na mgbe ị na-a theụ ọgwụ a na ọgwụ a maka izu 3 ma ọ bụ karịa, ọ gaghị ekwe omume ịme ka ọ̀tụ̀tụ̀ ọbara ji erugharị n’arụ, mgbe ahụ, a pụrụ ịmụba ọgwụ ahụ gaa 5 mg nke ọgwụ Dilaprel ® 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-ezughi oke mgbochi hypertensive nke otu ubochi 5 mg, ihe ndi ozo na akpo antihypertensive, tumadi diuretics ma obu “mgbochi ngwa” na-egbochi ura, nwere ike itinye ya na ogwugwo.

Ọrịa obi na-adịghị ala ala
Usoro izizi bụ 1.25 mg / day *. Dabere na nzaghachi onye ọrịa na usoro ọgwụgwọ ahụ, enwere ike ịbawanye dose ahụ. A na-atụ aro ka ịgbanye ya okpukpu abụọ na oge izu 1-2. A ga-ewere ọgwụ were si 2.5 mg ma ọ bụ karịa otu ugboro ma ọ bụ ekewa abụọ. Ogo kachasị kwa ụbọchị bụ 10 mg.

Site na nkụchi obi nke mepụtara n'ime ụbọchị ole na ole mbụ (site na nke abụọ ruo ụbọchị nke itoolu) mgbe nnukwu nsogbu myocardial infarction.
Ọgwụ nke mbụ bụ 5 mg, nke kewara abụọ, 2mg nke ụtụtụ 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 inye 1.25 mg ugboro abụọ n'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.
Usoro kachasị akwadoro kwa ụbọchị 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 Dilaprel ®, a na-atụ aro ka ọgwụgwọ malite na nke kachasị dị ntakịrị - 1.25 mg otu ugboro n'ụbọchị *. Ekwesịrị ịkpachara anya na mmụba ọ bụla na dose.

Na-arịa ọrịa shuga ma ọ bụ nephropathy na-arịa ọrịa mamịrị
Ọgwụ nke mbụ bụ 1.25 mg otu ugboro n'ụbọchị *. Ọgwụ ahụ nwere ike ịbawanye ọgwụ 5 ugboro otu ugboro n'ụbọchị.
Oke kachasị kwa ụbọchị bụ 5 mg.

Ojiji nke ọgwụ Dilaprel ® na ụfọdụ ndị ọrịa

Ndị ọrịa nwere ọrụ mgbazinye nsogbu
Site na CC site na 50 ruo 20 ml / min kwa 1.73 m² nke anụ ahụ dị elu, usoro mbụ kwa ụbọchị na-abụkarị 1.25 mg *.
Oke kachasị 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 *.

Ọrịa nwere ọgwụgwọ diuretic tupu oge ya
Ọ bụrụ na ọ ga - ekwe omume, ọ dị mkpa ịkagbu ọgwụ diuretics n'ime ụbọchị 2-3 (ọ dabere na oge nke ihe nsure ọkụ) tupu ịmalite ọgwụgwọ na Dilaprel ® ma ọ bụ, opekata mpe, belata dose nke ọgwụ diuretics. Treatmentgwọ ndị ọrịa dị otú a kwesịrị ịmalite site na ntakịrị ọgwụ nke 1.25 mg nke ramipril * nke a na-ewere otu ugboro kwa ụtụtụ. Mgbe ha takingụsịrị ọgwụ nke mbụ na oge ọ bụla mgbe ha nwesịrị ị ofụ ọgwụ ramipril na (ma ọ bụ) akwara mkpụrụ, ndị ọrịa kwesịrị ịnọ n'okpuru nlekọta ahụike maka opekata mpe awa asatọ iji zere mmeghachi omume hypotensive a na-achịkwaghị achịkwa.

Ndị okenye (ndị okenye karịrị afọ 65)
A na-ebelata ọgwụ mbụ ka ọ bụrụ 1.25 mg / ụbọchị *.

Ndị ọrịa nwere ọria imeju
Mmeghachi omume nke ọbara mgbali na ị takingụ Dilaprel ® nwere ike ịbawanye elu (n'ihi nkwụsịlata nke ramiprilat excretion) ma ọ bụ ibelata (n'ihi nkwụsị na ntughari 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.

* N'okwu a, ịnwere ike iji ọgwụ ramipril ọgwụ n'ụdị usoro onunu ogwu ọzọ: mbadamba 2.5 mg n'ihe ize ndụ.

Mmetụta akụkụ

Si usoro obi:
Ọtụtụ mgbe - mbelata ọbara mgbali elu, hyperension orthostatic, syncope, mgbu obi,
ugboro ugboro - ischemia myocardial, gụnyere mmepe nke ọgụ angina pectoris ma ọ bụ infịction myocardial infarction, tachycardia, arrhythmias (ọdịdị ma ọ bụ nwuo), palpitations, akụkụ akụkụ akụkụ, iwepụ ihu.

Site na usoro mkpụrụ ndụ:
ugboro ugboro - ọrụ akụrụ na-adịghị ala ala, gụnyere mmepe nke akwara oke, mmụba nke mmamịrị ewepụtara, mmụba na proteinuria dị, mmụba nke urea na creatinine n'ime ọbara, enweghi ike ọgbụgba n'ihi ọgbụgba ọgbụgba, mbelata libido,
ugboro-amaghị - gynecomastia.

Si n'etiti ụjọ usoro:
ọ na - abụkarị isi ọwụwa, mmetụta nke 'ịdị nro' n'isi, mmetụta nke ike ọgwụgwụ,
ugboro ugboro - ọgbụgba, agevzia (ọnwụ nke ịnụ ụtọ uto), dysgeusia (mmebi nke uto uto), obi erughị ala, nchekasị, oke iwe, nchekasị ụgbọ ala, mgbakasị ụra, gụnyere ụra,
ọ na - esighi ike - ịma jijiji, mmepe ma ọ bụ mgbasa nke nsogbu mgbasa ọbara na - akpata nhụjuanya ọnya afọ, vasculitis, asthenia, enweghị ike, ọgba aghara,
ugboro ugboro amaghi - ọrịa syna Raynaud, ọrịa ụbụrụ nke isheria, tinyere ischemic strok na ọrịa ụkwara ume ọkụ, ọrịa psychomotor na-akpata, paresthesia (senseshional na-ere ọkụ), parosmia (mmetụta na-enweghị isi nke isi), ntị na-adịghị mma, ịda mba.

Si uche:
ugboro ugboro - esemokwu ọhụụ, gụnyere ọhụhụ ụzọ, adịkarịghị - conjunctivitis, nkwarụ ntị, tinnitus,

Site na usoro mọzụlụ:
oge mgbu akwara, myalgia,
ugboro ugboro - arthralgia.

Site na nri digestive:
mgbe - mmeghachi omume afọ na afọ na eriri afọ, afọ mgbu, ahụ erughị ala nke afọ, dyspepsia, afọ ọsịsa, ọgbụgbọ, ọgbụgbọ,
ugboro ugboro - pancreatitis, gụnyere ihe na-egbu egbu, ịba ụba ọrụ nke enzymes nke pancreatic na plasma ọbara, ọrịa eriri afọ, mgbu afọ, gastritis, afọ ntachi, mucosa a na-ede ede, ụba ọrụ nke enzymes imeju (ALT, AST aminotransferases) na ịta ahụhụ nke bilirubin na plasma ọbara, anorexia, agụụ belatara,
adịkarịghị - glossitis, cholestatic jaundice, ọnya ọrịa hepatocellular, a maghị ugboro ole - aphthous stomatitis, ọrịa imeju akwara, cholestatic ma ọ bụ ọrịa cytolytic ọrịa (ọnwụ dị ụkọ).

Site na usoro iku ume:
ọtụtụ mgbe - akọrọ ụkwara (jọrọ njọ n'abalị dina ala), sinusitis, bronchitis, mkpụmkpụ ume,
ugboro ugboro - bronchospasm, tinyere ịka njọ nke ụkwara ume ọkụ, ọwara imi.

Na akpukpo ahu:
mgbe niile - ọnya anụ ahụ, ọkachasị maculopapular, adịkarịghị - angioedema, gụnyere egbu egbu (edema edema nwere ike ibute ihe mgbochi ikuku na-eduga na ọnwụ), itching skin, hyperhidrosis (sweating over ከመጠን), adịkarịghị - exfoliative dermatitis, urticaria, onycholysis,
ọ na-esiri ike - ị na-ahụghachi mmeghachi omume,
ugboro amaghi - necrolysis na-egbu egbu, Stevens-Johnson syndrome, erythema multiforme, pemphigus, psoriasis na-akawanye njọ, psoriasis-like dermatitis, pemphigoid ma ọ bụ lichenoid (lichenoid) exanthema ma ọ bụ enanthema, alopecia, anaphylactic ma ọ bụ anaphylactic anaphylactic reactions na-abawanye. ka nsí ahụhụ) mụbara ọgwụ mgbochi ọgwụ antiinuclear.

Site na akụkụ ahụ dị na hemopoietic:
ugboro ugboro - eosinophilia, adịkarịghị - leukopenia, gụnyere neutropenia na agranulocytosis, mbelata nke ọnụ ọgụgụ ọbara ọbara ọbara n'ọbara, mbelata nke mkpokọta hemoglobin, thrombocytopenia, ọnaghị amata ugboro ugboro - mgbochi ụmị ọkpụkpụ ọbara ọbara, pancytopenia, hemolytic anaemia.

Ndị ọzọ:
ugboro ugboro - ọbara mgbali elu.

Nnyocha ụlọ nyocha:
ọtụtụ mgbe - mmụba na potassium na ọbara, ugboro ole a na-amaghị - mbelata sodium n'ọbara. A kọwo na ọrịa hypoglycemia na ndị ọrịa nwere ọrịa shuga bụ ndị nara insulin na ọgwụ hypoglycemic ọgwụ.

Dodoụbiga ya ókè

Mmekọrịta na ọgwụ ndị ọzọ

Ojiji nke membranes dị elu nwere oke na-adịghị mma (dịka ọmụmaatụ, polyacrylonitrile membranes) n'oge ịba ọcha n'anya ma ọ bụ iji ọbara ọcha mee ihe n'oge oge nke lipoproteins dị ala na-abawanye ohere nke nnukwu mmeghachi omume anaphylactic.

Ngwakọta agwaghị ya
Site na mmiri nnu, a na - eji potassium eme nri (dịka ọmụmaatụ, amiloride, triamteren, spironolactone), enwere ike ịbawanye ụba na ụdị potassium ga - ekwe omume (iji ya mee ihe n'otu oge, a na-achọ nlele mgbe niile nke potassium potassium).

Ejikọtara ọnụ iji kpachara anya
Na ndị ọrụ antihypertensive (ọkachasị akwara) na ọgwụ ndị ọzọ na-ebelata ọbara mgbali (nitrates, tricyclic antidepressants), a na-ahụta ike nke mmetụta antihypertensive, yana mgbakwunye, a na-enyocha ihe sodium ọdịnaya.

Ọkpụkpụ hyperemia, ọgbụgbọ, vomiting, hypotension adịkarịghị ekwe omume na nhazi ọla edo.

Site na ọgwụ eji ehi ụra, ọgwụ ọgwụ na-egbu egbu, ndị na-ahụ maka ọgwụ na-egbu egbu na ọgwụ mgbu, mmụba na mmetụta antihypertensive. Site na vasopressor sympathomimetics (epinephrine), mbelata na antihypertensive mmetụta nke ramipril, a na-achọ nlebara anya nke ọbara mgbali mgbe niile.

Na allopurinol, procainamide, cytostatics, immunosuppressants, sistemu glucocorticosteroids na ọgwụ ndị ọzọ nwere ike imetụta oke hematological, ihe ize ndụ nke ịmalite leukopenia na-abawanye.

Site na nnu nnu lithium, mmụba na ụba nke lithium yana mmụba na akwara obi na mmetụta neurotoxic nke lithium.

Site na ndị na-ahụ maka hypoglycemic maka nchịkwa ọnụ (usoro sulfonylurea, biguanides), insulin, na njikọta mbelata insulin na-emegide n'okpuru ramipril, mmetụta hypoglycemic nke ọgwụ ndị a nwere ike ịbawanye na mmepe nke hypoglycemia.

Njikọ iji tụlee

Site na ọgwụ mgbochi mkpali na - abụghị steroidal (indomethacin, acetylsalicylic acid), na - ebelata mmetụta nke ramipril, ịbawanye ohere nke ọrụ ịgbazigharị na ịba ụba nke potassium ga - ekwe omume.

Site na heparin, mmụba nke potassium serum ga-ekwe omume.

Site na sodium chloride, ọ ga-ekwe omume ịbelata mmetụta antihypertensive nke ramipril na ọgwụgwọ dịtụ ala maka mgbaàmà nke nkụchi obi na-adịghị ala ala.

Na ethanol, enwere mmụba nke mgbaàmà nke vasodilation. Ramipril nwere ike iwelie mmetụta ọjọọ nke ethanol n'ahụ.

Na estrogens, mmetụta antihypertensive nke ramipril adịghị ike (njigide mmiri).

Ọgwụ ọgbụgba maka ọgwụ na-egbochi ahụhụ ụmụ ahụhụ: Ndị na - egbochi ACE, gụnyere ramipril, na - eme ka ohere nke anaphylactic siri ike ma ọ bụ mmeghachi omume anaphylactoid na nsị ahụhụ.

Na-emegide usoro ọgwụgwọ ya na ndị na - egbochi ACE, mmeghachi omume na - emetụta ahụhụ venom (dịka ọmụmaatụ, a beesụ, beps) na - etolite ngwa ngwa ma na - esikwa ike karị. Ọ bụrụ na ekwesighi iji ọgwụ ahụhụ mee ka ọ dị mkpa, a ga-anọchi ọgwụ mgbochi nke ACE nwa oge ka ọ jiri ọgwụ kwekọrọ na klas dị iche.

Ntụziaka pụrụ iche

Tupu ịmalite ọgwụgwọ na Dilaprel ®, ọ dị mkpa iji kpochapụ hyponatremia na hypovolemia. N'ime ndị ọrịa burula diuretics, ọ dị mkpa ịkagbu ha ma ọ bụ opekata mpe belata ọgwụ ha 2-3 ụbọchị tupu ịbanye Dilaprel ® (na nke a, a ga-eji nlezianya nyochaa ọnọdụ ndị ọrịa na-arịa ọrịa obi na-adịghị ala ala n'ihi ohere nke ịmalite decompensation n'ihi abawanye na mgbasawanye ọbara).

Mgbe ị takingụchara ọgwụ mbụ ahụ, yana ịba ụba ya na / ma ọ bụ ọgwụ nke nsị (ọkachasị akaghị), ọ dị mkpa iji hụ na nlebara anya nke ahụike nke onye ọrịa ọ dịkarịa ala elekere 8 iji were usoro kwesịrị ekwesị ma ọ bụrụ na mbelata ọbara mgbali elu.

Ọ bụrụ na a na-eji Dilaprel the mee ihe oge mbụ ma ọ bụ n'ọtụtụ na ndị ọrịa nwere ọrụ RAAS dị elu, mgbe ahụ, ha kwesịrị iji nlezianya nyochaa ọbara mgbali, karịsịa na mmalite ọgwụgwọ, ebe ndị ọrịa a nwere ohere dị ukwuu nke mbelata ọbara mgbali elu (lee akụkụ "Nkpachara anya") .

Ọ bụrụ na nsogbu ọbara ọgbụgba na akwara dị oke egwu na nkụchi obi, ọkachasị mgbe ọ na-arịa nnukwu ọrịa myocardial infarction, ọgwụgwọ Dilaprel ® kwesịrị ịmalite naanị n'ụlọ ọgwụ.

N'ime ndị ọrịa nwere nkụda mmụọ na-adịghị ala ala, ị theụ ọgwụ ahụ nwere ike iduga mmepe nke mbelata ọbara mgbali elu, nke n'ọnọdụ ụfọdụ na-esonyere oliguria ma ọ bụ azotemia na adịkarịghị site na mmepe nke nnukwu gbasara akụrụ. Ekwesịrị iji nlezianya na-emeso ndị ọrịa agadi, n'ihi na ha nwere ike ịdị na-echebara ndị na-egbochi ACE echiche nke ọma. N'ime usoro ọgwụgwọ mbụ, a na-atụ aro ka nyochaa njikwa ọrụ ndị na-arụ ọrụ (leekwa akụkụ "Usoro Ọgwụ na Nchịkwa").

N'ime ndị ọrịa maka mmụba ọbara mgbali nwere ike ịnwe otu ihe ize ndụ (dịka ọmụmaatụ, na ndị ọrịa nwere ọnya atherosclerotic warara nke akwara ọbara ma ọ bụ akwara akwara), ọgwụgwọ kwesịrị ịmalite n'okpuru nlekọta ahụike dị nso. Ekwesịrị ịkpachara anya n'oge mgbatị anụ ahụ na / ma ọ bụ ihu igwe na-ekpo ọkụ n'ihi ihe ize ndụ nke ọsụsọ na mmiri na-egbu mmiri na mmepe nke hypotension n'ihi mbelata olu nke na-ekesa ọbara na mbelata nke mkpokọta sodium n'ọbara.

N'oge ọgwụgwọ Dilaprel ®, anaghị atụ aro ị alcoholụ mmanya na-aba n'anya.

Akpukpo ọbara nke anakpo achi abughi ihe mgbochi nye aka ka ogooso mgbe ogbara obara kwusiri.

N'ihe banyere mmepe ugboro ugboro nke nnukwu akwara ọbara, a ga-ebelata dose ahụ ma ọ bụ kwụsị ọgwụ ahụ.

N'ime ndị ọrịa gwọchara ndị na-egbochi ACE, a hụrụ ntụgharị ihu nke ihu, aka, egbugbere ọnụ, ire, pharynx ma ọ bụ larynx. Ọ bụrụ na ọzịza na-apụta na mpaghara ihu (egbugbere ọnụ, nku anya) ma ọ bụ ire, ilo mmiri ma ọ bụ iku ume, onye ọrịa ahụ kwesịrị ịkwụsị ị takingụ ọgwụ ahụ ozugbo.

Ọkpụkpụ angioneurotic, nke edebere n'ime ire, pharynx ma ọ bụ akwara (mgbaàmà enwere ike: ilo mmiri ma ọ bụ iku ume), nwere ike ịbụ ihe egwu na - egbu mmadụ ma chọọ usoro ọsọ ọsọ iji kwụsị ya: nchịkwa subcutaneous nke 0.3-0.5 mg ma ọ bụ ntanye nke 0.1 mg nke adrenaline (n'okpuru nchịkwa nke ọbara mgbali elu, obi obi na ECG), na-esochi ojiji nke glucocorticosteroids (iv, i / m ma ọ bụ n'ime), nchịkwa intravenous nke antihistamines (ndị na-egbochi H1 na H2 histamine receptors) na-atụ aro, ma bụrụ nke adịghị ike na-adịghị mma, ugbo. nta C1-esterase nwere ike ịtụle mkpa okwu mmeghe na mgbakwunye na ndị na-egbochi adrenaline nke enzyme C1-esterase. Ekwesịrị ilebara onye ọrịa ahụ n'ụlọ ọgwụ, a ga-enwerịrị nlebara anya ruo mgbe mgbaàmà ahụ nwere ahụ efe kpamkpam, mana ọ na-erughị awa 24.

N'ime ndị ọrịa na-anata ndị na-egbochi ACE, a hụrụ oge ọrịa angioedema nke akụkụ eriri afọ, nke emere site na mgbu azụ na ya ma ọ bụ na-enweghị ọgbụgbọ na ọgbụgbọ, mgbe ụfọdụ, a na-ahụ ihu ihu ihu n'otu oge. Ọ bụrụ na onye ọrịa ahụ tolitere ihe mgbaàmà ndị a dị n'elu site na iji ya na ndị na - egbochi ACE, nchọpụta ọdịiche ahụ kwesịkwara ịtụle ohere nke ịmalite ịmịnye afọ.

Ọgwụgwọ nke chọrọ ime ka ahụhụ ghara ịta ahụhụ (a beesụ, beps) na ị inụ ihe mgbochi ACE n'otu oge nwere ike ịmalite mmeghachi omume anaphylactic na mmeghachi nke anaphylactoid (dịka ọmụmaatụ, mbelata ọbara mgbali, mkpụmkpụ ume, vomiting, mmeghachi ahụ anụ ahụ na-adịghị mma), nke nwere ike oge ụfọdụ na-egbu ndụ. Na-emegide usoro ọgwụgwọ ya na ndị na - egbochi ACE, mmeghachi omume na - emetụta ahụhụ venom (dịka ọmụmaatụ, a beesụ, beps) na - etolite ngwa ngwa ma na - esikwa ike karị. Ọ bụrụ na ekwesighi iji ọgwụ ahụhụ mee ka ọ dị mkpa, a ga-anọchi ọgwụ mgbochi nke ACE nwa oge ka ọ jiri ọgwụ kwekọrọ na klas dị iche.

Mgbe ị na - eji ihe ndị ACE inhibitors, akọwapụtara ihe egwu na - adị ndụ, anaphylactoid mmeghachi omume ngwa ngwa, mgbe ụfọdụ rue mmepe nke ujo n'oge hemodialysis ma ọ bụ mkpo plasma site na iji membranes dị elu (dịka ọmụmaatụ, polyacrylonitrile membranes) (leekwa ntuziaka ndị membrane). Ọ dị mkpa izere ijikọ ọnụ ọgwụ Dlaprel ® na membranes ndị dị otú ahụ, dịka ọmụmaatụ, maka usoro ọgwụgwọ ma ọ bụ mmamịrị. Na nke a, a ga-ahọrọ iji nke ọzọ membranes ma ọ bụ mwepu nke ndị na-egbochi ACE. A hụrụ mmeghachi omume ndị yiri ya na ụdị nke lipoproteins dị ala na-eji sulfate sulfate. Ya mere, ekwesighi iji usoro a mee ihe na ndị ọrịa na-anata ndị na-egbochi ACE.

Tupu ịwa ahụ (gụnyere ọgwụ ezé), ọ dị mkpa ịdọ onye na-agwọ ọrịa aka na ntị banyere iji ọgwụ mgbochi ACE.

Tupu na mgbe ọgwụgwọ ya na ndị na - egbochi ACE, ọ dị mkpa ịgbakọ ọnụọgụ nke leukocytes ma chọpụta usoro leukocyte.

Ewubeghi nchekwa na ike nke Dilaprel children n’ebe ụmụaka na ụmụaka nọ n’agbata afọ 18.

A na-atụ aro iji nlezianya nyochaa ụmụ amụrụ ọhụrụ ndị ekpughere intrauterine kpughere ndị na-egbochi ACE iji chọpụta hypotension arterial, oliguria na hyperkalemia. Na oliguria, ọ dị mkpa iji nọgide na-enwe ọbara mgbali na mmanụ na-esi ísì ụtọ site na iwebata mmiri na vasoconstrictors kwesịrị ekwesị. N'ime ụmụ amụrụ ọhụrụ, enwere ihe ọghọm nke oliguria na nsogbu akwara ozi, ikekwe n'ihi mbelata ọbara na akụrụngwa ọbara n'ihi ụkọ ọbara ọbara nke ndị na - egbochi ACE (nke ụmụ nwanyị dị ime na mgbe ha mụchara nwa).

N'ime ndị ọrịa nwere ọrịa obi na-adịghị ala ala, iji ọgwụ Dlaprel ® mee ọgwụ nwere ike iduga mmepe nke mbelata ọbara mgbali elu, nke n'ọnọdụ ụfọdụ na-esonyere oliguria ma ọ bụ azotemia, na adịkarịghị, mmepe nke nnukwu gbasara akụrụ. Ndị ọrịa nwere ajọ ọria akwara ma ọ bụ nkụchi obi dara ada kwesịrị ịmalite ọgwụgwọ n'ụlọ ọgwụ.

N'ime ndị ọrịa nwere ọrụ imeju na-adịghị mma, mmeghachi omume na ọgwụgwọ Dilaprel ® nwere ike ịkwalite ma ọ bụ mee ka ike gwụ ha. Na mgbakwunye, na ndị ọrịa nwere ajọ ọrịa na edema na / ma ọ bụ ascites, mmụba dị ukwuu nke sistemụ renin-angiotensin-aldosterone (RAAS) ga-ekwe omume, yabụ, ekwesịrị ilebara anya pụrụ iche na ọgwụgwọ nke ndị ọrịa a.

Nyochaa usoro nyocha ụlọ ọgwụ tupu oge a na-agwọ Dilaprel treatment (ihe ruru otu oge kwa ọnwa n'ọnwa 3-6 mbụ nke ọgwụgwọ)
kachasị mkpa na ndị ọrịa nwere nnukwu ihe ize ndụ nke neutropenia - na arụ ọrụ ezigharị mkpị, ọrịa nke anụ ahụ na-ejikọta ma ọ bụ na ndị ọrịa na-anata oke ọgwụ ọgwụ, yana ihe ịrịba ama mbụ nke ibute ọrịa. Mgbe emere nkwenye neutropenia (ọnụọgụ nke neutrophils erughị 2000 / )l), ekwesịrị ịkwụsị usoro ọgwụgwọ ACE.

Na ọgwụgwọ nke ndị na - egbochi ACE na izu mbụ nke ọgwụgwọ ma atụkwasakwaziri ya nlele akụrụ. Ọ dị mkpa nlezianya nlebara anya maka ndị ọrịa nwere ọrịa obi na -akpata obi, na-arụ ọrụ akụrụ, mgbe ọrịa akụrụgharị, ndị ọrịa nwere ọrịa akụrụngwa akwara metụtara akwara na ọnya akụrụ abụọ (na ndị ọrịa dị otú ahụ, nwedịrị ntakịrị mmụba na serum creatinine ịta nwere ike ịbụ onye gosiputara na aru akụrụ ya wedara aka).

Ihe ngbako electrolyte: A na-atụ aro ka a na-agbakarị ọgwụ potassium mgbe niile. Ọkachasị ịmatachaa etu ihe kwesiri isi eme ya bụ ihe ana - eme ka ndị ọrịa nwee ọrụ mkpo ya, oke mmiri, elektrọnte anya, na nkụchi obi.

Akwadoro ijikwa ọnụọgụ ọbara iji chọpụta leukopenia enwere ike. A na-atụ aro ka a na-agbakarị anya na mbido ọgwụgwọ na ndị ọrịa nwere nsogbu gbasara akụrụngwa, yana ndị ọrịa nwere ọrịa anụ ahụ na-arịa ma ọ bụ na ndị ọrịa na-anata ọgwụ ndị ọzọ nwere ike ịgbanwe foto dị elu (lee mpaghara “Mmekọrịta na ọgwụ ndị ọzọ”) . Njikwa ọnụ ọgụgụ nke leukocytes dị mkpa maka nchọpụta mbụ nke leukopenia, nke kachasị mkpa na ndị ọrịa nwere nnukwu mmụba ya, yana ihe ịrịba ama mbụ nke ibute ọrịa. Mgbe ihe mgbaàmà metụtara leukopenia pụtara (dịka ọmụmaatụ, ahụ ọkụ, ọnya ọnya afọ, tonsillitis), ọ dị mkpa ileba anya ngwa ngwa onyonyo ịwa ahụ. N'ọnọdụ ihe ịrịba ama nke ọbara ọgbụgba (petechiae pere mpe, ụcha na-acha ọbara ọbara na anụ ahụ na mucous membranes), ọ dịkwa mkpa ijikwa ọnụ ọgụgụ platelet n'ọbara.

Ọ bụrụ na jaundice ma ọ bụ mmụba dị ukwuu na ọrụ nke enzymes imeju (aminotransferase ALT, AST), ọ ga-akwụsị ịgwọ Dilaprel and ma ọ bụrụ na elebara ahụike nke onye ọrịa anya.

Mwepụta wepụtara ya na ihe mejupụtara

Dilaprel onunu ogwu udiri - capsules: gelatin siri ike, nha nke 3, na onodu ogwu nke 2.5 mg - ahu ọcha na okpu odo, na onunu ogwu nke 5 mg - ahu aru na okpu, na onunu ogwu nke 10 mg - ahu ọcha na okpu, filler - mass powder. ihe fọrọ nke nta ka ọ bụrụ ọcha ma ọ bụ na-acha ọcha, friable ma ọ bụ compacted, na-akụghasị mgbe a na - agbanye ya (na ngwugwu ọnya: 7 p.., n'ime igbe kaadi 2 ma ọ bụ 4 ngwugwu, 10 PC., n'ime igbe kaadi 1, 2, 3, 5 ma ọ bụ 6 nchịkọta. , 14 PC., N'ime igbe kaadiboodu 1, 2 ma ọ bụ 4 nkwakọ).

Ngwakọta nke otu Capsule:

ihe na-arụ ọrụ: ramipril - 2.5, 5 ma ọ bụ 10 mg,
ihe inyeaka: ihe ndị na-eme ka calcium stearate, aerosil (silloon silicon dioxide), lactose (lactose monohydrate - maka capsules 10 mg),
ikpe na mkpuchi: gelatin, titanium dioxide, iron na-acha agba edo oxide edo edo (maka okpu abụọ na mmiri mg 5 na mg).

Dilaprel: ntuziaka maka ojiji (usoro na usoro)

A na-eralomi okpokoro Dilaprel n'ọnụ ma ọ bụrụ na a withụghị ya mmiri. (1 /₂ iko). Ofdị irè nke ọgwụ a adịghị adabere na nri oriri.

A na-ahọrọ ọgwụ ahụ n'otu n'otu, na-eburu n'uche ihe ngosipụta ụlọ ọgwụ, mmetụta ọgwụgwọ na ịnagide ọgwụ ahụ. Oge ọgwụgwọ a na-adịkarị ogologo oge, dọkịta kpebiri na ọ ga-ekpebi oge ọ ga-ekpebi ikpe ọ bụla.

Dilaprel usoro onunu ogwu nyere aka (ma ewezugoro ya):

ọbara mgbali: usoro mbu bụ 2.5 mg 1 oge kwa ụbọchị n'ụtụtụ. Ọ bụrụ na n’ime izu atọ ọbara mgbali adịghị agbanwe agbanwe, ịnwere ike ịbawanye ọgwụ kwa ụbọchị gaa 5 mg. Ọ bụrụ na ọgwụgwọ ọgwụgwọ kwa ụbọchị nke 5 mg ezughi oke, ọ nwere ike okpukpu abụọ na izu abụọ ruo oke nke 10 mg kwa ụbọchị, ma ọ bụ enwere ike ịgbakwunye ọgwụ ndị ọzọ antihypertensive na usoro ọgwụgwọ, na-egbochi ndị nwere ọciumụ calcium na ngwa ngwa.
ụdị ọrịa obi na - adịghị ala ala: mbụ ọgwụ - 1.25 mg kwa ụbọchị. Dabere na nsonaazụ nke ọgwụgwọ ahụ na iji nnabata dị mma, a na-atụ aro ka ọ jiri nwayọ belata ọgwụ ahụ, na-agbakọọ ya na oge nke izu 1-2, mana ọ gafeghị 10 mg kwa ụbọchị. A pụrụ ị Doụ ya mgbe ọ bụla kwa 2,5 mg otu ugboro n'ụbọchị ma ọ bụ ekewa abụọ,
ngwangwa obi na ngosiputa akuko nke putara 2 - 2 ubochi onwaputara oria omimi: nkpuru mbu bu 2.5 mg 2 n’oge ubochi (ututu na anyasi). Site na mbelata ọbara mgbali elu, ọ dị mkpa iji belata ọgwụ mbụ ka 1.25 mg ugboro abụọ n'ụbọchị. Mgbe ahụ, dabere n'ọnọdụ onye ọrịa ahụ, enwere ike ịgbakwunye okpukpu abụọ ya na nkeji nke ụbọchị 1-3. Na nke a, enwere ike belata ugboro ole ị theụ kwa ụbọchị ruo 1 oge kwa ụbọchị. Otu a na-atụ aro ya kwa ụbọchị bụ 10 mg,
ụdị ọrịa obi na-adịghị ala ala (NYHA klas III - klaasị arụ ọrụ IV), nke mere ozugbo ọrịa infesction dị njọ: nke mbụ - 1.25 mg otu ugboro n’ụbọchị, n’ọdịniihu, yana mmụba ọ bụla, a ga-egosipụta oke ịkpachara anya. Ọ bụ nanị dibia na-abịa, ọ bụ dọkịta na-ahụ maka usoro ọgwụ, ga - esote ya.
mgbochi nke ọrịa strok, infarction myocardial, ma ọ bụ ọnwụ sitere na CVD (n'ime ndị ọrịa nwere nnukwu ọrịa obi): usoro mbụ - 2.5 mg otu ugboro n'ụbọchị. Site na iji ọgwụ mgbochi ọgwụ nke ọma, a na-atụ aro ka ọ were nwayọ bulie ya. Mgbe izu 1 nke ọgwụgwọ gasịrị, ọ nwere ike okpukpu abụọ, mgbe ahụ n’ime izu 3 gaa na ụdị mmezi a na-ahụkarị 10 mg otu ugboro kwa ụbọchị,
na-arịa ọrịa mamịrị ma ọ bụ ọrịa mamịrị nephropathy: ọgwụ mbụ bụ 1.25 mg otu ugboro kwa ụbọchị, mgbe ahụ enwere ike ịba ụba ruo 5 mg / ụbọchị, ewe otu oge.

Na-atụ aro Dilaprel usoro onunu ogwu usoro mgbazi maka ụfọdụ ọrịa / ọnọdụ:

ọbara ọgbụgba siri ike (ọkwa III), metabolism mmiri-salt na-emetụta ya na ọnọdụ nke mbelata ọbara mgbali elu dị egwu (dịka ọmụmaatụ, nwere nnukwu ọnya ụbụrụ nke ụbụrụ na akwara ụkwara): usoro izizi - 1.25 mg kwa ụbọchị,
Nsogbu akụrụ na CC nke 50- 20 ml / min nke nwere mpaghara 1.73 m 2: usoro izizi bụ 1.25 mg / ụbọchị, otu kachasị kwa ụbọchị bụ 5 mg,
agadi dị ihe karịrị afọ 65: ọgwụ mbụ - 1.25 mg kwa ụbọchị,
ọdịda nke imeju: oke ọgwụ bụ 2.5 mg kwa ụbọchị. N'oge usoro ọgwụgwọ mbụ, ojiji nke ọgwụ a kwesịrị ịdị n'okpuru nlekọta ahụike dị nso, ebe ọkwa ọbara mgbali ọbara nwere ike ịdị iche iche n'otu akụkụ ma ọ bụ n'akụkụ nke ọzọ.
usoro ọgwụgwọ gara aga ya na diuretics: ọgwụ mbụ bụ 1.25 mg otu ugboro n’ụtụtụ (a na-atụ aro ka ị kagbuo diuretics ma ọ bụ belata ọgwụ ha ruo ụbọchị 2-3 tupu ịmalite Dilaprel). N'oge usoro ọgwụgwọ mbụ, yana n'oge mmụba ọ bụla na dose nke ramipril na / ma ọ bụ diuretics, iji zere mmeghachi omume hypotensive, nlezianya nyocha ahụike nke ọnọdụ onye ọrịa ọ dịkarịa ala awa 8 dị mkpa.

Ime na lactation

Dịka ntuziaka ahụ si dị, Dilaprel bụ ihe mgbochi ime na oge inye nwa.

Tupu usoro ọgwụgwọ, a ga-agụpụ afọ ime. Ọ bụrụ na ịtụrụ ime mere n’oge ị theụ ọgwụ ahụ, ọ dị mkpa ịkagbu ya ozugbo enwere ike wee depụta ọgwụ ọzọ.

Inweta Dilaprel n’oge afọ ime (karịchaa n’oge nke mbụ) nwere ike ibute mbelata ọbara nke nwa ebu n’afọ na nwa amụrụ, ọrụ imebi akụrụ nwa ebu n’afọ, ọrụ akụrụngwa arụ, hypoplasia nke ọkpụkpụ okpokoro isi, hyperkalemia, nkwekọrịta nke nsọtụ, hypoplasia nke akpa ume, na mbibi nke okpokoro isi. Maka ụmụ amụrụ ọhụrụ ekpughere intrauterine na ACE inhibitors, ọ dị mkpa iji nlezianya nyochaa maka oliguria, hyperkalemia na hypotension, na mgbakwunye, ha nwere ihe ize ndụ nke nsogbu akwara ozi.

Ọ bụrụ n’ịchọrọ ịgwọ Dilaprel n’oge a na-enye nwa ara, a ga-akwụsị ịfeụ ara.

Dilaprel, ntuziaka maka ojiji (Usoro na usoro onunu ogwu)

A na-ewere usoro ị drugụ ọgwụ ahụ na-eburu n'uche mmeghachi omume nke ahụ onye ọrịa, ogo nke usoro pathological. Ighapu ahihia nile n’ebughi mmiri. Ihe kachasị ị dailyụ ọgwụ kwa ụbọchị bụ 10gigram.

Na ọbara mgbali ike Dilaprel na - ebido were ọgwụ were were 2,5 mg kwa ụbọchị. Site na ọgwụgwọ ọgwụgwọ adịghị ike ma ọ bụ enweghị ya maka ụbọchị iri abụọ na otu, usoro ịba ụba na-abawanye ruo 5 mg. Na ọgwụgwọ CHF usoro onunu ogwu bu 1.25 mg / ubochi ma, oburu na odi nkpa, aghazie uzo a.

Na arụ ọrụ ezumike ọrụ

Dilaprel bụ contraindicated na nnukwu akụrụ nsogbu (na CC erughị 20 ml / min nwere ahụ elu mpaghara nke 1.73 m 2), ndị ọrịa nwere nephropathy gwọọ ọgwụ na-abụghị steroidal anti-inflammatory ọgwụ (NSAIDs), glucocorticosteroids (GCS), immunomodulators na / ma ọ bụ ndị ọzọ na-ahụ maka cytotoxic.

Na ịkpachapụ anya, a ga-ewere Dilaprel maka ọrụ akwara arụrụala (CC karịrị 20 ml / min nwere mpaghara elu akụkụ nke 1.73 m 2) - n'ihi ihe ọghọm nke ịmalite hyperkalemia na leukopenia, ya na hemodynamically dị mkpa n'otu akwara akwara arten stenosis (ọnụnọ nke akụrụ abụọ), na mgbe amuchara akụrụ.

Mmekorita

Agaghị atụkọta ọgwụ ọgwụ Dilaprel na ọgwụ na-enye potassium na salts ọgwụ (n'ihi ihe ọghọm nke mmụba akpọrọ na mkpokọta potassium na ọbara). Ejikọtara ọnụ iji kpachara anya.

Jiri nlezianya dọọ Dilaprel:

na ọgwụ antihypertensive, ọkachasị akụrụngwa, na ọgwụ narcotic, ọgwụ ịrahụ ụra, ndị na - ahụ ihe mgbu n'ihi akpọtụ ike nke mmetụta hypotensive,
ya na vasopressor sympathomimetics n'ihi ọghọm nke mbelata mmetụta hypotensive nke ọgwụ ahụ,
ya na procainamideimmunosuppressants allopurinolsistemụ GKS, cytostatics yana ọgwụ ndị ọzọ na-emetụta pịnịstrị ọbara ọbara n'ihi oke ihe ọghọm nke mmepe leukopenia,
site na ọgwụ hypoglycemic maka nchịkwa ọnụ, n'ihi mmụba omume hypoglycemic nke ọgwụ ndị a nwere ihe egwu nke mmepe hypoglycemia,
ya na nnu nnu nke lithium: nsogbu nke neuro- na akwara nke lithium,
ya na estrogen: n'ihi ọghọm nke imebi mmetụta hypotensive nke ọgwụ ahụ,
ya na heparin n'ihi ihe egwu nke ịba ụba itinye uche nke potassium n'ime ọbara.

Site na ịrụ ọrụ ọrụ imeju

N'ime ndị ọrịa nwere ọrụ imeju na-arụ ọrụ, enwere ike ịhụ mmụba na mbelata mmetụta ramipril. N'ihi enweghị ahụmịhe banyere iji ya, ekwesịrị ịhazi Dilaprel jiri nlezianya nye ndị ọrịa dị otú a.

Ekwesịrị ilebara anya nke imeju anya nke ukwuu site na edema na / ma ọ bụ ascites n'ihi nsonaazụ pụrụ iche nke RAAS.

Mkparịta ụka ọgwụ ọjọọ

Ojiji Dilaprel na oge ufodu ogwu nwere ike iduga uto uto a:

Ngwakọta potassium na mkpụrụ ndụ ihe na-akpata potassium (spironolactone, triamteren, amiloride), ọgwụ ndị ọzọ na-abawanye ọdịnaya plasma potassium (cyclosporine, tacrolimus, trimethoprim): ịba ụba ọdịnaya plasma potassium,
telmisartan: ịba ụba nke ọrụ akwara ọrụ, hyperkalemia, hypotension, ọgbụgba,
ọgwụ nwere aliskiren, yana ndị na-anabata AT1 na-egbochi ihe mgbochi (angiotensin II receptor antagonists): n'ihi mgbochi abụọ nke RAAS, ihe ize ndụ nke ịmalite hyperkalemia, ọrụ ezigharị nsogbu, oke ọbara ọgbụgba,
ọgwụ antihypertensive (dịka ọmụmaatụ diuretics) na ọgwụ ndị ọzọ na - ebelata ọbara ọgbụgba (ọgwụ tricyclic antidepressants, nitrates, anesthesia mpaghara na ọgwụ, alfuzosin, baclofen, prazosin, doxazosin, terazosin, tamsulosin): potentiation nke antihypertensive mmetụta,
nhazi ọla edo (sodium aurothiomalate) maka nchịkwa intravenous: hyperemia ihu, hypotension, ọgbụgbọ, ọgbụgbọ,
ọgwụ ịrahụ ụra, ọgwụ mgbu na ọgwụ ọgwụ: ụba antihypertensive mmetụta,
vasopressor sympathomimetics (isoproterenol, epinephrine, dopamine, dobutamine): mbelata na mmetụta antihypertensive nke ramipril,
immunosuppressants, corticosteroids (mineralocorticosteroids, glucocorticoids), cytostatics, allopurinol, procainamide na ọgwụ ndị ọzọ na-emetụta paradaịs hematological: ịba ụba nke ibute mmeghachi omume hematological,
lithium salts: ịba ụba ịta plasma nke lithium ma mee ka nkwalite ya na akwara pụta,
ndị nnọchianya hypoglycemic (gụnyere insulins, ndị ọrụ hypoglycemic maka nchịkwa ọnụ, sulfonylureas): mmụba hypoglycemic nke ọgwụ ndị a ruo mmepe nke hypoglycemia,
vildagliptin: ụba nke Quincke edema,
NSAIDs (acetylsalicylic acid na dose nke ihe karịrị 3 g kwa ụbọchị, cyclooxygenase-2 inhibitors, indomethacin): mgbochi nke ramipril, ịba ụba nke ọdịda akụrụngwa na mmụba na ụba nke potassium na plasma ọbara.
sodium chloride: na-ebelata ihe ogwugwu abuba nke ramipril,
heparin: ịba ụba suru potassium ịta,
ethanol: ihe mgbaàmà nke vasodilation, ịba ụba nke ethanol n'ahụ,
estrogens: mbelata nke mmetụta dị ala nke ramipril,
ndị ọzọ na - egbochi ACE: ohere dị ukwuu nke ịmalite imebi akụrụngwa (gụnyere nnukwu ọdịdị), hyperkalemia,
nkwadebe ndị a gụnyere na usoro ịtụgharị uche maka ụmụ ahụhụ hymenoptera: nwekwuo ohere nke anaphylactic siri ike ma ọ bụ mmeghachi omume anaphylactoid na ebe a na-eme hymenoptera.

Ihe atụ nke Dilaprel bụ: Prenesa, Diroton, Enap, Lipril, Renipril.

Nyocha nke Dilaprel

Nyocha banyere Dilaprel dị ole na ole ma bụrụkarịrị eziokwu. Ọgwụ a na-arụ ọrụ nke ọma mgbe ọ dị mkpa ka emegharia ọbara mgbali elu na iche na ọgwụ ndị ọzọ. Mmeghachi omume na-adịghị mma dị ụkọ. Agbanyeghị, ekwuputara na iji ogologo oge, mgbakwunye ahụ na ịda mba nke mmetụta ahụ na-apụta.

Ntuziaka maka iji Dilaprel: usoro na usoro onunu ogwu

A na-e capukarị oria Dilaprel ọnụ, loda ya kpamkpam ma jiri mmiri mmiri (100 ml) zuru ezu sachaa, tupu, n'oge ma ọ bụ mgbe nri gasịrị.

Dọkịta na-edepụta usoro na oge ọgwụgwọ ọ bụla, na-eburu n'uche ihe ngosipụta ụlọ ọgwụ, nnagide ọgwụ na mmetụta ọgwụgwọ. Oge iji ya na-abụkarị ogologo.

Na-atụ aro Dilaprel usoro onunu ogwu:

ọbara mgbali: usoro mbido bụ 2.5 mg otu ụtụtụ. Ọ bụrụ na ọbara mgbali adịghị nkịtị mgbe ụbọchị 21 gachara ọgwụgwọ, enwere ike ịbawanye ọgwụ kwa ụbọchị ruo 5 mg. Na enweghị ọgwụgwọ zuru oke nke mmụba a na-abawanye, onye ọrịa nwere ike inye ya onye ọzọ hypotensive nnọchi anya (gụnyere diuretics ma ọ bụ ngwa mkpọchi calcium), ma ọ bụ mgbe ụbọchị 14-21 nke iji, mụbaa ya na oke nke 10 mg kwa ụbọchị,
nkụda obi na - adịghị ala ala: mbụ ọgwụ - 1.25 mg kwa ụbọchị. Site na ịnwe ezigbo ọgwụ ọgwụ, enwere ike ịbawanye ogwu ahụ, yana obere oge nke ụbọchị 7-14, na usoro nke na-enye nchịkwa zuru oke nke ọrịa ahụ, mana ọ bụghị karịa 10 mg kwa ụbọchị. Enwere ike kee ogwu karịrị 2.5 mg n'ime 2,
akwara obi dara ada, bidoro site n ’ubochi abuo rue onwa iteghete ka ubara myocardial infarction: nkpuru mbu - 2.5 mg 2 ugboro ubochi (ututu na anyasi). N'ihe banyere mbelata ọbara mgbali elu, a ga-ebelata ọgwụ izizi ka 1.25 mg ugboro abụọ n'ụbọchị. Mgbe ahụ, enyere ọnọdụ onye ọrịa ahụ, enwere ike ịgbatị ya okpukpu abụọ na nkeji nke ụbọchị 1-3. Mgbe ahụ enwere ike ibugharị onye ọrịa ahụ otu ọgwụ kwa ụbọchị. Dosebọchị kwa ụbọchị ekwesịghị ịkarị 10 mg,
oke obi ọgụ na-egbu egbu (NYHA klas III - klaasị arụ ọrụ ọrụ) nke mere ozugbo infarction na-arịa nnukwu myocardial: ọgwụ mbụ - 1.25 mg otu ugboro n’ụbọchị, mgbe ahụ, a ga-elebara anya pụrụ iche na mmụba ọ bụla,
na-arịa ọrịa mamịrị ma ọ bụ ọrịa mamịrị nephropathy: ọgwụ mbụ bụ 1.25 mg otu ugboro n'ụbọchị. Ọzọkwa, enwere ike ịbawanye ya n'ọrụ ruo kwa ụbọchị nke 5 mg ma were ya otu ugboro,
mbelata nke puru omume nke mpecardial infarction, ọrịa strok, ma ọ bụ ọnwụ obi na ndị ọrịa nwere nnukwu ọrịa obi: ọgwụ mbụ bụ 2.5 mg otu ugboro n'ụbọchị. Site na ezigbo ohere ịrabụ ọgwụ ahụ, a na-atụ aro ka okpukpu abụọ karịa ka ọ gachara ụbọchị asaa nke ọgwụgwọ, mgbe ahụ n’ime ụbọchị 21 nke ọgwụgwọ, bulie ya na 10 mg - ọgwụ a na-emebu.

Ntuziaka akwadoro usoro usoro usoro ọgwụgwọ Dilaprel maka ndị otu ọrịa pụrụ iche:

arụ ọrụ na arụ ọrụ ezumike (CC 50-20 ml / min kwa 1.73 m 2 anụ ahụ dị elu): ọgwụ mbụ kwa ụbọchị - 1.25 mg. Oke kachasị bụ 5 mg kwa ụbọchị,
mmebi nke mmiri-electrolyte nguzogide, ma ọ bụ ọbara mgbali elu akwara, ma ọ bụ oké atherosclerotic ọnya nke akwara ọbara na akụkụ akwara: nke mbụ bụ 1.25 mg kwa ụbọchị,
ndị ọrịa karịa afọ 65: ọgwụ mbụ - 1.25 mg kwa ụbọchị,
arụ ọrụ imeju na-arụ ọrụ: ọgwụ kachasị ukwuu kwa ụbọchị bụ 2.5 mg. Ekwesịrị ị Theụ ọgwụ a na mmalite ọgwụgwọ n'okpuru nlekọta ahụike dị nso, ebe ọ bụ na ọbara mgbali nwere ike ibelata ma ọ bụ mụbaa.

Maka ndị ọrịa nwere ọgwụ mgbu diuretic n'oge gara aga, a na-egosipụta ojiji nke Dilaprel nanị ụbọchị ole na ole mgbe kagbuo ma ọ bụ mbelata ọgwụ nke diuretics na mbido mbụ kwa ụbọchị nke 1.25 mg. Mgbe ọ theụsịrị ọgwụ nke mbụ yana n'ọtụtụ ọ bụla, e kwesịrị inye onye ọrịa nlekọta ahụike maka awa 8 iji gbochie mmepe nke mmeghachi omume hypotensive a na-achịkwaghị achịkwa.

Dilaprel, ntuziaka maka ojiji (usoro na usoro onunu ogwu)

A na-e capara okpu dilaprel ọnụ, agbanyeghị nri a ga-eri, were ọkara otu iko mmiri sachaa.

A na-ahọrọ dose nke ọgwụ ahụ n'otu n'otu, na-eburu n'uche nnagide ya na nsonaazụ ọgwụgwọ. Ọgwụgwọ na-adịkarị ogologo.

Usoro a tụrụ aro ka usoro maka ndị ọrịa nwere ọrịa imeju na akụrụ ha:

mmụba ọbara: 2,5 mg otu ugboro n'ụbọchị (n'ụtụtụ), mgbe izu 3 nke ị theụ ọgwụ ahụ na ọgwụ a yana enweghị mmetụta a tụrụ anya ya, ọ ga-ekwe omume ịbawanye ọgwụ ahụ gaa na 5 mg kwa ụbọchị, mgbe izu 2-3 ọzọ nke ị theụ ọgwụ ahụ na ọgwụ nke 5 mg n'ihe banyere na arụ ọrụ ya ezughi oke, enwere ike ịbawanye ọgwụ kwa ụbọchị ruo 10 mg, nhọrọ ọzọ dịkwa mma - ojiji nke Dilaprel na ọgwụ nke 5 mg kwa ụbọchị yana mgbakwunye nke ndị ọzọ antihypertensive na usoro ọgwụgwọ ahụ, dịka ọmụmaatụ, ngwa ngwa ndị na-egbochi calcium ma ọ bụ diuretics,
nkụda obi na-adịghị ala ala: 1.25 mg kwa ụbọchị na mbido ọgwụgwọ, emesia, na-eburu n'uche mmeghachi omume onye ọrịa, ọ ga-ekwe omume ịgbanye okpukpu abụọ kwa izu 1-2 ruo nke kachasị kwa ụbọchị nke 10 mg,
nkụchi obi nke toro mgbe nnukwu ọrịa myocardial infarction na oge site na ụbọchị nke abụọ ruo ụbọchị itoolu: 5 mg kwa ụbọchị na usoro onyonyo abụọ (n'ụtụtụ na mgbede) na mbido ọgwụgwọ, ya na ntachi obi na ọgwụgwọ mbụ maka ụbọchị abụọ ka a ga-ewere 1. , 25 mg nke ramipril ugboro abụọ n'ụbọchị, n'ọdịniihu, na-eburu n'uche mmeghachi omume onye ọrịa, ọ ga-ekwe omume ịba okpukpu abụọ kwa ụbọchị 1-3 ruo mgbe a na-enweta ọgwụ kwa ụbọchị nke 10 mg, ugboro ugboro nke nchịkwa ọgwụ ahụ ka oge na-aga ka ọ belata otu ugboro n'ụbọchị.
renal nephropathy: 1.25 mg otu ugboro kwa ụbọchị na mbido ọgwụgwọ, n'ọdịniihu, enwere ike ịbawanye ọgwụ ahụ gaa 5 mg otu ugboro kwa ụbọchị (oke kachasị kwa ụbọchị),
mbelata n'ọdịdị mgbu azụ, nkụchi obi ma ọ bụ ihe nwute ọnwụ nke obi na ndị ọrịa sitere na otu ihe dị oke egwu dị na obi: 2.5 mg nke ramipril otu ugboro kwa ụbọchị na mbido ọgwụgwọ, enwere ike ịbawanye ọnụọgụ ọgwụ mgbe izu 1 gachara, na izu 3 na-esote enwere ike ịba ụba nke Dilaprel ruo 10 mg otu ugboro n'ụbọchị.

Ọ bụrụ na arụ ọrụ ezinaụlọ nwere nsogbu (mwepụ nke mkpụrụ osisi 50-20 / min), a ga-eji ọgwụ ahụ na ọgwụ mbụ kwa ụbọchị nke 1.25 mg, yana oke kachasị na ndị ọrịa dị otú ahụ agaghị agafe 5 mg kwa ụbọchị.

Na ọbara ọgbụgba dị egwu, na ndị ọrịa nwere nguzo mmiri-electrolyte na-arịa ọrịa na ndị ọrịa maka oke ọbara mgbali na-esonye na nsogbu ụfọdụ, mmalite mbụ nke ramipril bụ 1.25 mg kwa ụbọchị.

Ndị ọrịa na - anata ọgwụgwọ tupu ha amalite ọgwụgwọ na Dilaprel kwesịrị, ma ọ bụrụ na ọ ga - ekwe omume, kwusi iwere ụbọchị 2-3 tupu ịmalite ọgwụgwọ ma ọ bụ belata ọgwụ ha. Ekwesịrị iji usoro 1.25 mg malite ịmalite ọgwụgwọ Ramipril. Mgbe ị takingụsịrị usoro izizi, yana mmụba ọ bụla na ọgwụ ọgwụ na / ma ọ bụ ọgwụ mgbatị, achọrọ nlezianya nyocha ahụike nke onye ọrịa ahụ ọbụlagodi 8 awa, nke na-enyere aka izere mbelata ọbara mgbali elu na-achịkwa.

Ndị ọrịa karịrị afọ 65 kwesịrị ịnata Dilaprel na usoro mbụ nke 1.25 mg kwa ụbọchị.

N'ihe banyere ọrụ imeju na - arụ ọrụ, ọgwụ kachasị maka ọgwụ kwa ụbọchị ekwesịghị ịgafe 2.5 mg.

Ọnụahịa Dilaprel na ụlọ ahịa ọgwụ

Pricegwọ nke Dilaprel dị na ụlọ ahịa ọgwụ dị iche iche na-adịtụ iche, ọ daberekwa na usoro onunu ogwu na nkwakọ. Nke dịkarịrị ọnụ ahịa ọgwụ taa: 2.5 mg capsules (pcs 28 n'ime ngwugwu) - 149 rubles, 5 mg capsules (pcs 28. Na ngwugwu) - 227–266 rubles, capsules 10 mg (pcs 28 n'ime ngwugwu) - 267-315 rubles.

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