Mokhoa oa ho sebelisa lithethefatsi Telsartan N?

Tlhaloso ea foromo ea litekanyetso

Matlapa a 12,5 mg + 40 mg. Oval, biconvex, mela e 'meli, mokato o le mong ho tloha ho pinki e bobebe ho isa ho pinki, lera le leng le tloha ho le lesoeu ho isa ho le lesoeu ka le pinki le kenelletseng. Bokaholimo bo bosoeu ba matlapa ho na le kotsi mme ho na le "T" le "1" ka mahlakoreng a eona a bapileng.

Matlapa a 12,5 mg + 80 mg. Oval, biconvex, mela e 'meli, mokato o le mong ho tloha ho pinki e bobebe ho isa ho pinki, lera le leng le tloha ho le lesoeu ho isa ho le lesoeu ka le pinki le kenelletseng. Bokaholimo bo bosoeu ba matlapa ho na le kotsi 'me u manehiloe "T" le "2" ka mahlakoreng a eona a bapileng.

Foromo ea litekanyetso

Mefuta ea mantlha ea 'mele le ea lik'hemik'hale:

matlapa ho tloha ho o mosoeu ho isa ho o mosoeu, o se na khetla, o bopehile joaloka "T" le "L" ka mahlakoreng a mabeli a moeli oa phoso mme o hatisitsoe ka "40" (bakeng sa matlapa a 40 mg) kapa a bonts'ang "80" ( bakeng sa matlapa a 80 mg) ka lehlakoreng le leng.

Contraindication

Hypersensitivity (ho kenyelletsa le tse ling tse hlahisoang ke sulfonamide, cholestasis, ho hloleha ka matla ha sebete, ho se sebetse hantle haholo ha mokokotlo (CC ka tlase ho 30 ml / min), hypokalemia, hyponatremia, hypercalcemia, lefutso la ho se mamelle lefu la setho sa botšehali, ho ba le lactation dilemo tse fihlang ho dilemo tse 18 (ho sebetsa hantle le polokeho ha e so thehwe) Tlhokomeliso: Ho se sebetse hantle ha sebete kapa lefu le tsoelang pele la sebete (kotsi ea ho hema ka lebaka la pherekano ea electrolyte), lefu la pelo lipakeng methapo ea kutlo kapa ho ruruha ha methapo e le 'ngoe ea methapo, ho se sebetse hantle ha masapo, boemo kamora ho fetisoa ha meno, ho fokotseha ha bcc (kalafo ea kaholimo ea diuretic, ho ja ka mokhoa o thibelang ho ja letsoai, lets'ollo kapa ho hlatsa), ho nyekeloa ke pelo, aortic kapa mitral stenosis, CHD, SLE gout.

Mokhoa oa ho sebelisa: litekanyetso le kalafo

Ka hare, ho sa tsotelehe lijo tse ngata, 1 nako ka letsatsi.

Matlapa a nang le karolelano ea telmisartan / hydrochlorothiazide 40 / 12,5 mg le 80 / 12,5 mg a ka fuoa bakuli bao tšebeliso ea telmisartan ka tekanyo ea 40 kapa mg kapa hydrochlorothiazide ka tekanyo ea 12,5 mg e sa lebiseng taolong e lekaneng ea khatello ea mali.

Ha ho hlokahale phetoho ea litheko mabapi le ho se sebetse hantle ha lipholiso tse bonolo le tse itekanetseng, hammoho le bakuli ba tsofetseng.

Ka ho hloleha ha sebete ho fokola ho teba ha boima, tekanyetso ha ea lokela ho feta 40 / 12,5 mg ka letsatsi.

Ketso ea pharmacological

Telmisartan ke mohanyetsi ea itseng oa li-receptors tsa angiotensin II (mofuta oa AT1). Displaces angiotensin II ho tloha khokahanong le li-receptor, e se na ts'ebetso ea agonist e amanang le receptor ena. E theha kamano ea nako e telele feela le AT1 subtype ea angiotensin II receptors. Ha e na setsoalle bakeng sa li-receptor tse ling, ho kenyelletsa le receptor ea AT2 le ba bang, li-receptor tse fumanehang tsa angiotensin. Telmisartan e lebisa ho fokotseha hoa khatello ea aldosterone ho plasma ea mali. Ha e ame tšebetso ea plasma renin le liteishene tsa ion, ACE, ha e sebetse bradykinin.

Ka tekanyo ea 80 mg, phello e matla ea angiotensin II e koetsoe ka botlalo. Tšusumetso ea lithethefatsi e nka lihora tse fetang tse 24, ho kenyelletsa le lihora tse 4 tsa ho qetela pele u nka tekanyetso e latelang. Ho qala hoa ts'ebetso ea hypotensive ho lemohuoa ka nako ea lihora tse 3 kamora ho ba tekanyetso ea pele. Ho fokotseha ho phahameng ha khatello ea mali hangata ho bonoa libeke tse 4 kamora ho qala kalafo.

Ka khatello ea mali ea methapo, e fokotsa khatello ea mali le systolic, ntle le ho ama sekhahla sa pelo. Tabeng ea ho hlakoloa ha telmisartan ka tšohanyetso, butle-butle khatello ea mali e khutlela boemong ba eona ba pele ntle le nts'etsopele ea "ho hula" lefu.

Hydrochlorothiazide ke thiazide diuretic. Ha e ame ho ts'oaroa ha li-electrolyte ka har'a li-renal tubules, e eketsa ka kotloloho tlhahiso ea Na + le Cl- (e batlang e le ka tekanyo e lekanang). Phello ea diuretic e lebisa ho fokotseheng ha bcc, keketseho ea tšebetso ea plasma renin, keketseho ea secretion ea aldosterone mme e tsamaisana le keketseho ea litaba tsa K + le bicarbonate ka har'a moroto, hammoho le hypokalemia. Ka tsamaiso e tšoanang ea telmisartan, ho fokotseha ha tahlehelo ea K + e bakoang ke hydrochlorothiazide hoa tsebahala, mohlomong ka lebaka la thibelo ea sistimi ea renin-angiotensin-aldosterone. Kamora ho nka hydrochlorothiazide, diuresis e atoloha kamora lihora tse peli, phello e phahameng e bonoa kamora lihora tse ka bang tse 4. Phello ea diuretic e phehella hoo e ka bang lihora tse 6-12.

Phello e phahameng ea antihypertensive ea lithethefatsi hangata e fihlelloa libeke tse 4 kamora ho qala kalafo.

Litlamorao

Ho tsoa ts'ebetsong ea phefumoloho: ts'oaetso ea phepelo ea phepelo e kaholimo (ho kenyelletsa bronchitis, pharyngitis, sinusitis), ho hema ka thata, dyspnea, syndrome ea khatello ea matšoafo (ho kenyeletsa pneumonia le edema ea pulmonary).

Ho tsoa ho CCC: bradycardia, tachycardia, arrhythmia, letšoao le fokotsehileng la khatello ea mali, orthostatic hypotension, necrotic angiitis (vasculitis), bohloko ba sefuba.

Ho tloha lehlakoreng la tsamaiso ea methapo e kholo: ho teneha ho hoholo, ho tšaba, khatello ea maikutlo, ho tsekela, ho akheha, ho hloka boroko, ho hloka botsitso ha o tsamaea, paresthesia.

Ho tsoa ho lijo tsa ka mpeng: bohloko ba ka mpeng, lets'ollo, letšollo, ho senyeha ha takatso ea lijo, sialadenitis, molomo o ommeng, lefufuru, ho hlatsa, ho nyekeloa, pancreatitis, jaundice (hepatocellular kapa cholestatic).

Ho tsoa ho sistimi ea endocrine: hyperglycemia, glucosuria, mamello e fokolang ea tsoekere.

Ho tloha ka lehlakoreng la metabolism: hypercholesterolemia, hyperuricemia, hypokalemia, hyponatremia, e fokotsehile BCC, "metabolism" e senyehileng ea electrolyte, hypercalcemia.

Ho tsoa lithong tsa hemopoietic: eosinophilia, anemia ea aplasiki, anemia ea hemolytic, myelodepression, leukopenia, neutropenia / agranulocytosis, thrombocytopenia.

Ho tsoa ts'ebetsong ea urine: ts'oaetso ea "urinary system", "interstitial nephritis" e sa sebetseng hantle ea renal.

Ho tsoa ho tsamaiso ea musculoskeletal: arthralgia, arthrosis, bohloko ba morao, bohloko bo tlase ba leoto, myalgia, ho ts'oaroa ha mesifa ea namane (crumpi), matšoao a kang tendonitis, bofokoli ba mesifa, mesifa ea mesifa.

Litla-morao: ho se sebetse hantle ka mokhoa oa anaphylactic, eczema, erythema, letlalo le hlohlontšitsoeng, lupus-like letlalo, letlalo vasculitis, photosensitivity, lekhopho la letlalo, ho phatloha ho hoholo ha SLE, chefo e matla ea chefo ea methapo ea methapo, angioedema, urticaria.

Ho tsoa ho litho tsa kutlo: ho senyeha hoa pono, ho fifala ha pono (nakoana), xanthopsia, vertigo.

Ho tsoa ts'ebetsong ea kemolo: potency e fokotsehile.

Matšoao a laboratori: ho fokotseha ha Hb, hypercreatininemia, ts'ebetso e eketsehileng ea transaminase ea "sebete", hypertriglyceridemia.

Mefuta e meng: Lefu la tsoekere, feberu, ho eketsa mofufutso. Matšoao (telmisartan): ho fokotseha ha khatello ea mali, tachycardia le / kapa bradycardia.

Matšoao (hydrochlorothiazide): hypokalemia (mesifa ea mesifa, ho eketseha ha mesifa ho bakoang ke tšebeliso ea methapo ea pelo glycosides kapa lithethefatsi tsa antiarrhythmic), hypochloremia, ho haelloa ke metsi ka lebaka la ho hlohlona haholo, ho nyekeloa ke pelo, ho otsela.

Phekolo: Ho kenoetsa ho hlatsa, ho hlatsa ka mpeng, ho ts'eloa ka makala a mangata, a lipontšo le a tšehetsang, ho lekola mokokotlo oa li-electrolyte le creatinine serumeng ea mali. Tabeng ea ho fokotseha ho hoholo ha khatello ea mali, mokuli o lokela ho beoa sebakeng se otlolohileng, a phete tahlehelo ea li-electrolyte, bcc.

Telmisartan ha e tlosoe ke hemodialysis. Tekanyo ea ho tlosoa ha hydrochlorothiazide nakong ea hemodialysis ha e e-so theoe.

Litaelo tse khethehileng

Ho bakuli ba nang le pelo ea methapo ea methapo ea methapo kapa lesapo la mokokotlo le sebetsang feela ha u sebelisa lithethefatsi tse amang tsamaiso ea renin-angiotensin-aldosterone, menyetla ea ho fokotseha ho boleloang le ho hloleha ha rems e eketseha.

Ha ho na boiphihlelo ka ho hlophisoa ha bakuli ba nang le bothata bo matla ba ho lemala kapa kamora ho fetisoa ha meno. Ka botebo kapa ka tekano tekano ea ho hloleha ha a phekolo ea masapo, ho ikemisetsa nako le nako ha motho a le mothating oa K +, ho khothalletsoa hore ho be le creatinine ka serum ea mali. Ts'ebeliso ea li-thiazide diuretics ho bakuli ba nang le bothata ba ho phekoloa ka methapo e ka lebisang azotemia. Ho khothaletsoa ho lekola nako le nako ts'ebetso ea liphio.

Bakeng sa bakuli ba fokotsehileng ba BCC le / kapa hyponatremia (ka lebaka la kalafo ea diuretic, thibelo ea ho ja letsoai, ho hlatsa kapa ho hlatsa), ho ka fokotsoa hore khatello ea mali e fokola ka ho fetisisa, haholoholo kamora ho nka tekanyetso ea pele ea moriana. Pele o qala ts'ebeliso ea lithethefatsi, ho hlokahala hore ho lokisoe mathata ana.

Ho bakuli ba nang le CHF e matla, renal artery stenosis, ts'ebeliso ea lithethefatsi tse amang boemo ba renin-angiotensin-aldosterone system e kanna ea tsamaisana le nts'etsopele ea ho fokotseha ho feteletseng ha khatello ea mali, hyperazotemia, oligouria, kapa maemong a sa tloaelehang, ho hloleha ha real haholo.

Ho bakuli ba nang le "hyperaldosteronism" ea mantlha, lithethefatsi tse sebelisang antihypertgency, ts'ebetso ea ts'ebetso ea eona e sitisang ts'ebetso ea sistimi ea renin-angiotensin-aldosterone, hangata ha e na thuso. Maemong a joalo, ho khethoa ha moriana ha ho khothalletsoe.

Ho bakuli ba nang le lefu la tsoekere, ho ka hlokahala liphekolo ka tekanyetso ea li-insulin kapa tsa molomo. Nakong ea kalafo ka thiazide diuretics, mofuta oa morao-rao oa lefu la tsoekere o ka hlaha.

Maemong a mang, tšebeliso ea thiazide diuretics e ka ba le hyperuricemia le gout.

Nakong ea phekolo, ho hlokahala hore ho hlahlojoe nako le nako ea ho hlaseloa ha li-electrolyte ka serum ea mali.

Kotsi ea hypokalemia e eketseha ho bakuli ba lefu la cirrhosis, le li-diuresis tse eketsehileng, tlhahiso e sa lekaneng ea molomo ea li-electrolyte, hammoho le maemong a tšebeliso e tšoanang ea GCS kapa ACTH

Telmisartan, e leng karolo ea lithethefatsi, e ka lebisa ho hyperkalemia. Le ha hyperkalemia ea bohlokoa ho tsa bongaka e sa tlaleheloa ka ts'ebeliso ea litokisetso, ho lokela ho hlokomeloe hore lintlha tse kotsi bakeng sa nts'etsopele ea eona li kenyelletsa ho renal le / kapa ho nyekeloa ke pelo le lefu la tsoekere.

Ha ho na bopaki ba hore lithethefatsi li ka fokotsa kapa tsa thibela hyponatremia e bakoang ke lithethefatsi tsa diuretic. Hypochloremia hangata e bitsoa hanyane mme ha e hloke khalemelo.

Hydrochlorothiazide e ka fokotsa Ca2 + excretion le sesosa (ka lebaka la ho se utloisisane ho tsebahalang ha Ca2 + metabolism) nakoana le hypercalcemia e nyane. Hypercalcemia ea bohlokoa le ho feta e ka ba sesupo sa hyperparathyroidism ea morao-rao. Pele o tseba ts'ebetso ea litšoelesa tsa parathyroid, moriana o tlameha ho hlakoloa.

Bakeng sa bakuli ba nang le lefu la mokokotlo oa mokokotlo, ho fokotseha ka sekhahla ha khatello ea mali ho ka lebisa ho kenngeng ha myocardial kapa stroke.

Tekanyetso ea letsatsi le letsatsi e khothalletsoang ea 40 / 12,5 kapa 80 / 12,5 e na le 169 kapa 338 mg ea sorbitol, ka ho latellana.

Kotsi ea ho ba le karohano ea mefuta eohle ea hydrochlorothiazide e eketsoa ho bakuli ba nang le nalane ea mafu a kulang kapa asthma ea bronchial.

Ho na le litlaleho tsa nts'etsopele ea SLE e sebelisang thiazide diuretics.

Moriana, haeba ho hlokahala, o ka sebelisoa hammoho le lithethefatsi tse ling tsa antihypertensive.

Nakong ea kalafo, ho tlameha ho ba hlokolosi ha u etsa lintho tse ka bang kotsi (ho kenyelletsa ho khanna koloi) tse hlokang ho tsepamisa mohopolo le lebelo le ho feta ha maikutlo a psychomotor (monyetla oa ho holofatsa ho tsekela le ho otsela ha o sebelisa lithethefatsi tsa antihypertensive).

Telmisartan ha e na phello ea teratogenic, empa e na le phello ea fetoto. Tabeng ea kemolo e reriloeng, moriana o lokela ho nkeloa sebaka ke lithethefatsi tse ling tse lumelletsoeng ho sebelisoa nakong ea kemaro. Haeba ho ima ho thehiloe, o lokela ho emisa hang hang ho sebelisa lithethefatsi.

Ka trimester ea II le III, tšebeliso ea lithethefatsi e ka baka pherekano ea electrolyte ka popelong. Nts'etsopele ea neonatal thrombocytopenia, jaundice (ka popelong kapa lesea le sa tsoa hlaha) maemong a mme a nka thiazide diuretics e tlalehiloe. Ha ho tsejoe hore na telmisartan e fetela lebese la matsoele, li-thiazide diuretics li fetela lebeseng la matsoele 'me li ka thibela lactation.

Tšebelisano

Ka tšebeliso e tšoanang ea Li + le lingiotensin II receptor antagonists, keketseho ea khatello ea Li + serum ea mali le keketseho ea litlamorao. Ts'ebeliso ea hydrochlorothiazide e fokotsa ho hlakisoa ha Li +. Ho shebisisa ka hloko hoa hlokahala, ho beha leihlo tlhokomelo ea Li + serum.

Phello ea hypokalemic ea hydrochlorothiazide e felisoa ke phello e bolokang potassium ea telmisartan. Leha ho le joalo, phello ea hypokalemic ea hydrochlorothiazide e ka matlafatsoa ke lithethefatsi tse ling tse lebisang ho hypokalemia (ho kenyelletsa diuretics tse ling, li-laxatives, GCS, ACTH, amphotericin, carbenoxolone, penicillin G sodium, salicylic acid le tse tsoang ho eona).

Tšebeliso e le 'ngoe ea diuretics tsa potasiamo tse sa qhekelleng, litokisetso tsa K +, le lithethefatsi tse ling tse ka eketsang litaba tsa serum K + (ho kenyelletsa le sodium heparin), K + - phepelo ea phepo e nepahetseng e ka lebisa ho hyperkalemia.

Ka tšebeliso e kopanetsoeng le pelo glycosides, antiarrhythmic le lithethefatsi tse ling tse bakang pelo le methapo e kang pirouette, ho khothaletsoa ho lekola nako le nako ho ts'oaroa ha K + plasma ea mali.

Telmisartan e ntlafatsa phello ea hypotensive ea lithethefatsi tse ling tsa antihypertensive.

Lithethefatsi li ka eketsa khatello ea "digoxin" (ho fihla ho 39%), ka hona, ho ka hlokahala tlhokomelo ea plasma ea digoxin.

Ts'ebeliso e ts'oanang ea hydrochlorothiazide e nang le ethanol, barbiturates, narcotic analgesics - kotsi ea ho ba le hypotension ea orthostatic, le li-hypoglycemic agents (ka bobeli ka molomo le ka insulin) - litekanyetso tsa litekanyetso tsa lithethefatsi tsa hypoglycemic li ka hlokahala, ka metformin - kotsi ea lactic acidosis, e nang le colestyramine le cooleptyoline le coolecryramine le glycosides ea pelo - kotsi ea hypokalemia kapa hypomagnesemia (arrhythmias), le NSAIDs - ho fokotseha hoa litlamorao tsa diuretic, natriuretic le antihypertensive hydrochlorothiazide, e nang le mochini oa khatello oa khatello (ho kenyelletsa le norepinephrine - ho fokolisa phello ea litsi tsa khatello ea khatello, ka ho phomola ho sa amaneng le mokokotlo oa mesifa (ho kenyelletsa tubocurarine) - keketseho ea ketso ea ba ntlafatsang mesifa, ka phetoho ea litheko tsa lithethefatsi tsa uricosuric li ka hlokahala, hobane (ka lebaka la hyper e bakoang ke hydrochlorothiazide), e nang le allopurinol - keketseho ea khafetsa ea karabelo ea hypersensitivity ho allopurinol, ka letsoai la Ca2 + - kotsi ea ho ba le hypercalcemia (ka lebaka la ho fokotseha ha tlhahiso ea eona), le beta-adrenergic blockers le diazok peo - kotsi ea kholo ea "hyperglycemia" e nang le m-anticholinergics (ho kenyeletsoa le atropine, biperiden) - keketseho ea bioavailability ea hydrochlorothiazide (ka lebaka la ho fokotseha hoa matla a ka mpeng).

Lithethefatsi li ka eketsa kotsi ea litla-morao tsa amantadine, li fokotsa phokotseho ea lithethefatsi tsa cytotoxic (ho kenyelletsa cyclophosphamide, methotrexate) le ho ntlafatsa phello ea tsona ea myelosuppression.

Mofumahali

Hydrochlorothiazide ke thiazide diuretic. Liazard diuretics e ama ho ts'oaroa ha li-electrolyte ka har'a lipompo tsa renal, e ntseng e eketsa ka kotloloho tlhahiso ea sodium le chloride (e batlang e lekana le e lekanang). Phello ea diuretic ea hydrochlorothiazide e lebisa ho fokotseha ha bcc, keketseho ea tšebetso ea plasma renin, keketseho ea secretion ea aldosterone, e lateloe ke keketseho ea potasiamo le hydrocarbonates mme, ka lebaka leo, ho fokotseha ha potasiamo ho plasma ea mali.Ka tsamaiso e ts'oanang ka telmisartan, ho na le tloaelo ea ho emisa tahlehelo ea potasiamo e bakoang ke diuretics tsena, mohlomong ka lebaka la RAAS blockade.

Kamora ho tsamaisoa ka molomo, diuresis e eketseha kamora lihora tse peli, 'me phello e phahameng e bonoa kamora lihora tse ka bang 4. Phello ea diuretic ea lithethefatsi e tsoela pele lihora tse ka bang 6-12.

Ts'ebeliso ea nako e telele ea hydrochlorothiazide e fokotsa kotsi ea mathata a lefu la pelo le lefu le tsoang ho bona.

Telmisartan - E ikhethang ARA II (Mofuta oa AT₁), e sebetsa hantle ha e nkuoa ka molomo. E na le tumellano e phahameng ea AT subtype₁li-receptors tsa angiotensin II, eo ketso ea angiotensin II e fumanehang ka eona. Displaces angiotensin II ho tloha khokahanong le li-receptor, ntle le ho bonts'a thepa ea agonist e amanang le receptor ena. Telmisartan e tlama feela ho AT subtype₁li-receptors tsa angiotensin II. Khokahano e ntse e tsoela pele. Ha e na kamano ea li-receptor tse ling, incl. ho AT₂receptor le li-receptors tse ling tse ithutoang tse fokolang tsa angiotensin. Bohlokoa ba tšebetsong ba li-receptor tsena, hammoho le phello ea ho tsosa ha tsona ho fetelletseng le angiotensin II, mohopolo oa eona o eketsehang ha ho khethoa telmisartan, ha o so ithutoe.

Telmisartan e fokotsa bongata ba aldosterone ho plasma ea mali, ha e thibele renin ho plasma ea mali ebile ha e thibele litsela tsa ion. Telmisartan ha e thibele ACE (kininase II), eo hape e thusang ho senyeha ha bradykinin. Ka hona, keketseho ea litlamorao tse bakoang ke bradykinin ha e lebelloe.

Bakeng sa bakuli ba nang le khatello ea mali ea methapo, telmisartan ka tekanyo ea 80 mg e thibela ka botlalo phello ea khatello ea mali ea angiotensin II. Ho qala ha ts'ebetso ea antihypertensive ho bonoa nakong ea lihora tse 3 ka mor'a taolo ea pele ea molomo ea telmisartan. Tšusumetso ea lithethefatsi e nka lihora tse 24 mme e lula e le bohlokoa ho fihlela lihora tse 48. Phello e boletsoeng ea antihypertensive hangata e hlaha libeke tse 4 kamora ts'ebeliso ea kamehla ea lithethefatsi.

Ho bakuli ba nang le khatello ea mali ea methapo, telmisartan e fokotsa SBP le DBP ntle le ho ama sekhahla sa pelo.

Tabeng ea ho hlakoloa ha telmisartan ka tšohanyetso, butle-butle khatello ea mali e khutlela boemong ba eona ba pele ntle le nts'etsopele ea lefu la ho tlohela.

Phuputsong e entsoeng ka telmisartan, ho ile ha hlahlojoa linyeoe tsa lefu la pelo, lefu le sa amaneng le lefu la myocardial, stroke se sa bolaeeng kapa sepetlele ka lebaka la ho hloleha ha pelo. Ho fokotseha ha bokuli ba pelo le lefu la mafu ho bakuli ba nang le kotsi ea lefu la pelo (lefu la mokokotlo oa mokokotlo, lefu la mokokotlo, lefu la sethoathoa kapa ts'oaetso ea lefu la sethoathoa ka tšenyo ea methapo e amanang le litho tse kang retinopathy, hypertrophy ea methapo ea methapo ea methapo historing) e netefalitsoe. tse fetang lilemo tse 55.

Phello e phahameng ea antihypertensive ea lithethefatsi Telsartan ® N hangata e fihlelloa libeke tse 4 kamora ho qala kalafo.

Mofumahali

Ts'ebeliso e kopaneng ea telmisartan le hydrochlorothiazide ha e ame li-pharmacokinetics tsa karolo ka 'ngoe ea motsoako.

Kamora ho tsamaisoa ha molomo ka lithethefatsi Telsartan ® N C_max plasma hydrochlorothiazide e fihlelloa ka nako ea lihora tse 1-3. Ho nepahala ha bioavailability ke hoo e ka bang 60% (ho ipapisitsoe le tlhahiso ea menoana e felletseng). Liprotheine tsa Plasma li tlama 64% ea hydrochlorothiazide, le V_d ke (0.8 ± 0.3) l / kg. Hydrochlorothiazide ha e tšeloe 'meleng' me e hlahisoa ke liphio hoo e batlang e sa fetohe. Hoo e ka bang karolo ea 60% ea ente e kentsoeng e felisoa ka nako ea lihora tse 48. Tlhaloso ea molao ea molao e ka bang 250-300 ml / min. T_1/2 hydrochlorothiazide ke lihora tse 10-15.

Ho na le phapang lipapisong tsa plasma ho banna le basali. Ho basali, khatello ea telmisartan ho plasma e phahame ka makhetlo a mabeli ho feta ho banna, mme basali le bona ba na le keketseho e fokolang ea kliniki ea hydrochlorothiazide.

Ho hloleha hape Bakeng sa bakuli ba nang le ts'ebetso ea renal e sa sebetseng hantle, tekanyo ea ho felisoa ha hydrochlorothiazide e fokotsehile. Boithuto ho bakuli ba nang le 90 ml / min creatinine Cl bo bontšitse hore T_1/2 hydrochlorothiazide ea eketseha. Ho bakuli ba nang le "renal function" ba fokotsehileng_1/2 hoo e ka bang lihora tse 34

Ha a kenella ka potlako ananeloa ho tloha Phekolo ea ka mpeng. Bioavailability ke hoo e ka bang 50%. Khokahanyo ea tlhoro e etsahala kamora lihora tse ka bang 0.5-1.5. Ha e nkuoa ka mokhoa o ts'oanang le lijo, ho fokotseha ha AUC ho tloha ho 6 ho 19% (ha u nka tekanyetso ea 40 le 160 mg, ka ho latellana). Lihora tse 3 kamora ho kenella, ho kenella kahare ho lero la mali hoa ts'oaroa ho sa tsotelehe lijo.

Ho na le phapang khoebong ea telmisartan ho plasma ho banna le basali. C_max ho plasma, makhetlo a 3 le AUC e phahameng ho makhetlo a 2 ho basali ha e bapisoa le banna ntle le tšusumetso e kholo ea katleho. Leha ho le joalo, keketseho ea phello ea hypotensive ha e bonoe ho basali.

Kamano ea bohlokoa le liprotheine tsa plasma (tse fetang 99,5%), haholo-holo ka albin le alpha₁-cid glycoprotein. V_d e ka bang 500 a etsang dilitara tse

Telmisartan e tšelisoa ke khokahano le glucuronic acid. Metabolites ha e sebetse ka mokhoa oa meriana. T_1/2 e feta lihora tse 20

E pepesitsoe ka mpeng e sa fetohe, 'me e entsoe ke liphio - ka tlase ho 2%. Tlhahiso ea plasma ka kakaretso e phahame (hoo e ka bang 900 ml / min).

Bakuli ba baholo. Pharmacokinetics ea telmisartan ho bakuli ba tsofetseng ha e fapana le bakuli ba banyenyane. Phetoho ea mori ha e hlokehe.

Ho hloleha hape Ho fetola tekanyetso ea telmisartan ho bakuli ba nang le ho fokola ha methapo ha ho hlokehe, ho kenyelletsa le bakuli ba hemodialysis. Telmisartan ha e tlosoe ke hemodialysis.

Ho hloleha ha sebete. Boithuto ba pharmacokinetics ho bakuli ba nang le bothata ba sebete bo bontšitse keketseho ea bioavailability e ka bang 100%. Ka ho hloleha ha sebete T_1/2 ha e fetohe (Bona. "Tekanyetso le tsamaiso").

Bokhachane le pelehi

Ts'ebeliso ea lithethefatsi Telsartan ® N e kopantsoe nakong ea kemolo.

Boiphihlelo ba nang le hydrochlorothiazide nakong ea kemolo, haholo nakong ea trimester ea pele, e na le moeli.

Hydrochlorothiazide e tšela sethala sa placental. Ha ho fanoa ka mochine oa ts'ebetso oa pharmacological oa ts'ebetso ea hydrochlorothiazide, ho nahanoa hore ts'ebeliso ea eona nakong ea bokhachane ba bobeli le ba boraro ba bokhachane e ka sitisa ho tlosoa ha fetoplacental mme ea baka liphetoho mokhoeng oa bokhachane le mofetsong, joalo ka jaundice, tsitsinyeho ho tekano ea metsi-electrolyte le thrombocytopenia.

Hydrochlorothiazide ha ea lokela ho sebelisoa ho phekola khatello ea maikutlo e bohlokoa ho basali ba bakhachane, ntle le maemong ao a sa tloaelehang moo lingaka tse ling li ke keng tsa sebelisoa.

Ts'ebeliso ea ARA II nakong ea kemolo e tšoaetsanoa.

Ha u lemoha ho ima, setlhare se lokela ho emisoa hanghang.

Haeba ho hlokahala, ho sebelisoe mofuta o mong oa kalafo o lokela ho sebelisoa (lihlopha tse ling tsa lithethefatsi tse thibelang antihypertensive tse lumelletsoeng ho sebelisoa nakong ea kemaro).

Phekolo ea Telsartan ® H e tšoaelitsoe nakong ea ho anyesa.

Lithutong tsa liphoofolo, litlamorao tsa telmisartan le hydrochlorothiazide mabapi le kemolo ha lia ka tsa bonoa. Boithuto mabapi le litlamorao tsa tsoalo ea motho ha lia etsoa.

Tekanyetso le tsamaiso

Ka hare ho sa tsotelehe lijo.

Telsartan ® N e lokela ho nkuoa nako e le 'ngoe ka letsatsi.

Telsartan ® N (12.5 mg + 40 mg) e ka laeloa bakuli bao monotherapy ka telmisartan ka tekanyo ea 40 mg kapa monotherapy e nang le hydrochlorothiazide ha e lebise taolong e lekaneng ea khatello ea mali.

Telsartan ® N (12.5 mg + 80 mg) e ka laeloa bakuli bao monotherapy ba nang le telmisartan ka tekanyo ea 80 mg kapa sethethefatsi Telsartan ® N (12.5 mg + 40 mg) ha e lebise taolong e lekaneng ea khatello ea mali.

Ho bakuli ba nang le khatello e matla ea methapo ea methapo, lethal dose e phahameng ea letsatsi le letsatsi ea telmisartan ke 160 mg / ka letsatsi. Tekanyetso ena e ne e mamelloa hantle ebile e sebetsa.

Lihlopheng tse ikhethang tsa bakuli

Ts'ebetso ea mokokotlo e sa sebetseng. Boiphihlelo bo lekanyelitsoeng ka ts'ebeliso ea motsoako oa hydrochlorothiazide le telmisartan ho bakuli ba nang le bothata ba ho fokola ba leseling kapa bo itekanetseng ha bo hloke liphetoho tsa tekanyetso maemong ana. Ho bakuli ba joalo, ts'ebetso ea ho hlaba ka liphio e lokela ho beoa leihlo (ka Cl creatinine e ka tlase ho 30 ml / min, bona "Contraindication").

Ts'ebetso ea sebete e sa sebetseng. Ho bakuli ba nang le ts'ebetso ea sebete e fokolang le e leka-lekaneng (Tekanyetso ea bana le P), lethal dose la letsatsi le letsatsi la Telsartan ® N ha lea lokela ho feta 12,5 mg + 40 mg ka letsatsi (bona Pharmacokinetics).

Boloetse. Reimi ea litekanyetso ha e hloke liphetoho.

Bongata

Ha ho na linyeoe tsa overdose tse fumanoeng. Matšoao a ho ba teng ha overdose a entsoe ka matšoao a tsoang likarolong tse ling tsa moriana.

Matšoao a overdose ea hydrochlorothiazide: ho ferekana ho lekantsoeng la mali-electrolyte ea mali (hypokalemia, hypochloremia), ho fokotseha ha BCC, ho ka lebisang ho mesifa le mesifa le / kapa ho mpefala ho hoholo ho tsoa ho CCC: arrhythmias e bakoang ke ts'ebeliso e le 'ngoe ea li-glycosides tsa pelo kapa lithethefatsi tse ling tsa antiarrhythmic.

Matšoao a bosholu ba telmisartan: letšoao le fokotsehileng la khatello ea mali, tachycardia, bradycardia.

Phekolo: matšoao kalafo, hemodialysis ha e na thuso. Tekanyo ea ho tlosoa ha hydrochlorothiazide nakong ea hemodialysis ha e e-so theoe. Ho hlahlojoa khafetsa ha litaba tsa electrolyte le serum creatinine ho hlokahala.

Moetsi

Dr. Reddy's Laboratories Ltd., India. Dr. Reddy's Laboratories Ltd., India. Yuniti ea thuto-kholo, Sy. Che. 41, Bachupally Village, Qhobosheane ea Qutubullapur, Setereke sa Ranga Reddy, Telangana, India.

Tlhahisoleseling mabapi le litletlebo le karabelo e sa rateheng ea lithethefatsi e lokela ho romeloa atereseng e latelang: Ofisi ea baemeli ea Dr. Reddy's Laboratories Ltd. 115035, Moscow, Ovchinnikovskaya nab., 20, leq. 1.

Mohala: (495) 795-39-39, fax: (495) 795-39-08.

Melemo ea pharmacological

Telmisartan ke mohanyetsi ea itseng oa receptor ea angiotensin II (mofuta oa AO 1), ea sebetsang ho tsamaiso ea molomo. Ho ba le tumellano e phahameng, telmisartan e nkela angiotensin II setulong sa eona le AO 1 subtype receptor, e ikarabellang bakeng sa ketso ea angiotensin II. Telmisartan ha e bontše ketsahalo e 'ngoe le e' ngoe ho recensor ea AO 1 joalo ka agonist. Telmisartan e ikamahanya le li-receptor tsa AO 1 ka nako e telele. Setlhare ha se bonts'e kamano ho li-receptor tse ling, ho kenyeletsoa AO 2 mme tse ling ha li na sebopeho sa li-receptors tsa AT. Karolo e sebetsang ea li-receptor tsena ha e tsejoe, hammoho le phello ea ho tsosa ha bona ho fetelletseng ka angiotensin II, boemo ba eona bo eketsang telmisartan. Telmisartan e fokotsa methapo ea mali ea almosterone ea plasma. Telmisartan ha e thibetsoe ke renin ea plasma ea motho, ebile ha e thibele liteishene tsa ion. Telmisartan ha e thibele ACE (kinase II), eo le eona e senyang bradykinin. Kahoo, motho ha aa lokela ho lebella ho eketseha ha maikutlo a mabe a amanang le bradykinin.

Ho batho, telmisartan ka tekanyo ea 80 mg e batla e hatella ka botlalo phello ea angiotensin II ho eketseha ha khatello ea mali.

Ts'ebetso ea Kliniki le Polokeho

Phekolo ea khatello ea mali e bohlokoa

Kamora tekanyetso ea pele ea telmisartan, butle-butle phello ea antihypertensive e qala ho hlaha ka har'a 3:00. Phokotso e phahameng ea khatello ea mali hangata e fihlelloa libeke tse 4-8 kamora ho qala kalafo mme e phehella kalafo e telele.

Matla a antihypertensive a lula a le teng letsatsi le fetang letsatsi ka mor'a ho nka tekanyetso, ho kenyelletsa le 4:00 ea ho qetela pele ho lethal dose le latelang, joalo ka ha ho bonts'itsoe tekanyo ea khatello ea mali ea nakong e tlang. Sena se netefatsoa khafetsa ke karolelano ea masala ho phello ea tlhase, e fetang 80% kamora ts'ebeliso ea litekanyetso tsa 40 le 80 mg tsa telmisartan litekong tsa bongaka tse laoloang ke placebo. Ho na le kamano e hlakileng pakeng tsa lethalinyana le nako ea ho hlaphoheloa ha khatello ea mali ea systolic ea pele (SBP). Lintlha tse mabapi le khatello ea mali ea diastolic (DBP) ha li lumellane.

Ho bakuli ba nang le khatello ea mali ea methapo, telmisartan e fokotsa khatello ea mali ea systolic le khatello ea diastolic, ha e sa ame sekhahla sa ho sisinyeha ha pelo. Tlatsetso ea litlamorao le li-natriuretic tsa lithethefatsi mesebetsing ea eona ea hypotensive ha e e-so tsejoe. Ho sebetsa ha telmisartan ho theola khatello ea mali ho tšoana le lithethefatsi tse ling tse emelang lihlopha tse ling tsa lithethefatsi tsa antihypertensive (lithuto tsa kliniki ho bapisa telmisartan le amlodipine, atenolol, enalapril, hydrochlorothiazide le lisinopril).

Ka ho khaotsa ka tšohanyetso kalafo ea telmisartan, khatello ea mali butle-butle e khutlela boemong boo pele bo neng bo le kalafong matsatsi a 'maloa ntle le matšoao a khatello ea maikutlo a khutlang.

Litekong tsa kliniki le papiso e tobileng ea lithethefatsi tse peli tsa antihypertgency, linyeoe tsa ho khohlela ho omileng li ne li fokola haholo ka telmisartan ho fapana le li-inhibitors tsa ACE.

Telmisartan e kenella ka potlako, le ha palo e anngoeng e fapana. Tekanyetso e akaretsang ea bioavailability ea telmisartan e batla e le 50%. Ha o sebelisa telmisartan ka lijo, sebaka se tlas'a khatello ea nako ea mahloriso (AUC 0-∞) se fokotseha ho tloha ho 6% (ka tekanyo ea 40 mg) ho 19% (ka lethal dose ea 160 mg). 3:00 kamora ts'ebeliso, khatello ea telmisartan ka plasma ea mali e ts'oana ha e nooa ka mpeng e se nang letho kapa ha e nooa le lijo.

Ho fokotseha hanyane ho AUC ho lebelletsoe ho fokotsa phello ea kalafo. Ha ho na kamano e pakeng tsa litekanyetso le mahlaseli a plasma ea lithethefatsi. C max hape, ho isa tekanyong e tlase, AUC e eketseha ka bongata ka tekanyo ea 40 mg.

Telmisartan e tlameletsoe haholo liprotheine tsa plasma (> 99.5%), haholo albin le alpha-1 acid glycoprotein. Boholo bo boholo ba phepelo (V dss) ka ho lekana bo lekana le 500 L.

Telmisartan e tšelisoa ke khokahano ea motsoako oa motsoali ho glucuronide, conjugate ha e na mesebetsi ea meriana.

Telmisartan e tšoauoa ka setlama se kopantseng sa bio-exponential pharmacokinetic le ho felisoa ha halofo ea bophelo ba nako e fetang lihora tse 20. Sebaka se phahameng sa plasma (C max), le ho isa tekanyong e fokolang, sebaka se katlasehong ea nako ea mahloriso (AUC) se eketseha ka mokhoa o sa lekanang lethalong. Ha ho na bopaki ba tlhahlobo ea bohlokoa ea telmisartan ha u sebelisa tekanyetso e khothalletsoang. Ho basali, ho tsepamisa mohopolo oa plasma ho ne ho phahame ho feta ho banna ntle le phello e kholo ea katleho.

Kamora ho buoa ka molomo, telmisartan e batla e pepesitsoe ka ho felletseng ka har'a maro, haholo ha e sa fetoloe. Tlhahiso eohle ea lithethefatsi ka moroto ke lilemo tse 70. Ho kopana le lithethefatsi tse ling tse amang sisteme ea renin-angiotensin-aldosterone, le / kapa ts'ebeliso ea li-addithone tse nang le potasiamo.

Ho kgothaletswa ka hloko ho hlokomela maemo a potasiamo ho bakuli ba kotsing.

Li-inhibitors tsa ACE, telmisartan, le ling tse ling tsa li-receptor antepton tse ling ha li sebetse hantle ho theola khatello ea mali ho bakuli ba morabe oa Negroid ho feta merabeng e meng, mohlomong ka lebaka la hore bakuli ba nang le khatello ea methapo ea methapo ea lebelo la Negroid ba na le menyetla e tlase ea renin.

Ha u sebelisa lithethefatsi life kapa life tsa antihypertgency, ho fokotseha ho hoholo ha khatello ea mali ho bakuli ba nang le lefu la ischemic cardiopathy kapa lefu la pelo le ischemic lefu la pelo ho ka lebisa ho ruruheng ha myocardial kapa stroke.

Sebelisa nakong ea bokhachane kapa leboteng

Ha ho na data e nepahetseng mabapi le ts'ebeliso ea Telmisartan bakeng sa basali baimana.

Motheo oa mafu a tšoaetso ea teratogenicity ka lebaka la ts'ebeliso ea li-inhibitors tsa ACE nakong ea trimester ea pele ea kemolo e ne e sa kholise, empa keketseho e nyane ea menyetla e ke ke ea qheleloa ka thoko.

Lingaka tsa li-receptor tsa Angiotensin II ha lia lokela ho qala nakong ea kemero. Haeba ts'ebetso ea kalafo e amanang le lihanyetsi tsa angiotensin II e nkoa e hlokahala, 'me mokuli o rera ho ima, ho khothalletsoa ho khutlisetsa kalafo ka kalafo ea antihypertensive ka profil ea polokeho nakong ea kemolo. Haeba ho ima ho thehiloe, kalafo ka li-angiotensin II receptor antagonists e lokela ho khaotsa hanghang mme kalafo e 'ngoe e loketseng e lokela ho qala.

Hoa tsebahala hore tšebeliso ea li-angiotensin II receptor antagonists nakong ea likhahla tsa II le III tsa moimana li baka fetotoxic ho batho (ts'ebetso e sa sebetseng ea renal, oligohydramniosis, ho lieha ho etsoa ha masapo a cranial) le neonatal toxicity (ho hlleha ha renal, hypotka, hyperkalemia). Haeba ts'ebeliso ea bahanyetsi ba li-receptor ba angiotensin II e qalile ho tsoa ho nako ea bobeli ea bokhachane, ho kgothaletswa ho etsa tlhahlobo ea ultrasound ea monoana le masapo a mokokotlo oa fetal. Boemo ba masea ao bo-'m'ae ba nkileng lingangele tsa angiotensin II li lokela ho beoa leihlo ka hloko bakeng sa boteng ba methapo ea methapo (sheba likarolo "Contraindication" le "likarolo tsa ts'ebeliso").

Telmisartan ha e khothalletsoe nakong ea ho anyesa, kaha ha ho tsejoe hore na e qepuoa ka lebese la motho. Ho khethoa kalafo e 'ngoe e nang le profil ea polokeho e ithutoang hantle, haholo ha ho anyesa lesea le sa tsoa hlaha kapa pele ho nako.