Ungayithatha kanjani i-Lozartan yezidakamizwa nokuthi yiziphi izinzuzo zayo

ILosartan ingesinye sezidakamizwa ezisiza ukuthengwa kwezingcindezi emhlabeni. Isizathu salokhu kuthandwa isikhathi eside sokusebenza kanye nephrofayili yokuphepha ephezulu yalo muthi. Isenzo seLosartan sithatha amahora angama-24, ngakho-ke umthamo owodwa wenele ngosuku. Uma kuqhathaniswa namanye amaphilisi we-antihypertensive, lesi sidakamizwa sincane kakhulu amathuba emiphumela emibi. Kungakho kubonakaliswa ngokuzibophezela okukhulu ekwelashweni: uma uke wazama iLosartan, iziguli ezingama-92% ziyazikhethela.

Ubekwa ubani umuthi

Ukufa ngenxa yemivimbo kanye nesifo senhliziyo kuhlela kuqala esakhiweni sokufa kwabantu abadala emhlabeni wonke. Kulindelekile ukuthi maduze nje lezi zifo ziphenduke imbangela enkulu yokukhubazeka. EYurophu, kungenzeka ukuthi kubuyiswe le nkambiso, inani lokufa kwabantu ngenxa yesifo senhliziyo (CVD) lihamba kancane kodwa ngokuqinisekile liyehla. Ososayensi balinganisela ukuthi indima eyinhloko kule mpumelelo ayiyona yezindlela zokwelapha ezisezingeni eliphakeme, kepha yizinyathelo ezilula zokuvimbela izici zobungozi zeCVD.

Izici ezibaluleke kakhulu yilezi:

• umfutho wegazi ophakeme;
• i-cholesterol eyeqile kanye ne-triglycerides emikhunjini;
• isifo sikashukela
• ukukhuluphala

Uma ingcindezi ingaphezulu kwesejwayelekile, ingozi yokufa evela kwiCVD imayelana ne-1%, uma ingcindezi ephezulu ihambisana nenye into engu-1 - 1,6%, enye into engu-2 - u-3.8%. Umsebenzi kadokotela ekuboneni izici zobungozi ukunciphisa umthelela wabo emzimbeni: ukunciphisa ingcindezi yokuqondisa amanani, ulungise iphrofayili ye-lipid kanye noshukela wegazi, futhi wenze nesisindo ngokwejwayelekile.

I-Losartan inomphumela obizwa ngokuthi yi-hypotensive, umthamo wesidakamizwa ukhethiwe ngokuya ngengcindezi yokuqala neqondiwe.

Umuthi unqunywe emacaleni alandelayo:

Uma ukhetha umthamo ofanele futhi uthatha iLosartan ngaphandle kwezikhala, ungafinyelela izinga lokucindezela okuqondiwe ku-50% weziguli. Konke okunye kunconyelwa ukwelashwa okuhlanganayo: enye i-ejenti ye-antihypertensive ingezwa kuhlobo lokwelashwa. Izidakamizwa zesimanje zinikezela ngokwejwayelekile kwencindezi yeziguli ezingaphezu kwama-90%.

Izibalo zokuthatha izidakamizwa ze-antihypertensive eRussia ziyaxaka: phakathi kwabantu abanomfutho wegazi ophakeme, cishe abantu abangamaphesenti angama-70 abantu basedolobheni kanye no-45% wezakhamizi zakuleli dolobhana bayazi ngalesi sifo. Baphathwa ngokuqondiswa futhi bagcina ingcindezi ezingeni elijwayelekile lama-23% kuphela.

Umfutho wegazi ophezulu kanye nengcindezi yokugcotshwa kwengcindezi kungaba yinto yesikhathi esedlule - mahhala

Ukuhlaselwa yinhliziyo nemivimbo kuyimbangela ecishe ibe yi-70% yabo bonke ukufa emhlabeni. Abantu abayisikhombisa kwabayishumi bafa ngenxa yokuqothuka kwemithambo yenhliziyo noma yobuchopho. Cishe kuzo zonke izimo, isizathu sokuphela okubi kangaka kuyafana - ukucindezela kwegazi kubangelwa umfutho wegazi ophakeme.

Kungenzeka futhi kudingekile ukudambisa ingcindezi, ngaphandle kwalokho akukho lutho. Kepha lokhu akuselaphi lesi sifo uqobo, kepha kusiza kuphela ukulwa nophenyo, hhayi imbangela yalesi sifo.

• Ukucindezela okujwayelekile - 97%
• Ukuqedwa kwe-vein thrombosis - 80%
• Ukuqedwa kokushaya kwenhliziyo okuqinile - 99%
• Ukususa ikhanda - 92%
• Ukwanda kwamandla ngesikhathi sosuku, ngcono ukulala ebusuku - 97%

Kanjani umuntu osuselwa izidakamizwa

Ukutholwa kokuqala, okwaholela ekugcineni ekusungulweni kweLozartan, kwenziwa ngasekupheleni kwekhulu le-19. I-renin enzyme, okuyingxenye ebalulekile yokulawula umfutho wegazi, yahlukaniswa namaseli ezinso. Ngemuva kweminyaka emashumi ambalwa, kwatholakala into ethile kumthambo wezinso onamandla amakhulu emikhunjini, okuholela ekunciphiseni kwawo. Ibizwa ngokuthi i-angiotensin. Isixhumanisi sokugcina salesi simiso satholakala maphakathi nekhulu lama-20. Yaba yi-hormone i-aldosterone, eyenziwe ngezindlala ze-adrenal. Lokhu kwakwanele ukuqonda ukuthi ithoni yemithambo igcinwa kanjani emzimbeni kanye nomfutho wegazi ophakeme uvikelwe.

Ngamazwi alula, le ndlela elandelayo isebenza emizimbeni yethu: lapho ingcindezi yehla ezinso, kwakhiwa i-renin, esebenza nge-angiotensin. I-Angiotensin ibunjwe ku-angiotensin I, okuyi-peptide engasebenzi, bese kuthi, ngokubamba iqhaza kwe-enzyme ye-ACE, iguqulwe ibe yi-angiotensin II. Umuthi ophumelelayo yi-vasoconstrictor eqinile, obangela ukukhuphuka ngokushesha kwengcindezi futhi uvuselele ukukhiqizwa kwe-aldosterone, ebhekene nokudla kwamanzi ngosawoti.

ILosartan yadalwa ngeminyaka yama-90s yekhulu leminyaka edlule. Wayengesidakamizwa sokuqala eqenjini elisha lezidakamizwa ngengcindezelo, okwabizwa ngokuthi yi-angiotensin II receptor blockers, esifushanisiwe i-ARB. Manje kuleli qembu lezidakamizwa ezi-6. Igama labo bonke, ngaphandle kukaLozartan, liphela ngo-Sartan, ngakho-ke babizwa nangokuthi amaSartan.

Isenzo seLosartan sisuselwa ekuvimbeleni isenzo se-angiotensin II, ngenkathi umuthi ungathinti ezinye izinhlobo zokulawulwa kokusebenza kwemithambo yegazi nenhliziyo.

Lokho okusizwa ngumuthi lokhu:

1. Isenzo esikhulu yi-hypotensive. Umuthi uqala ukwehlisa umfutho ngemuva kwehora, ufinyelela umphumela wawo omkhulu ngemuva kwamahora ayi-6. Isikhathi sokusebenza esiphelele siwusuku olu-1. ILosartan ihlala ichazwa isikhathi eside, ngoba iqala ukuhlinzeka ngokuncipha okuzinzile kwengcindezi kuphela ngemuva kwezinyanga eziyi-1-1,5.
2. Ukucindezelwa kohlelo lokulawulwa kwengcindezi kuvimbela ukuqhubeka kokuhluleka kwenhliziyo. Ama-inhibitors e-ACE asebenza kuleli cala asebenza kangcono, kepha i-losartan ibekezelelwa kangcono.
3. Vikela ama-nephrons ezinso ekubhujisweni, anciphise ukuthuthukiswa kokuhluleka kwezinso, ukubambezela isidingo sesiguli se-hemodialysis. I-Losartan inganciphisa i-excretion yamaprotheni kumchamo ngama-35%, amathuba okuhluleka kwezinso ngokuphelele - ngo-28%.
4. Kuvikela ubuchopho nge-hypertension: kunciphisa ingozi yokushaywa unhlangothi, kuthuthukisa inkumbulo. Ososayensi bakholelwa ukuthi lesi senzo asihlotshaniswa kuphela nokwehla kwengcindezi, kepha neminye, engekafundi imiphumela yemithi.
5. Kuholela ekuthuthukisweni kwesimo sezicubu ezixhunyiwe: kuqinisa izindonga zemithambo yegazi, kugqugquzela ukululama kwemisipha. Kukholelwa ukuthi umphumela owengeziwe weLosartan "unecala" kulokhu - ukukhuthaza ukukhiqizwa kwe-collagen.
6. Isiza ukuqeda i-uric acid eyeqile, ngakho-ke kunconyelwa ikakhulukazi ukunciphisa umfutho ezigulini ezine-gout.

Imithamo yamathebulethi e-losartan

Into esebenzayo eyingxenye ye-losartan yi-potassium losartan. Umuthi wokuqala yinkampani yaseMelika Cozaar iMerck. Imithi ebizwa ngokuthi i-losartan ngama-generics. Ziqukethe into efanayo esebenzayo futhi zinemithamo efanayo ne-Cozaar yasekuqaleni.

Ama-analogues alandelayo abhalisiwe eRussia:

Imithamo yamathebulethi e-losartan:

• I-12.5 mg ingasetshenziswa uma i-losartan ichazwe namanye ama-antihypertgency agents.
• I-25 mg yithamo elijwayelekile lama-diuretics.
• I-50 mg - ngokuya ngemiyalo, le dosi ikuvumela ukuthi wenze ngokwejwayelekile ukucindezela ezigulini eziningi, kunqunywa kaningi.
• I-100 mg ithathwa uma kuncishiswa ingcindezi kusuka ezinombolweni eziphakeme.

Kukhona futhi amaphilisi okuhlanganisa aqukethe ngokushesha izinto ezi-2 ezinomphumela we-hypotensive: losartan potassium kanye ne-diuretic hydrochlorothiazide. Ngaphansi kwegama uLozartan N, akhiqizwa nguCanonfarm, Atoll noGideon Richter. Intengo ye-Losartan N - ama-ruble ayi-160-430.

Ungayithatha kanjani

Imithetho yokuthatha i-losartan emiyalweni yokusebenzisa:

1. Umuthi udakwa 1 isikhathi ngosuku, kodwa ukuze kube lula, ithebhulethi ingahlukaniswa ngemithamo emi-2.
2. Umyalo uthi akunandaba ukuthi uwuthatha nini lo muthi ekuseni noma kusihlwa. ILosartan ivulekile okungenani amahora angama-24. Into esemqoka ukungashintshi isikhathi esamukelwe sokwamukela. Ukubuyekezwa kweziguli kubonisa ukuthi ukwamukelwa kwasekuseni kusathandeka. Kulokhu, inani eliphakeme lokusebenza kweLosartan liwela ngesikhathi sosuku esisebenza kakhulu.
3. Ukudla akukuphazamisi kakhulu ukumuncwa nokusebenza kwe-losartan, ngakho-ke kungathathwa ngaphambi noma ngemuva kokudla.
4. Umthamo wokuqala wansuku zonke weziguli eziningi ngu-50 mg. Ingakhushulwa kungakapheli ngisho isonto ngemuva kokuthatha umuthi.
5. Ekwehlulekeni kwenhliziyo, ukuphatha kuqala ngo-12,5 mg, khuphula kancane kancane isilinganiso sibe ngu-50 mg.
6. Ngokuhluleka kwesibindi, ukwehluleka okunzima kwe-renal, ezigulini ezineminyaka engaphezu kwengama-75, umthamo wokuqala ngu-25 mg.
7. Umthamo omkhulu wansuku zonke yi-100 mg, lapho kukhona ukwehluleka kwenhliziyo kungandiswa ngudokotela kuye ku-150 mg.

Uma ithebhulethi engu-1 yeLosartan 100 mg inganele ukwenze ingcindezi iguqule, ingahlanganiswa nezidakamizwa ze-antihypertensive ezivela kwamanye amaqembu.

Yikuphi ukucindezela odokotela batusa ukuqala ukwelashwa ne-losartan? Njengomthetho, kusuka ezingeni le-140/90. Leli zinga selivele lithathwa njengeliphakeme futhi lithinta kabi isimo semithambo yegazi nomsebenzi wenhliziyo, izinso nobuchopho. Ngokucindezela okwanda njalo noma ukweqa okuphindaphindiwe, kuyabekwa umthamo ongaguquki weLosartan. I-Hypertension yisifo esingalapheki, ngakho baphuza umuthi noma ngabe kubonakala sengathi ingcindezi ibuyele kwesejwayelekile. Ngaphezu kwamaphilisi, izindlela ezisebenzayo zokulwa nomfutho wegazi ophakeme kungukuncipha kwesisindo, umsebenzi ophakeme, ukuyeka ukubhema, ukukhawulela utshwala, ukukhulisa ukusetshenziswa kwemifino nokunciphisa inani likasawoti, nokugwema izimo ezicindezelayo.

Imiphumela emibi engenzeka

Imiphumela emibi ye-losartan imnene, imvamisa ihamba yodwa, ayidingi ukuhoxiswa ekwelashweni. Umuthi udlule ngempumelelo izifundo eziningana ezilawulwa yi-placebo, lapho kutholakala khona ukuthi imvamisa yezimpawu ezingathandeki ezenzeka lapho kuthathwa iLosartan iphansi kakhulu kunaseqenjini le-placebo (2,32 no-3.7%).

Ngokusho kweziguli ezinomfutho wegazi ophakeme, imiphumela engathandeki iyivelakancane kakhulu kuzo, kungenzeka ukulandelela ubudlelwane phakathi kokuphuza amaphilisi nokuba ngcono kwempilo emacaleni angawodwa. Njengomthetho, imiphumela emibi ihamba kancane emvelweni. Iziguli zaphawula inkungu emakhanda abo, isiyezi, umlomo owomile ekuqaleni kokwemukelwa. Ekupheleni kwenyanga eyi-1, lezi zinto ziyanyamalala.

Idatha evela emiyalweni yemiphumela emibi eyenzeka ngaphezulu kwe-1% (ngokusho kwesigaba se-WHO kubhekwa kaningi) kweziguli ezithatha i-losartan:

E-10% yeziguli ezinesifo sikashukela nokusebenza kokulimala kwezinso, kwakukhuphuka i-potassium yegazi kuye ku-5.5 futhi ngaphezulu ngesilinganiso esijwayelekile esingu-3.4-5.3. Lapho uthatha i-placebo, ukwanda okunjalo kwatholakala kwiziguli ezi-3.4%. Ngaphandle kwalokho, i-losartan ibekezelelwa kahle kuleli qembu leziguli.

Ngokusho kwemiyalo, ngokuhluleka kwenhliziyo, i-hyperkalemia yabonwa ngaphansi kwesilinganiso esingu-1%, imvamisa yomphumela ongathandeki yanda ngethamo elandayo lisuka ku-50 laya ku-150 mg.

Contraindication

Imiyalo yokusebenzisa i-losartan iqukethe uhlu oluphelele lwe-contraindication ukuze isetshenziswe:

1. Umuthi ungadala ukungezwani komzimba. Zenzeka ngaphansi kwe-1% yeziguli ezinomfutho wegazi. Ukuphendula kwe-anaphylactic kungenzeka, ngakho-ke, iziguli ezake zahlushwa i-angioedema kufanele ziqaphele ikakhulukazi ekuqaleni kokwelashwa. Ingozi enkulu kakhulu kubantu abanokungezwani nama-ACE inhibitors.
2. Kuyenqatshelwa ekwehlulekeni kwesibindi okunzima, ngoba umsebenzi wesibindi ongasebenzi kahle uholela ekukhuleni okukhulu ekuqoqweni kwe-potassium losartan egazini, okungukuthi, i-overdose. Isiguli singathola i-hypotension enamandla ne-tachycardia.
3. Ama-Losartan nawo wonke ama-sartan akufanele aphuzwe ngesikhathi sokukhulelwa. Ngokwesihlukaniso se-FDA, lo muthi ungowesigaba D. Lokhu kusho ukuthi ngokuqhubeka kocwaningo kwasungulwa futhi kwafakazela imiphumela emibi enganeni. Ukuphazamiseka okungenzeka kwezinso zezingane, kubambezela ukukhula kwamathambo kaswazi, oligohydramnios. Kwi-trimester yokuqala, ukusetshenziswa kwesidakamizwa akunangozi. Imiyalo yokusebenzisa iqukethe inkomba: uma ukukhulelwa kuqala ngesikhathi sokuthatha i-Losartan, umuthi ukhanselwa ngokushesha. Owesifazane kudingeka ahlolwe ngokungeziwe ku-2nd trimester - i-ultrasound yesibeletho ukukhomba ukungahambi kahle kokukhula kwezinso nesikhumba.
4. ILosartan iyenqatshelwa ku-hepatitis B, njengoba kungaziwa ukuthi ingena yini ebisini.
5. Amathebulethi e-Lozartan awakwazi ukusetshenziswa ezinganeni ngenxa yokuntuleka kwedatha ekuphepheni kwayo komzimba okhulayo.
6. Ngokwesakhiwo se-losartan kune-lactose (noma i-cellactose), ngakho-ke umuthi awukwazi ukuthatha uma ukutholwa kwawo kuphazamiseka.
7. Ngenxa yokusebenzelana kwezidakamizwa, kwenqatshelwe ukuphuza i-losartan kanye ne-aliskiren (izidakamizwa ezivela ekucindezelweni kweRixil, Rasilez, Rasil) ezigulini ezisengozini enkulu yokwehluleka kwezinso: ngesifo sikashukela nesezinso.

Lezi zimo ezilandelayo aziyona imibimbi eqinile yokwelashwa nge-losartan, kepha zidinga ukunakwa okukhethekile empilweni yabo: isifo sezinso, i-hyperkalemia, ukuhluleka kwenhliziyo, noma yikuphi ukuphazamiseka ekunikezelweni kwegazi kuya ebuchosheni, ukukhiqizwa ngokweqile kwe-aldosterone.

Njengoba i-losartan ingahlangani ne-ethanol, imiyalo ayichazi ukuhambisana kotshwala nomuthi. Kodwa-ke, odokotela bakwenqabela ngokuphelele ukusetshenziswa kotshwala ngesikhathi sokwelashwa ngamaphilisi okucindezela. U-Ethanol ukhulisa isimo semithambo yegazi, akhuthaze ukuthuthukiswa komfutho wegazi futhi ngaleyo ndlela aqede ngokuphelele umphumela wokwelapha weLosartan.

Ama-analog namagama

Okwamanje, eRussia kubhaliswa ama-analogu angaphezu kwayishumi kuphela, futhi emhlabeni kukhona okuningi kakhulu kwabo. Kumakhemisi amaningi, ungathenga izinketho ezi-2 zokukhishwa kweCozaar:

• iphakethe lamathebhulethi ayi-14 ama-50 mg abiza cishe ama-ruble ayi-110.,
• Iphakethe lamathebhulethi angama-28 we-100 mg lilinye - ama-ruble angama-185.

Ama-Generator ezinkampani ezinkulu zemithi awabizi kakhulu, futhi kwesinye isikhathi okuncane kakhulu kunokwasekuqaleni. Kepha zingathengwa ekhemisi eliseduze, futhi kungenzeka ukukhetha umthamo ofanele.

Ungangena esikhundleni se-losartan ngale mithi elandelayo:

Ama-Analogs angahluka kancane kulawangempela ngokuya ngesilinganiso sokulamula namandla esenzo, ngakho-ke, odokotela batusa ukukhetha lawo ma-generics adlule ezawo izivivinyo zokwelashwa. Isibonelo, ku-Lozap no-Lorista, imiphumela ye-hypotensive yamahora angama-24, umphumela ofanayo kuso sonke isikhathi sesenzo, izinga eliphansi lemiphumela. Ukubuyekezwa kweziguli kuqinisekisa umbono wodokotela. Amathebhulethi akalwe kakhulu yiLozartan evela eVertex nase-Ozone (Atoll), eLorista naseLozap.

Qhathanisa nezidakamizwa ezifanayo

Ucwaningo oluhilela amaqembu ahlukahlukene emishanguzo ye-antihypertensive aluzange luveze noma iyiphi inzuzo ebalulekile kunoma iyiphi yezidakamizwa. Lokhu kusho ukuthi yonke imithi yesimanje ngokulinganayo inciphisa ingcindezi nengozi ye-CVD. Ngokwemvelo, inqobo nje uma umthamo ukhethwe kahle, kanti amaphilisi athathwa ngokuqhubekayo, ngaphandle kokushiywa. Umehluko omkhulu ezindleleni zokucindezela ukubekezelela kwabo namandla emiphumela emibi, kunguku ngqo kulezi zindlela lapho kukhethwa umuthi odingekayo.

I-Losaratan nezimpawu zayo kubonakaliswa ukubekezelela okuhle kakhulu:

1. Amathuba amancane kunabanye okuholela ekunciphiseni ngokweqile kwengcindezi, mancane amathuba okubangela ukuhlangana kwe-collaptoid ezigulini.
2. Ngokungafani ne-beta-blockers (propranolol, atenolol, njll.), Ama-analogia eLosartan awathinti isigqi senhliziyo, ukwakheka, futhi awubangeli i-bronchospasm ngokukhwehlela.
3. Uma siqhathanisa ama-sartan nezimbangi zawo eziyinhloko, i-ACE inhibitors (Captopril, enalapril, ramipril, njll.), Bese kuvela ukuthi i-losartan ibangela ukukhwehlela kaningi (emiyalweni yokusebenzisa, imvamisa ingu-9.9% yama-ACE inhibitors, u-3.1% we-losartan ), hyperkalemia, edema kaQuincke.
4. Umphumela we-losartan awuncike eminyakeni yobudala, ubuhlanga, ubulili kanye nemingcele ye-hemodynamic.
5. Ekubuyekezweni kweziguli ezisebenzisa umuthi, kuvame ukuthi kube nesitatimende sokuthi i-losartan ibuthakathaka kunamanye amaphilisi wokucindezela. Ucwaningo luyaliphikisa leliqiniso. Iqiniso ngukuthi imiphumela yalesi sidakamizwa inyuka kancane, ithola amandla aphelele kungakapheli amasonto ayi-2-5. Ekupheleni kwalesi sikhathi, ukusebenza kweLosartan kuyafana nezinye izidakamizwa ze-antihypertensive.
6. Ukubuyekezwa kwemininingwane evela ezifundweni eziningi ezibandakanya iLosartan kukhombisa ukuthi amandla ayo awahlukile kuma-ACE inhibitors. Basondele futhi ekwehliseni imvamisa yemivimbo kanye nokuhlaselwa yisifo senhliziyo, ikhwalithi yempilo, umthelela emzimbeni weziguli ezine-nephropathy nesifo sikashukela.
7. Isikhathi esithatha isikhathi eside ukufeza umphumela omkhulu sisuswa ukuphikelela kweLosartan. Ngokusebenzisa isikhathi eside, ukusebenza kwe-ACE inhibitors kanye ne-beta-blockers kungancipha, futhi lokhu kuvame kakhulu ngamaphilisi weLozartan.
8. Ekwehlulekeni kwenhliziyo, inzuzo yeLosartan kanye nokufana kwayo akukafakazelwa; idatha yocwaningo lwezokwelapha alusavumeli isiphetho sokugcina. Kuze kube manje, ukuhlanganiswa kwe-aldosterone antagonists (spironolactone) nge-beta-blockers kubhekwa njengokusebenza kakhulu. Ukuhlanganiswa kwama-sartans nge-ACE inhibitors kusendaweni yesibili.

Ukubuyekezwa kweziguli