Imithetho yokuphuza amaphilisi okucindezela i-Noliprel kanye nokubuyekezwa kweziguli

I-Noliprel isidakamizwa esiyinhlanganisela esinethembisayo sokwehlisa umfutho wegazi. Izakhi ezimbili ezisebenzayo ngaphakathi kwethebhulethi elilodwa ziyahlangabezana ngokugcwele nezidingo zendlela yesimanje yokwelashwa kwe-hypertension. Izidakamizwa ezinjalo zisebenza kakhulu kunokujwayelekile, ngaphezu kwalokho, mancane amathuba okuthi zibangele imiphumela emibi. Ukufinyelela ezingeni lokucindezela okuqondiwe (imvamisa kungaphansi kwe-140/90), ama-50% eziguli ezinesifo somfutho wegazi kufanele athathe izidakamizwa eziningana ngezikhathi ezahlukahlukene. Le ndlela yokwelashwa ivame ukungasebenzi, njengoba iziguli eziningi zikhohlwa ukuphuza iphilisi ngesikhathi. I-noliprel ehlanganisiwe ithuthukisa kakhulu ukunamathela ekwelashweni, ngoba ithathwa kanye kuphela ngosuku.

Ubekwa ubani umuthi

Abangaphezu kwengxenye yabantu abangaphezu kweminyaka engama-60 bahlushwa umfutho wegazi ophakeme. Njalo ngonyaka, le nkinga iba yanda futhi iphuthuma kakhulu, njengoba empilweni yomuntu wanamuhla kunezinto eziningi futhi eziyingozi kakhulu zokucindezela okwandayo: ukucindezelwa, ukungabikho kokuhamba, isisindo esindayo, imikhuba engenampilo, umoya ongcolile. I-Hypertension ingenye yezimbangela eziphambili zokuhlaselwa yisifo sohlangothi kanye nesifo senhliziyo, ngakho-ke udinga ukwelashwa ngokushesha ngemuva kokutholwa.

Impikiswano mayelana nengcindezi yokuthi aqale ukuphuza amaphilisi seyaphela isikhathi eside. Ngokuya ngezigaba okwamukelwa kuwo wonke umhlaba, izinga le-120/80 libhekwa njengejwayelekile, kanti nezinga eliphakeme libhekwa njenge-139/8. I-Level 1 umfutho wegazi ophezulu utholakala kusukela ezingeni le-140/90. Ngezifo zesifo sikashukela nezinso, umkhawulo ophansi ungaphansi, kunqunywe amaphilisi, kuqalwa ngezinombolo ezili-130/80. Ekuqaleni kwesifo, ingcindezi ijwayelekile esikhathini esiningi, ikhuphuka ngezikhathi ezithile. Izindlela ezingezona izidakamizwa ziyasebenza ngalesi sikhathi: ukudla, ukuyeka i-nicotine notshwala, imisebenzi yansuku zonke, ukunciphisa umzimba. Imithi ixhunyiwe uma kungeke kwenzeke ukwenze ingcindezi ngokwejwayelekile ngalezi zinyathelo.

Ngokusho kodokotela, okokuqala, iziguli eziningi zidinga kuphela umuthi owodwa onento eyodwa esebenzayo. Uma ukwelashwa okunjalo kungasebenzi, sebenzisa izidakamizwa eziningana ze-antihypertensive noma inhlanganisela eyodwa. I-Noliprel iqukethe enye inhlanganisela ephumelela kakhulu yezithako ezisebenzayo, ihlanganisa i-ACE inhibitor ne-diuretic.

Izinzuzo zamaphilisi okuhlanganisa:

1. Izinto ezakha iNoliprel zithinta izimbangela zokuthuthuka komfutho wegazi ophezulu ezinhlangothini ezihlukile, ngakho-ke umphumela wazo ohlangene unamandla futhi uzinze ngokwengeziwe.
2. Ukuncishiswa kwengcindezi kutholakala ngemithamo ephansi yezinto ezisebenzayo, ngakho imvamisa yemiphumela engathandeki iphansi.
3. Ngenxa yenhlanganisela eyenziwe kahle, into eyodwa inciphisa imiphumela emibi yomunye - i-diuretic ivimbela i-hyperkalemia, engacasulwa yi-ACE inhibitor.
4. Umphumela weNoliprel ohlangene ukhula ngokushesha okukhulu.
5. Isiguli sidinga ukuphuza kuphela ithebhulethi engu-1 ngosuku, okushiwoyo kwenzeka kaningi kunokuthatha izidakamizwa ezihlukene ezi-2-3, ngakho-ke ukusebenza ngempumelelo kokwelashwa kuphezulu.

Okuwukuphela kwenkomba yokusetshenziswa kweNoliprel yi-hypertension. Lona umuthi onomuthi ophansi osezingeni eliphezulu ongabekwa kunoma yisiphi isiguli esingenayo i-contraindication. Ukukhethwa kwamaphilisi athile wokucindezela kuncike kakhulu ezifweni ezixakile ze-hypertension. Ngokwemiyalo, i-Noliprel ingenye yezidakamizwa ezinconyiwe zokunciphisa ingcindezi kubantu abanesifo sikashukela, ngoba inesinye sezimpawu eziphephe kakhulu zesifo sikashukela - i-indapamide. Iphinde ibekelwe ukusebenza kwe-metabolic syndrome, ukuhluleka kwenhliziyo okungapheli, isifo senhliziyo, i-nephropathy, isifo sokuqina kwemithambo yegazi.

Uwenza kanjani umuthi uNoliprel

Ukuhlanganiswa kwezinto ezisebenzayo kumathebhulethi aseNoliprel kubhekwa njengento engenangqondo kuphela, kodwa futhi kusebenza kakhulu. Inikeza umphumela ngokushesha kwizimbangela ezi-2 zehypertension:

1. I-perindopril ye-izidakamizwa ingeyeqembu lezidakamizwa ze-ACE inhibitor. Kuyaphazamisa umsebenzi wohlelo lwe-renin-angiotensin, ngenxa yokuthi ingcindezi emzimbeni wethu ilawulwa. I-Perindopril ivimbela ukwakheka kwe-hormone angiotensin II, enomphumela oqinile we-vasoconstrictor. Iphinda futhi yandise isenzo se-bradykidin - i-peptide evimba imithambo yegazi. Yini esiza i-perindopril: ngokusetshenziswa isikhathi eside, ayigcini ngokunciphisa ingcindezi, kepha futhi yehlisa umthwalo emithanjeni yegazi nasenhlizweni, ithuthukisa isimo sezindonga zemithambo yegazi, inciphisa kancane ukumelana ne-insulin.
2. Into yesibili ekwakhiweni kweNoliprel, i-indapamide, isebenza ngendlela efanayo ne-thiazide diuretics: ithuthukisa ukumbumbuluzwa komchamo, ikhuphula ukuphuma kwe-sodium, chlorine, magnesium, potassium ngomchamo. Ngasikhathi sinye, inani lamanzi emzimbeni liyancipha, okuholela ekwehleni kwengcindezi emikhunjini.

Eminye yemiphumela emibi ye-ACE inhibitors, ne-perindopril ikakhulukazi, yi-hyperkalemia, engavusa ukuphazamiseka kwesigqi senhliziyo. Lesi simo sikhula ngenxa yokuntuleka kwe-aldosterone yehomoni, ukuvela kwayo kulawulwa yi-angiotensin II. Ngenxa yokuba khona kwe-indapamide, ekhipha i-potassium ngokweqile, lapho uthatha iNoliprel, imvamisa ye-hyperkalemia iphansi kakhulu kunokwelashwa nge-perindopril 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%

Ukubuyekezwa okwenziwa ngabachwepheshe bezenhliziyo ngeNoliprel kuyinto enhle kakhulu. Idumela elihle lomuthi lisekelwa izifundo eziningi.

Imininingwane ngesenzo seNoliprel:

• ngenyanga yokuqala yokwelashwa, izinga lokucindezela liyancipha ku-74% weziguli, ngenyanga yesithathu - ku-87%;
• kuma-90% eziguli ezinesifo segazi esidala, ngemuva kwenyanga yokuphatha, ingcindezi ephansi ingancishiswa ibe ngama-90;
• ngemuva konyaka wokusetshenziswa, umphumela ophikelelayo uphikelela kuma-80% eziguli.
• umuthi usebenza kahle ezigulini ezidinga ukwelashwa okunolaka: imithamo ephezulu noma izidakamizwa eziningana ze-antihypertensive. Ukhombisa imiphumela emihle kakhulu ene-diphicathy nephropathy, kanye ne-hypricrophy yesokunxele.
• INoliprel ibonakala ngokuphepha okuphezulu. Izigameko zemiphumela emibi kakhulu cishe azifani ne-placebo.

Ekwelapheni umfutho we-hypertension, i-WHO yeluleka esikhundleni sokukhulisa umthamo womuthi ovela engxenyeni eyodwa ukushintshela kuhlanganiswe nezidakamizwa, futhi kungakuhle ukuthi uqale uthathe izidakamizwa zomuthi ophansi. Amacwecwe eNoliprel ahambisana ngokuphelele nalezi zincomo.

Khipha ifomu nomthamo

Umkhiqizi weNoliprel yinkampani yaseFrance ekhiqiza amakhambi, eyaziwa ngentuthuko yayo emkhakheni wezokwelapha izifo zenhliziyo nesifo sikashukela. Phambilini, lo muthi wakhiqizwa ngohlobo lwe-2: Noliprel / Noliprel Forte. Kusukela ngo-2006, ukwakheka kwayo sekushintshile, kwaqala ukusetshenziswa okunye usawoti we-perindopril. Ngenxa yalokhu, impilo eshalofini lamathebulethi ngaphandle kokulahleka kwekhwalithi yakwazi ukwanda ngesigamu. Ngenxa yesisindo ehlukahlukene sikasawoti, umthamo wamathebhulethi kwadingeka ushintshwe kancane. Manje isidakamizwa siyatholakala ezinguqulweni ezi-3:

INoliprel ikhiqizwa amafektri akwaServier aseFrance naseRussia. Izinto ezisebenzayo zazo zonke izinketho zomthamo zenziwa eFrance kuphela.

Amathebhulethi eNoliprel anomumo wobude obuthile, avikelwe yilolwakhiwo lwamafilimu, ngoba okulula ukuhlukanisa uhhafu wedosi unikezwa notch. Ukupakisha - ibhodlela lepulasitiki elinamathebulethi angama-30. Omunye umakhi wokuphaka awunikezwanga.

Ungayithatha kanjani

Ngokwesilinganiso esiphakeme kakhulu sokucindezela, iNoliprel ingabekwa ngokushesha ngemuva kokutholwa kwalesi sifo. Uma isimo singabucayi (ngebanga loku-1 le-hypertension), izidakamizwa ezinengxenye eyodwa ziyathandwa.

Ngokusho kwemiyalo, ukukhethwa komthamo weNoliprel kuqala ngemithamo emincane kakhulu. Uma ngosizo lwabo bekungenakwenzeka ukufeza izinga lokucindezela okuqondiwe, umthamo uyandiswa. Umuthi awufiki ukusebenza kwawo ngokushesha, ngakho-ke kuyalulekwa ukulinda okungenani inyanga eyi-1 ngaphambi kokukhulisa umthamo.

Iziguli ezikhulu kakhulu ezinesifo somzimba ngaphambi kokuthatha iNoliprel, imiyalelo yokusebenzisa incoma ukuthi uhlolwe ukuze uhlole impilo yezinso.

Imiphumela emibi engenzeka

Onke ama-inhibitors e-ACE abhekwa njengezidakamizwa ngokuphepha okuphezulu. KwaNoliprel, iphrofayili yokubekezelela ayihlukile kakhulu kune-placebo.

Imiphumela emibi yeNoliprel yilena:

• hypotension ekuqaleni kokuphatha kanye ne-overdose (imvamisa efinyelela ku-10%);
• ukukhwehlela, kwanda izinga lempilo, kepha kungabi yingozi emaphashini (cishe ama-10%);
• ushintsho kuzinga le-potassium yegazi (kufika ku-3%);
• ukwehluleka okukhulu kwe-renal phambi kwe-pathology yezinso (kufika ku-0,01%);
• ukwephula ukwakheka noma ukukhula kwesibeletho (imvamisa ayinqunywa, ngoba iNoliprel iyenqatshelwe ngesikhathi sokukhulelwa);
• ukungahambisani nezinto zeNoliprel, i-edema kaQuincke (okufika ku-10%);
• izinkinga zokunambitha (kufika ku-10%);
• ukunciphisa kwe-hemoglobin (kufika ku-0,01%).

Ngokusho kwemiyalo, imiphumela emibi ejwayelekile yeNoliprel kanye ne-analogues yayo ukukhwehlela okuomile, okungacasuli, kufana ne-allergic. Kwenzeka ngonyaka wokuqala wokwelashwa. Imvamisa yale nto ayixhomekeki kwigama lomuthi kanye nesimo sempilo sesiguli. Kodwa-ke, ukukhwehlela akuvamile izikhathi ezi-2 kwabesilisa kunabesifazane (eqenjini lonke le-ACE inhibitors, i-6% uma kuqhathaniswa ne-14%), nakumaCaucasian kaningi kunase-Asia.

Ngokwokubuyekezwa kweziguli eziphuza umuthi, imvamisa ukukhwehlela kubangelwa umphimbo obabayo noma obabayo, endaweni eqondile iyaqina. Lapho uthatha iNoliprel, imvamisa yalomphumela wecala, ngokusho kokulinganisa okuhlukahlukene, isuka ku-5 iye ku-12%. Kwesinye isikhathi inkinga yokukhwehlela ingaxazululwa ngama-antihistamines, kepha cishe cishe ama-3% eziguli aphoqelelwa ukuthi ayeke ukwelashwa neNoliprel.

Umphumela wesibili ovame kakhulu wesidakamizwa ukuqina kwemizwa ezinsukwini zokuqala zokwelashwa. Imiyalo esetshenziswayo ikhombisa ukuthi ubungozi buphakeme kakhulu ezigulini ezinamandla kakhulu ezinesifo somfutho wegazi, ngokuphelelwa amandla emzimbeni (okufaka phakathi ukusetshenziswa okungalawulwa kwezimpawu zokugomela), i-pathologies yezinso nemithambo yemithambo yegazi. Iziguli ezinobungozi obukhulu be-hypotension kufanele ziqale ukwelashwa ngaphansi kokuhlolwa ngudokotela, mhlawumbe esibhedlela. Kwezinye iziguli ezinomfutho wegazi, kwanele ukulandela imithetho elula: qala ukwelashwa ngethamo elincane, kudla uketshezi oluningi, ukunciphisa isikhashana usawoti ekudleni, futhi uhlale ekhaya ezinsukwini zokuqala.

Izibhebhe zeNoliprel zingathinta i-potassium yegazi. Ukushoda kwe-potassium, i-hypokalemia, kubonwa cishe ezigidini ezimbili (2%) zeziguli, kuvame ukuziveza njengokukhathala okwandayo, izinhlungu noma ukugoba ematholeni. Imvamisa yombuso ophambene, i-hyperkalemia, ekhonjiswe kwimiyalo, ingaphansi kwe-1%. Lesi simo sivame ukwenzeka kusifo sikashukela nakwezinso.

Umphumela weNoliprel ku-hemoglobin awubalulekanga futhi awubeki ingozi empilweni, imvamisa ungatholakala kuphela ngezindlela zaselebhu.

Izinkinga zokunambitha zingaba zimbi kakhulu. Ekubuyekezweni kwabo, iziguli ezinesifo somfutho wegazi zibachaza njengokunambitheka okumnandi noma okusansimbi, ukuncipha kokunambitheka, futhi kuyaqabukela njengomuzwa ovuthayo emlonyeni. Ezimweni ezinzima, lezi ziphazamiso ziholela ekulahlekelweni kwesifiso sokudla nokwenqaba ukuthatha iNoliprel. Le mphumela wecala incike kumthamo womuthi futhi uvame ukuhamba wedwa ngemuva kwezinyanga ezintathu.

Contraindication

Izidakamizwa ezihlanganisiwe zinokuphikisana okuningana kunezijwayelekile, ngoba abakhiqizi bahlola ubungozi bokusebenzisa into ngayinye esebenzayo ngokuhlukile.

Imiyalo yokusebenzisa iNoliprel inqabela ngokuphelele ukusetshenziswa kwayo ezimweni ezilandelayo:

1. Nge-hypersensitivity yezinto ezisebenzayo noma ezinye izinto zeNoliprel, kuya kwezinye izidakamizwa zeqembu le-ACE inhibitor, ukuze sulfonamides.
2. Uma ngaphambili, lapho kuthathwa ama-inhibitors e-ACE, isiguli sine-Quincke edema.
3. Nge-hypolactasia: kwithebhulethi iNoliprel mayelana ne-74 mg ye-lactose.
4. Ebuntwaneni, kusukela ukuphepha kokukodwa kwezakhi ezisebenzayo zesidakamizwa sekufundiwe.
5. Ezigulini ezinesifo sikashukela noma sokulimala kwe-renal function (GFR <60), i-Noliprel akufanele ithathwe kanyekanye ne-aliskiren ngenxa yokuhlangana kokusetshenziswa kwezidakamizwa.
6. Ku-nephropathy yesifo sikashukela, iNoliprel iyenqatshelwa ukuthi inqunywe kanye nama-sartan (Losartan, Telmisartan kanye ne-analogues), ngoba lokhu kuhlanganiswa kukhulisa ubungozi be-hyperkalemia ne hypotension.
7. Ngenxa yobukhona ekwakhekeni kwe-diuretic, izinso nokuhluleka kwesibindi esiteji esinzima nakho kuyimpikiswano. Engcupheni enkulu yokwehluleka kwezinso, ukuqapha okwengeziwe kuyadingeka: ukuhlolwa okuvamile (njalo ezinyangeni ezi-2) kwegazi le-potassium ne-creatinine.
8. Ngesikhathi se-GW. Umuthi uvimbela i-lactation, ungavusa i-hypokalemia enganeni, hypersensitivity to sulfonamides. Ingozi iphakeme ikakhulukazi ezinyangeni zokuqala zokuphila. Imiyalo yokusetshenziswa incoma ukufaka esikhundleni seNoliprel nesinye, i-ejenti efundile ye-hypotensive ngesikhathi sokuqina kwesibindi i-B.
9. Ngesikhathi sokukhulelwa, i-Noliprel ingaba nomthelela ongemuhle ku-fetus. I-Perindopril inqamula ku-placenta iye egazini lengane futhi ingahle iholele ku-pathologies yokukhula. Emavikini okuqala, ngenkathi kwenziwa izitho, i-Noliprel ayinangozi kangako, ngakho-ke asikho isidingo sokuqeda ukukhulelwa okungakahlelwanga. Owesifazane udluliselwa ngokuphuthumayo kwesinye isidakamizwa se-antihypertensive futhi afakwe ekhethekile ukuthola ngokushesha ukwephulwa okungenzeka. Ukusuka kwe-2nd trimester, i-Noliprel ingadala i-hypotension, ukwehluleka kwezinso ku-fetus, i-anemia kanye nokuqina kwamaphaphu kusanda kuzalwa, i-oligohydramnios, kanye nokungahambanga kahle kwe-placental.
10. Ngokuhlanganiswa kweNoliprel nezidakamizwa ekwelapheni i-arrhythmias, antipsychotic, antipsychotic, erythromycin, moxifloxacin, tachycardia kungenzeka. Uhlu oluphelele lwezinto ezinobungozi olusebenzayo lunikezwa emiyalweni.

Ukuhambisana kotshwala nesidakamizwa akukubi. I-Ethanol ayihlangani nezakhi zeNoliprel, ngakho-ke, akuyona inkambiso eqinile yokusetshenziswa kwayo.Kodwa-ke, ngokusetshenziswa njalo, utshwala buvusa umfutho njalo, okusho ukuthi, benza okuphambene neNoliprel. Ngokusho kokubuyekezwa, noma isiphuzo esisodwa sotshwala esinalo muthi kuholela ekucindezelweni okuyingozi kwempilo nempilo engemihle izinsuku eziningana.

Ama-analog namagama

Ama-analog aphelele yimithi equkethe izinto ezifanayo ezisebenzayo kumthamo ofanayo namathebulethi okuqala. Amandla ale mithi ayalingana, ngakho-ke angakwazi ukufaka esikhundleni seNoliprel nganoma yisiphi isikhathi, isikhathi sokulungiselela nokukhethwa komthamo omusha akudingeki.

Ukufana okugcwele kweNoliprel yile:

Izincomo ezintsha zokwelashwa kwe-hypertension zibonisa ukuthi ukushintshwa kwezidakamizwa okuvame ukwenziwa, ushintsho lomthamo alufaneleki futhi kungaholela ekucindezelekeni okuthe xaxa. Ukuthatha umuthi owodwa wokuhlanganisa kubhekwa njengokusebenza kangcono ukwedlula ukwelapha ngezidakamizwa ezimbili ezinezinto ezifanayo ezisebenzayo. Uma kungenakwenzeka ukuthenga iNoliprel enqunyiwe, kungcono ukuyibuyisela ngama-analogues agcwele. Kulokhu, kungakuhle ukhethe izidakamizwa ezinkampanini ezaziwayo zemithi zaseYurophu nezikhulu zaseRussia.

Ezimweni ezimbi kakhulu, ungafaka esikhundleni seNoliprel ngamathebulethi amabili. Into esemqoka ukukhetha umthamo ofanele, kufanele uqondane ncamashi nalowo obekwe udokotela.

Izinketho zokubuyiselwa okunje:

Qhathanisa nezidakamizwa ezifanayo

Ukulungisa ingcindezi ngokwejwayelekile, iziguli eziningi ezinomfutho omkhulu kufanele ziphuze izidakamizwa ezi-2 kuya kwezi-4. Ekuqaleni kwalesi sifo, ama-sartan noma i-ACE inhibitors (β-pril) anqunyelwe, ngoba avikela izinso nenhliziyo ngaphezu kwezinye izidakamizwa. Lapho nje zingasebenzi, ama-diuretics anikezwa isiguli ngokwengeziwe: ngokuvamile ama-loopback diuretics anconyelwa ukwehluleka kwezinso, lawo ma-thiazide anconyelwa ukungabikho kwawo.

Ukuhlanganiswa okungaguquki kubhekwa njengokukhetha okuhle kakhulu, okungukuthi, izilinganiso zezinto eziningana ezisebenzayo zibaliwe futhi zaqinisekiswa kuvivinyo lomtholampilo ngaphakathi kwethebulethi eyodwa.

Inhlanganisela ye-thiazide diuretic nangezimpukane yiyona ethandwa kakhulu futhi ingenye enamandla. Kuyasebenza ezigulini ezikhulu kakhulu ezinomfutho wegazi onokwehluleka kwenhliziyo. Imvamisa, i-hydrochlorothiazide ihlanganiswe ne-enalapril (Enap, Enafarm, Enam H), fosinopril (Fozid, Fozikard), lisinopril (Lisinoton, Lisinopril), Captopril (Caposide). Inzuzo enkulu yale nhlanganisela imvamisa encishisiwe yemiphumela emibi. Kulezi zidakamizwa, iNoliprel ibhekwa njengenye ephephe futhi ethembisa kakhulu. Okufana nomthetho eqenjini langaphambilini lezidakamizwa ukuhlanganiswa kwama-diuretics nama-sartan - I-Lozartan N, i-Lozap Plus, i-Valsacor, iDuopress nabanye.

Akunakwenzeka ukukhetha okusebenzayo kakhulu kulezi zinhlanganisela ezingenhla, ngoba zisondele emandleni esenzo. Akukho sifundo esisodwa esingakhombisa ukuthi inzuzo yangempela yesidakamizwa esisodwa kwesinye sonke.

I-Noliprel esikhundleni salezo ezinye izinto ezisebenzayo (noma ngabe zingoweqembu elifanayo) ingathathwa kuphela ngemuva kokubonana nodokotela. Lapho ushintshela komunye umuthi, kuzofanela ukhethe kabusha umthamo, futhi kaningi kunokujwayelekile, lawula ingcindezi yokuvimbela umfutho we-hypotension ongaba khona.

Ukubuyekezwa kweziguli