Yikuphi ukucindezelwa okunqunyelwe i-Enap nemiyalo yomuthi

I-Enap iyithuluzi elisebenzayo lethebhulethi elenzelwe ukwengeza umfutho wegazi ophakeme njalo. Isakhi esisebenzayo somuthi, i-enalapril, isidakamizwa esidumile kakhulu se-antihypertensive eRussia, Belarus, e-Ukraine. Kufundwe kahle, kusetshenziswe iminyaka engaphezu kweshumi nambili, ukusebenza ngempumelelo kuqinisekiswe inqwaba yezifundo. I-WHO ifake i-enalapril ohlwini lwayo lwezidakamizwa ezibalulekile. Izidakamizwa ezisebenza kahle kakhulu, eziphephile futhi ngasikhathi sinye kuphela eziklanyelwe ukwelapha izifo ezivame kakhulu futhi eziyingozi eziwela kulolu hlu.

Ubekwa ubani umuthi

I-Hypertension iyinkinga evamile yabelaphi, ama-cardiologists, ama-endocrinologists, kanye ne-nephrologists. Umfutho wegazi ophakeme ungumngane ojwayelekile wesifo sikashukela ne-metabolic syndrome, into ebaluleke kakhulu ekwenzekeni kwe-pathologies yenhliziyo nemithambo yegazi. Ngisho nokukhuphuka okuncane kwengcindezi ngaphezulu kwezinga lelitshe kuyingozi, ikakhulukazi ezigulini ezinokwenzeka kakhulu kwezinkinga zenhliziyo. Ekucindezelweni okungenhla kuka-180/10, ubungozi bomonakalo enhliziyweni, ebuchosheni nasezinsweni bukhuphuka kayishumi.

I-Hypertension yisimo esingamahlalakhona, ngakho-ke iziguli kufanele ziphuze umuthi nsuku zonke impilo yazo yonke. Ukucindezela kwaphi kokuqala ukuphuza amaphilisi kuya ngezifo ezihambelanayo. Kubantu abaningi, i-140/90 ibhekwa njengegreyidi elibucayi. Kwabanesifo sikashukela, liphansi - i-130/80, ekuvumela ukuthi uvikele esinye sezitho ezisengozini kakhulu kulezi ziguli - izinso. Ekwehlulekeni kwezinso, kungakuhle ukugcina ingcindezi iphansi kancane, ngakho-ke amaphilisi aqala ukuphuza, aqala ngezinga le-125/75.

Njengomthetho, amaphilisi we-Enap anqunywe ekuqaleni kwalesi sifo, ngokushesha ngemuva kokutholwa komfutho wegazi ophakeme. Umuthi ukuvumela ukuthi wehlise izinga lokuphakama, kwe-systolic, kwengcindezi ngama-20, nangaphansi, i-diastolic, ngamayunithi ayi-10. Lokhu kwehla kwenza kube nokwenzeka ngokwejwayelekile ukucindezelwa kweziguli ezingama-47. Vele, sikhuluma ngezinkomba ezijwayelekile. Kulezo ziguli ezingafinyelelanga izinga lokuhlosiwe, kunikezwa umuthi owengeziwe we-1-2 we-antihypertensive drug.

Ngokusho kwemiyalo, amaphilisi we-Enap asetshenziswa emacaleni alandelayo:

1. Isibonakaliso esiyinhloko sokusetshenziswa kwe-Enap ngumfutho wegazi ophakeme, okungukuthi, ingcindezi ephakeme ngokungapheli. I-Enalapril ibhekwa njengenye yezindlela zakudala zokwelapha umfutho wegazi ophezulu, ngakho-ke, ezifundweni eziningi zomtholampilo, izidakamizwa ezintsha ziqhathaniswa ngokusebenza nazo. Kwatholakala ukuthi izinga lokuncishiswa kwengcindezi ngesikhathi sokwelashwa nge-Enap licishe lifane nalapho bethatha ezinye izidakamizwa ze-antihypertensive single-element, kufaka phakathi nezesimanje kakhulu. Okwamanje, azikho izidakamizwa ezisebenza kangcono kunezinye. Odokotela, bekhetha amaphilisi athile wokucindezela, ikakhulukazi baqondiswa yizindawo zabo ezingeziwe kanye nezinga lokuphepha lesiguli esithile.
2. I-Enap inomphumela we-cardioprotective, ngenxa yalokho, ibekelwa izifo zenhliziyo: ukuhluleka kwenhliziyo okuvele kutholakale, ingozi enkulu yokwehluleka ezigulini ezine-hypertrophy yesibeletho sobunxele. Ngokusho kwesazi sezinhliziyo, ukusetshenziswa kwe-Enap kanye neqembu layo eqhathaniswa nalezi ziguli kunganciphisa ukufa kwabantu, kunciphise imvamisa esibhedlela, kunciphise ukuqhubeka kwesifo, kwezinye izimo kuthuthukisa ukubekezelela umzimba futhi kunciphise nobunzima bezimpawu. Ingozi yokufa ezigulini ezinciphisa umfutho wegazi ngu-Enap noma inhlanganisela ye-Enap ene-diuretics iphansi ngo-11% kunalabo abasebenzisa i-diuretics kuphela ukulawula i-hypertension. Ekwehlulekeni kwenhliziyo, umuthi uvame ukubekwa kumithamo ephezulu, imvamisa ephakathi nendawo.
3. I-Enap inezinto ezilwa ne-atherosclerotic, ngakho-ke kunconyelwa i-coronary ischemia. Ukusetshenziswa kwayo kwezifo zenhliziyo ezi-coronary kukuvumela ukuthi unciphise ubungozi bokushaywa yi-30%, kanye nengozi yokufa ngama-21%.

Ngabe usebenza kanjani umuthi?

Into esebenzayo yamathebhulethi we-Enap yi-enalapril maleate. Ngokwesimo sayo sokuqala, ayinamphumela we-pharmacological, ngakho-ke, ibhekisela kuma -rodrug. I-Enalapril ingena egazini bese idluliselwa esibindini kanye nayo, lapho iphenduka ibe yi-enalaprilat - into enezindawo ezishisiwe ze-hypotensive. Cishe i-65% ye-enalapril ingena egazini, ama-60% ayo angena esibindini aphenduka abe yi-enalaprilat. Ngakho-ke, i-bioavailability ephelele yesidakamizwa icishe ibe ngama-40%. Lokhu ngumphumela omuhle. Isibonelo, ku-lisinopril, esasebenza kwithebhulethi futhi ayidingi ukungenelela kwesibindi, lesi sibalo singama-25%.

Izinga nezinga lokufakwa kwe-enalapril nokuguqulwa kwalo libe yi-enalaprilat akuxhomekile ekugcwalisweni kwepheshana lesisu, ukuze ungakhathazeki, thatha lo muthi ngaphambi kokudla noma ngemuva. Kuzona zozimbili lezi zinhlobo, inani eliphakeme lento esebenzayo egazini lizofinyelelwa ngemuva kwamahora ama-4 kusukela ngesikhathi sokuphatha.

I-Enap akuyona umuthi osheshayo owenza izinto ngokushesha, akunqweneleki ukuwuthatha ukumisa inkinga ebangwa yi-hypertensive. Kepha ngokwamukelwa njalo, kukhombisa ukusebenza okuzinzile. Ngokusho kokubuyekezwa kweziguli ezisebenzisa umuthi, ingcindezi yokuncipha ku-Enap ayivelakancane. Ukuze amaphilisi asebenze ngokugcwele, kudingeka ukuthi adakwe okungenani izinsuku ezintathu ngaphandle kokuphazamiseka ngasikhathi sinye.

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%

Cishe i-2/3 ye-enalapril ikhishwa emchameni, 1/3 - ngomquba. Ngokuhluleka kwe-reso, i-excretion ingaba nzima, ukugcwala kwe-enalapril egazini kuyakhuphuka, ngakho-ke iziguli zingadinga ukunciphisa umthamo ongaphansi kweleveli.

Ngokusho kokuhlangana kweqembu lephemithi, iqembu i-enalapril iyi-ACE inhibitor. Yasungulwa ngo-1980 futhi yaba ngeyesibili eqenjini layo ngemuva kokubanjwa inkunzi. Isenzo se-Enap sichazwa ngokuningiliziwe emiyalweni yokusetshenziswa. Kuhloswe ngayo ukucindezela uhlelo lokulawulwa kwengcindezi - i-RAAS. Umuthi uvimba i-angiotensin-converting enzyme, edingekayo ekwakhekeni kwe-angiotensin II - i-hormone eyakha imithambo yegazi. I-blockade ye-ACE iholela ekuqabuleni kwezicubu zemithambo yethambo kanye nokwehla kwengcindezi. Ngaphezu komphumela we-hypotensive, i-Enap ithinta ukwakheka kwama-aldosterone, ama-antidiuretic hormone, i-adrenaline, i-potassium kanye namazinga we-renin egazini, ngakho-ke, umuthi unezici eziningi eziwusizo ezigulini ezinomfutho wegazi, ungabali ukuncipha kwengcindezi:

1. Umfutho wegazi ophakeme uphoqa i-ventricle yangakwesobunxele (igumbi eliyinhloko lenhliziyo) ukuthi isebenze kakhulu, okuvame ukuholela ekwandisweni kwayo. Ukuqina, ukuqina kokulahleka kodonga lwezinhliziyo kukhulisa amathuba okuba ne-arrhythmia kanye nokwehluleka kwenhliziyo izikhathi ezi-5, ukushaya kwenhliziyo izikhathi ezi-3. Amathebhulethi we-Enap awakwazi ukuvimba nje amanye ama-hypertrophy asele kwesokunxele, kodwa futhi abangela ukubuyiswa kwawo, futhi lo mphumela uyabonakala ngisho nasezigulini ezinesifo segazi esidala.
2. Kuwo wonke amaqembu emithi yokucindezela, i-Enap namanye ama-inhibitors e-ACE anomphumela obizwa kakhulu we-nephroprotective. Nge-glomerulonephritis, i-nephropathy yesifo sikashukela kunoma yisiphi isigaba, umuthi ubambezela ukuthuthukiswa kokulimala kwezinso. Ukusebenza isikhathi eside (ukubonwa bekungaphezu kweminyaka eyi-15) Ukwelashwa kwe-enalapril kuvimbela i-nephropathy kushukela kanye ne-microalbuminuria.
3. Izinqubo ezifanayo njengase-ventricle yangakwesobunxele (ukuphumula, umthwalo omncane), lapho i-Enap isetshenziswa, yenzeka kuyo yonke imikhumbi. Ngenxa yalokho, imisebenzi ye-endothelium ibuyiselwa kancane kancane, imikhumbi iba namandla futhi ibe namandla.
4. Ukuya esikhathini kubantu besifazane kuvame ukuholela ekubonakaleni komfutho wegazi ophakeme noma ukwanda kobunzima bento ekhona. Isizathu salokhu ukuntuleka kwe-estrogen, okuholela ekwandeni komsebenzi we-ACE. Ama-inhibitors e-ACE anomphumela ofanayo ne-estrogen ku-RAAS, ngenxa yalokho, asetshenziswa kabanzi kwabesifazane be-postmenopausal. Ngokusho kokubuyekezwa, amaphilisi we-Enap akulesi sigaba seziguli awanciphisi nje kuphela umfutho wegazi futhi abekezelelwa kalula, kepha futhi enza buthaka ukuyeka ukuya esikhathini: anciphise ukukhathala nokuqina, andise i-libido, athuthukise imizwa, asuse ukuvutha okushisayo nokujuluka.
5. Izifo zamaphaphu ezingalapheki zingaholela ku-hypepension ye-pulmonary. Ukufakelwa kweziguli ezinjalo kunganciphisa ingcindezi yamaphaphu, kwandise ukukhuthazela, futhi kuvikele ukwehluleka kwenhliziyo. Ngaphezu kwamasonto ayi-8 wokuphatha, ukwehla okujwayelekile kwengcindezi kungamayunithi ama-6 (ukusuka kuma-40.6 kuya kwangama-34.7).

Khipha ifomu nomthamo

Umakhi we-Enap - inkampani yamazwe omhlaba iKrka, ekhiqiza izidakamizwa ezijwayelekile. I-Enap iyi-analogue ye-enalapril yokuqala eyenziwe nguMerck ngaphansi kwegama lomkhiqizo iRenitec. Kuyamangaza ukuthi ukuthandwa nokuthengiswa kwe-Enap eRussia kuphakeme kakhulu kunaleyo yaseRenitek, yize intengo yemithi icishe ifane.

I-Enalapril maleate, into ethengisa izidakamizwa yesidakamizwa i-Enap, yenziwa eSlovenia, eNdiya naseChina. Kwezimboni zale nkampani, sekufakiwe izintambo zokulawulwa kwekhwalithi enamazinga amaningi, ngakho-ke, ngaphandle kwendawo yokukhiqizwa kwe-enalapril, amaphilisi aqediwe anokusebenza okuphezulu okuphezulu. Ukunyathela nokufaka amaphilisi kwenziwa eSlovenia naseRussia (isitshalo seKRKA-RUS).

I-Enap inemithamo eminingana:

Ngaphezu kwengxenye eyodwa ye-Enap, i-Krka ikhiqiza izidakamizwa ezihlanganayo ne-enalapril ne-diuretic hydrochlorothiazide (Enap-N, Enap-NL) kwezinketho ezintathu zemithamo.

Yini esiza ukwelashwa okuhlangene ne-Enap-N:

• kunciphisa ingcindezi ezigulini ezinomfutho ophakeme, lapho i-ejenti eyodwa ye-antihypertensive inganikeli umphumela oyifunayo;
• kunciphisa ubunzima bemiphumela emibi. I-Enalapril ingathathwa kumthamo ophansi uma ufaka i-diuretic kuyo;
• Ama-Enap-N amaphilisi ahlanganisiwe aqinisekisiwe ukusebenza amahora angama-24 noma ngaphezulu, ngakho-ke ayakhonjelwa ezigulini lapho umphumela we-enalapril eba mkhulu khona ekugcineni kosuku.

I-Enalapril ene-hydrochlorothiazide ngenye yezinhlanganisela ezinengqondo kakhulu nezisebenzayo. Lezi zinto ziyahambisana, ngenxa yokuthi umphumela wazo uthuthuka kanjani, futhi ingozi yemiphumela emibi iyancipha.

Kukhona nesidakamizwa esisiza ngokushesha emugqeni we-Enap, otholakala ngesisombululo. Odokotela bayayisebenzisa ukunciphisa ingcindezi ngesikhathi senhlekelele. Ngokungafani namathebulethi, i-Enap-R akuyona okokuthengisa izidakamizwa. Isithako saso esisebenzayo yi-enalaprilat, iqala ukusebenza ngokushesha ngemuva kokuphathwa kwe-intravenous, ukugxilisa okuphezulu kufinyelelwa ngemuva kwemizuzu engu-15.

Zonke izinketho zokukhishwa kwamathebhulethi we-Enap:

Ungayithatha kanjani

Imiyalo yokusetshenziswa kwe-Enap ayikhombisi ukuthi uzothatha nini: ekuseni noma kusihlwa, lawa mathebhulethi. Odokotela bavame ukunquma umthamo wasekuseni ukuze umuthi ulinganise ngempumelelo ukusebenza komzimba, ukucindezelwa nokunye ukucindezela. Kodwa-ke, kunobufakazi bokuthi ekupheleni kosuku umphumela we-enalapril uyanda. Ngaphandle kokuthi ukwehla komphumela kuthathwa njengento engelutho (esiphezulu se-20%), ezinye iziguli zingakhuphula ingcindezi ngezikhathi zasekuseni.

Ukuvama kwemithi kubalulekile ekulawuleni umfutho wegazi ophakeme. Ukuvunwa kudakwa nsuku zonke, kugwema ukuphazamiseka. Umuthi uqongelela emzimbeni izinsuku eziningana ngaphambi kokuthi umphumela wawo ube mkhulu. Ngakho-ke, ukudlula okukodwa kungavusa isikhathi eside (kufinyelela ezinsukwini ezi-3), kepha ngokuvamile ukwanda okuncane kwengcindezi. Hhayi izindaba zokwenza njalo, kepha nesikhathi esifanayo sokwamukelwa. Ngokusho kocwaningo, i-Enap inikeza imiphumela emihle kakhulu ezigulini ezaziphuza amaphilisi ngewashi le-alamu, zigwema ukuphambuka ohlelweni isikhathi esingaphezu kwehora.

Ngokusho kwemiyalo, ukuphathwa kwe-Enap kuqala ngesilinganiso sokuqala, esinqunywa ngudokotela ngokubheka izinga lokucindezela kanye nokuba khona kwezinye izifo. Ngokuvamile, i-5 noma i-10 mg ithathwa njengethamo lokuqala. Ngemuva kwethebhulethi yokuqala, umfutho wegazi ulinganiswa kaningana ngosuku, bese imiphumela iyaqoshwa. Uma izinga lokucindezela okuqondiwe (i-140/90 noma eliphansi) lingafinyelelwanga noma kukhona ama -exges wokucindezela, umthamo ukhuphuka kancane ngemuva kwezinsuku ezi-4. Ngokuvamile kuthatha cishe inyanga ukukhetha umthamo. I-Enap inokukhethwa okubanzi kwemithamo. Ngaphezu kwalokho, wonke amaphilisi, aqala nge-5 mg, afakwe nge-notch, okungukuthi, angahlukaniswa ngesigamu. Ngenxa yalesi isilinganiso, ungakhetha ngokunembe ngangokunokwenzeka.

Ezigulini eziningi, izindleko zokwelapha umfutho wegazi ophakeme zibalulekile, futhi kwesinye isikhathi zinqume. I-Enap isho izidakamizwa ezingabizi, noma ngabe zithathwa umthamo ophelele. Intengo emaphakathi yenkambo yanyanga zonke, ebalwa njengokubuyekezwa kweziguli, ingama-ruble ayi-180. Amanye ama-inhibitors e-ACE awabizi kakhulu, ngokwesibonelo, ama-perindopril omakhi ofanayo (i-Perinev) azobiza ama-ruble angama-270.

Kubiza malini u-Enap:

Imiphumela emibi engenzeka

Ngokwemiphumela yezifundo zemitholampilo, ososayensi bahlaziya ukubekezelela i-Enap njengokuhle. Kodwa-ke, umphumela we-hypotensive womuthi uvusa ukubukeka kweminye imiphumela emibi, ngakho-ke ukwelashwa kufanele kuqalwe ngokuqapha okwandayo. Amacwecwe okuqala akufanele athathwe uma umzimba ukhubazekile ngenxa yesifo sohudo, ukugabha, ukuthola okunganele kwamanzi nosawoti. Phakathi nesonto, imithwalo eyeqile, ngokuba ekushiseni, eshayela imoto, esebenza ekuphakameni ayinconywa.

Imiphumela emibi ye-Enap ngokwemiyalo:

Contraindication

Uhlu lwe-contraindication oluqinile lokuthatha i-Enap:

1. I-Hypersensitivity enalapril / enalaprilat kanye nezinye izidakamizwa ezihlobene ne-ACE inhibitors.
2. I-Angioedema ngemuva kokusetshenziswa kwezidakamizwa ezingenhla.
3. Esikhathini sikashukela kanye ne-pathology yezinso, ukusetshenziswa kwe-Enap ene-aliskiren kungukuphikisana (iRasilez ne-analogues).
4. I-Hypolactasia, ngoba ithebhulethi iqukethe i-lactose monohydrate.
5. Izifo ze-Hematological - anemia kakhulu, isifo se-porphyrin.
6. Ukuncelisa. I-enalapril ngamanani amancane ingena ebisini, ngenxa yalokho, ingavusa ukwehla kwengcindezi enganeni.
7. Iminyaka yezingane. Ukusetshenziswa kwe-enalapril kwafundwa eqenjini elilinganiselwe lezingane ezingaphezu kweminyaka engu-6 ubudala, ukuthatha u-2,5 mg ngosuku kwakubhekwa njengokuphephile. Imvume yokusebenzisa i-Enap ezinganeni ayitholakalanga, ngakho-ke, emiyalweni yakhe, ubudala bezingane bubhekiselwa kuma-contraindication.
8. Ukukhulelwa Kuma-trimesters e-2 ne-3, i-Enap iyaphulwa, ku-trimester yokuqala ayinconywa.

Ukuthatha amaphilisi e-Enap ngabesifazane beminyaka yokuzala izingane kudinga ukunakekelwa okukhethekile. Izindlela zokuvimbela inzalo ezisebenzayo kumele zisetshenziswe kukho konke ukwelashwa. Uma ukukhulelwa kwenzeka, umuthi ukhanselwa ngokushesha ngemuva kokutholwa kwawo. Ukukhishwa kwesisu akudingekile, ngoba ubungozi be-umbungu obungakafinyeleli emavikini ayi-10 okukhula aphansi.

Imiyalo yokusebenzisa isexwayisa: uma i-Enap yathathwa ku-trimester yesi-2, ubungozi be-oligohydramnios, umsebenzi wezinso ophazamisekile we-fetus, nokwakheka okungathandeki kwamathambo e-skull kuphezulu. Ukuze unqume ngokuqhubeka kokukhulelwa, uzodinga i-ultrasound yezinso, ugebhezi, ukucaciswa kwenani loketshezi lwe-amniotic. Usanda kuzalwa nonina othathe i-Enap ngesikhathi sokukhulelwa usengozini enkulu ye-hypotension.

I-Enap notshwala akufiseleki ukuhlanganisa. Noma umthamo owodwa we-ethanol esigulini udla imishanguzo ye-antihypertensive, ungadala ukwehla okukhulu kwengcindezi. Ukuwa kwe-Orthostatic kuvame ukuvela: ingcindezi incipha ngokushesha ngokushintshwa kwendlela ethile yokusebenza. I-Hypertension iba mnyama emehlweni, isiyezi esinzima senzeka, futhi ukufiphala kungenzeka. Ngokuhlukunyezwa okuphindaphindiwe, ukuhambisana kotshwala nomuthi kubi kakhulu. Ngenxa yokudakwa, isiguli sinenkinga yokungapheli kwemithambo, okuholela ekwandeni kwengcindezi. I-Spasm iphikelela cishe ezinsukwini ezi-3 ngemuva komthamo wokugcina we-ethanol.

Ama-analog namagama

Kunamathebhulethi angaphezu kwabayishumi nambili abhalisiwe anezinto ezifanayo ku-Russian Federation. Phakathi kweziguli ezinomfutho wegazi ophezulu, ukufana okugcwele okugcwele kwe-Enap kudume kakhulu:

• USwitzerland Enalapril Hexal ovela enkampanini yezokwelapha uSandoz;
• I-Enalapril FPO yomkhiqizi waseRussia u-Obolenskoye;
• I-enalapril yaseRussia evela e-Izvarino nase-Ozone;
• I-Enalapril Renewal Company ukubuyekeza;
• I-Enalapril evela eHemofarm, eSerbia;
• UHungary Ednit, uGideon Richter;
• IJalimane Burlipril, BerlinHemi;
• URenetek, Merck.

I-Enap ingathathelwa indawo le mithi nganoma yisiphi isikhathi; ukubonisana nodokotela akudingekile. Into esemqoka ukuphuza umuthi omusha ku-dosi efanayo kanye nemvamisa efanayo. Umuthi oshibhile kulolu hlu yi-Enalapril Renewal, amaphilisi angama-20. Ama-20 mg angama-ruble angama-22 kuphela. Okubiza kakhulu yiRenitek, amaphilisi ayi-14. I-20 mg ngayinye izobiza ama-ruble ayi-122.

Uma ama-inhibitors e-ACE ebanga ukungezwani komzimba, amaphilisi we-hypotensive avela kwamanye amaqembu kungenzeka abe yi-Enap substitute. Umuthi othize ukhethwa ngudokotela oholayo ngemuva kokuhlola isimo se-hypertension. Ngokusho kwezincomo ze-WHO, ama-diuretics (adume kakhulu yi-hydrochlorothiazide ne-indapamide), i-calcium antagonists (amlodipine) noma i-beta-blockers (atenolol, bisoprolol, metoprolol) anqunyelwe. AmaSartan awathandeki, ngoba asondelene kakhulu nesenzo se-Enap futhi angavusa ukusabela okuphindaphindiwe kwe-allergen.

Lapho ukukhulelwa kwenzeka, ezinye izidakamizwa ze-antihypertensive zichazwa esikhundleni se-Enap. Kusetshenziswa kuphela lawo mathebhulethi okuthi ukuphepha kwengane kufakazelwe. Njengomthetho, lezi yizidakamizwa ezindala. Umuthi wolayini wokuqala uthathwa njenge-methyldopa (Dopegit). Uma kungenakubekwa ngesizathu esithile, khetha i-atenolol noma i-metoprolol.

Qhathanisa nezidakamizwa ezifanayo

Izindlela zamakhemikhali ze-ACE inhibitors azifani kangako. Ngokumangazayo, umphumela walezi zinto emzimbeni ucishe ufane. Indlela yokusebenza, uhlu lwezenzo ezingathandeki ngisho nokuphikisana kusondele kakhulu kubo. Ukusebenza kahle kwe-antihypertensive futhi kulinganiselwa ososayensi ngokufanayo.

Kodwa-ke, umehluko othile kuma-ACE inhibitors usekhona:

1. Okokuqala, umthamo uhlukile. Lapho ushintsha usuka ku-Enap uye kwi-analogue yeqembu, umthamo kuzodingeka ukhethwe kabusha, kuqala ngobuncane.
2. I-Captopril kufanele idakwe esiswini esingenalutho, nayo yonke eminye izidakamizwa eqenjini - kungakhathalekile isikhathi sokudla.
3. Ama-enalapril athandwa kakhulu, i-capopril, i-lisinopril, i-perindopril adalulwa ikakhulukazi ezinso, ngakho-ke, ngokwehluleka kwe-renal, kunengozi enkulu yokusebenzisa ngokweqile i-overdose. Izinso zithinteka ekuqothulweni kwe-trandolapril ne-ramipril ngezinga elincane, kufinyelela ku-67% wento efakwa emzimbeni wesibindi.
4. Inhibitors iningi le-ACE, kufaka phakathi i-enalapril, lingama-izidakamizwa. Zisebenza kakhulu ezifweni zesibindi kanye ne-gastrointestinal. I-Captopril ne-lisinopril ekuqaleni ziyasebenza, umphumela wazo awuxhomekile esimweni sohlelo lokugaya ukudla.

Ukukhetha umuthi othize, udokotela akacabangi nje kuphela la ma-nuances, kodwa nokutholakala kwalesi sidakamizwa. Uma i-Enap ibekelwe wena futhi ibekezelelwa kahle, akunconywa ukuyiguqula kwamanye amaphilisi. Uma i-Enap inganikezi ukulawulwa kwengcindezi okuzinzile, enye i-ejenti ye-antihypertgency yengezwa kunhlobo yonyango.

Ukubuyekezwa kweziguli