Izinkomba zokusetshenziswa Diuver nemiyalo eningiliziwe

I-Diuver ingelinye lama-diuretics anamandla amakhulu. Imithamo ephansi yesidakamizwa (aze afike ku-5 mg) anciphisa kahle umfutho wegazi, ngenkathi inomphumela omncane wokugaya, ngenxa yalokho asetshenziselwa ukwelapha umfutho wegazi ophakeme. Ngokusho kocwaningo, i-Diuver ingakwazi ukwenza umfutho wegazi kube ngama-60% eziguli. Umuthi ungahlanganiswa nezidakamizwa ze-antihypertensive ezivela kuwo wonke amaqembu. Ngomthamo we-5-20 mg, umphumela we-Diuver diuretic uthuthukiswa kakhulu, ngakho-ke, imithamo ephezulu isetshenziselwa ukukhulula i-edema, kufaka phakathi ukwehluleka kwenhliziyo.

Isibonisi Sokukhombisa

Umuthi ungowesigaba se-loop diuretics. Indawo okwenziwa kuyo le mishanguzo yingxenye ekhuphukayo ye-nephron loop, eyayibizwa ngokuthi i-Henle loop ngemuva kososayensi abayitholile. Esikhathini esivulekile se-nephron ye-renal, kubuye kubuye kubuye umchamo kubuyele egazini le-potassium ne-sodium chloride. Imvamisa, cishe ikota yesodium engena umchamo oyinhloko idonswa emuva. I-loop diuretics ivimba lokhu kuhamba, ngenxa yomsebenzi wabo, izinga lokwakheka komchamo liyakhuphuka, ukuchama kuba njalo, umthamo we-intracellular fluid uyancipha, futhi ngasikhathi sinye, ingcindezi iyancipha.

Ku-Diuver yezidakamizwa, into esebenzayo yi-torasemide. Phakathi kokujikeleza kwe-loopt kuvunyelwe eRussia Federation, wayengowokugcina ukungena kwezokwelapha, cishe ngeminyaka yama-80 yekhulu lama-20.

Ukusuka kwendlela yokusebenza kuyacaca ukuthi i-Diuver isiza ini kusuka ku:

1. Imvamisa, kubekelwe i-edema, kufaka phakathi naleyo evela ngenxa yokuhluleka kwenhliziyo, izifo ezingamahlalakhona zezinso namaphaphu. I-Edema eyakha i-nephrotic syndrome ingahle incishiswe kuphela nge-loop diuretics.
2. Isibonakaliso sesibili sokusetshenziswa kwalesi sidakamizwa yi-hypertension. I-Diuver ivame ukutuswa ezigulini okungenzeka ukuthi ukukhuphuka kwengcindezi kubangelwe yizizathu eziningana ngasikhathi sinye: ukuphazamiseka ohlelweni lokulawula ingcindezi, i-vasospasm, ukuzwela ngokweqile komzimba ngosawoti.
3. I-Diuver isetshenziswa lapho kunesidingo, i-diuresis ephoqelekile, ngokwesibonelo, ekwelapheni ubuthi bezidakamizwa. Ukuvimbela ukopha, isiguli sifakwa nge-saline.

Amathebhulethi e-Diuver kanye nokufana kwawo okuphelele kungesinye sezomzimba ezinamandla kakhulu, ngakho-ke kuvame ukubekelwa iziguli ezinokungalapheki kahle kwegazi okugulisayo: abantu asebekhulile, iziguli ezinokwehluleka kwenhliziyo, isifo sikashukela nokunye ukuphazamiseka komzimba, kubandakanya i-dyslipidemia. Uma ingcindezi ingekho ngaphezulu kakhulu kunokwejwayelekile, ingancishiswa kalula ngamalungiselelo alula kakhulu, ngokwesibonelo, ama-thiazide-like diuretics noma ama-ACE inhibitors.

Ngabe usebenza kanjani umuthi?

Isisekelo somphumela we-hypotensive we-Diuver inqubo eyinkimbinkimbi odokotela abayibiza ngokuthi "umphumela ophindwe kathathu":

1. I-Diuver inhibits reabsorption ye-sodium, ngaleyo ndlela isiza ukunciphisa izitolo eziwuketshezi emzimbeni. Ngokungafani nezinye i-loop diuretics, lo mphumela we-Diuver uthathwa njengomkhulu.
2. Umuthi ukhuthaza ukumbiwa kwe-calcium kusuka emisipha yezindonga zemithambo, ngenxa yokuthi ukuzwela kwabo ku-catecholamines kunciphisa. Futhi, lokhu kuholela ekuqabuleni kwezindonga zemithambo yegazi, kwehlise ingcindezi.
3. Impahla eyingqayizivele ye-Diuver ukuncipha komsebenzi wohlelo lokuphinda umfutho weRAAS, okuchazwa ngokuthengiswa kwe-torasemide nomsebenzi we-angiotensin II receptors. Ngenxa yalokhu, imisipha yemikhumbi ayavinjelwa, ukuthuthukiswa kwemiphumela ejwayelekile yokuqina kokuqina kwegazi kuyancipha: i-myocardial hypertrophy nezindonga zemithambo yegazi.

I-Diuver ine-bioavailability ephezulu: Ngaphezu kwe-80% yento esebenzayo ingena egazini. Ngaphezu kwalokho, izinga le-bioavailability lincike kancane ezimfanelweni zokugaya kweziguli. Imiyalo yokusebenzisa ikuvumela ukuthi uyithathe ngaphambi kokudla noma ngemuva kokudla, ngoba ukudla akukuphazamisi ukumuncwa kwe-torasemide. Ngenxa yalezi zimpawu, isenzo sikaDiverver sibikezelwa kakhulu. Amathebulethi angathathwa ngesikhathi esikahle futhi ngasikhathi sinye qiniseka ukuthi azosebenza ngokushesha okukhulu.

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%

I-Pharmacokinetics yeTorasemide:

Khipha ifomu nomthamo

I-Diuver yenziwa yinkampani yemithi yaseCroatia iPliva Hrvatsk, okungelinye lokwahlukanisa kweTeva. E-Russia, isidakamizwa sithandwa kakhulu. Ngokusho kocwaningo lokumaketha ngonyaka we-2013, lapho kunesidingo khona ukunquma i-torasemide, 90% yabezenhliziyo bathanda iDiver.

Amathebulethi ayinawo umhlanganisela wefilimu, ukwakhiwa kubandakanya:

• torasemide;
• i-lactose;
• isitashi;
• i-sodium starch glycolate;
• isilika;
• i-magnesium stearate.

Umuthi unemithamo emibili kuphela - u-5 no-10 mg, kepha amaphilisi afakwe notch, okuwavumela ukuba ahlukaniswe ngesigamu. Izinketho zokupakisha nentengo ye-Diuver:

Okwe-hypertension, imiyalo incoma ukuqala ukwelashwa ngethamo lansuku zonke le-2,5 mg. Kulokhu, ingcindezi izokwehla kancane kancane ngaphandle komphumela oqinile wokugaya. I-Diuver inqunywe isikhathi eside. Imiphumela yokuqala ingalindelwa esontweni lokuqala lokwelashwa, umphumela omkhulu uba ngemuva kwezinyanga ezi-3 zokuphatha. Ukwehla kwengcindezi okujwayelekile lapho kuthatha iDiuver kungu-17/12 (okuphezulu kuncipha ngo-17, kwehle ngo-12 mmHg), kwiziguli ezinomfutho ophakeme onokuzwela okwengeziwe kwe-diuretics - kufinyelela ku-27/2. Ngokusebenza okunganele, umthamo ungaphindwa kabili, kepha amandla emiphumela we-hypotensive azokhuphuka kancane, futhi ukuphuma komchamo kungasebenza. Uma kuqhathaniswa nokubuyekezwa kodokotela, kunengqondo ngokwengeziwe ukusebenzisa ukwelashwa okuhlanganisiwe: Ukudonsela ku-umthamo omncane nomunye umuthi wokucindezela.

Nge-edema, ukwelashwa kuqala nge-5 mg, umthamo ungakhushulwa kancane kancane ube ngu-20 mg. Nge-edema enkulu, imbangela yayo ingaba yi-nephrotic syndrome, udokotela angakhulisa umthamo uye kuma-40, kwezinye izimo aze afike ku-200 mg. Ngomthamo we-5-20 mg, umuthi ungabekwa isikhathi eside, ngamanani aphezulu - kuze kube yilapho i-edema inyamalala.

Ungayithatha kanjani

Umyalo unikeza umthamo owodwa we-Diuver, kungakhathalekile ukuthi umthamo unqunyelwe yini. Ngokusho kokubuyekezwa, odokotela bangabeka lo muthi kabili ngosuku uma umthamo uphakeme noma umphumela unganele usuku lonke. Uma kunesidingo, ithebhulethi ingahlukaniswa ngesigamu futhi ichotshozwe.

Isikhathi esihle sokuthatha i-Diuver sisekuseni ngemuva kokudla kwasekuseni. Kulokhu, ithebhulethi engu-1 iyokwanela ukwehla okufana kokucindezela kwengcindezi ngosuku, futhi ukushibilika kwengcindezi yemvelo kuzohlala: kuzokhuphuka kancane ekuseni, lapho ithebulethi lingakaqali ukusebenza ngamandla wonke, futhi kusihlwa, lapho umphumela wokuhlanzeka womuthi uphela.

Uma ukwelashwa kuhambisana nokuchama kaningi futhi kungakuvumeli ukuba uphile impilo ejwayelekile, ukwamukela kungahanjiswa kusihlwa. Ngokusetshenziswa kusihlwa kweDiver, kuyadingeka ukulawula ukucindezela kwasekuseni, ngoba ingaba ngaphezulu kwamazinga ajwayelekile.

Izincomo zeziguli ezithatha amaphilisi e-Diuver:

I-Diuver ingalimaza ukunakwa kokunakwa, ngakho-ke, uma kuthathwa, ukushayela kanye nomsebenzi odinga ukugxilwa ngokweqile akunasidingo.

Imiphumela emibi engenzeka

Iningi lemiphumela emibi ye-Diuver ihlobene nomphumela wayo wokugaya. Njengoba ukuphuma komchamo ngokuqondile kuncike kumthamo womuthi, ukusabela okungathandeki kuvela kaningi lapho uthatha imithamo ephezulu.

Imiphumela emibi engaba khona:

• I-Hyponatremia. Uma ungazinaki izincomo zemiyalo yokusetshenziswa, ukusweleka kwe-sodium, ukuncipha kwethamo lamanzi emzimbeni kungenzeka. Lesi simo sigcwele i-hypotension kuze kube sesimweni sokushaqeka, ukuncipha kokukhiqizwa komchamo, ukuvalwa kwemithambo yegazi ngezifo zegazi, kanye nezifo zesibindi - kanye ne-encephalopathy. Ngesikhathi esifanayo, i-excretion ye-potassium ne-hydrogen inyuka, i-hypochloremic alkalosis ingahle ikhule - ukwanda kwe-pH yegazi;
• I-Hypokalemia ivela ngokudla okunganele kwe-potassium. Kungavusa i-arrhythmia, ikakhulukazi ezigulini ezinomfutho wegazi ezinqunywe i-glycosides yenhliziyo;
• Ukushoda kwe-Magnesium kugcwala i-arrhythmias, i-calcium - imisipha yokuncipha;
• Imiphumela emibi yokuzwa. Kungahle kube nomsindo noma ukuqina kwendlebe ezindlebeni, ukukhubazeka kwezindlebe, kufaka phakathi isiyezi esinzima. Imvamisa yale miphumela emibi iphakeme ngokuphathwa kwe-toratiide, futhi lapho uyithatha ndawonye ne-ethaconic acid (i-Diuver group analog). Njengomthetho, ngemuva kokuhoxiswa kwamathebhulethi e-Diuver, ukulalelwa kubuyiselwa ngokwakho;
• Ukuphazamiseka kwemetabolic. Imiyalo ikhombisa ukuthi ukwanda kwezinga le-uric acid egazini, ukukhula kwe-gout, noma ukwanda kwesifundo sesifo esikhona kungenzeka;
• I-Hyperglycemia, engakhuculula isifo sikashukela uma isiguli sinamaphutha kuso;
• Ukwanda kwe-cholesterol;
• Ukungezwani komzimba;
• Ukuphazamiseka kokugaya ukudla;
• I-photosensitivity - ekhulisa ukuzwela kwesikhumba elangeni.

Imvamisa yemiphumela emibi emiyalweni yokusetshenziswa ayikhonjisiwe, noma kunjalo, kuyaziwa ukuthi kwabesifazane kuphezulu.

Contraindication

Emaqenjini ambalwa eziguli ezinomfutho wegazi, imiyalo yokusetshenziswa kweDiver iyakwenqabela ukusetshenziswa kwayo. Iningi le-contraindication lihambisana nokushoda kwe-sodium nokuphelelwa amandla ngenxa yomthelela we-diuretic wamathebulethi.

Amathebhulethi e-Diuver anokuhambisana okungafani notshwala. I-Ethanol ibuye ibe yi-diuretic, ngakho-ke, uma idliwa ngamanani amakhulu kanye ne-torasemide, isiguli singakhipha ukomisa okukhulu, okuhambisana nokuphelelwa ukwazi, ukushaya ngamandla nokuqina kokucindezela. Contraindication kufaka phakathi ukusetshenziswa njalo kotshwala emithanjeni emincane, ngoba isiguli kungenzeka sizwe ukusabela okubi, ikakhulukazi ukungalingani kwe-electrolyte.

Ama-analog namagama

Amalungelo wesidakamizwa sokuqala esine-ntho esebenzayo ye-torasemide angokwenkampani yaseMelika iRoche, ibizwa ngeDemadex. Akukho eYurophu noma eRussia Demadex ayibhalisiwe. I-Diuver kanye nama-analogues ayo aqukethe i-torasemide yi-Demadex generics.

Ngezifanekiselo zeDiuver eRussia, le mithi elandelayo yabhaliswa:

Uma uwafaka la maphilisi ngokuthandwa, uDiver kuzodingeka abeke indawo yokuqala, alandelwe yiBritomar, Torasemid evela eNorth Star, eTrigrim kanye neLotonel ngomugqa obanzi.

Phakathi kwama-analogues, indawo ekhethekile kuhlala iTrigrim neTorasemide yenkampani ye-Ozone. Le mithi yiyona kuphela enomthamo we-2,5 mg, ngakho-ke ithathwa kalula ngama-degree degrees we-hypertension, ehlanganiswe neminye imishanguzo ye-antihypertensive.

I-Britomar ihlukile. Kuyahluka ngokuyisisekelo kwezinye izidakamizwa ngendlela yokukhululwa. Amathebulethi ama-Britomar anomphumela wesikhathi eside. Ngokusho kweziguli, kunomthelela omncane ekwakhekeni komchamo, futhi ngenxa yalokho kulula ukubekezelela. Ngokusho kocwaningo, umphumela we-diuretic walo muthi usuphuzile, ukwakheka komchamo okuphezulu kwenzeka emahoreni ayi-6 ngemuva kokungenisa, isifiso sokuchama sibuthakathaka, kepha umthamo wansuku zonke womchamo uyefana noDiver's. Kukholelwa ukuthi i-torasemide ende isikhathi eside kungenzeka ukuthi ibangele i-hypoglycemia futhi iphephe kakhulu ezinso. Kodwa-ke, kunobufakazi bokuthi umphumela wokuvikela we-torasemide ejwayelekile enhliziyweni unamandla kunokuqina.

Qhathanisa nezidakamizwa ezifanayo

Okusondele kakhulu kuDiver ngomqondo wesinyathelo yi-loop diuretics furosemide (eyangempela yiLasix, i-generics Furosemide) ne-ethacosterone acid (umuthi ongu-1 ubhalisiwe e-Russian Federation - Uregit).

Umehluko obalulekile wale mishanguzo:

1. I-Bioavailability ye-torasemide iphakeme kakhulu kune-furosemide. Ngaphezu kwalokho, umphumela we-torasemide ezigulini ezahlukahlukene uyefana, futhi umphumela we-furosemide uvame ukuncika ezimweni ngazinye futhi uhluka kakhulu.
2. Isenzo se-furosemide ne-ethaconic acid sishesha, kepha sifushane, ngakho-ke badinga ukuthathwa kaningi ngosuku ngosuku.
3. IFurosemide ayikwazi ukusebenza njenge-esikhundleni se-Diuver ekwelashweni kwe-hypertension yesikhathi eside, kepha ibhekana ngokushesha nezinkinga ezinkulu zegazi. Ngomthamo owodwa, uqala ukusebenza ngemuva kwengxenye yehora, ngokuphathwa kwe-intravenous - ngemuva kwemizuzu eyi-10.
4. Noma uLasix noma uregit abanawo umphumela ophindwe kathathu ku-Diuver. Ukuncishiswa kwengcindezi ngosizo lwabo kutholakala kuphela ngokususa uketshezi.
5. I-Diuver mancane amathuba okuthi ibangele imiphumela emibi kune-Lasix (imvamisa, ngokulandelana, ingu-0.3 no-4.2%).
6. Ama-diuretics anesenzo esiqinile nesisheshayo anomphumela wokuphindwaphindwa - ukususwa okusamanzana okusheshayo, bese kuba nokuqongelela kwawo okulandelayo Uma usebenzisa i-Diuver, lo mphumela awukho.
7. Akuvumelekile ukufaka esikhundleni se-Diuver ngama-analogues eqembu uma unesifo senhliziyo, ngoba kubekezelelwa kangcono iziguli ezinjalo. Imvamisa yokuphindiselwa esibhedlela ngenxa yokwehluleka kwenhliziyo kulabo abathatha i-torasemide ingama-17%, kulabo abaphuza i-furosemide - 32%.

Ukubuyekezwa kweziguli