preparatis samedicino gamoyenebis instruqcia ko-reniteki
preparatis samedicino gamoyenebis instruqcia ko-reniteki
preparatis samedicino gamoyenebis instruqcia ko-reniteki
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nebadarTulia saqarTvelos Sromis,<br />
janmrTelobisa da socialuri dacvis saministros mier<br />
registraciis # ws r 001094<br />
<strong>preparatis</strong> <strong>samedicino</strong> <strong>gamoyenebis</strong> <strong>instruqcia</strong><br />
<strong>ko</strong>-<strong>reniteki</strong><br />
(CO-RENITEC)<br />
savaWro dasaxeleba<br />
<strong>ko</strong>-<strong>reniteki</strong><br />
wamlis forma<br />
tabletebi<br />
Semadgenloba<br />
TiToeuli tableti Seicavs:<br />
aqtiur nivTierebas: enalapril maleati 20 mg da hidroqloroTiazidi 12.5 mg.<br />
damxmare nivTierebebs: natriumis hidrokarbonati (bikarbonati), laqtoza, simindis<br />
saxamebeli, simindis saxamebeli Jelatinizirebuli, rkinis oqsidi yviTeli, magniumis<br />
stearati.<br />
aRweriloba<br />
mrgvali tableti yviTeli feris; erT mxares amotvifrulia MSD 718, meore mxares ki<br />
danayofi.<br />
farma<strong>ko</strong>logiuri jgufi<br />
hipotenziuri <strong>ko</strong>mbinirebuli saSualeba (angiotenzingardamqmneli fermenti (agf)<br />
inhibitori + diurezuli saSualeba).<br />
ATX <strong>ko</strong>di: C09BA02<br />
farma<strong>ko</strong>logiuri Tvisebebi<br />
<strong>ko</strong>-<strong>reniteki</strong> warmoadgens agf inhibitoris (enalapril maleati) da diurezulis<br />
(hidroqloroTiazidi) <strong>ko</strong>mbinacias.<br />
<strong>ko</strong>-<strong>reniteki</strong> arteriuli hipertenziis (ah) samkurnalo maRalefeqturi saSualebaa. misi<br />
ori <strong>ko</strong>mponentis hipotenziuri efeqti avsebs erTmaneTs 24 saaTis ganmavlobaSi.<br />
arteriuli hipertenziiT daavadebul pacientTa umravlesoba ukeT reagirebs <strong>ko</strong><strong>reniteki</strong>T<br />
mkurnalobaze, vidre calkeul mis <strong>ko</strong>mponentze.<br />
farma<strong>ko</strong>dinamika<br />
<strong>ko</strong>mbinirebul preparat <strong>ko</strong>-reniteks gaaCnia antihipertenziuli da diurezuli<br />
moqmedeba. enalaprili warmoadgens agf-s inhibitors, romelic xels uwyobs<br />
angiotenzin I-is gardaqmnas angiotenzin II presorul substanciaSi. Sewovis Semdeg<br />
enalaprili hidrolizis gziT gardaiqmneba enalaprilatad, romelic inhibirebas<br />
ukeTebs agf-s. agf-s inhibireba iwvevs sisxlis plazmaSi angiotenzin II-is<br />
<strong>ko</strong>ncentraciis Semcirebas, ris Sedegadac matulobs sisxlis plazmis reninis<br />
aqtivoba (reninis produqciis Secvlaze ukuqcevadi uaryofiTi reaqciis Tavidan<br />
acilebis Sedegad) da klebulobs aldosteronis sekrecia.<br />
agf ferment kinazin II-s identuria, amitom enalaprili aseve ablokirebs<br />
vazodilatirebadi moqmedebis mqone peptidis – bradikininis daSlas. enalaprilis<br />
Terapiul moqmedebaSi am efeqtis mniSvneloba dasazustebelia. dResdReobiT<br />
iTvleba, rom is meqanizmi, romlis saSualebiTac enalaprili amcirebs arteriul<br />
wnevas (aw), aris renin-angiotenzin-aldosteronuli sistemis aqtivobis daqveiTeba,<br />
rac mniSvnelovan rols TamaSobs arteriuli wnevis regulirebaSi. enalaprili<br />
antihipertenziul moqmedebas axdens im pacientTa SemTxvevaSic ki, romelTac reninis<br />
dabali <strong>ko</strong>ncentracia aqvT. arteriuli wnevis dacemas Tan axlavs saerTo<br />
1
periferiul sisxlZarRvTa winaaRmdegobis Sesusteba, gulis kumSvis umniSvnelo<br />
momateba. enalaprilis miRebis Sedegad imatebs TirkmelSi sisxlis dineba, magram<br />
gorglisebri filtraciis done ucvleli rCeba. Tumca, im pacientTa SemTxvevaSi,<br />
romelTac gorglisebri filtracia Tavidanve Semcirebuli aqvT, misi done, rogorc<br />
wesi, imatebs.<br />
enalapriliT antihipertenziuli Terapia iwvevs marcxena parkuWis mniSvnelovan<br />
regresias da misi disfunqciis progresirebis Senelebas. arteriuli hipertenziiT<br />
daavadebul pacientTaTvis enalaprilis miReba iwvevs arteriuli wnevis dacemas,<br />
rogorc vertikalur, aseve mSvid mdgomareobaSi, gulis SekumSvis sixSiris momatebis<br />
gareSe.<br />
simptomaturi postularuli hipotenzia iSviaTad viTardeba. zogierT pacientTa<br />
SemTxvevaSi, arteriuli wnevis optimaluri dawevis miRwevas sWirdeba Terapia<br />
ramdenime kviris manZilze. enalapriliT Terapiis Sewyveta ar iwvevs arteriuli<br />
wnevis mkveTr momatebas.<br />
agf-s aqtiurobis efeqturi inhibireba, rogorc wesi, viTardeba enalaprilis<br />
erTjeradi dozis SigniT miRebidan 2-4 saaTis Semdeg. antihipertenziuli moqmedeba<br />
iwyeba 1 saaTis manZilze, arteriuli wnevis maqsimaluri daweva xdeba <strong>preparatis</strong><br />
miRebidan 4-6 saaTis Semdeg. moqmedebis xangrZlivoba damokidebulia dozaze. Tumca,<br />
re<strong>ko</strong>mendebuli dozis miRebisas, antihipertenziuli moqmedeba da hemodinamikuri<br />
efeqtebi 24 saaTis manZilze SenarCundeba. enalaprili amcirebs kaliumis ionebis<br />
kargvas, romelsac hidroqloroTiazidis miReba iwvevs. enalaprilsa da<br />
hidroqloroTiazids msgavsi dozirebis reJimi aqvT. amitom, <strong>ko</strong>-<strong>reniteki</strong><br />
enalaprilisa da hidroqloroTiazidis erToblivi miRebis mosaxerxebel wamlis<br />
formas warmoadgens.<br />
hidroqloroTiazidi Sardmdeni da antihipertenziuli saSualebaa, romelic xels<br />
uwyobs reninis aqtivobis momatebas. miuxedavad imisa, rom enalaprilis<br />
antihipertenziuli moqmedeba vrceldeba arteriuli hipertenziis mqone im<br />
pacientebis SemTxvevaSic ki, romelTac reninis dabali <strong>ko</strong>ncentracia aqvT,<br />
hidroqloroTiazidis damatebiTi gamoyeneba aseTi pacientebis SemTxvevaSi<br />
arteriuli wnevis metad gamoxatul dawevas iwvevs.<br />
enalaprilisa da hidroqloroTiazidis <strong>ko</strong>mbinaciis gamoyeneba iwvevs aw-s dawevis<br />
efeqtis gaZlierebas gansxvavebiT Terapiis im sqemisagan, rodesac TiToeuli<br />
preparati cal-calke iniSnebba da inarCunebs preparat <strong>ko</strong>-<strong>reniteki</strong>s antihipertenziul<br />
moqmedebas 24 saaTis manZilze.<br />
farma<strong>ko</strong>kinetika<br />
enalaprili<br />
SigniT miRebis Semdeg enalaprili swrafad Seiwoveba, enalaprilis maqsimaluri<br />
<strong>ko</strong>ncentracia sisxlis SratSi aRiniSneba misi miRebidan 1 saaTis manZilze. SigniT<br />
miRebis Semdeg absorbacia daaxloebiT 60% Seadgens. Sewovis Semdeg xdeba<br />
enalaprilis swrafi hidrolizeba da warmoiqmneba aqtiuri nivTiereba enalaprilati,<br />
agf-s mZlavri inhibitori. enalaprilatis maqsimaluri <strong>ko</strong>ncentracia sisxlis SratSi<br />
aRiniSneba enalaprilis dozis miRebidan 3-4 saaTis Semdeg. enalaprilis gamoyofa<br />
upiratesad Tirkmelebis saSualebiT xdeba. ZiriTadi metabolitebi, romlebic<br />
SardSi ganisazRvreba, aris enalaprilati, romelic dozis daaxloebiT 40% Seadgens<br />
da ucvleli enalaprili. hidrolizisa da enalaprilatis garda, monacemebi<br />
enelaprilis mniSvnelovani metabolizis Sesaxeb ar arsebobs. sisxlis plazmaSi<br />
enalaprilatis <strong>ko</strong>ncentracias xangrZlivi dasrulebis faza aqvs, romelic<br />
ganpirobebulia agf-sTan dakavSirebuli enalaprilatis gamonTavisuflebasTan.<br />
Tirkmlis normaluri funqciis pirebs Soris enalaprilatis stabiluri <strong>ko</strong>ncentracia<br />
miiRweva enalaprilis miRebidan me-4 dRes. enalaprilatis naxevradgamoyofis<br />
(T1/2) periodi <strong>preparatis</strong> <strong>gamoyenebis</strong> mTeli kursis dros 11 saaTs Seadgens. sakvebis<br />
miReba ar axdens gavlenas enalaprilis Sewovaze. enalaprilis Sewovisa da<br />
2
hidrolizis xangrZlivoba msgavsia sxvadasxva re<strong>ko</strong>mendebuli Terapiuli dozebis<br />
dros.<br />
hidroqloroTiazidi<br />
hidroqloroTiazidis T 1/2 5,6-dan 14,8 saaTamde. ar ganicdis metabolizms, magram<br />
swrafad gamoiyofa Tirkmelebis saSualebiT. SigniT miRebuli dozis aranakleb 61%<br />
ucvleli saxiT gamoiyofa 24 saaTis manZilze. hidroqloroTiazidi aRwevs<br />
placentaSi, magram ar aRwevs hematoencefalur barierSi.<br />
enalapril maleatisa da hidroqloroTiazidis <strong>ko</strong>mbinacia<br />
enalaprilisa da hidroqloroTiazidis mravaljeradi miReba ar axdens gavlenas (an<br />
mxolod umniSvnelod) <strong>preparatis</strong> TiToeuli <strong>ko</strong>mponentis bioSeRwevadobaze. preparat<br />
<strong>ko</strong>-<strong>reniteki</strong>s <strong>ko</strong>mbinirebuli tabletis miReba misi ingredientebis calkeuli wamlis<br />
formiT erTdrouli miRebis bioeqvivalenturia.<br />
miRebis Cveneba<br />
arteriuli hipertenzia (pacientTaTvis, romlebisTvisac naCvenebia <strong>ko</strong>mbinirebuli<br />
Terapia).<br />
ukuCveneba<br />
- hipermgrZnobeloba <strong>preparatis</strong> nebismieri <strong>ko</strong>mponentis mimarT;<br />
- hipermgrZnobeloba sulfonamidebis mimarT;<br />
- anamnezSi angionevrozuli SeSupeba, romelic dakavSirebulia agf<br />
inhibitorebis daniSvnasTan, aseve genetikuri an idiopaTuri angionevrozuli<br />
SeSupeba;<br />
- 18 wlamde asakis pacientTaTvis (usafrTxoeba da efeqturoba ar aris<br />
dadgenili);<br />
- anuria;<br />
- hemodializi Tirkmlis ukmarisobis mqone pacientTa SemTxvevaSi.<br />
sifrTxiliT<br />
aortaluri stenozi, cerebrovaskularuli daavadeba (maT Soris Tavis tvinis<br />
sisxlis mimoqcevis ukmarisoba), gulis iSemiuri daavadeba, gulis qronikuli<br />
ukmarisoba, SemaerTebeli qsovilis mwvave autoimunuri sistemuri daavadeba (maT<br />
Soris sistemuri wiTeli mglura, sklerodermiti), Zvlis tvinis sisxlwarmoqmnis<br />
daTrgunva, Saqriani diabeti, hiperkaliemia, Tirkmlis arteriis ormxrivi stenozi,<br />
mdgomareoba Tirkmlis transplantaciis Semdeg, Tirkmlis da/an RviZlis ukmarisoba,<br />
natriumis SemzRudveli dieta, mdgomareoba, romelsac Tan axlavs cirkulirebadi<br />
sisxlis moculobis Semcireba (maT Soris diarea, Rebineba), xandazmuli asaki.<br />
miReba fexmZimobis dros<br />
re<strong>ko</strong>mendebuli ar aris <strong>preparatis</strong> gamoyeneba fexmZimobis dros. fexmZimobis<br />
dadgenisaTanave Sewyvetil unda iqnas preparat <strong>ko</strong>-<strong>reniteki</strong>s miReba. gamonakliss<br />
warmoadgens is SemTxvevebi, rodesac <strong>preparatis</strong> miRebas dedisTvis sasicocxlo<br />
mniSvneloba aqvs. <strong>preparatis</strong> fexmZimobis meore da mesame trimestris dros miRebis<br />
SemTxvevaSi, agf inhibitorebi nayofis an Cvilis daavadebas an sikvdils iwvevs. am<br />
periodis ganmavlobaSi agf inhibitorebis gamoyenebas uaryofiTi gavlena aqvs<br />
nayofsa da Cvilze, kerZod, arteriuli wnevis vardna, Tirkmlis ukmarisoba,<br />
hiperkaliemia da/an Cvilis Tavis qalis hipoplazia. SesaZlebelia oligohidramnionis<br />
Camoyalibeba, rac, rogorc wesi, Tirkmlis funqciis klebis Sedegadaa mosalodneli.<br />
es daavadeba iwvevs kidurebis <strong>ko</strong>ntraqturas, Tavis qalis deformacias, maT Soris,<br />
saxis nawilis, filtvebis hipoplazias.<br />
re<strong>ko</strong>mendebuli ar aris fexmZimobis dros diurezulebis gamoyeneba, rameTu SesaZloa<br />
gamoiwvios nayofisa da axalSobilis siyviTle, Trombocitopenia da, mozrdil<br />
pacientTa msgavsad, sxva gverdiTi efeqtebi. <strong>preparatis</strong> fexmZimobis dros <strong>gamoyenebis</strong><br />
aucileblobis SemTxvevaSi, pacienti gafrTxilebul unda iqnas mosalodneli<br />
safrTxis Sesaxeb. im iSviaT SemTxvevaSi, rodesac <strong>preparatis</strong> daniSvna aucilebeli<br />
3
xdeba fexmZime qalisTvis, mkurnalobis procesSi nayofis mdgomareobis dasadgenad<br />
regularulad ultrabgeriTi gamokvleva unda tardebodes. gamokvleul unda iqnas<br />
aseve intraamnionuri sivrce oligohidramnionis sawyis stadiaSi gamosavlenad.<br />
oligohidramnionis gamovlenisTanave unda Sewydes <strong>ko</strong>-<strong>reniteki</strong>s miReba, garda im<br />
SemTxvevebisa, rodesac <strong>preparatis</strong> miRebas sasicocxlo mniSvneloba aqvs dedisaTvis.<br />
Tumca, rogorc eqimebma, aseve pacientebma unda icodnen, rom oligohidramnioni<br />
SesaZloa ganviTardes, rodesac ukve adgili aqvs nayofis Seuqcevad dazianebas.<br />
axalSobilebi, romelTa dedebi preparats Rebulobdnen, saWiroeben regularul<br />
<strong>ko</strong>ntrols arteriuli wnevis dacemis, oliguriisa da hiperkaliemiis mxriv.<br />
enalaprili, romelic placentaSi aRwevs, SesaZloa gamoyvanil iqnas axalSobilis<br />
sisxlismimoqcevidan peritonealuri dializis saSualebiT. Teoriulad,<br />
SesaZlebelia <strong>preparatis</strong> sisxlidan gamodevna sisxlis cvladi gadasxmis gziT.<br />
dResdReobiT ar arsebobs hidroqloroTiazidis nayofis sisxlismimoqcevidan<br />
gamodevnis klinikuri gamocdileba.<br />
miReba ZuZuTi kvebis dros<br />
rogorc enalaprili, aseve Tiaziduri diurezulebi xvdeba dedis rZeSi. <strong>preparatis</strong><br />
<strong>gamoyenebis</strong> aucileblobis SemTxvevaSi, pacientma ZuZuTi kveba unda Sewyvitos.<br />
miRebis wesi da dozireba<br />
<strong>preparatis</strong> SigniT miRebaze ar moqmedebs sakvebis miReba.<br />
arteriuli hipertenzia:<br />
Cveuli doza Seadgens 1 tablets dRe-RameSi erTxel. saWiroebisamebr, SesaZlebelia<br />
dozirebis gazrda – 2 tableti dRe-RameSi.<br />
adreuli mkurnaloba diurezulebiT:<br />
<strong>ko</strong>-<strong>reniteki</strong>T mkurnalobis dasawyisSi SesaZloa ganviTardes arteriuli wnevis<br />
simptomaturi dacema. es xSirad vlindeba im pacientTa SemTxvevaSi, romlebsac<br />
diurezulebis gamoyenebiT Catarebulma Terapiam daarRvia wyal-eleqtrolituri<br />
balansi. Terapia diurezulebis gamoyenebiT Sewyvetil unda iqnas <strong>ko</strong>-<strong>reniteki</strong>T<br />
mkurnalobis dawyebamde 2-3 dRiT adre.<br />
Tirkmlis ukmarisoba<br />
Tiaziduri diurezulebi xSirad arasakmarisad efeqturia Tirkmlis funqciis<br />
moSlis mqone pacientTa SemTxvevaSi da sruliad araefeqturia kreatininis<br />
klirensis 30ml/wT-mde da qvemoT (zomieri da gamoxatuli Tirkmlis ukmarisoba)<br />
dawevis dros, rac gasaTvaliswinebelia Terapiis SerCevis dros. im pacientTa<br />
SemTxvevaSi, romelTa SemTxvevaSi kreatininis klirensis diapazoni 30-dan 80 ml/wTmde<br />
aRwevs, <strong>ko</strong>-<strong>reniteki</strong> gamoiyeneba mxolod <strong>preparatis</strong> TiToeuli <strong>ko</strong>mponentis dozis<br />
saguldagulo SerCevis Semdeg. enalaprilis re<strong>ko</strong>mendebuli doza zomieri Tirkmlis<br />
ukmarisobis dros 5-10 mg Seadgens.<br />
gverdiTi movlenebi<br />
<strong>ko</strong>-<strong>reniteki</strong>, rogorc wesi, advilad gadasatania. klinikuri gamokvlevebis dros<br />
gverdiTi movlenebi, rogorc wesi, zomieri iyo da umetes SemTxvevaSi, mkurnalobas<br />
ar saWiroebda.<br />
gverdiT movlenebs Soris yvelaze gavrcelebulia Tavbrusxveva da Warbi<br />
moTenTiloba, romlebic, rogorc wesi, swrafad qreboda da iSviaTad saWiroebda<br />
<strong>preparatis</strong> moxsnas.<br />
sxva gverdiTi movlenebi (1-2%): kunTebis krunCxva, Rebineba, asTenia orTostaturi<br />
efeqtebi, maT Soris, orTostaturi hipotenzia, Tavis tkivili, xvela da impotencia.<br />
iSviaTad gvxvdeba Semdegi arasasurveli movlenebi, romlebic aRiniSna an<br />
<strong>ko</strong>ntrolirebadi klinikuri gamokvlevebis, an farTo <strong>gamoyenebis</strong> procesSi:<br />
sisxlismimoqcevis organoTa sistema:<br />
gulyra, arteriuli wnevis gamoxatuli dacema, gulis aCqareba, taqikardia, tkivili<br />
gulis areSi.<br />
4
saWmlis momnelebeli organoTa sistema: pankreatiti, diarea, Rebineba, dispefsia,<br />
tkivili muclis areSi, meteorizmi, yabzoba.<br />
centraluri nervuli sistema:<br />
uZiloba, Zilianoba, paresTeziebi, momatebuli nervuli agznebadoba.<br />
sasunTqi sistema:<br />
qoSini.<br />
kanis safari:<br />
stivens-jonsonis sindromi, kanis gamonayari, qavili, hiperhidrozi.<br />
sxva:<br />
Tirkmlis funqciis moSla, Tirkmlis ukmarisoba, libidos Sesusteba, simSrale piris<br />
RruSi, podagra, Suili yurebSi, arTralgia.<br />
aRweril iqna sindromebis <strong>ko</strong>mpleqsi, romelic Seicavs cxelebas, serozits,<br />
vaskulits, mialgias/miozits, arTralgias/arTrits, dadebiTi testi antinukleur<br />
antisxeulebze, eriTrocitebis dagrovebis siswrafis momateba, eozinofilia da<br />
lei<strong>ko</strong>citozi. SesaZloa gamovlindes fotosensibilizacia.<br />
alergiuli reaqciebi / angionevrozuli SeSupeba:<br />
saxis, kidurebis, tuCebis, enis, xmovani iogebis, kidurebis da/an saylapavis<br />
angionevrozuli SeSupebis SemTxveva Zalze iSviaTad gamovlenila (ix.<br />
gansakuTrbuli miTiTebebi). aseve iSviaTad gamovlenila intersticiuli<br />
angionevrozuli SeSupeba, romelic dakavSirebulia agf inhibitorebis miRebasTan,<br />
maT Soris, enalaprilTan.<br />
laboratoriuli maCveneblebi:<br />
hiperkaliemia, hiperurikemia da hipokaliemia. aRiniSna aseve Sratis kreatininis<br />
<strong>ko</strong>ncentraciis da RviZlis fermentebis aqtivobisa da/an Sratis bilirubinis<br />
momateba. es maCveneblebi, rogorc wesi, normalizdeboda <strong>ko</strong>-<strong>reniteki</strong>T mkurnalobis<br />
dasrulebis Semdeg. aRiniSna hemoglobinisa da hematokritis maCveneblebis daweva.<br />
Warbi doza<br />
simptomebi:<br />
enalapril maleati<br />
arteriuli wnevis gamoxatuli dacema, romelic <strong>preparatis</strong> miRebidan daaxloebiT 6<br />
saaTis Semdeg iwyeba. sisxlis plazmaSi enalaprilatis <strong>ko</strong>ncentracia, romelic 100-<br />
200-jer aRemateba Terapiuli dozis daniSvnis Sedegad Camoyalibebul <strong>ko</strong>ncentracias,<br />
aRiniSna Sesabamisad 300 da 440 mg enalaprilis miRebis Semdeg.<br />
hidroqloroTiazidi<br />
simptomatika, gamowveuli eleqtrolitebis dakargviTa (hipokaliemia, hipoqloremia,<br />
hipoanatriemia) da dehidtrataciiT Warbi diurezis gamo. Tu pacienti adre<br />
digitalisis preparatebs Rebulobda, hipokaliemiam, SesaZloa, ariTmia gamoiwvios.<br />
mkurnaloba<br />
ar arsebobs specifiuri monacemebi <strong>preparatis</strong> Warbi dozis miRebis samkurnalod.<br />
pacienti eqimis mkacri <strong>ko</strong>ntrolis qveS unda imyofebodes, mkurnaloba dauyovnebliv<br />
unda iqnas Sewyvetili. mkurnaloba – simptomaturi. gadaudebel zomad SeiZleba<br />
CaiTvalos kuWis amorecxva, Tuki preparati cota xnis winaa miRebuli, aseve<br />
dehidrataciis, eleqtrolituri balansisa da arteriuli wnevis mkveTri dawevis<br />
<strong>ko</strong>reqcia sayovelTaod gavrcelebuli meTodebis gamoyenebiT: 0.9% natriumis<br />
qloridis xsnaris Sinagani infuzia. efeqturia, aseve, angiotenzin II-s Seyvana.<br />
enalaprilatis gamoyvana sisxlismimoqcevis sistemidan SesaZlebelia hemodializis<br />
saSualebiT (ix. gansakuTrebuli miTiTebebi, hemodializze myofi pacientebi).<br />
urTierTqmedeba sxva samkurnalo saSualebebTan<br />
sxva hipotenziuri saSualebebi<br />
enalaprilis sxva hipotenziur saSualebebTan daniSnvisas SesaZloa aRiniSnos<br />
efeqtis sumireba.<br />
5
Sratis kaliumi<br />
kaliumis dakargva Tiaziduri diurezulebis miRebis fonze, rogorc wesi, sustdeba<br />
enalaprilis moqmedebiT. sisxlis SratSi kaliumis <strong>ko</strong>ncentracia, rogorc wesi,<br />
normis farglebSi rCeba.<br />
kaliumi<br />
kaliumis damatebebis, kaliumis damzogveli diurezulebis an kaliumis Semcveli<br />
marilebis gamoyeneba, gansakuTrebiT, Tirkmlis ukmarisobis mqone pacientTa<br />
SemTxvevaSi, iwvevs SratSi kaliumis Semcvelobis mkveTr momatebas.<br />
liTiumis preparatebi<br />
liTiumis preparatebs, rogorc wesi, ar niSnaven diurezulebs, an agf<br />
inhibitorebTan erTad. diurezulebi da agf inhibitorebi asusteben Tirkmelebis<br />
mier liTiumis gamoyofas, ris Sedegadac imatebs liTiumiT intoqsikaciis riski.<br />
arasteroiduli anTebis sawinaaRmdego preparatebi (aasp)<br />
Tirkmlis funqciis moSlis mqone zogierTi im pacientis SemTxvevaSi, romlebic aasps<br />
Rebuloben, agf inhibitorebis gamoyenebam, SesaZloa, Tirkmlis funqciis gauareseba<br />
gamoiwvios. es cvlilebebi, rogorc wesi, Seqcevadia.<br />
aramadepolarizebeli miorelaqsantebi<br />
Tiaziduri diurezulebis Sedegad imatebs mgrZnobeloba tubokurarinis mimarT.<br />
hipotenziuri efeqtis Semcirebas xels uwyobs aasp, estrogenebi, eTanoli.<br />
imunodepresantebi, alopurinoli, citostaturebis miReba zrdis hematotoqsikurobis<br />
risks.<br />
gansakuTrebuli miTiTebebi<br />
arteriuli hipotenzia da wyal-eleqtrolituri balansis moSla<br />
rogorc nebismieri hipotenziuri Terapiis dros, zogierTi pacientis SemTxvevaSi,<br />
SesaZloa, ganviTardes arteriuli wnevis simptomaturi dacema. savaldebuloa<br />
pacientTa gamokvleva wyal-eleqtrolituri balansis – siTxis ukmarisobis,<br />
hipovolemiis, hipoanatriemiis, hipoqloremiuli alkalozis, hipomagniemiis an<br />
hipokalemiis moSlis klinikuri niSnebis dadgenis mizniT, romlebic, SesaZloa,<br />
diareis an Rebinebis Sedegad gaCndes. aseT pacientebs periodulad unda CautardeT<br />
eleqtrolitebis ganmsazRvreli gamokvleva. gansakuTrebuli yuradReba unda mieqces<br />
gulis iSemiuri daavadebis an cerebrovaskularuli daavadebis mqone pacientebs,<br />
romlebic <strong>ko</strong>-reniteks Rebuloben, rameTu arteriuli wnevis mkveTrma dawevam,<br />
SesaZloa, miokardis infarqti an insulti gamoiwvios.<br />
arteriuli wnevis gamoxatuli dacemis dros pacienti unda dawves loginSi da,<br />
saWiroebisamebr, gamoyenebul unda iqnas 0.9% natriumis qloridis xsnaris Sinagani<br />
infuzia. arteriuli wnevis droebiTi dacema rpeparatis daniSnvis dros ar uSlis<br />
xels mis Semdgom gamoyenebas. arteriul wnevasa da cirkulirebadi sisxlis<br />
moculobis normalizaciis Semdgom SesaZloa aRdgenil iqnas Terapia an<br />
Semcirebuli doziT, an <strong>preparatis</strong> <strong>ko</strong>mponentebis calkeuli <strong>gamoyenebis</strong> gziT.<br />
aortaluri stenozi / hipertrofiuli kardiomiopaTia<br />
rogorc sxva, vazodilatirebadi moqmedebis mqone preparatebi,<br />
agf inhibitorebi didi sifrTxiliT unda daeniSnos im pacientebs, romelTac<br />
garTulebuli aqvT gulis marcxena parkuWSi sisxlis cvla.<br />
Tirkmlis ukmarisoba<br />
Tiaziduri diurezulebi xSirad arasakmarisad efeqturia Tirkmlis funqciis<br />
moSlis mqone pacientTa SemTxvevaSi da sruliad araefeqturia kreatininis<br />
klirensis 30ml/wT-mde da qvemoT (zomieri da gamoxatuli Tirkmlis ukmarisoba)<br />
dawevis dros, rac gasaTvaliswinebelia Terapiis SerCevis dros. preparati ar unda<br />
daeniSnos Tirkmlis ukmarisobis mqone pacients (kreatininis klirensis 80 ml/wT-ze<br />
naklebi), sanam <strong>preparatis</strong> calkeuli <strong>ko</strong>mponentebis SerCevis Sedegad ar dadgindeba,<br />
romeli preparati Seicavs pacientisaTvis saWiro dozas. zogieT pacientTa<br />
SemTxvevaSi, romelTac ar aqvT Tirkmelebis raime daavadeba, mkurnalobis<br />
6
dawyebamde, enalapriliTa da diurezulebiT Terapiis dros aReniSna sisxlSi Sardovanas,<br />
xolo SratSi ki kreatininis umniSvnelo momateba. aseT SemTxvevaSi,<br />
Sewyvetil unda iqnas mkurnaloba. SemdgomSi, SesaZlebelia Terapiis aRdgena<br />
Semcirebuli dozis miRebiT, an <strong>preparatis</strong> calkeuli <strong>ko</strong>mponentebis daniSvniT.<br />
Tirkmlis arteriis ormxrivi stenoziT an cali Tirkmlis arteriis stenoziT<br />
daavadebul zogierT pacientTa SemTxvevaSi, agf inhibitorebiT mkurnalobis Sedegad<br />
aRniSnul iqna sisxlSi Sardovanasa da SratSi kreatininis momateba. es cvlilebebi<br />
Seqcevadi xasiaTisaa da, rogorc wesi, mkuranlobis Sewyvetis Semdeg maCveneblebi<br />
normas ubrundeba.<br />
RviZlis daavadeba<br />
Tiaziduri diurezulebi sifrTxiliT gamoiyeneba RviZlis funqciis moSlis an<br />
RviZlis progresirebadi daavadebis mqone pacientTa SemTxvevaSi, radgan wyaleleqtrolituri<br />
balansis umniSvnelo cvlilebasac ki SeuZlia RviZlis <strong>ko</strong>mis<br />
gamowveva.<br />
qirurgia / zogadi anesTezia<br />
didi qirurgiuli operaciebis an zogadi anesTeziis dros, rodesac gamoiyeneba<br />
hipotenziuri efeqtis mqone preparatebi, enalaprilati blokirebas ukeTebs<br />
angiotenzin II warmoqmnas reninis <strong>ko</strong>mpensatorul gamonTavisuflebasTan mimarTebaSi.<br />
garda amisa, arteriuli wnevis gamoxatuli vardnis ganviTarebis SemTxvevaSi,<br />
SesaZlebeli iqneba misi <strong>ko</strong>reqcia Sesayvani siTxis raodenobis gazrdis gziT.<br />
metaboluri da endokrinuli efeqtebi<br />
Tiaziduri diurezulebi xSirad glu<strong>ko</strong>zis mimarT tolerantobis darRvevs iwvevs.<br />
SesaZloa saWiro gaxdes hipoglikemiur saSualebaTa dozis <strong>ko</strong>reqcia, maT Soris,<br />
insulinis.<br />
Tiaziduri diurezulebi amcirebs SardSi kalciumis eqskrecias, aseve SratSi<br />
kalciumis <strong>ko</strong>ncentraciis umniSvnelo momatebas. gamoxatuli hiperkaliemia, SesaZloa,<br />
faruli hiperparatireozis niSani iyos. Tiaziduri diurezulebis miReba Sewyvetil<br />
unda iqnas farisebri jirkvlis funqciis kvlevis dawyebamde. qolesterinisa da<br />
trigliceridebis <strong>ko</strong>ncentraciis momateba SesaZloa aseve Tiaziduri diurezulebiT<br />
TerapiasTan iyos dakavSirebuli, Tumca, hidroqloroTiazidis 12,5 mg dozis miRebis<br />
dros, romelsac <strong>ko</strong>-<strong>reniteki</strong>s tableti Seicavs, aseTi efeqti an ar gamovlenila, an<br />
mxolod umniSvnelo xasiaTs atarebda. zogierT pacientTa SemTxvevaSi, Tiaziduri<br />
diurezulebiT Terapiam, SesaZloa, gamoiwvios hiperurikemia da/an podagra. Tumca,<br />
enalaprilma SesaZloa xeli Seuwyos SardSi Sardis mJavis momatebas, ris xarjzec<br />
Sesustdeba hidroqloroTiazidis hiperurikemiuri efeqti.<br />
alergiuli reaqciebi / angionevrozuli SeSupeba<br />
agf inhibitorebiT, maT Soris, enalapriliT mkurnalobisas, iSviaTad gamovlenila<br />
saxis, kidurebis, tuCebis, enis, xmovani iogebis, kidurebis da/an saylapavis<br />
angionevrozuli SeSupebis SemTxvevebi. es movlenebi SesaZloa gaCndes mkurnalobis<br />
nebismier dros. aseT SemTxvevaSi, dauyovnebliv unda Sewydes enalaprilis miReba.<br />
msgavsi klinikuri simptomebis <strong>ko</strong>reqciis mizniT, pacienti eqimis <strong>ko</strong>ntrolis qveS<br />
unda imyofebodes. dakvirvebis Sewyveta SesaZlebelia mxolod zemoaRniSnuli<br />
simptomebis gavlis Semdeg. Tuki SeSupeba saxisa da tuCebis areSi vrceldeba,<br />
rogorc wesi, specifiuri mkurnaloba saWiro ar aris, antihistaminuri saSualebebiT<br />
Catarebuli Terapia am SemTxvevaSi sakmaod efeqturia.<br />
saylapavis SeSupebasTan dakavSirebul angionevrozuli SeSupebas zogjer letaluri<br />
dasasruli aqvs. im SemTxvevaSi, rodesac SeSupebis lokalizaciis adgilia ena,<br />
xmovani iogebi da saylapavi, rac sasunTqi gzebis obstruqcias iwvevs, pacients<br />
dauyovnebliv unda SeuyvanoT kanqveS 0.1% (0,3-0,5 ml) epinefrinis xsnari, raTa<br />
SesaZlebeli gaxdes sasunTqi gzebis gaxsna.<br />
negroiduli rasis pacientebs Soris, romlebic agf inhibitorebs Rebuloben,<br />
SeSupeba ufro xSorad aRiniSneba. pacientebi, romelTac anamnezSi aqvT<br />
7
angioSeSupeba, romelic ar aris dakavSirebuli agf inhibitorebis miRebasTan, sxva<br />
pacientebze metad arian agf inhibitorebis miRebis fonze angionevrozuli SeSupebis<br />
warmoqmnis riskis qveS (ix. aseve ukuCveneba). pacientebi, romlebic Tiazidur<br />
diorezulebs Rebuloben, SesaZloa gauCndeT alergiuli reaqciebi alergiuli<br />
anamnezisgan damoukidebladac. aseT pacientebs Soris dafiqsirebula sistemuri<br />
wiTeli mgluras recidivis an garTulebis SemTxvevebi.<br />
sifrifanafrTianebis Sxamisagan damzadebuli alergeniT hiposensibilizaciis<br />
Catarebis dros anafilaqtoiduri reaqciebi<br />
iSviaT SemTxvevebSi, pacientebs, romlebic agf inhibitorebs Rebulobdnen,<br />
uviTardebodaT sicocxlisaTvis saSiSi sifrifanafrTianebis Sxamisagan dazadebuli<br />
alergeniT hiposensibilizaciis Catarebis dros anafilaqtoiduri reaqciebi.<br />
SesaZlebelia msgavsi reaqciebis Tavidan acileba, Tu hiposensibilizaciis<br />
dawyebamde droebiT iqneba Sewyvetil agf inhibitorebis miReba.<br />
hemodializze myofi pacientebi<br />
<strong>ko</strong>-<strong>reniteki</strong>s daniSvna ukunaCvenebia Tirkmlis ukmarisobis mqone pacientTaTvis,<br />
romlebic hemodializze imyofebian (ix. ukuCveneba). anafilaqtoiduri reaqciebis<br />
SemTxvevebi dafiqsirebula im pacientTa Soris, romlebic imyofebodnen dializze<br />
maRalgamtariani membranebis gamoyenebiT (mag. AN 69) da Rebulobdnen agf<br />
inhibitorebs. aseTi pacientebis SemTxvevaSi gamoyenebul unda iqnas sxva tipis<br />
dializuri membranebi an sxva jgufis hipotenziuri saSualebebi.<br />
xvela<br />
agf inhibitorebis miRebis fonze zogjer vlindeba xvelis SemTxvevebi. rogorc wesi,<br />
xvela araproduqtiuli, Zlieri xasiaTisaa da wydeba mxolod Terapiis dasrulebis<br />
Semdeg. agf inhibitorebis miRebasTan dakavSirebuli xvela warmoadgens xvelis<br />
diagnostikis diferencialur nawils.<br />
gamoyeneba xandazmuli pacientebis SemTxvevaSi<br />
enalaprilisa da hidroqloroTiazidis erTdrouli miRebis efeqturobisa da<br />
amtanobis klinikuri gamokvlevebis Sedegebi erTnairia axalgazrda da xandazmul<br />
pacientebs Soris.<br />
gamoyeneba pediatriaSi<br />
dadgenili ar aris <strong>preparatis</strong> bavSvebis samkurnalod <strong>gamoyenebis</strong> usafrTxoeba da<br />
efeqturoba.<br />
gamoSvebis forma<br />
blisterSi moTavsebulia 7 tableti an 56 tableti fla<strong>ko</strong>nSi. muyaos <strong>ko</strong>lofSi 1,2 an<br />
4 blisteri an 1 fla<strong>ko</strong>ni, <strong>gamoyenebis</strong> <strong>instruqcia</strong>sTan erTad.<br />
Senaxvis pirobebi<br />
sia B<br />
30 0 -ze nakleb temperaturaze, bavSvebisaTvis miuwvdomel adgilas.<br />
vargisianobis vada<br />
tabletebisTvis, romlebic moTavsebulia 7 tableti blisterSi, 1, 2 an 4 blisteri<br />
muyaos <strong>ko</strong>lofSi, miRebis <strong>instruqcia</strong>sTan erTad – 36 Tve<br />
tabletebisaTvis, romlebic moTavsebulia 56 tableti maRali simkvrivis fla<strong>ko</strong>nSi, 1<br />
fla<strong>ko</strong>ni miRebis <strong>instruqcia</strong>sTan erTad – 24 Tve.<br />
dauSvebelia <strong>preparatis</strong> gamoyeneba SefuTvaze miTiTebuli vargisianobis vadis<br />
amowurvis Semdeg.<br />
afTiaqidan gacemis pirobebi<br />
gaicema eqimis receptiT.<br />
mwarmoebeli firma<br />
“Merck Sharp & Dohme, B.V.”, haarlemi, niderlandebi<br />
8
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