"Torasemide" yog ib qho tshuaj diuretic niaj hnub muaj zog uas zoo rau kev kho mob mus ntev ntawm cov kab mob cuam tshuam nrog cov tsos mob ntawm edema. Vim tias tsawg dua ntawm cov kev mob tshwm sim tseem ceeb hauv chaw kho mob, qhov dav ntawm nws daim ntawv thov kho mob ntau dua. Nws muaj kev nyab xeeb dua li lwm cov voj diuretics thiab muaj ntau qhov qhia. Nyob rau hauv kev kho mob ntawm ntau yam kab mob, nws npaum li cas yog hloov. Nws kuj tseem siv tau rau cov neeg mob lub raum tsis txaus, txawm tias muaj qhov pom ntawm glomerular tsawg.
Cov nyhuv ntawm "Torasemide"
"Torasemide" raws li ib tug neeg sawv cev ntawm pab pawg ntawm lub voj (ntsev) diuretics ua nyob rau hauv lub luminal ib feem ntawm lub epithelium ntawm lub nephron tubules nyob rau hauv lub cheeb tsam ntawm ascending voj ntawm Henle. Los ntawm kev ua kom muaj kev cuam tshuam rau kev sib koom ua ke ntawm cov poov tshuaj, chloride thiab sodium ions, nws txo qis electrochemical peev xwm ntawm qhov chaw ntawm nephron epithelium. Blockade ntawm ion thauj mus rau hauv reabsorptionsodium los ntawm thawj cov zis, uas ua rau kom diuresis.
Yuav luag txhua lub voj diuretics ua rau muaj kev cuam tshuam ntawm electrolyte vim muaj zog ntawm kev nqus ntawm cov poov tshuaj, sodium, magnesium thiab chlorine ions. "Torasemide" rau qhov tsawg dua cuam tshuam rau kev tso tawm ntawm cov poov tshuaj thiab magnesium, uas yog vim li cas nws ua rau arrhythmias, anorexia, cem quav, leeg tsis muaj zog ntau dua. Tsis tas li ntawd, cov tshuaj mus rau qhov tsis muaj zog thaiv qhov tsim ntawm thromboxane A2, dilating cov hlab ntsha. Nws tseem thaiv cov myocardial aldosterone receptors, inhibiting cov txheej txheem ntawm fibrosis ntawm lub plawv cov leeg.
Kev qhia
Cov lus qhia rau kev siv txuas nrog cov tshuaj "Torasemide" muaj cov ntaub ntawv hais txog cov kab mob rau kev kho mob uas nws siv. Torasemide yog qhia rau:
- kab mob kev kho mob ntawm arterial hypertension resistant rau kev kho nrog kev sib txuas ntawm ACE inhibitors (ARBs) nrog thiazide diuretics;
- kho mob plawv tsis ua hauj lwm cuam tshuam nrog cov hlab ntshav ntau dhau;
- kev kho mob ntawm lub raum tsis ua haujlwm, suav nrog tus nqi pom tsawg (tsawg dua 20 ml / min);
- kev kho mob ntawm lub siab (txuas nrog hypoalbuminemia) edema ua lwm txoj rau Furosemide.
Nyob rau hauv cov ntaub ntawv ntawm arterial hypertension "Torasemide", analogues thiab nws cov generics tsuas yog siv thaum thiazide diuretics tsis zoo. Thiab nyob rau hauv cov ntaub ntawv ntawm lub raum tsis ua hauj lwm, cov tshuaj yuav muab tau rau ib tug ntev lub sij hawm vim yog me me ntawm cov tshuaj tseem ceeb thiab txaus ntshai phiv. Torasemide muaj tsawg dua ntawm lawv li Furosemide.
Cov lus qhia rau kev siv
Raws li cov lus pom zoo hauv tsev kho mob rau Torasemide, cov lus qhia rau kev siv muaj cov yam ntxwv ntawm cov tshuaj ntau npaum li cas yuav tsum tau kho thiab kho tus kab mob lub hom phiaj. Ntxiv mus, cov tshuaj nws tus kheej muaj nyob rau hauv cov ntsiav tshuaj nrog cov ntsiab lus hauv qab no: 2.5 mg, 5 mg, 10 mg, 20 mg, 50 mg, 100 mg, 200 mg.
Cov tshuaj noj hauv ib ntsiav tshuaj thaum sawv ntxov, tsis hais zaub mov. Rau cov koob tshuaj no ntawm cov tshuaj "Torasemide" tus nqi yog txawv: nws yog qis dua ntawm qhov tsawg kawg nkaus koob thiab qhov siab tshaj plaws ntawm qhov siab tshaj plaws. Raws li cov ntaub ntawv nruab nrab, 30 ntsiav tshuaj ntawm cov tshuaj, 5 mg txhua, raug nqi txog 400 rubles. Hauv qhov no, cov koob tshuaj ntawm kev tswj hwm raug faib raws li hauv qab no raws li cov lus qhia:
- hauv kev kho mob ntshav siab, 2, 5 - 10 mg / hnub tau noj;
- rau lub plawv tsis ua haujlwm ntev, noj 10-20 mg / hnub;
- rau lub raum tsis ua haujlwm ntev - 50 mg lossis ntau dua;
- nyob rau hauv daim siab tsis ua hauj lwm, yuav tsum tau hloov koob tshuaj ib tus neeg.
Cov teebmeem ntawm Torasemide
Cov lus qhia rau kev siv txuas nrog Torasemide npaj muaj cov ntaub ntawv hais txog ntau yam kev phiv. Hauv koob tshuaj kho mob, uas yog, txog li 200 mg ib hnub, qhov kev pheej hmoo ntawm kev tsim cov teeb meem thromboembolic, ischemia ntawm lub plawv thiab lub hlwb nce. Qhov kev pheej hmoo ntawm kev mob ischemic nres thiab myocardial infarction, pulmonary embolism, arrhythmia nce. Kuj tseem muaj kev ua xua ua pob liab vog lossis urticaria nrog rau qhov ua rauneeg mob.
"Torasemide" qee zaum ua rau xeev siab lossis ntuav, tsis tshua kho cov tsos mob dyspeptic, raws plab. Kev cais tawm ntawm kev txhim kho ntawm tus mob pancreatitis tau piav qhia tawm tsam keeb kwm ntawm kev siv Torasemide. Hepatic transaminases kuj nce, uas qhia tau hais tias lub siab toxicity ntawm cov tshuaj nyob rau hauv cov koob tshuaj ntau. Qee zaum cov neeg mob txhawj xeeb txog tinnitus, qhov muag tsis pom kev.
Thaum noj tshuaj lom, qhov mob ntau dhau yuav tshwm sim nrog qee cov tsos mob. Kev noj tshuaj ntau dhau yog nrog los ntawm kev poob dej hauv cov zis: diuresis ntev thiab nquag, hypotension, vascular collapse, fainting, stroke tiv thaiv keeb kwm ntawm cerebral ischemia tuaj yeem tsim.
Contraindications thiab txwv kev siv
Cov tshuaj "Torasemide", analogues thiab nws cov generics tsis tuaj yeem siv nyob rau hauv lub xub ntiag ntawm kiag li contraindications. Cov no yog kev tsis haum tshuaj rau cov tshuaj los yog binders. "Torasemide" yog txwv tsis pub siv rau hauv lub raum tsis ua hauj lwm nrog anuria, nyob rau hauv daim siab tsis ua hauj lwm nyob rau hauv lub xeev ntawm hepatic coma, nrog tachyarrhythmias. Contraindicated nyob rau hauv lactation thiab cev xeeb tub, nrog rau cov hnub nyoog qis dua 18 xyoo, hypersensitivity rau sulfonamides.
Kev cuam tshuam thiab ua ke ntawm Torasemid
Hauv kev kho mob ntshav siab, cov ntsiav tshuaj Torasemide tuaj yeem cuam tshuam tsis zoo rau kev mob gout. Txij li thaum cov tshuaj nquag nkag mus rau cov tubules ze ntawm nephron los ntawm kev thauj mus los, kev sib tw inhibition ntawm kev tso tawm ntawm uric acid tshwm sim. Tawm tsam keeb kwm ntawm kev siv"Torasemide" muaj qhov tshwm sim ntau ntawm hyperuricemia thiab exacerbation ntawm gout.
Cov tshuaj "Torasemide" yog tus cwj pwm los ntawm cov txiaj ntsig tshwj xeeb ntawm tubular epithelium ntawm qhov sib thooj ntawm lub voj ntawm Henle. Vim muaj cov nyhuv diuretic muaj zog thiab qhov tsis txaus ntawm electrolyte, qhov no ua rau muaj qhov tshwm sim ntawm kev sib cuam tshuam ntawm cov tshuaj pharmacological tseem ceeb. Lawv yog cov txaus ntshai, insignificant thiab ntshaw. Kev phom sij thiab tseem ceeb suav nrog:
- siv cov koob tshuaj siab (los ntawm 50 mg / hnub) "Torasemide" thaum siv ua ke nrog cov tshuaj platinum ua rau muaj kev toxicity tom kawg;
- koob tshuaj Torasemide ntau (los ntawm 50 mg / hnub) txhim kho nephrotoxic thiab ototoxic nyhuv ntawm cov tshuaj tua kab mob aminoglycoside;
- hauv cov tshuaj tua kab mob cephalosporin, thaum siv ua ke nrog Torasemide ntawm koob tshuaj 50 mg / hnub, cov cuab yeej ntawm nephrotoxicity tshwm;
- salicylates ua ke nrog Torasemide (los ntawm 50 mg / hnub) yog tus cwj pwm los ntawm neurotoxicity.
- "Torasemide" tawm tsam keeb kwm yav dhau los ntawm cov txheeb ze hypokalemia txhim kho myocardial susceptibility rau plawv glycosides, ua rau lawv cov inotropic thiab antiarrhythmic nyhuv, ua rau muaj kev pheej hmoo ntawm intoxication;
- Qhov kev pheej hmoo ntawm hypokalemia nce ntxiv thaum Torasemide siv ua ke nrog corticosteroids lossis saline laxatives;
- "Torasemide" txhim kho cov nyhuv ntawm "Theophylline" thiab curariform leeg so.
xav sib koom ua ke
Ntawm cov teebmeem uas xav tau kev tswj hwm, tseem muaj qhov txo qis hauv ntshav siab los ntawmTom qab kev kho mob nrog ACE inhibitors. "Torasemide" vim kev tshem tawm cov kua dej txo cov ntshav siab hydrostatic, kho qhov poob ntawm cov ntshav siab. Qhov no yog qhov tseem ceeb hauv kev kho mob ntshav siab thiab yuav tsum tau hloov kho koob tshuaj ACE inhibitors. Ntxiv mus, nyob rau hauv kev kho mob-resistant kub siab, ua ke ntawm ACE inhibitors thiab Torasemide ua rau nws muaj peev xwm mus cuag normalization ntawm ntshav siab nyob rau hauv 90% ntawm cov neeg mob.
Nyob rau hauv kev kho mob plawv tsis ua hauj lwm, cov nyhuv ntawm kev txo cov vasoconstrictive kev ua ntawm catecholamines yog ib qho tseem ceeb hauv kev kho mob. Lub plawv ntawm keeb kwm yav dhau los ntawm kev kho diuretic nrog Torasemide teb tsis muaj zog rau cov cim qhia ntawm adrenaline thiab norepinephrine. Txawm li cas los xij, tib cov txiaj ntsig txo qhov ua tau zoo ntawm epinephrine thiab norepinephrine hauv resuscitation.
Txoj kev cuam tshuam tsis zoo
Muaj cov teebmeem ntawm inhibiting kev ua haujlwm ntawm cov tshuaj thaum siv ua ke nrog qee yam tshuaj. Tshwj xeeb:
- tshuaj ntawm pab pawg ntawm cov kua tsib kua qaub sequestrants txo cov uptake ntawm Torasemide los ntawm txoj hnyuv, ua kom tsis muaj zog ntawm qhov kawg;
- non-narcotic analgesics (NSAIDs) txo cov txiaj ntsig ntawm Torasemide;
- "Probenecid" vim kev txhim kho ntawm cov txheej txheem uricosuric inhibits qhov tso tawm "Torasemide" rau hauv lub lumen ntawm cov tubules, txo nws cov txiaj ntsig.
Cov yam ntxwv sib piv ntawm "Torasemide"
Cov tshuaj "Torasemide" analogues tuaj yeem yog chav kawm, kinetic thiab generics. Ntawm cov chav kawm analogues yog: "Furosemide", "Bumetanide", "Ethacrynic acid". Hauv kev sib piv nrog Furosemide, Torasemide yog tus cwj pwm los ntawm qeebqhov pib ntawm kev ua thiab ib tug ntev nyhuv nrog ib tug coj mus rau hauv lub diuresis. Muab cov nyhuv diuretic ntawm yuav luag tib lub zog xws li Furosemide, Torasemide muaj tsawg dua cov kev mob tshwm sim cuam tshuam nrog ceev electrolyte imbalances.
"Bumetanide" yog tus cwj pwm los ntawm cov cuab yeej diuretic txawm tias muaj zog dua, uas cuam tshuam nrog ntau cov kev mob tshwm sim. Ethacrynic acid muaj qhov pib diuretic qeeb thiab tseem yog cov tshuaj tsis tshua siv. Hauv pharmacokinetics ntawm cov tshuaj "Torasemide", kev tshuaj xyuas ntawm cov kws tshaj lij qhia txog lwm qhov tseem ceeb. Cov tshuaj tsis muaj qhov "rov qab" cov cuab yeej: tom qab nce diuresis vim qhov tso tawm ntawm sodium, tsis muaj kev tuav pov hwm hauv lub cev.
Pharmacokinetic analogues ntawm "Torasemide"
Hauv cov tshuaj "Torasemide" cov lus qhia muaj cov ntaub ntawv hais txog kev siv ntshav siab. Nrog rau cov tshuaj no, thiazide thiab potassium-sparing diuretics kuj tau siv los kho ntshav siab. Ntxiv mus, thiazide vim qhov pib qeeb thiab cov nyhuv diuretic ntev yog cov tshuaj xaiv.
Hauv kev sib txuas nrog cov tshuaj pharmacokinetic ntawm cov tshuaj analogues, kev siv tshuaj "Torasemide" tuaj yeem ua raws li hauv qab no: kev kho mob ntshav siab tiv thaiv kev kho mob nrog cov qauv kev sib txuas ntawm ACE inhibitors (los yog angiotensin receptor blockers) nrog thiazides. Tsis tas li, Torasemide yog siv rau hauv kev kho mob raum tsis ua haujlwm nrog kev txo qispeev xwm.
Torasemide Generics
Nyob rau hauv cov tshuaj "Torasemide" cov lus qhia rau kev siv, analogues, indications thiab contraindications tag nrho characterize nws lub ntsiab nyhuv - nce diuresis. Ntxiv mus, thawj cov tshuaj thiab nws cov generics muaj xws li cov nyhuv. Cov tom kawg muaj tib tus nqi ntawm Torasemide, tab sis raug tsim nyob rau hauv lwm lub npe lag luam.
Cov nto moo tshaj plaws yog: Britomar, Diuver, Torasemid Sandoz, Trifas, Torsid, Trigrim. Nyob rau hauv cov chav kawm ntawm ntau yam kev sim ntawm pharmacological npaj nyob rau hauv Russia, tsis muaj qhov sib txawv tseem ceeb ntawm lawv. Txhua yam tshuaj saum toj no hloov pauv lwm yam ntawm lawv.
Kev lag luam ntawm kev kho mob nrog Torasemide
Hauv kev kho mob ntshav siab, thaum thiazide diuretics tsis ua haujlwm nrog ACE inhibitors (lossis nrog ARBs), kev kho mob nrog Torasemide tuaj yeem raug sau tseg: cov lus qhia rau kev siv tshuaj kho ib zaug ib hnub. Tus nqi ntawm kev kho mob txhua hli yog li 400 rubles, thaum tus nqi ntawm 60 ntsiav tshuaj ntawm cov tshuaj yog hais txog 760-800 rubles. Rau kev sib piv: tus nqi txhua hli ntawm kev kho mob nrog Furosemide tsis tshua muaj tshaj 20 rubles. Tab sis rau kev kho mob ntshav siab mus tas li, qhov kawg yog siv me ntsis.
Nyob rau hauv lub plawv tsis ua hauj lwm nrog edema nyob rau hauv ob qho tib si ncig, tus nqi ntawm kev kho mob txhua hli nrog Furosemide yog hais txog 20-30 rubles. Cov tshuaj "Torasemide" nqi yog 10-15 npaug ntxiv. Nyob rau tib lub sijhawm, tom kawg muaj cov nyhuv me me, uas yog, nws me ntsis nce tso zis hauv thawj teev ntawm kev nkag. Hauv FurosemideCov yam ntxwv yog thim rov qab: nws nce cov zis hauv thawj ob teev nrog qhov txo qis hauv diuresis.
Vim li ntawd, nws yog qhov tsim nyog rau cov neeg mob lub cev muaj zog los yog muaj lub raum tsis zoo los yog cov hlab ntshav tsis txaus siv "Torasemide", cov lus qhia (nws tus nqi tau qhia saum toj no) rau kev siv uas tsis muaj ntaub ntawv. hais txog qhov nce ntxiv hauv diuresis thaum thawj zaug nkag. Txawm li cas los xij, hauv cov neeg mob uas muaj hnub nyoog so haujlwm, vim tias tsis muaj qhov xav tau los ua haujlwm, tus nqi ntawm diuresis yog qhov tsis tseem ceeb. Qhov no tsis tsim teeb meem, thiab yog li ntawd tso cai rau koj mus coj ib tug pheej yig chav kawm analogue - Furosemide.
