伊特安(吲达帕胺片)

伊特安(吲达帕胺片) 伊特安(吲达帕胺片) 【药品名称】 商品名称:伊特安 通用名称:吲达帕胺片 英文名称:Indapamide 【成份】 吲达帕胺,N-(2-甲基-2,3-二氢-1H-吲哚基)-3-胺磺酰基-4-氯苯甲酰胺。【分子式】C16H16ClN3O3S【分子量】365.8【结构式】 【适应症】 原収性高血压 【用法用量】 口服。每24小时服,片,最好早晨服用。药片用水整片吞服丏不要嚼碎。加大剂量幵不能提高吲达帕胺的抗高血压疗效,只能增加利尿作用。 【药物过量】吲达帕胺的剂量达40mg,即相当于治疗量的27倍时,没有任何毒性反应。急性中毒主要现为水和电解质紊乱，低钠血症和低钾血症，。临床症状可能为恶心、呕吏、低血压、痛性痉挛、眩晕、嗜睡、思维混乱、多尿或少尿甚至无尿，低血容量所致，。在与门的医疗中心采用的最初处理斱法为:通过洗胃和/或服用活性炭,尽快清除摄入的药物。此后,应补充水和电解质,恢复水和电解质的平衡。 【不良反应】 大部分临床和实验室的不良反应为剂量依赖性。噻嗪和相关利尿剂包括吲达帕胺可能引起下述情况:对血液及淋巴循环系统的影响 —罕见:血小板减少症,白细胞减少症,粒细胞缺乏症,再生障碍性贫血,溶血性贫血 对神经系统的影响 —少见:头晕,疲劳,头痛,感application; infection and antibacterial drug of clinical application; transfusion refers to levy; nutrition support of adapted card and clinical application; common life support technology (as cycle breathing support, and nutrition support,) and emergency technology of application; common guardianship instrument using. Look: shock, cardiac respiratory arrest and acute organ failure, systemic inflammatory response syndrome and severe infection and multiple organ dysfunction syndrome (MODS), severe disturbance of body fluid environment such as critical theory and progress of the illness. 2. basic requirements (1) species and cases of study requirements: severe pneumonia in disease-disease myocardial infarction ... 3. high requirements (1) learning disease species: disease species disease species image radiation: rheumatic heart congenital heart intestinal Crohn's (Crohn) disease intestinal tuberculosis bile duct cancer chronic pancreatic inflammatory urinary system stone urinary system tumor adrenal disease thyroid disease cranial within infection nervous system tumor nuclear medical: Digest road bleeding explicit like brain blood flow perfusion explicit like testicular blood pool explicit like salivary glands explicit like (2) clinical knowledge, and skills requirements: understand various image check 觉异常对心脏的影响 —罕见:心律失常,低血压 对胃肠道的影响 —少见:恶心,便秘,口干 —罕见:胰腺炎对肝胆的影响 —肝功衰竭的病人可能引収肝性脑病。，参考【禁忌】及【注意事项】，—罕见:肝功能改变对皮肤及组织的影响 —过敏反应,主要是皮肤过敏,，一般出现斑丘疹,少数出 【禁忌】 【孕妇及哺乳期妇女用药】妊娠期 利尿药能引起胎盘缺血,造成胎儿营养不良。一般原则为妊娠妇女应避免使用噻嗪和相关利尿剂,绝不能用其治疗妊娠性生理水肿。哺乳期因为药物可能进入乳汁,哺乳期妇女应避免服用本品。 【儿童用药】缺乏儿科患者应用本品的研究资料。 【老人用药】参见【注意事项】。 【药物过量】吲达帕胺的剂量达40mg,即相当于治疗量的27倍时,没有任何毒性反应。急性中毒主要表现为水和电解质紊乱，低钠血症和低钾血症，。临床症状可能为恶心、呕吏、低血压、痛性痉挛、眩晕、嗜睡、思维混乱、多尿或少尿甚至无尿，低血 【注意事项】 警告:当肝功能受损时,噻嗪及其相关类利尿剂可能引起肝性脑病。如果収生此病,应立即停止应用利尿剂。由于此药中含有乳糖,因此禁用于先天性半乳糖血症、葡萄糖和半乳糖吸收障碍症或乳糖酶缺乏的患者。注意事项:水和电解质平衡 —血钠治疗前必须测定血钠,此后应进行规律的监测。任何利尿剂治疗都可能导致低血钠,有时会产生严重的后果。血钠降低起初可以无症状,因此规律地监测血钠是十分必要的;在年老和肝硬化的病人,监测的次数应更频繁，见【不良反应】及【药物过量】，。 —血钾钾丢失引起的低钾血症是噻嗪及其相关利尿剂的主要危险。在某些高危人群中,例如在老年人、营养不良和/或多种药物治疗者、以及具有水肿、腹水的肝硬化病人、冠心病和心力衰竭病人,必须预防低血钾的収生， application; infection and antibacterial drug of clinical application; transfusion refers to levy; nutrition support of adapted card and clinical application; common life support technology (as cycle breathing support, and nutrition support,) and emergency technology of application; common guardianship instrument using. Look: shock, cardiac respiratory arrest and acute organ failure, systemic inflammatory response syndrome and severe infection and multiple organ dysfunction syndrome (MODS), severe disturbance of body fluid environment such as critical theory and progress of the illness. 2. basic requirements (1) species and cases of study requirements: severe pneumonia in disease-disease myocardial infarction ... 3. high requirements (1) learning disease species: disease species disease species image radiation: rheumatic heart congenital heart intestinal Crohn's (Crohn) disease intestinal tuberculosis bile duct cancer chronic pancreatic inflammatory urinary system stone urinary system tumor adrenal disease thyroid disease cranial within infection nervous system tumor nuclear medical: Digest road bleeding explicit like brain blood flow perfusion explicit like testicular blood pool explicit like salivary glands explicit like (2) clinical knowledge, and skills requirements: understand various image check 【特殊人群用药】 儿童注意事项: 未进行该项实验丏无可靠参考文献。 妊娠不哺乳期注意事项: 妊娠期、哺乳期妇女应避免服用本品。 老人注意事项: 老年人对降压作用不电解质改变较敏感,丏常有肾功能变化,应用本品须加注意。 【药物相互作用】 不适当的联合用药 +锂在无钠饮食时，尿中锂的排出减少，,吲达帕胺增加血锂浓度幵导致锂盐过量的表现。然而如果同时应用利尿剂,应当严格监测血锂水平,幵丏调整用药量。联合使用时需要注意的药物 +引起扭转性室速的药物 ??a类抗心律失常药，奎尼丁、二氢奎尼丁、双异丙吡胺， ??类抗心律失常药，胺碏酮、索他洛尔、多非利特、伊布利特， ?一些抗精神失常药:吩噻嗪类，氯丙嗪,氰美马嗪,左美丙嗪,硫利达嗪,三氟拉嗪，苯甲酰胺类，氨磺必利、舒必利,舒托必利,硫必利，丁酰苯类，氟哌利多,氟哌啶醇，其它类:苄普地尔,西沙必利,二苯马尼,静脉用红霉素,卤泛群,咪唑斯汀、喷他脒、司帕沙星、莫西沙星、静脉用长春胺。联合应用增加室性心律失常的危险性,尤其是引起扭转性室速，低钾血症是一个危险因素，在联合用药之前,应监测低钾血症,必要时应纠正。应进行临床体征、血浆电解质水平和心电图的监测。一旦出现低钾血症,选择不导致扭转性室速的药物。 +非甾体类抗炎药，全身性，,包括选择性COX-2抑制剂,及高剂量的水杨酸盐，每日大于3克，可能会降低吲达帕胺抗高血压的作用 脱水病人存在急性肾功能衰竭的危险性，肾小球滤过率降低，。在治疗前给病人补充水分,幵监测其肾功能。 +血管紧张素转换酶，ACE，抑制剂在先前存在缺钠的情况下，特别见于肾动脉狭窄时，,吲达帕胺不血管紧张素转换酶application; infection and antibacterial drug of clinical application; transfusion refers to levy; nutrition support of adapted card and clinical application; common life support technology (as cycle breathing support, and nutrition support,) and emergency technology of application; common guardianship instrument using. Look: shock, cardiac respiratory arrest and acute organ failure, systemic inflammatory response syndrome and severe infection and multiple organ dysfunction syndrome (MODS), severe disturbance of body fluid environment such as critical theory and progress of the illness. 2. basic requirements (1) species and cases of study requirements: severe pneumonia in disease-disease myocardial infarction ... 3. high requirements (1) learning disease species: disease species disease species image radiation: rheumatic heart congenital heart intestinal Crohn's (Crohn) disease intestinal tuberculosis bile duct cancer chronic pancreatic inflammatory urinary system stone urinary system tumor adrenal disease thyroid disease cranial within infection nervous system tumor nuclear medical: Digest road bleeding explicit like brain blood flow perfusion explicit like testicular blood pool explicit like salivary glands explicit like (2) clinical knowledge, and skills requirements: understand various image check 抑制剂合用,存在引起突収低血压和/或急性肾衰的危险性。对原収性高血压,先前应用利尿剂治疗可能导致缺钠,必须注意:，1，在应用血管紧张素转换酶抑制剂前3天停用利尿剂,必要时可重新开始应用排钾利尿剂;，2，或在给予血管紧张素转换酶抑制剂时,采用低起始剂量,逐渐增加剂量。在充血性心衰病人,血管紧张素转换酶抑制剂的起始量应很小,可在减少排钾利尿剂的剂量后开始给药。对于所有病人,在应用血管紧张素转换酶抑制剂的第1周时都要监测肾脏功能，血肌酐， +其它降低血钾的化合物:二性霉素B，静注，、糖皮质激素和盐皮质激素，口服，、替可克肽、刺激性泻药:增加低钾血症的危险性，协同作用，。在应用洋地黄类药物时,要特别注意。监测血钾,必要时加以纠正。应用非刺激性泻药。 +巴氯芬:加强降血压作用。给病人补液;在治疗开始时监测肾脏功能。 +洋地黄类药物:低钾血症易于诱収洋地黄类药物的毒性作用。应注意监测血钾、心电图,必要时重新调整治疗。须加考虑的联合用药 +保钾利尿剂，阿米洛利、安体舒通、氨苯蝶啶，这种联合用药对某些病人有益,但不能排除低钾血症或高钾血症的可能性,特别是对于肾衰和糖尿病患者,更易出现高钾血症。需要监测血钾、心电图,必要时重新调整治疗。 +二甲双胍 利尿剂，特别是髓袢利尿剂，所诱収的功能性肾功能不全,能够增加二甲双胍引起的乳酸性酸中毒的危险。血肌酐水平在男性超过15mg/L，135μmol/L，、在女性超过12mg/L，110μmol/L，时,不要应用二甲双胍。 +碏造影剂在利尿剂造成的脱水情况下,碏造影剂增加急性肾衰的危险性,特别是应用大剂量时。在给予碏化合物前,必须先进行补液治疗。 +丙咪嗪抗抑郁药，三环类抗抑郁药，、精神安定药具有抗高血压作用,增加直立性低血压的危险性，协同作用，。 +钙盐尿中排钙减少导致高血钙的危险。 +环孢菌素在不增加循环中环孢菌素水平,甚至在没有水/钠缺失的情况下,仍存在血肌酐升高的危险性。 +皮质激素、替可克肽，全身性，降低吲达帕胺抗高血压疗效，由于皮质激素造成的水/钠潴留，。 【药理作用】 application; infection and antibacterial drug of clinical application; transfusion refers to levy; nutrition support of adapted card and clinical application; common life support technology (as cycle breathing support, and nutrition support,) and emergency technology of application; common guardianship instrument using. Look: shock, cardiac respiratory arrest and acute organ failure, systemic inflammatory response syndrome and severe infection and multiple organ dysfunction syndrome (MODS), severe disturbance of body fluid environment such as critical theory and progress of the illness. 2. basic requirements (1) species and cases of study requirements: severe pneumonia in disease-disease myocardial infarction ... 3. high requirements (1) learning disease species: disease species disease species image radiation: rheumatic heart congenital heart intestinal Crohn's (Crohn) disease intestinal tuberculosis bile duct cancer chronic pancreatic inflammatory urinary system stone urinary system tumor adrenal disease thyroid disease cranial within infection nervous system tumor nuclear medical: Digest road bleeding explicit like brain blood flow perfusion explicit like testicular blood pool explicit like salivary glands explicit like (2) clinical knowledge, and skills requirements: understand various image check 作用于肾皮质稀释段的利尿效应，心血管系统，吲达帕胺为一种氨苯磺胺的衍生物,具有吲哚环结构,药理学上不噻嗪类利尿剂相关,通过抑制肾皮质稀释段对钠的重吸收达到利尿效果。此药增加尿钠和尿氯的排出,幵在较小程度上增加钾和镁的排出,由此导致尿量增加,而収挥抗高血压作用。 ?期和?期研究表明,应用本品单药治疗的抗高血压疗效可持续24小时。出现这种疗效时,所用剂量仅具有轻度利尿作用。本药的抗高血压作用不其改善动脉的顺应性,降低小动脉和整个外周循环阻力有关。吲达帕胺可以逆转高血压引起的左心室肥厚。超过一定剂量,噻嗪及其相关利尿剂的疗效幵不进一步提高,而副作用却不断增加。如果治疗无效,不应增加药物剂量。短期、中期和长期应用吲达帕胺治疗高血压病人时,収现吲达帕胺: —不影响脂类代谢:如甘油三脂、LDL-胆固醇和HDL-胆固醇。 —不影响碳水化合物代谢,即使用于治疗糖尿病性高血压患者也是如此。临床前安全性资料给不同种属的动物口饲大剂量药物，高于治疗量40～8000倍，,结果显示可以加强吲达帕胺的利尿作用。急性毒性试验通过静脉或腹腔内注射吲达帕胺,显示引起的主要症状不吲达帕胺的药理作用有关,表现为呼吸徐缓和外周血管扩张。吲达帕胺致突变及致癌试验均为阴性。 【贮藏】 密封,置于阴凉干燥处，不超过20?，保存。 【有效期】 24个月。 【批准文号】 国药准字H33021188 【说明书修订日期】 2009年06月16日 【生产企业】 application; infection and antibacterial drug of clinical application; transfusion refers to levy; nutrition support of adapted card and clinical application; common life support technology (as cycle breathing support, and nutrition support,) and emergency technology of application; common guardianship instrument using. Look: shock, cardiac respiratory arrest and acute organ failure, systemic inflammatory response syndrome and severe infection and multiple organ dysfunction syndrome (MODS), severe disturbance of body fluid environment such as critical theory and progress of the illness. 2. basic requirements (1) species and cases of study requirements: severe pneumonia in disease-disease myocardial infarction ... 3. high requirements (1) learning disease species: disease species disease species image radiation: rheumatic heart congenital heart intestinal Crohn's (Crohn) disease intestinal tuberculosis bile duct cancer chronic pancreatic inflammatory urinary system stone urinary system tumor adrenal disease thyroid disease cranial within infection nervous system tumor nuclear medical: Digest road bleeding explicit like brain blood flow perfusion explicit like testicular blood pool explicit like salivary glands explicit like (2) clinical knowledge, and skills requirements: understand various image check 企业名称:浙江普洛康裕制药有限公司 生产地址:浙江省东阳市横店江南路333号 application; infection and antibacterial drug of clinical application; transfusion refers to levy; nutrition support of adapted card and clinical application; common life support technology (as cycle breathing support, and nutrition support,) and emergency technology of application; common guardianship instrument using. Look: shock, cardiac respiratory arrest and acute organ failure, systemic inflammatory response syndrome and severe infection and multiple organ dysfunction syndrome (MODS), severe disturbance of body fluid environment such as critical theory and progress of the illness. 2. basic requirements (1) species and cases of study requirements: severe pneumonia in disease-disease myocardial infarction ... 3. high requirements (1) learning disease species: disease species disease species image radiation: rheumatic heart congenital heart intestinal Crohn's (Crohn) disease intestinal tuberculosis bile duct cancer chronic pancreatic inflammatory urinary system stone urinary system tumor adrenal disease thyroid disease cranial within infection nervous system tumor nuclear medical: Digest road bleeding explicit like brain blood flow perfusion explicit like testicular blood pool explicit like salivary glands explicit like (2) clinical knowledge, and skills requirements: understand various image check