Телпрес Таблетки, 98 шт, 40 мг

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Обладает высоким сродством к подтипу AT1 рецепторов ангиотензина II, через которые реализуется действие ангиотензина II. Вытесняет ангиотензин II из связи с рецептором, не обладая действием агониста в отношении этого рецептора. Телмисартан связывается только с подтипом AT1 рецепторов ангиотензина II. Связь носит длительный характер."}},{"type":"paragraph","data":{"text":"Не обладает сродством к другим рецепторам, в том числе к АТ2 рецептору и другим, менее изученным рецепторам ангиотензина. Функциональное значение этих рецепторов, а также эффект их возможной избыточной стимуляции ангиотензином II, концентрация которого увеличивается при назначении телмисартана, не изучены."}},{"type":"paragraph","data":{"text":"Снижает концентрацию альдостерона в крови, не ингибирует ренин в плазме крови и не блокирует ионные каналы. Телмисартан не ингибирует ангиотензинпревращающий фермент (кининаза II) (фермент, который также разрушает брадикинин). Поэтому усиления побочных эффектов, вызываемых брадикинином, не ожидается."}},{"type":"paragraph","data":{"text":"У пациентов с артериальной гипертензией телмисартан в дозе 80 мг полностью блокирует гипертензивное действие ангиотензина II. Начало антигипертензивного действия отмечается в течение 3-х часов после первого приема телмисартана внутрь. Действие препарата сохраняется в течение 24 часов и остается значимым до 48 часов. Выраженный антигипертензивный эффект обычно развивается через 4 недели после регулярного приема препарата."}},{"type":"paragraph","data":{"text":"У пациентов, страдающих артериальной гипертензией, телмисартан снижает систолическое и диастолическое артериальное давление (АД), не оказывая влияния на частоту сердечных сокращений (ЧСС)."}},{"type":"paragraph","data":{"text":"В случае резкой отмены телмисартана АД постепенно возвращается к исходному уровню без развития синдрома \"отмены\"."}},{"type":"paragraph","data":{"text":"\u003cb\u003eФармакокинетика:\u003c/b\u003e"}},{"type":"paragraph","data":{"text":"Всасывание"}},{"type":"paragraph","data":{"text":"При приеме внутрь быстро всасывается из желудочно-кишечного тракта. Биодоступность составляет около 50 %. При приеме одновременно с пищей снижение AUC (площадь под кривой \"концентрация-время\") колеблется от 6 % (при дозе 40 мг) до 19 % (при дозе 160 мг). Спустя 3 часа после приема, концентрация в плазме крови выравнивается независимо от приема пищи."}},{"type":"paragraph","data":{"text":"Распределение"}},{"type":"paragraph","data":{"text":"Связь с белками плазмы крови - 99,5 %, в основном с альбумином и альфа-1 гликопротеином. Среднее значение видимого объема распределения в равновесной концентрации - 500 л."}},{"type":"paragraph","data":{"text":"Метаболизм"}},{"type":"paragraph","data":{"text":"Метаболизируется путем конъюгирования с глюкуроновой кислотой. Метаболиты фармакологически неактивны."}},{"type":"paragraph","data":{"text":"Выведение"}},{"type":"paragraph","data":{"text":"Период полувыведения (Т1/2) - более 20 час. Выводится через кишечник в неизмененном виде, выведение почками - менее 2 % от принятой дозы. Общий плазменный клиренс высокий (900 мл/мин) по сравнению с \"печеночным кровотоком\" (около 1500 мл/мин)."}},{"type":"paragraph","data":{"text":"\u003cb\u003eФармакокинетика у особых групп пациентов\u003c/b\u003e"}},{"type":"paragraph","data":{"text":"Гендерные различия"}},{"type":"paragraph","data":{"text":"Наблюдается разница в плазменных концентрациях у мужчин и женщин. Сmах (максимальная концентрация) и AUC были приблизительно в 3 и 2 раза, соответственно, выше у женщин по сравнению с мужчинами без значимого влияния на эффективность. Коррекции доз не требуется."}},{"type":"paragraph","data":{"text":"Пожилые пациенты"}},{"type":"paragraph","data":{"text":"Фармакокинетика телмисартана у пациентов пожилого возраста не отличается от фармакокинетики у молодых пациентов. Коррекции доз не требуется."}},{"type":"paragraph","data":{"text":"Пациенты с нарушением функции почек"}},{"type":"paragraph","data":{"text":"У пациентов с легким и умеренным нарушением функции почек коррекции дозы телмисартана не требуется."}},{"type":"paragraph","data":{"text":"Пациентам с тяжелой почечной недостаточностью и пациентам, находящимся на гемодиализе, рекомендована более низкая начальная доза - 20 мг в сутки."}},{"type":"paragraph","data":{"text":"Телмисартан не выводится с помощью гемодиализа."}},{"type":"paragraph","data":{"text":"Пациенты с нарушением функции печени"}},{"type":"paragraph","data":{"text":"Исследования фармакокинетики у пациентов с печеночной недостаточностью показали увеличение абсолютной биодоступности телмисартана практически до 100 %."}},{"type":"paragraph","data":{"text":"При печеночной недостаточности Т1/2 не изменяется. У пациентов с легкими и умеренными нарушениями функции печени (класс А и В по шкале Чайлд-Пью) суточная доза препарата не должна превышать 40 мг."}}]},{"id":8,"name":"Показания к применению","slug":"indications","body":[{"type":"paragraph","data":{"text":"Артериальная гипертензия;"}},{"type":"paragraph","data":{"text":"Снижение сердечно-сосудистой заболеваемости и смертности у пациентов в возрасте 55 лет и старше с высоким риском сердечно-сосудистых заболеваний."}}]},{"id":9,"name":"Противопоказания","slug":"contraindications","body":[{"type":"paragraph","data":{"text":"- Повышенная чувствительность к действующему веществу или вспомогательным компонентам препарата;"}},{"type":"paragraph","data":{"text":"- Беременность;"}},{"type":"paragraph","data":{"text":"- Период грудного вскармливания;"}},{"type":"paragraph","data":{"text":"- Обструктивные заболевания желчевыводящих путей;"}},{"type":"paragraph","data":{"text":"- Тяжелые нарушения функции печени (класс С по шкале Чайлд-Пью);"}},{"type":"paragraph","data":{"text":"- Одновременное применение препарата Телпрес с алискиреном у пациентов с сахарным диабетом и/или нарушением функции почек (скорость клубочковой фильтрации менее 60 мл/мин/1,73 м2);"}},{"type":"paragraph","data":{"text":"- Одновременное применение ингибиторов АПФ у пациентов с диабетической нефропатией;"}},{"type":"paragraph","data":{"text":"- Возраст до 18 лет (эффективность и безопасность не установлены)."}},{"type":"paragraph","data":{"text":"С осторожностью:"}},{"type":"paragraph","data":{"text":"- Двусторонний стеноз почечных артерий или стеноз артерии единственной почки;"}},{"type":"paragraph","data":{"text":"- Нарушения функции печени и/или почек (см. раздел \"Особые указания\");"}},{"type":"paragraph","data":{"text":"- Состояние после трансплантации почки (опыт применения отсутствует);"}},{"type":"paragraph","data":{"text":"- Снижение объема циркулирующей крови (ОЦК) вследствие предшествующей диуретической терапии, ограничения приема поваренной соли, диареи или рвоты;"}},{"type":"paragraph","data":{"text":"- Гипонатриемия;"}},{"type":"paragraph","data":{"text":"- Гиперкалиемия;"}},{"type":"paragraph","data":{"text":"- Хроническая сердечная недостаточность;"}},{"type":"paragraph","data":{"text":"- Ишемическая болезнь сердца;"}},{"type":"paragraph","data":{"text":"- Стеноз аортального и митрального клапана;"}},{"type":"paragraph","data":{"text":"- Идиопатический гипертрофический субаортальный стеноз (гипертрофическая обструктивная кардиомиопатия);"}},{"type":"paragraph","data":{"text":"- Первичный альдостеронизм (эффективность и безопасность не установлены);"}},{"type":"paragraph","data":{"text":"- Одновременное применение с ингибиторами АПФ или алискиреном;"}},{"type":"paragraph","data":{"text":"- Одновременное применение с препаратами калия, калийсберегающими диуретиками;"}},{"type":"paragraph","data":{"text":"- Сахарный диабет."}}]},{"id":12,"name":"Способ применения и дозы","slug":"dosage","body":[{"type":"paragraph","data":{"text":"Внутрь, вне зависимости от приема пищи."}},{"type":"paragraph","data":{"text":"Артериальная гипертензия"}},{"type":"paragraph","data":{"text":"Начальная рекомендованная доза препарата Телпрес составляет 1 таб. (40 мг) один раз в сутки. В случаях, когда терапевтический эффект не достигается, максимальная рекомендованная доза препарата Телпрес может быть увеличена до 80 мг один раз в сутки. При решении вопроса об увеличении дозы следует принимать во внимание, что максимальный антигипертензивный эффект обычно достигается в течение 4-8 недель после начала лечения."}},{"type":"paragraph","data":{"text":"Снижение сердечно-сосудистой заболеваемости и смертности"}},{"type":"paragraph","data":{"text":"Рекомендованная доза - 1 таблетка препарата Телпрес 80 мг 1 раз в сутки."}},{"type":"paragraph","data":{"text":"В начальный период лечения рекомендуется наблюдение за уровнем артериального давления (АД), может потребоваться коррекция антигипертензивной терапии."}},{"type":"paragraph","data":{"text":"Нарушение функции почек"}},{"type":"paragraph","data":{"text":"У пациентов с серьезными нарушениями функции почек и пациентов, находящихся на гемодиализе, опыт применения ограничен. У таких пациентов рекомендованная стартовая доза составляет 20 мг в сутки. У пациентов с легкими и умеренными нарушениями функции почек коррекции дозы не требуется."}},{"type":"paragraph","data":{"text":"Нарушение функции печени"}},{"type":"paragraph","data":{"text":"У пациентов с легкими и умеренными нарушениями функции печени (класс А и В по шкале Чайлд-Пью, соответственно) суточная доза препарата Телпрес не должна превышать 40 мг."}},{"type":"paragraph","data":{"text":"Пожилые пациенты"}},{"type":"paragraph","data":{"text":"У пациентов пожилого возраста не требуется коррекции дозы."}}]},{"id":13,"name":"Побочное действие","slug":"side_effects","body":[{"type":"paragraph","data":{"text":"В целом, частота возникновения нежелательных реакций, отмеченная для телмисартана сопоставима с аналогичной для плацебо. Наблюдаемые случаи побочных эффектов не коррелировали с полом, возрастом или расовой принадлежностью пациентов."}},{"type":"paragraph","data":{"text":"Инфекционные и паразитарные заболевания:"}},{"type":"paragraph","data":{"text":"нечасто: инфекции верхних дыхательных путей, в том числе фарингит и синусит, инфекции мочевыводящих путей (включая цистит);"}},{"type":"paragraph","data":{"text":"неизвестной частоты: сепсис, включая сепсис с летальным исходом."}},{"type":"paragraph","data":{"text":"Нарушения со стороны крови и лимфатической системы:"}},{"type":"paragraph","data":{"text":"нечасто: анемия;"}},{"type":"paragraph","data":{"text":"редко: тромбоцитопения;"}},{"type":"paragraph","data":{"text":"неизвестной частоты: эозинофилия."}},{"type":"paragraph","data":{"text":"Нарушения со стороны психики:"}},{"type":"paragraph","data":{"text":"нечасто: депрессия; редко: тревожность."}},{"type":"paragraph","data":{"text":"Нарушения со стороны нервной системы:"}},{"type":"paragraph","data":{"text":"нечасто: бессонница, синкопе, вертиго; редко: обморок."}},{"type":"paragraph","data":{"text":"Нарушения со стороны органа зрения:"}},{"type":"paragraph","data":{"text":"редко: нарушение зрения."}},{"type":"paragraph","data":{"text":"Нарушения со стороны сердца:"}},{"type":"paragraph","data":{"text":"нечасто: брадикардия; редко: тахикардия."}},{"type":"paragraph","data":{"text":"Нарушения со стороны сосудов:"}},{"type":"paragraph","data":{"text":"нечасто: выраженное снижение АД*, ортостатическая гипотензия;"}},{"type":"paragraph","data":{"text":"* часто наблюдалось у пациентов с контролируемым АД, которые получали лечение телмисартаном с целью снижения риска сердечно-сосудистой смертности в дополнение к стандартному лечению."}},{"type":"paragraph","data":{"text":"Нарушения со стороны дыхательной системы, органов грудной клетки и средостения:"}},{"type":"paragraph","data":{"text":"нечасто: одышка, кашель."}},{"type":"paragraph","data":{"text":"Нарушения со стороны желудочно-кишечного тракта:"}},{"type":"paragraph","data":{"text":"нечасто: боль в животе, диарея, диспепсия, метеоризм, рвота;"}},{"type":"paragraph","data":{"text":"редко: расстройство желудка, дискомфорт, сухость слизистой оболочки полости рта, нарушения функции печени/заболевания печени."}},{"type":"paragraph","data":{"text":"Нарушения со стороны иммунной системы:"}},{"type":"paragraph","data":{"text":"редко: гиперчувствительность, ангионевротический отек (в т. ч. со смертельным исходом); неизвестной частоты: анафилактические реакции."}},{"type":"paragraph","data":{"text":"Нарушения со стороны кожи и подкожных тканей"}},{"type":"paragraph","data":{"text":"нечасто: гипергидроз, кожный зуд, сыпь;"}},{"type":"paragraph","data":{"text":"редко: эритема, лекарственная сыпь, токсическая кожная сыпь, экзема, неизвестной частоты: крапивница."}},{"type":"paragraph","data":{"text":"Нарушения со стороны скелетно-мышечной системы и соединительной ткани: нечасто: миалгия, боль в спине (например, ишиас), мышечные спазмы;"}},{"type":"paragraph","data":{"text":"редко: артралгия, боль в конечностях;"}},{"type":"paragraph","data":{"text":"неизвестной частоты: боль в области сухожилий (тендинитоподобные симптомы)."}},{"type":"paragraph","data":{"text":"Нарушения со стороны почек и мочевыводящих путей:"}},{"type":"paragraph","data":{"text":"нечасто: почечная недостаточность, в т. ч. острая почечная недостаточность."}},{"type":"paragraph","data":{"text":"Нарушения со стороны питания и обмена веществ:"}},{"type":"paragraph","data":{"text":"нечасто: гиперкалиемия."}},{"type":"paragraph","data":{"text":"Общие расстройства:"}},{"type":"paragraph","data":{"text":"нечасто: боль в груди, астения (слабость);"}},{"type":"paragraph","data":{"text":"редко: гриппоподобное состояние."}},{"type":"paragraph","data":{"text":"Влияние на результаты лабораторных показателей и инструментальных исследований:"}},{"type":"paragraph","data":{"text":"нечасто: повышение концентрации креатинина в крови;"}},{"type":"paragraph","data":{"text":"редко: повышение концентрации мочевой кислоты в крови, \"печеночных\" ферментов, активности креатинфосфокиназы в сыворотке крови, снижение гемоглобина, гипогликемия (у пациентов с сахарным диабетом)."}}]},{"id":14,"name":"Передозировка","slug":"overdose","body":[{"type":"paragraph","data":{"text":"Информация относительно передозировки ограничена."}},{"type":"paragraph","data":{"text":"Симптомы: наиболее значимые - выраженное снижение АД и тахикардия, также может наблюдаться брадикардия, головокружение, повышение концентрации креатинина в сыворотке крови и острая почечная недостаточность."}},{"type":"paragraph","data":{"text":"Лечение: симптоматическое и поддерживающее. Предлагаемые меры включают: вызывание рвоты и/или промывание желудка, прием активированного угля, восполнение недостатка жидкости и солей. Постоянный контроль содержания электролитов и креатинина в сыворотке крови. Гемодиализ не эффективен."}}]},{"id":15,"name":"Взаимодействие с другими лекарственными средствами","slug":"drugs_interaction","body":[{"type":"paragraph","data":{"text":"Телмисартан может увеличивать антигипертензивный эффект других антигипертензивных средств. Другие виды взаимодействий, имеющие клиническую значимость, не выявлены. Сочетанное применение с дигоксином, варфарином, гидрохлоротиазидом, глибенкламидом, ибупрофеном, парацетамолом, симвастатином и амлодипином не приводит к клинически значимому взаимодействию."}},{"type":"paragraph","data":{"text":"Двойная блокада ренин-ангиотензин-альдостероновой системы (РААС)."}},{"type":"paragraph","data":{"text":"Сопутствующее применение телмисартана с алискиреном противопоказано пациентам с сахарным диабетом или почечной недостаточностью (СКФ менее 60 мл/мин/1,73 м2 площади поверхности тела) и не рекомендуется другим пациентам. Одновременное применение телмисартана и ингибиторов АГ1Ф противопоказано у пациентов с диабетической нефропатией."}},{"type":"paragraph","data":{"text":"Данные клинических исследований показали, что двойная блокада РААС вследствие комбинированного применения ингибиторов АПФ, АРА II или алискирена связана с повышенной частотой нежелательных явлений, таких как артериальная гипотензия, гиперкалиемия и нарушение функции почек (включая острую почечную недостаточность) в сравнении с применением только одного лекарственного средства, действующего на РААС."}},{"type":"paragraph","data":{"text":"Риск развития гиперкалиемии может возрастать при совместном применении с другими лекарственными препаратами, способными вызывать гиперкалиемию (калийсодержащие пищевые добавки и заменители соли, содержащие калий и калийсберегающие диуретики (спиронолактон, эплеренон, триамтерен или амилорид), нестероидные противовоспалительные препараты (НПВП, включая селективные ингибиторы циклооксигеназы-2 (ЦОГ)), гепарин, иммунодепрессанты (циклоспорин, такролимус, триметоприм)). При необходимости на фоне документально подтвержденной гипокалиемии совместное применение препаратов следует осуществлять с осторожностью и регулярно контролировать содержание калия в плазме крови."}},{"type":"paragraph","data":{"text":"Дигоксин"}},{"type":"paragraph","data":{"text":"При совместном приеме телмисартана с дигоксином было отмечено увеличение средней Сmах дигоксина в плазме крови на 49 % и минимальной концентрации на 20 %. В начале лечения, при подборе дозы и прекращении лечения телмисартаном следует тщательно контролировать концентрацию дигоксина в плазме крови для ее поддержания в рамках терапевтического диапазона."}},{"type":"paragraph","data":{"text":"Калийсберегающие диуретики или калийсодержащие пищевые добавки"}},{"type":"paragraph","data":{"text":"Антагонисты рецепторов ангиотензина II, такие как телмисартан, снижают вызываемую диуретиком потерю калия. Калийсберегающие диуретики, например, спиронолактон, эплеренон, триамтерен или амилорид, калийсодержащие пищевые добавки или заменители соли могут привести к значимому повышению содержания калия в плазме крови. Если сопутствующие применение показано, поскольку имеется документально подтвержденная гипокалиемия, их следует применять с осторожностью и на фоне регулярного контроля калия в плазме крови."}},{"type":"paragraph","data":{"text":"Препараты лития"}},{"type":"paragraph","data":{"text":"При совместном приеме препаратов лития с ингибиторами АПФ и АРАII, включая телмисартан, возникало обратимое повышение концентрации лития в плазме крови и его токсического действия. При необходимости применения данной комбинации препаратов рекомендуется тщательно контролировать концентрации лития в плазме крови."}},{"type":"paragraph","data":{"text":"Нестероидные противовоспалительные лекарственные препараты (НПВП)"}},{"type":"paragraph","data":{"text":"НПВП (включая ацетилсалициловую кислоту в дозах, используемых для противовоспалительного лечения, ингибиторы ЦОГ-2 и неселективные НПВП) могут ослаблять антигипертензивное действие АРАII. У некоторых пациентов с нарушением почечной функции (например, пациентов с обезвоживанием, пожилых пациентов с нарушением функции почек) совместное применение АРАIIи препаратов, угнетающих циклооксигеназу-2 может приводить к дальнейшему ухудшению почечной функции, включая развитие острой почечной недостаточности, которая, как правило, является обратимой. Поэтому совместное применение препаратов следует осуществлять с осторожностью, особенно пожилым пациентам. Следует обеспечить надлежащее поступление жидкости, кроме того, в начале совместного применения и периодически в дальнейшем следует контролировать показатели функции почек."}},{"type":"paragraph","data":{"text":"Диуретики (тиазидные или петлевые диуретики)"}},{"type":"paragraph","data":{"text":"Предшествующее лечение высокими дозами диуретиков, такими как фуросемид (петлевой диуретик) и гидрохлоротиазид (тиазидный диуретик), может привести к гиповолемии и риску развития артериальной гипотензии в начале лечения телмисартаном."}},{"type":"paragraph","data":{"text":"Прочие антигипертензивные средства"}},{"type":"paragraph","data":{"text":"Действие телмисартана может усиливаться при совместном применении других антигипертензивных лекарственных средств. На основании фармакологических свойств баклофена и амифостина можно предположить, что они будут усиливать терапевтический эффект всех антигипертензивных средств, включая телмисартан. Кроме того, ортостатическая гипотензия может усиливаться на фоне приема алкоголя, барбитуратов, наркотических средств или антидепрессантов."}},{"type":"paragraph","data":{"text":"Кортикостероиды (для системного применения)"}},{"type":"paragraph","data":{"text":"Кортикостероиды ослабляют действие телмисартана."}}]},{"id":16,"name":"Особые указания","slug":"","body":[{"type":"paragraph","data":{"text":"Нарушения функции печени"}},{"type":"paragraph","data":{"text":"Применение препарата Телпрес противопоказано у пациентов с холестазом, обструкцией желчевыводящих путей или тяжелым нарушением функции печени (класс С по классификации Чайлд-Пью) (см. раздел \"Противопоказания\"), поскольку телмисартан в основном выводится с желчью. Предполагают, что у подобных пациентов снижен печеночный клиренс телмисартана. У пациентов с легкой или умеренной степенью нарушения функции печени (класс А и В по классификации Чайлд-Пью) препарат Телпрес следует применять с осторожностью (см. раздел \"С осторожностью\")."}},{"type":"paragraph","data":{"text":"Реноваскулярная гипертензия"}},{"type":"paragraph","data":{"text":"При лечении лекарственными средствами, действующими на РААС, у пациентов с двусторонним стенозом артерий или стенозом артерии единственной функционирующей почки возрастает риск возникновения тяжелой артериальной гипотензии и почечной недостаточности."}},{"type":"paragraph","data":{"text":"Нарушение функции почек и пересадка почки"}},{"type":"paragraph","data":{"text":"При применении препарата Телпрес у пациентов с нарушением функции почек рекомендован периодический контроль содержания калия и креатинина в плазме крови. Опыт клинического применения препарата Телпрес у пациентов, недавно перенесших трансплантацию почки, отсутствует."}},{"type":"paragraph","data":{"text":"Снижение объема циркулирующей крови"}},{"type":"paragraph","data":{"text":"Симптоматическая артериальная гипотензия, особенно после первого приема препарата Телпрес, может возникать у пациентов с пониженным ОЦК и/или содержанием натрия в плазме крови на фоне предшествующего лечения диуретиками, ограничения приема поваренной соли, диареи или рвоты. Подобные состояния (дефицит жидкости и/или натрия) должны быть устранены до начала приема препарата Телпрес."}},{"type":"paragraph","data":{"text":"Двойная блокада ренин-ангиотензин-альдостероновой системы"}},{"type":"paragraph","data":{"text":"Сопутствующее применение телмисартана с алискиреном противопоказано пациентам с сахарным диабетом или почечной недостаточностью (скорость клубочковой фильтрации менее 60 мл/мин/1,73 м2) (см. раздел \"Противопоказания\")."}},{"type":"paragraph","data":{"text":"Одновременное применение телмисартана и ингибиторов АПФ противопоказано у пациентов с диабетической нефропатией (см. раздел \"Противопоказания\")."}},{"type":"paragraph","data":{"text":"В результате угнетения РААС были отмечены: артериальная гипотензия, обморок, гиперкалиемия и нарушение почечной функции (в том числе острая почечная недостаточность) у предрасположенных к этому пациентов, особенно при совместном применении нескольких лекарственных средств, так же действующих на эту систему. Поэтому двойная блокада РААС (например, на фоне приема телмисартана с другими антагонистами РААС) не рекомендована."}},{"type":"paragraph","data":{"text":"В случаях зависимости сосудистого тонуса и функции почек преимущественно от активности РААС (например, у пациентов с хронической сердечной недостаточностью или заболеваниями почек, в том числе, при стенозе почечных артерий, или стенозе артерии единственной почки), назначение препаратов, влияющих на эту систему, может сопровождаться развитием острой артериальной гипотензии, гиперазотемии, олигурии и, в редких случаях, острой почечной недостаточностью."}},{"type":"paragraph","data":{"text":"Первичный альдостеронизм"}},{"type":"paragraph","data":{"text":"У пациентов с первичным альдостеронизмом лечение антигипертензивными лекарственными средствами, действие которых осуществляется путем угнетения РААС, как правило, неэффективно."}},{"type":"paragraph","data":{"text":"Стеноз аортального и митрального клапана, гипертрофическая обструктивная кардиомиопатия"}},{"type":"paragraph","data":{"text":"Необходимо соблюдать осторожность при применении препарата Телпрес (так же, как и других сосудорасширяющих средств) у пациентов с аортальным или митральным стенозом, а также гипертрофической обструктивной кардиомиопатией."}},{"type":"paragraph","data":{"text":"Гиперкалиемия"}},{"type":"paragraph","data":{"text":"Прием лекарственных средств, действующих на РААС может вызвать гиперкалиемию. У пациентов пожилого возраста, пациентов с почечной недостаточностью или сахарным диабетом, пациентов, также принимающих лекарственные препараты, способствующие повышению содержания калия в плазме крови, и/или пациентов с сопутствующими заболеваниями гиперкалиемия может привести к летальному исходу."}},{"type":"paragraph","data":{"text":"При решении вопроса о сопутствующем применении лекарственных средств, действующих на РААС, необходимо оценить соотношение \"риск-польза\"."}},{"type":"paragraph","data":{"text":"Основными факторами риска развития гиперкалиемии, которые следует учитывать, являются:"}},{"type":"paragraph","data":{"text":"- сахарный диабет, почечная недостаточность, возраст (пациенты старше 70 лет);"}},{"type":"paragraph","data":{"text":"- сочетание с одним или более лекарственным средством, действующим на РААС и/или калийсодержащими пищевыми добавками. Лекарственными препаратами или терапевтическими классами лекарственных препаратов, которые могут вызывать гиперкалиемию, являются заменители соли, содержащие калий, калийсберегающие диуретики, ингибиторы АПФ, антагонисты рецептора ангиотензина II, нестероидные противовоспалительные препараты (НПВП, в том числе селективные ингибиторы ЦОГ-2), гепарин, иммунодепрессанты (циклоспорин или такролимус) и триметоприм;"}},{"type":"paragraph","data":{"text":"- интеркуррентные заболевания, в особенности обезвоживание, острая сердечная недостаточность, метаболический ацидоз, нарушение функции почек, синдром цитолиза (например, острая ишемия конечностей, рабдомиолиз, обширная травма)."}},{"type":"paragraph","data":{"text":"Пациентам из группы риска рекомендуется тщательно контролировать содержание калия в плазме крови (см. раздел \"Взаимодействие с другими лекарственными средствами)."}},{"type":"paragraph","data":{"text":"Этнические отличия"}},{"type":"paragraph","data":{"text":"Ингибиторы АПФ, телмисартан и другие АРАII, по-видимому, менее эффективно снижают артериальное давление у пациентов негроидной расы, чем у представителей других рас, возможно, вследствие большей предрасположенности к снижению активности ренина в популяции данных пациентов."}},{"type":"paragraph","data":{"text":"Прочее"}},{"type":"paragraph","data":{"text":"Как и при применении других антигипертензивных средств, чрезмерное снижение уровня АД у пациентов, страдающих ишемической кардиомиопатией или ишемической болезнью сердца может приводить к развитию инфаркта миокарда или инсульта."}},{"type":"paragraph","data":{"text":"Влияние на способность управлять трансп. ср. и мех.:"}},{"type":"paragraph","data":{"text":"Специальных клинических исследований влияния препарата на способность управлять автомобилем и механизмами не проводилось. При управлении автомобилем и работе с механизмами, требующими повышенной концентрации внимания, следует соблюдать осторожность, так как на фоне приема телмисартана редко могут возникать головокружения и сонливость."}}]},{"id":19,"name":"Условия хранения","slug":"storage","body":[{"type":"paragraph","data":{"text":"При температуре не выше 25 °С."}},{"type":"paragraph","data":{"text":"Хранить в недоступном для детей месте!"}}]},{"id":20,"name":"Срок годности","slug":"expiry_date","body":[{"type":"paragraph","data":{"text":"2 года."}}]}],"source":null},"description_toggle":false,"short_description":"Фармакодинамика:Телмисартан - специфический антагонист рецепторов ангиотензина II (тип AT1), эффективный при приеме внутрь. Обладает высоким сродством к подтипу AT1 рецепторов ангиотензина II, через которые реализуется действие ангиотензина II. Вытесняет ангиотензин II из связи с рецептором, не обладая действием агониста в отношении этого рецептора. Телмисартан связывается только с подтипом AT1 рецепторов ангиотензина II. Связь носит длительный характер. Не обладает сродством к другим рецепторам, в том числе к АТ2 рецептору и другим, менее изученным рецепторам ангиотензина. Функциональное значение этих рецепторов, а также эффект их возможной избыточной стимуляции ангиотензином II, концентрация которого увеличивается при назначении телмисартана, не изучены. Снижает концентрацию альдостерона в крови, не ингибирует ренин в плазме крови и не блокирует ионные каналы. Телмисартан не ингибирует ангиотензинпревращающий фермент (кининаза II) (фермент, который также разрушает брадикинин). Поэтому усиления побочных эффектов, вызываемых брадикинином, не ожидается. У пациентов с артериальной гипертензией телмисартан в дозе 80 мг полностью блокирует гипертензивное действие ангиотензина II. Начало антигипертензивного действия отмечается в течение 3-х часов после первого приема телмисартана внутрь. Действие препарата сохраняется в течение 24 часов и остается значимым до 48 часов. Выраженный антигипертензивный эффект обычно развивается через 4 недели после регулярного приема препарата. У пациентов, страдающих артериальной гипертензией, телмисартан снижает систолическое и диастолическое артериальное давление (АД), не оказывая влияния на частоту сердечных сокращений (ЧСС). В случае резкой отмены телмисартана АД постепенно возвращается к исходному уровню без развития синдрома \"отмены\".Фармакокинетика:Всасывание При приеме внутрь быстро всасывается из желудочно-кишечного тракта. Биодоступность составляет около 50 %. При приеме одновременно с пищей снижение AUC (площадь под кривой \"концентрация-время\") колеблется от 6 % (при дозе 40 мг) до 19 % (при дозе 160 мг). Спустя 3 часа после приема, концентрация в плазме крови выравнивается независимо от приема пищи. Распределение Связь с белками плазмы крови - 99,5 %, в основном с альбумином и альфа-1 гликопротеином. Среднее значение видимого объема распределения в равновесной концентрации - 500 л. Метаболизм Метаболизируется путем конъюгирования с глюкуроновой кислотой. Метаболиты фармакологически неактивны. Выведение Период полувыведения (Т1/2) - более 20 час. Выводится через кишечник в неизмененном виде, выведение почками - менее 2 % от принятой дозы. Общий плазменный клиренс высокий (900 мл/мин) по сравнению с \"печеночным кровотоком\" (около 1500 мл/мин).Фармакокинетика у особых групп пациентовГендерные различия Наблюдается разница в плазменных концентрациях у мужчин и женщин. Сmах (максимальная концентрация) и AUC были приблизительно в 3 и 2 раза, соответственно, выше у женщин по сравнению с мужчинами без значимого влияния на эффективность. Коррекции доз не требуется. Пожилые пациенты Фармакокинетика телмисартана у пациентов пожилого возраста не отличается от фармакокинетики у молодых пациентов. Коррекции доз не требуется. Пациенты с нарушением функции почек У пациентов с легким и умеренным нарушением функции почек коррекции дозы телмисартана не требуется. Пациентам с тяжелой почечной недостаточностью и пациентам, находящимся на гемодиализе, рекомендована более низкая начальная доза - 20 мг в сутки. Телмисартан не выводится с помощью гемодиализа. Пациенты с нарушением функции печени Исследования фармакокинетики у пациентов с печеночной недостаточностью показали увеличение абсолютной биодоступности телмисартана практически до 100 %. При печеночной недостаточности Т1/2 не изменяется. У пациентов с легкими и умеренными нарушениями функции печени (класс А и В по шкале Чайлд-Пью) суточная доза препарата не должна превышать 40 мг.","substance":[{"id":697,"title":"Телмисартан","title_latin":"Telmisartanum","slug":"telmisartan_697"}],"branding":null,"valid_for_quick_buy":true,"is_available_to_delivery":false,"comments":null,"image_alt":"Телпрес - фото упаковки","image_share":{"isTouch":{"default":"https://vseapteki.ru/cropping/thumbnails/101/70099/share_default/"},"isFromTablet":{"default":"https://vseapteki.ru/cropping/thumbnails/101/70099/share_default/"}},"diseases":[],"other_packages":[{"id":126618,"title":"Телпрес","subtitle":{"full":"Таблетки, коробка, 28 шт, 20 мг, для приема внутрь","short":"Таблетки, 28 шт, 20 мг","package":"28 шт, 20 мг"},"prescription":true,"catalog_section_id":117,"manufacturer":{"id":3382,"title":"Laboratorios Liconsa, 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