ICarvedilol vs.metoprolol: Umehluko, ukufana, nokuthi yikuphi okungcono kuwe
Izidakamizwa Vs. UmnganiUkubuka konke kwezidakamizwa nokwehluka okuyinhloko | Izimo zilashwa | Ukusebenza | Ukutholakala komshuwalense nokuqhathaniswa kwezindleko | Okuqhamuka uma udla imishanguzo | Ukusebenzisana kwezidakamizwa | Izexwayiso | Imibuzo evame ukubuzwa
I-Carvedilol ne-metoprolol yimithi kadokotela esetshenziselwa ukwelapha umfutho wegazi ophakeme (umfutho wegazi ophezulu) nezinkinga zenhliziyo, njengokuhluleka kwenhliziyo. Le mithi ingasetshenziselwa ukunciphisa ingozi yokufa ngemuva kokuhlaselwa yinhliziyo (i-myocardial infarction).
Kokubili i-carvedilol ne-metoprolol kubhekwa njenge beta-blocker , eyaziwa nangokuthi ama-beta-adrenergic block agents. Zisebenza ngokuvimba ama-beta receptors, avimba imiphumela ye-norepinephrine ne-epinephrine enhliziyweni nasemithanjeni yegazi. Ama-beta-blocker asiza ukwehlisa umfutho wegazi nokushaya kwenhliziyo kancane ukukhulula ukucindezeleka enhliziyweni.
I-Carvedilol ne-metoprolol yimithi ejwayelekile. Yize babelana ngokufana, futhi banokuhluka kwesilinganiso, ukwakheka, kanye nemiphumela emibi.
Uyini umehluko omkhulu phakathi kwe-carvedilol ne-metoprolol?
ICarvedilol ibhekwa njenge-beta-blocker engakhethi. Lokhu kusho ukuthi i-carvedilol ingavimba womabili ama-beta-1 receptors kanye ne-beta-2 receptors. Ama-beta-1 receptors atholakala enhliziyweni ngenkathi ama-beta-2 receptors atholakala ngokuyinhloko emisipheni ebushelelezi. ICarvedilol ibuye ivimbe ama-alpha receptors emithanjeni yegazi, esiza ukwehlisa umfutho wegazi.
ICarvedilol yigama elijwayelekile likaCoreg. Imvamisa ithathwa njenge-3.125 mg, 6.25 mg, 12.5 mg, noma i-25 mg tablet yomlomo kabili ngosuku. ICarvedilol iyatholakala nangefomu ekhishwe isikhathi eside (i-Coreg CR) engathathwa kanye nsuku zonke.
IMetoprolol iyi-block-1 blocker ekhethiwe evimba kakhulu ama-beta-1 receptors enhliziyweni. Kodwa-ke, ibuye ivimbe ama-beta-2 receptors, yize esezingeni elincane. Ama-beta-blocker akhethiwe angaba nemiphumela ehluke kancane ngokuqhathaniswa ne-beta-blockers engakhethisi.
IMetoprolol iza ngezindlela ezimbili ezihlukene zikasawoti: i-metoprolol tartrate ne-metoprolol succinate . I-Metoprolol tartrate, eyaziwa nangokuthi igama elithi Lopressor, iyithebhulethi yomlomo ekhishwa ngokushesha eza ngamandla ka-25 mg, 37.5 mg, 50 mg, 75 mg, no-100 mg. I-Metoprolol succinate, eyaziwa nangokuthi igama lomkhiqizo iToprol XL, iyithebhulethi yomlomo ekhishwa enwetshiwe eza ngamandla ka-25 mg, 50 mg, 100 mg, no-200 mg.
OKUSHIWO: I-Metoprolol vs. Atenolol
| Umehluko omkhulu phakathi kwe-carvedilol ne-metoprolol | ||
|---|---|---|
| ICarvedilol | I-Metoprolol | |
| Isigaba sezidakamizwa | I-beta-blocker | I-beta-blocker |
| Isimo somkhiqizo / ejwayelekile | Uhlobo lomkhiqizo nolwejwayelekile luyatholakala | Uhlobo lomkhiqizo nolwejwayelekile luyatholakala |
| Ngubani igama lomkhiqizo? | I-Coreg (ukukhishwa ngokushesha) I-Coreg CR (ukukhishwa okunwetshiwe) | I-Lopressor (ukukhishwa ngokushesha) I-Toprol XL (ukukhishwa okunwetshiwe) |
| Izidakamizwa zingena ngaziphi izinhlobo? | Ithebhulethi yomlomo | Ithebhulethi yomlomo |
| Uyini umthamo ojwayelekile? | ICarvedilol (ukukhishwa ngokushesha): 25 mg kabili ngosuku I-Carvedilol (ukukhululwa okunwetshiwe): 10 kuya ku-80 mg kanye ngosuku Isilinganiso sincike esimweni esiphethwe | I-Metoprolol tartrate (ukukhishwa ngokushesha): 50 kuya ku-100 mg kabili ngosuku I-Metoprolol succinate (enwetshiwe-ukukhishwa): 25 kuya ku-100 mg kanye ngosuku Isilinganiso sincike esimweni esiphethwe |
| Yelashwa isikhathi esingakanani? | Isikhati eside | Isikhati eside |
| Ubani ovame ukusebenzisa umuthi? | Abantu abadala | Abantu abadala |
Izimo eziphathwe yi-carvedilol ne-metoprolol
Kokubili i-carvedilol ne-metoprolol succinate kuvunyelwe i-FDA ukwelapha ukwehluleka kwenhliziyo okubangelwa ischemia, umfutho wegazi ophakeme, noma i-cardiomyopathy. Bobabili ama-beta-blockers nawo avunyelwe ukwelapha umfutho wegazi ophezulu.
Ama-beta-blockers ajwayele ukusetshenziswa ngaphezu kweminye imithi efana nayo i-angiotensin-converting enzyme (ACE) inhibitors kanye nomchamo. Ukwehlisa umfutho wegazi we-systolic noma we-diastolic kungasiza ekwehliseni ubungozi bomcimbi wenhliziyo njengokuhlaselwa yinhliziyo noma isifo sohlangothi.
ICarvedilol ne-metoprolol kungasetshenziswa ukunciphisa ubungozi bokugula nokufa kulandela ukumelwa yinhliziyo . Le mithi futhi ingaphatha ukungasebenzi kahle kwe-ventricular ngemuva kwesifo senhliziyo.
Yomibili le mithi ingasetshenziselwa ukwelapha i-angina pectoris, noma ubuhlungu besifuba, obudalwa yisifo senhliziyo. I-Carvedilol noma i-metoprolol ingahle inqunyelwe ukunciphisa ukuhlaselwa kwe-angina futhi ithuthukise amakhono okuzivocavoca kulabo abanesifo senhliziyo noma ukwehluleka kwenhliziyo.
Ukusetshenziswa okungekho kwelebula kwe-carvedilol ne-metoprolol kufaka phakathi ukwelashwa kwama-arrhythmias, noma isigqi senhliziyo esingajwayelekile, njenge-atrial fibrillation.
| Isimo | ICarvedilol | I-Metoprolol |
| Ukwehluleka kwenhliziyo | Yebo | Yebo |
| Umfutho wegazi ophezulu | Yebo | Yebo |
| I-infarction ye-myocardial | Yebo | Yebo |
| Angina pectoris | Ngaphandle kwelebula | Yebo |
| I-Arrhythmia | Ngaphandle kwelebula | Ngaphandle kwelebula |
Ingabe i-carvedilol noma i-metoprolol isebenza kangcono?
I- ICarvedilol noma iMetoprolol European Trial (I-COMET) bekuyisilingo esilawulwa ngokungahleliwe esiqhathanisa i-carvedilol ne-metoprolol ezigulini ezinokuhluleka kwenhliziyo okungamahlalakhona. Icala lenziwa cishe eminyakeni emihlanu ezigulini ezingaphezu kwe-1,500. Imiphumela, eyashicilelwa kufayela le- I-Lancet , ikhombise ukufa kwezimbangela ezingama-34% ze-carvedilol kuqhathaniswa ne-40% ye-metoprolol. Ngamanye amagama, i-carvedilol itholakale ikhulisa ukusinda ezigulini zokwehluleka kwenhliziyo ngaphezu kwe-metoprolol.
Ucwaningo lokuqhathanisa lwango-2021 oluvela ku- Ijenali YaseMelika Yezenhliziyo kutholakale ukuthi awukho umehluko ophawulekayo emazingeni okusinda ngemuva kokuhlaselwa yinhliziyo nge-carvedilol kuqhathaniswa ne-metoprolol ezigulini ezinengxenyenamba yokukhipha i-ventricular kwesobunxele engaphezu kwama-40%. Kodwa-ke, kulabo abanengxenyenamba yokukhipha i-ventricular engaphansi kuka-40%, i-carvedilol ingaba i-beta-blocker ephumelela kakhulu.
Ngokuya nge- ukuhlaziywa kwe-meta , i-carvedilol ne-metoprolol ziyafana ngokusebenza uma zisetshenziswa ngemuva kokuhlaselwa yisifo senhliziyo. Uma kuqhathaniswa ne-placebo, bobabili ama-beta-blockers atholakele ukunciphisa kakhulu imicimbi yenhliziyo nokuhlasela kwenhliziyo okwalandela. Kodwa-ke, azikho izinzuzo ezibalulekile ekufeni konke, ukuvuselelwa kwemithambo yegazi, kanye nokulaliswa esibhedlela okutholakale i-carvedilol noma i-metoprolol.
Kokubili i-carvedilol ne-metoprolol kungaba izinketho zokwelashwa ezisebenzayo . Ukwelashwa kungahle kwenziwe kube ngokwakho ngokuya ngesimo esiphethwe, imiphumela emibi engaba khona, nezindleko. Xhumana nomhlinzeki wezokunakekelwa kwempilo mayelana nokwelashwa okungcono kakhulu kuwe.
Ukuhlanganisa kanye nokuqhathanisa izindleko kwe-carvedilol vs. metoprolol
ICarvedilol imbozwe yizinhlelo eziningi zeMedicare nezomshuwalense. I-copay izoncika kwifomula yecebo nokuhlanganiswa. Intengo emaphakathi yemali ye-carvedilol icishe ibe ngama- $ 160. Ngisho nomshwalense, i-carvedilol ingabiza. Ukusebenzisa ikhadi lesaphulelo le-SingleCare le-carvedilol kungakwazi ukwehlisa izindleko eziphuma ephaketheni ziye ku- $ 5.
IMetoprolol ibuye imbozwe yizinhlelo eziningi zeMedicare nezomshuwalense. Thintana nosokhemisi wakho noma uhlelo lomshuwalense ukuthola ukuthi ngabe ipayipi le-metoprolol lingaba yini. Intengo emaphakathi yemali ye-metoprolol icishe ibe yi- $ 168. Ikhadi lesaphulelo le-SingleCare le-metoprolol tartrate noma i-metoprolol succinate lingakusiza ukuthi wonge kakhulu ezindlekweni zomuthi.
| ICarvedilol | I-Metoprolol | |
| Ngokuvamile embozwe umshwalense? | Yebo | Yebo |
| Imbozwe ngokujwayelekile yi-Medicare Part D? | Yebo | Yebo |
| Ubuningi | Amaphilisi angama-60 (6.25 mg) | Amaphilisi angama-60 (25 mg) |
| I-Medicare copay ejwayelekile | $ 0– $ 15 | $ 0– $ 65 |
| Izindleko ze-SingleCare | $ 4 + | $ 4 + |
Imiphumela emibi ejwayelekile ye-carvedilol vs. metoprolol
ICarvedilol ne-metoprolol babelana ngemiphumela efanayo efanayo. Imiphumela emibi kakhulu ye-carvedilol yisiyezi, ukukhathala, ubuthakathaka, umfutho wegazi ophansi (i-hypotension), isifo sohudo, ushukela ophakeme wegazi (i-hyperglycemia), ukushaya kwenhliziyo okuhamba kancane (i-bradycardia), nokuzuza kwesisindo. Imiphumela emibi kakhulu yokukhathala kwe-metoprolol, isiyezi, isifo sohudo, ukulunywa nokudangala.
Imiphumela emibi kakhulu ye-carvedilol ne-metoprolol kungenzeka, njengokuphikisana negazi, umfutho ophansi wegazi oyingozi, kanye ne-bronchospasms noma ukuphefumula okuncane. Funa usizo lwezokwelashwa ngokushesha uma uhlangabezana nokuqubuka okukhulu, ukuvuvukala, noma ukuphefumula kanzima ngemuva kokuthatha i-carvedilol noma i-metoprolol.
| ICarvedilol | I-Metoprolol | |||
| Umphumela oseceleni | Kusebenza? | Imvamisa | Kusebenza? | Imvamisa |
| Isiyezi | Yebo | 32% | Yebo | 10% |
| Ukukhathala | Yebo | 24% | Yebo | 10% |
| I-Hypotension | Yebo | 9% | Yebo | 1% |
| Uhudo | Yebo | 12% | Yebo | 5% |
| I-Hyperglycemia | Yebo | 12% | Yebo | * |
| Ubuthakathaka | Yebo | 7% | Yebo | 10% |
| Ukushaya kwenhliziyo kuhamba kancane | Yebo | 9% | Yebo | 3% |
| Ukuzuza kwesisindo | Yebo | 10% | Yebo | * |
| Ukuphelelwa umoya | Yebo | * | Yebo | 3% |
| Imikhawulo ebandayo | Akunjalo | - | Yebo | 1% |
| Ukucindezeleka | Yebo | <1% | Yebo | 5% |
| Ukulunywa | Yebo | <1% | Yebo | 5% |
* akubikiwe
Ukuvama akususelwa kudatha evela esivivinyweni sekhanda kuya ekhanda. Lokhu kungenzeka kungabi uhlu oluphelele lwemiphumela emibi engenzeka. Sicela ubheke udokotela wakho noma umhlinzeki wezokunakekelwa kwempilo ukuze ufunde kabanzi.
Umthombo: DailyMed ( ICarvedilol ), IDailyMed ( I-Metoprolol )
Ukusebenzisana kwezidakamizwa kwe-carvedilol kuqhathaniswa ne-metoprolol
Kokubili i-carvedilol ne-metoprolol kunganciphisa umfutho wegazi nokushaya kwenhliziyo okuhamba kancane. Ngakho-ke, bangakwazi ukuxhumana neminye imithi enemiphumela efanayo. Kokubili i-carvedilol ne-metoprolol, njengabaningi be-beta-blockers, bangasebenzisana nama-ejenti wehlisa umfutho wegazi, i-monoamine oxidase inhibitors (MAOIs), kanye ne-calcium channel blockers. Ukuthatha le mithi ndawonye kungakhuphula ingozi yomfutho wegazi ophansi okuyingozi noma ukwehlisa izinga lokushaya kwenhliziyo.
I-Carvedilol ne-metoprolol zicutshungulwa kakhulu esibindi yi-enzyme ye-CYP2D6. Izidakamizwa ezivimbela le enzyme zingasebenzisana ne-carvedilol ne-metoprolol, okungaholela emazingeni akhuphukile e-carvedilol noma i-metoprolol. Ukukhuphuka kwamazinga egazi e-carvedilol noma i-metoprolol kungaholela engcupheni yemiphumela emibi.
Ama-beta blockers angakhuphula imiphumela yokwehlisa ushukela egazini yemithi yomlomo ye-hypoglycemic efana ne-glipizide, metformin, noma i-insulin. Ukuqapha kufanele kululeke uma le mithi ithathwa ndawonye.
Bona ithebula elingezansi ukuthola okunye ukuxhumana kwezidakamizwa okungenzeka.
| Izidakamizwa | Isigaba sezidakamizwa | ICarvedilol | I-Metoprolol |
| Clonidine IGuanethidine Hlanganisa kabusha | Ama-alpha-adrenergic agents | Yebo | Yebo |
| USelegiline Isocarboxazid I-Phenelzine | I-Monoamine oxidase inhibitors (MAOIs) | Yebo | Yebo |
| Amlodipine Nifedipine | Ama-block block wesiteshi seCalcium | Yebo | Yebo |
| I-Fluvoxamine I-Fluoxetine I-chlorpromazine I-Quinidine I-Ritonavir I-Terbinafine | I-CYP2D6 inhibitors | Yebo | Yebo |
| IGlipizide I-Metformin I-Rosiglitazone Sitagliptin | Ama-hypoglycemics omlomo | Yebo | Yebo |
| I-Dihydroergotamine I-Ergotamine | Ama-alkaloids atholakalayo | Yebo | Yebo |
| I-Hydralazine | Ama-Vasodilators | Yebo | Yebo |
| I-Digoxin | Ama-glycosides enhliziyo | Yebo | Yebo |
| ICyclosporine | Ama-immunosuppressants | Yebo | Yebo |
| I-Dipyridamole | Ama-Platelet inhibitors | Yebo | Yebo |
Thintana nochwepheshe wezokunakekelwa kwempilo mayelana nokunye ukuxhumana kwezidakamizwa okungenzeka
Izexwayiso nge-carvedilol ne-metoprolol
Ama-beta blockers akufanele amiswe ngokungazelelwe. Esikhundleni salokho, kufanele bathathwe kancane kancane ukuze banciphise amanani. Kungaba nobungozi obandayo bokugula komthambo we-coronary, i-angina, i-myocardial infarction, ne-ventricular arrhythmias ngemuva kokuyekisa ngokungazelelwe i-beta-blocker.
Ama-beta blockers angazifihla izimpawu ze-hypoglycemia noma i-hyperthyroidism , njengokushaya kwenhliziyo okusheshayo. Iziguli ezinesifo sikashukela kanye nalabo abanezinkinga ze-thyroid bangadinga ukusebenzisa ukuqaphela ngama-beta-blockers.
Kokubili i-carvedilol ne-metoprolol kuthwala izexwayiso ze-bronchospasm, ikakhulukazi kulabo abanesifo esingapheliyo se-pulmonary disease (COPD) noma ezinye izinkinga zokuphefumula. Noma kunjalo, izifundo kukhombisile ukuthi ama-beta-blockers empeleni anganciphisa ukukhushulwa futhi akhulise ukusinda kulabo abane-COPD.
Tshela umhlinzeki wakho wezokunakekelwa kwempilo uma unomlando wokwehluleka kwenhliziyo ukuminyana, i-asthma, ukushaya kwenhliziyo okuhamba kancane, izinkinga zesibindi, noma ukusabela okweqile kokungezwani komzimba nezithako ze-carvedilol noma i-metoprolol. Xhumana nomhlinzeki wezokunakekelwa kwempilo ukuthola ezinye izexwayiso kanye nezinyathelo ezihlobene nokusetshenziswa kwe-carvedilol noma i-metoprolol.
Imibuzo ebuzwa njalo mayelana ne-carvedilol vs. metoprolol
Yini i-carvedilol?
ICarvedilol umuthi we-beta-blocker osetshenziselwa ukwelapha ukwehluleka kwenhliziyo nomfutho wegazi ophezulu. Ingasetshenziselwa ukwandisa ukusinda ngemuva kokuhlaselwa yinhliziyo. ICarvedilol iza ngamafomu akhishwa ngokushesha futhi enwetshiwe. Kwakuyi-FDA evunyelwe ngo-1995.
Yini i-metoprolol?
IMetoprolol ngumuthi we-beta-blocker ongelapha ukwehluleka kwenhliziyo, umfutho wegazi ophakeme kanye nobuhlungu besifuba obungapheli. I-Metoprolol succinate, ifomu lokukhishwa elandisiwe le-metoprolol nalo livunyelwe yi-FDA ukwelapha ukwehluleka kwenhliziyo. I-metoprolol ekhishwa ngokushesha iqukethe i-metoprolol tartrate. IMetoprolol ekuqaleni yayigunyazwe yi-FDA ngo-1978.
Ngabe i-carvedilol ne-metoprolol ziyefana?
Kokubili i-carvedilol ne-metoprolol kungama-beta-adrenergic receptor blockers, noma ama-beta-blockers. Zombili zisetshenziselwa ukwelapha ukwehluleka kwenhliziyo okungapheli nomfutho wegazi ophezulu. Noma kunjalo, ziqukethe izithako ezahlukahlukene ezisebenzayo futhi zisebenza ngezindlela ezihluke kancane. ICarvedilol iyi-beta-blocker engakhethi futhi i-metoprolol iyi-beta-1 blocker ekhethiwe ye-beta-block.
Ngabe i-carvedilol noma i-metoprolol ingcono?
ICarvedilol ne-metoprolol yomibili imishanguzo esebenza kahle kakhulu uma iqhathaniswa ne-placebo. ICarvedilol ingaba ngcono ezigulini ezithile ezinokwehluleka kwenhliziyo, ngokusho kwe Isivivinyo se-COMET . I-Carvedilol ne-metoprolol ngokufanayo ziyasebenza ekwandiseni ukusinda ngemuva kokuhlaselwa yinhliziyo. Imihlahlandlela kusuka e-American College of Cardiology (ACC) kanye neAmerican Heart Association (AHA) bancoma ukusetshenziswa kwe-carvedilol, metoprolol succinate, noma i-bisoprolol yeziguli ezinokwehluleka kwenhliziyo ezinengxenyenamba ye-ejection encishisiwe. Xhumana nomhlinzeki wezokunakekelwa kwempilo ngenketho engcono yokwelashwa yesimo sakho esithile.
Ngingasebenzisa i-carvedilol noma i-metoprolol ngenkathi ngikhulelwe?
Ama-beta blockers angama evame ukusetshenziswa kwabesifazane abakhulelwe abanezimo zenhliziyo. Kodwa-ke, abukho ubufakazi obukhombisa ukuthi ama-beta-blocker aphephe ngokuphelele noma ayingozi ngesikhathi sokukhulelwa. Kokubili i-carvedilol ne-metoprolol kungathwala ingozi yokulimala kwengane. Xhumana nomhlinzeki wezokunakekelwa kwezempilo ngezeluleko ngaphambi kokuba usebenzise i-beta-blocker ngesikhathi ukhulelwe.
Ngingasebenzisa i-carvedilol noma i-metoprolol ngotshwala?
Kungaba nengozi eyengeziwe yemiphumela emibi lapho kuhlanganiswa i-beta-blocker notshwala. Ukuthatha i-carvedilol noma i-metoprolol ngotshwala kungakhuphula ubungozi bokuzela, isiyezi, nomfutho wegazi ophansi. Utshwala bunganciphisa nokusebenza kwe-beta-blockers.
Ingabe i-carvedilol yehlisa umfutho wegazi ngaphezu kwe-metoprolol?
ICarvedilol yehlisa umfutho wegazi ngaphezu kwe-metoprolol. Lokhu kungenxa yokuthi i-carvedilol inezakhiwo ze-vasodilating ezisiza ukukhulula imithambo yegazi nokwehlisa umfutho wegazi. Azikho izifundo eziqhathanise ngqo imiphumela yokwehlisa umfutho wegazi we-carvedilol ne-metoprolol. Noma kunjalo, i-carvedilol ingasiza ukuvimbela imicimbi yenhliziyo ngaphezu kwe-metoprolol ezigulini ezine-hypertensive.
Ungashintsha kusuka ku-metoprolol uye ku-carvedilol? / Kuphephile yini ukushintsha ama-beta blocker?
Ngokuvamile kuphephile ukushintsha ama-beta-blockers uma kudingeka noma njengoba kunconywe ngumhlinzeki wezokunakekelwa kwempilo. Ngokuya nge-beta-blocker, iswishi ingashesha noma umthamo we-beta-blocker wokuqala ungasuswa ebeleni ngenkathi umthamo we-beta-blocker omusha ukhuphuka kancane kancane ube ngumthamo ohlosiwe. Ukuvakasha kokulandelela kungadingeka ukuhlola ukusebenza kwe-beta-blocker entsha.
Yini indawo enhle ye-carvedilol?
Ukushintshwa okungcono kakhulu kwe-carvedilol kuzoya ngesimo esiphethwe. Kunemithi emibili kuphela evunyelwe yi-FDA yokwelapha ukwehluleka kwenhliziyo ngaphandle kwe-carvedilol: i-bisoprolol ne-metoprolol succinate. Ezinye izibonelo ze-beta-blockers zifaka i-atenolol, i-nebivolol ne-propranolol.
Ingabe kukhona i-beta blocker engcono kune-metoprolol?
Ezinye izindlela ezingaba khona ze-metoprolol succinate yokwelapha ukwehluleka kwenhliziyo zifaka i-bisoprolol ne-carvedilol. I-beta blocker engcono izosebenza kangcono kuwe. Ezinye izinto zingadlala indima ekukhetheni i-beta blocker, njengezindleko, imiphumela emibi, neminye imishanguzo ongayisebenzisa.
