---------------------------------------------------------------
 详细处方信息以本药内容附件PDF文件（2011112118150519.pdf）的“原文Priscribing Information”为准
---------------------------------------------------------------
部分中文博脈舒处方资料（仅供参考）

商品名：BLOPRESS 8MG

中文名：博脈舒錠

健保局藥理類別：心臟用藥

孕婦用藥分級
C 級：
在對照的動物研究試驗中顯示該藥學物對胚胎有不良反應（致畸胎性或殺胚胎性或其他），但未進行人體懷孕婦女研究；或者尚無對照的人體懷孕婦女或動物研究試驗。只有在可能的利益大於潛在的危險，才可使用此藥物。

結構式 
3-((2'-(2H-tetrazol-5-yl)biphenyl-4-yl)methyl)-2-ethoxy-3H-benzo[d]imidazole-4-carboxylic acid
 
藥理作用 
1. 本品是一種前驅藥(prodrug)，適於口服。在胃腸道吸收時，經酯化水解會迅速轉變成活性物(Candesartan)，Candesartan是一種angiotensin Ⅱ接受體拮抗劑，選擇性的與AT₁接受體緊密結合且緩慢地分離。它對angiotensin Ⅱ接受體並無作用劑(agonist)的活性。
2. Candesartan不會抑制ACE，亦不影響bradykinin和substance P。在以ACE抑制劑為對照組的比較性臨床試驗中，使用本品的患者其咳嗽的發生率較低。另外Candesartan不會與其他荷爾蒙接受體結合，或是阻斷與心血管調節有關的重要離子通道。對Angiotensin Ⅱ(AT₁)接受體的拮抗作用與劑量有關，會增加血中renin、angiotensin Ⅰ和angiotensin Ⅱ值，也會使血中aldosterone濃度降低。
3. 以高血壓而言，本品具劑量相關(dose-dependent)且持續降低動脈血壓的作用。而其降壓作用是由於全身周邊阻力降低且沒有反射性心跳增加。同時也無首次劑量導致嚴重或過度降低血壓或停藥後有反跳性(rebound)增高血壓的作用。
4. 婦女用藥安全等級:D-在妊娠第二及第三期使用
 
適應症 
本態性高血壓。
 
用法用量 
本品口服1天1次，建議初劑量由4mg開始，通常維持劑量為8mg，最大劑量可至16mg。可依其臨床反應來調整劑量，一般在開始治療後四週內可達穩定或最大降壓藥效。本品可空腹服用或與食物併服。
 
藥動力學 
1. 本品單一劑量給藥，其降壓的起始作用(onset)在2小時內發生，以任何劑量繼續治療下，通常最大降壓效困可於四週內達到；長期治療下，可持續降壓。本品一天一次，可提供持續24小時有效、穏定的降壓作用，在此給藥間隔下，最大藥效和投藥後24小時(trough)藥效，幾無差異。
2. Blopress口服投予生體可用率約15%，吸收不受食物影響。半衰期約為9小時，其血清中蛋白結合率大於99% ， 肝、腎排除分別為67%及33%。
 
副作用 
副作用通常輕微且短暫，其發生率和劑量、年齡無關。常見副作用有頭痛、上呼吸道感染、背痛、昏眩、噁心、咳嗽、流行性感冒樣症狀、疲勞、腹痛、下痢、咽炎、末梢水腫、嘔吐、支氣管炎及鼻炎。
 
交互作用 
1. 和其他降血壓藥物併用，本品的降壓作用可能會增加。
2. 基於其他會影響RAAS的藥物之臨床使用經驗，當與保鉀利尿劑、鉀補充劑、含鉀離子之代鹽或其他可能增加血鉀值的藥物(如heparin)併用時，可能會使血鉀值增加。
3. 當ACEI和鋰劑併用時，曾有血鋰值可逆性增加和毒性出現的報告。雖然本品仍未見相關報告，但上述副作用發生的可能性無法被排除。故與鋰劑併用時，建議應小心監測患者之血鋰值。
4. Candesartan生體可用率不受食物影響。
 
禁忌 
(1)對本品成份過敏者。(2)孕婦及授乳婦。(3)嚴重肝功能不全者或膽汁鬱滯者。
 
注意事項 
1. 腎動脈狹窄：其他會影響renin-angiotensin-aldosterone system(RAAS)的藥物(如ACE inhibitors)，對兩側腎動脈狹窄或單腎且腎動脈狹窄的患者，可能會使血清肌酸酐(creatinine)或血中尿素氮增加。雖然本品至今未有相關報告，但angiotensin Ⅱ接受體拮抗劑可能會有類似現象發生。
2. 血管內血液量不足：和作用在RAAS的其他藥物類似，對血管內血液量不足的患者(如以高劑量利尿劑治療)，可能會發生有症狀之低血壓。因此在服用本品前應先矯正此情形。
3. 腎功能不全：本品使用於重度腎功能不全者，應考慮定期監測血鉀值和血清肌酸酐(creatinine)濃度。對於重度或末期腎功能不全者[肌酸酐廓清率(Clcreatinine)＜15ml/min]之臨床使用經驗有限。
4. 主動脈瓣、僧帽瓣狹窄(及阻塞肥厚性心肌病變)：如其他血管擴張劑，對主動脈瓣狹窄、僧帽瓣狹窄及阻塞性肥厚性心肌病變者，應特別小心使用。
5. 原發性皮質醛酮分泌過多症(Primary hyperaldosteronism)：罹患原發生皮質醛酮分泌過多症的病人，通常對具有RAAS抑制作用的降血壓藥物無反應。因此，對此類患者本品不建議使用。
6. 高血鉀症：基於其他作用於RAAS的藥物之臨床使用經驗，當與保鉀利尿劑、鉀補充劑、含鉀離子之代鹽或其他可能增加血液鉀值的藥物(如heparin)併用時，可能會引起血鉀值增加。
 
藥品保存方式 
藥品應置於攝氏 15 ~ 25 度乾燥處所；如發生變質或過期，不可再食用。

• Molecular formula of blopress is C24H20N6O3
• Chemical IUPAC Name is 2-ethoxy-3-[[4-[2-(2H-tetrazol-5-yl)phenyl]phenyl]methyl]-3H-benzoimidazole-4-carboxylicacid
• Molecular weight is 440.454 g/mol
• Blopress available : 4mg tablets, 8mg tablets, 16mg tablets, 32mg tablets

Blopress, an angiotensin II receptor antagonist, is used for the treatment of hypertension (high blood pressure). It works by blocking chemicals in the body that cause blood vessels to tighten. It also relaxes the blood vessels to help blood flow more freely throughout the body.

Blopress is used alone or in combination with other medications in the treatment of high blood pressure. It can be used to treat heart failure, as well. In one study, Blopress was shown to lower both mortality and morbidity rates in congestive heart failure.

Some medical conditions may interfere with Blopress treatment. Patients suffering from heart disease, kidney disorders, liver ailments or diabetes should let their doctor know before starting this medication. Patients should also inform their doctor if they have any food, medicine, or substance allergies, or low blood or sodium levels.

Taking Blopress during the first trimester of pregnancy can injure or even kill an unborn baby. Women who are pregnant, plan to become pregnant, or who become pregnant during the course of treatment must inform their doctor of their condition immediately. Doctors also advise patients to refrain from breastfeeding their infants during treatment, as Blopress can pass into breast milk and harm the nursing infant.

Prior to any surgery, patients should tell their doctor if they are taking Blopress. If they are allergic to Blopress or any of its ingredients, or are allergic to other medications, they should let their doctor know as well.

Taking Blopress with diuretics or lithium may aggravate the side effects. ACE inhibitors like captopril and potassium-sparing diuretics can increase the potassium levels in the blood when taken with Blopress. It is important for patients to let their doctor know what kinds of medications they are taking, whether prescription, over-the-counter medications, or any vitamin, mineral or herbal supplement, before they start taking Blopress.

Patients taking Blopress should refrain from driving or performing any activities that involve great amounts of risk. This is because the medication can cause dizziness. Consuming alcoholic beverages or taking medicines containing alcohol should be avoided as they can aggravate the symptoms of lightheadedness.

Within two weeks of beginning treatment, patients will experience a marked decrease in their blood pressure levels. If other blood pressure medication is taken in tandem with Blopress, they may also experience fatigue for the first few weeks after starting the medication.

Doctors may order regular laboratory testing, including monitoring of blood pressure levels, during Blopress treatment. This is to determine whether the medication has taken effect, or if there are any adverse side effects.

The usual side effects include dizziness, headaches, diarrhea, colds, sore throats, and other upper respiratory tract infections. If patients experience side effects that include rashes, hives, breathing difficulties, swelling of the facial areas, chest pain, fainting, fever and chills, irregular heartbeat, constant dizziness and jaundice, they are advised to seek emergency medical care immediately.

Blopress is a promedication manufactured by AstraZeneca and Takeda Pharmaceuticals. It is available under the brands Blopress, Atacand, Atacan02, Amias and Ratacand. It comes in 4 mg. round white tablets, and 8, 16 and 32 mg. round pink tablets.

Blopress should be taken according to the doctor's prescription, usually once or twice a day, with or without meals. While Blopress can control hypertension, it cannot totally eliminate it. It is a maintenance medication that should be taken regularly and patients are advised not to stop taking this medicine without first consulting their doctor. 

---------------------------------------------------------------
 详细处方信息以本药内容附件PDF文件（2011112118150519.pdf）的“原文Priscribing Information”为准
---------------------------------------------------------------