{"id":51987,"date":"2023-09-20T09:27:34","date_gmt":"2023-09-20T09:27:34","guid":{"rendered":"https:\/\/medsname.com\/vymada\/"},"modified":"2026-05-01T10:49:12","modified_gmt":"2026-05-01T10:49:12","slug":"vymada","status":"publish","type":"product","link":"https:\/\/medsbase.com\/ro\/product\/vymada\/","title":{"rendered":"Vymada"},"content":{"rendered":"<p><!-- medsbase-tldr-answer --><\/p>\n<div style=\"background:#fff8e1;border-left:4px solid #f5a623;padding:18px 22px;margin:0 0 24px 0;border-radius:4px;\">\n<h3 class=\"wp-block-heading\" style=\"margin:0 0 8px 0;font-size:16px;font-weight:700;\">\u26a1 R\u0103spuns rapid \u2014 Ce este Vymada?<\/h3>\n<p style=\"margin:0;\"><strong>Vymada<\/strong> este 50 \u0219i 100 mg <strong>sacubitril\/valsartan<\/strong> comprimate de la Novartis \u2014 un <strong>inhibitor al receptorului de angiotensin\u0103-neprilizin\u0103 (ARNI)<\/strong>. Componenta sacubitril inhib\u0103 neprilizina (o enzim\u0103 care degradeaz\u0103 peptidele natriuretice, bradikinina \u0219i adrenomedulina), stimul\u00e2nd calea benefic\u0103 vasodilatatoare \u0219i a peptidei natriuretice; componenta valsartan blocheaz\u0103 receptorul de angiotensin\u0103-II, prevenind vasoconstric\u021bia \u0219i re\u021binerea de sodiu indus\u0103 de aldosteron. <strong>Terapie de prim\u0103 inten\u021bie pentru HF-REF (FE \u226440%)<\/strong> conform ghidurilor ESC 2021 \u0219i AHA\/ACC 2022 \u2014 \u00eenlocuie\u0219te inhibitorul ACE sau ARB la majoritatea pacien\u021bilor stabili cu HF-REF (PARADIGM-HF 2014 a ar\u0103tat o sc\u0103dere cu 20% a deceselor cardiovasculare sau a spitaliz\u0103rilor pentru insuficien\u021b\u0103 cardiac\u0103 fa\u021b\u0103 de enalapril). Doz\u0103: 50 \u0219i 100 mg de dou\u0103 ori pe zi; titra\u021bi la fiecare 2-4 s\u0103pt\u0103m\u00e2ni p\u00e2n\u0103 la doza \u021bint\u0103 de 97\/103 mg de dou\u0103 ori pe zi. <strong>Contraindica\u021bie absolut\u0103 \u00een sarcin\u0103, istoric de angioedem\u0103 cu inhibitor ACE sau ARB \u0219i \u00een decurs de 36 de ore de la orice doz\u0103 de inhibitor ACE<\/strong> (este necesar\u0103 o perioad\u0103 de eliminare pentru a evita angioedemul).<\/p>\n<\/div>\n<div class=\"medsbase-trust-strip\" style=\"background:#f4f8fb;border:1px solid #d8e3eb;padding:12px 16px;margin:16px 0;border-radius:4px;font-size:14px;\">\n<strong>Ce beneficii ofer\u0103 MedsBase:<\/strong> Produc\u0103tor certificat WHO-GMP \u00b7 Ambalaj discret \u00b7 Livrare la nivel mondial \u00b7 Peste 1.400 de recenzii verificate <a href=\"https:\/\/medsbase.com\/ro\/reviews\/\">ale clien\u021bilor<\/a>\n<\/div>\n<p class=\"medsbase-reship-line\" style=\"font-size:14px;color:#444;margin:8px 0 18px;\">\ud83d\udce6 Fiecare comand\u0103 este acoperit\u0103 de politica noastr\u0103 de <a href=\"https:\/\/medsbase.com\/ro\/medsbase-re-shipment-assurance-policy\/\"><strong>Politica noastr\u0103 de Reexpediere Garantat\u0103<\/strong><\/a> \u2014 dac\u0103 coletul dumneavoastr\u0103 nu sose\u0219te \u00een 20 de zile lucr\u0103toare, \u00eel relivr\u0103m.<\/p>\n<h3>De ce s\u0103 comanzi de la MedsBase<\/h3>\n<p>Medicamentele noastre generice sunt procurate de la produc\u0103tori certifica\u021bi WHO-GMP \u0219i expediate la nivel mondial \u00een ambalaje discrete \u0219i simple \u2014 f\u0103r\u0103 denumirea medicamentului pe exteriorul coletului. Pl\u0103\u021bile cu cardul sunt procesate printr-un procesor reglementat (descrierile de pe extrasul de cont includ un procesor de pl\u0103\u021bi cu card reglementat \u2014 niciodat\u0103 \u201cMedsBase\u201d sau numele vreunui medicament). Accept\u0103m \u0219i criptomonede \u0219i transferuri bancare SEPA. Fiecare comand\u0103 este sus\u021binut\u0103 de Politica noastr\u0103 de Asigurare pentru Relivrare.<\/p>\n<h2 class=\"wp-block-heading\">Ce este Vymada?<\/h2>\n<p>Vymada sunt comprimate de 50 \u0219i 100 mg sacubitril\/valsartan de la Novartis, furnizate \u00een cutii de 28-84 de comprimate. Ini\u021bial Novartis Entresto (2015); primul inhibitor al receptorului de angiotensin\u0103-neprilizin\u0103 (ARNI).<\/p>\n<h2 class=\"wp-block-heading\">Cum func\u021bioneaz\u0103 ARNI<\/h2>\n<p>Dou\u0103 mecanisme complementare:<\/p>\n<ul>\n<li><strong>Sacubitril<\/strong> (un prodrug activat la LBQ657) inhib\u0103 <strong>neprilizina<\/strong>, o endopeptidaz\u0103 legat\u0103 de membran\u0103 care degradeaz\u0103 peptidele natriuretice (ANP, BNP, CNP), bradikinina \u0219i adrenomedulina. Inhibi\u021bia cre\u0219te nivelul acestor peptide benefice, produc\u00e2nd vasodilata\u021bie, naturiez\u0103, efecte antifibrotice \u0219i reducerea tonusului simpatic.<\/li>\n<li><strong>Valsartan<\/strong> blocheaz\u0103 receptorul AT de angiotensin\u0103-II<sub>1<\/sub> , prevenind vasoconstric\u021bia \u0219i re\u021binerea de sodiu indus\u0103 de aldosteron.<\/li>\n<li><strong>De ce \u00een combina\u021bie?<\/strong> Neprilizina degradeaz\u0103 \u0219i angiotensin-II; inhibarea izolat\u0103 a neprilizinei cre\u0219te astfel nivelul angiotensin-II. Combinarea cu un ARB previne aceast\u0103 problem\u0103. (O combina\u021bie anterioar\u0103, omapatrilat, \u00eembin\u0103 inhibarea neprilizinei cu inhibarea ACE \u0219i a provocat rate inacceptabile de angioedem \u2014 motiv pentru care ARNI utilizeaz\u0103 ARB \u00een loc de ACEi \u0219i de este necesar\u0103 \u00eentreruperea tratamentului cu inhibitori ACE \u00eenainte de trecerea la ARNI.)<\/li>\n<\/ul>\n<h2 class=\"wp-block-heading\">Dovezi<\/h2>\n<p><strong>PARADIGM-HF (2014)<\/strong> \u2014 8.442 de pacien\u021bi cu HF-REF (FE \u226440%) deja sub terapie medical\u0103 optim\u0103 randomiza\u021bi la sacubitril\/valsartan sau enalapril 10 mg de 2 ori pe zi. Oprit\u0103 prematur din cauza beneficiului: <strong>reducere cu 20% a deceselor cardiovasculare sau a spitaliz\u0103rilor pentru insuficien\u021b\u0103 cardiac\u0103<\/strong> (endpoint principal), reducere cu 16% a mortalit\u0103\u021bii din toate cauzele. Aceasta a fost prima terapie care a dep\u0103\u0219it un inhibitor ACE la doz\u0103 maxim\u0103 \u00een HF-REF. A stabilit ARNI ca terapie de prim\u0103 linie \u00een HF-REF \u00een ghidurile din 2016.<\/p>\n<p><strong>PARAGON-HF (2019)<\/strong> \u2014 4.822 de pacien\u021bi cu insuficien\u021b\u0103 cardiac\u0103 cu frac\u021bie de ejec\u021bie p\u0103strat\u0103 (HF-PEF, FE \u226545%); nu a atins endpointul principal (reducere de 13%, p=0,06), dar a eviden\u021biat beneficiu \u00een subgrupul cu FE 45-57%. FDA a aprobat o indica\u021bie mai larg\u0103 pentru HF \u00een 2021, inclusiv HF-PEF; ghidurile pozi\u021bioneaz\u0103 mai prudent ARNI \u00een HF-PEF c\u00e2nd FE este moderat redus\u0103.<\/p>\n<p><strong>TRANSITION \u0219i PIONEER-HF (2019)<\/strong> \u2014 ini\u021bierea ARNI \u00een timpul spitaliz\u0103rii pentru insuficien\u021b\u0103 cardiac\u0103 acut\u0103 este sigur\u0103 \u0219i determin\u0103 o reducere mai mare a NT-proBNP dec\u00e2t trecerea ulterioar\u0103 la acesta.<\/p>\n<h2 class=\"wp-block-heading\">Utiliz\u0103ri aprobate<\/h2>\n<ul>\n<li><strong>Insuficien\u021b\u0103 cardiac\u0103 cu frac\u021bie de ejec\u021bie redus\u0103 (HF-REF, EF \u226440%)<\/strong> \u2014 \u00eenlocuire de prim\u0103 inten\u021bie pentru inhibitor ACE sau ARB la majoritatea pacien\u021bilor<\/li>\n<li><strong>Insuficien\u021b\u0103 cardiac\u0103 cu frac\u021bie de ejec\u021bie p\u0103strat\u0103 sau u\u0219or redus\u0103<\/strong> \u2014 aprobat de FDA; pozi\u021bionarea \u00een ghiduri variaz\u0103 \u00een func\u021bie de subgrupul EF<\/li>\n<li>Ini\u021biere \u00een timpul spitaliz\u0103rii pentru insuficien\u021b\u0103 cardiac\u0103 acut\u0103 (TRANSITION, PIONEER-HF)<\/li>\n<\/ul>\n<h2 class=\"wp-block-heading\">Dozaj<\/h2>\n<p>Concentra\u021bii disponibile (mg sacubitril \/ mg valsartan):<\/p>\n<ul>\n<li>24\/26 mg (sc\u0103zut\u0103)<\/li>\n<li>49\/51 mg (moderat\u0103)<\/li>\n<li>97\/103 mg (\u021bint\u0103)<\/li>\n<\/ul>\n<p><strong>Titrarea tipic\u0103:<\/strong> \u00eencepe\u021bi cu 49\/51 mg de dou\u0103 ori pe zi la pacien\u021bii stabili pe inhibitor ACE sau ARB; \u00eencepe\u021bi cu 24\/26 mg de dou\u0103 ori pe zi la pacien\u021bii naive la inhibitor ACE, cu tensiune arterial\u0103 sc\u0103zut\u0103, insuficien\u021b\u0103 renal\u0103 sau peste 75 de ani. Titra\u021bi la fiecare 2-4 s\u0103pt\u0103m\u00e2ni p\u00e2n\u0103 la 97\/103 mg de dou\u0103 ori pe zi.<\/p>\n<p><strong>Regul\u0103 critic\u0103 la trecerea de la inhibitor ACE:<\/strong> <strong>asigura\u021bi o perioad\u0103 de sp\u0103lare de 36 de ore<\/strong> dup\u0103 ultima doz\u0103 de inhibitor ACE \u00eenainte de a \u00eencepe Vymada \u2014 inhibarea combinat\u0103 a ACEi + neprilisina cre\u0219te substan\u021bial riscul de angioedem. Nu este necesar\u0103 perioad\u0103 de sp\u0103lare la trecerea de la ARB.<\/p>\n<p><strong>Monitorizare:<\/strong> TA, potasiu, creatinin\u0103 la baz\u0103, la 1-2 s\u0103pt\u0103m\u00e2ni \u0219i la fiecare 3-4 luni. A\u0219tepta\u021bi-v\u0103 la o cre\u0219tere moderat\u0103 a creatininei (similar\u0103 cu ACEi\/ARB). NT-proBNP pentru monitorizarea r\u0103spunsului (not\u0103: BNP nu poate fi utilizat deoarece neprilisina degradeaz\u0103 BNP; utiliza\u021bi NT-proBNP care nu este substrat pentru neprilisina).<\/p>\n<h2 class=\"wp-block-heading\">Efecte Secundare<\/h2>\n<ul>\n<li><strong>Hipotensiune<\/strong> \u2014 mai mult dec\u00e2t inhibitorii ACE\/ARB singuri; limitare de doz\u0103 la mul\u021bi pacien\u021bi<\/li>\n<li><strong>Hiperkaliemie<\/strong> \u2014 monitoriza\u021bi potasiul<\/li>\n<li><strong>Cre\u0219terea creatininiei<\/strong> \u2014 a\u0219teptat\u0103, similar cu inhibitorii ACE\/ARB<\/li>\n<li><strong>Angioedem<\/strong> \u2014 rar\u0103 (~0,5%); mai frecvent\u0103 la pacien\u021bii de culoare<\/li>\n<li><strong>Tuse<\/strong> \u2014 mai rar\u0103 dec\u00e2t cu inhibitorii ACE<\/li>\n<li>Ameteal\u0103, oboseal\u0103, le\u0219in<\/li>\n<\/ul>\n<h2 class=\"wp-block-heading\">Contraindica\u021bii<\/h2>\n<ul>\n<li>Istoric de angioedem cu inhibitor ACE sau ARB<\/li>\n<li>Utilizare concomitent\u0103 a inhibitorului ACE sau \u00een decurs de 36 de ore de la ultima doz\u0103 de inhibitor ACE<\/li>\n<li>Sarcin\u0103 (teratogen \u2014 componenta valsartan)<\/li>\n<li>Afectare hepatic\u0103 sever\u0103 (Child-Pugh C)<\/li>\n<li>Hipersensibilitate cunoscut\u0103<\/li>\n<li>Utilizare concomitent\u0103 de aliskiren la pacien\u021bii diabetici<\/li>\n<\/ul>\n<h2 class=\"wp-block-heading\">Interac\u021biuni medicamentoase<\/h2>\n<ul>\n<li><strong>Inhibitori ACE \u2014 CRITIC.<\/strong> Este necesar\u0103 o perioad\u0103 de abstinen\u021b\u0103 de 36 de ore \u00eenainte de a trece la ARNI. Nu combina\u021bi niciodat\u0103.<\/li>\n<li><strong>\u2014 evita\u021bi combina\u021bia \u00een diabet \u0219i BCR (studiul ALTITUDE oprit prematur din cauza riscului)<\/strong> \u2014 combina\u021bie contraindecat\u0103 \u00een diabet; evita\u021bi \u00een alte cazuri.<\/li>\n<li><strong>Suplimente de potasiu, diuretice economisitoare de potasiu<\/strong> \u2014 hiperkaliemie aditiv\u0103.<\/li>\n<li><strong>AINS<\/strong> \u2014 reduce efectul antihipertensiv; cre\u0219te riscul de insuficien\u021b\u0103 renal\u0103 acut\u0103 (triplu impact cu diureticul).<\/li>\n<li><strong>Litiu<\/strong> \u2014 clearance renal redus; monitoriza\u021bi nivelurile.<\/li>\n<li><strong>Inhibitori PDE5<\/strong> \u2014 risc adi\u021bional de hipotensiune.<\/li>\n<\/ul>\n<h2 class=\"wp-block-heading\">Depozitare<\/h2>\n<p>P\u0103stra\u021bi Vymada la temperaturi sub 25\u00b0C \u00een blisterul original. Depozita\u021bi \u00een loc inaccesibil copiilor.<\/p>\n<h2 id=\"faqs\">\u00centreb\u0103ri frecvente<\/h2>\n<h3 class=\"wp-block-heading\">Trebuie s\u0103 \u00eentrerup inhibitorul meu de ACE \u00eenainte de a lua Vymada?<\/h3>\n<p>Da \u2014 \u00eentrerupe\u021bi inhibitorul de ACE \u0219i a\u0219tepta\u021bi 36 de ore \u00eenainte de a \u00eencepe Vymada. Inhibarea combinat\u0103 a neprilisinei + inhibarea ACE cauzeaz\u0103 rate inacceptabile de angioedem (lec\u021bia din studiul e\u0219uat OVERTURE cu omapatrilat). Nu este necesar\u0103 o perioad\u0103 de pauz\u0103 la trecerea de la un ARB.<\/p>\n<h3 class=\"wp-block-heading\">Va \u00eenlocui Vymada alte medicamente pentru insuficien\u021b\u0103 cardiac\u0103?<\/h3>\n<p>Nr. Vymada \u00eenlocuie\u0219te componenta inhibitor ACE sau ARB a terapiei pentru insuficien\u021b\u0103 cardiac\u0103. Continua\u021bi cu beta-blocantul, antagonistul receptorului de mineralocorticoizi (spironolacton\u0103, eplerenon\u0103), inhibitorul SGLT2 \u0219i orice diuretice neschimbate. Terapia modern\u0103 \u201ccvadrupl\u0103\u201d pentru HF-REF este: ARNI + beta-blocant + antagonist MR + SGLT2i.<\/p>\n<h3 class=\"wp-block-heading\">De ce se m\u0103soar\u0103 NT-proBNP \u0219i nu BNP?<\/h3>\n<p>Neprilisina (pe care o inhib\u0103 Vymada) degradeaz\u0103 BNP, dar nu \u0219i NT-proBNP. Sub terapie ARNI, nivelurile de BNP cresc artificial (deoarece este mai pu\u021bin degradat), ceea ce face m\u0103surarea neclar\u0103. NT-proBNP este un produs de clivaj care nu este substrat pentru neprilisin\u0103, a\u0219adar continu\u0103 s\u0103 reflecte severitatea insuficien\u021bei cardiace sub terapie ARNI.<\/p>\n<h3 class=\"wp-block-heading\">Pot lua Vymada \u00een timpul sarcinii?<\/h3>\n<p>Nu \u2014 componenta de valsartan este teratogen\u0103 (agenereza renal\u0103 fetal\u0103, oligohidramnios). \u00centrerupe\u021bi ARNI \u00eenainte de o sarcin\u0103 planificat\u0103 sau la confirmarea unei sarcini neplanificate.<\/p>\n<h3 class=\"wp-block-heading\">Unde pot cump\u0103ra Vymada online?<\/h3>\n<p>Pute\u021bi cump\u0103ra Vymada (sacubitril\/valsartan 50 \u0219i 100 mg, 28-84 comprimate) de la MedsBase cu ambalaj discret \u0219i livrare la nivel mondial.<\/p>\n<p><!-- medsbase-related-alts-v1 --><\/p>\n<h2 class=\"wp-block-heading\">Medicamente cardio-vasculare conexe<\/h2>\n<ul>\n<li><a href=\"https:\/\/medsbase.com\/ro\/abana\/\">Abana \u2014 formul\u0103 ayurvedic\u0103 cardiac\u0103<\/a><\/li>\n<li><a href=\"https:\/\/medsbase.com\/ro\/ambrican\/\">Ambrican \u2014 Ambrisentan 5 mg (ERA pentru HAP)<\/a><\/li>\n<li><a href=\"https:\/\/medsbase.com\/ro\/cardace\/\">Cardace \u2014 Ramipril (inhibitor ACE)<\/a><\/li>\n<li><a href=\"https:\/\/medsbase.com\/ro\/cordarone\/\">Cordarone \u2014 Amiodaron\u0103 100\/200 mg<\/a><\/li>\n<li><a href=\"https:\/\/medsbase.com\/ro\/lonitab\/\">Lonitab \u2014 Minoxidil 5 mg (vasodilatator oral)<\/a><\/li>\n<li><a href=\"https:\/\/medsbase.com\/ro\/xarelto-20\/\">Xarelto 20 \u2014 Rivaroxaban 20 mg (DOAC)<\/a><\/li>\n<li><a href=\"https:\/\/medsbase.com\/ro\/high-blood-pressure-medication\/\"><strong>R\u0103sfoi\u021bi toate medicamentele pentru hipertensiune arterial\u0103<\/strong><\/a><\/li>\n<\/ul>\n<div style=\"background:#fff3f3;border-left:4px solid #d9534f;padding:16px 20px;margin:24px 0;border-radius:4px;\"><strong>\u2695 Dezaprobare medical\u0103.<\/strong> Aceast\u0103 pagin\u0103 are scop informativ \u0219i nu \u00eenlocuie\u0219te sfatul medical al unui medic calificat. Hipertensiunea, insuficien\u021ba cardiac\u0103 \u0219i aritmiile necesit\u0103 diagnostic, monitorizare \u0219i individualizarea dozei de c\u0103tre un medic \u2014 utiliza\u021bi \u00eentotdeauna beta-blocante sub \u00eendrumare medical\u0103.<\/div>","protected":false},"excerpt":{"rendered":"<p>Vymada sunt comprimatele sacubitril\/valsartan 50\/100 mg de la Novartis \u2014 primul inhibitor al receptorului de angiotensin\u0103-neprilizin\u0103 (ARNI), comercializat global sub denumirea Entresto. Studiul PARADIGM-HF (2014) a stabilit o reducere cu 20% a deceselor cardiovasculare sau a spitaliz\u0103rilor pentru insuficien\u021b\u0103 cardiac\u0103 vs enalapril \u00een HF-REF. \u00cenlocuitor de prim\u0103 linie pentru ACEi\/ARB \u00een HF-REF stabil conform ghidurilor ESC 2021 \u0219i AHA\/ACC 2022. CRITIC: este necesar un interval de 36 de ore c\u00e2nd se trece de la un inhibitor ACE (risc de angioedem). BNP nu poate monitoriza r\u0103spunsul \u2014 utiliza\u021bi NT-proBNP.<\/p>","protected":false},"featured_media":51988,"comment_status":"open","ping_status":"open","template":"","meta":[],"product_brand":[],"product_cat":[3141,3223,3260,3356],"product_tag":[3437,3438,3439],"class_list":{"0":"post-51987","1":"product","2":"type-product","3":"status-publish","4":"has-post-thumbnail","6":"product_cat-category-overview","7":"product_cat-chronic-conditions","8":"product_cat-heart-blood-pressure","9":"product_cat-high-blood-pressure-medication","10":"product_tag-sacubitril","11":"product_tag-valsartan","12":"product_tag-vymada","14":"first","15":"outofstock","16":"shipping-taxable","17":"purchasable","18":"product-type-variable","19":"has-default-attributes"},"acf":[],"_links":{"self":[{"href":"https:\/\/medsbase.com\/ro\/wp-json\/wp\/v2\/product\/51987","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/medsbase.com\/ro\/wp-json\/wp\/v2\/product"}],"about":[{"href":"https:\/\/medsbase.com\/ro\/wp-json\/wp\/v2\/types\/product"}],"replies":[{"embeddable":true,"href":"https:\/\/medsbase.com\/ro\/wp-json\/wp\/v2\/comments?post=51987"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/medsbase.com\/ro\/wp-json\/wp\/v2\/media\/51988"}],"wp:attachment":[{"href":"https:\/\/medsbase.com\/ro\/wp-json\/wp\/v2\/media?parent=51987"}],"wp:term":[{"taxonomy":"product_brand","embeddable":true,"href":"https:\/\/medsbase.com\/ro\/wp-json\/wp\/v2\/product_brand?post=51987"},{"taxonomy":"product_cat","embeddable":true,"href":"https:\/\/medsbase.com\/ro\/wp-json\/wp\/v2\/product_cat?post=51987"},{"taxonomy":"product_tag","embeddable":true,"href":"https:\/\/medsbase.com\/ro\/wp-json\/wp\/v2\/product_tag?post=51987"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}