Mapiritsi a Hypoglycemic Glybomet: malangizo ogwiritsira ntchito

Mankhwala a hypoglycemic amapangidwa ngati ma mawonekedwe ozungulira a mthunzi woyera. Piritsi lililonse la Glibomet limakhala ndi metformin hydrochloride ndi glibenclamide, zomwe zimagwira ngati zigawo zogwira ntchito. Zinthu zothandiza ndi gelatin, MCC, mtundu wobalalika kwambiri, mtundu wowuma, chimanga chambiri, glycerin, diethyl phthalate, cellulose acetate phthalate ndi talc.

Kuti mugwiritse ntchito mankhwala a hypoglycemic Glybomet, malangizo ogwiritsira ntchito amalangizidwa pokhapokha ngati mankhwala a monotherapy omwe ali ndi mankhwala amkamwa kapena mankhwala othandizira pakudya sangathandize pochiza matenda osokoneza bongo omwe amadalira shuga. Kuphatikiza apo, wopanga amalimbikitsa kuti apange mapiritsiwo ndi kuchepa kwa chidwi cha sulfonylureas chifukwa chogwiritsa ntchito nthawi yayitali.

Zokhudza zoyipa zomwe zimachitika komanso zoyipa zomwe zingachitike, maonekedwe omwe nthawi zambiri amayamba chifukwa cha kumwa mapiritsi a Glybomet, chiopsezo cha hypoglycemia, cholestatic jaundice kapena hepatitis ziyenera kufotokozedwa pano choyamba. Kuphatikiza apo, anthu ena omwe amagwiritsa ntchito chida ichi amatha kukumana ndi mavuto monga kusanza, kupweteka mutu, kufooka, kusokonezeka kwa mlengalenga, ming'oma, paresis, kukokana kwa minofu, megaloblastic kapena hemolytic anemia, kupweteka kwa molumikizana.

Glybomet - kapangidwe

Kuphatikizidwa mu piritsi lililonse la mankhwala awiri omwe amagwira ntchito - metformin hydrochloride (400 mg) ndi glibenclamide (2.5 mg) zimapangitsa kuti azitha kupewa glycemia, komanso kuchepetsa mlingo wa magawo. Ngati aliyense wa iwo atagwiritsidwa ntchito ngati monotherapy, mlingo wake umakhala wokwera kwambiri.

Ili ndi chilinganizo ndi maipi mu mawonekedwe a cellulose, wowuma chimanga, colloidal silicon dioksidi, gelatin, glycerin, talc, magnesium stearate, acetylphthalyl cellulose, diethyl phthalate.

Zotsatira za pharmacological

Chimodzi mwazinthu zazikulu zogwira ntchito, glibenclamide, ndi m'badwo watsopano wa mankhwala a sulfonylurea omwe amaphatikizidwa pamndandanda wazofunikira zamankhwala okhala ndi pancreatic ndi extrapancreatic.

Sizimangoyambitsa ntchito ya kapamba konse, komanso zimathandizira kupanga insulin. Limagwirira awo ntchito zawo zachokera kutetezedwa kwa ma pancreatic β-cell owonongeka ndi glucose wamakani, omwe amawonetsa kupitilira kwa shuga, komanso kukondoweza kwa insulini yamatsenga a maselo.

Kutenga Glibomet mogwirizana ndi glycemic control kumachepetsa kagayidwe ka lipid komanso kumachepetsa chiopsezo cha magazi. Ntchito ya insulin imawonjezeka, ndipo limodzi nawo mayamwidwe a glucose ndim minofu ndi chiwindi. Mankhwala amagwira gawo lachiwiri ndikupanga insulin.

Metformin ndi ya biguanides - kalasi ya zinthu zopatsa mphamvu zomwe zimachepetsa kusagwirizana kwa maselo akhungu kupita ku insulin yawoyawo. Kubwezeretsa kumva sikulinso kofunikira kuposa kupititsa patsogolo katulutsidwe ka timadzi tambiri, chifukwa ndi matenda amtundu wa 2, kapamba amatulutsa ngakhale ochulukirapo.

Metformin imathandizira kulumikizana kwa ma receptors ndi insulin, imawonjezera mphamvu ya postreceptor. Pakakhala insulin m'magazi, zozizwitsa zimawonetsedwa.

Metformin ili ndi mawonekedwe apadera:

Imachepetsa kuyamwa kwa glucose ndimatumbo amimba ndikuthandizira kugwiritsidwa ntchito kwake mu minofu,
Zoletsa gluconeogeneis,
Kuteteza b-cell ku apoptosis yothamanga,
Amachepetsa chiopsezo cha mtundu uliwonse wa acidosis komanso matenda oopsa,
Amasintha kukhathamiritsa kwa madzi am'magazi, kugwira ntchito kwa endothelial ndi metabolism yamafuta (amachepetsa kuchuluka kwa cholesterol "yoyipa" ndi triglycerol m'magazi),
Amathandizira kuchepa kwa thupi - chinthu chofunikira pakulamulira kwamatenda a mtundu wa 2 mtundu wa DS,
Kuchepetsa magazi kufupika ndi oxidative nkhawa,
Ili ndi fibrinolytic zotsatira poletsa minofu ya plasminogen activator,
Imalepheretsa njira za oncological (kwakukulu, matenda a shuga amawonjezera chiopsezo cha oncology ndi 40%),
Amachepetsa chiopsezo cha imfa kuchokera ku zochitika zamtima.

Kuunikiridwa mozama kwa odwala matenda ashuga a 5800 omwe ali ndi matenda a shuga a 2 adachitika ku China. Otenga nawo mbali pachiyeso adalandira metformin kuphatikizira ndi kusintha kwa moyo. Gulu lolamulira, odzipereka anangosintha moyo wawo. Kwa miyezi 63, mgulu loyamba, kufa anali anthu 7.5 pa anthu 1000 / zaka ziwiri, wachiwiri - kwa miyezi 45, motero anthu 11.

Mankhwalawa amayamba kugwira ntchito maola awiri atalowa m'mphepete, mphamvu yake imapangidwa kwa maola 12. Metformin siziwopseza hypoglycemic. Mankhwala okhala ndi umboni wokwanira, wadutsa mayeso okhazikika a nthawi ndipo amafunikira matenda ashuga pamilingo yonse yolimbikitsira mankhwala.

Masiku ano, msika wogulitsa mankhwala umapereka magawo 10 a mankhwala antidiabetes, koma metformin akadali mankhwala odziwika kwambiri ochizira matenda a shuga 2 pachimake chilichonse cha matendawa.

Kuphatikiza kwa synergistic pazinthu ziwiri zomwe zikugwira ntchito ku Glibomet kumatha kusintha thupi.

Mphamvu ya pancreatic - mankhwalawa amachepetsa "khungu" la maselo, amathandizira kubisika kwa insulin yake, ndikuteteza maselo a b.
Owonjezera-pancreatic zotsatira - biagudin amakhudza mwachindunji minofu ndi mafuta minofu, amachepetsa shuga.

Mlingo woyenera wa kuchuluka kwa zinthu zomwe zimagwira ntchito zimatha kusintha mlingo wa mankhwala. Kwa ma b-cell, kusunthika kotereku ndikofunikira kwambiri: kumawonjezera chitetezo cha mankhwalawa, kumachepetsa chiopsezo cha kuwonongeka kwa magwiridwe antchito, ndikuchepetsa mwayi wokhala ndi zotsatirapo zoyipa.

Mphamvu ya Pharmacokinetic

Glybenclamide kuchokera m'matumbo am'mimba amatengedwa ndikugawidwa bwino - ndi 84%, kuchuluka kwa mankhwalawa kumatha kuwonedwa pambuyo pa maola 1-2. Gawo lomwe limapangidwa ndimapuloteni a magazi ndi 97%.

Metabolism ya Glibenclamide imachitika m'chiwindi, pomwe imasinthidwa kwathunthu kukhala metabolites yogwira. Hafu ya zinthu zomwe zawonongeka imadutsa impso, theka linalo kudzera m'miyendo ya bile. Hafu ya moyo amakhala pafupifupi maola 10.

Metformin imalowerera kwathunthu m'matumbo am'mimba, imagawidwa nthawi yomweyo ku ziwalo ndi minofu, sikugwirizana ndi mapuloteni amwazi konse. The bioavailability wa chigawo chimachokera 50-60%.

Pazonse, kuchuluka kwakukulu kwa zosakaniza zamkati mwa magazi kumachitika ola limodzi kapena awiri mutamwa mapiritsi.

Zisonyezero zochizira ndi Glybomet

Malangizo akuwonetsa kuti mankhwalawa ndi omwe amaperekedwa kwa odwala matenda ashuga amtundu wa 2, kuphatikizapo odwala matenda a shuga omwe amadalira odwala matenda ashuga, ngati zakudya zopatsa thanzi, zomwe zimapangitsa kuti azichita masewera olimbitsa thupi komanso zina mwa njira zina za hypoglycemic sizinapereke zotsatira zake.

Mankhwala ambiri amakhala ndi zotsatira zowonjezera, ngati thupi siliyankha moyenera mankhwala, amasintha algorithm ya mankhwala polemba Glibomet pamapiritsi.

Kwa yemwe mankhwala amatsutsana

Popeza mankhwalawa ali ndi zovuta pavuto, sizodabwitsa kuti ali ndi zoletsa zokwanira kuvomereza.

Mankhwala atha kukhala owopsa:

Ndi matenda ashuga
Ngati wodwala amakonda kwambiri zosakaniza za formula,
Anthu odwala matenda ashuga oyamba ndi matenda oyamba,
Ndi matenda ashuga komanso mawonekedwe am'malire, Momwe mungatenge Glibomet

Pali zoletsa kutenga Glibomet:

Ndi matenda a chithokomiro
Ngati wodwala akudwala malungo.
Ngati mbiri ya hypofunction ya pituitary cortex ndi adrenal gland.

Mlingowo umatsimikiziridwa ndi endocrinologist malinga ndi zaka za wodwalayo komanso mawonekedwe azachipatala, koma wopanga akuwonetsa kuti akuyamba ndi mapiritsi awiri tsiku lililonse, akumagwiritsa ntchito mankhwalawo. Mulingo waukulu wa mankhwalawa ndi 2 g / tsiku. Ndikofunika kugawa phwandoli nthawi zonse. Ngati chiwerengerochi sichikuyembekezeredwa, chithandizo chovuta chimayikidwa ndi kuwonjezera kwa mankhwala amphamvu.

Zotsatira zoyipa ndi bongo

Pali zotsatira zoyipa zambiri zomwe zimachitika mutatha kumwa Glibomet, koma izi siziyenera kukhala chifukwa chokana mankhwalawa, chifukwa kuvulaza komwe kumachitika mthupi ndi matenda ashuga osawerengeka kumakhala kwakukulu kwambiri kuposa kuwopsa kwa zotsatira zoyipa.

Kuti mupewe zoterezi, ndikofunikira kuwerengera mulingo woyenera. Ngati chizolowezichi chachulukira, odwala matendawa amadzutsa njala yosatha, mphamvu, mantha, kugwedezeka kwa dzanja.

Zizindikiro za mankhwala osokoneza bongo amathanso kukhala tachycardia, khungu pakhungu, kuchuluka thukuta, kukomoka.

Zotsatira zoyipa kwambiri mutatha kutenga Glibomed, hypoglycemia, omwe ali pachiwopsezo kwambiri ndi odwala omwe afooka chifukwa cha matenda omwe atenga nthawi yayitali, odwala matenda ashuga okalamba "omwe amadziwa bwino matenda ashuga, zidakwa, anthu omwe amagwira ntchito zolimbitsa thupi, komanso aliyense amene amakhala ndi njala yochepa. zosakwana 1000 kcal / tsiku.) zakudya.

Mwa Zizindikiro zodziwika bwino, ambiri ndi:

Mutu
Zovuta za Epigastric,
Matenda a Dyspeptic
Mitundu yosiyanasiyana yokhudza thupi lawo siligwirizana.

Ngati kusakhalitsa kwakanthawi kumachitika mutamwa mapiritsi, kumatha kuthetseratu chithandizo chamankhwala. Ngati zizindikiro zili zolimba kapena zizindikiro za ziwonetsero zimawonekera, ndiye kuti muyenera kusankha mtundu wa Glibomet.

Zotsatira Zogwiritsa Ntchito Mankhwala

Kuwonjezeka kwa hypoglycemic zotsatira za Glybomet kumawonedwa panthawi yofanana ndi zotumphukira za decumarol, phenylbutamazone, β-blockers, oxytetracycline, allopurinol, cimetidine, ethanol, sulfinpyrazone mu Mlingo wofunikira, phenenecid, chloramphenicol, prophylonocole wamkulu, .

Mankhwala ophatikizidwa ndi mahomoni a chithokomiro, zoteteza pakamwa, barbiturates, mankhwala a thiazide diuretic amalepheretsa Glibomet.

Malangizo apadera

Kugwiritsa ntchito Glibomet kumayimitsidwa nthawi yomweyo ngati pali zizindikiro za lactic acidosis: kufooka lakuthwa, kusanza, kuphipha kwa minofu, kupweteka pamimba. Wovutitsidwayo amafunikira kuchipatala mwachangu.

Malangizowo akuwalimbikitsa kuti azilandira chithandizo ndi Glybomet kuti aperekeze kuwunika kwa creatinine poyesa magazi. Kwa odwala matenda ashuga omwe ali ndi impso wathanzi, kuwunika koteroko ndikofunikira kamodzi pachaka, odwala omwe mtundu wawo wa creatinine ali pafupi kwambiri ndi malire, ndipo odwala okhwima ayenera kuyesedwa kawiri pachaka.

Masiku awiri asanachitike opaleshoni yokonzekera, momwe kugwiritsa ntchito mankhwala owononga a msana kapena obalalitsa, kutenga Glibomet kwathetsedwa ndipo odwala matenda ashuga asinthika kukhala a insulin. Mutha kubwezeretsa njira ya mankhwalawa ndi Glybomet pambuyo poti wodwala waloledwa kudya mkamwa. Ngakhale ndi impso zomwe zimagwira ntchito pafupipafupi, adotolo samapanga chisankhochi pasanathe masiku awiri opareshoni.

Kumwa mapiritsi pamafunika kusamala mukamagwira ntchito yomwe ingakhale yoopsa ku moyo komanso thanzi, komanso poyendetsa magalimoto. Izi zimaphatikizidwa ndi chiopsezo cha hypoglycemia, kuchepa kwa kuchuluka kwa zochitika zama psychomotor komanso kuthekera kwakuya kwambiri.

Zotsatira za chithandizo chamankhwala ndi Glybomet zimadalira kwambiri kulondola kwa kutsatira malangizo ndi malangizo a endocrinologist: kudya ndi kugona ndikupumula, kuchita masewera olimbitsa thupi pafupipafupi, kuwongolera glycemic mwadongosolo, kuphatikizapo kunyumba.

Mukamagwiritsa ntchito mankhwalawa, ndikofunikira kuchepetsa kumwa kwambiri momwe mungathere (chizolowezi chake ndi kapu ya vinyo wofiyira kamodzi pa sabata), popeza ethanol imayambitsa chitukuko cha glycemia, komanso mavuto a disulfiram - ululu m'chigawo cha epigastric, mavuto a dyspeptic, kutentha kwa thupi ndi mutu, kutayika. kulumikizana, kupweteka mutu, palpitations.

Mtengo wa mankhwala ndi malamulo osungira

Kodi Glybomet ndi yotsika mtengo ku malo ogulitsa mankhwala? Kutengera ndi dera, mankhwalawo amatha kugulitsidwa ma ruble 200-350. Phukusi lililonse la Glibomet, chithunzi chake chomwe chikuwoneka m'gawoli, chili ndi miyala 40.
Kuti mankhwalawa asathenso kugwira ntchito, ayenera kutetezedwa kuchokera ku dzuwa lowala komanso chinyezi chachikulu.

Mankhwala ofanana

Ngati Glibomed ngakhale mu zovuta mankhwala samapereka kufunika, chifuwa kapena zina zoyipa zawoneka, mankhwalawo amaloŵedwa ndi analogues ndi chinthu choyenera chogwira ntchito.

Kwa Glibomed, mankhwalawa amatha kukhala mapiritsi a Diabeteson, gawo lalikulu lomwe limagwira ndi glyclazide, kapena Dimaril, momwe gulu lothandizira limafanana ndi imodzi mwazinthu za Glibomed, glimepiride.

Mankhwala ena othandizira odwala omwe ali ndi vuto lofananalo, Gluconorm, Bagomet Plus, Glucovans, Glibenclamide osakanikirana ndi Metformin, Glyukofast adalembedwa.The endocrinologist amapanga m'malo, awerengeranso mlingo. Kusintha kwa regimen ya chithandizo ndikotheka: ma analogu amafotokozedwa onse muzovuta kuchipatala komanso mawonekedwe a monotherapy, kuwonjezera pa zakudya zosachepera carb komanso zolimbitsa thupi.

Ndizosatheka kulosera momwe thupi lingachitire mankhwala atsopano, nthawi yoyamba ndikofunikira mverani zonse zomwe mukuwuza ndikuwuzeni adotolo za kusintha kwamwadzidzidzi kulemera kwake, kuchepa mphamvu kwa thupi, Zotsatira za kuyesedwa kwa glycemia ndi glucometer ndi zina zofunika panthawi yankhani.

Ndemanga pa mawonekedwe a Glibomet

Za mankhwala a Glycomet omwe amawerengera odwala matenda ashuga amakhudzana kwambiri ndi momwe matchulidwe ake amagwirira ntchito kuposa kugwira bwino ntchito.

Ngati mulingo woyenera wasankhidwa molondola, mayankho ake amakhala abwino, nthawi zina pamakhala zonena za zovuta zina. Koma popeza kuwerengera kumeneku ndi kwamunthu payekha, kutengera maphunziro azachipatala ndi momwe mayendedwe amunthu amadwala, kusinthana kwa zochitika pankhaniyi kulibe ntchito, ndipo mpaka kumakhala koopsa.

Pofotokozera mfundo zonse, titha kunena kuti Glibomed ndiye mankhwala oyamba a mtundu 2 wa matenda ashuga monotherapy: mtengo wotsika mtengo, mbiri yayikulu yotetezeka, kusalowerera mokhudzana ndi kulemera kwa thupi, zotsatira zopindulitsa pazotsatira zamtima komanso zamankhwala.

Zachidziwikire, kugwiritsa ntchito kwake sikungatheke kwa aliyense (monga mankhwala ena a hypoglycemic), koma mankhwalawa amagwirizana ndi zamakono zamakhalidwe abwino ndikugwirizana.

Pharmacology

Kuphatikizika kwokhazikika kwamankhwala awiri am'magazi a hypoglycemic a magulu osiyanasiyana a pharmacological: glibenclamide ndi metformin.

Metformin A gulu la Biguanides ndipo amachepetsa zomwe zili ndi shuga ndi postprandial glucose m'magazi am'magazi. Metformin simalimbikitsa kubisirana kwa insulin chifukwa chake siyambitsa hypoglycemia.Ili ndi njira zitatu zochitira: imachepetsa kupanga shuga ndi chiwindi poletsa gluconeogeneis ndi glycogenolysis, zimawonjezera chidwi cha zotumphukira za insulin zolandilira, kugwiritsa ntchito komanso kugwiritsa ntchito shuga m'maselo a minofu, ndikuchepetsa mayamwidwe a glucose m'matumbo am'mimba. Imakhazikika kapena kuchepetsa thupi mwa odwala matenda ashuga.

Ilinso ndi phindu pamapangidwe a lipid a magazi, kuchepetsa cholesterol yathunthu, LDL ndi triglycerides.

Metformin ndi glibenclamide zimakhala ndi njira zosiyanasiyana zochitira zinthu, koma zimathandizana wina ndi mnzake pogwira ntchito. Kuphatikizidwa kwa ma othandizira awiri a hypoglycemic kumathandizira pakuchepetsa shuga.

Glibenclamide. Mukaperekedwa, kuyamwa kuchokera m'matumbo am'mimba ndizoposa 95%. T max - maola 4, V d - pafupifupi malita 10. Kuyankhulana ndi mapuloteni a plasma ndi 99%. Imakhala yofunikira kwambiri m'chiwindi ndikupanga ma metabolites awiri osagwira, omwe amatsitsidwa ndi impso (40%) komanso matumbo (60%). T 1/2 - kuyambira maola 4 mpaka 11

Metformin pambuyo m`kamwa makonzedwe, zimatengedwa kuchokera m'mimba thirakiti mokwanira, C max mu plasma imafikiridwa pasanathe maola 2,5. Mtheradi bioavailability wochokera 50 mpaka 60%. Ndi kuyamwa kwa munthawi yomweyo, kuyamwa kwa metformin kumachepetsedwa ndikuchedwa. Metformin imagawidwa mwachangu mu minofu, sikuti imagwira mapuloteni a plasma. Amapangidwira pamlingo wofooka kwambiri ndikuwonetsa impso. Kuvomerezeka kwa metformin mu maphunziro athanzi ndi 400 ml / min, zomwe zimawonetsa kukhalapo kwa secretion ya tubular yogwira. Pafupifupi 20-30% ya metformin imatulutsidwa kudzera m'matumbo osasinthika. T 1/2 ndi pafupifupi maola 6.5. Ngati vuto laimpso likulephera, kutsimikizika kwa impso kumachepa, monga momwe kumapangidwira kupanga kwa creatinine, pomwe T 1/2 imawonjezeka, zomwe zimapangitsa kuti plasma metformin iwonjezeke. Metformin ndi glibenclamide zopezeka piritsi limodzi zimakhala zofanana bioavailability monga mapiritsi okhala ndi metformin kapena glibenclamide patokha. The bioavailability ya metformin kuphatikiza ndi glibenclamide sichikhudzidwa ndi chakudya, komanso bioavailability wa glibenclamide. Komabe, kuchuluka kwa mayamwa a glibenclamide kumawonjezera ndi chakudya.

Kugwiritsa ntchito kwa zinthu Glibenclamide + Metformin

Type 2 shuga mellitus mwa achikulire omwe ali ndi vuto losagwiritsa ntchito zakudya, masewera olimbitsa thupi komanso monotherapy yapita ndi metformin kapena zotumphukira za sulfonylurea, m'malo mwa chithandizo cham'mbuyomu ndimankhwala awiri (metformin ndi sulfonylurea derivative) mwa odwala omwe ali ndi khola komanso glycemia yoyenera.

Contraindication

Hypersensitivity to metformin, glibenclamide kapena sulfonylurea exivatives, mtundu 1 shuga mellitus, matenda ashuga ketoacidosis, matenda a shuga, matenda ashuga, kulephera kwaimpso kapena kuwonongeka kwa impso (creatinine Cl osakwana 60 ml / min), zikhalidwe zowawa zomwe zingayambitse kusintha kwa ntchito impso: kuchepa madzi m'thupi, matenda opatsirana, mantha, kupangika kwa mankhwala a ayodini okhala ndi ayodini (onani "Precautions"), matenda owopsa kapena osachiritsika omwe amakhala ndi hypoxia minofu: kulephera kwa mtima kapena kupuma, kuchepa kwaposachedwa kwam'mimba, kufooka kwa chiwindi, porphyria, kugwiritsa ntchito miconazole, matenda opatsirana, chithandizo chachikulu cha opaleshoni, kuvulala, kuwotcha kwakukulu ndi zina zofunika pa insulin, zakumwa zoledzeretsa kwambiri, kuledzera pachimake, lactic acidosis ( kuphatikiza pa anamnesis), kutsatira zakudya zamafuta ochepera (osakwana 1000 kcal / tsiku), kutenga pakati, nthawi yoyamwitsa, ana ochepera zaka 18.

Mimba komanso kuyamwa

Pa mimba, ntchito contraindicated. Wodwalayo ayenera kuchenjezedwa kuti panthawi ya mankhwalawa pamodzi ndi glibenclamide + metformin, ndikofunikira kudziwitsa dokotala za mimba yomwe yakonzekereratu komanso nthawi yomwe mayi adzakhale ndi pakati. Pokonzekera kutenga pakati, komanso ngati muli ndi pakati pa nthawi yomwe mukumwa mankhwalawa, iyenera kuthetsedwa, ndipo mankhwala a insulin ayenera kuyikidwa.

Imakhudzidwa panthawi yoyamwitsa, chifukwa palibe deta pa kuthekera kwa kuphatikiza glibenclamide + metformin kuti ilowe mkaka wa m'mawere. Ngati ndi kotheka, ntchito nthawi yoyamwitsa iyenera kusintha kupita ku insulin kapena kusiya kuyamwitsa.

Kutetemera ndi chimbudzi

Pafupifupi zimapukusidwa kwathunthu mu chiwindi. Hafu yoyamba ya chinthucho imatuluka ndi mkodzo, ndipo 50% yachiwiri imatuluka ndi ndulu. T1 / 2 - 3-16 maola.

Madzi ndi kugawa

Mafuta ochokera m'mimba okumbamo pafupifupi 50%. Full bioavailability ndi 50-60%. Omwazika pompopompo, zimakhala kuti sizikugwirizana ndi mapuloteni a plasma.

Kutetemera ndi chimbudzi

Metabolism imakhala yofooka kwambiri, yopukutidwa kuchokera mthupi limodzi ndi mkodzo (pafupifupi momwe imapangidwira kale) komanso pang'ono ndi ndowe. T1 / 2 - 9-12 maola.

Zizindikiro zogwiritsidwa ntchito

Glibomet imayikidwa ndi dokotala kwa odwala omwe ali ndi matenda a shuga a mtundu wachiwiri panthawi yomwe zakudya, masewera ndi chithandizo cham'mbuyomu ndi glibenclamide kapena metformin sizinathandize. Komanso, mankhwalawa akuwonetsedwa kuti agwiritsidwe ntchito ngati mankhwala olowa m'malo mwa odwala omwe ali ndi vuto la glycemia.

Mlingo ndi nthawi yayitali ya mankhwala zimaperekedwa payekhapayekha, dokotala amadalira mtundu wa kagayidwe kazakudya wodwala ndi kuchuluka kwa shuga m'magazi.

Mlingo wocheperako nthawi zambiri mapiritsi 1 mpaka 3 patsiku. Kenako, mankhwalawa amasankhidwa pang'onopang'ono mpaka atakwanitsa.

Monga lamulo, mapiritsi amatengedwa kawiri patsiku madzulo ndi m'mawa m'maola.

Mlingo wapamwamba kwambiri wa mankhwala a glybomet ndi okwanira mapiritsi 5 patsiku.

Zotsatira zoyipa

Ponena za kagayidwe kachakudya, kakulidwe ka hypoglycemia ndi kuwonjezeka kwa magazi lactate kuyenera. Pankhani yokhudza chakudya cham'mimba, ndemanga zikuwonetsa kuti mwina kumakhala kulawa kwa "chitsulo" mkamwa, kusanza, nseru komanso kusowa kwa chakudya.

Nthawi zina, kugwiritsa ntchito glibometa kumayambitsa hepatitis, cholestatic jaundice komanso hyperreactivity ya michere ya chiwindi. Mankhwalawa amathanso kuyambitsa chifuwa, chowonetseredwa mu mawonekedwe a urticaria, kupangitsa kuti ma protein azioneka mkodzo, kupweteka m'malo olumikizirana mafupa ndikuyambitsa kutentha kwambiri.

Komanso, ndemanga za anthu odwala matenda ashuga atatha kumwa mankhwalawa zimawonetsa kupezeka kwa matenda akhungu (photosensitivity), kusamva bwino, kupweteka kwa mutu, paresis, chizungulire komanso malaise.

Nthawi zina, mukamwa mowa, kugwiritsa ntchito mankhwalawa kumayambitsa "antabuse".

Mawonekedwe

Mankhwala ndi mankhwala a Glybomet ndi mankhwala ayenera kuyikidwa motsogozedwa ndi katswiri.

Kukachitika lactic acidosis (zopweteka, malaise, kusanza), ndikofunikira kusiya kugwiritsa ntchito mankhwalawa ndikuchita chithandizo chofunikira.

Komanso, wodwalayo ayenera kutsatira zakudya zinazake, azilamulira kuchuluka kwa shuga ndipo ngati pali zizindikiro zilizonse za lactic acidosis, pitani kuchipatala msanga.

Zofunika! Mukamagwiritsa ntchito glibomet, simuyenera kumwa mowa.

Malangizo omwe aphatikizidwa ndi mankhwalawa amachenjeza: mukamayendetsa galimoto, glibomet imatha kuvulaza, chifukwa Kukula kwa hypoglycemia sikumasankhidwa.

Bongo

Ngati mapiritsi amayambitsa bongo, ndiye kuti mawonekedwe a lactic acidosis amachitika chifukwa cha metformin ndi hypoglycemia yomwe imachitika chifukwa cha glibenclamide.

njala
malaise
zovuta zamitsempha
kutuluka thukuta kwambiri
kulumikizidwa bwino kosuntha
kugunda kwa mtima
kugona kosalekeza
khungu lotuwa
kumverera kwa mantha
paresthesia pamkamwa,
kugona kusokonezedwa
kunjenjemera
mutu
nkhawa.

Ngati hypoglycemia ikupita patsogolo, ndiye kuti kulephera kudziwa komanso kudziletsa ndikotheka.

Lactic acidosis imafunikira chithandizo mwachangu mosamalitsa. Njira yothandiza kwambiri ya mankhwala ndi hemodialysis.

Pankhani ya hypoglycemia yofatsa kapena yolimbitsa thupi, ndikofunikira kutenga madzi kapena shuga. Mu hypoglycemia yayikulu, jakisoni wovomerezeka wa njira ya shuga (40%) kapena glucagon amaperekedwa.

Zofunika! Wodwala akayambanso kudziwa, ayenera kudya zakudya zopatsa mphamvu kuti asayambirenso ku hypoglycemia.

Kuchita ndi mankhwala ena

Mankhwala amatha kuonjezera mphamvu ya hypoglycemic pankhani yogwiritsa ntchito dicumarol, oxytetracycline, beta-blockers, sulfonamides, salicylates, chloramphenicol, ethanol, allopurinol, sulfinpyrazone, miconazole, MAO zoletsa, probenecid ndi cimetidine.

Mphamvu ya kumwa gibomet imatha kuchepetsedwa ndi mahomoni a chithokomiro ndipo ngati mankhwalawo adatengedwa ndi epinephrine, barbiturates, glucocorticosteroids, thiazide diuretics, njira zakulera (mapiritsi).

Komanso, mankhwalawa amatha kupititsa patsogolo mphamvu za kutenga ma antioagulants, ndipo mukamayanjana ndi cimetidine, chiopsezo cha lactic acidosis chimakulanso.

Zizindikiro za hypoglycemia mwina sizingaoneke chifukwa cha beta-adrenolocators.

Model Clinical-Pharmacological Article 1

Zochita pafamu. Oral ophatikizidwa a hypoglycemic wothandizila, womwe ndi wochokera m'badwo wachiwiri. Ili ndi pancreatic ndi extrapancreatic zotsatira. Glibenclamide imalimbitsa katemera wa insulini pochepetsa kutsekemera kwa mapapo a khungu la glucose, imakulitsa chidwi cha insulini ndikumangiriza kwake kwa chandamale, imakulitsa kutulutsidwa kwa insulini, ndikuwonjezera mphamvu ya insulin pamatenda a minofu ndi chiwindi. Machitidwe mu gawo lachiwiri la insulin katulutsidwe. Metformin imalepheretsa gluconeogenesis m'chiwindi, amachepetsa kuyamwa kwa glucose kuchokera m'matumbo am'mimba ndikuwonjezera kugwiritsidwa ntchito kwake mu minofu, kumachepetsa zomwe zili ndi TG ndi cholesterol mu seramu yamagazi. Amawonjezera kumangiriza kwa insulin ku ma receptors (pakalibe insulini m'magazi, chithandizo cha mankhwala sichikuwonetsedwa). Sichimayambitsa kukhudzana kwa hypoglycemic. Mphamvu ya hypoglycemic imayamba pambuyo pa maola awiri ndipo imatha maola 12.

Pharmacokinetics Glibenclamide imathamanga mwachangu komanso mwachilungamo (84%) yotengedwa m'mimba, TC max - maola 7-8. Kuyankhulana ndi mapuloteni a plasma - 97%. Imakhala ngati imapukusidwa kwathunthu m'chiwindi kuti metabolites osagwira. 50% yochotsa impso, 50% - ndi bile. T 1/2 - maola 10-16. Madzi atamwa kudzera m'matumbo am'mimba (48-52%), Metformin imachotsedwa impso (makamaka osasinthika), pang'ono ndi matumbo. T 1/2 - 9-12 h.

Zizindikiro. Type 2 shuga mellitus (ndi kulephera kwa zakudya mankhwala kapena monotherapy ndi pakamwa hypoglycemic mankhwala).

Contraindication Hypersensitivity, mtundu wa 1 matenda a shuga, matenda ashuga ketoacidosis, matenda ashuga komanso kukomoka, lactic acidosis (kuphatikizapo mbiri), kulephera kwa aimpso (creatinine kuposa 135 mmol / l mwa amuna komanso akazi opitilira 110 mmol / l) , omwe ungayambitse matenda a impso (kuphatikizapo kuchepa kwa madzi m'thupi, matenda opatsirana, mantha, kupweteka kwa mitsempha yolimbana ndi ayodini), matenda oyipa komanso osakhazikika omwe amachitika ndi minofu hypoxia (kuphatikizapo mtima, kulephera kupuma, kugunda kwamtima kwaposachedwa myoca Inde, mantha), kwa chiwindi insufficiency, pachimake mowa kuledzera, porphyria, concomitant ntchito miconazole, mimba, mkaka wa m'mawere.

Mosamala. Uchidakwa, kusakwanira kwa adrenal, hypofunction ya anterior pituitary, matenda a chithokomiro omwe ali ndi vuto la ntchito.

Mlingo Mkati, ndikudya. Mlingo wa mlingo amasankhidwa payekha, kutengera mtundu wa kagayidwe. Nthawi zambiri, kumwa poyambira ndi piritsi limodzi (2,5 mg glibenclamide ndi 500 mg metformin), ndikusankha pang'onopang'ono masabata onse a 1-2 kutengera index ya glycemic.

Mukamachotsa chithandizo chophatikizika cham'mbuyomu ndi metformin ndi glibenclamide (monga zigawo zikuluzikulu), mapiritsi 1-2 (2,5 mg wa glibenclamide ndi 500 mg ya metformin) amatchulidwa, kutengera mlingo wapitawu wa chilichonse.

Mlingo wambiri watsiku ndi tsiku ndi mapiritsi 4 (2,5 kapena 5 mg a glibenclamide ndi 500 mg ya metformin).

Zotsatira zoyipa. Metformin: nseru, kusanza, kupweteka kwam'mimba, kusowa kwa chakudya, "chitsulo" mkamwa, erythema (monga mawonekedwe a hypersensitivity), kuchepa kwa mayamwidwe, chifukwa chake, kuchuluka kwa cyanocobalamin m'madzi am'magazi (ndi kugwiritsa ntchito nthawi yayitali), lactic acidosis.

Glibenclamide: hypoglycemia, maculopapular zidzolo (kuphatikiza pa mucous membrane), kuyabwa pakhungu, urticaria, photosensitivity, nseru, kusanza, kusapeza mu epigastric dera, kuchuluka kwa hepatic transaminases, hepatitis, leukopenia, thrombocytosis, thrombocytopenia , mapapu apulutsu, mapapu, kupindika, hepatic porphyria, hyponatremia, hypercreatininemia, kuchuluka kwa urea m'magazi am'magazi, kuphatikizika kwa mankhwala ngati (munthawi imodzi ndi ethanol).

Bongo. Zizindikiro: hypoglycemia ndi lactic acidosis.

Chithandizo: ndi hypoglycemia (ngati wodwalayo akudziwa) - shuga mkatimu, ndikutayika - iv dextrose kapena 1-2 ml ya glucagon. Pambuyo podziwikanso, ndikofunikira kuti mupatse wodwalayo chakudya chambiri m'zakudya zamafuta ochepa (kuti mupewe kukonzanso kwa hypoglycemia).

Kuchita. Miconazole ndi chiopsezo cha hypoglycemia (mpaka chikomokere).

Fluconazole - chiopsezo chotenga hypoglycemia (chimawonjezera T 1/2 sulfonylurea zotumphukira).

Phenylbutazone amatha kuthana ndi sulfonylureas (glibenclamide) kuchokera pakulumikizana ndi mapuloteni, omwe angapangitse kuwonjezeka kwawo kwakukulu mu plasma yamagazi komanso chiopsezo cha hypoglycemia.

Kugwiritsidwa ntchito kwa mankhwala okhala ndi ayodini omwe ali ndi ayodini (chifukwa cha kayendetsedwe ka mafupa) kungayambitse kukulitsa kwa ntchito yaimpso komanso kuchuluka kwa metformin, komwe kumawonjezera chiopsezo cha lactic acidosis. Kuchiza ndi mankhwalawa kumathetsedwa maola 48 asanakonzedwe ndipo amayambiranso osapezekanso maola 48 pambuyo pake.

Kugwiritsa ntchito ma ethanol okhala ndi mapangidwe kumbuyo kwa glibenclamide kungayambitse kukulira kwa kusintha kwa mawonekedwe a disulfiram.

GCS, beta 2 - adrenostimulants, okodzetsa angayambitse kuchepa kwa mphamvu ya mankhwala, kusintha kwa mankhwala kungafunike.

ACE zoletsa - chiwopsezo cha hypoglycemia kugwiritsa ntchito sulfonylureas (glibenclamide).

Beta-blockers imachulukitsa zovuta komanso zovuta za hypoglycemia.

Mankhwala a antibacterial ochokera ku gulu la sulfonamides, fluoroquinolones, anticoagulants (coumarin derivatives), mao inhibitors, chloramphenicol, pentoxifylline, lipid-kuchepetsa mankhwala ochokera pagulu la fibrate, disopyramides - chiopsezo cha hypoglycemia pogwiritsa ntchito glibenclamide.

Malangizo apadera. Kuchita maopaleshoni akuluakulu komanso kuvulala, kuwotcha kwambiri, matenda opatsirana omwe ali ndi febrile syndrome kungafunike kuthetsedwe kwa mankhwala a pakamwa a glypoglycemic ndi makonzedwe a insulin.

Ndikofunikira kuyang'anira kuchuluka kwa shuga m'magazi pamimba yopanda kanthu ndikatha kudya, kupindika kwa tsiku ndi tsiku m'magazi ndi mkodzo.

Odwala ayenera kuchenjezedwa za chiwopsezo chowonjezereka cha hypoglycemia milandu ya ethanol, NSAIDs, ndi njala.

Kusintha kwa mlingo ndikofunikira pakulimbitsa thupi ndi malingaliro, kusintha kwa zakudya.

Njira zopewera zimakhazikitsidwa panthawi ya mankhwala a beta-blockers.

Ndi zizindikiro za hypoglycemia, chakudya chamagulu (shuga) chimagwiritsidwa ntchito, muzovuta, yankho la dextrose limayendetsedwa pang'onopang'ono iv.Zovulala, kuvulala, maopareshoni, matenda opatsirana ndi febrile syndrome, kusinthira ku insulin ndikulimbikitsidwa.

M'pofunika kuletsa mankhwalawa patatsala masiku awiri kuti mupeze mayeso a angiographic kapena urographic (mankhwalawa amayambiranso patatha maola 48 atawunika).

Poyerekeza ndi kagwiritsidwe ntchito ka zinthu zopangidwa ndi ethanol, kukula kwa zotsatira za disulfiram ndizotheka.

Munthawi ya chithandizo, chisamaliro chikuyenera kuchitika poyendetsa magalimoto ndi kuchita zina zomwe zingakhale zoopsa zomwe zimafunikira chidwi chochulukirapo komanso kuthamanga kwa zochitika zama psychomotor.

Kulembetsa boma boma. Kusindikiza kovomerezeka: m'ma 2. M: Medical Council, 2009. - Vol 2, gawo 1 - 568 s., Gawo 2 - 560 s.

Kuchita zinthu zina

Acarbose imawonjezera mphamvu ya hypoglycemic ya kuphatikiza kwa glibenclamide + metformin.

Allopurinol *

Allopurinol imawonjezera mphamvu ya hypoglycemic ya kuphatikiza kwa glibenclamide + metformin.

Ascorbic acid *

Mlingo wambiri, ascorbic acid (acidine mkodzo wa mankhwala) umawonjezera mphamvu ya kuphatikiza kwa glibenclamide + metformin pochepetsa kuchuluka kwa kudzipatula ndikuwonjezera kubwezeretsanso kwa glibenclamide.

Asparaginase

Asparaginase imachepetsa mphamvu ya kuphatikiza kwa glibenclamide + metformin.

Acetazolamide *

Acetazolamide imachepetsa mphamvu ya kuphatikiza kwa glibenclamide + metformin.

Baclofen imazindikira zotsatira za kuphatikiza kwa glibenclamide + metformin.

Bezafibrat *

Bezafibrat imapititsa patsogolo zotsatira za hypoglycemic kuphatikiza kwa glibenclamide + metformin.

Bromocriptine *

Bromocriptine imawonjezera mphamvu ya hypoglycemic ya kuphatikiza kwa glibenclamide + metformin.

Vancomycin *

Glucagon imachepetsa mphamvu ya kuphatikiza kwa glibenclamide + metformin.

Ngati ndi kotheka, makonzedwe apanthawi yomweyo a glibenclamide + metformin danazole ndipo mukasiya kuyamwa, muyenera kusintha mlingo wa kuphatikiza womwe umayang'aniridwa ndi glycemia (danazol ili ndi vuto la hyperglycemic ndikuchepetsa mphamvu).

Ma Disopyramides *

Disopyramide imapititsa patsogolo zotsatira za hypoglycemic kuphatikiza kwa glibenclamide + metformin.

Isoniazid amawonetsa zotsatira za kuphatikiza kwa glibenclamide + metformin.

Calcium calcium

Calcium chloride (acidine mkodzo wa mankhwala) imawonjezera mphamvu ya kuphatikiza kwa glibenclamide + metformin pochepetsa kuchuluka kwa kudzipatula ndikuwonjezera kubwezeretsanso kwa glibenclamide.

Captopril imakulitsa zotsatira za kuphatikizika kwa glibenclamide + metformin ndikuwonjezera mwayi wokhala ndi zovuta za hypoglycemic pokonzanso kulolera kwa shuga ndikuchepetsa kufunika kwa insulini.

Miconazole imawonjezera mphamvu ya kuphatikiza kwa glibenclamide + metformin, imatha kupangitsa kukula kwa hypoglycemia (mpaka kukula kwa chikomokere).

Niacin *

Nicotinic acid (muyezo waukulu) amachepetsa mphamvu ya kuphatikiza kwa glibenclamide + metformin.

Nifedipine imawonjezera mayamwidwe ndi C max wa metformin ndikuchepetsa mayeso ake.

Pentoxifylline *

Pentoxifylline imathandizira kuchuluka kwa hypoglycemic kuphatikiza kwa glibenclamide + metformin.

Pyridoxine *

Pyridoxine imawonjezera mphamvu ya hypoglycemic ya kuphatikiza kwa glibenclamide + metformin.

Procainamide *

Reserpine imawonjezera mphamvu ya kuphatikiza kwa kuphatikiza kwa glibenclamide + metformin.

Rifampicin *

Rifampicin amachepetsa mphamvu ya kuphatikiza kwa glibenclamide + metformin.

Salbutamol *

Salbutamol imafooketsa mphamvu ya kuphatikiza kwa glibenclamide + metformin.

Theophylline imakulitsa mphamvu ya kuphatikiza kwa kuphatikiza kwa glibenclamide + metformin.

Terbutaline *

Terbutaline imachepetsa mphamvu ya kuphatikiza kwa glibenclamide + metformin.

Tetracycline *

Tetracycline imalimbikitsa zotsatira za hypoglycemic kuphatikiza kwa glibenclamide + metformin.

Furosemide imawonjezera C max metformin ndi 22% ndi AUC ndi 15% (popanda kusintha kwakukulu pakubwezeretsa kwa impso). Metformin imachepetsa C max furosemide ndi 31%, AUC ndi 12% ndi T 1/2 mwa 32% (popanda kusintha kwakukulu pakubwezeretsa kwa impso).

Chloramphenicol *

Chloramphenicol imapititsa patsogolo zotsatira za hypoglycemic ya glibenclamide + metformin.

Chlorpromazine *

Chlorpromazine mu Mlingo wambiri (100 mg / tsiku) amachepetsa mphamvu ya kuphatikiza kwa glibenclamide + metformin, chifukwa amachititsa kuchuluka kwa glycemia.

Chlortalidone *

Chlortalidone imazindikira zotsatira za kuphatikiza kwa glibenclamide + metformin.

Cimetidine (mankhwala a cationic) otulutsidwa m'matumba omwe amapikisana ndi mayendedwe a tubular ndikuwonjezera C max metformin ndi 60% ndi AUC ndi 40%.

Enalapril imawonjezera mphamvu ya hypoglycemic ya kuphatikiza kwa glibenclamide + metformin ndikuwonjezera mwayi wokhala ndi zovuta za hypoglycemic pokonzanso kulolera kwa shuga ndikuchepetsa kufunika kwa insulin.

Epinephrine imachepetsa mphamvu ya kuphatikiza kwa glibenclamide + metformin.

Ndi makonzedwe apanthawi imodzi a glibenclamide + metformin ndi mowa, chiwopsezo chokhala ndi vuto la hypoglycemic, kuphatikizira milandu ya chikomokere, ndi lactic acidosis chikuwonjezeka, motero mgwirizano uyenera kupewedwa.

Ethionamide imapititsa patsogolo zotsatira za hypoglycemic kuphatikiza kwa glibenclamide + metformin.

Nthawi zambiri pochiza matenda a shuga 2, sikokwanira kugwiritsa ntchito njira imodzi yokha mwaziphuphu. Biguanides ndi mosemphanitsa akuyenera kuwonjezeredwa ku chithandizo cha mankhwala a sulfonylurea.

Madokotala opanga adatha kupanga mankhwala Glibomet, omwe ndi ophatikiza magulu awiri mokwanira, chifukwa cha njira zingapo zotulutsira mavuto, amathetsa mavuto a anthu omwe akudwala matendawa.

Mankhwala a Glibomet adapangidwira kuti azisinthasintha shuga mwa odwala omwe ali ndi matenda ashuga a 2, omwe amayesa kubweretsa shuga kuti akhale abwinobwino ndi chithandizo chamankhwala, kumwa mankhwala ochokera ku sulfonylurea kapena biguanides sikulephera.

The analemba mankhwala zikuphatikizapo 2 yogwira zinthu:

glibenclamide 2,5 mg - woyimira m'badwo wachiwiri wa sulfonylurea
Metformin 400 mg ndi zotumphukira za biguanides.

Unyinji wopanga piritsi umayimiriridwa ndi gulu limodzi la omwe akubwera.

Pamwamba pa mapiritsiwo mumakhala zokutira ndi talc ndikuphatikizira amodzi amitundu ya mapadi ndi diethyl phthalate.

Zotsatira za pharmacological

Mwa kumwa mapiritsi a Glibomet, zolinga ziwiri zimakwaniritsidwa:

kutsika kwa shuga kukhala magawo wamba,
malamulo a mafuta kagayidwe.

Nchiyani chimayambitsa izi? Chimodzi mwazinthuzi chimagwira ntchito yake:

Glibenclamide imawonjezera katulutsidwe ka insulin mu kapamba (intrapancreatic effect) ndipo imakhudza kuzindikira kwa minyewa yake pazowonjezera zake. Mothandizidwa ndi, glucose kuchokera pabedi la mtima amapita mu hepatocytes ndi mu minofu, pomwe amakapangira glycogen depot.
Metformin imawonjezera chidwi cha zotumphukira zimakhala ku insulin, imalepheretsa kuyamwa kwa glucose m'matumbo a m'matumbo, imatchinga kaphatikizidwe ka gluconeogenesis, ndikuwongolera metabolism yamafuta.

Mphamvu ya zigawo ziwirizi imathandiza kuchepetsa kuchuluka kwa aliyense wa iwo popanda tsankho, komwe kumachitika patatha maola awiri pambuyo pa utsogoleri ndipo kumatenga maola 12. Kuphatikiza apo, izi zimachepetsa chiopsezo cha mavuto.

Mu thupi, glibenclamide ndi metformin zimachita mosiyanasiyana. Glibenclamide imagwira mapuloteni a plasma ndipo imapukusidwa mu chiwindi, pambuyo pake imatulutsidwa ndi bile ndi mkodzo mwa mawonekedwe a metabolites osagwira. Metformin simalowa mumalowa ndi mapuloteni, imalowa m'matipi, pomwe imagwira ntchito popanda kupangika. Imapakidwa makamaka ndi mkodzo, pang'ono m'matumbo.

Malangizo ogwiritsira ntchito

Zambiri mwazomwe zimayendetsedwera pakayendetsedwe ndi Mlingo amafotokozedwa mu malangizo ogwiritsira ntchito Glibomet.

Pali njira imodzi yokha yothira mankhwalawo - mapiritsi amatengedwa pakamwa ndi chakudya. Mlingo woyambira umachokera ku mapiritsi 1 mpaka 3 patsiku. Mtsogolomo, endocrinologist amasankha payekha, poganizira momwe wodwalayo alili komanso kuchuluka kwa shuga. Pazipita tsiku mlingo sayenera upambana 6 mapiritsi.

Mlingo wosankhidwa ndi dokotala umasinthidwa panthawi yamankhwala ndi shuga. Cholinga cha kusankha kwa mankhwalawa ndikuwonetsetsa kuti shuga ali ndi magazi ochepa.

Chisamaliro chiyenera kutengedwa poyendetsa ndi kugwira ntchito ndi makina osunthira.

Kuchita ndi mankhwala ena

Kuchita ndi mitundu ingapo ya mankhwala kumabweretsa kuwonjezeka kwa zotsatira za hypoglycemic. Izi zikuphatikiza:

kukonzekera kwa coumarin,
salicylates,
opanga beta
sulfonamides,
Mao zoletsa
miconazole
mowa wa ethyl.

Glibomet imawonjezera mphamvu ya anticoagulants.

Zotsatira zotsutsana za hypoglycemia ndi:

glucocorticoids,
kulera kwamlomo
okodzetsa a mndandanda wa thiazine,
barbiturates
adrenaline
mahomoni a chithokomiro.

Beta blockers mafuta mu chiwonetsero cha matenda a hypoglycemia, zomwe zimakhala zowopsa kwa odwala matenda ashuga.

Othandizira a Iodine omwe amalowetsedwa m'mitsempha amathandizira kuti metformin ipangidwe, chifukwa chake pali chiopsezo cha lactic acidosis.

Pali fanizo la Glibamet pochita ndi kapangidwe kake.

Glucovans ndi kuphatikiza kophatikizira kwa hypoglycemic action, yopangidwa ndi Merck, France. Mapiritsi okhala ndi glibenclamide ndi metformin m'matumba a chithuza mapiritsi 15. Mu phukusi 2 kapena 4 matuza.
Metglib - ili ndi mawonekedwe ofanana, mapiritsi a zidutswa 40 pa paketi iliyonse.
Bagomet-kuphatikiza - zinthu zofanana ziwiriziwiri, koma mlingo wake ndi wosiyana pang'ono. Mu phukusi la mapiritsi 30. Wopanga Argentina.
Gluconorm - kuphatikiza kwa zinthu ziwiri zomwezo, zidutswa 40 chilichonse, zimaperekedwa kuchokera ku India.
Ma analogi a Glibomet omwe ali osiyana mu kapangidwe kake koma ofanana ndi omwewo akuphatikizira:
Amaryl yochokera glimepiride 1.2.3.4 mg mu matuza a zidutswa 15, phukusi la matuza 2, 4, 6 kapena 8. Kupezeka ku Germany.
Maninil ndi Diabetes - zochokera ku glibenclamide, ndizomwe zimachokera ku 2nd sulfonurea.
Maninil - mapiritsi a 1.75 mg, 3.5 mg ndi 5 mg a zidutswa 120. Wopanga - Berlin-Chemie, Germany.
Diabeteson MV - mapiritsi 30 kapena 60 mg a mapiritsi a 60 kapena 30, motero. Wantchito Laborator, wogulitsa mankhwala ku France.

Poyerekeza, Maninil - Diabetes ayenera kupatsidwa chidwi ndi Diabetes, ngati mankhwala osavulaza.

Kwa mtengo, Glybomet ndi ma fanizo ake ali mumtundu wofanana.

Mtengo wapakati pa Glibomed umachokera ku ruble 200 mpaka 300.
Glucovans - mtengo uli pamtunda wa 250 - 350 rubles.
Bagomet-plus imagulitsidwa ma ruble 225 -235.
Metglib ikhoza kugulidwa pafupifupi ma ruble 230.
Maninil amatenga ma ruble a 130 -170.
Diabetes mkati mwa malire a 159 - 202 rubles.
Mtengo wa Amaryl umachokera ku ma 150 mpaka 3400 rubles. Amaryl imagulitsidwa pamtengo wokwera kwambiri pamtundu waukulu wa 4 mg wa mapiritsi 90.

Home »Cholecystitis» Glibomet - malangizo, ntchito, kugwiritsa ntchito mankhwalawa, ndemanga. Hypoglycemic m`kamwa mankhwala a gulu lachiwiri glybomet

Momwe mungatenge Glibomet

Poyerekeza ndi ndemanga za ma endocrinologists, kuti mupewe lactic acidosis, odwala matenda ashuga kuposa zaka 60, olimbitsa thupi tsiku lililonse, muyenera kumwa mankhwala mosamala, kujambula glucometer pafupipafupi.

Pali zoletsa kutenga Glibomet:

Kupanga ndi mafomu omasulira

Kapangidwe ka piritsi ya Glibomet kumaphatikizapo magawo awiri ogwira ntchito, omwe ndi glibenclamide, komanso metformin hydrochloride, kachigawo kambiri ka zinthu izi ndi 2.5 mg ndi 400 mg, motsatana. Zowonjezera zomwe zilipo:

Glycerol dibehenate
Povidone
Colloidal silicon dioxide
Magnesium wakuba
Croscarmellose sodium
Macrogol.

Mapiritsi ndi ozungulira, oyera kwamiyala, pali chiopsezo mbali imodzi. Mapiritsi amayikidwa mu chithuza chamtundu wa ma PC 20, M'kati mwa matuza awiri.

Kuchiritsa katundu

Glibomet ndi ya chiwerengero cha mankhwala a hypoglycemic omwe ali ndi kuphatikiza, zomwe zimagwira ndi zotumphukira za sulfonylurea, komanso genuanideide yachiwiri. Mankhwala amathandizira kaphatikizidwe ka insulin mu kapamba chifukwa chochepetsa kupindika kwa β-cell mwa glucose yokha. Thupi limakulitsa chiwopsezo cha insulin, pomwe kumangiriza ma cell enieniwo kumawonjezeka, ndipo kutulutsidwa kwa insulin kumakhala bwino. Pa mankhwala antidiabetesic, njira ya mayamwidwe glucose ndi maselo a chiwindi ndi minofu amakhala yofanana, amalepheretsa lipolysis zomwe zimachitika mu minofu ya adipose. Kuwonetsedwa kwa glibenclamide kwalembedwa gawo lachiwiri la insulin secretion.

Metformin ndi membala wa gulu la Biguanide. Imakhala ndi mphamvu yolimbikitsira kuzizira kwa minofu kuti ipangire insulin, imachepetsa kuyamwa kwa glucose mwachindunji m'matumbo, imalepheretsa gluconeogeneis, komanso imakhudza bwino njira ya metabolid ya lipid. Potengera momwe izi zakhudzidwira, ndizotheka kuchepetsa msanga thupi mwa anthu omwe akudwala matenda ashuga.

Zotsatira za hypoglycemic za mankhwala Glibomet zimalembedwa patatha maola awiri pambuyo poti atenge mapiritsi ndipo maola 12 otsatira apulumutsidwa. Chifukwa cha kuphatikiza kwa zinthu ziwiri zomwe zimagwira, kaphatikizidwe ka insulin yomwe imatchedwa endo native, imakhudza kwambiri osati minofu ndi adipose, komanso minofu ya chiwindi (chifukwa cha kuchepa kwa gluconeogeneis). Pankhaniyi, kukondoweza mwamphamvu kwa β-cell ya kapamba sikunalembedwe, komwe kumachepetsa mwayi wa ziwalo zam'magazi komanso kukula kwa zizindikiro zingapo zammbali.

Mlingo wa mayamwidwe a glibenclamide ndi mucosa wam'mimba uli pafupifupi 84%. Mlingo wapamwamba kwambiri wa chinthuchi m'magazi amalembedwa mkati mwa maola 1-2 atatha kugwiritsa ntchito mankhwala. Kuyankhulana ndi mapuloteni a plasma - 97%. Kusintha kwa metabolism kwa chinthuchi kumachitika m'maselo a chiwindi; zotsatira zake, ma metabolites angapo osagwira amapangidwa. Mukamachotsa zinthu za metabolic, matumbo am'mimba komanso dongosolo la impso zimakhudzidwa. Kutha kwa theka la moyo nthawi zambiri sikuyenera kupitirira maola 5-10.

Kuyamwa kwa metformin ndi mucosa wam'mimba kwambiri. Mukalowa mu kayendedwe ka systemic, kugawa kwake mwachangu mu minofu kumawonedwa, pafupifupi sikulowa muubwenzi ndi mapuloteni a plasma. Izi zimapangidwa pang'ono, zotulutsidwa ndi aimpso ndi matumbo. Hafu ya moyo wa metformin ndi maola 7.

Glibomet: malangizo onse ogwiritsira ntchito

Mankhwala adapangira pakamwa. Tengani Glybomet ndi zakudya. Mlingo ndi njira ya chithandizo zimasankhidwa payekha poganizira zomwe zikupezeka m'thupi, kuchuluka kwa shuga m'magazi, komanso chithunzi chonse cha kagayidwe kazachilengedwe.

Nthawi zambiri, muyeso woyamba wa mankhwala Glibomet ndi mapiritsi atatu. Munthawi ya antiidiabetesic mankhwala, mlingo wogwira bwino kwambiri umasankhidwa, womwe umachepetsa kuchuluka kwa shuga pamikhalidwe yokhazikika. Ndizofunikira kudziwa kuti mulingo wapamwamba kwambiri wa mankhwala tsiku lililonse ndi mapiritsi 6.

Kufotokozera kwa kapangidwe kake. Fomu Yotulutsira Mankhwala

Mankhwala "Glibomet" amapezeka mu mawonekedwe a mapiritsi ozungulira oyera okhala ndi chipolopolo cholimba. Amayikidwa m'matumba oyenera a zidutswa 20. Mu pharmacy mutha kugula phukusi lokhala ndi matuza awiri.

Ichi ndi chida chophatikizidwa, motero, chipangidwecho chili ndi magawo awiri ogwira ntchito - glibenclamide (2,5 ml piritsi limodzi) ndi metformin mu mawonekedwe a hydrochloride.Inde, kukonzekera kumakhalanso ndi zinthu zothandiza, makamaka, wowuma chimanga, silicon dioxide, cellcrystalline cellulose, talc, diethyl phthalate, glycerin, cellulose acetate phthalate, gelatin.

Kodi mankhwalawa amakhudza bwanji thupi?

Inde, poyambira, ndikofunikira kumvetsetsa zomwe mankhwalawo ali. Zotsatira za hypoglycemic pokonzekera Glibomet zimatsimikiziridwa ndi zomwe zili ndi zigawo ziwiri nthawi imodzi.

Chida ichi chimagwira pa kapamba, monga madera omwe amayang'anira thupi. Nthawi yomweyo, mankhwalawa amathandizira chidwi cha maselo olimbana ndi mahomoni awa. Chifukwa chake, Glibomet imathandizira kutsitsa shuga wamagazi popanda kugwiritsa ntchito insulin yopanga, yofunikira kwambiri kwa matenda ashuga a 2.

Mankhwala amakhalanso ndi milomo yotsitsa lipid. Mothandizidwa ndi iye, kuchuluka kwa mafuta m'magazi kumatsika, komwe kumachepetsa mwayi wamagazi m'magazi (ma magazi). Metformin ndi m'gulu la Biguanides. Izi zimayambitsa njira zamagwiritsidwe ntchito a glucose ndi minofu, zimalepheretsa gluconeogeneis mu chiwindi, ndipo zimalepheretsa adsorption yama chakudya ndi makhoma a m'mimba.

Glibenclamide imatengedwa mwachangu ndi makhoma a matumbo ndipo imakhala pafupi kwathunthu (97%) yomanga mapuloteni a plasma. Mu chiwindi, limasweka, ndikupanga metabolites osagwira, omwe amachotsedwa m'thupi limodzi ndi ndowe ndi mkodzo. Hafu ya moyo ndi maola 5. Metformin imadziwikanso mwachangu mthupi, koma sikugwirizana ndi mapuloteni a plasma. Izi sizimaphatikizidwa m'thupi. wofanana ndi maola awiri.

Kodi mankhwalawo amagwiritsidwa ntchito bwanji?

Anthu ambiri ali ndi matenda onga matenda ashuga 2. Zakudya ndi chithandizo pankhaniyi ndizofunikira kwambiri. Monga lamulo, kwa odwala amapanga zakudya zoyenera. Mutha kusintha shuga yanu yamagazi ndi sulfonylureas.

Mankhwala "Glibomet" amawonetsedwa ngati chithandizo chamankhwala ndikudya ndalama zomwe zili pamwambazi sizimapereka mphamvu yofunikira.

Momwe mungamwe mankhwalawa "Glibomet"? Mlingo umatsimikiziridwa payekhapayekha. Monga lamulo, mlingo woyambirira ndi mapiritsi awiri. Amatengedwa ndi chakudya. Komanso, kuchuluka kwa mankhwalawa kumawonjezereka kuti akwaniritse kwambiri. Mlingo wa tsiku ndi tsiku sayenera kupitirira 2 g ya metformin. Kenako, mlingo umachepetsedwa.

Mankhwala "Glibomet": contraindication pa mankhwala

Awa ndi mankhwala amphamvu komanso oopsa, omwe angatengedwe pokhapokha ndi chilolezo cha dokotala. Mankhwala ali ndi mndandanda wosangalatsa wa zotsutsana, zomwe muyenera kuzidziwa musanayambe chithandizo:

Hypersensitivity magawo othandizira komanso othandiza pamapiritsi,
Matupi a sulfonylurea zotumphukira zina, komanso sulfamide, probenecid kapena sulfamide diuretics,
Mankhwala omwe amapezeka mwa amayi panthawi yoyembekezera,
kuchepa kwa mphamvu kuchokera ku mankhwala,
matenda ashuga komanso ovuta
kukhumudwa kwa aimpso, kulephera kwa impso,
kusowa kwamadzi
matenda opatsirana
matenda otupa omwe angayambitse kukula kwa minofu hypoxia,
kwambiri pathologies a mtima dongosolo, kuphatikizapo mavuto kufalikira, kuchepa kwa mtima, kuchepa kwa poizoni ndi mtima mantha,
matenda oopsa a kupuma kwamthupi,
myocardial infaration kapena nthawi yokonzanso pambuyo pake,
kugwiritsa ntchito munthawi yomweyo mankhwala okodzetsa ndi mankhwala a kuthamanga kwa magazi,
acidosis kapena chiwopsezo cha chitukuko chake,
kukhalapo kwa mbiri ya wodwalayo pamilandu ya lactic acidosis,
matenda oopsa a chiwindi
mavuto a kupuma,
kukonzanso pambuyo pang'ono pang'ono kapamba,
dystrophic pathologies,
uchidakwa wambiri, mkhalidwe woledzera pachimake,
magazi akutuluka
zigawenga
kuyamwa
kusala kudya kapena kutsatira zakudya zokhwima.

Ngati muli ndi zilizonse zotsutsana pamwambapa, ndiye chifukwa chake muyenera kuuza a endocrinologist.

Kodi njira zochizira zoopsa zomwe zimabweretsa ndi ziti?

Kodi nthawi zonse kumakhala kotetezeka kumwa mapiritsi a Glibomet? Zotsatira zoyipa zakumbuyo zamankhwala ndizotheka. Milandu yakuchitika kwawo, komabe, sikujambulidwa nthawi zambiri, koma chithandizo chimakhudza magulu osiyanasiyana.

Dongosolo la Lymphatic ndi magazi . Hemolytic anemia, leukopenia, thrombocytopenia, pancytopenia, erythrocytopenia.
CNS . Nthawi ndi nthawi kupweteka kwa mutu, kusokonezeka kwa kamvekedwe ka malingaliro.
Zowongolera masomphenya. Kusokonezeka kwa malo okhala, kuchepa kwa maonedwe acuity, komwe kumalumikizidwa ndi kusintha kwa shuga m'magazi.
Kupenda . Kuwonjezeka kwambiri kwa thupi, hypoglycemia, lactic acidosis. Kuchiza kwa nthawi yayitali nthawi zina kumabweretsa kuyamwa kwa vitamini B12 m'matumbo, omwe pambuyo pake amathandizira kukulitsa kuchepa kwa magazi m'thupi.
Matumbo oyenda . Kusanza, kusanza, kutulutsa, kupweteka m'zigawo za epigastric, kugona pafupipafupi, kusowa chilakolako chakufa, mawonekedwe akumaso amkamwa, kumverera kwadzadza m'mimba.
Khungu komanso minyewa yofinya . Khungu loyenda, erythema, mitundu yosiyanasiyana ya exanthema, limakulitsa khungu lathu kuti lisinthe, khungu lawo siligwirizana.
Thupi lawo siligwirizana . Kuwala pakhungu, kutupa, jaundice, kuchepa kwakukulu kwa kuthamanga kwa magazi, kupuma, zochitika zadzidzidzi.
Chiwindi . Intrahepatic cholestasis, mankhwala a chiwindi.
Mavuto ena amatha kuwonekera, makamaka, kuwonjezeka kwamkodzo tsiku lililonse, kuwonongeka kwa mapuloteni ndi sodium ndi thupi chifukwa cha kusokonezeka kwa impso.

Ndikofunika kudziwa kuti ambiri mwamavutikawa safuna kuti athetse chithandizo chokwanira - ndikokwanira kuti muchepetse mulingo wake ndipo zotsatirapo zake zimasiyana lokha. Kuchuluka kwa tsiku lililonse kwa mankhwalawa kuyenera kuwonjezeka pang'onopang'ono komanso pang'onopang'ono.

Zambiri pazokhudzana ndi mankhwala ena

Mankhwala "Glibomet" (metformin) sangatengedwe ndi ethyl mowa, chifukwa izi zimawonjezera mwayi wokhala ndi lactic acidosis. Pa chithandizo, zakumwa zoledzeretsa komanso zakumwa zoledzeretsa ziyenera kutayidwa.

Kugwiritsa ntchito mankhwalawa kumayimitsidwa maola 48 njira zisanagwiritsidwe ntchito poyerekeza ndi ayodini. Kugwiritsa ntchito munthawi yomweyo mankhwalawa kungayambitse kulephera kwa impso.

Ngati mutenga "Glibomet" pamodzi ndi insulin, anabolic steroids, beta-adrenergic blockers, mankhwala a tetracycline, ndiye kuti chiopsezo chokhala ndi hypoglycemia chikuwonjezeka. Anthu odwala matenda ashuga nthawi zonse amafunika kudziwitsa dokotala za mankhwala omwe amamwa.

Mtengo ndi fanizo

Mankhwala amakono, mankhwala "Glibomet" amagwiritsidwa ntchito nthawi zambiri. Ndemanga ya anthu odwala matenda ashuga, zikuwonetsa ndi zotsutsana ndi, zinthu zofunika. Koma chosasiyananso ndi mtengo wake. Zachidziwikire, ndizovuta kutchula nambala yeniyeni, koma mwatsatanetsatane mtengo wa mapiritsi 40 umachokera ku 340 mpaka 380 rubles, womwe kwenikweni siwambiri.

Inde, mankhwalawa sakhala oyenera nthawi zonse kwa odwala. Pali zolowa m'malo zokwanira pamsika wamakono wamankhwala. Mwachitsanzo, ndi matenda ashuga amtundu wachiwiri, njira monga Avandamet, Vokanamet, Glukovans amagwiritsidwa ntchito nthawi zambiri. Osatinso kawirikawiri, odwala amapatsidwa Dibizid, Dianorm kapena Sinjarji. Zachidziwikire, ndiopezeka pa endocrinologist omwe amatha kusankha analogue othandiza.