Kukonzekera kwa Thiazolidinedione

Thiazolidinediones amawonetsa zotsatira mwa kuchepa kwa insulin. Pali ma 2 thiazolidinediones omwe amapezeka pamsika - rosiglitazone (Avandia) ndi pioglitazone (Actos). Troglitazone anali woyamba m'gulu lawo, koma adathetsedwa chifukwa adayambitsa chiwindi ntchito.

Njira yamachitidwe. Thiazolidinediones imakulitsa chidwi cha insulin pochita monga minofu ya adipose, minofu ndi chiwindi, komwe zimakulitsa kugwiritsidwa ntchito kwa glucose ndikuchepetsa kaphatikizidwe kake (1,2). Njira zomwe amagwirira ntchito sizomveka bwino.

Kuchita bwino Pioglitazone ndi rosiglitazone amagwiranso ntchito mofananamo kapena pang'ono pang'onopang'ono monga othandizira ena a hypoglycemic. Mtengo wapakati wa hemoglobin wa glycosylated mukamatenga rosiglitazone amatsika ndi 1,2-1,5%, ndipo kuchuluka kwa lipoproteins okwera komanso otsika kumawonjezeka.

Kutengera ndi kafukufukuyu, zitha kuganiziridwa kuti chithandizo cha thiazolidinedione sichotsika mtengo potengera mphamvu ya mankhwala a metformin, koma chifukwa cha mtengo wokwera ndi zotsatirapo zake, mankhwalawa sagwiritsidwa ntchito popereka chithandizo choyambirira cha matenda ashuga

Zotsatira za thiazolidinediones pamtima pamtima. Mankhwala osokoneza bongo omwe ali mgululi amatha kukhala ndi anti-yotupa, antithrombotic ndi anti-atherogenic, koma ngakhale izi, deta yomwe imawonetsa kuchepa kwa chiwopsezo cha matenda amtima sichodabwitsa, ndipo kuchuluka kwa zoyipa ndizowopsa.

(4,5,6,7) Zotsatira za kusanthula kwa meta zikuwonetsa kufunikira kwa kusamala pakugwiritsa ntchito thiazolidatediones ndi rosiglitazone makamaka, mpaka data yatsopanoyo itsimikizire kapena kukana deta yomwe ili pamtima.

Komanso, ndikofunikira kulingalira za kuthekera kwakukhumudwitsa mtima. Panthawi imeneyi, sikulimbikitsidwa kugwiritsa ntchito rosiglitazone ngati nkotheka kugwiritsa ntchito mankhwala otetezeka (metformin, sulfonylureas, insulin).

Lipids. Pa mankhwala a pioglitazone, kuchuluka kwa osachulukitsa lipids kumakhalabe kosasinthika, pomwe mankhwala a rosiglitazone, kuwonjezeka kwa kuchuluka kwa lipid kumawonedwa ndi pafupifupi 8-16%. (3)

1. Kuchulukitsa kumva kwa minofu.

2. Kuchulukitsa kaphatikizidwe ka insulin m'maselo a beta a kapamba.

3. Kuchulukitsa kuchuluka kwa ma isanc a pancreatic (komwe insulin imapangidwa m'maselo a beta).

4. Kuchulukitsa kuchuluka kwa glycogen m'chiwindi (chakudya chosungirako chopangidwa kuchokera ku shuga) ndikuchepetsa gluconeogeneis (kapangidwe ka glucose kuchokera kumapuloteni, mafuta ndi zina zopanda mafuta). Nthawi yomweyo, kugwiritsidwa ntchito kwa glucose kumachulukitsa, mapangidwe ndi ndende mu magazi amachepa.

5. Amachepetsa mulingo wa triglycerides (lipids, gawo lalikulu lamafuta amthupi).

6. Zingayambitse kuyambanso kwa ovulation mwa azimayi omwe ali ndi pululatrate kuzungulira nthawi ya premenopusing.

7. Imawonjezera mphamvu ya hypoglycemic ya othandizira ena am'kamwa kwambiri, makamaka metformin.

Chitetezo

Kulemera. Ma thiazolidinediones onse amatha kuwonjezera kulemera. Izi zimatengera mlingo komanso nthawi yayitali ya mankhwala ndipo zitha kukhala zazikulu. gawo lalikulu la kulemera kwakukulu limachitika chifukwa cha kusungunuka kwa madzi mthupi.

(8) Kulemera kwambiri kumatha kuchitika chifukwa cha kuchuluka kwa adipocytes. Kusungidwa kwamadzi ndi kulephera kwa mtima. Peripheral edema imapezeka mu 4-6% ya odwala omwe amatenga thiazolidatediones (kufanizira, mu gulu la placebo okha 1-2%).

kudzikundikira kwamadzi kumeneku kumatha kudzetsa mtima. kutsikira kwamadzimadzi kumatha kuchitika chifukwa cha kutsegulanso kwa sodium reabsorption kudzera m'misewu ya epithelial sodium, ntchito yomwe imachulukana ndikusangalatsa kwa RAPP-gamma.

Musculoskeletal system. Pali umboni wambiri woti thiazolidatediones amachepetsa kufooka kwa mafupa ndikuwonjezera mwayi wowonongeka, makamaka azimayi. (10) Chiwopsezo chotheratu chotenga kachilomboka ndichoperewera, koma mankhwalawa sayenera kugwiritsidwa ntchito mwa amayi omwe amakhala ndi mafupa ochepa komanso amakhala ndi chiopsezo cha fractures.

Hepatotoxicity. Ngakhale rosiglitazone ndi pioglitazone sanalumikizidwe ndi hepatotoxicity m'mayesero azachipatala omwe amaphatikizapo odwala 5,000, milandu 4 ya hepatotoxicity inanenedwa ndi thiazolidinediones.

Eczema Mankhwala a Rosiglitazone agwirizanitsidwa ndi eczema.

Edema wa macula. Zomwe zimayambitsa izi sizikudziwika. Wodwala yemwe ali ndi chiopsezo chowonjezeka cha edema sayenera kulandira thiazolidatediones.

Contraindication

  • 1. Lemberani matenda ashuga a 2 shuga, pamene mankhwala othandizira pakudya ndi zochita zolimbitsa thupi sizitsogolera kuti alipidwe chifukwa cha matendawo.
  • 2. Kulimbitsa machitidwe a Biguanides osakwanira kwenikweni chifukwa chomaliza.
  • 1. Mtundu woyamba wa matenda ashuga.
  • 2. Matenda a shuga a ketoacidosis (kuchuluka kwambiri m'magazi a matupi a ketone), chikomokere.
  • 3. Mimba komanso kuyamwa.
  • 4. Matenda a chiwindi ndi pachimake komanso opuwala.
  • 5. Kulephera kwa mtima.
  • 6. Hypersensitivity mankhwala.

Thiazolidinediones: malangizo ogwiritsira ntchito ndi kagwiritsidwe ntchito kake

Mankhwala amakono amagwiritsa ntchito mitundu yosiyanasiyana ya mankhwala kuchiza matenda amtundu wa 2.

Limodzi mwa maguluwa ndi thiazolidinediones, omwe ali ndi vuto lofanananso ndi metformin.

Amakhulupirira kuti, poyerekeza ndi chinthu chomwe chatchulidwa pamwambapa, thiazolidatediones ndi otetezeka.

Zolemba

1) Zotsatira za troglitazone: othandizira atsopano a hypoglycemic odwala omwe ali ndi NIDDM yosayendetsedwa bwino ndi chithandizo chamankhwala. Iwamoto Y, Kosaka K, Kuzuya T, Akanuma Y, Shigeta Y, Kaneko T Diabetes Care 1996 Feb, 19 (2): 151-6.

2) Kupititsa patsogolo kulekerera kwa glucose ndi insulin kukana kunenepa kwambiri mothandizidwa ndi troglitazone. Nolan JJ, Ludvik B, Beerdsen P, Joyce M, Olefsky J N Engl J Med 1994 Nov 3,331 (18): 1188-93.

3) Yki-Jarvinen, H. Dokotala Therapy: Thiazolidinediones. N Engl J Med 2004, 351: 1106.

4) Ubwenzi pakati pa Vascular Reacaction ndi Lipids ku Mexico-America ku America ndi Type 2 Diabetes Treated ndi Pioglitazone. Wajcberg E, Sriwijitkamol A, Musi N, Defronzo RA, Cersosimo E J Clin Endocrinol Metab. 2007 Apr, 92 (4): 1256-62. Epub 2007 Jan 23

5) Kuyerekeza pioglitazone vs glimepiride pakukula kwa coronary atherosulinosis mwa odwala omwe ali ndi matenda a shuga a 2: PERISCOPE mayesero oyendetsedwa mosasamala. Nissen SE, Nicholls SJ, Wolski K, Nesto R, Kupfer S, Perez A, Jure H,

6) Chiyeso chosasinthika cha zotsatira za rosiglitazone ndi metformin pak kutupa ndi subclinical atherosulinosis kwa odwala omwe ali ndi matenda a shuga a 2. DJ Wogulitsa, Taylor AJ, Langley RW, Jezior MR, Vigersky RA Am Mtima J. 2007 Mar, 153 (3): 445.e1-6.

7) GlaxoSmithKline. Phunzirani palibe. ZM2005 / 00181/01: Avandia Cardiovascular Event Modeling Project. (Ikupezeka pa Juni 7, 2007, pa Htz. Http :ctr.gsk.co.uk/summary/Rosiglitazone/III_CVmodeling.pdf).

8) Troglitazone monotherapy imakongoletsa kuwongolera kwa glycemic kwa odwala omwe ali ndi mtundu wa matenda a shuga 2: kafukufuku wosasankhidwa, wowongoleredwa. Gulu La Maphunziro a Troglitazone. Fonseca VA, Valiquett TR, Huang SM, Ghazzi MN, Whitcomb RW J Clin Endocrinol Metab 1998 Sep, 83 (9): 3169-76.

9) Thiazolidinediones imakulitsa kuchuluka kwamadzi amthupi kudzera PPARgamm kukondoweza kwa ENaC-mediated a impso mchere. Guan Y, Hao C, Cha DR, Rao R, Lu W, Kohan DE, Magnuson MA, Redha R, Zhang Y, Breyer MD Nat Med 2005 Aug, 11 (8): 861-866. Epub 2005 Jul 10.

10) TI - Zotsatira za mafupa a thiazolidatedione. Gray A Osteoporos Int. 2008 Feb, 19 (2): 129-37. Epub 2007 Sep 28.

11) Zotsatira za rosiglitazone pamafupipafupi a shuga kwa odwala omwe ali ndi vuto la glucose kapena omwe ali ndi vuto la kusala kudya: kuyesedwa kosasankhidwa. Gerstein HC, Yusuf S, Bosch J, Pogue J, Sheridan P, Dinccag N, Hanefeld M, Hoogwerf B, Laakso M, Mohan V, Shaw J, Zinman B, Holman RR Lancet. 2006 Sep 23,368 (9541): 1096-105

12) Gulu Lofufuza la DPP. Kupewa kwa matenda a shuga a 2 omwe ali ndi troglitazone mu pulogalamu yoletsa matenda ashuga. Matenda a shuga 2003, 52 Suppl 1: A58.

Kodi matendawa amathandizidwa bwanji?

Chithandizo chamakono cha matenda ashuga ndi njira zingapo.

Njira zochizira zimaphatikizapo maphunziro azachipatala, kutsatira zakudya zokhwima, kulimbitsa thupi, kugwiritsa ntchito mankhwala osokoneza bongo komanso kugwiritsa ntchito maphikidwe achire.

Kuthandiza odwala matenda ashuga kumaphatikizapo kugwiritsa ntchito mankhwala apadera kuti mukwaniritse zina mwa njira zochizira.

Zolinga zamankhwala awa ndi:

  • kukhalabe kuchuluka kwa insulin ya mahomoni pamlingo wofunikira,
  • kuchuluka kwa shuga m'magazi,
  • cholepheretsa kupititsa patsogolo kwa njira ya pathological,
  • kulowererapo kwa mawonekedwe a zovuta ndi zotsatira zoyipa.

Njira ya achire imaphatikizanso kugwiritsa ntchito magulu otsatirawa a mankhwala:

  1. Kukonzekera kwa Sulfonylurea, komwe kumakhala pafupifupi magawo makumi asanu ndi anayi a zana onse a mankhwala ochepetsa shuga. Mapiritsi oterewa amathandizira mawonekedwe a insulin kukana.
  2. Biguanides ndi mankhwala okhala ndi chinthu monga metformin. Gawo lake limakhala ndi phindu pa kuwonda, komanso limathandizira kuchepetsa shuga. Monga lamulo, sagwiritsidwa ntchito ngati vuto la impso ndi chiwindi, chifukwa limakhazikika mu ziwalo izi.
  3. Alpha-glycosidase inhibitors amagwiritsidwa ntchito prophylactically kuteteza kukula kwa matenda ashuga a 2. Ubwino waukulu wa mankhwala a gululi ndikuti sotsogolera ku chiwonetsero cha hypoglycemia. Mankhwala okhala ndiwothandiza amathandizanso pakukula kwa kulemera, makamaka ngati mankhwala azakudya amatsatiridwa.
  4. Thiazolidinediones angagwiritsidwe ntchito ngati mankhwala akuluakulu ochizira matenda am'mimba kapena pamodzi ndi mankhwala ena ochepetsa shuga. Choyambitsa chachikulu cha mapiritsi ndikuwonjezera chidwi cha insulin, motero zimapangitsa kukana. Mankhwalawa sagwiritsidwa ntchito popanga mtundu wa matenda a shuga 1, chifukwa amatha kuchita zokha pamaso pa insulin, yomwe imapangidwa ndi kapamba.

Kuphatikiza apo, meglitinides amagwiritsidwa ntchito - mankhwala omwe amachulukitsa katemera wa insulin, motero akukhudza maselo a pancreatic beta.

Kutsika kwa glucose kumawonedwa patatha mphindi khumi ndi zisanu mutamwa mapiritsi.

Zotsatira za thiazolidinediones pa thupi?

Mankhwala ochokera pagulu la thiazolidinediones ali ndi cholinga choteteza kukana kwa insulin.

Amakhulupirira kuti mapiritsi ngati amenewa atha kulepheretsa kutenga matenda ashuga amtundu wa 2.

Pharmacology yamakono imayimira mitundu iwiri yayikulu kuchokera pagululi - Rosiglitazone ndi Pioglitazone.

Zotsatira zazikulu za mankhwala opaka thupi:

  • onjezerani kuchuluka kwa minofu kuti mumve insulin,
  • gwiritsani ntchito kuchuluka kwa maselo am'mimba a pancreatic,
  • kumawonjezera mphamvu ya metformin kuphatikiza mankhwala.

Kukonzekera kuchokera ku gulu la thiazolidinediones kumagwiritsidwa ntchito motere:

  1. Zochizira komanso kupewa matenda amtundu wa 2 shuga.
  2. Kuchepetsa thupi mukamadwala matenda a shuga komanso masewera olimbitsa thupi amatsatiridwa.
  3. Kuti muwonjezere mphamvu ya mankhwala ochokera pagulu la Biguanide, ngati omalizirawa saonekera kwathunthu.

Mapiritsi amakono a thiazolidcedione amatha kuperekedwa pamankhwala osiyanasiyana, kutengera mtundu wa kukula kwa matenda - fifitini, makumi atatu ndi makumi anayi ndi kasanu aomwe akuphatikizidwa. Njira ya chithandizo tikulimbikitsidwa kuti muyambe ndi mlingo wocheperapo komanso kumwa kamodzi patsiku. Pakatha miyezi itatu, ngati kuli kotheka, onjezani mlingo.

Nthawi zambiri, mankhwalawa amagwiritsidwa ntchito kutsitsa shuga m'magazi. Kuphatikiza apo, muzochitika zamankhwala, ndichizolowezi kupatula odwala omwe amamwa mapiritsi kuti "ayankhe" komanso "osayankha" pazotsatira za mankhwalawo.

Amakhulupirira kuti mphamvu yogwiritsira ntchito thiazolidinediones ndiyochepa pang'ono poyerekeza ndi mankhwala ochepetsa shuga a magulu ena.

Kukonzekera kwa Thiazolidinedione

Troglitazone (Rezulin) anali mankhwala a m'badwo woyamba wa gululi. Adakumbukiridwa kuchokera kugulitsa, popeza momwe amawonekera adawonetsa molakwika pachiwindi.

Rosiglitazone (Avandia) ndi mankhwala m'badwo wachitatu m'gululi. Inaleka kugwiritsidwa ntchito mu 2010 (yoletsedwa ku European Union) zitadziwika kuti zimawonjezera chiopsezo cha matenda amtima.

Dzinalo lantchito yogwiraZitsanzo ZamalondaMlingo piritsi limodziMg
PagogazonePioglitazone Bioton15 30 45

Limagwirira ntchito pioglitazone

Kuchita kwa pioglitazone kulumikizana ndi cholumikizira chapadera cha PPAR-gamma, chomwe chili mkati mwa cell. Chifukwa chake, mankhwalawa amakhudza ntchito ya maselo ogwirizana ndi kukonza shuga. Chiwindi, mchikakamizo chake, chimapanga zochepa. Pa nthawi yomweyo, chidwi cha insulin chimakulirakulira.

Zofunika kudziwa: kodi insulin kukana

Izi ndizowona makamaka kwa maselo amafuta, minofu ndi chiwindi. Ndipo, pali kuchepa kwa kusunthika kwa shuga m'magazi a glucose komanso kukwaniritsa kuchuluka kwa glucose ya postprandial.

Kugwiritsa ntchito

Kuphatikiza apo, zatsimikiziridwa kuti mankhwalawa ali ndi zina zowonjezera zopindulitsa:

  • Amachepetsa kuthamanga kwa magazi
  • Zimakhudzanso cholesterol (imawonjezera kupezeka kwa "cholesterol yabwino", ndiye kuti, HDL, ndipo sichulukitsa "cholesterol yoyipa" - LDL),
  • Imalepheretsa mapangidwe ndi kukula kwa atherosulinosis,
  • Amachepetsa chiopsezo cha matenda a mtima (mwachitsanzo, kugunda kwa mtima, sitiroko).

Werengani zambiri: Jardins amateteza mtima

Kwa omwe pioglitazone adalembedwa

Pioglitazone ikhoza kugwiritsidwa ntchito ngati mankhwala amodzi, i.e. monotherapy. Komanso, ngati muli ndi mtundu wachiwiri wa matenda ashuga, kusintha kwanu pa moyo sikupereka zotsatira zomwe zikuyembekezeka ndipo pali zotsutsana ndi metformin, kulekerera kwake kosavomerezeka komanso zoyipa zake zomwe zingachitike

Kugwiritsa ntchito pioglitazone ndikotheka ndikuphatikiza ndi mankhwala ena othandizira (mwachitsanzo, acarbose) ndi metformin ngati zochita zina sizibweretsa bwino

Pioglitazone itha kugwiritsidwanso ntchito ndi insulin, makamaka kwa anthu omwe thupi lawo limachita mosavomerezeka ndi metformin.

Werengani zambiri: Momwe mungatenge metformin

Momwe mungatenge pioglitazone

Mankhwalawa amayenera kumwa kamodzi patsiku, pakamwa, panthawi yokhazikika. Izi zitha kuchitika musanadye komanso pambuyo chakudya, popeza chakudya sichikhudza mayamwidwe a mankhwalawo. Chithandizo nthawi zambiri chimayamba ndi mlingo wotsikirapo. Panthawi yomwe chithandizo cha mankhwalawa sichikhutiritsa, chitha kuchepa.

Kugwiritsa ntchito bwino kwa mankhwalawa kumawonedwa pakachitika matenda a 2 odwala, koma Metformin sangathe kugwiritsidwa ntchito, monotherapy yokhala ndi mankhwala amodzi saloledwa.

Kuphatikiza apo pioglitazone imachepetsa postprandial glycemia, plasma glucose ndipo imakhazikika hemoglobin ya glycated, imakhalanso ndi chiwonjezero chabwino pakuthamanga kwa magazi ndi cholesterol yamagazi. Kuphatikiza apo, sizimayambitsa zosankha.

Zotsatira zoyipa

Zotsatira zoyipa zomwe zingachitike ndi pioglitazone chithandizo ndi monga:

  • Kuchuluka kwamadzi m'thupi (makamaka mukamagwiritsa ntchito insulin)
  • Kuchulukana kwa mafupa osachedwa, omwe amadzala ndi kuvulala kowonjezereka,
  • Matenda opumira pafupipafupi
  • Kulemera.
  • Kusokonezeka tulo.
  • Kuchepa kwa chiwindi.

Kumwa mankhwalawa kungakulitse chiwopsezo cha macular edema (chizindikiro choyamba chitha kukhala chowonongeka pakuwona, komwe kuyenera kufotokozedwa mwachangu kwa ophthalmologist) komanso chiopsezo chokhala ndi khansa ya chikhodzodzo.

Mankhwalawa samayambitsa hypoglycemia, koma amachulukitsa chiopsezo chake chikagwiritsidwa ntchito ndi mankhwala omwe amachokera ku insulin kapena sulfonylurea.

Werengani zambiri: Mankhwala atsopano pochiza matenda a shuga a mellitus Trulicity (hlalglutide)

Mapiritsi1 tabu
pioglitazone30 mg
pioglitazone hydrochloride 33.06 mg,

- matumba otumphuka (3) - mapaketi okhala ndi makatoni. 10 ma PC. - matumba otumphuka (6) - mapaketi a makatoni. 30 ma PC. - zitini za polima (1) - mapaketi a makatoni.

- Mabotolo a polymer (1) - mapaketi a makatoni.

Zotsatira za pharmacological

Wothandizira pakamwa wa hypoglycemic, wachokera pagulu la thiazolidinedione. Agonist wamphamvu, wosankha wa gamma receptors wopangidwa ndi peroxisome proliferator (PPAR-gamma). PPAR gamma receptors imapezeka mu adipose, minofu minofu ndi chiwindi.

Kutsegula kwa ma nyukiliya okwanira PPAR-gamma modulates kusindikizidwa kwa majini angapo amtundu wa insulin omwe amathandizira kuwongolera kwa glucose ndi lipid metabolism. Imachepetsa kukana kwa insulini mu zotumphukira ndipo mu chiwindi, chifukwa cha izi pali kuwonjezeka kwa kumwa kwa glucose wodalira insulin komanso kuchepa kwa kupanga kwa glucose m'chiwindi.

Mosiyana ndi zotumphukira za sulfonylurea, pioglitazone simalimbikitsa kubisalira kwa insulin mwa maselo a pancreatic beta.

Mtundu wachiwiri wa matenda a shuga a mellitus (osadalira insulini), kuchepa kwa kukana insulini motsogozedwa ndi pioglitazone kumapangitsa kuchepa kwa ndende ya magazi, kuchepa kwa plasma insulin ndi hemoglobin A1c (glycated hemoglobin, HbA1c).

Mtundu wachiwiri wa matenda a shuga a mellitus (osadalira insulini) omwe ali ndi vuto la lipid metabolism lomwe limagwirizanitsidwa ndi kugwiritsa ntchito pioglitazone, pali kuchepa kwa TG komanso kuwonjezeka kwa HDL. Nthawi yomweyo, mulingo wa LDL ndi cholesterol yathunthu mwa odwala sasintha.

Pharmacokinetics

Pambuyo pakulowetsa pamimba yopanda kanthu, pioglitazone amadziwika m'madzi am'madzi pambuyo pa mphindi 30. Cmax mu plasma imatheka pambuyo 2 maola.Mukamadya, panali kuwonjezeka pang'ono kwa nthawi kuti mufikire Cmax mpaka maola 3-4, koma kuchuluka kwa mayeso sikunasinthe.

Mutatenga limodzi mlingo, Vd ya pioglitazone pafupifupi 0,63 ± 0,41 l / kg. Kumangiriza mapuloteni a seramu a anthu, makamaka okhala ndi albumin, ndi oposa 99%, kumangiriza mapuloteni ena a seramu sikumatchulidwa kokwanira. Ma metabolites a pioglitazone M-III ndi M-IV amakhudzidwanso kwambiri ndi serum albin - oposa 98%.

Pioglitazone imapangidwa kwambiri mu chiwindi ndi hydroxylation ndi oxidation. Metabolites M-II, M-IV (hydroxy derivatives of pioglitazone) ndi M-III (keto ofanana ndi pioglitazone) amawonetsa zochitika zam'magulu azikhalidwe zamtundu wa shuga. Ma metabolabolites nawonso amasinthidwa pang'ono kukhala ma conjugates a glucuronic kapena sulfuric acid.

Kagayidwe ka pioglitazone mu chiwindi kumachitika ndi nawo gawo la isoenzymes CYP2C8 ndi CYP3A4.

T1 / 2 ya pioglitazone yosasinthika ndi maola 3-7, pioglitazone yathunthu (pioglitazone ndi metabolites yogwira) ndi maola 16-24. Kuwonekera kwa pioglitazone ndi 5-7 l / h.

Pambuyo pakukonzekera pakamwa, pafupifupi 15-30% ya mlingo wa pioglitazone umapezeka mkodzo. Pioglitazone ochepa kwambiri amachotsedwa ndi impso, makamaka mu mawonekedwe a metabolites ndi ma conjugates. Amakhulupirira kuti akamwetsa, muyezo umodzi umapukusidwa mu ndulu, zonse osasinthika komanso mawonekedwe a metabolites, ndikuchotsa m'thupi ndi ndowe.

The wozungulira pioglitazone ndi yogwira metabolites mu seramu magazi kukhalabe wokwanira okwanira maola 24 pambuyo limodzi makonzedwe a tsiku ndi tsiku mlingo.

Lembani matenda ashuga a 2 a mellitus (osadalira insulini).

Kuyanjana kwa mankhwala osokoneza bongo

Mukamagwiritsa ntchito mtundu wina wa thiazolidinedione munthawi yomweyo ndi njira zakulera zamkamwa, kuchepa kwa kuchuluka kwa ethinyl estradiol ndi norethindrone mu plasma kumawonedwa ndi pafupifupi 30%. Chifukwa chake, pogwiritsa ntchito munthawi yomweyo kugwiritsa ntchito pioglitazone ndi njira zakulera zamkamwa, ndizotheka kuchepetsa mphamvu zakulera.

Ketoconazole linalake ndipo limalepheretsa chiwindi kuphatikizika kwa pioglitazone.

Malangizo apadera

Pioglitazone sayenera kugwiritsidwa ntchito pamaso pazowoneka bwino za matenda a chiwindi mu gawo logwira kapena kuwonjezeka kwa ntchito ya ALT 2,5 kuposa VGN. Ndi kuchuluka zolimbitsa ntchito za chiwindi michere (ALT osachepera 2.

5 times apamwamba VGN) isanayambe kapena munthawi ya chithandizo ndi odwala a pioglitazone amayenera kufufuzidwa kuti adziwe chomwe chikuwonjezera. Ndi kuwonjezeka kwapang'onopang'ono kwa ntchito ya enzyme ya chiwindi, chithandizo chiyenera kuyambitsidwa mosamala kapena kupitiriza.

Pankhaniyi, kuwunikira pafupipafupi chithunzi cha kuchipatala ndikuwonetsetsa momwe ntchito ya chiwindi imayendera.

Pankhani ya kuchuluka kwa ntchito ya transaminases mu magazi seramu (ALT> 2.

Kuwirikiza kawiri kuposa VGN) kuwunika kwa chiwindi kuyenera kuchitidwa mowirikiza mpaka mulingowo ubwerere mwakale kapena kuzowonetsa zomwe zimawonedwa musanalandire chithandizo.

Ngati ntchito za ALT ndizokwera katatu kuposa VGN, ndiye kuti kuyesa kwachiwiri kuti mupeze ntchito ya ALT kuyenera kuchitika posachedwa. Ngati zochitika za ALT zikadatsala pang'ono 3 times> VGN pioglitazone ziyenera kusiyidwa.

Pa mankhwala, ngati mukukayikira kuti chitukuko cha chiwindi chimayambitsa matenda (mawonekedwe a nseru, kusanza, kupweteka kwam'mimba, kutopa, kusowa kwa chakudya, mkodzo wakuda), kuyesa kwa chiwindi kuyenera kutsimikizika. Lingaliro la kupitiriza kwa pioglitazone mankhwala liyenera kutengedwa pamaziko a zidziwitso zamankhwala, poganizira magawo a labotale. Pankhani ya jaundice, pioglitazone iyenera kusiyidwa.

Mosamala, pioglitazone iyenera kugwiritsidwa ntchito kwa odwala omwe ali ndi edema.

Kukula kwa kuchepa kwa magazi m'thupi, kuchepa kwa hemoglobin ndi kuchepa kwa hematocrit kungalumikizidwe ndi kuchuluka kwa plasma ndipo sikuwonetsa zovuta zamatenda ena.

Ngati ndi kotheka, kugwiritsa ntchito nthawi imodzi ya ketoconazole iyenera kuwunika kuchuluka kwa glycemia.

Zowopsa zochepa za kuchuluka kwakanthawi kwamachitidwe a CPK adadziwika motsutsana ndi kugwiritsa ntchito pioglitazone, komwe kunalibe zotsatirapo za chipatala. Ubwenzi wamachitidwe awa ndi pioglitazone sichikudziwika.

Miyezo yapakati ya bilirubin, AST, ALT, alkaline phosphatase ndi GGT inachepa pakuwunika kumapeto kwa chithandizo cha pioglitazone poyerekeza ndi zofananira zofananira asanalandire chithandizo.

Musanayambe chithandizo komanso chaka choyamba chamankhwala (miyezi iwiri iliyonse) komanso nthawi ndi nthawi, zochitika za ALT ziyenera kuyang'aniridwa.

Mu kafukufuku woyesera pioglitazone samawonetsedwa kuti ndi mutagenic.

Kugwiritsa ntchito pioglitazone mwa ana sikulimbikitsidwa.

Mimba komanso kuyamwa

Pioglitazone imaphatikizidwa pakatundu ndi pakati.

Odwala omwe ali ndi insulin, ndipo amayambira kuzungulira pang'onopang'ono, mankhwalawa ndi thiazolidatediones, kuphatikizapo pioglitazone, amatha kuyambitsa mazira. Izi zimawonjezera chiopsezo cha kutenga pakati ngati kulera koyenera sikugwiritsidwa ntchito.

Mu kafukufuku woyesera adawonetsedwa mu nyama zomwe pioglitazone alibe teratogenic ndipo sizikhudza chonde.

Ndi chiwindi ntchito

Pioglitazone sayenera kugwiritsidwa ntchito pamaso pazowoneka bwino za matenda a chiwindi mu gawo logwira kapena kuwonjezeka kwa ntchito ya ALT 2,5 kuposa VGN. Ndi kuchuluka zolimbitsa ntchito za chiwindi michere (ALT osachepera 2.

5 times apamwamba VGN) isanayambe kapena munthawi ya chithandizo ndi odwala a pioglitazone amayenera kufufuzidwa kuti adziwe chomwe chikuwonjezera. Ndi kuwonjezeka kwapang'onopang'ono kwa ntchito ya enzyme ya chiwindi, chithandizo chiyenera kuyambitsidwa mosamala kapena kupitiriza.

Pankhaniyi, kuwunikira pafupipafupi chithunzi cha kuchipatala ndikuwonetsetsa momwe ntchito ya chiwindi imayendera.

Pankhani ya kuchuluka kwa ntchito ya transaminases mu magazi seramu (ALT> 2.

Kuwirikiza kawiri kuposa VGN) kuwunika kwa chiwindi kuyenera kuchitidwa mowirikiza mpaka mulingowo ubwerere mwakale kapena kuzowonetsa zomwe zimawonedwa musanalandire chithandizo.

Ngati ntchito za ALT ndizokwera katatu kuposa VGN, ndiye kuti kuyesa kwachiwiri kuti mupeze ntchito ya ALT kuyenera kuchitika posachedwa. Ngati zochitika za ALT zikadatsala pang'ono 3 times> VGN pioglitazone ziyenera kusiyidwa.

Pa mankhwala, ngati mukukayikira kuti chitukuko cha chiwindi chimayambitsa matenda (mawonekedwe a nseru, kusanza, kupweteka kwam'mimba, kutopa, kusowa kwa chakudya, mkodzo wakuda), kuyesa kwa chiwindi kuyenera kutsimikizika. Lingaliro la kupitiriza kwa pioglitazone mankhwala liyenera kutengedwa pamaziko a zidziwitso zamankhwala, poganizira magawo a labotale. Pankhani ya jaundice, pioglitazone iyenera kusiyidwa.

Kufotokozera kwa mankhwala ASTROZON kumayambira pazovomerezeka zovomerezeka kuti zigwiritsidwe ndikuvomerezedwa ndi wopanga.

Kodi mwapeza cholakwika? Sankhani ndikusindikiza Ctrl + Lowani.

Kukonzekera kwa Thiazolidinedione - mawonekedwe ndi mawonekedwe a ntchito

Popeza tizilombo toyambitsa matenda a shuga a mtundu 2, odwala amamuika mankhwala ena a hypoglycemic osiyanasiyana. Ena amalimbikitsa kupanga insulin ndi maselo a pancreatic, pomwe ena amalondola kukana insulini.

Thiazolidinediones ali m'gulu lomaliza la mankhwala.

Mawonekedwe a thiazolidinediones

Thiazolidinediones, mwa kuyankhula kwina, glitazones, ndi gulu la mankhwala ochepetsa shuga omwe amafunitsitsa kukulitsa zotsatira za kubereka. Zochizira matenda a shuga zayamba kugwiritsidwa ntchito posachedwa - kuyambira 1996. Amaperekedwa mosamalitsa monga mankhwala.

Glitazones, kuwonjezera pa hypoglycemic action, imathandizira mtima wamtima. Ntchito yotsatirayi idawonedwa: antithrombotic, antiatherogenic, anti-kutupa. Mukamatenga thiazolidinediones, kuchuluka kwa hemoglobin ya glycated kumachepera pafupifupi 1.5%, ndipo mulingo wa HDL umakulanso.

Chithandizo cha mankhwala a mkalasi lino sichothandiza kwenikweni kuposa kuchiritsa ndi Metformin. Koma sizigwiritsidwa ntchito poyambira ndi 2 shuga. Izi ndichifukwa cha zovuta zoyipa komanso mtengo wokwera. Masiku ano, glitazones amagwiritsidwa ntchito kutsitsa glycemia wokhala ndi zotumphukira za sulfonylurea ndi metformin. Zitha kutumikiridwa padera ndi iliyonse ya mankhwalawo, komanso kuphatikiza.

Zindikirani! Pali umboni kuti kutenga glitazones mwa anthu omwe ali ndi prediabetes kumachepetsa chiopsezo chotenga matendawa ndi 50%. Malinga ndi zotsatira za kafukufukuyu, zidapezeka kuti kutenga thiazolidinediones kuachedwetsa matendawa pofika zaka 1.5. Koma atasiya kugwiritsa ntchito mankhwalawa mkalasi, zoopsa zinayinso zomwezo.

Mwa zina mwa mankhwalawa pali zabwino komanso zoyipa:

  • onjezani thupi ndi 2 kg pafupifupi,
  • Mndandanda waukulu wazotsatira zoyipa
  • Sinthani mbiri ya lipid
  • Momwe zimakhudzira insulin kukana
  • ntchito yochepetsera shuga poyerekeza ndi metformin, zotumphukira za sulfonylurea,
  • kuthamanga kwa magazi
  • sinthani zinthu zomwe zikukhudza chitukuko cha atherosulinosis,
  • kusunga madzi, ndipo chifukwa chake, ngozi zakulephera kwamtima zimawonjezeka,
  • muchepetse kufooka kwa mafupa, ndikuchulukitsa chiwopsezo cha kugwa,
  • hepatotoxicity.

Zizindikiro ndi contraindication

Thiazolidinediones amapatsidwa mankhwala osokoneza bongo omwe amadalira shuga (mtundu 2 shuga):

  • monga monotherapy kwa odwala omwe amawongolera kuchuluka kwa glycemia popanda mankhwala (zakudya ndi zolimbitsa thupi),
  • Monga njira ziwiri zophatikizira limodzi ndi kukonzekera kwa sulfonylurea,
  • Monga chithandizo chachiwiri ndi metformin yoyang'anira mokwanira glycemic,
  • ngati katatu chithandizo cha "glitazone + metformin + sulfonylurea",
  • kuphatikiza ndi insulin
  • kuphatikiza ndi insulin ndi metformin.

Zina mwazopinga zomwe amamwa mankhwala:

  • tsankho
  • mimba / mkaka wa m`mawere
  • wazaka 18
  • Kulephera kwa chiwindi - kuuma koopsa komanso kwapakati,
  • kulephera kwamtima kwambiri
  • Kulephera kwa aimpso ndikovuta.

Yang'anani! Thiazolidinediones sichikuperekedwa kwa odwala omwe ali ndi matenda ashuga a mtundu woyamba.

chopereka cha mankhwala a gulu la thiazolidatedione:

Mlingo, njira yoyendetsera

Glitazones amatengedwa mosasamala chakudya. Kusintha kwa magazi kwa okalamba omwe amapatuka pang'ono m'chiwindi / impso sikuchitika. Omaliza omaliza a odwala ndi omwe amatsitsa kumwa ochepa tsiku lililonse. Mlingo umatsimikiziridwa ndi dokotala payekhapayekha.

Kuyamba kwa mankhwalawa kumayamba ndi mlingo wochepa. Ngati ndi kotheka, imachulukidwa m'maganizo kutengera mankhwala. Akaphatikizidwa ndi insulin, mlingo wake umakhalabe wosasinthika kapena umachepetsa ndi malipoti a machitidwe a hypoglycemic.

Mndandanda wa Mankhwala Osokoneza Thuzi

Oimira awiri a glitazone akupezeka pamsika wamankhwala masiku ano - rosiglitazone ndi pioglitazone. Woyamba m'gululi anali troglitazone - posakhalitsa idathetsedwa chifukwa chopanga chiwindi choopsa.

Mankhwala motengera rosiglitazone akuphatikiza:

  • 4 mg avandia - Spain,
  • 4 mg Diagnitazone - Ukraine,
  • Kuthamanga pa 2 mg ndi 4 mg - Hungary.

Mankhwala okhala ndi piogitazone akuphatikiza:

  • Glutazone 15 mg, 30 mg, 45 mg - Ukraine,
  • Nilgar 15 mg, 30 mg - India,
  • Dropia-Sanovel 15 mg, 30 mg - Turkey,
  • Pioglar 15 mg, 30 mg - India,
  • Pyosis 15 mg ndi 30 mg - India.

Kuchita ndi mankhwala ena

  1. Rosiglitazone. Kuledzera sikukhudza kuwongolera glycemic. Palibe kuyanjana kwakukulu ndi njira zolerera za piritsi, Nifedipine, Digoxin, Warfarin.
  2. Pagogazone. Akaphatikizidwa ndi rifampicin, mphamvu ya pioglitazone imachepetsedwa. Mwina kuchepa pang'ono mu mphamvu ya kulera pomwe mukumwa mankhwala apiritsi. Mukamagwiritsa ntchito ketoconazole, kuyang'anira glycemic nthawi zambiri ndikofunikira.

Thiazolidinediones samangochepetsa kuchuluka kwa shuga, komanso zimakhudza dongosolo lamtima. Kuphatikiza pazopindulitsa, ali ndi zinthu zingapo zoyipa, zomwe zimakonda kwambiri ndikutukuka kwa mtima komanso kuchepa kwa mafupa.

Amagwiritsidwa ntchito mwachangu mu zovuta mankhwala, kugwiritsa ntchito thiazolidatediones popewa kukula kwa matendawa kumafunikanso kuphunzira.

Adalimbikitsa Zolemba Zina Zogwirizana

Mankhwala ochepetsa shuga

Zizindikiro zogwiritsidwa ntchito
Amagwiritsidwa ntchito ngati mtundu 2 wa shuga ndi kusayenda bwino kwa mankhwala azakudya, onse monga monotherapy komanso akaphatikizidwa ndi mankhwala ochepetsa shuga a magulu ena.
Kuchita kwa mankhwala a gululi ndikuwonjezera kukulitsa chidwi cha maselo am'mimba kuti apange insulin. Chifukwa chake, amachepetsa kukana kwa insulin.

Muzochita zamakono zamankhwala, mankhwala awiri a gululi amagwiritsidwa ntchito: Rosiglitazone ndi Pioglitazone.

Mphamvu yamachitidwe a mankhwalawa ndi motere: amachepetsa kukana kwa insulini pakukulitsa kapangidwe ka maselo a transporter a glucose.
Zochita zawo ndizotheka pokhapokha mutakhala ndi insulin yanu.

Kuphatikiza apo, amachepetsa mulingo wa triglycerides ndi mafuta aulere acids m'magazi.

Pharmacokinetics: Mankhwala osokoneza bongo amatengedwa mwachangu m'mimba. Pazowonjezera ndende m'magazi zimatheka pambuyo pa maola atatu pambuyo pa kukonzekera (rosiglitazone pambuyo pa maola 1-2, pioglitazone pambuyo pa maola 2-4).

Wopangidwira m'chiwindi. Pioglitazone imapanga metabolites yogwira, izi zimaperekanso kanthu kena.

Contraindication Mtundu wa matenda a shuga a mellitus. Mimba ndi mkaka wa m'mawere. Miyezo ya ALT yopitilira muyeso nthawi 2.5 kapena kuposerapo.

Age ali ndi zaka 18.

Zotsatira zina zoyipa za ALT, komanso kukula kwa chiwindi pakhungu ndi hepatitis pogwiritsa ntchito thiazolidinediones, zalembedwa.

Chifukwa chake, ndikofunikira kuyesa ntchito ya chiwindi musanamwe mankhwalawo ndikuwunikira nthawi ndi nthawi mukamamwa thiazolidatediones.

Kutenga thiazolidinediones kumatha kukulitsa kulemera. Izi zimawonedwa ndi monotherapy, komanso kuphatikiza kwa thiazolidatediones ndi mankhwala ena. Cholinga cha izi sichikudziwika ndendende, koma zotheka izi zimachitika chifukwa cha kuchuluka kwa madzi mthupi.

Kusungidwa kwamphamvu sikuti kumangowonjezera kulemera, komanso kumayambitsa edema komanso kukulitsa mtima ntchito.
Ndi edema yayikulu, kugwiritsa ntchito okodzetsa ndikofunika.

Kulephera kwa mtima kumachitika nthawi zambiri thiazolidatediones akaphatikizidwa ndi mankhwala ena ochepetsa shuga, kuphatikiza insulin. Ndi monotherapy yokhala ndi thiazolidinediones kapena insulin, chiopsezo cholephera pamtima ndi chochepa kwambiri - chochepera 1%, ndipo akaphatikizidwa, chiwopsezocho chimakwera mpaka 3%.

Mwina chitukuko cha kuchepa kwa magazi m'thupi mu 1-2% ya milandu.

Njira yogwiritsira ntchito
Pioglitazone amatengedwa kamodzi patsiku. Mankhwalawa sagwirizana ndi kudya.

Mlingo wamba ndi 15-30 mg, mlingo waukulu ndi 45 mg tsiku lililonse.

Rosiglitazone imatengedwa nthawi 1-2 patsiku. Mankhwalawa sagwirizana ndi kudya.

Mlingo wapakati ndi 4 mg, mlingo waukulu ndi 8 mg tsiku lililonse.

Zizindikiro zogwiritsidwa ntchito
Amagwiritsidwa ntchito mwa odwala omwe ali ndi matenda a shuga 2, komanso onenepa, komanso odwala 1 a mellitus a shuga limodzi ndi insulin.

Pakadali pano, mankhwala amodzi a gulu la Biguanide amagwiritsidwa ntchito - Metformin (Siofor, Avandamet, Bagomet, Glyukofazh, Metfogamma).

Metformin imathandizira kuchepetsa kulemera kwa thupi ndi pafupifupi 1-2 makilogalamu pachaka.

Njira yamachitidwe
Metformin amasintha mayamwidwe a shuga ndi maselo am'matumbo, zomwe zimapangitsa kuchepa kwa shuga m'magazi.

Komanso metformin imathandizira kuchepetsa kulakalaka, komwe kumayambitsa kuchepa kwa thupi.

Pharmacokinetics
Metformin imakhala ndi ndende yake pambuyo pa maola 1.5-2 pambuyo pa kuwongolera.

Kudzikundikira kwake m'chiwindi, impso ndi ma chinsisi.

Amachotsa impso. Ngati vuto laimpso, kusokonekera kwa mankhwalawa ndikotheka.

Hypersensitivity kwa mankhwalawa .mimba ndi mkaka wa m'mawere. Kusokonezeka kwa chiwindi. Kusokoneza impso. Kulephera kwamtima.

Zaka zopitilira 60.

Zotsatira zoyipa
Mwina kukula kwa magazi m'thupi.

Hypoglycemia.
Zosankha
Gwiritsani ntchito mankhwalawa mosamala mu matenda owopsa, njira zopangira opaleshoni, komanso kuchulukitsa matenda oyamba.

Muyenera kusiya kumwa mankhwalawa patatsala masiku awiri kuti mugwiridwe ntchito.

Mwina kuphatikiza kwa metformin ndi mankhwala ena ochepetsa shuga, kuphatikiza insulin.

Zochokera ku sulfonylureas

Zizindikiro zogwiritsidwa ntchito
Type 2 matenda a shuga.

Njira yamachitidwe
Kukonzekera kwa gulu la sulfonylurea zotumphukira ndi ma secretogens. Amagwira pama cell a beta a kapamba ndikulimbikitsa kuphatikizira kwa insulin.

Amathandizanso kuyika shuga m'magazi.

Mphamvu yachitatu yomwe mankhwalawa amakhala nayo pathupi ndikuti amathandizira insulin yokha, ikukweza mphamvu yake m'maselo a minyewa.

Pharmacokinetics
Masiku ano, zotumphukira za sulfonylurea za m'badwo wachiwiri zimagwiritsidwa ntchito.

Mankhwala omwe ali mgululi amachotseredwa kudzera mu impso ndi chiwindi, kuphatikiza ndi glurenorm, yomwe imatulutsidwa m'matumbo.

Contraindication Insulin amadalira matenda a shuga.

Mimba komanso kuyamwa.

Zotsatira zoyipa
Chifukwa chakuti mankhwalawa amachulukitsa katemera wa insulin, vuto la kugona mopitirira muyeso limawonjezeka, zomwe zimapangitsa kuti thupi lizikula. Ndikofunikira kusankha molondola mlingo womwe hypoglycemic ikuchitika, kupewa mankhwalawa.

Mankhwala osokoneza bongo ochulukirapo amatha kubweretsa kukana mankhwala omwe amachepetsa shuga (ndiye kuti, zotsatira za mankhwala omwe amachepetsa shuga amachepetsa kwambiri).

Mankhwala omwe ali mgululi angayambitse hypoglycemia. Simungathe kuwonjezera mlingo wa mankhwalawa popanda kufunsa dokotala.

Mawonetseredwe am'mimba amatha kutulutsa mseru, kusanza, kuwonda, kudzimbidwa.

Thupi lawo siligwirizana mu urticaria ndi kuyabwa nthawi zina.

Mwina kukula kwa kuchepa kwa magazi m'thupi mwatsopano.

Njira yogwiritsira ntchito
Kuchuluka kwa kukonzekera kwa gulu "Derivatives of sulfanylureas" kumatha mphamvu kwa maola 12, motero nthawi zambiri amatengedwa kawiri patsiku.

Ndikotheka kutenga katatu patsiku ndikusunga Mlingo watsiku ndi tsiku. Izi zimachitika pofuna kuthana ndi mankhwalawo.

Zosankha
Gliclazide ndi glimepiride zimakhala ndi mphamvu yayitali, choncho zimatengedwa kamodzi patsiku.

Meglitinides (Nesulfanylurea Secretagogues)

Awa ndiwowongolera a glucose, amachititsa kuchuluka kwa insulin, komwe kumakhudza maselo a beta a kapamba.

Mankhwala awiri a gululi amagwiritsidwa ntchito - Repaglinide (Novonorm) ndi Nateglinide (Starlix).

Zizindikiro zogwiritsidwa ntchito
Matenda a shuga osagwirizana ndi insulin omwe amakhala ndi vuto la kudya.

Njira ya kuchitira Kupititsa patsogolo kupanga insulini. Zochita zawo cholinga chake ndikuchepetsa prandial hyperglycemia, ndiye kuti, hyperglycemia atatha kudya.

Hypoglycemic zotsatira za mankhwala amayamba mphindi 7-15 mutamwa mapiritsi.

Mphamvu ya hypoglycemic ya mankhwalawa si yayitali, motero ndikofunika kuwatenga kangapo patsiku.

Chosangalatsa makamaka ndi chiwindi.
Contellindus a insulin-amadalira shuga mellitus. Mimba ndi mkaka wa m`mawere. Zaka zosakwana zaka 18. Matenda a impso.

Mawonetseredwe am'mimba amatha kutulutsa mseru, kusanza, kuwonda, kudzimbidwa.

Thupi lawo siligwirizana mu urticaria ndi kuyabwa nthawi zina.

Nthawi zambiri, mankhwala omwe ali mgululi amatha kuyambitsa hypoglycemia.

Mwina kuwonjezeka kwa thupi lanu pomwa mankhwala osokoneza bongo.

Mwina chitukuko cha kusuta kwa Meglitinides.

Njira yogwiritsira ntchito
Repaglinide imatengedwa theka la ola musanadye katatu katatu patsiku (makamaka musanadye chilichonse).
Mlingo umodzi wambiri ndi 4 mg, tsiku lililonse - 16 mg.

Nateglinid B.yzftu amatengedwa musanadye kwa mphindi 10 katatu pa tsiku.

Zosankha
Mwina kuphatikiza ndi mankhwala ochepetsa shuga a magulu ena, mwachitsanzo, ndi metformin.

Acarbose (α Glycosidase Inhibitors)

Zisonyezero zogwiritsidwa ntchito: Matenda a shuga omwe amadalira insulin.

Monga prophylaxis yamtundu wa 2 wa matenda ashuga mwa anthu omwe ali ndi vuto la shuga.

Njira yamachitidwe
Amachepetsa kuyamwa kwa glucose m'matumbo chifukwa amamangilira ma enzyme omwe amawononga ma carbohydrate ndikuletsa ma enzymewo kuti asamere. Zakudya zamafuta osagwiritsika ntchito sizimakodwa ndi matumbo am'mimba.

Sichikukhudzanso kuchuluka kwa insulin yopanga, chifukwa chake, chiopsezo chokhala ndi hypoglycemia sichitha.

Zimathandizira kuchepetsa kulemera kwa thupi chifukwa zimasokoneza mayamwidwe am'mimba m'matumbo.
Pharmacokinetics
Imakhala ndi ziwonetsero ziwiri zofunikira - pambuyo pa 1.5 - maola awiri mutatha kumwa mankhwalawa komanso pambuyo maola 16-20.

Amayamwa ndi m'mimba thirakiti. Amapukusidwa makamaka m'matumbo, mochepera impso.
Contraindication
Pachimake ndi matenda a m'mimba thirakiti pa exacerbations.

Matenda a chiwindi, kuphatikizapo matenda enaake.

Mimba komanso kuyamwa.

Zaka mpaka 18 - tengani mosamala.

Zotsatira zoyipa
Kuchokera m'mimba thirakiti - nseru, kusanza, kutulutsa.

Mukamadya chakudya, zimatha kuchitika pakumwa mankhwala.

Thupi lawo siligwirizana - urticaria, kuyabwa.

Maonekedwe a edema ndizotheka.

Momwe mungagwiritsire ntchito: Tengani ola limodzi musanadye katatu patsiku.

Yambani ndi mlingo wocheperako ndipo pang'onopang'ono muwonjezere mlingo.

Zosankha
Zochita za opaleshoni, kuvulala, matenda opatsirana angafunike kuchepetsedwa kwakanthawi kwa mankhwalawo komanso kusintha kwa insulin.

Ndikofunikira kutsatira mosamalitsa chakudya chokhala ndi chakudya chochepa cha "kudya" chakudya.

Zotsatira za mankhwalawa zimadalira mlingo - kukwera kwa mankhwalawo, chakudya chochepa cha thupi chimapangidwa.

Mwina kuphatikiza ndi mankhwala ena ochepetsa shuga. Tiyenera kukumbukira kuti acarbose imawonjezera mphamvu ya mankhwala ena ochepetsa shuga.

Kusiya Ndemanga Yanu