Fenofibrate: malangizo ogwiritsira ntchito, analogi, mitengo ndi kuwunika

Kufotokozera kogwirizana ndi 30.08.2016

• Dzina lachi Latin: Fenofibrate
• Code ya ATX: C10AB05
• Chithandizo: Fenofibrate
• Wopanga: Sopharma (Bulgaria), Canonfarm Production CJSC (Russia)

1 piritsi 145 mg fenofibrate. Wowuma wa chimanga, silicon dioxide, croscarmellose sodium mannitol, magnesium stearate, povidone, MCC, ngati zida zothandizira.

Mankhwala

Hypolipidemic zotumphukira fibroic acid. Yoyambitsa alpha zolandiriraamalimbitsa lipolysisatherogenic lipoproteins. Zimathandizira pakuchepetsa VLDL ndi LDL ndi kuchuluka HDL. Imachepetsa zabwino ndi 40-55% triglycerides ndi cholesterol (kufikira ochepera - mwa 20-25%).

Popeza izi, kugwiritsa ntchito fenofibrate kumasonyezedwa kwa odwala omwe ali ndi hypercholesterolemiakuphatikizidwa ndi hypertriglyceridemia (kapena popanda iwo). Matendawa amachepetsa kwambiri pakumwa xanthomas (madipoziti cholesterol,, kuchuluka komweko kumachepera fibrinogen ndi C-yogwira mapulotenikusamalira uric acid (25%). Kuphatikiza apo, chinthu chogwira chimachepetsa kusakanikirana kuchuluka kwa mapulateleti ndi shuga wamagazi pomwe matenda ashuga.

Pharmacokinetics

Mankhwala osokoneza bongo ochita kupanga amakhala ndi bioavailability wapamwamba. Mafuta amathandizidwa tikamamwa ndi chakudya. Cmax mtima pambuyo 4-5 maola. Pogwiritsa ntchito nthawi yayitali, ndende ya plasma imakhazikika. Metabolite yayikulu ndi fenofibroic acid, yomwe imatsimikiziridwa mu plasma. Olimba albin.

Imapukusidwa ndi impso ndi theka la moyo wa maola 20. Mkati mwa sabata imodzi amawonetsedwa kwathunthu. Mankhwalawa samaphatikizika ngakhale ndikugwiritsa ntchito nthawi yayitali.

Zizindikiro zogwiritsidwa ntchito

• kuchepa kwa ndende triglycerides at hyperglyceridemia,
• kuphatikiza mankhwala ndi ma statins ndi chosakanizika dyslipidemia odwala Matenda a mtima wa Ischemic, mtima atherosulinosis, matenda ashuga,
• choyambirira Hyperlipidemia.

Contraindication

• Hypersensitivity
• wazaka 18
• kulephera kwa chiwindi
• zolemetsa kulephera kwa aimpso,
• matenda a gallbladder
• aakulu kapena pachimake kapamba,
• yoyamwitsa.

Ndi mosamala amayika liti hypothyroidism, uchidakwa pakukalamba, ngati cholowa cha matenda amisempha chimalemedwa.

Zotsatira zoyipa

• nseru, kuchepa kwa chakudya, kulemera ndi kupweteka mkati epigastric,
• kukana hemoglobin,
• kutaya tsitsi
• leukopenia,
• kuchuluka transaminase,
• myositis ndi mwayi rhabdomyolysis (ngati vuto laimpso).

Katundu wa zomwe zimagwira

Malinga ndi radar, fenofibrate (fenofibrate) ndi mankhwala ochokera pagulu la fibrate, lomwe limachokera ku fibroic acid. Njira zomwe amagwirira ntchito sizomveka bwino. Komabe, potengera njira zomwe zafotokozedwera m'mabuku, titha kunena kuti zotsatira za kuchepa kwa lipid zimatheka chifukwa cha enzymatic ntchito - chifukwa cha kuchuluka kwa lipoprotein lipase. Mothandizidwa ndi enzyme iyi, kuwonongeka kwa triglycerides kwalimbikitsidwa ndipo kupanga mafuta a cholesterol kumasokonekera.

Kuphatikiza apo, michere iyi imachepetsa kuthekera kwa kuphatikiza kwa mapulateleti (amamatirana mofooka), amachepetsa shuga ya seramu kwa odwala matenda ashuga, komanso amachepetsa uric acid. Kupanga kwakukulu kwa mankhwalawa kumachitika m'chiwindi, kuphatikiza kwakukulu kwamapuloteni kumakhala ndi bioavailability yayikulu. Imafufutidwa ndi impso, motero, isanayambe komanso nthawi yopanga fenofibrate, ntchito zawo zowunikira ziyenera kuyang'aniridwa. Amapezeka m'mapiritsi okhala ndi mlingo wa 145 mg. Kuchuluka kwa paketi kumasiyana 10 mpaka 100 ma PC.

Njira yamachitidwe

Fenofibrate ndi yochokera ku fibrin acid. Amachepetsa milingo ya lipid poyambitsa kugwira ntchito kwa peroxisome alpha receptor proliferation activator (PPARa). PPARa imayendetsa lipoprotein lipases ndikuchepetsa kuchuluka kwa apoprotein CIII, kukulitsa lipolysis ndikuchotsa tinthu tokhala ndi ma triglyceride kuchokera ku plasma. PPAR imakulanso milingo yama apoproteins AI ndi AII, yomwe imachepetsa kuchuluka kwambiri kwa lipoproteins (VLDL) yotsika kwambiri (LDL) yokhala ndi apoprotein ndikuwonjezera milingo ya lipoproteins yapamwamba kwambiri (HDL) yokhala ndi apoproteins AI ndi AII. Kuphatikiza apo, pakuchepetsa kaphatikizidwe ndikukulitsa mphamvu ya lipoproteins yotsika kwambiri, fenofibrate imachulukitsa lumen ya LDL ndikuchepetsa kuchuluka kwa LDL yaying'ono komanso yowonda yomwe imagwirizanitsidwa ndi matenda a mtima.

Tricor: Zizindikiro zogwiritsidwa ntchito

Tricor ndiye chithandizo choyambirira cha hypercholesterolemia ndi hypertriglyceridemia chokha kapena vuto la mitundu yosakanikirana yamatenda (mitundu ya dyslipidemia IIa, IIb, III, IV ndi V), komanso / kapena ngati chithandizo chotsatira sichikhala chokwanira kapena chimabweretsa zotsatira zosavomerezeka. Kuphatikiza apo, ku Europe, fenofibrate imagwiritsidwa ntchito kuphatikiza matenda osakanikirana kwa odwala omwe ali ndi chiopsezo chachikulu cha matenda amtima kuwonjezera pa statin ngati triglycerides ndi HDL sizilamuliridwa bwino. Fenofibrate imaphatikizidwa mwa ana, amayi oyembekezera komanso oyembekezera, odwala omwe ali ndi vuto la chiwindi, kupezeka kwa ma gallstones, odwala omwe ali ndi hypersensitivity kuti fenofibrate ndi / kapena othandizira, pazochitika zodziwika bwino za chithunzi kapena zojambula za Phototoxic pochiza mafupa kapena ketoprofen.

Kuchita

Imawonjezera mphamvu ya ma anticoagulants - pamakhala ngozi yotaya magazi. Ndikulimbikitsidwa kuchepetsa mlingo wa anticoagulants.

Kuphatikiza ndi Mao zoletsa ndi cyclosporine ikhoza kusokoneza ntchito ya impso. Cholestyramine amachepetsa mayamwidwe. Mukamatenga ndi ena mafupa ndi ma statins pamakhala chiopsezo cha zovuta m'minyewa.

Pharmacology

Pogwiritsa ntchito ma PPARα receptors (alpha receptors omwe amathandizira ndi peroxisome proliferator), fenofibroic acid (metabolite yogwira ya fenofibrate) imakulitsa lipolysis ndi plasma excretion ya atherogenic lipoprotein yokhala ndi nkhani yayikulu ya triglycerides poyambitsa lipoprotein lipase ndi kuphatikizira kapangidwe. Kutsegula kwa PPARcy kumathandizanso kuti kuphatikizika kwa apolipoproteins AI ndi AII kukhale.

Zotsatira zomwe zafotokozedwa pamwambapa za lipoproteins zimayambitsa kuchepa kwa zomwe zidutswa za LDL ndi VLDL, zomwe zimaphatikizapo apolipoprotein B, komanso kuwonjezeka kwa zomwe zili ndizigawo za HDL, zomwe zimaphatikizapo apolipoproteins AI ndi AII.

Chifukwa chokonza zakuphwanya kaphatikizidwe ndi katemera wa VLDL, fenofibrate imawonjezera chilolezo cha LDL ndikuchepetsa zomwe zili ndiung'ono waung'ono wa LDL, kuwonjezereka komwe kumawonedwa kwa odwala omwe ali ndi vuto la atherogenic lipid phenotype (kuphwanya kwapafupipafupi kwa odwala omwe ali pachiwopsezo cha matenda a coronary artery matenda).

Mu maphunziro azachipatala, zidadziwika kuti kugwiritsa ntchito fenofibrate kumachepetsa cholesterol yonse ndi 20-25% ndi triglycerides ndi 40-55% ndi kuwonjezeka kwa cholesterol ya HDL ndi 10-30%. Odwala omwe ali ndi hypercholesterolemia, momwe LDL-cholesterol yotsika ndi 20- 35%, kugwiritsa ntchito fenofibrate kunapangitsa kutsika kwa ziwerengero: "chonse cholesterol / HDL-cholesterol", "LDL-cholesterol / HDL-cholesterol" ndi "Apo B / Apo AI ", Zomwe ndizizindikiro za chiopsezo cha atherogenic.

Popeza zotsatira za LDL cholesterol ndi triglycerides, kugwiritsa ntchito fenofibrate kumathandiza odwala omwe ali ndi hypercholesterolemia, onse komanso opanda hypertriglyceridemia, kuphatikiza yachiwiri hyperlipoproteinemia ndi mtundu wa 2 matenda a shuga. Kuphatikiza apo, amachepetsa kuchuluka kwa michere ndi uric acid m'magazi am'magazi, ndipo ndimankhwala akakhala nthawi yayitali amachepetsa ma amana a cholesterol owonjezera.

Pambuyo pakukonzekera pakamwa, fenofibrate imatulutsidwa mofulumira ndi ma esterases. Mu plasma, ndi okhawo okhazikika metabolite wa fenofibrate omwe amapezeka - fenofibroic acid, T_max omwe mu plasma imatheka mkati mwa maola 2-3. Kumangiriza kwa fenofibroic acid ku mapuloteni a plasma kuli pafupifupi 99%, C_ss akwanitsa mkati 1 sabata. Fenofibrate ndi fenofibroic acid sachita oxidative metabolism yokhudza cytochrome P450. T_1/2 fenofibroic acid - pafupifupi maola 20. Amapangidwa makamaka ndi impso (fenofibroic acid ndi glucuronide wake). Sichikupanga.

Fenofibroic acid chilolezo cha pakamwa kamodzi pa fenofibrate sichisintha malinga ndi zaka ndipo ndi 1.2 l / h mwa okalamba (wazaka 77-87) ndi 1.1 l / h mwa odwala.

Odwala omwe amalephera kwambiri aimpso (creatinine Cl creatinine Cl 30-80 ml / min) amawonjezera T_1/2 fenofibroic acid.

M'maphunziro azachipatala, kuyerekezera kunapangidwa ndi mitundu iwiri yosiyanasiyana ya fenofibrate - "micronized" ndi "non-microne." Kuyerekeza ma sampuli zamagazi a odzipereka athanzi atatha kuyamwa mafomu awa adawonetsa kuti 67 mg ya mawonekedwe "owonetsedwa", amtundu wa bioequivalent mpaka 100 mg wa mawonekedwe "osatulutsa micron".

Mlingo ndi makonzedwe

Mapiritsi a Fenofibrate aledzera kwathunthu, osafunafuna komanso osagawika. Chifukwa chake, mphamvu yonse ya mankhwalawa imatheka - chifukwa cha nembanemba, imafikira magawo ofunikira am'mimba ndipo imalowetsedwa iwo. Kwa odwala akuluakulu, mlingo wa tsiku ndi tsiku ndi kapisozi kamodzi patsiku. Amawerengedwa kuti ndiopamwamba - 145 mg.

M'mabukuwa muli umboni wa kugwiritsa ntchito mankhwalawa panthawi yapakati. Pomaliza pamaphunziro angapo a sayansi, zidadziwika kuti zotsatira za teratogenic ndi fetotoxic kuchokera pamapiritsi a fenofibrate sizinawonedwe. Komabe, izi ndizosowa ndipo sizimapereka chifukwa chokwanira chamankhwala chokhazikitsidwa kuti apatsidwe mankhwalawo. Chifukwa chake, mukakhala ndi pakati, amatha kuthamangitsidwa pokhapokha ngati mukuwonetsetsa mayendedwe ake ndi mapindu ake. Panthawi yoyamwitsa, udindo wa madokotala ndi wolimba - fibrate imatsutsana.

Kugwiritsa Ntchito

Ndemanga za madotolo ndi odwala awo omwe adamwa mankhwala ozunguza bongo a Fenofibrate, omwe ali ndi chiyembekezo. Ndi mphamvu ya lipid-kutsitsa kwenikweni, amakhala otsika poyerekeza ndi ma statins, koma amayambitsa zovuta zingapo. Nthawi zambiri amagwiritsidwa ntchito ngati gawo la mankhwala ochiritsira motsutsana ndi momwe asinthira masinthidwe, kusintha kwa zakudya ndi kukhazikitsidwa kwa mankhwala a metabolism.

Zotsatira zoyipa

Tiyenera kukumbukira kuti mankhwalawa ali ndi zotsatira zoyipa zambiri, kotero muyenera kuwonetsetsa kuti palibe zotsutsana. Pambuyo kumwa mapiritsi, wodwalayo amatha kuyanjana ndi zotupa, kuyabwa, ming'oma kapena photosensitivity, ndipo kuchuluka kwa creatinine ndi urea kumatha kuchuluka.

Zosasangalatsa zimachitika mu mawonekedwe a kupweteka kwam'mimba, nseru, kusanza, kutsegula m'mimba, kusisita. Nthawi zina, pancreatitis yachilendo imawoneka, mawonekedwe a gallstones, osakhala ndi hepatitis. Ngati munthu ali ndi zizindikiro zoyambitsidwa ndi jaundice kapena kuyabwa pakhungu, wodwalayo ayenera kuyezetsa matenda a chiwindi ndi kusiya kumwa Fenofibrate.

Nthawi zina zoyipa zimawonetsedwa mu mawonekedwe a kupukusa myalgia, myositis, kuphipha kwa minofu, kufooka, rhabdomyolysis, kuwonjezeka kwa ntchito ya creatine phosphokinase. Anthu ena amakhala ndi mitsempha yayikulu ya m'mitsempha, ma pulmonary embolism, kuwonjezera hemoglobin komanso kuchuluka kwa maselo oyera am'mutu, kupweteka mutu, komanso kusowa pogonana. Pazochitika zapadera, pneumopathy ya interstitial imapezeka.

Milandu yama bongo osaneneka sichinazindikiridwe, koma ngati pali kukayikira kwa kugwiritsa ntchito molakwika mankhwalawa, mankhwala othandizira ndi othandizira amalembedwa. Kugwiritsa ntchito hemodialysis sikuthandiza. Maavidididi enieni sakudziwika.

Mukamagwiritsa ntchito mankhwala ovuta komanso kugwiritsa ntchito mankhwala ena, chisamaliro chapadera chiyenera kuthandizidwa.

• Fenofibrate imathandizira zotsatira za anticoagulants pamlomo, zotulukazi nthawi zambiri zimayambitsa magazi. Chifukwa chake, pakuyamba kwa chithandizo, mlingo wa anticoagulants umachepetsedwa ndi 1/3. Kenako, adotolo amasankha mankhwalawo payekhapayekha, poganizira momwe wodwalayo alili komanso zotsatira za mayeso.
• Cyclosporin, wogwiritsidwa ntchito molumikizana ndi fenofibrate, amachepetsa ntchito yaimpso, motere, ndikusintha kwakukulu mu magawo a labotale, chithandizo chathetsedwa. Ngati mankhwala a nephrotoxic amagwiritsidwa ntchito limodzi, phindu ndi chiwopsezo zimayesedwa, pambuyo pake mlingo wowopsa kwambiri umadziwika.
• Ngati muphatikiza kumwa mankhwalawo ndi gulu la HMG-CoA reductase inhibitors, kulephera kwa impso, myopathy, rhabdomyolysis kumatha kukhazikika. Mukadziwika ndi sequestrants ya bile acid, kuyamwa kwa Fenofibrate kumachepa, chifukwa chake, mapiritsi ochepetsa lipid amatengedwa ola limodzi kapena maola 6 mutatha kugwiritsa ntchito mankhwala ena.

Mitu ya mankhwalawa

Pali mankhwala angapo omwe ali ndi mawonekedwe ofanana. Izi zikuphatikizapo mapilogalamu a Trilipix, Exlip, Tsiprofibrat, Lipantil, mapiritsi a Tricor. Komanso mu pharmac mungagule mankhwala momwemonso thupi - Livostor, Storvas, Tulip, Atorvakor.

Wodwala amatha kusankha payekha mankhwala ogwiritsira ntchito, atapatsidwa mawonekedwe ndi mlingo womwe dokotala wamulembera. Poona ndemanga, mapiritsi omwe adapangidwa ku Japan, USA, Western ndi Eastern Europe amawona kuti ndi othandiza kwambiri.

Chifukwa chake, fenofibrate imathandizira pochiza hypercholesterolemia motsutsana ndi matenda a shuga 2. Kuti muthe kuthamanga komanso kogwira ntchito, ma statin amatengedwanso. Mankhwalawa amagwiritsidwa ntchito bwino pochiza anthu akuluakulu. Mapiritsi amachepetsa triglycerides, siyani kukula kwa kusintha kwa fundus, kusintha mkhalidwe wamiyendo.

Chithandizo cha atherosclerosis akufotokozedwa mu kanema munkhaniyi.

Kugwiritsa ntchito bwino

Mayeso atatu osasinthika, akhungu awiri, amitundu yambiri, mayeso a magawo atatu adawonetsa kuti chifukwa cha chithandizo cha mankhwala a fenofibric acid ndi ma statins (atorvastatin, rosuvastatin ndi simvastatin), kuwongolera kokwanira mu HDL ndi milingo ya triglycerides kumawonedwa kuposa ndi statin monotherapy. Kuphatikiza apo, pali kusinthika kochulukira kwamlingo wa LDL poyerekeza ndi fenofibric acid monotherapy. Kafukufuku wa 2005 FIELD, yemwe adayang'ana zotsatira za fenofibrate mu shuga mellitus, wamkulu kwambiri, wophatikiza odwala 9795 omwe ali ndi matenda a shuga a 2, sanawonetse kuchepa kwa chiopsezo chomaliza chachikulu (infalction ya non-fatyo ya myocardial ndi kufa chifukwa cha matenda amtima). M'matumba am'modzi (matenda amtima), kuchepa kwapadera kwa matenda a mtima okwana 11% kunawonedwa. Odwala ambiri omwe ali mgululi la placebo adalandira ma statins panthawi ya kafukufuku, zomwe zidapangitsa kufooka. Pambuyo posintha ma statins, kuchepa kwachiwopsezo kunali 19% chifukwa cha infalction yopanda magazi ndi kufa kwa matenda a mtima, ndi 15% pamatenda amtima. Kafukufukuyu adawonetseranso kuchepetsedwa kopindulitsa pachiwopsezo cha zovuta za microvascular kwa odwala omwe ali ndi matenda a shuga a 2. Kugwiritsa ntchito fenifibrate kunachepetsa kupita patsogolo kwa albuminuria (14% kupita patsogolo pang'ono ndi 15% yowonjezeranso poyerekeza ndi placebo). Kuphatikiza apo, panali kuchepetsedwa kwa 30% pakufunika kwa laser chithandizo cha retinopathy. Kuwunika kothandizirako kwa kafukufukuyu kunawonetsa kuti fenofibrate imachepetsa kufunika kwa chithandizo choyambirira cha laser ndi 31%, kumachepetsa ma macular edema ndi 31% komanso proliferative retinopathy ndi 30%.Pazophunzira zochepa, fenofibrate adawonetsedwa kuti akuchititsa kutsika kapena kukula kwa retinopathy mwa odwala onse komanso ndi 79% mwa odwala omwe ali ndi retinopathy omwe analipo kale. Kuphatikiza apo, kafukufukuyu adawonetsa kuti fenofibrate imachepetsa kuchuluka kwa zosadandaulitsa ndi 38%. Monga ma fiber ambiri, fenofibrate imatha kuyambitsa kudzimbidwa ndi myopathy (kupweteka kwa minofu), komanso kawirikawiri rhabdomyolysis. Chiwopsezocho chimakula chikaphatikizidwa ndi ma statins. Komabe, kafukufukuyu amapereka chidziwitso chofunikira kuti kugwiritsa ntchito fenofibrate kwa nthawi yayitali ndikwabwino pankhani yotetezeka kwa odwala omwe ali ndi matenda a shuga a 2, ngakhale kuphatikiza kwa mankhwala osaphunziridwa a hypolipidemic. Mu kafukufukuyu, palibe vuto limodzi la rhabdomyolysis mwa odwala omwe amaphatikiza mankhwala a fenofibrate ndi statin adalemba. Chifukwa chake, pali umboni wambiri wosonyeza kuti kugwiritsa ntchito fenofibrate / statins ndi kotetezeka komanso kogwira mtima pochiza dyslipidemia mwa odwala omwe ali ndi matenda a 2 omwe ali pachiwopsezo chokhala ndi matenda amtima. Komabe, kafukufuku wina, ACCORD, sakugwirizana ndi mawu ali pamwambawa ogwira ntchito. Kafukufuku waposachedwa waposachedwa wa kafukufuku wa FIELD, omwe adasindikizidwa mu 2009 ndi Diabetes Care, adawonetsa kuti fenofibrate imayambitsa kuchepa kwakukulu kwa matenda amtima wamatenda omwe ali ndi cholesterol yotsika ya HDL komanso matenda oopsa. Kuchita kwakukulu kwambiri kwa fenofibrate pakuchepetsa chiopsezo cha CVD kunawonedwa mwa odwala omwe ali ndi dyslipidemia (TG> 2.3 mmol / L ndi otsika HDL-C) omwe adawonetsa kuchepa 27% pangozi yolingana ndi kuchuluka kwa ma CVD. Umboni wina ukusonyeza kuti phindu lenileni la fenofibrate limawonjezera kukhalapo kwa mawonekedwe a metabolic a syndrome. Chiwopsezo chachikulu kwambiri komanso phindu lalikulu la fenofibrate zimawonedwa pakati pa odwala omwe ali ndi hypertriglyceridemia, komabe, izi sizotsatira pazotsatira za kafukufukuyu. Zoyambitsa matenda oopsa a macro- ndi microvascular matenda zimachitika chifukwa chodulidwa miyendo kwa odwala omwe ali ndi matenda a shuga a 2. Chithandizo cha Fenofibrate chimagwirizanitsidwa ndi chiopsezo chochepa chakudulidwa, makamaka kuchotsedwa kwazing'ono popanda matenda odziwika a ziwiya zazikulu, mwina kudzera m'njira zosagwiritsa ntchito lipid. Zotsatira izi zitha kubweretsa kusintha kwa chithandizo chamankhwala ambiri komanso kupewa. Mu 2010, kafukufuku wopangidwa ndi ACCord a Organisation for the Control of Cardiovascular Risk for Diabetes adawonetsa kuti kugwiritsa ntchito fenofibrate komanso ma statins odwala omwe ali ndi matenda a 2 sikumachepetsa chiopsezo cha matenda amtima kuposa kugwiritsa ntchito ma statins okha. Mu kuyesa kwa ACCord, odwala 5,518 adaphunzira zaka zoposa 4,7, kupereka umboni wotsimikizika wa kusowa kwa mapindu enieni a moyo mukamagwiritsa ntchito ma fibrate mwa odwala omwe ali ndi matenda a shuga ambiri. Ngakhale kuti kafukufuku wa ACCord lipid sanapereke thandizo pazomwe amapanga pakuwonjezera fenofibrate kuma statins mwa odwala omwe ali ndi matenda a shuga 2 mtundu wa 2, adathandizira kwambiri pazotsatira za mayeso a fibrate monotherapy, kuwonetsa phindu la mankhwalawa m'magulu a odwala omwe ali ndi dyslipidemia. Makamaka, kafukufuku wa ACCord lipid amawoneka kuti akutsimikizira kuti fenofibrate ikhoza kuwonjezeredwa ku statin therapy kwa odwala omwe ali ndi matenda a 2 matenda a shuga komanso muloprotein cholesterol wambiri, koma osalimbikira, hypertriglyceridemia (> 200 mg / DLL) ndi cholesterol yochepa ya lipoprotein. kuchuluka kachulukidwe (lipid-kuchepetsa mankhwala, michere, lipolysis, cholesterol kutsitsa, matenda a mtima, hypercholesterolemia, hypertriglyceridemia, albuminuria, matenda ashuga, matenda ashuga, g Purton, dyslipidemia

Vasilip - malangizo ogwiritsira ntchito

Ndizotheka kuchepetsa zomwe zili zam'magazi a lipid osangokhala ndi zakudya komanso zolimbitsa thupi. Mankhwala amakono ali ndi njira zomwe zimathandizanso ntchito imeneyi. Vasilip ndi mankhwala otchuka kwambiri komanso ogwiritsidwa ntchito kwambiri omwe amadziwika kwambiri kwa odwala azachipatala komanso amtima. Musanalandire, muyenera kufunsira katswiri nthawi zonse, kusankhana nthawi ndikuwerenga malangizo mosamala.

Zotsatira za pharmacological

Mankhwalawa amapezeka mosiyanasiyana, ndipo amapangidwa ndi mpweya wa Aspergillus terreus. Kulowa m'thupi laumunthu, zigawo za vasilip (simvastatin) zimawola ndi hydrolysis mu zotuluka za hydroxy acid, zomwe zimagwira ntchito yofunikira ya pharmacological kuti muchepetse mafuta m'thupi.

Mayamwidwe yogwira mankhwala amapezeka matumbo. Mlingo wa mayamwidwe ndiwokwera kwambiri, pafupifupi 61-85%. Gawo lamankhwala lomwe silingamwetsedwe m'mimba limatuluka ndi ndowe. Malangizowo akuwonetsa kuti zapamwamba kwambiri zomwe zimapezeka m'magazi amwazi zimatha kuonedwa pambuyo pa maola 1-1.3 mutatha kumwa mankhwalawa. Simvastatin imagwira ntchito kwambiri m'chiwindi.

Komanso, mankhwalawa amagwira ntchito ngati metabolite yogwira, yomwe imangoyendetsa njira zambiri zomwe zimachitika mthupi la munthu ndi cholesterol yambiri pang'onopang'ono, komanso imalepheretsanso kuchepa kwa HMG-CoA. Enzyme iyi, ndiyothandizanso kutembenuka koyambirira kwa mevalonate kuchokera ku HMG-CoA. Ndi pafupifupi mawu awa, munthu amatha kufotokozera gawo loyambirira la cholesterol synthesis. Vasilip amasokoneza kudziunjikira kwa cholesterol ndipo potero amachepetsa mulingo wake mwachilengedwe komanso m'mbuyomu.

Kuphatikiza apo, kugwiritsidwa ntchito kwa vasilip kungachepetse kuchuluka kwa osalimba a lipoprotein, triglycerides ndi cholesterol yokwanira, malinga ndi kutsimikiza kwa magazi. Nthawi yomweyo, pali kuchuluka kwa lipoprotein yapamwamba kwambiri, yomwe imalimbana ndi ma lipid amana pamakoma amitsempha yamagazi. Chifukwa chake, vasilip imachepetsa kuthamanga kwa magazi, ndiye kuti, imasintha kuchuluka kwa zigawo za "zoyipa" komanso "zabwino" za lipid.

Ziyenera kudziwidwa komanso "mbali" zabwino zoterezi za vasilip, monga kuchepetsa kuchepa komanso kusuntha kwa maselo ngati njira ya atherosulinotic m'thupi la munthu yayamba kale. Onsewa akuwonetsedwa mu malangizo. Nthawi zambiri, kuchulukana kumawonedwa kumapeto kwa njira yotupa, ndipo ndikuwonjezeka kwa chiwerengero cha maselo omwe m'njira zambiri amakhala chiyambi cha kupangika kwa zolembera m'matumba. Simvastatin imathetseratu njirazi ndipo potero imasunga machitidwe a ziwiya momwe zidaliri kale.

Pomaliza, vasilip amathandizira kuteteza magwiridwe antchito a mtima. Izi zimapangira zinthu zomwe ndizofunikira kwambiri pakudziwitsa kamvekedwe ka mtima, kupindika, zochitika za mtima ndi kusefera kwa impso. Pankhani yakuwonjezeka kwa cholesterol m'magazi, muyeso wa zinthu zomwe zimapangidwa ndi endotheliocytes umasokonezeka, zomwe zimabweretsa kuwoneka kwa mavuto achiwiri. Kugwiritsiridwa ntchito kwa vasilip monga othandizira kutsitsa kwa lipid kumakupatsani mwayi woti muyambenso kugwira ntchito mwamphamvu kwa endothelium ndipo potero mumabweretsa kuphatikizira kwa magawo omwe akukwanira pazofunikira.

Mlingo ndi makonzedwe

Mlingo woyamba wa mankhwalawa sakhala wodziwika bwino pakusintha kwamwazi. Malinga ndi malangizowo, kuyambika kwa vasilip kumatha kuchitika pakatha milungu iwiri, zomwe sizabwino ndipo sizikuwonetsa chidwi cha wodwalayo pakuvomera kwake. Achire kwambiri achire zotsatira zimatheka pambuyo masabata 4-6 kuyambira chiyambi chogwiritsa ntchito vasilip. Ndi chithandizo chopitilira ndi mankhwalawa, zotsatira zake zimasungidwa. Ikathetsedwa, cholesterol yamagazi imabweranso yoyambayo, ndiye kuti, pamlingo womwe unkawonedwa wodwala asanalandire chithandizo.

Njira yogwiritsira ntchito zimatengera mtundu wamatenda komanso kuuma kwawo. Mu matenda a mtima, a mtima amapereka mankhwala 20 mg / tsiku kwa wodwala. Mlingo wa tsiku ndi tsiku ungathe kuwonjezeka pang'onopang'ono, ngati zikuwonetsa. Izi nthawi zambiri zimachitidwa osapitilira mwezi umodzi kuyambira pomwe mankhwalawa adayamba. Mtengo wokwanira wa mankhwala omwe amwedwa patsiku ndi 40 mg.

Kwa odwala omwe ali ndi vuto la impso kapena okalamba, kuwonjezereka kwa tsiku ndi tsiku kwa vasilip sikulimbikitsidwa. Ngati kulephera kwa impso kutchulidwa (kodziwika ndi mtundu wa creatinine chilolezo chochepera 30 ml / min), ndiye kuti mtima wamankhwala amakupatsani mlingo wa mankhwala osaposa 10 mg / tsiku. Ngakhale kuwonjezeka pang'ono kwa odwala kwa odwala motere kuyenera kuchitika moyang'aniridwa ndi dokotala komanso kuyang'anitsitsa matendawo.

Ndi hypercholesterolemia, tsiku lililonse mlingo wa mankhwalawa umasiyana 10 mpaka 80 mg. Mankhwalawa amayenera kumwedwa madzulo, ndipo sizitengera chakudya chamadzulo. Monga matenda a mtima, mtima wa vasilip umayamba ndi 10 mg. Pambuyo pa milungu 4 yokha pomwe mutha kuwonjezera kuchuluka kwa mankhwala omwe amamwa tsiku lililonse. Ngati hypercholesterolemia ndi cholowa, mlingo patsiku kuchokera 40 mpaka 80 mg. Kuchuluka kwa mankhwalawa kumatengera kuopsa kwa matendawa.

Ngati mankhwalawa akuyenera kutengedwa ndi wodwala yemwe wangomaliza kupatsirana, ndipo njirayi imayendetsedwa ndi kuikidwa kwa cyclosporine, ndiye kuti mawonekedwe a vasilip azitha kusamala kwambiri. Chifukwa chake, pankhaniyi, mlingo woyenera wa mankhwalawa malinga ndi malangizo sayenera kupitilira 10 mg / tsiku.

Zotsatira zoyipa

• Kuchokera kumbali ya dongosolo lamkati lamanjenje: kutopa, zotumphukira za m'mimba, kukhumudwa, kusokonezeka kwa kugona, kupweteka mutu.
• Kuchokera m'mimba thirakiti: kuchuluka kwa hepatic transaminases, dyspepsia, kapamba, nseru ndi kusanza, kudzimbidwa.
• Kuchokera kwamtundu wama genitourinary system: kuphwanya kwa potency, kuwonongeka kwa impso.
• Mbali ya minofu: dermatomyositis, kufooka kwa minofu, rhabdomyliosis ndi kulephera kwa aimpso. Zotsatira zoyipa izi zimayamba kawirikawiri, makamaka kwa odwala omwe amamwa cyclosporine kapena mankhwala ena ku gulu la ma statins limodzi.
• Kuchokera pamalingaliro: kupangika kwa mandala.
• Zotsatira zina zoyipa: photosensitivity, alopecia.

Nthawi zina, kumwa mankhwalawa kumadziwika ndi ziwengo monga mkoko, kutentha thupi, chikanga, komanso kufiira khungu. Muzochitika izi, ndikofunikira kudziwitsa dokotala za momwe thupi limachitidwira kumwa mankhwalawo. Kuyesedwa kwa magazi kumathanso kuwonetsa kusintha monga kuchuluka kowonjezera kwa eosinophils ndi ESR.

Mwambiri, vasilip amaloledwa bwino ndi odwala. Zotsatira zoyipa ndi zoyipa sizimachitika kawirikawiri, modekha, ndipo zimadutsa mwachangu.

Mankhwala ochulukirapo akapaka ntchito

Nthawi zambiri, mankhwala osokoneza bongo a simvastatin samakhala ndi vuto lililonse pa thanzi la wodwalayo, koma ayenera kudziwa zoyenera kuchitira pakakhala zotere. Nthawi zambiri amakhala ocheperako pang'onopang'ono. Pambuyo pa izi, ndikofunikira kuyang'anitsitsa momwe thupi liliri, kuwona ntchito za impso ndi chiwindi komanso kapangidwe kazinthu zonse zamagazi. Ngati pali chowopseza cha rhabdomyolysis kapena kulephera kwa impso, ndizomveka kupitilira hemodialysis kuti tichotse zotsatira zoyipa za mankhwala osokoneza bongo.

Owerenga athu adagwiritsa ntchito bwino Aterol kutsitsa cholesterol. Kuwona kutchuka kwa malonda, tidaganiza zoperekera chidwi chanu.

Zowonjezera kutenga vasilip

Kungokweza mulingo wa cholesterol m'magazi sikuti chifukwa chokhazikitsidwa ndi vasilip kwa wodwala. Ndikofunikira kuyesedwa kwa magazi kwa ma enzymes a chiwindi (AlAT ndi AsAT). Mlingo wa ma transaminase awa mukamamwa vasilip akhoza kuchuluka, koma chifukwa zomwe zili kale kale, chithandizo chitha. Mukamalandira mankhwala a vasilip, kuyang'anira nthawi zonse mawonekedwe a magazi ndi ziwindi zimafunikanso. Izi zipangitsa kuti adotolo azigwiritsa ntchito nthawi yake moyenera ndikusintha ngati pakufunika kutero. Ngati, mutayamba kumwa sivastatin, milingo ya hepatic transaminases imakwera katatu, ndiye ichi ndiye kuyimitsidwa kwa mankhwalawo.

Kusamalidwa makamaka kuyenera kuchitika ndi adotolo poyerekeza ndi odwala omwe amakonda kumwa mowa kwambiri. Popereka mankhwala a simvastatin, zakumwa zomwe zimakhala ndi zakumwa zoledzeretsa siziyenera kuphatikizidwa kwathunthu, ndipo adokotala ayenera kuchenjeza wodwala za izi. Chenjezo lofananalo liyenera kuchitidwa mwa odwala omwe ali ndi matenda a chiwindi.

Palibe chidziwitso pakugwiritsa ntchito mankhwalawa pokhudzana ndi anthu ochepera zaka 18, chifukwa chake kumwa vasilip mu gulu lino sikulimbikitsidwa.

Palinso chiopsezo chokhala ndi myopathy. M'maphunziro a labotale, izi zimadziwika ndi kuwonjezeka kwa ntchito ya kachigawo kakang'ono ka minyewa ya creatine phosphokinase. Ngati mulingo uwu uposa zovomerezeka nthawi 10, ndiye kuti titha kukambirana za kuyambika kwa myopathy. Zizindikiro zowonjezera zingaphatikizepo kufooka kwa minofu, kuwuma. Muzovuta kwambiri, rhabdomyliosis yovuta imayamba. Minofu minofu iyi imawonongedwa limodzi ndi chitukuko chaimpso. Anthu omwe amatenga simvastatin mogwirizana ndi fibrate (hemofibrozil, fenofibrate), ma macrolide maantibayotiki (erythromycin ,cacithromycin), ritonavir (an proteinase inhibitor), antifungal othandizira a gulu la azole (ketoconazole, itroconazole), cyclosporium ali pachiwopsezo chachikulu. Ndi kulephera kwaimpso komwe kulipo, palinso chiopsezo cha kuyambuka ndi kukula kwa myopathy.

Kutenga simvastatin sikupangitsa kuti zisinthe, chifukwa chake zingalimbikitsidwe, kuphatikiza oyendetsa ndi anthu omwe ntchito yawo ndikuwongolera kayendedwe kazovuta.

Kodi pali ma fanizo?

Analogue yosavuta kwambiri ya mankhwala a vasilip ndi simvastatin, omwe ali ake othandizira kwambiri. Mtengo wake ndiwotsika pafupifupi 2,5 kuposa mtengo wa vasilip. Mutha kupezanso ma analoves a vasilip omwe ali pansi pa mayina awa:

• simvastatin alkaloid,
• simgal
• chosavuta
• Zokor
• cholembera,
• simvalimit
• aries
• simvastol
• simvor
• symlo
• simvaheksal,
• simvacol
• Machitidwe.

Kusiyana kwa ma analogu onse ndizochepa. Itha kukhala ndi kuchuluka, kuchuluka kwa mapiritsi phukusi limodzi. Mayina osiyanasiyana a mankhwala opanga osiyanasiyana amakhalanso ndi mtengo wosiyanasiyana, koma izi siziyenera kukhudzanso mphamvu ya mankhwalawa.

Ndemanga za mankhwala

Nthawi zonse ndinali ndimanenepa kwambiri, koma m'zaka zaposachedwa pomwe ndidayamba kuzindikira kuti zimabweretsa zovuta zazikulu. Izi sizongokhala katundu mutadutsa masitepe angapo ndikukwera masitepe. Izi sizisintha ngakhale pakudekha. Uku ndikutopa kwamaso nditatha kuwonera TV kwakanthawi kochepa. Zachidziwikire, ndidatembenukira kwa katswiri. Ndidayendera dokotala wamtima ndi wamaso. Pambuyo pa kufufuza, kunapezeka kuti ndinali ndi cholesterol yayikulu, ndipo panali ngozi zambiri chifukwa cha sitiroko. Ngakhale kuwonongeka kwa mawonekedwe, mpaka kulumala, kumatha kupita patsogolo. Anandiuza kuti nditenge vasilip kuti ndichepetse magazi anga. Sindinamve mphamvu ya kumwa koyamba kwa mankhwalawo, ngakhale ndimamwa molingana ndi malangizo. Mwakutero, adotolo adandichenjeza za izi, chifukwa chake sindidakhala ndi nkhawa kwambiri.Pang'onopang'ono, ndidayamba kuzindikira kuti zimandivuta kupuma, komanso mwambiri kusuntha. Kwa ine, izi ndi kupita patsogolo kofunikira. Zachidziwikire, ndikumvetsa kuti nkhondo yolimbana ndi cholesterol yowonjezereka sidzangokhala mankhwala okha, koma ndine wokondwa kuti ndinatenga gawo lofunikira kwambiri kuti ndikonze moyo wanga.

Kwa nthawi yayitali ndinkagwira ntchito m'gulu, kumalangiza makasitomala. Monga zimachitika kawirikawiri, kupsinjika kwakhala gawo limodzi la moyo wanga. Zakudya zamadzulo zimachepetsa mantha komanso kusakwiya, komabe, zidathandiza. Sindinapite kwa dokotala nthawi yomweyo, ndikangomva kutchuthi. Nditayezetsa, zidapezeka kuti ndinali ndi cholesterol yambiri. Dokotalayo anandiuza zovuta zoyipa za cholesterol yayikulu komanso matenda ambiri okhala ndi vuto. Ndidaganiza zokhala ndi thanzi labwino, ndipo ndimakonda kulandira mankhwala akumwa. Vasilip ndi mankhwala abwino kwambiri omwe amachepetsa cholesterol yamagazi, zomwe zikutanthauza kuti amachotsa gawo lalikulu la chiwopsezo cha zovuta. Thanzi langa nditatha kulithetsa, nditha kudutsanso kwambiri popanda kupuma movutikira. Tsopano ndili ndi mphamvu komanso chiyembekezo kuti nditha kusintha moyo wanga mwakuchepetsa cholesterol, ndipo vasilip ndi wondithandizira. Mwa njira, patapita kanthawi kuyambira pachiyambire kudya kwa vasilip, dokotala adandilola kuti ndichepetse mlingo, womwe umatsimikizira kuchira kwanga.

Monga ambiri, iye nthawi zonse amawona thanzi lake ngati kanthu, sanatsatire kadyedwe kake komanso moyo wake. Pofika zaka 45, ndinali nditayamba kulemera kwambiri, koma zimangokhala ngati ndili ndi vuto lakuthwa, komwe ndimatha kuchotsa nthawi iliyonse. Ndi pokhapo pomwe ana adayamba kundinyoza ndikusadzidandaula komanso thanzi lawo, ndidapita kwa dokotala. Zidapezeka kuti cholesterol yanga idakwera kwambiri. Komanso, pamakhala chiwopsezo chachikulu cha matenda a mtima kapena sitiroko, popeza malo amafuta a cholesterol omwe ali ndi maziko osakhazikika. Vasilip wakhala gawo la mankhwala ophatikiza. Kuti mukwaniritse izi, ziyenera kumwedwa nthawi zonse, osati nthawi ndi nthawi. Zimatsitsa kwenikweni cholesterol. Mwa njira, zanzeru zanga kwa ine zidapita popanda chifukwa, chifukwa mankhwalawa sagwira ntchito mwachangu, koma patapita kanthawi. Komabe, mphamvu zake zimakhala zazitali, ndiye kuti, patapita masiku angapo mankhwala atasiya, mulingo wa cholesterol ukadali wabwinobwino kwakanthawi. Mtengo wa mankhwalawo siwokwera kwambiri, koma mtengo umagwira ntchito yofunika kwambiri kwa anthu ngati ine - anthu amisinkhu yopuma asanapume pantchito. Mwanjira ina, kuwunika kwanga za mankhwalawa ndi kwabwino.