Amaril M > Chithandizo ndi kupewa

Chimodzi mwazinthu zomwe zimagwiritsidwa ntchito ndi glimepiridewokhoza kuyambitsa kubisala ndi kumasulidwa insulin kuchokera kwa beta maselo a kapamba, kusintha kukhudzika kwa zotumphukira zimakhala ndi mphamvu ya insulin.

Chothandizira chinanso ndi metformin ndi mankhwala a hypoglycemic omwe ali m'gulu la Biguanide. Pankhaniyi, kuchuluka kwa zinthu za hypoglycemic kumawonetsedwa ndikusungidwa mwachinsinsi insulinngakhale yaying'ono. Metformin ilibe gawo lililonse pama cell a pancreatic beta, insulin secretion, ndipo kayendetsedwe kake mu mankhwala othandizira sikuti kumabweretsa chitukuko hypoglycemia.

Amakhulupirira kuti metformin amatha kuyambitsa mphamvu ya insulin, kuonjezera mphamvu ya minyewa yake, zoletsa gluconeogenesis mu chiwindi, muchepetse kupanga ma free acids, muchepetse oxidation wamafuta, kulakalaka, kuyamwa kwa chakudya cham'mimba ndi zina zotero.

Pazitali kwambiri ya mankhwalawa m'madzi a m'magazi amafikira mkati mwa maola 2,5 pambuyo pobwereza 4 mg tsiku. Mkati mwa thupi, kuphatikiza kwake konse kokwanira kumadziwika. Kudya sikuthandiza kwambiri pakamwa, kumangoleketsa kuthamanga kwake. Gawo lalikulu la Amaryl M metabolites limachotsedwa kudzera mu impso, ndi ena onse m'matumbo.

Zinapezeka kuti mankhwalawa amatha kulowa mkati mwa chotchinga ndikuthira mkaka wa m'mawere.

Zizindikiro zogwiritsidwa ntchito

Chizindikiro chachikulu cha kuikidwa kwa Amaryl M ndi mtundu wachiwiri wa matenda ashuga omwe ali ndi vuto lakudya, zolimbitsa thupi ndi kuchepa kwa thupi, ngati:

glycemic control siyikupezeka limodzi ndi zakudya, zolimbitsa thupi, kuchepa thupi komanso monotherapy yokhala ndi metformin kapena glimepiride,
kuphatikiza mankhwala glimepiride ndi metformin m'malo mwa kumwa kuphatikiza umodzi.

Contraindication

Sitikulimbikitsidwa kumwa mankhwalawa ndi:

mtundu 1 shuga
matenda ashuga ketoacidosisodwala matenda ashuga komanso okhazikika, pachimake kapena aakulu metabolic acidosis,
Hypersensitivity mankhwala
chiwindi cholakwika kwambiri,
Kulephera kwaimpso ndi kuwonongeka kwaimpso,
kufunikira kotukuka lactic acidosis,
kupsinjika kulikonse
wosakwana zaka 18
chakudya cholakwika ndi mankhwala osokoneza bongo am'mimba,
uchidakwa wambiri, kuledzera
kufupika kwa lactase, galactose tsankho, shuga-galactose malabsorption,
mkaka wa m'mimba, pakati ndi zina zotero.

Zotsatira zoyipa

Kutenga Amaril M, makamaka koyambirira, kumatha kuyambitsa zovuta zingapo zomwe zimakhudza ziwalo zofunika ndi machitidwe.

Kukula kwa hypoglycemia nthawi zambiri kumakhala kokhazikika ndipo kumayendetsedwa ndi: mutunjala, nseru, kusanza, ulesi, ulesi, kugona kusokonezedwa, nkhawakukwiya, kuchepa kwa chidwi komanso kukhala tcheru, kuchepa kwa ma psychomotor, kukhumudwa, chisokonezozolankhula zopanda pake ndi masomphenya, kunjenjemera ndi zina zotero.

Pankhaniyi, kuukira kwa hypoglycemia kwakukulu kungafanane ndi kuphwanya kwa magazi. Mutha kuthana ndi zizindikiro zosafunikira pochotsa chiwonetsero cha glycemia.

Malangizo a Amaryl M (Njira ndi Mlingo)

Mlingo wa mankhwala Amaryl M nthawi zambiri umatsimikiziridwa ndi zomwe zili mumtsempha wamagazi m'magazi a anthu. Kuti mupeze metabolic yofunika, mankhwalawa amayamba ndi mlingo wotsika kwambiri.

Munthawi yamankhwala, kuchuluka kwa shuga m'magazi ndi mkodzo kuyenera kutsimikiziridwa nthawi zonse. Kuwunikira pafupipafupi glycosylated hemoglobin m'magazi ndikofunikira.

Ngati mankhwala sanasamalidwe bwino kapena kudumpha mlingo wotsatira, osavomerezeka kuti mumalize ndikugwiritsa ntchito Mlingo wapamwamba.

Mankhwalawa Amaryl M, kagayidwe kachakudya kayendedwe ka minofu ndi insulinzomwe zimachepetsa kufunikira kwa glimepiride. Chifukwa chake, muyenera kuchepetsa mlingo wake kapena kusiya kumwa mankhwalawa, omwe angapewe kukula kwa hypoglycemia.

Nthawi zambiri, mankhwala 1-2 kamodzi tsiku lililonse mankhwala imodzi ndi chakudya.

Mlingo woyenera tsiku lililonseglimepiride ndi - 8 mg, ndipo metformin - 2000 mg. Mlingo umodzi woyenera kwambiri ndi womwe umatengedwa kuti ndi phwando, monga malangizo a Amaril M - 2 mg + 500 mg, motero.

Nthawi zambiri, chithandizo ndi Amaryl M chimaphatikizapo kugwiritsidwa ntchito kwakanthawi.

Kutulutsa mawonekedwe ndi kapangidwe kake

Mapiritsi a Amaryl ali ndi:

1 ml glimepiride - pinki,
2 ml ya glimepiride - wobiriwira,
3 mg glimepiride - kuwala wachikasu
4 mg ya glimepiride - zobiriwira.

M'matumba a mapiritsi 15, matuza awiri papaketi iliyonse.

Zothandiza pa Amaril ndi: polyvidone 25000, lactose monohydrate, magnesium stearate, microcrystalline cellulose, sodium starch glycolate.

Bongo

Ndi mankhwala osokoneza bongo a Amaryl M, hypoglycemia imayamba, nthawi zina imayambitsa kukomoka komanso kukomoka, komanso lactic acidosis.

Zikatero, chithandizo chimaperekedwa malinga ndi kuuma hypoglycemia. Ngati mawonekedwe ofatsa adadziwika popanda kutaya chikumbumtima, kusintha kwamitsempha, ndikofunikira kuti mutenge dextrose (glucose) mkati, ndikusintha mlingo wa mankhwalawa komanso zakudya. Kwanthawi yayitali, ndikofunikira kupitiliza kuyang'anira wodwalayo mpaka ngozi ndi thanzi litachotsedwa.

Mitundu ikuluikulu ya hypoglycemia, yokhala ndi chikomokere, kukomoka ndi zizindikiro zina zamitsempha, zimafunikira kuchipatala wodwala. Mankhwala ena amachitidwa kuchipatala, kutengera zizindikiro zake.

Njira yogwiritsira ntchito ndi Mlingo wa Amaril

Mlingo weniweni wa Amaril umatsimikizika potengera kuchuluka kwa shuga m'magazi.

Poyamba, mankhwalawa amapatsidwa mankhwala ocheperako kuti akwaniritse zofunika pakuwongolera kagayidwe kachakudya.

Pogwiritsa ntchito Amaril, wodwalayo ayenera kuyang'anira kuchuluka kwa shuga m'magazi, komanso glycosylated hemoglobin.

Mapiritsi a Amaryl amachotsedwa kwathunthu, kutsukidwa ndi theka kapu yamadzi.

Mlingo woyambirira wa Amaril ndi 1 mg pa tsiku. Kuchuluka kwa milingo kuyenera kuchitika pang'onopang'ono, pakapita milungu iwiri, motere 1 mg-2 mg-3 mg-4 mg-6 mg-6 mg-8 mg patsiku.

Monga lamulo, lomwe lili ndi shuga wambiri wowongolera, mulingo woyenera wa Amaril ndi 1-4 mg. Kugwiritsidwa ntchito kwa Amaril muyezo wa 6 mg kapena kupitilira tsiku lililonse ndi kothandiza kwa magulu ena a odwala.

Pafupipafupi komanso nthawi yogwiritsira ntchito Amaril imatsimikiziridwa ndi omwe amapita kuchipatala, poganizira zaka, zovuta za matendawa, moyo wa wodwalayo, komanso mtundu wa zakudya zake.

Mlingo wa tsiku ndi tsiku wa Amaril uyenera kumwa kamodzi, makamaka asanadye kadzutsa kapena chakudya china. Ndikofunika kuti musadumphe chakudya mutatha kumwa mapiritsi.

Pogwiritsa ntchito Amaril, kusintha kwa mankhwalawa kungafunike chifukwa chakuwongolera kwa metabolic. Kusintha kwa mlingo wa Amaril kungafunenso kwa:

Kusintha kwa moyo
Kuchepetsa thupi
Kupezeka kwa zinthu zomwe zimayambitsa chitukuko cha hyperglycemia kapena hypoglycemia.

Malinga ndi malangizo, Amaryl amatengedwa kwa nthawi yayitali.

Glimepiride

Glimepiride ndi mankhwala amkamwa a hypoglycemic omwe amachokera ku m'badwo wachitatu wa sulfonylurea. Chithandizo chogwira ntchito chimakhala ndi pancreatic pogwira ntchito ndikupanga insulini kuchokera ku β-cell ya kapamba, komanso mphamvu yowonjezera mphamvu, kukulitsa chidwi cha minofu ndi minofu yamafuta.

Oimira a sulfonylurea zotumphukira zimawonjezera kupanga kwa insulin potseka adenosine triphosphate (ATP) - njira zotsalira za potaziyamu zomwe zimatulutsidwa mu nembanemba ya cytoplasmic ya pancreatic β-cell. Kutseka kwa njira za potaziyamu kumapangitsa kuti ma cell a "cell" athe, ndikuthandizira kutsegulidwa kwa mayendedwe a calcium komanso kuchuluka kwa calcium.

Katemera wogwira amalumikizidwa / kulumikizidwa ndi kuchuluka kwakukulu mmalo kuchokera ku protein ya of-cell ya kapamba (maselo kulemera 65 kD / SURX), yomwe imalumikizidwa ndi njira zotengera potaziyamu za ATP, koma mosiyana ndi zotumphukira zina za sulfonylurea, kulumikizidwa kumachitika patsamba lina (protein ndi mol.weight 140 kD / SUR1). Izi zimayambitsa kutulutsidwa kwa insulin ndi exocytosis, koma kuchuluka kwa insulini yomwe imapangidwa munjira imeneyi ndi yotsika kwambiri poyerekeza ndi zomwe zimachitika, mwachizolowezi chogwiritsidwa ntchito ngati sulfonylurea (glibenclamide ndi ena). Zochepetsera zochepa zomwe zimapangitsa glimepiride pakupanga insulin zimachepetsa nawonso vuto la hypoglycemia.

Glimepiride amawonetsa pamlingo wotchulika, poyerekeza ndi chikhalidwe cha sulfonylurea, zotulukapo zowonjezera, makamaka, kuchepa kwa insulin kukana, antiatherogenic, antioxidant ndi antiplatelet katundu.

Kuchotsa glucose m'magazi kumachitika ndi minofu ndi ma adipose minofu ndikuchita nawo mapuloteni apadera a mayendedwe (GLUT1 ndi GLUT4) amtundu wa cell. Pamaso pa mtundu 2 wa matenda a shuga, kutulutsa kwa glucose kupita ku izi kumatanthauza gawo lomwe limagwiritsidwira ntchito moperewera. Glimepiride imapereka chiwopsezo chochuluka kwambiri cha kuchuluka kwa zochita zama glucose transporter (GLUT1 ndi GLUT4), zomwe zimapangitsa kuti glucose atenge ndi zotumphukira zake. The yogwira thunthu amakhala inhibitory zotsatira pa ATP-amadalira potaziyamu potaziyamu am'mimba minofu ya m'mimba kwambiri. Potengera maziko a mankhwalawa ndi glimepiride, kuthekera kwa ischemic myocardial preconditioning kumakhalabe.

The yogwira ntchito kumabweretsa kuwonjezeka kwa phospholipase C, potero kuwonjezera akuti- ndi glycogeneis chifukwa cha mankhwalawa, komanso tikulephera kumasulidwa kwa glucose chiwindi ndi kukulitsa gawo la intracellular la fructose-2,6-bisphosphate, lomwe limalepheretsa gluconeogeneis.

Glimepiride mosamala amaletsa ntchito ya cycloo oxygenase ndikuchepetsa kutembenuka kwa arachidonic acid kukhala thromboxane A₂kusewera gawo lofunikira mu kuphatikizira kwa maselo amwazi. Chidacho chimathandizira kuchepetsa milingo ya lipid ndikuchepetsa kwambiri peroxidation, yomwe imalumikizidwa ndi anti-atherogenic yayo. Zotsatira zake za mankhwalawa, kuchuluka kwa alpha-tocopherol amkati kumawonjezereka, komanso zochitika za glutathione peroxidase, catalase ndi superoxide dismutase, zomwe zimachepetsa kupsinjika kwa oxidative m'thupi, komwe kumakhalapo mwa mtundu 2 shuga.

Metformin ndi mankhwala a hypoglycemic omwe ali m'gulu la gulu la Biguanide, mphamvu ya hypoglycemic yomwe imawonedwa motsutsana ndi maziko osungidwa pakupanga insulin (ngakhale akuchepera). Zomwe zimagwira sizikhudza maselo a β-kapamba ndipo sizithandiza kupanga insulin, chifukwa chake, mu mankhwala othandizira sizitsogolera pakukula kwa hypoglycemia mwa anthu.

Mphamvu yogwiritsira ntchito mankhwalawa sichinakhazikitsidwe kwathunthu, komabe, akukhulupirira kuti metformin imatha kupititsa patsogolo zotsatira za insulin, kapena ikhoza kukhala yotsiriza m'magawo a zotumphukira zolandilira. Chidacho chimathandizira kukulitsa chidwi chamtundu wa insulin chifukwa cha kuchuluka kwa zolandirira insulini zomwe zili pamwamba pamitsempha yama cell. Kuphatikiza apo, metformin imachepetsa njira yogwiritsira ntchito gluconeogeneis m'chiwindi, imachepetsa mafuta oxidation ndikupanga mafuta achepetsa, amachepetsa msana wa triglycerides (TG), lipoproteins ochepa (LDL), komanso ochepa osalimba a lipoproteins (VLDL) m'magazi. Metformin imachepetsa kudya ndipo imachepetsa kuyamwa kwa matumbo. Mankhwala amathandizanso kukonza michere ya magazi monga fibrinolytic chifukwa cha kuletsa kwa minofu ya plasminogen activator inhibitor.

Amaril M, malangizo ogwiritsira ntchito: njira ndi mlingo

Amaryl M amatengedwa pakamwa, ndi chakudya, 1 kapena 2 pa tsiku.

Mlingo wa Amaril M umatsimikiziridwa payekhaponse kutengera kutsekemera kwa shuga m'magazi. Ndikulimbikitsidwa kugwiritsa ntchito antidiabetesic othandizira muyezo wotsika kwambiri, womwe umalola kukwaniritsa kuyenera kwa metabolic.

Munthawi yamankhwala, mumayenera kukhazikika shuga m'magazi ndi mkodzo, komanso kuchuluka kwa hemoglobin ya glycosylated m'magazi.

Ngati mwaphonya kumwa mwanjira yotsatira mwangozi, palibe chifukwa choti mulipirire ngongoleyo chifukwa chogwiritsa ntchito mlingo waukulu.

Ngati mulumpha chakudyacho kapena mlingo kapena mukakhala kuti sizotheka kumwa Amaril M, wodwalayo akhazikitse dongosolo loti achitepo kanthu ndi adotolo.

Popeza kuwongolera kwa kagayidwe kachakudya kumalumikizidwa ndi kukhudzika kwa minyewa ku insulin, kuchepa kwa kufunika kwa glimepiride kumatha kudziwidwa panthawi ya mankhwala. Pofuna kupewa kupezeka kwa hypoglycemia, pamafunika kuchepetsa nthawi ya Amaril M kapena kusiya kumwa.

Mlingo umodzi wofanana wa metformin ndi 1000 mg, mlingo waukulu wa tsiku lililonse ndi 2000 mg. Pazipita tsiku lililonse glimepiride ndi 8 mg. Mlingo wa glimepiride owonjezera 6 mg pa tsiku umagwira makamaka kwa ochepa odwala.

Pankhani yosamutsa wodwala pogwiritsa ntchito njira imodzi yophatikizira glimepiride ndi metformin kupita ku Amaryl M, mlingo wotsiriza umakhazikitsidwa potengera Mlingo wa zinthu zomwe wodwala akutenga kale. Ngati ndi kotheka kuwonjezera kuchuluka kwa mankhwalawa, tikulimbikitsidwa kuphatikiza mlingo wa mankhwalawa tsiku lililonse mu piritsi limodzi la 1 mg + 250 mg kapena piritsi la Amaryl M 2 mg + 500 mg.

Njira ya chithandizo nthawi zambiri imakhala yayitali.

Malangizo apadera

Lactic acidosis ndizosowa kwambiri, koma zovuta za metabolic (ndi kufa kwakukulu popanda chithandizo choyenera) zomwe zimayamba chifukwa cha kudzikundikira kwa metformin panthawi yamankhwala. Mukumwa mankhwala a metformin, lactic acidosis imawonedwa makamaka pakakhala matenda a shuga ndi kulephera kwambiri kwaimpso, kuphatikiza ndi zotupa za impso ndi aimpso a hypoperfusion, nthawi zambiri okhala ndi njira zambiri zomwe zimafunikira chithandizo chamankhwala / opaleshoni. Zowopsa zomwe zimakhudzana ndikukula kwa lactic acidosis zimaphatikizapo: kusala kudya kwa nthawi yayitali, kumwa kwambiri Mowa wokhala ndi ethanol, ketoacidosis, matenda osokoneza bongo a shuga, zinthu zomwe zimayambitsa minofu hypoxia, komanso kulephera kwa chiwindi. Lactic acidosis imatha kudziwonetsa ngati hypothermia, kupweteka kwam'mimba, kuperewera kwa acidotic ndikutsatira kupuma. Kupanikizika uku kumadziwika ndi kuchepa kwa magazi pH, kuchuluka kwa lactate m'magazi (oposa 5 mmol / l), kusalinganika kwa elekitirogilamu ndi kuwonjezeka kwa kuchepa kwa anions ndi chiŵerengero cha lactate / pyruvate. Ngati metformin ndiyomwe imayambitsa lactic acidosis, plasma yake nthawi zambiri imaposa 5 mcg / ml.

Ngati mukukayikira kukhazikika kwa lactic acidosis, ndikofunikira kusiya kumwa metformin ndikumuyika wodwala kuchipatala.

Kuopseza kwa lactic acidosis kumakulirakulira ndikuchulukirachulukira kwa zovuta kuwonongeka kwa impso ndi ukalamba. Kuopsa kwa vutoli kumatha kuchepetsedwa ndikuwunika ntchito zaimpso ndikugwiritsa ntchito mitundu yaying'ono ya metformin. M'pofunikanso kusamala kuti musamwe mankhwalawa mothandizidwa ndi kuperewera kwa madzi m'thupi kapena hypoxemia.

Ndi zizindikiritso zomwe zilipo za matenda a chiwindi, Amaril M sayenera kutengedwa, popeza kuthekera kochotsa lactate kumatha kuchepa kwambiri motsutsana ndi maziko a ntchito ya chiwindi. Amafunikira kusiya kwakanthawi kogwiritsa ntchito mankhwalawa musanapange maphunziro ndi intravascular ukukhazikitsa zinthu za radiopaque zokhala ndi ayodini, komanso musanayambe kuchitapo opareshoni. Metformin ndi yoletsedwa kwa maola 48 asanafike ndi maola 48 atachitidwa opaleshoni pogwiritsa ntchito mankhwala opaleshoni wamba.

Tiyenera kukumbukira kuti lactic acidosis imakonda kukhazikika pang'onopang'ono ndipo imawonetsedwa kokha ndi mawonekedwe osakhazikika monga thanzi lofooka, kugona kwambiri, myalgia, kusokonezeka kwa m'mimba, komanso kusokonezeka kwa m'mimba. Poyerekeza ndi maziko a acidosis, kuchepa kwa magazi, kuchepa kwa magazi ndi matenda a bradyarrhythmia. Ngati zizindikiro zotere zikuwoneka, muyenera kufunsa dokotala.

Lactic acidosis imatha kupezeka odwala omwe ali ndi matenda osokoneza bongo pamaso pa metabolic acidosis komanso chifukwa cha kuperewera kwa ketonemia ndi ketonuria (zizindikiro za ketoacidosis).

Mkati mwa sabata yoyamba ya mankhwala, kuwonetsetsa bwino kuchuluka kwa shuga m'magazi ndikofunikira chifukwa chakuwopsa kwa hypoglycemia, makamaka ndi chiwopsezo cha chitukuko. Nthawi zina, kusintha kwa Amaril M kapena chithandizo chonse kungakhale kofunikira.

Zizindikiro za hypoglycemia, zomwe zikuwonetsa malamulo a adrenergic antihypoglycemic, komwe ndi kuyankha kwa zotsatira za hypoglycemia, kumatha kukhala kofatsa kwambiri kapena kusapezeka kwathunthu pakukula kwa pang'onopang'ono, komanso kwa okalamba, panthawi ya michere ya neuropathy kapena kuphatikiza mankhwala ndi beta-adrenoblockers, guanethid clonidine ndi ena omvera chisoni.

Pofuna kukhalabe ndi glycemia, muyenera kutsatira zakudya, kuchita masewera olimbitsa thupi, kuchepetsa thupi, ndipo ngati pangafunike, imwani mankhwalawa pafupipafupi. Zizindikiro za glycemia yoyendetsedwa ndi magazi mosavomerezeka ingaphatikizepo: khungu louma, oliguria, ludzu, kuphatikizapo zamatenda olimba, ndi ena.

Nthawi zonse zimakhala zotheka kuletsa hypoglycemia mwachangu ndi chakudya cham'magazi - shuga kapena shuga, mwachitsanzo, chidutswa cha shuga, tiyi wokhala ndi shuga, msuzi wa zipatso wokhala ndi shuga, ndi zina zotere. , cholowa m'malo mwake sichothandiza.

Pa mankhwala, tikulimbikitsidwa kuwunika nthawi ndi nthawi kuchuluka kwa hemoglobin / hematocrit, kuchuluka kwa maselo ofiira, komanso zikuwonetsa ntchito ya aimpso (serum creatinine m'magazi): osachepera 1 nthawi pachaka - ndi ntchito yofanana ndi impso, osachepera 2-4 pachaka - milandu ya seramu CC pamlingo wapamwamba wa odwala okalamba.

Kukopa pa kuthekera koyendetsa magalimoto ndi njira zowerengeka

Mankhwalawa, makamaka kumayambiriro kwa maphunzirowo, mukasinthana ndi mankhwala ena kapena osagwiritsa ntchito Amaril M, kuchepa kwa mayankho kumanenedwa. Mukamayendetsa galimoto kapena machitidwe ena osunthika pakukonzekera chithandizo, chisamaliro chimayenera kuthandizidwa, makamaka ngati pali vuto la hypoglycemia komanso / kapena kuchepa kwa kuwongolera koyambira kwawo.

Mimba komanso kuyamwa

Amaryl M ali contraindicated pa mimba chifukwa cha zotheka kusintha chitukuko cha mwana wosabadwayo. Mimba ikachitika kapena kukonzekera, odwala amafunika kudziwitsa dokotala amene akupita.

Amayi omwe ali ndi vuto la metabolism wamafuta, omwe sangasinthidwe kokha ndi zakudya komanso masewera olimbitsa thupi, ayenera kupatsidwa insulin.

Pofuna kupewa kulandira antidiabetesic wothandizila mkaka wa m'mawere m'thupi la mwana, kugwiritsa ntchito Amaril M pa mkaka wabwinobwino kumatsutsana. Ngati kuli koyenera kuchitira hypoglycemia, wodwalayo asinthana ndi mankhwala a insulin kapena kusiya kuyamwitsa.

Ndi mkhutu aimpso ntchito

Amaril M amadziphimba chifukwa cha matenda operewera aimpso ndi kulephera kwa impso .Serumininin d≥ mg 1.2 mg / dL (110 μmol / L) mwa akazi ndi ≥ 1.5 mg / dL (135 μmol / L) mwa amuna, kapena kuchepa kwa CC ndi chifukwa chowonjezera pakuwopseza kwa lactic acidosis ndi zovuta zina za metformin. Kuchiza ndi mankhwalawa amadziwikanso kwa odwala omwe ali ndi hemodialysis, komanso pamaso pa zovuta zomwe zingayambitse vuto laimpso, monga intravascular yokonza ma ayodini osiyanitsa othandizira, zotupa zopweteka, kuchepa thupi, mantha.

Gwiritsani ntchito mu ukalamba

Chifukwa chowonjezera chiopsezo cha lactic acidosis ndi zovuta zina za metformin, odwala okalamba ayenera kugwiritsa ntchito Amaril M mosamala kwambiri (chifukwa cha kuchepa kwapafupipafupi kwa ntchito yaimpso), makamaka pazomwe zimayambitsa kuwonongeka kwa impso, monga kuyambitsa mankhwala ndi ma diuretics, antihypertensive mankhwala. komanso ma NSAID. Mlingo uyenera kuikidwa mosamala komanso kuyang'anira ntchito ya impso uyenera kuchitidwa.

Ndemanga za Amarila M

Malinga ndi ndemanga ya Amaril M, mankhwalawa ndi othandizira a hypoglycemic omwe amapereka kuchepa kwa kuchuluka kwa shuga m'magazi ndikusungidwa kwake pamalo otetezeka. Odwala amati kuti akwaniritse zotsatira zabwino za chithandizo chamankhwala, ndikofunikira kutsatira zakudya zoyenera ndikuchita zolimbitsa thupi zokwanira.

Kuipa kwa mankhwalawa, malinga ndi mawunikidwe, ndizovuta zambiri, komanso zochitika zovuta zomwe zimachitika nthawi zambiri pochiritsa. Odwala ambiri sasangalala ndi okwera, malingaliro awo, mtengo wa Amaril M..

Zotsatira za pharmacological

Glimepiride imakhala ndi mphamvu pa thupi. Ndi yotengedwa m'badwo wachitatu sulfonylurea.

Amaryl ali ndi mphamvu yayitali. Mapiritsi akagwiritsidwa ntchito, kapamba amayambitsidwa, ndipo ma cell a beta amayambitsa. Zotsatira zake, insulin imayamba kumasulidwa kwa iwo, mahomoni amalowa m'magazi. Izi zimathandizira kuchepetsa kuchuluka kwa shuga mutatha kudya.

Nthawi yomweyo, glimepiride imakhala ndi extrapancreatic. Zimawonjezera kukhudzika kwa minofu, minofu yamafuta ku insulin. Mukamagwiritsa ntchito mankhwala, antioxidant, antiatherogenic, antiplatelet zotsatira zimawonedwa.

Amaril amasiyana ndi ena omwe amapezeka m'magulu ena a sulfonylurea chifukwa chakuti akagwiritsidwa ntchito, zomwe zimapezeka m'matumbo a insulin ndizotsika kuposa mukamagwiritsa ntchito mankhwala ena a hypoglycemic. Chifukwa cha izi, chiopsezo cha hypoglycemia ndichochepa.

Kulimbitsa njira yogwiritsira ntchito glucose mu minofu ndi mafuta minofu kumakhala kotheka chifukwa cha kupezeka kwa mapuloteni apadera a mayendedwe mu ziwalo za cell. Amaryl amalimbikitsa zochitika zawo.

Mankhwalawa sikulepheretsa njira za ATP zotsekera mtima za mtima. Akadali ndi mwayi kuzolowera moyo wa ischemic.

Chithandizo cha Amaryl chimalepheretsa kupanga shuga m'magazi a chiwindi. Kuwonetsa kumeneku kumachitika chifukwa cha kuchuluka kwa fructose-2,6-biophosphate mu hepatocytes. Izi zimayimitsa gluconeogeneis.

Mankhwalawa amathandiza kutsekereza katulutsidwe wa cycloo oxygenase, kuchepetsa kusintha kwa kusintha kwa thromboxane A2 kuchokera ku arachidonic acid. Chifukwa cha izi, kuchuluka kwa kuphatikiza kwa mapulateleti kumachepa. Mothandizidwa ndi Amaril, kuwonongeka kwa ma oxidative reaction, omwe amawonedwa m'matenda osagwirizana ndi insulin, amachepetsa.

Lemberani mankhwala potengera glimepiride kwa odwala omwe ali ndi matenda amtundu II, ngati zolimbitsa thupi, zakudya sizingakuthandizeni kuyendetsa shuga.

Malangizo ogwiritsira ntchito akuwonetsa kuti amaloledwa kuphatikiza Amaril ndi jekeseni wa metformin, insulin.

Dr. Bernstein akuumiriza kuti kusankhidwa kwa ma hypoglycemic othandizira sikuli kolondola, ngakhale pali zambiri zomwe zingagwiritsidwe ntchito. Amatinso kuti mankhwalawa ndi owopsa, amalimbikitsa zovuta za metabolic. Kuthetsa matendawa, simungagwiritse ntchito mankhwala ochokera ku sulfonylurea, koma zakudya zomwe zimaphatikizidwa ndi mtundu wina wa mankhwala.

Malangizo ogwiritsira ntchito

Tengani Amaryl kuvomerezedwa ndi kusankhidwa kwa adokotala. Katswiriyo amasankha mlingo woyamba wa wodwala aliyense payekha. Zimatengera kuchuluka kwa shuga m'magazi, kuchuluka kwa shuga mu mkodzo.

Kumayambiriro kwamankhwala, ndikulimbikitsidwa kumwa mapiritsi okhala ndi 1 mg ya glimepiride. Onjezani mlingo pang'onopang'ono. Mapiritsi a 2 mg amasamutsidwa osati kale kuposa masabata 1-2 atatha chithandizo. Pa magawo oyamba, dokotalayo amawunika momwe wodwalayo alili, kutengera zomwe zimachitika ndi mankhwalawo, amasintha mankhwalawo. Mulingo wovomerezeka tsiku lililonse ndi 6-8 mg ya glimepiride.

Ngati mankhwala othandizira sangatheke ngakhale mutatenga kuchuluka kokwanira kotheka kwa Amaril, ndiye kuti insulin imawonjezedwanso.

Ndikofunikira kumwa mapiritsi musanadye chakudya 1 kamodzi patsiku. Madokotala amalimbikitsa kumwa mankhwalawa musanadye chakudya cham'mawa. Ngati ndi kotheka, amaloledwa kusintha nthawi yolandirira nkhomaliro.

Kukana chakudya pambuyo pa Amaril waledzera koletsedwa. Kupatula apo, izi zimadzetsa kugwa kwamphamvu mu glucose. Hypoglycemia imatha kuwonetsa kuwonongeka kwamitsempha, kuyambitsa kukomoka kwa matenda ashuga, imfa.

Mapiritsiwo amameza lonse osafuna kutafuna.

Kuchita

Asanapereke mankhwala Amaryl, dokotala ayenera kudziwa kuti ndi mankhwala ati omwe wodwala amamwa. Mankhwala ena amalimbikitsa, ena amachepetsa hypoglycemic zotsatira za glimepiride.

Mukamachititsa maphunziro, zidapezeka kuti kuchepa kwakukulu kwa shuga m'magazi kumawonedwa mukamadyedwa:

othandizira odwala matenda am'mimba
Phenylbutazone
Oxyphenbutazone,
Azapropasone
Sulfinpyrazone,
Metformin
Tetracycline
Miconazole
salicylates,
Mao zoletsa
mahomoni ogonana amuna
anabolic steroids
mankhwala a quinol,
Clarithromycin
Fluconazole
omvera,
mafupa.

Chifukwa chake, sikulimbikitsidwa kuti muyambe kumwa Amaryl nokha popanda kulandira mankhwala kuchokera kwa dokotala.

Otsatirawa amachepetsa mphamvu ya glimepiride:

progestogens
estrogens
thiazide okodzeya,
saluretics
glucocorticoids,
nicotinic acid (mukamagwiritsa ntchito muyezo waukulu),
mankhwala othandizira (operekedwa nthawi yayitali),
barbiturates
Rifampicin,
Glucagon.

Zoterezi ziyenera kukumbukiridwa posankha mlingo.

Sympatolytics (beta-blockers, reserpine, clonidine, guanethidine) ali ndi zotsatira zosayembekezereka pa hypoglycemic zotsatira za Amaril.

Mukamagwiritsa ntchito zomwe zimachokera ku coumarin, dziwani kuti: glimepiride imakulitsa kapena kufooketsa mphamvu ya mankhwalawa pathupi.

Dotolo amasankha mankhwala osokoneza bongo, mankhwala osokoneza bongo a anti-yotupa, komanso mankhwala ena otchuka.

Amaryl imaphatikizidwa ndi insulin, metformin. Kuphatikiza uku kumafunikira pamene mukutenga glimepiride sikutheka kukwaniritsa kufunika kwa metabolic. Mlingo wa mankhwala uliwonse umayikidwa ndi dokotala payekhapayekha.

Nthawi zina, madokotala amalimbikitsa kumwa Yanumet ndi Amaril nthawi yomweyo. Ndi mankhwalawa, wodwala amalandira:

Kuphatikiza kwapadera kwa zosakaniza zomwe zingagwire bwino ntchito kumathandizanso kuthandizira, kumathandizira kuwongolera momwe anthu odwala matenda ashuga angathere.

Tsiku lotha ntchito

Gwiritsani ntchito mankhwalawa ndikuloledwa kwa miyezi 36 kuyambira tsiku lotulutsidwa.

Woyenerera endocrinologist ayenera kusankha cholowa m'malo cha Amaryl. Amatha kukupatsirani analogi yopangidwa pamaziko a chinthu chomwechi, kapena asankhe mankhwala opangidwa kuchokera ku zinthu zina.

Odwala amatha kupatsidwa mwayi wogwirizira Russian, Diamerid, wotsika mtengo. Mapiritsi 30 a mankhwalawa, opangidwa pamaziko a glimepiride, ndi mlingo wa 1 mg mu mankhwala, odwala amalipira 179 p. Ndi kukakamizidwa kwa ndende yogwira ntchito, mtengo umakwezeka. Kwa diamerid mu gawo la 4 mg, 383 p.

Ngati ndi kotheka, sinthani Amaryl ndi mankhwala a Glimepiride, omwe amapangidwa ndi kampani yaku Russia Vertex. Mapiritsi osonyezedwawo ndiokwera mtengo. Phukusi la ma PC 30. 2 mg iyenera kulipira 191 p.

Mtengo wa Glimepiride Canon, womwe umapangidwa ndi Canonfarm, ndi wotsika kwambiri. Mtengo wa phukusi la mapiritsi 30 a 2 mg amadziwika kuti ndi wotsika mtengo, ndi 154 p.

Ngati glimepiride ndi yolekerera, odwala amapatsidwa ma analogi ena omwe amapangidwa pamaziko a metformin (Avandamet, Glimecomb, Metglib) kapena vildagliptin (Galvus). Amasankhidwa poganizira zomwe zimachitika m'thupi la wodwalayo.

Mowa ndi Amaryl

Sizingatheke kuneneratu pasadakhale momwe zakumwa zakumwa zoledzeretsa zimakhudzira munthu yemwe amamwa mankhwala osokoneza bongo a glimepiride. Mowa umatha kufooketsa kapena kuwonjezera mphamvu ya hypoglycemic ya Amaril. Chifukwa chake, sizingathe kuwonongedwa nthawi yomweyo.

Mankhwala a Hypoglycemic ayenera kumwa kwa nthawi yayitali. Chifukwa cha izi, kuletsa kwakumwa pakumwa zakumwa zoledzeretsa kwa ambiri kumakhala vuto.

Mimba, kuyamwa

Munthawi yamatumbo a mwana, kuyamwitsa wakhanda, zotumphukira za sulfonylurea sizingagwiritsidwe ntchito. M'magazi a mayi woyembekezera, kuchuluka kwa glucose kuyenera kukhala kosadutsa malire. Kupatula apo, hyperglycemia imabweretsa chiwopsezo cha kubadwa mwatsopano, kumawonjezera kufa kwa ana.

Amayi oyembekezera amapititsidwa ku insulin. Ndikotheka kupatula kuthekera kwa poizoni wamavuto osokoneza bongo kwa mwana mu utero ngati mutasiya sulfonylurea pa gawo lokonzekera kutenga pakati.

Pa mkaka wa m`mawere, mankhwala a Amaril amaletsedwa. Zinthu zodutsa zimapita mkaka wa m'mawere, thupi la wakhanda. Mukamayamwitsa, ndikofunikira kuti mayiyu asinthe mankhwala a insulin.

Kwa odwala ambiri, malingaliro a chithandizo cha endocrinologist sikokwanira kuti ayambe kumwa mankhwala atsopano. Madokotala amati mapiritsi amathandizira kapamba kuti apange insulin, pomwe akuwonjezera chidwi cha minofu kwa icho. Izi zimathandizira kuti glucose ayambe kulowa mu thupi.

Koma odwala akufuna kumva lingaliro la mankhwalawo kuchokera kwa odwala matenda ashuga ena. Kufunitsitsa kudziwa kuwunika kwa odwala ena kumachitika chifukwa cha kukwera mtengo kwa mankhwalawa. Kupatula apo, pali mitundu yambiri yamankhwala ogulitsa omwe amapangidwa kuti achepetse shuga, mtengo wake umatsika kwambiri.

Mukamatenga Amaril kwa zaka 1-2, palibe zoyipa zomwe zimawonedwa.Kuchita kumawonetsa kuti ochepa amakumana ndi zovuta akamagwiritsa ntchito mankhwalawa. Nthawi zambiri, mavuto amayamba Amaril M akagwiritsidwa ntchito ngati mankhwala, omwe kuwonjezera pa glimepiride amaphatikizanso metformin. Odwala amadandaula chifukwa cha kuzizira thupi, kuyabwa pakhungu, kukula kwa matenda oopsa. Mukatha kugwiritsa ntchito mapiritsi, anthu ena amamva vuto la hypoglycemic likuyandikira, ngakhale mukamayang'ana zimapezeka kuti kuchepa kwa kuchuluka kwa glucose sikofunikira.

M'miyezi yoyambirira yogwiritsa ntchito, glimepiride amakonzekera bwino shuga. Koma madokotala ena amawona kuti mphamvu ya mankhwalawo imayamba kuwonongeka pakapita nthawi. Wodwalayo amawonjezera kuchuluka kwa mankhwalawa, kenako amaphatikiza mankhwala. Iyi ndi njira yokhayo yokwaniritsira kusintha kwakanthawi kwa boma. Koma chifukwa chakuchepa kwa mphamvu ya mankhwalawa, wodwalayo amapitilira shuga mthupi. Izi zimabweretsa kuwonongeka kwapang'onopang'ono.

Mothandizidwa ndi Amaril, odwala matenda ashuga atha kusintha pang'ono pang'onopang'ono kufunika koti apange jakisoni wokhazikika wa insulin. Ngakhale kumayambiriro kwa chithandizo, ambiri ali ndi zizindikiro za hypoglycemia. Odwala amadandaula chifukwa cha mseru, manja akunjenjemera, chizungulire, kumangokhala ndi njala. Pang'onopang'ono, vutolo limayenda bwino, mawonekedwe owoneka amachoka.

Mtengo, kuti mugule

Mapiritsi a Amaryl amagulitsidwa pafupifupi mankhwala onse. Mtengo wa phukusi la zidutswa 30 mwachindunji zimatengera mulingo womwe dokotala walimbikitsa.

Kuchuluka kwa mg glimepiride	Mtengo, pakani.
1	348
2	624
3	939
4	1211

Mapaketi a mapiritsi 90 akugulitsidwa. Ngati mumagula Amaril phukusi loterolo, mudzapulumutsa pang'ono. Pozaza matenti 90 (2 mg) muyenera kulipira 1728 p.

Anthu odwala matenda ashuga amalangizidwanso kuti aziyang'anira mitengo m'masitolo osiyanasiyana. Amaryl nthawi zina amagulitsidwa pamtengo.

Pharmacokinetics

Kutulutsidwa m'mimba yokuya kwathunthu komanso mwachangu. 98% yomangidwa kumapuloteni. Kudya sizimakhudza mayamwidwe. Amatsimikiza mu mkaka wa m'mawere ndikuwoloka placenta. Metabolism imachitika m'chiwindi ndikupanga zinthu zopanda ntchito. Ngati kugwira ntchito kwa impso kumalephera, chinthucho chimangokhala chofooka kumapuloteni amwazi ndipo chimatulutsidwa mwachangu mkodzo. Osakopeka ndi matishu. Amachotseredwa m'matumbo ndi impso.

Kuyamwa kwa Metformin kumathamanga. Sizimanga kumapuloteni. Chiwopsezo cha kuwerengeka kwa chinthu m'thupi mwa odwala omwe ali ndi vuto laimpso kumawonjezeka. Amathira mkodzo.

Ngati kugwira ntchito kwa impso kumalephera, chinthucho chimangokhala chofooka kumapuloteni amwazi ndipo chimatulutsidwa mwachangu mkodzo.

Ndi chisamaliro

Chenjezo liyenera kuchitika mukamagwiritsa ntchito mapiritsi:

zakudya zosakhazikika
moyo wamakhalidwe
Matenda a chithokomiro osakwanira
ukalamba
kulimbitsa thupi
shuga-6-phosphate dehydrogenase akusowa.

Pamaso pa matenda omwe amaphatikizira njira ya matenda a shuga, ndikofunikira kusintha mlingo ndikuwunika kuchuluka kwa glycemia.

Zotsatira zoyipa za Amaril 500

Amaryl 500 imatha kuyambitsa mavuto osiyanasiyana kuchokera ku mantha amanjenje - kugona, kusowa chidwi, komanso kusowa tulo.

Mankhwalawa amadziwika ndi zotsatira zoyipa kuchokera pakatikati mwa mantha mu mawonekedwe a kusowa tulo.

Kuchokera kumbali ya kagayidwe

Zizindikiro kuchokera kumbali ya kagayidwe - kupweteka mutu, chizungulire, kusatha kutsimikiza, kufinya, kunjenjemera, palpitations, kukokana, kuchuluka kwa mavuto, thukuta. Zizindikiro zikuwonetsa kukula kwa hypoglycemia.

Urticaria, pruritus, zidzolo, mantha anaphylactic.

Thupi lawo siligwirizana zomwe zimachitika mutamwa mankhwalawa zimaphatikizapo: kuyabwa ndi zotupa.

Kuyenderana ndi mowa

Kugwiritsa ntchito mowa kumapangitsa kuti pakhale zovuta zina zoyipa. Mothandizidwa ndi ethanol, kuchuluka kwa shuga kumatha kutsika kwambiri. Kugwiritsa ntchito mankhwala mosokoneza bongo kumawonjezera chiopsezo cha chiwindi ndi impso.

Pali ma fanizo amodzi pamachitidwe a pharmacological:

Malangizo awonetsa contraindication ndi mavuto. Musanagwiritse ntchito chida chofananacho, ndibwino kukaonana ndi dokotala.

Malangizo a Amaril M Galvus Met malangizo a Glimecomb

Ndemanga za Amaril 500

Marina Sukhanova, dotolo, Irkutsk

Mankhwala ocheperako poyerekeza ndi othandizira ena a hypoglycemic amachititsa kuchepa kwa insulin. Komanso, mankhwalawa amavomerezedwa bwino ndi odwala (kuphatikizapo chiopsezo chochepetsedwa cha hypoglycemia). Mankhwalawa amachepetsa kudya. Zabwino kwa odwala omwe alibe shuga.

Maxim Sazonov, endocrinologist, Kazan

Zinthu zomwe zimagwira ntchito zimathandizana wina ndi mnzake. Metformin imathandizira zotsatira za glimepiride. M'magazi mumakhala kuchepa kwa glucose, LDL ndi triglycerides. Chida chabwino kwambiri chopewera shuga. Zotsatira zoyipa zimatha kuchitika mwa mawonekedwe a ziwengo, hypoglycemia, kusokonezeka kwa tulo.

Marina, wazaka 43, Samara

Mtundu wachiwiri wa matenda ashuga, mankhwala othandizika omwe amaphatikizidwa amaphatikizidwa. Zimalepheretsa kukula kwa hyperglycemia ndipo sikumatsogolera ku hypoglycemia, ngati mulingo wofunikira umatsatiridwa. M'masabata ochepa, adayamba kumva kuwawa, kenako m'mimba adatuluka. Zizindikiro zinazimiririka pakapita nthawi, ndipo tsopano sindimamva chilichonse chovuta.

Analogs Amaryl M, mtengo pama pharmacies

Ngati ndi kotheka, m'malo Amaryl M 2mg + 500mg, izi zitha kuchitika ndi analogue mu achire zotsatira - awa ndi mankhwala:

Mukamasankha analogues, ndikofunikira kumvetsetsa kuti malangizo ogwiritsira ntchito Amaryl M, mtengo ndi malingaliro, sagwiranso ntchito ngati mankhwala omwewo. Ndikofunikira kupeza upangiri wa dokotala komanso kuti usasinthe popanda mankhwala.