Kodi kuchiritsa kwa matenda ashuga a Januvia kumathandiza bwanji?

Mankhwala

Hypoglycemic mankhwalapakamwa pakamwa, kusankha kwambiri dipeptidyl peptidase-4 blocker. Amasiyana m'mapangidwe ndi momwe insulin, biguanides, zotumphukira za sulfonylurea, γ-receptor agonists, alpha-glycosidase blockers, analogi glucagon-ngati peptide 1ndi amylin. Kuletsa dipeptidyl peptidase-4, sitagliptinamachulukitsa kuchuluka kwa awiri odziwika mahomoni a insretin: insulinotropic glucose-peptide ndi glucagon-ngati peptide 1.

Ma mahomoni amenewa amatsegulidwa m'matumbo, ndipo kuchuluka kwake kumawonjezeka poyankha chakudya. Amayamwa Ndi gawo lamkati lazoyang'anira kagayidweshuga. Ndi wabwinobwino kapena kuchuluka kwa plasma shugamahomoni ampretin tsitsani kaphatikizidweinsulinndi chinsinsi chake ndi kapamba.

Geptcon-ngati peptide 1 amalepheretsanso kubisalira glucagon kapamba. Kuchepetsa nkhani glucagonpakati pambiri insulin zimayambitsa kuchepa kwa kaphatikizidweshugachiwindi, zomwe pamapeto pake zimayambitsa kufooka glycemia.

Pa otsika ndende shugamu plasma zotulukapo za izi mahomoni ampretinkutsindika insulin ndi kukakamira kubisala glucagon osalembetsa.Geptcon-ngati peptide 1ndi insulinotropic glucose wodalira peptidesizimakhudza kusankha glucagonpoyankha chitukuko hypoglycemia.

Sitagliptin amalepheretsa hydrolysis ma insretinsenzyme dipeptidyl peptidase-4potero kuchulukitsa milingo ya plasma yamitundu yogwira glucagon-ngati peptide 1ndi insulinotropic glucose wodalira peptide. Kuchulukitsa zomwe ziliincretins, sitagliptinkumawonjezera katulutsidwe wa shugainsulin ndipo imalepheretsa kubisala glucagon. Mwa anthu okhala ndi mtundu 2 shugakumbuyo hyperglycemiaizi zimasintha insulin ndi glucagon kuyambitsa kuchepa kwa ndende glycated hemoglobin ndi kuchepa shugamu magazi.

Mwa anthu okhala ndi mtundu 2 shuga kumwa muyezo wa Januvia kumadzetsa kuponderezana kwa zochitika enzymedipeptidyl peptidases-4masana, zomwe zimapangitsa kuwonjezereka kwa kuzungulira ma insretins(glucagon-ngati peptide 1ndi insulinotropic glucose wodalira peptide) 2-3 nthawi, kuchuluka kuchuluka insulinndi C peptide mu plasma, kutsitsa msinkhu glucagon m'mwazi, kufooka glycemiapamimba yopanda kanthu.

Pharmacokinetics

Pambuyo pa kugwiritsidwa ntchito kwa 100 mg ya mankhwalawa, kuyamwa mwachangu kumadziwika sitagliptin ndikukwaniritsa zabwino kwambiri m'magazi pambuyo pa maola 1-4. Mtheradi bioavailability pafupifupi 87%. Kugwiritsa ntchito mafuta munthawi yomweyo sikusintha pharmacokinetics sitagliptin.

Kumangika kwa zinthu zogwira ntchito kuma protein a plasma kumafika 38%.

Gawo laling'ono lokha la mankhwalawa lomwe limatengedwa limasinthidwa. 16% ya mankhwala amuchotseredwa ngati ma metabolites. 6 metabolites amadziwika sitagliptinzomwe mwina zilibe ntchito zake. Ma enzymes oyambilira omwe amachititsa kagayidwe sitagliptinndi CYP2C8 ndiCYP3A4.Mpaka 79% ya mankhwalawa amachotsedwa mu mawonekedwe ake oyamba ndi mkodzo. Hafu ya moyo sitagliptin ndi pafupifupi maola 12.5.

Zizindikiro zogwiritsidwa ntchito

• Monga gawo la mankhwala ophatikiza mtundu 2 shuga kulimbitsa kuwongolera glycemia molumikizana ndi PPAR-γ agonists kapena Metforminpamene zolimbitsa thupi ndipo chakudya kuphatikiza ndi monotherapy ndi njira zomwe zili pamwambazi sizikupatsani mwayi wolamulira glycemia.
• Monotherapy ndi mankhwala monga kuwonjezera pa zochitika zolimbitsa thupi ndi zakudya kuti muthandizire kuwongolera glycemic mwa odwala mtundu 2 shuga.

Contraindication

• mtundu 1 shuga,
• mimba ndi nyere,
• matenda ashuga ketoacidosis,
• Hypersensitivityku zigawo za mankhwala,
• Sikoyenera kupereka mankhwalawa kwa anthu ochepera zaka 18.

Ndi bwino kupereka mankhwala mosamala kwa odwala omwe ali ndi kulephera kwa aimpso. At kulephera kwa impso odziletsa komanso ovutirapo, odwala omwe ali ndi gawo logonjetsera izi, omwe akufunikira hemodialysis makonzedwe olandirira njira ndikofunikira.

Zotsatira zoyipa

• Mavuto ochokera kupuma: kupuma thirakiti matenda, nasopharyngitis.
• Mavuto ochokera ntchito zamanjenje: mutu.
• Mavuto ochokera chimbudzi: m'mimba kupweteka, kutsegula m'mimbakusanza, nseru.
• Mavuto ochokera musculoskeletal system: arthralgia.
• Mavuto ochokera chitetezo chokwanira: hypoglycemia.
• Mavuto Azidziwitso a Laborator: Zowonjezera Zambiri uric acidkuchepa pang'ono kwa ndende zamchere phosphatasekuchuluka kwa neutrophils.

Januvia, malangizo ogwiritsira ntchito (Njira ndi Mlingo)

Malangizo a Januvia akhazikitsa mlingo woyenera wa mankhwalawa akamagwiritsidwa ntchito ngati mankhwala a monotherapy kapena osakaniza ndi mankhwala ena mu 100 mg tsiku lililonse.

Mankhwalawa amaloledwa kumwa mosasamala zakudya. Ngati wodwalayo adayiwala kumwa mankhwalawo, ndiye kuti ndikofunika kumwa mankhwalawa mwachangu. Ndi zoletsedwa kumwa kawiri mlingo wa mankhwalawo.

Ndi digiri yofatsa kulephera kwa aimpsoKusintha kwa Mlingo sikofunikira.

Wofatsa kulephera kwa aimpso Mlingo uyenera kukhala 50 mg tsiku lililonse.

Kwambiri kulephera kwa aimpso ndi odwala omwe ali ndi gawo lomaliza kulephera kwa impsokomanso ngati kuli kofunikira hemodialysis Mlingo wa mankhwalawa 25 mg tsiku lililonse.

Bongo

Zizindikiro za mankhwala osokoneza bongo: mutamwa kamodzi pa 800 mg ya mankhwalawa, kusintha kosavuta kunapezeka kudula QTc.Maphunziro azachipatala a kumwa mankhwalawa pa mlingo wopitilira 800 mg patsiku sizinachitike.

Mankhwala osokoneza bongo: chapamimba thonje, kudya ammayankhomakuwunika kwa zizindikiro zofunika, zothandizira komanso zothandizira.

Zogwira ntchito zoyipa wolumala.

Kuchita

Kuwonjezeka pang'ono kwa ndende yayikulu kunadziwika. Digoxin mukamacheza ndi sitagliptin.

Panalinso kuwonjezeka kwa chiwopsezo chachikulu sitagliptin mwa odwala akamagwiritsa ntchito molumikizana ndi Cyclosporine.

Malangizo apadera

Pa matenda mayesero a mankhwala, pafupipafupi zimachitika hypoglycemia ikagwiritsidwa ntchito, inali yofanana ndi yomwe imagwiritsidwa ntchito ndi placebo.

Odwala Olipidwa kulephera kwa chiwindi kusintha kwa muyezo wa mankhwala sikofunikira.

Analogs of Januvia: Galvus, Comboglize XR, Nesin, Ongliz, Trazent.

Simuyenera kupereka mankhwala kwa anthu azaka zosakwana 18.

Kupanga ndi mawonekedwe a kumasulidwa

Mankhwala amapezeka monga mapiritsi. Amakhala ozungulira, ofiira apinki, mthunzi wa beige umawoneka. Piritsi lililonse pamakhala chizindikiro:

• "221" - ngati mulingo wambiri wa 25 mg,
• "112" - 50 mg,
• "277" - 100 mg.

Chofunikira chachikulu ndi mankhwala sitagliptin (phosphate monohydrate yake).

Mapiritsi amayikidwa m'matumba.

Zotsatira zamatsenga

Kutanthauza "Januvia" kumatanthauza gulu la mankhwala opangidwa ndi hypoglycemic. Mankhwala ndi incretin, choletsa DPP-4. Ikugwiritsidwa ntchito mochizira matenda a shuga II. Mukamamwa, pali kuwonjezeka kwa ma protein omwe amagwira ntchito, kukondoweza kwa zomwe akuchita. Maselo a pancreatic amalimbikitsa kapangidwe ka insulin. Nthawi yomweyo, secretion ya glucagon imapanikizika - chifukwa chake, mulingo wa glycemia umachepa.

Mwanthawi yabwinobwino, ma impretins amapangidwa m'matumbo amunthu, pomwe kudya kwawo kumawonjezeka. Iwo ali ndi udindo wolimbikitsa ntchito yopanga insulin.

Mukamamwa mankhwalawa, kuchuluka kwa hemoglobin ya glycated kumachepa (chizindikiro chomwe chimatsimikizira kuchuluka kwa shuga m'magazi m'miyezi yapitayi), kuthamanga kwa glucose kumachepa, kulemera kwa thupi kwa odwala matenda ashuga kumakhala kosiyanasiyana.

Mankhwala othandizira amamwetsedwa kwa maola 1-4. Kudya zakudya zamafuta sikusintha ma pharmacokinetics a mankhwalawa. Pafupifupi 79% ya mankhwala amakhalabe osasinthika ndi mkodzo.

Zizindikiro zogwiritsidwa ntchito

Endocrinologists amalembera Januvia (mankhwala a matenda ashuga) monga chothandiza kwambiri pazochita zapadera zamthupi komanso kudya kwa glycemic control mwa odwala omwe ali ndi matenda a shuga a 2. Monotherapy imagwiritsidwa ntchito pogwiritsa ntchito mankhwala a Januvia ngati Metformin isalolerane.

Monga gawo la mankhwala othandizira, imagwiritsidwa ntchito limodzi ndi:

• "Metformin", ngati kugwiritsa ntchito chida ichi kuphatikiza zochitika zolimbitsa thupi komanso kudya sikupereka zotsatira zomwe mukufuna,
• kukonzekera kwa sulfonylurea (Euglucon, Daonil, Diabeteson, Amaril), kupatula kuti kugwiritsidwa ntchito kwawo palimodzi ndi kukonza kwamachitidwe sikubala zomwe zikuyembekezeredwa, ndi tsankho la Metformin,
• Otsutsana ndi PPARy (mankhwala a TZD - thiazolidinediones): "Pioglitazone", "Rosiglitazone" pomwe ogwiritsa ntchito ali oyenera, koma samapereka zotsatira zomwe zimafunidwa palimodzi ndi katundu ndi zakudya.

Gwiritsani ntchito chida ngati gawo la mankhwala atatu:

• kuphatikiza ndi Metformin, kukonzekera kwa sulfonylurea, kudya komanso kuchita masewera olimbitsa thupi, ngati kuphatikiza kumeneku sikupangitsa kuti azitha kuyang'anira glycemia,
• kuphatikiza ndi Metformin ndi PPARy odana naye, ngati kuwongolera glycemic panthawi yomwe akudya, kudya komanso kuchita masewera olimbitsa thupi sikuthandiza.

Itha kuthandizidwanso ngati mankhwala owonjezera a shuga akamagwiritsa ntchito insulin, osagwiritsa ntchito Metformin, pamene magawo omwe amatengedwa samapereka glycemic control.

Njira zogwiritsira ntchito

Madokotala omwe amapereka mankhwala a Januvia ayenera kufotokozera mtundu wa zakumwa. Odwala ambiri amalimbikitsa mapiritsi okhala ndi 100 mg yogwira zinthu. Pozindikira kulephera kwapakati kwapakati, a mapiritsi a 50 mg amagwiritsidwa ntchito. Ngati odwala ali ndi vuto lalikulu la impso, amafunikira hemodialysis, ndiye kuti mapiritsi 25 mg ndi omwe amapatsidwa.

Pofatsa kuti chiwindi chilephere, kusintha kwa mankhwalawa sikofunikira.

Ngati mankhwalawa amatchulidwa kuti ndi gawo limodzi la mankhwala othandizira, ndiye kuti mutha kuchepetsa chiopsezo cha hypoglycemia pochepetsa mlingo wa mankhwala a insulin kapena sulfonylurea.

Imwani piritsi 1 patsiku, mosasamala chakudya. Mukadumpha mlingo wotsatira, sizovomerezeka kugwiritsa ntchito mapiritsi 2 tsiku limodzi.

Mndandanda wazopondera

Musanayambe kumwa, muyenera kudziwa nthawi yomwe simungathe kugwiritsa ntchito mankhwalawa. Contraindations akuphatikiza:

• Mtundu I shuga
• Hypersensitivity pazinthu zomwe zimapanga mankhwala,
• chitukuko cha matenda ashuga ketoacidosis,
• nthawi ya pakati ndi mkaka wa m`mawere.

Contraindations imaphatikizapo ubwana. Mankhwalawa sanayesedwe pa odwala omwe ali ndi zaka 18.

Zotsatira zoyipa zomwe zingachitike

Ndemanga za madotolo zikuwonetsa kuti odwala ambiri amalolera mankhwalawo limodzi ndi monotherapy kapena kuphatikiza ndi mankhwala ena.

Kafukufuku akuwonetsa kuti palibe kuyanjana pakati pa kumwa mankhwalawa komanso thanzi la odwala, koma zovuta zotsatirazi zinali zofala kwambiri pakumwa Januvia kuposa pamene amatenga placebo. Mwa zina zofala:

• chitukuko cha matenda a nasopharyngitis ndi matenda opatsirana thirakiti,
• mavuto a dyspeptic
• hypoglycemia.

Kusintha kwakukuru mumadongosolo a labotale, ECG sikunawonedwe.

Kuyanjana kwa mankhwala osokoneza bongo

Ndi munthawi yomweyo makonzedwe a mankhwala ozikidwa ndi sitagliptin ndi Digoxin, kugwiritsidwa ntchito kotsiriza kumawonjezeka.

Akaphatikizidwa ndi cyclosporine, kuchuluka kwa sitagliptin kumawonjezeka.

Mankhwala a "Rosiglitazone", "Simvastatin", "Metformin", "Warfarin", ndi njira zakulera za pakamwa "Januvia" sizikhudzidwa.

Koma mukamagwiritsa ntchito mankhwala ophatikiza, odwala ayenera kuchenjezedwa za kuopsa kwa hypoglycemia.

Mtengo wa ndalama

Si nzika iliyonse ya ku Russia yokhala ndi matenda a shuga II omwe angakwanitse kugula Januvia. Paketi ya mapiritsi 28 a 100 mg itenga ma ruble 1675. Kuchuluka kwawonetsedwa ndikokwanira masabata anayi a chithandizo. Popeza kuti kumwa mankhwalawa kuyenera kukhala nthawi yayitali, chifukwa ambiri mtengo wake ndi wokwera kwambiri.

Pamodzi ndi adotolo, mutha kusankha cholowa m'malo mwa mankhwalawa.

Kulembera magulu apadera a odwala

Poyesedwa, mankhwala a Januvia anaperekedwa kwa odwala azaka zopitilira 65. Kugwira bwino kwake, kulolera komanso chitetezo zinali zofanananso ndi odwala omwe ali ndi zaka 65. Pankhaniyi, zidapezeka kuti mlingo suyenera kusintha. Koma musanapereke mankhwala, ndikofunikira kuyang'ana momwe impso zimagwirira ntchito.

Pochita ana, mankhwalawa sanagwiritsidwe ntchito. Pankhani imeneyi, sikulimbikitsidwa kwa odwala omwe ali ndi zaka 18.

Kusankhidwa kwa analogu

Odwala ambiri omwe dokotala adamulembera Januvia amayesa kupeza fanizo la mankhwalawo. Kupatula apo, mtengo wake ndi wokwera ambiri. Kuphatikiza apo, sitagliptin si panacea ya matenda ashuga. Amawonjezera kuwonjezera pa zakudya ndi zolimbitsa thupi kuti zitsimikizire kuwongolera kwathunthu kwa matenda a shuga a mtundu II.

Ngati mungayang'ane pa nambala ya ATX 4, ndiye kuti fanizo la chidacho ndi:

• "Onglisa" - yogwira mankhwala saxagliptin,
• Galvus - vildagliptin,
• Galvus Met - vildagliptin, metformin,
• "Trazhenta" - linagliptin,
• "Combogliz Prolong" - metformin, saxagliptin,
• Nesina ndi alogliptin.

Makina ochitapo kanthu pa thupi la ndalama izi ndi zofanana. Amakhudza bwino ntchito yamanjenje ndi mtima, kupondera chilolezo.

Ndondomeko yamitengo

Ngati magwiridwe antchito ndi kugwiritsa ntchito bwino kwa mankhwala omwe amawaganizira kuti ndi fanizo la Januvia ndi ofanana, odwala ambiri amasankha omwe ali otsika mtengo. Paketi ya mapiritsi 30 Galvus Met ingagulidwe kwa ma ruble 1,487. Pamapiritsi 28 omwe amapangidwa pansi pa dzina "Galvus" ayenera kupatsa ma ruble 841.

Koma chida "Onglisa" ndiokwera mtengo kwambiri: kwa mapiritsi 30 muyenera kulipira ma ruble a 1978. Osakhala wotsika mtengo kwambiri komanso "Trazhenta": mapiritsi 30 a malo ogulitsa mankhwala amafunika pafupifupi ma ruble 1866.

Wodula kwambiri pakati pazofanizira zomwe waperekedwa ndi Combogliz Prolong yamapiritsi 30 okhala ndi 1 g ya metformin ndi 5 mg ya saxagliptin, ma ruble 2863 ayenera kuperekedwa. Koma pamalonda pali "Combogliz Pronge" yokhala ndi 1 g ya metformin ndi 2,5 mg wa saxagliptin. Pamapiritsi a 56, odwala matenda ashuga amalipira ma ruble 2,866.

Makhalidwe oyerekeza mankhwala

Popeza Galvus, yopangidwa kuchokera ku vildagliptin, ndi yotsika mtengo kuposa 2 Januvia, odwala ambiri akudzifunsa ngati nkotheka kumwa mankhwala otsika mtengo. Mukamamwa mankhwalawa, zochita za enzyme DPP-4 zimatsekedwa kwa tsiku limodzi. Chifukwa chake, ndikokwanira kugwiritsa ntchito piritsi limodzi patsiku. Nthawi yomweyo, nthawi ya ma protein omwe amapangidwa ndi thupi imakulitsidwa.

Ngati wodwala amupatsa mlingo wa 50 mg wa vildagliptin, ndiye kuti uyenera kutengedwa kamodzi m'mawa. Pa mlingo wa tsiku lililonse wa 100 mg, muyenera kumwa 50 mg kawiri pa tsiku. Izi zikutanthauza kuti kwa masiku 28 a kumwa mankhwalawa, mapaketi awiri a mankhwalawa amafunika.

"Januvia" kapena "Galvus": zomwe zili bwino, sizovuta kudziwa. Zotsatira zoyipa mukamamwa mankhwalawa ndizosowa.Nthawi zambiri, pafupipafupi zomwe zimachitika mwadzidzidzi zimakhala zofanana ndi zomwe odwala amatenga ndi placebo. Mukamagwiritsa ntchito "Galvus" mavuto omwe amagwira ntchito pachiwindi amatha. Koma atachotsa chithandizo, zinthu zimasintha.

Mankhwalawa amatha kuphatikizidwa mosamala ndi mankhwala ena omwe amapangidwa kuti achepetse kuchuluka kwa shuga m'magazi. Pogwiritsa ntchito nthawi zonse, mtengo wa hemoglobin wa glycated pachaka umatsika ndi 0.7-1.8%. Endocrinologist amalembera ndalama kutengera zomwe akudziwa ndi iliyonse ya mankhwalawa.

Makhalidwe omwewo a mankhwalawa "Ongliza." Madotolo ake amatha kupereka m'malo mwa "Galvus" kapena "Januvia". Koma musaiwale kuti zida zonsezi zimathandizira kuyendetsa glycemia mukadali chakudya komanso kuchita masewera olimbitsa thupi.

Malingaliro odwala

Pakatha mwezi umodzi wotenga, odwala matenda ashuga amalankhula za kusintha kwa boma. Mwachitsanzo, anthu omwe adotolo adalimbikitsa kuti atenge Januvia m'malo mwa Diabetes ayoni izi:

• kubwezera kumacheperachepera, kuwerenga kwa shuga m'mawa kumakhazikika,
• mutatha kudya, shuga imagizi imakhazikika pakanthawi kochepa,
• palibe milandu yakuchepa kwambiri kwa shuga, kukhazikika kwake, mosasamala kanthu za momwe zinthu ziliri, amakhalabe okhazikika.

Inde, kuweruza ndi kuwunika kwa odwala, ambiri sakhutitsidwa ndi mtengo wa malonda. Izi zimatchedwa kuti kubwerera m'mbuyo kwa odwala matenda ashuga. Koma m'malo ena, anthu amalandila chipukuta misozi chifukwa cha mtengo wa mankhwalawa. Izi zimachepetsa kwambiri katundu pabanja.

Ambiri amasankha izi: amamwa mankhwalawa m'mawa. Kupatula apo, zigawo zomwe zimagwira ntchito zimayenera kulipira chakudya chomwe chimalowa mthupi tsiku lonse. Ngakhale madotolo amati nthawi ya tsiku siyofunikira. Chachikulu ndikumwa mapiritsi tsiku lililonse popanda mipata nthawi yomweyo. Izi zisunga kuchuluka kwa mahomoni pamlingo womwewo.

Zowona, ena odwala matenda ashuga amati pakapita kanthawi mphamvu ya mankhwalawo imachepa. Mashuga a shuga ayambiranso. Izi zimachitika ndi kupita patsogolo kwa matendawa. Mutha kuyesa kubwezeretsa pang'ono kuchepa kwa ntchitoyo posankha mitundu yoyenera yolimbitsa thupi.

Kumayambiriro kwa ntchito kwa Januvia, ziyenera kumvetsedwa kuti iyi si njira yodziyimira payokha. Mankhwalawa amagwiritsidwa ntchito ngati gawo la mankhwala osakanikirana ndikuphatikizidwa ndi mtundu wa moyo. Idzakhala yothandiza pokhapokha chiwerengero chokwanira cha mahomoni a insretin akapangidwa m'thupi.

Mlingo wa mawonekedwe ndi kapangidwe kake

Chithunzi cha Janucius incretomimetic, chithunzi chake chomwe chaperekedwa m'gawoli, chimapangidwa pamaziko a sitagliptin, omwe amaperekedwa mwanjira ya phosphate monohydrate. Gwiritsani ntchito mapiritsi a mitundu yosiyanasiyana ndi mafilimu: magnesium, cellcrystalline cellulose, sodium, calcium hydrogen phosphate.

Anthu odwala matenda ashuga amatha kusiyanitsa kuchuluka kwa mankhwalawa mu utoto: ndi mlingo wochepa - pinki, wokhala ndi mtengo wambiri - beige. Kutengera kulemera, mapiritsiwo amalembedwa: "221" - mlingo 25 mg, "112" - 50 mg, "277" - 100 mg. Mankhwalawa amadzaza m'matumba otupa. Pakhoza kukhala matuza angapo m'bokosi lililonse.

Pa boma lotentha lofika 30 ° C, mankhwalawa amatha kusungidwa mkati mwa nthawi yovomerezeka (mpaka chaka).

Momwe Januvia amagwirira ntchito

Mankhwala opangidwa a hypoglycemic ndi a gulu la ma insretin mimetics omwe amaletsa DPP-4. Kugwiritsa ntchito pafupipafupi kwa Januvia kumawonjezera kupanga ma insretin, kumalimbikitsa ntchito yawo. Kupanga kwamkati mwa insulin kumachulukitsa, kaphatikizidwe ka glucagon mu chiwindi kumachepetsa.

Kuwongolera kwa pakamwa kumalepheretsa kuwonongeka kwa glucagon-ngati peptide GLP-1, komwe kumapangitsa gawo labwino kwambiri pakuwona insulini yodalira shuga, ndikuyambiranso kuzungulira kwazinthu zathupi. Njira izi zimathandizira kuti glycemia ikhale yachilendo.

Sitagliptin imathandizira kuchepetsa hemoglobin ya glycated, glucose othamanga, komanso kulemera kwa thupi. Kuchokera pamimba yodyetsera, mankhwalawa amalowetsedwa m'magazi mkati mwa maola 1-4. Nthawi ya ingestion ndi chakudya chama caloric sichimakhudza ma pharmacokinetics a inhibitor.

Mankhwalawa ndi oyenera kutsatiridwa nthawi iliyonse yoyenera: musanadye, mutatha kudya komanso panthawi ya chakudya. Mpaka 80% ya yogwira pophika imapukutidwa ndi impso. Mankhwalawa angagwiritsidwe ntchito onse mu monotherapy komanso mu zovuta za chithandizo cha matenda a shuga a 2, makamaka ngati chiwopsezo cha hypoglycemic chikuwonjezeka.

Mu chiwembu chokhazikika, Januvia amathandizidwa ndi Metformin, zakudya zotsika kwambiri za carb komanso masewera olimbitsa thupi.

Mutha kuwona momwe limagwirira ntchito yamankhwala pa vidiyoyi:

Yemwe amawonetsedwa ngati mankhwalawo

Januvia amawerengedwa mtundu wa matenda ashuga amitundu iwiri pamagawo osiyanasiyana owongolera matenda.

Akaphatikizidwa ndi mankhwala ena a hypoglycemic, Januvia amalembedwa:

• Kuphatikiza pa Metformin, ngati kusintha kwamakhalidwe sikunabweretse zotsatira zomwe zikuyembekezeka,
• Pamodzi ndi zotumphukira za gulu la sulfonylurea - Euglucan, Daonil, Diabeteson, Amaril, ngati chithandizo cham'mbuyomu sichinali chokwanira kapena wodwalayo samalekerera Metformin,
• Kufanana ndi thiazolidinediones - Pioglitazan, Rosiglitazone, ngati kuphatikiza koteroko kuli koyenera.

Mankhwala atatu, Januvius amaphatikizidwa:

• Ndi Metformin, zotumphukira za sulfonylurea, zakudya zamagetsi otsika ndi masewera olimbitsa thupi, popanda popanda Januvia sizingatheke kukwaniritsa 100% glycemic control,
• Imodzi ndi Metformin ndi thiazolidinediones, PPARy okonda, ngati matenda ena oyendetsa matenda sanakhale othandiza kwambiri.

Ndizotheka kugwiritsa ntchito Januvia kuwonjezera pa insulin mankhwala ngati mankhwalawa athetsa vuto la kukana insulini.

Ndani sayenera kutumizidwa sitagliptin

Ndi matenda amtundu 1 shuga ndi ziwopsezo zomwe zimapangidwa ndimomwe zimapangidwira, Januvia adatsutsana. Osatipatsa mankhwala:

1. Amayi oyembekezera komanso oyembekezera
2. Ndi matenda ashuga a ketoacidosis,
3. Muubwana.

Odwala omwe ali ndi aimpso amtunduwu popereka Januvia amayenera kuti awonjezere chidwi. Woopsa mawonekedwe, ndibwino kusankha analogi mankhwala. Odwala pa hemodialysis amayang'aniridwa nthawi zonse.

Kukhoza kwamavuto

Pankhani ya bongo, hypersensitivity, osankhidwa bwino mankhwalawa, zotsatira zosafunikira zitha kuwoneka ngati zochulukitsa za matenda omwe alipo kapena kukula kwa atsopano. Zochitika zoterezi ndizothekanso chifukwa chogwirizana ndi zovuta za mankhwala omwe munthu wodwala matenda ashuga amalandira.

Pakati pa zovuta za matenda ashuga, pali mitundu yovuta yamatenda (diabetesic ketoacidosis, precoma ndi glycemic coma) komanso yayitali - angiopathy, neuropathy, retinopathy, nephropathy, encephalopathy, ndi zina zambiri. Nephropathy ndiye njira yofunika kwambiri yothetsera matenda a impso - 44% ya milandu pachaka, mitsempha ndiyo imayambitsa mabala osapweteka kwambiri (60% ya milandu yatsopano pachaka).

Ngati malingaliro a dokotala pokhudzana ndi kuchuluka ndi nthawi yavomerezekayo satsatiridwa, zovuta za dyspeptic ndi vuto la kuchepa kwa malungo ndizotheka.

Zotsatira zina zoyipa, kufooka kwa chitetezo chathupi kumachitika nthawi zambiri, limodzi ndi matenda opatsirana thirakiti.

Za mankhwala a Januvia mu ndemanga, odwala matenda ashuga amadandaula za kupweteka kwa mutu komanso kutsika kwa magazi. Pazowunikira, kuwerengera kwa leukocyte kumatha kuwonjezeka pang'ono, koma madokotala sawona kuti izi ndizofunikira. Mosadalirika sanapeze kulumikizana ndi mankhwalawa ndi chitukuko cha kapamba.

Pogwiritsa ntchito nthawi yayitali ya sitagliptin, kuphwanya kumbali ya mtima, mitsempha yamagazi, ndikupanga magazi ndizotheka. Wodwala matenda ashuga ayenera kudziwitsidwa za kufunika kokachezera dokotala ngati kusintha kwa kuthamanga kwa magazi kapena kugunda kwa mtima pamene mukumwa Januvia.

Sipanakhalepo milandu yosokoneza mankhwalawa machitidwe azachipatala; kusinthika kwakukwanira kwaumoyo, kungogwira kwake ntchito kochepa ndizotheka.

Milandu yambiri

Januvia ndi mankhwala oopsa, ndipo kutsatira kwambiri malangizo a endocrinologist ndiye chofunikira pakuchita bwino kwake. Mlingo wotetezeka wa sitagliptin ndi 80 mg.

Kafukufuku wokhudzana ndi bongo wa bongo anachitika ndi kuwonjezeka kakhumi pa mlingo uwu.

Ngati vuto la hypoglycemic litayamba, wolakwiridwayo amadandaula mutu, kufooka, matenda osokoneza bongo, kuipira kwa thanzi, ndikofunikira kutsuka m'mimba, kupatsa wodwalayo mankhwala othandiza. Chithandizo cha Syndrome chimaperekedwa kuchipatala cha odwala matenda ashuga.Milandu ya bongo imagwiritsidwa ntchito kwambiri nthawi zambiri. Izi zimakonda kuphatikizidwa ndi tsankho la munthu payekha kapena chifukwa cha mankhwala ena omwe amagwiritsidwa ntchito popanga zovuta.

Hemodialysis ya Januvia siyothandiza. Kwa maola 4, pomwe njirayi imatha, mutatha kumwa kamodzi, 13% yokha ya mankhwalawo ndi yomwe idatulutsidwa.

Kuthekera kwa Januvia ndi zovuta mankhwala

Sitagliptin sikuletsa ntchito ya Simvastatin, Warfarin, Metformin, Rosiglitazone. Januvia amatha kugwiritsidwa ntchito ndi amayi omwe amagwiritsa ntchito njira zakulera pakamwa pafupipafupi. Kukhazikika kwapakati pa Dioxin kumathandizira pang'ono kuti izi zitheke, koma kusintha kotereku sikutanthauza kusintha kwa mlingo.

Januvia angagwiritsidwe ntchito limodzi ndi cyclosporine kapena zoletsa (monga ketoconazole). Zotsatira za sitagliptin mu zochitika izi sizowopsa ndipo sizisintha momwe mungalandire mankhwalawa.

Malangizo ogwiritsira ntchito

Mankhwala a Januvia, malangizo ogwiritsira ntchito amapangidwa mwatsatanetsatane, ndipo ayenera kuphunziridwa isanayambike maphunziro.

Ngati nthawi yakuvomerezedwa yasowa, mankhwalawo amayenera kuledzera nthawi yoyamba. Nthawi yomweyo, kuwerengetsa kawiri kawiri ndizowopsa, popeza payenera kukhala nthawi yotalikirana pakati Mlingo.

Mlingo wofanana wa Januvia ndi 100 mg / tsiku. Ndi a impso pathologies ofatsa pang'ono zolimba, 50 mg / tsiku amathandizira ngati matendawa akula ndikukula kwambiri, mankhwalawa amasinthidwa kukhala 25 mg / tsiku. Ngati mankhwalawa agwiritsidwa ntchito limodzi ndi mankhwala ena ochepetsa shuga, milingo ya insulin kapena mapiritsi iyenera kuchepetsedwa kuti muchepetse hypoglycemia.

Ngati ndi kotheka, dialysis ikuchitika, pomwe mankhwala osachepera mlingo. Nthawi yolandila Januvia siimakhudzidwa ndi nthawi ya mchitidwe. Paakula (kuyambira zaka 65), odwala matenda ashuga amatha kugwiritsa ntchito mankhwalawa popanda zoletsa zina, ngati pakadalibe zovuta kuchokera ku impso. Potsirizira pake, kusintha kwa mlingo kumafunika.

Analogs a Januvius

Machesi molingana ndi mawonekedwe

Mtengo kuchokera ku ma ruble 90. Analogue ndiotsika mtengo ndi ma ruble a 1305

Machesi molingana ndi mawonekedwe

Mtengo wake umachokera ku ma ruble 97. Analogue ndiotsika mtengo kwa ma ruble 1298

Machesi molingana ndi mawonekedwe

Mtengo kuchokera ku ma ruble 115. Analogue ndiyotsika mtengo ndi ma ruble 1280

Machesi molingana ndi mawonekedwe

Mtengo wake umachokera ku ma ruble 130. Analogue ndiyotsika mtengo ndi 1265 rubles

Machesi molingana ndi mawonekedwe

Mtengo wake umachokera ku ma ruble 273. Analogue ndiotsika mtengo ndi 1122 rubles

Machesi molingana ndi mawonekedwe

Mtengo wake umachokera ku ma ruble 287. Analogue ndiotsika mtengo ndi ma 110 rubles

Machesi molingana ndi mawonekedwe

Mtengo wake umachokera ku ma ruble 288. Analogue ndiyotsika mtengo ndi ma ruble 1107

Machesi molingana ndi mawonekedwe

Mtengo wake umachokera ku ma ruble 435. Analogue ndiyotsika mtengo ndi ma ruble 960

Machesi molingana ndi mawonekedwe

Mtengo wake umachokera ku ma ruble 499. Analogue ndiotsika mtengo ndi ma ruble 896

Machesi molingana ndi mawonekedwe

Mtengo wake umachokera ku 735 rubles. Analogue ndiotsika mtengo ndi 660 rubles

Machesi molingana ndi mawonekedwe

Mtengo kuchokera ku ma ruble 982. Analogue ndiotsika mtengo ndi ma ruble 413

Machesi molingana ndi mawonekedwe

Mtengo kuchokera ku ma ruble 1060. Analogue ndiyotsika mtengo ndi ma ruble 335

Machesi molingana ndi mawonekedwe

Mtengo wake umachokera ku ma ruble 1301. Analogue ndiotsika mtengo ndi ma ruble 94

Machesi molingana ndi mawonekedwe

Mtengo wake umachokera ku ma ruble a 1806. Analogue ndiokwera mtengo kwambiri pa ma ruble 411

Machesi molingana ndi mawonekedwe

Mtengo wake umachokera ku ruble 2128. Analogue ndiokwera mtengo kwambiri ndi ma ruble 733

Machesi molingana ndi mawonekedwe

Mtengo kuchokera ku 2569 rubles. Analogue ndiokwera mtengo kwambiri ndi ma ruble 1174

Machesi molingana ndi mawonekedwe

Mtengo wake umachokera ku ruble 3396. Analogue ndiokwera mtengo kwambiri ma rubleti a 2001

Machesi molingana ndi mawonekedwe

Mtengo kuchokera pa ma ruble 4919. Analogue ndiokwera mtengo kwambiri pa ma ruble 3524

Machesi molingana ndi mawonekedwe

Mtengo kuchokera ku ma ruble 8880. Analogue ndiokwera mtengo kwambiri pa ma ruble a 7485

Malangizo ogwiritsira ntchito ndi Januvius

Nambala yolembetsa :Dzina la malonda : JANUVIA / JANUVIA

Dzinalo Lopanda Padziko Lonse : Sitagliptin

Mlingo : mapiritsi okhala ndi filimu

Kupanga :

Piritsi 1 yokhala ndi filimu yokhala ndi sitagliptin phosphate hydrate yofanana ndi 25 mg, 50 mg, 100 mg sitagliptin.
Othandizira: microcrystalline cellulose, calcium hydrogen phosphate osakhudzidwa, croscarmellose sodium, magnesium stearate, sodium stearyl fumarate.
Phale (Opadray® II: Pink 85 F97191 pa Mlingo wa 25 mg, Kuwala beige 85 F 17498 pa Mlingo wa 50 mg, Beige 85 F 17438 pa mulingo wa 100 mg) muli mowa wa polyvinyl, titanium dioxide, macrogol (polyethylene glycol) 3350, talc, iron oxide chikasu, chitsulo oxide chofiira.

Kufotokozera

Mapiritsi okhala mozungulira a biconvex amtundu wopepuka wa pinki wokhala ndi mawonekedwe ofooka a beige, wokutidwa ndi chipolopolo cha film wokhala ndi "221" mbali imodzi ndi yosalala mbali inayo.
50 mg mapiritsi:
Mapiritsi ozungulira a biconvex amtundu wopepuka wa beige, wokutidwa ndi chipolopolo cha filimu wokhala ndi "112" mbali imodzi ndi yosalala mbali inayo.
Mapiritsi a 100 mg:
Mapiritsi okhala ndi biconvex beige ozungulira opakika utoto wophatikizika ndi "277" mbali imodzi komanso yosalala mbali inayo.

Gulu la Pharmacotherapeutic

Dipeptidyl peptidase inhibitor 4.

Nambala ya ATX : A10VN01

Mankhwala

Mankhwala
JANUVIA (sitagliptin) ndi choletsa pakamwa, posankha kwambiri wa enzyme dipeptidyl peptidase 4 (DPP-4), omwe cholinga chake ndi kuchiza matenda a shuga 2 a mellitus. Sitagliptin amasiyana mu kapangidwe ka mankhwala ndi zochita za pharmacological kuchokera ku analogi ya glucagon-peptide-1 (GLP-1), insulini, zotumphukira za sulfonylurea, biguanides, gamma receptor agonists yokhazikitsidwa ndi peroxisome proliferator (PPAR-γ), alpha-glycosidase. Mwa kuletsa DPP-4, sitagliptin imachulukitsa kuchuluka kwa mahomoni awiri odziwika a banja la insretin: GLP-1 ndi insulinotropic peptide (HIP) ya glucose. Mahomoni a banja la incretin amasungidwa m'matumbo masana, msambo wawo umawonjezeka poyankha pakudya. Ma incretins ndi gawo limodzi lazinthu zamkati zomwe zimakhazikitsa shuga homeostasis. Pa milingo yachilendo kapena yokwezeka ya shuga m'magazi, mahomoni am'banja la intretin amathandizira kuwonjezeka kwa insulin, komanso chinsinsi chake ndi maselo a pancreatic beta chifukwa chakuwonetsa ma intracellular methanems omwe amayenderana ndi cyclic AMP.
GLP-1 imathandizanso kupondereza kuchuluka kwa katulutsidwe ka glucagon ndi ma cell a pancreatic alpha. Kuchepa kwa ndende ya glucagon poyang'ana kumbuyo kwa kuchuluka kwa insulin kumapangitsa kuchepa kwa kupanga shuga kwa chiwindi, komwe kumapangitsa kutsika kwa glycemia.
Pazakudya zambiri zamagalasi am'magazi, zotsatira zomwe zimaphatikizidwa ndi ma insulin kutulutsidwa kwa insulin komanso kuchepa kwa katulutsidwe ka glucagon sikuwoneka. GLP-1 ndi HIP sizikhudza kutulutsidwa kwa glucagon poyankha hypoglycemia. Pansi pa zochitika zathupi, ntchito ya ma impretins imachepetsedwa ndi enzyme DPP-4, yomwe hydrolyzes imapangika mwachangu ndikupanga zinthu zosagwira.
Sitagliptin imalepheretsa hydrolysis ya ma impretins ndi enzyme DPP-4, potero kuwonjezera kuchuluka kwa plasma kwa mitundu yogwira ya GLP-1 ndi HIP. Kuchulukitsa kuchuluka kwa ma insretins, sitagliptin kumawonjezera kutulutsa shuga komwe kumadalira glucose ndikuthandizira kuchepetsa kubisika kwa glucagon. Odwala omwe ali ndi mtundu wachiwiri wa matenda a shuga omwe ali ndi hyperglycemia, kusintha kumeneku kwa insulin ndi glucagon kumapangitsa kutsika kwa glycosylated hemoglobin НbBr11 ndi kuchepa kwa plasma ndende ya glucose, yotsimikizika pamimba yopanda kanthu komanso pambuyo poyesa kupanikizika.
Odwala omwe ali ndi mtundu wachiwiri wa matenda a shuga, kutenga mlingo umodzi wa YANUVIA kumayambitsa zoletsa za DPP-4 kwa maola 24, zomwe zimawonjezera kuchuluka kwa kuzungulira kwa ma protein a GLP-1 ndi HIP chifukwa cha 2-3, kuwonjezeka kwa plasma ndende ya insulin ndi peptide, kuchepa kwa kuchuluka kwa glucagon m'madzi am'magazi, kuchepa kwa glucose othamanga, komanso kuchepa kwa glycemia pambuyo poyatsira shuga kapena kutsitsa chakudya.

Pharmacokinetics
Pharmacokinetics ya sitagliptin yakhala yodziwika bwino mwa anthu athanzi komanso odwala matendawa a mtundu wa 2. Mwa athanzi, pambuyo pakamwa makonzedwe a 100 mg a sitagliptin, kuyamwa mwachangu kwa mankhwalawa kumawonedwa ndi kuchuluka kwakukulu (Cmax) kuyambira 1 mpaka maola 4 kuyambira nthawi ya makonzedwe. Dera lomwe limasungidwa nthawi yayitali (AUC) limachulukana molingana ndi kuchuluka kwa mankhwalawo, ndipo mu maphunziro abwino ndi 8.52 μMh / h mukamamwa 100 mg pakamwa, Cmax ndi 950 nM, ndipo theka la moyo ndi maola 12,4. Plasma AUC ya sitagliptin inakula ndi pafupifupi 14% pambuyo pa mlingo wotsatira wa 100 mg ya mankhwalawa kuti apeze gawo lofanana pambuyo atamwa koyamba. Ma intra- komanso apakati pa kusiyanitsa kwapakati pa sitagliptin AUC sikunachitike.
Mafuta
Mtheradi bioavailability wa sitagliptin pafupifupi 87%. Popeza kugwiritsidwa ntchito kwa mankhwala a YANUVIA komanso zakudya zamafuta sizikhudza mafakitokiya, mankhwala a YANUVIA amatha kutumikiridwa mosasamala chakudya.
Kugawa
Kuchulukitsa kwapakati pamagawidwe ofanana pambuyo pa gawo limodzi la 100 mg ya sitagliptin mwa odzipereka athanzi ndi pafupifupi 198 L. Gawo la sitagliptin lomwe limamangiriza mapuloteni a plasma ndilotsika kwambiri 38%.
Kupenda
Pafupifupi 79% ya sitagliptin amachotsedwa mu mkodzo.
Kachigawo kochepa chabe kamankhwala kamene kamalandiridwa m'thupi kamapukusidwa.
Pambuyo pa 14C yolembedwa kuti sitagliptin mkati, pafupifupi 16% ya mankhwala a radio radio adachotsedwa mu mawonekedwe a metabolites ake. Zotsatira za metabolites 6 za sitagliptin zidapezeka, mwina sizingokhala ndi DPP-4 zoletsa. Kafukufuku wa in vitro awulula kuti puloteni yoyamba yomwe imakhudzidwa ndi metabolg yoletsedwa ya sitagliptin ndi CYP3A4 yokhudza CYP2C8.
Kuswana
Pambuyo pa 14C yolembedwa kuti sitagliptin idaperekedwa kwa odzipereka athanzi, pafupifupi 100% ya mankhwala omwe adathandizidwa adachotsedwa: 13% kudzera m'matumbo, 87% ndi impso mkati mwa sabata limodzi atatha kumwa mankhwalawo. Nthawi yotsika theka la moyo wa sitagliptin mwa makonzedwe amkamwa a 100 mg pafupifupi maola 12.4; chilolezo cha impso ndi pafupifupi 350 ml / mphindi.
Kukula kwa sitagliptin kumachitika makamaka chifukwa cha impso pogwiritsa ntchito njira yoteteza tinthu tating'onoting'ono. Sitagliptin ndi gawo logawa chotulutsa chamoyo cha mtundu wachitatu wa anthu (hOAT-3), omwe angatenge nawo gawo la kuchotsa kwa sitagliptin ndi impso. Mwachidziwitso, kuphatikiza kwa hOAT-3 pakuyendetsa sitagliptin sikunaphunzire. Sitagliptin ndi gawo laling'ono la p-glycoprotein, amenenso angatenge nawo gawo la kuchotsa kwa impso kwa sitagliptin. Komabe, cyclosporin, choletsa p-glycoprotein, sichinachepetse chilolezo cha sitagliptin.

Pharmacokinetics m'magulu odwala
Odwala omwe ali ndi vuto la impso
Kafukufuku wotseguka wa mankhwala JANUVIA pamlingo wa 50 mg patsiku amaphunzira mankhwala ake a pharmacokinetics mwa odwala omwe ali ndi vuto losasintha la impso. Odwala omwe amaphatikizidwa ndi phunziroli adagawika m'magulu ofooka aimpso (kulengedwa kwa creatinine kuyambira 50 mpaka 80 ml / min), chilolezo (cha mtundu wa creatinine kuyambira 30 mpaka 50 ml / min) ndi kulephera kwakamphumo (creatinine chilolezo chosakwana 30 ml / min), komanso odwala omwe ali ndi matenda a impso omwe amafunikira dialysis.
Odwala omwe ali ndi vuto lofooka la impso, panalibe kusintha kwakukulu pamatenda a plasma sitagliptin poyerekeza ndi gulu loyang'anira odzipereka athanzi.
Kuwonjezeka kawiri kwa sitagliptin AUC poyerekeza ndi gulu loyang'anira kunawonedwa mwa odwala omwe amalephera kupezeka bwino aimpso, kuwonjezeka kwaposachedwa kanayi kwa AUC kumawonedwa mwa odwala omwe amalephera kwambiri aimpso, komanso kwa odwala omwe ali ndi vuto laimpso kumapeto kwake. Sitagliptin idachotsedwa pang'ono kuzunguliridwa ndi hemodialysis: 13.5% yokha ya mankhwalawo imachotsedwa m'thupi pakapita dialysis ya maola atatu.
Chifukwa chake, pofuna kukwaniritsa kuchuluka kwa mankhwalawa kwa magazi m'magazi am'magazi (ofanana ndi omwe odwala omwe ali ndi vuto laimpso) odwala omwe ali ndi vuto lochepa kwambiri komanso aimpso, kusintha koyenera kumafunikira (onani Mlingo ndi Ulamuliro).
Odwala omwe ali ndi vuto la chiwindi
Odwala omwe ali ndi chiwindi chochepa kwambiri (7-16 point on the Child-Pugh wadogo), AUC ndi Cmax wamba wa sitagliptin omwe ali ndi mlingo umodzi wowonjezera wa 100 mg ndi pafupifupi 21% ndi 13%, motero. Chifukwa chake, kusintha kwamtundu wa mankhwalawa ngati chiwindi chofatsa kapena chochepa sichikofunikira.
Palibe chidziwitso chachipatala pakugwiritsa ntchito sitagliptin kwa odwala omwe ali ndi vuto lolemera la hepatic (oposa 9 mfundo pamiyeso ya Mwana-Pugh). Komabe, chifukwa chakuti mankhwalawa amuchotsa impso, munthu sayenera kuyembekeza kusintha kwakukulu mu pharmacokinetics ya sitagliptin mwa odwala omwe ali ndi vuto lotupa la hepatic.
Odwala okalamba
Zaka za odwala sizinakhale ndi vuto lililonse pamawonekedwe a pharmacokinetic magawo a sitagliptin. Poyerekeza ndi achinyamata, odwala okalamba (azaka 65-80) ali ndi kuchuluka kwa sitagliptin pafupifupi 19%. Palibe kusintha kwa mlingo malinga ndi zaka zofunikira

Zizindikiro zogwiritsidwa ntchito

Monotherapy
Mankhwala JANUVIA akuwonetsedwa monga kuwonjezera pa zakudya ndi zolimbitsa thupi kuti alimbikitse kuwongolera kwa glycemic kwa odwala omwe ali ndi matenda a shuga a 2. Kuphatikiza mankhwala.
Mankhwala JANUVIA akuwonetsedwanso kwa odwala omwe ali ndi mtundu wachiwiri wa matenda osokoneza bongo omwe amawongolera glycemic control kuphatikiza ndi metformin kapena PPARγ agonists (mwachitsanzo, thiazolidinedione), pamene kudya ndi kuchita masewera olimbitsa thupi kuphatikiza ndi monotherapy ndi mankhwala omwe atchulidwa sikupangitsa kuti glycemic ikwaniritse.

Contraindication

• Hypersensitivity ku zilizonse za mankhwala,
  
• mimba, yoyamwitsa,
  
• mtundu 1 shuga
  
• matenda ashuga ketoacidosis.
  

Palibe zambiri pakugwiritsa ntchito mankhwalawa JANUVIA machitidwe a ana mwa odwala ochepera zaka 18. Chifukwa chake, kugwiritsa ntchito mankhwala JANUVIA m'gulu lino la odwala sikulimbikitsidwa.Ndi chisamaliro

Kulephera kwina
Mlingo kusintha kwa JANUVIA kwa odwala omwe ali ndi kuchepa kwapakati komanso mwamphamvu aimpso, komanso kwa odwala omwe ali ndi vuto la impso omwe amafunikira hemodialysis (onani Mlingo ndi Administration).

Gwiritsani ntchito pa nthawi yoyembekezera komanso mkaka wa m`mawere

Panalibe maphunziro owongoleredwa a mankhwalawa YANUVIA mwa amayi apakati, chifukwa chake palibe chidziwitso chachitetezo cha kugwiritsa ntchito kwake amayi apakati. Mankhwala JANUVIA, monga mankhwala ena amkamwa a hypoglycemic, ali osavomerezeka kuti mugwiritse ntchito pamimba. Palibe deta pazakudya za sitagliptin mkaka. Chifukwa chake, mankhwalawa JANUVIA sayenera kutumikiridwa pa mkaka womwewo.

Mlingo ndi makonzedwe

Mlingo wovomerezeka wa mankhwala JANUVIA ndi 100 mg kamodzi patsiku monga monotherapy kapena kuphatikiza ndi metformin kapena agonist wa PPARγ (mwachitsanzo, thiazolidinedione).
JANUVIA imatha kutengedwa mosasamala kanthu za chakudyacho.
Ngati wodwala walephera kumwa mankhwalawo JANUVIA, ayenera kumwedwa nthawi yomweyo wodwalayo akakumbukira mlingo womwe wasowa. Musalole kuwiriridwa kawiri pa mankhwala JANUVIA.
Odwala omwe ali ndi vuto la impso
Odwala omwe amalephera kupweteka aimpso (creatinine chilolezo cha ≥50 ml / mphindi, pafupifupi ndendende ndi plasma creatinine ≤1.7 mg / dL mwa amuna, ≤1.5 mg / dL mwa akazi) safunika kusintha mlingo wa mankhwala a JANUVIA.
Kwa odwala omwe amalephera kupweteka aimpso (creatinine chilolezo ≥30 ml / mphindi, koma 1.7 mg / dl, koma ≤3 mg / dl mwa amuna,> 1.5 mg / dl, koma ≤2.5 mg / dl mwa azimayi ) muyezo wa mankhwala JANUVIA ndi 50 mg kamodzi patsiku.
Kwa odwala omwe amalephera kwambiri aimpso (creatinine chilolezo cha 3 mg / dL mwa amuna,> 2,5 mg / dL mwa akazi), komanso ndi end-site renal pathology ofunika hemodialysis, mlingo wa mankhwala JANUVIA ndi 25 mg kamodzi patsiku. Mankhwala JANUVIA angagwiritsidwe ntchito mosasamala ndondomeko ya hemodialysis.
Odwala omwe ali ndi vuto la chiwindi
Palibe kusintha kwa mankhwalawa kwa JANUVIA kwa odwala omwe ali ndi vuto lochepa la chiwindi. Mankhwala sanaphunziridwe kwa odwala omwe ali ndi vuto lalikulu la chiwindi.
Odwala okalamba
Palibe kusintha kwa mankhwalawa kwa JANUVIA kwa odwala okalamba.

Mankhwala JANUVIA nthawi zambiri amaloledwa ngati monotherapy komanso kuphatikiza mankhwala ena a hypoglycemic. M'mayesero azachipatala, zochitika zonse za zotsatira zoyipa, komanso pafupipafupi kuperewera kwa mankhwala chifukwa chotsatira chake, anali ofanana ndi omwe ali ndi placebo.
Zochitika zoyipa zomwe sizinachitike pachiyanjano popanda kugwiritsa ntchito mankhwala a YANUVIA pa mlingo wa 100 mg ndi 200 mg patsiku, koma nthawi zambiri kuposa placebo, pafupipafupi ndi ≥3%: matenda opatsirana am'mimba apakati (YANUVIA 100 mg - 6.8%, YANUVIA 200 mg - 6.1%, placebo - 6.7%), nasopharyngitis (YANUVIA 100 mg - 4.5%, YANUVIA 200 mg - 4,4%, placebo - 3,3%), mutu (YANUVIA 100 mg - 3,6%, YANUVIA 200 mg - 3.9%, placebo - 3.6%), matenda otsegula m'mimba (YANUVIA 100 mg - 3.0%, YANUVIA 200 mg - 2.6%, placebo - 2.3%), arthralgia (YANUVIA 100 mg - 2.1%, YANUVIA 200 mg - 3.3%, placebo - 1.8%)
Zotsatira zonse za hypoglycemia mwa odwala omwe amachitidwa ndi YANUVIA zinali zofanana ndi placebo (YANUVIA 100 mg - 1.2%, YANUVIA 200 mg - 0.9%, placebo - 0.9%).
Pafupipafupi mwadzidzidzi zotsatira zina zoyipa kuchokera m'matumbo am'mimba mutatenga YANUVIA pamankhwala onse awiriwa zinali zofanana ndi za placebo, kupatula kupweteka kambiri komwe kumachitika pakumwa YANUVIA pa 200 mg patsiku: kupweteka kwam'mimba (YANUVIA 100 mg - 2.3%, YANUVIA 200 mg - 1.3%, placebo - 2.1%), nseru (YANUVIA 100 mg - 1.4%, YANUVIA 200 mg - 2.9%, placebo - 0.6%), kusanza (YANUVIA 100 mg - 0,8%, YANUVIA 200 mg - 0,7%, placebo - 0.9%), matenda am'mimba (YANUVIA 100 mg - 3.0%, YANUVIA 200 mg - 2.6%, placebo - 2.3%).
Zosintha zasayansi
Kusanthula kwa kafukufuku wamankhwala a mankhwalawa kunawonetsa kuwonjezeka pang'ono kwa uric acid (pafupifupi 0,5 mg / dl poyerekeza ndi placebo, kuchuluka kwa 5-5,5 mg / dl) mwa odwala omwe amalandira mankhwalawa YANUVIA pa mlingo wa 100 ndi 200 mg patsiku. Panalibe milandu yachitukuko cha gout.
Kunali kuchepa pang'ono pa kuchuluka kwa zamchere kwambiri phosphatase (pafupifupi 5 IU / L poyerekeza ndi placebo, pafupifupi mlingo wa 56-62 IU / L), pang'ono pokhudzana ndi kuchepa pang'ono kwa kachigawo kakang'ono ka mafupa a alkaline phosphatase.
Panali kuwonjezeka pang'ono pa chiwerengero cha leukocyte (pafupifupi 200 / μl poyerekeza ndi placebo, pafupifupi 6600 / μl), chifukwa cha kuchuluka kwa neutrophils. Izi zimadziwika kwambiri, koma si maphunziro onse.
Zosintha zomwe zidasungidwa mu magawo a labotale sizikuwoneka kuti ndizofunikira kwambiri.
Munthawi yamankhwala ndi YANUVIA, panalibe kusintha kwakukulu pamankhwala ofunikira komanso ECG (kuphatikiza ndi QTc).

Bongo

Panthawi ya mayesero azachipatala mwa odzipereka athanzi, mlingo umodzi wa 800 mg wa YANUVIA nthawi zambiri unkakhala woperewera. Kusintha kocheperako pakatikati pa QTc, komwe sikumawoneka ngati kofunika kwambiri, kunadziwika mu kafukufuku wina wamankhwala a YANUVIA pa mlingo wa 800 mg patsiku. Mlingo woposa 800 mg patsiku kwa anthu sunaphunzire.
Pankhani ya mankhwala osokoneza bongo, ndikofunikira kuyambitsa njira zothandizira: kuchotsa mankhwalawa osagwiritsidwa ntchito m'mimba, kuwunika mayendedwe ofunikira, kuphatikiza ECG, komanso kukhazikitsidwa kwa mankhwala othandizira, ngati pakufunika kutero.
Sitagliptin salemala bwino. M'maphunziro azachipatala, ndi 13.5% yokha ya mankhwala omwe amachotsedwa m'thupi panthawi ya dialysis ya maola atatu. Kutalika kwa dialysis kumatha kutumikiridwa ngati pakufunika. Palibe umboni wotsimikiza za kugwira ntchito kwa peritoneal dialysis kwa sitagliptin.

Kuchita ndi mankhwala ena

Pophunzira pakukhudzana ndi mankhwala ena, sitagliptin sanakhale ndi vuto lililonse pama pharmacokinetics a mankhwala otsatirawa: metformin, rosiglitazone, glibenclamide, simvastatin, warfarin, kulera kwapakamwa. Kutengera ndi izi, sitagliptin sichimaletsa CYP isoenzymes CYP3A4, 2C8 kapena 2C9. Kutengera ndi data ya in vitro, sitagliptin mwina sikulepheretsa CYP2D6, 1A2, 2C19 kapena 2B6, komanso sikulimbikitsa CYP3A4.
Panali kuwonjezeka pang'ono kwa AUC (11%), komanso Cmax (18%) ya digoxin akaphatikizidwa ndi sitagliptin. Kukula kumeneku sikumawerengedwa ngati kofunika kwambiri m'chipatala. Sizikulimbikitsidwa kusintha mlingo wa digoxin kapena mankhwala a YANUVIA akagwiritsidwa ntchito palimodzi.
Kuwonjezeka kwa AUC ndi Cmax kwa mankhwala a YANUVIA kunazindikiridwa ndi 29% ndi 68%, motero, mwa odwala omwe amaphatikiza pakumwa limodzi pamlomo wa 100 mg wa mankhwala a YANUVIA komanso mlingo umodzi wamkamwa wa 600 mg wa cyclosporine, choletsa wa p-glycoprotein.
Kusintha koonekera mu pharmacokinetic machitidwe a sitagliptin sikuwoneka ngati ofunikira. Kusintha kwa muyezo wa mankhwala JANUVIA mukamaphatikizidwa ndi cyclosporine ndi zina za p-glycoprotein inhibitors (mwachitsanzo, ketoconazole) sikulimbikitsidwa.
Kafukufuku wopanga kuchuluka kwama pharmacokinetic kwa odwala komanso odzipereka athanzi (N = 858) pamankhwala osiyanasiyana (N = 83, pafupifupi theka lawo lomwe limafotokozedwa ndi impso) sanawonetse zazomwe zimachitika pazinthu izi pa pharmacokinetics ya sitagliptin.

Malangizo apadera

Hypoglycemia
M'maphunziro a kachipatala a YANUVIA ya mankhwala monga monotherapy kapena gawo limodzi la mankhwala a metformin kapena pioglitazone, zochitika za hypoglycemia mukamagwiritsa ntchito mankhwala a YANUVIA zinali zofanana ndi pafupipafupi za hypoglycemia mukamagwiritsa ntchito placebo. Kugwiritsa ntchito kwa mankhwala a JANUVIA kuphatikiza mankhwala omwe angayambitse hypoglycemia, monga insulin, zotumphukira za sulfonylurea, sizinafufuzidwe.
Gwiritsani ntchito mwa okalamba.
M'mayesero azachipatala, kufunikira ndi chitetezo cha mankhwala a YANUVIA mwa okalamba (zaka ≥65, odwala 409) anali ofanana ndi omwe ali ndi odwala ochepera zaka 65.
Palibe kusintha kwa muyezo pa msinkhu komwe kumafunikira. Odwala okalamba amatha kukhala ndi kulephera kwa impso. Chifukwa chake, monga m'mazaka ena onse, kusintha kwa mankhwalawa kwa odwala omwe ali ndi vuto lalikulu laimpso ndikofunikira (onani Mlingo ndi Ulamuliro).

Kukopa pa kuyendetsa magalimoto ndi kugwira ntchito ndi njira .

Palibe maphunziro omwe adachitidwa kuti adziwe momwe mankhwala a YANUVIA amathandizira kuyendetsa magalimoto.Komabe, zotsatira zoyipa za mankhwala JANUVIA pakutha kuyendetsa galimoto kapena njira zovuta sizikuyembekezeredwa.

Kutulutsa Fomu

Mapiritsi 14 mu PVC / Al chithuza. 1, 2, 4, 6, kapena matuza 7 amaikidwa m'bokosi la makatoni ndi malangizo ogwiritsa ntchito.

Malo osungira

Sungani ku kutentha kosaposa 30 ° C.
Pewani kufikira ana.

Tsiku lotha ntchito

Zaka 2
Osagwiritsa ntchito tsiku lotha ntchito likusonyezedwa pa phukusi.

Malangizo apadera

Yanuvia ikhoza kugulidwa mu chipatala cha mankhwala okha ndi mankhwala. Hypoglycemia, malinga ndi kafukufuku, chithandizo chovuta kwambiri sichachulukanso kuposa placebo. Zokhudza thupi la Januvia motsutsana ndi maziko a insulin yayikulu sizinaphunzire, kotero odwala ali ndi malire pa kuwongolera kwa hypoglycemic.

Zotsatira zoyipa za mankhwalawa pakutha kuyendetsa kayendedwe kapena njira zovuta sizinalembedwe, popeza kuti gawo la yogwira pakatikati lamanjenje sililetsa.

Hypersensitivity mukatenga Januvia imatha kufotokozedwa ngati mantha a anaphylactic. Nkhope ya wovutikayo imatupa, totupa totuluka. Mwazovuta kwambiri, edema ya Quincke imawonedwa. Ndi zizindikiro zotere, mankhwalawa amangoimitsidwa ndikupempha thandizo kuchipatala.

Januvia mu zovuta mankhwala amagwiritsidwa ntchito posowa zotsatira zofunika mutatenga Metformin ndi kusintha kwasinthidwe. Muthanso kugwiritsa ntchito mankhwalawa posintha insulin.

Kodi wothandizira hypoglycemic ndi chiyani?

Mankhwala a shuga a Januvia ayamba kutchuka pakati pa akatswiri azachipatala komanso odwala omwe ali ndi vutoli.

Kukonzekera kwa piritsi kumakhala ndi tanthauzo la hypoglycemic ndipo ndi gulu la DPP-4 zoletsa.

Kugwiritsa ntchito mankhwalawa kumalimbikitsa kukula kwa mankhwala omwe amagwira ntchito ndipo amathandizanso kuchitapo kanthu. Panthawi yovomerezeka ya kugwira ntchito kwa thupi, ma insretin amapangidwa m'matumbo, ndipo msambo wake umakwera kwambiri mutatha kudya.

Chifukwa cha chitukuko cha matenda a shuga, kulephera kumachitika m'njira imeneyi, ndipo chifukwa chake, akatswiri azachipatala amakwaniritsa kuchira kwawo mwa kupereka kwa odwala mankhwala a Januvia.

Ma insretins ndi omwe amachititsa kuti insulin ipange.

Zina mwazida zazikuluzikulu monga chipangizo chachipatala ndi:

1. Kuchepa kwa ndende ya glycated hemoglobin.
2. Kuthetsa kwa zizindikiro za hyperglycemia (kuphatikizapo kuchepa kwa shuga m'magazi).
3. Matenda a kulemera kwa thupi.

Mankhwalawa amapezeka piritsi la mawonekedwe piritsi lozungulira, lamtengo wapatali la beige.

Chofunikira chachikulu ndi sitagliptin (mnn), monga zida zothandizira ndi calcium hydrogen phosphate, microcrystalline cellulose, magnesium stearate, croscarmellose ndi sodium stearyl fumarate, amenenso ndi gawo la mankhwalawa. Dziko lomwe lidachokera ku Januvia ndi Netherlands, kampani yopanga mankhwala MERCK SHARP & DoHME.

Mapiritsi okhala ndi gawo laentigliptin, monga lamulo, amagwiritsidwa ntchito ngati:

• mu zovuta zochizira matenda ngati mtundu 2 shuga mellitus, kuwonjezera hypoglycemic zotsatira molumikizana ndi okana kapena metformin hydrochloride,
• monga monotherapy pakukula kwa insulin-yodziyimira payokha ya matenda osokoneza bongo omwe amaphatikizidwa ndi mitundu yothandizira yopanda mankhwala - mankhwala othandizira pakudya ndi masewera olimbitsa thupi.

Dziwani kuti chithandizo chovuta kugwiritsa ntchito mankhwala a magulu otsatirawa:

1. Sitagliptin nthawi zambiri imagwiritsidwa ntchito molumikizana ndi metformin (Siafor, Glucofage, Formmetin).
2. Ndi zotumphukira za sulfonylurea (Diabeteson kapena Amaryl).
3. Ndi mankhwala ochokera ku gulu la thiazolidinediones (Pioglitazole, Rosiglitazone).

Mapiritsi a Januvia, omwe amaphatikiza sitagliptin, amatengeka msanga atatengedwa ndikufika pazowonjezera zambiri za plasma patatha maola anayi.

Mlingo wa bioavailability wathunthu ndi wokulirapo ndipo umafanana ndi 90 peresenti.

Malangizo ogwiritsira ntchito mankhwalawa

Makampani opanga zamankhwala apanga njira zopangira mankhwala azamankhwala okhala ndi mitundu yambiri yamagulu othandizira.

Kudziwa dokotala yemwe ali mulingo woyenera kwambiri kwa wodwala amatsimikiza ndi dokotala.

Kusankha kwa mlingo wa mankhwalawa kumachitika pokhapokha wodwala atamuunika.

Kukonzekera kwa piritsi kumawonetsedwa pamsika wamankhwala munthawi yayitali:

• mankhwala ali 25 mg yogwira pophika,
• kuchuluka kwa yogwira ndi 50 mg,
• Januvia 100 mg - mapiritsi okhala ndi mlingo wapamwamba kwambiri.

Malangizo a Januvia ogwiritsira ntchito akuwonetsa kufunikira kwa mankhwalawa pogwiritsa ntchito njira yotsatirayi:

1. Mapiritsi amatengedwa pakamwa, kutsukidwa ndi madzi okwanira, osasamala chakudyacho.
2. Mlingo wa tsiku ndi tsiku wa mankhwalawa uyenera kukhala mamiligalamu zana limodzi la yogwira.
3. Ngati mukuphonya mlingo wotsatira, musangonanso kawiri pa nthawi yotsatira.
4. Ngati wodwalayo wasokoneza ntchito yaimpso pakhungu lolephera kuzungulira, mulingo wake uyenera kuchepetsedwa kukhala mamiligalamu makumi asanu. Pogwiritsa ntchito zovuta za impso, mulingo wovomerezeka suyenera kupitirira mamiligalamu makumi awiri ndi asanu a chinthucho.

Kugwiritsa ntchito sitagliptin kumaloledwa kokha monga akuwongolera ndi katswiri wazachipatala.

Pankhani ya mankhwala osokoneza bongo, kusintha kwa gawo la QTc kumatha kupezeka. Monga chithandizo, njira monga gastric lavage, kugwiritsa ntchito mankhwala a enterosorbent ndi symptomatic therapy mumagwiritsidwa ntchito.

Zotsatira zoyipa komanso zovuta zoyipa

Mankhwala a Januvia ali ndi zotsatira zoyipa zochepa, mosiyana ndi mankhwala ena ochepetsa shuga.

Gawo logwiralo limalolezedwa ndi thupi mosavuta, popanda kuchititsa zinthu zoyipa.

Kuphatikiza apo, nthawi zina, zovuta zoyipa zamagulu ndi machitidwe a thupi zimatha kuchitika.

Monga lamulo, zotsatira zoyipa ngati izi zimatha pambuyo posiya mankhwala.

Zotsatira zoyipa zimatha kuchitika kupuma kwa mawonekedwe a nasopharyngitis kapena matenda opatsirana am'mapapo.

Kuphatikiza apo, wodwalayo amatha kudandaula za chitukuko cha njirazi:

1. Mutu waukulu.
2. Ululu pamimba, limodzi ndi kupuma mseru, kusanza, kapena kutsekula m'mimba.
3. Mawonekedwe a hypoglycemia.
4. Malinga ndi zotsatira za kusanthula, kupatuka kotsatiraku kumatha kuchitika - kuchuluka kwa uric acid ndipo ma neutrophils amawonjezeka, kuchuluka kwa alkaline phosphatase kumachepa.

Komanso pakati pazowoneka bwino titha kuwerengetsa kuwonjezeka kwa kugona, chifukwa chomwe sichikulimbikitsidwa kuyendetsa magalimoto kapena kuchita zochitika ndi njira zomwe zimafunikira chidwi chochulukirapo.

Ndemanga za ogula ndi akatswiri azachipatala

Mwa odwala ambiri omwe adagwiritsa ntchito mankhwalawa, ndemanga zake nthawi zambiri zimakhala zabwino.

Ndemanga zoyipa nthawi zambiri zimagwirizanitsidwa ndi kuphwanya malangizo pakugwiritsa ntchito mankhwalawa.

About Januvia, ndemanga zikuwonetsa kuti mankhwalawa ali ndi zabwino zingapo.

Ubwino wofunikira kwambiri wa othandizira a hypoglycemic, poyerekeza ndi mankhwala ena ochepetsa shuga, ndi awa:

• pali kusintha kwa shuga m'magazi, chiphuphu chimagwira pang'ono,
• mutatha kudya, mankhwalawa amagwira ntchito mwachangu, ndikukonzanso kuchuluka kwa glycemia,
• shuga wamagazi amasiya kukhala "spasmodic" mwachilengedwe, madontho akuthwa kapena kukwera samawonedwa.

Dziwani kuti malinga ndi malangizo ogwiritsira ntchito mankhwalawa, mapiritsi amatha kumwa nthawi iliyonse ya tsiku, mosasamala kanthu za kudya.

Nthawi yomweyo, odwala amakonda mankhwalawa m'mawa, ponena kuti mwanjira imeneyi zotsatira zokhazikika komanso zotchulidwa zimayang'aniridwa, chifukwa mankhwalawa amayenera kulipira chakudya chomwe chimadza masana.

Malingaliro a madotolo ndikuti palibe kusiyana pakumwa mankhwala ndipo lamulo lalikulu ndikutsatira njira komanso osaphonya pulogalamu yotsatira. Ndi chiwembu ichi chomwe chimalola kuti chithandizo chamankhwala chikhale ndi zotsatira zabwino.

Nthawi zina, odwala matenda ashuga akuti patapita nthawi, mankhwalawa amayamba kuchepa ndipo amalumpha m'magazi a glucose amayambiranso. Izi zikufotokozedwa ndikukula kwina kwa njira ya pathological.

Malinga ndi odwala, kubwezera kwakukulu kwa Januvia ndi mitengo yamitengo yamankhwala.

Mtengo wa mankhwala wokhala ndi mlingo waukulu umasiyana kuchokera ku 1,500 mpaka 1,700 ma ruble pakompyuta (mapiritsi 28).

Kwa odwala matenda ashuga ambiri, mtengo umakhala wosapilira, poti mankhwalawo amayenera kumwedwa nthawi zonse, ndipo kuyikika kotero ndikokwanira pasanathe mwezi umodzi.

Ndiye chifukwa chake, odwala amayamba kufunafuna mankhwala omwe ndi otsika mtengo.

Hypoglycemic analogs

Januvia ndi analogues zitha kugulidwa ku malo ogulitsa mankhwala ngati muli ndi mankhwala omwe dokotala wakulemberani.

Masiku ano, malo ogulitsa ku Russia sangapereke maulalo okhala ndi chinthu chimodzi chomwechi kwa ogula.

Tikayerekezera nambala ya ATX-4 mwangozi, ndiye kuti ma fanizo ena a Januvia atha kukhala ngati mankhwala osokoneza bongo.

Onglisa ndi othandizira kuti asinthe magazi. Chofunikira chachikulu ndi saxaglipin mu Mlingo wa ma milligram awiri ndi theka kapena isanu. Mankhwalawa akuphatikizidwa ndi gulu la DPP-4 zoletsa. Nthawi zambiri amagwiritsidwa ntchito ngati mankhwala osakanikirana molumikizana ndi mapiritsi a metformin. Mtengo wa mankhwalawa ndi pafupifupi ma ruble 1800.

Galvus Met - ili ndi zigawo ziwiri zazikulu - vildagliptin ndi metformin hydrochloride. Loyamba ndi kuyimira gulu la othandizira makina osokoneza bongo a kapamba ndipo amathandizira kukulitsa chidwi cha maselo a beta kuti alowe shuga monga momwe adawonongera.

Nthawi yomweyo, metformin hydrochloride imalepheretsa ntchito ya gluconeogenesis, imalimbikitsa glycolysis, yomwe imapangitsa kuti shuga ikhale bwino komanso maselo amthupi. Kuphatikiza apo, pali kuchepa kwa mayamwidwe am'magazi ndimaselo a m'matumbo. Mankhwala samatsogolera pakukula kwa hypoglycemia. Mtengo wa chida choterocho umachokera ku 1300 mpaka 1500 rubles.

Galvus machitidwe ake ndi ofanana ndi Galves Met, kupatula kuti ili ndi gawo limodzi lokha - vildagliptin. Mtengo wa mankhwalawa umachokera ku ruble 800.

Osakhalitsa - piritsi la mankhwala okhala ndi tanthauzo la hypoglycemic. Chofunikira chachikulu ndi linagliptin. Mbali zazikulu zamankhwala zomwe mankhwala amaphatikizira zimaphatikizapo kutulutsa matenda a glycemia, kuwonjezeka kwa kuchuluka kwa ma insretin, kuwonjezeka kwa katulutsidwe kamatenda a shuga. Mtengo wa Transgent ndi pafupifupi ma ruble 1700.

Ndi iti mwa mankhwalawa omwe ithandizire kuchepetsa mphamvu ya shuga ndikuyimitsa kukula kwa matenda, ndiye dokotala wokhayo amene angasankhe. Sitikulimbikitsidwa kudziyimira pawokha mankhwala omwe adalembedwa ndi katswiri wazachipatala.

Othandizira a hypoglycemic akufotokozedwa mu kanema munkhaniyi.

Kutulutsa Fomu

Mankhwala "Januvia" amapangidwa ngati mapiritsi. Ndi ozungulira, ofiira owoneka bwino apinki ndi kukhudza kwa beige. Piritsi lililonse lili ndi cholembera:

• "221" pamene kutumikiridwa kwa zinthu ndi 25 mg,
• "112" pamene kutumikiridwa kwa zinthu ndi 50 mg,
• "227" pamene kutumikiridwa kwa zinthu ndi 100 mg.

Mapiritsi amadzaza ma mbale ndi maselo.

Mtengo wa mankhwala

Si nzika iliyonse ya ku Russia yomwe ili ndi matenda a shuga a 2 omwe amatha kugula mapiritsi a "Januvia" a shuga, mtengo wake ndi wokwera. Phukusi la 28 makapisozi a 100 mg, mtengo wake umayikidwa pa 1675 rubles.

Kuzindikira kwa shuga - ingomwani tsiku lililonse.

Kuchuluka kwa matendawa kumatha pambuyo pa milungu 4 yochizira. Popeza kuti mankhwalawa amamwa nthawi yayitali, mtengo wake umawoneka wachilendo kwambiri. Pokambirana ndi adotolo, kufananizira kukonzekera kwa Januvia kumaganiziridwa.

The mapiritsi

Kapu imodzi imodzi ya mankhwala a shuga a Januvia imatha kukhala ndi 100, 50, ndi 25 mg ya sitagliptin.

Mulinso zinthu zothandiza: calcium hydrogen phosphate, magnesium stearate, sodium stearyl fumarate.

Filimu yakunja imakhala ndi mowa wa polyvinyl, titanium dioxide, iron ironide, talc ndi red iron oxide.

Zolemba zogwiritsira ntchito

Kumwa mankhwala ndi mankhwala 0,1 ga.

Ngati mapiritsi a Januvia amagwiritsidwa ntchito limodzi ndi Metformin, ndiye kuti kusintha kwa mankhwalawa sikofunikira.

Mlingo wa mankhwala a shuga a Januvia ungangosinthidwa kokha ngati atengedwa limodzi ndi insulin. Izi ndizofunikira kuti pasakhale mwayi wa hypoglycemia.

Odwala okalamba safunika kusintha kutumikiridwa kwa Januvia chifukwa cha matenda ashuga. Koma muyenera kulipira omwe ali ndi zaka zopitilira 75. Palibe maphunziro omwe adachitidwa ndi odwala a m'badwo uno.

Mitu ya mankhwalawa

Mankhwala ambiri akuyesera kupeza ma fanizo. Palinso ma fanizo a Januvia, chifukwa ndi okwera mtengo kwambiri, ndipo si aliyense amene angakwanitse kugula mankhwalawa. Kuphatikiza apo, sitagliptin sitiwona ngati machiritso a matenda ashuga. Pakukonzekera kwa "Januvia", malangizowo akuti amafotokozedwanso ngati njira yothandizira kudya komanso kuchita masewera olimbitsa thupi, kotero kuti kuwunika kwathunthu matenda ashuga amtundu II.

Analogue ya Januvia ndi:

Mwa mtundu wa zomwe zimakhudza thupi, mankhwalawa ndi ofanana kwambiri. Zimakhudza bwino mitsempha ndi mtima, komanso zimaletsa kupezeka kwa kudya kosalekeza.

Pomwe mapangidwe a mankhwalawo ali ofanana, mtengo wawo ungasiyane kwambiri. Ndipo malingana ndi mfundo iyi, odwala amasankha mankhwalawo omwe amawakwanira. Ndikosavuta kukhazikitsa zomwe zili zabwino kuposa "Galvus Met" kapena "Januvia", chifukwa sizosiyana pamtengo. Pa phukusi "Galvus Met", pomwe pali mapiritsi 30, mtengo wake umayikidwa pafupifupi 1487 rubles.

Koma Yanuviya ali ndi ma analoge omwe ndi otsika mtengo, mwachitsanzo, Galvus, pomwe mapiritsi 28 angagulidwe ma ruble 841, omwe, mwachidziwikire, ndi otsika mtengo kwambiri.

Ndipo mtengo wa Ongliza ndiwokwera kwambiri kuposa wa Januvia - wodwalayo amalipira pafupifupi ma ruble 1978 phukusi la makapisozi 30. "Trazhenta" osati kutali ndi mankhwala am'mbuyomu - mapiritsi 30 amatenga pafupifupi ma ruble 1866.

Mankhwala okwera mtengo kwambiri ofanana ndi a Januvia anali Combogliz Prolong, momwe mapiritsi 30 amatenga ma ruble 2863. Koma pali mitundu yosiyanasiyana ya mankhwalawa, pomwe mapiritsi a 56 angagulidwe ma ruble 2866.

Malingaliro a madotolo

Pokonzekera Januvia, 100 mg, malangizowo akuti mapiritsi amatha kumwa nthawi zambiri masana, osachepera usiku, mosasamala momwe wodwalayo amakonda kudya.

Madokotala amakhulupirira kuti palibe kusiyana komwe wodwala amamwa mankhwalawa - m'mawa kapena madzulo, chinthu chachikulu ndikuti saphonya phwando. Ndi chifukwa ichi chomwe chingapangitse kuti mankhwalawa akhale othandiza.

Ndemanga za Januvia

Ndi mtundu wa 2 wodwala matenda osokoneza bongo popanda mapiritsi ochepetsa shuga, ndi ochepa omwe amatha kupewa kuyamwa kwa glucose.

Ndikofunikanso kupeza mankhwala anu omwe angakuthandizeni kuthana ndi matenda anu osawonjezera mavuto anu atsopano ku shuga.

Mukamasankha mankhwala oyenera a hypoglycemic a kulowererapo kwa matenda ashuga, akatswiri amatchera khutu ku glycemic komanso kuthekera kopanda glycemic. Poyamba, uku ndi kuchepa kwa glycated hemoglobin, chiopsezo cha hypoglycemia, insulin secretion, ndi mbiri yotetezeka. Kachiwiri - kusintha kwa kulemera kwa thupi, HF zowopsa, kulekerera, mbiri yachitetezo, kuthekera, mtengo, kugwiritsa ntchito mosavuta.

About mankhwala a Januvia chiyembekezo chamadokotala: kusala kudya kwa glycemia kuli pafupi ndi kwabwinobwino, kuchuluka kwa gluprose wa postprandial pomwe kudya sikudutsa malire ovomerezeka, madontho a shuga osawonongeka samawonedwa, mankhwalawo ndi otetezeka komanso ogwira ntchito ndipo amakwaniritsa bwino zofunikira zake. Maganizo a Pulofesa A.S. Ametova, mutu. Dipatimenti ya Endocrinology ndi Diabetesology GBOU DPO RMAPO Ministry of Health of the Russian Federation, za mwayi wa sitagliptin, onani vidiyo:

Makonda a odwala omwe akutenga Januvia ndi osakanikirana.

A.I. Ndakhala ku Metformin kwa zaka zitatu tsopano, adokotala sanakonde mayeso omaliza, ndidamuwonjezera Januvia. Ndakhala ndikumwa piritsi limodzi kwa mwezi tsopano. Adotolo adati mutha kumwa nthawi iliyonse, koma ndikumva bwino m'mawa. Ndipo mankhwalawa amayenera kugwira ntchito, choyambirira, masana, pomwe katundu pa thupi ndi wokwanira. Sindinazindikire chilichonse chamtsogolo, pomwe akumwabetsa shuga.

T.O. Mtsutso wofunikira pakuyesera thanzi langa ndi mtengo wamankhwala. Kwa Januvia, mtengo wake siwowonjezera ndalama: Ndinagula mapiritsi 28 a 100 mg kwa ma ruble 1675. Zinandikwanira kwa mwezi umodzi. Mankhwalawa ndi othandizadi, shuga ndi abwinobwino, koma ndikufunika kugula mapiritsi ena, chifukwa chake polingalira penshoni yanga ndikupempha dokotala kuti andilowe m'malo. Mwina wina angauze analogue yotsika mtengo?

Kuyerekezera kofananira kwa fanizo la Januvia

Ngati tingayerekeze mankhwalawa malinga ndi code ya ATX 4, ndiye m'malo mwa Januvia, mutha kusankha analogues:

• Onglizu ndi saxagliptin wogwira,
• Galvus, yopangidwa pamaziko a vildagliptin,
• Galvus Met - vildagliptin kuphatikiza ndi metformin,
• Trazentu ndi yogwira mankhwala linagliptin,
• Combogliz Prolong - potengera metformin ndi saxagliptin,
• Nesinu ndi yogwira pophika alogliptin.

Mphamvu yamakonzedwe a mankhwalawa ndi ofanana: amaletsa kulakalaka, osalepheretsa dongosolo lamkati lamanjenje komanso mtima. Ngati mungayerekeze analogi ndi Yanuvia pamtengo, ndiye kuti mutha kupeza zotsika mtengo: kwa mapiritsi 30 a Galvus Meta omwe ali ndi mlingo womwewo, muyenera kulipira rubles 1,448, pazidutswa 28 za Galvus - 841 rubles. Onlisa adzagwiritsa ntchito ndalama zambiri: 1978 rubles for 30 pcs. Mugawo lamtengo womwewo ndi Trazhenta: 1866 rubles. mapiritsi 30. Odula kwambiri pamndandandawu adzakhala Combogliz Kutalika: 2863 rubles. 30 ma PC.

Ngati sizotheka kupeza chindapusa chochepa cha mtengo wa mankhwala othandizira odwala matenda ashuga, mutha kusankha njira yovomerezeka ndi dokotala.

Masiku ano, matenda a shuga a 2 siwolepheretsa moyo wathunthu. Anthu odwala matenda ashuga amatha kugwiritsa ntchito mankhwala aposachedwa amitundu osiyanasiyana paziwonetsero, zida zamankhwala zothandizira kuperekera mankhwala ndikudziyang'anira nokha glycemia. Sukulu za odwala matenda ashuga adapangidwa m'mabungwe azachipatala komanso malo ophunzirira, ndipo pali zidziwitso zonse zapaintaneti.

Kodi Januvia ndi piritsi yatsopano yovomerezeka yothandizira matenda a shuga a 2 kapena chofunikira mwasayansi.