Metformin: Ndingatenge nthawi yayitali bwanji ndipo ndikuwonjezera bongo?

M'mawunikidwe anu (glucose 7.4, glycated hemoglobin 8.1), kukhalapo kwa matenda a shuga sikukayika - munapezeka kuti mwazindikira. Metformin imaperekedwa moyenera mu T2DM, mlingo umasankhidwa payekha. Metformin imathandizira kuchepetsa shuga m'magazi komanso kunenepa kwambiri.

Zokhudza kudya pambuyo pa zaka 60: ngati ntchito ya ziwalo zamkati (makamaka chiwindi, impso, mtima) imasungidwa, ndiye kuti Metformin imaloledwa kulandira zaka 60. Ndi kuchepa kutchulidwa kwa ziwalo zamkati, mlingo wa Metformin umachepa, kenako umathetsedwa.

Kuphatikiza ndi L-thyroxine: L-thyroxine imatengedwa m'mawa m'mimba yopanda mphindi 30 asanadye, osambitsidwa ndi madzi oyera.
Metformin imatengedwa pambuyo pa chakudya cham'mawa komanso / kapena mutatha kudya (ndiye kuti 1 kapena 2 kawiri tsiku lililonse mukatha kudya), chifukwa kusala metformin kumakwiyitsa khoma lam'mimba ndi matumbo.
Mankhwala omwe ali ndi metformin ndi L-thyroxine akhoza kuphatikizidwa, uku ndi kuphatikiza kwapafupipafupi (matenda ashuga ndi hypothyroidism).

Chinthu chachikulu chomwe muyenera kukumbukira kuwonjezera pa chithandizo chamankhwala ndicho kutsatira zakudya, zolimbitsa thupi (izi zithandiza kuchepetsa thupi) komanso kuwongolera shuga.

Limagwirira ntchito a Metformin

Zochita za chinthucho zimalinga kupewetsa mphamvu ya gluconeogenesis yomwe imachitika m'chiwindi. Kupanga kwa glucose m'thupi kumachepa, magazi ake amathanso kuchepa. Dziwani kuti mu anthu odwala matenda ashuga, kuchuluka kwa shuga m'magazi kumapitilira katatu momwe amagwiritsidwira ntchito.

Mu chiwindi pali enzyme yotchedwa AMP-activated protein kinase (AMPK), yomwe imagwira ntchito yayikulu pakulembetsa insulin, metabolism yamafuta ndi glucose, komanso mphamvu yolimba. Metformin imayambitsa AMPK kuti aletse shuga.

Kuphatikiza pa kupondereza njira ya gluconeogeneis, metformin imagwiranso ntchito zina, monga:

• Amakhala bwino ndi zotumphukira za minofu ndi maselo kupita ku timadzi timene timatsitsa,
• zimawonjezera kukhudzana ndi shuga ndi maselo,
• kumabweretsa kukhatikiza kwa kukhatikiza kwa mafutulu amafuta acid,
• amathandizira kuyamwa kwa shuga m'mimba.

Kumwa mankhwalawa kumathandizira kuchepetsa kunenepa kwambiri mwa anthu. Metformin imatsitsa serum cholesterol, TG ndi LDL cholesterol pamimba yopanda kanthu. Nthawi yomweyo, sasintha kuchuluka kwa lipoproteins a kachulukidwe ena. Munthu wathanzi (wokhala ndi thanzi labwino) yemwe amatenga metformin sangamve kuwawa.

Kugwiritsa ntchito mankhwalawa, wodwalayo amatha kukwaniritsa kuchepa kwa shuga ndi 20%, komanso kuchuluka kwa hemoglobin ya glycosylated ndi 1.5%. Kugwiritsa ntchito mankhwalawa monga monotherapy, kuyerekezera ndi mankhwala ena ochepetsa shuga, insulin ndi zakudya zapadera, kumachepetsa mwayi wokhala ndi vuto la mtima. Kuphatikiza apo, kafukufuku wa 2005 (Cochrane Collaboration) adatsimikizira kuti kufa pakati pa odwala omwe ali ndi matenda a shuga a 2 amachepetsedwa ndikutenga Metformin.

Wodwala akamamwa piritsi la metformin, magazi ake amawonjezeka mkati mwa maola 1-3 ndipo ayamba kuchitapo kanthu. Mankhwalawa amamwetsa msanga mokwanira m'mimba.

Gawolo silimapangidwa, koma litulutsidwa mthupi la munthu ndi mkodzo.

Malangizo ogwiritsira ntchito mankhwalawa

Mankhwala Metformin amapezeka mu mawonekedwe a mapiritsi omwe ali ndi 500 mg yogwira ntchito (metformin hydrochloride). Kuphatikiza apo, mankhalawo amaphatikizapo zinthu zochepa zowonjezera: wowuma chimanga, crospovidone, povidone K90, magnesium stearate ndi talc. Paketi imodzi ili ndi matuza atatu a mapiritsi 10.

Katswiri wokhazikika yemwe amayesa thanzi la wodwalayo ndi amene angafotokozere za ntchito ya Metformin. Wodwala akamamwa mapiritsi, ayenera kutsatira malangizo onse a dokotala.

Malangizo a kuingiza amapezeka phukusi lirilonse lokonzekera. Mmenemo mungapeze zisonyezo zotsatirazi:

1. Type 2 shuga mellitus, makamaka mwa anthu onenepa kwambiri omwe samakonda ketoacidosis (kuphwanya chakudya cha m'thupi).
2. Kuphatikiza kwa insulin mankhwala ndi kukana kwa mahomoni, komwe kunayambikanso.

Dziwani kuti katswiri yekha ndi amene amatha kuwerengera mulingo woyenera, malinga ndi kuchuluka kwa shuga m'magazi a odwala matenda ashuga. Malangizowa amapereka mlingo waukulu wa mankhwalawa, omwe nthawi zambiri amafunikira kuwunikanso komanso kusintha.

Mlingo woyambirira wa mankhwalawa ndi mapiritsi a 1-2 (mpaka 1000 mg patsiku). Pakatha milungu iwiri, kuchuluka kwa metformin kumatheka.

Mlingo wokonza mankhwalawa ndi mapiritsi 3-4 (mpaka 2000 mg patsiku). Mlingo wapamwamba kwambiri watsiku ndi tsiku ndi mapiritsi 6 (3000 mg). Kwa okalamba (kuyambira zaka 60), ndikulimbikitsidwa kumwa metformin osaposa mapiritsi awiri patsiku.

Momwe mungamwe mapiritsi? Amawamwa yonse, kutsukidwa ndi kapu yaying'ono yamadzi, pakudya kapena pambuyo pake. Kuchepetsa mwayi wosakhudzana ndi njira yogaya chakudya, mankhwalawa agawidwe kangapo. Pakakhala vuto lalikulu la metabolic, mlingo wa mankhwalawa uyenera kuchepetsedwa kuti muchepetse kukula kwa lactic acidosis (lactic coma).

Metformin iyenera kusungidwa m'malo owuma komanso amdima osapeza ana aang'ono. Kutentha kosungira kumachokera ku +15 mpaka +25 degrees. Kutalika kwa mankhwalawa ndi zaka zitatu.

Contraindication ndi zovuta zoyipa

Monga mankhwala ena, kugwiritsa ntchito metformin kumatha kuphatikizidwa mwa anthu omwe ali ndi matenda enaake kapena pazifukwa zina.

Monga tanena kale, kwa odwala omwe ali ndi zaka zopitilira 60, makamaka omwe amagwira ntchito yolemetsa, mankhwalawa sayenera kugwiritsidwa ntchito, chifukwa amatha kutsogolera lactic acidosis.

Mndandanda wa zotsutsana ndi mankhwalawa siwocheperako. Kugwiritsa ntchito metformin ndizoletsedwa pomwe:

• precoma kapena chikomokere, wodwala matenda a ketoacidosis,
• kukanika kwa impso ndi chiwindi,
• matenda pachimake okhudza kugwira ntchito kwa impso (kuchepa madzi m'thupi, hypoxia, matenda osiyanasiyana, malungo),
• poyizoni ndi zakumwa zoledzeretsa kapena uchidakwa wambiri,
• aakulu kapena pachimake pathologies omwe ungayambitse kukula kwa myocardial infarction, kupuma kapena kulephera kwa mtima,
• lactic acid chikomaso (makamaka, mbiri),
• akuchita masiku osachepera awiri komanso kwa masiku awiri pambuyo pa mayeso a x-ray ndi radioisotope ndi jakisoni wa chinthu china chosiyana ndi ayodini,
• Zakudya zama calori zochepa (zosakwana calories 1000 patsiku),
• kunyamula mwana ndi kuyamwitsa,
• kuchuluka kwa zomwe mankhwala amapezeka.

Wodwala akamalandira mankhwala popanda kutsatira malangizo a dotolo, zovuta zina zimawoneka. Amalumikizidwa ndi ntchito yolakwika:

1. kupukusa m'mimba (kusanza, kusintha kwa kukoma, kuchuluka kwa chakudya, kusowa kwa chakudya, kutsekula m'mimba kapena kupweteka kwam'mimba),
2. hematopoietic ziwalo (kukula kwa megaloblastic anemia - kuchepa kwa folic acid ndi vitamini B12 m'thupi),
3. kagayidwe (kagayidwe ka lactic acidosis ndi B12 hypovitaminosis yolumikizana ndi malabsorption),
4. endocrine dongosolo (kukula kwa hypoglycemia, komwe kumawonetsedwa ndi kutopa, kusakwiya, kupweteka mutu komanso chizungulire, kulephera kudziwa).

Nthawi zina pamakhala zotupa pakhungu. Zotsatira zoyipa zomwe zimakhudzana ndi kusokonezeka kwa dongosolo la kugaya chakudya zimachitika kawirikawiri masabata awiri oyambilira. Izi zimachitika kawirikawiri m'thupi, pakatha masiku 14, kukomoka kwa metformin kumachitika, ndipo zizindikirazo zimapita zokha.

Chithandizo Cha bongo

Munthu wodwala matenda ashuga akamamwa mankhwala pamankhwala apamwamba kuposa omwe walangizidwa ndi dokotala kapena wowerengeka amatha kubweretsa mavuto ambiri mthupi lake, osatchulanso kuti amwalira. Ndi mankhwala osokoneza bongo, zotsatira zowopsa zimatha - lactic acidosis mu shuga. Chifukwa china chake chakukula kwake ndikuwunikira kwa mankhwalawa pakukanika kwa impso.

Chizindikiro cha lactic acidosis ndichakudya cham'mimba, kupweteka kwam'mimba, kutentha pang'ono kwa thupi, kupweteka kwa minofu, kuchuluka kwa kupuma, chizungulire komanso kupweteka m'mutu, kukomoka, komanso ngakhale kupweteka.

Ngati wodwala wazindikira chimodzi mwazizindikirozi, kuchotsedwa kwa metformin ndikofunikira. Chotsatira, muyenera kumugoneka wodwala kuchipatala mwachangu. Dokotala amatsimikiza zamtundu wa lactate, pamaziko a izi, amatsimikizira kapena amatsimikizira kuti apezeka ndi matendawa.

Njira yabwino yochotsera kuchuluka kwa lactate ndi metformin ndi njira ya hemodialysis. Kuti athetse zizindikiro zotsalira, chithandizo chamankhwala chimachitika.

Tiyenera kudziwa kuti kugwiritsa ntchito metformin ndi othandizira okhala ndi sulfonylurea kungayambitse kuchepa msanga kwa shuga.

Kuchita ndi njira zina

Pogwiritsa ntchito metformin movutikira ndi mankhwala ena, kusintha kwamankhwala kumachitika pakati pazigawo zamankhwala zomwe zimapangitsa kapena kuchepetsa kuchepa kwa shuga kwa metformin.

Chifukwa chake, kugwiritsa ntchito metformin ndi danazole nthawi yomweyo kumabweretsa chiwopsezo chachikulu cha shuga. Mosamala, muyenera kugwiritsa ntchito chlorpromazine, yomwe imachepetsa kutulutsa kwa insulin, potero kuonjezera glycemia. Mankhwalawa pogwiritsa ntchito antipsychotic ngakhale mankhwala atachotsedwa, Mlingo wa metformin uyenera kusintha.

Kuwona kwa kuwonjezereka kwa kutsika kwa shuga kumachitika mukamadya:

1. Glucocorticosteroids (GCS).
2. Sympathomimetics.
3. Njira zopewera ntchito zamkati.
4. Epinofrina.
5. Kuyambitsa kwa glucagon.
6. Mahomoni a chithokomiro.
7. Makonda a phenothiazone.
8. Zopopera za loop ndi thiazides.
9. Acototic acid.

Kuchiza ndi cimetidine kungayambitse kukula kwa lactic acidosis. Kugwiritsa ntchito metformin, kumafooketsa mphamvu ya anticoagulants.

Kumwa mowa nthawi zambiri kumapangidwa mukamagwiritsa ntchito metformin. Kuledzera kwambiri ndi zakudya zochepa zama calorie komanso zakudya zopanda thanzi, njala kapena kulephera kwa chiwindi kumabweretsa mapangidwe a lactic acidosis.

Chifukwa chake, pakumwa mankhwala a metformin, odwala ayenera kuwunika ntchito ya impso. Kuti achite izi, amafunika kuwirikiza kawiri pachaka kuti aphunzire kuchuluka kwa mkaka wa m'magazi. M'pofunikanso kuwunikanso zomwe zidapangidwa ndi creatinine m'magazi. Ngati zotsatira zake zikuwonetsa kuti chiwonetsero cha creatinine ndichoposa 135 μmol / L (wamwamuna) ndi 110 μmol / L (wamkazi), kusiya mankhwala ndikofunikira.

Ngati wodwala wapezeka kuti ali ndi matenda opatsirana a bronchopulmonary kapena matenda opatsirana a genitourinary system, katswiri ayenera kuthandizidwa mwachangu.

Kuphatikizidwa kwa metformin ndi mankhwala ena ochepetsa shuga, monga jakisoni wa insulin ndi sulfonylureas, nthawi zina kumabweretsa kuchepa kwa ndende. Vutoli liyenera kuganiziridwa kwa odwala omwe amayendetsa magalimoto kapena maginito ovuta. Muyenera kusiya ntchito yowopsa nthawi yanthawi yamankhwala.

Pogwiritsa ntchito mankhwala ena aliwonse, wodwalayo ayenera kudziwitsa dokotala za izi, zomwe zingasinthe Mlingo komanso nthawi ya maphunziro.

Mtengo, ndemanga ndi fanizo

Mtengo wa Metformin umatengera kuti ndi wochokera kunja kapena wopangidwa.

Popeza pophika ndi othandizira odziwika a hypoglycemic m'malo osiyanasiyana padziko lapansi, mayiko ambiri amapanga.

Mutha kugula mankhwalawa popereka mankhwala ku pharmacy, pali njira yosankhira mankhwalawo pa intaneti.

Mtengo wa mankhwalawa umatengera dera la mankhwalawa m'gawo la Russian Federation ndi wopanga

• Metformin (Russia) Ayi. 60 - mtengo wotsika kwambiri ndi ma ruble a 196, ndipo okwera ndi ma ruble 305.
• Metformin-Teva (Poland) Ayi 60 - mtengo wotsika kwambiri ndi ma ruble 247, ndipo okwera ndi 324 rubles.
• Metformin Richter (Hungary) No. 60 - mtengo wotsika kwambiri ndi ma ruble 287, ndipo okwera ndi 344 rubles.
• Metformin Zentiva (Slovakia) Ayi 30 - mtengo wotsika kwambiri ndi ma ruble 87, ndipo okwera ndi ma ruble 208.
• Metformin Canon (Russia) Ayi 60 - mtengo wotsika kwambiri ndi ma ruble 230, ndipo okwera ndi ma ruble 278.

Monga mukuwonera, mtengo wa mankhwalawa Metformin ndiwotsika kwambiri, kotero aliyense amene ali ndi ndalama zosiyana akhoza kugula. Kuphatikiza apo, ndizopindulitsa kwambiri kugula mankhwala osokoneza bongo, chifukwa mtengo wake umakhala wotsika, ndipo chithandizo chake ndizofanana.

Ndemanga ya anthu ambiri odwala matenda ashuga akuwonetsa kuti Metformin ndiwothandiza kugwiritsira ntchito mankhwala a hypoglycemic. Amathandizira msanga kuchuluka kwa shuga m'magazi ndikuwonjezera mphamvu ya hypoglycemic ndikugwiritsa ntchito nthawi yayitali. Odwala ambiri amadziwa kuvuta kwa kugwiritsa ntchito mankhwalawa ndi mtengo wake wotsika, womwe ndi mwayi waukulu. Akafunsidwa ngati kuli kotheka kumwa metformin kuti muchepetse thupi, anthu amayankha bwino.

Anthu ambiri amadabwa ngati zizindikiro zochotsera zimachitika mutatenga metformin. Kuchotsa kwa mankhwalawa sikuyambitsa kuchuluka kwa shuga m'magazi komanso kuchuluka kwa thupi.

Zina mwazolakwika ndi kusokoneza kwam'mimba zomwe zimakhudzana ndi chizolowezi chomwa mankhwalawa. Pakatha milungu iwiri, zizindikilo zoterezi zimangokha zokha.

Chifukwa chakuti mankhwalawo omwe ali ndi mankhwala othandizira metformin amapangidwa padziko lonse lapansi, ali ndi mayina ambiri. Kusiyanako kudzangokhala zomwe zina zomwe zimagwiritsidwa ntchito. Zolemba za mankhwala a Metformin ndi Glformin, Metfogamma, Bagomet, Siofor, Glyukofazh, Altar ndi ena. Mankhwala omwe agwiritsidwa ntchito amayenera kukhudza thanzi la wodwalayo, osayambitsa mavuto.

Kusagwiritsidwa ntchito bwino kwa mankhwala ndi metformin kumalumikizidwa ndi kulephera kutsatira zakudya zapadera za matenda ashuga, moyo wokhazikika, komanso kusakhazikika kwa shuga. M'malo mwake, kumwa mankhwala okha sikungakupatseni zotsatira za hypoglycemic. Ndikungokhala ndi moyo wathanzi, kugwiritsa ntchito mankhwala osokoneza bongo ndikutsatira malangizo onse a dotolo omwe angapangitse thanzi la wodwalayo ndikuchepetsa zizindikiro za matenda ashuga. Kanemayo munkhaniyi aperekanso chidziwitso chokhudza mankhwalawa.