Vildagliptin - malangizo, analogi ndi ndemanga za odwala

Vildagliptin ndi mankhwala osokoneza bongo a hypoglycemic omwe amagwiritsidwa ntchito kuchipatala pochiza matenda osokoneza bongo omwe amadalira insulin. M'nkhaniyi tikambirana za vildagliptin - malangizo ogwiritsira ntchito.

Yang'anani! Mu gulu la anatomical-achire-kemikali (ATX), vildagliptin akuwonetsedwa ndi code A10BH02. Dzinalo Lopanda Ntchito Lapadziko Lonse (INN): Vildagliptin.

Pharmacodynamics ndi pharmacokinetics: malongosoledwe

Vildagliptin ndi inhibitor ya dipeptidyl peptidase-4 (DPP-4). Enzyme imayambitsa ma mahomoni awiri (omwe amatchedwanso ma impretins) mahomoni am'mimba - glucagon-ngati peptide mtundu 1 (GP1T) ndi glucose amadalira insulinotropic polypeptide (GZIP). Onsewa amathandizira kuti amasulidwe a insulin, omwe amamasulidwa poyankha kudya zakudya.

DPP-4 zoletsa za mtundu wa 2 shuga mellitus (T2DM) zimatsogolera kutulutsidwa kwa mankhwala a insulin komanso kuchepa kwa glucagon, motero, kutsika kwa glycemia.

Vildagliptin imalowa mwachangu pambuyo pakamwa. Peak plasma ndende amawona pambuyo maola 1-2. Bioavailability ndi 85%. Vildagliptin imapangidwa ndi pafupifupi 2/3, ndipo ina yonse imachotsedwapo osasinthika. Mathandizo ochulukitsa kudzera mu cytochromes ndi glucuronidation amatenga gawo laling'ono mu kagayidwe ka mankhwala. Metabolite yayikulu siyogwira mankhwala. Mankhwalawa amachotsedwa ndi 85% kudzera mkodzo ndipo 15% kudzera mu chopondera. Kutha kwa theka-moyo kumapangika kuyambira 2 mpaka 3 maola.

Zizindikiro ndi contraindication

Vildagliptin ayesedwa mu kafukufuku wazachipatala wambiri mwa anthu odwala matenda ashuga a 2. Kuzungulira kwa HbA1c mwa odwala kumachokera ku 7.5% mpaka 11%. Maphunziro onse otsatirawa anali akhungu m'maso, komanso adatenga milungu 24.

Kafukufuku atatu adayerekezera vildagliptin monotherapy (50 mg kawiri tsiku lililonse) ndi othandizira ena othandizira. Anthu 760 adathandizidwa ndi vildagliptin kapena metformin (1000 mg / tsiku) pachaka. Mu gulu la vildagliptiptin, kuchuluka kwa HbA1c kutsika ndi 1.0%, pagulu la metformin - ndi 1.4%. Kusiyana kumeneku sikunatilole kutsimikizira koyamba malingaliro akale oti vildagliptin sanali ogwira ntchito kwenikweni ngati metformin. Hafu ya odwala idatsatiridwa chaka chachiwiri, ndipo zotsatirapo zake zinali zofanana ndendende ndi chaka choyamba. Pakafukufuku wachiwiri, HbA1c idachepetsedwa ndi 0.9% ndi vildagliptin ndi 1.3% yokhala ndi rosiglitazone (kamodzi 8 mg / tsiku). Poyerekeza ndi acarbose (katatu pa 110 mg / tsiku), kuchepa kwa HbA1c kunawonedwa mokomera vildagliptin (1.4% motsutsana ndi 1.3%).

Mu maphunziro 4, anthu omwe sanakhutire ndi kayendetsedwe ka glycemic ndi mankhwala omwe alipo a antidiabetesic adalembedwa vildagliptin kapena placebo. Kafukufuku woyamba adagwiritsa ntchito vildagliptin ndi metformin (≥1600 mg / tsiku), wachiwiri ndi pioglitazone (45 mg / tsiku) kapena glimepiride (≥ 3 mg / tsiku), ndipo wachinayi ndi insulin (≥30E / tsiku). Pogwiritsa ntchito mitundu yonse 4 ya vildagliptin, kuchepa kwakukulu kwa ndende ya HbA1c kungatheke. Pakuwerenga kwa sulfonylurea, kusiyana pakati pa miyeso iwiri ya vildagliptin (50,000 mcg patsiku) sikunatchulidwe kokwanira kuposa maphunziro a metformin ndi pioglitazone.

Pakafukufuku wina, odwala 607 omwe anali ndi vuto la shuga la 2 omwe sanachitike kale adagawika m'magulu anayi: woyamba adalandira vildagliptin (zana mg / tsiku), wachiwiri adalandira pioglitazone (makumi atatu mg / tsiku), enawo awiri adalandira vildaglitin ndi pioglitazo. Mukamamwa mankhwalawa, HbA1c idatsika ndi 0,7%, ndi pioglitazone ndi 0,9%, ndi mlingo wotsikirapo ndi 0.5%, komanso ndi mlingo wapamwamba ndi 1.9%. Komabe, mankhwala ophatikiza omwe agwiritsidwa ntchito phunziroli sagwirizana ndi chithandizo choyambirira cha matenda a shuga 2 nbgf.

Ma incretins ali ndi theka lalifupi kwambiri amoyo ndipo amawonongeka mwachangu ndi enzyme. Pali mayesero osiyanasiyana okhala ndi vildagliptin onse mu monotherapy komanso kuphatikiza njira zina zochizira - metformin ndi glitazone.

Zotsatira zoyipa

Zotsatira zoyipa zomwe zimachitika kawirikawiri ndi vildagliptin kuposa ndi placebo ndiz chizungulire, kupweteka kwa mutu, zotupa zakumaso, kudzimbidwa, arthralgia, ndi matenda opatsirana am'mimba. Hypoglycemia imachitika pokhapokha.

Zotsatira zoyipa zomwe zimawonedwa m'mayesero onse azachipatala onse omwe ali ndi monotherapy komanso kuphatikiza njira zina zochiritsira ndizochulukirapo mu uric acid m'magazi komanso kuchepa kwapang'onopang'ono pamlingo wa serum alkaline phosphatase.

Milingo ya Transaminase sikukwera kawirikawiri. Komabe, hepatotoxic zotsatira zimachitika mwanjira ya tsiku ndi tsiku ya 100 mg. Ngakhale owopsa a mtima arrhythmias adachitika mu maphunziro a nyama pamiyeso yayitali ya vildagliptin, mayesero azachipatala asonyeza kuti pafupipafupi ma degree a AV block amakhala apamwamba mukamamwa mankhwalawo.

Kafukufuku wazinyama adawonetsa kuti mankhwalawa angayambitse zotupa za khungu la necrotic, komanso kuwonongeka kwaimpso. Mwa anthu, zinthu zotere nthawi zambiri sizinachitike. Komabe, US Food and Drug Administration (FDA) idasinthira kuvomereza kufikira chitetezo chitatsimikiziridwa.

Mlingo ndi bongo

Vildagliptin imapezeka m'mapiritsi a 50 mg. Mankhwalawa amavomerezedwa ku Russia pochiza matenda amtundu wa 2 wa odwala akuluakulu. Mlingo wa tsiku ndi tsiku sayenera kupitirira 50 mg. Musanayambe mankhwala, ndipo miyezi itatu iliyonse mchaka choyamba, kuchuluka kwa ma transaminases kuyenera kuyang'aniridwa.

Odwala omwe ali ndi nephropathy (kuvomerezeka kwa creatinine pansi pa ml / mphindi), hepatopathy yovuta kwambiri komanso kuchuluka kwambiri kwa transaminases (pamene malire apamwamba a kupitirira kupitirira nthawi 2.5) saloledwa. Chenjezo liyeneranso kuchitidwa pang'onopang'ono kulephera kwa mtima (NYHA III ndi IV), chifukwa vildagliptin sichimamveka bwino. Palibe chidziwitso pakugwiritsa ntchito panthawi yomwe muli ndi pakati, kuyamwa. Odwala osakwana zaka 16 sayenera kugwiritsa ntchito mankhwalawa.

Mu 2013, kafukufuku awiri adazindikira chiopsezo chowonjezereka cha pancreatitis ndi pancreatic cell metaplasia. Maphunzirowa adasindikizidwa m'magazini, zomwe zimapangitsa FDA ndi European Medicines Agency kuti ipemphe maphunziro owonjezera kuti athe kuchitira chiopsezo cha kapamba ndi mankhwala.

Kuchita

M'mayesero azachipatala, kuyanjana ndi mankhwala ena sikunawonedwe. Kuchepa kwa mgwirizano kumakhala kotsika, chifukwa vildagliptin sichimapangidwira kudzera mu superfamily ya cytochrome P450 ndipo, motero, sikutilepheretsa kuchepa kwa kagayidwe kake ka mankhwala a cytochrome P450. Mankhwalawa amatha kuyanjana ndi othandizira ena odwala matenda ashuga, thiazide diuretics, corticosteroids, kukonzekera kwa chithokomiro, komanso sympathomimetics.

Zofananira zazikulu za mankhwala.

Maganizo a woyeserera ndi woleza mtima.

Vildagliptin imalembedwa chifukwa cha kusathandiza kwa njira zina zamankhwala - kusintha kwa zakudya, zolimbitsa thupi kapena kusowa poyankha kwa metformin. Mankhwalawa amachepetsa kuchuluka kwa ma monosaccharides m'magazi, koma amathanso kuyambitsa mavuto, chifukwa chomwenso chimafunika.

Viktor Alexandrovich, katswiri wa matenda ashuga

Metformin adalembedwa, omwe sanathandize komanso adayambitsa dyspepsia yayikulu. Kenako adasinthira kukhala vildaglptin, yomwe idasintha glycemia ndikuchepetsa zizindikiro. Panali malingaliro oti atatha kupukusa chakudya anayamba kuyenda bwino. Glycemia imayeza nthawi zonse - zonse zimakhala zabwinobwino. Ndipitiliza kupitabe.

Mtengo (mu Russian Federation)

Mtengo wa vildagliptin (50 mg / tsiku) ndi ma ruble 1000 pamwezi. Sitagliptin (100 mg / tsiku), inhibitor inanso ya DPP-4, imakhala yokwera mtengo kwambiri ndipo imawononga ma ruble 1800 pamwezi, koma pakalibe kufananizidwa kwachidziwikire sikudziwika ngati othandizira awiriwa ali ofanana pamtunduwu. Kuchiza ndi metformin kapena sulfonylureas, ngakhale pa mlingo waukulu kwambiri, ndizosakwana ma ruble 600 pamwezi.

Uphungu! Musanagwiritse ntchito njira iliyonse, muyenera kufunsa katswiri kuti mupewe zomwe zingachitike. Kudzichiritsa nokha kumatha kuvulaza kuposa kuchita zabwino.

Ndemanga za madokotala za galvus

Vildagliptin, i.e. Galvus ndi mankhwala omwe amayesedwa nthawi ndi odwala. Zolinga zamankhwala payekhapayekha, chiopsezo chochepa cha hypoglycemia, zimakhala bwino komanso zimatheka msanga. Zowonjezerazo sizingakhale koma kusangalala, chifukwa chake ndimakonda kusankha "Galvus".

Gwiritsani ntchito kawiri pa tsiku.

Zabwino kwambiri mutatengedwa komanso bwino kwambiri glycemic control. Ndimasankhanso okalamba - zonse zili bwino!

Chimodzi mwazomwe amamwa mankhwala ku Russia pochiza matenda amishuga 2. Mphamvu yake ndi chitetezo chake chimayesedwa kwa nthawi. Imalekereredwa bwino ndi odwala, imachepetsa shuga m'magazi, pomwe chiopsezo cha hypoglycemia ndi chochepa kwambiri. Mtengo wake wotsika mtengo ndikofunikira, womwe umakondweretsa onse madokotala ndi odwala.

Vildagliptin ("Galvus") ndi mankhwala achiwiri a gulu la IDDP-4, lolembetsedwa ku Russian Federation pochiza odwala omwe ali ndi matenda a shuga a 2, chifukwa chake chogwiritsidwa ntchito mdziko lathu ndichitali. Galvus adadzikhazikitsa ngati mankhwala othandiza komanso otetezeka omwe amaloledwa bwino ndi odwala, samathandizira pakulemera, komanso ali ndi chiopsezo chochepa pankhani ya hypoglycemia. Mankhwalawa angagwiritsidwe ntchito kuchepetsa ntchito yaimpso, yomwe imakhala yofunika kwambiri pothandizira odwala okalamba omwe ali ndi matenda amtundu wa 2. Zotsatira za kafukufuku wofufuza preclinical and clinical shows that DPP-4 inhibitors (kuphatikiza Galvus) ikhoza kukhala ndi mwayi wogwiritsidwa ntchito osati monga hypoglycemic, komanso ngati nephroprotective therapy.

Maganizo a odwala a Galvus

Adasankhanso kulemba ndemanga zamankhwala "Galvus". Tsoka ilo, kumwa mankhwalawa kunasinthitsa chaka cha moyo wanga kukhala gehena. Ndili ndi gonarthrosis wa mawondo ndipo aliyense akumvetsa kuvuta kwake. Ndikunena kuti chovuta kwambiri ndikuti miyendo yanga ipweteka. Ndipo ululu ukayamba kungokhala wamisala, pomwe sizingatheke kugona, kutambasulira kapena kukhotetsa miyendo yanu, kutembenukira mbali inayo, ingogwirani miyendo yanu. Ngati zikuwoneka kuti mu caviar iliyonse mumakhala bomba ndipo atatsala pang'ono kuphulika, ndiye kuti kulakalaka kumangofa. Ndili ndi ululu wapamwamba kwambiri, ngakhale madokotala amadabwa ndipo ngati ndinena kuti ndizovuta kupirira, ndiye kuti kupweteka kotereku sikungatheke. Ndimo momwe ndimakhalira nonse a chaka cha 2018 ndipo moyo wa hellish udakonzedwa kwa ine ndi Galvus. Chifukwa chake, ndikufuna kuchenjeza iwo omwe ali ndi vuto lililonse lolumikizana kapena msana, kapena atangoyamba kupweteka miyendo ndi msana. Cholinga cha izi chikhoza kukhala kulandiridwa kwa "Galvus", komwe nthawi zambiri kumayambitsa arthralgia. Ndinaleka kuzilandira kuyambira pa Januware 2, ndipo moyo wanga unakhala wosangalala. Sindinganene kuti miyendo yatsopano yakula, koma ndimatha kutambasitsa miyendo yanga pabedi, ndimatha kugwira minofu yamiyendo yanga popanda kumva ululu wam'mbuyo, ndipo ichi ndi chisangalalo kale, nditazunzidwa chotere.

Zaka 9 za matenda ashuga 2. Dotolo adayamba kupatsa Siofor. Ndinkamwa kamodzi, ndidangochotsa - tsiku loipa kwambiri m'moyo wanga! Miyezi isanu ndi umodzi yapitayo, adotolo adalangiza Galvus. Poyamba ndinali wokondwa kuti kunalibe "Siofor athari", koma shuga sanathenso kuchepa, koma panali ululu m'mimba, kumverera kuti chakudya sichikupitilira kuposa m'mimba ndikugona pamenepo ndi mwala, kenako mutu tsiku lililonse. Yaletsedwa - mutu suvulala.

Nditadwala matenda a shuga 2 zaka zapitazo, pomwepo adandiika pa insulin ndipo adalemba "Galvus". Anati mukuyenera kumwa pafupifupi chaka chimodzi. Pomwe ndimamwa, shuga adakhala bwino. Koma kenako zidali zokwera mtengo kwambiri kwa ine, ndipo nditatha kumwa kwa chaka chimodzi, ndidasiya kugula. Tsopano shuga wambiri. Ndipo ndimakwanitsa kugula galvus, koma ndikuopa zovuta zake pachiwindi.

Ndidatenga Galvus + Metformin kwa mwezi umodzi. Sanali kumva bwino. Kusiya kuvomera, zidakhala bwino. Ndapuma kwa mwezi umodzi ndipo ndikufuna kuyesanso. Zotsatira za shuga ndizabwino mukamamwa mankhwalawa.

Chaka chachiwiri ndimatenga galvus 50 mg ndi metformin 500 mg m'mawa ndi madzulo. Kumayambiriro kwa chithandizo, mapiritsi asanachitike, anali ndi insulin malinga ndi chiwembu 10 + 10 + 8 kuphatikiza yotalikirapo ya magawo 8. Miyezi isanu ndi umodzi pambuyo pake, shuga wa shuga adatsika 12,5,5,5! Tsopano mapiritsi ndi 5.5-5.8! Kulemera kunachepetsedwa kuchoka pa 114 kupita ku 98 kg ndikukula kwa masentimita 178. Ndikuwerengera pulogalamu yamakompyuta ya Kalori. Ndikulangizani aliyense! Pa intaneti, mutha kusankha iliyonse.

Amayi ali ndi matenda ashuga a 2. Dotolo adayamba kumuyambitsa Maninil, koma pazifukwa zina samakwanira amayi ake, ndipo shugayo sanachepe ndipo thanzi lake silinali labwino. Chowonadi ndi chakuti amayi anga salinso bwino ndi mtima. Kenako idasinthidwa ndi Galvus, ichi ndi mankhwala abwino kwambiri. Ndiwotheka kumwa - ngakhale musanadye, ngakhale mutatha, komanso kamodzi patsiku piritsi. Shuga amachepetsedwa osati pang'ono, koma pang'onopang'ono, pomwe amayi akumva bwino. Chokhacho chomwe chimakhumudwitsa pang'ono ndikuti chimakhudza chiwindi, koma kwa chithandizo chake, amayi amamwa zitsamba zosiyanasiyana, kotero zonse zili bwino.

Kufotokozera kwapfupi

Mankhwala a galvus (yogwira mankhwala vildagliptin) ndi mankhwala a hypoglycemic, mwa zochita zake zamankhwala, zokhudzana ndi zoletsa za enzyme dipeptidyl peptidase-4 (DPP-4) ndipo amagwiritsidwa ntchito pochiza matenda a shuga 2. Posachedwa, malingaliro a mahomoni am'mimba ogwiritsira ntchito ngati oyang'anira kutulutsira insulin akukulitsidwa kwambiri. Zinthu zomwe zimaphunziridwa kwambiri mwamaumbidwe motere monga momwe ziliri pakalipano ndi insulinotropic polypeptide, yofupikitsidwa ngati HIP, ndi peptide 1 ya glucagon 1, yofupikitsidwa ngati GLP-1. Dzina la gulu la zinthu izi ndi ma insretin: mahomoni am'mimba otetezedwa chifukwa cha chakudya komanso kugwira ntchito kwa insulin chifukwa cha β-cell a kapamba (omwe amadziwika kuti "incretin athari"). Koma mu pharmacology palibe njira zosavuta: GLP-1 ndi ma GUIs sakhala moyo wautali, zomwe zimapatula mwayi wogwiritsidwa ntchito ngati mankhwala. Pankhaniyi, adaganiziridwa kuti asayambitse ma insretin kuchokera kunja, koma kuti ayesetse kusunga zachilengedwe amkati syntherin momwe angathere, kupondereza zochita za enzyme zomwe zimawawononga, dipeptidyl peptidase-4 (DPP-4). Kuletsa kwa enzymeyi kumachulukitsa moyo ndi zochitika za HIP ndi GLP-1, kukulitsa kuchuluka kwawo m'magazi. Izi zikutanthauza kuti kuchuluka kwa insulin / glucagon kumapangidwira, kubisalira kwa insulini ndi ma pancreatic β-cell kumalimbikitsidwa, pomwe kubisalira kwa glucagon α-cell kumapanikizika. Mwachidule, gawo loyambirira la nkhaniyi, ziyenera kudziwidwa kuti DPP-4 zoletsa ndi gulu latsopano la mankhwala a hypoglycemic omwe cholinga chake ndi kuyambitsa okha ma insretin.Komanso, malinga ndi kuyerekezera koyambirira, mankhwalawa ali ndi mwayi kuposa othandizira ena odwala matenda ashuga malinga ndi kuchuluka / chitetezo.

Maphunziro a labotale, azachipatala komanso otsatsa malonda amatsimikizira "ntchito" yawo pakuwonjezera kuchuluka kwa insulin, insulin, kutsitsa glucagon, kuletsa mapangidwe a shuga mu chiwindi, ndikuchepetsa minofu kukana insulin. Sitingakane kuti DPP-4 inhibitors ndi gulu lolimbikitsa kwambiri pochiza matenda a shuga a mtundu wachiwiri. "Wokumba" pakati pa mankhwalawa ndi mtundu wa mankhwala omwe amachokera ku kampani yotchuka kwambiri yapadziko lonse yaku Swiss Novartis. Ku Russia, mankhwalawa adayamba kugwiritsidwa ntchito mu 2008 ndipo posakhalitsa adapeza ulemu kwambiri kuchokera kwa endocrinologists, ochita malire ndi kukondweretsa kwa akatswiri. Zomwe, ndizosadabwitsa, ndizopatsa umboni waukulu wa galvus. M'mayesero azachipatala omwe odzipereka oposa 20,000 adatenga nawo gawo, kugwiritsa ntchito mankhwalawa kunatsimikiziridwa pamapangidwe a monotherapy komanso kuphatikiza othandizira ena a hypoglycemic (metformin, zotengera sulfonylurea, zotumphukira za thiazolidinedione) ndi insulin. Chimodzi mwazabwino za galvus ndikuthekera kwa kugwiritsidwa ntchito kwake mu odwala okalamba omwe ali ndi "gulu" lonse la matenda osiyanasiyana, kuphatikizapo mtima ndi aimpso.

Chimodzi mwa ziwalo zochepa zomwe zimakumana ndi galvus ndi chiwindi. Pankhaniyi, mukadali pa maphunziro a pharmacological, ndikofunikira kuyang'anira magwiridwe antchito a chiwindi, ndipo poyambira zizindikiro za jaundice, musiyane ndi pharmacotherapy kenako ndikusiya galvus. Ndi matenda a shuga a mtundu 1, galvus sagwiritsidwa ntchito.

Galvus imapezeka pamapiritsi. Rimage regimen imasankhidwa ndi dokotala payekhapayekha, mutha kumwa mankhwalawo mosasamala za kudya.

Pharmacology

Oral hypoglycemic mankhwala. Vildagliptin - nthumwi ya kalasi ya zopititsa patsogolo zomwe zimapangidwira pancreas, mosankha zimalepheretsa pulotidyl peptidase-4 (DPP-4) ya enzyme. Kulepheretsa mwachangu komanso kwathunthu kwa ntchito ya DPP-4 (> 90%) kumayambitsa kuwonjezeka kwa kubisa komanso kokhala ndi chakudya komwe kumapangitsa mtundu wa 1 glucagon-peptide (GLP-1) ndi glucose-wodalira insulinotropic polypeptide (HIP) kuchokera kumatumbo kulowa kutsekemera kwazinthu tsiku lonse.

Kuchulukitsa kuzungulira kwa GLP-1 ndi HIP, vildagliptin kumapangitsa kuwonjezeka kwa chidwi cha pancreatic β-cell ku glucose, zomwe zimabweretsa kusintha kwa secretion wa glucose-based insulin.

Mukamagwiritsa ntchito vildagliptin pa mlingo wa 50-100 mg / tsiku kwa odwala omwe ali ndi vuto lachiwiri la matenda a shuga, kusintha kwa ntchito ya kapamba kumadziwika. Kuchulukitsa kwa magwiridwe antchito a β-cell kumadalira kuchuluka kwa kuwonongeka kwawo koyamba, choncho mwa anthu opanda shuga - omwe amakhala ndi shuga m'magazi am'magazi), vildagliptin simalimbikitsa kutulutsa kwa insulin komanso sikuchepetsa shuga.

Mwakulitsa kuchuluka kwa mawonekedwe amkati mwa GLP-1, vildagliptin kumawonjezera chidwi cha maselo a α-glucose, zomwe zimapangitsa kuti pakhale kusintha kwamalamulo a shuga a glucagon. Kutsika kwa glucagon ochulukirapo panthawi ya chakudya, kumayambitsa kuchepa kwa insulin.

Kuwonjezeka kwa kuchuluka kwa insulin / glucagon poyang'ana kumbuyo kwa hyperglycemia, chifukwa cha kuchuluka kwa kuchuluka kwa GLP-1 ndi HIP, kumayambitsa kuchepa kwa kupanga kwa chiwindi ndi chiwindi chonse munthawi ya chakudya ndikatha kudya, zomwe zimayambitsa kuchepa kwa kuchuluka kwa shuga m'magazi am'magazi.

Kuphatikiza apo, motsutsana ndi magwiritsidwe ntchito a vildagliptin, kuchepa kwa milomo ya lipids m'magazi amwazi kumadziwika, komabe, izi sizikugwirizana ndi zomwe zimachitika pa GLP-1 kapena HIP komanso kusintha kwa ntchito ya pancreatic β-cell.

Amadziwika kuti kuwonjezeka kwa GLP-1 kumatha kuchepetsa m'mimba, koma izi sizikuwoneka ndi kugwiritsa ntchito vildagliptin.

Mukamagwiritsa ntchito vildagliptin mu 5795 odwala omwe ali ndi mtundu wa 2 shuga mellitus kwa masabata 12 mpaka 52 monga monotherapy kapena osakanikirana ndi metformin, zotumphukira za sulfonylurea, thiazolidinedione, kapena insulin, kuchepa kwakukulu kwakanthawi kwakanthawi kwa kuchuluka kwa hemoglobin ya glycated (HbA_1s) komanso kusala magazi.

Pamene kuphatikiza kwa vildagliptin ndi metformin kunagwiritsidwa ntchito ngati chithandizo choyambirira cha odwala omwe ali ndi matenda a shuga 2, kutsika kwa HbA komwe kumadalira mlingo kumawonedwa kwa milungu 24_1c komanso kulemera kwa thupi poyerekeza ndi monotherapy ndi mankhwalawa. Milandu ya hypoglycemia inali yochepa kwambiri m'magulu onse awiri ochiritsira.

Mu kafukufuku wazachipatala, mukamagwiritsa ntchito vildagliptin pa mlingo wa 50 mg 1 nthawi / tsiku kwa miyezi 6 kwa odwala omwe ali ndi mtundu wa 2 matenda osokoneza bongo osakanikirana ndi mkhutu aimpso ntchito yapakatikati (GFR ≥30 mpaka 2) kapena kwambiri (GFR 2), kuchepa kwakukulu kwakanthawi Hba_1cpoyerekeza ndi gulu la placebo.

Mu kafukufuku wazachipatala, mukamagwiritsa ntchito vildagliptin pa mlingo wa 50 mg 2 / tsiku ndi / popanda metformin osakanikirana ndi insulin (pafupifupi mlingo wa 41 IU / tsiku) mwa odwala omwe ali ndi matenda a shuga 2, kuchepa kwa HbA_1c kumapeto (-0.77%), ndi chizindikiro choyambirira, pafupifupi, 8.8%. Kusiyanako ndi placebo (-0.72%) kunali kofunikira kwambiri pamawonekedwe. Zomwe zimachitika mu hypoglycemia pagulu lomwe limalandira mankhwalawa zidafananizidwa ndi hypoglycemia m'gululo la placebo. Mu kafukufuku wazachipatala ogwiritsa ntchito vildagliptin pa mlingo wa 50 mg 2 nthawi / tsiku nthawi yomweyo ndi metformin (≥1500 mg / tsiku) osakanikirana ndi glimepiride (≥4 mg / tsiku) mwa odwala omwe ali ndi matenda a shuga 2_1c iwerengero itatsika kwambiri ndi 0.76% (chizindikiro choyambirira, pafupifupi, 8.8%).

Pharmacokinetics

Vildagliptin imatengedwa mwachangu ndi kumeza ndi bioavailability yokwanira 85%. Munthawi ya achire, kuchuluka kwa C_max vildagliptin mu plasma ndi AUC pafupifupi mwachindunji ndikuwonjezereka kwa kuchuluka kwa mankhwalawa.

Pambuyo pakulowetsa pamimba yopanda kanthu, nthawi yofika C_max vildagliptin m'madzi am'magazi ndi 1 h 45 min. Ndi kudya nthawi imodzi ndi chakudya, kuchuluka kwa mankhwalawa kumachepa pang'ono: kuchepa kwa C_max pofika 19% ndi kuwonjezeka kwa nthawi kuti zitheke mpaka maola 2 30 mphindi. Komabe, kudya sikumakhudza kuchuluka kwa mayamwidwe ndi AUC.

Kumangiriza kwa vildagliptin kuma protein a plasma ndikotsika (9.3%). Mankhwalawa amagawidwa chimodzimodzi pakati pa plasma ndi maselo ofiira amwazi. Kugawa kwa Vildagliptin kumachitika mopitilira muyeso, V_ss Pambuyo pa utsogoleli wa iv ndi malita 71.

Biotransfform ndiye njira yayikulu yodziwitsira ya vildagliptin. Mu thupi la munthu, 69% ya mlingo wa mankhwalawo amasandulika. Metabolite yayikulu - lay151 (57% ya mlingo) imagwira ntchito pamankhwala ndipo ndi chida cha hydrolysis cha gawo la cyano. Pafupifupi 4% ya mankhwala omwe amapezeka amide hydrolysis.

M'maphunziro oyesera, zotsatira zabwino za DPP-4 pa hydrolysis yamankhwala zimadziwika. Vildagliptin siinapangidwe ndi CYP450 isoenzymes. Vildagliptin si gawo lapansi, sichingaletse ndipo sichilowetsa CYP450 isoenzymes.

Mutamwa mankhwalawo mkati, pafupifupi 85% ya mankhwalawa imayendetsedwa ndi impso ndipo 15% kudzera m'matumbo, impso ya vildagliptin yosasinthika ndi 23%. T_1/2 pambuyo kumeza pafupifupi 3 maola, ngakhale mlingo.

Pharmacokinetics mu milandu yapadera yamankhwala

Gender, BMI, ndi mafuko sizimakhudza ma pharmacokinetics a vildagliptin.

Odwala omwe ali ndi vuto la chiwindi ntchito yofatsa kwambiri mwamphamvu (6-10 mfundo malinga ndi gulu la ana-Pugh), atagwiritsidwa ntchito kamodzi pamankhwala, kuchepa kwa bioavailability wa vildagliptin ndi 20% ndi 8%, motero. Odwala omwe ali ndi vuto lowopsa la chiwindi (mfundo 12 malinga ndi gulu la Mwana-Pugh), bioavailability wa vildagliptin imachulukitsidwa ndi 22%. Kuwonjezeka kapena kuchepa kwa kuchuluka kwa bioavailability kwa vildagliptin, osapitirira 30%, sikutanthauza kuchipatala. Panalibe kulumikizana pakati pa kuwonongeka kwa chiwindi chovuta ndi kukhudzana kwa mankhwalawa.

Odwala omwe ali ndi vuto laimpso, ofatsa, olimbitsa, kapena AUC, vildagliptin kuchuluka kwa 1,4, 1,7, komanso 2 nthawi kuyerekeza ndi odzipereka athanzi. The AUC ya metabolite lay151 inachulukitsa 1.6, 3.2 ndi 7.3 zina, ndipo metabolite BQS867 - 1.4, 2.7 ndi 7.3 nthawi odwala omwe ali ndi vuto la impso ofatsa, odziletsa komanso owopsa. Zowerengeka zochepa mwa odwala omwe ali ndi vuto lothana ndi vuto la aimpso (CRF) zimawonetsa kuti zizindikiro zomwe zili mgululi ndizofanana ndi zomwe zili ndi odwala omwe ali ndi vuto laimpso. The kuchuluka kwaabela151 metabolite mwa odwala end-siteji CRF kuchuluka ndi 2-3 zina poyerekeza ndi ndende odwala kwambiri aimpso kuwonongeka. Kuchotsa vildagliptin pa hemodialysis kumakhala kochepa (maola 4 pambuyo pa limodzi mlingo ndi 3% ndi kutalika kwa maola oposa 3-4).

Kuchuluka kwa bioavailability wa mankhwalawa ndi 32% (kuchuluka kwa C_max 18%) mwa odwala opitilira 70 siwofunika kwambiri ndipo samakhudza kuletsa kwa DPP-4.

Zomwe zimachitika mu pharmacokinetic za vildagliptin mwa ana ndi achinyamata ochepera zaka 18 sizinakhazikitsidwe.

Kutulutsa Fomu

Mapiritsiwo ndi oyera kuti ayambitse chikaso chamtundu, wozungulira, wosalala, wokhala ndi mbali zokutidwa, mbali ina pali pepala la "NVR", mbali inayo - "FB".

Omwe amathandizira: cellcrystalline cellulose - 95.68 mg, anactrous lactose - 47.82 mg, sodium carboxymethyl wowuma - 4 mg, magnesium stearate - 2,5 mg.

7 ma PC - matuza (2) - mapaketi a makatoni.
7 ma PC - matuza (4) - mapaketi a makatoni.
7 ma PC - matuza (8) - mapaketi a makatoni.
7 ma PC - matuza (12) - mapaketi a makatoni.
14 ma PC. - matuza (2) - mapaketi a makatoni.
14 ma PC. - matuza (4) - mapaketi a makatoni.
14 ma PC. - matuza (8) - mapaketi a makatoni.
14 ma PC. - matuza (12) - mapaketi a makatoni.

Galvus amatengedwa pakamwa, ngakhale atakhala chakudya chotani.

Mlingo wa mankhwalawa wa mankhwalawa uyenera kusankhidwa payekha kutengera momwe umagwirira ntchito komanso kulolera.

Mlingo wovomerezeka wa mankhwalawa nthawi ya monotherapy kapena ngati gawo limodzi la mankhwala ophatikizika ndi metformin, thiazolidinedione kapena insulin (osakanikirana ndi metformin kapena opanda metformin) ndi 50 mg kapena 100 mg patsiku. Odwala omwe ali ndi matenda oopsa a 2 omwe alandila chithandizo cha insulin, Galvus amalimbikitsidwa pa 100 mg / tsiku.

Mlingo wovomerezeka wa Galvus monga gawo limodzi la mankhwala ophatikiza patatu (vildagliptin + sulfonylurea derivatives + metformin) ndi 100 mg / tsiku.

Mlingo wa 50 mg / tsiku ayenera kumwedwa nthawi 1 m'mawa. Mlingo wa 100 mg / tsiku uyenera kugawidwa m'magawo 2 a 50 mg m'mawa ndi madzulo.

Ngati mwaphonya mlingo, mlingo wotsatira uyenera kumwedwa mwachangu, pomwepo tsiku lililonse sayenera kupitirira.

Ikagwiritsidwa ntchito ngati gawo limodzi la magawo awiri ophatikizika ndi mankhwala a sulfonylurea, muyezo wa Galvus ndi 50 mg 1 nthawi / tsiku m'mawa. Mankhwala akaphatikizana ndi mankhwala a sulfonylurea, kugwiritsa ntchito bwino mankhwala pamlingo wa 100 mg / tsiku anali ofanana ndi mlingo wa 50 mg / tsiku. Ndi osakwanira kachipatala motsutsana ndi maziko ogwiritsa ntchito mlingo wapamwamba wa tsiku lililonse wa 100 mg, kuti muthane ndi vuto la glycemia, mankhwala ena a hypoglycemic ndiwothekanso: metformin, zotumphukira za sulfonylurea, thiazolidinedione kapena insulin.

Odwala ndi mkhutu aimpso ndi kwa chiwindi ntchito kufatsa mphamvu, kukonza Mlingo wa mankhwala sikufunika. Odwala ndi mkhutu aimpso ntchito ya zolimbitsa kwambiri ndi kwambiri digiri (kuphatikizapo kudwala matenda aimpso kulephera hemodialysis), mankhwala ayenera kugwiritsidwa ntchito pa mlingo wa 50 mg 1 nthawi / tsiku.

Odwala okalamba (≥ zaka 65), palibe kusintha kwa mlingo kwa Galvus komwe kumafunikira.

Popeza palibe chidziwitso chakugwiritsa ntchito Galvus mwa ana ndi achinyamata osakwana zaka 18, sikulimbikitsidwa kugwiritsa ntchito mankhwalawa m'gulu la odwala.

Bongo

Galvus imalekeredwa bwino ikaperekedwa pa mlingo mpaka 200 mg / tsiku.

Zizindikiro: mukamagwiritsa ntchito mankhwalawa 400 mg / tsiku, kupweteka kwa minofu kumatha kuchitika, kawirikawiri - mapapo ndi kufupika kwa paresthesia, kutentha thupi, kutupa ndi kuchuluka kwapang'onopang'ono kwa ndende ya lipase (2 times kuposa VGN). Ndi kuwonjezeka kwa mlingo wa Galvus mpaka 600 mg / tsiku, kukulitsa kwa edema ya malekezero okhala ndi ma presthesias ndi kuwonjezeka kwa kuchuluka kwa CPK, ALT, protein-m-protein komanso myoglobin ndizotheka. Zizindikiro zonse za mankhwala osokoneza bongo komanso kusintha kwa magawo a ma laboratite amatha pambuyo pakutha kwa mankhwalawa.

Chithandizo: Kuchotsa mankhwalawa m'thupi kudzera mu dialysis ndikosatheka. Komabe, hydrolytic metabolite yayikulu ya vildagliptin (lay151) imatha kuchotsedwa m'thupi ndi hemodialysis.

Mimba komanso kuyamwa

Palibe deta yokwanira yogwiritsira ntchito mankhwalawa Galvus mwa amayi apakati, chifukwa chake mankhwalawa sayenera kugwiritsidwa ntchito panthawi yoyembekezera.

Popeza sizikudziwika ngati vildagliptin yokhala ndi mkaka wa m'mawere idachotsedwa mwa anthu, Galvus sayenera kugwiritsidwa ntchito pa mkaka wa m'mawere (yoyamwitsa).

M'maphunziro oyesera, mutagwiritsidwa ntchito mu Mlingo wowirikiza 200 kuposa momwe analimbikitsira, mankhwalawa sanayambitse kuchepa kwa chonde komanso kukula koyambira kwa mluza ndipo sanatulutse zotsatira za teratogenic.

Malangizo apadera

Popeza deta yogwiritsira ntchito vildagliptin mu odwala omwe ali ndi vuto la mtima losagwirizana ndi gawo la magawo atatu a NYHA malinga ndi gulu la NYHA (tebulo 1) ndilochepa ndipo sililola chomaliza
Mapeto, tikulimbikitsidwa kugwiritsa ntchito Galvus mosamala mu gulu ili la odwala.

Kugwiritsa ntchito vildagliptin kwa odwala omwe ali ndi vuto la mtima losakhazikika IV magwiridwe antchito IV malinga ndi gulu la NYHA sikulimbikitsidwa chifukwa chosowa deta yakuchipatala pakugwiritsa ntchito vildagliptin pagulu la odwala.

Tebulo 1. Kugawidwa kwa New York kwa Ntchito Yogwira Ntchito ya Odwala Okhala Ndi Kulephera Kwa Mtima ((monga kusinthidwa), NYHA, 1964

Kuwonongeka kwa chiwindi

Popeza, nthawi zina, kugwiritsa ntchito vildagliptin kuwonetsa kuwonjezeka kwa ntchito ya aminotransferases (nthawi zambiri popanda mawonekedwe a chipatala), tikulimbikitsidwa kudziwa magawo a michere ya chiwindi musanayambe kutumiza Galvus, komanso pafupipafupi chaka chotsatira chamankhwala. Wodwala akakhala ndi zochita zambiri za aminotransferases, zotsatira zake ziyenera kutsimikiziridwa ndi kafukufuku wachiwiri, kenako azindikire magawo a ziwindi za chiwindi ntchito kufikira atasintha.Ngati zochitika za AST kapena ALT ndizokwera katatu kuposa VGN (monga zimatsimikiziridwa ndi maphunziro obwerezedwa), tikulimbikitsidwa kuletsa mankhwalawo.

Ndi chitukuko cha jaundice kapena zizindikiro zina zamagulu operewera a chiwindi pakhungu la Galvus, mankhwalawa ayenera kuyimitsidwa nthawi yomweyo. Pambuyo pakuwonetsa zizindikiro za ntchito ya chiwindi, chithandizo cha mankhwala sichitha kuyambiranso.

Ngati ndi kotheka, mankhwala a insulin Galvus amangogwiritsidwa ntchito limodzi ndi insulin. Mankhwala sayenera kugwiritsidwa ntchito kwa odwala omwe ali ndi matenda a shuga 1 kapena mankhwalawa a matenda ashuga a ketoacidosis.

Kukopa pa kuyendetsa magalimoto ndi kayendedwe kazinthu

Zotsatira zamankhwala a Galvus pakutha kuyendetsa magalimoto ndi njira zowongolera sizinakhazikitsidwe. Ndi chitukuko cha chizungulire pakumwa mankhwala, odwala sayenera kuyendetsa magalimoto kapena kugwira ntchito ndi njira.

Zotsatira za pharmacological

Vildagliptin (Mtundu wacilatini - Vildagliptinum) ndi gulu la zinthu zomwe zimapangitsa kuti mabulogu a Langerhans azitulutsa komanso aletse ntchito ya dipeptidyl peptidase-4. Zotsatira za puloteni iyi ndizowononga mtundu wa 1 glucagon-peptide (GLP-1) ndi insulinotropic polypeptide (HIP) ya glucose.

Zotsatira zake, machitidwe a dipeptidyl peptidase-4 amathandizidwa ndi zinthuzo, ndipo kupanga kwa GLP-1 ndi HIP kumalimbikitsidwa. Mipira yawo ikachuluka, vildagliptin imapangitsa chidwi cha maselo a beta ku glucose, yomwe imawonjezera kupanga kwa insulin. Kukula kwa magwiridwe antchito a maselo a beta kumadalira mwachindunji kuwonongeka kwawo. Chifukwa chake, mwa anthu omwe ali ndi shuga wathanzi akamagwiritsa ntchito mankhwala okhala ndi vildagliptin, sizikhudza kupangika kwa timadzi timene timachepetsa shuga komanso, motero, shuga.

Kuphatikiza apo, mankhwalawa akachulukitsa zomwe zili mu GLP-1, nthawi yomweyo, mphamvu ya glucose imawonjezeka m'maselo a alpha. Kuchita koteroko kumaphatikizapo kuwonjezeka kwa kukhazikika kwa glucose komwe kumatengera maselo a alpha a cell, otchedwa glucagon. Kutsitsa kuchuluka kwake mukamadya chakudya kumathandizira kuchotsa chitetezo chokwanira mu cell insulin.

Pomwe kuchuluka kwa insulin ndi glucagon kumawonjezeka, komwe kumatsimikiziridwa ndi kuchuluka kwa HIP ndi GLP-1, mu boma la hyperglycemic, shuga mu chiwindi amayamba kupanga pang'ono, onse pakudya komanso pambuyo pake, zomwe zimapangitsa kuchepa kwa glucose m'magazi a shuga.

Tiyenera kudziwa kuti, pogwiritsa ntchito Vildagliptin, kuchuluka kwa milomo kumacheperanso mukatha kudya. Kuwonjezeka kwa zomwe zili mu GLP-1 nthawi zina kumayambitsa kuchepa kwam'mimba, ngakhale zotere sizinapezeke pakubaya.

Kafukufuku waposachedwa wokhudzana ndi odwala pafupifupi 6,000 pamasabata 52 adatsimikizira kuti kugwiritsa ntchito vildagliptin kumatsitsa shuga pamimba yopanda kanthu komanso glycated hemoglobin (HbA1c) pamene mankhwalawa amagwiritsidwa ntchito:

• monga maziko a mankhwala,
• kuphatikiza ndi metformin,
• kuphatikiza ndi zotumphukira za sulfonylurea,
• kuphatikiza ndi thiazolidatedione,

Mlingo wa glucose umatsikanso ndi kuphatikiza kwa vildagliptin ndi insulin.

Momwe vildagliptin idapezeka

Zambiri zokhudzana ndi maretretin zidawoneka zaka zoposa 100 zapitazo, mmbuyo mu 1902. Zinthu zinalekanitsidwa ndi matumbo a nthumbu ndipo zimatchedwa kuti makande. Kenako kuthekera kwawo kolimbikitsa kutulutsa kwa ma enzymes kuchokera ku kapamba ofunikira kugaya chakudya kunapezeka. Zaka zingapo pambuyo pake, panali malingaliro omwe mawonekedwe a minyewa ingakhudzirenso ntchito ya mahomoni. Zinapezeka kuti odwala omwe ali ndi glucosuria, akamamwa mankhwala ampretin, kuchuluka kwa shuga mu mkodzo kumachepa kwambiri, kuchuluka kwa mkodzo kumachepa, ndipo thanzi limayenda bwino.

Mu 1932, mahomoni adakhala ndi dzina lamakono - glucose-insulinotropic polypeptide (HIP) ya shuga. Zinapezeka kuti zimapangidwa m'maselo a mucosa a duodenum ndi jejunum. Pofika 1983, ma peptides awiri ngati glucagon (GLPs) anali atadzipatula. Zinapezeka kuti GLP-1 imayambitsa kutulutsa kwa insulini poyankha kuchuluka kwa shuga, ndipo katulutsidwe kake kamachepetsedwa mu odwala matenda ashuga.

Machitidwe GLP-1:

• imalimbikitsa kumasulidwa kwa insulin kwa odwala matenda a shuga,
• imachulukitsa kupezeka kwa chakudya m'mimba,
• amachepetsa kufunika kwa chakudya, amathandizira kuchepetsa thupi,
• imakhudzanso mtima ndi mitsempha yamagazi,
• amachepetsa kupanga glucagon mu kapamba - timadzi timene timafooketsa insulin.

Imagawikana ndi ma enzyme DPP-4, omwe amapezeka pa endothelium ya capillaries yomwe imalowa m'matumbo, chifukwa izi zimatenga mphindi ziwiri.

Kugwiritsa ntchito zamankhwala pazotsatira izi kunayamba mu 1995 ndi kampani yopanga zamankhwala Novartis. Asayansi adatha kudzipatula pazinthu zomwe zimasokoneza ntchito ya enzyme ya DPP-4, ndichifukwa chake njira yamoyo ya GLP-1 ndi HIP inachuluka kangapo, ndipo kuphatikiza kwa insulin kumakulanso. Pulogalamu yoyamba yokhazikika pamapangidwe othandizira omwe amapititsa cheke cha chitetezo chinali vildagliptin. Dzinali lapeza zambiri: apa pali gulu latsopano la hypoglycemic othandizira "gliptin" ndi gawo la dzina la wopanga wake Willhower, komanso chidziwitso chazomwe angathe kugwiritsa ntchito mankhwalawa kuti achepetse glycemia "gly" komanso ngakhale chidule "inde", kapena dipeptidylamino peptidase. -4.

Zochita za vildagliptin

Kuyamba kwa nthawi ya ma incretin pothandizira odwala matenda ashuga kumayesedwa ngati chaka cha 2000, pomwe mwayi woletsa DPP-4 unawonetsedwa koyamba ku Congress of Endocrinologists. Munthawi yochepa, vildagliptin yatenga malo okhazikika machitidwe a mankhwala othandizira odwala matenda a shuga m'maiko ambiri padziko lapansi. Ku Russia, chinthucho chidalembetsedwa mu 2008. Tsopano vildagliptin imaphatikizidwa pachaka mndandanda wazithandizo zofunika.

Kupambana mwachangu kumeneku kumachitika chifukwa cha mawonekedwe apadera a vildagliptin, omwe atsimikiziridwa ndi zotsatira za maphunziro oposa 130 apadziko lonse lapansi.

Ndi matenda a shuga, mankhwalawa amakulolani:

1. Sinthani kayendedwe ka glycemic. Vildagliptin mu tsiku lililonse 50 mg amathandizira kuchepetsa shuga atatha kudya ndi pafupifupi 0,9 mmol / L. Glycated hemoglobin imachepetsedwa ndi 1%.
2. Pangani kupindika kwa glucose pothana ndi nsonga. Mlingo wapamwamba wa postprandial glycemia umachepa pafupifupi 0,6 mmol / L.
3. Molondola muchepetsani kuthamanga kwa magazi masana ndi usiku m'miyezi isanu ndi umodzi yoyambirira.
4. Sinthani kagayidwe ka lipid makamaka pochepetsa kuchuluka kwa lipoproteins otsika. Asayansi amawona kuti izi ndizowonjezera, sizikugwirizana ndi kuwongolera kwa shuga.
5. Chepetsani kunenepa komanso m'chiuno mwa odwala onenepa kwambiri.
6. Vildagliptin imadziwika ndi kulolerana kwabwino komanso chitetezo chachikulu. Ma epicode a hypoglycemia nthawi yomwe amagwiritsidwa ntchito ndi osowa kwambiri: chiwopsezo ndi chotsika kwambiri kuposa nthawi yomwe mumatenga zotengera za sulfonylurea.
7. Mankhwala amapita bwino ndi metformin. Odwala omwe atenga metformin, kuwonjezeredwa kwa 50 mg ya vildagliptin kuthandizira kumathandizanso kuchepetsa GH ndi 0.7%, 100 mg ndi 1.1%.

Malinga ndi malangizo, machitidwe a Galvus, dzina lamalonda la vildagliptin, zimatengera mwachindunji kutukukira kwa maselo a pancreatic beta komanso kuchuluka kwa shuga. Mtundu woyamba wa matenda ashuga komanso amitundu iwiri ya ashuga omwe ali ndi kuchuluka kwa maselo a beta owonongeka, vildagliptin ilibe mphamvu. Mwa anthu athanzi komanso odwala matenda ashuga okhala ndi shuga wamba, sizingayambitse vuto la hypoglycemic.

Pakadali pano, vildagliptin ndi mawonekedwe ake amawonetsedwa ngati mankhwala a mzere wachiwiri pambuyo pa metformin. Amatha kusintha m'malo mwazomwe zimapezeka pang'onopang'ono za sulfonylurea, zomwe zimapangitsanso insulin, koma zimakhala zopanda chitetezo.

Mankhwala osokoneza bongo omwe ali ndi vildagliptin

Maumwini onse a vildagliptin ali ndi ufulu wokhala ndi a Novartis, omwe adayika kuyesetsa ndi ndalama zambiri pakukweza ndikuyambitsa mankhwalawo pamsika. Mapiritsi amapangidwa ku Switzerland, Spain, Germany. Posakhalitsa akuyembekezeka kukhazikitsa mzerewu ku Russia kunthambi ya Novartis Neva. Mankhwala, omwe ndi vildagliptin palokha, ali ndi mbiri yaku Switzerland yokha.

Vildagliptin ili ndi zinthu 2 za Novartis: Galvus ndi Galvus Met. Zomwe zimagwiritsidwa ntchito ku Galvus ndi vildagliptin chokha. Mapiritsi ali ndi gawo limodzi la 50 mg.

Galvus Met ndi kuphatikiza kwa metformin ndi vildagliptin piritsi limodzi. Zosankha zamtundu zomwe zilipo: 50/500 (mg sildagliptin / mg metformin), 50/850, 50/100. Kusankha kumeneku kumakupatsani mwayi woganizira zomwe zimachitika ndi matenda ashuga mwa wodwala winawake ndikusankha moyenera mankhwalawa.

Malinga ndi odwala matenda ashuga, kutenga Galvus ndi metformin piritsi zosiyana ndi zotsika mtengo: mtengo wa Galvus ndi pafupifupi ma ruble 750, metformin (Glucofage) ndi ma ruble 120, Galvus Meta pafupifupi 1600 rubles. Komabe, chithandizo chophatikizidwa ndi Galvus Metom chinadziwika kuti chinali chothandiza komanso chosavuta.

Galvus ilibe fanizo ku Russia yokhala ndi vildagliptin, popeza mankhwalawa ali oletsedwa mwachisawawa. Pakadali pano, ndizoletsedwa kupangira mankhwala aliwonse okhala ndi vildagliptin, komanso chitukuko cha chinthucho. Kuchita kumeneku kumapangitsa wopanga kubwezeretsanso mtengo wa maphunziro ambiri ofunikira kulembetsa mankhwala atsopano.

Chizindikiro chovomerezeka

Vildagliptin imangowonetsa mtundu wa shuga wachiwiri. Malinga ndi malangizo, mapiritsi akhoza kulembedwa:

1. Kuphatikiza pa metformin, ngati mulingo woyenera mulibe matenda okwanira
2. M'malo mwake sulfonylurea (PSM) kukonzekera mu odwala matenda ashuga ndi chiopsezo cha hypoglycemia. Chifukwa chake chimatha kukhala kukalamba, mawonekedwe a chakudya, masewera ndi zina zolimbitsa thupi, kuchepa kwa mitsempha, kuwonongeka kwa chiwindi ndi njira ya chimbudzi.
3. Anthu odwala matenda ashuga omwe ali ndi chifuwa ku gulu la PSM.
4. M'malo mwa sulfonylurea, ngati wodwalayo akufuna kuti achedwetse kuyamba kwa mankhwala a insulin momwe angathere.
5. Monga monotherapy (pokhapokha vildagliptin), ngati mutenga Metformin mwapangidwa kapena simungathe chifukwa cha zovuta zoyipa.

Kulandila kwa vildagliptin mosakayikira kuyenera kuphatikizidwa ndi zakudya za anthu odwala matenda ashuga komanso maphunziro akuthupi. Kukana kwambiri kwa insulin chifukwa cha kuchuluka kwa ntchito komanso kudya kosagwiritsidwa ntchito m'thupi kumatha kukhala cholepheretsa kubwezeretsa chiphuphu cha shuga. Malangizowa amakupatsitsani kuphatikiza vildagliptin ndi metformin, PSM, glitazones, insulin.

Mlingo woyenera wa mankhwalawa ndi 50 kapena 100 mg. Zimatengera kuopsa kwa matenda ashuga. Mankhwalawa amakhudza kwambiri glycemia ya postprandial, motero m`pofunika kumwa mlingo wa 50 mg m'mawa. 100 mg amagawidwa chimodzimodzi m'maphwando a m'mawa ndi madzulo.

Pafupipafupi pazinthu zosafunikira

Ubwino wawukulu wa vildagliptin ndizovuta zochepa pamagwiritsidwe ake. Vuto lalikulu mu odwala matenda ashuga omwe amagwiritsa ntchito PSM ndi insulin ndi hypoglycemia. Ngakhale kuti nthawi zambiri zimadutsa mofatsa, madontho a shuga amakhala owopsa mumitsempha yamitsempha, chifukwa chake amayesa kuzipewa momwe angathere. Malangizo ogwiritsira ntchito amadziwitsa kuti chiopsezo cha hypoglycemia mutatenga vildagliptin ndi 0.3-0.5%. Poyerekeza, pagulu lolamulira lomwe silimamwa mankhwalawa, chiwopsezo ichi chidapatsidwa 0,2%.

Kutetezedwa kwakukulu kwa vildagliptin kumawonekeranso chifukwa cha maphunziro, palibe munthu wodwala matenda ashuga amene amayenera kuchoka pamankhwala chifukwa cha zotsatira zake zoyipa, monga zikuwonetsedwera ndi chiwerengero chomwecho cha kukana chithandizo m'magulu omwe atenga vildagliptin ndi placebo.

Ochepera ochepera 10% adadandaula za chizungulire pang'ono, ndipo ochepera 1% adadzimbidwa, kupweteka kwa mutu, ndi kutupa kwa malekezero. Zinapezeka kuti kugwiritsa ntchito nthawi yayitali kwa vildagliptin sikuti kumawonjezera pafupipafupi zotsatira zake zoyipa.

Doctor of Medical Science, Mutu wa Institute of Diabetesology - Tatyana Yakovleva

Ndakhala ndikuphunzira matenda a shuga kwa zaka zambiri. Zimakhala zowopsa anthu ambiri akamwalira, ndipo makamaka amakhala olumala chifukwa cha matenda ashuga.

Ndithamangira kunena mbiri yabwino - Endocrinological Research Center ya Russian Academy of Medical Sayansi yakwanitsa kupanga mankhwala omwe amachiritsa odwala matenda ashuga mellitus. Pakadali pano, kugwiritsa ntchito bwino kwa mankhwalawa kuyandikira 98%.

Nkhani ina yabwino: Unduna wa Zaumoyo wateteza kukhazikitsidwa kwa pulogalamu yapadera yomwe imalipira mtengo wa mankhwalawo. Ku Russia, odwala matenda ashuga mpaka Meyi 18 (kuphatikiza) nditha kuipeza - Kwa ma ruble 147 okha!

Malinga ndi malangizo, contraindication kumwa mankhwalawa ndi hypersensitivity vildagliptin, ubwana, pakati ndi mkaka wa m`mawere. Galvus imakhala ndi lactose monga gawo lothandizira, chifukwa chake, pakakhala zovuta, mapiritsi awa ndi oletsedwa. Galvus Met imaloledwa, popeza palibe lactose pakapangidwe kake.

Vildagliptin analogues

Pambuyo pa vildagliptin, zinthu zingapo zapezeka zomwe zitha kuletsa DPP-4. Onsewa ndi fanizo:

• Saksagliptin, dzina lamalonda Onglisa, wopanga Astra Zeneka. Kuphatikizika kwa saxagliptin ndi metformin kumatchedwa Combogliz,
• Sitagliptin ilipo mu kukonzekera kwa Januvius kuchokera ku kampani Merck, Xelevia wochokera ku Berlin-Chemie. Sitagliptin yokhala ndi metformin - zomwe zimagwiritsidwa ntchito ndi mapiritsi awiri a Janumet, analog ya Galvus Meta,
• Linagliptin ali ndi dzina lamalonda Trazhenta. Mankhwalawa ndi ubongo wa kampani ya ku Germany Beringer Ingelheim. Linagliptin kuphatikiza metformin piritsi limodzi amatchedwa Gentadueto,
• Alogliptin ndi gawo limodzi la mapiritsi a Vipidia, omwe amapangidwa ku USA ndi Japan ndi Takeda Pharmaceuticals. Kuphatikiza kwa alogliptin ndi metformin kumapangidwa pansi pa amalonda Vipdomet,
• Gozogliptin ndiye mndandanda wokha wa vildagliptin. Adakonzekera kuti amasulidwe ndi Satereks LLC. Kutulutsa kokwanira, kuphatikiza mankhwala, kudzachitika m'chigawo cha Moscow. Malinga ndi zotsatira za mayeso azachipatala, chitetezo ndi kugwira ntchito kwa gozogliptin kunali pafupi ndi vildagliptin.

M'magawo ogulitsa ku Russia, mutha kugula Ongliza (mtengo wamaphunziro a pamwezi ndi pafupifupi ruble 1800), Combogliz (kuchokera ma ruble 3200), Januvius (1500 rubles), Kselevia (1500 rubles), Yanumet (kuchokera 1800), Trazhentu ( 1700 rub.), Vipidia (kuchokera 900 rub.). Malinga ndi kuchuluka kwa zowunikira, titha kunena kuti odziwika bwino kwambiri pa fanizo la Galvus ndi Januvius.

Madokotala amakambirana za vildagliptin

Madokotala amayamikira kwambiri vildagliptin. Amatchulanso zabwino za mankhwalawa kuti ndi chilengedwe cha machitidwe ake, kulolerana kwabwino, kupitiliza kwa hypoglycemic kwenikweni, chiopsezo chochepa cha hypoglycemia, maubwino ena owonjezeranso njira yoponderezera kukula kwa microangiopathy komanso kukonza mkhalidwe wamakoma azombo zazikulu.

Vildagliptin, ndithudi, imachulukitsa mtengo wamankhwala, koma nthawi zina (pafupipafupi hypoglycemia) palibenso njira ina yabwino. Zotsatira za mankhwalawa zimawerengedwa kuti ndizofanana ndi metformin ndi PSM, pakupita nthawi, zizindikiro za metabolism za carbohydrate zimasintha pang'ono.

Komanso werengani izi:

• Mapiritsi a Glyclazide MV ndi mankhwala otchuka kwambiri kwa odwala matenda ashuga.
• Mapiritsi a Dibicor - zabwino zake ndi chiyani kwa odwala omwe ali ndi matenda ashuga (phindu la ogula)

Onetsetsani kuti mwaphunzira! Kodi mukuganiza kuti kuyamwa kwa mapiritsi ndi insulini kwa nthawi yonse yokhayo ndi njira yokhayo yothanirana ndi shuga? Sichowona! Mutha kutsimikizira izi nokha ndikuyamba kuzigwiritsa ntchito. werengani zambiri >>

Kodi vildagliptin ndi chiyani?

Pofufuza njira yabwino yothandizira matenda a shuga a 2, asayansi adawona kuti ndizotheka kuyang'anira kuchuluka kwa shuga m'magazi mothandizidwa ndi mahomoni am'mimba.

Zimapangidwa poyankha chakudya cholowa m'mimba ndipo zimayambitsa kapangidwe ka insulin poyankha glucose yemwe amapezeka pachakudya. Imodzi mwama hormone awa idapezeka mu 30s ya XX century, idasiyanitsidwa ndi ntchofu wamatumbo apamwamba. Tazindikira kuti zimayambitsa hypoglycemia. Anamupatsa dzina "incretin."

Nthawi yamankhwala atsopano othandizira matenda a shuga a 2 adayamba mchaka cha 2000, ndipo idakhazikitsidwa ndi vildagliptin. Novartis Pharma adapatsidwa mwayi wotcha gulu latsopanoli la othandizira a hypoglycemic mwanjira yake. Umu ndi momwe amapangira dzina lawo "glyptines".

Kuyambira 2000, maphunziro opitilira 135 adachitidwa m'maiko osiyanasiyana omwe atsimikizira kuti vildagliptin ndiyothandiza komanso chitetezo. Zidawululidwanso kuti kuphatikiza kwake ndi metformin kumayambitsa hypoglycemia kangapo poyerekeza ndi kugwiritsidwa ntchito kwa Biguanides ndi glimepiride.

Ku Russia, kumapeto kwa chaka cha 2008, malo olembetsedwa oyamba kumene adalembetsedwa pansi pa dzina lazamalonda Galvus, ndipo adalowa mu pharmacies mu 2009. Pambuyo pake, mtundu wophatikizidwa ndi metformin wotchedwa "Galvus Met" udawonekera pamsika wamankhwala; umapezeka m'mitengo itatu.

Mankhwala okhala ndi Vildagliptin

Ku Russia, ndalama ziwiri zokha ndizolembetsa, zomwe zimakhazikitsidwa ndi glyptin.

Dzina lamalonda, mlingo

Mtengo, pakani

Galvus 50 mg820 Galvus Met 50 + 10001 675 Galvus Met 50 + 5001 680 Galvus Met 50 + 8501 695

M'mayiko ena, pali mankhwala omwe amatchedwa Eucreas kapena Vildagliptin chabe.

Zizindikiro zogwiritsidwa ntchito

Mankhwala ozunguza bongo amatengedwa ku mankhwalawa mtundu wa matenda ashuga a 2. Ndikofunikira kwambiri kuphatikiza kudya ndi masewera olimbitsa thupi pafupipafupi komanso zakudya zapadera.

Mwatsatanetsatane, vildagliptin imagwiritsidwa ntchito:

1. Monga mankhwala okhawo omwe amathandizira anthu omwe ali ndi biguanide tsankho.
2. Kuphatikiza ndi metformin, pamene zakudya ndi masewera zilibe mphamvu.
3. Ndi mitundu iwiri ya mankhwala, komanso mankhwala a sulfonylurea, giuanides, thiazolidinediones kapena insulin, pamene monotherapy yokhala ndi mankhwalawa, limodzi ndi masewera olimbitsa thupi komanso zakudya, sizinapatse zotsatira zomwe mukufuna.
4. Kuphatikiza pa chithandizo chamankhwala, monga chithandizo chachitatu: kuphatikiza ndi metformin ndi zotumphukira za sulfonylurea, odwala omwe adamwa kale mankhwala omwe adagwirizana nawo adachita masewera ndikutsatira zakudya, koma sanalandire bwino glycemic.
5. Monga mankhwala owonjezera, munthu akagwiritsa ntchito insulin ndi metformin, komanso motsutsana ndi zamasewera komanso zakudya zoyenera, sanalandire phindu la glucose.

Contraindication ndi zoyipa

Monga njira zina zilizonse za mtundu wa matenda ashuga a 2, vildagliptin ili ndi mikhalidwe ndi matenda ena mndandanda wa zotsutsana, momwe kuvomerezedwa ndizochepa kapena kuloledwa mosamala kwambiri.

Izi zikuphatikiza:

• tsankho lililonse pazinthu zomwe zikuchitika,
• Mtundu woyamba wa shuga
• kusowa kwa enzyme yomwe imaphwanya galactose, tsankho lake,
• nthawi ya pakati komanso yoyamwitsa,
• zaka za ana
• mitundu yoopsa ya mkhutu wamatumbo ndi impso,
• lactic acidosis,
• metabolic acidosis ndi vuto la asidi-maziko olimbitsa thupi.

Chenjezo limaperekedwa pochiza vildagliptin ndi anthu omwe apezeka ndi:

• pachimake kapamba (kalelo kapena masiku ano),
• gawo lotsiriza la matenda a impso pamene hemodialysis ichitika,
• Gulu lothandiza la mtima la matenda olephera.

Ngakhale vildagliptin imakhala ndi zotsatira zochepa poyerekeza ndi othandizira ena a hypoglycemic, adakalipo, koma amafotokozeredwa:

1. Mchitidwe wamsempha (NS): chizungulire, kupweteka mutu.
2. GIT: kawirikawiri, matenda amkuwa.
3. Machitidwe a mtima: edema nthawi zina imawoneka m'manja kapena miyendo.

Kuphatikiza ndi metformin:

1. NS: Kugwedezeka kwa manja, chizungulire, kupweteka kwa mutu.
2. Mimba thirakiti: nseru.

Zotsatira zoyipa zomwe zanenedwa atatulutsidwa kwa vildagliptin ku msika wogulitsa mankhwala:

• zotupa chiwindi matenda
• kuyabwa ndi khungu lawo
• kapamba
• zotupa za pakhungu,
• kupweteka kupweteka m'malo.

Kuphunzira mwalamulo kwa mankhwala

Kafukufuku woposa onse muzochita zamankhwala (Edge) ndiwokonda kwambiri. Munali nawo anthu 46,000 okhala ndi CD-2 ochokera kumaiko 27 apadziko lapansi. Pogwira ntchito yapadziko lonse lapansi, zidapezeka kuti momwe chiwongolerochi chizigwira ntchito bwino mukamagwiritsa ntchito vildagliptin mwachindunji komanso kuphatikiza kwa metformin.

Mlingo wamba wa hemoglobin wa glycated mwa anthu onse unali pafupifupi 8.2%.

Cholinga chowunikira: kuwunika zotsatira poyerekeza ndi magulu ena a mapiritsi a hypoglycemic.

Ntchito yoyamba: kudziwa kuchuluka kwa odwala omwe ali ndi kuchepa kwa glycated hemoglobin (oposa 0,3%) sangakhale ndi edema ya malekezero, kukulitsa kwa hypoglycemia, kulephera chifukwa cha zovuta pamatumbo am'mimba, kulemera kwakukulu (kupitirira 5% yoyamba )

Zotsatira:

• kuchita bwino ndi chitetezo kwa achichepere (opitilira zaka 18) ndi ukalamba,
• pafupifupi kuchuluka kwa thupi
• ingagwiritsidwe ntchito matenda a impso,
• kugwiritsa ntchito bwino kwatsimikiziridwa ngakhale ndi CD-2 yokhalitsa,
• Kupanga kwa glucagon kumalepheretsa
• ntchito ya pancreatic β-cell imasungidwa kwambiri.

Ubwino ndi zoyipa zamagwiritsidwe

Vildagliptin - mankhwala a gulu latsopano la othandizira a hypoglycemic. Zimakhala ndi zotsatira zabwino mthupi, mosiyana ndi mankhwala akale. Ngakhale poyamba idayikidwa mu mzere wachiwiri wopita kwa matenda a shuga a 2, koma m'zaka zaposachedwa ndi a mzere woyamba wa mankhwala.

• pafupifupi sizotsatira zoyipa kuchokera m'matumbo am'mimba,
• vildagliptin sichikukhudza kulemera, makamaka kuphatikiza ndi metformin,
• imasunga ntchito ya pancreatic β-cell,
• amathetsa kusamvana pakati pa insulin ndi glucagon,
• kumawonjezera ntchito ya mahomoni amunthu am'mimba,
• amachepetsa chiopsezo cha hypoglycemia kangapo,
• Imachepetsa phindu la hemoglobin ya glycated,
• opangidwa monga mapiritsi,
• osanenanso kawiri pa tsiku,
• kugwiritsa ntchito sikudalira kukhalapo kapena kusowa kwa chakudya m'mimba.

• sayenera kutengedwa ndi ana osakwana zaka 18, unamwino ndi azimayi omwe ali ndiudindo
• kuvomerezedwa ndizoletsedwa ngati m'mbuyomu adapezeka kuti ali ndi pancreatitis yayikulu,
• mtengo.

Ma analogi a Vildagliptin

Alibiretu mwachindunji. Ku Russia, Galvus ndi Galvus Met okha ndi omwe adalembetsa pamaziko ake. Ngati tilingalira za mankhwala omwewo mgulu lomwelo, titha kusiyanitsa "Januvia", "Onglisa", "Trazhenta", "Vipidia".

Zinthu zomwe zimagwiritsidwa ntchito ndi mankhwalawa ndizosiyana, koma zonse ndi za glisitins. M'badwo uliwonse watsopano, pali zophophonya zochepa komanso zabwino zina.

Ngati tiganizira gulu la ma protein, "Baeta" ndi "Saksenda" titha kuwayesa ngati analogues. Koma mosiyana ndi ma gliptins, mankhwalawa amapezeka mwa mawonekedwe a jakisoni wothandizirana, omwe ali ndi kuchuluka kwake.

Chilichonse chimasankhidwa mosiyanasiyana payekhapayekha, kulabadira zotsutsana, zotsatira zoyipa, kuchita bwino, chitetezo, ndi matenda omwe angayambitse matenda a shuga a mtundu wachiwiri.

Russian

Ma analogi a Vildagliptin opangidwa ndi makampani opanga mankhwala ophatikizira mankhwala akuphatikizapo mndandanda wocheperako - Diabefarm, Formmetin, Glformin, Gliclazide, Glidiab, Glimecomb. Mankhwala otsalawo amapangidwa kunja.

Vildagliptin sagwiritsidwa ntchito palokha mwazinthu zilizonse zomwe zaperekedwa. Amasinthidwa ndi zinthu zofananira zomwe zimayambitsa chiwonetsero chazinthu komanso mtundu wa kuwonekera kwa thupi la munthu.

Zinthu zazikulu zomwe zimayikidwa pazokha za Vildagliptin:

• Metformin - Glformin, Formetin,
• Glyclazide - Diabefarm, Glidiab, Glyclazide,
• Glyclazide + Metformin - Glimecomb.

Pali zinthu ziwiri zokha zomwe zimapezeka zomwe zimaletsa shuga wambiri m'thupi. Ngati aliyense sangathe kupirira payekhapayekha, mankhwalawa amaphatikizidwa limodzi ndi mankhwala osakaniza (Glimecomb).

Ndi mtengo, opanga aku Russia ali kutsalira kwakunja. Anzake akunja anakula mtengo, atakhala oposa ruble 1000.

Foretin (ma ruble 119), Diabefarm (ma ruble 130), Glidiab (ma ruble 140) ndi Gliclazide (147 rubles) ndiwo mankhwala otsika mtengo kwambiri ku Russia. Gliformin ndiokwera mtengo kwambiri - 202 ma ruble. pafupifupi mapiritsi 28. Wotsika mtengo kwambiri ndi Glimecomb - rubles 440.

Zowonjezera

Mankhwala ochepetsa chiwonetsero cha matenda ashuga, opangidwa m'maiko ena, amapezeka ochulukirapo kuposa olowa m'malo.

Mankhwalawa otsatirawa amasiyanitsidwa, omwe amatha kuthetsa kuchuluka kwa shuga m'magazi mwa anthu.

• USA - Trazhenta, Januvia, Combogliz Prolong, Nesina, Yanumet,
• Netherlands - Onglisa,
• Germany - Galvus Met, Glibomet,
• France - Amaril M, Glucovans,
• Malawi - Vipidia,
• Spain - Avandamet,
• India - Gluconorm.

Mankhwala achilendo akuphatikizapo Galvus, yokhala ndi Vildagliptin. Kutulutsidwa kwake kudakhazikitsidwa ku Switzerland. Masinthidwe amtheradi sanapangidwe.

Posinthana mumapatsidwa mankhwala ofanana, koma osakaniza ndi ena. Zomwe zimagwirira ntchito limodzi ndikupanga zigawo ziwiri zimasiyanitsidwa:

• Linagliptin - Trazhenta,
• Sitagliptin - Onglisa,
• Saxagliptin - Januvius,
• Alogliptin benzoate - Vipidia, Nesina,
• Rosiglitazone + Metformin - Avandamet,
• Saksagliptin + Metformin - Comboglyz Prolong,
• Glibenclamide + Metformin - Gluconorm, Glucovans, Glibomet,
• Sitagliptin + Metformin - Yanumet,
• Glimepiride + Metformin - Amaril M.

Mankhwala achilendo amakhala ndi mtengo wokwera. Chifukwa chake Gluconorm - ma ruble 176, Avandamet - ma ruble 210 ndi a Glukovans - ma ruble 267 ndiotsika mtengo kwambiri. Pamtengo wokwera pang'ono - Glibomet ndi Glimecomb - 309 ndi 440 rubles. motero.

Gawo lamtengo wapakati ndi Amaril M (773 rubles) Mtengo kuchokera ku ma ruble 1000. amapanga mankhwala:

• Vipidia - 1239 rub.,
• Galvus Met - 1499 rub.,
• Onglisa - ma ruble 1592.,
• Trazhenta - 1719 rubles.,
• Januvia - 1965 rub.

Otsika kwambiri ndi Combogliz Prolong (2941 rubles) ndi Yanumet (2825 rubles).

Chifukwa chake, Galvus, yomwe ili ndi mankhwala othandizira Vildagliptin, si mankhwala okwera mtengo kwambiri. Amalembedwa m'gulu la mitengo yapakatikati, poganizira mankhwala onse akunja.

Victoria Sergeevna

"Ndakhala wodwala matenda ashuga kwa zaka zambiri, ndinapezeka kuti ndili ndi matenda omwe ndinapeza (mtundu 2). Dotolo adandiuza kuti nditenge Galvus, koma mlingo, womwe unali wocheperako, womwe unakulirakulira, sunachepetse shuga yanga, umangokulira.

Khungu loyipa lidawonekera mthupi. Nthawi yomweyo ndidasinthira kukhala Galvus Met. Ndi iye yekha amene ndimamva bwino. ”

Yaroslav Viktorovich

“Ndinapezeka kuti ndadwala matenda ashuga posachedwapa. Nthawi yomweyo adalamula Galvus kutengera Vildagliptin. Koma adatsitsa shuga wanga pang'onopang'ono kapena sanagwire konse.

Ndidatembenukira ku pharmacy, komwe adandilangizira kuti ndithane ndi mankhwala aku Russia, osapweteka kuposa wina wachilendo - Gliformin. Nditangomaliza kumwa, shuga anga adatsika. Tsopano ndimangovomereza iye. ”