Amaril mankhwala a m'badwo watsopano

Mapiritsi a Amaryl a matenda a shuga a 2: phunzirani zonse zomwe mukufuna. Otsatirawa ndi buku lophunzitsira lolemba m'chinenero chomveka. Unikani zomwe zikuwonetsa, contraindication, Mlingo, mavuto, kuchuluka kwa mapindu ndi kuvulaza thupi. Mvetsetsani momwe angatenge Amaril molondola, patatha maola angapo kuti mankhwalawo ayamba kuchita, kodi imagwirizana ndi mowa. Munkhaniyi, mankhwalawa akuyerekeza ndi mapiritsi a Diabeteson, Glyukofazh ndi Yanumet. Zina zomwe zalembedwera ndizotsika mtengo zamakina opanga zoweta. Amaril siotsika mtengo m'mafakitala, koma ndi yabwino chifukwa ndikokwanira kumwa kamodzi patsiku. Zomwe zimagwira ndi glimepiride.

Chithandizo cha matenda a shuga a 2 Amaryl: zambiri

Malangizo ogwiritsira ntchito

Kutenga Amaryl, ngati piritsi lina lililonse la shuga, muyenera kutsatira zakudya.

Werengani za kupewa ndi kuchiza mavuto:

Pansipa pali mayankho a mafunso omwe amafunsidwa kawirikawiri ndi odwala matenda a shuga a 2.

Momwe mungatenge Amaryl: musanadye kapena pambuyo chakudya?

Amaryl amatengedwa chakudya chisanadye, kuti nthawi yakwana iyambike kudya momwe chakudya chadyedwera. Monga lamulo, adokotala amalamula odwala matenda ashuga kuti amwe mankhwalawa musanadye chakudya cham'mawa. Ndipo ngati wodwala nthawi zambiri alibe kadzutsa, imwani piritsi musanadye. Mndandanda womwe uli ndi yogwira glimepiride uyenera kutengedwa chimodzimodzi.

Osayesa kudumpha chakudya mutatha Amaril. Ndikofunikira kudya, apo ayi mankhwalawo amachepetsa shuga la magazi kwambiri ndikukhalanso. Uku ndikovuta kwambiri komwe kumatha kuyambitsa zizindikiro zakusiyanasiyana. Kuchokera ku manjenje ndi palpitations mpaka chikomokere ndi imfa. Kuopsa kwa hypoglycemia ndi chimodzi mwazifukwa zomwe sizikulimbikitsidwa kutenga glimepiride. Zomwe muli nazo ndizotetezeka komanso zothandiza.

Kodi mankhwalawa amagwirizana ndi mowa?

Malangizo ogwiritsira ntchito mapiritsi a Amaril amafunika anthu odwala matenda ashuga kuti asamamwe mowa panthawi yonse ya mankhwala. Chifukwa kumwa mowa kumawonjezera chiopsezo cha matenda a hypoglycemia ndi chiwindi. Kusagwirizana kwa mankhwala glimepiride ndi mowa ndi vuto lalikulu. Chifukwa ndi mankhwala kwa nthawi yayitali, kudya kwa nthawi yayitali, komanso osati kwa chithandizo chanthawi yochepa.

Nthawi yomweyo, odwala omwe ali ndi matenda a shuga a mtundu wachiwiri omwe samamwa mapiritsi owopsa ndipo amathandizidwa molingana ndi iwo, saloledwa kumwa mowa momwe angathere. Onani nkhani "" "kuti mumve zambiri. Mutha kusunga shuga wabwinobwino ndipo nthawi zina mumalolera kumwa kapu kapena awiri osavulaza thanzi.

Kutenga nthawi yayitali bwanji?

Tsoka ilo, palibe chidziwitso chokwanira chambiri kuti atenga Amaril atayamba kuchitapo kanthu. Shuga wamagazi amatsika kwambiri pambuyo pa maola awiri ndi atatu. Mwambiri, mphamvu ya mankhwalawa imayamba kale kwambiri, pambuyo pa mphindi 30-60. Chifukwa chake musachedwe kudya chakudya kuti hypoglycemia isachitike. Zotsatira zilizonse zotengedwa muyezo wa glimepiride zimatha kuposa tsiku limodzi.

Werengani za zomwe zachitika ndi matenda ashuga:

Zomwe zili bwino: Amaryl kapena Diabeteson?

Mankhwalawa onse amaphatikizidwa. Ndi bwino kukana kumwa ..

Yesetsani kudziwa dokotala yemwe adapereka Amaryl kapena Diabeteson ndi zomwe zili patsamba lino. Mankhwala oyamba, a Diabetes, adachulukitsa kufa kwa odwala omwe adamwa. Chifukwa chake, idachotsedwa mwakachetechete ku malonda. Tsopano mutha kugula kokha mapiritsi. Amachita modekha, komabe ndi zovulaza.

Kodi ndibwino kumwa chiyani: Amaryl kapena Glucophage?

Amaryl ndimankhwala oyipa .. - ndi nkhani ina. Awa ndi mankhwala oyambirira a Metformin, gawo lofunikira kwambiri mu njira yothandizira odwala matenda ashuga amtundu wa 2. - mankhwalawa si owopsa, koma ndi othandiza kwambiri. Kuti mupewe matenda abwino a shuga, muyenera kusinthira ku. Chakudya chopatsa thanzi chimaphatikizidwa ndi kugwiritsa ntchito mankhwalawa Glucophage, ndipo, ngati ndi kotheka, komanso ndi jakisoni wa insulini yochepa.

Kodi ndingatenge Yanumet ndi Amaril nthawi imodzi?

Amaryl ndi mapiritsi ena okhala ndi glimepiride sayenera kumwedwa pazifukwa zomwe zafotokozedwa pamwambapa. Yanumet ndi mankhwala osakanikirana okhala ndi metformin. Panthawi yolemba, ndimtengo wokwera mtengo kwambiri ndipo mulibe mnzake wotsika mtengo. Mwakutero, mutha kutenga. Koma mutha kuyesa kuchoka pa iyo kukhala metformin yangwiro, koposa zonse. Ngati mungathe kuchita izi popanda kuwonjezera vuto la matenda ashuga, mupulumutsa ndalama zambiri mwezi uliwonse.

Amaril analogues

Panthawi yokonzekera nkhaniyo kuchokera ku ma analogu omwe adagulitsidwa, Glimepirid-Teva okha omwe amapangidwa ndi Pliva Hrvatska, Croatia adagulitsa m'masitolo ogulitsa mankhwala. Nthawi yomweyo, Amaril ali ndi malo ambiri achi Russia, omwe ndi otsika mtengo kwambiri kuposa mankhwala oyambirirawo.

Zofananira zaku Russia za Amaril

Wopanga aliyense amatulutsa njira zonse za mtundu wa glimepiride - 1, 2, 3 ndi 4 mg. Onani kupezeka kwa mankhwala ndi mitengo yamafesi.

Mankhwala oyamba a Amaryl kapena analogues otsika mtengo: zomwe mungasankhe

Werengani chifukwa chake Amaryl ndi mawonekedwe ake ndizovulaza chifukwa chake muyenera kukana kuzitenga komanso zomwe zili bwino kulowa. Tsamba lawebusayiti limaphunzitsanso zokhazokha ndikuisunga mosavomerezeka popanda kufa ndi njala, kumwa mankhwala oopsa komanso okwera mtengo, jakisoni wa Mlingo waukulu wa insulin.

Amaryl M: mankhwala osakaniza

Amaryl M ndi mankhwala ophatikiza matenda a shuga a 2. Muli zinthu ziwiri zogwira ntchito piritsi limodzi - glimepiride ndi. Mukamawerenga pamwambapa, glimepiride ndiyabwino ndipo sibwino kuitenga. Koma metformin siyabwino konse, koma ndiyothandiza kwambiri kwa odwala matenda ashuga. Mankhwalawa amachepetsa shuga m'magazi, amateteza ku zovuta za matenda a shuga, amathandizira kuchepetsa thupi komanso kutalikitsa moyo.

Kutulutsa Fomu

Amaryl akugulitsa mawonekedwe piritsi. Mtundu umatengera muyeso wa zomwe zikugwira:

• 1 mg glimepiride - pinki,
• 2 - zobiriwira
• 3 - chikasu chopepuka
• 4- wabuluu.

Amasiyana mu zolemba zomwe zimagwiritsidwa ntchito pamapiritsi.

Zotsatira za pharmacological

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

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

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

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

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

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

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

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

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

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

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

Contraindication

Amaril sayenera kutumizidwa kwa odwala omwe:

• kudalira insulini
• ketoacidosis, matenda ashuga,
• Impso imagwidwa (kuphatikiza pa vuto la hemodialysis),
• Kugwiritsa ntchito bwino kwa chiwindi,
• kusalolera payekha kapena hypersensitivity glimepiride, othamangitsa, mankhwala ena a gulu la sulfonylurea,
• zaka za ana.

Madokotala sayenera kupereka mankhwalawa kwa odwala omwe ali ndi vuto la kudya, kudya mosasamala, kuchepetsa calorie, kudya osakwana 1000 kcal. Contraindication ndikuphwanya njira ya mayamwidwe a chakudya kuchokera m'mimba thirakiti.

Zotsatira zoyipa

Mankhwalawa ndi Amaril, zinthu zambiri zosafunikira zimatha kupezeka, mwanjira ina kapena zina zomwe zimakhudza ntchito ya thupi lonse. Nthawi zambiri, zoyipa zimawonetsedwa ndi hypoglycemia, zomwe zimasonyezedwa: nseru, kusanza,,,, ndi zizindikiro zina zambiri. Nthawi zina chithunzi choopsa cha hypoglycemia chimafanana ndi stroke. Pambuyo pakutha kwake, zizindikiro zosafunikira zimasonekanso kwathunthu.

Pa gawo loyambirira la chithandizo, mavuto ndi masomphenya, kugaya chakudya, ndi kapangidwe ka magazi zimatha kuchitika. Ndizothekanso kukula, komwe kumatha kusanduka zovuta. Chifukwa chake, ngati zizindikiro zosafunikira zikuwonekera, muyenera kufunsa dokotala.

Malangizo a Amaryl (Njira ndi Mlingo)

Mapiritsiwo adapangira kuti azigwiritsidwa ntchito mkati, osafuna kutafuna komanso kumwa zakumwa zambiri.

Nthawi zambiri, mlingo umatsimikiziridwa ndi kuchuluka kwa shuga m'magazi. Mankhwala, mankhwala otsika kwambiri ndi omwe amapereka, omwe amathandiza kukwaniritsa kuyenera kwa metabolic

Malangizo ogwiritsira ntchito Amaril amanenanso kuti mankhwalawa amafunikira kutsimikiza kwa shuga m'magazi komanso kuchuluka kwa hemoglobin ya glycosylated.

Kudya kotheka kosayenera kwa mapiritsi, komanso kulumpha mlingo wotsatira, sikulimbikitsidwa kuti mudzazidwenso ndi mlingo wowonjezera. Zinthu zoterezi zimafunika kuvomerezedweratu ndi adokotala.

Kumayambiriro kwa chithandizo, odwala amapatsidwa mlingo wa 1 mg. Ngati ndi kotheka, mlingo umakulitsidwa pang'onopang'ono, ndikuwonetsetsa kuchuluka kwa shuga m'magazi malinga ndi chiwembu: 1 mg - 2 mg - 3 mg - 4 mg - 6 mg - 8 mg. Mlingo wamba wa tsiku ndi tsiku wa odwala omwe ali ndi vuto labwino ndi 1- mg wa yogwira mankhwala. Mlingo wa tsiku lililonse wa 6 mg kapena kupitilirapo umabweretsa zotsatira za ochepa ochepa odwala.

Mlingo watsiku ndi tsiku wa mankhwalawa amakhazikitsidwa ndi adokotala, chifukwa ndikofunikira kuganizira zina zosiyanasiyana, mwachitsanzo, nthawi yakudya, kuchuluka kwa zochita zolimbitsa thupi, ndi zina zambiri.

Nthawi zambiri, kudya kamodzi kwa tsiku ndi tsiku kwamankhwala kumayikidwa, musanadye chakudya cham'mawa chokwanira kapena woyamba kudya. Ndikofunika kuti mutatha kumwa mapiritsi musaphonye chakudya.

Amadziwika kuti kukonza kagayidwe kazakudya kamakhudzana ndikukula kwa insulin sensitivity, ndipo panthawi ya chithandizo, kufunika kwa glimepiride ikhoza kukana. Mutha kupewa kukulitsa kwa hypoglycemia mwa kuchepetsa mlingo kapena kusiya kumwa Amaril.

Panthawi ya achire, kusintha kwa mlingo glimepiride chitha kuchitika pamene:

• kuchepetsa thupi
• Khalidwe limasintha
• zikamera za zinthu zina zomwe zimatsogolera ku hypoglycemia kapena hyperglycemia.

Monga lamulo, chithandizo cha Amaril chikuchitika kwa nthawi yayitali.

Bongo

Mu milandu pachimake bongo kapena ntchito kwa nthawi yayitali glimepiride kwambiri hypoglycemia, yomwe ikhoza kuwononga moyo, ingachitike.

Ngati mankhwala osokoneza bongo apezeka, muyenera kufunsa dokotala.Hypoglycemia imatha kuyimitsidwa ndikamamwa chakudya, mwachitsanzo, shuga kapena kachidutswa kakang'ono ka maswiti aliwonse. Mpaka pomwe zizindikiro za hypoglycemia zitathetsedwa kwathunthu, wodwalayo amafunika kuyang'aniridwa mosamala ndi madokotala, chifukwa mawonekedwe osafunikira angayambenso. Mankhwala ena zimatengera zizindikirocho.

Kuchita

Kugwiritsa ntchito kwa glimepiride ndi mankhwala ena kumatha kuyambitsa kukula kwa hypoglycemia, mwachitsanzo, ndiInsulin ndi othandizira ena ACE inhibitors, anabolic steroids ndi mahomoni ogonana amunazotumphukira Coumarin, Cyclophosphamide, Dizopyramide, Fenfluramine, Feniramidol, Fibrate, Fluoxetine, Guanethidine, Ifosfamide, MAO zoletsa, para-aminosalicylic acid, Phenylbutazone, Azapropazone, Oksifenbutazonom, Salinamil ndi ena.

Phwando , barbiturates , GKS , diazoxides , okodzetsa , ndi othandizira ena achifundo, mankhwala othandizira (osagwiritsidwa ntchito nthawi yayitali), (pamitunda yayitali), estrogen ndi progestogens, phenothiazines, phenytoins, rifampicins,Madzi a chithokomiro amakhala ayodini amachititsa kufooka kwa vuto la hypoglycemic, motero, limawonjezera kuchuluka kwa shuga m'magazi.

Kulimbitsa kapena kufooketsa mphamvu ya hypoglycemic ya glimepiride amatha kutsekereza H2-histamine receptors ,, ndi beta-blockers.

Kutulutsa Mafomu

Mankhwalawa amapezeka mu mawonekedwe a mapiritsi ozungulira (1-4 mg). Kumbali imodzi ya piritsi ndi kuwerenga mawu olembedwa HD125. Mu chithuza chimodzi 15 zidutswa. Matuza okha ali ndi makhadibhodi. Mutha kugula mankhwalawa m'matumba awiri, anayi, asanu ndi amodzi kapena asanu ndi atatu. Mapiritsiwa ndi osiyanasiyana: pinki imakhala ndi 1 mg, wobiriwira 2 mg, Amaryl 3 mg - lalanje mu mtundu ndi Amaryl 4 mg - mapiritsi amtambo wabuluu.

Piritsi limodzi:

• glimepiride wa m'badwo wachitatu - chinthu chachikulu chomwe chimatsitsa shuga, chinthu chomwe chimatulutsidwa ku sulfamide,
• povidone - mankhwala othandizira,
• lactose ndi molekyu yamadzi (monohydrate),
• cellcrystalline mapadi,
• sodium carboxymethyl wowuma - zakudya zowonjezera, tackifier, thickener,
• indigo carmine - chakudya choteteza utoto
• magnesium stearate (kukhazikika kwa antifoam).

Amaril ndiwosavuta kugwiritsa ntchito, muyenera kumwa mapiritsi kamodzi m'mawa. Malangizo ogwiritsira ntchito, komanso mtengo wake ndi wokwera mtengo kwa wodwala aliyense amene ali ndi matenda a endocrine.

Ndemanga za Amaril

Kawunikidwe ambiri a odwala ndi akatswiri akuwonetsa kuti pochiza matenda osokoneza bongo, kusankha koyenera kwa mankhwalawa komanso njira zochizira ndikofunikira kwambiri.

Komanso, ndemanga za Amaril zikuwonetsa kuti mankhwalawa siabwino kwa onse odwala matenda ashuga. Nthawi zambiri, poyambira kulandira chithandizo, odwala amasintha kwambiri zomwe zili m'magazi. Komabe, akatswiri akukhulupirira kuti pazochitika zotere, kusintha kwa mankhwalawa ndikofunikira pakuwonjezeka ndipo izi sizomwe zikuwonetsa kuti mankhwalawo alibe mphamvu.

Zachidziwikire, kusintha kulikonse komwe kumakhudzana ndikukula komanso kutsika kwa mlingo kuyenera kuchitika moyang'aniridwa ndi katswiri. Kukhazikitsidwa kuti kulandira kosaphunzira ku Amaril kungayambitse zovuta za matendawa.

Tsiku lotha ntchito

Gwiritsani ntchito mankhwalawa ndikuloledwa kwa miyezi 36 kuyambira tsiku lotulutsidwa.

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

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

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

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

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

Mowa ndi Amaryl

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

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

Omwe Alipo Amaril Mapulogalamu Okhazikika

Chimodzi mwa zofananira zotsika mtengo kwambiri za Amaril pamapiritsi ndi:

Onani momwe ma fanizo a Amaril amagwira ntchito.

Ili ndi chinthu chofanana ndi Amaryl. Zotsatira zakuchizira zimachitika chifukwa cha kutseguka kwa maselo a pancreatic beta ndi zinthu zopangidwa ndi shuga.

1. Kutalikirana pakati pa phwando sikuyenera kupitilira nthawi yoikika.
2. Zolakwika mukamamwa mankhwalawa sizingalepheretsedwe ndikuzunguliridwa kwakukulu kwa mankhwalawo.
3. Wodwalayo ayenera kudziwitsa dokotala za kugwiritsa ntchito mankhwalawa.
4. Kukula kwa hypoglycemia pambuyo pa kupangika kwa Diamerid mu gawo la 1 mg / tsiku, akuwonetsa kuti zakudya zofunikira ndizofunikira.

Mtengo wa diamerid umachokera ku 206 rubles. pa paketi iliyonse.

Mankhwala ali ndi ake machitidwe:

1. Gawo logwira mu mankhwalawa limayambitsa katulutsidwe ndikuchotsa insulin kuchokera ku kapamba.
2. Kuchulukitsa kupezeka kwa zotumphukira zimakhala ndi zotsatira za insulin.

Tengani, poyamba kunyamula gawo la mankhwalawo. Nthawi zambiri, amasankhidwa potengera kuwunika kwa shuga m'magazi.

Pali malamulo angapo ogwiritsira ntchito mankhwalawa:

1. Kumayambiriro kwa mankhwala, pafupifupi 1 mg ya glimepiride ndi mankhwala, 1 nthawi patsiku.
2. Zotsatira zamankhwala zikaonekera, gawo ili limagwiritsidwa ntchito ngati othandizira.
3. Ngati palibe kusintha, ndiye kuti mutha kuwonjezera mlingo wake mpaka 4 mg / tsiku.
4. Mlingo wapamwamba kwambiri ndi 8 mg / tsiku.

Pafupifupi, mtengo wa mankhwalawa umachokera ku ruble 740-780 pa paketi iliyonse.

Amasintha kuchuluka kwa shuga wamagazi mwa odwala omwe ali ndi matenda a shuga.

Ili ndi zovuta zingapo:

1. Hypoglycemic.
2. Kutulutsa.
3. Zopinga.
4. Kuteteza ndi kubwezeretsa.
5. Antioxidant.
6. Antibacterial.
7. Cholagogue ndi diuretic zotsatira.

Amatsimikiza ndi dokotala mu mulingo woyenera kukwaniritsa:

1. Mafuta ovomerezeka akumagazi ndi mkodzo.
2. Gwiritsani ntchito zodzitetezera ku matenda amtima.
3. Amasonyezedwa kuti azigwiritsidwa ntchito ndi odwala omwe ali ndi matenda a chiwindi, m'mimba kapena matumbo.

Munthawi ya kumwa mankhwalawa, munthu ayenera kutsatira mosamala Mlingo wosankhidwa ndi moyo wake. Pafupifupi, Vijaysar itha kugulika ma ruble 282.

Pali ma fanizo aku Russia a mankhwala a Amaril, omwe amathandizanso pakuwathandiza.

• Glimepiride Canon.
• Glimepiride.
• Glimecomb.
• Glformin.
• Kutalika kwa Glformin.

Mimba, kuyamwa

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

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

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

Pharmacological mawonekedwe a mankhwala

Amaryl ndi mankhwala a hypoglycemic omwe amathandiza kuwongolera dzuwa la plasma. Yogwira pophika mankhwala ndi glimepiride. Monga omwe adatsogolera, Glibenclamide, Amaril ndiwonso wochokera ku gulu la sulfonylurea, lomwe limalimbikitsa kaphatikizidwe ka insulin kuchokera ku maselo a b pancreatic a Langerhans.

Kuti akwaniritse zomwe akufuna, amatseka njira ya potaziyamu ya ATP ndi chidwi chochulukirapo. Sulfonylurea ikalumikizana ndi ma receptor omwe ali pamalimba a b-cell, zochitika za gawo la K-AT zimasintha. Kutsekeka kwa njira za calcium ndi kuwonjezeka kwa kuchuluka kwa ATP / ADP mu cytoplasm kumapangitsa kuti membrane awonongeke. Izi zimathandiza kumasula njira za calcium ndikuwonjezera kuchuluka kwa calcium ya cytosolic.

Zotsatira za kukopa kwachidziwikire kwa ma granules achinsinsi, omwe ndi njira yotulutsira maselo a mankhwala ophatikizira mkati mwa sing'anga, amatha kutulutsa insulin m'magazi.

Glimepiride ndi woimira m'badwo wachitatu wa sulfonylureas. Zimapangitsa kuti amasulidwe mahomoni a pancreatic mwachangu, amathandizira chidwi cha insulini cha mapuloteni komanso maselo a lipid.

Tizilomboti timatulutsa michere timagulugasi timagwiritsa ntchito mapuloteni ochokera ku ma cell a cell. Ndi mtundu wodziimira payekha wa shuga, kusintha kwa shuga m'matipi kumachepetsedwa. Glimepiride imalimbikitsa kukwera kwa kuchuluka kwa mapuloteni oyendetsa ndikuwonjezera ntchito yawo. Mphamvu yamphamvu kwambiri ya kapamba imathandizira kuchepetsa kukanira kwa insulin (insensitivity) kwa mahomoni.

Amaryl imalepheretsa kuphatikizika kwa glucogen ndi chiwindi chifukwa cha kuchuluka kwa kuchuluka kwa fructose-2,6-bisphosphate ndi antiaggregant (chopinga cha kupangidwa kwa thrombus), antiatherogenic (kuchepa kwa zizindikiro za cholesterol "choyipa") komanso antioxidant (kusinthika, kuthana ndi kukalamba). Njira za oxidation zimachepetsedwa chifukwa chowonjezeka pazomwe zimakhala za end-native b-tocopherol komanso ntchito ya antioxidant enzymes.

Ngakhale milingo yaying'ono ya Amaril imathandizira kwambiri glucometer.

Pharmacokinetics wa mankhwala

Popanga Amaril, gawo lalikulu lomwe limagwira ndi glimepiride kuchokera ku gulu la sulfonylurea. Povidone, lactose monohydrate, magnesium stearate, microcrystalline cellulose ndi utoto wa E172, E132 amagwiritsidwa ntchito ngati ojambula.

Amaryl imayendetsa michere ya chiwindi 100%, kotero ngakhale kugwiritsidwa ntchito kwa nthawi yayitali kwa mankhwalawa sikuwopseza kudzikundikira kwake pazinthu komanso minyewa. Zotsatira zakonzedwe, zotumphukira ziwiri za glipemiride zimapangidwa: hydroxymetabolite ndi carboxymethabolite. Metabolite yoyamba imapatsidwa mankhwala omwe amapereka chokhazikika cha hypoglycemic.

M'magazi, zomwe zimakhala pazomwe zimagwira ntchito zimawonedwa pakatha maola awiri ndi theka. Kuwona zamtundu wathunthu wa bioavailability, mankhwalawa saletsa odwala matenda ashuga posankha zakudya zomwe "agwiritse" mankhwalawo. Mafuta adzakhala mulimonse 100%.

Likukhalira kuti mankhwala pang'onopang'ono, mlingo wa kumasulidwa kwa zimakhala ndi madzi kuchokera ku mankhwala (chilolezo) ndi 48 ml / min.Kutha kwa theka-moyo kumachokera ku maola 5 mpaka 8.

Kupititsa patsogolo kwakukulu mu glycemic indices kumawonedwa ngakhale ndi zovuta ndi chiwindi, makamaka, mukulira (woposa zaka 65) komanso ndi vuto la chiwindi, kugwiritsidwa ntchito kwa chinthucho ndi kwachibadwa.

Glimepiride Canon

Ndi mankhwala a hypoglycemic omwe amamwa pakamwa. Zimakhudza maselo a kapamba ndikutulutsa insulin.

Mankhwalawa ali ndi mitundu ingapo yamvuto:

1. Kutulutsa kwina-pancreatic pa thupi, komwe kumawonjezera kuthekera kwa minofu kukulitsa insulin.
2. Imachepetsa kukonza kwa insulin m'chiwindi.
3. Imalepheretsa kupanga kwa shuga.

Lemberani pakamwa. Mankhwala osakanikirana ndi insulin atha kutumizidwa, chifukwa chosowa mankhwalawa. Komabe, posankha mtundu wa mankhwalawo, muyenera kuwunika mwatsatanetsatane wa zomwe zili m'magazi. Mankhwalawa nthawi zambiri amakhala aatali. Mtengo pafupifupi wa ruble 165.

Kutalika kwa Glformin

Amalemba mtundu wa shuga wachiwiri mwa odwala omwe ali ndi kunenepa kwambiri. Mankhwalawa amagwiritsidwa ntchito onse mu monotherapy komanso kuphatikiza ndi mankhwala ena.

Mutha kumwa mosasamala chakudya. Mlingo ndi pafupipafupi zimatsimikiziridwa kutengera mtundu womwe umagwiritsidwa ntchito. Lemberani mankhwala mpaka katatu / tsiku. Pakadutsa masiku 15 mukuyenera kusintha mlingo.

Zofananira zamankhwala, mtengo

Amaril yatumizanso ku ma analogu, omwe ali ndi mtengo wokwera, koma zowunikira zowonjezereka:

1. Avandaglim . Muli zinthu ziwiri zowonjezera, zomwe ndi rosiglitazone maleate ndi glimepiride. Amasintha kuwongolera kwa glycemic kwa odwala omwe ali ndi matenda a shuga a 2.
2. Avandamet. Mankhwala osakanikirana otengera rosiglitazone maleate ndi metformin hydrochloride. Zimalimbikitsa insulin chiwopsezo.
3. Bagomet Plus. Kuwonetseraku kumadalira kuphatikizika kwokhazikika kwa zinthu ziwiri izi metformin ndi glibenclamide. Oyamba amachepetsa kuchuluka kwa shuga m'magazi, amalepheretsa kuyamwa kwa mafuta amthupi komanso amachepetsa kuchuluka kwa gluconeogenesis. Metformin imakhudza bwino mawonekedwe a lipid m'magazi, amatsitsa cholesterol ndi triglycerides mmenemo. Glibenclamide imachepetsa zomwe zili m'magazi. About mapiritsi otsika mtengo kuti muchepetse cholesterol - mayina, mitengo ndi malingaliro omwe tidalemba.
4. Bagomet . Ili ndi zotsatilapo zingapo zabwino:

• amachepetsa mayamwidwe,
• amachepetsa gluconeogenesis,
• kumawonjezera kuphatikizika kwa glucose,
• kumawonjezera kuthekera kwa minofu pazotsatira za insulin.

Mtengo wake umachokera ku ruble 68 mpaka ma ruble 101.

Zisonyezero zogwiritsira ntchito mapiritsi a Amaryl

The yogwira mankhwala malinga ndi malangizo pokonzekera Amaril ndi glimepiride.

Mankhwalawa ali ndi zotsatirapo zabwino:

1. Amathandizira kupanga insulin.
2. Kuchulukitsa chiwopsezo cha zimakhala kuti insulin opangidwa ndi thupi.
3. Amatulutsa insulin.
4. Ali ndi ntchito zina.
5. Kutha kusintha myocardium ku ischemia kumakhalabe.
6. Zochita za antithrombotic.

Mankhwala a matenda a shuga a 2 amagwiritsidwa ntchito. Potere, mankhwalawa angagwiritsidwe ntchito onse mu monotherapy, komanso pamodzi ndi mankhwala ena.

Mlingo ndi makonzedwe

Mtengo wa Amaryl umachokera ku ruble 820 mpaka ma ruble 2300 pa paketi iliyonse.

Pogwiritsa ntchito Amaril, ndikofunikira kutsatira malamulo ena:

1. Kusankha kwa dose kumachitika kokha ndi adokotala. Mlingo woyambirira ndi 1 mg 1 nthawi patsiku.
2. Mlingo uyenera kukhala wofanana ndi pafupipafupi wa mankhwalawo.
3. Mapiritsiwo amameza lonse osafuna kutafuna.
4. Imwani mankhwalawo ndi theka la lita imodzi yamadzi.
5. Ndikofunika kwambiri kuti musadumphe zakudya.
6. Mankhwalawa ndiwotalikirapo.
7. Mwina kugwiritsidwa ntchito kwa Amaril ndi metformin. Komanso, chithandizo choterechi chikuyenera kuchitika ndikufufuzidwa kwathunthu kachipatala.
8. Ngati sikungatheke kukwaniritsa kuchuluka kwa shuga m'magazi mwa kumwa mlingo wovomerezeka wa Amaril, ndiye kuti mankhwalawa atapangidwa ndi glimepiride ndi insulin.
9. Kusamutsa wodwala kuchokera ku mankhwala a hypoglycemic kupita ku Amaryl kumachitika ndi kukhazikitsidwa kwa Mlingo woyamba wa 1 mg.

Zotsatira zoyipa

Nthawi zina, zotsatira zoyipa zimatha kugwiritsidwa ntchito ndi Amaril.

Amawonekera atamwa mankhwalawo:

• mutu
• kutopa konse
• nseru
• akukumbutsa
• kugona kusokonezedwa ndi nkhawa
• chisokonezo mu chikumbumtima
• spasms zam'mimba.
• kulephera kudziletsa.

• Nthawi zambiri, kusokonezeka kwakanthawi mu mawonekedwe amawonedwe kumadziwika, komwe kumachitika chifukwa cha kusintha kwa glucose m'magazi.

• kusanza
• kutsegula m'mimba
• kupweteka kwam'mimba
• kuwonjezera mphamvu ya ma enzymes a chiwindi,
• jaundice.

Thupi lawo siligwirizana (mwina kudzera mawonekedwe awonetsedwe):

• urticaria pakhungu,
• kumverera kwa kuyabwa
• zotupa pakhungu.

Nthawi zina, mavuto owonjezereka angachitike:

Kuti mupewe kukula kwa zovuta mutamwa mankhwalawa, muyenera kufunsa dokotala musanagwiritse ntchito mankhwalawa.

Amaril samachita izi. Osasakaniza mankhwalawa ndi mowa. Inde, muyenera kutenga Amaryl pokhapokha mutakambirana ndi dokotala.

metformin, alogliptin 262 rub1750 UAH

Momwe mungagwiritsire ntchito Amaryl

Mankhwala amapangidwa mwanjira ya mapiritsi ozungulira omwe ali ndi mzere wogawa, womwe umakupatsani mwayi wogawa muyezo. Mtundu wa mapiritsiwo umatengera Mlingo: 1 mg glimepiride - chipolopolo, 2 mg - khungu, 3 mg - chikasu.

Kapangidwe kameneka sikanasankhidwe mwamwayi: ngati mapiritsi amatha kusiyanitsidwa ndi mtundu, izi zimachepetsa chiopsezo cha bongo mwangozi, makamaka mwa okalamba.

Mapiritsi amayikidwa m'matumba a 15 ma PC. Bokosi lililonse limatha kukhala ndi mitundu iwiri mpaka itatu.

Zomwe mungagwiritse ntchito pa Amaril:

Mapiritsi a Amaryl (phukusi la zidutswa 30) amagulitsidwa pamtengo wa:

• 260 rub - 1 mg,
• 500 rub - 2 mg aliyense
• 770 rub. - 3 mg aliyense
• 1020 rub. - 4 mg aliyense.

Mutha kupeza mapiritsi a mapiritsi 60, 90,120.

Mabokosi a Amaril amasungidwa kutentha firiji (mpaka madigiri 30) kwa zosaposa zaka zitatu. Zipangizo zothandizira sayenera kupezeka ndi ana.

Zofananira zina za mankhwala

Anthu odwala matenda ashuga, makamaka "odziwa bwino", monga lamulo, amakhala ndi zovuta zambiri zotsutsana: matenda oopsa, mtima ndi mtima, kusokonezeka kwa metabolic, impso ndi chiwindi. Ndi kitiyi, simuyenera kungomwa mankhwala ochepetsa shuga.

Pofuna kupewa nthenda yamitsempha yamagazi ndi mtima, mankhwala omwe ali ndi aspirin adayikidwa. Amaryl imachotsa phula mapuloteni, koma mulingo wake m'magazi sunasinthe. Zotsatira zonse zovuta za ntchito zovuta zimatha kusintha.

Kupititsa patsogolo ntchito AMARE Kuwonjezera yake insulin, Allopurinu, coumarin ofanana nawo, anabolic mankhwala, guanethidine, chloramphenicol, fluoxetine, fenfluramine, pentoxifylline, Feniramidolu, fibric asidi ofanana nawo, phenylbutazone, miconazole, azapropazone, probenecid, quinolones, oxyphenbutazone, salicylates, tetracycline, sulfinpyrazone, Tritocqualin ndi sulfonamides.

Amaril amachepetsa kuthekera kuwonjezera Epinephrine, glucocorticosteroids Diazoxide, mankhwala othandizira, Glucagon, barbiturates, Acetazolamide, saluretics, thiazide diuretics, nicotinic acid, Phenytoin, Phenothiazine, Rifampicin, Chlorpromazine, ndi progestin.

Amaryl kuphatikiza histamine H2 receptor blockers, reserpine ndi clonidine imapereka zotsatira zosayembekezereka ndi madontho a glucometer mbali iliyonse. Zotsatira zomwezi zimapereka mowa ndi Amaril.

Mankhwalawa sasokoneza ntchito ya ACE inhibitors (Ramipril) ndi anticoagulant agents (Warfarin) mwanjira iliyonse.

Kugwirizana kwa Hypoglycemic

Ngati mankhwala ena aliwonse a hypoglycemic ayenera kulowetsedwa ndi Amaril, muyeso wocheperako (1 mg) umayikidwa, ngakhale pokhapokha wodwala atalandira chithandizo cham'mbuyomu muyezo waukulu. Choyamba, momwe chamoyo cha matenda ashuga chimayang'aniridwa kwa masabata awiri, kenako mlingo umasintha.

Ngati wothandizila odwala matenda ashuga omwe ali ndi theka la moyo adagwiritsidwa ntchito pamaso pa Amaril pofuna kupewa kukula kwa hypoglycemia, payenera kukhala kupuma masiku angapo atachotsedwa.

Ngati njira yachikhalidwe yolipira shuga ya Metformin siyilola kuwongolera kwathunthu matenda a shuga, mungathe kuwonjezera Amaril 1 mg. Ngati zotsatirazo sizikukwaniritsa, pang'onopang'ono zimasinthidwa mpaka 6 mg / tsiku.

Ngati chiwembu cha Amaril + Metformin sichinakwaniritse zoyembekezeredwa, chimasinthidwa ndi Insulin, ndikukhalabe chizolowezi cha Amaril. Jakisoni wa insulin amayambanso ndi mlingo wochepera. Ngati zizindikiro za glucometer sizili zolimbikitsa, onjezani kuchuluka kwa Insulin. Kugwiritsanso ntchito limodzi kwamankhwala kumakhalabe koyenera, chifukwa kumakupatsani mwayi wochepetsa mphamvu ya mahomoni ndi 40% poyerekeza ndi mahomoni oyera.

Kuphatikiza pa Amaril, endocrinologist amakhalanso ndi zosankha: Amaperid, Glemaz, Diapyrid, Diameprid, Glimepiride, Diagliside, Reclid, Amix, Glibamide, Gllepid, Glayri, Panmicron, Glibenclamide, Gligenclad, Glliblik Dimari Glimaril, Glyclazide, Manil, Maninil, Glimed, Glioral, Olior, Glynez, Glirid, Gluktam, Glypomar, Glyurenorm, Diabeteson, Diabresid.

Mankhwalawa adapangira zochizira matenda a shuga a mtundu wachiwiri. Amagwiritsidwa ntchito limodzi ndi monotherapy komanso mu zovuta kuchipatala motsatana ndi Metformin kapena Insulin.

Gawo logwira ntchito la Amaril limagonjetsa chotchinga cha placenta, ndipo mankhwalawa amapatsanso mkaka wa m'mawere. Pachifukwachi, sioyenera kuti azimayi oyembekezera azikumbukira. Ngati mkazi akufuna kukhala mayi, ngakhale asanakhale ndi pakati pa mwana, ayenera kusamutsidwira ku insulin popanda Amaril. Kwa nthawi yakudyetsa, nthawi zoterezi zimasungidwa, ngati pakufunika chithandizo ndi Amaril, kuyamwitsa kuyimitsidwa.

Kugwiritsa ntchito mankhwalawa odwala matenda ashuga komanso vuto lomwe lisanafike pa chikomokere ndilosavomerezeka. M'mavuto akulu a matenda ashuga (monga ketoacidosis), Amaryl sawonjezedwa. Mankhwalawa sioyeneranso kwa odwala matenda ashuga okhala ndi mtundu woyamba wa matenda.

Ndi magwiridwe antchito a impso ndi chiwindi, Amaryl sichothandiza, Amaril sakutchulidwa kwa hemodialysis ndi matenda ashuga, komanso kwa tsankho la glipemiride kapena mankhwala ena a sulfonamide ndi gulu la sulfonylurea.

Ndi matumbo paresis kapena m'matumbo, kutsekeka kwa mankhwalawa kumasokonezeka, kotero Amaril sakulamula mavuto ngati awa pakukula. Amafuna kusinthana ndi insulin komanso kuvulala kambiri, maopaleshoni, matenda otentha kwambiri, komanso kuwotcha koopsa.

Amaril akhoza kukhala limodzi ndi hypoglycemic zimachitika. Nthawi zina odwala amadandaula chifukwa cha chizungulire, ena amachulukitsa kugona, pamakhala manjenjenje, thukuta kwambiri, komanso vuto lakulankhula. Mu matenda a shuga, nthawi zambiri mumakhala njala yosalamulirika, matenda osokoneza bongo, chisangalalo m'dera la chiwindi. Kutheka kwa vuto la mtima, chotupa pakhungu. Nthawi zina magazi amatuluka.

Kugwiritsa ntchito mankhwalawa kwakanthawi, komanso kumwa mopitirira muyeso, kumayambitsa hypoglycemia, zomwe zimafotokozedwa m'gawo lakale.

Wodwala matenda ashuga ayenera kukhala ndi cholembera chofotokoza bwino za matenda ake ndi china chake kuchokera ku chakudya cham'thupi (maswiti, makeke). Madzi okoma kapena tiyi ndiwofunikanso, pokhapokha popanda zotsekemera zotengera.Woopsa milandu, wodwala ayenera kuchipatala mwachangu kuti akonzenso chapamimba ndi makonzedwe a absorbents (adamulowetsa kaboni, zina ndi zina).

Zotsatira zoyipa

Nthawi zina, kugwiritsa ntchito Amaril kumayendera limodzi ndi zotsatira zoyipa mwanjira ya kutaya kwamaso, mavuto ndi njira yoyendera magazi, matenda a metabolic, matenda am'mimba.

Mwa zina zofala:

Kutenga Amaril kumakhudza kuthamanga kwa ma psychomotor reaction - kuyendetsa galimoto, komanso ntchito yofunikira kuti ithe chidwi, makamaka koyambirira kwa chithandizo, sizigwirizana ndi Amaril chithandizo.

Mankhwala Okhala Pamalo a Pharmacy

Amamasulidwa pa mankhwala.

Kodi Amaryl ndi ndalama zingati? Mtengo wapakati pama pharmacies umatengera mtundu wa kumasulidwa:

• Mapiritsi a Amaryl 1 mg, 30 ma PC. - kuchokera 262 rub.
• Mapiritsi a Amaryl 2 mg, 30 ma PC. - kuchokera pa 498 rub.
• Mapiritsi a Amaryl 3 mg, 30 ma PC. - kuchokera 770 rub.
• Mapiritsi a Amaryl 4 mg, 30 ma PC. - kuchokera 1026 rub.

Mimba komanso kuyamwa

Amaryl amadziwikiridwa ndi pakati. Ngati mayi wapezeka kuti ali ndi pakati kapena pokhapokha ngati ali ndi pakati, mkazi ayenera kuthandizidwa ndi insulin.

Zakhazikitsidwa kuti glimepiride imatulutsidwa mkaka wa m'mawere. Pa nthawi ya mkaka wa m'mawere, mkazi amayenera kupita ku insulin kapena kusiya kuyamwa.

Malangizo apadera

Dokotala, pofotokozera wodwala Amaryl kapena Amaryl M, ayenera kuchenjeza za kuthekera kwa zotsatirapo zoyipa, ndipo koposa zonse - za kupezeka kwa hypoglycemia ngati wodwalayo amamwa mankhwalawo, koma amaiwala kudya. Potere, wodwalayo amalangizidwa kuti nthawi zonse azinyamula maswiti kapena shuga muzidutswa kuti athe kukweza msanga shuga.

Kuphatikiza pa kupenda kwa magazi ndi mkodzo mwatsatanetsatane, mankhwalawa Amaril ndi Amaril M amathanso kuwunika kuchuluka kwa magazi ndi ntchito ya chiwindi.

M'mikhalidwe yovuta, yotsatana ndi kutulutsidwa kwa adrenaline m'magazi, mphamvu ya Amaril ndi Amaril M imachepa. Zinthu ngati izi zimatha kukhala ngozi, mikangano m’banja kapena kuntchito, matenda omwe akukwera kwambiri. Zikatero, kusunthira kwakanthawi kwa wodwala kupita ku insulin kumachitika.

Kuyanjana kwa mankhwala osokoneza bongo

Kugwiritsa ntchito komweko kwa amaryl ndi insulin, mankhwala ena ochepetsa shuga, maantibayotiki ena (ma tetracyclines, sulfanilamides, clarithromycin), mlingo waukulu wa pentoxifylline, fluoxetine, fluconazole, anabolic steroids, ACE inhibitors (Captoprilprin, drilopril, erin, priloprilprin. . Kuphatikizidwa kwa amaryl ndi barbiturates, mankhwala opatsirana, ma diuretics, mlingo waukulu wa nicotinic acid, ndi rifampicin adzakhala ndi zotsutsana.

Beta-blockers (carvedilol, atenolol, bisoprolol, metoprolol, etc.), reserpine, clonidine, zotumphukira za coumarin ndi mowa zimatha kuwonjezera ndikuchepetsa mphamvu ya hypoglycemic ya amaryl.

Amaril amadziwika kuti ndiodziwika bwino pakati pa odwala matenda ashuga. Kulandila kwake kumalola odwala kuwongolera momwe alili, kuchepetsa mwayi wokhala ndi hyperglycemia. Mankhwala okhawo amalembera anthu okhawo omwe ali ndi matenda a shuga a II.

Zomwe zimagwira ku Amaril ndi glimepiride. Zomwe mapiritsiwo amaphatikizidwira ndizothandiza. Mndandanda wawo udzadalira mlingo wa glimepiride. Kuphatikiza kosiyana kwa zinthu zowonjezera pamapiritsi ndi chifukwa cha mtundu wina.

INN (dzina lapadziko lonse): glimepiride (Latin Glimepiride).

Amalil M1, M2 amagulitsanso malo ogulitsa mankhwala. Kuphatikiza pa glimepiride, kapangidwe ka mapiritsiwa kumaphatikiza metformin mu 250 kapena 500 mg, motsatana. Mankhwala osakanikirana awa amatha kupatsidwa ndi endocrinologist wokha.

Kuphatikizika kosiyanasiyana, kungagwirizane mukuwonetsa ndikugwiritsa ntchito njira

Kuti tipeze mndandanda wamtengo wotsika mtengo wa mankhwala okwera mtengo, timagwiritsa ntchito mitengo yomwe imatipatsa mankhwala opitilira 10,000 mu Russia yonse. Dongosolo la mankhwala osokoneza bongo ndi fanizo lawo limasinthidwa tsiku ndi tsiku, chifukwa chake zambiri zomwe zimaperekedwa patsamba lathu zimakhazikika pofika lero. Ngati simunapeze analogue yosangalatsa kwa inu, chonde gwiritsani ntchito kusaka pamwambapa ndikusankheni mankhwala osangalatsa kuchokera pamndandanda. Patsamba lililonse la iwo mupeza zosankha zonse za mankhwala omwe mungafune, komanso mitengo ndi ma adilesi omwe amapezekamo.

Mndandanda wazomwe zikuwonetsa ndi zotsutsana pazovomerezeka

Amaryl ali ndi zizindikiro zotsatirazi kuti agwiritse ntchito. Njira yayikulu ndiyo chithandizo cha matenda ashuga amtundu wa 2. Amaril ndi oyenera onse kwa odwala omwe safuna jakisoni wa insulin, komanso kwa iwo omwe akuwonetsedwa insulin kuti akhale bwino.

Pochiza matenda a shuga, mapiritsi a Amaryl amalembedwa makamaka ngati mankhwala oyenera. Koma ndi osakwanira kagayidwe kazakudya (makamaka ngati wodwala amupatsa mankhwala), Glimepiride osakanikirana ndi Metformin ndi mankhwala. Izi zitha kusintha bwino kagayidwe ka metabolic. Poterepa, zotsatira zake zimakhala bwino poyerekeza ndi zomwe zidapezeka ndi mitundu yina ya mankhwala.

Zotsatira zabwino zomwe zidachitika chifukwa cha zovuta kuchipatala pogwiritsa ntchito Glimepiride ndi Metformin zidapangitsa kuti mankhwalawa apangidwe Amaryl M. Mankhwala amapatsidwa mankhwalawa ngati chithandizo cha matenda osokoneza bongo omwe ali ndi mankhwala ovuta, nchofunika kwa odwala.

Amaril yotsitsa shuga imatha kumwa odwala omwe amafunika jakisoni wa insulin nthawi zonse. Nthawi yomweyo, kagayidwe kachakudya kamakonzanso bwino, koma mlingo wa glimepiride tikulimbikitsidwa kuti ukhale wotsika.

Monga mankhwala aliwonse, mankhwalawo sangatchulidwe kuti ndi otetezeka. Amaril ali ndi zotsutsana, ndipo mndandanda wawo ndi waukulu.

Choyamba, tikulimbikitsidwa kusamala kumwa mankhwalawo panthawi yoyamba ya chithandizo: panthawiyi, pali chiwopsezo cha kuchepa kwambiri kwa glucose. Ngati patapita nthawi chiopsezo cha hypoglycemia chikadalipo, tikulimbikitsidwa kusintha njira ina kapena chithandizo cha Amaril. Muyenera kusamala komanso ndi matenda ena, moyo wosayenera, zakudya zopanda thanzi.

Matenda otsatirawa (kapena machitidwe a thupi) ndizopinga zazikulu pakusankhidwa kwa Amaril:

1. Matenda a shuga kapena kholo.
2. Ketoacidosis.
3. Matenda akulu a chiwindi ndi impso.
4. Kusalolera kapena hypersensitivity kwa zigawo zikuluzikulu za mankhwala.
5. Matenda operewera (kusakhazikika kwa lactose, kuchepa kwa lactase, ndi zina).
6. Mimba Pakukonzekera kutenga pakati, njira yochiritsira imayenera kusinthidwa. Wodwalayo amapatsidwa jakisoni wa insulin, mankhwalawa sanadziwike.
7. Panthawi yoyamwitsa, chithandizo cha insulin chimapitilira. Ngati chifukwa chilichonse mankhwalawa sakhala oyenera, Amaril amaperekedwa kwa wodwala, koma tikulimbikitsidwa kuti asiye kuyamwa.

Mankhwala samatchulidwa pochiza matenda a shuga a mtundu woyamba. Chotsutsana kwathunthu ndi zaka za ana. Palibe zambiri zamankhwala zololeza mankhwala kwa ana.

Chifukwa chake, mankhwalawa amathandizira ana odwala matenda ashuga.

Zowonjezera zamankhwala

Popereka Amaril kapena Amaril M, dokotala sayenera kungopereka malangizo a mankhwalawa moyenera, komanso kuchenjezanso za zovuta zomwe zingachitike. Chisamaliro makamaka chiyenera kuperekedwa ku chiwopsezo cha hypoglycemia, chomwe chingayambike ngati wodwalayo angaiwale kudya atangomwa Amaril. Kuti mupewe hypoglycemia, ndibwino kukhala ndi chidutswa cha shuga kapena maswiti nanu.

Kuphatikiza pa kuchuluka kwa shuga komanso kuchuluka kwa shuga mumkodzo, wodwalayo ayenera kuyang'ana momwe impso ndi chiwindi zimagwirira ntchito.

Funso lodziwika ndiloti ngati ndizotheka kumwa mowa panthawi yamankhwala ndi Amaril. Ndikofunika kukumbukira kuti mowa nthawi zambiri umalekeredwa bwino pa mankhwala a shuga ndipo sungaphatikizidwe ndi mankhwala ambiri. Amaril nawonso ndi a amenewo. Zotsatira za kumwa mankhwala ndi mowa nthawi yomweyo zimatha kukhala zosayembekezeka. Nthawi zina, mphamvu ya mankhwalawo imakhala yokwezeka, ndipo mwa ena imachepetsedwa kwambiri. Chifukwa chake, mukalandira chithandizo, muyenera kusiya mowa ndi mankhwala omwe amamwa mowa.

Ponena za kulumikizana kwa Amaril ndi mankhwala ena, chilichonse pano chimatengera mtundu wa mankhwalawa. Kutenga mankhwala ena kumathandizira kukonza kwa Amaril, ena - kumachepetsa. Mndandanda wa onse omwe ndi mankhwala ena ndiwowonjezera. Chifukwa chake, ngati ndi kotheka, imwani mankhwala ena, ndikofunikira kudziwitsa dokotala yemwe akupezeka ndi matendawa ndi mankhwala omwe amwe. Poterepa, adotolo azitha kusankha mankhwalawa omwe sangakhale ndi chidwi chambiri pakugwira ntchito kwa Amaril.

Zotsatira zilizonse zoyipa zikachitika, muyenera kusiya kumwa mankhwalawo ndi kupita kwa dokotala.

Ndemanga za mankhwala

Pogwiritsa ntchito Amaryl pa matenda a shuga a 2, ndemanga zinalandira kuchokera kwa odwala ambiri. Izi zikutsimikizira kuti, ngati mulingo woyenera, mankhwalawa amalimbana ndi hyperglycemia.

Kuphatikiza pakuchita bwino, ogula ambiri adatcha mitundu yosiyanasiyana ya mapiritsiyo ngati abwino a mankhwalawa - izi zimathandiza kuti asasokoneze mankhwalawo ndi mlingo wosiyana wa glimepiride.

Ndemanga zomwe zalandiridwa pa Amaril sizinangotsimikiza kugwira ntchito kwake kokha, komanso zotsatira zoyipa zomwe zikuwonetsedwa mu malangizo opita ku Amaril.

Nthawi zambiri, odwala omwe amamwa mankhwalawa amawonetsa zizindikiro za hypoglycemia:

1. Zofooka.
2. Kutentha.
3. Kugwedezeka thupi lonse.
4. Chizungulire
5. Kuchulukitsa chilakolako.

Nthawi zambiri, monga chotulukapo, pamakhala ngozi yotha kuzindikira. Chifukwa chake, iwo omwe amatenga Amaril amayenera kumanyamula nthawi zonse zinthu zokhala ndi shuga (mwachitsanzo, maswiti), kuti, ngati zingafunike, azitha kuwonjezera misanga yawo ndikupanga thanzi. Komabe, malinga ndi madotolo, kusintha kwa shuga sikuti kukuwonetsa kuti mankhwalawo alibe mphamvu. Zizindikiro zotere zikawoneka, ndikokwanira kusintha mlingo.

Vuto lodziwika kwa madalaivala omwe amakakamizidwa kuti achite ma hypoglycemic othandizira limakhala likuipiraipira poyendetsa galimoto. Zotsatira zoyipa zofananazo zikuwonetsedwa mu malangizo omwe ali mndandanda wazotsatira zoyipa. Kutsika kwake kumachitika pofotokoza chifukwa cha glimepiride yamatsenga.

Mwa odwala omwe ali ndi matenda ashuga okalamba, mu ndemanga ya Amaril, ambiri adanenanso za vuto limodzi: ngakhale kuti Amaril amatsitsa shuga, mankhwala a shuga ndiokwera mtengo kwambiri, chifukwa mankhwalawa atha kulipira ndalama zambiri kuposa ena kupanga.

Mtengo ndi fanizo la mankhwala

Mutha kugula Amaril mu pharmacy yokhazikika yamzinda, koma pali phanga limodzi: silikugulitsidwa. Monga mankhwala ena othandizira odwala matenda ashuga, muyenera kupereka mankhwala kuti mugule Amaryl.

Funso lina lodziwika lomwe limasangalatsa anthu ambiri odwala matenda ashuga ndiloti Amaril amawononga ndalama zingati. Mtengo wa mankhwalawa zimadalira kuchuluka kwa mapiritsi omwe ali mumapakewo ndi kuchuluka kwa mankhwalawa. Chifukwa chake, mwachitsanzo, phukusi la mankhwalawa limakhala ndi mapiritsi 30, kutengera mlingo, kuchokera kuma ruble 200 mpaka 850. Pankhaniyi, Amaril 1 mg amawononga ma ruble 230-280, ma CD a Amaril mapiritsi 2 mg - 450-560 rubles, 3 mg - kwa ma ruble 630-830. Mapiritsi okwera mtengo kwambiri Amaril 4 mg 90 pcs. - zimawononga ma ruble 870-1080.

Amaril M angagulidwe ndi ma ruble 570-600. Ndikofunikira kulingalira kuti pamtengo wotere mutha kugula mapiritsi a Amaril 2mg + 500 mg. Ndizovuta kwambiri kupeza Mlingo wotsika (1 mg + 250), chifukwa nthawi zambiri samayikidwa ndi madokotala, ndipo mwakutero, sagulitsidwa kwenikweni.

Malangizo a Amaryl M

MALANGIZO
pa kugwiritsa ntchito mankhwalawa
AMARIL M

Kutulutsa Fomu
Mapiritsi okhala ndi mafilimu.

Zotsatira za pharmacological
Amaryl® M ndi mankhwala ophatikiza a hypoglycemic, omwe amaphatikiza glimepiride ndi metformin.
Pharmacodynamics of glimepiride
Glimepiride, imodzi mwazinthu zomwe zimagwira ntchito ku Amaril ® M, ndi mankhwala a hypoglycemic operekera pakamwa, zomwe zimachokera ku sulfonylurea m'badwo wachitatu.
Glimepiride imathandizira kubisalira ndi kutulutsidwa kwa insulin kuchokera ku pancreatic β-cell (pancreatic athari), kumapangitsa chidwi cha zotumphukira (minofu ndi mafuta) ku zochita za endo native insulin (extrapancreatic athari).
Zokhudza insulin katulutsidwe
Zomwe zimachokera ku sulfonylureas zimawonjezera katemera wa insulin potseka njira zotsalira za potaziyamu za ATP zomwe zimapezeka mu membala wa cytoplasmic wa β-cell a kapamba.
Kutseka njira za potaziyamu, amachititsa kutsika kwa maselo a β-cell, omwe amathandiza kutsegula njira za calcium ndikukulitsa kuchuluka kwa calcium kulowa m'maselo. Glimepiride, yokhala ndi gawo lalikulu kwambiri, imaphatikiza ndi kuzungulira pancreatic β cell protein (maselo kulemera 65 kD / SURX), yomwe imalumikizidwa ndi njira zotengera potaziyamu za ATP, koma imasiyana ndi malo omangika a zotumphukira za sulfonylurea (mapuloteni okhala ndi kulemera kwakukulu kwa 140 kD / SUR1). Njirayi imabweretsa kutulutsidwa kwa insulin ndi exocytosis, pomwe kuchuluka kwa insulin komwe kumakhala kochepa kwambiri kumakhala kochepa kwambiri poyerekeza ndi zomwe zimachokera ku sulfonylurea ya m'badwo wachiwiri (mwachitsanzo, glibenclamide). Mphamvu yochepetsetsa ya glimepiride pa insulin secretion imaperekanso chiopsezo chochepa cha hypoglycemia.
Ntchito zowonjezera
Monga zachikhalidwe za sulfonylurea zachikhalidwe, koma mochuluka kwambiri, glimepiride yatchulira zotsatira zakunja (kutsika kwa insulin kukana, antiatherogenic, antiplatelet ndi antioxidant zotsatira).Kugwiritsa ntchito kwa shuga ndi zotumphukira (minofu ndi mafuta) kumachitika pogwiritsa ntchito mapuloteni apadera oyendetsa (GLUT1 ndi GLUT4) omwe amapezeka mu cell membranes. Kutumiza kwa glucose mumisempha imeneyi mumitundu yachiwiri ya shuga ndikusuntha pang'ono pakugwiritsa ntchito shuga. Glimepiride mofulumira imachulukitsa kuchuluka ndi ntchito yama glucose onyamula ma cell (GLUT1 ndi GLUT4), zomwe zimapangitsa kuti chiwopsezo cha glucose chikhale ndi zotumphukira.
Glimepiride imakhala yofooka kwambiri pamayendedwe a potPamu odalira a ATP. Mukatenga glimepiride, kuthekera kwa kagayidwe kazinthu kosintha kwa myocardium kuti ischemia amasungidwe.
Glimepiride imawonjezera ntchito ya phospholipase C, chifukwa chake kuchuluka kwa calcium kwamankhwala am'mimba ndi mafuta kumachepa, ndikupangitsa kuchepa kwa ntchito ya protein kinase A, yomwe imayambitsa kukondoweza kwa glucose metabolism.
Glimepiride amalepheretsa shuga kuti chiwindi chiwonjezeke ndi zina zake za fructose-2,6-bisphosphate, zomwe zimalepheretsa gluconeogeneis.
Glimepiride mosamala imalepheretsa cycloo oxygenase ndikuchepetsa kutembenuka kwa arachidonic acid kukhala thromboxane A2, chinthu chofunikira chogwirizana cha endogenous.
Glimepiride imathandizira kuchepetsa zamadzimadzi za lipid, zimachepetsa kwambiri lipid peroxidation, yomwe imalumikizidwa ndi anti-atherogenic yayo.
Glimepiride imawonjezera zomwe zili ndi ambulera ya io-tocopherol, zochitika za catalase, glutathione peroxidase ndi superoxide dismutase, zomwe zimathandizira kuchepetsa zovuta za oxidative nkhawa m'thupi la wodwalayo, lomwe limapezeka mthupi la odwala omwe ali ndi matenda a shuga.

Pharmacodynamics of metformin
Metformin ndi mankhwala a hypoglycemic ochokera pagulu la Biguanide. Zotsatira zake za hypoglycemic ndizotheka pokhapokha ngati katulutsidwe ka insulin (ngakhale kamachepetsedwa) kali kokhazikika. Metformin sichimakhudza maselo a pancreatic β komanso samakulitsa katulutsidwe ka insulini. Mlingo wothandizirana, metformin sayambitsa hypoglycemia mwa anthu. Kupanga kwa metformin sikumadziwika bwino. Amakhulupirira kuti metformin ikhoza kuyambitsa zotsatira za insulini kapena kuti imatha kuwonjezera zotsatira za insulin m'magawo a receptor receptor. Metformin imakulitsa chidwi cha insulin pakuwonjezera kuchuluka kwa zolandirira insulin padziko lapansi. Kuphatikiza apo, metformin imalepheretsa gluconeogenesis m'chiwindi, amachepetsa mapangidwe a mafuta achilengedwe omasuka ndi oxidation yamafuta, komanso amachepetsa ndende ya triglycerides (TG), LDL ndi VLDL m'magazi. Metformin imachepetsa kudya ndipo imachepetsa kuyamwa kwa matumbo. Amakonza michere ya magazi ya fibrinolytic mwa kuletsa minofu ya plasminogen activator inhibitor.
Pharmacokinetics
Glimepiride
Zogulitsa
Ndi kumeza mobwerezabwereza mankhwala tsiku lililonse 4 mg Cmax mu seramu zimatheka pambuyo pafupifupi maola 2,5, ndipo mpaka 309 ng / ml. Pali ubale womwe ulipo pakati pa mlingo ndi Cmax wa glimepiride m'madzi am'magazi, komanso pakati pa mlingo ndi AUC. Mukamwetsa glimepiride mtheradi bioavailability wathunthu. Kudya kulibe vuto lililonse chifukwa chonyamula, kupatula kutsika pang'ono pang'onopang'ono.
Kugawa
Glimepiride imadziwika ndi Vd yotsika kwambiri (pafupifupi 8.8 L), pafupifupi wofanana ndi Vd wa albin, omanga kwambiri mapuloteni a plasma (oposa 99%) komanso chilolezo chochepa (pafupifupi 48 ml / min).
Glimepiride amamuchotsa mkaka wa m'mawere ndikuwoloka chotchinga. Glimepiride salowerera BBB.
Kuyerekeza kwa limodzi komanso angapo (kawiri / tsiku) kayendetsedwe ka glimepiride sikunawululire kusiyana kwakukulu mu magawo a pharmacokinetic, ndipo kusiyana kwawo kwa odwala osiyanasiyana sikunali koyenera. Kuchuluka kwakukulu kwa glimepiride kunalibe.
Kupenda
Glimepiride imapangidwa mu chiwindi ndikupanga ma metabolites awiri - ma hydroxylated ndi carboxylated, omwe amapezeka mu mkodzo ndi ndowe.
Kuswana
T1 / 2 pa plasma ya mankhwala a seramu, yofanana ndi mobwerezabwereza makonzedwe, pafupifupi maola 5-8Mutatha kutenga glimepiride muyezo waukulu, T1 / 2 imawonjezeka pang'ono.
Pambuyo pakukonzekera kamlomo kamodzi, 58% ya glimepiride imachotsedwa impso (mwa mawonekedwe a metabolites) ndi 35% kudzera m'matumbo. Zinthu zosasinthika mkodzo sizikupezeka.
Terminal T1 / 2 ya hydroxylated ndi carboxylated glimepiride metabolites ndi maola 3-5 ndi maola 5-6, motsatana.
Pharmacokinetics mu milandu yapadera yamankhwala
Odwala a mitundu yosiyanasiyana ndi misinkhu yosiyanasiyana, magawo a pharmacokinetic mu glimepiride ndi ofanana.
Odwala omwe ali ndi vuto la impso (otsika CC), panali chizolowezi chowonjezera kuchuluka kwa glimepiride komanso kutsika kwake kozungulira pama seramu yamagazi, zomwe zimachitika makamaka chifukwa cha kupukusa kwapafupipafupi kwa glimepiride chifukwa chotsika mapuloteni am'madzi am'magazi. Chifukwa chake, m'gulu lino la odwala palibe chiopsezo chowonjezereka cha glimepiride.
Metformin
Zogulitsa
Pambuyo pakukonzekera pakamwa, metformin imatengedwa kuchokera m'matumbo am'mimba kwathunthu. Mtheradi bioavailability ndi 50-60%. Cmax mu plasma imakhala pafupifupi 2 μg / ml ndipo imatheka pambuyo pa maola 2,5.Ndibwino kuti mukumeza chakudya, kuyamwa kwa metformin kumachepa ndikuchepera.
Kugawa komanso kagayidwe
Metformin imagawidwa mwachangu mu minofu, sikuti imagwira mapuloteni a plasma. Amapangidwira pamlingo wofooka kwambiri.
Kuswana
T1 / 2 ndi pafupifupi maola 6.5. Atalimbikitsidwa ndi impso. Kuvomerezeka kwa odzipereka athanzi ndi 440 ml / min (nthawi 4 kuposa KK), zomwe zimawonetsa kukhalapo kwa secretion ya tubular yogwira ya metformin. Pharmacokinetics mu milandu yapadera yamatenda Ndi kulephera kwa aimpso, pamakhala chiopsezo cha kuchuluka kwa mankhwalawa.
Pharmacokinetics ya Amaril® M yokhala ndi Mlingo wokhazikika wa glimepiride ndi metformin
Cmax ndi AUC imatha kumwa mankhwala osakanikirana a piritsi (piritsi lokhala ndi glimepiride 2 mg + metformin 500 mg) amakwaniritsa njira za bioequivalence mukayerekeza ndi zofananira zomwezo mukamamwa pamodzi monga kukonzekera kwapadera (piritsi la glimepiride 2 mg ndi piritsi ya metformin 500 mg).
Kuphatikiza apo, kuchuluka kwa kuchuluka kwa Cmax ndi AUC kwa glimepiride kunawonetsedwa ndi kuwonjezeka kwa mlingo wake pakuphatikizidwa ndi Mlingo wokhazikika kuchokera 1 mg mpaka 2 mg ndi mlingo wokhazikika wa metformin (500 mg) pokonzekera izi.
Kuphatikiza apo, panalibe kusiyana kwakukulu pachitetezo, kuphatikiza mbiri ya zovuta zosagwirizana, pakati pa odwala omwe amatenga Amaril M 1 mg + 500 mg ndi odwala omwe Amaril M 2 mg + 500 mg.

Zizindikiro
Chithandizo cha matenda a shuga a 2 (kuwonjezera pa zakudya, masewera olimbitsa thupi komanso kuwonda):
pamene glycemic control siyingatheke ndi monotherapy yokhala ndi glimepiride kapena metformin,
Mukamachotsa kuphatikiza mankhwala ndi glimepiride ndi metformin ndikumwa imodzi ya mankhwala Amaril® M.

Contraindication
Mtundu woyamba wa shuga
matenda ashuga ketoacidosis (kuphatikiza mbiriyakale), chikomokere cha matenda a shuga
pachimake kapena matenda metabolic acidosis,
kwambiri kuwonongeka kwa chiwindi ntchito (osadziwa ntchito, chithandizo cha insulini ndikofunikira kuti chiwonetsero chokwanira cha glycemic),
hemodialysis odwala (kupanda nzeru)
Kulephera kwaimpso ndi kuwonongeka kwa impso (plasma creatinine ndende ≥1.5 mg / dL (135 μmol / L) mwa amuna ndi ≥1.2 mg / dL (110 μmol / L) mwa akazi kapena kuchepa kwa CK (chiwopsezo cha lactic acidosis) ndi zotsatira zina za metformin)
pachimake zinthu zomwe matenda aimpso (kuchepa madzi m`thupi, matenda oopsa, mantha, intravascular makonzedwe a ayodini osiyanitsidwa) ndikotheka,
matenda owopsa komanso osachiritsika omwe angayambitse minyewa hypoxia (mtima kapena kupuma, kusokonekera kwamatenda ndi subacute myocardial infarction, mantha),
chizolowezi chopanga lactic acidosis, mbiri ya lactic acidosis,
zinthu zopsinjika (kuvulala kwambiri, kuwotcha, maopaleshoni, matenda oopsa ndi malungo, septicemia),
kutopa, kufa ndi njala, kutsatira zakudya zochepa zama calori (zosakwana 1000 cal / tsiku),
Malabsorption chakudya ndi mankhwala osokoneza bongo (ndi matumbo kutsekeka, matumbo paresis, kutsegula m'mimba, kusanza),
uchidakwa wambiri, kuledzera
lactase akusowa, galactose tsankho, shuga-galactose malabsorption,
mimba, kukonzekera pakati,
nthawi yoyamwitsa,
ana ndi achinyamata ochepera zaka 18 (zosakwanira pachipatala),
Hypersensitivity pamagawo a mankhwala,
Hypersensitivity kuti sulfonylureas, mankhwala a sulfa kapena biguanides.
Mosamala: m'masabata oyamba omwe mumalandira chithandizo ndi Amaril ® M, chiopsezo cha hypoglycemia chikuwonjezeka, chomwe chimafuna kuwunikira mosamala. M'mikhalidwe yomwe chiwopsezo cha kukhala ndi hypoglycemia chikuwonjezeka (odwala omwe safuna kapena osagwirizana ndi dokotala, odwala ambiri okalamba, kudya kwambiri, kudya mosazolowereka, kudya zakudya, odwala omwe ali ndi vuto lochita masewera olimbitsa thupi chifukwa chomwa thupi Zakudya, pakumwa zakumwa zomwe zimakhala ndi ethanol, makamaka kuphatikiza kudya kudya, chiwindi ndiimpso, komanso zovuta zina za endocrine. iwo monga chithokomiro chithokomiro, kusowa kwa timadzi mu anterior pituitary ndi adrenal cortex, kukhudza kagayidwe kagayidwe kapena kutseguka kwa njira zomwe zimapangitsa kukulitsa kuchuluka kwa glucose panthawi ya hypoglycemia, panthawi yopanga matenda omwe amalumikizana panthawi yamankhwala kapena masinthidwe a moyo (monga Odwala amafunikira kwambiri kuwunika kwa shuga wamagazi ndi zizindikiro za hypoglycemia, angafunikire kusintha kwa Amaril® M). Ndi munthawi yomweyo kugwiritsa ntchito mankhwala ena. Odwala okalamba (nthawi zambiri amakhala ndi kuchepa kwa asymptomatic mu ntchito yaimpso). Nthawi zina pamene ntchito ya impso imakula, monga kuyamba kumwa mankhwala a antihypertensive kapena okodzetsa, komanso NSAIDs (chiwopsezo cha lactic acidosis ndi zotsatira zina za metformin). Mukamagwira ntchito yolemera (chiopsezo chokhala ndi lactic acidosis mukatenga metformin imawonjezeka). Ndi abrasion kapena kusowa kwa zizindikiro za adrenergic antiglycemic malamulo poyambira kukhala ndi hypoglycemia (odwala okalamba, omwe ali ndi vuto lochita kuperewera kwa magazi kapena munthawi yomweyo amakhala ndi beta-blockers, clonidine, guanethidine ndi ena omvera chisoni, odwala oterowo amafunika kuwunika mozama magazi a glucose) . Pankhani ya kuchepa kwa glucose-6-phosphate dehydrogenase (mwa odwala oterewa, mukamamwa mankhwala a sulfonylurea, hemolytic anemia ikhoza kukhala, motero, kugwiritsa ntchito mitundu ina ya mankhwala a hypoglycemic omwe siotuluka mu sulfonylurea mu odwala awa ayenera kuganiziridwa).

Mimba komanso kuyamwa
Mankhwalawa amatsutsana pakukonzekera kutenga pakati.
Mankhwala sayenera kumwedwa panthawi yomwe ali ndi pakati chifukwa cha zovuta zomwe zingachitike pakukula kwa fetal. Amayi oyembekezera ndi amayi omwe akukonzekera kubereka ayenera kudziwitsa oyang'anira azaumoyo.Pa nthawi yoyembekezera, azimayi omwe ali ndi vuto la metabolism wama metabolism omwe samakonzedwa ndi zakudya zomwezo komanso zolimbitsa thupi ayenera kulandira insulin.
Pofuna kupewa kumwa mankhwalawa mkaka wa m'mawere, azimayi omwe akuyamwitsa sayenera kumwa mankhwalawa. Ngati kuli kofunikira kuchita mankhwala a hypoglycemic, wodwalayo amayenera kupita ku chithandizo cha insulin, apo ayi ayenera kusiya kuyamwitsa.

Malangizo apadera
Lactic acidosis
Lactic acidosis ndizosowa koma zowopsa (zomwe zimafa kwambiri popanda kupezeka chithandizo choyenera) zovuta za metabolic zomwe zimayamba chifukwa cha kudzikundikira kwa metformin panthawi yamankhwala. Milandu ya lactic acidosis yokhala ndi metformin yawonedwa makamaka mwa odwala omwe ali ndi matenda osokoneza bongo omwe amalephera kwambiri aimpso. Kukula kwa lactic acidosis kungayambitse ndipo kuyenera kuchepetsedwa poyesa kupezeka kwa zinthu zina zokhudzana ndi chiopsezo cha lactic acidosis mwa odwala, monga odwala matenda osokoneza bongo a mellitus, ketoacidosis, kusala kudya kwa nthawi yayitali, kumwa kwambiri zakumwa zomwe zimakhala ndi ethanol, kulephera kwa chiwindi ndi zina zomwe zimayendetsedwa ndi hypoxia.
Lactic acidosis imadziwika ndi kufupika kwa acidotic, kupweteka kwam'mimba komanso hypothermia, ndi chitukuko cha pambuyo pake chamkati. Kuwonetsera ma labotale ndi kuwonjezeka kwa kuchuluka kwa lactate m'magazi (> 5 mmol / l), kuchepa kwa pH ya magazi, kuphwanya kwa-electrolyte usawa ndi kuwonjezeka kwa kuchepa kwa anions ndi chiŵerengero cha lactate / pyruvate. Panthawi yomwe metformin imayambitsa lactic acidosis, plasma ndende ya metformin nthawi zambiri imakhala> 5 μg / ml. Ngati lactic acidosis ikukayikira, metformin iyenera kusiyidwa pomwepo ndipo wodwala ayenera kuchipatala.
Pafupipafupi milandu ya lactic acidosis mwa odwala omwe amamwa metformin ndi yotsika kwambiri (pafupifupi 0,03 milandu / zaka 1000 za odwala). Milandu yomwe yatchulidwa idachitika makamaka mwa odwala omwe ali ndi matenda osokoneza bongo omwe ali ndi vuto lalikulu laimpso, kuphatikizapo Ndi kobadwa nako matenda a impso ndi aimpso hypoperfusion, nthawi zambiri pamaso pamachitidwe ambiri amafunikira chithandizo chamankhwala.
Chiwopsezo cha lactic acidosis chimawonjezeka ndi kuopsa kwa impso kukanika komanso ndi zaka. Kuchepa kwa lactic acidosis mukamalandira metformin kungathe kuchepetsedwa ndikuwunikira ntchito ya aimpso ndikugwiritsa ntchito mitundu yaying'ono ya metformin. Pazifukwa zomwezo, pazinthu zomwe zimakhudzana ndi hypoxemia kapena kuchepa mphamvu kwa madzi, ndikofunikira kupewa kupewa Amaril® M.
Chifukwa chakuti kusokonekera kwa chiwindi kugwira ntchito kungachepetse kutulutsa kwa lactate, kugwiritsa ntchito Amaril ® M kuyenera kupewedwa mwa odwala omwe ali ndi zizindikiro zamankhwala kapena zasayansi ya matenda a chiwindi.
Kuphatikiza apo, kuyendetsa kwa Amaril ® M kuyenera kuyimitsidwa kwakanthawi maphunziro a x-ray osagwirizana ndi intaneti ya iodine yomwe ili ndi zotsutsana nawo isanachitike. Metformin iyenera kuyimitsidwa kwakanthawi kwa maola 48 asanafike ndi maola 48 atachitidwa opaleshoni pogwiritsa ntchito mankhwala opaleshoni wamba.
Nthawi zambiri lactic acidosis imayamba pang'onopang'ono ndipo imawonetsedwa pokhapokha ngati simunadziwike bwino, monga thanzi lofooka, myalgia, kulephera kupuma, kuwodzera kugona komanso kusadziwika kwa m'matumbo. Ndi acidosis, hypothermia, kuchepa kwa magazi ndi kukana kwa bradyarrhythmia ndikotheka. Wodwala komanso dokotala yemwe akupezekapo ayenera kudziwa kufunikira kwa zizindikirozi. Wodwalayo ayenera kulangizidwa kuti azidziwitsa dokotala ngati izi zikuchitika.Kuti mumvetse bwino matenda a lactic acidosis, ndikofunikira kudziwa kuchuluka kwa ma electrolyte ndi ma ketones m'magazi, kuchuluka kwa shuga m'magazi, pH ya magazi, kuchuluka kwa lactate ndi metformin m'magazi. Kusala plasma plasma lactate ndende kusala kudya kwaposachedwa, koma kupitirira 5 mmol / l mwa odwala omwe akutenga metformin, sikukutanthauza lactic acidosis, kuchuluka kwake kungafotokozeredwe ndi njira zina, monga matenda osokoneza bongo oletsa kubereka kapena kunenepa kwambiri, mwamphamvu kwambiri katundu kapena zolakwika zaluso panthawi yoyeserera magazi pakuwunika.
Kupezeka kwa lactic acidosis wodwala yemwe ali ndi matenda osokoneza bongo omwe ali ndi metabolic acidosis chifukwa cha ketoacidosis (ketonuria ndi ketonemia) ayenera kuganiziridwa.
Lactic acidosis ndi vuto lovuta lomwe limafuna chithandizo chamankhwala. Pankhani ya lactic acidosis, muyenera kusiya kumwa Amaril ® M ndikuyambitsa njira zothandizira ambiri. Metformin imachotsedwa m'magazi pogwiritsa ntchito hemodialysis ndi chilolezo chofika mpaka 170 ml / min, chifukwa chake, ndikulimbikitsidwa, malinga ngati palibe zosokoneza za hemodynamic, hemodialysis yomweyo kuti ichotse metformin ndi lactate wokhazikika. Njira zotere nthawi zambiri zimayambitsa kuzimiririka kwazizindikiro komanso kuchira.
Kuwunika momwe mankhwalawa amathandizira
Kuchita bwino kwa mankhwala aliwonse a hypoglycemic kuyenera kuyang'aniridwa pang'onopang'ono kuwunika kwa glucose ndi glycosylated hemoglobin m'magazi. Chithandizo cha mankhwalawa ndikutanthauza kusintha matendawa. Kuchuluka kwa hemoglobin wa glycosylated kumapangitsa kuwunika kwa glycemic control.
Hypoglycemia
Mu sabata yoyamba yamankhwala, kuwunikira mosamala ndikofunikira chifukwa cha chiwopsezo cha hypoglycemia, makamaka ndi chiwopsezo chowonjezeka cha chitukuko chake (odwala omwe safuna kapena osafuna kutsatira malingaliro a dokotala, odwala ambiri okalamba, zakudya zopanda pake, zakudya zopanda pake, kapena zakudya zosaduka, Ndi vuto pakati pa zolimbitsa thupi kudya zakudya, kudya zakudya, kudya Mowa, makamaka kuphatikiza kudya, kulumala kwa impso, ndi vuto lalikulu. ntchito ya chiwindi, ndimatenda ena osawerengeka a endocrine system (mwachitsanzo, kukanika kwina kwa chithokomiro ndi kusowa kwa mahomoni mu anterior pituitary kapena adrenal cortex, pomwe kugwiritsa ntchito mankhwala ena omwe amakhudza kagayidwe kazakudya.
Zikatero, kuyang'anitsitsa shuga wamagazi ndikofunikira. Wodwala ayenera kudziwitsa dokotala za zinthu izi zomwe zingayambitse ngozi komanso zizindikiro za hypoglycemia, ngati zingatero. Ngati pali chiopsezo cha hypoglycemia, kusintha kwa mankhwalawa kwa mankhwalawa kapena chithandizo chonse chofunikira kungafunike. Njira izi zimagwiritsidwa ntchito nthawi iliyonse matenda akayamba kuthandizira kapena kusintha kwa moyo wa wodwalayo kumachitika. Zizindikiro za hypoglycemia, zomwe zimawonetsa adrenergic antihypoglycemic regulation poyankha kukulitsa hypoglycemia, sitha kutchulidwa kapena kusakhalapo ngati hypoglycemia imayamba pang'onopang'ono, komanso mwa odwala okalamba, omwe ali ndi vuto la neuronomic kapena ndiwothandizanso pamodzi ndi beta-blockers, clonidine, ndi ena ammosoma.
Pafupifupi nthawi zonse, hypoglycemia imatha kuimitsidwa msanga ndi kudya kwapakatikati (shuga kapena shuga, mwachitsanzo, chidutswa cha shuga, msuzi wa zipatso wokhala ndi shuga, tiyi ndi shuga). Pachifukwa ichi, wodwalayo ayenera kunyamula shuga osachepera 20 g. Angafunike thandizo kuchokera kwa ena kuti apewe zovuta. Zilime zotsekemera sizothandiza.
Kuchokera pazomwe mukugwiritsa ntchito mankhwala ena a sulfonylurea, zimadziwika kuti, ngakhale kuti mphamvu zoyambirira zomwe zidatengedwa, hypoglycemia imatha kubwereranso, motero odwala ayenera kuyang'aniridwa kwambiri. Kukula kwambiri kwa hypoglycemia kumafuna chithandizo chamankhwala komanso kuyang'aniridwa kwachipatala, nthawi zina chithandizo cha mankhwala.
Mayendedwe onse
Ndikofunikira kuti muchepetse vuto la glycemia mothandizidwa ndi zovuta: kutsatira zakudya ndi kuchita masewera olimbitsa thupi, kuchepetsa thupi, ndipo ngati ndi kotheka, kudya mankhwala a hypoglycemic nthawi zonse. Odwala ayenera kudziwitsidwa zakufunika kotsatira kutsatira malangizo azakudya komanso kuchita masewera olimbitsa thupi nthawi zonse.
Zizindikiro zamatenda a glucose omwe amayendetsedwa bwino m'magazi amaphatikizapo oliguria, ludzu, ludzu lalikulu, khungu louma, ndi ena.
Ngati wodwala amathandizidwa ndi dokotala osam'chiritsa (mwachitsanzo, kuchipatala, ngozi, kufunikira kwa dokotala patsiku loti atuluke), wodwalayo ayenera kumuuza zakudwala ndi matenda a shuga.
M'mikhalidwe yovuta (mwachitsanzo, kuwawa, opareshoni, matenda opatsirana ndi malungo), kuwongolera glycemic kungakhale osokonezeka, komanso kusintha kwakanthawi kochepa ka insulini kungafunike kuti muwonetsetse pakufunika kwa metabolic.
Impso ntchito kuwunika
Amadziwika kuti metformin imakumbidwa makamaka ndi impso. Ndi vuto laimpso, chiwopsezo cha kuphatikizika kwa metformin komanso kukula kwa lactic acidosis kumawonjezeka. Pamene serum creatinine ndende ikapitilira zaka zapamwamba za malire, monga Amaryl® M sikulimbikitsidwa. Kwa odwala okalamba, kuchepetsedwa mosamala kwa mlingo wa metformin ndikofunikira kuti musankhe mankhwalawa ochepera, chifukwa ntchito ya impso imachepa ndi msinkhu. Ntchito yeniyeni kwa odwala okalamba iyenera kuyang'aniridwa pafupipafupi ndipo, monga lamulo, mlingo wa metformin suyenera kuwonjezeka mpaka mlingo wake wokwanira tsiku lililonse.
Kugwiritsa ntchito kwina kwa mankhwalawa kungakhudze impso kapena kuwonekera kwa metformin, kapena kuyambitsa kusintha kwakukulu mu hemodynamics.
Kafukufuku wa X-ray wokhala ndi intravascular management ya iodine okhala ndi mitundu yosiyanitsa (mwachitsanzo, intravenous urography, intravenous cholangiography, angiography ndi CT pogwiritsa ntchito sing'anga): Zinthu za I / O zosiyanitsa za iodini zomwe zimapangidwa kuti zifufuze zimatha kuyambitsa kupweteka kwambiri kwaimpso, kugwiritsidwa ntchito kwawo kumagwirizana ndi chitukuko lactic acidosis odwala akutenga metformin. Ngati kuphunzira koteroko kukonzekera, Amaril® M iyenera kuthetsedweratu njirayi isayambiridwenso pambuyo pake patatha maola 48. Njira ya Amaril® imatha kuyambiranso pokhapokha kuwunikira komanso kupeza magwiridwe antchito aimpso.
Mikhalidwe yomwe hypoxia imatha
Kuwonongeka kapena kugwedezeka kwa magwero aliwonse, kusokonezeka kwa mtima pachimake, kulowetsedwa kwakumaso, komanso zinthu zina zodziwika ndi minofu hypoxemia ndi hypoxia kungayambitsenso kulephera kwa impso komanso kuwonjezera ngozi ya lactic acidosis. Ngati odwala omwe amamwa mankhwalawa ali ndi zoterezi, ayenera kusiya kumwa mankhwalawo.
Opaleshoni
Ndi chithandizo chilichonse chomwe mungakonzekere kuchitidwa opaleshoni, ndikofunikira kusiya mankhwala ndi mankhwalawa mkati mwa maola 48 (kupatula njira zazing'ono zomwe sizikufuna kuletsa kudya ndi madzi), mankhwalawa sangathenso kuyambikanso kufikira pakulowetsa mkamwa ndikubwezeretsanso ntchito.
Mowa (zakumwa zomwe zimakhala ndi ethanol)
Ethanol amadziwika kuti amalimbikitsa mphamvu ya metformin pa lactate metabolism. Odwala ayenera kuchenjezedwa kuti asamwe zakumwa zomwe zimakhala ndi ethanol pamene akutenga Amaril® M.
Kuwonongeka kwa chiwindi
Popeza lactic acidosis imagwirizanitsidwa ndi vuto la chiwindi nthawi zina, odwala omwe ali ndi matenda am'chipatala kapena a labotale kuwonongeka kwa chiwindi ayenera kupewa kugwiritsa ntchito mankhwalawa.
Sinthani mkhalidwe wamatenda a wodwala wokhala ndi shuga yoyendetsedwa kale
Wodwala matenda a shuga a mellitus, omwe kale anali olamulidwa ndi kugwiritsa ntchito metformin, ayenera kuwunika nthawi yomweyo, makamaka ndi matenda owopsa komanso osazindikira bwino, kupatula ketoacidosis ndi lactic acidosis. Phunziroli liphatikizire: kutsimikiza kwa seramu electrolyte ndi matupi a ketone, kuchuluka kwa shuga wamagazi ndipo, ngati kuli kofunikira, magazi pH, magazi a lactate, pyruvate ndi metformin. Pamaso pa mtundu uliwonse wa acidosis, Amaril® M iyenera kuyimitsidwa nthawi yomweyo ndi mankhwala ena omwe adayikidwa kuti azitha kuyang'anira glycemic.
Zidziwitso Zodwala
Odwala ayenera kudziwa zoopsa zomwe zingachitike ndi mankhwalawa, komanso njira zina zamankhwala zomwe zingagwiritsidwe ntchito. Ndikofunikanso kufotokozera momveka bwino kufunika kotsatira malangizo azakudya, kuchita masewera olimbitsa thupi pafupipafupi komanso kuyang'anira kuchuluka kwa shuga m'magazi, glycosylated hemoglobin, ntchito yaimpso komanso magawo a hematological, komanso chiopsezo chokhala ndi hypoglycemia, zizindikiro zake ndi chithandizo, komanso mikhalidwe kudziwikiratu kukukula kwake.
The kuchuluka kwa vitamini B12 m'magazi
Kuchepa kwa kuchuluka kwa vitamini B12 mu seramu pansipa kwawonekeranso pakalibe kuwonetsera kwachipatala kunawonedwa pafupifupi 7% ya odwala omwe amatenga Amaril ® M, komabe, sizinachitike kawirikawiri motsatana ndi kuchepa kwa magazi ndipo zimasinthidwa mwachangu pomwe mankhwalawa adatha kapena vitamini B12 itaperekedwa. Odwala omwe ali ndi vuto losakwanira kapena mavitamini B12 amatha kutsitsa kuchuluka kwa vitamini B12. Kwa odwala oterewa, pafupipafupi, zaka zilizonse ziwiri, kutsimikiza kwa kuchuluka kwa vitamini B12 mu seramu yamagazi kungakhale kothandiza.
Laborator chithandizo chitetezo
Hematological magawo (hemoglobin kapena hematocrit, maselo ofiira am'magazi) ndi ntchito yaimpso (serum creatinine ndende) iyenera kuyang'aniridwa osachepera kamodzi pachaka kwa odwala omwe ali ndi vuto lofanana laimpso, komanso osachepera 2-4 pachaka odwala omwe ali ndi ndende ya creatinine mu seramu pa VGN ndi odwala okalamba. Ngati ndi kotheka, wodwalayo amawonetsedwa koyenera ndikuwathandiza pa kusintha kulikonse kwachidziwikire kwa matenda. Ngakhale kuti chitukuko cha kuchepa kwa magazi m'thupi cha megaloblastic sichinawoneke kawirikawiri mukamalandira metformin, ngati akukayikira, kuyesedwa kuyenera kuchitika kupatula kusowa kwa vitamini B12.

Kukopa pa kuyendetsa magalimoto ndi njira zina zofunika kuwonjezera chidwi cha anthu
Kuchuluka kwa wodwalayo kumatha kuwonongeka chifukwa cha hypoglycemia ndi hyperglycemia, makamaka kumayambiriro kwa mankhwalawa kapena kusintha kwa mankhwalawa, kapena kusamalira mankhwalawa mosasamala. Izi zimatha kukhudza kuyendetsa bwino magalimoto ndikuchita zina zomwe zingakhale zoopsa.
Odwala ayenera kuchenjezedwa za kufunika kosamala poyendetsa, makamaka pakakhala vuto la hypoglycemia ndi / kapena kuchepa kwakali kwa oyambira ake.

Kupanga
Piritsi limodzi lili:
Zinthu zomwe zimagwira ntchito: glimepiride micronized 2 mg, metformin hydrochloride 500 mg.
Omwe amathandizira: lactose monohydrate, sodium carboxymethyl wowuma, povidone K30, cellcrystalline cellulose, crospovidone, magnesium stearate.
Zomwe zimapangidwa ndi membrane wa filimuyi: hypromellose, macrogol 6000, titanium dioxide (E171), sera wa carnauba.

Mlingo ndi makonzedwe
Monga lamulo, muyeso wa Amaril® M umatsimikiziridwa ndi kuphatikizidwa kwa shuga m'magazi a wodwala. Mlingo wotsika kwambiri wokwanira kukwaniritsa zoyenera za metabolic uyenera kugwiritsidwa ntchito.
Pa mankhwala ndi Amaril ® M, ndikofunikira kudziwa pafupipafupi kuchuluka kwa shuga m'magazi. Kuphatikiza apo, kuwunika pafupipafupi kuchuluka kwa hemoglobin ya glycosylated m'magazi kumalimbikitsidwa.
Kukhazikika kwa mankhwala osokoneza bongo, mwachitsanzo, kudumpha mlingo wotsatira, sikuyenera kuthandizidwa ndi kudya kwina kwa mlingo waukulu.
Zochita za wodwalayo pakafunikira zolakwa mukamamwa mankhwalawo (makamaka, polumphira mlingo wotsatira kapena kudumphira chakudya), kapena ngati sizotheka kumwa mankhwalawo, ayenera kukambirana ndi wodwalayo ndi dokotala pasadakhale.
Chifukwa Popeza kuwongolera kwa metabolic kumalumikizidwa ndi kukhudzika kwa minofu kumapangitsa insulini, kufunikira kwa glimepiride kumatha kuchepa panthawi yamankhwala ndi Amaril® M. Pofuna kupewa kukula kwa hypoglycemia, ndikofunikira kuchepetsa mlingo kapena kusiya kumwa Amaril® M.
Amaryl® M iyenera kumwedwa 1 kapena 2 / tsiku ndi chakudya.
Mulingo waukulu wa metformin pa mlingo uliwonse ndi 1000 mg.
Mulingo wambiri watsiku ndi tsiku: glimepiride - 8 mg, wa metformin - 2000 mg.
Ndi owerengeka ochepa okha omwe ali ndi tsiku lililonse la glimepiride oposa 6 mg.
Popewa kukula kwa hypoglycemia, mlingo woyambirira wa Amaril ® M sayenera kupitilira Mlingo wa glimepiride ndi metformin yomwe wodwala wayamba kumwa. Mukasamutsa odwala kuti atenge kuphatikiza kwa glimepiride ndi metformin ku Amaryl® M, mlingo wake umatsimikiziridwa pamiyeso ya glimepiride ndi metformin yoyambira kale. Ngati pakufunika kuwonjezera mlingo, tsiku ndi tsiku mlingo wa Amaryl® M uyenera kukhala wozikika piritsi limodzi lokha la Amaryl® M 1 mg + 250 mg kapena piritsi 1 Amaryl® M 2 mg + 500 mg.
Kutalika kwa chithandizo: Amaril® M nthawi zambiri amathandizidwa nthawi yayitali.
Kafukufuku wokhudza chitetezo ndi luso la mankhwalawa kwa ana omwe ali ndi matenda a shuga a 2 sanachitike.
Amadziwika kuti metformin imachotsedwa makamaka ndi impso, ndipo popeza chiwopsezo chokhala ndi vuto lalikulu la metformin mwa odwala omwe ali ndi vuto laimpso ndilambiri, chitha kugwiritsidwa ntchito mwa odwala omwe ali ndi vuto laimpso. Chifukwa chakuti ndi zaka, ntchito ya impso imachepa, odwala metformin okalamba ayenera kugwiritsidwa ntchito mosamala. Mlingo uyenera kusankhidwa mosamala komanso kuyang'anira kuwonekera kwa ntchito yaimpso kuyenera kuthandizidwa.

Zotsatira zoyipa
Glimepiride + metformin
Kugwiritsa ntchito kuphatikiza kwa glimepiride ndi metformin, onse mwanjira yophatikiza yaulere yopangidwa ndi glimepiride ndi metformin, komanso monga kukonzekera kophatikizidwa ndi Mlingo wokhazikika wa glimepiride ndi metformin, kumalumikizidwa ndi mawonekedwe omwewo a chitetezo monga kugwiritsidwa ntchito kwa lirilonse la mankhwalawa mosiyana.
Glimepiride
Kutengera luso lazachipatala ndi glimepiride ndi chidziwitso chodziwika pazopeza zina za sulfonylurea, kukulitsa zovuta zomwe zalembedwa pansipa ndizotheka.
Kuchokera kumbali ya kagayidwe ndi zakudya: kukulitsa kwa hypoglycemia ndikotheka, komwe kungakhale kofalikira. Zizindikiro zakukula kwa hypoglycemia - kupweteka mutu, kupweteka kwambiri, kusanza, kufooka, kufoka, kusowa tulo, kuchepa chidwi pang'onopang'ono, kuchepa tulo komanso kuchepa kwa ma psychomotor, kupsinjika, kusokonezeka, kusokonezeka kwa mawu, aphasia, kuwonongeka kwa mawonekedwe, kunjenjemera, paresis, kusokonezeka kwa chidwi, chizungulire, kusowa pogwira, kulephera kudziletsa, kupuma, kukomoka, kugona komanso kulephera kuzindikira mpaka kukula kwa chikomokere, kupuma kosakhazikika ndi bradycardia.Kuphatikiza apo, kukulira kwa zizindikiro za adrenergic anti-glycemic regulation poyambitsa kukulitsa kwa hypoglycemia, monga kutuluka thukuta, khungu la khungu, nkhawa zowonjezera, tachycardia, kuthamanga kwa magazi, kumva kukwera kwa kugunda kwa mtima, angina pectoris ndi kusokonekera kwa mtima. Chithunzi cha matenda ovuta kwambiri a hypoglycemia chingafanane ndi kuphwanya kwamatenda. Zizindikiro zimakhala kuti zimathetsedwa nthawi zonse pambuyo pakutha kwa hypoglycemia.
Kuchokera kumbali ya gawo la masomphenyawo: kuwonongeka kwakanthawi kowoneka, makamaka koyambirira kwa chithandizo, chifukwa cha kusinthasintha kwa kuchuluka kwa shuga m'magazi. Chomwe chikuwonongeka m'maso ndikusintha kwakanthawi chifukwa cha kufupika kwa malensi, kutengera kukhazikika kwa magazi m'magazi, komanso chifukwa cha kusintha kwa mndandanda wawo wamagama.
Kuchokera mmimba: Kukula kwa zizindikiro zam'mimba, monga mseru, kusanza, kumverera kwodzaza m'mimba, kupweteka kwam'mimba komanso kutsegula m'mimba.
Kumbali ya chiwindi ndi njira ziwiri: hepatitis, kuchuluka kwa michere ya chiwindi ndi / kapena cholestasis ndi jaundice, yomwe imatha kupita patsogolo pachiwopsezo cha chiwindi, koma ikhoza kudutsa pambuyo pakutha kwa glimepiride.
Kuchokera pa hemopoietic dongosolo: thrombocytopenia, nthawi zina - leukopenia kapena hemolytic anemia, erythrocytopenia, granulocytopenia, agranulocytosis kapena pancytopenia. Mankhwala atalowa m'msika, milandu yovuta ya thrombocytopenia (yokhala ndi mapuloteni ochepera 10,000 / μl) ndi thrombocytopenic purpura ikufotokozedwa.
Kusokonezeka kwa dongosolo la chitetezo chamthupi: zimachitika mthupi kapena pseudo-allergic eg. Izi zimachitika pafupifupi nthawi zonse zimakhala ndi mawonekedwe ofatsa, koma amatha kulowa mu mawonekedwe owopsa ndi kupuma movutikira kapena kuchepa kwa kuthamanga kwa magazi, mpaka pakukhazikika kwa anaphylactic. Pakachitika chitukuko cha urticaria, adotolo ayenera kudziwitsidwa nthawi yomweyo. Kuphatikiza ziwengo kumatheka ndi zotumphukira zina za sulfonylurea, sulfonamides, kapena zinthu zina. Thupi lawo siligwirizana.
Zina: photosensitization, hyponatremia.
Metformin
Kuchokera kumbali ya kagayidwe: lactic acidosis.
Kuchokera pamatumbo: matumbo am'mimba (mseru, kusanza, kupweteka kwam'mimba, kupangika kwa mpweya, kuwonda ndi matenda anorexia) - zomwe zimachitika kawirikawiri ndi metformin monotherapy - ndizotheka pafupifupi 30% kuposa ndi placebo, makamaka koyambirira nthawi ya chithandizo. Zizindikirozi zimakhalapo kwakanthawi, ndikumangopitiliza mankhwala mosamalitsa. Nthawi zina, kuchepetsa kwakanthawi kwa mankhwalawa kungakhale kothandiza. Chifukwa chakuti kukula kwa zizindikiro za m'mimba nthawi yoyamba ya chithandizo kumadalira mlingo, Zizindikiro zimatha kuchepetsedwa pang'onopang'ono ndikukula kwa mankhwalawo ndikumwa mankhwala ndi chakudya. Popeza kutsegula m'mimba kwambiri komanso / kapena kusanza kumatha kubweretsa kusowa kwam'madzi komanso azotemia asanabadwe, akaonekera, muyenera kusiya kwakanthawi kutenga Amaril® M. Maonekedwe a nonspecific m'matumbo mwa odwala omwe ali ndi mtundu wachiwiri wa matenda a shuga, okhala ndi chikhalidwe chokhazikika mukamamwa Amaril ® M imatha kugwirizanitsidwa osati kokha ndi chithandizo chamankhwala, komanso matenda opatsirana kapena kukula kwa lactic acidosis.
Kumayambiriro kwa chithandizo ndi metformin, pafupifupi 3% ya odwala amatha kumva kukoma kosasangalatsa kapena zitsulo mkamwa, zomwe nthawi zambiri zimazimiririka zokha.
Kumbali ya chiwindi ndi biliary thirakiti: mayesero osagwira ntchito a chiwindi kapena hepatitis, omwe adayambiranso pamene metformin adasiya. Ndi chitukuko cha pamwambapa kapena zina zopanda pake, wodwalayo ayenera kudziwitsa dokotala wanu za izi nthawi yomweyo. Popeza zochita zina zosasangalatsa, incl.hypoglycemia, lactic acidosis, matenda a hematologic, zovuta zina za mziwopsezo komanso zovuta zina komanso vuto la chiwindi lingathe kuwopseza moyo wa wodwalayo, ngati zoterezi zitachitika, wodwalayo ayenera kudziwitsa dokotala wake za izi ndikuletsa kuperekera mankhwala asanalandire malangizo kuchokera kwa dokotala.
Pa khungu ndi subcutaneous zimakhala: erythema, kuyabwa, zotupa.
Kuchokera ku hemopoietic dongosolo: kuchepa magazi, leukocytopenia kapena thrombocytopenia. Odwala omwe amatenga Metformin kwa nthawi yayitali, nthawi zambiri pamakhala kuchepa kwa vitamini B12 mu seramu yamagazi chifukwa kuchepa kwa mayamwidwe ake. Ngati wodwala ali ndi vuto la kuchepa kwa magazi m'thupi la megaloblastic, mwayi wochepetsera kuyamwa kwa vitamini B12 wogwirizana ndi kugwiritsa ntchito metformin uyenera kuganiziridwanso.

Kuyanjana kwa mankhwala osokoneza bongo
Kuchita kwa glimepiride ndi mankhwala ena
Wodwala yemwe akutenga glimepiride akapatsidwa mankhwala kapena kusiya nthawi yomweyo, mankhwala ena ndi otheka, osagwirizana ndi omwe angachitike: kuchuluka kapena kufooka kwa mphamvu ya glogepcide. Kutengera luso lazachipatala lomwe limakhala ndi glimepiride ndi zina sulfonylureas, zomwe mankhwala omwe alembedwa pansipa ayenera kuganiziridwa.
Ndi mankhwala omwe amadzitchinjiriza komanso oyeserera a CYP2C9 isoenzyme: glimepiride imapangidwa ndi gawo la CYP2C9 isoenzyme. Kagayidwe kake kamakhudzidwa ndi kugwiritsa ntchito nthawi imodzi kwa ma inducers a CYP2C9 isoenzyme, mwachitsanzo, rifampicin (chiwopsezo chochepetsera hypoglycemic zotsatira za glimepiride akagwiritsidwa ntchito ndi oyambitsa CYP2C9 isoenzyme ndikuchulukitsa chiopsezo cha hypoglycemia ngati iwo atathetsedwa ndi kusintha kwa magawo a CPPC22.Pl2Cepac2P.P2C2 inhibitor ya CPPC. chiwopsezo chachikulu cha kukhala ndi hypoglycemia ndi zotsatira zoyipa za glimepiride atatengedwa mogwirizana ndi zoletsa za CYP2C9 isoenzyme komanso chiopsezo chochepetsera hypoglycemia yake Momwe zimakhazikitsidwa popanda kusintha kwa glimepiride).
Ndi mankhwala omwe amathandizira hypoglycemic zotsatira za glimepiride: insulin ndi hypoglycemic mankhwala opaka pakamwa, ma inhibitors a ACE, anabolic mankhwala, mahomoni ogonana amuna, chloramphenicol, anticoagulants, coumarin, zotumphukira za cyclophosphamide, disopyramide, phenfluramine fenamides, fenamides fenamides, fenamides fenamides. Mao zoletsa, miconazole, fluconazole, aminosalicylic acid, pentoxifylline (mlingo waukulu wa makolo), phenylbutazone, azapropazone, oxyphenbutazone, probenecid, anti mwatsatanetsatane mankhwala quinolone ofanana nawo, salicylates, sulfinpyrazone, clarithromycin, mankhwala a sulfa antimicrobials, tetracyclines, tritokvalin, trofosfamide: kuchuluka chiopsezo hypoglycemia, pamene ntchito mankhwala awa ndi glimepiride ndi chiopsezo cha kuwonongeka kwa ulamuliro glycemic pa Kulipira awo popanda kukonzedwa mlingo wa glimepiride.
Ndi mankhwala omwe amachepetsa mphamvu ya hypoglycemic: acetazolamide, barbiturates, glucocorticosteroids, diazoxide, diuretics, epinephrine (adrenaline) kapena ma sympathomimetics, glucagon, mankhwala othandizira (ntchito yayitali), nicotinic acid (milingo yayikulu), estrojeni, prorojeni, prorojeni, prorojeni, prorojeni mahomoni a chithokomiro: chiopsezo chowonjezeka cha kayendedwe ka glycemic mukamagwiritsidwa ntchito limodzi ndi mankhwalawa ndikuwonjezera mwayi wokhala ndi hypoglycemia ngati atathetsedwa popanda kusintha kwa glimepiride.
Ndi histamine H2 receptor blockers, beta-adrenergic blockers, clonidine, reserpine, guanethidine: ndizotheka kuwonjezera kapena kuchepa kwa hypoglycemic zotsatira za glimepiride. Kusamala mosamala kwa shuga wamagazi pamafunika.Beta-blockers, clonidine, guanethidine ndi reserpine chifukwa choletsa zomwe zimachitika m'magazi amanjenje poyankha hypoglycemia zimapangitsa kuti chitukuko cha hypoglycemia chisawonekere kwa wodwala ndi dokotala ndipo potero zimawonjezera chiwopsezo chake.
Ndi ethanol: kugwiritsa ntchito kwambiri mankhwala osokoneza bongo a ethanol kungathe kufooketsa kapena kuwonjezera mphamvu ya hypoglycemic ya glimepiride.
Ndi anticoagulants osadziwika, zotumphukira za coumarin: glimepiride imatha kuwongolera komanso kuchepetsa zovuta za anticoagulants, coumarin.
Ndi sequestrants of bile acids: gudumu-binder limangiriza glimepiride ndi amachepetsa mayamwidwe glimepiride kuchokera kugaya chakudya. Pankhani yogwiritsa ntchito glimepiride, osachepera maola 4 musanayambe cadelovel, palibe mgwirizano womwe umawonedwa. Chifukwa chake, glimepiride iyenera kumwedwa osachepera maola 4 musanatenge magudumu.

Kugwirizana kwa metformin ndi mankhwala ena
Osavomerezeka kuphatikiza
Ndi ethanol: kuledzera kwa pachimake mowa, chiopsezo chokhala ndi lactic acidosis imachulukirachulukira, makamaka ngati kulumpha kapena kudya chakudya chokwanira, kupezeka kwa chiwindi. Pewani mowa (ethanol) ndi mankhwala okhala ndi ethanol.
Ndi mankhwala okhala ndi ayodini omwe amaphatikizana ndi ayodini: maselo ena amtundu wa iodine omwe amatha kuyimitsidwa mosiyanasiyana angayambitse kukula kwa aimpso, omwe angayambitse kudziwitsidwa kwa metformin komanso chiwopsezo cha lactic acidosis. Metformin iyenera kusiyidwa phunzirolo lisanachitike kapena mkati mwawerengera ndipo siliyenera kuyambiranso patatha maola 48 litatha, kuyambiranso kwa metformin kumatheka pokhapokha patatha phunzirolo ndi zizindikiro zodziwika za ntchito ya impso.
Ndi maantibayotiki omwe ali ndi kutchulidwa kwa nephrotoxic zotsatira (galamicin): chiwopsezo cha lactic acidosis.
Kuphatikiza kwa mankhwala omwe ali ndi metformin omwe amafunika kusamala
Ndi GCS (yofunikira komanso yogwiritsidwa ntchito kwanuko), beta2-adrenostimulants ndi okodzetsa amkati ndi zochitika zamkati za hyperglycemic: dziwitsani wodwalayo za kufunika kowunikira pafupipafupi kuchuluka kwa shuga m'magazi, makamaka kumayambiriro kwa kuphatikiza mankhwala. Pangakhale kofunikira kusintha muyezo wa hypoglycemic therapy mukamagwiritsa ntchito kapena mutatha kusiya mankhwala omwe ali pamwambawa.
Ndi ACE zoletsa: ACE zoletsa amachepetsa magazi. Kusintha kwa mankhwala a hypoglycemic kungafunike pakugwiritsa ntchito kapena mutachotsa zoletsa za ACE.
Mankhwala omwe amalimbikitsa kupezeka kwa hypoglycemic zotsatira za metformin: insulin, sulfonylureas, anabolic steroids, guanethidine, salicylates (kuphatikiza acetylsalicylic acid), beta-blockers (kuphatikiza propranolol), Mao inhibitors: pakugwiritsa ntchito munthawi yomweyo mankhwalawa Ndi metformin, kuyang'anira wodwalayo mosamala ndikuwongolera kuchuluka kwa shuga m'magazi ndikofunikira, chifukwa ndizotheka kuwonjezera kuchuluka kwa hypoglycemic ya metformin.
Ndi mankhwala omwe amachepetsa mphamvu ya hypoglycemic ya metformin: epinephrine, corticosteroids, mahomoni a chithokomiro, estrogens, pyrazinamide, isoniazid, nicotinic acid, phenothiazines, thiazide diuretics ndi okodzetsa am'magulu ena, zoletsa zam'kamwa, phenytoin, sympathomimetics: slowly Mankhwalawa ndi metformin, kuyang'anira wodwalayo mosamala ndikuwunika kuchuluka kwa shuga m'magazi ndikofunikira, chifukwa kufooketsa kwa hypoglycemic kwenikweni.
Kuyanjana komwe kuyenera kukumbukiridwa
Ndi furosemide: mu kafukufuku wazachipatala pazokhudzana ndi metformin ndi furosemide pamene amatengedwa kamodzi mwa athanzi odzipereka, adawonetsedwa kuti kugwiritsa ntchito mankhwalawa kumakhudza magawo awo a pharmacokinetic. Furosemide inakulitsa Cmax ya metformin m'madzi am'magazi ndi 22%, ndi AUC ndi 15% popanda kusintha kwakukulu kwa aimpso kwa metformin. Mukamagwiritsidwa ntchito ndi metformin, Cmax ndi AUC ya furosemide idatsika ndi 31% ndi 12%, motero, poyerekeza ndi furosemide monotherapy, ndipo terminal T1 / 2 idatsika ndi 32% popanda kusintha kwakukuru kwa impso kwa furosemide. Zambiri pazokhudzana ndi metformin ndi furosemide pogwiritsa ntchito nthawi yayitali sizipezeka.
Ndi nifedipine: mu kafukufuku wamankhwala wokhudzana ndi kugwiritsidwa ntchito kwa metformin ndi nifedipine wokhala ndi mlingo umodzi mwa odzipereka athanzi, zinaonetsedwa kuti kugwiritsa ntchito pamodzi kwa nifedipine kumawonjezera Cmax ndi AUC ya metformin m'magazi a plasma ndi 20% ndi 9%, motero, komanso kumawonjezera kuchuluka kwa metformin yotulutsidwa ndi impso. Metformin inali yovuta kwambiri pa pharmacokinetics ya nifedipine.
Ndi mankhwala a cationic (amiloride, dicogsin, morphine, procainamide, quinidine, quinine, ranitidine, triamteren, trimethoprim ndi vancomycin): mankhwala a cationic omwe atulutsidwa ndi secretion ya tubular mu impso amatha kungochita ndi metformin chifukwa cha mpikisano wamba. Kuyanjana pakati pa metformin ndi cimetidine wamlomo kunawonedwa mwa odzipereka athanzi pamaulendo azachipatala a kuyanjana kwa metformin ndi cimetidine ogwiritsa ntchito kamodzi komanso kangapo, komwe kunali kuwonjezeka kwa 60% ya plasma Cmax ndi kuchuluka kwa magazi a metformin komanso kuchuluka kwa 40% ya plasma ndi kuchuluka kwa metformin AUC. Ndi gawo limodzi, palibe kusintha kwa T1 / 2. Metformin sizinakhudze pharmacokinetics ya cimetidine. Ngakhale kuti kulumikizanaku kumangokhala kungoganiza chabe (kupatula cimetidine), kuwunika mosamala odwala kuyenera kuthandizidwa ndikuwongolera kwa mankhwala a metformin ndi / kapena mankhwala omwe akukhudzana nawo amayenera kuchitika pokhapokha ngati makonzedwe apakati pa mankhwala a cationic atulutsidwa kuchokera mthupi ndi makina a chinsinsi a proximal tubule.
Ndi propranolol, ibuprofen: mwa odzipereka athanzi labwino mumaphunziro pamtundu umodzi wa metformin ndi propranolol, komanso metformin ndi ibuprofen, sizinasinthe pamagawo awo a pharmacokinetic.

Bongo
Mankhwala osokoneza bongo a glimepiride
Zizindikiro: Amaryl® M imakhala ndi glimepiride, mankhwala osokoneza bongo (omwe amagwiritsidwa ntchito kwambiri komanso amatha kugwiritsa ntchito mankhwalawa kwa nthawi yayitali) angayambitse hypoglycemia yoopsa kwambiri.
Chithandizo: atangokhala ndi bongo wa glimepiride wakhazikitsidwa, muyenera kudziwitsa dokotala wanu nthawi yomweyo.
Dokotala asanafike, wodwalayo ayenera kumwa shuga, ngati nkotheka, mwa mtundu wa dextrose (glucose).
Odwala omwe atenga chiopsezo cha glimepiride ayenera kukhala ndi zotumphukira ndi makala oyambitsa. Nthawi zina, monga njira yolepheretsa, kugonekedwa kuchipatala ndikofunikira. Hypoflycemia yofatsa popanda kutaya chikumbumtima komanso mawonekedwe a mitsempha iyenera kuthandizidwa ndikuwongolera pakamwa kwa dextrose (glucose) ndikusintha kwa zakudya kwa Amaril ® M ndi / kapena wodwala. Kuwunikira kwambiri kuyenera kupitilizidwa mpaka adokotala atatsimikizira kuti wodwalayo ali pachiwopsezo (ziyenera kudziwitsidwa kuti hypoglycemia ikhoza kuchitika pambuyo pobwezeretsanso koyambirira kwa kutsata kwazonse shuga m'magazi).
Chidziwitso chachikulu cha bongo ndi kuwonongeka kwakukuru kwa hypoglycemic ndi zizindikiro monga kutayika kwa chikumbumtima kapena zovuta zina zamitsempha ndizofunikira kwambiri zomwe zimafuna kuti wodwala azimugoneka mwachangu. M'mawonekedwe a wodwalayo, kukhazikitsa njira yokhazikika ya shuga (dextrose) mu / mu jet, mwachitsanzo, kwa akuluakulu amayamba ndi 40 ml ya yankho la 20% ya shuga (dextrose).
Njira ina yothandizira achikulire ndikukhazikika kwa glucagon, mwachitsanzo, pa mlingo wa 0.5 mpaka 1 mg iv, s / c kapena i / m.
Wodwala amawonetsetsa mosamala kwa maola osachepera 24-48, chifukwaPambuyo pakuwoneka kachipatala, hypoglycemia ikhoza kuyambiranso.
Chiwopsezo chodzidzidwanso cha hypoglycemia nthawi yayikulu ndi njira yotsatsira imatha kupitilira masiku angapo.
Pochiza hypoglycemia mwa ana omwe ali mwangozi glimepiride, ayenera kusamala mosamala mlingo wa dextrose womwe umayang'aniridwa pafupipafupi ndimagazi a shuga, chifukwa chotheka cha hyperglycemia.

Mankhwala osokoneza bongo a metformin
Zizindikiro: ndi metformin m'mimba mu kuchuluka kwa 85 g ya hypoglycemia sikunachitike. Chiwopsezo chachikulu cha odwala kapena chiwopsezo chogwirizana ndi wodwala chokhala ndi lactic acidosis ndi Metformin chitha kubweretsa kukula kwa lactic acidosis.
Chithandizo: lactic acidosis ndi vuto lofunika kuchipatala. Njira yothandiza kwambiri yochotse lactate ndi metformin ndi hemodialysis. Ndi hemodynamics yabwino, metformin imatha kupukusidwa ndi hemodialysis ndi chilolezo chofika ku 170 ml / min.

Malo osungira
Pewani kufikira ana pa kutentha osapitirira 30 ° C.

Tsiku lotha ntchito
Zaka zitatu Zonse zimaperekedwa pofuna kudziwa zambiri osati chifukwa chodzipangira nokha kapena kusintha mankhwala.

Amaryl ndi mankhwala omwe amathandiza kuchepetsa shuga m'magazi.

Kulandila kwake kumayambira pomwe kusowa kwa insulini sikungakhalenso kulipiridwanso ndi njira zina - masewera olimbitsa thupi, mankhwala wowerengeka, koma osafunikira.

Kumwa mankhwalawa kumathandiza anthu omwe ali ndi matenda ashuga, omwe atha kusintha kwambiri moyo wawo.

Chifukwa chake, Amaryl, analogues omwe amapangidwa ndi makampani osiyanasiyana azamankhwala, amagwiritsidwa ntchito kwambiri pothandizira pakukonzekera kwa insulin m'thupi.

Amaryl ndi mawonekedwe ake amasonyezedwa matenda amtundu wa II.Chofunikira chachikulu cha mankhwalawa ndi glimepiride.

Mankhwala a m'badwo wachitatu, omwe adapangidwa pamaziko a sulfanylurea, amayamba kugwira ntchito kapamba, pang'onopang'ono kukweza maselo ake a b, omwe ali ndi udindo wopanga insulin. Mothandizidwa ndi kapamba, kapamba amapanga insulini yambiri, ndipo kuchuluka kwa shuga m'magazi kumatsika.