Metamine ya mankhwala: malangizo ogwiritsira ntchito

Metformin ndi biguanide yokhala ndi antihyperglycemic effect. Amachepetsa onse shuga komanso kuchuluka kwa glucose atatha kudya m'madzi am'magazi. Simalimbikitsa kubisalira kwa insulin ndipo sikuyambitsa vuto la hypoglycemic.

Metformin imagwira ntchito m'njira zitatu:

kumabweretsa kuchepa kwa kupanga kwa shuga m'chiwindi chifukwa cha kuletsa kwa gluconeogenesis ndi glycogenolysis,
bwino minofu insulin kumva bwino mwa kusintha kutenga ndi kugwiritsa ntchito zotumphukira shuga
Iachedwetsa mayamwidwe am'matumbo m'matumbo.

Metformin imathandizira kapangidwe ka glycogen mu intracellular mwa kuchita glycogen synthetases. Kuchulukitsa kuchuluka kwa mayendedwe amitundu yonse ya ma membrane glucose transport (GLUT).

Ngakhale zimakhudza kuchuluka kwa shuga m'magazi, metformin imakhudzanso kagayidwe ka lipid: imatsitsa cholesterol yathunthu, lipoproteins yotsika komanso triglycerides.

Panthawi ya mayesero azachipatala pogwiritsa ntchito metformin, kulemera kwamthupi la wodwalayo kunakhazikika kapena kumachepetsa. Kuphatikiza pakukhudza kuchuluka kwa shuga m'magazi, metformin imakhala ndi phindu pa metabolidi ya lipid. Mukamamwa mankhwalawa mu mankhwala othandizira, apakati komanso nthawi yayitali, zimadziwika kuti metformin amachepetsa cholesterol, otsika osalimba lipoproteins ndi triglycerides.

Zogulitsa. Mutatenga metformin, nthawi yofika ndende yozama (T max) ili pafupifupi maola 2,5. The bioavailability ya mapiritsi a 500 mg kapena 800 mg ndi pafupifupi 50-60% mwa odzipereka athanzi. Pambuyo pakukonzekera pakamwa, chidutswa chomwe sichikumwa ndipo chimalimbidwa ndi ndowe ndi 20-30%.

Pambuyo pakukonzekera pakamwa, kuyamwa kwa metformin kumakhala kokhazikika komanso kosakwanira.

Ma pharmacokinetics a mayamwidwe a metformin amawerengedwa kuti ndi osagwirizana. Mukamagwiritsidwa ntchito pazovomerezeka za metformin ndi regimens, makulidwe a plasma okhazikika amapezeka mkati mwa maola 24-48 ndipo ndi ochepera 1 1g / ml. M'mayeso azachipatala omwe amawongolera, kuchuluka kwa plasma metformin (C max) sikudaposa 5 μg / ml ngakhale ndi waukulu.

Ndi chakudya chofananacho, kuyamwa kwa metformin kumachepa ndikuchepera.

Pambuyo pakulowetsa pa 850 mg, kuchepa kwambiri kwa plasma ndende ndi 40%, kuchepa kwa AUC ndi 25%, ndikuwonjezereka kwa mphindi 35 pakubwera nthawi yayitali. Kukula kwamankhwala kwakusintha kumeneku sikudziwika.

Kugawa. Kumanga mapuloteni a Plasma ndikosatheka. Metformin imalowa m'magazi ofiira. Kuchuluka kwambiri m'magazi kumakhala kocheperako poyerekeza ndi kuchuluka kwa magazi a m'magazi, ndipo kumachitika pambuyo pake. Maselo ofiira nthawi zambiri amayimira chipinda chogawirako chachiwiri. Voliyumu yapakati yogawa (Vd) imachokera ku malita 63-276.

Kupenda. Metformin imachotsedwa mu mkodzo osasinthika. Palibe ma metabolites omwe amapezeka mwa anthu.

Pomaliza Kuvomerezeka kwa metformin ndi> 400 ml / min., Izi zikuwonetsa kuti metformin imachotsedwera chifukwa cha kusefera kwa madzi ndi kubisala kwa tubular. Mutamwa, theka-moyo ndi pafupifupi maola 6.5. Mu vuto la impso, kutsekeka kwa impso kumatsika molingana ndi kupezeka kwa creatinine chilolezo, motero kuthetsa theka la moyo kumawonjezeka, komwe kumabweretsa kuwonjezeka kwa plasma metformin.

Zizindikiro zogwiritsidwa ntchito

Type 2 shuga mellitus ndi kulephera kwa zakudya mankhwala ndi masewera olimbitsa thupi, makamaka kwa odwala onenepa kwambiri

monga monotherapy kapena kuphatikiza mankhwala molumikizana ndi ena othandizira pakamwa a hypoglycemic kapena molumikizana ndi insulin pochizira akuluakulu.
monga monotherapy kapena kuphatikiza mankhwala omwe ali ndi insulin pochiza ana azaka zopitilira zaka 10 ndi achinyamata.

Kuchepetsa zovuta za matenda ashuga okalamba omwe ali ndi matenda a shuga a 2 komanso onenepa kwambiri ngati mankhwala oyambira mzere woyamba wokhala ndi mankhwala osachita bwino.

Njira yogwiritsira ntchito

Monotherapy kapena kuphatikiza mankhwalawa molumikizana ndi ena othandizira pakamwa.

Nthawi zambiri, muyeso woyamba wa 500 mg kapena 850 mg (methamine, mapiritsi 500 mg kapena 850 mg) kawiri pa tsiku nthawi yakudya kapena itatha.

Pambuyo masiku 10-15, mlingo uyenera kusinthidwa malinga ndi zotsatira za milingo ya shuga mu seramu yamagazi.

Kuchepetsa pang'onopang'ono kwa mlingo kumachepetsa mavuto kuchokera m'mimba.

Pochiza ndi Mlingo wambiri (2000-3000 mg patsiku), n`zotheka kusintha mapiritsi awiri aliwonse a Metamin, 500 mg piritsi limodzi la Metamin, 1000 mg.

Mlingo woyenera kwambiri ndi 3000 mg patsiku, womwe umagawidwa pawiri.

Pofuna kusintha kuchokera kwa wodwala matenda ena, ndikofunikira kusiya kumwa mankhwalawa ndikupereka metformin monga tafotokozera pamwambapa.

Kuphatikiza mankhwala osakanikirana ndi insulin.

Kuti akwaniritse bwino kuchuluka kwa shuga m'magazi, metformin ndi insulin zitha kugwiritsidwa ntchito ngati mankhwala osakanikirana.

Monotherapy kapena mankhwala ophatikizira limodzi ndi insulin.

Mankhwala Mankhwala amagwiritsidwa ntchito mwa ana opitirira zaka 10 ndi achinyamata. Nthawi zambiri, muyeso woyamba wa 500 mg kapena 850 mg wa methamine 1 nthawi patsiku panthawi kapena mukatha kudya. Pambuyo masiku 10-15, mlingo uyenera kusinthidwa malinga ndi zotsatira za milingo ya shuga mu seramu yamagazi.

Kuchepetsa pang'onopang'ono kwa mlingo kumachepetsa mavuto kuchokera m'mimba.

Mlingo woyenera kwambiri ndi 2000 mg patsiku, womwe umagawidwa mu 2-3 Mlingo.

Kwa odwala okalamba, kuchepa kwa impso kumatha, motero, mlingo wa metformin uyenera kusankhidwa potengera kuyeserera kwa ntchito yaimpso, yomwe iyenera kuchitidwa pafupipafupi.

Odwala aimpso kulephera. Metformin itha kugwiritsidwa ntchito kwa odwala omwe amalephera kupweteka aimpso, gawo Sha (creatinine clearance 45-59 ml / min kapena GFR 45-59 ml / mphindi / 1.73 m 2) pokhapokha pazinthu zina zomwe zingakulitse chiopsezo cha lactic acidosis, kusintha kwa mlingo wotsatira: mlingo woyambirira ndi 500 mg kapena 850 mg wa metformin hydrochloride 1 nthawi patsiku. Mlingo wapamwamba ndi 1000 mg patsiku ndipo uyenera kugawidwa pawiri. Kusanthula mosamala kwa ntchito ya impso (miyezi 3-6 iliyonse) kuyenera kuchitika.

Ngati creatinine chilolezo kapena GFR itatsikira ku 2, motero, metformin iyenera kuyimitsidwa nthawi yomweyo.

Contraindication

Hypersensitivity kuti metformin kapena china chilichonse cha mankhwala,
matenda ashuga ketoacidosis, matenda ashuga,
Kulephera kwaimpso kwa zolimbitsa (gawo IIIIb) komanso kuwonda kwambiri kapena kuwonongeka kwa aimpso (kulengedwa kwa chilolezo 2,
pachimake zinthu ndi chiopsezo cha aimpso kukanika, monga: kuchepa magazi, matenda opatsirana, mantha
matenda omwe angayambitse kukula kwa hypoxia (makamaka pachimake matenda kapena kufalikira kwa matenda osachiritsika) kuwonongeka kwa mtima, kulephera kupuma, kulowetsedwa kwaposachedwa, kutsika
Kulephera kwa chiwindi, poyizoni wauchidakwa, uchidakwa.

Kuchita ndi mankhwala ena

Kuphatikiza sikulimbikitsidwa.

Mowa Kuledzera kwa pachimake kumayenderana ndi chiopsezo chowonjezeka cha lactic acidosis, makamaka ngati akusala kudya kapena kutsatira zakudya zochepa zopatsa mphamvu, komanso ndi vuto la chiwindi. Mankhwalawa Methamine mowa ndi mankhwala omwe ali ndi mowa uyenera kupewedwa.

Iodini wokhala ndi zinthu za radiopaque. Kukhazikitsidwa kwa zinthu zomwe zimakhala ndi ayodini zomwe zimayambitsa matenda a iodine kungayambitse kulephera kwa impso, chifukwa chake, kuwerengetsa kwa metformin komanso chiopsezo chowonjezeka cha lactic acidosis.

Kwa odwala omwe ali ndi GFR> 60 ml / mphindi / 1.73 m 2, metformin iyenera kuyimitsidwa isanachitike kapena mkati mwa phunziroli ndipo sayenera kuyambiranso kupitirira maola 48 mutatha phunzirolo, pokhapokha kuwunikanso ntchito ya aimpso ndikutsimikizira kuti kulibe kuwonongeka kwina kwa impso (onani. gawo "Zomwe zikugwiritsidwa ntchito").

Odwala omwe amalephera kupweteka aimpso (GFR 45-60 ml / mphindi / 1.73 m 2) ayenera kusiya kugwiritsa ntchito Metformin maola 48 asanagwiritse ntchito mankhwala okhala ndi ayodini ndipo sayenera kuyambiranso kumayambiriro maola 48 mutatha kafukufuku, pokhapokha kuwunikanso ntchito yaimpso. ndi chitsimikizo cha kusowa kwa kuwonongeka kwa impso.

Kuphatikiza kuyenera kugwiritsidwa ntchito mosamala.

Mankhwala omwe ali ndi vuto la hyperglycemic (GCS of systemic and local action, sympathomimetics, chlorpromazine). Ndikofunikira kuthana ndi shuga m'magazi pafupipafupi, makamaka kumayambiriro kwa chithandizo. Munthawi yotsiriza komanso yothandizirayi itatha, ndikofunikira kusintha mlingo wa methamine motsogozedwa ndi glycemia.

Ma inhibitors a ACE amatha kuchepetsa magazi. Ngati ndi kotheka, Mlingo wa mankhwalawa uyenera kusinthidwa palimodzi.

Ma diuretics, makamaka ozungulira okodzetsa, angakulitse chiopsezo cha lactic acidosis chifukwa kuchepa kwa ntchito ya impso.

Zolemba zogwiritsira ntchito

Lactic acidosis ndizosowa kwambiri koma zovuta za metabolic (kuchuluka kwa kufa popanda chithandizo chadzidzidzi), zomwe zimatha kuchitika chifukwa chakuwoneka kwa metformin. Nkhani za lactic acidosis zidanenedwa kwa odwala omwe ali ndi matenda osokoneza bongo omwe ali ndi vuto la impso kapena lakuthwa muimpso.

Zina mwamagetsi ziyenera kuganiziridwanso kuti mupewe kukula kwa lactic acidosis: matenda osokoneza bongo omwe samayendetsa bwino, ketosis, kusala kudya kwa nthawi yayitali, kumwa kwambiri mowa, kulephera kwa chiwindi, kapena vuto lililonse lomwe lingachitike ndi hypoxia (mtima wosakhazikika, kupunduka kwadzuwa).

Lactic acidosis imatha kuwoneka ngati kukokana minofu, kudzimbidwa, kupweteka kwam'mimba komanso asthenia yayikulu. Odwala ayenera kudziwitsa dokotala nthawi yomweyo zomwe zimachitika, makamaka ngati odwala adalekerera kale kugwiritsa ntchito metformin. Zikatero, ndikofunikira kusiya kugwiritsa ntchito metformin mpaka izi zitamveka bwino. Mankhwala a Metformin amayenera kuyambiridwanso pambuyo powunikira phindu / chiopsezo pazochitika zina ndikuwunika ntchito ya impso.

Zizindikiro Lactic acidosis imadziwika ndi kufupika kwa acidic, kupweteka kwam'mimba komanso hypothermia, kupititsa patsogolo kukoma mtima kumatha. Zizindikiro zakuzindikira zimaphatikizapo kuchepa kwa labot mu magazi pH, kuwonjezeka kwa kuchuluka kwa lactate mu seramu yamagazi pamtunda wa 5 mmol / l, kuchuluka kwa anion ndi gawo la lactate / pyruvate. Pankhani ya lactic acidosis, ndikofunikira kuchipatala wodwala nthawi yomweyo. Dokotala ayenera kuchenjeza odwala za chiwopsezo cha kukula ndi zizindikiro za lactic acidosis.

Kulephera kwina. Popeza impformin imachotsedwa ndi impso, ndikofunikira kuyang'ana kuvomerezeka kwa creatinine (titha kuwerengera ndi kuchuluka kwa plasma creatinine wogwiritsa ntchito njira ya Cockcroft-Gault) kapena GFR musanayambe komanso pafupipafupi pakumwa mankhwala a Metamin

odwala aimpso ntchito - osachepera 1 pachaka,
Kwa odwala okhala ndi chilolezo cha creatinine m'munsi mwa odwala wamba komanso okalamba - osachepera 2-4 pachaka.

Pankhaniyi pamene creatinine chilolezo 2), metformin imatsutsana.

Kuchepetsa aimpso odwala okalamba ndizofala komanso asymptomatic. Chenjezo liyenera kuchitika pakakhala vuto la impso, mwachitsanzo, ngati mutha kuchepa mphamvu kapena kumayambiriro kwa chithandizo chamankhwala a antihypertensive, okodzetsa, komanso kumayambiriro kwa mankhwala a NSAIDs.

Ntchito yamtima. Odwala omwe ali ndi vuto la mtima ali ndi chiopsezo chachikulu chokhala ndi hypoxia komanso kulephera kwa impso. Odwala omwe ali ndi vuto la mtima wosakhazikika, metformin itha kugwiritsidwa ntchito poyang'anira mtima ndi ntchito yaimpso. Metformin imaphatikizidwa kwa odwala omwe ali ndi vuto la mtima komanso losakhazikika.

Ma ayodini okhala ndi ayodini. Kukhazikitsidwa kwa ma radiopaque othandizira maphunziro a radiology kungayambitse kulephera kwa impso, ndipo chifukwa cha izi kumayambitsa kuphatikizidwa kwa metformin komanso chiopsezo chowonjezeka cha lactic acidosis. Odwala omwe ali ndi GFR> 60 ml / mphindi / 1.73 m 2, kugwiritsa ntchito metformin kuyenera kuyimitsidwa isanachitike kapena panthawi yophunzira ndipo sikuyenera kuyambiranso kupitilira maola 48 mutatha phunziroli, pokhapokha mutayang'ananso ntchito ya aimpso ndikutsimikizira kuti kulibe kuwonongeka kwina kwaimpso.

Odwala omwe amalephera kupezeka ndi aimpso (GFR 45-60 ml / mphindi / 1.73 m 2) ayenera kusiya kugwiritsa ntchito Metformin maola 48 asanagwiritse ntchito mankhwala okhala ndi ayodini ndipo sayenera kuyambiranso kumayambiriro maola 48 mutatha kafukufukuyu, pokhapokha mutayambiranso ntchito ya aimpso ndi chitsimikizo cha kusowa kwa kuwonongeka kwa impso.

Zithandizo za opaleshoni. Ndikofunikira kusiya kugwiritsa ntchito Metamine maola 48 asanafike pakuchita opaleshoni yomwe idakonzedweratu, yomwe imachitika pansi pa opaleshoni yovomerezeka, msana kapena kuwonongeka kwam'mimba ndipo osayambiranso kale kuposa maola 48 atangoyamba kugwira ntchito kapena kubwezeretsa zakudya zapakamwa komanso ngati ntchito yachilendo ya impso yakhazikitsidwa.

Ana. Musanayambe chithandizo ndi metformin, kuwunika kwa mtundu wachiwiri wa shuga kuyenera kutsimikiziridwa. Zotsatira zakukula kwa metformin komanso kutha kwa ana sizinadziwikebe. Komabe, palibe deta pazotsatira za kukula kwa metformin ndi kutha msanga pogwiritsa ntchito metformin, chifukwa chake, kuwunikira mosamala magawo awa kwa ana omwe amathandizidwa ndi metformin, makamaka panthawi yakutha, akulimbikitsidwa.

Ana azaka zapakati pa 10 mpaka 12. Kuchita bwino komanso chitetezo cha metformin mwa odwala a m'badwo uno sizosiyana ndi zomwe zimachitika mwa ana achikulire ndi achinyamata.

Njira zina. Odwala ayenera kutsatira zakudya, kudya zakudya zamagulu onse tsiku lonse ndikuwunika magawo a labotale. Odwala onenepa kwambiri ayenera kupitiliza kutsatira zakudya zamafuta ochepa. Ndikofunikira kuyang'anira metabolism ya carbohydrate.

Metformin monotherapy siyimayambitsa hypoglycemia, koma muyenera kusamala mukamagwiritsa ntchito metformin ndi insulin kapena othandizira ena pakamwa (mwachitsanzo, sulfonylureas kapena meglitinidam.

Mwina kukhalapo kwa zidutswa za zipolopolo zam'mapapo. Izi ndizabwinobwino ndipo sizofunika m'thupi.

Ngati mumatsutsa mashuga ena, funsani dokotala musanamwe mankhwalawa, chifukwa mankhwalawa ali ndi lactose.

Gwiritsani ntchito pa nthawi yoyembekezera

MimbaMatenda osagwirizana ndi matenda a shuga panthawi yomwe ali ndi pakati (gestational kapena kulimbikira) amawonjezera mwayi wokhala ndi vuto lobadwa nalo komanso kufa kwa perinatal. Pali zosowa zochepa pakugwiritsa ntchito metformin mwa amayi apakati omwe samawonetsa chiopsezo chowonjezereka cha kubadwa kwatsopano. Kafukufuku wamtsogolo sanawonetse vuto pa kutenga pakati, kukulira mluza kapena mwana wosabadwa, kubereka ndi kubereka. Pankhani yakonzekera kukonzekera kutenga pakati, komanso pakakhala kuti muli ndi pakati, ndikulimbikitsidwa kugwiritsa ntchito metformin pochiza matenda ashuga, komanso insulini kukhalabe ndi kuchuluka kwa shuga m'magazi pafupi ndi masiku onse momwe mungathere, kuchepetsa chiopsezo cha kusokonezeka kwa fetal.

Kuyamwitsa. Metformin imachotsedwa mkaka wa m'mawere, koma palibe zotsatira zoyipa zomwe zimawonedwa mu neonates / makanda omwe adayamwa. Komabe, popeza palibe chidziwitso chokwanira pa mankhwalawa, kuyamwitsa sikulimbikitsidwa panthawi ya metformin. Lingaliro loletsa kuyamwitsa liyenera kuganiziridwapo zabwino za kuyamwitsa ndi chiopsezo cha zovuta zoyamwitsa khanda.

Chonde. Metformin siyimakhudzanso chonde cha amuna ndi akazi akagwiritsidwa ntchito Mlingo

600 mg / kg / tsiku, lomwe linali lokwanira kuchuluka kwa katatu tsiku lililonse, lomwe limalimbikitsidwa kuti lizigwiritsidwa ntchito mwa anthu ndipo limawerengeredwa potengera thupi.

Kutha kukopa momwe zinthu zikuyendera mukamayendetsa magalimoto kapena njila zina.

Metformin monotherapy siyimakhudzanso kuchuluka kwa zochita mukamayendetsa kapena kugwiritsa ntchito zida, chifukwa mankhwalawa samayambitsa hypoglycemia.

Komabe, kusamala kuyenera kuchitika mukamagwiritsa ntchito metformin kuphatikiza ena othandizira a hypoglycemic (sulfonylureas, insulin, kapena meglitidines) chifukwa choopsa cha hypoglycemia.

Mankhwala Mankhwala amagwiritsidwa ntchito pochiza ana azaka 10.

Bongo

Pogwiritsa ntchito mankhwalawa mlingo wa 85 g, kukula kwa hypoglycemia sikunachitike. Komabe, pankhaniyi, kukula kwa lactic acidosis kunawonedwa. Pankhani ya kukula kwa lactic acidosis, chithandizo ndi Metamine chiyenera kuyimitsidwa ndipo wodwala amagonekedwa kuchipatala mwachangu. Njira yothandiza kwambiri yochotsa lactate ndi metformin kuchokera mthupi ndi hemodialysis.

Zotsatira zoyipa

Mavuto a metabolism ndi zakudya: lactic acidosis (onani gawo "Zogwiritsira ntchito").

Ndi kugwiritsa ntchito mankhwalawa kwa nthawi yayitali odwala omwe ali ndi vuto la kuchepa kwa magazi m'thupi, kuchepa kwa vitamini B 12 kungachepe, komwe kumayendetsedwa ndi kuchepa kwa msanga m'magazi a magazi. Ndikulimbikitsidwa kuti chifukwa cha kuchepa kwa vitamini B 12 kumaganiziridwa ngati wodwala ali ndi vuto la kuchepa kwa magazi m'thupi.

Kuchokera ku dongosolo lamanjenje: kulawa chisokonezo.

Kuchokera pamimba: kukhumudwa, kusanza, kutsegula m'mimba, kupweteka kwam'mimba, kusowa kwa chakudya. Nthawi zambiri, zoyipa izi zimachitika poyambira chithandizo ndipo, monga lamulo, zimazimiririka zokha. Popewa kupezeka kwa zotsatira zoyipa m'mimba, tikulimbikitsidwa kuti pang'onopang'ono muwonjezere mlingo wa mankhwalawa ndikugwiritsa ntchito mankhwalawa katatu patsiku panthawi kapena mukatha kudya.

Kuchokera pamatumbo: kuperewera kwa chiwindi ntchito kapena chiwindi, chomwe chimazimiririka atasiya kugwira ntchito kwa metformin.

Pa khungu ndi subcutaneous minofu: khungu lawo siligwirizana, kuphatikizapo zidzolo, erythema, pruritus, urticaria.