Amaril M: Malangizo ntchito ndi mankhwala

Kufotokozera za mtundu wa kipimo

Mapiritsi 1 + 250 mg: oval, biconvex, wokutidwa ndi chovala choyera cha filimu, chojambula "HD125" mbali imodzi.

Mapiritsi 2 + 500 mg: chowulungika, biconvex, wokutidwa ndi chovala choyera cha filimu, chojambula "HD25" mbali imodzi ndikuphatikizira mbali inayo.

Mankhwala

Amaryl ® M ndi mankhwala ophatikiza a hypoglycemic, omwe amaphatikiza glimepiride ndi metformin.

Glimepiride, imodzi mwazinthu zomwe zimagwira ntchito ku Amaril ® M, ndi mankhwala a hypoglycemic operekera pakamwa, zomwe zimachokera ku m'badwo wachitatu sulfonylurea.

Glimepiride imathandizira kubisalira ndi kutulutsidwa kwa insulin kuchokera ku maselo a pancreatic beta (pacreatic 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 zotengera potaziyamu za ATP zomwe zimapezeka mu cell la cytoplasmic la cell ya pancreatic beta. Titseka njira zam potaziyamu, zimayambitsa kukokoloka kwa maselo a beta, omwe amathandiza kutsegulira njira za calcium ndikuwonjezera kuchuluka kwa calcium m'maselo.

Glimepiride, yokhala ndi gawo lalikulu kwambiri, imaphatikiza ndi kufinya kuchokera ku pancreatic beta-cell protein (maselo kulemera 65 kD / SURX), yomwe imalumikizidwa ndi njira zotengera potaziyamu za ATP, koma imasiyana ndi malo omangika a zotumphukira za sulfonylurea zotumphukira (mapuloteni okhala ndi molekyu yayikulu ya 140 kD / SUR1).

Njirayi imabweretsa kutulutsidwa kwa insulin ndi exocytosis, pomwe kuchuluka kwa insulin yobisika kumakhala kochepa kwambiri poyerekeza ndi zomwe zimachitika pompopompo (mwachikhalidwe) sulfonylurea derivatives (mwachitsanzo glibenclamide). Mphamvu yochepetsetsa ya glimepiride pa insulin secretion imaperekanso chiopsezo chochepa cha hypoglycemia.

Monga zachikhalidwe za sulfonylurea zachikhalidwe, koma kwakukulu kwambiri glimepiride wanena zowonjezera zotsatira (kuchepa kwa insulin kukana, antiatherogenic, antiplatelet ndi antioxidant zotsatira).

Kugwiritsa ntchito shuga m'magazi 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 mtima wa ATP-K + a mtima. Mukatenga glimepiride, kuthekera kwa kagayidwe kazinthu kosintha kwa myocardium kuti ischemia amasungidwe.

Glimepiride imachulukitsa ntchito ya phospholipase C, yomwe lipogenesis ndi glycogeneis imatha kuphatikizidwa m'misempha yokhayokha ya minofu ndi mafuta.

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 imathandiza kuchepetsa zamadzimadzi za lipid, zimachepetsa kwambiri lipid peroxidation, yomwe imalumikizidwa ndi anti-atherogenic zotsatira

Glimepiride imawonjezera zomwe zili amkati mwa alpha-tocopherol, zochitika za catalase, glutathione peroxidase ndi superoxide dismutase, zomwe zimathandizira kuchepetsa zovuta za oxidative nkhawa m'thupi la wodwalayo, lomwe limakhalapo nthawi zonse mu mtundu 2 wa shuga.

Hypoglycemic mankhwala ochokera pagulu la Biguanide. Zotsatira zake za hypoglycemic ndizotheka pokhapokha ngati katulutsidwe ka insulin (ngakhale kamachepetsedwa) kali kokhazikika. Metformin ilibe gawo lililonse la ma cell a pancreatic beta ndipo siliwonjezera katemera wa insulini; mu Mlingo wothandizirana, samayambitsa hypoglycemia mwa anthu.

Njira zomwe amagwirira ntchito sizomveka bwino. Amakhulupirira kuti metformin ikhoza kuyambitsa zotsatira za insulin kapena kuonjezera zotulukazi 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 kuchuluka kwa triglycerides (TG) ndi LDL ndi VLDL m'magazi. Metformin imachepetsa kudya ndipo imachepetsa kuyamwa kwa matumbo. Amakonza michere yamagazi ya fibrinolytic mwa kuponderezana ndi minofu ya plasminogen activator inhibitor.

Pharmacokinetics

Pamene kumwa tsiku lililonse 4 mg C_max mu plasma yomwe idafika pafupifupi maola 2,5 pambuyo pakumwa pakamwa ndipo ndi 309 ng / ml, pali ubale wolumikizana pakati pa mlingo ndi C_max komanso pakati pa mlingo ndi AUC. Mukamwetsa glimepiride mtheradi bioavailability wathunthu. Kudya kulibe vuto lililonse chifukwa chonyamula, kupatula kutsika pang'ono pang'onopang'ono. Glimepiride amadziwika ndi V wotsika kwambiri_d (pafupifupi 8.8 L), pafupifupi wofanana ndi kuchuluka kwa kugawa kwa albumin, kuchuluka kwakukulu kwa mapuloteni a plasma (oposa 99%) ndi chilolezo chotsika (pafupifupi 48 ml / min).

Pambuyo pakamwa limodzi lokha la glimepiride, 58% ya mankhwalawa imachotsedwa ndi impso (mwa mawonekedwe a metabolites) ndi 35% kudzera m'matumbo. T_1/2 pa plasma wozungulira mu seramu yofanana ndi Mlingo wambiri, ndi maola 5-8. Mutamwa mankhwalawa muyezo waukulu, T_1/2 .

Mkodzo wopanda ntchito ndi ndowe zimavumbulutsa ma metabolite awiri osagwira ntchito omwe amachokera pachiwindi, amodzi mwa iwo ndi ma hydroxy, ndipo chachiwiri ndimachokera ku carboxy. Pambuyo pakamwa makonzedwe a glimepiride, terminal T_1/2 ma metabolites awa anali 3-5 ndi maola 5-6, motero.

Glimepiride amamuchotsa mkaka wa m'mawere ndikuwoloka chotchinga. Kupyola mu BBB kumalowa bwino. Kuyerekeza kwa osakwatiwa komanso angapo (kangapo patsiku) kasamalidwe ka glimepiride sikunawonetse kusiyana kwakukulu mu magawo a pharmacokinetic, kusiyanasiyana kwawo mwa odwala osiyanasiyana kunali kosiyana. Kuchuluka kwakukulu kwa glimepiride kunalibe.

Odwala a mitundu yosiyanasiyana ndi misinkhu yosiyanasiyana, magawo a pharmacokinetic mu glimepiride ndi ofanana. Odwala omwe ali ndi vuto la aimpso (okhala ndi vuto lochepera la creatinine), panali chizolowezi chowonjezera kutsimikiza kwa glimepiride komanso kutsika kwake kwakukhudzidwa kwambiri m'mitsempha yamagazi, yomwe imachitika makamaka chifukwa cha kuphipha kwapang'onopang'ono kwa mapuloteni amadzi a m'magazi. Chifukwa chake, m'gulu lino la odwala palibe chiopsezo chowonjezereka cha glimepiride.

Pambuyo pakukonzekera pakamwa, metformin imatengedwa kuchokera m'matumbo athunthu. Mtheradi wa bioavailability wa metformin ndi pafupifupi 50-60%. C_max (pafupifupi 2 μg / ml kapena 15 μmol) mu plasma imatheka pambuyo pa maola a 2,5.Ndibwino kuti mupeze chakudya nthawi yomweyo, kuyamwa kwa metformin kumachepa ndikuchepera.

Metformin imagawidwa mwachangu mu minofu, sikuti imagwira mapuloteni a plasma. Amapangidwira pamlingo wofooka kwambiri ndikuwonetsa impso. Kuvomerezeka kwamaphunziro oyenera ndi 440 ml / min (nthawi 4 kuposa momwe amapangira creatinine), zomwe zimawonetsa kukhalapo kwa katulutsidwe katulutsidwe ka tubular. Pambuyo pakulowetsa, terminal T_1/2 ili pafupifupi maola 6.5. Ndi kulephera kwa aimpso, kumachulukana, pamakhala chiopsezo cha kuchuluka kwa mankhwalawa.

Pharmacokinetics ya Amaril ® M yokhala ndi Mlingo wokhazikika wa glimepiride ndi metformin

Makhalidwe a C_max ndi AUC mutamwa mankhwala osakanikirana a piritsi (piritsi lokhala ndi glimepiride 2 mg + metformin 500 mg) mukakumana ndi bioequivalence poyerekeza ndi magawo omwewo mutatenga kuphatikiza komweko monga kukonzekera kwapadera (piritsi la glimepiride 2 mg ndi piritsi ya metformin 500 mg) .

Kuphatikiza apo, kuchuluka kwa kuchuluka kwa C kumawonekera._max ndi AUC ya glimepiride ndi kuwonjezeka kwa mlingo wake pakaphatikizidwe ndi Mlingo wokhazikika kuchokera 1 mpaka 2 mg ndi muyeso wa metformin (500 mg) wopanga mankhwalawa.

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 amatenga Amaril ® M 2 mg / 500 mg.

Zizindikiro Amaril ® M

Chithandizo cha matenda a shuga 2 (kuwonjezera pa zakudya, zolimbitsa thupi ndi kuwonda):

ngati glycemic control siyingatheke pogwiritsa ntchito zakudya, zolimbitsa thupi, kuchepa thupi komanso monotherapy yokhala ndi glimepiride kapena metformin,

Posintha kuphatikiza mankhwala ndi glimepiride ndi metformin ndi mankhwala osakaniza amodzi.

Contraindication

mtundu 1 shuga

mbiri ya matenda ashuga a ketoacidosis, matenda a shuga, matenda a shuga

hypersensitivity to sulfonylurea derivatives, sulfonylamide kukonzekera kapena biguanides, komanso aliyense mwa omwe amapeza mankhwalawo.

kwambiri chiwindi ntchito (osadziwa ntchito, odwala oterewa amafunika chithandizo cha insulin kuti awonetsetsetsetso wokwanira wa glycemic),

odwala hemodialysis (kupanda nzeru)

Kulephera kwaimpso ndi kuwonongeka kwa aimpso (serum creatinine ndende: ≥1.5 mg / dL (135 μmol / L) mwa amuna ndi ≥1.2 mg / dL (110 μmol / L) mwa akazi kapena kuchepa kwa chilolezo cha creatinine (kuchuluka chiopsezo cha lactic acidosis ndi zotsatira zina za metformin),

pachimake momwe impso imawonongera ndikotheka (kuchepa madzi m'thupi, matenda opatsirana, mantha, kupangika kwa chitetezo cha othandizira okhala ndi ayodini, onani gawo "Malangizo Apadera"),

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, kulowererapo kwa opaleshoni, 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),

kuphwanya mayamwidwe a chakudya ndi mankhwala osokoneza bongo (m'mimba otsekemera, 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).

mu malo omwe mumakhala chiopsezo chowonjezereka cha hypoglycemia (odwala omwe safuna kapena sangathe (odwala ambiri okalamba) kuti agwirizane ndi dokotala, kudya kwambiri, kudya mosasamala, kudya zakudya, odwala omwe ali ndi vuto pakati pa masewera olimbitsa thupi komanso kudya zakudya zamafuta ambiri, kusintha kwa zakumwa, pakumwa zakumwa zomwe zimakhala ndi ethanol, makamaka kuphatikiza ndi kudya kosazungulira, chiwindi ndi impso, komanso zovuta zina za endocrine. monga kukanika kwa chithokomiro, kusowa kwa mahomoni mu anterior pituitary kapena adrenal cortex, kukhudza kagayidwe kazakudya kapena kutseguka kwa njira zomwe zimapangitsa kuti magazi azikhala ndi magazi nthawi yayitali kwambiri pa hypoglycemia, ndikupanga matenda opatsirana panthawi ya chithandizo kapena kusintha kwa moyo) ( mwa odwala, kuwunika mosamala kuchuluka kwa shuga m'magazi ndi zizindikiro za hypoglycemia ndikofunikira, angafunikire kusintha kwa glimepiride kapena hypoglide yonse kemicheskoy mankhwala)

kugwiritsa ntchito mankhwala munthawi yomweyo (onani "Kuyanjana"),

mwa odwala okalamba (nthawi zambiri amakhala ndi kuchepa kwa asymptomatic mu ntchito ya impso), muzochitika zomwe ntchito ya impso imatha kuwonongeka, monga kuyamba kumwa mankhwala a antihypertensive kapena diuretics, komanso NSAIDs (chiwopsezo cha lactic acidosis ndi zotsatira zina za metformin),

mukamagwira ntchito yolemera (chiopsezo chokhala ndi lactic acidosis mukamayamwa metformin),

ndi abrasion kapena kusowa kwa zizindikiro za adrenergic antiglycemic malamulo poyambitsa kukulitsa kwa hypoglycemia (odwala okalamba, ndi neuropathy ya autonomic mantha dongosolo kapena munthawi yomweyo mankhwala a beta-blockers, clonidine, guanethidine ndi ena ma audiatholics) (mwa odwala, kuwunika kosamala kwa shuga m'magazi)

ndi kusakwanira kwa glucose-6-phosphate dehydrogenase (mwa odwala, mukamamwa mankhwala a sulfonylurea, hemolytic anemia imatha kukhala, chifukwa chake, kugwiritsa ntchito mitundu ina ya mankhwala a hypoglycemic omwe siachokera ku sulfonylurea mu odwala awa ayenera kuganiziridwa).

Mimba komanso kuyamwa

Mimba Contraindicated pa mimba chifukwa chotheka chosokoneza chitukuko cha intrauterine. Amayi oyembekezera ndi amayi omwe akukonzekera kubereka ayenera kudziwitsa oyang'anira azaumoyo. Pa nthawi ya pakati, azimayi omwe ali ndi vuto la metabolism wam'mimba, zakudya zosasinthika komanso masewera olimbitsa thupi ayenera kulandira insulin.

Kuchepetsa. Pofuna kupewa kuyamwa kwa mankhwalawa mkaka wa m'mawere, amayi omwe akuyamwitsa sayenera kumwa mankhwalawa. Ngati ndi kotheka, wodwalayo amayenera kupita ku insulin kapena kusiya kuyamwitsa.

Zotsatira zoyipa

Kutengera luso la kugwiritsa ntchito glimepiride ndi deta yodziwika pazinthu zina za sulfonylurea, kupanga zotsatira zotsatirazi za mankhwalawa ndizotheka.

Kuchokera kumbali ya kagayidwe ndi zakudya: kukula kwa hypoglycemia, yomwe ikhoza kutuluka (monga momwe amachokera ku sulfonylurea).Zizindikiro zakukula kwa hypoglycemia ndi monga: kupweteka mutu, njala, kutsekemera, kusanza, kufwenthera, kusokonezeka kwa tulo, kuda nkhawa, kukwiya, kuchepa chidwi, kuchepa tulo, kuchepa m'maganizo, kupsinjika, kupsinjika, kuphwanya masomphenya, kunjenjemera, paresis, kusokonezeka kwa chidwi, chizungulire, kusowa chithandizo, kulephera kudziletsa, kupuma, kukomoka, kugona komanso kulephera kuzindikira mpaka kufika pakoma, kupuma kosakhazikika, bradycardia. Kuphatikiza apo, zizindikiro za kukula kwa adrenergic zimachitika mu hypoglycemia zitha kudziwika: kuchuluka thukuta, khungu la khungu, nkhawa zowonjezera, tachycardia, kuthamanga kwa magazi, kumva kugunda kwa mtima, angina pectoris ndi arrhasmia. Chithunzi cha matenda ovuta kwambiri a hypoglycemia chingafanane ndi kuphwanya kwamatenda. Zizindikiro zimakhala kuti zimathetsedwa nthawi zonse atachotsa glycemia.

Kuchokera kumbali ya gawo la masomphenyawo: kuwonongeka kwamawonekedwe (makamaka kumayambiriro kwa chithandizo chifukwa cha kusinthasintha kwa kuchuluka kwa shuga m'magazi).

Kuchokera mmimba: mseru, kusanza, chidzalo m'mimba, kupweteka kwam'mimba komanso kutsegula m'mimba.

Pa mbali ya chiwindi ndi biliary thirakiti: kuchuluka kwa chiwindi michere ndi chiwindi ntchito (mwachitsanzo, cholestasis ndi jaundice), komanso hepatitis, yomwe imatha kupita chiwindi.

Kuchokera pamagazi ndi dongosolo lamitsempha yamagazi: thrombocytopenia, nthawi zina - leukopenia, hemolytic anemia kapena erythrocytopenia, granulocytopenia, agranulocytosis kapena pancytopenia. Kusamala bwino kwa wodwalayo ndikofunikira, popeza milandu ya aplastic anemia ndi pancytopenia inalembedwa panthawi ya mankhwala a sulfonylurea. Izi zikachitika, mankhwalawo ayenera kusiyidwa ndipo chithandizo choyenera chiyambike.

Kuchokera ku chitetezo chamthupi: thupi siligwirizana kapena pseudo-thupi lawo siligwirizana (mwachitsanzo, kuyabwa, ming'oma, kapena totupa). Kusintha koteroko nthawi zambiri kumachitika mosadukiza, koma kumatha kulowa kwambiri, ndikapumira kapena kuchepa kwa magazi, mpaka kugwedezeka kwa anaphylactic. Ming'oma ikachitika, pitani kuchipatala mwachangu. Kuphatikiza kwa ziwengo ndi kotheka ndi sulfonylureas, sulfonamides kapena zinthu zina. Thupi lawo siligwirizana.

Zina: photosensitivity, hyponatremia.

Kuchokera kumbali ya kagayidwe ndi zakudya: lactic acidosis (onani. "Malangizo apadera"), hypoglycemia.

Kuchokera mmimba: kutsegula m'mimba, kusanza, kupweteka m'mimba, kusanza, kuchuluka kwa mpweya, kusowa kudya - zomwe zimachitika kawirikawiri ndi metformin monotherapy. Zizindikirozi zimapezeka pafupifupi 30% kuposa momwe odwala akumvera a placebo, makamaka kumayambiriro kwa chithandizo. Zizindikirozi zimakhala zachidule komanso zosagwirizana paokha. Nthawi zina, kuchepetsa kwakanthawi kwa mankhwalawa kungakhale kothandiza. Pa maphunziro azachipatala, metformin idathetsedwa pafupifupi 4% ya odwala chifukwa cha zomwe zimachitika m'matumbo.

Popeza kukulira kwa zisonyezo kuchokera m'matumbo am'mimba kumayambiriro kwa chithandizo kumadalira mlingo, mawonekedwe awo amatha kuchepetsedwa pang'onopang'ono ndikuwonjezera mlingo ndikuyamba mankhwalawo ndi chakudya.

Popeza kutsegula m'mimba ndi / kapena kusanza kungayambitse kuchepa kwa madzi m'thupi ndi kulephera kwa impso, zikachitika, mankhwalawa ayenera kuyimitsidwa kwakanthawi.

Kumayambiriro kwa chithandizo ndi metformin, pafupifupi 3% ya odwala amatha kumva kukoma kosasangalatsa kapena zitsulo mkamwa, zomwe nthawi zambiri zimangopita zokha.

Pa khungu: erythema, kuyabwa, zotupa.

Kuchokera pamagazi ndi dongosolo lamitsempha yamagazi: kuchepa magazi, leukocytopenia, kapena thrombocytopenia. Pafupifupi 9% ya odwala omwe adalandira monotherapy ndi Amaril ® M, ndipo mwa 6% ya odwala omwe adalandira chithandizo ndi metformin kapena metformin / sulfonylurea, pali kuchepa kwa asymptomatic mu mavitamini B₁₂ m'magazi am'magazi (kuchuluka kwa folic acid m'madzi a m'magazi sikunachepetse kwambiri). Ngakhale izi, kuchepa kwa magazi m'thupi kokha ndi megaloblastic komwe kunalembedwa pamene akutenga Amaril ® M, ndipo palibe zomwe zimawonjezera mu neuropathy. Chifukwa chake, kuwunika koyenera kwa mavitamini B ndikofunikira.₁₂ mu madzi am'magazi (angafunike monga makulidwe anthawi zonse a vitamini B₁₂).

Kuchokera ku chiwindi: chiwindi ntchito.

Milandu yonse ya kupezeka kwa zoyipa zomwe zili pamwambazi kapena zochita zina zoyipa ziyenera kufotokozedwa kwa dokotala. Chifukwa chakuti ena osakhudzidwa zimachitikira, incl. hypoglycemia, matenda a hematological, thupi lawo siligwirizana ndimatenda amisala komanso vuto la chiwindi lingasokoneze moyo wa wodwalayo, ngati atakula, wodwalayo ayenera kudziwitsa dokotala za iwo ndikuyimitsanso kuperekera mankhwala asanakalandire malangizo kuchokera kwa dokotala. Mavuto osayembekezereka a Amaryl ® M, kupatula zomwe zimadziwika kale ku glimepiride ndi metformin, sizinawonekere panthawi ya mayeso a kachipatala komanso mayeso otseguka a gawo III.

Kutenga kuphatikiza kwa mankhwalawa, onse awiri mwanjira yophatikizika yaulere yopangidwa ndi glimepiride ndi metformin, komanso ngati mankhwala osakanikirana ndi Mlingo wokhazikika wa glimepiride ndi metformin, umagwirizananso ndi chitetezo chofanana ndi kugwiritsa ntchito iliyonse ya mankhwalawa mosiyana.

Kuchita

Ngati wodwala yemwe akutenga glimepiride adalembedwa kapena atayimitsidwa nthawi yomweyo, mankhwala ena akhoza kuwonjezereka osafunikira komanso kufooketsa kwa hypoglycemic zotsatira za glimepiride. Kutengera kuzomwe zachitika ndi glimepiride ndi zina zokhudzana ndi sulfonylurea, njira zomwe mankhwala omwe alembedwa pansipa ayenera kuganiziridwa.

Ndi mankhwala omwe amadzitchinjiriza kapena oletsa CYP2C9

Glimepiride imapangidwa ndi cytochrome P450 CYP2C9. Amadziwika kuti kagayidwe kake kamakhudzidwa ndi kugwiritsa ntchito nthawi imodzi kwa CYP2C9 inducers, mwachitsanzo rifampicin (chiwopsezo chochepetsedwa ndi hypoglycemic zotsatira za glimepiride akagwiritsidwa ntchito munthawi yomweyo ndi CYP2C9 inducers ndi chiwopsezo chowonjezeka cha hypoglycemia ngati CYP2C9 inducers ducampondment ya canc2ndcamp22 ya canc2ndcamp22 ya cancPamp22c92 c92c92 c92 c92 cuccamp ya Cc. Kukula kwa hypoglycemia ndi zotsatira zoyipa glimepiride akagwidwa limodzi ndi mankhwalawa komanso chiopsezo chocheperako cha hypoglycemic zotsatira za glimepiride palibe CYP2C9 zoletsa popanda kusintha kwa glimepiride).

Ndi mankhwala omwe amalimbikitsa hypoglycemic effect

Ma insulin ndi pakamwa a hypoglycemic othandizira, ma inhibitors a ACE, allopurinol, anabolic steroids, mahomoni ogonana amuna, chloramphenicol, coumarin anticoagulants, cyclophosphamide, disopyramide, phenfluramine, pheniramidol, fibrate, fluoxetine, azolinofluoromethanesolinlueside (ndi makulidwe a parenteral mu Mlingo wambiri), phenylbutazone, probenecid, antimicrobial othandizira a gulu la quinolone, salicylates, sulfinpyrazone, sulfonamide zotumphukira, ma tetracyclines, atatu okvalin, trofosfamide, azapropazone, oxyphenbutazone.

Chiwopsezo cha hypoglycemia chimawonjezeka pamodzi ndi munthawi yomweyo kugwiritsa ntchito mankhwala omwe ali pamwambawa ndi glimepiride ndi chiwopsezo chowonjezeka cha glycemic control ngati atachotsa popanda kusintha kwa glimepiride.

Ndi mankhwala omwe amachepetsa mphamvu ya hypoglycemic

Acetazolamide, barbiturates, GCS, diazoxide, okodzetsa, epinephrine kapena sympathomimetics, glucagon, mankhwala othandizira (ogwiritsira ntchito nthawi yayitali), nicotinic acid (muyezo waukulu), estrogens, progestogens, phenothiazines, phenytoin, rifampicin, mahomoni a chithokomiro.

Chiwopsezo chowongolera glycemic control ndi kuphatikiza kwa mankhwala omwe ali pamwambawa komanso chiopsezo cha hypoglycemia ngati atachotsedwa popanda kusintha kwa glimepiride achulukitsidwa.

Ndi mankhwala omwe amatha kutsitsa ndikuchepetsa mphamvu ya hypoglycemic

Mbiri H blockers₂receptors, clonidine ndi reserpine.

Pogwiritsa ntchito munthawi yomweyo, kuwonjezeka komanso kuchepa kwa mphamvu ya hypoglycemic ya glimepiride ndikotheka. 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 othandizira omvera chisoni

Amatha kuchepetsa kapena kuletsa zomwe zimachitika m'masisitimu am'maganizo poyankha hypoglycemia, zomwe zimapangitsa kuti chiwonetsero cha hypoglycemia chisawonekere kwa wodwala ndi adokotala ndipo potero amawonjezera ngozi yake yamwadzidzidzi.

Kugwiritsa ntchito kwambiri kwa ethanol kumatha kufooketsa kapena kufalitsa mphamvu ya hypoglycemic ya glimepiride.

Ndi anticoagulants osadziwika, zotumphukira za coumarin

Glimepiride imatha kuwonjezera komanso kuchepetsa zovuta za anticoagulants, ma coumarin omwe amapezeka.

Kuledzera pachimake, chiopsezo chokhala ndi lactic acidosis imachuluka, makamaka ngati kulumpha kapena kudya chakudya chokwanira, kupezeka kwa chiwindi. Mowa (ethanol) ndi mankhwala okhala ndi ethanol ayenera kupewedwa.

Ndi othandizira ayodini

Magetsi omwe amaphatikizidwa ndi ayodini omwe ali ndi mankhwala osakanikirana angayambitse kukula kwa impso, komwe kumapangitsa kuti metformin ikhale ndi chiwopsezo cha lactic acidosis. Metformin iyenera kuyimitsidwa maphunziro asanachitike kapena phunzirolo ndipo sayenera kuyambiranso patatha maola 48. Metformin imatha kuyambiridwanso pokhapokha phunziroli litapezeka komanso zisonyezo zabwinobwino za ntchito yaimpso zikapezeka (onani "Maupangiri Apadera").

Ndi maantibayotiki omwe atchulidwa nephrotoxic zotsatira

Chiwopsezo chowonjezeka cha lactic acidosis (onani "Malangizo apadera").

Kuphatikiza kwa mankhwala omwe ali ndi metformin omwe amafunika kusamala

Ndi corticosteroids (mwazinthu komanso zogwiritsidwa ntchito wamba), beta₂-adrenostimulants ndi okodzetsa okhala ndi mkati mwa hyperglycemic ntchito. Wodwala ayenera kudziwitsidwa za kuwunika pafupipafupi 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 zoletsa zoletsa za ACE

ACE zoletsa amachepetsa kuchuluka kwa shuga m'magazi. Kusintha kwa mankhwala a hypoglycemic kungafunike pakugwiritsa ntchito kapena mutachotsa zoletsa za ACE.

Ndi mankhwala omwe amalimbikitsa Hypoglycemic zotsatira za metformin: insulin, sulfonylureas, anabolic steroids, guanethidine, salicylates (acetylsalicylic acid, etc.), beta-blockers (propranolol, etc.), Mao inhibitors

Pankhani yogwiritsa ntchito pamodzi mankhwalawa ndi metformin, kuyang'anira wodwalayo mosamala ndikuwunika kuchuluka kwa shuga m'magazi ndikofunikira, popeza kuchulukitsa kwa hypoglycemic zotsatira za glimepiride.

Ndi mankhwala omwe amachepetsa mphamvu ya hypoglycemic ya metformin: epinephrine, corticosteroids, mahomoni a chithokomiro, estrogens, pyrazinamide, isoniazid, nicotinic acid, phenothiazines, thiazide diuretics ndi diuretics yamagulu ena, kulera pakamwa, phenytoin, sympathomimetics, pang'toinin, sympathomimetics.

Pankhani yogwiritsa ntchito pamodzi mankhwalawa ndi metformin, kuyang'anira wodwalayo mosamala ndikuwunika kuchuluka kwa shuga m'magazi ndikofunikira, popeza kufooketsa kwa hypoglycemic kwenikweni.

Kuchita mogwirizana

Mu kafukufuku wazachipatala pakuyanjana kwa metformin ndi furosemide pamene adatengedwa kamodzi odzipereka athanzi, zidawonetsedwa kuti kugwiritsa ntchito mankhwalawa munthawi yomweyo kumakhudza magawo awo a pharmacokinetic. Furosemide inachulukitsa C_max metformin mu plasma ndi 22%, ndi AUC - mwa 15% popanda kusintha kwakukulu kwa impso chilolezo cha metformin. Mukamagwiritsa ntchito metformin C_max ndi AUC ya furosemide idatsika ndi 31 ndi 12%, motero, poyerekeza ndi furosemide monotherapy, ndikuti kuthetseratu theka la moyo kumatsika ndi 32% popanda kusintha kwakukulu kwa aimpso a furosemide. Zambiri pazokhudzana ndi metformin ndi furosemide pogwiritsa ntchito nthawi yayitali sizipezeka.

Pakafukufuku wamankhwala wokhudzana ndi kugwiritsidwa ntchito kwa metformin ndi nifedipine ndi gawo limodzi mwa odzipereka athanzi, zinaonetsedwa kuti kugwiritsa ntchito munthawi yomweyo nifedipine kumawonjezera C_max ndi AUC ya metformin m'madzi am'magazi ndi 20 ndi 9%, motero, komanso imachulukitsa kuchuluka kwa metformin yotulutsidwa ndi impso. Metformin inali yovuta kwambiri pa pharmacokinetics ya nifedipine.

Ndi mankhwala a cationic (amiloride, digoxin, morphine, procainamide, quinidine, quinine, ranitidine, triamteren, trimethoprim ndi vancomycin)

Mankhwala a Cationic omwe atulutsidwa ndi kubisalira kwa chiberekero m'magazi, amatha kuyanjana ndi metformin chifukwa cha mpikisano wapaulendo wamba. Kuyanjana koteroko pakati pa metformin ndi cimetidine wamlomo kunawonedwa mwa odzipereka athanzi mu maphunziro azachipatala a kuyanjana kwa metformin ndi cimetidine omwe amagwiritsidwa ntchito kamodzi ndi kawiri, komwe kunali kuwonjezeka kwa 60% pazovuta za plasma komanso kuchuluka kwa metformin m'magazi ndikuwonjezeka kwa 40% ya plasma ndi kuchuluka kwa AUC metformin. Ndi gawo limodzi, panalibe zosintha mu theka-moyo. Metformin sizinakhudze pharmacokinetics ya cimetidine. Ngakhale kuti matumizidwe oterowo amakhalabe achiboliboli (kupatulapo cimetidine), kuwunika mosamala odwala kuyenera kuthandizidwa ndikuwonetsa kusintha kwa metformin ndi / kapena mankhwala omwe akukhudzana nawo amayenera kuchitika chifukwa cha munthawi yomweyo makonzedwe a cationic a mthupi atulutsidwa kuchokera mthupi.

Ndi propranolol, ibuprofen

Mwa odzipereka athanzi mumaphunziro pamtundu umodzi wa metformin ndi propranolol, komanso metformin ndi ibuprofen, sizinasinthe mu magawo awo a pharmacokinetic.

Mlingo ndi makonzedwe

Monga lamulo, mlingo wa Amaril ® M uyenera kutsimikiziridwa ndi kutsata kwa glucose 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 ndi mkodzo. Kuphatikiza apo, kuwunika pafupipafupi kuchuluka kwa hemoglobin ya glycosylated m'magazi kumalimbikitsidwa.

Kukhazikika kwa mankhwalawa.

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.

Popeza kuyendetsa bwino kagayidwe kachakudya kumalumikizidwa ndi kukhudzika kwa minyewa ku insulin, kufunikira kwa glimepiride kumatha kuchepa panthawi yamankhwala ndi Amaril ® M. Kuti mupewe kukula kwa hypoglycemia, ndikofunikira kuchepetsa mlingo kapena kusiya kumwa Amaril ® M.

Mankhwala ayenera kumwedwa 1 kapena 2 pa tsiku 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 womwe wodwala wayamba kutenga. Posamutsa odwala kuti asatenge njira imodzi yophatikizira glimepiride ndi metformin kupita ku Amaril ® M, mlingo wake umatsimikiziridwa pamiyeso ya glimepiride ndi metformin yomwe yatengedwa kale.

Ngati pakufunika kuwonjezera mlingo, tsiku lililonse la Amaril ® M liyenera kukhala lophatikizidwa ndi ziwonetsero za tebulo limodzi lokha. Amaril ® M 1 mg / 250 mg kapena piritsi 1/2. Amaril ® M 2 mg / 500 mg.

Kutalika kwa chithandizo. Nthawi zambiri chithandizo ndi Amaril ® M chimachitika nthawi yayitali.

Malangizo apadera

Lactic acidosis ndiyosowa koma yowopsa (yokhala ndi kufa kwakukulu popanda chithandizo choyenera) metabolic complication, yomwe imayamba chifukwa cha kudzikundikira kwa metformin panthawi ya chithandizo. Milandu ya lactic acidosis yokhala ndi Metformin yawonedwa makamaka mwa odwala omwe ali ndi matenda osokoneza bongo omwe amalephera kwambiri aimpso. Kuchuluka kwa lactic acidosis kumatha ndipo kuyenera kuchepetsedwa poyesa kupezeka kwa zinthu zina zomwe zingayambitse matenda a lactic acidosis mwa odwala, monga matenda osokoneza bongo oopsa a mellitus, ketoacidosis, kusala kudya kwa nthawi yayitali, kumwa kwambiri zakumwa zomwe zimakhala ndi ethanol, kulephera kwa chiwindi, komanso zochitika zina zokhala 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 magazi pH, kuphwanya kwa-electrolyte bwino ndi kuwonjezeka kwa kuperewera kwa anion ndi kuchuluka kwa lactate / pyruvate. Panthawi yomwe metformin imayambitsa lactic acidosis, plasma ndende ya metformin nthawi zambiri imakhala> 5 μg / ml. Ngati lactic acidosis ikukayikiridwa, metformin iyenera kuyimitsidwa nthawi yomweyo ndipo wodwala ayenera kuchipatala nthawi yomweyo.

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 , wokhala ndi matenda obadwa nawo a impso komanso a impso hypoperfusion, nthawi zambiri pamakhala zochitika zambiri zothandizidwa ndi opereshoni.

Chiwopsezo chokhala ndi lactic acidosis chimawonjezeka ndi kuopsa kwa vuto laimpso komanso ukalamba. Kuchepa kwa lactic acidosis mukamalandira metformin kungathe kuchepetsedwa ndikuwunikira ntchito ya aimpso ndikugwiritsa ntchito mitundu yaying'ono ya metformin. Pa chifukwa chomwechi, pazinthu zomwe zimakhudzana ndi hypoxemia kapena kuchepa thupi, ndikofunikira kupewa kumwa mankhwalawa.

Monga lamulo, chifukwa chakuti kuwonongeka kwa chiwindi kungachepetse kutulutsa kwa lactate, kugwiritsa ntchito mankhwalawa kuyenera kupewedwa kwa odwala omwe ali ndi matenda am'chipatala kapena a labotale matenda a chiwindi.

Kuphatikiza apo, mankhwalawa amayenera kusiyidwa kwakanthawi musanayambe maphunziro a x-ray omwe ali ndi intravascular management ya iodine yomwe ili ndi zotsutsana ndi isanachitike opaleshoni.

Nthawi zambiri, lactic acidosis imayamba pang'onopang'ono ndipo imawonetsedwa kokha ndi zizindikiro zosakhala zachidziwitso, monga thanzi loperewera, myalgia, kulephera kupuma, kuwonjezeka kwa tulo komanso vuto losagwirizana ndi 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, magazi a HH, kuchuluka kwa lactate ndi metformin m'magazi. Kusala plasma plasma lactate ndende kusala kudya kwaposachedwa kwambiri, koma m'munsi mwa 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 mankhwalawo ndikuchita zina zothandizirana ponseponse. Chifukwa chakuti metformin imachotsedwa m'magazi pogwiritsa ntchito hemodialysis ndi chilolezo chofika mpaka 170 ml / min, tikulimbikitsidwa, malinga ngati palibe zosokoneza za hemodynamic, hemodialysis yomweyo kuchotsa metformin ndi lactate wophatikizidwa. 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.

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, mankhwala osokoneza bongo a Amaril ® M, omwe ali ndi vuto losagwirizana la endocrine system (mwachitsanzo, kusowa kwa chithokomiro komanso kusowa kwa mahomoni a anterior pituitary or adrenal cortex, mukugwiritsa ntchito mankhwala ena omwe amakhudza kagayidwe kazakudya (onani "Kulumikizana" ").

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, zikuwonetsa malamulo a adrenergic antihypoglycemic poyankha kukulitsa hypoglycemia (onani "Zotsatira zoyipa"), atha kukhala osatchulika kapenanso kusapezeka ngati hypoglycemia imayamba pang'onopang'ono, komanso kwa odwala okalamba, omwe ali ndi neuropathy ya autonomic mantha system kapena munthawi yomweyo mankhwala a beta-blockers, clonidine, guanethidine ndi ena a sympatholytics.

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, ndi zina). Pachifukwa ichi, wodwalayo ayenera kunyamula shuga osachepera 20 g. Angafunike thandizo kuchokera kwa ena kuti apewe zovuta. Zilime zotsekemera sizothandiza.

Kuchokera pazochitika ndi mankhwala ena a sulfonylurea, zimadziwika kuti, ngakhale kuti mphamvu zoyambirira zimatengedwa, hypoglycemia imatha kubwereranso. Chifukwa chake, odwala ayenera kuyang'aniridwa bwino. Kukula kwambiri kwa hypoglycemia kumafuna chithandizo chamankhwala komanso kuyang'aniridwa kwachipatala, nthawi zina, chithandizo cha mankhwala.

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 tsiku loti atuluke, etc.), wodwalayo ayenera kumuuza za matenda 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. Chifukwa chake, pamene kuchuluka kwa creatinine m'magazi seramu kukadutsa zaka zapamwamba zofananira, monga kumwa mankhwala osavomerezeka. Kwa odwala okalamba, kusanthula mosamala mlingo wa metformin ndikofunikira kuti musankhe mlingo wothandiza wothandizadi, popeza Ndi zaka, ntchito ya impso imachepa. 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 wophatikizidwa ndi intrate yotupa ya ma iodine okhala ndi mitundu yosiyanasiyana (mwachitsanzo, intravenous urography, intravenous cholangiography, angiography ndi computer tomography (CT) pogwiritsa ntchito njira yosiyanitsira pakati: zosiyanitsa za ayodini zomwe zili ndi cholinga chofufuzira zimatha kuyambitsa kupweteka kwa impso, kugwiritsidwa ntchito kwawo kumayenderana ndi chitukuko cha lactic acidosis odwala atatenga metformin (onani. Contraindication ").

Chifukwa chake, ngati akukonzekera kuchita kafukufuku wotere, Amaril ® M iyenera kuthetsedweratu njirayi isanapangidwenso pambuyo pa maola 48 pambuyo pa njirayi. Mutha kuyambiranso chithandizo ndi mankhwalawa pokhapokha ngati mukuwunikira ndikuzindikira zowoneka bwino za ntchito yaimpso.

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.

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. Chifukwa chake, odwala ayenera kuchenjezedwa kuti asamwe zakumwa zomwe zimakhala ndi ethanol pomwa mankhwalawa.

Kuwonongeka kwa chiwindi

Popeza nthawi zina lactic acidosis imalumikizidwa ndi vuto la chiwindi, monga lamulo, odwala omwe ali ndi matenda kapena a labotale zizindikiro za 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 bwino ndi kugwiritsa ntchito metformin, ayenera kuwunika nthawi yomweyo, makamaka ngati ali ndi matenda oopsa komanso osadziwika 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, mankhwalawa ayenera kusiyidwa pomwepo ndi mankhwala ena onse kuti akhale osamala.

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.

Vitamini B Kukhazikika₁₂ m'magazi

Vitamini B wapezeka₁₂ Pansi pazomwe zimachitika mu seramu yamagazi pakalibe chiwonetsero chazachipatala zinaonedwa pafupifupi 7% ya odwala omwe akutenga Amaril ® M, komabe, samakonda kuyenda ndi magazi pamene mankhwalawa amachotsedwa kapena vitamini B akaperekedwa.₁₂ zidasinthidwa mwachangu. Anthu ena (osowa kapena vitamini B₁₂) wotsogola kuchepa kwa ndende ya vitamini B₁₂. Kwa odwala oterewa, pafupipafupi, zaka ziwiri zilizonse, kutsimikiza kwa seramu ya vitamini B mu seramu yamagazi kumatha kukhala kothandiza.₁₂.

Laborator chithandizo chitetezo

Hematological magawo (hemoglobin kapena hematocrit, erythrocyte count) ndi kuwonongeka kwa impso (serum creatinine ndende) iyenera kuyang'aniridwa kamodzi pachaka kwa odwala omwe ali ndi vuto lanthete, komanso osachepera 2-5 pachaka odwala omwe ali ndi ndende ya creatinine magazi seramu pamlingo wapamwamba wa okalamba ndi okalamba odwala. 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 ndi metformin, ngati akukayikira, kuyesedwa kuyenera kuphatikizidwa kuperewera kwa vitamini B₁₂.

Zokhudza mphamvu pakutha kuyendetsa magalimoto kapena njila zina. Kuchuluka kwa wodwala kumatha kuwonongeka chifukwa cha hypoglycemia ndi hyperglycemia, makamaka kumayambiriro kwa mankhwalawa kapena kusintha kwa mankhwala, kapena kugwiritsa ntchito mankhwalawa mosasamala. Izi zimatha kukhudza kuyendetsa pamagalimoto ndi njira zina. Odwala ayenera kuchenjezedwa za kufunika kokhala osamala poyendetsa magalimoto, makamaka ngati akukonda kukhala ndi hypoglycemia komanso / kapena kuchepa kwa kuwonongeka kwa omwe amayambira.

Mphamvu ya mankhwalawa pa thupi la wodwalayo

Glimepiride yomwe ili mu mankhwalawa imakhudza minyewa ya pancreatic, ikuthandizira pakapangidwe ka insulin, ndipo imathandizira kulowa kwake m'magazi. Kudya kwa insulini m'madzi am'magazi kumathandizira kuchepetsa shuga mumthupi la wodwala wokhala ndi matenda a shuga a 2.

Kuphatikiza apo, glimepiride imayendetsa njira zoyendetsera kashiamu kuchokera m'madzi am'magazi kupita m'maselo a pancreatic. Kuphatikiza apo, zoletsa zomwe zimapangitsa kuti pakhale yogwira mankhwala popanga ma atherosselotic zolembera pamitsempha yamagazi yamitsempha yamagazi.

Metformin yomwe ili ndi mankhwalawa imathandizira kuchepetsa shuga mumthupi la wodwalayo. Gawo la mankhwalawa limapangitsa magazi kutuluka kwa chiwindi ndipo limathandizira kutembenuka kwa shuga ndimaselo a chiwindi kukhala glucogen. Kuphatikiza apo, metformin imakhala ndi phindu pakulowetsa shuga kwa madzi a m'magazi ndimaselo am'misempha.

Kugwiritsidwa ntchito kwa Amaril M mu mtundu 2 wa shuga kumalola nthawi yamankhwala kukhala ndi tanthauzo lalikulu mthupi lanu pogwiritsa ntchito mankhwala ochepetsa.

Izi ndizosafunikira kwenikweni kuti thupi lizigwira bwino ntchito ndi ziwalo za thupi.

Malangizo ogwiritsira ntchito mankhwalawa

Malangizo ogwiritsira ntchito mankhwalawa Amaryl m akuwonetseratu kuti mankhwalawa avomerezedwa kuti agwiritsidwe ntchito pamaso pa odwala matenda a shuga 2.

Mlingo wa mankhwalawa umatsimikizika malinga ndi kuchuluka kwa shuga m'magazi a m'magazi. Tikulimbikitsidwa, kugwiritsa ntchito njira zophatikizira monga Amaril m, kuti mupereke mlingo woyenera wa mankhwala ofunikira kuti mukwaniritse pazotheka zabwino.

Mankhwala ayenera kumwedwa nthawi 1-2 patsiku. Ndikofunika kumwa mankhwala ndi chakudya.

Mlingo wokwanira wa metformin mu gawo limodzi sayenera kupitirira 1000 mg, ndi glimepiride 4 mg.

Mlingo watsiku ndi tsiku wa mankhwala awa sayenera kupitilira 2000 ndi 8 mg, motsatana.

Mukamagwiritsa ntchito mankhwala omwe ali ndi 2 mg glimepiride ndi 500 mg metformin, kuchuluka kwa mapiritsi omwe amamwa patsiku sikuyenera kupitirira anayi.

Mankhwala onse omwe amwedwa patsiku amagawika pawiri.

Wodwala akangotenga kachakudya kena kamene kamakhala ndi glimepiride ndi metformin kuti atenge mankhwala ophatikizika a Amaril, mlingo woyenera kumwa mankhwalawo uyenera kukhala wochepa.

Mlingo wa mankhwala omwe atengedwa ngati kusintha kwa mankhwala ophatikizika amasinthidwa malinga ndi kusintha kwa shuga m'thupi.

Kuti muwonjezere Mlingo watsiku ndi tsiku, ngati kuli kotheka, mutha kugwiritsa ntchito mankhwala okhala ndi 1 mg ya glimepiride ndi 250 mg ya metformin.

Kuchiza ndi mankhwalawa ndikutalika.

Contraindging kugwiritsa ntchito mankhwalawa ndi awa:

1. wodwala ali ndi matenda ashuga 1.
2. Kupezeka kwa matenda ashuga ketoacidosis.
3. Kukula m'thupi la wodwalayo chikomokere.
4. Kukhalapo kwa zovuta zazikulu pakugwira ntchito kwa impso ndi chiwindi.
5. Nthawi ya bere ndi nthawi ya mkaka wa m'mawere.
6. Kukhalapo kwa tsankho la munthu pazigawo za mankhwala.

Mukamagwiritsa ntchito Amaril M m'thupi la munthu, zotsatirazi zimabweretsa:

• mutu
• kugona ndi kusokonezeka kwa tulo,
• mavuto
• mavuto a kulankhula
• kunjenjemera miyendo
• zosokoneza pakugwira ntchito kwamtima;
• nseru
• kusanza
• kutsegula m'mimba
• Anemia
• thupi lawo siligwirizana.

Zotsatira zoyipa zikachitika, muyenera kufunsa dokotala za kusintha kwa mankhwalawa kapena kusiya mankhwala.

Zomwe zimagwiritsidwa ntchito ndi mankhwala Amaryl M

Dokotala wopezekapo, kusankha wodwala kuti amwe mankhwalawo, amakakamizidwa kuchenjeza za zovuta zina mthupi. Choyambitsa chachikulu komanso chowopsa cha zotsatira zoyipa ndi hypoglycemia. Zizindikiro za hypoglycemia zimayamba kudwala ngati amwa mankhwala osadya.

Pofuna kuletsa kupezeka kwa vuto la hypoglycemic mthupi, wodwalayo ayenera kukhala ndi maswiti kapena shuga mzidutswa ndi iye. Dotolo afotokozere wodwalayo mwatsatanetsatane zomwe zizindikiro zoyambirira za mawonekedwe a hypoglycemic mthupi ndizo, popeza moyo wa wodwala umadalira kwambiri izi.

Kuphatikiza apo, panthawi ya chithandizo cha matenda a shuga a mtundu wachiwiri, wodwalayo ayenera kuyang'anira kuchuluka kwa shuga m'magazi.

Wodwala ayenera kukumbukira kuti mphamvu ya mankhwalawa imachepa pakakumana ndi zovuta, chifukwa chotulutsidwa kwa adrenaline m'magazi.

Zoterezi zimatha kukhala ngozi, mikangano kuntchito komanso m'moyo wa munthu ndi matenda omwe amatsatana ndi kukwera kwambiri kwa kutentha kwa thupi.

Mtengo, ndemanga za mankhwala ndi mawonekedwe ake

Nthawi zambiri, pali ndemanga zabwino za mankhwalawa. Kukhalapo kwa ndemanga zabwino zambiri kumatha kukhala umboni wa kugwiriridwa ntchito bwino kwa mankhwalawa mukamagwiritsa ntchito mlingo woyenera.

Odwala omwe amasiya ndemanga zawo za mankhwalawa nthawi zambiri amawonetsa kuti chimodzi mwazotsatira zoyipa zomwe zimagwiritsidwa ntchito ndi Amaril M ndikupanga hypoglycemia. Pofuna kuti asasokoneze mlingo akamamwa mankhwalawa, opanga kuti athe kuthandizira odwala amapaka mitundu yosiyanasiyana ya mankhwalawo mitundu yosiyanasiyana, yomwe imathandiza kuyenda.

Mtengo wa Amaril zimatengera Mlingo womwe uli mkati mwake pazomwe zimagwira.

Amaril m 2mg + 500mg ali ndi mtengo pafupifupi pafupifupi 580 rubles.

The fanizo la mankhwala ndi:

Mankhwalawa onse ndi fanizo la Amaril m mu kapangidwe kazinthu. Mtengo wa analogues, monga lamulo, ndi wotsika pang'ono poyerekeza ndi mankhwala oyambayo.

Mu kanema munkhaniyi, mutha kudziwa zambiri zamankhwala ochepetsa shuga awa.