Yanumet - malangizo ogwiritsidwa ntchito

Mankhwala Yanumet ndi kuphatikiza kwa zinthu ziwiri za hypoglycemic ndi makina othandizira (othandizira) a zochita. Adapangidwa kuti azilamulira bwino glycemia mwa odwala omwe ali ndi mtundu II matenda a shuga. Mwachilengedwe sitagliptinndi choletsa dipeptidyl peptidases-4 (abbr. DPP-4), pomwe metforminNdi nthumwi ya kalasi khwawa.

Zotsatira za pharmacological sitagliptinngati choletsa wa DPP-4 chikuyankhidwa ndi kuyambitsa ma insretins. Poletsa DPP-4, kuchuluka kwa mahomoni awiri ogwira ntchito a banja lino amakula. ma insretin: glucagon-ngati peptide-1 (GLP-1),komanso shuga wodalira insulinotropic polypeptide (HIP). Ma mahomoni awa ndi gawo limodzi lamthupi lathu lomwe limayendetsa homeostasisshuga. Ngati mulingo shugam'magazi ndimakhalidwe abwinobwino kapena okwera, ndiye kuti ma insretins omwe ali pamwambapa amathandizira pakuwonjezera kaphatikizidwe insulin ndi kubisika kwake. Kuphatikiza apo, GLP-1 ikulepheretsa magawikidwe glucagon, zomwe zimalepheretsa kuphatikiza kwa shuga m'chiwindi. Sitagliptinmu achire Mlingo saletsa ntchito michere - dipeptidyl peptidases-8 ndi dipeptidyl peptidases-9.

Chifukwa cha kulolera kwakukulu kwa shugaodwala mtundu II matenda a shuga kudzera metformin, amachepetsa kuyambira ndi kuzungulira kwa glucose m'magazi. Kuphatikiza apo, pali kuchepa kwa kaphatikizidwe shugamu chiwindi (gluconeogenesis, kunyowa kumachepa shugam'matumbo, kumverera kwa insulinchifukwa chojambula ndikugwiritsa ntchito mamolekyulu a shuga. Ma pharmacological limagwirira zake ndi osiyana ndi ena pakamwa hypoglycemic othandizira ena m'makalasi ena.

Zizindikiro zogwiritsidwa ntchito

Mankhwala Janumet akuwonetsedwa monga kuwonjezera pa boma la zochita zolimbitsa thupi komanso kutsatira Zakudyazomwe zimapangitsa kuti glycemic ikulamulire bwino mtundu II matenda ashuga. Chithandizo chitha kuchitika limodzi:

• ndi mankhwala omwe zinthu zomwe zimagwira zochokera sulfonylurea (kuphatikiza mankhwala atatu)
• ndi PPAR agonists (mwachitsanzo, kachikachiyama),
• ndi insulin.

Contraindication

• Hypersensitivity pazinthu zilizonse za Yanumet,
• zinthu zina zomwe zimakhudza ntchito ya impso, monga kugwedeza, kusowa kwamadzi, matenda,
• pachimake / matenda omwe amatsogolera hypoxiaminofu: mtima, kulephera kupuma, posachedwa myocardial infaration,
• impso kapena chiwindi choopsa,
• chikhalidwe pachimake mowakapena matenda ngati uchidakwa,
• lembani matenda ashuga,
• pachimake kapena chodwala metabolic acidosiskuphatikiza matenda ashuga ketoacidosis,
• maphunziro a radiology
• mimba ndi mkaka wa m`mawere.

Malangizo pa Yanumet (Njira ndi Mlingo)

Mapiritsi a Janumet amatengedwa kawiri patsiku ndi zakudya. Pofuna kuchepetsa zotsatira zoyipa kuchokera m'matumbo am'mimba, mlingo umachulukanso. Mlingo woyambirira umasankhidwa malinga ndi gawo lomwe lilipo la hypoglycemic therapy.

Malangizo ogwiritsa ntchito Yanumet amawonetsa mlingo woyenera wa tsiku lililonse sitagliptin- 100 mg.

Yang'anani! Mlingo wa mankhwala a hypoglycemic Yanumet ayenera kusankhidwa payekhapayekha, poganizira momwe chithandizo chake chikuyendera, kugwira ntchito kwake komanso kulolera.

Bongo

Mukamamwa bongo wa Yanumet, ndikofunikira kuti ziyenera kuchitidwa: chotsani m'matumbo am'magazi a mankhwala osagwiritsidwa ntchito, yang'anirani zizindikiro zofunikaECG), gwira hemodialysis ndi kupereka mankhwala ngati kuli koyenera, kukonza.

Kuchita

Sipanatenge kafukufuku wokhudzana ndi kuyanjana kwapakati pa mankhwala a Janumet, koma kafukufuku wokwanira wachitika pa chilichonse chomwe chimagwira - sitagliptinndi metformin.

• Sitagliptinmukamacheza ndi mankhwala ena mumapangitsa kuchuluka Auc, kuchuluka ndende (C max) wa Digoxin, Januvia, Cyclosporinkomabe, izi kusintha kwa ma pharmacokinetic sikuwonedwe ngati kwakufunika kwambiri mwachipatala.
• Mlingo umodzi Furosemidekumabweretsa kuwonjezeka Ndi max metformin ndi Aucmu plasma ndi magazi pafupifupi 22% ndi 15%, motero Ndi max ndi AUC Furosemide kuchepa.
• Pambuyo kutenga Nifedipineukuwonjezeka ndi max metforminndi 20% ndi AUC ndi 9%.

Fomu ya Mlingo:

Zomwe chipolopolo chimakhala pa mulingo wa 50 mg / 500 mg:
Opadry ® II Pink 85 F94203 (mowa wa polyvinyl, titanium dioxide E171, macrogol / polyethylene glycol 3350, talc, iron oxide ofiira E172, iron oxide wakuda E172),

Zomwe chipolopolo chimakhala pa mulingo wa 50 mg / 850 mg:
Opadry ® II Pink 85 F94182 (mowa wa polyvinyl, titanium dioxide E171, macrogol / polyethylene glycol 3350, talc, iron oxide red E172, iron oxide wakuda E172),

Zomwe chipolopolo chimakhala pa mulingo wa 50 mg / 1000 mg:
Opadry ® II Red 85 F15464 (mowa wa polyvinyl, titanium dioxide E171, macrogol / polyethylene glycol 3350, talc, iron oxide red E172, iron oxide wakuda E172).

Kufotokozera

Mapiritsi a Janumet 50/500 mg: kapangidwe kake, biconvex, filimu wokutira, pinki yopepuka, cholembedwa "575" mbali imodzi ndi yosalala mbali inayo

Mapiritsi a Yanumet 50/850 mg: kapangidwe kake, biconvex, wokutidwa ndi utoto wofiirira wa pinki, cholembedwa "515" chokhala mbali imodzi ndi yosalala mbali inayo.

Mapiritsi a Yanumet 50/1000 mg: kapangidwe kake, biconvex, wokutidwa ndi chimbale chofiyira chofiyira, cholembedwa "577" chokhala mbali imodzi ndi yosalala mbali inayo.

Mankhwala

Sitagliptin
Sitagliptin ndi wokonda kugwiritsa ntchito kwambiri enzyme inhibitor (DPP-4), yomwe imagwiritsidwa ntchito pochiza matenda a shuga II mellitus.
Zotsatira zamankhwala a DPP-4 zoletsa zimatulutsidwa ndi kuyambitsa kwa ma insretins. Mwa kuletsa DPP-4, sitagliptin imachulukitsa kuchuluka kwa mahomoni awiri odziwika a banja la apretin: glucagon-peptide 1 (GLP-1) ndi insulinotropic polypeptide (HIP) ya glucose.
Ma incretins ndi gawo limodzi lazinthu zamkati zomwe zimakhazikitsa shuga homeostasis. Ndi shuga wabwinobwino kapena wokwezeka wamagazi, GLP-1 ndi GUI imachulukitsa kaphatikizidwe ndi katulutsidwe ka insulin ndi maselo a pancreatic β-cell. GLP-1 imalepheretsanso kubisalira kwa glucagon ndi ma pancreatic α-cell, motero kuchepetsa kuphatikizika kwa shuga m'chiwindi. Njira iyi yochitira zinthu imasiyana ndi ya sulfonylurea yotumphukira, yomwe imalimbikitsa kutulutsa kwa insulin m'magazi ochepa a shuga, omwe amachititsa kukula kwa sulfonyl-ikiwa chifukwa cha hypoglycemia osati mwa odwala omwe ali ndi mtundu II matenda a shuga, komanso odzipereka athanzi. Pokhala choletsa chosankha kwambiri komanso chothandiza cha DPP-4 enzyme, sitagliptin muzoyimira zochizira sizimalepheretsa zochitika za enzymes zokhudzana ndi DPP-8 kapena DPP-9. Sitagliptin amasiyana mu kapangidwe ka mankhwala ndi zochita za pharmacological kuchokera ku analogues ya GLP-1, insulin, sulfonylureas kapena mitiglinides, biguanides, γ-receptor agonists omwe amathandizidwa ndi peroxisis proliferator (PPAR), cy-glycosidase inhibitors ndi ma amylin analogues.

Metformin
Izi wothandizila hypoglycemic kumawonjezera kulolerana kwa glucose kwa odwala omwe ali ndi mtundu II matenda a shuga, kuchepetsa basal ndi gluprose wa postprandial plasma. Ma pharmacological momwe amagwirira ntchito amasiyana ndi njira yochitira pakamwa hypoglycemic mankhwala amakalasi ena.
Metformin imachepetsa kaphatikizidwe ka shuga m'chiwindi, mayamwidwe am'matumbo m'matumbo ndikuwonjezera chidwi cha insulin polimbikitsa kutulutsa kwina ndi kugwiritsa ntchito shuga.Mosiyana ndi zotumphukira za sulfonylurea, metformin siyambitsa hypoglycemia mwa odwala omwe ali ndi mtundu wachiwiri wa matenda a shuga kapena odzipereka othandiza (kupatula zina, onani MALANGIZO OTHANDIZA) ndipo samayambitsa hyperinsulinemia. Mukamalandira mankhwala a metformin, insulin secretion siyimasintha, pomwe kusala kwa insulin komanso kuchuluka kwa insulin tsiku ndi tsiku kumatha kuchepa.

Pharmacokinetics

Njira yamachitidwe
50 mg / 500 mg ndi 50 mg / 1000 mg mapiritsi a Yanumet (sitagliptin / metformin hydrochloride) amakhala bioequivalent pamene mitundu yosiyanasiyana ya sitagliptin phosphate (Januvia) ndi metformin hydrochloride imatengedwa mosiyanasiyana.
Popeza kuchuluka kwa mapiritsi otsimikiziridwa ndi mapiritsi okhala ndi mulingo wocheperako komanso wapamwamba wa mapiritsi, mapiritsi okhala ndi gawo lalitali la metformin ya 850 mg amadziwikanso ndi bioequivalence, malinga ndi kuchuluka kwa mankhwalawa amaphatikizidwa piritsi.

Zogulitsa
Sitagliptin. Mtheradi bioavailability wa sitagliptin pafupifupi 87%. Kulandila kwa sitagliptin nthawi imodzi ndi zakudya zamafuta sizimakhudza ma pharmacokinetics a mankhwalawa.

Metformin hydrochloride. Mtheradi wa bioavailability wa metformin hydrochloride akagwiritsidwa ntchito pamimba yopanda 500 mg ndi 50-60%. Zotsatira za kafukufuku wa mapiritsi amodzi a mapiritsi a metformin hydrochloride mu Mlingo kuchokera 500 mg mpaka 1500 mg ndi kuchokera 850 mg mpaka 2550 mg akusonyeza kuphwanya kwa kuchuluka kwa mlingo ndi kuchuluka kwake, komwe kumakhala chifukwa cha kuchepa mayamwidwe koposa kuchulukitsa. Kugwiritsira ntchito mosiyanasiyana mankhwala ndi chakudya kumachepetsa kuchuluka ndi kuchuluka kwa metformin, monga momwe zikuwonetsedwera ndi kuchepa kwa Cmax ndi 40%, kuchepa kwa AUC ndi 25%, ndikuchepetsa kwa mphindi 35 mpaka Tmax itakwaniritsidwa pambuyo pa gawo limodzi la 850 mg ya metformin nthawi yomweyo ndi chakudya poyerekeza ndi mfundo mukamamwa mankhwala ofanana pamimba yopanda kanthu.
Kufunika kwachipatala pochepetsa magawo a pharmacokinetic sikunakhazikitsidwe.

Kugawa
Sitagliptin. Kuchulukitsa kwapakati pamagawidwe ofanana pambuyo pa gawo limodzi la 100 mg ya sitagliptin mwa odzipereka athanzi ndi pafupifupi 198 L. Gawo la sitagliptin, lomwe limalumikiza mapuloteni a plasma, ndilochepa kwambiri (38%).

Metformin. Kuchuluka kwa metformin pambuyo pakamwa kamodzi pa 850 mg kotalika 654 ± 358 L. Metformin kokha mwa gawo laling'ono kwambiri lomwe limangiriza mapuloteni a plasma, mosiyana ndi zotumphukira za sulfonylurea (mpaka 90%). Metformin imagawa pang'ono ndi pang'ono m'magazi ofiira a m'magazi. Mukamagwiritsa ntchito metformin mu Mlingo woyeserera, kuchuluka kwa plasma ya boma lofanana (nthawi zambiri malinga ndi maphunziro olamulidwa, Cmax ya mankhwalawa sanadutse 5 μg / ml ngakhale atamwa mlingo waukulu wa mankhwalawa.

Kupenda
Sitagliptin. Pafupifupi 79% ya sitagliptin amachotsedwa mu mkodzo, kusintha kwa kagayidwe kake ka mankhwala ndi kochepa.
Pambuyo 14 C-yolembedwa kuti sitagliptin idaperekedwa pakamwa, pafupifupi 16% ya mankhwala omwe adatumizidwa adachotseredwa ngati sitagliptin metabolites. Kuphatikizidwa kochepa kwa metabolites 6 a sitagliptin kunawululidwa komwe sikunakhudze chilichonse cha plasma DPP-4 inhibitory shughuli ya sitagliptin. M'maphunziro mu vitro ma isoenzymes a cytochrome system CYP 3A4 ndi CYP 2C8 amadziwika kuti ndiwofunikira kwambiri omwe amagwira nawo kagayidwe kochepa ka sitagliptin.

Metformin. Patangodutsa kamodzi metformin kwa odzipereka athanzi labwino, pafupifupi mankhwala onsewo sanatulutsidwe mkodzo. Panalibe kusintha kwa kagayidwe kachakudya ndi chiwindi, ndipo ma metabolites osasinthika omwe adapezeka mwa anthu atachotsedwa.

Kuswana
Sitagliptin.Mutatenga 14 C-yolembedwa kuti sitagliptin mkati, pafupifupi mlingo wonse womwe umaperekedwa umatuluka mkatikati mwa sabata, kuphatikiza 13% m'matumbo am'mimba ndi 87% mkodzo. T_1/2 sitagliptin yokhala ndi pakamwa makonzedwe a 100 mg ndi pafupifupi maola 12.4, chilolezo cha impso ndi pafupifupi 350 ml / min.
Kupukusa kwa sitagliptin kumachitika makamaka chifukwa cha impso pochita kukonzekera kwa tubular secretion. Sitagliptin ndi gawo limodzi la transporter ya organic human anions ya mtundu wachitatu (hOAT-3), yomwe ikuphatikizidwa ndikuchotsa impso ndi impso.
Kufunikira kwamankhwala chifukwa cha kuphatikizidwa kwa hOAT-3 pakuyendetsa sitagliptin sikunakhazikitsidwe. Kutenga mbali kwa p-glycoprotein pakutsitsika kwa impso kwa sitagliptin (monga gawo lapansi) ndikotheka, komabe, zoletsa za p-glycoprotein cyclosporin sizimachepetsa chiwonetsero cha sitagliptin.

Metformin. Chilolezo cha metformin chimaposa chilolezo cha creatinine mwa nthawi 3,5, kuwonetsa secretion yogwira impso ngati njira yayikulu yodziwitsira. Pafupifupi 90% ya metformin imachotseredwa ndi impso nthawi yoyamba ya maola 24 ndi phindu lachiwonetsero cha plasma pafupifupi maola 6.2 M'magazi, mtengo wamtunduwu umakwera mpaka maola 17.6, ndikuwonetsa kutengapo gawo kwa maselo ofiira amwazi ngati gawo logawa.

Pharmacokinetics m'magulu odwala

Odwala Awa Matenda Ati A shuga Aakulu

Sitagliptin. Ma pharmacokinetics a sitagliptin mwa odwala omwe ali ndi mtundu II shuga mellitus ali ofanana ndi pharmacokinetics a odzipereka athanzi.
Metformin. Ndi ntchito yaimpso yosungidwa, magawo a pharmacokinetic pambuyo pa kamodzi komanso mobwerezabwereza makonzedwe a metformin odwala omwe ali ndi mtundu wachiwiri wa matenda osokoneza bongo komanso odzipereka athanzi ali ofanana; kuwerengera kwa mankhwalawa akagwiritsidwa ntchito pazithandizo zochizira sikuchitika.

Odwala ndi mkhutu aimpso ntchito

Janumet sayenera kulembedwa kwa odwala omwe ali ndi vuto la impso (onani CONTRAINDICATIONS).

Sitagliptin. Kwa odwala omwe amalephera kupezeka ndi aimpso, kuwonjezeka kwapawiri-kawiri kwa AUC ya sitagliptin kunadziwika, ndipo mwa odwala omwe ali ndi maginito oopsa komanso operewera (pa hemodialysis), kuwonjezeka kwa AUC kunali kokwanira 4 kuyerekeza ndi mfundo zoyang'anira odzipereka athanzi.

Metformin. Odwala ndi kuchepa aimpso ntchito T_1/2 mankhwalawa amakulirakulira, ndipo chilolezo cha impso chimachepetsa mogwirizana ndi kuchepa kwa chilolezo cha creatinine.

Odwala omwe ali ndi vuto la chiwindi

Sitagliptin. Odwala omwe ali ndi kuchuluka kwa hepatic kusakwanira (7-9 point on the Child-Pugh wadogo), kuchuluka kwa AUC ndi Cmax kwa sitagliptin pambuyo pa mlingo umodzi wa 100 mg kuwonjezeka ndi 21 ndi 13%, motero, poyerekeza ndi odzipereka athanzi. Kusiyana kumeneku sikofunikira pachipatala.
Palibe zambiri zakuchipatala pakugwiritsira ntchito sitagliptin kwa odwala omwe ali ndi vuto loopsa la hepatic (> 9 point on the Child-Pugh wadogo). Komabe, potengera njira yomwe impso imakhudzira mankhwala osokoneza bongo, kusintha kwakukulu mu pharmacokinetics kwa sitagliptin mwa odwala omwe ali ndi vuto lalikulu la hepatic osakwaniritsidwa.

Metformin. Kafukufuku wa magawo a pharmacokinetic a metformin mwa odwala omwe ali ndi vuto la chiwindi sanachitike.

Odwala okalamba

Kusintha kokhudzana ndi zaka mu pharmacokinetics yamankhwala kumachitika chifukwa chakuchepa kwa ntchito ya impso.
Kuchiza ndi Yanumet sikumawonetsedwa kwa odwala omwe ali ndi zaka zopitilira 80, kupatula anthu omwe ali ndi chizolowezi chodziwika bwino (onani MALANGIZO OTHANDIZA).

Mlingo ndi makonzedwe:

Yanumet imagwiritsidwa ntchito kawiri patsiku ndi chakudya, komanso kuwonjezeka pang'onopang'ono kwa mankhwalawa kuti muchepetse mavuto omwe amachokera m'matumbo am'mimba, omwe ali ndi mawonekedwe a metformin.

Malangizo

Mlingo woyambirira wa mankhwalawa umatengera chithandizo cha hypoglycemic. Janume amatengedwa katatu patsiku ndi chakudya.

Mlingo woyamba wa Yanumet kwa odwala omwe sanakwanitse kuwongolera ndi metformin monotherapy ayenera kupereka mlingo wa mangliptin 100 mg tsiku lililonse, ndiye 50 mg ya sitagliptin 2 pa tsiku kuphatikiza mlingo waposachedwa wa metformin.

Mlingo woyamba wa Yanumet kwa odwala omwe sanachite bwino ndi monotherapy ndi sitagliptin ndi 50 mg ya sitagliptin / 500 mg ya metformin hydrochloride 2 kawiri pa tsiku. M'tsogolomu, mlingo umatha kuwonjezeka mpaka 50 mg ya sitagliptin / 1000 mg wa metformin hydrochloride 2 pa tsiku.

Kwa odwala omwe amagwiritsa ntchito mankhwalawa a sitagliptin chifukwa cha kuwonongeka kwa impso, chithandizo ndi Janumet chimatsutsana.

Kwa odwala omwe akutenga kuphatikiza kwa sitagliptin ndi metformin

Pakusintha kwa mankhwalawa ophatikizidwa ndi sitagliptin ndi metformin, mlingo woyambirira wa mankhwalawo ungafanane ndi mlingo womwe adagwiritsa ntchito sitagliptin ndi metformin.

Kwa odwala omwe atenga awiri mwa atatu awa mankhwala a hypoglycemic - sitagliptin, metformin kapena sulfonylurea

Mlingo woyamba wa mankhwalawa Janumet amayenera kupereka tsiku lililonse mankhwala a sitagliptin 100 mg (50 mg sitagliptin 2 kawiri pa tsiku).
Mlingo woyambirira wa metformin umatsimikizika pamaziko a glycemic control dalili ndi zomwe zilipo (ngati wodwala akutenga mankhwalawa) mlingo wa metformin. Kuwonjezeka kwa mlingo wa metformin kuyenera kukhala pang'onopang'ono kuti muchepetse zotsatira zoyipa kuchokera m'matumbo am'mimba.

Kwa odwala omwe akutenga mankhwala a sulfonylurea, ndikofunika kuti achepetse mlingo womwe ulipo kuti muchepetse chiopsezo cha sulfonyl-ikiwaletsa hypoglycemia.

Kwa odwala omwe amatenga mankhwala awiri mwa awa a hypoglycemic - sitagliptin, metformin, kapena PPAR-γ agonist (mwachitsanzo, thiazolidinediones)

Mlingo woyenera wovomerezeka wa mankhwalawa uyenera kupereka tsiku lililonse mankhwala a sitagliptin 100 mg (50 mg sitagliptin 2 pa tsiku). Mlingo woyambirira wa metformin umatsimikizika pamaziko a glycemic control dalili ndi zomwe zilipo (ngati wodwala akutenga mankhwalawa) mlingo wa metformin. Kuwonjezeka kwa mlingo wa metformin kuyenera kukhala pang'onopang'ono kuti muchepetse zotsatira zoyipa kuchokera m'matumbo am'mimba.

Kwa odwala omwe amatenga mankhwala awiri mwa awa a hypoglycemic - sitagliptin, metformin kapena insulin

Mlingo woyamba wa mankhwalawa Janumet amayenera kupereka tsiku lililonse mankhwala a sitagliptin 100 mg (50 mg sitagliptin 2 kawiri pa tsiku). Mlingo woyambirira wa metformin umatsimikizika pamaziko a glycemic control dalili ndi zomwe zilipo (ngati wodwala akutenga mankhwalawa) mlingo wa metformin. Kuwonjezeka kwa mlingo wa metformin kuyenera kukhala pang'onopang'ono kuti muchepetse zotsatira zoyipa kuchokera m'matumbo am'mimba. Kwa odwala omwe akuyamba kugwiritsa ntchito insulin, mlingo wochepetsetsa wa insulin ungafunike kuti muchepetse chiopsezo cha hypoglycemia.

Kafukufuku wapadera wokhudzana ndi chitetezo ndikuyenda bwino kwa kusintha kwa chithandizo kuchokera ku mankhwala ena a hypoglycemic kupita kuchipatala ndi mankhwala a Yanumet ophatikizidwa sanachitike.
Kusintha kulikonse pa mankhwalawa a mtundu II matenda a shuga kuyenera kuchitika mosamala komanso kuyang'aniridwa, poganiza kusintha komwe kungachitike muyezo wa glycemic control.

Zotsatira zoyipa

Mankhwala osakanikirana ndi sitagliptin ndi metformin

Kuyambitsa mankhwala

Mu masabata a 24 omwe amayang'aniridwa ndi placebo omwe amawongolera njira zoyambirira zamagulu ophatikizira mankhwala a sitagliptin ndi metformin (sitagliptin 50 mg + metformin 500 mg kapena 1000 mg × 2 kawiri pa tsiku) pagulu la mankhwala ophatikiza poyerekeza ndi metformin yamagulu a monotherapy (500 mg kapena 1000 mg × 2 kamodzi patsiku), sitagliptin (100 mg kamodzi patsiku) kapena placebo, zotsatirazi zoyipa zomwe zimakhudzana ndi kumwa mankhwalawo zimawonedwa, zimachitika pafupipafupi ndi ≥ 1% pagulu la mankhwala osakanikirana ndipo nthawi zambiri kuposa gulu la placebo: kutsekula m'mimba (sitagliptin + metform n - 3.5%, metformin - 3,3%, sitagliptin - 0,0%, placebo - 1.1%), nseru (1.6%, 2.5%, 0.0% ndi 0,6%), dyspepsia (1.3%, 1.1%, 0.0% ndi 0.0%), flatulence (1.3%, 0.5%>, 0.0%> ndi 0.0%). kusanza (1.1%, 0.3%), 0.0% ndi 0.0%>), kupweteka kwa mutu (1.3%, 1.1%, 0.6% ndi 0.0%) ndi hypoglycemia (1.1 %, 0.5%>, 0.6%) ndi 0.0%).

Kuonjezera sitagliptin ku metformin mankhwala aposachedwa

Mu sabata la 24, kafukufuku wowongoleredwa ndi placebo, ndi kuwonjezera kwa mangliptin pa 100 mg / tsiku pamankhwala aposachedwa ndi metformin, zovuta zokhazo zomwe zimagwirizana ndi kumwa mankhwalawo zimawonedwa pafupipafupi ndi ≥1%> pagulu lachipatala lomwe ali ndi sitagliptin komanso nthawi zambiri kuposa gulu la placebo , panali nseru (sitagliptin + metformin - 1.1%, placebo + metformin - 0,4%).

Hypoglycemia ndi zina zoyipa kuchokera m'mimba thirakiti

M'maphunziro oyendetsedwa ndi placebo ophatikizidwa ndi sitagliptin ndi metformin, chiwopsezo cha hypoglycemia (mosasamala kanthu za ubale wapadera) m'magulu othandizira othandizira anali ofanana ndi pafupipafupi m'magulu othandizira a metformia osakanikirana ndi placebo (1,3-1,6% ndi 2.1) % motsatana). Pafupipafupi pazochitika zoyipa zochokera m'matumbo am'mimba (mosatengera momwe zimayambira-pochitika) m'magulu ophatikizira chithandizo a sitagliptia ndi metformia anali ofanana ndi pafupipafupi m'magulu a metformia monotherapy: matenda am'mimba (sitagliptin + metformin - 7.5%. Metformin - 7.7%). nseru (4,8%, 5.5%). kusanza (2.1%. 0.5%). kupweteka kwam'mimba (3.0%, 3.8%).

M'maphunziro onse, zoyipa zamtundu wa hypoglycemia zidalembedwa pamaziko a ripoti zonse za matenda a hypoglycemia, kuchuluka koonjezera kwa glucose m'magazi sikunafunikire.

Mankhwala osakanikirana ndi sitagliptin, metformin ndi zotumphukira za sulfonylurea

Mu sabata la 24, kafukufuku wowongoleredwa ndi placebo wogwiritsa ntchito sitagliptin pa 100 mg / tsiku motsutsana ndi chithandizo chamakono chophatikizidwa ndi glimepiride pa mlingo wa ≥4 mg / tsiku ndi metformia mu mlingo wa ≥ 1500 mg / tsiku, zotsatirazi zotsatirazi zimawonedwa ndi mankhwalawa, zimawonedwa ndi ndi pafupipafupi ≥1% mu gulu la mankhwalawa ndi sitagliptia ndipo nthawi zambiri kuposa gulu la placebo: hypoglycemia (sitagliptin -13.8%, placebo -0.9%), kudzimbidwa (1.7% ndi 0.0%), metformia limodzi ndi placebo (1, 3-1.6% ndi 2.1% motsatana). Pafupipafupi pazochitika zoyipa zochokera m'matumbo am'mimba (mosatengera momwe zimayambira-pochitika) m'magulu ophatikizira chithandizo a sitagliptia ndi metformia anali ofanana ndi pafupipafupi m'magulu a metformia monotherapy: matenda am'mimba (sitagliptin + metformin - 7.5%. Metformin - 7.7%). nseru (4,8%, 5.5%). kusanza (2.1%. 0.5%). kupweteka kwam'mimba (3.0%, 3.8%).

M'maphunziro onse, zoyipa zamtundu wa hypoglycemia zidalembedwa pamaziko a ripoti zonse za matenda a hypoglycemia, kuchuluka koonjezera kwa glucose m'magazi sikunafunikire.

Mankhwala osakanikirana ndi sitagliptin, metformia, ndi zotumphukira za sulfonylurea

Mu sabata la 24, kafukufuku wowongoleredwa ndi placebo wogwiritsa ntchito sitagliptin pa 100 mg / tsiku motsutsana ndi chithandizo chamakono chophatikizidwa ndi glimepiride pa mlingo wa ≥4 mg / tsiku ndi metformia mu mlingo wa ≥ 1500 mg / tsiku, zotsatirazi zotsatirazi zimawonedwa ndi mankhwalawa, zimawonedwa ndi ≥ 1% mu gulu la mankhwalawa ndi sitagliptin ndipo nthawi zambiri kuposa gulu la placebo: hypoglycemia (sitagliptin -13.8%, placebo -0.9%), kudzimbidwa (1.7% ndi 0.0%).

Mankhwala osakanikirana ndi sitagliptin, metformin ndi agonist wa PPAR-γ

Malinga ndi kafukufuku woyesedwa ndi placebo wogwiritsa ntchito sitagliptin pa 100 mg / tsiku motsutsana ndi chithandizo chamakono chophatikizidwa ndi rosiglitazone ndi metformin sabata la 18 la mankhwalawa, zotsatirazi zoyipa zomwe zimagwirizana ndi mankhwalawa zimawonedwa, pafupipafupi ≥1% mu gulu la mankhwalawa ndi sitagliptin komanso pafupipafupi, kuposa pagulu la placebo: mutu waching'alang'ala (sitagliptin - 2.4%, placebo - 0.0%), matenda am'mimba (1.8%, 1.1%), nseru (1,2%, 1.1%), hypoglycemia (1.2%, 0.0%), kusanza (1.2%. 0.0%). Pa sabata la 54 la mankhwala ophatikiza, zotsatirazi zoyipa zomwe zimakhudzana ndi mankhwalawa zimawonedwa, pafupipafupi> 1% pagulu lachipatala lomwe ali ndi sitagliptin ndipo nthawi zambiri kuposa gulu la placebo: mutu (sitagliptin -2.4%, placebo - 0,0% ), hypoglycemia (2.4%, 0,0%), matenda opatsirana am'mapapo apakati (1.8%, 0,0%), nseru (1.2%, 1.1%), chifuwa (1,2% , 0.0%), matenda a mafangasi a pakhungu (1,2%, 0,0%), zotumphukira edema (1,2%, 0,0%), kusanza (1.2%, 0.0%).

Mankhwala osakanikirana ndi sitagliptin, metformin ndi insulin

Mu sabata la 24, kuphunzira koyendetsedwa ndi placebo pogwiritsa ntchito sitagliptin pa 100 mg / tsiku motsutsana ndi maziko a chithandizo chamakono chophatikizidwa ndi metformin pa mlingo wa ≥1500 mg / tsiku ndi pafupipafupi mlingo wa insulin choyipa chokhacho chomwe chimakhudzana ndi kumwa mankhwalawa ndikuti nthawi zambiri> 1% mu gulu la mankhwalawa ndi sitagliitin ndipo nthawi zambiri kuposa gulu la placebo panali hypoglycemia (sitagliptin - 10.9%, placebo - 5.2%.

Kafukufuku wina wa masabata a 24, pomwe odwala adalandira sitagliptin ngati adjunct mankhwala othandizira insulin (omwe ali ndi kapena opanda metformin), zotsatira zoyipa zomwe zimawoneka pafupipafupi ndi ≥1% pagulu lazachipatala ndi sitagliptin ndi metformin. ndipo nthawi zambiri kuposa mu gulu la placebo ndi metformin, panali kusanza (sitagliptin ndi metformin -1.1%, placebo ndi metformin - 0.4%).

Pancreatitis

Pakuwunika kochulukirapo kwa mayesero 19 amisala awiri akhungu omwe amagwiritsidwa ntchito mosiyanasiyana pakugwiritsa ntchito sitagliptin (pa mlingo wa 100 mg / tsiku) kapena mankhwala othandizira (yogwira kapena placebo), ora la chitukuko cha pancreatitis pachimake anali mlandu wa 0.1 pazaka zana zothandizira odwala pagulu lililonse (onani gawo "Malangizo apadera. Pancreatitis").

Palibe kupatuka kwakuthupi kwamankhwala ofunikira kapena zofunikira za ECG (kuphatikiza nthawi yanthawi ya QTc) zomwe zimawonedwa ndi mankhwala ophatikizidwa ndi sitagliitin ndi metformin.

Zotsatira zoyipa chifukwa chogwiritsa ntchito sitagliptin

Odwala sanakumanepo ndi zovuta chifukwa cha sitagliptin, komwe pafupipafupi kunali ≥1%.

Zotsatira zoyipa chifukwa chogwiritsa ntchito metformin

Zotsatira zoyipa zomwe zimawonedwa mu gulu la metformin ku> 5% ya odwala komanso kawirikawiri kuposa gulu la placebo ndimatumbo, matani akumwera / kusanza, flatulence, asthenia, dyspepsia, kusapeza pamimba komanso mutu.

Zolemba pambuyo pa kulembetsa

Nthawi yalembetsedwe kuyang'anira kugwiritsa ntchito mankhwalawa Yanumet kapena sitagliptin. ophatikizidwa ndi kapangidwe kake, mu monotherapy ndi / kapena kuphatikiza mankhwala ndi othandizira ena a hypoglycemic, zochitika zowonjezera zinadziwika.

Popeza izi zidapezedwa mwakufuna kwa anthu omwe alibe kukula kosagwirizana, mgwirizano ndi zomwe zimachitika pazochitika zoyipa izi ndi mankhwala sizingadziwike. Izi ndi monga: hypersensitivity reaction, anaphylaxis: angioneurotic edema: zotupa pakhungu: urticaria: khungu vasculitis: zotupa za pakhungu, kuphatikiza Stevens-Johnson syndrome, chifuwa chachikulu, kuphatikizapo hemorrhagic ndi necrotic mawonekedwe omwe ali ndi vuto loopsa komanso losavomerezeka: kuwonongeka kwaimpso kuphatikiza pachimake aimpso kulephera (dialysis nthawi zina amafunikira), matenda am'mimba opatsirana kupuma, nasopharyngitis, kudzimbidwa: kusanza, kupweteka kwa mutu: arthralgia: myalgia, kupweteka kwa miyendo, kupweteka kumbuyo.

Zosintha zasayansi

Sitagliptin
Pafupipafupi kupatuka kwa magawo a labotale m'magulu azachipatala omwe ali ndi sitagliptip ndi metformin anali ofanana ndi pafupipafupi m'magulu azachipatala omwe ali ndi placebo ndi metformin. Ambiri, koma si mayesero onse azachipatala omwe anazindikira kuwonjezeka pang'ono kwa kuchuluka kwa maselo oyera a magazi (pafupifupi 200 / μl poyerekeza ndi placebo, zomwe zili pamayambiriro a chithandizo cha 6600 / μl). chifukwa cha kuchuluka kwa neutrophils. Kusintha kumeneku sikuti kwamwenso kofunika.

Metformin
Mu maphunziro azachipatala olamulidwa a metformin wokhala ndi masabata 29, kuchepa kwa ndende ya ciaiocobalamin (vitamini B)₁₂) kuchita zikuluzikulu zamagulu a magazi seramu pafupifupi 7% ya odwala, popanda chiwonetsero chazachipatala. Kutsika komweku chifukwa cha kusankha malabsorption a vitamini B₁₂ (ndiko kuti, kuphwanya mapangidwe a tata ndi mkati mwa Chida chofunikira kuti mayamwidwe a vitamini B₁₂ )sizowonjezera zomwe zimayambitsa kukula kwa kuchepa kwa magazi m'thupi ndipo zimakonzedwa mosavuta ndi kuthetsedwa kwa metformin kapena kuwonjezera vitamini B₁₂ (onani gawo "Malangizo Apadera. Metformin").

Malangizo apadera

Pancreatitis

Panthawi yolembetsa pambuyo pa kuunikira, malipoti adalandiridwa pa chitukuko cha kapamba kapamba, kuphatikizapo hemorrhagic kapena necrotic yotsitsa komanso yopanda pake, odwala omwe amatenga sitagliitin (onani gawo "Zotsatira zoyipa.

Popeza mauthengawa adalandiridwa mwakufuna kuchokera kwa anthu omwe alibe kukula, sizingatheke kuwerengera pafupipafupi mauthengawa kapena kukhazikitsa ubale wophatikizika ndi nthawi ya mankhwalawa. Odwala ayenera kudziwitsidwa za mawonekedwe amtundu wa pancreatitis yayikulu: kulimbikira, kupweteka kwambiri pamimba. Mawonetseredwe azachipatala a kapamba anazimiririka atasiya ntchito ya sitagliptin. Pankhani ya pancreatitis yomwe ikukayikira, ndikofunikira kusiya kumwa mankhwalawa Janumet ndi mankhwala ena oopsa.

Impso ntchito kuwunika

Njira yomwe mungakonde yochotsera metformin ndi sitagliptin ndikuwonetsa impso. Chiwopsezo cha kudzikundikira kwa metformin komanso kukula kwa lactic acidosis kumawonjezeka molingana ndi kuchuluka kwa vuto laimpso, chifukwa chake, mankhwalawa Janumet sayenera kutumizidwa kwa odwala omwe ali ndi serum creatinine woipa kuposa zaka zapamwamba. Odwala okalamba, chifukwa cha kuchepa kwa zaka ndi ntchito ya impso, munthu ayenera kuyesetsa kukwaniritsa kuyang'anira kwa glycemic osachepera mlingo wa Yanumet. Odwala okalamba, makamaka opitirira zaka 80. yang'anirani usiku ntchito. Musanayambe chithandizo ndi Yanumet, komanso kamodzi pachaka mutayamba kulandira chithandizo, mothandizidwa ndi mayeso oyenera, ntchito yofanana ndi impso imatsimikiziridwa. Ndi mwayi wowonjezereka wa kukanika kwa impso, kuwunika ntchito kwa impso kumachitika nthawi zambiri, ndipo akapezeka, a Janumet amachotsedwa.

Kukula kwa hypoglycemia ndi munthawi yomweyo kugwiritsa ntchito sulfonylureas kapena insulin

Monga momwe amachitira ena othandizira a hypoglycemic, hypoglycemia imagwiritsidwa ntchito nthawi yomweyo ya sitagliptin ndi metformin limodzi ndi insulin kapena zotumphukira za sulfonylurea (onani gawo "Zotsatira zoyipa"). Kuti muchepetse chiopsezo chokhala ndi hypoglycemia ya sulfonyl-ikiwa kapena insulin, muyenera kuchepetsedwa (onani gawo "Mlingo ndi Ulamuliro").

Sitagliptin

Kukula kwa hypoglycemia ndi munthawi yomweyo kugwiritsa ntchito sulfonylureas kapena insulin

M'maphunziro a kachipatala a sitagliptin, onse a monotherapy komanso osakanizidwa ndi mankhwala omwe samatsogolera pakupanga hypoglycemia (ndiye kuti metformin kapena PPARγ agonists - thiazolidinediones). kuchuluka kwa hypoglycemia pagulu la odwala omwe akutenga sitagliptin. anali pafupi pafupipafupi pagulu la odwala omwe akutenga placebo.

Monga ena othandizira ena a hypoglycemic, hypoglycemia imagwiritsidwa ntchito nthawi yomweyo ya sitagliptin limodzi ndi insulin kapena zotumphukira za sulfonylurea (onani gawo "Zotsatira zoyipa"). Kuti muchepetse chiopsezo chotenga matenda a sulfonyl-ikiwa kapena insulini-insulin, mankhwalawa amachokera ku sulfonylurea kapena insulin ayenera kuchepetsedwa (onani gawo "Mlingo ndi Ulamuliro").

Hypersensitivity zimachitika

Pa nthawi yolembetsa kuyang'anira kugwiritsa ntchito mankhwalawa Yanumet kapena sitagliptin, omwe ndi gawo limodzi, mu monotherapy komanso / kapena palimodzi ndi ena othandizira a hypoglycemic, ma hypersensitivity reaction. Izi zimaphatikizapo anaphylaxis, angioedema, zotupa za pakhungu, kuphatikizapo matenda a Stevens-Johnson.Popeza izi zidapezedwa mwakufuna kwa anthu omwe sakudziwika, ubale ndi zomwe zimachitika pakadali pano sizingadziwike. Izi zimachitika m'miyezi itatu yoyambirira chitatha mankhwala ndi sitagliptin. ena amawonetsedwa atamwa mlingo woyamba wa mankhwalawo. Ngati makulidwe a hypersensitivity reaction akukayikira, ndikofunikira kusiya kumwa Janumet, onaninso zifukwa zina zomwe zingayambitse chitukuko chosagwirizana ndikupereka mankhwala ena ochepetsa lipid (onani magawo "Contraindication" ndi "Zotsatira Zotsatira."

Metformin

Lactic acidosis

Lactoapidosis ndi osowa koma zovuta kagayidwe kachakudya kamene kamayamba chifukwa cha kudzikundikira kwa metformin panthawi yamankhwala ndi Yanumet. Imfa mu lactic acidosis imafika pafupifupi 50%. Kukula kwa lactic acidosis kumatha kuchitika motsutsana ndi maziko a matenda ena apadera, makamaka, matenda a shuga kapena matenda ena aliwonse, omwe amaphatikizidwa ndi hyioperfusion komanso hypoxemia yamatenda ndi ziwalo zina. Lactic acidosis imadziwika ndi kuchuluka kwa lactate m'madzi a m'magazi (> 5 mmol / l). yafupika magazi pH, kusokonezeka kwa electrolyte ndi kuwonjezeka kwa nthawi ya anion, kuwonjezeka kwa chiŵerengero cha lactate / pyruvate. Ngati metformin ndiyomwe imayambitsa acidosis, ndende yake ya plasma imakonda> 5 μg / ml. Malinga ndi malipoti, lactic acidosis pamankhwala omwe amapezeka ndi metformin adayamba kukhala osowa kwambiri (pafupifupi 0,03 pazaka za wodwala wazaka 1000. Ndi chifuwa cha anthu pafupifupi 0,015 pazaka 1000 za odwala). Kwa odwala a 20,000 a Metformin chithandizo, palibe milandu ya lactic acidosis yomwe imanenedwapo mayesero azachipatala.

Milandu yodziwika yachitika makamaka mwa odwala omwe ali ndi matenda opatsirana a shuga omwe amalephera kwambiri aimpso, kuphatikizapo matenda aimpso kwambiri komanso aimpso, omwe amaphatikizidwa nthawi zambiri ndi concomitant angapo somatic / opaleshoni ya polypharmacy.

Chiwopsezo chokhala ndi lactic acidosis mwa odwala omwe ali ndi vuto losatha la mtima, omwe amafunika kuwongolera mankhwala osokoneza bongo, makamaka osakhazikika kwa angina pectoris / matenda osakhazikika pamtima pachimake, limodzi ndi hypoperfusion ndi hypoxemia. Chiwopsezo chokhala ndi lactic acidosis imachulukana molingana ndi kuchuluka kwa vuto laimpso komanso msambo wodwala, chifukwa chake, kuyang'anira ntchito yaimpso, komanso kugwiritsa ntchito mlingo wochepa wa metformin, kungachepetse chiopsezo cha lactic acidosis. Kuwunikira mosamala kwa ntchito ya impso ndikofunikira makamaka pothandizira odwala okalamba, ndipo odwala omwe ali ndi zaka zosaposa 80 amathandizidwa ndi metformin pokhapokha ngati chitsimikiziro chokwanira cha impso ndi zotsatira za kuwunika kwa creatinine chilolezo, popeza odwalawa ali pachiwopsezo chokhala ndi lactic acidosis. Kuphatikiza apo, mulimonse momwe mungayambire ndi hypoxemia, kufooka kapena sepsis, metformin iyenera kuthetsedwa nthawi yomweyo.

Popeza kuti chiwopsezo cha chiwindi chimagwira ntchito, mkaka wa lactate umachepetsedwa kwambiri, metformin sayenera kutumizidwa kwa odwala omwe ali ndi matenda am'thupi kapena a labotale a chiwindi. Mankhwalawa ndi megformin, kumwa kwambiri kuyenera kukhala kochepa, popeza mowa umatha kugwiritsa ntchito metformin pa lactate metabolism. Kuphatikiza apo, chithandizo ndi metformin chimaletseka kwakanthawi panthawi yophunzira intravascular X-ray ndi kulowererapo kwa ma opaleshoni. Kukhazikika kwa lactic acidosis nthawi zambiri kumakhala kovuta kudziwa, ndipo kumayendera limodzi ndi zizindikiro zosadziwika, monga malaise, myalgia. kupuma kwa vuto la kupuma, kugona kugona kwambiri, ndi zizindikiro zopanda pake.Ndi kukulira kwa njira ya lactic acidosis, hypothermia, ochepa hypotension, ndi bradyarrhythmia yolumikizana ndi zina zomwe zingatheke. Dokotala komanso wodwala ayenera kudziwa tanthauzo la zizindikiro zotere, ndipo wodwalayo ayenera kudziwitsa dokotala za mawonekedwe awo. Kuchiza ndi metformin kumathetsedwa mpaka zinthu zitatha. Plasma wozungulira wa ma elekitirodi, ma ketulo, magazi a mtima amatsimikiza, komanso (malinga ndi zidziwitso) kufunika kwa pH kwa magazi, kuchuluka kwa lactate. Nthawi zina chidziwitso cha plasma cha metformin chingakhale chothandiza. Wodwala atazolowera mulingo woyenera wa metformin, zizindikiro zam'mimba zodziwika bwino zamankhwala oyamba zimayenera kutha. Ngati zizindikiro zotere zikuwoneka, ndiye kuti zilipo. Nthawi zambiri zimakhala chizindikiro cha lactic acidosis kapena matenda ena akulu.

Ngati, pamankhwala othandizira ndi metformin, kuchuluka kwa lactate m'madzi am'madzi am'magazi kupyola malire apamwamba, osatsalira kuposa 5 mmol / l, izi sizoyambitsa matenda a lactic acidosis ndipo mwina atha kukhala chifukwa cha zinthu monga matenda osokoneza bongo oletsa kupindika kapena kunenepa kwambiri, kapena kuchita masewera olimbitsa thupi kwambiri, kapena luso zolakwika. Kwa wodwala aliyense yemwe ali ndi matenda a shuga komanso metabolic acidosis popanda kutsimikizira ketoacidosis (ketonuria ndi ketoemia), pamakhala chiwopsezo cha lactic acidosis.

Lactic acidosis ndi chikhalidwe chofunikira kuchipatala. Chithandizo cha Metformin chathetsedwa ndipo njira zoyenera zochiritsira nthawi yomweyo zimachitika. Popeza metformin imawunikidwa mwachangu mpaka 170 ml / mphindi pansi pa hemodynamics yabwino, hemodialysis yomweyo ikulimbikitsidwa kuti ikonzenso mwachangu acidosis ndikuchotsa metformin yophatikizika. Izi nthawi zambiri zimayambitsa kutha msanga kwa zizindikiro zonse za lactic acidosis ndi kubwezeretsanso mkhalidwe wa wodwalayo (onani gawo "Contraindication").

Hypoglycemia

Munthawi yokhazikika, ndi metformin monotherapy, hypoglycemia sichimakula, koma kukula kwake ndikothekera kumbuyo kwa njala, pambuyo poti mphamvu yayikulu yolipirira popanda kubwezeretsanso kwa ma calorie otentha, mukumwa mankhwala ena a hypoglycemic (sulfonylurea zotumphukira ndi insulin) kapena mowa. Kukula kwakukulu, kukula kwa hypoglycemia kumakhudza odwala okalamba, ofooka kapena otaya mtima, odwala omwe amamwa mowa kwambiri, odwala omwe adrenal kapena pituitary insuffence. Hypoglycemia ndizovuta kuzindikira odwala okalamba komanso odwala omwe amatenga beta-blockers.

Chithandizo chothandizirana

Pharmacotherapy yolumikizana imatha kusokoneza ntchito yaimpso kapena kugawa kwa metformin. Kugwiritsa ntchito munthawi yomweyo mankhwala osokoneza bongo omwe amawononga ntchito ya impso, hemodynamics kapena kugawa kwa metformin (monga mankhwala a cationic omwe amachotsedwa m'thupi ndi katulutsidwe ka tubular) kuyenera kuyikidwa mosamala (onani gawo "Kuyanjana ndi mankhwala ena. Metformin").

Maphunziro a radiological omwe ali ndi intrate ya cell ya iodine okhala ndi mitundu yosiyanasiyana (i.e.

Intravascular dongosolo la iodine lokhala ndi mitundu yothandizira limagwirizanitsidwa ndikukula kwa lactic acidosis mu odwala omwe amatenga metformin ndipo amatha kuyambitsa kuwonongeka kwakanthawi (onani gawo "Contraindication"). Chifukwa chake, odwala omwe akukonzekera kuphunzira ayenera kusiya kumwa Janumet kwa maola 48 asanafike komanso mkati mwa maola 48 pambuyo phunziroli. Kuyambiranso kwamankhwala ndikovomerezeka pokhapokha ngati umboni wa labotale yatsimikizidwe yantchito.

Mikhalidwe ya Hypoxic

Kuchepa kwa mtima (kugwedezeka) kwa matenda amtundu uliwonse, kulephera kwa mtima, pachimake pamatchulidwe amthupi ndi zina zomwe zimayendetsedwa ndi chitukuko cha hypoxemia. zimatha kupangitsa kukula kwa lactic acidosis ndi aimpso azotemia. Ngati zomwe zidatchulidwa zimadwala wodwala panthawi ya chithandizo ndi Yanumet. kumwa mankhwala ayenera kuyimitsidwa yomweyo. Kuchitapo kanthu pakugwiritsira ntchito kwa opaleshoni Kugwiritsa ntchito mankhwala Janumet kuyenera kuyimitsidwa kwa nthawi yonse yoyenera kuchitidwa opaleshoni (kupatula zina zazing'ono zomwe sizimafunikira zoletsa ndi kumwa) komanso mpaka chakudya chazakudya chitayambiridwanso, kuperekera umboni wa labotale yotsimikizika ya ntchito yachilendo.

Kumwa mowa

Mowa umapangitsa mphamvu ya metformin pa metabolism ya lactic acid. Wodwalayo ayenera kuchenjezedwa za kuopsa kwa kuledzera (mlingo umodzi wa kuchuluka kapena kuchuluka kwa Mlingo wochepa) munthawi ya chithandizo ndi Yanumet.

Kuwonongeka kwa chiwindi

Popeza pali milandu yodziwika ya lactic acidosis odwala omwe ali ndi vuto la chiwindi, osavomerezeka kupereka mankhwala a Janumet kwa odwala omwe ali ndi matenda am'kati mwa matenda a chiwindi.

The kuchuluka kwa cyanocobalamin (vitamini B₁₂) m'magazi am'magazi

M'maphunziro olamulidwa a metformin okhala ndi masabata 29, 7% ya odwala adawonetsa kuchepa kwa nthawi yayitali ya cyanocobalamin (vitamini B₁₂) m'magazi am'magazi popanda chitukuko cha matenda a matenda. Kutsika kofananako kungakhale chifukwa chosankha malabsorption a vitamini B₁₂ (ndiko kuti, kuphwanya mapangidwe ovuta ndi chinthu chamkati cha Castle. Chofunikira pakufunikira kwa vitamini B ndipo), kawirikawiri sikumayambitsa kukula kwa kuchepa kwa magazi ndipo kumakonzedwa mosavuta ndi kuthetsedwa kwa metformin kapena kuchuluka kwa vitamini B ndi. Pochita ndi Yanumet, tikulimbikitsidwa kuwunika magawo a hematological magazi chaka chilichonse, ndipo zopatuka zilizonse zomwe zimachitika ziyenera kuphunziridwa ndikusinthidwa. Odwala a Vitamini B akusowa₁₂ (chifukwa cha kuchepa kwa magazi kapena kuyamwa kwa vitamini B₁₂ kapena calcium) tikulimbikitsidwa kudziwa kuchuluka kwa plasma ya vitamini B₁₂ patadutsa zaka 2-3.

Sinthani mu kachipatala ka odwala omwe ali ndi mtundu wachiwiri wa matenda a shuga

Ngati mankhwalawa a labotale kapena matenda amtundu wamatenda (makamaka mawonekedwe aliwonse omwe sangadziwike bwino) awonekere mu wodwala yemwe ali ndi vuto lachiwiri la matenda a shuga mellitus munthawi ya chithandizo ndi Yanumet, ketoacidosis kapena lactic acidosis ayenera kuyikidwa pompopompo. Kuunika kwa wodwala kuyenera kuphatikizapo kuyesedwa kwa magazi kwa ma electrolyte ndi kston. kuchuluka kwa shuga m'magazi, komanso (malinga ndi zomwe zikuwonetsa) pH ya magazi, kuchuluka kwa plasma kwa lactate, pyruvate ndi metformin. Ndi chitukuko cha acidosis ya etiology iliyonse, muyenera kusiya kumwa mankhwala Janumet ndikuchita zoyenera kukonza acidosis.

Kuwonongeka kwa glycemic control

Panthawi ya kupsinjika kwa thupi. Mu nthawi ngati izi, kusintha kwakanthawi kwa mankhwalawa Janumet ndi insulin mankhwala ndikovomerezeka, ndipo atatha kuthetsa vutoli, wodwalayo angathe kuyambiranso chithandizo cham'mbuyomu.

Kukopa pa kuyendetsa magalimoto ndi kugwira ntchito ndi njira

Palibe maphunziro omwe adachitidwa kuti adziwe momwe mankhwala a Janumet amathandizira poyendetsa magalimoto ndikugwira ntchito ndi makina. Komabe, milandu ya chizungulire ndi kugona kugona komwe kumachitika ndi sitagliptin kuyenera kuganiziridwanso.

Kuphatikiza apo, odwala ayenera kudziwa kuopsa kwa hypoglycemia ndi munthawi yomweyo kugwiritsa ntchito mankhwala a Janumet omwe amachokera ku sulfoylurea kapena insulin

Wopanga:

Zoyikidwa:
Merck Sharp ndi Dome B.V., Netherlands
Merck Sharp & Dohme B.V., Netherlands
Waarderweg 39, 2031 BN Haarlem, Netherlands
kapena
Frosst Iberica S.A., Spain Frosst Iberica, S.A. Via Complutense,
140 Alcala de Henares (Madrid), 28805 Spain
kapena
Open Joint-Stock Company Chemical and Pharmaceutical Combine AKRIKHIN (AKRIKHIN OJSC)
142450, dera la Moscow, chigawo cha Noginsky, mzinda wa Staraya Kupavna, ul. Kirova, 29.

Kupereka kuwongolera kwapamwamba:
Merck Sharp ndi Dome B.V., Netherlands
Merck Sharp & Dohme B.V., Netherlands Waarderweg 39,
2031 BN Haarlem, Netherlands kapena

Open Joint-Stock Company Chemical and Pharmaceutical Combine AKRIKHIN (AKRIKHIN OJSC)
142450, dera la Moscow, chigawo cha Noginsky, mzinda wa Staraya Kupavna, ul. Kirova, 29.

Kodi mapiritsi a Yanumet amagwira ntchito bwanji

Pambuyo popezeka ndi matenda ashuga, lingaliro pa chithandizo chofunikira limapangidwa potengera kusanthula kwa hemoglobin wa glycated. Ngati chizindikirochi chili pansipa 9%, wodwala angafune mankhwala amodzi okha, metformin, kuti achulukitse glycemia. Ndiwothandiza kwambiri makamaka kwa odwala omwe ali ndi kunenepa kwambiri komanso ochepa nkhawa. Ngati glycated hemoglobin ndi yokwera, mankhwala amodzi nthawi zambiri sikokwanira, chifukwa chake, kuphatikiza mankhwalawa amalembedwa kwa odwala matenda ashuga, omwe amachepetsa shuga kuchokera ku gulu lina amawonjezeredwa ndi metformin. Ndikotheka kutenga kuphatikiza kwa zinthu ziwiri piritsi limodzi. Zitsanzo za mankhwalawa ndi Glibomet (metformin yokhala ndi glibenclamide), Galvus Met (wokhala ndi vildagliptin), Janumet (ndi sitagliptin) ndi mayendedwe awo.

Mukamasankha kuphatikiza koyenera, zotsatira zoyipa zomwe mapiritsi onse a antiidiabetes ali nawo ndizofunikira. Zotsatira za sulfonylureas ndi insulin kwambiri zimawonjezera chiopsezo cha hypoglycemia, kulimbikitsa kulemera, PSM imathandizira kutsika kwa maselo a beta. Kwa odwala ambiri, kuphatikiza kwa metformin ndi DPP4 inhibitors (gliptins) kapena incretin mimetics kumakhala koyenera. Magulu onse awiriwa amalimbikitsa kuphatikiza kwa insulin popanda kuvulaza maselo a beta komanso popanda kuyambitsa hypoglycemia.

Sitagliptin yomwe ili mumankhwala a Janumet inali yoyambirira kwambiri pa ma glissins. Tsopano ndiye woimira ophunzira kwambiri pa gululi. Katunduyo amathandizira nthawi yayitali ya ma insretin - mahomoni apadera omwe amapangidwa chifukwa cha kuchuluka kwa glucose ndikuthandizira kutulutsa kwa insulin m'magazi. Chifukwa cha ntchito yake mu matenda ashuga, insulin synthesis imalimbikitsidwa mpaka 2. Ubwino wosakayikitsa wa Yanumet ndikuti umagwira kokha ndi shuga wambiri. Glycemia ikakhala yachilendo, ma insretin samatulutsa, insulin simalowa m'magazi, chifukwa chake, hypoglycemia sichimachitika.

Zotsatira zazikulu za metformin, gawo lachiwiri la mankhwala Janumet, ndi kuchepa kwa insulin. Chifukwa cha izi, glucose amapita bwino kulowa mu minofu, kumasula mitsempha ya magazi. Zowonjezera koma zofunika ndiz kuchepa kwa kapangidwe ka shuga m'chiwindi, komanso kuchepa kwa mayamwidwe a shuga m'zakudya. Metformin siyimakhudzanso kugwira ntchito kwapancreatic, chifukwa, sikuyambitsa hypoglycemia.

Malinga ndi madotolo, mankhwalawa ophatikizidwa ndi metformin ndi sitagliptin amachepetsa hemoglobin wa glycated ndi 1.7%. Matenda oyipa kwambiri a shuga amawalipiridwa, ndikamachepetsa hemoglobin yokhala ndi glycated imapatsa Janumet. Ndi matenda oopsa> 11, kutsika kwapakati kuli 3,6%.

Zisonyezero zakudikirira

Mankhwala a Yanumet amagwiritsidwa ntchito pochepetsa shuga kokha ndi matenda a shuga 2. Chithandizo cha mankhwala sichimaletsa kudya komwe kumachitika komanso maphunziro akuthupi, chifukwa palibe piritsi limodzi lokha lomwe lingathe kuthana ndi insulin yayikulu, kuchotsa kuchuluka kwa shuga m'magazi.

Malangizo ogwiritsira ntchito amakulolani kuphatikiza mapiritsi a Yanumet ndi metformin (Glucofage ndi analogues), ngati mukufuna kuwonjezera mlingo wake, komanso sulfonylurea, glitazones, insulin.

Yanumet imawonetsedwa makamaka kwa odwala omwe safuna kutsatira malangizo a dokotala mosamala. Kuphatikiza kwa zinthu ziwiri papiritsi limodzi sikukonda kwa wopanga, koma njira yowongolera glycemic control.Kungopereka mankhwala ogwira ntchito sikokwanira, muyenera odwala matenda ashuga kuti muwapatse njira yoyenera, ndiye kuti, dziperekeni ku chithandizo. Kwa matenda osachiritsika ndi matenda a shuga, kuphatikiza, kudzipereka kumeneku ndikofunikira kwambiri. Malinga ndi ndemanga za odwala, zidapezeka kuti 30-90% ya odwala ndi okhazikika. Zinthu zambiri zomwe adokotala adakulangizani, ndi mapiritsi ambiri omwe muyenera kumwa patsiku, mwayi wake womwe chithandizo chotsimikizidwa sichidzatsatiridwa. Mankhwala osakanikirana omwe ali ndi zosakaniza zingapo zogwira ntchito ndi njira yabwino yowonjezera kutsatira mankhwalawa, chifukwa chake kukonza thanzi la odwala.

Mlingo ndi mawonekedwe

Mankhwala a Yanumet amapangidwa ndi Merck, Netherlands. Tsopano kupanga kwayamba pamaziko a kampani yaku Russia Akrikhin. Mankhwala ochokera kunja ndi ochokera kunja ali ofanana kwathunthu, amalamulidwa chimodzimodzi. Mapiritsiwo ali ndi mawonekedwe amtali, ophimbidwa ndi nembira yamafilimu. Kuti azigwiritsa ntchito mosavuta, zimapakidwa utoto wosiyanasiyana kutengera mlingo.

Zotheka kuchita:

Yanumet Long ndi mankhwala atsopano, ku Russian Federation adalembedwa mu 2017. Mapangidwe a Yanumet ndi Yanumet Long amafanana, amasiyana pokhapokha piritsi. Zomwe zimagwiritsidwa ntchito ziyenera kumwedwa kawiri pa tsiku, popeza metformin imagwira ntchito osaposa maola 12. Ku Yanumet, Long Metformin imamasulidwa kusinthidwa pang'onopang'ono, kotero mutha kumwa kamodzi patsiku popanda kutaya ntchito.

Metformin imadziwika ndi pafupipafupi zotsatira zoyipa zamagetsi. Metformin Long imathandizira kulolerana kwa mankhwalawa, amachepetsa kutsekula m'mimba ndi zovuta zina kawiri. Poyerekeza ndi ndemanga, pamlingo wambiri, Yanumet ndi Yanumet Long zimapereka kuchepa kwakanthawi kofanana. Kupanda kutero, Yanumet Long iwina, amapereka bwino glycemic control, amachepetsa kwambiri insulin kukana ndi cholesterol.

Alumali moyo wa Yanumet 50/500 ndi zaka 2, Mlingo waukulu - zaka zitatu. Mankhwala amagulitsidwa malinga ndi mankhwala a endocrinologist. Mtengo woyenerera m'mafakisi:

Malangizo ogwiritsira ntchito

Malangizo omwe amalimbikitsa a shuga:

1. Mlingo woyenera wa sitagliptin ndi 100 mg, kapena mapiritsi awiri.
2. Mlingo wa metformin umasankhidwa kutengera mtundu wa chidwi cha insulin komanso kulekerera kwa chinthu ichi. Kuti muchepetse chiwopsezo cha zotsatira zosasangalatsa zotenga, mlingo umakulitsidwa pang'onopang'ono, kuchokera ku 500 mg. Choyamba, amamwa Yanumet 50/500 kawiri pa tsiku. Ngati shuga la magazi satsitsidwa mokwanira, patatha sabata limodzi kapena awiri, mulingo utha kuwonjezereka mpaka mapiritsi 2 a 50/1000 mg.
3. Ngati mankhwala a Janumet awonjezeredwa ku sulfonylurea zotumphukira kapena insulin, mlingo wake uyenera kuchulukitsidwa mosamala kwambiri kuti musaphonye hypoglycemia.
4. Mlingo waukulu wa Yanumet ndi mapiritsi 2. 50/1000 mg.

Kupititsa patsogolo kulekerera kwa mankhwalawa, mapiritsi amatengedwa nthawi yomweyo ndi chakudya. Ndemanga za anthu odwala matenda ashuga akuti zakudya zamtunduwu sizogwira ntchito, ndibwino kuphatikiza mankhwalawo ndi chakudya cholimba chomwe chili ndi mapuloteni komanso zakudya zama pang'onopang'ono. Magawo awiri amagawidwa kotero kuti pakati pawo panali maola 12.

Chenjezo mukamamwa mankhwala:

1. Zinthu zomwe zimapanga Yanumet zimapukusidwa makamaka mkodzo. Ndi vuto laimpso, chiwopsezo cha kuchepetsedwa kwa Metformin chimakulanso ndikukula kwa lactic acidosis. Kuti mupewe izi, ndikofunikira kupenda impso musanapange mankhwala. M'tsogolomu, mayeso amachitika chaka chilichonse. Ngati creatinine ndiwopamwamba kuposa wabwinobwino, mankhwalawa amachotsedwa.Akuluakulu odwala matenda ashuga amadziwika ndi kukalamba chifukwa cha matenda a impso, chifukwa chake amalimbikitsidwa mlingo wochepa wa Yanumet.
2. Pambuyo pa kulembedwera kwa mankhwalawo, panali ndemanga za milandu yamatenda a pancreatitis omwe ali ndi matenda ashuga omwe adatenga Yanumet, kotero wopanga amachenjeza za chiwopsezo mu malangizo ogwiritsa ntchito. Ndikosatheka kukhazikitsa pafupipafupi zotsatira zoyipa izi, chifukwa izi sizinalembedwe m'magulu olamulira, koma zitha kulingaliridwa kuti ndizosowa kwambiri. Zizindikiro za kapamba: kupweteka kwambiri pamimba, kupereka kumanzere, kusanza.
3. Ngati mapiritsi a Yanumet atengedwa limodzi ndi gliclazide, glimepiride, glibenclamide ndi ena a PSM, hypoglycemia ndiyotheka. Zikachitika, mlingo wa Yanumet umasiyidwa wosasinthika, mlingo wa PSM umachepetsedwa.
4. Kutengera mowa kwa Yanumet kulibe vuto. Metformin kuledzera komanso kusakhazikika kwa mowa kumatha kuyambitsa lactic acidosis. Kuphatikiza apo, zakumwa zoledzeretsa zimathandizira kukulitsa zovuta za matenda a shuga ndikupangitsa chiphuphu chake.
5. Kupsinjika kwa thupi (chifukwa cha kuvulala kwambiri, kuwotcha, kuwonda, matenda, kutupa kwambiri, opaleshoni) kumatha kuwonjezera shuga. Panthawi yochira, malangizowo akutsimikiza kuti musinthane ndi insulin kwakanthawi, kenaka mubwerere ku chithandizo cham'mbuyo.
6. Malangizowo amalola magalimoto oyendetsa, kugwiritsa ntchito njira za odwala matenda ashuga omwe akutenga Yanumet. Malinga ndi ndemanga, mankhwalawa angayambitse kugona komanso chizungulire, chifukwa kumayambiriro kwake kuyenera muyenera kusamala makamaka za vuto lanu.

Zotsatira zoyipa za mankhwalawa

Mwambiri, kulolerana kwa mankhwalawa kumawerengeka ngati kwabwino. Zotsatira zoyipa zingayambitse metformin yokha. Zotsatira zoyipa zomwe zimagwiritsidwa ntchito ndi chithandizo cha sitagliptin zimawonedwa monga momwe ziliri ndi placebo.

Malinga ndi zomwe zaperekedwa m'malangizo a mapiritsiwo, kuchuluka kwa zovuta zomwe sizidutsa 5%:

• matenda otsegula m'mimba - 3.5%,
• nseru - 1.6%
• kupweteka, kulemera pamimba - 1,3%,
• kupanga gasi owonjezera - 1,3%,
• mutu - 1,3%,
• kusanza - 1.1%
• hypoglycemia - 1.1%.

Komanso nthawi yamaphunziro komanso nthawi yolembera anthu, odwala matenda ashuga anati:

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

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

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

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

• chifuwa, kuphatikiza mitundu yoopsa,
• pachimake kapamba
• kuwonongeka kwaimpso,
• matenda kupuma
• kudzimbidwa
• kupweteka molumikizana, kumbuyo, miyendo.

Mwambiri, Yanumet siikugwirizana ndi kuphwanya izi, koma wopanga adawaphatikiza ndi malangizo. Mwambiri, pafupipafupi zotsatirapo za odwala matenda ashuga ku Yanumet sizisiyana ndi gulu lolamulira lomwe silinalandire mankhwalawa.

Kuphwanya kosowa kwambiri, koma kwenikweni komwe kumachitika mutatenga Janumet ndi mapiritsi ena okhala ndi metformin ndi lactic acidosis. Izi ndizovuta kuchiza matenda owopsa a shuga - mndandanda wazovuta za matenda ashuga. Malinga ndi wopanga, pafupipafupi ndi 0,03 zovuta pazaka 1000 za munthu. Pafupifupi 50% ya anthu odwala matenda ashuga sangathe kupulumutsidwa. Zomwe zimayambitsa lactic acidosis zimatha kukhala zochulukirapo kwa Yanumet, makamaka kuphatikiza ndi zinthu zopatsa chidwi: aimpso, mtima, chiwindi ndi kulephera kupuma, uchidakwa, kufa ndi njala.

Zotsatira za pharmacological

Mankhwala Janumet ndi kuphatikiza kwa mankhwala awiri a hypoglycemic omwe ali ndi njira yothandizira (yophatikizira) yogwira, yopangidwa kuti iwongolere glycemic control mwa odwala omwe ali ndi matenda a 2 matenda ashuga: sitagliptin, anhibitor wa dipeptidyl peptidase-4 (DPP-4) enzyme, ndi metformin, woimira kalasi yayikulu.

Sitagliptin ndi choletsa pakamwa, chosankha kwambiri cha DPP-4 mochizira matenda a shuga a 2. Zotsatira zam'magazi zamkaka wa mankhwala osokoneza bongo a DPP-4 amawongolera ndi kuyambitsa kwa ma insretins. Mwa kuletsa DPP-4, sitagliptin imachulukitsa kuchuluka kwa mahomoni awiri odziwika a banja la apretin: glucagon-peptide 1 (GLP-1) ndi insulinotropic polypeptide (HIP) ya glucose. Ma incretins ndi gawo limodzi lazinthu zamkati zomwe zimakhazikitsa shuga homeostasis. Pazoyimira zamagulu a glucose abwinobwino, kukhathamiritsa kwa gluP-1 ndi GUIs kumawonjezera kaphatikizidwe ndi katulutsidwe ka insulin ndi maselo a pancreatic beta. GLP-1 imathandizanso kubisalira kwa glucagon ndi maselo a pancreatic alpha, motero kuchepetsa kuphatikizika kwa shuga m'chiwindi. Njira iyi yochitira zinthu imasiyana ndi makina amachitidwe a sulfonylurea, omwe amachititsa kuti amasulidwe a insulin azikhala otsika kwambiri m'magazi a shuga, omwe amadziwika ndi kukula kwa sulfonyl-ikiwa chifukwa cha hypoglycemia osati odwala omwe ali ndi mtundu wa matenda a shuga 2, komanso mwa anthu athanzi. Pokhala choletsa chosankha kwambiri komanso chothandiza cha DPP-4 enzyme, sitagliptin muzoyimira zochizira sizimalepheretsa zochitika za enzymes zokhudzana ndi DPP-8 kapena DPP-9. Sitagliptin amasiyana mu kapangidwe ka mankhwala ndi zochita za pharmacological kuchokera ku analogues ya GLP-1, insulin, zotumphukira zochokera ku sulfonylurea kapena meglitinides, biguanides, gamma receptor agonists opangidwa ndi peroxis proliferator (PPARy), alpha-glycosidase inhibitors ndi ma amylin analogues.

Metformin ndi mankhwala a hypoglycemic omwe amathandizira kulolera kwa glucose kwa odwala omwe ali ndi matenda a shuga a 2, amachepetsa kuyamwa kwa shuga ndi postprandial glucose. Ma pharmacological momwe amagwirira ntchito amasiyana ndi njira yochitira pakamwa hypoglycemic mankhwala amakalasi ena. Metformin imachepetsa kaphatikizidwe ka shuga m'chiwindi, imachepetsa mayamwidwe am'matumbo, ndikuwonjezera chidwi cha insulini poyamwa komanso kugwiritsa ntchito shuga

Yanumet akuwonetsedwa ngati chowonjezera pakudya ndi machitidwe olimbitsa thupi kuti alimbikitse kuwongolera kwa glycemic kwa odwala omwe ali ndi mtundu II shuga mellitus omwe sanapeze kuyang'anira koyambira kumbuyo kwa monotherapy ndi metformin kapena sitagliptin, kapena atalephera kuphatikiza mankhwala awiri. Yanumet akuwonetsedwa limodzi ndi mankhwala a sulfonylurea (kuphatikiza kwa mankhwala atatu) monga kuwonjezera pa zakudya ndi zolimbitsa thupi zolimbitsa glycemic control kwa odwala omwe ali ndi matenda amtundu wa II omwe sanachite bwino pakumalizidwa atalandira mankhwala awiri mwa atatu awa: metformin, sitagliptin kapena zotumphukira. sulfonylureas. Janumet akuwonetsedwa limodzi ndi PPAR-? Agonists (mwachitsanzo, thiazolidinediones) monga njira yowonjezera pakudya ndikuwongolera njira zolimbikitsira glycemic control kwa odwala omwe ali ndi matenda amtundu wa II omwe samakwanitsa kuwongolera mokwanira atatha kulandira mankhwala awiri mwa atatu awa: metformin, sitagliptin, kapena PPAR-β agonist. Yanumet akuwonetsedwa kwa odwala omwe ali ndi mtundu wachiwiri wa matenda osokoneza bongo a mellitus (kuphatikiza kwa mankhwala atatu) monga chowonjezera pa chakudya ndi zolimbitsa thupi kuti azitha kuyendetsa bwino glycemic control limodzi ndi insulin.

Mimba komanso kuyamwa

Panalibe maphunziro olamulidwa mokwanira a mankhwalawa Yanumet kapena zigawo zake mwa amayi apakati, chifukwa chake, palibe deta yokhudza chitetezo chazomwe amagwiritsa ntchito amayi apakati.Mankhwala Janumet, monga mankhwala ena amkamwa a hypoglycemic, ali osavomerezeka kuti agwiritsidwe ntchito panthawi yomwe muli ndi pakati. Sipanakhalepo kafukufuku woyesa wa mankhwala ophatikizidwa a Yanumet kuti awone momwe amathandizira pakubereka. Zomwe zimapezeka pokhapokha kuchokera ku maphunziro a sitagliptin ndi metformin zimaperekedwa.

Kutulutsa mawonekedwe ndi kapangidwe kake

Yanumet imapezeka mu mawonekedwe a mapiritsi okhala ndi filimu: chowulungika, biconvex, mumadontho atatu (metformin / sitagliptin): 500 mg / 50 mg - yokhala ndi zokutira zapinki za pinki, mbali imodzi yalembedwa "575", 850 mg / 50 mg - yokhala ndi utoto wa film wa pinki, wolemba "515" mbali imodzi, 1000 mg / 50 mg - wokhala ndi zokutira wamafilimu ofiira, "577" wolemba mbali imodzi, maziko ake ndi oyera kuyambira oyera mpaka oyera (malinga Ma PC 14. M'matumphu, pamatamba okhala ndi matuza 1, 2, 4, 6 kapena 7).

Piritsi limodzi lili:

• zosakaniza: metformin hydrochloride - 500 mg, 850 mg kapena 1000 mg, sitagliptin phosphate monohydrate - 64.25 mg, womwe ndi wofanana ndi 50 mg wa sitagliptin,
• zothandizira: sodium stearyl fumarate, microcrystalline cellulose, sodium lauryl sulfate, povidone,
• kapangidwe kake pa chipolopolo: mapiritsi pamwala wa 500 mg / 50 mg (pinki wopepuka) - Opadry II Pink, 85 F 94203, pa mlingo wa 850 mg / 50 mg (pinki) - Opadray II Pink, 85 F 94182, pa mlingo wa 1000 mg / 50 mg (bulauni ofiira) - Opadry II Red, 85 F 15464, kapangidwe ka zipolopolo za mapiritsi onse ndi monga: mowa wa polyvinyl, macrogol-3350, titanium dioxide (E171), iron ironideide (E172), iron ironide (E172) ), talc.

Pharmacokinetics

Kugwiritsa ntchito Yanumet mu Mlingo wa 500 mg / 50 mg, 850 mg / 50 mg ndi 1000 mg / 50 mg ndi bioequivalent pakayendetsedwe kazigawo zoyenera za metformin ndi sitagliptin.

Mtheradi bioavailability: sitagliptin - pafupifupi 87%, metformin (mutamwa mlingo wa 500 mg pamimba yopanda kanthu) - 50-60%. Ma pharmacokinetics a sitagliptin pomwe amatenga ndi zakudya zamafuta sasintha. Kuthamanga ndi kuchuluka kwa zophatikizidwa ndi metformin pamene mukumwa ndi chakudya kumachepetsedwa. Kufunika kwachipatala pakuwonjezera nthawi kuti mufikire ndikuchepetsa kuchuluka kwa plasma ndende (C_max) metformin sinayikiridwe.

Kumanga mapuloteni a Plasma: sitagliptin - 38%, metformin - pang'ono kwambiri.

Gawo la metformin limagawidwa kwakanthawi m'magazi ofiira, kuchuluka kwa plasma yokomera boma motsutsana ndi maziko a njira yolimbikitsira imafikiridwa pambuyo pa maola 24-48 ndipo nthawi zambiri imakhala yochepera 0,001 mg / ml.

Ma cytochrome P isoenzymes amakhudzidwa ndi kagayidwe kochepa ka sitagliptin.₄₅₀ CYP3A4 ndi CYP2C8. Kusintha kwa metabolic kwa sitagliptin ndizochepa, pafupifupi 79% ya mlingo wotengedwa umatuluka kudzera impso osasinthika.

Metformin imakumbidwa kudzera mu impso osasinthika pafupifupi (90%) mkati maola 24.

Hafu ya moyo (T_1/2) Sitagliptin ndi pafupifupi maola 12.4, chilolezo cha impso ndi pafupifupi 350 ml / mphindi.

Kuchulukitsa kwamkati kwa sitagliptin kumachitika makamaka pogwiritsa ntchito secretion ya tubular.

T_1/2 metformin yochokera ku plasma pafupifupi maola 6.2, kuchokera magazi - maola 17,6. Njira yake yayikulu yodutsira impso imayambitsa kuwonjezeka kwa chiwonetsero cha 3.5-kupitilizidwa kwa aimpso pa creatinine chilolezo.

Kuchulukitsidwa kwa metformin motsutsana ndi kagwiritsidwe ntchito ka mankhwala othandizira sikuchitika.

Odwala omwe ali ndi vuto laimpso losiyanasiyana, theka la moyo wa Yanumet limakulitsidwa, ndende yonse (AUC) ya sitagliptin m'madzi a m'magazi imachulukanso. Simungagwiritse ntchito mankhwalawa chifukwa cha kuwonongeka kwa impso.

Ndi digirii yolimbitsa (7-9 point on the Child-Pugh wadogo) ya kufooka kwa chiwindi, mlingo umodzi wa sitagliptin pa mlingo wa 100 mg umatsogolera pakuwonjezeka kwa mtengo wake wa C_max ndi 13%, AUC - ndi 21%. Palibe zambiri zachipatala pazomwe zimagwiritsa ntchito mankhwalawa ovuta kwambiri (mfundo zoposa 9 pamlingo wa Mwana-Pugh) kulephera kwa chiwindi.

Jenda, mtundu, kapena kulemera kwa wodwala sizimakhudza magawo a pharmacokinetic a zomwe zimagwira.

Odwala okalamba amakhala ndi kutalika kwa T_1/2 ndi kuwonjezera C_max . Kusintha kumeneku kumalumikizidwa ndi kuchepa kwokhudzana ndi zaka zakale pantchito ya impso.Ali ndi zaka zopitilira 80, kulandira chithandizo ndi Yanumet kumatheka kokha mwa odwala omwe ali ndi vuto laimpso komanso CC.

Kafukufuku wokhudza kuyamwa ndi chitetezo cha kumwa mwa ana sichinachitike.

Kuyanjana kwa mankhwala osokoneza bongo

The munthawi yomweyo kupereka angapo Mlingo wa sitagliptin (50 mg kawiri pa tsiku) ndi metformin (1000 mg kawiri pa tsiku) sizimapangitsa kusintha kwakukulu mumagulu a mankhwala a pharmacokinetic a odwala omwe ali ndi matenda a shuga a 2.

Kafukufuku wolumikizana ndi Yanumet ndi mankhwala ena sanachitike. Chifukwa chake, popereka mankhwala othandizira, munthu akuyenera kutsogoleredwa ndi zotsatira za kafukufuku wofanana yemwe amapangidwa padera pa sitagliptin ndi metformin.

Ndi munthawi yomweyo kugwiritsa ntchito sitagliptin:

• rosiglitazone, glibenclamide, simvastatin, warfarin, kulera pakamwa: palibe kusintha kwakufunika kwakanema mu pharmacokinetics kumachitika, sitagliptin sichikuletsa isoenzymes ya cytochrome P system₄₅₀ CYP3A4, CYP2C8, CYP2C9, sichotsetsa isoenzymes CYP1A2, CYP2D6, CYP2B6, CYP2C19, sichilimbikitsa CYP3A4,
• fibrate, statins, ezetimibe (hypocholesterolemic agents), clopidogrel, antihypertensive mankhwala, kuphatikizapo angiotensin II receptor antagonists, angiotensin kutembenuza enzyme inhibitors, beta-adrenergic blockers agents, hydrochlorothiazide, slowly calcium blockers, non-steroidal antioxidants (fluoxetine, sertraline, bupropion), proton pump inhibitors (omeprazole, lansoprazole), antihistamines (cetirizine), sildenafil: osakhudza kuwala kwa mutu akokinetiku sitagliptin,
• digoxin, cyclosporine: mwakukonda kwawo amawonjezera kwambiri mfundo zawo za AUC ndi C_max.

Ndi munthawi yomweyo kugwiritsa ntchito metformin:

• glyburide: sizimayambitsa kulumikizana kwakukulu pakuchitika,
• furosemide: imasintha magawo ake a pharmacokinetic, kumawonjezera mtengo wa C_max metformin ndi 22%, AUC m'magazi athunthu - mwa 15%, chiwonetsero chaimpso cha mankhwalawa sichisintha kwambiri.
• nifedipine: kumabweretsa kuyamwa, kuchuluka kwa plasma ndi kuchuluka kwa metformin yotulutsidwa ndi impso,
• othandizira cationic - morphine, amiloride, digoxin, procainamide, quinine, quinidine, trimethoprim, vancomycin, runitidine, triamteren: amatha kupikisana pogwiritsa ntchito njira yothandizira impsozi ya tuber,
• phenothiazines, diuretics, glucocorticosteroids, kukonzekera kwa chithokomiro, kulera kwamkamwa, estrogens, nicotinic acid, phenytoin, sympathomimetics, isoniazid, osachepera calcium njira blockers: kukhala ndi hyperglycemic angathe, kusokoneza magwiritsidwe a glycemic, ndikofunikira kuyang'anira magwiritsidwe a glycemic,
• mankhwala omwe amamangirira mapuloteni a plasma, monga salicylates, sulfonamides, chloramphenicol, probenecid: osagwirizana ndi metformin.

Zofanizira za Yanumet ndi izi: Yanumet Long, Velmetia, Amaril M, Glibomet, Glukovans, Gluconorm, Avandamet, Galvus Met, Douglimaks, Tripride.

Ndemanga za Yanumet

Ndemanga za Yanumet ndi zabwino. Odwala ndi madotolo amawonetsa mphamvu ya mankhwalawa ndikuwonetsa kuti ndiwowonjezera bwino pakudya ndi zochitika zolimbitsa thupi pochiza matenda a shuga a mtundu wachiwiri. Monotherapy ndi kuphatikiza mankhwalawa, kuphatikiza Yanumet, imapereka chiwongolero chokhazikika cha glycemic komanso kusowa kwa zotsatira zoyipa zachipatala.

Madokotala amalangiza mosamala kwambiri mndandanda wazopondera potenga Yanumet ndikutsatira mosamalitsa malangizo onse a dokotala.

Zoyipa zonse zimachitika chifukwa cha mtengo wokwera wa mankhwalawo, chifukwa chofunikira kudya kosalekeza.

Yanumet: kapangidwe kake ndi mawonekedwe ake

Chofunikira chachikulu pa fomula ndi metformin hydrochloride. Mankhwalawa amawaika mu 500 mg, 850 mg kapena 1000 mg piritsi limodzi.Sitagliptin imathandizira pophika wamkulu, mu kapisozi imodzi imakhala 50 mg pa mlingo uliwonse wa metformin. Pali zokometsera zina zamkati zomwe sizili ndi chidwi ndi luso lamankhwala.

Makapisozi otukusira osindikizidwa amatetezedwa ku fake ndi mawu olembedwa "575", "515" kapena "577", kutengera mlingo. Phukusi lililonse la makatoni limakhala ndi mbale ziwiri kapena zinayi za zidutswa 14. Mankhwala omwe mumalandira amathandizidwa.

Bokosi likuwonetsanso moyo wa alumali wa mankhwalawo - zaka ziwiri. Mankhwala omalizira ayenera kutayidwa. Zofunikira pakusungidwa ndizoyenera: malo owuma osafikiridwa ndi dzuwa ndi ana omwe ali ndi kutentha kwa madigiri 25.

Kuthekera kwama pharmacological

Yanumet ndi njira yolingalira ya mankhwala awiri ochepetsa shuga omwe ali ndi zowonjezera (zowonjezera kwa wina ndi mzake): metformin hydrochloride, yomwe ndi gulu la Biguanides, ndi sitagliptin, choletsa DPP-4.

Synagliptin

Gawoli lapangidwa kuti lizigwiritsidwa ntchito pakamwa. Limagwirira ntchito ya sitagliptin zachokera kukondoweza kwa ma insretins. DPP-4 ikakhala yolephereka, mulingo wa GLP-1 ndi ma HIP peptides, omwe amawongolera glucose homeostasis, amawonjezeka. Ngati ntchito yake ndiyabwino, ma insretin amayambitsa kupanga insulin pogwiritsa ntchito maselo a β-cell. GLP-1 imalepheretsanso kupangidwa kwa glucagon ndi ma α-cell mu chiwindi. Algorithm iyi siyofanana ndi lingaliro lamavuto am'makalasi a sulfonylurea (SM) omwe amalimbikitsa kupanga kwa insulin pamlingo wina uliwonse wa glucose.

Ntchito zotere zimatha kuyambitsa hypoglycemia osati odwala matenda ashuga okha, komanso odzipereka athanzi.

DPP-4 enzyme inhibitor mu Mlingo wolimbikitsidwa sikulepheretsa ntchito ya michere ya PPP-8 kapena PPP-9. Mu pharmacology, sitagliptin siili ofanana ndi mawonekedwe ake: GLP-1, insulin, zochokera kwa SM, meglitinide, biguanides, α-glycosidase inhibitors, γ-receptor agonists, amylin.

Chifukwa cha metformin, kulolera shuga mu mtundu 2 wa shuga kumawonjezereka: kukhazikika kwawo kumachepa (onse a postprandial ndi basal), insulin kukana kumachepa. Mphamvu ya momwe mankhwalawo amathandizira ndi yosiyana ndi mfundo za kagwiritsidwe ntchito ka mankhwala ochepetsa shuga. Poletsa kupanga kwa glucogen ndi chiwindi, metformin imachepetsa kuyamwa kwake ndi makhoma am'mimba, imachepetsa kukana kwa insulini, ndikupititsa patsogolo ziphuphu.

Mosiyana ndi kukonzekera kwa SM, metformin sichimayambitsa kupweteka kwa hyperinsulinemia ndi hypoglycemia ngakhale odwala matenda ashuga omwe ali ndi matenda amtundu wa 2, kapena gulu lowongolera. Panthawi ya mankhwalawa ndi metformin, kupanga insulini kumakhalabe pamlingo womwewo, koma kuthamanga kwake komanso kutsika kwa tsiku ndi tsiku kumachepa.

Zogulitsa

The bioavailability wa sitagliptin ndi 87%. Kugwiritsanso ntchito kwamafuta komanso zakudya zopatsa mphamvu zambiri sizikukhudza kuchuluka kwa mayamwidwe. Mulingo wambiri wa mankhwala ophatikizira m'magazi umakhazikika pambuyo pa maora 1-4 pambuyo poti wachotsedwa m'mimba.

The bioavailability wa metformin pamimba yopanda kanthu mpaka 60% pa mlingo wa 500 mg. Ndi muyezo umodzi waukulu waukulu (mpaka 2550 mg), mfundo ya kuchuluka kwake, chifukwa cha kuyamwa kochepa, inaphwanyidwa. Metformin imayamba kugwira ntchito patatha maola awiri ndi theka. Mlingo wake umafika 60%. Mulingo wambiri wa metformin umakhazikitsidwa pambuyo pa tsiku limodzi kapena awiri. Pakudya, mphamvu ya mankhwalawa imachepa.

Kugawa

Kuchuluka kwa kagawidwe ka sungliptin kogwiritsa ntchito 1 mg ya gulu loyang'anira omwe adayeserera anali 198 l. Mlingo womangidwa m'mapuloteni a magazi ndi ochepa - 38%.

Pakuyesera kofananako ndi metformin, gulu lolamulira linapatsidwa mankhwala mu kuchuluka kwa 850 mg, voliyumu yogawa nthawi yomweyo inali yamtundu wa malita 506.

Ngati tiyerekeza ndi mankhwala a kalasi la SM, metformin kwenikweni sikugwirizana ndi mapuloteni, kanthawi kochepa kamapezeka m'maselo ofiira amwazi.

Ngati mumwa mankhwalawa muyezo wabwino, wokwanira (Mapeto

Mpaka 80% ya mankhwalawa imachotsedwa ndi impso, metformin samapangidwira mu thupi, pagulu loyang'anira pafupifupi gawo lonse lomwe latsalira mu mawonekedwe ake patsiku. Hepatic kagayidwe ndi excretion mu bile ducts kulibe kwathunthu. Sinagliptin imachotsedwanso chimodzimodzi (mpaka 79%) yokhala ndi metabolism yaying'ono. Pankhani yamavuto a impso, mlingo wa Yanumet uyenera kufotokozedwa. Ndi hepatic pathologies, mikhalidwe yapadera yamankhwala siyofunika.

Kwa omwe akuwonetsedwa ndi omwe samawonetsedwa Yanumet

Mankhwalawa adapangira kuti azilamulira matenda ashuga amtundu wa 2. Amasankhidwa nthawi zina.

1. Kuphatikiza pa kusintha kwa moyo kusintha glycemic mbiri ya munthu wodwala matenda ashuga, ngati metformin monotherapy sikupereka zotsatira 100%.
2. Yanumet imagwiritsidwa ntchito popanga zinthu zovuta pamodzi ndi zotumphukira za SM ngati njira "metformin + ya gulu la SM + yokhala ndi carb yochepa ndi katundu wanyumba" siyothandiza kwenikweni.
3. Mankhwalawa amaphatikizidwa, ngati kuli kotheka, ndi a gamma receptor agonists.
4. Ngati jakisoni wa insulini sapereka chiwongola dzanja chathunthu cha shuga, Yanumet imayikidwa nthawi yomweyo.

Contraindication mu malangizo ndi awa:

• Hypersensitivity pazomwe zimapangidwira,
• Coma (wodwala matenda ashuga)
• Matenda a impso,
• Matenda opatsirana
• Jekeseni wa mankhwala ndi ayodini (iv),
• Zodabwitsa
• Matenda omwe amachititsa kuperewera kwa oxygen m'matupi,
• Matenda a chiwindi, poyizoni, uchidakwa,
• Kuyamwitsa
• Mtundu woyamba wa shuga.

Zotsatira zoyipa

Musanagwiritse ntchito, muyenera kuphunzira mndandanda wazotsatira zoyipa ndi zizindikiro zawo kuti mumdziwitse dokotalayo munthawi yokhudza momwe thupi limayendera kuti mukonze ma regimen. Zina mwazinthu zosafunikira:

• Kutsokomola
• Matenda a Dyspeptic
• Mutu ngati migraine,
• Kusuntha kwamatumbo
• Matenda opatsirana
• Kuchepetsa kugona
• Kuchulukitsa kwa kapamba ndi zina zomwe zimayambitsa kapamba,
• Kutupa,
• Kuchepetsa thupi, matenda a anorexia,
• Matenda oyamba ndi khungu.

Zotsatira zoyipa zitha kuwerengeredwa pa WHO:

• Nthawi zambiri (> 1 / 0,1),
• Nthawi zambiri (> 0.001, 0.001, Momwe mungagwiritsire ntchito

Mawu oyamba akuti "anakumana" m'dzina la mankhwalawa akuwonetsa kupezeka kwa metformin m'mapangidwe ake, koma mankhwalawa amatengedwa chimodzimodzi monga mankhwala a Januvia, mankhwala ozikidwa ndi sitagliptin popanda metformin.

Dokotala amawerengera, ndipo amwe mapiritsi m'mawa ndi madzulo ndi chakudya.

Nthawi zina, munthu ayenera kusamala kwambiri pochita ndi Janumet.

1. Pachimake kapamba. Sitagliptin imatha kupititsa patsogolo zizindikiro zake. Dokotala ayenera kuchenjeza wodwala: ngati pali kupweteka pamimba kapena hypochondrium yamanja, muyenera kusiya kumwa mankhwalawo.
2. Lactic acidosis. Mkhalidwe wovutawu komanso wosowa kwambiri ndiwowopsa ndi zotsatira zakupha, ndipo mankhwalawo amasokonezeka zizindikiro zikaonekera. Itha kuzindikirika ndi kupuma movutikira, kupweteka kwa epigastric, kuzizira, kusintha kwa kapangidwe ka magazi, kupindika kwa minofu, asthenia, ndi matumbo a m'mimba thirakiti.
3. Hypoglycemia. M'mikhalidwe yodziwika bwino, mosiyana ndi zomwe Yanumet idakhala, sizimapanga. Zimatha kupsya mtima chifukwa chokhala ndi masewera olimbitsa thupi mopitirira muyeso, kutsika pang'ono kwa calorie (mpaka 1000 kcal / tsiku), mavuto omwe amapezeka m'magulu a adrenal komanso gland pituitary, uchidakwa, komanso kugwiritsa ntchito β-blockers. Ikuwonjezera mwayi wa hypoglycemia munthawi yomweyo mankhwala ndi insulin.
4. Zotsatira zam'mimba. Chiwopsezo chokhala ndi lactic acidosis imawonjezeka ndi matenda a impso, motero ndikofunikira kuyang'anira creatinine. Izi ndizofunikira makamaka kwa odwala matenda ashuga okhwima, chifukwa kufooka kwaimpso kumatha kukhala kozizira.
5. Hypersensitivity. Ngati thupi limagwirizana ndi matupi ake osagwirizana, mankhwalawo amachotsedwa.
6. Kuthandizira opaleshoni. Ngati wodwala matenda ashuga apanga opaleshoni, masiku awiri zisanachitike, Janumet adathetsedwa ndipo wodwalayo amamuika insulin.
7. Mankhwala okhala ndi ayodini.Ngati othandizira ayodini akhazikitsidwa ndi Yanumet, izi zimatha kupweteka matenda a impso.

Zotsatira za Yanumet pa amayi apakati zimangophunziridwa pa oimira nyama zanyama zokha. Mwa akazi apakati, zovuta za kukula kwa fetal sizinalembedwe ndi Metformin. Koma lingaliro lotere silokwanira kupereka mankhwala kwa amayi apakati. Sinthani ku insulin pa gawo lokonzekera kukhala ndi pakati.

Metformin imadutsanso mkaka wa m'mawere, nthawi yayitali, Yanumet siinakhazikitsidwe.

Metformin siyimasokoneza magalimoto oyendetsa kapena njira zovuta, ndipo sinagliptin ikhoza kuyambitsa kufooka ndi kugona, chifukwa chake, Januvia sagwiritsidwe ntchito ngati kuchitapo kanthu mwachangu ndikuwonetsetsa kwambiri.

Zotsatira za bongo

Kuti mupewe mankhwala owonjezera a metformin, simungathe kuwagwiritsa ntchito kuwonjezera pa Yanumet. Mankhwala osokoneza bongo ndi owopsa ndi lactic acidosis, makamaka ndi metformin yowonjezera. Zizindikiro za mankhwala osokoneza bongo zikawoneka, mankhwala othandizira amagwiritsidwa ntchito omwe amaletsa kumwa.

Chifukwa chiyani kupanga Metformin kukhala ndi Yanuvia, Galvus, Onglyza, Glybyuryd, ngati mutha kugwiritsa ntchito zida zomwezo munthawi yayitali? Kuyesa kwasayansi kwawonetsa kuti ndi mtundu uliwonse wamachitidwe owongolera matenda a shuga 2, Metformin ilipo (ngakhale atasinthira ku insulin). Komanso, mukamagwiritsa ntchito zinthu ziwiri zomwe zimagwira ntchito mosiyanasiyana, mphamvu ya mankhwalawa imawonjezeka ndipo mutha kuchita ndi mapiritsi ochepetsa.

Ndikofunika kuti muziwongolera mlingo wa metformin mu phukusi (500 mg, 850 mg kapena 1000 mg) popewa matenda owonjezera. Kwa odwala omwe amaiwala kumwa mapiritsi amtundu uliwonse pa nthawi, mwayi wotenga zonse zomwe amafunikira nthawi imodzi ndi mwayi wabwino womwe umakhudza kwambiri chitetezo ndi zotsatira za chithandizo.

Analogi ndi mitengo

Yanumet ndi mankhwala okwera mtengo: pafupifupi, mtengo wopezeka m'magulu a anthu ogulitsa mankhwala amachokera ku ma ruble awiri ndi theka kupita ku ruble 3,000 pa mabokosi a 1-7 (mapiritsi 14 mu chithuza chimodzi). Amapanga mankhwala oyamba ku Spain, Switzerland, Netherlands, USA, Puerto Rico. Mwa analogues, Velmetia yekha ndiye woyenera kupanga. Kugwiritsa ntchito bwino komanso mtundu wa mankhwala a ATC ndi ofanana:

Glibomet imaphatikizapo metformin ndi glibenclamide, zomwe zimapereka mphamvu ya hypoglycemic ndi hypolipidemic. Zizindikiro zakugwiritsira ntchito ndizofanana ndi malingaliro a Yanumet. Douglimax imakhazikitsidwa ndi metformin ndi glimepiride. Makina owonetsera komanso mawonekedwe akufanana kwambiri ndi Yanumet. Tripride ili ndi glimepiride ndi pioglitazone, omwe ali ndi vuto la antiidiabetes komanso mawonekedwe ofananawo. Avandamet, yomwe ndi kuphatikiza kwa metformin + rosiglitazone, ilinso ndi katundu wa hypoglycemic.

Ngati Yanumet si yoyenera

Zomwe zimapangitsa kuti mankhwalawo athetse

Ngati mankhwalawa sagwiririra ntchito bwino shuga, amadzilowetsa ndi jakisoni wa insulin. Mapiritsi ena pankhaniyi sagwira ntchito. Mwachidziwikire, kuchokera ku mankhwala othandizira okhudzana ndi mankhwala osokoneza bongo, kapamba adagwira ntchito, komanso mtundu wapamwamba kwambiri wa matenda ashuga 2 wadutsa mtundu woyamba wa shuga.

Ngakhale mapiritsi amakono kwambiri sangakhale othandiza ngati mutanyalanyaza malangizo a endocrinologist pa zakudya zotsika kwambiri za carb komanso katundu wolemera.

Zotsatira zoyipa nthawi zambiri zimakwiyitsidwa ndi metformin, sitagliptin pankhaniyi ndiyopanda vuto. Malinga ndi kuthekera kwachuma chake, Metformin ndi mankhwala apadera, musanayankhe m'malo mwake, ndikofunikira kuyesetsa kwambiri kuti musinthe. Matenda a Dyspeptic adzadutsa nthawi, ndipo metformin imapangitsa shuga kukhala yabwinobwino popanda kuwononga kapamba ndi impso.Zotsatira zoyipa zosaperekedwa zimaperekedwa ndikudya Janumet asanadye kapena chakudya, koma panthawi ya chakudya.

Pazachuma, ndikotheka m'malo mwa Janumet kapena Januvia kokha ndi metformin yoyera. Pamaukonde azachipatala, ndibwino kuti musankhe malonda a Glyukofazh kapena Siofor m'malo mwa opanga zapakhomo.

Anthu odwala matenda ashuga komanso madokotala za Yanumet

Za mankhwala Janumet, ndemanga za madokotala ndizogwirizana. Madokotala ati: mwayi wofunikira wa zigawo zake (makamaka sitagliptin) ndikuti samayambitsa hypoglycemia. Mukapanda kuphwanya lamulo latsopanolo ndikutsatira malangizo pazakudya ndi maphunziro akuthupi, zikwangwani za mita zidzatsika kwambiri. Ngati pali zovuta mu epigastrium ndi zina zosayenera, ndikofunikira kugawa mlingo wa tsiku ndi tsiku mu 2 Mlingo wambiri kuti muchepetse nkhawa. Pambuyo pakuzolowera, mutha kubwerera ku boma lapitalo, ngati shuga ali pamwamba pazofunikira, kusintha kwa dokotala komwe kungachitike ndi dotolo ndikotheka.

About Yanumet, kuwunika kwa odwala kumatsutsana, chifukwa matendawa amachitika mosiyanasiyana. Kwambiri, odwala okalamba amadandaula za zotsatira zoyipa, chifukwa impso, komanso thupi lonse, zimasokonezeka kale ndi matenda oyanjana.

Akatswiri a Endocrin ali ndi mwambi wotchuka: "Katemera wa masewera ndi zakudya - katemera wa matenda ashuga." Aliyense amene akufuna piritsi lozizwitsa, ndipo akukhulupirira motsimikiza kuti mapiritsi atsopano, cholembera china kapena tiyi yazitsamba azitha kuchiritsa matenda ashuga popanda kuyeserera kwambiri, ayenera kukumbukira nthawi zambiri.

Momwe mungatenge, njira ya makonzedwe ndi kumwa

Mlingo wa mankhwalawa Yanumet wa mankhwalawa uyenera kusankhidwa payekhapayekha, pozindikira momwe chithandizo chikuyendera, kugwiritsa ntchito bwino komanso kulekerera, koma osapitilira muyeso womwe umalimbikitsidwa tsiku lililonse la sitagliptin 100 mg. Mankhwala Yanumet nthawi zambiri amaperekedwa kawiri pa tsiku ndi zakudya, ndi kuwonjezeka kwapang'onopang'ono kwa mankhwalawa, kuti muchepetse mavuto omwe amachokera ku m'mimba thirakiti (GIT), chikhalidwe cha metformin. Mlingo woyambirira wa mankhwalawa Janumet zimatengera chithandizo chamakono cha hypoglycemic.

Malangizo apadera

Gwiritsani ntchito mu Yanumet wachikulire: popeza njira yayikulu yotsatsira sitagliptin ndi metformin ndi impso, ndipo popeza ntchito yotsitsika ya impso imachepa ndi msinkhu, njira zothetsera mankhwala a Yanumet zikuwonjezeka molingana ndi zaka. Odwala okalamba amayesedwa mosamala ndi kuwayang'anira matenda aimpso.