22 May, 2024
    Mankhwala

    Zofananira zabwino za amaryl

    Chifukwa cha mtengo wotsika wa Amaril, ma analogu amagwiritsidwa ntchito nthawi zambiri kuphatikiza shuga m'magazi a matenda ashuga omwe ali ndi matenda odziyimira pawokha. Mankhwalawa ndi abwino kuti azikhala ndi glycemia wokhala ndi zakudya zapadera komanso masewera.

    Komabe, si aliyense amene angakwanitse kugula wothandizirana ndi hypoglycemic. Chifukwa chake, munkhaniyi, pharmacological zochita za Amaril zidzaululidwa ndipo mawonekedwe ake apamwamba opangidwa ku Russia adzatchulidwa.

    Pharmacological zochita za mankhwala

    Amaryl ndi mankhwala amkamwa a hypoglycemic omwe amathandiza kutsitsa shuga wamagazi polimbikitsa kumasulidwa ndi kutsegulira kwa insulin kapangidwe ndi maselo a beta enieni omwe amapezeka m'matumbo a pancreatic.

    Njira yayikulu yolimbikitsira kaphatikizidwe ndikuti Amaril imakulitsa kuyankha kwa maselo a beta kuti chiwonjezere kuchuluka kwa shuga m'magazi a anthu.

    Mlingo wocheperako, mankhwalawa amathandizira kuwonjezeka pang'ono kwa insulin. Amaryl ali ndi katundu wowonjezera chidwi cha insulin-yotengera minofu yamitsempha yama cell kupita ku insulin.

    Pokhala chotumphuka cha sulfonylurea, Amaril amatha kusokoneza ntchito yopanga insulin. Izi zimatsimikiziridwa ndikuti gawo lomwe limagwiritsa ntchito mankhwalawa limalumikizana ndi njira za ATP zama cell a beta. Amaryl imamangiriza mapuloteni pamwamba pa membrane wa cell kusankha. Katunduyu wa mankhwala amalola kuwonjezera kukhudzidwa kwa maselo am'mimba kuti apange insulin.

    Glucose owonjezereka amalowetsedwa makamaka ndi ma cell a minofu minofu ya thupi.

    Kuphatikiza apo, kugwiritsa ntchito mankhwalawa kumalepheretsa kupezeka kwa glucose ndi maselo a chiwindi. Izi zimachitika chifukwa cha kuwonjezeka kwa zomwe zili ndi fructose-2,6-biophosphate, zomwe zimapangitsa kuti gluconeogeneis aletse.

    Kukhazikitsa kwa insulin kaphatikizidwe kumachitika chifukwa chakuti yogwira mankhwala imathandizira kuchuluka kwa potaziyamu ion m'magazi a beta, komanso kuchuluka kwa potaziyamu kwambiri mu cell kumapangitsa kuti mahomoni azigwiritsa ntchito kwambiri.

    Mukamagwiritsa ntchito mankhwala othandizira osakanikirana ndi metformin, odwala amakhala ndi kusintha kwa kagayidwe kazakudya ka minyewa ya shuga mthupi.

    Kuchita mankhwala ophatikizira limodzi ndi jakisoni wa insulin. Njira yolamulirayi imagwiritsidwa ntchito pokhapokha ngati mulingo woyenera wa metabolic usachitike mukamamwa mankhwala amodzi. Popanga mankhwala amtunduwu a matenda a shuga, muyenera kusintha njira ya insulin.

    Kuchuluka kwa insulin yomwe imagwiritsidwa ntchito pamtunduwu wa mankhwala kumachepetsedwa kwambiri.

    Pharmacokinetics wa mankhwala

    Ndi muyezo umodzi wa mankhwalawa tsiku lililonse la 4 mg, kuchuluka kwake kumawonekera pambuyo maola 2,5 ndikufika 309 ng / ml. The bioavailability wa mankhwalawa 100%. Kudya sikunakhudze mayendedwe a mayamwidwe, kupatula kuchepa pang'ono kwakanthawi.

    Chithandizo chogwira ntchito cha mankhwala chimadziwika ndi kuthekera kwa kulowa mkaka wa m'mawere kudzera mwa chotchinga chachikulu. Zomwe zimachepetsa mwayi wogwiritsa ntchito mankhwalawa panthawi yoyembekezera komanso yoyamwitsa.

    Kagayidwe kake kogwira ntchito komweko kamachitika m'matumbo a chiwindi. Isoenzyme yayikulu yomwe imakhudzidwa ndi metabolism ndi CYP2C9.Pa kagayidwe kazinthu zazikulu zomwe zimagwira ntchito, ma metabolites awiri amapangidwa, omwe pambuyo pake amawatulutsa ndowe ndi mkodzo.

    Kutupa kwa mankhwalawa kumachitika ndi impso mu 58% ndipo pafupifupi 35% mothandizidwa ndi matumbo. Zomwe zimagwiritsidwa ntchito ndi mankhwala mu mkodzo sizimadziwika kuti sizisintha.

    Malinga ndi zotsatira za kafukufukuyu, zidapezeka kuti pharmacokinetics sizimatengera jenda la wodwalayo komanso msinkhu wake.

    Ngati wodwala walephera kugwira ntchito kwa impso ndi chimbudzi, wodwala amakhala ndi chiwonetsero cha glimepiride ndi kuchepa kwakachepa kwa ndende ya magazi, komwe kumachitika chifukwa chothamangitsa mankhwalawa chifukwa chotsitsa chomanga ma protein

    Zotsatira za mankhwala

    Amaryl amadziwika kuti ndi wachitatu m'badwo wa sulfonylurea. Mayiko omwe akutulutsa mankhwalawa ndi Germany ndi Italy. Mankhwala amapangidwa piritsi la 1, 2, 3 kapena 4 mg. Piritsi limodzi la Amaril lili ndi chigawo chachikulu - glimepiride ndi zina zotulutsa.

    Zotsatira za glimepiride makamaka zimachepetsa shuga wamagazi polimbikitsa kupanga insulin ndi maselo a beta. Kuphatikiza apo, chinthu chogwira ntchito chimakhala ndi insulinomimetic ndipo chimawonjezera chidwi cha zolandilira maselo ndi mahomoni ochepetsa shuga.

    Wodwala akamamwa Amaryl, kuchuluka kwambiri kwa glimepiride kumachitika pambuyo pa maola 2,5. Mankhwalawa amatha kumwa mosaganizira nthawi yakudya. Komabe, kudya pang'ono kumakhudza ntchito ya glimepiride. Kwenikweni, mbali imeneyi imachotsedwa m'thupi kudzera m'matumbo ndi impso.

    Dokotala wothandizirawa amapatsa mapiritsi a Amaril kwa odwala omwe ali ndi matenda a shuga a 2 monga monotherapy kapena akaphatikizidwa ndi othandizira a hypoglycemic.

    Komabe, kumwa mankhwalawa sikulepheretsa kupitiriza kudya zakudya zoyenera, zomwe zimapatula mafuta am'mimba komanso chakudya chamagetsi, komanso moyo wokangalika.

    Malangizo ogwiritsira ntchito mankhwalawa

    Simungagule mankhwala popanda kuuzidwa ndi dokotala. Musanagwiritse ntchito mankhwalawa, muyenera kupita kwa dokotala ndikumufunsa mafunso anu onse. Ndi iye omwe angadziwe kuchuluka kwa mankhwalawa ndikuwapatsa mtundu wa mankhwala malinga ndi kuchuluka kwa shuga.

    Mapiritsi a Amaryl amatengedwa pakamwa, popanda kutafuna, ndikutsukidwa ndi madzi okwanira. Ngati wodwalayo adayiwala kumwa mankhwalawo, kuonjezera kuchuluka kwa mankhwalawo ndizoletsedwa. Pa chithandizo, muyenera kuyang'ana kuchuluka kwa shuga, komanso kuchuluka kwa hemoglobin ya glycosylated.

    Poyamba, wodwalayo amatenga muyezo umodzi wa 1 mg patsiku. Pang'onopang'ono, pakadutsa sabata limodzi kapena awiri, mlingo wa mankhwalawa ukhoza kuwonjezeka ndi 1 mg. Mwachitsanzo, 1 mg, kenako 2 mg, 3 mg, ndi zina mpaka 8 mg tsiku lililonse.

    Anthu odwala matenda ashuga omwe ali ndi vuto labwino la glycemic amatenga mlingo wofikira 4 mg.

    Nthawi zambiri, mankhwalawa amatengedwa kamodzi musanadye chakudya cham'mawa kapena, ngati mungadumphe kugwiritsa ntchito mapiritsi, musanadye chakudya chachikulu. Potere, katswiriyu ayenera kuganizira za moyo wa anthu odwala matenda ashuga, nthawi yakudya komanso zochita zake zolimbitsa thupi. Kusintha kwa mankhwalawa kungafunike ngati:

    1. kuchepetsa thupi
    2. kusintha kwa zizolowezi zanu (zakudya, kupsinjika, nthawi yakudya),
    3. zinthu zina.

    Ndikofunikira kufunsa dokotala ndikuyamba ndi mlingo wochepa (1 mg) wa Amaril ngati wodwala akufunika:

    • kusintha kwa mankhwala ena ochepetsa shuga ndi Amaril,
    • kuphatikiza kwa glimepiride ndi metformin,
    • kuphatikiza ndi glimepiride ndi insulin.

    Sibwino kumwa mankhwala kwa odwala omwe ali ndi vuto la impso, komanso kulephera kwa impso komanso / kapena chiwindi.

    Contraindication ndi zoyipa zosiyanasiyana

    Amaril glimepiride yomwe ili mu mankhwalawo, komanso zowonjezera zina, sizimakhudza thupi la odwala matenda ashuga.

    Komanso njira zina, mankhwalawa ali ndi contraindication.

    Ndi zoletsedwa kwa odwala kumwa mapiritsi awa:

    • mtundu wodwala wa shuga
    • nthawi ya bere ndi kuyamwitsa,
    • matenda ashuga ketoacidosis (kuphwanya chakudya kagayidwe kachakudya), matenda a shuga ndi chikomokere,
    • odwala ochepera zaka 18,
    • galactose tsankho, lactase akusowa,
    • kukula kwa shuga-galactose malabsorption,
    • kuphwanya chiwindi ndi impso, makamaka odwala omwe akudwala hemodialysis,
    • munthu tsankho kwa zomwe zili mankhwala, sulfonylurea zotumphukira, sulfonamide wothandizila.

    Malangizo omwe aphatikizidwa akuti m'masabata oyamba omwe amathandizira, Amaryl ayenera kumwedwa mosamala kuti apewe kukula kwa chikhalidwe cha hypoglycemic. Kuphatikiza apo, vuto la malabsorption lazakudya ndi mankhwala osokoneza bongo, kuperewera kwa glucose-6-phosphate dehydrogenase, matenda oyanjana, komanso pamaso pa chiwopsezo chokhala ndi boma la hypoglycemic, Amaryl imagwiritsidwa ntchito mosamala.

    Ndi kugwiritsidwa ntchito molakwika kwa mapiritsi (mwachitsanzo, kudumphira m'magulu), zimayambitsa zovuta zazikulu:

    1. Mkhalidwe wa Hypoglycemic, zizindikiro zomwe zimakhala ndi mutu komanso chizungulire, kusokonezeka kwa chidwi, kukwiya, chisokonezo, kugona, kukomoka, kunjenjemera, kukokana, komanso kuwona kwamaso.
    2. Kuphatikiza kwa adrenergic ngati yankho la kuchepa msanga kwa shuga, kuwonetseredwa ndi nkhawa, palpitations, tachycardia, kusokonezeka kwa phokoso la mtima komanso kuwoneka thukuta lozizira.
    3. Matenda am'mimba - kupsinjika, kusanza, kupweteka kwam'mimba, kutsekula m'mimba, chitukuko cha chiwindi, kuchuluka kwa michere ya chiwindi, jaundice kapena cholestasis.
    4. Kuphwanya hematopoietic dongosolo - leukopenia, thrombocytopenia, granulocytopenia ndi zina zina matenda.
    5. Ziwengo, owonetsedwa ndi zotupa pakhungu, kuyabwa, ming'oma, nthawi zina kuwopsa kwa anaphylactic ndi vasculitis.

    Zina zomwe zimachitika ndizothekanso - photosensitization ndi hyponatremia.

    Mtengo, ndemanga ndi fanizo

    Mtengo wa mankhwala Amaryl mwachindunji zimatengera mtundu wa kumasulidwa kwake. Popeza mankhwalawo amalowetsedwa kunja, motero, mtengo wake ndi wokwera kwambiri. Mitengo yamapiritsi a Amaryl ndi awa.

    • 1 mg 30 mapiritsi - 370 rub.,
    • Mapiritsi a 2 mg 30 - ma ruble 775.,
    • 3 mg 30 mapiritsi - 1098 rub.,
    • 4 mg 30 mapiritsi - 1540 rub.,

    Pankhani ya odwala matenda ashuga za momwe mankhwalawo alili, ali ndi chiyembekezo. Ndi kugwiritsa ntchito mankhwalawa kwa nthawi yayitali, shuga m'magazi amabwerera mwakale. Ngakhale mndandandandawo uli ndi zotsatira zoyipa zomwe zingachitike, kuchuluka kwake kumakhala kochepa kwambiri. Komabe, pali ndemanga zoyipa za odwala omwe amagwirizana ndi mtengo wokwera wa mankhwalawo. Ambiri aiwo amayenera kuyang'ana m'malo mwa Amaril.

    M'malo mwake, mankhwalawa ali ndi ma fanizo ambiri ndi ma analogu opangidwa ku Russian Federation, mwachitsanzo:

    1. Glimepiride ndi mankhwala omwe ali ndi mankhwala omwewo, contraindication ndi mavuto. Kusiyanako kumangokhala pazowonjezera. Mtengo wapakati wa mankhwalawa (2 mg No. 30) ndi 189 rubles.
    2. Diagninide ndi othandizira kuchepetsa shuga, m'mapangidwe ake amafanana ndi mankhwala omwe atumizidwa NovoNorm. Zomwe zimagwiritsidwa ntchito ndizoyipa. Novonorm (Diagninide) ali ndi zofanana zofanana zotsutsana komanso zoyipa zosiyanasiyana. Kuti mumvetsetse kusiyana pakati pa ma analogu awiriwa, ndikofunikira kuyerekeza mtengo: mtengo wa Diaglinide (1 mg No. 30) ndi ma ruble 209, ndipo NovoNorm (1 mg No. 30) ndi ma ruble 158.
    3. Glidiab ndi mankhwala a ku Russia, amenenso ndi analogue a mellitus odziwika bwino a shuga.Mtengo wapakati wa mapiritsi a Glidiab (80 mg No. 60) ndi ma ruble a 130, ndipo mtengo wa mankhwalawa Diabeteson (30 mg No. 60) ndi ma ruble 290.

    Amaryl ndi mankhwala abwino ochepetsa shuga, koma okwera mtengo. Chifukwa chake, imatha kusinthidwa ndi mankhwala otsika mtengo, onse apakhomo (Diclinid, Glidiab), ndikugulitsa mankhwala akunja (NovoNorm, Diabeteson). Kuphatikizikako kumakhala ndi glimepiride, kapena zinthu zina zomwe zimapangitsa kuchepa kwa shuga. Kudziwa za fanizo, adotolo ndi wodwalayo amatha kusankha kuti ndi mankhwala ati omwe angathe kumwa. Kanemayo munkhaniyi akupitiliza mutu wa Amaril wa matenda ashuga.

    Amaril - malangizo ntchito mankhwalawa matenda ashuga, limagwirira, contraindication ndi ndemanga

    Matenda a 2 a shuga ndi matenda oopsa omwe nthawi zambiri amapezeka mwa anthu opitilira 40 omwe amakonda kunenepa kwambiri.

    Kuchepetsa chidwi cha zimakhala kuti insulini, komanso kuchepa kwa mphamvu ya pancreatic, kumabweretsa kufunika kwa mankhwala osokoneza bongo ndi glimepiride.

    Mankhwala othandiza ndi Amaril, omwe amatha kuchepetsa kugwiritsidwa ntchito kwa glucose ndi chiopsezo chochepa cha mavuto.

    Mankhwalawa ndi am'chipatala komanso am'magulu a mankhwala a pakamwa a hypoglycemic a m'badwo wachitatu sulfonylurea. Amaryl amakhala atatenga nthawi yayitali.

    Kuphatikizidwa, limodzi ndi zotsatira zazikulu za antioxidant kanthu komanso kuthana ndi mtima wamagetsi, kunapangitsa kuti mankhwalawa agwiritsidwe ntchito kwambiri pothana ndi matenda amtundu wa 2 osagwirizana ndi matenda a metformin monotherapy.

    Mankhwala amaperekedwa pamsika mumitundu inayi yamasulidwe, iliyonse yomwe imapangidwira chithandizo cha matenda a shuga, kutengera mtundu wa wodwalayo:

    1. Amaril, 1 mg: mapiritsi a pinki oblong a mawonekedwe osalala, mbali zonse ziwiri pali chiopsezo chogawana, chilembo "h" ndi cholembedwa "NMK".
    2. Amaril, 2 mg: magome obiriwira obiriwira a mawonekedwe osyasyalika, mbali zonse ziwiri pali chiopsezo chogawana, chilembo "h" ndi cholembedwa "NMM".
    3. Amaril, 3 mg: mapiritsi achikasu achikasu ndi mapiritsi a mawonekedwe amiyala, mbali zonse ziwiri pali chiopsezo chogawanitsa, zilembo "h" ndi lolemba "NMN".
    4. Amaril, 4 mg: mapiritsi abuluu oblong, mawonekedwe osalala, mbali zonse ziwiri pali chiopsezo chogawana, chilembo "h" ndi cholembedwa "NMO".
    Zogwira ntchitoZothandiza
    Glimepiridelactose monohydrate, sodium carboxymethyl wowuma, povidone, microcrystalline cellulose, magnesium stearate, utoto wofiirira ndi wachikasu chitsulo okusayidi, indigo carmine

    Mankhwala ndi a gulu la mankhwala a hypoglycemic omwe ali m'gulu la sulfonylurea. Gawo logwira ntchito la Amaril limathandizira zotsatira za insulin kuchokera ku maselo a pancreatic.

    Kuchita izi kumachitika chifukwa chakutha kwa mankhwalawa kuwonjezera chidwi cha kapamba kuti azitha kukopa kwa glucose.

    Pamodzi ndi zomwe tafotokozazi, Amaril ali ndi kuthekera kokuchita zowonjezera pancreatic ndikuwonjezera chidwi cha minofu kuti ipangire insulin. Glimepiride imachedwetsa kutulutsa shuga m'magazi.

    Pazitali kwambiri mu seramu ya magazi mutatenga 4 mg ya mankhwalawa imafikiridwa pambuyo pa maola 2,5. The bioavailability wa yogwira pophika ndi 100%.

    Kutenga Amaril palimodzi ndi chakudya pafupifupi sikumakhudza kuchuluka kwa mayamwidwe ndi kuchuluka kwa kagayidwe ka shuga. Glimepiride amatha kuthana ndi zotchinga ndikuyika mkaka wa m'mawere.

    Kupanga kwa mankhwala kumachitika m'chiwindi kudzera pakupanga ma metabolites omwe amalowa ndowe (35%) ndi mkodzo (58%).

    Zizindikiro zogwiritsidwa ntchito

    Amaril amagwiritsidwa ntchito bwino pochiza odwala akulu omwe ali ndi matenda a shuga a 2 popanda kufunika kwa monotherapy ndi insulin.Njira yoyendetsera imayikidwa pakakhala kuti kuchuluka kwa shuga m'magazi sikungakhale kosungika kokha mothandizidwa ndi zolimbitsa thupi, kuchepa thupi komanso zakudya zapadera.

    Amaryl amatengedwa pakudya kapena musanadye, asamba ndi madzi. Pa gawo loyamba la kuvomereza, pamakhala chiopsezo cha hypoglycemia, kotero kuyang'anira kwa dokotala ndikofunikira. Mlingo wa glimepiride umatsimikiziridwa ndi zotsatira za kudziwa kuchuluka kwa shuga mu mkodzo ndi magazi.

    Kulandila kumayamba ndi piritsi limodzi (1 mg glimepiride) patsiku. Kupitilira apo, pamene vuto la glycemic control likupezeka, mlingo umakwera mpaka 2 mg kapena kuposa. Kutalikirana pakati pa kuwonjezeka ndi masabata 1-2. Mulingo waukulu ndi 6 mg tsiku lililonse.

    Mankhwala osakanikirana a insulin amangoperekedwa ndi adokotala.

    Mowa ndi Amaryl

    Mankhwalawa amakhudza kwambiri shuga. Izi zimapangidwanso pakukonzanso kwakukulu mothandizidwa ndi mowa. Zotsatira za hypoglycemic zitha kuchuluka kapena kuchepa, ndipo ndizovuta kuneneratu za zotsatira zomwe zikuwonetsedwa, zomwe zimatsogolera pakuletsa kugwiritsa ntchito zakumwa zoledzeretsa mukamamwa mankhwalawo.

    Kuyanjana kwa mankhwala osokoneza bongo

    Chifukwa cha kagayidwe kake kogwira ntchito m'chiwindi, kusamala kuyenera kugwiritsidwa ntchito pophatikiza mankhwalawa ndi ma inducers kapena zoletsa za cytochrome isoenzymes (Rifampicin, Fluconazole). Glimepiride

    1. Insulin, hypoglycemic othandizira, ma steroid, chloramphenicol, zotumphukira za coumarin, ma fibrate, ma quinolones, salicylates, sulfonamides, ma tetracyclines omwe angayambitse kuchepa kwa mphamvu ya hypoglycemic.
    2. Ma Barbiturates, glucocorticosteroids, diuretics, Epinephrine, mankhwala othandizira, ma estrogens, zotumphukira za asidi a nicotinic, mahomoni a chithokomiro amachepetsa mphamvu ya mankhwalawa.
    3. Reserpine imatha kuchepetsa ndikuwonjezera mphamvu ya glimepiride.

    Zotsatira zoyipa

    Kutengera komwe kumamwa mankhwalawo, zotsatira zoyipa zamagulu osiyanasiyana ndi machitidwe zimatha kukhazikika. Nthawi zambiri zimawonetsedwa:

    • hypoglycemia (kupweteka mutu, kuda nkhawa, kukwiya, kuchepa chidwi, kukhumudwa, kuyankhula ndi mawonekedwe osokonezeka, kupsinjika, delirium, chizungulire, bradycardia, kutaya chikumbumtima),
    • thukuta lozizira
    • palpitations, sitiroko,
    • kusanza, kusanza, kupsinjika pamimba, kutsekula m'mimba, chiwindi, jaundice,
    • kuchuluka kwa mapangidwe am'magazi, leukopenia, kuchepa magazi (kuchepa hemoglobin), granulocytopenia, agranulocytosis,
    • thupi lawo siligwirizana (kuyabwa, zidzolo, urticaria, anaphylactic mantha, vasculitis),
    • hyponatremia,
    • zithunzi.

    Bongo

    Malangizo ntchito Amaril amachenjeza za kuwonetsa kwa zizindikiro za bongo kapena kusokonekera kwa nthawi yayitali ndi mankhwalawa mu milingo yayitali kwambiri. Itha kuyimitsidwa mwachangu potenga chidutswa cha shuga, tiyi wokoma, msuzi.

    Mankhwala ambiri osokoneza bongo amawopseza kuti atayika, matenda amitsempha. Ndi kukomoka, 40 ml ya 20% dextrose kapena glucose solution amaperekedwa kwa munthu, kapena 0,5-1 mg ya glucagon imayendetsedwa kholo.

    Nthawi zina, regimen lavage yodikirira ndiyofunikanso, ndimomwe amathandizira kudya.

    Zofananira za Amaril

    Mankhwala othandizira omwe amapezeka pano akuphatikizapo mankhwala a sulfonylurea ogwirizana ndi matenda a shuga a mtundu wachiwiri. Analogs of means:

    • Glimepiride - mankhwala okhala ndi dzina lofanana,
    • Diagninide - mankhwala ochepetsera shuga omwe amachokera ku repaglinide,
    • NovoNorm - mankhwala ochokera kunja, akuphatikizanso repaglinide,
    • Glidiab - mankhwala achi Russia ozikidwa pa glimepiride,
    • Diabetes ndi mankhwala ochokera kunja kwa matenda ashuga.

    Amaril kapena Diabeteson - zomwe zili bwino

    Mankhwala onsewa amapatsidwa mtundu wachiwiri wa matenda a shuga ndipo amapezeka piritsi.

    Amasintha matendawa kuti apange insulin, amalimbikitsa kumva kukoka kwa minofu, mafuta am'munsi komanso chisonyezo cha nthawi kuchokera pakudya kupita ku kutulutsidwa kwa insulin.

    Ngati wodwala wasokoneza ntchito yaimpso, mankhwalawa amachepetsa mapuloteni mu mkodzo. Kusiyana pakati pa mankhwala ndi mtengo - Diabeteson ndiyotsika mtengo.

    Mtengo wa Amaril

    Kugulitsidwa kwa Amaril kumawononga ndalama kutengera kuchuluka kwa zinthu zomwe zikugwira, kuchuluka kwa mapiritsi omwe ali paphukusi komanso mfundo zamitengo ya kampani yogulitsa. Ku malo ogulitsa mankhwala ku Moscow, mtengo wa mankhwalawa udzakhala:

    Mtundu wamankhwalaMtengo, ma ruble
    Mapiritsi 2 mg 30 ma PC.629
    4 mg 90 ma PC.2874
    1 mg 30 ma PC.330
    4 mg 30 ma PC.1217
    2 mg 90 ma PC.1743
    3 mg 30 ma PC.929
    3 mg 90 ma PC.2245

    Ndili ndi matenda oopsa, owopsa, choncho ndiyenera kumwa mapiritsi a Amaril a matenda ashuga a 2. Ndimakonda momwe zimagwirira ntchito mosavuta - piritsi limodzi patsiku. Poyamba ndimamwa matenda a shuga, koma zimandipangitsa kuti ndizunguzika, nthawi zambiri ndimadwala. Ndi mankhwalawa palibe zoterezi, koma zimawononga zochulukirapo. Ine kulibwino ndiziwalola kuposa kupirira kusapeza bwino.

    Mayi anga ali ndi matenda ashuga a 2 ndipo akutenga mapiritsi a Amaryl. Amakonda kumwa mankhwala potengera mtundu wa metformin, koma tsopano amakakamizidwa kuti asinthane ndi mankhwala othandiza kwambiri. Amaona kuyenera kwazomwe zikuchitika komanso kusapezeka kwa zotsatirapo zake. Amayi amasangalala ndi ntchito yamankhwala, akuti amachepetsa shuga.

    Anatoly, wazaka 41

    Ndili ndi matenda ashuga, koma osadalira insulini. Tiyenera kuchepetsa shuga wamwazi ndi mapiritsi apadera. Ndimatenga Amaril chifukwa adalembedwa ndi dokotala. Ndimamwa mapiritsi a 2 mg, koma posachedwa ndikusinthira - kuwonjezeka pang'onopang'ono kwa ndende kumabweretsa thanzi labwino.

    Zomwe zafotokozedwa m'nkhaniyi ndizongowatsogolera zokha. Zipangizo za nkhaniyi sizitanthauza chithandizo chokha. Ndi dokotala woyenera yekha yemwe angadziwe za matenda ake ndikuwapatsa chithandizo chamankhwala malinga ndi zomwe wodwala wina ali nazo.

    Mapiritsi a Amaryl - malangizo, ndemanga za wolandirayo, mtengo wake

    Amaryl ili ndi glimepiride, yomwe ndi ya m'badwo watsopano, wachitatu, wa sulfonylurea derivatives (PSM). Mankhwalawa ndiokwera mtengo kwambiri kuposa glibenclamide (Maninil) ndi glyclazide (Diabeteson), koma kusiyana kwa mtengo kumatsimikiziridwa ndi kukwera kwambiri, kuchitapo kanthu mwachangu, kuthana ndi kufinya, komanso chiopsezo chochepa cha hypoglycemia.

    Ndi Amaril, maselo a beta amatsitsidwa pang'onopang'ono kuposa mibadwo yam'mbuyomu ya sulfonylureas, kotero kupititsa patsogolo kwa shuga kumachepetsedwa ndipo chithandizo cha insulin chidzafunika pambuyo pake.

    Ndemanga zomwe zimamwa mankhwalawa ndizabwino: Imatsika shuga bwino, ndi yosavuta kugwiritsa ntchito, kumwa mapiritsi kamodzi patsiku, mosasamala za mlingo. Kuphatikiza pa glimepiride koyera, kuphatikiza kwake ndi metformin kumapangidwa - Amaril M.

    Moni Dzina langa ndine Galina ndipo sindilinso ndi matenda ashuga! Zinanditengera milungu itatu yokhakubwezeretsa shuga kwachikhalidwe komanso kusakhala mankhwala osokoneza bongo
    >>Mutha kuwerenga nkhani yanga apa.

    Malangizo achidule

    MachitidweAmachepetsa shuga m'magazi, zomwe zimakhudza gawo lake mbali ziwiri:

    1. Imayendetsa kaphatikizidwe ka insulin, ndikubwezeretsa gawo loyambirira, mwachangu kwambiri lamasamba ake. PSM yotsalayi idalumpha gawo ili ndikugwirira ntchito yachiwiri, kotero shuga imachepetsedwa pang'onopang'ono.
    2. Imachepetsa kukana insulini mwachangu kuposa ena a PSM.

    Kuphatikiza apo, mankhwalawa amachepetsa chiwopsezo cha thrombosis, kuchepetsa cholesterol, ndikuchepetsa kupsinjika kwa oxidative.ZizindikiroMatenda a shuga okha mitundu iwiri. Njira yofunikira yogwiritsira ntchito maselo a beta osungidwa pang'ono, omwe ali ndi zotsalira za insulin yawo.Ngati kapamba asiya kutulutsa mahomoni, Amaril sanalembedwe. Malinga ndi malangizo, mankhwalawa amatha kumwa ndi metformin ndi insulin.MlingoAmaryl amapangidwa mu mawonekedwe a mapiritsi okhala mpaka 4 mg ya glimepiride. Kuti mugwiritse ntchito mosavuta, Mlingo uliwonse uli ndi mtundu wake. Amawatenga kwa masiku 10, pambuyo pake amayamba kukula pang'onopang'ono mpaka shuga atasintha. Mlingo wololedwa wambiri ndi 6 mg. Ngati sichikuperekera chiphuphu kwa anthu odwala matenda ashuga, mankhwala ochokera m'magulu ena kapena insulin amawonjezeredwa ku regimen yothandizira.BongoKuchulukitsa mlingo wambiri kumabweretsa hypoglycemia wa nthawi yayitali. Pambuyo matenda a shuga, amatha kubwereza masiku ena atatu. Nthawi yonseyi, wodwalayo amayenera kuyang'aniridwa ndi abale, omwe ali ndi mankhwala osokoneza bongo ambiri - kuchipatala.Contraindication

    1. Hypersensitivity zimachitika glimepiride ndi zina PSM, othandizira zigawo zikuluzikulu za mankhwalawa.
    2. Kuperewera kwa insulini yamkati (mtundu 1 wa matenda ashuga, kapangidwe ka pancreatic).
    3. Kulephera kwakukulu kwaimpso. Kuthekera kotenga Amaril ku matenda a impso kumatsimikizika pambuyo pakupenda chiwalo.
    4. Glimepiride imapangidwa mu chiwindi, motero, kulephera kwa chiwindi kumaphatikizidwanso m'malangizo monga contraindication.

    Amaryl imayimitsidwa kwakanthawi ndikusinthidwa ndi jakisoni wa insulin panthawi yapakati komanso mkaka wa m`mawere, zovuta za matenda ashuga, kuyambira ketoacidosis mpaka kukomoka kwa hyperglycemic. Ndi matenda opatsirana, kuvulala, kuchuluka kwambiri m'maganizo, Amaril mwina sangakhale okwanira kuteteza shuga, chifukwa chake mankhwalawa amathandizidwa ndi insulin, nthawi yayitali. Kuopsa kwa hypoglycemiaMwazi wamagazi umatsika ngati wodwala matenda ashuwalawo adayiwala kudya kapena sanabwezeretse shuga yemwe adagwiritsa ntchito masewera olimbitsa thupi. Kuti matenda achulukane glycemia, muyenera kudya chakudya chambiri, nthawi zambiri chidutswa cha shuga, kapu yamadzi kapena tiyi wotsekemera ndikokwanira. Ngati mlingo wa Amaril wapitilira, hypoglycemia ikhoza kubwereza kangapo panthawi yamankhwala. Pankhaniyi, shuga atayamba kukula, amayesa kuchotsa glimepiride m'mimba: amayamba kusanza, kumwa adsorbents kapena mankhwala otupa. Mankhwala osokoneza bongo oopsa amapha; chithandizo cha hypoglycemia chimaphatikizira glucose yovomerezeka. Zotsatira zoyipaKuphatikiza pa hypoglycemia, mukamatenga Amaril, mavuto ammimbayo amatha kuyang'aniridwa (osakwana 1% ya odwala), chifuwa, kuyambira kutupira komanso kuyabwa mpaka kugundana kwa anaphylactic (>werengani nkhani ya Alla Viktorovna

    Amaryl kapena Glucophage

    Kunena zowona, funso Amaril kapena Glucofage (metformin) siliyenera kuyankhidwa ngakhale. Glucophage ndi mawonekedwe ake a shuga 2 amalembedwa nthawi zonse koyamba, popeza amagwira bwino kwambiri kuposa mankhwala ena pazomwe zimayambitsa matendawa - insulin kukana. Ngati dokotala amalembera mapiritsi a Amaryl okha, luso lake ndilokayikira.

    Ngakhale kuphatikiza chitetezo, mankhwalawa amakhudza mwachindunji kapamba, zomwe zikutanthauza kuti amafupikitsa kapangidwe ka insulin yanu. PSM imayikidwa pokhapokha ngati metformin singalekerere bwino kapena kuchuluka kwake sikokwanira kwa glycemia wabwinobwino. Monga lamulo, izi mwina zimatha kubwezera kwambiri matenda ashuga, kapena matenda okhalitsa.

    Amaril ndi Yanumet

    Yanumet, monga Amaryl, imakhudza magulu onse a insulin komanso kukana insulini. Mankhwala osokoneza bongo amasiyana mu kagwiritsidwe kake ndi kapangidwe ka mankhwala, motero amatha kutengedwa limodzi. Yanumet ndimankhwala atsopano, motero amafunika kuchokera ku ma ruble 1800. ya paketi yaying'ono kwambiri. Ku Russia, mayendedwe ake adalembetsa: Combogliz ndi Velmetia, omwe siotsika mtengo kuposa oyambira.

    Nthawi zambiri, chiphuphu cha shuga chimatha kupezeka ndi kuphatikiza kwa metformin yotsika mtengo, zakudya, masewera olimbitsa thupi, nthawi zina odwala amafunikira PSM.Yanumet ndiyofunika kugula pokhapokha ngati mtengo wake ulibe phindu ku bajeti.

    Kusagwirizana ndi odwala matenda ashuga ndi mankhwala okhazikika ndiye chifukwa chachikulu chomwe kuwonongera kwa matenda ashuga.

    Kusintha kwa njira yochizira matenda ena aliwonse kumadwalitsa nthawi zonse zotsatira zake, chifukwa chake, mwa kusankha kwa odwala, mankhwala osakanikirana ndi omwe amakonda.

    Amaryl M ali ndi kuphatikiza komwe kumagwiritsidwa ntchito kwambiri pamankhwala ochepetsa shuga: metformin ndi PSM. Piritsi lililonse lili ndi 500 mg ya metformin ndi 2 mg ya glimepiride.

    Ndikosatheka kulondola ndendende zonse zomwe zili ndi piritsi limodzi la odwala osiyanasiyana. Pakati gawo la shuga, metformin yambiri, glimepiride yocheperako imafunikira.

    Palibe oposa 1000 mg a metformin omwe amaloledwa pa nthawi, odwala omwe ali ndi vuto lalikulu ayenera kumwa Amaril M katatu patsiku.

    Kusankha mlingo weniweni, ndikofunikira kuti odwala omwe alangidwa azitenga Amaril padera pakudya cham'mawa komanso Glucofage katatu patsiku.

    Adawunikiridwa ndi Maxim, wazaka 56. Amaril adalembedwa kwa amayi anga m'malo mwa Glibenclamide kuti ndichotse pafupipafupi hypoglycemia. Mapiritsiwa amatsitsa shuga osapweteka kuposa pamenepo, modabwitsa zotsatira zoyipa m'mawu, koma kwenikweni sizinapezeke. Tsopano amatenga 3 mg, shuga amagwira pafupifupi 7-8.

    Tili ndi mantha kuti tichepetse kwambiri, popeza amayi ali ndi zaka 80, ndipo samamvekanso nthawi zonse chizindikiro cha hypoglycemia. Anayang'aniridwa ndi Elena, wazaka 44. Amaril adalembedwa ndi endocrinologist ndipo adandiwuza kuti ndimwe mankhwala aku Germany, osati otchipa. Kuti ndisunge, ndagula phukusi lalikulu, ndiye kuti mtengo wake piritsi limodzi ndi zochepa. Ndili ndimatumba okwanira miyezi itatu.

    Mapiritsiwo ndi ochepa kwambiri, obiriwira, amtundu wachilendo. Chotupacho chimakonzedwa, motero ndikofunikira kuchigawa m'magawo. Malangizo ogwiritsira ntchito ndi ochepa - masamba 4 m'zilembo zazing'ono. Kuthamanga shuga tsopano ndi 5.7, mlingo wa 2 mg. Awunikiridwa ndi Catherine, wazaka 51. Ndakhala ndikudwala matenda a shuga kwa zaka 15, munthawi imeneyi ndidasintha mitundu yambiri ya mankhwala.

    Tsopano ndikumangotenga miyala ya Amaryl ndi Kolya insulin Protafan. Metformin idathetsedwa, adanena kuti ndizopanda pake, kuchokera ku insulin yofulumira ndimamva bwino. Shuga, zoona, siabwino, koma pali zovuta zina. Adafotokozedwa ndi Alexander, wazaka 39. Mapiritsi ochepetsera shuga adandisankhira nthawi yayitali komanso yovuta. Metformin sanayende mwanjira iliyonse, sizotheka kuthana ndi mavuto.

    Zotsatira zake, tinakhazikika ku Amaril ndi Glukobay. Amasunga shuga bwino, hypoglycemia imatheka pokhapokha ngati simukudya panthawi. Chilichonse ndichabwino kwambiri komanso cholosera, palibe mantha kuti mudzuka m'mawa. Kamodzi, m'malo mwa Amaril, adapatsa Russian Glimepiride Canon. Sindinawone kusiyana kulikonse, kupatula kuti phukusi silabwino.

    Chonde dziwani: Kodi mumalota kuti muthetse matenda ashuga kamodzi? Phunzirani momwe mungathetsere matendawa, osagwiritsa ntchito mankhwala okwera mtengo, pogwiritsa ntchito ... >>werengani zambiri apa

    Diabetes, Maninil ndi mankhwala ofanana ndi omwe amachepetsa shuga - ndibwino kumwa ndi matenda ashuga?

    Njira zochizira mtundu wa matenda ashuga a mtundu wachiwiri (2M mellitus (DM)) zikusintha chaka chilichonse. Izi ndichifukwa cha chitukuko cha sayansi ya zamankhwala, tanthauzo la zomwe zimayambitsa komanso magulu omwe ali pachiwopsezo.

    Mpaka pano, makampani opanga mankhwala akhoza kupereka pafupifupi magulu 12 a mankhwala osiyanasiyana, omwe amasiyana machitidwe amachitidwe ndi mitengo.

    Mankhwala ambiri nthawi zambiri amabweretsa chisokonezo pakati pa odwala ngakhale akatswiri azachipatala. Izi sizosadabwitsa, chifukwa wopanga aliyense akuyesera kupereka mphamvu yogwira dzina latsopanolo.

    Munkhaniyi tikambirana za Diabetes, analogues ndi kufananiza ndi mankhwala ena. Ndi mankhwala omwe amatchuka kwambiri pakati pa endocrinologists. Izi zimachitika makamaka chifukwa cha kuchuluka kwamtengo wapatali.

    Diabeteson ndi Diabeteson MV: kusiyana

    Diabeteson - mankhwala omwe amagwira ntchito ndi glycoslazide, omwe amatanthauza mtundu wa sulfonylurea. Kwa zaka zopitilira 50 pamsika, mankhwalawa adawonetsa chitetezero chabwino ndikuyenda bwino kwamankhwala.

    Diabeteson imapangitsa kaphatikizidwe ka insulin mwa ma cell a beta, amalimbikitsa kulowetsedwa kwa glucose m'matipi, amalimbitsa khoma lamitsempha, ndikuletsa kukula kwa nephropathy.

    Mapiritsi a Diabeteson MV 60 mg

    Pocheperako zimakhudza njira zamagazi. Choyipa chachikulu cha mankhwalawa ndikumasulidwa kwake kosaloledwa ndipo motero zimapangitsa masamba a masamba masana. Kagayidwe kofananira kamayambitsa kusinthasintha kwakukulu pamlingo wa glycemia.

    Asayansi apeza njira yotithandizira ndikupanga Diabeteson MV (yotulutsidwa pang'onopang'ono). Mankhwalawa amasiyana ndi omwe adakhazikitsidwa posunthika komanso pang'onopang'ono pazomwe zimagwira - glyclazide. Chifukwa chake, shuga amamangidwa paphiri lamtundu wina.

    Mankhwalawa sanena kusiyana kwa njira zamankhwala.

    Kodi ndingatenge nthawi yomweyo?

    Mapangidwe a Maninyl akuphatikiza glibenclamide - chinthu chogwira ntchito, chomwe, monga gliclazide, ndichimodzi mwazomwe zimachokera ku sulfanylurea.

    Kukhazikitsidwa kwa oimira awiri a gulu lomwelo la zamankhwala sikuli bwino.

    Izi ndichifukwa choti chiwopsezo cha zovuta zoyambira chikukula.

    Ndi Glucophage

    Zomwe zimagwira mu Glucofage ndi metformin, woimira gulu lalikulu la Biguanide. Maziko a kamangidwe ka kachulukidwe kake ndikokulira kwa kulolera kwa glucose ndi kuchepa kwa kuchuluka kwa mayamwidwe am'mimba m'matumbo.

    Glucophage mapiritsi 1000 mg

    Malinga ndi malingaliro a American Association of Clinical Endocrinology (2013), metformin imayikidwa makamaka mtundu wa 2 matenda ashuga. Awa ndiomwe amadziwika kuti ndi monotherapy, osakwanira amatha kuthandizidwa ndimankhwala ena, kuphatikiza Diabetes. Chifukwa chake, kugwiritsidwa ntchito kwakanthawi kwa mitundu iwiriyi ndikovomerezeka komanso koyenera.

    Ndikofunika kukumbukira kuti ndi endocrinologist yekha yemwe ayenera kusankha ndikuphatikiza mankhwala.

    Glyurenorm imaphatikizapo glycidone, woimira gulu la sulfanylurea.

    Pakuchita bwino ndi chitetezo, mankhwalawa ndi apamwamba kuposa a Diabetes, koma nthawi yomweyo amakhala okwera mtengo (pafupifupi kawiri).

    Mwa zabwino, kusintha koyenera kuchitapo kanthu, chiwopsezo chochepa cha hypoglycemia, komanso kupezeka bwino kwa bioavailability kuyenera kuunikiridwa. Mankhwala atha kulimbikitsidwa ngati gawo limodzi la zovuta za matenda a shuga.

    Glimepiride (dzina lamalonda Amaryl) ndi mtundu wachitatu wa sulfonylurea, ndiye chida chamakono.

    Imathandizira kupanga insulin ya insulin kwa nthawi yayitali (mpaka maola 10 - 15).

    Modziletsa amalepheretsa zovuta za matenda ashuga monga kuwonongeka kwa mawonekedwe ndi nephropathy.

    Poyerekeza ndi kumbuyo kwa kutenga Amaril, chiopsezo chotenga hypoglycemia ndi 2 - 3%, mosiyana ndi Diabeteson (20 - 30%).Izi ndichifukwa choti glimeperide siyimalepheretsa kubisalira kwa glucagon chifukwa chakuchepa kwa shuga m'magazi. Mankhwalawa ali ndi mtengo wokwera, zomwe zimakhudza kupezeka kwake konsekonse.

    Kumayambiriro kwa chithandizo chamatenda a shuga omwe adapezeka kumene, madokotala amalimbikitsa kuti asinthe moyo (kuchepa thupi, kuwonjezera zolimbitsa thupi). Ndi kusakwanira, mankhwala othandizira omwe ali ndi Metformin amalumikizidwa.

    Maninil mapiritsi 3.5 mg

    Mlingo umasankhidwa pasanathe mwezi umodzi, glycemia, lipid metabolism, ndi impso mapuloteni a impso amayang'aniridwa. Ngati, motsutsana ndi momwe mankhwalawo amathandizira ndi Metformin, sizingatheke kuthandizira matendawa, ndiye kuti mankhwala a gulu lina (omwe nthawi zambiri amatengedwa kuchokera ku sulfanilurea) - mankhwalawa.

    Ngakhale kuti Maninil adapangidwa koyambirira kwa 60s, akupitilira kutchuka ndikupikisana ndi Diabeteson. Izi ndichifukwa cha mtengo wotsika komanso kufalikira.Kusankha kwa mankhwala kuyenera kuchitika ndi endocrinologist pamaziko a mbiriyakale yazachipatala ndi maphunziro azachipatala ndi a labotale.

    Glibomet ndi imodzi mwazinthu zambiri zophatikiza shuga. Muli 400 mg ya metformin hydrochloride ndi 2,5 mg ya glibenclamide.

    Glibomet ndiyothandiza kwambiri kuposa Diabeteson.

    Chifukwa chake, mu mawonekedwe a piritsi limodzi, wodwala amatenga magawo awiri ogwira ntchito pamagulu osiyanasiyana a mankhwala nthawi imodzi.

    Tiyenera kudziwa kuti pophatikiza mankhwala, ngozi ya mavuto, kuphatikiza zinthu za hypoglycemic, imakulanso. Chenjezo liyenera kumwedwa moyang'aniridwa ndi endocrinologist ndi zizindikiro za labotale.

    Chithandizo chogwira ntchito cha Glucofage ndi metformin hydrochloride.

    Amawerengera makamaka omwe amapezeka posachedwa a shuga poyerekeza ndi zakudya. Ili ndi zovuta zingapo zoyipa, mwachitsanzo, kukula kwa lactic acidosis ndi hypoglycemia.

    Chifukwa chake, Diabetes ndi mankhwala otetezeka, mosiyana ndi Glucofage, amathandizira kubisalira kwa insulin.

    Gliclazide MV

    Gliclazide ndi kutulutsa pang'onopang'ono kwa yogwira pang'onopang'ono amawongolera glycemia, pomwe mukumwa mankhwalawa palibe mikhalidwe ya hypoglycemic.

    Chifukwa chachilendo cha kapangidwe ka mankhwala, imatha kutengedwa kamodzi patsiku.

    Pambuyo pakugwiritsidwa ntchito kwa nthawi yayitali, kuledzera ndi kuchepa kwa ntchito sikuwonetsedwa (syntulin insulin siyikakamizidwa).

    Mphamvu za antiaggregant za Gliclazide MV, zomwe zimapangitsa kuti khoma lisafike pamimba zidadziwika. Anthu odwala matenda ashuga amatha kuposa ntchito yabwino, chitetezo, koma mtengo wokwera mtengo kwambiri.

    Ndi zovuta zachuma za wodwala, Gliclazide MV ikhoza kukhala yovomerezeka ngati mankhwala osankha matenda ashuga.

    Glidiab MV

    Glidiab MV imakhala ndi gliclazide, yomwe imamasulidwa pang'onopang'ono. Poyerekeza ndi Diabeteson MV, onse a mankhwalawa atha kutumikiridwa muzochitika zina zamankhwala, okhala ndi zotsatirapo zoyipa komanso zoyipa zomwe zimachitika.

    Zomwe mukufunikira kudziwa za Diabeteson mu kanema:

    Ndikofunikira kukumbukira kuti shuga ndi njira ya moyo. Ngati munthu saleka zizolowezi zoyipa, osasamalira thupi lake, ndiye kuti palibe mankhwala omwe angamuthandize. Chifukwa chake, asayansi apeza kuti podzafika 2050 aliyense wokhala padziko lapansi adzadwala nthendayi.

    Izi zimachitika chifukwa cha kuchepa kwa chikhalidwe cha chakudya, vuto lomwe limakulirakulira la kunenepa kwambiri. Kwakukulukulu, si shuga yokhayokha yomwe imakhala yoyipa, koma zovuta zomwe zimayambitsa. Mwa mavuto omwe ambiri amakhala nawo ndi kuchepa kwa masomphenya, kulephera kwa impso, kusokonekera kwa magazi ndi ziwalo.

    Kuwonongeka kwa ziwiya ndi mitsempha yam'munsi yam'munsi kumayambitsa kulumala koyambirira. Mavuto onse omwe ali pamwambawa atha kupewedwa bwino ngati malingaliro a endocrinologist atsatiridwa.

    The zikuchokera, Mlingo, Mlingo mawonekedwe

    Mankhwalawa amapezeka ndi mawonekedwe osiyanasiyana a glimepiride ndi metformin. M'mitundu yamtundu umodzi, mapiritsi awo ndi 1 mg ndi 250 mg, motero, wina - wina kuchuluka: 2 ndi 500 mg.

    • Zomwe zimapangidwira ndizowonjezera ndizofanana: lactose (mu mawonekedwe a monohydrate), sodium CMC, povidone-K30, CMC, crospovidone, E572.
    • Zomwe zimapangidwira mu filimuyi: hypromellose, macrogol-6000, E171, E903.

    Mapiritsi ofanana chowulungika mawonekedwe, otumphukira mbali zonse ziwiri, otsekedwa ndi zokutira zoyera za filimu yomata. Amasiyana polemba chizindikiro: pamalo amodzi a mapiritsi a 1 mg / 250 mg, kusindikizidwa kwa HD125 kumayikidwa, ndipo Amaril-M (2/500) wodziwika bwino amakhala ndi chizindikiro cha HD25.

    Mitundu yonse iwiri ya Amaril M imayikidwa m'matumba a mapiritsi 10. Mu phukusi la makatoni akuda - ma mbale atatu okhala ndi mapiritsi, osafunikira.

    Kuchiritsa katundu

    Mankhwala ophatikiza pamodzi, zotsatira zake zimachitika chifukwa cha zinthu zomwe zimagwira (glimepiride ndi metformin).

    Katundu woyamba ndi wa gulu la zotumphuka za m'badwo wachitatu. Ili ndi kuthekera kolimbikitsa kupanga ndi kumasula kwa insulin kuchokera ku maselo a pancreatic, kumakulitsa chiwopsezo cha adipose ndi minofu yamatumbo ku zotsatira za zinthu zamkati. Mphamvu ya hypoglycemic imatheka chifukwa cha apamwamba, mosiyana ndi m'badwo wa 2 sulfonamides, kuthekera kwa chinthu kuwongolera kuchuluka kwa insulin yopangidwa ndi thupi. Malo omwewo amawonetsetsa kuti mankhwalawa amachepetsa chiopsezo cha hypoglycemia.

    Monga zotumphukira zina za sulfonylurea, gawo la Amaril M limachepetsa kukana kwa insulin, imakhala ndi antioxidant, imalepheretsa magazi kuwundana, ndikuchepetsa zotupa za CCC. Imathandizira kayendedwe ka glucose kumisempha ndikugwiritsira ntchito kwake, kumalimbikitsa kagayidwe ka glucose.

    Pambuyo mwadongosolo makonzedwe a 4 mg (tsiku lililonse), kuchuluka kwambiri kwa chinthu m'magazi kumapangidwa pambuyo maola 2,5. Kudya pafupifupi osakhudzidwa ndi mayamwidwe, kumangoleketsa liwiro lake.

    Imatha kulowa mkaka wa m'mawere ndikudutsa placenta. Amasinthika m'chiwindi, ndikupanga mitundu iwiri ya metabolites, yomwe imapezeka mkodzo ndi ndowe.

    Gawo lalikulu la chinthu limachotsedwa m'thupi ndi impso ndipo ena kudzera m'matumbo.

    Thupi lomwe lili ndi hypoglycemic effect limaphatikizidwa m'gulu la Biguanides. Mphamvu yake yotsitsa shuga imatha kudziwonetsa pokhapokha ngati kupangira insulin ya insulin kumapitilizidwa. Thupi silikhudza ma β-cell a kapamba ndipo mulimonsemo amathandizira kupanga insulin. Mankhwalawa akamamwa, sayambitsa kukwiya.

    Pakadali pano, momwe amagwirira ntchito yake sanadziwike bwino lomwe. Amakhulupirira kuti imatha kupititsa patsogolo zotsatira za insulin. Amadziwika kuti chinthu chimathandizira chiwopsezo cha minofu kupita ku insulin pakuwonjezera kuchuluka kwa zolandirira maselo a cell. Kuphatikiza apo, metformin imachepetsa kupanga shuga m'magazi, imachepetsa mapangidwe a maulere aulere, imalepheretsa kagayidwe ka mafuta, ndipo imachepetsa zomwe zili m'magazi. Mankhwalawa amachepetsa kudya, potero amathandizira kuti asungidwe a odwala matenda ashuga kapena kuwonda.

    Pambuyo pakukonzekera pakamwa, imatenga gawo lonse la chakudya. Kudya ndi chakudya kumatha kuchepa komanso kupewa. Imagawidwa pompopompo, zimakhala kuti sizimangiriza ma protein a plasma. Sichikupangika.

    Kuchotsa mthupi kumachitika kudzera mu impso. Ngati chiwalo sichikugwira ntchito moyenera, pamakhala chiwopsezo cha kukopeka kwa chinthucho.

    Njira yogwiritsira ntchito

    Kuchuluka kwa mankhwalawa amawerengedwa payekhapayekha kwa wodwala aliyense mogwirizana ndi zomwe zikuwonetsa glycemia. Kuchiza ndi Amaril M, malinga ndi malangizo ogwiritsira ntchito, tikulimbikitsidwa kuti muyambe ndi mlingo wotsika kwambiri womwe mungathe kuwongolera ma hypoglycemic. Pambuyo pa izi, mlingo umatha kusintha malingana ndi chizindikiro cha shuga m'magazi.

    Ngati piritsi ikusowa, ndiye kuti simungathe kubwezeretsanso mankhwala omwe mwasowa mulimonse, apo ayi akhoza kubweretsa kuchepa kwakukulu pamlingo wa glycemia. Odwala ayenera kulangizidwa pasadakhale zoyenera kuchita pakakhala zotere.

    Ndi kaongoleredwe kabwino ka glycemic, pakakhala kuwonjezeka kwa zovuta za insulin, kufunika kwa mankhwala kumatha kuchepa panthawi ya mankhwala a Amaril M. Popewa hypoglycemia, muyenera kuchepetsa kuchuluka kwa nthawi yake kapena kusiya kumwa mapiritsi.

    Dongosolo lamankhwala limatsimikiziridwa ndi adotolo, koma opanga amalimbikitsa kumwa kamodzi kapena kawiri patsiku ndi chakudya. Mulingo wambiri wovomerezeka wa metformin wololedwa pa mlingo umodzi ndi 1 g, tsiku lililonse - 2 g.

    Popewa hypoglycemia, kumayambiriro kwa mankhwala, kuchuluka kwa mapiritsi sikuyenera kukhala kwakukulu kuposa kuchuluka kwa tsiku ndi tsiku kwa metformin ndi glimepiride, yomwe wodwala adatenga maphunziro apitawa. Ngati wodwalayo asamutsidwa kupita ku Amaryl-M kuchokera ku mankhwala ena, ndiye kuti muyezo umawerengeredwa molingana ndi kuchuluka komwe kwatengedwa kale. Ngati ndi kotheka, onjezani mlingo wa mankhwalawa, ndibwino kuti muwonjezere ndi theka la piritsi la Amaril M 2 mg / 500 mg.

    Kutalika kwa maphunzirawa kumatsimikiziridwa ndi katswiri, mankhwalawa amavomerezedwa kuti azigwiritsidwa ntchito kwa nthawi yayitali.

    Pa nthawi yoyembekezera komanso yoyamwitsa

    Mankhwala Amaryl M sayenera kugwiritsidwa ntchito ndi amayi apakati ndi amayi omwe akukonzekera kukhala mayi. Amayi oyembekezera akuyenera kudziwitsa dokotala za zolinga zake kapena kupezeka kwa pakati pa mankhwala a hypoglycemic, kuti athe kupereka mankhwala ena ochepetsa shuga kapena kumuwonjezera ku insulin.

    Kafukufuku wokhudza nyama zoberekera adawulula kuti metformin yomwe ilipo m'mankhwala ingayambitse vuto lakukula kwa mwana wosabadwayo / mwana wosabadwayo ndikusokoneza mwana pambuyo pake.

    Amadziwika kuti metformin imatha kulowa mkaka wa m'mawere mosavuta. Chifukwa chake, kuti tipewe zovuta za thupi la mwana, ndikofunikira kuti mkaziyo akane kuyamwa kapena kusinthira ku mankhwala ena okhala ndi vuto la hypoglycemic lomwe limaloledwa unamwino.

    Contraindication ndi Kusamala

    Mtengo wapakati: (1 mg / 250 mg) - 735 ma ruble., (2 mg / 500 mg) - 736 rubles.

    Mapiritsi a Amaryl M sayenera kumwa ngati:

    • Mtundu I shuga
    • Mavuto a matenda ashuga: ketoacidosis (kuphatikizapo mbiri yakale), kholo ndi chikomokere
    • Mtundu uliwonse wa metabolic acidosis (pachimake kapena aakulu)
    • Matenda akulu a chiwindi (chifukwa chosadziwa zambiri)
    • Hemodialysis
    • Kulephera kwamkati ndi matenda akulu (kupezeka kwakukulu kwa lactic acidosis)
    • Mulingo uliwonse wamavuto omwe ungawononge ntchito ya impso (kuchepa magazi, matenda opatsirana, kugwiritsa ntchito mankhwala okhala ndi ayodini)
    • Matenda omwe amasokoneza kuyenda kwa mpweya mu minofu (kulephera kwa mtima, kulowetsedwa kwa myocardial, mantha)
    • Kukhazikika kwa thupi kwa lactic acidosis (incl. Mbiri ya lactacidemia)
    • Mikhalidwe yopsinjika (kuvulala kovuta, kuwotcha kwamafuta kapena mankhwala, kulowererapo kwa opaleshoni, matenda oopsa ndi concomitant fever, magazi poyipa
    • Zakudya zopanda thanzi chifukwa cha njala, zakudya zamafuta ochepa, komanso kuperewera kwa zakudya m'thupi
    • Matenda a mayamwidwe m'matumbo am'mimba (paresis ndi matumbo kutsekeka)
    • Kudalira kwambiri kwa mowa, mowa wambiri
    • Kuperewera kwa thupi lactase, galactose immune, GH malabsorption syndrome
    • Kukonzekera kutenga pakati, kutenga pakati, kuyamwa
    • Asanafike zaka 18 (chifukwa chosowa chitetezo chokwanira kwa achichepere)
    • Mulingo wapamwamba kwambiri wa chidwi cha munthu payekha kapena kusalolera kwathunthu kuzinthu zomwe zakonzedwa, komanso mankhwala aliwonse omwe ali ndi zotumphukira za sulfanilurea, biguanides.

    Zomwe muyenera kudziwa mukamapereka Amaril M

    Kumayambiriro kwa mankhwalawa, chiopsezo chowonjezereka cha hypoglycemia nchotheka, motero, patangopita milungu yochepa, muyenera kuyang'ananso mosamala ndipo ngati kuli koyenera, glycemia wolondola. Zowopsa ndi:

    • Kulephera kwa wodwala kapena kusafuna kutsatira malangizo a chipatala
    • Zakudya zoperewera m'thupi (zakudya zopanda chakudya, zakudya zosafunikira, mphamvu zosapangidwanso)
    • Kumwa mowa
    • Matenda a Metabolic chifukwa cha endocrine matenda (matenda a chithokomiro, kusokonekera kwa magawo a GM omwe amachititsa kuti kagayidwe ka metabolic)
    • Kulowa Ndi Matenda Akulitsa Matenda
    • Kumwa mankhwala ena osaganizira kuti ndi Amaril M
    • Okalamba: kuwonongeka kwa impso, popanda chizindikiro
    • Kumwa mankhwala omwe amakhudza chikhalidwe cha impso (kumwa okodzetsa omwe amachepetsa kuthamanga kwa magazi, ma NSAID, ndi ena otero)
    • Zizindikiro zochepa kapena zopotoza zam'mbuyo za hypoglycemia.

    Kuchita mankhwala osokoneza bongo

    Pa mankhwala ndi Amaril M, ziyenera kukumbukiridwa kuti magawo awiri omwe amagwira ntchito omwe amapangidwa amatha kuphatikizira limodzi kapena molumikizana mosagwirizana ndi mankhwala ena. Zotsatira zake, izi zimatha kukhudza zochizira kapena kuwongolera kwa glycemic ndikuwatsogolera kuzinthu zosayembekezereka.

    Kusintha kwa metabolism kumachitika ndi kutenga nawo mbali mwachindunji kwa CYP2C9 isoenzyme. Chifukwa chake, katundu wake amasintha akaphatikizidwa ndi zoletsa kapena zoletsa za amkati. Ngati ndi kotheka, kuphatikiza koteroko kuyenera kuonetsetsa kuti mulondola komanso ngati kuli koyenera, sinthani:

    • Mphamvu yochepetsera shuga ya glimepiride imatheka chifukwa cha mphamvu ya ACE zoletsa, ma anabolics, mahomoni achimuna, mankhwala osokoneza bongo a coumarin, MAO, cyclophosphamide, phenfluramine, pheniramidol, fibrate, fluconazole, salicylates, sulfanilamides, antipatitiscline.
    • Mphamvu ya hypoglycemic imachepetsedwa pomwe Amaril M akuphatikizidwa ndi Acetazolamide, barbiturates, diuretics, sympathomimetics, GCS, Mlingo waukulu wa nicotinic acid, glucagon, mahomoni (chithokomiro, estrogens, progestogens), Phenothiazine, Rifampicin, kugwiritsa ntchito mankhwala osokoneza bongo kwa nthawi yayitali.

    Zina zomwe zingachitike:

    • Mwanjira yolumikizana ndi otsutsana a H2-histamine receptors, BAB, Clonidine, Reserpine, mphamvu ya Amaril M imatha kusinthasintha, kukulira kapena kutsika. Kuti mupewe zovuta, ndikofunikira kuyang'anira glycemia mosamala, monga mwa zizindikiro zake, musinthe mankhwalawa tsiku lililonse. Kuphatikiza apo, mankhwalawa amathandizira ma receptors a NS, chifukwa chomwe kuyankhidwa kwa chithandizo kumasokonezedwa. Chifukwa chake, izi zitha kubweretsa kuchepa kwa kuwonetsa kwa zizindikiro za hypoglycemia, zomwe zimawonjezera chiwopsezo cha kulimba kwake.
    • Ndi kuphatikiza kwa glimepiride ndi ethanol motsutsana ndi zakumwa zoledzeletsa kapena mtundu wa zakumwa zoledzeretsa, zotsatira zake za hypoglycemic zitha kuchuluka kapena kuchepa.
    • Akaphatikizidwa ndi zotumphukira za coumarin, anticoagulants, zosintha zawo zimasunthika mbali imodzi.
    • Kuyamwa kwa glimepiride kuchokera m'mimba thirakiti kumachepa mchikakamizo cha Kolesevelam, ngati adamwa pamaso pa Amaril M. Koma ngati mumwa mankhwalawo mobwerezabwereza ndi kupatula kwa maola osachepera anayi, ndiye kuti palibe zotsatira zoyipa zomwe zingachitike.

    Zomwe zimachitika ndi metformin ndi mankhwala ena

    Kuphatikiza kosafunikira kumaphatikizapo:

    • Kuphatikiza ndi ethanol. Poizoni wakumwa wambiri, chiwopsezo cha lactic acidosis chimakulanso, makamaka motsutsana ndi maziko azakudya zomwe zimatsala kapena chakudya chosakwanira, kukhalapo kwa chiwindi chokwanira. Pochita mankhwala ndi Amaril M, munthu ayenera kupewa zakumwa zoledzeretsa komanso mankhwala osokoneza bongo.
    • Ndi othandizira ayodini. Mukaphatikiza mankhwala a Amaril M ndi njira zomwe zimaphatikizira intravascular dongosolo la osiyanitsa, chiopsezo cha kuwonongeka kwa impso chimakulanso. Chifukwa chosagwira bwino kwa limba, metformin imadziunjikira ndi chitukuko chotsatira cha lactic acidosis. Pofuna kupewa zovuta, Amaril M ayenera kuyimitsidwa kumwa masiku awiri isanachitike njira zomwe zili ndi ayodini, osamwa nthawi yomweyo atatha kafukufuku wamankhwala. Amaloledwa kuyambiranso maphunzirowa pokhapokha atalandira data kuti palibe zopatuka pamikhalidwe ya impso.
    • Kuphatikiza ndi maantibayotiki omwe amakhudza impso kumabweretsa mapangidwe a lactic acidosis.

    Kuphatikiza komwe kuli ndi metformin, komwe kumafunika kusamala:

    • Akaphatikizidwa ndi corticosteroids am'deralo kapena a systemic, othandizira okodzetsa ndi 2-adrenostimulants, m'magazi a m'magazi amayenera kuwunika pafupipafupi kuposa masiku onse (makamaka kumayambiriro kwa kuzungulira kwazovuta) kuti athe kuthekera kusintha kwa mankhwalawo panthawi ya mankhwala kapena mankhwala atachotsedwa.
    • Mukaphatikizidwa ndi ACE inhibitor ndi metformin, mankhwala oyamba amatha kuchepetsa glycemia, chifukwa chake, kusintha kwa mankhwalawa kumafunika panthawi ya mankhwala kapena atachotsa zoletsa za ACE.
    • Mukaphatikizidwa ndi mankhwala omwe amatha kupititsa patsogolo zotsatira za metformin (insulin, anabolics, sulfonylurea ndi zotumphukira, asipirin ndi salicylates), kuwunikira mwatsatanetsatane misempha ya glucose ndikofunikira kusintha molondola komanso munthawi yake mlingo wa metformin mutatha kusiya mankhwalawa motsutsana ndi maziko a chithandizo chamtundu wa Amaril M.
    • Momwemonso, kuwongolera glycemic ndikofunikira pamene Amaril M akuphatikizidwa ndi mankhwala omwe amachepetsa mphamvu yake (GCS, mahomoni a chithokomiro, mankhwala a thiazide, kulera kwapakamwa, sympathomimetics, calcium antagonists, etc.) kusintha mlingo ngati pakufunika.

    Zotsatira zoyipa

    Zotsatira zoyipa za kutenga Amaril M zimachitika chifukwa cha zonse ziwiri zomwe zimapezeka mu metformin ndi glimepiride, komanso kuphatikizidwa kwa njira zosiyanasiyana mthupi.

    Zotsatira zoyipa zomwe zidatchulidwa pansipa ndizotsatira zamankhwala zomwe zimachitika ndi glimepiride ndi zina zotengera sulfanylurea. Hypoglycemia ikhoza kupatsirana. Amapezeka mumtundu wa:

    • Mutu
    • Njala yokhazikika
    • Kholingo, kusanza
    • Zofooka zambiri
    • Kusokonezeka tulo (kugona kapena kugona)
    • Kuchulukitsa mantha, nkhawa
    • Anthu okwiya kwambiri
    • Kulephera kuganizira, kunachepetsa chidwi
    • Kuletsa kwa psychomotor zimachitika
    • Chisokonezo
    • Zovuta
    • Zovuta zam'madera osankhidwa m'malo osankhidwa
    • Masomphenya otsika
    • Kusokonekera kwa mawu
    • Khunyu
    • Kukomoka (kotheka chikomokere)
    • Kupuma pang'ono, bradycardia
    • Thukuta lozizira, loterera
    • Tachycardia
    • Kuthamanga kwa magazi
    • Zosangalatsa pamtima
    • Arrhythmias.

    Nthawi zina, pamene hypoglycemia imakhala yoopsa kwambiri, imatha kusokonezedwa ndi matenda oopsa a m'mimba a GM. Vutoli limayenda bwino atachotsa hypoglycemia.

    Zotsatira zina zoyipa

    • Zowonongeka: Kuchepa kwakanthawi kovuta (makamaka kumachitika kumayambiriro kwa chithandizo). Zimayambika chifukwa cha kusinthasintha kwa glycemia, komwe kumapangitsa kuti mitsempha yotupa ituluke, yomwe imawonetsedwa pakatikati pa kukonzanso.
    • Ziwalo zam'mimba: nseru, kusanza, kupweteka, kutsegula m'mimba, kumatulutsa, kumverera kwodzaza.
    • Chiwindi: chiwindi, chiwopsezo cha michere, jaundice, cholestasis. Ndi kupita patsogolo kwa pathologies, kukulitsa kwa zinthu zomwe zikuwopseza moyo wa wodwalayo ndikotheka. Vutoli limatha kusintha pambuyo posiya mankhwala.
    • Hematopoietic ziwalo: thrombocytopenia, nthawi zina khansa ya m'magazi ndi zina chifukwa cha kusintha kwa kapangidwe ka magazi.
    • Chitetezo cha mthupi: matupi awo sagwirizana ndi bodza (zotupa, kuyabwa, urticaria). Nthawi zambiri amawonetsedwa pang'ono, koma nthawi zina amatha kupita patsogolo, kuwonetseredwa ndi dyspnea, kutsika kwa kuthamanga kwa magazi, kugwedezeka kwa anaphylactic. Kuphwanya kungakhalenso chifukwa chodziwikirana ndi sulfanylurea kapena zinthu zina. Ndikofunikira kulumikizana ndi katswiri.
    • Zochita zina: Kuzindikira kwamphamvu kwa dermis pakuwala kwa dzuwa ndi radiation ya UV.

    Chovuta chambiri chotsatira chogwiritsa ntchito mankhwala omwe ali ndi metformin ndi lactic acidosis. Kuphatikiza apo, chinthucho chimatha kuyambitsa chisokonezo pakugwira ntchito kwamkati ndi ziwalo.

    • Ziwalo zogaya chakudya: Nthawi zambiri - nseru, kusanza, kupweteka, kusilira, kuchuluka kwa mapangidwe agesi, kusowa kwa chilimbikitso. Zizindikiro zimakhazikika pang'onopang'ono, zimadziwika ndi gawo loyambirira la mankhwala.Mukamapitiliza kutenga Amaril M amachoka paokha. Kuchepetsa vutoli pambuyo pa mapiritsi ndi kuwaletsa, tikulimbikitsidwa kuti muwonjezere mlingo pang'onopang'ono, ndikuphatikiza mankhwala ndi chakudya. Ngati kutsegula m'mimba kwambiri komanso / kapena kusanza kumayamba, ndiye kuti kuchepa madzi m'thupi ndi azabememia ya prerenal ikhoza kukhala zotsatira. Pankhaniyi, mankhwala a Amaril M ayenera kusokonezedwa mpaka mkhalidwe waumoyo ukhale wolimba.
    • Ziwalo zam'maso: Zosasangalatsa "zachitsulo" zosasangalatsa
    • Chiwindi: Kuchepa kwa magwiridwe antchito a thupi, chiwindi (mwina kubwezeretsa pambuyo posiya mankhwala). Pamavuto a chiwindi, wodwalayo ayenera kulumikizana ndi katswiri wochizira posachedwa.
    • Khungu: kuyabwa, zotupa, erythema.
    • Hematopoietic ziwalo: kuchepa magazi, leukemia ndi thrombocytopenia. Ndi njira yayitali, pali kuchepa pazomwe zili ndi vit. B12 m'magazi, kupezeka kwa megaloblastic anemia.

    Kutulutsa Fomu

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

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

    Amasiyana mu zolemba zomwe zimagwiritsidwa ntchito pamapiritsi.

    Kuchita

    Asanapereke mankhwala Amaryl, dokotala ayenera kudziwa kuti ndi mankhwala ati omwe wodwala amamwa. Mankhwala ena amalimbikitsa, ena amachepetsa hypoglycemic zotsatira za glimepiride.

    Mukamachititsa maphunziro, zidapezeka kuti kuchepa kwakukulu kwa shuga m'magazi kumawonedwa mukamadyedwa:

    • othandizirana pakamwa
    • Phenylbutazone
    • Oxyphenbutazone,
    • Azapropasone
    • Sulfinpyrazone,
    • Metformin
    • Tetracycline
    • Miconazole
    • salicylates,
    • Mao zoletsa
    • mahomoni ogonana amuna
    • anabolic steroids
    • mankhwala a quinol,
    • Clarithromycin
    • Fluconazole
    • omvera,
    • mafupa.

    Chifukwa chake, sikulimbikitsidwa kuti muyambe kumwa Amaryl nokha popanda kulandira mankhwala kuchokera kwa dokotala.

    Otsatirawa amachepetsa mphamvu ya glimepiride:

    • progestogens
    • estrogens
    • thiazide okodzeya,
    • saluretics
    • glucocorticoids,
    • nicotinic acid (mukamagwiritsa ntchito muyezo waukulu),
    • mankhwala othandizira (operekedwa nthawi yayitali),
    • barbiturates
    • Rifampicin,
    • Glucagon.

    Zoterezi ziyenera kukumbukiridwa posankha mlingo.

    Sympatholytics (beta-blockers, reserpine, clonidine, guanethidine) ali ndi zotsatira zosayembekezereka pa hypoglycemic zotsatira za Amaril.

    Mukamagwiritsa ntchito zomwe zimachokera ku coumarin, zindikirani: glimepiride imakulitsa kapena kufooketsa mphamvu ya mankhwalawa pathupi.

    Dokotalayo amasankha mankhwala osokoneza bongo, mankhwala osokoneza bongo a anti-yotupa, komanso mankhwala ena otchuka.

    Amaryl imaphatikizidwa ndi insulin, metformin. Kuphatikiza uku kumafunikira pamene mukutenga glimepiride sikutheka kukwaniritsa kufunika kwa metabolic. Mlingo wa mankhwala uliwonse umayikidwa ndi dokotala payekhapayekha.

    Kuphatikiza kwapadera kwa zosakaniza zogwira ntchito kumathandizira kukonza bwino kwa mankhwala, kumathandizira kuwongolera bwino momwe odwala matenda ashuga.

    Tsiku lotha ntchito

    Gwiritsani ntchito mankhwalawa ndikuloledwa kwa miyezi 36 kuyambira tsiku lotulutsidwa.

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

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

    Ngati ndi kotheka, m'malo mwa Amaryl ndi Glimepiride, yomwe imapangidwa ndi kampani yaku Russia Vertex. Mapiritsi osonyezedwawo ndiokwera mtengo. Phukusi la ma PC 30.2 mg iyenera kulipira 191 p.

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

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

    Mimba, kuyamwa

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

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

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

    • E11 Matenda a shuga osadalira insulin

    Kufotokozera za mtundu wa kipimo

    Amaryl 1 mg: mapiritsi ndi apinki, oblong, osalala ndi mzere wogaula mbali zonse ziwiri. Wolemba "NMK" komanso wolemba "h" mbali ziwiri.

    Amaryl 2 mg: mapiritsi ndiwobiliwira, oblong, osalala ndi mzere wogaula mbali zonse ziwiri. Wolemba "NMM" komanso wolemba "h" mbali ziwiri.

    Amaryl 3 mg: mapiritsi ndi wotumbulika chikasu, oblong, lathyathyathya wokhala ndi mzere mbali zonse ziwiri. Wolemba "NMN" komanso "st" h "mbali ziwiri.

    Amaryl 4 mg: mapiritsi a buluu, oblong, osalala ndi mzere wogaula mbali zonse ziwiri. Wolemba "NMO" komanso wolemba "h" mbali ziwiri.

    Pharmacokinetics

    Ndi Mlingo wambiri wa glimepiride muyezo wa tsiku ndi tsiku wa 4 mg C m'magazi seramu umatheka pambuyo pa maola pafupifupi 2,5 ndipo umafika 309 ng / ml. Pali ubale womwe ulipo pakati pa mlingo ndi C max wa glimepiride mu plasma, 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 imadziwika ndi gawo lotsika kwambiri (pafupifupi 8.8 L), pafupifupi lofanana ndi kuchuluka kwa kugawa kwa albumin, kumanga kwambiri mapuloteni a plasma (oposa 99%) ndi chilolezo chotsika (pafupifupi 48 ml / min). T 1/2 yotsimikizika, yokhazikitsidwa ndi seramu pozungulira pobwereza mankhwalawa, pafupifupi maola 5-8. Mutatha kumwa kwambiri, pali kuwonjezeka pang'ono kwa T 1/2.

    Pambuyo pa limodzi mlingo wa glimepiride, 58% ya mankhwalawa amachotsedwa impso ndi 35% ya mlingo kudzera m'matumbo. Glimepiride yosasinthika mumkodzo sadziwika.

    Mu mkodzo ndi ndowe, metabolites awiri adadziwika chifukwa cha kagayidwe kachakudya ka chiwindi (makamaka pogwiritsa ntchito CYP2C9), imodzi mwa izo inali yochokera ku hydroxy, ndipo inayo imachokera ku carboxy. Pambuyo pakuyamwa kwa glimepiride, terminal T 1/2 ya metabolites iyi inali ya 3-5 ndi maola 5-6, motero.

    Glimepiride amamuchotsa mkaka wa m'mawere ndikuwoloka chotchinga.

    Kuyerekeza kwa osakwatiwa komanso angapo (kamodzi patsiku) kayendedwe ka glimepiride sikunawonetse kusiyana kwakukulu mu magawo a pharmacokinetic, kusiyana kwawo kotsika kwambiri pakati pa odwala osiyanasiyana kumawonedwa. Palibe kuchuluka kwakukulu kwa mankhwalawa.

    Ma paracokinetic magawo ndi ofanana mwa odwala azikhalidwe zosiyanasiyana komanso azaka zosiyanasiyana. Odwala omwe ali ndi vuto la aimpso (okhala ndi vuto lochepera la creatinine), amakhala ndi chizolowezi chomakulitsa chiwonetsero cha glimepiride ndi kutsika kwake mozama kwambiri mu seramu yamagazi, yomwe, mwanjira zonse, imachitika chifukwa chofulumira kwa mankhwalawa chifukwa chomanga thupi pang'ono. Chifukwa chake, m'gulu lino la odwala palibe chiopsezo chowonjezereka cha mankhwalawa.

    Mankhwala

    Glimepiride imachepetsa kuchuluka kwa shuga m'magazi, makamaka chifukwa cha kukondoweza kwa kutulutsa kwa insulin m'maselo a beta. Zotsatira zake zimaphatikizidwa makamaka ndi kuwongolera kwa kuthekera kwa ma cell a pancreatic beta poyankha kukondoweza kwa thupi ndi glucose. Poyerekeza ndi glibenclamide, kutenga milingo yotsika ya glimepiride kumayambitsa kutulutsidwa kwa insulin yaying'ono pomwe ikukwaniritsa kuchepa kwamphamvu kwa magazi. Izi zimapereka umboni wothandizira kukhalapo kwa extrapancreatic hypoglycemic zotsatira mu glimepiride (kuchuluka kwa chidwi cha minofu ndi insulinomimetic kwenikweni).

    Katemera wa insulin. Monga zochokera ku sulfonylurea zina zonse, glimepiride imayang'anira kubisala kwa insulin mwakuchita ndi njira zamtundu wa potaziyamu wa ATP pama cell a beta-cell. Mosiyana ndi zotumphukira zina za sulfonylurea, glimepiride imadzisankhira mapuloteni omwe ali ndi kulemera kwa 65 kilodaltons (kDa) yomwe imapezeka m'zigawo za ma cell a pancreatic beta. Kuchita uku kwa glimepiride ndi mapuloteni omwe amamangiriza kwa iwo kumayendetsa kutsegulidwa kapena kutseka kwa njira zamtundu wa potaziyamu za ATP.

    Glimepiride amatseka njira za potaziyamu. Izi zimayambitsa kukhumudwitsidwa kwa maselo a beta ndipo zimatsogolera kutsegulidwa kwa njira zopangira calcium komanso kumva kashiamu kulowa m'selo. Zotsatira zake, kuwonjezeka kwa intracellular calcium ndende kumapangitsa kuti insulin itulutsidwe ndi exocytosis.

    Glimepiride imathamanga mwachangu motero imakhala yolumikizana ndipo imamasulidwa ku mgwirizano womwe uli ndi zomanga thupi kuposa glibenclamide. Amaganizira kuti nyumbayi yomwe ili ndi chiwopsezo chachikulu kwambiri cha glimepiride yokhala ndi mapuloteni omanga kwa iyo imatsimikizira mphamvu yake yotengeka ya maselo a beta ku glucose ndi chitetezo chawo ku kukomoka komanso kufooka msanga.

    Zomwe zimawonjezera chidwi cha minofu ku insulin. Glimepiride imapititsa patsogolo zotsatira za insulin pa mayamwidwe a glucose mwa zotumphukira zimakhala.

    Insulinomimetic kwenikweni. Glimepiride imakhala ndi zotsatira zofanana ndi zomwe zimapangitsa kuti insulini ikhale ndi mayamwidwe amtunduwu komanso kutulutsidwa kwa glucose ku chiwindi.

    Glucose wa Peripheral umatengedwa ndikuwutumiza mu ma cell a minofu ndi adipocytes. Glimepiride imawonjezera mwachindunji kuchuluka kwamamolekyu omwe amayendetsa glucose m'matumbo a plasma a maselo am'mimba ndi adipocytes. Kuwonjezeka kwa kudya kwamaselo am'magazi kumabweretsa kutseguka kwa glycosylphosphatidylinositol-enieni phospholipase C. Zotsatira zake, ndende ya calcium ya intracellular imachepa, ndikupangitsa kuchepa kwa ntchito ya protein kinase A, yomwe imayambitsa kukondoweza kwa metabolism ya glucose.

    Glimepiride amalepheretsa shuga kuti chiwindi chiwonjezeke ndi kuchuluka kwa fructose-2,6-bisphosphate, zomwe zimalepheretsa gluconeogeneis.

    Zotsatira za kuphatikizidwa kwa maselo a m'magazi ndikupanga zolembera za atherosulinotic. Glimepiride amachepetsa kuphatikiza kwa ma platelet mu vitro komanso vivo. Izi zikuwoneka kuti zimagwirizanitsidwa ndi kusankha kwa COX, komwe kumayambitsa mapangidwe a thromboxane A, chinthu chofunikira kwambiri cha kuphatikizira kwa maselo.

    Antiatherogenic mphamvu ya mankhwala. Glimepiride imathandizira kuti mitundu ya lipid ikhale yachulukidwe, imachepetsa mulde aldehyde m'magazi, zomwe zimapangitsa kuchepa kwakukulu kwa lipid peroxidation.

    Kuchepetsa zovuta za oxidative kupsinjika, komwe kumakhalapo nthawi zonse kwa odwala omwe ali ndi mtundu wa matenda a shuga 2: Glimepiride imawonjezera kuchuluka kwa endo native α-tocopherol, zochitika za catalase, glutathione peroxidase ndi superoxide dismutase.

    Zokhudza mtima. Kudzera pamayendedwe a potaziyamu a ATP (onani pamwambapa), sulfonylureas imathandizanso dongosolo la mtima.Poyerekeza ndi zamtundu wa sulfonylurea zotumphukira, glimepiride imakhala yocheperako kwambiri pamachitidwe a mtima. Amachepetsa kuphatikiza kwa maselo a m'magazi ndipo amatsogolera pakuchepetsa kwakukulu kwa mapangidwe a atherosrance.

    Mwa odzipereka athanzi labwino, mlingo woyenera wa glimepiride ndi 0,6 mg. Mphamvu ya glimepiride ndi kumwa modalira ndi kubereka. Kuyankha kwakuthupi pakulimbitsa thupi (kuchepa kwa insulin katemera) wokhala ndi glimepiride kumakhalabe.

    Palibe kusiyana kwakukulu pazotsatira zake, kutengera kuti mankhwalawo adatengedwa mphindi 30 asanadye kapena nthawi yomweyo asanadye. Odwala omwe ali ndi matenda ashuga, kuwongolera kokwanira kwa metabolic kumatha kupezeka mkati mwa maola 24 ndi mlingo umodzi. Kuphatikiza apo, pakufufuza kwachipatala, odwala 12 mwa 16 omwe ali ndi vuto la impso (Cl creatinine 4-79 ml / min) adakwanitsanso kuwongolera kokwanira ka metabolic.

    Kuphatikiza mankhwala ndi metformin. Kwa odwala omwe sakwaniritsa machitidwe owongolera a metabolic akagwiritsa ntchito mlingo waukulu wa glimepiride, kuphatikiza mankhwala ndi glimepiride ndi metformin kungayambike. M'maphunziro awiri, popanga mankhwala osakanikirana, zimatsimikiziridwa kuti kuwongolera kwa metabolic kuli bwino kuposa momwe amathandizira aliyense mwa mankhwalawa mosiyana.

    Kuphatikiza mankhwala ndi insulin. Kwa odwala omwe sangakwanitse kuyang'anira metabolic wokwanira pogwiritsa ntchito kuchuluka kwa glimepiride, munthawi yomweyo insulini ingayambike. Malinga ndi zotsatira za kafukufuku awiri, ndikugwiritsa ntchito kuphatikiza uku, kusintha komweko pakukonzanso kagayidwe kachakudya kamakwaniritsidwa monga kugwiritsira ntchito insulin imodzi yokha, komabe, pophatikiza mankhwalawa insulin yotsika ndiyofunikira.

    Gwiritsani ntchito ana. Palibe deta pakukwaniritsidwa kwakutali komanso chitetezo mukamagwiritsa ntchito mankhwalawa kwa ana.

    Type 2 shuga mellitus (mu monotherapy kapena ngati gawo la mankhwala ophatikizika ndi metformin kapena insulin).

    Mimba komanso kuyamwa

    Glimepiride ndi contraindicated mwa amayi apakati. Ngati mayi wapezeka kuti ali ndi pakati kapena pokhapokha ngati ali ndi pakati, mkazi ayenera kuthandizidwa ndi insulin.

    Glimepiride imadutsa mkaka wa m'mawere, kotero sichingatengere mkaka wa mkaka. Pankhaniyi, muyenera kusinthana ndi insulin kapena kusiya kuyamwitsa.

    Malangizo apadera

    M'magawo apadera ovuta a nkhawa, monga kuvutika maganizo, chithandizo cha opaleshoni, matenda a febrile fever, metabolic control ikhoza kudwala kwambiri odwala matenda a shuga, ndipo angafunikire kusinthidwa kwakanthawi kuti alandire insulin kuti azitha kuyendetsa bwino metabolism.

    M'milungu yoyamba ya chithandizo, chiopsezo chokhala ndi hypoglycemia chitha kuchuluka, chifukwa chake, kuyang'anira kuchuluka kwa shuga m'magazi ndikofunikira pakadali pano.

    Zomwe zimayambitsa chiopsezo cha hypoglycemia zimaphatikizapo:

    Kusunthika kapena kulephera kwa wodwala (nthawi zambiri kumawonedwa mu odwala okalamba) kuti azithandizana ndi dokotala,

    Kuperewera kwa zakudya m'thupi, kudya mosazolowereka kapena kudya chakudya,

    Kukula pakati pa zolimbitsa thupi ndi chakudya chamafuta,

    Kumwa mowa, makamaka kuphatikiza ndi zakudya zodumphadumpha,

    Zowopsa za impso,

    Kuchepa kwa chiwindi kwa hepatic (odwala omwe ali ndi vuto lalikulu la chiwindi, kusinthika kwa mankhwala a insulin akuwonetsedwa, osachepera mpaka kupezeka kwa metabolic),

    Matenda ena ophatikizika a endocrine omwe amasokoneza kagayidwe kazakudya kapena kuphatikizika kwa adrenergic poyankha hypoglycemia (mwachitsanzo, chithokomiro china cha chithokomiro komanso cha anterior pituitary dysfunction, adrenal insufficiency

    Kugwiritsa ntchito mankhwala munthawi yomweyo (onani gawo "Kuyanjana"),

    Kulandila kwa glimepiride posakhala zizindikiro zakulandila kwake.

    Kuchiza ndi zotumphukira za sulfonylurea, zomwe zimaphatikizapo glimepiride, kungayambitse kukula kwa hemolytic anemia, chifukwa chake, odwala omwe ali ndi vuto la glucose-6-phosphate dehydrogenase ayenera kusamala makamaka pokhazikitsa glimepiride ndipo ndibwino kugwiritsa ntchito othandizira a hypoglycemic omwe siabwino.

    Pamaso pa zinthu zomwe zili pamwambazi, kukulitsa kwa hypoglycemia kungafune kusintha kwa glimepiride kapena chithandizo chonse. Izi zimagwiranso ntchito pakupezeka kwa matenda omwe amakumana nawo panthawi yamankhwala kapena kusintha kwa moyo wa odwala.

    Zizindikiro za hypoglycemia zomwe zimawonetsa kuwukira kwa thupi chifukwa cha hypoglycemia (onani gawo "Zotsatira zoyipa") zitha kukhala zofatsa kapena kusapezeka ndi kukula kwapang'onopang'ono kwa hypoglycemia, mwa odwala okalamba, odwala omwe ali ndi vuto la neuronomic, kapena odwala omwe amalandira beta -adrenoblockers, clonidine, reserpine, guanethidine ndi ena omvera achifundo.

    Hypoglycemia imatha kuthetsedwa mwachangu ndi kupezeka msanga kwa chakudya cham'mimba chambiri (glucose kapena sucrose).

    Monga momwe ena amachokera ku sulfonylurea, ngakhale atakwanitsa kupumula kwa hypoglycemia, hypoglycemia ikhoza kuyambiranso. Chifukwa chake, odwala ayenera kuyang'aniridwa mosalekeza.

    Mu hypoglycemia yayikulu, chithandizo chamankhwala ndi kuyang'aniridwa kwachipatala, ndipo nthawi zina, kugonekedwa kwa odwala kuchipatala kumafunikanso.

    Mankhwalawa glimepiride, kuwunika pafupipafupi kwa chiwindi ndi chithunzi cha magazi (makamaka kuchuluka kwa leukocytes ndi mapulateleti) kumafunika.

    Popeza zovuta zina, monga hypoglycemia, kusintha kwakukuru mu chithunzi cha magazi, zovuta zina za thupi, kulephera kwa chiwindi, pamikhalidwe inayake ikhoza kuwopseza moyo, ngati mukuchitika zosakhumudwitsa kapena zowopsa, wodwalayo ayenera kudziwitsa dokotala wopezekapo za iwo ndipo osatero Mulimonsemo, musapitilize kumwa mankhwalawo osalimbikitsa.

    Kukopa pa kuyendetsa magalimoto ndi njila zina. Pankhani ya kukula kwa hypoglycemia kapena hyperglycemia, makamaka kumayambiriro kwa mankhwalawa kapena kusintha kwa mankhwalawa, kapena mankhwalawa akapanda kumwa mankhwala pafupipafupi, kuchepa kwa chidwi ndi kuthamanga kwa zochitika zama psychomotor ndikotheka. Izi zitha kulepheretsa wodwala kuyendetsa magalimoto kapena njira zina.

    Wopanga

    Sanofi-Aventis Deutschland GmbH, Germany, yopangidwa ndi Sanofi-Aventis S.p.A. (Italy).

    Stabilimento di Scoppito, Strada Statale 17, km 22, I-67019 Scoppito (L "Aquilla), Italy.

    Amaryl ili ndi glimepiride, yomwe ndi ya m'badwo watsopano, wachitatu, wa sulfonylurea derivatives (PSM). Mankhwalawa ndiokwera mtengo kwambiri kuposa glibenclamide (Maninil) ndi glyclazide (Diabeteson), koma kusiyana kwa mtengo kumatsimikiziridwa ndi kukwera kwambiri, kuchitapo kanthu mwachangu, kuthana ndi kufinya, komanso chiopsezo chochepa cha hypoglycemia.

    Ndikofunikira kudziwa! Nkhani yatsopano yomwe ikulangizidwa ndi ma endocrinologists a Kuwunika Kwachisawawa Kokulu! Ndi zofunika tsiku lililonse.

    Ndi Amaril, maselo a beta amatsitsidwa pang'onopang'ono kuposa mibadwo yam'mbuyomu ya sulfonylureas, kotero kupititsa patsogolo kwa shuga kumachepetsedwa ndipo chithandizo cha insulin chidzafunika pambuyo pake.

    Ndemanga zomwe zimamwa mankhwalawa ndizabwino: Imatsika shuga bwino, ndi yosavuta kugwiritsa ntchito, kumwa mapiritsi kamodzi patsiku, mosasamala za mlingo. Kuphatikiza pa glimepiride koyera, kuphatikiza kwake ndi metformin kumapangidwa - Amaril M.

    Matenda a shuga ndi kupsinjika kudzakhala chinthu chakale

    Matenda a shuga ndi omwe amayambitsa pafupifupi 80% yonse yamikwingwirima ndi kuduladula. Anthu 7 mwa anthu 10 amafa chifukwa cha mitsempha ya mtima kapena ubongo.Pafupifupi nthawi zonse, chifukwa chomaliza chomaliza ndi chimodzimodzi - shuga wamwazi.

    Shuga akhoza ndipo ayenera kugwetsedwa; Koma izi sizichiritsa matendawa, koma zimangothandiza kulimbana ndi kufufuza, osati zomwe zimayambitsa matendawa.

    Mankhwala okhawo omwe amalimbikitsidwa moyenera pochiza matenda ashuga komanso amagwiritsidwa ntchito ndi ma endocrinologists pantchito yawo ndi awa.

    Kugwiritsa ntchito bwino kwa mankhwalawa, kuwerengera malinga ndi njira yokhazikika (kuchuluka kwa odwala omwe achiwonjezere kuchuluka kwa odwala omwe ali mgulu la anthu 100 omwe adachitiridwa chithandizo):

    • Matenda a shuga - 95%
    • Kuthetsa kwa mitsempha thrombosis - 70%
    • Kuthetsa kwa kugunda kwamtima kwamphamvu - 90%
    • Kuthana ndi kuthamanga kwa magazi - 92%
    • Kulimbitsa tsiku, kukonza kugona usiku - 97%

    Opanga si bungwe lazamalonda ndipo amalipidwa ndi chithandizo cha boma. Chifukwa chake, tsopano wokhala aliyense ali ndi mwayi.

    • Chakudya chomwe amamwa mapiritsi chizikhala chambiri,
    • Palibe chifukwa choti mulumphe chakudya. Ngati simungakhale ndi chakudya cham'mawa, kulandiridwa kwa Amaril kumasulidwa ku nkhomaliro,
    • ndikofunikira kupanga yunifolomu yama protein m'magazi. Cholinga ichi chimakwaniritsidwa ndikudya pafupipafupi (pambuyo maola 4), kugawa kwamoto m'mbale zonse. Kutsika zakudya, kumakhala kosavuta kuti zitheke.

    Amaril aledzera zaka zambiri osapuma. Ngati mulingo wambiri wachepetsa shuga, muyenera kusintha mankhwalawo ku insulin.

    Nthawi yogwira

    Amaryl ali ndi bioavailability kwathunthu, 100% ya mankhwalawo imafika pamalo ochitapo kanthu. Malinga ndi malangizo, kuchuluka kwa glimepiride m'magazi kumapangidwa pambuyo maola 2,5. Kutalika kokwanira kwa zochita kumapitilira maola 24, kukwera kwakukulu, mapiritsi a Amaril otalikirawo adzagwira ntchito.

    Chifukwa cha nthawi yayitali, mankhwalawa amaloledwa kumwa kamodzi patsiku. Popeza kuti 60% ya anthu odwala matenda ashuga samatsata malangizo a dokotala, kumwa kamodzi kungathandize kuchepetsa kusowa kwa mankhwalawa ndi 30%, motero kusintha njira ya matenda ashuga.

    Contraindication

    Pali mndandanda waukulu wotsutsana ndi Amaril:

    • Mtundu 1
    • kuphwanya kwambiri chiwindi ndi impso,
    • matenda ashuga ketoacidosis, precoma ndi chikomokere,
    • , ,
    • kupezeka kwa matenda obadwa nawo monga makolo, galactose tsankho, shuga-galactose malabsorption kapena kuchepa kwa lactase,
    • zaka za ana
    • kusalolera kapena chidwi ndi mankhwalawo ndi zina zotero.

    Chenjezo limafunikira poyambira chithandizo cha odwala, popeza panthawiyi pamakhala chiopsezo cha hypoglycemia. Ngati mwayi wopeza hypoglycemia ulimbikire, ndiye kuti muyenera kusintha kamwedwe kake glimepiride kapena mankhwala othandizira. Kuphatikiza apo, kukhalapo kwa matenda wamba komanso matenda ena, moyo, thanzi ndi zina zambiri kumafunikira chisamaliro chapadera.

    Malangizo a Amaryl (Njira ndi Mlingo)

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

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

    Malangizo ogwiritsira ntchito Amaril amadziwikanso kuti pa chithandizo, kutsimikiza kwa kukhazikika kwa magazi m'magazi komanso kuchuluka kwa hemoglobin ya glycosylated kumafunika.

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

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

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

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

    Amadziwika kuti kuwongolera kagayidwe kazakudya kumakhudzana ndikuwonjezera chidwi cha insulin, ndipo panthawi ya chithandizo, kufunika glimepiride ikhoza kukana. Hypoglycemia imatha kupewedwa ndi kuchepetsedwa kwa Mlingo kapena kusiya Amaril.

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

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

    Monga lamulo, chithandizo cha Amaril chikuchitika kwa nthawi yayitali.

    Malonda ogulitsa

    M'mafakitala, mutha kupeza Amaryl ngati mumalandira kuchokera kwa dokotala.

    Zosunga

    Mapiritsi a Glimepiride amayenera kusungidwa m'malo amdima, otetezedwa kuti asayang'ane ndi dzuwa mwachindunji, kufikira ana. Kutentha kosungira - mpaka +30 о С.

    Tsiku lotha ntchito

    Gwiritsani ntchito mankhwalawa ndikuloledwa kwa miyezi 36 kuyambira tsiku lotulutsidwa.

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

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

    Ngati ndi kotheka, m'malo mwa Amaryl ndi Glimepiride, yomwe imapangidwa ndi kampani yaku Russia Vertex. Mapiritsi osonyezedwawo ndiokwera mtengo. Phukusi la ma PC 30. 2 mg iyenera kulipira 191 p.

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

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

    Mowa ndi Amaryl

    Sizingatheke kuneneratu pasadakhale momwe zakumwa zakumwa zoledzeretsa zimakhudzira munthu amene amakonzekera zochokera glimepiride. Mowa umatha kufooketsa kapena kuwonjezera mphamvu ya hypoglycemic ya Amaril. Chifukwa chake, sizingathe kuwonongedwa nthawi yomweyo.

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

    Mimba, kuyamwa

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

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

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

    • E11 Matenda a shuga osadalira insulin

    Kupanga ndi mawonekedwe a kumasulidwa

    mu chomangira chotchinga ma CD 15, mu paketi awiri makatoni 2, 4, 6 kapena 8.

    mu chomangira chotchinga ma CD 15, mu paketi awiri makatoni 2, 4, 6 kapena 8.

    mu chomangira chotchinga ma CD 15, mu paketi awiri makatoni 2, 4, 6 kapena 8.

    Kufotokozera za mtundu wa kipimo

    Amaryl 1 mg: mapiritsi ndi apinki, oblong, osalala ndi mzere wogaula mbali zonse ziwiri. Wolemba "NMK" komanso wolemba "h" mbali ziwiri.

    Amaryl 2 mg: mapiritsi ndiwobiliwira, oblong, osalala ndi mzere wogaula mbali zonse ziwiri. Wolemba "NMM" komanso wolemba "h" mbali ziwiri.

    Amaryl 3 mg: mapiritsi ndi wotumbulika chikasu, oblong, lathyathyathya wokhala ndi mzere mbali zonse ziwiri. Wolemba "NMN" komanso "st" h "mbali ziwiri.

    Amaryl 4 mg: mapiritsi a buluu, oblong, osalala ndi mzere wogaula mbali zonse ziwiri. Wolemba "NMO" komanso wolemba "h" mbali ziwiri.

    Feature

    Hypoglycemic wothandizira pakamwa makonzedwe a gulu la sulfonylurea a m'badwo wachitatu.

    Zotsatira za pharmacological

    Pharmacokinetics

    Ndi Mlingo wambiri wa glimepiride muyezo wa tsiku ndi tsiku wa 4 mg C m'magazi seramu umatheka pambuyo pa maola pafupifupi 2,5 ndipo umafika 309 ng / ml. Pali ubale womwe ulipo pakati pa mlingo ndi C max wa glimepiride mu plasma, 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 imadziwika ndi gawo lotsika kwambiri (pafupifupi 8.8 L), pafupifupi lofanana ndi kuchuluka kwa kugawa kwa albumin, kumanga kwambiri mapuloteni a plasma (oposa 99%) ndi chilolezo chotsika (pafupifupi 48 ml / min). T 1/2 yotsimikizika, yokhazikitsidwa ndi seramu pozungulira pobwereza mankhwalawa, pafupifupi maola 5-8. Mutatha kumwa kwambiri, pali kuwonjezeka pang'ono kwa T 1/2.

    Pambuyo pa limodzi mlingo wa glimepiride, 58% ya mankhwalawa amachotsedwa impso ndi 35% ya mlingo kudzera m'matumbo. Glimepiride yosasinthika mumkodzo sadziwika.

    Mu mkodzo ndi ndowe, metabolites awiri adadziwika chifukwa cha kagayidwe kachakudya ka chiwindi (makamaka pogwiritsa ntchito CYP2C9), imodzi mwa izo inali yochokera ku hydroxy, ndipo inayo imachokera ku carboxy. Pambuyo pakuyamwa kwa glimepiride, terminal T 1/2 ya metabolites iyi inali ya 3-5 ndi maola 5-6, motero.

    Glimepiride amamuchotsa mkaka wa m'mawere ndikuwoloka chotchinga.

    Kuyerekeza kwa osakwatiwa komanso angapo (kamodzi patsiku) kayendedwe ka glimepiride sikunawonetse kusiyana kwakukulu mu magawo a pharmacokinetic, kusiyana kwawo kotsika kwambiri pakati pa odwala osiyanasiyana kumawonedwa. Palibe kuchuluka kwakukulu kwa mankhwalawa.

    Ma paracokinetic magawo ndi ofanana mwa odwala azikhalidwe zosiyanasiyana komanso azaka zosiyanasiyana. Odwala omwe ali ndi vuto la aimpso (okhala ndi vuto lochepera la creatinine), amakhala ndi chizolowezi chomakulitsa chiwonetsero cha glimepiride ndi kutsika kwake mozama kwambiri mu seramu yamagazi, yomwe, mwanjira zonse, imachitika chifukwa chofulumira kwa mankhwalawa chifukwa chomanga thupi pang'ono. Chifukwa chake, m'gulu lino la odwala palibe chiopsezo chowonjezereka cha mankhwalawa.

    Mankhwala

    Glimepiride imachepetsa kuchuluka kwa shuga m'magazi, makamaka chifukwa cha kukondoweza kwa kutulutsa kwa insulin m'maselo a beta. Zotsatira zake zimaphatikizidwa makamaka ndi kuwongolera kwa kuthekera kwa ma cell a pancreatic beta poyankha kukondoweza kwa thupi ndi glucose.Poyerekeza ndi glibenclamide, kutenga milingo yotsika ya glimepiride kumayambitsa kutulutsidwa kwa insulin yaying'ono pomwe ikukwaniritsa kuchepa kwamphamvu kwa magazi. Izi zimapereka umboni wothandizira kukhalapo kwa extrapancreatic hypoglycemic zotsatira mu glimepiride (kuchuluka kwa chidwi cha minofu ndi insulinomimetic kwenikweni).

    Katemera wa insulin. Monga zochokera ku sulfonylurea zina zonse, glimepiride imayang'anira kubisala kwa insulin mwakuchita ndi njira zamtundu wa potaziyamu wa ATP pama cell a beta-cell. Mosiyana ndi zotumphukira zina za sulfonylurea, glimepiride imadzisankhira mapuloteni omwe ali ndi kulemera kwa 65 kilodaltons (kDa) yomwe imapezeka m'zigawo za ma cell a pancreatic beta. Kuchita uku kwa glimepiride ndi mapuloteni omwe amamangiriza kwa iwo kumayendetsa kutsegulidwa kapena kutseka kwa njira zamtundu wa potaziyamu za ATP.

    Glimepiride amatseka njira za potaziyamu. Izi zimayambitsa kukhumudwitsidwa kwa maselo a beta ndipo zimatsogolera kutsegulidwa kwa njira zopangira calcium komanso kumva kashiamu kulowa m'selo. Zotsatira zake, kuwonjezeka kwa intracellular calcium ndende kumapangitsa kuti insulin itulutsidwe ndi exocytosis.

    Glimepiride imathamanga mwachangu motero imakhala yolumikizana ndipo imamasulidwa ku mgwirizano womwe uli ndi zomanga thupi kuposa glibenclamide. Amaganizira kuti nyumbayi yomwe ili ndi chiwopsezo chachikulu kwambiri cha glimepiride yokhala ndi mapuloteni omanga kwa iyo imatsimikizira mphamvu yake yotengeka ya maselo a beta ku glucose ndi chitetezo chawo ku kukomoka komanso kufooka msanga.

    Zomwe zimawonjezera chidwi cha minofu ku insulin. Glimepiride imapititsa patsogolo zotsatira za insulin pa mayamwidwe a glucose mwa zotumphukira zimakhala.

    Insulinomimetic kwenikweni. Glimepiride imakhala ndi zotsatira zofanana ndi zomwe zimapangitsa kuti insulini ikhale ndi mayamwidwe amtunduwu komanso kutulutsidwa kwa glucose ku chiwindi.

    Glucose wa Peripheral umatengedwa ndikuwutumiza mu ma cell a minofu ndi adipocytes. Glimepiride imawonjezera mwachindunji kuchuluka kwamamolekyu omwe amayendetsa glucose m'matumbo a plasma a maselo am'mimba ndi adipocytes. Kuwonjezeka kwa kudya kwamaselo am'magazi kumabweretsa kutseguka kwa glycosylphosphatidylinositol-enieni phospholipase C. Zotsatira zake, ndende ya calcium ya intracellular imachepa, ndikupangitsa kuchepa kwa ntchito ya protein kinase A, yomwe imayambitsa kukondoweza kwa metabolism ya glucose.

    Glimepiride amalepheretsa shuga kuti chiwindi chiwonjezeke ndi kuchuluka kwa fructose-2,6-bisphosphate, zomwe zimalepheretsa gluconeogeneis.

    Zotsatira za kuphatikizidwa kwa maselo a m'magazi ndikupanga zolembera za atherosulinotic. Glimepiride amachepetsa kuphatikiza kwa ma platelet mu vitro komanso vivo. Izi zikuwoneka kuti zimagwirizanitsidwa ndi kusankha kwa COX, komwe kumayambitsa mapangidwe a thromboxane A, chinthu chofunikira kwambiri cha kuphatikizira kwa maselo.

    Antiatherogenic mphamvu ya mankhwala. Glimepiride imathandizira kuti mitundu ya lipid ikhale yachulukidwe, imachepetsa mulde aldehyde m'magazi, zomwe zimapangitsa kuchepa kwakukulu kwa lipid peroxidation.

    Kuchepetsa zovuta za oxidative kupsinjika, komwe kumakhalapo nthawi zonse kwa odwala omwe ali ndi mtundu wa matenda a shuga 2: Glimepiride imawonjezera kuchuluka kwa endo native α-tocopherol, zochitika za catalase, glutathione peroxidase ndi superoxide dismutase.

    Zokhudza mtima. Kudzera pamayendedwe a potaziyamu a ATP (onani pamwambapa), sulfonylureas imathandizanso dongosolo la mtima. Poyerekeza ndi zamtundu wa sulfonylurea zotumphukira, glimepiride imakhala yocheperako kwambiri pamachitidwe a mtima. Amachepetsa kuphatikiza kwa maselo a m'magazi ndipo amatsogolera pakuchepetsa kwakukulu kwa mapangidwe a atherosrance.

    Mwa odzipereka athanzi labwino, mlingo woyenera wa glimepiride ndi 0,6 mg. Mphamvu ya glimepiride ndi kumwa modalira ndi kubereka. Kuyankha kwakuthupi pakulimbitsa thupi (kuchepa kwa insulin katemera) wokhala ndi glimepiride kumakhalabe.

    Palibe kusiyana kwakukulu pazotsatira zake, kutengera kuti mankhwalawo adatengedwa mphindi 30 asanadye kapena nthawi yomweyo asanadye. Odwala omwe ali ndi matenda ashuga, kuwongolera kokwanira kwa metabolic kumatha kupezeka mkati mwa maola 24 ndi mlingo umodzi. Kuphatikiza apo, pakufufuza kwachipatala, odwala 12 mwa 16 omwe ali ndi vuto la impso (Cl creatinine 4-79 ml / min) adakwanitsanso kuwongolera kokwanira ka metabolic.

    Kuphatikiza mankhwala ndi metformin. Kwa odwala omwe sakwaniritsa machitidwe owongolera a metabolic akagwiritsa ntchito mlingo waukulu wa glimepiride, kuphatikiza mankhwala ndi glimepiride ndi metformin kungayambike. M'maphunziro awiri, popanga mankhwala osakanikirana, zimatsimikiziridwa kuti kuwongolera kwa metabolic kuli bwino kuposa momwe amathandizira aliyense mwa mankhwalawa mosiyana.

    Kuphatikiza mankhwala ndi insulin. Kwa odwala omwe sangakwanitse kuyang'anira metabolic wokwanira pogwiritsa ntchito kuchuluka kwa glimepiride, munthawi yomweyo insulini ingayambike. Malinga ndi zotsatira za kafukufuku awiri, ndikugwiritsa ntchito kuphatikiza uku, kusintha komweko pakukonzanso kagayidwe kachakudya kamakwaniritsidwa monga kugwiritsira ntchito insulin imodzi yokha, komabe, pophatikiza mankhwalawa insulin yotsika ndiyofunikira.

    Gwiritsani ntchito ana. Palibe deta pakukwaniritsidwa kwakutali komanso chitetezo mukamagwiritsa ntchito mankhwalawa kwa ana.

    Type 2 shuga mellitus (mu monotherapy kapena ngati gawo la mankhwala ophatikizika ndi metformin kapena insulin).

    Contraindication

    Hypersensitivity glimepiride kapena mankhwala ena othandizira, mankhwala ena a sulfonylurea kapena mankhwala a sulfa (chiopsezo cha hypersensitivity reaction),

    mtundu 1 shuga

    matenda ashuga ketoacidosis, matenda a shuga komanso chikomokere,

    kukanika kwa chiwindi (kusowa kwazachipatala)

    kwambiri aimpso kuwonongeka, kuphatikizapo Odwala hemodialysis (kupanda matenda

    zaka za ana (kusowa kwazachipatala),

    Matenda amtundu wa makolo monga galactose tsankho, kuchepa kwa lactase kapena malabsorption a glucose-galactose.

    mkhalidwe mu masabata oyambirira a chithandizo (chiopsezo chowonjezeka cha hypoglycemia). Ngati pali zovuta zomwe zingayambitse kukula kwa hypoglycemia (onani gawo "Malangizo Apadera"), kusintha kwa glimepiride kapena chithandizo chonse chofunikira chitha,

    Matenda omwe amakumana nawo mukamalandira chithandizo kapena kusintha moyo wa odwala (kusintha zakudya ndi kudya, kuchuluka kapena kuchepa thupi),

    malabsorption chakudya ndi mankhwala osokoneza bongo m'mimba thirakiti (m'mimba kutsekeka, matumbo paresis).

    Mimba komanso kuyamwa

    Glimepiride ndi contraindicated mwa amayi apakati. Ngati mayi wapezeka kuti ali ndi pakati kapena pokhapokha ngati ali ndi pakati, mkazi ayenera kuthandizidwa ndi insulin.

    Glimepiride imadutsa mkaka wa m'mawere, kotero sichingatengere mkaka wa mkaka. Pankhaniyi, muyenera kusinthana ndi insulin kapena kusiya kuyamwitsa.

    Zotsatira zoyipa

    Kuchokera kumbali ya kagayidwe: zotsatira za hypoglycemic of Amaril, hypoglycemia ikhoza kukhala, yomwe, monga ena sulfonylureas, imatha kupitilira.

    Zizindikiro za hypoglycemia ndi izi: mutu, njala, nseru, kusanza, kutopa, kugona, kusokonezeka kwa tulo, kuda nkhawa, kupsa mtima, chidwi chokwanira, kukhala tcheru ndi kuthamanga kwa kusintha, kusokonezeka, kusokonezeka kwa mawu, aphasia, kusokonezeka kowoneka, kunjenjemera, paresis, kusokonezeka kwa malingaliro, chizungulire, kulephera kudziletsa, kutsekemera, ubongo, kukayikira kapena kutaya chikumbumtima, mpaka kukomoka, kupuma kosakhazikika, bradycardia.

    Kuphatikiza apo, mawonetseredwe a adrenergic anti-regulation amatha kuchitika poyankha hypoglycemia, monga mawonekedwe a kuzizira, thukuta lomata, nkhawa, tachycardia, matenda oopsa, angina pectoris, palpitations, ndi kusokonekera kwa mtima.

    Kuwonetsedwa kuchipatala kwa hypoglycemia yayikulu ikhoza kukhala yofanana ndi sitiroko. Zizindikiro za hypoglycemia pafupifupi nthawi zambiri zimatha atatha.

    Kuchokera kumbali ya chiwalo cha masomphenyawo: munthawi yamankhwala Zomwe zimayambitsa ndikusintha kwakanthawi kwa ma lens, kutengera kuchuluka kwa shuga m'magazi, ndipo chifukwa cha izi, kusintha kwa ma index a mandala.

    Kuchokera pamatumbo am'mimba: nthawi zina - nseru, kusanza, kumva kupweteka kapena kufalikira kwa epigastrium, kupweteka kwam'mimba, kutsegula m'mimba, zina - hepatitis, kuchuluka kwa michere ya chiwindi ndi / kapena cholestasis ndi jaundice, yomwe imatha kupita patsogolo pakulephera kwa chiwindi. , koma atha kusintha zomwe zimachitika mankhwala atasiya.

    Kuchokera pa hemopoietic dongosolo ndi dongosolo la lymphatic: kawirikawiri - thrombocytopenia, nthawi zina - leukopenia, hemolytic anemia, erythrocytopenia, granulocytopenia, agranulocytosis ndi pancytopenia.

    Mavuto ambiri: Nthawi zina, thupi siligwirizana ndi pseudo-matupi awo, monga pruritus, urticaria, zotupa pakhungu, ndizotheka. Kuchita kotereku kumatha kuyambukira kwambiri ndi kupuma movutikira, kutsika kwakukulu kwa kuthamanga kwa magazi, komwe nthawi zina kumatha kupitilira kugwedezeka kwa anaphylactic. Ngati zizindikiro za urticaria zikuwoneka, pitani kuchipatala msanga. Nthawi zina, pakhoza kukhala kuchepa kwa seramu sodium wozungulira, allergic vasculitis, photosensitivity.

    Kuchita

    Glimepiride imapangidwa ndi cytochrome P4502C9 (CYP2C9), yomwe iyenera kukumbukiridwa ikagwiritsidwa ntchito nthawi yomweyo ndi inducers (mwachitsanzo rifampicin) kapena zoletsa (mwachitsanzo fluconazole) CYP2C9.

    Kuthekera kwa hypoglycemic kanthu ndipo, nthawi zina, chitukuko cha hypoglycemia chogwirizana ndi izi chitha kuwonedwa ndikaphatikizidwa ndi imodzi mwazomwezi: insulin ndi othandizira ena a hypoglycemic pazoyang'anira pakamwa, ACE inhibitors, anabolic steroids ndi mahomoni ogonana amuna, chloramphenicol, coumarin derivatives, cyclophosphamide, cyclophosphamide, , fenfluramine, pheniramidol, fibrate, fluoxetine, guanethidine, ifosfamide, MAO zoletsa, fluconazole, para-aminosalicylic acid, pentoxifylline (apamwamba m mlingo), phenylbutazone, azapropazone, oxyphenbutazone, probenecid, quinolones, salicylates, sulfinpyrazone, clarithromycin, sulfonamides, tetracyclines, tritokvalin, trofosfamide.

    Kuchepetsa mphamvu ya hypoglycemic ndi kuwonjezereka komwe kumagwirizana ndi kuchuluka kwa shuga m'magazi kumatha kuwonedwa ndikaphatikizidwa ndi imodzi mwazomwezi: acetazolamide, barbiturates, GCS, diazoxide, diuretics, epinephrine ndi othandizira ena, glucagon, mankhwala opatsirana kwa nthawi yayitali (nicotinic acid) (muyezo waukulu), estrogens ndi progestogens, phenothiazines, phenytoin, rifampicin, mahomoni okhala ndi chithokomiro.

    Blockers of H 2 histamine receptors, beta-blockers, clonidine ndi reserpine amatha onse kupititsa patsogolo ndi kufooketsa mphamvu ya hypoglycemic ya glimepiride. Mothandizidwa ndi othandizira achifundo, monga beta-blockers, clonidine, guanethidine ndi reserpine, zizindikiro za kutsutsa kwa adrenergic poyankha hypoglycemia zitha kuchepetsedwa kapena kulibe.

    Ngakhale mukumwa glimepiride, kuwonjezeka kapena kufooka kwa zochita za coumarin zitha kuonedwa.

    Kumwa mowa kamodzi kapena kosatha kumatha kukulitsa ndi kufooketsa mphamvu ya gloglycemic ya glimepiride.

    Bongo

    Zizindikiro: mankhwala osokoneza bongo, komanso chithandizo chambiri chotenga nthawi yayitali ya glimepiride, kumatha kubweretsa hypoglycemia yoopsa kwambiri.

    Chithandizo: mankhwala atapezeka kwambiri, muyenera kudziwitsa dokotala nthawi yomweyo. Hypoglycemia nthawi zambiri imatha kuyimitsidwa mwachangu ndi kudya kwakanthawi kwamatumbo (shuga kapena chidutswa cha shuga, msuzi wa zipatso kapena tiyi). Pankhaniyi, wodwalayo ayenera kukhala ndi shuga pafupifupi 20 g (zidutswa 4 za shuga). Zomakoma sizothandiza pochita hypoglycemia.

    Mpaka pomwe dokotala angaganize kuti wodwalayo ali pachiwopsezo, wodwalayo amafunika kuyang'aniridwa mosamala ndi madokotala. Tiyenera kukumbukira kuti hypoglycemia imatha kuyambiranso pambuyo poyambitsanso koyamba magazi a magazi.

    Wodwala yemwe akudwala matenda ashuga amathandizidwa ndi madotolo osiyanasiyana (mwachitsanzo, pakakhala kuchipatala pambuyo pangozi, atadwala kumapeto kwa sabata), ayenera kuwauza za matenda ake ndi chithandizo cham'mbuyomu.

    Nthawi zina kuchipatala wodwala angafunike, ngakhale pokhapokha ngati pakufunika kusamala. Kuchuluka kwa mankhwala osokoneza bongo kwambiri komanso kuwonetsa kozama monga kuwonongeka kwa chikumbumtima kapena vuto lina lalikulu la mitsempha ndizofunikira kuchipatala ndipo zimafunikira chithandizo chamankhwala ndi kuchipatala.

    Ngati wodwalayo sakudziŵa kanthu, jakisoni wamkati wokhazikika wa dextrose (glucose) ndikofunikira (kwa akulu, kuyambira 40 ml ya yankho la 20%). Ngati njira ina ya achikulire, mtsempha wa magazi, kulowerera kapena kutsekeka kwa glucagon ndikotheka, mwachitsanzo, pa mlingo wa 0.5-1 mg.

    Mankhwala a hypoglycemia chifukwa cha mwangozi a Amaril ndi ana kapena ana aang'ono, mlingo wa dextrose womwe umayendetsedwa uyenera kusinthidwa molingana ndi kuthekera koopsa kwa hyperglycemia, ndikuwongolera kwa dextrose kuyenera kuchitika pang'onopang'ono poyang'anira kuchuluka kwa shuga.

    Pankhani ya bongo wa Amaril, mwina pangafunike kutsuka m'mimba ndikuthanso makala.

    Pambuyo pobwezeretsa mwachangu kuchuluka kwa shuga m'magazi, kulowetsedwa kwamphamvu kwa dextrose yotsikira ndende yofunikira ndikupewa kuyambiranso kwa hypoglycemia. Kuchuluka kwa shuga m'magazi mwa odwala oterowo kuyenera kuyang'aniridwa pafupipafupi kwa maola 24. Muzochitika zazikulu kwambiri za hypoglycemia, chiopsezo chochepetsa kuchuluka kwa glucose m'magazi mpaka kuchuluka kwa hypoglycemic kumatha masiku angapo.

    Mlingo ndi makonzedwe

    Mkati, kwathunthu, popanda kutafuna, kutsuka ndi madzi okwanira (pafupifupi makapu 0,5).

    Monga lamulo, mlingo wa Amaril umatsimikiziridwa ndi kutsata kwa shuga m'magazi. Mlingo wotsika kwambiri wokwanira kukwaniritsa zoyenera za metabolic uyenera kugwiritsidwa ntchito.

    Pa mankhwala ndi Amaril, ndikofunikira kudziwa pafupipafupi kuchuluka kwa shuga m'magazi. Kuphatikiza apo, kuwunika pafupipafupi milingo ya hemoglobin ya glycosylated kumalimbikitsidwa.

    Kukhazikika kwa mankhwalawa.

    Zochita za wodwalayo pakafunika zolakwa mukamamwa mankhwalawo (makamaka, podumpha mlingo wotsatira kapena kudumpha chakudya) kapena pamikhalidwe yomwe sizingatheke kumwa mankhwalawo ayenera kukambirana ndi wodwalayo ndi adokotala pasadakhale.

    Koyamba mlingo ndi kusankha kwa mankhwala

    Mlingo woyambirira ndi 1 mg ya glimepiride 1 nthawi patsiku.

    Ngati ndi kotheka, tsiku lililonse mlingo ungakulidwe pang'onopang'ono (pakadutsa milungu iwiri). Ndikulimbikitsidwa kuti kuwonjezeka kwa mlingo kuchitidwa ndikuwonetsetsa kuchuluka kwa shuga m'magazi komanso mogwirizana ndi gawo lotsatira la kuchuluka kwa 1 mg - 2 mg - 3 mg - 4 mg - 6 mg (mg8 mg).

    Mlingo umakhala pakati pa odwala omwe ali ndi shuga wambiri

    Mwachizolowezi, tsiku lililonse odwala omwe ali ndi shuga yoyendetsedwa bwino amakhala ndi theka mg glimepiride. Mlingo wa tsiku ndi tsiku wopitilira 6 mg umagwira kwambiri mwa ochepa ochepa odwala.

    Nthawi yomwe mumamwa mankhwalawa ndikugawa zamankhwala tsiku lonse limatsimikiziridwa ndi dokotala, kutengera moyo wa wodwalayo panthawi yopatsidwa (nthawi yakudya, kuchuluka kwa zochitika zolimbitsa thupi).

    Nthawi zambiri, mlingo umodzi wa mankhwalawa masana ndi wokwanira. Ndikulimbikitsidwa kuti pankhaniyi, mlingo wonse wa mankhwalawo uyenera kumwedwa musanadye chakudya cham'mawa chokwanira, kapena ngati sichinatenge nthawi imeneyo, musanadye chakudya chachikulu choyamba. Ndikofunika kwambiri kuti musadumphe chakudya mutamwa mapiritsi.

    Popeza kuyendetsa bwino kagayidwe kachakudya kumalumikizidwa ndi kukhudzika kwa insulin, kufunika kwa glimepiride kumatha kuchepa panthawi ya chithandizo. Pofuna kupewa kukula kwa hypoglycemia, ndikofunikira kuchepetsa mlingo kapena kusiya kumwa Amaril.

    Momwe mankhwalawa a glimepiride angafunikire:

    Kuchepetsa thupi wodwala

    Zosintha paumoyo wa wodwalayo (kusintha kadyedwe, nthawi ya chakudya, kuchuluka kwa zochita zolimbitsa thupi),

    Kukula kwa zinthu zina zomwe zimatsogolera pakupanga chidwi cha hypoglycemia kapena hyperglycemia (onani gawo "Malangizo apadera").

    Chithandizo cha glimepiride nthawi zambiri chimachitika kwa nthawi yayitali.

    Kusamutsa wodwala kuchokera kwa wothandizira wina wa hypoglycemic wothandizira pakamwa kupita ku Amaryl

    Palibe ubale uliwonse pakati pa Mlingo wa Amaril ndi ena othandizira pakhungu. Wothandizira wina wa hypoglycemic pakakonzedwe kamlomo ndikusinthidwa ndi Amaril, tikulimbikitsidwa kuti njira yoyendetsera kayendetsedwe kake ndi chimodzimodzi ndi koyamba kwa Amaril, i.e. Mankhwalawa ayenera kuyamba ndi mlingo wochepa wa 1 mg (ngakhale wodwalayo atamupititsa ku Amaryl ndi muyeso wokwanira wa mankhwala ena a hypoglycemic pakumwa pakamwa). Kuchulukitsa kwa mlingo uliwonse kuyenera kuchitika m'magawo, kukumbukira kuyankha kwa glimepiride molingana ndi malangizo omwe ali pamwambawa.

    M'pofunika kuganizira mphamvu ndi kutalika kwa zotsatira za m'mbuyomu hypoglycemic wothandizira pakamwa. Kulowetsa chithandizo kungafunike kuti mupewe zovuta zilizonse zomwe zingapangitse chiopsezo cha hypoglycemia.

    Gwiritsani ntchito limodzi ndi metformin

    Odwala omwe ali ndi matenda osokoneza bongo omwe amawongolera osakwanira, akalandira mlingo waukulu wa glimepiride kapena metformin, mankhwalawa atha kuphatikizana ndi mankhwalawa. Pankhaniyi, chithandizo cham'mbuyomu chomwe chili ndi glimepiride kapena metformin chimapitilira mlingo womwewo, ndipo mlingo wowonjezera wa metformin kapena glimepiride umayamba ndi mlingo wochepa, womwe umasinthidwa kutengera mulingo woyenera wa metabolic mpaka muyeso wambiri watsiku ndi tsiku.Kuphatikiza mankhwala kuyenera kuyang'aniridwa ndi achipatala.

    Gwiritsani ntchito limodzi ndi insulin

    Odwala omwe ali ndi matenda osokoneza bongo omwe amawongolera osakwanira, insulin imatha kuperekedwa nthawi yomweyo mutatenga mlingo waukulu wa tsiku ndi tsiku wa glimepiride. Pankhaniyi, mlingo womaliza wa glimepiride woperekedwa kwa wodwala amakhalabe wosasinthika. Pankhaniyi, chithandizo cha insulin chimayamba ndi Mlingo wochepa, womwe umayamba kuwonjezeka mothandizidwa ndi shuga m'magazi. Chithandizo chophatikiza chimafunika kuyang'aniridwa mosamala ndi madokotala.

    Gwiritsani ntchito odwala omwe ali ndi impso. Pali chidziwitso chochepa pakugwiritsa ntchito mankhwalawa odwala omwe ali ndi vuto la aimpso. Odwala omwe ali ndi vuto la impso amatha kukhudzidwa kwambiri ndi hypoglycemic zotsatira za glimepiride (onani magawo "Pharmacokinetics", "Contraindication").

    Gwiritsani ntchito odwala omwe ali ndi vuto la chiwindi. Pali zambiri zochepa pakugwiritsa ntchito mankhwalawa chifukwa cha kulephera kwa chiwindi (onani gawo "Contraindication").

    Gwiritsani ntchito ana. Zambiri pa kugwiritsa ntchito mankhwalawa kwa ana sikokwanira.

    Malangizo apadera

    M'magawo apadera ovuta a nkhawa, monga kuvutika maganizo, chithandizo cha opaleshoni, matenda a febrile fever, metabolic control ikhoza kudwala kwambiri odwala matenda a shuga, ndipo angafunikire kusinthidwa kwakanthawi kuti alandire insulin kuti azitha kuyendetsa bwino metabolism.

    M'milungu yoyamba ya chithandizo, chiopsezo chokhala ndi hypoglycemia chitha kuchuluka, chifukwa chake, kuyang'anira kuchuluka kwa shuga m'magazi ndikofunikira pakadali pano.

    Zomwe zimayambitsa chiopsezo cha hypoglycemia zimaphatikizapo:

    Kusunthika kapena kulephera kwa wodwala (nthawi zambiri kumawonedwa mu odwala okalamba) kuti azithandizana ndi dokotala,

    Kuperewera kwa zakudya m'thupi, kudya mosazolowereka kapena kudya chakudya,

    Kukula pakati pa zolimbitsa thupi ndi chakudya chamafuta,

    Kumwa mowa, makamaka kuphatikiza ndi zakudya zodumphadumpha,

    Zowopsa za impso,

    Kuchepa kwa chiwindi kwa hepatic (odwala omwe ali ndi vuto lalikulu la chiwindi, kusinthika kwa mankhwala a insulin akuwonetsedwa, osachepera mpaka kupezeka kwa metabolic),

    Matenda ena ophatikizika a endocrine omwe amasokoneza kagayidwe kazakudya kapena kuphatikizika kwa adrenergic poyankha hypoglycemia (mwachitsanzo, chithokomiro china cha chithokomiro komanso cha anterior pituitary dysfunction, adrenal insufficiency

    Kugwiritsa ntchito mankhwala munthawi yomweyo (onani gawo "Kuyanjana"),

    Kulandila kwa glimepiride posakhala zizindikiro zakulandila kwake.

    Kuchiza ndi zotumphukira za sulfonylurea, zomwe zimaphatikizapo glimepiride, kungayambitse kukula kwa hemolytic anemia, chifukwa chake, odwala omwe ali ndi vuto la glucose-6-phosphate dehydrogenase ayenera kusamala makamaka pokhazikitsa glimepiride ndipo ndibwino kugwiritsa ntchito othandizira a hypoglycemic omwe siabwino.

    Pamaso pa zinthu zomwe zili pamwambazi, kukulitsa kwa hypoglycemia kungafune kusintha kwa glimepiride kapena chithandizo chonse. Izi zimagwiranso ntchito pakupezeka kwa matenda omwe amakumana nawo panthawi yamankhwala kapena kusintha kwa moyo wa odwala.

    Zizindikiro za hypoglycemia zomwe zimawonetsa kuwukira kwa thupi chifukwa cha hypoglycemia (onani gawo "Zotsatira zoyipa") zitha kukhala zofatsa kapena kusapezeka ndi kukula kwapang'onopang'ono kwa hypoglycemia, mwa odwala okalamba, odwala omwe ali ndi vuto la neuronomic, kapena odwala omwe amalandira beta -adrenoblockers, clonidine, reserpine, guanethidine ndi ena omvera achifundo.

    Hypoglycemia imatha kuthetsedwa mwachangu ndi kupezeka msanga kwa chakudya cham'mimba chambiri (glucose kapena sucrose).

    Monga momwe ena amachokera ku sulfonylurea, ngakhale atakwanitsa kupumula kwa hypoglycemia, hypoglycemia ikhoza kuyambiranso. Chifukwa chake, odwala ayenera kuyang'aniridwa mosalekeza.

    Mu hypoglycemia yayikulu, chithandizo chamankhwala ndi kuyang'aniridwa kwachipatala, ndipo nthawi zina, kugonekedwa kwa odwala kuchipatala kumafunikanso.

    Mankhwalawa glimepiride, kuwunika pafupipafupi kwa chiwindi ndi chithunzi cha magazi (makamaka kuchuluka kwa leukocytes ndi mapulateleti) kumafunika.

    Popeza zovuta zina, monga hypoglycemia, kusintha kwakukuru mu chithunzi cha magazi, zovuta zina za thupi, kulephera kwa chiwindi, pamikhalidwe inayake ikhoza kuwopseza moyo, ngati mukuchitika zosakhumudwitsa kapena zowopsa, wodwalayo ayenera kudziwitsa dokotala wopezekapo za iwo ndipo osatero Mulimonsemo, musapitilize kumwa mankhwalawo osalimbikitsa.

    Kukopa pa kuyendetsa magalimoto ndi njila zina. Pankhani ya kukula kwa hypoglycemia kapena hyperglycemia, makamaka kumayambiriro kwa mankhwalawa kapena kusintha kwa mankhwalawa, kapena mankhwalawa akapanda kumwa mankhwala pafupipafupi, kuchepa kwa chidwi ndi kuthamanga kwa zochitika zama psychomotor ndikotheka. Izi zitha kulepheretsa wodwala kuyendetsa magalimoto kapena njira zina.

    Wopanga

    Sanofi-Aventis Deutschland GmbH, Germany, yopangidwa ndi Sanofi-Aventis S.p.A. (Italy).

    Stabilimento di Scoppito, Strada Statale 17, km 22, I-67019 Scoppito (L "Aquilla), Italy.

    Amaryl ili ndi glimepiride, yomwe ndi ya m'badwo watsopano, wachitatu, wa sulfonylurea derivatives (PSM). Mankhwalawa ndiokwera mtengo kwambiri kuposa glibenclamide (Maninil) ndi glyclazide (Diabeteson), koma kusiyana kwa mtengo kumatsimikiziridwa ndi kukwera kwambiri, kuchitapo kanthu mwachangu, kuthana ndi kufinya, komanso chiopsezo chochepa cha hypoglycemia.

    Ndikofunikira kudziwa! Nkhani yatsopano yomwe ikulangizidwa ndi ma endocrinologists a Kuwunika Kwachisawawa Kokulu! Ndi zofunika tsiku lililonse.

    Ndi Amaril, maselo a beta amatsitsidwa pang'onopang'ono kuposa mibadwo yam'mbuyomu ya sulfonylureas, kotero kupititsa patsogolo kwa shuga kumachepetsedwa ndipo chithandizo cha insulin chidzafunika pambuyo pake.

    Ndemanga zomwe zimamwa mankhwalawa ndizabwino: Imatsika shuga bwino, ndi yosavuta kugwiritsa ntchito, kumwa mapiritsi kamodzi patsiku, mosasamala za mlingo. Kuphatikiza pa glimepiride koyera, kuphatikiza kwake ndi metformin kumapangidwa - Amaril M.

    Malangizo achidule

    MachitidweAmachepetsa shuga m'magazi, zomwe zimakhudza gawo lake mbali ziwiri:
    1. Imayendetsa kaphatikizidwe ka insulin, ndikubwezeretsa gawo loyambirira, mwachangu kwambiri lamasamba ake. PSM yotsalayi idalumpha gawo ili ndikugwirira ntchito yachiwiri, kotero shuga imachepetsedwa pang'onopang'ono.
    2. Imachepetsa kukana insulini mwachangu kuposa ena a PSM.

    Kuphatikiza apo, mankhwalawa amachepetsa chiopsezo cha thrombosis, amatulutsa cholesterol, komanso amachepetsa kupsinjika kwa oxidative.

    Amaryl amachotsedwamo pang'ono mkodzo, pang'ono kudzera m'matumbo, motero angagwiritsidwe ntchito mwa odwala omwe amalephera kupweteka kwa impso, ngati impsoyo yasungidwa pang'ono.

    ZizindikiroMatenda a shuga okha mitundu iwiri. Njira yofunikira yogwiritsira ntchito maselo a beta osungidwa pang'ono, omwe ali ndi zotsalira za insulin yawo. Ngati kapamba asiya kutulutsa mahomoni, Amaril sanalembedwe. Malinga ndi malangizo, mankhwalawa amatha kumwa ndi metformin ndi insulin. Mlingo

    Amaryl amapangidwa mu mawonekedwe a mapiritsi okhala mpaka 4 mg ya glimepiride. Kuti mugwiritse ntchito mosavuta, mulingo uliwonse umakhala ndi mtundu wake.

    Mlingo woyambira ndi 1 mg. Amawatenga kwa masiku 10, pambuyo pake amayamba kukula pang'onopang'ono mpaka shuga atasintha. Mlingo wololedwa wambiri ndi 6 mg.Ngati sichikuperekera chiphuphu kwa anthu odwala matenda ashuga, mankhwala ochokera m'magulu ena kapena insulin amawonjezeredwa ku regimen yothandizira.

    BongoKuchulukitsa mlingo wambiri kumabweretsa hypoglycemia wa nthawi yayitali. Pambuyo matenda a shuga, amatha kubwereza masiku ena atatu. Nthawi yonseyi, wodwalayo amayenera kuyang'aniridwa ndi abale, omwe ali ndi mankhwala osokoneza bongo ambiri - kuchipatala.Contraindication

    1. Hypersensitivity zimachitika glimepiride ndi zina PSM, othandizira zigawo zikuluzikulu za mankhwalawa.
    2. Kuperewera kwa insulin (, pancreatic resection).
    3. Kulephera kwakukulu kwaimpso. Kuthekera kotenga Amaril ku matenda a impso kumatsimikizika pambuyo pakupenda chiwalo.
    4. Glimepiride imapangidwa mu chiwindi, motero, kulephera kwa chiwindi kumaphatikizidwanso m'malangizo monga contraindication.

    Amaryl imayimitsidwa kwakanthawi ndikusinthidwa ndi jakisoni wa insulin panthawi yapakati komanso mkaka wa m`mawere, zovuta za matenda ashuga, kuyambira ketoacidosis mpaka kukomoka kwa hyperglycemic. Ndi matenda opatsirana, kuvulala, kuchuluka kwambiri m'maganizo, Amaril mwina sangakhale okwanira kuteteza shuga, chifukwa chake mankhwalawa amathandizidwa ndi insulin, nthawi yayitali.

    Kuopsa kwa hypoglycemia

    Mwazi wamagazi umatsika ngati wodwala matenda ashuwalawo adayiwala kudya kapena sanabwezeretse shuga yemwe adagwiritsa ntchito masewera olimbitsa thupi. Kuti matenda achulukane glycemia, muyenera kudya chakudya chambiri, nthawi zambiri chidutswa cha shuga, kapu yamadzi kapena tiyi wokoma ndi wokwanira.

    Ngati kuchuluka kwa Amaril kwadutsa, hypoglycemia ikhoza kubwereza kangapo panthawi yamankhwala. Pankhaniyi, shuga atayamba kukula, amayesa kuchotsa glimepiride m'mimba: amayamba kusanza, kumwa adsorbents kapena mankhwala otupa. Mankhwala osokoneza bongo oopsa amapha; chithandizo cha hypoglycemia chimaphatikizira glucose yovomerezeka.

    Zotsatira zoyipaKuphatikiza pa hypoglycemia, mukamamwa Amaril, mavuto ammimbayo amatha kuyang'aniridwa (osakwana 1% ya odwala), chifuwa, kuyambira pakupanda mkamwa mpaka kuyabwa mpaka phokoso la anaphylactic (8%). Pambuyo p kulipirira matendawa, kufunika kwa mankhwala a hypoglycemic kumachepa, ndipo Amaryl imathetsedwa.

    Mankhwala amatengedwa ndi chakudya. . Mapiritsiwa sangaphwanyidwe, koma amatha kugawidwa pakati pangozi. Chithandizo cha Amaril chimafuna kukonza kwa zakudya:

    Matenda a shuga ndi kupsinjika kudzakhala chinthu chakale

    Matenda a shuga ndi omwe amayambitsa pafupifupi 80% yonse yamikwingwirima ndi kuduladula. Anthu 7 mwa anthu 10 amafa chifukwa cha mitsempha ya mtima kapena ubongo. Pafupifupi nthawi zonse, chifukwa chomaliza chomaliza ndi chimodzimodzi - shuga wamwazi.

    Shuga akhoza ndipo ayenera kugwetsedwa; Koma izi sizichiritsa matendawa, koma zimangothandiza kulimbana ndi kufufuza, osati zomwe zimayambitsa matendawa.

    Mankhwala okhawo omwe amalimbikitsidwa moyenera pochiza matenda ashuga komanso amagwiritsidwa ntchito ndi ma endocrinologists pantchito yawo ndi awa.

    Kugwiritsa ntchito bwino kwa mankhwalawa, kuwerengera malinga ndi njira yokhazikika (kuchuluka kwa odwala omwe achiwonjezere kuchuluka kwa odwala omwe ali mgulu la anthu 100 omwe adachitiridwa chithandizo):

    • Matenda a shuga - 95%
    • Kuthetsa kwa mitsempha thrombosis - 70%
    • Kuthetsa kwa kugunda kwamtima kwamphamvu - 90%
    • Kuthana ndi kuthamanga kwa magazi - 92%
    • Kulimbitsa tsiku, kukonza kugona usiku - 97%

    Opanga si bungwe lazamalonda ndipo amalipidwa ndi chithandizo cha boma. Chifukwa chake, tsopano wokhala aliyense ali ndi mwayi.

    • Chakudya chomwe amamwa mapiritsi chizikhala chambiri,
    • Palibe chifukwa choti mulumphe chakudya. Ngati simungakhale ndi chakudya cham'mawa, kulandiridwa kwa Amaril kumasulidwa ku nkhomaliro,
    • ndikofunikira kupanga yunifolomu yama protein m'magazi. Cholinga ichi chimakwaniritsidwa ndikudya pafupipafupi (pambuyo maola 4), kugawa kwamoto m'mbale zonse. Kutsika zakudya, kumakhala kosavuta kuti zitheke.

    Amaril aledzera zaka zambiri osapuma.Ngati mulingo wambiri wachepetsa shuga, muyenera kusintha mankhwalawo ku insulin.

    Nthawi yogwira

    Amaryl ali ndi bioavailability kwathunthu, 100% ya mankhwalawo imafika pamalo ochitapo kanthu. Malinga ndi malangizo, kuchuluka kwa glimepiride m'magazi kumapangidwa pambuyo maola 2,5. Kutalika kokwanira kwa zochita kumapitilira maola 24, kukwera kwakukulu, mapiritsi a Amaril otalikirawo adzagwira ntchito.

    Chifukwa cha nthawi yayitali, mankhwalawa amaloledwa kumwa kamodzi patsiku. Popeza kuti 60% ya anthu odwala matenda ashuga samatsata malangizo a dokotala, kumwa kamodzi kungathandize kuchepetsa kusowa kwa mankhwalawa ndi 30%, motero kusintha njira ya matenda ashuga.

    Kuyenderana ndi mowa

    Zakumwa zoledzeretsa zimakhudza Amaryl mosasamala, zimatha kuwonjezera ndikuchepetsa mphamvu yake. Chiwopsezo cha hypoglycemia yoika moyo pangozi imachuluka, kuyambira ndi kuledzera pang'ono. Malinga ndi odwala matenda ashuga, kumwa mowa mwauchidakwa ndi osaposa kapu ya vodika kapena kapu ya vinyo .

    Zofananira za Amaril

    Mankhwalawa ali ndi mitundu ingapo yotsika mtengo yofanana ndi yogwiritsira ntchito komanso Mlingo, wotchedwa ma generics. Kwenikweni, awa ndi magome a zokolola zapakhomo, kuchokera kwa omwe angogulitsidwe komwe mungagule Korona Glimepirid-Teva yokha ya ku Croatia. Malinga ndi ndemanga, analogi za ku Russia sizili zoyipa kuposa momwe Amaril amatengera kunja.

    Zofananira za Amaril Dziko lopanga Wopanga Mtengo wazochepa mlingo.
    GlimepirideRussia110
    Glimepiride CanonKupanga kwa Canonfarm.155
    DiameridAkrikhin180
    Glimepiride-tevaCroatiaPliva wa Khrvatsk135
    GlemazArgentinaKimika Montpelliersapezeka m'mafakisi

    Amaryl kapena Diabeteson

    Pakadali pano, PSM yamakono komanso yotetezeka kwambiri ndi glimepiride ndi mtundu wa gliclazide wautali (ndi analogues). Mankhwalawa onse ndi ocheperako kuposa omwe amapangira omwe angayambitse hypoglycemia.

    Komabe, mapiritsi a Amaryl a shuga ndi abwino:

    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 wapanga kukhazikitsidwa komwe kumalipirira mtengo wokwera wa mankhwalawo. Ku Russia, odwala matenda ashuga mpaka Marichi 2 nditha kuipeza - Kwa ma ruble 147 okha!

    • zimakhudza kulemera kwa odwala ochepa
    • zoyipa zam'mtima sizimatchulidwa,
    • odwala matenda ashuga amafuna kuchuluka kwa mankhwalawa (mulingo wambiri wa odwala matenda ashuga pafupifupi 3 mg wa Amaril),
    • kutsika kwa shuga mukamamwa Amaril kumayendetsedwa ndi kuchepa kwapansi pa misulin. Kwa Diabeteson, chiwerengerochi ndi 0.07, cha Amaril - 0.03. Mu PSM yotsalira, chiwonjezerochi chimakhala choyipa: 0.11 cha glipizide, 0,16 kwa glibenclamide.

    Amaryl kapena Glucophage

    Kunena zowona, funso Amaril kapena Glucofage (metformin) siliyenera kuyankhidwa ngakhale. ndipo mawonekedwe ake a shuga 2 amalembedwa nthawi zonse koyamba, popeza amagwira bwino kwambiri kuposa mankhwala ena pazomwe zimayambitsa matenda - kukana insulin. Ngati dokotala amalembera mapiritsi a Amaryl okha, luso lake ndilokayikira .

    Ngakhale kuphatikiza chitetezo, mankhwalawa amakhudza mwachindunji kapamba, zomwe zikutanthauza kuti amafupikitsa kapangidwe ka insulin yanu. PSM imayikidwa pokhapokha ngati metformin singalekerere bwino kapena kuchuluka kwake sikokwanira kwa glycemia wabwinobwino. Monga lamulo, izi mwina zimatha kubwezera kwambiri matenda ashuga, kapena matenda okhalitsa.

    Amaril ndi Yanumet

    Yanumet, monga Amaryl, imakhudza magulu onse a insulin komanso kukana insulini.Mankhwala osokoneza bongo amasiyana mu kagwiritsidwe kake ndi kapangidwe ka mankhwala, motero amatha kutengedwa limodzi. Yanumet ndimankhwala atsopano, motero amafunika kuchokera ku ma ruble 1800. ya paketi yaying'ono kwambiri. Ku Russia, mayendedwe ake adalembetsa: Combogliz ndi Velmetia, omwe siotsika mtengo kuposa oyambira.

    Nthawi zambiri, chiphuphu cha shuga chimatha kupezeka ndi kuphatikiza kwa metformin yotsika mtengo, zakudya, masewera olimbitsa thupi, nthawi zina odwala amafunikira PSM. Yanumet ndiyofunika kugula pokhapokha ngati mtengo wake ulibe phindu ku bajeti.

    Kusagwirizana ndi anthu odwala matenda ashuga ndi mankhwala okhazikika ndiye chifukwa chachikulu. Kusintha kwa njira yochizira matenda ena aliwonse kumadwalitsa nthawi zonse zotsatira zake, chifukwa chake, mwa kusankha kwa odwala, mankhwala osakanikirana ndi omwe amakonda. Amaryl M ali ndi kuphatikiza komwe kumagwiritsidwa ntchito kwambiri pamankhwala ochepetsa shuga: metformin ndi PSM. Piritsi lililonse lili ndi 500 mg ya metformin ndi 2 mg ya glimepiride.

    Ndikosatheka kulondola ndendende zonse zomwe zili ndi piritsi limodzi la odwala osiyanasiyana. Pakati gawo la shuga, metformin yambiri, glimepiride yocheperako imafunikira. Palibe oposa 1000 mg a metformin omwe amaloledwa pa nthawi, odwala omwe ali ndi vuto lalikulu ayenera kumwa Amaril M katatu patsiku. Kusankha mlingo weniweni, ndikofunikira kuti odwala omwe alangidwa azitenga Amaril padera pakudya cham'mawa komanso Glucofage katatu patsiku.

    Chifukwa cha mtengo wotsika wa Amaril, ma analogu amagwiritsidwa ntchito nthawi zambiri kuphatikiza shuga m'magazi a matenda ashuga omwe ali ndi matenda odziyimira pawokha. Mankhwalawa ndi abwino kuti azikhala ndi glycemia wokhala ndi zakudya zapadera komanso masewera.

    Komabe, si aliyense amene angakwanitse kugula wothandizirana ndi hypoglycemic. Chifukwa chake, munkhaniyi, pharmacological zochita za Amaril zidzaululidwa ndipo mawonekedwe ake apamwamba opangidwa ku Russia adzatchulidwa.

    Pharmacological zochita za mankhwala

    Amaryl ndi mankhwala amkamwa a hypoglycemic omwe amathandiza kutsitsa shuga wamagazi polimbikitsa kumasulidwa ndi kutsegulira kwa insulin kapangidwe ndi maselo a beta enieni omwe amapezeka m'matumbo a pancreatic.

    Njira yayikulu yolimbikitsira kaphatikizidwe ndikuti Amaril imakulitsa kuyankha kwa maselo a beta kuti chiwonjezere kuchuluka kwa shuga m'magazi a anthu.

    Mlingo wocheperako, mankhwalawa amathandizira kuwonjezeka pang'ono kwa insulin. Amaryl ali ndi katundu wowonjezera chidwi cha insulin-yotengera minofu yamitsempha yama cell kupita ku insulin.

    Pokhala chotumphuka cha sulfonylurea, Amaril amatha kusokoneza ntchito yopanga insulin. Izi zimatsimikiziridwa ndikuti gawo lomwe limagwiritsa ntchito mankhwalawa limalumikizana ndi njira za ATP zama cell a beta. Amaryl imamangiriza mapuloteni pamwamba pa membrane wa cell kusankha. Katunduyu wa mankhwala amalola kuwonjezera kukhudzidwa kwa maselo am'mimba kuti apange insulin.

    Glucose owonjezereka amalowetsedwa makamaka ndi ma cell a minofu minofu ya thupi.

    Kuphatikiza apo, kugwiritsa ntchito mankhwalawa kumalepheretsa kupezeka kwa glucose ndi maselo a chiwindi. Izi zimachitika chifukwa cha kuwonjezeka kwa zomwe zili ndi fructose-2,6-biophosphate, zomwe zimapangitsa kuti gluconeogeneis aletse.

    Kukhazikitsa kwa insulin kaphatikizidwe kumachitika chifukwa chakuti yogwira mankhwala imathandizira kuchuluka kwa potaziyamu ion m'magazi a beta, komanso kuchuluka kwa potaziyamu kwambiri mu cell kumapangitsa kuti mahomoni azigwiritsa ntchito kwambiri.

    Mukamagwiritsa ntchito mankhwala othandizira osakanikirana ndi metformin, odwala amakhala ndi kusintha kwa kagayidwe kazakudya ka minyewa ya shuga mthupi.

    Kuchita mankhwala ophatikizira limodzi ndi jakisoni wa insulin. Njira yolamulirayi imagwiritsidwa ntchito pokhapokha ngati mulingo woyenera wa metabolic usachitike mukamamwa mankhwala amodzi.Popanga mankhwala amtunduwu a matenda a shuga, muyenera kusintha njira ya insulin.

    Kuchuluka kwa insulin yomwe imagwiritsidwa ntchito pamtunduwu wa mankhwala kumachepetsedwa kwambiri.

    Pharmacokinetics wa mankhwala

    Ndi muyezo umodzi wa mankhwalawa tsiku lililonse la 4 mg, kuchuluka kwake kumawonekera pambuyo maola 2,5 ndikufika 309 ng / ml. The bioavailability wa mankhwalawa 100%. Kudya sikunakhudze mayendedwe a mayamwidwe, kupatula kuchepa pang'ono kwakanthawi.

    Chithandizo chogwira ntchito cha mankhwala chimadziwika ndi kuthekera kwa kulowa mkaka wa m'mawere kudzera mwa chotchinga chachikulu. Zomwe zimachepetsa mwayi wogwiritsa ntchito mankhwalawa panthawi yoyembekezera komanso yoyamwitsa.

    Kagayidwe kake kogwira ntchito komweko kamachitika m'matumbo a chiwindi. Isoenzyme yayikulu yomwe imakhudzidwa ndi metabolism ndi CYP2C9. Pa kagayidwe kazinthu zazikulu zomwe zimagwira ntchito, ma metabolites awiri amapangidwa, omwe pambuyo pake amawatulutsa ndowe ndi mkodzo.

    Kutupa kwa mankhwalawa kumachitika ndi impso mu 58% ndipo pafupifupi 35% mothandizidwa ndi matumbo. Zomwe zimagwiritsidwa ntchito ndi mankhwala mu mkodzo sizimadziwika kuti sizisintha.

    Malinga ndi zotsatira za kafukufukuyu, zidapezeka kuti pharmacokinetics sizimatengera jenda la wodwalayo komanso msinkhu wake.

    Ngati wodwala walephera kugwira ntchito kwa impso ndi chimbudzi, wodwala amakhala ndi chiwonetsero cha glimepiride ndi kuchepa kwakachepa kwa ndende ya magazi, komwe kumachitika chifukwa chothamangitsa mankhwalawa chifukwa chotsitsa chomanga ma protein

    Zotsatira za mankhwala

    Amaryl amadziwika kuti ndi wachitatu m'badwo wa sulfonylurea. Mayiko omwe akutulutsa mankhwalawa ndi Germany ndi Italy. Mankhwala amapangidwa piritsi la 1, 2, 3 kapena 4 mg. Piritsi limodzi la Amaril lili ndi chigawo chachikulu - glimepiride ndi zina zotulutsa.

    Zotsatira za glimepiride makamaka zimachepetsa shuga wamagazi polimbikitsa kupanga insulin ndi maselo a beta. Kuphatikiza apo, chinthu chogwira ntchito chimakhala ndi insulinomimetic ndipo chimawonjezera chidwi cha zolandilira maselo ndi mahomoni ochepetsa shuga.

    Wodwala akamamwa Amaryl, kuchuluka kwambiri kwa glimepiride kumachitika pambuyo pa maola 2,5. Mankhwalawa amatha kumwa mosaganizira nthawi yakudya. Komabe, kudya pang'ono kumakhudza ntchito ya glimepiride. Kwenikweni, mbali imeneyi imachotsedwa m'thupi kudzera m'matumbo ndi impso.

    Dokotala wothandizirawa amapatsa mapiritsi a Amaril kwa odwala omwe ali ndi matenda a shuga a 2 monga monotherapy kapena akaphatikizidwa ndi othandizira a hypoglycemic.

    Komabe, kumwa mankhwalawa sikulepheretsa kupitiriza kudya zakudya zoyenera, zomwe zimapatula mafuta am'mimba komanso chakudya chamagetsi, komanso moyo wokangalika.

    Malangizo ogwiritsira ntchito mankhwalawa

    Simungagule mankhwala popanda kuuzidwa ndi dokotala. Musanagwiritse ntchito mankhwalawa, muyenera kupita kwa dokotala ndikumufunsa mafunso anu onse. Ndi iye omwe angadziwe kuchuluka kwa mankhwalawa ndikuwapatsa mtundu wa mankhwala malinga ndi kuchuluka kwa shuga.

    Mapiritsi a Amaryl amatengedwa pakamwa, popanda kutafuna, ndikutsukidwa ndi madzi okwanira. Ngati wodwalayo adayiwala kumwa mankhwalawo, kuonjezera kuchuluka kwa mankhwalawo ndizoletsedwa. Pa chithandizo, muyenera kuyang'ana kuchuluka kwa shuga, komanso kuchuluka kwa hemoglobin ya glycosylated.

    Poyamba, wodwalayo amatenga muyezo umodzi wa 1 mg patsiku. Pang'onopang'ono, pakadutsa sabata limodzi kapena awiri, mlingo wa mankhwalawa ukhoza kuwonjezeka ndi 1 mg. Mwachitsanzo, 1 mg, kenako 2 mg, 3 mg, ndi zina mpaka 8 mg tsiku lililonse.

    Anthu odwala matenda ashuga omwe ali ndi vuto labwino la glycemic amatenga mlingo wofikira 4 mg.

    Nthawi zambiri, mankhwalawa amatengedwa kamodzi musanadye chakudya cham'mawa kapena, ngati mungadumphe kugwiritsa ntchito mapiritsi, musanadye chakudya chachikulu. Potere, katswiriyu ayenera kuganizira za moyo wa anthu odwala matenda ashuga, nthawi yakudya komanso zochita zake zolimbitsa thupi. Kusintha kwa mankhwalawa kungafunike ngati:

    1. kuchepetsa thupi
    2. kusintha kwa zizolowezi zanu (zakudya, kupsinjika, nthawi yakudya),
    3. zinthu zina.

    Ndikofunikira kufunsa dokotala ndikuyamba ndi mlingo wochepa (1 mg) wa Amaril ngati wodwala akufunika:

    • kusintha kwa mankhwala ena ochepetsa shuga ndi Amaril,
    • kuphatikiza kwa glimepiride ndi metformin,
    • kuphatikiza ndi glimepiride ndi insulin.

    Sibwino kumwa mankhwala kwa odwala omwe ali ndi vuto la impso, komanso kulephera kwa impso komanso / kapena chiwindi.

    Contraindication ndi zoyipa zosiyanasiyana

    Amaril glimepiride yomwe ili mu mankhwalawo, komanso zowonjezera zina, sizimakhudza thupi la odwala matenda ashuga.

    Komanso njira zina, mankhwalawa ali ndi contraindication.

    Ndi zoletsedwa kwa odwala kumwa mapiritsi awa:

    • mtundu wodwala wa shuga
    • nthawi ya bere ndi kuyamwitsa,
    • (kuphwanya zakudya kagayidwe kachakudya matenda)
    • odwala ochepera zaka 18,
    • galactose tsankho, lactase akusowa,
    • kukula kwa shuga-galactose malabsorption,
    • kuphwanya chiwindi ndi impso, makamaka odwala omwe akudwala hemodialysis,
    • munthu tsankho kwa zomwe zili mankhwala, sulfonylurea zotumphukira, sulfonamide wothandizila.

    Malangizo omwe aphatikizidwa akuti m'masabata oyamba omwe amathandizira, Amaryl ayenera kumwedwa mosamala kuti apewe kukula kwa chikhalidwe cha hypoglycemic. Kuphatikiza apo, vuto la malabsorption lazakudya ndi mankhwala osokoneza bongo, kuperewera kwa glucose-6-phosphate dehydrogenase, matenda oyanjana, komanso pamaso pa chiwopsezo chokhala ndi boma la hypoglycemic, Amaryl imagwiritsidwa ntchito mosamala.

    Ndi kugwiritsidwa ntchito molakwika kwa mapiritsi (mwachitsanzo, kudumphira m'magulu), zimayambitsa zovuta zazikulu:

    1. Mkhalidwe wa Hypoglycemic, zizindikiro zomwe zimakhala ndi mutu komanso chizungulire, kusokonezeka kwa chidwi, kukwiya, chisokonezo, kugona, kukomoka, kunjenjemera, kukokana, komanso kuwona kwamaso.
    2. Kuphatikiza kwa adrenergic ngati yankho la kuchepa msanga kwa shuga, kuwonetseredwa ndi nkhawa, palpitations, tachycardia, kusokonezeka kwa phokoso la mtima komanso kuwoneka thukuta lozizira.
    3. Matenda am'mimba - kupsinjika, kusanza, kupweteka kwam'mimba, kutsekula m'mimba, chitukuko cha chiwindi, kuchuluka kwa michere ya chiwindi, jaundice kapena cholestasis.
    4. Kuphwanya hematopoietic dongosolo - leukopenia, thrombocytopenia, granulocytopenia ndi zina zina matenda.
    5. Ziwengo, owonetsedwa ndi zotupa pakhungu, kuyabwa, ming'oma, nthawi zina kuwopsa kwa anaphylactic ndi vasculitis.

    Zina zomwe zimachitika ndizothekanso - photosensitization ndi hyponatremia.

    Mtengo, ndemanga ndi fanizo

    Mtengo wa mankhwala Amaryl mwachindunji zimatengera mtundu wa kumasulidwa kwake. Popeza mankhwalawo amalowetsedwa kunja, motero, mtengo wake ndi wokwera kwambiri. Mitengo yamapiritsi a Amaryl ndi awa.

    • 1 mg 30 mapiritsi - 370 rub.,
    • Mapiritsi a 2 mg 30 - ma ruble 775.,
    • 3 mg 30 mapiritsi - 1098 rub.,
    • 4 mg 30 mapiritsi - 1540 rub.,

    Pankhani ya odwala matenda ashuga za momwe mankhwalawo alili, ali ndi chiyembekezo. Ndi kugwiritsa ntchito mankhwalawa kwa nthawi yayitali, shuga m'magazi amabwerera mwakale. Ngakhale mndandandandawo uli ndi zotsatira zoyipa zomwe zingachitike, kuchuluka kwake kumakhala kochepa kwambiri. Komabe, pali ndemanga zoyipa za odwala omwe amagwirizana ndi mtengo wokwera wa mankhwalawo.Ambiri aiwo amayenera kuyang'ana m'malo mwa Amaril.

    Piritsi limodzi la mankhwalawa limaphatikizanso ntchito - glimepiride - 1-4 mg ndi zigawo zothandizira: lactose monohydrate, povidone, sodium carboxymethyl starch, microcrystalline cellulose, indigo carmine ndi magnesium stearate.

    Kutulutsa Fomu

    Amaryl amapangidwa m'mapiritsi okhala ndi 1-4 mg, omwe amawaika mu 15 zidutswa pachimake. Paketi imodzi ya mankhwalawa imatha kuphatikizira matuza 2, 4, 6 kapena 8.

    Zotsatira za pharmacological

    Mapiritsi a Amaryl ali ndi vuto la hypoglycemic.

    Pharmacodynamics ndi pharmacokinetics

    Contraindication

    Pali mndandanda waukulu wotsutsana ndi Amaril:

    • Mtundu 1
    • kuphwanya kwambiri chiwindi ndi impso,
    • matenda ashuga ketoacidosis, precoma ndi chikomokere,
    • , ,
    • kupezeka kwa matenda obadwa nawo monga makolo, galactose tsankho, shuga-galactose malabsorption kapena kuchepa kwa lactase,
    • zaka za ana
    • kusalolera kapena chidwi ndi mankhwalawo ndi zina zotero.

    Chenjezo limafunikira poyambira chithandizo cha odwala, popeza panthawiyi pamakhala chiopsezo cha hypoglycemia. Ngati mwayi wopeza hypoglycemia ulimbikire, ndiye kuti muyenera kusintha kamwedwe kake glimepiride kapena mankhwala othandizira. Kuphatikiza apo, kukhalapo kwa matenda wamba komanso matenda ena, moyo, thanzi ndi zina zambiri kumafunikira chisamaliro chapadera.

    Zotsatira zoyipa

    Mankhwalawa Amaril akamagwiritsidwa ntchito mosiyanasiyana, zimachitika zosiyanasiyana. Nthawi zambiri, zoyipa zimawonetsedwa ndi hypoglycemia, zomwe zimasonyezedwa: nseru, kusanza,,,, ndi zizindikiro zina zambiri. Nthawi zina chithunzi choopsa cha hypoglycemia chimafanana ndi stroke. Pambuyo pakutha kwake, zizindikiro zosafunikira zimasonekanso kwathunthu.

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

    Malangizo a Amaryl (Njira ndi Mlingo)

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

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

    Malangizo ogwiritsira ntchito Amaril amadziwikanso kuti pa chithandizo, kutsimikiza kwa kukhazikika kwa magazi m'magazi komanso kuchuluka kwa hemoglobin ya glycosylated kumafunika.

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

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

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

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

    Amadziwika kuti kuwongolera kagayidwe kazakudya kumakhudzana ndikuwonjezera chidwi cha insulin, ndipo panthawi ya chithandizo, kufunika glimepiride ikhoza kukana.Hypoglycemia imatha kupewedwa ndi kuchepetsedwa kwa Mlingo kapena kusiya Amaril.

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

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

    Monga lamulo, chithandizo cha Amaril chikuchitika kwa nthawi yayitali.

    Bongo

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

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

    Kuchita

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

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

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

    Malonda ogulitsa

    Mankhwala, mankhwala amaperekedwa ndi mankhwala.

    Ndemanga za Amaril

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

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

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

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