Baeta Long - malangizo a boma kuti agwiritse ntchito

Ndi yankho la subcutaneous management. Mu syringe cholembera imatha kukhala 1.2 kapena 2.4 ml ya yogwira ntchito. Phukusili limakhala ndi cholembera chimodzi.

Zomwe akuphatikizidwazo zikuphatikiza:

• exenatide - 250 mcg,
• sodium acetate thunthu,
• glacial acetic acid,
• mannitol
• metacresol
• madzi a jakisoni.

"Baeta Long" ndi ufa wokonzekera kuyimitsidwa, wogulitsidwa wathunthu ndi zosungunulira. Mtengo wa mankhwalawa ndiwokwera kwambiri, umagwiritsidwa ntchito nthawi zambiri. Imaperekedwa pokhapokha.

Zotsatira za pharmacological

Ili ndi vuto la hypoglycemic. Kwambiri bwino magazi kuwongolera shuga, kutsegula ntchito ya pancreatic beta maselo, kukakamiza katulutsidwe katemera wa glucagon, timapitiriza shuga-wodalira insulin katulutsidwe ndipo amachepetsa m'matumbo kutulutsa.

Exenatide ndi yosiyana pakapangidwe ka insulin, sulfonylurea ndi zinthu zina, chifukwa chake sichingakhale cholowa m'malo chamankhwala.

Odwala omwe amamwa mankhwala a Bayeta amachepetsa kudya, amasiya kulemera, komanso amakhala bwino.

Pharmacokinetics

Iwo odzipereka mwachangu, pazotheka ambiri - pambuyo 2 maola. Zotsatira zake sizimadalira malo a jakisoni. Zimapukusidwa m'matumbo am'mimba, kapamba. Imafufutidwa ndi impso patatha maola 10.

Type 2 shuga mellitus, ndipo amagwiritsidwa ntchito ngati monotherapy komanso kuphatikiza mankhwala ena a hypoglycemic.

Contraindication

• Hypersensitivity pamagawo ake,
• Matenda owopsa am'mimba ndipo ali ndi concomitant gastroparesis,
• Mbiri ya matenda ashuga a ketoacidosis,
• Kulephera kwakukulu kwaimpso,
• Mtundu woyamba wa shuga
• Mimba komanso kuyamwa
• Age ali ndi zaka 18.

Malangizo ogwiritsira ntchito (njira ndi Mlingo)

Mankhwalawa amaperekedwa mwachangu pamimba, m'mapewa, m'chiuno kapena matako. Tsamba la jakisoni liyenera kusinthidwa pafupipafupi. Yambani ndi mlingo wa 5 mcg kawiri tsiku lililonse musanadye. Mutha kuonjezera mlingo mpaka 10 mcg kawiri pa tsiku pambuyo pa masabata anayi, ngati akuwonetsedwa. Ndi mankhwala ophatikiza, kusintha kwa sulfonylurea ndi zotumphukira kwa insulin kungafunike.

Fomu ya Mlingo:

Seti imodzi ili ndi (munthawi imodzi):
Mphamvu:
Chithandizo: exenatide 2.0 mg
Othandizira: polymer 50:50 DL 4AP (Copoly-D, L-lactide-glycolide) 37.2 mg, sucrose 0,8 mg Solvent:
Carmellose sodium 19 mg (kuchuluka kungasinthe kuti mukwaniritse mawonekedwe a) 63 g

Khola limodzi la syringe limakhala ndi (mu kipimo chimodzi):
Mphamvu:
Chithandizo: exenatide 2.0 mg
Othandizira: polymer 50:50 DL 4AP (Copoly-D, L-lactide-glycolide) 37.2 mg, sucrose 0,8 mg Solvent:
Carmellose sodium 19 mg (kuchuluka kungasinthe kuti mukwaniritse mawonekedwe a) , 36 mg, madzi a jekeseni 604 mg

Mankhwala

Kudalira kwa gluense kumathandizira chinsinsi cha insulin ndi maselo a beta a kapamba. Ndi kuchepa kwa kuchuluka kwa shuga m'magazi, kuchepa kwa insulin katulutsidwe kumachitika. Potengera momwe exenatide idagwiritsidwira ntchito limodzi ndi metformin ndi / kapena thiazolidinedione, ma pafupipafupi a ma epogopi a hypoglycemia sanadutse pafupipafupi mawonekedwe omwe amapezeka mu gulu la placebo omwe ali ndi metformin ndi / kapena thiazolidinedione, omwe atha kukhala chifukwa cha magwiritsidwe a glucose-insulinotropic mechanism of action (onani gawo "Maupangiri apadera" ").

Exenatide imalepheretsa kubisika kwa glucagon, ndende yomwe imadziwika kuti imachulukirachulukira odwala omwe ali ndi matenda a shuga 2 a mellitus (T2DM). Kutsika kwa kuchuluka kwa glucagon m'magazi kumapangitsa kutsika kwa glucose kumasulidwa ndi chiwindi. Exenatide sichimasokoneza chitetezo chabwinobwino cha glucagon ndi mahomoni ena poyankha kuchepa kwa ndende yamagazi. Exenatide amachepetsa njira yotulutsa m'mimba, potero amachepetsa kuchuluka kwa glucose kuchokera ku chakudya kulowa m'magazi.

Exenatide adawonetsedwa kuti achepetse kuchuluka kwa zakudya zomwe zimadyedwa chifukwa chakuchepa kwa kudya komanso kuchuluka kwa satiety.

Zotsatira za Pharmacodynamic
Exenatide imathandizira kuwongolera kwa glycemic chifukwa kuchepa kwakanthawi kwa glucose wa posterandial komanso kuthamanga kwa glucose wamagazi mwa odwala omwe ali ndi matenda a shuga a 2. Mosiyana ndi endo native GLP-1, mbiri ya pharmacokinetic ndi pharmacodynamic ya Bayeta Long imapereka mwayi wogwiritsidwa ntchito kamodzi pa sabata.

Mu kafukufuku wa pharmacodynamic wa exenatide mwa odwala omwe ali ndi matenda a shuga 2 (n = 13), kubwezeretsa gawo loyamba la insulin ndikusintha gawo lachiwiri la insulin secretion poyankha kulowetsedwa kwa bolus kunasonyezedwa.

Kuchita Mwachipatala ndi Chitetezo
Odwala a 1628 omwe adachita nawo mayesero azachipatala a Bayeta Long mankhwala (odwala 804 adalandira mankhwala a Bayeta Long), 54% anali amuna, 46% anali azimayi, odwala 281 anali azaka (omwe 141 odwala adalandira Bayeta Long) anali) wazaka 65.

Glycemic control
M'maphunziro awiri (nthawi ya masabata 24 ndi 30), kukonzekera kwa Bayeta ® Long 2 mg kumayerekezedwa kamodzi pa sabata ndi exenatide 2 kawiri pa tsiku. M'maphunziro onsewa, muyeso woyamba wa kuchuluka kwa glycosylated hemoglobin (HbA_1c) m'magazi (patatha milungu 4 kapena 6) panali kuchepa kwa chizindikiro ichi. Kugwiritsa ntchito Bayeta Long kunapereka kuchepa kwakukulu kwa kuchuluka kwa a HbA_1c poyerekeza ndi odwala omwe amalandira exenatide 2 pa tsiku. Matenda ofunikira a Bayeta Long pankhani ya HbA_1c Anazindikira palokha woyambira hypoglycemic mankhwala mu maphunziro onsewa. M'magulu onsewa (kukonzekera kwa Bayeta Long ® ndi extenatide 2 kawiri patsiku (kukonzekera kwa Bayeta)) kuchepa kwa thupi kumawonedwa pokhudzana ndi zoyambira zoyambirira, ngakhale kuti kusiyana pakati pamagulu othandizira sikunali kofunikira.

Kuchepetsa kowonjezera mu ndende ya HbA_1c ndipo kuchepa kwamphamvu kwa thupi kunawonedwa kwa osachepera milungu 52 mwa odwala omwe amaliza gawo loyendetsedwa ndi sabata la 30 ndi gawo la 22 la sabata losalamuliridwa. Odwala omwe amathandizidwa ndi Bayeta Long, kuchepa kwa ndende ya HbA kumawonedwa kumapeto kwa gawo lotseguka la kafukufukuyu._1c 2.0% poyerekeza ndi poyambira.

Mu kafukufuku wamasabata 26, kukonzekera kwa 2-mg Bayeta Long kunapereka kuchepetsedwa kothandizadi kwa ndende ya HbA_1c, kuchepa kwakukulu kwa kuchuluka kwa thupi komanso kuchepa kwapadera kwa episode a hypoglycemia poyerekeza ndi insulin glargine kamodzi patsiku. Zomwe zidapezedwa mu gawo lowonjezereka la kafukufukuyu (masabata 156) zinali zogwirizana ndi zotsatira zomwe zapezeka pambuyo pa milungu 26 yamankhwala.

Pakufufuza kwa khungu kwamasabata 26, Bayeta Long adayerekezedwa ndi sitagliptin ndi pioglitazone pamlingo waukulu wa tsiku ndi tsiku wa odwala omwe amalandiranso metformin. Baeta ® Long idawonetsa ukulu woposa sitagliptin ndi pioglitazone pakuchepetsa kuchuluka kwa HbA_1c mogwirizana ndi zoyambirira. Kukonzekera kwa Baeta ® Kwa nthawi yayitali kunali kwabwino kwambiri kuposa sitagliptin, kupereka kuchepa kwa thupi, pomwe kuwonjezeka kwa thupi kunadziwika m'gulu la pioglitazone.

Kulemera kwa thupi
M'maphunziro onse a Bayeta Long, kuchepa kwa thupi pokhudzana ndi zoyambira zenizeni kunadziwika.Kuchepa kwa thupi ndi kugwiritsa ntchito Bayeta Long kumawonedwa mosasamala kanthu kuti odwala akudwala mseru kapena ayi, ngakhale kuchepa kwa thupi kumadziwika kwambiri m'gulu la odwala omwe ali ndi mseru (kuchepa pafupifupi makilogalamu 2.9-5.2) Odwala omwe ali ndi mseru, poyerekeza ndi kuchepa kwa makilogalamu a 2,2,9,9 kwa odwala osakhomera mseru).

Gawo la odwala omwe anali ndi kuchepa kwa thupi komanso kuchepa kwa ndende ya HbA_1c, kuyambira 70 mpaka 79% (kuchuluka kwa odwala omwe anali ndi kuchepa kwa a HbA_1canali 88-96%).

Plasma / seramu glucose
Mankhwala a Bayeta Long adathandizira kuchepetsa kusuntha kwa plasma / seramu glucose. Kuchepa uku kunawonedwa pambuyo pa 4 milungu yovomerezeka. Kutsika kwa gluprose wa postprandial kunadziwikanso. Kusintha kochita kusala kwamagazi pamagazi kunali kosakhazikika pakadutsa milungu 52

Ntchito ya cell ya Beta
Kafukufuku wachipatala akuwonetsa kusintha kwa ntchito ya beta cell, yomwe idayesedwa pogwiritsa ntchito mtundu wa homeostatic evaluation mfano (HOMA-B). Zokhudza beta ya cell cell inali yokhazikika pamasabata 52 achithandizo.

Kupsinjika kwa magazi
M'maphunziro a Bayeta Long, kuchepa kwa magazi a systolic (SBP) ndi 2.9-4.7 mm RT adadziwika. Art. Pakuyerekeza kwa masabata 30 a Bayeta Long ndi Exenatide 2 kawiri patsiku (kukonzekera kwa Bayeta ®), mitundu yonse iwiri ya chithandizo idapereka kuchepa kwakukulu kwa SBP yokhudzana ndi zoyambira (4.7 ± 1.1 mm Hg ndi 3.4 ± 1.1 mmHg, motsatana) popanda kusiyana kwakukulu podziwika pakati pa magulu azachipatala. Kupititsa patsogolo kwa SBP kwakanthawi kwamasabata 52 a chithandizo.

Mbiri ya Lipid
Bayeta Long sizinawononge mbiri ya lipid.

Pharmacokinetics
Zizindikiro za Exenatide mayamwidwe zimazindikira kuthekera kwa mankhwala a Bayeta Long kwa nthawi yayitali. Pambuyo polowa m'magazi, exenatide imagawidwa ndikuchotseredwa malinga ndi katundu wodziwika bwino wa pharmacokinetic (wofotokozedwa m'ndime iyi).

Zogulitsa
Munthawi yogwiritsira ntchito Bayeta Long® pa 2 mg kamodzi pa sabata, ambiri ogwiritsa ntchito exenatide amapitilira ndende yothandiza kwambiri (

50 pg / ml) pakatha milungu iwiri ya mankhwala, kenako ndikuwonjezereka kwa kuchuluka kwa ma exenatide m'madzi am'magazi kwa masabata 6-7. M'masabata otsatira, kuchuluka kwa ma exenatide kunatsalira pa 300 pg / ml, zomwe zikuwonetsa kukwaniritsidwa kwa boma lofanana. Chiyanjano chogwirizanitsa cha exenatide chimasungidwa pamakonzedwe pafupipafupi kamodzi pa sabata ndikusinthasintha kochepa pakati pazambiri ndizocheperako.

Kugawa
Pafupifupi kuchuluka kogawika kwa exenatide pambuyo subcutaneous makonzedwe a limodzi mlingo ndi 28 malita.

Kutetemera ndi chimbudzi
Kafukufuku wamtsogolo awonetsa kuti exenatide imachotsedwera makamaka ndi impso pa kusefera kwamadzi, kutsatiridwa ndi proteinolytic cleavage. Chiyeso chowoneka chapakati cha exenatide ndi 9 l / h. Makhalidwe a pharmacokinetic samatengera mlingo wa exenatide. Ambiri plasma ndende ya exenatide amachepetsa pansi pa kudziwika pafupifupi milungu 10 atachotsa Bayeta Long chithandizo.

Pharmacokinetics mwapadera matenda
Odwala ndi mkhutu aimpso ntchito
Kupenda kwa Pharmacokinetic pagulu la odwala omwe ali ndi vuto la impso yolandila Bayeta Long pa 2 mg ikuwonetsa kuti kufooka kwa impso pakati (n = 10) ndi kufatsa (n = 56), kuwonjezeka kwa chiwonetsero cha systemic expenatide ndikotheka, motero. ndi 74% ndi 23% poyerekeza ndi odwala omwe ali ndi vuto laimpso (n = 84).

Odwala omwe ali ndi vuto la chiwindi
Kafukufuku wa pharmacokinetic mwa odwala omwe ali ndi vuto la chiwindi sichinachitike. Exenatide amachotseredwa makamaka ndi impso, motero kuphwanya chiwindi, zomwe sizingakhudze kuchuluka kwa exenatide m'magazi.

Jenda, mtundu ndi kulemera kwa thupi
Jenda, mtundu ndi kulemera kwa thupi sizikhala ndi vuto lililonse pama paracokinetic magawo a exenatide.

Odwala okalamba
Zambiri zokhudzana ndi odwala okalamba ndizochepa, koma zomwe zikupezeka sizikusonyeza kusintha kwakukulu pamlingo wokhudzana ndi exenatide ndi kuchuluka kwa msinkhu mpaka zaka 75.

Ndi kuyambitsidwa kwa exenatide pa mlingo wa 10 μg 2 kawiri patsiku, odwala omwe ali ndi matenda a shuga 2 azaka 75-85 akuwonetsa kuwonjezeka kwa AUC (dera lomwe lili pansi pa mapiritsi a pharmacokinetic) ndi avareji ya 36% poyerekeza ndi odwala azaka zapakati pa zaka 45-65, zomwe mwina , imagwirizanitsidwa ndi kuchepa kwa ntchito ya impso mwa okalamba (onani gawo "Mlingo ndi makonzedwe").

Gwiritsani ntchito pa nthawi yoyembekezera komanso nthawi yoyamwitsa

Mimba
Zambiri pakugwiritsa ntchito Bayeta Long mwa amayi apakati ndizochepa. Kafukufuku wazinyama awonetsa kukhalapo kwa kawopsedwe kaziberekedwe. Kugwiritsa ntchito mankhwala Bayeta Long nthawi yapakati ndi contraindicated.

Kuyamwitsa
Palibe umboni wotsimikizira kuti Bayeta Long imatha kudutsa mkaka wa m'mawere. Bayeta ® Kutalika sikuyenera kugwiritsidwa ntchito pakuyamwa.

Mlingo ndi makonzedwe

Odwala omwe ali ndi exenatide therapy asinthana katatu patsiku (kukonzekera kwa Bayeta ®) kupita ku Bayeta Long chithandizo, kuwonjezeka kwakanthawi kwamagazi kumayang'aniridwa, komwe kumachitika pafupipafupi, patadutsa milungu iwiri atayamba chithandizo.

Ndi makina ophatikizira a Bayeta Long omwe akukonzekera ndi metformin, thiazolidinedione, kapena kuphatikiza mankhwalawa, mlingo woyambira wa metformin ndi / kapena thiazolidinedione sungasinthe. Pankhani ya kuphatikiza kwa Bayeta Long ndi zotumphukira za sulfonylurea, njira yochepetsera kapangidwe ka sulfonylurea ingafunike kuti muchepetse chiopsezo cha hypoglycemia (onani gawo la "Special Instructions").

Baeta ® Kutalika kuyenera kugwiritsidwa ntchito kamodzi pa sabata tsiku lomwelo la sabata. Ngati ndi kotheka, tsiku la sabata lingasinthidwe, pomwe mlingo wotsatira umaperekedwa posapitilira maola 24 mutatha kumwa koloko. Mankhwala a Baeta ® Long amatha kugwiritsidwa ntchito nthawi iliyonse masana, mosasamala kanthu za kudya.

Ngati mlingo watayika, uyenera kuperekedwa mwachangu. Kenako odwala amatha kubwerera ku ndandanda yama sabata yogwiritsira ntchito. Jakisoni awiri a Bayeta Long sayenera kuchitika tsiku limodzi.

Kugwiritsa ntchito Bayeta ® Kutalika sikutanthauza kudziwongolera kwina koyimitsidwa kwa glucose m'magazi. Kudziyang'anira wekha wamagazi wamagazi kungafunike kuti musinthe mlingo wa sulfonylurea.

Ngati, pakutha kwa chithandizo cha mankhwala ndi Bayeta Long, kugwiritsa ntchito mankhwala ena a hypoglycemic kuyamba, kuchuluka kwa Bayeta Long kuyenera kuganiziridwanso (onani gawo la Pharmacokinetics).

Gwiritsani ntchito m'magulu a odwala odwala mwapadera
Odwala okalamba
Kusintha kwa mankhwalawa malinga ndi zaka sikofunikira, koma popereka mankhwala kwa odwala okalamba, mwayi wochepetsetsa wa impso ndi msinkhu uyenera kuganiziridwanso (onani gawo lina - "Odwala omwe ali ndi vuto la impso"). Zochitika zamankhwala ndi mankhwalawa odwala omwe ali ndi zaka zopitilira 75 ndizochepa kwambiri (onani gawo "Pharmacokinetics").

Odwala ndi mkhutu aimpso ntchito
Odwala ndi mkhutu aimpso ntchito ofatsa zovuta (kulengedwa kwa creatinine chilolezo cha 50-80 ml / mphindi) sikofunikira. Kugwiritsa ntchito Bayeta Long kwa odwala omwe amachepetsa mphamvu ya impso (kulengedwa kwa creatinine 30-50 ml / min) sikulimbikitsidwa chifukwa chochepa kwambiri pazachipatala (onani.gawo "Pharmacokinetics"). Bayeta ® Long imaphatikizidwa kwa odwala omwe amalephera-a impso kulephera kapena kuwonongeka kwambiri kwaimpso (kulengedwa kwa creatinine ® chilolezo chotalika mwa ana ndi achinyamata osakwana zaka 18 sizinakhazikitsidwe.

Njira yogwiritsira ntchito
Bayeta ® Long cholinga chake ndikugwiritsidwa ntchito ndi odwala. Chotupa kapena cholembera chimayenera kugwiritsidwa ntchito ndi wodwala m'modzi komanso kamodzi.

Musanakonzekere kuyimitsidwa, onetsetsani kuti zosungunulira sizowonekera ndipo sizikhala ndi ma cell owoneka. Kuyimitsidwa okonzekerako kuyenera kugwiritsidwa ntchito nthawi yomweyo jakisoni, osasungidwa.

Ngati mankhwalawa adapanga mazira, sungagwiritsidwe ntchito.

Ndikulimbikitsidwa kuti wodwalayo kapena wachibale wake / womusamalira wodwalayo yemwe sanaphunzire maphunziro a udokotala alandire maphunziro mumalamulo odzibayira nokha. Ndikofunikira kutsatira mosamalitsa malingaliro a Maupangiri kuti mugwiritse ntchito cholembera cha Bayeta Long kapena Malangizo ogwiritsira ntchito Bayeta Long drug kit yomwe ili pabokosi la makatoni.

Mankhwalawa amayenera kuperekedwa mwachangu pamimba, ntchafu kapena phewa nthawi yomweyo atasakaniza ufa ndi zosungunulira.

Malangizo okonzekera kuyimitsidwa kwa mankhwala omwe amapezeka amauzidwa mu Maupangiri ogwiritsira ntchito cholembera cha syringe Bayeta Long kapena Maupangiri ogwiritsira ntchito mankhwala a Bayeta Long.

Zotsatira zoyipa

Pogwiritsa ntchito kulembetsa pambuyo pa kulembetsa kawiri patsiku, malipoti osowa alandila za chitukuko cha pancreatitis pachimake ndi kulephera kwaimpso (onani gawo "Malangizo Apadera").

Otsatirawa ndi deta pazotsatira zoyipa za Bayeta Long, zomwe zachitika poyesa zamankhwala ndi ntchito zotsatsa zotsatsa. Zotsatira zoyipa zimaperekedwa pogwiritsa ntchito mawu osankhidwa malinga ndi magulu a ziwalo zamagulu ndikuwonetsa pafupipafupi. Pafupipafupi mwadzidzidzi zochitika zimafotokozedwa motere: pafupipafupi (≥ 1/10), nthawi zambiri (≥ 1/100, 1.

Kuchokera kumbali ya kagayidwe ndi zakudya: pafupipafupi - hypoglycemia 1 (pankhani yophatikiza ndi sulfonylurea), nthawi zambiri - kusowa kwa chilimbikitso 1, infrequently - kuperewera kwa madzi m'thupi 1.

Kuchokera ku dongosolo lamanjenje: Nthawi zambiri - kupweteka mutu 1, chizungulire 1, kawirikawiri kukanika kwa 1, kugona.

Kuchokera m'mimba: Nthawi zambiri - nseru 1, kutsegula m'mimba 1, kusanza 1, kusanza 1, kupweteka kwam'mimba 1, gastroesophageal Reflux matenda 1, kutumphukira 1, kudzimbidwa 1, kusabereka 1, infrequently - matumbo kutsekeka 1, kupweteka kwa 1, kusadziwika pafupipafupi - pachimake kapamba 2 (onani gawo "Malangizo Apadera").

Pa khungu ndi subcutaneous minofu: Nthawi zambiri - kuyabwa ndi / kapena urticaria 1, kawirikawiri hyperhidrosis 1, alopecia 1, osadziwika mwatsatanetsatane - macular ndi papular zidzolo 2, angioedema 2, abscesses ku jekeseni malo ndi cellulite 2.

Kuchokera ku impso ndi kwamkodzo thirakiti: pafupipafupi - aimpso kuwonongeka, kuphatikizapo pachimake aimpso kulephera, aimpso kulephera, aimpso kulephera, kuchuluka seramu creatinine ndende 1 (onani gawo "Malangizo apadera")

Zovuta zamtundu ndi zovuta zomwe zimapezeka pamalo opangira jakisoni: Nthawi zambiri - kuyabwa pa jekeseni 1, kutopa 1, erythema pa jakisoni wa jekeseni 1, asthenia 1, modabwitsa - zotupa pa malo a jekeseni 1, kawirikawiri - kumverera kwa nkhawa 1.

Zosintha mu ma laborator: ma frequency osatchulidwa - kuwonjezeka kwa chiwembu cha mayiko wamba (INR) (onani gawo la "Special Instructions").
1 Frequency imatsimikizika pamaziko a data kuchokera kumaphunziro a nthawi yayitali amathandizidwe ndi chitetezo cha exenatide yayitali, chiwerengero chonse cha odwala ndi 2868 (kuphatikiza odwala 1002 omwe amatenga sulfonylurea).
2 Frequency imakhazikitsidwa pamaziko a mauthenga ongoyambira pamene exenatide wa nthawi yayitali amagwiritsidwa ntchito pagulu la anthu osadziwika.

Makhalidwe azomwe zimachitika mosiyanasiyana
Hypoglycemia
Pankhani yogwiritsira ntchito Bayeta Long pokonzekera limodzi ndi kukonzekera kwa sulfonylurea, chiwopsezo chachikulu cha hypoglycemia chinawoneka (24.0% poyerekeza ndi 5.4%) (onani gawo "Malangizo Apadera"). Kuchepetsa chiopsezo cha hypoglycemia panthawi yophatikiza mankhwalawa, kusintha kwa sulfonylurea kungafunike (onani magawo "Mlingo ndi makonzedwe" ndi "Malangizo apadera").

Mankhwala a Bayeta Long adalumikizidwa ndi kuchepa kwapadera kwambiri kwa hypoglycemia poyerekeza ndi insulin glargineapy kwa odwala omwe amalandila metformin (3% motsutsana 19%) ndipo mwa odwala omwe amalandiranso metformin ndi sulfonylurea (20% poyerekeza ndi 42%). Zolemba zambiri za hypoglycemia zolembedwa mu mayeso azachipatala a nthawi yayitali (99.9%, n = 649) zinali zofatsa ndikutsimikiza pambuyo pakumwa zakudya zam'kamwa. Wodwala m'modzi anali ndi gawo la hypoglycemia yayikulu, chifukwa anali ndi shuga wochepa m'magazi (2.2 mmol / L), ndipo thandizo lakunja lidafunikira kuti atenge mafuta kuti aimitse hypoglycemia.

Kuchepetsa mseru
Khalidwe lodziwika bwino lomwe linali mseru. Mwambiri, gawo limodzi la nseru lidadziwika mu 20% ya odwala omwe amalandila Bayeta Long. Nthawi zambiri mseru umakhala wofatsa kapena wapakati. Odwala ambiri omwe adakumana ndi mseru kumayambiriro kwa chithandizo, mankhwalawa amayamba mseru panthawi ya chithandizo. Zomwe zimapangitsa kuti athetse chithandizo chamankhwala chifukwa cha zovuta zomwe zimachitika pakadutsa masabata 30 osungidwa ndi placebo anali 6% mwa odwala omwe amalandila Bayeta Long. Zochitika zodziwika bwino kwambiri zomwe zimafuna kuti discontinuation yachipatala mu magulu onse azachipatala azikhala ndi mseru komanso kusanza. Kusintha kwa mankhwala chifukwa cha mseru kapena kusanza kunachitika mu ® Long.

Jekeseni tsamba lanu
M'maphunziro asanu omwe ali ndi mphamvu yogwira masabata 24-30, mayankho omwe adachitika jekeseni adawonedwa mu 17.1% ya odwala omwe amalandila Bayeta Long.

Mwambiri, izi zimachitika pang'onopang'ono ndipo, nthawi zambiri, sizinapangitse kuti mankhwalawo athe. Odwala amatha kulandira chithandizo chamankhwala pomwe akupitiliza mankhwala ndi Bayeta Long. Muyenera kusankha malo atsopano pakukhazikitsa mankhwalawa nthawi iliyonse yovulala.

M'maphunziro azachipatala, kupangidwa kwa zisindikizo zazing'ono zam'madzi pama malo a jekeseni nthawi zambiri kumawonedwa, zomwe ndi zotsatira za kukhalapo kwa ma polymer ma microspheres pakupanga kukonzekera, omwe akuphatikizapo 50:50 DL 4AP polymer (Copoly-D, L-lactide-glycolide). Ambiri mwa zisindikizo zaumwini anali asymptomatic, sanasokoneze kutenga nawo mbali phunzirolo, ndipo adasowa patadutsa milungu 4-8.

Mapangidwe a antibody
Mankhwala okhala ndi mapuloteni ndi ma peptides amatha kukhala ndi immunogenic katundu, chifukwa, pambuyo pa kayendedwe ka Bayeta Long, ma antibodies a exenatide amatha kupanga. Odwala ambiri omwe ma antibodies anapezeka, titer yawo inachepa pakapita nthawi.

Kukhalapo kwa ma antibodies (titer yayikulu kapena yotsika) sikunagwirizane ndi kuchuluka kwa kayendetsedwe ka glycemic. M'mayesero azachipatala a Bayeta Long, pafupifupi 45% ya odwala adawonetsa ma antibodies ochepa kumapeto kwa kafukufukuyu. Pafupifupi, kuchuluka kwa odwala omwe ali ndi ma antibodies anali ofanana pamayeso onse azachipatala. Pafupifupi, m'mayesero azachipatala a gawo 3, 12% ya odwala anali ndi anti anti titer. Mwa ena mwa odwalawa, kuyankha kwa glycemic ku Bayeta Long chithandizo kunalibe kumapeto kwa nthawi yowerengera yoyendetsedwa, mu 2.6% ya odwala omwe ali ndi titer yayikulu ya antibodies, glycemic control sanachite bwino, ndipo mu 1.6% ya odwala palibe kusintha ngakhale pakalibe ma antibodies.

Odwala omwe ali ndi antibodies to exenatide adawonetsa kukhudzana kwambiri ndi jakisoni wothandizira (mwachitsanzo, redness of the khungu and kuyamwa), koma nthawi yomweyo, pafupipafupi komanso mtundu wa zovuta zotsatirazi mwa odwalawa zinali zofanana ndendende ndi odwala omwe alibe ma antibodies kuti atulutse magazi .

Odwala omwe amathandizidwa ndi Bayeta Long, pafupipafupi njira zomwe zimayambitsa jakisoni (nthawi zambiri, kuyabwa ndi kapena popanda erythema) mu 30-milungu komanso maphunziro a masabata a 26 anali 9%. Izi zimachitika kawirikawiri kawirikawiri kwa odwala omwe ali ndi vuto losagwirizana ndi ma antibodies (4%) poyerekeza ndi odwala omwe ali ndi zotsatira zabwino (13%), omwe ali ndi chiwopsezo chapamwamba kwambiri mwa odwala omwe ali ndi anti anti titer.

Kusanthula kwa ma antibody sampulines sikunawonetse kuyambiranso kwakanthawi ndi ma peptides ofananawo (glucagon kapena GLP-1).

Kuchepetsa thupi mwachangu
Mu kafukufuku wamasabata 30, pafupifupi 3% ya odwala (n = 4/148) omwe amathandizidwa ndi Bayeta Long anali ndi gawo limodzi lokhala ndi kanthawi kochepa (kuchepa kwa thupi pakati pamaulendo awiri otsatizana oposa 1, 5 kg pa sabata).

Kuchuluka kwa mtima
Mwa anthu okhazikika omwe ali ndi Bayeta Long pamavuto azachipatala, kuwonjezeka kwa mtima kugunda kwa 2.6 pamphindi kumadziwika. Mu 15% ya odwala ochokera ku gulu la Bayeta Long, kugunda kwa mtima kwakweza ndi ≥ 10 kumenyedwa pamphindi, kuwonjezeka kwa kugunda kwa mtima kwaposachedwa ndi ≥ 10 kumenyedwa pamphindi m'magulu ena azachipatala kumawonedwa mu 5-10% ya odwala.

Kuyanjana ndi mankhwala ena ndi mitundu ina yogwiritsira ntchito mankhwalawa

Mukamamwa mapiritsi a paracetamol pa mlingo wa 1000 mg pamimba yopanda kanthu kapena mutatha kudya, mutatha masabata 14 pochiza ndi Bayeta Long, palibe kusintha kwakukulu mu AUC ya paracetamol poyerekeza ndi nthawi yoyendetsa. Cmax (kuchuluka kwa ndende) ya paracetamol yafupika ndi 16% (pamimba yopanda kanthu) ndi 5% (mutatha kudya), ndi tmax (nthawi yofikira kuchuluka kwambiri) ikuwonjezeka kuyambira ola limodzi pakulamulira mpaka maola 1.4 (pamimba yopanda kanthu) ndi 1, Maola atatu (mutatha kudya).

Kukonzekera kwa Sulfonylurea
Chifukwa cha kuchuluka kwa vuto la hypoglycemia munthawi ya mankhwala a sulfonylurea, kusintha kwa mankhwala a sulfonylurea kungafunike (onani magawo "Mlingo ndi utsogoleri" ndi "Malangizo apadera").
Zotsatira za maphunziro oyanjana omwe amaperekedwa pansipa amapezeka pogwiritsa ntchito exenatide pa mlingo wa 10 μg 2 kawiri pa tsiku.

Hydroxymethylglutaryl CoA reductase inhibitors
AUC ndi Cmax ya lovastatin idatsika ndi 40% ndi 28%, motero, ndipo tmax idakwera pafupifupi maola 4 pomwe exenatide imagwiritsidwa ntchito kawiri patsiku ndi mlingo umodzi wa lovastatin (40 mg) poyerekeza ndi mfundo zomwe amaziona ndi lovastatin yekha. Mu masabata 30 omwe amayendetsedwa ndi placebo omwe amawongolera kawiri kawiri patsiku, kugwiritsa ntchito nthawi yomweyo kwa HMG-CoA reductase inhibitors sikunapangitse kusintha kwamphamvu mu lipid mbiri (onani gawo la Pharmacodynamics). Kusintha koyambirira kwa mlingo sikofunikira, komabe, ngati kuli kofunikira, mbiri ya lipid iyenera kuyang'aniridwa.

Warfarin
Ngati warfarin idatengedwa Mphindi 35 pambuyo poyang'anira exenatide (2 kawiri pa tsiku), kuwonjezereka kwa tmax pafupifupi 2 hours kumadziwika. Palibe kusintha kwakukulu muCmax kapena AUC komwe kunawonedwa. Pali malipoti akuwonjezeka kwa INR pomwe mukugwiritsa ntchito warfarin ndi exenatide. Odwala omwe amatenga mankhwala a warfarin ndi / kapena coumarin, ndikofunikira kuwongolera INR koyambirira kwa chithandizo ndi Bayeta Long (onani gawo "Zotsatira zoyipa").

Digoxin ndi lisinopril
Mu maphunziro okhudzana ndi mankhwala osokoneza bongo, ma exenatide (2 kawiri patsiku) sanakhale ndi vuto lililonse pakumveka kwa Cmax kapena AUC wa digoxin ndi lisinopril, komabe, kuwonjezeka kwa tmax pafupifupi 2 hours kumadziwika.

Ethinyl estradiol ndi levonorgestrel
Pambuyo pogwiritsira ntchito njira yothandizira pakamwa yophatikizira (30 μg ya ethinyl estradiol ndi 150 μg ya levonorgestrel) ola limodzi musanayambe kuyang'anira exenatide (kawiri pa tsiku), palibe kusintha kwa AUC, Cmax kapena Cmin (ndende yocheperako) ya ethinyl estradiol ndi levonorgestrel. Mukamagwiritsa ntchito njira yotsekera pakamwa mphindi 35 mutatenga Exenatide (kawiri patsiku), AUC sinasinthidwe, komabe, kuchepa kwa Cmax ya ethinyl estradiol ndi 45% ndi Cmax ya levonorgestrel ndi 2741%, komanso kuwonjezeka kwa tmax ndi maola 2-4 chifukwa kuchepa kwa m'mimba . Kuchepa kwa Cmax sikofunikira mwakuthupi, chifukwa chake kusintha kwa mankhwalawa pakuletsa pakamwa sikofunikira.

Malangizo apadera

Baeta ® Long siyikulimbikitsidwa ngati njira yoyamba ya chithandizo cha matenda a shuga 2 odwala omwe ali ndi vuto lochepa la glycemic pazakudya ndi zolimbitsa thupi.

Bayeta ® Long siimalo yama insulini, kuphatikiza ndi insulin kuphatikizidwa (onani gawo "Contraindication").

Bayeta Long sayenera kutumikiridwa kudzera m'mitsempha kapena m'mitsempha.

Mlingo umodzi wa mankhwalawa uli ndi zosakwana 1 mmol wa sodium (23 mg), i.e. Kukonzekera kuli konse kwa sodium.

Kuopsa kwa zotupa za chithokomiro cha C-cell
Kuperekera kwa pritatide yayitali kwa nyama zapakhungu (makoswe) pamankhwala ofunikira kwambiri amaphatikizidwa ndi kuwonjezeka kwa zotupa za chithokomiro C cha cell poyerekeza ndi gulu loyang'anira. Malinga ndi zotsatira za kafukufuku wamankhwala komanso zamankhwala, sizingatheke kupatula chiwopsezo chofanana ndi zotupa za C-cell (kuphatikiza khansa ya medullary) ya chithokomiro cha chithokomiro. Mankhwalawa amadziwikiratu odwala omwe ali ndi khansa ya chithokomiro mu mbiri yakale kapena banja, komanso mtundu wa 2 MEN.

Serum calcitonin ndi chizindikiro cha khansa ya chithokomiro cha medullary. Kuwonetsetsa kwa chizolowezi chowongolera ma seramu calcitonin kapena kuwunika kwa chithokomiro kuti adziwe msanga wa khansa yapakati pa odwala omwe amalandila Bayeta ® Long sichinakhazikitsidwe. Kuwunika koteroko kungakulitse chiwopsezo cha njira zosafunikira chifukwa chotsimikiza kwa serum calcitonin pakudziwitsa khansa ya medullary komanso zochitika zapamwamba za matenda a chithokomiro. Kuchulukitsa kwambiri kwa seramu calcitonin kumatha kuwonetsa khansa yapakati, ndipo odwala omwe ali ndi khansa ya medullary nthawi zambiri amakhala ndi kupindika> 50 ng / L. Ngati kuchuluka kwa seramu calcitonin kutsimikiza ndikuwonjezeka, wodwalayo amayenera kupitilizidwa. Odwala omwe ali ndi mafinya a chithokomiro chokhazikitsidwa panthawi yoyesedwa kapena kupindika kwa khosi amayeneranso kuwunikiridwa. Odwala ayenera kudziwitsidwa za chiwopsezo cha zotupa za chithokomiro ndi zizindikiro zawo (onani gawo "Contraindication").

Matenda aimpso
Odwala omwe ali ndi vuto loti aimpso amalephera kugwiritsa ntchito hemodialysis, kugwiritsa ntchito exenatide 2 kawiri pa tsiku kumayendetsedwa ndi kuthamanga kwaminyewa yam'mimba thirakiti, motero, Bayeta Long mankhwala amalekanitsidwa ndi odwala omwe amalephera ndi aimpso kulephera. creatinine ® Kutalika kwa odwala omwe ali ndi vuto laimpso kuwongolera pang'ono (kulengedwa kwa creatinine chilolezo 30-50 ml / min) sikofunikira chifukwa chochepa kwambiri zokumana nazo zamankhwala.

Nthawi zambiri vuto laimpso lidanenedwa ndikulembedwera kwa mankhwalawa, kuphatikizapo kuwonjezeka kwa serum creatinine ndende, kukula kwa kulephera kwa impso, kuwonjezeka kwa maphunziro a kulephera kwa impso, kulephera kwaimpso.Mwanthawi zina, hemodialysis imafunika. Zina mwazinthu izi zimatha kukhala chifukwa cha kusowa kwamadzi chifukwa cha mseru, kusanza, ndi / kapena kutsekula m'mimba, komanso / kapena ndimankhwala omwe amatha kudziwika kuti aimpso / madzi kagayidwe. Mankhwala ophatikizana anali ndi angiotensin-converting enzyme inhibitors, omwe si a antiidal a antiidal, mankhwala okodzetsa. Mukamapereka mankhwala othandizira ndikuchotsa mankhwalawo, mwina chifukwa chomwe chimayambitsa masinthidwe a metabolism, kuphatikizapo exenatide, kuwonongeka kwaimpso kunabwezeretsedwa. Malinga ndi zotsatira za kafukufuku wamankhwala komanso preclinical, nephrotoxicity ya exenatide sichinatsimikizidwe.

Matenda akulu am'mimba thirakiti
Bayeta Long sanaphunzitsidwe mwa odwala omwe ali ndi matenda oopsa a m'mimba, kuphatikizapo paresis yam'mimba. Kugwiritsidwa ntchito kwa Bayeta ® Nthawi zambiri kumayambitsa zovuta kuchokera m'matumbo am'mimba monga mseru, kusanza ndi kutsekula m'mimba, chifukwa chake kugwiritsa ntchito mankhwalawa kwa odwala omwe ali ndi matenda oopsa a m'mimba kumatsutsana.

Pachimake kapamba
Zovuta za pancreatitis zowopsa zimanenedwapo ndikugwiritsa ntchito Bayeta Long. Mukamapereka mankhwala othandizira kukonza, kapamba adathetsedwa, komabe, kawirikawiri, kuyambika kwa necrotic kapena hemorrhagic pancreatitis ndi / kapena kufa kunadziwika. Odwala adziwitsidwe za zomwe zimachitika ndi chifuwa chachikulu cha kapamba: kulimbikira kupweteka pamimba. Ngati pancreatitis ikukayikira, chithandizo cha exenatide iyenera kusiyidwa. Wodwala akapezeka ndi pancreatitis pachimake, mankhwala a Bayeta Long® sayeneranso kutumikiridwa. Mankhwala a Baeta ® Long ndi ophatikizika kwa odwala omwe ali ndi mbiri ya kapamba.

Mankhwala onga
Kugwiritsa ntchito pamodzi kwa Bayeta Long ndi insulin, D-phenylalanine derivatives (meglitinides), alpha-glucosidase inhibitors, dipeptidyl peptidase-4 inhibitors ndi ma GLP-1 receptor agonists ena sanaphunzire. Kugwiritsa ntchito pamodzi kwa Bayeta ® Long ndi Exenatide 2 kawiri patsiku (Bayeta ®) sikunaphunzire ndipo sikulimbikitsidwa.

Hypoglycemia
Pankhani yogwiritsira ntchito kukonzekera kwa Bayeta Long pamodzi ndi kukonzekera kwa sulfonylurea, chiwopsezo chachikulu cha hypoglycemia chadziwika. Zawonekeranso mu kafukufuku wazachipatala kuti odwala omwe ali ndi vuto lofooka laimpso omwe amalandila chithandizo cha sulfonylurea anali ndi chiopsezo chachikulu cha zochitika za hypoglycemic poyerekeza ndi odwala omwe ali ndi vuto laimpso. Kuti muchepetse chiopsezo cha hypoglycemia wogwiritsidwa ntchito ndi mankhwala a sulfonylurea, lingalirani kuchepetsa mlingo wa mankhwalawa.

Kuchepetsa thupi mwachangu
Kuchepetsa thupi mwachangu kunanenedwa pamlingo wa> 1.5 makilogalamu pa sabata kwa odwala omwe amalandira exenatide. Kuchepetsa thupi kotereku kumatha kukhala ndi mavuto. Ndi kuchepa msanga kwa thupi mwa odwala, ndikofunikira kuwongolera zizindikiro za cholelithiasis.

Kuchita ndi Warfarin
Milandu yakuwonjezeka kwa INR, nthawi zina zokhudzana ndi magazi, adanenedwa kuti agwiritsidwa ntchito pamodzi ndi warfarin ndi exenatide (onani gawo "Kuyanjana ndi mankhwala ena ndi mitundu ina yamagulu osokoneza bongo").

Kuchotsera mankhwala
Zotsatira za Bayeta ® Pambuyo pakuyimitsidwa kwa kayendetsedwe kake zimatha kukhalapo kwa nthawi yayitali, popeza kuchuluka kwa plasma m'magazi kumatsika kwa masabata 10. Chifukwa chake, popereka mankhwala ena ndikusankha kuchuluka kwake, izi ziyenera kukumbukiridwa, chifukwa zimachitika kawirikawiri komanso zomwe zimachitika, mwina pang'ono, mwina chifukwa cha kupezeka kwa exenatide m'madzi a m'magazi.

Mapangidwe a antibody
Odwala omwe amalandila Bayeta Long, ma antibodies opita ku exenatide amatha kupanga.
Ma antibodies a Exenatide anali otsimikiza mu odwala onse omwe amathandizidwa ndi Bayeta Long mu 5 omwe amayendetsedwa ndi mayesero azachipatala ndi mankhwala oyerekeza omwe amakhala kwa milungu 24-30. Mu 6% ya odwala omwe amalandira Bayeta Long, mapangidwe a antibody adalumikizidwa ndi yankho lochepetsedwa la glycemic. Ngati mayankho a glycemic akuchulukirachulukira kapena ngati cholowera cha glycemic sichingachitike, kuthekera kwa njira ina yopangira hypoglycemic kuyenera kuwunikiridwa (onani gawo "Zotsatira zoyipa").

Hypersensitivity zimachitika
Ndi pambuyo polembetsa kugwiritsidwa ntchito kwa exenatide, milandu yokhudza hypersensitivity reaction (monga anaphylactic reaction and angioedema) yanenedwapo. Ngati vuto la hypersensitivity litayamba, muyenera kusiya kugwiritsa ntchito mankhwala a Bayeta Long ndi mankhwala ena, kugwiritsa ntchito komwe kungayambitse vuto la hypersensitivity, ndipo pitani kuchipatala msanga (onani gawo "Zotsatira zoyipa").

Zokhudza malo jakisoni
Pogwiritsa ntchito Bayeta Long atalemba kale, milandu yayikulu yokhudza kupweteka kwa jakisoni (monga zilonda zam'mimba, cellulitis ndi necrosis) yanenedwa, kuphatikizapo kupanga zisindikizo zapambuyo pake. Nthawi zina, chithandizo cha opaleshoni chinafunika (onani gawo "Zotsatira zoyipa").

Chonde
Kafukufuku wokhudzana ndi Bayeta ® Kutalika kwachuma kwa anthu sikunachitike.

Packer (phukusi loyambirira)

Amilin Ohio Electric, USA
8814 Trade Port Drive, West Chester, Ohio 45071, USA
Amylin Ohio LLC, USA
8814 Trade Port Drive, West Chester, Ohio 45071, USA

Vetter Pharma-Fertigun GmbH & Co KG, Germany (zosungunulira)
Eisenbahnstrasse 2-4, 88085 Langenargen, Germany
Vetter Pharma-Fertigung GmbH & Co KG, Germany Eisenbahnstrasse 2-4, 88085 Langenargen, Germany

Packer (yachiwiri (yogula))

Amilin Ohio ELC, USA (cholembera)
8814 Trade Port Drive, West Chester, Ohio 45071, USA
Amylin Ohio LLC, USA
8814 Trade Port Drive, West Chester, Ohio 45071, USA

Enestia Belgium NV, Belgium (seti)
Kloknerstraat 1, Hamont-Ahel, B-3930, Belgium
Enestia Belgium NV, Belgium
Klocknerstraat 1, Hamont-Achel, B-3930, Belgium

Kupereka Ulamuliro Wamakhalidwe

AstraZeneca UK Limited, UK
Silk Road Business Park, Mcclesfield, Cheshire, SK10 2NA, UK
AstraZeneca UK Limited, United Kingdom
Silk Road Business Park, Macclesfield, Cheshire, SK10 2NA, United Kingdom

Amilin Ohio ELC, USA (cholembera)
8814 Trade Port Drive, West Chester, Ohio 45071, USA
Amylin Ohio LLC, USA
8814 Trade Port Drive, West Chester, Ohio 45071, USA

Zambiri zimapezeka mukapempha:
Zoyimira AstraZeneca UK Limited, UK, ku Moscow ndi
LLC AstraZeneca Pharmaceuticals 125284 Moscow, ul. Kuthamanga, 3, p. 1

Kutulutsa mawonekedwe ndi kapangidwe kake

Baeta Long amamasulidwa mu mawonekedwe a ufa pakukonzekera kuyimitsidwa kwa ma subcutaneous (s / c) kayendetsedwe kazinthu zazitali: pafupifupi zoyera kapena zoyera, zosungunulira ndizopanda utoto kapena chikasu / bulauni chowoneka (chotsekedwa - ufa wofanana ndi 2 mg wa exenatide, mu Botolo lowonekera la galasi 3 ml, lotsekeka ndi cholembera cha mphira cha chlorobutyl ndi kapu ya aluminium yokhala ndi kapu ya polypropylene, ndi 0,65 ml zosungunulira mu syrive ya galasi 1.5 ml yokhala ndi piston ya polypropylene yokhala ndi yokhala ndi pulobulo ya rombutyl ya pulatifomu ndi cholumikizira cha Luer, mumtundu wotsekedwa womata 1, kuphatikiza 1 botolo ndi ufa, 1 syringe ndi solvent, 1 adapter ndi singano 2 zosabala, bokosi la carton lokhala ndi nthawi yoyamba kutsegula 4 matumba a matuza, syringe cholembera - chipinda cha kutsogolo kwa cholembera chimakhala ndi ufa wofanana ndi 2 mg wa exenatide, kumbuyo kwa chipinda cha galasi chowoneka bwino chophatikizika ndi cholembera - 0,65 ml solvent, mu chosindikizira chosindikizira 1 cholembera ndi singano imodzi yosabala, pamatcheni okhala ndi makatoni okhala ndi njira yoyamba yotsegulira matuza 4 a blister ndi 1 singano yosabala.Paketi iliyonse ilinso ndi malangizo ogwiritsa ntchito Bayeta Long).

Mlingo 1 wa ufa (1 kapena 1 syringe cholembera) muli:

• yogwira mankhwala: exenatide - 2 mg,
• zowonjezera zina: sucrose, polymer 50:50 DL 4AP Copoly- (D, L-lactide-glycolide).

Solvent zikuchokera: polysorbate 20, carmellose sodium, sodium dihydrogen phosphate monohydrate, sodium kolorayidi, sodium hydrogen phosphate heptahydrate, madzi a jekeseni, kuphatikiza cholembera syringe - 1 M sodium hydroxide solution.

Mankhwala

Exenatide ndi agonist wa glucagon-ngati peptide-1 receptors (GLP-1), akuwonetsa zotsatira zina za antihyperglycemic zomwe zimachitika mu GLP-1. Mndandanda wa amino acid womwe uli mu exenatide umagwirizana pang'ono ndi mndandanda wa anthu GLP-1. Kafukufuku wa in vitro awonetsa kuti chinthu chogwira ntchito chimamangirira ndikuwonjezera zolumikizira za GLP-1, ndi ma cyclic adenosine monophosphate (cAMP) ndi / kapena njira zina zotumizira mauthenga muzochitika zake.

Glucose wa Exenatide amathandizira kupanga insulini pancreatic β-cell. Kutsika kwa kupanga kwa insulin kumachitika motsutsana ndi maziko a kuchepa kwa shuga m'magazi. Ngati mankhwalawa amagwiritsidwa ntchito limodzi ndi thiazolidinedione ndi / kapena metformin, pafupipafupi ma episode a hypoglycemia sanadutse kwambiri okhawo omwe ali mgulu la placebo ndi thiazolidinedione ndi / kapena metformin. Izi zitha kukhala chifukwa cha glucose-insulinotropic limagwirira ntchito.

Exenatide linalake ndipo tikulephera kupanga glucagon, amene mlingo woyenera wokwera mu odwala 2 mtundu wa mellitus. Kutsika kwa glucagon m'magazi kumachepetsa kuthamanga kwa glucose kumasulidwa ndi chiwindi. Koma munthawi yomweyo, exenatide sindiye ikubweretsa kuphwanya kwachilendo kwa glucagon ndi mahomoni ena omwe amayamba chifukwa cha kuchepa kwa shuga m'magazi. Baeta Long imathandizira kuti muchepetse kutulutsa kwam'mimba, zomwe zimachepetsa kuchuluka kwa shuga m'magazi. Kugwiritsa ntchito kwanyengoyi kumathandizira kuchepetsa kuchuluka kwa zakudya zomwe zimadyedwa chifukwa chakuchepa kwa chilimbikitso ndi kuwonjezereka kwa kumverera kwodzaza.

Exenatide imathandizira kuwongolera glycemic chifukwa kuchepa kwakanthawi kwa magazi a glucose ndi gluprose wa postprandial mwa odwala omwe ali ndi matenda a shuga a 2. Mosiyana ndi endo native GLP-1, mbiri ya pharmacodynamic ndi pharmacokinetic ya Baeta Long amalola kugwiritsa ntchito mankhwalawa kamodzi masiku 7 alionse. Mu kafukufuku wa pharmacodynamic wa exenatide mwa odwala omwe ali ndi matenda a shuga a 2, kubwezeretsa gawo I kwa insulin katulutsidwe ndikusintha kwa gawo lachiwiri kunawonetsedwa poyang'anira kukhudzana kwa intravenous (iv) borus.

Pakadutsa maphunziro awiri (nthawi ya masabata 24 ndi 30), Baeta Long pa nthawi ya 2 mg 1 nthawi m'masiku 7 adayerekezeredwa ndi exenatide amene amatengedwa katatu patsiku (mankhwala a Bayeta). M'maphunziro onsewa, kuchepa kwa glycated hemoglobin (HbA_1c) m'magazi linajambulidwa kale pakuyambirira - masabata 4 kapena 6 atayamba kuphunzira. Odwala omwe amalandira mankhwalawa, panali kuchepa kwakukulu kwa HbA_1s poyerekeza ndi odwala ochokera ku gulu la exenatide, omwe amatengedwa kawiri pa tsiku. M'magulu onse awiriwa, kuchepa kwa thupi pokhudzana ndi kuyambira kunawonedwanso, koma kusiyana pakati pamagulu sikunali kopambana.

Kuchepetsa kwa HbA_1c ndipo kuchepa kwamphamvu kwa thupi kunalembedwa pafupifupi masabata 52 mwa odwala omwe anamaliza gawo lokhala ndi sabata la 30 ndipo sabata la 22 linakulitsa gawo losalamuliralo.

Mu kafukufuku wazaka 26 wa Baeta Long pa mlingo wa 2 mg unapangitsa kutsika kwakukulu kwa ndende ya HbA_1c, kuchepa kwakukulu kwa kuchuluka kwa thupi komanso kuchepa kwakukulu kwa zochitika za hypoglycemia poyerekeza ndi insulin glargine, yomwe imapezeka kamodzi patsiku. Komanso, kafukufuku wokhudzidwa ndi khungu wamasabata a 26 adawonetsa kukula kwa Bayeta Long pa pioglitazone ndi sitagliptin, omwe amatengedwa pamlingo waukulu tsiku lililonse akamamwa metformin, kuchepetsa mulingo wa HbA_1c wachibale

M'maphunziro onse a Mankhwala a Baeta Long, kuchepa kwa thupi kogwirizana ndi zomwe zimakhazikitsidwa koyambirira kunalembedwa.

Mankhwala osokoneza bongo adathandizanso kuchepa kwakukulu kwa plasma / seramu glucose. Kuchepetsa kumeneku kunadziwika sabata 4 zokha atangoyamba kumene chithandizo. Kuphatikiza apo, kutsika kwa glucose wa postprandial kunalembedwa. Kusintha kwa kusala kwamagazi m'magazi kunakhazikika pakadutsa masabata 52 a chithandizo.

Pa maphunziro a mankhwalawa, kuchepa kwa magazi a systolic (SBP) a 2.9-4.7 mm Hg akuti. Art. mogwirizana ndi zoyambirira. Kuwongolera kopindulitsa kwa chidziwitso cha GARDEN kunawonedwa pamasabata 52 achithandizo.

Zizindikiro zogwiritsidwa ntchito

Kugwiritsa ntchito Baeta Long ndikulimbikitsidwa kwa matenda a shuga a mtundu wa 2 ngati njira yowonjezerapo mankhwala a metformin, thiazolidinedione, sulfonylurea, kuphatikiza kwa metformin ndi zotumphukira zochokera ku sulfonylurea kapena thiazolidinedione ndi metformin pazovuta zokwanira zolimba glycemic (ngati othandizira awa amagwiritsidwa ntchito pamlingo wololera wambiri).

Baeta Long, malangizo ogwiritsira ntchito: njira ndi mlingo

Mankhwala a Baeta Long amawayendetsa pang'onopang'ono m'mimba, ntchafu kapena kutsogolo nthawi iliyonse masana, mosasamala kanthu za kudya.

Mlingo wovomerezeka wa hypoglycemic wothandizira ndi 2 mg 1 nthawi m'masiku 7.

Pankhani yosamutsa wodwala kuchokera ku Exenatide 2 kawiri patsiku (mankhwala a Bayeta) kupita ku chithandizo cha Bayeta Long, ndikotheka kuwona kuwonjezereka kwakanthawi kwamagazi a shuga, omwe nthawi zambiri amapezeka mkati mwa masiku 14 atayamba chithandizo.

Pogwiritsa ntchito mankhwalawa ndi thiazolidinedione, metformin, kaphatikizidwe ka zinthu izi, mlingo woyambira wa thiazolidinedione ndi / kapena metformin sungasinthe. Ngati Baeta Long adayikidwa limodzi ndi mpweya wa sulfonylurea, kuchepetsa mankhwalawa kungafunike kuti muchepetse chiopsezo cha hypoglycemia.

Baeta Long iyenera kuperekedwa kamodzi masiku 7, tsiku lomwelo la sabata. Ngati ndi kotheka, mutha kusintha tsiku lokonzekera mankhwalawa, koma mlingo wotsatira mu nkhani iyi uyenera kuperekedwa mosapitirira maola 24 mutatha jekeseni wam'mbuyomu.

Ngati mungadumphe mlingo, muyenera kuyikamo nthawi yochepa kwambiri, ndikugwiritsa ntchito Baeta Long monga mwa nthawi zonse. Chitani jakisoni awiri a mankhwalawa tsiku limodzi siliyenera kutero.

Kuchiza ndi mankhwalawa sikutanthauza kuti aziyang'anira kuchuluka kwa shuga m'magazi, komabe, kulamulidwa koteroko kungakhale kofunikira kuti musinthe mlingo wa mankhwala a sulfonylurea.

Kumayambiriro kwa kugwiritsidwa ntchito kwa othandizira ena a hypoglycemic atamaliza maphunziro a Bayeta Long, amafunika kuti aziganizira kuchuluka kwa mankhwalawa.

Wothandizira wa hypoglycemic adapangira odwala kuti azigwiritsa ntchito moyenera. Cholembera cha syringe kapena jakisoni imagwiritsidwa ntchito kamodzi kokha mwa wodwala m'modzi. Musanakonzekere kuyimitsidwa, onetsetsani kuti zosungunulira ndi zowonekera ndipo siziphatikiza tinthu tambiri. Kuyimitsidwa komwe kumachokera ku ufa sikungasungidwe; kuyenera kugwiritsidwa ntchito nthawi yomweyo pakukonzekera.

Osagwiritsa ntchito kukonzanso koyenda kale.

Wodwala kapena munthu womusamalira komanso osakhala ndi maphunziro a zachipatala ayenera kuphunzira mosamala malamulowo kuti adzivulaze nokha ndikutsatira mosamalitsa malangizo omwe afotokozedwa mu bukuli pogwiritsa ntchito cholembera / gawo la Baeta Long, lophatikizika ndi mankhwalawo.

Zotsatira zoyipa

Zochitika zodziwika bwino zomwe zidalembedwa munthawi ya mankhwala ndimankhwala anali mseru ndi m'mimba. Khansa ya m'mimba, yomwe inali yofala kwambiri, imawonekera mwa odwala ambiri kumayambiriro kwa maphunzirowa, pambuyo pake, pakachitika chithandizo, zotsatirapo za izi zimayamba kuchepa. Matenda ambiri omwe amapezeka pakugwiritsidwa ntchito kwa hypoglycemic othandizira anali am'mapapu kapena anali olimba.

Pogwiritsa ntchito Bayeta Long, zochitika zotsatirazi zidalembedwa:

kagayidwe kazakudya ndi mavuto: nthawi zambiri (≥ 1/10) - hypoglycemia¹ (kuphatikiza mankhwala a sulfonylurea, chifukwa chake nthawi zambiri zochitika za hypoglycemia zolembedwa m'mayesero azachipatala zinali zochepa komanso zimatsimikizika pambuyo pakukonzekera kwa chakudya cham'mimba), nthawi zambiri (≥ 1 / 100 ndi 50 ng / L Ngati vutoli la seramu calcitonin litakulirakulira, wodwalayo amayenera kukayezetsa mayeso ena. ducation chithokomiro.

Panthawi yolembetsa Baeta Long atalemba kale, panali malipoti a kulephera kugwira ntchito kwa impso, monga kuchuluka kwa seramu creatinine, kulephera kwaimpso, kukulira kulephera kwa impso, komanso kulephera kwaimpso. Nthawi zina, zoterezi zinali zofunika. Zambiri mwa izi zimatha kuyambitsidwa ndi madzi am'mimba chifukwa cha kutsegula m'mimba ndi / kapena kusanza komanso / kapena chifukwa chogwiritsa ntchito mankhwala omwe amasokoneza kagayidwe kamadzi kapena ntchito ya impso, zomwe zingaphatikizepo diuretics, mankhwala osokoneza bongo a antiidal (NSAIDs), angiotensin-converting enzyme inhibitors (ACE inhibitors). Mukamapereka mankhwala othandizira komanso kusiya mankhwala omwe amayambitsa izi, vuto laimpso limayambiranso. Nephrotoxicity ya exenatide malinga ndi zotsatira za kafukufuku sizinatsimikizidwe.

Poyerekeza ndi chithandizo cha mankhwala ndi Bayeta Long, kawirikawiri, kapangidwe ka kapamba kachulukidwe, kameneka kamadutsa pambuyo pa chithandizo cha kukonza, kunalembedwa. Komabe, mawonekedwe a hemorrhagic kapena necrotic pancreatitis ndi / kapena kufa anali osowa kwambiri. Zizindikiro za pancreatitis pachimake ndizopweteka kwambiri pamimba. Ngati mukukayikira kuti izi zikuchitika, mankhwalawa ayenera kusiyidwa.

Mukamagwiritsa ntchito exenatide, milandu yothamanga kwambiri imadziwika - pamlingo woposa 1.5 makilogalamu pa sabata. Kuchepetsa thupi kotereku kumatha kubweretsa zotsatira zoyipa, chifukwa chomwe ndi mbali iyi ndikofunikira kuyang'anitsitsa mosamala Zizindikiro za cholelithiasis.

Kukopa pa kuthekera koyendetsa magalimoto ndi njira zowerengeka

Kafukufuku wokhudzana ndi mphamvu yakuwongolera mphamvu zamagalimoto ndi njira zina sizinachitike. Pankhani yogwiritsira ntchito Baeta Long limodzi ndi kukonzekera kwa sulfonylurea mukamayendetsa kapena kugwiritsa ntchito njira zovuta, ndikulimbikitsidwa kuti chisamaliro chitengedwe kuti muchepetse kupezeka kwa hypoglycemia.

Mimba komanso kuyamwa

Amayi azaka zobereka azigwiritsa ntchito njira zodalirika zolerera panthawi ya chithandizo.Chifukwa chakuti Baeta Long amakhala ndi nthawi yayitali yochotsa, mankhwala osokoneza bongo amayenera kumaliza miyezi itatu asanakonzekere kutenga pakati.

Zambiri pazomwe zimagwiritsidwa ntchito ndi akazi azimayi omwe ali ndi pakati zimakhala zochepa. M'maphunziro a nyama zanyama zam'madzi, poizoni wakubala adapezeka.

Zambiri zomwe zimatsimikizira kuthekera kwa exenatide kuponyedwa mkaka wa munthu sizikupezeka.

Pa nthawi yoyembekezera komanso mkaka wa m'mawere, chithandizo cha Bayeta Long chimapangidwa.

Ndi mkhutu aimpso ntchito

Zakhazikitsidwa kuti odwala omwe amathandizidwa ndi Baeta Long pa mlingo wa 2 mg, pamaso pa matenda aimpso ofatsa komanso olimbitsa, kuwonjezeka kwa dongosolo la exenatide ndi 23 ndi 74%, motero, kumayang'aniridwa, poyerekeza ndi anthu omwe ali ndi ntchito yachilendo.

Pamaso pa kufooka pang'ono kwa matenda a impso (CC 50-80 ml / min), sikofunikira kusintha Mlingo wa Bayeta; chifukwa cha kuzungulira koopsa (30-50 ml / min), sikulimbikitsidwa kuti mugwiritse ntchito mankhwalawa chifukwa chodziwa kwambiri zaumoyo, munthawi yayitali. kusokonezeka (CC pansipa 30 ml / min) kapena kugwiritsidwa ntchito kwa mankhwalawa kumapeto kwa gawo.

Ndi chiwindi ntchito

Odwala omwe ali ndi vuto la chiwindi, kuphunzira kwa mankhwala osokoneza bongo sikuchitika. Popeza Baeta Long imachotsedwa makamaka ndi impso, zovuta za chiwindi zomwe sizikugwira zimakhudza kuchuluka kwa magazi a exenatide.

Pamaso pa matenda a chiwindi, kusintha kwa mankhwalawa sikofunikira.

Gwiritsani ntchito mu ukalamba

Zambiri zokhudzana ndi odwala okalamba ndizochepa, koma malinga ndi chidziwitso chomwe chilipo, kusintha kwakukulu pamlingo wa kutulutsa exenatide sikuyembekezeredwa ndikuwonjezereka kwa zaka mpaka zaka 75.

Pogwiritsa ntchito extenatide 2 pa tsiku pa mlingo wa 0,01 mg, odwala omwe ali ndi matenda a shuga 2 azaka zapakati pa 75-85 akuwonetsa kuwonjezeka kwa AUC (kukula kwa malo omwe ali kumapeto kwa pharmacokinetic) ndi pafupifupi 36% poyerekeza ndi odwala omwe ali ndi zaka 45-65, zomwe , mwina chifukwa cha kufooka kwa impso muukalamba.

Odwala okalamba omwe amagwiritsa ntchito Bayeta Long safuna kusintha kwa mlingo, koma kutha kwa kuchepa kwa ntchito ya impso ndi msinkhu kuyenera kuganiziridwanso.

Kuyanjana kwa mankhwala osokoneza bongo

• mankhwala amkamwa (mankhwala ozindikira kuchuluka kwa kutsuka kwa m'mimba): kuchepa kwakukulu kwa mankhwalawa ndi kuchuluka kwa mayamwidwe awa sikuyembekezeredwa, chifukwa chomwe kusinthaku kwa mankhwala awo sikofunikira,
• paracetamol (pa mlingo wa 1000 mg): patatha milungu 14 ya chithandizo ndi Bayeta Long, panalibe kusintha kwakukulu mu AUC ya paracetamol yomwe idatengedwa pamimba yopanda kanthu kapena itatha kudya, poyerekeza ndi nthawi yolamulira, ndende yayikulu (C_max) paracetamol mutatha kudya komanso pamimba yopanda kanthu yatsika ndi 5 ndi 16%, motero, komanso nthawi yakufika pozungulira (T_max) ikuwonjezereka kuchokera pafupifupi ola limodzi pakulamulira mpaka maola 1.3 (mutatha kudya) ndi maola 1.4 (pamimba yopanda kanthu),
• Kukonzekera kwa sulfonylurea: chiwopsezo cha hypoglycemia chikuchulukirachulukira, kusinthaku kwa mankhwalawa kungafunike.

Zotsatira za maphunziro pazogwirizana zomwe zidalembedwa ndi Exenatide 2 kawiri patsiku pa mlingo wa 0,01 mg:

• warfarin: mukamatenga warfarin, kuwonjezeka kwa T kunawonedwa patatha mphindi 35 pambuyo pa jekeseni wa exenatide_max pafupifupi maora awiri, kusintha kwakukuru C_max kapena AUC sanazindikiridwe, panali malipoti akuwonjezeka kwa INR, pakuyambirira kwa chithandizo cha mankhwala ndi Bayeta Long, ngati agwiritsidwa ntchito nthawi yomweyo ndi warfarin ndi / kapena coumarin ofunikira, ndikofunikira kuyang'anira zizindikiro za INR,
• hydroxymethylglutaryl-CoA reductase inhibitors (HMG-CoA reductase), kuphatikizapo lovastatin pa mlingo wa 40 mg 1 nthawi patsiku: kuchepa kwa C_max ndi AUC ya lovastatin ndi 28 ndi 40%, motsatana, komanso kuwonjezeka kwa T_max pafupifupi, mpaka maola 4 poyerekeza ndi mafuta omwe amawonekera pokhapokha mutatenga lovastatin yokha, pazesabata 30 zowongolera zomwe zimagwiritsidwa ntchito pogwiritsa ntchito exenatide ndi HMG-CoA reductase inhibitors, panalibe kusintha kwamphamvu kwa lipid metabolism, kusintha kwa mankhwalawa sikofunikira, koma ngati ndi kotheka, mbiri ya lipid iyenera kuyang'aniridwa,
• levonorgestrel (0.15 mg) ndi ethinyl estradiol (0,03 mg): palibe kusintha pazowonetsa C_max/ C_mphindi ndi AUC ya zinthu izi atatenga njira yolerera pakamwa, ziwalo zomwe zidali, ola limodzi asanakonzedwe kwa exenatide, pogwiritsa ntchito njira zophatikizira pakati pa mphindi 35 atayang'anira exenatide, kusintha kwa AUC sikunalembedwe, komabe, kuchepa kwa C kunawonedwa_max levonorgestrel ndi 27-41%, ethinyl estradiol ndi 45%, komanso kuwonjezeka kwa T_max pofika maola 2-5 chifukwa kuchepa kwa kuchuluka kwa matumbo, kutsika kwa C_max sikofunika mwakuthupi, kotero, kusintha kwa njira yolerera pakamwa sikofunikira,
• lisinopril ndi digoxin: palibe zofunikira pakuwona C zomwe zinajambulidwa_max kapena AUC yazinthu izi, koma kuwonjezeka kwa T kumawonedwa_max kwa maola awiri.

Zofanizira za Baeta Long ndi Trulicity, Viktoza, Baeta, Lixumia, ndi zina.

Migwirizano ndi machitidwe osungidwa

Sungani choyikiratu choyambirira pamalo otetezedwa ndi kuwala, kwa ana, kutentha kwa 2-8 ° C, osazizira. Mutatsegula paketi, mankhwalawa amatha kusungidwa mmatumba osindikizidwa osaposa milungu inayi pa kutentha osaposa 30 ° C.

Moyo wa alumali wa cholembera ndi zaka 2, kit ndi zaka zitatu.

Ndemanga za Baeta Long

Ndemanga za Baeta Long kuchokera kwa odwala omwe ali patsamba lachipatala sapezeka, chifukwa chakuti mankhwalawo adangolembedwa ndi Ministry of Health of Russia mchaka cha 2017. Akatswiri amakamba za exenatide ngati othandizira odwala matenda ashuga komanso mtundu wambiri wa 35 kg / m², omwe sanathe kukwaniritsa zigwiritsidwe za glycemic pokhapokha pa monotherapy ndi metformin / thiazolidinedione, kapena kuphatikiza kwa mankhwalawa kapena kuphatikiza kwa metformin Kukonzekera kwa sulfonylurea (mukamagwiritsa ntchito mankhwalawa muyezo waukulu wololera). Phindu lokhala ndi nthawi yayitali pochita zinthu zam'thupi limaphatikizanso chitetezo chamtima chokhazikitsidwa munthawi ya mayesero azachipatala komanso kutsika kwa ma jakisoni a 4-5 pamwezi. Izi, malinga ndi akatswiri, zitha kuthandiza kuwonjezera kutsatira kwa wodwala chithandizo.

Kufotokozera za mankhwalawa, mawonekedwe a mawonekedwe ndi mawonekedwe

Baeta imakhala ngati logoglucagon receptor agonist (glucagon-ngati peptide), yopangidwa poyankha chimbudzi ndi chakudya. Mankhwalawa amathandizira kuchepetsa mphamvu za glucose, amathandizira kugwira ntchito kwa maselo a beta mu kapamba.

Ngakhale kufanana ndi insulin, Baeta imasiyana ndi mahomoni mu kapangidwe kake kama mankhwala ndi mankhwala ena, komanso mtengo wake.

Mankhwalawa amapezeka m'matenti a syringe, omwe ndi analogue a insulin omwe amagwiritsidwa ntchito ndi odwala ambiri. Zingwe zopangira jakisoni siziphatikizidwamo, ndiye kuti ziyenera kugulidwa padera. Phukusili limangokhala ndi cholembera cha syringe chokha ndi makatoni olembetsedwa omwe amakhala ndi mankhwalawo mu voliyumu ya 1.2 kapena 2.4.

1. Chofunikira kwambiri ndi Exenatide (250 mcg).
2. Acetic acid sodium mchere (1.59 mg) ndi chinthu chothandiza.
3. Chuma Metacresol mu kuchuluka kwa 2.2 mg.
4. Madzi ndi zotulutsa zina (zimakhala mpaka 1 ml).

Baeta ndi njira yopanda utoto wopanda fungo.

Odwala apadera

Anthu omwe ali ndi matenda ashuga nthawi zambiri amakhala ndi matenda ena okhalitsa. Pankhaniyi, muyenera kusamala makamaka pogwiritsa ntchito mankhwala a Bayeta.

Gulu la odwala omwe amafunikira chisamaliro chapadera limaphatikizapo:

1. Kukhala ndi kuphwanya ntchito ya impso. Odwala omwe akuwonetsa kuchepa kwa aimpso mwina sayenera kusintha mlingo wa Bayet.
2. Kuphwanya chiwindi. Ngakhale izi sizikhudza kusintha kwa kuchuluka kwa magazi m'magazi, kufunsa dokotala wofunikira ndikofunikira.
3. Ana. Zotsatira za mankhwalawa pa thupi la achinyamata osakwana zaka 12 sizinaphunzire. Mu achinyamata zaka 12-16 zitakhazikitsidwa yankho (5 μg), magawo a pharmacokinetic anali ofanana ndi deta yomwe idapezeka mu kafukufuku wa odwala akuluakulu.
4. Amimba Chifukwa cha zovuta zomwe zingachitike ngati mankhwalawa amakula mwana wosabadwayo, amalephera kugwiritsidwa ntchito ndi amayi oyembekezera.

Mankhwala osokoneza bongo komanso kuyanjana ndi mankhwala ena

Mawonekedwe monga kusanza kwambiri, nseru yayikulu, kapena kuchepa m'magazi m'magazi kungasonyeze kuchuluka kwa mankhwalawa (kupitirira muyeso wovomerezeka wa nthawi 10).

Chithandizo cha mankhwalawa chikuyenera kukhala chochepetsa zizindikiro. Ndi chiwonetsero chofooka cha hypoglycemia, ndikokwanira kudya chakudya chamthupi, ndipo ngati pali zizindikiro zazikulu, angafunike kukhazikika kwa dextrose.

Pochita mankhwalawa ndi jekeseni la Bayeta, limodzi ndi mankhwala ena, mfundo zofunika kuziganizira ndi monga:

1. Mankhwala omwe amafunika kunyowetsedwa mwachangu m'matumbo am'mimba amayenera kumwa 1 ola limodzi asanayambitsidwe ndi Byet kapena mu chakudya chotere ngati jakisoni safunika.
2. Kuchita bwino kwa Digoxin kumatsika ndi kayendedwe kamodzi ka Byet, ndipo nthawi yake yakuwonjezeka imawonjezeka ndi maola 2,5.
3. Ngati kuli kofunika kuchepetsa kuthamanga kwa magazi ndi mankhwala a Lisinopril, ndikofunikira kuyang'anira nthawi yayitali pakati pa kumwa mapiritsi ndi jekeseni wa Bayet.
4. Mukatenga Lovastatin, theka la moyo wake limakulitsidwa ndi maola 4.
5. Nthawi yodzipatula ya warfarin kuchokera mthupi imawonjezeka ndi 2 maola.

Malingaliro okhudzana ndi mankhwalawa

Kuchokera pakuwunika kwa odwala, zitha kutsimikiziridwa kuti magwiridwe antchito a Bajeta ndi kuwongolera atatha kugwiritsa ntchito, ngakhale ambiri amawona mtengo wokwera wa mankhwalawo.

Matenda a shuga adawulula zaka 2 zapitazo. Munthawi imeneyi, kuyesera kuchepetsa shuga pogwiritsa ntchito mankhwala osiyanasiyana sikuyenda bwino. Mwezi watha, adotolo adandipatsanso jakisoni wampweya wa Bayet. Ndinawerenga ndemanga pa intaneti ndikuganiza zamankhwala. Zotsatira zake zinali zodabwitsa. M'masiku 9 okhazikitsidwa, shuga anali atachepera 18mmol / l mpaka 7 mmol / l. Kuphatikiza apo, ndinatha kutaya owonjezera a 9 kg. Tsopano sindikumva kukoma mkamwa mwanga. Chokhacho chomwe chimapangitsa kuti mankhwalawo akhale osavomerezeka ndi mtengo wabwino.

Elena Petrovna

Kwa mwezi umodzi anapha Baeta. Zotsatira zake, ndinatha kuchepetsa shuga m'magawo angapo ndikuchepetsa thupi ndi 4 kg. Ndine wokondwa kuti chisangalalo chachepa. Dotolo adalimbikitsa kupitiliza kuperekera mankhwalawa kwa mwezi wina, koma pakadali pano ndaganiza zokhala ndizotsatira zamankhwala ndikubwerera pamapiritsi akale. Mtengo wake ndi wokwera kwa ine, chifukwa sindingathe kuugula mwezi uliwonse.

Vidiyo pazogwiritsa ntchito cholembera cha syringe ndi mankhwala:

Kodi nditha kusintha mankhwalawo?

Palibe fanizo la yankho la kayendetsedwe ka Bayet pamsika wamafuta. Pali "Baeta Long" wokha - ufa wokonzekera kuyimitsidwa komwe kumagwiritsidwa ntchito jakisoni.

Mankhwala otsatirawa ali ndi zochizira zofanana, monga Baeta:

1. Victoza. Chidacho chapangidwa kuti chikhale chopondaponda ndipo chimapezeka ngati malembera. Kugwiritsidwa ntchito kwake ndi odwala omwe ali ndi matenda a shuga a 2 amatha kuchepetsa shuga ndikuchepa.
2. Januvia - likupezeka piritsi.Ndi njira imodzi yotsika mtengo yomwe imakhudzanso thupi.

Mankhwala a Baeta amapezeka kuzipatala zomwe amalembera. Mtengo wake umasinthasintha mozungulira ma ruble 5200.

Gwiritsani ntchito muubwana ndi ukalamba

Palibe chidziwitso cha mankhwalawa pa thupi la ana osakwana zaka 18, chifukwa chake, sichikugwiritsidwa ntchito pochita zawo. Ngakhale pali chidziwitso chogwiritsidwa ntchito mwa ana kuyambira zaka 12, Zizindikiro zamankhwala zinali zofanana ndi za akulu. Koma nthawi zambiri njira zina zimakhazikitsidwa.

Itha kugwiritsidwa ntchito pochiza odwala okalamba. Komabe, muyenera kuwunika momwe anthu omwe ali ndi mbiri ya ketoacidosis kapena omwe ali ndi vuto laimpso. Odwala oterewa amalangizidwa kuti azichita mayeso pafupipafupi.

Yerekezerani ndi mankhwala ofanana

Mankhwala odula awa ali ndi ma analogu omwe amathanso kugwiritsidwa ntchito pochiza matenda ashuga. Tiyeni tiwone madera awo mwatsatanetsatane.

Kugwiritsa ntchito analogues kumatheka pokhapokha ndi chilolezo cha adokotala. Kudzipatsa nokha koletsedwa!

Anthu amadziwa kuti zoyipa sizimachitika kawirikawiri, nthawi zambiri zimakhala ndi mlingo wosankhidwa bwino. Zotsatira za kuchepa thupi zimatchulidwa, ngakhale sizomwezo zonse. Mwambiri, "Bayeta" imawunika anthu odwala matenda ashuga omwe akudziwa zambiri.

Alla: “Ndakhala ndikugwiritsa ntchito mankhwalawa kwa zaka ziwiri. Munthawi imeneyi, shuga amabwerera mwakale, ndipo kulemera kwake kunachepa ndi 8 kg. Ndimakonda kuti imagwira ntchito mwachangu komanso popanda mavuto. Ndikukulangizani. ”

Oksana: "Baeta" ndi njira yodula, koma imathandizira ndi matenda a shuga. Shuga amapitilira chimodzimodzi, zomwe ndimakondwera nazo. Sindinganene kuti amachepetsa kwambiri kulemera, koma ndinasiya kuyambiranso. Koma kulakalaka kumawongolera. Ndikufuna kudya zochepa, chifukwa chake kulemera kwakhalapo nthawi yayitali. Nthawi zambiri, ndimakhutira ndi mankhwalawa. ”

Igor: “Anandipatsa mankhwalawa kuti andipatse chithandizo nditamwa mapiritsi anga akale. Mwambiri, chilichonse chimakwanira, kupatula mtengo wokwera kwambiri. "Bayetu" sichingatheke pazopindulitsa, muyenera kulamula pasadakhale. Uku ndiye kusokonekera kokhako. Sindikufuna kugwiritsa ntchito ma analogu pano, koma ndi angakwanitse. Ngakhale ndikutha kudziwa kuti ndinamva kusintha kwake msanga - masabata angapo atangoyamba kumwa. Chikhumbo chinachepa, motero adachepetsa thupi nthawi yomweyo. ”

Pomaliza

"Baeta" ndi mankhwala othandiza omwe amadziwika kwambiri pakati pa odwala matenda a shuga. Nthawi zambiri amamuika mankhwala ena akasiya kugwira ntchito. Ndipo mtengo wokwera umatha chifukwa cha kuwonjezeka kwa kuchepa thupi komanso kuwonetsa kovuta kwa odwala omwe akupatsidwa chithandizo. Chifukwa chake, "Bayeta" nthawi zambiri imakhala ndi malingaliro abwino kuchokera kwa onse omwe amagwiritsa ntchito mankhwalawa ndi madokotala.

Zolemba za maphunziro a matenda a shuga a 2 okalamba

Njira yodwala matenda ashuga a mtundu 2 kwa anthu okalamba ndiosiyana ndi kwa achinyamata. Matendawa ali ndi zotsatirazi:

• Imachitika popanda zizindikilo zakunja zokhala ndi matenda a shuga - palibe Zizindikiro zakukodza pafupipafupi, ludzu, pakamwa lowuma,
• pali zizindikiro zapadera za matendawa - kusokonezeka kwa kukumbukira, kufooka wamba,
• Kusintha kwamapangidwe m'makoma amitsempha yamagazi wapezeka kale panthawi yodziwitsa,
• Matenda a minyewa angapo akupanga,
• mwa odwala ambiri okalamba, kuwunika kwa labotale sikuwonetsa kukwezeka kwa magazi m'thupi.

Kaya chithandizo chamankhwala okalamba chikuyenda bwino zimadalira zinthu zambiri:

• zambiri za wodwala
• kukhalapo kapena kusakhalapo kwa mtima
• kumvetsetsa kwa odwala komanso kuthekera kochita zinthu zofunika tsiku ndi tsiku - kuwunika shuga, kumwa mapiritsi, kudya,
• kuopsa kwa hypoglycemia - kuchepa kwambiri kwa shuga m'magazi pansi pa mulingo woyenera,
• kuchuluka kwa kusokonezeka kwa chidwi mwa wodwala - kuchepa kwa kukumbukira, kusungidwa kwa kulingalira, kuganiza bwino kwa malingaliro.

Kusungulumwa, penshoni yocheperako, kuyiwalako, zovuta zophunzira njira zofunikira za matenda ashuga pakudziletsa kwamatenda zimayambitsa zovuta zina pothandizira odwala okalamba.

Lembani mankhwala a shuga a 2 kuti muchepetse shuga

Mankhwala ochepetsa msuzi amagawika m'magulu angapo malinga ndi momwe amachitira. Mndandanda wamakalasi a mankhwala osokoneza bongo a shuga ndi motere:

• biguanides (metformin),
• Kukonzekera kwa sulfonylurea
• glinids (meglitinides),
• kachikachiyama (glitazones),
• α-glucosidase zoletsa,
• glucagon-ngati peptide receptor agonists -1 (aGPP-1),
• dipeptidyl peptidase-4 zoletsa (IDPP-4, gliptins),
• lembani 2 sodium glucose cocransporter zoletsa (INGLT-2, glyphlosins),
• insulini.

Mapiritsi zochizira matenda a shuga okalamba 2, zofunika zapadera zimagwira:

• chiopsezo cha hypoglycemia - kutsika kwadzidzidzi kwa shuga m'munsi mwambiri, kuyenera kuchepetsedwa
• kusowa kwa chiwindi, impso, mtima,
• mankhwalawa sayenera kuyenderana ndi mankhwala ena.
• kumwa mapiritsi kuyenera kukhala kosavuta.

Zochizira matenda amtundu wa 2 odwala okalamba, mankhwala otetezeka kwambiri ndi ma dipeptidyl peptidase-4 inhibitors. Ndi kugwiritsa ntchito kwawo, chiwopsezo cha hypoglycemia amachepetsa.

Metformin imalembedwa kwa anthu aang'ono ndi okalamba, ngati wodwalayo alibe zotsutsana ndi kuvomereza kwake.
Mosamala, odwala azaka zoyenera ayenera kukonzekera sulfonylurea, popeza chiwopsezo cha hypoglycemia chimawonjezeka ndi ukalamba. Pambuyo pa zaka 61, osavomerezeka kumwa gibenclamide - mapiritsi a gululi.

Chenjezo limaperekedwa kuti alembe 2 sodium glucose cotransporter inhibitors. Sayenera kugwiritsidwa ntchito ndi ma diuretics.
Thiazolidinediones ngati njira yothandizira odwala matenda ashuga okalamba sizomwe zidalembedwa.

Biguanides pochiza matenda a shuga agwiritsidwa ntchito kwazaka zopitilira 50. Omwe akuimira gulu lantchito la mankhwalawa ndi metformin ndi phenformin. Komabe, phenformin idathetsedwa chifukwa chowonjezera chiopsezo cha kupangika kwa lactic acidosis pamene akumatenga. Lactic acidosis (mkaka chikomokere) ndizovuta zowonjezera zomwe zimakhudzana ndikuphwanya acid acid yoyambira bwino pakukweza kwa acidity. Lactic acidosis yoyambitsidwa ndi metformin ndiyosowa kwambiri. Chifukwa chake, kuyambira 2005, malinga ndi malingaliro a mabungwe apadziko lonse a shuga, metformin ndi mankhwala a mzere woyamba wochizira matenda a shuga a mtundu wachiwiri.

Kukonzekera koyambirira kwa metformin ndi mankhwala omwe ali pansi pa mayina ogulitsa Siofor (Berlin-Chemie AG, Germany), Glucophage (Nycomed, Austria). Mapiritsi ali ndi mitundu yambiri ya mankhwala - generic mankhwala.

Metformin ndi piritsi yothandiza kuchepetsa magazi yomwe imagwiritsidwa ntchito kwambiri m'maiko ambiri. Mankhwalawa amagwiritsidwa ntchito pochiza matenda a shuga a 2 kwa nthawi yayitali, chifukwa chake zochita za antihyperglycemic zimamveka bwino. Kukhazikika kuti mankhwalawa amayambitsa:

• kuchepa kwam'mimba chakudya
• kuchuluka kutembenuka kwa shuga m'matumbo mwanga,
• kuchuluka kwa insulin kwa ma receptor,
• kuchuluka kwa shuga m'mimba,
• kutsika kwa shuga m'magazi, triglycerides ndi lipoproteins ochepa,
• kuchuluka kwa osachulukitsa lipoproteins.

Metformin imagonjetsa kukana, kusazindikira (kukana) kwa zotumphukira zimakhala ku insulin, makamaka minofu ndi chiwindi. Chifukwa chogwiritsa ntchito mankhwalawa:

• kupanga shuga kumalepheretsa chiwindi,
• insulin sensitivity ndi minofu ya glucose ikukweza
• mafuta acids amadzaza

Kutsika kwa zotumphukira za insulin kukakamizidwa ndi metformin kumapangitsa kuti pakhale shuga mu chiwindi, minofu ndi minyewa ya adipose. Chifukwa cha izi, hyperglycemia sichimakula, zomwe ndizowopsa pakupanga zovuta za matendawa.

Zina mwazotsatira za metformin ndi kutsekula m'mimba ndi mavuto ena am'mimba: kulawa kwazitsulo pakamwa, nseru, matenda a anorexia, omwe kumayambiriro kwa chithandizo amawonedwa pafupifupi 20% ya odwala, koma zimadutsa patatha masiku angapo. Matendawa amakhudzana ndikuchepa kwa mayamwidwe a shuga m'matumbo aang'ono ndi metformin. Zokwanira mu chakudya cham'mimba, chakudya chopatsa mphamvu chimapangika kupatsa mphamvu komanso kusweka. Kusinthasintha pang'onopang'ono kwa wodwalayo kuti apangidwe ndi metformin kumathandizidwa ndi kupatsidwa mankhwala osachepera 500 mg, woyamba asanagone, kenako palimodzi kapena atatha kudya, ndi kapu yamadzi. Metformin imawonjezera lactate zomwe zimakhala m'matumbo aang'ono ndipo imangochulukitsa kuchuluka kwake m'magazi, zomwe zimawonjezera chiopsezo cha lactic acidosis.

Kafukufuku wasonyeza kuti pochiza matenda ashuga, metformin ndi mankhwala othandiza omwe amachepetsa shuga m'magazi pachiwopsezo chokhala ndi hypoglycemia poyerekeza ndi sulfonylurea ndi insulin. Siofor ndi mankhwala othandiza omwe amachepetsa kupanga shuga ndi chiwindi, zomwe zikutanthauza kuti zimakhudza chinthu chofunikira kwambiri pakuwonjezera kuchuluka kwa shuga m'magazi.

Tsopano metformin ndiye mankhwala abwino kwambiri ochizira matenda amishuga a 2. Sungatchedwe kuti mankhwala aposachedwa, chida cham'badwo wotsiriza, koma chidwi cha mankhwalawa sichitha. Kafukufuku wambiri amachitika ndi mankhwalawa. Mankhwalawa ndi apadera, monga momwe mwayi watsopano wamagwiritsidwe ake umawululidwa.
Zimakhazikitsidwa kuti kuwonjezera pa antihyperglycemic, metformin imakhala ndi zotsatiranso zina. Mankhwalawa amakhudza njira zomwe zimatsogolera pakukula kwa atherosulinosis:

• Amagwira ntchito za endothelium - masanjidwe a maselo okhala mkati mwa magazi ndi ziwiya zamitsempha, zamitsempha yama mtima,
• amachiritsa matenda osachiritsika,
• amachepetsa kuopsa kwa oxidative nkhawa - njira maselo kuwonongeka chifukwa makutidwe ndi okosijeni,
• bwino zimakhudza mafuta kagayidwe ndi njira ya kusungunuka kwa magazi kuundana.

Metformin si chithandizo chokwanira cha matenda a shuga a mtundu wachiwiri, komanso mankhwalawa omwe ali ndi prophylactic zotsatira zolimbana ndi matenda a mtima. Mankhwala amatha kulepheretsa kukula kwa maselo a chotupa, komanso kuchepetsa kuchepa kwa ukalamba. Komabe, maphunziro owonjezera amafunikira kutsimikizira izi.

Dipeptidyl peptidase-4 inhibitors (gliptins) - mankhwala atsopano a shuga

Ma inhibitors a dipeptidyl peptidase-4 ndi mankhwala atsopano omwe amachepetsa shuga ya magazi. Mankhwalawa adapangidwa ndikuganizira chidziwitso cha thupi la ma insretins, mahomoni omwe amapangidwa pambuyo pa chakudya komanso zomwe zimapangitsa kuti pakhale insulin, yomwe idawoneka m'zaka za m'ma 2000. Malinga ndi momwe machitidwe a gulu lino la mankhwalawa atengedwera:

• shuga wodalira shuga
• shuga yodalira glucagon katulutsidwe - katemera wa kapamba,
• kuchepa kwa shuga m'magazi.

Chimodzi mwazinthu zabwino zazikulu za gulu latsopano lamapiritsi ochepetsa shuga ndikusowa kwa chiopsezo cha hypoglycemia. Mu ukalamba, zochitika za hypoglycemic zimatha kuyambitsa vuto la matenda oopsa, kupanikizana kwa ziwiya zam'mimba ndi chitukuko cha infarate yokhala ndi myocardial infarction, kuwonongeka kwadzidzidzi.
Ma Gliptins angathe kutumizidwa:

• zochizira odwala omwe apezeka ndi matenda a shuga,
• osalekerera kapena kuphwanya malire poika ma biguanides,
• kuphatikiza ndi mapiritsi ena ochepetsa shuga.

Mankhwala amakhala ndi zovuta zochepa, samayambitsa kuwonjezeka kwa thupi, kuchepa kwapang'onopang'ono kwa m'mimba. Kulandila kwa glyptins sikuyenda ndi chitukuko cha edema. Mankhwalawa amitundu iwiri ya matenda ashuga amatha kumwa mankhwala aliwonse a impso. Metformin, glucagon-like peptide receptor agonists, ndi cy-glucosidase inhibitors amachititsa kukhumudwa m'matumbo, pomwe glyptins amaloledwa bwino ndi odwala.
Koma chithandizo chatsopano cha matenda ashuga chili ndi vuto lalikulu. Mankhwalawa ndi okwera mtengo.
Mosamala, mankhwala a shuga omwe ali mgululi "dipeptidyl peptidase-4 inhibitors" adalembedwa:

1. kulephera kwambiri kwa chiwindi (kupatula saxagliptin, linagliptin),
2. ndi kulephera kwa mtima.

Mapiritsi a matenda amtundu wa 2 shuga a gulu la gliptins amalembedwa mu ketoacidosis, vuto la shuga lomwe limadza chifukwa cha kusowa kwa insulin panthawi yapakati komanso mkaka wa m'mawere.
Muzochita zamankhwala, ma dipeptidyl peptidase-4 zoletsa agwiritsidwa ntchito kuyambira 2005. Mndandanda wamankhwala omwe ali m'gulu la IDPP-4 lolembetsedwa ku Russia awonetsedwa mu tebulo 1.
Gome 1

Pakati pawo, ma gliptins amasiyana nthawi yotenga kanthu, kuyanjana ndi mankhwala ena, mwayi wogwiritsidwa ntchito m'magulu ena a odwala. Pankhani yochepetsera kuchuluka kwa shuga m'magazi, chitetezo ndi kulolerana, mapiritsi amtundu wa 2 awa ndi ofanana.

Mankhwalawa a shuga amaperekedwa limodzi ndi metformin. Vildagliptin ndi sitagliptin atha kutumikiridwa ndi insulin kukonzekera, komwe kumatsegula mwayi watsopano wophatikiza mankhwala kwa odwala omwe atenga nthawi yayitali.

Zoletsa za dipeptidyl peptidase-4 kuyambira pomwe mawonekedwe awo adakwanitsa kutenga malo olimba pakati pa mankhwalawa pochizira matenda a shuga a 2. Chiwopsezo chochepa cha hypoglycemia, osakhudzanso kulemera kwa thupi, ndipo palibe zoyipa zochokera m'matumbo am'mimba zimasiyanitsa kalasi ili la mankhwala ndi mankhwala ena pochizira matenda amtundu wa 2.

Kukonzekera kwa Sulfonylurea

Malinga ndi momwe amagwirira ntchito, kukonzekera kwa sulfonylurea ndi gawo la othandizira omwe amayambitsa insulin secretion (secretagogues). Kwa zaka zambiri, mankhwalawa a gululi akhala abwino pakati pa mapiritsi onse omwe amachepetsa shuga ya magazi. Mapiritsi amathandizira kupanga insulini m'magazi ndipo ndi njira yothandiza kwambiri pakuwongolera shuga.

Koma kugwiritsa ntchito sulfonylurea kukonzekera kumalumikizidwa ndi kuwonjezeka kwakukulu kwa kulemera kwa thupi ndi chiopsezo cha hypoglycemia, ndipo chitetezo chamthupi chimayamba msanga. Chifukwa chake, gululi la mankhwalawa limatsutsana ndi mankhwala ena omwe amachepetsa shuga la magazi. Koma ngati pali contraindication pakugwiritsa ntchito metformin, sulfonylureas amalembedwa ngati mapiritsi akuluakulu.

Odwala okalamba, chifukwa cha chiwopsezo cha hypoglycemia, kukonzekera kwa sulfonylurea kumalimbikitsidwa kuti ayambitsidwe Mlingo wokwanira theka akadali aang'ono, ndipo mlingo uyenera kuwonjezeka pang'onopang'ono.

Mndandanda wa mankhwala omwe ali mgululi ndiwotalikirapo. Mankhwala amagawika m'mibadwo iwiri. Oimira ambiri am'badwo wotsatira wa sulfonylurea ndi glimepiride, glibenkamide, glyclazide, glipizide, glycidone.Mankhwala a m'badwo woyamba sagwiritsidwa ntchito pochita matenda.
Mndandanda wa mankhwala am'magulu a sulfonylurea aperekedwa mu tebulo 2.
Gawo 2

Mavuto ena akhoza kubuka, omwe mapiritsi ndi abwino kwa wodwala wina, yemwe mankhwalawo amachokera pamndandanda. Pakati pawo, mapiritsiwa ndi osiyana:

• magazi kutsitsa ntchito,
• Kutalika kwa kuchitapo kanthu
• Malangizo
• chitetezo.

Kafukufuku wambiri wachitika momwe mankhwala othandizira odwala matenda ashuga a sulfonylurea adayesedwanso kuti atetezeke. Komabe, ndi glibenclamide okha omwe adadziwika ndi World Health Organisation ndi Unduna wa Zaumoyo ku Russia ngati mankhwala abwino kwambiri omwe amalimbikitsidwa kuti agwiritse ntchito matenda a shuga kuchokera kwa onse oimira kalasi iyi.

Glibenclamide ndi piritsi ya shuga yothandiza yomwe yapulumutsa miyoyo ya odwala ambiri padziko lonse lapansi. Mankhwalawa ali ndi njira yodziwika yothandizira, komanso ndi yekhayo mankhwala a sulfonylurea omwe chitetezo chawo chimayesedwa pakagwiritsidwe ntchito mwa amayi apakati. Kuchita bwino ndi chitetezo cha glibenclamide pochiza matenda amtundu wa 2 zatsimikiziridwa ndi kafukufuku wautali wa umboni wokwera. Mphamvu yowonjezera ya mankhwalawa pakuchepetsedwa kwa zovuta za microvascular ndi kugwiritsa ntchito kwakanthawi kumadziwika. Kuchiza ndi glibenclamide imodzi kwazaka zambiri kumawonedwa ngati njira yofunika kwambiri, nthawi zina chithandizo chokhacho chothandiza.

Zoposa zaka 10 zapitazo, mawonekedwe a glibenclamide adapangidwa, omwe ali ndi zabwino kwambiri, pafupifupi zana la bioavailability, zomwe zimayamba mwachangu kwambiri.

Okalamba salimbikitsidwa kuti apereke sulfonylureas yayitali yochita chiopsezo cha hypoglycemia. M'malo mwake, ndibwino kutenga gliclazide, glycidone.

Ma glinids (meglitinides)

Ma Clinids amalimbikitsa katemera wa pancreatic insulin. Muzochita zamankhwala, gulu ili la mapiritsi a mtundu wa 2 shuga limagwiritsidwa ntchito pafupipafupi: silothandiza kwenikweni kuposa mankhwala a sulfonylurea, koma ndi okwera mtengo. Makamaka, ma glinids amapatsidwa shuga wa magazi akamatuluka atatha kudya (postprandial glycemia). Mankhwala amalimbikitsa gawo loyambirira la insulin. Atatha mapiritsiwo, amawamwetsa mwachangu, ndikufika pandende yayikulu kwambiri ya plasma mkati mwa ola limodzi.
Makhalidwe a mankhwalawo, mndandanda wazabwino ndi zoyipa zomwe amagwiritsidwa ntchito ndi mankhwala opangidwa ndi dongo akuwonetsedwa mu tebulo 3.
Gawo 3

Α-glucosidase inhibitors - mankhwala atsopano

Limagwirira a zochita za mankhwala a kalasi la cy-glucosidase inhibitors zimakhazikitsidwa pang'onopang'ono kumasulidwa kwa glucose kuchokera ku zovuta zamankhwala. Izi zimachepetsa hyperglycemia atatha kudya. Mwa kuwongolera kuyamwa kwa glucose m'matumbo, alpha-glucosidase inhibitors amachepetsa kusinthasintha kwa tsiku ndi tsiku m'madzi am'magazi.

Mankhwala a gululi salimbikitsa insulin secretion, chifukwa chake, osatsogolera ku hyperinsulinemia, osayambitsa hypoglycemia. Kuchepetsa kuyamwa kwa glucose m'magazi motsogozedwa ndi mankhwala a kalasi cy-glucosidase inhibitors kumathandizira kugwira ntchito kwa kapamba ndikuwatchinjiriza ku kutopa kwambiri.

Class cy-glucosidase inhibitors imaphatikizapo acarbose, miglitol, ndi voglibosis. Mankhwala atsopano kuchokera pagululi ndi voglibosis. Malinga ndi mayesero azachipatala, voglibosis imathandiza kwambiri pochiza odwala omwe ali ndi matenda a shuga a 2 omwe amakhala ndi glucose othamanga kwambiri (7.7 mmol / L) ndi high postprandial glycemia (oposa 11.1 mmol / L). Ubwino wa mankhwalawa ndikuti palibe zomwe zimachitika mu hypoglycemic, zomwe ndizofunikira kwambiri kwa okalamba.
Ku Russia, ma acarbose okha ndi omwe amalembetsa ku mankhwala osokoneza bongo. Dzina lamalonda lazinthu zomwe zili ndi ichi ndi Glucobay. Mapiritsi amapezeka mu mlingo wa 50 ndi 100 mg, ayenera kumwedwa katatu patsiku.

Zotsatira zoyipa zomwe zimachitika kwambiri mukamamwa ma cul-glucosidase inhibitors zikutuluka, kusokonekera komanso kutsekula m'mimba, zovuta zomwe zimatengera mlingo wa mankhwalawa komanso kuchuluka kwa chakudya. Zotsatira izi sizingatchulidwe kuti ndi zowopsa, koma ndi chifukwa chofala chomwe amachotsera mankhwalawa. Zotsatira zoyipa zimayamba chifukwa cha kuchuluka kwa chakudya chamafuta omwe amapaka m'matumbo akulu. Kukula kwa zosafunikira zotsatira kumachepetsedwa ndikuyamba kulandira chithandizo chochepa ndi kukulitsa Mlingo pang'onopang'ono.

Kuphwanya kwakukulu kogwiritsa ntchito mankhwalawa a kalasi cy-glucosidase inhibitors ndi matenda am'mimba.

Glucagon-ngati peptide receptor agonists -1 - mankhwala a shuga a mibadwo yotsiriza

Glucagon-like peptide-1 receptor agonists (AH) (GLP-1) ndi mankhwala aposachedwa kwambiri pochiza matenda ashuga.
Chochita chachikulu chogwiritsira ntchito mankhwalawa mkalasi ndicho kukondoweza kwa insulin yotulutsidwa ndi maselo a beta. Mankhwala amachepetsa m'mimba. Izi zimachepetsa kusinthasintha kwa postprandial glycemia. Mankhwala osokoneza bongo a mkalasi imeneyi amathandizira kumverera kwodzaza ndi kuchepetsa kudya, kuchepetsa chiopsezo chokhala ndi matenda amtima.
Mndandanda wa mankhwala a gulu la glucagon-ngati peptide-1 receptor agonist akuwonetsedwa mu tebulo 4.
Gawo 4

Zomwe zalembedwera AR GPP-1 zili ndi zosiyana pamapangidwe amitundu.Ena mwa mankhwalawa amagwiritsidwa ntchito kale - amawongolera shuga pambuyo pakudya, pomwe ena - omwe siopanda mankhwala - amachepetsa shuga la magazi.

Short-acting prandial ARGP-1 ARs (exenatide ndi lixisenatide) amalepheretsa katulutsidwe wa glucagon ndikuchepetsa gastric motility ndikuchotsa. Izi zimabweretsa kutsika kwa mayamwidwe a glucose m'matumbo ang'onoang'ono komanso moyenera amachepetsa kutulutsa kwa insulin.

Ma ARGP-1 AR omwe amakhala atakhala kwa nthawi yayitali amathandizira kapamba, kuchititsa insulin kutchinga komanso kuletsa kupanga kwa glucagon. Izi zimathandizira kuchepa kwapang'onopang'ono kwa postprandial glycemia komanso kuchepa kwakukulu kwa glucose yothamanga popewa kubisalira kwa glucagon ndikuchepetsa chilakolako chofuna kudya.

Ma nonprandial ARPP-1 AR akuphatikiza ndi ma exenatide osachedwa, liraglutide, albiglutide, ndi semaglutide. Njira zingapo zochitira zinthu zimachepetsa kuyamwa kwa zinthu kuchokera kumisempha yodutsa. Zotsatira zake, kutalika kwa mankhwalawa kumawonjezeka.
Zabwino ndi zoyipa zamakalasi A mankhwala a GLP-1 amalembedwa pa tebulo 5.
Gawo 5

Gulu latsopanoli la mankhwala likulembedwera chithandizo cha matenda a shuga 2 ngati njira yolumikizira mankhwala a metformin, sulfonylureas, kapena kuphatikiza kwa izi kuti apititse patsogolo kulamulidwa kwa glycemic.

Kulandila kwa kalasi A mankhwala a GLP-1 sikuyenda ndi hypoglycemia, koma 30 - 45% ya odwala amawonetsa zovuta kuchokera m'matumbo am'mimba - kusokonezeka mu mawonekedwe a mseru, kusanza kapena kutsegula m'mimba, komwe kumachepera nthawi.

Type 2 sodium glucose cotransporter inhibitors (glyphlozines) - mitundu yatsopano yamankhwala 2 a shuga

Mitundu 2 ya sodium glucose cocransporter inhibitors (INGLT-2) ndi mapiritsi aposachedwa omwe amachepetsa shuga la magazi. Monga njira ya m'badwo waposachedwa, INGLT-2 imachita zinthu mosiyana kwambiri ndi mtundu wina uliwonse wa mankhwala a shuga. Limagwirira a zochita za mankhwala a mkalasi lino amachepetsa kuyimitsanso kwina kuphatikizira shuga mu impso. Izi zimachotsa glucose m'thupi mkodzo. Zotsatira zake, pali kuchepa kwakutali, komwe amadalira glucose akamakulitsa katulutsidwe ka insulin komanso kuchepa kwa insulin.

Mndandanda wa mankhwala a kalasi ya glyphlozin omwe adalembetsedwa ku Russia ndi mayina awo azamalonda ndi awa:

• dapagliflozin (Forsig),
• empagliflozin (ma jardins),
• canagliflozin (Invocana).

Mapiritsi a kalasi ya Glyphlosin amalimbikitsa kuphipha kwa shuga mu mkodzo. Kuchokera pamenepa, odwala amachepetsa thupi. Mu maphunziro, odwala omwe amatenga dapagliflozin osakanikirana ndi metformin kwa milungu 24 adataya thupi kwambiri kuposa omwe amatenga metformin yokha. Kulemera kwa thupi sikuchepetsa osati chifukwa chamadzi, komanso chifukwa cha mafuta. Komabe, mankhwala atsopano a shuga sangakhale piritsi la chakudya. Kuchepa kwambiri kwa thupi kumachepa pomwe shuga m'magazi amafika pamitengo yochepa.

Mankhwala a kalasi ya Glyphlosin amawonetsedwa pa gawo lililonse la matendawa kuphatikiza mitundu ina iliyonse yamankhwala. Ndi otetezeka komanso ogwira ntchito.
Komabe, odwala omwe akutenga dapagliflozin ali pachiwopsezo chotenga matenda amtundu, makamaka matenda oyamba ndi mafangasi.Komanso, mankhwalawa m'sukuluyi amalimbikitsa kuchuluka kwa lipoprotein otsika, komwe ndikofunikira kuganizira, chifukwa odwala matenda a shuga ali pachiwopsezo cha matenda amtima.
Zowopsa zomwe zingachitike mutatenga mapiritsi a kalasi ndi mtundu 2 wa sodium glucose cotransporter zoletsa:

• achina,
• kuwonongeka kwaimpso,
• diuretic kwenikweni
• kutsika kwa magazi pamagazi,
• kutsitsa magazi
• kuphwanya mineral metabolism.

Mankhwala amathandizidwa mosamala mu ukalamba, ndi matenda opatsirana a genitourinary thirakiti, pamene akumwabe okodzetsa.
Mankhwala a kalasi ya Glyphlosin ali ndi vuto lalikulu. Ndiokwera mtengo.

Thiazolidinediones (glitazones) - mankhwala atsopano a shuga 2

Thiazolidinediones ndi gulu latsopano la mankhwala. Adavomerezedwa kuti agwiritsidwe ntchito ngati mankhwala ochizira matenda a shuga 2 mu 1996. Kupanga kwawo kwamachitidwe ndi kuwonjezeka kwa insulin sensivivity, ndiko kuti, insulin kukana, chimodzi mwamagawo ofunikira a shuga.

Kuthana ndi kuchepetsedwa kwa chidwi cha maselo ku insulin, mapiritsi amathandizira mphamvu yokhudza thupi lawo la insulin ndipo nthawi yomweyo amachepetsa kuchuluka kwake m'magazi. Kuphatikiza apo, glitazones amatha kusungirako magwiridwe antchito, ndiye kuti, amatha kuletsa matenda amtundu wa 2, omwe amawapangitsa kukhala apamwamba kuposa mapiritsi ena pochiza matenda ashuga.

Ku Russia, mankhwala awiri ochokera pagulu lomwe analingaliridwa adalembetsa - rosiglitazone ndi pioglitazone. Odwala amatenga rosiglitazone padziko lonse lapansi kwazaka zambiri. Nthawi zambiri amatumizidwa ndi matenda ashuga ku Russia. Kutetezeka kwa mtima wa Rosiglitazone kunanenedwapo kale: chiopsezo chowonjezereka cha kuphwanya myocardial ndi kufa kwamtima. Komabe, mankhwalawo pambuyo pake adakonzedwanso.

Kafukufuku awonetsa kuti ngati rosiglitazone amathandizidwa ndi mankhwala amodzi kokha kwa nthawi yayitali, kufunika kowonjezeranso mankhwala sikubwera mwachangu monga momwe kumachitikira ndi ena (glyburide kapena metformin) omwe amaphunzira mankhwala.

Glitazone mankhwala ili ndi maubwino angapo. Koma achipatala sathamangira kuyambitsa mankhwala a mkalasi lino machitidwe ambiri. Maganizo a gulu lachipatala okhudzana ndi kufunikira ndi chitetezo cha ntchito ya thiazolidatedione agawidwa. Zomwe zimatsutsa kwambiri ndikusowa kwa chidziwitso pa chitetezo cha mankhwalawa kwa nthawi yayitali.
Zambiri pazotsatira zoyipa za glitazones ndizofunikira:

• kunenepa kwambiri (pafupifupi 3 - 6 kg),
• madzi osungidwa ndi chitukuko cha edematous syndrome ndi kulephera kwa mtima,
• kuchepa kwa mafupa a minerals.

Kafukufuku wowonjezera amafuna deta yomwe kugwiritsidwa ntchito kwa thiazolidinediones kumalumikizidwa ndi chiwopsezo chowonjezeka cha neoplasms zoyipa, makamaka zotupa za colon, monga momwe zimatsimikizidwira ndi maphunziro oyesera. Chiwopsezo chowonjezeka chapezeka pamlingo wokulirapo wa rosiglitazone.
Musanalembe mankhwala a kalasi ya thiazolidinedione, ndikofunikira kuti muwunike kuopsa kwa mtima. Zomwe zimayambitsa chiwopsezo chake ndi izi:

• kulephera kwa mtima
• myocardial infarction kapena matenda a mtima,
• ochepa matenda oopsa
• lamanzere lamitsempha lamanzere,
• kuwonongeka kwakukuru m'mavala a mtima,
• zaka zopitilira 70
• nthawi yodwala matenda ashuga yoposa zaka 10,
• kutupa kapena kuchiza ndi malupu okodzetsa,
• kukula kwa edema kapena kuwonda pakukula mankhwalawa ndi glitazones,
• mankhwala a insulin
• kukhalapo kwa matenda a impso kulephera (creatinine woposa 200 μmol / l).

Kuphunzira njira zolondola ndi madera omwe kugwiritsa ntchito mankhwalawo gululi, maphunziro ambiri azachipatala akhala akupitilizidwa.

Koma mpaka pano, mankhwala aposachedwa a mtundu wachiwiri wa matenda ashuga a mtundu wa thiazolidatediones sanagwiritsidwe ntchito ngati mankhwala akuluakulu othandizira odwala. Ziyeso zowonjezera zamankhwala ziyenera kuchitidwa kuti zitsimikizire chitetezo kuti chigwiritsike ntchito kwa nthawi yayitali.

Okalamba insulin mankhwala

Ndi maphunziro apang'onopang'ono a shuga, ndizotheka kupereka insulin kwa wodwala. Insulin siyingatengedwe pakamwa ngati mapiritsi, chifukwa madzi a m'mimba amaziwona mwanjira yomweyo monga chakudya ndikuphwanya mofulumira kuposa momwe zimakhalira. Kuti mupeze mlingo wa insulin, muyenera kupeza jakisoni. Njira zochizira kukonzekera kwa insulin mu ukalamba sizosiyana ndi zomwe odwala amakumana nazo.

Ma insulin amagawidwa kukhala mankhwala achidule komanso osakhalitsa. Kutalika kwa nthawi ya insulin mu anthu osiyanasiyana ndi munthu payekha. Chifukwa chake, kusankha kwa insulini regimen kumachitika moyang'aniridwa ndi madokotala. Mu chipatala, mulingo wa glycemia umayendetsedwa, mlingo wa insulin umasankhidwa molingana ndi njira za metabolic m'thupi, zakudya, zolimbitsa thupi.

Popeza wodwalayo amapereka insulin payekha, chithandizo cha insulin mwa odwala okalamba ndizotheka pokhapokha ngati ntchito zachidziwitso za odwala okalamba zimasungidwa, malingaliro awo adziko ndi okwanira, ataphunzira malamulo a insulin chithandizo ndikudziyang'anira payekha glycemia.
Mndandanda wa kukonzekera kwa insulini kolembetsedwa ku Russia kukuwonetsedwa mu tebulo 6.
Gawo 6

Ndi mankhwala ati a shuga omwe amakhala bwino: akale kapena atsopano

Akatswiri apadziko lonse pankhani yogwiritsa ntchito bwino mankhwala sawalimbikitsa kuti pakhale mankhwala osokoneza bongo atsopano omwe alipo. Kusiyana kwake ndi komwe kumachitika ngati mankhwala atsopano "adasintha" chithandizo cha matenda. Kutetezeka kwathunthu kwa mankhwala kumatsimikiziridwa pokhapokha zaka 10 pambuyo poti anthu ambiri akugwiritsa ntchito moona.

Mapiritsi abwino kwambiri a matenda a shuga a 2 amadziwika ndi World Health Organisation okha metformin ndi glibenclamide.Chifukwa ndi iwo omwe ali ndi umboni wabwino kwambiri kuti mapiritsiwa ndi othandiza komanso otetezeka. Mankhwala omwe amatchulidwa amaphatikizidwa bwino kwambiri malinga ndi "kuthekera - chitetezo - mtengo wamankhwala."
Malingaliro akulu ndi malingaliro athunthu okhudzana ndi kuthekera kwa kuwongolera njira ya matenda a shuga 2 amapezekedwa ndikugwiritsa ntchito mapiritsi a metformin ndi glibenclamide. Kafukufuku wamkulu, yemwe adatha zaka 5, kuwunika kugwira ntchito ndi chitetezo cha metformin, glibenclamide ndi rosiglitazone pochiza odwala omwe ali ndi matenda amtundu wa 2, nawonso adawonetsa motsimikiza kuti mankhwala "akale" ndi othandiza kwambiri. Amakhala otetezeka poyerekeza ndi rosiglitazone "yatsopano".
Chofunika kwambiri posankha mtundu wa mankhwala a shuga 2 ndikofunikira kuti pakhale njira yoyenera yolumikizira glycemic ngati njira yotsimikiziridwa kwambiri yopewa komanso yochepetsa kupitilira kwa zovuta za micro- and macrovascular.

Komabe, chitsimikizo chofunikira kwambiri chikugogomezeredwa: kwa mankhwala osokoneza bongo "akale" a shuga, zovuta zomwe zimachitika zimamveka bwino ndipo pafupifupi zonse zimayembekezereka komanso zongoyerekeza. Zowopsa zomwe zimayambitsa mapiritsi "atsopano" zimatha kukhala zosayembekezereka komanso zadzidzidzi. Chifukwa chake, kufufuza kwanthawi yayitali komanso mapulogalamu owunikira, makamaka mankhwala omwe ali ndi ziwalo zambiri zomwe angakwaniritse, ndizofunikira kwambiri.

Mwachitsanzo, rosiglitazone, woimira gulu la thiazolidinediones, omwe anali ndi zida zambiri zowonetsera, anali kugwiritsa ntchito moyenera kwa zaka pafupifupi 8, pamene kwa nthawi yoyamba pamakonzedwe a maphunziro azachipatala a nthawi yayitali, njira yatsopano idawululidwa - mafupa. Pambuyo pake, zidapezeka kuti izi, zomwe zimapangidwanso ndi pioglitazone, zomwe zimayamba kupezeka mwa akazi, zimagwirizanitsidwa ndi kuwonjezeka kwa pafupipafupi kwa ma fractures. Kafukufuku wotsatira adawonetsa chiopsezo chowonjezeka cha myocardial infarction ndi rosiglitazone komanso chiopsezo chokhala ndi khansa ya chikhodzodzo ndi pioglitazone.

Zotsatira zoyipa za mankhwala osokoneza bongo zitha kukhala "zowononga" kwambiri kwa odwala omwe ali ndi matendawa. Ngakhale mavuto monga hypoglycemia, kuwonda, osanenanso za kukhala ndi edema, mafupa am'mimba, kulephera kwamtima kosagwirizana, ndizabwino kwambiri kwa odwala omwe ali ndi matenda amtundu wa 2, omwe amakonda kwambiri kufanana ndi matenda am'mimba.

Kumvetsetsa izi, ndibwino kuti muyambe kulandira chithandizo chamankhwala omwe aphunziridwa kwambiri. Alibe mbiri yabwino yachitetezo okha, komanso luso lapamwamba kwambiri la hypoglycemic. Mankhwala "atsopano" analibe nthawi kuti atsimikizire chitetezo chawo pogwiritsa ntchito nthawi yayitali. Kuphatikiza apo, sanawonetse zotsatira zabwino za hypoglycemic poyerekeza ndi zachikhalidwe, "zakale". Mfundozi zimachitika pambuyo pa maphunziro ambiri.

Ndi mankhwala ati omwe mungakonde? Kodi njira yabwino kwambiri yothetsera matenda a shuga a 2 ndi iti? European Association for the Study of Diabetes imalimbikitsa kusankha mankhwala omwe ali ndi umboni wokwanira (wofufuza) womwe umatsimikizira zabwino ndi chitetezo cha kalasi iliyonse yamankhwala ochizira matenda a shuga.

Mbadwo waposachedwa wamankhwala umawoneka kuti ndiwothandiza kwambiri. Koma chiyembekezo chogwiritsidwa ntchito chiziyembekezedwa pokhapokha chitsimikiziro cha machitidwe ambiri komanso yayitali. Ku Europe ndi USA, odwala ambiri akupitiliza kuthandizidwa ndimankhwala otsimikiziridwa komanso ophunziridwa bwino.
Njira zothandiza kwambiri poyambira chithandizo cha matenda a shuga 2 zimakhalapo ngati metformin, poganizira zotsatira zake zabwino, komanso zotumphukira za sulfonylureas - gulu loyambirira la mankhwala osokoneza bongo omwe amathandizira kwambiri ndikusintha kwa mankhwalawa.

Mitundu "yakale" yakale, yamakhwala - mankhwala a metformin ndi sulfonylureas amakhalabe odziwika padziko lonse lapansi pochiza matenda amtundu wa 2. Chifukwa chomwe adawasankhira zokonda zawo anali zotsatirazi:

• chitetezo pakuchiritsa odwala
• kukwaniritsa zotsatira zabwino za nthawi yayitali,
• kukhudzidwa kwa moyo wabwino komanso chiyembekezo cha moyo,
• kuthekera kwachuma.

Ndipo mankhwalawa adzakhala ofunikira pachipatala cha matenda ashuga kufikira zowonjezereka zokhudzana ndi mankhwala atsopano zikupezeka, mpaka maphunziro akulu atawonetsa luso lawo lokwera poyerekeza ndi mankhwala achikhalidwe.

Zotsatira zoyesedwa kwakanthawi kachipatala komanso zokumana nazo zazikulu zomwe zimapezeka muzochitika zokhazikika ndizotsimikizika komanso zotsimikizika kwambiri posankha mankhwala othandizira mankhwalawa matenda a shuga.