Mtundu watsopano wopatsa shuga. Sizigwira ntchito pamagulu ena odziwika a hypoglycemic agents. Mwamsanga amachepetsa shuga m'magazi ndikulimbikitsa gawo loyamba la secretion insulin kapamba. Kukondoweza kwachinsinsi insulin amagwirizana ndi blockade wa njira za potaziyamu. Kumaphatikizapo kuvomereza calcium ayoni mu β khungu kapamba ndi kubisalira insulin. Zapadera tropism kuti β maselo kapamba ndipo sasokoneza mayendedwe a potaziyamu a myocardium. Mankhwala salowerera mu cell ndipo amagwira ntchito yake pa nembanemba, samaletsa biosynthesis insulin.

Kumwa mankhwalawa musanadye kwa mphindi 15-30 kumachepetsa shuga nthawi yonse ya chakudya. Kuchepetsa amadalira shuga m'magazi kumadziwika.

Pharmacokinetics

Mofulumira odziwira kuchokera Matumbo, ndipo kuchuluka kwakukulu kwa yogwira ntchito kumatsimikiziridwa mkati mwa ola limodzi. Ndiye mulingo kubwezera amachepetsa mwachangu, ndipo pambuyo maola 4 otsika ozindikira amadziwika. Bioavailability ndi 63%. Ili ndi voliyumu yotsika komanso kuchuluka kwamapuloteni ambiri. Kutha kwa theka-moyo kuli pafupifupi ola limodzi, kuchotsedwa kwathunthu mu maola 4-6. Mulingo wokwanira CYP2C8 isoenzymes ndi CYP3A4, metabolites ndi hypoglycemic zotsatira, osadziwika. Amatulutsidwa m'matumbo, ndi gawo laling'ono ndi impso.

Odwala omwe ali ndi vuto laimpso sayenera kusintha koyamba mlingo, koma onjezerani mlingo mosamala. Ndi vuto lalikulu la chiwindi, kukhathamira kwotalikirapo komanso kokhazikika kumatsimikiziridwa kubwezera mu seramu.

Contraindication

• wodwala insulin matenda ashuga,
• matenda ashuga ketoacidosis,
• wodwala matenda ashuga,
• mimba ndi mkaka wa pansi
• matenda opatsirana
• kukanika kwambiri kwa chiwindi,
• Hypersensitivity
• ntchito ndi gemfibrozil.

Amafotokozera mosamala vuto la chiwindi. kulephera kwa aimpsofebrile syndrome uchidakwakuperewera kwa zakudya m'thupi. Kafukufuku wokhudza odwala omwe ali ndi zaka 18 ndi zaka zopitilira 75 sizinachitike.

Zotsatira zoyipa

Zotsatira zoyipa:

Zotsatira zochepa zoyipa:

• kuyabwa, zotupa,
• vasculitis,
• urticaria,
• hypoglycemic chikomokere,
• kuchepa kwa mawonekedwe
• matenda amtima
• kusanza, kudzimbidwa, mseru,
• kuchuluka kwa chiwindi michere ya mawonekedwe osakhalitsa.

NovoNorm, malangizo ogwiritsira ntchito (Njira ndi Mlingo)

Mapiritsi amatengedwa pakamwa musanadye kwa mphindi 15-30. Mlingo amasankhidwa payekha ndipo zimatengera mulingo. shuga. Mlingo woyambirira wa 0,5 mg tikulimbikitsidwa musanadye. Mlingo umasinthidwa kamodzi pa sabata. Mukasintha kuchokera ku mankhwala ena a hypoglycemic, mlingo woyambirira wa 1 mg umalimbikitsidwa musanadye. MD limodzi 4 mg, ndi tsiku lililonse osaposa 16 mg. Kuphatikiza mankhwala ndi metformin kapena kachikachiyama koyamba mlingo ntchito kubwezera chimodzimodzi ndi monotherapy. M'tsogolomu, mlingo wa mankhwala uliwonse umasinthidwa.

Bongo

Mankhwala osokoneza bongo amatha kuchitika. hypoglycemia: thukuta lalikulu, chizungulirekunjenjemera m'thupi mutu. Chithandizo chofatsa hypoglycemia imakhala ndi kutenga dextrose mkati kapena zakudya zazakudya zambiri. Zowopsa hypoglycemia glucose wamkati umafunika.

Kuchita

Sinthani mphamvu ya mankhwalawa gemfibrozil, trimethoprim, ketoconazole, rifampicin, chindwana, cyclosporin, itraconazoleena wothandizira wa hypoglycemiczoletsa makutidwe a monoaminesalicylates osasankha β-blockers, IAPF, octreotide, anabolic steroids, mankhwala osokoneza bongo omwe amaletsa kutupa komanso mowa.
Nthawi yomweyo Deferasirox imakhala ndi zochulukirapo kubwezera, mogwirizana ndi komwe, mlingo wa wotsiriza umachepetsedwa. β-blockers zizindikiro za chigoba hypoglycemia.

Kulera kwapakamwa, barbiturates kumachepetsa mphamvu ya hypoglycemic ya mankhwala, rifampicinzotumphukira thiazide, carbamazepine, glucocorticosteroidsmahomoni a chithokomiro danazol.

Ndemanga za NovoNorm

Kusiyanitsa kwakukulu pakati pa mankhwalawa ndi mankhwala ena ochepetsa shuga ndikutuluka kwakuthupi - pambuyo pa mphindi 10, ndipo kutalika ndi maola atatu. Uwu ndiye mwayi wake wachipatala. Kuchotsa kwotalika hafu ya moyo kumateteza β maselo kuchokera kutopa, ndipo abwezeretsa zosungiramo zakale mpaka chakudya chotsatira cha odwala. Kupanda hyperinsulinemia pakati chakudya kumachepetsa ngozi hypoglycemia.

Mankhwala omwe amakhala atachotsera theka moyo, nthawi zonse amalimbikitsa kumasulidwa insulin, motero, odwala ayenera kudya mosamalitsa zakudya (zitatu zazikuluzikulu ndi zina zitatu zowonjezera). Kudumpha chakudya kumayamba hypoglycemia. Chifukwa chakuti iyi ndi mankhwala osakhalitsa, wodwala amakhala ndi chakudya chaulere, amatha kudumpha zakudya popanda chiwopsezo chachikulu hypoglycemia. Muyenera kumwa mapiritsi pokhapokha mukamadya. Mphindi ino zimadziwika kuti zabwino kwa odwala ambiri pakuwunika kwawo.

• «... Poyerekeza ndi Maninil, machitidwewo ndiabwino kwambiri. Osachepera ziyenera ine».
• «... Ndikuvomereza zaka zingapo. Imagwira ngati mlingo wa insulin. Palibe mavuto».
• «... Shuga amachepetsa bwino ndipo nthawi yayitali ikufanana».

Odwala ambiri amadziwa kuti mankhwalawa adapangidwa kuti aphatikizidwe metformin, zomwe zidaloleza kuwongolera kosamalitsa matenda ashuga. Njira yokwanira imeneyi imalola kuchuluka kwa insulini. w ndi munthawi yomweyo kuchepetsa minofu insulin. Mapiritsi a NovoNorm ndi otetezeka, olekeredwa bwino ndipo amakhala ndi zovuta zingapo. Mbali ndi kukondera pamatumbo, komwe kumapangitsa kugwiritsa ntchito odwala omwe ali ndi vuto la impso.

Zizindikiro zogwiritsidwa ntchito

Mankhwala NovoNorm Amagwiritsidwa ntchito pochiza matenda amisempha 2 a shuga ndi kulephera kwa kudya mankhwala, zolimbitsa thupi ndi kuwonda.
Odwala omwe ali ndi mtundu wachiwiri wa matenda a shuga, repaglinide ingagwiritsidwenso ntchito limodzi ndi metformin kapena thiazolidinediones pakagwiridwe kokwanira ka glycemic sikungatheke ndi monotherapy ndi repaglinide, metformin kapena thiazolidinediones.

Njira yogwiritsira ntchito

kukhalapo kwa kukana kwachiwiri kwa wodwala). Odwala omwe ali ndi matenda a shuga a mtundu wachiwiri, omwe matenda ashuwarawa nthawi zambiri amawongoleredwa ndi chakudya, njira yochepa yothandizira matendawo ingakhale yokwanira panthawi yotayika kwa glycemic control.
Pankhani yogwiritsidwa ntchito nthawi yomweyo ndi mankhwala ena - onani magawo "Kuyanjana" ndi "Malangizo Apadera".
Mlingo woyambira. Mlingo wa mankhwalawa umatsimikiziridwa ndi dokotala kutengera kuchuluka kwa shuga m'magazi.
Kwa odwala omwe sanalandirepo mankhwala ena amkamwa a hypoglycemic, njira imodzi yoyambirira asanadye ndi 0,5 mg. Kusintha kwa Mlingo kumachitika nthawi 1 pa sabata kapena nthawi imodzi mu masabata awiri (pomwe mukuyang'ana kuchuluka kwa shuga m'magazi monga chisonyezo cha kuyankha kwa mankhwala).
Ngati wodwalayo atembenuka kuti atenge mankhwala ena amkamwa a hypovlycemic kuti alandire mankhwala a NovoNorm ®, ndiye kuti mlingo woyambira woyamba musanadye 1 mg.
Mulingo woyenera. Mulingo wovomerezeka umodzi musanadye chakudya chachikulu ndi 4 mg. Mankhwala okwanira tsiku lililonse sayenera kupitirira 16 mg.
Odwala omwe adalandiranso mankhwala ena amkamwa a hypoglycemic. Kutumiza kwa odwala omwe ali ndi mankhwalawa ndi mankhwala ena amkamwa a hypoglycemic kuthandizira ndi repaglinide kungachitike nthawi yomweyo. Nthawi yomweyo, palibe ubale weniweni womwe umapezeka pakati pa mlingo wa repaglinide ndi mlingo wa mankhwala ena a hypoglycemic. Mlingo woyambira wabwino kwambiri kwa odwala omwe amasinthidwanso ndikuwonjezera 1 mg musanadye chakudya chachikulu chilichonse.
Kuphatikiza mankhwala Repaglinide ikhoza kutumikiridwa limodzi ndi metformin kapena thiazolidatediones posayang'anira kuchuluka kwa shuga wamagazi pama monotherapy ndi metformin, thiazolidinediones kapena repaglinide. Pankhaniyi, mlingo womwewo wa repaglinide umagwiritsidwanso ntchito ngati monotherapy. Kenako, mlingo wa mankhwala uliwonse umasinthidwa malinga ndi kuchuluka kwa shuga m'magazi.
Ana ndi achinyamata. Kuchita bwino ndi chitetezo cha mankhwala omwe amakhalanso ndi zaka 18 sizinafufuzidwe. Palibe zambiri zomwe zilipo.

Mlingo

Zoyambira zathupi komanso mankhwala:

mapiritsi (1 mg) achikasu, ozungulira, biconvex, mbali imodzi amalembedwa ndi chizindikiro cha kampani Novo Nordisk,

mapiritsi (2 mg) ndi a brownish-pink, ozungulira, biconvex, mbali imodzi ili ndi chizindikiro cha kampani Novo Nordisk.

Mankhwala

Njira yamachitidwe . NovoNorm ndi othandizira kuchitira pakamwa insulin secretion. NovoNorm imachepetsa shuga wamagazi, ndikulimbikitsa katulutsidwe ka insulin ndi kapamba, ndipo mphamvu ya mankhwalawa imatengera kuchuluka kwa maselo a b omwe amasungidwa kuzinyalala za gland.

NovoNorm atseka njira zotengera potaziyamu za ATP mu membala wa b-cell ndi puloteni yapadera. Izi zimayambitsa kukhumudwa kwa ma cell a b ndipo zimatsogolera kutsegulidwa kwa njira za calcium, kumakulitsa kulowa kwa calcium ion mu cell, yomwe imapangitsa kuti insulini isabisike.

Zotsatira zokhudzana ndi pharmacodynamics ya mankhwala . Odwala omwe ali ndi matenda amtundu wa II, kuwonjezeka kwa insulin ndende kumachitika pakadutsa mphindi 30 atayamba kulowereranso. Izi zimachepetsa kuchuluka kwa shuga m'magazi nthawi yonse ya chakudya. Kuchulukitsa kwa repaglinide mu madzi a m'magazi kumatsika mofulumira, kutsika kwake kumawonedwa kwa odwala omwe ali ndi matenda amtundu wa II mkati mwa 4:00 atatha kumwa.

Mphamvu zamankhwala ndi chitetezo.Mutatenga 0,5 mpaka 4 mg ya repaglinide mwa odwala omwe ali ndi mtundu II matenda a shuga, kuchepa kwa shuga komwe kumadalira shuga kumawonetsedwa. Kutengera ndi zotsatira za maphunziro azachipatala, tikulimbikitsidwa kuti mutenge repaglinide musanadye chakudya. Mankhwalawa nthawi zambiri amatengedwa mphindi 15 asanadye, komabe, nthawi yomwe ingatengepo imatha kusiyanasiyana ndi chakudya musanadye mphindi 30 asanadye.

Mafuta NovoNorm imatengeka mosavuta kuchokera m'matumbo am'mimba, zomwe zimapangitsa kuti chiwopsezo cha mankhwalawa chikhale m'magazi am'magazi. Chiwopsezo cha kuchuluka kwa mankhwalawa m'madzi a m'magazi amafikira 1:00 pambuyo pa makonzedwe. Atafika pachimake, kuchuluka kwa plasma kwa mankhwalawa kumacheperachepera. Kutenga repaglinide nthawi yomweyo musanadye, mphindi 15 kapena 30 mphindi musanadye kapena pamimba yopanda kanthu sikukhudza kwambiri mfundo za pharmacokinetics. The pharmacokinetics of repaglinide amadziwika ndi pafupifupi mwamtheradi bioavailability (63%, coefflication wa kusiyanasiyana 11%). Panthawi ya mayesero azachipatala, kusinthasintha kwakukulu m'magazi a m'magazi a odwala osiyanasiyana kudadziwika, wodwala yemweyo, mulingo wake umasiyana kuchokera kutsika mpaka pakati (35%). Popeza kusankha kwa mtundu wa repaglinide kumachitika chifukwa cha mayankho a wodwalayo, kusinthika kwakukulu kwa odwala osiyanasiyana sikukhudza mphamvu ya mankhwalawa.

Kugawa . The pharmacokinetics of repaglinide amadziwika ndi voliyumu yochepa yogawa

(30 l, yomwe ikufanana ndikugawika mu madzi amkati), repaglinide imamangiriza mosavuta (98%) mapuloteni a plasma a odwala.

Kuswana . Atafika ku C _max ndende ya mankhwala plasma amachepetsa mofulumira. Hafu ya moyo pafupifupi 1:00. Repaglinide imachotsedwa mwachangu m'magazi mkati mwa maola 4-6. Repaglinide imapangidwa kotheratu makamaka ndi kutenga CYP2C8 ndi ma enzymes a CYPZA4. Zake metabolites zimayambitsa kwambiri hypoglycemia.

Repaglinide ndi metabolites ake amuchotsa makamaka ndi bile. Pansi pa 2% ya mlingo wotengedwa umapezeka ndowe. Kachigawo kakang'ono (pafupifupi 8%) kamodzinso kamene kamaperekedwako kamapezeka mkodzo ngati metabolites.

Odwala omwe ali ndi matenda amtundu wa II omwe ali ndi kusiyanasiyana kwa kulephera kwa impso, ma pharmacokinetics a repaglinide adatsimikiza atamwa kamodzi, komanso khola. Odwala ndi yachilendo aimpso ntchito ndi kufatsa pang'ono zolimbitsa, m'derali pansi pamapindikira "repaglinide ndende - nthawi" ndi C _max zinali zofanana (motsatana 56.7 ng / (ml × h) ndi 57.2 ng / (ml × h) 37,5 ng / ml ndi 37.7 ng / ml). Odwala omwe ali ndi kuchepa kwa aimpso, matchulidwe amawuwo adawonjezereka pang'ono (98.0 ng / (ml × h) ndi 50.7 ng / ml). Komabe, mkati mowerengera awa, kuphatikizika kofooka kunapezeka pakati pa kuchuluka kwa repaglinide ndi clearinine chilolezo. Kwa odwala omwe ali ndi vuto la impso, sikofunikira kusankha koyamba kodzikundikiranso. Kuwonjezeka kwa mlingo wotsatira kwa odwala omwe ali ndi matenda amtundu II omwe ali ndi vuto laimpso kapena kulephera kwaimpso komwe kumapangitsa hemodialysis kuyenera kuchitika mosamala.

Mwakuyang'ana, pokhapokha ngati waphunzira mlingo umodzi womwe umachitika ndi

Odzipereka 12 athanzi komanso odwala 12 omwe ali ndi matenda ena a chiwindi (kuwuma kwake komwe kumatsimikizika malinga ndi kuchuluka kwa Child Pugh komanso chilolezo cha caffeine), zikuwonetsedwa kuti odwala omwe ali ndi chiwopsezo chachikulu cha hepatic, kuphatikiza kwaulere kwathunthu komanso kotsekemera mu seramu yamagazi ndikokwera komanso kumatenga nthawi yayitali kuposa odzipereka athanzi (dera lomwe limapindidwa "lopindika" nthawi ina) mwa anthu athanzi ndi 91.6 ng / (ml × h), mwa odwala - _max mwa odwala athanzi - 46.7 ng / ml, mwa odwala - 105.4 ng / ml). Dera lomwe limapindika "kubwezera kwa nthawi yayitali - nthawi" (AUC) yolumikizana ndi gawo la tiyi wa khofi. Mbiri yakuchuluka kwa glucose m'magulu onse opimidwa anali ofanana. Mukamamwa Mlingo wokhazikika, odwala omwe ali ndi vuto la chiwindi amakhala ndi vuto lalikulu la repaglinide ndi metabolites kuposa odzipereka athanzi. Ndi chifukwa chake odwala omwe ali ndi vuto la chiwindi, repaglinide iyenera kugwiritsidwa ntchito mosamala. Mukamasankha Mlingo, nthawi zina ziyenera kuwonjezeka kuti muwone bwino momwe wodwalayo amayankhira.

Deta Yotetezera.

Malinga ndi zotsatira za kafukufuku wakale yemwe amavomerezedwa, palibe vuto lililonse lamankhwala lomwe limapezeka kwa anthu. Poyeserera nyama, zinawonetsedwa kuti repaglinide ilibe teratogenic. Kafukufuku wazinyama awonetsa kawopsedwe kabala. Kulakwitsa kwa Netratogenetic kwa malekezero amapezeka mu fetus ndi makoswe obadwa kumene kwa makoswe omwe anapatsidwa mlingo waukulu wa mankhwalawa pomaliza magawo a mimba ndi msambo. Repaglinide idapezeka mkaka wa nyama yoyesera.

Type II matenda a shuga a mellitus (osagwirizana ndi insulin amadalira shuga, INCD), mukamagwiritsa ntchito zakudya, kuchepetsa thupi ndi kuchita zolimbitsa thupi, sizingatheke kukwaniritsa kuwongolera kwamwazi wamagazi.

Kugwiritsanso ntchito kwa repaglinide kuphatikiza ndi metformin kapena thiazolidatediones kumathandizidwanso kwa odwala omwe ali ndi mtundu II shuga mellitus, momwe kuwongolera glycemic kosakwanira sikungatheke mwa kumwa mankhwalawa mosiyana. Kuchiza kuyenera kuyambitsidwa ngati chowonjezera pakudya kapena masewera olimbitsa thupi kuti muchepetse kuchuluka kwa shuga wamagazi chifukwa chakudya.

Zolemba zogwiritsira ntchito

Repaglinide iyenera kuthandizidwa kuti pakhale vuto losagwirizana ndi kuchuluka kwa shuga m'magazi poyang'anira kudya komanso kuchita masewera olimbitsa thupi.

Repaglinide, monga zina zolimbikitsira za insulin katulutsidwe, zimatha kuyambitsa kukula kwa hypoglycemia.

Mankhwala osakanikirana ndi gulu la ndewu ya Hagedorn (NPH-insulin) kapena thiazolidatediones.

Kafukufuku wachitika pa chithandizo chophatikiza ndi NPH-insulin kapena thiazolidinediones. Komabe, kuwunika kwa chiopsezo / kupindula kwa chibale molingana ndi mitundu ina ya mankhwala othandizira ndikofunikira.

Kuphatikiza mankhwala ndi metformin.

Ndi mankhwala ophatikizidwa ndi metformin, chiopsezo cha hypoglycemia chimawonjezeka. Ngati wodwala yemwe wakwanitsa kukhazikika kwa kayendedwe ka glycemic mothandizidwa ndi mankhwala a hypoglycemic amakanizidwa (kutentha, kuvulala, matenda opatsirana kapena kulowererapo kwa opaleshoni), ndiye kuti pali kuphwanya kwa kuwongolera uku. Zikatero, zingakhale bwino kusiya kumwa mankhwala osokoneza bongo komanso kusinthitsa kwakanthaŵi insulin.

Pachimake coronary syndrome.

Chithandizo cha Repaglinide chitha kuphatikizidwa ndi chiopsezo chowonjezeka cha pachimake coronary syndrome (mwachitsanzo, kulowerera kwa myocardial).

Odwala ambiri, ndi kuwonjezeka kwa nthawi yomwe amamwa mankhwalawa a hypoglycemic, mphamvu yawo ya hypoglycemic imachepa. Izi zitha kuchitika chifukwa cha kuphatikizika kwa matenda ashuga kapena kuchepa kwa mayankho a thupi pakumwa mankhwalawo. Vutoli limatchedwa yachiwiri kusakwanira, liyenera kusiyanitsidwa ndi kusakwanira kwenikweni, komwe wodwalayo sayankha mankhwalawa kwa nthawi yoyamba. Musanapange matenda a sekondale yoperewera, ndikofunikira kuyesa kusintha mankhwalawo, komanso kuwunika wodwalayo kutsatira malangizo ake pakudya komanso zolimbitsa thupi.

Magulu apadera a odwala

Odwala ofooka komanso otopa . Kusankhidwa kwa Mlingo wa odwala ofowoka komanso ofooka kuyenera kuchitika makamaka mosamala kuti muteteze matenda a hypoglycemia (onani Gawo "Njira Yogwiritsira ntchito ndi Mlingo").

Ana. Palibe zambiri zomwe zilipo.

Okalamba okalamba (woposa zaka 75) . Palibe zambiri zomwe zilipo.

Kulephera kwa chiwindi . Mukamamwa mankhwala abwinobwino odwala omwe ali ndi vuto la chiwindi, kuchuluka kwa ziwengo zina zake ndi michere zimatha kukhala zambiri kuposa odwala omwe ali ndi chiwindi chokwanira. Ichi ndichifukwa chake odwala omwe ali ndi vuto la chiwindi amayenera kusamala akamagwiritsa ntchito repaglinide (onani gawo "Contraindication"). Zosankha pakati pa kusankha kwa mankhwalawa ziyenera kukulitsidwa kuti muwone bwino momwe wodwalayo amayankhira (onani gawo la Pharmacokinetics).

Kulephera kwina. Ngakhale pali kulumikizana kofooka pakati pamlingo wa kubwezeretsanso ndi chilolezo cha creatinine, kuwonekeratu kwa zinthu izi m'magazi am'magazi a odwala omwe ali ndi vuto lalikulu laimpso kumachepa. Popeza odwala omwe ali ndi matenda osokoneza bongo omwe amakhala ndi zovuta za aimpso amachulukitsa kukhudzika kwa insulin, kusamala kuyenera kuchitidwa posankha mtundu wa mankhwalawa (onani gawo la Pharmacokinetics).

Gwiritsani ntchito pa nthawi yoyembekezera

Kafukufuku wokhudza kupatsanso mankhwala kwa azimayi oyembekezera komanso oyamwitsa sanachitike. Ichi ndichifukwa chake ndizosatheka kuyesa chitetezo chazomwe amagwiritsa ntchito amayi apakati. Mankhwala sangathe kugwiritsidwa ntchito nthawi izi.

Kuti mumve zambiri pa kafukufuku wokhudza kubereka wa nyama, onani

Deta Yotetezera.

Kutha kukopa momwe zinthu zikuyendera mukamayendetsa magalimoto kapena njila zina.

Ndi hypoglycemia mwa odwala, kuthekera kwazowunikira kwambiri komanso momwe angachitire kungachepe. Izi zimatha kukhala pachiwopsezo china pomwe maluso amenewa amakhala ofunikira kwambiri (mwachitsanzo, poyendetsa galimoto kapena njira zina).

Odwala ayenera kulangizidwa kuti ateteze njira zoteteza ku hypoglycemia poyendetsa. Izi ndizofunikira kwambiri kwa iwo omwe afooketsa zizindikiro za kutsogola kwa hypoglycemia, kapena iwo omwe nthawi zambiri amakumana ndi zochitika za hypoglycemia. M'magawo amenewa, kuyendetsa bwino kwakukulu kuyenera kuwunikiridwa.

Zotsatira zoyipa

Nthawi zambiri, pamakhala zotsatira zoyipa zomwe zimachitika chifukwa cha kusintha kwa shuga m'magazi, ndiye kuti, hyperglycemia ndi hypoglycemia. Pafupipafupi mwadzidzidzi mwanjira imeneyi zimatengera zonse zomwe wodwalayo ali nazo: makonda, Mlingo, kuchuluka kwa zolimbitsa thupi ndi nkhawa.

Kutengera ndi luso logwiritsa ntchito mankhwala osokoneza bongo a repaglinide ndi mankhwala ena ochepetsa shuga, zovuta zomwe zimadziwika (≥ 1/100 musanadziwitsidwe) zitha kusiyanitsidwa Amvera

Hypoglycemic mankhwala Novonorm: malangizo, ntchito, mtengo, ndemanga, analogies

Matenda oopsa monga matenda a shuga amapezeka tsiku lililonse odwala ambiri amisinkhu yosiyanasiyana.

Mbali yayikulu ya chithandizo chake ndi zakudya zapadera, zomwe ziyenera kutsagana ndi zochitika zina zolimbitsa thupi.

Ndipo nthawi zambiri, kuwonjezera pa izi, akatswiri amapereka mankhwala omwe amawonjezera insulin m'magazi. Imodzi mwa mankhwalawa ndi Novonorm, malangizo ogwiritsira ntchito omwe tidzakambirana pambuyo pake.

Zotsatira za pharmacological

Mankhwala a Novonorm ndi mankhwala omwe ali m'gulu la othandizira pakamwa. Imatha kuletsa njira zamtundu wa adenosine triphosphate zotengera potaziyamu zomwe zimakhala m'zigawo za ma cell a beta.

Zitatha izi, nembanemba imasokonekera ndipo njira za calcium zimatsegulidwa, ndipo, zimathandizira kukulira kwa kuchuluka kwa calcium ion mu cell ya beta. Zomwe zimagwiritsidwa ntchito ndizoyipa.

Chofunikira chachikulu cha mankhwalawa ndi kuthekera kuchepetsa glucose wamagazi, chifukwa cha theka lalifupi. Odwala omwe amatenga Novonorm sangawope kutsatira zakudya zamafuta zambiri, zomwe siziloledwa mukamamwa ena othandizira a hypoglycemic.

Pambuyo pakumwa koyambirira kwa mankhwalawa, zotsatira zake zamankhwala, zomwe zimathandiza kuwonjezera zomwe zili mu insulin ya m'magazi, zimatheka pambuyo pa mphindi 10-30. Kutsika kwa plasma wozungulira yogwira ntchito kumachitika pambuyo pa maola anayi kuchokera nthawi yomwe mwamwa mankhwalawa. Pambuyo pamlomo makonzedwe a Novonorm, kuchuluka kwake kwa thunthu kumachitika pambuyo pa ola limodzi.

Malangizo ogwiritsira ntchito

Novonorm imayikidwa kokha ngati njira yowonjezera yazakudya zolimbitsa thupi nthawi zonse. Izi ndizofunikira kuti muchepetse kuchuluka kwa shuga m'magazi a anthu.

Mapiritsi a Novonorm omwe akuphatikizana ndi mapiritsi amawonetsa kuti mankhwalawa amayenera kumwedwa pakamwa asanadutse, ndipo kuchuluka kwa mankhwalawa kumasiyana kawiri mpaka kanayi patsiku. Nthawi yomweyo, izi zimachitika mphindi 15 musanadye chakudya. Ndikofunika kukumbukira kuti ngati wodwala pazifukwa zina zasowa chakudya chachikulu, ndiye kuti mankhwalawo sayenera kumwa.

Phaleli silikulimbikitsidwa kutafuna, komanso pogaya, liyenera kukhala lathunthu komanso kutengedwa pakamwa, kutsukidwa ndi madzi okwanira. Kutalika kwa mankhwala, komanso mulingo woyenera wa mankhwala amatsimikiziridwa payekhapayekha kwa wodwala aliyense.

Mlingo woyambira wodwala wamkulu nthawi zambiri amakhala mamilimita 0,5 a repaglinide.

Pakatha sabata limodzi kapena awiri kuyambira pa kuyamba kwa mankhwalawa, mankhwalawa akhoza kuchuluka. Panthawi yogwiritsira ntchito, ndikofunikira kuyang'anitsitsa kuchuluka kwa shuga m'magazi kuti muwone molondola momwe mphamvu ya mankhwalawo ingachepetse thupi.

Mulingo wovomerezeka umodzi wa Novonorm ndi ma milligram anayi, ndipo mlingo wa tsiku ndi tsiku sayenera kupitirira 16 milligram. Akuluakulu omwe adagwiritsa ntchito mankhwala ena amkati mwa Novonorm nthawi zambiri amapatsidwa milligram imodzi ya repaglinide mu gawo loyambirira.

Odwala omwe afooka komanso kuchepa mphamvu, ndikofunikira kusankha mosamala. Nthawi zambiri amapatsidwa kwa anthu oterowo pang'ono. Mankhwala ovuta a Metformin ndi Novonorm, muyezo wochepetsetsa ungafunike kuposa monotherapy ndi mankhwalawa.

Odwala omwe alembetsa impso safunika kusintha njira yoyamba ya mankhwalawa, koma ndikofunika kukumbukira kuti kusamala kuyenera kugwiritsidwa ntchito pakuwonjezera mlingo wa Novonorm.

Kuyanjana kwa mankhwala osokoneza bongo

Mukamagwiritsa ntchito mankhwala, muyenera kudziwa kuti mankhwalawa omwe adzagwiritsidwa ntchito paliponse amakhudza kagayidwe kazakudya, kamene kamayambitsa kusintha kwa mlingo.

Pamene Novonorm amalumikizana ndi mankhwala ena, monga: glarinthromycin, anabolic steroids, osasankha beta-blockers, ethanol, monoamine oxidase inhibitors, zotsatira zowonjezera theka la moyo wa repaglinide umawonedwa.

Kusintha kwakukulu mu pharmacokinetics yogwira ntchito ya Novonorm sikuchitika ndi munthawi yomweyo kugwiritsa ntchito mankhwalawa: Nifedipine, Cimetidine, Simvastatin, estrogens.

Makanema okhudzana nawo

Zambiri pamankhwala a shuga:

Mankhwala a Novonorm ndi othandizira pakamwa pofulumira a insulin. Ndemanga za mankhwalawa zabwino. Amachepetsa msanga shuga m'magazi. Izi zimachitika chifukwa cha kukondoweza kwa insulin ndi kapamba. Ndipo mphamvu ya mankhwalawo mwachindunji imatengera kuchuluka kwa magwiritsidwe a b-cell omwe amasungidwa kuzilonda za gland. Mankhwala amathandizidwa ndi zakudya komanso kuchita masewera olimbitsa thupi ngati chowonjezera.

Zizindikiro ndi contraindication

Mankhwala ndi mankhwala woopsa milandu matenda, pamene sizingatheke bwino kuthana ndi shuga mu mtundu 2 matenda a shuga. Amalembera anthu omwe ali ndi kunenepa kwambiri, amathandizira kuchepetsa thupi.

Sizoletsedwa kutenga anthu omwe ali ndi matenda amtundu wa 1, omwe amakhala ndi vuto la hypersensitivity pazinthu zilizonse zomwe zimapangidwa ndi mankhwala. Contraindified mu matenda kapena pachimake aimpso, kupuma, chiwindi kulephera.

Kugwiritsidwa ntchito kwa "novonorm" kumapangidwa mosiyanasiyana mu zotsatirazi zowawa:

• Matenda opatsirana pachimake
• Opaleshoni
• Zakudya za insulin
• Matenda a shuga a ketoacidosis kapena lactic acidosis,
• Pachimake kapena kuchulukitsa kwa matenda a chiwindi osagwira.

Sizoletsedwa kupereka mankhwala pa nthawi yomwe mayi ali ndi pakati komanso mkaka wa m'mawere.

Mosamala komanso moyang'aniridwa ndi dokotala, ndizotheka kutumiza kwa anthu omwe ali ndi matenda oopsa, okhala ndi uchidakwa, cachexia, kapena mavuto ena akudya.

Sipanakhalepo mayesero azachipatala ndipo palibenso chidziwitso chokhudza momwe mankhwalawo amathandizira thupi la mwana, chifukwa chake madokotala samalimbikitsa chifukwa chosowa chidziwitso chodziwitsa odwala omwe ali ndi zaka 18.

"Novonorm" imalowa mu chotchinga ndipo imatha kuyambitsa kusokonezeka kwa chitukuko cha fetal, zomwe zikutanthauza kuti imaphatikizidwa mwa azimayi panthawi yoyembekezera.

Ndemanga za madotolo pazatsopano

NovoNorm ndi mankhwala abwino kwambiri kwa odwala matenda a shuga. Kugwiritsa ntchito bwino kwa mankhwalawa kumatheka chifukwa chophatikizidwa ndi zigawo zikuluzikulu pazigawo zoyenera. Kuchita mwachangu. Mankhwala "NovoNorm" pagawo lamtengo ndiwovomerezeka kwambiri kwa odwala. Mtengo ndiwotsika m'mafamu azitawuni.

Zotsatira zoyipa za mankhwalawa ndizosowa kwambiri.

Ndemanga za odwala zatsopano

Kwa odwala omwe ali ndi zaka za shuga zaka 40, jakisoni wa insulini amatchulidwa, koma ngati munthu ndi wamkulu kuposa zaka 45, ndiye kuti madokotala amapereka mapiritsi okha. Chifukwa chake agogo anga adasankhidwa mapiritsi awa. Poyerekeza ndi Maninil, zotsatira za NovoNorm ndizabwino kwambiri. Kuphatikiza pakuchepetsa misempha yamagazi, mankhwalawa alibe zotsatira zoyipa. Komabe, izi zimagwira ntchito ngati munthu alibe mavuto a mtima komanso zifukwa zina. Kuphatikizanso ndikofunikira kudziwa mtengo wotsika komanso kupezeka. Kugulitsidwa ku pharmacy iliyonse.

Agogo anga amadwala matenda ashuga ndipo tsiku lililonse akukulira, popeza zaka zake ndi zazikulu. Dokotala wake adangomulangiza za mankhwalawa. Agogo adachita mantha poyamba, kenako adaganiza zoyesa ndipo tsopano amagwiritsa ntchito Novonorm yekha. Ikuwoneka kuti ikugwira ntchito ngati insulin yofulumira. Palibe zoyipa, zimagwira ntchito mwachangu. Agogo ndi okondwa, ndipo ndawadekha. Mwa njira, ndiyotsika mtengo ndipo imapezeka mosavuta m'mafakitala ambiri.

Kufotokozera kwapfupi

Novonorm ndi pakamwa yochepa yochita hypoglycemic mankhwala ochizira matenda amtundu wa 2. Posachedwa, machitidwe a endocrinological aphatikizanso mankhwala omwe amapereka malingaliro enieni a pambuyo pa kudya pambuyo podya) glucose pokhazikitsa ma pancreatic ß-cell obisala insulin. Mpaka pano, awiriwa amagwiritsidwa ntchito: novonorm (repaglinide) ndi starlix (nateglinide). Loyamba lafotokozedwa m'nkhaniyi.

Novonorm (mankhwala omwe amagwiritsidwa ntchito ndi mankhwala - repaglinide) amatha kuchepetsa shuga m'magazi am'magazi, "kumalimbikitsa" ma "pancreatic ß" kuti apange insulin yambiri. Makina a zochita za mphuno ndi motere: chinthu chogwira ntchito chimalumikizana ndi "chibadwidwe" cholandilira pazinthu za ß maselo a mabungwe a Langerhans, kutsekereza njira zotsalira za potaziyamu wa ATP ndikuwonongeranso nembanemba. Ma metamorphoses onsewo, amatsegula njira zamtundu wa calcium zotsekedwa mpaka pano. Mosazengereza, ma ioni a calcium amayamba kulowa mu cell en masse, akuwononga magawo ndi insulin ndikuthandizira kuti amasulidwe mu cell kulowa malo othandizira.

Odwala omwe ali ndi matenda a shuga a mtundu wachiwiri, kudya kwa novonorm kumapereka "zenera" ya theka pomwe nthawi ya glucose ikhala ikuyandikira. Pakadali pano, kuchuluka kwa novonorm m'mwazi kumazirala ndipo pambuyo maola 4, mankhwalawa sadziwonekanso. Nthawi yokwanira kudya yatsopano ndisanafike chakudya. Mankhwalawa amatha kugwiritsidwa ntchito ngati mankhwala a mzere woyamba, komanso kwa odwala omwe salabadira kulandira chithandizo cha mankhwala a sulfonylureas kapena biguanides (metformin).

Mankhwalawa amatha kukhala ndi mtundu woyenera wa glycemia wodwala onenepa kwambiri omwe "adakhalapo" pa metformin, pomwe akupereka zovuta zingapo. Mwachidziwikire, kugwiritsa ntchito kuphatikiza kwa Novonorm + Metformin ndizothandiza kwambiri kuposa kugwiritsa ntchito mankhwalawa mosiyana.Pazoyesedwa zamayeso azachipatala zazitali, mawonekedwe atsopano malinga ndi kusunga magawo a biochemical pamlingo wolipirira carbohydrate metabolism unadutsa glipizide (movogleken) ndipo anali pamzere ndi glibenclamide (maninil) ndi glyclazide (diabetesone).

Novonorm amatchulidwa ngati kuwonjezera pa zakudya ndi masewera olimbitsa thupi. Monga tanena kale, ziyenera kutengedwa mphindi 15-30 asanadye kwambiri, i.e. 2-4 pa tsiku. Odwala omwe amadzilola kudya mosasamala amalangizidwa ndi dotolo mwatsatanetsatane zomwe adachita akathamangitsa zakumwa zatsopano. Mulimonsemo, mlingo umatsimikiziridwa payekha, kutengera kuchuluka kwa shuga m'magazi am'magazi. Chifukwa Novonorm ndi mankhwala omwe amathandizira kutulutsidwa kwa insulin, mwanjira inayake imatha kubweretsa kusintha kwa hypoglycemic, monga gawo limodzi la pharmacotherapy, chiwopsezochi chikuwonjezeka. Popita nthawi, mukatenga chizolowezi chatsopano (komanso mankhwala aliwonse otsitsa shuga), kulekerera, chinthu chodziwika ngati kukana kwachiwiri, kumayamba. Zikatero, kusintha kwa mlingo kapena zofunika kwa wodwalayo pakukonzekera malangizo oyendetsera thupi ndi zakudya zofunika.

Pharmacology

Oral hypoglycemic wothandizira. Mwamsanga amachepetsa shuga m'magazi ndikulimbikitsa kutulutsa kwa insulin kuti isagwire ntchito pancreatic β-cell. Limagwirira ntchito limayenderana ndi kuthekera kotchinga njira zotsalira za ATP pamafelemu a β-cell pochita zinthu zina zomwe zimapangitsa kuti maselo azitseguka komanso kutsegulidwa kwa njira za calcium. Zotsatira zake, kuchuluka kwa calcium kumapangitsa kuti insulin itulutsidwe ndi ma cell a β.

Pambuyo pakutenga repaglinide, kuyankha kwa insulinotropic pakudya kwa mphindi 30, komwe kumapangitsa kutsika kwa shuga m'magazi. Pakati pa chakudya, palibe kuwonjezeka kwa insulin. Odwala omwe ali ndi matenda a shuga a mitundu yachiwiri (omwe samadalira insulini), akamamwa mankhwala obwera chifukwa cha 500 μg mpaka 4 mg, amadziwika kuti kuchuluka kwa shuga m'magazi kumadziwika.

Kutulutsa Fomu

Mapiritsiwo ndi oyera, ozungulira, a biconvex, mbali imodzi amadziwika ndi chizindikiro cha kampani (ng'ombe Apis).

Omwe amathandizira: poloxamer 188 - 0.143 mg, povidone - 1.543 mg, meglumine - 0,25 mg, wowuma chimanga - 10 mg, calcium hydrogen phosphate anhydrous - 38.2 mg, microcrystalline cellulose (E460) - 38.264 mg, glycerol 85% (glycerin) - 1.4 mg potaziyamu polacryline (potaziyamu polyacrylate) - 4 mg, magnesium stearate - 0,7 mg.

15 ma PC. - matuza (2) - mapaketi a makatoni.
15 ma PC. - matuza (6) - mapaketi a makatoni.

Rimage regimen imakhazikitsidwa payekhapayekha, kusankha mlingo kuti mukulitse milingo ya shuga.

Mlingo woyambira wabwino ndi 500 mcg. Kuchulukitsa kwa mankhwalawa kuyenera kuchitidwa osapitilira sabata ziwiri za kudya kwambiri, kutengera magawo a labotale ofooketsa kagayidwe.

Mlingo waukulu: umodzi - 4 mg, tsiku lililonse - 16 mg.

Mukatha kugwiritsa ntchito mankhwala ena a hypoglycemic, mlingo woyambira ndi 1 mg.

Tengani chakudya chachikulu chilichonse. Nthawi yoyenera kumwa mankhwalawa ndi mphindi 15 musanadye, koma angathe kumwa mphindi 30 musanadye kapena nthawi yomweyo musanadye.

Mimba komanso kuyamwa

Gwiritsani ntchito pa mimba ndi mkaka wa m`mawere ali contraindicated.

M'maphunziro oyesera, zidapezeka kuti palibe mphamvu ya teratogenic, koma ikagwiritsidwa ntchito pamlingo wambiri m'magawo omaliza a mimbayo, embryotoxicity komanso kusokonezeka kwa miyendo mwa mwana wosabadwayo. Repaglinide imafukusidwa mkaka wa m'mawere.

Malangizo apadera

Ndi chiwindi kapena matenda a impso, opaleshoni yayikulu, matenda kapena matenda aposachedwa, kuchepa kwa kugwiranso ntchito kwa zotheka kumatha.

Gwiritsani ntchito mosamala odwala omwe ali ndi matenda a impso.

Odwala ofooka kapena odwala omwe amachepetsa zakudya, ayenera kuyambiranso kumwa mankhwalawa. Popewa kuthana ndi hypoglycemic pagulu la odwala, mlingo uyenera kusankhidwa mosamala.

Mikhalidwe yomwe ikukwera ya hypoglycemic nthawi zambiri imakhala yotsogola ndipo imaletseka mosavuta kudya mafuta. Woopsa, zitha kukhala zofunikira / pakubweretsa shuga. Kuchepa kwa kukhazikika kotereku kumatengera mlingo, zakudya mthupi, kulimbitsa thupi, kupsinjika.

Chonde dziwani kuti beta-blockers amatha kufinya zizindikiro za hypoglycemia.

Pa chithandizo, odwala ayenera kupewa kumwa mowa, monga Mowa umatha kukulitsa ndikuwonjezera mphamvu ya hypoglycemic ya repaglinide.

Kukopa pa kuyendetsa magalimoto ndi kayendedwe kazinthu

Poyerekeza ndi kagwiritsidwe ntchito ka ntchito yoyambitsanso, kutha kuyendetsa galimoto kapena kuchita zinthu zina zoopsa kuyenera kuyesedwa.

Mlingo ndi bongo

"Novonorm", malangizo ogwiritsira ntchito amaphatikizapo kufotokoza kwa njira ya chithandizo, yomwe imasinthidwa mosamala kwa wodwala aliyense. Amawerengera molumikizana ndi zakudya komanso mankhwala ena a hypoglycemic, amadziwikirana molumikizana ndi insulin.

Ndi bwino kumwa mphindi 15-30 musanadye.

Nthawi zambiri mlingo woyambira ndi 0,5 mg pa tsiku, ngati wodwalayo amalekerera mwachilungamo, muyezo umatha kuchuluka mu masabata 1-2, atatha kuyesedwa ndi mayeso a labotale.

Ndikofunikira kufunsa wodwalayo za zofunika kuchita ndi kuchepa kwambiri kwa glycemia, za zakudya zoyenera komanso zochita za tsiku ndi tsiku.