Momwe mungasinthire Galvus mu shuga: analogues zapakhomo ndi zakunja

Mapiritsi a Galvus ndi Galvus Met A shuga: Phunzirani Zonse Zomwe Mukufuna. Otsatirawa ndi buku lophunzitsira lolemba m'chinenero chomveka. Phunzirani zowonetsera, contraindication ndi Mlingo. Galvus Met ndi mankhwala othandiza odwala matenda ashuga amtundu wa 2, omwe ali odziwika kwambiri, ngakhale ali ndi mtengo wokwera. Imachepetsa shuga m'magazi ndipo sikuti imayambitsa mavuto akulu. Zosakaniza zomwe zimagwiritsidwa ntchito pophatikiza ndi vildagliptin ndi metformin. Mapiritsi a Galvus ali ndi vildagliptin yoyera, yopanda metformin.

Werengani mayankho a mafunso:

1. Yanumet kapena Galvus Met: omwe mankhwalawa ali bwino.
2. Momwe mungamwe mapiritsi awa kuti pasakhale m'mimba.
3. Kugwirizana kwa Galvus ndi Galvus Met ndi mowa.
4. Momwe mungasinthe vildagliptin ngati sichithandiza kapena ndiokwera mtengo kwambiri.

Galvus ndi Galvus Met: nkhani yatsatanetsatane

Galvus ndi mankhwala atsopano. Zinayamba kugulitsa zaka zosakwana 10 zapitazo. Mulibe malo otsika mtengo otetezera nyumba, chifukwa patent sichitha. Pali zithunzi za opanga opikisana - Yanuviya ndi Yanumet, Onglisa, Vipidiya ndi ena. Koma mankhwalawa onse amatetezedwa ndi ma Patenti ndipo ndiokwera mtengo. Pansi pake amafotokozedwa mwatsatanetsatane kuti ndi mapiritsi otchipa omwe mungathe kusintha m'malo mwa vildagliptin ngati simungathe kugula mankhwalawa.

Malangizo ogwiritsira ntchito

Mukamamwa Galvus kapena Galvus Met, ngati mapiritsi ena aliwonse a shuga, muyenera kutsatira zakudya.

Galvus Met ali ndi ndemanga zabwino za odwala pakati pa mitundu yonse ya 2 ya mapiritsi a shuga omwe amagulitsidwa m'mayiko olankhula Chirasha. Odwala ambiri amadzitamandira kuti mankhwalawa adatsitsa shuga wawo kuchokera kuzizindikiro zakumwamba kupita ku 7-8 mmol / L. Kuphatikiza apo, osati mndandanda wa shuga ukukula, komanso thanzi. Komabe, vildagliptin si panacea ya matenda ashuga, kuphatikiza ndi metformin. Muyenera kukhala ndi moyo wathanzi, makamaka kutsatira zakudya. Pa matenda akulu a shuga, palibe mapiritsi, ngakhale okwera mtengo komanso okongola kwambiri, omwe angabwezeretse jakisoni wa insulin.

Galvus kapena Galvus Met: ndibwino bwanji? Zimasiyana bwanji?

Galvus ndi vildagliptin koyera, ndipo Galvus Met ndi mankhwala ophatikiza okhala ndi vildagliptin ndi metformin. Mwambiri, metformin imatsitsa shuga m'magazi odwala matenda ashuga kuposa vildagliptin. Chifukwa chake, muyenera kutenga Galvus Met, pokhapokha ngati wodwala ali ndi contraindication yayikulu pakusankhidwa kwa metformin. M'masiku oyambirira a chithandizo, kutsegula m'mimba, kunyansidwa, kutulutsa magazi ndi matenda ena am'mimba kumatha kuchitika. Koma ndikofunikira kudikirira ndikudikirira mpaka adutse. Zotsatira zamankhwala zomwe zimakwaniritsidwa zimakusangalatsani chifukwa chazovuta.

Zofanizira zazikulu za Galvus

Pakadali pano, ambiri a Galvus analogues apangidwa, omwe amatha kukhala omangidwa komanso gulu lawo lamankhwala.

Galvus Met ndi analogue yanyumba ya Galvus. Analog yophatikizika ya Galvus Met imapezeka mu 50 + 1000, vildagliptin mu gawo limodzi lokhala ndi 50 mg, metformin 100 mg.

Ma analogues odziwika kwambiri a Galvus mu muyeso wa 50 mg ndi awa:

Zonsezi m'malo mwa zomwe zidapangidwa kale, poyerekeza ndi izi, zovuta ndizosiyanasiyana, zomwe ziyenera kulingaliridwa mwatsatanetsatane.

Izi zimathandizira kuyang'anitsitsa njira zosiyanasiyana zamankhwala ochepetsera shuga zomwe zimaperekedwa pamsika wamakampani apamtunda.

Vipidia - cholowa m'malo mwa Galvus

Vipidia ndi othandizira a hypoglycemic, omwe amagwira ntchito omwe ali alogliptin. Kugwiritsa ntchito mankhwalawa pochizira matenda amishuga a m'magazi a 2 kungathandize kuchepetsa kuchuluka kwa hemoglobin wa glycated ndi glucose m'thupi la wodwalayo.

Kusiyana pakati pa Vipidia ndi Galvus kuli m'gulu lomwe limagwiritsidwa ntchito, ngakhale onse ali m'gulu lomweli - DPP-4 zoletsa.

Mankhwalawa amagwiritsidwa ntchito onse pa monotherapy komanso ngati gawo limodzi la zovuta zochizira matenda amisempha monga amodzi mwa zigawo zina za mankhwala. Mlingo woyenera tsiku lililonse ndi 25 mg. Chipangizocho chitha kutengedwa mosasamala nthawi yakudya.

Mankhwalawa adapangidwa pakudziwika kwa zizindikiro za ketoacidosis wodwala.

Kuphatikiza apo, kugwiritsidwa ntchito kwazomwekuletsedwa:

• mtundu 1 shuga
• kulephera kwamtima kwambiri
• aimpso ndi chiwindi kulephera.

Mukamagwiritsa ntchito analog yotsika mtengo ya Galvus, wopanga akuwonetsa zomwe zingachitike zotsatirazi:

1. Mutu.
2. Zomverera zowawa mu epigastrium.
3. Zotupa pakhungu.
4. Matenda opatsirana a ziwalo za ENT.

Mankhwalawa okwera mtengo, malinga ndi malangizo, sanalembedwe chithandizo cha matenda achiwopsezo amtundu wa II mwa ana ndi amayi apakati, chifukwa cha kusowa kwa chidziwitso chokhudzana ndi gawo lomwe limagwira mthupi la thupi m'magulu awa.

Trazhenta ndi mankhwala omwe kugwiritsa ntchito kwake kumathandiza kuchepetsa kuchuluka kwa shuga m'thupi la wodwala wokhala ndi matenda a shuga a mtundu wachiwiri. Zomwe zimagwiritsa ntchito mankhwalawa ndi linagliptin. Kapangidwe kameneka kamapereka kuchepa kwa glucose m'chiwindi ndikuwongolera chizindikiro chake m'madzi a m'magazi. Chizindikiro chogwiritsidwa ntchito ndi kupezeka kwa wodwala wa mtundu wa 2 shuga.

Kusiyana kwa Galvus ndikuti mankhwalawa alibe mlingo woyendetsedwa bwino. Mlingo wofunikira wa mankhwalawa amasankhidwa payekha.

Mankhwalawa sagwiritsidwa ntchito kwa matenda amtundu wa 1, komanso pamaso pa hypersensitivity pamagawo a mankhwalawa komanso matenda ashuga a ketoacidosis.

Pa mankhwalawa, zotsatira zoyipa za mawonekedwe a chifuwa, kapamba ndi kuphatikizana kwammphuno kumatha kuchitika.

Mankhwalawa si mankhwala pa matenda a ana osaposa zaka 18 ndi amayi apakati.

Kusiyana kwa Onglizy kuchokera ku Galvus

Onglisa ndi othandizira pakamwa. Onglisa amasiyana ndi Galvus poyambira ndi gawo lalikulu lomwe limagwira ntchito. Mosiyana ndi Galvus, yomwe ili ndi vildagliptin, Onglisa ali ndi saxagliptin mwanjira ya hydrochloride. Magawo onse awiriwa ali m'gulu la mankhwala omwewo - DPP-4 inhibitors.

Kugwiritsira ntchito mankhwala a mtundu 2 matenda a shuga kungachepetse kuchuluka kwa glucagon m'magazi musanadye komanso pambuyo pake. Onglyza amatchulidwa kuti azimuthandizira, komanso kuwonjezera mphamvu yochepa yazakudya zomwe zimagwiritsidwa ntchito, komanso ngati gawo lochizira matenda.

Contraindication kuti agwiritse ntchito ndi:

• kupezeka kwa matenda a shuga 1
• kuchitira mankhwala osakanikirana ndi jakisoni wa insulin,
• Kukula kwa thupi la wodwala ketoacidosis.

Pokonza njira zochiritsira mothandizidwa ndi mankhwalawa, wodwalayo amatha kukumana ndi mavuto am'mutu, kutupa, kumva kupweteka m'mphuno.

Kugwiritsa ntchito mankhwalawa mankhwalawa kwa ana ndi amayi omwe akubala mwana ndizoletsedwa, chifukwa cha kusowa kwa data yotsimikizika mwachipatala pazokhudzana ndi gawo lazogwira ntchito pamagulu awa.

Januvius - Generic Galvus

Yanuvuya ndi mankhwala a hypoglycemic omwe amapangidwa pamaziko a sitagliptin. Amapezeka mu piritsi.

Kugwiritsa ntchito mankhwalawa kumathandizira kuponderezana kwa glucagon, yomwe imachepetsa glycemia. Amaloledwa kugwiritsa ntchito mankhwalawa pokhapokha ngati pali matenda a shuga a 2.

Kusintha kwa Mlingo kumachitika ndi kupezeka dokotala kutengera mtundu wa kukula kwa hyperglycemia. Ndi koletsedwa kugwiritsa ntchito matenda ashuga amtundu woyamba, komanso ngati wodwala akutsutsana ndi mbali za mankhwala.

Zotsatira zoyipa komanso zosayenera panthawi ya mankhwala a Yanuvia zimatha kuphatikizira kupweteka kwa mutu, kupweteka kwa malo olumikizirana mafupa, njira zopatsirana m'mapazi apamwamba a kupuma, kutsegula m'mimba, komanso kumva mseru.

Mankhwala ali oletsedwa kugwiritsidwa ntchito pochita njira zochizira amayi apakati komanso odwala omwe ali ndi zaka 18.

Mtengo wa mankhwala omwe amapezeka pamsika wogulitsa mankhwala ndikuwunika za iwo

Galvus imapangidwa ndi Novartis, wopanga mankhwala ku Switzerland. Malondawa ali ngati mapiritsi a 50 mg. Phukusili lili ndi mapiritsi 28. Mtengo wa mankhwala pamsika wa Russian Federation ukhoza kuyambira 701 mpaka 2289 rubles. Mtengo wapakati pamsika wam'nyumba ndi ma ruble 791 pa paketi iliyonse.

Malinga ndi odwala, Galvus ndi mankhwala ochita bwino.

Vipidia pamsika wamankhwala ogulitsa ali ndi mtengo wokwera pang'ono poyerekeza ndi mankhwala oyambirirawo. Pafupifupi, mtengo phukusi lililonse la mankhwala okhala ndi mapiritsi okhala ndi 12,5 mg ndi ma ruble 973, ndipo mapiritsi okhala ndi 25 mg amatsika ndi 250 rub rubles.

Ndemanga zambiri za mankhwalawa ndi zabwino, ngakhale zilinso zopanda pake, nthawi zambiri ndemanga zotere zimachitika chifukwa chakuti kumwa mankhwalawo sikunakhale ndi vuto lililonse m'magazi.

Trazhenta ndi analogue yoitanitsa ku Galvus chifukwa chake mtengo wake umaposa mankhwala oyambirirawo. Mankhwalawa amapangidwa ku Austria, mtengo wake ku Russia umachokera ku ruble 1551 mpaka 1996, ndipo mtengo wamba wonyamula mankhwala ndi ma ruble 1648.

Ambiri mwa odwala amavomereza kuti mankhwalawa ndi othandiza kwambiri.

Zizindikiro zogwiritsidwa ntchito

Kodi chimathandiza Galvus Met ndi chiyani? Malinga ndi malangizo, mankhwalawa amapatsidwa mankhwala ochizira matenda a shuga a 2 (kuphatikizapo masewera olimbitsa thupi ndi zakudya) pazochitika zotsatirazi:

• Kuperewera kwa mphamvu ya monotherapy ndi metformin kapena vildagliptin,
• Kugwiritsa ntchito kale mankhwala ophatikizidwa ndi metformin ndi vildagliptin ngati mankhwala amodzi,
• Matatu kuphatikiza mankhwala ndi insulin odwala omwe analandira kale mankhwala a insulin mu mlingo wokhazikika ndi metformin, koma sanakwaniritse kuwongolera koyenera kwa glycemic,
• Mankhwala osakanikirana ndi mankhwala a sulfonylurea (mankhwala ophatikiza patatu) mwa odwala omwe adalandira chithandizo cha mankhwala a sulfonylurea ndi metformin, koma sanakwanitse kuwongolera mokwanira glycemic,
• Mankhwalawa oyambira odwala omwe ali ndi matenda a shuga a 2 omwe ali osakwanira kuchita masewera olimbitsa thupi, mankhwala othandizira pakudya komanso ngati pakufunika kusintha, glycemic control.

Zotsatira zoyipa

Malangizowa amachenjeza za mwayi wopanga zotsatirapo zoyipa mukamapereka Galvus Met:

• Kuchokera m'mimba thirakiti - nseru, m'mimba kupweteka, matumbo mayamwidwe a vitamini B12.
• Machitidwe amanjenje - mutu, chizungulire, kugwedezeka (manja akunjenjemera).
• Chiwindi ndi biliary thirakiti - hepatitis (kutupa chiwindi) ndi kuphwanya magwiridwe antchito ake.
• Matenda a musculoskeletal - arthralgia (mawonekedwe a ululu mu mafupa), kawirikawiri myalgia (kupweteka kwa minofu).
• Khungu komanso minyewa yodutsa - mawonekedwe a matuza, kuterera kwa khungu ndi kutupa kwa khungu.
• Metabolism - kukula kwa lactic acidosis (kuchuluka kwa uric acid komanso kusintha kosintha kwa magazi komwe kumapita kumbali ya acidic).
• Thupi lawo siligwirizana - zotupa pakhungu lake ndi kuyabwa kwake, ming'oma (chizolowezi chamtundu, kutupa, kufanana ndi kuwotchera kwa nettle). Kuwonetseredwa koopsa kwa thupi la mziwopsezo mu mawonekedwe a angioedema Quincke edema (khungu lolimba ndi zotupa pakhungu ndi ziwalo zakunja) kapena kugwedezeka kwa anaphylactic (kuchepa kwapang'onopang'ono kwa kuchepa kwamphamvu kwa magazi ndi ziwalo zingapo) kulephera.

Kukula kwa hypoglycemia ndikotheka - kutsatana ndi kuwoneka kwa kunjenjemera kwa dzanja, "thukuta lozizira" - Pankhaniyi, ndikofunikira kutenga chakudya cham'mimba mosavuta (tiyi wokoma, maswiti) mkati.

Contraindication

Amakanizidwa kuti apereke Galvus Met pazochitika zotsatirazi:

• Ndi chidwi chachikulu ndi zigawo za mankhwala,
• Kulephera kwamkati ndi ntchito ina yaimpso.
• Mitundu yamatenda omwe angayambitse kukula kwa impso - kuwonda, kutentha thupi, matenda, hypoxia ndi zina,
• Kuchepa kwa chiwindi,
• Mtundu woyamba wa shuga
• Uchidakwa wambiri, chakumwa choledzeretsa chachikulu,
• Mimba komanso kuyamwa
• Uchidakwa wambiri, chakumwa choledzeretsa chachikulu,
• Kutsatira zakudya zama hypocaloric (zosakwana 1000 kcal patsiku),
• Asanakwanitse zaka 18.

Fotokozerani mosamala:

• Odwala a zaka 60 akugwira ntchito yolemera kupanga (lactic acidosis imatha kukhala).

Mimba komanso kuyamwa

Popeza palibe chidziwitso chokwanira pakugwiritsa ntchito mankhwalawa amayi apakati, kugwiritsa ntchito panthawi yomwe muli ndi pakati kumatsutsana.

Milandu ya vuto logaya shuga mwa amayi apakati, pamakhala chiwopsezo chodzala ndi vuto lobadwa nalo, komanso kufalikira kwamatenda a kubadwa kwa neonatal. Kuteteza matenda a shuga m'magazi panthawi yapakati, insulin monotherapy tikulimbikitsidwa.

M'maphunziro oyesera, popereka vildagliptin mu Mlingo wowirikiza 200 kuposa momwe analimbikitsira, mankhwalawa sanayambitse chimbudzi ndikukula koyambirira kwa mwana wosabadwayo ndipo sanatanthauze mwana wosabadwayo. Popereka mankhwala a vildagliptin osakanikirana ndi metformin paziwerengero 1: 10, panalibe zotsatira zakuthambo kwa mwana wosabadwayo.

Popeza sizikudziwika ngati vildagliptin kapena metformin adachotsedwa mkaka waumunthu, kugwiritsa ntchito mankhwalawa panthawi yoyamwitsa kumatsutsana.

Analogs Galvus Met, mtengo pama pharmacies

Ngati ndi kotheka, Galvus Met ikhoza kuthandizidwa ndi analogue mu achire - awa ndi mankhwala:

1. Sofamet
2. Nova Met
3. Methadiene
4. Vildagliptin,
5. Galvus
6. Trazenta,
7. Forin Pliva.

Mukamasankha analogi, ndikofunikira kumvetsetsa kuti malangizo ogwiritsira ntchito Galvus Met, mtengo ndi malingaliro sizigwira ntchito ndi mankhwala omwewo. Ndikofunikira kupeza upangiri wa dokotala komanso kuti usasinthe popanda mankhwala.

Mtengo m'masitolo a ku Russia: Mapiritsi a Galvus Met 50 mg + 500 mg 30 - kuchokera ku ruble 1,140 mpaka 1,505, 50 mg + 850 mg 30 - kuchokera 1,322 mpaka ruble 1,528, Galvus adakumana ndi mapiritsi a 50 mg + 1,000 mg 30 - malinga ndi 1,395 mpaka 1,599 rubles, malinga Mankhwala 782.

Sungani pamalo owuma pamatenthedwe mpaka 30 ° C. Pewani kufikira ana. Alumali moyo - 1 chaka 6 miyezi.

Yanumet kapena Galvus Met: ndi mankhwala ati omwe amaposa?

Yanumet ndi Galvus Met ndi mankhwala ofanana kuchokera kwa opanga awiri osiyanasiyana omwe amapikisana. Ali ndi mtengo wofanana. Kulongedza mankhwala Yanumet ndi okwera mtengo, koma amakhala ndi miyala yambiri. Palibe mwa awa mankhwalawa omwe ali ndi ma analogues otsika mtengo, chifukwa mankhwalawa onse akadali atsopano, otetezedwa ndi ma Patent. Mankhwalawa onse adatenga ziwonetsero zabwino kuchokera kwa odwala olankhula Chirasha omwe ali ndi matenda a shuga a 2. Tsoka ilo, kulibe chidziwitso pakadali koyankha molondola kuti ndi iti mwa mankhwalawa amachepetsa shuga yamagazi. Onse ali abwino komanso otetezeka. Kumbukirani kuti popanga mankhwalawa, Yanumet metformin ndi yofunika kwambiri kuposa sitagliptin.

Galvus kapena metformin: ndibwino bwanji?

Wopangayo akuti vildagliptin ndiye chinthu chachikulu chogwiritsa ntchito pamapiritsi a Galvus Met. Ndipo metformin ndi gawo lothandiza chabe. Komabe, Dr. Bernstein akuti metformin amatsitsa shuga koposa magazi a vildagliptin. Galvus Met ali ndi ndemanga zabwino kwambiri za odwala pakati pa mitundu yonse yatsopano ya 2 shuga. Pali lingaliro kuti gawo lalikulu pakupambana ili limaseweredwa ndi metformin wakale wakale, osati vildagliptin yatsopano yokhala ndi mawu.

Galvus Met yodula imathandizira pang'ono kuchokera ku shuga wambiri kuposa miyala yotsika mtengo ya pureform. Komabe, zimasintha pang'ono zotsatira za chithandizo cha matenda ashuga, ndipo zimawononga kangapo kuposa Siofor kapena Glucofage. Ngati mwayi wazachuma ungalole, tengani vildagliptin + metformin. Ngati mukusowa ndalama, mutha kusinthira ku metformin yoyera. Chithandizo chake chabwino kwambiri ndi mankhwala oyambitsidwa kunja, Glucofage.

Mapiritsi a Siofor nawonso ndi otchuka. Mwina amachita moperewera pang'ono kuposa Glucofage, komanso zabwino. Mankhwalawa onse amakhala otsika mtengo kuposa Galvus Met. Mutha kupeza ndi miyala yotsika mtengo ya metformin yopangidwa ku Russia ndi mayiko a CIS, koma ndibwino osazigwiritsa ntchito.

Tsoka ilo, palibe chidziwitso chokwanira chofananizira mwachindunji cha Galvus Met ndi metformin yoyera. Ngati nthawi zosiyanasiyana mumamwa mankhwalawa Glucofage kapena Siofor, komanso Galvus Met, chonde gawani zomwe mwakumana nazo mu ndemanga iyi. Galvus (vildagliptin wangwiro) ndi mankhwala ofooka a matenda a shuga a 2. Ndikofunika kuti mutenge popanda mankhwala ena pokhapokha ngati pali zotsutsana ndi metformin. Koma ndikwabwino m'malo mwake kuti ayambe kubayila insulin.

Momwe mungatenge Galvus Met

Odwala omwe ali ndi matenda a shuga a mtundu 2 nthawi zambiri samveka bwino kutenga vildagliptin (mankhwala a Galvus), pokana metformin. Chifukwa chake, zotsatirazi zikufotokoza njira zomwe zingamwe mankhwala ophatikizira a Galvus Met. Nthawi zina, odwala amadandaula kuti sangathe kulekerera mankhwalawa chifukwa cha kutsegula m'mimba kwambiri komanso zina. Poterepa, yesani mtundu wa Metformin ndi mlingo woyambira wotsika ndikukula kwake pang'onopang'ono. Nthawi zambiri, m'masiku ochepa thupi limasinthasintha, kenako mankhwalawa amayenda bwino. Metformin ndi mankhwala ofunika kwambiri kwa odwala omwe ali ndi matenda ashuga a 2. Kana kutero pokhapokha ngati pali zotsutsana kwambiri.

Kodi mungapewe bwanji kukhumudwa?

Kuti musakhumudwe, muyenera kuyamba ndi kipimo chochepa cha metformin, kenako ndikupangitsani pang'onopang'ono. Mwachitsanzo, mutha kugula mapiritsi 30 a Galvus Met 50 + 500 mg ndikuyamba kumwa kamodzi patsiku. Pakakhala zovuta zoyipa, pakatha masiku 7, sinthani mapiritsi awiri a 50 + 500 mg patsiku, m'mawa ndi madzulo.

Mukamaliza kulongedza, mutha kusinthira ku mankhwala 50 + 850 mg, kumwa mapiritsi awiri patsiku. Mapeto ake, odwala matenda ashuga ayenera kumwa mankhwala a Galvus Met 50 + 1000 mg, mapiritsi awiri patsiku, mosakhazikika. Mwanjira iyi, mudzalandira vildagliptin mu mlingo waukulu wa tsiku ndi tsiku wa 100 mg ndi metformin ina 2000 mg.

Anthu omwe ali ndi matenda a shuga a mtundu wachiwiri ndi kunenepa kwambiri amatha kumwa metformin mpaka 3000 mg patsiku. Kuti muwonjezere mlingo wa mankhwalawa, ndizomveka kutenga piritsi yowonjezera ya metformin 850 kapena 1000 mg pa nkhomaliro. Ndikofunika kugwiritsa ntchito mankhwala oyamba Glucofage.

Mankhwala Siofor alinso abwino, ngati si mapiritsi a zoweta zapakhomo zokha. Mwina sizingakhale zabwino kuti mutenge mankhwala awiri osiyanasiyana a shuga nthawi imodzi. Komabe, kuwonjezera tsiku lililonse la metformin kuyambira 2000 mg mpaka 2850 kapena 3000 mg kumatha kuwongolera shuga wamagazi ndikuthandizira kuchepa kwambiri. Mwinanso, zotsatira zake zimakhala zoyenera kuchita.

Mankhwala a Galvus, omwe ali ndi vildagliptin yoyera popanda metformin, amawononga pafupifupi kawiri kawiri kuposa Galvus Met. Anthu odwala matenda ashuga omwe ali ndi chilango komanso gulu labwino amatha kupulumutsa ndalama potenga Galvus ndi Metformin padera. Tikubwerezanso kuti kukonzekera bwino kwa metformin ndi Glucofage kapena Siofor, koma osati mapiritsi opangidwa ku Russia Federation ndi mayiko a CIS.

Odwala ambiri omwe ali ndi matenda ashuga, shuga amadzuka m'mimba kwambiri m'mimba, kenako masana zimakhala zabwinobwino. Zikatero, mutha kutenga piritsi ya Galvus m'mawa ndi madzulo, ndipo ngakhale usiku, metformin 2000 mg monga gawo la mankhwala Glucofage Long. Metformin wokhala ndi nthawi yayitali amagwira ntchito m'thupi usiku wonse, kotero kuti m'mawa wotsatira, shuga yofulumira ali pafupi ndi nthawi yochepa.

Kodi mankhwalawa amagwirizana ndi mowa?

Malangizo omwe akugwiritsidwa ntchito saupereka yankho lenileni la funso ili. Palibe chovuta kuledzera. Chifukwa zimawonjezera chiopsezo cha kapamba, mavuto a chiwindi, shuga wochepa wamagazi ndi zovuta zina zomwe zingayambitse kuchipatala komanso ngakhale kufa. Komabe, sizikudziwika ngati mowa ungathe kumwa pang'ono. Malangizo ogwiritsira ntchito mankhwalawa Galvus Met mwachindunji samalola, koma samawaletsa. Mutha kumwa mowa pang'ono mosapeneka. Werengani nkhani yakuti “Mowa wa Matenda a shuga.” Ikuwonetsa mowa wovomerezeka wa amuna ndi akazi achikulire, komanso zakumwa zomwe amakonda anthu ashuga. Ngati simungathe kukhala odziletsa, muyenera kupewa mowa.

Kodi chida ichi chimakuthandizani kuti muchepetse kunenepa? Kodi zimakhudza bwanji kulemera?

Zotsatira za kafukufuku wapamwamba zimanena kuti Galvus ndi Galvus Met sizikhudza kulemera kwa thupi la wodwalayo. Komabe pochita, anthu ambiri omwe amatenga metformin amatha kutsitsa mapaundi ochepa. Mwambiri, inunso muchita bwino. Makamaka ngati mupitilira zakudya zamafuta ochepa kuti muchepetse matenda a shuga, monga Dr. Bernstein analimbikitsa.

Kodi chingalowe m'malo ndi Galvus Met?

Zotsatirazi zikufotokozera momwe mungasinthire Galvus Met pazinthu zotsatirazi:

• Mankhwalawa sathandiza konse, shuga wodwala ndiwambiri kwambiri.
• Mapiritsi amathandizira, koma osakwanira, shuga amakhalabe pamwamba pa 6.0 mmol / L.
• Mankhwalawa ndi okwera mtengo kwambiri, sangakwanitse odwala matenda ashuga ndi abale ake.

Ngati vildagliptin ndi / kapena metformin pafupifupi kapena osathandiza kwenikweni, muyenera kuyamba kubayirira insulin. Osayesa kugwiritsa ntchito mapiritsi ena aliwonse, chifukwa sangakhale a ntchito iliyonse. Matenda a wodwalayo ndiwotsogola kwambiri kuti kapamba amatha ndipo amasiya kutulutsa insulin. Simungachite popanda jakisoni wa insulin, ndipo muyenera kuchita jakisoni zingapo patsiku. Kupatula apo, muyenera kudziwa zovuta zoopsa za matenda ashuga.

Odwala odwala matenda ashuga ayenera kubweretsa shuga m'magazi a anthu athanzi - 4.0-5.5 mmol / l khansa maola 24 patsiku. Izi zitha kuchitika ngati muyesera. Phunzirani masitepe am'magawo a 2 matenda a shuga ndikuwachitapo kanthu. Kutsatira zakudya zama carb ochepa komanso kudya Galvus Met kumatha kuchepetsa shuga, koma nthawi zina sikokwanira.

Mwachitsanzo, shuga amakhalabe ndi 6.5-8 mmol / L. Pankhaniyi, muyenera kulumikizanso jakisoni wa insulin mu Mlingo wotsika. Ndi mtundu wanji wa insulini kuti mupeze jakisoni komanso munthawi yanji, muyenera kusankha nokha payekhapayekha poganizira zomwe zimachitika shuga masana. Odwala ena amakhala ndi shuga kwambiri m'mawa pamimba yopanda kanthu, pomwe ena - pachakudya chamadzulo kapena madzulo. Osanyalanyaza chithandizo cha insulin kuwonjezera pa zakudya ndi mapiritsi. Chifukwa ndi shuga wama 6.0 ndi pamwamba, zovuta za shuga zimapitilirabe, ngakhale pang'onopang'ono.

Zoyenera kuchita ngati mankhwalawa sangakwanitse?

Anthu odwala matenda ashuga, omwe mankhwala a Galvus ndi Galvus Met ndi okwera mtengo kwambiri, ayenera kusinthana ndi metformin yoyera. Zabwino koposa zonse, mankhwala oyamba a Glucofage. Zina zomwe zinatumizidwa kunja Siofor zimachita zochepa pang'onopang'ono kuposa Glucofage, komanso zabwino. Otsika mtengo kwambiri ndi mapiritsi a metformin omwe amapangidwa ku Russia Federation ndi mayiko a CIS. Koma amatha kutsitsa shuga ocheperako poyerekeza ndi mankhwala omwe amatsimikiziridwa kuchokera kunja. Yesetsani kuti mutsatire zakudya zamafuta ochepa. Zakudya zopatsa thanzi zomwe zimakwanira inu ndizokwera mtengo kuposa chimanga, mbatata, ndi zinthu zina zamafuta. Koma popanda zakudya zamafuta ochepa, simungathe kudziteteza ku zovuta za matenda ashuga.

Analogs mwa chisonyezo ndi njira yogwiritsira ntchito

Kuphatikizika kosiyanasiyana, kungagwirizane mukuwonetsa ndikugwiritsa ntchito njira

Kodi mungapeze bwanji analogue yotsika mtengo ya mankhwala okwera mtengo?

Kuti mupeze chiwonetsero chotsika mtengo cha mankhwala, chofananira kapena chofanana, choyambirira timalimbikitsa kulabadira kapangidwe kake, zomwe ndi zinthu zomwezo zomwe zikugwira komanso zomwe zikugwiritsidwa ntchito. Zomwe zimagwiritsidwanso mosiyanasiyana ndi mankhwalawa zimawonetsa kuti mankhwalawo ndi ofanana ndi mankhwalawo, monga mankhwala ena kapena mitundu ina. Komabe, musaiwale za zovuta zomwe zimagwiritsidwa ntchito ndi mankhwala ofanana, omwe angakhudze chitetezo ndi kugwiranso ntchito. Musaiwale za malangizo a madotolo, kudzipereka nokha kungawononge thanzi lanu, chifukwa chake onani dokotala wanu musanagwiritse ntchito mankhwala.

Malangizo a Galvus Met

Kutulutsa Fomu
Mapiritsi okhala ndi mafilimu.

Kupanga
Piritsi 1 ili ndi vildagliptin 50 mg + metformin 500, 850 kapena 1000 mg,

Kulongedza
mu phukusi la 6, 10, 18, 30, 36, 60, 72, 108, 120, 180, 216 kapena 360 ma PC.

Zotsatira za pharmacological
Kapangidwe kamankhwala Galvus Met kamaphatikizira ma 2 a hypoglycemic othandizira omwe ali ndi njira zosiyanasiyana zochitira: vildagliptin, omwe ali mgulu la dipeptidyl peptidase-4 inhibitors (DPP-4), ndi metformin (mu mawonekedwe a hydrochloride) - woimira kalasi ya Biguanide. Kuphatikizidwa kwa zinthuzi kumakupatsani mwayi wolamulira kuchuluka kwa glucose wamagazi mwa odwala omwe ali ndi matenda a shuga a 2 kwa maola 24.

Vildagliptin
Vildagliptin, nthumwi ya kalasi ya othandizira kulumikizana ndi zida zapachiberekero, mosamala amaletsa enzyme DPP-4, yomwe imawononga mtundu 1 wa glucagon ngati peptide (GLP-1) ndi glucose-insulinotropic polypeptide (HIP).
Kuletsa mwachangu komanso kwathunthu ntchito za DPP-4 kumayambitsa kuwonjezeka kwa zonse zoyambira komanso zotsitsimutsa chakudya za GLP-1 ndi HIP kuchokera m'matumbo kumayendedwe azinthu tsiku lonse.
Mwakuwonjezera milingo ya GLP-1 ndi HIP, vildagliptin imayambitsa kukhudzika kwa maselo a pancreatic to-glucose, zomwe zimabweretsa kusintha kwa secretion ya shuga. Kuchuluka kwa kusintha kwa ntchito ya β-cell kumadalira kuchuluka kwa kuwonongeka kwawo koyamba, choncho mwa anthu omwe alibe shuga mellitus (omwe ali ndi shuga wambiri m'magazi am'magazi), vildagliptin simalimbikitsa kutulutsa kwa insulin komanso sikuchepetsa kuchuluka kwa shuga.
Mwa kuwonjezera milingo ya amkati mwa GLP-1, vildagliptin imawonjezera mphamvu ya maselo a α-glucose, zomwe zimapangitsa kuti pakhale kusintha kwamalamulo a shuga a glucagon. Kutsika kwa kuchuluka kwa glucagon okwanira mutatha kudya, kumapangitsa kuchepa kwa insulin.
Kuwonjezeka kwa kuchuluka kwa insulin / glucagon poyang'ana kumbuyo kwa hyperglycemia, chifukwa cha kuchuluka kwa kuchuluka kwa GLP-1 ndi HIP, kumayambitsa kuchepa kwa kupanga kwa chiwindi ndi chiwindi nthawi yonse ya chakudya komanso pambuyo pake, zomwe zimapangitsa kuchepa kwa kuchuluka kwa shuga m'magazi am'magazi.
Kuphatikiza apo, motsutsana ndi kagwiritsidwe ntchito ka vildagliptin, kuchepa kwa kuchuluka kwa lipids m'madzi am'magazi pambuyo podyedwa, komabe, izi sizikugwirizana ndi zomwe zimachitika pa GLP-1 kapena HIP komanso kusintha kwa magwiridwe antchito a cell pancreatic islet.
Amadziwika kuti kuwonjezeka kwa ndende ya GLP-1 kungapangitse kuti m'mimba muchepetse pang'ono, komabe, motsutsana ndi kugwiritsidwa ntchito kwa vildagliptin, zotsatira zofananira sizimawonedwa.
Mukamagwiritsa ntchito vildagliptin mu 5759 odwala omwe ali ndi mtundu wa 2 shuga mellitus wa masabata 52 monga monotherapy kapena osakanikirana ndi metformin, zotumphukira za sulfonylurea, thiazolidinedione, kapena insulin, kuchepa kwakukulu kwakanthawi kwakanthawi kwa kuchuluka kwa glycated hemoglobin (Нb Ver1с) komanso kusala shuga wamagazi.

Metformin
Metformin imathandizira kulolerana kwa glucose mwa odwala omwe ali ndi matenda a shuga 2 mwakuchepetsa kuchuluka kwa glucose nthawi yoyamba komanso isanachitike. Metformin imachepetsa kupanga kwa chiwindi ndi chiwindi, imachepetsa mayamwidwe am'matumbo m'matumbo ndikuchepetsa kukana kwa insulin polimbikitsa kutulutsa ndi kugwiritsa ntchito shuga mwa zotumphukira zake. Mosiyana ndi mankhwala a sulfonylurea, metformin sayambitsa hypoglycemia kwa odwala omwe ali ndi matenda a shuga 2 kapena anthu athanzi (kupatula milandu yapadera). Mankhwalawa ndi mankhwalawa sikuti kumayambitsa kukula kwa hyperinsulinemia. Pogwiritsa ntchito metformin, insulin katulutsidwe sikasintha, pomwe ma insulin plasma pamimba yopanda kanthu komanso masana amatha kuchepa.
Metformin imathandizira kuphatikizika kwa glycogen synthesis mwa glycogen synthase ndikukulitsa kutulutsa kwa glucose ndi mapuloteni ena amtundu wa glucose transporter (GLUT-1 ndi GLUT-4).
Pogwiritsa ntchito metformin, njira yothandiza pa kagayidwe ka lipoproteins imadziwika: kuchepa kwa kuchuluka kwa cholesterol, LDL cholesterol ndi triglycerides, yosagwirizana ndi mphamvu ya mankhwala a plasma glucose.

Vildagliptin + Metformin
Mukamagwiritsa ntchito mankhwala ophatikizira ndi vildagliptin ndi metformin mu Mlingo wa tsiku ndi tsiku wa 1,500-,000,000 mg wa metformin ndi 50 mg wa vildagliptin 2 pa tsiku 1 chaka, kuchepa kwakukulu kwa kuchuluka kwa shuga m'magazi kunawonedwa (kutsimikizika ndi kuchepa kwa HbA1c) komanso kuchuluka kwa odwala omwe ali ndi kuchepa. Kuzunza kwa HbA1c kunali pafupifupi 0,6-0.7% (poyerekeza ndi gulu la odwala omwe akupitiliza kulandira metformin yokha).
Odwala omwe amalandila vildagliptin ndi metformin, kusintha kwakukulu pa kulemera kwamunthu poyerekeza ndi koyambirira sikunawonedwe. Masabata 24 atayamba chithandizo, m'magulu a odwala omwe amalandila vildagliptin osakanikirana ndi metformin, panali kuchepa kwa magazi ndi abambo mwa odwala omwe ali ndi matenda oopsa.
Pamene kuphatikiza kwa vildagliptin ndi metformin kunagwiritsidwa ntchito ngati chithandizo choyambirira cha odwala omwe ali ndi matenda a shuga 2 masabata 24, kuchepa kwa HbA1c komwe kumadalira mlingo komanso kulemera kwa thupi kumawonedwa poyerekeza ndi monotherapy ndi mankhwalawa. Milandu ya hypoglycemia inali yochepa kwambiri m'magulu onse awiri ochiritsira.
Mukamagwiritsa ntchito vildagliptin (50 mg 2 kawiri pa tsiku) ndi / popanda metformin osakanikirana ndi insulin (pafupifupi mlingo - 41 PIECES) mwa odwala omwe ali ndi mayesero azachipatala, chizindikiro cha HbA1c chidachepa kwambiri - ndi 0.72% (chizindikiro choyambirira - pafupifupi 8, 8%). Zomwe zimachitika mu hypoglycemia pagulu lochiritsidwalo zinali zofanana ndi zochitika za hypoglycemia pagulu la placebo.
Mukamagwiritsa ntchito vildagliptin (50 mg 2 kawiri pa tsiku) pamodzi ndi metformin (≥1500 mg) osakanikirana ndi glimepiride (≥4 mg / tsiku) mwa odwala omwe ali ndi mayeso azachipatala, chizindikiro cha HbA1c chatsika kwambiri chifukwa cha kuchuluka kwa 0.76% (kuchokera pamlingo wapakati - 8.8%).

Pharmacokinetics
Vildagliptin
Zogulitsa. Mukamwa pamimba yopanda kanthu, vildagliptin imatengedwa mwachangu, Tmax - maola 1,75 pambuyo pa kuperekedwa. Ndi kuyamwa munthawi yomweyo ndi chakudya, kuchuluka kwa mayamwidwe a vildagliptin kumachepa pang'ono: pali kuchepa kwa Cmax ndi 19% ndikuwonjezeka kwa Tmax mpaka maola 2.5. Komabe, kudya sikumakhudza kuchuluka kwa mayamwidwe ndi AUC.
Vildagliptin imatengedwa mwachangu, ndipo tanthauzo lake lonse la bioavailability pambuyo pakamwa ndi 85%. Cmax ndi AUC mu mulingo wothandizirana umachulukirachulukira molingana ndi mlingo.
Kugawa. Mlingo womangiriza wa vildagliptin ku mapuloteni a plasma ndi wotsika (9.3%). Mankhwalawa amagawidwa chimodzimodzi pakati pa plasma ndi maselo ofiira amwazi. Kugawa kwa vildagliptin kumachitika mopitilira muyeso, Vss pambuyo pa iv ndi malita 71.
Kupenda. Biotransfform ndiye njira yayikulu yodziwitsira ya vildagliptin. Mu thupi la munthu, 69% ya mlingo wa mankhwalawo amasandulika. Metabolite yayikulu - lay151 (57% ya mlingo) imagwira ntchito pamankhwala ndipo ndi mankhwala a hydrolysis a cyanocomponent. Pafupifupi 4% ya mankhwala omwe amapezeka amide hydrolysis.
M'maphunziro oyesera, zotsatira zabwino za DPP-4 pa hydrolysis yamankhwala zimadziwika. Vildagliptin sichimaphatikizidwa ndi gawo la cytochrome P450 isoenzymes. Malinga ndi kafukufuku wa in vitro, vildagliptin si gawo la P450 isoenzymes, sichingolepheretse ndipo sichilimbikitsa cytochrome P450 isoenzymes.
Kuswana. Pambuyo pakulowetsa mankhwalawa, pafupifupi 85% ya dontholi imachotsedwa mu mkodzo ndi 15% kudzera m'matumbo, kupweteka kwa impso kwa vildagliptin kosasinthika ndi 23%. Ndi on / kumayambiriro, pafupifupi T1 / 2 imafika 2 maola, chilolezo chonse cha plasma ndikuwonetsa kwa vildagliptin ndi 41 ndi 13 l / h, motsatana. T1 / 2 pambuyo pakumwa pakamwa ndi pafupifupi maola atatu, mosasamala kanthu.
Magulu apadera a odwala
Gender, index misa, ndi mafuko sizikhudzanso pharmacokinetics ya vildagliptin.
Kuwonongeka kwa chiwindi. Odwala omwe ali ndi vuto lochepa kwambiri la hepatic (6-10 mfundo malinga ndi Gulu-Pugh), atagwiritsidwa ntchito kamodzi, bioavailability ya vildagliptin imachepetsedwa ndi 20 ndi 8%, motero. Odwala omwe ali ndi vuto lochepa kwambiri la hepatic (mfundo 12 malinga ndi gulu la ana-Pugh), bioavailability wa vildagliptin imachulukitsidwa ndi 22%. Kusintha kwakukulu mu bioavailability kwa vildagliptin, kuwonjezeka kapena kuchepa kwapakati mpaka 30%, sikofunika kuchipatala. Malumikizidwe apakati pa kuvuta kwa chiwindi ndi kuwonongeka kwa mankhwalawa sikunawonekere.
Matenda aimpso. Odwala omwe ali ndi vuto lochepa laimpso wofatsa, wolimbitsa thupi komanso wowonda kwambiri, odwala hemodialysis akuwonetsa kuwonjezeka kwa Cmax ya 8-66% ndi AUC ndi 32- 134%, komwe sikikugwirizana ndi kuuma kwa aimpso, komanso kuwonjezeka kwa AUC ya metabolite ofooka a1515. 1.6-6.7 nthawi, kutengera kuzunza kwa kuphwanya. T1 / 2 ya vildagliptin sichisintha. Odwala ofooka aimpso kuwonongeka, kusintha kwa vildagliptin sikofunikira.
Odwala ≥65 wazaka zakubadwa. Kuchuluka kwambiri kwa kuphatikiza kwa bioavailability wa mankhwalawa ndi 32% (kuchuluka kwa Cmax ndi 18%) mwa anthu opitilira 70 sikutanthauza kuchipatala ndipo sikukhudza zoletsa za DPP-4.
Odwala ≤18 wazaka. Zomwe zimachitika mu pharmacokinetic za vildagliptin mwa ana ndi achinyamata ochepera zaka 18 sizinakhazikitsidwe.

Metformin
Zogulitsa. Mtheradi wa bioavailability wa metformin atamwa kwambiri 500 mg pamimba yopanda 50-60%. Tmax mu plasma - 1.81-2.69 mawola. Ndi kuwonjezeka kwa mlingo wa mankhwalawa kuchokera 500 mpaka 1500 mg kapena Mlingo kuchokera 850 mpaka 2250 mg mkati, kuwonjezeka kwapang'onopang'ono kwa magawo a pharmacokinetic kunadziwika (kuposa zomwe zingayembekezeredwe pa ubale wololera). Izi zimachitika osati chifukwa chosintha kuchotsedwa kwa mankhwalawo ngati kutsika kwake kumayamwa. Poyerekeza zakumbuyo yazakudya, kuchuluka ndi mayamwidwe a metformin kumachepera pang'ono. Chifukwa chake, ndimtundu umodzi wa mankhwalawa pa mlingo wa 850 mg ndi chakudya, panali kuchepa kwa Cmax ndi AUC pafupifupi 40 ndi 25% komanso kuwonjezeka kwa Tmax ndi mphindi 35. Kufunika kwamankhwala pazinthu izi sikunakhazikike.
Kugawa. Ndi kumwa kamodzi pamlomo kwa 850 mg, Vd yodziwika bwino ya metformin ndi (654 ± 358) l. Mankhwalawa sakumanga ma protein a plasma, pomwe ena amachokera ku sulfonylurea. Metformin imalowa m'magazi ofiira (mwina kulimbitsa njirayi kwakanthawi). Mukamagwiritsa ntchito metformin molingana ndi chiwembu chokhazikika (mlingo woyenera komanso pafupipafupi wa makonzedwe), plasma Css ya mankhwalawa imafikiridwa mkati mwa maola 24-48 ndipo, monga lamulo, sizidutsa 1 μg / ml. M'mayeso azachipatala olamulidwa, Cmax ya metformin m'madzi a m'magazi sanali kupitirira 5 μg / ml (ngakhale atamwa kwambiri.
Kuswana. Pogwiritsa ntchito metformin imodzi yokha kwa odzipereka athanzi, imathiridwa impso osasinthika. Pankhaniyi, mankhwalawa samapangidwira m'chiwindi (palibe metabolites omwe apezeka mwa anthu) ndipo samatulutsidwa mu ndulu. Popeza chiwonetsero cha impso cha metformin ndichokwera pafupifupi 3.5 kuchulukirapo kuposa kulengedwa kwa creatinine, njira yayikulu yothetsera mankhwalawa ndi secretion ya tubular. Tilowetsedwa, pafupifupi 90% ya mlingo woyamwa timayamwa kudzera mu impso m'maola 24 oyambirira, ndipo T1 / 2 kuchokera ku plasma imakhala pafupifupi maola 6.2. T1 / 2 ya metformin yochokera m'magazi athunthu ndi pafupifupi maola 17.6, kuwonetsa kudziunjikira gawo lalikulu la mankhwalawo m'magazi ofiira.
Magulu apadera a odwala
Paulo Sichikhudzanso ma pharmacokinetics a metformin.
Kuwonongeka kwa chiwindi. Odwala omwe ali ndi vuto la kuchepa kwa hepatic, kuphunzira za mankhwala a pharmacokinetic a metformin sikunachitike.
Matenda aimpso. Odwala omwe amachepetsa impso (omwe akuyerekezeredwa ndi creatinine chilolezo), T1 / 2 ya metformin kuchokera ku plasma ndi magazi athunthu, ndipo mawonekedwe ake aimpso amatsika molingana ndi kuchepa kwa chilolezo cha creatinine.
Odwala ≥65 wazaka zakubadwa. Malinga ndi kafukufuku wochepa wa pharmacokinetic, mwa anthu athanzi ≥65 wazaka, panali kuchepa kwa chiwonetsero chonse cha plasma ndi kuchuluka kwa T1 / 2 ndi Cmax poyerekeza ndi achinyamata. Ma pharmacokinetics a metformin mwa anthu opitilira zaka 65 amatha kuphatikizidwa ndi kusintha kwa impso. Chifukwa chake, mwa odwala omwe ali ndi zaka zopitilira 80, kuikidwa kwa mankhwala Galvus Met ndikotheka pokhapokha ngati chilolezo cha mtundu wa creatinine chikuchitika.
Odwala ≤18 wazaka. Mankhwala a metformin a ana ndi achinyamata ochepera zaka 18 sanakhazikitsidwe.
Odwala amitundu yosiyanasiyana. Palibe umboni wazomwe zimachitika chifukwa cha kuleza mtima kwa mafuko a chemformin. Mu maphunziro azachipatala olamulidwa a metformin mwa odwala omwe ali ndi mtundu wachiwiri wa matenda ashuga amitundu yosiyanasiyana, zotsatira za hypoglycemic zamankhwala zimawonetsedwa chimodzimodzi.

Vildagliptin + Metformin
Kafukufukuyu adawonetsa bioequivalence malinga ndi AUC ndi Cmax a Galvus Met mu mitundu itatu yosiyanasiyana (50 mg + 500 mg, 50 mg + 850 mg ndi 50 mg + 1000 mg) ndi vildagliptin ndi metformin omwe adatengedwa mosiyanasiyana Mlingo wapadera.
Zakudya sizikhudzanso kuchuluka kwa mayeso a vildagliptin mu kapangidwe ka mankhwala a Galvus Met. Makhalidwe a Cmax ndi AUC a metformin popanga mankhwala a Galvus Met pomwe amamwa ndi chakudya amatsika ndi 26 ndi 7%, motero. Kuphatikiza apo, motsutsana ndi maziko azakudya, kuyamwa kwa metformin kunayamba kuchepa, zomwe zinayambitsa kuwonjezeka kwa Tmax (kuyambira maola 2 mpaka 4). Kusintha kofananako kwa Cmax ndi AUC panthawi ya chakudya kunawonedwa pankhani ya Metformin kokha, komabe, pomaliza, kusintha sikunali kofunikira. Zotsatira za chakudya pa pharmacokinetics za vildagliptin ndi metformin popanga mankhwala a Galvus Met sizinasiyane ndi zomwe pomwa mankhwalawa onse.

Galvus Met, mawonekedwe ogwiritsira ntchito
Type 2 shuga mellitus (kuphatikiza mankhwala othandizira pakudya ndi masewera olimbitsa thupi): osakwanira mokwanira kwa monotherapy ndi vildagliptin kapena metformin, m'mbuyomu odwala omwe amalandila chithandizo cha vildagliptin ndi metformin mwanjira yodziwikiritsa.

Contraindication
Kulephera kwa impso kapena kuwonongeka kwa impso: ndi seramu creatinine wambiri ya ≥1.5 mg% (> 135 μmol / lita) kwa amuna ndi ≥1.4 mg% (> 110 μmol / lita) kwa akazi,
pachimake zinthu zomwe zimachitika ndi chiwopsezo cha impso: kuchepa magazi (ndi m'mimba, kusanza), kutentha thupi, matenda opatsirana, mikhalidwe ya hypoxia (mantha, sepsis, matenda a impso, matenda a bronchopulmonary),
kukomoka mtima komanso kupsinjika kwa mtima, kupweteka kwa mtima kwambiri, kulephera kwamtima ndi mantha (mantha),
kulephera kupuma
chiwindi ntchito,
pachimake kapena matenda metabolic acidosis (kuphatikizapo matenda ashuga a ketoacidosis osakanikirana kapena wopanda chikomokere). Matenda ashuga ketoacidosis ayenera kuwongoleredwa ndi insulin mankhwala,
lactic acidosis (kuphatikizapo mbiri ya)
Mankhwalawa sanalembedwe masiku awiri asanachitike opaleshoni, radioisotope, maphunziro a x-ray ndikuyambitsa kwa othandizira ndipo pakatha masiku awiri atachitidwa,
mimba
kuyamwa
mtundu 1 shuga
uchidakwa wambiri, chakumwa chakumwa choledzeretsa,
kutsatira zakudya zochepa zama calori (zosakwana ma kilomita 1000 patsiku),
ana ochepera zaka 18 (mphamvu ndi chitetezo chogwiritsa ntchito sizinakhazikitsidwe),
Hypersensitivity to vildagliptin kapena metformin kapena chilichonse cha mankhwala.

Mlingo ndi makonzedwe
Mankhwala a Galvus Met amatengedwa ndi chakudya kuti achepetse zovuta zoyipa zamagetsi, mawonekedwe a metformin. Mlingo woyeserera wa Galvus Met uyenera kusankhidwa payekha kutengera momwe umagwirira ntchito komanso kulolera, mlingo woyambirira umasankhidwa poganizira momwe wodwala amathandizira ndi vildagliptin ndi / kapena metformin. Mukamagwiritsa ntchito Galvus Met, musapitirire mlingo woyenera wa tsiku ndi tsiku wa vildagliptin (100 milligrams).

Zotsatira zoyipa
Njira zotsatirazi zinagwiritsidwa ntchito poyesa zochitika zazovuta (AE): pafupipafupi (≥1 / 10), nthawi zambiri (≥1 / 100, zosintha zoyipa, zomwe zimagwirizana ndi kugwiritsa ntchito mankhwala osakanikirana ndi vildagliptin ndi metformin (pafupipafupi pakukula kwa zomwe pagulu la vildagliptin + metformin chosiyana ndi chomwe chimagwiritsidwa ntchito pa placebo ndi metformin kuposa 2%) zoperekedwa pansipa:
Kuchokera ku dongosolo lamanjenje:
Nthawi zambiri - mutu, chizungulire, kugwedezeka.
Mukamagwiritsa ntchito vildagliptin kuphatikiza ndi metformin mu Mlingo wosiyanasiyana, hypoglycemia imawonedwa mu 0.9% ya milandu (poyerekeza, pagulu la placebo limodzi ndi metformin - mu 0.4%).
Mlingo wa AE kuchokera mu chakudya chamagaya pamankhwala ophatikiza ndi vildagliptin / metformin anali 12,9%. Pogwiritsa ntchito metformin, ma AE omwewo adawonedwa mu 18.1% ya odwala.
M'magulu a odwala omwe amalandila metformin osakanikirana ndi vildagliptin, kusokonezeka kwa m'mimba kunadziwika ndi pafupipafupi 10% -15%, ndipo pagululi odwala amalandila metformin osakanikirana ndi placebo, pafupipafupi 18%.
Kafukufuku wazachipatala wautali wotalika mpaka zaka 2 sanawonetse kupatuka kowonjezereka mu mbiri yachitetezo kapena zoopsa zomwe sizinachitike mutagwiritsa ntchito vildagliptin monga monotherapy.
Mukamagwiritsa ntchito vildagliptin ngati monotherapy:
Kuchokera kwamanjenje: kawirikawiri - chizungulire, kupweteka mutu,
Kuchokera pamimba yogaya: kawirikawiri - kudzimbidwa,
Dermatological zimachitika: nthawi zina - zotupa pakhungu,
Kuchokera ku minculoskeletal system: nthawi zambiri - arthralgia.
Zina: nthawi zina - zotumphukira edema
Mukamagwiritsa ntchito mankhwala ophatikizira ndi vildagliptin + metformin, kuwonjezeka kwakukulu kwa pafupipafupi kwa zomwe zili pamwambapa za AE zomwe zalembedwa ndi vildagliptin sikunawonedwe.
Kumbuyo kwa monotherapy ndi vildagliptin kapena metformin, zochitika za hypoglycemia zinali 0.4% (nthawi zina).
Monotherapy yokhala ndi vildagliptin ndi chithandizo chophatikizidwa cha vildagliptin + metformin sizinakhudze thupi la wodwalayo.
Kafukufuku wazachipatala wautali wotalika mpaka zaka 2 sanawonetse kupatuka kowonjezereka mu mbiri yachitetezo kapena zoopsa zomwe sizinachitike mutagwiritsa ntchito vildagliptin monga monotherapy. Kafukufuku wotsatsa:
Mukafukufuku wotsatsa, zotsatirazi zotsatirazi zidadziwika: pafupipafupi - urticaria.
Kusintha kwa magawo a labot mukamagwiritsa ntchito vildagliptin pa mlingo wa 50 mg kamodzi patsiku kapena 100 mg patsiku (mu 1 kapena 2 waukulu) kwa chaka chimodzi, pafupipafupi kuchuluka kwa ntchito kwa alanine aminotransferase (AlAt) ndi aspartate aminotransferase (AsAt) koposa katatu poyerekeza ndi malire apamwamba abwinobwino (VGN), anali 0.3% ndi 0.9%, motsatana (0.3% pagulu la placebo).
Kuwonjezeka kwa ntchito ya AlAt ndi AsAt, monga lamulo, kunali asymptomatic, sikukula ndipo sikunayendetsedwe ndi cholestasis kapena jaundice.
Mukamagwiritsa ntchito metformin ngati monotherapy:
Matenda a metabolism: kawirikawiri - amachepetsa mayamwidwe a vitamini B12, lactic acidosis. Kuchokera kugaya chakudya: pafupipafupi - nseru, kusanza, kutsegula m'mimba, kupweteka m'mimba, kusowa chilakolako cha chakudya, nthawi zambiri - kukoma kwazitsulo mkamwa.
Kuchokera chiwindi ndi biliary thirakiti: kawirikawiri kwambiri - kuphwanya kwa magawo a michere ya chiwindi ntchito.
Pa khungu ndi subcutaneous minofu: kawirikawiri - zimachitika khungu (makamaka erythema, kuyabwa, urticaria).
Popeza kuchepa kwa mayamwidwe a vitamini B12 ndi kuchepa kwa ndende yake ya seramu panthawi yogwiritsira ntchito metformin sikunali kofunikira kwambiri mwa odwala omwe amalandira mankhwalawa kwa nthawi yayitali, izi zosafunikira sizikhala ndi matendawo. Kuganizira kuyenera kuperekedwa pakuchepetsa mayamwidwe a vitamini B12 mwa odwala a meWIblastic anemia.
Milandu ina yophwanya chizindikiro cha biochemical cha chiwindi kapena chiwindi, chomwe chimawonedwa ndikugwiritsa ntchito metformin, idathetsedwa atatha kuchotsedwa kwa metformin.

Malangizo apadera
Odwala omwe amalandira insulin, Galvus Met sangathe m'malo mwa insulin.
Vildagliptin
Kuwonongeka kwa chiwindi
Popeza poika vildagliptin, kuwonjezeka kwa zochitika za aminotransferases (kawirikawiri popanda mawonekedwe amankhwala) kumadziwika nthawi zambiri kuposa gulu loyang'anira, asanaikidwe a Galvus Met, komanso pafupipafupi pakumwa mankhwala, tikulimbikitsidwa kudziwa magawo a michere ya chiwindi. Ngati wodwalayo ali ndi zochitika zambiri za aminotransferases, izi ziyenera kutsimikiziridwa ndikufufuza mobwerezabwereza, ndipo nthawi zonse muzindikire magawo amomwe ammagazi a chiwindi ntchito mpaka atasintha. Ngati kuchuluka kwa ntchito kwa AsAt kapena AlAt ndi 3 kapena kuposa nthawi ya VGN kutsimikiziridwa ndikufufuza mobwerezabwereza, ndikulimbikitsidwa kuletsa mankhwalawo.

Kuyanjana kwa mankhwala osokoneza bongo
Vildagliptin + Metformin
Pogwiritsa ntchito nthawi yomweyo vildagliptin (100 mg 1 nthawi patsiku) ndi metformin (1000 mg 1 nthawi patsiku), kwakukulu pakukhudzana kwa mankhwala a pharmacokinetic pakati pawo sikunawonedwe. Ngakhale pamayesero azachipatala, kapena munthawi yogwiritsidwa ntchito kwambiri kwa Galvus Met odwala omwe amalandila mankhwala ena ozungulira ndi zinthu, zosayembekezereka sizinapezeke.

Vildagliptin
Vildagliptin ali ndi mwayi wotsika wolumikizana ndi mankhwala. Popeza vildagliptin si gawo lapansi la ma enzymes a cytochrome P (CYP) 450, komanso sikulepheretsa kapena kuyambitsa ma enzymes awa, momwe amagwiritsidwira ntchito ndi mankhwala omwe ali am'magazi, ma inhibitors kapena inducers a P (CYP) 450. Pogwiritsa ntchito nthawi yomweyo vildagliptin sizikhudza kuchuluka kwa kagayidwe ka mankhwala omwe ali magawo a michere: CYP1A2, CYP2C8, CYP2C9, CYP2C19, CYP2D6, CYP2E1 ndi CYP3A4 / 5. Palibe chithandizo chamankhwala chamtundu wa vildagliptin chomwe chimagwiritsidwa ntchito nthawi zambiri pochiza matenda amishuga 2 mellitus (glibenclamide, pioglitazone, metformin) kapena yocheperako zochiritsira (amlodipine, digoxin, ramipril, simvastatin, valsartan, warfarin).

Metformin
Furosemide imachulukitsa Cmax ndi AUC ya metformin, koma sizimakhudzanso mawonekedwe ake aimpso. Metformin imachepetsa Cmax ndi AUC ya furosemide komanso sizikhudzanso mawonekedwe ake aimpso.
Nifedipine imawonjezera mayamwidwe, Cmax ndi AUC ya metformin, kuwonjezera, imawonjezera kuphipha kwake mu mkodzo. Metformin kwenikweni sikukhudza magawo a pharmacokinetic a nifedipine.
Glibenclamide sichikhudza magawo a pharmacokinetic / pharmacodynamic a metformin. Metformin nthawi zambiri imachepetsa Cmax ndi AUC ya glibenclamide, koma kukula kwake kwake kumasiyana kwambiri. Pachifukwachi, kufunikira kwakukhudzaku kumachitika pakadali pano.
Ma organic cations, mwachitsanzo, amiloride, digoxin, morphine, procainamide, quinidine, quinine, ranitidine, triamteren, trimethoprim, vancomycin, ndi zina zotere, zotulutsidwa ndi impso pogwiritsa ntchito katulutsidwe ka tubular, zimatha kuyanjana ndi metformin, popeza zimatha kupikisana mayendedwe wamba. Chifukwa chake, cimetidine imakulitsa kuchuluka kwa metformin mu plasma / magazi ndi AUC ndi 60% ndi 40%, motero. Metformin sichikhudza magawo a pharmacokinetic a cimetidine. Chenjezo liyenera kuchitika mukamagwiritsa ntchito Galvus Met limodzi ndi mankhwala omwe amakhudza ntchito ya impso kapena kugawa kwa metformin m'thupi.
Mankhwala ena - mankhwala ena amatha kuyambitsa hyperglycemia ndikuchepetsa mphamvu ya othandizira a hypoglycemic. Mankhwalawa amaphatikiza thiazides ndi ma diuretics ena, glucocorticosteroids, phenothiazines, mahomoni a chithokomiro, estrogens, kulera kwamlomo, phenytoin, nicotinic acid, sympathomimetics, calcium antagonists ndi isoniazid. Mukamapereka mankhwala othandizira, kapena, mosiyana, ngati amachotsedwa, tikulimbikitsidwa kuwunika bwino ntchito ya metformin (zotsatira zake za hypoglycemic) ndipo ngati kuli kotheka, sinthani mlingo wa mankhwalawo. Kugwiritsa ntchito nthawi yomweyo danazol osavomerezeka kuti apewe hyperglycemic zotsatira za chomaliza. Ngati mankhwala a danazol akufunika ndipo atasiya kuyimitsa, kusintha kwa metformin kumafunika motsogozedwa ndi shuga. Chlorpromazine: akagwiritsidwa ntchito mu milingo yayikulu (100 mg patsiku) amawonjezera glycemia, kuchepetsa kutulutsa kwa insulin. Pochiza ma antipsychotic komanso mutasiya kuyimilira, kusintha kwa mankhwalawa kumafunikira motsogozedwa ndi shuga.
Iodini wokhala ndi ma radiopaque othandizira: kafukufuku wama radiology ogwiritsa ntchito ayodini omwe amakhala ndi radiopaque angayambitse kukula kwa lactic acidosis kwa odwala omwe ali ndi matenda osokoneza bongo omwe amakanika ndi aimpso kulephera.
2 betathomimetics wothandizika: onjezani glycemia chifukwa cholimbikitsidwa ndi beta-2 receptors. Pankhaniyi, kuyang'anira glycemic ndikofunikira. Ngati ndi kotheka, insulin ikulimbikitsidwa. Ndi munthawi yomweyo kugwiritsa ntchito metformin ndi sulfonylurea zotumphukira, insulin, acarbose, salicylates, kuchuluka kwa hypoglycemic.
Popeza kugwiritsidwa ntchito kwa metformin kwa odwala omwe ali ndi vuto loledzera lakumwa kumawonjezera mwayi wokhala ndi lactic acidosis (makamaka panthawi yanjala, kutopa, kapena kulephera kwa chiwindi), mu chithandizo ndi Galvus Met, munthu ayenera kupewa kumwa mowa komanso mankhwala okhala ndi ethyl mowa.

Bongo
Vildagliptin
Vildagliptin imalekeredwa bwino ikaperekedwa pa mlingo mpaka 200 mg / tsiku. Mukamagwiritsa ntchito mankhwalawa 400 mg / tsiku, kupweteka kwa minofu, kovuta kufatsa komanso kosakhalitsa, kutentha, edema, komanso kuwonjezeka kwapang'onopang'ono kwa ndende ya lipase (2 times kuposa VGN). Ndi kuwonjezeka kwa mlingo wa vildagliptin mpaka 600 mg / tsiku, kukulitsa kwa edema ya malekezero, limodzi ndi paresthesias, ndikuwonjezereka kwa kuchuluka kwa creatinine phosphokinase, AcAt, C-reactive protein ndi myoglobin, ndizotheka. Zizindikiro zonse za mankhwala osokoneza bongo komanso kusintha kwa magawo a ma laboratite amatha pambuyo pakutha kwa mankhwalawa.
Kuchoka m'thupi kudzera mu dialysis ndikosatheka. Komabe, hydrolytic metabolite yayikulu ya vildagliptin (lay151) imatha kuchotsedwa m'thupi ndi hemodialysis.

Metformin
Milandu ingapo ya mankhwala osokoneza bongo a metformin adanenedwa, kuphatikiza chifukwa chobayira mankhwalawa kuchuluka kwa magalamu oposa 50. Ndi mankhwala osokoneza bongo a metformin, hypoglycemia imawonedwa pafupifupi 10% ya milandu (komabe, ubale wake ndi mankhwalawo sunakhazikike), mu 32% ya milandu, lactic acidosis idadziwika. Zizindikiro zoyambirira za lactic acidosis ndi mseru, kusanza, kutsegula m'mimba, kuchepa kwa kutentha kwa thupi, kupweteka kwam'mimba, kupweteka kwa minofu, mtsogolomo pakhoza kukhala kupuma kwamphamvu, chizungulire, chikumbumtima champhamvu komanso kukula kwa chikomokere. Metformin imachotsedwa m'magazi ndi hemodialysis (pomwe pali chilolezo mpaka 170 ml / min) popanda kusokonezeka kwa hemodynamic. Chifukwa chake, hemodialysis ingagwiritsidwe ntchito pochotsa metformin m'magazi ngati mankhwala atagwiritsidwa ntchito mopitirira.
Pankhani ya bongo, chithandizo choyenera chothandizira chikuyenera kuchitika molingana ndi momwe wodwalayo alili komanso mawonetsedwe ake am'chipatala.

Malo osungira
Galvus Met imasungidwa m'malo owuma osawonekera kwa ana pamtunda wotsika kuposa 30 ° C.