Kuphatikiza hypoglycemic mankhwala Avandamet

mu chithuza 14 ma PC., mumapaketi okhala ndi makatoni 1, 2, 4 kapena 8.

mu chithuza 14 ma PC., mumapaketi okhala ndi makatoni 1, 2, 4 kapena 8.

* Dongosolo losavomerezeka ndi mayiko ena onse omwe adalimbikitsidwa ndi WHO; mu Russian Federation, matchulidwe a dzina lapadziko lonse amavomerezedwa - rosiglitazone.

Mankhwala

Mankhwala osakanikirana a hypoglycemic ophatikizidwa pakamwa. Avandamet ali ndi zida ziwiri zogwira ntchito zomwe zimapangitsa kuti chiwonetsero cha matenda ashuga a 2 chikule kwambiri: rosiglitazone maleate, gulu la thiazolidinedione, ndi metformin hydrochloride, woimira kalasi yayikulu. Limagwirira a thiazolidinediones limakhala makamaka kukulitsa chidwi cha chandamale kuti insulin, pamene Biguanides amachita makamaka mwa kuchepetsa kupanga amkati glucose wa chiwindi.

Rosiglitazone - kusankha nyukiliya ya PPAR ya nyukiliya_s(peroxisomal proliferator activated receptors gamma)zokhudzana ndi mankhwala a hypoglycemic ochokera pagulu la thiazolidinediones. Amawongolera kuwongolera kwa glycemic pakukulitsa kumva kwa insulini pazinthu zofunika kwambiri monga minofu ya adipose, minofu yam'mimba, ndi chiwindi.

Amadziwika kuti kukana insulini kumatenga gawo lofunikira mu pathogenesis yamtundu wa shuga wa 2. Rosiglitazone imayendetsa bwino kagayidwe ka metabolic pochepetsa glucose wamagazi, kuzungulira insulini ndi mafuta acids aulere.

Ntchito ya hypoglycemic ya rosiglitazone idawonetsedwa mu kafukufuku woyesera pamitundu ya mtundu 2 matenda a shuga. Rosiglitazone imasungirako ntchito ya β-cell, monga zikuwonetsedwa ndi kuwonjezeka kwa masheya a Langerhans a kapamba komanso kuwonjezeka kwa zinthu zawo za insulin, komanso kumalepheretsa kukula kwa hyperglycemia yayikulu. Zinapezekanso kuti rosiglitazone imachepetsa kwambiri kukula kwa impso komanso kusokonekera kwa magazi. Rosiglitazone simalimbikitsa kubisirana kwa insulin ndi kapamba ndipo samayambitsa hypoglycemia mu makoswe ndi mbewa.

Kupititsa patsogolo kayendedwe ka glycemic kumayendera limodzi ndi kuchepa kwakukulu kwa seramu insulin. Kuzungulira kwa insulin precursor, komwe anthu amakhulupirira kuti kumayambitsa matenda a mtima, kumacheperachepera. Chimodzi mwazotsatira zazikulu zamankhwala ndi rosiglitazone ndi kuchepa kwakukulu kwa kuchuluka kwamafuta acids.

Metformin ndi nthumwi ya kalasi ya greatuanides, yomwe imagwira ntchito makamaka pochepetsa kupanga glucose wamkati m'chiwindi. Metformin imachepetsa kutsika kwa shuga ndi pambuyo pa plasma. Simalimbikitsa insulin katemera chifukwa chake siyambitsa hypoglycemia. Pali njira zitatu zoyeselera za metformin: kuchepa kwa kupanga kwa shuga mu chiwindi mwa kuletsa kwa gluconeogeneis ndi glycogenolysis, kuwonjezeka kwa minyewa ya minyewa kuti ipangire insulini, kuwonjezereka kwa kugwiritsidwa ntchito ndikugwiritsa ntchito glucose ndi zotumphukira za minofu.

Metformin imathandizira kaphatikizidwe ka glycogen kaphatikizidwe ka glycogen synthetase enzyme. Imawonjezera ntchito yamitundu yonse ya transmembrane glucose transmit. Mwa anthu, mosasamala kanthu momwe zimakhudzira glycemia, metformin imasintha kagayidwe ka lipid. Pogwiritsa ntchito metformin pamankhwala othandizira pakuyesa kwapakatikati komanso kwakanthawi, zawonetsedwa kuti metformin imatsitsa kuchuluka kwa cholesterol yonse, cholesterol ya LDL ndi triglycerides.

Chifukwa cha mitundu yosiyanasiyana koma yowonjezera zochita, kuphatikiza mankhwala ndi rosiglitazone ndi metformin kumabweretsa kusintha kwa synergistic pakulamulira kwa glycemic kwa odwala omwe ali ndi matenda a shuga a 2.

Kutulutsa mawonekedwe, kapangidwe kake ndi ma CD

INN ya avandamet, yomwe idakhazikitsidwa ku Russian Federation potsatira kuvomerezedwa ndi WHO, ndi rosiglitazone.

The Rejista ya State ikuwonetsa masakanidwe a makatoni amakhadi a mankhwalawo malinga ndi LSR-000079 pa 05/29/2007:

• Chungu chimodzi - mapiritsi 14 okhala ndi mafilimu,
• Katemera wa makatoni - 1, 2, 4 kapena 8 mbale,
• Metformin hydrochloride 500 mg / tabu.,
• Kuchuluka kwa rosiglitazone ndi 1 kapena 2 mg / tabu. (chawonetsedwa pa ma CD)
• Pakati pazinthu zothandizira: magnesium stearate, MCC, hypromellose 3cP, povidone 29 - 32, lactose monohydrate, MCC, hypromellose 3cP ndi wowonda wa carboxymethyl,
• Chipolopolo chachikasu: Opadry I chikasu chitsulo okusayidi, macrogol 400, titanium dioxide, hypromellose 6cP (mapiritsi a rosiglitazone 1 mg / tabu.),
• Chipolopolo chofiirira: Opadry I red iron oxide, macrogol 400, titanium dioxide, hypromellose 6cP.

Kutengera dera, malo komanso njira zopezera mankhwalawo, mtengo wake ungakhale wosiyana ndi womwe waperekedwa pano. Pafupipafupi, mtengo wa Avandamet ndi ma piritsi a 56 ≥ 1,490 rubles.

Pharmacokinetics

Kafukufuku wa Avandamet bioequivalence (4 mg / 500 mg) adawonetsa kuti magawo onse a mankhwalawa, rosiglitazone ndi metformin, anali bioequivalent mapiritsi a 4 mg rosiglitazone wamwamuna ndi mapiritsi a 500 mg metformin hydrochloride akagwiritsidwa ntchito nthawi imodzi. Kafukufukuyu adawonetsanso kuchuluka kwa milingo ya rosiglitazone pakupanga kophatikizira kwa 1 mg / 500 mg ndi 4 mg / 500 mg.

Kudya sikusintha AUC ya rosiglitazone ndi metformin. Komabe, kumiza nthawi imodzi kumabweretsa kutsika kwa C_max rosiglitazone - 209 ng / ml poyerekeza ndi 270 ng / ml ndikuchepa kwa C_max metformin - 762 ng / ml poyerekeza ndi 909 ng / ml, komanso kuwonjezeka kwa T_max rosiglitazone - maola 2.56 poyerekeza ndi maola 0.98 ndi metformin - maola 3.96 poyerekeza ndi maola atatu.

Pambuyo pakuyamwa kwa rosiglitazone mu Mlingo wa 4 mg kapena 8 mg, tanthauzo lenileni la bioavailability wa rosiglitazone ndi pafupifupi 99%. C_max rosiglitazone zimatheka pafupifupi ola limodzi mutatha kumeza. Mothandizidwa ndi mlingo wa mankhwalawa, plasma wozungulira wa rosiglitazone ndiwofanana ndi mlingo wake.

Kutenga rosiglitazone ndi chakudya sikusintha AUC, koma kuyerekeza ndi kusala kudya, kumachepa pang'ono C_max (pafupifupi 20- 28%) ndi kuchuluka kwa T_max (1.75 h).

Kusintha kwakung'ono kumeneku sikofunika kwenikweni, motero, rosiglitazone imatha kutengedwa mosasamala kanthu za chakudya. Kuwonjezeka kwa pH kwa zam'mimba sizimakhudza mayamwidwe a rosiglitazone.

Pambuyo m`kamwa makonzedwe a metformin T_max pafupifupi maora 2,5, pa Mlingo wa 500 kapena 850 mg, kuchuluka kwathunthu kwa anthu athanzi ndi pafupifupi 50-60%. Mafuta a metformin ndi okhazikika komanso osakwanira. Pambuyo pakukonzekera pakamwa, kachigawo kosagwiritsidwa ntchito komwe kanapezeka mu ndowe anali 20-30% ya mlingo.

Amaganiziridwa kuti mayamwidwe a metformin siwotchi. Mukamagwiritsa ntchito metformin mwachizolowezi komanso Mlingo C_SS mu plasma zimafikiridwa mkati mwa maola 24-48 ndipo, monga lamulo, zosakwana 1 μg / ml. M'mayeso azachipatala olamulidwa, C_max metformin sapitilira 4 μg / ml, ngakhale pambuyo oyang'anira waukulu.

Kudya munthawi yomweyo kumachepetsa mayamwidwe a metformin ndipo kumachepetsa pang'ono mayamwidwe. Pambuyo m`kamwa makonzedwe a metformin muyezo wa 850 mg pamene kudya ndi_max amatsika ndi 40% ndi AUC ndi 25%, T_max ukuwonjezeka ndi 35 min. Kukula kwamankhwala kwasintha sizikudziwika.

Kuchulukitsa kwa kugawa kwa rosiglitazone kuli pafupifupi 14 l, ndipo kuchuluka kwa plasma Cl kuli pafupifupi 3 l / h. Mlingo wapamwamba kwambiri womanga mapuloteni a plasma - pafupifupi 99.8% - sizimatengera kuzunzidwa komanso zaka za wodwalayo. Pakadali pano, palibe chidziwitso pazokonzekera zosakonzekera za rosiglitazone pamene imatengedwa nthawi 1-2 patsiku.

Kumanga kwa metformin kwa mapuloteni a plasma ndikosatheka. Metformin imalowa m'magazi ofiira. C_max magazi otsika kuposa C_max plasma ndipo imafikiridwa pafupifupi nthawi yomweyo. Maselo ofiira mwina ndi gawo lachigawo logawa.

Voliyumu yapakati yogawa imasiyanasiyana malita 63 mpaka 276.

Imayang'aniridwa ndi kagayidwe kake kwambiri, komwe kamatulutsidwa mu mawonekedwe a metabolites. Njira zazikulu za metabolic ndizo N-demethylation ndi hydroxylation, zotsatiridwa ndi conjugation ndi sulfate ndi glucuronic acid. Ma metabolites a rosiglitazone alibe ntchito za pharmacological.

Kafukufuku mu vitro adawonetsa kuti rosiglitazone imapangidwa makamaka ndi isoenzyme CYP2C8 ndikuchepera pang'ono ndi isoenzyme CYP2C9.

M'mikhalidwe mu vitro rosiglitazone ilibe mphamvu yoletsa chidwi pa isoenzymes CYP1A2, CYP2A6, CYP2C19, CYP2D6, CYP2E1, CYP3A ndi CYP4A, kotero sizokayikitsa kuti mu vivo imalowa mu kukhudzana kwakukulu kwachilengedwe ndi mankhwala omwe amapangidwa ndi ma isoenzymes awa a P450 cytochrome system. Mu vitro rosiglitazone amachepetsa CYP2C8 (IC₅₀ - 18 μmol) ndikulephera pofooka CYP2C9 (IC₅₀ - 50 μmol). Kuwerengera mogwirizana kwa rosiglitazone ndi warfarin mu vivo idawonetsa kuti rosiglitazone sichilumikizana ndi gawo lapansi la CYP2C9.

Metformin siinapangidwe ndipo imachotsedwa osasinthika ndi impso. Palibe metformin metabolites omwe adadziwika mwa anthu.

Chiwerengero chonse cha plasma Cl cha rosiglitazone chili pafupi 3 L / h, ndipo T yomaliza_1/2 - pafupifupi maola 3-4. Pakadali pano, palibe chidziwitso pazokopa zosayembekezereka za rosiglitazone pamene zimatengedwa nthawi 1-2 patsiku. Pafupifupi 2/3 yamkamwa ya rosiglitazone imatheka ndi impso, pafupifupi 25% imatulutsidwa m'matumbo. Zosasinthika, rosiglitazone simapezeka mumkodzo kapena ndowe. Chomaliza t_1/2 metabolites - pafupifupi maola 130, omwe akuwonetsa kutulutsa kwapang'onopang'ono. Ndi kulowetsedwa mobwerezabwereza kwa rosiglitazone, kuphatikizika kwa metabolites ake m'madzi a m'magazi, makamaka metabolite yayikulu (parahydroxysulfate), ndende yomwe, mwina, ikhoza kuwonjezeka nthawi 5, siyimasankhidwa.

Imayatsidwa osasinthika ndi impso kudzera mu kusefera kwamadzi ndi kubisalira kwa tubular. Metalin ya Renal Cl - yoposa 400 ml / min. Pambuyo pakukonzekera pamlomo, T yomaliza_1/2 metformin - pafupifupi maola 6.5

Pharmacokinetics mu milandu yapadera yamankhwala

Panalibe kusiyana kwakukulu mu pharmacokinetics of rosiglitazone kutengera jenda ndi zaka.

Panalibe kusiyana kwakukulu mu pharmacokinetics ya rosiglitazone mwa odwala omwe ali ndi vuto laimpso, komanso matenda okodzetsa.

Odwala omwe ali ndi chiwindi chochepa kwambiri (chiwonetsero cha ana-Pugh B ndi C) C_max ndipo AUC anali okwera katatu, zomwe zinali zotsatira za kuchuluka kwa mapuloteni a plasma ndikuchepetsa chilolezo cha rosiglitazone.

Odwala omwe ali ndi vuto la impso, chilolezo cha impso chimachepa molingana ndi kuchepa kwa creatinine chilolezo, motero, kuyimitsidwa kwa theka la moyo kumawonjezeka, chifukwa chake, plasma mozama pakuwonjezeka kwa metformin.

Zizindikiro Avandamet

Type 2 matenda a shuga:

- pakuwongolera glycemic ndi kusakhazikika kwa mankhwala othandizira pakudya kapena monotherapy yodziwika ndi thiazolidatedione kapena mankhwala a metformin, kapena othandizirana kale ndi thiazolidinedione ndi metformin (othandizira awiri).

- glycemic control kuphatikiza ndi mankhwala a sulfonylurea (atatu ofunikira mankhwala).

Contraindication

Hypersensitivity pamagawo a mankhwala,

kulephera kwa mtima (I - IV magawo ogwirira ntchito malinga ndi gulu la NYHA),

matenda owopsa kapena osachiritsika omwe amatsogolera minofu hypoxia (mwachitsanzo, kulephera kwa mtima kapena kupuma, kulowetsedwa kwaposachedwa, kugwedezeka),

uchidakwa, kuledzera

kulephera kwa aimpso (serum creatinine> 135 μmol / L mwa akazi ndipo> 100 μmol / L mwa akazi ndi / kapena Cl creatinine HDL ndi LDL, kuchuluka kwa cholesterol / HDL sikunasinthidwe. Kuwonjezeka kwa kulemera kwa thupi kumadalira mlingo ndipo kungalumikizidwe ndi kusungidwa kwa madzimadzi ndi kudziunjikira Mafuta kapena kuchepa kwamafuta kwambiri pamodalira.

Kuchokera ku dongosolo lamanjenje lamkati Chizungulirenthawi zambirinthawi zambiri Mutunthawi zambiri

Kuchokera pamtima Kulephera kwa mtima / edema ya pulmonarynthawi zambirinthawi zambiri Myocardial ischemianthawi zambirinthawi zambirinthawi zambirinthawi zambiri Kuwonjezeka kwa zochitika za kulephera kwa mtima kumawonedwa ndikuwonjezeredwa kwa rosiglitazone kwa sulfonylurea kapena insulin basedapy. Chiwerengero cha zomwe tatchulazi sichitilola kuti titchule mwachidule zokhudzana ndi kuchuluka kwa mankhwalawa, koma pafupipafupi milandu imakhala yokwanira tsiku lililonse la rosiglitazone 8 mg poyerekeza ndi tsiku la 4 mg. Zizindikiro za myocardial ischemia nthawi zambiri zimawonedwa poika rosiglitazone kwa odwala omwe akukhala ndi insulin. Zambiri pa kuthekera kwa rosiglitazone kuonjezera chiopsezo cha myocardial ischemia sikokwanira. Kuwunikanso koyesedwa kwa mayesero afupipafupi a chipatala ndi placebo, koma osagwirizana ndi mankhwala, akuwunikira kulumikizana pakati pa kutenga rosiglitazone ndi chiopsezo chokhala ndi myocardial ischemia. Izi sizitsimikiziridwa ndi kafukufuku wazachipatala wautali wokhala ndi mankhwala othandizira (metformin ndi / kapena sulfonylurea), komanso ubale pakati pa rosiglitazone ndi chiopsezo chokhala ndi ischemia sichinakhazikitsidwe. Chiwopsezo chowonjezeka cha kuwonongeka kwa ischemic myocardial kuwonedwa kwa odwala omwe anali nthawi yoyesedwa pazachipatala pazoyambira nitrate. Rosiglitazone siivomerezeka kwa odwala omwe amalandira chithandizo chokhala ndi nitrate.

Kuchokera m'mimba Kudzimbidwa (pang'ono kapena pang'ono)nthawi zambirinthawi zambirinthawi zambirinthawi zambiri

Kuchokera ku minculoskeletal system Mafupa owundananthawi zambiri Myalgianthawi zambiri Malipoti ambiri okhudzana ndi makomedwe ankhondo, manja ndi phazi mwa azimayi

Kuchokera mthupi lonse Kutupanthawi zambirinthawi zambirinthawi zambirinthawi zambiri Wofatsa kuti muchepetse edema, nthawi zambiri mumadalira mlingo.

Zotsatira zotsatirazi zidanenedwa panthawi yotsatsa.

Zotsatira zoyipa: kawirikawiri - anaphylactic zimachitika.

Kuchokera pamtima: kawirikawiri, matenda olephera a mtima / mapapo.

Malipoti okhudza zomwe zimachitika pamenepa adagulitsidwa rosiglitazone, wogwiritsidwa ntchito ngati monotherapy komanso kuphatikiza othandizira ena a hypoglycemic. Amadziwika kuti chiopsezo chokhala ndi matenda a mtima chikuwonjezeka kwambiri kwa odwala matenda a shuga poyerekeza ndi odwala omwe alibe shuga.

Kuchokera m'mimba: Sipanakhalepo lipoti la kufooka kwa chiwindi, limodzi ndi kuchuluka kwa chiwindi, koma kulumikizana pakati pa chithandizo cha matenda a rosiglitazone ndi chiwindi sikunakhazikike.

Zotsatira zoyipa: kawirikawiri - angioedema, urticaria, zidzolo, kuyabwa.

Kuchokera kumbali ya ziwalo zamasomphenya: kawirikawiri - macular edema.

Ziyeso zamankhwala ndi chidziwitso chotsatsa pambuyo

Kuchokera m'mimba: Nthawi zambiri - zizindikiro za dyspeptic (nseru, kusanza, kutsegula m'mimba, kupweteka kwam'mimba, anorexia). Nthawi zambiri amakula popereka mankhwala muyezo waukulu komanso kumayambiriro kwa chithandizo, nthawi zambiri zimadalira palokha. Nthawi zambiri kulawa kwazitsulo mkamwa.

Dermatological zimachitika: kawirikawiri - erythema. Amadziwika ndi odwala omwe ali ndi hypersensitivity ndipo makamaka anali ofatsa.

Zina: kawirikawiri - lactic acidosis, kuchepa kwa vitamini B₁₂.

Kuchita

Panalibe maphunziro apadera okhudzana ndi kuyanjana kwa Avandamet. Zomwe zili pansipa zikuwonetsa zambiri pazomwe zimagwira ntchito za Avandamet (rosiglitazone ndi metformin).

Gemfibrozil (CYP2C8 inhibitor) pa mlingo wa 600 mg 2 kawiri patsiku ukuwonjezeka C_SS 2 times rosiglitazone. Kuwonjezeka koteroko kwa rosiglitazone kumalumikizidwa ndi chiopsezo cha zotsatira zoyipa za mankhwalawa, chifukwa chake, ndi kuphatikiza kwa Avandamet ndi CYP2C8 inhibitors, kuchepetsa kwa rosiglitazone kungafunike.

Ma inhibitors ena a CYP2C8 adayambitsa kuwonjezeka pang'ono kwa dongosolo la rosiglitazone.

Rifampicin (inducer wa CYP2C8) pa mlingo wa 600 mg / tsiku adachepetsa kuchuluka kwa rosiglitazone ndi 65%. Chifukwa chake, mwa odwala omwe amalandira enosme ya rosiglitazone komanso inducme ya CYP2C8, ndikofunikira kuyang'anitsitsa shuga wamagazi ndikusintha mlingo wa rosiglitazone ngati pakufunika.

Kugwiritsa ntchito mobwerezabwereza rosiglitazone kumawonjezera C_max ndi AUC wa methotrexate ndi 18% (90% CI: 11-26%) ndi 15% (90% CI: 8-23%), motero, poyerekeza ndi mlingo womwewo wa methotrexate pakalibe rosiglitazone.

Mu mankhwalawa achire, rosiglitazone sanakhale ndi vuto lililonse pama pharmacokinetics ndi pharmacodynamics a mankhwala ena amkamwa a hypoglycemic omwe amagwiritsidwa ntchito munthawi yomweyo, kuphatikiza metformin, glibenclamide, glimepiride ndi acarbose.

Zinawonetsedwa kuti rosiglitazone ilibe gawo lalikulu pama pharmacokinetics a S (-) - warfarin (gawo lapansi la enzyme ya CYP2C9).

Rosiglitazone sichikhudza pharmacokinetics ndi pharmacodynamics a digoxin kapena warfarin ndipo sasintha zochita za anticoagulant zam'mbuyo.

Panalibe kuyanjananso kwakukulu kwa matenda a rosiglitazone ndi nifedipine kapena njira yoletsa kubereka pakamwa (yopangidwa ndi ethinyl estradiol ndi norethisterone) yogwiritsidwa ntchito nthawi imodzi, yomwe imatsimikizira mwayi wocheperako wogwirizana wa rosiglitazone ndi mankhwala omwe amaphatikizika ndi gawo la CYP3A4.

Mankhwala osokoneza bongo a pachimake pakumwa mankhwala osakanikirana ndi rosiglitazone + metformin, ngozi ya lactic acidosis chifukwa cha kuchuluka kwa metformin imawonjezeka.

Mankhwala a Cationic omwe amathandizidwa ndi aimpso glomerular secretion (kuphatikizapo cimetidine) amatha kuyanjana ndi metformin, kupikisana nawo machitidwe ambiri a chimbudzi (ndikofunikira kuyang'anitsitsa kuchuluka kwa shuga wamagazi ndikusintha chithandizo ngati pakufunika kugwiritsa ntchito mankhwala a cationic omwe atulutsidwa ndi impso glomerular secretion).

Kuphatikizira kwa radiopaque kukonzekera komwe kumakhala ndi ayodini kungayambitse kulephera kwa impso, komwe kungapangitse kuchuluka kwa metformin komanso kupanga lactic acidosis (metformin iyenera kusiyidwa osakwana maola 48 atatha radiology ndi zabwino kutsimikizika kwa ntchito ya impso).

Kukonzekera komwe kumafunikira chisamaliro chapadera

GCS (yothandiza komanso yogwiritsira ntchito wamba), β agonists₂- adrenoreceptors, okodzetsa amatha kuyambitsa matenda a hyperglycemia, ngati ndi kotheka, kugwiritsa ntchito pamodzi ndi Avandamet kumafunikira kuwunika pafupipafupi kuchuluka kwa shuga m'magazi, makamaka kumayambiriro kwa chithandizo, kusintha kwa Avandamet kungafunike, kuphatikiza pa kusiya mankhwala.

Ma inhibitors a ACE amatha kuchepetsa magazi. Ngati ndi kotheka, kugwiritsa ntchito nthawi yomweyo kapena kusiya mankhwala kuyenera kusintha moyenera mlingo wa Avandamet.

Mlingo ndi makonzedwe

Mkati. Mankhwalawa amalembera achikulire.

Dongosolo laling'ono la mankhwalawa limasankhidwa ndikuyika payekha.

Avandamet akhoza kumwedwa mosasamala kanthu za chakudya. Kumwa Avandamet nthawi yakudya kapena itatha, kumachepetsa kugaya osafunikira komwe kumachitika ndi metformin.

Mlingo woyambira wokhazikitsidwa kwa akuluakulu ophatikizika a rosiglitazone / metformin ndi 4 mg / 1000 mg. Mlingo wa tsiku ndi tsiku wa kuphatikiza kwa rosiglitazone / metformin utha kuwonjezeredwa kuti muchepetse kuwongolera kwamunthu aliyense payekha. Mlingo uyenera kuwonjezeka pang'onopang'ono mpaka pazofunikira - 8 mg ya rosiglitazone / 2000 mg wa metformin patsiku.

Kuchepetsa pang'ono kwa mankhwalawa kungafooketse mayendedwe osafunikira kuchokera kumimba yamagetsi (makamaka chifukwa cha metformin). Mlingo uyenera kuchuluka mu 4 mg / tsiku la rosiglitazone ndi / kapena 500 mg / tsiku la metformin. The achire zotsatira pambuyo kusintha kwa mankhwalawa sizingachitike kwa masabata 6-8 kwa rosiglitazone komanso masabata 1-2 kwa metformin.

Mukasintha kuchokera ku mankhwala ena amkamwa a hypoglycemic ndikuphatikizana ndi rosiglitazone ndi metformin, zochitika ndi nthawi yayitali ya mankhwala apambuyo ayenera kukumbukiridwa.

Mukasintha kuchokera ku rosiglitazone + metformin mankhwala ngati mankhwala amodzi kupita kuchipatala cha Avandamet, mlingo woyambirira wa kuphatikiza kwa rosiglitazone ndi metformin uyenera kutengera mlingo womwe wapezeka kale wa rosiglitazone ndi metformin.

Mu odwala okalamba, mavitamini oyamba ndi kukonza a Avandamet ayenera kusinthidwa mokwanira, chifukwa kuchepa kwa impso. Kusintha kwa mlingo uliwonse kuyenera kuchitika molingana ndi ntchito ya impso, yoyenera kuyang'aniridwa nthawi zonse.

Odwala omwe ali ndi vuto lofooka la hepatic (kalasi A (mfundo 6 kapena zochepa) pa sikelo ya Mwana-Pugh), kusintha kwa mlingo wa rosiglitazone sikofunikira. Popeza kuwonongeka kwa chiwindi ndi njira imodzi yomwe imayambitsa lactic acidosis kuthandizira ndi metformin, kuphatikiza kwa rosiglitazone ndi metformin sikulimbikitsidwa kwa odwala omwe ali ndi vuto la chiwindi.

Odwala omwe amalandira Avandamet osakanikirana ndi sulfonylurea, mlingo woyambirira wa rosiglitazone mutatenga Avandamet uyenera kukhala 4 mg / tsiku. Kuukitsa mlingo wa rosiglitazone mpaka 8 mg / tsiku kuyenera kuchitika mosamala pambuyo pofufuza za zovuta zomwe zimakhudzana ndikusungidwa kwa madzimadzi m'thupi.

Bongo

Pakadali pano palibe deta pa bongo wa Avandamet. M'maphunziro azachipatala, odzipereka adalekerera pakamwa limodzi la rosiglitazone mpaka 20 mg.

Zizindikiro mankhwala osokoneza bongo a metformin (kapena concomitant chiopsezo cha lactic acidosis) angayambitse kukula kwa lactic acidosis.

Chithandizo: lactic acidosis ndi chithandizo chamankhwala mwadzidzidzi ndipo imafunikira chithandizo kuchipatala. Chithandizo chothandizira chikulimbikitsidwa kuwunikira wodwala matenda ake. Kuchotsa lactate ndi metformin m'thupi, hemodialysis iyenera kugwiritsidwa ntchito, komabe, rosiglitazone samachotsedwa ndi hemodialysis (chifukwa chomanga mapuloteni ambiri).

Malangizo apadera

Kuphatikiza kwa rosiglitazone + metformin, kuphatikiza Avandamet imagwira ntchito pokhapokha ikupanga insulin, kotero mankhwalawa sayenera kuperekedwa pochiza odwala omwe ali ndi matenda a shuga 1.

Chifukwa cha kuchuluka kwa insulin, mankhwalawa ophatikizana a rosiglitazone + metformin mwa azimayi a premenopausal omwe ali ndi kutsutsana ndi insulin (mwachitsanzo, odwala omwe ali ndi polycystic ovary syndrome) angayambitse kuyambiranso kwa ovulation. Odwala otere amatha kutenga pakati. Amayi a Premenopausal adalandira rosiglitazone panthawi yoyesedwa. Kuchepa kwa mahomoni kunawonedwa poyeserera, koma panthawi ya chithandizo cha amayi omwe anali ndi rosiglitazone panalibe zovuta zoyipa zomwe zimatsatiridwa ndi kusamba kwa msambo. Pankhani ya kusamba kwa msambo, kuthekera kopitilira chithandizo ndi Avandamet kuyenera kuwunikiridwa mozama.

Chifukwa cha kudzikundikira kwa metformin nthawi zina, kusokonezeka kwakukulu kwa metabolic kumachitika - lactic acidosis - makamaka pagulu la odwala omwe ali ndi matenda osokoneza bongo omwe ali ndi vuto lalikulu laimpso. Musanayambe chithandizo ndi metformin, motero, kuphatikiza kwa rosiglitazone + metformin, ndikofunikira kuwunika pazovuta zomwe zingachitike chifukwa cha lactic acidosis, mwachitsanzo, matenda osokoneza bongo a shuga, ketosis, kusala kwa nthawi yayitali, kumwa mowa kwambiri, ntchito yolakwika ya chiwindi (kuphatikizapo chiwindi) matenda limodzi ndi minofu hypoxia. Ngati lactic acidosis ikukayikira, Avandamet ayenera kuthetsedwa ndipo wodwala agonekere kuchipatala nthawi yomweyo.

Zambiri zochepa zimapezeka pamankhwala a odwala omwe amalephera kwambiri aimpso ndi rosiglitazone. Metformin imakumbidwa ndi impso, musanayambe chithandizo ndi Avandamet komanso nthawi zonse, ndikofunikira kudziwa kuchuluka kwa creatinine mu seramu. Chisamaliro makamaka chiyenera kuperekedwa kwa odwala omwe ali ndi chiopsezo chowonjezereka cha matenda a impso, mwachitsanzo, odwala okalamba kapena odwala omwe vuto lawo limatha kutsagana ndi kuchepa kwa ntchito yaimpso (kuchepa thupi, matenda opatsirana kapena kuwopsa). Avandamet sayenera kulembedwa kwa odwala omwe ali ndi serum creatinine ndende> 135 μmol / L mwa amuna kapena> 110 μmol / L mwa akazi.

Odwala omwe ali ndi vuto lofooka la hepatic (6 mfundo kapena mochepera pa Mwana-Pugh), mlingo wa rosiglitazone si wofunikira. Komabe, poganizira kuti chiwopsezo cha ntchito ya chiwindi ndi chiopsezo cha lactic acidosis yolumikizidwa ndi metformin, kuphatikiza kwa rosiglitazone ndi metformin sikulimbikitsidwa kwa odwala omwe ali ndi vuto la chiwindi.

Amachokera ku thiazolidinedione, incl. rosiglitazone imatha kuyambitsa kapena kukulitsa njira yolephera chifukwa cha mtima. Pambuyo pa kuyambiranso kwa mankhwala a rosiglitazone komanso nthawi yopereka mlingo, kuwunika mosamala kwa wodwalayo ndikofunikira poyerekeza ndi zizindikiro zotsatirazi ndi zizindikiro zakulephera kwa mtima: kuthamanga komanso kulemera kwakukulu, kufupika. Ndi chitukuko cha zizindikiro za kulephera kwa mtima, muyenera kuwunika kuchepetsa mlingo kapena kusiya kwa Avandamet ndikupereka mankhwala mogwirizana ndi zomwe zilipo pakali pano pochiza matenda a mtima. Kugwiritsa ntchito kuphatikiza kwa rosiglitazone + metformin sikulimbikitsidwa kwa odwala omwe ali ndi chiwonetsero chazovuta za mtima. Mankhwalawa amadziwikiratu odwala omwe ali ndi vuto la mtima I-IV wogwira ntchito molingana ndi gulu la NYHA.

Odwala omwe ali ndi pachimake coronary syndrome (ACS) sanaphatikizidwe ndi mayesero azachipatala. Popeza kukulitsa kwa ACS kumawonjezera chiopsezo cha kulephera kwa mtima, sikulimbikitsidwa kugwiritsa ntchito rosiglitazone mwa odwala omwe ali ndi ACS. Zambiri pa kuthekera kwa rosiglitazone kuonjezera chiopsezo cha myocardial ischemia sikokwanira. Kuwunikanso koyesedwa kwa mayesero afupipafupi a chipatala ndi placebo, koma osagwirizana ndi mankhwala, akuwunikira kulumikizana pakati pa kutenga rosiglitazone ndi chiopsezo chokhala ndi myocardial ischemia. Izi sizitsimikiziridwa ndi kafukufuku wazachipatala wautali wokhala ndi mankhwala othandizira (metformin ndi / kapena sulfonylurea), komanso ubale pakati pa rosiglitazone ndi chiopsezo chokhala ndi ischemia sichinakhazikitsidwe. Chiwopsezo chowonjezeka cha kuwonongeka kwa ischemic myocardial kuwonedwa kwa odwala omwe anali nthawi yoyesedwa pazachipatala pazoyambira nitrate.

Palibenso data yodalirika yokhudza kumwa mankhwalawa a hypoglycemic, kuphatikizapo magulu a thiazolidinedione okhala pamatumbo akulu odwala omwe ali ndi matenda a shuga 2.

Rosiglitazone siivomerezeka kwa odwala omwe amatenga chithandizo chofanana cha nitrate.

Pali malipoti osowa pakukula kapena kuwonjezereka kwa matenda ashuga a macular edema ndi kuchepa kwamawonekedwe owoneka. Mwa odwala omwewo, chitukuko cha zotumphukira edema nthawi zambiri chimanenedwa. Nthawi zina, kuphwanya koteroko kunathetsedwa atasiya kulandira chithandizo. Kuyenera kukumbukiridwa kuthekera kotukuka kwa vuto ngati wodandaula akudandaula za kuchepa kowonekera.

Odwala omwe amalandiridwa ndi Avandamet pazinthu zitatu zophatikizika ndi sulfonylurea atha kukhala pachiwopsezo cha kukhala ndi hypoglycemia yodalira mlingo. Mungafunike kuchepetsa kuchepetsa nthawi yomweyo kumwa mankhwalawo.

Metformin ndipo, chifukwa chake, Avandamet ayenera kuchotsedwa maola 48 asanafike pa opaleshoni yopanga mankhwala ndipo mankhwalawo sayenera kuyambiranso pasanathe maola 48 atangoyamba kugwira ntchito.

Kuyika / kukhazikitsa kwa mitundu yosiyanitsa ndi ayodini m'maphunziro a x-ray kungayambitse kulephera kwa impso. Poganizira izi, Avandamet, ngati mankhwala okhala ndi metformin, ayenera kuchotsedwa isanachitike kapena panthawi yotsutsana ndi x-ray, ndizotheka kuyambiranso pokhapokha atatsimikizira ntchito yofanana ndi impso.

Pakufufuzidwa kwakutali kwa monotherapy yamtundu wa shuga wachiwiri kwa odwala omwe sanalandirepo mankhwala a hypoglycemic, kuwonjezereka kwa pafupipafupi kwa azimayi omwe ali mgulu la rosiglitazone (9,3%, 2.7 milandu pazaka 100 zodwala) adadziwika poyerekeza ndi magulu a metformin ( 5.1%, milandu 1.5 pazaka 100 zodwala) ndi glyburide / glibenclamide (3.5%, milandu 1.3 pazaka 100 zodwala). Ambiri mwa mauthenga omwe adanenedwa mgulu la rosiglitazone okhudzana ndi kuphulika kwa mkono, dzanja ndi phazi. Chiwopsezo chowonjezereka cha fractures chiyenera kuganiziridwa popereka rosiglitazone, makamaka kwa azimayi. Ndikofunikira kuyang'anira mkhalidwe wamtundu wamafupa ndikukhalanso wathanzi lamafupa malinga ndi machitidwe ovomerezeka a chithandizo.

Ndi munthawi yomweyo makonzedwe a CYP2C8 zoletsa kapena ma inducers komanso munthawi yomweyo kugwiritsa ntchito mankhwala a cationic omwe atulutsidwa ndi impso glomerular secretion, kuyang'anira magazi ndi kusintha kwa rosiglitazone kapena metformin ndikofunikira.

Kugwiritsa Ntchito Kwa Ana

Pakadali pano, palibe chidziwitso pakugwiritsa ntchito mankhwalawa kwa ana ndi achinyamata ochepera zaka 18, chifukwa chake kugwiritsa ntchito mankhwalawa sikulimbikitsidwa.

Kukopa pa kuyendetsa magalimoto ndi kayendedwe kazinthu

Rosiglitazone ndi metformin sizimakhudza kuyendetsa magalimoto ndi kugwira ntchito ndi makina.

Zotsatira za pharmacological

Avandamet - mankhwala ophatikiza a hypoglycemic, amalembedwa kwa odwala pakamwa. Piritsi lirilonse limakhala ndi zinthu ziwiri zazikulu zomwe zimakhala ndi njira yowonjezera yopititsira patsogolo kulamulidwa ndi matenda a shuga osadalira insulini. Mankhwala a Rosiglitazone amadziwika kuti ndi thiazolidinedione, ndipo metformin hydrochloride ndi biguanides. Limagwirira ntchito yoyamba imakhazikika pakuwonjezeka kwa insulini kumverera kwa minofu yolosera, ndipo yachiwiriyo imathandizira kuchepetsa kupanga kwa glucose amkati mwa chiwindi.

Kusankha Nyukiliya PPAR Antagonist_s Rosiglitazone amawongolera insulin kudziwa chiwindi, mafupa am'mimba, minofu ya adipose. Mu pathogenesis ya mtundu 2 matenda a shuga, kutsutsana ndi insulin kumachita mbali yofunika, gawo limachepetsa mafuta acids, insulin ndi glucose ozungulira m'magazi. Amathandizanso kagayidwe.

Pazoyesedwa zazinyama, pazitsanzo za matenda osokoneza bongo omwe amadalira insulin, mankhwalawa adawonetsa ntchito ya hypoglycemic. M'maphunziro oyesera, kuchuluka kwa kapamba kunalembedwa chifukwa cha kuchuluka kwa zisumbu za Langerhans, kuchuluka kwa insulini kunachuluka, ndipo ntchito za β-cell zinasungidwa.

Anachepa kwambiri hyperglycemia. Rosiglitazone amachepetsa kukula kwa ochepa matenda oopsa, aimpso kukanika. Mu mbewa, makoswe, pancreatic insulin secretion sichikulimbikitsidwa, sizimayambitsa kugwa ndi shuga. Glycemic control imakhala bwino potsatira limodzi kuchepa kwambiri kwa insulin kachulukidwe ka seramu precursors.

Gawo lina la mankhwalawa - metformin - amachepetsa kupanga glucose wamkati. Imachepetsa postprandial, basal ndende. Mchitidwewu suyambitsa hypoglycemia, simalimbikitsa kupanga insulin. Njira yayikulu yochitira:

• kuyamwa kwa shuga wosavuta m'matumbo kumachedwetsedwa,
• kugwiritsidwa ntchito kwa glucose mwa zotumphukira zimakhala kumayambitsidwa, kumwa kwake kumawonjezeka, kumva kwa minofu kumakulirakulira,
• zoletsa wa glycogenolysis, gluconeogeneis. Avandamet pamapeto pake amachepetsa kupanga shuga kwa chiwindi.

Metformin imayambitsa enzyme ya glycogen synthetase kudzera mu intracellular glycogen synthesis. Kuchita kwa transmembrane shuga onyamula amitundu yonse kumakhala bwino. Gawolo limasintha kagayidwe ka lipid mosasamala kanthu za kuthamanga kwa shuga m'magazi. Malinga ndi zotsatira za kafukufuku wa zamankhwala, chithandizo chamankhwala ichi chimawonetsa kuchepa kwa kuchuluka kwa triglycerides, cholesterol yathunthu ndi LDL.

Chofunikira: kugwiritsa ntchito kuphatikiza kwa zinthu ziwiri zazikulu zogwira ntchito za avandamet kumawongolera kuwongolera kwa glycemic mwa anthu omwe ali ndi matenda osokoneza bongo omwe amadalira insulin.

Kupenda

Rosiglitazone imalowetsedwa kwambiri m'magazi ndikusinthidwa kukhala zinthu zofunikira m'thupi, pambuyo pake zigawo zake zimapukusidwa ndi metabolites. Hydroxylation, N-demethylation ndi njira zazikulu zowonjezera komanso kagayidwe kachakudya, zimayendera limodzi ndi conjugation ndi glucuronic acid, sulfate. Thupi limapangidwa ndi CYP2C8 isoenzymes, ndipo CYP2C9 ndi yocheperako.

Kuletsa kwa rosiglitazone sikukhudza ma isoenzymes a CYP4A, CYP3A, CYP2E1, CYP2D6, CYP2C19, CYP2A6, CYP1A2. Ndi CYP2C8 isoenzymes, zoletsa zolimbitsa, zomwe zili ndi CYP2C9, ndizofooka. Kuchita ndi magawo a CYP2C9 kulibe.

Metformin sinasinthidwe kukhala zinthu zina, imatulutsa kuchokera m'thupi kudzera mu impso osasinthika. Ma metabolites amtunduwu samadziwika mwa anthu.

Kupukusira kwa rosiglitazone ndi njira yayitali yomwe imatenga maola 130, imachitika kudzera m'matumbo ambiri ¼ pamamwa, komanso impso mu 2/3. Ngakhale mu ndowe, kapena mkodzo, chinthuchi sichinapezeke mwanjira yachilengedwe. Kuwonjezeka modzikuza kwa parahydroxy sulfate (metabolite yayikulu ya chigawo) kumawonedwa ndikubwerezabwereza makonzedwe. Kuchulukitsa m'madzi a m'magazi sikumaphatikizidwa.

Kudzera kwa katulutsidwe katulutsidwe, kusefedwa kwa glomerular, metformin imachotsedwanso ndi impso. Njirayi imatenga maola 6.5 pa liwiro loposa 400 ml kwa mphindi.

Akuluakulu

Endocrinologist amasankha mlingo komanso njira zochizira aliyense payekhapayekha.

Kuchita kwa avandamet sikudalira chakudya. Kugwiritsa ntchito mapiritsi ndi chakudya kapena mukatha kumachepetsa mwayi wosagwirizana ndi m'mimba thirakiti.

Kuvomerezedwa kwa avandamet ndikulimbikitsidwa kuti muyambe ndi mlingo wa tsiku ndi tsiku wa 4 mg pa 1000 mg. Kuchuluka kumeneku kumatha kuwonjezeka pang'onopang'ono mpaka kufika pa 2000 mg ya rosiglitazone ndi 8 mg ya metformin (pazambiri), koma izi ziyenera kuchitidwa kokha ndikuwongolera mwamphamvu njira ya glycemia. Ndi kuwonjezeka pang'onopang'ono, mosadukiza, osakhudzika m'matumbo amachepetsedwa. Gawo la tsiku ndi tsiku ndi 500 mg ya metformin ndi 4 mg ya rosiglitazone.

Mawonekedwe a achire zotsatira zakusinthira kwa mankhwalawa zimawonedwa munthawi ya masiku 7 mpaka 14, kwa rosiglitazone mkati mwa masiku 42 - 56.

Chofunikira: Kutalika kwa nthawi, ntchito ya mankhwala a hypoglycemic omwe kale amatengedwa pakamwa, iyenera kuganiziridwa mukasinthira ku Avandamet. Kuwerengedwa kwa koyamba mlingo utatha wa makonzedwe apadera a zinthu ziwiri zoyambira za avandamet zachokera kuchuluka kwa zigawo zomwe zidatengedwa.

Kwa okalamba

Chifukwa cha kuchepa kwa ntchito yaimpso m'gulu lino la odwala, kukonza, mawonekedwe oyamba a avandamet ayenera kusinthidwa mokwanira. Kukhala bwino kwa openshoni kuyenera kuyang'aniridwa bwino, shuga yamagazi iyenera kuyang'aniridwa nthawi zonse. Kutengera ndi zomwe mwapeza, sinthani mlingo wa avandamet.

Panthawi ya chiwindi ntchito

Pankhaniyi, kusintha kwa mlingo ndi ma regosens a rosiglitazone sikufunika. Ngati sulfonylurea ilipo mu mankhwalawa, muyeso woyamba wa chigawocho uzikhala 4 mg patsiku. Kuwonjezeka kwa tsiku ndi tsiku kwa chinthu ichi kuyenera kuchitika mosamala, pambuyo pakuphunzira kosungidwa ndi madzimadzi ndi kuwunika kwa zomwe zimachitika pakumwenso kwamankhwala.

Zotsatira zoyipa

Kupezeka kwa zosafunika zotsatira kumayambitsidwa ndi magawo onse omwe amagwira ntchito a mankhwalawo mosiyanasiyana. Mndandanda:

• ziwengo: ≥0.1 - kuyabwa pakhungu, zidzolo, uritisaria, angioedema, ≥ 0.0001 - 0.001 - anaphylactic reaction,
• dongosolo lamtima: ≥ 0.0001 - 0,001 pulmonary edema, mtima kulephera,
• m'mimba dongosolo: ≥ 0.0001 - 0,001 - chiwindi ntchito ndi kuwonjezeka enzyme ndende, chitsulo
• ziwalo zamawonedwe: ≥ 0.0001 - 0.001 - macular edema,
• khungu, mucous nembanemba: ≥ 0.0001 - 0.001 - erythema wofatsa, womwe umawonedwa mwa odwala omwe ali ndi hypersensitivity,
• Zina: ≥ 0.0001 - 0.001 - B akusowa₁₂lactic acidosis.

Kugwiritsa Ntchito Mankhwala Avandamet ndi mankhwala ena

Palibe kafukufuku yemwe adachitapo pankhaniyi. Zambiri zimagwiritsidwa ntchito pazinthu zomwe zimapanga payekha.

• CYP2C8 gemfibrozil inhibitor ndi kudya kawiri tsiku lililonse pa 600 mg kawiri C_SS chinthu. Mungafunike kuchepetsa kuchepetsa
• CYP2C8 inducer rifampicin pa mlingo wa tsiku ndi tsiku mpaka 600 mg inachepetsa gawo la chinthucho ndi 65%, zomwe zimafuna kusintha kwa mankhwalawa ngati kuli koyenera ndikugwiritsa ntchito Avandamet, potengera zotsatira za kuyang'anira shuga wamagazi mosamala,
• pamene amatengedwa ndi acarbose, glimepiride, glibenclamide, metformin, warfarin, digoxin, norethisterone, ethinyl estradiol monga gawo la njira zakulera zamkamwa, nifedipine pa pharmacodynamics, pharmacokinetics of the most kikubwa zotsatira za rosiglitazone sanatero.

• pali chiwopsezo chowonjezeka cha lactic acidosis mu poyizoni wa mowa wamphamvu,
• mankhwala a cationic amapikisanirana dongosolo limodzi lokhala ndi vacandamet ndi Avandamet, lomwe limafuna kuyesa mosamala magawo a magazi,
• okodzetsa, β agonists₂--adrenoreceptors, corticosteroids am'deralo komanso achilengedwe amayambitsa hyperglycemia, yomwe imafuna kuwunikira pafupipafupi zizindikiro za shuga kumayambiriro kwa chithandizo, pang'ono - panthawi yonse ya mankhwala. Mankhwalawa atathetsedwa, kuwunika kwa mtundu wa mankhwala a Avandamet ndikofunikira,
• Mlingo wa mankhwalawa umasinthidwa mukamayimitsa kapena kutenga ma AC a inhibitors omwe amachepetsa kuchuluka kwa shuga m'magazi.

Mimba komanso kuyamwa

Palibe deta yokwanira pazotsatira zogwiritsa ntchito avandamet panthawi yapakati. Palibe chidziwitso chokhudza kulowa kwa mankhwalawa mkaka wa mayi woyamwitsa.

Kukhazikitsidwa kwa mankhwala Avandamet pa mkaka wa m'mawere kapena pathupi kumalimbikitsidwa pokhapokha ngati chiwopsezo ku thanzi la mwana ndichipindulitsa amai.

Fananizani ndi fanizo

Pamsika wam'nyumba, mwa mankhwala omwewo angapezeke akugulitsa: Fomu, Metformin-Richter, Metglib, Glformin Prolong, Glformin, Glimecomb. Pakati pa mankhwala achilendo pali zinthu 30, Avandia, Avandaglim zochokera rosiglitazone, ndi zina zonse zochokera metformin.

Elena, 37 (Moscow)

Ndikudwala matenda ashuga a 2 kwa zaka 4, ndakhala ndikutenga Avandamet komaliza ndi theka. Ili ndiye chithandizo chokhacho chomwe chimandithandizira kuchepetsa matenda a shuga. Chifukwa cha kuchuluka kwa shuga mu shuga, mlingowo unakulirakulira. Ndimayang'anira glycemia pafupipafupi, ndimadwala, ngakhale antchito ogwira ntchito amawazindikira. Chobwereza chokha ndicho mtengo.

Bogdan, 62 (Tver)

Poyamba ndinkaonetsetsa kuti ndikalamba, chifukwa ndimakhala wotopa, wotopa kwambiri komanso wotopa. Wogwira ntchito adalangiza mankhwalawo, adati amangogulitsa ndi mankhwala basi. Tinapita kukayang'aniridwa, zomwe sindimakonda. Mankhwala adayikidwa. Pambuyo pa sabata loyamba lovomerezeka, zovuta zamatumbo nthawi zambiri zimayamba kuvuta, ngakhale malangizo atatsatiridwa. Sanayime miyezi isanu ndi umodzi tsopano. Koma kuphulika kwa nyonga, mphamvu zake ndizoyenera, ngakhale mtengo wokwanira wamapiritsi si chisoni, thanzi ndilofunika kwambiri.

Kristina, 26 (Voronezh)

Ndinapezeka kuti ndili ndi matenda osokoneza bongo omwe amadalira insulin kwa nthawi yayitali, koma adotolo adandidziwitsa mankhwala avandamet osakwana chaka chapitacho. Izi zinandipulumutsa ku chidziwitso chodwala cha insulin. Aliyense amene akuyenera kuchita jakisoni amvetsetse kusiyana pakati pa chithandizo ndi mapiritsi ndi kudziyimira pawokha pobayira.

Pomaliza

Mankhwalawa amalembedwa ndi dokotala yekha yemwe amatha kudziwa bwino momwe wodwalayo alili, asankhe mlingo wokwanira, asinthe nthawi yake pamankhwala ake. Chifukwa chachilengedwe chazambiri zomwe zimapangidwa ndi mankhwalawa, ndizowopsa kuzisinkhasinkha. Izi zimatha kuyambitsa mavuto osafunikira. Thandizo losagwirizana limawopseza kuwonongeka kwa thanzi la wodwalayo.

Migwirizano ndi magwiritsidwe akusungidwa

Ana akuyenera kukhala ndi malo ochepa osungiramo mankhwala. Mankhwalawa safuna kuti pakhale mawonekedwe apadera osungira. Analimbikitsa T osungira 25 digiri Celsius. Musagwiritse ntchito mankhwalawa tsiku lomwe linatha, lomwe ndi miyezi 24. Ndikofunikira kuti mutsegule khunyu nthawi yomweyo musanamwe mankhwalawa chifukwa cha kuchuluka kwa mankhwalawa. Pewani kuwala kwa dzuwa. Mankhwala ndi a gulu la mankhwala omwe amapezeka ku pharmacies. Musanagwiritse ntchito, onetsetsani kuti mwawerengera zakale zakugwiritsa ntchito mankhwalawo kuchokera pakudya ndi mankhwala. Onani kupezeka kwa mankhwalawo ndi manejala wa mankhwala opezeka pa intaneti pa foni kapena pafomu ya mayankho. Mutha kugula Avandamet ku Moscow ndi zigawo zina za Russia mu pharmacy yathu ya intaneti. Malinga ndi malamulo a Russian Federation (Decree of the Government of the Russian Federation of 01/19/1998 No. 55) mankhwalawa monga mankhwala sangabwerenso ndikusinthana.

Momwe mungagwiritsire ntchito: Mlingo ndi njira ya chithandizo

Mkati, mlingo umasankhidwa payekha. Kulandila nthawi ya chakudya kapena itatha, kumachepetsa mavuto omwe amachitika chifukwa cha m'mimba. Mlingo woyambirira wa kuphatikiza rosiglitazone + metformin ndi 4 mg / 1000 mg. Mlingo ukuwonjezeka pang'onopang'ono (4 mg patsiku la rosiglitazone ndi / kapena 500 mg wa metformin), mlingo waukulu wa tsiku ndi tsiku ndi 8 mg wa rosiglitazone / 2000 mg wa metformin.

The achire zotsatira (pambuyo kusintha kwa mankhwalawa) limawonekera pambuyo masabata 6-8 kwa rosiglitazone komanso pambuyo pa masabata 1-2 kwa metformin.

Mukasintha kuchokera ku mankhwala ena a hypoglycemic kukhala rosiglitazone ndi metformin, ntchito ndi nthawi yayitali ya mankhwala apambuyo ayenera kukumbukiridwa. Mukamasintha kuchokera ku rosiglitazone ndi mankhwala a metformin ngati mankhwala amodzi, mlingo woyambirira wa kuphatikiza kwa rosiglitazone ndi metformin umatengera Mlingo womwe watengedwa.

Kusintha kwa Mlingo kwa okalamba kumadalira deta ya impso.

Kuphatikiza kwa rosiglitazone + metformin ndi zotumphukira za sulfonylurea, mlingo woyambirira wa rosiglitazone uyenera kukhala 4 mg patsiku. Kuwonjezeka kwa rosiglitazone mpaka 8 mg patsiku kuyenera kumwedwa mosamala (chiopsezo cha madzi osungidwa m'thupi).

Mafunso, mayankho, ndemanga pa mankhwala Avandamet

Zomwe zimaperekedwa zimakonzekera akatswiri azamankhwala komanso zamankhwala. Chidziwitso chokwanira chokhudza mankhwalawa chili m'malangizo omwe amaphatikizidwa ndi zomwe amapanga ndi wopanga. Palibe chidziwitso chomwe chatumizidwa patsamba lino kapena tsamba lililonse la tsamba lathu chomwe chingagwire ntchito ngati cholowa m'malo mwapadera kwa katswiri.