Glimecomb - mankhwala ophatikizira awiri a matenda a shuga a 2

Piritsi limodzi lili:

yogwira zinthu: metformin hydrochloride malinga ndi 100% zinthu-500 mg, glycazide malinga ndi 100% chinthu-40 mg,

zotuluka: sorbitol, povidone, croscarmellose sodium, magnesium stearate.

Mapiritsi kuyambira oyera mpaka oyera okhala ndi kirimu wowoneka bwino kapena wachikasu, lofiirira-wozungulira, wokhala ndi bevel komanso chiwopsezo. Kukhalapo kwa marbulo kumaloledwa.

Gulu la PHARMACOTHERAPEUTIC:

wophatikizira wa hypoglycemic wothandizira pakamwa (Biguanide + sulfonylurea group pokonzekera)

MTUNDU WA ATX: A10BD02

ZOCHULUKA ZA PHARMACOLOGICAL Pharmacodynamics.

Glimecomb ® ndi kuphatikiza kosakanikirana kwamankhwala awiri othandizira a hypoglycemic pamagulu osiyanasiyana a pharmacological: glyclazide ndi metformin. Ili ndi zotsatira za pancreatic komanso zopanda pancreatic.

Gliclazide imathandizira kubisalira kwa insulin ndi kapamba, kumawonjezera chidwi cha zotumphukira kuti insulin. Imalimbikitsa ntchito ya intracellular michere - minofu glycogen synthetase. Amabwezeretsa chimfine choyambirira cha insulin, imachepetsa nthawi kuyambira pakudya mpaka pakuyamba kwa insulin, ndikuchepetsa hyperglycemia ya postprandial. Kuphatikiza pa kukhudza kagayidwe kazakudya, kumakhudza ma cellcirculation, kuchepetsa kupendekera ndi kuphatikizika kwa maselo, kuchedwetsa kukula kwa parietal thrombosis, kufooketsa kupezeka kwamitsempha yama cell ndipo kumalepheretsa kukula kwa michere yam'mimba, komanso kubwezeretsa kusintha kwa thupi. Imachepetsa kukula kwa matenda ashuga retinopathy osagwirizana, ndi matenda ashuga a nephropathy omwe amagwiritsidwa ntchito kwa nthawi yayitali, kuchepa kwakukulu kwa proteinuria kumadziwika. Siziwonjezera kuchuluka kwa kulemera kwa thupi, chifukwa zimakhala ndi chiwonetsero choyambirira cha insulin secretion ndipo sichimayambitsa hyperinsulinemia, zimathandizira kuchepetsa kulemera kwa odwala onenepa kwambiri, kutsatira zakudya zoyenera.

Metformin ndi m'gulu la Biguanides. Amachepetsa kuchuluka kwa shuga m'magazi mwa kuletsa gluconeogeneis m'chiwindi, kuchepetsa kuyamwa kwa glucose m'matumbo am'mimba ndikuwonjezera kugwiritsidwa ntchito kwake mu minofu. Kuchepetsa ndende mu magazi seramu ya triglycerides, cholesterol ndi otsika kachulukidwe lipoproteins (motsimikiza chopanda kanthu m'mimba) ndipo sasintha kuchuluka kwa lipoproteins a ena kachulukidwe. Imathandizira kukhazikika kapena kuchepetsa thupi. Pakakhala insulin m'magazi, chithandizo cha mankhwala sichikuwonetsedwa. Hypoglycemic zimachitika sizimayambitsa. Amawongolera michere yamagazi ya fibrinolytic chifukwa cha kuponderezedwa kwa choletsa wa activator profibrinolysin (plasminogen).

Gliclazide. Mafuta ndi okwera. Pambuyo pamlomo makonzedwe a 40 mg, kuchuluka kwambiri m'madzi amadzi am'magazi kumatha pambuyo pa maola 2-3 ndipo amafika ku 2-3 μg / ml. Kuyankhulana ndi mapuloteni a plasma ndi 85-97%. Kutha kwa theka-moyo ndi maola 8-20. Amapukusidwa mu chiwindi. Imafufutidwa makamaka mu mawonekedwe a metabolites ndi impso - 70%, kudzera m'matumbo - 12%. Mwa anthu okalamba, kusintha kwakukulu pamawonekedwe a pharmacokinetic sikuwoneka. Metformin. Mafuta - 48-52%. Mwansanga mwachangu m'mimba thirakiti. Mtheradi bioavailability (pamimba yopanda kanthu) ndi 50-60%, kumeza chakudya ndi chakudya kumachepetsa kuchuluka kwake ndi 40% ndikuchepetsa kukwaniritsa kwake ndi mphindi 35. Kuzunzidwa kwa Plasma kumachitika pambuyo pa maola 1.81-2.69 ndipo osapitilira 1 μg / ml. Kulumikizana ndi mapuloteni a plasma ndikosathandiza, kumatha kudziunjikira m'magazi ofiira a m'magazi. Hafu ya moyo ndi maola 6.2. Imadziwitsidwa ndi impso, osasinthika (kusefera kwa glomerular ndi secretion ya tubular) komanso m'matumbo (mpaka 30%).

MALO OGWIRITSITSA NTCHITO Ntchito

• Type 2 shuga mellitus ndi kulephera kwa zakudya mankhwala, masewera olimbitsa thupi ndi chithandizo cham'mbuyomu ndi metformin kapena gliclazide.

• Kulandila chithandizo cham'mbuyomu ndi mankhwala awiri (metformin ndi gliclazide) mwa odwala omwe ali ndi matenda a shuga a 2 omwe ali ndi khola komanso magazi olamulidwa bwino.

MALANGIZO OTHANDIZA

• Hypersensitivity kuti metformin, glyclazide kapena zinthu zina za sulfonylurea, komanso zinthu zothandizira,

• lembani matenda ashuga 1

• diabetesic ketoacidosis, matenda a shuga, matenda a shuga,

• kwambiri aimpso,

• pachimake zinthu zomwe zingayambitse kusintha kwa impso: kuchepa magazi, matenda akulu, mantha,

• pachimake kapena matenda opatsirana omwe amakhala ndi minofu hypoxia: kulephera kwa mtima kapena kupuma, kulowetsedwa kwaposachedwa, mantha,

• mimba, nthawi yoyamwitsa,

• munthawi yomweyo makonzedwe a miconazole,

• Matenda opatsirana, chithandizo chachikulu cha opaleshoni, kuvulala, kuwotcha kwakukulu ndi zina zomwe zimafuna chithandizo cha insulin,

• uchidakwa wambiri, kuledzera kwambiri,

• lactic acidosis (kuphatikizapo mbiri)

- gwiritsani ntchito maola osachepera 48 isanachitike komanso mkati mwa maola 48 mutachita maphunziro a radioisotope kapena x-ray ndikukhazikitsa ma iodine okhala ndi zosiyana pakati,

• kutsatira zakudya zotsalira zama calori (zosakwana 1000 calories / tsiku).

Sitikulimbikitsidwa kugwiritsa ntchito mankhwalawa mwa anthu opitirira zaka 60 omwe amagwira ntchito zolimbitsa thupi, zomwe zimagwirizanitsidwa ndi chiwopsezo chokhala ndi lactic acidosis mwa iwo.

Ndi chisamaliro

Feverish syndrome, adrenal insufficiency, hypofunction ya anterior pituitary gland, matenda a chithokomiro omwe ali ndi vuto la chithokomiro.

KUGWIRITSA NTCHITO CHIYEMBEKEZO NDIPONSO KULIMBITSA KWAMBIRI

Pa nthawi yoyembekezera, kugwiritsa ntchito mankhwala Glimecomb® ndi contraindicated. Mukakonzekera kutenga pakati, komanso ngati mayi ali ndi pakati pa nthawi yomwe mukumwa Glimecomb ®, mankhwalawa ayenera kusiyidwa ndipo mankhwala a insulin ayenera kuyikidwa.

Glimecomb ® imaphatikizidwa pakamayamwa, popeza mankhwalawa amatha kulowa mkaka wa m'mawere. Pankhaniyi, muyenera kusinthana ndi insulin kapena kusiya kuyamwitsa.

ULEMEKEZO NDI KULAMULIRA

Mankhwalawa amagwiritsidwa ntchito pakumwa, pakudya kapena musanadye. Mlingo wa mankhwalawa umatsimikiziridwa ndi dokotala aliyense payekha kwa wodwala aliyense, kutengera kuchuluka kwa shuga.

Nthawi zambiri mlingo woyambira ndi mapiritsi 1-3 patsiku ndi kusankha pang'onopang'ono kwa mankhwalawo mpaka kubwezera kwamatenda kuyenera.

Nthawi zambiri mankhwalawa amatengedwa 2 pa tsiku (m'mawa ndi madzulo). Pazipita tsiku lililonse mapiritsi 5.

ZOTHANDIZA ZONSE

Kuchokera kumbali ya kagayidwe: vuto la kuphwanya kwa dosing regimen ndikudya mokwanira, hypoglycemia (mutu, kumva kutopa, njala, kuchuluka kwa thukuta, kufooka, kufooka, chizungulire, kusokonezeka kwa mgwirizano, kusokonezeka kwa minyewa kwakanthawi, ndi kupitirira kwa hypoglycemia, wodwalayo atha kulephera kudziletsa komanso chikumbumtima), nthawi zina - lactic acidosis (kufooka, myalgia, kupuma, kugona, kugona m'mimba, hypothermia, kuchepa kwa magazi, Reflex b radiarrhythmia).

Kuchokera pamimba yodyetsera: dyspepsia (nseru, kutsegula m'mimba, kumva kupweteka kwa epigastrium, kukoma kwa "chitsulo" mkamwa), kuchepa kudya - zovuta zimachepa ndi mankhwalawa pakudya, kawirikawiri - kuwonongeka kwa chiwindi (hepatitis, cholestatic jaundice - kumafuna kuchotsedwa kwa mankhwala, kuchuluka kwa "chiwindi" transaminases, zamchere phosphatase).

Kuchokera ku ziwalo za hemopoietic: kawirikawiri - zoletsa za m'matumbo a hematopoiesis (magazi m'thupi, thrombocytopenia, leukopenia).

Thupi lawo siligwirizana: kuyabwa, urticaria, zotupa za maculopapular.

Pazifukwa zoyipa, mankhwalawa amayenera kuchepetsedwa kapena kugwiritsidwa ntchito kwa mankhwalawo kwakanthawi.

Zina: kuwonongeka kwa mawonekedwe.

Zotsatira zoyipa zina za sulfonylurea zotumphukira: erythropenia, agranulocytosis, hemolytic anemia, pancytopenia, alculgic vasculitis, chiwopsezo cha chiwindi.

CHONCHO

Mankhwala osokoneza bongo kapena kupezeka kwa zinthu zomwe zingachitike pachiwopsezo kungayambitse kukula kwa lactic acidosis, popeza metformin ndi gawo limodzi la mankhwalawa. Ngati zizindikiro za lactic acidosis zikuwoneka, siyani kumwa mankhwalawa. Lactic acidosis ndi vuto lofunika kuchipatala msanga, mankhwalawa a lactic acidosis ayenera kuchitika kuchipatala. Chithandizo chothandiza kwambiri ndi hemodialysis. Mankhwala osokoneza bongo amathanso kukulitsa vuto la hypoglycemia chifukwa cha kupezeka kwa gliclazide pokonzekera. Ndi hypoglycemia yofatsa kapena yolimbitsa, shuga (dextrose) kapena yankho la shuga amatengedwa pakamwa. Ngati kwambiri hypoglycemia (kutaya chikumbumtima), 40% dextrose (glucose) solution kapena glucagon imayendetsedwa kudzera m'mitsempha, intramuscularly, subcutaneally. Pambuyo pozindikira, wodwalayo ayenera kupatsidwa chakudya chamagulu owonjezera chakudya kuti asayambenso kukonzekera hypoglycemia.

KUGWIRITSANA NDIPONSO ZITSANZO ZINA

Zoletsa za hypoglycemic zotsatira za mankhwalawa ndi angiotensin kutembenuza ma enzyme inhibitors (Captopril, enalapril), H2-histamine receptor blockers (cimetidine), mankhwala antifungal (miconazole, fluconazole), mankhwala omwe si a antiidal anti-inflammatory (NSAIDs), phenylbenzofenbazon ), anti-tuberculosis (ethionamide), salicylates, coumarin anticoagulants, anabolic steroids, beta-blockers, monoamine oxidase inhibitors, sulfonamides Zochita zinthu denga, cyclophosphamide, chloramphenicol, fenfluramine, fluoxetine, guanethidine, pentoxifylline, tetracycline, theophylline, tubular katulutsidwe blockers, reserpine, bromocriptine, disopyramide, pyridoxine, mankhwala ena hypoglycemic (acarbose, biguanides, insulin, etc.), allopurinol gentamycin.

Barbiturates, glucocorticosteroids, adrenergic agonists (epinephrine, clonidine), antiepileptic mankhwala (phenytoin), wosakwiya calcium njira blockers, carbonic anhydrase inhibitors (acetazolamide), thiazide diuretics, chlortalidone, trifenazole azeneazideazole , morphine, ritodrine, salbutamol, terbutaline, glucagon, rifampicin, mahomoni a chithokomiro, mchere wa lithiamu, milingo yayikulu ya nikotini acid, chlorpromazine, kulera kwapakamwa komanso estrogens.

Amawonjezera chiopsezo chotukuka kwamitsempha yam'mimba komanso pazinthu zamtima zamtima glycosides. Mankhwala omwe amalepheretsa mafupa a hematopoiesis kuonjezera chiopsezo cha myelosuppression.

Ethanol imawonjezera mwayi wokhala ndi lactic acidosis.

Metformin imachepetsa kuchuluka kwambiri mumagazi (C max) ndi T 1 / 4furosemide ndi 31 ndi 42.3%, motsatana. Furosemide imawonjezera C max metformin ndi 22%.

Nifedipine imawonjezera mayamwidwe, C max, amachepetsa mayeso a metformin.

Mankhwala a Cationic (amiloride, digoxin, morphine, procainamide, quinidine, quinine, ranitidine, triamteren ndi vancomycin) omwe amapezeka mu mphukira za mpikisano wamayendedwe a tubular system, ndipo akamalandira mankhwala kwa nthawi yayitali amatha kuwonjezera ma C metxin ndi 60%.

MALANGIZO OTHANDIZA

Kuchiza ndi Glimecomb ® kumachitika kokha kuphatikiza ndi kashiamu wotsika, zakudya zama carb otsika. Ndikofunikira kuwunika pafupipafupi kuchuluka kwa shuga m'magazi pamimba yopanda kanthu ndikatha kudya, makamaka masiku oyamba a mankhwalawa.

Glimecomb ® imatha kutumikiridwa kokha kwa odwala omwe amalandira chakudya chokhazikika, chomwe chimaphatikizapo chakudya cham'mawa, kuonetsetsa kuti kudya chakudya chamagulu ambiri.

Popereka mankhwala, muyenera kukumbukira kuti chifukwa cha kudya kwa sulfonylurea, zotupa za hypoglycemia zimatha kukhazikika, ndipo nthawi zina zimakhala zovuta komanso zimatenga nthawi yayitali, zomwe zimafuna kugonekedwa kwa chipatala ndi shuga kwa masiku angapo. Hypoglycemia nthawi zambiri imayamba kudya zakudya zochepa zopatsa mphamvu, pambuyo pochita masewera olimbitsa thupi kwa nthawi yayitali kapena mwamphamvu, mutamwa mowa, kapenanso kumwa mankhwala angapo a hypoglycemic nthawi imodzi.

Kuti mupewe kukula kwa hypoglycemia, muyenera kusankha mosamala komanso mosamala payekha, komanso kupatsa wodwalayo chidziwitso chonse chamankhwala omwe akufuna.

Ndi kuchuluka kwa thupi ndi malingaliro, posintha zakudya, kusintha kwa mlingo wa Glimecomb® ndikofunikira.

Makamaka chidwi ndi machitidwe a mankhwala a hypoglycemic: okalamba, odwala omwe salandira chakudya chokwanira, omwe amakhala ndi chifowoka chokwanira, odwala omwe ali ndi vuto la kusowa kwa pituitary-adrenal. Beta-blockers, clonidine, reserpine, guanethidine amatha kuphimba mawonetseredwe azachipatala a hypoglycemia.

Odwala ayenera kuchenjezedwa za chiwopsezo chowonjezereka cha hypoglycemia milandu ya ethanol, NSAIDs, ndi njala.

Kulowerera kwakukulu ndikuvulaza, kuwotcha kwakukulu, matenda opatsirana omwe ali ndi febrile syndrome kungafune kuthetsedwe kwa mankhwala amkamwa a hypoglycemic ndi kukhazikitsidwa kwa mankhwala a insulin. Mankhwala, kuwunika kwa aimpso ndikofunikira; kutsimikiza kwa plasma lactate kuyenera kuchitidwa osachepera 2 pachaka, komanso maonekedwe a myalgia. Kukula kwa lactic acidosis kumafuna discontinuation chithandizo.

Maola 48 asanafike opaleshoni kapena kukonzekera kwamkati wokhala ndi ayodini, Glimecomb® iyenera kusiyidwa, chithandizo chikuyambiridwanso pambuyo maola 48.

Poyerekeza ndi momwe amathandizira ndi Glimecomb®, wodwalayo ayenera kusiya kumwa mowa komanso / kapena mankhwala okhala ndi ethanol.

Munthawi ya chithandizo, chisamaliro chikuyenera kuchitika poyendetsa magalimoto ndi kuchita zina zomwe zingakhale zoopsa zomwe zimafuna kuti anthu azisamalira komanso azithamanga kwambiri.

Zisonyezero zakudikirira

Sulfonylurea derivatives (PSM) ndi mitundu yodziwika bwino kwambiri yamankhwala 2 a odwala matenda ashuga pambuyo pa metformin. Kuphatikizidwa kwa PSM ndi metformin ndikofunikira kwa odwala omwe omwe kudya-carb ochepa, masewera, ndi metformin samapereka kuchepetsedwa kwa shuga. Zinthu izi zimagwira pazinthu zazikulu za matenda a shuga a 2 opezeka matenda ashuga: kukana kwambiri kwa insulini komanso kuchepa kwa insulin, chifukwa chake, pophatikiza amapatsa zotsatira zabwino. Glyclazide, yomwe ndi gawo la mankhwala Glimecomb, ndi PSM wa mibadwo iwiri ndipo imawerengedwa kuti ndi imodzi mwazinthu zotetezeka kwambiri mgulu lake.

Mapiritsi a Glimecomb angalembedwe:

1. Pamene chithandizo cham'mbuyomu chidasiya kupereka chindapusa chabwino cha matenda ashuga.
2. Atangozindikira matenda ashuga, ngati mulingo wa glycemia ndiwokwera kwambiri.
3. Ngati wodwalayo salola kuti metformin ikhale yayikulu.
4. Kuchepetsa kuchuluka kwa mapiritsi odwala omwe amatenga gliclazide ndi metformin.
5. Anthu odwala matenda ashuga omwe glibenclamide (Maninil ndi analogues) kapena kuphatikiza kwake ndi metformin (Glibomet et al.) Amayambitsa kufooka pafupipafupi kapena kosatsimikizika kwa hypoglycemia.
6. Odwala omwe amalephera aimpso omwe glibenclamide amaletsedwa.
7. Ndi matenda a shuga ophatikizidwa ndi matenda a mtima. Gliclazide sanawonetsedwe kuti alibe vuto pa myocardium.

Malinga ndi kafukufuku, kale mwezi umodzi wochiritsira ndi Glimecomb, shuga yofulumira imachepa ndi pafupifupi 1.8 mmol / L.Pogwiritsa ntchito mankhwalawa, mphamvu zake zimakulirakulira, miyezi itatu itachepa kale 2.9. Matenda a miyezi itatu amasinthidwe a shuga mu theka la odwala omwe amakhala ndi matenda osokoneza bongo a shuga, pomwe mankhwalawa sanali oposa mapiritsi 4 patsiku. Kulemera kwambiri komanso hypoglycemia yayikulu, yofunikira kuchipatala, sinalembedwe ndi mankhwalawa.

Pharmacology Glimecomb

Kuphatikiza kwa PSM ndi metformin kumawonedwa ngati kwachikhalidwe. Ngakhale pakubwera othandizira atsopano a hypoglycemic, mabungwe apadziko lonse a shuga ndi Unduna wa Zaumoyo ku Russian Federation akupitilizabe kuphatikiza kuphatikiza uku monga kopatsa chidwi kwambiri. Glimecomb ndi yosavuta kugwiritsa ntchito komanso yotsika mtengo. Zigawo zake ndizothandiza komanso zotetezeka.

Glyclazide yokhala ndi matenda a shuga a 2 amathandizira kupanga insulin yake, ndikuyamba kugwira ntchito gawo lake loyamba, pomwe shuga yangolowa kumene m'magazi. Kuchita izi kumakupatsani mwayi wochepetsera glycemia mukatha kudya, kutumiza glucose kuzinthu zotumphukira. Glyclazide imalepheretsa kukhazikika kwa angiopathy: imalepheretsa thrombosis, imasintha kukoka kwam'mimba komanso mkhalidwe wamakoma amitsempha yamagazi. Zotsatira zabwino za gliclazide pamapeto a retinopathy ndi nephropathy zatsimikiziridwa. Mapiritsi a Glimecomb kwenikweni samatsogolera ku insulin yochuluka m'magazi, chifukwa sayambitsa kulemera. Malangizowo adanenanso kuthekera kwa gliclazide kusintha kukhudzika kwa insulin, koma mwanjira iyi ali kutali ndi metformin, mtsogoleri wodziwika polimbana ndi insulin.

Metformin ndi mankhwala okhawo omwe amalimbikitsidwa kwa anthu amitundu mitundu iwiri ya matenda ashuga kupatula. Zimathandizira kusintha kwa glucose kuchokera m'mitsempha kupita m'magazi, kumalepheretsa kupanga kwa chiwindi ndi chiwindi, kuchedwa kuyamwa kwake m'matumbo. Mankhwala amalimbana bwino ndi matenda a lipid metabolism, omwe amadziwika ndi mtundu 2 wamatendawa. Chifukwa cha ndemanga zambiri za odwala matenda ashuga, metformin imagwiritsidwa ntchito kuchepa thupi. Sichimayambitsa hypoglycemia, akagwiritsidwa ntchito molingana ndi malangizo amakhala otetezeka kwathunthu. Zoyipa za gawo ili la Glimecomb ndizowonjezereka pazosafunikira pazakudya zam'mimba.

Pharmacokinetics yamagulu a mankhwala:

Maola 2 mutayikidwa pamimba yopanda kanthu

Maola 2,5 ngati mumwa mankhwalawo nthawi yomweyo ndi chakudya, monga malangizo amalangizira.

Glimecomb wa mankhwala ali ndi mwayi umodzi - 40 + 500, piritsi 40 mg la glyclazide, 500 mg ya metformin. Kuti mupeze theka la theka, piritsi likhoza kugawidwa, pali chiwopsezo.

Ngati munthu wodwala matenda ashuga sanalandire metformin kale, piritsi limodzi limayesedwa ngati mankhwala oyambira. Masabata awiri otsatira ndikosayenera kuichulukitsa, kotero mutha kuchepetsa chiwopsezo cha kusapeza bwino m'mimba. Odwala omwe amadziwa metformin ndipo amalekerera bwino amatha kutumizidwa mapiritsi atatu a Glimecomb. Mlingo wofunikira umatsimikiziridwa ndi dokotala, poganizira kuchuluka kwa glycemia wodwala komanso mankhwala ena omwe amamwa.

Ngati mlingo woyambira simupereka zotsatira zomwe zimafunikira, zimachulukana pang'onopang'ono. Pofuna kupewa hypoglycemia, nthawi yayitali yosintha pakati pa sabata iyenera kukhala sabata limodzi. Kutalika kololedwa ndi mapiritsi 5. Ngati pa kumwa motere, Glimecomb sapereka chindapusa cha matenda a shuga, ndiye kuti mankhwala ena ochepetsa shuga amaperekedwa kwa wodwala.

Ngati wodwala amakhala ndi insulin yambiri, Glimecomb mu shuga amatha kumwa ndi metformin. Chiwerengero cha mapiritsi pamenepa amawerengedwa kuti kuchuluka kwa metformin sikupitirira 3000 mg.

Malangizo a kumwa Glimecomb

Kupititsa patsogolo kulekerera kwa metformin ndikutchingira dontho lakuthwa la shuga, mapiritsi a Glimecomb amamwa nthawi yomweyo ndi chakudya kapena atangochita. Chakudya chizikhala chabwino komanso chizikhala ndi chakudya, makamaka chovuta kugaya. Poyerekeza ndi ndemanga, mpaka 15% ya anthu odwala matenda ashuga amakhulupirira kuti kumwa Glimecomb ndi mankhwala ena ochepetsa shuga kumatha kufunika kotsatira zakudya. Zotsatira zake, amamwa kuchuluka kwa mankhwalawa, omwe amawonjezera zovuta zake komanso mtengo wa chithandizo, akudandaula za shuga yayikulu, komanso m'mbuyomu amakumana ndi zovuta za matenda ashuga.

Tsopano palibe piritsi limodzi la shuga lomwe lingalowe m'malo mwa zakudya. Ndi nthenda yachiwiri ya 2, zakudya zimawonetsedwa popanda chakudya chambiri, komanso zoletsa zamafuta pang'ono, ndipo nthawi zambiri zimakhala ndi zopatsa mphamvu za calorie - chakudya cha matenda a shuga a 2. Ndondomeko ya chithandizo imaphatikizira kukula kwa kulemera ndi kuchuluka kwa ntchito.

Kuonetsetsa kuti yunifolomu ya Glimecomb masana, mlingo womwe wapatsidwa umagawidwa pawiri - Mlingo ndi madzulo. Malinga ndi ndemanga, zotsatira zabwino kwambiri za chithandizo zimawonedwa mwa odwala omwe amamwa mankhwalawa katatu (mutatha kudya chilichonse), ngakhale kuti malangizo omwe angagwiritsidwe ntchito samapereka mwanjira imeneyi.

Doctor of Medical Science, Mutu wa Institute of Diabetesology - Tatyana Yakovleva

Ndakhala ndikuphunzira matenda a shuga kwa zaka zambiri. Zimakhala zowopsa anthu ambiri akamwalira, ndipo makamaka amakhala olumala chifukwa cha matenda ashuga.

Ndithamangira kunena mbiri yabwino - Endocrinological Research Center ya Russian Academy of Medical Sayansi yakwanitsa kupanga mankhwala omwe amachiritsa odwala matenda ashuga mellitus. Pakadali pano, kugwiritsa ntchito bwino kwa mankhwalawa kuyandikira 98%.

Nkhani ina yabwino: Unduna wa Zaumoyo wateteza kukhazikitsidwa kwa pulogalamu yapadera yomwe imalipira mtengo wa mankhwalawo. Ku Russia, odwala matenda ashuga mpaka Meyi 18 (kuphatikiza) nditha kuipeza - Kwa ma ruble 147 okha!

Zotsatira zoyipa

Zotsatira zoyipa zambiri zimatha kufooka ngati mutsatira malamulo oti mutenge ndikuwonjezera mlingo kuchokera pamalangizo. Kuletsa kwa Glimecomb chifukwa cha tsankho sikufunika kwenikweni.

Contraindication

Mukapanda kumwa Glimecomb:

• mtundu 1 shuga
• hypoglycemia. Mankhwalawa sangamwe mowa mpaka shuga atayamba kuchita bwino,
• zovuta za matenda a shuga, matenda oopsa komanso kuvulala komwe kumafunikira mankhwala a insulin. Mlandu wa lactic acidosis m'mbuyomu,
• mimba, yoyamwitsa,
• X-ray yokhala ndi ma ayodini okhala ndi ayodini
• tsankho ku zilizonse za mankhwala.
• aimpso, kulephera kwa chiwindi, hypoxia, ndi matenda omwe angayambitse izi,
• uchidakwa, kumwa kwambiri kamodzi.

Odwala omwe ali ndi matenda a mahomoni. okalamba odwala matenda ashuga pogwiritsa ntchito nthawi yayitali, chiwopsezo cha mavuto amabwera, chifukwa chake akamamwa Glimecomb, ayenera kusamala makamaka ndi thanzi lawo.

Kugwirizana kwina ndi mankhwala ena

Mphamvu ya glimecomb imatha kulimbikitsidwa kapena kufooka mukamamwa mankhwala ena. Mndandanda wamachitidwe ogwiritsira ntchito mankhwalawa ndiwambiri, koma nthawi zambiri kusintha kwa magwiridwe antchito sikofunikira kwambiri ndipo kungasinthidwe mosavuta posintha mlingo.

Zofananira

Glimecomb alibe ma analoge athunthu olembedwa mu Russian Federation. Ngati mankhwalawo mulibe mankhwala, mankhwala awiri omwe ali ndi zinthu zomwezo angathe kusintha:

1. Metformin ili mu Glucofage yoyambilira yopangidwa ku France, Siofor yaku Germany, Metformin yaku Russia, Merifatin, Glformin. Onse ali ndi mlingo wa 500 mg. Kwa odwala matenda ashuga osalekerera bwino a metformin, mawonekedwe osinthika a mankhwalawa ndi abwino, omwe amatsimikizira kuti kulowa kwa magazi kulowa mthupi ndikuchepetsa kwambiri mavuto. Awa ndi mankhwala Metformin Long Canon, Metformin MV, Formin Long ndi ena.
2. Gliclazide ndiyotchuka kwambiri pa hypoglycemic. Katunduyu ndi gawo la Russian Glidiab ndi Diabefarm. Gliclazide yosinthidwa pano amawona ngati mawonekedwe omwe amakonda. Kugwiritsidwa ntchito kwake kumachepetsa kuchepa komanso kuopsa kwa hypoglycemia. Gliclazide yosinthidwa imakhala mu kukonzekera Diabefarm MV, Diabeteson MV, Gliclazide MV, Diabetalong, etc. Mukamagula, muyenera kuyang'anira chidwi ndi mankhwalawa, mungafunike kugawa piritsi pakati.

Pali mitundu yambiri ya magulu a Glimecomb pamsika waku Russia. Ambiri a iwo ndi ophatikiza a metformin okhala ndi glibenclamide. Mankhwalawa sakhala otetezeka kuposa glimecomb, chifukwa nthawi zambiri amayambitsa hypoglycemia. M'malo abwino a Glimecomb ndi Amaryl (metformin + glimepiride). Pakadali pano, ndiwotsogola kwambiri wamagulu awiri ndi PSM.

Mtengo wa paketi ya mapiritsi 60 a Glimecomb ndi wochokera pa 459 mpaka 543 rubles. Gliclazide ndi metformin kuchokera kwa wopanga yemweyo adzagula ma ruble 187. pa mlingo womwewo (mapiritsi 60 a Glidiab 80 mg amatenga ma ruble 130, mapiritsi 60. Gliformin 500 mg - 122 rubles). Mtengo wophatikizira kukonzekera koyambirira kwa gliclazide ndi metformin (Glucofage + Diabeteson) ndi ma ruble pafupifupi 750, onse omwe ali mu mawonekedwe osinthika.

MALO A ISSUE

Mapiritsi 40 mg + 500 mg. Mapiritsi 30, 60 kapena 120 mu botolo la mankhwala opangidwa ndi pulasitiki. Pa mapiritsi 10 kapena 20 mu chovala matuza. Botolo lirilonse kapena mapepala 6 otchinga a mapiritsi 10, kapena matumba asanu a matumboni 20 mapiritsi 20 aliwonse pamodzi ndi malangizo ogwiritsira ntchito paketi ya katoni.

Zambiri

Glimecomb ndi mankhwala othandizira odwala matenda ashuga amtundu wa 2. Zofunikira zake ziwiri ndi metformin ndi gliclazide. Choyambirira chimakhudzana ndi biguanides, chachiwiri ndi kutengera kwa sulfonylurea.

Kuphatikizika kwake pakuphatikizidwa kwa magawo awiri otchuka komanso othandiza. Ubwino waukulu pamankhwala ena ophatikiza ndi chiopsezo chochepa cha hypoglycemia. Amapangidwa ndi kampani yaku Russia ya mankhwala Akrikhin.

Zizindikiro zogwiritsidwa ntchito

Mankhwalawa amapangidwira odwala omwe ali ndi matenda a shuga a 2. Choyamba, madokotala amati mankhwala azakudya, komanso zolimbitsa thupi tsiku lililonse. Ngati, patapita nthawi yayitali, njira izi sizinabweretse zotsatira zomwe zikuyembekezeredwa, mankhwalawa amathandizidwa ndimankhwala. Poyamba, wodwalayo amapatsidwa mankhwala amodzi amodzi omwe amapangidwa ndi metformin. Ngati achire zotsatira sizichitika, kuphatikiza kwa mankhwala kumasonyezedwa.

Kutulutsa Fomu

"Glimecomb" ndi miyala yoyera yofiirira ya cylindrical mawonekedwe. Makina amaloledwa. Pali gawo la diametrical la chiopsezo. Mapiritsi amayikidwa m'mabokosi a 30 kapena 60 zidutswa.

Mtengo wokwanira wanyamula ma PC 30 a "Glimecomba" m'masitolo aku Russia ndi 276 rubles.

Mtengo wongoyerekeza ma CD 60 - kuchokera 524 ma ruble.

Piritsi lililonse lili ndi 500 mg ya metformin ndi 40 g ya gliclazide. Izi ndi zinthu ziwiri zazikulu zogwira ntchito. Ndi magawo omwe amawonetsera kukwera kwake kwapamwamba, komanso "kufatsa" kwa chochitikacho.

Kuzindikira kwa shuga - ingomwani tsiku lililonse.

Mwa zina zazing'ono zomwe: sorbitol, povidone, magnesium stearate, croscarmellose sodium.

Chifukwa chosowa lactose, mankhwalawa amaloledwa kugwiritsidwa ntchito mwa anthu omwe ali ndi tsankho.

Malangizo ogwiritsira ntchito

Mapiritsi a Glimecomb amapangidwira kuti azigwiritsidwa ntchito pakamwa pakudya kapena musanadye. Zimatengera kukula kwa muyezo komanso momwe matenda am'mimba alili odwala. Pa mankhwala, ndikofunikira kutsatira malamulo a zakudya zochepa. Malinga ndi malamulowa, palibe chifukwa chomwe muyenera kudumphira chakudya cham'mawa.

Mawonekedwe akuthupi la wodwalayo, komanso mkhalidwe wamaganizo ake, amathandizira kwambiri pamtengowo. Njala, ngakhale itakhala yochepa, ndipo makamaka kumwa mowa, sikuloledwa.

Phukusili liyenera kusungidwa pamalo amdima pa kutentha mpaka 25 ° C. Musanagule, ndibwino kumvetsera mwachidwi tsiku la kupanga ndi kumaliza ntchito. Mankhwala okhala ndi tsiku lotha ntchito omwe ali pafupi kutha ndi bwino kuti asagule.

Zolemba zogwiritsira ntchito

Chifukwa cha chiwopsezo chachikulu chokhala ndi lactic acidosis, Glimecomb siyikulimbikitsidwa kwa anthu okalamba azaka zopitilira 60, komanso odwala omwe akuchita ntchito zolimbitsa thupi.

Mimba ndi contraindication mwamtheradi ake ntchito. Chifukwa chake, panthawi yonyamula mwana, komanso panthawi yakukonzekera kutenga pakati, ziyenera m'malo mwake ndi mankhwala ena.

Kuyamwitsa sikugwirizana ndi Glimecomb. Pankhaniyi, mayi woyamwitsa ali ndi chisankho: mwina kumaliza kumaliza mkaka ndi kusinthanitsa ndi chakudya chongoganiza, kapena m'malo mwake mankhwalawo pawokha.

Kugwiritsa ntchito mosamala ndikotheka kwa odwala omwe ali ndi matenda a endocrine system.

Timapereka kuchotsera kwa owerenga tsamba lathu!

Mankhwala a Glimecomb amaloledwa kwa odwala matenda ashuga omwe amatsatira zonse zofunika pazakudya zama carb ochepa. Chakudya chizikhala chokhazikika. Zovuta zazikulu pakati pa chakudya zimapangitsa kutsika kwa magazi. Komanso, hypoglycemia mwadzidzidzi imatha kuyambitsa kumwa ngakhale pang'ono, komanso mankhwala osokoneza bongo omwe si a antiidal.

Kuchita ndi mankhwala ena

Zithandizo zochizira za Glimecomb zitha kulimbikitsidwa ndikufooketsedwa ndi mankhwala ena. Nthawi zambiri, izi sizofunikira kwambiri ndipo zimathetsedwa ndikusintha pang'ono kwa mlingo.

Mankhwala omwe amachepetsa kuthekera kwa Hypoglycemic kwa Glimecomb:

• mankhwala a antiidal
• mankhwala aliwonse a mahomoni, kuphatikizapo njira zakulera,
• okodzetsa
• mankhwala okhala ndi nikotini acid,
• antidepressants.

Mankhwala omwe amalimbikitsa luso la glycemic:

• antimicrobials
• Vitamini B6
• mankhwala omwe si a mahomoni omwe amaletsa kutupa,
• mankhwala ena omwe amachepetsa shuga ya magazi, kuphatikiza insulin.

Mulimonsemo, ndi adokotala okhawo omwe amatha kusintha mlingo wa Glimecomb. Wodwala amangoyenera kumuchenjeza munthawi yake za mankhwalawa omwe amamwa kapena akufuna kumwa.

Zotsatira zoyipa

Glimecomb ili ndi mndandanda waukulu wazotsatira zoyipa. Kuti muchepetse kuthamanga kwawo pathupi, ndikofunikira kutsatira mosamalitsa malamulo olandirira omwe afotokozedwa malangizo.

Glimecomb imalekeredwa bwino. Kutseka kwake chifukwa cha tsankho kumakhala kosowa kwambiri.

Pharmacokinetics ya mankhwala mankhwala

Mankhwala amadziwika ndi kupezeka kwa pancreatic ndi extrapancreatic kwenikweni.

Gliclazide imathandizira kupangika kwa insulin ndi maselo a beta a kapamba ndipo amathandizira kukulitsa chidwi cha maselo otengera insulin. Kuphatikiza apo, pawiri imathandizira kukulitsa chidwi cha puloteni yamkati - minofu ya glycogen synthetase. Kugwiritsa ntchito gliclazide kumathandizira kubwezeretsa kutalika kwa insulin katulutsidwe ndikuchepetsa hyperglycemia ya postpradial.

Kuphatikiza pa kukopa njira za kagayidwe kazakudya, kugwiritsa ntchito pawiri kumakhudzanso kuchuluka kwa magazi, kutsitsa kuchuluka kwa zomatira ndi kuphatikizira kwa mapulateleti, kuchepetsa kuchepa kwa peteretal thrombosis, kubwezeretsa kuyenera kwachilendo kwa makoma amitsempha, kumachepetsa mayankho amitsempha yamagalasi kuti adrenaline ngati microangiopathy.

Kugwiritsa ntchito gliclazide kumathandiza kuti muchepetse kukula kwa matenda ashuga; komanso, pamaso pa nephropathy, kuchepa kwa proteinuria kumawonedwa.

Metformin ndi mankhwala omwe ali m'gulu la Biguanide. Pulogalamuyi imathandizira kuchepetsa shuga m'magazi a m'magazi. Zotsatira zake zimatheka mwa kulepheretsa njira ya gluconeogenesis m'maselo a chiwindi, komanso pochepetsa kuchuluka kwa glucose kuchokera ku lumen ya m'mimba, komanso mwa kupititsa patsogolo mayamwidwe a glucose ndi maselo a minyewa. Kugwiritsa ntchito metformin kumathandizira kuchepetsa serum triglycerides, cholesterol ndi otsika kachulukidwe lipoproteins. Kukhazikitsidwa kwa metformin m'thupi kumapereka kuchepa komanso kukhazikika kwa thupi.

Kugwiritsa ntchito metformin pakalibe insulini m'magazi sikuti kumawonetsa kuwonekera kwa chidziwitso chifukwa cha kuwonekera kwa hypoglycemic sikuchitika. Kugwiritsa ntchito metformin kumathandizanso kupanga michere ya magazi.

Izi zimatheka ndikapondaponda inhibitor ya minisitara.

Zizindikiro ndi contraindication kugwiritsa ntchito mankhwalawa

Zizindikiro ntchito Glimecomb ndi mtundu 2 shuga mellitus Popeza kulibe ntchito ntchito zakudya mankhwala ndi zolimbitsa thupi, komanso popeza palibe zotsatira za achire zotsatira ndi metaformine ndi glycazide.

Glimecomb imagwiritsidwa ntchito m'malo mwa njira ziwiri zomwe zimapangidwa kale ndi Metformin ndi Glycoside, malinga ngati mulingo wamagazi ndi wokhazikika komanso wowongoleredwa bwino.

Glimecomb imakhala ndi njira zosiyanasiyana zotsutsana ndi mankhwalawa.

Zomwe zili pakati pazotsutsana ndi izi:

1. Hypersensitivity ya thupi la wodwalayo pazotsatira za metformin, gliclazide kapena sulfonylureas ina. Kuphatikiza apo, mankhwalawa sayenera kugwiritsidwa ntchito pamaso pa hypersensitivity pazinthu zina zowonjezera za mankhwalawa.
2. Kupezeka kwa matenda a shuga 1.
3. Kukhalapo kwa matenda ashuga a ketoacidosis, matenda a shuga komanso kuperewera kwa zochitika za hypa.
4. Kukula kwambiri aimpso kuwonongeka.
5. Kukhazikika kwa mikhalidwe yovuta kwambiri yomwe ingayambitse kusintha kwa impso, kukula kwa kusowa kwamadzi, matenda opatsirana ndikuwopseza.
6. Kukula kwa matenda aakulu ndi pachimake, limodzi ndi kupezeka kwa minofu hypoxia.
7. Kumachitika kwa aimpso kulephera.
8. Porphyria.
9. Nthawi ya bere ndi nthawi yoyamwitsa.
10. Munthawi yomweyo makonzedwe a miconazole.
11. Matenda opatsirana komanso kulowererapo kwa ma opaleshoni, kuwotcha kwakukulu ndi kuvulala kwakukulu, komwe panthawi yamankhwala kumafuna kugwiritsa ntchito insulin.
12. Kukhalapo kwa uchidakwa woperewera ndi kuledzera.
13. Kukula kwa lactic acidosis.
14. Kutsatira zakudya zamafuta ochepa.

Kuphatikiza pa milandu iyi, mankhwalawo saloledwa kugwiritsidwa ntchito poyeserera mawonekedwe a ayodini.

Osagwiritsa ntchito mankhwalawa pochiza odwala matenda ashuga omwe afika zaka 60, omwe akumana ndi zovuta zolimbitsa thupi. Izi zimachitika chifukwa chakukula kwakukulu kwa lactic acidosis mwa odwala.

Chenjezo makamaka liyenera kuchitika pakumwa mankhwala ngati wodwalayo ali ndi vuto losakhazikika, kuperewera kwa magwiridwe antchito a adrenal, kukhalapo kwa hypofunction ya anterior pituitary gland, matenda a chithokomiro.

Kugwiritsa ntchito mankhwala osokoneza bongo

Malangizo ogwiritsira ntchito Glimecomba amawongolera ndikufotokozera mwatsatanetsatane mikhalidwe yonse yomwe imalimbikitsidwa kumwa mankhwalawa komanso ngati kugwiritsa ntchito mankhwalawo ndikuloledwa. Malangizo tsatanetsatane wazotsatira zonse zomwe zimachitika mukamagwiritsa ntchito mankhwalawa komanso mulingo woyenera kuti mugwiritse ntchito.

Mankhwalawa amagwiritsidwa ntchito pakumwa pakudya kapena akangomaliza kudya. Mlingo wofunikira wovomerezeka umadziwika ndi dokotala malinga ndi zotsatira za mayeso ndi machitidwe a thupi la wodwalayo. Mlingo wa mankhwalawa umatsimikizika malinga ndi kuchuluka kwa shuga m'thupi la wodwalayo.

Nthawi zambiri, muyeso woyamba wa mankhwala omwe adokotala amawalimbikitsa ndi mapiritsi atatu patsiku, ndi kusankha pang'onopang'ono kwa mankhwalawa kuti aperekenso chipukuta misozi cha matenda ashuga. Ngati simutsatira malangizowo, ndiye kuti matenda ashuga akhazikika.

Nthawi zambiri, mankhwalawa amayenera kumwa kawiri patsiku m'mawa ndi madzulo. Ndipo mulingo woyenera wa mankhwalawa ukhoza kukhala mapiritsi 5.

Pali malangizo apadera omwe akuyenera kutsatidwa pochita mankhwala a Glimecomb:

• Mankhwalawa ayenera kuchitika pokhapokha ngati amadya chakudya chochepa mphamvu zopatsa mphamvu,
• odwala ayenera kudya chakudya chopatsa thanzi, chomwe chimaphatikizapo chakudya cham'mawa,
• popewa kukula kwa zizindikiro za hypoglycemia, kusankha kwa munthu payekha kuyenera kupangidwa,
• Ngati kupsinjika kwakuthupi ndi kwamatenda kumachitika mthupi, kusintha kwa mankhwalawa kumayenera kuchitika,

Mukamachita mankhwala ndi mankhwala monga Glimecomb, muyenera kukana kumwa zakumwa zoledzeretsa ndi zakudya zomwe zimakhala ndi ethanol pazomwe zimapangidwa.

Muyenera kusamala makamaka mukamagwiritsa ntchito mankhwalawa pogwira ntchito zamtunduwu zomwe zimafuna kuti anthu aziganiza mwachangu komanso mwachangu.

Zotsatira zoyipa

Mukamamwa mankhwalawo, wodwalayo amatha kukumana ndi mavuto ambiri.

Pazakudya za metabolic, kuphwanya mlingo wa mankhwalawa kapena kugwiritsa ntchito chakudya chokwanira, mavuto amatha kuyambitsa hypoglycemia. Mkhalidwe wamtunduwu umayendetsedwa ndi mutu, kuwoneka ngati kutopa, kumva mwamphamvu njala, kuchuluka kwa mtima, mawonekedwe a chizungulire, komanso mgwirizano woperewera.

Kuphatikiza apo, ngati kuphwanya kwamphamvu kwa wodwala, vuto lactic acidosis lingayambike, kuwonetsedwa ndi kufooka kwa myalgia, kugona kwambiri, kupweteka m'mimba ndi kuchepa kwa kuthamanga kwa magazi.

Mavuto otsatirawa atha kupezeka m'matumbo a ziwalo:

1. kumverera kwa nseru
2. kukula kwa matenda otsegula m'mimba,
3. maonekedwe akumawonda kwambiri mu epigastrium,
4. Maonekedwe a chitsulo mkamwa,
5. kuchepa kwamtima
6. Nthawi zina, kuwonongeka kwa chiwindi monga hepatitis, cholestatic jaundice ndipo ena amakula.

Ngati pali chiwindi pakhungu, mankhwalawa amayenera kuyimitsidwa nthawi yomweyo.

Pankhani yakuphwanya Mlingo ndi mfundo za mankhwala, kukulitsa kuponderezana kwa zinthu zopanga magazi ndikotheka.

Zotsatira zake zoyipa, wodwalayo amatha kuyanjana ndi matendawa, wowoneka ngati kuyabwa, urticaria ndi zotupa za maculopapular.

Wodwala akayamba kudwala chifukwa chomwa mankhwalawo, muyenera kuchepetsa mankhwalawo kapena kusiya kugwiritsa ntchito mankhwalawo.