Diaformin od

Zikutanthauza othandizira a hypoglycemic ntchito pakamwa. Oyang'anira ndende shugam'magazi, koma sizikhudza chinsinsi insulinchifukwa chake osakhoza kuyambitsa hypoglycemia mwa munthu wathanzi.

Mankhwala

Diaformin imakhudza kagayidwe kachakudya ka thupi la munthu m'njira zingapo. Mutatha kumwa mankhwalawa:

• imawonjezera kukhudzika kwa ma receptors ku mahomoni insulin,
• kugwiritsa ntchito maselo kumawonjezeka shuga,
• kukula kwa hepatic gluconeogeneis amasintha
• m'matumbo am'mimba mafuta ambiri samalowa kwambiri,
• kuchuluka kwa metabolidi ya lipid kumawonjezeka, pomwe zizindikiro monga LDL, TG ndi cholesterol.

Pharmacokinetics

Kuchokera pakumwa koyamba pa mapiritsi, chinthucho chimagwira bwino ndimatumbo. Komanso, bioavailability wake ndi 50-60%. Koma ndikamamwa nthawi yomweyo ndi chakudya, mayamwidwe amachepetsa ndipo amapezeka pang'onopang'ono.

Kamodzinso m'thupi, chinthucho chimadziunjikira pang'onopang'ono ndipo zimapezeka m'malo osasinthika timatulutsa mkodzo komanso ndowe. Kuchotsa theka moyo kuchokera kwamoyo kumatenga maola 9-12. Koma ngati ntchito ya impso imalephera, imatenga nthawi yayitali. Pankhaniyi, pamakhala chiopsezo chakuti mankhwalawa amadzaza mthupi ndikupangitsa bongo wambiri.

Zizindikiro zogwiritsidwa ntchito

Diaformin yasonyezedwa:

• insulin yodziyimira payokhamatenda ashugamwa akulu, akalemedwa ndi kunenepa kwambiri komanso kulandira chithandizo cha zakudya kwatsimikizira kuti sikothandiza.
• wodwala insulinmatenda ashuga (kuphatikiza Diaformin ndi insulin) Kugwiritsa ntchito Diaformin kumawonetsedwa makamaka kwa odwala omwe ali ndi kunenepa kwambiri, pamene kukana kwachiwiri kwa insulin kumawonedwa.

Contraindication

Mankhwala saloledwa kutenga ndi:

• wodwala matenda ashugakapena kholo,
• dibetic ketoacidosis,
• kuphwanya maluso a impso,
• kukhalapo kwa thupi la machitidwe ndi ma pathologies momwe mumakhala chiopsezo chophwanya kwambiri ntchito ya impso,
• kusowa kwamadzi
• wamphamvu malungo,
• sepsis,
• kudabwitsa,
• mitundu yayikulu ya matenda opatsirana,
• mtimandi kulephera kupuma,
• lakuthwa myocardial infaration,
• kukanika kwa chiwindi
• aakulu uchidakwa,
• poyyl ethyl
• kupezeka lactic acidosis mu anamnesis,
• kufooka kwa thupi (chifukwa cha zakudya zochepa zopatsa mphamvu, kulimbitsa thupi kwakukulu muukalamba),
• opaleshoni yaposachedwa
• mimba.

Zotsatira zoyipa

Pa mankhwala, vuto losagwirizana ndi mankhwalawa kuchokera machitidwe osiyanasiyana a thupi limatha kuonekera.

Kuchokera m'mimba:

• kulawa kwazitsulo mkamwa
• nseru ndi kusanza,
• kusowa kwa chakudya
• mavuto a dyspeptic
• kupweteka m'mimba
• chisangalalo.

Kuti muchepetse kapena kuchepetsa zizindikirozi, mutha kumwa antispasmodic kapena imodzi mwamankhwala atropine ndi kuyamba kumwa mapiritsi mukatha kudya kawiri kapena katatu patsiku. Ngati izi sizinabweretse mpumulo, kuyang'anira kwa Diaformin kwathetsedwa.

Kuchokera kumbali ya kagayidwe kachakudya:

• lactic acid diathesis - Ichi ndi chizindikiro chachindunji cha kuchoka kwa mankhwalawo.
• hypovitaminosis B12 (kokha ndi mankhwala a nthawi yayitali).

Zingakhalenso ziwengo mu mawonekedwe kuyabwa ndi zotupa pakhungu. Osati kawirikawiri, chosakhudzidwa kuchokera ku hematopoietic system imawonedwa - kukula kwa matenda a megaloblastic.

Diaformin, malangizo ogwiritsira ntchito

Mlingo ndi nthawi yayitali ya chithandizo ayenera kusankhidwa ndi dokotala wodwala aliyense payekhapayekha. Izi zimatengera kuopsa kwa matendawa komanso kuchuluka kwa shuga m'magazi.

Ndikofunikira kuyamba kulandira chithandizo cha mankhwala a 500-1000 mg tsiku lililonse. Mutha kuwonjezera kuchuluka kwake pakatha masiku 10-15, poganizira kuchuluka kwa shuga m'magazi. Nthawi zambiri, ndimankhwala amakonzanso, tengani 1500-2000 mg wa mankhwala patsiku. Mlingo wovomerezeka tsiku lililonse ndi 3000 mg.

Kwa ana a zaka 10, mankhwalawa amatha kuikidwa ndi koyamba mlingo wa 500 kapena 850 ml patsiku. Kuchuluka komwe mlingo ungakuwonjezeke ndi 2000 mg / tsiku, pamene mlingo umagawidwa pawiri kapena katatu.

Senda piritsi popanda kutafuna. Izi zimachitika tikamadya kapena tikatha kudya. Kuti muchepetse zovuta zosachokera m'mimba ndi matumbo, ndikofunika kuti muswe mlingo wa tsiku ndi tsiku mumadontho angapo.

Bongo

Ndi mankhwala osokoneza bongo amakula lactic acidosis. Itha kuzindikirika ndi zizindikiro izi:

• kutsegula m'mimba,
• kumverera nseru,
• kusanza,
• kutentha kwambiri kwa thupi
• kupweteka kwa minofu
• kupweteka m'mimba
• kulephera kupuma mu mawonekedwe a kupuma movutikira,
• chizungulirezomwe zingayambitse kulephera kudziwa,
• chikomokere(ndi zovutalactic acidosis).

Zizindikiro zoyambirira zitangoonekera lactic acidosis, ndikofunikira kusiya kumwa mankhwalawo ndikupita naye kuchipatala. Zizindikiro zitha kuperekedwa. M'chipatala, wodwalayo ayenera kuchitidwa hemodialysiskuchotsa mankhwalawo m'thupi.

Ndemanga za odwala za diformin od

Ndimagula pafupipafupi mapiritsi a Diaformin 850. Awa ndi mankhwala omwe odwala matenda ashuga amamwa. Amatengedwa osakanikirana ndi mankhwala ena pamene shuga yamagazi ili kwinakwake 8-10 mmol / l. Muyenera kumwa Diaformin tsiku lililonse ndi zakudya katatu patsiku. Mankhwala amagulitsa shuga bwino. Ndikudziwa anthu ambiri omwe amamwa mankhwala a Diaformin ndi Glucovans kwazaka zambiri. Amati mankhwalawo amawathandiza kwambiri. Mukamamwa, chilakolako chimakhala bwino. Ululu wamtima unachepa, ndipo odwala matenda oopsa amayambiranso kuthamanga. Ndipo mtengo wake siwokwera kwambiri. Ngati ndizofunikira, zitha kutengedwa.

Mnzanu amatenga "Diaformin." Poyamba ndimamva kuti awa ndi mankhwala oikidwa chifukwa cha matenda ashuga. Koma mzanga alibe matenda ashuga. Nditayamba kumufunsa chifukwa chomwe Diaformin adalembedwa, zidamuwoneka kuti mankhwalawa amatha kuledzera ndi kunenepa kwambiri. Anthu onenepa kwambiri amakhala ndi vuto la kulekerera shuga (prediabetes), ndipo Diaformin amatenga nawo mafuta owotcha, osati kutsika shuga wamagazi wokha. Kuphatikiza pa zakudya, zotsatira zake zimatchulidwa kwambiri. Pakupita mwezi umodzi atamwa mankhwalawo, kuchepa thupi kunayamba kuonekera, zolimbitsa thupi zinawonjezeka, kufooka kunatha.

Pharmacology

Oral hypoglycemic wothandizila kuchokera pagulu la Biguanides (dimethylbiguanide). Kupanga kwa zochita za metformin kumalumikizidwa ndi kuthekera kwake kuponderezera gluconeogeneis, komanso mapangidwe a mafuta achilengedwe omasuka ndi kukhatikiza kwa mafutawa. Zimawonjezera chidwi cha zotumphukira zolandilira ku insulin ndikugwiritsa ntchito shuga ndi maselo. Metformin siyimakhudzanso kuchuluka kwa insulin m'magazi, koma imasintha ma pharmacodynamics pochepetsa kuchuluka kwa insulini kuti imasulidwe ndikuwonjezera kuchuluka kwa insulin kuti proinsulin.

Metformin imalimbikitsa kapangidwe ka glycogen pochita glycogen synthetase. Kuchulukitsa kuchuluka kwa mayendedwe amtundu uliwonse wa ma membrane glucose. Kuchepetsa mayamwidwe m'matumbo.

Amachepetsa msana wa triglycerides, LDL, VLDL. Metformin imakweza michere yamagazi ya fibrinolytic mwa kuponderezana ndi minyewa yokhala ngati minofu ya plasminogen activator inhibitor.

Ngakhale mutamwa metformin, thupi la wodwalayo limakhalabe lolimba kapena limatsika pang'ono.

Kutulutsa Fomu

30 ma PC - matumba otumphuka (1) - mapaketi a makatoni.
30 ma PC - mapepala otumphukira (2) - mapaketi a makatoni.
30 ma PC - matumba otumphukira (3) - mapaketi a makatoni.

Amamwa pakamwa, panthawi ya chakudya kapena itatha.

Mlingo komanso kuchuluka kwa makonzedwe zimatengera mtundu womwe umagwiritsidwa ntchito.

Ndi monotherapy, muyeso umodzi woyamba wa akulu ndi 500 mg, kutengera mtundu womwe umagwiritsidwa ntchito, pafupipafupi makonzedwe ake ndi katatu kapena tsiku. Ndizotheka kugwiritsa ntchito 850 mg 1-2 nthawi / tsiku. Ngati ndi kotheka, mlingo umakulitsidwa pang'onopang'ono ndi sabata limodzi. mpaka 2-3 g / tsiku.

Ndi monotherapy ya ana azaka zapakati pa 10 ndi akulu, mlingo woyambayo ndi 500 mg kapena 850 1 nthawi / tsiku kapena 500 mg 2 nthawi / tsiku. Ngati ndi kotheka, ndi nthawi osachepera 1 sabata, muyezo mutha kuchuluka mpaka 2 g / tsiku mu Mlingo wa 2-3.

Pambuyo masiku 10-15, mlingo uyenera kusinthidwa kutengera zotsatira za kutsimikiza kwa shuga m'magazi.

Kuphatikiza mankhwala ndi insulin, mlingo woyambirira wa metformin ndi 500-850 mg katatu / tsiku. Mlingo wa insulin umasankhidwa malinga ndi zotsatira za kutsimikiza kwa shuga m'magazi.

Kuchita

Pogwiritsa ntchito munthawi yomweyo ndimomwe zimachokera ku sulfonylurea, acarbose, insulin, salicylates, ma inhibitors a MAO, oxytetracycline, zoletsa ACE, ndi clofibrate, cyclophosphamide, hypoglycemic zotsatira za metformin zimatha kupititsidwa patsogolo.

Pogwiritsa ntchito munthawi yomweyo ndi GCS, njira yolerera ya mahomoni pakugwiritsira ntchito pakamwa, danazol, epinephrine, glucagon, mahomoni a chithokomiro, zotuluka za phenothiazine, zotupa za thiazide, zotumphukira za nicotinic acid, kuchepa kwa mphamvu ya hypoglycemic ya metformin ndikotheka.

Odwala omwe amalandila metformin, kugwiritsidwa ntchito kwa ayodini okhala ndi zotsutsana poyerekeza ndi mayeso (kuphatikizapo intravenous urography, intravenous cholangiography, angiography, CT) kumawonjezera chiopsezo cha kusokonekera kwa impso ndi lactic acidosis. Izi kuphatikiza ndi zotsutsana.

Beta₂-adrenomimetics mu mawonekedwe a jakisoni amawonjezera kuchuluka kwa shuga m'magazi chifukwa cha kukondoweza kwa β₂-makampani. Poterepa, ndikofunikira kuwongolera kuchuluka kwa shuga m'magazi. Ngati ndi kotheka, tikulimbikitsidwa kupereka insulin.

Kugwiritsa ntchito cimetidine mozungulira kungakulitse chiopsezo cha lactic acidosis.

Kugwiritsa ntchito munthawi yomweyo mankhwala a "loop" okodzetsa kungayambitse kukula kwa lactic acidosis chifukwa chakulephera kugwira ntchito kwaimpso.

Yofanana makonzedwe ndi Mowa kumapangitsa ngozi lactic acidosis.

Nifedipine imachulukitsa mayamwidwe ndi C_max metformin.

Mankhwala a Cationic (amiloride, digoxin, morphine, procainamide, quinidine, quinine, ranitidine, triamteren, trimethoprim ndi vancomycin) omwe amatulutsidwa mu renal tubules kupikisana ndi metformin kwa machitidwe oyendetsa ma tubular ndipo angayambitse kuchuluka kwa C_max.

Malangizo apadera

Osatengera kuti wodwalayo ali ndi matenda a impso, milingo ya lactate iyenera kutsimikizidwa osachepera kawiri pachaka pochita ndi Diaformin. Zomwezi zikuyenera kuchitika ngati zilonda za minofu ziwoneka.

Ngati mukumwa chithandizo ndikofunikira kupita kukayezetsa wa radioisotope kapena X-ray, pomwe mungayankhe motsutsana ndi mankhwala ayodini, muyenera kusiya kumwa mankhwalawa masiku awiri njira yofufuzira isanachitike. Patatha masiku awiri itatha, chithandizo chitha kupitilizidwa.

Palibe kafukufuku wokwanira kuti anene kuti mankhwalawa ndi otetezeka komanso othandizira pochotsa ana, chifukwa chake sanakhazikitse ana ochepera zaka 10.

Pa mimba ndi mkaka wa m`mawere

Kugwiritsa ntchito panthawiyi sikumveka bwinobwino. Palibe zotsatira za teratogenic zomwe zapezeka, koma zimadziwika kuti metformin limalowa mwaulere chotchingira. Chifukwa chake, ndikofunikira kupereka mankhwala ngati njira yomaliza, pomwe chiopsezo ku thanzi la mayi chimaposa chiopsezo kwa mwana.

Ma Analogs akuphatikizapo:

Mtengo wa Diaformin komwe mugule

Mutha kugula Diaformin mu pharmacy wokhazikika, koma ndibwino kuyang'ana kupezeka pasadakhale. Mapiritsi amatula 60 rubles (phukusi la mapiritsi 30 a 500 mg aliyense) mpaka 300 ma ruble (phukusi la mapiritsi 60 a 1000 mg aliyense).

Mtengo wa mapiritsi ku Ukraine umachokera ku 50 hhucnias (30 zidutswa 500 mg aliyense) mpaka 180 h scrollnias (60 zidutswa za 1000 mg aliyense).

Mlingo

500 mg ndi mapiritsi a 850 mg

Piritsi limodzi lili:

yogwira mankhwala: metformin hydrochloride - 500 mg ndi 850 mg

zotupa: mapiritsi a 500 mg: mbatata wowuma, microcrystalline cellulose, povidone, polyethylene glycol (macrogol 4000), magnesium stearate,

Mapiritsi a 850 mg: mbatata wowuma, lactose monohydrate, cellcrystalline cellulose, povidone, polyethylene glycol (macrogol 4000), calcium stearate.

Mapiritsi a mawonekedwe ozungulira, okhala ndi cylindrical, oyera kapena pafupifupi oyera, okhala ndi bevel ndi notch (mulingo wa 500 mg)

Mapiritsi a Oblong, okhala ndi biconvex kumtunda, oyera kapena pafupifupi oyera, ali ndi chiopsezo kapena chosavulaza (pa mulingo wa 850 mg)

Njira yogwiritsira ntchito

Monotherapy kapena kuphatikiza mankhwalawa molumikizana ndi ena othandizira pakamwa.
Nthawi zambiri koyamba mlingo wa mankhwalawa Diaformin 500 mg kapena 850 mg 2-3 kawiri pa tsiku mukamadya kapena mutatha kudya.
Pambuyo masiku 10-15, mlingo uyenera kuchotsedwa malinga ndi zotsatira za muyeso wa glucose mu seramu yamagazi.
Kuchepetsa pang'onopang'ono kwa mlingo kumachepetsa mavuto kuchokera m'mimba.
Pochizira Mlingo wambiri, Diaformin imagwiritsidwa ntchito, mapiritsi okhala ndi mafilimu, 1000 mg aliyense.
Mlingo woyenera kwambiri ndi 3000 mg patsiku, womwe umagawidwa pazigawo zitatu.
Pofuna kusintha kuchokera ku mankhwala ena antidiabetes, ndikofunikira kusiya kumwa mankhwalawa ndikupereka Diaformin, monga tafotokozera pamwambapa.
Kuphatikiza mankhwala ndi insulin.
Kuti akwaniritse bwino kuchuluka kwa shuga m'magazi, metformin ndi insulin zitha kugwiritsidwa ntchito ngati mankhwala osakanikirana. Mwachizolowezi, mlingo woyambirira ndi 500 mg kapena 850 mg wa Diaformin katatu patsiku, pamene mlingo wa insulin uyenera kusankhidwa malinga ndi zotsatira za kuyeza shuga.
Ana.
Monotherapy kapena kuphatikiza mankhwala omwe ali ndi insulin.
Diaformin imagwiritsidwa ntchito mwa ana opitirira zaka 10. Nthawi zambiri, muyeso woyamba wa 500 mg kapena 850 mg wa Diaformin 1 nthawi patsiku panthawi kapena mukatha kudya. Pambuyo masiku 10-15, mlingo uyenera kuchotsedwa malinga ndi zotsatira za muyeso wa glucose mu seramu yamagazi.
Kuchepetsa pang'onopang'ono kwa mlingo kumachepetsa mavuto kuchokera m'mimba.
Mlingo woyenera kwambiri ndi 2000 mg patsiku, womwe umagawidwa mu 2-3 Mlingo.
Kwa odwala okalamba, kuchepa kwa ntchito yaimpso ndikotheka, chifukwa chake, mlingo wa metformin uyenera kusankhidwa malinga ndi kuwunika kwa impso, komwe kuyenera kuchitidwa pafupipafupi (onani gawo "Zogwiritsira ntchito").
Odwala aimpso kulephera. Diaformin itha kugwiritsidwa ntchito kwa odwala omwe amalephera kupweteka aimpso, gawo IIIa (creatinine clearance 45-59 ml / min kapena GFR 45-59 ml / min / 1.73 m2) pokhapokha ngati pali zovuta zina zomwe zingapangitse chiwopsezo cha lactic acidosis, kutsatiridwa kusintha kwa mlingo: koyamba mlingo ndi 500 mg kapena 850 mg 1 nthawi patsiku. Mlingo wapamwamba ndi 1000 mg patsiku, womwe umagawidwa pawiri. Kusanthula mosamala kwa impso kuyenera kuchitika miyezi itatu iliyonse ndi itatu.
Ngati kulengedwa kwa creatinine kapena GFR kutsika kufika pa 45 ml / mphindi kapena 45-59 ml / mphindi / 1,73 m2, Diaformin iyenera kuyimitsidwa nthawi yomweyo.
Ana. Diaformin itha kugwiritsidwa ntchito mwa ana opitilira zaka 10.

Mankhwala

Pharmacokinetics

Pambuyo pakulowetsa, metformin imatengedwa kuchokera m'matumbo am'mimba pafupifupi kwathunthu, 20-30% ya mankhwala imatsimikiza ndowe. Mtheradi bioavailability kuchokera 50 mpaka 60%. Ndi kuyamwa kwa munthawi yomweyo, kuyamwa kwa metformin kumachepa ndikuchepera.

Metformin imagawidwa mwachangu mu minofu, sikuti imagwira mapuloteni a plasma.

Metformin imapangidwa pang'ono ndikupukusidwa ndi impso.Kuvomerezeka kwa anthu athanzi ndi 440 ml / min (nthawi 4 kuposa creatinine), komwe kumawonetsa kubisalira kwa tubular secretion. Hafu ya moyo pafupifupi maola 9-12. Ndi kulephera kwa aimpso, zimachulukana, pamakhala chiopsezo cha kukopeka kwa mankhwalawa.

Mankhwala

Metformin imachepetsa hyperglycemia, sizitsogolera pakupanga hypoglycemia. Mosiyana ndi sulfonylurea, simalimbikitsa kubisalira kwa insulin ndipo sikuyambitsa vuto la hypoglycemic mwa anthu athanzi. Metformin imawonjezera chidwi cha zotumphukira zolandilira ku insulin komanso kugwiritsa ntchito shuga ndi minofu ya minofu. Amalepheretsa gluconeogenesis m'chiwindi. Imachedwetsa mayamwidwe am'mimba m'matumbo. Imakhala ndi phindu pa metabolidi ya lipid: imachepetsa zomwe zimakhala ndi cholesterol yathunthu, lipoproteins yotsika komanso triglycerides.

Kuyanjana kwa mankhwala osokoneza bongo

Ndi munthawi yomweyo kugwiritsa ntchito mankhwala Diaformin ndi danazole, kukula kwa zotsatira za hyperglycemic ndikotheka. Ngati mankhwala a danazol akufunika ndipo atayimitsa, kusintha kwa mlingo wa Diaformin kumafunika motsogozedwa ndi glycemia level.

Ndi munthawi yomweyo kugwiritsa ntchito mankhwala Diaformin wokhala ndi mankhwala osokoneza bongo a ethanol, chiopsezo chotenga lactic acidosis panthawi yoledzera ya mowa umachulukirachulukira, makamaka mukasala kudya kapena kutsatira zakudya zochepa zopatsa mphamvu, komanso ngati chiwindi chikulephera.

Chlorpromazine mu Mlingo wambiri (100 mg / tsiku) amachepetsa kutulutsa insulin ndikuwonjezera kuchuluka kwa shuga m'magazi. Pogwiritsa ntchito munthawi yomweyo ma antipsychotic ndipo atayimitsa makina awo, kusintha kwa Diaformin kumafunika motsogozedwa ndi msana wa glycemia. Glucocorticosteroids (wogwiritsa ntchito mwa zonse komanso zodalirika) amachepetsa kulolera kwa shuga ndikuwonjezera kuchuluka kwa shuga m'magazi ena amachititsa ketosis. Ngati ndi kotheka kugwiritsa ntchito kuphatikiza koteroko ngakhale mutatsiriza glucocorticosteroid makonzedwe, kusintha kwa Diaformin kumafunika motsogozedwa ndi shuga m'magazi.

Pogwiritsa ntchito munthawi yomweyo "loop" diuretics ndi Diaformin, pamakhala chiopsezo cha lactic acidosis chifukwa chowoneka ngati kulephera kwaimpso. Diaformin sayenera kutumizidwa ngati kuvomerezeka kwa creatinine

Zolemba zogwiritsira ntchito

Lactic acidosis chosowa kwambiri, koma chowopsa cha metabolic (chiwopsezo chachikulu cha kufa pakalibe chithandizo chamankhwala mwadzidzidzi), chomwe chingachitike chifukwa chophatikizidwa ndi metformin. Nkhani za lactic acidosis zidanenedwa kwa odwala omwe ali ndi matenda osokoneza bongo omwe ali ndi vuto la impso kapena lakuthwa muimpso.

Zina mwamagetsi ziyenera kuganiziridwanso kuti mupewe kukula kwa lactic acidosis: matenda osokoneza bongo omwe samayendetsa bwino, ketosis, kusala kudya kwa nthawi yayitali, kumwa kwambiri mowa, kulephera kwa chiwindi, kapena vuto lililonse lomwe lingakhale ndi hypoxia (mtima wosaloleka, kupunduka kwamtima).

Lactic acidosis imatha kuwoneka ngati kukokana minofu, kudzimbidwa, kupweteka kwam'mimba komanso asthenia yayikulu. Odwala ayenera kudziwitsa dokotala nthawi yomweyo zomwe zimachitika, makamaka ngati odwala adalekerera kale kugwiritsa ntchito metformin. Zikatero, ndikofunikira kusiya kugwiritsa ntchito metformin mpaka izi zitamveka bwino. Mankhwala a Metformin amayenera kuyambiridwanso pambuyo powunikira phindu / chiopsezo pazochitika zina ndikuwunika ntchito ya impso.

Zizindikiro . Lactic acidosis imadziwika ndi kufupika kwa acidic, kupweteka kwam'mimba komanso hypothermia, kupititsa patsogolo kukoma mtima kumatha. Zizindikiro zakuzindikira zimaphatikizapo kuchepa kwa labot mu magazi pH, kuwonjezeka kwa kuchuluka kwa lactate mu seramu yamagazi pamwamba pa 5 mmol / l, kuwonjezeka kwa kusiyana kwa anion ndi chiŵerengero cha lactate / pyruvate. Pankhani ya kukula kwa lactic acidosis, ndikofunikira kuchipatala wodwala nthawi yomweyo (onani gawo "Overdose"). Dokotala ayenera kuchenjeza odwala za chiopsezo chokhala ndi lactic acidosis.

Kulephera kwina . Popeza metformin imachotsedwa impso, kale komanso nthawi zonse mukamalandira chithandizo ndi Diaformin ®, ndikofunikira kuyang'ana kuchuluka kwa creatinine (kungayesedwe ndi kuchuluka kwa plasma creatinine wogwiritsa ntchito njira ya Cockcroft-Gault) kapena GFR:

• odwala aonekera aimpso ntchito osachepera 1 pachaka,
• Odwala a creatinine chilolezo cha m'munsi mwa odwala wamba ndi okalamba osachepera 2-4 pachaka.

Ngati creatinine chilolezo ndi 2), metformin imatsutsana (onani gawo "Contraindication").

Kuchepetsa aimpso odwala okalamba ndizofala komanso asymptomatic. Chenjezo liyenera kuchitika pakakhala vuto la impso, mwachitsanzo, ngati magazi atha kapena kumayambiriro kwa chithandizo cha mankhwala a antihypertensive, okodzetsa, komanso kumayambiriro kwa mankhwala a NSAID. Zikatero, timalimbikitsidwanso kuyang'anira ntchito ya impso musanayambe chithandizo ndi metformin.

Ntchito yamtima . Odwala omwe ali ndi vuto la mtima ali ndi chiopsezo chachikulu chokhala ndi hypoxia komanso kulephera kwa impso. Odwala omwe ali ndi vuto la mtima wosakhazikika, metformin itha kugwiritsidwa ntchito poyang'anira mtima ndi ntchito yaimpso. Metformin imaphatikizidwa kwa odwala omwe ali ndi vuto la mtima komanso losakhazikika (onani gawo "Contraindication").

Ma ayodini okhala ndi ayodini . Kugwiritsa ntchito kwaukadaulo kwa ma radiopaque othandizira pophunzira ma radiology kungayambitse kulephera kwa impso ndipo, monga chotulukapo, kumayambitsa kuphatikizidwa kwa metformin komanso chiwopsezo cha lactic acidosis. Odwala omwe ali ndi GFR> 60 ml / mphindi / 1.73 m 2, kugwiritsa ntchito metformin kuyenera kuyimitsidwa isanachitike kapena mkati mwaphunziroli ndipo osayambiranso kale patatha maola 48 pambuyo phunziroli komanso pokhapokha kuwunikanso ntchito ya impso ndikutsimikizira kuti kulibe kuwonongeka kwina kwa impso (onani. gawo "Kuyanjana ndi mankhwala ena ndi mitundu ina (mogwirizana)".

Odwala omwe amalephera kupweteka aimpso (GFR 45-60 ml / mphindi / 1.73 m 2) ayenera kusiya kugwiritsa ntchito Metformin maola 48 asanagwiritse ntchito ma ayodini okhala ndi ayodini ndipo sayenera kuyambiranso kumayambiriro maola 48 mutatha kafukufukuyo komanso ngati atayambiranso ntchito ya aimpso ndi chitsimikizo cha kusowa kwa kuwonongeka kwa aimpso (onani "Kuyanjana ndi mankhwala ena ndi mitundu ina yoyanjana").

Opaleshoni . Ndikofunikira kusiya kugwiritsa ntchito Diaformin ® maola 48 asanafike kuchitidwe opaleshoni yomwe idakonzedwa, yomwe imachitika pansi paano, msana kapena opaleshoni yotsitsa ndipo osayambiranso kale kuposa maola 48 atachitidwa opaleshoni kapena kubwezeretsanso zakudya zam'kamwa kokha ngati ntchito yokhazikika ya aimpso yakhazikitsidwa.

Ana . Musanayambe chithandizo ndi metformin, kuwunika kwa mtundu wachiwiri wa shuga kuyenera kutsimikiziridwa. Malinga ndi zotsatira za kafukufuku wazachipatala wa chaka chimodzi, zotsatira za metformin pa kukula ndi kutha kwa ana sizinawululidwe. Komabe, palibe chidziwitso pazotsatira za kukula kwaformform komanso kutha msinkhu pogwiritsa ntchito Diaformin ®, chifukwa chake, kuwunikira mosamala magawo awa kwa ana omwe amathandizidwa ndi metformin, makamaka panthawi yakutha, akulimbikitsidwa.

Ana azaka zapakati pa 10 mpaka 12. Malinga ndi zotsatira za kafukufuku wazachipatala, kuyendetsa bwino komanso chitetezo m'gululi sizinasiyane ndi zomwe zimachitika mwa ana okulirapo. Mankhwala ayenera kuikidwa mosamala kwa ana azaka zapakati pa 10 mpaka 12.

Njira zina . Odwala ayenera kutsatira zakudya, kudya yunifolomu yanga tsiku lonse. Odwala onenepa kwambiri ayenera kupitiliza kutsatira zakudya zamafuta ochepa. Ndikofunikira kuyang'anira pafupipafupi zizindikiro za kagayidwe kazakudya.

Monotherapy yokhala ndi metformin sikuti imayambitsa hypoglycemia, koma kusamala kuyenera kuchitika pamene kugwiritsa ntchito Diaformin ® ndi insulin kapena othandizira ena pakamwa (mwachitsanzo, sulfonylureas kapena meglitinide) angakulitse mphamvu ya hypoglycemic.

Gwiritsani ntchito pa nthawi yoyembekezera kapena mkaka wa m'mawere.

Mimba Matenda osagwirizana ndi matenda a shuga panthawi yomwe ali ndi pakati (gestational kapena kulimbikira) amawonjezera mwayi wokhala ndi vuto lobadwa nalo komanso kufa kwa perinatal.

Kuyamwitsa. Metformin imachotsedwa mkaka wa m'mawere, koma palibe zotsatira zoyipa zomwe zimawonedwa mu neonates / makanda omwe adayamwa. Komabe, popeza palibe chidziwitso chokwanira pa mankhwalawa, kuyamwitsa sikulimbikitsidwa pakuchiritsidwa ndi Diaformin ®. Lingaliro loletsa kuyamwitsa liyenera kuganiziridwapo zabwino za kuyamwitsa ndi chiopsezo cha zovuta zoyamwitsa khanda.

Chonde . Metformin sizinakhudze chonde nyama ikagwiritsidwa ntchito mu Mlingo wa 600 mg / kg / tsiku, lomwe linali lokwera pafupifupi katatu kuposa kuchuluka kwa tsiku lililonse kwa anthu chifukwa cha thupi.

Kutha kukopa momwe zinthu zikuyendera mukamayendetsa magalimoto kapena njila zina.

Diaformin ® siyimakhudzanso kuchuluka kwa zimachitika mukamayendetsa kapena kugwiritsa ntchito njira zina, popeza monotherapy ndimankhwala samayambitsa hypoglycemia.

Komabe, metformin iyenera kugwiritsidwa ntchito mosamala kuphatikiza ena othandizira a hypoglycemic (sulfonylureas, insulin, kapena meglitinides) chifukwa choopsa cha hypoglycemia.

Zotsatira zoyipa

Metabolism: lactic acidosis.

Pogwiritsa ntchito mankhwalawa kwanthawi yayitali, mayamwidwe a vitamini B akhoza kuchepa ₁₂ , yomwe imayendetsedwa ndi kuchepa kwa mulingo wake mu seramu yamagazi. Ndikulimbikitsidwa kuti kuganiziridwa motere kungachitike chifukwa cha hypovitaminosis B. ₁₂ ngati wodwalayo ali ndi meWIblastic anemia.

Kuchokera ku dongosolo lamanjenje: kulakwira.

Kuchokera mmimba: kusokonezeka kwam'mimba, monga mseru, kusanza, kutsegula m'mimba, kupweteka kwam'mimba, kusowa kudya. Nthawi zambiri, zoyipa izi zimachitika poyambira chithandizo ndipo nthawi zambiri zimazimiririka zokha. Popewa kupezeka kwa zoyipa m'mimba, timalimbikitsidwa kuti muchepetse ntchito pang'onopang'ono ndi kugwiritsidwa ntchito kwa mankhwalawa panthawi ya chakudya kapena itatha.

Kuchokera m'mimba: kuphwanya chiwonetsero cha chiwindi kapena hepatitis, yomwe imazimiririka pambuyo pakutha kwa metformin.

Pa khungu ndi subcutaneous minofu: zimachitika pakhungu, kuphatikizapo erythema, pruritus, urticaria.