Mankhwalawa amapezeka pokhapokha piritsi. Mapiritsiwo akhoza kukhala ndi mtundu wina. Zimatengera kuzunzika kwa gulu lomwe limagwira ndi utoto mkati mwawo. Amakutidwa ndi chipolopolo chapadera.

Piritsi limodzi lili ndi 2.5 mg ya saxagliptin ndi 500 kapena 1000 mg ya metformin hydrochloride. Mapiritsiwo amakhala ndi mawonekedwe a convex oblong. Kutengera ndi kuchuluka kwa metformin, amatha kukhala ndi mtundu wa bulauni, pinki kapena wachikaso. Kumbali zonse ziwiri ndizotsatsira zomwe zimapangidwa ndi inki wabuluu. Zothandiza monga: carmellose sodium, magnesium stearate ndi cellulose.

Mankhwalawa amapezeka pokhapokha piritsi.

Mapiritsiwo ali m'matumba apadera oteteza 7 ma PC. m'modzi aliyense. Phukusi la makatoni limakhala ndi matuza anayi ndi malangizo onse oti mugwiritse ntchito.

Zotsatira za pharmacological

Mankhwalawa amaphatikizika pazomwe zimapangidwa ndi 2 yogwira mankhwala. Izi zimapangitsa kukhala chida chachilengedwe pothandizira matenda a shuga a 2. Saxagliptin imagwira ntchito ngati choletsa, ndikuthandizira pakupanga zida za peptide, ndipo Metformin ndi m'gulu la Biguanides. Ma metabolites omwe amagwira ntchito amasulidwa muzisinthidwe zosiyanasiyana.

Metformin imatha kuchepetsa gluconeogeneis. Mafuta oxidation amasiya, ndipo insulin chiwopsezo chimakula kwambiri. Kugwiritsa ntchito shuga m'magazi kumathamanga. Mothandizidwa ndi Metformin, kuphatikiza glycogen kumatheka. Shuga amayamba kumizidwa pang'onopang'ono mu ziwalo zam'mimba, zomwe zimapangitsa kuti achepetse thupi kwambiri.

Saxagliptin imalimbikitsa kutulutsa insulin mwachangu kuchokera ku ma cell a pancreatic beta. Njira imeneyi imatengera kuchuluka kwa shuga m'magazi am'magazi. Glucagon secretion amachepetsa, zomwe zimalepheretsa kuchuluka kwa shuga m'zipangidwe zina za chiwindi. Saxagliptin imathandizira kuchepetsa kukangika kwa mahomoni enaake, ma insretin. Nthawi yomweyo, mulingo wawo m'magazi umakwera, ndipo kuchuluka kwa shuga pamimba yopanda kanthu kumatsika pambuyo pa chakudya chachikulu.

Pharmacokinetics

Saxagliptin nthawi zonse amasinthidwa kukhala metabolite. Metformin, ngakhale utasefedwa bwino mu impso tubules, umachotsedwa m'thupi m'njira zosasinthika. Pazinthu zambiri pazogwira ntchito zimawonedwa maola 6 mutatha kumwa mapiritsi.

Metformin, ngakhale utasefedwa bwino mu impso tubules, umachotsedwa m'thupi m'njira zosasinthika.

Contraindication

Siligwiritsidwa ntchito pochiza matenda amishuga a mtundu woyamba 1, komanso pachitukuko cha matenda ashuga a ketoacidosis, chifukwa mukakhala kuti mankhwalawa sakhala ndi vuto lofunika kwambiri.

Kuphatikiza apo, pali zovuta zingapo zotsutsana pamankhwala omwe timamwa:

kusokonezeka kwa matenda a impso,
lactic acidosis,
lactose tsankho ndi ntchito zochizira waukulu Mlingo wa insulin,
mtima
zamanjenje, septicemia,
pachimake myocardial infaration,
Hypersensitivity yogwira mankhwala
pachimake komanso matenda metabolic acidosis,
wazaka 18
Zakudya zochepa zopatsa mphamvu
mimba ndi kuyamwa,
ntchito mankhwalawa okhala ndi ayodini omwe angayambitse kukula kwa impso.

Comboglyz ndi contraindicated kuphwanya yachibadwa aimpso ntchito.
Comboglis imatsutsana ndi vuto la mtima.
Comboglyz ndi contraindicated mu pachimake myocardial infarction.
Comboglyz imaphatikizidwa muzakudya zopatsa mphamvu zochepa.

Zotsutsana zonsezi ndizowona. Nthawi zambiri, ndi ma pathologies oterewa, insulin imagwiritsidwa ntchito pochiza matenda ashuga.

Kodi kutenga combogliz?

Pankhani yogwiritsa ntchito mankhwala a antiglycemic, mlingo wa Combogliz uyenera kutumikiridwa aliyense wodwala, kutengera mtundu wa thanzi. Mankhwala tikulimbikitsidwa kuti amwe madzulo, bwino ndi chakudya. Kukula kwa mlingo umodzi wa Saxagliptin sikuyenera kupitirira 2,5 mg kapena kwa 5 mg wamkulu patsiku.

Ndikofunika kumeza miyala yonse osatafuna. Iyenera kutsukidwa ndi madzi ambiri owiritsa.

Mukaphatikizidwa ndikugwiritsa ntchito mobwerezabwereza ndi cytochrome isoenzymes, mlingo womwe umalimbikitsa ndi piritsi limodzi la 2,5 mg patsiku.

Ndikofunika kumeza miyala yonse osatafuna.

Zotsatira zoyipa za Comboglize

Odwala nthawi zambiri amawona kukula kosakhudzidwa kosafunikira:

mutu, mpaka kuwoneka pafupipafupi migraine.
Zizindikiro za kuledzera, kuwonetsa mseru, kusanza komanso kutsegula m'mimba kwambiri,
kukoka kupweteka pamimba
zovuta zamkati mwa kwamikodzo,
kutupa kwa nkhope ndi miyendo,
kufooka kwa mafupa kumawonjezeka, motero, izi zimapangitsanso chiwopsezo cha fractures mutatenga Saksagliptin (kusanthula kwa gulu kuchokera ku 2.5 mpaka 10 mg) ndi placebo,
achina,
matupi awo sagwirizana ndi zotupa pakhungu ndi urticaria,
chisangalalo
Kuphwanya makonda azinthu zina ndizotheka.

Odwala nthawi zambiri amawona kukula kwa zovuta zosafunikira mwanjira ya mutu.
Odwala nthawi zambiri amawona kukula kwa zovuta pazoyipa zamkati mwa mawonekedwe achisangalalo.
Odwala nthawi zambiri amawona kukula kosakhudzidwa kosakhudzana ndi mseru.

Zizindikiro zotere ziyenera kutha kwathunthu pambuyo kusintha kwa mankhwalawo kapena kusiya mankhwala kwathunthu. Ngati zizindikiro za kuledzera zikhalabe, chithandizochi chitha kukhala chofunikira.

Malangizo apadera

Mukamamwa mankhwalawa, ndikofunikira kuyesedwa kuti muone kusintha kwa impso. Pali chiopsezo chachikulu cha lactic acidosis. Izi zimachitika makamaka kwa okalamba.

Mukamagwiritsa ntchito Saksagliptin, kuchepa kwa mankhwalawa kwa kuchuluka kwa ma lymphocyte kumatha kuchitika. Zotsatira zake zimawonedwa pakumwa mlingo wa 5 mg mu regimen yoyambirira ndi Metformin poyerekeza ndi monotherapy ndi Metformin yokha.

Gwiritsani ntchito pa nthawi yoyembekezera komanso mkaka wa m`mawere

Sitikulimbikitsidwa kutenga nthawi yakubala. Masiku ano, palibe kafukufuku wosakwanira ngati mapiritsi ali ndi mphamvu iliyonse pa mwana wosabadwayo. Chithandizo cha mankhwalawa chimatha kuthandizira kuonekera kwa zonyansa za fetal komanso kukula kwakanthawi. Ngati ndi kotheka, amayi onse apakati amasamutsidwa kupita ku chithandizo cha insulin pamtengo wotsika.

Iwo ali osavomerezeka kumwa mankhwala munthawi ya bere.

Palibe zambiri zodalirika ngati mankhwalawa amatha kudutsa mkaka wa m'mawere. Chifukwa chake, akatswiri amalangiza kuti asiye kuyamwa.

Gwiritsani ntchito mu ukalamba

Ndi chisamaliro chapadera, mankhwalawa amaperekedwa kwa okalamba. Ali ndi chiopsezo chowonjezeka pamavuto osiyanasiyana, chifukwa chake, kuyang'anira nthawi zonse zaumoyo wa akatswiri ndi endocrinologist kumafunika. Ngati pakufunika izi, ndiye kuti mlingowo umachepetsedwa wotsika kwambiri, pomwe njira zochiritsira zabwino zimakwaniritsidwa. Kuti apange kuchitapo kwa placebo, mavitamini owonjezera amalembedwa kwa odwala ena okalamba, makamaka omwe ali ndi vuto la m'maganizo.

The ntchito aimpso kuwonongeka

Pali chiwopsezo chowonjezeka cha metabolic acidosis yogwiritsidwa ntchito nthawi yayitali. Ndikwabwino kwa odwala omwe ali ndi vuto laimpso kulephera kuchepetsa mlingo wochepa kapena kukana kumwa mankhwalawo.

Ndi koletsedwa kutenga odwala omwe ali ndi vuto la chiwindi.

Kuchuluka kwa Comboglize

Mankhwalawa amaloledwa ndi odwala. Pali milandu yambiri ya bongo. Pokhapokha mwadzidzidzi makonzedwe a mlingo waukulu ndi momwe maonekedwe ena angapangire kukula kwa lactic acidosis. Chodziwika pakati pawo:

mavuto ndi kupuma dongosolo
kutopa ndi kukwiya kwambiri,
minofu kukokana
kupweteka kwambiri pamimba
mawonekedwe akununkhira kwa acetone kuchokera mkamwa.

Pankhaniyi, chapamimba kapena hemodialysis chingathandize. Ndi hypoglycemia yofatsa, amalimbikitsidwa kuti azidya zotsekemera kapena kumwa tiyi wokoma.

Kuchita ndi mankhwala ena

Kugwiritsa ntchito pamodzi kwa Comboglize ndi mankhwala ena kungathandize kuwonjezera plasma wozungulira lactate. Mankhwalawa ndi monga:

Kukonzekera kwa magnesium
Nicotinic acid
Rifampicin,
okodzetsa
Isoniazid,
mahomoni a chithokomiro,
calcium tubule blockers,
estrogens.

Kugwiritsa ntchito pamodzi kwa Comboglize ndi Nicotinic acid kumatha kukulitsa plasma ndende ya lactate.
Kuphatikiza kwa Combogliz ndi Rifampicin kungakulitse kuchuluka kwa plasma.
Kuphatikiza kwa Comboglize ndi okodzetsa kumawonjezera plasma ndende ya lactate.

Kuphatikizika ndi Pioglitazone sikukukhudza pharmacokinetics a Saxagliptin. Kuphatikiza apo, kuphatikiza ndi kugwiritsidwa ntchito kamodzi kwa Saksagliptin, ndiye kuti patatha maola atatu 40 mg wa Famotidine, mawonekedwe azamankhwala nawonso sasintha.

Mukamatenga Combogliz, kugwiritsa ntchito ndalama mwanjira imeneyi kumatha kuchepa:

Fluconazole
Erythromycin,
Ketoconazole,
Furosemide
Verapamil
Mowa.

Ngati wodwala amatenga chimodzi mwazomwe zalembedwa, ndiye kuti muyenera kudziwitsa dokotala.

Kuyenderana ndi mowa

Mowa umaletsedwa kwa odwala omwe ali ndi matenda osokoneza bongo. Zimathanso kukhudzidwa kwa mankhwalawa.

Njira zomwe zimasiyana pakapangidwe kake, koma ndizofanana kofanana mu njira zochizira:

Kutalika kwa Combogliz,
Bagomet,
Janumet
Galvus Met,
Glibomet.

Analogue ya Combogliz ndi Bagomet.
Analogue ya Comboglize ndi Glybomet.
Analogue ya Comboglize ndi Yanumet.

Musanayambe kulandira chithandizo chamankhwala, muyenera kuwerenga mosamala malangizo a mankhwalawo chifukwa aliyense wa iwo atha kukhala ndi zotsutsana zambiri. Kuphatikiza apo, mlingo wa mankhwalawo ndi wosiyana.

Zosungidwa zamankhwala

Sungani pamalo pomwe sipangachitike dzuwa. Kutentha kosungirako - chipinda. Mankhwalawa ayenera kukhala pamalo owuma komanso otetezedwa kwa ana ang'ono momwe angathere.

Mankhwala angagulidwe ku pharmacy ndi mankhwala.

Ndemanga za Comboglize

Stanislav, wazaka 44, dokotala wa matenda ashuga, St. Petersburg: "Ndakhala ndikugwiritsa ntchito mankhwalawa kwa nthawi yayitali machitidwe anga. Zotsatira zake zimakhala zabwino. Mulingo wa shuga m'magazi omwe ali ndi mtundu wachiwiri wa matenda osokoneza bongo amatsika pambuyo pa maphunziro. "Zimatenga ndalama zochepa kuposa nthawi yayitali, koma mphamvu zake zimakhala zofanana, kapangidwe kake kamafanana. Odwala ena amakhala ndi vuto la urticaria. Koma zonse zimachoka mwachangu. Chifukwa chake, ndimalimbikitsa mankhwalawa kwa odwala anga onse."

Varvara, wazaka 46, wodwala matenda am'madzi, a Penza: "Ndinkakonda kundipatsa mankhwala kuti magazi anga akhale ngati ali ndimagazi. Koma panali ndemanga zambiri zoyipa kuchokera kwa odwala. Izi zimachitika chifukwa choti nthawi zambiri zimachitika zovuta. Odwala amakafika kuchipatala ali ndi zoopsa. Zikatero, muyenera kuletsa mankhwalawo ndikuganiza zolocha m'malo mwake. Chifukwa chake, ndikulimbikitsa kuti odwala ayambe ndi mlingo wotsika kwambiri kuti ayang'anire momwe thupi lilili.

Valery, wazaka 38, ku Moscow: "Adalemba mapiritsi ndi endocrinologist. Ndili ndi matenda a shuga a mtundu wachiwiri. Matenda a shuga adabweranso mwachangu. Mfundozi zidapitilira kwakanthawi pambuyo pakutha kwa chithandizo chamankhwala. M'masiku oyambirirawo ndidadwala matenda ambiri. Zonse zapita, mphamvu ya mankhwalawo yayamba kuchuluka. Mankhwalawa ndiokwera mtengo pang'ono. "

Andrei, wazaka 47, Rostov-on-Don: "Mankhwalawa sanakwanitse. Patatha piritsi loyamba ndinayamba kumva kupweteka. Nditayamba kusanza, mutu sunayime kwa nthawi yayitali. Ndinayenera kukaonana ndi dokotala. Anawauza kuti azidonthetsa anthu. Zonse zitatha kukhala zabwinobwino, mankhwala okhudzana ndi mankhwalawo adawerengedwa, komanso pambuyo pake panali zovuta zoyipa zoledzera. Kuphatikiza apo, zotupa zoyipa zimatuluka pakhungu. Chifukwa chake, Insulin idalembedwa. "

Julia, wazaka 43, Saratov: "Ndikhutira ndi momwe mankhwalawo amathandizira. Sewero la shuga linayambiranso kuyenda bwino.

Gulu la mankhwala

Mankhwala a Oral hypoglycemic. Dipeptidyl peptidase inhibitor (DPP-4 inhibitor). Nambala ya PBX A10B N.

Kuphatikiza pa kadyedwe ndi masewera olimbitsa thupi kuti muthandizire kulamulira kwa glycemic mwa odwala akuluakulu omwe ali ndi matenda amtundu II, ngati chithandizo ndi saxagliptin ndi metformin ndichoyenera.

Mlingo ndi makonzedwe

Ndi mankhwala a antihyperglycemic, mlingo wa Comboglyz XR uyenera kutumikiridwa payekhapayekha, kutengera mtundu wa chithandizo chomwe wodwalayo ali nawo, kugwiranso ntchito kwake komanso kulolera, ndipo sayenera kupitilira muyeso wokwanira wa 5 mg metformin wokhazikika wotulutsidwa 2000 mg. Monga lamulo, kukonzekera kwa Combogliz XR kuyenera kugwiritsidwa ntchito kamodzi patsiku, madzulo, pakudya, pang'onopang'ono kuwonjezeka kwa mankhwalawa kuti muchepetse mavuto kuchokera m'matumbo omwe amaphatikizidwa ndi ntchito ya metformin.

Ngati mankhwala omwe ali ndi mankhwala osakaniza omwe ali ndi saxagliptin ndi metformin amawona kuti ndioyenera, mlingo woyenera wa saxagliptin ndi 2.5 mg kapena 5 mg kamodzi patsiku.

Mankhwala oyamba a metformin hydrochloride okhazikika ndi 500 mg kamodzi patsiku, omwe amathanso kukhala a 2000 mg kamodzi patsiku. Mlingo waukulu wa Comboglyz XR - Saxagliptin 5 mg / Metformin Sustain Release 2000 mg umagwiritsidwa ntchito ngati mapiritsi awiri a 2,5 mg / 1000 mg kamodzi patsiku.

Palibe maphunziro apadera omwe amafufuza za chitetezo ndi mphamvu ya Combogliz XR mwa odwala omwe adachitidwapo kale ndi othandizira ena a antihyperglycemic, ndikusamutsidwa ku Combogliz XR. Kusintha kulikonse kwamankhwala a shuga II kuyenera kuchitidwa mosamala komanso kuyang'aniridwa pafupipafupi, chifukwa pakhoza kukhala kusintha pakulamulira kwa glycemic.

Mapiritsi a Comboglyz XR ayenera kumezedwa lonse koma osaphwanyika, opsinjidwa kapena kutafuna. Nthawi zina zida zosagwira za Combogliz XR mu ndowe zimatha kuwoneka ngati chofewa, chonyowa chomwe chimafanana ndi cholembera choyambirira.

Olimba CYP3A4 / 5 zoletsa.

Mukamagwiritsidwa ntchito ndi potent cytochrome P450 3A4 / 5 inhibitors (CYP3A4 / 5) (mwachitsanzo, ketoconazole, atazanavir, clarithromycin, indinavir, itraconazole, nefazodone, nelfinavir, ritonavir, saquinavir ndi tlithromicin tlitrominininukinicinupinicinupitin .

Zotsatira zoyipa

Monotherapy ndi adjunctive kuphatikiza mankhwala

Zotsatira zoyipa kwambiri (kutukuka kwa zomwe zanenedwa mwa odwala osachepera 2 omwe amalandila saxagliptin pa 2,5 mg, kapena odwala osachepera 2 omwe amalandila saxagliptin pa mlingo wa 5 mg) wokhudzana ndi kuchoka kwachangu kwa mankhwalawa anali lymphopenia (0,1% ndi 0,5% motsutsana 0%, motero), totupa (0,2% ndi 0,3% motsutsana ndi 0,3%), magazi okwera aininine (0,3% ndi 0). % motsutsana 0%) ndi kuchuluka kwa CPK m'magazi (0,1% ndi 0,2% motsutsana 0%).

Odwala omwe amalandila saxagliptin pa 2,5 mg, kupweteka kwamutu (6.5%) anali njira yokhayo yomwe imanenedwa pafupipafupi ndi ³5% ndipo nthawi zambiri kuposa momwe odwala amalandirira placebo.

Zotsatira zoyipa zomwe zimafotokozedwa mu ³2% ya odwala omwe amalandila saxagliptin pa 2,5 mg saxagliptin pa 5 mg, ndipo ³1% pafupipafupi kuposa placebo, amaphatikiza sinusitis (2.9% ndi 2.6% motsutsana 1) , 6%, motero), kupweteka kwam'mimba (2.4% ndi 1.7% motsutsana ndi 0.5%), gastroenteritis (1.9% ndi 2.3% motsutsana ndi 0.9%) ndi kusanza (2.2) % ndi 2.3% motsutsana 1.3%).

Pafupipafupi fractures anali 1 ndi 0,6 pa 100 zaka-odwala, motero, saxagliptin (kuphatikiza mlingo wa 2,5 mg, 5 mg ndi 10 mg) ndi placebo. Pafupipafupi fractures kwa odwala omwe amathandizidwa ndi saxagliptin sizinawonjezeke pakapita nthawi. Chiyanjano cha causal sichinakhazikitsidwe, ndipo kafukufuku wamakedzana sanawonetse zoyipa za saxagliptin pamafupa.

Chodabwitsa monga thrombocytopenia, chomwe chimagwirizana ndi matenda a idiopathic thrombocytopenic purpura, chinawonedwa pa pulogalamu yofufuza zamankhwala.

Zotsatira zoyipa zomwe zimakhudzana ndi saxagliptin omwe amagwiritsidwa ntchito ndi metformin odwala omwe ali ndi matenda amtundu wa II omwe sanalandire chithandizo

Odwala omwe amalandila chithandizo chophatikizika ndi saxagliptin ndi metformin, monga adjunct kapena ngati mankhwala oyambitsidwa koyambirira, kutsegula m'mimba kunali chokhacho cha m'mimba chomwe chimachitika mu ≥5% ya odwala m'gulu lililonse lazithandizo. Zomwe zimayambitsa matenda otsegula m'mimba zinali 9.9%, 5.8%, ndi 11.2% pagulu lomwe limalandira saxagliptin pa mlingo wa 2,5 mg, 5 mg ndi gulu la placebo, motero, panthawi yophunzira ndi kuwonjezera kwa saxagliptin kuti metformin. Pafupipafupi panali 6.9% ndi 7.3% m'magulu omwe amalandila 5 mg saxagliptin kuphatikiza metformin ndi metformin monotherapy pophunzira njira zoyambirira zophatikiza pogwiritsa ntchito metformin.

Zambiri pazotsatira zoyipa "hypoglycemia" zidakhazikitsidwa pamipanda yonse ya hypoglycemia. Kuyeza kwa munthawi yomweyo kuchuluka kwa shuga sikunali kofunikira. Chiwopsezo cha hypoglycemia chinali 3,4% mwa odwala omwe sanadziwe zamankhwala omwe amapatsidwa saxagliptin pa mlingo wa 5 mg kuphatikiza metformin, ndi 4.0% mwa odwala omwe amalandila metformin monotherapy.

Hypersensitivity zimachitika

Zotsatira zoyipa zotere za urticaria ndi edema ya nkhope zimadziwika kuti 1.5%, 1.5% ndi 0,4% ya odwala omwe amalandila saxagliptin pa 2,5 mg, saxagliptin pa mlingo wa 5 mg ndi placebo, motero. Palibe aliyense mwa odwala omwe ali ndi vutoli omwe amafuna kuti agonekere kuchipatala, ndipo palibe omwe adanenedwa kuti anali pangozi.

Zizindikiro zazikulu za dziko lamthupi

Odwala omwe amalandila monotherapy ndi saxagliptin kapena mankhwala osakanikirana ndi metformin, kusintha kwakukulu mwatsatanetsatane kwamayendedwe a thupi sikunawonedwe.

Zotsatira zoyipa zomwe zimachitika kawirikawiri m'maphunziro zidanenedwa pakukula kwa> 5% ya odwala omwe amalandiridwa ndi metformin okhazikika amasulidwe a hydrochloride, ndipo nthawi zambiri kuposa odwala a placebo, anali ndi matenda am'mimba komanso kusanza.

Chiwerengero chonse cha ma lymphocyte

M'maphunziro azachipatala, kuchuluka kwa ma laboratre kupatuka kwazinthu kunali kofanana kwa odwala omwe amatenga saxagliptin pa mlingo wa 5 mg ndi iwo omwe akukonzekera.

Saxagliptin sanawonetse mphamvu yayikulu kapena yolimba pang'onopang'ono chifukwa cha kupatsidwa zinthu za m'mwazi.

Mankhwala a Vitamini Otsika ₁₂ mu seramu, popanda mawonetseredwe azachipatala, adawonedwa pafupifupi 7% ya odwala.

Gwiritsani ntchito pa nthawi yoyembekezera kapena mkaka wa m'mawere

Palibe deta yokwanira yogwiritsira ntchito mankhwalawa amayi apakati.

Mankhwala sayenera kugwiritsidwa ntchito panthawi yomwe muli ndi pakati.

Ngati ndi kotheka, chithandizo chiyenera kusiya kuyamwitsa.

Chitetezo ndikuwoneka bwino kwa Combogliz XR mu odwala aang'ono sichinakhazikitsidwe.

Zolemba zogwiritsira ntchito

Lactic acidosis ndi chosowa koma chachikulu kagayidwe kachakudya kamene kamatha kukhazikika chifukwa cha kuchuluka kwa metformin panthawi ya mankhwala a Comboglyz XR; kufa kwa lactic acidosis ndi 50%. Lactic acidosis imatha kukhazikikanso pokhudzana ndi zovuta zina zapathupi, kuphatikizapo matenda a shuga, komanso motsutsana ndi maziko oopsa a minofu ya hypoperfusion ndi hypoxemia. Lactic acidosis imadziwika ndi kuwonjezeka kwa milingo ya lactate yamagazi (> 5 mmol / L), kuchepa kwa pH, kuphwanya kapangidwe ka electrolyte pamodzi ndi kuwonjezeka kwa nthawi ya anion komanso kuwonjezeka kwa chiŵerengero cha lactate / pyruvate. Ngati metformin ndiyomwe imayambitsa lactic acidosis, milingo ya plasma metformin imakonda> 5 μg / ml. Zomwe zanenedwa za lactic acidosis mwa odwala omwe amalandila metformin hydrochloride ndi ochepa kwambiri. M'milandu yomwe yanenedwa, lactic acidosis imapezeka makamaka mwa odwala matenda a shuga komanso kuwonongeka kwa impso, kuphatikizapo matenda obadwa nawo a impso ndi aimpso, omwe nthawi zambiri amakhala ndi zovuta zambiri zokhudzana ndi zamankhwala. Chiwopsezo chokhala ndi lactic acidosis imachulukitsidwa mwa odwala omwe ali ndi mtima wofooka womwe amafunikira chithandizo chamankhwala, makamaka kwa odwala omwe ali ndi vuto losakhazikika kapena lopweteka kwambiri la mtima ndi mwayi wa hypoperfusion ndi hypoxemia.

Nthawi zambiri, kuyambika kwa lactic acidosis kumakhala kovutirapo ndipo kumayendetsedwa ndi zizindikiro zosakhazikika monga malaise, myalgia, kupuma, kuchuluka kwa kugona, komanso kuperewera kopweteka. Ndi acidosis yambiri, hypothermia, ochepa hypotension, ndi bradyarrhythmia zimatha kuchitika. Wodwalayo ndi dokotala wake ayenera kukumbukira kufunika kwa chizindikirocho, ndipo wodwalayo ayenera kuchenjezedwa za kufunika kodziwitsa dokotala ngati atakula. Metformin iyenera kuyimitsidwa mpaka zinthu zitamveka bwino. Kuti muchite izi, mutha kudziwa kuchuluka kwa ma electrolyte mu seramu, kuchuluka kwa ma ketoni, shuga m'magazi ndipo, ngati akuwonetsa, pH ya magazi, mulingo wa lactate komanso ngakhale mulingo wa metformin m'magazi.

Kusala kwam'madzi am'magazi lactate m'magazi a venous, pamtunda wapamwamba kwambiri, koma osakwana 5 mmol / L mwa odwala omwe akutenga metformin, sizitanthauza kuwopseza lactic acidosis ndipo atha kufotokozeredwa ndi njira zina, monga matenda osokoneza bongo osayendetsa bwino kapena kunenepa kwambiri, kuchita zolimbitsa thupi kwambiri kapena zovuta zamakina pokonza zitsanzo.

Lactacidosis iyenera kukayikiridwa mwa aliyense wodwala matenda ashuga omwe ali ndi metabolic acidosis popanda zizindikiro za ketoacidosis (ketonuria ndi ketonemia).

Lactic acidosis ndiwadzidzidzi momwe chithandizo chimachitikira kuchipatala. Kwa wodwala yemwe ali ndi lactic acidosis yemwe akutenga metformin, mankhwalawo amathetsedwa ndipo njira zothandizira zimayikidwa. Metformin hydrochloride ikuchitika dialysis (ndi chilolezo cha 170 ml / mphindi. Ndi hemodynamic parameter), motero, hemodialysis imalimbikitsa kuti ichiritsidwe mankhwala a acidosis komanso kuchotsedwa kwa metformin yophatikizika. Njira zotere nthawi zambiri zimayambitsa kukonzanso mwachangu kwa zizindikiro ndi kuchira.

Kuwonongeka kwa chiwindi

Popeza kuwonongeka kwa chiwindi kumagwirizana ndi zochitika zingapo za lactic acidosis, makonzedwe a Combogliz XR ayenera kupewedwa mwa odwala omwe ali ndi matenda am'chipatala kapena a labotale matenda a chiwindi.

Kuyesa kwa impso

Odwala omwe ali ndi misinkhu ya serum creatinine yomwe imapitirira malire apamwamba abwinobwino zaka zawo sayenera kulandira Combogliz XR. Mwa odwala okalamba, kukonzekera kwa Comboglize XR kuyenera kudalilidwa mosamala mpaka mlingo wochepa utakhazikitsidwa wokwanira glycemic, chifukwa ntchito ya impso imayamba kuwonongeka. Odwala okalamba, makamaka odwala mu zaka zopitilira 80, ntchito yaimpso iyenera kuyang'aniridwa pafupipafupi, ndipo, mwambiri, Comboglize XR iyenera kukhala yachigawo mpaka metformin yokwanira yomwe ili gawo lamankhwala.

Musanayambe mankhwala ndi Combogliz XR, ndipo osachepera 1 pachaka, ndikofunikira kuwunikira ntchito ya aimpso ndikuchita mwanjira zonse.

Pafupifupi 7% ya odwala adakumana ndi kuchepa kwa vitamini B ₁₂ milingo yachilendo mu magazi a seramu omwe kale amafanana ndi chizolowezi, popanda mawonetseredwe azachipatala. Kutsika komweko, mwina chifukwa cha mayamwidwe a vitamini B ₁₂ ndi intrinsic factor-B zovuta ₁₂ imagwiritsidwa ntchito kawirikawiri chifukwa cha kuchepa magazi m'thupi ndipo imayambiranso mofulumira pambuyo pakuchotsa metformin kapena kupereka mankhwala okhala ndi vitamini B ₁₂ . Odwala omwe atenga Combogliz XR amalimbikitsidwa kuti azichita kuyezetsa magazi pafupipafupi chaka chilichonse, ndipo kupatuka kulikonse kuyenera kuzindikirika ndikuchiritsidwa.

Anthu ena (osakwanira kudya kapena kulowetsa vitamini B ₁₂ kapena calcium) amakhala ndi mavitamini B ochepa ₁₂ pansipa. Odwala awa ayenera kuchita kuwunikira mlingo wa vitamini B wambiri. ₁₂ mu magazi seramu ndi imeneyi kwa zaka 2-3.

Mowa umawonjezera mphamvu ya metformin pa lactate metabolism. Odwala ayenera kuchenjezedwa za ngozi ya kumwa kwambiri zakumwa zoledzeretsa, pawiri kapena kawirikawiri, mukamagwiritsa ntchito mankhwala a Combogliz XR.

Kugwiritsa ntchito kwa Combogliz XR kuyenera kusiyidwa kwakanthawi kwa nthawi ya opaleshoniyo (kupatula njira zazing'ono zomwe sizigwirizana ndi zoletsa chakudya kapena madzi akumwa) ndipo siziyenera kugwiritsidwa ntchito mpaka wodwalayo atha kudya chakudya pakamwa komanso ntchito ya impso sizachilendo.

Zosintha pamatenda a odwala omwe ali ndi mtundu wachiwiri wa matenda a shuga

Wodwala matenda a shuga II, omwe kale anali olamulidwa bwino ndi Comboglyz XR, omwe ali ndi zopatuka kuchokera ku mayeso a labotale kapena matenda azachipatala (makamaka osawoneka bwino kapena matenda osadziwika), ayenera kuwunika mwachangu kupezeka kwa ketoacidosis kapena lactic acidosis.

Gwiritsani ntchito ndi mankhwala omwe amachititsa hypoglycemia

Insulin katulutsidwe zolimbitsa thupi monga sulfonylurea kumabweretsa hypoglycemia. Chifukwa chake, mukagwiritsidwa ntchito limodzi ndi saxagliptin, kuchepetsa mlingo wa insulin wa seculin kungafunike kuti muchepetse chiopsezo cha hypoglycemia.

Hypoglycemia simakula mwa odwala omwe amalandila metformin monotherapy nthawi yayitali, kapena mowa wa ethyl. Makamaka omvera makamaka pa hypoglycemic action ndi chilimwe komanso odwala ofooka, omwe amadya pang'ono, omwe adrenal insufficiency kapena pituitary gland, omwe amamwa mowa mwauchidakwa. Kwa odwala okalamba komanso odwala omwe amatenga beta adrenergic receptors, hypoglycemia imavuta kudziwa.

Mankhwala olumikizana omwe amakhudza ntchito ya impso kapena metformin pharmacokinetics

Mankhwala olimbana ndi omwe amatha kusokoneza ntchito ya impso kapena angayambitse kusintha kwakukulu kwa hemodynamic, kapena kukhudza ma pharmacokinetics a metformin, monga mankhwala a cationic omwe amatsitsidwa ndi secretion tubular, ayenera kugwiritsidwa ntchito mosamala.

Mayeso a radiology omwe amaphatikizapo kulowetsedwa kwa intrate ya othandizira a iodated

Kafukufuku wokhudzana ndi intravascular dongosolo la ayodini wosiyanitsa amatha kuyambitsa kuwonongeka kwa impso ndipo amagwirizana ndi lactic acidosis odwala omwe amalandila metformin.

Ndi lactic acidosis yogwirizana ndi kugwa kwa mtima chifukwa china chilichonse, mtima wosakhazikika, kupunduka kwamatenda am'mimba komanso matenda ena omwe amadziwika ndi kukula kwa hypoxemia komanso kungayambitse azrenemia ya prerenal. Matendawa akapezeka mu odwala omwe amalandira Combogliz XR, mankhwalawo ayenera kusiyidwa mwachangu.

Kuwonongeka kwa magazi a shuga

Wodwala yemwe ali ndi vuto la matenda ashuga ali ndi vuto lililonse ngati kutentha thupi, kuvulala, matenda opatsirana, kapena kuchitidwa opaleshoni, kutaya kwa glycemic kwakanthawi kumatha. Zikatero, zingakhale bwino kusiya Combogliz XR ndikuyambitsa insulin kwakanthawi. Kutenga Combogliz XR kumatha kuyambanso kufunsa kuukira koopsa.

Zotsatira za mtima

Kafukufuku wazachipatala yemwe adapereka umboni wotsimikizika wochepetsera chiopsezo cha matenda opezeka m'macrovascular pogwiritsa ntchito Combogliz XR kapena mankhwala ena aliwonse odana ndi shuga sanachitike.

Gwiritsani ntchito odwala okalamba

Popeza saxagliptin ndi metformin amachotsedwa pang'ono ndi impso ndipo nthawi zambiri ntchito yaimpso imachepetsedwa mwa okalamba, Comboglize XR iyenera kugwiritsidwa ntchito mosamala odwala okalamba.

Saxagliptin. Panalibe kusiyana kwachipatala pakuchitika pakati pa chilimwe ndi odwala achinyamata, koma chidwi chachikulu cha odwala ena okalamba sichingaletsedwe.

Metformin hydrochloride. XR comboglyz iyenera kugwiritsidwa ntchito mwa odwala omwe ali ndi vuto lofanana laimpso. Mlingo woyambirira ndi wokonza metformin uyenera kukhala wokhazikika mwa odwala okalamba chifukwa chitha kuchepa aimpso m'gululi. Kusintha kwa Mlingo kuyenera kuchitidwa pambuyo pakuwunikira bwino kwa impso.

Palibe maphunziro apadera omwe adachitidwa kuti aphunzire za chitetezo ndi kufunikira kwa Comboglize XR mwa odwala omwe adachitidwapo kale ndi othandizira ena a antihyperglycemic, kenaka adasamutsidwa ku Combogliz XR.

Kusintha kulikonse kwamankhwala a shuga II kuyenera kuchitidwa mosamala komanso kuyang'aniridwa pafupipafupi, chifukwa pakhoza kukhala kusintha pakulamulira kwa glycemic.

Odwala ndi kapamba. Pa maphunziro atatsatsa malonda, malipoti a pancreatitis owopsa adalandiridwa. Odwala ayenera kudziwitsidwa ndi chizindikiro cha pancreatitis yovuta kwambiri: kulimba kwam'mimba kwambiri. Ngati pancreatitis ikukayikira, XR Comboglize iyenera kusiyidwa.

Kulephera kwa mtima. Mu kafukufuku wa SAVOR, kuchuluka kwa odwala kuchipatala chifukwa cha kulephera kwa mtima kwa odwala omwe amalandila saxagliptin kunali kwakukulu kuposa kwa omwe akulandira placebo, ngakhale kuti ubale wa causal sunakhazikitsidwe. Chenjezo limalangizidwa kugwiritsa ntchito Comboglize XR mwa odwala omwe ali ndi chiopsezo chogonekedwa kuchipatala chifukwa cha kulephera kwa mtima, monga mbiri yolephera mtima kapena kuchepa kwapakati kapena kupweteka kwambiri kwa aimpso. Odwala ayenera kudziwitsidwa ndi zomwe zimachitika chifukwa cha kulephera kwa mtima ndikuwalangizani kuti afotokozere zomwe zimachitika.

Sethralgia yayikulu komanso yolakwika. Munthawi yolembetsa pambuyo polembetsa, milandu yovuta komanso yolakwika ya arthralgia inalembedwa ndikugwiritsa ntchito ma DPP-4 zoletsa. Nthawi yodziwika bwino ya matenda kuyambira tsiku limodzi mpaka zaka zingapo atayamba chithandizo. Kukula kwa zizindikiro kumachepa atasiya kumwa mankhwalawo. Odwala ena adakumananso ndi zovuta atayambiranso mankhwala omwewo pogwiritsa ntchito mankhwala ena a DPP-4.

Kutha kusinthitsa kuchuluka kwa zochita mukamayendetsa kapena kugwiritsa ntchito njira zina.

Kafukufuku wokhudza momwe mungayendetsere magalimoto ndikugwira ntchito ndi machitidwe sanachitike. Popeza kupezeka kwa chizungulire ngati chovuta, nthawi ya chithandizo siyenera kuyendetsa magalimoto kapena kugwira ntchito ndi njira.

Kuyanjana ndi mankhwala ena ndi mitundu ina yoyanjana

Enzyme Inducers CYP3A4 / 5

Saxagliptin. Rifampicin adathandizira kwambiri kukhudzana kwa saxagliptin, sizinaperekedwe ndi kusintha kwaderali mkati mwa ndende yozungulirapo (AUC) ya metabolite yogwira, 5-hydroxyasaleagliptin. Rifampicin sanakhudze zoletsa za plasma dipeptidyl peptidase-4 (PPP-4) kwa maola 24. Chifukwa chake, kusintha mlingo wa saxagliptin sikulimbikitsidwa.

CYP3A4 / 5 Enzyme Inhibitors

Zoletsa Zoyeserera za CYP3A4 / 5

Saxagliptin. Diltiazem yowonjezera kukhudzana ndi saxagliptin. Kuwonjezeka kofanana kwa plasma ndende ya saxagliptin kumayembekezeredwa pamaso pa zoletsa zina zolimbitsa thupi za cytochrome P450 3A4 / 5 (CYP3A4 / 5) (i.e. amprenavir, aprepitant, erythromycin, fluconazole, fosamprenavir, madzi a mphesa ndi verapamil. Komabe, kusintha mlingo wa saxagliptin sikulimbikitsidwa.

Olimba CYP3A4 / 5 Ma Inhibitors

Ketoconazole adachulukitsa kukhudzana kwa saxagliptin. Kukula kofananira kwa plasma ndende ya saxagliptin kuyembekezeredwa pamaso pa zoletsa zina zamphamvu za CYP3A4 / 5 (mwachitsanzo, atazanavir, clarithromycin indinavir, itraconazole, nefazodone, nelfinavir, ritonavir, saquinavir ndi telithromycin).

Mwachidziwikire, mankhwala a cationic (mwachitsanzo, amiloride, digoxin, morphine, procainamide, quinidine, quinine, ranitidine, triamteren, trimethoprim kapena vancomycin), omwe amathandizidwa ndi a renal tubular secretion, amatha kulumikizana ndi metformin, kupikisana pa dongosolo la mayendedwe a tubular. Mitundu yofananira pakati pa metformin ndi cimetidine pakayendetsedwe kamlomo imawonedwa mwa odzipereka athanzi mu maphunziro a kuyanjana kwa metformin ndi cimetidine onse ndi mlingo umodzi komanso ndi mulingo wambiri, ndikuwonetsa kuchuluka kwakukulu _max ) metformin mu plasma komanso m'magazi athunthu ndi 60% komanso kuwonjezeka kwa AUC ya metformin 40% ya plasma ndi magazi athunthu ndi 40%. Pakufufuza kamodzi kwa theka, moyo wa theka sunasinthidwe. Metformin sizinakhudze pharmacokinetics ya cimetidine. Ngakhale kuchitapo kanthu koteroko kumangokhala kungoyeserera (kupatula kuyanjana ndi cimetidine), tikulimbikitsidwa kuti nthawi zambiri tiziwona momwe odwala aliri ndikusintha mlingo wa Comboglyz XR ndi / kapena kusokoneza mankhwala ngati odwalawa atenga mankhwala a cationic omwe amuchotsera kudzera mu proximal renal tubular excretory system.

Mu kafukufuku umodzi wothandizidwa ndi odwala omwe ali ndi mtundu wachiwiri wa shuga, mgwirizano wa metformin ndi glibenclamide sizinasinthe kapena pharmacokinetics kapena pharmacodynamics ya metformin. AUC ndi C adachepa _max glibenclamide, koma zinthu izi zinali zosiyana kwambiri. Popeza phunziroli linagwiritsidwa ntchito kamodzi, ndipo panalibe kulumikizana pakati pa milingo ya glibenclamide m'magazi ndi momwe mafasilodynamics amafotokozera, kufunikira kwakukhudzana ndi mankhwalawa sikudziwika.

Kafukufuku wogwirizana pakati pa metformin ndi furosemide ogwiritsa ntchito limodzi limodzi ndi gawo la odzipereka wathanzi adawonetsa zotsatira za mgwirizano m'magawo a pharmacokinetic a mankhwalawa.

Kafukufuku wokhudzana ndi kuphatikiza kwa metformin ndi nifedipine wokhala ndi mlingo umodzi mwa odzipereka athanzi kunawonetsa kuti kuthandizirana ndi nifedipine kumawonjezera mtengo wa C _max ndi AUC ya metformin mu plasma ndi 20% ndi 9%, motero, ndikuchulukitsa kuchuluka kwa mankhwalawa amkodzo. Mtengo _max ndipo theka-moyo sunasinthe. Nifedipine inathandizira kuyamwa kwa metformin. Mphamvu ya metformin pa nifedipine inali yochepa.

Gwiritsani ntchito mankhwala ena

Mankhwala ena amatha kubweretsa hyperglycemia ndipo angapangitse kuti magazi a magazi asamayende bwino. Mankhwalawa amaphatikiza thiazides ndi ma diuretics ena, corticosteroids, phenothiazides, kukonzekera kwa mahomoni a chithokomiro, estrogens, kulera kwapakamwa, phenytoin, nicotinic acid, sympathomimetics, calcium blockers ndi isoniazid. Popereka mankhwala ngati amenewa kwa wodwala yemwe amalandira kukonzekera kwa Combogliz XR, ndikofunikira kuyang'anitsitsa zizindikiro za kuchepa kwa magazi m'thupi la wodwalayo. Mankhwala oterowo atathetsedwa mwa wodwala yemwe amalandila Combogliz XR, ndikofunikira kuyang'anitsitsa zomwe wodwala akuonetsa za hypoglycemia.

Mwa odzipereka athanzi, pomwe amathandizirana ngati gawo la maphunziro a kulumikizana ndi limodzi mlingo, pharmacokinetics ya metformin ndi propanolol, komanso metformin ndi ibuprofen, sizinasinthe.

Metformin sikugwirizana kwenikweni ndi mapuloteni a plasma; chifukwa chake, momwe amagwiritsidwira ntchito ndi mankhwala omwe amaphatikiza mapuloteni pamlingo wambiri (monga salicylates, sulfonamides, chloramphenicol ndi probenecid) sangafanane ndi sulfonylureas, omwe amaphatikizana kwambiri ndi mapuloteni a plasma.

Zochita Zamankhwala

Saxagliptin ndi Metformin Hydrochloride

Kugwiritsira ntchito mosiyanasiyana Mlingo umodzi wa saxagliptin (100 mg) ndi metformin (1000 mg) sikunasinthe ma pharmacokinetics a saxagliptin kapena metformin odzipereka athanzi.

Kafukufuku wapadera wokhudzana ndi momwe pharmacokinetic imathandizira kugwiritsa ntchito mankhwala ndi Combogliz XR sizinachitike, ngakhale kafukufuku wofanana adachitika pogwiritsa ntchito saxagliptin payokha komanso metformin payokha.

Mu vitro kugwiritsa ntchito mankhwala

Metabolism ya Saxagliptin imaphatikizidwa makamaka ndi CYP3A4 / 5.

Mu mu vitro M'maphunziro, saxagliptin ndi metabolite yake yogwira inapanikiza CYP1A2, 2A6, 2B6, 2C9, 2C19, 2D6, 2E1 kapena 3A4 koma sanatenge CYP1A2, 2B6, 2C9 kapena 3A4.

Kumangidwa kwa saxagliptin ndi metabolite yake yogwira kumapuloteni mu vitro mu seramu ya anthu ndiwosamveka. Chifukwa chake, kumanga kwa mapuloteni sikungakhale ndi phindu lililonse pa pharmacokinetics ya saxagliptin kapena mankhwala ena.

Mu kusanthula kwa mankhwala a vivo

Zotsatira za saxagliptin pa mankhwala ena

Mu maphunziro, saxagliptin sanasinthe kwambiri ma pharmacokinetics a metformin, glibenclamide, pioglitazone, digoxin, simvastatin, diltiazem, ndi ketoconazole.

Metformin. Kugwiritsa ntchito limodzi nthawi imodzi saxagliptin (100 mg) ndi metformin (1000 mg), gawo lapansi la HOCT-1 ndi hOCT-2, sikunasinthe pharmacokinetics ya metformin mwa anthu athanzi. Chifukwa chake, saxagliptin si choletsa hOCT-1 ndi hOCT-2 -oyimira pakati.

Gliburide. Zotsatira zamakonzedwe ophatikizika a limodzi la saxagliptin (10 mg) ndi glibenclamide (5 mg), gawo limodzi la CYP2C9, mtengo wa Cmax wa glibenclamide mu plasma yamagazi ukuwonjezeka ndi 16%. Komabe, mtengo wa AUC wa glibenclamide sunasinthe. Chifukwa chake, saxagliptin pafupifupi siyimalepheretsa kagayidwe kamene kamayesedwa ndi CYP2C9.

Pagogazone. Zotsatira zamakonzedwe a concomitant (kamodzi patsiku) zamitundu yambiri ya saxagliptin (10 mg) ndi pioglitazone (45 mg), gawo lapansi CYP2C8, mtengo wa Cmax wa pioglitazone mu plasma yamagazi ukuwonjezeka ndi 14%. Komabe, mtengo wa AUC wa pioglitazone sunasinthe. Chifukwa chake, saxagliptin sanachedwetse kapena kuwonjezera mphamvu ya CYP2C8.

Digoxin. Mu Chifukwa cha kugwiritsidwa ntchito mosavomerezeka (kamodzi patsiku) zamitundu yambiri ya saxagliptin (10 mg) ndi digoxin (0.25 mg), gawo lapansi P-gp, pharmacokinetics ya digoxin sizinasinthe. Chifukwa chake, saxagliptin sakhala cholepheretsa kapena chosokoneza cha P-gp chosinthira pakati.

Simvastatin. Zotsatira za kugwiritsidwa ntchito mosavomerezeka (kamodzi patsiku) zamitundu yambiri ya saxagliptin (10 mg) ndi simvastatin (40 mg), gawo lapansi CYP3A4 / 5, ma pharmacokinetics a simvastatin sanasinthe. Chifukwa chake, saxagliptin sakhala choletsa kapena wochititsa kagayidwe kamene kamayesedwa ndi CYP3A4 / 5.

Diltiazem. Zotsatira zogwiritsidwa ntchito mosakanikirana (kamodzi patsiku) zamankhwala ambiri a saxagliptin (10 mg) ndi diltiazem (360 mg, fomu yolimbikitsidwa yotulutsidwa), inhibitor yapakati ya CYP3A4 / 5, kuchuluka kwa Cmax kwa diltiazem m'madzi a m'magazi kumawonjezeka ndi 16%. Komabe, mtengo wa AUC wa diltiazem sunasinthe.

Ketoconazole Zotsatira za kugwiritsa ntchito limodzi mlingo wa saxagliptin (100 mg) ndi

Kutulutsa mawonekedwe, kapangidwe kake ndi ma CD

Filimu Yotulutsira Kutulutsidwa Kwa Makanema Piritsi limodzi lili: Zinthu zothandiza: metformin - 1000 mg, saxagliptin - 2,5 mg. 7 ma PC - matuza (4) - mapaketi a makatoni.
7 ma PC - matuza (8) - mapaketi a makatoni.

Filimu Yotulutsira Kutulutsidwa Kwa Makanema Piritsi limodzi lili: Zinthu zothandiza: metformin - 1000 mg, saxagliptin - 5 mg. 7 ma PC - matuza (4) - mapaketi a makatoni.

Filimu Yotulutsira Kutulutsidwa Kwa Makanema Piritsi limodzi lili: Zinthu zothandiza: metformin - 500 mg, saxagliptin - 5 mg. 7 ma PC - matuza (4) - mapaketi a makatoni.

Kuyanjana kwa mankhwala osokoneza bongo

Mankhwala ena amachulukitsa hyperglycemia (thiazide ndi ma diuretics ena, glucocorticosteroids, phenothiazines, kukonzekera kwa mahomoni a chithokomiro, estrogens, njira zakulera zamkati, phenytoin, nicotinic acid, sympathomimetics, pang'onopang'ono calcium blockers ndi isoniazid). Popereka kapena kuletsa mankhwala ngati wodwala akutenga Combogliz, kuchuluka kwa shuga m'magazi kuyenera kuyang'aniridwa mosamala. Mlingo womangidwa wa metformin ku mapuloteni amadzi a m'magazi ndi ochepa, kotero sizingatheke kuti azilumikizana ndi mankhwala omwe amaphatikizidwa kwambiri ndi mapuloteni a plasma, monga salicylates, sulfonamides, chloramphenicol ndi probenecid (mosiyana ndi zomwe zimachokera ku sulfonylurea, zomwe zimamangidwa kwambiri. ndi mapuloteni a seramu).

Zowonetsa za isoenzymes CYP3A4 / 5

Rifampicin amachepetsa kwambiri ma saxagliptin osasintha AUC ya metabolite yake yogwira, 5-hydroxy-saxagliptin. Rifampicin sichikuwakhudza kuletsa kwa DPP-4 m'magazi a magazi munthawi yamahora a 24 a chithandizo.

CYP3A4 / 5 Isoenzyme Inhibitors

Diltiazem imakulitsa mphamvu ya saxagliptin ikagwiritsidwa ntchito limodzi. Kuwonjezeka kwa kuchuluka kwa saxagliptin m'madzi a m'magazi kuyembekezeredwa ndikugwiritsa ntchito amprenavir, aprepitant, erythromycin, fluconazole, fosamprenavir, madzi a mphesa ndi verapamil, komabe, kumwa kwa saxagliptin sikulimbikitsidwa. Ketoconazole amachulukitsa kuchuluka kwa saxagliptin mu plasma. Kuwonjezeka kofananako kwa kuchuluka kwa saxagliptin m'madzi a m'magazi kuyembekezeredwa pamene ma inhibizes ambiri a nzoenzymes CYP3A4 / 5 amagwiritsidwa ntchito (mwachitsanzo, atazanavir ,cacithromycin, indinavir, itraconazole, nefazodone, nelfinavir, ritonavir, saquinavir ndi telithromycin. Mukaphatikizidwa ndi inhibitor yamphamvu ya CYP3A4 / 5 isoenzymes, mlingo wa saxagliptin uyenera kuchepetsedwa kukhala 2.5 mg.

Mankhwala a Cationic (mwachitsanzo, amiloride, digoxin, morphine, procainamide, quinidine, quinine, ranitidine, triamterone, trimethoprim kapena vancomycin), omwe amachotseredwa ndi impso kudzera mu kusefera kwa glomerular, akhoza kungogwirizana ndi metformin, kupikisana mayendedwe wamba. Mu maphunziro okhudzana ndi mankhwala a metformin ndi cimetidine kamodzi komanso mobwerezabwereza kayendetsedwe ka mankhwalawa, kuyanjana kwa metformin ndi cimetidine pakumwa pakamwa mu odzipereka athanzi kunawonedwa, kuwonjezeka kwa 60% pazowonjezera za metformin mu plasma ndi magazi athunthu ndi kuwonjezeka kwa 40% kwa AUC ya metformin mu plasma ndi kwathunthu magazi. Metformin sichikhudza pharmacokinetics ya cimetidine. Ndikulimbikitsidwa kuyang'anira odwala mosamala, ndipo ngati ndi kotheka, sinthani muyezo wa odwala omwe amamwa mankhwala a cationic omwe amuchotsa kudzera mu proximal renal tubule system.

Pakufufuza kwa kuyanjana kwa mankhwala a metformin ndi furosemide ndi mlingo umodzi wa mankhwalawo, wopangidwa pa odzipereka athanzi, kuyanjana kwawo kwa pharmacokinetic kuwululidwa. Furosemide imawonjezera Cmax ya metformin mu plasma ndi magazi ndi 22% ndi AUC m'magazi ndi 15% popanda kusintha kwakukulu kwa aimpso kwa metformin. Akaphatikizidwa ndi metformin, Cmax ndi AUC, furosemide amachepetsa ndi 31% ndi 12%, motero, ndipo theka la moyo limatsika ndi 32% popanda kusintha kwawonekera kwa impso chilolezo cha furosemide. Palibe deta pakukhudzana kwa metformin ndi furosemide pogwiritsa ntchito nthawi yayitali.

Pakufufuza kwa kuyanjana kwa mankhwala osokoneza bongo a metformin ndi nifedipine ndi mlingo umodzi wa mankhwalawa, wothandizidwa ndi odzipereka athanzi, nifedipine imawonjezera Cmax ya plasma metformin ndi 20% ndi AUC ndi 9%, ndikuwonjezera impso ya impso. Tmax ndi T1 / 2 sizinasinthe. Nifedipine imawonjezera mayamwidwe a metformin. Metformin ilibe gawo lililonse pa pharmacokinetics ya nifedipine.

Saxagliptin ndi Metformin

Kugwiritsa ntchito limodzi mphamvu ya saxagliptin (100 mg) ndi metformin (1000 mg) sikukhudza kwambiri pharmacokinetics ya saxagliptin kapena metformin odzipereka athanzi. Palibe maphunziro apadera a pharmacokinetic okhudzana ndi mankhwala omwe amagwiritsidwa ntchito ndi Combogliz adachitidwa, ngakhale kuti kafukufuku wotereyu wachitika ndi zigawo zake: saxagliptin ndi metformin.

Zotsatira za mankhwala ena pa saxagliptin

Glibenclamide: Kugwiritsa ntchito kamodzi kwa saxagliptin (10 mg) ndi glibenclamide (5 mg), gawo laling'ono la isoenzyme CYP2C9, kuchulukitsa Cmax ya saxagliptin ndi 8%, komabe, saxagliptin AUC sinasinthe.

Pioglitazone: Kugwiritsa ntchito saxagliptin mobwerezabwereza kamodzi patsiku (10 mg) ndi pioglitazone (45 mg), gawo laling'ono la isoenzyme CYP2C8 (lolimba) ndi CYP3A4 (ofooka), silikuwakhudza pharmacokinetics a saxagliptin.

Digoxin: Kugwiritsa ntchito saxagliptin mobwerezabwereza kamodzi patsiku (10 mg) ndi digoxin (0.25 mg), gawo lapansili la P-glycoprotein, sikukhudza pharmacokinetics ya saxagliptin.

Simvastatin: Kugwiritsanso ntchito kwa saxagliptin kamodzi patsiku (10 mg) ndi simvastatin (40 mg), gawo lapansi la CYP3A4 / 5 isoenzymes, Cmax ya saxagliptin ndi 21%, komabe, saxagliptin AUC sinasinthe.

Diltiazem: Kuphatikiza kugwiritsidwa ntchito kamodzi kwa saxagliptin (10 mg) ndi diltiazem (360 mg wowerengeka wa mulingo wofanana muyezo), inhibitor ya CYP3A4 / 5 isoenzymes, kumawonjezera Cmax ya saxagliptin ndi 63%, ndi AUC - mwa nthawi 2.1. Izi zimatsatiridwa ndi kuchepa kofananira kwa Cmax ndi AUC ya metabolite yogwira ndi 44% ndi 36%, motsatana.

Ketoconazole: Kugwiritsa ntchito limodzi mankhwala a saxagliptin (100 mg) ndi ketoconazole (200 mg maola 12 aliwonse molingana) kumawonjezera Cmax ndi AUC ya saxagliptin 2.4 ndi 3.7 nthawi. Izi zimatsatiridwa ndi kuchepa kofananira kwa Cmax ndi AUC ya metabolite yogwira ndi 96% ndi 90%, motsatana.

Rifampicin: Kugwiritsa ntchito limodzi muyezo wa saxagliptin (5 mg) ndi rifampicin (600 mg kamodzi tsiku lililonse pachilichonse) amatsitsa Cmax ndi AUC ya saxagliptin ndi 53% ndi 76%, motsatana, ndi Cmax (39%), koma popanda kuchuluka AUC amasintha mu metabolite yogwira.

Omeprazole: Kugwiritsa ntchito mosiyanasiyana kwa saxagliptin pa 10 mg kamodzi patsiku ndi omeprazole pa 40 mg, gawo limodzi la isoenzyme CYP2C19 (olimba) ndi isoenzyme CYP3A4 (ofooka), choletsa cha isoenzyme CYP2C19 ndi cholender MRP.

Aluminium hydroxide + magnesium hydroxide + simethicone: Kugwiritsa ntchito limodzi mphamvu ya saxagliptin (10 mg) ndi kuyimitsidwa komwe kuli ndi aluminium hydroxide (2400 mg), magnesium hydroxide (2400 mg) ndi simethicone (240 mg), kuchepetsa Cmax ya saxagliptin ndi 26%, komabe 26%, saxagliptin saxagliptin sasintha.

Famotidine: Kutenga muyezo umodzi wa saxagliptin (10 mg) patatha maola atatu muyezo umodzi wa famotidine (40 mg), choletsa wa hOCT-1, hOCT-2, ndi HOCT-3, kumawonjezera Cmax ya saxagliptin ndi 14%, koma AUC ya saxagliptin sasintha.

Mimba komanso kuyamwa

Chifukwa chakuti mankhwalawa Comboglis pa nthawi yomwe ali ndi pakati sanawerenge, mankhwalawa sayenera kutumikiridwa panthawi yomwe ali ndi pakati.

Sizikudziwika ngati saxagliptin kapena metformin akadutsa mkaka wa m'mawere. Popeza kuthekera kwa kulowa kwa mankhwala a Combogliz mu mkaka wa m'mawere sikumayikidwa padera, kugwiritsa ntchito mankhwalawa panthawi ya mkaka wa m`mawere kumatsutsana.

Momwe mungagwiritsire ntchito mankhwala Comboglize?

Comboglize ndi mankhwala abwino omwe amagwiritsidwa ntchito popanga matenda a shuga a mtundu wachiwiri. Imathandizira matenda a shuga. Kuphatikizikako kumaphatikizapo magawo awiri omwe amagwira ntchito, omwe amakupatsani mwayi kugwiritsa ntchito chida.