Viktoza - malangizo * ogwiritsidwa ntchito

Fomu ya Mlingo - yankho la subcutaneous makonzedwe: osakhala opanda maonekedwe (3 ml aliyense * m'magalati amtundu wa galasi, omwe amatsekedwa mu cholembera cha pulasitiki chotayidwa pobayira mobwerezabwereza, pachithunzithunzi cha makatoni a 1, 2 kapena 3 syringe pensulo).

* Mu 1 syringe cholembera (3 ml) muli mulingo 10 wa 1.8 mg, 15 Mlingo wa 1.2 mg kapena 30 Mlingo wa 0,6 mg.

Ntchito yogwira: liraglutide, mu 1 ml - 6 mg.

Zothandiza: hydrochloric acid / sodium hydroxide q.s., sodium hydrogen phosphate dihydrate, phenol, propylene glycol, madzi a jekeseni.

Katundu

Mankhwala
Liraglutide ali ndi nthawi yayitali ya maola 24 ndipo amakonzanso kayendedwe ka glycemic pochepetsa kuchuluka kwa shuga m'magazi ndikatha kudya odwala omwe ali ndi matenda a shuga a 2.
Kutupa kwa inshuwaransi
Ndi kuwonjezeka kwa ndende ya magazi, liraglutide imawonjezera katemera wa insulin. Mukamagwiritsa ntchito mankhwala osokoneza bongo a glucose, insulin katulutsidwe pambuyo pokhazikitsa limodzi muyezo wa liraglutide kwa odwala omwe ali ndi matenda a shuga 2 amawonjezera pamlingo wofanana ndi maphunziro apamwamba (mkuyu. 1).

Pancreatic beta cell ntchito
Liraglutide inasintha ntchito ya pancreatic beta cell, monga zikuwonekera gawo loyamba ndi lachiwiri la kuyankha kwa insulin komanso chinsinsi chachikulu cha maselo a beta. Kafukufuku wa Pharmacodynamic wa odwala omwe ali ndi matenda a shuga a 2 adawonetsa kubwezeretsedwa kwa gawo loyamba la insulin secretion (kulowetsedwa kwa insulin), kusintha kwa gawo lachiwiri la insulin secretion (mayeso a cell a hyperglycemic) komanso chinsinsi chachikulu cha insulin (arginine stimulation test).
Pakati pa masabata a 52 omwe amachitika ndi Victoza ®, panali kuwongolera magwiridwe antchito a ma cell a pancreatic beta, monga momwe zikuwonetsedwera ndikuwunika kwa homeostatic model of the works of pancreatic beta cell (HOMA index) ndi kuchuluka kwa insulin kwa proinsulin.
Katemera wa Glucagon:
Liraglutide, yolimbikitsa kubisika kwa insulin komanso kuletsa chinsinsi cha glucagon, amachepetsa kuchuluka kwa shuga m'magazi. Liraglutide sikulepheretsa kuyamwa kwa glucagon pazotsika zamagalasi. Kuphatikiza apo, motsutsana ndi maziko a liraglutide, kupanga kwapansi kwa glucose amkati kunawonedwa.
Kuchotsa mafuta m'mimba:
Liraglutide imayambitsa kuchepa pang'ono m'matumbo, motero kuchepetsa mphamvu ya glucose ya postprandial m'magazi.
Kulemera kwa thupi, kuchuluka kwa thupi ndi mphamvu zamagetsi:
M'maphunziro omwe ali ndi kuwonjezeka kwa thupi komwe kumaphatikizidwa m'maphunziro azachipatala a liraglutide, omalizirawa adapangitsa kuchepa kwambiri kwa thupi. Kufufuza pogwiritsa ntchito computer tomography (CT) ndi njira ziwiri zopangira ma X-ray mayamwidwe (DERA) kunawonetsa kuti kuchepa kwa thupi kunachitika makamaka chifukwa chotaya minofu ya adipose ya odwala. Zotsatirazi amafotokozeredwa ndikuti panthawi yamankhwala omwe amapezeka ndi liraglutide mwa odwala, njala ndi kugwiritsa ntchito mphamvu zimachepa.
Electrophysiology yamtima (Efc):
Zotsatira za liraglutide pakukonzanso kwa mtima kumayesedwa pakuphunzira kwa EFS. Kugwiritsa ntchito liraglutide mu ndende yolingana mu tsiku ndi tsiku mpaka 1,8 mg sikutulutsa kutalika kwa EPS.
Mphamvu zamankhwala
Odwala 3992 omwe ali ndi vuto lachiwiri la matenda ashuga 2 adasinthidwa mosawerengeka m'mayesero amtundu wa 5 a khungu la chitetezo ndi chidziwitso chochitidwa kuti athe kuwunika momwe Victoza ® amawongolera glycemic. Victoza ® therapy yatulutsa bwino kwambiri mu HbA1skusala kudya kwa glucose komanso kutsata kwa gluprose poyerekeza ndi placebo.
Glycemic control
Mankhwala Viktoza ® mu mawonekedwe a monotherapy kwa masabata 52 anachititsa kuchuluka kwamankhwala (p ®), pomwe odwala omwe akuchita nawo mayesero azachipatala ophatikizira mankhwala a Victoza ®, a HbA wamba1s idatsika ndi 1.1-2.5%.
Mankhwala Viktoza ® pamasabata a 26 omwe amaphatikizidwa ndi metformin, kukonzekera kwa sulfonylurea kapena metformin ndi thiazolidinedione kunapangitsa chidwi chambiri (p ® ndi metformin, kuphatikiza kwa insulini kunapereka ntchito zambiri poyerekeza ndi mankhwala a Victoza ® ndi metformin pambuyo pa milungu 26 yamankhwala (kuchepa HbA1c ndi 0.52%).
Zinadziwika kuti mphamvu ya mankhwalawa Victoza ® pa mlingo wa 0,6 mg wophatikizidwa ndi sulfonylurea kapena kukonzekera kwa metformin ndi kwapamwamba kuposa placebo, koma nthawi yomweyo kutsika kuposa mu Mlingo wa 1.2 mg ndi 1.8 mg.
Chiwerengero cha odwala omwe akwaniritsa kuchepa kwa HbA1s
Poyerekeza ndi kumbuyo kwa monotherapy ndi Viktoza ® pa kafukufuku wamasabata 52, kuchuluka kwa odwala omwe adakwaniritsa HbA1s ® kuphatikiza ndi metformin, sulfonylurea zotumphukira, kapena kuphatikiza kwa metformin ndi thiazolidinedione, kuchuluka kwa odwala omwe afika ku HbA1s ≤ 6.5%, yowerengeka kwambiri (p ≤ 0.0001) inachuluka mokhudzana ndi kuchuluka kwa odwala omwe amalandira chithandizo chokhacho, popanda kuwonjezera kwa Victoza ®, omwe ali ndi mankhwala a hypoglycemic.
M'magulu a odwala omwe sanakwanitse kuwongolera glycemic nthawi ya mankhwala ndi Victoza ® ndi metformin, kuchuluka kwa odwala omwe akwaniritsa chandamale HbA1s (® HbA idakwaniritsidwa1s ® zonse mu mawonekedwe a monotherapy, komanso kuphatikiza amodzi kapena awiri amkamwa hypoglycemic othandizira. Kuchepa kumeneku kunawonedwa kale m'masabata awiri oyambira kuchokera pomwe mankhwala adayamba.
Postprandial Glycemia
Kugwiritsa ntchito mankhwalawa Victoza ® kwa masiku atatu kudya zakudya zofunikira kunathandiza kuchepetsa kuchuluka kwa gluprose wa postprandial ndi 31-49 mg% (1.68-2.71 mmol / l).
Kulemera kwa thupi
Monotherapy ya milungu 52 ndi Viktoza ® idalumikizidwa ndi kuchepa thupi.
Munthawi yonse yophunzira zamankhwala, kuchepa thupi kumathandizanso kugwiritsidwa ntchito ndi Victoza ® kuphatikiza ndi metformin komanso kuphatikiza metformin ndi sulfonylureas kapena kuphatikiza kwa metformin ndi thiazolidinedione.
Kuchepetsa thupi kwa odwala omwe amalandira Victoza ® osakanikirana ndi metformin adawonekeranso pambuyo pa kuwonjezeredwa kwa insulin.
Kuchepetsa kwakukulu kwa kulemera kwa thupi kunawonedwa mwa odwala omwe anali ndi chidziwitso chowonjezeka cha thupi (BMI) kumayambiriro kwa phunziroli.
Monotherapy yokhala ndi Viktoza ® kwa masabata 52 idapangitsa kutsika kwa voliyumu ya m'chiuno ndi 3,3,6,6 cm.
Kuchepa kwa thupi kunawonedwa mwa odwala onse omwe amalandira chithandizo cha Victoza ®, ngakhale atakumana ndi vuto lodana ndi mseru.
Mankhwala Viktoza ® monga gawo la mankhwala osakanikirana ndi metformin adachepetsa kuchuluka kwa mafuta ozungulira ndi 13-17%.
Osamwa mowa wa boatohepatosis
Liraglutide amachepetsa kuuma kwa steatohepatosis mwa odwala matenda a shuga a 2.
Kupsinjika kwa magazi
Kafukufuku wazachipatala wa nthawi yayitali wasonyeza kuti mankhwalawa Victoza ® amachepetsa kuthamanga kwa magazi a systolic ndi pafupifupi 2.3-6.7 mm Hg. milungu iwiri yoyambirira ya chithandizo. Kuchepa kwa magazi a systolic kumachitika musanayambe kuchepa thupi.
Zambiri zakuchipatala
Pakuyerekeza kopitilira muyeso ndi chitetezo cha mankhwalawa Victoza ® (pa Mlingo wa 1.2 mg ndi 1.8 mg) ndi choletsa dipeptidyl peptidase-4 sitagliptin pa mlingo wa 100 mg mwa odwala omwe sanakwaniritse bwino pa chithandizo cha metformin, kutsika kwabwino kunatsimikiziridwa pambuyo pa milungu 26 ya mankhwala HbA1s mukamagwiritsa ntchito Victoza ® mu Mlingo onse awiri poyerekeza ndi sitagliptin (-1.24%, -1.50% poyerekeza ndi -0.90%, p ® poyerekeza ndi sitagliptin (43,7% ndi 56.0% ndi poyerekeza ndi 22.0%, p ® inali yayitali kwambiri poyerekeza ndi odwala omwe analandira sitagliptin (-2.9 kg ndi -3.4 kg, poyerekeza -1.0 kg, p ®, nseru zinali zofala. Komabe nseru inali yochepa, ndipo zochitika za Hypoglycemia wofatsa sizinali zosiyana kwambiri atachiritsidwa ndi Victoza ® ndi sitagliptin (0.178 ndi 0.161, poyerekeza ndi 0.106 milandu / wodwala pachaka).1s ndi mwayi wa Viktoza ® poyerekeza ndi sitagliptin adawonedwa pambuyo pa sabata la 26 la mankhwala ndi Viktoza ® (1,2 mg ndi 1.8 mg) ndipo adatsimikizika pambuyo pa sabata la 52 la chithandizo (-1.29% ndi -1.51% Poyerekeza ndi -0.88%, p ®, zomwe zidapangitsa kutsika kwakukulu kwa HbA1s pa sabata la 78 la chithandizo (0,24% ndi 0,45%, 95 Cl: kuchokera ku 0.41 mpaka 0.07 ndi kuchokera -0.67 mpaka 0.23).
Pa kafukufuku woyerekeza mphamvu ndi chitetezo cha mankhwalawa Victoza ® (pa mlingo wa 1.8 mg) ndi exenatide (pa mlingo wa 10 μg kawiri patsiku) mwa odwala omwe sanakwanitse kuwongolera mokwanira pa mankhwalawa ndi metformin ndi / kapena sulfonylurea, atatha masabata 26 atagwiritsa ntchito mankhwalawa Victoza ® adazindikira kuchepa kwakukulu kwa HbA1s poyerekeza ndi exenatide (-1.12% poyerekeza ndi -0.79%, p ® poyerekeza ndi exenatide (54.2% poyerekeza ndi 43.4%, p = 0.0015). Kulemera kwa pafupifupi 3 makilogalamu. Chiwerengero cha odwala omwe anali ndi mseru anali ochepa m'magulu a odwala omwe amalandira mankhwalawa Viktoza ®, poyerekeza ndi exenatide. Kuchulukana kwa hypoglycemia kunachepa kwambiri pagulu la odwala omwe amalandira mankhwalawa Viktoza ®, poyerekeza ndi exenatide ( 1 932 poyerekeza ndi milandu ya 2 600 / wodwala pachaka, p = 0.01) Pambuyo pa masabata 26 okhudzana ndi exenatide, odwala amakhoza adasamutsidwira ku Victoza ®, zomwe zidapangitsa kutsika kwakukulu kwa HbA1s pa sabata la 40 la mankhwalawa (-0.32%, p ® kwa masabata 52 anasintha kumva kwa insulini poyerekeza ndi kukonzekera kwa sulfonylurea, komwe kunawululidwa pogwiritsa ntchito mtundu wa homeostatic popanga HOMA-IR insulin.

Pharmacokinetics
Mafuta
The mayamwidwe liraglutide pambuyo subcutaneous makonzedwe, pang'onopang'ono, nthawi kufikira pazipita plasma ndende ndi 8-12 mawola mlingo wa mankhwala. Kuzindikira kwakukulu (Cmax) liraglutide mu plasma atatha kulowetsedwa mwanjira imodzi ya 0.6 mg ndi 9,4 nmol / L. Ndi kukhazikitsidwa kwa liraglutide pa mlingo wa 1,8 mg, chisonyezero chapakati chofananira ndende ya plasma (AUC?/24) imafika pafupifupi 34 nmol / L. Kuwonetsedwa kwa liraglutide kumalimbikitsidwa molingana ndi mlingo womwe umaperekedwa. Pambuyo makonzedwe a liraglutide mu limodzi mlingo, intrapopulation coeffnty kusintha m'malo omwe amakhala mu ndende nthawi ya AUC ndi 11%. Mtheradi bioavailability wa liraglutide pambuyo subcutaneous makonzedwe pafupifupi 55%.
Kugawa
Kuchuluka kwa magawidwe a liraglutide mu minofu pambuyo pa subcutaneous makonzedwe ndi 11-17 malita. Pafupifupi muyeso wogawa liraglutide pambuyo pa intravenous makonzedwe ndi 0.07 l / kg. Liraglutide imamangilira mapuloteni a plasma (> 98%).
Kupenda
Kwa maola 24 pambuyo pa kuperekedwa kwa odzipereka athanzi limodzi la 3 H-liraglutide yolembedwa ndi radioot isotope, gawo lalikulu la plasma silinasinthe liraglutide. Ma metabolites awiri a plasma adapezeka (≤ 9% ndi ≤ 5% ya kuchuluka kwa plasma radioacaction). Liraglutide imapangidwira mozungulira, monga mapuloteni akuluakulu, osakhudza gawo lililonse monga njira yowonekera.
Kuswana
Mlingo wa 3 H-liraglutide utaperekedwa, liraglutide wosasinthika sanapezeka mumkodzo kapena ndowe. Kachigawo kochepa chabe kamene kamayendetsedwa ndi radioactivity mwa ma metabolites omwe amalumikizana ndi liraglutide (6% ndi 5%, motero) ndi impso kapena matumbo. Zinthu zokhala ndi wailesi zimapukutidwa ndi impso kapena matumbo, makamaka masiku 6 kapena 6 atatha kumwa mankhwalawa, ndipo ndi metabolites atatu. Wapakati chilolezo kuchokera thupi pambuyo subcutaneous makonzedwe a liraglutide limodzi mlingo pafupifupi 1,2 l / h ndi kuthetsa theka moyo pafupifupi 13 maola.
Magulu apadera a odwala
Ukalamba:
Kafukufuku wa Pharmacokinetic pagulu la odzipereka athanzi komanso kusanthula kwa data ya pharmacokinetic omwe amapezeka mwa odwala (azaka 18 mpaka 80) akuwonetsa kuti zaka sizikhala ndi vutoli kwakukulu pamatenda a pharmacokinetic a liraglutide.
Jenda: Kafukufuku wopanga kuchuluka kwa anthu omwe amapezeka pofufuza zotsatira za liraglutide mwa odwala achimuna ndi amuna, ndi kafukufuku wa pharmacokinetic pagulu la odzipereka omwe ali ndi thanzi labwino akuwonetsa kuti jenda silikhala ndi vuto lililonse la pharmacokinetic katundu wa liraglutide.
Fuko: Kafukufuku wogwiritsa ntchito anthu ku pharmacokinetic pofufuza momwe zotsatira za liraglutide zimayendera m'magulu azungu, akuda, aku Asia, ndi ku Spain akuti anthu amtundu sakhala ndi vuto lililonse panjira ya pharmacokinetic ya liraglutide.
Kunenepa kwambiri: Kafukufuku wowerengeka woyerekeza kuchuluka kwa anthu akusonyeza kuti mzere wambiri (BMI) ulibe gawo lalikulu pakukhudzana kwa pharmacokinetic liraglutide.
Kulephera kwa chiwindi:
Mankhwala a pharmacokinetic a liraglutide adawerengeka pa kafukufuku wamankhwala a mlingo umodzi wa mankhwalawa omwe ali ndi matenda osiyanasiyana a chiwindi. Odwala omwe ali ndi vuto lochepa la hepatic (malinga ndi gulu la ana Pugh, kudwala kwamtundu wa 5 - 6 mfundo) komanso kusokonekera kwambiri kwa hepatic (malinga ndi gulu la Mwana Pugh, kudwala kwazovuta> 9 point) anaphatikizidwa mu phunziroli. Kuwonetsedwa kwa liraglutide pagulu la odwala omwe ali ndi vuto la chiwindi sikunali kwakukulu kuposa komwe kumachitika mu gulu la maphunziro abwino, zomwe zikuwonetsa kuti kulephera kwa chiwindi sikukhudza kwambiri pharmacokinetics ya liraglutide.
Kulephera kwamayiko:
Pharmacokinetics ya liraglutide yaphunziridwa mwa odwala omwe ali ndi madigiri osiyanasiyana a kulephera kwa impso mu kafukufuku umodzi. Kafukufukuyu anaphatikiza maphunziro omwe ali ndi kusiyanasiyana kwa kulephera kwa impso: kuchokera pa kufatsa (kuwunika kwa creatinine chilolezo cha 50-80 ml / min) mpaka kuukali (kuyesa kwa imvume ya creatinine ® mwa ana sikunachitike.
Dongosolo Losanthula Phunziro la Chitetezo
Zotsatira za kafukufuku wamakhalidwe oyamwa ndi kuyambitsa kuchuluka kwa mankhwalawa, kuphatikizapo genotoxicity, zikuwonetsa kuti kugwiritsa ntchito liraglutide sikuyambitsa thanzi la munthu.
Chithokomiro cha chithokomiro cha C cha cell cha makoswe ndi mbewa zinkadziwika pazaka ziwiri zakufufuza zamankhwala omwe amapezeka m'miyendo ndipo sizinawaphe. Mlingo wopanda poizoni (NOAEL) sunakhazikitsidwe makoswe. Kuwoneka kwa zotupa zotere mu mbewa zochitidwa ndi liraglutide kwa miyezi 20 sikunachitike. Zotsatira zomwe zidapezedwa m'maphunziro pa makoswe zimayenderana ndi kuti makoswe amamva kwambiri makina omwe si a genotoxic eniake omwe amaphatikizidwa ndi GLP-1 receptor. Tanthauzo la zomwe zimapezeka kwa anthu ndizotsika, koma sizingasiyidwe konse. Maonekedwe a neoplasms ina iliyonse yokhudzana ndi mankhwalawa sanawonedwe.
Kafukufuku wanyama sanawonetse chovuta cha mankhwalawa chonde, koma pakhala chiwonjezeko chambiri mu pafupipafupi kumwalira koyambirira kwa nthawi ya mankhwalawa panthawi yamankhwala omwe ali ndi mlingo waukulu kwambiri wa mankhwalawo. Kukhazikitsidwa kwa mankhwala a Viktoza ® ku makoswe mkati mwa mimba yawo kunawapangitsa kuti achepetse thupi la amayi awo komanso kukula kwa mluza ndi zomwe amaphunzira mosakwanira nthiti, komanso kupatuka kwa kapangidwe ka mafupa m'gulu la akalulu. Kukula kwa akhanda m'gululi kunachepa panthawi ya mankhwala ndi Victoza ®, ndipo kuchepa uku kumapitirirabe pambuyo poyamwitsa m'gululi la mitundu yolandiridwa ndi liraglutide. Sizikudziwika zomwe zinapangitsa kuchepa kotereku kwa makoswe obadwa kumene - kuchepa kwa mkaka wa amayi awo chifukwa chakuwongolera mwachindunji kwa GLP-1, kapena kusakwanira kwa mkaka wa m'mawere ndi makoswe a amayi chifukwa chakuchepa kwa kudya kwawo kwa calorie.

Mlingo

Subcutaneous solution 6 mg / ml

1 ml yankho lili

yogwira mankhwala - liraglutide 6 mg,

excipients: sodium hydrogen phosphate dihydrate, propylene glycol, phenol, hydrochloric acid (2M solution) / sodium hydroxide (2M solution), madzi a jakisoni.

Transparent colorless kapena pafupifupi color color, kopanda zopanda pake pakayesedwe.

Mlingo ndi makonzedwe

Mankhwala Viktoza® amagwiritsidwa ntchito kamodzi patsiku nthawi iliyonse, mosasamala kanthu za kudya, amatha kutumikiridwa ngati jekeseni wamkati pamimba, ntchafu kapena phewa. Malo ndi nthawi ya jakisoni zimatha kusiyanasiyana popanda kusintha kwa mlingo. Komabe, ndikofunikira kumwa mankhwalawa nthawi yomweyo, nthawi yabwino kwa wodwala. Zambiri pazomwe mungagwiritse ntchito mankhwalawa Viktoza® zimapezeka pagawo kuti mugwiritse ntchito ndikuchotsa. Mankhwala Viktoza ® sangathe kugwiritsidwa ntchito pakuwongolera ndi mtsempha wamitsempha.

Mlingo woyamba wa Victoza® ndi 0,6 mg wa patsiku. Mukatha kugwiritsa ntchito mankhwalawa kwa sabata limodzi, mlingo uyenera kuchuluka mpaka 1.2 mg. Pali umboni kuti mwa odwala ena, phindu la mankhwalawa limawonjezeka ndi kuwonjezeka kwa mlingo wa mankhwalawa kuchokera ku 1.2 mg mpaka 1.8 mg. Kuti akwaniritse kuwongolera bwino kwambiri kwa glycemic mwa wodwala ndikutengera luso la kuchipatala, mlingo wa Viktoza® ukhoza kuwonjezeka mpaka 1.8 mg mukatha kugwiritsa ntchito mlingo wa 1.2 mg kwa sabata limodzi. Kugwiritsa ntchito mankhwalawa tsiku ndi tsiku pamwambapa 1.8 mg ndikulimbikitsidwa.

Mankhwala Victoza ® amatha kugwiritsidwa ntchito ngati chowonjezera pakubwera kwa mankhwala omwe alipo ndi metformin kapena mankhwala ophatikizika ndi metformin ndi thiazolidinedione. Mankhwalawa ndi metformin osakanikirana ndi thiazolidatedione akhoza kupitilizidwa Mlingo wapano.

Victoza ® ikhoza kugwiritsidwa ntchito ngati adjunct panthawi yomwe ilipo sulfonylurea mankhwala kapena pophatikiza ndi metformin ndi sulfonylurea kapena basal insulin. Viktoza ® ikangowonjezeredwa ku sulfonylurea kapena basal insulin, njira yochepetsera sulfonylurea kapena basal insulin iyenera kuganiziridwa kuti muchepetse chiopsezo cha hypoglycemia yosafunikira (onani gawo "Malangizo Apadera").

Kusintha mlingo wa Victoza®, kudziwunikira kwa shuga wamagazi sikofunikira. Komabe, kumayambiriro kwa mankhwala a Viktoza® osakanikirana ndi zotumphukira za sulfonylurea kapena basal insulin, kudziwunikira kwa shuga wamagazi kungafunike kusintha mlingo wa kukonzekera kwa sulfonylurea.

Magulu apadera a odwala

Okalamba (> zaka 65): Palibe kusankha kwa mlingo womwe umafunikira malinga ndi zaka zake. Palibe chidziwitso chochepa pakugwiritsira ntchito mankhwalawa odwala omwe ali ndi zaka 75 ndi kupitirira (onani gawo "Pharmacokinetics").

Odwala ndi mkhutu aimpso ntchito

Palibe chifukwa chosinthira mankhwalawa odwala omwe ali ndi mawonekedwe ofatsa aimpso (creatinine chilolezo 60 - 90 ml / min). Pali zochepa chabe pochiza odwala omwe amalephera kupweteka aimpso (creatinine chilolezo 30-59 ml / min) ndipo palibe chidziwitso chamankhwala a odwala omwe amalephera kwambiri aimpso (creatinine chilolezo pansi pa 30 ml / min). Pakadali pano, Victoza sakuvomerezeka kuti agwiritsidwe ntchito ndi odwala omwe ali ndi vuto loopsa laimpso, ngakhale odwala omwe ali ndi vuto la matenda a impso (onani gawo la Pharmacokinetics)

Odwala omwe ali ndi vuto la chiwindi

Zomwe zimachitika pothandiza odwala omwe ali ndi vuto lililonse la chiwindi (mofatsa, modekha komanso mwamphamvu) pakali pano ndizochepa kwambiri polimbikitsa kugwiritsa ntchito Victoza (onani gawo la Pharmacokinetics).

Odwala odwala

Mankhwala Victoza ali osavomerezeka kwa ana ndi achinyamata ochepera zaka 18 chifukwa cha kusowa kwa chitetezo chazomwe zimagwiritsidwa ntchito.

Zotsatira zoyipa

M'mayesero azachipatala, zotsatira zoyipa zomwe zimanenedwa kawirikawiri kuchokera m'mimba: m'mimba ndi matenda am'mimba (olembedwa> 10% ya odwala), kusanza, kudzimbidwa, kupweteka kwam'mimba komanso zizindikiro za kukomoka (zolembedwa mu ≥ 1%, koma ≤ 10 % ya odwala).

Kumayambiriro kwa mankhwalawa ndi Viktoza ®, zovuta zoyipa zam'mimba izi zimatha kuchitika pafupipafupi, koma m'mene chithandizo chimapitirira, zotsatira zake zimachepera masiku angapo kapena masabata. Zotsatira zoyipa mwanjira ya kupweteka kwam'mutu komanso matenda am'mimba opatsirana amawonedwa pafupipafupi (1 - 10% ya odwala). Kuphatikiza apo, kukulitsa kwa machitidwe a hypoglycemic ndikotheka, makamaka mukamagwiritsa ntchito mankhwala Victoza® osakanikirana ndi mankhwala a sulfonylurea (olembetsedwa>> 10% ya odwala). Hypoglycemia yayikulu imayamba kutsutsana ndi maziko osakanikirana a mankhwala a Viktoza® omwe ali ndi sulfonylureas.

Zotsatira zoyipa zazinenedwapo nthawi zambiri.

Kufotokozera kwa zomwe zimachitika munthu akamakumana ndi mavuto

Mu kafukufuku wazachipatala ogwiritsa ntchito liraglutide monga monotherapy, zochitika za hypoglycemia zokhala ndi liraglutide zinali zochepa poyerekeza ndi hypoglycemia mwa odwala omwe amathandizidwa ndi mankhwala omwe amagwiritsidwa ntchito (glimepiride). Zovuta zomwe zimachitika kawirikawiri zimaphatikizapo matenda am'mimba, matenda, komanso kuzizira.

Zolemba zambiri za hypoglycemia zotsimikizika m'mayesero azachipatala sizinachitike. Pakafukufuku wogwiritsa ntchito liraglutide monga monotherapy, panalibe milandu yayikulu ya hypoglycemia. Zolemba zowopsa za hypoglycemia sizachilendo ndipo poyambirira zimawonedwa ndikugwiritsa ntchito liraglutide kuphatikiza ndi sulfonylurea (zochitika za 0.02 pachaka cha odwala). Chiwopsezo chochepa kwambiri cha ma episode (0.001 episode pa zaka zodwala) chikuwonetsedwa ndi kayendetsedwe ka liraglutide kuphatikiza ndi antidiabetesic antchito ena kupatula sulfonylurea. Chiwopsezo cha hypoglycemia ndichopere ndikugwiritsa ntchito basal insulin ndi liraglutide (chigawo cha 1.0 pachaka cha odwala, onani gawo la Pharmacodynamics).

Mimba Zosiyanasiyana

Pamene liraglutide ndi metformin ataphatikizidwa, odwala 20,7% adanenapo za gawo limodzi la nseru ndi 12,6% ya odwala adanena gawo limodzi la matenda am'mimba.

Pamene liraglutide yophatikizidwa ndi sulfonylurea, odwala 9.1% adanenapo za gawo limodzi la nseru ndi 7.9% ya odwala adanena gawo limodzi la matenda otsegula m'mimba. Zotsatira zoyipa zambiri zinali zofatsa kapena zopatsa mphamvu ndipo zinali ndi chikhalidwe chodalira mlingo.

Ndi chithandizo chotenga nthawi yayitali, kufupika ndi kuchepa kwa odwala ambiri omwe anali ndi mseru koyamba.

Kwa odwala omwe ali ndi zaka zopitilira 70, pochiza ndi liraglutide, vuto la m'mimba limatha kuchitika kawirikawiri.

Odwala omwe ali ochepetsetsa pang'ono komanso aimpso kulephera (kwa mtundu wa creatinine chilolezo cha 60-90 ml / mphindi ndi 30-59 ml / mphindi,), matumbo amkati amachitika nthawi ya mankhwala a liraglutide.

Kuchotsedwa kwa Odwala Kuchokera Mayesero

M'mayesero olamulidwa kwanthawi yayitali (masabata a 26 kapena kupitirira apo), kuchuluka kwa odwala omwe sanatengere mayeso chifukwa chotsatira chotsatira anali 7.8% kwa odwala omwe amathandizidwa ndi liraglutide ndi 3.4% kwa odwala ochokera pagulu lothandizira poyerekeza. Zotsatira zoyipa zomwe zimapangitsa kuti mayeserowa atengedwe pochotsa odwala omwe ali ndi liraglutide zimaphatikizapo nseru (2.8% ya odwala) ndi kusanza (1.5% ya odwala).

Zokhudza malo jakisoni

Zomwe zimachitika jekeseni la mankhwalawa zidanenedwa pafupifupi 2% ya odwala pakapita nthawi yayitali a Victoza (masabata 26 kapena kuposerapo). Izi zimachitika nthawi zambiri.

Pakupita kwa nthawi yayitali mayesero a Victoza (masabata 26 kapena kuposerapo), pakhala pali milandu yambirimbiri yokhudza kupweteka kwa kapamba (pancreatitis)

Contraindication

- Hypersensitivity ku chinthu yogwira kapena zina

zida zomwe zimapanga mankhwala

- gwiritsani ntchito odwala omwe ali ndi matenda a shuga 1

- mankhwala a matenda ashuga ketoacidosis

kwambiri aimpso ndi kwa chiwindi kulephera

- ana ndi achinyamata azaka zapakati pa 18

- mimba ndi mkaka wa m`mawere

Zochita zamankhwala osokoneza bongo

Mu vitro kugwiritsa ntchito mankhwala

Liraglutide adawonetsa kuthekera kocheperako kwa kayendedwe ka mankhwala osokoneza bongo chifukwa cha kagayidwe mu cytochrome P-450 (CYP), komanso kumanga mapuloteni a plasma.

Mu vivo kuyanjana kwa mankhwala osokoneza bongo

Kuchepetsa pang'ono m'matumbo mukamayamwa liraglutide kumatha kukhudza mayamwidwe amtundu wothandizidwa pakamwa. Kafukufuku wokhudzana ndi mankhwala osokoneza bongo sanawonetse kuchepa kwakanthawi kokwanira kwa mankhwalawa. Odwala angapo omwe amathandizidwa ndi Victoza® anali ndi gawo limodzi la matenda otsekula m'mimba. Kutsekula m'mimba kumatha kuthana ndi mayamwa am'magazi omwe amagwiritsidwa ntchito nthawi imodzi ndi Victoza®.

Warfarin ndi zotumphukira zina za coumarin

Kafukufuku wokhudzana ndi kuyenderana kwa mankhwalawa sanachitike. Kumayambiriro kwa chithandizo cha mankhwala ndi Victoza® mwa odwala omwe amalandila warfarin kapena zotumphukira zina, ndikofunikira kuti aziyang'anira INR (International Normalized Relationship) pafupipafupi.

Liraglutide sizinachititse kusintha kwakukulu kwa paracetamol pambuyo paudindo wake umodzi wa 1000 mg. Kuchuluka kwa paracetamol mu plasma (Cmax) kunatsika ndi 31%, ndipo nthawi yayikulu yoti ifike pachimake (tmax) m'magazi a magazi idakulitsidwa ndi mphindi 15. Ndi munthawi yomweyo makonzedwe a liraglutide ndi paracetamol, kusintha kwa mankhwalawa sikofunikira.

Liraglutide sizinachititse kusintha kwakukulu kwakukuru mu zotsatira za atorvastatin pambuyo paudindo wake umodzi 40 mg. Chifukwa chake, kusintha kwa mlingo wa atorvastatin pamene mukumwa Victoza® sikofunikira. Kuchuluka kwa plasma ndende ya atorvastatin (Cmax) kunatsika ndi 38%, ndipo nthawi yayikulu kuti ifike pachimake mu plasma ndende (tmax) mwa odwala omwe amalandila liraglutide kutalika kuchokera kwa maola atatu kapena atatu.

Liraglutide sizinapangitse kusintha kwakukulu kwa griseofulvin pambuyo pa utsogoleri wa limodzi wa 500 mg. Chiwerengero chachikulu cha griseofulvin (Cmax) chakwera ndi 37%, pomwe nthawi yofikira kuchuluka kwake (tmax) mu plasma sinasinthe. Mlingo kusintha kwa griseofulvin ndi mankhwala ena okhala otsika solubility ndi mkulu permeability sikofunikira.

Kukhazikitsidwa kwa digoxin mu gawo limodzi la 1 mg ndikugwiritsa ntchito liraglutide kunawonetsa kuchepa kwa malo omwe ali kumapeto kwa gawo (AUC) la digoxin ndi 16%, kuchuluka kwakukulu kwa plasma (Cmax) kwa digoxin kutsika ndi 31%. Nthawi yofikira kufikira pachimake ndende (tmax) ya digoxin pomwe mukutenga liraglutide inachulukitsa kuchokera ola limodzi ndi theka. Kutengera ndi zotsatira zomwe zapezeka, kusintha kwa digoxin pakumwa liraglutide sikofunikira.

Kupanga kwa lisinopril mu gawo limodzi la 20 mg pamene akugwiritsa ntchito liraglutide kunawonetsa kuchepa kwa malo omwe ali pansi pajika (AUC) ya lisinopril ndi 15%, kuchuluka kwakukulu kwa plasma (Cmax) kwa lisinopril kutsika ndi 27%. Nthawi yayitali yoti afike pachimake (tmax) ya plasma pomwe amatenga liraglutide inakwera kuchokera maola asanu ndi limodzi mpaka asanu ndi atatu. Kutengera ndi zotsatira, kusintha kwa mankhwalawa kwa lisinopril ndi digoxin pamene mukumwa liraglutide sikofunikira.

Kuchuluka kwa plasma ndende (Cmax) ya ethinyl estradiol ndi levonorgestrel mu Mlingo umodzi munthawi ya mankhwala a liraglutide amatsitsidwa ndi 12% ndi 13%, motero. M'mikhalidwe yofananayo, nthawi yofikira kufikira pachimake ndende (tmax) ya mankhwalawa inali maola 1.5 pambuyo pake kuposa masiku onse. Matenda ofunikira kwambiri pazotsatira zonse za ethinyl estradiol ndi levonorgestrel m'thupi alibe liraglutide. Chifukwa chake, njira zakulera zomwe onse awiriwa amapangira pochita ndi liraglutide sizisintha.

Palibe mankhwala a pharmacokinetic kapena pharmacodynamic a liraglutide ndi insulin odziwika omwe adapezeka ndi limodzi ntchito ya insulin detemir pa 0,5 U / kg ndi liraglutide pa mlingo wa 1.8 mg mwa odwala omwe ali ndi mtundu 2 shuga.

Zinthu zomwe zimawonjezeredwa ku Victoza® zimatha kubweretsa kuchepa kwa liraglutide. Popeza kuyeseza koyenderana sikunachitike, Viktoza ® siingasakanikirane ndi mankhwala ena, kuphatikizapo kulowetsedwa.

Malangizo apadera

Victoza ® sayenera kugwiritsidwa ntchito mwa odwala omwe ali ndi matenda osokoneza bongo a mtundu wa 1 kapena matenda a diabetes ketoacidosis.

Victoza® sichilowa m'malo mwa insulin.

Zomwe zimachitika pogwiritsa ntchito Victoza® kwa odwala omwe ali ndi vuto la mtima la makalasi othandizira a I-II malinga ndi Functional Classization of Chronic Heart Failure (CHF) ya New York Cardiac Association (NYHA) ndi yochepa ndipo chifukwa chake liraglutide iyenera kugwiritsidwa ntchito mosamala mwa odwalawo. Palibe chidziwitso chothandizira odwala omwe mtima wawo walephera kwamkalasi yachitatu - IV malinga ndi gulu la NYHA ndipo chifukwa chake kulimbikitsidwa kwa liraglutide mwa odwala sikulimbikitsidwa.

Zambiri pa kugwiritsa ntchito mankhwala a Viktoza® kwa odwala omwe ali ndi matenda am'matumbo a m'matumbo ndi ochepa, kugwiritsa ntchito mankhwala Viktoza ® m'magulu awa odwala sikulimbikitsidwa. Kugwiritsa ntchito mankhwalawa Viktoza® kumalumikizidwa ndi kukhazikika kwakanthawi kochepa kochokera m'matumbo am'mimba, monga mseru, kusanza ndi kutsekula m'mimba.

Kugwiritsa ntchito kwa agonists ena a GLP-1 kwalumikizidwa ndi chiopsezo chokhala ndi pancreatitis. Milandu ingapo ya kapamba amphaka amanenedwa. Odwala ayenera kudziwitsidwa za mawonekedwe a kakulidwe kachulukidwe kapamba: kulimbikira kupweteka kwambiri pamimba. Ngati pancreatitis ikukayikiridwa, chithandizo cha mankhwala a Victoza® ndi mankhwala ena owopsa ayenera kuyimitsidwa nthawi yomweyo.

Mukamatsimikizira kuti pali pancreatitis yodziwika bwino, kugwiritsa ntchito mankhwala a Viktoza® sikuyenera kuyambiranso. Chenjezo liyenera kuchitika popereka mankhwala kwa odwala omwe ali ndi mbiri ya kapamba.

Matenda a chithokomiro

Pa mayesero azachipatala a Victoza ®, zovuta za chithokomiro zimanenedwa, kuphatikizapo kukwezedwa kwa seramu calcitonin, kuphatikiza chithokomiro cha chithokomiro ndi chithokomiro, motero liraglutide iyenera kugwiritsidwa ntchito mosamala, makamaka kwa odwala omwe ali ndi matenda omwe analipo kale. chithokomiro cha chithokomiro (onani gawo "Zotsatira zoyipa").

Odwala omwe akutenga liraglutide kuphatikiza ndi sulfonylurea kapena basal insulin atha kukhala ndi chiopsezo cha hypoglycemia (onani gawo "Zotsatira zoyipa"). Chiwopsezo cha hypoglycemia chitha kuchepetsedwa pochepetsa mlingo wa sulfonylurea kapena basal insulin.

Zizindikiro ndi kuchepa kwa madzi m'thupi, kuphatikizapo kuperewera kwaimpso ndi kulephera kwaimpso, afotokozedwa mwa odwala omwe akutenga liraglutide. Odwala omwe akutenga liraglutide ayenera kulangizidwa za kuchepa kwa madzi m'thupi kutengera zotsatira zoyipa kuchokera m'matumbo am'mimba ndikulimbikitsidwa kuti chisamaliro chitengedwe popewa kuchepa kwamadzi m'thupi.

Dongosolo Losanthula Phunziro la Chitetezo

Zotsatira zamaphunziro oyambira, potsatira maphunziro omwe amavomerezedwa ambiri pamatenda, kawopsedwe omwe ali ndi Mlingo wambiri wa mankhwala ndi genotoxicity, adawonetsa kuti kugwiritsa ntchito liraglutide sikuwopseza thanzi la munthu.

Neoplasms ya rat chithokomiro C-maselo ndi mbewa zapezeka pazaka ziwiri zoyesera za kuvomerezeka kwa mankhwala mu makoswe ndipo sizinaphe. Palibe umboni wazotsatira zoyipa (NOAEL) zomwe zimawonedwa ndi makoswe. Kuoneka kwa ma neoplasms otere mu mbewa zochitidwa ndi liraglutide kwa miyezi 20 sikunachitike. Zotsatira zomwe zimapezeka pamayeso pa makoswe zimagwirizana ndi mfundo yoti makoswe amamva kwambiri makulidwe a glucagon-peptide -1 (GLP-1) osagwidwa. Kufananira kwa zomwe zimapezeka kwa anthu ndizotsika, koma sizingasiyidwe konse. Maonekedwe a neoplasms ina iliyonse yokhudzana ndi mankhwalawa sanawonedwe.

M'maphunziro a nyama, panalibe chowongolera chachindunji cha mankhwalawa pachonde, koma panali kuwonjezeka pang'ono kwa kufa kwa embryonic koyambirira panthawi yamankhwala ndikumwa kwambiri. Kukhazikitsidwa kwa mankhwala a Viktoza ku makoswe pakatikati pa nthawi ya bere kunawapangitsa kuti achepetse kulemera kwa thupi la amayi ndi mluza momwe zimakhudzira nthiti zomwe sizimamveka bwino, komanso kupatuka kwa kapangidwe ka chigoba m'gulu la akalulu. Kukula kwa akhanda pagulu la makoswe panthawi ya mankhwala ndi Victoza kunachepa, ndipo kuchepa kumeneku kunapitirirabe kwakanthawi pambuyo poyamwitsa gulu la mitundu yolandira mitundu yayikulu ya liraglutide. Sizikudziwika zomwe zinapangitsa kuchepa kotereku kwa makoswe obadwa kumene - kuchepa kwa kumwa kwawo mkaka wa amayi chifukwa chakuwongolera mwachindunji kwa gluc-1 peptide GLP-1, kapenanso kusakwanira kwa mkaka wa m'mawere ndi makoswe a amayi chifukwa chakuchepa kwa chakudya chawo cha ma calorie.

Pambuyo pa kubaya kwa jekisoni wa liraglutide mu akalulu, wofatsa wocheperako kutulutsa magazi, redness, ndi kutupa pamalo a jekeseni adawonedwa.

Gwiritsani ntchito pa nthawi yoyembekezera komanso nthawi yoyamwitsa

Kafukufuku wanyama sanawonetse chovuta cha mankhwalawa chonde, koma pakhala chiwonjezeko chambiri mu pafupipafupi kumwalira koyambirira kwa nthawi ya mankhwalawa panthawi yamankhwala omwe ali ndi mlingo waukulu kwambiri wa mankhwalawo. Kapangidwe ka Viktoza ® kuti makoswe pakati pa pakati pawo kunapangitsa kuchepa kwa thupi la amayi awo ndi kukula kwa mluza, zomwe zimapangitsa kuphunzira nthito, komanso kupatuka pamapangidwe am'magulu azigulu. Kukula kwa anthu obadwa kumene mu gulu la akhola pa mankhwala a Victoza® kunachepa, ndipo kuchepa kumeneku kunapitirira pambuyo poyamwitsa m'gululi la anthu omwe amalandira mlingo waukulu wa liraglutide. Sizikudziwika zomwe zinapangitsa kuchepa kotereku kwa makoswe obadwa kumene - kuchepa kwa mkaka wa amayi awo chifukwa chakuwongolera mwachindunji kwa GLP-1, kapena kusakwanira kwa mkaka wa m'mawere ndi makoswe a amayi chifukwa chakuchepa kwa chakudya chawo cha ma calorie.

Zambiri zokwanira pa kugwiritsa ntchito mankhwalawa Victoza® mwa amayi apakati sizikupezeka. Chiwopsezo chomwe chilipo kwa anthu sichikudziwika.

Mankhwala Viktoza ® sangathe kugwiritsidwa ntchito pa nthawi yomwe ali ndi pakati, m'malo mwake, amalimbikitsidwa kuchita ndi insulin. Ngati wodwalayo akukonzekera kutenga pakati, kapena kuti mimba yayamba kale, chithandizo chokhala ndi Victoza® chiyenera kuyimitsidwa nthawi yomweyo.

Palibe zokuchitikirani ndi kugwiritsa ntchito mankhwala Victoza® mwa amayi oyamwitsa, kugwiritsa ntchito mankhwalawa pakamwa kumayesedwa.

Zambiri za momwe mankhwalawa amatha kuyendetsa magalimoto ndi machitidwe ake owopsa

Kafukufuku wokhudzana ndi mphamvu ya mankhwalawa Victoza ® pa luso loyendetsa magalimoto ndi kugwira ntchito ndi njira sikunachitike. Odwala ayenera kuchenjezedwa kuti ayenera kusamala kuti apewe kutukuka kwa vuto la hypoglycemia poyendetsa ndi kugwiritsa ntchito njira, makamaka ngati Victoza ® imatengedwa ngati gawo la mankhwala osakanikirana ndi sulfonylureas kapena basal insulin.

Bongo

Zizindikiro: munthawi ya chipatala cha Victoza ®, m'modzi mwa odwala omwe ali ndi matenda amishuga yachiwiri adakumana ndi mankhwala osokoneza bongo omwe amapezeka ndi jekeseni wa 72 mg (40% ya mlingo woyenera wa 1.8 mg). Mankhwala osokoneza bongo amachititsa mseru kwambiri komanso kusanza. Palibe hypoglycemia yomwe idadziwika. Wodwalayo anachira kwathunthu popanda zovuta.

Chithandizo: Njira zoyenera zamankhwala zimavomerezeka, kutengera ndi zizindikiro ndi zizindikiro zake.

Mankhwala

Liraglutide ndi analogue ya anthu GLP-1 (glucagon-like peptide-1). Kupangidwa ndi njira yogwiritsira ntchito biotechnology ya recombinant DNA (deoxyribonucleic acid) pogwiritsa ntchito Saccharomyces cerevisiae strain, yomwe ili ndi 97% ya Homology yaumunthu ya GLP-1, imamanga ndikuyambitsa zolandirira za GLP-1 mwa anthu.

RecPoror ya GLP-1 ndi chandamale cha omwe ali ndi chiberekero cha GLP-1, chomwe ndi hormone yakumapeto ya insretin, yomwe imalimbikitsa shuga-wodalira insulin secretion m'maselo a pancreatic β-cell. Poyerekeza ndi mbadwa za GLP-1, ma pharmacodynamic ndi ma pharmacokinetic Mbiri ya liraglutide amalola kuti ziziyendetsedwa kamodzi patsiku.

Ndi jakisoni wotsekemera, mawonekedwe a chinthucho amakhala motengera njira zitatu:

  • kuyanjana, komwe kumapereka kuyimitsidwa kwa liraglutide,
  • zomatira albin,
  • kuchuluka kwa kukhazikika kwa enzymatic motsutsana ndi DPP-4 (dipeptidyl peptidase-4) ndi NEP (enzyme neutral endopeptidase), yomwe imapangitsa T yayitali1/2 (theka-moyo) wa chinthu kuchokera plasma.

Zotsatira za liraglutide zimakhazikitsidwa pakuyanjana ndi ma GLP-1 receptors enieni, chifukwa chomwe kuchuluka kwa cAMP (cyclic adenosine monophosphate) kumakulirakulira. Mothandizidwa ndi chinthucho, kukhudzika kwa glucose komwe kumapangitsa kuti insulin itulutsidwe kumawonedwa, ndipo ntchito ya pancreatic β-cell imayenda bwino. Nthawi yomweyo, kutsanulira kwa glucose komwe kumachitika mobisa kwambiri. Chifukwa chake, ndi kuchuluka kwa shuga m'magazi, kubisala kwa glucagon kumachepetsa ndipo kutulutsidwa kwa insulin kumalimbikitsidwa.

Komabe, odwala omwe ali ndi hypoglycemia, liraglutide amatsitsa insulin secretion popanda kuletsa secretion wa glucagon. Njira yochepetsera glycemia imaphatikizaponso kuchepetsedwa pang'ono kwa kutsuka kwa m'mimba. Pogwiritsa ntchito njira zomwe zimayambitsa kuchepa kwa njala komanso kuchepa kwa mphamvu yamagetsi, liraglutide imabweretsa kuchepa kwa minofu ya adipose komanso kuwonda.

GLP-1 ndi owongolera azakudya ndi zama calorie, zolandilira za peptidezi zimapezeka m'malo angapo aubongo omwe akukhudzidwa ndi kayendetsedwe kazakudya.

Mukamachititsa maphunziro a nyama, zidapezeka kuti kudzera mwa kuphatikiza mwachindunji kwa zolandila za GLP-1, liraglutide imathandizira zizindikiritso ndikuchepetsa ma siginolo am'manja, potero kumatsogolera kuwonda.

Komanso, malinga ndi maphunziro a nyama, liraglutide imachedwetsa kukula kwa matenda ashuga. Katunduyu ndiwothandiza kwambiri pakukondweretsedwa kwapadera kwa pancreatic β-cell ndikulepheretsa imfa ya β-cell (apoptosis), yomwe imayendetsedwa ndi ma cytokines ndi mafuta aulere acids. Chifukwa chake, liraglutide imawonjezera insulin biosynthesis ndikuwonjezera kuchuluka kwa β-cell. Pambuyo polimbitsa shuga ndende, liraglutide imasiya kuwonjezera kuchuluka kwa ma pancreatic β-cell.

Wovutitsayo amakhala ndi nthawi yayitali ya maola 24 ndikuwongolera kuwongolera kwa glycemic, komwe kumatheka chifukwa chochepetsa kuchuluka kwa shuga m'magazi ndikatha kudya ndi shuga yachiwiri.

Gulu la mankhwala

Mankhwala ena a hypoglycemic, kupatulapo insulin.

Code ATC A10V X07.

Victoza ® imagwiritsidwa ntchito pochiza mtundu wachiwiri wa matenda a shuga kwa anthu akuluakulu kuti akwaniritse kuwongolera kwa glycemic molumikizana ndi:

  • metformin kapena sulfonylurea mu odwala omwe ali ndi vuto loipa la glycemic, ngakhale akugwiritsa ntchito mankhwala ambiri a metformin kapena sulfonylurea monga monotherapy,
  • metformin ndi sulfonylureas, kapena metformin ndi thiazolidinediones mu odwala omwe ali ndi vuto loipa la glycemic ngakhale atalandira chithandizo kawiri.

Kuphatikiza chithandizo ndi basal insulin mwa odwala omwe sanakwanitse kuwongolera glycemic moyenera mothandizidwa ndi Viktoza ndi metformin.

Zotsatira zoyipa

M'mayeso asanu akuluakulu azachipatala a nthawi yayitali, odwala opitilira 2500 adalandira Victoza ® yekha kapena kuphatikiza ndi metformin, wokhala ndi glimepiride (wokhala ndi metformin kapena wopanda metformin), sulfonylurea (wokhala ndi kapena wopanda metformin), kapena metformin + rosiglitazone.

Kuwunika kwa zotsatira zoyipa kunachitika pa zotsatirazi: nthawi zambiri

(≥ 1/10), nthawi zambiri (kuyambira ≥ 1/100 mpaka ® - 2501). Zotsatira zoyipa zotsatirazi zimafotokozedwa, zomwe zimachitika kuti pagulu la odwala omwe amalandira mankhwalawa Viktoza® inadutsa kuposa 5% pafupipafupi pagulu lomwe adalandira mankhwala oyerekeza. Zotsatira zoyipa zimaphatikizidwanso, zomwe zimachitika kuti ndi ³1%, koma zimachitika nthawi zopitilira 2 poyerekeza ndi mankhwala oyerekeza.

Matenda a Metabolic ndi zakudya: Nthawi zambiri - hypoglycemia, anorexia, adachepetsa chilakolako chambiri - kuchepa thupi *.

Mavuto a Mitsempha Yotupa: Nthawi zambiri - mutu, chizungulire.

Mavuto Oopsa: Nthawi zambiri - nseru, kutsegula m'mimba, pafupipafupi - kusanza, kupsinjika, kupweteka pamimba, kudzimbidwa, matenda am'mimba, kutulutsa, kupweteka, gastroesophageal Reflux matenda, kugaya, kupweteka kwa mano, gastroenteritis kawirikawiri - kapamba).

Matenda a Mtima: nthawi zambiri - kuchuluka kwa mtima (HR).

Matenda Osiyanasiyana: samakonda anaphylactic zimachitika.

Matenda ndi zofalikira: Nthawi zambiri - chapamwamba kupuma thirakiti matenda (nasopharyngitis, bronchitis).

Mavuto azomwe zimapezeka ndi jekeseni: pafupipafupi - malaise, nthawi zambiri - kutopa, kutentha thupi, zomwe zimachitika pamalo a jekeseni.

Impso ndi matenda amkodzo : pafupipafupi - Kulephera kwam impso, * kuwonongeka kwaimpso.

Pa khungu ndi subcutaneous minofu : Nthawi zambiri - wotupa, wowerengeka - urticaria, kuyabwa.

(* Onani gawo la Ntchito Yofunsira).

Kufotokozera kwa zomwe zimachitika munthu akamakumana ndi mavuto

Panthawi yoyesedwa kuchipatala Viktoza® monotherapy monotherapy, zochitika za hypoglycemia mwa odwala omwe amatenga Victoza ® zinali zochepa poyerekeza ndi odwala omwe amalandila chithandizo chogwiritsa ntchito (glimepiride). Zotsatira zoyipa zomwe zidachitika ndizovuta zam'mimba, matenda, komanso kuphwanya.

Mwambiri zolembedwa panthawi ya mayesero azachipatala, zotsimikizika za hypoglycemia sizinachitike. Panthawi ya monotherapy ndi Viktoza®, kunalibe mlandu umodzi wokhwimitsa kwambiri wa hypoglycemia. Hypoglycemia yayikulu imachitika kawirikawiri ndipo imawonedwa limodzi ndi chithandizo cha Viktoza® ndi sulfonylurea (milandu ya 0,02 / odwala). Nthawi zambiri (0.001 kesi / wodwala wazaka) pamakhala zochitika za hypoglycemia nthawi ya mankhwala a Victoza® kuphatikiza ndi mankhwala ena amkamwa antidiabetic (i.e. osati ndi sulfonylurea).

Pambuyo pakuwonjezera kwa insulin kuti muchepetse odwala, adalandira liraglutide 1.8 mg metformin; panalibe milandu ya hypoglycemia yayikulu. Zovuta za hypoglycemia wofatsa zinali zochitika za 0.286 pachaka cha odwala. M'magulu oyerekezera, kuchuluka kwa hypoglycemia kofikira kunali kwa 0,029 milandu kwa wodwala pachaka pochiza ndi liraglutide

1.8 mg ndi 0,129 milandu pachaka odwala ndi chithandizo cha metformin.

Matenda am'mimba

Milandu yambiri ya mseru inali yofatsa kapena yapakati, kwakanthawi ndipo kawirikawiri sinayambitsa kuchira.

Mankhwala ophatikizidwa pamodzi ndi Victoza ® ndi metformin, nseru zimachitika kamodzi kamodzi mu 20.7% ya odwala, ndi matenda am'mimba mu 12.6% ya odwala. Akaphatikizidwa ndi Viktoza ® ndi sulfonylurea, mseru unachitikira kamodzi mwa 9,1% ya odwala, ndi matenda am'mimba mu 7.9%. Milandu yambiri anali ofatsa kapena olimbitsa pang'ono ndipo anali ogwirizana ndi mlingo.

Kwa odwala omwe ali ndi zaka zopitilira 70, kusokonezeka kwa dongosolo la m'mimba kumatha kuchitika ndi chithandizo cha Victoza®.

Odwala omwe ali ndi vuto laimpso wofatsa (kulengedwa kwa creatinine chilolezo cha 60-90 ml / min), zovuta za m'mimba zimatha kuchitika kawirikawiri ndi mankhwala a Viktoza ®.

Kuchotsa mankhwala

Pazoyesedwa kwanthawi yayitali (masabata 26 kapena kupitilira), pafupipafupi kudzipereka kwa mankhwala a Viktoza® chifukwa cha zovuta zomwe zimachitika anali 7.8%, ndipo kuchoka kwa mankhwala oyerekeza anali 3.4%. Choyambitsa chachikulu chomwechi mwa odwala omwe amalandira Victoza® chinali nseru (2.8%) ndi kusanza (1.5%).

Chifukwa cha mphamvu zomwe zimagwiritsidwa ntchito ndi mankhwala omwe ali ndi mapuloteni kapena ma peptides, anti-liraglutidn antibodies amatha kupanga odwala omwe ali ndi Victoza ®. Adapezeka odwala pafupifupi 6.6%. Kupanga kwa antibody sikugwirizana ndi kuchepa kwa mphamvu ya Victoza®.

Jekeseni tsamba lanu

Pazoyesedwa kwanthawi yayitali (masabata 26 kapena kupitilira), zomwe zimachitika pamalo opangira jakisoni wa Viktoza® zidanenedwa pafupifupi 2% ya odwala. Izi zimachitika nthawi zambiri.

Munthawi yayitali ya mayesero azachipatala, milandu ingapo idanenedwa pamankhwala a Viktoza ® (® sanakhazikitsidwe kapena kupatulidwa.

Matenda a chithokomiro

Zovuta zonse za kusowa kwa chithokomiro panthawi yonse yophunzira (nthawi yayitali komanso yayitali) panali milandu 33,5, 30.0 ndi 21.7 pa zaka 1000 za odwala omwe amapezeka ndi liraglutides, mankhwala a placebo ndi kuyerekezera, ndi 5.4 , 2.1 ndi 0.8 milandu, motero, adanenedwa kuti adakumana ndi zovuta zoyipa.

Odwala omwe amathandizidwa ndi Victoza®, zotupa za chithokomiro, kuchuluka kwa calcitonin m'magazi, ndi goiter nthawi zambiri zimadziwika.

Pambuyo pa kukhazikitsidwa kwa Victoza® pamsika, zochitika zamtundu uliwonse kuphatikizapo urticaria, zidzolo, ndi pruritus. Milandu ingapo ya kusintha kwa anaphylactic ndi zizindikiro zowonjezera monga hypotension, palpitations, dyspnea, ndi edema zanenedwanso.

Gwiritsani ntchito pa nthawi yoyembekezera komanso mkaka wa m`mawere

Zambiri zokwanira pa kugwiritsa ntchito mankhwalawa Viktoza® amayi apakati sizikupezeka. Kafukufuku wazinyama awonetsa kawopsedwe kaziberekedwe (onani Gawo "Preclinical Safety Data"). Chiwopsezo chomwe chilipo kwa anthu sichikudziwika.

Mankhwala Viktoza® sayenera kugwiritsidwa ntchito panthawi yomwe ali ndi pakati, tikulimbikitsidwa kupaka insulin m'malo mwake. Ngati wodwala akufuna kukhala ndi pakati kapena pakati, ndiye kuti Victoza ® iyenera kusiyidwa.

Nthawi yochepetsetsa

Sizikudziwika ngati liraglutide imapukusidwa mkaka wa m'mawere. Kafukufuku wazinyama adawonetsa kuti kuchuluka kwa ma liraglutides ndi ma metabolites ake ofananirako kwambiri amalowa mkaka. Chifukwa chosakwanira pakamayamwa, mankhwalawa Viktoza® sayenera kugwiritsidwa ntchito.

Chifukwa cha kusowa kwa deta, Victoza® siyikulimbikitsidwa kwa ana.

Zolemba zogwiritsira ntchito

Victoza ® sagwiritsidwa ntchito pochiza odwala amtundu wa shuga 1 kapena matenda ashuga ketoacidosis.

Viktoza ® si cholowa m'malo mwa insulin.

Mphamvu ya kuchuluka kwa liraglutide mwa odwala omwe amathandizidwa kale ndi insulin, osawunikira.

Zochitika zakuchiritsa odwala ndi mtima wofundika wa m'makalasi a I-II (malinga ndi gulu la New York Association of Cardiology - NYHA) ndizochepa, ndipo palibe chidziwitso pakuchiritsa kwa odwala omwe ali ndi mtima wovuta wa makalasi a III-IV.

Chifukwa chochepa, sizikulimbikitsidwa kupereka mankhwala a Viktoza® kwa odwala omwe ali ndi matenda a matumbo a shuga ndi matenda a shuga a gastroparesis.

Kugwiritsa ntchito ma analogu ena a GLP-1 kumaphatikizidwa ndi chiopsezo chokhala ndi pancreatitis. Pali malipoti angapo a pancreatitis pachimake. Odwala ayenera kudziwitsidwa za mawonekedwe amtundu wa pachimake kapamba (kulimbikira, kupweteka kwambiri pamimba). Ngati pancreatitis ikukayikira, chithandizo cha Viktoza ® ndi mankhwala ena oyambitsa ziyenera kusiyidwa.

Panthawi ya mayeso azachipatala, zovuta zomwe zimadziwika kuchokera ku chithokomiro cha chiwindi zimachulukitsa kuchuluka kwa calcitonin m'magazi, chotupa ndi chotupa, makamaka kwa odwala omwe ali ndi matenda a chithokomiro (onani gawo "Matenda osintha").

Odwala omwe adalandira chithandizo cha Victoza ® adakumana ndi vuto la kuchepa madzi m'thupi, kuphatikizapo kuwonongeka kwa impso ndi kulephera kwaimpso.

Odwala omwe akupangidwira Victoza ® ayenera kuchenjezedwa za kuthekera kwa madzi m'thupi chifukwa cha vuto la kugaya chakudya m'mimba ndi kufunika kotenga njira zopewera kuchepa madzi m'thupi.

Odwala omwe amalandira mankhwala a Viktoza® nthawi yomweyo ndi sulfonylurea, chiopsezo chokhala ndi hypoglycemia chikuwonjezeka (onani gawo "Zotsatira zosiyana"). Chiwopsezo cha hypoglycemia chitha kuchepetsedwa pochepetsa mlingo wa sulfonylurea.

Kutha kukopa momwe zinthu zikuyendera mukamayendetsa magalimoto kapena njila zina

Kafukufuku wokhudza momwe Victoza® imayendera pakukwaniritsa magalimoto ndi njila zina sizinachitike. Odwala ayenera kulangizidwa kuti achitepo kanthu kuti ateteze kuwonongeka kwa hypoglycemia panthawi yoyendetsa galimoto kapena makina ena, makamaka mukamagwiritsa ntchito mankhwala a Viktoza® nthawi yomweyo ndi sulfonylurea.

Kuyanjana ndi mankhwala ena ndi mitundu ina yoyanjana .

Mu vitro liraglutide anawonetsa kuthekera kotsika kwambiri kwa pharmacokinetics ya zinthu zina zogwira ntchito, kusinthana komwe kumalumikizidwa ndi cytochrome 450 komanso kumangiriza kumapuloteni a plasma.

Liraglutide imayambitsa kuchepa pang'ono m'matumbo, ikhoza kuthana ndi mayamwa omwe amagwiritsidwa ntchito munthawi yomweyo.

Liraglutide sanasinthe chiwonetsero chonse cha paracetamol patatha gawo limodzi la 1000 mg. Kuchuluka kwa paracetamol (C max ) idatsika ndi 31%, komanso nthawi yofika ndende zambiri (t max ) adakwera mpaka mphindi 15. Pogwiritsa ntchito munthawi yomweyo paracetamol, kusintha kwa mankhwala sikofunikira.

Atorvastatin Liraglutide sanasinthe chiwonetsero chonse cha atorvastatin chamlingo wofunika kwambiri patatha mlingo umodzi wa iwo pa 40 mg. Pankhaniyi, kugwiritsa ntchito njira imodzi ya Viktozoy® kusintha kwa atorvastatin sikofunikira. Coadminende ndi liraglutide C max atorvastatin idatsika ndi 38%, ndi t max chinakwera kuchokera 1:00 mpaka 3:00.

Griseofulvin Liraglutide sanasinthe chiwonetsero chonse cha griseofulvin pambuyo pa mlingo umodzi wa 500 mg. C max kuchuluka ndi 37%, pomwe t max sizinasinthe. Kusintha kwa Mlingo pogwiritsa ntchito griseofulvin ndi zina zotsika muzu zomwe zili ndi chokwanira kwambiri sizimafunikira.

Lisinopril ndi digoxin

Pambuyo jakisoni imodzi ya 20 mg ya lisinopril kapena 1 mg ya digoxin osakanikirana ndi liraglutide, kuchepa m'deralo pansi pa nthawi yozungulirapo (AUC) ya mankhwalawa kunadziwika ndi 15% ndi 16%, motero C max idatsika ndi 27% ndi 31%, motsatana. T max lisinopril inachulukira kuyambira 6:00 mpaka 8:00, pomwe digoxin imakulira kuyambira 1:00 mpaka 1.5 maola. Kutengera zotsatira izi, mukamagwiritsa ntchito liraglutide, kusintha kwa mankhwalawa kwa lisinopril kapena digoxin sikofunikira.

Pogwiritsa ntchito mlingo umodzi wotsekemera pakamwa, liraglutide yafupika C max ethinyl estradiol kapena levonorgestrel ndi 12% ndi 13%, motero, ndi t max kuchuluka ndi 1.5 maola. Izi sizinawonetse kukhudzika kwa chiwonetsero chonse cha ethinyl estradiol kapena levonorgestrel, zomwe zikusonyeza kuti kugwiritsidwa ntchito kwa liraglutide sikungakhudze kulera kwapakati pa ethinyl estradiol ndi levonorgestrel.

Warfarin ndi zotumphukira zina za coumarin

Palibe kafukufuku wokhudzana ndi mankhwala omwe adachitika. Kumayambiriro kwa chithandizo ndi Viktoza® kwa odwala omwe amalandila warfarin kapena zotumphukira zina, kuyang'anira pafupipafupi kwa INR (International Normalized Ratio) ndikulimbikitsidwa.

Odwala omwe ali ndi mtundu wokhazikika wa matenda a shuga 2 omwe amakhala munthawi yomweyo a insulin, Detemir (5 U / kg) ndi liraglutide (1.8 mg) sanawonetse kuyanjana kwa pharmacokinetic ndi pharmacodynamic.

Pharmacokinetics

Pambuyo pa kayendetsedwe ka subcutaneous, kuyamwa kwa liraglutide kumayamba pang'onopang'ono, Tmax (nthawi yoti mufikire kuchuluka kwa ndende) mu plasma ndi maola 8-12. Cmax (kuchuluka kwa ndende) mu plasma pambuyo kukhazikitsa limodzi mlingo wa 0.6 mg ndi 9,4 nmol / L. Mukamagwiritsa ntchito mlingo wa 1.8 mg pafupifupi Css (equilibrium concentration) mu plasma imafika pafupifupi 34 nmol / L. Kuwonekera kwa chinthu kumathandizidwa molingana ndi mlingo. The intra-payekha payekha kusintha kwa AUC (dera pansi pa ndende nthawi pamapindikira) pambuyo makonzedwe a liraglutide limodzi mlingo 11%. Mtheradi bioavailability pafupifupi 55%.

Zikuwoneka Vd (kuchuluka kwa magawidwe) a liraglutide mu minofu yokhala ndi njira yotsogola yoperekera ndi 11-17 l, mtengo wapakati wa Vd pambuyo mtsempha wa magazi makonzedwe - 0,07 l / kg. Kumanga kwofunikira kwa liraglutide ndi mapuloteni a plasma kumadziwika (> 98%).

Kagayidwe ka liraglutide kumachitika ngati mapuloteni akuluakulu, osatenga nawo mbali monga njira yodziwitsira chiwalo chilichonse. Maola 24 pambuyo pa kuperekedwa kwa mlingo umodzi, mankhwala osasinthidwawo amakhalabe gawo lalikulu la plasma. Ma metabolites awiri adapezeka mu plasma (≤ 9 ndi ≤ 5% ya mlingo wonse).

Liraglutide wosasintha pambuyo makonzedwe a 3 H-liraglutide mu mkodzo kapena ndowe sichitsimikizike. Kachigawo kochepa chabe ka metabolites komwe kamakhudzana ndi thunthu kamakhudzidwa ndi impso kapena matumbo (6 ndi 5%, motero). Pambuyo subcutaneous makonzedwe a limodzi liraglutide, pafupifupi chilolezo cha thupi pafupifupi 1,2 l / h pochotsa T1/2 pafupifupi maola 13.

Tulutsani mawonekedwe ndi ma CD

3 ml ya mankhwalawa mu cartridge yagalasi 1 hydrolytic kalasi, yokhazikika ndi disk ya brongosutyl rabara / polyisoprene mbali imodzi ndi piston ya brongosutyl mphira mbali inayo. Katiriji amasindikizidwa mu cholembera cha pulasitiki chomwe chingatayike angapo.

Ma syringe awiri a pulasitiki otayika a jekeseni angapo pamodzi ndi malangizo ogwiritsira ntchito kuchipatala komanso zilankhulo zaku Russia zimayikidwa pakatoni.

Cholembera chilichonse cha syringe (3 ml) chimakhala ndi Mlingo 30 wa 0,6 mg, 15 Mlingo wa 1,2 mg kapena 10 mg wa 1.8 mg wa liraglutide.

Zizindikiro zogwiritsidwa ntchito

Malinga ndi malangizo, Viktoza amagwiritsidwa ntchito pa matenda a shuga 2 kuphatikiza zakudya komanso masewera olimbitsa thupi kuti akwaniritse kuwongolera kwa glycemic.

Njira zotheka kugwiritsa ntchito mankhwalawa:

  • monotherapy
  • kuphatikiza chithandizo chamankhwala amodzi kapena angapo amkamwa hypoglycemic othandizira (thiazolidinediones, sulfonylureas, metformin) mwa odwala omwe alephera kukwaniritsa bwino glycemic nthawi ya chithandizo cham'mbuyomu,
  • kuphatikiza mankhwala a basal insulin odwala omwe alephera kukwaniritsa bwino glycemic control pogwiritsa ntchito Victoza osakanikirana ndi metformin.

Malangizo ogwiritsira ntchito Victoza: njira ndi mlingo

Victoza amayenera kutumikiridwa mosabereka m'mimba, phewa kapena ntchafu kamodzi patsiku, ngakhale zakudya. Malo ndi nthawi ya jekeseni imatha kusinthidwa popanda kusintha kwa mlingo, komabe, ndikofunikira kuperekera mankhwalawa pafupifupi nthawi yomweyo, yomwe ili yabwino kwambiri kwa wodwalayo.

Kupititsa patsogolo kulekerera kwamatumbo, chithandizo chimalimbikitsidwa ndi mlingo wa tsiku lililonse wa 0,6 mg. Pambuyo pa sabata yochepa, mlingo umakulitsidwa ku 1,2 mg. Ngati ndi kotheka, pofuna kukwaniritsa njira yabwino kwambiri yolamulira glycemic, poganizira luso la Victoza, kuwonjezeka kwa mlingo mpaka 1.8 mg ndikotheka patatha sabata limodzi. Kugwiritsa ntchito Mlingo wapamwamba sikulimbikitsidwa.

Mankhwalawa amatha kuikidwa kuwonjezera pa mankhwala omwe akupitilira ndi metformin kapena kuphatikiza mankhwala ndi metformin osakanikirana ndi thiazolidinedione. Mlingo womaliza suyenera kusintha.

Wowonongera amatha kuwonjezeredwa ku mankhwala omwe alipo a sulfonylurea kapena mankhwala a metformin osakanikirana ndi mankhwala a sulfonylurea. Pankhaniyi, kuti muchepetse mwayi wokhala ndi hypoglycemia yosafunikira, mlingo wa zotumphukira za sulfonylurea ziyenera kuchepetsedwa.

Victoza amathanso kuwonjezeredwa ndi basal insulin, koma kuti muchepetse chiopsezo cha hypoglycemia, ndikofunikira kuchepetsa mlingo wa insulin.

Ngati mungadumphe mlingo:

  • Ngati maola opitilira 12 asanadutse, muyenera kulowa muyezo womwe mwasowa posachedwa,
  • ngati maola opitilira 12 apita, mlingo wotsatira uyenera kutumikiridwa tsiku lotsatira panthawi yoyenera, mwachitsanzo, sikofunikira kulipiritsa mlingo womwe wakuphayo popereka muyeso wowonjezera kapena wowirikiza.

Maupangiri ogwiritsa ntchito mankhwala osokoneza bongo

Cholembera chilichonse cha syringe chimapangidwa kuti chizigwiritsa ntchito payekha.

Mankhwalawa amayenera kuperekedwa pogwiritsa ntchito singano mpaka 8 mm kutalika mpaka 32G wandiweyani (osaphatikizidwa, motero wogulidwa payokha). Ma cholembera a syringe amaphatikizidwa ndi singano zotayira za NovoTvist ndi NovoFayn.

Victoza sayenera kuperekedwa ngati yankho likuwoneka losiyana ndi madzi owoneka bwino, osakonda kopanda utoto.

Simungathe kulowa mankhwalawa ngati chayamba kuzizira.

Osasunga cholembera ndi singano yomata. Pambuyo pa jekeseni aliyense, amayenera kutayidwa. Kuchita izi kumalepheretsa kutayikira, kuipitsidwa ndi matenda a mankhwalawo, komanso kumatsimikizira kulondola kwa dosing.

Malo osungira

Sungani ku 2 ° C mpaka 8 ° C (mufiriji). Osamawuma.

Ngati cholembera syringe ntchito: gwiritsani ntchito mkati mwa mwezi umodzi. Sungani kutentha osapitirira 30 ° C kapena kuchokera 2 º C mpaka 8 º C (mufiriji). Osamawuma. Osasunga ndi singano yomata. Phimbani cholembera ndi chipewa kuti mutetezere kuwala.

Pewani patali ndi ana!

Gwiritsani Ntchito ndi Kutaya Chitsogozo

Victoza® silingagwiritsidwe ntchito ngati ikuwoneka yosiyana ndi madzi owoneka bwino komanso opanda khungu.

Victoza ® siyingagwiritsidwe ntchito ngati itaundana.

Victoza® imatha kuperekedwa pogwiritsa ntchito singano mpaka 8 mm kutalika mpaka 32G. Khola la syringe lakonzedwa kuti lizigwiritsidwa ntchito limodzi ndi singano zotayira za NovoFayn ® kapena NovoTvist ®.

Singano za phula sizikuphatikizidwa.

Wodwalayo adziwitsidwa kuti singano yomwe imagwiritsidwa ntchito iyenera kutayidwa pambuyo pobayira iliyonse, komanso kuti cholembera chokhala ndi singano yolumikizidwa sichitha kusungidwa. Kuchita koteroko kumalepheretsa kuipitsidwa, kachiromboka komanso kutayikira kwa mankhwalawo ku cholembera ndikutsimikizira dosing yolondola.

Kusiya Ndemanga Yanu