Glemaz mankhwala: malangizo ntchito > Chithandizo ndi kupewa

Fomu ya Mlingo - mapiritsi: amakona atatu, matalala, owoneka bwino obiriwira, ndipo mawonekedwe atatu ofanana amawayika pang'onopang'ono pang'onopang'ono pang'onopang'ono ndikugawa m'magawo anayi ofanana (5 kapena 10 matuza, paketi ya makatoni 3 kapena 6 matuza )

Yogwira pophika: glimepiride, piritsi limodzi - 4 mg.

Zowonjezera: cellcrystalline cellulose, magnesium stearate, cellulose, croscarmellose sodium, wanzeru buluu, utoto wachikasu wa quinoline.

Contraindication

Mtundu woyamba wa shuga
Leukopenia
Zowonongeka zazing'onoting'ono zamkati (kuphatikizapo contraindication kwa odwala omwe ali ndi hemodialysis),
Kukanika kwa chiwindi,
Matenda a shuga komanso chikomokere, matenda ashuga a ketoacidosis,
Zophatikizira ndi malabsorption chakudya ndi chitukuko cha hypoglycemia (kuphatikizapo matenda opatsirana),
Osakwana zaka 18
Mimba komanso kuyamwa
Hypersensitivity zigawo zikuluzikulu za mankhwala kapena mankhwala ena a sulfonylurea ndi mankhwala a sulfonamide.

Glemaz iyenera kugwiritsidwa ntchito mosamala pazochitika zomwe zimafuna kuti wodwala am'patse insulin, monga malabsorption ya chakudya ndi mankhwala osokoneza bongo m'matumbo (kuphatikizapo gastric paresis ndi kutsekeka kwamatumbo), chithandizo chachikulu cha opaleshoni, kuvulala kwambiri zingapo, kuwotcha kambiri.

Mlingo ndi makonzedwe

Glemaz anatengedwa pakamwa. Mlingo wa tsiku ndi tsiku uyenera kumwedwa pakumwa limodzi musanadye chakudya cham'mawa kapena chakudya choyambirira. Mapiritsi amayenera kumeza popanda kutafuna, kutsukidwa ndi madzi okwanira (pafupifupi ½ chikho). Mutamwa mapiritsi, sikulimbikitsidwa kuti mulumphe zakudya.

Mlingo woyambira ndi kukonza umatsimikiziridwa payekha kutengera zotsatira za kutsimikiza kwa magazi a m'magazi.

Kumayambiriro kwa chithandizo, 1 mg ya glimepiride nthawi zambiri imayikidwa (1 /₄ mapiritsi) 1 nthawi patsiku. Ngati n`kotheka kukwaniritsa mulingo woyenera kwambiri, mankhwalawa amapitilizidwa kumwa chimodzimodzi.

Popeza glycemic control, tsiku ndi tsiku mlingo umakulitsidwa pang'onopang'ono, kuwunika kuchuluka kwa shuga m'magazi: masabata onse a 1-2, woyamba mpaka 2 mg, kenako mpaka 3 mg, kenako mpaka 4 mg (mlingo wopitilira 4 mg umagwira ntchito pokhapokha pokhapokha pakachitika zina) ) Mlingo wovomerezeka tsiku lililonse ndi 8 mg.

Nthawi komanso pafupipafupi kumwa mankhwalawa zimatsimikiziridwa ndi adokotala potengera moyo wa wodwalayo. Mankhwalawa ndiwotalikirapo, olamulidwa ndi shuga wamagazi.

Gwiritsani ntchito limodzi ndi metformin

Ngati glycemic control siyingatheke kwa odwala omwe akutenga metformin, kuphatikiza mankhwala ndi Glemaz kungafotokozeke. Pankhaniyi, mlingo wa metformin umasungidwa mulingo womwewo, ndipo glimepiride amalembedwa muyeso wochepa, pambuyo pake umakulitsidwa pang'onopang'ono mpaka mlingo waukulu wa tsiku ndi tsiku (kutengera kuchuluka kwa shuga m'magazi). Kuphatikiza mankhwala kumachitika moyang'aniridwa ndi achipatala.

Gwiritsani ntchito limodzi ndi insulin

Ngati odwala omwe amalandira Glemaz pa mlingo waukulu ngati mankhwala amodzi kapena osakanikirana ndi mlingo waukulu wa metformin sangathe kukwaniritsa kuwongolera kwa glycemic, kuphatikiza mankhwala omwe amapezeka ndi insulin atha kulembedwa. Pankhaniyi, mlingo womaliza wa glimepiride umasinthidwa, ndipo insulin imayikidwa muyezo wochepa ndipo ngati kuli kotheka, pang'onopang'ono muwonjezere kuyang'aniridwa kwa glucose m'magazi. Chithandizo chophatikiza chimachitika moyang'aniridwa ndi achipatala.

Kusamutsa wodwala kupita ku Glemaz kuchokera ku mankhwala ena amkamwa a hypoglycemic

Posamutsa wodwala kuchokera kwa wothandizira wodwala pakamwa wina, mlingo woyambirira wa glimepiride uyenera kukhala 1 mg, ngakhale mankhwala ena atatengedwa pa mlingo waukulu. Ngati ndi kotheka, mtsogolomo, mlingo wa Glemaz umachulukirachulukira mogwirizana ndi malangizo omwe afotokozedwa pamwambapa ndikuganizira momwe mungagwiritsire ntchito mankhwalawa nthawi yayitali komanso nthawi yayitali ya mankhwala a hypoglycemic. Nthawi zina, makamaka mukamagwiritsa ntchito mankhwala a hypoglycemic omwe ali ndi moyo wautali, zingakhale zofunikira kusiya kwakanthawi (kwa masiku angapo) kuti mupewe zowonjezera zomwe zimawonjezera chiopsezo cha hypoglycemia.

Kusamutsa wodwala kuchokera ku insulin kupita ku glimepiride

Pazochitika zapadera, pochita insulin mankhwala mwa odwala omwe ali ndi matenda a shuga 2, pomwe amalipiritsa matendawa ndikusungidwa kwapadera kwa pancreatic β-cell, insulin ikhoza m'malo mwa glimepiride. Kulandila kwa Glemaz kumayamba ndi gawo limodzi la 1 mg, kusamutsidwa kumachitika moyang'aniridwa ndi achipatala.

Zotsatira zoyipa

Metabolism: Maganizo a hypoglycemic omwe amapezeka atangomwa mankhwalawa (amatha kukhala ndi mawonekedwe owopsa komanso mapikidwe, sangathe kuyimitsidwa nthawi zonse),
Matumbo a pakhungu: kupweteka kwam'mimba, kumva kupsinjika kapena kusamva bwino mu epigastrium, nseru, kusanza, kutsekula m'mimba, jaundice, cholestasis, kuchuluka kwa hepatic transaminases, hepatitis (mpaka kufooka kwa chiwindi),
Dongosolo la hematopoietic: aplastic kapena hemolytic anemia, erythrocytopenia, leukopenia, granulocytopenia, pancytopenia, agranulocytosis, thrombocytopenia (zolimbitsa kwambiri),
Gulu la masomphenya: pafupipafupi kumayambiriro kwamankhwala - kuwonongeka kwakanthawi kochepa,
Thupi lawo siligwirizana: urticaria, zotupa pakhungu, kuyabwa (nthawi zambiri wodekha, koma amatha kupita patsogolo, limodzi ndi kufupika ndi kutsika magazi, kumayambitsa mantha a anaphylactic), kuchepa kwa ziwindi ndi sulfonamides ndi sulfonylureas kapena zinthu zina zofanana, vasculitis.
Zina: nthawi zina - hyponatremia, asthenia, photosensitivity, kupweteka kwa mutu, khungu la kumapeto kwa khungu.

Malangizo apadera

Glemaz amayenera kutengedwa mosamalitsa malinga ndi malingaliro a dokotala. Zolakwika zolandirira (mwachitsanzo, kudumpha mlingo wotsatira) sizingathetsedwe ndi mlingo wotsatira wa mlingo wapamwamba. Wodwala ayenera kukambirana ndi adokotala pasadakhale njira zomwe ziyenera kumwedwa chifukwa cha zolakwa kapena ngati vuto lotsatira silingatheke panthawi yotsatiridwa. Wodwala ayenera kudziwitsa dokotala ngati watenga mlingo waukulu kwambiri.

Kukula kwa hypoglycemia atamwa Glemaz tsiku lililonse 1 mg zikutanthauza kuti glycemia imatha kuyendetsedwa ndi zakudya zokha.

Pokhapokha kulipira mtundu wa matenda a shuga a 2, phindu la insulini limawonjezeka, kotero kuti kuchepetsa kwa glimepiride kungafunike. Popewa kukula kwa hypoglycemia, muyenera kuchepetsa kwakanthawi kapena kuletsa Glemaz. Kusintha kwa Mlingo kuyeneranso kuchitika posintha kulemera kwa thupi la wodwala, moyo wake, kapena zinthu zina zomwe zingapangitse kukula kwa hypo- kapena hyperglycemia.

Makamaka kuyang'anira wodwala ndikofunikira mu milungu yoyamba ya chithandizo, chifukwa Ndi munthawi imeneyi pomwe chiopsezo chokhala ndi hypoglycemia chikuchulukirachulukira. Zomwezi zimachitikanso polumpha zakudya kapena kudya mosasamala.

Tiyenera kukumbukira kuti zizindikiro za hypoglycemia zimatha kuchotsedwa kapena kupezeka kwathunthu kwa anthu okalamba, odwala omwe ali ndi vuto la neuronomic komanso odwala omwe amalandira beta-blockers, reserpine, clonidine, guanethidine. Hypoglycemia pafupifupi nthawi zonse imatha kuyimitsidwa mwachangu ndi kudya kwakanthawi kwamatumbo (shuga kapena glucose, mwachitsanzo, mu mawonekedwe a chidutswa cha shuga, tiyi wokoma kapena madzi a zipatso). Pachifukwa ichi, tikulimbikitsidwa kuti odwala nthawi zonse amakhala ndi shuga g 20% (zidutswa 4 za shuga woyengedwa) nawo. Okometsa pachipatala cha hypoglycemia sikugwira ntchito.

Nthawi yonse ya chithandizo ndi Glemaz, ndikofunikira kuwunika pafupipafupi kuchuluka kwa shuga m'magazi, kuchuluka kwa glycosylated hemoglobin, ntchito ya chiwindi, chithunzi cha magazi otumphukira (makamaka kuchuluka kwa mapulateleti ndi maselo oyera a magazi).

M'mikhalidwe yovuta (mwachitsanzo, ndi matenda opatsirana omwe ali ndi malungo, opaleshoni kapena kuvulala), kufunikira kosintha kwakanthawi kwa wodwala kupita ku insulin kungafunike.

Pa mankhwala, kusamala kuyenera kuchitika pochita zinthu zoopsa, kukhazikitsa zomwe zimafuna kuthana ndi chidwi komanso kuwonjezera chidwi (kuphatikizapo poyendetsa magalimoto).

Kuyanjana kwa mankhwala osokoneza bongo

Pogwiritsa ntchito nthawi yomweyo Glemaz ndi mankhwala ena, kusintha kwake kungatheke - kulimbikitsa kapena kufooketsa. Chifukwa chake, kuthekera kwa kumwa mankhwala ena onse kuyenera kuvomerezedwa ndi dokotala.

Kulimbikitsa zochita za hypoglycemic za Glemaz ndipo, monga chotulukapo chake, kukula kwa hypoglycemia kumatha kuyambitsa kuphatikizana ndi mankhwala otsatirawa: insulin, metformin, mankhwala ena apakamwa a hypoglycemic, angiotensin kutembenuza ma enzyme, ma anabolic steroid ndi mahomoni achimuna aamuna, ma inhibitors a salicylates (mu acid), othandizira antimicrobial - ma quinolone ofunikira, ma tetracyclines, sympatholytics (kuphatikizapo guanethidine), sulfonamides ena osakhalapo, etc. coumarin ofanana nawo, fibrates, allopurinol, trofosfamide, fenfluramine, ifosfamide, fluoxetine, miconazole, cyclophosphamide, chloramphenicol, oxyphenbutazone, tritokvalin, azapropazone, fluconazole, sulfinpyrazone, phenylbutazone, pentoxifylline (kutumikiridwa parenterally mu mlingo waukulu).

Kuchepa mphamvu kwa hypoglycemic zochita za Glemaz ndipo, monga chotulukapo chake, kuchuluka kwa shuga m'magazi, kumatha kuyambitsa kuphatikizana ndi mankhwala otsatirawa: glucocorticosteroids, thiazide diuretics, mankhwala opatsirana kwa nthawi yayitali, estrogens ndi progestogens, barbiturates, epinephrine ndi ena a syapometics. nicotinic acid (muyezo waukulu) ndi zotumphukira zake, shuga, diazoxide, acetazolamide, zotumphukira za phenothiazine, kuphatikiza chlorpromazine, rifampicin, phenytoin, mchere wa lithiamu, mahomoni a chithokomiro.

Reserpine, clonidine, histamine H blockers₂ma receptor amatha kufooketsa ndikuwonjezera mphamvu ya hypoglycemic ya glimepiride. Mothandizidwa ndi mankhwalawa ndi guanethidine, kufooka kapena kusakhalapo kwa zizindikiro za matenda a hypoglycemia ndikotheka.

Glimepiride imatha kufooketsa kapena kuwonjezera zomwe zimachitika chifukwa cha coumarin.

Panthawi yomweyo kugwiritsa ntchito mankhwala omwe amalepheretsa mafupa a hematopoiesis, chiopsezo chokhala ndi myelosuppression ukuwonjezeka.

Kuledzera kamodzi kapena kosatha kwa zakumwa zoledzeretsa kumatha kukulitsa ndikuchepetsa mphamvu ya hypoglycemic ya Glemaz.

The fanizo la mankhwala Glemaz ndi awa: Amaryl, Glimepiride, Glimepiride Canon, Diamerid.

Malangizo a Glemaz (njira ndi Mlingo)

Mapiritsi a Glemaz amatengedwa pakamwa kamodzi mu nthawi yomweyo asanadye kapena pakudya kadzutsa, kapena woyamba kudya. Tengani mapiritsi athunthu, osatafuna, imwani madzi ambiri (pafupifupi makapu 0,5). Mlingo umayikidwa payekhapayekha malinga ndi zotsatira za kuwunika pafupipafupi kwa ndende ya magazi.

Mlingo woyamba: 1 mg 1 nthawi patsiku. Mukakwaniritsa mulingo woyenera wodwala, tikulimbikitsidwa kumwa mankhwalawa ngati mlingo wokonza.

Pakakhala kuti palibe glycemic control, kuwonjezeka kwapang'onopang'ono kwa tsiku ndi tsiku mlingo ndikotheka (kuwunikira pafupipafupi kuchuluka kwa shuga wamagazi pamasabata a 1 mpaka 2) mpaka 2 mg, 3 mg kapena 4 mg patsiku. Mlingo wopitilira 4 mg pa tsiku umatha kuperekedwa pokhapokha pokhapokha pokhapokha.

Pazipita mlingo tsiku lililonse: 8 mg.

Njira ya chithandizo: kwanthawi yayitali, motsogozedwa ndi shuga m'magazi.

Gwiritsani ntchito limodzi ndi metformin

Popeza glycemic ikuyendetsa odwala omwe akutenga metformin, chithandizo chothandizirana ndi glimepiride ndizotheka.

Tikusungabe mlingo wa metformin chimodzimodzi, mankhwalawa glimepiride amayamba ndi mlingo wochepa, kenako mlingo umawonjezeka malinga ndi kuchuluka kwa shuga m'magazi, mpaka kuchuluka kwa tsiku lililonse.

Kuphatikiza mankhwala kuyenera kuchitika moyang'aniridwa ndi achipatala.

Gwiritsani ntchito limodzi ndi insulin

Nthawi zina, monotherapy ndi Glemaz, komanso kuphatikiza ndi metformin, sizimapereka zotsatira zomwe zikufunidwa: glycemic control siyingatheke. Zikatero, kuphatikiza kwa glimepiride ndi insulin ndikotheka. Pankhaniyi, mlingo womaliza wa glimepiride woperekedwa kwa wodwala amakhalabe wosasinthika, ndipo chithandizo cha insulin chimayamba ndi mlingo wocheperako, ndikuwonjezereka kwapang'onopang'ono kwa mlingo wake motsogozedwa ndi ndende yamagazi.

Kuphatikiza chithandizo kumafunika kuyang'aniridwa kuchipatala.

Chotsani kuchokera ku mankhwala ena amkamwa a hypoglycemic kupita ku glimepiride

Mlingo woyamba wa tsiku lililonse: 1 mg (ngakhale wodwalayo atamupatsira glimepiride ndi muyezo waukulu wa mankhwala ena amkamwa a hypoglycemic).

Kukula kulikonse kwa gawo la Glemaz kuyenera kuchitika m'magawo, kutengera mphamvu ya mankhwalawa, mlingo ndi nthawi ya zochita za hypoglycemic wothandizira.

Nthawi zina, makamaka mukamamwa mankhwala a hypoglycemic ndi moyo wautali wa moyo, zingakhale zofunikira kwakanthawi (m'masiku ochepa) kusiya chithandizo kuti mupewe zowonjezera zomwe zimawonjezera chiopsezo cha hypoglycemia.

Kutanthauzira kuchokera ku insulin kupita ku glimepiride

Pazochitika zapadera, pochita insulin mankhwala mwa odwala omwe ali ndi matenda a shuga 2, pomwe amalipiritsa matendawa ndikusunga chinsinsi cha pancreatic β-cell, ndikotheka m'malo mwa insulin ndi glimepiride.

Kutanthauzira kumachitika moyang'aniridwa ndi dokotala.

Mlingo woyambirira: 1 mg patsiku.

Zotsatira zoyipa

Kugwiritsa ntchito mankhwalawa kungayambitse zotsatirazi:

Metabolism: atangomwa mankhwalawa, kuwoneka kwa kusintha kwa hypoglycemic ndikotheka, komwe kumatha kukhala ndi zovuta komanso mawonekedwe ndipo sangathe kuyimitsidwa nthawi zonse.
Zowona m'maso: munthawi yamankhwala (makamaka pachiyambi chake), zosokoneza pang'onopang'ono zomwe zimakhudzana ndi kusintha kwa shuga m'magazi zitha kuonedwa.
Hematopoietic dongosolo: leukopenia, aplastic kapena hemolytic anemia, okwera kwambiri thrombocytopenia, pancytopenia, agranulocytosis, erythrocytopenia ndi granulocytopenia.
Matumbo: Kukumana ndi nseru, kusanza, kupweteka kwam'mimba, kusasangalala kapena kupweteka kwa epigastrium, kutsegula m'mimba, kuchuluka kwa chiwindi michere, jaundice, cholestasis, hepatitis (kuphatikizapo kukula kwa chiwindi.
Mawonekedwe a mziwopsezo: zotupa pakhungu, kuyabwa, urticaria kumatha kuchitika. Nthawi zambiri, machitidwe oterewa ndi ofatsa, koma nthawi zina amatha kupita patsogolo, limodzi ndi kufupika kwa thupi (mpaka kufalikira kwa anaphylactic), kuchepa kwa kuthamanga kwa magazi. Mtanda-thupi lawo siligwirizana ndi ena amachokera ku sulfonylurea, sulfonamides kapena sulfonamides n`zotheka, komanso kukula kwa ziwengo vasculitis.
Zina: zina, kukula kwa mochedwa cutphous porphyria, photosensitivity, hyponatremia, asthenia, ndi mutu ndikotheka.

Zotsatira za pharmacological

Glemaz ndi mankhwala osokoneza bongo a hypoglycemic. Chofunikira chachikulu cha mankhwalawa ndi glimepiride, chomwe chimapangitsa kuti pakhale kutulutsidwa ndi kutulutsidwa kwa insulin kuchokera ku pancreatic β-cell (pancreatic athari), kumapangitsa chidwi cha zotumphukira (minofu ndi mafuta) pazochita zake zomwe zimapangitsa insulin (yowonjezera pancreatic).

Ndikangoyamwa kamodzi, impso zimatenga pafupifupi 60% ya mankhwalawa, 40% yotsala imadutsa matumbo. Zinthu zosasinthika mkodzo sizinapezeke. T_1/2 pa plasma wozungulira wa mankhwalawa mu seramu wofanana ndi angapo dosing, ndi maola 5 - 8. Kuwonjezeka kwa T ndikotheka._1/2 mutamwa mankhwalawa.

Bongo

Malinga ndi ndemanga ya Glemaz, atamwa mankhwalawa kwambiri, hypoglycemia imatha kukhazikika, maola 12-72, omwe amatha kubwereza pambuyo pobwezeretsa kuchuluka kwa shuga m'magazi.

Hypoglycemia imawonetsedwa ndi: thukuta lochulukirapo, tachycardia, nkhawa, palpitations, kuthamanga kwa magazi ndi chidwi, kupweteka mtima, kupweteka mutu, kunjenjemera, chizungulire, kugona, kusanza, kusanza, kuda nkhawa, kupsa mtima, kupsinjika, kusokonezeka, , paresis, kunjenjemera, kugwedezeka, kumva kukomoka, chikomokere.

Pofuna kuthana ndi bongo, ndikofunikira kuti mutsitse wodwala. Chakumwa chachikulu ndi sodium picosulfate ndikuyambitsa makala zimasonyezedwanso.

Ngati mankhwalawa atha kugwiritsidwa ntchito, ndiye kuti matumbo am'mimba amachitika, ndiye kuti chithunzi cha sodium ndi makala oyambitsa amayamba, kenako dextrose imayambitsidwa. Mankhwala ena ndiwowonekera.

Kuchita ndi mankhwala ena

Ndi munthawi yomweyo kugwiritsa ntchito mankhwala ndi:

Metformin, insulin, ena m'kamwa hypoglycemic wothandizira, allopurinol, Ace zoletsa, mahomoni chiwalo chachimuna, anabolic mankhwala, chloramphenicol, cyclophosphamide, coumarin ofanana nawo, ifosfamide, trofosfamide, fibrates, fenfluramine, sympatholytic, fluoxetine, Mao zoletsa, pentoxifylline, miconazole, probenecid, phenylbutazone , oxyphenbutazone, azapropazone, salicylates, quinolone, zotumphukira, sulfinpyrazone, fluconazole, tritokvalin - zimachitika kuwopsa kwa zotsatira zake zamatsenga,
Acetazolamide, diazoxide, barbiturates, saluretics, shuga
Mbiri H blockers₂-teceptors, clonidine, mowa - zimatha kufooka ndikuwonjezera mphamvu ya hypoglycemic,
Ndi mankhwala omwe amalepheretsa mafupa a hematopoiesis, chiwopsezo cha myelosuppression chawonjezeka.