Glibenclamide (Glibenclamide)

Glibenclamide
Pake wa mankhwala
IUPAC	5-chloro-N-(4-N- (cyclohexylcarbamoyl) sulfamoylphenethyl) -2-methoxybenzamide
Choyimira chokha	C23H28Cln3O5S
Unyinji wa Molar	494.004 g / mol
Cas	10238-21-8
PubChem	3488
Drugbank	APRD00233
Gulu
ATX	A10BB01
Pharmacokinetics
Kumanga Mapuloteni a Plasma	Zowonjezera
Kupenda	Chiwindi hydroxylation (CYP2C9-mediated)
Hafu ya moyo.	Maola 10
Kupatula	Impso ndi chiwindi
Mlingo Wamitundu
mapiritsi
Njira zoyendetsera
mkati
Mayina ena
Maninil

Glibenclamide (syn. Antibet, Apoglyburide, Gene glib, Gilearm, Glibamide, Glibenclamide Teva, Gliburide, Glucobene, Daonil, Dianti, Maninil, Euglycon) Ndi nthumwi ya m'badwo wachiwiri wa zotumphukira za sulfonylurea, yomwe ndi imodzi mwazodziwika komanso zophunziridwa kuchepetsa shuga, zomwe kuyambira 1969 zakhala zikugwiritsidwa ntchito kwambiri m'maiko ambiri padziko lapansi ngati chithandizo chodalirika komanso chotsimikizika cha mtundu wa matenda ashuga a mtundu wa 2 osagwirizana ndi kusintha kwa moyo.

Ngakhale pakubwera kukonzekera kwatsopano kwa sulfonylurea ndi machitidwe otsogola, komanso mankhwala othandizira odwala matenda opatsirana pogwiritsa ntchito njira zina, ndimangoyambira pang'ono kumaliza mbiri ya glibenclamide - pofufuza ndi zamankhwala, mankhwalawa sikuti akuwayikira chabe pakuwunika kwa mamolekyulu atsopano komanso njira zochiritsira, komanso akuwonetsa zothandiza zina katundu.

Kuchita bwino ndi chitetezo

Njira yayikulu yogwiritsira ntchito glibenclamide, ngati nthumwi zina za kukonzekera kwa sulfonylurea, imaphunziridwa bwino pamlingo wamilandu yolandirira. Glibenclamide imalepheretsa njira zotsalira za potaziyamu ya ATP (K + -ATP-chPels), yotumizidwa pamatumbo am'magazi a pancreatic beta. Kutha kwa kuchoka mu cell potaziyamu kumayambitsa kukhumudwa kwa membrane ndi kuchuluka kwa Ca 2+ ions kudzera m'misewu yama calcium yotsalira. Kuwonjezeka kwa intracellular calcium calcium kudzera mu activation ya calcium / mododulin wodalira mapuloteni kinase II kumalimbikitsa exocytosis ya chinsinsi granules ndi insulin, chifukwa chomwe timadzi timalo timalowa mu madzi a cellellular ndi magazi. Kuyanjana kosalinganika kwa sulfonylurea kukonzekera kwa beta-cell receptors kumatsimikizira ntchito zawo zotsitsa shuga. Glibenclamide ili ndi mgwirizano wapamwamba kwambiri wolandila sulfonylurea pama cell a beta komanso zotheka kwambiri kutsitsa shuga pakati pokonzekera sulfonylurea.

Zomwe zimapangitsa kuti pakhale insulin katulutsidwe mwachindunji zimatengera mlingo wa glibenclamide wotengedwa ndipo umawonetsedwa mu hyperglycemia komanso mu standardoglycemia kapena hypoglycemia.

Gulu lonse lokonzekera sulfonylurea, pamlingo wina kapena wina, limakhala ndi zotulukapo (zowonjezera-pancreatic), zomwe zikuwonjezera chidwi cha zotumphukira, makamaka mafuta ndi minofu, kuchitira insulin ndikuwongolera kupezeka kwa shuga ndi maselo.

Kugwiritsa ntchito ndikusintha chitetezo |Contraindication

Hypersensitivity to sulfonylurea derivatives and sulfonamide mankhwala, mtundu 1 shuga mellitus, matenda ashuga ketoacidosis, matenda ashuga poyambira, matenda a shuga mellitus kuwonongeka kwa matenda opatsirana, kuvulala, kuwotcha, opaleshoni, kupweteka kwambiri kwa impso ndi chiwindi.

Kupanga ndi mafomu omasulira

Mu 1 tabu. mankhwala a antidiabetesic ali ndi 1.75 mg, 3.5 mg kapena 5 mg pazomwe zimagwira, zomwe ndi glibenclamide.

Komanso mumankhwala mulipo:

• Povidone
• Lactose Monohydrate
• Wowuma wa mbatata
• Magnesium wakuba
• Ponceau 4R.

Mapiritsiwo ndi ozungulira, amtundu wapinki pamtundu, amatha kutuluka. Mankhwalawa amapezeka mu botolo lagalasi lomwe lili ndi mapiritsi a 120, buku lina lowonjezera limasungidwa.

Kuchiritsa katundu

Ndizofunikira kudziwa kuti dzina la malonda a mankhwalawa limagwirizana ndi dzina la chinthucho. Mankhwalawa ali ndi vuto la hypoglycemic onse omwe ali ndi matenda a shuga 2, komanso anthu athanzi. Limagwirira ntchito limapangidwa chifukwa cha kuchuluka kwa insulini ndi β-cell ya kapamba chifukwa cha kukondoweza. Zoterezi zimatengera, choyamba, pamlingo wa glucose omwe amakhala pakati pa β-cell.

Mutatha kumwa mapiritsi, mphamvu yogwira imathamanga ndipo imafikira. Ndi chakudya, palibe kuchepa kwakukulu kwa kuchuluka kwa mayamwidwe a glibenclamide. Chizindikiro cha kulumikizana ndi mapuloteni a plasma ndi 98%. Kwambiri kuzungulira kwa chinthu mu seramu kumachitika pambuyo 2,5 maola. Kuchepa kwa kuchuluka kwa glibenclamide kulembedwa pambuyo pa maola 8-10 ndipo zimatengera mlingo wa mankhwala omwe wodwala amamwa. Kutha kwa theka la moyo kuli pafupifupi maola 7.

Kusintha kwa metabolism kwa glibenclamide kumachitika m'maselo a chiwindi, metabolites amapangidwa, omwe satenga nawo gawo pakuchepetsa mphamvu ya shuga yogwira ntchito. Kupukusa kwa zinthu za metabolic kumachitika ndi mkodzo, komanso ndi ndulu wofanana, kutulutsa kotsiriza kwa metabolites kumachitika pambuyo pa maola 45-72.

Anthu omwe ali ndi vuto la chiwindi, akuchedwa kuwonetsa glibenclamide. Odwala aimpso kulephera, chindapusa ofooka metabolites mwachindunji mu mkodzo kumawonjezera compensatory.

Malangizo ogwiritsira ntchito mapiritsi

Mtengo: kuchokera pa ma ruble 56 mpaka 131.

Mlingo wa mankhwalawa amatsimikiziridwa payekha poganizira zaka za wodwala, glycemia, komanso kuopsa kwa matendawa. Ndikulimbikitsidwa kumwa mapiritsi pamimba yopanda kanthu kapena mutatha kudya maola awiri mutatha kudya.

Nthawi zambiri, avareji ya tsiku ndi tsiku imasiyana pakati pa 2,5 mg - 15 mg. Pafupipafupi kugwiritsa ntchito mapiritsi ndi 1-3 p. tsiku lonse.

Kulandila kwa Mlingo wa tsiku ndi tsiku wa 15 mg ndipo pamwambapa mumawonetsedwa kwambiri, sikuti kumawonjezera kuchuluka kwa mankhwalawa. Okalamba amalimbikitsidwa kuti ayambe kulandira chithandizo cha 1 mg patsiku.

Kusintha kuchokera ku mankhwala amtundu wa antiidiabetes kapena kusinthanso kwa mankhwalawa kuyenera kuchitika moyang'aniridwa ndi dokotala.

Njira zopewera kupewa ngozi

Zochizira zochiritsira ziyenera kuchitika pang'onopang'ono kuwunika shuga ndi mkodzo.

Pa chithandizo, muyenera kukana kumwa zakumwa zoledzeretsa, chifukwa kupanga kwa hypoglycemia, komanso mawonekedwe a disulfiram-ngati, sikuchotsedwa.

Zizindikiro za hypoglycemia zikawoneka, zidzakhala zofunikira kulipirira kusowa kwa shuga mwa kukamwa kwa dextrose. Pofuna kukhala osazindikira, dextrose imaperekedwa kudzera m'mitsempha. Popewa kuyambiranso, ndikofunikira kulemetsedwacho ndi chakudya.

Kuchita mankhwala osokoneza bongo

Mankhwala a antimycotic oficic action, ethionamide, fluoroquinolones, Mao ndi ACE zoletsa, H2-blockers, NSAIDs, mankhwala a tetracycline, paracetamol, insulin, anabolic steroid mankhwala, cyclophosphamide, β-adrenergic blockers, clofibrate, reserpilamin, prober allopurinol, paracetamol, komanso chloramphenicol amatha kukulitsa zovuta za hypoglycemia.

Ma COC, barbiturates, glucagon, saluretics, kukonzekera malinga ndi mchere wa lithiamu, diazoxide, zotupa za nicotinic acid, phenothiazines, komanso mankhwala a adrenomimetic amachepetsa mphamvu ya hypoglycemic ya glibenclamide.

Zimatanthawuza kuti mkodzo wa asidi umakulitsa mphamvu ya mankhwalawa.

Rifampicin amalimbikitsa inactivation wa yogwira mankhwala ndipo amachepetsa ake achire zotsatira.

Zotsatira zoyipa

Zotsatira izi zitha kuchitika:

• CCC ndi hematopoietic dongosolo: eosinophilia, erythrocytopenia, thrombocytopenia, leukocytopenia, granulocytopenia, osowa kwambiri agranulocytosis, nthawi zina kuchepa kwa magazi m'thupi (hemolytic kapena hypoplastic mtundu)
• NS: Kupweteka mutu kumayendera limodzi ndi chizungulire
• Zokhudza zomverera: kuphwanya kwa zomverera
• Metabolism: kukula kwa mochedwa cutphous porphyria, proteinuria, komanso hypoglycemia
• Mimba thirakiti: dyspepsia, chiwindi matenda, cholestasis
• Mawonekedwe a mziwopsezo: zotupa pakhungu
• Ena: fever, polyuria, kulemera, arthralgia, komanso kukula kwa photosensitivity.

Bongo

Hypoglycemia ndiyotheka, momwe mumakhala kumva njala, kufooka, kuseka thukuta, kuchuluka kwa mtima, kugwedezeka kwa minofu, kusokonekera kwa kulankhula, kuda nkhawa, kupweteka kwa mutu komanso chizungulire chachikulu, komanso kuperewera kwamaso.

Woopsa milandu, 50% shuga kapena 5-10% dextrose solution ayenera kuyikiridwa, intravenous makonzedwe a glucagon n`zotheka. Pankhaniyi, zidzakhala zofunika kuwongolera zizindikiro za glycemia, kuchuluka kwa ma elekitirodi, creatinine, komanso urea.

Ambiri akuyang'ana maumboni a Glibenclamide (analogues) omwe angakhale ndi chofanana ndi achire. Pakati pawo, Maninil amadziwika.

Berlin Chemie, Germany

Mtengo kuyambira 99 mpaka 191 rubles.

Mankhwala ndi analogue a Glibenclamide, zinthu zomwe zimagwirizana zimayenderana, motero, ndipo zotsatira zakepi limafanana. Mankhwala amapezeka piritsi.

• Mtengo wotsika
• Amachepetsa mwayi wokhala ndi retinopathy ndi nephropathy
• Kuchitapo kanthu kwanthawi yayitali (maola oposa 12).

• Mankhwala Opezeka
• Contraindified mu ketoacidosis
• Zitha kupangitsa kuti musavutike.

Kufotokozera kwamphamvu yogwira (INN) Glibenclamide.

Pharmacological kanthu - hypoglycemic, hypocholesterolemic.

Matenda a 2 a shuga ndi kulephera kulipira hyperglycemia ndi zakudya, kuchepa thupi, zolimbitsa thupi.

Hypersensitivity (kuphatikizapo mankhwala osokoneza bongo a sulfa, thiazide diuretics), matenda okhudzana ndi matenda ashuga, ketoacidosis, kupsa kwambiri, opaleshoni ndi kuvulala, matumbo, kutsekeka kwa m'mimba, machitidwe omwe amaphatikizidwa ndi kulowetsedwa kwa chakudya (kukula kwa hypoglycemia matenda, etc.), hypo- kapena hyperthyroidism, chiwindi ndi impso ntchito, leukopenia, mtundu 1 matenda a shuga, kutenga pakati, kuyamwitsa.

Mimba komanso mkaka wa m'mawere: Zovomerezeka. Pa nthawi ya chithandizo ayenera kusiya kuyamwitsa.

Kuchokera kumbali ya mtima ndi magazi (hematopoiesis, hemostasis): kawirikawiri - thrombocytopenia, granulocytopenia, erythrocytopenia, pancytopenia, eosinophilia, leukocytopenia, agranulocytosis (osowa kwambiri), mwa zina.

Kuchokera kwamanjenje ndi ziwalo zam'maganizo: mutu, chizungulire, kusintha kwa zomverera.

Kuchokera kumbali ya kagayidwe: hypoglycemia, proteinuria, mochedwa cutphous porphyria.

Kuchokera mmimba thirakiti: kuphwanya chiwindi ntchito, cholestasis, dyspepsia.

Thupi lawo siligwirizana: zotupa za pakhungu (erythema, dermatitis).

Zina: fever, arthralgia, polyuria, kulemera kwakukulu, photosensitivity.

Mogwirizana: Systemic antifungals (azole derivatives), fluoroquinolones, tetracyclines, chloramphenicol (ziletsa kagayidwe), H2-blockers, beta-blockers, ACE inhibitors, NSAIDs, Mao inhibitors, clofibrate, bezafibrat, probenecid, paracetamol, anabolic pentoxifylline, allopurinol, cyclophosphamide, reserpine, sulfonamides, insulin - potentiate hypoglycemia. Ma Barbiturates, phenothiazines, diazoxide, glucocorticoid ndi mahomoni a chithokomiro, estrogens, gestagens, glucagon, mankhwala a adrenomimetic, mchere wa lithiamu, zotumphukira za nicotinic komanso saluretics zimafooketsa mphamvu ya hypoglycemic. Urine acidifying agents (ammonium chloride, calcium chloride, ascorbic acid mu waukulu Mlingo) zimathandizira zotsatira (kuchepetsa kuchuluka kwa kudzipatula ndi kuwonjezera reabsorption). Ndi synergist (yowonjezera) yama anticoagulants osadziwika. Rifampicin imathandizira inactivation ndikuchepetsa kugwira ntchito.

Zizindikiro: hypoglycemia (njala, kufooka kwambiri, kuda nkhawa, kupweteka mutu, chizungulire, thukuta, kulumala, kunjenjemera kwa minyewa, matenda ammimba, mathupi olankhula ndi masomphenya, kusokonezeka kwa chikumbumtima ndi kuperewera kwa mutu.

Chithandizo: m'malo modekha - shuga wambiri, tiyi otentha otentha, msuzi wa zipatso, madzi a chimanga, uchi, pamavuto akulu - kukhazikitsidwa kwa njira ya shuga ya 50% (50 ml iv ndi mkati), kulowetsedwa mosalekeza iv dextrose solution, i / m makonzedwe a glucagon 1-2 mg, diazoxide 200 mg pakapita maola 4 aliwonse kapena 30 mg iv kwa mphindi 30, ndi matenda a edema - mannitol ndi dexamethasone, kuwunika glycemia (mphindi 15 zilizonse), kutsimikiza pH, urea nayitrogeni, creatinine, ma elekitirodi.

Mlingo ndi kayendetsedwe: Mkati, osatafuna, osambitsidwa ndi madzi pang'ono. Mlingo watsiku ndi tsiku amasankhidwa payekha, kutengera zaka, kuopsa kwa matenda ashuga, kuchuluka kwa vuto la hyperglycemia, ndipo nthawi zambiri amakhala 1.25-20 mg (mlingo woyamba ndi 2,5-5 mg / tsiku, mlingo waukulu wa tsiku lililonse ndi 20-25 mg), womwe umayikidwa mu kamodzi, kawiri, kawirikawiri - mitundu itatu yamphindi 30-60 (mitundu yojambulidwa kwa mphindi 10-15) musanadye. Ndi osakwanira kwenikweni, kuphatikiza ndi biguanides ndi insulin ndikotheka.

Chenjezo: Popewa matenda a hypoglycemic, kudya nthawi zonse kuyenera kuonedwa. Chofunika ndikugwiritsa ntchito chakudya osapitirira ola limodzi mutatha kugwiritsa ntchito mankhwalawa. Mukasankhidwa kuti mupeze mlingo woyambirira kapena kusintha kuchokera ku mankhwala ena a hypoglycemic, kutsimikiza kwa shuga kumasonyezedwa (kangapo pa sabata). Mothandizidwa ndi mankhwalawa, kusintha kwamphamvu kwa glucose (glycosylated hemoglobin) mu seramu yamagazi ndikofunikira (osachepera 1 mu miyezi 3). Tiyenera kukumbukira kuti mawonetsedwe azachipatala a hypoglycemia amatha kutsekedwa mukamamwa beta-blockers, clonidine, reserpine, guanethidine. Pankhani ya kusintha kwa glibenclamide kuchokera ku insulin pa 40 mayunitsi / tsiku kapena kuposerapo, patsiku loyamba theka la insulini ndi 5 mg ya glibenclamide ndi mankhwala osinthika pang'onopang'ono. Amagwiritsidwa ntchito mosamala odwala okalamba - amayamba kulandira chithandizo ndi theka Mlingo, womwe umasinthidwa osaposa 2,5 mg / tsiku ndi gawo la sabata, ndi zikhalidwe za fexile. dzuwa ndi kuletsa zakudya zamafuta. Kumayambiriro kwa chithandizo, zochitika zomwe zimafunikira pazomwe zimachitika sizikulimbikitsidwa.

Wopanga: LLC "Kampani yamankhwala" Health "Ukraine

Code PBX: A10B B01

Fomu yotulutsidwa: Ma fomu a Mlingo wolimba. Mapiritsi

Makhalidwe wamba. Zopangidwa:

Mayina apadziko lonse komanso amakhemikolo: glibenclamide, 5-chloro-N-amino-sulfonylphenylethyl-2-methoxybenzamide,
zida zoyenera zakuthupi ndi mankhwala: mapiritsi oyera, mawonekedwe osalala ndi bevel,
Piritsi 1 lili ndi 5 mg glibenclamide,
zotuluka: mannitol, mbatata wowuma, povidone, calcium kashiamu.

Katundu

Mankhwala Hypoglycemic wothandizila, m'badwo wachiwiri sulfonylurea derivative. Kutsitsa kwa shuga kwa mankhwalawa kumachitika chifukwa cha kupangika kovuta kwa pancreatic ndi extrapancreatic kanthu.
Pancreatic zochita zimakhala polimbikitsa katulutsidwe wa insulin ndi pancreatic b-maselo, amene limodzi ndi kusamukira ndi kuchuluka kutulutsidwa kwa amkati insulin. Izi zimachitika chifukwa cha kulumikizana kwa glibenclamide ndi ma receptors ophatikizidwa ndi njira ya ATP-yotengera K + ya plasma membrane ya kugwira ntchito kwa mab-cell a kapamba, kuchepa kwamimba kwa cell membrane, kutsegula kwa njira zotsalira za Ca2 +. Imaletsa kumasulidwa kwa glucagon ndi ma cell a pancreatic.
Mphamvu ya extrapancreatic imakhala ikukulitsa mphamvu ya zotumphukira zamkati mwa zochita za insulin, kuletsa kaphatikizidwe ka shuga ndi glycogen m'chiwindi.
Kuwonjezeka kwamankhwala a insulin komanso kuchepa kwa glucose kumachitika pang'onopang'ono, zomwe zimachepetsa chiopsezo cha hypoglycemic. Mphamvu ya hypoglycemic imayamba pambuyo pa maola awiri pambuyo povomerezeka, ikafika patatha maola 7-8 ndipo imatha maola 8-12.
Glibenclamide imathandizira kubisala kwa pancreatic ndi gastric somatostatin (koma osati glucagon), imakhala ndi zolimbitsa modabwitsa (chifukwa chakuwonjezeka kwa impso clearance ya madzi aulere). Amachepetsa chiopsezo chakukulitsa mavuto onse obwera chifukwa chosagwiritsa ntchito insulin-mtima (mtima, mtima) komanso matenda okhudzana ndi matenda ashuga. Imakhala ndi mtima ndi antiarrhythmic kwenikweni.

Pharmacokinetics Pambuyo pakumwa pakamwa, imathamanga ndipo imatsala pang'ono kulowa m'mimba. Zakudya zokhazokha zimatha kuyamwa.
Kuzindikira kwamphamvu kwambiri m'magazi patangotha ​​kamodzi kumatheka pambuyo pa maola 1-2. Kumangiriza kwa mapuloteni amwazi - oposa 98%. Imalowa mosavuta kudzera muchotsekereza cha placental.
Amayikika mu chiwindi mu zinthu ziwiri zosagwira (pafupifupi zofanana), imodzi imatulutsidwa ndi impso, ndipo ina ndi ya bile. Kutha kwa theka-moyo ndi maola 6-10. Thupi silimazungulira.
Pharmacokinetics mu milandu yapadera yamankhwala. Odwala ndi mkhutu aimpso ntchito ofatsa kwa zolimbitsa digiri, palibe kusiyana kwakukulu mu pharmacokinetics ya mankhwalawa, chifukwa cha kukokomeza kwakukulu (creatinine kupitirira 30 ml / min) ndikotheka.

Mlingo ndi makonzedwe:

Gawani mkati, mphindi 20-30 musanadye, osafuna kutafuna, ndimadzi pang'ono (pafupifupi kapu ya ½).
Mlingo woyambira ndi kukonzanso, nthawi ya makonzedwe ndikugawa tsiku ndi tsiku mlingo umakhazikitsidwa payokha malinga ndi zotsatira za kutsimikiza kwa nthawi zonse muyezo wa shuga m'magazi ndi mkodzo.
Mlingo woyambirira wa mankhwalawa ndi 2.5 mg (piritsi 1/2) 1 nthawi patsiku. Ngati ndi kotheka, kuwonjezeka kwa tsiku ndi tsiku mlingo kumachitika ndikuwonetsetsa kuchuluka kwa shuga m'magazi, pang'onopang'ono kuchuluka kwa mankhwalawa kwa masiku angapo mpaka sabata limodzi ndi 2,5 piritsi (1/2 piritsi) mpaka mlingo wogwira. Mlingo wothandiza kwambiri ndi 15 mg (mapiritsi atatu). Mlingo pamwambapa 15 mg / tsiku musachulukitse kukula kwa hypoglycemic.
Mlingo wa tsiku ndi tsiku wa 10 mg (mapiritsi 2) amatengedwa 1 nthawi patsiku, asanadye chakudya cham'mawa. Pa mlingo wapamwamba tsiku lililonse, tikulimbikitsidwa kuti tiziigawa awiri Mlingo 2: 1, m'mawa komanso madzulo.
Odwala okalamba, chithandizo chimayamba ndi theka, chomwe chimawonjezeredwa ndi osaposa 2,5 mg / tsiku ndi gawo la sabata.
Kusintha kwa thupi la wodwalayo kapena moyo wake, komanso mawonekedwe a zinthu zomwe zikuwonjezera pachiwopsezo cha kukhala ndi hypo- kapena hyperglycemia, kusintha kwa mankhwalawa ndikofunikira.
Gwiritsani ntchito limodzi ndi insulin. Glibenclamide osakanikirana ndi insulin amalephera pomwe sizingatheke kukwaniritsa kuchuluka kwa shuga m'magazi mwa kutenga mlingo waukulu wa glibenclamide mu monotherapy. Komanso, motsutsana ndi malekezero a mlingo womaliza wa glibenclamide woperekedwa kwa wodwala, chithandizo cha insulin chimayamba ndi mlingo wocheperako, ndikuwonjezereka kwapang'onopang'ono kwa mlingo wa insulin mothandizidwa ndi magazi. Kuphatikiza chithandizo kumafunika kuyang'aniridwa kuchipatala. Mukaphatikiza glibenclamide ndi insulin, mlingo wotsiriza umatha kuchepetsedwa ndi 25-50%.
Pakadali pano, palibe chidziwitso pakugwiritsa ntchito mankhwalawa pochiza ana.

Zomwe Mungagwiritse Ntchito:

Mankhwala amagwiritsidwa ntchito mosamala vuto la febrile syndrome, uchidakwa, matenda a chithokomiro (hypo- kapena), odwala okalamba komanso odwala omwe ali ndi vuto la chiwindi.
Ndi monotherapy wotalikirapo (woposa zaka 5), ​​kukana kwachiwiri kumayamba.
Kuyang'anira magawo a ma labotale. Mankhwalawa ndi mankhwalawa, ndikofunikira kuyang'anira kuchuluka kwa shuga m'magazi ndi mkodzo (kangapo pa sabata panthawi ya kusankha kwa mankhwalawo), komanso kuchuluka kwa glycosylated hemoglobin (osachepera 1 m'miyezi itatu), zomwe zingatheke kuzindikiridwa kwa nthawi yayikulu kapena yachiwiri kukana kwa mankhwala. Kuphatikiza apo, ndikofunikira kuwongolera kugwira ntchito kwa chiwindi ndi chithunzi cha magazi otumphukira (makamaka kuchuluka kwa mapulateleti ndi leukocytes).
Zomwe zimafuna kusintha kwa wodwala kuchokera ku glibenclamide kupita ku insulin chithandizo: zochulukirapo, zowawa zambiri, opaleshoni yayikulu, malabsorption chakudya ndi mankhwala osokoneza bongo m'matumbo (matumbo kutsekeka, matumbo a m'mimba), chiwindi chachikulu ndi vuto la impso. kukhala pa hemodialysis. Kufunika kosinthira kwakanthawi kwa insulin kumatha kubuka m'mikhalidwe yovuta (kuvulala, kulowererapo, opatsirana matenda opatsirana ndi kutentha)
Chiwopsezo cha chitukuko kumayambiriro kwa mankhwala ndi glibenclamide. M'masabata oyamba a chithandizo, chiopsezo chokhala ndi hypoglycemia chitha kuchuluka (makamaka ndi zakudya zosasinthika kapena kudya chakudya). Zotsatirazi zingathandizire kukulitsa:
kusafuna kapena (makamaka ukalamba) kusakwanira kwa wodwala kuti azigwirizana ndi dokotala,
kudya kosakhazikika, kulumpha zakudya, kuperewera kwa zakudya m'thupi,
kusasamala pakati zolimbitsa thupi kudya chakudya
kusintha kwa zakudya
kumwa mowa, makamaka wopanda chakudya chokwanira kapena kulumpha zakudya,
kuwonongeka kwaimpso,
kukanika kwambiri kwa chiwindi,
mankhwala osokoneza bongo
matenda osagwirizana a endocrine dongosolo lomwe limakhudza kagayidwe kakang'ono ka mankhwala a caroglycemia (kuphatikizapo matenda a chithokomiro, kusowa kwa pituitary kapena adrenocortical),
Kugwiritsa ntchito munthawi yomweyo mankhwala ena (onani Chiyanjano ndi mankhwala ena).
Zizindikiro za hypoglycemia zimatha kukhala zofowoka kapenanso kusakhalapo panthawi yomwe ikukula pang'onopang'ono kwa odwala okalamba, komanso kwa odwala omwe ali ndi vuto lochita kudziyimira palokha kapena munthawi yomweyo amalandila chithandizo ndi b-adrenoreceptor blockers, clonidine, reserpine, guanethidine, kapena sympatholytics.

Mankhwalawa amayenera kumwedwa pokhapokha ngati pali Mlingo wokhazikika komanso panthawi inayake patsiku.

Nthawi ya makonzedwe ndikugawa tsiku ndi tsiku mankhwala amathandizidwa ndi adokotala, potengera mawonekedwe a tsiku la wodwala.
Chovomerezeka ndi chakudya pasanathe ola limodzi mutatha kumwa mankhwalawa.
Kuti mukwaniritse bwino kuwongolera kwa glycemia pamlingo wopatsa glibenclamide, ndikofunikira kutsatira zakudya zoyenera, kuchita masewera olimbitsa thupi ndipo ngati kuli kotheka, muchepetse thupi. Muyenera kusiya kutalikirana ndi dzuwa kwanthawi yayitali ndikuchepetsa kugwiritsa ntchito mafuta.
Zolakwika pakuwongolera kwa glibenclamide (kusiyidwa kwa mankhwalawa chifukwa cha kuyiwalika) sikungakhale kotheka ndi kuwongolera kwotsatira kwa mlingo wapamwamba. Dokotala ndi wodwala ayenera kukambirana njira zoyenera kutsatira panjira ya zolakwa (kulumpha mlingo, kudumpha chakudya) kapena ngati sikotheka kumwa mankhwalawo panthawi yoyenera.
Wodwala ayenera kudziwitsa dotoloyo mwadzidzidzi chifukwa cha kumwa kwambiri mwangozi kapena kuchuluka kwa mankhwalawo.
Kusamutsa kwa wodwala glibenclamide kuchokera kukonzekera kwina kwa sulfonylurea (kupatula chlorpramide) ndi insulin (tsiku lililonse mlingo - oposa 40 magawo). Mukasamutsa wodwala ku glibenclamide, ndikofunikira kuti muwonjezere mlingo pang'onopang'ono. Ndi mankhwala a insulin, theka la insulin ndi 5 mg ya glibenclamide ndi mankhwala tsiku loyamba.
Kukopa pa kuyendetsa magalimoto ndi kugwira ntchito ndi njira. Kumayambiriro kwa mankhwalawa kapena kugwiritsa ntchito glibenclamide, kuchepa kwa chidwi ndi kuthamanga kwa zomwe psychomotor imachita chifukwa cha hypo- kapena hyperglycemia zitha kudziwika. Zikatero, muyenera kupewa kuchita zinthu zomwe zingakhale zoopsa zomwe zimafunikira chisangalalo chochulukirapo komanso kuthamanga kwa zochitika zama psychomotor.

Zotsatira zoyipa:

Kuchokera kumbali ya kagayidwe. Hypoglycemia, kuphatikiza nocturnal (mutu, njala, kutopa, zolota usiku, mkhalidwe woledzera, kunjenjemera, chisokonezo, kuyankhula ndi zosokoneza, kawirikawiri - chikomokere). Kuphatikiza apo, chifukwa cha njira ya mayankho a adrenergic, nthawi zina zimakhala zotsatirazi: thukuta lozizira, lomata ,. Hypersensitivity ku mowa, kunenepa, dyslipidemia, kuyika kwa adipose minofu, atatha ntchito - hypothyroidism.
Kuchokera m'mimba thirakiti. Nthawi zina - nseru, kumva kupsinjika kapena kusasangalala ndi epigastrium, kupweteka kwam'mimba, kuchepa kapena kuchuluka kwa chilakolako, kawirikawiri - kusowa kwa chiwindi ntchito, cholestatic jaundice,.
Kuchokera ku magazi. Osowa kwambiri - hemolytic kapena aplastic, pancytopenia,.
Thupi lawo siligwirizana. Pafupipafupi - erythema multiforme, exfoliative, photosensitivity. Kuphatikiza kwa ziwengo ndi mankhwala ena a sulfonylurea, sulfonamides ndi mankhwala ngati thiazide ndizotheka.
Ena. Hypoosmolarity kapena vuto losakwanira katulutsidwe wa mankhwala a antidiuretic (kukhumudwa, kufooka, nkhope, matako ndi manja, kukokana, stupor, chikomokere), kusokonezeka kwa malo kwakanthawi.

Mogwirizana ndi mankhwala ena:

Amveke hypoglycemic kanthu za glibenclamide kumachitika pamene ntchito insulin kapena mankhwala ena hypoglycemic, zoletsa angiotensin akatembenuka enzyme, allopurinol, anabolic mankhwala timadzi chiwalo chachimuna, chloramphenicol, cimetidine coumarin ofanana nawo, cyclo-, Trojan ndi ifosfamide, fenfluramine, feniramidolom, fibrates, fluoxetine, guanethidine, MAO zoletsa, miconazole, fluconazole, pentoxifylline, phenylbutazone, oxyphenbutazone, azapropano Om, Probenecid, salicylates, sulfinpyrazone, kuleza akuchita sulfonamides, tetracyclines, tritokvalinom.
Kuchepa kwa mphamvu ya hypoglycemic ya glibenclamide ndikotheka ndikugwiritsa ntchito munthawi yomweyo ndi acetazolamide, barbiturates, glucocorticosteroids, diazoxide, saluretics, thiazide diuretics, epinephrine (adrenaline) ndi ena a sympathomimetics, glucagon, mankhwala opatsa mphamvu (acid). , estrogens ndi progestogens, phenothiazine, phenytoin, rifampicin, mahomoni a chithokomiro, mchere wa lithiamu, chlorpromazine.
Onse kulimbitsa ndi kufooketsa kwa hypoglycemic zotsatira za glibenclamide titha kuwonedwa ndikugwiritsa ntchito pamodzi ndi histamine H2 receptor blockers, clonidine ndi reserpine, kumwa kamodzi kapena kosalekeza.
Potengera maziko a kutenga glibenclamide, kuwonjezeka kapena kufooka kwa zomwe zimachitika mu coumarin zitha kuonedwa.

Pharmacodynamics ndi pharmacokinetics

Glibenclamide ndi mankhwala a m'kamwa a hypoglycemic okhudzana ndi zotumphukira sulfonylureas. Limagwirira ntchito a Glibenclamide limaphatikizapo kukondoweza kwa β-cell secretion mu kapambapowonjezera kutulutsidwa kwa insulin. Kwambiri, kufunikira kwake kumawonekera mu gawo lachiwiri la kupanga insulini. Izi zimawonjezera chidwi cha zotumphukira kuti ziwonjezere insulin, komanso kulumikizana kwake ndi maselo ojambulidwa. Kuphatikiza apo, glibenclamide imadziwika ndi zotsatira za hypolipidemic komanso kuchepa kwa katundu wa thrombogenic.

Mkati mwa thupi, kuyamwa mwachangu komanso kwathunthu kwa zinthuzo m'mimba mwake. Kuyankhulana ndi mapuloteni a plasma kumafanana ndi 95%. mankhwalawa ikuchitika mu chiwindi, zomwe zimapangitsa kupangika kwa osagwira ntchito. Excretion amapezeka makamaka mu mkodzo ndi gawo - bile, mu mawonekedwe a metabolites.

Malangizo apadera

Ndikulimbikitsidwa kuthandiza odwala omwe ali ndi vuto la chiwindi ndi impso, omwe ali ndi mavuto, matenda a adrenal gland kapena chithokomiro, komanso uchidakwa.

Kwa njira yonse yothandizira odwala, kuwunika mosamala kuchuluka kwa shuga m'magazi ndi kutulutsa shuga ndikofunikira.

Ngati hypoglycemia ikukula mwa odwala omwe ali ndi chikumbumtima, ndiye kuti shuga kapena shuga amapatsidwa pakamwa. Zikatere, chikumbumtima chimaperekedwa kudzera m'mitsempha, ndipo glucagon - kudzera m'mitsempha, mozungulira kapena kudzera mu mtsempha.

Munthu akachira, nthawi yomweyo wodwalayo amapatsidwa chakudya chambiri kuti apewe kuchepa kwa magazi pafupipafupi.

Glibenclamide ndi mankhwala omwe ali ndi hypoglycemic katundu kuchokera ku gulu lachigawo chachiwiri cha sulfonylurea. Lilinso ndi hypolipidemic zotsatira ndipo limachepetsa chiopsezo cha mtima wamanjenje.

Makhalidwe wamba

Dzina la mankhwala Glibenclamide pamafilimu apadziko lonse Lachilatini ndi Glibenclamide. Kunja, mankhwalawa ndi piritsi yapinki yopepuka mu mawonekedwe a disc yokhala ndi mzere wogawa. Vutolo limatha kukhala ndi miyala ya marble yopanda zing'onozing'ono.

Mapiritsi okhala ndi matuza 10 zidutswa. Mu bokosi limodzi mumatha kupezeka mbale 12 zotere.

Glibenclamide imamasulidwa ndi mankhwala, imasungidwa munthawi yovomerezeka, popanda ana. Malangizowo anati moyo wa alumali - 5 zaka. Mankhwala omalizidwa sayenera kumwa.

Piritsi lirilonse limakhala ndi 5 mg ya glibenclamide ndi maipi mu lactose monohydrate, wowonda wa mbatata, magnesium stearate, polyvinylpyrrolidone, E 124.

Makampani opanga mankhwala ochokera kumayiko ena amapanga mankhwala othandizira:

Imayambitsa ndi kampani yaku Ukraine. Kwa Glibenclamide, mtengo womwe umakhala mu Russian pharmacy chain ndi ma 270-350 rubles.

Pharmacodynamics wa mankhwala

Oral hypoglycemic mankhwala. Ku Glibenclamide, limagwirira ntchito limatengera kukondoweza kwa kupanga insulin ndi ma pancreatic β-cell. Mofananamo, insulin kukana kwa zotumphukira zimakhala kuchepa. Mankhwalawa amagwira ntchito ngati pali ma β-cell okwanira mu kapamba omwe amapanga mahomoni amkati. Amachepetsa mankhwala ndi kuphatikizira kwa kupatsidwa zinthu za m'magazi.

Makhalidwe a Pharmacokinetic

Kuchokera m'mimba thirakiti pambuyo pakukonzekera pakamwa pamimba yopanda kanthu, mankhwalawa amadziwikiridwa mwachangu, amaphatikiza mapuloteni amwazi ndi 95%. Kusintha kwa yogwira mankhwala kukhala munthawi ya metabolites kumachitika mu chiwindi. Excretion imayang'aniridwa ndi impso ndi bile ducts. Hafu ya moyo kuchokera pamagazi amachokera ola limodzi ndi theka mpaka maola atatu ndi theka. Shuga amawongolera mlingo umodzi wa mankhwalawa kwa maola osachepera 12.

Ndi hepatic pathologies, mankhwala osokoneza bongo amaletsa.Ngati kulephera kwa chiwindi kukufotokozedwera mu mawonekedwe ofooka, izi sizikhudza njira ya kuchotsa kwa metabolites; m'malo ovuta kwambiri, kudzikundikira kwawo sikuphatikizidwa.

Mafotokozedwe a magulu a nosological

Mapiritsi ndi oyera kapena oyera ndi mtundu wachikasu pang'ono kapena wonyezimira, ploskilindris wokhala ndi chiopsezo.

Hypoglycemic wothandizira pakamwa makonzedwe a gulu la sulfonylurea a m'badwo wachiwiri.

Glibenclamide ili ndi pancreatic ndi extrapancreatic zotsatira. Imalimbikitsa kukonzekera kwa insulini pochepetsa pancreatic beta-cell glucose irrigation, kumakulitsa kumva kwa insulini komanso kumangika kwa ma cell okunga, kumakulitsa kutulutsidwa kwa insulini, ndikuwonjezera mphamvu ya insulin pamatumbo a minofu ndi chiwindi cha glucose, ndikuletsa lipolysis mu adipose minofu (zotsatira zowonjezera pancreatic) . Machitidwe mu gawo lachiwiri la insulin katulutsidwe. Imakhala ndi hypolipidemic kwambiri, imachepetsa magazi a magazi.

Mphamvu ya hypoglycemic imayamba pambuyo pa maola awiri, imafika pakatha maola 7-8 ndipo imatha maola 12. Mankhwala amathandizira kuwonjezeka kwa insulin ndende komanso kutsika kosavuta kwa shuga m'magazi am'magazi, omwe amachepetsa chiopsezo cha mikhalidwe ya hypoglycemic. Ntchito ya glibenclamide imawonetsedwa ndi ntchito ya endocrine yosungidwa ndi kapamba kuti apange insulin.

Mukamamwa pakamwa, mayamwidwe am'mimba ndi 48-84%. Nthawi yakukwanira kuzunzidwa kwakukulu ndi maola 1-2, voliyumu yogawa ndi malita 9-10. Kuyankhulana ndi mapuloteni a plasma ndi 95-99%. The bioavailability ya glibenclamide ndi 100%, yomwe imakulolani kumwa mankhwalawa pafupifupi musanadye. Zolepheretsa za placental zimadutsa bwino. Imakhala ngati imaphatikizidwa kwathunthu m'chiwindi ndikupanga ma metabolites awiri osagwira ntchito, amodzi omwe amatsitsidwa ndi impso, ndi ena ndi bile. Kutha kwa theka-moyo ndikuchokera maola atatu mpaka 10-16.

Type 2 shuga mellitus ndi kulephera kwa zakudya mankhwala.

mtundu 1 shuga

matenda ashuga ketoacidosis, matenda a shuga komanso chikomokere,

vuto pambuyo pancreatic resection,

kukanika kwambiri kwa chiwindi,

kuvulala kwambiri aimpso,

hypersensitivity to glibenclamide ndi / kapena zotumphukira zina za sulfonylurea, sulfonamides, okodzetsa okhala ndi gulu la sulfonamide mu molekyulu, ndi phenenecide, monga amadziwika kuchokera ku anamnesis zimachitika mtanda

kuwonongeka kwa kagayidwe kazakudya mu matenda opatsirana kapena pambuyo pakuchita maopaleshoni yayikulu ndikusonyezedwa,

Matumbo, m'mimba,

machitidwe omwe amaperekedwa ndi malabsorption chakudya ndi kukula kwa hypoglycemia,

mimba ndi nthawi yoyamwitsa.

Glibenclamide ikuyenera kugwiritsidwa ntchito:

Matenda a chithokomiro (opuwala)

makamaka a anterior pituitary or adrenal cortex,

mwa odwala okalamba chifukwa choopa kukhala ndi hypoglycemia.

Chotsatira chovuta kwambiri pa matenda a glibenclamide ndi hypoglycemia. Vutoli limatha kutenga mtundu wophatikizika ndikuthandizira kukulira koopsa, mpaka kwa comatose, wodwalayo wopatsa moyo kapena kutha. Ndi odwala matenda ashuga polyneuropathy kapena mankhwala ophatikizika ndi mankhwala a mtima wachifundo (onani gawo "Kuyanjana ndi mankhwala ena"), oyambira ena a hypoglycemia amatha kukhala ofatsa kapena osakhala kwathunthu.

Zomwe zimayambitsa kukula kwa hypoglycemia zimatha kukhala: kuchuluka kwa mankhwala osokoneza bongo, chisonyezo cholakwika, chakudya chosamvetseka, odwala okalamba, kusanza, kutsegula m'mimba, kuthamanga kwa thupi, matenda omwe amachepetsa kufunikira kwa insulin (chiwopsezo cha chiwindi ndi ntchito ya impso, hypofunction ya adrenal cortex, pituitary kapena chithokomiro cha chithokomiro) , uchidakwa, komanso kulumikizana ndi mankhwala ena (onani gawo "Kuyanjana ndi mankhwala ena"). Zizindikiro za hypoglycemia ndi izi: Njala yayikulu, thukuta lodzidzimutsa, palpitations, khungu pakhungu, paresthesia mkamwa, kunjenjemera, nkhawa zambiri, mutu, kugona, kusokonezeka kwa tulo, kumva mantha, kulumikizana kwakanthawi, kusokonezeka kwa minyewa kwakanthawi (mwachitsanzo. zovuta zowoneka ndi zolankhula, mawonetseredwe a paresis kapena ziwalo kapena kusinthika kwa malingaliro. Ndi kupita patsogolo kwa hypoglycemia, odwala amatha kulephera kudziletsa komanso kuzindikira. Nthawi zambiri wodwala wotere amakhala ndi khungu lonyowa, komanso wamatsenga.

Pamodzi ndi hypoglycemia, izi ndizotheka:

Mavuto Oseketsa Dongosolo Lamatumbo: sikumachitika mseru, kugona, kusanza, kukoma kwa "chitsulo" mkamwa, kumva kupsinjika ndi chidzalo m'mimba, kupweteka kwam'mimba komanso kutsekula m'mimba. Nthawi zina, kuwonjezeka kwakanthawi kwa ntchito ya "chiwindi" ma enzymes (alkaline phosphatase, glutamine-oxalacetic acetic aminotransferase, glutamine-pyruvic aminotransferase mu magazi seramu, hepatitis yozizira ndi jaundice afotokozedwa.

Sichimawoneka thupi siligwirizana: zotupa, kuyabwa kwa khungu, urticaria, redness, khungu la Quincke, pamakhala zotupa pakhungu, ndikuyamwa kwambiri pakhungu lalikulu ndikuwonjezera kuwala kwadzuwa. Osowa kwambiri, kusintha kwa khungu kumatha kukhala ngati chiyambi cha kukhwima kwambiri kwamikhalidwe, limodzi ndi kufupika ndi kuchepa kwa kuthamanga kwa magazi kufikira atayamba kudabwitsidwa, komwe kumawopseza moyo wa wodwalayo. Milandu payekhapayokha ofotokozedwayo kwambiri kukonzedwa thupi lawo siligwirizana zotupa pakhungu, kupweteka palimodzi, kutentha thupi, ma protein a mkodzo ndi jaundice.

Kuchokera ku hemopoietic system: thrombocytogeny samadziwika kawirikawiri kapena kawirikawiri leukocytopeia, agranulocytosis. Nthawi zina, hemolytic anemia kapena pancytopenia amakula.

Zotsatira zina Zina zodziwikiratu zimaphatikizapo: kufooka okodzetsa, kuwoneka kwakanthawi kwamapuloteni mu mkodzo, kuwonongeka kwakanthawi ndi malo ogona, komanso kugwiritsidwa ntchito moledzera kwa kumwa pambuyo pakumwa, komwe kumanenedwa ndi zovuta za ziwalo zoyendera ndi kupuma (kusachita ngati kumva: kusanza, kumva kutentha pamaso ndi thupi lakumaso, tachycardia, chizungulire, kupweteka mutu.

Ngati bongo, kukula kwa hypoglycemia ndikotheka.

Ndi hypoglycemia yofatsa kapena yolimbitsa, shuga amatuluka kapena njira yotsekemera amatengedwa pakamwa.

Ngati kwambiri hypoglycemia (kutaya chikumbumtima), 40% dextrose (glucose) solution kapena glucagon imayendetsedwa kudzera m'mitsempha, intramuscularly, subcutaneally.

Pambuyo pozindikira, wodwalayo ayenera kupatsidwa chakudya chamagulu owonjezera chakudya kuti asayambenso kukonzekera hypoglycemia.

Kulimbikitsa mphamvu ya hypoglycemic ya Glibenclamide kumawonetsedwa pakamodzi kugwiritsa ntchito kwa angiotensin-inhibiting enzyme inhibitors, othandizira a anabolic.

zoletsa zina za mankhwala a hypoglycemic (mwachitsanzo, acarbose, biguanides) ndi insulin, mankhwala osagwiritsa ntchito mankhwala a anti-yotupa (NSAIDs), beta-blockers, quinine, quinolone derivatives, chloramphenicol, clofibrate, coumarin derivatives, obeyyramidine, microfenoxaminefulifenlaminen, frenfulfinfulifinosulin, mafrofenoxaminfinfululin, mafrofenoxamine, microfenoxulifenfululin, mafrofenoxamine, mafrofenoxamine, mafrofenoxlifenfulinene, mafrofenoxaminfinfulofinlaminene, mafrofenoxamine para-aminosalicylic acid, pentoxifylline (Mlingo waukulu wothandizidwa ndi makolo), perhexiline, zotumphukira za pyrazolone, phenylbutazones, phosphamides (mwachitsanzo cyclophosphamide, ifos amide, trofosfamide), probenecid, salicylates, sulfinpirazona, sulphonamides, tetracyclines ndi tritokvalina. Urine acidifying agents (ammonium chloride, calcium chloride) zimathandizira zotsatira za glibenclamide pochepetsa kuchuluka kwa kudzipatula kwake ndikuwonjezera o reabsorption.

Mankhwala omwe amalepheretsa mafupa a hematopoiesis kuonjezera chiopsezo cha myelosuppression.

Pamodzi ndi kuchuluka kwa zochitika za hypoglycemic, beta-blockers, clonilip, guanethidine ndi reserpine, komanso mankhwala omwe ali ndi kachipangizoka chapakati pazochita, amatha kufooketsa chidwi cha akatswiri a hypoglycemia.

Mphamvu ya gloglycemic ya glibenclamide ingathe kuchepetsedwa ndi kugwiritsa ntchito pamodzi kwa barbiturates, isoniazid, cyclosporine, diazoxide, glucorticostrosroids, glucagon, nicotinates (muyezo waukulu), phenytoin, phenothiazines, rifampicip, thiazide diuretics chithokomiro England, blockers a "pang'onopang'ono" calcium njira, othandizira omvera ndi ma lithiamu mchere.

Kugwiritsa ntchito kwambiri mowa ndi mankhwala osokoneza bongo kungakulitse kuphwanya kwa kagayidwe kazakudya.

Otsutsa a H2 receptor amatha kufooketsa, kumbali imodzi, ndikuthandizira zotsatira za hypoglycemic za Glibenclamide inayo. Nthawi zina, pentamidine imapangitsa kuchepa kwamphamvu kapena kuchuluka kwa kuchuluka kwa shuga m'magazi. Zotsatira za zotumphukira za coumarin zitha kuchuluka kapena kuchepa.

Pamodzi ndi kuchuluka kwa vuto la beta-blockers, clonidine, guanethidine ndi reserpine, komanso mankhwala omwe ali ndi kachipangizoka chapakati, kungafooketse chidwi cha akatswiri a hypoglycemia.

Mankhwalawa amayenera kumwa pafupipafupi ndipo ngati ndi kotheka, nthawi yomweyo. Ndikofunikira kuyang'anitsitsa mosamalitsa a mankhwala ndi zakudya.

Dotolo ayenera kuganizira mosamala kuperekedwa kwa Glibenclamide mwa odwala omwe ali ndi vuto la chiwindi ndi impso, komanso ndi hypofunction ya chithokomiro, anterior pituitary kapena adrenal cortex. Kusintha kwa mlingo wa Glibenclamide ndikofunikira ndi kupsinjika kwa thupi ndi malingaliro, kusintha kwa zakudya. Kuchita maopaleshoni akuluakulu komanso kuvulala, kuwotcha kwambiri, matenda opatsirana omwe ali ndi febrile syndrome kungafune kutha kwa mankhwalawa a hypoglycemic mankhwala ndi makonzedwe a insulin.

Odwala ayenera kuchenjezedwa za chiwopsezo chowonjezereka cha hypoglycemia pakagwiritsidwe ntchito ka mowa, NSAIDs, ndi njala.

Kumayambiriro kwa chithandizo, pakusankha kwa mlingo, odwala omwe amakonda kupititsa patsogolo hypoglycemia samalimbikitsidwa kuchita zochitika zomwe zimafuna chidwi ndi kuthamanga kwa zochitika zama psychomotor.

Pochiza odwala a lactase akusowa, ziyenera kukumbukiridwa kuti mankhwalawa ali ndi lactose monohydrate.

Pamalo amdima pakutentha kosaposa 25 ° C.

Pewani kufikira ana.

Mankhwala Okhala Pamalo a Pharmacy

Mankhwala ali antithrombotic, lipid-kutsitsa ndi hypoglycemicmachitidwe.

Mlingo ndi mankhwala

Glibenclamide tikulimbikitsidwa kuti mugwiritse ntchito mukangodya. Endocrinologist amawerengera mlingo kutengera zotsatira za kuyezetsa magazi kwa shuga, zaka za wodwalayo, kuopsa kwa matenda omwe ali pachiwonetsero, matenda a concomitant komanso ambiri thanzi.

Pa gawo loyamba la matendawa, muyezo wamba ndi 2,5-5 mg / tsiku. Imwani mankhwalawa kamodzi mukatha kudya m'mawa. Ngati chiphuphu chonse cha glycemia sichingatheke, dokotala amatha kusintha mankhwalawa powonjezera 2,5 mg ya mankhwalawa patatha sabata limodzi. Mlingo wakumbuyo (mpaka 15 mg / tsiku) ndi wofanana ndi mapiritsi atatu. Mlingo wapamwamba kwambiri sakonda kutumikiridwa, ndipo palibe kuchuluka kwakukulu kwa glycemia.

Ngati wodwala matenda ashuga ali ndi kulemera kochepera 50 makilogalamu, muyezo woyamba wa mankhwala ndi 2 mg, womwe umafanana ndi theka la piritsi. Ngati chizolowezi chatsiku ndi tsiku sichidutsa magawo awiri, amaledzera kwathunthu m'mawa pakudya kadzutsa, nthawi zina, mankhwalawa amagawidwa kawiri, m'mawa ndi madzulo muyezo wa 2: 1.

Glibenclamide ikasamutsidwa pambuyo pa chithandizo chopambana ndi mitundu ina ya mankhwala a hypoglycemic, mlingo woyambira udzakhala 2.5 mg kamodzi, m'mawa.

Mosachita bwino, mutha kusintha zomwe zimachitika mlungu uliwonse powonjezera 2,5 mg.

Ngati zotsatira za mankhwala omwe ali ndi mankhwala opatsirana odwala matenda ashuga sizikhutitsa, mlingo woyambira uzikhala 5 mg m'mawa mukatha kudya. Ngati ndi kotheka, kusintha kwa 2,5-5 mg mlungu uliwonse ndikololedwa. Muyeso malire amakhalabe omwewo - 15 mg / tsiku.

Ngati mulingo wambiri watsiku ndi tsiku wa Glibenclamide, mukuwona zakudya zamafuta ochepa komanso zolimbitsa thupi zolimbitsa thupi, sizipereka chindapusa cha shuga 100%, shuga imasamutsidwira ku regimen yonse. Chithandizo chachikulu chimaphatikizidwa ndi ma biguanides, insulin, ndi ena othandizira a hypoglycemic.

Ngati kupangika kwina kwa insulin kwa odwala matenda ashuga ndi mtundu wachiwiri wa matenda ndikumaponderezedwa, chithandizo chovuta sichikutsimikizirani zotsatira zofananazo ndi monotherapy ndi kukonzekera kwa insulin.

Ngati, pazifukwa zina, nthawi yoti mutenge Glibenclamide idasowa kwa ola limodzi kapena awiri, simungathe kumwa mankhwalawa mtsogolo. Mawa lotsatira, tengani mlingo wambiri, osalimbikitsa kuti muwonjezere kuchuluka kwake.

Zotsatira zoyipa

Ndi bongo wa mankhwala, hypoglycemic mayiko osiyanasiyana zovuta kupezeka, kuphatikizapo chikomokere. Ndi kumwa mowa kwambiri ndi kamodzi kapena kawiri pa tsiku, kugwira ntchito mopitirira muyeso, mavuto a chiwindi, chithokomiro cha impso ndi impso, zotsatira zosayeneranso zotheka.

Milandu yakuchulukirapo kwa Glibenclamide

Kugwiritsa ntchito mosamala magawo a mankhwalawa kumadzetsa vuto lalikulu la hypoglycemia, lomwe ndi loopsa kwa moyo wa amene akumenyedwayo.

Zotsatira zofananazo zitha kupezeka ndikugwiritsa ntchito mankhwalawo motsutsana ndi zakudya zosakhazikika, ntchito yolimbitsa thupi, mphamvu ya mankhwala ena omwe amamwa molumikizana ndi Glibenclamide.

Zizindikiro za vuto la hypoglycemic:

• Njala yosalamulirika
• Kuchepetsa kugona
• Mankhwala
• Kutha
• Kuchulukitsa thukuta
• Mutu
• Matenda a Dyspeptic
• Hypertonicity
• Kudzanja kwamanja
• Tachycardia.

Kupatuka mu ntchito ya psyche yokhala ndi mavuto a endocrine kungathe kuwonetsedwa mukusokonezeka kwa chikumbumtima, kugona, kukhumudwa, kuthana ndi magwiridwe antchito, kusowa chidwi, kugawanika kuyang'ana, mantha pamene mukuyendetsa galimoto kapena kuwongolera njira, malo okhumudwitsa, mkwiyo, mavuto amitsempha yamagazi komanso ziwalo zopumira. chikomokere.

Onse mwamtheradi komanso osokoneza bongo, hypoglycemia imatchulidwa bwino kuyerekeza ndi mankhwala osokoneza bongo a m'badwo woyamba sulfanylurea.

Kuti muchepetse mkhalidwe wa wozunzidwayo mofatsa pang'ono pang'ono poukira, mungatengere mwachangu chakudya - maswiti, theka la kapu ya tiyi ndi shuga kapena madzi (osakometsa okoma). Ngati njira zotere sizikwanira, shuga (40%) kapena Dextrose (5-10%) amalowetsedwa mu mtsempha, glucagon (1 mg) amalowetsedwa m'matumbo. Diazoxide imatha kutengedwa pakamwa. Ngati wozunzidwayo adatenga acarbose, hypoglycemia ya m'mlomo imatha kuwongoleredwa kokha ndi shuga, koma osati ndi oligosaccharides.

Ngati wozunzidwa wa hypoglycemia akadali wachidziwitso, shuga amaperekedwa kuti agwiritsidwe ntchito mkati. Zikatayika, glucose amathandizidwa ndi iv, glucagon - iv, i / m komanso pansi pakhungu. Ngati chikumbumtima chibwerera, pofuna kupewa kubwezeretsanso, munthu wodwala matenda ashuga ayenera kuperekedwa ndi zakudya zochokera ku chakudya chambiri.

Kuwunika kwa glycemia, pH, creatinine, elekitrodiya, urea nayitrogeni imayang'aniridwa nthawi zonse.

Zotsatira Zamachitidwe a Glibenclamide

Kutupa kwa glimenclamide kumachedwetsedwa, ndikumakulitsa kuthekera kwake kwa hypoglycemic, azopropanone, miconazole, coumaric acid kukonzekera, oxyphenbutazone, sulfonamide gulu mankhwala, phenylbutazone, sulfapyrazonfeniramidol.

Kuphatikiza kwa mankhwala osakaniza ndi njira zina zochepetsera shuga zomwe zimachepetsa kukana kwa insulin kumawonetsa zotsatira zofananazo.

Pogwiritsa ntchito munthawi yomweyo kugwiritsa ntchito mankhwala a anabolic, allopurinol, cimetidine, ad-adrenoreceptor blockers, cyclophosphamide, guanethidine, clofibric acid, monoamine oxidase inhibitors, sulfonamides omwe ali ndi nthawi yayitali, salicylates, tetracyclines, mowa, zoyambira zazikulu.

Ngati achire regimen ali ndi barbiturates, chlorpromazine, rifampicin, diazoxide, adrenaline, acetazolamide, mankhwala ena a sympathomimetic, shuga , saluretics, mchere wa lithiamu, kuchuluka kwa mowa ndi mankhwala ofewetsa tuvi, mphamvu ya glimenclamide imachepa.

Zotsatira zosayembekezereka za kuyanjana ndikugwiritsa ntchito kufanana zimawonetsedwa ndi otsutsana ndi H2 receptor.