Dianormet ya mankhwala: malangizo ntchito

Pharmacokinetics Dianormet (yogwira pophika metformin -1.1 - dimethylbiguanide hydrochloride) ndi othandizira a hypoglycemic pakumwa kwa gulu la Biguanide. Amachepetsa glucose okwera mwa odwala matenda ashuga. Mankhwala amagwira ntchito yake mosasamala kanthu za chinsinsi cha kapamba. Makina ochitapo kanthu a Dianormet akuchitika chifukwa cha kulepheretsa kuyendetsa kwa ma elekitirimia a kupuma kwamkati mwa membrane wa mitochondria, komwe kumayambitsa kuchepa kwa kuchuluka kwa intracellular ATP ndi kutseguka kwa glycolysis ya anaerobic, chifukwa cha glucose yemwe amalowa m'maselo kuchokera ku gawo lachiberekero ndi kuchuluka kwa glycogen. monga matumbo, chiwindi, komanso minofu ndi adipose minofu.
Machitidwe a Dianormet afikira:

• Matumbo - amalepheretsa mayamwidwe a shuga m'matumbo, amachepetsa kuyendetsa m'mimba ndi matumbo,
• chiwindi - amalepheretsa gluconeogenesis ndi kutsika kwa glucose m'magazi, kumathandizira anaerobic glycolysis,
• zotumphukira - kumawonjezera kukoka kwa minofu ya glucose, komwe kumachitika chifukwa cha kuwonjezeka kwa zochita za insulin (zochita pamlingo wa insulin receptor - kuwonjezeka kwa chiwerengero ndi kuyanjana ndi ma receptor, komanso ma receptor - kutsegula kwa machitidwe omwe amayendetsa glucose kumaselo). Zotsatira zake, Dianormet simalimbikitsa kutulutsidwa kwa insulin ndi maselo a pulogalamu ya kapamba ya kapamba, amathandizira kuthetsa hyperinsulinemia, yomwe ndi imodzi mwazomwe zimayambitsa kupanikizika kwa mitsempha komanso kuchuluka kwa kulemera kwa mtundu II matenda a shuga.

Kuphatikiza apo, Dianormet ali ndi zotsatira zoyipa za metabolic:

• magazi lipids - Amachepetsa kuchuluka kwa cholesterol yokwanira 10-20% ndi zigawo zake: LDL ndi VLDL, zomwe zimakhudzana ndi zoletsa zawo biosynthesis mu khoma lamatumbo ndikuwonjezera chimbudzi kudzera m'mimba. Imachulukitsa HDL ndi 10-20% ndipo imachepetsa TG ndi 10-20% (ngakhale mulingo wake umachulukitsidwa ndi 50%) poletsa kukhathamiritsa kwa mafuta acid, kutsitsa insulin, komanso kuletsa mayamwidwe a shuga m'matumbo,
• coagulation ndi fibrinolysis dongosolo - Amachepetsa kuzindikira kwamapulatini kuti azisakanikirana, zimapangitsa kuti michere yokhala ndi michere yowonjezera t-PA (minofu ya plasminogen activator), ikuchepetsa mphamvu ya PAI-1 (minofu ya plasminogen activator inhibitor) ndikuchepetsa mulingo wa fibrinogen,
• mtsempha wamagazi - amalepheretsa kuchuluka kwa minofu yosalala ya minyewa.

Zowonjezera kagayidwe kachakudya ka mankhwala amathandizira pakumayenda bwino kwa magazi, kuletsa kwa chitukuko cha matenda ashuga komanso kupewa mavuto monga matenda oopsa (matenda oopsa) ndi matenda a mtima. Odwala onenepa kwambiri, amatha kuchepetsa thupi, makamaka kumayambiriro kwa chithandizo.
Pharmacokinetics Amakamizidwa mu duodenum ndi matumbo ang'onoang'ono. Bioavailability ndi 50-60%. Mankhwalawa sakumanga mapuloteni am magazi, amagawidwa mwachangu m'matumbo osiyanasiyana, amadziunjikira makamaka khoma la m'mimba (m'mimba, duodenum ndi m'matumbo aang'ono), chiwindi, minofu, impso, gland. Pazipita ndende mu seramu zimatheka pambuyo 2 mawola. Hafu ya moyo ndi maola 1.5-6. Mosiyana ndi phenformin, Dianormet samapangidwira mu thupi. Mankhwalawa amachotsedwa mu mkodzo (pafupifupi 90% mkati mwa maola 12). Odwala okalamba komanso vuto laimpso, ma pharmacokinetics a metformin amasintha kwambiri. Chiwonetsero chonse komanso kupweteka kwa impso mu okalamba odwala chimachepetsedwa ndi 35-40%, mwa odwala omwe amalephera komanso aimpso - mwa 74-78%. Ngati aimpso ntchito, kuwonongeka kwa mankhwala n`zotheka.

Kugwiritsa ntchito Dianormet ya mankhwala

Mukakhala panthawi ya chakudya kapena nthawi yomweyo.
Dianormet 500: koyamba mlingo wa 500 mg patsiku. Mlingo uyenera kuchuluka pang'onopang'ono kuti mupeze bwino. Nthawi zambiri imwani 500 mg (piritsi 1) katatu patsiku. Mlingo wambiri watsiku ndi tsiku ndi 2500 mg.
Dianormet 850: mlingo woyambirira wa 850 mg / tsiku. Mlingo uyenera kuchuluka pang'onopang'ono kuti mupeze bwino. Nthawi zambiri imwani piritsi limodzi katatu patsiku. Mlingo waukulu kwambiri ndi 2500 mg / tsiku.
Achire achire kwambiri amatha pambuyo masiku 10-14 a chithandizo, motero mankhwalawa sayenera kuchuluka msanga.
Mukamagwiritsa ntchito Dianormet munthawi yomweyo ndi insulin m'masiku 4-6 oyambirira, mlingo wa insulin sunasinthidwe, mtsogolomo, mlingo wa insulin umachepetsedwa pang'onopang'ono (ndi 4- IU masiku angapo).

Contraindication kugwiritsa ntchito mankhwala Dianormet

Hypersensitivity mankhwala, matenda ashuga, metabolic acidosis, lactic acidosis, mkhalidwe wa hypoxia (chifukwa cha hypoxemia, mantha, etc.), aimpso, chiwindi kulephera, kuzungulira kwa kulephera kwa minofu hypoxia, myocardial infarction, kupuma kwamphamvu, kupsa kwambiri, ntchito, matenda opatsirana , kugwiritsidwa ntchito kwa mankhwala okhala ndi ayodini, zakumwa zoledzeretsa, nthawi yokhala ndi pakati komanso mkaka wa m'mawere.

Zotsatira zoyipa za mankhwala Dianormet

Kusala kudya, kulawa kwazitsulo mkamwa, nseru, kusanza, kupweteka m'mimba, kutsegula m'mimba. Kutsika kwamphamvu kwa izi kumatheka chifukwa chogwiritsa ntchito mankhwalawa ndi chakudya kapena poyambira kulandira mankhwalawa otsika tsiku lililonse. Ngati dyspeptic phenomena sikhala kwaokha kwa nthawi yayitali, mankhwalawo ayenera kusiyidwa.
Osowa kwambiri, kupweteka kwa mutu ndi chizungulire, kutopa, thupi lawo siligwirizana zimadziwika.
Ndi chithandizo chotenga nthawi yayitali, matenda amitsempha am'madzi am'mimba amatha kupezeka chifukwa cha malabsorption a vitamini B12 ndi folic acid. Mukamagwiritsa ntchito mankhwalawa, n`zotheka kukhala ndi lactic acidosis, komwe kumayambitsidwa ndi minyewa hypoxia, aimpso, chiwindi kapena kupuma, kulephera kwa magazi, minofu hypoxia, matenda opatsirana ndi oncological, hypovitaminosis, kumwa mowa, mankhwala opaleshoni, ukalamba. Zikatero, hemodialysis akuwonetsedwa. Mankhwala a Dianormet osakanikirana ndi mankhwala a sulfonylurea ndi / kapena insulin hypoglycemia atha kukhala, mwa njira zotere, kusintha kwa mankhwalawa kwa mankhwala omwe amagwiritsidwa ntchito ndikofunikira.

Malangizo apadera ogwiritsira ntchito mankhwala Dianormet

Pa chithandizo ndi Dianormet, kuchuluka kwa shuga m'magazi ndi mkodzo kuyenera kuyang'aniridwa nthawi ndi nthawi. Ngati ndi kotheka, kuchitapo kanthu kwa opaleshoni, kukhazikitsidwa kwa mankhwala othandizira Dianormet kwa nthawi yochepa kwathetsedwa. Kumwa mowa kumawonjezera chiopsezo cha lactic acidosis pochiza Dianormet. Ndi kuphatikiza kwa Dianormet kuphatikiza ndi mankhwala a sulfonylurea ndi insulin, osakwanira kudya, atatha kulimbitsa thupi kwambiri kapena ngati atamwa mowa kwambiri, mkhalidwe wa hypoglycemic ungayambike, womwe uyenera kukumbukiridwa poyendetsa magalimoto ndikugwiritsa ntchito njira zowopsa.
Asanayambe ndikupereka chithandizo ndi Dianormet, ndikofunikira kuwunikira zizindikiro za chiwindi ndi impso. Pogwiritsa ntchito mankhwalawa kwa nthawi yayitali, kuyezetsa magazi a morphological kuyenera kuchitika kamodzi pachaka, popeza metformin ikhoza kuyikidwa m'maselo ofiira a magazi.

Kuchita ndi Mankhwala Dianormet

Dianormet amachita mogwirizana ndi zotumphukira za sulfonylurea (glibenclamide, glipizide), insulin ndi acarbose. Amiloride, digoxin, quinidine, morphine, procainamide, triamteren, trimethoprim, cimetidine, ranitidine, Famotidine, calcium njira blockers (makamaka nifedipine) amalepheretsa tubular excretion mu impso ndipo angakulitse kuchuluka kwa Dianormet mu seramu yamagazi. Furosemide imawonjezera kuchuluka kwa Dianormet mu seramu yamagazi, ndipo Dianormet amachepetsa ndende ndi theka la moyo wa furosemide.
Mukamagwiritsidwa ntchito ndi mankhwala omwe amatha kutsogolera ku hypoglycemia (clofibrate, probenecid, propranalol, rifampicin, sulfonamides, salicylates), mlingo wa Dianormet umachepetsedwa.
Mankhwala omwe amatha kuyambitsa hyperglycemia (mankhwala opatsirana kudzera pakamwa okhala ndi estrogen, corticosteroids, diuretics, isoniazid, nicotinic acid, phenytoin, chlorpromazine, mahomoni a chithokomiro, sympathomimetics) amatha kuchepetsa kugwira ntchito kwa Dianormet. Pankhani yogwiritsidwa ntchito pamodzi ndi mankhwalawa, zomwe zimakhala m'magazi ziyenera kuyang'aniridwa ndipo ngati pakufunika kutero, chiwonjezero chofanana cha Dianormet. Mowa wa Ethyl umawonjezera chiopsezo cha lactic acidosis. Colestyramine ndi giya zimachepetsa kuyamwa kwa Dianormet, kuchepetsa zotsatira zake. Ndalamazi ziyenera kugwiritsidwa ntchito maola angapo mutatha Dianormet. Mankhwala timapitiriza zotsatira za anticoagulants mkamwa a gulu la coumarin.

Mankhwala osokoneza bongo a Dianormet, Zizindikiro ndi mankhwala

Ngakhale kwambiri mankhwala osokoneza bongo nthawi zambiri samatsogolera kukula kwa hypoglycemia, koma ndikuwopseza lactic acidosis: kukulira kwa thanzi, kufooka, kupweteka kwa minofu, nseru, kusanza, kutsekula m'mimba, kupweteka m'mimba, kulephera kupuma. Chithandizo cha lactic acidosis - hemodialysis.
Zizindikiro bongo wofatsa: kugona, kusawona bwino, kupuma kwamkamwa. Zizindikirozi zikaonekera, wodwalayo amayenera kuyang'aniridwa ndi dokotala. Chithandizo Zizindikiro.
Mu kwambiri bongo, kuchepa kapena kuwonjezeka kwa kuthamanga kwa magazi, ana opukusika, tachy kapena bradycardia, ischuria (chifukwa cha kutulutsa kwa chikhodzodzo), matumbo hypokinesia, hypo- kapena hyperthermia, kuchuluka kwa tendon, kulephera kupuma, kupweteka, kupweteka. Chithandizo - kusiya mankhwala, chapamimba, hemodialysis, kubwezeretsa magazi pH, kuchotsedwa kwa hypoxia, anticonvulsant mankhwala, kukhazikika kwa ntchito za mtima ndi kupuma dongosolo.

Malangizo ogwiritsira ntchito Dianormet

Metformin 500 mg, 850 mg kapena 100 mg.

Zosakaniza zina: povidone, talc, magnesium stearate.

lembani matenda ashuga 2 a mellitus (osadalira insulini) omwe ali ndi vuto lothandizidwa ndi zakudya, makamaka odwala omwe ali ndi kunenepa kwambiri: monga monotherapy kapena mankhwala ophatikizika ndi ena othandizira pakamwa a hypoglycemic kapena kuphatikiza ndi insulini pochiza akuluakulu, monga monotherapy kapena kuphatikiza ndi insulin zochizira ana kuyambira zaka 10.

Kuchepetsa zovuta za matenda ashuga odwala akulu omwe ali ndi matenda a shuga 2 komanso onenepa kwambiri omwe amagwiritsa ntchito metformin ngati mankhwala a mzere woyamba wokhala ndi mankhwala osakwanira.

Momwe mungagwiritsire ntchito: Mlingo ndi njira ya chithandizo

Mkati, mkati mwakudya kapena musanadye, odwala osalandira insulin, 1 g (mapiritsi 2) kawiri pa tsiku kwa masiku atatu oyamba kapena 500 mg katatu pa tsiku, kuyambira masiku 4 mpaka 14 - 1 g katatu patsiku, pakatha masiku 15 Mlingo ungathe kuchepetsedwa poganizira zomwe zili m'magazi ndi mkodzo. Kukonza tsiku lililonse mlingo - 1-2 g.

Mapiritsi a retard (850 mg) amatengedwa 1 m'mawa ndi madzulo. Pazipita tsiku mlingo 3 g.

Ndi munthawi yomweyo kugwiritsa ntchito insulin pa mlingo wochepera 40 mayunitsi / tsiku, muyezo wa metformin ndi womwewo, pamene mlingo wa insulin ungachepetse pang'onopang'ono (mwa magawo 4-8 / tsiku tsiku lililonse). Pa mlingo wa insulin yoposa 40 mayunitsi / tsiku, kugwiritsa ntchito metformin ndi kuchepa kwa insulin kumafunikira chisamaliro chachikulu ndikuchitika kuchipatala.

Zotsatira za pharmacological

Biguanide, othandizira pakamwa. Odwala omwe ali ndi matenda a shuga, amachepetsa kuchuluka kwa shuga m'magazi ndikulepheretsa gluconeogenesis m'chiwindi, kuchepetsa kuchepa kwa glucose m'matumbo am'mimba ndikuwonjezera kugwiritsidwa ntchito kwake mu minofu, kumachepetsa kuchuluka kwa TG, cholesterol ndi LDL (kutsimikizika pamimba yopanda kanthu) mu seramu komanso osasokoneza kuchuluka kwa milomo ina. Imakhazikika kapena kuchepetsa thupi.

Pakakhala insulin m'magazi, chithandizo cha mankhwala sichikuwonetsedwa. Hypoglycemic zimachitika sizimayambitsa. Amawongolera michere yamagazi ya fibrinolytic chifukwa cha kuponderezedwa kwa choletsa wa activator profibrinolysin (plasminogen).

Zotsatira zoyipa

Kuchokera pamimba: kukhumudwa, kusanza, "zitsulo" mkamwa, kuchepa kwa chilakolako chofuna kudya, kukomoka, kupweteka kwam'mimba.

Kuchokera kumbali ya kagayidwe: nthawi zina - lactic acidosis (kufooka, myalgia, kupuma, kugona, kupweteka kwam'mimba, hypothermia, kuchepa kwa magazi, Reflex bradyarrhythmia), ndi chithandizo cha nthawi yayitali - hypovitaminosis B12 (malabsorption).

Kuchokera ku ziwalo za hemopoietic: Nthawi zina - megaloblastic anemia.

Thupi lawo siligwirizana: zotupa pakhungu.

Potenga zovuta, mankhwalawa amayenera kuchepetsedwa kapena kuletsedwa kwakanthawi. Zizindikiro: lactic acidosis.

Kuchita

Amachepetsa Cmax ndi T1 / 2 ya furosemide ndi 31 ndi 42.3%, motsatana.

Zosagwirizana ndi ethanol (lactic acidosis).

Gwiritsani ntchito mosamala limodzi ndi anticoagulants osalunjika komanso cimetidine.

Zotsatira za sulfonylureas, insulin, acarbose, MAO zoletsa, oxytetracycline, ACE zoletsa, clofibrate, cyclophosphamide ndi salicylates zimathandizira.

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

Furosemide imachulukitsa Cmax ndi 22%.

Nifedipine imawonjezera mayamwidwe, Cmax, imachepetsa mayeso.

Mankhwala a Cationic (amiloride, digoxin, morphine, procainamide, quinidine, quinine, ranitidine, triamteren ndi vancomycin) omwe amatulutsidwa m'mapikisano olimbana ndi machitidwe ogwiritsira ntchito ma tubular ndipo amatha kuonjezera Cmax ndi 60% ndi chithandizo chanthawi yayitali.