Metformin nthawi yogwiritsira ntchito

Metformin (dimethylbiguanide) - wothandizira antidiabetic wogwiritsa ntchito mkati, omwe ali mgulu la biguanides. Kugwiritsa ntchito bwino Metformin Zimaphatikizidwa ndi kuthekera kwa chinthu chogwira ntchito poletsa gluconeogeneis m'thupi. The yogwira thunthu linalake ndipo tikulephera mayendedwe a ma elekitironi a kupuma maukonde a mitochondria. Izi zimabweretsa kuchepa kwa kuchuluka kwa ATP mkati mwa maselo ndi kukondoweza kwa glycolysis, kochitidwa mwa njira yopanda mpweya. Zotsatira zake, glucose amatenga maselo kuchokera kumalo akunja kumawonjezera, ndipo kupanga kwa lactate ndi pyruvate mu chiwindi, matumbo, adipose ndi minofu minofu kumakulanso. Malo ogulitsa a glycogen m'maselo a chiwindi amachepa. Sizimayambitsa zotsatira za hypoglycemic, chifukwa siziyambitsa kupanga insulin.

Imachepetsa njira zamafuta oxidation ndikuletsa zoletsa zamafuta a mafuta. Poyerekeza ndi momwe mankhwalawo amagwiritsidwira ntchito, mankhwalawo amasintha chifukwa cha kuchepa kwa insulin. Kuwonjezeka kwa kuchuluka kwa insulin / proinsulin kumadziwikanso. Chifukwa cha mapangidwe a momwe mankhwalawo amathandizira, pali kuchepa kwa shuga mu seramu yamagazi atadya chakudya, chizindikiro chachikulu cha shuga chimachepetsedwa. Chifukwa chakuti mankhwalawa samalimbikitsa kupangika kwa insulin ndi maselo a kapamba, amasiya ma hyperinsulinemia, omwe amadziwika kuti ndi chinthu chimodzi chofunikira kwambiri pakuwonjezera kulemera kwa thupi mu shuga komanso kukula kwa zovuta zam'mimba. Kutsika kwa glucose kumachitika chifukwa cha kuchuluka kwa minofu ya m'magazi komanso kuwonjezeka kwamphamvu ya zotumphukira za insulin. Mwa anthu athanzi (opanda matenda ashuga) mukamamwa metformin, kuchepa kwa shuga sikumawonedwa. Metformin imathandizira kuchepetsa thupi kunenepa kwambiri komanso matenda a shuga mwa kupondereza chilakolako cha chakudya, kuchepetsa kuyamwa kwa shuga m'zakudya ndi m'mimba thirakiti komanso kumalimbikitsa anaerobic glycolysis.

Metformin imakhalanso ndi vuto la fibrinolytic chifukwa cha kuletsa kwa PAI-1 (minofu mtundu wa plasminogen activator inhibitor) ndi t-PA (minitsi plasminogen activator).
Mankhwala amathandizira njira ya biotransfform ya glucose mu glycogen, imayendetsa magazi m'magazi a chiwindi. Katundu wa Hypolipidemic: amachepetsa mulingo wa LDL (otsika kachulukidwe lipoproteins), triglycerides (ndi 10-20% ngakhale ndikuwonjezeka koyambirira kwa 50%) ndi VLDL (otsika kwambiri a lipoproteins). Chifukwa cha zotsatira za metabolic, metformin imayambitsa kuwonjezeka kwa HDL (high density lipoproteins) ndi 20-30%.

Mankhwala tikulephera kukula kwa yosalala minofu zinthu za chotengera khoma. Imakhala ndi phindu pa mtima komanso kupewa matenda a matenda ashuga.

Pambuyo pakukonzekera kwa pakamwa, pazomwe zimakhala pazomwe zimagwira ntchito zimafikira m'magazi pambuyo pa maola 2,5. Odwala omwe adalandira mankhwalawa pazambiri zovomerezeka, zomwe zili kwambiri m'magazi a plasma sizinadutse 4 /g / ml. Patatha maola 6 mutamwa mapiritsi, kuyamwa kwa zinthu zomwe zimagwirizana ndi mankhwalawo kumatha, komwe kumayendetsedwa ndi kuchepa kwa ndende ya plasma metformin . Mukamamwa mankhwalawa pambuyo pa masiku awiri ndi awiri, kutsata kwa metformin kumapezeka m'magazi mkati mwa 1 μg / ml kapena kuchepera.

Ngati mumwa mankhwalawa mukudya chakudya, ndiye kuti pali kuchepa kwa mayamwidwe a metformin kuchokera ku mankhwalawa.Metformin imapangidwa makamaka m'makoma a chimba cham'mimba: yaying'ono ndi duodenum, m'mimba, komanso tiziwalo tating'ono ndi chiwindi. Hafu ya moyo ili pafupifupi maola 6.5. Ndi kugwiritsa ntchito kwamkati kwa metformin, phindu lenileni la bioavailability mwa anthu athanzi lili pafupifupi 50-60%. Pang'onopang'ono mapuloteni a plasma. Kugwiritsa ntchito secretion ya tubular ndi kusefera kwa glomerular, imakumba impso kuyambira 20 mpaka 30% ya mlingo womwe umayendetsedwa (osasinthika, chifukwa, mosiyana ndi formin, sunapangidwe). Mu vuto la impso, kutsekeka kwa impso kumatsika molingana ndi kupezeka kwa creatinine, chifukwa chake, kuchuluka kwa plasma ndi theka la moyo wa metformin kuwonjezeka kuchokera mthupi, zomwe zingayambitse kudzikundikira kwa chinthu chogwira ntchito mthupi.

Chifukwa metformin sichithandiza

Nthawi zina odwala amadandaula kuti mankhwalawa sawathandiza, ndiye kuti, sagwirizana ndi ntchito yake yayikulu - yotulutsa shuga. Izi zitha kuchitika pazifukwa zingapo. Pansipa ndalemba zifukwa zomwe metformin singathandizire.

Metformin sinatchulidwepo chizindikiro
Osakwanira mlingo
Chithandizo Cha Mankhwala
Kulephera kudya mukamamwa metformin
Munthu aliyense

Nthawi zina zimakhala zokwanira kukonza zolakwika ndikuchepetsa shuga sizingakudikirire.

Kuchita ndi mankhwala ena

Pogwiritsa ntchito metformin movutikira ndi mankhwala ena, kusintha kwamankhwala kumachitika pakati pazigawo zamankhwala, zomwe zimapangitsa kapena kuchepetsa kuchepa kwa shuga kwa metformin.

Chifukwa chake, kugwiritsa ntchito metformin ndi danazole nthawi yomweyo kumabweretsa chiwopsezo chachikulu cha shuga. Mosamala, muyenera kugwiritsa ntchito chlorpromazine, yomwe imachepetsa kutulutsa kwa insulin, potero kuchulukitsa glycemia.

Kuwona kwa kuwonjezereka kwa kutsika kwa shuga kumachitika mukamadya:

Glucocorticosteroids (GCS).
Sympathomimetics.
Njira zopewera ntchito zamkati.
Epinofrina.
Kuyambitsa kwa glucagon.
Mahomoni a chithokomiro.
Makonda a phenothiazone.
Zopopera za loop ndi thiazides.
Acototic acid.

Kuchiza ndi cimetidine kungayambitse kukula kwa lactic acidosis. Kugwiritsa ntchito metformin, kumafooketsa mphamvu ya anticoagulants.

Kumwa mowa nthawi zambiri kumapangidwa mukamagwiritsa ntchito metformin. Kuledzera kwambiri ndi zakudya zochepa zama calorie komanso zakudya zopanda thanzi, njala kapena kulephera kwa chiwindi kumabweretsa mapangidwe a lactic acidosis.

Chifukwa chake, pakumwa mankhwala a metformin, odwala ayenera kuwunika ntchito ya impso. Kuti achite izi, amafunika kuwirikiza kawiri pachaka kuti aphunzire kuchuluka kwa mkaka wa m'magazi. M'pofunikanso kuwunikanso zomwe zidapangidwa ndi creatinine m'magazi.

Ngati wodwala wapezeka kuti ali ndi matenda opatsirana a bronchopulmonary kapena matenda opatsirana a genitourinary system, katswiri ayenera kuthandizidwa mwachangu.

Kuphatikizidwa kwa metformin ndi mankhwala ena ochepetsa shuga, monga jakisoni wa insulin ndi sulfonylureas, nthawi zina kumabweretsa kuchepa kwa ndende. Vutoli liyenera kuganiziridwa kwa odwala omwe amayendetsa magalimoto kapena maginito ovuta. Muyenera kusiya ntchito yowopsa nthawi yanthawi yamankhwala.

Zosagwirizana ndi ethanol, loop diuretics, ma iodine okhala ndi radiopaque othandizira, chifukwa zimawonjezera chiopsezo cha lactic acidosis, makamaka pankhani yanjala kapena zakudya zama calorie ochepa. Pogwiritsa ntchito metformin, zakumwa zoledzeretsa komanso zakumwa zoledzeretsa ziyenera kupewedwa.

Gwiritsani ntchito mosamala limodzi ndi anticoagulants osalunjika komanso cimetidine.Zotumphukira za Sulfonylurea, insulin, acarbose, monoamine oxidase inhibitors (MAOs), oxytetracycline, angiotensin kutembenuza enzyme (ACE) zoletsa, clofibrate, cyclophosphamide ndi salicylates zimathandizira zotsatira za metformin.

Pogwiritsa ntchito munthawi yomweyo ndi glucocorticosteroids, kuphatikiza kwa pakamwa, epinephrine, glucagon, mahomoni a chithokomiro, zotumphukira za phenothiazine, nicotinic acid, thiazide diuretics, kuchepa kwa mphamvu ya metformin ndikotheka.

Nifedipine imathandizira kuyamwa, C max, imachepetsa kuchoka.

Zinthu za Cationic (amiloride, digoxin, morphine, procainamide, quinidine, quinine, ranitidine, triamteren ndi vancomycin) zimapikisana machitidwe ogwiritsira ntchito ma tubular ndipo, ndi chithandizo chambiri, zimatha kuwonjezera ma C ndi 60%.

Metformin ndi mankhwala ochokera ku kalasi ya biguanides, yomwe imagwiritsidwa ntchito mwachangu pochiza matenda amtundu wa 2 shuga.

Chofunikira chachikulu cha mankhwalawo ndi Metroformin hydrochloride, silicon dioxide, povidone, magnesium stearate, macrogol amagwiritsidwa ntchito ngati zida zothandiza.

Mankhwalawa amagwiritsidwa ntchito mwachangu kuchepetsa magazi. Nthawi yomweyo, kuchepa kwa zizindikiro kumachitika osati pambuyo pa chakudya chachikulu, komanso kumakupatsani mwayi kuti muchepetse maziko. Gawo lalikulu la mapiritsi limakupatsirani mwayi wopanga insulin ndi kapamba, yemwe amakhudza thupi ndipo samatulutsa chiwopsezo cha hypoglycemia. Kuphatikiza apo, zina mwazabwino ndi izi:

kulowerera kwa hyperinsulinomia,
zimapangitsa kuchepetsa thupi,
amachepetsa chiopsezo cha matenda opatsirana ndi mtima,
zimakhudza kagayidwe kazida ka lipid m'thupi,
amachepetsa makutidwe ndi mafutawa,
Amachepetsa kuchuluka kwa cholesterol yoyipa,
amachepetsa chiopsezo cha matenda a shuga,
amachepetsa triglycerides.

Mankhwalawa amatengedwa pakamwa, pambuyo pake patatha maola awiri kapena atatu ntchito yake yayikulu imayamba kuonekera. Pafupifupi maola asanu ndi limodzi atatha kumwa mankhwalawa, plasma ndende ya metformin imachepa, popeza kuyamwa kwa chinthucho kumatha.

Mukamalandira mankhwalawa pakapita masiku angapo, mutha kuwona kupezeka kwake kosalekeza m'magazi ochepa.

Metformin ya mankhwala okalamba imachepetsa kuwopsa kwa mitundu yambiri ya khansa mu mbewa ndi makoswe, komanso imalepheretsa chitukuko cha zotupa za khansa poyesa zikhalidwe zamtundu wa anthu ndi kumalizidwa kwa anthu.

Kuphatikizidwa kwa metformin ndi aspirin kumalepheretsa kukula kwa maselo a khansa ya pancreatic poletsa mapuloteni odana ndi apoptotic Mcl-1 ndi Bcl-2 (www.ncbi.nlm.nih.gov/pubmed/26056043). Ma Caspase ndi ma enzymes omwe amapangitsa kuti maselo afe.

Kuphatikizidwa kwa metformin ndi aspirin kumalepheretsa kukula kwa maselo a khansa yapachiberekero kudzera mwa kutsegula kwa caspse-3 (www.ncbi.nlm.nih.gov/pubmed/26056043) Metformin imachepetsa TNF alpha (www.ncbi.nlm.nih.

gov / pubmed / 24009539) STAT3 (siginayi ya transducer ndi activator ya cholembera 3) - mapuloteni okhazikika ndi olemba kuchokera ku STAT banja la mapuloteni. Metformin bwino imalepheretsa STAT3 ndipo imatha kuletsa magawo a khansa ya chikhodzodzo komanso cell carcinoma ya esophagus (www.ncbi.nlm.nih.

gov / pubmed / 26245871) (www.ncbi.nlm.nih.gov/pubmed/24577086) Tyrosine kinase 2 ndi enzyme yomwe imakhudzidwa ndikuwonetsa ma IL-6, IL-10 ndi IL-12. Atha kutenga nawo gawo pa chitetezo chokwanira.

Kusintha kwa mtundu wa TYK2 kumalumikizidwa ndi Een hyperimmunoglobulin syndrome (Hies), chitetezo choyambirira chodziwika ndi milingo yayikulu ya immunoglobulin E (https://en.wikipedia.org/wiki/Tyrosine_kinase_2) Metformin imalepheretsa kukula kwa khansa ya prostate mwa kupondera Tyrosine kinase 2 (ww. ncbi.nlm.nih.

gov / pubmed / 26721779) Kusintha kwa masinthidwe ndi kuchuluka kwa β-catenin kumalumikizidwa ndi mitundu yambiri ya khansa, kuphatikizapo hepatocellular carcinoma, khansa ya colorectal, khansa yam'mapapu, mawere, ovarian ndi endometrial cancer. https: //en.wikipedia.

org / wiki / Beta-catenin Metformin mlingo-wodalira amalepheretsa β-catenin mu khansa ya m'mawere (www.ncbi.nlm.nih.gov/pubmed/28035400) PPAR-γ - Peroxisome proliferator-activated receptor gamma.PPAR-γ imayang'anira kagayidwe ka mafuta komanso kusunga shuga.

Makoswe a PPAR-γ akugogoda alibe matupi a adipose mukamadya zakudya zamafuta kwambiri. Mankhwala ambiri othandizira insulin omwe amagwiritsidwa ntchito pochiza matenda osokoneza bongo amachititsa kuti PPAR-γ yochepetse shuga popanda kuwonjezera katulutsidwe ka insulin. (https://en.wikipedia.org/wiki/Peroxisome_proliferator-activated_receptor_gamm)

khansa yam'mapapo yam'mimba yovuta kwambiri (80% ya milandu), khansa ya colorectal, glioblastoma, mutu ndi zotupa za khosi. Protein iyi imakhudzidwa ndi 30% ya makhansa onse (zotupa za epithelial minofu). Metformin imalepheretsa EGFR mu glioblastoma www.ncbi.nlm.nih.

gov / pubmed / 21766499 Kinase AKT1 ndi njira yofunika kwambiri ya njira yolumikizira PI3K / AKT ndipo ikuphatikizidwa ndi kayendetsedwe ka kuchuluka kwa maselo, kukula ndi kupulumuka. Chisamaliro chachikulu chimaperekedwa pophunzira ntchito za enzymeyi chifukwa chakuti imagwira ntchito ngati ancogen m'matenda ambiri owopsa https: //en.wikipedia.

org / wiki / Protein_kinase_B Metformin imapumira AKT1 www.ncbi.nlm.nih.gov/pubmed/12890675 Metformin yachepetsa chiopsezo cha oncology ndi moyo wautali chifukwa chochepetsa mitundu yambiri ya khansa m'magawo osiyanasiyana a mbewa omwe amapezeka ndi ma khansa osiyanasiyana (onani chithunzi kumanzere) www.ncbi.nlm.nih.gov/pmc/articles/PMC3906334

Metformin ndi mankhwala omwe angathe kuchitira mankhwalawa kwa odwala matenda ashuga.

Ndi zaka, chifukwa cha atherosulinosis yamitsempha yamagazi, amuna ambiri amadwala erection. Metformin ya mankhwala okalamba imasintha kukonzanso kwa mbewa ndipo potero umagwira kusabala, komwe kumachitika chifukwa cha mtima wamatumbo.

Ndipo ichi ndi chomwe chimapangitsa kwambiri kusabala. Zochita za metformin pang'onopang'ono - njira yothandizira. Akatswiri aku America ochokera ku Yunivesite ya Georgia awonetsa kuti mankhwala ochiritsira okalamba a metformin amatha kukulitsa mitsempha yamagazi yamagazi yomwe ili m'magazi.

Metformin imachepetsa kuchuluka kwa zotupa komanso zimachepetsa kutupa mu nyamakazi kwa odwala matenda a shuga.

Lumikizanani ndi zomwe mungapeze:

Metformin imachepetsa ma enzymes okwera ndipo imatha kuchiza matenda osokoneza bongo a mafuta a chiwindi (NAFLD) mwa odwala omwe ali ndi matenda osokoneza bongo.

Nthawi zambiri mumamva kuti metformin "imabzala chiwindi." Koma mayeso angapo azachipatala akuwonetsa kuti, poganizira za zotsatira za metabolic komanso mbiri yabwino yachitetezo, metformin imawoneka ngati mankhwala olonjeza pachipatala cha NAFLD, makamaka kwa odwala omwe ali ndi mbali za metabolic syndrome.

Limagwirira a zochita za metformin

Chofunikira kwambiri cha metformin ndikupewa kupangira shuga.

Metformin imayambitsa kutulutsidwa kwa michere ya chiwindi AMPK, yomwe imayang'anira kagayidwe kazigazi ndi mafuta. Kutsegulira uku kumabweretsa kuponderezedwa kwa kupanga kwa shuga m'chiwindi. Ndiye kuti, shuga owonjezera chifukwa cha metformin samapangidwa.

Kuphatikiza apo, metformin imakulitsa chidwi chake ndi insulin yake ndikuwonjezera kutuluka kwa glucose (pogwiritsa ntchito insulin, glucose imaperekedwa ku maselo onse amthupi ndikukhala gwero lamphamvu), imawonjezera mafuta acid oxidation, ndikuchepetsa mayamwidwe a glucose m'matumbo am'mimba.

Kuchedwa kuyamwa kwa glucose m'matumbo am'mimba ndi metformin kumathandizira kuti shuga azichepa kwambiri mutatha kudya, komanso kuwonjezera kukhudzidwa kwa maselo omwe akulimbana ndi insulin yawo.

Pambuyo pakukonzekera pakamwa, metformin imalowa m'matumbo am'mimba, kugwira kwake ntchito kumayamba pambuyo pa maola 2,5. Ndipo metformin imachotsedwanso ndi impso patatha pafupifupi maola 9-12. Tiyenera kudziwa kuti metformin imatha kudziunjikira m'chiwindi, impso ndi minofu.

Kugwiritsa ntchito metformin kumayamba ndi kudya kwa 500-850 mg katatu patsiku pakudya kapena mutatha kudya. Kukuwonjezereka kwapang'onopang'ono kwa mlingo kumatheka kutengera zotsatira zamagazi pamagazi.

Njira yokonzanso metformin nthawi zambiri imakhala 1500-2000 mg / tsiku.

Kuti muchepetse mavuto kuchokera m'matumbo am'mimba, mlingo wa tsiku ndi tsiku umagawidwa mu Mlingo wa 2-3. Pazipita tsiku lililonse 3000 mg / tsiku, ogaŵikana 3 waukulu.

Mankhwala oyamba a metformin ndi French Glucophage.

Jenereta ya Glucophage: Metformin ya kampani Ozone (Russia), Siofor, etc.

Komabe, kuti muchepetse mavuto a metformin (m'matumbo am'mimba) ndikuwongolera moyo wa odwala omwe ali ndi matenda a shuga 2, metformin yomwe idatenga nthawi yayitali idapangidwa ndikutulutsidwa pansi pa dzina la Glucofage Long ndi kulowetsa pang'onopang'ono kwa metformin yogwira ntchito. Glucophage yayitali imatha kutengedwa kamodzi patsiku, zomwe, ndizosavuta kwa odwala.

Mafuta a metformin omwe amakhala nthawi yayitali ali m'matumbo am'mimba.

Zochita za chinthucho zimalinga kupewetsa mphamvu ya gluconeogenesis yomwe imachitika m'chiwindi. Kupanga kwa glucose m'thupi kumachepa, magazi ake amathanso kuchepa. Dziwani kuti mu anthu odwala matenda ashuga, kuchuluka kwa shuga m'magazi kumapitilira katatu momwe amagwiritsidwira ntchito.

Mu chiwindi pali enzyme yotchedwa AMP-activated protein kinase (AMPK), yomwe imagwira ntchito yayikulu pakulembetsa insulin, metabolism yamafuta ndi glucose, komanso mphamvu yolimba. Metformin imayambitsa AMPK kuti aletse shuga.

Kuphatikiza pa kupondereza njira ya gluconeogeneis, metformin imagwiranso ntchito zina, monga:

Amakhala bwino ndi zotumphukira za minofu ndi maselo kupita ku timadzi timene timatsitsa,
zimawonjezera kukhudzana ndi shuga ndi maselo,
kumabweretsa kukhatikiza kwa kukhatikiza kwa mafutulu amafuta acid,
amathandizira kuyamwa kwa shuga m'mimba.

Kumwa mankhwalawa kumathandizira kuchepetsa kunenepa kwambiri mwa anthu. Metformin imatsitsa serum cholesterol, TG ndi LDL cholesterol pamimba yopanda kanthu. Nthawi yomweyo, sasintha kuchuluka kwa lipoproteins a kachulukidwe ena.

Wodwala akamamwa piritsi la metformin, magazi ake amawonjezeka mkati mwa maola 1-3 ndipo ayamba kuchitapo kanthu. Mankhwalawa amamwetsa msanga mokwanira m'mimba.

Metformin imayendetsa katulutsidwe ka hepatic enzyme AMP-activated protein kinase (AMPK), yomwe imayang'anira kagayidwe ka mafuta ndi mafuta. Kukhazikitsa kwa AMPK ndikofunikira pakuwonjezera mphamvu ya metformin pa gluconeogenesis m'chiwindi.

Kuphatikiza pa kulepheretsa njira ya gluconeogenesis m'chiwindi, metformin imawonjezera chidwi cha minyewa kupita ku insulin, kumawonjezera kutulutsa kwa glucose, kumawonjezera kukhatikiza kwa mafuta acids, ndikumachepetsa kuyamwa kwa glucose kuchokera m'mimba.

Kunena mwachidule, ndiye kuti chakudya chamafuta ambiri akangolowa mthupi, pancreatic insulin imayamba kupulumutsidwa kuti magazi a shuga azikhala ochepa.

Zakudya zomanga thupi zopezeka m'zakudya zimayilowetsa m'matumbo ndipo zimasanduka shuga, zomwe zimalowa m'magazi. Mothandizidwa ndi insulin, imaperekedwa ku maselo ndikuyamba kupezeka mphamvu.

Chiwindi ndi minofu imatha kusunga glucose owonjezereka, ndipo imatulutsanso mosavuta m'magazi ngati kuli koyenera (mwachitsanzo, ndi hypoglycemia, komanso kuchita zolimbitsa thupi). Kuphatikiza apo, chiwindi chimatha kusunga glucose kuchokera ku michere ina, mwachitsanzo, kuchokera ku mafuta ndi ma amino acid (zomanga zomanga mapuloteni).

Chochita chofunikira kwambiri cha metformin ndicho kuletsa (kupondaponda) kupanga shuga ndi chiwindi, komwe ndi mtundu wa matenda a shuga a 2.

Mphamvu ina ya mankhwalawa ikuwonetsedwa pakupezeka kwa shuga m'matumbo, zomwe zimapangitsa kuti magazi azitha kuchepa m'magazi pambuyo poti adye (kuchuluka kwa shuga m'magazi), komanso kukulitsa chidwi cha maselo kupita ku insulini (maselo amomwe amayamba kulabadira mwachangu maselo yomasulidwa panthawi ya shuga).

Pambuyo pakukonzekera pakamwa, piritsi ya metformin imatengedwa m'mimba. Zochita za yogwira zimayamba maola a 2,5 pambuyo pa kukhazikitsa ndipo pambuyo pa maola 9 ndi 12 ndi impso. Metformin imatha kudzikundikira m'chiwindi, impso, komanso minofu ya minofu.

Kumayambiriro kwa mankhwalawa, metformin imakonda kutumikiridwa kawiri kapena katatu patsiku musanadye kapena mutatha kudya, 500-850 mg aliyense. Pambuyo pa maphunziro a masiku a 10-15, mphamvu yake pa shuga m'magazi imawunikiridwa ndipo ngati kuli koyenera, mlingo umawonjezedwa moyang'aniridwa ndi dokotala. Mlingo wa metformin ukhoza kuwonjezeka mpaka 3000 mg. patsiku, ogaŵikana 3 Mlingo wofanana.

Malangizo apadera ogwiritsa ntchito ndi kuwunika kwa wodwala

Monga mankhwala aliwonse, metformin ili ndi malangizo ake. Ndidapereka zofunikira mu mawonekedwe otchuka, kuti mumvetse momwe mankhwalawa amagwirira ntchito. Tiyeni tiyambire kuyambira pachiyambi pomwe ndipo tilingalire za momwe machitidwe a metformin aphatikizidwira, ndipo ngati mwanjira zasayansi, ndiye pharmacodynamics ndi pharmacokinetics ya mankhwala, koma zosavuta.

Makina a Metformin amagwira ntchito mwachangu posanthula mndandanda wazisonyezo.

Malinga ndi malangizo, mankhwalawa amagwiritsidwa ntchito pochiza matenda a shuga a 2, komanso kupewa matenda.

Mapiritsi a shuga a Metformin amalembedwa kwa anthu azaka zonse, kuphatikiza ana azaka 10.

Pazinthu zina, zitha kulimbikitsidwa kale.

Musanagwiritse ntchito Metformin, muyenera kudziwa zomwe amagwiritsa ntchito.

Pankhaniyi, ndikwabwino kutsatira malingaliro a dokotala yemwe amapereka mankhwala, poganizira zomwe wodwala aliyense ali nazo.

Zizindikiro zodziwika ngati mankhwalawa ndi:

lembani 1 ndi matenda ashuga 2
prediabetes (mkhalapakati),
kunenepa kwambiri ndi kuvutitsidwa kwa insulin,
matenda acopolycystic ovary,
kagayidwe kachakudya matenda
pamasewera
kupewa kukalamba.

Ngakhale pali mndandanda wazambiri zamankhwala omwe mungamwe Metformin, nthawi zambiri amatengedwa ndi matenda a shuga a 2. Mu mtundu woyamba wamatenda, mankhwalawa amagwiritsidwa ntchito kwambiri kawirikawiri, makamaka ngati cholumikizira insulin.

Kafukufuku ambiri adawonetsa kuti ngakhale kumwa mankhwalawa nthawi imodzi ndi jakisoni wa insulin, kufunika kwa mahomoni kumachepa pafupifupi 25-50%. Kuphatikiza apo, atatha kugwiritsa ntchito mankhwalawa kwa nthawi yayitali, kubwezeretsedwa kwa kagayidwe kazakudya kumatha bwino. Amagwiritsidwanso ntchito mumtundu wachiwiri wa shuga, womwe umafuna jakisoni wa insulin.

Mtundu wachiwiri wa matenda, Metformin amalembedwa pafupifupi pafupifupi chilichonse. Pa monotherapy, mlingo uyenera kuwonjezeka pang'onopang'ono. Chifukwa chake, poyamba amaloledwa kugwiritsa ntchito piritsi limodzi patsiku (500 kapena 850 mg).

Popita nthawi, mlingo wa mankhwalawa ukhoza kuwonjezereka mwa kufunsa dokotala musanatero. Mlingo waukulu patsiku suyenera kupitilira 2,5 mg, ndiye kuti, wodwalayo amatha kumwa mapiritsi atatu patsiku. Pakatha milungu iwiri, kagayidwe kazakudya umayamba kubwerera mwakale. Pambuyo pakufika pamlingo wabwinobwino wamagazi, mulingo umatha kuchepetsedwa.

Kuphatikizidwa kwa mankhwalawa Metformin ndi sulfonylurea kumatha kubereka kwakanthawi kochepa. Koma thupi la munthu limazolowera kwambiri mankhwala amtunduwu. Chifukwa chake, monotherapy yokhala ndi Metformin imatha kukhala ndi tanthauzo lokhalitsa.

Anthu ambiri odwala matenda ashuga omwe ali ndi mtundu wachiwiri wa matenda ndi onenepa kwambiri kapena onenepa kwambiri.

Zikatero, kugwiritsa ntchito mankhwalawa Metformin kungakhale ndi zotsatira zabwino pakuchepetsa thupi kwa wodwala. Koma pofuna kuvulaza thupi lake, wodwala matenda ashuga ayenera kutsatira izi:

Njira ya mankhwala sayenera kupitirira masiku 22.
Kumwa mapiritsi, wodwalayo ayenera kukhala ndi moyo wokangalika.
Kumwa mankhwalawo kumayenderana ndi kumwa kwambiri.
Mankhwalawa amalepheretsa wodwala kudya.

Tsiku lililonse, wodwala matenda ashuga ayenera kuchita zinthu zina zolimbitsa thupi, kaya kuthamanga, kukwera maulendo, kusambira, volleyball, mpira wachinyamata ndi zina zambiri. Kuchokera muzakudya muyenera kupatula zopaka zophika mkate, makeke, chokoleti, kupanikizana, uchi, zipatso zotsekemera, zakudya zamafuta ndi zokazinga.

Dokotalayo amadzidalira payekha mlingo wa mankhwalawo. Sizingatheke kuti muzingochita nokha mankhwala chifukwa izi zimabweretsa zotsatirapo zoyipa. Itha kugwiritsidwanso ntchito ndi anthu omwe onenepa kwambiri, koma amakonda kuzala.

Kugwiritsidwa ntchito kwa Metformin kukuwonetsedwa pochiza matenda amishuga amtundu wa 2 omwe ali ndi vuto laimpso, komanso boma. Chizindikiro chowoneka chogwiritsidwa ntchito ndi mtundu wa 2 shuga, limodzi ndi kunenepa kwambiri.

Amagwiritsidwanso ntchito ngati gawo la zovuta kuchiza matenda am'mimba-visceral kunenepa.

Nthawi yomwe amagwiritsidwa ntchito pazachipatala, kuwunika kwa Metformin kunali kwabwino kwambiri kotero kuti atayesa mayeso azachipatala omwe adawatsimikizira, mu 2007 mankhwalawa adalimbikitsidwa kuti agwiritsidwe ntchito pochita zochizira matenda a matenda ashuga a mtundu woyamba, monga cholowa pakuchiritsa matenda a insulin.

Mapiritsi a Metformin amatengedwa mosamalitsa kudya, kumwa madzi ambiri. Mlingo woyamba ndi woyamba ndi 1000 mg patsiku, pakadutsa masabata awiri, pang'onopang'ono, mankhwalawo amawonjezeka, phindu lake limasinthidwa motsogozedwa ndi deta ya labotale pamlingo wa shuga m'magazi.

Mlingo wovomerezeka waukulu ndi 3000 mg patsiku. Mlingo wa tsiku ndi tsiku utha kugwiritsidwa ntchito nthawi imodzi, koma kumayambiriro kwa chithandizo chamankhwala, pakusintha kwazinthu, tikulimbikitsidwa kuti muugawe mu 2-3 Mlingo, womwe umathandizira kuchepetsa zotsatira zoyipa za mankhwala pamimba.

Kupezeka kwakukulu kwa mankhwalawa m'madzi am'magazi kumachitika pakatha maola awiri pambuyo pa utsogoleri, pambuyo pa maola 6 akuyamba kutsika. Pambuyo masiku awiri akumwa pafupipafupi, kuphatikizira kwa mankhwalawo m'magazi kumakhazikitsidwa, malinga ndi ndemanga, Metformin imayamba kukhala ndi zotsatira zowonekera masabata awiri pambuyo poyambira kutsata.

Ndi kuphatikiza kwa Metformin ndi insulin, kuyang'aniridwa kwachipatala ndikofunikira, ndi milingo yayikulu ya insulin kuchipatala.

Zotsutsana zotsatirazi zikuwonetsedwa mu malangizo a Metformin:

Zamakono kapena zam'mbuyomu lactic acidosis
Mkhalidwe wokongola
Hypersensitivity pazinthu zilizonse za mankhwala,
Matenda a impso, komanso matenda opatsirana omwe angayambitse kuphwanya,
Kulephera kwa adrenal,
Kulephera kwa chiwindi
Matenda a shuga
Zinthu zonse zomwe zimayambitsa matenda am'madzi (kusanza, kutsegula m'mimba) ndi hypoxia (kugwedezeka, kulephera kwa mtima),
Mowa Tiyenera kukumbukira kuti ngakhale kugwiritsidwa ntchito limodzi kwa Metformin ndi mowa kumatha kuyambitsa zovuta za metabolic,
Matenda opatsirana nthawi yovuta kwambiri, limodzi ndi kutentha,
Matenda opatsirana pakufika pobweza,
Opaleshoni yayikulu ndi kukonza ntchito pambuyo,
Kuyamwitsa

Mimba, monga ubwana, siziwonedwanso kuti ndi contraindication wothira kumwa mankhwalawa, popeza ndizotheka kupereka Metformin zochizira matenda a gestational ndi achinyamata, komabe, muzochitika izi, chithandizo chimachitika mosamalitsa pazoyang'anira zamankhwala.

Metformin ikuphunziridwa m'maiko ambiri: intaneti yadzaza ndi mauthenga okhudza zinthu zomwe zapezeka kumene.Chifukwa chake, kodi kugwiritsa ntchito metformin ndi machenjezo lero ndi otani?

Metformin imaletsa ndikuwongolera matenda ashuga a 2.
Metformin samachepetsa shuga mutangomwa muyezo woyamba. Kuchita kwake kumayamba pambuyo pa maola 2,5. Kutsika kwa shuga m'magazi kumachitika m'masiku ochepa - kuyambira masiku 7 mpaka 14.
Sichimayambitsa hypoglycemia mu mankhwala othandizira, ali ndi bongo - osowa kwambiri.
Metformin ikhoza kuphatikizidwa ndi insulin, maninil, etc.
Dr. R. Bernstein (USA) akuti metformin imachepetsa chiwopsezo cha khansa, komanso imachepetsa mahomoni am'malo amanjala, potero amathandizira kukhazikika kwamphamvu.
Malinga ndi Craig Kerry, metformin itha kugwiritsidwa ntchito bwino povuta pa matenda a oncology ndi mtima.
Metformin imalimbikitsa kukula kwa ma neuron atsopano muubongo ndi chingwe cha msana.
Mu matenda a Alzheimer's, kuchuluka kwamaselo am'mitsempha mwanga mu hippocampus, gawo laubongo momwe zikumbukiro zatsopano zimachepa kwambiri. Zochitika zimawonetsa kuti kutenga 1000 mg ya metformin patsiku kwa anthu olemera 60 makilogalamu kumawongolera kwambiri luso lotha kukumbukira zina zatsopano.
Pali malingaliro osiyana akuti metformin palokha imachulukitsa chiopsezo cha matenda a dementia. Ofufuza ku Taiwan otsogozedwa ndi Dr. Yichun Kuan adachita kafukufuku wa odwala 9300 omwe ali ndi matenda amtundu wa 2, ndikuwunika mphamvu ya metformin pagulu lolamulira la odwala. Mapeto awo: wodwalayo akamatenga metformin komanso kukulitsa mlingo, ndiye kuti ali ndi vuto lakelo. Malingaliro awa amafunsidwa ndi akatswiri ambiri.
Metformin imachepetsa kutupa kwamtundu - chimodzi mwazomwe zimayambitsa kukalamba, imateteza mtima ndi mitsempha yamagazi kukalamba.
Mankhwala amasintha cholesterol, kutsitsa kiwango cha otsika-kachulukidwe kolesterol.
Metformin imachepetsa kuchuluka kwa ma enzymes a chiwindi ndipo imatha kuchiza matenda osagwirizana ndi mafuta a chiwindi odwala omwe ali ndi matenda ashuga.
Amachepetsa chiopsezo chaimfa kuchokera kumaluwa a zovuta za matenda ashuga pafupi 30%.
Metformin ilibe zotsutsana kwambiri pamatenda a impso, chiwindi, komanso kulephera kwamtima kosatha. Ngati alipo, adokotala amasintha mlingo, ndipo wodwalayo akupitilizabe kugwiritsa ntchito metformin. Komabe, lingaliro la adokotala ndi zovuta zamtima, chiwindi ndi impso za wodwalayo mwina sizingakhale bwino kuti amwe mankhwalawa.
Metformin imatha kuchepetsa kuchuluka kwa vitamini B12, chifukwa chake mukamagwiritsa ntchito, muyenera kuwunika kuchuluka kwa magazi.
Chimagwiritsidwa ntchito pakalibe ovulation mu osabereka odwala.
Metformin imakhazikitsa kulemera panthawi yomwe imayambitsidwa ndi antipsychotic mankhwala.
Sungaphatikizidwe ndi mowa kuti mupewe zovuta zamtundu wa lactic acidosis (zovuta zakupha).
Metformin ndi woyimira kukhala wowachiritsa ku ukalamba.
Ikuphunziridwa ngati mankhwala omwe angathe kuchitira mankhwalawa kwa odwala matenda amisempha.

Zotsatira za pharmacological	Metformin imathandizira kusintha kwa shuga kwa odwala omwe ali ndi matenda a shuga a 2, ndipo nthawi zina amapatsidwa mtundu wa matenda a shuga. Amachepetsa kusala kudya mukatha kudya, zimapangitsa kuchuluka kwa magazi kwakanthawi. Zimapangitsanso chiwindi kuti chizitulutsa shuga wocheperako, komanso zimakhudza mayamwidwe azakudya zamafuta m'mimba. Kuchulukitsa chidwi cha maselo ku insulin. Sichikondweretsa kapamba kuti apange insulin yowonjezera, ndiye kuti palibe chiopsezo cha hypoglycemia.
Pharmacokinetics	Mankhwalawa amachotsa impso ndi mkodzo pafupifupi osasinthika. Kuyamwa kwa chinthu yogwira pamapiritsi a nthawi yayitali (ndi analogues) kumayamba pang'onopang'ono poyerekeza ndi mapiritsi wamba. Kwa anthu omwe ali ndi vuto la impso, kugwiritsidwa ntchito kwa magazi m'magazi kungachuluke, ndipo izi sizabwino.
Zizindikiro zogwiritsidwa ntchito	Type 2 shuga mellitus, makamaka mwa anthu onenepa kwambiri komanso omwe amalephera kuzindikira minyewa mpaka insulin (insulin kukana).Kutenga metformin pokhapokha, koma sikusintha, kudya ndi kuchita zolimbitsa thupi. Kugwiritsa ntchito mankhwalawa kwa matenda ashuga, kuchepa thupi komanso kuwonjezera moyo kufotokozedwa mwatsatanetsatane patsamba lino.

Zotsatira za pharmacological	Metformin imathandizira kusintha kwa shuga kwa odwala omwe ali ndi matenda a shuga a 2, ndipo nthawi zina amapatsidwa mtundu wa matenda a shuga. Imachepetsa shuga kusala mutatha kudya, ndipo pakapita nthawi imasintha zotsatira za kuyesa kwa magazi kwa glycated hemoglobin HbA1C. Zimapangitsanso chiwindi kuti chizitulutsa shuga wocheperako, komanso zimakhudza mayamwidwe azakudya zamafuta m'mimba. Kuchulukitsa chidwi cha maselo ku insulin. Sichikondweretsa kapamba kuti apange insulin yowonjezera, ndiye kuti palibe chiopsezo cha hypoglycemia.
Pharmacokinetics	Mankhwalawa amachotsa impso ndi mkodzo pafupifupi osasinthika. Kuyamwa kwa chinthu yogwira pamapiritsi a nthawi yayitali (Glucofage Long and analogues) kumayamba pang'onopang'ono poyerekeza ndi mapiritsi wamba. Kwa anthu omwe ali ndi vuto la impso, kugwiritsidwa ntchito kwa magazi m'magazi kungachuluke, ndipo izi sizabwino.
Zizindikiro zogwiritsidwa ntchito	Type 2 shuga mellitus, makamaka mwa anthu onenepa kwambiri komanso omwe amalephera kuzindikira minyewa mpaka insulin (insulin kukana). Kutenga metformin pokhapokha, koma sikusintha, kudya ndi kuchita zolimbitsa thupi. Kugwiritsa ntchito mankhwalawa kwa matenda ashuga, kuchepa thupi komanso kuwonjezera moyo kufotokozedwa mwatsatanetsatane patsamba lino.

Contraindication

Kuwongolera kovuta kwa matenda ashuga ndi zigawo za ketoacidosis, chikomokere shuga. Kulephera kwakukulu kwa impso - glomerular filtration rate (GFR) pansi pa 45 ml / min, creatinine pamwambapa 132 μmol / L mwa amuna, pamwamba pa 141 μmol / L mwa akazi. Kulephera kwa chiwindi. Matenda opatsirana pachimake. Uchidakwa wambiri kapena uchidakwa. Kuthetsa madzi m'thupi

Malangizo apadera

Metformin iyenera kuyimitsidwa maola 48 isanachitike opaleshoni yomwe ikubwera kapena kafukufuku wa radiopaque. Muyenera kudziwa za lactic acidosis - zovuta kwambiri m'magazi pomwe pH yochokera ku 7.37-7.43 imatsikira ku 7.25 kapena kutsikira. Zizindikiro zake: kufooka, m'mimba, kupuma movutikira, kusanza, chikomokere. Kuopsa kwa vutoli ndi zero, kupatula kwa anthu omwe amamwa mankhwalawa ngati pali ma contraindication kapena kupitilira Mlingo womwe umalimbikitsa tsiku lililonse.

Sonyezani shuga lanu kapena sankhani jenda kuti mulimbikitsidwe

Zindikirani zaka za mwamunayo

Sonyezani zaka za mkazi

Mlingo

Ndikulimbikitsidwa kuti ndiyambe kulandira mankhwalawa tsiku lililonse la 500-850 mg ndikuwonjezera pang'onopang'ono mpaka 2550 mg, mapiritsi atatu 850 mg. Mapiritsi a nthawi yayitali, mlingo waukulu wa tsiku ndi tsiku ndi 2000 mg. Mlingo umachulukitsidwa ngati wodwalayo alibe zotsatira zoyipa, osapitirira kamodzi pa sabata, kapena ngakhale masiku khumi ndi asanu. Mapiritsi owonjezera-amatulutsidwa amatengedwa 1 kamodzi patsiku usiku. Odwala mapiritsi 3 pa tsiku ndi chakudya.

Zotsatira zoyipa

Odwala nthawi zambiri amadandaula za matenda otsegula m'mimba, nseru, kusowa kudya, komanso kuphwanya malingaliro akumva. Izi sizoyipa zowopsa zomwe nthawi zambiri zimangokhala zokha m'masiku ochepa. Kuti muwachepetse, yambani ndi 500 mg ndipo musathamangire kuti muwonjezere mlingo watsiku ndi tsiku. Choyipa kwambiri ngati kuyimitsa, kuzizira, osati kungopumira m'mimba kumawonekera. Metformin imasokoneza mayamwidwe a vitamini B12.

Mimba komanso Kuyamwitsa	Metformin imatsutsana panthawi ya pakati komanso nthawi yoyamwitsa, chifukwa imadutsa mwa placenta ndikulowetsa mkaka wa m'mawere. Sichikugwiritsidwa ntchito pochiza matenda ashuga. Kumbali inayi, kugwiritsa ntchito mankhwalawa a PCOS ndikwabwino komanso kothandiza. Ngati mutazindikira kuti muli ndi pakati, ndikupitilirabe - zili bwino. Mutha kuphunzira nkhaniyi mu Russian za izi.
Kuchita ndi mankhwala ena	Pewani kumwa mapiritsi owononga a shuga, osawagwiritsa ntchito ndi metformin.Kuphatikiza ndi insulin kungayambitse shuga m'magazi. Pangakhale kuyanjana koyipa ndi mankhwala othandizira kuthamanga kwa magazi komanso kulephera kwa mtima. Chiwopsezo chawo sichikhala chachikulu. Werengani malangizo omwe amagwiritsidwa ntchito phukusi ndi mankhwala kuti mumve zambiri.
Bongo	Milandu yamafotokozedwe osokoneza bongo afotokozedwa pogwiritsa ntchito kamodzi 50% ya mankhwala kapena zambiri. Kuchepetsa kwakukulu kwa shuga m'magazi kumakhala kochepa, koma chiopsezo cha lactic acidosis ndicho pafupifupi 32%. Kufunika kuchipatala mwachangu. Ndizotheka kugwiritsa ntchito dialysis kuti muchepetse kuchotsedwa kwa mankhwala m'thupi.
Fomu yotulutsidwa, zikhalidwe ndi magwiritsidwe ake	Mapiritsi okhala ndi 500, 850 kapena 1000 mg pazomwe zimagwira. Mankhwalawa amayenera kusungidwa kuchokera kwa ana kuti atenthedwe ndi kutentha osapitirira 25 ° C. Moyo wa alumali ndi zaka zitatu kapena zisanu.

Gawani pamagulu ochezera

Ndi chakudya chiti chomwe chimasintha magazi?

Zamkatimu Zakudya za shuga komanso kufuna kutaya mafuta Olemera kalori, zoperewera komanso.

Zamkatimu Zida Zambiri za PreventionPevzner Zakudya Na. 5 za Zofunikira Pancreatitis

Chifukwa chiyani pali shuga wochepa wa magazi Ngati simumalandira shuga wamagazi ambiri, ndiye kuti imayambitsa pachimake ndipo.

Zovuta za ochepa matenda oopsa Kodi magazi oopsa amagwira ntchito bwanji?

Njira yogwiritsira ntchito

Kuvomerezedwa kwa mankhwala ndi okalamba kumachitika pokhapokha poona kuchuluka kwa kuwunika kwa impso.
Zochizira zathunthu zimachitika pakatha masabata awiri mutamwa mankhwalawa.

Ngati muyenera kupita Metformin ndi wothandizila pakamwa wina wa hypoglycemic, ndiye kuti mankhwala am'mbuyomu ayenera kusiyidwa, kenako yambani ndi Metformin mkati mwa mlingo woyenera.

Ndi kuphatikiza kwa insulin ndi Metformin, mulingo wa insulin sunasinthidwe mu masiku 4- 6. M'tsogolomo, ngati pakufunika kutero, mlingo wa insulin umachepetsedwa - masiku angapo otsatirawa ndi 4-8 IU. Ngati wodwala alandila insulini yoposa 40 IU patsiku, ndiye kuti kuchepetsa kwa mankhwalawa pogwiritsa ntchito Metformin kumachitika kokha kuchipatala, chifukwa amafunika chisamaliro chachikulu.

Njira zodziwika za metformin

Chofunikira kwambiri cha metformin ndikupewa kupangira shuga.

Kuchedwa kuyamwa kwa glucose m'matumbo am'mimba ndi metformin kumathandizira kuti shuga azichepa kwambiri mutatha kudya, komanso kuwonjezera kukhudzidwa kwa maselo omwe akulimbana ndi insulin yawo. Katunduyu wa metformin amalola kuti agwiritsidwe ntchito prediabetes - kupewa matenda ashuga omwe amakonda.

Pambuyo pakukonzekera pakamwa, metformin imalowa m'matumbo am'mimba, kugwira kwake ntchito kumayamba pambuyo pa maola 2,5. Ndipo metformin imachotsedwanso ndi impso patatha pafupifupi maola 9-12. Tiyenera kudziwa kuti metformin imatha kudzikundikira m'chiwindi, impso ndi minofu.

Njira yokonzanso metformin nthawi zambiri imakhala 1500-2000 mg / tsiku.

Kuti muchepetse mavuto kuchokera m'matumbo am'mimba, mlingo wa tsiku ndi tsiku umagawidwa mu Mlingo wa 2-3.Pazipita tsiku lililonse 3000 mg / tsiku, ogaŵikana 3 waukulu.

Mankhwala oyamba a metformin ndi French Glucophage.

Jenereta ya Glucophage: Metformin ya kampani Ozone (Russia), Siofor, etc.

Komabe, kuti muchepetse mavuto a metformin (m'matumbo am'mimba) ndikuwongolera moyo wa odwala omwe ali ndi matenda a shuga 2, metformin yomwe idatenga nthawi yayitali idapangidwa ndikutulutsidwa pansi pa dzina la Glucofage Long ndi kulowetsa pang'onopang'ono kwa metformin yogwira ntchito. Glucophage yayitali imatha kutengedwa kamodzi patsiku, zomwe, ndizosavuta kwa odwala.

Mafuta a metformin omwe amakhala nthawi yayitali ali m'matumbo am'mimba.

Zotsatira zoyipa za metformin

Pogwiritsa ntchito metformin kwanthawi yayitali, kuchepa kwa mayamwidwe a vitamini B12 kungawonedwe. Ngati megablastic anemia yapezeka, makulitsidwe owonjezera a vitamini B12 amafunikira.
Nthawi zambiri, mavuto am'mimba amayamba (kusekemera, kusanza, kutsegula m'mimba), kutulutsa magazi, kupweteka kwam'mimba, kusintha kwa kulawa, kusowa kwa chakudya. Pankhaniyi, metformin iyenera kumwedwa ndi chakudya kuti muchepetse mkwiyo m'matumbo.
Pogwiritsa ntchito nthawi yayitali, komanso mukamamwa metformin wokhala ndi milingo yayikulu ya mowa, lactic acidosis imatha kuwoneka - kuchuluka kwambiri kwa lactic acid m'magazi, komwe kumatha kuwopseza moyo wa wodwalayo. Imachitika kawirikawiri ndi mankhwala osokoneza bongo a metformin komanso odwala omwe ali ndi vuto la impso.
Nthawi zambiri khungu limakhudza - erythema, zidzolo, ma dermatoses.
Nthawi zambiri, kukomoka kwa chiwindi, hepatitis, kumatha mankhwala atatha.

Metformin imagwiritsidwa ntchito pokhapokha ngati dokotala wanena, ndipo tchuthi chake ndi mankhwala okha.

Katundu wapadera ndi kugwiritsa ntchito kwatsopano kwa metformin

Metformin ikuphunziridwa m'maiko ambiri: intaneti yadzaza ndi mauthenga okhudza zinthu zomwe zapezeka kumene. Chifukwa chake, kodi kugwiritsa ntchito metformin ndi machenjezo lero ndi otani?

Metformin imaletsa ndikuwongolera matenda ashuga a 2.
Metformin samachepetsa shuga mutangomwa muyezo woyamba. Kuchita kwake kumayamba pambuyo pa maola 2,5. Kutsika kwa shuga m'magazi kumachitika m'masiku ochepa - kuyambira masiku 7 mpaka 14.
Sichimayambitsa hypoglycemia mu mankhwala othandizira, ali ndi bongo - osowa kwambiri.
Metformin ikhoza kuphatikizidwa ndi insulin, maninil, etc.
Dr. R. Bernstein (USA) akuti metformin imachepetsa chiwopsezo cha khansa, komanso imachepetsa mahomoni am'malo amanjala, potero amathandizira kukhazikika kwamphamvu.
Malinga ndi Craig Kerry, metformin itha kugwiritsidwa ntchito bwino povuta pa matenda a oncology ndi mtima.
Metformin imalimbikitsa kukula kwa ma neuron atsopano muubongo ndi chingwe cha msana.
Mu matenda a Alzheimer's, kuchuluka kwamaselo am'mitsempha mwanga mu hippocampus, gawo laubongo momwe zikumbukiro zatsopano zimachepa kwambiri. Zochitika zimawonetsa kuti kutenga 1000 mg ya metformin patsiku kwa anthu olemera 60 makilogalamu kumawongolera kwambiri luso lotha kukumbukira zina zatsopano.
Pali malingaliro osiyana akuti metformin palokha imachulukitsa chiopsezo cha matenda a dementia. Ofufuza ku Taiwan otsogozedwa ndi Dr. Yichun Kuan adachita kafukufuku wa odwala 9300 omwe ali ndi matenda amtundu wa 2, ndikuwunika mphamvu ya metformin pagulu lolamulira la odwala. Mapeto awo: wodwalayo akamatenga metformin komanso kukulitsa mlingo, ndiye kuti ali ndi vuto lakelo. Malingaliro awa amafunsidwa ndi akatswiri ambiri.
Metformin imachepetsa kutupa kwamtundu - chimodzi mwazomwe zimayambitsa kukalamba, imateteza mtima ndi mitsempha yamagazi kukalamba.
Mankhwala amasintha cholesterol, kutsitsa kiwango cha otsika-kachulukidwe kolesterol.
Metformin imachepetsa kuchuluka kwa ma enzymes a chiwindi ndipo imatha kuchiza matenda osagwirizana ndi mafuta a chiwindi odwala omwe ali ndi matenda ashuga.
Amachepetsa chiopsezo chaimfa kuchokera kumaluwa a zovuta za matenda ashuga pafupi 30%.
Metformin ilibe zotsutsana kwambiri pamatenda a impso, chiwindi, komanso kulephera kwamtima kosatha. Ngati alipo, adokotala amasintha mlingo, ndipo wodwalayo akupitilizabe kugwiritsa ntchito metformin. Komabe, lingaliro la adokotala ndi zovuta zamtima, chiwindi ndi impso za wodwalayo mwina sizingakhale bwino kuti amwe mankhwalawa.
Metformin imatha kuchepetsa kuchuluka kwa vitamini B12, chifukwa chake mukamagwiritsa ntchito, muyenera kuwunika kuchuluka kwa magazi.
Chimagwiritsidwa ntchito pakalibe ovulation mu osabereka odwala.
Metformin imakhazikitsa kulemera panthawi yomwe imayambitsidwa ndi antipsychotic mankhwala.
Sungaphatikizidwe ndi mowa kuti mupewe zovuta zamtundu wa lactic acidosis (zovuta zakupha).
Metformin ndi woyimira kukhala wowachiritsa ku ukalamba.
Ikuphunziridwa ngati mankhwala omwe angathe kuchitira mankhwalawa kwa odwala matenda amisempha.

Kuchokera pamndandandawu, kugwiritsidwa ntchito kwatsopano kwa metformin (kupatula mtundu wa matenda ashuga 2) omwe adafufuza ndi asayansi akuwunikiridwa. Pofuna chilungamo, ziyenera kunenedwa kuti zambiri mwazomwe zikugwiritsidwa ntchitozi zikutsutsa ntchito ya ofufuza ena. Chifukwa chake, akatswiri akadatsutsanabe ngati Metformin amachepetsa kulemera kapena ayi. Ntchito zina zimawonetsa kukopa bwino kwa ovulation ndi metformin, pomwe ena amafotokoza zovuta zazing'ono za mankhwalawa pa njira yobereka.

Wopanga zamasamba Sorokina Vera Vladimirovna

Mankhwala odziwika bwino kwambiri a shuga padziko lapansi ndi Metformin, ndipo amamwa tsiku lililonse ndi anthu 120 miliyoni. Mbiri ya mankhwalawa ili ndi zaka zopitilira makumi asanu ndi limodzi, munthawi yomwe kafukufuku wambiri wachitika, ndikuwonetsa kugwira ntchito kwake komanso chitetezo kwa odwala. Nthawi zambiri, Metformin imagwiritsidwa ntchito ngati mtundu wa 2 matenda a shuga kuti muchepetse kukana kwa insulini, koma nthawi zina imatha kugwiritsidwa ntchito poletsa zovuta zamagulu a carbohydrate komanso kuwonjezera pa insulin yothandizira matenda amtundu wa 1.

Ndikofunikira kudziwa! Nkhani yatsopano yomwe ikulangizidwa ndi ma endocrinologists a Kuwunika Kwachisawawa Kokulu! Ndi zofunika tsiku lililonse.

Mankhwalawa ali ndi zotsutsana pang'ono ndipo alibe zotsatira zoyipa zamankhwala ena ochepetsa shuga: sizimawonjezera ngozi.

Tsoka ilo, Metformin akadali ndi zolakwika. Malinga ndi ndemanga, mu wachisanu mwa odwala omwe amamwa, matenda am'mimba amawonedwa. Ndikotheka kuchepetsa mwayi womwe ungachitike ngati mankhwalawo amachokera mu chakudya chambiri pang'onopang'ono kuwonjezera kuchuluka kwa mankhwalawa ndikugwiritsa ntchito njira zatsopano zotulutsira nthawi yayitali.

Matenda a shuga ndi kupsinjika kudzakhala chinthu chakale

Matenda a shuga ndi omwe amayambitsa pafupifupi 80% yonse yamikwingwirima ndi kuduladula. Anthu 7 mwa anthu 10 amafa chifukwa cha mitsempha ya mtima kapena ubongo. Pafupifupi nthawi zonse, chifukwa chomaliza chomaliza ndi chimodzimodzi - shuga wamwazi.

Shuga akhoza ndipo amayenera kugwetsedwa, apo ayi. Koma izi sizichiritsa matendawa, koma zimangothandiza kulimbana ndi kufufuza, osati zomwe zimayambitsa matendawa.

Mankhwala okhawo omwe amavomerezeka pamankhwala othandizira odwala matenda ashuga komanso amagwiritsidwa ntchito ndi ma endocrinologists pantchito yawo ndi awa.

Kugwiritsa ntchito bwino kwa mankhwalawa, kuwerengera malinga ndi njira yokhazikika (kuchuluka kwa odwala omwe achiwonjezere kuchuluka kwa odwala omwe ali pagulu la anthu 100 omwe adachitiridwa chithandizo):

Matenda a shuga - 95%
Kuthetsa kwa mitsempha thrombosis - 70%
Kuthetsa kwa kugunda kwamtima kwamphamvu - 90%
Kuthana ndi kuthamanga kwa magazi - 92%
Kulimbitsa tsiku, kukonza kugona usiku - 97%

Opanga si bungwe lazamalonda ndipo amalipidwa ndi chithandizo cha boma. Chifukwa chake, tsopano wokhala aliyense ali ndi mwayi.

Zizindikiro zogwiritsa ntchito Metformin

Metformin inachita kupangidwa kukhala chomera wamba chomwe chimadziwika kuti chimachepetsa shuga. Kuchepetsa kawopsedwe ndikupititsa patsogolo hypoglycemic mbuzi, ntchito inayambika pakugawa zinthu zofunikira kuchokera pamenepo.Adadzakhala anyuanides. Pakadali pano, Metformin ndi mankhwala okhawo m'gululi omwe adakwanitsa kuthana ndi chitetezo, ena onsewo adadzakhala ovulaza chiwindi ndipo adawonjezera kwambiri chiopsezo cha lactic acidosis.

Chifukwa chogwira ntchito bwino komanso ndi zovuta zochepa, ndi mankhwala a mzere woyamba wochizira matenda amtundu wa 2, ndiye kuti, adakhazikitsidwa koyamba. Metformin sikukula insulin. Osatengera izi, chifukwa cha kuchepa kwa shuga m'magazi, timadzi timatha kupangika mopanga kuchuluka, komwe nthawi zambiri kumachitika mtundu wa shuga wachiwiri ukayamba.

Kulandila kwake kumakupatsani mwayi:

Limbikitsani kuyankhidwa kwa maselo ku insulin, ndiye kuti, muchepetse - chomwe chimayambitsa vuto lama carbohydrate mwa anthu onenepa kwambiri. Metformin kuphatikiza zakudya komanso kupsinjika kungathe kufalitsa mtundu wa shuga wa 2, ndikuchiritsika kwakukulu, ndikuthandizira kuthetsa.
Kuchepetsa mayamwidwe am'mimba m'matumbo, omwe amachepetsa shuga m'magazi.
Kuchepetsa kapangidwe ka shuga m'chiwindi, chifukwa cha momwe mulingo wake m'magazi umatsikira pamimba yopanda kanthu.
Khudzani ndi lipid yamagazi: onjezani zomwe zili ndi milomo yambiri ya m'mimba mwake, kuchepetsa cholesterol ndi triglycerides yoyipa m'mitsempha yamagazi. Izi zimachepetsa chiopsezo cha zovuta zamatenda a shuga.
Sinthani njira za resorption zatsopano zamagazi m'mitsempha, kufooketsa kudziphatika kwa leukocytes, ndiko kuti, kuchepetsa chiopsezo cha atherosulinosis.
Kuchepetsa thupi, makamaka chifukwa chowopsa cha kagayidwe ka mafuta a visceral. Pambuyo pakugwiritsa ntchito zaka 2, kulemera kwa odwala kumatsika ndi 5%. Ndi kuchepa kwa caloric kudya, zotsatira za kuchepa thupi zimayenda bwino.
Yambitsani kuyenda kwa magazi mu zotumphukira zimakhala, ndiko kuti, kukonza zakudya zawo.
Kupangitsa ovulation kukhala ndi polycystic ovary, motero, imatha kutengedwa pokonzekera kutenga pakati.
Tetezani ku khansa. Izi zatsegulidwa posachedwa. Kafukufuku awonetsa kutulutsa katundu wa antitumor mu mankhwalawa; chiopsezo chokhala ndi oncology mwa odwala chatsika ndi 31%. Ntchito yowonjezereka ikuchitika kuti iphunzire ndikutsimikizira izi.
Chepetsani kukalamba. Uwu ndiye mphamvu yopanda tanthauzo ya Metformin, zoyeserera zimachitika kokha pa nyama, zimawonetsa kuwonjezeka kwa nthawi yomwe moyo ungayesedwe makoswe. Palibe zotsatira za kuyesedwa kwathunthu kwachipatala ndi kutenga nawo gawo kwa anthu, kotero ndizoyambiranso kunena kuti Metformin imachulukitsa moyo. Pakadali pano, izi ndizowona kwa odwala omwe ali ndi matenda ashuga okha.

Chifukwa cha kuchuluka kwa thupi mu thupi, zikuwonetsa kugwiritsidwa ntchito kwa Metformin sikuti amangothandiza kuchiza matenda a shuga a mtundu wachiwiri. Itha kuthandizidwa bwino kupewa matenda osokoneza bongo, kuwongolera kuonda. Kafukufuku wasonyeza kuti mwa anthu omwe ali ndi prediabetes ( ,, , owonjezera insulin) pamene Metformin yokha imagwiritsidwa ntchito, matenda a shuga anali ochepa 31%. Powonjezera zakudya ndi maphunziro akuthupi ku chiwembucho kunakwaniritsa bwino zotsatira: 58% ya odwala anatha kupewa matenda ashuga.

Metformin imachepetsa chiwopsezo cha zovuta zonse za shuga ndi 32%. Mankhwalawa akuwonetsa zotsatira zochititsa chidwi popewa macroangiopathies: mwayi wokhala ndi vuto la mtima komanso sitiroko umachepetsedwa ndi 40%. Izi zimafananizidwa ndi zotsatira za cardiprotectors - mankhwala opsinjika ndi ma statins.

Mtundu wa kumasulidwa kwa mankhwala ndi kumwa

Mankhwala oyamba omwe ali ndi Metformin amatchedwa Glucofage, chizindikiro cha kampani ya ku France Merck. Chifukwa chakuti zaka zopitilira 10 zapita kuchokera pamene mankhwalawa adayamba kupanga ndikupeza patent yake, kupanga mankhwala omwe ali ndi mawonekedwe omwewo - majenito, ndizololedwa.

Malinga ndi ndemanga za madotolo, otchuka komanso apamwamba kwambiri:

Germany Siofor ndi Metfogamma,
Israeli Metformin-Teva,
Russian Glyfomin, Novoformin, Formmetin, Metformin-Richter.

Ma genetic ali ndi mwayi wotsimikizika: ndi wotsika mtengo kuposa mankhwala oyambirirawo.Sipangokhala zovutirapo: chifukwa cha mawonekedwe opangira, mphamvu zawo zitha kukhala zochepa, ndikuyeretsa. Popanga mapiritsi, opanga amatha kugwiritsa ntchito zinthu zina, zomwe zimatha kubweretsanso zina.

Mankhwala amapangidwa mwanjira ya mapiritsi amkamwa, Mlingo wa 500, 850, 1000 mg. Kuchepetsa shuga mu zovuta zamatumbo a metabolism kumawonedwa kuyambira 500 mg. Kwa odwala matenda ashuga, mulingo woyenera kwambiri ndi 2000 mg . Ndi kuwonjezeka kwa iye mpaka 3000 mg, zotsatira za hypoglycemic zimakula pang'onopang'ono kuposa chiwopsezo cha mavuto. Kuchulukanso kwa mlingo sikuti kungokhala kopindulitsa, komanso koopsa. Ngati mapiritsi awiri a 1000 mg sanakwaniritse kuchepa kwa glycemia, wodwalayo amamulembera mankhwala ochepetsa shuga a magulu ena.

Kuphatikiza pa Metformin yoyera, kukonzekera kophatikizidwa kwa matenda ashuga kumapangidwa, mwachitsanzo, Glibomet (yokhala ndi glibenclamide), Amaryl (ndi glimepiride), Yanumet (ndi sitagliptin). Cholinga chawo chimakhala cholondola mu shuga wa nthawi yayitali, pomwe ntchito za pancreatic zimayamba kuwonongeka.

Palinso mankhwala ogwiritsira ntchito nthawi yayitali - mulingo woyambira wa Glucofage Long (Mlingo wa 500, 750, 1000 mg), analogues wa Metformin Long, Glformin Prolong, Formin Long. Chifukwa cha kapangidwe kapadera ka piritsi, kuyamwa kwa mankhwalawa kumachepetsedwa, zomwe zimayambitsa kuchepa kwapawiri kwa pafupipafupi zovuta zoyambira m'matumbo. Mphamvu ya hypoglycemic imasungidwa bwino. Metformin ikamwezedwa, gawo lolembamo kanthulo limatulutsidwa mu ndowe. Chokhacho chingabwezeretse mawonekedwe awa ndiwowonjezeka pang'ono mu triglycerides. Kupanda kutero, zotsatira zabwino pa lipid mbiri yamagazi zimatsalira.

Momwe mungatenge metformin

Yambani kutenga Metformin ndi piritsi limodzi la 500 mg. Ngati mankhwalawa amalekeredwa bwino, mlingo umawonjezereka mpaka 1000 mg. Kutsitsa kwa shuga kumayamba pang'onopang'ono, kutsika kwamphamvu kwa glycemia kumawonedwa pambuyo pa milungu iwiri yoyendetsa. Chifukwa chake, mlingo umakulitsidwa ndi 500 mg mu sabata kapena awiri, mpaka matenda a shuga amalipiridwe. Kuti muchepetse vuto logaya chakudya, tsiku lililonse mutha kugawa magawo atatu.

Kutulutsa pang'onopang'ono metformin kumayamba kumwa ndi piritsi limodzi, nthawi yoyamba yomwe mankhwalawa amasinthidwa pambuyo masiku 10-15. Kuchuluka kwakuloledwa ndi mapiritsi atatu a 750 mg, mapiritsi 4 a 500 mg. Voliyumu yonse ya mankhwalawa amamwa nthawi yomweyo, nthawi yamadzulo. Mapiritsi sangathe kuphwanyidwa ndikugawika magawo, chifukwa kuphwanya kapangidwe kake kumayambitsa kutayika kwa nthawi yayitali.

Mutha kutenga Metformin kwa nthawi yayitali, kupuma kwa chithandizo sikofunikira. Pa phwando ndipo musasiye. Pamaso pa kunenepa kwambiri, amachepetsa kudya kwa caloric.

Kugwiritsa ntchito nthawi yayitali kumatha kubweretsa kusowa kwa vitamini B12, chifukwa chake odwala matenda ashuga omwe amatenga Metformin ayenera kudya zakudya zamtundu tsiku lililonse, makamaka chiwindi, impso ndi ng'ombe, ndikuyesedwa pachaka chifukwa cha kuchepa kwa magazi m'thupi la B12.

Kuphatikiza kwa metformin ndi mankhwala ena:

Kugawana zoletsa	Kukonzekera	Zosafunika
Zoletsedwa kotheratu	Kukonzekera kosiyanitsa ndi X-ray ndi ayodini	Mungamupangitse lactic acidosis. Metformin imachotsedwa masiku 2 asanayambe kuphunzira kapena kugwira ntchito, ndikuyambiranso masiku awiri pambuyo pawo.
Zoletsedwa kotheratu	Opaleshoni
Zosafunika	Mowa, zakudya zonse ndi mankhwala okhala nazo	Amawonjezera chiopsezo cha lactic acidosis, makamaka odwala matenda ashuga pazakudya zama carb ochepa.
Kuwongolera kowonjezera kumafunikira	Glucocorticosteroids, chlorpromazine, beta2-adrenergic agonists	Kukula kwa shuga
	Mankhwala opanikiza kupatula ACE inhibitors	Kuopsa kwa hypoglycemia
	Zodzikongoletsera	Kuthekera kwa lactic acidosis

Zotsatira zoyipa ndi contraindication

Zotsatira zoyipa za kutenga Metformin ndi pafupipafupi zomwe zimachitika:

Zochitika Zosiyanasiyana

Zizindikiro

Pafupipafupi

Mavuto a chimbudzi

Kuchepetsa mphuno, kusowa kwa chilakiko, chimbudzi chamasamba, kusanza.

≥ 10%

Kukhumudwa

Kulawa kwazitsulo mkamwa, nthawi zambiri pamimba yopanda kanthu.

≥ 1%

Thupi lawo siligwirizana

Kutupa, redness, kuyabwa.

Limagwirira ntchito a Metformin

Kuphatikiza pa kupondereza njira ya gluconeogeneis, metformin imagwiranso ntchito zina, monga:

Amakhala bwino ndi zotumphukira za minofu ndi maselo kupita ku timadzi timene timatsitsa,
zimawonjezera kukhudzana ndi shuga ndi maselo,
kumabweretsa kukhatikiza kwa kukhatikiza kwa mafutulu amafuta acid,
amathandizira kuyamwa kwa shuga m'mimba.

Kumwa mankhwalawa kumathandizira kuchepetsa kunenepa kwambiri mwa anthu. Metformin imatsitsa serum cholesterol, TG ndi LDL cholesterol pamimba yopanda kanthu. Nthawi yomweyo, sasintha kuchuluka kwa lipoproteins a kachulukidwe ena. Munthu wathanzi (wokhala ndi thanzi labwino) yemwe amatenga metformin sangamve kuwawa.

Kugwiritsa ntchito mankhwalawa, wodwalayo amatha kukwaniritsa kuchepa kwa shuga ndi 20%, komanso kuchuluka kwa hemoglobin ya glycosylated ndi 1.5%. Kugwiritsa ntchito mankhwalawa monga monotherapy, kuyerekezera ndi mankhwala ena ochepetsa shuga, insulin ndi zakudya zapadera, kumachepetsa mwayi wokhala ndi vuto la mtima. Kuphatikiza apo, kafukufuku wa 2005 (Cochrane Collaboration) adatsimikiza kuti kufa pakati pa odwala omwe ali ndi matenda a shuga a 2 amachepetsedwa ndikutenga Metformin.

Wodwala akamamwa piritsi la metformin, magazi ake amawonjezeka mkati mwa maola 1-3 ndipo ayamba kuchitapo kanthu. Mankhwalawa amamwetsa msanga mokwanira m'mimba.

Gawolo silimapangidwa, koma litulutsidwa mthupi la munthu ndi mkodzo.

Malangizo ogwiritsira ntchito mankhwalawa

Mankhwala Metformin amapezeka mu mawonekedwe a mapiritsi omwe ali ndi 500 mg yogwira ntchito (metformin hydrochloride). Kuphatikiza apo, mankhalawo amaphatikiza zinthu zowonjezera zochepa: wowuma chimanga, crospovidone, povidone K90, magnesium stearate ndi talc. Paketi imodzi ili ndi matuza atatu a mapiritsi 10.

Katswiri wokhazikika amene amayesa momwe thanzi la wodwalayo lingatithandizire kugwiritsa ntchito mankhwalawa Metformin. Wodwala akamamwa mapiritsi, ayenera kutsatira malangizo onse a dokotala.

Malangizo a kuingiza amapezeka phukusi lirilonse lokonzekera. Mmenemo mungapeze zotsatirazi zomwe mungagwiritse ntchito:

Type 2 shuga mellitus, makamaka mwa anthu onenepa kwambiri omwe samakonda ketoacidosis (kuphwanya chakudya cha m'thupi).
Kuphatikiza kwa insulin mankhwala ndi kukana kwa mahomoni, komwe kunayambikanso.

Dziwani kuti katswiri yekha ndi amene amatha kuwerengera mulingo woyenera, malinga ndi kuchuluka kwa shuga m'magazi a odwala matenda ashuga. Malangizowa amapereka mlingo waukulu wa mankhwalawa, omwe nthawi zambiri amafunikira kuwunikanso komanso kusintha.

Mlingo woyambirira wa mankhwalawa ndi mapiritsi a 1-2 (mpaka 1000 mg patsiku). Pakatha milungu iwiri, kuchuluka kwa metformin kumatheka.

Mlingo wokonza mankhwalawa ndi mapiritsi 3-4 (mpaka 2000 mg patsiku). Mlingo wapamwamba kwambiri watsiku ndi tsiku ndi mapiritsi 6 (3000 mg). Kwa okalamba (kuyambira zaka 60), ndikulimbikitsidwa kumwa metformin osaposa mapiritsi awiri patsiku.

Momwe mungamwe mapiritsi? Amawamwa yonse, kutsukidwa ndi kapu yaying'ono yamadzi, pakudya kapena pambuyo pake. Kuchepetsa mwayi wosakhudzana ndi njira yogaya chakudya, mankhwalawa agawidwe kangapo. Pakakhala vuto lalikulu la metabolic, mlingo wa mankhwalawa uyenera kuchepetsedwa kuti muchepetse kukula kwa lactic acidosis (lactic coma).

Metformin iyenera kusungidwa m'malo owuma komanso amdima osapeza ana aang'ono. Kutentha kosungira kumachokera ku +15 mpaka +25 degrees. Kutalika kwa mankhwalawa ndi zaka zitatu.

Contraindication ndi zovuta zoyipa

Monga mankhwala ena, kugwiritsa ntchito metformin kumatha kuphatikizidwa mwa anthu omwe ali ndi matenda enaake kapena pazifukwa zina.

Monga tanena kale, kwa odwala omwe ali ndi zaka zopitilira 60, makamaka omwe amagwira ntchito yolemetsa, mankhwalawa sayenera kugwiritsidwa ntchito, chifukwa amatha kutsogolera lactic acidosis.

Mndandanda wa zotsutsana ndi mankhwalawa siwocheperako. Kugwiritsa ntchito metformin ndizoletsedwa pomwe:

precoma kapena chikomokere, matenda,
kukanika kwa impso ndi chiwindi,
matenda pachimake okhudza kugwira ntchito kwa impso (kuchepa madzi m'thupi, hypoxia, matenda osiyanasiyana, malungo),
poyizoni ndi zakumwa zoledzeretsa kapena uchidakwa wambiri,
aakulu kapena pachimake pathologies omwe ungayambitse kukula kwa myocardial infarction, kupuma kapena kulephera kwa mtima,
lactic acid chikomaso (makamaka, mbiri),
akuchita masiku osachepera awiri komanso kwa masiku awiri pambuyo pa mayeso a x-ray ndi radioisotope ndi jakisoni wa chinthu china chosiyana ndi ayodini,
Zakudya zama calori zochepa (zosakwana calories 1000 patsiku),
kunyamula mwana ndi kuyamwitsa,
kuchuluka kwa zomwe zili pamankhwala.

Wodwala akamalandira mankhwala popanda kutsatira malangizo a dotolo, zovuta zina zimawoneka. Amalumikizidwa ndi ntchito yolakwika:

kupukusa m'mimba (kusanza, kusintha kwa kukoma, kuchuluka kwa chakudya, kusowa kwa chakudya, kutsekula m'mimba kapena kupweteka kwam'mimba),
hematopoietic ziwalo (kukula kwa megaloblastic anemia - kuchepa kwa folic acid ndi vitamini B12 m'thupi),
kagayidwe (kagayidwe ka lactic acidosis ndi B12 hypovitaminosis yolumikizana ndi malabsorption),
dongosolo la endocrine (kukula kwa hypoglycemia, komwe kumawonetsedwa ndi kutopa, kusakwiya, kupweteka mutu komanso chizungulire, kutaya chikumbumtima).

Nthawi zina pamakhala zotupa pakhungu. Zotsatira zoyipa zomwe zimakhudzana ndi kusokonezeka kwa dongosolo la kugaya chakudya zimachitika kawirikawiri masabata awiri oyambilira. Izi zimachitika kawirikawiri m'thupi, pakatha masiku 14, kukomoka kwa metformin kumachitika, ndipo zizindikirazo zimapita zokha.

Chithandizo Cha bongo

Munthu wodwala matenda ashuga akamamwa mankhwala pamankhwala akuluakulu kuposa momwe walangizidwa ndi dokotala angawononge thupi lake kwambiri, osatchulanso kuti amwalira. Ngati bongo uli ndi vuto lalikulu, zotsatira zake zingachitike -. Chifukwa china chake chakukula kwake ndikuwunikira kwa mankhwalawa pakukanika kwa impso.

Chizindikiro cha lactic acidosis ndichakudya cham'mimba, kupweteka kwam'mimba, kutentha pang'ono kwa thupi, kupweteka kwa minofu, kuchuluka kwa kupuma, chizungulire komanso kupweteka m'mutu, kukomoka, komanso ngakhale kupweteka.

Ngati wodwala wazindikira chimodzi mwazizindikirozo, kuchotsedwa kwa metformin ndikofunikira. Chotsatira, muyenera kumugoneka wodwala kuchipatala mwachangu. Dokotala amatsimikiza zomwe zili ndi lactate, pamaziko a izi, amatsimikizira kapena kukana kuwunika kwake.

Njira yabwino yochotsera kuchuluka kwa lactate ndi metformin ndi njira ya hemodialysis.Kuti athetse zizindikiro zotsalira, chithandizo chamankhwala chimachitika.

Tiyenera kudziwa kuti kugwiritsa ntchito metformin ndi othandizira okhala ndi sulfonylurea kungayambitse kuchepa msanga kwa shuga.

Kuchita ndi njira zina

Pogwiritsa ntchito metformin movutikira ndi mankhwala ena, kusintha kwamankhwala kumachitika pakati pazigawo zamankhwala, zomwe zimapangitsa kapena kuchepetsa kuchepa kwa shuga kwa metformin.

Chifukwa chake, kugwiritsa ntchito metformin ndi danazole nthawi yomweyo kumabweretsa chiwopsezo chachikulu cha shuga. Mosamala, muyenera kugwiritsa ntchito chlorpromazine, yomwe imachepetsa kutulutsa kwa insulin, potero kuchulukitsa glycemia. Mankhwalawa pogwiritsa ntchito antipsychotic ngakhale mankhwala atachotsedwa, Mlingo wa metformin uyenera kusintha.

Kuwona kwa kuwonjezereka kwa kutsika kwa shuga kumachitika mukamadya:

Glucocorticosteroids (GCS).
Sympathomimetics.
Njira zopewera ntchito zamkati.
Epinofrina.
Kuyambitsa kwa glucagon.
Mahomoni a chithokomiro.
Makonda a phenothiazone.
Zopopera za loop ndi thiazides.
Acototic acid.

Kuchiza ndi cimetidine kungayambitse kukula kwa lactic acidosis. Kugwiritsa ntchito metformin, kumafooketsa mphamvu ya anticoagulants.

Chifukwa chake, pakumwa mankhwala a metformin, odwala ayenera kuwunika ntchito ya impso. Kuti achite izi, amafunika kuwirikiza kawiri pachaka kuti aphunzire kuchuluka kwa mkaka wa m'magazi. M'pofunikanso kuwunikanso zomwe zidapangidwa ndi creatinine m'magazi. Ngati zotsatira zake zikuwonetsa kuti chiwonetsero cha creatinine ndichoposa 135 μmol / L (wamwamuna) ndi 110 μmol / L (wamkazi), kusiya mankhwala ndikofunikira.

Ngati wodwala wapezeka kuti ali ndi matenda opatsirana a bronchopulmonary kapena matenda opatsirana a genitourinary system, katswiri ayenera kuthandizidwa mwachangu.

Pogwiritsa ntchito mankhwala ena aliwonse, wodwalayo ayenera kudziwitsa dokotala za izi, zomwe zingasinthe Mlingo komanso nthawi ya maphunziro.

Mtengo, ndemanga ndi fanizo

Mtengo wa Metformin umatengera kuti ndi wochokera kunja kapena wopangidwa.

Popeza pophika ndimtundu wotchuka wa hypoglycemic m'malo osiyanasiyana padziko lapansi, mayiko ambiri amapanga.

Mutha kugula mankhwalawa popereka mankhwala ku pharmacy, pali njira yosankhira mankhwalawo pa intaneti.

Mtengo wa mankhwalawa umatengera dera la mankhwalawo m'gawo la Russian Federation ndi wopanga

Metformin (Russia) Ayi. 60 - mtengo wotsika kwambiri ndi ma ruble a 196, ndipo okwera ndi ma ruble 305.
Metformin-Teva (Poland) Ayi 60 - mtengo wotsika kwambiri ndi ma ruble 247, ndipo okwera ndi 324 rubles.
Metformin Richter (Hungary) No. 60 - mtengo wotsika kwambiri ndi ma ruble 287, ndipo okwera ndi 344 rubles.
Metformin Zentiva (Slovakia) Ayi 30 - mtengo wotsika kwambiri ndi ma ruble 87, ndipo okwera ndi ma ruble 208.
Metformin Canon (Russia) Ayi 60 - mtengo wotsika kwambiri ndi ma ruble 230, ndipo okwera ndi ma ruble 278.

Monga mukuwonera, mtengo wa mankhwalawa Metformin ndiwotsika kwambiri, kotero aliyense amene ali ndi ndalama zambiri akhoza kugula. Kuphatikiza apo, ndizopindulitsa kwambiri kugula mankhwala osokoneza bongo, chifukwa mtengo wake umakhala wotsika, ndipo chithandizo chake ndizofanana.

Kodi Metformin ndi chiyani?

Omwe akutsogolera pakuwongolera matenda a shuga 2 amatenga Metformin. Ndi ya pagogo. Izi ndi zinthu zomwe zimachepetsa shuga. Kugwiritsa ntchito bwino kwa mankhwalawa kumatsimikiziridwa ndi nthawi, machitidwe ogwiritsa ntchito, monga zikuwonekera ndi kuwunika kwa odwala. Awa ndiwo mankhwala okhawo omwe amagwiritsidwa ntchito pochiza matenda a shuga kwa ana. Metformin ili ndi mayina angapo, imagulitsidwa ngati Glucofage, Siofor, Glformin. Zimatengera wopanga komanso kapangidwe kazomwe amapangira mankhwala.

Kupanga ndi mawonekedwe a kumasulidwa

Metformin imapezeka mu piritsi. Amakhala ozungulira, biconvex, wokutidwa ndi chipika cha enteric choyera. Mankhwalawa amadzaza m'matumba a zidutswa 10 kapena 15. Katemera wa Carton adzagwira mapiritsi 30. Gome likuwonetsa kapangidwe ka kapisozi kamodzi kamankhwala:

Yogwira pophika

Metformin hydrochloride (kapena dimethylbiguanide)

Wowuma chimanga (kapena mbatata)

Pharmacodynamics ndi pharmacokinetics

Metformin imalepheretsa kaphatikizidwe ka ATP (adenosine triphosphoric acid) mu mitochondria (ma cell organelles apadera). Njirayi imakhudza mwachindunji njira zingapo zamomwe zimapangidwira zimakhudzana ndi metabolism ya carbohydrate. Kamodzi m'thupi, dimethylbiguanide imayambitsa kuchepa kwa ndende chifukwa cha njira zingapo:

imalepheretsa gluconeogeneis (njira ya kupanga shuga m'magulu osagwiritsa ntchito chakudya) m'chiwindi,
kumawonjezera mphamvu minofu insulin,
Amasintha magwiritsidwe ake a shuga ndi ma cell,
Imachepetsa mayamwidwe a glucose m'matumbo ang'ono.

Mothandizidwa ndi mankhwalawa mutatha kudya, palibe kusintha kwakuthwa kwa glucose. Mankhwala:

sizimayambitsa hypoglycemia (matenda ogwirizana ndi kuchepa kwa shuga),
zilibe kanthu pa kaphatikizidwe ka insulin,
amachepetsa msana wa triglycerides, otsika osalimba lipoprotein m'madzi a m'magazi,
Ili ndi mphamvu ya fibrinolytic (thrombo-absorbable) chifukwa cha kukakamiza kwa minofu ya plasminogen activator inhibitor (puloteni yomwe imalimbikitsa kapangidwe ka enzyme ya fibrinolytic).

Madzi a mayamwidwe amapezeka kuchokera m'matumbo. Mlingo wokhazikika wa mankhwalawa uli ndi 50-60% bioavailability. Metformin samachita ndi mapuloteni am magazi. Thupi limadziunjikira tiziwalo timene timataya, minofu, minyewa, ndi chiwindi. Imafufutidwa ndi impso zosasinthika. Metformin monotherapy poyerekeza ndi mankhwala ena kuti achulukitse kuchuluka kwa shuga amachepetsa:

chiopsezo cha myocardial infaration,
kuchuluka kwa odwala omwe ali ndi matenda ashuga a 2.

Momwe angatenge

Mapiritsiwo amameza lonse, kutsukidwa ndi madzi ambiri. Mlingo woyambira osachepera 500 mg kamodzi patsiku, upamwamba wake ndi 2,5-3 g.Amalimbikitsidwa kumwa mapiritsi a metformin mukatha kudya kapena nthawi yomweyo musanakagone. Mlingo wa mankhwalawa ndibwino kuwonjezera pang'onopang'ono. Mlingo woyamba wa dimethylbiguanide umayambitsa kusokonezeka m'mimba ndipo umasokoneza chimbudzi. Kulawa kwazitsulo, nseru ndizizindikiro za mankhwala osokoneza bongo oyamba amagwiritsidwa ntchito ngati mankhwala.

Ndi monotherapy ndi mankhwala, ndikwabwino kutsatira zomwe zatsimikiziridwa:

Sabata yoyamba, mankhwala ambiri a 500 mg amatengedwa 1 nthawi.
Kenako, tsiku ndi tsiku mlingo ukuwonjezeka mpaka 850-1000 mg ndikugawidwa pawiri.
Ngati njira za metabolic sizikhutira pamlingo waukulu wa 2000 mg, sulfonylureas iyenera kuwonjezeredwa ndi metformin kapena insulin iyenera kugwiritsidwa ntchito.
Kukula kwa mlingo kumatengera shuga wowerengera. Mlingo wamtundu amasankhidwa payekha ndi dokotala.
Odwala okalamba, pazipita tsiku lililonse ndi 1000 mg.

Metformin: Ndingatenge nthawi yayitali bwanji ndipo ndikuwonjezera bongo?

Odwala omwe ali ndi matenda a shuga a mtundu wachiwiri, funso limakhala kuti, Metformin imatenga nthawi yayitali bwanji? M'malo mwake, yankho la funsoli mulibe.Palibe dokotala amene angatchule nthawi yeniyeni, popeza chithandizo cha wodwala aliyense chimadalira thanzi lake, kuchuluka kwa shuga, kuopsa kwa matenda ashuga ndi matenda ena okhudzana ndi izi.

Matenda a shuga amatchedwa mliri wa m'ma 2000. Izi ndichifukwa choti chaka chilichonse chiwerengero cha odwala omwe ali ndi matenda amtunduwu chikukula. Kafukufuku akuwonetsa kuti 90% ya onse odwala matenda ashuga ali ndi matenda amtundu wachiwiri, mwa iwo alipo azimayi ambiri omwe ali onenepa kwambiri kuposa amuna.

Metformin ndi mankhwala otchuka pakati pa odwala matenda ashuga omwe samadalira insulin omwe sangathe kuchepetsa shuga ndi zakudya zapadera komanso masewera olimbitsa thupi. Kuphatikiza apo, imagwiritsidwanso ntchito kupewa zomwe zimachitika chifukwa cha matenda ashuga komanso zotupa za khansa. Koma magwiridwe antchito a mankhwalawo, mungatani kuti mugwiritse ntchito moyenera kuti musadzivulaze? Chabwino, tiyeni tiyese kuzindikira izi.

Limagwirira ntchito a Metformin

Kuphatikiza pa kupondereza njira ya gluconeogeneis, metformin imagwiranso ntchito zina, monga:

Amakhala bwino ndi zotumphukira za minofu ndi maselo kupita ku timadzi timene timatsitsa,
zimawonjezera kukhudzana ndi shuga ndi maselo,
kumabweretsa kukhatikiza kwa kukhatikiza kwa mafutulu amafuta acid,
amathandizira kuyamwa kwa shuga m'mimba.

Wodwala akamamwa piritsi la metformin, magazi ake amawonjezeka mkati mwa maola 1-3 ndipo ayamba kuchitapo kanthu. Mankhwalawa amamwetsa msanga mokwanira m'mimba.

Gawolo silimapangidwa, koma litulutsidwa mthupi la munthu ndi mkodzo.

Metformin ndi mankhwala okhawo omwe amathandizira kupewa matenda ashuga ndi mtima

Wolemba:
Aef. Cardiology ndi Angiology 1/2011

MD M.N. Mamedov, M.N. Kovrigina, Ph.D. E.A. Poddubskaya

Masiku ano, metformin ndi imodzi mwamankhwala omwe amagwiritsidwa ntchito kwambiri masiku ano. Mu 2006, International Diabetes Federation idalandira malingaliro atsopano othandizira odwala matenda ashuga, momwe metformin idapangidwira ngati mankhwala a mzere woyamba kuphatikiza kusintha kwa moyo kuti ayambe kulandira chithandizo. Pazaka zisanu zapitazi, izi sizinasinthe.

Komabe, mbiri yakagwiritsidwe ntchito ka greatuanides mu endocrinological zochita inali yodzala ndi chiyembekezo komanso zokhumudwitsa. Biguanides yoyamba - phenformin ndi buformin adagwiritsidwa ntchito mkati mwa zaka za XX, posakhalitsa adagulitsidwa chifukwa chogulitsa chifukwa cha lactic acidosis.Metformin anapangidwa ndi Sterne mu 1957. Mu 1960, maphunziro oyamba azachipatala adakhazikitsidwa, omwe adawonetsa kuti kuchepa kwa glycemia sikumayendetsedwa ndi kuchuluka kwa thupi ndi chiwopsezo cha hypoglycemia. Mu 1980, pogwiritsa ntchito njira yowuma, zinaonetsedwa kuti metformin imachepetsa kukana kwa insulin.

Mu 1995, kwa nthawi yoyamba, FDA (American Food and Health Administration) idavomereza kugwiritsa ntchito metformin ku United States. Pakafukufuku wokhazikitsidwa ndi FDA, metformin adapezeka kuti ali wofanana ndi chitetezo ndi mankhwala ena othandizira. Zimawonetsedwanso kuti metformin imakhala ndiubwino kuposa ma biguanides ena, imadziunjikira makamaka m'matumbo ang'onoang'ono komanso m'matumbo a salivary, osati m'misempha, yomwe ndi malo apamwamba a mapangidwe a lactate. Malinga ndi mayesero ambiri azachipatala, pafupipafupi mankhwala a metformin ogwirizana ndi lactic acidosis ndi 8.4 pa odwala 100,000, komanso pochiza mankhwala ena aliwonse a antipyretic (kuphatikiza glibenclamide) - 9 pa 100 miliyoni.

Pazaka 50 zapitazi, maphunziro oyesera a 5500 ndi zamankhwala adachitidwa pazinthu zosiyanasiyana pakuchita bwino komanso chitetezo cha metformin.

Zotsatira za Antihyperglycemic of Metformin

Zotsatira za metformin pamagazi a shuga wamagazi ndizofanana ndi zotsatira za othandizira ena odwala matenda ashuga. Metformin siyimayambitsa hyperinsulinemia, m'malo mwake, kuchuluka kwa insulin nthawi zambiri kumachepera, komwe kumalumikizidwa ndi kusintha kwa insulin.

Pakafukufuku wawukulu wazachipatala (wakhungu, wowona mosasinthika, wowongolera malo, wofanana ndi gulu) wokhudzana ndi odwala 451, zotsatira za antihyperglycemic zotengera zotsatira za metformin zidawerengedwa. Kuchepa komweko kwa shuga m'magazi ndi glycated hemoglobin amawonedwa mosiyana ndi maziko a metformin mu Mlingo wa 500-2000 mg / tsiku. Odwala omwe ali ndi matenda ashuga, tsiku lililonse 2000 mg ya metformin anali okwanira kuwongolera shuga m'magazi. Mu msika waku Russia, metformin Glucofage yoyambirira imaperekedwa mwanjira zitatu za 500 mg, 850 mg ndi 1000 mg.

Pamodzi ndi izi, metformin imachulukitsa kugwiritsidwa ntchito kwa glucose panthawi yowuma, yomwe imalumikizidwa ndi kusintha kwa zotumphukira za insulin. Kupititsa patsogolo kagayidwe ka glucose kumalumikizidwa ndi kuwonjezeka kwa metabolism osagwirizana ndi okosijeni, ndiye kuti, popanda phindu la oxidation. Zotsatira za metformin pa kapangidwe ka shuga m'chiwindi zimaphunziridwa mwa odwala 7 omwe ali ndi mtundu wa 2 matenda osokoneza bongo panthawi ya chithandizo ndi metformin mankhwala omwe amakhala miyezi itatu. Metformin imachepetsa kwambiri kupanga shuga mu chiwindi ndi pafupipafupi gluconeogeneis poyerekeza ndi gawo loyamba.

Kafukufuku wakutsogolo wa Britain akuwonetsa kuti metformin ili ndi mphamvu yopulumutsa insulin. Mankhwala a insulini amakhalabe otsika kwambiri mwa anthu omwe amasankhidwa mosagwirizana ndi gulu la metformin poyerekeza ndi magulu a mankhwala a sulfonylurea (glibenclamide kapena chlorpropamide) kapena jakisoni wa insulin.

Kupewa matenda ashuga oyamba ndi metformin

Kupewa koyamba kwa matenda ashuga kumaphatikizapo kugwiritsa ntchito njira zovuta, kuphatikizapo kusintha kwa moyo komanso kugwiritsa ntchito mankhwala osokoneza bongo pakati pa anthu omwe ali pachiwopsezo. Choyamba, gululi limaphatikizapo anthu omwe ali ndi prediabetes (kuthamanga kwambiri kwa glycemia ndi kulekerera kwa glucose).

Mu zaka 1976-1980, monga gawo la kafukufuku wapadziko lonse ndi US National Health and Nutrition Examination Survey (NHANES II), akuluakulu 3092 adayesa kulolera shuga. Kupezeka kwa hyperglycemia patatha maola awiri atamwa 75 ga shuga kumalumikizidwa ndi kuwonjezereka kwa milandu yonse yamatenda a mtima. Zambiri zowonjezera zimapezeka mu kafukufuku yemwe akuyembekezeredwa, Kafukufuku kuchokera ku matenda a shuga a Diabetes Epidemiology: Collaborative Analysis Of Diagnostic Criteria ku Europe (DECODE), omwe adawonetsa gawo lofunikira la prediabetes pakukula kwa zovuta zamatenda a matenda a mtima (CVD). Hyperglycemia idayesedwa ndi kudya mwachangu glucose komanso pambuyo poyeserera kulolerana kwa glucose mwa anthu 22,514 pazaka zopitilira 8.8. Kukhalapo kwa kudya kwambiri kwa glycemia kunathandizira chiopsezo cha kufa kuchokera ku CVD. Komabe, NTG (kulolerana kwa glucose kulolerana) ndikofunikira kwambiri pakukula kwa zovuta zamankhwala.

Mabukuwa adafalitsa zotsatira za maphunziro angapo azachipatala omwe amagwiritsa ntchito mankhwala omwe ali ndi njira zosiyanasiyana zochitira kupewa matenda ashuga. Pali maphunziro atatu oyembekezeredwa m'mabuku (BIGPRO 1, BIGPRO 1.2 ndi DPS) omwe adawunika kuyendetsedwa kwa metformin m'magulu a odwala omwe ali ndi vuto logona m'mimba, matenda oopsa, hypertriglyceridemia komanso odwala NTG. Dokotala Prevention Programme (DPP) mwina ndi imodzi mwazachipatala zazikulu kwambiri zopewa matenda ashuga. Kafukufukuyu adachitika m'malo 27 ku United States, adakonzekera kwa zaka zitatu mpaka 6, koma adamaliza pasadakhale mu Ogasiti 2001, pomwe zolinga zazikulu zidakwaniritsidwa. Mu kafukufuku wa DPP, mankhwala oyambirira a Metformin Glucofage ® adagwiritsidwa ntchito. Mmenemo, odwala omwe ali ndi NTG adasanjidwa m'magulu atatu:

Malangizo a placebo + osintha malinga ndi kusintha kwa moyo (odwala adalandira malingaliro olembedwa kuti adye, azichita zolimbitsa thupi komanso athetse kusuta),
metformin (Glucofage ®) 850 mg 2 kawiri pa tsiku + malingaliro oyenera okhudza moyo,
Kusintha kwamphamvu kwa moyo (osachepera 7% kuchepetsa kulemera kwa thupi, kutsika pang'ono kwa calorie ndi hypolipidemic zakudya, zolimbitsa thupi zolimbitsa thupi kwa mphindi 15 / sabata, ndikuyang'aniridwa ndi achipatala pamwezi.

Kafukufuku woyerekeza pakati pa magulu a placebo ndi metformin anali akhungu m'maso. Mwambiri, chiopsezo chokhala ndi matenda a shuga a 2 adachepa ndi 58% mwa anthu omwe adasintha njira zawo, ndipo mwa 31% mwa anthu omwe adalandira metformin pa mlingo wa 850 mg kawiri pa tsiku kwa zaka zitatu. Mukamasanthula timabuku tating'ono tomwe tinaphatikizidwa phunziroli, zidapezeka kuti metformin inachepetsa kwambiri vuto la matenda ashuga a 2 mwa anthu osakwanitsa zaka 45, komanso mwa anthu omwe ali ndi kunenepa kwambiri (BMI ≥ 35 kg / m 2). M'magulu awa, chiopsezo chokhala ndi matenda ashuga a 2 amatsika ndi 44-55% ngakhale osasintha momwe amakhalira.

Metformin ndi kuchepa kwa ngozi ya mtima

Mu 1998, zotsatira za Britain Prospential Diabetes Study (UKPDS) zidasindikizidwa, zomwe zidawonetsa zotsatira zabwino zakutha kwa mtima mwa anthu omwe ali ndi matenda ashuga. Kafukufukuyu adawonetsera mwayi wa metformin kuposa mankhwala ena ochepetsa shuga pakuchepetsa zovuta zazikulu komanso zotheka pakuwongolera glycemia.

Kafukufuku yemwe akuyembekezeredwa adayang'ana momwe njira zingapo zamankhwala zimathandizira, kuphatikiza kusintha kwa moyo, metformin, sulfonylureas, ndi mankhwala a insulin mwa anthu omwe adwala matenda ashuga. Zotsatira za kafukufukuyu zikuwonetsa kuti chithandizo champhamvu chogwiritsidwa ntchito ndi magulu atatu a mankhwalawa chinali chothandiza kwambiri kuposa chithandizo chamankhwala wamba. Pankhani ya kayendetsedwe ka glycemic, palibe kusiyana kwakukulu pakati pa mankhwalawa komwe kunapezeka.

Monga kukonzekera kwa metformin, UKPDS idagwiritsa ntchito kukonzekera kwa metformin Glucofage ®.

Metformin (Glucofage ®) inali yothandiza kwambiri kuposa kusintha kwamakhalidwe. Zotsatira za hypoglycemic za metformin zimafanana ndi sulfonylurea ndi insulin. Kusintha kwa kayendetsedwe ka glycemic sikunayende limodzi ndi kuwonjezeka kwa misempha ya plasma, pomwe kusintha kwa insulin sensitivity kunadziwika.

Mankhwalawa amagwiritsidwa ntchito mwa anthu omwe ali ndi matenda oopsa a shuga komanso onenepa kwambiri komanso onenepa kwambiri (n = odwala a 1704 omwe ali ndi zochulukirapo za 120% zolemera zolimbitsa thupi). Wapakati achire mlingo wa metformin anali 2550 mg / tsiku. Zotsatira zamankhwala, metformin inathandizira kuti kuchepa kwa kufa ndi 36%, kufa chifukwa cha matenda ashuga ndi 42%, zovuta zonse za matenda ashuga ndi 32%, komanso kulowetsedwa kwa myocardial ndi 39% (onani tebulo).

Gome 1. UKPDS: Kupewa kwamatenda amtima mwa kusintha matenda a shuga mwa odwala omwe ali ndi matenda a shuga a 2 (n = 5100)

Mapeto	Metformin (2550 mg / tsiku)		Sulphonylureas / insulin kukonzekera
Mapeto	Zowopsa Zoopsa%	Kusiyana Kwa Chidaliro	Zowopsa Zoopsa%	Kusiyana Kwa Chidaliro
Imfa yokhudza matenda a shuga	↓42%	0,017	↓20%	0,19
Imfa chifukwa chilichonse	↓36%	0,011	↓8%	0,49
Chiwopsezo chotengera zovuta zilizonse	↓32%	0,0023	↓7%	0,46
Chiwopsezo cha myocardial infarction	↓39%	0,01	↓21%	0,11
Stroko	↓41%	0,13	↓14%	0,60

Mu gulu la odwala omwe akutenga metformin mu katatu

Kodi metformin ndiyotheka mwa ana ndi achinyamata?

Metformin imasintha glycemia mwa achinyamata omwe ali ndi matenda a shuga a mtundu wachiwiri. Mu kafukufuku wosasinthika, wakhungu wazaka ziwiri kwa achinyamata omwe ali ndi matenda a shuga a 2, metformin adachepetsa kwambiri glucose komanso glycated globulin poyerekeza ndi placebo (p

Ku Europe, metformin 500 mg imatchulidwa ngati monotherapy kapena kuphatikiza ndi insulin mwa achinyamata azaka 10 ndi akulu. Mlingo woyambira wa metformin ndi piritsi limodzi panthawi kapena pambuyo pake. Pambuyo masiku 10-15, ngati kuli kotheka, mlingo wa mankhwalawo umakulanso. Kuchepetsa kukakamira kwa mankhwalawa kumachepetsa mavuto kuchokera m'matumbo.

Malangizo aposachedwa othandizira odwala matenda amtundu wa 2 amathandizira kugwiritsidwa ntchito kwa mankhwalawa kwa ana ndi achinyamata omwe ali ndi matenda a shuga a mtundu wachiwiri. American Diabetes Association Consensus Committee idaganiza kuti odwala omwe alibe zizindikiro zowopsa za hyperglycemia "amatha kuthandizidwa ndimankhwala olimbitsa thupi komanso masewera olimbitsa thupi, koma nthawi zambiri amafunikira kulandira chithandizo chamankhwala." Ku US, metformin imalembedwa ngati achinyamata omwe ali ndi matenda a shuga a 2 komanso monga gawo la njira zophatikizira achinyamata achinyamata (azaka 17 ndi akulu). Chifukwa chake, metformin ndi mankhwala okhawo akumwa ovomerezeka a ana opitirira zaka 10. Ku Russia, Europe ndi USA, amodzi mwa omwe ali mgululi - Glucophage - amavomerezedwa kuti azigwiritsidwa ntchito machitidwe a ana, kuyambira ali ndi zaka 10.

Pomaliza

Metformin ndi mankhwala othandizira odwala matenda a shuga, ndipo ngati ndi kotheka, angagwiritsidwe ntchito bwino ndi mankhwala ena operekera matenda ashuga: sulfonylureas, meglitinides, glitazones, alpha-glucosidase inhibitors. Zowopsa zomwe zimayambitsa ngozi, komanso kudzera mwa insulin, komanso njira zodziyimira payekha, metformin imachepetsa kwambiri zochitika zamtima komanso kufa.

Metformin imalekeredwa bwino komanso yotetezeka. Chiwopsezo chokhala ndi lactic acidosis sichikukwera poyerekeza ndi mankhwala ena antidiabetes.

Malinga ndi malingaliro a International Diabetes Federation ndi American Diabetes Association, metformin ndiye chisankho choyamba mwa odwala omwe ali ndi matenda a shuga a 2. Mu kafukufuku wapa matenda a shuga, metformin adachepetsa chiopsezo chokhala ndi matenda ashuga mwa anthu omwe ali ndi vuto loyambirira la chakudya. Malinga ndi kafukufuku woyembekezeredwa ku Britain wokhudzana ndi matenda a shuga, mwa mankhwala onse ampweya wa shuga, metformin ndi yapadera pochepetsa kufooka komanso kufa. M'mayeso onse azachipatala, kukonzekera koyambirira kwa Metformin, Glucofage ®, kunagwiritsidwa ntchito.

Prediabetes - Chithandizo Mwachidule

Ngati mwapezeka kuti muli ndi matenda a prediabetes, ndiye kuti inunso mudzakhala ndi mwayi wothandiza mankhwalawo, ndipo mudzakhala ndi mwayi wokonza izi kapena kuchedwa kupitirira kwa matenda ashuga a mtundu 2. Kuchepetsa thupi, kutsatira zakudya zopatsa thanzi, komanso kuchita masewera olimbitsa thupi pafupipafupi ndizothandiza kwambiri kupewa kapena kuchedwetsa kuyambika kwa matenda ashuga, komanso kumachepetsa chiopsezo chanu chobwera ndi mavuto ena, monga matenda a mtima kapena matenda a sitiroko. Zitha kumveka zosavuta, koma ndizofunikira kwambiri thanzi lanu lonse komanso kupewa matenda ashuga.

Nthawi zina, kuwonjezera pa zakudya ndi masewera olimbitsa thupi, dokotala angakupatseni mankhwala. Koma kafukufuku waposachedwa awonetsa zotsatira zopatsa chidwi popewa matenda ashuga pomangotsatira kadyedwe ndi masewera olimbitsa thupi. Kafukufuku wina wofunikira ku United States (Dongosolo la Chitetezo cha Matenda a shuga) adawonetsa kuti kusintha kwamoyo kumeneku kunali kothandiza kwambiri pakuchepetsa chiopsezo chotenga matenda ashuga kuposa kumwa mankhwala:

Yendetsani kulemera kwanu

Anthu ambiri omwe ali ndi prediabetes ndi onenepa kwambiri ndipo amakhala ndi index ya thupi (BMI) yama 25 kapena kuposerapo. Ngati BMI yanu ili 25 kapena kuposerapo, kutaya 5-10% ya kulemera kwanu kungathandize kupewa kapena kuchedwetsa kukula kwa matenda ashuga a mtundu 2 Kulemera koyenera kumathandiza thupi lanu kugwiritsa ntchito bwino insulin.Kafukufuku waposachedwa wasonyeza kuti kuchepa thupi mwa anthu omwe ali ndi prediabetes kumachepetsa kukana insulini. Mlingo wa kusintha umakhala wofanana ndi kulemera kotayika.

Tsatirani zakudya zoyenera

Ngati muli ndi matenda osokoneza bongo, mutha kupewa kapena kuchedwetsa kukula kwa matendawa mwakuchita izi:

Lankhulani ndi dotolo wanu za njira yodyera yomwe muyenera kudya.

Kafukufuku wina wamkulu adapeza kuti anthu omwe amadya masamba, nsomba, nkhuku, komanso zakudya za tirigu wokwanira ali ndi chiopsezo chokhala ndi shuga yachiwiri poyerekeza ndi anthu omwe amadya kwambiri nyama yofiira, nyama yophika, ndi mkaka wamafuta zopangidwa, chimanga chotsekemera ndi maswiti.

Kukonzekera zakudya zanu za prediabetes nthawi zambiri kumakupangitsani kuwona zamitundu yatsopano. Pali njira zingapo zosavuta zosinthira zakudya zanu. Katswiri wovomerezeka wazakudya atha kukuthandizani kupanga mapulani azakudya zomwe zikugwirizana ndi moyo wanu.

Chitani masewera olimbitsa thupi pafupipafupi

Akatswiri amakulangizani kuti muchite zotsatirazi mukamachita masewera olimbitsa thupi:

Kutenga zinthu zingapo kwa mphindi 10 kapena kupitilira masana, mutha kutsatira malangizowa. Mutha kusankha nokha mtundu wamtundu uliwonse kapena wolimbitsa thupi. Lankhulani ndi dokotala musanayambe pulogalamu yanu yochita masewera olimbitsa thupi.

Kuchita masewera olimbitsa thupi kumakuthandizani kuti muchepetse shuga lanu lamagazi pogwiritsa ntchito glucose ngati gwero lamphamvu panthawi yophunzira komanso pambuyo poti muchite zolimbitsa thupi. Zimakuthandizaninso kuyankha bwino ku insulin ndikuchepetsa mwayi wanu wokhala ndi matenda ashuga. Kuphatikiza apo, kuchita masewera olimbitsa thupi kumakuthandizani kuti mukhale ndi thanzi labwino, muchepetse cholesterol yambiri, mumachulukitsa kuchuluka kwa choleopolotein (HDL) kapena cholesterol yabwino. Izi phindu zimathandizanso kupewa kukula kwa matenda a mtima ndi magazi a m'magazi (matenda amtima). Mutha kuthandizanso kuchepetsa chiwopsezo chanu chotenga matenda ashuga mwakuchita masewera olimbitsa thupi kwakanthawi nthawi iliyonse.

Makalasi akhoza kukhala ndi kuyenda pang'ono kapena kuchita masewera olimbitsa thupi, monga kuthamanga, kuthamanga, kuyendetsa njinga kapena kusewera tenisi. Kafukufukuyu adawonetsanso kuti zinthu zina, monga kulima kapena kuphimba matalala, zimathanso kukhala ndi phindu. Lankhulani ndi dokotala wanu za pulogalamu ya pulogalamu yoyeserera yolimbitsa thupi.

Imwani mankhwala ngati mankhwala

Nthawi zina, madokotala amalembera mapiritsi kukonzekera, nthawi zambiri metformin. Amachepetsa kuchuluka kwa shuga wopangidwa ndi chiwindi mwa munthu wokhala ndi insulin. Izi zitha kukhala zoyenera pa polycystic ovary syndrome. Ngati dokotala wakupangirani mankhwala osakaniza ndi prediabetes, musaiwale kutenga monga momwe adakulamulirirani.

Ngati mumasuta ndudu, lankhulanani ndi dotolo wanu za momwe mungasiyire chizolowezichi. Kusuta kungathandize pa kukula kwa matenda ashuga amtundu wa 2 komanso zovuta zake zoyambirira. Kuti mumve zambiri, onani gawo lakuti, “Kusuta.”

Yanikani kuthamanga kwa magazi ndi cholesterol

Ngati muli ndi matenda am'mbuyomu, ndiye kuti mwayi wokhala ndi matenda amtima wanu ndiwokwera kuposa omwe ali ndi shuga. Dokotala wanu amatha kuyeza kuthamanga kwa magazi anu ndipo nthawi zina amayang'ana magazi anu kuti akhale ndi cholesterol. Kuchepetsa cholesterol yanu pamlingo woyenera ndi kusungabe kuthamanga kwa magazi anu kukhala mamilimita 140/90, mungachepetse chiopsezo chanu chokhala ndi matenda amtima ndi mitsempha yayikulu.

Kutsatira zakudya zopatsa thanzi komanso kuchita masewera olimbitsa thupi pafupipafupi, muthanso kuthamanga magazi komanso kuthana ndi mafuta m'thupi mwanu. Anthu omwe ali ndi kiwango chachikulu cha cholesterol lipoprotein (HDL) cholesterol yama 35 milligram pa desilita (mg / dl) kapena otsika, kapena triglycerides a 250 mg / dl kapena apamwamba, ali ndi chiopsezo chowonjezereka cha matenda a shuga 2.

Zosankha

Kulembera mapiritsi kwa odwala azaka zapakati pa 60 ndi kupitilira apo sikofunikira. Izi zingayambitse lactic acidosis. Milingo ya Serum creatinine iyenera kutsimikiziridwa musanachiritsidwe komanso pafupipafupi pakumwa (kamodzi pachaka pamlingo woyenera). Ngati mulingo woyambirira wa creatinine unali wopitilira wabwinobwino kapena pamlingo wapamwamba, ndiye kuti pafupipafupi ma phunziroli limakhala lambiri kawiri ndi chaka. Okalamba akhoza kukhala ndi asymptomatic course of a impso kulephera, chifukwa chake, amathandizanso kuchuluka kwa creatinine 2-4 pachaka.
Ndi onenepa kwambiri, muyenera kutsatira zakudya zopatsa thanzi.

Mukumwa mankhwalawa, odwala ayenera kutsatira zakudya zomwe zimayikidwa payekha, zomwe zimaganizira kagawidwe koyenera kwa chakudya patsiku. Poyamba kumwa ma diuretics, mankhwala osapweteka a antiidal komanso mankhwala a antihypertensive, pakhoza kukhala zovuta monga kulephera kwa impso. Mwa odwala, Metformin iyenera kugwiritsidwa ntchito mosamala pokhudzana ndi kuwonongeka kwa impso.
Pambuyo pakuchita opaleshoni, mankhwala othandizira amapangidwanso pambuyo masiku awiri. Nthawi iyi isanachitike, Metformin sayenera kumwedwa. Mayeso amtundu wa Laborator owunikira njira ya shuga amachitika mosamala komanso pafupipafupi, kuwonera kwakanthawi.

Magawo ofunikira

Mutu:	METGHIN
Code ya ATX:	A10BA02 -

Matenda a shuga ndi imodzi mwazovuta zazikulu zamankhwala amakono. Amaleredwa pamwambapa chifukwa cha kukwera mtengo kwa chithandizo, zovuta komanso zovuta (mpaka kulumala), komanso kufa kwamphamvu. Chifukwa chake, pakati pa odwala omwe ali ndi matenda amtundu wa 2, kufa kwawo kumakhala kuchulukirapo kawiri konse kuposa kumene kuli ambiri. Metformin ya pakamwa ya hypoglycemic idapangidwa kuti igwire nkhondo chimodzimodzi ndi matendawa, "okoma" modabwitsa, koma osatinso chowonadi chake. Masiku ano, mankhwalawa sangatchulidwe mwanjira ina yopanga nzeru: wayambitsidwa mu machitidwe a endocrinological kuyambira kumapeto kwa zaka za 50s. zaka zana zapitazo. Pakadali pano, metformin ndi, yopanda kukokomeza, mankhwala ochepetsa mphamvu kwambiri piritsi. Kapangidwe ka kachitidwe kake kanakhala kamafotokozedwatu m'mashelufu, ndipo izi zimamupangiranso iye. Metformin imalepheretsa gluconeogeneis (kaphatikizidwe kagayidwe) m'magazi, imachepetsa kuyamwa kwa glucose m'matumbo ang'ono, imawonjezera kuthekera kwa zotumphukira zogwiritsa ntchito shuga, ndikuwonjezera chidwi cha minyewa yolandirira. Chofunika kwambiri, mankhwalawa samakhudza kupanga kwa insulin yake kapamba ndipo samayambitsa zotsatira za hypoglycemic zomwe zimachitika ndi mankhwala ochepetsa shuga (muyeso womwe umatha kukhala hypoglycemic chikomokere).

Zotsatira zina zamankhwala zimaphatikizira kuchepa kwa kuchuluka kwa triglycerides ndi "zoipa" lipoproteins (LDL) m'magazi, kukhazikika (ndipo nthawi zina ngakhale kuchepa) muzolemera za wodwalayo, komanso fibrinolytic (antithrombic).

Mlingo wa metformin umatsimikiziridwa ndi dokotala munthawi iliyonse ndipo zimatengera kuchuluka kwa shuga m'magazi. Malinga ndi malingaliro onse, mankhwalawa amayamba kumwa ndi 500-1000 mg (omwe ali ofanana ndi mapiritsi a 1-2). Pambuyo masiku 10-14, amaloledwa kuwonjezera mlingo, kutengera zomwe zikuwonetsa masiku ake kuchuluka kwa magazi.Mlingo wokonzanso wa metformin umachokera ku 1500-2000 mg, omwe ndi 3000 mg. Okalamba okalamba ndi vuto lapadera. Choyamba, dziwani kuti mwa anthu azaka makumi asanu ndi awiri, omwe, ngakhale ali ndi zaka zambiri, akupitiliza kugwira ntchito zolimbitsa thupi, metformin ikhoza kuyambitsa lactic acidosis. Pankhaniyi, kumwa mankhwalawa kwa odwala kumapangidwa. Nthawi zina, okalamba sayenera kumwa zosaposa 1000 mg za metformin patsiku. Mapiritsi amalimbikitsidwa kuti amwe ndi chakudya kapena pambuyo pake ndi kapu yamadzi. Mlingo wa tsiku ndi tsiku nthawi zambiri umagawidwa pawiri.

Pharmacology

Oral hypoglycemic wothandizila kuchokera pagulu la Biguanides (dimethylbiguanide). Kupanga kwa zochita za metformin kumalumikizidwa ndi kuthekera kwake kuponderezera gluconeogeneis, komanso mapangidwe a mafuta achilengedwe omasuka ndi makulidwe a oxidation. Zimawonjezera chidwi cha zotumphukira zolandilira ku insulin ndikugwiritsa ntchito shuga ndi maselo. Metformin siyimakhudzanso kuchuluka kwa insulin m'magazi, koma imasintha ma pharmacodynamics pochepetsa kuchuluka kwa insulini kuti imasulidwe ndikuwonjezera kuchuluka kwa insulin kuti proinsulin.

Metformin imathandizira kapangidwe ka glycogen pochita pa glycogen synthetase. Kuchulukitsa kuthekera kwamitundu yonse yamtundu wama glucose oyenda. Kuchepetsa mayamwidwe m'matumbo.

Lowers triglycerides, LDL, VLDL. Metformin imakweza michere yamagazi ya fibrinolytic mwa kuponderezana ndi minyewa yotulutsa minyewa ya plasminogen activator inhibitor.

Ngakhale mutatenga Metformin, thupi la wodwalayo limakhalabe lolimba kapena limatsika pang'ono.

Pharmacokinetics

Pambuyo pakukonzekera pakamwa, metformin imayamba pang'onopang'ono komanso osakwanira kuchokera mmimba. C max mu plasma imafikiridwa patatha pafupifupi maola 2,5. Ndi mlingo umodzi wa 500 mg, kupezeka kwathunthu kwa bioavailability ndi 50-60%. Ndi kuyamwa kwa munthawi yomweyo, kuyamwa kwa metformin kumachepetsedwa ndikuchedwa.

Metformin imagawidwa mwachangu mu minofu ya thupi. Sizikugwirizana ndi mapuloteni a plasma. Amadziunjikira mu ndulu zakumaso, chiwindi ndi impso.

Imafufutidwa ndi impso zosasinthika. T 1/2 kuchokera ku plasma ndi maola 2-6.

Pankhani ya kuwonongeka kwaimpso, kuwerengetsa kwa metformin ndikotheka.