Metformin: contraindication ndi mavuto, pazipita tsiku lililonse

Matenda a shuga amapezeka m'magulu awiri. Matenda a shuga 1 amtundu wa insulin amatchedwa wodalira insulin. Ndi matenda amtunduwu, kaphatikizidwe ka enzyme yapadera mu kapamba, insulin, yomwe imaphwanya shuga, imalephera. Matenda a shuga a Type 2 amatchedwa kudalira insulin. Ndi mtundu wamtunduwu wa shuga, ntchito ya pancreatic sichiwonongeka, komabe, pali kuchepa kwa chidwi cha insulin m'matumbo a thupi, ndipo kupanga shuga m'magazi a chiwindi kumakulanso.

Anthu ambiri amadwala matenda amishuga a 2 okalamba, koma posachedwa matenda ashuga tsopano ndi "achichepere". Cholinga cha izi chinali moyo wongokhala, kupsinjika, kusiya kudya mwachangu komanso kusadya bwino. Pakadali pano, matenda ashuga ndi matenda oopsa, omwe pakakhala kuti palibe kuwonekera kwakunja kumawonjezera kwambiri chiopsezo cha kugunda kwamtima ndi stroke, magazi ndi mtima. Chifukwa chake, asayansi akhala akufufuza kwa nthawi yayitali mankhwala omwe angathandize kuchepetsa shuga m'magazi ndipo nthawi yomweyo sangavulaze thupi.

Kufotokozera kwa mankhwalawa

Kuchokera pamalingaliro amakanidwe, mankhwala a metformin amatanthauza Biguanides, zotumphukira za guanidine. Mwachilengedwe, guanidine amapezeka muzomera zina, mwachitsanzo, mankhwala a abulosi, omwe akhala akugwiritsidwa ntchito pochiza matenda ashuga kuyambira Middle Ages. Komabe, guanidine weniweni ndi woopsa kwa chiwindi.

Metformin idapangidwa molingana ndi guanidine kumbuyo mu 20s ya zaka zapitazi. Ngakhale pamenepa, zinali zodziwika za malo ake a hypoglycemic, koma panthawiyo, chifukwa cha mafashoni a insulin, mankhwalawa adayiwalika kwakanthawi. Kungoyambira m'ma 1950s, pomwe zidadziwika kuti chithandizo cha insulin cha matenda a shuga a 2 chimakhala ndi zovuta zambiri, mankhwalawa adayamba kugwiritsidwa ntchito ngati othandizira odwala matenda ashuga ndipo patapita kanthawi pang'ono adadziwika chifukwa chogwira ntchito bwino, chitetezo komanso zovuta zingapo zoyipa ndi zotsutsana.

Masiku ano, metformin imadziwika kuti ndi mankhwala odziwika bwino kwambiri padziko lonse lapansi. Zalembedwa pa WHO Essential Medicines. Zakhazikitsidwa modalirika kuti kugwiritsa ntchito metformin pafupipafupi kumatha kuchepetsa chiopsezo cha kufa kuchokera ku matenda a mtima omwe amayamba chifukwa cha matenda ashuga. Kafukufuku awonetsa kuti mwa anthu omwe ali onenepa kwambiri komanso omwe ali ndi matenda a shuga a 2, chithandizo chokhala ndi metformin ndichothandiza kwambiri kuposa chithandizo chamankhwala a insulin ndi mankhwala ena othandizira, komanso 40% yothandiza kwambiri kuposa chithandizo chamadokotala okha. Poyerekeza ndi mankhwala ena opatsirana pogwiritsira ntchito mankhwala osokoneza bongo, mankhwalawa amakhala ndi zovuta zochepa, ndipo ma monotherapy ake samayambitsa hypoglycemia, samayambitsa zovuta - lactic acidosis (poyizoni wa magazi ndi lactic acid).

Metformin ndi m'gulu la mankhwala opangira matenda a shuga a mtundu wachiwiri. Mutatenga Metformin, imachepetsa kuchuluka kwa shuga m'magazi, kuchuluka kwa hemoglobin ya glycosylated ndikuwonjezera kulolera kwa glucose m'thupi. Mankhwala alibe carcinogenic katundu, sasokoneza chonde.

Limagwirira ntchito achire zochita za metformin zosiyanasiyana. Choyamba, amachepetsa kupanga shuga m'magazi a chiwindi. Mtundu wachiwiri wa matenda ashuga, kupanga shuga mu chiwindi ndikwambiri kangapo kuposa kwawonso. Metformin imatsitsa chizindikiro ichi ndi wachitatu. Izi zikufotokozedwa ndi kutsegulidwa kwa metformin ya michere ina ya chiwindi, yomwe imagwira ntchito kwambiri pakupanga shuga ndi mafuta.

Komabe, limagwirira lomwe metformin amachepetsa glucose m'magazi sikuti amangopetsa kupangika kwa glucose m'chiwindi. Metformin imakhalanso ndi zotsatirazi mthupi:

• bwino kagayidwe kachakudya njira,
• amachepetsa mayamwidwe m'matumbo,
• bwino magwiritsidwe a shuga mu zotumphukira zimakhala,
• kumawonjezera mphamvu minofu insulin,
• ali ndi fibrinolytic.

Pakakhala insulin m'magazi, mankhwalawa samawonetsa ntchito yake ya hypoglycemic. Mosiyana ndi mankhwala ena ambiri opatsirana, mankhwala a metformin samabweretsa zovuta - lactic acidosis. Kuphatikiza apo, sizikhudza kupanga insulin ndi maselo a kapamba. Komanso, mankhwalawa amatha kuchepetsa kuchuluka kwa cholesterol yoyipa "yoyipa" - lipoproteins yotsika kwambiri (popanda kuchepetsa kuchuluka kwa cholesterol "yabwino" - lipoproteins yapamwamba), kuchepetsa kuchepa kwa mafuta oxidation komanso kupanga mafuta aulere acids. Chofunikira, metformin imakulitsa mphamvu ya insulini kuti ipangitse mapangidwe a minofu yamafuta, chifukwa chake mankhwalawa amatha kuchepetsa kapena kukhazikitsa thupi. Katundu womaliza wa metformin ndi chifukwa chake mankhwalawa amagwiritsidwa ntchito nthawi zambiri ndi omwe akufuna kuchepetsa thupi.

Tiyeneranso kudziwa zabwino zomwe mankhwalawa amakhudzana ndi mtima. Metformin imalimbitsa minofu yosalala ya mitsempha yamagazi, imalepheretsa chitukuko cha matenda ashuga a shuga.

Pharmacokinetics

Mapiritsi, metformin imawonetsedwa ngati hydrochloride. Ndi ufa wopanda utoto wamadzimadzi, wosungunuka kwambiri m'madzi.

Metformin ndi mankhwala osokoneza bongo. Nthawi zambiri, zotsatira zabwino za kumwa zimayamba kuwonekera pambuyo pa masiku 1-2. Munthawi imeneyi, pamakhala kuchuluka kwa mankhwala omwe amakhala m'magazi, mpaka 1 μg / ml. Pankhaniyi, kuchuluka kwa mankhwalawa m'magazi kungawonedwe kale maola 2,5 pambuyo pa kuperekedwa. Mankhwalawa amamangirira kumapulogalamu am magazi. Hafu ya moyo ndi maola 9 mpaka 12. Imapukusidwa makamaka ndi impso zosasinthika.

Anthu omwe ali ndi vuto laimpso amatha kumva kuwonjezeka kwa mankhwala m'thupi.

Chizindikiro chachikulu cha kugwiritsa ntchito mankhwalawa Metformin ndi matenda a shuga a 2. Komanso, matendawa sayenera kuvomerezedwa ndi ketoacidosis. Ndikofunika kwambiri kupereka mankhwala kwa odwala omwe samathandizidwa ndi zakudya zama carb ochepa, komanso kwa odwala omwe onenepa kwambiri. Nthawi zina, mankhwalawa amatha kugwiritsidwa ntchito limodzi ndi insulin. Komanso, mankhwalawa nthawi zina amatha kuperekedwa kwa matenda osokoneza bongo (matenda ashuga oyambitsidwa ndi pakati).

Mankhwalawa atha kugwiritsidwanso ntchito ngati munthuyo wasokoneza insulini, koma kuchuluka kwa shuga wamagazi sikupitilira zinthu zotsutsa. Matendawa amatchedwa prediabetesic. Komabe, akatswiri ambiri amakonda kuti panthawiyi, masewera olimbitsa thupi komanso kudya ndizothandiza kwambiri, ndipo mankhwala othandizira odwala matenda a prediabetes siothandiza kwenikweni.

Kuphatikiza apo, mankhwalawa amatha kutumizidwa pamatenda ena, mwachitsanzo, ndi mazira a polycystic, mafupa a chiwindi osagwirizana ndi mowa, kutha msanga. Matendawa amaphatikizidwa chifukwa chakuti ndi iwo mumakhala kusazindikira kwa minofu kuti insulin. Komabe, kugwira ntchito kwa metformin m'matenda awa sikunakhalepo umboni wofanana ndi wa matenda ashuga. Nthawi zina mankhwalawa amagwiritsidwanso ntchito ngati amachepetsa thupi, ngakhale kuti mankhwala ovomerezeka amatanthauza kugwiritsa ntchito metformin uku ndi kukayikira, makamaka ngati sikokhudza anthu omwe ali ndi kunenepa kwambiri kwa matenda.

Kutulutsa Fomu

Mankhwalawa amapezeka pokhapokha ngati mapiritsi omwe ali ndi Mlingo wa 500 ndi 1000 mg. Palinso mapiritsi okhala ndi mphamvu kwa nthawi yayitali ndi mlingo wa 850 mg, wokutidwa ndi kuphatikiza kwapadera kwa enteric.

Analogue yofunika kwambiri ya metformin yomwe ili ndi chinthu chomwechi ndi Gulcofage wa ku France. Mankhwalawa amawonedwa ngati apachiyambi, ndi mankhwala ena omwe ali ndi metformin, opangidwa ndi makampani osiyanasiyana azamankhwala padziko lonse lapansi - ma generics. Mankhwalawa amagawidwa mu mankhwala popanda mankhwala.

Contraindication

Mankhwala ali ndi zingapo zotsutsana:

• mitundu yoopsa ya mtima, kupuma komanso aimpso,
• chiwindi ntchito,
• pachimake myocardial infaration,
• pachimake ubongo
• matenda ashuga ketoacidosis,
• matenda a shuga
• lactic acidosis (kuphatikizapo mbiri ya)
• Matenda ndi mikhalidwe yomwe imabweretsa chiwopsezo cha impso,
• kusowa kwamadzi
• matenda oopsa (makamaka bronchopulmonary ndi aimpso),
• hypoxia
• kugwedeza
• sepsis
• opaleshoni yayikulu (pankhani iyi, kugwiritsa ntchito insulin kukuwoneka),
• uchidakwa wambiri kapena kuledzera (chiwopsezo cha lactic acidosis),
• mayeso ozindikira pakukhazikitsa zinthu zomwe zili ndi ayodini (masiku awiri njira isanachitike komanso masiku awiri pambuyo pake),
• Zakudya zama hypocaloric (zosakwana 1000 Kcal patsiku),
• kuchuluka kwa creatinine m'magazi (135 μmol / l mwa amuna ndi 115 μmol / l mwa akazi),
• Matenda a matenda ashuga
• malungo.

Mosamala, mankhwalawa amayenera kuperekedwa kwa achikulire ndi anthu omwe akuchita ntchito yayikulu yochita masewera olimbitsa thupi (chifukwa choonjezera chiopsezo cha lactic acidosis).

Mankhwala ali osavomerezeka kwa odwala osakwana zaka 18, panthawi yoyembekezera komanso mkaka wa m`mawere, ndi kuchuluka kwa chidwi cha mankhwalawa. Nthawi zina, mumatha kugwiritsa ntchito mankhwalawa panthawi yapakati komanso muubwana (wopitilira zaka 10) moyang'aniridwa ndi dokotala.

Malangizo apadera

Ngati chithandizo chikuchitika, ndiye kuti ntchito ya impso iyenera kuyang'aniridwa. Osachepera kawiri pachaka, ndikofunikira kuyang'ana kuchuluka kwa asidi a lactic m'magazi. Ngati kupweteka kwamisempha kumachitika, onani mwachangu kuchuluka kwa lactic acid.

Komanso, kawiri pachaka ayenera kuwunika momwe impso imagwirira (mtundu wa creatinine m'magazi). Izi zimachitika makamaka kwa okalamba.

Ndi monotherapy, mankhwalawa samakhudza dongosolo lamkati lamanjenje, chifukwa chake amatha kugwiritsa ntchito mankhwalawa mwa anthu omwe amayendetsa magalimoto ndikumagwira ntchito yomwe imafunikira chidwi.

Zotsatira zoyipa

Zotsatira zoyipa kwambiri mukamamwa metformin zimakhudzana ndi m'mimba. Nthawi zambiri mukamamwa mapiritsi, zochitika monga kupweteka kwam'mimba, nseru, kusanza, kutsegula m'mimba, kutsegula m'mimba kumatha kuonedwa. Kuti mupewe izi, mapiritsi ayenera kumwedwa nthawi yakudya itatha kapena itangotha. Ndizothekanso kuwoneka ngati kulumikizana kwachitsulo mkamwa, kusowa chilakolako chofuna kudya, zotupa pakhungu.

Zotsatira zonse zili pamwambazi sizikuwopseza. Nthawi zambiri zimachitika kumayambiriro kwa zamankhwala ndikudziyendetsa zokha. Pofuna kupewa zinthu zosasangalatsa zomwe zimakhudzana ndi m'mimba, ma antispasmodics kapena maantacid akhoza kutengedwa.

Osowa kwambiri, mankhwalawa amatha kubweretsa lactic acidosis, kuchepa kwa magazi m'thupi, hypoglycemia, kuchepa kwa kupanga kwa mahomoni a chithokomiro ndi testosterone mwa amuna. Hypoglycemia nthawi zambiri imachitika ngati mankhwala ena othandizira odwala shuga, mwachitsanzo, sulfonylureas, amatengedwa limodzi ndi metformin. Pogwiritsa ntchito nthawi yayitali, mankhwalawa angayambitse kuchepa kwa vitamini B12.

Zotsatira za Hypoglycemic sizimachotsedwa pakumwa NSAIDs, ACE inhibitors ndi Mao, beta-blockers, cyclophosphamide. Mukamamwa GCS, epinephrine, sympathomimetics, diuretics, mahomoni a chithokomiro, glucagon, estrogens, calcium antagonists, nicotinic acid, m'malo mwake, mphamvu ya mankhwalawa imachepa.

Mankhwala okhala ndi ayodini angayambitse kulephera kwa impso ndikuwonjezera mwayi wa lactic acidosis. Ngati lactic acidosis ikukayikiridwa, kuchipatala kumafunikira.

Malangizo ogwiritsira ntchito

Monga lamulo, kumayambiriro kwa mankhwala, mankhwalawa ayenera kugwiritsidwa ntchito 0.5-1 g kamodzi patsiku. Mlingo uwu uyenera kutsatiridwa kwa masiku atatu. Kuyambira masiku 4 mpaka 14 ndikofunikira kumwa mapiritsi a metformin 1 g katatu patsiku. Ngati kuchuluka kwa shuga kwatsika, mlingo umatha kuchepetsedwa. Monga mlingo wokonza, mapiritsi a metformin ayenera kumwedwa pa 1500-2000 mg patsiku. Pankhani ya mapiritsi okhala ndi nthawi yayitali (850 mg), ndikofunikira kumwa piritsi limodzi kawiri patsiku - m'mawa ndi madzulo.

Mulingo woyenera ndi 3 g (mapiritsi 6 a mankhwalawa, 500 mg aliyense) patsiku. Mu okalamba, kuwonongeka kwa impso ndikotheka, chifukwa chake, pazipita tsiku lililonse sayenera kupitirira 1000 mg (mapiritsi 2 a mankhwala 500 mg aliyense). Sayeneranso kusokoneza chithandizo ndi mankhwalawo, chifukwa chake ayenera kudziwitsa adokotala.

Ndikofunika kumwa piritsi mukangodya ndi madzi ambiri. Kumwa mankhwala mwachindunji ndi chakudya kumachepetsa mayamwidwe ake m'magazi. Mlingo wa tsiku ndi tsiku umalimbikitsidwa kuti ugaledwe mu Mlingo wa 2-3.

Mlingo wa mankhwalawa akagwiritsidwa ntchito limodzi ndi insulin (pa mlingo wa insulin yochepera 40) tsiku limafanana chimodzimodzi ndi insulin. M'masiku oyamba kumwa metformin, mlingo wa insulin suyenera kuchepetsedwa. Pambuyo pake, mlingo wa insulin ungachepetse. Njirayi iyenera kuchitika moyang'aniridwa ndi dokotala.

Bongo

Metformin ndi mankhwala otetezeka ndipo ngakhale Mlingo wake waukulu (posagwirizana ndi mankhwalawa), monga lamulo, samatsogolera kuchepa koopsa kwa shuga wamagazi. Komabe, ndi mankhwala osokoneza bongo, pali ngozi inanso, yocheperako - kuwonjezereka kwa kuchuluka kwa lactic acid m'magazi, omwe amatchedwa lactic acidosis. Zizindikiro za lactic acidosis ndizopweteka pamimba ndi minofu, kusintha kwa kutentha kwa thupi, kusokonezeka kwa chikumbumtima. Vutoli limapezekapezeka pakalibe chithandizo chamankhwala limatha kubweretsa kumwalira chifukwa chokhala ndi vuto laukoma. Chifukwa chake, ngati pazifukwa zina mankhwala osokoneza bongo amachitika, wodwala amayenera kupita kwa dokotala. Pankhani ya bongo wambiri, symptomatic mankhwala amachitika. Kuchotsa mankhwalawa magazi pogwiritsa ntchito hemodialysis kumathandizanso.

Mtengo ndi limagwirira ntchito ya mankhwala

Metformin ndi mankhwala amkamwa a hypoglycemic ochokera pagulu la Biguanide. Kodi mtengo wamankhwala ndi chiyani? Mu mankhwala, mtengo wa Metformin ndi 120-200 rubles. Paketi imodzi ili ndi miyala 30.

Yogwira pophika mankhwala ndi metformin hydrochloride. Mulinso zosakaniza zothandiza, monga E171, propylene glycol, talc, hypromellose, silicon dioxide, magnesium stearate, starch ya chimanga, povidone.

Ndiye kodi ma pharmacological amakumana ndi metformin bwanji? Ngati mukukhulupirira malangizo ogwiritsira ntchito mankhwalawa, ndiye kuti chigawo chake chogwira ntchito chimachita motere:

• Amachotsa insulin kukana. Ichi ndi gawo lofunikira kwambiri, chifukwa odwala ambiri omwe ali ndi matenda ashuga amakana zotsatira za insulin. Izi ndi zopangidwa ndi kukula kwa hyperglycemic chikomokere ndi zina zofunika kwambiri.
• Zimathandizira kuchepetsa kuyamwa kwa glucose m'matumbo. Chifukwa cha izi, wodwalayo samadumphadumpha mu shuga. Kutengera mlingo woyenera wa Metformin, kuchuluka kwa glucose kudzakhazikika. Koma pali mbali yolandila ndalama. Metformin hydrochloride kuphatikiza insulin mankhwala kungayambitse kukula kwa hypoglycemic chikomokere. Ndi chifukwa chake pogwiritsa ntchito munthawi yomweyo mankhwalawa komanso kugwiritsa ntchito insulin, kusintha kwa mlingo kungakhale kofunikira.
• Amalepheretsa gluconeogenesis m'chiwindi. Njirayi imayikidwa mmalo mwa glucose, omwe thupi limalandira kuchokera ku mphamvu zina.Chifukwa cha kuchepetsedwa kupanga shuga kuchokera ku lactic acid, kuchuluka kwa shuga ndi zovuta zina za shuga zitha kupewedwa.
• Imachepetsa chilako. Nthawi zambiri, mtundu wachiwiri wa matenda ashuga ndi chifukwa cha kunenepa kwambiri. Ichi ndichifukwa chake, mosiyana ndi momwe amakhalira pakudya, wodwala amalimbikitsidwa kugwiritsa ntchito mankhwala othandizira. Metformin ndiyopadera pamtundu wake, chifukwa imangothandiza kusakhazikika kwamisempha yamagazi, komanso imathandizira mphamvu yothandizira pakudya pofika 20-50%.
• Matendawa magazi m'thupi. Mukamagwiritsa ntchito Metformin, kuchepa kwamlingo wa triglycerides ndi lipoproteins yotsika kumawonedwa.

Metformin hydrochloride imalepheretsanso njira ya peroxidation yamafuta. Uwu ndi mtundu wa kupewa khansa.

Zowonetsa ndi malangizo ogwiritsira ntchito Metformin

Kodi kugwiritsa ntchito Metformin ndikoyenera? Ngati mukukhulupirira malangizo ogwiritsira ntchito, mankhwalawa angagwiritsidwe ntchito pochiza matenda a shuga a 2.

Komanso, mapiritsi angagwiritsidwe ntchito ngati monotherapy kapena kuphatikiza mankhwala ndi othandizira ena a hypoglycemic. Mankhwala ena amagwiritsidwa ntchito kwambiri pothana ndi zakudya zomwe sizithandiza shuga.

Ndizofunikira kudziwa kuti zomwe zikuwonetsa kugwiritsidwa ntchito kwa Metformin sikuti ndizochepa pamenepa. Mankhwalawa amagwiritsidwa ntchito kwambiri pochiza matenda a prediabetes ndi cleropolicystosis a thumba losunga mazira. Mwa zina mwa zomwe zikugwiritsidwa ntchito, metabolic syndrome ndi kunenepa kwambiri zimadziwikanso, zomwe zimathandizira ndikupanga insulin.

Kodi mungasankhe bwanji mulingo wa Metformin? Mlingo watsiku ndi tsiku wa Metformin amatha kusankhidwa yekhayo. Potere, adotolo ayenera kudziwa zambiri za mbiriyakale, chifukwa wothandizirawa wa hypoglycemic ali ndi zotsutsana zingapo kuti agwiritse ntchito.

Ndikufuna kudziwa kuti Metformin imapezeka mu mitundu yosiyanasiyana. Itha kukhala 1000, 850, 500, 750 mg. Komanso, pali mankhwala osakanikirana a shuga, omwe ali ndi 400 mg ya metformin hydrochloride.

Nanga, ndi mlingo uti womwe ukhalabe wabwino? Mlingo woyambirira wa Metformin ndi 500 mg, ndipo pafupipafupi kayendetsedwe kake ndi katatu patsiku. Muyenera kugwiritsa ntchito mankhwalawo mukatha kudya.

Pambuyo pa milungu ingapo yamankhwala, mlingo wake umatha kusintha. Chilichonse chimadalira shuga. Glycemia tikulimbikitsidwa kuyesedwa tsiku lililonse pamimba yopanda kanthu. Pazifukwa izi, ndibwino kugwiritsa ntchito glucometer.

Kodi Metformin amatenga nthawi yayitali bwanji? Sizingatheke kuyankha funsoli. Posankha kutalika kwa chithandizo, mikhalidwe ya munthu imakhudzidwa, makamaka, kuchuluka kwa shuga m'magazi, kulemera ndi msinkhu. Chithandizo chake chimatha masiku 15, masiku 21 kapena “kupitilira” mwezi umodzi.

Mlingo wapamwamba wa Metformin ndi 2000 mg patsiku. Tiyenera kudziwa kuti munthawi yomweyo kugwiritsa ntchito insulin, mlingo uyenera kuchepetsedwa mpaka 500-850 mg patsiku.

Zotsatira zoyipa za Metformin

Zotsatira zoyipa za Metformin ndi ziti? Pali chinthu china monga chiwopsezo chofunikira cha othandizira a hypoglycemic, makamaka Metformin. Zimakhala ndi chiyani?

Chowonadi ndi chakuti ndi matenda amtundu wa 2 wodwala, wodwalayo ayenera kuyang'anitsitsa kuchuluka kwa zopatsa mphamvu, ndipo makamaka kuchuluka kwa chakudya chomenecho. Ngati wodwala matenda ashuga amagwiritsa ntchito othandizira a hypoglycemic, ndikukhala pachakudya chokhazikika, ndiye kuti mwayi wokhala ndi hypoglycemia ndiwokwera kwambiri - kuchepa kowopsa kwa shuga m'magazi.

Zina mwazotsatira zoyipa za Metformin zitha kusiyanitsidwa:

• Kuphwanya kwa hematopoietic dongosolo. Metformin akagwiritsidwa ntchito, mwayi wa thrombocytopenia, leukocytopenia, erythrocytopenia, granulocytopenia, hemolytic anemia, pancytopenia Koma ziyenera kudziwidwa kuti zovuta zonsezi zimasinthidwa, ndipo zimadzisintha pambuyo pake kuti mankhwala atatha.
• Kulephera mu chiwindi. Amawoneka ngati kukula kwa chiwindi ndi hepatitis. Koma atakana Metformin, zovuta izi zimadzithetsa. Izi zikutsimikiziridwa ndikuwunika kwa madokotala ndi odwala.
• Lawani kuphwanya. Vutoli limachitika nthawi zambiri. Makina enieni a chitukuko cha kukomoka kwa ulesi motsogozedwa ndi metformin hydrochloride sakudziwika.
• Zotupa pakhungu, erythema, urticaria.
• Lactic acidosis. Vutoli ndi loopsa kwambiri. Nthawi zambiri pamakhala mlingo woyenera wosankhidwa, kapena wodwala matenda ashuga akamwa mankhwala omwe sanamwe.
• Kuphwanya munjira yogaya chakudya. Vutoli limawoneka nthawi zambiri, monga zimawonekera ndi kuwunika kwa odwala. Zovuta zam'mimba zomwe zimapezeka m'mimba zimawonetsedwa ngati mseru, kusanza, kukoma kwazitsulo mkamwa, komanso kusowa kwa chilakolako chofuna kudya. Koma mwachilungamo, ndikofunikira kudziwa kuti zovuta izi zimawonekera m'magawo oyambilira a chithandizo, kenako ndikudzikonza.
• Mafuta omwe anali ndi mavitamini B12 ochepa.
• Zofooka zambiri.
• Hypoglycemic chikomokere.

Mavuto omwe ali pamwambawa atawoneka, tikulimbikitsidwa kugwiritsa ntchito mawonekedwe a Metformin ndikuchita chithandizo chamankhwala.

Metformin

Metformin imachepetsa shuga. Koma mukamalankhula ndi mankhwala ena, mankhwalawa amawonjezera, kapena mosemphanitsa, amachepetsa mphamvu yake ya hypoglycemic.

Izi zimatha kubweretsa zovuta zina. Ndikufuna kudziwa nthawi yomweyo kuti zotsatira za hypoglycemic zimatheka kwambiri pophatikiza Metformin ndi zotumphukira za sulfonylurea. Pankhaniyi, kusintha kwa mlingo kumafunika.

Zotsatirazi zingathenso kukulitsa kwambiri zotsatira za Metogin:

1. Acarbose.
2. Mankhwala osokoneza bongo oletsa kuponderezana.
3. Monoamine oxidase zoletsa.
4. Oxytetracycline.
5. Angiotensin-otembenuza enzyme zoletsa.
6. Cyclophosphamide.
7. Zothandiza pofikira.
8. Beta blockers.

Corticosteroids, diuretics, analogues of samostanin amachepetsa mphamvu ya matenda a shuga ndi Metformin. Zinadziwikanso kuti zotsatira za hypoglycemic zimachepa pogwiritsa ntchito nthawi imodzi ya glucagon, mahomoni a chithokomiro, estrogens, nicotinic acid, calcium antagonists ndi isoniazids.

Tiyeneranso kukumbukira kuti cimeteredin, akamagwiritsa ntchito Metformin, amawonjezera mwayi wokhala ndi lactic acidosis.

Ndi mankhwala ati omwe angagwiritsidwe ntchito limodzi ndi metformin?

Pochiza matenda a shuga, mankhwalawa monga Januvia nthawi zambiri amaperekedwa mogwirizana ndi Metformin. Mtengo wake ndi ma ruble 1300-1500. Chofunikira chachikulu cha mankhwalawa ndi sitagliptin.

Izi zimalepheretsa DPP-4, ndikukulitsa kuchuluka kwa GLP-1 ndi HIP. Mahomoni a banja la incretin amasungidwa m'matumbo kwa tsiku, pambuyo pake mlingo wawo umakwera atatha kudya.

Ma incretins ndi gawo limodzi lazinthu zofunikira pakuwongolera shuga homeostasis. Ndi milingo yayikulu yokwera m'magazi, mahomoni ochokera ku banja lino amathandizira kuwonjezeka kwa insulin kapangidwe kake komanso katulutsidwe ka khungu la beta.

Momwe mungamwe mankhwalawo? Mlingo woyambira ndi 100 mg 1 nthawi patsiku. Koma kusankha mulingo woyenera kwambiri, muyenera kukhala dokotala. Kuwongolera kumaloledwa, makamaka ngati Januvia amagwiritsidwa ntchito molumikizana ndi Metformin.

Zotsatira pa Januvia:

• Mtundu woyamba wa shuga.
• Chiwopsezo kwa opezeka mankhwala.
• Matenda a shuga ketoacidosis.
• Nthawi ya pakati ndi kuyamwa.
• Zaka za ana.
• Ndi kusamala pakulephera kwa chiwindi. Ndi vuto la hepatobiliary system, kuchepetsa mlingo kungakhale kofunikira. Izi zikuwonetsedwa ndi kafukufuku wofufuza, ndikuwunika kwa endocrinologists.

Kodi mankhwalawa ali ndi mavuto? Zachidziwikire, ali ndi malo oti akhale. Koma Januvia nthawi zambiri amayambitsa zovuta pamene mlingo akukwera mpaka 200 mg. Mukukhalabe ndi Mlingo wochepa, mwayi wazotsatira zake ndizochepa.

Malinga ndi malangizo, mukamamwa mapiritsi, mavuto monga kupuma thirakiti, matenda am'mimba, mutu, m'mimba, nseru, kusanza, arthralgia imatha.

Komanso, mwayi wokhudzana ndimomwe thupi limagwirira komanso hypoglycemia sitingadziwe.

Analogue yabwino kwambiri ya Metformin

Analogue yabwino kwambiri ya Metformin ndi Avandia. Wothandizira wa hypoglycemic ndi wokwera mtengo kwambiri - ma ruble 5000-5500. Phukusi limodzi lili ndi mapiritsi 28.

Yogwira pophika mankhwala ndi rosiglitazone. Avandia amagwiritsidwa ntchito pochiza matenda amtundu wa 2 shuga. Komanso, itha kugwiritsidwa ntchito molumikizana ndi Metformin, ndipo itha kugwiritsidwa ntchito mosiyana.

Momwe mungasankhire nthawi yakumwa mapiritsi? Ziyenera kunenedwa nthawi yomweyo kuti mutha kumwa mankhwalawo musanayambe kapena musanadye. Mlingo woyambirira ndi 4 mg wa tsiku patsiku la 1-2. Pambuyo pa masabata a 6-8, mlingo ungathe kuwonjezeka ndendende kawiri. Kuwonjezereka kumachitika ngati 4 mg yachilengedwe matenda a shuga siwawonedwa.

Zotsatira zosagwiritsidwa ntchito ndi mankhwalawa:

1. Mtundu woyamba wa shuga.
2. Ziwengo magawo a mankhwala.
3. Nthawi yochepetsetsa.
4. Zaka za ana (mpaka zaka 18).
5. Mimba
6. Mtima wowonda kapena kulephera kwa impso.

Mukamagwiritsa ntchito Avandia, zovuta zamagulu a kupuma kapena mtima zimachitika.

Palinso kuthekera kowonjezera thupi. Malangizowo amafotokozanso kuti mankhwalawa angayambitse magazi m'thupi, kuperewera kwa chiwindi ndi hypercholesterolemia. Koma kuwunika kwa odwala kumawonetsa kuti chithandizo chamankhwala chimalekeredwa bwino. Kanemayo munkhaniyi ayankhula za momwe Metformin imagwirira ntchito.

Zizindikiro zogwiritsidwa ntchito

Type II shuga mellitus (osadalira insulini) wopanda mankhwala othandizira, makamaka odwala onenepa kwambiri:

- Monga monotherapy kapena kuphatikiza mankhwalawa molumikizana ndi othandizira ena am'mlomo a hypoglycemic kapena molumikizana ndi insulin pochizira akuluakulu.

- Monga monotherapy kapena kuphatikiza mankhwala omwe ali ndi insulin pochizira ana okulirapo kuposa zaka 10.

Mlingo ndi makonzedwe

Monotherapy kapena kuphatikiza mankhwalawa molumikizana ndi ena othandizira pakamwa.

Akuluakulu Nthawi zambiri, muyeso woyamba wa 500 mg kapena 850 mg wa metformin katatu patsiku panthawi ya chakudya kapena pambuyo pake. Pambuyo masiku 10-15 chithandizo, mlingo uyenera kusinthidwa malinga ndi zotsatira za miyeso ya seramu glucose. Kuwonjezeka kwapang'onopang'ono kwa mankhwalawa kumathandizira kuchepetsa zoyipa kuchokera kumimba.

Mlingo woyenera kwambiri ndi 3000 mg patsiku, womwe umagawidwa pazigawo zitatu.

Pochiza Mlingo wambiri, Metformin amagwiritsidwa ntchito muyezo wa 1000 mg.

Pankhani ya kusintha kwa mankhwalawa ndi Metformin, ndikofunikira kusiya kumwa mankhwala othandizira ena.

Kuphatikiza mankhwala osakanikirana ndi insulin.

Kuti akwaniritse bwino kuchuluka kwa shuga m'magazi, metformin ndi insulin zitha kugwiritsidwa ntchito ngati mankhwala osakanikirana. Mwachizolowezi, mlingo woyambirira ndi 500 mg kapena 850 mg wa metformin katatu patsiku, pamene mlingo wa insulin umasankhidwa malinga ndi zotsatira za kuyeza shuga.

Monotherapy kapena mankhwala ophatikizira limodzi ndi insulin.

Ana. Metformin imalembedwa kwa ana opitirira zaka 10. Nthawi zambiri, muyeso woyambirira ndi 500 mg kapena 850 mg wa metformin 1 nthawi patsiku panthawi kapena mukatha kudya. Pambuyo masiku 10-15 chithandizo, mlingo uyenera kusinthidwa malinga ndi zotsatira za miyeso ya seramu glucose.

Kuwonjezeka kwapang'onopang'ono kwa mankhwalawa kumathandizira kuchepetsa zoyipa kuchokera kumimba.

Mlingo woyenera kwambiri ndi 2000 mg patsiku, womwe umagawidwa mu 2-3 Mlingo.

Odwala okalamba Matenda aimpso osokoneza, motero, mlingo wa metformin uyenera kusankhidwa malinga ndi kuwunika kwa impso, komwe kuyenera kuchitidwa pafupipafupi.

Kuchita ndi mankhwala ena

Zosagwirizana ndi ethanol, loop diuretics, ma iodine okhala ndi radiopaque othandizira, chifukwa zimawonjezera chiopsezo cha lactic acidosis, makamaka pazochitika zanjala kapena zakudya zochepa. Pogwiritsa ntchito metformin, zakumwa zoledzeretsa komanso zakumwa zoledzeretsa ziyenera kupewedwa. Mukamayesa X-ray, mankhwalawa amayenera kuthetsedwa mkati mwa maola 48 ndipo osapangidwanso mkati mwa masiku awiri atatha kuphunzira.

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 imachulukitsa mayamwidwe, C_maxImachepetsa mayeso.

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

Njira zopewera kupewa ngozi

Lactic acidosis ndizosowa koma zovuta kwambiri za metabolic zomwe zimatha kuchitika chifukwa cha kuphatikizika kwa metformin hydrochloride. Milandu ya lactic acidosis mwa odwala omwe ali ndi matenda osokoneza bongo komanso kulephera kwambiri kwaimpso akuti. Zowopsa za lactic acidosis: kusungidwa bwino kwa matenda a shuga, ketosis, kusala kudya kwa nthawi yayitali, kumwa kwambiri mowa, kulephera kwa chiwindi, kapena vuto lililonse lomwe lingakhale ndi hypoxia.

Lactic acidosis imadziwika ndi kukokana kwa minofu, kufupika kwa acidic, kupweteka kwam'mimba komanso hypothermia, kupititsa patsogolo kukomoka kumatha. Zolemba zasayansi zakukula kwa lactic acidosis ndi kuchuluka kwa ma serum lactate oposa 5 mmol / l, kuchepa kwa magazi pH kutsutsana ndi kusokonezeka kwa elekitirodi, ndi kuchuluka kwa lactate / pyruvate. Ngati lactic acidosis ikukayikiridwa, ndikofunikira kusiya kugwiritsa ntchito mankhwalawo ndikuperekera odwala kuchipatala mwachangu.

Kulephera kwina. Popeza metformin imachotsedwa impso, isanayambe komanso itagwiritsidwa ntchito ndi Metformin, ma serum creatinine ayenera kuwunika, makamaka odwala omwe ali ndi vuto la impso komanso odwala okalamba. Chenjezo liyenera kugwiritsidwa ntchito ngati matenda a impso angadwalidwe, mwachitsanzo, kumayambiriro kwa chithandizo cha mankhwala a antihypertensive, okodzetsa, komanso kumayambiriro kwa mankhwala a NSAID.

Ma ayodini okhala ndi ayodini. Mukamayendetsa maphunziro a radiology pogwiritsa ntchito ma radiopaque othandizira, ndikofunikira kuti musiye kugwiritsa ntchito metformin maola 48 musanayambe phunzirolo kuti musayambirenso kupitirira maola 48 mutatha kuwunika kwa radiology ndikuwunika ntchito yaimpso.

Opaleshoni. Ndikofunika kusiya kugwiritsa ntchito metformin maola 48 musanachitike opaleshoni yokonzekera, osayambiranso kale kuposa maola 48 mutagwira ntchito ndikuwunika kwa aimpso.

Ana. Malinga ndi zotsatira za kafukufuku wazachipatala, zotsatira za metformin pa kukula ndi kutha kwa ana sizinawululidwe. Komabe, palibe chidziwitso chokhudzana ndi metformin pakukula ndi kutha msambo pogwiritsa ntchito metformin, chifukwa chake ndikofunikira kugwiritsa ntchito mankhwalawa mosamala kwambiri ana akatha msanga, makamaka azaka za 10 mpaka 12.

Odwala ayenera kutsatira zakudya ndikuwunika magawo a labotale. Pogwiritsa ntchito metformin yophatikizira ndi insulin kapena zotumphukira za sulfonylurea, kuchuluka kwa zotsatira za hypoglycemic ndikotheka.

Kukopa pa kuyendetsa magalimoto ndi kayendedwe kazinthu.

Mankhwala akaphatikizidwa ndi mankhwala ena a hypoglycemic (sulfonylurea derivatives, insulin), mikhalidwe ya hypoglycemic imatha kukhazikika momwe kuthekera kuyendetsa magalimoto ndi zochitika zina zoopsa zomwe zimafunikira chidwi chochulukirapo komanso kuthamanga kwa psychomotor reaction.

Gwiritsani ntchito pa nthawi yoyembekezera komanso mkaka wa m`mawere

Mankhwalawa amayesedwa kuti agwiritse ntchito panthawi yoyembekezera komanso panthawi yoyamwitsa.

Mukakonzekera kapena poyambitsa kutenga pakati, metformin iyenera kusiyidwa ndipo mankhwala a insulin ayenera kukhazikitsidwa. Wodwala ayenera kuchenjezedwa za kufunika kodziwitsa dokotala ngati ali ndi pakati. Amayi ndi mwana ayenera kuyang'aniridwa.

Sizikudziwika ngati metformin yachotsedwa mkaka wa m'mawere. Ngati ndi kotheka, ntchito mankhwalawa pa mkaka wa m`mawere ayenera kusiya kuyamwitsa.

Limagwirira a zochita za metformin

Metformin imayambitsa kutulutsidwa kwa hepatic enzyme AMP-activated protein kinase (AMPK), yomwe imayang'anira kagayidwe ka mafuta ndi mafuta. AMPK activation imafunikira inhibitory zotsatira za metformin pa gluconeogeneis mu chiwindi.

Kuphatikiza pa kupondeleza njira ya gluconeogeneis m'chiwindi metformin imachulukitsa zamisempha kudziwa insulin, kumawonjezera kutulutsa kwa glucose, kumawonjezera mafuta acid oxidation, ndikuchepetsa mayamwidwe am'mimba kuchokera m'mimba.

Kunena mwachidule, kenako chakudya chokhala ndi chakudya chamagulu ambiri, thupi limayamba kubisalira kuti likhale ndi shuga m'magazi. 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 imafotokozedwanso mu kuzengereza kuyamwa kwa shuga m'matumbo, yomwe imakupatsani mwayi wochepetsera shuga m'magazi mukatha kudya (shuga ya m'magazi am'mimba), komanso kuwonjezera kuchuluka kwa maselo kupita ku insulin (maselo amchilungamo amayamba kuyankha mwachangu kwambiri ku insulin, yomwe imatulutsidwa panthawi ya shuga).

Kuyankha kwa Dr. R. Bernstein pa metformin: "Kudya kwa Metformin kuli ndi zinthu zina zabwino - kumachepetsa matenda a khansa ndipo kumachepetsa ma ghostin amanjala, potero kumachepetsa chizolowezi chakudya kwambiri. Komabe, m'zochitika zanga, sizofanizira zonse za metformin zomwe zimagwira ntchito mofananamo. Nthawi zonse ndimalemba Glucophage, ngakhale kuti ndiokwera mtengo kuposa anzanga ”(Diabetes Soluton, kope 4. P. 249).

Kodi metformin imathamanga motani?

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

Metforminum imakonda kutumizidwa kumayambiriro kwa mankhwala. kawiri mpaka katatu tsiku lililonse isanadye kapena itatha, 500-850 mg. 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 zitha kuchuluka mpaka 3000 mg. patsiku, ogaŵikana 3 Mlingo wofanana.

Ngati kuchuluka kwa shuga m'magazi sikucheperachepera, ndiye kuti funso la kuphatikiza mankhwala ophatikizidwa limaganiziridwa. Mankhwala osakanikirana a metformin amapezeka pamisika ya Russia ndi Chiyukireniya, monga: Pioglitazone, Vildagliptin, Sitagliptin, Saksagliptin ndi Glibenclamide. Ndikothekanso kupereka mankhwala othandizira ndi insulin.

Metformin wokhala ndi nthawi yayitali komanso mawonekedwe ake

Pofuna kuthana ndi mavuto am'mimba komanso kusintha kwa moyo wa odwala, France idapangidwa Metformin wopitilira. Glucophage Long - mankhwala osachedwa mayamwidwe yogwira mankhwala, omwe angathe kumwedwa kamodzi pa tsiku. Njirayi imalepheretsa kulandiridwa kwa nsonga mu ndende ya metformin m'magazi, imathandizira pakulolera kwa metformin komanso kumachepetsa kuchitika kwa vuto logaya chakudya.

Mafuta a metformin omwe amakhala nthawi yayitali amapezeka m'matumbo am'mimba. Asayansi apanga njira yothandizira kuphatikiza kwa gel (GelShield) ("gel mkati mwa gel"), yomwe imathandiza metformin pang'onopang'ono komanso moyenera kumasulidwa ku fomu ya piritsi.

Ma analogi a Metformin

Mankhwala oyamba ndi French Glucophage. Pali ma analogues (ma generics) ambiri a metformin. Izi zikuphatikiza kukonzekera kwa Russia Gliformin, Novoformin, Formmetin ndi Metformin Richter, Germany Metfogamma ndi Siofor, Croatia Formin Pliva, Bagometine waku Argentina, Metetini-Teva, Slovak Metformin Zentiva.

Ma enformin okhala ndi nthawi yayitali komanso mtengo wawo

Kodi metformin imakhudza bwanji chiwindi ndi impso?

Metformin ikhoza kukhala ndi zoyipa pachiwindi ndi impso, motero, ndizoletsedwa kuti zizipereka kwa odwala omwe ali ndi matenda osachiritsika (omwe ali ndi matenda a impso, hepatitis, cirrhosis, etc.).

Metformin iyenera kupewa odwala omwe ali ndi matenda enaake. Zotsatira za mankhwalawa zimachitika mwachindunji ndipo zimatha kusintha zomwe zimayambitsa kapena kungayambitse hypoglycemia, kutseka kapangidwe ka gluconeogenesis. Mwina mapangidwe a kunenepa mu chiwindi.

Komabe, nthawi zina, metformin imakhudza bwino matenda a chiwindi, choncho mawonekedwe a chiwindi akamamwa mankhwalawa amayenera kuyang'aniridwa mosamala.

Matenda otupa chiwindi, metformin iyenera kusiyidwa, chifukwa matenda a chiwindi akhoza kukulira. Pankhaniyi, ndikofunikira kuti musinthe mankhwala a insulin, monga insulin imalowa mwachindunji m'magazi, kudutsa chiwindi, kapena kupereka mankhwala a sulfonylureas.

Zotsatira zoyipa za metformin pa chiwindi chathanzi sizinadziwikebe.

Mutha kuwerenga zambiri patsamba lathu. za kutenga metformin ya matenda a impso.

Kodi metformin imawakhudza bwanji amayi apakati omwe ali ndi vuto la shuga?

Kukhazikitsa metformin kwa amayi apakati sikungokhala kuphwanya malamulo ayi; Komabe insulin nthawi zambiri amatchulidwa zochizira matenda ashuga. Izi zikufotokozedwa ndizotsatira zotsutsana za kafukufuku pazotsatira za metformin pa odwala oyembekezera.

Kafukufuku wina ku United States adawonetsa kuti metformin ndiyotetezeka panthawi yapakati. Amayi omwe ali ndi matenda osokoneza bongo omwe amatenga metformin anali ndi vuto lochepera panthawi ya kubereka kuposa odwala omwe ali ndi insulin. Ana obadwa kwa azimayi omwe adalandira metformin amachepetsa kwambiri mafuta a visceral, omwe amawapangitsa kuti asamangokhalira kukana insulini m'moyo wam'tsogolo.

Poyeserera nyama, palibe zoyipa za metformin pa kukula kwa fetal zomwe zinaonedwa.

Ngakhale izi, m'maiko ena, metformin sikulimbikitsidwa kuti imagwiritsidwa ntchito ndi amayi oyembekezera. Mwachitsanzo, ku Germany, mankhwala omwe amapezeka pa nthawi ya pakati komanso matenda ashuga ndi oletsedwa, ndipo odwala omwe akufuna kumwa amatenga ziwopsezo zonse ndikulipirira okha. Malinga ndi madokotala aku Germany, metformin ikhoza kukhala yovulaza mwana wosabadwa ndipo imayambitsa kukana kwa insulini.

Ndi mkaka wa mkaka, metformin iyenera kutayidwa.chifukwa imadutsa mkaka wa m'mawere. Kuchiza ndi metformin panthawi yoyamwitsa kuyenera kutha.

Kodi metformin imakhudza bwanji mazira?

Metformin imagwiritsidwa ntchito kwambiri pochiza matenda amtundu wa 2, koma imalembedwanso polycystic ovary syndrome (PCOS) chifukwa cha ubale pakati pa matenda awa, chifukwa polycystic ovary syndrome nthawi zambiri imagwirizanitsidwa ndi insulin.

Mayesero azachipatala omwe anamalizidwa mu 2006-2007 adatsimikiza kuti kufunikira kwa metformin kwa ovary ya polycystic sikwabwino kuposa zotsatira za placebo, ndipo metformin yophatikizidwa ndi clomiphene siyabwino kuposa clomiphene yokha.

Ku UK, kugwiritsa ntchito metformin ngati chithandizo choyambira cha polycystic ovary syndrome sikulimbikitsidwa. Cholinga cha clomiphene chimawonetsedwa ngati umboni komanso kufunika kwa kusintha kwa moyo, mosasamala za mankhwala.

Metformin chifukwa cha kusabereka kwa akazi

Maphunziro angapo azachipatala awonetsa kugwira ntchito kwa metformin pakubala, limodzi ndi clomiphene. Metformin iyenera kugwiritsidwa ntchito ngati mankhwala a mzere wachiwiri ngati chithandizo cha Clomiphene chawonetsedwa kuti sichothandiza.

Kafukufuku wina akuwonetsa metformin osasungapo ngati njira yayikulu yothandizira, popeza imakhala ndi zotsatira zabwino osati pazongowonjezera, komanso kukana kwa insulin, hirsutism ndi kunenepa kwambiri, zomwe zimawonedwa nthawi zambiri ndi PCOS.

Prediabetes ndi metformin

Metformin imatha kutumikiridwa kwa prediabetes (anthu omwe ali pachiwopsezo chokhala ndi matenda ashuga a 2), omwe amachepetsa mwayi wokhala ndi matendawa, ngakhale kuti kuchita zolimbitsa thupi kwambiri komanso kudya moyenera ndi chakudya kumakhala kofunikira kwambiri pachifukwa ichi.

Ku United States, kafukufuku adachitika malinga ndi omwe gulu limodzi la maphunziro lidapatsidwa metformin, ndipo winayo adapita kukachita masewera ndikutsatira kadyedwe. Zotsatira zake, kuchuluka kwa anthu odwala matenda ashuga m'gulu la anthu amoyo wathanzi anali 31% kochepera poyerekeza ndi omwe amachokera ku prediabetes amamwa metformin.

Izi ndi zomwe amalemba za prediabetes ndi metformin m'mabuku amodzi a sayansi omwe adasindikizidwa PubMed - Zosungidwa zazingelezi za Chingerezi zofalitsa zamankhwala ndi zamankhwala (PMC4498279):

"Anthu omwe ali ndi shuga wambiri, osadwala matenda ashuga, ali pachiwopsezo chotenga matenda amtundu wa 2, omwe amatchedwa" prediabetes. " prediabetes nthawi zambiri zimagwira ntchito kwa malire kusala shuga m'magazi am'magazi (kusokonekera kwa glucose) komanso / kapena plasma glucose opulumutsidwa patatha maola awiri atayeza mayeso a shuga a pakamwa ndi 75 g. shuga (kulolera shuga). Ku USA, ngakhale malire apamwamba a glycated hemoglobin (HbA1c) amawonedwa ngati prediabetes.
Anthu omwe ali ndi prediabetes ali ndi chiopsezo chowonjezeka cha micvasvascular and development of macrovascular complication.zofanana ndi zovuta zazitali za matenda ashuga. Kuyimitsa kapena kusintha kupitirira kwa kuchepa kwa chidwi cha insulini ndikuwonongeka kwa ntchito za β-cell ndizofunikira kuti zithetse matenda a shuga a 2.

Njira zambiri zakonzedwa zokhudzana ndi kuchepa thupi: mankhwala a pharmacological (metformin, thiazolidinediones, acarbose, jakisoni wa basal insulin komanso kumwa mankhwala ochepetsa thupi) komanso opaleshoni ya bariatric. Izi zimapangidwa kuti muchepetse vuto la matenda ashuga a mtundu wa 2 mwa anthu omwe ali ndi prediabetes, ngakhale zotsatira zabwino sizikwaniritsidwa nthawi zonse.

Metformin imalimbikitsa zochita za insulin mu chiwindi ndi minofu ya mafupandi kugwirira ntchito kwake pakuchedwetsa kapena kuletsa kuyambika kwa matenda ashupi kwatsimikiziridwa m'mayesero akulu akulu, okonzedwa, osasankhidwa,

kuphatikiza mapulogalamu othana ndi matenda a shuga. Zaka makumi ambiri ogwiritsa ntchito kuchipatala awonetsa izi metformin nthawi zambiri imakhala yololera komanso yotetezeka. "

Kodi ndingatenge Metformin kuti ndichepetse thupi? Zotsatira zakufufuza

Malinga ndi kafukufuku, metformin imatha kuthandiza anthu ena kuchepa thupi. Komabe sizikudziwikabe kuti metformin imabweretsa bwanji kuwonda.

Chikhulupiriro chimodzi nchakuti metformin imachepetsa kudya, kuchititsa kuchepa thupi. Ngakhale kuti metformin imathandizira kuchepetsa thupi, mankhwalawa sanapangidwire mwachindunji ndicholinga ichi.

Malinga ndi kusinthidwa kwakanthaŵi kwakanthaŵi (onani: PubMed, PMCID: PMC3308305), kuchepa thupi pogwiritsa ntchito metformin kumayamba kuchitika pang'onopang'ono, kwa zaka ziwiri. Kuchuluka kwa ma kilogalamu omwe adatayika kumasiyananso pakati pa anthu osiyanasiyana ndipo kumalumikizidwa ndi zinthu zina zambiri - ndi lamulo la thupi, ndi kuchuluka kwa zopatsa mphamvu zomwe zimadyedwa tsiku ndi tsiku, ndi njira ya moyo. Malinga ndi zotsatira za phunziroli, maphunziro, pafupifupi, adataya kuchokera ku 1.8 mpaka 3.1 makilogalamu atatha zaka ziwiri kapena kupitilira atatenga metformin. Poyerekeza ndi njira zina zochepetsera kunenepa (zakudya zama carb otsika, zolimbitsa thupi, kusala), izi ndizoposa zotsatira zochepa.

Kusagwiritsa ntchito mankhwalawa mosaganizira mbali zina za moyo wathanzi sikuti kumapangitsa kuti muchepetse thupi. Anthu omwe amatsata zakudya zathanzi ndikuchita masewera olimbitsa thupi akamamwa metformin amakonda kuchepetsa thupi. Izi ndichifukwa choti metformin imachulukitsa kuchuluka kwa zopatsa mphamvu panthawi yochita masewera olimbitsa thupi. Ngati simukuchita nawo zamasewera, ndiye kuti simungakhale ndi mwayiwu.

Kuphatikiza apo, kuchepa kulikonse kwa thupi kumapitirirabe bola mutamwa mankhwalawo. Izi zikutanthauza kuti ngati muleka kumwa metformin, pali mwayi wambiri wobwerera kulemera koyambirira. Ndipo ngakhale mutamwa mankhwalawo, mutha kuyamba kunenepa pang'onopang'ono. Mwanjira ina metformin sindiwo “mapiritsi amatsenga” oti muchepetse kunenepa mosiyana ndi zomwe anthu ena amayembekeza. Werengani zambiri za izi m'mabuku athu: Kugwiritsa ntchito metformin pakuchepetsa thupi: ndemanga, maphunziro, malangizo

Kodi metformin imalembera ana?

Kuvomerezeka kwa metformin kwa ana ndi achinyamata opitilira zaka khumi ndikololedwa - izi zatsimikiziridwa ndi maphunziro osiyanasiyana azachipatala. Sanawonetse mavuto aliwonse omwe amakhudzidwa ndi chitukuko cha mwana, koma chithandizo chikuyenera kuchitika moyang'aniridwa ndi dokotala.

• Metformin imachepetsa kupanga kwa glucose m'chiwindi (gluconeogeneis) ndikuwonjezera chidwi cha minyewa yamthupi kupita ku insulin.
• Ngakhale kuti mankhwalawa amagulika kwambiri padziko lapansi, momwe amagwirira ntchito sakumveka, ndipo maphunziro ambiri amatsutsana.
• Kutenga metformin m'malo opitilira 10% kumayambitsa matumbo. Kuti athane ndi vutoli, metformin yomwe idatenga nthawi yayitali idapangidwa (choyambirira ndi Glucofage Long), yomwe imachepetsa kuyamwa kwa chinthu chomwe chimagwira ndikupangitsa mphamvu yake m'mimba kutayirira.
• Metformin sayenera kumwedwa chifukwa cha matenda owopsa a chiwindi (hepatitis, cirrhosis) ndi impso (kulephera kwaimpso, pachimake nephritis).
• Kuphatikiza ndi mowa, metformin imatha kuyambitsa matenda akupha lactic acidosis, ndichifukwa chake amaletsedwa kumwa mowa mwa zidole zazikulu.
• Kugwiritsa ntchito metformin kwanthawi yayitali kumayambitsa kusowa kwa vitamini B12, chifukwa chake ndikofunika kumwa zowonjezera za vitaminiyu.
• Metformin siyikulimbikitsidwa kuti pakhale shuga komanso matenda ashuga, komanso poyamwitsa, umalowa mkaka.
• Metformin si "mapiritsi amatsenga" ochepetsa thupi.Kuchepetsa thupi ndikwabwino mwakutsatira zakudya zopatsa thanzi (kuphatikiza kuchepetsa chakudya) pamodzi ndi zolimbitsa thupi.

Source:

1. Petunina N.A., Kuzina I.A. Ma Metformin omwe amagwira ntchito kwa nthawi yayitali. 2012. No3.
2. Kodi metformin imayambitsa lactic acidosis? / Kuwunikira mwatsatanetsatane: mfundo zazikulu // Nkhani zamankhwala ndi mankhwala. 2011. Ayi 11-12.
3. Kutetezeka Kwa Nthawi yayitali, Kulekerera, ndi Kuchepetsa Thupi Kumalumikizana ndi Metformin mu Dongosolo la Kupewa Kachilombo ka Matenda a shuga / Atsopano. 2012 Apr, 35 (4): 731-737. PMCID: PMC3308305.