Amaril M

Mankhwala
Glimepiride - chinthu chokhala ndi vuto la hypoglycemic pakagwiritsiridwa pakamwa, kupezeka kwa sulfonylurea. Amagwiritsidwa ntchito pa matenda a shuga a mtundu II.
Glimepiride imalimbikitsa kubisika kwa insulin ndi by-cell ya kapamba, kumawonjezera kutulutsidwa kwa insulin. Monga zotumphukira zina za sulfonylurea, zimawonjezera chidwi cha pancreatic β-cell kukondoweza kwa glucose. Kuphatikiza apo, glimepiride, monga zotumphukira zina za sulfonylurea, ili ndi mphamvu yowonjezera pancreatic.
Kumasulidwa kwa insulin
Sulfonylurea imayang'anira chinsinsi cha insulini potseka njira ya ATP yotseka pamimba ya β-cell, izi zimabweretsa kutsika kwa membrane wa khungu, chifukwa chomwe njira zambiri za calcium zimalowera m'maselo, zomwe zimapangitsa kuti insulini itulutsidwe.
Ntchito zowonjezera
Kuchuluka kwa extrapancreatic ndikuwonjezera kukhudzika kwa zotumphukira zimakhala ku insulin ndikuchepetsa kutenga kwa insulin ndi chiwindi. Kutumiza kwa glucose kuchokera m'magazi kupita ku minofu ndi minyewa ya adipose kumachitika kudzera m'mapuloteni apadera amtundu woyendetsedwa ndi membrane wa khungu. Kutumiza kwa glucose kumka ndi izi zomwe ndi gawo lomwe limachepetsa kuchuluka kwa shuga. Glimepiride imachulukitsa mwachangu kuchuluka kwa okhathamira ogulitsa glucose pamatumbo a plasma a minofu ndi maselo amafuta, potero amalimbikitsa kukoka kwa glucose.
Glimepiride imawonjezera ntchito ya phospholipase C yeniyeni ya glycosyl phosphatidylinositol, ndipo izi zimagwirizanitsidwa ndi kuwonjezeka kwa lipogenesis ndi glycogeneis omwe amawonedwa m'magazi amtundu wamafuta ndi minofu mothandizidwa ndi chinthu ichi.
Glimepiride amalepheretsa kupanga kwa shuga m'chiwindi, kuwonjezera kuchuluka kwa ndende ya fructose-2,6-diphosphate, yomwe imalepheretsa gluconeogeneis.
Metformin
Metformin ndi biguanide yokhala ndi hypoglycemic effect, yomwe imadziwonetsera kuchepa m'magawo onse oyambira a glucose m'magazi am'magazi komanso mulingo wake m'magazi am'magazi mutatha kudya. Metformin simalimbikitsa kubisalira kwa insulini ndipo imabweretsa kukula kwa hypoglycemia.
Metformin ili ndi njira zitatu:

• amachepetsa kupanga shuga wa chiwindi poletsa gluconeogeneis ndi glycogenolysis,
• minofu minofu kumawonjezera insulin mphamvu, bwino zotumphukira ndikugwiritsa ntchito shuga,
• amalepheretsa mayamwidwe a shuga m'matumbo.

Metformin imathandizira kapangidwe ka glycogen mu intracellular, kukhudza glycogen synthase.
Metformin imawonjezera kuchuluka kwa mayendedwe a eniake a glucose membrane (GLUT-1 ndi GLUT-4).
Mosasamala za shuga wamagazi, metformin imakhudza kagayidwe ka lipid. Izi zikuwonetsedwa mukamagwiritsa ntchito mankhwalawa mu Mlingo wothandizirana panthawi yoyesedwa pakati kapena pakanthawi yayitali: metformin imachepetsa kuchuluka kwa cholesterol, LDL ndi TG.
Pharmacokinetics
Glimepiride
Mafuta
Glimepiride ali ndi pakamwa kwambiri bioavailability. Kudya sikumakhudza mayamwidwe, kokha kuthamanga kwake kumachepera pang'ono. Kwambiri ndende ya madzi am`magazi amafikira pafupifupi 2,5 mawola pakamwa (pafupifupi 0,3 μg / ml ndi mobwerezabwereza makonzedwe tsiku lililonse 4 mg). Pali ubale womwe ulipo pakati pa mlingo wa mankhwalawa, kuchuluka kwambiri kwa plasma ndi AUC.
Kugawa
Mu glimepiride, pali gawo laling'ono kwambiri logawa (pafupifupi 8.8 L), pafupifupi lofanana ndi kuchuluka kwa kugawa kwa albumin. Glimepiride imakhala ndi mapuloteni ambiri a plasma (99%) komanso chilolezo chochepa (pafupifupi 48 ml / min).
Mu nyama, glimepiride imafukusidwa mkaka, imatha kulowa mu placenta. Kulowera kudzera mu BBB ndikosavomerezeka.
Biotransformation ndi kuthetsedwa
Pafupifupi theka moyo, womwe umatengera kuchuluka kwa mankhwalawa m'magazi, nthawi yayitali maola 5-8. Mutamwa mankhwalawa muyezo waukulu, theka la moyo linawonedwa.
Mlingo umodzi wampweya wa radiolabeled glimepiride, 58% ya mankhwalawa amachotsedwa mu mkodzo ndipo 35% ndi ndowe. Zosasinthika, chinthu chomwe chili mkodzo sichinadziwike. Ndi mkodzo ndi ndowe, 2 metabolites amachotsedwa, omwe amapangidwa chifukwa cha kagayidwe mu chiwindi ndi gawo la enzyme ya CYP 2C9: hydroxy ndi carboxy. Pambuyo pakamwa makonzedwe a glimepiride, kuchotsera kwa matendawa theka la moyo wa ma metabolites awa anali maola atatu ndi atatu ndi maola 5-6, motero.
Kufanizira kunawonetsa kusapezeka kwa kusiyana kwakukulu mu pharmacokinetics atatenga dozi limodzi ndi angapo, kusiyanasiyana kwa zotsatira za munthu m'modzi kunali kotsika kwambiri. Kuchulukitsa kwakukulu sikunawonedwe.
Ma pharmacokinetics mwa amuna ndi akazi, komanso m'magulu osiyanasiyana a odwala, ndi omwewo. Kwa odwala omwe ali ndi lowinine chilolezo, panali chizolowezi chowonjezera chilolezo komanso kutsika kwa kuchuluka kwa plasma ya glimepiride, chifukwa chomwe kuchotsedwa kwache kumachitika chifukwa chomanga mapuloteni am'magazi. Kuchotsa ma metabolites awiri ndi impso kumachepa. Palibe chiwopsezo chowonjezereka cha kukopeka kwa mankhwala mwa odwala.
Mwa odwala 5, opanda matenda a shuga, koma atachitidwa opaleshoni pa duct ya bile, ma pharmacokinetics anali ofanana ndi omwe ali ndi thanzi labwino.
Metformin
Mafuta
Pambuyo pakukonzekera kwa metformin, nthawi yofika kwambiri ya plasma concentration (tmax) ndi maola 2,5. Mtheradi wa bioavailability wa metformin akapatsidwa mlingo wa 500 mg pakamwa kwa odzipereka athanzi ndi pafupifupi 50-60%. Pambuyo pakukonzekera pakamwa, gawo lomwe silinasambidwe mu ndowe linali 20-30%.
Kuyamwa kwa Metformin pambuyo pakumwa pakamwa kumakhala kokhazikika komanso kosakwanira. Pali malingaliro oti ma pharmacokinetics a mayamwidwe a metformin ndi mzere. Nthawi zonse Mlingo woyendetsedwera ndi dongosolo la metformin, kuchuluka kwa plasma kumachitika pambuyo pa maola 24- 48 ndipo osaposa 1 μg / ml. M'mayeso azachipatala olamulidwa, Cmax metformin mu plasma yamagazi sinapose 4 μg / ml, ngakhale ndi waukulu.
Kudya kumachepetsa digiriyo ndipo kumakulitsa pang'ono nthawi ya mayamwidwe a metformin. Mutatenga mlingo wa 850 mg ndi chakudya, kuchepa kwa plasma Cmax ndi 40%, kuchepa kwa AUC ndi 25%, ndi kutalika kwa tmax ndi 35 min. Kukula kwakukhalira kwa kusinthaku sikudziwika.
Kugawa.
Kumanga kwa mapuloteni a Plasma ndikosatheka. Metformin imagawidwa m'magazi ofiira. Cmax m'magazi ndi ochepa kuposa Cmax mu plasma ndipo amapezeka pafupifupi nthawi imodzi. Maselo ofiira mwina ndi malo obisalirako achiwiri. Mtengo wapakati wama buku ogawa umachokera ku malita 63-276.
Biotransformation ndi kuthetsedwa.
Metformin imachotsedwa mu mkodzo osasinthika. Kuvomerezeka kwa aimpso kwa metformin ndi 400 ml / min, zomwe zikuwonetsa kuti metformin imachotsedwanso ndi kusefedwa kwa glomerular ndi secretion ya tubular. Pambuyo pakulowetsa, kutha kwa theka-moyo kumakhala pafupifupi maola 6.5. Ngati ntchito yaimpso imalephera, chiwonetsero cha impso chimachepetsa poyerekeza kupezeka kwa creatinine, chifukwa chomwe kuphatikiza theka la moyo ndikutalikitsa, komwe kumayambitsa kuwonjezeka kwa plasma metformin.

Zisonyezero zamankhwala Amaryl m

Monga chowonjezera chakudya ndikuwonjezera zochitika zolimbitsa thupi kwa odwala omwe ali ndi mtundu II matenda a shuga:

• milandu pamene monotherapy yokhala ndi glimepiride kapena metformin sichimapereka chiwongolero choyenera cha glycemic,
• Amena kuphatikiza mankhwala ndi glimepiride ndi metformin.

Kugwiritsa ntchito mankhwala Amaryl m

Mlingo wa mankhwala antidiabetic umayikidwa payekha kutengera zotsatira za kuwunika pafupipafupi kuchuluka kwa shuga m'magazi. Monga lamulo, tikulimbikitsidwa kuti ayambe kulandira mankhwalawa pogwiritsa ntchito mlingo wotsika kwambiri ndikuwonjezera mlingo wa mankhwalawa malinga ndi kuchuluka kwa shuga m'magazi a wodwala.
Mankhwalawa amagwiritsidwa ntchito ndi anthu akuluakulu okha.
Mankhwalawa amatengedwa 1 kapena 2 pa tsiku musanadye kapena nthawi ya chakudya.
Pankhani ya kusintha kwa kugwiritsa ntchito kuphatikizira kwa glimepiride ndi metformin, Amaril M adalembedwa, poganizira Mlingo womwe wodwala akutenga kale.

Contraindative kugwiritsa ntchito mankhwala Amaryl m

- Type I shuga mellitus, matenda ashuga ketonemia, matenda a shuga ndi chikomokere, pachimake kapena matenda metabolic acidosis.
- Hypersensitivity zigawo zikuluzikulu za mankhwalawa, sulfonylurea, sulfonamides kapena biguanides.
- Odwala omwe ali ndi vuto la chiwindi kwambiri kapena odwala omwe ali ndi hemodialysis. Ngati chiwopsezo chachikulu cha ntchito ya chiwindi ndi impso, ndikofunikira kusunthira ku insulin kuti mukwaniritse bwino kuchuluka kwa shuga m'magazi.
- Nthawi ya mimba ndi kuyamwitsa.
- Odwala amakonda kukula kwa lactic acidosis, mbiri ya lactic acidosis, matenda a impso kapena matenda aimpso (monga zikuwonekera ndi kuwonjezeka kwa plasma creatinine misempha ya ≥1.5 mg / dL mwa amuna ndi ≥1.4 mg / dL mwa azimayi kapena kutsitsa kwa kuvuta kwa creatinine), komwe kumatha kuchitika chifukwa cha kugwa kwa mtima (kugwedezeka), kulowetsedwa kwamatenda am'mimba, komanso septicemia.
- Odwala omwe amapatsidwa intravenous radiopaque kukonzekera komwe kuli ayodini, chifukwa mankhwalawa amatha kuyambitsa kupweteka kwa impso (kutenga Amaril M kuyenera kuyimitsidwa kwakanthawi) (onani "Malangizo Apadera").
- Matenda opatsirana, mikhalidwe isanachitike komanso itatha opaleshoni, kuvulala kwambiri.
- Odwala njala, cachexia, hypofunction wa pituitary kapena adrenal gland.
- Kuwonongeka kwa chiwindi, kuwonongeka kwakukulu kwa ntchito yam'mapapo ndi zina zomwe zimatha kutsagana ndi kupezeka kwa hypoxemia, kumwa kwambiri mowa, kuchepa kwa madzi m'mimba, kusokonezeka m'mimba, kuphatikiza kutsekula m'mimba ndi kusanza.
- Collstive mtima kulephera amafuna chithandizo chamankhwala.
- Matenda a impso.
- Zaka za ana.

Zotsatira zoyipa za mankhwala Amaryl m

Glimepiride
Kutengera luso la kugwiritsa ntchito mankhwala Amaril M ndi deta pazinthu zina za sulfonylurea, ndikofunikira kulingalira za zovuta zotsatirazi za mankhwala:
Hypoglycemia: popeza mankhwalawa amachepetsa shuga m'magazi, izi zimatha kubweretsa kukula kwa hypoglycemia, komwe, potengera zomwe zimagwiritsidwa ntchito pazomwe zimagwiritsidwa ntchito masiku ena a sulfonylurea, zitha kupitilira Zizindikiro za hypoglycemia ndi izi: kupweteka mutu, kugona kwambiri ("nkhandwe"), nseru, kusanza, kusowa tulo, kusokonezeka kwa tulo, kuda nkhawa, kupsa mtima, kusokonezeka m'maganizo, kusokonezeka, kusokonezeka kwa mawu, aphasia, kuwonongeka kwa mawonekedwe, kunjenjemera, paresis, kusokonezeka kwa malingaliro, chizungulire, kusowa thandizo, kukoka mtima, kugwidwa pakati pa genesis, kugona ndi kuwonongeka kwa chikumbumtima mpaka kukula kwa chikomokere, kupuma kosakhazikika ndi bradycardia. Kuphatikiza apo, pakhoza kukhala zizindikiro za kutsutsana ndi adrenergic: kutuluka thukuta, khungu, tachycardia, matenda oopsa (ochepa matenda oopsa), kumverera kwa nthawi yayitali, kuukira kwa angina pectoris ndi mtima wa arrhythmias. Mawonetsedwe azachipatala a matenda oopsa a hypoglycemia atha kufanana ndi sitiroko. Zizindikiro zonsezi zimatha pafupifupi kutha pambuyo pa mkhalidwe wa glycemic.
Kuphwanya ziwalo zamasomphenya: pa chithandizo (makamaka pachiyambipo), kuwonongeka kwapang'onopang'ono chifukwa cha kusintha kwa kuchuluka kwa shuga m'magazi kungaoneke.
Kuphwanya kwam'mimba: nthawi zina mseru, kusanza, kumva kutopa kwambiri kapena kumva kuti mwadzaza zigawo za epigastric, kupweteka kwam'mimba komanso kutsegula m'mimba.
Kuphwanya chiwindi ndi matenda amisili: Nthawi zina, ndizotheka kuwonjezera ntchito za chiwindi michere ndi chiwindi ntchito (cholestasis ndi jaundice), komanso hepatitis, yomwe imatha kupita patsogolo pakulephera kwa chiwindi.
Kuchokera kumagazi: kawirikawiri thrombocytopenia, kawirikawiri leukopenia, hemolytic anemia kapena erythrocytopenia, granulocytopenia, agranulocytosis kapena pancytopenia. Kuyang'anira wodwalayo mosamala ndikofunikira, popeza munthawi ya chithandizo ndi sulfonylurea kukonzekera panali milandu ya aplastic anemia ndi pancytopenia. Zitachitika izi, muyenera kusiya kumwa mankhwalawo ndikuyamba kulandira chithandizo choyenera.
Hypersensitivity: kawirikawiri, thupi siligwirizana kapena pseudo-thupi lawo siligwirizana, mwachitsanzo, kuyabwa, urticaria, kapena zidzolo. Kusintha kotereku nthawi zambiri kumakhala kwapakati, koma kumatha kupita patsogolo, limodzi ndi kufupika ndi hypotension, mpaka kugwedezeka. Ngati ming'oma itachitika, pitani kuchipatala mwachangu.
Ena: Nthawi zina, vasculitis, kugwa kwa photosensitivity ndi kuchepa kwa sodium mu madzi am`magazi kumaonedwa.
Metformin
Lactic acidosis: onani "MALANGIZO OTHANDIZA" ndi "KUDZILETSA".
Hypoglycemia.
Kuchokera m'mimba: Nthawi zambiri - kutsegula m'mimba, kusanza, kusanza, kugona ndi kugona. Kwa odwala omwe analandila monotherapy, Zizindikirozi zimapezeka pafupifupi 30% pafupipafupi kuposa kwa odwala omwe adayamba placebo, makamaka kumayambiriro kwa chithandizo. Zizindikirozi zimakhalitsa pang'onopang'ono ndipo zimazimiririka lokha ndi chithandizo chanthawi zonse. Nthawi zina, kuchepetsa kwakanthawi kwa mankhwalawa kungakhale kothandiza. Panthawi ya mayesero azachipatala, mankhwalawa anathetsedwa pafupifupi 4% ya odwala chifukwa cha zomwe zimachitika m'matumbo.
Popeza Zizindikiro zam'mimba zimayambira pamankhwala zimatengera mlingo, mawonekedwe awo amatha kuchepetsedwa pang'onopang'ono kuwonjezera mlingo ndi kumwa mankhwalawa panthawi ya chakudya.
Kutsegula m'mimba ndi / kapena kusanza kumatha kubweretsa kusowa kwamadzi ndi azotemia yapambuyo, pamenepa, mankhwalawa ayenera kuyimitsidwa kwakanthawi.
Kupezeka kwa nonspecific matenda am'mimba mwa odwala okhazikika pamene akumwabe Amaril M akhoza kukhala osagwirizana ndi kugwiritsa ntchito mankhwalawa, ngati kupezeka kwa nthendayi yamatenda ndi lactic acidosis sikungachitike.
Kuchokera ku ziwalo zomverera: kumayambiriro kwa mankhwala ndi mankhwalawa, pafupifupi 3% ya odwala amatha kudandaula za chisangalalo kapena zitsulo pakamwa, zomwe, mwachizolowezi, zimazimiririka zokha.
Khungu: kupezeka kwa zotupa ndi mawonekedwe ena. Zikatero, mankhwalawo ayenera kusiyidwa.
Kuchokera kumagazi: kawirikawiri, kuchepa magazi, leukocytopenia, kapena thrombocytopenia. Pafupifupi 9% ya odwala omwe adalandira monotherapy ndi Amaril M ndi 6% ya odwala omwe adalandira chithandizo ndi Amaril M kapena sulfonylurea adawonetsa kuchepa kwa asymptomatic mu plasma B12 (plasma folate sinachepe kwambiri). Ngakhale izi, kuchepa kwa magazi m'thupi la megaloblastic kunalembedwa pomwe amamwa mankhwalawo, palibe kuwonjezeka kwa chiwopsezo cha neuropathy komwe kunawonedwa. Zomwe zili pamwambazi zimafunikira kuwunika mosamala kuchuluka kwa vitamini B12 m'magazi am'magazi kapena nthawi zina yowonjezera vitamini B12.
Kuchokera ku chiwindi: Nthawi zina, vuto la chiwindi limagwira.
Milandu yonse ya kupezeka kwa zoyipa zomwe zili pamwambazi kapena zochita zina zoyipa ziyenera kufotokozedwa kwa dokotala. Mavuto osayembekezereka a mankhwalawa, kupatula zomwe zimadziwika kale ku glimepiride ndi metformin, sizinawoneke panthawi ya mayesero a kachipatala komanso mayeso a gawo lotseguka la III.

Malangizo apadera ogwiritsira ntchito Amaryl m

Njira zopewera kusamala.
Mu sabata yoyamba ya mankhwala ndi mankhwalawa, kuwunika mosamala mkhalidwe wa wodwalayo ndikofunikira chifukwa cha chiwopsezo cha hypoglycemia. Kuopsa kwa hypoglycemia kumakhalapo mwa otsatirawa kapena m'malo otere:

• kufunitsitsa kapena kulephera kwa wodwala kugwirizana ndi dokotala (makamaka muukalamba),
• kuperewera kwa zakudya m'thupi, zakudya zopanda pake,
• kusasamala pakati zolimbitsa thupi kudya chakudya
• kusintha kwa zakudya
• kumwa mowa, makamaka pamodzi ndi kudumpha zakudya,
• kuwonongeka kwaimpso,
• kukanika kwambiri kwa chiwindi,
• mankhwala osokoneza bongo
• Matenda ena ophatikizika a endocrine system (kukanika kwa chithokomiro, komanso kusokonekera kwa adenohypophysial kapena adrenocortical), komwe kumakhudza kagayidwe kazachilengedwe ndi kukokana kwa hypoglycemia,
• kugwiritsa ntchito munthawi yomweyo mankhwala ena (onani gawo "Kuyanjana ndi othandizira ndi mitundu ina ya zochitika").

Zikatero, ndikofunikira kuwunika pafupipafupi kuchuluka kwa shuga, ndipo wodwalayo ayenera kudziwitsa dokotala za zomwe tafotokozazi komanso za zochitika za hypoglycemia, ngati zitachitika. Ngati pali zinthu zomwe zimawonjezera chiopsezo cha hypoglycemia, muyenera kusintha mlingo wa Amaril M kapena regimen yonse yamankhwala. Izi ziyeneranso kuchitidwa ngati pali matenda kapena kusintha kwa moyo wa wodwala. Zizindikiro za hypoglycemia zomwe zimawonetsa kukokana kwa adrenergic zitha kuthetsedwa kapena kusakhalapo pokhapokha ngati hypoglycemia imayamba pang'onopang'ono: odwala okalamba, odwala omwe ali ndi vuto la neuronomic, kapena mwa omwe nthawi yomweyo amalandila chithandizo ndi β-adrenoreceptor blockers, clonidine, reserpine, guanethidine, ammosoma.
Njira zodzitetezera:

• Mulingo wokwanira wamagazi umayenera kusamalidwa ndikutsatira nthawi yomweyo kudya komanso kuchita masewera olimbitsa thupi, komanso, ngati kuli koyenera, pochepetsa thupi komanso kumwa Amaril M. pafupipafupi. Zizindikiro zakuchepa kwa shuga m'magazi zimachulukanso pafupipafupi (polyuria) ), ludzu lalikulu, kamwa youma ndi khungu louma.
• Wodwala ayenera kudziwitsidwa za zabwino ndi zoopsa zomwe zingachitike chifukwa chogwiritsa ntchito mankhwalawa Amaril M, komanso kufunikira kotsatira kudya komanso kuchita masewera olimbitsa thupi nthawi zonse.
• Nthawi zambiri, hypoglycemia imatha kuthetsedwa mwachangu ndikutenga chakudya (shuga kapena shuga, mu mawonekedwe a chidutswa cha shuga, msuzi wa zipatso ndi shuga kapena tiyi wokoma). Pazinthu izi, wodwalayo ayenera kunyamula shuga osachepera 20 g. Popewa zovuta, wodwala angafunike thandizo la anthu osavomerezeka. Zomangira zotsekemera zochizira hypoglycemia sizothandiza.
• Kuchokera pazomwe amagwiritsa ntchito mankhwala ena a sulfonylurea, zimadziwika kuti, ngakhale kuti njira zochiritsika zolondola zimatengedwa, kuthekera kwa hypoglycemia ndikotheka. Pankhaniyi, wodwalayo ayenera kuyang'aniridwa mosalekeza. Hypoglycemia yayikulu imafunikira chithandizo choyang'aniridwa ndi adokotala, ndipo nthawi zina, kugonekedwa kwa odwala kuchipatala.
• Ngati wodwala alandila chithandizo kuchokera kwa dokotala wina (mwachitsanzo, panthawi yakugonekedwa kuchipatala, ngozi, ngati pakufunika kutero, pezani chithandizo kuchipatala), ayenera kumuuza za matenda ake a matenda ashuga ndi chithandizo chomwe adalandira kale.
• M'mikhalidwe yopsinjika (mwachitsanzo, ndi kuwawa, opaleshoni, matenda opatsirana a hyperthermia), kuchuluka kwa shuga m'magazi kumatha kusokonekera, ndipo kungakhale kofunikira kusamutsa kwakanthawi wodwalayo kukonzekera insulin kuti athe kuwongolera kagayidwe kachakudya koyenera.
• Mankhwalawa ndi Amaril M, Mlingo wochepa kwambiri umagwiritsidwa ntchito. Mankhwala ndi mankhwalawa, ndikofunikira kuyang'anira kuchuluka kwa shuga m'magazi ndi mkodzo. Kuphatikiza apo, tikulimbikitsidwa kuti tidziwe kuchuluka kwa hemoglobin ya glycosylated. Ndikofunikanso kuwunika momwe mankhwalawo amathandizira, ndipo ngati sikokwanira, ndikofunikira kusamutsira wodwalayo chithandizo china.
• Kumayambiriro kwa mankhwalawa, mukasinthana ndi mankhwala ena kupita ku amaril M, kuchepa kwa chidwi ndi zomwe zimachitika chifukwa cha hypo- kapena hyperglycemia zitha kuonedwa. Izi zimatha kusokoneza kuyendetsa galimoto kapena kugwira ntchito ndi zina.
• Kuwongolera kwa ntchito yeniyeni: zimadziwika kuti Amaryl M imapukutidwa makamaka ndi impso, motero, chiopsezo cha kuphatikizidwa kwa metformin komanso kukula kwa lactic acidosis kumawonjezeka molingana ndi kuopsa kwa aimpso. Pankhaniyi, odwala omwe plasma creatinine imadutsa malire a zaka zapamwamba kwambiri sayenera kumwa mankhwalawa. Kwa odwala okalamba, kuchepetsedwa mosamala kwa mlingo wa Amaril M ndikofunikira kuti muzindikire mlingo wocheperako womwe umawonetsa mphamvu ya glycemic, chifukwa ntchito ya impso imachepa ndi msinkhu. Odwala okalamba, ntchito yaimpso iyenera kuyang'aniridwa pafupipafupi, ndipo mankhwalawa, mwachizolowezi, sayenera kukhala ndi mlingo waukulu.
• Kugwiritsa ntchito munthawi yomweyo mankhwala ena omwe angawonongere ntchito ya impso kapena ma pharmacokinetics a metformin: kugwiritsa ntchito munthawi yomweyo mankhwala omwe angawononge ntchito ya impso kapena amachititsa kusintha kwakukulu mu hemodynamics, kapena okhudza pharmacokinetics ya mankhwala Amaryl M, mankhwala omwe ali ndi cation, iyenera kugwiritsidwa ntchito mosamala, popeza kuti impso zawo zimachitika ndi impso ndi secretion wa tubular.
• Kafukufuku wa X-ray wokhala ndi mitsempha yolumikizira ma othandizira omwe ali ndi ayodini (intravenous urography, intravenous cholangiography, angiography komanso computer tomography (CT) wogwiritsa ntchito wothandizirana ndi ena: lactic acidosis odwala omwe akutenga Amaryl M (onani gawo "Contraindication"). Chifukwa chake, odwala omwe akukonzekera kuphunzira akuyenera kusiya kugwiritsa ntchito Amaril M kale, panthawi komanso kwa maola 48 mutatha kuchita njirayi. Pankhaniyi, mankhwalawa sayenera kubwezeretsedweranso mpaka kuwunika kwachiwiri kwa impso kuchitike.
• Hypoxic zinthu: mtima kugwa (mantha) a genesis, pachimake congestive mtima kulephera, pachimake myocardial infarction ndi zina mikhalidwe momwe hypoxemia akhoza limodzi ndi mawonekedwe a lactic acidosis, komanso angayambitse azrenemia prerenal. Ngati odwala omwe akutenga Amaryl M ali ndi vuto lofananalo, mankhwalawo amayenera kutha yomweyo.
• Zochita za opaleshoni: pakuchitika kwa maopaleshoni iliyonse, ndikofunikira kuti muchepetse chithandizo kwakanthawi ndi mankhwalawa (kupatula njira zazing'ono zomwe sizikufuna zoletsa kudya komanso madzimadzi) Mankhwalawa sangathenso kuyambika kufikira wodwala ayamba kudya yekha, ndipo zotsatira za kuyesedwa kwa impso sizili mwa malire.
• Kuledzera: popeza mowa umathandizira zotsatira za metformin pa lactate metabolism, odwala ayenera kuchenjezedwa kuti asamwe mowa wambiri, wosakwatiwa kapena wosakhazikika pakumwa Amaril M.
• Ntchito ya chiwindi chosokoneza: sayenera kutumizidwa kwa odwala omwe ali ndi matenda a chiwindi kapena chiwopsezo cha chiwindi.
• Mulingo wa Vitamini B12: panthawi yoyesedwa mwachipatala, komwe kumatenga milungu 29, pafupifupi 7% ya odwala omwe adatenga Amaril M adawonetsa kuchepa kwa plasma B12, koma osatsatiridwa ndi mawonetseredwe azachipatala. Kuchepetsa kumeneku kumatheka chifukwa cha kuchuluka kwa vitamini B12 - kulowererapo kwa vitamini B12, komwe sikumayendetsedwa kwambiri ndi kuchepa magazi ndipo kumatha msanga mukasiya kumwa mankhwalawa kapena vitamini B12 akapatsidwa.
  Anthu ena (omwe alibe mafuta okwanira kapena mavitamini B12 kapena calcium) amakhala ndi chizolowezi chochepetsa kuchuluka kwa vitamini B12. Kwa odwala oterowo, zitha kukhala zothandiza nthawi zonse, zaka 2-3 zilizonse, kudziwa kuchuluka kwa vitamini B12 m'madzi am'magazi.
• Zosintha pamatenda a wodwala omwe ali ndi vuto la matenda am'mbuyomu: kupezeka kwa magawo a matenda kuchokera ku chizolowezi kapena matendawo matenda (makamaka osawoneka bwino) mwa wodwala yemwe anali ndi mwayi wotsogola panthawi ya matenda a shuga ndi metformin, amafunika kumuwunika mwachangu kupatula ketoacidosis ndi lactic acidosis . Ndikofunikira kudziwa kuchuluka kwa ma electrolyte ndi matupi a ketone m'magazi am'magazi, kuchuluka kwa shuga m'magazi, komanso, ngati akuwonetsa, magazi pH, mulingo wa lactate, pyruvate ndi metformin. Pamaso pa mtundu uliwonse wa acidosis, makonzedwe a Amaril M amayenera kuyimitsidwa pomwepo ndipo njira zina zofunika kukonza mankhwala ziyenera kuyamba.

Odwala ayenera kudziwitsidwa za zabwino ndi zoopsa zomwe zingachitike chifukwa chogwiritsidwa ntchito ndi Amaril M, komanso za njira zina zochiritsira. M'pofunikanso kudziwitsa za kufunikira kwa kudya, kuchita masewera olimbitsa thupi pafupipafupi, komanso kufunika kowunikira shuga wamagazi, glycosylated hemoglobin, ntchito ya impso, ndi magawo a hematological.
Odwala amafunika kufotokozedwa kuti ndi chiopsezo cha lactic acidosis ndi chiyani, momwe zimakhalira ndi zomwe zimathandizira kuti ziwonekere. Odwala ayenera kulangizidwa kuti asiye kumwa mankhwalawo ndikuwonana ndi dokotala nthawi yomweyo ngati zizindikiro monga kuchuluka pafupipafupi komanso kupuma kwambiri, myalgia, malaise, kugona, kapena zizindikiro zina zosadziwika. Ngati wodwala wakwanitsa kumwa mankhwala a Amaril M, ndiye kuti kupezeka kwa matenda am'mimba omwe amawoneka koyambirira kwa mankhwala mwina sikugwirizana ndi kugwiritsa ntchito mankhwalawa. Kuwoneka kwa zizindikiro zam'mimba m'magawo apambuyo a chithandizo kumatha chifukwa cha lactic acidosis kapena matenda ena akulu.
Nthawi zambiri, metformin, yomwe imatengedwa yokha, siyimayambitsa hypoglycemia, ngakhale kuti zimachitika ndi nthawi yomweyo kugwiritsa ntchito metformin yokhala ndi zotuluka pakamwa. Kuyambitsa chithandizo chophatikiza, wodwalayo amafunika kufotokozedwa za kuwopsa kwa hypoglycemia, zizindikiro zomwe zimagwirizana ndi zomwe zimathandizira mawonekedwe ake.
Gwiritsani ntchito odwala okalamba
Amadziwika kuti metformin imakumbidwa makamaka ndi impso. Popeza chiopsezo chokhala ndi vuto lalikulu la Amaryl M odwala omwe ali ndi vuto la Impso ndiwambiri, mankhwalawa angagwiritsidwe ntchito kokha mwa odwala omwe ali ndi vuto laimpso. Chifukwa chakuti ndi zaka, ntchito yaimpso imachepa, mwa anthu okalamba metformin amagwiritsidwa ntchito mosamala. Ndikofunikira kusankha mosamala mlingo ndikuwunikira ntchito ya impso. Monga mwachizolowezi, odwala okalamba samachulukitsa mlingo wa metformin kufika pazambiri.
Zizindikiro zasayansi
Zotsatira zamankhwala pogwiritsa ntchito mankhwala aliwonse osokoneza bongo ziyenera kuyang'aniridwa pafupipafupi pakusala kudya kwa magazi ndi glycosylated hemoglobin. Nthawi yoyamba kuchuluka kwa mankhwalawa, chisonyezo cha chithandizo cha mankhwala ndi kuthamanga kwa shuga m'magazi. Komabe, kuwerengera kwa glycosylated hemoglobin ndikofunikira pakuwunika kukwaniritsa kuyang'anira matenda kwakanthawi.
Ndikofunikanso kuyang'anira ma hematological magawo (hemoglobin / hematocrit ndikuwona ma indices am'magazi ofiira) ndi ntchito ya impso (creatinine) osachepera 1 pachaka. Mukamagwiritsa ntchito metformin, kuchepa kwa magazi m'thupi kumakhala kovuta, komabe, ngati pali kukayikira komwe kumachitika, ndikofunikira kupatula kuchepa kwa vitamini B12.
Gwiritsani ntchito panthawi yoyembekezera komanso mkaka wa m`mawere. Amaryl M sayenera kumwedwa panthawi yomwe ali ndi pakati chifukwa cha chiwopsezo chomwe chingapezeke kwa mwana. Odwala omwe ali ndi pakati komanso odwala omwe akukonzekera kutenga pakati ayenera kudziwitsa dokotala. Odwala otere ayenera kusamutsidwa ku insulin.
Popewa kumeza kwa Amaril M pamodzi ndi mkaka wa m'mawere m'matumbo a mwana, sayenera kutengedwa ndi azimayi pakubala. Ngati ndi kotheka, wodwalayo ayenera kugwiritsa ntchito insulin kapena kusiyiratu kuyamwitsa.
Carcinogenesis, mutageneis, kuchepa chonde
Kupitiliza maphunziro kuti mudziwe kuchuluka kwa mankhwalawa kunachitika mu mbewa ndi mbewa ndikutalika kwa masabata 104 ndi masabata 91, motero. Pankhaniyi, Mlingo wofika 900 mg / kg / tsiku ndi 1500 mg / kg / tsiku, motero, udagwiritsidwa ntchito. Mlingo onse pafupifupi katatu umaposa mlingo waukulu wa tsiku lililonse, womwe umalimbikitsidwa kuti ugwiritse ntchito mwa anthu ndipo umawerengeredwa potengera thupi. Palibe abambo kapena mbewa zazikazi zomwe zikusonyeza chizindikiro cha kuperewera kwa metformin. Momwemonso, mu makoswe amphongo, zotupa za metformin sizinapezeke. Komabe, mu makoswe achikazi Mlingo wa 900 mg / kg / tsiku, kuwonjezeka kwa benign uterine stromal polyps kunawonedwa.
Zizindikiro za metformin mutagenicity sizinapezeke pa mayeso aliwonse awa: Mayes a Ames (S. Typhi mulium), mayeso a kusintha kwa mtundu (maselo a mbewa), mayeso a cherrosome aberration (ma lymphocyte a anthu), ndi mayeso a micronucleus mu vivo (mafupa a mbewa).
Metformin sizinakhudze chonde amuna ndi akazi mu Mlingo omwe amafikira 600 mg / kg / tsiku, ndiye kuti, mumadontho omwe anali okwanira kawiri tsiku lililonse omwe amalimbikitsidwa kugwiritsidwa ntchito mwa anthu ndipo amawerengedwa potengera thupi.
Ana. Chitetezo ndi kufunika kwa mankhwalawa kwa ana sichinakhazikitsidwe.
Kutha kusinthitsa kuchuluka kwa zochita mukamayendetsa kapena kugwiritsa ntchito njira zina.
Wodwala ayenera kuchenjezedwa za kusamala poyendetsa magalimoto ndikugwiritsa ntchito njira.

Amaril M mogwirizana ndi mankhwala

Glimepiride
Wodwala yemwe amamwa Amaryl M nthawi yomweyo amalandila mankhwala ena kapena kusiya kumwa, izi zimatha kuwonjezeka osafunikira kapena kuchepa kwa hypoglycemic zotsatira za glimepiride.Kutengera kuzomwe mugwiritse ntchito Amaril M ndi sulfonylureas zina, ndikofunikira kulingalira kuthekera kwa machitidwe amtunduwu a Amaril M ndi mankhwala ena.
Glimepiride imapangidwa ndi enzyme CYP 2C9. Amadziwika kuti kagayidwe kake kamakhudzidwa ndi kugwiritsa ntchito nthawi imodzi kwa inducers (rifampicin) kapena ma inhibitors (fluconazole) CYP 2C9.
Mankhwala omwe amalimbikitsa zotsatira za hypoglycemic.
Mankhwala a insulin kapena pakamwa antidiabetic, ACE inhibitors, alopurinol, anabolic steroids, mahomoni ogonana amuna, chloramphenicol, anticoagulants, omwe ndi zotumphukira za coumarin, cyclophosphamide, disopyramide, phenfluramine, pheniramidine, microfluoroethanolin, microfluenololinololinololin, microfluanololinololinolin, microfluonolololin, microfluonolinolin, microfluenololinolin, microfluenololinolin, microfluenololinolin, microfluonolinolin, microfluenolol. paraaminosalicylic acid, pentoxifylline (ndi makulidwe a makolo pamitunda yayitali), phenylbutazone, phenenicide, mankhwala a gulu la quinolone, salicylates, sulfinpyrazone, sulfonamide, tetra cyclins, tritokvalin, trofosfamide, azapropazone, oxyphenbutazone.
Mankhwala omwe amachepetsa mphamvu ya hypoglycemic.
Acetazolamide, barbiturates, corticosteroids, diazoxide, okodzetsa, epinephrine, glucagon, mankhwala othandizira (omwe amagwiritsidwa ntchito kwa nthawi yayitali), nicotinic acid (muyezo waukulu), estrogens ndi progestogens, phenothiazine, phenytoin, rifampicin, mahomoni a chithokomiro.
Mankhwala omwe amatha kukulitsa ndikuchepetsa mphamvu ya hypoglycemic.
H2 receptor antagonists, clonidine ndi reserpine.
Ma blockers a β-adrenergic receptors amachepetsa kulolera kwa glucose, potero amawonjezera chiwopsezo cha hypoglycemia (chifukwa cha kutsutsana kwazovuta).
Mankhwala motsogozedwa ndi omwe amalepheretsa kapena kutsekeka kwa zizindikiro za adrenergic kukokana kwa hypoglycemia:
Ma Sympatholytic othandizira (clonidine, guanethidine ndi reserpine).
Kumwa mowa kamodzi komanso kosatha kumatha kukulitsa kapena kuchepetsa mphamvu ya Amaril M. Amaril M kungapangitse komanso kuchepetsa mavuto obwera chifukwa cha coumarin.
Metformin
Pogwiritsa ntchito munthawi yomweyo mankhwala ena, lactic acidosis imayamba. Matenda a wodwala amayenera kuyang'aniridwa mosamala ngati angagwiritse ntchito nthawi imodzi ndi mankhwala otsatirawa: kukonzekera kwa radiopaque yokhala ndi ayodini, maantibayotiki omwe ali ndi mphamvu ya nephrotoxic (giramicin, ndi zina).
Pogwiritsa ntchito nthawi yomweyo ndi mankhwala ena, zotsatira za hypoglycemic zimatha kukula komanso kuchepa. Kuyang'anira wodwala mosamala ndikuwunika kuchuluka kwa shuga m'magazi ndikofunikira pakagwiritsidwe ntchito kofanana ndi mankhwala otsatirawa:

• mankhwala omwe amathandizira zotsatira: insulin, sulfonamides, sulfonylureas, anabolic steroids, guanethidine, salicylates (aspirin, ndi zina), β-adrenoreceptor blockers (propranolol, etc.), Mao inhibitors.
• mankhwala omwe amachepetsa vutoli: adrenaline, corticosteroids, mahomoni a chithokomiro, estrogens, diuretics, pyrazinamide, isoniazid, nicotinic acid, phenothiazines.

Gliburide: munthawi yophunzira momwe mungagwiritsire ntchito limodzi njira imodzi yodwala odwala matenda ashuga a mtundu II omwe ali ndi metformin ndi glyburide, kusintha kwa pharmacokinetics ndi pharmacodynamics a metformin kunayambitsidwa. Panali kuchepa kwa AUC ndi Cmax) kwa glyburide, komwe kunali kosiyanasiyana. Chifukwa chakuti mlingo umodzi unayambitsidwa phunziroli, komanso chifukwa cha kusakanikirana pakati pa milingo ya glyburide m'magazi am'magazi ndi zotsatira zake za mankhwala, palibe kutsimikiza kuti kulumikizanaku ndikofunika kwachipatala.
Furosemide: Pakafukufuku wowerengera mgwirizano pakati pa metformin ndi furosemide popereka mlingo umodzi kwa odzipereka athanzi, zidawonetsedwa kuti kuwongolera munthawi yomweyo kwa mankhwalawa kumakhudzanso magawo awo a pharmacokinetic. Furosemide inakulitsa Cmax ya metformin m'madzi am'magazi ndi 22%, ndi AUC - mwa 15% popanda kusintha kwakukulu kwa aimpso kwa metformin. Mukamagwiritsidwa ntchito ndi metformin, Cmax ndi AUC ya furosemide idatsika ndi 31% ndi 12%, motero, poyerekeza ndi furosemide monotherapy, ndipo kuwonongedwa kwa theka-moyo kunatsika ndi 32% popanda kusintha kwakukulu pakubwezeretsa kwa impso kwa furosemide. Palibe deta pakukhudzana kwa metformin ndi furosemide ndikugwiritsa ntchito nthawi yayitali.
Nifedipine: munthawi yowerengera kuti muphunzire kuyanjana pakati pa metformin ndi nifedipine popereka mlingo umodzi kwa odzipereka athanzi, zinaonetsedwa kuti kuyendetsa munthawi yomweyo nifedipine kumawonjezera Cmax ndi AUC ya metformin m'magazi am'magazi ndi 20% ndi 9%, komanso, ndikuwonjezera kuchuluka kwa mankhwala omwe amachotsedwa pamankhwala ndi mkodzo. Metformin alibe mphamvu pa pharmacokinetics ya nifedipine.
Kukonzekera kwa cationic: kukonzekera kwa cationic (amiloride, digoxin, morphine, procainamide, quinidine, quinine, ranitidine, triamteren, trimethoprim, vancomycin), omwe amathandizidwa ndi impso pogwiritsa ntchito katulutsidwe ka tubular, theoretally angathe kuyanjana ndi metformin chifukwa cha mpikisano ya ana wamba. Kuyanjana pakati pa metformin ndi cimetidine pakagwiritsiridwa ntchito pakamwa kumawonedwa pakapita maphunziro kuti ayesere kuyanjana pakati pa metformin ndi cimetidine kudzera m'mankhwala angapo komanso angapo a mankhwala kwa odzipereka athanzi. Maphunzirowa adawonetsa kuwonjezeka kwa 60% mu Cmax ya metformin mu plasma, komanso kuwonjezeka kwa 40% ku AUC ya metformin mu plasma. Pakati pa phunziroli ndi limodzi mlingo, palibe kusintha komwe kunapezeka kutalika kwa theka-moyo. Metformin sichikhudza pharmacokinetics ya cimetidine. Ngakhale kuti machitidwe oterewa ndioganiza (kupatula cimetidine), ndikofunikira kuyang'anitsitsa odwala ndikusintha Mlingo wa metformin ndi (kapena) mankhwala omwe amalumikizana nawo, ngati mankhwala a cationic amachotsedwa m'thupi mwa chinsinsi kutsika kwa impso.
Ena: Mankhwala ena amatha kuyambitsa kuchuluka kwa shuga m'magazi ndipo amatha kupangitsa kuti magazi a glycemic asawonongeke. Mankhwalawa akuphatikiza thiazide ndi ma diuretics ena, corticosteroids, phenothiazines, mahomoni a chithokomiro, estrogens, njira zakulera zamkamwa, phenytoin, nicotinic acid, sympathomimetics, calcium blockers ndi isoniazid. Popereka mankhwala ngati amenewa kwa wodwala yemwe akutenga mankhwala a metformin, ndikofunikira kuyang'anitsitsa mosamala kuti mankhwalawo azikhala oyenera.
Panthawi yowerengera kuti muphunzire kuyanjana ndikupereka mlingo umodzi kwa odzipereka athanzi, a pharmacokinetics a metformin ndi propranolol, komanso metformin ndi ibuprofen, sanasinthe ndikugwiritsa ntchito munthawi yomweyo.
Kuchuluka kwa metformin kwa mapuloteni amadzi a m'magazi sikokwanira, zomwe zikutanthauza kuti kuyanjana ndi mankhwala omwe amaphatikiza bwino mapuloteni amadzi a plasma, monga salicylates, sulfonylamides, chloramphenicol, probenecid, ndizochepa kwambiri poyerekeza ndi mapuloteni a m'magazi a plasma. .
Metformin ilibe katundu woyamba kapena wachiwiri kwa pharmacodynamic, omwe ungapangitse kuti asagwiritsidwe ntchito ngati mankhwala osangalatsa kapena osokoneza bongo.

Mankhwala ochulukirapo a Amaril M, Zizindikiro ndi chithandizo

Popeza mankhwalawa ali ndi glimepiride, mankhwala osokoneza bongo amatha kutsitsa shuga wa magazi. Hypoglycemia popanda kutaya chikumbumtima komanso kusintha kwamitsempha kuyenera kuchitidwa mothandizidwa ndi glucose wamlomo komanso kusintha kwa mankhwala ndi (kapena) zakudya za wodwala. Milandu yambiri ya hypoglycemia, yomwe imayendetsedwa ndi chikomokere, zopweteka ndi zina zamitsempha, sizosowa kwenikweni, koma ndizofunikira zomwe zimafunikira wodwalayo kuchipatala. Ngati matenda a hypoglycemic coma apezeka kuti mukukayikira, kapena kuti akukayikira kuti mwachitika, wodwalayo amayenera kuyamwa mozungulira (40%) shuga ndi iv, kenako achite kulowetsedwa kwa glucose wokhazikika (10%) pamlingo womwe umapangitsa khola kukhala lolimba kuchuluka kwa shuga m'magazi pamwamba pa 100 mg / dl. Wodwala amafunikira kuwunikira pafupipafupi kwa maola 24 mpaka 48, chifukwa atatha kukonza mkhalidwe wa wodwalayo, hypoglycemia ikhoza kubwereranso.
Chifukwa cha kukhalapo kwa metformin pokonzekera, kukhazikitsa lactic acidosis ndikotheka. Metformin ikalowa m'mimba mokwanira mpaka 85 mg, hypoglycemia siinawonedwe. Metformin imathandizidwa ndi dialysis (chilolezo chofika mpaka 170 ml / min ndipo chimapatsidwa hemodynamics yoyenera). Chifukwa chake, ngati bongo umayikiridwa, hemodialysis ikhoza kukhala yothandiza pochotsa mankhwalawa m'thupi.