GENTADUETO - (JENTADUETO) malangizo ogwiritsira ntchito

2.5 mg / 850 mg mapiritsi okhala ndi mafilimu, 2.5 mg / 1000 mg

Piritsi limodzi lili

zinthu zofunikira: linagliptin 2.5 mg,

metformin hydrochloride 850 mg kapena 1000 mg,

zotuluka: arginine, wowuma chimanga, Copovidone, silicon dioxide colloidal anhydrous, magnesium stearate,

kujambula kwama filimu: titanium dioxide (E171), iron (III) oxide chikasu (E172) (kwa mulingo wa 2.5 mg / 850 mg), chitsulo (III) okusayidi wofiira (E172), propylene glycol, hypromellose 2910, talc.

Mapiritsiwa amakhala atakulungidwa ndi utoto wamafuta amtundu wa lalanje, ululu, wokhala ndi biconvex, ndikulemba logo ya kampani ya BI mbali imodzi ndikulemba "D2 / 850" mbali inayo (pamlingo wa 2.5 mg / 850 mg).

Mapiritsiwa anali atakulungidwa ndi chithunzi cha utoto wofiirira wa pinki, chowongolera, chokhala ndi biconvex, ndikulemba logo ya kampani ya BI mbali imodzi ndikujambulitsa "D2 / 1000" mbali inayo (kwa mulingo wa 2.5 mg / 1000 mg).

Kutulutsa mawonekedwe, kapangidwe kake ndi ma CD

Mapiritsi, omwe amakutidwa ndi filimu, ndi lalanje wowoneka bwino, utoto, biconvex, wojambula ndi logo ya Beringer Ingelheim mbali imodzi ndikujambulidwa "D2 / 850" mbali inayo.

Othandizira: arginine, wowuma chimanga, Copovidone, silicon dioxide, colloidal anhydrous, magnesium stearate.

Phula: titanium dioxide (E171), iron oxide ofiira (E172), iron oxide chikasu (E172), propylene glycol, hypromellose 2910, talc.

Ma PC 10 - matuza (6) - mapaketi a makatoni.

tabu. zokutira filimu, 2,5 mg / 1000 mg: 60 ma PC.
Reg. No: 10072/13/16/18 ya 03/05/2018 - Nthawi yachitsimikiziro reg. kumenyedwa wopanda malire

Mapiritsiwa ndi ophatikizidwa ndi utoto wofiirira wautoto, oval, biconvex, wojambula ndi logo ya kampani mbali imodzi ndikujambulidwa ndi "D2 / 1000" mbali inayo.

Othandizira: arginine, wowuma chimanga, Copovidone, silicon dioxide, colloidal anhydrous, magnesium stearate.

Phula: titanium dioxide (E171), iron oxide ofiira (E172), propylene glycol, hypromellose 2910, talc.

Tulutsani mawonekedwe, ma CD ndi kapangidwe kake

Mapiritsiwo anali atakulungidwa ndi utoto wamafuta amtundu wachikaso, oval, biconvex, ndi zolemba za kampaniyo mbali imodzi ndikujambula "D2 / 500" mbali inayo.

Othandizira: arginine - 12,5 mg, chimanga wowuma - 20 mg, Copovidone - 47,5 mg, anhydrous colloidal silicon dioxide - 2.5 mg, magnesium stearate - 5 mg.

Zomwe zimapangidwa povala filimuyi: titanium dioxide (E171) - 2.88 mg, utoto wachikasu wachitsulo (E172) - 0,12 mg, propylene glycol - 0,6 mg, hypromellose 2910 - 6 mg, talc - 2.4 mg.

Ma PC 10 - matuza opangidwa ndi PVC / PCTFE / Al (3) - mapaketi a makatoni.
Ma PC 10 - matuza opangidwa ndi PVC / PCTFE / Al (6) - mapaketi a makatoni.

Zotsatira za pharmacological

Mankhwala osakanikirana a hypoglycemic ophatikizidwa pakamwa. Gentadueto ® ndi kuphatikiza kokhazikika kwa zinthu ziwiri za hypoglycemic - linagliptin ndi metformin hydrochloride.

Linagliptin ndi choletsa wa enzyme DPP-4 (dipeptidyl peptidase 4, EC code 3.4.14.5), yomwe ikuphatikizidwa ndi kupangika kwa mahomoni a insretin - glucagon-like peptide-1 (GLP-1) ndi glucose-insulinotropic polypeptide (GIP). Ma hormone awa amawonongeka mwachangu ndi enzyme DPP-4. Zonsezi ma incretin zimakhudzana ndi kuyendetsa thupi kwa glucose homeostasis. Mlingo woyambira wa insretin secretion masana ndi wotsika, umakwera msanga mutatha kudya. GLP-1 ndi GIP zimathandizira insulin biosynthesis ndi katulutsidwe kake ka khungu la pancreatic beta pamaso pamagulu a glucose abwinobwino. Kuphatikiza apo, GLP-1 imachepetsa kubisalira kwa glucagon ndi maselo a pancreatic alpha, omwe amatsogolera kuchepa kwa kupanga kwa shuga mu chiwindi. Linagliptin imagwira bwino komanso imasinthidwa kumanga ku DPP-4, yomwe imayambitsa kuwonjezeka kosasunthika kwa milingo ya insretin ndikukonzanso kwakanthawi kantchito yawo. Linagliptin imakulitsa katemera wa insulini kutengera kuchuluka kwa shuga ndipo amachepetsa katulutsidwe wa glucagon, zomwe zimapangitsa kusintha kwa glucose homeostasis. Linagliptin imamangiriza ku DPP-4 kusankha, mu vitro kusankha kwake kupitirira kusankha kwa DPP-8 kapena ntchito ya DPP-9 nthawi zopitilira 10,000.

Kuchiza ndi linagliptin kumathandizira kwambiri kuyika ma cell a beta-cell, kuphatikiza HOMA (chitsanzo pakuwunika homeostasis), kuchuluka kwa proinsulin mpaka insulin, komanso kuyankha kwa maselo a beta molingana ndi mayeso a kulekerera kwa chakudya.

Metformin ndi biguanide ndipo imakhala ndi vuto la hypoglycemic, kutsitsa pansi ndi shuga wa plasma wa plasma. Metformin simalimbikitsa kubisirana kwa insulini motero sikubweretsa hypoglycemia.

Metformin hydrochloride ili ndi njira zitatu:

1. Kuchepetsa mapangidwe a shuga m'chiwindi poletsa gluconeogeneis ndi glycogenolysis,

2. Kuchulukana kwa mafupa am'magazi minofu ndikugwiritsa ntchito kwake mwakukulitsa mphamvu ya insulin,

3. Kuchepetsa mayamwidwe am'matumbo m'matumbo.

Metformin imathandizira kapangidwe ka glycogen mu intracellular mwa kuchita glycogen synthetase.

Metformin hydrochloride imawonjezera kuchuluka kwa mayendedwe amtundu uliwonse waomwe akutsata glucose membrane.

Metformin hydrochloride mwa anthu, mosasamala kanthu za momwe amawonongera glycemia, ali ndi phindu pa metabolid ya lipid:

• amachepetsa cholesterol yathunthu, cholesterol mu LDL ndi triglycerides.

Kuonjezera linagliptin ku metformin mankhwala

Kuchita bwino ndi chitetezo cha linagliptin, yogwiritsidwa ntchito limodzi ndi metformin kwa odwala omwe ali ndi glycemia, omwe sanali kuyang'aniridwa mokwanira ndi metformin monotherapy, adawerengeredwa m'maphunziro angapo amaso akhungu, owongoleredwa ndi placebo.

Kuphatikizidwa kwa linagliptin ndi metformin kumapereka chiwonetsero chofunikira komanso chofunikira mu magawo a glycemic popanda kusintha kulemera kwa thupi kuposa kutenga gawo lililonse palokha. Makamaka, mulingo wa glycosylated hemoglobin A (HbA1c), glucose wothamanga wa plasma (GPN), glucose wa 2 plasma atatha kudya (GLP) amachepetsa kwambiri.

Kuwunika kwa meta mu 5,239 odwala omwe ali ndi vuto lachiwiri la 2 omwe adachita nawo mayeselo a kuchipatala a 8 adawonetsa kuti chithandizo cha linagliptin sichichulukitsa chiwopsezo cha mtima (kufa kwamtima, infarction ya nonfatal myocardial, sitiroko yapadera kapena hospitalization chifukwa chosakhazikika kwa angina pectoris).

Pharmacokinetics

Kafukufuku wa Bioequivalence omwe adachitika mwa odzipereka athanzi adawonetsa kuti Gentadueto ® ndi yofanana ndi linagliptin ndi metformin.

Kugwiritsa ntchito kwa Gentadueto ® ndi chakudya sikunachititse kuti kusintha kwa magawo a pharmacokinetic a linagliptin. AUC wa metformin sanasinthe, koma pafupifupi serum metformin C max pankhani ya mankhwalawo ndi chakudya idatsitsidwa ndi 18%. Pankhani yogwiritsa ntchito mankhwalawa ndi chakudya, kuwonjezeka kwa nthawi yakufika kwa C max wa metformin mu plasma ndi maola awiri. Izi ndi zinthu zomwe zikuwonetsa zinthu zomwe zimapangidwa ndi Gentadueto ®.

Pambuyo pakamwa ya linagliptin pa mlingo wa 5 mg, mankhwalawa adayamba kuyamwa, C max mu plasma (Median T max) adafikiridwa pambuyo pa maola 1.5. Kuzunza kwa linagliptin mu plasma kumachepetsa biphasic. Mtheradi bioavailability wa linagliptin pafupifupi 30%. Popeza kasamalidwe ka linagliptin limodzi ndi zakudya zamafuta ambiri sizinakhudze kwambiri mankhwala a pharmacokinetics, linagliptin itha kugwiritsidwa ntchito limodzi ndi chakudya komanso mosasamala za kudya.

Mutatenga linagliptin mu gawo limodzi la 5 mg, pafupifupi V d ndi pafupifupi 1110 L, zomwe zimawonetsa kufalikira kokwanira mu minofu. Kumangidwa kwa linagliptin kwa mapuloteni a plasma kumadalira kuchuluka kwa mankhwalawa. Ngati ndende ndi 1 nmol / L, kumangako kuli pafupifupi 99%, ndipo pakuwonjezeka kwa ndende ya linagliptin mpaka ≥30 nmol / L, kumangako kumatsika mpaka 75-89%, komwe kumawonetsera kuchuluka kwa kulumikizana kwa mankhwalawa ndi DPP-4 monga kuchuluka kwa kuchuluka kwa linagliptin. Pazikulu za linagliptin, pomwe kumangiriza kwa DPP-4 kwadzaza kwathunthu, 70-80% ya linagliptin itamangidwa kumapuloteni ena a plasma, ndipo 20-30% ya mankhwalawo anali momasuka.

Pankhani ya kumwagliptin muyezo wa 5 mg 1 nthawi / tsiku, C ss ya mankhwalawa m'madzi a plasma idakwaniritsidwa pambuyo pa mlingo wachitatu, pomwe AUC ya linagliptin mu plasma idakwera pafupifupi 33% poyerekeza ndi mlingo woyamba. Ma coefficients amasinthidwe a AUC a linagliptin anali ochepa (12.6% ndi 28,5%, motsatana). Makhalidwe a AUC a linagliptin mu plasma omwe ali ndi Mlingo wowonjezeka adakulanso pang'ono. Ma pharmacokinetics a linagliptin athanzi komanso odwala omwe ali ndi mtundu wa 2 mellitus nthawi zambiri anali ofanana.

Kafukufuku wa in vitro awonetsa kuti linagliptin ndi gawo lapansi la P-glycoprotein ndi CYP3A4. Ritonavir, pent inhibitor wa P-glycoprotein ndi CYP3A4, zinapangitsa kuti chiwonetserocho chiwonjezeke kawiri (chikuwonetsedwa pamaziko a AUC) a linagliptin, ndikugwiritsanso ntchito linagliptin palimodzi ndi rifampicin, cholimbitsa cholimba cha P-glycoprotein ndi CYP3A anortulort a 40 of the an 40 of an aup of a a lot of a lot of a 40 a led of a 40 a led of a an 40th of a an 40th of a an 40th of a an 40th of a an 403 a a4 of the an 40th of a an ledigul a a lot of a lot of a lot of a a lot of a lot of a a lot of a aitor. %, makamaka chifukwa cha kuwonjezeka (kapena, motero, kuchepa) kwa bioavailability ya linagliptin chifukwa cha zoletsa (kapena, mwanjira ina) ya P-glycoprotein.

Kutetemera ndi chimbudzi

Gawo laling'ono la mankhwala lomwe limalandiridwa limapangidwa. Njira yayikulu yakuzembera kudzera m'matumbo (pafupifupi 85%). Pafupifupi 5% ya linagliptin imachotsedwa mu mkodzo. Mmodzi metabolite wamkulu wa mankhwalawo adadziwika, kuwonetsedwa kwapachibale komwe gawo lofanana ndi 13.3% yowonetsedwa kwa linagliptin. Metabolite iyi ilibe zochita zamatsenga ndipo samathandizira pakulepheretsa kwa linagliptin motsutsana ndi plasma DPP-4.

Terminal T 1/2 yayitali - maola opitilira 100, makamaka chifukwa chodzaza, kumangika kwa linagliptin ndi DPP-4 ndipo sikuti kumayambitsa kuchuluka kwa mankhwalawa. Kutheka kwa T 1/2 pakuphatikizira kwa linagliptin, komwe kumapangidwira pambuyo pobwereza linagliptin pa mlingo wa 5 mg, pafupifupi maola 12

Kuchotsa chilolezo ndi pafupifupi 70 ml / mphindi.

Pharmacokinetics mu milandu yapadera yamankhwala

Odwala omwe ali ndi vuto lililonse la impso, kusintha kwa dokotala wa linagliptin sikuti kumafunika. Kulephera kwaimpso sikunakhudze pharmacokinetics ya linagliptin odwala omwe ali ndi matenda ashuga a 2.

Odwala omwe ali ndi kuchepa pang'ono, pang'ono kapena kwambiri hepatic, akusintha kwa mlingo wa linagliptin sikufunika.

Maphunziro a pharmacokinetics a lignagliptin mwa ana sanachitike.

Kuwona kusintha malingana ndi jenda, kuchuluka kwa thupi, mtundu, zaka za odwala sizofunikira.

Pambuyo pakuyamwa kwa metformin, C max mu plasma imafikira maola 2,5. Mu odzipereka athanzi, bioavailability wa metformin hydrochloride pambuyo pakamwa mankhwala pa 850 mg pafupifupi 50-60%. Mutatha kumwa mankhwalawo mkati, pafupifupi 20-30% ya mankhwalawa samayamwa ndikuwotcha matumbo osasinthika.

Metformin hydrochloride imadziwika ndi nonlinear mayamwidwe pharmacokinetics. Metformin hydrochloride ikagwiritsidwa ntchito pazovomerezeka, C ss mu plasma imatheka mkati mwa maola 24-48 ndipo, monga lamulo, ndizochepera 1 μg / ml.

Zakudya zimachepetsa mayamwidwe a metformin hydrochloride ndipo zimachepetsa kuyamwa. Pambuyo kugwiritsa ntchito mankhwalawa pa mlingo wa 850 mg ndi chakudya, C max inali yocheperachepera 40, AUC 25% yocheperako, ndipo nthawi yofika C max idakulitsidwa ndi mphindi 35. Kukula kwazachipatala kukuchepa kwa izi sizikudziwika.

Kumanga kwa metformin kwa mapuloteni a plasma ndikosatheka. Metformin hydrochloride imamangiriza ku maselo ofiira amwazi. Ndi max metformin m'magazi ndi otsika kuposa plasma, ndipo zimatheka pafupifupi nthawi imodzi. Maselo ofiira amaganiza kuti ndiye chipinda chowonjezera chogawa mankhwalawa. Wapakati V d amasiyanasiyana malita 63 mpaka 276.

Kutetemera ndi chimbudzi

Mwa anthu, ma metabolites a mankhwalawa samadziwika. Metformin hydrochloride imakumbidwa ndi impso sikusintha. The aimpso chilolezo cha metformin hydrochloride amaposa 400 ml / mphindi, zomwe zimawonetsera kuchuluka kwa mankhwalawa ndi glomerular kusefera ndi katulutsidwe katulutsidwe. Pambuyo pakulowetsa, terminal T 1/2 pafupifupi maola 6.5

Mu vuto la impso, kutsekeka kwa impso kumachepa mogwirizana ndi CC, chifukwa chake, T 1/2 marefu, omwe amatsogolera kuchuluka kwa plasma metformin hydrochloride.

Pharmacokinetics mu milandu yapadera yamankhwala

Pambuyo pa kugwiritsidwa ntchito kamodzi kwa metformin pa mlingo wa 500 mg mwa ana, mbiri ya pharmacokinetics inali yofanana ndi zomwe zimachitika munthu wamkulu wathanzi.

Pambuyo kugwiritsa ntchito mankhwalawa mobwerezabwereza 500 mg 2 / tsiku kwa masiku 7 a ana odwala matenda ashuga, C max mu plasma ndi AUC 0-t anali pafupifupi 33% ndi 40% ochepera kuposa odwala achikulire omwe amadwala matenda a shuga metformin pa mlingo wa 500 mg 2 / tsiku kwa masiku 14. Popeza mlingo wa mankhwalawa umasankhidwa payekha malinga ndi kuchuluka kwa kayendetsedwe ka glycemia, zowerengera izi ndizofunikira kwambiri pakuchipatala.

Zizindikiro zogwiritsidwa ntchito

Type 2 matenda a shuga:

• pofuna kupititsa patsogolo kayendedwe ka glycemic (kuphatikiza zakudya ndi masewera olimbitsa thupi) pakagwiritsidwe ntchito ka nthawi yomweyo linagliptin ndi metformin ndikofunikira: mwa odwala omwe chithandizo chawo ndi metformin chokha sichothandiza kwenikweni, kapena kwa odwala omwe amalandila kale linagliptin ndi metformin ngati osiyana mankhwala osokoneza bongo,
• kuphatikiza ndi sulfonylurea zotumphukira (zophatikiza kuphatikiza katatu) kuwonjezera pa zakudya ndi masewera olimbitsa thupi omwe odwala omwe mankhwalawa amapezeka ndi metformin ndi sulfonylurea pazambiri zovomerezeka sizothandiza.

Mlingo

Zokhudza pakamwa.

Mulingo woyenera ndi 2.5 mg / 850 mg kapena 2.5 mg / 1000 mg 2 nthawi / tsiku.

Mlingo uyenera kusankhidwa payekha malinga ndi momwe wodwalayo alili. Mlingo wapamwamba kwambiri wa tsiku lililonse wa Gentadueto ® ndi 5 mg wa linagliptin ndi 2000 mg ya metformin.

Gentadueto ® iyenera kumwedwa ndi chakudya kuti muchepetse zovuta zomwe zimachitika m'matumbo oyambitsidwa ndi metformin.

Kwa odwala omwe mtundu wachiwiri wa shuga umakhala wopanda mankhwalawa wokwanira ndi manformin monotherapy pa mlingo wolekereka wokwanira, Gentadueto® nthawi zambiri imayenera kutumikiridwa kuti mlingo wa linagliptin ndi 2,5 mg 2 nthawi / tsiku (tsiku lililonse 5 mg), ndipo mlingo wa metformin umakhalabe womwewo. monga kale.

Kwa odwala omwe amasamutsidwa kuchokera kugwiritsidwa ntchito kwa linagliptin ndi metformin, Gentadueto ® iyenera kuyikidwa kuti mulingo wa linagliptin ndi metformin ukhale wofanana ndi kale.

Kwa odwala omwe ali ndi mtundu wa shuga wachiwiri samakhala wolamulidwa mokwanira ndimankhwala ophatikiza awiri ophatikizika pogwiritsa ntchito mulingo wovomerezeka wa metformin komanso zotumphukira za sulfonylurea, Gentadueto ® nthawi zambiri imayikidwa kuti mlingo wa linagliptin ndi 2.5 mg 2 nthawi / tsiku (tsiku ndi tsiku 5 mg), komanso mlingo metformin anali yemweyo monga kale.

Gentadueto ® ikagwiritsidwa ntchito limodzi ndi mtundu wa sulfonylurea, zotumphukira za m'munsi za sulfonylurea zitha kufunsidwa kuti muchepetse chiopsezo cha hypoglycemia.

Kuti mugwiritse ntchito Mlingo wosiyanasiyana wa metformin, Gentadueto ® ikupezeka mu mitundu iyi:

• linagliptin 2.5 mg + metformin hydrochloride 850 mg kapena metformin hydrochloride 1000 mg.

Gentadueto ® (chifukwa cha kupezeka kwa metformin mu kapangidwe kake) imapangidwa mwa odwala omwe ali ndi vuto locheperako kapena loipa kwambiri la impso (CC

Gentadueto ® (chifukwa cha kukhalapo kwa metformin mu kapangidwe kake) imapangidwa mu odwala omwe ali ndi vuto la chiwindi.

Popeza metformin imachotsedwa impso, ndipo pakukalamba ndimakonda kuchepa mphamvu ya impso, mwa okalamba omwe akutenga Gentadueto ®, ndikofunikira kuyang'anira ntchito ya impso.

Pakusowa mankhwalawa, ayenera kumwedwa wodwala akangokumbukira izi. Osamwa kawiri mlingo nthawi yomweyo.

Zotsatira zoyipa

Odwala kulandira mankhwala osakanikirana a linagliptin ndi metformin

Nthawi zambiri:

• kudya kwakachepa, kutsekula m'mimba, mseru,
• hypoglycemia.

Nthawi zambiri:

• nasopharyngitis,
• hyperacaction of the bronchi,
• kuchuluka kwa amylase,
• Hypersensitivity (angioedema, urticaria, zidzolo).

Zosowa:

• mutu, chizungulire,
• kusanza
• kapamba
• kutsokomola
• kuyabwa

Odwala kulandira metformin monotherapy

Nthawi zambiri:

• kulawa zosokoneza,
• kupweteka m'mimba
• Matenda a hepatobiliary - kusintha kwa zizindikiro za chiwindi, hepatitis,
• erythema, urticaria.

Zosowa:

• kagayidwe kachakudya matenda - lactic acidosis,
• kuphwanya mayamwidwe a vitamini B 12 (ndi chithandizo cha nthawi yayitali) kungayambitse (munthawi zosowa kwambiri) kufooka kwakukulu kwa vitamini B 12, mwachitsanzo, kuchepa kwa magazi m'thupi.

Contraindication

• Hypersensitivity pamagawo a mankhwala,
• mtundu 1 shuga
• matenda ashuga ketoacidosis, matenda a shuga,
• Kulephera kwa impso kapena kuwonongeka kwa impso (KK ® imaphatikizidwa pakatundu wa pakati ndi kuyamwa.

Kafukufuku wokhudza momwe mankhwalawa amakhudzira chonde chaumunthu sanachitike. M'maphunziro oyambira pogwiritsa ntchito mlingo wapamwamba kwambiri wa linagliptin (240 mg / kg / tsiku), womwe umapitilira kukhudzana ndi anthu nthawi zopitilira 900, zotsatira zoyipa sizaberekedwe.

Maphunziro okwanira komanso oyendetsedwa bwino ndi mankhwalawa Gentadueto ® kapena ziwalo zake payekha mwa amayi apakati sizinachitike. M'maphunziro a kubereka asanachitike, panalibe zotsatira za teratogenic zogwirizana ndi kuphatikiza kwa linagliptin ndi metformin. Zambiri pakugwiritsa ntchito metformin mwa amayi apakati ndizochepa.

Gentadueto ® sayenera kugwiritsidwa ntchito panthawi yomwe akukonzekera. Insulin iyenera kugwiritsidwa ntchito, yomwe imalola kuti magazi azikhala mozungulira pafupi ndi zabwinobwino komanso kuchepetsa chiopsezo cha matenda obwera chifukwa cha fetal omwe amayamba chifukwa cha kuchuluka kwa shuga.

Metformin imakumbidwa mkaka waumunthu. Palibe umboni woti mwina lignagliptin ingalowe mkaka wa munthu.

Malangizo apadera

Gentadueto ® imalekanitsidwa chifukwa cha odwala omwe ali ndi matenda a shuga 1 kapena chifukwa cha matenda ashuga a ketoacidosis.

Kugwiritsa ntchito kwa mankhwala Gentadueto ® kuphatikiza ndi insulin sikunaphunziridwe mokwanira.

Hypoglycemia ndi gawo lodziwika bwino la sulfonylureas. Chifukwa chake, mukamagwiritsa ntchito Gentadueto ® pophatikiza ndi zotumphukira za sulfonylurea, mutha kusamala. Kuthekera kochepetsa mlingo wa zotuluka za sulfonylurea kuyenera kukumbukiridwa.

Metformin monotherapy siyimayambitsa hypoglycemia, koma kupanikizika kumeneku kumatha kuchitika ngati zopatsa mphamvu zimachepetsedwa, ngati zochitika zolimbitsa thupi sizichitika ndi kuchuluka kwa zopatsa mphamvu zowonjezera, kapena mankhwala ena a hypoglycemic (mwachitsanzo, zotumphukira za sulfonylurea ndi insulin) amagwiritsidwa ntchito kapena ethanol.

Lactic acidosis ndizosowa kwambiri koma zovuta za metabolic zomwe zingachitike chifukwa cha kuchuluka kwa metformin hydrochloride. Zolemba zotsindikirika za lactic acidosis mwa odwala omwe amalandila metformin hydrochloride zimachitika makamaka m'matenda a shuga, limodzi ndi kulephera kwambiri kwaimpso, komanso pamaso pa zinthu zowopsa monga matenda osokoneza bongo osokoneza bongo a mellitus, ketosis, kusala kudya kwa nthawi yayitali, kumwa kwambiri mowa, kulephera kwa chiwindi ndi Mulingo uliwonse umakhala ndi hypoxia.

Matenda a lactic acidosis:

• chiopsezo cha lactic acidosis iyenera kukumbukiridwa pakukula kwa madandaulo osakhazikika monga kupweteka kwam'mimba ndi asthenia yayikulu.

Lactic acidosis imadziwika ndi kufupika kwa acidotic, kupweteka kwam'mimba komanso hypothermia, kenako kutsekeka kwa chikomokere. Zosintha mu magawo a labotale ndizofunikira kuzindikira - kuchepa kwa magazi pH, kuchuluka kwa lactic acid mu plasma yoposa 5 mmol / l, kuchuluka kwa kuperewera kwa anion ndi kuchuluka kwa lactate / pyruvate. Ngati metabolic acidosis ikukayikiridwa, metformin iyenera kusiyidwa, ndipo wodwalayo ayenera kuchipatala mwachangu.

Popeza metformin hydrochloride imakumbidwa ndi impso, tikulimbikitsidwa kuti mulingo wa serum creatinine uzitsimikiziridwa pafupipafupi mtsogolo musanayambe mankhwala ndi:

• Odwala omwe ali ndi vuto la impso, osachepera pachaka,
• Odwala omwe ali ndi serum creatinine wambiri malinga ndi VGN, komanso odwala osachepera 2-4 pachaka.

Kwa odwala okalamba, kuchepa kwa asymptomatic kumathandizira kuwona. Kusamalidwa kwapadera kuyenera kuchitidwa pazochitika zomwe zingayambitse kuchepa kwa ntchito yaimpso, mwachitsanzo, poyambira antihypertensive, diuretic therapy kapena kugwiritsa ntchito NSAIDs. Chenjezo liyenera kuchitidwa pochiza odwala omwe ali ndi zaka 80 ndi akulu.

Popeza kuphatikiza kwazinthu zowerengeka za ayodini zopangira maphunziro a radiology kungayambitse kulephera kwa impso, kugwiritsa ntchito metformin hydrochloride kuyenera kuyimitsidwa pasadakhale kapena mkati mwa maphunziro awa. Kugwiritsa ntchito metformin hydrochloride kumatha kuyambiranso patatha maola 48 maphunzirowa atatha ndipo pokhapokha mutalandira zotsatira za kuyambiranso kwa ntchito yaimpso, osonyeza kuti palibe kusintha.

Metformin hydrochloride iyenera kuyimitsidwa maola 48 musanachite opaleshoni yosankhidwa pogwiritsa ntchito opaleshoni yayikulu, kapena msana. Kugwiritsa ntchito mankhwalawa kungayambitsidwenso osadutsa maola 48 atachitidwa opaleshoni kapena mutayambiranso zakudya pakamwa, ndipo pokhapokha ngati zotsatira za kukonzanso ntchito kwa aimpso zikuwonetsa.

Panthawi yolembetsa pambuyo pa kulembedwa, chitukuko cha pancreatitis pachimake mwa odwala omwe amatenga linagliptin adalembedwa. Pankhani ya kapamba, Gentadueto ® iyenera kusiyidwa.

Kukopa pa kuyendetsa magalimoto ndi kayendedwe kazinthu

Palibe maphunziro omwe adachitidwa kuti aphunzire momwe mankhwalawo amathandizira kuyendetsa magalimoto ndikugwira ntchito yofunika chidwi komanso kuthamanga kwa zochitika zama psychomotor. Poona milandu ya chizungulire pakumwa mankhwala, muyenera kusamala. Ngati odwala akumana ndi chizungulire, ayenera kupewa zinthu zomwe zingakhale zoopsa, kuphatikizapo kuyendetsa magalimoto ndi makina owongolera.

Bongo

Panthawi yoyesedwa pamayeso aumoyo wathanzi, Mlingo umodzi wa linagliptin, womwe umafikira 600 mg (nthawi 2000 kuchuluka), anali wololera. Zochitika pakugwiritsa ntchito mankhwala mu Mlingo wopitilira 600 mg mwa anthu sizipezeka.

Pamene metformin imagwiritsidwa ntchito mu Mlingo mpaka 850 mg, hypoglycemia siinawoneke, ngakhale pakhala pali lactic acidosis. Mankhwala ochulukirapo a metformin angayambitse lactic acidosis. Lactic acidosis ili m'gulu la zochitika zachipatala zadzidzidzi, chithandizo chamankhwala chimachitika chipatala.

Zizindikiro

• hypoglycemia, nseru, chizungulire ndizotheka.

Chithandizo:

• gastric lavage, kudya adsorbents,
• kuchita ndi chithandizo cha matenda - mu / pakubweretsa zamadzimadzi, kuwongolera ndi kusintha kwa mawonekedwe a glycemic. Njira yothandiza kwambiri yochotsa lactate ndi metformin hydrochloride ndi hemodialysis.

Kuyanjana kwa mankhwala osokoneza bongo

Kugwiritsa ntchito nthawi yomweyo kwa odzipereka athanzi linagliptin (10 mg 1 nthawi / tsiku) ndi metformin (850 mg 2 nthawi / tsiku) sikunasinthe kwambiri pharmacokinetics ya linagliptin kapena metformin.

Kafukufuku wa Pharmacokinetic okhudzana ndi mankhwala a Gentadueto ® sanachitike, komabe, kafukufuku wotereyu wachitika ndi zigawo za Gentadueto ®, linagliptin ndi metformin.

Linagliptin sanakhale ndi vuto lililonse pakumveka kwa pharmacokinetics of metformin, glibenclamide, simvastatin, pioglitazone, warfarin, digoxin ndi njira zakulera zapakamlomo, zomwe zimagwirizana ndi data ya vivo pamayendedwe apansi a mankhwala omwe amapezeka ndi CYP2C8, 4 isoenzymes, CYP2A4, glycoprotein ndi transporter wa organic cations (TOK).

Metformin. Kugwiritsa ntchito pamodzi kwa metformin (kugwiritsidwa ntchito mobwerezabwereza pa mlingo wa 850 mg 3 nthawi / tsiku) ndi linagliptin (pa supratherapeutic mlingo wa 10 mg 1 nthawi / tsiku) sikumabweretsa kusintha kwakukulu mu pharmacokinetics ya linagliptin kapena metformin.

Zothandiza kuchokera ku sulfonylureas. Kugwiritsa ntchito kwa linagliptin pakamwa (kuchuluka kwa 5 mg) ndi glibenclamyl pa mlingo umodzi (glyburide 1.75 mg) sikusintha pharmacokinetics ya linagliptin mu kufanana. Komabe, pali kuchepa kwamankhwala kovuta kwambiri mu AUC ndi C max glibenclamide ndi 14%. Popeza glibenclamide imapangidwa makamaka ndi CYP2C9, izi zimatsimikiziranso mawu oti linagliptin sikuti choletsa CYP2C9. Palibe kuyanjana kwakukulu kwachipatala komwe kumayembekezeredwa ndi zotumphukira zina za sulfonylurea (mwachitsanzo, glipizide, tolbutamide ndi glimepiride), yomwe, ngati glibenclamide, imapangidwa makamaka ndi CYP2C9.

Pangamanga. Kugwiritsa ntchito kwa linagliptin (kamodzi 10 mg / tsiku) ndi pioglitazone (angapo Mlingo wa 45 mg / tsiku), yomwe ndi gawo la CYP2C8 ndi CYP3A4, kulibe gawo lililonse lazamankhwala pama-pharmacokinetics a linagliptin kapena pioglitazone, kapena metabolites yogwira ya pioglitazone.

Ritonavir. Kugwiritsa ntchito kwa linagliptin limodzi (5 mg / tsiku) ndi ritonavir (Mlingo wambiri wa 200 mg pamlomo) kumawonjezera AUC ndi C max wa linagliptin, motsatana, pafupifupi 2 ndi katatu. Zosintha izi mu pharmacokinetics za lignagliptin sizimaganiziridwa kuti ndizofunika kwambiri. Chifukwa chake, kulumikizana kwakukulu pamankhwala ndi ma P-glycoprotein / CYP3A4 inhibitors sikumayembekezeredwa, ndipo kusintha kwa mankhwala sikofunikira.

Rifampicin. Kugwiritsira ntchito kofananira kwa linagliptin ndi rifampicin kumabweretsa kutsika kwa AUC ndi C max ya linagliptin pamlingo wofanana ndi 39,6% ndi 43.8%, motsatana, komanso kutsika kwa kuletsa kwa ntchito zoyambira za DPP-4 ndi 30%. Chifukwa chake, chikuyembekezeka kuti luso la linagliptin pophatikizana ndi P-glycoprotein likhalebe, ngakhale silingawonekere kwathunthu.

Digoxin. Kugwiritsidwa ntchito kambiri kwa linagliptin (5 mg / tsiku) ndi digoxin (0.25 mg / tsiku) sikukukhudza pharmacokinetics a digoxin.

Warfarin. Linagliptin, wogwiritsidwa ntchito mobwerezabwereza pa mlingo wa 5 mg / tsiku, sanasinthe pharmacokinetics ya S (-) kapena R (+) warfarin, yomwe ndi gawo laling'ono la CYP2C9, lomwe limawonetsa kusowa kwa luso la linagliptin poletsa CYP2C9.

Simvastatin. Linagliptin, wogwiritsidwa ntchito mobwerezabwereza muyezo wa 10 mg / tsiku, ali ndi mphamvu zochepa pa pharmacokinetics ya simvastatin, yomwe sikutanthauza kusintha kwa mlingo.

Kulera kwamlomo. Kugwiritsa ntchito kwa linagliptin muyezo wa 5 mg wa levonorgestrel kapena ethinyl estradiol sikusintha ma pharmacokinetics a mankhwalawa mogwirizana.

Metformin. Kugwiritsidwa ntchito kwa metformin panthawi yoledzera ya mowa pachimake kumawonjezera chiopsezo cha lactic acidosis (makamaka ngati mukufa ndi njala, kuperewera kwa chakudya m'thupi kapena kulephera kwa chiwindi). Mowa ndi mankhwala okhala ndi ethyl mowa uyenera kupewedwa.

Mankhwala a Cationic omwe amathandizidwa ndi aimpso secretion (mwachitsanzo, cimetidine) amatha kuyanjana ndi metformin, kupikisana ndi machitidwe wamba a impso. Chifukwa chake, ndi munthawi yomweyo kugwiritsa ntchito mankhwala a cationic omwe amathandizidwa ndi aimpso secretion, kuwunika mosamala glycemia, kusintha kwa mankhwala a metformin mkati mwa njira yolimbikitsira komanso (ngati kuli kotheka) chithandizo cha matenda a shuga opatsirana ndikofunikira.

Mankhwala

Kafukufuku wa Bioequivalence omwe adachitika mwa odzipereka athanzi adawonetsa kuti GENTADUETO ndi yofanana ndi linagliptin ndi metformin hydrochloride yophatikiza mankhwalawa.

Kugwiritsa ntchito kwa mankhwala GENTADUETO 2,5 / 1000 mg ndi chakudya sikuti kumabweretsa kusintha kwa magawo a pharmacokinetic a linagliptin. Madera omwe ali munthawi yogwiritsira ntchito metformin samasintha, komabe, kuchuluka kwa metformin mu seramu pankhani yogwiritsira ntchito mankhwalawa ndi chakudya kumachepetsedwa ndi 18%. Kugwiritsa ntchito mankhwalawa pamimba yopanda kanthu kumayambitsa kuchepetsedwa kufikira kuchuluka kwa metformin mu seramu kwa maola awiri. Kusintha kumeneku sikofunika kwenikweni.

Otsatirawa ndi deta yomwe ikuwonetsa kuchuluka kwa mankhwala a pharmacokinetic omwe amagwiritsidwa ntchito ndi mankhwala a GENTADUETO.

Pharmacokinetics ya lignagliptin yaphunziridwa bwino mu odzipereka athanzi komanso odwala omwe ali ndi mtundu wa 2 matenda a shuga. Mutatenga linagliptin pakamwa pa 5 mg, mankhwalawa amalowetsedwa msanga, nsonga za plasma (Median Tmax) zimachitika pambuyo pa maola 1.5. Plasma linagliptin yozungulira imachepetsa magawo atatu. Hafu ya theka-yayitali ndi yayitali (kupitirira maola 100), zomwe zimachitika chifukwa chogwira kwambiri, kumangika kwa linagliptin ndi DPP-4 ndipo sikuti kumayambitsa kuchuluka kwa mankhwalawa. Hafu yaumoyo wa kuchuluka kwa linagliptin, wokhazikika pambuyo pobwereza linagliptin pa 5 mg, pafupifupi maola 12. Pambuyo pa mlingo umodzi wa 5 mg wa linagliptin, plasma wozama wa mankhwala pamlingo wamphamvu wolingana umatheka pambuyo pa mlingo wachitatu, ndipo plasma AUC ya linagliptin imawonjezeka pafupifupi 33% poyerekeza ndi mlingo woyamba. Ma coefficients amasinthidwe a AUC of linagliptin anali ochepa: 12.6% ndi 28,5%. The pharmacokinetics of lignagliptin silinelinear chifukwa kudalira kwa lignagliptin ndi DPP-4. Chiwonetsero chonse cha plasma AUC ya linagliptin imachulukitsa kamodalira pochepera pa AUC yopanda malire, ikukula modalira. Ma pharmacokinetics a linagliptin ndi ofanana mu thanzi komanso mwa odwala omwe ali ndi matenda a shuga a 2.

Mafuta: The bioavailability mtheradi wa linagliptin pafupifupi 30%. Kulandila kwa linagliptin ndi chakudya chamafuta ambiri kumawonjezera nthawi kuti ifikire kuchuluka kwa plasma ndende (Cmax) pofika maola 2 ndipo kumabweretsa kutsika kwa Cmax ndi 15%, koma sizikuwakhudza AUC0-72h. Palibe kusintha kwakukuru kuCmax ndi Tmax, chifukwa chake, linagliptin itha kugwiritsidwa ntchito mosasamala kanthu pakudya.

Kugawa: chifukwa cha kumangika kwa minofu, kuchuluka kwakukulu kwa magawidwe pamlingo wamphamvu wolingana pambuyo pa gawo limodzi la 5 mg ndi pafupifupi 1110 malita, zomwe zikuwonetsa kufalikira kokwanira mu minofu. Kumangidwa kwa linagliptin kwa mapuloteni a plasma kumadalira kuchuluka kwa mankhwalawa ndikuchepetsa ndi 99% pa 1 nmol / L mpaka 75-89% pa ≥30 nmol / L, komwe kumawonetsera kuchuluka kwa kulumikizana kwa mankhwalawa ndi DPP-4 ndi kuchuluka kwa lignagliptin. Pazowunikira kwambiri kwa linagliptin, pomwe kumangiriza kwa DPP-4 kwadzaza kwathunthu, 70-80% ya linagliptin imamangiriza mapuloteni ena a plasma (osati DPP-4), ndipo 30-20% ya mankhwalawa ali mwaulere.

Kutetemera ndi chimbudzi: Mutatenga 10 mg ya linagliptin, pafupifupi 5% imachotsedwa mu mkodzo. Metabolism imathandizanso pakuchotsa linagliptin. Metabolite imodzi yayikulu idadziwika popanda zochitika zam'magazi komanso ndi vuto la 13.3% ya linagliptin pamlingo wamphamvu wolingana, motero, sichimatulutsa mphamvu ya linagliptin pa DPP-4 mu plasma. Pafupifupi 85% imachotsedwa (ndi ndowe 80% ndi mkodzo 5%) patatha masiku 4 mutatha kutsata. Chilolezo chotsogola molingana ndi 70 ml / min.

Odwala omwe ali ndi vuto la impso: mu gawo la mphamvu yolingana mwa odwala omwe ali ndi vuto laimpso, mawonekedwe a linagliptin ali ofanana ndi mbiri yowonetsedwa mwa odzipereka athanzi. Odwala omwe ali ndi vuto la aimpso ochepa, kuwonjezeka kwapang'onopang'ono kwa mawonekedwe a nthawi pafupifupi 1.7 kumawonedwa poyerekeza ndi gulu lolamulira. Mbiri yowonekera kwa odwala omwe ali ndi mtundu wa 2 matenda a shuga komanso kulephera kwakukulu kwaimpso inakulitsa pafupifupi nthawi 1.4 poyerekeza ndi odwala omwe ali ndi matenda a shuga a 2 omwe ali ndi ntchito yachilendo. Makhalidwe oloseredwa a AUC a linagliptin mu gawo la mphamvu yolimbana ndi odwala omwe ali ndi vuto lothana ndi vuto la impso amawonetsa kuchuluka kwa kupezeka kwa mankhwala kwa odwala omwe ali ndi kuchepa kwapakati kapena kuvulala kwambiri kwa aimpso. Kuphatikiza apo, linagliptin sinafotokozeredwa pamlingo wofunika kwambiri panthawi ya hemodialysis kapena peritoneal dialysis. Odwala omwe ali ndi vuto lililonse la impso, kusinthidwa kwa mlingo wa linagliptin sikofunikira, chifukwa chake, mutha kupitiliza kutenga linagliptin piritsi limodzi patsiku la 5 mg ngati mankhwala a DENTADUETO akhazikitsidwa chifukwa cha kupezeka kwa vuto laimpso.

Odwala omwe ali ndi vuto la chiwindi chodwala: odwala omwe ali ndi vuto la chiwindi gawo lililonse (Gulu la ana-Pugh A, B, ndi C), mitengo ya AUC ndi Cmax ya lignagliptin anali ofanana ndi gulu loyang'anira atatha kutenga Mlingo wambiri wa lignagliptin wa 5 mg.

Mlingo woyenera malinga ndi jenda, kuchuluka kwa thupi (BMI), mtundu, ndi zaka za odwala sizofunikira.

Mafuta: mutatenga Metformin mkati, Tmax imafikiridwa pambuyo maola 2,5. Mu odzipereka athanzi, mtheradi bioavailability wa metformin hydrochloride pambuyo pakamwa makonzedwe a 500 mg kapena 850 mg ndi pafupifupi 50-60%. Mutatha kumwa mankhwalawo mkati, pafupifupi 20-30% ya mankhwalawa samayamwa ndikuwachotsa ndowe zomwe sizinasinthidwe.

Mafuta a metmorphine hydrochloride amadzala ndi osakwanira, ma pharmacokinetics a mayamwidwe siwoloza. Mukatenga Mlingo wovomerezeka wa metformin hydrochloride, kutsata kwa plasma kokhazikika kumatha maola 24-48 ndipo, monga lamulo, ndi ochepera 1 μg / ml. M'maphunziro azachipatala, Cmax plasma metformin hydrochloride kuchuluka sikudapitirira 5 μg / ml, ngakhale pamlingo waukulu. Kudya kumachepetsa mayamwidwe a metformin hydrochloride ndikuchepetsa pang'ono. Mukatha kugwiritsa ntchito mankhwalawa pamtunda wa 850 mg, pamodzi ndi chakudya, kuwerenga kwa Cmax ndi 40% yotsika, AUC 25% kutsika, Tmax imawonjezeka ndi mphindi 35. Kukula kwazachipatala kukuchepa kwa izi sizikudziwika.

Kugawa: Metformin yomwe imamangiriza mapuloteni a plasma ndiwosamveka. Metformin hydrochloride imagawidwa ndi maselo ofiira amwazi. Kuchuluka kwa mankhwalawa m'magazi kumatsika kuposa plasma ndipo kumatheka pafupifupi nthawi imodzi. Maselo ofiira amaganiza kuti ndiye chipinda chowonjezera chogawa mankhwalawa. Voliyumu yapakati yogawa (Vd) imasiyana malita 63 mpaka 276.

Metabolism ndi chimbudzi: metformin hydrochloride imachotsedwa impso sizinasinthidwe. Mwa anthu, ma metabolites a mankhwalawa samadziwika. The aimpso chilolezo cha metformin hydrochloride amaposa 400 ml / mphindi, zomwe zimawonetsera kuchuluka kwa mankhwalawa ndi glomerular kusefera ndi katulutsidwe katulutsidwe. Pambuyo kumwa mankhwala mkati, wodwala theka moyo pafupifupi 6.5 maola.

Mu vuto la impso, kutsekeka kwa impso kumachepa mogwirizana ndi kupezeka kwa creatinine chilolezo, choncho theka la moyo limatenga nthawi yayitali, zomwe zimabweretsa kuwonjezeka kwa plasma metformin hydrochloride level.

GENTADUETO ndi kuphatikiza kosakanikirana kwazinthu ziwiri zomwe zimachepetsa shuga - linagliptin ndi metformin hydrochloride, ndi njira yowonjezera yochitira zinthu mokulitsa magazi a odwala omwe ali ndi matenda a shuga a 2.

Linagliptin ndi choletsa wa enzyme DPP-4 (dipeptidyl peptidase 4), yomwe ikuphatikizidwa ndi inactivation ya mahomoni amtundu - glucagon-ngati peptide-1 (GLP-1) ndi glucose-wodalira insulinotropic polypeptide (GIP). Ma hormone awa amawonongeka mwachangu ndi enzyme DPP-4. Ma insretin onsewa akukhudzidwa ndi kuyendetsa thupi kwa glucose homeostasis. Mlingo woyambira wa insretin secretion masana ndi wotsika, umakwera msanga mutatha kudya. GLP-1 ndi GIP zimathandizira kukhala biosynthesis ndi secretion ya insulin ndi masamba a pancreatic beta pamlingo wambiri komanso wokwera wamagazi. Kuphatikiza apo, GLP-1 imachepetsa kubisalira kwa glucagon ndi maselo a pancreatic alpha, omwe amatsogolera kuchepa kwa kupanga kwa shuga mu chiwindi.

Linagliptin imagwira bwino ntchito komanso imasinthiratu ku DPP-4, yomwe imapangitsa kuwonjezeka kosasunthika kwa ma insretins ndikusungabe zochitika zawo kwa nthawi yayitali. Linagliptin imakulitsa katulutsidwe kamatenda a shuga ndipo imachepetsa katulutsidwe wa glucagon, kukonza glucose homeostasis. Linagliptin imangiriza kusankha ku DPP-4; mu vitro, kusankha kwake kupitilira kwa DPP-8 kapena ntchito yake motsutsana ndi DPP-9 nthawi zopitilira 10,000.

Metformin hydrochloride ndi biguanide ndipo imakhala ndi hypoglycemic, kuchepetsa basal ndi postprandial plasma glucose. Metformin simalimbikitsa kubisirana kwa insulini motero sikubweretsa hypoglycemia.

Metformin ili ndi njira zitatu:

- Kuchepetsa mapangidwe a shuga m'chiwindi poletsa minofu gluconeogeneis ndi glycogenolysis

- kuchuluka kwa kudzikundikira ndi kupezeka kwa glucose pogwiritsa ntchito minofu yamatumbo pakukulitsa chidwi cha insulin

- Kuchepetsa mayamwidwe a shuga m'matumbo

Metformin hydrochloride imathandizira kapangidwe ka glycogen mu intracellular pochita glycogen synthetase.

Metformin hydrochloride imawonjezera kuchuluka kwa mayendedwe a mitundu yonse yodziwika ya ma membrane a glucose.

Mosasamala kanthu za momwe zimakhudzira glycemia, metformin hydrochloride imakhala ndi phindu pa metabolidi ya lipid: imachepetsa kuchuluka kwa cholesterol yathunthu, cholesterol ku LDL ndi triglycerides.

Kuphatikiza kwa linagliptin kwa metformin chithandizo: mphamvu ndi chitetezo cha linagliptin kuphatikiza ndi metformin mwa odwala omwe ali ndi vuto losakwanira glycemic ndi metformin monotherapy adawerengedwa mu kafukufuku wofufuza kawiri wakhungu, wowongoleredwa ndi placebo wokhala ndi milungu 24. Kuphatikiza kwa linagliptin ndi metformin kumapereka kusintha kwakukulu pamatayidwe a glycemic popanda kusintha kulemera kwa thupi kuposa kutenga gawo lililonse palokha. Mlingo wa glycosylated hemoglobin A (HbA1c) umachepetsedwa kwambiri poyerekeza ndi placebo, kuchokera pamlingo woyambira, komanso kusala shuga wa m'magazi (GPN), glucose wa 2 plasma mutatha kudya (GLP) poyerekeza ndi placebo ndi malo okwera kuchuluka kwa odwala omwe akufika pamlingo wa HbA1c.

Kuchita bwino ndi chitetezo cha lignagliptin pa mlingo wa 2,5 mg kawiri pa tsiku poyerekeza ndi 5 mg kamodzi patsiku pophatikizana ndi metformin mwa odwala omwe ali ndi vuto losakwanira glycemic pa metformin monotherapy adayesedwa mu kafukufuku wamasabata 12 wamaso awiri, owonera-placebo. Kulandila kwa linagliptin pa mlingo wa 5 mg kamodzi patsiku ndi 2,5 mg kawiri patsiku kunapereka kuchepa kwakukulu kwakukulu pamlingo wa HbA1c kuchokera koyambira koyamba poyerekeza ndi placebo. Zowoneka za hypoglycemia mwa odwala omwe amalandidwa linagliptin zinali zofanana ndi zomwe zili mgulu la placebo. Kusiyanitsa kwakukulu kwa kulemera kwa thupi pakati pamagulu kunalibe.

Linagliptin monga cholumikizira mankhwala ochiritsira ophatikizidwa ndi metformin ndi sulfonylurea: kuwunika mphamvu ndi chitetezo cha linagliptin (5 mg) poyerekeza ndi placebo, kafukufuku wamawonekedwe a placebo a masabata 24 adachitidwa mwa odwala omwe sanalandire chithandizo chophatikizidwa ndi metformin komanso sulfonylurea. zotsatira zabwino. Linagliptin adapereka kuwongolera kwakukulu mu HbA1c poyerekeza ndi placebo. Kulandila kwa linagliptin kunathandizira kwambiri mkhalidwe wa odwala omwe afika pamlingo wa HbA1c, komanso kusala glucose (GPN) poyerekeza ndi placebo. Kusiyanitsa kwakukulu kwa kulemera kwa thupi pakati pamagulu kunalibe.

Linagliptin monga othandizira ena othandizira chithandizo ndi metformin ndi empagliflozin: Odwala omwe ali ndi vuto losakwanira la glycemic akamamwa metformin ndi empagliflozin (10 mg kapena 25 mg), chithandizo cha 24-sabata ndi 5 mg linagliptin, yemwe adachita ngati wothandizira wina, adayambitsa kuchepa kwakukulu kwa pafupifupi phindu losinthidwa HbA1c yokhudzana ndi yoyambira poyerekeza ndi mankhwala owonjezera a placebo, motero. Mukamamwa linagliptin 5 mg, kuchuluka kwakukulu kwa odwala omwe ali ndi HbA1c> 7.0% poyambira kufikira HbA1c

Mlingo ndi makonzedwe

Mlingo wa mankhwala GENTADUETO uyenera kusankhidwa payekha malinga ndi momwe wodwalayo alili.

Mulingo woyenera ndi 2.5 mg / 850 mg kapena 2,5 mg / 1000 mg kawiri tsiku lililonse. Mlingo wapamwamba wa GentADUETO wokwanira tsiku lililonse ndi 5 mg wa linagliptin ndi 2000 mg wa metformin.

Mayendedwe ogwiritsira ntchito: GENTADUETO iyenera kumwedwa kawiri pa tsiku ndi chakudya kuti muchepetse chiopsezo cha zovuta m'matumbo oyambitsidwa ndi metformin.

Odwala ayenera kutsatira zakudya zomwe zakudya zimamwa tsiku lonse. Odwala onenepa kwambiri ayenera kutsatira zakudya zamafuta ochepa.

Mlingo wakusoweka: ngati mwakusowa mankhwalawa uyenera kumwedwa wodwala akangokumbukira izi. Osamamwa mlingo wambiri nthawi imodzi tsiku limodzi, pamenepa, phwando liyenera kudumpha.

Kwa odwala omwe salandira metformin

Kwa odwala omwe salandila metformin, mlingo woyambira ndi 2,5 mg wa linagliptin / 500 mg metformin hydrochloride kawiri tsiku lililonse.

Kwa odwala omwe matenda a shuga a 2 samayendetsedwa mokwanira ndi metformin monotherapy pa mlingo waukulu, mlingo woyambirira wa mankhwalawa uyenera kukhala 2,5 mg wa linagliptin kawiri pa tsiku (mlingo wa tsiku 5 mg), ndipo mlingo wa metformin umakhalabe womwewo monga kale .

Kwa odwala omwe asamutsidwa kuchokera ku mankhwala osakanikirana a linagliptin ndi metformin, mankhwala a GENTADUETO ayenera kuikidwa kuti mankhwalawa a linagliptin ndi metformin akhale ofanana ndi omwe adatengedwa kale.

Kwa odwala omwe matenda a shuga a 2 samayendetsedwa mokwanira ndimankhwala awiri ophatikiza ogwiritsa ntchito mankhwala a metformin komanso sulfonylurea, mankhwala a DENTADUETO amalembedwa kuti mlingo wa linagliptin ndi 2.5 mg kawiri patsiku (tsiku ndi tsiku 5 mg), komanso mlingo metformin inali yofanana ndi yomwe idatengedwa kale.

Pogwiritsa ntchito GENTADUETO kuphatikiza ndi zotumphukira za sulfonylurea, mlingo wochepetsetsa wa zotumphukira za sulfonylurea ungafunikire kuchepetsa chiopsezo cha hypoglycemia

Kwa odwala omwe ali ndi mankhwalawa ophatikizira kawiri ndi insulin komanso mlingo waukulu wa metformin, samapereka chiwongolero chokwanira cha glycemic, mankhwala a GENTADUETO nthawi zambiri amadziwikiridwa kuti mlingo wa linagliptin ndi 2.5 mg kawiri patsiku (tsiku lililonse 5 mg), ndipo Mlingo wa metformin unali wofanana ndi womwe unatengedwa kale.

Mukaphatikizidwa ndi linagliptin ndi metformin wokhala ndi insulin, mlingo wochepetsetsa wa insulin ungafunike kuti muchepetse chiopsezo cha hypoglycemia.

Kuti mugwiritse ntchito Mlingo wosiyanasiyana wa metformin, GENTADUETO ikupezeka pazotsatira izi: linagliptin 2.5 mg + metformin 850 mg kapena metformin 1000 mg.

Magulu apadera a odwala

Aimpso ntchito aimpso: mankhwalawa angathe kumwedwa mwa odwala omwe ali ndi vuto laimpso (gawo 3a, creatinine chilolezo cha 45-59 ml / mphindi kapena gloperular filtration rate (GFR) ya 45-59 ml / mphindi / 1.73 m2, pokhapokha pakalibe nthawi zina zomwe zingakulitse chiopsezo cha lactic acidosis posankha mlingo wotsatira: mlingo woyenera wa metformin ndi 500 mg kawiri patsiku.

Ndikofunikira kuyang'anira ntchito ya impso (onani gawo "Malangizo apadera").

Ngati creatinine chilolezo

Zochita zamankhwala osokoneza bongo

Mayendedwe onse. Kuphatikiza kwamitundu yambiri ya linagliptin (10 mg kamodzi patsiku) ndi metformin (850 mg kawiri patsiku) sikunakhudze kwambiri pharmacokinetics ya linagliptin kapena metformin odzipereka athanzi.

Kafukufuku wokhudzana ndi kuphatikiza kwa mankhwala a pharmacokinetic a mankhwala a GENTADUETO ndi mankhwala ena sanachitike, komabe, pankhaniyi, zosakaniza za wogwira ntchito za mankhwala a GENTADUETO, linagliptin ndi metformin, adaphunzira.

Mu vitro Linagliptin ndi mpikisano wopanda mphamvu wa CYP3A4 (CYP isoenzyme), ali ndi mphamvu yofooka kapena yolimbitsa thupi poletsa CYP3A4 chifukwa cha momwe amagwirira ntchito, koma samaletsa zina za CYP isoenzymes. Linagliptin sikuti amayambitsa CYP isoenzymes.

Linagliptin ndi gawo lapansi la glycoprotein-P (P-gp) ndi zoletsa (mpaka pang'ono) P-gp-Mediated digoxin mayendedwe. Kutengera pazotsatira izi komanso deta yomwe imapezeka mu kafukufuku wokhudzana ndi mankhwala omwe amapezeka mu vivo, kuthekera kwa linagliptin kulowa mkati molumikizana ndi mankhwala ndi magawo ena a P-gp amawonedwa ngati osatheka.

Mu vivo. Zotsatira zamankhwala zotsatirazi zimawonetsa kuwopsa kochepa kwakukhudzana ndi mankhwalawa mogwirizana ndi mankhwala othandizira. Palibe zochitika zambiri zamankhwala zomwe zimafunikira kusintha kwa mlingo.

Linagliptin analibe gawo lalikulu pakukhudzidwa kwa pharmacokinetics of metformin, glibenclamide, simvastatin, pioglitazone, warfarin, digoxin kapena njira zakulera zapakamlomo, zomwe zimawonetsa kulephera kochepetsa kuchitapo kanthu kwa mankhwala osokoneza bongo mu vivo ndi magawo a CYP3A4, CYP2C9, P -P2C2.

Metformin. Kuphatikiza mankhwala a metformin (Mlingo wambiri tsiku lililonse wa 850 mg katatu pa tsiku) ndi linagliptin pa 10 mg 1 nthawi patsiku sikuti kumabweretsa kusintha kwakukulu mu pharmacokinetics ya linagliptin kapena metformin. Chifukwa chake, linagliptin sikuti tikuletsa ma mayunule a ma organic cations.

Zothandiza kuchokera ku sulfonylureas. Ma pharmacokinetics a 5 mg a linagliptin pamlingo wamphamvu wolingana sasintha mukamamwa mlingo umodzi wa 1.75 mg wa glibenclamide (glyburide). Komabe, kuchepa kwakukulu kwa AUC ndi Cmax kwa glibenclamide ndi 14% kudadziwika.Popeza glibenclamide imapangidwa makamaka ndi CYP2C9, chifukwa chake, linagliptin si choletsa CYP2C9. Kuchita kwakukulu kwachikondwerero sikumayembekezeredwa ndi zotumphukira zina za sulfonylurea (mwachitsanzo, glipizide, tolbutamide ndi glimepiride), yomwe, ngati glibenclamide, imapangidwa makamaka ndi CYP2C9.

Pangamanga. Kugwiritsa ntchito kwa linagliptin Mlingo wambiri wa kuchuluka kwa mankhwalawa okwanira 10 mg patsiku ndi pioglitazone angapo Mlingo wa 45 mg patsiku, yomwe ndi gawo limodzi la CYP2C8 ndi CYP3A4, osakhala ndi vuto lililonse la mapiritsi a lamoglinetin ndi pioglitazone kapena pioglitazone metabolites.

Ritonavir. Kugwiritsa ntchito kwa linagliptin limodzi mlingo wa 5 mg ndi ritonavir kuchuluka kwa 200 mg kumakulitsa AUC ndi Cmax ya linagliptin pafupifupi kawiri ndi katatu, motsatana. Kuchita kwakukulu kwachinsinsi ndi zina za P-gp ndi CYP3A4 inhibitors sikuyembekezeredwa ndipo kusintha kwa mlingo sikofunikira.

Rifampicin. Kugwiritsanso ntchito mobwerezabwereza kwa linagliptin ndi rifampicin kumabweretsa kuchepa kwa AUC, Cmax ndi kuchepa kwa zoletsa zomwe zimapangitsa ntchito zoyambira za DPP-4. Mphamvu yachipatala ya linagliptin, yogwiritsidwa ntchito limodzi ndi P-gp yogwiritsira ntchito inducers, idzasungidwa, ngakhale singathe kuwonekera kwathunthu. Kuphatikiza ndi zina zomwe zimayambitsa P-gp ndi CYP3A4, monga carbamazepine, phenobarbital, ndi phenytoin, sizinaphunzire.

Digoxin. Kugwiritsidwanso mobwerezabwereza kwa linagliptin pa mlingo wa 5 mg patsiku ndi digoxin pa mlingo wa 0,25 mg wa patsiku sizikhudza pharmacokinetics of digoxin.

Warfarin. Kugwiritsa ntchito mobwerezabwereza kwa linagliptin pa mlingo wa 5 mg patsiku sikusintha pharmacokinetics ya S (-) kapena R (+) warfarin, yomwe ndi gawo la CYP2C9, chifukwa chake, lignagliptin imalephera kuletsa CYP2C9.

Simvastatin. Kugwiritsidwa ntchito mobwerezabwereza kwa linagliptin pamlingo waukulu wowonjezera wa 10 mg patsiku kumakhudza kwambiri pharmacokinetics ya simvastatin ndipo sikutanthauza kusintha kwa mlingo. Pambuyo pa kutsekemera kwa linagliptin tsiku lililonse pazokwanira 10 mg ndi simvastatin 40 mg kwa masiku 6, simvastatin AUC inakulitsa ndi 34%, ndi plasma Cmax ndi 10%. Chifukwa chake, linagliptin imawonedwa ngati choletsa choperewera cha CYP3A4-mediated metabolism, ndikusintha kwa mankhwala a co-metabolised a CYP3A4 sikufunika.

Kulera kwamlomo. Kugwiritsa ntchito kwa linagliptin muyezo wa 5 mg wa levonorgestrel kapena ethinyl estradiol sikusintha mkhalidwe wokhazikika wa pharmacokinetics a mankhwalawa.

Kuphatikiza komwe kumafunikira kusamala: glucocorticoids (ogwiritsa ntchito mwadongosolo komanso makamaka), agonist a beta-2 ndi okodzetsa ali ndi mphamvu yawo ya hyperglycemic. Pochiza mankhwalawa, makamaka kumayambiriro kwa kugwiritsa ntchito kwawo, odwala ayenera kudziwitsidwa za izi ndikuwunika pafupipafupi kuchuluka kwa shuga m'magazi kuyenera kuchitika.

Kuphatikizika komwe kunaperekedwa: kugwiritsa ntchito metformin panthawi yoledzera ya pachimake kumawonjezera chiopsezo cha lactic acidosis, makamaka ngati mukufa ndi njala, kuperewera kwa chakudya m'thupi, kapena vuto la chiwindi. Mowa ndi mankhwala okhala ndi ethyl mowa uyenera kupewedwa.

Mankhwala a Cationic omwe amathandizidwa ndi tubular secretion, monga cimetidine, amatha kuyanjana ndi metformin, kupikisana nawo m'njira wamba yoyenda ndi matenda a tubular renal. Chifukwa chake, kugwiritsa ntchito mankhwalawa munthawi yomweyo kugwiritsa ntchito mankhwala a cationic, kuwunika mosamala glycemia, kusintha kwa mankhwala a metformin mkati mwa njira yolimbikitsira, ndikusintha kwa matenda a shuga ngati pakufunika kutero.

Intravascular dongosolo la zosiyana othandizira zochokera iodine pa x-ray maphunziro kungayambitse kukula kwa aimpso ndi kudzikundikira kwa metformin ndi chiopsezo cha lactic acidosis.

Odwala omwe ali ndi GFR> 60 ml / mphindi / 1.73 m2 ayenera kusiya kumwa mankhwalawo isanachitike kapena panthawi yoyeserera ndipo osayambiranso kwa maola 48 otsatira. Kwa odwala omwe ali ndi vuto laimpso kuwonda (omwe ali ndi GFR pakati pa 45 ndi 60 ml / mphindi / 1.73 m2), kugwiritsa ntchito metformin kuyenera kusiyidwa kwa maola 48 kusanayambike kwa ma ayodini omwe ali ndi ayodini ndipo asayambirenso kupitirira maola 48 atayesedwa ndi kuyesa kwa ntchito yaimpso. .

Tulutsani mawonekedwe ndi ma CD

Mapiritsi 10 amayikidwa mu blister strip ma CD kuchokera polyvinyl chloride / polychlorotrifluoroethylene (PVC / PCTFE) ndi zojambula zotayidwa.

6 matumba zotupa pamodzi ndi malangizo ogwiritsira ntchito zachipatala m'boma komanso zilankhulo zaku Russia zimayikidwa pamakatoni.

Mafunso, mayankho, ndemanga pa mankhwala Gentadueto

Zomwe zimaperekedwa zimakonzekera akatswiri azamankhwala komanso zamankhwala. Chidziwitso chokwanira chokhudza mankhwalawa chili m'malangizo omwe amaphatikizidwa ndi zomwe amapanga ndi wopanga. Palibe chidziwitso chomwe chatumizidwa patsamba lino kapena tsamba lililonse la tsamba lathu chomwe chingagwire ntchito ngati cholowa m'malo mwapadera kwa katswiri.

Kodi Jentadueto ndi chiyani?

Jentadueto imakhala ndi linagliptin ndi metformin. Linagliptin ndi metformin ndi mankhwala a shuga a pakamwa omwe amathandiza kuwongolera shuga. Metformin imagwira ntchito pochepetsa kupanga shuga (shuga) m'chiwindi ndikuchepetsa mayamwidwe am'matumbo m'matumbo. Linagliptin amagwira ntchito mwakuwunika milingo ya insulin yomwe thupi lanu limatulutsa mukatha kudya.

Jentadueto amagwiritsidwa ntchito limodzi ndi zakudya komanso masewera olimbitsa thupi kuti azitha kusintha shuga ya magazi mwa akulu omwe ali ndi matenda a shuga a 2.

Jentadueto sanapangidwe kuti azichiritsa matenda ashuga amtundu woyamba.

Chidziwitso Chofunikira

Simuyenera kugwiritsa ntchito Jentadueto ngati muli ndi matenda oopsa a impso kapena matenda ashuga a ketoacidosis (funsani dokotala wanu kuti akuthandizeni).

Anthu ena amakhala ndi lactic acidosis pomwe akumamwa metformin. Zizindikiro zoyambirira zimawonjezereka pakapita nthawi, ndipo vutoli limatha kufa. Siyani kumwa Jentadueto ndipo pezani chithandizo chamankhwala chamankhwala ngati muli ndi zizindikiro zofowoka, monga kupweteka kwa minofu kapena kufooka, kupuma movutikira, kupweteka m'mimba, mseru, komanso kumva kufooka kapena kutopa kwambiri.

Mankhwala Ochepetsa Okhazikika a FDA: Kodi Angakuthandizeni?

Musanatenge Jentadueto, muuzeni dokotala ngati muli ndi matenda a chiwindi, matenda oopsa, matenda a mtima, mbiri ya kapamba, ngati mwadwala matenda a mtima posachedwapa, kapena ngati muli ndi zaka zopitilira 80 ndipo simunayesedwe.

Ngati mukufuna opaleshoni kapena X-ray kapena makina ojambula pamanja ogwiritsa ntchito utoto womwe umabayidwa m'mitsempha yanu, muyenera kusiya kwakanthawi kuti mugwire Jentadueto.

Musanayambe kumwa mankhwalawa

Simuyenera kugwiritsa ntchito Jentadueto ngati mukusowa metformin (Actoplus Met, Avandamet, Fortamet, Glucophage, Riomet) kapena linagliptin, kapena:

Ngati munakumanapo ndi vuto lalikulu loti silikuyenda bwino (mavuto kupumira, kutupa, zotupa pakhungu) lina linagliptin (Tradjenta),

Ngati muli ndi matenda oopsa a impso, kapena

Ngati muli ndi matenda ashuga a ketoacidosis (onani dokotala kuti akalandire chithandizo).

Anthu ena omwe amamwa metformin amakhala ndi vuto lalikulu lotchedwa lactic acidosis. Izi zitha kukhala zowonjezereka ngati muli ndi matenda a chiwindi kapena impso, kulephera kwa mtima, vuto la mtima kapena stroke, matenda akulu, ngati muli ndi zaka zopitilira 65, ngati mwakomoka magazi, kapena ngati mumamwa mowa wambiri. Lankhulani ndi dokotala wanu za ngozi yanu.

Kuti muwonetsetse kuti Jentadueto ndiotetezeka kwa inu, auzeni dokotala ngati muli:

Matenda a impso (impso yanu ingafunike kufufuzidwa musanamwe mankhwalawa),

ma gallstones

High triglycerides (mtundu wamafuta m'magazi)

Mbiri yakuledzera, kapena

Ngati muli ndi zaka zopitilira 80 ndipo simunayeserepo impso.

Ngati mukufuna opaleshoni kapena X-ray kapena makina ojambula pamanja ogwiritsa ntchito utoto womwe umabayidwa m'mitsempha yanu, muyenera kusiya kwakanthawi kuti mugwire Jentadueto. Onetsetsani kuti omwe akukusamalirani amadziwa pasadakhale kuti mukugwiritsa ntchito mankhwalawa.

Tsatirani malangizo a dokotala anu ogwiritsira ntchito Jentadueto ngati muli ndi pakati kapena poyamwitsa. Kuwongolera shuga ndikofunikira kwambiri panthawi yomwe muli ndi pakati, ndipo Mlingo wanu akhoza kukhala wosiyana panthawi iliyonse yomwe muli ndi pakati. Mlingo wanu ungakhale wosiyana mukamayamwa.

Sizikudziwika ngati linagliptin ndi metformin zimadutsa mkaka wa m'mawere kapena ngati zingakhudze khanda. Uzani dokotala wanu ngati mukuyamwitsa.

Jentadueto sivomerezedwa kuti igwiritsidwe ntchito ndi aliyense wosakwana zaka 18.

Kodi ndingatenge bwanji jentadueto?

Tengani Jentadueto ndendende monga momwe dokotala wanenera. Tsatirani mayendedwe onse patsamba lolemba. Musamamwe mankhwalawa zazikulu kapena zazing'ono, kapena kwa nthawi yayitali kuposa momwe mwalimbikitsidwira.

Tengani Jentadueto kawiri tsiku lililonse ndi chakudya, pokhapokha ngati dokotala wakuuzani mwanjira ina.

Shuga wamagazi ochepa (hypoglycemia) amatha kuchitika kwa aliyense yemwe ali ndi matenda ashuga. Zizindikiro zake zimaphatikizira kupweteka mutu, njala, thukuta, kusakwiya, chizungulire, mseru, kuthamanga kwa mtima, komanso kumva kuda nkhawa kapena kufinya. Kuti muchiritse msanga shuga wamagazi ochepa, nthawi zonse khalani ndi shuga msanga, monga zipatso zamadzimadzi, caramel, crackers, zoumba kapena koloko yosaphika.

Dokotala wanu atha kukulemberani jakisoni wambiri wa glucagon kuti mugwiritse ntchito vuto lalikulu la hypoglycemia ndipo sangathe kudya kapena kumwa. Onetsetsani kuti abale anu ndi anzanu apamtima amadziwa momwe angakupatseni jakisoni mwadzidzidzi.

Onaninso zisonyezo za shuga wambiri (hyperglycemia), monga ludzu lotupa kapena kukodza, kuwona kwamaso, mutu, ndi kutopa.

Dokotala wanu angafune kuti musiye kumwa Jentadueto kwakanthawi kochepa ngati mukudwala, kutentha thupi kapena matenda, kapena ngati mwachita opaleshoni kapena kuthandizidwa mwadzidzidzi.

Kuchuluka kwa shuga m'magazi kumatha kudalira kupsinjika, matenda, opareshoni, masewera olimbitsa thupi, mowa, kapena kudumphadumpha. Funsani dokotala musanasinthe mlingo wanu kapena ndandanda ya mankhwala.

Jentadueto ndi gawo limodzi chabe la pulogalamu yonse yothandizira odwala, yomwe imaphatikizaponso zakudya, masewera olimbitsa thupi, kuchepetsa thupi, kuyezetsa magazi pafupipafupi, komanso chisamaliro chapadera chamankhwala. Tsatirani malangizo a dokotala anu mosamala kwambiri.

Sungani Jentadueto firiji kutali ndi chinyezi ndi kutentha.

Linagliptin ndi dongosolo ya metformin dosing

Dose Lothandiza Akuluakulu a Jentadueto Type 2 Shuga:

Linagliptin-metformin Mapiritsi Otulutsira Pompopompo:
- Mlingo woyambirira wa odwala omwe pakali pano sanalandire metformin: linagliptin 2,5 mg / metformin 500 mg pamlomo kawiri pa tsiku
- Mlingo woyambira wa odwala omwe akulandira metformin: linagliptin 2,5 mg ndi theka la momwe mankhwalawo amapezekera pakhungu kawiri patsiku
- Mlingo woyambirira wa odwala omwe akulandila linagliptin ndi metformin ngati magawo awiri: sinthani ku mankhwala ophatikizira omwe ali ndi gawo limodzi la gawo lililonse pakamwa kawiri pa tsiku
Mlingo wokonzera: aliyense payekha malinga ndi chitetezo ndi magwiridwe antchito.
Mlingo waukulu: linagliptin 5 mg / tsiku, metformin 2000 mg / tsiku

Linagliptin-metformin mapiritsi otulutsidwa otulutsidwa:
- Mlingo woyambirira wa odwala omwe pakali pano sanalandire metformin: linagliptin 5 mg / metformin yotulutsidwa - imasulidwa 1000 mg pakamwa kamodzi patsiku
- Mlingo woyambirira wa odwala omwe akulandira metformin: linagliptin 5 mg molumikizana ndi mlingo wofanana tsiku lililonse wa metformin pakamwa kamodzi patsiku.
- Mlingo woyambirira wa odwala omwe akulandila linagliptin ndi metformin ngati magawo awiri: sinthani ku mankhwala ophatikizira omwe ali ndi gawo limodzi la gawo lililonse pakanthawi kamodzi patsiku
Mlingo wokonzera: aliyense payekha malinga ndi chitetezo ndi magwiridwe antchito.
Mlingo waukulu: linagliptin 5 mg / tsiku, metformin 2000 mg / tsiku

Ndemanga:
Odwala omwe ali ndi mapiritsi a 2,5 mg / metformin osasunthika kuchokera ku 2.5 mg / metformin linagliptin ayenera kumwa mapiritsi awiri kamodzi patsiku.
-Ukagwiritsidwa ntchito limodzi ndi insulin kapena chinsinsi cha insulini, mankhwala ochepetsa insulin kapena insulin angafunike kuti muchepetse chiopsezo cha hypoglycemia.

Gwiritsani ntchito: Kuwongolera glycemic control mwa akulu omwe ali ndi mtundu wa shuga wachiwiri monga njira yolumikizira zakudya ndi kuchita masewera olimbitsa thupi ngati chithandizo cha linagliptin ndi metformin chiri choyenera.

Onaninso: Zambiri za Mlingo (mwatsatanetsatane)

Kodi chimachitika ndi chiyani ngati ndimagwiritsa ntchito bongo mopitirira malire?

Pezani thandizo lachipatala mwadzidzidzi kapena imbani foni ya Poison pa 1-800-222-1222. Mutha kukhala ndi zizindikiro za shuga wochepa wamagazi, monga kufooka kwambiri, kusawona bwino, thukuta, kupuma, kunjenjemera, kupweteka m'mimba, kusokonezeka, komanso kukokana.

Zotsatira zoyipa za Jentadueto

Pezani chithandizo chamankhwala mwadzidzidzi ngati muli ndi vuto la Jentadueto: ming'oma, kupuma movutikira, kutupa kwa nkhope yanu, milomo, lilime, kapena mmero.

Siyani kumwa Jentadueto ndikuyimbira foni dokotala nthawi yomweyo ngati muli ndi vuto la kapamba: kupweteka kwambiri m'mimba mwanu kumafalikira msana wanu, nseru ndi kusanza, kusowa kwa chakudya, kapena kugunda kwamtima.

Anthu ena amakhala ndi lactic acidosis pomwe akumamwa metformin. Zizindikiro zoyambirira zimawonjezereka pakapita nthawi, ndipo vutoli limatha kufa. Pezani thandizo lachipatala mwadzidzidzi ngati muli ndi zizindikiro zochepa, monga:

Ululu kapena kufooka

Khungu kapena kumva kuzizira m'm mikono ndi miyendo yanu,

Kumva chizungulire, chizungulire, kutopa, kapena kufooka kwambiri,

Kupweteka m'mimba, kunyansidwa ndi kusanza, kapena

Kuchepa kapena kusasinthasintha kwa mtima.

Itanani dokotala nthawi yomweyo ngati muli:

Zovuta za autoimmune - kuyabwa, matuza, kuwonongeka kwa khungu lakunja,

Zowawa kapena zowawa zolumikizana mafupa,

Kutupa, kulemera msanga, kapena

Kuchita khungu kolimba ndikutupa, zilonda zapakhosi, kutupira pamaso panu kapena lilime, kuwoneka pamaso panu, kupweteka pakhungu, kenako zotupa pakhungu kapena lofiirira lomwe limafalikira (makamaka kumaso kapena kumtunda kwa thupi) ndikuyambitsa kutulutsa ndi kusisima.

Zotsatira zoyipa za Jentadueto zitha kuphatikizaponso:

Zowawa zam'maso, mphuno zonenepa, kapena

Uwu si mndandanda wathunthu wazotsatira zoyipa, ndipo zina zitha kuchitika. Funsani dokotala wanu za zoyipa. Mutha kuwonetsa zoyipa za FDA pa 1-800-FDA-1088.

Onaninso: Zotsatira zoyipa (mwatsatanetsatane)

Ndi mankhwala ena ati omwe angakhudze Jentadueto?

Mankhwala ena amatha kukulitsa kapena kuchepetsa zotsatira za Jentadueto pakuchepetsa magazi. Uzani dokotala wanu za mankhwala onse omwe muli nawo komanso zomwe mumayambira kapena kusiya kugwiritsa ntchito, makamaka:

Rifampin (pochiza chifuwa chachikulu), kapena

Insulin kapena mankhwala ena a shuga a pakamwa.

Mndandandawu suti wathunthu. Mankhwala ena amatha kuyanjana ndi linagliptin ndi metformin, kuphatikizapo mankhwala omwe amapezeka pakompyuta, mavitamini, ndi mankhwala azitsamba. Osati zochitika zonse zomwe zingatheke zomwe zalembedwa mu bukhuli lamankhwala.