Glucophage: malangizo ogwiritsira ntchito

Glucophage amapangidwa monga mapiritsi:

• 500 kapena 850 mg: filimu yokutira, yoyera, biconvex, yozungulira, yopingasa - yoyera yoyera (500 mg: ma PC 10. M'matumba, matuza atatu kapena asanu mumakatoni, ma 15 ma PC. 2 kapena matuza mu bokosi la makatoni, ma PC 20. M'matumba, matuza atatu kapena asanu pamakatoni, 850 mg: ma PC 15. M'matumba, matuza awiri kapena anayi mu bokosi la makatoni, ma PC 20. 3 kapena matuza 5
• 1000 mg: yokutidwa ndi filimu, yoyera, biconvex, chowulungika, chokhala ndi notch mbali zonse ziwiri ndi cholembedwa "1000" mbali imodzi, gawo lamtundu wa yunifolomu yoyera (10 m'matumba, 3, 5, 6 kapena Zotulutsa 12 pamatoni okhala ndi makatoni, ma PC 15. M'matumba, matuza 2, 3 kapena 4 mu mtolo wa makatoni).

Piritsi limodzi lili ndi:

• Mphamvu yogwira: metformin hydrochloride - 500, 850 kapena 1000 mg,
• Zothandiza zothandizirana (motengera): povidone - 20/34/40 mg, magnesium stearate - 5 / 8.5 / 10 mg.

Zomwe zimapangidwa ndi chipolopolo:

• 500 ndi 850 mg mapiritsi (motero): hypromellose - 4 / 6.8 mg,
• Mapiritsi a 1000 mg: opadra oyera (macrogol 400 - 4.55%, hypromellose - 90.9%, macrogol 8000 - 4.55%) - 21 mg.

Mankhwala

Metformin imachepetsa mawonetseredwe a hyperglycemia, poletsa kukula kwa hypoglycemia. Mosiyana ndi zotumphukira za sulfonylurea, mankhwalawa sathandizira kupanga insulin mthupi ndipo silikhala ndi vuto la thanzi. Metformin imachepetsa chidwi cha zotumphukira zolandilira ku insulin ndikuthandizira kugwiritsika ntchito kwa glucose m'maselo, komanso imalepheretsa kaphatikizidwe ka glucose pachiwindi chifukwa choletsa glycogenolysis ndi gluconeogeneis. Vutoli limachepetsa kuyamwa kwa shuga m'matumbo.

Metformin imayendetsa kaphatikizidwe ka glycogen pochita glycogen synthase ndikuwonjezera kuthekera kwamtundu uliwonse wamtundu wa glucose omata. Amakhudzanso kukonzekera kwa lipid metabolism, kuchepetsa kuchuluka kwa triglycerides, otsika osalimba lipoprotein ndi cholesterol yonse.

Poyerekeza ndi momwe chithandizo cha Glucofage chilili, thupi la wodwalayo mwina limakhalabe lokha kapena limachepetsedwa pang'ono.

Kafukufuku wachipatala amatsimikizira mphamvu ya mankhwalawa popewa matenda ashuga odwala matenda ashuga omwe ali ndi chiwopsezo chowonjezereka cha kukhazikitsidwa kwa matenda ashuga a 2 ngati njira yomwe akutsimikiza asinthe sikutsimikizira kuti matendawa ndi olondola.

Pharmacokinetics

Pambuyo pakukonzekera pakamwa, metformin imatengedwa kuchokera m'matumbo am'mimba kwathunthu. Mtheradi bioavailability ukufika 50-60%. Kuchuluka kwazinthu zambiri m'madzi a m'magazi kumafikira pafupifupi maola 2,5 pambuyo pa kuperekedwa ndipo pafupifupi 2 μg / ml kapena 15 μmol. Mukatenga Glucofage nthawi yomweyo ndi chakudya, mayamwidwe a metformin amachepetsa ndikuchepetsa.

Metformin imagawidwa mwachangu mthupi lonse ndipo imangomangiriza mapuloteni pang'ono. Gawo lokhazikika la Glucofage limapukusidwa bwino kwambiri ndipo limatulutsidwa mkodzo. Kuvomerezeka kwa metformin mwa anthu athanzi ndi 400 ml / min (omwe ndi okwanira 4 kuposa kuwala kwa creatinine). Izi zikutsimikizira kukhalapo kwa yogwira tubular secretion. Hafu ya moyo ndi pafupifupi maola 6.5. Odwala omwe amalephera kupezeka aimpso, zimawonjezeka, ndipo chiopsezo cha kuchuluka kwa mankhwalawo chimakulanso.

Zizindikiro zogwiritsidwa ntchito

Malinga ndi malangizo, Glucophage ndi mankhwala a matenda a shuga 2, makamaka kwa odwala onenepa kwambiri, osagwira ntchito zolimbitsa thupi ndi mankhwala:

• Akuluakulu: monga monotherapy kapena munthawi yomweyo ndi mankhwala ena amkamwa a hypoglycemic kapena ndi insulin,
• Ana ochokera zaka 10: monotherapy kapena munthawi yomweyo ndi insulin.

Contraindication

• Kulephera kwamkati kapena kuwonongeka kwaimpso (kulengedwa kwa creatinine chilolezo (CC) zosakwana 60 ml mphindi imodzi),
• Matenda a shuga: ketoacidosis, precoma, chikomokere,
• Kuwonetsedwa kwamankhwala matenda osachiritsika kapena pachimake omwe angayambitse minofu hypoxia, kuphatikizapo mtima, kulephera kupuma, infarction yovuta kwambiri,
• Zovuta pachimake komwe kumakhala chiwopsezo chokhala ndi vuto la impso: matenda opatsirana kwambiri, kusowa kwamadzi (ndi kusanza, kutsekula m'mimba), kugwedezeka,
• Kuchepa kwa chiwindi, chiwindi,
• Kuvulala koopsa ndi opaleshoni yayikulu (munthawi yomwe chithandizo cha insulin chimasonyezedwa),
• Lactic acidosis (kuphatikizapo mbiri),
• Papoize ethanol poyizoni, uchidakwa wambiri,
• Kutsatira zakudya zama hypocaloric (zosakwana 1000 kcal patsiku),
• Nthawi yochepera maola 48 asanafike komanso maola 48 atatha maphunziro a radiology kapena radioisotope omwe ali ndi intrate ya oyang'anira othandizira ayodini
• Mimba
• Hypersensitivity mankhwala.

Glucophage iyenera kumwedwa mosamala odwala azaka zopitilira 60, amayi oyamwitsa, komanso odwala omwe akuchita ntchito zolimbitsa thupi (chifukwa cha chiwopsezo chachikulu cha lactic acidosis).

Malangizo ogwiritsira ntchito Glucofage: njira ndi mlingo

Glucophage iyenera kutengedwa pakamwa.

Kwa akulu, mankhwalawa angagwiritsidwe ntchito ngati monotherapy kapena munthawi yomweyo ndi mankhwala ena a pakamwa a hypoglycemic.

Kumayambiriro kwa chithandizo, Glucofage 500 kapena 850 mg nthawi zambiri imayikidwa. Mankhwalawa amatengedwa katatu patsiku ndi chakudya kapena akangomaliza kudya. Kutengera kuchuluka kwa shuga m'magazi, kuwonjezereka kwapang'onopang'ono kwa mlingo kumatheka.

Njira yokonzanso tsiku lililonse la Glucofage nthawi zambiri imakhala 1,500-2,000 mg (pazipita 3,000 mg). Kumwa mankhwalawa katatu patsiku kumachepetsa kuopsa kwa mavuto am'mimba. Komanso, kuwonjezeka kwapang'onopang'ono kwa mlingo kungapangitse kusintha kwa kulekerera kwa m'mimba kwa mankhwalawa.

Odwala omwe amalandila metformin mu Mlingo wa 2000-3000 mg tsiku akhoza kusamutsidwa kupita ku Glucofage pa mlingo wa 1000 mg (pazipita - 3000 mg patsiku, wogawidwa pazigawo zitatu). Mukakonzekera kusinthaku kuti mumwe mankhwala ena a hypoglycemic, muyenera kusiya kumwa ndikuyamba kugwiritsa ntchito Glucofage pamwambapa.

Kuti mukwaniritse bwino shuga wamagazi, metformin ndi insulin zingagwiritsidwe ntchito munthawi yomweyo. Mlingo umodzi woyamba wa Glucofage nthawi zambiri umakhala 500 kapena 850 mg, pafupipafupi makonzedwe amakhala kawiri pa tsiku. Mlingo wa insulin uyenera kusankhidwa potengera kuchuluka kwa shuga m'magazi.

Kwa ana kuyambira zaka 10, Glucofage imatha kutengedwa ngati monotherapy kapena nthawi imodzi ndi insulin. Mlingo woyamba umodzi nthawi zambiri umakhala wa 500 kapena 850 mg, pafupipafupi pakukhazikitsa - 1 nthawi patsiku. Kutengera ndende ya magazi pambuyo masiku 10-15, mlingo umatha kusintha. Mulingo wambiri watsiku ndi tsiku ndi 2000 mg, wogawidwa pamitundu iwiri.

Odwala okalamba ayenera kusankha mtundu wa metformin pang'onopang'ono pomuwonetsa mawonekedwe a impso (serum creatinine ayenera kutsimikizika osachepera 2-4 pachaka.

Glucophage imatengedwa tsiku ndi tsiku, popanda yopuma. Pambuyo pakutha kwa chithandizo, wodwalayo ayenera kudziwitsa dokotala za izi.

Zotsatira zoyipa

• Matumbo: Nthawi zambiri - kusanza, kusanza, kutsegula m'mimba, kusowa chilimbikitso, kupweteka pamimba. Nthawi zambiri, zizindikiro zotere zimayambika nthawi yoyamba ya chithandizo ndipo, monga lamulo, zimangopita zokha. Kupititsa patsogolo kulekerera kwam'mimba, tikulimbikitsidwa kumwa glucophage panthawi kapena mukatha kudya kawiri pa tsiku. Mlingo uyenera kuchuluka pang'onopang'ono,
• Machitidwe amsempha: nthawi zambiri - kulawa chisokonezo,
• Metabolism: kawirikawiri - lactic acidosis, yokhala ndi chithandizo cha nthawi yayitali, mayamwidwe a vitamini B12 amatha kuchepa, omwe amayenera kuganiziridwa makamaka kwa odwala omwe ali ndi vuto la kuchepa kwa magazi m'thupi,
• Chiwindi ndi matenda amisili: kawirikawiri - chiwindi, chiwindi ntchito. Monga lamulo, zoyipa zomwe zimachitika pambuyo pochotsedwa kwa metformin zitatha,
• Khungu ndi minyewa yodukiza: kawirikawiri - kuyabwa, erythema, zotupa.

Zotsatira zoyipa za ana zimafanana muukali ndi chilengedwe kwa iwo omwe ali odwala.

Bongo

Mukamamwa Glucophage muyezo wa 85 g (ichi ndi 42,5 kuchulukitsa tsiku lililonse), odwala ambiri sanasonyeze kuwonetsa kwa hypoglycemia, komabe, odwala adachita lactic acidosis.

Kugwiritsa ntchito kwambiri mankhwala osokoneza bongo kapena kupezeka kwa zinthu zomwe zingayambitse chiopsezo kungayambitse kukula kwa lactic acidosis. Muzochitika za zizindikiro za matendawa, chithandizo cha Glucofage chimayimitsidwa nthawi yomweyo, wodwalayo amayikidwa kuchipatala ndipo chikhazikitso cha lactate m'thupi chatsimikiza kuti amvetsetse. Njira yothandiza kwambiri yothanirana ndi metformin ndi lactate ndi hemodialysis. Syndrome dalili zimasonyezedwanso.

Malangizo apadera

Chifukwa cha kuphatikizika kwa metformin, kusowa kosowa koma koopsa ndikotheka - lactic acidosis (pali kuthekera kwakukulu kwa kufa popanda chithandizo chamankhwala mwadzidzidzi). Nthawi zambiri, matendawa amakula mwa odwala omwe ali ndi matenda osokoneza bongo omwe amalephera kwambiri aimpso. Zina zokhudzana ndi chiopsezo ziyeneranso kulingaliridwa: ketosis, matenda osokoneza bongo a shuga, uchidakwa, kulephera kwa chiwindi, kusala kudya kwakanthawi komanso zochitika zina zokhudzana ndi hypoxia yayikulu.

Kukula kwa lactic acidosis kumatha kuwonetsedwa ndi zizindikiro zosadziwika monga kukokana kwa minofu, limodzi ndi zizindikiro za dyspeptic, ululu wam'mimba komanso asthenia yayikulu. Matendawa amadziwika ndi kufupika kwa acidotic ndi hypothermia yotsatiridwa ndi chikomokere.

Ntchito ya Glucophage iyenera kusokonezedwa maola 48 asanafike pokonzekera opareshoni. Mankhwalawa atha kuyambiridwanso osapitirira maola 48 atachitidwa opaleshoni, malinga ngati ntchito ya impso imadziwika kuti ndi yachilendo pakubwereza.

Musanatenge Glucofage, komanso pafupipafupi mtsogolomo, kutsegula kwa creatinine kuyenera kutsimikiziridwa: odwala omwe ali ndi vuto laimpso - osachepera pachaka, odwala okalamba, komanso kuvomerezedwa kwa creatinine pamunsi yotsika - kawiri pachaka .

Kusamala makamaka kumafunikira kuti pakhale vuto laimpso pakati pa okalamba, komanso kugwiritsa ntchito nthawi imodzi ya Glucofage ndi mankhwala a antihypertensive, okodzetsa kapena mankhwala osapinga a antiidal.

Mukamagwiritsa ntchito Glucophage mu ana, kuzindikira kwa matenda a shuga a 2 kuyenera kutsimikiziridwa musanachitike chithandizo. Metformin siyimakhudzidwa ndi kutha ndi kukula. Komabe, chifukwa cha kuchepa kwa nthawi yayitali, tikulimbikitsidwa kuwunika mosamala zotsatira zam'magazi pazinthu izi mwa ana, makamaka nthawi yakutha. Kuwunikira kosamala kwambiri ndikofunikira kwa ana azaka za 10-12.

Odwala amalangizidwa kuti azitsatira zakudya zomwe azidya tsiku lonse. Ndi onenepa kwambiri, muyenera kupitiriza kutsatira zakudya zama hypocaloric (koma osachepera 1000 kcal patsiku).

Kuti muthane ndi matenda a shuga, ndikulimbikitsidwa kuti kuyezetsa magazi pafupipafupi kuchitike pafupipafupi.

Ndi monotherapy, metformin siyimayambitsa hypoglycemia, koma ikagwiritsidwa ntchito nthawi yomweyo ndi insulin kapena othandizira ena a hypoglycemic (kuphatikizapo sulfonylureas, repaglinide), kusamala kuyenera kugwiritsidwa ntchito poyendetsa magalimoto ndi njira zovuta.

Mimba komanso kuyamwa

Matenda osawerengeka omwe ali ndi shuga panthawi yoyembekezera amawonjezera ngozi ya kubadwa kwa mwana wosabadwa ndi infinatal infa. Umboni woperewera kuchokera ku kafukufuku wazachipatala umatsimikizira kuti kutenga Metformin mwa odwala omwe ali ndi pakati sikungakulitse chiwopsezo chodziwika bwino mwa akhanda.

Mukakonzekera kutenga pakati, komanso ngati mimba imachitika pakumwa mankhwala a Glucofage ngati muli ndi matenda osokoneza bongo a prediabetes, mtundu wa mankhwala uyenera kuthetsedwa. Odwala omwe ali ndi matenda a shuga a 2 amapatsidwa mankhwala a insulin. Madzi a glucose a plasma amayenera kusungidwa pamlingo woyandikira kwambiri kuti achepetse chiopsezo cha kusokonezeka kwa kubereka kwa mwana wosabadwayo.

Metformin imatsimikiziridwa mu mkaka wa m'mawere. Zotsatira zoyipa za akhanda pakubwera pakumwa ma Glucofage sizinawoneke. Komabe, popeza chidziwitso chogwiritsira ntchito mankhwalawa m'gululi pakadali pano sichokwanira, kugwiritsa ntchito metformin panthawi yotsekemera sikulimbikitsidwa. Lingaliro la kusiya kapena kupitiriza kuyamwitsa limapangidwa pambuyo pabwino la kuyamwitsa ndi chiopsezo chotengera zovuta zomwe zimayambira khanda.

Kuyanjana kwa mankhwala osokoneza bongo

Glucophage sangagwiritsidwe ntchito nthawi imodzi ndi ma ayodini okhala ndi ayodini.

Mankhwala osavomerezeka kuti atengedwe pamodzi ndi ethanol (chiwopsezo cha lactic acidosis ndi kuledzera kwa pachimake kumawonjezeka ngati chiwindi chikulephera, kutsata zakudya zopatsa mphamvu ndi kuperewera kwa zakudya m'thupi).

Chenjezo liyenera kutengedwa ndi Glucofage ndi danazole, chlorpromazine, glucocorticosteroids ogwiritsa ntchito apakhungu ndi mwatsatanetsatane, "kuzungulira" okodzetsa, beta2-adrenergic agonists ngati jakisoni. Kugwiritsa ntchito pamodzi ndi mankhwala omwe ali pamwambapa, makamaka kumayambiriro kwa chithandizo, kuwunika pafupipafupi magazi a glucose kungafunike. Ngati ndi kotheka, mlingo wa metformin panthawi ya chithandizo uyenera kusinthidwa.

Angiotensin-converting enzyme inhibitors ndi mankhwala ena a antihypertensive amatha kuchepetsa magazi. Ngati ndi kotheka, kusintha kwa metformin ndikofunikira.

Pogwiritsa ntchito munthawi yomweyo kugwiritsa ntchito glucophage ndi acarbose, zotumphukira za sulfonylurea, salicylates ndi insulin, hypoglycemia imayamba.

Mankhwala a Cationic (digoxin, amiloride, procainamide, morphine, quinidine, triamteren, quinine, ranitidine, vancomycin ndi trimethoprim) kupikisana ndi metformin kwa machitidwe oyendetsa ma tubular, omwe angayambitse kuwonjezereka kwa ndende yake yambiri (Cmax).

Ma Glucophage analogues ndi awa: Bagomet, Glucophage Long, Glycon, Glyminfor, Glformin, Metformin, Langerin, Metadiene, Metospanin, Siofor 1000, Formmetin.

Ndemanga za Glucofage

Ndemanga zambiri za Glucofage zimagwirizana makamaka ndi kagwiritsidwe kake ka thupi. Odwala ena amati njira yochepetsera thupi inavomerezedwa ndi dokotala, chifukwa chakuti kudya kapena kuchita masewera olimbitsa thupi sikunathandize. Komanso, mankhwalawa sagwiritsidwa ntchito pothana ndi kilogalamu yowonjezera, komanso kubwezeretsa ntchito yobereka mwa akazi. Komabe, kutenga metformin pazolinga izi sikothandiza nthawi zonse: kuyesa kotereku kumatha kuyambitsa kukula kwa ma pathologies akulu. Zotsatira zenizeni za kafukufukuyu sizikudziwika. Ndi matenda a shuga, glucophage ndi othandiza ndipo nthawi zambiri amathandizira kuchepetsa thupi.

Mtengo wa glucophage m'masitolo ogulitsa mankhwala

M'mafakitala, mtengo wa Glucofage 500 mg ndi ngati ma ruble a 105-127 (mapiritsi 30 aphatikizidwa ndi phukusi) kapena ma ruble 144-186 (mapiritsi 60 60 aphatikizidwa ndi phukusi). Mutha kugula mankhwala ndi mlingo wa 850 mg wa pafupifupi ma ruble 127-187 (mapiritsi 30 aphatikizidwa ndi phukusi) kapena ma ruble a 190-244 (mapiritsi 60 60 aphatikizidwa ndi phukusi). Mtengo wa Glucofage ndi Mlingo wa 1000 mg ndi pafupifupi ma ruble 172205 (mapiritsi 30 amaphatikizidwa ndi phukusi) kapena ma ruble 273-340 (mapiritsi 60 60 amaphatikizidwa ndi phukusi).

Zotsatira za pharmacological

Glucofage ® imachepetsa hyperglycemia, osatsogolera pakupanga hypoglycemia.Mosiyana ndi zomwe zimachokera ku sulfonylurea, sizimalimbikitsa kutulutsa insulin ndipo sizimatero

Hypoglycemic zotsatira mu wathanzi anthu. Zimawonjezera chidwi cha zotumphukira zolandilira ku insulin ndikugwiritsa ntchito shuga ndi maselo. Imachepetsa kupanga shuga kwa chiwindi poletsa gluconeogeneis ndi glycogenolysis. Kuchepetsa mayamwidwe m'matumbo.

Metformin imathandizira kapangidwe ka glycogen pochita glycogen synthase. Kuchulukitsa kuchuluka kwa mayendedwe amtundu uliwonse wa ma membrane glucose.

Kuphatikiza apo, imakhala ndi phindu pa metabolidi ya lipid: imachepetsa zomwe zimakhala ndi cholesterol yonse, lipoproteins yotsika komanso triglycerides.

Ngakhale mutamwa metformin, thupi la wodwalayo limakhalabe lolimba kapena limatsika pang'ono.

Zithunzi za 3D

Kufotokozera za mtundu wa kipimo

500 ndi 850 mg mapiritsi: yoyera, yozungulira, ya biconvex, yokhala ndi mafilimu, pamtanda - yopanda choyera.

Mapiritsi a 1000 mg: yoyera, chowulungika, biconvex, yokutidwa ndi chithunzi cha filimu, yopanga notch mbali zonse ziwiri ndikujambula "1000" mbali imodzi, pamtanda wamtanda - misa yoyera yayikulu.

Zisonyezero za mankhwala Glucofage ®

lembani matenda a shuga 2, makamaka odwala kunenepa kwambiri, komanso kulephera kwamankhwala olimbitsa thupi komanso kuchita masewera olimbitsa thupi:

- akuluakulu, monga monotherapy kapena kuphatikiza ena othandizira pakamwa kapena ma insulin,

- mwa ana kuyambira zaka 10 monga monotherapy kapena kuphatikiza insulin,

kupewa matenda a shuga a mtundu wachiwiri kwa odwala omwe ali ndi prediabetes omwe ali ndi chiopsezo chowonjezereka cha mtundu 2 wa shuga, momwe kusintha kwasinthidwe sikunalole kuti chiwonetsero chokwanira cha glycemic chikwaniritsidwe.

Mimba komanso kuyamwa

Matenda a shuga omwe sanakulipiridwe panthawi ya kubereka amalumikizidwa ndi chiwopsezo chowonjezeka cha zilema zakubadwa ndi kufa kwa perinatal. Zambiri zomwe zikusonyeza kuti kutenga metformin mwa amayi apakati sikuti kumawonjezera mwayi wokhala ndi vuto la kubala mwa ana.

Pokonzekera kutenga pakati, komanso ngati mayi ali ndi pakati pam'mbuyo pa kutenga matenda a metformin omwe ali ndi prediabetes ndi mtundu wachiwiri wa shuga, mankhwalawo ayenera kusiyidwa, ngati vuto la matenda ashuga a mtundu wa 2, limaperekedwa. Ndikofunikira kusungitsa glucose omwe ali m'madzi am'magazi pamlingo woyandikira kwambiri kuti achepetse vuto la fetus.

Metformin imadutsa mkaka wa m'mawere. Zotsatira zoyipa za akhanda pa nthawi yoyamwitsa pamene mukumwa metformin sizinawoneke. Komabe, chifukwa cha kuchuluka kwa deta, kugwiritsa ntchito mankhwalawa panthawi yoyamwitsa sikulimbikitsidwa. Lingaliro loletsa kuyamwitsa liyenera kuganiziridwanso zabwino za kuyamwitsa ndi chiopsezo cha zotsatira zoyipa mwa khanda.

Kuchita

Iodini wokhala ndi radiopaque wothandizira: motsutsana ndi kaimidwe ka ntchito yaimpso kwa odwala omwe ali ndi matenda ashuga, kuwunika kwa X-ray pogwiritsa ntchito ma ayodini okhala ndi ayodini kungayambitse kukula kwa lactic acidosis. Kuchiza ndi Glucofage ® kuyenera kuyimitsidwa maola 48 isanachitike kapena pakuwunika kwa X-ray pogwiritsa ntchito ma iodine okhala ndi ma radiopaque othandizira ndipo sayenera kuyambiranso patadutsa maola 48 atatha, ngati ntchito ya impso idadziwika ngati yovomerezeka pakubwereza.

Mowa: ndi kuledzera kwa pachimake, chiopsezo chokhala ndi lactic acidosis imachulukirachulukira, makamaka vuto la kuperewera kwa zakudya m'thupi, kutsatira zakudya zochepa za calorie, komanso kulephera kwa chiwindi. Mukamwa mankhwalawa, mowa ndi mankhwala okhala ndi Mowa zimayenera kupewedwa.

Kuphatikiza komwe kumafunikira kusamala

Danazole: munthawi yomweyo makonzedwe a danazol ali osavomerezeka kuti apewe hyperglycemic zotsatira zomaliza. Ngati mankhwala a danazol akufunika ndipo atayimitsa koyamba, kusintha kwa mankhwala Glucofage ® kumafunika mothandizidwa ndi magazi.

Chlorpromazine: Pamene kumwedwa mu waukulu Mlingo (100 mg / tsiku) kumawonjezera kuchuluka kwa shuga m'magazi, kuchepetsa kutulutsidwa kwa insulin. Mankhwalawa antipsychotic ndipo atayimitsa chomaliza, kusintha kwa mankhwalawa kumafunikira motsogozedwa ndimagazi a shuga.

GKS mwatsatanetsatane komanso kwawoko kuchepetsa kulolera kwa shuga, kuwonjezera kuchuluka kwa shuga m'magazi, nthawi zina kumapangitsa ketosis. Mankhwalawa corticosteroids ndipo atayimitsa kudya kwotsirizira, kusintha kwa mankhwala Glucofage ® motsogozedwa ndi magazi a shuga pamafunika.

Zotsatira: munthawi yomweyo kugwiritsa ntchito malupu okodzetsa kungayambitse kukulitsa kwa lactic acidosis chifukwa chotheka kugwira ntchito kwaimpso. Glucofage ® sayenera kulembedwa ngati Cl creatinine ali pansi pa 60 ml / min.

Yovuta β₂-adrenomimetics: kuonjezera kuchuluka kwa shuga m'magazi chifukwa cha kukondoweza kwa β₂-makampani. Poterepa, ndikofunikira kuwongolera kuchuluka kwa shuga m'magazi. Ngati ndi kotheka, insulin ikulimbikitsidwa.

Ndi kugwiritsa ntchito mankhwala omwe ali pamwambawa, kuwunika pafupipafupi magazi a shuga kungafunike, makamaka kumayambiriro kwa chithandizo. Ngati ndi kotheka, mlingo wa metformin ungasinthidwe munthawi yamankhwala ndikatha.

Mankhwala a antihypertensive, kupatula AID zoletsa, kumachepetsa shuga. Ngati ndi kotheka, mlingo wa metformin uyenera kusinthidwa.

Ndi munthawi yomweyo kugwiritsa ntchito mankhwala Glucofage ® ndi sulfonylurea zotumphukira, insulin, acarbose, salicylates, kukula kwa hypoglycemia ndikotheka.

Nifedipine kumawonjezera mayamwidwe ndi C_max metformin.

Mankhwala a Cationic (amiloride, digoxin, morphine, procainamide, quinidine, quinine, ranitidine, triamteren, trimethoprim ndi vancomycin) omwe amatulutsidwa mu renal tubules kupikisana ndi metformin kwa machitidwe oyendetsa ma tubular ndipo angayambitse kuchuluka kwa C_max .

Mlingo ndi makonzedwe

Monotherapy ndi kuphatikiza mankhwalawa kuphatikiza othandizira ena am'mlomo a hypoglycemic othandizira a 2 matenda a shuga. Mulingo woyambira woyamba ndi 500 kapena 850 mg katatu patsiku mukatha kudya.

Pakadutsa masiku 10 mpaka 10, tikulimbikitsidwa kusintha mlingo woyambira pazotsatira za kuyeza kuchuluka kwa shuga m'magazi am'magazi. Kukula pang'onopang'ono kwa mankhwalawa kumathandizira kuchepetsa zoyipa kuchokera m'mimba.

Mankhwala okonza mankhwalawa nthawi zambiri amakhala 1500-2000 mg / tsiku. Kuti muchepetse mavuto kuchokera m'matumbo am'mimba, mlingo wa tsiku ndi tsiku uyenera kugawidwa mu Mlingo wa 2-3. Mlingo wapamwamba kwambiri ndi 3000 mg / tsiku, wogawidwa mu 3 waukulu.

Odwala omwe atenga metformin mu Mlingo wa 2000-3000 mg / tsiku amatha kusamutsidwa ku mankhwala Glucofage ® 1000 mg. Mlingo woyenera kwambiri ndi 3000 mg / tsiku, womwe umagawidwa pazigawo zitatu.

Pankhani yakukonzekera kusintha kwa kutenga wothandizila wina wa hypoglycemic: muyenera kusiya kumwa mankhwalawa ndikuyamba kumwa Glucofage ® mu mlingo womwe ukunenedwa pamwambapa.

Kuphatikiza ndi insulin. Kukwaniritsa bwino shuga wamagazi, metformin ndi insulin mwa odwala omwe ali ndi matenda a shuga a 2 angagwiritsidwe ntchito ngati mankhwala osakanikirana. Mlingo woyamba wa Glucofage ® ndi 500 kapena 850 mg kawiri pa tsiku, pomwe mlingo wa insulin umasankhidwa potengera kuchuluka kwa shuga m'magazi.

Monotherapy ya prediabetes. Mlingo wamba ndi 1000-1700 mg / patatha masiku kapena nthawi ya chakudya, yogawika awiri.

Ndikulimbikitsidwa kumayendetsa glycemic pafupipafupi kuti muwone kufunika kogwiritsira ntchito mankhwalawa.

Kulephera kwina. Metformin itha kugwiritsidwa ntchito kwa odwala omwe amalephera kupweteka aimpso (Cl creatinine 45-59 ml / min) pokhapokha ngati pali zinthu zomwe zingakulitse chiopsezo cha lactic acidosis.

Odwala a Cl creatinine 45-55 ml / mphindi. Mlingo woyambirira ndi 500 kapena 850 mg kamodzi patsiku. Mlingo wapamwamba ndi 1000 mg / tsiku, logawidwa mu 2 waukulu.

Ntchito yeniyeni iyenera kuyang'aniridwa mosamala (miyezi itatu iliyonse).

Ngati Cl creatinine ali pansi pa 45 ml / min, mankhwalawa amayenera kuyimitsidwa nthawi yomweyo.

Ukalamba. Chifukwa cha kuchepa kwa ntchito yaimpso, mlingo wa metformin uyenera kusankhidwa poyang'anitsitsa mawonetseredwe aimpso (kudziwa kuchuluka kwa creatinine mu seramu osachepera 2-5 pachaka).

Ana ndi achinyamata

Mwa ana kuyambira zaka 10, Glucofage ® ikhoza kugwiritsidwa ntchito limodzi mu monotherapy komanso kuphatikizidwa ndi insulin. Mulingo woyambira woyamba ndi 500 kapena 850 mg 1 nthawi patsiku mutatha kudya kapena. Pambuyo masiku 10-15, mlingo uyenera kusinthidwa potengera kuchuluka kwa magazi. Mulingo wambiri watsiku ndi tsiku ndi 2000 mg, wogawidwa pamitundu iwiri.

Glucofage ® iyenera kumwedwa tsiku lililonse, osasokoneza. Ngati chithandizo chalekeka, wodwalayo ayenera kudziwitsa dokotala.

Wopanga

Magawo onse opanga, kuphatikiza kuwongolera bwino. Merck Sante SAAS, France.

Production siteji ya Production: Center de Prodion Semois, 2, rue du Pressoir Ver, 45400, Semois, France.

Kapena ngati mutayika mankhwala a LLC Nanolek:

Kupanga kwa fomu yomalizira ya Mlingo ndi ma CD (ma CD oyambira) Merck Santé SAAS, France. Center de Production Semois, 2 rue du Pressoire Ver, 45400 Semois, France.

Sekondale (ma CD a ogula) ndikupereka kuwongolera kwapamwamba: Nanolek LLC, Russia.

612079, dera la Kirov, chigawo cha Orichevsky, Levintsy tawuni, Biomedical zovuta "NANOLEK"

Magawo onse opanga, kuphatikiza kuwongolera bwino. Merck S.L., Spain.

Adilesi ya malo opanga: Polygon Merck, 08100 Mollet Del Valles, Barcelona, ​​Spain.

Wogwirizira satifiketi yakulembetsa: Merck Santé SAAS, France.

Zogwirizana ndi makasitomala ndi zidziwitso pazinthu zovuta ziyenera kutumizidwa ku adilesi ya LLC Merk: 115054, Moscow, ul. Zokwanira, 35.

Tele: (495) 937-33-04, (495) 937-33-05.

Alumali moyo wa mankhwala Glucofage ®

500 mg mapiritsi okhala ndi mafilimu - zaka 5.

500 mg mapiritsi okhala ndi mafilimu - zaka 5.

mapiritsi wokutidwa ndi filimu wokutira wa 850 mg - zaka 5.

mapiritsi wokutidwa ndi filimu wokutira wa 850 mg - zaka 5.

filimu TACHIMATA mapiritsi 1000 mg - zaka 3.

filimu TACHIMATA mapiritsi 1000 mg - zaka 3.

Osagwiritsa ntchito tsiku lotha ntchito likusonyezedwa pa phukusi.

Glucophage zikuchokera

Chithandizo chogwira: metformin hydrochloride, piritsi 1 yokhala ndi 500 mg ili ndi 500 mg metformin hydrochloride, yomwe imafanana ndi 390 mg metformin, piritsi 1 yokutidwa 850 mg ili ndi 850 mg metformin hydrochloride, yolingana ndi 662.90 mg metformin, piritsi 1 yokutidwa 1000 mg chipolopolo chili ndi 1000 mg ya metformin hydrochloride, yomwe imafanana ndi 780 mg ya metformin.

Othandizira: K 30, magnesium stearate, filimu yophimba mapiritsi a 500 mg, 850 mg ya hypromellose, makanema ojambulira mapiritsi a 1000 mg opadra KLIA (hypromellose, macrogol 400, macrogol 8000).

Fomu lamasulidwe a Glucofage

Mapiritsi okhala ndi mafilimu.

Zofunikira za physico-mankhwala: mapiritsi 500 okhala ndi matendawa, mapiritsi a 850 mg ozungulira okhala ndi biconvex, mapiritsi okhala ndi filimu yoyera, mapiritsi okhala ndi filimu, mapiritsi apakati wozungulira a 1000 mg ndi bevel, mapiritsi okhala ndi utoto wofiirira , yokhala ndi notch mbali zonse ziwiri ndi chithunzi cha "1000" mbali imodzi.

Gulu la mankhwala

Oral hypoglycemic wothandizira, kupatula insulin. Biguanides. Code ATX A10V A02.

Glucophage pharmacology

Metformin ndi biguanide yokhala ndi antihyperglycemic effect. Glucophage, limagwirira ntchito yomwe ndikupanga kusintha kwa shuga, imachepetsa kuchuluka kwa shuga m'mimba yopanda kanthu ndikatha kudya. Samalimbikitsa insulin katemera ndipo samayambitsa hypoglycemic effect yolumikizidwa ndi njirayi.

Metformin imagwira ntchito m'njira zitatu:

1. kumabweretsa kuchepa kwa kupanga kwa shuga m'chiwindi chifukwa cha kuletsa kwa gluconeogenesis ndi glycogenolysis,
2. imapangitsa chidwi cha insulin m'misempha, yomwe imapangitsa kuti pakhale kutuluka kowonjezereka komanso kugwiritsa ntchito shuga,
3. Iachedwetsa mayamwidwe am'matumbo m'matumbo.

Metformin imathandizira kapangidwe ka glycogen mu intracellular mwa kuchita glycogen synthetases. Kuchulukitsa kuchuluka kwa mayendedwe a mitundu yonse yodziwika ya ma membrane glucose transport (GLUT).

Mosasamala kanthu za momwe zimakhudzira kuchuluka kwa shuga m'magazi, metformin imathandizira kagayidwe ka lipid. Zotsatira izi zatsimikiziridwa ndi Mlingo wothandizila pakuwongolera kwapakati kapena kwa nthawi yayitali: metformin lowers whole cholesterol, lowensens lipoproteins and triglycerides.

Panthawi ya mayesero azachipatala pogwiritsa ntchito metformin, kulemera kwamthupi la wodwalayo kunakhazikika kapena kumachepetsa.

Zogulitsa. Mutatha kutenga metformin, nthawi yoti mufikire pazambiri (Tmax) ili pafupifupi maola 2,5. The bioavailability ya mapiritsi a 500 mg kapena 800 mg ndi pafupifupi 50-60% mwa odzipereka athanzi. Pambuyo pakulowetsa, kachigawo kamene sikametsedwa kamakumba ndowe ndikufika 20-30%.

Pambuyo pakukonzekera pakamwa, kuyamwa kwa metformin kumakhala kokhazikika komanso kosakwanira.

Ma pharmacokinetics a mayamwidwe a metformin amawerengedwa kuti ndi osagwirizana. Mukamagwiritsidwa ntchito pazovomerezeka za metformin, kukhazikika kwa plasma kumachitika mkati mwa maola 24-48 ndipo ndi ochepera 1 μg / ml. M'mayeso azachipatala omwe amawongolera, kuchuluka kwa plasma metformin (Cmax) sikunapitirire 5 μg / ml ngakhale ndi waukulu.

Ndi chakudya chofananacho, kuyamwa kwa metformin kumachepa ndikuchepera.

Pambuyo pakulowa kwa mlingo wa 850 mg, kuchepa kwa ndende yambiri ya plasma ndi 40%, kuchepa kwa AUC ndi 25%, ndi kuwonjezereka kwa mphindi 35 panthawi yoti anthu afike pozindikira kwambiri plasma. Kukula kwamankhwala kwakusintha kumeneku sikudziwika.

Kugawa. Kumanga kwa mapuloteni a Plasma ndikosatheka. Metformin imalowa m'magazi ofiira. Kuchuluka kwambiri m'magazi kumakhala kocheperako poyerekeza ndi kuchuluka kwa magazi a m'magazi, ndipo kumachitika pambuyo pake. Maselo ofiira nthawi zambiri amayimira chipinda chogawirako chachiwiri. Voliyumu yapakati yogawa (Vd) imachokera ku malita 63-276.

Kupenda. Metformin imachotsedwa mu mkodzo osasinthika. Palibe ma metabolites omwe amapezeka mwa anthu.

Kuswana. Kuvomerezeka kwa aimpso kwa metformin ndi> 400 ml / min. Izi zikuwonetsa kuti metformin imachotsedwanso ndi kusefera kwamadzi ndi kubisalira kwa tubular. Pambuyo makonzedwe, kuchotsa theka moyo ndi pafupifupi 6.5 maola. Mu vuto la impso, kutsekeka kwa impso kumatsika molingana ndi kupezeka kwa creatinine chilolezo, motero kuthetsa theka la moyo kumawonjezeka, komwe kumabweretsa kuwonjezeka kwa plasma metformin.

Glucophage amakhala ndi matenda

Type 2 shuga mellitus ndi kulephera kwa zakudya mankhwala ndi zolimbitsa thupi, makamaka odwala onenepa kwambiri:

• monga monotherapy kapena kuphatikiza mankhwalawa molumikizana ndi ena othandizira pakamwa a hypoglycemic kapena kuphatikiza ndi insulini pochiza akuluakulu,
• monga monotherapy kapena kuphatikiza mankhwala omwe ali ndi insulin pochizira ana azaka za 10 ndi achinyamata.

Kuchepetsa zovuta za matenda ashuga okalamba omwe ali ndi matenda a shuga a 2 komanso onenepa kwambiri ngati mankhwala oyambira mzere woyamba wokhala ndi mankhwala osachita bwino.

Mlingo

500 mg, mapiritsi a 850 mg ndi mapiritsi a 1000 mg

Piritsi limodzi lili

yogwira mankhwala ndi metformin hydrochloride 500 mg, 850 mg kapena 1000 mg,

zokopa: povidone, magnesium stearate,

kapangidwe ka makanema ojambulira ndi hydroxypropyl methylcellulose; mapiritsi a 1000 mg, oyera opadra YS-1-7472 (hydroxypropyl methylcellulose, macrogol 400, macrogol 8000).

Glucophage 500 mg ndi 850 mg: kuzungulira, mapiritsi a biconvex, oyera-okhala ndi filimu

GlucofageÒ 1000 mg: chowonjezera, mapiritsi a biconvex, wokutidwa ndi filimu yoyera, wokhala pachiwopsezo chosweka mbali zonse ziwiri ndikulemba "1000" mbali imodzi ya piritsi

Mankhwala

Pambuyo pakukonzekera kwa pakamwa kwa mapiritsi a metformin, kuchuluka kwakukulu kwa plasma (Cmax) kumachitika pambuyo pa maola pafupifupi 2,5 (Tmax). Mtheradi wa bioavailability mwa anthu athanzi ndi 50-60%. Pambuyo pakukonzekera pakamwa, 20-30% ya metformin imatulutsidwa kudzera m'mimba m'mimba (GIT) yosasinthika.

Mukamagwiritsa ntchito metformin muyezo komanso ulamuliridwe, makonzedwe a plasma okhazikika amakwaniritsidwa mkati mwa maola 24-48 ndipo nthawi zambiri amakhala osakwana 1 μg / ml.

Mlingo womangidwa wa metformin kupita ku mapuloteni a plasma suwoneka. Metformin imagawidwa m'magazi ofiira. Mulingo wambiri m'magazi ndi wotsika kuposa plasma ndipo umafikiridwa pafupifupi nthawi yomweyo. Pafupifupi voliyumu yogawa (Vd) ndi malita 63-276.

Metformin imachotsedwa mu mkodzo osasinthika. Palibe metformin metabolites omwe adadziwika mwa anthu.

Kuyambiranso kwa aimpso kwa metformin ndi kopitilira 400 ml / min, komwe kumawonetsa kuchotsedwa kwa metformin pogwiritsa ntchito kusefedwa kwa glomerular ndi secretion ya tubular. Pambuyo pakamwa, theka la moyo ndi pafupifupi 6.5 maola.

Mu vuto la impso, kutsekeka kwa impso kumachepa mogwirizana ndi kupezeka kwa creatinine chilolezo, motero, kuthetseratu theka la moyo kumawonjezereka, komwe kumabweretsa kuwonjezeka kwa plasma metformin.

Metformin ndi biguanide yokhala ndi antihyperglycemic effect, yomwe imachepetsa onse shuga ndi postprandial plasma glucose. Simalimbikitsa insulin katemera chifukwa chake siyambitsa hypoglycemia.

Metformin ili ndi njira zitatu:

(1) amachepetsa kupanga shuga wa chiwindi poletsa gluconeogeneis ndi glycogenolysis,

(2) Amawonjezera kukhudzika ndikugwiritsika ntchito kwa zotumphukira m'mitsempha ndikuwonjezera chidwi cha insulini,

(3) Kuchedwa kuyamwa kwamatumbo.

Metformin imalimbikitsa kapangidwe ka intracellular glycogen pochita glycogen synthase. Zimathandizanso kuthekera kwamitundu yonse ya ma membrane glucose transport (GLUT).

M'maphunziro azachipatala, kutenga metformin sikunakhudze thupi kapena kunachepetsa pang'ono.

Mosasamala kanthu za momwe zimakhudzira glycemia, metformin imathandizira kagayidwe ka lipid. Panthawi yoyesedwa pazachipatala pogwiritsa ntchito Mlingo wothandizira, zimapezeka kuti metformin imatsitsa cholesterol yonse, lipoproteins yotsika komanso triglycerides.

Zochita zamankhwala

Mowa: chiopsezo chokhala ndi lactic acidosis imatheka chifukwa cha kuledzera kwa pachimake, makamaka ngati atafa ndi vuto la kusowa m'thupi kapena kuperewera kwa zakudya m'thupi ndi vuto la chiwindi. Pa chithandizo ndi Glucofage®, mowa ndi mankhwala omwe ali ndi mowa uyenera kupewedwa.

Mitundu yokhala ndi Iodine:

Mothandizidwa ndi iodine okhala ndi ayodini omwe ali ndi vuto losiyanitsa amatha kuyambitsa impso. Izi zimatha kudzetsa chidwi cha metformin ndikupangitsa lactic acidosis.

Odwala omwe ali ndi eFFR> 60 ml / mphindi / 1.73 m2, kugwiritsa ntchito metformin kuyenera kusiyidwa isanayambike kapena kumaphunziriridwa pogwiritsa ntchito mankhwala okhala ndi ayodini, musayambirenso kupitilira maola 48 mutatha kafukufukuyu, komanso pokhapokha mutayang'ananso ntchito ya impso, yomwe idawonetsa zotsatira zabwinobwino, malinga ngati sizingawononge pambuyo pake.

Odwala omwe ali ndi vuto laimpso zolimbitsa thupi (eGFR 45-60 ml / mphindi / 1.73 m2), metformin iyenera kuchotsedwa maola 48 asanagwiritse ntchito mankhwala okhala ndi ayodini ndipo asayambirenso kupitirira maola 48 mutatha kafukufukuyu kuwunika kwa impso, komwe kunawonetsa zotsatira zabwinobwino komanso kuwonetsa kuti sizingavutike pambuyo pake.

Kuphatikiza komwe kumafunikira kusamala

Mankhwala omwe ali ndi vuto la hyperglycemic (glucocorticoids (yachilengedwe komanso yachilengedwe) ndi a audiotomimetics): kutsimikiza kwa pafupipafupi kwa shuga wamagazi kungafunike, makamaka kumayambiriro kwa chithandizo. Ngati ndi kotheka, Mlingo wa metformin wokhala ndi mankhwala oyenera uyenera kusintha mpaka womaliza utatha.

Ma diuretics, makamaka ozungulira okodzetsa, amatha kukulitsa chiopsezo cha lactic acidosis chifukwa chakuwonongeka kwawo pa vuto la impso.

Tulutsani mawonekedwe ndi ma CD

Mapiritsi okhala ndi mafilimu, 500 mg ndi 850 mg:

Mapiritsi 20 aikidwa mu zotumphukira zotulutsa za filimu ya polyvinyl chloride ndi zojambulazo za aluminium.

Ma paketi atatu ophatikizidwa pamodzi ndi malangizo ogwiritsira ntchito zachipatala m'boma ndipo zilankhulo zaku Russia zimayikidwa mu katoni

Mapiritsi okhala ndi mafilimu, 1000 mg:

Mapiritsi 15 aikidwa mu zotumphukira zotulutsa za filimu ya polyvinyl chloride ndi zojambulazo za aluminium.

4 mapaketi a contour palimodzi ndi malangizo ogwiritsira ntchito zachipatala m'boma ndipo zilankhulo zaku Russia zimayikidwa pabokosi

Mimba komanso kuyamwa

Matenda a shuga omwe sanakulipiridwe panthawi ya kubereka amalumikizidwa ndi chiwopsezo chowonjezeka cha zilema zakubadwa ndi kufa kwa perinatal. Zambiri zomwe zikusonyeza kuti kutenga metformin mwa amayi apakati sikuti kumawonjezera mwayi wokhala ndi vuto la kubala mwa ana.

Pokonzekera kutenga pakati, komanso pathupi mukatenga Metformin, mankhwalawa ayenera kutha, ndipo mankhwala a insulin ayenera kuikidwa. Ndikofunikira kusungitsa glucose omwe ali m'madzi am'magazi pamlingo woyandikira kwambiri kuti achepetse vuto la fetus.

Metformin amachotseredwa mkaka wa m'mawere. Zotsatira zoyipa za akhanda pa nthawi yoyamwitsa pamene mukumwa metformin sizinawoneke. Komabe, chifukwa cha kuchuluka kwa deta, kugwiritsidwa ntchito kwa mankhwalawa panthawi yoyamwa sikulimbikitsidwa. Lingaliro loletsa kuyamwitsa liyenera kuchitika poganizira zabwino za kuyamwitsa ndi chiopsezo chomwe chingakhalepo

mavuto mu mwana.

Zolemba zogwiritsira ntchito

Zokhudza mphamvu pakutha kuyendetsa magalimoto ndimakina

Monotherapy yokhala ndi Glucofage® siyimayambitsa hypoglycemia, chifukwa chake, sizikhudza kuthekera koyendetsa magalimoto ndi machitidwe.

Komabe, odwala ayenera kuchenjezedwa za chiopsezo cha hypoglycemia mukamagwiritsa ntchito metformin limodzi ndi mankhwala ena a hypoglycemic (zotumphukira za sulfonylurea, insulin, repaglinide, etc.).