Galvus - malangizo, ntchito, ndemanga, analogs ndi mitundu ya mapiritsi 50 mg, 50, 50 850, 50 1000 Met wa mankhwala ochizira matenda a shuga 2 akuluakulu, ana ndi mimba

Munkhaniyi, mutha kuwerengera malangizo ogwiritsira ntchito mankhwalawa Galvus. Amapereka ndemanga kuchokera kwa alendo omwe amabwera patsamba lino - ogula mankhwalawa, komanso malingaliro a akatswiri azachipatala pakugwiritsa ntchito Galvus machitidwe awo. Chopempha chachikulu ndikuti muwonjezere ndemanga zanu za mankhwalawa: mankhwalawo adathandizira kapena sanathandizire kuchotsa matendawa, ndizovuta ziti zomwe zimawoneka ndi zotsatirapo zake, zomwe mwina sizinalengezedwe ndi wopanga. Galvus analogues kupezeka komwe kumaoneka ma analogues. Gwiritsani ntchito mankhwalawa mtundu wa shuga wachiwiri mwa akulu, ana, komanso panthawi yoyembekezera. The zikuchokera mankhwala.

Galvus - Hypoglycemic mankhwala. Vildagliptin (zomwe zimagwiritsidwa ntchito ndi mankhwala a Galvus) ndi woimira gulu lazomwe zimapangitsa kuti pakhale pancreas, mwaulesi amalepheretsa dipeptidyl peptidase-4 (DPP-4). Kuletsa mwachangu komanso kwathunthu kwa zochitika za DPP-4 (zopitilira 90%) kumayambitsa kuwonjezeka kwa kubisala komanso kusungunuka kwa chakudya kwa mtundu wa 1 glucagon-peptide (GLP-1) ndi glucose wodalira insulinotropic polypeptide (HIP) kuchokera kumatumbo kulowa kutsekemera kwatsiku lonse.

Kuchulukitsa kuzungulira kwa GLP-1 ndi HIP, vildagliptin kumapangitsa kuwonjezeka kwa maselo a pancreatic beta ku glucose, zomwe zimabweretsa kusintha kwa secretion wa glucose-based insulin.

Mukamagwiritsa ntchito vildagliptin pa mlingo wa 50-100 mg wa patsiku kwa odwala omwe ali ndi matenda a shuga 2, kusintha kwa ntchito ya kapamba kumadziwika. Kukula kwa magwiridwe antchito a maselo a beta kumadalira kuchuluka kwa kuwonongeka kwawo koyamba, choncho mwa anthu omwe alibe matenda a shuga mellitus (omwe ali ndi shuga wa m'magazi), vildagliptin simalimbikitsa kutulutsa kwa insulin komanso sikuchepetsa shuga.

Mwakulitsa kuchuluka kwa mawonekedwe amkati mwa GLP-1, vildagliptin kumawonjezera chidwi cha maselo a α-glucose, zomwe zimapangitsa kuti pakhale kusintha kwamalamulo a shuga a glucagon. Kutsika kwa glucagon ochulukirapo panthawi ya chakudya, kumayambitsa kuchepa kwa insulin.

Kuwonjezeka kwa kuchuluka kwa insulin / glucagon poyang'ana kumbuyo kwa hyperglycemia, chifukwa cha kuchuluka kwa kuchuluka kwa GLP-1 ndi HIP, kumayambitsa kuchepa kwa kupanga kwa chiwindi ndi chiwindi chonse munthawi ya chakudya ndikatha kudya, zomwe zimayambitsa kuchepa kwa kuchuluka kwa shuga m'magazi am'magazi.

Kuphatikiza apo, motsutsana ndi kagwiritsidwe ntchito ka vildagliptin, kuchepa kwa milomo ya lipids m'magazi amwazi kumadziwika, komabe, izi sizikugwirizana ndi zotsatira zake ku GLP-1 kapena HIP komanso kusintha kwa magwiridwe antchito a maselo a pancreatic beta.

Amadziwika kuti kuwonjezeka kwa GLP-1 kumatha kuchepetsa m'mimba, koma izi sizikuwoneka ndi kugwiritsa ntchito vildagliptin.

Galvus Met ndi mankhwala ophatikizidwa pakamwa a hypoglycemic. Kapangidwe ka Gal Gal Met kamakhala ndi othandizira awiri a hypoglycemic omwe ali ndi njira zosiyanasiyana zochitira: vildagliptin, omwe ali mgulu la dipeptidyl peptidase-4 zoletsa, ndi metformin (mu mawonekedwe a hydrochloride), woimira kalasi yayikulu. Kuphatikizidwa kwa zinthuzi kumakupatsani mwayi wowongolera shuga m'magazi mwa odwala omwe ali ndi matenda a shuga a 2 pasanathe maola 24.

Kupanga

Vildagliptin + Excipients (Galvus).

Vildagliptin + Metformin hydrochloride + Excipients (Galvus Met).

Pharmacokinetics

Akamamwa pamimba yopanda kanthu, vildagliptin imatengedwa mwachangu. Ndi kulowetsedwa munthawi yomweyo ndi chakudya, kuchuluka kwa mayamwidwe a vildagliptin kumachepa pang'ono, komabe, kudya kwa zakudya sikukhudza kuchuluka kwa mayamwidwe ndi AUC. Mankhwalawa amagawidwa chimodzimodzi pakati pa plasma ndi maselo ofiira amwazi. Biotransfform ndiye njira yayikulu yodziwitsira ya vildagliptin. Mu thupi la munthu, 69% ya mlingo wa mankhwalawo amasandulika. Pambuyo pakulowetsa mankhwalawa, pafupifupi 85% ya mankhwalawa imachotsedwa impso ndi 15% kudzera m'matumbo, impso ya vildagliptin yosasinthika ndi 23%.

Gender, index misa, ndi mafuko sizikhudzanso pharmacokinetics ya vildagliptin.

Zomwe zimachitika mu pharmacokinetic za vildagliptin mwa ana ndi achinyamata ochepera zaka 18 sizinakhazikitsidwe.

Potengera zakudya, kuchuluka ndi mayamwidwe a metformin kumachepetsedwa. Mankhwalawa sakumanga ma protein a plasma, pomwe ena amachokera ku sulfonylurea. Metformin imalowa m'magazi ofiira (mwina kulimbitsa njirayi kwakanthawi). Ndi dongosolo limodzi lokhazikika kwa odzipereka athanzi, metformin imachotsedwanso ndi impso sizisintha. Sizimaphatikizidwa m'chiwindi (palibe ma metabolites omwe apezeka mwa anthu) ndipo samatulutsidwa mu ndulu. Mukamamwa, pafupifupi 90% ya mlingo woyamwa umapukusidwa kudzera mu impso mkati mwa maola 24 oyambirira.

Gender ya odwala sichikhudza pharmacokinetics ya metformin.

Mankhwala a metformin a ana ndi achinyamata ochepera zaka 18 sanakhazikitsidwe.

Zotsatira za chakudya pa pharmacokinetics za vildagliptin ndi metformin popanga mankhwala a Galvus Met sizinasiyane ndi zomwe pomwa mankhwalawa onse.

Zizindikiro

Type 2 matenda a shuga:

monga monotherapy kuphatikizapo mankhwala othandizira ndi masewera olimbitsa thupi,
Odwala omwe amalandila kale mankhwala ophatikizira ndi vildagliptin ndi metformin ngati mankhwala amodzi (a Galvus Met),
kuphatikiza ndi metformin ngati mankhwala oyamba ndimankhwala osakwanira othandizira kudya komanso kuchita masewera olimbitsa thupi,
monga gawo limodzi la magawo awiri ophatikizira mankhwala a metformin, zotumphukira za sulfonylurea, thiazolidinedione kapena insulini popewa kugwiritsa ntchito mankhwala osokoneza bongo, kuchita masewera olimbitsa thupi komanso monotherapy ndi mankhwalawa.
Monga mbali ya mankhwala ophatikiza patatu: kuphatikiza ndi mankhwala a sulfonylurea ndi metformin odwala omwe kale amathandizidwa ndi zotumphukira za sulfonylurea ndi metformin motsutsana ndi maziko azakudya ndi masewera olimbitsa thupi komanso omwe sanakwanitse kuwongolera glycemic yoyenera,
Monga mbali ya mankhwala ophatikiza patatu: kuphatikiza insulin ndi metformin mwa odwala omwe kale adalandira insulin ndi metformin pazakudya ndi masewera olimbitsa thupi omwe sanakwanitse kuyendetsa bwino glycemic.

Kutulutsa Mafomu

Mapiritsi 50 mg (Galvus).

Mapiritsi okhala ndi 50 + 500 mg, 50 + 850 mg, 50 + 1000 mg (Galvus Met).

Malangizo ogwiritsira ntchito ndi mtundu wa mankhwala

Galvus amatengedwa pakamwa, ngakhale atakhala chakudya chotani.

Mlingo wa mankhwalawa wa mankhwalawa uyenera kusankhidwa payekha kutengera momwe umagwirira ntchito komanso kulolera.

Mlingo wovomerezeka wa mankhwalawa nthawi ya monotherapy kapena ngati gawo limodzi la mankhwala ophatikizika ndi metformin, thiazolidinedione kapena insulin (osakanikirana ndi metformin kapena opanda metformin) ndi 50 mg kapena 100 mg patsiku. Odwala omwe ali ndi mtundu wovuta kwambiri wa matenda a shuga a 2 omwe amalandiridwa ndi insulin, Galvus amalimbikitsidwa pa 100 mg tsiku lililonse.

Mlingo wovomerezeka wa Galvus monga gawo limodzi la mankhwala ophatikiza katatu (vildagliptin + sulfonylurea derivatives + metformin) ndi 100 mg patsiku.

Mlingo wa 50 mg patsiku uyenera kutumikiridwa mu 1 piritsi. Mlingo wa 100 mg patsiku uyenera kutumikiridwa 50 mg kawiri pa tsiku m'mawa komanso madzulo.

Ikagwiritsidwa ntchito ngati gawo limodzi la magawo awiri ophatikizika ndi mankhwala a sulfonylurea, mlingo woyenera wa Galvus ndi 50 mg 1 nthawi patsiku m'mawa. Mankhwala akaphatikizana ndi mankhwala a sulfonylurea, mphamvu ya mankhwala pa mlingo wa 100 mg patsiku inali yofanana ndi ya 50 mg patsiku. Ndi osakwanira kachipatala motsutsana ndi maziko ogwiritsa ntchito mlingo wapamwamba wa tsiku lililonse wa 100 mg, kuti muthane ndi vuto la glycemia, mankhwala ena a hypoglycemic ndiwothekanso: metformin, zotumphukira za sulfonylurea, thiazolidinedione kapena insulin.

Odwala omwe ali ndi vuto laimpso wofatsa komanso kwa chiwindi, kusintha kwa mlingo sikofunikira. Odwala omwe ali ndi pakati kapena matenda opatsika aimpso (kuphatikizapo matenda omwe amalephera kupweteka aimpso), mankhwalawa ayenera kugwiritsidwa ntchito pa mlingo wa 50 mg kamodzi patsiku.

Odwala okalamba (zaka zopitilira 65), kukonza mtundu wa Galvus sikofunikira.

Popeza palibe chidziwitso pakugwiritsa ntchito mankhwalawa kwa ana ndi achinyamata osakwana zaka 18, sikulimbikitsidwa kugwiritsa ntchito mankhwalawa m'gulu la odwala.

Mankhwala amaperekedwa pakamwa. Mlingo wa mankhwala Galvus Met uyenera kusankhidwa payekha kutengera momwe ungagwiritsire ntchito bwino komanso kulolera. Mukamagwiritsa ntchito Galvus Met, musapitirire mlingo wovomerezeka wa tsiku ndi tsiku wa vildagliptin (100 mg).

Mlingo woyambira wa mankhwala a Galvus Met uyenera kusankhidwa, poganizira njira zomwe wodwalayo amathandizira ndi vildagliptin ndi / kapena metformin. Kuti muchepetse kuwonongeka kwa zoyipa pazakudya zamagetsi zomwe zimapangidwa ndi metformin, Galvus Met imatengedwa ndi chakudya.

Mlingo woyambirira wa Galvus Met osagwira ntchito ya monotherapy yokhala ndi vildagliptin: chithandizo ndi Galvus Med chitha kuyambitsidwa ndi piritsi limodzi ndi mulingo wa 50 mg / 500 mg kawiri pa tsiku, ndipo mutatha kuwunika momwe mankhwalawo amathandizira, mankhwalawa amatha kuwonjezeka pang'onopang'ono.

Mlingo woyambirira wa Galvus Met osagwira ntchito ya metformin monotherapy: kutengera mlingo wa metformin womwe watengedwa kale, chithandizo ndi Galvus Met chitha kuyamba ndi piritsi limodzi lokha ndi 50 mg / 500 mg, 50 mg / 850 mg kapena 50 mg / 1000 mg kawiri pa tsiku.

Mlingo woyambirira wa Galvus Met mwa odwala omwe adalandira kale mankhwala osakanikirana ndi vildagliptin ndi metformin ngati mapiritsi osiyana: kutengera Mlingo wa vildagliptin kapena metformin womwe watengedwa kale, chithandizo ndi Galvus Met ziyenera kuyambitsidwa ndi piritsi pafupi momwe mungathere kulandira chithandizo cha 50 mg / 500 mg , 50 mg / 850 mg kapena 50 mg / 1000 mg, ndipo masinthidwe ake.

Mlingo woyambirira wa Galvus Met ngati mankhwala oyamba kwa odwala omwe ali ndi matenda a shuga 2 osakwanira mthupi la zakudya komanso kuchita masewera olimbitsa thupi: monga mankhwala oyambira, Galvus Met amayenera kutumikiridwa pa mlingo woyambirira wa 50 mg / 500 mg kamodzi patsiku ndipo pang'onopang'ono atawunika njira yothandizira achire titrate mlingo wa mpaka 50 mg / 100 mg 2 kawiri pa tsiku.

Kuphatikiza mankhwala ndi Galvus Met palimodzi ndi sulfonylurea zotumphukira kapena insulin: mlingo wa Galvus Met amawerengedwa kuchokera pa mlingo wa vildagliptin 50 mg 2 kawiri pa tsiku (100 mg patsiku) ndi metformin pa mlingo wofanana ndi womwe kale umagwiritsidwa ntchito ngati mankhwala amodzi.

Kugwiritsa ntchito Galvus Met kumadziwikiratu odwala omwe amalephera kuwonongeka kwa impso kapena kuwonongeka kwa impso.

Metformin imachotsedwa impso. Popeza odwala opitirira zaka 65 nthawi zambiri amakhala ndi kuchepa kwa aimpso, Galvus Met imayikidwa m'gulu lino la odwala omwe ali ndi mlingo wochepa womwe umatsimikizira kuti matenda a glucose amakhala nawo pokhapokha atatha kudziwa QC kuti itsimikizire ntchito yachilendo. Mukamagwiritsa ntchito mankhwalawa odwala omwe ali ndi zaka zopitilira 65, ndikofunikira kuwunika nthawi zonse aimpso.

Popeza chitetezo ndi luso la Galvus Met mwa ana ndi achinyamata osakwana zaka 18 sizinaphunzire, kugwiritsa ntchito mankhwalawa kumatsutsana ndi gulu ili la odwala.

Zotsatira zoyipa

mutu
chizungulire
kunjenjemera
kuzizira
kusanza, kusanza,
gastroesophageal Reflux,
kupweteka m'mimba
kutsegula m'mimba, kudzimbidwa,
chisangalalo
achina,
hyperhidrosis
kutopa
zotupa pakhungu
urticaria
kuyabwa
arthralgia
zotumphukira edema,
hepatitis (chosinthika pakulekanitsa mankhwala),
kapamba
kukhazikika khungu
matuza
kuchepa mayamwidwe a vitamini B12,
lactic acidosis
kulawa kwazitsulo mkamwa.

Contraindication

Kulephera kwa impso kapena kuwonongeka kwa impso: ndi seramu ya creatinine yoposa 1.5 mg% (kuposa 135 μmol / l) kwa amuna komanso oposa 1.4 mg% (oposa 110 μmol / l) azimayi,
zovuta pachimake ndi chiwopsezo cha aimpso kukanika: kuchepa magazi (ndi kutsegula m'mimba, kusanza), kutentha thupi, matenda opatsirana, mikhalidwe ya hypoxia (mantha, sepsis, matenda a impso, matenda a bronchopulmonary),
kukomoka mtima komanso kupsinjika kwa mtima, kupweteka kwa mtima kwambiri, kulephera kwamtima ndi mantha (mantha),
kulephera kupuma
chiwindi ntchito,
pachimake kapena matenda metabolic acidosis (kuphatikizapo matenda ashuga a ketoacidosis osakanikirana kapena wopanda chikomokere). Matenda ashuga ketoacidosis ayenera kuwongoleredwa ndi insulin mankhwala,
lactic acidosis (kuphatikizapo mbiri),
Mankhwalawa sanalembedwe masiku awiri asanachitike opaleshoni, radioisotope, maphunziro a x-ray ndikuyambitsa kwa othandizira ndipo pakatha masiku awiri atachitidwa,
mimba
kuyamwa
mtundu 1 shuga
uchidakwa wambiri, chakumwa chakumwa choledzeretsa,
kutsatira zakudya zochepa zama calori (zosakwana 1000 kcal patsiku),
ana ochepera zaka 18 (mphamvu ndi chitetezo chogwiritsa ntchito sizinakhazikitsidwe),
Hypersensitivity to vildagliptin kapena metformin kapena chilichonse cha mankhwala.

Popeza odwala omwe ali ndi vuto la chiwindi ntchito nthawi zina, lactic acidosis adadziwika, yomwe mwina ndi imodzi mwazotsatira zoyipa za metformin, Galvus Met sayenera kugwiritsidwa ntchito mwa odwala omwe ali ndi matenda a chiwindi kapena magawo ophatikizika a hepatic biochemical.

Mosamala, tikulimbikitsidwa kugwiritsa ntchito mankhwala okhala ndi metformin mwa odwala opitirira zaka 60, komanso pochita ntchito yayitali chifukwa chakuwopsa kwa lactic acidosis.

Mimba komanso kuyamwa

Popeza amayi apakati sakhala ndi deta yokwanira yogwiritsira ntchito mankhwalawa Galvus kapena Galvus Met, kugwiritsa ntchito mankhwalawa panthawi yapakati kumatsutsana.

Milandu ya vuto logaya shuga mwa amayi apakati, pamakhala chiwopsezo chodzala ndi vuto lobadwa nalo, komanso kufalikira kwamatenda a kubadwa kwa neonatal. Kuteteza matenda a shuga m'magazi panthawi yapakati, insulin monotherapy tikulimbikitsidwa.

Mu kafukufuku woyesera, popereka vildagliptin mu Mlingo wowirikiza 200 kuposa momwe analimbikitsira, mankhwalawa sanayambitse chimbudzi ndikukula kwam'mbuyo kwa mluza ndipo sanatanthauze mwana wosabadwayo. Popereka mankhwala a vildagliptin osakanikirana ndi metformin paziwerengero 1: 10, panalibe zotsatira zakuthambo kwa mwana wosabadwayo.

Popeza sizikudziwika ngati vildagliptin kapena metformin adachotsedwa mkaka waumunthu, kugwiritsa ntchito mankhwala Galvus panthawi yoyamwitsa kumatsutsana.

Gwiritsani ntchito ana

Olimbikitsidwa mu ana ndi achinyamata osakwana zaka 18 (zoyenera ndi chitetezo chogwiritsa ntchito sizinakhazikitsidwe).

Gwiritsani ntchito odwala okalamba

Mosamala, tikulimbikitsidwa kugwiritsa ntchito mankhwala okhala ndi metformin mwa odwala omwe ali ndi zaka zopitilira 60.

Malangizo apadera

Odwala omwe amalandira insulin, Galvus kapena Galvus Met sangathe kulowa insulin.

Popeza poika vildagliptin, kuwonjezeka kwa zochitika za aminotransferases (kawirikawiri popanda chiwonetsero chamankhwala) kumadziwika nthawi zambiri kuposa gulu loyang'anira, musanalowe mankhwala Galvus kapena Galvus Met, komanso pafupipafupi pakumwa mankhwala, tikulimbikitsidwa kudziwa magawo awiri a michere ya chiwindi. Wodwala akakhala ndi zochita zambiri za aminotransferases, zotsatira zake ziyenera kutsimikiziridwa ndi kafukufuku wachiwiri, kenako azindikire magawo a ziwindi za chiwindi ntchito kufikira atasintha. Ngati kuchuluka kwa ntchito ya AST kapena ALT ndi 3 kapena kuposa pamenepo kuposa VGN kutsimikiziridwa ndikufufuza mobwerezabwereza, ndikulimbikitsidwa kuletsa mankhwalawo.

Lactic acidosis ndizosowa kwambiri koma zovuta za metabolic zomwe zimachitika ndi kudzikundikira kwa metformin mthupi. Lactacidosis yogwiritsira ntchito metformin imawonedwa makamaka mwa odwala omwe ali ndi matenda osokoneza bongo omwe ali ndi vuto lalikulu laimpso. Chiwopsezo chokhala ndi lactic acidosis imachulukitsidwa mwa odwala omwe samatha kuchiza matenda a shuga, okhala ndi matenda a ketoacidosis, kugona kwa nthawi yayitali, kumwa mowa kwambiri, kulephera kwa chiwindi, ndi matenda omwe amayambitsa hypoxia.

Ndi chitukuko cha lactic acidosis, kupuma movutikira, kupweteka kwam'mimba ndi hypothermia zimadziwika, ndikutsatira chikomokere. Zizindikiro zotsatirazi za Laborator zimakhala ndi phindu lazidziwitso: kuchepa kwa magazi pH, seramu lactate ndende yopitilira 5 nmol / l, komanso kuchuluka kwa anionic interval ndi kuchuluka kwa lactate / pyruvate. Ngati metabolic acidosis ikukayikira, mankhwalawo ayenera kusiyidwa ndipo wodwala amapezeka nthawi yomweyo kuchipatala.

Popeza metformin imapanikizika kwambiri ndi impso, chiwopsezo cha kudziunjikira kwake ndi kukula kwa lactic acidosis ndichopepuka, ntchito yaimpso imalephera. Mukamagwiritsa ntchito mankhwalawa, Galvus Met amayenera kuwunikira ntchito ya impso, makamaka pazotsatira zotsatirazi zomwe zimathandizira kuphwanya kwake: gawo loyamba la mankhwalawa antihypertensive mankhwala, othandizira a hypoglycemic, kapena NSAIDs. Monga lamulo, ntchito ya impso iyenera kuyesedwa musanayambe chithandizo ndi Galvus Met, ndipo osachepera 1 nthawi pachaka kwa odwala omwe ali ndi vuto laimpso komanso osachepera 2-4 pachaka kwa odwala omwe ali ndi serum creatinine pamwamba pa VGN. Odwala omwe ali pachiwopsezo cha kuwonongeka kwa impso, ayenera kuyang'aniridwa koposa kawiri pachaka. Ngati zizindikiro za kuwonongeka kwa impso zikuwoneka, Galvus Met iyenera kuyimitsidwa.

Mukamachita maphunziro a x-ray omwe amafunikira ma intaneti ophatikizidwa ndi ma iodine osakanikirana ndi ma radiopaque, Galvus Met iyenera kuyimitsidwa kwakanthawi (maola 48 zisanachitike, komanso mkati mwa maola 48 mutatha kafukufukuyo), chifukwa kuwongolera kwazinthu zokhala ndi ayodini komwe kumakhala ndi radiopaque kungayambitse kuwonongeka kwambiri mu ntchito ya impso ndikuwonjezera ngozi kukula kwa lactic acidosis. Mutha kuyambiranso kutenga Galvus Met pokhapokha kuwunika kwachiwiri kwa impso.

Mu pachimake mtima kulephera (mantha), pachimake mtima, infarction pachimake ndi zina zomwe zimadziwika ndi hypoxia, kukula kwa lactic acidosis ndi prerenal pachimake aimpso kulephera. Zitachitika izi pamwambapa, mankhwalawo ayenera kusiyidwa pomwepo.

Panthawi yopangira opaleshoni (kupatula ntchito zing'onozing'ono zomwe sizikugwirizana ndi kuchepetsa kudya ndi madzi), Galvus Met iyenera kusiyidwa. Mutha kuyambiranso kumwa pambuyo poti wodwala wayamba kudya yekha ndipo zikuwonetsedwa kuti ntchito yake impso siyowala.

Zakhazikitsidwa kuti ethanol (mowa) zimathandizira zotsatira za metformin pa lactate metabolism. Odwala ayenera kuchenjezedwa za kusapezeka kwa kumwa mowa mwa kugwiritsa ntchito mankhwala a Galvus Met.

Zinapezeka kuti metformin pafupifupi 7% ya milandu imayambitsa kuchepa kwa asymptomatic mu seramu vitamini B12. Kutsika kotereku kumachitika kawirikawiri kwambiri kumabweretsa kukula kwa magazi m'thupi. Zikuoneka, atasiya kugwiritsa ntchito metformin ndi / kapena vitamini B12, ma seramu ambiri a vitamini B12 amasintha msanga. Odwala omwe amalandila Galvus Met, ndikulimbikitsidwa osachepera 1 pachaka kuti ayesetse kuyesa magazi ndipo ngati zotsutsana zilizonse zadziwika, dziwani zomwe zikuyambitsa ndikuchita zoyenera. Zikuwoneka kuti, odwala ena (mwachitsanzo, odwala omwe ali osakwanira kapena mavitamini a vitamini B12 kapena calcium) amakhala ndi chiyembekezo chotsitsa kuchuluka kwa vitamini B12. Muzochitika zoterezi, zingalimbikitsidwe kudziwa seramu ya Vitamini B12 osachepera nthawi imodzi mu zaka 2-3.

Ngati wodwala yemwe ali ndi mtundu wa 2 matenda a shuga, omwe adayankha kale chithandizo, adawonetsa kuwonongeka (kusintha kwa ma labotale kapena mawonetseredwe azachipatala), ndipo zizindikiro zake sizinatchulidwe momveka bwino, kuyesedwa kuyenera kuchitika mwachangu kuti mudziwe ketoacidosis ndi / kapena lactic acidosis. Ngati acidosis mwanjira imodzi kapena ina ikatsimikiziridwa, muyenera kusiya Galvus Met mwachangu ndikuchita zoyenera.

Nthawi zambiri, mwa odwala omwe amalandila Galvus Met okha, hypoglycemia siimayang'aniridwa, koma imatha kuchitika motsutsana ndi maziko azakudya zochepa zopatsa mphamvu (pamene zolimbitsa thupi sizingalipidwe ndi zomwe zili ndi chakudya cha calorie), kapena motsutsana ndi zakumwa zakumwa. Hypoglycemia nthawi zambiri imakhala mwa okalamba, ofooka kapena operewera, komanso motsutsana ndi maziko a hypopituitarism, adrenal insuffidence kapena kuledzera. Kwa odwala okalamba komanso odwala omwe amalandira beta-blockers, kuzindikira kwa hypoglycemia kumatha kukhala kovuta.

Ndi kupsinjika (kutentha thupi, kuvulala, matenda, opaleshoni) yomwe idayamba wodwala amalandira othandizira a hypoglycemic m'njira yokhazikika, kuchepa kothamanga kwa ntchito yomalizirayi kwakanthawi. Pankhaniyi, mwina pangafunike kuletsa Galvus Met ndikupereka insulin. Mutha kuyambiranso chithandizo ndi Galvus Met pambuyo pakutha kwa nyengo yovuta kwambiri.

Kukopa pa kuyendetsa magalimoto ndi kayendedwe kazinthu

Zotsatira za mankhwalawa Galvus kapena Galvus Met pa kuthekera koyendetsa magalimoto ndi kugwiritsa ntchito njira sizinaphunzire. Ndi chitukuko cha chizungulire poyambira kugwiritsa ntchito mankhwalawa, munthu ayenera kupewa kuyendetsa magalimoto ndikugwira ntchito ndi zida.

Kuyanjana kwa mankhwala osokoneza bongo

Pogwiritsa ntchito nthawi yomweyo vildagliptin (100 mg 1 nthawi patsiku) ndi metformin (1000 mg 1 nthawi patsiku), palibe zofunika kwambiri pakubwera pakati pa pharmacokinetic pakati pawo. Ngakhale munthawi ya mayeso azachipatala, kapenanso panthawi yogwiritsidwa ntchito kwambiri kwa chipatala kwa Galvus Met mu odwala omwe amalandila mankhwala ena okhudzana ndi zinthu, zinthu zomwe sizinapezeke sizinapezeke.

Vildagliptin ali ndi mwayi wotsika wolumikizana ndi mankhwala. Popeza vildagliptin si gawo lapansi la cytochrome P450 isoenzymes, komanso sikulepheretsa kapena kuyambitsa ma isoenzymes awa, momwe amagwiritsidwira ntchito ndi mankhwala omwe ali am'munsi, ma inhibitors, kapena P450 inducers ndiokayikitsa. Pogwiritsa ntchito nthawi yomweyo vildagliptin sizikhudza kuchuluka kwa kagayidwe ka mankhwala omwe ali magawo a michere: CYP1A2, CYP2C8, CYP2C9, CYP2C19, CYP2D6, CYP2E1 ndi CYP3A4 / 5.

Palibe chithandizo chamankhwala chamtundu wa vildagliptin chomwe chimagwiritsidwa ntchito nthawi zambiri pochiza matenda amishuga 2 mellitus (glibenclamide, pioglitazone, metformin) kapena yocheperako zochiritsira (amlodipine, digoxin, ramipril, simvastatin, valsartan, warfarin).

Furosemide imachulukitsa Cmax ndi AUC ya metformin, koma sizimakhudzanso mawonekedwe ake aimpso. Metformin imachepetsa Cmax ndi AUC ya furosemide ndipo siyikhudzanso mawonekedwe ake aimpso.

Nifedipine imawonjezera mayamwidwe, Cmax ndi AUC ya metformin, kuwonjezera, imawonjezera kuphipha kwake mu mkodzo. Metformin kwenikweni sikukhudza magawo a pharmacokinetic a nifedipine.

Glibenclamide sichikhudza magawo a pharmacokinetic / pharmacodynamic a metformin. Metformin nthawi zambiri imachepetsa Cmax ndi AUC ya glibenclamide, koma kukula kwake kwake kumasiyana kwambiri. Pachifukwachi, kufunikira kwakukhudzaku kumachitika pakadali pano.

Ma organic cations, mwachitsanzo, amiloride, digoxin, morphine, procainamide, quinidine, quinine, ranitidine, triamteren, trimethoprim, vancomycin, ndi ena, omwe amathandizidwa ndi impso pogwiritsa ntchito katulutsidwe ka tubular, atha kugwirizananso ndi metformin, popeza amapikisana machitidwe ogwirizana a mafupa. Cimetidine imakulitsa kuchuluka kwa metformin mu plasma / magazi ndi AUC ndi 60% ndi 40%, motero. Metformin sichikhudza magawo a pharmacokinetic a cimetidine.

Chenjezo liyenera kuchitika mukamagwiritsa ntchito Galvus Met limodzi ndi mankhwala omwe amakhudza ntchito ya impso kapena kugawa kwa metformin m'thupi.

Mankhwala ena amatha kuyambitsa hyperglycemia ndikuchepetsa mphamvu ya othandizira a hypoglycemic, mankhwalawa amaphatikiza thiazides ndi zina zotulutsa, glucocorticosteroids (GCS), phenothiazines, kukonzekera kwa mahomoni a chithokomiro, estrogens, kulera kwapakamwa, phenytoin, nicotinic acid, sympathomimetics, ndi calcium antagonists. Mukamapereka mankhwala othandizira, kapena, mosiyana, ngati amachotsedwa, tikulimbikitsidwa kuwunika bwino ntchito ya metformin (zotsatira zake za hypoglycemic) ndipo ngati kuli kotheka, sinthani mlingo wa mankhwalawo.

Kugwiritsa ntchito nthawi yomweyo danazol osavomerezeka kuti apewe hyperglycemic zotsatira za chomaliza. Ngati mankhwala a danazol akufunika ndipo atasiya kuyimitsa, kusintha kwa metformin kumafunika motsogozedwa ndi shuga.

Chlorpromazine akamwedwa muyezo waukulu (100 mg patsiku) amawonjezera glycemia, kuchepetsa kutulutsa kwa insulin. Pochiza ma antipsychotic komanso mutasiya kuyimilira, kusintha kwa mankhwalawa kumafunikira motsogozedwa ndi shuga.

Kafukufuku wama radiology wogwiritsa ntchito ma iodine okhala ndi ayodini amatha kuyambitsa kukula kwa lactic acidosis kwa odwala omwe ali ndi matenda osokoneza bongo omwe amalephera kugwira ntchito mwamphamvu.

Anapatsidwa jakisoni, beta2-sympathomimetics amachulukitsa glycemia chifukwa cha kukondoweza kwa beta2-adrenergic receptors. Pankhaniyi, kuyang'anira glycemic ndikofunikira. Ngati ndi kotheka, insulin ikulimbikitsidwa.

Ndi munthawi yomweyo kugwiritsa ntchito metformin ndi sulfonylurea zotumphukira, insulin, acarbose, salicylates, kuchuluka kwa hypoglycemic.

Popeza kugwiritsa ntchito metformin kwa odwala omwe amamwa mowa kwambiri kumawonjezera chiopsezo cha lactic acidosis (makamaka panthawi yanjala, kutopa, kapena kulephera kwa chiwindi), odwala ayenera kupewa kumwa mowa komanso mankhwala omwe amakhala ndi ethanol (mowa) panthawi ya chithandizo ndi Galvus Met.

Mndandanda wa mankhwala Galvus

Zofanana muzochitika zamagulu:

Analogs mu pharmacological group (ma hypoglycemic agents):