Momwe mungatenge Diagninid wa matenda ashuga?

Piritsi limodzi lili:

Repaglinide malinga ndi zinthu 100% - 0,5 mg, 1 mg ndi 2 mg,

Poloxamer (mtundu 188) 3 mg, 3 mg kapena 3 mg, meglumine 10 mg, 10 mg kapena 13 mg, lactose monohydrate 47.8 mg, 47,55 mg kapena 61.7 mg, microcrystalline cellulose 33.7 mg, 33, 45 mg kapena 45 mg, potaziyamu polacryline 4 mg, 4 mg kapena 4 mg, colloidal silicon diabetes 0,5 mg, 0,5 mg kapena 0,7 mg, magnesium stearate 0,5 mg, 0,5 mg kapena 0,6. mg motero.

Mankhwala

Short-pamlomo hypoglycemic mankhwala. Imalimbikitsa kutulutsa kwa insulin ku magawo a beta a kapamba. Imalepheretsa njira zotsalira za ATP munkati mwa maselo a beta kudzera m'mapuloteni enieni, omwe amachititsa kuti maselo a beta atsegulidwe komanso kutsegulidwa kwa njira za calcium. Kuchulukanso kwa calcium ions kumapangitsa insulin kutulutsa. Odwala omwe ali ndi mtundu wachiwiri wa matenda a shuga, mankhwalawa amayankhidwa pakatha mphindi 30 atatha kumwa mankhwalawo. Izi zimapereka kuchepa kwa kuchuluka kwa shuga m'magazi nthawi yonse ya chakudya. Pankhaniyi, kuchuluka kwa mankhwala obaya omwe amapezeka m'madzi a m'magazi kumatha kuchepa, ndipo maola 4 atatha kumwa mankhwalawa, kupezeka kwa repaglinide kumapezeka mwa plasma ya odwala omwe ali ndi matenda a shuga a 2. Mukamagwiritsa ntchito repaglinide mu mlingo wochokera pa 0,5 mpaka 4 mg, kuchepa kwa shuga komwe kumachitika mu glucose kumadziwika.

Pharmacokinetics

Mukamamwa pakamwa, mayamwidwe a repaglinide kuchokera m'matumbo am'mimba amakhala okwera. Nthawi yofika ndende yayitali ndi ola limodzi. Nthawi zambiri bioavailability wa repaglinide ndi 63% (kusintha kosiyanasiyana ndi 11%). Popeza titration wa mlingo wa repaglinide ikuchitika kutengera yankho la mankhwala, kusinthasintha osiyanasiyana sikukhudza mphamvu ya mankhwala.

Kugawa voliyumu - 30 l. Kuyankhulana ndi mapuloteni a plasma - 98%.

Zimapukusidwa kwathunthu m'chiwindi pakukhudzana ndi CYP3A4 kuma metabolites osagwira.

Imafufutidwa makamaka m'matumbo, ndi impso - 8% mu mawonekedwe a metabolites, kudzera m'matumbo - 1%. Hafu ya moyo ndi ola limodzi.

Kugwiritsanso ntchito kwa repaglinide mwachizolowezi kwa odwala omwe ali ndi vuto la chiwindi kungayambitse kuchuluka kwa chitetezo cham'magazi komanso metabolites kuposa odwala omwe ali ndi chiwindi chokwanira. Pankhaniyi, kugwiritsa ntchito repaglinide kumakhudzana ndi odwala omwe ali ndi vuto la chiwindi, ndipo odwala omwe ali ndi vuto la chiwindi komanso ofatsa chiwindi amafunika kugwiritsidwa ntchito mosamala. Zotheka pakati pakusintha kwa mankhwalawa ziyeneranso kuwonjezeredwa kuti zitsimikizike moyenera momwe mankhwalawo amathandizira.

Dera lomwe lili pansi pa ndende nthawi yayikulu (AUC) komanso kuchuluka kwambiri kwa zotupa m'madzi a m'magazi (C_maxali chimodzimodzi kwa odwala omwe ali ndi vuto laimpso komanso odwala omwe ali ndi vuto laimpso ofatsa kapena mwamphamvu. Odwala omwe ali ndi vuto la impso, kuwonjezeka kwa AUC ndi C kunadziwika_maxkomabe, kupendekera kochepa chabe pakati pa kuchuluka kwa repaglinide ndi chilolezo cha creatinine kunawululidwa. Zikuwoneka kuti odwala omwe ali ndi vuto la impso palibe chifukwa chosinthira koyamba mlingo. Komabe, kuwonjezeka kwa mlingo wotsatira kwa odwala omwe ali ndi mtundu wa matenda a shuga 2 kuphatikiza kwambiri kuwonongeka kwa impso, komwe kumafunikira hemodialysis, kuyenera kuchitika mosamala.

Diagninide: Zowonetsa

Type 2 shuga mellitus (ndi kusachita bwino kwa mankhwala othandizira kudya, kuchepa thupi komanso kuchita masewera olimbitsa thupi) mu monotherapy kapena kuphatikiza ndi metformin kapena thiazolidinediones mu milandu momwe sizingatheke kukwaniritsa kokwanira pakuwongolera glycemic pogwiritsa ntchito monotherapy ndi repaglinide kapena metformin kapena thiazolidinediones.

Diagninide: Contraindication

- Hypersensitivity kudziwika kuti repaglinide kapena chilichonse cha mankhwala.

- Type 1 shuga

- Matenda a shuga a ketoacidosis, matenda a shuga komanso chikomokere,

- Matenda opatsirana, chithandizo chachikulu cha opaleshoni ndi zina zomwe zimafuna chithandizo cha insulin,

- Kusokonezeka kwamphamvu kwa chiwindi,

- Nthawi yomweyo kupangidwa kwa gemfibrozil (onani "Kuyanjana ndi mankhwala ena"),

- Lactase akusowa, lactose tsankho, shuga-galactose malabsorption,

- Mimba komanso kuyamwa,

- Ana a zaka mpaka 18.

Kafukufuku wazachipatala wa odwala omwe ali ndi zaka zosakwana 18 ndi zaka zopitilira 75 sizinachitike.

Ndi chisamaliro (kufunika kowunikira mosamala) kuyenera kugwiritsidwa ntchito ngati chiwindi chisafooketse pang'ono, digiri yodwala, kulephera kwaimpso, kuledzera, vuto lalikulu, kusowa kwa chakudya m'thupi.

Mimba komanso kuyamwa

Kafukufuku wokhudzana ndi kugwiritsa ntchito repaglinide mwa amayi apakati sanachitike. Chifukwa chake, chitetezo cha repaglinide mwa amayi apakati sichinaphunzire.

Nthawi yoyamwitsa

Kafukufuku wokhudzana ndi kugwiritsa ntchito repaglinide mwa amayi nthawi yoyamwitsa sanachitike. Ngati kuli kofunikira kugwiritsa ntchito mankhwalawa panthawi yoyamwitsa, kuyamwitsa kuyenera kutha.

Mlingo ndi makonzedwe

Mankhwala Diagnlinide ® amalembedwa monga cholumikizira kudya mankhwala ndi zochita zolimbitsa thupi kuti achepetse kuchuluka kwa shuga m'magazi;

Mankhwalawa amatengedwa pakamwa musanadye chakudya chachiwiri, katatu kapena kanayi patsiku, nthawi zambiri mphindi 15 isanayambike chakudya, koma amathanso kuumwa pakadutsa mphindi 30 chakudya chisanafike.

Mlingo wa mankhwalawa amasankhidwa payekha kwa wodwala aliyense, kutengera kuchuluka kwa shuga m'magazi.

Mlingo woyambirira ndi 0,5 mg / tsiku (ngati wodwalayo adatenga mankhwala ena amkamwa a hypoglycemic - 1 mg). Kusintha kwa Mlingo kumachitika nthawi 1 pa sabata kapena 1 nthawi m'masabata awiri (poyang'ana kwambiri kuchuluka kwa shuga m'magazi, monga chisonyezo cha kuyankha kwa mankhwala). Mlingo umodzi wambiri ndi 4 mg. Mlingo wapamwamba tsiku lililonse ndi 16 mg.

Kusamutsa odwala ndi mankhwala ena amkamwa hypoglycemic mankhwala Repaglinide chithandizo chitha kuchitika nthawi yomweyo. Komabe, ubale womwe ulipo pakati pa mlingo wa repaglinide ndi mlingo wa mankhwala ena a hypoglycemic sunawululidwe. Mulingo woyambira woyambira wa repaglinide mukamachokera ku mankhwala ena a hypoglycemic ndi 1 mg musanadye.

Repaglinide ikhoza kutumikiridwa limodzi ndi metformin kapena thiazolidatediones ngati magazi sayenda mokwanira m'magazi a monotherapy ndi metformin, thiazolidinediones kapena repaglinide. Pankhaniyi, mlingo womwewo wa repaglinide umagwiritsidwanso ntchito ngati monotherapy. Kenako patsani kusintha kwa mankhwalawa aliyense malinga ndi kuchuluka kwa shuga m'magazi.

Magulu apadera a odwala

(onani gawo "Malangizo Apadera").

Sitikulimbikitsidwa kugwiritsa ntchito repaglinide kwa anthu ochepera zaka 18 chifukwa cha kusowa kwa chidziwitso chokwanira pa chitetezo chake komanso kugwira ntchito mu gulu la odwala.

Kuzindikira: Zotsatira zoyipa

Zotsatira zoyipa kwambiri ndizo hypoglycemia, pafupipafupi zomwe zimatengera, monga mtundu uliwonse wa mankhwala a shuga, pazinthu zomwe munthu amadya, monga kumwa mankhwala, kuchuluka kwa mankhwalawa, nkhawa.

Izi ndi zotsatirapo zoyipa zomwe zimawonedwa ndikugwiritsanso ntchito kwa repaglinide ndi othandizira ena pakamwa. Zotsatira zonse zoyipa zimagawidwa malinga ndi kuchuluka kwa chitukuko, zomwe zimafotokozedwa ngati: Nthawi zambiri (≥1 / 100 kuti

Ndi mankhwala osokoneza bongo, hypoglycemia imayamba.

Zizindikiro anjala, thukuta kwambiri, kugona, kunjenjemera, kuda nkhawa, kupweteka mutu, kusowa tulo, kusakwiya, kukhumudwa, kuyankhula modumphadumpha komanso masomphenya.

Pogwiritsa ntchito repaglinide odwala omwe ali ndi mtundu wa 2 shuga mellitus pakanthawi kochulukirapo ka 4 mpaka 20 mg 4 pa tsiku (ndi chakudya chilichonse), wachibale wowonjezera bongo amawonetsedwa kwa masabata 6, akuwonetsa kuchepa kwambiri kwa ndende ya glucose komanso kukula kwa zizindikiro za hypoglycemia.

Pakakhala zizindikiro za hypoglycemia, ayenera kuchita zinthu zoyenera kuti achulukitse glucose m'magazi (kumwa dextrose kapena zakudya zopatsa mphamvu mkati). Woopsa hypoglycemia (kusowa chikumbumtima, chikomokere), dextrose umayendetsedwa kudzera m'mitsempha. Pambuyo kuchira kwa chikumbumtima - kudya zakudya zopatsa mphamvu mosavuta (kupewa kupewa kukonzanso kwa hypoglycemia).

Kuchita

Kuyanjana kwa repaglinide ndi mankhwala omwe amakhudza kagayidwe kachakudya kagayidwe kachakudya kuyenera kukumbukiridwa.

Metabolism, ndipo motero kutsimikizika kwa repaglinide, imatha kusintha motsogozedwa ndi mankhwala omwe amachititsa, kupondereza kapena kuyambitsa michere kuchokera ku gulu la cytochrome P-450. Kusamala makamaka kuyenera kuchitika ndi munthawi yomweyo kugwiritsa ntchito CYP2C8 ndi CYP3A4 zoletsa zomwe zimapanga repaglinide. Kafukufuku akuwonetsa kuti kayendetsedwe kamodzimodzi ka Deferasirox, komwe kali kofooka ka CYP2C8 ndi CYP3A4, ndi repaglinide kumabweretsa kuwonjezeka kwa systemic zotsatira za repaglinide, kuchepa kwapang'onopang'ono koma kwakukulu pamagazi a glucose. Ndi makonzedwe a munthawi yomweyo a Deferasirox ndi Repaglinide, ndikofunikira kulingalira kuchepa kwa mlingo wa Repaglinide ndikuwunikira mosamala kuchuluka kwa shuga m'magazi.

Pogwiritsa ntchito munthawi yomweyo clopidogrel, CYP2C8 inhibitor, ndi repaglinide, kuwonjezereka kwa dongosolo la repaglinide komanso kuchepa pang'ono kwa ndende yamagazi. Ngati repaglinide ndi clopidogrel zimagwiritsidwa ntchito nthawi yomweyo, kuyang'anira shuga ndikuwonetsetsa popereka matenda kuyenera kuchitika.

OATP1B1 anion transport protein inhibitors (mwachitsanzo, cyclosporin) amathanso kukulitsa kuchuluka kwa plasma repaglinide.

Mankhwala otsatirawa amatha kukulitsa kapena / kutalikitsa mphamvu ya hypoglycemic ya repaglinide:

Gemfibrozil, trimethoprim, rifampicin, clarithromycin, ketoconazole, itraconazole, cyclosporine, mankhwala ena a hypoglycemic, monoamine oxidase inhibitors, osagwiritsa ntchito beta-adrenergic blocking agents, angiotensin otembenuza enzyme inhibitors, salicylate, nonstidididididi, osapatsirana.

Beta-blockers amatha kufinya zizindikiro za hypoglycemia.

Kukhazikitsidwa munthawi yomweyo kwa cimetidine, nifedipine kapena simvastatin (omwe ndi gawo la CYP3A4) ndi repaglinide sikukhudza kwambiri magawo a pharmacokinetic a repaglinide.

Repaglinide siyingakhudze kwambiri mphamvu ya pharmacokinetic ya digoxin, theophylline, kapena warfarin akamagwiritsa ntchito odzipereka athanzi. Chifukwa chake, palibe chifukwa chofuna kusintha kwa mankhwalawa pakaphatikizidwa ndi repaglinide.

Mankhwala otsatirawa amatha kufooketsa mphamvu ya hypoglycemic of repaglinide:

Njira zakulera za pakamwa, rifampicin, barbiturates, carbamazepine, thiazides, glucocorticosteroids, danazole, mahomoni a chithokomiro komanso sympathomimetics.

Kugwiritsa ntchito njira zakulera za pakamwa (ethinyl estradiol / levonorgestrel) sizitengera kusintha kwakukulu pamatenda onse a bioavailability a repaglinide, ngakhale kuchuluka kwambiri kwa repaglinide kumatheka kale. Repaglinide siyingakhudze kwambiri kukhudzana kwa levonorgestrel, koma mphamvu yake ya bioavailability ya ethinyl estradiol silingatsutsidwe.

Pachifukwa ichi, pakukhazikitsidwa kapena kuletsedwa kwa mankhwala omwe ali pamwambawa, odwala omwe alandila repaglinide ayenera kuyang'aniridwa mosamala kuti azindikire kuphwanya kwa glycemic control.

Malangizo apadera

Repaglinide ikuwonetsedwa pakuyendetsa bwino glycemic ndikuwonjezereka kwa zizindikiro za matenda a shuga panthawi ya zakudya, masewera olimbitsa thupi, komanso kuchepa thupi.

Popeza repaglinide ndi mankhwala omwe amachititsa kuti insulin itulutsidwe, imatha kuyambitsa hypoglycemia. Ndi mankhwala ophatikiza, chiopsezo cha hypoglycemia chimakulanso.

Kulowerera kwakukulu ndi kuvulala, kuwotcha kwakukulu, matenda opatsirana omwe ali ndi febrile syndrome kungafune kutha kwa mankhwalawa a hypoglycemic mankhwala ndi mankhwala osakhalitsa a insulin.

Ndikofunikira kuwunika pafupipafupi kuchuluka kwa shuga m'magazi pamimba yopanda kanthu ndikatha kudya. Wodwalayo ayenera kuchenjezedwa za chiwopsezo chowonjezereka cha hypoglycemia pakagwiritsidwe ntchito ka mowa, NSAIDs, komanso pakusala kudya.

Kusintha kwa mlingo ndikofunikira pakulimbitsa thupi ndi malingaliro, kusintha zakudya.

Odwala omwe ali ndi vuto la kuperewera kwa zakudya m'thupi, komanso odwala omwe ali ndi vuto la kuperewera kwa zakudya m'thupi, chisamaliro chimayenera kuthandizidwa posankha koyamba ndi kukonzanso, komanso kupatsidwa ulemu, pofuna kupewa hypoglycemia

Magulu apadera a odwala

Kusankhidwa kwa odwala omwe ali ndi matenda a shuga a 2 osakanikirana ndi mkhutu kwambiri aimpso kuyenera kuchitika mosamala.

Kukhazikitsidwa kwa Mlingo wa repaglinide odwala omwe ali ndi vuto la chiwindi kungayambitse kuchuluka kwambiri kwa chiwindi ndi ma metabolites kuposa odwala omwe ali ndi chiwindi chokwanira. Pankhani imeneyi, poika repaglinide amadziwikiratu odwala omwe ali ndi vuto la chiwindi (onani gawo la "Contraindication"), komanso odwala omwe ali ndi vuto la hepatic ofatsa kwambiri osapatsanso digiri ya repaglinide ayenera kugwiritsidwa ntchito mosamala. Zotheka pakati pakusintha kwa mankhwalawa ziyeneranso kuwonjezeredwa kuti zitsimikizike moyenera momwe mankhwalawo amathandizira.

Kukopa pa kuyendetsa magalimoto ndi kugwira ntchito ndi njira

Kuthekera kwa odwala kuti aziganiza mwachangu komanso kuthamanga kwa momwe angachitire zimatha kuwonongeka panthawi ya hypoglycemia ndi hyperglycemia, zomwe zimakhala zowopsa nthawi zomwe luso ili ndilofunikira kwambiri (mwachitsanzo, poyendetsa magalimoto kapena kugwira ntchito ndi makina ndi makina). Odwala ayenera kulangizidwa kuti achitepo kanthu popewa kukula kwa hypoglycemia ndi hyperglycemia poyendetsa magalimoto ndikugwira ntchito ndi njira. Izi ndizofunikira kwambiri kwa odwala omwe alibe kapena kuchepa kwa zizindikiro zakutsogolo kwa hypoglycemia kapena magawo a hypoglycemia. Muzochitika izi, kuthekera kwa ntchito yotereyi kuyenera kuganiziridwa.

Zizindikiro ndi contraindication

Monga mankhwala ena, Diclinid ali ndi zizindikiro zomwe angagwiritse ntchito. Monga tafotokozera pamwambapa, aikidwa kuti alembe odwala matenda ashuga achiwiri kuti akhale ndi shuga. Malinga kuti zomwe zidachitidwa kale machitidwe a kadyedwe komanso masewera sizinapereke chithandizo choyenera.

Simungathe kumwa mankhwalawa ngati wodwalayo ali ndi vuto losagwirizana ndi mankhwala kapena mbali zake zonse, chifukwa izi zimapangitsa kuti thupi lizigwirizana.

Mankhwalawa sanatchulidwe chithandizo cha matenda a shuga a mtundu woyamba, ndi mtundu wa matenda a shuga a ketoacidosis, precomatosis, chikomokere, chiwindi chodwala, kuwonda kwa lactase.

Mndandanda wa contraindication siwocheperako ndipo umaphatikizapo zinthu zotsatirazi:

• Nthawi ya bere, kuyamwitsa.
• Zaka za ana, ndiko kuti, mpaka zaka 18.
• Simungathe kuphatikiza mankhwalawa ndi gemfibrozil.
• Opaleshoni yayikulu.
• Matenda opatsirana.
• Zovulala zazikulu.

Zotsutsana zomwe zatchulidwa pamwambapa ndizowona. Mwanjira ina, mankhwalawa samatchulidwa ngati ali ndi mbiri yodwala. Pamodzi ndi iwo, zotsutsana mwanjira zina zimasiyanitsidwanso.

Izi zikutanthauza kuti asanapereke mankhwala, dokotala amafananizira kuthekera kwa zotsatira za mankhwala ndi kuopsa kwa zotsatira zoyipa ndi zovuta zina.

Milandu yoyeserera imaphatikizidwa ndi febrile syndrome, kulephera kwa impso, kuperewera kwa zakudya, mtundu wa zakumwa zoledzeretsa, komanso vuto lalikulu la wodwalayo.

Mankhwala apita mayesero onse azachipatala. Komabe, kafukufuku mpaka zaka 18 ndi zopitilira 75 sizinachitike.

Mwina mukukumana ndi mankhwalawa

Ndemanga za odwala zimazindikira kuti mankhwalawa amathandizira msanga kuchepetsa shuga komanso kukhala bwino. Pamodzi ndi izi, ambiri amalankhula za zoyipa zomwe zasintha chifukwa chogwiritsa ntchito mankhwalawa.

Zovuta zomwe zimachitika kwambiri ndi boma la hypoglycemic. Tsoka ilo, pafupifupi sizingatheke kuti muchepetse kwambiri shuga. Popeza vutoli limatengera zinthu zambiri: kuchuluka kwa mankhwalawa, kudya, kuchita masewera olimbitsa thupi, kupsinjika, neurosis, kumva mwamphamvu, ndi zina zambiri.

Zotsatira zoyipa zimatha kuchitika mwa njira ya metabolic: monga tanena kale, izi makamaka ndi hypoglycemia. Monga lamulo, ndikokwanira kutenga chakudya chochepa kuti matenda akhale bwino. Pafupifupi nthawi zina, mungafunike kupita kuchipatala msanga.

Abstract ya mankhwalawa ikufotokoza zotsatirazi zoyipa:

1. Pa mbali ya chitetezo chathupi: makulidwe azachilengedwe, monga vasculitis, thupi lawo siligwirizana ndi mawonekedwe amkhungu - zotupa, kuyabwa, redness la khungu.
2. Kusokonezeka kwa m'mimba ndi m'mimba, kupweteka m'mimba, kutsutsana ndi mseru komanso kusanza.
3. Kuchuluka kwa chiwindi michere, chiwindi ntchito.

Amadziwika kuti kumwa mankhwalawa kumatha kusokoneza mawonekedwe.

Monga lamulo, chizindikiro ichi ndi chosakhalitsa, chodzilimbitsa pamankhwala. Pafupifupi nthawi zina, kuchotsa mankhwalawo kungakhale kofunikira.

Malangizo ogwiritsira ntchito

Mankhwala Diclinid si panacea, ndizowonjezera pa zolimbitsa thupi komanso zakudya zamagulu otsika kwa odwala matenda ashuga. Pokhapokha pokhapokha ngati chithandizo chofunikira chamankhwala chitha.

Mlingo wa mankhwalawa nthawi zonse umasankhidwa payekha. Choyimira chachikulu ndizomwe zimayambitsa shuga. Mukamasankha mlingo, matenda oyanjana ndi zinthu zina zimawerengedwa.

Malangizo ogwiritsira ntchito akuti mapiritsi amayenera kumwedwa kotala la ola limodzi asanadye kwakukulu. Komabe, mutha kutenga theka la ola musanadye.

Zambiri zamankhwala kudzera pa Diagninid:

• Mlingo wofanana kwa odwala omwe sanamwe mapiritsi kuti muchepetse shuga m'magazi a 2 matenda a shuga ndi 0.5 mg.
• Ngati wodwalayo adatenga kale hypoglycemic wothandizira, ndiye kuti mlingo woyambirira ndi 1 mg.
• Pamafunika, ndizovomerezeka kusintha mlingo wa mankhwalawa kamodzi pakapita masiku 7-14.
• Mukuyankhula pafupifupi, mutatha kuchuluka konse, mlingo woyenera ndi 4 mg wa mankhwalawa, womwe umagawidwa paz Mlingo atatu patsiku.
• Mlingo waukulu wa mankhwalawa ndi 16 mg.

Ngati wodwala amatenga wothandizanso wina wa hypoglycemic ndipo akuyenera kusinthidwa pazifukwa zina zilizonse zamankhwala, ndiye kuti kusinthira ku Diagninid kumachitika popanda kusintha kwakanthawi. Popeza ndizosatheka kukhazikitsa kuchuluka kwa mankhwalawa pakati pa mankhwalawa, koma mlingo woyamba si oposa 1 mg.

Mlingo womwe watchulidwa umasamalidwa mosasamala kanthu za momwe mankhwalawo amayendera. Makamaka, onse mu monotherapy komanso mu zovuta za chithandizo cha matenda a shuga a 2 mtundu wa mellitus. Mtengo wake umachokera ku ma ruble 200.

Ma Analogs a Diaglinide, mitengo ndi malingaliro

Diaglinide ili ndi ma analogu ochepa, ndipo NovoNorm, komanso Repaglinide, amawatumiza. Mtengo wa NovoNorm umasiyana kuchokera ku ma ruble 170 mpaka 250. Mankhwala atha kugulidwa ku malo ogulitsira kapena ku pharmacie, ndikololedwa kugula mankhwala pa intaneti.

Mankhwalawa amasungidwa m'malo amdima, osafikirika kwa ana aang'ono. Alumali moyo wa mankhwala ndi zaka ziwiri.

Pambuyo pofufuza ndemanga zingapo za anthu odwala matenda ashuga, titha kunena kuti mankhwalawo amatha bwino ntchitoyo, amathandizira kusintha shuga ndikuwasunga pamalo omwe akufuna. Komabe, wodwalayo amafunika kuyesetsa kudya ndi kuchita zolimbitsa thupi.

Palinso ndemanga zoyipa, zomwe zimayambitsidwa chifukwa chosagwirizana ndi kuchuluka kwa mankhwalawo, komanso zolakwitsa pakudya.

Ndipo munganene chiyani za mankhwalawa? Kodi mwamwa ma piritsiwo, ndipo adagwira bwanji ntchito yanu?