Gliclada® (30 mg) Gliclazide > Chithandizo ndi kupewa

30 mg mapiritsi otulutsidwa

Piritsi limodzi lili

ntchito yogwira - gliclazide 30 mg

zokopa: hypromellose (4000 **), hypromellose (100 **)

calcium carbonate, lactose monohydrate, colloidal silicon dioxide, magnesium stearate

Ubwino wa mamasulidwe amadzimadzi a 2% (m / v) yankho lamadzi la hypromellose

Mapiritsi Oval, kuyambira oyera mpaka oyera, biconvex

Gulu la Pharmacotherapeutic

Njira zochizira matenda ashuga. Mankhwala ochepetsa shuga a pakamwa. Zothandiza kuchokera ku sulfonylureas. Gliclazide

Nambala ya ATX A10VB09

Zotsatira za pharmacological

Pharmacokinetics

Zogulitsa ndi kugawa

Mutatha kumwa mankhwalawo mkati, gliclazide imatenga gawo lonse la m'mimba. Kuchulukana kwa gliclazide mu plasma kumawonjezeka pang'onopang'ono mkati mwa maola 6 atatha kukhazikitsa ndikufika kumapanga omwe akupitilira kuyambira 6 mpaka 12 ora. Kusiyanasiyana kwamunthu aliyense kumakhala kotsika. Kudya sizimakhudza kuchuluka kwa mayamwidwe. Voliyumu yogawa ndi pafupifupi malita 30. Plasma kumanga mapuloteni pafupifupi 95%. Mlingo umodzi tsiku lililonse wa mankhwala a Gliclada® umawonetsetsa kuti glyclazide yogwira plasma imaposa maola 24.

Gliclazide imapangidwa makamaka mu chiwindi. Zotsatira zake za metabolites zilibe zochitika za pharmacological. Kuyanjana kwa mlingo womwe umatengedwa mpaka 120 mg ndi kuchuluka kwa mankhwalawa m'madzi a plasma ndikodalira kwa nthawi.

Hafu ya moyo (T1 / 2) ya gliclazide ndi maola 12-20. Imafufutidwa makamaka ndi impso mu mawonekedwe a metabolites, ochepera 1% omwe amaponyedwa mkodzo osasinthika.

Pharmacokinetics mu milandu yapadera yamankhwala

Okalamba, palibe kusintha kwakufunika kwamapiritsi a pharmacokinetic komwe kwapezeka.

Mankhwala

Gliclada ® ndi mankhwala amkamwa a hypoglycemic ochokera pagulu lotsatira la sulfonylurea, omwe amasiyana ndi mankhwala omwewo mwa kukhalapo kwa mphete ya Nter heterocyclic yokhala ndi chomangira cha endocyclic.

Glyclada® imatsitsa shuga m'magazi ndikulimbikitsa kuteteza kwa insulin ndi maselo a Langerhans okhala ndi maselo a R. Pambuyo pa zaka ziwiri zamankhwala, kuwonjezereka kwa kuchuluka kwa insulin ya postprandial ndi secretion ya C-peptides kumatsalira. Mtundu wachiwiri wa matenda a shuga, mankhwalawa amabwezeretsa chiyambi champhamvu cha insulin chifukwa cha kuchuluka kwa shuga ndikupangitsa gawo lachiwiri la insulin katulutsidwe. Kuwonjezeka kwakukulu kwa insulin katulutsidwe kumawonedwa poyankha kukondoweza chifukwa cha zakudya zomwe amapatsa ndi shuga.

Kuphatikiza pa kukhudza kagayidwe kazachilengedwe, Glyclada® imathandizanso pakukula kwa ma cell. Mankhwalawa amachepetsa chiopsezo cha chotupa chamagazi am'magazi, kukhudza magawo awiri omwe angatenge nawo gawo la zovuta za matenda osokoneza bongo: kuletsa kwapang'onopang'ono kwa kuphatikiza kupatsidwa zinthu zam'magazi komanso kutsika ndi kuchepa kwa kuchuluka kwa ma cell a activation (beta-thromboglobulin, thromboxane B2), komanso kubwezeretsanso micrinolytic mtima endothelial ntchito ndi kuchuluka kwa minofu plasminogen activator.

Mlingo ndi makonzedwe

Mankhwalawa amangolembera okhawo odwala akuluakulu.

Ndikulimbikitsidwa kuti mutenge piritsi (mapiritsi) osatafuna nthawi ya m'mawa. Mukaphonya mlingo wotsatira tsiku lotsatira, simungathe kuwonjezera mlingo.

Mlingo wa tsiku ndi tsiku wa Glyclad® umachokera pa 30 mpaka 120 mg (1 mpaka 4 mapiritsi). Mlingo wa mankhwalawa amasankhidwa potengera wodwalayo.

Mlingo woyambira wabwino ndi 30 mg tsiku lililonse. Pogwiritsa ntchito shuga poyang'anira shuga, muyezo wogwiritsa ntchito mankhwalawa ungagwiritsidwe ntchito.

Ndi osakwanitsa kuwongolera kuchuluka kwa shuga, tsiku ndi tsiku mlingo wa mankhwalawa ungathe kuwonjezeka mpaka 60, 90 kapena 120 mg. Kutalika pakati pa kuchuluka kulikonse kwa mankhwalawa kuyenera kukhala osachepera mwezi umodzi, kupatula kwa odwala omwe shuga ya m'magazi sanatsike pambuyo pa masabata awiri okhazikitsa. Zikatero, mlingo umatha kuchuluka pakatha masabata awiri chiyambireni mankhwala. Mlingo woyenera kwambiri ndi 120 mg patsiku.

Kusintha kuchokera ku 80 mg Glyclazide Mapiritsi kupita ku Mapepala Otulutsidwa a Glyclad®

Pankhani yoyendetsa bwino magwiritsidwe a shuga m'magazi a wodwalayo ndi mapiritsi a 80 mg glycoslide, atha kubwezeretsedwanso ndi Glyclada® pang'onopang'ono piritsi limodzi la glycoslide 80 mg = 1 piritsi la Glyclada®.

Kusintha kuchokera ku mankhwala ena a hypoglycemic kupita ku Glyclad®

Pakusintha, muyezo komanso theka la moyo wam'mbuyomu uyenera kuganiziridwanso. Nthawi yosintha nthawi zambiri sikufunikira. Kuvomereza kwa mankhwala Glyclada® kuyenera kuyamba ndi 30 mg, kutsatiridwa ndikusintha malinga ndi momwe metabolic anachita.

Mukasintha kuchokera ku mankhwala ena a gulu la sulfonylurea ndi moyo wautali wa moyo, kuti mupewe kuwonjezereka kwa mankhwalawa, nthawi yopanda mankhwala masiku angapo ingafunike.

Zikatero, kusintha kwa mapiritsi a Glyclad® kuyenera kuyamba ndi mlingo woyambirira wa 30 mg, kenako ndikuwonjezereka kwa mlingo kutengera mphamvu ya metabolic.

Gwiritsani ntchito limodzi ndi mankhwala ena antidiabetes

Gliclada® ikhoza kulembedwa molumikizana ndi biguanides, alpha-glucosidase inhibitors kapena insulin. The munthawi yomweyo mankhwala a insulin ayenera kuyamba kuyang'aniridwa ndi dokotala.

Okalamba okalamba (woposa zaka 65)

Mankhwala ndi mankhwala omwewo omwe ali ndi zaka zosakwana 65.

Odwala wofatsa kapena wolimbitsa aimpso ntchito, mankhwala ndi mankhwala mwachizolowezi Mlingo.

Odwala omwe ali ndi chiopsezo chowonjezeka cha hypoglycemia: kuperewera kwa zakudya m'thupi, kuperewera kwambiri kapena kuperewera kwapafupipafupi kwa endocrine (hypopituitarism, hypothyroidism, kusowa kwa adrenocorticotropic hormone, pambuyo poti pakhale nthawi yayitali komanso / kapena mlingo waukulu wa corticosteroid, matenda okhudzana ndi mtima. tsiku lililonse 30 mg.

Zotsatira zoyipa

hypoglycemia (vuto la kudya mosakhazikika kapena kudumphira chakudya): kupweteka mutu, kusowa kwa chakudya, nseru, kusanza, kutopa, kusokonezeka kwa tulo, kukhumudwa, kusokonezeka, kukwiya, kusamala kwambiri, kuchepetsa kuchepa, kupsinjika, kusowa chidwi, vuto lazowoneka ndi zolankhula. , aphasia, paresis, kunjenjemera, kuchepa mphamvu, chizungulire, bradycardia, kupsinjika, kulephera kudziletsa, kugona, kupuma osakhazikika, kugona, kugona, kupuma komanso kugona. Zizindikiro za adrenergic ndizotheka: thukuta lolimba, nkhawa, tachycardia, kuthamanga kwa magazi, kupweteka mumtima, arrhythmia

kupweteka kwam'mimba, kusanza, kusanza, kutsegula m'mimba, kudzimbidwa (kungachepetsedwe ndikumwa mankhwalawa pakudya kadzutsa)

kuchuluka kosinthika pamlingo wa hepatic enzymes (ALT, AST, zamchere phosphatase), hepatitis (kawirikawiri), hyponatremia

zotupa pakhungu, kuyabwa, urticaria, angioedema, erythema, maculopapular totupa, zotupa zina (monga Stevens-Johnson syndrome, poermal necrolysis yoopsa)

kuchepa magazi, leukopenia, thrombocytopenia, granulocytopenia, pancytopenia (kusintha pambuyo kuchotsedwa kwa mankhwala)

kuchepa kwa mawonekedwe kwakanthawi, makamaka kumayambiriro kwa chithandizo, chifukwa cha kusintha kwa shuga m'magazi

Contraindication

kudziwika kwa hypersensitivity kwa gliclazide kapena gawo lina lothandiza la mankhwalawo, komanso mankhwala ena a gulu la sulfonylurea kapena sulfonamides

mtundu 1 shuga

matenda ashuga ketoacidosis, precomatosis ndi matenda ashuga

kwambiri aimpso kapena chiwindi kulephera

mimba ndi mkaka wa m`mawere

Zochita zamankhwala osokoneza bongo

Kugwiritsa ntchito kwa gliclazide ndi miconazole kophatikizidwa chifukwa cha chiopsezo cha hypoglycemia, mpaka hypoglycemic coma.

Glyclazide siyikulimbikitsidwa kuti mugwiritse ntchito nthawi imodzi ndi phenylbutazone ndi mowa chifukwa chowonjezera chiopsezo cha hypoglycemia. Munthawi yamankhwala omwe mumalandira ndi mankhwalawa, ndikofunikira kupewa kumwa mowa ndikumwa mankhwala okhala ndi mowa.

Pokhudzana ndi chiwopsezo cha kukhala ndi hypoglycemia, kusamala kuyenera kugwiritsidwa ntchito popereka mankhwala a gliclazide ndi antidiabetic a magulu ena (insulins, acarbose, biguanides), beta-blockers, fluconazole, angiotensin-converting enzyme inhibitors (capopril, enalapril), ndi H2 receptor ant, ndi H2 receptor ant. (IMAO), sulfonamides ndi mankhwala osapweteka a antiidal.

Kugwiritsa ntchito gliclazide ndi danazol mosavomerezeka sikulimbikitsidwa chifukwa chakuwonjezeka kwa glucose wamagazi. Ngati ndi kotheka, kuikidwa kwa kuphatikiza kumeneku kuyenera kuwunika bwino kuchuluka kwa shuga m'magazi ndi mkodzo, ndipo nthawi zina, sinthani mlingo wa gliclazide munthawi ya chithandizo ndi danazol pambuyo pake.

Poona chiwopsezo cha kukhala ndi hyperglycemia, kusamala kuyenera kugwiritsidwa ntchito pophatikiza gliclazide ndi chlorpromazine (pa mlingo wa> 100 mg patsiku, chomaliza chimayambitsa kuchepa kwa insulin katulutsidwe). Pakutalika kwa mankhwala a chlorpromazine, mungafunike kusintha kwa gliclazide.

Glucocorticosteroids (wogwiritsa ntchito mwa zonse ndi wamba: intraarticular, sub- kapena subcutaneous, rectal) ndi tetracosactides, akagwiritsidwa ntchito limodzi ndi glycoslazide, amawonjezera kuchuluka kwa shuga m'magazi ndipo, chifukwa chakuchepa kwa kulolerana kwa carbohydrate, angayambitse ketosis. Pa mankhwala ndi pambuyo glucocorticoid mankhwala, kusintha kwa gliclazide kungafunike.

Chenjezo liyenera kugwiritsidwa ntchito pophatikiza gliclazide ndi ritodrine, salbutamol ndi tertbutaline (mtsempha wa magazi) chifukwa cha chiwopsezo cha kukhala ndi hyperglycemia. Ngati ndi kotheka, pitani ku insulin.

Ndi kuphatikiza kwa gliclazide ndi anticoagulants (warfarin, etc.), kuwonjezeka kwa anticoagulant kungawonedwe.

Malangizo apadera

Mankhwala ayenera kuikidwa pokhapokha ngati wodwala amadya chakudya (kuphatikizapo chakudya cham'mawa).

Chiwopsezo cha hypoglycemia chimawonjezeka ndi kadyedwe kochepa kalori, mutatha nthawi yayitali kapena kumwa kwambiri thupi, mukumwa mowa, kapena mukumagwiritsa ntchito mankhwala angapo a hypoglycemic.

Poganizira za chiwopsezo chowonjezereka cha hypoglycemia, tikulimbikitsidwa kuti nthawi zonse muzithanso kudya chakudya cham'madzi (ngati chakudya chimatengedwa mochedwa, ngati chakudya chosakwanira, kapena chakudya chikakhala ndi zakudya zochepa).

Hypoglycemia imatha kupezeka pambuyo pa kugwiritsa ntchito sulfonylurea. Nthawi zina zimakhala zazitali komanso zazitali. Kugonekedwa kuchipatala kungafunike, ndipo shuga angafunikire kwa masiku angapo.

Kuti muchepetse chiopsezo chokhala ndi gawo la hypoglycemic, kulangizidwa mosamala kwa wodwala ndikofunikira.

Zinthu zomwe zimawonjezera chiopsezo cha hypoglycemia:

Bongo

Kulephera kwamkati ndi chiwindi: Pharmacokinetic ndi pharmacodynamic zimatha gliclazide zimatha kusintha odwala ndi hepatic kapena kwambiri aimpso kulephera. Zolemba za Hypoglycemic zomwe zimachitika mwa odwalawa zimatenga nthawi yayitali, chifukwa chake kuwunika koyenera kuyenera kuchitidwa.

Wodwala ayenera kudziwitsidwa zakufunika kwakudya, kufunika kochita zinthu zolimbitsa thupi pafupipafupi komanso kuwunika pafupipafupi kuchuluka kwa shuga m'magazi. Odwala ndi mabanja awo akuyenera kufotokozera kuwopsa kwa hypoglycemia, kufotokoza za zizindikiro zake, njira zamankhwala othandizira komanso zinthu zomwe zikuwonetseratu kukula kwa vutoli.

Magazi ochepetsa magazi

Kugwiritsa ntchito bwino kwa kuwongolera kwa glucose m'magazi a wodwala omwe amalandila mankhwala othandizira odwala matenda ashuga angakhudzidwe ndi zinthu izi: kutentha thupi, kuvulala thupi, matenda, kapena kuchitapo kanthu opaleshoni. Nthawi zina, pangafunike kupereka mankhwala a insulin.

Mphamvu ya hypoglycemic ya mankhwala aliwonse otenga matenda am'mimba, kuphatikizapo gliclazide, mwa odwala ambiri amachepetsa pakapita nthawi chifukwa cha kuchuluka kwa matenda ashuga kapena kuchepa kwa kuyankha kwa mankhwalawa (kusowa kwenikweni kwa chithandizo). Mapeto a yachiwiri kusowa kwa zotsatira za mankhwala atha kupangidwa pokhapokha ngati mutha kusintha mlingo wokwanira ngati wodwalayo atsatira zakudya.

Mukamayang'ana momwe magazi a glucose amathandizira, tikulimbikitsidwa kuti mulingo wa glycated hemoglobin (kapena glucose mu plasma ya magazi a venous) uyesedwe.

Kupereka mankhwala a sulfonylurea kwa odwala omwe ali ndi vuto la shuga-6-phosphate dehydrogenase kungayambitse kuchepa kwa magazi m'thupi. Chenjezo liyenera kuchitika popereka gliclazide kwa odwala omwe ali ndi vuto la shuga-6-phosphate dehydrogenase, ndikuganizira njira zina zochizira ndi mankhwala ena.

Zambiri Mwapadera

Gliclada® ili ndi lactose. Odwala omwe ali ndi matenda osowa kwambiri a galactose tsankho, kuperewera kwa lappase kapena glucose-galactose malabsorption sayenera kumwa mankhwalawa.

Zambiri za momwe mankhwalawo amatha kuyendetsa magalimoto kapena njira zowopsa

Chenjezo liyenera kuchitidwa poyendetsa magalimoto kapena njira zina, makamaka poyambira chithandizo.

Bongo

Zizindikiro zolimbitsa kwambiri hypoglycemia.

Chithandizo: Zizindikiro za hypoglycemia wolimbitsa popanda kutaya chikumbumtima kapena zizindikiro za matenda amitsempha, kuthetsa kudya zamafuta, kusintha kwa mankhwala komanso / kapena kusintha kwa zakudya. Kuyang'aniridwa kwakanthawi kachipatala kuyenera kupitilizidwa mpaka adokotala awonetsetse kuti wodwala ndi wodekha komanso wopanda ngozi.

Zochitika zikuluzikulu za hypoglycemia, limodzi ndi chikomokere, kukomoka kapena matenda ena am'mitsempha, amafunikira chisamaliro chachipatala komanso kuchipatala msanga. Ngati hypoglycemic coma ikupezeka kapena mukukayikira, glucagon ndi 50 ml ya glucose solution (20-30% kudzera m'mitsempha) amayenera kubayidwa nthawi yomweyo, kenako ndikupitiliza kulowetsedwa kwa 10% shuga pamlingo womwe umatsimikizira kuti kuchuluka kwa shuga m'magazi kumapitilira 1 g / l . Wodwala ayenera kuyang'aniridwa mosamala ndi madokotala. Hemodialysis siyothandiza.

Gulu la mankhwala

Oral hypoglycemic othandizira, sulfonamides, urea zotumphukira. Code ATX A10V B09.

Glyclazide ndi mankhwala osokoneza bongo a hypoglycemic, omwe amachokera ku sulfonylurea, omwe amasiyana ndi mankhwala ena ndi kukhalapo kwa mphete ya heterocyclic yomwe ili ndi nayitrogeni ndipo imakhala ndi ma endocyclic.

Glyclazide imachepetsa kuchuluka kwa shuga m'magazi chifukwa cha kukondoweza kwa insulin chifukwa cha maselo β masisamba a pancreatic a Langerhans. Kuwonjezeka kwa kuchuluka kwa insulin ya postprandial ndi secretion ya C-peptide kumakhalabe ngakhale patatha zaka 2 ntchito mankhwalawa. Gliclazide ilinso ndi mphamvu ya hemovascular.

Zokhudza insulin katulutsidwe.

Odwala omwe ali ndi matenda amtundu wa II, gliclazide imabwezeretsa chiyambi champhamvu cha insulin chifukwa cha kuchuluka kwa shuga ndikuwonjezera gawo lachiwiri la insulin. Kuwonjezeka kwakukulu kwa insulin katulutsidwe kumachitika molingana ndi kuchuluka kwa chakudya kapena shuga.

Glyclazide imachepetsa microthrombosis chifukwa cha njira ziwiri zomwe zimathandizira pokonzekera zovuta za matenda osokoneza bongo:

pang'ono amalepheretsa kuphatikizana kwa kupatsidwa zinthu za m'magazi komanso zomatira, amachepetsa kuchuluka kwa zolembera zam'magazi (β-thromboglobulin, thromboxane B 2)
zimakhudza ntchito ya fibrinolytic ya mtima endothelium (imawonjezera ntchito ya tRA).

Mathero oyambilira anali ndi zochitika zazikulu kwambiri (kufa kwa mtima, kufooka kopanda magazi), kupha koopsa) komanso michere ya cellvascular (yatsopano kapena nephropathy, retinopathy).

Odwala 11,140 adaphatikizidwa pazoyesa zamankhwala. M'milungu isanu ndi umodzi ya nthawi yoyambitsa, odwalawo adapitiliza kumwa mankhwala ochepetsa shuga. Kenako, molingana ndi mfundo yosasinthika, odwala amapatsidwa gawo loyenera la glycemic control regimen (n = 5569) kapena regimen yoyendetsedwa ndi glycoslazide, mapiritsi osinthidwa, kutengera njira ya glycemia control (n = 5571). Njira yogwiritsira ntchito kwambiri glycemic control idakhazikitsidwa ndi gliclazide, mapiritsi okhala ndi masinthidwe osinthika, kuyambira koyambirira kwa chithandizo, kapena kuikidwa kwa gliclazide, mapiritsi okhala ndi kutulutsidwa kosinthika, m'malo mwa chithandizo chamankhwala (chithandizo chomwe wodwala adalandira panthawi yophatikizira), ndikuwonjezereka kwa mlingo mpaka muyeso kenako ndi kuphatikiza kwa mankhwala ena ochepetsa shuga, ngati kuli kotheka, monga metformin, acarbose, thiazolidinediones kapena insulin. Odwala amayang'aniridwa kwambiri ndikutsatira zakudya mosamalitsa.

Zowonerera zidatenga zaka 4.8. Zotsatira zamankhwala ndi gliclazide, mapiritsi otulutsidwa osinthika, omwe anali maziko a njira yolimbikitsira glycemic (pafupifupi momwe mulingo wa HbAlc - 6.5%) poyerekeza ndi kayendetsedwe ka glycemia wamba (pafupifupi momwe muliri wa HbAlc - 7.3%), panali kuchepa kwakukulu Chiwopsezo chapakati cha 10% cha zovuta zazikulu za macro- ndi microvascular ((HR) 0.90, 95% Cl 0.82, 0.98 p = 0.013, 18.1% ya odwala ochokera pagululi lolamulira kwambiri poyerekeza ndi 20% ya odwala ochokera pagululi kuyang'anira wamba). Ubwino wa njira yokhazikika yolamulira glycemic poika gliclazide, mapiritsi osinthika osinthika chifukwa cha mankhwalawa adachitika chifukwa cha:

kuchepa kwakukulu kwa chiwopsezo chochepa cha zochitika zazikulu za miseru ndi 14% (HR 0.86, 95% Cl 0.77, 0.97, p = 0.014, 9.4% motsutsana ndi 10.9%),
kuchepa kwakukulu kwa chiwopsezo chochepa cha milandu yatsopano kapena kupitirira kwa nephropathy ndi 21% (HR 0.79, 95% Cl 0.66 - 0.93, p = 0.006, 4.1% motsutsana ndi 5.2%),
kuchepa kwakukulu kwa 8% pachiwopsezo cha microalbuminuria chomwe chidachitika nthawi yoyamba (HR 0.92, 95% Cl 0.85 - 0.99, p = 0.030, 34.9% motsutsana ndi 37.9%),
kuchepa kwakukulu pachiwopsezo cha impso ndi 11% (HR 0.89, 95% Cl 0.83, 0.96, p = 0.001, 26.5% motsutsana.

Pamapeto pa kafukufukuyu, 65% ndi 81.1% ya odwala omwe ali mgulu lolamulira (motsutsana 28.8% ndi 50.2% ya gulu lolamulira wamba) adakwaniritsa HbAlc ≤ 6.5% ndi ≤ 7%, motsatana. 90% ya odwala omwe ali mu gulu lowongolera adatenga gliclazide, mapiritsi okhala ndi masinthidwe osinthika (pafupifupi tsiku lililonse mlingo anali 103 mg), 70% ya iwo amatenga mlingo wambiri tsiku lililonse wa 120 mg. Mu gulu la glycemic kwambiri lozikidwa pa gliclazide, mapiritsi osinthika osinthika, thupi la wodwalayo linakhazikika.

Ubwino wa njira yogwirira ntchito kwambiri glycemic yozikidwa pa gliclazide, mapiritsi osinthidwa osinthidwa, sizidalira kutsitsa magazi.

Mlingo wa gliclazide m'madzi a m'magazi umakwera nthawi ya 6 koloko, ndikufika paphiri la maola 6 mpaka 12 pambuyo pakupereka mankhwala.

Kusinthasintha kwa munthu payekha sikungatheke.

Glyclazide imalowerera kwathunthu. Kudya sikumakhudza kuchuluka ndi mayamwidwe ake.

Plasma kumanga mapuloteni pafupifupi 95%. Ubale pakati pa kumwa womwe umatengedwa pamlingo wofika pa 120 mg ndi dera lomwe limaponderezedwa nthawi yayitali. Voliyumu yogawa ndi pafupifupi malita 30.

Gliclazide imapukusidwa mu chiwindi ndikuchotsa mkodzo; zosakwana 1% ya zomwe zimagwira mumkodzo sizimasinthika. Palibe metabolites yogwira mu plasma.

Hafu ya moyo wa gliclazide ndi maola 12-20.

Odwala okalamba, palibe kusintha kwamankhwala kofunikira mu pharmacokinetics yamankhwala.

Mlingo umodzi wa mankhwala Glyclada, mapiritsi osinthika amasintha, amakhala ndi glycazide wa plasma kwa maola 24.

Type II matenda a shuga:

kuchepa ndi kuwongolera kwa glucose wa magazi pang'onopang'ono ngati shuga sangathe kusintha magazi pang'onopang'ono chifukwa cha chakudya, masewera olimbitsa thupi kapena kuchepa thupi
kupewa mavuto a mtundu II matenda oopsa: kuchepetsa chiopsezo cha macro- ndi microcotic, kuphatikiza milandu yatsopano kapena kufalikira kwa nephropathy mwa odwala omwe ali ndi mtundu II matenda a shuga.

Wopanga

Krka, dd Novo Mesto, Slovenia

6marješka 6, 8501 Novo Mesto, Slovenia

Adilesi ya bungweli yomwe imavomereza zodula kuchokera kwa ogula pamsika wazogulitsa (katundu) ku Republic of Kazakhstan

Krka Kazakhstan LLP, Kazakhstan, 050059, Almaty, Al-Farabi Ave. 19, nyumba 1 b,

Kuyanjana ndi mankhwala ena ndi mitundu ina yoyanjana

Pogwiritsa ntchito mankhwala, munthawi yomweyo makonzedwe omwe angayambitse hypo- kapena hyperglycemia, Sidid akuchenjeza wodwalayo za kufunika kowunika mosamala kuchuluka kwa shuga m'magazi panthawi ya chithandizo. Mlingo kusintha kwa mankhwala a hypoglycemic angafunike pambuyo komanso mukamaliza kumwa mankhwalawa.

Mankhwala omwe angapangitse chiwopsezo cha hypoglycemia

Miconazole (yogwiritsa ntchito makina, oromucous gel) imakulitsa zotsatira za hypoglycemic ndi chitukuko cha zizindikiro za hypoglycemia kapenanso kukomoka.

Osavomerezeka kuphatikiza

Phenylbutazone (wogwiritsa ntchito mwaudyidwe) amakulitsa mphamvu ya hypoglycemic ya sulfonylurea (amasintha kulumikizana kwake ndi mapuloteni a plasma ndipo / kapena amachepetsa kutulutsa kwake. Ndikofunika kugwiritsa ntchito mankhwala ena odana ndi kutupa ndikupangitsa chidwi cha wodwalayo pakufunika ndi kudziletsa. Ngati ndi kotheka, Mlingo wa Glyclad umawongoleredwera panthawi komanso pambuyo pa anti-kutupa mankhwala.

Mowa umapangitsa kuti hypoglycemic ichitike (poletsa zomwe zimachitika), zomwe zingayambitse khansa ya hypoglycemic. Pewani kugwiritsa ntchito mankhwala okhala ndi mowa, komanso kumwa mowa.

Kuphatikiza komwe kumafunikira kusamala

Kulimbikitsa mphamvu ya hypoglycemic ya mankhwala ndipo, nthawi zina, hypoglycemia imatha kukhazikika chifukwa chogwiritsidwa ntchito mofanananso ndi mankhwala ena opatsirana pogwiritsa ntchito mankhwala monga insulin, acarbose, metformin, thiazolidinediones, dipeptidyl peptidase 4 inhibitors, glucose-1-phosphate receptor agonists, ACE inhibitors (Captopril, enalapril), H 2 receptor antagonists, Mao inhibitors, sulfonamides, clarithromycin, komanso mankhwala osapatsa munthu a antiidal.

Mankhwala omwe angayambitse kuchuluka kwa shuga m'magazi

Osavomerezeka kuphatikiza

Danazole: Mphamvu ya diabetogenic ya Danazol.

Ngati kugwiritsa ntchito mankhwalawa sikungapewedwe, wodwalayo ayenera kuchenjezedwa za kufunikira kwakudziyang'anira pawokha mumkodzo ndi magazi. Pangakhale kofunikira kusintha ngati mumathandizira odwala omwe ali ndi vuto la matenda asidiabetic panthawi ndi pambuyo povomerezeka ndi danazol.

Kuphatikiza komwe kumafunikira kusamala

Chlorpromazine (antipsychotic): kugwiritsa ntchito milingo yayikulu ya chlorpromazine (> 100 mg patsiku) kumakulitsa kuchuluka kwa shuga m'magazi (chifukwa cha kuchepa kwa insulin katemera).

Wodwala ayenera kuchenjezedwa za kufunika ndikuwunika kuchuluka kwa shuga m'magazi. Pangakhale kofunikira kusintha mankhwala a antidiabetic yogwira ntchito panthawi komanso pambuyo pa chithandizo cha antipsychotic.

Glucocorticoids (yogwiritsa ntchito mwa zonse ndi zapakhungu: kukonzekera kwamkati, khungu ndi kukonzanso) ndi tetracosactrin kumakulitsa shuga wamagazi ndikutheka kwa ketosis (chifukwa cha kulekerera kwa chakudya chamthupi kudzera mu glucocorticoids).

Wodwala ayenera kuchenjezedwa za kufunika ndikuwunika kuchuluka kwa shuga m'magazi, makamaka kumayambiriro kwa chithandizo. Pangakhale kofunikira kusintha momwe antidiabetic othandizira amathandizira komanso pambuyo pa chithandizo cha glucocorticoid.

Ritodrin, salbutamol, terbutaline (c) amachulukitsa kuchuluka kwa shuga m'magazi chifukwa cha agonists a beta-2.

Iyenera kuchenjezedwa za kufunika koyendetsa magazi m'magazi. Ngati ndi kotheka, wodwala amayenera kupita ku insulin.

Kuphatikiza komwe muyenera kusamala

Chithandizo cha anticoagulants (monga warfarin, etc.) kukonzekera kwa sulfonylurea kumatha kupititsa patsogolo ntchito ya anticoagulant ndi chithandizo chogwirizana. Kusintha kwa mankhwalawa kwa anticoagulant kungafunike.

Zolemba ntchito

Chithandizo chimaperekedwa kwa odwala omwe amatha kutsatira chakudya chokwanira komanso chokhazikika (kuphatikizapo chakudya cham'mawa). Ndikofunika kuti mumatha kudya zakudya zamagulu kawiri kawiri kawiri chifukwa cha chiwopsezo cha hypoglycemia, chomwe chimachitika zakudya zikafika mochedwa, mosakwanira, kapenanso ngati chakudya chili chochepa m'thupi. Chiwopsezo cha hypoglycemia chimawonjezeka ndi zakudya zochepa zopatsa mphamvu, kuchita masewera olimbitsa thupi kwa nthawi yayitali komanso kumwa kwambiri.

Hypoglycemia imatha kuchitika chifukwa chogwiritsidwa ntchito nthawi imodzi ya sulfonylurea kukonzekera komanso (onani "Zosintha zina)" nthawi zina zimakhala zovuta komanso zimapitilira. Nthawi zina kuchipatala komanso kugwiritsa ntchito shuga kwa masiku angapo amafunikira.

Kuyesedwa kwathunthu kwa odwala, kugwiritsa ntchito mlingo winawake wa mankhwalawo ndikutsatira mosamalitsa Mlingo wofunsira ndikugwiritsira ntchito ndikofunikira kuti muchepetse chiopsezo cha hypoglycemia.

Zinthu zomwe zimawonjezera chiopsezo cha hypoglycemia:

kukana kapena (makamaka mwa odwala okalamba) kulephera kwa wodwala kugwirizana,
Zakudya zochepa zama calorie kapena zakudya zosakhazikika, chakudya, kusala kapena kusintha zakudya,
kuphwanya malire pakati pa zolimbitsa thupi ndi kuchuluka kwa chakudya,
kulephera kwa aimpso
kulephera kwambiri kwa chiwindi
mankhwala osokoneza bongo a Glyclad,
matenda ena a endocrine dongosolo: matenda a chithokomiro, hypopituitarism ndi adrenal kusakwanira,
kugwiritsa ntchito munthawi yomweyo mankhwala ena (onani gawo "Kuyanjana ndi mankhwala ena ndi mitundu ina yothandizirana").

Kulephera kwamkati ndi chiwindi

Pharmacokinetics ndi / kapena pharmacodynamics ya gliclazide amatha kusiyanasiyana kwa odwala omwe amalephera kapena aimpso. Magawo a hypoglycemia omwe amapezeka mwa odwala oterewa amatha nthawi yayitali ndipo amafunikira njira zina.

Zidziwitso Zodwala

Wodwalayo ndi abale ake ayenera kuchenjezedwa za chiwopsezo cha hypoglycemia, afotokozere zizindikiro zake (onani gawo "Zotsatira zoyipa"), chithandizo, komanso zinthu zomwe zimawonjezera chiopsezo cha chitukuko chake.

Odwala ayenera kudziwa kufunikira kwa zakudya, kuchita masewera olimbitsa thupi pafupipafupi, komanso kuchuluka kwa shuga wamagazi nthawi zonse.

Kuphwanya malamulo a magazi

Zinthu zotsatirazi zingakhudze kuchuluka kwa shuga m'magazi omwe ali ndi odwala omwe amamwa mankhwala a antiidiabetes: fever, trauma, matenda, kapena opareshoni. Nthawi zina, insulin ingafunike.

Mphamvu ya hypoglycemic yamankhwala amtundu uliwonse wa antidiabetes, kuphatikizapo gliclazide, amachepetsa pakapita nthawi ambiri mwa odwala: izi zimatha kuchitika chifukwa cha kuchuluka kwa matenda ashuga kapena kuchepa kwa mayankho a mankhwalawa. Zodabwitsazi zimadziwika kuti kulephera kwachiwiri, komwe kumasiyana ndi koyamba pomwe chinthu chogwira ntchito sichikuyenda bwino mankhwalawa ndi mankhwala a mzere woyamba. Kusintha kwa mlingo woyenera ndi zakudya ziyenera kuchitidwa musanatumize wodwalayo ku gulu lachiwiri lolephera.

Ndikulimbikitsidwa kudziwa mulingo wa glycosylated hemoglobin (kapena mulingo wa shuga mukusala kwamadzi am'magazi). Kudziyang'anira wekha wamagazi kungakhale koyenera.

Chithandizo cha odwala omwe ali ndi vuto la shuga-6-phosphate dehydrogenase ndi kukonzekera kwa sulfonylurea kungayambitse hemolytic anemia. Popeza gliclazide ndi ya gulu la mankhwala a sulfonylurea, odwala omwe ali ndi vuto la glucose-6-phosphate dehydrogenase ayenera kusamalanso; chithandizo china ndi mankhwala omwe alibe sulfonylurea iyenera kuganiziridwanso.

Malangizo Apadera Ponena za Zinthu Zina

Gliclada ili ndi lactose. Odwala omwe ali ndi chibadwa chochepa cha chibadwa cha lactose, omwe ali ndi galactosemia kapena shuga-galactose malabsorption sayenera kumwa mankhwalawa.

Gwiritsani ntchito pa nthawi yoyembekezera kapena mkaka wa m'mawere.

Palibe zokumana nazo zamagwiritsidwe ntchito a gliclazide pa nthawi yomwe ali ndi pakati, ngakhale pali umboni wina wogwiritsidwa ntchito kwa sulfonylureas ena.

Kuwongolera odwala matenda ashuga kuyenera kuchitika musanachitike pakati kuti muchepetse vuto la kubereka komwe kumachitika chifukwa cha kusowa kwa chiwongolero cha matenda ashuga.

Kugwiritsa ntchito mankhwala a antidiabetesic osavomerezeka sikulimbikitsidwa, insulin ndiye mankhwala akuluakulu ochiritsira matenda a shuga panthawi yapakati. Ndikulimbikitsidwa kusamutsa wodwala kupita ku insulin ngati ali ndi mimba yomwe yakonzekera kapena ikachitika.

Zambiri pazamalowedwe a gliclazide kapena ma metabolites ake mkaka wa m'mawere sizikupezeka. Popeza kuopsa kwa kukhala ndi hypoglycemia mwa mwana, kugwiritsa ntchito mankhwalawa kumapangidwa mwa azimayi omwe akuyamwitsa.

Kutha kusinthitsa kuchuluka kwa zochita mukamayendetsa kapena kugwiritsa ntchito njira zina.

Gliclada ilibe mphamvu yodziwika pakutha kuyendetsa galimoto kapena kugwira ntchito ndi makina. Komabe, odwala ayenera kusamala ndi kuyambika kwa zizindikiro za hypoglycemia ndipo ayenera kusamala poyendetsa kapena kugwiritsa ntchito makina, makamaka kumayambiriro kwa chithandizo.

Zotsatira zoyipa

Kutengera kuzindikira kwa gliclazide ndi zotumphukira za sulfonylurea, zotsatira zotsatirazi zanenedwapo.

Zakudya zoperewera, makamaka chakudya chamagetsi mukamakonzekera sulfonylurea, kuphatikizapo Glyclad, zingayambitse kukula kwa hypoglycemia. Zizindikiro zotheka za hypoglycemia: kupweteka mutu, kugona kwambiri, kusanza, kutopa, kugona tulo, nkhawa, kusakhazikika, kusokonezeka maganizo, kulephera kuzindikira komanso kuchepetsa zomwe zimachitika, kupsinjika, masomphenya komanso kuyankhula, aphasia, kunjenjemera, paresis, kusokonezeka kwa malingaliro. , chizungulire, kulephera kudziletsa, kupuma, kukoka, kupuma, bradycardia, kugona, kusazindikira komanso ngakhale kukulitsa chikomokere chakupha.

Kuphatikiza apo, pakhoza kuwonetseredwa vuto la adrenergic system: thukuta kwambiri, kukhathamira khungu, nkhawa, tachycardia, matenda oopsa, mtima palpitations, angina pectoris ndi arrhasmia.

Nthawi zambiri Zizindikiro zimatha pambuyo pa kudya chakudya chamagulu (shuga). Komabe, zotsekemera zaukatswiri zilibe ntchito. Zochitika ndi kukonzekera kwina kwa sulfonylurea kumawonetsa kuti hypoglycemia imatha kuchitika mobwerezabwereza, ngakhale ngati njira zoyesedwa zimachitika mwachangu.

Ngati magawo a hypoglycemia ali ovuta komanso opitilira, ngakhale atayang'aniridwa kwakanthawi ndi shuga, kufunikira kuchipatala mwachangu ndikofunikira kuchipatala ndikofunikira.

Milandu yambiri ya hypoglycemia imawonedwa mwa odwala omwe ali ndi chithandizo cha insulin.

Zotsatira zina zoyipa

Kuchokera m'mimba thirakiti: kupweteka kwam'mimba, nseru, kusanza, dyspepsia, kutsegula m'mimba ndi kudzimbidwa. Zizindikiro izi zimatha kuchotsedwa kapena kuchepetsedwa potenga gliclazide nthawi yam'mawa.

Izi ndizotsatira zoyipa zomwe sizachilendo.

Pa khungu ndi subcutaneous minofu: zotupa, kuyabwa, urticaria, angioedema, redness, maculopapular zidzolo, oxous zochita (mwachitsanzo, Stevens-Johnson syndrome ndi poizoni epermermal necrolysis).

Kuchokera kuzinthu zamagazi ndi zam'mimba: kusintha kwa ma hematological, kuphatikiza magazi, leukopenia, thrombocytopenia, granulocytopenia. Zochitika izi ndizosowa ndipo nthawi zambiri zimatha pambuyo pakutha kwa mankhwalawo.

Kumbali ya chiwindi ndi matenda amisempha: kuwonjezeka kwa michere ya chiwindi (AST, ALAT, alkaline phosphatase), hepatitis (milandu yotalikirana). Pankhani ya jaundice ya cholestatic, kugwiritsa ntchito mankhwalawa kuyenera kusiyiratu.

Kuchokera kumbali ya gawo la masomphenyawo: kuwonongeka kwakanthawi kowonekera, chifukwa cha kusinthika kwa kuchuluka kwa gluu m'magazi, kuwonongeka kwakanthawi kwamawonekedwe kumachitika, makamaka kumayambiriro kwa chithandizo.

Zotsatira zomwe zimapangidwa mu sulfonylurea:

Monga ndi kukonzekera kwina kwa sulfonylurea, pakhala pali zochitika za erythrocytopenia, agranulocytosis, hemolytic anemia, pancytopenia, allergic vasculitis, hyponatremia, ma enzymes okwera a chiwindi komanso kuwonongeka kwa chiwindi (mwachitsanzo, ndi cholestasis ndi jaundice) ndi hepatitis yomwe imatha pambuyo pakutha kapena milandu imodzi imatsogolera ku chiwopsezo cha chiwindi.

Mankhwala

Gliclazide imachepetsa shuga m'magazi chifukwa cha kukondoweza kwa insulin chifukwa cha maselo β maselo a pancreatic a Langerhans. Kuwonjezeka kwa kuchuluka kwa insulin ya postprandial ndi secretion ya C-peptide kumakhalabe ngakhale patatha zaka 2 ntchito mankhwalawa.

Gliclazide ilinso ndi mphamvu ya hemovascular.

Zokhudza insulin katulutsidwe.

Gliclazide imachepetsa microthrombosis ndi njira ziwiri zomwe zimathandizira pakupanga zovuta za matenda a shuga:

pang'ono amalepheretsa kuphatikizana kwa kupatsidwa zinthu za m'magazi komanso zomatira, amachepetsa kuchuluka kwa zolembera zam'magazi (β-thromboglobulin, thromboxane B 2)
zimakhudza ntchito ya fibrinolytic ya mtima endothelium (imawonjezera ntchito ya tRA).

Kupewa mavuto a matenda a shuga a mtundu II.

ADVANCE ndi mayesero apadziko lonse lapansi okhala ndi mayeso osiyanasiyana, okhala ndi cholinga chodziwitsa phindu la njira yolamulira glycemic (HbAlc ≤ 6.5%) kutengera mapiritsi otulutsidwa a glycoslide (Gliclazide MR) poyerekeza ndi kayendetsedwe ka magazi ka glycemic komanso phindu lochepetsa kuthamanga kwa magazi kukakamiza pogwiritsa ntchito kuphatikiza kwa perindopril / indapamide poyerekeza ndi placebo kumbuyo kwa chithandizo chamakono (kufananiza kwamaso awiri) molingana ndi zomwe zimachitika pakulu michere- ndi zochitika za microvascular odwala omwe ali ndi matenda a shuga a II.

Mathero oyambilira anali ndi zochitika zazikulu kwambiri (kufa kwa mtima, kufooka kopanda magazi), kupha koopsa) komanso michere ya cellvascular (yatsopano kapena nephropathy, retinopathy).

Phunziroli lidaphatikizapo odwala 11 140 omwe ali ndi mtundu wachiwiri wa matenda a shuga a mellitus (zikutanthauza: zaka 66, BMI (thupi misa) 28 kg / m 2, nthawi ya zaka 8 za shuga, HbAlc mulingo wa 7.5% ndi SBP / DBP (systolic kuthamanga kwa magazi / kuthamanga kwa magazi (diastolic magazi) 145/8 mmHg). Mwa odwala, 83% anali ndi matenda oopsa, mwa 325 odwala ndi 10%, matenda apachilengedwe ndi micro-michere adalembedwa m'mbiri ya matendawa, motsatana, ndipo mu 27%, microalbuminuria (MAU) adapezeka. Odwala ambiri ankalandira chithandizo cha matenda ashuga amtundu II, 90% - pomwa mankhwalawo (47% - monotherapy, 46% - chithandizo chowirikiza ndi 7% - katatu patatu) ndi 1% ndi insulin pomwe 9% anali pa chakudya basi. Poyamba, sulfonylurea (72%) ndi metformin (61%) ndiwo anali okhazikika. Thercomitant Therapy idaphatikizapo 75% ya mankhwala omwe amachepetsa kuthamanga kwa magazi (BP), mankhwala opatsirana ndi lipid (35%, makamaka ma statins - 28%), aspirin ndi ena othandizira antiplatelet (47%). Pakati pa masabata a 6 omwe akutsogolera kuphatikiza kwa perindopril / indapamide komanso ochiritsira ochepetsa shuga, odwala omwe ali ndi mfundo zosasankhidwa adayatsidwa gawo lodziwikiratu la glycemic regimen (n = 5569), kapena MR glycazide regimen kutengera luso la glycemia control (n = 5571). Njira yothanirana ndi vuto la glycemic kwambiri idachokera pakupanga mankhwala a Gliclazide MR kuyambira pachiwonetsero cha mankhwala kapena pa mankhwala a Gliclazide MR m'malo mwa chithandizo chamankhwala (chithandizo chomwe wodwala anali kulandira panthawi yophatikizidwa) ndi kuwonjezeka kwa mlingo mpaka pazofunikira ndiye, ngati kuli koyenera, kuwonjezera kwa mankhwala ena ochepetsa shuga, monga: metformin, acarbose, thiazolidinediones kapena insulin. Odwala amayang'aniridwa kwambiri ndikutsatira zakudya mosamalitsa.

Zowonerera zidatenga zaka 4.8. Zotsatira za chithandizo cha Gliclazide MR, chomwe chinali njira ya njira yolamulirira glycemic kwambiri (avareji ya HbAlc ndi 6.5%) poyerekeza ndi kayendetsedwe ka glycemia (pafupifupi gawo la HbAlc ndi 7.3%), kutsika kwakukulu kwa 10% chiopsezo chachikulu cha macro- ndi microvascular complication ((HR) 0.90, 95% Cl 0.82, 0.98 p = 0.013, 18.1% ya odwala ochokera pagululi lolamulira kwambiri poyerekeza ndi 20% ya odwala ochokera pagulu lolamulira). Ubwino wa njira yolimbana ndi glycemic kwambiri ndikusankhidwa kwa MR gliclazide pamaziko a chithandizo anali chifukwa:

kuchepa kwakukulu kwa chiwopsezo chochepa cha zochitika zazikulu za miseru ndi 14% (HR 0.86, 95% Cl 0.77, 0.97, p = 0.014, 9.4% vs 10.9%),
kuchepa kwakukulu pachiwopsezo chatsopano cha milandu yatsopano kapena kupitirira kwa nephropathy ndi 21% (HR 0.79, 95% Cl 0.66 - 0.93, p = 0.006, 4.1% vs 5.2%),
kuchepa kwakukulu pachiwopsezo chaching'ono cha microalbuminuria, chomwe chidayamba kwa nthawi yoyamba, ndi 8% (HR 0.92, 95% Cl 0.85 - 0.99, p = 0.030, 34.9% vs 37.9%),
kuchepa kwakukulu pachiwopsezo cha impso ndi 11% (HR 0.89, 95% Cl 0.83, 0.96, p = 0.001, 26.5% vs. 29.4%).

Pamapeto pa kafukufukuyu, 65% ndi 81.1% ya odwala omwe ali m'gulu lolamulira kwambiri (vs 28.8% ndi 50.2% ya gulu lolamulira wamba) adakwaniritsa HbAlc ≤ 6.5% ndi ≤ 7%, motsatana.

90% ya odwala omwe ali mu gulu lowongolera amatenga Gliclazide MR (pafupifupi tsiku lililonse mankhwala anali 103 mg), 70% ya iwo ankamwa mlingo wambiri tsiku lililonse wa 120 mg. Gulu lolamulira la glycemic lozikidwa pa Gliclazide MR, thupi la wodwalayo linakhazikika.

Phindu la Glycoslazide MR-based intly glycemic control njira sizinali zodalira kuchepetsa magazi.

Mlingo wa gliclazide m'madzi a m'magazi umakwera nthawi ya 6:00 koyamba, ndikufika paphiri lomwe limakhalapo kwa maola 6 mpaka 6 pambuyo popereka mankhwala. Gliclazide imalowetsedwa kwathunthu m'mimba. Kudya sikumakhudza kuchuluka ndi mayamwidwe ake.

Ubale pakati pa mlingo mpaka 120 mg ndi dera lomwe limaphatikizidwa ndi nthawi yotsalira. Kulumikizira mapuloteni a plasma ndi 95%.

Gliclazide pafupifupi imapukusidwa kwathunthu mu chiwindi ndikuchotsa mkodzo. Pansi pa 1% ya gliclazide amachotsedwa mu mkodzo. Palibe metabolites yogwira mu plasma.

Hafu ya moyo wa gliclazide kuchokera mthupi ndi maola 12-20. Voliyumu yogawa ndi pafupifupi malita 30.

Mukamagwiritsa ntchito limodzi mlingo wa mankhwalawa, kuchuluka kwa gliclazide m'madzi a m'magazi kumakhalabe kwa maola 24.

Mwa odwala okalamba, magawo a pharmacokinetic sasintha kwambiri.

Kusiyanasiyana kwamunthu payekha ndi kotsika.

Type II matenda a shuga:

kuchepa ndi kuwongolera kwa shuga wamagazi pomwe sizingatheke kutulutsa shuga pokhapokha mwa kudya, masewera olimbitsa thupi kapena kuwonda
kupewa mavuto a mtundu II matenda oopsa: kuchepetsa chiopsezo cha macro- ndi microcotic, kuphatikiza milandu yatsopano kapena kufalikira kwa nephropathy mwa odwala omwe ali ndi mtundu II matenda a shuga.

AnaChildren

Gwiritsani ntchito pa nthawi yoyembekezera kapena mkaka wa m'mawere

Kugwiritsa ntchito mankhwala a antidiabetesic osavomerezeka sikulimbikitsidwa, insulin ndiye mankhwala akuluakulu ochiritsira matenda a shuga panthawi yapakati. Ndikulimbikitsidwa kuti wodwalayo amasamutsire insulini pokhapokha ngati akukonzekera pakati kapena pakachitika.