Malangizo ogwiritsira ntchito mapiritsi a Amaryl

Piritsi limodzi la Amarsh 1 mg lili: yogwira mankhwala: glimepiride - 1 mg,

zotuluka: lactose monohydrate, sodium carboxymethyl wowuma (tun A), povidone 25000 (E1201), cellcosestalline cellulose (E460), magnesium stearate (E470), utoto wofiira wa oxide (E172).

Piritsi limodzi la Amarsh 2 mg lili: yogwira mankhwala: glimepiride - 2 mg,

zotuluka: lactose monohydrate, sodium carboxymethyl wowuma (mtundu A), povidone 25000 (E1201), microcrystalline cellulose (E460), magnesium stearate (E470), indalo carmine aluminium varnish (E132).

Piritsi limodzi la Amarsh 3 mg lili: yogwira mankhwala: glimepiride - 3 mg.

zotuluka: lactose monohydrate, sodium carboxymethyl wowuma (mtundu A), povidone 25000 (E1201), microcrystalline cellulose (E460), magnesium stearate (E470), utoto wachikasu wachitsulo (E172).

Piritsi limodzi la Amarsh 4 mg lili: yogwira mankhwala: glimepiride - 4 mg.

zotuluka: lactose monohydrate, sodium carboxymethyl wowuma (mtundu A), povidone 25000 (E1201), microcrystalline cellulose, magnesium stearate (E460), indigo carmine aluminium varnish (E132).

Amarsh 1 mg: Oblong, mapiritsi a pinki osalala ndi mbali zonse ndi poyambira yogawana mbali zonse ziwiri. Sitepe Yapamwamba: NMK / dzina la Brand. Sitampu yapansi: dzina la Brand / NMK.

Amarsh 2 mg: Oblong, mapiritsi obiriwira obiriwira kumbali zonse ndi poyambira yogawa mbali zonse ziwiri. Sitepe Yapamwamba: NMM / dzina la Brand. Sitampu yapansi: dzina la Brand / NMM.

Amarsh 3 mg: Oblong, miyala yosalala mbali zonse ziwiri za mtundu wachikasu wopepuka wokhala ndi poyambira mbali zonse ziwiri. Sitepe Yapamwamba: NMN / dzina la Brand. Sitampu yapansi: dzina la Brand / NMN.

Amarsh 4 mg: Oblong, miyala yosalala mbali zonse ziwiri za piritsi ya buluu yokhala ndi poyambira yogawa mbali zonse ziwiri. Stampu Yapamwamba: Dzina la NMO / Brand. Sitampu yapansi: dzina la Brand / NMO.

Zotsatira za pharmacological

Glimepiride, chinthu chogwira ntchito cha Amaril, ndi mankhwala a hypoglycemic (kuchepetsa-shuga) ogwiritsira ntchito pakamwa - zotumphukira za sulfonylurea.

Glimepiride imathandizira kubisalira ndi kutulutsidwa kwa insulini kuchokera ku cell ya beta ya kapamba (pancreatic athari), kumapangitsa chidwi cha zotumphukira (minofu ndi mafuta) kuchitira kwake kwina insulin (kutulutsa kwa extrapancreatic).

Sulfonylurea yotumphukira imayang'anira katemera wa insulin potseka njira zotsalira za potaziyamu za ATP zomwe zimapezeka mu cell wa cytoplasmic wa pancreatic beta cell. Titseka njira zam potaziyamu, zimayambitsa kukokoloka kwa maselo a beta, omwe amathandiza kutsegulira njira za calcium ndikuwonjezera kuchuluka kwa calcium m'maselo. Glimepiride, yokhala ndi malo ambiri olowa mmalo, imaphatikizana ndikuyamba kuchokera ku pancreatic beta-cell protein (molar misa 65 kD / SURX), yomwe imalumikizidwa ndi njira zotengera potaziyamu za ATP, koma zimasiyana ndi tsamba lomwe limamangidwa nthawi zonse

sulfonylureas (mapuloteni molar misa 140 kD / SUR1). . - X p>

Izi zimatsogolera kuti amasulidwe a insulin ndi exocytosis, pankhaniyi. - mtundu wa insulin yobisika umakhala wochepa kwambiri poyerekeza ndi sulfonylureas yachikhalidwe. Zosangalatsa zochepa za glimepiride pa insulin secretion zimapereka chiopsezo chochepa cha hypoglycemia.

Kuphatikiza apo, zotchulidwa za extrapancreatic zotsatira za glimepiride (kuchepa kwa insulin kukana, kuchepa kwamphamvu pa mtima dongosolo, anti-atherogenic, anti-aggregation ndi antioxidant zotsatira) zomwe zimasonyezedwanso, zomwe zimakhalanso ndi miyambo yachikhalidwe ya sulfonylurea, koma pang'ono.

Kugwiritsa ntchito bwino kwa glucose m'magazi ndi zotumphukira (minofu ndi mafuta) kumachitika pogwiritsa ntchito mapuloteni apadera oyendetsa (GLUT1 ndi GLUT4) omwe amapezeka mu cell membranes. Kutumiza kwa glucose mumisempha imeneyi mu mtundu wachiwiri wa shuga ndi gawo lochepetsera kugwiritsa ntchito shuga. Glimepiride mofulumira imachulukitsa kuchuluka ndi ntchito yama glucose onyamula ma cell (GLUT1 ndi GLUT4), zomwe zimapangitsa kuti chiwopsezo cha glucose chikhale ndi zotumphukira.

Glimepiride imakhala yofooka pang'ono pa K_ANjira za TF zamtima wamkati. Mukatenga glimepiride, kuthekera kwa kagayidwe kazinthu kosintha kwa myocardium kuti ischemia amasungidwe.

Glimepiride imawonjezera ntchito ya glycosyl phosphatidylinositol-enieni phospholipase C, pomwe mankhwala osokoneza bongo a lipoenais ndi glycogeneis amatha kuthandizira m'misempha yokhayokha ya minofu ndi mafuta.

Glimepiride imalepheretsa kupanga kwa glucose m'chiwindi mwa kuchulukitsa kuchuluka kwa chidwi cha fructose-2,6-bisphosphate, komwe kumapangitsa kuti gluconeogeneis.

Glimepiride mosamala imalepheretsa cycloo oxygenase ndikuchepetsa kutembenuka kwa arachidonic acid kukhala thromboxane A2, yomwe imalimbikitsa kuphatikizana kwa maselo, potero kupereka mphamvu ya antithrombotic.

Glimepiride imathandizira kuti mapangidwe a lipid agwirizane, amachepetsa kuchuluka kwa aldehyde m'magazi, zomwe zimayambitsa kuchepetsedwa kwakukulu kwa lipid peroxidation, izi zimapangitsa kuti anti-atherogenic zotsatira za mankhwala. Glimepiride imachulukitsa gawo la endo native a-tocopherol, zochitika za catalase, glutathione peroxidase ndi superoxide dismutase, zomwe zimathandizira kuchepetsa zovuta za oxidative mu thupi la wodwalayo, lomwe limapezekapezeka nthawi zonse mu mtundu 2 shuga.

Mwa anthu athanzi, osachepera ogwira pakamwa mlingo wa glimepiride ndi 0,6 mg. Mphamvu ya glimepiride ndi kumwa modalira ndi kubereka. Kuyankha kwakuthupi pakuchita zolimbitsa thupi kwambiri ndi kuchepa kwa insulin katulutsidwe pamene mukutenga glimepiride kumakhalabe.

Palibe kusiyana kwakukulu pakukhudzidwa, kutengera kuti mankhwalawo adatengedwa mphindi 30 asanadye kapena nthawi yomweyo asanakadye chakudya. Mwa odwala omwe ali ndi matenda ashuga, kuwongolera kwa metabolic kokwanira pa maola 24 kungatheke mwa kumwa kamodzi tsiku lililonse.

Ngakhale kuti glimepiride hydroxymetabolite idapangitsa kuchepa kwakachepa kwamagazi m'magazi athanzi, metabolite iyi imangoyang'anira gawo laling'ono la zotsatira zamankhwala.

Kuphatikiza Therapy ndi Metformin

Kafukufuku wina wachipatala, zidatsimikizika kuti odwala omwe ali ndi zotsatira zosakwanira zamankhwala, ngakhale atapeza mlingo waukulu wa metformin, kugwiritsa ntchito pamodzi kwa glimepiride ndi metformin kumapereka kuyendetsa bwino kwa metabolic poyerekeza ndi metformin monotherapy.

Kuphatikiza mankhwala ndi insulin

Zomwe zimaphatikizidwa ndi glimepiride ndi insulin ndizochepa. Odwala omwe sanalandire chithandizo chamankhwala omwe ali ndi Mlingo wambiri wa glimepiride amatha kuyamba nthawi yomweyo insulin. M'mayeso awiri azachipatala, kuphatikiza chithandizo kunaperekanso kusintha kwa metabolic monga insulin monotherapy, komabe, pankhani yophatikiza mankhwalawa, kuchepetsa kwa insulin kunafunikira.

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Ana ndi achinyamata

Chiyeso chachipatala chokhala ndi mphamvu yogwira (glimepiride mpaka 8 mg patsiku kapena metformin mpaka 2,000 mg patsiku) masabata makumi awiri ndi atatu anachitika ndi ana 285 (azaka 8 mpaka 17) omwe ali ndi matenda a shuga a 2. Mapulogalamu onse awiriwa, glimepiride ndi metformin, adawonetsa kuchepa kwakukulu kwa HbAlc polemekeza kuchuluka koyamba kwa glimepiride -0.95 (mu seramu 0, 41), metformin -1.39 (mu seramu 0.40). Ngakhale izi, glimepiride sizinakwaniritse mawonekedwe a "kukhala oyipitsitsa kuposa metformin", kuweruza ndi kusintha kwapakati pa HbAlc pankhani yoyang'anira koyamba. Kusiyana kwake kunali 0.44% pokomera metformin. Upper malire (1.05) 95% chidaliro

kutalika kwakusiyanako kunali kokulirapo kuposa malire ovomerezeka osakwanira pang'ono ofanana ndi 0.3%,

Chithandizo cha glimepiride sichinawululire zowonjezera zokhudzana ndi chitetezo cha ana poyerekeza ndi zomwe zimachitika kwa odwala akuluakulu omwe ali ndi matenda a shuga a 2. Palibe zambiri kuchokera ku kafukufuku wautali wautali komanso maphunziro a chitetezo cha odwala.

Pharmacokinetics

Mukamwetsa glimepiride zake bioavailability wathunthu. Kudya kulibe vuto lililonse chifukwa chonyakamira, kupatula pang'ono pang'onopang'ono pakuyamwa. Kugwiritsa ntchito glimepiride mobwerezabwereza tsiku lililonse la 4 mg, pazipita ndende yamagazi seramu (C_mosamala) imafikiridwa patatha pafupifupi maola 2,5 ndipo imakhala 309 ng / ml, pali ubale wolumikizana pakati pa mlingo ndi Stax, komanso pakati pa mlingo ndi AUC (dera lomwe lili pansi pa nthawi yotsalira).

Glimepiride imadziwika ndi gawo lotsika kwambiri (pafupifupi 8.8 L), pafupifupi lofanana ndi kuchuluka kwa kugawa kwa albumin, chomangira kwambiri mapuloteni a plasma (oposa 99%) komanso chilolezo chotsika (pafupifupi 48 ml / min).

Biotpansformatssh ndi kuchotsedwa

Pambuyo pakamwa limodzi lokha la glimepiride, 58% amachotsera mkodzo ndipo 35% amakhala ndi ndowe. Zinthu zosasinthika mkodzo sizinapezeke. Kuchotsa theka moyo plasma wozungulira wa mankhwala seramu lolingana ndi angapo dosing regimen ndi 5-8 maola. Mutatenga mlingo waukulu, theka la moyo limakulitsidwa pang'ono.

Ma metabolites awiri osagwira ntchito amadziwika mkodzo ndi ndowe, zomwe zimapangidwa chifukwa cha kagayidwe kachakudya mu chiwindi, imodzi imachokera mu hydroxy, ndipo inayo ndi yochokera ku carboxy. Pambuyo pakuyamwa kwa glimepiride, theka lamoyo la ma metabolites awa ndi maola 3-5 ndi maola 5-6, motero.

Glimepiride amamuchotsa mkaka wa m'mawere ndikuwoloka chotchinga. Mankhwala amalowa bwino kudzera mu chotchinga cha magazi.

Kuyerekeza kwa osakwatiwa komanso angapo (kamodzi patsiku) kayendedwe ka glimepiride sikunawonetse kusiyana kwakukulu pama parachetinetic magawo, ndipo kusiyana kwawo kotsika kwambiri kunawonedwa pakati pa odwala osiyanasiyana. Kuchulukitsa kwakukulu kwa mankhwalawo kunalibe.

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Ma paracokinetic magawo ndi ofanana mwa odwala azikhalidwe zosiyanasiyana komanso azaka zosiyanasiyana. Odwala omwe ali ndi vuto la aimpso (okhala ndi vuto lochepera la creatinine), panali chizolowezi chowonjezera kutsimikiza kwa glimepiride komanso kutsika kwake kwakukhudzidwa kwambiri mu seramu yamagazi, yomwe imachitika makamaka chifukwa cha kufulumira kwa mankhwalawa chifukwa cha kutsika kwa mapuloteni. Chifukwa chake, m'gulu lino la odwala palibe chiopsezo chowonjezereka cha mankhwalawa.

Kuyesedwa kwa kuphunzira za pharmacokinetics, chitetezo, ndi kulekerera kwa 1 mg imodzi ya glimepiride mwa odwala 30 (ana 4 azaka 10 mpaka 12 ndi ana 26 wazaka 12-17) omwe ali ndi matenda a shuga 2 -i_mongat, C_max ndi X fanizochny zoyesedwa m'mbuyomu.

Contraindication

Glimepiride sayenera kugwiritsidwa ntchito:

• Hypersensitivity glimepiride kapena chinthu chilichonse chofooka cha mankhwalawo, ku zotumphukira zina za sulfonylurea kapena mankhwala a sulufa.

• wodwala matenda a shuga

• matenda ashuga ketoacidosis, matenda a shuga ndi mpweya,

• kukanika kwambiri kwa chiwindi,

• kwambiri aimpso kuwonongeka (kuphatikizapo odwala hemodialysis),

• mimba ndi mkaka wa m`mawere.

Mimba komanso kuyamwa

Glimepiride ndi contraindicated mwa amayi apakati. Ngati mayi wapezeka kuti ali ndi pakati kapena pokhapokha ngati ali ndi pakati, mkazi ayenera kuthandizidwa ndi insulin.

Popeza glimepiride, mwachiwonekere, imadutsa mkaka wa m'mawere, sayenera kuperekedwa kwa azimayi panthawi yobereka. Pankhaniyi, ndikofunikira kusinthira ku insulin mankhwala kapena kusiya kuyamwitsa.

Mlingo ndi makonzedwe

Cholinga cha pakamwa.

Chomwe chikuyendetsa bwino matenda a shuga ndichakudya choyenera, kuchita masewera olimbitsa thupi, komanso kuwunika magazi ndi mkodzo pafupipafupi. Kupatuka pamafotokozedwe azakudya sizingalipidwe ndi mapiritsi kapena insulin.

Koyamba mlingo ndi kusankha kwa mankhwala

Mlingo wa glimepiride amatsimikiza mwa kuwunika kwa shuga m'magazi ndi mkodzo.

Mlingo woyambirira ndi 1 mg ya glimepiride patsiku, ngati munthawi yomweyo zinthu zikuyenda bwino - mankhwalawa amayenera kusungidwa pakumwa.

Kwa mitundu yina ya dosing, mapiritsi amapezeka pamiyeso yoyenera.

Ngati ndi kotheka, tsiku ndi tsiku mlingo ungathe kuwonjezeka pang'onopang'ono poonetsetsa kuchuluka kwa shuga m'magazi (mosinthana ndi masabata a 1-2) komanso motere: 1 mg - 2 mg - 3 mg - 4 mg glimepiride patsiku.

Mlingo wa glimepiride owonjezera 4 mg pa tsiku umabweretsa zotsatira zabwino pokhapokha pokhapokha. Pazipita la tsiku lililonse lofika 6 mg.

Nthawi ndi pafupipafupi kumwa mlingo wa tsiku ndi tsiku zimatsimikiziridwa ndi adokotala, poganizira moyo wa wodwalayo. Monga lamulo, kuikidwa kwa tsiku ndi tsiku mlingo umodzi musanadye kapena panthawi ya chakudya cham'mawa kapena, ngati tsiku lililonse mulibe

idatengedwa nthawi yoyamba isanayambe kapena panthawi yachakudya choyamba. Kusintha kwa mankhwalawa sikuyenera kuthetsedwera pambuyo pake pakukonzekera mlingo wapamwamba. Mapiritsi a Amaril amatengedwa kwathunthu, osafuna kutafuna, ali ndi madzi okwanira (pafupifupi makapu 0,5). Ndikofunika kwambiri kuti musadumphe zakudya mutatha Amaril.

Gwiritsani ntchito limodzi ndi metformin

Ngati zosakwanira kukhazikika kwa shuga m'magazi odwala akutenga metformin, mankhwala oyanjana ndi glimepiride angayambike. Ndikusungabe mlingo wa metformin pamlingo womwewo, chithandizo ndi glimepiride chimayamba ndi mlingo wochepa, kenako mlingo wake umakulitsidwa pang'onopang'ono malingana ndi kuchuluka kwa gawo la 6 mg. Kuphatikiza mankhwala kuyenera kuchitika moyang'aniridwa ndi achipatala.

Gwiritsani ntchito limodzi ndi insulin

Mu milandu yomwe sizingatheke kukwaniritsa kuchuluka kwa shuga m'magazi mwa kutenga mlingo waukulu wa glimepiride mu monotherapy kapena kuphatikiza ndi mlingo waukulu wa metformin, kuphatikiza kwa glimepiride ndi insulin. Pankhaniyi, mlingo womaliza wa glimepiride woperekedwa kwa wodwala amakhalabe wosasinthika. Pankhaniyi, mankhwala a insulin amayamba ndi mlingo wochepera, ndikuwonjezereka kwapang'onopang'ono kwa mlingo wa insulin motsogozedwa ndi kuchuluka kwa shuga m'magazi. Kuphatikiza chithandizo kumafunika kuyang'aniridwa kuchipatala. Ndikusungabe nthawi yayitali glycemic control, kuphatikiza mankhwalawa kumatha kuchepetsa zofuna za insulini mpaka 40%.

Kusamutsa wodwala kuchokera ku mankhwala ena amkamwa a hypoglycemic kuti glimepiride Palibe ubale weniweni pakati pa Mlingo wa glimepiride ndi mankhwala ena amkamwa a hypoglycemic. Posamutsidwa kuchokera ku mankhwalawa kukhala glimepiride, mlingo woyambirira wa tsiku lomaliza uyenera kukhala 1 mg (ngakhale wodwalayo asamutsira glimepiride ndi mlingo waukulu wa mankhwala ena amkamwa a hypoglycemic).Kuwonjezeka kulikonse kwa glimepiride kuyenera kuchitika m'magawo, chifukwa cha kuyankha kwa glimepiride molingana ndi malangizo omwe ali pamwambawa. M'pofunika kuganizira mlingo ntchito ndi nthawi ya zotsatira za hypoglycemic wothandizira. Nthawi zina, makamaka mukamamwa mankhwala a hypoglycemic ndi theka lalitali-moyo (mwachitsanzo, chlorpropamide), zingakhale zofunikira kwakanthawi (m'masiku ochepa) kusiya kumwa mankhwala kuti mupewe chiwopsezo cha hypoglycemia.

Kusamutsa wodwala kuchokera ku insulin kupita ku glimepiride

Muzochitika zapadera, ngati odwala omwe ali ndi mtundu wa shuga wachiwiri amalandila mankhwala a insulin, ndiye kuti ndi kubwezeredwa kwa matendawa komanso ndi chinsinsi cha magawo a pancreatic beta cell, atha kuwonetsedwa kusintha kwa glimepiride. Kutanthauzira kuyenera kuchitika moyang'aniridwa ndi achipatala. Pankhaniyi, kusamutsa wodwala ku glimepiride kumayamba ndi kuchuluka kwa glimepiride 1 mg.

Kugwiritsa ntchito impso ndi chiwindi

Zosakwanira zomwe zimapezeka pakugwiritsa ntchito mankhwalawa odwala omwe ali ndi impso komanso chiwindi (onani gawo Contraindication).

Ana ndi achinyamata

Zambiri pakugwiritsa ntchito glimepiride mwa odwala omwe ali ndi zaka 8 sizipezeka. Kwa ana a zaka zapakati pa 8 ndi 17, pali zochepa zomwe zimagwiritsidwa ntchito pa glimepiride mwanjira ya monotherapy (onani gawo la Pharmacokinetics ndi Pharmacodynamics). Zambiri zomwe zilipo pakuwoneka bwino ndi chitetezo sizokwanira kugwiritsa ntchito glimepiride mu ana, chifukwa chake kugwiritsa ntchito koteroko sikololedwa.

Zotsatira zoyipa

Zambiri pazotsatira zoyipa zomwe zimachitika chifukwa cha kutenga glimepiride ndi zina zotumphukira za sulfonylurea zimaperekedwa pansipa pamayeso azachipatala. Zotsatira zoyipa zimagawidwa m'magulumagulu a ziwalo zamagulu ndipo zimayikidwa m'magulu kuti zitsike pafupipafupi (kawirikawiri:> 1/10, nthawi zambiri:> 1/100, 1/1000, 1/10000,

Bongo

Pambuyo pakuyamwa kwa mlingo waukulu wa glimepiride, kukula kwa hypoglycemia ndikotheka, kuchokera kwa maola 12 mpaka 72, komwe kungachitike mobwerezabwereza pambuyo pobwezeretsanso koyamba kuchuluka kwa shuga m'magazi. Hypoglycemia nthawi zambiri imatha kuyimitsidwa mwachangu ndi kudya kwakanthawi kwamatumbo (shuga kapena shuga, mwachitsanzo, mu mawonekedwe a chidutswa cha shuga, msuzi wa zipatso zotsekemera kapena tiyi). Pankhaniyi, wodwalayo ayenera kukhala ndi shuga pafupifupi 20 g (zidutswa 4 za shuga). Zomakoma sizothandiza pochita hypoglycemia. Nthawi zambiri, kuyang'anira kuchipatala ndikulimbikitsidwa. Chithandizo chimaphatikizira kusanza, kumwa madzi (madzi kapena mandimu okhala ndi makala ophatikizika (adsorbent) ndi sodium sulfate (mankhwala opaka). Mukamamwa mankhwala ambiri, kupweteka kwam'mimba kumasonyezedwa, ndikutsatira kukhazikitsidwa kwa makala olimbitsa ndi sodium sodium. Chithunzi cha matenda oopsa a hypoglycemia chithunzi cha matenda a stroke, motero, chimafuna chithandizo chamankhwala oyang'aniridwa ndi adokotala, komanso m'malo ena ndi kuchipatala kwa wodwala. Mwadzidzidzi, kuyambitsa shuga, ngati kuli kofunikira Mwanjira ya jekeseni wa 50 ml ya 40% yankho, kenako kulowetsedwa kwa 10% yankho mosamala pakuwunika kwa shuga m'magazi, chithandizo china chiyenera kukhala chisonyezo.

Zizindikiro za hypoglycemia zimatha kusunthika kapena kusowa kwathunthu kwa odwala okalamba, odwala omwe ali ndi vuto lauronomic kapena kulandira chithandizo cha munthawi yomweyo ndi p-adrenoblockers, clonidine, reserpine, guanethidine kapena othandizira ena.

Wodwala yemwe akudwala matenda ashuga amathandizidwa ndi madotolo osiyanasiyana (mwachitsanzo, pomwe ali kuchipatala pambuyo pangozi, atadwala kumapeto kwa sabata), ayenera kuwauza za matenda ake komanso za chithandizo cham'mbuyomu.

Mankhwala a hypoglycemia omwe adayamba chifukwa cha mwangozi a Amaril ndi ana kapena ana aang'ono, mlingo wa dextrose (50 ml wa yankho la 40%) uyenera kuyang'aniridwa mosamala kuti mupewe hyperglycemia yoopsa. Pankhani imeneyi, kuyang'anira mosamalitsa kuchuluka kwa shuga m'magazi ndikofunikira.

Kuchita ndi mankhwala ena

Pankhani ya kugwiritsa ntchito mitundu ina ya mankhwala osokoneza bongo, kuchepa kosafunikira komanso kuwonjezeka kosayenera kwa hypoglycemic zotsatira za glimepiride kumatha kuchitika. Motere, mankhwala ena amatha kumwedwa kokha ndi chilolezo (kapena monga akuwongolera) dokotala.

Glimepiride imapangidwa ndi cytochrome P4502C9, yomwe iyenera kugwiritsidwa ntchito ngati imagwiritsidwa ntchito limodzi ndi inducers (mwachitsanzo rifampicin) kapena ma inhibitors (mwachitsanzo fluconazole).

Mu machitidwe a vivo omwe adasindikizidwa m'mabukuwa akuwonetsa kuti fluconazole, imodzi mwa zoletsa zamphamvu kwambiri za CY32C9, imawonjezera AUC ya glimepiride pafupifupi nthawi 2.

Kutengera momwe zinachitikira ndi glimepiride ndi zotumphukira zina za sulfonylurea, zochitika zotsatirazi ziyenera kudziwika.

Kuwonjezeka kwa zotsatira za hypoglycemic komanso kusintha kwa hypoglycemia komwe kumayenderana ndi izi kungaonedwe pamodzi ndi kugwiritsa ntchito munthawi yomweyo glimepiride ndi mankhwala otsatirawa:

- phenylbutazone, azapropazone, oxyphenbutazone,

- insulin ndi mankhwala ena a hypoglycemic, monga metformin,

- salicylates ndi aminosalicylic acid,

- anabolic steroids ndi mahomoni ogonana amuna,

- chloramphenicol, ena omwe akhala akuchita sulfonamides, tetracyclines, quinolones ndi clarithromycin,

- angiotensin otembenuza enzyme (ACE) zoletsa,

- fluoxetine, monoamine oxidase inhibitors (MAO),

- allopurinol, phenenicide, sulfinpyrazone,

- cyclo-, tro- ndi ifosfamides,

- pentoxifylline (ndi makina oyang'anira

Kuchepa kwa mphamvu ya hypoglycemic ndikuwonjezereka kwa kuchuluka kwa shuga m'magazi kungaoneke pamodzi ndi munthawi yomweyo kugwiritsa ntchito glimepiride ndi mankhwala otsatirawa:

- estrogens ndi progestogens,

- saluretics ndi thiazide okodzetsa,

- mahomoni a chithokomiro, glucocorticosteroids

- epinephrine ndi othandizira ena achifundo,

- nicotinic acid (muyezo waukulu) ndi zotumphukira za nicotinic acid,

- mankhwala othandizira (osagwiritsidwa ntchito nthawi yayitali),

- glucagon, barbiturates ndi rifampicin,

Zotchinga N₂ma receptor, clonidine ndi reserpine amatha kuphatikiza ndikuchepetsa mphamvu ya hypoglycemic ya glimepiride.

Mothandizidwa ndi othandizira achifundo, monga beta-blockers, clonidine, guanethidine ndi reserpine, zizindikiro za kutsutsa kwa adrenergic poyankha hypoglycemia zitha kuchepetsedwa kapena kulibe.

Poyerekeza ndi kutenga glimepiride, kuwonjezeka kapena kufooka kwa zomwe zimachitika mu coumarin zitha kuonedwa.

Kumwa mowa kamodzi kapena kosatha kumatha kukulitsa ndi kufooketsa mphamvu ya gloglycemic ya glimepiride.

Zolemba ntchito

Glimepiride iyenera kumwedwa nthawi yomweyo musanadye kapena chakudya.

Ngati zakudya zimwedwa mosiyanasiyana kapena kudumpha paliponse, wodwala yemwe amalandila chithandizo cha glimepiride akhoza kuyamba

hypoglycemia. Zizindikiro zotheka za hypoglycemia ndi monga: kupweteka mutu, kugona kwambiri, kusanza, kusanza, kumva kutopa, kugona, kusokonezeka kwa tulo, nkhawa, kupsa mtima, kusokonezeka kwa chidwi, chidwi ndi kuchitapo, kukhumudwa, kusokonezeka, kuyankhula ndi zosokoneza. , kusokonezeka kwa malingaliro, chizungulire, kumva kusowa pogwira, kulephera kudziletsa, chisangalalo, ubongo, kusokonezeka ndi kusazindikira, kuphatikiza chikomokere, kupuma kosafunikira, bradycardia. Kuphatikiza apo, chifukwa cha mayendedwe a adrenergic, zizindikiro monga kuzizira, thukuta lambiri, nkhawa, tachycardia, matenda oopsa a mtima, kukoka kwa mtima, angina pectoris, ndi kusokonekera kwa mtima.

Mawonetsero azachipatala owonetsa kwambiri hypoglycemia angafanane ndi mawonedwe azachipatala a sitiroko.

Pafupifupi nthawi zonse, Zizindikiro zimatha kuwongolera mwachangu chifukwa cha kuchuluka kwa ma hydrocarbons (shuga). Zokometsera zopanga sizigwira ntchito nthawi imodzi.

Monga momwe amadziwira kuchokera pakugwiritsa ntchito zinthu zina za sulfonylurea, ngakhale atagwiritsa ntchito bwino poyambira penogono, pambuyo pake hypoglycemia ikhoza kubwereranso.

Hypoglycemia yayitali kapena yayitali, yomwe imangoyendetsedwa kwakanthawi ndi shuga wambiri, imafunikira kuchipatala mwachangu kapena ngakhale kuchipatala.

Zomwe zimathandizira kukhazikitsa hypoglycemia zimaphatikizapo:

- kukayikira kapena (nthawi zambiri muukalamba) kusakwanira kwa odwala kumagwirizana ndi dokotala, zoperewera, zakudya zopanda pake, kudumpha chakudya, kusala kudya,

- Zosintha zakudya

- Kusagwirizana pakati pa zolimbitsa thupi ndi chakudya

-kumamwa mowa, makamaka kuphatikiza ndi kudya zakudya,

- aimpso kuwonongeka, chiwindi ntchito kwambiri,

- matenda ena osawerengeka a endocrine system yomwe imakhudza kagayidwe kazakudya, kapena kafotokozedwe ka hypoglycemia (mwachitsanzo, kukanika kwa chithokomiro, kusowa kwa pituitary kapena kusakwanira kwa adrenal cortex), kugwiritsa ntchito mankhwala ena (onani mogwirizana ndi mankhwala ena )

Kuchiza ndi glimepiride kumafuna kuwunika pafupipafupi kuchuluka kwa shuga m'magazi ndi mkodzo. Kuphatikiza apo, milingo ya glycosylated hemoglobin imalimbikitsa.

Komanso, pakumwa mankhwala a glimepiride, kuwunika pafupipafupi kwa chiwindi ndi kuwerengera m'magazi (makamaka leukocytes ndi mapulateleti) ndikofunikira.

M'mikhalidwe yovuta (mwachitsanzo, ngozi zitachitika, zochitika zadzidzidzi, matenda ophwa, etc.), kusintha kwakanthaŵi kwa insulini kungasonyezedwe.

Palibe chochitika ndi glimepiride mwa odwala omwe amalephera kwambiri aimpso kapena odwala omwe akufuna hemodialysis. Odwala omwe ali ndi vuto lalikulu laimpso kapena kwa hepatic akusowa akusintha kupita ku insulin.

Chithandizo cha mankhwala a sulfonylurea angayambitse hemolytic anemia mwa odwala omwe ali ndi shuga-6-phosphate dehydrogenase. Popeza glimepiride ndi ya gulu la sulfonylurea zotumphukira, iyenera kugwiritsidwa ntchito mosamala odwala omwe ali ndi vuto la shuga-b-phosphate dehydrogenase. Kuphatikiza apo, zosankha zamankhwala ziyenera kuganiziridwa ndi othandizira ena omwe mulibe sulfonylurea.

Amaryl imakhala ndi lactose monohydrate, chifukwa chake sayenera kumwedwa mwa odwala omwe ali ndi cholowa chokhala ndi lactose, kuperewera kwa lactase kapena mayamwidwe a glucose-lactose.

Kafukufuku wokhudzana ndi mphamvu ya glimepiride pakutha kuyendetsa magalimoto ndi machitidwe sanachitike. Kuyankha kwa wodwalayo kapena kuthekera kwachepetsa kumatha kuchepetsedwa chifukwa chokhazikitsa hypoglycemia kapena hyperglycemia, kapena, mwachitsanzo, chifukwa cha kuwonongeka kwa mawonekedwe. Izi zimatha kukhala zowopsa nthawi zomwe maluso amenewa ali ofunika kwambiri (mwachitsanzo, poyendetsa galimoto kapena makina).

Odwala ayenera kudziwitsidwa za kufunika kosamala kuti apewe hypoglycemia poyendetsa. Izi ndizofunikira kwambiri kwa odwala omwe ali ndi ma epicode a hypoglycemia, kapena odwala omwe sakwanira kwenikweni kapena samadziwa kwenikweni zizindikiro zoyambirira za hypoglycemia. Muzochitika izi, kuthekera kwa magalimoto oyendetsa kapena makina ogwiritsira ntchito kuyenera kulingaliridwa.

Kupanga ndi mawonekedwe a kumasulidwa

Amaryl amapangidwa m'mapiritsi okhala ndi 1-4 mg, omwe amawaika mu 15 zidutswa pachimake. Paketi imodzi ya mankhwalawa imatha kuphatikizira matuza a 2, 4, 6 kapena 8.

• Piritsi limodzi la mankhwalawa limaphatikizanso yogwira - glimepiride - 1-4 mg ndi zothandizira: lactose monohydrate, povidone, sodium carboxymethyl starch, cellcrystalline cellulose, indigo carmine ndi magnesium stearate.

Gulu la zamankhwala ndi mankhwala: pakamwa hypoglycemic mankhwala.

Malangizo ogwiritsira ntchito

Malinga ndi malangizo ogwiritsira ntchito, mulingo wa kukonzekera kwa Amaryl ndi Amaryl M umapangidwa ndi dokotala aliyense payekha kwa wodwala aliyense, kutengera kuchuluka kwa shuga kwa wodwala. Mankhwala ayenera kugwiritsidwa ntchito mu muyezo wochepa wokwanira kuti mupeze kuyamwa kwa metabolic.

Malangizo ogwiritsira ntchito Amaril amanenanso kuti mankhwalawa amafunikira kutsimikiza kwa shuga m'magazi komanso kuchuluka kwa hemoglobin ya glycosylated.

Mapiritsi a Amaryl ayenera kumwedwa kwathunthu, osafuna kutafuna, ndi madzi okwanira (pafupifupi chikho cha 1/2). Ngati ndi kotheka, mapiritsi a Amaryl ya mankhwala akhoza kugawidwa limodzi ndi zoopsa m'magawo awiri ofanana.

• Mlingo woyambirira wa Amaril ndi 1 mg 1 nthawi / tsiku. Ngati ndi kotheka, mlingo wa tsiku ndi tsiku ungathe kuwonjezeka pang'onopang'ono (masabata awiri ndi awiri) poyang'anitsitsa shuga wamagazi ndi zotsatirazi: 1 mg-2 mg-3 mg-4 mg-4 mg-6 mg (-8 mg) patsiku .
• Odwala omwe ali ndi mtundu 2 wa shuga wowongoleredwa, mlingo wa tsiku ndi tsiku nthawi zambiri umakhala 1-4 mg. Mlingo wa tsiku ndi tsiku wopitilira 6 mg umagwira kwambiri mwa ochepa ochepa odwala.

Kuphwanya kumwa kwa mapiritsi, mwachitsanzo, kudumpha mlingo wotsatira, sikuyenera kupangidwa mwa kugwiritsa ntchito Amaril muyezo wapamwamba.

Nthawi yotenga mapiritsi ndi kugawa Mlingo tsiku lonse imatsimikiziridwa ndi dokotala. Nthawi yomweyo, zimaganizira moyo wa wodwalayo (kuchuluka kwa zolimbitsa thupi, nthawi yakudya, chakudya). Mlingo wa tsiku ndi tsiku umafotokozedwa mu 1 piritsi, musanadye chakudya cham'mawa chokwanira. Ngati mlingo wa tsiku ndi tsiku simunatenge, musanadye chakudya chachikulu choyamba. Ndikofunika kuti musadumphe chakudya mutamwa mankhwalawa.

Mankhwala a glimepiride nthawi zambiri amachitika kwa nthawi yayitali.