Momwe mungagwiritsire ntchito mankhwala Glukovans?

Mlingo wa Glucovans - mapiritsi: biconvex wopangidwa ndi kapisozi mu utoto wautali wa utoto wa lalanje wokhala ndi zolemba mbali imodzi ya "2,5" kapena utoto wachikasu wokhala ndi zolemba za "5" (ma PC 15.

Glibenclamide - 2,5 mg kapena 5 mg,
Metformin hydrochloride - 500 mg.

Omwe amathandizira: povidone K30, sodium ya croscarmellose, magnesium stearate, cellcrystalline cellulose.

Zomwe chipolopolochi ndi chopepuka lalanje / chikasu: opadry OY-L-24808 pinki / opadry 31-F-22700 chikasu (hypromellose 15cP, lactose monohydrate, titanium dioxide, iron oxide wofiira, iron oxide wakuda / utoto wa quinoline chikasu, macrogol, oxide iron chikasu), madzi oyeretsedwa.

Mankhwala

Glucovans ndi kuphatikiza kosakanikirana kwamankhwala awiri am'magazi a hypoglycemic, omwe ali m'magulu osiyanasiyana a pharmacological: glibenclamide ndi metformin.

Metformin ndi gawo la gulu la greatuanide ndipo amachepetsa kuchuluka kwa gluprose wa postprandial ndi basal plasma. Sichikondwerero chopanga insulin, chomwe chimayambitsa chiopsezo chochepa cha hypoglycemia. Njira zitatu zoyenera kuchitira chinthu:

kuyamwa kwa shuga m'magazi,
kukulitsa chidwi cha zotumphukira za insulin zolandilira, kuonjezera kumwa ndikugwiritsira ntchito shuga mwa maselo amisempha,
kuchepa kwa kaphatikizidwe kagayidwe kachakudya ka chiwindi kudzera mu kuletsa kwa glycogenolysis ndi gluconeogeneis.

Metformin imakhudzanso kukonzekera kwa lipid ya magazi, kuchepetsa kuchuluka kwa triglycerides, otsika kachulukidwe lipoproteins (LDL) ndi cholesterol yathunthu.

Glibenclamide ndi mtundu wachiwiri wa sulfonylurea. Mlingo wa glucose pamene chinthu chofunikirachi chimalowetsedwa chimachepetsedwa chifukwa cha kupangika kwa insulin yopangidwa ndi maselo a beta omwe amapezeka m'matumbo.

Njira zoyeserera za metformin ndi glibenclamide ndizosiyana, koma zinthuzo zimakhala ndi mgwirizano wolumikizana ndipo zimatha kupititsa patsogolo ntchito ya hypoglycemic, yomwe imalola kuchepa kwakukulu kwa shuga m'magazi.

Pharmacokinetics

Mayamwidwe glibenclamide kuchokera m'mimba thirakiti pambuyo m`kamwa makonzedwe oposa 95%. Gawo logwira ntchito la Glucovans limapangidwa modabwitsa. Kuchuluka kwa zinthu mu plasma kumafikira pafupifupi maola 4, ndipo kuchuluka kwake kumagawa pafupifupi malita 10. Glibenclamide imamangiriza mapuloteni a plasma ndi 99%. Pafupifupi 100% imapukusidwa mu chiwindi, ndikupanga metabolites awiri osagwira, omwe amachotseredwa ndi bile (60% ya mlingo womwe umatengedwa) ndi mkodzo (40% ya mlingo womwe umatengedwa). Kutha kwa theka la moyo kumasiyana maola 4 mpaka 11.

Pambuyo pakukonzekera pakamwa, metformin imatengedwa kuchokera m'mimba kwambiri, ndipo kuchuluka kwake kwa plasma kumafika mkati mwa maola 2,5. Pafupifupi 20-30% ya chinthucho imachotsedwa pamimba yamagaya osasinthika. Mtheradi bioavailability ndi 50-60%.

Metformin imagawidwa mu minofu pa liwiro lalikulu, ndipo kuchuluka kwake komwe kumamangiriza mapuloteni a plasma ndikochepa. Thupi limapukusidwa pang'ono ndikufukutsidwa kudzera mu impso. Kutha kwa theka-moyo kuli pafupifupi maola 6.5. Odwala omwe ali ndi vuto la impso, pali kuchepa kwa chiwonetsero cha impso ndi kuwonjezeka kwa theka la moyo, zomwe zimabweretsa kuwonjezeka kwa zomwe zili metformin m'madzi a m'magazi.

Kuphatikiza kwa glibenclamide ndi metformin mu mankhwala amodzi kumadziwika ndi bioavailability yomweyo mukamatenga mafomu apiritsi omwe ali ndi zosakaniza izi mosiyana. Kudya sikumakhudzanso bioavailability wa Glucovans, omwe amaphatikiza glibenclamide ndi metformin. Komabe, kuchuluka kwa mayamwidwe glibenclamide mukamamwa ndi chakudya kumachuluka.

Zizindikiro zogwiritsidwa ntchito

Malinga ndi malangizo, Glucovans imalembedwa kwa akulu omwe ali ndi matenda a shuga 2 ngati:

Monotherapy yam'mbuyomu yokhala ndi sulfonylureas kapena metformin, chithandizo chamankhwala ndi zolimbitsa thupi sizinathandize,
Mankhwala osakanikirana omwe amaphatikizidwa ndi metformin ndi sulfonylurea amachokera kwa odwala omwe ali ndi chiwongolero chokhazikika komanso chokhazikika ayenera kusinthidwa ndi monotherapy.

Contraindication

Mtundu woyamba wa shuga
Matenda a shuga komanso chikomokere
Matenda a shuga ketoacidosis
Lactic acidosis, kuphatikizapo mbiri ya
Kulephera kwamkati ndi / kapena chiwindi,
Kuchepa kwamphamvu kwa ntchito
Zowawa zomwe zimayambitsa kusintha kwa impso: matenda operewera, kuchepa madzi m'thupi, kugwedezeka, michere ya ayodini yokhala ndi zotsutsana;
Porphyria
Minofu hypoxia pamaso pa mitundu pachimake kapena matenda kupuma kapena mtima kulephera, mantha, waposachedwa myocardial infarction,
Nthawi yokhala ndi pakati komanso yoyamwitsa,
Kugwiritsa ntchito miconazole moyenera,
Opaleshoni yayikulu
Kumwa mowa kwambiri, uchidakwa wopitirira,
Kutsatira zakudya zama hypocaloric (zosakwana 1000 kcal patsiku),
Glucose-galactose malabsorption syndrome, galactose tsankho, lactase akusowa,
Osakwana zaka 18
Zoposa zaka 60, pochita masewera olimbitsa thupi (ngozi ya lactic acidosis),
Hypersensitivity zigawo zikuluzikulu za mankhwala kapena zotumphukira zina za sulfonylurea.

Mosamala, a Glucovans amalimbikitsidwa kuti: matenda a chithokomiro azitsutsana ndikuphwanya ntchito yake, adrenal insufficiency, febrile syndrome, hypofunction ya anterior pituitary gland.

Malangizo ogwiritsira ntchito Glucovans: njira ndi mlingo

Mapiritsi a Glucovans amalimbikitsidwa kuti amwe ndi zakudya, ndipo zochuluka za chakudya zamafuta ziyenera kukhala m'zakudya.

Dokotala amamulembera aliyense payekha, poganizira kuchuluka kwa glycemia.

Mlingo woyambirira ndi piritsi limodzi la Glucovans 2.5 mg / 500 mg kapena Glucovans 5 mg / 500 mg kamodzi patsiku.

Posamutsa wodwala wophatikiza kapena monotherapy ndi sulfonylurea ndi metformin kupita kuchipatala cha Glucovans, pofuna kupewa hypoglycemia, mlingo woyambirira suyenera kupitilira muyeso womwewo wa tsiku lililonse wa mankhwala omwe adamwa kale. Kuti mukwaniritse kuyendetsa bwino shuga, magazi ayenera kuchuluka pang'onopang'ono, osaposa 5 mg / 500 mg tsiku lililonse pakapita milungu iwiri kapena kuchepera. Kusintha kwa Mlingo kuyenera kuchitidwa nthawi zonse kutengera mtundu wa glycemia.

Pazipita tsiku lililonse mapiritsi 4 Glucovans 5 mg / 500 mg kapena mapiritsi 6,5 mg / 500 mg. Malamulo a mapiritsi amatsimikiziridwa payekhapayekha, zimatengera mlingo wa tsiku lililonse wa mankhwalawa.

Piritsi limodzi (la kumwa) - 1 nthawi patsiku, m'mawa,
Mapiritsi 2 kapena 4 (mulingo uliwonse) - 2 kawiri pa tsiku, m'mawa ndi madzulo,
3, 5 kapena 6 mapiritsi a 2,5 mg / 500 mg kapena mapiritsi atatu a 5 mg / 500 mg - katatu pa tsiku, ayenera kumwedwa m'mawa, masana ndi madzulo.

Kwa odwala okalamba, muyeso woyamba sayenera kupitilira piritsi limodzi 2,5 mg / 500 mg. Cholinga cha kumwa ndi kugwiritsidwa ntchito kwa Glucovans kuyenera kuyang'aniridwa pafupipafupi kuti ntchito ya impso.

Zotsatira zoyipa

Kuchokera pamatumbo am'mimba: pafupipafupi - kusowa kudya, nseru, kupweteka m'mimba, kusanza, kutsekula m'mimba. Zizindikiro zimawonekera kumayambiriro kwa chithandizo ndipo zimakhala zosakhalitsa. Osowa - matenda a chiwindi, chiwindi,
Kuchokera pazinthu zam'maganizo: nthawi zambiri - kukoma kwazitsulo mkamwa. Kumayambiriro kwa zamankhwala, kuwonongeka kwakanthawi kwakanthawi nkotheka,
Kuchokera kumbali ya kagayidwe: hypoglycemia, kawirikawiri - kuukiridwa kwa khungu porphyria ndi porphyria, osowa kwambiri - lactic acidosis. Ndi chithandizo chakanthawi - kuchepa kwa kuchuluka kwa Vitamini B12 mu seramu yamagazi (kungayambitse kuchepa kwa magazi m'thupi). Poyerekeza ndi zakumwa zakumwa zoledzeretsa, momwe ndimakhalira mosaganizira,
Ziwalo za hematopopoietic: kawirikawiri - thrombocytopenia ndi leukopenia, kawirikawiri - pancytopenia, hemolytic anemia, mapapu aplasia, agranulocytosis,
Pa khungu: kawirikawiri - kuyabwa, miluza ngati zotupa, osowa - dermatitis, exrymama multiforme, photosensitivity,
Thupi lawo siligwirizana: kawirikawiri - urticaria, kawirikawiri - visceral kapena khungu Matupi vasculitis, anaphylactic mantha. Ndi dongosolo munthawi yomweyo, mtanda-hypersensitivity kuti sulfonamides ndi zotuluka zawo zitheke,
Laborator Zizindikiro: pafupipafupi - kuwonjezeka kwa kuchuluka kwa creatinine ndi urea mu seramu yamagazi pamlingo wapamwamba, kawirikawiri - hyponatremia.

Bongo

Mankhwala osokoneza bongo a Glucovans amatha kudzutsa kukula kwa hypoglycemia, chifukwa kuchokera ku sulfonylurea ndi gawo limodzi la mankhwalawa.

Zizindikiro za hypoglycemia wofatsa kwambiri pakakhala kusokonezeka kwa dongosolo lamanjenje lamkati ndi syncope nthawi zambiri zimakonzedwa ndikumwa shuga. Muyenera kusinthanso kuchuluka kwa Glucovans ndi / kapena kusintha zakudya. Ngati odwala omwe ali ndi matenda a shuga atha kudwala kwambiri matenda am'mimba, atatsatana ndi paroxysm, chikomokere kapena matenda ena amitsempha, akuyenera kulandira chithandizo chamankhwala mwadzidzidzi. Pambuyo poti wapezeka ndi dokotala kapena pakukayikira pang'ono kwa hypoglycemia, njira yolimbikira yothetsera vuto la dextrose imalimbikitsidwa wodwala asanamugonekere kuchipatala. Wodwalayo akadziwikanso, amayenera kupatsidwa chakudya chambiri chamafuta, omwe amatha kuzamwa mosavuta, zomwe zimalepheretsa kukonzanso kwa hypoglycemia.

Kukhazikika kwa nthawi yayitali kwa a Glucovans mu Mlingo wambiri kapena ma conjugate omwe ali pachiwopsezo chitha kubweretsa kukula kwa lactic acidosis, popeza metformin ndi gawo lamankhwala. Lactic acidosis imawonedwa ngati vuto lofunika kuchipatala, ndipo chithandizo chake chikuyenera kuchitika kuchipatala. Njira zothandiza kwambiri zamankhwala zomwe zimalimbikitsa kupukusa kwa lactate ndi metformin zimaphatikizapo hemodialysis.

Odwala omwe ali ndi vuto la chiwindi, kutsimikizika kwa glibenclamide mu madzi a m'magazi kumatha kuchuluka. Popeza chinthu ichi chimamangirira kwambiri mapuloteni amadzi a m'magazi, kutha kwake pa hemodialysis ndikosatheka.

Malangizo apadera

Chithandizo chimalimbikitsidwa kuti chizitha kuperekedwa limodzi ndi kuwunika kosalekeza m'magazi pambuyo podya.

Munthawi ya makonzedwe a Glucovans, ndikofunikira kulingalira kuti mungakhale ndi lactic acidosis, zizindikiro za matendawa zimatha kuoneka ngati kupweteka kwam'mimba, malaise kwambiri, kukokana kwa minofu ndi matenda osokoneza bongo.

Mukamagwiritsa ntchito mankhwala a Glucovans, pamakhala chiwopsezo cha kukhala ndi hypoglycemia, nthawi zambiri imapezeka mwa odwala omwe amakhala ndi zakudya zochepa, osatsata chakudya, amamwa mowa, amalandila masewera olimbitsa thupi ndi hypocaloric zakudya. Kusamala popereka, kusankha mosamala mlingo wa mankhwala ndi kukhazikitsidwa kwa malingaliro a dokotala kumachepetsa mwayi wodwala.

Ndi zoletsedwa kumwa mowa panthawi ya mankhwala.

Asanakhazikitsidwe a Glucovans komanso munthawi ya kayendetsedwe ka maphunziro, kafukufuku wokhazikika amayenera kuchitidwa kuti adziwe kuchuluka kwa ndende ya serum creatinine. Kusanthula kuyenera kuchitidwa kwa odwala omwe ali ndi vuto laimpso osachepera 1 pachaka, ndi kuwonongeka kwa impso ndi okalamba - kawiri pachaka.

Ngati matenda opatsirana a bronchi, mapapu, kapena ziwalo za urogenital akaonekera, pitani kuchipatala msanga.

Mimba komanso kuyamwa

Kukhazikika kwa pakati kumakhala kotsutsana ndi kugwiritsa ntchito glucovans. Odwala ayenera kudziwitsidwa kuti panthawi ya mankhwalawa ndi mankhwalawa ayenera kudziwitsa adokotala za kukonzekera kutenga pakati kapena nthawi yake. M'magawo onse awiriwa, Glucovans imathetsedwa ndipo njira ya insulin imayikidwa.

Palibe chidziwitso pa kuthekera kwa metformin kuphatikiza ndi glibenclamide kudutsa mkaka wa m'mawere, chifukwa chake, kuyikidwa kwa mankhwalawa panthawi yotsekera sikovomerezeka.

Gwiritsani ntchito mu ukalamba

Mlingo wa odwala okalamba umakhazikitsidwa poganizira momwe ntchito yaimpso imayenera kuyesedwa nthawi zonse. Mlingo woyamba mwa odwala a gululi ndi piritsi limodzi 2,5 mg / 500 mg.

Sitikulimbikitsidwa kugwiritsa ntchito Glucovans mwa odwala omwe ali ndi zaka zopitilira 60 ndipo thupi lawo limachita masewera olimbitsa thupi, zomwe zimafotokozedwa ndi chiopsezo chowonjezeka cha lactic acidosis mwa iwo.

Kuyanjana kwa mankhwala

Glucovans makonzedwe amayenera kuyimitsidwa masiku awiri asanafike ndikupangidwanso masiku awiri pambuyo pokonzekera kulowetsedwa kwa ayodini okhala ndi zotsutsana.

Kugwiritsa ntchito miconazole munthawi yomweyo kumaletsedwa, chifukwa chambiri chotupa cha hypoglycemia, mpaka kukomoka.

Kuphatikiza kwa mankhwalawa ndi mankhwala okhala ndi ethanol ndi phenylbutazone osavomerezeka, chifukwa amachititsa kuchuluka kwa hypoglycemic kwa Glucovans.

Pogwiritsa ntchito nthawi yomweyo ndi bosentan, chiopsezo cha hepatotoxic zochita chimawonjezeka, mphamvu ya glibenclamide imachepa.

Mlingo waukulu wa chlorpromazine umachepetsa kutulutsa kwa insulin, zomwe zimapangitsa kuti glycemia iwonjezeke.

Mphamvu ya hypoglycemic ya Glucovans imachepa akaphatikizidwa ndi glucocorticosteroids, tetracosactide, okodzetsa, danazol ndi beta2-adrenergic agonists.

Ngakhale mukutenga ndi ma inhibitors a angiotensin (ACE), kuphatikizapo enalapril ndi captopril, pali kuchepa kwa shuga wamagazi.

Kuphatikiza ndi metformin kumafuna chisamaliro chapadera kwa odwala omwe amathandizika ndi impso, chifukwa mwayi wokhala ndi lactic acidosis ndiwokwera pogwiritsa ntchito "loop" diuretics.

Kuphatikiza kwa Glucovans ndi sympathomimetics, beta-blockers, reserpine, clonidine, guanethidine amabisala zizindikiro za hypoglycemia.

Kusintha kwa Mlingo ndikofunikira mukatenga fluconazole, pamakhala chiopsezo cha hypoglycemia.

Glibenclamide imachepetsa mphamvu yotsutsa ya desmopressin.

Zotsatira za hypoglycemic za Glucovans zimawonjezeka ndikugwiritsira ntchito munthawi yomweyo ndi monoamine oxidase inhibitors (MAOs), sulfonamides, anticoagulants (coumarin derivatives), fluoroquinolones, chloramphenicol, pentoxifylline, lipid-kuchepetsa mankhwala kuchokera pagulu la fibrate, disopyramide.

Ma analogi a Glucovans ndi awa: Glybomet, Glukonorm, Glyukofast, Bagomet Plus, Metformin, Siofor.

Ndemanga za Glucovans

Odwala omwe ali ndi matenda ashuga nthawi zambiri amasiya ndemanga za Glucovans pa intaneti. Nthawi zambiri amakambirana nkhani zokhudzana ndi kusankha kwa mankhwalawa komanso ma regimens othandizira, komanso momwe amathandizira ndi mankhwala ena. Komabe, kuwunikira pawokha kumatsutsana. Malipotiwo akuti kuti akwaniritse bwino kwambiri panthawi ya chithandizo, ndikofunikira kuwerengera kuchuluka kwa zopatsa mphamvu ndi chakudya chamagulu, komanso kuwunika mosamala kuchuluka kwa mankhwalawa.

Komabe, palinso malingaliro pazachabechabe za Glucovans. Odwala amadandaula chifukwa cha kusasintha kwa thanzi komanso kupatuka kwakukulu kuchokera ku kuchuluka kwazomwe zimapangitsa shuga m'magazi (hypoglycemia). Odwala ena amati kuti thanzi lawo likhale lachilendo amayenera kusintha njira yayitali komanso moyenera.

Glucovans kumasulidwa mawonekedwe, mankhwala ma CD ndi zikuchokera.

Mapiritsiwa anali atakulungidwa ndi chipolopolo chopepuka cha lalanje, chowoneka ngati kapisozi, biconvex, cholembedwa "2,5" mbali imodzi.

1 tabu
metformin hydrochloride
500 mg
glibenclamide
2,5 mg

Othandizira: povidone K30, magnesium stearate, croscarmellose sodium, microcrystalline cellulose, Opadry (Opadri) OY-L-24808, madzi oyeretsedwa.

15 ma PC. - matuza (2) - makatoni.
20 ma PC. - matuza (3) - makatoni.

Mapiritsi okhala ndi chikasu ndi kapangidwe kake kama-kapisolo, biconvex, wolemba "5" mbali imodzi.

1 tabu
metformin hydrochloride
500 mg
glibenclamide
5 mg

Othandizira: povidone K30, magnesium stearate, croscarmellose sodium, microcrystalline cellulose, Opadry (Opadri) 31F22700, madzi oyeretsedwa.

15 ma PC. - matuza (2) - makatoni.
20 ma PC. - matuza (3) - makatoni.

Kufotokozera kwa mankhwalawa kumatengera malangizo ovomerezeka omwe angagwiritsidwe ntchito.

Pharmacological kanthu Glucovans

Mankhwala osakanikirana a hypoglycemic ophatikizidwa pakamwa.

Glucovans ndi kuphatikiza kosakanikirana kwamankhwala awiri am'magazi a magulu osiyanasiyana a pharmacological.

Metformin ndi ya gulu la Biguanides ndipo amachepetsa shuga wa seramu pakuwonjezera mphamvu ya zotumphukira mu zochita za insulin ndikuwonjezera kukweza kwa glucose. Metformin imachepetsa mayamwidwe am'mimba mu chakudya cham'mimba ndipo imalepheretsa gluconeogeneis m'chiwindi. Zimakhalanso ndi phindu pamapangidwe amtundu wa lipid m'magazi, kuchepetsa kuchuluka kwa cholesterol yathunthu, LDL ndi TG.

Glibenclamide amatanthauza zochokera ku sulfonylurea zochokera m'badwo wachiwiri. Mlingo wa glucose mukamatenga glibenclamide amachepetsa chifukwa cha kukondoweza kwa insulin yotulutsidwa ndi maselo a pancreatic.

Mlingo ndi njira ya mankhwala.

Mlingo wa mankhwalawa umatsimikiziridwa ndi dokotala aliyense payekha kwa wodwala aliyense, kutengera mlingo wa glycemia.

Nthawi zambiri, muyeso woyamba wa Glucovans ndi 1 tabu. 500 mg / 2,5 mg patsiku. Mukamachotsa mankhwala ophatikizira am'mbuyomu ndi metformin ndi glibenclamide, mapiritsi 1-2 amapatsidwa. Glucovansa 500 mg / 2.5 mg kutengera mlingo wapitayo wa mlingo. Pakadutsa milungu iwiri ndi chimodzi kuchokera poyambira kumwa, mankhwalawa amasinthidwa malinga ndi glycemia.

Mapiritsi ayenera kumwedwa ndi zakudya.

Pazipita tsiku lililonse mapiritsi 4. Glucovansa 500 mg / 2,5 mg kapena 2 tabu. Glucovansa 500 mg / 5 mg.

Zotsatira zoyipa za Glucovans:

Kuchokera pamimba yodyetsera: kumayambiriro kwa mankhwalawa, kusanza, kusanza, kupweteka m'mimba, kuchepa kwa chidwi chokwanira kumatha kuchitika (nthawi zambiri, kudutsa palokha komanso sikufuna chithandizo chapadera, kuti muchepetse kukula kwa zizindikirozi, tikulimbikitsidwa kumwa mankhwalawa mu 2 kapena 3 Mlingo, kuchuluka kwa mankhwala imathandizanso kulolerana kwake), mwina kutsekemera kwa “chitsulo” mkamwa.

Zina: erythema, megaloblastic anemia, lactic acidosis.

Kuchokera mmimba dongosolo: nseru, kusanza, kupweteka kwa epigastric, kuchuluka kwa chiwindi michere.

Kuchokera ku hemopoietic dongosolo: leukopenia, thrombocytopenia, osowa - agranulocytosis, hemolytic anemia, pancytopenia.

Thupi lawo siligwirizana: - urticaria, zidzolo, kuyabwa khungu.

Zina: hypoglycemia, zosachitika motsatira disuffiram mukamamwa mowa.

Malangizo apadera ogwiritsira ntchito Glucovans.

Pa mankhwalawa ndi a Glucovans, ndikofunikira kuyang'anira kuchuluka kwa shuga m'magazi pamimba yopanda kanthu ndikatha kudya.

Wodwalayo ayenera kuchenjezedwa kuti ngati kusanza komanso kupweteka kwam'mimba kumayendera limodzi ndi kukokana kwa minofu kapena kuwonekera kwapakati pa Glucovans, ndiye kuti mankhwalawo ayenera kusiyidwa ndipo muyenera kufunsa dokotala, chifukwa izi zimatha kukhala zizindikiro za lactic acidosis.

Wodwala ayenera kudziwitsa dokotala za mawonekedwe a matenda a bronchopulmonary kapena matenda a kwamikodzo.

Maola 48 asanafike opaleshoni kapena iv. Yoyamwa yokhala ndi ayodini wokhala ndi ma radiopaque, ma glucovans ayenera kuyimitsidwa. Chithandizo cha glucovans chikulimbikitsidwa kuti chibwezeretsedwe pambuyo pa maola 48.

Pa mankhwala, osavomerezeka kumwa mowa.

Kukopa pa kuyendetsa magalimoto ndi kayendedwe kazinthu

Pa chithandizo ndi a Glucovans, munthu sayenera kuchita zinthu zomwe zimafunikira kuti aziganizira kwambiri komanso azithamanga pama psychomotor reaction.

Kuyanjana kwa Glucovans ndi mankhwala ena.

Mankhwala othandizira ku Glucovans (chiwopsezo chowonjezeka cha hypoglycemia)

Pogwiritsa ntchito munthawi yomweyo ndi ma Glucovans, miconazole imatha kupangitsa kukula kwa hypoglycemia (mpaka kukula kwa chikomokere).

Fluconazole imachulukitsa T1 / 2 ya zotumphukira za sulfonylurea ndipo zimawonjezera chiopsezo cha hypoglycemic reaction.

Kumwa mowa mwauchidakwa kumawonjezera chiopsezo cha hypoglycemic reaction (mpaka kukula kwa chikomokere). Pa mankhwala ndi a Glucovans, mowa ndi mankhwala omwe ali ndi ethanol (mowa) ayenera kupewedwa.

Kugwiritsa ntchito kwa ACE inhibitors (Captopril, enalapril) kumawonjezera mwayi wokhala ndi zovuta za hypoglycemic odwala omwe ali ndi matenda osokoneza bongo pochotsa zotuluka za sulfonylurea mwa kukonza kugwirizira kwa shuga komanso kuchepetsa kufunika kwa insulin.

Beta-blockers imachulukitsa zovuta komanso zovuta za hypoglycemia. Beta-blockers maski zizindikiro za hypoglycemia monga palpitations ndi tachycardia.

Mankhwala omwe amachepetsa mphamvu ya glucovans

Danazole ali ndi vuto la hyperglycemic. Ngati mankhwala a danazol akufunika ndipo mukasiya kumwa mankhwalawa, muyenera kusintha mlingo wa Glucovans motsogozedwa ndi glycemia.

Chlorpromazine mu Mlingo wambiri (100 mg / tsiku) amachititsa kuchuluka kwa glycemia.

GCS imachulukitsa glycemia ndipo imatha kubweretsa chitukuko cha ketoacidosis.

Beta2-adrenostimulants imachulukitsa glycemia chifukwa cha kukondoweza kwa 2-adrenergic receptors.

Ma diuretics (makamaka "zopunthwitsa") zimayambitsa chitukuko cha ketoacidosis chifukwa cha kukhazikika kwa magwiridwe antchito olephera.

Mu / pakubweretsa mankhwala okhala ndi ayodini omwe amachititsa kuti magazi azitha kuyambitsa kupweteka kwa impso, komwe kumapangitsa kuti mankhwalawa apangidwe mthupi komanso kukula kwa lactic acidosis.

Beta-blockers maski zizindikiro za hypoglycemia, monga palpitations ndi tachycardia.

Mlingo ndi makonzedwe

Mapiritsi a Glucovans adapangira pakamwa. Mapiritsi amatengedwa panthawi ya chakudya, omwe amayenera kukhala ndi kuchuluka kwa chakudya chamagulu, kupewa hypoglycemia.

Mlingo wa mankhwalawa amasankhidwa ndi adokotala.

Mlingo woyambirira wa Glucovans ndi piritsi limodzi (2,5 mg + 500 mg kapena 5 mg + 500 mg) kamodzi patsiku. Ndikulimbikitsidwa kuwonjezera mlingo uliwonse pakapita milungu iwiri kapena kuposa osaposa 500 mg a metformin ndi 5 mg ya glibenclamide patsiku kuti athe kutsata bwino kuchuluka kwa shuga m'magazi.

Posintha njira yothandizira yophatikiza ndi glibenclamide ndi metformin, mlingo woyambirira suyenera kukhala wapamwamba kuposa mlingo wa tsiku ndi tsiku wa glibenclamide ndi metformin yomwe idatengedwa kale. Pakatha milungu iwiri iliyonse mankhwala atayamba, Mlingo wa mankhwalawa umasinthidwa.

Pazipita tsiku lililonse a Glucovans ndi mapiritsi 4 5 mg + 500 mg kapena mapiritsi 6,5 mg + 500 mg.

Mlingo wa mankhwala:

Popanga mankhwala piritsi limodzi patsiku - m'mawa, m'mawa.
Ndi mapiritsi 2, 4 patsiku - m'mawa ndi madzulo,
Ndi mapiritsi a 3, 5, 6 patsiku - m'mawa, masana ndi madzulo.

Mlingo

500 mg / 2,5 mg ndi mapilogalamu 500 a 500 mg / 5 mg

Ckusiya

Mlingo 500 mg / 2,5 mg

Piritsi limodzi lili

ntchito: metformin hydrochloride 500 mg

glibenclamide 2,5 mg,

zokopa: croscarmellose sodium, povidone K 30, cellcrystalline cellulose, magnesium stearate

kapangidwe ka chipolopolo cha Opadry OY-L-24808 ndi pinki: lactose monohydrate, hypromellose 15cP, macrogol, titanium dioxide E 171, iron oxide chikasu E 172, iron oxide red E 172, iron oxide wakuda E 172.

Mlingo 500 mg / 5 mg

Piritsi limodzi lili

ntchito: metformin hydrochloride 500 mg

glibenclamide 5 mg

zokopa: croscarmellose sodium, povidone K 30, cellcrystalline cellulose, magnesium stearate

kapangidwe ka chipolopolo cha Opadry 31-F-22700 ndi chikasu: lactose monohydrate, hypromellose 15 cP, macrogol, quinoline chikasu varnish E 104, titanium dioxide E 171, iron oxide chikasu E 172, iron oxide red E 172.

Mlingo 500 mg / 2,5 mg: mapiritsi okhala ndi utoto wamafilimu amtundu wa lalanje wowoneka bwino, kapangidwe kake kolumikizidwa ndi biconvex pamwamba ndikulemba "2,5" mbali imodzi.

Mlingo 500 mg / 5 mg: mapiritsi okhala ndi chipolopolo chachikasu, chipewa chowumbidwa ndi biconvex pamwamba ndikulemba "5" mbali imodzi.

Mankhwala

Pharmacokinetics

Metformin ndi Glibenclamide

The bioavailability ya metformin ndi glibenclamide kuphatikiza ndi ofanana ndi bioavailability a metformin ndi glibenclamide pamene amatengedwa munthawi yomweyo. Kudya sikumakhudza ma bioavailability a metformin osakanikirana ndi glibenclamide, komanso bioavailability wa glibenclamide osakanikirana ndi metformin. Komabe, kuchuluka kwa mayamwa a glibenclamide kumawonjezera ndi chakudya.

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

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

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

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

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

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

Mukaperekedwa, kuyamwa kuchokera m'matumbo am'mimba ndizoposa 95%. Peak plasma woipa umafikiridwa pambuyo pafupifupi maola 4. Kuyankhulana ndi mapuloteni a plasma ndi 99%.

Glibenclamide imapukusidwa kwathunthu m'chiwindi kupanga metabolites awiri.

Glibenclamide imachotsedwa kwathunthu kuchokera mthupi pambuyo pa maola 45-72 mu mawonekedwe a metabolites: ndi bile (60%) ndi mkodzo (40%). Theka lomaliza la moyo ndi maola 4-11.

Kukhala kwa hepatatic kumachepetsa kagayidwe ka glibenclamide ndikuchepetsa kwambiri kutulutsa kwake.

Biliary excretion wa metabolites imachulukira vuto la kulephera kwa impso (kutengera kuwonongeka kwa impso ntchito) pang'onopang'ono kwa 30 ml / min. Chifukwa chake, kulephera kwa impso sikukhudza kuwonongeka kwa glibenclamide, pomwe creatinine chilolezo chimakhalabe pamtunda wa 30 ml / min.

Pharmacokinetics m'magulu apadera odwala:

Odwala odwala

Panalibe kusiyana kwama pharmacokinetics a metformin ndi glibenclamide mwa ana komanso akulu athanzi.

Mankhwala

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

Metformin ili ndi njira zitatu:

amachepetsa kupanga shuga wa chiwindi poletsa gluconeogeneis ndi glycogenolysis,

imawonjezera kukhudzidwa ndikugwiritsika ntchito kwa zotumphukira m'mitsempha ndikuwonjezera chidwi cha insulini,

Iachedwetsa mayamwidwe am'matumbo m'matumbo.

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

Mosasamala kanthu za momwe zimakhudzira glycemia, metformin imathandizira kagayidwe ka lipid. Panthawi yoyesedwa pazachipatala pogwiritsa ntchito Mlingo wothandizira, zimapezeka kuti metformin imatsitsa cholesterol yonse, lipoproteins yotsika komanso triglycerides. Zotsatira zamtundu wa lipid metabolism sizinawonedwe pamayesero azachipatala pogwiritsa ntchito mankhwala osakanikirana ndi metformin ndi glibenclamide.

Glibenclamide ndi wa gulu la m'badwo wachiwiri wa sulfonylureas wokhala ndi theka la moyo. Glibenclamide imayambitsa kutsika kwa shuga m'magazi, zomwe zimapangitsa kupanga insulin ndi kapamba. Kuchita izi kumadalira kupezeka kwa β-maselo a masinthiko a Langerhans.

Kukondoweza kwa insulin katulutsidwe ndi glibenclamide poyankha chakudya ndikofunikira.

Kugwiritsa ntchito glibenclamide kwa odwala omwe ali ndi matenda ashuga kumayambitsa kuwonjezeka kwa kuyankha kwa insulin. Njira yowonjezera ya postprandial mu mawonekedwe a secretion a insulin ndi C-peptide imapitirira miyezi isanu ndi umodzi itatha chithandizo.

Metformin ndi glibenclamide zimakhala ndimayendedwe osiyanasiyana, koma mogwirizana zimathandizira zomwe antihyperglycemic zimachita. Glibenclamide imathandizira kupanga insulin ndi kapamba, ndipo metformin imachepetsa kukana kwa maselo ku insulin pochita zotumphukira (minofu yamatumbo) komanso chidwi cha chiwindi kwa insulin.

Mlingo ndi makonzedwe

Glucovans® iyenera kumwedwa ndi chakudya. Malangizo a mankhwalawa amasinthidwa malinga ndi zakudya zomwe munthu amadya. Chakudya chilichonse chimayenera kutsagana ndi chakudya chokhala ndi chakudya chokwanira chomanga thupi kuti mupewe kuchitika kwa hypoglycemia.

Mlingo wa mankhwalawa uyenera kusinthidwa malinga ndi kuyamwa kwa metabolic (glycemia, HbA1c).

Glucovans 500 mg / 5 mg ingagwiritsidwe ntchito makamaka mwa odwala omwe sanakwanitse kuwongolera mokwanira pamene akutenga Glucovans 500 mg / 2.5 mg.

Chithandizo chimayenera kuyamba ndi mlingo wa mankhwala ophatikizana omwe kale anali mankhwala a metformin ndi glibenclamide. Mlingo uyenera kuwonjezeka pang'onopang'ono kutengera ndi magawo a glycemic.

Mlingo umasinthidwa milungu iwiri iliyonse kapena kupitilira apo ndi piritsi limodzi, kutengera mtundu wa glycemia.

Kuwonjezeka kwapang'onopang'ono kwa mlingo kungathandize kuchepetsa kulolerana kwa m'mimba komanso kupewa kukula kwa hypoglycemia.

Mulingo wambiri watsiku ndi tsiku wa Glucovans® 500 / 2.5 ndi mapiritsi 6.

Mlingo wambiri watsiku ndi tsiku wa Glucovans® 500/5 mg ndi mapiritsi atatu.

Mwapadera, kuwonjezeka kwa mapiritsi 4 a mankhwalawa Glucovans® 500 mg / 5 mg patsiku angalimbikitsidwe.

Mlingo wa mankhwala Glucovans® 500 mg / 2.5 mg

Kamodzi patsiku: m'mawa nthawi ya chakudya cham'mawa, ndikupatsidwa piritsi limodzi patsiku.

Kawiri pa tsiku: m'mawa ndi madzulo, ndi mapiritsi awiri kapena anayi patsiku.

Katatu patsiku: m'mawa, masana ndi madzulo, ndi mapiritsi atatu, 5 kapena 6 patsiku.

Mlingo wa mankhwala Glucovans® 500 mg / 5 mg

Kamodzi patsiku: m'mawa nthawi ya chakudya cham'mawa, ndikupatsidwa piritsi limodzi patsiku.

Kawiri pa tsiku: m'mawa ndi madzulo, ndi mapiritsi awiri kapena anayi patsiku.

Katatu patsiku: m'mawa, masana ndi madzulo, ndi mapiritsi atatu patsiku.

Palibe zambiri pakugwiritsa ntchito mankhwalawa ndi insulin.

Mukutenga Glucovans ® ndi chelator wa bile, tikulimbikitsidwa kuti mutenge Glucovans® osachepera maola 4 pamaso pa chelator anu wa bile kuti muchepetse ngozi ya kuyamwa.

Malangizo apadera a magulu ena a odwala

Okalamba komanso odwala a senile

Mlingo wa Glucovans ® uyenera kusinthidwa kutengera magawo a ntchito ya impso. Mlingo woyamba ndi piritsi limodzi la Glucovans® 500 mg / 2.5 mg. Kuwunika pafupipafupi kwa impso ndikofunikira.