Avandamet ndi kuphatikiza kwa hypoglycemic.
Dzinalo Losayenerana
Metformin limodzi ndi rosiglitazone.
Avandamet ndi kuphatikiza kwa hypoglycemic.
ATX
Ndalama za ATX - A10BD03.
Kutulutsa mafomu ndi kapangidwe kake
Mankhwala amapezeka piritsi. Mapiritsiwo ali ndi magawo awiri omwe amagwira ntchito - metformin ndi rosiglitazone. Yoyamba ili mu hydrochloride, yachiwiri ndi yamphongo.
Kuchuluka kwa metformin piritsi limodzi ndi 500 mg. Zomwe zili rosiglitazone ndi 1 mg.
Mankhwalawa amapezeka m'matulu a makatoni, omwe ali ndi matuza 1, 2, 4 kapena 8. Iliyonse ya izo imaphatikizapo mapiritsi 14, okhala ndi filimu.
Pogulitsa ndi Avandamet yokhala ndi rosiglitazone ya 2 mg.
Zotsatira za pharmacological
Mankhwalawa amatanthauza mankhwala ochepetsa shuga a mkamwa. Amaphatikiza zinthu ziwiri zogwira ntchito, zomwe zimathandiza kuti odwala azitha kupeza shuga.
Rosiglitazone ndi wa gulu la thiazolidinediones, metformin ndi chinthu chochokera ku gulu la Biguanide. Zimathandizana, zimagwira ntchito imodzi pa maselo a zotumphukira zimakhala ndi gluconeogenesis m'chiwindi.
Pogwiritsa ntchito rosiglitazone, kuchuluka kwa ma cell a pancreatic kumadziwika.
Rosiglitazone imawonjezera chidwi cha zotumphukira zimakhala ku insulin. Chifukwa cha izi, zimatha kugwiritsa ntchito shuga owonjezera m'magazi.
Thupi limagwira pazomwe zimalumikizana kwambiri ndi matenda apakhungu a matenda a shuga osagwirizana ndi insulin. Kulimbana ndi minyewa ya insulin sikulola kuti timadzi timene timayendetsa shuga mokwanira. Mothandizidwa ndi rosiglitazone, zomwe zimapezeka mu insulin, shuga ndi mafuta acid m'magazi zimachepa.
Ndi kugwiritsidwa ntchito kwake, kuchuluka kwa masamba a pancreatic omwe amachititsa kuti pakhale insulin amadziwika. Zimalepheretsanso kupezeka kwamavuto ku ziwalo zomwe mukufuna. Thupi silimakhudzanso kuchuluka kwa kutulutsa kwa insulin m'maselo ndipo sikungayambitse kuchepa kwapadera kwa glucose.
M'maphunziro, kuchepa kwa insulin ndi zomwe zimayambira m'magazi zidadziwika. Pali umboni kuti izi zimapanga zinthu zambiri zimakhudza dongosolo lamtima.
Metformin imachepetsa ntchito ya shuga m'magazi a chiwindi. Mothandizidwa ndi iye, magulu onse a shuga ndi shuga pambuyo poti adya amakhala osakhazikika. Thupi silimapangitsa kuti insulin ipangidwe ndi maselo a isanger a Langerhans.
Kuphatikiza pa kulepheretsa gluconeogenesis m'chiwindi, chinthu chogwira ntchito chimawonjezera chidwi cha zotumphukira ku insulin, imathandizira kugwiritsa ntchito shuga waulere, ndikuchepetsa kuyamwa kwa glucose kudzera mucosa ya m'mimba.
Metformin imachepetsa ntchito ya shuga m'magazi a chiwindi.
Metformin imathandizira kuthamanga kupanga glycogen m'maselo. Imayendetsa mayendedwe a glucose transporter omwe amapezeka pama cell membrane. Imayendetsa kagayidwe ka mafuta acids, kuchepetsa kuchuluka kwa cholesterol ndi lipids zina zovulaza.
Kuphatikiza kwa rosiglitazone ndi metformin kumathandizira kuti pakhale chithandizo chokwanira. Zinthu zimakhudza magawo onse a pathogenesis yamaellell omwe samatengera insulin, potero amapereka chiwongolero chabwino kwambiri cha glucose.
Pharmacokinetics
Kumwa mankhwala ndi chakudya kumachepetsa mphamvu yayikulu yogwira zinthu zonse ziwiri. Moyo wawo theka ukuwonjezereka.
Mukamwa, rosiglitazone imatengeka ndi matumbo a m'mimba. Acidity yam'mimba sizimakhudza kuchuluka kwa mayamwidwe. Bioavailability pafupifupi ukufika 100%. Thupi limamangilira pafupifupi kwathunthu kunyamula ma peptides. Sichikupanga. Kuzindikira kwambiri kumachitika m'magazi pambuyo pa mphindi 60 pambuyo pa kuperekedwa.
Zosintha pamagetsi a zinthu malinga ndi kudya zakudya sizofunikira kwambiri pakliniki. Izi zimakuthandizani kuti mumwe mankhwalawa, mosasamala nthawi yakudya.
Rosiglitazone imasinthidwa metabolic motsogozedwa ndi michere ya chiwindi. Isoenzyme yayikulu yomwe imayang'anira kusintha kwa zinthu ndi CYP2C8. Ma metabolabolites omwe amapangidwa chifukwa cha zochita amakhala osagwira.
Acidity yam'mimba sizimakhudza kuchuluka kwa mayamwidwe.
Hafu ya moyo wa chinthucho imakhala mpaka maola 130 ndi ntchito yachibadwa ya impso. 75% ya mankhwalawa amatuluka mumkodzo, pafupifupi 25% imachoka m'thupi monga mbali ya ndowe. Excretion imachitika mu mawonekedwe a ofooka metabolites, chifukwa chake, theka la moyo silimabweretsa kuwonjezeka kwa zotsatira zoyipa chifukwa chokomera.
Mulingo woyenera kwambiri wa metformin umawonedwa mu plasma patatha maola atatu mutatha kumwa mapiritsi. The bioavailability wa ichi sichikupita 60%. Mpaka 1/3 ya mlingo wotengedwa umasinthidwa osasinthika m'matumbo. Gawo logwiralo silimagwira kuti lipereke ma peptides. Imatha kulowa m'magazi ofiira.
Mankhwala a metacokinetic amasintha mothandizidwa ndi chakudya. Kukula kwakukhalira kwa kusintha kumeneku sikumveka bwino.
Kukula kwa chinthu chodabwitsachi kumachitika momwe zimakhalira. Kuchotsa hafu ya moyo ndi maola 6-7. Amachotsa impso.
Zizindikiro zogwiritsidwa ntchito
Mankhwalawa amalembera mankhwalawa omwe samachepetsa insulin omwe amadalira shuga, onse monga monotherapy komanso osakaniza ena a hypoglycemic.
Mankhwala amapatsidwa mankhwala ochizira omwe samatengera insulin.
Contraindication
Zoyipa pazakugwiritsa ntchito Avandamet ndi:
- Hypersensitivity payekha pazinthu zomwe zimagwira kapena zinthu zina zomwe zimapanga;
- kulephera kwa mtima;
- kulephera kupuma;
- zadzidzidzi;
- uchidakwa
- ketoacidosis;
- chikhazikitso;
- Kulephera kwaimpso ndi kupezeka kwa creatinine pansi pa 70 ml / min.;
- kuperewera kwa madzi m'thupi mwanjira yoti ingayambitse impso;
- kugwiritsa ntchito mitundu yosiyanitsa yokhala ndi ayodini;
- munthawi yomweyo insulin.
Ndi chisamaliro
Mosamala, mankhwalawa amagwiritsidwa ntchito limodzi ndi okodzetsa ndi ma beta-adrenergic agonists. Kuphatikizana kotereku kungayambitse kukula kwa hyperglycemia. Izi zitha kupewedwa powunikira shuga wamagazi pafupipafupi.
Momwe mungatenge Avandamet
Ndi matenda ashuga
Ndikofunika kumwa mankhwalawa nthawi yakudya kapena itatha. Izi zimachepetsa chiopsezo cha zotsatira zoyipa m'mimba. Mlingo umasankhidwa payekha.
Avandamet amalembedwa ngati mankhwala azakudya komanso zolimbitsa thupi sizilola kuti magazi azikhala ndi shuga wokwanira.
Mlingo woyambirira watsiku ndi tsiku ndi 4 mg wa rosiglitazone ndi 1000 mg ya metformin. Pambuyo pake imatha kusinthidwa kuti igwire bwino ntchito. Mlingo wapamwamba tsiku lililonse ndi 8 mg / 2000 mg.
Ndikulimbikitsidwa kuti muwonjezere mlingo pang'onopang'ono, zomwe zingapangitse thupi kuti lizolowere mankhwala. Kuyembekeza kusintha kwa njira zochizira kumatha masabata awiri atasinthidwa.
Zotsatira zoyipa za Avandamet
Pa mbali ya gawo la masomphenyawo
Macular edema imatha kuwonedwa.
Kuchokera minofu ndi mafupa
Kumwa mankhwalawa kumatha kukhala limodzi ndi kuwonjezeka kwa mafupa am'mimba, kupweteka kwa minofu.
Matumbo
Zotsatira zoyipa izi zitha kuchitika:
- kuphwanya chopondapo;
- kuchuluka chiwindi michere ntchito.
Hematopoietic ziwalo
Zitha kuwonekera:
- kuchepa magazi
- kuchepa kwa maselo a mapulateleti;
- kuchuluka kwa granulocyte;
- leukopenia.
Pakati mantha dongosolo
Zotsatira zotsatirazi zingachitike:
- Chizungulire
- mutu.
Kuchokera pamtima
Zotsatira zoyipa izi zitha kuchitika:
- kulephera kwa mtima;
- myocardial ischemia.
Matupi omaliza
Mwina kuwoneka kwa anaphylactic zimachitika, angioedema, totupa, kuyabwa, urticaria, mapapu edema.
Zokhudza mphamvu pakuwongolera njira
Avandamet sichikhudzanso kuchuluka kwa chidwi ndi kuthamanga kwa kayendedwe, kotero palibe chifukwa chokana kuwongolera njira kapena kuyendetsa galimoto.
Malangizo apadera
Gwiritsani ntchito mu ukalamba
Popereka mankhwala kwa achikulire, ndikofunikira kulingalira za kuchepetsa ntchito kwa aimpso. Iyenera kuyang'aniridwa pakagwiritsidwe ntchito ka mankhwala. Mlingo uyeneranso kusankhidwa poganizira kuvomerezeka kwa aimpso kwa creatinine. Izi zikuthandizani kupewa zovuta zina zosafunikira.
Kupatsa ana
Zambiri pakugwiritsa ntchito Avandamet pochiza odwala omwe ali mgululi ndilosakwanira nthawi yayitali. Ndikulimbikitsidwa kuti musankhe choyenera chida.
Zambiri pakugwiritsa ntchito Avandamet pochiza ana sikokwanira kuti adziwike bwino.
Gwiritsani ntchito pa nthawi yoyembekezera komanso mkaka wa m`mawere
Umboni woti mankhwalawa ukhoza kulowa mkati mwa chotchinga sichimalola kuti amayi azitha kupereka mankhwala momasuka pa nthawi yomwe ali ndi pakati. Gululi la odwala nthawi zambiri limasankhidwa kuti likhale ndi insulin, m'malo mwake pakangokhala othandizira a hypoglycemic
Mukamayamwa, kuyimitsidwa kwa Avandamet sikulimbikitsidwa. M'malo oyenera akhoza kukhala insulini. Ngati mankhwala othandizira ndi mankhwalawa akufunika kwa mayi woyamwitsa, ndikofunika kusamutsa mwanayo kuti akwanitse kudya.
Gwiritsani ntchito ntchito yolakwika ya chiwindi
Kutsika pang'ono kwa hepatic ntchito sikufuna kusintha kwa mlingo. Ndi kukanika kwambiri kwa hepatobiliary thirakiti, ndikulimbikitsidwa kuti chithandizo chichitike moyang'aniridwa ndi dokotala. Izi zikuthandizira kupewa lactic acidosis. Ndikothekanso kusankha njira zina zowongolera glycemia.
The ntchito aimpso kuwonongeka
Kuchepa kwambiri kwaimpso kumafuna kuwunika pafupipafupi zomwe dokotala akuchita. Avandamet asanaikidwe, zinthu zonse zowopsa ziyenera kulingaliridwa. Ngati kuwunika kwawonetsero kukuwonetsa kukhalapo kwa lactic acidosis, chithandizo chiyenera kusiyidwa ndipo wodwala agonekere kuchipatala.
Ngati kuchuluka kwa seramu creatinine kupitilira 135 μmol / L (amuna) ndi 110 μmol / L (azimayi), muyenera kukana kupereka mankhwala.
Mankhwala ochulukirapo a Avandamet
Mankhwala osokoneza bongo omwe amaphatikizidwa ndi kuphatikizika kwa lactic acidosis chifukwa cha pharmacological ntchito ya metformin. Izi matenda amafuna hospitalization wa wodwala ndi chithandizo chamankhwala mwadzidzidzi.
Lactate ndi chigawo chogwira ntchito chimapukusidwa ndi hemodialysis. Ndikofunikira kupatsa wodwala chithandizo chamankhwala, chifukwa rosiglitazone imakhalabe m'thupi chifukwa chomangiriza kunyamula ma peptides.
Kuchita ndi mankhwala ena
Avandamet ndi mankhwala ophatikiza, palibe deta pazomwe zimagwirizana ndi mankhwala. Kafukufuku wokhudzana ndi mankhwala ogwiritsidwa ntchito ndi zinthu zomwe zimagwiritsidwa ntchito mosiyanasiyana.
Kusamalidwa makamaka kuyenera kuchitika mukamagwiritsa ntchito glucocorticosteroids.
Kusamalidwa kwapadera kuyenera kuchitika pamodzi ndi munthawi yomweyo kugwiritsa ntchito mankhwala omwe ali ndi glucocorticosteroids, okodzetsa, beta2-agonists. Kuphatikiza koteroko kumatha kuyambitsa kuchuluka kwa shuga wa seramu.
Kuphatikiza pamodzi kwa mankhwalawa ndi nitrate osavomerezeka. Izi zingayambitse kuchuluka kwa zizindikiro za myocardial ischemia.
Kuphatikiza ndi sulfonylurea kungayambitse kuchepa kwa matenda a m'magazi a plasma. Zikatero, kuyang'aniridwa mosamala kwa shuga wamagazi ndikulimbikitsidwa.
Kuyenderana ndi mowa
Kumwa mowa panthawi ya mankhwala ndi Avandamet kumawonjezera chiopsezo cha lactic acidosis. Mkhalidwe wamtunduwu ndi kuphwanya kwambiri homeostasis, komwe kungayambitse kusanza.
Zakumwa zoledzeretsa kuphatikiza ndi mankhwalawa zimathandizanso kuti pakhale zovuta zina zoyipa za mankhwalawa.
Analogi
Zofananira za mankhwalawa ndi:
- Glucophage;
- Glucovans;
- Subetta.
Kupita kwina mankhwala
Mankhwala omwe mumalandira.
Mtengo
Zimatengera malo ogula.
Zosungidwa zamankhwala
Iyenera kusungidwa kutentha osapitirira + 25 ° C.
Tsiku lotha ntchito
Chogulacho ndi choyenera kugwiritsidwa ntchito patatha zaka zitatu kuyambira tsiku lotulutsidwa. Kugwiritsanso ntchito sikulimbikitsidwa.
Wopanga
Mankhwalawa amapangidwa ndi Glaxo Wellcom S.A., Spain.
Ndemanga
Gennady Bulkin, endocrinologist, Yekaterinburg
Mankhwala si malo osavuta, koma chida chothandiza pothana ndi matenda osokoneza bongo omwe amadalira shuga. Kuphatikiza kwa zinthu ziwiri zogwira ntchito kumapangitsa kuti glycemic iyende bwino. Chidacho chimagwira paliponse pazotulutsa pancreatic komanso pamaselo a ziwalo zopumira. Izi zimapatsa insulin sensitivity.
Ndikupangira mankhwalawa kwa anthu odwala matenda ashuga a mtundu 2 omwe samatha kukhala ndi shuga wamagazi ambiri pogwiritsa ntchito mankhwala, masewera olimbitsa thupi komanso mankhwala ena. Chipangizochi chili ndi mphamvu, choncho chisamaliro chikuyenera kuthandizidwa pakumwa mankhwala.
Alisa Chekhova, endocrinologist, Moscow
Avandamet ndi amodzi mwa mankhwala othandiza kwambiri pakuwongolera glycemic. Nthawi zambiri ndimapereka kwa odwala kwambiri. Kuphatikizika kwa zosakaniza zogwira ntchito kumatha kukwaniritsa kusintha kwazinthu zopanda chiyembekezo kwambiri.
Palinso zovuta. Kuchiza kumafuna kuwunikidwa mosamala ndi dokotala. Mlingo wosankhidwa moyenera komanso kuwunika pafupipafupi kuchuluka kwa shuga kumathandiza kupewa mavuto.
Leonid wazaka 32, St. Petersburg
Ndakhala ndikutenga Avandamet zoposa chaka. Izi zisanachitike ndinayesa njira zambiri, koma zonsezo zinasiya kugwira ntchito kwa nthawi. Matenda a shuga ndi matenda owopsa omwe, ngati sanachiritsidwe, amakhudza thupi lonse.
Kuti ndikhale ndi thanzi labwino, ndidapita kwa katswiri wazopeza wa endocrinologist. Mtengo wa phwandoli unali wolira, koma ndinapeza zomwe ndimafuna. Adotolo adandipatsa mankhwalawa. Pakatha sabata, kuchuluka kwa shuga kunachepa. Patatha mwezi umodzi, adayamba kukhala bwino. Ndikuthokoza kwambiri dotolo ndi Avandamet pondibwezera zachilenge.
Victoria, wazaka 45, Moscow
Dokotala anachenjeza kuti chida ichi ndichothandiza kwambiri. Sindikadavomera ngati ndikadadziwa zomwe ndikumana nazo panthawi ya chithandizo. Pena patatha milungu iwiri nditayamba kutenga Avandamet, zimachitika zoyipa. Anayamba kuda nkhawa ndi mseru, kudzimbidwa. Chizungulire, thanzi linasokonekera. Ndimayenera kumuwona dokotala. Anapeza choloweza, pambuyo pake zotsatirapo zake zonse.
