Chifukwa cha mtengo wotsika wa Amaril, ma analogu amagwiritsidwa ntchito nthawi zambiri kuphatikiza shuga m'magazi a matenda ashuga omwe ali ndi matenda odziyimira pawokha. Mankhwalawa ndi abwino kuti azikhala ndi glycemia wokhala ndi zakudya zapadera komanso masewera.
Komabe, si aliyense amene angakwanitse kugula wothandizirayu. Chifukwa chake, munkhaniyi, pharmacological zochita za Amaril zidzaululidwa ndipo mawonekedwe ake ophatikizidwa ku Russia adzatchulidwa.
Pharmacological zochita za mankhwala
Amaryl ndi mankhwala amkamwa a hypoglycemic omwe amathandiza kutsitsa shuga wamagazi polimbikitsa kumasulidwa ndi kutsegulira kwa insulin kapangidwe ndi maselo a beta enieni omwe amapezeka m'matumbo a pancreatic.
Njira yayikulu yolimbikitsira kaphatikizidwe ndikuti Amaril amathandizira kuyankha kwa maselo a beta kuti chiwonjezeke cha kuchuluka kwa shuga m'magazi a anthu.
Mlingo wocheperako, mankhwalawa amathandizira kuwonjezeka pang'ono kwa insulin. Amaryl ali ndi katundu wowonjezera chidwi cha insulin-yotengera minofu yamitsempha yama cell kupita ku insulin.
Pokhala chotumphuka cha sulfonylurea, Amaril amatha kusokoneza ntchito yopanga insulin. Izi zimatsimikiziridwa ndikuti gawo lomwe limagwiritsa ntchito mankhwalawa limalumikizana ndi njira za ATP zama cell a beta. Amaryl imamangiriza mapuloteni pamwamba pa membrane wa cell kusankha. Katunduyu wa mankhwala amalola kuwonjezera kukhudzidwa kwa maselo am'mimba kuti apange insulin.
Glucose owonjezereka amalowetsedwa makamaka ndi ma cell a minofu minofu ya thupi.
Kuphatikiza apo, kugwiritsa ntchito mankhwalawa kumalepheretsa kupezeka kwa glucose ndi maselo a minyewa ya chiwindi. Izi zimachitika chifukwa cha kuwonjezeka kwa zomwe zili ndi fructose-2,6-biophosphate, zomwe zimathandizira kulepheretsa kwa gluconeogeneis.
Kukhazikitsa kwa insulin kaphatikizidwe kumachitika chifukwa chakuti yogwira mankhwala imathandizira kuchuluka kwa potaziyamu ion m'magazi a beta, komanso kuchuluka kwa potaziyamu kwambiri mu cell kumapangitsa kuti mahomoni azigwira bwino ntchito.
Mukamagwiritsa ntchito mankhwala othandizira osakanikirana ndi metformin, odwala amakhala ndi kusintha kwa kagayidwe kazakudya kamphamvu ka shuga mthupi.
Kuchita mankhwala ophatikizira limodzi ndi jakisoni wa insulin. Njira yolamulirayi imagwiritsidwa ntchito pokhapokha ngati mulingo woyenera wa metabolic usachitike mukamamwa mankhwala amodzi. Mukamachita mankhwala amtunduwu a matenda a shuga, muyenera kusintha njira ya insulin.
Kuchuluka kwa insulin yomwe imagwiritsidwa ntchito pamtunduwu wa mankhwala kumachepetsedwa kwambiri.
Pharmacokinetics wa mankhwala
Ndi muyezo umodzi wa mankhwalawa tsiku lililonse la 4 mg, kuchuluka kwake kumachitika pambuyo pa maola 2,5 ndikufika 309 ng / ml. The bioavailability wa mankhwalawa 100%. Kudya sikunakhudze mayendedwe a mayamwidwe, kupatula kuchepa pang'ono kwakanthawi.
Chithandizo chogwira ntchito cha mankhwala chimadziwika ndi kuthekera kwa kulowa mkaka wa m'mawere kudzera mwa chotchinga chachikulu. Zomwe zimachepetsa mwayi wogwiritsa ntchito mankhwalawa panthawi yoyembekezera komanso yoyamwitsa.
Kagayidwe kake ka chinthu chogwira ntchito mu minofu ya chiwindi. Isoenzyme yayikulu yomwe imakhudzidwa ndi metabolism ndi CYP2C9. Pakukonza kagayidwe kake ka zigawo zikuluzikulu, ma metabolites awiri amapangidwa, omwe pambuyo pake amawatulutsa ndowe ndi mkodzo.
Kutupa kwa mankhwalawa kumachitika ndi impso mu 58% ndipo pafupifupi 35% mothandizidwa ndi matumbo. Zomwe zimagwiritsidwa ntchito ndi mankhwala mu mkodzo sizimadziwika kuti sizinasinthe.
Malinga ndi zotsatira za kafukufukuyu, zidapezeka kuti pharmacokinetics sizimatengera jenda la wodwalayo komanso msinkhu wake.
Ngati wodwala walephera kugwira ntchito kwa impso ndi chimbudzi, wodwalayo ali ndi chiwonetsero cha glimepiride ndi kuchepa kwa ndende yake yambiri m'magazi a seramu, omwe amayamba chifukwa chothamangitsa kwambiri mankhwalawa chifukwa chotsitsa chomanga ma protein
Zotsatira za mankhwala
Amaryl amadziwika kuti ndi wachitatu m'badwo wa sulfonylurea. Mayiko omwe akutulutsa mankhwalawa ndi Germany ndi Italy. Mankhwala amapangidwa piritsi la 1, 2, 3 kapena 4 mg. Piritsi limodzi la Amaril lili ndi chigawo chachikulu - glimepiride ndi zina zotulutsa.
Zotsatira za glimepiride makamaka zimachepetsa shuga wamagazi polimbikitsa kupanga insulin ndi maselo a beta. Kuphatikiza apo, chinthu chogwira ntchito chimakhala ndi insulinomimetic ndipo chimawonjezera chidwi cha maselo a maselo kuti timadzi timene timatsitsa.
Wodwala akamamwa Amaryl, kuchuluka kwambiri kwa glimepiride kumachitika pambuyo pa maola 2,5. Mankhwalawa amatha kumwa mosaganizira nthawi yakudya. Komabe, kudya pang'ono kumakhudza ntchito ya glimepiride. Kwenikweni, chinthuchi chimapukusidwa kudzera m'matumbo ndi impso.
Katswiri wodziwikiratu amawerengera mapiritsi a Amaril kwa odwala omwe ali ndi matenda a shuga a 2 monga monotherapy kapena akaphatikizidwa ndi othandizira a hypoglycemic.
Komabe, kumwa mankhwalawa sikulepheretsa kupitiriza kudya zakudya zoyenera zomwe sizimapatula mafuta am'mimba komanso chakudya chamagulu, komanso moyo wokangalika.
Malangizo ogwiritsira ntchito mankhwalawa
Simungagule mankhwala popanda kuuzidwa ndi dokotala. Musanagwiritse ntchito mankhwalawa, muyenera kupita kwa dokotala ndikumufunsa mafunso anu onse. Ndi iye omwe angadziwe kuchuluka kwa mankhwalawa ndikuwapatsa mtundu wa mankhwala malinga ndi kuchuluka kwa shuga.
Mapiritsi a Amaryl amatengedwa pakamwa popanda kutafuna, ndikutsukidwa ndi madzi okwanira. Ngati wodwalayo adayiwala kumwa mankhwalawo, kuonjezera kuchuluka kwa mankhwalawo ndizoletsedwa. Mankhwala, muyenera kuwunika kuchuluka kwa shuga komanso kuchuluka kwa hemoglobin ya glycosylated.
Poyamba, wodwalayo amatenga muyezo umodzi wa 1 mg patsiku. Pang'onopang'ono, pakadutsa sabata limodzi kapena awiri, kuchuluka kwa mankhwalawa kumatha kuwonjezeka ndi 1 mg. Mwachitsanzo, 1 mg, kenako 2 mg, 3 mg, ndi zina mpaka 8 mg tsiku lililonse.
Anthu odwala matenda ashuga omwe ali ndi vuto labwino la glycemic amatenga mlingo wofikira 4 mg.
Nthawi zambiri, mankhwalawa amatengedwa kamodzi musanadye chakudya cham'mawa kapena, ngati mungalumphe kugwiritsa ntchito mapiritsi, musanadye chakudya chachikulu. Potere, katswiriyu ayenera kuganizira za moyo wa anthu odwala matenda ashuga, nthawi yakudya komanso zochita zake zolimbitsa thupi. Kusintha kwa mankhwalawa kungafunike ngati:
- Kuchepetsa thupi;
- kusintha munthawi yamoyo (chakudya, katundu, nthawi yakudya);
- zinthu zina.
Onetsetsani kuti mwawonana ndi dokotala ndikuyamba ndi mlingo wochepa (1 mg) wa Amaril ngati wodwala akufunika:
- kusintha kwa mankhwala ena ochepetsa shuga ndi Amaril;
- kuphatikiza kwa glimepiride ndi metformin;
- kuphatikiza ndi glimepiride ndi insulin.
Sibwino kumwa mankhwala kwa odwala omwe ali ndi vuto la impso, komanso kulephera kwa impso komanso / kapena chiwindi.
Contraindication ndi zoyipa zosiyanasiyana
Amaril glimepiride yomwe ili mu mankhwalawo, komanso zowonjezera zina, sizimakhudza thupi la odwala matenda ashuga nthawi zonse.
Komanso njira zina, mankhwalawa ali ndi contraindication.
Sizoletsedwa kumwa mapiritsi kwa odwala motere:
- mtundu wa shuga wodalira insulin;
- nthawi ya bere ndi kuyamwitsa;
- matenda ashuga ketoacidosis (kuphwanya chakudya kagayidwe kachakudya), chikhalidwe cha matenda a shuga;
- odwala osakwana zaka 18;
- galactose tsankho, lactase akusowa;
- kukula kwa shuga-galactose malabsorption;
- kuphwanya chiwindi ndi impso, makamaka odwala akudwala hemodialysis;
- munthu tsankho kwa zomwe zili mankhwala, sulfonylurea zotumphukira, sulfonamide wothandizila.
Malangizo omwe aphatikizidwa akuti m'masabata oyamba omwe amathandizira, Amaryl ayenera kumwedwa mosamala kuti apewe kukula kwa chikhalidwe cha hypoglycemic. Kuphatikiza apo, ngati pakuphwanya mayamwidwe a chakudya ndi mankhwala kuchokera m'matumbo, kuperewera kwa glucose-6-phosphate dehydrogenase, matenda wamba komanso pakakhala pangozi yakukhala ndi mtundu wa hypoglycemic, Amaril amagwiritsidwa ntchito mosamala.
Pogwiritsa ntchito mapiritsi molakwika (mwachitsanzo, kudumphira m'magawo), zimakhudzanso izi:
- Mkhalidwe wa Hypoglycemic, zizindikiro zomwe zimakhala ndi mutu komanso chizungulire, kusokonezeka kwa chidwi, kukwiya, chisokonezo, kugona, kukomoka, kunjenjemera, kupsinjika ndi kuwona kwamaso.
- Kuphatikiza kwa adrenergic ngati yankho la kuchepa msanga kwa shuga, kuwonetsedwa ndi nkhawa, palpitations, tachycardia, kugunda kwa mtima komanso kuwoneka thukuta lozizira.
- Matenda am'mimba - kupsinjika, kusanza, kupweteka kwam'mimba, kutsekula m'mimba, chitukuko cha chiwindi, kuchuluka kwa michere ya chiwindi, jaundice kapena cholestasis.
- Kuphwanya hematopoietic dongosolo - leukopenia, thrombocytopenia, granulocytopenia ndi zina zina matenda.
- Ziwengo, owonetsedwa ndi zotupa pakhungu, kuyabwa, ming'oma, nthawi zina kuwopsa kwa anaphylactic ndi vasculitis.
Zina zimachitika - photosensitization ndi hyponatremia.
Mtengo, ndemanga ndi fanizo
Mtengo wa Amaril mwachindunji umatengera mtundu wa kumasulidwa kwake. Popeza mankhwalawo amalowetsedwa kunja, motero, mtengo wake ndi wokwera kwambiri. Mitengo yamapiritsi a Amaryl ndi awa.
- 1 mg 30 mapiritsi - 370 ma ruble;
- 2 mg 30 mapiritsi - 775 ma ruble;
- 3 mg 30 mapiritsi - 1098 ma ruble;
- 4 mg 30 mapiritsi - 1540 rubles;
Pankhani ya odwala matenda ashuga za momwe mankhwalawa amathandizira, ali ndi chiyembekezo. Pogwiritsa ntchito mankhwalawa kwa nthawi yayitali, shuga m'magazi amabwerera mwakale. Ngakhale mndandandandawo uli ndi zotsatira zoyipa zomwe zingachitike, kuchuluka kwake kumakhala kochepa kwambiri. Komabe, pali ndemanga zoyipa za odwala omwe amagwirizana ndi mtengo wokwera wa mankhwalawo. Ambiri aiwo amayenera kuyang'ana m'malo mwa Amaril.
M'malo mwake, mankhwalawa ali ndi ma fanizo ambiri ndi ma analogu opangidwa ku Russian Federation, mwachitsanzo:
- Glimepiride ndi mankhwala omwe ali ndi mankhwala omwewo, contraindication ndi mavuto. Kusiyanako kumangokhala pazowonjezera. Mtengo wapakati wa mankhwalawa (2 mg No. 30) ndi 189 rubles.
- Diagninide ndi mankhwala ochepetsa shuga, m'mapangidwe ake amafanana ndi mankhwala omwe amatumizidwa NovoNorm. Zomwe zimagwiritsidwa ntchito ndizopatsanso. Novonorm (Diagninide) ali ndi zofanana zofanana zotsutsana komanso zoyipa zomwe zimachitika. Kuti mumvetsetse kusiyana pakati pa ma analogu awiriwa, ndikofunikira kuyerekeza mtengo: mtengo wa Diaglinide (1 mg No. 30) ndi ma ruble 209, ndipo NovoNorm (1 mg No. 30) ndi ma ruble 158.
- Glidiab ndi mankhwala a ku Russia, amenenso ndi analogue a shuga wodziwika bwino a shuga. Mtengo wapakati wa mapiritsi a Glidiab (80 mg No. 60) ndi ma ruble a 130, ndipo mtengo wa mankhwalawa Diabeteson (30 mg No. 60) ndi ma ruble 290.
Amaryl ndi mankhwala abwino ochepetsa shuga, koma okwera mtengo. Chifukwa chake, ikhoza m'malo mwa zotsika mtengo, zonse zapakhomo (Diclinid, Glidiab), ndikugulitsa mankhwala akunja (NovoNorm, Diabeteson). Kuphatikizikako kumakhala ndi glimepiride, kapena zinthu zina zomwe zimapangitsa kuchepa kwa shuga. Kudziwa za fanizo, adotolo ndi wodwalayo atha kusankha kuti ndi mankhwala ati omwe angathe kumwa. Kanemayo munkhaniyi akupitiliza mutu wa Amaril wa matenda ashuga.
