Hypoglycemic mankhwala Januvia (malangizo ndi ndemanga za anthu odwala matenda ashuga)

Januvia ndi woyamba mankhwala antidiabetesic okhudzana ndi gulu latsopano laopangidwa, DPP-4 inhibitors. Ndi kuyamba kwa Januvia, nthawi yatsopano ya mankhwala a shuga inayamba pa matenda a shuga. Malinga ndi asayansi, kupanga izi ndikosafunanso kuposa kupezeka kwa metformin kapena kupanga insulin. Mankhwala atsopanowa amachepetsa shuga moyenera monga kukonzekera kwa sulfonylurea (PSM), koma nthawi yomweyo sikubweretsa hypoglycemia, imalekeredwa mosavuta ndipo imathandizanso kubwezeretsa maselo a beta.

Malinga ndi malangizo, Januvia akhoza kumwedwa ndi othandizira ena a hypoglycemic, kuphatikiza ndi insulin.

Zizindikiro zogwiritsidwa ntchito

Malinga ndi malingaliro a mayanjano ambiri a anthu odwala matenda ashuga, mankhwala a mzere woyamba, womwe umaperekedwa akangomupeza matenda a shuga a 2, ndi metformin. Ndi kupanda kwake, mankhwala a mzere wachiwiri amawonjezeredwa. Kwa nthawi yayitali, mwayiwo unaperekedwa kukonzekera kwa sulfonylurea, chifukwa zimakhudza shuga m'magazi kuposa mankhwala ena. Pakadali pano, madotolo ochulukirachulukira akutsamira mankhwala atsopano - GLP-1 mimetics ndi DPP-4 inhibitors.

Monga lamulo wamba, Januvia ndi mankhwala a shuga mellitus, omwe amawonjezeredwa ndi metformin pa gawo lachiwiri la chithandizo cha matenda ashuga. Chomwe chikuwonetsa pakufunika kwa mankhwala ochepetsa shuga wachiwiri ndi glycated hemoglobin> 6.5%, malinga ngati metformin imatengedwa pamtunda woyandikira kwambiri, zakudya zamagulu ochepa zimayang'aniridwa, ndikuchita zolimbitsa thupi pafupipafupi kumatsimikiziridwa.

Mukamasankha zomwe mungamupatse wodwala: kukonzekera kwa sulfonylurea kapena Januvia, samalani kuopsa kwa hypoglycemia kwa wodwalayo.

Matenda a shuga ndi kupsinjika kudzakhala chinthu chakale

• Matenda a shuga -95%
• Kuthetsa kwa mitsempha thrombosis - 70%
• Kuthetsa kwa kugunda kwamtima kwamphamvu -90%
• Kuthana ndi kuthamanga kwa magazi - 92%
• Kuwonjezeka kwa mphamvu masana, kukonza kugona usiku -97%

Zisonyezero zakalandiridwa kwa Januvia ndi fanizo:

1. Odwala omwe amachepetsa kudziwa kwa hypoglycemia chifukwa cha neuropathy kapena zifukwa zina.
2. Anthu odwala matenda ashuga amakhala ndi chiyembekezo chofika usiku.
3. Osowa, odwala okalamba.
4. Anthu odwala matenda ashuga omwe amafunikira chisamaliro chachikulu poyendetsa galimoto, kugwira malo okwera, ndi njira zovuta, etc.
5. Odwala omwe amakhala ndi hypoglycemia pafupipafupi amatenga sulfonylurea.

Mwachilengedwe, aliyense amene ali ndi matenda ashuga amatha kupita ku Januvia akafuna. Chizindikiro chokwanira cha Januvia ndi kuchepa kwa hemoglobin wa glycated ndi 0,5 peresenti kapena kuposerapo atalandira chithandizo kwa miyezi isanu ndi umodzi. Ngati izi sizikwaniritsidwa, wodwalayo ayenera kusankha mankhwala ena. Ngati GH yafupika, koma osafikanso pozolowereka, wothandizira wachitatu wa hypoglycemic amawonjezeredwa ku regimen yothandizira.

Kodi mankhwalawo amagwira ntchito bwanji?

Kuchulukitsa ndi mahomoni am'mimba omwe amapangidwa atatha kudya ndikumapangitsa kuti insulini itulutsidwe. Akamaliza kugwira ntchito yawo, amathandizidwa mwachangu ndi enzyme yapadera - mtundu 4 dipeptidyl peptidase, kapena DPP-4. Januvia linalake, kapena linalake ndipo tikulephera. Zotsatira zake, ma insretins amakhala m'magazi motalikirapo, zomwe zikutanthauza kuti kaphatikizidwe ka insulin kamakhala kolimba, ndipo shuga amayamba kuchepa.

Mitundu yonse ya ma inhibitors onse a DPP-4 omwe amagwiritsidwa ntchito mu shuga mellitus:

• Januvia ndi analogues amatengedwa pakamwa, amapezeka piritsi;
• amalimbikitsa kuchuluka kwa maretretins, koma osapitirira 2 nthawi ya thupi;
• pafupifupi osakhala zotsatira zoyipa m'mimba;
• Osamakhudza zoipitsitsa;
• hypoglycemia mu matenda a shuga ndizochepa kwambiri kuposa kukonzekera kwa sulfonylurea;
• kuchepetsa hemoglobin wa glycated ndi 0.5-1.8%;
• zimakhudzanso kusala komanso postprandial glycemia. Kuthamanga kwa glucose kumachepetsedwa, kuphatikizapo chifukwa chakuchepa kwa kubisika kwake ndi chiwindi;
• onjezerani unyinji wa maselo a beta mu kapamba;
• musakhudze kubisala kwa glucagon poyankha hypoglycemia, osachepetsa malo ake osungira chiwindi.

Malangizo ogwiritsira ntchito amafotokozera mwatsatanetsatane pharmacokinetics ya sitagliptin, chinthu chogwira ntchito cha Januvia. Ili ndi bioavailability yapamwamba (pafupifupi 90%), imakamwa kuchokera m'matumbo am'mimba mkati mwa maola 4. Zochitikazo zimayamba kale theka la ola pambuyo pa utsogoleri, zotsatira zake zimatha kuposa tsiku limodzi. Mu thupi, sitagliptin kwenikweni samapukusidwa, 80% imachotsedwa mu mkodzo mofananamo.

Wopanga Januvia ndiye bungwe la America Merck. Mankhwala omwe amalowa mumsika waku Russia amapangidwa ku Netherlands. Pakadali pano, kupanga sitagliptin ndi kampani yaku Russia Akrikhin wayamba. Maonekedwe ake pamashelefu apachipatala akuyembekezeredwa mu 2 kotala la 2018.

Malangizo ogwiritsira ntchito

Mankhwala a Januvia akupezeka mu gawo la 25, 50, 100 mg. Mapiritsiwo ali ndi nembanemba wamafilimu ndipo amakhala utoto kutengera mlingo: 25 mg - wotumbululuka pinki, 50 mg - mkaka, 100 mg - beige.

Mankhwalawa ndi ovomerezeka kwa maola opitilira 24. Amatengedwa kamodzi patsiku nthawi iliyonse, mosasamala nthawi yakudya komanso kapangidwe kake. Malinga ndi ndemanga, mutha kusintha nthawi yolandira Januvia ndi 2 maola osapereka nsembe glycemia.

Maupangiri akutsatira malangizo:

1. Mulingo woyenera kwambiri ndi 100 mg. Amalembedwa pafupifupi odwala matenda ashuga onse omwe alibe contraindication. Kuyamba ndi mlingo wocheperako ndikuwonjezera pang'onopang'ono sikofunikira, popeza Januvia amaloledwa bwino ndi thupi.
2. Impso zimathandizira pakuchotsa sitagliptin, chifukwa chake, ndi kulephera kwaimpso, mankhwalawa amatha kudziunjikira m'magazi. Kuti mupewe kumwa mopitirira muyeso, mlingo wa Januvia umasinthidwa kutengera mtundu wa kusakwanira. Ngati GFR> 50, 100 mg yokhazikika imaperekedwa. Ndi GFR <50 - 50 mg, GFR <30 - 30 mg.
3. Kwa odwala omwe ali ndi vuto la kuchepa kwa hepatic, kusintha kwa mankhwalawa kwa Januvia sikofunikira, chifukwa sitagliptin sichimapangidwira impso.
4. Pa odwala matenda ashuga okalamba, kuchuluka kwa sitagliptin m'magazi kumakhala pafupifupi 20% kuposa achinyamata. Kusiyana kotereku sikumakhudza glycemia ndipo sikungayambitse bongo, sikofunikira kusintha kuchuluka kwa Januvia.

Kutsitsa kwa shuga kwa Januvia:

Zotsatira zoyipa

Kafukufuku yemwe adayesa kulekerera kwa Januvia, adaganiza kuti mankhwalawa, okha kapena osakanikirana ndi mapiritsi ena a antiidiabetes, alibe zotsatira zoyipa. Panalibe kusiyana kwakukulu pamanambala a odwala omwe ali ndi matenda ashuga ochokera ku gulu loyendetsa ndi omwe amatenga Januvia. Komabe, malangizo ogwiritsira ntchito akuwonetsa zovuta zonse zaumoyo zomwe odwala adakumana nazo: matenda opatsirana, mutu, kudzimbidwa, ndi zina zambiri.

Malinga ndi odwala matenda ashuga, mapiritsi a Januvia kwenikweni samayambitsa hypoglycemia. Izi ndichifukwa chakuti imagwira ntchito pokhapokha ngati magazi atuluka m'magazi. Shuga amatha kugwa pokhapokha ngati mukugwiritsa ntchito Januvia pogwiritsa ntchito sulfonylurea. Kuti mupewe izi, muyenera kuchepetsa kuchuluka kwa PSM.

Malingaliro a Katswiri

Arkady Alexandrovich

Endocrinologist wodziwa zambiri

Funsani katswiri funso

Zaka zingapo zapitazo, zidziwitso zidawoneka kuti Januvia ndiwopsa kwambiri kwa odwala matenda ashuga omwe ali ndi matenda amtima. Adatsutsidwa mu 2015. Kafukufuku wazaka zitatu adatsimikizira kuti mankhwalawa a Januvia samakulitsa chiopsezo cha mtima, matenda a mtima, angina pectoris, ndi matenda ena amtima.

Kodi Johnvia walandiridwa kwa ndani?

Mankhwala a Januvia sangatengedwe kwa anthu omwe ali ndi hypersensitivity ku sitagliptin kapena zosakaniza zina za piritsi. Mukatenga, zidzolo, angioedema, anaphylaxis ndizotheka.

Zotsatira za mankhwalawa sizinaphunzire kwa ana, nthawi yapakati komanso mkaka wa m`mawere. Chifukwa cha kusowa kwa chitetezo chazotetezedwa, malangizowa amaletsa kulandira chithandizo ku Yanuvia m'magulu a odwala matenda ashuga.

Monga mapiritsi ena ochepetsa shuga, Januvia sagwiritsidwa ntchito chifukwa cha zovuta za matenda ashuga, panthawi yochira kuchokera kuvulala kwambiri komanso kuchitira opareshoni.

Bongo

Malinga ndi malangizowo, khosi lalitali la Yanuvia limalekeredwa bwino. Ngati mlingo waukulu watengedwa, wodwala yemwe ali ndi matenda osokoneza bongo angafunike chithandizo chamankhwala: kuchotsedwa kwa mapiritsi osagwiritsidwa bwino ntchito m'mimba, dialysis, chithandizo chothandizira.

Zitha kusintha

Analogue yathunthu ya Januvia ndi Kselievia waku Germany. Sizotheka kugula izo ku Russia, mukamayitanitsa kunja kumayiko ena ndi pafupifupi ma euro 80 pamwezi wazithandizo.

Kukonzekera kofanana (DPP-4 inhibitors) ndi zofanana (GLP-1 mimetics):

Mankhwala a Januvia alibe ma analogi otsika mtengo pano, pafupi ndi mtengo wa maphunziro apamwezi - Galvus (pafupifupi rubles 1,500) ndi Ongliza (1900 rubles).

Januvia kapena Galvus - zomwe zili bwino

Ndemanga za madotolo zikuwonetsa kuti Galvus ndi Januvia ali pafupi momwe angathere malinga ndi mfundo yantchito ndi kutsika kwa shuga, ngakhale pali zinthu zina zomwe zimagwira. Izi zimatsimikiziridwa ndi data ya kafukufukuyu, momwe mankhwalawo adafananizidwa:

• Piritsi limodzi la Januvia 100 mg ndilofanana ndi mapiritsi 2 a Galvus 50 mg;
• mwa anthu omwe ali ndi matenda a shuga oletsa kupindika, hemoglobin wambiri amatsika mpaka 7% mu 59% ya odwala matenda ashuga amatenga Januvia, 65% ya odwala pa Galvus;
• Hypoglycemia wofatsa idawonedwa mu 3% ya odwala pa Januvia, mu 2% - pa Galvus. Hypoglycemia yayikulu inalibe pakumwa mankhwalawa.

Malinga ndi wopanga, pothandizidwa ndi Galvus, cholesterol ndi magazi triglycerides amachepetsedwa, potero amachepetsa chiopsezo cha zovuta zam'mitsempha. Ku Januvia, palibe zotere zomwe zidapezeka.

Mtengo

Mtengo wa phukusi la Januvia, wowerengedwa kwa masabata 4 atalandiridwa, kuchokera ku 1489 mpaka 1697 rubles. Amagulitsidwa kokha ndi mankhwala operekedwa ndi endocrinologist kapena akatswiri. Odwala matenda ashuga omwe adalembetsa ali ndi mwayi wolandila Januvia kwaulere, popeza sitagliptin ali pamndandanda wamankhwala ofunikira (Vital and Essential Diction). Malinga ndi ndemanga, mankhwalawa sanapezeke konse kumadera onse a Russia.

Ndemanga Zahudwala

Ndinkakonda kumwa Diabeteson MV ndi Siofor, tsopano ndinayamba kugwiritsa ntchito mankhwala a Januvia. Ndondomeko ya chithandizo ndi 100 mg ya Januvia m'mawa, 3 times 500 mg ya Siofor masanawa. Zomwe munganene kuchokera mwezi wa kayendetsedwe: shuga yofulumira yakula pang'ono, tsopano pafupifupi 5.7-6.7. Atatha kudya, adayambanso kupitilira zizolowezi. Kuyankha kwa katundu kwasintha. M'mbuyomu, pambuyo pa ola limodzi, magawo ankayambitsa hypoglycemia, shuga nthawi zina amatsikira mpaka 3. Tsopano pang'onopang'ono amatsika mpaka 5.5, kenako amakula mpaka nthawi yake. Mwambiri, hemoglobin wa glycated wakula pang'ono, ndipo kusinthasintha kwa shuga patsiku kwachepa kwambiri.

Ku Germany, Galvus adapita, atasamukira ku Russia, adokotala anga akukakamira pa Januvia. Amachepetsa shuga chimodzimodzi, koma adamvanso bwino. Kodi chifukwa chake, sindikumvetsa. Popeza kuti kumva ndikadali lingaliro labwinobwino, Januvia amachita bwino kwambiri matenda ashuga.

Januvia adawonjezera mankhwalawo ku zovuta za Levemir + Humalog. Zowoneka zoyamba ndi zabwino - mankhwalawa amayankha kokha shuga wambiri, wotsika samakhudza, amagwira ntchito pang'onopang'ono, popanda kudumpha. Mlingo wa insulin unachepetsedwa ndi kotala. Phindu lomwe silinatchulidwe mu malangizowa ndi kuchepa kwa chikhumbo ndi gawo limodzi mwa magawo atatu. Ndikuganiza kuti iyi ndi mankhwala othandiza.

Mankhwalawa ndiabwino kwambiri. Imasinthasintha shuga, imathandiza kuchepetsa thupi, sizimayambitsa njala yayikulu ndikadumphira chakudya, monga Gliclazide MV. Choyipa chachikulu cha Januvia ndi mtengo wake wokwera. Anapereka mankhwala aulere, tsopano sindingathe kulandira mapiritsi kuchipatala, ndasiya kale ntchito. Ndiyenera kugula ndekha.