Mankhwala a odwala matenda ashuga Glimepiride: malangizo ndi kuwunika kwa wodwala

Glimepiride (Glimepiride) - amakono kwambiri amakono a sulfonylurea. Ndi matenda ashuga, zimawonjezera kutulutsa kwa insulin m'magazi, kumachepetsa glycemia. Kwa nthawi yoyamba, chinthu ichi chogwiritsidwa ntchito ndi Sanofi m'mapiritsi a Amaryl. Tsopano mankhwala okhala ndi izi amapangidwa padziko lonse lapansi.

Russian glimepiride imaperekedwanso bwino, imachepetsa shuga, imayambitsa zovuta zochepa, monga mapiritsi oyambirirawo. Ndemanga zikuwonetsa zabwino komanso mtengo wotsika wa mankhwala apakhomo, chifukwa chake sizosadabwitsa kuti odwala matenda ashuga Glimepiride nthawi zambiri amakonda Amaril woyambirira.

Ndani akuwonetsedwa glimepiride

Mankhwala tikulimbikitsidwa kuti matenda a glycemia yekha mtundu 2 shuga. Malangizo ogwiritsira ntchito sanena kwenikweni ngati mankhwala ndi Glimepiride ali oyenera, popeza kusankha kwa mankhwala ndi kuchuluka kwake ndikoyenera kwa dokotala. Tiyeni tiyese kudziwa kuti ndi ndani yemwe akuwonetsedwa monga Glimepiride.

Shuga wa shuga amadzuka pazifukwa ziwiri: chifukwa cha kukana insulini komanso kuchepa kwa kutulutsa kwa insulin m'maselo a beta omwe amapezeka m'matumbo. Kukana kwa insulini kumayamba ngakhale matenda asanayambike shuga, amapezeka mwa odwala omwe ali ndi kunenepa kwambiri komanso prediabetes. Chifukwa chake ndi kuperewera kwa chakudya, kusachita masewera olimbitsa thupi, kunenepa kwambiri. Vutoli limaphatikizidwa ndi kuchuluka kwa insulini, mwanjira imeneyi thupi limayesetsa kuthana ndi kukana kwa maselo ndikuyeretsa magazi a glucose owonjezera. Pakadali pano, chithandizo chovomerezeka ndikusintha ndikukhala ndi moyo wathanzi ndikupereka mankhwala a metformin, omwe amachepetsa insulin kukana.

The glycemia wodwalayo akamakulirakulira, matenda a shuga amakula kwambiri. Matenda oyamba amakhudzana ndi kuchepa kwa insulin secretion, ndipo hyperglycemia imapezekanso mwa wodwala. Malinga ndi madokotala, pakupezeka kwa matenda ashuga, kuperewera kwa insulin kumapezeka pafupifupi theka la odwala. Pakadali pano matendawa, kuphatikiza insulin, mankhwala omwe amalimbikitsa kugwira ntchito kwa maselo a beta ayenera kufotokozedwa. Zothandiza kwambiri komanso zotsika mtengo kwambiri kwa iwo ndi sulfonylurea zotumphukira, chidule cha PSM.

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%

Malingaliro a Katswiri

Arkady Alexandrovich

Endocrinologist wodziwa zambiri

Funsani katswiri funso

Glimepiride ndi mankhwala amakono komanso otetezeka kuchokera ku gulu la PSM. Ndi m'badwo waposachedwa ndipo amavomerezeka kuti agwiritsidwe ntchito ndi mabungwe endocrinological padziko lonse lapansi.

Kutengera ndi zomwe tafotokozazi, tiziwonetsa zomwe zikuperekedwa kwa mankhwala a Glimepiride:

1. Kuperewera kwa mphamvu ya kudya, masewera olimbitsa thupi ndi metformin.
2. Zimatsimikiziridwa ndi kusanthula kwa insulin yawo omwe.

Malangizo amalola kugwiritsa ntchito mankhwala Glimepiride ndi insulin ndi metformin. Malinga ndi ndemanga, mankhwalawa amakhalanso bwino ndi glitazones, gliptins, incretin mimetics, acarbose.

Limagwirira a zochita za mankhwala

Kutulutsidwa kwa insulini kuchokera ku kapamba kulowa m'magazi ndikutheka chifukwa cha njira zapadera za KATP. Amapezeka m'maselo aliwonse amoyo ndipo amatulutsa potaziyamu kudzera mu nembanemba. Masewera a beta atakhala m'mitsempha ali mkati mozungulira, njira zotsalira za beta zimatseguka. Ndi kukula kwa glycemia, amatseka, zomwe zimayambitsa kuchuluka kwa calcium, kenako kutulutsidwa kwa insulin.

Mankhwala Glimepiride ndi mayendedwe ena onse a PSM pafupi potaziyamu, potero amawonjezera insulin ndikupanga. Kuchuluka kwa timadzi timene timatulutsidwa m'magazi kumangotengera kuchuluka kwa glimepiride, osati mlingo wa glucose.

Kwazaka makumi angapo zapitazi, mibadwo itatu, kapena kusinthika, kwa PSM idapangidwa ndikuyesedwa. Zochita zamankhwala a m'badwo wa 1, chlorpropamide ndi tolbutamide, zidalimbikitsidwa ndi mapiritsi ena a shuga, omwe nthawi zambiri amachititsa kuti hypoglycemia ikhale yosadziwika. Pofika mbadwo wa PSM 2, glibenclamide, glyclazide ndi glipizide, vutoli lidathetsedwa. Amalumikizana ndi zinthu zina zocheperako kuposa PSM yoyamba. Koma mankhwalawa amakhalanso ndi zoperewera zambiri: ngati kuphwanya zakudya ndi katundu, zimayambitsa hypoglycemia, zimayambitsa pang'onopang'ono kulemera, motero, kuwonjezeka kwa insulin. Malinga ndi kafukufuku wina, mibadwo ya PSM 2 imatha kusokoneza kugwira ntchito kwa mtima.

Mukamapanga mankhwala a Glimepiride, zotsatirapo zoyipa zomwe zidawerengedwa adaziganizira. Anatha kuwachepetsa pakukonzekera kwatsopano.

Ubwino wa Glimepiride kuposa PSM ya mibadwo yapitayi:

1. Chiwopsezo cha hypoglycemia chikamatengedwa ndi chotsika. Kulumikizana kwa mankhwalawa ndi ma receptor sikukhazikika kuposa momwe gulu limafotokozera, kuphatikiza, thupi limasungabe machitidwe omwe amalepheretsa kuphatikiza kwa insulin ndi shuga wochepa. Mukamasewera masewera, kusowa kwa chakudya m'zakudya, glimepiride imayambitsa Hypoglycemia wofatsa kuposa ena PSM. Zowonera zikuwonetsa kuti shuga mukamamwa mapiritsi a glimepiride amatsika pang'onopang'ono mu 0.3% ya odwala matenda ashuga.
2. Palibe cholemetsa pa kulemera. Kuonjezera insulin m'magazi kumalepheretsa kuchepa kwamafuta, pafupipafupi hypoglycemia imathandizira kukulira chilimbikitso ndi kudya kwambiri kwa caloric. Glimepiride ndiotetezeka pankhaniyi. Malinga ndi odwala, sizimayambitsa kulemera, ndipo kunenepa kwambiri kumathandizanso kuti muchepetse kunenepa.
3. Chiwopsezo chochepa cha matenda amtima. PSM imatha kulumikizana ndi njira za KatiP zomwe sizili mu kapamba kokha, komanso makoma amitsempha yamagazi, ndikuwonjezera chiopsezo cha matenda awo. Mankhwala glimepiride amangogwira ntchito kapamba, chifukwa chake amaloledwa kwa odwala matenda ashuga omwe ali ndi angiopathy ndi matenda amtima.
4. Malangizowo akuwonetsa kuthekera kwa Glimepiride kuti achepetse kukana kwa insulin, kuonjezera kaphatikizidwe ka glycogen, komanso kuletsa kupanga kwa shuga. Kuchita kumeneku ndi kocheperako kuposa metformin, koma bwino kuposa ena onse a PSM.
5. Mankhwalawa amagwira ntchito mwachangu kuposa ma analogues, kusankha kwa mlingo komanso kukwaniritsa chiphuphu cha matenda ashuga amatenga nthawi yochepa.
6. Mapiritsi a Glimepiride amalimbikitsa magawo onse a insulin katulutsidwe, chifukwa chake, amachepetsa glycemia mwachangu atatha kudya. Mankhwala okalamba amagwira ntchito makamaka mu gawo 2.

Mlingo

Mlingo wovomerezeka wa glimepiride, womwe opanga amamatira, ndi 1, 2, 3, 4 mg ya chinthu chogwiritsidwa ntchito piritsi. Mutha kusankha manambala olondola a mankhwalawo molondola kwambiri, ngati pakufunika kutero, mankhwalawa ndi osavuta kusintha. Monga lamulo, piritsi imakhala ndi chiopsezo, chomwe chimakulolani kugawanitsa pakati.

Kutsitsa kwa shuga kwa mankhwalawa kumawonjezeka nthawi yomweyo ndi kuwonjezeka kwa mlingo 1 mpaka 8 mg. Malinga ndi odwala matenda ashuga, anthu ambiri amangofunika 4 mg kapena kuchepera glimepiride kuti alipire shuga. Mlingo waukulu umatheka mwa odwala omwe ali ndi matenda ashuga komanso kukana kwambiri kwa insulin. Ayenera kuchepa pang'onopang'ono pomwe boma likukhazikika - kusintha kukhudzidwa kwa insulin, kuchepa thupi, komanso kusintha moyo.

Kutsika komwe akuyembekezeka ku glycemia (anthu wamba malinga ndi kafukufuku):

Zambiri kuchokera pamalangizo omwe amaperekedwa posankha mtundu womwe mukufuna:

1. Mlingo woyambira ndi 1 mg. Nthawi zambiri zimakhala zokwanira kwa anthu odwala matenda ashuga okhala ndi shuga pang'ono, komanso kwa odwala omwe ali ndi vuto la impso. Matenda a chiwindi samakhudza kukula kwa mlingo.
2. Chiwerengero cha mapiritsi amawonjezeka mpaka zolinga za shuga zifika. Popewa hypoglycemia, mlingo umakulitsidwa pang'onopang'ono, pakadutsa masabata awiri. Pakadali pano, miyeso yambiri ya glycemia ndiyofunikira kuposa masiku onse.
3. Kukula kwa Mlingo: mpaka 4 mg, kuwonjezera 1 mg, itatha - 2 mg. Mafuta akakhala kuti abwinobwino, siyani kuwonjezera kuchuluka kwa mapiritsi.
4. Mlingo wovomerezeka wokwanira ndi 8 mg, umagawidwa pazidutswa zingapo: 2 mpaka 4 mg kapena 3; 3 ndi 2 mg.

Malangizo atsatanetsatane oti mugwiritse ntchito

Kuchuluka kwa mankhwalawa kumachitika patatha pafupifupi maola awiri kuchokera pakukhazikitsidwa kwake. Pakadali pano, glycemia ikhoza kuchepa pang'ono. Chifukwa chake, ngati mumamwa Glimepiride kamodzi patsiku, nsonga yotereyi imakhala imodzi, ngati mungagawe mankhwalawa katatu, nsonga idzakhala iwiri, koma yofatsa. Kudziwa mawonekedwe awa a mankhwalawa, mutha kusankha nthawi yolowa. Ndikofunika kuti pachimake pachakudya chitatha chakudya chochepa chomwe chimakhala ndi pang'onopang'ono, osagwirizana ndi zolimbitsa thupi zomwe mwakonzekera.

Kuopsa kwa hypoglycemia kumachulukitsidwa chifukwa cha kusakhazikika kapena kuperewera kwa zakudya m'thupi, kuchita masewera olimbitsa thupi moperewera chifukwa cha kudya koperewera, matenda akulu, zovuta za endocrine, komanso mankhwala ena.

Mogwirizana ndi malangizo a mankhwalawa:

Zojambula za kutenga ana ndi amayi apakati

Ikagwiritsidwa ntchito pa nthawi ya pakati, Glimepiride imalowa m'magazi a mwana wosabadwayo ndipo imayambitsa hypoglycemia mmenemo. Komanso, thupilo limadutsa mkaka wa m'mawere, ndipo kuchokera pamenepo kumalowa kumayamwa. Pa nthawi yoyembekezera komanso HB, kutenga Glimepiride ndizoletsedwa. FDA (American Medicines Administration) imatulutsa Glimepiride ngati kalasi C. Izi zikutanthauza kuti kafukufuku wazinyama awulula kuti zinthuzi zimakhudza mwana wosabadwa.

Glimepiride sanalembedwe kwa ana, ngakhale atapezeka kuti ali ndi matenda ashuga a 2. Mankhwalawa sanapatse mayeso ofunikira, momwe zimachitika kuti chamoyo chikhale sichinaphunzire.

Mndandanda wazotsatira zoyipa

Zotsatira zoyipa kwambiri za Glimepiride ndi hypoglycemia. Malinga ndi mayeso, chiwopsezo chake ndichochepa kwambiri poyerekeza ndi PSM yamphamvu kwambiri - glibenclamide. Shuga ikutsikira, komwe kunapangitsa kuti alowe muchipatala ndipo amafunika otsika ndi shuga, mwa odwala ku Glimepiride - mayunitsi 0,86 pa munthu wazaka 1000. Poyerekeza ndi glibenclamide, chizindikirochi ndi chotsika 6.5. Ubwino wosakayikira wa mankhwalawa ndi chiopsezo chotsika cha hypoglycemia pakuchita masewera olimbitsa thupi kwa nthawi yayitali.

Zotsatira zina zoyipa za glimepiride kuchokera kuzomwe mungagwiritse ntchito:

Palinso uthenga wokhudzana ndi kuthekera kwa kubisala kwa katulutsidwe ka mankhwala a antidiuretic. Zotsatira zoyesayesazi zimayesedwabe, kotero sizinaphatikizidwe mu malangizo.

Pakhoza kukhala bongo

Ngakhale mankhwala a Glimepiride ali amakono komanso ofatsa, amakhalabe amoyo a sulfonylurea, zomwe zikutanthauza kuti bongo lawo limabweretsa hypoglycemia. Mbali iyi imachokera munjira ya mankhwalawa, imatha kupewedwa pang'onopang'ono powona kuchuluka kwake.

Lamulo la kupewa hypoglycemia ku malangizo ogwiritsira ntchito: ngati piritsi la Glimepiride linasowa, kapena palibe chitsimikizo kuti mankhwalawo adamwa, mulingo sayenera kuwonjezeka pa mlingo wotsatira, ngakhale shuga ya magazi itadzuka.

Hypoglycemia ikhoza kuyimitsidwa ndi shuga - msuzi wokoma, tiyi kapena shuga. Sikoyenera kuyembekezera zikhalidwe, mbiri yokwanira ya glycemic. Popeza mankhwalawa amagwira ntchito pafupifupi tsiku limodzi, shuga wobwezeretsanso mwakale amatha kucheperabe mpaka ziwerengero zoopsa. Nthawi yonseyi yomwe muyenera kuyang'anira glycemia, osangosiyira nokha wodwala matenda ashuga.

Mankhwala osokoneza bongo okwanira nthawi yayitali, kugwiritsa ntchito njira yayitali ya glimepiride ndi oopsa. Wodwala wodwala matenda ashuga, kutha kwa chikumbumtima, matenda amitsempha, kukomoka kwa hypoglycemic ndikotheka. Zikakhala zovuta, madontho obwereza a shuga amatha masiku angapo.

Mankhwala osokoneza bongo - kutsuka kwa chapamimba, zotengera, kubwezeretsa kwa Normoglycemia pobweretsa shuga m'mitsempha.

Contraindication

Nthawi zina, kumwa mankhwala Glimepiride kumatha kukhalavulaza:

• HS, zaka za ana;
• mimba, matenda ashuga;
• woopsa mitundu ya hepatic kapena aimpso kulephera. Kugwiritsa ntchito mapiritsi a glimepiride mu dialysis odwala sikunaphunzire;
• kutsimikizira mtundu 1 shuga. Ngati matenda osakhalitsa amtundu amadziwika (Modi, latent), kusankha mankhwala glimepiride ndikotheka;
• zovuta za shuga. Hypoglycemia iyenera kuchotsedwa musanamwe piritsi lotsatira. Mwa mitundu yonse ya odwala ashuga komanso precom, mapiritsi aliwonse amathetsedwa;
• ngati wodwala matenda ashuga amatha kuphatikizana ndi zosakaniza zilizonse za piritsi, zotsatira za anaphylactic zimatheka ndikugwiritsabe ntchito;
• chifukwa chakuti mapangidwe a mapiritsiwo akuphatikiza ndi lactose, sangatengedwe ndi odwala omwe ali ndi vuto lobadwa nalo.

Malangizowo akuwonetsa chisamaliro chapadera kumayambiriro kwa mankhwala ndi glimepiride, pa gawo la kusankha kwa mankhwalawa, posintha zakudya kapena moyo wanu. Hyperglycemia imatha kubweretsa kuvulala, matenda opatsirana komanso kutupa, makamaka omwe amatsatana ndi kutentha thupi. Mu nthawi yochira, m'malo mwake, hypoglycemia ndiyotheka.

Matenda ogaya amatha kusintha magwiritsidwe a mapiritsi ngati mayamwidwe asokonezeka. Kuchepa kwa mpweya wa glucose-6-phosphate dehydrogenase mukamamwa mankhwala a Glimepiride akhoza kukulitsidwa.

Glimepiride analogues

Ma analogues omwe akupezeka ku Russia olembetsedwa mu kaundula wamankhwala:

Malinga ndi ndemanga ya anthu omwe ali ndi matenda ashuga, mapangidwe apamwamba a Amaril ndi Glimepiride-Teva ndi Glimepiride kupanga. Mitundu yotsalira yamafakitale ndi malo osowa.

Glimepiride kapena Diabeteson - zomwe zili bwino

Zomwe zimagwira mu Diabeteson ndi gliclazide, m'badwo wa PSM 2. Piritsi ili ndi mawonekedwe apadera, omwe amapereka pang'onopang'ono kupita kwa magazi kulowa m'magazi. Chifukwa cha izi, Diabeteson MV sachepera chifukwa cha hypoglycemia kuposa gliclazide yokhazikika. Mwa PSM yonse yomwe ilipo, ndi glyclazide yosinthika ndi glimepiride yomwe ma endocrinologists amalimbikitsa kuti ikhale yotetezeka kwambiri. Amathandizanso kuchepetsa shuga wofanana pamankhwala ofanana (1-6 mg wa glimepiride, 30-120 mg wa gliclazide). Pafupipafupi hypoglycemia mu mankhwalawa ilinso pafupi.

Diabeteson ndi Glimepiride amasiyana pang'ono. Chofunika kwambiri mwa iwo ndi:

1. Glimepiride amadziwika ndi chiŵerengero chotsika cha kukula kwa insulini / kuchepa kwa shuga - 0,03. Mu Diabeteson, chizindikirochi ndi 0.07. Chifukwa chakuti mukamamwa mapiritsi a glimepiride, insulin imapangidwa pang'ono, odwala matenda ashuga amachepetsa thupi, kukana insulini kumachepa, ndipo ma cell a beta amagwira ntchito nthawi yayitali.
2. Pali zambiri kuchokera ku maphunziro zomwe zimatsimikizira kusintha kwa odwala omwe ali ndi matenda a mtima pambuyo poti asinthe kuchokera ku Diabeteson kupita ku Glimepiride.
3. Odwala omwe amatenga metformin ndi glimepiride, amafa ochepa poyerekeza ndi odwala matenda ashuga omwe amapatsidwa mankhwala a gliclazide + metformin.

Glimepiride kapena Amaryl - zomwe zili bwino

Amaril ndi mankhwala oyamba opangidwa ndi m'modzi mwa atsogoleri pamsika wa mankhwala othandizira odwala matenda ashuga, nkhawa za Sanofi. Kafukufuku onse omwe atchulidwa pamwambowu adachitika ndi kutenga nawo gawo kwa mankhwalawa.

Komanso kukonzekera kwa glimepiride kumapangidwa pansi pa mayina omwewo ndi makampani asanu aku Russia. Ndi mitundu, kapena ma analogu, omwe ali ndi mawonekedwe ofanana kapena ofanana kwambiri. Onsewo ndi otsika mtengo kuposa Amaril. Kusiyana kwa mtengo kumachitika chifukwa chakuti mankhwalawa sanadutse mayeso onse omwe amafunikira kulembetsa mankhwala atsopano. Njira yopangira zamagetsi imakhala yosavuta, ndikokwanira kuti wopanga azitsimikizira kufanana kwa mapiritsi ake kwa Amaril woyambirira. Mlingo wa kuyeretsedwa, maipiipi, mawonekedwe a piritsi amatha kusiyanasiyana.

Ngakhale kuti ndemanga pa Amaril ndi Russian Glimepirides ndizofanana, pali odwala matenda ashuga omwe amakonda mankhwala oyamba okha. Ngati mukukayikira kuti generic itha kugwira ntchito moyipa, ndibwino kugula Amaril, chifukwa kudalira chithandizo chamankhwala ndikofunikira kwambiri. Zotsatira za placebo zimakhudza aliyense wa ife ndipo zimakhudza moyo wathu.

Mtengo ndi kusunga

Mtengo wa Glimepiride, 4 mg mlingo:

Ma analogu otsika mtengo kwambiri amapangidwa ndi Samara Ozone ndi Pharmproject ochokera ku St. Makampani onsewa akugula zinthu kuchokera ku makampani opanga mankhwala ku India.

Moyo wa alumali wa opanga osiyanasiyana umasiyana ndipo ndi zaka ziwiri kapena zitatu. Zofunikira pa kutentha kosungirako ndizofanana - zosaposa 25 digiri.

Ndemanga za Matenda a shuga