Repaglinide - gulu la mankhwala, malangizo ndi momwe mungasinthire

Mankhwala omwe amathandizira kupanga insulini amagawika m'magulu awiri: zofala zomwe zimapezeka sulfonylureas ndi meglitinides odziwika bwino, kapena ma glinids. Repaglinide ndikuyimira gulu lachiwiri. Kutsitsa kwa shuga kwa chinthucho kuli pafupifupi wofanana ndi kukonzekera kwa sulfonylurea.

Repaglinide imathandizira kapangidwe ka insulin, mosasamala kanthu za kuchuluka kwa glucose m'matumbo, motero amathanso kuyambitsa hypoglycemia. Kusiyana pakati pa mankhwalawa ndikuyamba mwachangu komanso nthawi yayitali, yomwe imakupatsani mwayi wochepetsera glycemia, popanda kugwiritsa ntchito chidwi ndi thupi. Kutchuka kwa mankhwalawa kumachepetsa kufunika kwa kudya musanadye chakudya chilichonse, zomwe zimawonjezera chiopsezo chodumpha mapiritsi ndikuchepetsa kutsatira kwa anthu odwala matenda ashuga kwa chithandizo chamankhwala.

Kukonzekera kwa repaglinide

Repaglinide ndi dzina lapadziko lonse lapansi lomwe mankhwala amatha kuzindikirika kulikonse padziko lapansi. Monga chida chogwiritsidwa ntchito, repaglinide ndi gawo lamapiritsi omwe amapangidwa ndi makampani osiyanasiyana azamankhwala omwe ali nawo pazopanga zawo. Mayina amalonda otsatirawa a repaglinide adalembetsedwa mu registry yama Russian mankhwala:

Mankhwala oyamba ndi Danish NovoNorm. Kafukufuku onse akulu adachitika ndi kutenga nawo gawo kwa mankhwalawa. NovoNorm imapezeka mu Mlingo wa 0,5; 1 ndi 2 mg, phukusi la mapiritsi 30. Mtengo wa paketi ndiwotsika - kuyambira 157 mpaka 220 rubles. pamtundu wina.

Diagninid ndi Iglinid ndi ma genics, kapena analogues, a NovoNorma. Mankhwalawa amawunikira kuti adziwe momwe amakhalanso ndi apachibale, ali ndi mphamvu yofanana yochepetsera shuga komanso mlingo, chitetezo chofanana. Malangizo a mankhwala ali pafupi kwambiri. Kusiyana kwa moyo wa alumali kumafotokozedwa ndi kapangidwe kosiyanasiyana ka zinthu zothandiza (zopanda ntchito). Kuunika kwa odwala matenda ashuga kumatsimikizira kuti choyambirira ndi ma analogue zimasiyana kokha mu mawonekedwe apiritsi ndi ma CD. Mtengo wa Diclinid ndi ma ruble 126-195. pa paketi iliyonse.

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%

Iglinid ndiwatsopano kwambiri mwa kukonzanso komwe kumachitika ku Russia. Pang'onopang'ono mankhwalawa akuyamba kuwonekera mu intaneti yogulitsa. Palibe ndemanga za Iglinid pano.

Zotsatira za pharmacological

Repaglinide ndi yochokera ku benzoic acid. Thupi limalumikizana ndi ma receptor apadera omwe amapezeka pa membrane wa maselo a beta, amatseka njira za potaziyamu, amatsegula njira zamtundu wa calcium, potero amalimbikitsa kutulutsa insulin.

Kuyambiranso kumwa pambuyo piritsi kumayamba msanga. Zotsatira zoyambirira za mankhwalawa zimadziwika pambuyo pa mphindi 10, ndiye kuti mankhwalawa akhoza kumwedwa musanadye. Kuzindikira kwakukulu m'matumbo kumachitika pambuyo pa mphindi 40-60, zomwe zimakupatsani mwayi wochepetsera posachedwa glycemia. Kukwaniritsidwa mwachangu kwa Normoglycemia mutatha kudya ndikofunikira kwambiri kuchokera pakulinga koteteza matenda osokoneza bongo omwe ali ndi vuto la matenda osokoneza bongo. Mafuta ochulukirapo, omwe amakhala kuyambira pakudya cham'mawa mpaka nthawi yogona, amawonjezera magazi, amalimbikitsa magazi, amapanga matenda a lipid, amabweretsa kuwonongeka mumitsempha yamagazi, ndikuwonjezera kupsinjika kwa oxidative.

Mosiyana ndi sulfonylurea derivatives (PSM), zotsatira za repaglinide zimatengera glycemia. Ngati zidutsa 5 mmol / l, mankhwalawa amagwira ntchito molimbika kuposa ndi shuga wochepa. Mankhwalawa amatha mofulumira, atatha theka la theka la repaglinide atachotsedwa m'thupi. Pambuyo maola 4, kuphatikiza kochepa kwa mankhwalawa kumapezeka m'magazi omwe sangathe kukhudza glycemia.

Phindu lokhalitsa zinthu mwachidule:

1. Kupanga kwa insulin komwe kumachitika pafupi kwambiri ndi zachilengedwe momwe zingathere.
2. Kutha kukwaniritsa chindapusa cha matenda ashuga.
3. Kuchepetsa chiopsezo cha hypoglycemia. Mukamamwa repaglinide, palibe mlandu umodzi wokhudza hypoglycemic coma womwe unalembedwa.
4. Kuperewera kwa hyperinsulinemia kosatha. Izi zikutanthauza kuti odwala matenda ashuga alibe kulemera.
5. Kuchepetsa kuchepa kwa beta cell ndi kupitirira kwa shuga.

Repaglinide imapukusidwa m'chiwindi, 90% kapena kuposerapo umatulutsidwa m'zimbudzi, mpaka 8% ya mankhwalawa imapezeka mkodzo. Zochitika zotere za pharmacokinetics zimalola kugwiritsa ntchito mankhwalawa kumapeto kwa matenda a shuga ndi nephropathy komanso matenda ena akuluakulu a impso.

Chizindikiro chovomerezeka

Repaglinide adapangira amitundu iwiri okha odwala matenda ashuga. Chofunikira ndi kupezeka kwa maselo a beta. Mu ma algorithms aku Russia ndi akunja pochiza matenda a shuga, ma glinides amatchulidwa ngati mankhwala osungirako, amadziwitsidwa ngati mapiritsi ena saloledwa.

Zisonyezero zogwiritsidwa ntchito:

1. Ngati njira ina ya metformin, ngati sichingalekerere kapena kuphatikizidwa. Ndizoyenera kuganizira kuti repaglinide ilibe mphamvu zowonekera pakumverera kwama cell kupita ku insulin, kuchepetsa shuga kumatheka pokhapokha polimbana ndi insulin chifukwa cha kuchuluka kwa mahomoni.
2. M'malo mwa mankhwala a sulfonylurea, ngati wodwalayo ali ndi vuto losagwirizana ndi imodzi mwazigawozi.
3. Kukulitsa dongosolo la mankhwalawa, ngati mankhwala omwe adapangidwapo kale asiya kupereka shuga. Malangizowa amakupatsitsani kuphatikiza repaglinide ndi metformin ndi insulin yayitali, thiazolidatediones. Ndi PSM, mankhwalawa sangathe kugwiritsidwa ntchito kuti achulukitse maselo a kapamba.
4. Malinga ndi madotolo, repaglinide imagwiritsidwa ntchito bwino mu odwala matenda ashuga omwe amafuna kusintha kosinthika pa mapiritsi: kudya kwambiri, kudumpha chakudya, pakudya.

Monga mapiritsi ena aliwonse a shuga, repaglinide imangogwira ntchito limodzi ndi zakudya komanso masewera olimbitsa thupi.

Pamene repaglinide amaletsa

Malangizo ogwiritsira ntchito oletsedwa kupereka mankhwala kwa amayi apakati ndi kuyamwa, ana ndi odwala matenda ashuga kuposa zaka 75, popeza m'magulu awa odwala chitetezo cha repaglinide sichitsimikiziridwa.

Monga othandizira onse pakamwa hypoglycemic, repaglinide singagwiritsidwe ntchito pazovuta za matenda ashuga (ketoacidosis, hyperglycemic coma ndi precoma) komanso m'malo ovuta kwambiri (kuvulala, maopareshoni, kuwotcha kwambiri kapena kutupa, matenda oopsa) - mndandanda wazovuta zonse. Ngati wodwala matenda ashuga akufunika kuchipatala, lingaliro la kuletsa mapiritsiwo ndikusunthira ku insulin limapangidwa ndi adokotala.

Kuti mankhwalawa athe kuyamwa mwachangu, ntchito za chiwindi zotetezeka ndizofunikira. Ngati vuto la chiwindi likulephera, mankhwalawa ndi repaglinide amaletsedwa ndi malangizo.

Ngati wodwala yemwe ali ndi matenda osokoneza bongo atenga gemfibrozil kuti akonzenso mawonekedwe a lipid wamagazi, NovoNorm ndi Diagninid sayenera kufotokozedwa, chifukwa pamene amatengedwa pamodzi, kupatsirana kwa repaglinide m'magazi kumadzuka katatu kapena kuposerapo, ndipo hypoglycemia yayikulu imatheka.

Malamulo Ovomerezeka

Repaglinide yaledzera chakudya chachikulu chisanachitike (kadzutsa, nkhomaliro, chakudya chamadzulo). Ngati chakudya chatulutsidwa kapena m'menemo osapatsa mafuta, musamwe mankhwalawo. Malinga ndi ndemanga, mankhwalawa amathandizika kwa odwala matenda ashuga omwe ali ndi moyo wakhama, komanso kwa okalamba omwe ali ndi vuto losakhazikika.

Zambiri pakugwiritsa ntchito mankhwalawa:

• pafupipafupi phwando - 2-4 zina;
• nthawi musanadye: analimbikitsa - mphindi 15, zovomerezeka - mpaka theka la ola;
• kumwa koyambirira ndi 0,5 mg wa matenda omwe angopezedwa kumene, 1 mg posinthira kukhala mapiritsi ena ochepetsa shuga;
• Mlingo ukuwonjezeka ngati chiwopsezo cha matenda ashuga sichokwanira. Makhalidwe - milingo yapamwamba ya shuga ya m'magazi a m'mimba ndi glycated hemoglobin;
• nthawi pakati pekuchulukitsa kwa mankhwala osachepera sabata;
• pazipita limodzi mlingo 4, tsiku lililonse 16 mg.

Malinga ndi malingaliro amakono, kumwa mapiritsi ochepetsa shuga mu mulingo woyenera siwofunika, chifukwa izi zimawonjezera chiopsezo cha zotsatila zawo. Ngati 2-3 mg ya repaglinide sikulipira matenda a shuga, ndikofunikira kuwonjezera mankhwala ena, osachulukitsa kuchuluka kwa mankhwalawa.

Zotsatira zoyipa

Zotsatira zoyipa kwambiri za repaglinide ndi hypoglycemia. Zimachitika ngati insulin yambiri yatulutsidwa m'magazi kuposa momwe ikufunikira kuti gwiritsidwe ntchito wa glucose obwera. Chiwopsezo cha hypoglycemia chimatengera zifukwa zake: mlingo wa mankhwalawa, zakudya, nkhawa, nthawi yayitali ndi kulimbitsa thupi.

Zotsatira zoyipa ndi pafupipafupi molingana ndi malangizo ogwiritsira ntchito:

Kuyanjana kwa mankhwala osokoneza bongo

Onjezerani kuchuluka kwa repaglinide m'magazi kapena kuonjezera zochita pa gemfibrozil, maantivitamincacithcinycin ndi rifampicin, ma antifungals, immunosuppressant cyclosporin, mao inhibitors, ACE inhibitors, NSAIDs, beta-blockers, salicylates, steroids, mowa.

Njira zakulera zam'mlomo, zotumphukira za barbituric acid ndi thiazide, glucocorticoids, antiepileptic carbamazepine, mankhwala a sympathomimetic, mahomoni a chithokomiro amachepetsa mphamvu ya kubwezeretsanso.

Popereka ndi kuletsa mankhwala omwe ali pamwambapa, kufunsa kwa dokotala komanso kuyang'anira glycemic pafupipafupi kumafunikira.

Repaglinide analogues

Analogue yapafupi kwambiri ya repaglinide ndi phenylalanine derivative nateglinide, thunthu limakhala ndi zotsatira zofananira komanso zazifupi. Mankhwala amodzi okha omwe ali ndi chophatikizira ichi akupezeka ku Russia - Starlix, wopanga NovartisPharma. Nateglide ya iye imapezeka ku Japan, mapiritsi okha - ku Italy. Mtengo wa Starlix ndi pafupifupi ruble 3,000 pamapiritsi 84.

Ma analogues a bajeti - kufalikira kwa PSM glibenclamide (Maninil), glycidone (Glurenorm), glyclazide (Diabeteson, Diabetalong, Glidiab, etc.) ndi glimepiride (Amaryl, Diamerid, etc.) PSM ndizochulukirapo kuposa repaglinide, popeza mphamvu zawo ndizotalikilapo.

Gliptins (Galvus, Januvia ndi mawonekedwe awo), opangidwa mwanjira ya mapiritsi ndi jekeseni wa insretin mimetics (Baeta, Victoza) nawonso ali m'gulu la othandizira omwe amalimbikitsa kuphatikizika kwa insulin. Mtengo wa chithandizo ndi gliptins umachokera ku ma ruble 1500. Mimetic incretin ndi okwera mtengo kwambiri, kuchokera ku ma ruble 5200.