Pioglitazone - mankhwala a 2 odwala matenda ashuga

Pioglitazone ndi mankhwala atsopano ochepetsa shuga; adayambitsidwa muzochitika zamankhwala mu 1996. Thupi limakhala la gulu la thiazolidinediones, momwe limagwirira ntchito mkati mwake ndikuwonjezera kukhudzika kwa minofu ya minofu ndi mafuta kuti apange insulin. Pioglitazone sizimakhudza mwachindunji kuchuluka kwa kutulutsidwa kwa mahomoni. Mankhwalawa amalekeredwa bwino, samayambitsa hypoglycemia, amakhala ndi vuto la metabolidi ya lipid. Zikuwonetsa zotsatira zabwino za anthu odwala matenda ashuga onenepa kwambiri.

Limagwirira ntchito pioglitazone

Kuchepetsa chidwi cha insulin ndi chimodzi mwazomwe zimayambitsa chiwonetsero cha matenda ashuga. Pioglitazone imatha kuchepetsa kukonzekera kwa insulin, komwe kumayambitsa kuponderezedwa kwa gluconeogeneis m'chiwindi, kuchepa kwa kuchuluka kwa mafuta m'magazi, komanso kuwonjezeka kwa kugwiritsidwa ntchito kwa glucose ndi minofu minofu. Nthawi yomweyo, glycemia amachepetsa, lipids yamagazi imasintha, ndipo glycation imachepetsa. Malinga ndi kafukufuku, Pioglitazone imatha kuwonjezera kukhathamika kwa glucose ndi 2,5.

Pachikhalidwe, metformin yakhala ikugwiritsa ntchito kuchepetsa insulin. Izi zimathandizira kudziwa kukoka kwa mahomoni makamaka m'chiwindi. Mu minofu ndi adipose zimakhala, mphamvu zake sizitchulidwa. Pioglitazone amachepetsa kukana m'mafuta ndi minofu, kupitilira mphamvu ya metformin. Amawonetsedwa ngati mankhwala a mzere wachiwiri pamene mphamvu ya metformin ilibe yokwanira (nthawi zambiri imakhala ndi kunenepa kwambiri komanso kusuntha pang'ono) kapena singalole kudwala matenda ashuga.

Pazotsatira zamankhwala ndi Pioglitazone, kuwopsa kwa glucose ndi lipids pamaselo a beta kumachepa, motero zochitika za maselo a beta zimayamba kuwonjezeka, machitidwe awo akamwalira amayamba kuchepa, kaphatikizidwe ka insulini amakhala bwino.

Mu malangizo ogwiritsira ntchito, zotsatira zabwino za Pioglitazone pazomwe zimayambitsa matenda a mtima. Pambuyo pa zaka 3 zakulamulira, kuchuluka kwa triglycerides kutsika pafupifupi 13%, cholesterol "yabwino" imawonjezeka ndi 9%. Chiwopsezo cha kugwidwa ndi matenda a mtima ndikuchepetsedwa ndi 16%. Zinatsimikiziridwa kuti, motsutsana ndi kagwiritsidwe ntchito ka Pioglitazone, makulidwe amitsempha yamagazi amathandizika, pomwe chiopsezo cha matenda ashuga amatsikanso.

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%

Pioglitazone silipanga phindu lochulukirapo, monga mankhwala omwe amakhudza kaphatikizidwe ka insulin. M'malo mwake, mwa odwala matenda a shuga pali kuchepa kwam'mimba chifukwa cha kuchepa kwa kuchuluka kwamafuta a visceral.

Pharmacokinetics of Pioglitazone malinga ndi malangizo: Pambuyo pakukonzekera pakamwa, chinthucho chimalowa m'magazi pambuyo pa theka la ola. Kupsinjika kwakukulu kumachitika pa maola awiri ngati mapiritsiwo aledzera pamimba yopanda kanthu, ndipo maola 3.5 ngati atengedwa ndi chakudya. Zochita pambuyo pa limodzi mlingo zimasungidwa kwa tsiku limodzi. Mpaka 30% ya Pioglitazone ndipo ma metabolites ake amamuchotsa mkodzo, ena onse ndi ndowe.

Kukonzekera kwa pioglitazone

Mankhwala oyamba a Pioglitazone amadziwika kuti ndi Aktos opangidwa ndi kampani yaku America ya mankhwala Eli Lilly. Zomwe zimagwiritsidwa ntchito pamapiritsi ndi Pioglitazone hydrochloride, ndipo zigawo zothandizira ndi cellulose, magnesium stearate ndi lactose. Mankhwala amapezeka Mlingo wa 15, 30, 45 mg. Tsopano kulembetsa kwa Aktos ku Russia kwatha, mankhwalawo sanalembetsedwenso, ndiye kuti simungagule m'mafakitore. Mukayitanitsa kuchokera ku Europe, mtengo wa gulu la Aktos udzakhala pafupifupi ruble 3300. pa paketi 28 yamapiritsi.

Ma Analogs ku Russia atenga mtengo wotsika mtengo. Mwachitsanzo, mtengo wa Pioglar ndi ma ruble 400. 30 mapiritsi 30 mg. Kukonzekera kwotsatira kwa Pioglitazone kwalembedwa m'kaundula wa boma:

Mankhwalawa onse ndi fanizo lathunthu la Aktos, ndiye kuti, amabwereza zonse zamapangidwe amomwe mankhwala apoyamba. Kuchita bwino kofanana kumatsimikiziridwa ndi maphunziro azachipatala. Koma ndemanga za anthu odwala matenda ashuga sizimagwirizana nawo nthawi zonse, anthu amakhulupirira kwambiri Aktos.

Chizindikiro chovomerezeka

Pioglitazone amagwiritsidwa ntchito kuchepetsa glycemia kokha mu mtundu 2 shuga. Monga othandizira odwala matenda amkamwa, Pioglitazone sangasinthe magazi ngati wodwalayo sanasinthe moyo wake. Osachepera, muyenera kuchepetsa kuchuluka kwa chakudya chamafuta omwe amamwetsedwa, ndikulemera kwambiri - ndi zopatsa mphamvu, ikani zolimbitsa thupi zanu zolimbitsa thupi. Kupititsa patsogolo glycemia ya postprandial, muyenera kusiyanitsa zakudya zomwe zili ndi GI yayikulu kuchokera pachakudya, gawani chakudya chokwanira chakudya chonse.

Pioglitazone imagwiranso ntchito ngati monotherapy, koma nthawi zambiri imafotokozedwa ngati gawo limodzi la mankhwala omwe amaphatikiza angapo othandizira a hypoglycemic. Malangizo ogwiritsira ntchito amakupatsani mwayi kugwiritsa ntchito Pioglitazone molumikizana ndi metformin, sulfonylureas, insulin.

Zisonyezo za mapiritsi:

1. Posachedwa wapeza matenda a shuga m'magulumagulu onenepa kwambiri, ngati odwala matenda ashuga ali ndi contraindication kuti agwiritse ntchito (aimpso kulephera) kapena kulekerera bwino (kusanza, kutsegula m'mimba) a metformin.
2. Pamodzi ndi metformin mu onenepa kwambiri a diabetes ngati metformin monotherapy sikokwanira kuti matenda akhale ndi shuga.
3. Kuphatikiza ndi kukonzekera kwa sulfonylurea, ngati pali chifukwa chokhulupirira kuti wodwalayo adayamba kuwononga kapangidwe ka insulin yake.
4. Matenda a shuga omwe amadalira insulin, ngati wodwala amafuna kwambiri Mlingo wa insulin chifukwa cha kuchepa kwa chidwi chake.

Contraindication

Malangizowa amaletsa kutenga pioglitazone pazochitika zotsatirazi:

• ngati hypersensitivity chimodzi mwa zigawo za mankhwala wapezeka. Matenda ofooka omwe amachitika pakayimitsidwa kapena pakhungu sayenera kuti mankhwala atulidwe;
• ndi mtundu 1 shuga mellitus, ngakhale wodwalayo akana insulin;
• mwa odwala matenda ashuga;
• pa mimba ndi HB. Kafukufuku m'magulu awa odwala omwe ali ndi matenda ashuga sanachitike, kotero sizikudziwika ngati Pioglitazone akudutsa chotchinga ndi kulowa mkaka. Mapiritsiwo amathetsedwa mwachangu akangokhala ndi pakati;
• kulephera kwamtima kwambiri;
• mu pachimake zomwe zimafunikira insulin mankhwala (kuvulala kwambiri, matenda ndi maopaleshoni, ketoacidosis), onse othandizira piritsi amachepa kwakanthawi.

Malangizowo akutsimikiza kumwa mankhwalawa mosamala vuto la edema, kuchepa magazi. Sikuti kuphwanya malamulo, koma kulephera kwa chiwindi kumafuna kuyang'aniridwa kwachipatala kowonjezera. Ndi nephropathy, pioglitazone ingagwiritsidwe ntchito mwachangu kuposa metformin, popeza mankhwalawa sakutulutsidwa ndi impso.

Chisamaliro makamaka chimafuna kuikidwa kwa Pioglitazone pa matenda aliwonse a mtima. Analogue yapafupi kwambiri, rosiglitazone, yawonetsa chiopsezo chowonjezeka cha myocardial ndi kufa chifukwa cha zovuta zina zamtima. Pioglitazone sanakhale ndi zoyipa zotere, koma njira zowonjezera mosamala mukamazitenga sizingasokoneze. Malinga ndi madotolo, amayesa kusewera nawo motetezeka ndipo samapereka Pioglitazone pachiwopsezo chochepa cha kugunda kwa mtima.

Kuyanjana kwa mankhwala osokoneza bongo

Ndi kuphatikiza kwa pioglitazone ndi mankhwala ena, kusintha kwa magwiridwe ake ndikotheka:

Mankhwala ena, palibe kuyanjana ndi Pioglitazone komwe kunapezeka.

Malamulo otenga Pioglitazone

Mosatengera kuchuluka kwa mankhwalawa, a pioglitazone amamwa kamodzi patsiku matenda a shuga. Zakudya sizimafunika.

Njira yosankha:

1. Monga kumwa poyambira, imwani 15 kapena 30 mg. Kwa odwala matenda ashuga onenepa kwambiri, malangizowo akuonetsa kuti ayambe kulandira mankhwala ndi 30 mg. Malinga ndi ndemanga, ndi gawo lolumikizana ndi metformin, 15 mg ya Pioglitazone patsiku ndikokwanira kwa ambiri.
2. Mankhwalawa amachepetsa kukana insulini, chifukwa chake ndikovuta kuyesa momwe amagwirira ntchito ndi mita ya shuga m'magazi. Anthu odwala matenda ashuga amafunikira kuwunika hemoglobin kotheka kotala. Mlingo wa Pioglitazone umachulukitsidwa ndi 15 mg ngati, pambuyo pa miyezi itatu itatenga GH, idakhalabe pamwamba 7%.
3. Ngati pioglitazone amagwiritsidwa ntchito limodzi ndi sulfonylurea kapena insulin, hypoglycemia ikhoza kukhala mwa odwala matenda ashuga. Pankhaniyi, muyenera kuchepetsa kuchuluka kwa mankhwala ena, mankhwalawa a pioglitazone sanasinthe. Kuunika kwa odwala omwe ali ndi insulin kukana kuwonetsa kuti mankhwalawa amatha kuchepetsa kuchuluka kwa insulini yomwe imagwiritsidwa ntchito ndi pafupifupi kotala.
4. Mlingo wambiri wololedwa ndi malangizo a shuga ndi 45 mg ndi monotherapy, 30 mg mukamagwiritsidwa ntchito molumikizana ndi mankhwala ena ochepetsa shuga. Ngati patatha miyezi itatu mutamwa pioglitazone pa mlingo waukulu, GH sanabwerere mwakale, wodwala wina amamulembera mankhwala kuti athetse glycemia.

Zotsatira zoyipa

Pooglitazone poika matenda azachipatala amalephera chifukwa cha zinthu zomwe sizabwino, zomwe zambiri zimachulukana ndikugwiritsa ntchito nthawi yayitali:

1. M'miyezi isanu ndi umodzi yoyambirira, mu 5% ya odwala matenda ashuga, mankhwalawa ndi pioglitazone osakanikirana ndi sulfonylurea kapena insulin amatsatana ndi kuwonjezeka kwa kulemera mpaka 3,7 kg, ndiye izi zimachitika. Mukamamwa ndi metformin, kulemera kwa thupi sikukula. Mu shuga mellitus, izi zosafunikira ndizofunikira, chifukwa odwala ambiri ndi onenepa kwambiri. Kuteteza mankhwalawa, ziyenera kunenedwa kuti kuchuluka kumachulukira makamaka chifukwa champhamvu yamafuta, ndipo kuchuluka kwamafuta owopsa kwambiri, m'malo mwake, kumachepa. Ndiye kuti, ngakhale akulemera kwambiri, Pioglitazone samathandizira kuti pakhale zovuta zama mtima a shuga.
2. Odwala ena amazindikira kusungunuka kwa madzi mthupi. Malangizo ogwiritsira ntchito amadziwitsa kuti kufalikira kwa edema yokhala ndi pioglitazone monotherapy ndi 5%, pamodzi ndi insulin - 15%. Kusungidwa kwa madzi kumayendetsedwa ndi kuchuluka kwa magazi ndi madzi akunja kwama cell. Ndi chifukwa ichi kuti milandu yakulephera kwa mtima imalumikizidwa ndi kayendetsedwe ka Pioglitazone.
3. Chithandizo chitha kuphatikizidwa ndi kuchepa pang'ono kwa hemoglobin ndi hematocrit. Cholinga chake ndikutsatiranso kwa madzimadzi, palibe zotsatira zoyipa pakapangidwe ka magazi komwe kamapezeka mu mankhwalawo.
4. Pogwiritsa ntchito nthawi yayitali ya rosiglitazone, analogue ya Pioglitazone, kuchepa kwa kufooka kwa mafupa komanso chiwopsezo chowonjezereka cha ma fractures adapezeka. Kwa Pioglitazone, palibe deta yotere.
5. Mu 0.25% ya odwala matenda a shuga, kupezekanso katatu kwa ALT. Nthawi zina, chiwindi amapezeka.

Kuwongolera zaumoyo

Kugwiritsa ntchito pioglitazone kumafuna kuwunika momwe odwala matenda ashuga:

Momwe mungasinthire Pioglitazone

Mwa zinthu zomwe zili mgulu la thiazolidatedione, rosiglitazone okha amalembetsa ku Russia kupatula Pioglitazone. Ndi gawo la mankhwala Roglit, Avandia, Avandamet, Avandaglim. Kafukufuku akuwonetsa kuti chithandizo cha nthawi yayitali ndi rosiglitazone chimawonjezera chiopsezo cha mtima, kufa kwa myocardial infarction, chifukwa chake, amadziwitsidwa pokhapokha ngati palibe njira ina.

Kuphatikiza pa Pioglitazone, mankhwala opangidwa ndi metformin amachepetsa kukana kwa insulin. Kupititsa patsogolo kulekerera kwa chinthuchi, mapiritsi osinthidwa osinthika adapangidwa - Glucofage Long ndi analogues.

Onse rosiglitazone ndi metformin ali ndi zotsutsana zambiri, chifukwa chake angathe kuperekedwa ndi adokotala.

Ndemanga za madotolo ndi odwala

Endocrinologists amati pioglitazone nthawi zambiri. Cholinga chakusakonda kwa mankhwalawa, amachitcha kufunikira kowongolera ma hemoglobin ndi ntchito za chiwindi, chiwopsezo chachikulu chodziwitsa mankhwala a angiopathy ndi odwala okalamba, omwe amapanga odwala ambiri. Nthawi zambiri, madokotala amawona ngati Pioglitazone ngati njira ina yopangira metformin ngati sikotheka kuigwiritsa ntchito, osati monga hypoglycemic yodziyimira payokha.

M'magulu a anthu odwala matenda ashuga, Pioglitazone nawonso satchuka. Cholepheretsa chachikulu kugwiritsa ntchito mankhwalawo ndi mtengo wokwera wa mankhwalawo, kulephera kumulandira kwaulere. Mankhwalawa sangapezeke ku mankhwala aliwonse, omwe sawonjezeranso kutchuka kwake. Zotsatira zoyipa za mankhwalawa, makamaka kuwonda, komanso nthawi ndi nthawi kuwonetsa zambiri zokhudzana ndi chiwopsezo cha matenda a mtima mukamwa glitazones kumadabwitsa odwala omwe ali ndi matenda ashuga.

Mapiritsi enieni adavotera odwala kuti ndi othandiza komanso otetezeka kwambiri. Amadalira zida zamagetsi zochepa, amakonda kulandira chithandizo mwanjira: metformin ndi sulfonylureas.