Amaril M ndi mankhwala othandiza kwa anthu odwala matenda ashuga. Cholinga chachikulu cha mankhwalawa ndikuchepetsa shuga zomwe zili mthupi. Mankhwala, mankhwala ochokera m'gulu lino amatchedwa hypoglycemic.
Zomwe zimapangidwira
Thupi limapangidwa ngati piritsi. Piritsi lililonse lili ndi 2 mg ya micronized glimepiride ndi 500 mg ya metformin hydrochloride. Komanso pokonzekera pali zina zowonjezera - magnesium stearate, lactose monohydrate, povidone, etc.
Mtengo wa amaryl m umatengera zinthu zambiri. Mtengo wapakati wa chinthu ndi ma ruble 600.
Mfundo yogwira ntchito
Mankhwalawa ali ndi zovuta za hypoglycemic. Chimodzi mwazinthu zomwe zimagwiritsa ntchito mankhwalawa - glimepiride - imayambitsa kupanga ndi kutulutsa insulin kuchokera ku kapamba. Kuphatikiza apo, chidachi chimakulitsa chidwi cha minyewa kuti chikuchitikire insulin.
Chinthu chinanso chogwira ntchito ndi metformin. Gawoli ndi la zinthu za hypoglycemic kuchokera pagulu la biguanides. Zotsatira za kaphatikizidwe kameneka zimawonekera motsutsana ndi kumbuyo kwa kupanga kwa insulin.
Metformin imatha kuwonjezera zochita za insulini ndikuwonjezera chiwopsezo cha zimakhala ndi izi. Komanso chida chimayambitsa kuchepa kwa kaphatikizidwe wamafuta acid ndi oxidation wamafuta, ndikuyimitsa gluconeogeneis m'chiwindi. Kuphatikiza apo, mankhwalawa amatsogolera kuchepa kwa chilakolako cha chakudya komanso kuperewera kwa chakudya chamafuta.
Zokwanira zomwe zimapezeka m'magazi zimachitika maola a 2,5 mutatha kudya 4 mg ya mankhwala patsiku. Thupi limayang'ana kwathunthu kukhathamiritsa kwa mankhwalawo. Kudya chakudya kulibe vuto lililonse pakumwedwa kwa mankhwalawa - kungachepetse kuthamanga kwa njirayi.
Gawo lalikulu la metabolites la mankhwala limachoka m'thupi kudzera mu impso. Zinthu zotsalazo zimapukusidwa m'matumbo. Pali umboni kuti mankhwalawa amatha kulowa mkaka wa m'mawere ndikuwoloka chotchinga.
Zizindikiro
Mankhwalawa amalembedwa kwa anthu odwala matenda ashuga a mtundu wachiwiri m'milandu yotsatirayi:
- Ndikofunikira kusintha chithandizo chovuta ndi glimepiride ndi metformin;
- Monotherapy yokhala ndi metformin kapena glimepiride sichimapereka zotsatira zomwe mukufuna.
Zolemba ntchito
Nthawi zambiri, mulingo wa chinthu umapangidwa malinga ndi kuchuluka kwa shuga m'thupi. Ndikofunikira kugwiritsa ntchito mlingo wotsika kwambiri womwe ungakwanitse kuti mupeze ma metabolic ofunikira.
Kugwiritsa ntchito molakwika mankhwalawa, monga kudumpha mlingo, sikuyenera kuthandizidwa ndi kukwera kwamphamvu nthawi yotsatira. Zochita za wodwala zolakwa zoterezi ziyenera kukambidwiratu ndi adokotala.
Naturalization wa kagayidwe kachakudya zimagwirizana ndi kuchuluka minyewa kumva insulin. Chifukwa chake, mukamagwiritsa ntchito amaryl m, kufunika kwa glimepiride kumachepetsedwa. Popewa kupezeka kwa hypoglycemia, ndikofunikira kuti muchepetse nthawi kapena kusiya kumwa mankhwala.
Mankhwalawa aledzera 1-2 pa tsiku ndi zakudya. Mlingo umodzi wa metformin ndi 1000 mg. Pazipita tsiku lililonse la metformin iyenera kukhala 2000 ml, glimepiride - 8 mg. Mwa odwala ochepa chabe, kugwiritsa ntchito zoposa 6 mg ya glimepiride kumakhala kothandiza kwambiri.
Popewa kupezeka kwa hypoglycemia, ndikofunikira kuwonetsetsa kuti kuchuluka koyamba kwa mankhwalawa sikupitilira mlingo wa metformin ndi glimepiride, womwe umatengedwa kale ndi munthu.
Ngati dokotala amusamutsira munthuyo amaryl m, mlingo umasankhidwa malinga ndi mankhwala omwe amwe. Ngati mukufunikira kuwonjezera voliyumu, kuchuluka kwa tsiku lililonse kuyenera kukhala kosaphatikizika pakubwera kwa theka la piritsi limodzi ndi 2 mg + 500 mg. Chithandizo cha mankhwalawa ziyenera kukhala zazitali. Kutalika kwake kumasankhidwa ndi katswiri.
Zapezeka kuti metformin imasiya thupi makamaka kudzera mu impso. Chifukwa chake, mwayi wokhala ndi zotsatirapo zovuta mwa anthu omwe ali ndi matenda a impso ndiwambiri kwambiri. Mankhwalawa akuyenera kugwiritsidwa ntchito pokhapokha ngati kusintha kwa chiwalochi.
Zotsatira zoyipa
Malangizo a amaryl m amawonetsa kuti nthawi zina mankhwala amabweretsa mavuto osayenera. Mankhwalawa amachititsa kuti magazi azikhala ndi shuga, zomwe zimapangitsa kuti munthu akhale ndi vuto la hypoglycemia.
Izi zitha kuwonedwa kwa nthawi yayitali ndipo zimayendera limodzi ndi mawonekedwe:
- Zovuta
- Kuchepetsa mseru
- Njala yayikulu;
- Kubweza
- Mutu;
- Kudziwitsa;
- Kusokonekera kwa mawu;
- Zowonongeka;
- Chizungulire
- Kuchuluka kugona;
- Chikumbumtima;
- Kuwonongeka kwa zomverera;
- Matenda opatsirana.
Panthawi zovuta, munthu amatha kuzindikira ndipo amatha kugwa. Nthawi zambiri pamakhala kupuma kosakhazikika ndipo bradycardia imachitika.
Kuphatikiza apo, pali chiwopsezo cha zizindikiro za kutsutsana ndi adrenergic. Vutoli limadziwika ndi thukuta lalikulu, mawonekedwe a angina pectoris, tachycardia, kukhuthala kwa dermis, arrhythmia. Mu zochitika zovuta, kuukira kwa hypoglycemia mu chithunzi cha chipatala kukufanana ndi sitiroko. Pambuyo pazachilengedwe, mawonekedwe omwe atchulidwa nthawi zambiri amatha.
Kuphatikiza pa mavuto omwe mankhwalawa amapezeka ndi mankhwalawa:
- Pa gawo loyamba la mankhwalawa, kusokonezeka kwakanthawi kochepa kumachitika kawirikawiri chifukwa chokhudzana ndi kusintha kwa glucose m'thupi.
- Chifukwa cha kuwonongeka kwa chakudya cham'mimba, mseru ndi kusanza kumachitika. Nthawi zambiri pamakhala kupsinjika kapena kumverera kwodzaza mu epigastrium. Palinso chiopsezo cha ululu wam'mimba komanso kutsekula m'mimba.
- Ndi kuwonongeka kwa chiwindi ndi biliary thirakiti, ntchito ya michere yamagulu imatha kukula. Palinso chiopsezo cha hepatitis, cholestasis. Mu zochitika zovuta, kulephera kwa chiwindi kumayamba.
- Ndi kuphwanya kwa hematopoietic dongosolo, leukopenia ndi thrombocytopenia kukulitsa. Palinso chiopsezo cha hemolytic anemia, agranulocytosis, granulocytopenia ndi zovuta zina. Panthawi yamankhwala, ndikofunikira kuwunika momwe wodwalayo alili, chifukwa paliopseza pancytopenia ndi aplastic anemia.
Mikhalidwe yotereyi ndiye maziko oletsa kugwiritsa ntchito mankhwalawa.
Ndi chidwi chachikulu ndi zosakaniza zamtunduwu, chifuwa kapena matumbo a pseudo. Izi zimawoneka ngati kumverera kwa kuyabwa ndi zotupa. Amatha kukhala ofatsa kapena opita patsogolo.
Nthawi zina, vasculitis yovomerezeka imatha kuoneka. Palinso chiopsezo cha photosensitivity ndi kuchepa kwa sodium m'magazi.
Contraindication
Chachikulu contraindication kugwiritsa ntchito mankhwalawa ndi awa:
- Mtundu woyamba wa shuga
- Kuzindikira kwakukulu pazigawo za mankhwala;
- Kukhalapo kwa zovuta za chiwindi kapena hemodialysis.
- Mimba ndi mkaka wa m`mawere;
- Chizolowezi mawonekedwe a lactic acidosis;
- Kuyamba kwa kukonzekera kosiyanitsa ndi ayodini. Pankhaniyi, kugwiritsa ntchito mankhwalawa kuyenera kuyimitsidwa kwakanthawi, popeza pali chiopsezo cha kuwonongeka kwa impso;
- Mavuto opatsirana opatsirana;
- Zomwe zimachitika ntchito isanayambe kapena itatha;
- Zowopsa;
- Kuchepa kwa ntchito kwa adrenal kapena pituitary, cachexia, kufa ndi njala;
- Matenda aimpso;
- Kulephera kwa mtima kwamphamvu komwe kumafuna kugwiritsa ntchito mankhwala;
- Zowonongeka kwa chiwindi, zovuta za mapapu ndi zovuta zina zomwe zimatha kutsagana ndi hypoxemia;
- Zakumwa zoledzeretsa, kuchepa thupi, kutaya thupi, kuphatikizapo kusanza ndi kutsegula m'mimba;
- Zaka za ana.
The zikuchokera mankhwala muli lactose. Chifukwa chake, mankhwalawa saloledwa kupereka kwa anthu omwe ali ndi vutoli. Chinanso chotsutsana ndi kupezeka kwa glucose-galactose malabsorption syndrome.
Bongo
Zikatero, chithandizo chimasankhidwa malinga ndi kuuma kwa hypoglycemia. Muzochepa zochepa zomwe siziphatikizidwa ndi kutaya khungu ndi minyewa, timalimbikitsidwa kugwiritsa ntchito dextrose mkati. Chofunikanso kwambiri ndikukonzanso zakudya komanso kumwa mankhwala.
Kwa kanthawi, ndikofunikira kuwunika momwe wodwalayo alili. Izi zimafunikira kuti athetse chiwopsezo ku thanzi la munthu ndi moyo.
Panthawi zovuta za hypoglycemia, yomwe imadziwika ndi kupweteka, chikomokere ndi zovuta zina zamitsempha, wodwala amayenera kuchipatala. Pambuyo pake, mankhwalawa amachitika kuchipatala. Njira zapadera zimasankhidwa kutengera mawonetsedwe ake.
Zochitika Pantchito
Kugwiritsa ntchito glimepiride ndi mankhwala ena kungakhudze kagayidwe kake. Izi zimagwira pakumwa fluconazole, rifampicin ndi mankhwala ena.
Kuphatikiza apo, pali mankhwala omwe amalimbikitsa zotsatira za hypoglycemic. Izi zimaphatikizapo insulin, allopurinol, anabolic steroids. Ma salicylates, phenylbutazone, phenenecid ndi zinthu zina zambiri zimakhala zofanana.
Kuphatikiza ndi zinthu zina kumachepetsa zotsatira za hypoglycemic. Izi zimaphatikizapo barbiturates, diuretics, acetazolamide, mankhwala ofewetsa tuvi tolimba. Katundu wofanana ndi estrogens, phenytoins, glucagon, etc.
Kuphatikizidwa kwa amaryl m ndi clonidide, reserpine, kapena histamine receptor blockers kungayambitse kuwonjezeka kapena kuchepa kwa mphamvu ya hypoglycemic.
Mukamagwiritsa ntchito mankhwala osakanikirana ndi ayodini, pamakhala chiopsezo cha impso. Izi zimayambitsa kuchuluka kwa metformin, komwe kumawonjezera chiopsezo cha lactic acidosis. Zikatero, siyani kugwiritsa ntchito mankhwalawa kwa masiku angapo.
Zofananazo zimatheka ngati kuphatikiza kwa amaryl m ndi ma antibacterial othandizira omwe ali ndi nephrotoxic. Izi zikuphatikiza ndi gentamicin.
Chifukwa chake, musanayambe mankhwala ndi mankhwalawa, muyenera kufunsa dokotala kuti mupeze kuphatikiza. Izi zikuthandizira kuchepetsa kuopsa kwa mankhwalawa.
Kuphatikizika kwa chinthu ndi zakumwa zoledzeretsa kungayambitse kuwonjezeka kapena kuchepa kwa mphamvu ya hypoglycemic ya glimepiride. Kuphatikiza apo, kuphatikiza uku kumawonjezera chiopsezo cha lactic acidosis. Kuwopsa kumeneku kumachulukana kwambiri ndi kulephera kwa chiwindi kapena kudumpha chakudya.
Chifukwa chake, ndikofunikira kwambiri pamlingo wa mankhwala ndi amaryl m kusiya zakumwa zoledzeretsa ndi mankhwala aliwonse omwe ali ndi ethanol.
Analogi
Mosalolera pazinthuzo, mutha kusankha fanizo la amaryl m. Zothandiza kwambiri zimaphatikizapo njira izi:
- Diamerid;
- Gluconorm;
- Glemaz;
- Meglimid.
Ndemanga
Ndemanga zambiri za amaryl m zimatsimikizira kuchuluka kwa mankhwalawa:
Amaryl m - chida chothandiza chomwe chimapereka kuchepa kwa shuga mthupi. Amalembedwa mwachangu kwa anthu omwe ali ndi matenda ashuga 1. Kuti mukwaniritse zotsatira zofunika, ndikofunikira kutsatira malangizo ndi malangizo onse azachipatala. Ngati zotere zimachitika, ndibwino kufunsa katswiri.
