Saxagliptin kwa odwala matenda ashuga - malangizo ogwiritsira ntchito

Palibe zovuta kuganiza kuti zaka 100 zapitazo kunalibe insulin, ndipo odwala matenda ashuga adatsimikiziridwa kuti afa mwachangu. Mankhwala ochepetsa shuga a matenda ashuga a mtundu 2 adawonekera mkatikati mwa zaka zapitazi, ndipo izi zisanachitike, odwalawa nawonso anamwalira, ngakhale sanachedwe kwambiri.

Masiku ano pa intaneti pali zambiri zokhudzana ndi mankhwala atsopano, njira zamankhwala, zida zawo

Chimodzi mwazatsopano za mankhwala othandizira odwala matenda ashuga ndi ma incretinomimetics (exenatide, liraglutide, sitagliptin, vildagliptin, saxagliptin). Kodi phindu la matenda ashuga ndi lotani?

Njira zakuchitikira ma insretins

Ma insretins ndi mahomoni amunthu. Matumbo awo am'mimba amatulutsa pambuyo pakudya, insulin katemera pakadali pano amawonjezeka ndi 80%. Mitundu iwiri yaiwo yazindikiridwa m'thupi - GLP-1 (glucone-like peptide-1) ndi HIP (insulinotropic polypeptide). Ma receptors omalizirawo amapezeka pa ma b-cell, ndipo mu GLP-1 amatha kupezeka mu ziwalo zosiyanasiyana, chifukwa chake ntchito yake ndi multivariate.

1. GLP-1 imathandizira kupanga insulin ya insulin mwa b-cell;
2. Homoni imalepheretsa kubisalira kwa glucagon ndi ma cell;
3. Incretin amachepetsa m'mimba;
4. Amachepetsa chilakolako chofuna kudya ndipo amamva bwino;
5. Zothandiza pa chapakati mantha dongosolo, mtima, mitsempha.

Glucagon, yomwe imapangidwa m'chiwindi cha b-cell, ndizomwe ndizofanana ndi insulin. Zimawonjezera kuchuluka kwa shuga m'magazi mwakuwamasula ku chiwindi.

Minofu imafunika glucose kuti ikwaniritse nkhokwe zamphamvu, pomwe ilipo mwa mtundu wa glycogen. Poletsa kuphatikiza kwa glucagon, mahomoni amtunduwu amatchinga kutulutsa shuga m'magazi, ndikungokulitsa kutulutsa kwa insulin.

Kodi maubwino amuchotsa pamimba munthu wodwala matenda ashuga? Thupi limamwa glucose wambiri m'matumbo. Ngati angaperekedwe kumeneko mumtundu waung'ono, sipadzakhala madontho akuluakulu a shuga. Izi zimathandiza kuthana ndi vuto la postprandial (masana) glycemia. Ndikosatheka kuphatikiza kudya kwakukonda kwa 2 matenda ashuga: GLP-1 imakhudza mwachindunji gawo lanjala mu hypothalamus.

Phindu la ma impretins pamtima ndi m'mitsempha yamagazi tsopano akuphunzira mwachangu. Muholo yofufuzira, zidapezeka kuti GLP-1 imathandizira kusinthika kwa maselo a kapamba komanso kuteteza maselo a b kuti asawonongeke.Ndi chiyani chomwe chimaletsa kugwiritsa ntchito mahomoni achilengedwe m'malo mwa mankhwala? GLP-1 imawonongedwa ndi DPP-4 (mtundu wa 4 dipeptidyl peptidase) m'mphindi 2, ndi HIP - mu maminiti 6.

Asayansi apeza magulu awiri a mankhwala ofanana ndi maretretin:

• Kutsatsa kagwiritsidwe ka ntchito ka GLP-1;
• Kuletsa ntchito ya enzyme DPP-4 ndikukulitsa moyo wa mahomoni.

Mtundu woyamba umaperekedwa pamsika wapanyumba ndi Bayeta (kutengera extenatide) ndi Viktoza (kutengera liraglutide) - analogues ya GLP-1, ikubwereza kwathunthu kuthekera kwake, koma ndi zotsatira zazitali. Zabwino zake zimatha kuwonjezeredwa ndikuchepera makilogalamu 4 kwa miyezi isanu ndi umodzi ndikuchepa kwa hemoglobin wa glycated ndi 1.8%.

Mtundu wachiwiri umayimiriridwa mdziko lathu ndi mankhwala atatu - Galvus (kutengera vildagliptin), Yanuviya (kutengera sitagliptin), Ongliza (mu kapangidwe kake - saxagliptin). Ntchito yawo yayikulu ndikuletsa enzyme DPP-4, yomwe imawononga ma protein. Ntchito yamahomoni imachulukitsa nthawi ziwiri, motero glycemia siziwopseza munthu. Ma Inhibitors ali ndi zotsatira zosasangalatsa zingapo, chifukwa mahomoni amakula m'thupi lanu.

Zotsatira za kulemera kwawo sizilowerera ndale, glycated hemoglobin imachepetsedwa chimodzimodzi monga gulu loyamba.

Fomu yotulutsa katundu

Saxagliptin ndiye mankhwala aposachedwa kwambiri a kalasi ya DPP-4 zoletsa. Dzina lake lamalonda ndi Onglisa. Amatulutsa mankhwalawa Mlingo wa 2,5 ndi 5 mg, amagulitsa mapiritsi. Alumali moyo wa mankhwala ndi zaka 3, malo osungirako ali muyezo.

Saxagliptin sakuphatikizidwa pamndandanda wabungwe la mankhwala okondweretsa, ngakhale kuti m'madera ena amalembedwa pamaziko a registritis yachigawo kuchokera ku bajeti yakomweko. Kuti mupeze chithandizo cha Onglisa pamitengo yamapulogalamu apakompyuta, muyenera kugwiritsa ntchito ma ruble 1700. pamwezi (mapiritsi a 5 mg). Poyerekeza, maphunziro a pamwezi a Januvia (mlingo wa 100 mg) adzagula ma ruble 2,400, Galvus - 900 rubles.

Malangizo ogwiritsira ntchito

Malangizo a Saksagliptin ogwiritsira ntchito akutsimikiza kutenga 1p / tsiku., Dongosolo silimamangidwa pakudya. Mutha kugwiritsa ntchito chida cha monotherapy kapena mawonekedwe ovuta.

Mankhwala ophatikiza saxagliptin ndi metformin sanapangidwebe, ngati fanizo lake YanuMeta ndi GalvusMeta.
Pazovuta zazing'onoting'ono, simukuyenera kusintha mankhwalawa; milandu yayikulu kwambiri, kuchuluka kwake kumachepetsedwa ndi 2 times.

Ndani amasankhidwa Saxagliptin

Mankhwala opangidwa ndi Saxagliptin (mawu ofanana - Onglisa) amatha kutumikiridwa ngakhale pa gawo la prediabetes la mtundu wa 2, pomwe kusinthidwa kwa njira yamoyo (kadyedwe kakang'ono ka carb, zochitika zolimbitsa thupi zokwanira, kayendetsedwe ka zochitika zam'magazi) sikupereka shuga m'magazi.

Saxagliptin ndi yoyeneranso chithandizo chovuta, ndendende kuchuluka kwa mankhwalawa omwe adzafotokozedwenso panthawi imodzi atazindikira, zidzadalira momwe glycated hemoglobin amathandizira. Kufanana ndi Ongliza, metformin imayikidwa, ndipo pakakhala kuti palibe machitidwe owongolera glycemic, kukonzekera kwa sulfonylurea ndi thiazolidatediones kumayikidwa.

Contraindication

Ndi

Mndandanda wonse:

1. Nthawi yokhala ndi pakati komanso yoyamwitsa;
2. Zaka: asanafike 18 ndi pambuyo pa zaka 75;
3. Ndi kobadwa nako shuga-galactose malabsorption;
4. Mtundu woyamba wa shuga;
5. Matenda ashuga ketoacidosis;
6. Ndi galactose tsankho, lactase akusowa;
7. Hypersensitivity pazigawo za formula.

Kuphatikiza pa zolembedwa zotsutsana, popanga njira yothandizira, dokotala amaganizira momwe saxagliptin amagwiritsidwira ntchito ndi mankhwala ena omwe wodwala matenda ashuga amatenga chifukwa cha matenda oyanjana. Ndikofunikira kudziwitsa endocrinologist nthawi zonse zowonjezerazo munthawi yake.

Zotsatira zoyipa ndi bongo

Saxagliptin ndiye wothandizira kwambiri pa hypoglycemic, chifukwa samayambitsa hypoglycemia, koma, ngati mankhwala aliwonse opangidwa, amatha kukhala ndi zotsatirapo zosayenera. Ngati zizindikirozi kapena vuto lililonse likuwoneka, muyenera kufunsa dokotala: amasintha mankhwalawo kapena asinthe m'malo mwake.

Zina mwazomwe zimachitika mosayembekezereka:

• Matenda opatsirana;
• Kutupa njira ya genitourinary dongosolo;
• Matenda a Dyspeptic;
• Mutu;
• Sinusitis
• Gastroenteritis

Malangizowo sanatchulidwe za kuchuluka kwa mankhwala osokoneza bongo, chifukwa maphunziro azachipatala omwe mankhwalawa anaperekedwa kwa odzipereka odzipereka pa Mlingo wopitilira muyeso ndi nthawi 80 sanasonyeze kuledzera.

Zitha kusintha saxagliptin

Mopanda kulekerera kapena contraindication, dokotala amasankha ma fanizo a saxagliptin. Palibe njira ina yomwe mungagwire Onglise ndi gawo lomweli, koma malinga ndi machitidwe aukatswiri, mkwiyo wa DPP-4 enzyme udatsekedwa:

1. Januvia ndiye mankhwala oyamba m'kalasi lino, omwe ankangogwiritsidwa ntchito ku USA kokha, kenako ku Europe. Hafu ya ola mutatha kudya, mankhwalawa amalepheretsa enzyme kwa tsiku limodzi. Mutha kugula mapiritsi pa 25,50 ndi 100 mg. Mlingo wokhazikika ndi 100 mg / tsiku. Zotsatira zake zikuwonekera patatha mwezi umodzi. Kuti muthane ndi zovuta mankhwala, mankhwalawa amapangidwa limodzi ndi metformin - YanuMet.
2. Galvus ndi mankhwala othandizira aku Swiss, oyenera kulandira chithandizo chovuta, kuphatikiza ndi insulin. Mankhwala ophatikizidwa a GalvusMet nawonso amatulutsidwa, kapangidwe kake kamathandizidwa ndi metformin. Choyamba, mapiritsi amatengedwa pa 50 mg / tsiku .. Ngati ndi kotheka, mulingo umachulukitsa, ndikugawa mu 2 waukulu.

Kuchita bwino ndi chitetezo cha mankhwala onse omwe ali mgululi ndi ofanana, kusankha kwa mankhwala enaake kudzadalira luso la zachuma la wodwala komanso chidziwitso cha endocrinologist ndi mankhwalawa. Kwa saxagliptin, mtengo ndiwofunikira kwambiri poyerekeza ndi analogues.

Saxagliptin yozikidwa palagis, njira zaposachedwa kwambiri za akatswiri azachipatala ku Europe pankhani ya matenda ashuga, sikuti amangokhala ndi vuto lokha, komanso zotsatira zina zowonjezera: zimachepetsa chilimbikitso ndi kulemera, zimateteza kapamba, zimathandizira kuwongolera kuthamanga kwa magazi, komanso zimatha kukhala ndi mtima.

Mutha kudziwa zambiri za ma insretins komanso kuthekera kwa mankhwala antidiabetesic zochokera pa webinar wa a endocrinologist a Dilyara Lebedeva mu kanemayu.