Matendawa masiku ano amakhudza 9% ya anthu padziko lapansi. Makampani opanga mankhwala ndi machitidwe azachipatala a mayiko otsogola padziko lonse lapansi akuika ndalama mabiliyoni ambiri, ndipo matenda ashuga akuyenda mozungulira dziko lapansi, kuyamba kukhala achichepere, ndikuyamba kukhala ankhanza.
Vutoli likufika pamlingo womwe sunkayembekezeredwa: pofika chaka cha 2020, theka la odwala biliyoni omwe ali ndi matenda a shuga a 2 akunenedweratu, ndipo madokotala sanaphunzire momwe angapewere matendawa moyenera.
Ngati ndi matenda amtundu wa 1 shuga, omwe amakhudza osakwana 10% ya onse odwala matenda ashuga, zonse ndizosavuta: muchepetse kuchuluka kwa shuga m'magazi mwa kubaya insulini (palibe chomwe chingaperekedwe pamenepo) ndipo zonse zikhala bwino (lero, kwa odwala oterowo, adayambitsa kapamba wochita kupanga) ), ndiye ndi matenda a shuga 2, ukadaulo wapamwamba sugwira ntchito.
Mwa fanizo, la matenda ashuga amtundu wa 2, shuga adanenedwa kukhala mdani wamkulu, kudzaza msika ndi mankhwala ochepetsa shuga. Limbikitsani chithandizo cha odwala matenda ashuga mothandizidwa ndi mapiramidi othandizira, mankhwala ena akapaka mankhwala amodzi, ndiye kuti wachitatu amawaonjezera izi, mpaka insulin itafika.
Kwa zaka 20 zapitazi, madokotala akhala akulimbana ndi shuga, koma zotsatira zake zimakhala zotsika, chifukwa zovuta ndi zovuta za mankhwala nthawi zambiri zimapambana, makamaka ngati simumatsatira mankhwalawa, musaganizire kuti mankhwalawo ndi a ndani ndipo ndani.
Chimodzi mwa ziwalo zomwe tikufuna ndi mtima ndi mtsempha wamagazi. Zimatsimikiziridwa kuti chithandizo chachikulu cha matenda ashuga chimayambitsa zosiyana ndipo zimapangitsa kufa kwa mitsempha. Shuga ndi chizindikiro chabe cha matenda amtundu wa 2; matendawa amatengera metabolic syndrome.
Mankhwala a m'badwo watsopano Onglisa, opangidwa ndi asayansi aku Britain ndi ku Italy, sikuti amangothandiza odwala, komanso luso la mtima. Mankhwala a mndandanda wa maretretin, omwe amaphatikizapo Onglisa, ndi zomwe zachitika posachedwa kwambiri pankhani ya matenda ashuga. Amagwira ntchito kuti achepetse kusadya komanso kuwonda - chimodzi mwazochitika zazikuluzikulu za matenda a shuga a 2.
Kuphatikiza apo, incretinomimetics silipiritsa hypoglycemia, amathandizira kuchepetsa kuthamanga kwa magazi, komanso kuteteza maselo a pancreatic. Mtengo wokwera komanso kusowa kwa chidziwitso chazachipatala chifukwa chakanthawi kochepa kogwiritsa ntchito mankhwalawa kumatha chifukwa cha zovuta za Onglisa, koma izi ndizofunanso nthawi.
Kupanga ndi mawonekedwe a kumasulidwa
Piritsi lililonse la Onglisa, chithunzi chake chomwe chaperekedwa m'gawoli, chili ndi 2.5 kapena 5 mg ya saxagliptin hydrochloride mu chipolopolo. Fomuloli idathandizidwa ndi ojambula: cellulose, lactose monohydrate, croscarmellose sodium, magnesium stearate ndi Opadrai utoto (yoyera, yachikaso ndi ya buluu ya mapiritsi a 2.5 mg ndi oyera, apinki komanso abuluu pamtundu wa 5 mg).
Mankhwalawa amatha kuzindikiridwa ndi mawonekedwe (mapiritsi a biconvex okhala ndi chikasu chachikasu ndikuwonetsa 2,5 / 4214 ndi pinki wolemba 5/4215). Zolemba zake zimasindikizidwa mbali iliyonse ndi inki wabuluu.
Mutha kugula mankhwala omwe mumalandira. Kwa mapiritsi a Ongliz, mtengo wake suchokera pagulu la bajeti: 30 ma PC. 5 mg ku Moscow muyenera kulipira ma ruble 1700. Wopanga adatsimikiza moyo wa alumali pazaka zitatu. Zosungidwa zamankhwala ndizofanana.
Zotsatira za pharmacological
Chofunikira chachikulu cha Onglisa ndi saxagliptin. Pakatha tsiku limodzi atalowa mgaye, amalepheretsa ntchito ya DPP-4 peptide. Mukakumana ndi glucose, kuponderezana kwa enzyme modabwitsa (nthawi 2-3) kumathandizira kubisalira kwa glucagon-ngati peptide-1 (GLP-1) ndi glucose-wodalira insulinotropic polypeptide (HIP).
Nthawi yomweyo, kuchuluka kwa glucagon m'maselo a B kumachepa, ntchito ya ma cell a b omwe amayang'anira kupanga insulin yachilengedwe imachulukanso. Zotsatira zake, zizindikiro za kusala ndi postprandial glycemia zimachepetsedwa kwambiri.
Chitetezo ndikugwiritsa ntchito mankhwalawa adaphunziridwa poyesa 6, momwe amodzi odzipereka a 4148 omwe adatenga nawo matenda a 2 adachita nawo. Onse ogwira nawo ntchito adawonetsa kusintha kwa glycated hemoglobin, shuga yodwala ndi glycemia pambuyo ponyamula katundu. Ophatikizira pawokha omwe sanakwaniritse 100% glycemic control adayatsidwa mankhwala owonjezera - thiazolidinediones, metformin, glibenclamide.
Odwala omwe ali ndi mankhwala owonjezera a antiidiabetes amawonetsa zotsatira zofananazo. Kulemera kwa onse omwe atenga nawo mbali pazokambirana kunakhazikika.
Saxagliptin akapatsidwa
Anthu odwala matenda ashuga a mtundu 2
- Monga monotherapy, kuphatikiza kusintha kwasinthidwe;
- Kuphatikiza, ndikuphatikiza kwa njira yapita ndi metformin, ngati monotherapy simapereka chiwongolero chonse cha glycemia;
- Pamodzi ndi zotumphukira za mndandanda wa sulfanylurea ndi thiazolidinediones, ngati kuphatikiza kwapapitako sikunakhale kokwanira.
Kwa Onglisa wapangika
Popeza saxagliptin ndi chothandizira champhamvu chomwe chimapangitsa ntchito ya maselo a B ndikulepheretsa ntchito ya maselo a b, chitha kugwiritsidwa ntchito ndi malire, makamaka, mankhwalawa sanasonyezedwe:
- Amayi oyembekezera komanso oyembekezera;
- Muubwana;
- Anthu odwala matenda ashuga omwe ali ndi matenda amtundu 1;
- Ndi mtundu wa 2 wodwala matenda a shuga;
- Amakhudzidwa ndi matenda ashuga a ketoacidosis;
- Ngati wodwala salola galactose;
- Ndi hypersensitivity pazomwe zimapangidwira.
Mukamasankha mtundu wa mankhwala, dokotala samangoyang'ana pa zomwe zaphatikizidwa, komanso mawonekedwe a saxagliptin a mankhwalawa omwe wodwala matenda ashuga amatenga ku matenda oyanjana. Chifukwa chake, mankhwala onse omwe munthu wodwala matenda ashuga amawagwiritsa ntchito limodzi, dokotala amayenera kudziwitsidwa munthawi yake.
Malangizo ogwiritsira ntchito
Dokotalayo ndi amene amawerengera kuchuluka kwa mankhwalawo payekhapayekha, poganizira zotsatira za mayeso, zaka, magawo a matendawo, momwe munthu amachitikira ndi thupi. Kwa Onglisa, malangizo ogwiritsira ntchito amalimbikitsa kumwa mapiritsiwo pakamwa, osamangidwa nthawi yakudya. Muyeso woyamba wa mankhwalawa ndi 5 mg / tsiku.
Kumayambiriro kwa mapangidwe a mankhwalawa, mawonekedwe apamwamba amawoneka motere:
- Saksagliptin - 5 mg / tsiku.;
- Metformin - 500 mg / tsiku.
Pambuyo masiku 10-15, njira yothandizira ma regimen yosankhidwa imawunikiridwa ndipo, ngati pakufunika, mlingo wa metformin umasinthidwa, kusunga muyezo wa Onglisa osasinthika.
Ngati nthawi yakumwa mankhwalawo ikusowa, imamwa mankhwalawo nthawi yoyamba. Simungathe kuchita zofananira, chifukwa thupi limafunikira nthawi kuti lizisinthe.
Ngati pali mbiri yodwala matenda a impso, ndiye kuti palibe chifukwa chodalira. Ndi mawonekedwe olimbitsa komanso okhwima, muyezo umachepetsedwa ndi 2 nthawi - 2,5 mg / tsiku. (nthawi imodzi).
Pa hemodialysis, piritsi imatha kumwa kumapeto kwa njirayi. Zotsatira za Onglisa kwa odwala omwe ali ndi ziwalo zam'mimba za m'mimba sizinaphunzire. Musanalembe mankhwala komanso nthawi yonseyi, ndikofunikira kuwunika momwe impso zimayendera.
Ndi hepatic pathologies, mankhwalawa amatchulidwa muyezo mlingo wa 5 mg / tsiku. Kwa odwala matenda ashuga okalamba, kumwa mankhwala sikofunikira, koma vuto la impso liyenera kuganiziridwanso.
Mlingo wa ma insretin umadulidwa mu zovuta ndi zovuta zoletsa:
- Atazanavir;
- Ketoconazole;
- Igraconazole;
- Nelfinavir;
- Clarithromycin;
- Ritonavir;
- Saquinavir;
- Indinavir;
- Telithromycin.
Palibe chidziwitso chakuvomerezeka pakugwiritsa ntchito mankhwalawa kwa amayi apakati ndi ana osakwana zaka 18, chifukwa chake, ma fanizo amasankhidwa m'gulu la odwala matenda ashuga.
Zosafunika zotsatira ndi mankhwala osokoneza bongo
Mankhwala a gulu lamagulu ampretin am'badwo waposachedwa kwambiri. Ndi malingaliro onse adotolo, Ongliz amaloledwa nthawi zambiri ndi ambiri odwala matenda ashuga.
Nthawi zina, zotsatirazi zalembedwa:
- Matenda a Dyspeptic;
- Mutu;
- Pancreatitis
- Matenda opatsirana a thirakiti;
- Matenda a urogenital a matenda opatsirana.
Ngati chimodzi mwazizindikiro zomwe zalembedwa kapena vuto lina lachilendo likuwoneka, muyenera kusiya kugwiritsa ntchito mankhwalawo ndikuyang'ana dokotala.
Pazifukwa zasayansi, mankhwalawa adaperekedwa kwa odzipereka mu Mlingo wopitilira muyeso ka 80. Zizindikiro za kuledzera sizokhazikika. Saxagliptin yowonjezera imatha kuchotsedwa pogwiritsa ntchito hemodialysis.
Malangizo owonjezera
Saxagliptin sanalembedwe mndandanda wapatatu momwe ma jakisoni a insulin amaphatikizidwira ndi metformin ndi thiazolidinediones, popeza zotsatira za kuyanjanazi sizinaphunzire. Kuwongolera impso kumachitika pa magawo onse a chithandizo ndi Onglisa, koma ndi mawonekedwe ofatsa, mlingo wake sasinthidwa, nthawi zina amachepetsa.
Saxagliptin pokhudzana ndi zotsatira za hypoglycemic ndiotetezeka konsekonse, koma kuphatikiza mankhwala a sulfonylurea kumatha kupangitsa zochitika za hypoglycemic. Chifukwa chake, ndi zovuta chithandizo, titration wa Mlingo wotsirizira njira ya kuchepetsa ndi kuvomerezedwa.
Pankhani ya kulekerera kwa mankhwalawa ophatikizana - DPP-4 zoletsa, Onglisa sakusungidwanso, popeza nthawi zina thupi limasokonekera kuyambira pakhungu loyipa mpaka kugunda kwa anaphylactic ndi angioedema, likufuna kuchotsedwa kwa mankhwala mwachangu.
Popeza mankhwalawa ali ndi lactose, sikuti amaperekedwa kwa odwala matenda ashuga omwe amalephera kutulutsa, kuperewera kwa lactose, shuga-galactose malabsorption.
Mukuyang'anira odwala matenda ashuga atatha kulandira chithandizo ndi Onglisa, pakhala pali zochitika zina za chitukuko cha kapamba. Popereka mankhwala a saxagliptin, wodwalayo ayenera kudziwitsidwa za chizindikiro: kupweteka kwapafupipafupi komanso kwapadera kwa epigastrium.
Ngati m'mimba mulibe vuto, muyenera kusiya kumwa mankhwalawo ndikuwuza adotolo. Zotsatira zake zimakhala zosakhalitsa komanso zosinthika, zimangopita kwa iwo atasiya kumwa mankhwalawo.
Mu aimpso kukanika modekha ndi woipa mawonekedwe, limodzi mlingo titation. M'mikhalidwe yovuta kwambiri, Onglizu amagwiritsidwa ntchito mosamala; pa siteji yodwala, pamene wodwalayo sangathe popanda hemodialysis, osagwiritsa ntchito konse. Kuwunikira momwe mkhalidwe wam impso muzochitika zotere umachitika isanayambike maphunziro ndipo miyezi isanu ndi umodzi yonse yogwiritsidwa ntchito ndi Ogliza.
Zochitika pochiza odwala matenda ashuga okalamba (kuyambira zaka 75) sizokwanira, chifukwa chake, gulu ili la odwala limafunikira chidwi chachikulu.
Zotsatira za kuthekera kwa Onglisa pakuwongolera mayendedwe kapena njira zovuta sizinafalitsidwe, chifukwa chake, odwala matenda ashuga ayenera kumwa mankhwalawa mosamala, makamaka chifukwa chizungulire chimachitika pakati pamavuto. Kuchita chidwi kwambiri ndi zoterezi zimafunika kwa odwala omwe amagwiritsa ntchito Onglisa mu chithandizo chovuta, chifukwa mankhwala ena othandizira amatha kudzetsa hypoglycemia.
Kugwiritsa ntchito mankhwalawa pamatenda amtima kumapangitsa kuti mankhwalawa achulukitse kugunda kwa mtima. Ku America, ngakhale ndi kuchuluka kwa shuga kwa nthawi yayitali, adotolo amafotokozera odwala matenda ashuga omwe ali ndi arrhythmia Onglizu kuti athandizire kuyamwa kwa glycemic komanso kubwezeretsa kugunda kwa mtima.
Kuyanjana ndi Mankhwala ndi Onglisa ndi fanizo
Malinga ndi kuchuluka kwa kafukufuku wasayansi, zotsatira za kulumikizana kwa Onglisa ndi zinthu zina panthawi yovuta kwambiri sizinafotokozeredwe ngati zofunika kwambiri pakubwera.
Zotsatira zakuthandizidwe kwa mankhwalawa pakumwa mowa, ndudu, zakudya zingapo, mankhwala othandizira kunyumba sanakhazikitsidwe.
Mu mawonekedwe apiritsi, kuchokera pamndandanda wa ma incretin, pamodzi ndi Onglisa, Galvus ndi Januvia amamasulidwa, cholembera - Baetu ndi Viktoza.
Katswiri ndi akatswiri
Pamabwalo azokambirana za mankhwala Ongliza, ndemanga zake ndizabwino, mwina kungobweza mtengo ndi mtengo womwe ukufanana ndi mtundu wake wa ku Europe.
Tsoka ilo, matenda, monga ukalamba, sangasinthe komanso sangapewere chifukwa thanzi, monga mukudziwa, sizingagulidwe, ndipo mtundu wachiwiri wa matenda ashuga sutchedwa tikiti yanjira imodzi.
Koma kapamba yemwe ali ndi matenda ashuga okhala ndi mtundu wachiwiri samakulirakulira, ali ndi malo obwezeretsanso ntchito zake, ndikuwathetsa ngati osagwira (kuchokera pakuwona insulin katemera).
Asanamasule Ongliza kumsika, wopanga adagwiritsa ntchito mabiliyoni ambiri osati kungowonetsa kusakhala ndi zotsatirapo zoipa, komanso kutsimikizira momwe amagwirira ntchito. Ngati mankhwalawa angathandizire kuchedwetsa zovuta kwa zaka 10- 20, ngakhale nthawi yino yodzaza (popanda vuto la mtima, chibadwa, khungu, khungu, kusabala, kuperewera kwa impso), muyenera kuyang'anitsitsa.
Ndemanga za kuthekera kwa Onglisa ndi zotsatira za mankhwala a shuga pa thanzi la endocrinologist Shmul Levit, mutu. Institute of Diabetesology, onani vidiyo:
