Mapiritsi a Yanumet a matenda a shuga a 2

Mapiritsi a Yanumet ogwiritsa ntchito amatanthauza mankhwala a hypoglycemic omwe amagwiritsidwa ntchito pobwezeretsa matenda a shuga a mtundu 2. Kuchita kwake kumakonzedwa ndi kapangidwe kazinthu kazomwe amapanga. Kodi ndi yani ndipo ndiigwiritsa ntchito moyenera?

Nthawi zambiri amalembedwa ngati kusintha kwa moyo komanso metformin monotherapy kapena chithandizo chovuta sichinabweretse zotsatira zomwe zikuyembekezeka. Nthawi zina amalembedwa kwa anthu omwe amachita nawo masewera olimbitsa thupi kuti athe kuwongolera mbiri yawo ya glycemic. Kuphatikiza pakudziwitsidwa kwathunthu ndi malangizo, musanagwiritse ntchito pa chilichonse, kufunsira kwa dokotala ndikofunikira.

Yanumet: kapangidwe kake ndi mawonekedwe ake

Chofunikira chachikulu pa fomulamu ndi metformin hydrochloride. Mankhwalawa amawaika mu 500 mg, 850 mg kapena 1000 mg piritsi limodzi. Sitagliptin imathandizira pophika wamkulu, mu kapisozi imodzi imakhala 50 mg pa mlingo uliwonse wa metformin. Pali zokometsera zina mu formula zomwe sizili ndi chidwi ndi luso lamankhwala.

Makapisozi a mavekedwe ena otetezedwa amatetezedwa kuchokera kunzake zolembedwa "575", "515" kapena "577", kutengera mlingo. Phukusi lililonse la makatoni limakhala ndi mbale ziwiri kapena zinayi za zidutswa 14. Mankhwala omwe mumalandira amathandizidwa.

Bokosilo likuwonetsanso moyo wa alumali wa mankhwalawo - zaka ziwiri. Mankhwala omalizira ayenera kutayidwa. Zofunikira pakusungidwa ndizoyenera: malo owuma osafikiridwa ndi dzuwa ndi ana omwe ali ndi kutentha kwa madigiri 25.

Kuthekera kwama pharmacological

Yanumet ndi njira yolingalira ya mankhwala awiri ochepetsa shuga omwe ali ndi zowonjezera (zothandizirana wina ndi mzake): metformin hydrochloride, yomwe ndi gulu la Biguanides, ndi sitagliptin, choletsa DPP-4.

Synagliptin

Gawoli lapangidwa kuti lizigwiritsidwa ntchito pakamwa. Limagwirira ntchito ya sitagliptin zachokera kukondoweza kwa ma insretins. DPP-4 ikakhala yolephereka, mulingo wa GLP-1 ndi HIP peptides, womwe umayendetsa glucose homeostasis, umachulukanso. Ngati ntchito yake ili yabwinobwino, ma insretin amachititsa kuti insulini igwiritsidwe ntchito β-cell. GLP-1 imalepheretsanso kupangidwa kwa glucagon ndi ma α-cell mu chiwindi. Algorithm iyi siyofanana ndi lingaliro lamavuto am'makalasi a sulfonylurea (SM) omwe amalimbikitsa kupanga kwa insulin pamlingo wina uliwonse wa glucose.

Ntchito zotere zimatha kuyambitsa hypoglycemia osati odwala matenda ashuga okha, komanso odzipereka athanzi.

DPP-4 enzyme inhibitor mu Mlingo wolimbikitsidwa sikulepheretsa ntchito ya michere ya PPP-8 kapena PPP-9. Mu pharmacology, sitagliptin siili ofanana ndi mawonekedwe ake: GLP-1, insulin, SM zotumphukira, meglitinide, biguanides, α-glycosidase inhibitors, γ-receptor agonists, amylin.

Metformin

Chifukwa cha metformin, kulolera shuga mu mtundu 2 wa shuga kumawonjezereka: kukhazikika kwawo kumachepa (onse a postprandial ndi basal), insulin kukana kumachepa. Mphamvu ya momwe mankhwalawo amathandizira ndi yosiyana ndi mfundo za ntchito zina zomwe zingapangitse kuchepetsa shuga. Poletsa kupanga kwa glucogen ndi chiwindi, metformin imachepetsa kuyamwa kwake ndi matumbo a m'matumbo, imachepetsa kukana kwa insulin, ndikupititsa patsogolo kutulutsa kwapadera.

Mosiyana ndi mankhwalawa a SM, metformin siyambitsa mkwiyo wa hyperinsulinemia ndi hypoglycemia komanso odwala matenda ashuga omwe ali ndi matenda amtundu wa 2, komanso gulu lotsogolera. Panthawi ya mankhwalawa ndi metformin, kupanga insulini kumakhalabe pamlingo womwewo, koma kuthamanga kwake komanso kutsika kwa tsiku ndi tsiku kumachepa.

Zolemba za Pharmacokinetic

Mankhwala osakanikirana a Yanumen ali ndi bioequivalent pakudya kosakwanira kwa Mlingo wa Januvia ndi Metformin.

Zogulitsa

The bioavailability wa sitagliptin ndi 87%. Kugwiritsanso ntchito kwamafuta komanso zakudya zopatsa mphamvu zambiri sizikukhudza kuchuluka kwa mayamwidwe. Mulingo wambiri wa mankhwala ophatikizira m'magazi umakhazikika pambuyo pa maora 1-4 pambuyo poti wachotsedwa m'mimba.

The bioavailability wa metformin pamimba yopanda kanthu mpaka 60% pa mlingo wa 500 mg. Ndi mlingo umodzi waukulu waukulu (mpaka 2550 mg), mfundo ya kuchuluka inaphwanyidwa, chifukwa cha kuyamwa kochepa. Metformin imayamba kugwira ntchito patatha maola awiri ndi theka. Mlingo wake umafika 60%. Mlingo wapamwamba kwambiri wa metformin amalembedwa patatha tsiku limodzi kapena awiri. Pakudya, mphamvu ya mankhwalawa imachepa.

Kugawa

Kuchuluka kwa kagawidwe ka sungliptin kogwiritsidwa ntchito kamodzi ka 1 mg ka gulu loyendetsa nawo pamayesedwe anali 198 l. Mlingo womangidwa kumapuloteni a magazi ndi ochepa - 38%.

Pazoyesanso zofananira ndi metformin, gulu loyendetsa linapatsidwa mankhwala mu 850 mg, kuchuluka kogawa nthawi yomweyo kunali pafupifupi malita 506.

Ngati tiyerekeza ndi mankhwala a kalasi la SM, metformin kwenikweni sikugwirizana ndi mapuloteni, kanthawi kochepa kamapezeka m'maselo ofiira amwazi.

Ngati mumwa mankhwalawa muyezo wabwino, mankhwalawa amafikira mulingo woyenera (<1 .g / ml) m'magazi patsiku limodzi kapena awiri. Malinga ndi zotsatira za kuyesaku, ngakhale pa malire a malire, nsonga ya zomwe zidapezeka m'magazi sizidaposa 5 μg / ml.

Pomaliza

Mpaka 80% ya mankhwalawa imachotsedwa ndi impso, metformin samapangidwira mu thupi, pagulu loyang'anira pafupifupi gawo lonse lomwe latsalira mu mawonekedwe ake patsiku. Hepatic kagayidwe ndi excretion mu bile ducts kulibe kwathunthu. Sinagliptin imachotsedwanso chimodzimodzi (mpaka 79%) yokhala ndi metabolism yaying'ono. Pankhani yamavuto a impso, mlingo wa Yanumet uyenera kufotokozedwa. Ndi hepatic pathologies, mikhalidwe yapadera yamankhwala siyofunika.

Pharmacokinetics yamagulu apadera a odwala

1. Anthu odwala matenda ashuga okhala ndi matenda amtundu wa 2. Makina a mayamwidwe ndikugawa kwa sitagliptin ndi ofanana ndimayendedwe amoyo wathanzi. Ngati impso ndizabwinobwino, kusiyana kwa mapiritsi a pharmacokinetic pogwiritsa ntchito mitundu iwiri ya metformin mu diabetes ndi odzipereka athanzi sanawonedwe. Kukonzekera kwa mankhwalawa kutsatira miyambo sikunakhazikike.
2. Pakulephera kwa impso, Yanumet sinafotokozeredwe, chifukwa mankhwalawo pafupifupi amachotsa impso, ndikupanga katundu wambiri pa chinthu chofunikira kwambiri.
3. Mu chiwindi pathologies ofatsa komanso zolimbitsa zovuta, limodzi mlingo wa sitagliptin sanawonetse kusiyana kwakukulu mayamwidwe ndi kufalitsa. Palibe zambiri pazotsatira za kumwa mankhwalawa chifukwa cha matenda owopsa a chiwindi, koma zam'tsogolo pankhaniyi sizabwino. Malinga ndi metformin, zotsatira za zoyesa zofananira sizinalembedwe.
4. Anthu odwala matenda ashuga okalamba. Kusiyana kokhudzana ndi zaka kumalumikizidwa ndi kukanika kwa impso, patatha zaka 80, Janumet samawonetsedwa (kupatula odwala matenda ashuga omwe ali ndi chizolowezi chovomerezeka cha cretatinin).

Kwa omwe adawonetsedwa komanso kwa omwe sanawonetsedwe Yanumet

Mankhwalawa adapangira kuti azilamulira matenda ashuga amtundu wa 2. Amasankhidwa nthawi zina.

1. Kuphatikiza pa kusintha kwa moyo kusintha glycemic mbiri ya munthu wodwala matenda ashuga, ngati metformin monotherapy sikupereka zotsatira 100%.
2. Yanumet imagwiritsidwa ntchito popanga mankhwala ophatikizika pamodzi ndi zotumphukira za SM ngati njira "metformin + mankhwala a gulu la SM + zakudya zapamwamba za carb ndi minofu katundu" sizinali zokwanira.
3. Mankhwalawa amaphatikizidwa, ngati kuli kotheka, ndi a gamma receptor agonists.
4. Ngati jakisoni wa insulin sangaperekenso chindapusa cha shuga, Yanumet imayikidwa limodzi.

Contraindication mu malangizo ndi awa:

• Hypersensitivity kwa zosakaniza za formula;
• Coma (wodwala matenda ashuga);
• Matenda a impso;
• Matenda opatsirana;
• Kulowetsa mankhwala omwe ali ndi ayodini (iv);
• Zodabwitsa;
• Matenda omwe amachititsa kuperewera kwa oxygen m'matupi;
• Kutha kwa chiwindi, poyizoni, kuledzera;
• Kuyamwitsa;
• Mtundu woyamba wa shuga.

Zotsatira zoyipa

Musanagwiritse ntchito, muyenera kuphunzira mndandanda wazotsatira zoyipa ndi zizindikiro zake kuti mumdziwitse dokotalayo munthawi yokhudza momwe thupi limayendera kuti mukonze ma regimen. Zina mwazinthu zosafunikira:

• Kuzonda kuzizira;
• Matenda a Dyspeptic;
• Mutu ngati migraine;
• Kusokonezeka kwa kayendedwe ka matumbo;
• Matenda opatsirana a thirakiti;
• Kuchepa kwa kugona;
• Kuchulukitsa kwa kapamba ndi ma pathologies ena a kapamba;
• Kutupa;
• Kuchepetsa thupi, anorexia;
• Matenda oyamba ndi khungu.

Zotsatira zoyipa zitha kuwerengeredwa pa WHO:

• Nthawi zambiri (> 1 / 0,1);
• Nthawi zambiri (> 0.001, <0.1);
• Nthawi zambiri (> 0.001, <0.01).

Ziwerengero zamanambala azachipatala zimawonetsedwa pagome.

Momwe mungagwiritsire ntchito

Mawu oyamba "anakumana" m'dzina la mankhwalawa akuwonetsa kupezeka kwa metformin m'mapangidwe ake, koma mankhwalawa amatengedwa chimodzimodzi ngati akuwonetsa Januvia, mankhwala ozikidwa ndi sitagliptin popanda metformin.

Dokotala amawerengera, ndipo amwe mapiritsi m'mawa ndi madzulo ndi chakudya.

Nthawi zina, munthu ayenera kusamala kwambiri ndi chithandizo cha Yanumet.

1. Pachimake kapamba. Sitagliptin imatha kupititsa patsogolo zizindikiro zake. Dokotala ayenera kuchenjeza wodwala: ngati pali kupweteka pamimba kapena hypochondrium yamanja, muyenera kusiya kumwa mankhwalawo.
2. Lactic acidosis. Mkhalidwe wowopsa kwambiri komanso wosowa kwambiriwu ndiowopsa ndi zotsatira zakupha, ndipo mankhwalawo amasokonezeka pamene zizindikiro zikuwoneka. Itha kuzindikirika ndi kupuma movutikira, kupweteka kwa epigastric, kuzizira, kusintha kwa kapangidwe ka magazi, kupindika kwa minofu, asthenia, ndi matumbo a m'mimba thirakiti.
3. Hypoglycemia. M'mikhalidwe yodziwika bwino, mosiyana ndi zomwe Yanumet idakhala, sizimapanga. Zimatha kupsya mtima chifukwa chokhala ndi masewera olimbitsa thupi mopitirira muyeso, kutsika pang'ono kwa calorie (mpaka 1000 kcal / tsiku), mavuto omwe amapezeka m'magulu a adrenal ndi gitu pituitary, uchidakwa, komanso kugwiritsa ntchito β-blockers. Ikuwonjezera mwayi wa hypoglycemia munthawi yomweyo mankhwala ndi insulin.
4. Zotsatira zam'mimba. Chiwopsezo chokhala ndi lactic acidosis imawonjezeka ndi matenda a impso, motero ndikofunikira kuyang'anira creatinine. Izi ndizofunikira makamaka kwa odwala matenda ashuga okhwima, chifukwa kufooka kwaimpso kumatha kukhala kozizira.
5. Hypersensitivity. Ngati thupi limagwirizana ndi matupi ake osagwirizana, mankhwalawo amachotsedwa.
6. Kuthandizira opaleshoni. Ngati wodwala matenda ashuga akukonzekera, masiku awiri zisanachitike, Janumet adathetsedwa ndipo wodwalayo amamuika insulin.
7. Mankhwala okhala ndi ayodini. Ngati ayodini wokhazikitsidwa ndi ayodini atayambitsidwa ndi Yanumet, izi zimatha kuyambitsa matenda a impso.

Zotsatira za Yanumet pa amayi apakati zimangophunziridwa pa oimira nyama zanyama zokha. Mwa akazi apakati, zovuta za chitukuko cha fetal sizinalembedwe mutatenga metformin. Koma lingaliro loterolo silokwanira kupereka mankhwala kwa amayi apakati. Sinthani ku insulin pa gawo lokonzekera kukhala ndi pakati.

Metformin imadutsanso mkaka wa m'mawere, motero, Yanumet sinafotokozeredwe mkaka wa m'mawere.

Metformin siyimasokoneza magalimoto oyendetsa kapena njira zovuta, ndipo sinagliptin ikhoza kuyambitsa kufooka ndi kugona, chifukwa chake, Januvia sagwiritsidwe ntchito ngati kuchitapo kanthu mwachangu ndi chidwi chachikulu pamafunika.

Zotsatira za bongo

Kuti mupewe mankhwala owonjezera a metformin, simungathe kuwagwiritsa ntchito kuwonjezera pa Yanumet. Mankhwala osokoneza bongo ndi owopsa ndi lactic acidosis, makamaka ndi metformin yowonjezera. Zizindikiro za mankhwala osokoneza bongo zikawoneka, mankhwala othandizira amagwiritsidwa ntchito omwe amaletsa kumwa.

Chifukwa chiyani kupanga Metformin kukhala ndi Yanuvia, Galvus, Onglyza, Glybyuryd, ngati mutha kugwiritsa ntchito zida zomwezo munthawi yayitali? Kuyesa kwasayansi kwawonetsa kuti ndi mtundu uliwonse wamachitidwe owongolera matenda a shuga 2, Metformin ilipo (ngakhale atasinthira ku insulin). Komanso, mukamagwiritsa ntchito zinthu ziwiri zomwe zimagwira ntchito mosiyanasiyana, mphamvu ya mankhwalawa imawonjezeka ndipo mutha kuchita ndi mapiritsi ochepetsa.

Ndikofunika kuti muziwongolera mlingo wa metformin mu phukusi (500 mg, 850 mg kapena 1000 mg) popewa matenda owonjezera. Kwa odwala omwe amaiwala kumwa mapiritsi amtundu uliwonse pa nthawi, mwayi wotenga zonse zomwe amafunikira nthawi imodzi ndi mwayi wabwino womwe umakhudza kwambiri chitetezo ndi zotsatira za chithandizo.

Kuyanjana kwa mankhwala osokoneza bongo

Kuthekera kwa metformin kumachepetsedwa ndi diuretics, glucagon, corticosteroids, mahomoni a chithokomiro, phenothiazines, kulera kwapakamwa m'mapiritsi, phenytoin, nicotinic acid, sympathomimetics, calcium antagonists, isoniazid. Pazoyesa, mlingo umodzi wa nifedipine unachulukitsa kuyamwa kwa metformin mwa omwe ali ndiumoyo mu kafukufuku, nthawi yoti afike pamlingo wokulirapo ndipo theka la moyo lidakhalabe lomwelo.

Mphamvu za hypoglycemic zidzakulitsidwa ndi insulin, mankhwala a gulu la sulfonylurea, acarbose, MAO ndi ACE zoletsa, NSAIDs, oxytetracycline, clofibrate zotumphukira, cyclophosphamide, β-blockers. Kugwiritsa ntchito kamodzi kokha kwa furosemide mwa ochita nawo bwino poyeserera kudakulitsa mayamwidwe ndikugawa metformin ndi 22% ndi 15%, motero. Makhalidwe azitsitsimutso a impso sanasinthe kwambiri. Palibe chidziwitso chokwanira chothandizira kuphatikizira mankhwala ndi furosemide ndi metformin.

Mankhwala omwe amasungidwa m'matubules amalimbana ndi kayendedwe, kotero pogwiritsa ntchito nthawi yayitali amatha kuwonjezera kuchuluka kwa metformin ndi 60%.

Cimetidine linalake ndipo amalepheretsa kuchuluka kwa metformin, kuchuluka kwa mankhwala m'magazi kungapangitse acidosis.

Yanumet imagwirizananso ndi mowa, yomwe imapangitsanso mwayi wa acidosis.

Pophunzira momwe mankhwala a magulu ena amaphatikizira (metformin, simvastatin, glibenclamide, warfarin, rosiglitazone, njira zakulera), sinagliptin sanali wogwira ntchito makamaka. Kuchuluka kwa plasma kwa digoxin kumawonjezeka ndi 18% pamene amatengedwa chimodzimodzi ndi sitagliptin.

Kafukufuku wazotsatira za anthu 858 omwe adachita nawo nawo kafukufukuyo omwe adatenga mitundu 83 ya mitundu yothandizirana, 50% yomwe idachotsa impso, sinalembepo phindu lililonse pakuyamwa ndi kugawa kwa sitagliptin.

Analogi ndi mitengo

Yanumet ndi mankhwala okwera mtengo: pafupifupi, mtengo wopezeka m'magulu a anthu ogulitsa mankhwala amachokera ku ma ruble awiri ndi theka kupita ku ruble 3,000 pa mabokosi a 1-7 (mapiritsi 14 mu chithuza chimodzi). Amapanga mankhwala oyamba ku Spain, Switzerland, Netherlands, USA, Puerto Rico. Mwa analogues, Velmetia yekha ndiye woyenera kupanga. Kugwiritsa ntchito bwino komanso mtundu wa mankhwala a ATC ndizofanana:

• Douglimax;
• Glibomet;
• Tripride;
• Avandamet.

Glibomet imaphatikizapo metformin ndi glibenclamide, zomwe zimapereka mphamvu ya hypoglycemic ndi hypolipidemic.Zizindikiro zakugwiritsira ntchito ndizofanana ndi malingaliro a Yanumet. Douglimax imakhazikitsidwa ndi metformin ndi glimepiride. Makina owonetsera komanso mawonekedwe ali ofanana kwambiri ndi Yanumet. Tripride ili ndi glimepiride ndi pioglitazone, omwe ali ndi vuto la antiidiabetes komanso mawonekedwe ofananawo. Avandamet, yomwe ndi kuphatikiza kwa metformin + rosiglitazone, ilinso ndi katundu wa hypoglycemic.

Ngati Yanumet si yoyenera

Zomwe zimapangitsa kuti mankhwalawo akhale m'malo mwake ndi osiyana: ena, mankhwalawo sathandiza pamlingo woyenera, kwa ena amachititsa zotsatira zoyipa kapena sangathe kugula.

Ngati mankhwalawa sagwiririra ntchito bwino shuga, amaloŵedwa ndi jakisoni wa insulin. Mapiritsi ena pankhaniyi sagwira ntchito. Mwachidziwikire, kuchokera ku mankhwala othandizira okhudzidwa ndi mankhwala osokoneza bongo, kapamba adagwira ntchito, komanso mtundu wapamwamba kwambiri wa matenda ashuga 2 wadutsa mtundu woyamba wa shuga.

Ngakhale mapiritsi amakono kwambiri sangakhale othandiza ngati mutanyalanyaza malangizo a endocrinologist pa zakudya zotsika kwambiri za carb komanso katundu wolemera.

Zotsatira zoyipa nthawi zambiri zimakwiyitsidwa ndi metformin, sitagliptin pankhaniyi ndiyopanda vuto. Malinga ndi kuthekera kwazachipatala chake, Metformin ndi mankhwala apadera, musanayankhe m'malo mwake, ndikofunikira kuyesetsa kwambiri kuti musinthe. Matenda a Dyspeptic adzadutsa nthawi, ndipo metformin imapangitsa shuga kukhala yabwinobwino popanda kuwononga kapamba ndi impso. Zotsatira zoyipa zoyipa zimaperekedwa mwa kutenga Janumet asanadye kapena pambuyo chakudya, koma panthawi ya chakudya.

Kuti musunge ndalama, mutha kusintha Janumet kapena Januvia kokha ndi metformin yoyera. Pamaukonde azachipatala, ndibwino kuti musankhe malonda a Glyukofazh kapena Siofor m'malo mwa opanga zapakhomo.

Anthu odwala matenda ashuga ndi madokotala za Yanumet

Za mankhwala Janumet, ndemanga za madokotala ndizogwirizana. Madokotala ati: mwayi wofunikira wa zigawo zake (makamaka sitagliptin) ndikuti samayambitsa hypoglycemia. Mukapanda kuphwanya lamulo latsopanolo ndikutsatira malangizo pazakudya ndi maphunziro akuthupi, zikwangwani za mita zidzatsika kwambiri. Ngati pali zovuta mu epigastrium ndi zina zosayenera, ndikofunikira kugawa mlingo wa tsiku ndi tsiku mu 2 Mlingo wambiri kuti muchepetse nkhawa. Pambuyo pakuzolowera, mutha kubwereranso ku boma lapitalo, ngati shuga ndiwambiri kuposa zomwe mukufuna, kusintha kwa dokotala komwe kungachitike ndi dotolo ndikotheka.

About Yanumet, kuwunika kwa wodwala kumakhala kosokoneza, chifukwa matendawa amachitika mosiyanasiyana. Kwambiri, odwala okalamba amadandaula za zotsatira zoyipa, chifukwa impso, komanso thupi lonse, zimasokonezeka kale ndi matenda oyanjana.

Endocrinologists ali ndi mwambi wotchuka: "Masewera ndi zakudya - katemera motsutsana ndi matenda ashuga." Aliyense amene akufuna piritsi lozizwitsa, ndipo akukhulupirira motsimikiza kuti mapiritsi atsopano, chigamba china chotsatsira kapena tiyi wazitsamba azichiritsa matenda ashuga popanda kuyeserera kwambiri, ayenera kukumbukira nthawi zambiri.