Aliyense wokhala m'dziko lapansi (komanso madera ena a China - sekondi iliyonse) amadwala kapena ali pachiwopsezo chotenga matenda a shuga. Zomwe zimayambitsa kufera (myocardial infarction ndi oncology) nthawi zambiri zimakhala za shuga, kaya ndizodziwikiratu kapena zosasinthika.
Pofuna kuthana ndi mliri wa zaka za zana lino la 200, mitundu mazana ambiri amankhwala apangidwa - onse azikhalidwe, okhala ndi umboni wokwanira, komanso opangidwa mwaluso, ofunikira chitsimikiziro chogwira ntchito. Chimodzi mwa mankhwala otchuka a antiidiabetes ndi a Glucovans a kampani yaku Austria Nycomed Austria GmbH.
Zotsatira za mankhwala
Zomwe zimapangidwira wophatikizira wa hypoglycemic zimaphatikizapo ziwiri zomwe zimagwira: Metformin ndi Glibenclamide. Chiwerengero chawo mwa makapisozi zimasiyanasiyana:
| Mlingo mg | glibenclamide, mg | metformin mg |
| 2,5 /500 | 2,5 | 500 |
| 5/500 | 5 | 500 |
Mankhwala, mumapezekanso zotupa: croscarmellose sodium, magnesium stearate, cellulose, povidone K 30.
Mankhwalawa amasulidwa ngati mapiritsi. Chipolopolo cha kapisozi chimatha kukhala chachikasu kapena lalanje. Mu mtundu woyamba, nambala ya "5" yalembedwa mbali yakutsogolo, lachiwiri - "2,5".
Zotsatira za pharmacological
Metformin ndi woimira gulu la ma biagudins. Cholinga chake chachikulu ndikuchepetsa kuchuluka kwa shuga a basal ndi postprandial m'magazi. Thupi silimbikitsa kupangika kwa amkati a insulin, chifukwa chake sikuti limayambitsa hypoglycemia. Njira zikuluzikulu zake:
- Kuchepetsa kapangidwe ka glycogen mu chiwindi poletsa njira za gluconeogeneis;
- Kuthetsa "khungu" la zotumphukira mahomoni zolandilira;
- Kuchuluka kwa kudya ndi kugwiritsa ntchito shuga m'maselo;
- Kuletsa kwa shuga.
Metformin imakhudzanso kagayidwe ka lipid: kuchuluka kwa triglycerol ndi "koyipa" cholesterol kumachepetsedwa kwambiri.
Glibenclamide ndi woimira gulu lachiwiri la mankhwala a sulfonylurea. Pulogalamuyo imathandizira kuti glycemia ikhale yachilendo chifukwa cha kukondoweza kwa maselo a β-cell omwe amapanga insulin.
Kupanga kwamachitidwe a zigawo za formula ndikosiyana, koma amakwanitsa kuthana ndi vuto la aliyense, ndikupanga mgwirizano. Pogwiritsa ntchito mosiyanasiyana, Mlingo wa mankhwala aliwonse pazotsatira zofananazo udzakhala wokwera kwambiri.
Mphamvu ya Pharmacokinetic
Glibenclamide ikamakulowetsa m'mimba m'matumbo imalowetsedwa ndi 95%. Monga gawo la mankhwala Glucovans® imapangidwa micron. Kuchuluka kwa ndende m'magazi kumatha maola 4, kuchuluka kwa magawo athunthu mpaka 10 malita. Glibenclamide imamangiriza mapuloteni ndi 99%. Kagayidwe kachakudya zimachitika m'chiwindi, komwe amasinthidwa kukhala ma inert metabolites awiri. Amatuluka m'thupi kudzera mu impso (mpaka 40%) komanso kudzera munjira ya biliary (mpaka 60%). Njira ya theka-moyo imachokera ku maola 4-11.
Pakaperekedwa pakamwa, metformin imalowetsedwa kwathunthu, chinthucho chimafika m'magazi awiri ndi theka. Popanda kusintha kwakukulu, 20-30% ya chinthucho imapukusa matumbo. The bioavailability wa metformin ndi 50-60%. Mu minofu, mankhwalawa amafalikira nthawi yomweyo ndipo samamangirira mapuloteni amwazi konse. Katunduyu samakhala pafupi kugwiritsidwa ntchito ndi kagayidwe, ambiri a iwo amatsitsidwa ndi impso. Hafu ya moyo imatenga pafupifupi maola 6 ndi theka.
Mu matenda a impso a impso, kuvomerezeka kwa creatinine kumachepetsedwa. T1 / 2 ndi chiwalo chomwe mukufuna sichichedwa, mankhwalawo amadziunjikira m'magazi. Glucovans bioavailability ndi ofanana ndi amitundu iliyonse. Kudya sikukhudza gawo ili, koma kuchuluka kwa mayeso a glibenclamide motsatana ndi chakudya kumakhala kwakukulu.
Ndani akuwonetsedwa mankhwalawo
Ovuta amapangidwira kuchiza matenda amtundu wa 2 shuga. Zimasankhidwa ngati kusintha kwamakhalidwe ndi chithandizo cham'mbuyomu ndi metformin kapena mankhwala ena osagwiritsa ntchito zotsatira zomwe zikuyembekezeka.
Mankhwala amalimbikitsidwa kwa odwala matenda ashuga omwe ali ndi shuga yokwanira kubwezeretsanso njira yapitayo yoyambira ndi mankhwala awiri osiyana - Metformin ndi oyimira gulu la sulfonylurea.
Momwe mungagwiritsire ntchito
Kutengera ndi mankhwalawa omwe amachitika chifukwa cha matenda ena a matenda ashuga, endocrinologist imakonzekera chiwembu. Pazomwe wopanga akupanga, miyezo yokhayo ya dozi yoyambira imasonyezedwa: kapisozi imodzi yamtundu uliwonse wa Glucovans.
Ngati mulingo wosankhidwa sakulipirira mokwanira glycemia munthawi ya kusintha kwa moyo, mutha kusintha, koma osapitilira sabata ziwiri, 5 mg ya glibenclamide + 500 mg ya metformin tsiku lililonse.
Posintha chithandizo chamankhwala cham'mbuyomu ndi a Glucovans, mlingo woyambira uyenera kukhala wofanana ndi zochitika za tsiku ndi tsiku za glibenclamide kapena mankhwala ofananawo kuchokera ku gulu la sulfonylurea, komanso metformin, yomwe idafotokozedwera pamankhwala apitawa.
Malinga ndi kuwerenga kwa glucometer pambuyo pa masabata awiri, mutha kusintha kuchuluka kwa glucovans.
Mapiritsi ambiri omwe angafotokozedwe kwa odwala matenda ashuga ndi zidutswa 4 pamiyeso ya 5 mg / 500 mg kapena 6 zidutswa za Glucovans ®, zosungika mu 2.5 mg / 500 mg.
Njira yogwiritsira ntchito zimatengera chiwembu chomwe adokotala adasankha. Kwa mapiritsi a 2,5 mg / 500 mg ndi 5 mg / 500 mg pali malingaliro oyenera.
- Ngati piritsi limodzi / tsiku lakhazikitsidwa, limamwa m'mawa ndi chakudya;
- Ngati chizolowezi cha tsiku lililonse chimakhala mapiritsi awiri kapena anayi, zimagawidwa m'mawa ndi madzulo, kukhalabe nthawi yomweyo;
- Ngati ndi kotheka, tengani mapiritsi a 3.5 kapena 6 / tsiku. pa mlingo wa 2,5 mg / 500 mg, amamwa ndi chakudya cham'mawa, nthawi ya nkhomaliro komanso chakudya chamadzulo;
- Pa mlingo wa 5 mg / 500 mg, mapiritsi atatu / tsiku ndi omwe amapatsidwa. ndikugawa m'magawo atatu: kadzutsa, nkhomaliro komanso chakudya chamadzulo.
Ndikofunikira kwambiri kulanda mapiritsi ndi chakudya chokwanira. Kutenga Glucovans pamimba yopanda kanthu kumayambitsa hypoglycemia.
Kwa odwala matenda ashuga okalamba, akamalemba mankhwala a algorithm, amayang'ana kwambiri pa magwiridwe antchito a impso.
Mlingo woyambira mulimonsemo mulibe piritsi limodzi la 2,5 mg / 500 mg. Pankhaniyi, momwe impso ziyenera kuyang'aniridwa mosalekeza.
Palibe zambiri zodalirika za Glucovans® pa ana, kugwira ntchito kwake ndi chitetezo chake, chifukwa chake, kugwiritsa ntchito sikulimbikitsidwa kwa ana.
Zolemba za Glucovans chithandizo
Mukamagwiritsa ntchito mankhwalawa, ndikofunikira kuyang'ana shuga wanu pamimba yopanda kanthu, komanso maola awiri mutatha kudya. Mwanjira yabwino, ndikofunikira kujambula kuwerenga kwa glucometer mu diary 5 r. / Day.
Lactic acidosis
Vutoli ndi losowa, koma lalikulu kwambiri kotero kuti aliyense wodwala matenda ashuga ayenera kudziwa za izi. Popanda chithandizo chamankhwala chofulumira, wozunzidwayo akhoza kufa. Mkhalidwe wowopsa umayamba kuphatikizika ndi metformin. Kusazindikira mosavomerezeka komweko kumalumikizidwa ndi kulephera kwa impso, motero, ndi pyelonephritis ndi zina komanso zovuta pachimake aimpso, mankhwalawa ayenera kumwedwa mosamala.
Zina zomwe zimayambitsa ngozi zimaphatikizira kuwongolera matenda a shuga a 2, ketosis, kusala kudya kwakutali kapena kuperewera kwa zakudya m'thupi, kuledzera, komanso kusokonezeka kwa chiwindi.
Kuopsa kwa lactic acidosis kumawonjezeka ndi kukokana kwa minofu, kukanika kwa dyspeptic, kupweteka m'dera la epigastric, kufooka kwakukulu.
Pamafunika kuchipatala mwachangu, kufupika kwa acidotic, kuchepa kwa oksijeni, hypothermia, chikomokere.
Hypoglycemia
Glibenclamide ilipo mu formula ya Glucovans ®, zomwe zikutanthauza kuti mwayi wa hypoglycemia mukamagwiritsa ntchito mapiritsi sungathetsedwe. Chidwi chosinthika chingathandizike kupewa kusintha kwadzidzidzi m'magazi a plasma. Ndikofunika kudziwitsa wodwalayo za zakudya zazakanthawi, chifukwa chakudya cham'mawa kapena chakudya cham'mawa chochepa kwambiri popanda chakudya, chakudya chamadzulo chosakonzekera chimatha kudzetsa hypoglycemia. Ndi katundu wowonjezereka wa minofu (masewera olimbitsa thupi, zolimbitsa thupi zolimbitsa thupi), mutatha phwando lochulukirapo, zakudya za hypocaloric kapena kugwiritsa ntchito mankhwala osokoneza bongo, mwayi wa hypoglycemia ndiwokwera kwambiri.
Kusintha kwatsankho komwe izi zimayambitsa kumawonetsedwa mu thukuta lakuchulukirachulukira, mantha, kuchuluka thukuta, kusokonezeka kwa mtima, matenda oopsa, matenda a mtima.
Ngati hypoglycemia imakula pang'onopang'ono, matenda a mtima samakhazikika nthawi zonse, makamaka ndi neuropathy kapena chithandizo chofanana ndi β-blockers, reserpine, clonidine, guanethidine.
Zizindikiro zina za hypoglycemia zimaphatikizapo:
- Chilango chosalamulirika;
- Mutu;
- Kubweza;
- Kutha;
- Kusagona bwino;
- Mantha;
- Kukonda
- Zosokoneza;
- Kuletsa;
- Zowonongeka;
- Mavuto olankhula;
- Kutentha;
- Kuwonongeka kwa mgwirizano;
- Kupukuta
- Mtima wosakwiya;
- Kukhumudwitsa.
Kusankha mosamala mankhwala, kuwerengetsa mulingo woyenera, komanso kudziwitsa odwala zotsatira zake ndizofunikira kwambiri kupewa. Ngati munthu wodwala matenda ashuga kale ali ndi vuto la hypoglycemia, ndikofunikira kubwereza njira yochiritsira.
Matenda a chiwindi ndi impso
The pharmacodynamic ndi pharmacokinetic machitidwe a anthu odwala matenda ashuga omwe ali ndi vuto la impso ndi chiwindi amasintha kwambiri. Hypoglycemia matenda opatsirana amakhala nthawi yayitali ndipo amafunikira chithandizo chokwanira.
Glycemia wosakhazikika
Ngati ndi kotheka, chithandizo chosasamala kapena chifukwa china chomwe chimayambitsa kuwonongeka kwa matenda ashuga, wodwalayo amasamutsidwa kwakanthawi ndi insulin. Zizindikiro za hyperglycemia zimatha kukodza pafupipafupi, ludzu losatha, kugona, kufooka, khungu lowuma lam'munsi chifukwa chakuyenda bwino kwa magazi. Masiku awiri asanayambe opareshoni kapena jakisoni wa sing'anga yothandizira kuti x-ray ilowe, Glucovans ® yathetsedwa, chithandizo chimayambitsidwanso pasanathe masiku awiri pambuyo pa opareshoni ndi njira zoyeserera zokwanira impso.
Mavuto a impso
Impso zimagwira nawo ntchito yochotsa metformin, motero, isanayambike maphunzirowa komanso mwadongosolo mukamagwiritsa ntchito mankhwalawa, kuyimitsidwa kwa creatinine kuyenera kuwunikiridwa. Anthu odwala matenda ashuga okhala ndi impso zathanzi amayenera kuyesedwa osachepera 1 r./year, anthu okalamba, komanso odwala omwe ali ndi chilolezo cha creatinine pamwambapa mwachizolowezi - 2-4 r./year.
Kuchepetsa kwamkati kumawonedwa mu odwala oopsa omwe amatenga diuretics ndi NSAIDs, kotero gulu ili la odwala matenda ashuga liyenera kuperekedwa mwachidwi.
Njira zina
Wodwala matenda am'mapapo kapena matenda a genitourinary dongosolo la matenda opatsirana, odwala matenda ashuga ayenera kuuza endocrinologist wawo za zovuta.
Zotsatira zoyipa
Pafupipafupi pazotsatira zosagwiritsidwa ntchito bwino ndi Glucovans zimawerengeredwa malinga ndi kuchuluka kwapadera kwa WHO:
- Nthawi zambiri: ≥ 0.1;
- Nthawi zambiri: ≥ 0.01, <0.1;
- Nthawi zambiri: ≥ 0.001, <0.01;
- Pafupipafupi: ≥ 0.0001, <0.001;
- Zosowa kwambiri: <0.0001.
Milandu yakutali siyikayesedwa ndi izi.
| Mbali iti ya kusintha | Mitundu ya Kuphwanya | Pafupipafupi |
| Njira zachikhalidwe | Hypoglycemia; Ral komanso khungu porphyria; Lactic acidosis Kuchepetsa kwamphamvu kwa vitamini B12 | osowa kawirikawiri |
| Kafukufuku wa Laborator | Kukula kwa urea ndi creatinine mu plasma; Hyponatremia | Zosowa kwambiri |
| Kutuluka kwa magazi | Leukopenia ndi thrombocytopenia; Hemolytic anemia, pancytopenia, agranulocytosis, aplasia | osowa kwambiri |
| CNS | kusintha kwa kukoma | nthawi zambiri |
| Masomphenya | utachepa mawonekedwe chifukwa cha hypoglycemia | kumayambiriro kwa maphunzirowa |
| Matumbo | mavuto a dyspeptic, kupweteka kwa epigastric zone, kusowa chilimbikitso | kumayambiriro kwa maphunzirowa |
| Chikopa | Kuyabwa, urticaria, maculopapular totupa; Vasculitis, dermatitis, erythema | sikawirikawiri kawirikawiri |
| Chitetezo chokwanira | anaphylactic mantha | kawirikawiri |
Nthawi zina matenda a chiwindi ndi hepatic pathologies amakula, amafunika chithandizo chapadera komanso kuthetsedwa kwa Glucovans.
Zotsatira Zogwiritsa Ntchito Mankhwala
Wodwala matenda ashuga amakakamizidwa kuti auze adokotala za mankhwala onse omwe atengedwe kuti athe kulingalira zomwe angathe kuchita akamagwiritsa ntchito algorithm komanso munthawi yake.
- Wolemba: Minazole yokhala ndi glibenclamide (yambitsa hypoglycemia), metformin ndi mankhwala okhala ndi ayodini (Glucovans adachotsedwa patatha maola 48).
Njira zomwe zingalimbikitsidwe: mankhwala osokoneza bongo a sulfonylurea ndi mowa (zoopsa za matenda ashuga), phenylbutazone yokhala ndi glibenclamide (imathandizanso kudziwa kuchuluka kwa mankhwala), bosentan ndi glibenclamide.
- Kuphatikiza ndi Glucovans ogwiritsidwa ntchito mosamala: Chlorpromazine (amalepheretsa insulin katulutsidwe), glucocorticosteroids (ketosis), danazol (hyperglycemia), diuretics (hyperglycemia, lactic acidosis), ACE inhibitors (hypoglycemia).
Zizindikiro za bongo ndi contraindication
Mankhwala osokoneza bongo ndi owopsa ndi hypoglycemia yamitundu yosiyanasiyana. Ndi mawonekedwe ofatsa, zizindikirazi zimathanso kuchotsedwa ndi shuga, ndipo kumakhala kofunikira kwambiri kutsegula zipatala, popeza kuopsa kwa lactic acidosis ndi chikomokere, makamaka ndi hypoglycemia wa nthawi yayitali. Ndi dokotala, muyenera kusintha mlingo ndi kugwirizanitsa zakudya.
Zoyipa:
- Hypersensitivity pazofunikira zosakaniza ndi zotuluka;
- Mtundu woyamba wa shuga;
- Ketoacidosis, chikomokere ndi mkhalidwe wake wam'mbuyo;
- Ntchito zapakhungu (chilolezo cha creatinine - mpaka 60 ml / min);
- Zinthu zomwe zimadzetsa matenda, mantha, kusowa kwamadzi;
- Pathologies omwe amayambitsa minofu hypoxia;
- Matenda a mtima ndi kupuma;
- Kukanika kwa hepatatic;
- Mimba komanso yoyamwitsa
- Chithandizo chachikulu cha opaleshoni;
- Kugwiritsa ntchito miconazole munthawi yomweyo;
- Uchidakwa;
- Lactic acidosis (mbiri);
- Kuperewera kwa thupi m'thupi
Mtengo ndi malo osungira
Mapiritsi amayikidwa m'matumba. Bokosi lililonse - 2 mbale. Kalata "M" yakhazikika pa ma CD - chitetezo ku mabodza. Gulitsani mankhwala omwe mumalandira.
Ku Glucovans, mtengo wamtengo muma pharmace amatengera dera, mtundu wa ma pharmacies ndi kipimo. Pafupipafupi, phukusi la 2.5 mg / 500 mg lingagulidwe kwa ma ruble 220., 5 mg / 500 mg - kwa ma ruble a 320.
Sungani mankhwalawo mchipinda popanda ana. Moyo wa alumali ndi zaka zitatu.
Glucovans: malingaliro a madokotala ndi ogwiritsa ntchito
About Glucovans, ndemanga za anthu odwala matenda ashuga amasakanikirana. Anthu azaka zakubadwa amalankhula za kugwiritsa ntchito mosavuta: musakumbukire kuti ndamwa chiyani piritsi lomwe ndidayiwala. Kwa ena, mankhwalawa asinthana bwino ndi insulin, chifukwa palibe amene amakonda jakisoni. Ena amadandaula za chizungulire, kupweteka kwam'mimba, kusowa kudya kosalekeza.
Madotolo mu ndemanga amati zovuta zoyambira koyamba kwa chithandizo chamankhwala ndi Glucovans ndizabwinobwino. Popita nthawi, thupi limasinthasintha. Simuyenera kuopa insulini, nthawi zina imakhala yokakamiza kwakanthawi. Mulimonsemo, kusankha kwa mankhwala nthawi zonse kumakhala kwa dokotala. Ambiri amazindikira kupezeka kwa mankhwalawo, ngakhale kuti ndi koyenera.
