Gluconorm: ntuziaka maka ojiji: ọnụahịa na nyocha nke ndị ọrịa mamịrị gbasara ọgwụ shuga

Ihe endocrinologist mere nchoputa - onodu oria odi ala. Ibu ibu na-etolite mgbe niile, nsogbu nke metabolic, nke ọma, ije shuga (ọrịa hypoglycemic syndrome). Na nkenke, ọchị. Mgbe ị mebiri nri, shuga na-apụta, nke ọma, mgbaàmà ndị ama ama na-apụta. Iji bido, iji belata agụụ, a na-enye m ọgwụ a na nri ehihie 1 otu ugboro kwa ụbọchị maka mbadamba 1, mana n'ụzọ ụfọdụ enweghị mmetụta ọfụma, ọlị. Agara m na dọkịta ọzọ, nke Siofor 850 nyere iwu ka m were ya n'onwe m. Mmetụta mmetụta a na-enwe n’ụbọchị mbụ oriri nnabata bịara dịrị mfe karị, n’uhuruchi achọrọ m iri obere. Mgbe ọgwụgwọ izu abụọ gasịrị, ịdị arọ belatara site na 1.5 n'arọ. Ee, obi na-adịkwa m mma.

Kemgbe otu afọ, achọpụtara m ụdị ọrịa shuga 2, mgbe nke a gasịrị, dọkịta nyere m iwu na m ga na-eri ezigbo nri na gluconorm. Anyị were otu onwa ihe dị ka otu ọnwa, mana ugbu a glucose adịghị elu karịa 6-7. Ọ bụ naanị ihe nwute na a ga-agbaso ihe oriri. Ọ bụ ezie na ahụike dị oke ọnụ karịa, n'ezie.

Nkọwapụta dị mkpirikpi

200 nde ... Ọ dị mma icheta ọnụ ọgụgụ a, n'ihi nke a bụ ọnụọgụgụ ọnụọgụgụ nke ndị na-arịa ọrịa shuga taa. Dịka amụma ndị sayensị si kwuo (ọ bụghịkwa ndị kachasị njọ), ka ọ na-erule 2030 mmụba nke ọnụ ọgụgụ a kwesiri ịtụ anya opekata mpe otu. Ihe abụọ na - akpata ọrịa na - edabere na mmalite nke ọrịa shuga: iguzogide insulin na enweghị nsogbu nke imepụta insulin ọgwụ endogenous. Iji belata ihe egwu nwere ike ibute ọrịa obi (isi, nkụchi obi na ọnya ụkwụ), i kwesiri idobe aka gị oge ọsịsọ (maọbụ, na mita) iji hụ na ị na-enyocha ọkwa glucose ọbara ọ bụla. N'akụkụ a, ịba ụba nke ọgwụgwọ bụ ụzọ dị mkpa n'ịgwọ ọrịa shuga. Dịka iwu, a na-amalite ọgwụgwọ antidiabetic na monotherapy, nke na-eji ma ọ bụ metformin ma ọ bụ sulfonylureas (glibenclamide glyclazide, glimepiride). N’ọdịnihu, na -ebibi nhụchaanya nke usoro mmiri ọgwụ, agwakọta ọgwụ iji mepụta ọgwụ insulin ma ọ bụ ejikọ insulin. Ọzọkwa: Ebe ọ bụ na a na-ahụta ọrịa shuga dị ka ọrịa na-aga n'ihu, ọbụlagodi na ihe ịga nke ọma nke monotherapy, n'oge na-adịghị anya, a ga-achọ mgbakwunye ọgwụ ọgwụ na otu ma ọ bụ abụọ usoro nhazi nke akwụkwọ akwụkwọ Mashkovsky.

Ngwakọta ọgwụ antidiabet na-ejikarị na omume ụlọ ọgwụ bụ metformin + glibenclamide. Ọgwụ gluconorm nke ọgwụ abụghị ihe ọzọ siri ike hypoglycemic ligament ligament abụọ. Metformin biguanide na-ebelata glucose ọbara site na iwetulata ọnụ ụzọ maka nnabata insulin n'ime akwara ma mekwaa ka ọmarịcha glucose site na anụ ahụ. Ihe a na - egbochi nnabata nke carbohydrates na nri diges ma na - egbochi njikọ glucose site na umeji. Metformin na-emekwa ka mkpụrụ ndụ ọbara dị mma, na -ebelata ọkwa cholesterol "ọjọọ". Glibenclamide, n'aka nke ya, bụ anụ ahụ nke anụ ume nke sulfonylurea. Ọ na-akpali ntọhapụ nke insulin site na ịbawanye ụba nke mkpụrụ ndụ reat-pancreatic ka glucose yana ogo ịdị nkọ nke insulin na mkpụrụ ndụ ndị chọrọ.

A na-ejikarị gluconorm maka nri na oke nke ekwenyere dọkịta (ọ nwere ike ịbụ otu onye n'ọnọdụ ọ bụla). Dika odi, ha "ebido" site na otu mbadamba ma mezie ogwu ahụ kwa izu 1-2, na-eburu n'uche ogo glucose n'ọbara, ebe ị gafere oke mbadamba mbadamba 5 kwa ụbọchị.

Ọgwụ Farmacology

Gluconorm ® bụ ngwongwo abụọ nke ọgwụ hypoglycemic nke otu ọgwụ dị iche iche: metformin na glibenclamide.

Metformin bụ otu nke biguanides ma belata ọbara ọgbụgba site na ịbawanyewanye uru anụ ahụ na-eme ka insulin dịkwuo elu ma mee ka mgbakwunye glucose dị elu. Na-ebelata nnabata nke carbohydrates na nri diges ma na-egbochi gluconeogenesis na imeju. Ọgwụ ahụ nwekwara mmetụta bara uru na profaịlụ nke ọbara, na-ebelata ogo nke cholesterol dị ala. LDL na triglycerides. Emeghị mmeghachi omume hypoglycemic.

Glibenclamide bụ otu nke usoro nke sulfonylurea nke ọgbọ nke abụọ. Ọ na - eme ka mmiri ọgwụ insulin dị ala site na iwetulata ọnụego glucose nke reat-cell na - eme ka ọ dịkwuo ala, na - emewanyewanye insulin na ya na - ejikọ ya na mkpụrụ ndụ, na - eme ka mwepụta insulin dịkwuo mma, na - eme ka mmetụta nke insulin nwee ike na akwara umeji na - egbochi lipolysis na adipose anụ ahụ. Ọrụ nke abụọ nke insulin insulin.

Mlọ ọgwụ

Mgbe ejiri hazie, nnabata si eriri afọ bụ 48-84%. Oge iru C_max - 1-2 awa V_d - 9-10 lita. Nkwukọrịta na protein protein bụ 95%.

Ọ fọrọ nke nta ka ọ bụrụ metabolized n'ime imeju ya na imepụta metabolites abụọ na-adịghị arụ ọrụ, otu n'ime ya bụ akụrụ ya na nke ọzọ na eriri afọ. Ndi_1/2 - site na 3 ruo 10-16 awa

Mgbe nchịkwa ọnụ gasịrị, ọ na-ewepu site na eriri afọ zuru ezu, 20-30% nke ọgwụ ahụ ka a na-ahụ oria. Ezigbo bioavailability sitere na 50 ruo 60%. Site na ntinye oge, a ga-ebelata nnabata nke metformin na egbu oge. A na-ekesa ya ngwa ngwa na anụ ahụ, ihe fọrọ nke nta ka ọ bụrụ na ọ nweghị ihe nchebe protein.

Ọ bụ metadolized ruo obere adịghị ike ma kpụrụ ya akụrụ. Ndi_1/2 odika awa 9-12

Mpempe mwepụta

Mpempe akwụkwọ mkpuchi na-acha ọcha ma ọ bụ ihe fọrọ nke nta ka ọ bụrụ nke na-acha ọcha na agba, gburugburu, biconvex, na nkwụsị site na ọcha ruo na-acha ọcha na-eji isi awọ.

Ndị ọkachamara: microcrystalline cellulose - 100 mg, ọka ọka - 20 mg, colloidal silicon dioxide - 20 mg, gelatin - 10 mg, glycerol - 10 mg, magnesium stearate - 7 mg, talc nke dị ọcha - 15 mg, croscarmellose sodium - 30 mg, steepụ sodium carboxymethyl - 18.3 mg, cellularphate - 2 mg, diethyl phthalate - 0.2 mg.

10 PC - blisters (4) - ngwugwu nke kaadiboodu.
20 nkp. - blisters (2) - ngwugwu nke kaadiboodu.

A na-eji ọgwụ eme ọnụ, ya na nri. Ọ bụ dọkịta ga-ekpebi ọ̀tụ̀tụ̀ ọgwụ ahụ n’otu n’otu n’otu n’arụrụ onye ọrịa ọ bụla, dabere n’ogologo glucose ọbara.

Otutu ogwu mbu bu 1 tab. (400 mg / 2.5 mg) / ụbọchị. Kwa izu 1-2 mgbe ịmalite ọgwụgwọ, a na-edozi ọ̀gwụ nke ọgwụ ahụ dabere na ọkwa glucose ọbara. Mgbe ị na-eji metformin na glybeklamide dochie usoro ọgwụgwọ agakọ gara aga, a na-enye mbadamba 1-2. Gluconorm dabere na usoro izizi nke akụkụ ọ bụla.

Oke kachasị kwa ụbọchị bụ mbadamba ise.

Dodoụbiga ya ókè

Dodoụbiga ihe ókè ma ọ bụ ọnụnọ nke ihe ndị dị ize ndụ nwere ike ịkpalite mmepe nke lactic acidosis, dị ka Metforminum bụ akụkụ nke nkwadebe. Mgbe ihe mgbaàmà nke lactic acidosis pụtara (vomiting, mgbu nke afọ, adịghị ike n'ozuzu, nkwonkwo akwara), ị ga-akwụsị ị .ụ ọgwụ ahụ. Lactic acidosis bụ ọnọdụ chọrọ nlekọta ahụike mberede, ọgwụgwọ nke lactic acidosis kwesịrị ịrụ n'ụlọ ọgwụ. Ọgwụ kachasị dị irè bụ ịba ọcha n'anya.

Do overụbiga mmanya ókè nwekwara ike ibute mmepe nke hypoglycemia n'ihi ọnụnọ nke glibenclamide na nkwadebe. Mgbaàmà nke hypoglycemia: agụụ, ọsụsọ gabiga ókè, adịghị ike, palpitations, pallor nke anụ ahụ, paresthesia nke mucosa ọnụ, ịma jijiji, nchekasị n'ozuzu oke, isi ọwụwa, iro ụra, nchekasị nke ụra, echiche nke egwu, njikwa nkwonkwo nke mmegharị, nsogbu akwara na-adịru nwa oge. N'iburu n'ọbara nke hypoglycemia, ndị ọrịa nwere ike ịkwụsị njide onwe onye na ọgụgụ isi.

Site na hypoglycemia dị nro ma ọ bụ nke na-adịghị ala ala, a na-ewere ọnụ na edere dextrose (glucose) ma ọ bụ mmiri shuga. N'ọnọdụ oke hypoglycemia (mwepu nke mmụọ), a na-edozi 40% dextrose (glucose) ma ọ bụ glucagon intravenous, v / m, s / c bụ iv. Mgbe ọ nwetasịrị onwe ya, a ga-enyerịrị onye ọrịa ahụ nri nwere carbohydrates iji zere ịmaliteghachi hypoglycemia.

Mmekorita

Ndị na - egbochi ACE (captopril, enalapril), ndị na - egbochi histamine H na - akwalite mmetụta hypoglycemic nke ọgwụ₂ndị na-anabata ọgwụ (cimetidine), ndị na-egbochi antifungal (miconazole, fluconazole), NSAIDs (phenylbutazone, azapropazone, oxyphenbutazone), fibrates (clofibrate, bezafibrat), ọgwụ mgbochi ụkwara nta (ethionamide), salicytates, anticoagulant antagon, MAO, sulfonamides na-arụ ọrụ ogologo oge, cyclophosphamide, chloramphenicol, fenfluramine, fluoxetine, guanethidine, pentoxifylline, tetracycline, theophylline, ihe na-egbochi ihe nzuzo, reserpine, bromocriptine, na-enupụ isi, pyridoxine, ndị ọzọ ọgwụ hypoglycemic (acarbose, biguanides, insulin), allopurinol.

Barbiturates, corticosteroids, adrenostimulants (epinephrine, clonidine), ọgwụ antiepileptik (phenytoin), ndị na-egbochi calcium Channel, ndị na-egbochi carbonic anhydrase inhibitors (acetazolamide), thiazide diuretics, chlortalidone, furosemide, diazanazide, triazene diazent , morphine, ritodrine, salbutamol, terbutaline, glucagon, rifampicin, homonụ nke ayodiin nwere mmiri ọgwụ, lithium salts, na oke onunu ogwu - nicotinic acid, chlorpromazine, mgbochi ogwu na nje.

Ọgwụ ure acidifying (ammonium chloride, calcium chloride, ascorbic acid na nnukwu doses) welie mmetụta ahụ site n’ibelata ogo nke dissociation na ịba ụba reabsorption nke glibenclamide.

Ethanol na - eme ka o nwee ohere nke lactic acidosis.

Metformin na-ebelata C_max na T_1/2 furosemide site na 31% na 42.3%, otu isi.

Furosemide na-abawanye C_max metformin site na 22%.

Nifedipine na-abawanye mmịpụta, C_max na-eji nwayọ kpochapu metformin.

Ọgwụ cationic (amiloride, digoxin, morphine, procainamide, quinidine, quinine, ranitidine, triamteren na vancomycin) zoro ezo na tubules na-asọrịta mpi maka sistemụ tubular ma nwee ike ịbawanye C na ọgwụgwọ ogologo oge._max 60% metformin.

Nsonaazụ

N'aka nke metabolism metabolism: hypoglycemia ga-ekwe omume.

Site na eriri afọ na imeju: adịkarịghị - ọgbụgbọ, ọgbụgbọ, mgbu nke afọ, enweghị agụụ, ụtọ "ọnụ" n'ọnụ, n'ụfọdụ ihe - cholestatic jaundice, ụba ọrụ nke enzymes imeju, ịba ọcha n'anya.

Site na sistemu hemopoietic: adịkarịghị - leukopenia, thrombocytopenia, erythrocytopenia, nke ukwuu - agranulocytosis, hemolytic ma ọ bụ megaloblastic anaemia, pancytopenia.

Site n'akụkụ nke sistemụ etiti: isi ọwụwa, dizziness, adịghị ike, ike ọgwụgwụ, adịkarịghị - paresis, nsogbu uche.

Allergic na immunopathological mmeghachi omume: adịkarịghị - urticaria, erythema, akpụkpọ itching, fever, arthralgia, proteinuria.

Mmeghachi omume udiri oria: na adighi ike - photoensitivity.

Site n'akụkụ nke metabolism: lactic acidosis.

Ndị ọzọ: mmeghachi omume dị ukwuu nke mmanya na-egbu egbu mgbe mmanya gasịrị, gosipụtara site na nsogbu nke akụkụ ahụ na akụkụ iku ume (disulfiram-like mmeghachi omume: vomiting, sensations nke okpomọkụ na ihu na elu ahu, tachycardia, dizzness, isi ọwụwa).

Diabetesdị shuga 2 n'ime ndị okenye:

• na enweghi ike nke usoro ọgwụgwọ nri, mmega ahụ na usoro ọgwụgwọ gara aga na metformin ma ọ bụ glibenclamide,
• iji dochie ọgwụ gara aga na ọgwụ abụọ (metformin na glibenclamide) na ndị ọrịa nwere ọkwa glucose ọbara dị mma ma na-achịkwa nke ọma.

Ihe ngbanwe

• ụdị shuga 1
• ọrịa mamịrị ketoacidosis, precca mamịrị, mamịrị shuga,
• hypoglycemia,
• oke nrụrụ akụrụ
• ọnọdụ ọjọọ nke nwere ike ibute mgbanwe mgbanwe ọrụ akụrụ (akpịrị ịkpọ nkụ, ọrịa na-efe efe, ujo),
• nnukwu ọrịa ma ọ bụ nke na-adịghị ala ala nke gụnyere hypoxia anụ ahụ (obi ma ọ bụ akụkụ okuku ume, ọdịda nke myocardial infarction, ujo),
• imeju imeju
• porfria
• ojiji nke miconazole,
• ọrịa na-efe efe, nnukwu ịwa ahụ, mmerụ ahụ, oke ọkụ na ọnọdụ ndị ọzọ chọrọ ọgwụgwọ insulin.
• egbu egbu egbu, ị intoụbiga mmanya ókè
• lactic acidosis (gụnyere akụkọ ihe mere eme),
• jiri ma ọ dịkarịa ala awa 48 tupu na n'ime awa 48 mgbe ị mụsịrị redioisotope ma ọ bụ x-ray na ntinye nke ayodiin nwere ọdịiche,
• rube isi na obere kalori (na-erughị calorie 1000 / ụbọchị),
• tụụrụ ime
• oge inye ara,
• hypersensitivity na metformin, glibenclamide ma ọ bụ ihe ndị ọzọ na-eme ka sulfonylurea, yana ihe inyeaka.

A naghị atụ aro ka iji ọgwụ ahụ mee ihe na ndị mmadụ karịa afọ 60 bụ ndị na-arụ ọrụ anụ ahụ dị arọ, nke ejikọtara ya na oke ihe ize ndụ nke ịmalite ọrịa lactic acidosis n'ime ha.

N'iji nlezianya anya: ọrịa febrile, adrenal insulence, hypofunction nke isi isi, ọrịa thyroid na arụ ọrụ.

Ime na lactation

N’ime ime, eji gluconorm emee ya. Mgbe ị na-eme atụmatụ ịtụrụ ime, yana n’ihe gbasara afọ ime n’oge iji Gluconorm, ọgwụ a ga-akwụsị ịhapụ ị shouldụ ọgwụ insulin.

A na-egbochi afọ ojuju n'ime mmiri ara, n'ihi na metformin na-abanye n'ime mmiri ara. N'okwu a, ị ga-agbanwere ọgwụ insulin ma ọ bụ kwụsị inye ara.

Ntụziaka pụrụ iche

Nnukwu ịwa ahụ na mmerụ ahụ, oke ọkụ, ọrịa na-efe efe na ọrịa febrile nwere ike ịchọ ịkwụsị ọgwụ yana ịhọpụta ọgwụ insulin.

Ọ dị mkpa ịdị na-enyocha ọkwa glucose oge niile n'ọbara na afọ efu na mgbe ị risịrị nri.

E kwesịrị ịdọ ndị ọrịa ọdụ gbasara ịba ụba hypoglycemia n'ọnọdụ ethanol, NSAIDs, na agụụ.

Imeghari otu ọ̀ dị mkpa maka ịghara oke nri anụ ahụ na nke mmetụta uche, mgbanwe nri.

N'oge ọgwụgwọ, a naghị atụ aro ị takeụ mmanya.

Oge 48 tupu a waa ya ahụ ma ọ bụ nchịkwa nke ihe na-enwe rediopaque nke nwere ayodiin, ekwesịrị ịkwụsị nchịkwa gluconorm. A na-atụ aro ịmalite ọgwụgwọ glconorm mgbe awa 48 gachara.

Mmetụta ikike ịkwọ ụgbọ ala na usoro nchịkwa

N'oge ọgwụgwọ, a ga-akpachara anya mgbe ị na-anya ụgbọ ala ma na-eme ihe ndị ọzọ nwere ike ịdị ize ndụ chọrọ mmụba nlebara anya na ọsọ nke mmeghachi omume psychomotor.