Amaril M: ntuziaka maka ojiji na ihe mejupụtara ọgwụ ahụ

Nkọwa nke ụdị usoro onunu ogwu

Mbadamba mbadamba 1 + 250: oval, biconvex, kpuchie ya n'ọbọ ihe nkiri na-acha ọcha, nke etinyere ya na "HD125" n'otu akụkụ.

Mbadamba mbadamba 2 + 500: oval, biconvex, kpuchie ya n'ọbọ ihe nkiri na-acha ọcha, nke a kanyere na "HD25" n'otu akụkụ ma ọfụma n'akụkụ nke ọzọ.

Mlọ ọgwụ

Amaryl ® M bụ ọgwụ ejikọtara hypoglycemic, nke gụnyere glimepiride na metformin.

Glimepiride, otu n'ime ihe ndị na-arụ ọrụ nke Amaril ® M, bụ ọgwụ hypoglycemic maka nchịkwa ọnụ, usoro nke atọ nke atọ atọ.

Glimepiride na-akpali secretion na ntọhapụ nke insulin site na mkpụrụ ndụ beta pancreatic (pacreatic utịp), na-eme ka amamịghe anụ ahụ (akwara na abụba) rụọ ọrụ insulin endogenous (mmetụta extrapancreatic).

Mmetụta insulin insulin

Ngwakọta nke sulfonylureas na-eme ka mmiri ọgwụ insulin na-aba ụba site na imechi ọwa mmiri ọgwụ ATP na-adabere na mkpụrụ ndụ cytoplasmic nke mkpụrụ ndụ beta pancreatic. Na-emechi oghere ndị dị na potassium, ha na-akpata depolarization nke mkpụrụ ndụ beta, nke na-enyere aka mepee ụzọ calcium ma na-abawanye usoro nke calcium n'ime sel.

Glimepiride, nwere ọnụego mgbanwe dị elu, na-ejikọ ma na-ewepụ protein protein beta-cell (molecule 65 kD / SURX), nke nwere njikọta nke ATP na-adabere na potassium, mana dị iche na saịtị na-ejikọ ọnụ nke njikọta sulfonylurea dị iche iche (protein na-enwe ọtụtụ mkpụkọ nke 140 kD / SUR1).

Usoro a na - eduga na mwepụta nke insulin site na exocytosis, ebe ego insulin zoro ezo dị obere karịa n'okpuru ọrụ ndị a na - ejikọ taata sulfonylurea (dịka glibenclamide). Mmetụta dị mkpirikpi na-akpali akpali nke glimepiride na mmụba insulin na-enyekwa ntakịrị nsogbu nke hypoglycemia.

Dị ka usoro ọdịnala sulfonylurea ọdịnala, mana n'ọtụtụ ukwuu glimepiride kwupụtara mmetụta extrapancreatic (ibelata insulin na-eguzogide ọgwụ, antiatherogenic, antiplatelet na mmetụta antioxidant).

Itinye glucose n'ahụ ọbara site na akwara anụ ahụ (akwara na abụba) na - apụta site na iji protin ndị njem (GLUT1 na GLUT4) dị na membranes sel. Transportbufe glucose na akwara ndị a na ụdị ọrịa shuga 2 bụ ihe nwere ọsọ ọsọ na iji ojiji nke glucose. Glimepiride na - eme ka ọnụọgụ glucose na - ebugharị ụmụ irighiri ihe (GLUT1 na GLUT4) na - eme ngwa ngwa, na - ebute mmụba nke glucose site na uru anụ ahụ.

Glimepiride nwere mmetụta mgbochi inhibitory na-esighi ike na ọwa mmiri ATP nke dabere na K + nke cardiomyocytes. Mgbe ị na-ewere glimepiride, a na-echekwa ike ịmegharị ikike nke metabolic nke myocardium na ischemia.

Glimepiride na-abawanye ọrụ nke phospholipase C, nke enwere ike ijikọ lipogenesis na glycogenesis na akwara dịpụrụ adịpụ na mkpụrụ ndụ abụba.

Glimepiride na-egbochi ntọhapụ nke glucose site na imeju site na ịba ụba intracellular nke fructose-2,6-bisphosphate, nke n'aka nke na-egbochi gluconeogenesis.

Glimepiride ahọrọ na-egbochi cyclooxygenase ma belata ntụgharị nke arachidonic acid na thromboxane A2, ihe dị mkpa na-agbakọ platelet endogenous.

Glimepiride na-enyere aka belata ọdịnaya nwere ume, belata pepaxidation lipid, nke metụtara ya na mmetụta anti-atherogenic

Glimepiride na-abawanye ọdịnaya nke alpha-tocopherol endogenous, ọrụ nke catalase, glutathione peroxidase na superoxide dismutase, nke na - enyere aka belata nrụgide oxidative n'ahụ ahụ onye ọrịa, nke na - adị mgbe niile n'ụdị ụdị ọrịa shuga 2 nke ọrịa mellitus.

Ọgwụ hypoglycemic sitere na ìgwè biguanide. Mmetụta hypoglycemic ọ ga-ekwe omume naanị ma ọ bụrụ na edobere nzuzo nke insulin (ọ bụ ezie na ọ belatara) Metformin enweghị mmetụta na mkpụrụ ndụ beta nke pancreatic ma ghara ịba ụba insulin; na usoro ọgwụgwọ, ọ dịghị ebute hypoglycemia na mmadụ.

Aghọtaghị usoro nke ihe ọ bụla. Ekwenyere na metformin nwere ike belata nsonaazụ insulin ma ọ bụ nwekwuo mmetụta ndị a na mpaghara ndị na-anabata nnabata. Metformin na - eme ka insulin nwee anụ ahụ na - eme ka ọnụọgụ nke ndị na - anabata insulin na - amụba n'ihu anụ ahụ. Na mgbakwunye, metformin na-egbochi gluconeogenesis na imeju, na-ebelata nguzobe abụba na abụba efu, na-ebelata mkpokọta triglycerides (TG) na LDL na VLDL na ọbara. Metformin dị ntakịrị belata agụụ ma belata nnabata nke carbohydrates na eriri afọ. Ọ na - eme ka akwara fibrinolytic dị n'ọbara site na - egbochi ihe mgbochi plasminogen activates inhibitor.

Mlọ ọgwụ

Mgbe ewere ya kwa ụbọchị 4 mg C_max na plasma ruru ihe dị ka awa 2.5 mgbe nchịkwa a na-ekwu okwu ma ọ bụ 309 ng / ml, enwere mmekọrịta dị n’etiti dose na C_max yana n'etiti dose na AUC. Mgbe inwetara glimepiride ya bioavailability zuru oke. Iri nri anaghị enwe mmetụta dị ukwuu n’ime mmiri, ewezuga ntakịrị nwayọ na ọsọ ya. Glimepiride bụ ihe eji amata V dị ala_d (ihe dị ka 8.8 L), ihe ruru nha olu nkesa albumin, ogo dị elu na-egbochi protein plasma (karịa 99%) na mkpochasị dị ala (ihe dịka 48 ml / min).

Mgbe otu ọgwụ glimepiride na-egbu, ọgwụ 58% nke ọgwụ ahụ bụ akụrụ na-apụ (naanị n'ụdị metabolites) yana 35% n'ime eriri afọ. Ndi_1/2 n'ọtụtụ plasma n'ọbara nke kwekọrọ n'ọtụtụ doses, ọ bụ awa 5-8. Mgbe ị theụsịrị ọgwụ ahụ na oke doses, a chọpụtara na-agbanye ọgwụ T._1/2 .

N'ime mmamịrị na feces, a na-achọpụta metabolites 2 na-adịghị emezi emezi nke mepụtara n'ihi metabolism na imeju, otu n'ime ha bụ hydroxy, nke abụọ abụrụ na mmanụ ụgbọ ala. Mgbe nchịkwa ọnụ nke glimepiride, ọnụ T_1/2 metabolites ndị a bụ awa 3-5 na awa 5-6.

Glimepiride na-apụ apụ na mmiri ara ara ma na-agafe ihe mgbochi placental. Site na BBB na-abanye n’adighi nma. Tụnyere nke nchịkwa otu na ọtụtụ (ugboro abụọ kwa ụbọchị) nke glimepiride ekpugheghị ọdịiche pụtara ìhè na ọgwụ pharmacokinetic, mgbanwe ha na ndị ọrịa dị iche. Nnukwu nnuku nke glimepiride abịaghị.

N'ime ndị ọrịa dị iche iche nwoke na nwanyị dị iche iche na otu dị iche iche, usoro ọgwụ na ọgwụ glimepiride bụ otu. N’ebe ndị ọrịa nwere nsogbu gbasara akụrụngwa (ya na iwepu ihe dị ala), enwere echiche ịbawanyewanye glimepiride ma belata ogo nke ọbara ya, nke kachasị bụ n’ihi ngwa ngwa glimepiride n’ihi obere njikọta ya na protein protein plasma. Yabụ, n'ụdị ndị ọrịa a, enweghị ihe ize ndụ ọzọ nke nchịkọta nke glimepiride.

Mgbe nchịkwa ọnụ gasịrị, a na-etinye metformin na ngọngọ nri kpamkpam. Ezigbo bioavailability nke metformin bụ ihe dịka 50-60%. C_max (ihe dị ka 2 μg / ml ma ọ bụ 15 μmol) na plasma na-enweta mgbe elekere abụọ 2.5. Site na nri nri n’otu oge, nnabata nke metformin na-ebelata ma belata.

A na-ekesa Metformin 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. Nwepu nke isiokwu siri ike bụ 440 ml / min (ugboro anọ karịa na creatinine), nke na-egosi ọnụnọ nke tubular nzuzo na-arụ ọrụ. Mgbe ịbasịchara, ọnụ T_1/2 bụ ihe dị ka awa 6.5. Na ọdịda akụrụngwa, ọ na-abawanye, enwere ihe ize ndụ nke nchịkọta nke ọgwụ.

Pharmacokinetics nke Amaril ® M nwere ọnụọgụ nke glimepiride na metformin

Nha C_max na AUC mgbe ị na-a aụ ọgwụ ọgwụ ngwungwu akpọrọ (mbadamba nwere glimepiride 2 mg + metformin 500 mg) na-ezute usoro bioequivalence ma e jiri ya tụọ otu ihe ahụ dịka nkwadebe dị iche (glimepiride mbadamba 2 mg na metformin 500 mg mbadamba) .

Na mgbakwunye, egosiri ọnụọgụ mgbakwunye na C._max na AUC nke glimepiride nwere mmụba nke ọnụọgụ ya na nkwonkwo nkwadebe yana usoro atọrọ site na 1 ruo 2 mg na usoro metformin (500 mg) mgbe niile.

Na mgbakwunye, enweghị ọdịiche dị mkpa na nchekwa, gụnyere profaịlụ nke mmetụta na-adịghị mma, n'etiti ndị ọrịa na-ewere Amaril ® M 1 mg / 500 mg na ndị ọrịa na-ewere Amaril ® M 2 mg / 500 mg.

Na-egosi Amaril ® M

Ọgwụgwọ ụdị ọrịa shuga mellitus nke 2 (na mgbakwunye nri, mmega ahụ na ịbelata oke):

n'ihe banyere mgbe enweghị ike inweta njikwa glycemic site na ijikọ nri, mmega ahụ, ibu belata na monotherapy na glimepiride ma ọ bụ metformin,

mgbe ị na-eji ọgwụ glimepiride na metformin dochie ọgwụ ọgwụ ngwakọta.

Ihe ngbanwe

ụdị shuga 1

Ọrịa ketoacidosis nke ọrịa mamịrị, ketoacidosis mamịrị, ọrịa shuga na precoma, nnukwu acid ma ọ bụ metabolic acidosis.

hypersensitivity na usoro nke sulfonylurea, nkwado nke sulfonylamide ma ọ bụ biguanides, yana ndị nke ọgwụ ọ bụla.

oke ọrụ imeju na-arụ ọrụ (enweghị ahụmịhe n'iji ya eme ihe, ndị ọrịa a chọrọ ọgwụgwọ insulin iji hụ na nchịkwa zuru oke).

ọrịa hemodialysis (enweghị ahụmihe)

Nmezi akụrụ gbasara arụrụala na arụ ọrụ ya (arụ ọrụ serum creatinine: ≥1.5 mg / dL (135 μmol / L) n’ime ụmụ nwoke na ≥1.2 mg / dL (110 μmol / L) n’ime ụmụ nwanyị ma ọ bụ belata ikike ịmepụta creatinine (mụbaa. ihe ize ndụ nke lactic acidosis na mmetụta ndị ọzọ nke metformin),

Ọnọdụ nnukwu nsogbu nke akụrụngwa akwara nwere ike ịnya (akpịrị ịkpọ nkụ, ọrịa na-efe efe, ujo, intravascular management nke ayodiin nwere ndị ọrụ dị iche iche, lee mpaghara “Ntuziaka Pụrụ Iche”),

ọrịa na-adịghị ala ala na-adịghị ala ala nke nwere ike ibute hypoxia anụ ahụ (obi ma ọ bụ akụkụ iku ume ọdịda, oke na subacute myocardial infarction, ujo),

ebumnuche ịmalite lactic acidosis, akụkọ ihe mere eme nke lactic acidosis,

ọnọdụ nrụgide (nnukwu mmerụ ahụ, ọkụ, ihe metụtara ịwa ahụ, ọrịa siri ike ọnya na-efe efe,)

ike ọgwụgwụ, agụụ, ịgbaso nri kalori (erughi 1000 kal / ụbọchị),

ịba ahụhụ na nri na ọgwụ na (digestive tract) (ya na eriri afọ, paresis, afọ ọsịsa, vomiting),

mebiri nke nnabata nri na ọgwụ ke digestive tract (ya na ngwara afọ, paresis eriri afọ, afọ ọsịsa, vomiting),

egbu egbu egbu, ị intoụbiga mmanya ókè

ụkọ lactase, ịkpa ókè galactose, glucose-galactose malabsorption,

ime, atụmatụ ịtụrụ ime,

oge inye ara,

ụmụaka na ndị na-eto eto na-erubeghị afọ 18 (ezughị ezu na ahụmịhe ahụike).

n’ọnọdụ ndị enwere ike ịba ụba hypoglycemia (ndị ọrịa na-adịghị njikere ma ọ bụ enweghị ike (nke na-abụkarị ndị agadi agadi)) iso dọkịta, na-eri nri na-adịghị mma, na-eri nri mgbe ụfọdụ, iri nri, ndị ọrịa nwere ihe mgbagha dị n'etiti mmega ahụ na iri nri carbohydrate, mgbanwe nri, mgbe ị drinkingụ ihe ọ containingụ containingụ nwere ethanol, ọkachasị yana nri nri, na imeju na akụrụ na-agwụ ike, yana ụfọdụ nsogbu endocrine na-adịghị agbakọ, t. dị ka ụfọdụ nsị nke thyroid, homonụ na-ezughị ezu nke ntụgharị ihu ma ọ bụ cortex nke metụtara adrenal, na-emetụta metabolism metabolism ma ọ bụ mmegharị nke usoro iji mee ka ịbawanye ọbara glucose n'oge hypoglycemia, na mmepe nke ọrịa intercurrent n'oge ọgwụgwọ ma ọ bụ mgbanwe mgbanwe na ndụ) () n’ebe ndị ọrịa dị otú a, iji nlezianya nyochaa nlebara glucose ọbara na ihe ịrịba ama nke hypoglycemia dị mkpa, ha nwere ike ịchọ mmezi dose nke glimepiride ma ọ bụ hypoglide dum. kemicheskoy ọgwụ)

iji otu ọgwụ ọgwụ n’otu oge (lee “Mmekọrịta”),

n'ime ndị ọrịa agadi (ha na-enwekarị mbelata asymptomatic na ọrụ akụrụ), n'ọnọdụ ebe ọrụ akụrụ nwere ike ịka njọ, dị ka mmalite nke ị antiụ ọgwụ antihypertensive ma ọ bụ diuretics, yana NSAIDs (ịba ụba nke lactic acidosis na mmetụta ndị ọzọ nke metformin),

mgbe ị na-arụ ọrụ arụ ọrụ siri ike (ihe ize ndụ nke ịmalite uto lactic acidosis mgbe ị na-ewere metformin na-abawanye),

na mwepu ma obu enweghi ihe mgbaàmà nke iwu adrenergic antiglycemic na nzaghachi na hypoglycemia (na ndi okenye agadi, na neuropathy nke sistemụ akwara ma ọ bụ usoro ọgwụgwọ na beta-blockers, clonidine, guanethidine na ndị ọzọ nwere ọmịiko) (n'ime ndị ọrịa dị otú a, nlezianya nyochaa nlebara glucose. n'ime ọbara)

n'ihe banyere adịghị ike glucose-6-phosphate dehydrogenase (na ndị ọrịa dị otú a, mgbe ị na-a sulfụ ọgwụ mkpịsị ọsịsị nke hymonụ, hemolytic anemia nwere ike ịmalite, yabụ, iji usoro ọgwụ hypoglycemic ọzọ na-abụghị ihe ndị na-eme ka sulfonylurea dị na ndị ọrịa a kwesịrị ịtụle).

Ime na lactation

Ime N'ime afọ ime n'ihi nsonaazụ ọ bụla ọ nwere ike na mmepe intrauterine. Womenmụ nwanyị dị ime na ụmụ nwanyị na-eme atụmatụ ime kwesịrị ịgwa onye nlekọta ahụike ha. N'oge afọ ime, ụmụ nwanyị nwere metabolism metabolism, nri na-adịghị adị na mmega ahụ kwesịrị ịnata ọgwụgwọ insulin.

Lactation. Iji zere ị milkụ mmiri ọgwụ ara tinyere ahụ nwata, ụmụ nwanyị na-a shouldụ ara ekwesịghị ị thisụ ọgwụ a. Ọ bụrụ na ọ dị mkpa, a ga-ebufe onye ọrịa ahụ na ọgwụgwọ insulin ma ọ bụ ịkwụsị inye ya ara.

Nsonaazụ

Dabere na ahụmịhe nke iji glimepiride na data amaara na usoro ndị ọzọ nke sulfonylurea, mmepe nke mmetụta ndị a na-esote ọgwụ ga-ekwe omume.

Site n'akụkụ nke metabolism na nri: mmepe nke hypoglycemia, nke enwere ike ibute ogologo (dika ya na usoro ndi ozo nke sulfonylurea).Ihe mgbaàmà nke hypoglycemia gụnyere: isi ọwụwa, agụụ siri ike, ọgbụgbọ, vomiting, lethargy, lethargy, nsogbu ihi ụra, nchekasị, oke iwe, belata nlebara anya, mbelata, mmeghachi omume psychomotor, ịda mba, ọgba aghara, enweghi ike ikwu okwu, aphasia, isi. ọhụụ, ịma jijiji, paresis, mmetụta uche na-adịghị ala ala, ọgbụgba, enweghị enyemaka, ọnwụ nke njide onwe onye, ​​enweghị nchekasị, ihe nhụjuanya, iro ụra na ọnwụ nke mmụọ ruo coma, iku ume na-emighị emi, bradycardia. Na mgbakwunye, enwere ike ịchọpụta ihe ịrịba ama banyere mmepe nke mmeghachi omume adrenergic na hypoglycemia: ọsụsọ na-aba ụba, ịrapara n'ahụ nke anụ ahụ, ịba ụba nchegbu, tachycardia, ọbara mgbali elu, mmetụta nke ịbawanye obi, angina pectoris na arrhythmia. Foto onyonyo a na-agha banyere mwakpo ọbara siri ike nwere ike ịdị ka nnukwu nnabata nke ụbụrụ. Ọrịa dị iche iche na-edozi mgbe niile mgbe ekpochachara glycemia.

Site n'akụkụ akụkụ ahụ nke ọhụụ: nkwarụ anya (ọkachasị na mmalite ọgwụgwọ n'ihi mgbanwe nke mkpokọta glucose n'ọbara).

Site na ngwara: ọgbụgbọ, ọgbụgbọ, afọ juru, afọ na afọ.

N'akuku nke imeju na akwara biliary: ịba ụba nke enzymes imeju na ọrụ imeju na-arụ ọrụ (dịka, cholestasis na jaundice), yana ịba ọcha n'anya, nke nwere ike ịga n'ihu na ọrịa imeju.

Site na ọbara ọbara yana sistem lymphatic: thrombocytopenia, n'ọnọdụ ụfọdụ - leukopenia, hemolytic anemia ma ọ bụ erythrocytopenia, granulocytopenia, agranulocytosis ma ọ bụ pancytopenia. Ọ dị mkpa iji nlezianya nyochaa ọnọdụ onye ọrịa, ebe ọ bụ na e dekọrọ okwu banyere ọrịa akwara na pancytopenia mgbe a na-eji nkwadebe sulfonylurea. Ọ bụrụ na ihe ịtụnanya ndị a emee, ekwesịrị ịkwụsị ọgwụ ahụ wee malite usoro ọgwụgwọ kwesịrị ekwesị.

Si dịghịzi usoro: Mmeghachi ahụ nfụkasị ma ọ bụ mmetụta pseudo (dịka ọmụmaatụ, itching, hives, ma ọ bụ rashes). Mmeghachi omume ndị a na-aga n'ihu mgbe niile n'ụdị nwayọ, mana ha nwere ike banye n'ụdị siri ike, yana ume mkpụmkpụ ma ọ bụ mbelata ọbara mgbali elu, ruo n'ọdịda jijiji anaphylactic. Ọ bụrụ na hives mere, gakwuru dọkịta ozugbo. Enwere ike iji ihe nfụkasị nwee mmerụ na sulfonylureas ndị ọzọ, sulfonamides ma ọ bụ ihe ndị ọzọ yiri ya. Allergic vasculitis.

Ndị ọzọ: fotoensitivity, hyponatremia.

Site n'akụkụ nke metabolism na nri oriri: lactic acidosis (lee. "Ntuziaka pụrụ iche"), hypoglycemia.

Site na ngwara: afọ ọsịsa, ọgbụgbọ, mgbu afọ, vomiting, ịba ụba gas, enweghị agụụ - mmeghachi omume kachasị na metformin monotherapy. Ihe mgbaàmà ndị a bụ ihe fọrọ nke nta ka ọ bụrụ 30% karịa ka ndị ọrịa na-ewere placebo, karịsịa na mmalite ọgwụgwọ. Mgbaàmà ndị a na-adịkarị nwayo ma na-edozi onwe ha. N'ọnọdụ ụfọdụ, mbelata obere oge enyemaka nwere ike inyere gị aka. N'oge ọmụmụ banyere ọgwụgwọ, kagbuo metformin na ihe fọrọ nke nta ka ọ bụrụ 4% nke ndị ọrịa n'ihi mmeghachi omume site na eriri afọ.

Ebe ọ bụ na mmepe nke mgbaàmà site na eriri afọ na mmalite ọgwụgwọ bụ ọgwụ dabere, enwere ike belata ihe ngosipụta ha site na iji nwayọ mụbaa dose ma were ọgwụ ahụ were nri.

Ebe ọ bụ na afọ ọsịsa na / ma ọ bụ ọgbụgbọ pụrụ ibute akpịrị ịkpọ nkụ na ọdịda nke akụrụ afọ, mgbe ha mere, a ga-akwụsị ọgwụ ahụ nwa oge.

Na nmalite ọgwụgwọ metformin, ihe dị ka 3% nke ndị ọrịa nwere ike ịnweta uto na-adịghị mma ma ọ bụ ọla na ọnụ, nke na-agakarị na nke ya.

N'akụkụ anụ ahụ: erythema, itching, ihe otutu.

Site na ọbara ọbara yana sistem lymphatic: anaemia, leukocytopenia, ma ọ bụ thrombocytopenia. Ihe dị ka 9% nke ndị ọrịa natara ọgwụgwọ monotherapy na Amaril ® M, na 6% nke ndị ọrịa natara ọgwụgwọ na metformin ma ọ bụ metformin / sulfonylurea, enwere mbelata asymptomatic na vitamin B.₁₂ n'ọbara plasma ọbara (ọkwa nke folic acid na plasma ọbara agbadabeghị nke ukwuu). N'agbanyeghi nke a, naanị megaloblastic anaemia ka edere mgbe ha na-ewere Amaril ® M, ọ nweghịkwa mmụba na nrịanrịa neuropathy. Ya mere, ekwesịrị ịchọrọ ọkwa vitamin B kwesịrị ekwesị.₁₂ na plasma ọbara (nwere ike ịchọ nchịkwa parenteral nke oge vitamin B)₁₂).

Site na imeju: arụ ọrụ imeju.

A ga-agwa dọkịta ozugbo ikpe gbasara ihe omume ndị a dị oke mma ma ọ bụ mmeghachi omume ndị ọzọ dị na dọkịta ozugbo. N'ihi eziokwu ahụ na ụfọdụ mmeghachi omume ndị na-adịghị mma, wdg. hypoglycemia, ọrịa ọgbụgba ọbara, oke nfụkasị ahụ na mmeghachi ahụ nfụkasị na ọdịda nke imeju nwere ike itinye ndụ onye ọrịa ahụ n'ihe, ọ bụrụ na ha etolite, onye ọrịa ahụ kwesịrị ịgwa dọkịta ahụ ozugbo banyere ha wee kwụsị ịchịkwa ọgwụ ahụ tupu ịnata ntụziaka site n'aka dọkịta. Achọpụtaghị mmeghachi omume ọjọọ na Amaryl ® M, ewezuga mmeghachi omume ndị a maralarị na glimepiride na metformin, ahụghị n'oge ọnwụnwa nke ụlọ ọgwụ na usoro III emepe emepe.

Anweta nchikota ọgwụ abụọ a, ma n'ụdị nke nchikota nke emebere nke glimepiride na metformin, yana ọgwụ a jikọtara ọnụ na usoro glimepiride na metformin, nwere otu njiri mara nchekwa dị ka ojiji nke ọgwụ ọ bụla iche.

Mmekorita

Ọ bụrụ na edepụtara onye ọrịa na-ewere glimepiride ma ọ bụ kagbuo ya n'otu oge, ọgwụ ndị ọzọ ga - ekwe omume ma mmụba na - achọghị na iwelata ike hypoglycemic mmetụta nke glimepiride. Dabere na ahụmịhe glimepiride na usoro ndị ọzọ na-enye sulfonylurea, mmekọrịta nke ọgwụ edepụtara n'okpuru a kwesịrị ịtụle.

Na ogwu nke inducers ma obu inhibitors nke CYP2C9

Glimepiride bụ nke cytochrome P450 CYP2C9 metabolized. A maara na metabolism ya na-emetụta n'otu oge nke CYP2C9 inducers, dịka ọmụmaatụ rifampicin (ihe ize ndụ nke ibelata hypoglycemic mmetụta nke glimepiride mgbe ejiri ya mee ihe n'otu oge na CYP2C9 inducers na ihe dị elu nke hypoglycemia ma ọ bụrụ na CYP2C9 induceeringideGoro-ngwa ngwa-ngwa-ngwa-ngwa kaPP) mmepe nke hypoglycemia na nsonaazụ nke glimepiride mgbe ejiri ọgwụ ndị a nwee nkwekọrịta na ohere nke mbelata mmetụta hypoglycemic nke glimepiride na ọ dịghị onye na-egbochi CYP2C9 na-enweghị nhazi mmezi nke glimepiride).

Na ọgwụ ndị na-eme ka mmetụta hypoglycemic dị elu

Ndị ọrụ insulin na ọnụ mmiri, ACE inhibitors, allopurinol, steroid anabolic, nwoke mmekọahụ holokoloji, chloramphenicol, coumarin anticoagulants, cyclophosphamide, na-enupụ isi, phenfluramine, pheniramidol, fibrates, fluoxetine, azolinofluoyinyin, (ya na nchịkwa parenteral na usoro onyonyo dị elu), phenylbutazone, probenecid, ndị na-alụ ọgụ ọgwụ nke quinolone otu, salicylates, sulfinpyrazone, ihe nchịkwa sulfonamide, tetracyclines, atọ. okvalin, trofosfamide, azapropazone, oxyphenbutazone.

Ihe ize ndụ nke hypoglycemia na-abawanye site na n'otu oge nke ọgwụ ndị a dị n'elu nwere glimepiride yana ihe ize ndụ nke njikwa glycemic na-akawanye njọ mgbe a kagbuo na-enweghị mmezi glimepiride.

Na ọgwụ ndị na-ebelata ike hypoglycemic

Acetazolamide, barbiturates, GCS, diazoxide, diuretics, epinephrine ma ọ bụ sympathomimetics, glucagon, laxatives (na iji ogologo oge), nicotinic acid (na oke ọnya), estrogens, progestogens, phenothiazines, phenytoin, rifampicin, homonụ thyroid.

Ihe ọghọm nke nchịkwa glycemic na-abawanye site na iji glimepiride jikọtara ya na ọgwụ ndị edepụtara na ihe ize ndụ nke hypoglycemia ma ọ bụrụ na akagbuo na-enweghị mmezi nke glimepiride.

Na ọgwụ nke nwere ike ịkwalite ma belata mmetụta hypoglycemic

Blo igbochi akụkọ histamine H₂ndị na-anabata ihe, clonidine na reserpine.

Iji otu oge, ma mmụba na mbelata na mmetụta hypoglycemic nke glimepiride ga-ekwe omume. Ọ dị mkpa iji nlezianya nyochaa nlebara glucose ọbara.

Beta-blockers, clonidine, guanethidine na reserpine n'ihi igbochi mmeghachi omume nke sistemu ọmịiko na nzaghachi hypoglycemia nwere ike ime ka mmepe nke hypoglycemia bụrụ ihe a na-adịghị ahụ anya na onye ọrịa na dọkịta ma si otú a na-abawanye ihe ize ndụ nke ihe omume ya.

Na ndị na-eme ebere

Ha nwere ike belata ma ọ bụ gbochie mmeghachi omume nke sistemụ ọmịiko na nzaghachi hypoglycemia, nke nwere ike ime ka mmepe nke hypoglycemia bụrụ ihe a na-adịghị ahụ anya na onye ọrịa na dọkịta ma si otú a bulie ohere nke ịdaba.

Nnukwu ethanol na-eji ọgwụ ike na nke na-adịghị ala ala nwere ike ịkọwa ma ọ bụ kwalite mmetụta hypoglycemic nke glimepiride.

Site na anticoagulants na-apụtaghị ìhè, ihe dị iche iche coumarin

Glimepiride nwere ike ịkwalite ma belata nsonaazụ anticoagulants na-apụtaghị ìhè, ọgwụ coumarin.

Into intoụbiga mmanya ókè, ihe ize ndụ nke ịmalite ịrịa lactic acidosis na-abawanye, karịchaa ma ọ bụrụ na imapụ ma ọ bụ erighị nri buru ibu, ọnụnọ nke imeju. Ekwesịrị izere mmanya (ethanol) na ọgwụ ethanol nwere.

Na ayodiin nwere ihe ndi ozo di iche

Nlekọta intravascular nke iodine nwere ihe dị iche nwere ike iduga mmepe nke ọdịda akụrụ, nke n'aka nke ya nwere ike ibute nchịkọta nke metformin na nnukwu ihe ize ndụ nke lactic acidosis. Ekwesịrị ịkwụsị Metformin tupu ọmụmụ ihe ahụ ma ọ bụ n'oge ọmụmụ ihe ahụ, ịmaliteghachi ya n'ime awa 48 mgbe ọ mụsịrị. Enwere ike ịmaliteghachi Metformin naanị mgbe ọmụmụ ihe ahụ na ngosipụta nkịtị nke arụmọrụ ezumike (lee "Ntuziaka Pụrụ Iche").

Na ọgwụ nje nwere ọgwụ nje nephrotoxic akpọrọ (gentamicin)

Riskbawanye n'ihe ize ndụ nke lactic acidosis (lee "Ntuziaka pụrụ iche").

Njikọ ọgwụ na metformin nke chọrọ ịkpachara anya

Na corticosteroids (usoro na maka ojiji mpaghara), beta₂-adrenostimulants na diuretics nwere ọrụ hyperglycemic dị n'ime. Ekwesịrị ịgwa onye ọrịa banyere mkpa ọ dị ịmatakwu nlezianya ịbanye n'ọtụtụ ụtụtụ glucose n'ọbara, karịsịa na mmalite njikọta ọgwụgwọ. Ọ nwere ike ịdị mkpa iji dozie usoro ọgwụgwọ hypoglycemic n'oge eji ya ma ọ bụ kwụsịchaa ọgwụ ndị dị n'elu.

Na ACE inhibitors

Ndị na - egbochi ACE nwere ike belata mkpụkọ glucose dị n'ọbara. Enwere ike ịchọ mmeghari usoro ọgwụgwọ hypoglycemic n'oge eji ma ọ bụ mgbe ọpụpụ nke ndị na - egbochi ACE.

Site na ogwu ndi n’eme ka aru aru nke hypoglycemic metformin: insulin, sulfonylureas, anabolic steroids, guanethidine, salicylates (acetylsalicylic acid, wdg), beta-blockers (propranolol, wdg), MAO inhibitors

N'ihe banyere ojiji nke ọgwụ ndị a n'otu oge na metformin, ọ dị mkpa ilebara onye ọrịa anya na ịchekwa oke glucose na ọbara. ike nke hypoglycemic mmetụta nke glimepiride ga-ekwe omume.

Iji ọgwụ ọjọọ eme ihe na-emebi ike hypoglycemic nke metformin: epinephrine, corticosteroids, homonụ thyroid, estrogens, pyrazinamide, isoniazid, nicotinic acid, phenothiazines, thiazide diuretics na diuretics nke ndị ọzọ, ọgwụ mgbochi, na-ekwu okwu ngwa ngwa, na-eleda mmụọ,

N'ihe banyere ojiji nke ọgwụ ndị a n'otu oge na metformin, ọ dị mkpa ilebara onye ọrịa anya na ịchekwa oke glucose na ọbara. ike omume hypoglycemic mmetụta.

Mmekorita ị ga-atụle

Na nyocha nke ulo ogwu banyere mmekorita nke metformin na furosemide mgbe ewere ya n’otu ndi nlere anya ahuike, e gosiputara n’otu oge iji ogwu ndia na emetuta ubara ogwu ha. Furosemide mụbara C_max metformin na plasma site na 22%, yana AUC - site na 15% na-enweghị mgbanwe ọ bụla dị mkpa na mkpochapu mkpo nke metformin. Mgbe ejiri metformin C_max na AUC nke furosemide belatara site na 31 na 12%, n'otu aka ahụ, ma e jiri ya tụnyere furosemide monotherapy, njedebe ikpeazụ nke ọkara belatara 32% na-enweghị mgbanwe ọ bụla dị ukwuu na mkpochapu mkpo nke furosemide. Ihe omuma banyere nmekorita nke metformin na furosemide na iji ogologo oge adighi adighi.

Na omumu ihe omumu banyere nmekorita nke metformin na nifedipine na otutu ndi n’enyemaka, emere ka egosiputa na n’otu oge nifedipine na - abawanye C_max na AUC nke metformin na plasma ọbara site na 20 na 9%, n'otu n'otu, ọ na-emekwa ka mkpụrụ nke metformin kọọpụtara. Metformin nwere mmetụta dị ntakịrị na ọgwụ ọgwụ nke nifedipine.

Na nkwadebe cationic (amiloride, digoxin, morphine, procainamide, quinidine, quinine, ranitidine, triamteren, trimethoprim na vancomycin)

Ọgwụ cationic nke tubular secretion na akụrụ na-enwe ike ịmekọrịta metformin n'ihi asọmpi maka sistemụ eburu mmiri ebubata ihe. A hụrụ mmekọrịta dị n'etiti metformin na ọnụ cimetidine na ndị ọrụ afọ ofufo mara mma n'ọmụmụ ihe omimi nke mmekọrịta nke metformin na cimetidine nwere otu na otutu, ebe enwere 60% mmụba na mkpokọta plasma kachasị na mkpokọta metformin n'ọbara na 40% na plasma na mkpokọta AUC metformin. Site na otu usoro, enweghị mgbanwe na ọkara ndụ. Metformin emetụtaghị ọgwụ ọgwụ nke cimetidine. N'agbanyeghi eziokwu na mmekorita di otu a na - agha usoro a (ma ewezuga cimetidine), ekwesiri ilebara ndi oria anya anya ma ghazie idozi metformin na / ma obu ogwu a na - eme ya, o gha eme n’otu oge ana - achikota ọgwụ ndi anonye n’ahu site na ahu.

Na propranolol, ibuprofen

N'ime ndị ọrụ afọ ofufo nwere ahụ ike na ọmụmụ n'ọtụtụ metformin na propranolol, yana metformin na ibuprofen, enweghị mgbanwe na paradaịs ọgwụ ha.

Usoro onunu ogwu na nhazi

Dịka iwu, a ga-ekpebi dose nke Amaril ® M site na itinye mgbanye glucose n'ọbara onye ọrịa. O kwesiri iji obere ọgwụ zuru ezu iji nweta ihe nchịkwa metabolic dị mkpa.

N'oge ọgwụgwọ na Amaril ® M, ọ dị mkpa iji oge niile kpebie mkpokọta glucose dị n'ọbara na mmamịrị. Na mgbakwunye, a na-atụ aro nlele mgbe niile maka pasent gemocosylated haemoglobin n'ọbara.

Iụ ọgwụ ọperụperụ na-ezighi ezi, dịka ọmụmaatụ, ịgafe ọgwụ ọzọ, agaghị agara gị agbanye ọzọ site na ị theụ ọgwụ ọzọ na-esote ya.

Omume onye ọrịa ga-ekwu maka njehie mgbe ị na-a theụ ọgwụ ahụ (karịchaa, mgbe ịpụghị ọgwụ ọzọ ma ọ bụ na-ahapụ nri), ma ọ bụ n'ọnọdụ ebe ọ na-agaghị ekwe omume ị theụ ọgwụ ahụ, onye ọrịa ahụ na onye dọkịta kwesịrị ịkọwa ya tupu oge eruo.

Ebe ọ bụ na a na-ejikọta njikwa metabolism na ụba anụ ahụ na insulin, mkpa nke glimepiride nwere ike ibelata n'oge ọgwụgwọ ya na Amaril ® M. Iji zere mmepe nke hypoglycemia, ọ dị mkpa iji belata dose ahụ n'oge ma ọ bụ kwụsị ị Amarụ Amaril ® M.

Ọgwụ a kwesịrị ị takenụ 1 ma ọ bụ ugboro abụọ n’ụbọchị n’oge nri.

Oke kachasị nke metformin kwa otu bụ 1000 mg.

Ogo kachasị ụbọchị: maka glimepiride - 8 mg, maka metformin - 2000 mg.

Ọ bụ naanị ọnụ ọgụgụ dị nta nke ndị ọrịa nwere ọgwụ glimepiride dị irè karịa kwa ụbọchị karịa 6 mg.

Iji zere mmepe nke hypoglycemia, usoro izizi nke Amaril ® M ekwesịghị gafere ogo nke glimepiride kwa ụbọchị na onye ọrịa na-ewere. Mgbe ị na-ebufe ndị ọrịa iwere nchikota nke onwe glimepiride na metformin na Amaril its M, a na-ekpebi mmiri ya na ndabere nke ewere glimepiride na metformin dị ka usoro dị iche iche.

Ọ bụrụ na ọ dị mkpa ịbawanye dose, kwa ụbọchị Amaril ® M ga-titled na mmụba nke naanị 1 tebụl. Amaril ® M 1 mg / 250 mg ma ọ bụ mbadamba 1/2. Amaril ® M 2 mg / 500 mg.

Oge ọgwụgwọ. A na-ejikarị Amaril ® M eme ọgwụgwọ ogologo oge.

Ntụziaka pụrụ iche

Lactic acidosis bụ ihe dị ụkọ ma sie ike (yana oke onwu na enweghị ọgwụgwọ kwesịrị ekwesị) nsogbu metabolic, nke na-etolite n'ihi nchịkọta nke metformin n'oge ọgwụgwọ. A chọpụtawo ọrịa lactic acidosis na Metformin tumadi na ndị ọrịa nwere ọrịa mellitus na nnukwu akụrụ. Enwere ike belata lactic acidosis site na ịtụle ọnụnọ nke ihe ndị ọzọ metụtara ihe ize ndụ maka lactic acidosis n'ime ndị ọrịa, dị ka ọrịa shuga na-adịghị mma nchịkwa, ketoacidosis, ibu ọnụ ogologo oge, ị heavyụ mmanya dị ukwuu nke nwere ethanol, ọrịa imeju, yana ọnọdụ nke hypoxia anụ ahụ.

Ejiri lactic acidosis bụ mkpirisi iku ume iku ume, afọ mgbu na hypothermia, ya na mmụba na-esote. Ngosiputa ihe nlere nke ulo nyocha bu mmụba nke lactate n’ime ọbara (> 5 mmol / l), mbelata ọbara pH, mmebi nke nguzo mmiri-electrolyte na mmụba nke ụkọ anion na ụkọ lactate / pyruvate. N'ọnọdụ ebe metformin bụ ihe kpatara lactic acidosis, plasma concentration nke metformin na-abụkarị> 5 μg / ml. Ọ bụrụ na echere lactic acidosis, a ga-akwụsị metformin ozugbo onye ọrịa kwesịrị ịga ụlọ ọgwụ ozugbo.

Ugboro nke ikpe a kọrọ na lactic acidosis na ndị ọrịa na-ewere metformin dị ala (ihe dị ka 0.03 ikpe / afọ 1000).

Akuko ikpe mere tumadi na ndị ọrịa nwere ọrịa mellitus nwere nnukwu akụrụ oke, gụnyere , nwere ọrịa akụrụ na ọrịa hypoperfusion, na-abụkarị ọnụnọ nke ọtụtụ ọnụnọ concoitant chọrọ ọgwụgwọ na ịwa ahụ.

Ihe ọghọm nke ibute lactic acidosis na-abawanye site n'ịdị ogo nke akụrụngwa akụrụ na afọ. Ohere nke lactic acidosis mgbe ị na-ewere metformin nwere ike belata belata site na ị na-elele ọrụ ezumike mgbe niile yana iji usoro metformin dị ntakịrị. Maka otu ihe ahụ, n'ọnọdụ metụtara hypoxemia ma ọ bụ akpịrị ịkpọ nkụ, ọ dị mkpa iji zere ị thisụ ọgwụ a.

Dịka iwu, n'ihi eziokwu nke ọrụ imeju na-arịa ya nwere ike belata nzere nke lactate, a ga-ezere iji ọgwụ a maka ndị ọrịa nwere akara ma ọ bụ ụlọ nyocha nke ọrịa imeju.

Na mgbakwunye, ọgwụ a ga-akwụsịtụ nwa oge tupu ya amalite ọmụmụ x-ray na nchịkwa intravascular nke ndị na-enwe ayodiin na tupu ịwa ahụ.

Mgbe mgbe, lactic acidosis na-etolite nwayọ ma gosipụta ya naanị site na mgbaàmà ndị na-enweghị nkọwa, dịka ahụike siri ike, myalgia, ọdịda iku ume, ịba ụba ụra na nsogbu nke eriri afọ. Site na iji acidosis akpọrọ akpọrọ, hypothermia, mbelata ọbara mgbali na bradyarrhythmia na-eguzogide omume ga-ekwe omume. Ma onye ọrịa ma dọkịta na-ahụ maka ịga kwesịrị ịma otú ihe mgbaàmà ndị a dị. Ekwesịrị ịgwa onye ọrịa ka ọ gwa dọkịta ozugbo ma ọ bụrụ na ụdị mgbaàmà ndị a na-eme. Iji kọwaa nchoputa nke lactic acidosis, ọ dị mkpa iji kpebie mkpokọta electrolytes na ketones n'ime ọbara, ịta glucose na ọbara, pH ọbara, ntinye nke lactate na metformin n'ime ọbara. Ibu ọnụ plasma plasma lactate na ọbara venous na-ebu ọnụ, gafere oke oke nkịtị, mana n'okpuru 5 mmol / L na ndị ọrịa na-ewere metformin, egosighi lactic acidosis, usoro ya nwere ike ịkọwa mgbakwunye ya site na usoro ndị ọzọ, dị ka ọrịa mellitus na-adịghị mma ma ọ bụ oke ibu, anụ ahụ siri ike. Ibu ma ọ bụ njehie nka n'oge nlele ọbara maka nyocha.

Ọnụnọ nke lactic acidosis na onye ọrịa nwere ọrịa mellitus nwere metabolic acidosis na enweghị ketoacidosis (ketonuria na ketonemia) kwesịrị iche.

Lactic acidosis bụ ọnọdụ dị oke mkpa chọrọ ọgwụgwọ ọrịa inpatient. N'ihe banyere lactic acidosis, ị kwesịrị ịkwụsị ịkwụsị ị thisụ ọgwụ a ozugbo wee gaa n'ihu ịkwado usoro nkwado n'ozuzu ya. N'ihi eziokwu ahụ bụ na ewepụrụ metformin n'ọbara site na iji hemodialysis na nhichapụ ihe ruru 170 ml / min, a na-atụ aro ya, ma ọ bụrụ na enweghị ọgba aghara metụtara hemodial, wemodialysis ozugbo iji wepụ metformin na lactate agbakọtara. Usoro ndị dị otú a na-edugakarị mgbapụ ngwa ngwa nke mgbaàmà na mgbake.

Nyochaa ịdị irè nke ọgwụgwọ

Ekwesịrị inyocha ịdị irè nke usoro ọgwụgwọ hypoglycemic ọ bụla site na nyochaa oge nke mkpokọta glucose na glycosylated haemoglobin n'ọbara. Ebumnuche nke ọgwụgwọ bụ ịbawanye usoro ndị a. Ntinye uche nke glycosylated haemoglobin na-enye ohere nyocha nke njikwa glycemic.

N'ime izu mbụ nke ọgwụgwọ, nlezianya nlezi anya dị mkpa n'ihi ihe ize ndụ nke hypoglycemia, ọkachasị na enwere ihe ọghọm nke mmepe ya (ndị ọrịa na-adịghị njikere ma ọ bụ enweghị ike ịgbaso ndụmọdụ dọkịta ahụ, ọtụtụ mgbe, ndị ọrịa agadi, nri na-adịghị mma, nri oge na-adịghị, ma ọ bụ nri ski, na ndagwurugwu a na-eme n'etiti mmega ahụ na oriri na-egbu nri, yana mgbanwe nri, yana oriri ethanol, ọkachasị yana nri nri, na arụ ọrụ ezughi oke, nwere nnukwu nsogbu ọrụ imeju, na oke nke Amaril ® M, yana ụfọdụ nsogbu erughị eru nke usoro endocrine (dịka ọmụmaatụ, ụfọdụ nsị thyroid na ụkọ homonụ nke akụkụ ihu) ma ọ bụ ọgwụ adrenal, mgbe ị na-eji ọgwụ ndị ọzọ na-emetụta metabolism metabolism (lee “Mmekọrịta ").

N'ụdị ndị a, ọ dị mkpa iji nlezianya nyochaa nlebara glucose ọbara. Onye ọrịa ahụ kwesịrị ịgwa dọkịta banyere ihe ndị a na - akpata ọrịa hypoglycemia, ma ọ bụrụ. Ọ bụrụ na enwere ihe ndị dị ize ndụ hypoglycemia, mmegharị ọgwụ nke ọgwụ a ma ọ bụ usoro ọgwụgwọ niile nwere ike ịchọ. A na-eji usoro a oge ọ bụla ọrịa bilitere n'oge ọgwụgwọ ma ọ bụ mgbanwe na ụzọ ndụ onye ọrịa ahụ. Ọrịa hypoglycemia, na-egosipụta iwu nchịkwa antihypoglycemic adrenergic na nzaghachi na hypoglycemia (lee “mmetụta ndị”), nwere ike belata akpọ ma ọ bụ ghara ịdị ma ọ bụrụ na hypoglycemia amalite nke nta nke nta, yana ndị ọrịa agadi, na-enwe neuropathy nke sistem akwara ma ọ bụ nke imekota oge. ọgwụgwọ na beta-blockers, clonidine, guanethidine na ndị ọzọ na-ekwu maka ọmịiko.

Ihe fọrọ nke nta ka ọ bụrụ mgbe niile, enwere ike ịkwụsị hypoglycemia ngwa ngwa nke carbohydrates ozugbo (glucose ma ọ bụ shuga, dịka ọmụmaatụ, mpempe shuga, ihe ọ fruitụ fruitụ mkpụrụ osisi nwere shuga, tii nwere shuga, wdg). Maka ebumnuche a, onye ọrịa kwesịrị ibu ma ọ dịkarịa ala 20 g shuga. O nwere ike chọọ enyemaka si n’aka ndị ọzọ iji zere nsogbu. Dochie shuga adịghị arụ ọrụ.

Site na ahụmịhe na ọgwụ ọgwụ sulfonylurea ndị ọzọ, a maara na, na agbanyeghị arụmọrụ mbụ nke usoro ana - eme, hypoglycemia nwere ike ịlọghachi. Ya mere, ndị ọrịa kwesịrị ilebara anya nke ọma. Mmepe nke nnukwu hypoglycemia chọrọ ọgwụgwọ na nlekọta ahụike ozugbo, n'ọnọdụ ụfọdụ, ọgwụgwọ inpatient.

Ọ dị mkpa iji nọgide na-enwe glycemia ezubere site n'enyemaka nke usoro mgbagwoju anya: ịgbaso nri na ịme mmega ahụ, belata oke ahụ, ma ọ bụrụ na ọ dị mkpa, ị drugsụ ọgwụ hypoglycemic mgbe niile. Ekwesịrị ịgwa ndị ọrịa banyere mkpa ọ dị ịgbaso akwụkwọ nri na mmega ahụ mgbe niile.

Ihe ngosi amamịghe nke ọbara shuga a haziri nke ọma gụnyere oliguria, akpịrị ịkpọ nkụ, akpịrị ịkpọ nkụ, akpịrị kpọrọ nkụ, na ndị ọzọ.

Ọ bụrụ na onye ọrịa anaghị agwọ ya ọrịa (dịka ọmụmaatụ, ụlọ ọgwụ, ihe ọghọm, mkpa ọ dị ịga leta dọkịta na ezumike ụbọchị, wdg), onye ọrịa ahụ kwesịrị ịgwa ya banyere ọrịa ahụ na ọgwụgwọ ọrịa shuga.

N'ọnọdụ nrụgide (dịka ọmụmaatụ, trauma, ịwa ahụ, ọrịa na-efe efe na ọnya), enwere ike ịnwe njikwa glycemic, yana ịgbatị ọgwụ nwa oge iji gwọọ ọgwụ metabolic dị mkpa.

Nyochaa akụrụ

A maara na metformin na-abụkarị ụmụ akụrụ. N'ịrụ ọrụ mgbazinye nsogbu, ihe ize ndụ nke nchịkọta nke metformin na mmepe nke lactic acidosis na-abawanye. Ya mere, mgbe ịta nke creatinine na ọbara ọbara gafere ogo nke afọ dị elu, ị thisụ ọgwụ a anaghị akwadoro. Maka ndị ọrịa agadi, ịkpachara anya tititi nke usoro nke metformin dị mkpa iji họrọ opekempe kachasị dị irè, dịka na afọ, ọrụ akụrụ mbelata. Ekwesịrị ilebara ọrụ mmerụ ahụ anya na ndị ọrịa merela agadi mgbe niile, dịkwa ka a na-achị, o kwesịrị ka a ghara ịgbatị ọ̀tụ̀tụ̀ metformin na ọ̀tụ̀tụ̀ ya kasị elu kwa ụbọchị.

Iji ọgwụ ndị ọzọ ejikọtara ọnụ nwere ike imetụta ọrụ akụrụ ma ọ bụ mpụta nke metformin, ma ọ bụ mee mgbanwe dị ukwuu na hemodynamics.

Ihe omumu ihe omuma banyere intravascular management nke iodine nwere ihe ndi ozo di iche (dika imaatu introvenous urography, intravenous cholangiography, angiography and compati tomography (CT) site na iji ihe di iche): ihe di iche-iche nwere iodine nwere ihe ndi eji eme nyocha nwere ike ibute oria akwara. mmepe nke lactic acidosis na ndị ọrịa na-ewere metformin (lee. "Contraindications").

Yabụ, ọ bụrụ na ezubere iduziri ụdị ọmụmụ a, a ga-akagbu Amaril ® M tupu usoro a wee ghara ịmalitegharị ọzọ na awa 48 na-esote usoro ahụ You nwere ike ịmaliteghachi usoro ọgwụ a naanị mgbe ị nyochachara ya ma nweta njirimara ndị na-egosi ọrụ arụmọrụ nkịtị.

Ọnọdụ nke hypoxia ga-ekwe omume

Ighapu ma obu ujo nke uzo obula, odida obi nke ukwu, infarction myocardial, na onodu ndi ozo putara hypoxemia na hypoxia, nwekwara ike ime ka akwara nke mbu nwa n’ewe ya ma nwekwuo ohere nke lactic acidosis. Ọ bụrụ na ndị ọrịa na-a drugụ ọgwụ a nwere ụdị ọnọdụ ahụ, ha kwesịrị ịkwụsị ọgwụ ozugbo.

Site na usoro ịwa ahụ ọ bụla, ọ dị mkpa ịkwụsị ọgwụ na ọgwụ a n'ime awa iri anọ na asatọ (ewezuga obere usoro nke anaghị achọ mgbochi na nri na mmiri mmiri), ọgwụgwọ agaghị enwe ike ịmaliteghachi ruo mgbe eweghachiri ọnụ okwu ma mata ọrụ nzipụ dị ka o kwesịrị.

Mmanya na-egbu egbu (ihe ọ drinksụ containingụ nwere ethanol)

A mara Ethanol ka ọ welie mmetụta nke metformin na metabolism nke lactate. Ya mere, a ga-akpachara ndị ọrịa anya ị consumụ mmanya nwere ethanol mgbe ha na-a thisụ ọgwụ a.

Ọrụ imeju na-arụ ọrụ

Ebe ọ bụ na n'ọnọdụ ụfọdụ lactic acidosis metụtara ọrụ imeju na-arụ ọrụ, dịka iwu, ndị ọrịa nwere akara ma ọ bụ ụlọ nyocha nke mmebi imeju kwesịrị izere iji ọgwụ a.

Agbanwe na onodu adabako nke onye ọrịa nwere oria shuga a na - ejikwa

Ekwesịrị nyochaa onye ọrịa nwere ọrịa mellitus, nke na-achịkwa nke ọma site na iji metformin, ozugbo enwere ọrịa mara mma na nke na-adịghị mma, iji wepu ketoacidosis na lactic acidosis. Ọmụmụ ihe ahụ kwesịrị ịgụnye: mkpebi siri ike nke serum electrolytes na ahụ ketone, ịta ọbara glucose na, ọ bụrụ na ọ dị mkpa, pH ọbara, ntinye ọbara nke lactate, pyruvate na metformin. Na ọnụnọ nke ụdị acidosis ọ bụla, ekwesịrị ịkwụsị ọgwụ a ozugbo yana ọgwụ ndị ọzọ edepụtara iji dozie njikwa glycemic.

Ozi Ndidi

Ekwesịrị ịgwa ndị ọrịa banyere ihe ọghọm na uru nke ọgwụ a, yana nhọrọ ọgwụgwọ ọzọ. Ọ dịkwa mkpa ịkọwa nke ọma mkpa ọ dị ịgbaso ntuziaka nri, na-eme mmega ahụ mgbe niile ma na-eleba anya na nchịkọta nke glucose n'ọbara, glycosylated hemoglobin, ọrụ akụrụngwa yana pesitara ọbara, yana ihe ize ndụ nke ịmalite hypoglycemia, ihe mgbaàmà ya na ọgwụgwọ ya, yana ọnọdụ na-eleba anya na mmepe ya.

Ntinye vitamin B₁₂ n’ime ọbara

Vitamin Belatara ebelata₁₂ dị ka usoro dị n'ọbara ọbara n'ọbara nke enweghị ọgwụgwọ, achọpụtara n'ihe dị ka 7% nke ndị ọrịa na-ewere Amaril ® M, agbanyeghị, ọ na-esikarị ike yana yana anaemia mgbe akagbuola ọgwụ a ma ọ bụ mgbe enyere ọgwụ vitamin B.₁₂ Ọ na-agbanweghachi ọsọ ọsọ. Peoplefọdụ ndị mmadụ (enweghi vitamin ma ọ bụ nwee vitamin)₁₂) buru amụma na mbelata vitamin ịta₁₂. Maka ndị ọrịa dị otú a, kwa ụbọchị, afọ 2-3 ọ bụla, mkpebi siri ike nke ndọpụ vitamin B n'ọbara nwere ike bara uru.₁₂.

Njikwa nchekwa nchekwa ụlọ nyocha

Ekwesịrị ilebara hematological pensụl (hemoglobin ma ọ bụ hematocrit, ọnụ ọgụgụ erythrocyte) na ọrụ akụrụ ya (serum creatinine ịta) ọ dịkarịa ala otu afọ na ndị ọrịa nwere ezigbo ọrụ mkpo ya, ma ọ dịkarịa ala, ugboro 2 - 4 kwa afọ na ndị ọrịa nwere ike itinye uche ya. ọbara n'ọbara na elu elu nke kwesịrị na ndị agadi ọrịa. Ọ bụrụ na ọ dị mkpa, a na-egosi onye ọrịa ahụ nyocha na ọgwụgwọ maka mgbanwe mgbanwe ọ bụla doro anya. N'agbanyeghị eziokwu ahụ bụ na anaghị ahụkarị mmepe nke megaloblastic anaemia mgbe ị na-ewere metformin, ọ bụrụ na a na-enyo enyo, a ga-eme nyocha iji wezuga ụkọ vitamin B.₁₂.

Mmetụta ikike ịkwọ ụgbọala ma ọ bụ usoro ndị ọzọ. Ọrịa mmeghachi omume nke onye ọrịa nwere ike ịka njọ n'ihi hypoglycemia na hyperglycemia, karịsịa na mmalite nke ọgwụgwọ ma ọ bụ mgbe mgbanwe ọgwụgwọ, ma ọ bụ iji ọgwụ ahụ na-adịghị agbanwe agbanwe. Nke a nwere ike imetụta ikike achọrọ iji ụgbọala na usoro ndị ọzọ. E kwesiri ịdọ ndị ọrịa aka na ntị banyere mkpa ọ dị ịkpachara anya mgbe ha na-anya ụgbọala, ọkachasị n'ụdị ebumnuche nke ịmalite hypoglycemia na / ma ọ bụ ibelata ogo nke ndị na - ebido ya.

Mmetụta ọgwụ nwere n'ahụ ahụ onye ọrịa

Glimepiride dị na ọgwụ ahụ na-emetụta akwara ndị na-eme ka akwara ahụ pụta, na-esonye na nhazi nke imepụta insulin, ma na-atụnye ụbanye na ọbara ya. Inweta insulin na plasma ọbara na-enyere aka belata ọkwa shuga n’ahụ nke onye ọrịa nwere ụdị shuga 2.

Na mgbakwunye, glimepiride na-eme ka usoro nke ibuga kalsel si plasma ọbara banye na mkpụrụ ndụ akwara. Na mgbakwunye, mmetụta ọgwụ ike na-arụ ọrụ na ịtọpụta oghere dị iche iche nke atherosclerotic na mgbidi nke arịa ọbara nke usoro ọbara.

Metformin dị na ọgwụ ahụ nyere aka belata ọkwa shuga n’ahụ onye ọrịa. Ihe mejupụtara ọgwụ a na-eme ka ọbara na-ekesa akwara nke imeju ma na-eme ka ntụgharị nke mkpụrụ ndụ imeju na glucogen gbanwee. Na mgbakwunye, metformin nwere mmetụta bara uru na nnweta glucose site na plasma ọbara site na mkpụrụ ndụ akwara.

Ojiji nke Amaril M na oria abuo na-enye ohere ka oge ogwugwo ahu nwee uto di uku na aru ahu mgbe ị na-eji ọgwụ di ala.

Eziokwu a abaghị uru dị nta maka ijigide ọnọdụ arụ ọrụ nke anụ ahụ na sistem nke anụ ahụ.

Ntuziaka maka iji ọgwụ ahụ

Ntuziaka maka iji ọgwụ ọjọọ Amaryl m na-egosi n'ụzọ doro anya na akwadoro ọgwụ a maka iji ọnụnọ nke ọrịa shuga 2 na onye ọrịa.

A na-ekpebi usoro ị drugụ ọgwụ ahụ dabere na oke glucose na plasma ọbara. A na-atụ aro ya, iji ụzọ ndị a jikọtara ọnụ dị ka Amaril m, depụta obere usoro ọgwụ dị mkpa iji nweta nsonaazu ọgwụgwọ kachasị mma.

Ekwesịrị ị drugụ ọgwụ ahụ 1-2 ugboro n'ụbọchị. Ọ kachasị mma iji nri were nri.

Ogwu kachasị nke metformin n’otu ọgwụ ekwesịghị gafere 1000 mg, na glimepiride 4 mg.

Ssụ ọgwụ kwa ụbọchị nke ogige ndị a ekwesịghị ịfe 2000 na 8 mg, n'otu n'otu.

Mgbe ị na-eji ọgwụ nwere 2 mg glimepiride na 500 mg metformin, ọnụọgụ mbadamba ụrọ kwa ụbọchị agaghị agafe anọ.

A na-ekezi ọnụọgụ ọgwụ a na-akwụ kwa ụbọchị ụzọ abụọ mbadamba mbadamba abụọ kwa ụbọchị.

Mgbe onye ọrịa ahụ kwụsịrị iwere ihe ụfọdụ nwere glimepiride na metformin rue ị Amarụ ọgwụ Amaril jikọtara ọnụ, oke ị takingụ ọgwụ ahụ na ọkwa ọgwụgwọ mbụ kwesịrị ịdị ntakịrị.

A na-edozi usoro ị Theụ ọgwụ ahụ dị ka ntughari na ọgwụ a jikọtara ọnụ na mgbanwe maka ọkwa shuga dị n’ahụ.

Iji mee ka usoro ị dailyụ ọgwụ dịkwuo ụbọchị, ọ bụrụ na ọ dị mkpa, ịnwere ike iji ọgwụ nwere 1 mg nke glimepiride na 250 mg nke metformin.

Treatmentgwọ ọgwụ a dị ogologo.

Ihe ndị a na-egbochi igbochi ọgwụ a bụ ọnọdụ ndị a:

1. onye ọrịa ahụ nwere ụdị ọrịa shuga 1.
2. Ọnụnọ nke ketoacidosis mamịrị.
3. Mmepe n'ime ahụ onye ọrịa nke coma mamịrị.
4. Ọnụnọ nke nnukwu nsogbu n’ọrụ akụrụ na akụrụ.
5. Oge ịgba aka na oge ịra nwa.
6. Ọnụnọ nke nnabata nke ọgwụ ahụ.

Mgbe ị na-eji Amaril M n'ahụ mmadụ, nsonaazụ ndị a nwere ike ịmalite:

• isi ọwụwa
• iro ụra na ọgba aghara ụra,
• ọnọdụ ịda mba
• nsogbu ụkọ
• na-ama jijiji n'ụkwụ
• ọgba aghara na arụ ọrụ nke akwara obi,
• ọgbụgbọ
• vomiting
• afọ ọsịsa
• Ọbara
• mmeghachi omume nfụkasị ahụ.

Ọ bụrụ na nsonaazụ dị n'akụkụ, ị ga-akpọtụrụ dọkịta gbasara ndozi nke ọgwụ ma ọ bụ iwepụ ọgwụ.

Akụkụ nke iji ọgwụ Amaryl M

Dọkịta na-aga, na-ahọpụta onye ọrịa ị theụ ọgwụ enyere egosipụtara, a ga-adọ ya aka na ntị banyere ihe nwere ike ime na ahụ. Ihe kachasị dị ize ndụ na nsonaazụ ya bụ hypoglycemia. Ọrịa hypoglycemia na-etolite n'ime onye ọrịa ma ọ bụrụ na ọ theụrụ ọgwụ n’erighị nri.

Iji kwusi ihe omume awara hypoglycemic n'ime ahụ, onye ọrịa ahụ ga-enwerịrị swiiti ma ọ bụ shuga mgbe niile. Dọkịta kwesịrị ịkọwa onye ọrịa ahụ n'ụzọ zuru ezu ihe akara mbụ nke ọdịdị nke hypoglycemic steeti n'ahụ ahụ, ebe ndụ onye ọrịa dabere na nke a.

Ọzọkwa, n'oge a na-agwọ ọrịa shuga nke ụdị nke abụọ, onye ọrịa ahụ kwesịrị ilebara ọkwa shuga ọbara anya.

Onye ọrịa ahụ kwesịrị icheta na ịdị irè nke ọgwụ ahụ na-ebelata mgbe ọnọdụ ndị na-akpata nchekasị bilitere, n'ihi ntọhapụ nke adrenaline n'ime ọbara.

Ọnọdụ ndị dị otú ahụ nwere ike ịbụ ihe ọghọm, esemokwu na ọrụ na ndụ onwe onye yana ọrịa na-ebilite na oke ịrị elu nke ahụ ọkụ.

Efu, nyocha banyere ọgwụ na analogues ya

Ọtụtụ mgbe, a na-enwe nyocha ndị dị mma banyere iji ọgwụ ahụ. Ọnụnọ nke ọnụọgụ nyocha dị mma nwere ike ịrụ ọrụ dị ka ihe akaebe nke oke ọgwụ a mgbe ejiri ya na usoro ọgwụgwọ kwesịrị ekwesị.

Ndị ọrịa na-ahapụ nyocha ha banyere ọgwụ na-egosipụtakarị na otu n'ime mmetụta ndị kachasị emetụta site na iji Amaril M bụ mmepe nke hypoglycemia. Iji ghara imebi usoro ịsụ ọgwụ ahụ mgbe ị na-a theụ ọgwụ ahụ, ndị na-emepụta ihe maka ịdị mma nke ndị ọrịa na-ese ụdị ọgwụ dị iche iche na agba dị iche iche, nke na-enyere aka ịnyagharị.

Ọnụahịa Amaril dabere na usoro onunu ogwu dị na ya nke ogige ọrụ nọ n'ọrụ.

Amaril m 2mg + 500mg nwere ọnụ ahịa ruru ọkara 580 rubles.

Ihe analogues nke ogwu bu:

Ọgwụ a niile bụ analogues nke Amaril m na igwe mejupụtara. Ọnụahịa analogues, dịka iwu, dị ntakịrị karịa nke ọgwụ mbụ.

Na vidiyo dị n'isiokwu a, ị nwere ike ịchọta ozi zuru ezu banyere ọgwụ na-ebelata shuga.