I-Amaril M: Imiyalo yokusetshenziswa nokwakhiwa komuthi

Umuthi uhloselwe ukusetshenziswa komlomo futhi uhlobene nokuthathwe kwesulfonylurea yesizukulwane sesithathu.

Ukukhishwa komuthi kwenziwa ngezindlela eziningana.

Umkhakha wemithi weziguli onesifo sikashukela sohlobo lwe-2 namuhla unikeza lezi zindlela ezilandelayo zomuthi wokwelapha:

1. Amaril.
2. Amaril M.
3. Amaril m cf.

Indlela ejwayelekile yesidakamizwa ifaka ekwakhekeni kwayo inhlanganisela eyodwa esebenzayo - glimepiride. I-Amaryl m ilungiselelo eliyinkimbinkimbi, elihlanganisa izingxenye ezimbili ezisebenzayo. Ngaphezu kwe-glimepiride, i-Amaril m nayo ifaka enye ingxenye esebenzayo - i-metformin.

Ngaphezu kwezingxenye ezisebenzayo, ukwakheka kwalesi sidakamizwa kufaka phakathi ezinye izinto ezidlala indima yokusekela.

Ukwakheka kwalesi sidakamizwa kufaka phakathi:

• i-lactose monohydrate;
• isitashi se-sodium carboxymethyl;
• i-povidone;
• i-crospovidone;
• i-magnesium stearate.

Ingaphezulu lamathebhulethi lifakwe kumafilimu, aqukethe lezi zinto ezilandelayo:

1. I-Hypromellose.
2. IMacrogol 6000.
3. I-titanium dioxide
4. I-Carnauba wax.

Amathebhulethi akhiqizwayo anesimo esisetshenzisiwe, esine-biconvex enesici sokuqopha emzimbeni.

I-Amaril m ikhiqizwa ngezindlela eziningi ezinokuqukethwe okuhlukile kwe-glimepiride ne-metformin.

Umkhakha wemithi ukhiqiza umuthi kulezi zinguquko ezilandelayo:

• ngesimo se-Amaril m 1 mg + 250 mg;
• ngesimo se-Amaril m 2 mg + 500 mg.

Enye yezinhlobonhlobo zomuthi i-Amaryl m isenzo se-ejenti i-Amaryl m yesikhathi eside. Lolu hlobo lwezidakamizwa lukhiqizwa yinkampani yemithi yaseKorea.

Umphumela womuthi emzimbeni wesiguli

I-glimepiride equkethwe umuthi ithinta izicubu ze-pancreatic, ibamba iqhaza ohlelweni lokulawula ukwenziwa kwe-insulin, futhi inomthelela ekungeneni kwayo egazini. Ukudakwa kwe-insulin ku-plasma yegazi kusiza ukwehlisa izinga loshukela emzimbeni wesiguli esinohlobo 2 sikashukela.

Ngaphezu kwalokho, i-glimepiride isebenzisa izinqubo zokuhambisa i-calcium zisuka kwi-plasma yegazi ziye kumaseli we-pancreatic. Ngaphezu kwalokho, umphumela wokuvinjelwa wento esebenzayo yesidakamizwa ekwakhiweni kwama-atherosulinotic plaque ezindongeni zemithambo yegazi yesistimu yokujikeleza kwamiswa.

I-Metformin equkethwe kulungiselelo isiza ukwehlisa izinga loshukela emzimbeni wesiguli. Le ngxenye yesidakamizwa ithuthukisa ukuhamba kwegazi kuzicubu zesibindi futhi ithuthukise ukuguqulwa kweshukela ngamaseli wesibindi abe yi-glucogen. Ngaphezu kwalokho, i-metformin inomphumela omuhle ekutholeni i-glucose kusuka ku-plasma yegazi ngamangqamuzana emisipha.

Ukusetshenziswa kwe-Amaril M ngohlobo 2 sikashukela kuvumela phakathi nenkathi yokwelapha ukuba nomphumela obaluleke kakhulu emzimbeni lapho usebenzisa imithamo ephansi yezidakamizwa.

Leli qiniso alibalulekanga kangako ekugcineni isimo esijwayelekile sokusebenza kwezitho nezinhlelo zomzimba.

I-Pharmacodynamics ne-pharmacokinetics ye-glimepiride

I-Glimepiride ivuselela imfihlo nokukhishwa kwe-insulin kumaseli we-pancreatic izicubu ngokuvala iziteshi ezithembele ku-potassium ze-ATP. Lesi senzo somuthi sibangela ukudonswa kwamaseli futhi kusheshise ukuvulwa kweziteshi ze-calcium. Le nqubo iholela ekujuleni kokukhishwa kwe-insulin kumaseli e-beta yi-exocytosis.

Lapho amaseli e-pancreatic evezwa i-pancreatic glimepiride, i-insulin ikhishwa ku-plasma yegazi ngokungaphansi kakhulu, ngokwesibonelo, ngaphansi kwethonya le-glibenclamide. Lesi senzo somuthi sivimbela ukuvela kwezimpawu ze-hypoglycemia emzimbeni.

I-Glimepiride isheshisa ukuthuthwa kwe-glucose kumaseli emisipha yemisipha ngokwenza kusebenze amaphrotheni okuhambisa i-GLUT1 ne-GLUT4, atholakala kulokho okwenziwa ngamangqamuzana amaseli izicubu zomzimba.

Ngaphezu kwalokho, i-glimepiride inomphumela wokuvimbela ukukhishwa kwe-glucose kumaseli wesibindi futhi ivimbela inqubo ye-gluconeogeneis.

Ukwethulwa kwe-glimepiride emzimbeni kuholela ekwehleni kwezinga le-lipid peroxidation.

Uma i-Amaril m ithathwa kaningi kumthamo wansuku zonke we-4 mg, khona-ke ukuqina okuphelele emzimbeni we-glimepiride kufinyelelwa emahoreni angama-2,5 ngemuva kokuthatha umuthi.

I-Glimepiride icishe ibe yi-bioavava ngokuphelele. Ukuthatha umuthi ngesikhathi sokudla akukuthinti kakhulu isilinganiso sokufakwa kwesidakamizwa egazini kusuka ku-lumen ye-gastrointestinal ipheshana.

Ukuhoxa kwe-glimepiride kwenziwa ngezinso. Cishe u-58% wezidakamizwa ezenziwa ngama-metabolites akhishwa yilezi zitho, cishe u-35% wezidakamizwa ukhishwa emzimbeni ngamathumbu. I-Half-life ye-glimepiride evela emzimbeni cishe amahora angama-5-6.

Ukwembulwa kwekhompiyutha ukungena ekwakhiweni kobisi lwebele nangesithintelo seplacental esibelethweni kwavezwa.

Ukuqongelelwa kwento esebenza lapho inqubo yokuthatha umuthi emzimbeni ingenzeki.

I-Pharmacodynamics ne-pharmacokinetics ye-metformin

I-Metformin isidakamizwa se-hypoglycemic okungeqembu le-Biguanides. Ukusetshenziswa kwaso kusebenza ngempumelelo kuphela uma isiguli sinohlobo lwesibili lwe-mellitus yesifo sikashukela futhi ukuhlanganiswa kwe-beta-cell of pancreatic insulin kugcinwa emzimbeni.

I-Metformin ayikwazi ukuthinta amaseli we-pancreatic izicubu futhi, ngenxa yalokho, ayithinti inqubo yokuhlanganiswa kwe-insulin. Uma usebenzisa umuthi emithanjeni yokwelapha, awukwazi ukuvusa ukubonakala kwezimpawu ze-hypoglycemia.

Indlela esebenza ngayo i-metformin emzimbeni womuntu namuhla ayiqondakali ngokuphelele.

Sekutholwe ukuthi ikhemikhali iyakwazi ukuthonya ama-receptors amaseli we-insulin-peripheral izicubu zomzimba, okuholela ekwandeni kokufakwa kwe-receptors kwe-insulin futhi, ngenxa yalokho, ukwanda kokufakwa kweglucose ngamaseli.

Umphumela we-inhibitory we-metformin ezinqubweni ze-gluconeogenesis; ngaphezu kwalokho, leli khompiyutha lisiza ukwehlisa inani lama-acid wamahhala akhiwa emzimbeni.

Ukudonswa kwe-metformin emzimbeni kuholela ekwehleni okuncane kwesifiso sokudla futhi kwehlise izinga lokufakwa kweglucose kusuka ku-lumen ye-gastrointestinal tract egazini.

I-bioavailability ye-metformin eyethulwe emzimbeni cishe i-50-60%. Ukuhlushwa okuphezulu kutholakala emahoreni angama-2,5 ngemuva kokuthatha umuthi.

Ngokuphathwa kanyekanye kwe-metformin ngokudla, kukhona ukwehla okuncane kwesilinganiso sokutholwa kwento eyakhiweyo kwiplasma yegazi.

Amakhemikhali awahlangani namaprotheni e-plasma futhi asatshalaliswa ngokushesha emzimbeni wonke. Ukukhishwa emzimbeni kwenziwa ngenxa yokusebenza kwezinso nohlelo lokuchamela. Ukuphila kwesigamu kweleketeni kungamahora angama-6-7.

Lapho kukhona ukwehluleka kwezinso, ukuthuthukiswa kokuqalwa komuthi kungenzeka.

Imiyalo yokusebenzisa umuthi

Imiyalo yokusetshenziswa komuthi i-Amaryl m ikhombisa ngokusobala ukuthi umuthi uvunyelwe ukusetshenziswa uma isiguli sinesifo sikashukela sohlobo 2.

Umthamo wesidakamizwa unqunywa ngokuya ngenani le-glucose epulini yegazi. Kunconywa, kusetshenziswa izindlela ezihlangene njenge-Amaril m, ukunquma umthamo omncane womuthi odingekayo ukufeza umphumela omuhle kakhulu wokwelapha.

Umuthi kufanele uphuzwe izikhathi ezi-1-2 phakathi nosuku. Kungcono ukuthatha umuthi ngokudla.

Umthamo omkhulu we-metformin kwithomu elilodwa akufanele udlule ku-1000 mg, kanye ne-glimepiride 4 mg.

Imithamo yansuku zonke yalezi zingxube akufanele idlule ku-2000 no-8 mg, ngokulandelana.

Lapho usebenzisa umuthi oqukethe i-2 mg ye-glimepiride ne-500 mg ye-metformin, inani lamathebulethi aphuthiwe ngosuku akufanele libe ngaphezulu kwamane.

Inani eliphelele lomuthi othathwe ngosuku lihlukaniswe ngemithamo emibili yamathebulethi amabili ngethamo.

Lapho isiguli sisuka ekuthatheni amalungiselelo athile aqukethe i-glimepiride ne-metformin ekuphuzeni isidakamizwa esihlanganisiwe se-Amaril, umthamo wokuthatha umuthi lapho usuqala ukwelashwa kufanele ube mncane.

Imithamo yomuthi othathwe njengokushintsha kwesidakamizwa esihlanganisiwe iyaguqulwa ngokuya ngokushintshwa kwezinga likashukela emzimbeni.

Ukwandisa umthamo wansuku zonke, uma kunesidingo, ungasebenzisa isidakamizwa esiqukethe i-1 mg ye-glimepiride ne-250 mg ye-metformin.

Ukwelashwa nalesi sidakamizwa yinde.

Ukuxhumana kokusebenzisa umuthi yilezi zimo ezilandelayo:

1. isiguli sinesifo sikashukela sohlobo 1.
2. Ukuba khona kwe-ketoacidosis yesifo sikashukela.
3. Ukuthuthuka emzimbeni wesiguli okomuntu onesifo sikashukela.
4. Ukuba khona kwezifo ezinzima ekusebenzeni kwezinso nesibindi.
5. Isikhathi sokukhulelwa kanye nesikhathi sokukhulelwa.
6. Ukuba khona kokungabekezelelani ngakunye ezingxenyeni zomuthi.

Uma usebenzisa i-Amaril M emzimbeni womuntu, imiphumela emibi elandelayo ingaqhamuka:

• ikhanda
• ukozela nokuphazamiseka kokulala;
• amazwe acindezelayo;
• ukuphazamiseka kokukhuluma;
• ukuthuthumela emilenzeni;
• ukuphazamiseka ekusebenzeni kohlelo lwezinhliziyo;
• isicanucanu
• ukuhlanza
• isifo sohudo
• I-Anemia
• ukungahambi kahle komzimba.

Uma imiphumela emibi ivela, kufanele uthintane nodokotela mayelana nokulungiswa kwamthamo noma ukuhoxiswa kwezidakamizwa.

Izici zokusebenzisa isidakamizwa i-Amaryl M

Udokotela ohambelayo, onquma isiguli ukuthi siphuze umuthi obonisiwe, unesibopho sokuxwayisa ngamathuba emiphumela emibi emzimbeni. Okuyingozi futhi okuyingozi kakhulu kwemiphumela emibi yi-hypoglycemia. Izimpawu ze-hypoglycemia ziba yisiguli uma ephuza umuthi ngaphandle kokudla.

Ukuvimba ukwenzeka kwesimo se-hypoglycemic emzimbeni, isiguli kumele ngaso sonke isikhathi sibe noswidi noma ushukela sibe izicucu naye. Udokotela kufanele achazele isiguli ngokuningiliziwe ukuthi yiziphi izimpawu zokuqala zokubonakala kwesimo se-hypoglycemic emzimbeni, ngoba impilo yesiguli incike kakhulu kulokhu.

Ngaphezu kwalokho, ngesikhathi sokwelashwa kwe-mellitus yesifo sikashukela sohlobo lwesibili, isiguli kufanele siqaphe njalo amazinga kashukela egazini.

Isiguli kufanele sikhumbule ukuthi ukusebenza komuthi kuyancipha lapho kwenzeka izimo ezicindezelayo, ngenxa yokukhishwa kwe-adrenaline egazini.

Izimo ezinje zingaba yizingozi, izingxabano emsebenzini kanye nasempilweni yomuntu siqu nezifo ezihambisana nokukhuphuka okuphezulu kokushisa komzimba.

Izindleko, ukubuyekezwa komuthi kanye nokufana kwawo

Imvamisa, kuba nokubuyekezwa okuhle ngokusetshenziswa komuthi. Ukuba khona kwenani elikhulu lokubuyekezwa okuhle kungasebenza njengobufakazi bokusebenza okuphezulu komuthi lapho kusetshenziswa kumthamo ofanele.

Iziguli ezishiya ukubuyekezwa kwazo mayelana nomuthi zivame ukukhombisa ukuthi omunye wemiphumela emibi kakhulu evela ekusebenziseni i-Amaril M ukuthuthukiswa kwe-hypoglycemia. Ukuze bangephule umthamo lapho bethatha lo muthi, abakhiqizi ukuze benze lula iziguli zipende izinhlobo ezahlukene zomuthi ngemibala ehlukene, esiza ukuzulazula.

Intengo ye-Amaril incike kumthamo oqukethwe kuwo amakhompiyutha asebenzayo.

I-Amaril m 2mg + 500mg inezindleko ezimaphakathi zama-ruble angama-580.

Izifanekiso zomuthi yilezi:

1. I-Glibomet.
2. Ama-Glucovans.
3. Dianorm m.
4. I-Dibizid-m.
5. I-Douglimax.
6. I-Glibenclamide.
7. IDuotrol.

Zonke lezi zidakamizwa ziyi-analogues ye-Amaril m ekwakhiweni kwengxenye. Intengo yama-analogues, njengomthetho, iphansi kancane kunaleyo yesidakamizwa sokuqala.

Kwividiyo ekulesi sihloko, ungathola imininingwane ephelele ngalesi sidakamizwa esinciphisa ushukela.