Ezigulini ezinesifo sikashukela sohlobo 2, umbuzo uvame ukuphakama, kuthatha isikhathi esingakanani iMetformin? Eqinisweni, impendulo yalo mbuzo ayikho. Akekho udokotela ongacacisa isikhathi esiqondile, ngoba ukwelashwa kwesiguli ngasinye kuya ngesimo sakhe sempilo, izinga leshukela, ubukhulu besifo sikashukela nezifo ezihlobene naso.
Isifo sikashukela i-mellitus sibizwa ngokuthi isifo sangekhulu lama-21. Lokhu kungenxa yokuthi minyaka yonke isibalo seziguli ezinalezi zifo siyakhuphuka. Izibalo zikhombisa ukuthi ama-90% abo bonke abantu abanesifo sikashukela abahlushwa uhlobo lwesibili lwesifo, phakathi kwabo isibalo esikhulu sabantu besifazane abakhuluphele sivezwa kunamadoda.
I-Metformin isidakamizwa esidumile phakathi kwesifo sikashukela esincike ku-insulin esingakwazi ukuthola ukuncishiswa kashukela ngokudla okukhethekile nokuzivocavoca. Ngaphezu kwalokho, isetshenziselwa futhi ukuvikela imiphumela emibi yesifo sikashukela kanye nesimila somdlavuza. Kepha iyini indlela yokusebenza komuthi, uwuthathe kanjani ngokufanele ukuze ungazilimazi? Ake sizame ukuthola lokhu.
Indlela yokusebenza ye-Metformin
Isenzo sento sihloselwe ukuvimbela inqubo ye-gluconeogenesis eyenzeka esibindini. Lapho ukukhiqizwa kwe-glucose esithoyini kuncishisiwe, izinga layo legazi nalo liyancipha. Kumele kuqashelwe ukuthi kuma-diabetes, isilinganiso sokwakheka kwe-glucose esibindini sidlula okungenani kathathu amanani ajwayelekile.
Esibindini kukhona i-enzyme ebizwa nge-AMP-activated protein kinase (AMPK), eyenza umsebenzi ophambili ekusayinisweni kwe-insulin, imetabolism yamafutha noshukela, kanye nasezilinganisweni zamandla. I-Metformin isebenzisa i-AMPK ukuvimbela ukukhiqizwa koshukela.
Ngaphezu kokucindezela inqubo ye-gluconeogeneis, i-metformin yenza eminye imisebenzi, okuyile:
- kuthuthukisa ukuzwela kwezicubu zomzimba kanye namaseli kufinyelela ekwehliseni ushukela;
- kwenyusa ukuthathwa koshukela ngamaseli;
- kuholela ekukhuliseni i-oxidation yamafutha acid;
- kuphambanisa ukumuncwa kwe-glucose emgodini wokugaya ukudla.
Ukuthatha umuthi kusiza ukwehlisa ukukhuluphala ngokweqile kubantu. I-Metformin yehlisa i-serum cholesterol, i-TG ne-LDL cholesterol esiswini esingenalutho. Ngasikhathi sinye, akuguquki inani lamapoprotein wezinye izingxenyana. Umuntu ophilile (onama-glucose ajwayelekile) othatha i-metformin ngeke ayizwe imiphumela yokwelashwa.
Ngokusebenzisa umuthi, isiguli singafinyelela ukwehla kokuqukethwe ushukela ngama-20%, kanye nokuqoqwa kwe-hemoglobin ye-glycosylated cishe nge-1.5%. Ukusetshenziswa kwesidakamizwa njenge-monotherapy, ngokuqhathanisa nezinye izidakamizwa ezinciphisa ushukela, i-insulin kanye nokudla okhethekile, kunciphisa amathuba okuba nesifo senhliziyo. Ngaphezu kwalokho, ucwaningo lwango-2005 (Cochrane Collaboration) lufakazele ukuthi ukushona kweziguli ezinesifo sikashukela sohlobo 2 kuncishiswa ngokuthatha iMetformin.
Ngemuva kokuthi isiguli siphuze ithebhulethi ye-metformin, izinga legazi lakhe lizokhuphuka ngaphezulu kwamahora angama-1-3 futhi uzoqala ukwenza isenzo. Umuthi udonswa ngokushesha ngokwanele emgudwini wesisu.
Ingxenye leyo ayisakhiwanga umzimba, kepha ikhishwe emzimbeni womuntu ngomchamo.
Imiyalo yokusebenzisa umuthi
Umuthi iMetformin ukhishwa ngendlela yamaphilisi aqukethe i-500 mg yento esebenzayo (metformin hydrochloride). Ngokwengeziwe kuyo, ithuluzi lifaka inani elincane lezinto ezengeziwe: isitashi sommbila, i-crospovidone, i-povidone K90, i-magnesium stearate ne-talc. Iphakethe elilodwa liqukethe izinhlayiya ezi-3 zamathebulethi ayi-10.
Uchwepheshe kuphela ohlola impilo yesiguli okufanele abonise ukusetshenziswa kwe-Metformin yezidakamizwa. Lapho isiguli siphuza amaphilisi, kufanele silandele ngokucophelela zonke izincomo zikadokotela.
Umyalo wokufaka uqukethwe kwiphakeji ngalinye lesidakamizwa. Kuyo ungathola izinkomba ezilandelayo ezisetshenziswayo:
- Uhlobo 2 sikashukela i-mellitus, ikakhulukazi kubantu abakhuluphele abangavunyelwe yi-ketoacidosis (i-carbohydrate metabolism).
- Ngokuhlanganiswa nokwelashwa kwe-insulin nokuphikisana nama-hormone, okwavela ngokwesibili.
Kumele kuqashelwe ukuthi uchwepheshe kuphela ongabala umthamo ofanele, unikezwe inani likashukela egazini likashukela. Imiyalo ihlinzeka ngemithamo ejwayelekile yomuthi, evame ukudinga ukubuyekezwa nokulungiswa.
Umthamo wokuqala wesidakamizwa ngamathebulethi ayi-1-2 (afinyelela ku-1000 mg ngosuku). Ngemuva kwamasonto amabili, ukwanda komthamo we-metformin kungenzeka.
Imithamo yokulungisa umuthi ngamathebulethi ama-3-4 (kufika ku-2000 mg ngosuku). Umthamo wansuku zonke ophakeme ungamathebhulethi ayi-6 (3000 mg). Kwabantu asebekhulile (kusuka eminyakeni engama-60) kunconyelwa ukuphuza i-metformin kungabi ngaphezu kwamathebhulethi ayi-2 ngosuku.
Ungaphuza kanjani amaphilisi? Zidliwa zigcwele, zigezwa ngengilazi encane yamanzi, ngesikhathi sokudla noma ngemuva kwaso. Ukwehlisa amathuba okuvela okungahambi kahle okuhambisana nohlelo lokugaya ukudla, umuthi kufanele uhlukaniswe kaningi. Lapho kuvela ukuphazamiseka okukhulu kwe-metabolic, umthamo wesidakamizwa kufanele uncishiswe ukugwema ukuthuthukiswa kwe-lactic acidosis (lactic coma).
I-Metformin kumele igcinwe endaweni eyomile neyomnyama ngaphandle kokuthola izingane ezincane. Izinga lokushisa ligcina kusuka ku- +15 kuya ku- +25 degrees. Isikhathi somuthi yiminyaka emi-3.
Contraindication kanye nemiphumela emibi
Njengayo yonke eminye imishanguzo, ukusetshenziswa kwe-metformin kungahle kubhekwe kubantu abane-pathologies ethile noma kwezinye izizathu.
Njengoba sekushiwo, ezigulini ezineminyaka engaphezu kwengama-60, ikakhulukazi labo abasebenza kanzima kanzima, lo muthi awunconywa ukuba usetshenziswe, ngoba ungaholela ekwakhiweni kwe-lactic acidosis.
Uhlu lwe-contraindication lwalesi sidakamizwa aluncane kangako. Ukusetshenziswa kwe-metformin kuvinjelwe lapho:
- i-precoma noma ikoma, ukuxilongwa kwe-ketoacidosis yesifo sikashukela;
- ukungasebenzi kwezinso nesibindi;
- izifo ezithinta kakhulu ezithinta ukusebenza kwezinso (ukuphuma komzimba, i-hypoxia, izifo ezahlukahlukene, umkhuhlane);
- ubuthi ngotshwala noma uphuzo oludakayo;
- i-pathologies engapheli noma ebukhali engahle iholele ekuthuthukisweni kwe-myocardial infarction, ukuphefumula noma ukwehluleka kwenhliziyo;
- i-lactic acid coma (ikakhulukazi, umlando);
- ukuqhuba okungenani izinsuku ezimbili ngaphambi nangezinsuku ezimbili ngemuva kokuhlolwa kwama-x-ray nama-radioisotope ngomjovo wengxenye ehlukile equkethe iodine;
- umsoco ophansi wekhalori (ngaphansi kwama-kilojoule ayi-1000 ngosuku);
- ukuthwala ingane nokuncelisa;
- ukwanda ukutholakala kokuqukethwe umuthi.
Lapho isiguli sithatha umuthi ngaphandle kokubambelela ezincomweni zikadokotela, imiphumela emibi ehlukahlukene ingavela. Zihlotshaniswa nokusebenza okungalungile:
- umgudu wokugaya ukudla (ukuhlanza, ukunambitha ushintsho, ukukhuphuka kwengqondo okugcwele, ukuntuleka kwesifiso sokudla, isifo sohudo noma ubuhlungu besisu);
- izitho ze-hematopoietic (ukuthuthukiswa kwe-megaloblastic anemia - ukuntuleka kwe-folic acid ne-vithamini B12 emzimbeni);
- i-metabolism (ukuthuthukiswa kwe-lactic acidosis ne-B12 hypovitaminosis ehambisana ne-malabsorption);
- uhlelo lwe-endocrine (ukuthuthukiswa kwe-hypoglycemia, ebonakaliswa ukukhathala, ukungaxineki, ukuphathwa ikhanda nesiyezi, ukulahleka kwengqondo).
Kwezinye izikhathi kungahle kube nokuqubuka kwesikhumba. Ukuphendula okungahambi kahle okuhambisana nokuphazamiseka kohlelo lokugaya ukudla kwenzeka kaningi emavikini amabili okuqala okwelashwa. Lokhu kusabela okujwayelekile komzimba, ngemuva kwezinsuku eziyi-14, umlutha we-metformin kwenzeka, futhi izimpawu zihamba zodwa.
Ukusekelwa ngokweqile
Umuntu onesifo sikashukela ukuphuza umuthi ngamazinga aphezulu kunalapho kukhonjiswe imiyalo noma kunqunywe udokotela ongabakhona kungadala omkhulu umonakalo emzimbeni wakhe, ingasaphathwa eyokufa. Nge-overdose, umphumela oyingozi ungenzeka - i-lactic acidosis kushukela. Enye imbangela yokuthuthuka kwayo ukugcotshwa komuthi uma kwenzeka ungasebenzi kahle kwinso.
Isibonakaliso se-lactic acidosis ukungcwatshwa, ubuhlungu besisu, izinga lokushisa lomzimba eliphansi, izinhlungu zemisipha, ukukhuphuka kwezinga lokuphefumula, isiyezi nobuhlungu ekhanda, ukufiphala, ngisho nokuqina komzimba.
Uma isiguli siqaphele okungenani eyodwa yezimpawu ezingenhla, ukukhanselwa okuphuthumayo kwe-metformin kuyadingeka. Okulandelayo, kufanele usesibhedlela isiguli ngokushesha ukuze uthole ukunakekelwa okuphuthumayo. Udokotela unquma okuqukethwe kwe-lactate, ngokwesisekelo salokhu, uqinisekisa noma uyenqaba ukutholwa.
Isilinganiso esihle kakhulu sokususa i-lactate ngokweqile nge-metformin inqubo ye-hemodialysis. Ukuqeda izimpawu ezisele, ukwelashwa okubonakalayo kuyenziwa.
Kumele kuqashelwe ukuthi ukusetshenziswa okuyinkimbinkimbi kwe-metformin kanye nama-ejenti ane-sulfonylurea derivatives kungadala ukwehla okusheshayo kokuhlushwa ushukela.
Ukuxhumana nezinye izindlela
Ngesikhathi sokusetshenziswa kwe-metformin enkingeni nezinye izidakamizwa, ukusabela kwamakhemikhali kwenzeka phakathi kwezakhi zezimali, ezithuthukisa noma zinciphise umphumela wokwehla ushukela we-metformin.
Ngakho-ke, ukusetshenziswa kwe-metformin ne-danazole ngasikhathi sinye kuholela ekwandeni okusheshayo kwamazinga kashukela. Ngokuqapha, udinga ukusebenzisa i-chlorpromazine, enciphisa ukukhishwa kwe-insulin, ngaleyo ndlela ikhulisa i-glycemia. Ngesikhathi sokulashwa ngama-antipsychotic ngisho nangemva kokukhishwa kwezidakamizwa, umthamo we-metformin udinga ukulungiswa.
Amathuba okukhuphuka komphumela wokunciphisa ushukela kwenzeka lapho kudliwa:
- I-Glucocorticosteroids (GCS).
- I-Sympathomimetics.
- Imithi yokuvimbela ukusetshenziswa kwangaphakathi.
- Epinofrina.
- Ukwethulwa kwe-glucagon.
- Ama-hormone egilo.
- Okususelwa ku-phenothiazone.
- I-Loop diuretics ne-thiazides.
- Izithasiselo ze-Nicotinic acid.
Ukwelashwa nge-cimetidine kungaholela ekwakhiweni kwe-lactic acidosis. Ukusetshenziswa kwe-metformin, kwenza buthaka umphumela wama-anticoagulants.
Ukuphuza utshwala kuvame ukuphikiswa lapho usebenzisa i-metformin. Ukudakwa kakhulu ngokudla okuphansi kanye nokudla okungenamkhawulo, ukubulawa yindlala noma ukwehluleka kwesibindi kuholela ekwakhekeni kwe-lactic acidosis.
Ngakho-ke, ngesikhathi sokwelashwa nge-metformin, iziguli kufanele ziqaphe umsebenzi wezinso. Ukuze wenze lokhu, badinga okungenani izikhathi ezimbili ngonyaka ukutadisha i-lactate ku-plasma. Kuyadingeka futhi ukuthi kuhlaziywe okuqukethwe i-creatinine esegazini. Uma imiphumela ikhombisa ukuthi i-creatinine concentration ingaphezulu kwe-135 μmol / L (owesilisa) no-110 μmol / L (owesimame), ukuyeka umuthi kuyadingeka.
Uma isiguli satholakala sinesifo esithathelwanayo se-bronchopulmonary noma i-pathology esithathelwanayo yohlelo lwezitho zofuzo, uchwepheshe kufanele aboniswe ngokuphuthumayo.
Ukuhlanganiswa kwe-metformin nezinye izidakamizwa ezinciphisa ushukela, njengokufakwa kwemijovo ye-insulin kanye ne-sulfonylureas, kwesinye isikhathi kuholela ekunciphiseni kokuhlushwa. Le nto kufanele ibhekelwe iziguli ezishayela izimoto noma izindlela eziyinkimbinkimbi. Kungadingeka ukuthi uyeke lomsebenzi oyingozi ngesikhathi sokwelashwa.
Lapho usebenzisa ezinye izidakamizwa, isiguli kufanele sazise udokotela ngalokhu, ongashintsha umthamo nobude besikhathi sokwelashwa.
Izindleko, ukubuyekezwa kanye nama-analogues
Intengo yeMetformin incike ekutheni ingeniswa noma ikhiqizwe ngaphakathi yini.
Njengoba isithako esisebenzayo singumenzeli we-hypoglycemic odumile ezingxenyeni ezihlukene zomhlaba, amazwe amaningi ayakhiqiza.
Ungawuthenga lo muthi ngokwethula umuthi ekhemisi, kukhona futhi nenketho yoku-oda umuthi online.
Izindleko zalo muthi zincike esifundeni somuthi osendaweni ye-Russian Federation kanye nomenzi
- I-Metformin (Russia) Cha 60 - izindleko ezisezingeni eliphansi ngama-ruble angama-196, kanti esiphezulu ngama-ruble angama-305.
- I-Metformin-Teva (Poland) Cha 60 - izindleko ezisezingeni eliphansi ngama-ruble angama-247, kanti esiphezulu ngama-ruble angama-324.
- I-Metformin Richter (Hungary) No. 60 - inani eliphansi lizi-ruble ezingama-287, kanti eliphezulu lingama-ruble angama-344.
- I-Metformin Zentiva (ISlovakia) Cha 30 - izindleko ezisezingeni eliphansi ngama-ruble angama-87, kanti esiphezulu ngama-ruble angama-208.
- I-Metformin Canon (Russia) Cha 60 - izindleko ezisezingeni eliphansi ngama-ruble angama-230, kanti esiphezulu ngama-ruble angama-278.
Njengoba ubona, izindleko zomuthi iMetformin ziphansi impela, ngakho-ke wonke umuntu onemali ehlukile angayithenga. Ngaphezu kwalokho, kunenzuzo ethe xaxa ukuthenga izidakamizwa ezifuywayo, ngoba intengo yazo inciphile, futhi umphumela wokwelapha uyefana.
Ukubuyekezwa kwabashukela abaningi kukhombisa ukuthi iMetformin isidakamizwa esisebenzayo se-hypoglycemic. Ngokushesha kunciphisa ukugcwala kweglucose egazini futhi kwandise umphumela we-hypoglycemic ngokusetshenziswa isikhathi eside komuthi. Iningi leziguli liyabona kalula ukusetshenziswa komuthi nezindleko zawo eziphansi, okuyinzuzo enkulu. Lapho ebuzwa ukuthi kungenzeka yini ukuphuza i-metformin ukwehlisa isisindo, abantu baphendula kahle.
Abantu abaningi bayazibuza ukuthi ngabe izimpawu zokuhoxa zenzeka yini ngemuva kokuthatha i-metformin. Ukukhishwa kwesidakamizwa akubangeli ukukhuphuka kwe-glucose egazini kanye nokwenyuka kwesisindo somzimba.
Phakathi kokushiyeka, kukhona ukwephulwa kokugaya okuhambisana nomlutha womzimba esenzweni somuthi. Ngemuva kwamasonto amabili, lezo zimpawu ezingezinhle zihamba zodwa.
Ngenxa yokuthi umuthi onama-elementform metformin akhiqizwa emhlabeni wonke, unamagama amaningi. Umehluko uzoba kuphela ukuthi yiziphi izinto ezingeziwe ezisetshenziswayo. Ama-analogues wezidakamizwa iMetformin nguGlatini, Metfogamma, uBagomet, uSiofor, uGlyukofazh, u-Altar nabanye. Umuthi osetshenzisiwe kufanele usithinte kahle isimo sempilo sesiguli, ngaphandle kokubanga imiphumela emibi.
Ukungasebenzi kokulashwa nge-metformin kuhlotshaniswa nokwehluleka ukulandela ukudla okhethekile kwesifo sikashukela, indlela yokuphila yokuhlala phansi, nokulawulwa okungazinzile kwamazinga kashukela. Eqinisweni, ukuthatha imishanguzo kuphela akunakukunikeza ngokuphelele umphumela we-hypoglycemic. Ukugcina impilo kuphela enempilo, ukwelashwa ngezidakamizwa nokulandela zonke izincomo zikadokotela kungathuthukisa impilo yesiguli futhi kunciphise nezimpawu zesifo sikashukela. Ividiyo ekule ndatshana izokwengeza ngolwazi mayelana nomuthi.
