AmaBiguanides izidakamizwa ezenzelwe ukwehlisa ushukela wegazi. Ithuluzi liyatholakala ngesimo samathebulethi.
Zisetshenziselwa, kaningi, ngohlobo lwe-2 yesifo sikashukela, njengesijobelelo.
Njengengxenye ye-monotherapy, izidakamizwa ze-hypoglycemic zichazwa kuyaqabukela. Imvamisa lokhu kwenzeka emaphesenti angama-5- 10%.
AmaBiguanides afaka lezi zidakamizwa ezilandelayo:
- I-Bagomet,
- Avandamet
- I-Metfogamma,
- I-Glucophage,
- I-Metformin Acre
- Siofor 500.
Okwamanje, eRussia, kanye nasemhlabeni wonke, ama-Biguanides asetshenziswa, ingxenye enkulu, i-methylbiguanide derivatives, okungukuthi, metformin:
- glucophage
- Siofor
- i-metpho-gamma,
- dianormet
- glyformin nabanye.
I-Metformin ihlukana kusuka ehoreni elilodwa nesigamu kuya emahoreni amathathu. Umuthi ukhiqizwa ezibhebheni ze-850 no-500 mg.
Imithamo yokwelapha ingu-1-2 g ngosuku.
Ungadla kuze kufike ku-3 g ngosuku lwesifo sikashukela.
Okuphuma ku-Butylbiguanide:
- i-silubin
- buformin
- Adebite.
Uyacelwa ukuthi uqaphele ukuthi ama-biguanides asetshenziswa kuphela, ngenxa yemiphumela emibi kakhulu, okungukuthi i-gysric dyspepsia.
Manje odokotela abancomi ukusebenzisa okuphuma ku-phenylbiguanide, ngoba kufakazelwa ukuthi kuholela ekuqongeleleni egazini lomuntu:
- i-pyruvate
- lactate
Isenzo sezidakamizwa
Ososayensi baveze ukuthi imiphumela enciphisa ushukela we-metformin kushukela ihlotshaniswa nomphumela othize wesidakamizwa echibini nasekwenzeni. Umphumela wehlisela ushukela we-metformin uhlotshaniswa nabathutha i-glucose esitokisini.
Umthamo wezinto zokuhambisa ushukela ukhuphuka ngenxa yokuchayeka kuma-Biguanides. Lokhu kubonakaliswa kuthuthukiso lweglucose oluthuthukisiwe kuwo wonke ulwelwesi lweseli.
Lo mphumela uchaza umphumela ezenzweni zombili i-insulin yomzimba ne-insulin evela ngaphandle. Izidakamizwa nazo zisebenza kulwelwesi lwe-mitochondrial.
I-Biguanides inhibit gluconeogenesis, ngalokho banegalelo ekwandeni kokuqukethwe kwe:
- lactate
- i-pyruvate,
- Alanine
Lezi zinto zingaphambili kwe-glucose kumongo we-gluconeogeneis.
Umthamo wezinto zokuhambisa ushukela ukhuphuka ngaphansi kwesenzo se-metformin kulwelwesi lwe-plasma. Imayelana:
- I-GLUT-4,
- I-GLUT-2,
- I-GLUT-1.
Ukuhamba kwe-glucose kuyashesha:
- kwimisipha ebushelelezi yemisipha
- endothelium
- izicubu zenhliziyo.
Lokhu kuchaza ukwehla kokungazweli kwe-insulin kubantu abanesifo sikashukela sohlobo 2 ngaphansi kwethonya le-metformin. Ukwanda kokuzwela kwe-insulin akuhambisani nokwenyuka kokuqanjwa kwayo ngamanyikwe.
Ngokuphikisana nesizinda sokwehla kokumelana ne-insulin, izinga eliyisisekelo elibonisa i-insulin egazini nalo liyancipha. Ukwanda kokuzwela kwe-insulin akuhambisani nokwenyuka kokuklanywa kwayo ngamanyikwe, njengalapho kusetshenziswa ama-sulfonylureas.
Lapho welapha nge-metformin kubantu, ukwehla kwesisindo kuyabonakala, kepha uma welapha ama-sulfonylurea agents kanye ne-insulin, umphumela ophikisayo ungaba. Ngaphezu kwalokho, i-metformin isiza ukwehlisa i-serum lipids.
Imiphumela emibi
Imiphumela emiphumela emqoka evela ekusetshenzisweni kwe-metformin kufanele ibonwe, indlela esebenza ngayo yile elandelayo:
- isifo sohudo, isicanucanu, ukugabha;
- ukunambitheka kwensimbi emlonyeni;
- ukungakhululeki esiswini;
- ukuncipha nokulahlekelwa yinhliziyo yokudla, kuze kufike ekuphambukeni ukudla;
- i-lactic acidosis.
Imiphumela emibi ebonisiwe nezenzo, njengomthetho, zisuka ngokushesha zinokwehla ngomthamo. Ukuhlaselwa yisifo sohudo kuwuphawu lokumisa ukuthatha i-metformin.
Uma uthatha i-Metformin 200-3000 mg ngosuku isikhathi eside, khona-ke kuzodingeka ukhumbule ukuthi ukumuncwa kwamapheshana esiswini kuzokwehla:
- Amavithamini we-B,
- i-folic acid.
Kuyadingeka ukuxazulula esimweni ngasinye inkinga yokuqokwa okwengeziwe kwamavithamini.
Kubalulekile ukugcina okuqukethwe kwe-lactate okuqukethwe kungaphansi kokulawulwa, futhi kuhlole lokhu okungenani kabili ngonyaka. Lokhu kubalulekile kunikezwe amandla e-metformin okukhulisa i-anaerobic glycolysis emathunjini amancane nasekuvimbeleni i-glycogenolysis esibindini.
Uma umuntu enezikhalazo zobuhlungu bemisipha nokunambitheka kwensimbi emlonyeni, kubalulekile ukutadisha izinga le-lactate. Uma okuqukethwe igazi layo lenyuke, khona-ke izindlela zokwelashwa nge-metformin kufanele zime.
Uma kungenakwenzeka ukutadisha izinga le-lactate egazini, khona-ke i-metformin ikhanseliwe kuze kube yilapho isimo sivamile, khona-ke wonke amathuba okuphathwa kwayo ayahlolwa.
I-contraindication esemqoka
Kunemikhawulo ethile yokusetshenziswa kwe-metformin:
- i-ketoacidosis yesifo sikashukela, kanye nethonya nezinye izimo zemvelaphi yesifo sikashukela;
- umsebenzi wokuphazamiseka wezinso, ukwanda kwe-creatinine egazini ngaphezu kwe-1.5 mmol / l;
- izimo ze-hypoxic zanoma iluphi uhlobo lwe-genesis (i-angina pectoris, ukwehluleka kokujikeleza, i-4 FC, i-angina pectoris, infarction ye-myocardial);
- ukwehluleka ukuphefumula;
- i-encephalopathy enamandla
- imivimbo
- i-anemia
- izifo ezithathelwanayo ezihlasela kakhulu, izifo zokuhlinzwa;
- utshwala
- ukwehluleka kwesibindi;
- ukukhulelwa
- izinkomba zomlando we-lactic acidosis.
Ngenqubo yokwanda kwesibindi, ama-biguanides anqunywa lapho i-hepatomegaly ibonwa njengomphumela we-hepatostatosis yesifo sikashukela.
Ngokuphazamiseka okungapheli kwe-allergic and dystrophic kwesibindi, umphumela wama-Biguanides ku-hepatic parenchyma ungaqoshwa, okuvezwa ku:
- ukubonakala kwe-cholestasis, kwesinye isikhathi kufika kuma-jaundice abonakalayo,
- ushintsho ekuhlolweni kwesibindi okusebenzayo.
E-hepatitis ephikelelayo engapheli, izidakamizwa kufanele zisetshenziswe ngokuqapha.
Ngokungafani nokususelwa kwe-sulfonylurea, ama-biguanides awanawo umphumela oqondile onobuthi emsebenzini we-hematopoietic womongo wamathambo nezinso. Kodwa-ke, zifakwe ku-contraindised ku:
- izifo zezinso ezikhuthaza ukwehla kokuhlunga kwe-glomerular
- ukugcinwa kwe-nitrogenous slag
- anemia kakhulu, ngenxa yengozi ye-lactacidemia.
Abantu abagulayo abagulayo kudingeka banikeze izidakamizwa ngokucophelela, ngoba lokhu kuhlotshaniswa nosongo lwe-lactic acidosis. Lokhu kusebenza kulezi ziguli ezisebenza kakhulu ngokomzimba.
Kukhona izidakamizwa, ukusetshenziswa kwayo ekwelapheni i-Biguanides kwandisa ukusebenza kwe-lactic acidosis, yilezi:
- i-fructose
- teturam
- ama-antihistamines
- ama-salicylates,
- ama-barbiturates.
