I-Yanumet - umuthi wokuhlanganisa onhlobo lwesifo sikashukela sohlobo 2

I-Yanumet iyisidakamizwa esinciphisa ushukela esinezinto ezimbili ezinezinto ezi-2 ezisebenzayo: i-metformin ne-sitagliptin. Umuthi wabhaliswa eRussia Federation ngonyaka we-2010. Emhlabeni jikelele, imishanguzo esekwe sitagliptin ithatha abantu abangaphezu kwezigidi ezingama-80 sikashukela. Ukuthandwa okunjalo kuhlotshaniswa nokusebenza kahle kanye nokuphepha okuphelele kwe-DPP-4 inhibitors, okubandakanya i-sitagliptin. I-Metformin ngokuvamile ibhekwa njengejwayelekile "legolide" ekwelapheni isifo sikashukela, ngokuyinhloko ichazwa ezigulini ezinesifo sohlobo 2. Ngokusho kwabanesifo sikashukela, azikho izingxenye zezidakamizwa eziholela ku-hypoglycemia, zombili lezi zinto azibangeli ukuzuza kwesisindo futhi zibe nomthelela ekulahlekelweni kwalo.

Asebenza kanjani amaphilisi weYanumet

Ngemuva kokuxilongwa kwesifo sikashukela, isinqumo ekwelashweni okudingekayo senziwa ngomphumela wokuhlaziywa kwe-hemoglobin ye-glycated. Uma ngabe le nkomba ingaphansi kwe-9%, isiguli singadinga umuthi owodwa kuphela, i-metformin, ukwenza i-glycemia ibe yodwa. Kusebenza kakhulu kwiziguli ezinesisindo esiphakeme kanye nezinga lokucindezela eliphansi. Uma i-hemoglobin ye-glycated ingaphezulu, umuthi owodwa ezimweni eziningi akwanele, Ngakho-ke, inhlanganisela yokwelapha inqunyelwe abanesifo sikashukela, isidakamizwa esinciphisa ushukela esivela kwelinye iqembu sengezwe kwi-metformin. Kungenzeka ukuthatha ukuhlanganiswa kwezinto ezimbili kwithebhulethi eyodwa. Izibonelo zezidakamizwa ezinje yiGlibomet (metformin ene-glibenclamide), Galvus Met (ene-vildagliptin), uJanumet (ene-sitagliptin) nezimpawu zabo.

Lapho ukhetha inhlanganisela efanelekile, imiphumela emibi wonke amaphilisi we-antidiabetic abalulekile. Ama-Derivatives we-sulfonylureas ne-insulin akhulisa kakhulu ingozi ye-hypoglycemia, akhuthaze ukuqina kwesisindo, i-PSM isheshise ukwehla kwamaseli we-beta. Ezigulini eziningi, inhlanganisela ye-metformin ene-DPP4 inhibitors (gliptins) noma ama-incretin mimetics izoba nengqondo. Womabili la maqembu akhulisa ukwakheka kwe-insulin ngaphandle kokulimaza amaseli we-beta futhi ngaphandle kokubangela i-hypoglycemia.

I-sitagliptin equkethwe umuthi weJanumet yayingowokuqala wama-gliptins. Manje ungummeleli ofundwe kakhulu kulesi sigaba. Umuthi udlulisela isikhathi sokuphila kwama-incretins, ama-hormone akhethekile akhiqizwa ukuphendula ushukela futhi kukhuthaza ukukhishwa kwe-insulin egazini. Njengomphumela womsebenzi wakhe kwisifo sikashukela, ukuhlanganiswa kwe-insulin kuthuthukiswa kuze kube izikhathi ezi-2. Inzuzo engabazeki yeYanumet ukuthi isebenza kuphela ngoshukela wegazi ophezulu. Lapho i-glycemia ivamile, ama-insretin akhiqizwa, i-insulin ayingeni egazini, ngenxa yalokho, i-hypoglycemia ayenzeki.

Umphumela oyinhloko we-metformin, ingxenye yesibili yomuthi uJanumet, ukwehla kokumelana ne-insulin. Ngenxa yalokhu, i-glucose ingena kangcono kwezicubu, ikhulule imithambo yegazi. Umphumela owengeziwe kodwa obalulekile wukwehla kokuhlanganiswa kwe-glucose esibindini, kanye nokwehla kokufakwa kweglue kusuka ekudleni. I-Metformin ayithinti ukusebenza kwe-pancreatic, ngenxa yalokho, ayibangeli i-hypoglycemia.

Isifo sikashukela nokucindezela kuzoba yinto yesikhathi esedlule

• Ukwehlela ushukela -95%
• Ukuqedwa kwe-vein thrombosis - 70%
• Ukuqedwa kokushaya kwenhliziyo okuqinile -90%
• Ukuqeda umfutho wegazi ophakeme - 92%
• Ukwanda kwamandla ngesikhathi sosuku, ngcono ukulala ebusuku -97%

Izinkomba zokuqokwa

Umuthi weYanumet usetshenziselwa ukunciphisa ushukela kuphela ngohlobo 2 sikashukela. Umuthi umuthi awukukhanseli ukudla okwedlule kanye nemfundo yomzimba, ngoba awukho umuthi owodwa wethebhulethi ongahlula ukumelana ne-insulin ephezulu, ususe noma yiliphi inani elikhulu likashukela egazini.

Umyalo wokusetshenziswa ukuvumela ukuthi uhlanganise amaphilisi weYanumet ne-metformin (i-Glucofage ne-analogues), uma ufuna ukwengeza umthamo wawo, kanye ne-sulfonylurea, glitazones, ne-insulin.

I-Yanumet ikhonjiswa ikakhulukazi kwiziguli ezingathambekele ekulandeleni ngokucophelela izincomo zikadokotela. Ukuhlanganiswa kwezinto ezimbili kwithebhulethi elilodwa akuyona into efifisayo yomenzi, kodwa indlela yokuthuthukisa ukulawulwa kwe-glycemic. Ukunquma nje izidakamizwa ezisebenzayo akwanele, udinga umuntu onesifo sikashukela ukuwaphuza ngendlela eqondile, okungukuthi, uzibophezele ekwelashweni. Ngezifo ezingamahlalakhona nesifo sikashukela, kubandakanya lokhu kuzibophezela kubaluleke kakhulu. Ngokuya kwezibuyekezo zeziguli, kutholakale ukuthi iziguli ezingama-30-90% zichaziwe ngokuphelele. Izinto eziningi udokotela azinqunyelwe, namathebhulethi amaningi okudingeka uwaphuze ngosuku, kuphakama amathuba okuba ukwelashwa okunconyiwe kungalandelwa. Izidakamizwa ezihlanganisiwe ezinezithako eziningana ezisebenzayo ziyindlela enhle yokwandisa ukubambelela ekwelashweni, futhi ngenxa yalokho zithuthukisa isimo sempilo seziguli.

Ifomu lomthamo kanye nomthamo

Umuthi uJanuet ukhiqizwa yinkampani iMerck, eNetherlands. Manje ukukhiqiza sekuqalile ngesisekelo senkampani yase-Akrikhin. Izidakamizwa zasekhaya nezangeniswa zifana ngokuphelele, zilawulwa ngokulawulwa kwekhwalithi efanayo. Amacwecwe anesimo esidlule, embozwe ulwelwesi lwefilimu. Ukuze kube lula ukuyisebenzisa, zipendiwe ngemibala ehlukahlukene ngokuya ngomthamo.

Izinketho ezingaba khona:

I-Yanumet Long isidakamizwa esisha ngokuphelele, e-Russian Federation yabhaliswa ngo-2017. Ukwakheka kweYanumet neYanumet Long kuyafana, kwehluka kuphela ekwakhiweni kwethebhulethi. Ukusetshenziswa kufanele kuthathwe kabili ngosuku, njengoba i-metformin isebenza amahora angaphezu kwama-12. EYanumet, i-Long Metformin ikhishwa modified kancane, ngakho-ke ungayiphuza kanye ngosuku ngaphandle kokulahleka kokusebenza.

I-Metformin iboniswa imvamisa ephezulu yemiphumela emibi ohlelweni lokugaya ukudla. I-Metformin Long ithuthukisa kakhulu ukubekezelela umuthi, inciphisa izehlakalo zokuqubuka komzimba kanye nokunye ukusabela okungekuhle amahlandla ama-2. Ukwahlulela ngokubuyekezwa, kumthamo ophelele, uYanumet kanye neYanumet Long kunikeza ukulahleka kwesisindo okulinganayo. Ngaphandle kwalokho, uYanumet Long uwina, uhlinzeka ngokulawulwa okungcono kwe-glycemic, kunciphisa ngempumelelo ukumelana kwe-insulin ne-cholesterol.

Impilo yeshalofu yeYanumet 50/500 yiminyaka emi-2, imithamo emikhulu - iminyaka emi-3. Umuthi uyathengiswa ngokuya ngemiyalelo ye-endocrinologist. Intengo elinganiselwa kumakhemisi:

Imiyalo yokusebenzisa

Imiyalo yethosi enconyiwe yesifo sikashukela:

1. Umthamo ofanele we-sitagliptin yi-100 mg, noma amaphilisi ama-2.
2. Umthamo we-metformin ukhethiwe ngokuya ngezinga lokuzwela i-insulin nokubekezelelwa kwento. Ukunciphisa ingozi yemiphumela emibi yokuthatha, umthamo wanda kancane kancane, usuka ku-500 mg. Okokuqala, baphuza iYanumet 50/500 kabili ngosuku. Uma ushukela wegazi ungokwehliswa ngokwanele, ngemuva kwesonto noma amabili, umthamo ungakhuphuka ube amaphilisi ama-2 we-50/100 mg.
3. Uma umuthi uJanumet ungezwa kuma-sulfonylurea derivatives noma i-insulin, kuyadingeka ukwandisa umthamo wawo ngokuqapha ngokweqile ukuze ungaphuthelwa i-hypoglycemia.
4. Umthamo omkhulu weYanumet ngamathebulethi ayi-2. 50/1000 mg.

Ukwenza ngcono ukubekezelelana kulo muthi, amaphilisi athathwa ngasikhathi sinye nokudla. Ukubuyekezwa kwesifo sikashukela kusikisela ukuthi ukudla okulula ngenxa yalokhu ngeke kusebenze, kungcono ukuhlanganisa umuthi nokudla okuqinile okuqukethe amaprotheni nama-carbohydrate aphambili. Kwabiwa amakheli amabili ukuze kuthi phakathi kwawo kuphume amahora ayi-12.

Izindlela zokuphepha lapho uphuza umuthi:

1. Izinto ezisebenzayo ezakha iYanumet zivezwa ngokuyinhloko emchameni. Ngomsebenzi we-renal ophazamisekile, ubungozi be-metformin obambezelekile bukhuphuka ngokukhula okulandelayo kwe-lactic acidosis. Ukuze ugweme lokhu kufakwa, kungakuhle uhlole izinso ngaphambi kokuyalela umuthi. Ngokuzayo, izivivinyo zidluliswa minyaka yonke. Uma i-creatinine ingaphezulu kokujwayelekile, umuthi ukhanseliwe. Ama-diabetics asebekhulile abonakala ngokungahambi kahle kweminyaka okuhlobene nomsebenzi wezinso, ngakho-ke, anconyelwa umthamo omncane weYanumet.
2. Ngemuva kokubhaliswa kwalesi sidakamizwa, kube nokubuyekezwa kwamacala we-pancreatitis acute ku-diabetics ukuthatha i-Yanumet, ngakho-ke umenzi uxwayisa ngengozi emiyalweni yokusetshenziswa. Akunakwenzeka ukusungula imvamisa yale miphumela emibi, ngoba le nkimbinkimbi ibingabaliwe kumaqembu okulawula, kodwa kungathathwa njengokuthi ayivelakancane kakhulu. Izimpawu ze-pancreatitis: Ubuhlungu obukhulu esiswini engenhla, ukunika ngakwesobunxele, ukuhlanza.
3. Uma amaphilisi e-Yanumet ethathwa kanye ne-gliclazide, glimepiride, glibenclamide kanye nezinye i-PSM, i-hypoglycemia kungenzeka. Lapho kwenzeka, umthamo weYanumet ushiywe ungashintshiwe, umthamo we-PSM uyancishiswa.
4. Ukuhambelana kotshwala kweJanumet akulungile. I-Metformin ekudakweni kotshwala obukhulu futhi obungamahlalakhona kungadala i-lactic acidosis. Ngaphezu kwalokho, iziphuzo ezidakayo ziyasheshisa ukuthuthukiswa kwezinkinga zesifo sikashukela futhi zenze imbuyiselo yakhona ibe nzima.
5. Ukuxineka ngokomzimba (ngenxa yokulimala kakhulu, ukushiswa, ukushisa ngokweqile, ukutheleleka, ukuvuvukala okubanzi, ukuhlinzwa) kungandisa ushukela wegazi kakhulu. Ngesikhathi sokutakula, umyalo uncoma ukushintshela isikhashana ku-insulin, bese ubuyela ekwelashweni kwangaphambilini.
6. Umyalo uvumela izimoto zokushayela, zisebenza ngezindlela zabanesifo sikashukela ukuthatha iYanumet. Ngokusho kokubuyekezwa, umuthi ungadala ukozela nokuzwela, ngakho-ke ekuqaleni kokuphathwa kwawo kufanele uqaphele ikakhulukazi ngesimo sakho.

Imiphumela emibi yesidakamizwa

Ngokuvamile, ukubekezelelwa kwalo muthi kulinganiswa njengokuhle. I-metformin kuphela engadala imiphumela emibi. Imiphumela emibi yokwelashwa nge-sitagliptin ibonwa kakhulu nge-placebo.

Ngokuya ngemininingwane enikezwe emiyalweni yamathebulethi, imvamisa yokuphendula okubi ayidluli i-5%:

• isifo sohudo - 3.5%;
• isicanucanu - 1.6%;
• izinhlungu, usizi esiswini - 1,3%;
• ukwakhiwa kwegesi ngokweqile - 1,3%;
• ikhanda - 1,3%;
• ukugabha - 1.1%;
• hypoglycemia - 1.1%.

Futhi phakathi kwezifundo kanye nangemva kwesikhathi sokubhalisa, abesifo sikashukela baphawula:

• komzimba, kufaka phakathi amafomu anamandla;
• i-pancreatitis eyingozi;
• umsebenzi wezinso ongonakalisiwe;
• izifo zokuphefumula;
• ukuqunjelwa
• Ubuhlungu ngokuhlangana, emuva, emilenzeni.

Okungenzeka ukuthi iYanumet ayihlobene nalokhu kwephula umthetho, kepha umenzi ubesabafaka emiyalweni. Ngokuvamile, imvamisa yale miphumela emibi kubantu abanesifo sikashukela eYanumet ayihlukile eqenjini lokulawula elingatholanga lesi sidakamizwa.

Ukwephula okungatheni, kepha okungokoqobo kakhulu okungenzeka uma uthatha uJanumet namanye amaphilisi ane-metformin yi-lactic acidosis. Lokhu kunzima ukwelapha ubunzima obukhulu beshukela - uhlu lwezinkinga zesifo sikashukela. Ngokusho komkhiqizi, imvamisa yakhona iyizinkinga ezi-0.03 ngonyaka weminyaka eyi-1000 yomuntu. Cishe i-50% yabantu abanesifo sikashukela abakwazi ukulondolozwa. Imbangela ye-lactic acidosis ingaba ukweqisa komthamo weJanumet, ikakhulukazi ngokuhlanganiswa nezici ezisikhathazayo: izinso, inhliziyo, isibindi kanye nokwehluleka ukuphefumula, ukudakwa, ukubulawa yindlala.

Umbono wesazi

U-Arkady Alexandrovich

I-Endocrinologist enolwazi

Buza uchwepheshe umbuzo

Izimpawu zokuqala zokuxakeka wubuhlungu bemisipha, ukuqina, ukufupheka, ukufushane komoya, ukozela. Lapho-ke i-hypotension, i-arrhythmia, ukwehla kwamazinga okushisa womzimba kungena. Lesi simo sidinga ukulaliswa esibhedlela ngokuphuthumayo. Abasebenzi bezempilo kumele baziswe ukuthi isiguli sinesifo sikashukela futhi sithatha iJanumet.

Contraindication

Ngaphambi kokuthatha noma yisiphi isidakamizwa, kufanele usijwayele ngohlu lwe-contraindication oluqukethwe kwimiyalo. Ukuba khona kwezifo ezinkulu kumele kwaziswe udokotela wakho.

Umuthi uJanumet awuthathwe ngamacala alandelayo:

• nge-hypersensitivity yezinto ezakha ithebhulethi. Ngaphezu kwe-sitagliptin ne-metformin, i-Yanumet iqukethe i-stearyl fumarate ne-sodium lauryl sulfate, cellulose, povidone, udayi, i-titanium dioxide, i-talc, i-polyvinyl alcohol. Ama-Analogs angaba nokwakheka okuhlukile okungekho okubangela i-allergies;
• okulinganiselwe kuya kokulimazeka kwezinso;
• ukwanda kwe-creatinine yegazi ngaphezulu kwesilinganiso sobudala;
• Uhlobo 1 sikashukela;
• I-ketoacidosis iyi-acute noma ihlala isikhathi eside, noma ngabe ayihambisani nokuqwashiswa okungafanele. Isifo sikashukela esine-hyperglycemic precoma kanye nesiphuphu emlandweni wokunquma umuthi singanikezwa ukuthi ushukela wegazi ubhekwa njalo;
• ngohlobo 2 lwesifo sikashukela esinqunyelwe isikhathi eside, okokuqala kunikwa i-insulin. I-Yanumet yezidakamizwa ingahamba ngemuva kokuzinza;
• umlando we-lactic acidosis, kungakhathalekile ukuthi yiziphi izinto ezakudabukisa lokho;
• ukuphuza ngokweqile, isikhathi esisodwa nokungapheli;
• ukungasebenzi kahle kwesibindi;
• ezinye izimo ezandisa ubungozi be-lactic acidosis - isifo senhliziyo, uhlelo lokuphefumula. Kulokhu, ubungozi buhlolwa udokotela ngesisekelo sedatha yokuhlolwa;
• ukomisa kakhulu;
• ukukhulelwa, ukuncelisa;
• ngesikhathi sokucindezelwa komzimba. Imbangela ingaba izifo ezingatheni nokulimala, ukushaya kwenhliziyo nezinye izimo ezinkulu.

Ama-Analog

I-Yanumet yezidakamizwa ine-analogue eyodwa ephelele - iVelmetia. Ikhiqizwa yinkampani iBerlin-Chemie, ilungu lenhlangano iMenarini. Umuthi wemithi ukhiqizwa eSpain nase-Italy, kwenziwa amaphilisi kanye nokufakwa e-Russia, egatsheni laseKaluga leBerlin-Chemie. IVelmetia inemithamo emi-2 yama-50/850 nama-50/100 mg. Intengo yeVelmetia iphakeme kakhulu kunomuthi wokuqala, ungawuthenga kuphela ngoku-oda. Analogs eRussia okwamanje ayikhiqizwa futhi ngeke ibe khona maduze.

Ama-analogues eqembu leYanumet izidakamizwa ezihlanganisa noma iyiphi i-gliptin ne-metformin. E-Russia, izinketho ezi-3 zibhalisiwe: I-Galvus Met (iqukethe i-vildagliptin), iCombogliz Prolong (saxagliptin) neGentadueto (linagliptin). I-analogue engabizi kakhulu yiGalvus Met, intengo yayo ngama-ruble ayi-1600. iphakethe lenyanga. ICombogliz Prolong neGentadueto zibiza cishe ama-ruble angama-3,700.

Umuthi weYanumet "ungaqoqwa" ngokuzimela kuJanuvia (umuthi womenzi ofanayo, isakhi esinciphisa ushukela lwe-sitagliptin) neGlucofage (metformin yasekuqaleni). Zombili lezi zidakamizwa zizobiza endaweni ethile kuma-ruble ayi-1650. ngomthamo ofanayo. Ngokusho kokubuyekezwa, le nhlanganisela ayisebenzi kabi kuneYanumet.

Ukubuyekezwa kwesifo sikashukela