Umuthi wezazi zesifo sikashukela Glimepiride: imiyalo nokubuyekezwa kweziguli

I-Glimepiride (Glimepiride) - amalungiselelo wesimanje kakhulu we-sulfonylurea. Ngesifo sikashukela, kwandisa ukuphuma kwe-insulin egazini, kunciphisa i-glycemia. Ngokokuqala ngqa, le nto esebenzayo yayisetshenziswa uSanofi kumathebulethi e-Amaryl. Manje izidakamizwa ezinalokhu kwakhiwa zikhiqizwa emhlabeni wonke.

I-glimepiride yaseRussia nayo ibekezelelwe kahle, inciphisa ushukela kahle, ibangela imiphumela emincane emincane, njengamathebulethi okuqala. Ukubuyekezwa kukhombisa ikhwalithi enhle kakhulu nentengo ephansi yemithi yasekhaya, ngakho-ke akumangazi ukuthi abantu abanesifo sikashukela Glimepiride bavame ukukhetha i-Amaril yasekuqaleni.

Uboniswa ngubani glimepiride

Isidakamizwa sinconyelwa ukwenziwa kwejwayelekile i-glycemia kuphela kuhlobo 2 sikashukela. Umyalo wokusetshenziswa awucacisi lapho ukwelashwa nge-Glimepiride kufanelekile, ngoba ukukhetha umuthi othile nomthamo wawo kungukufanele udokotela ohambelayo. Ake sizame ukuthola ukuthi ngubani okhonjiswe lesi sidakamizwa i-Glimepiride.

Ushukela wesifo sikashukela ukhuphuka ngenxa yezizathu ezimbili: ngenxa yokumelana ne-insulin kanye nokwehla kokukhishwa kwe-insulin kumaseli e-beta akuma-pancreas. Ukumelana ne-insulin kuqala ngaphambi kokuqala kwesifo sikashukela, kungatholakala ezigulini ezinokukhuluphala kanye ne-prediabetes. Isizathu ukungondleki kahle, ukuntuleka kokuzivocavoca, ukukhuluphala ngokweqile. Lesi simo sihambisana nokukhiqizwa okwandayo kwe-insulin, ngale ndlela umzimba uzama ukunqoba ukumelana kwamangqamuzana futhi uhlanze igazi likashukela ngokweqile. Ngalesi sikhathi, ukwelashwa okunengqondo ukuguqula indlela yokuphila enempilo futhi unqume i-metformin, umuthi onciphisa ngokuqinile ukumelana ne-insulin.

Lapho i-glycemia ephezulu yesiguli ikhuphuka, i-mellitus ethe xaxa iyaqhubeka. Ukuphazamiseka kokuqala kuhlotshaniswa nokwehla kwe-insulin secretion, futhi i-hyperglycemia iyenzeka futhi esigulini. Ngokusho kodokotela, ekuhlolweni kwesifo sikashukela, ukuntuleka kwe-insulin kutholakala cishe kwengxenye yeziguli. Kulesi sigaba salesi sifo, ngaphezu kwe-insulin, kufanele kunqunywe imithi egqugquzela ukusebenza kwamaseli we-beta. Ezisebenza kakhulu futhi ezingabizi kakhulu kuzo zithathwe ku-sulfonylurea, esifushanisiwe i-PSM.

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%

Umbono wesazi

U-Arkady Alexandrovich

I-Endocrinologist enolwazi

Buza uchwepheshe umbuzo

I-Glimepiride iyisidakamizwa sanamuhla nesiphephe kunazo zonke eqenjini lePSM. Kungokwesizukulwane sakamuva futhi kunconyelwe ukusetshenziselwa izinhlangano ze-endocrinological emhlabeni jikelele.

Ngokusekelwe kokushiwo ngenhla, sizogqamisa izinkomba zokuqokwa kwe-Glimepiride yezidakamizwa:

1. Ukuntuleka kokusebenza kokudla, ukuzivocavoca kanye ne-metformin.
2. Kufakazelwe ngokuhlaziywa kokuntuleka kwe-insulin yabo uqobo.

Umyalo uvumela ukusetshenziswa kwesidakamizwa i-Glimepiride ene-insulin ne-metformin. Ngokusho kokubuyekezwa, lesi sidakamizwa sihamba kahle nama-glitazones, ama-glissin, ama-incretin mimetics, i-acarbose.

Indlela yokusebenza yesidakamizwa

Ukukhishwa kwe-insulin kusuka kumanyikwe ukungena egazini kungenzeka ngenxa yeziteshi ezikhethekile ze-KATP. Bakhona kuwo wonke amaseli aphilayo futhi bahlinzeka ngokuhamba kwe-potassium ngokusebenzisa ulwelwesi lwayo. Lapho ukugcwala kwe-glucose emikhunjini kungaphansi kwemingcele ejwayelekile, lezi ziteshi ezisemangqamuzaneni e-beta zivulekile. Ngokukhula kwe-glycemia, bavala, okubangela ukungena kwe-calcium, bese kukhishwa i-insulin.

Isidakamizwa i-Glimepiride nazo zonke ezinye iziteshi ze-potassium ezisondelene ne-PSM, ngaleyo ndlela sikhulisa ukukhiqizwa kwe-insulin kanye nokufihlwa. Inani lamahomoni akhishwe egazini lincike kuphela kumthamo we-glimepiride, hhayi ezingeni le-glucose.

Emashumini ambalwa eminyaka adlule, izizukulwane ezi-3, noma ukuvuselelwa kabusha, kwePSM zisunguliwe futhi zahlolwa. Umsebenzi wezidakamizwa zesizukulwane sokuqala, i-chlorpropamide ne-tolbutamide, uthonywa kakhulu ngamanye amaphilisi kashukela, okuvame ukuholela ekuthini i-hypoglycemia ibe nzima kakhulu. Ngokuqala kwesizukulwane se-PSM 2, glibenclamide, glyclazide ne-glipizide, le nkinga yaxazululeka. Baxhumana nezinye izinto ziba buthaka kakhulu kune-PSM yokuqala. Kodwa le mishanguzo futhi inamaphutha amaningi: uma wephula isidlo nemithwalo, ibanga i-hypoglycemia, iholele ekuzuzeni kancane kancane kwesisindo, futhi ngenxa yalokho, ukwanda kokumelana ne-insulin. Ngokusho kwezinye izifundo, izizukulwane ze-PSM ezi-2 zingathinta kabi ukusebenza kwenhliziyo.

Lapho kwakhiwa i-izidakamizwa i-Glimepiride, imiphumela emibi engenhla yathathwa yabhekwa. Bakwazi ukubanciphisa kulungiselelo olusha.

Inzuzo ye-Glimepiride ngaphezulu kwe-PSM yezizukulwane ezedlule:

1. Ingozi ye-hypoglycemia uma ithathwa inciphile. Ukuxhumana komuthi nama-receptors kuzinze kancane kunaleyo eqhathaniswa yiqembu, ngaphezu kwalokho, umzimba ugcina ngokwengxenye imishini evimbela ukwakheka kwe-insulin nge-glucose ephansi. Lapho udlala ezemidlalo, ukuntuleka kwama-carbohydrate ekudleni, i-glimepiride ibangela i-hypoglycemia emnene kunenye i-PSM. Ukuqashelwa kukhombisa ukuthi ushukela lapho uthatha amaphilisi we-glimepiride ehla ngaphansi kwejwayelekile ku-0.3% yabanesifo sikashukela.
2. Akunamphumela kwesisindo. I-insulin engaphezulu egazini ivimbela ukuwohloka kwamafutha, i-hypoglycemia ejwayelekile inomthelela ekukhupheni isifiso sokudla kanye nokudla ngokwe-caloric okuphelele. I-Glimepiride iphephile kulokhu. Ngokusho kweziguli, akubangeli ukwanda kwesisindo, futhi ngokukhuluphala kufaka nomthelela ekwehliseni isisindo.
3. Ingozi ephansi yesifo senhliziyo. I-PSM iyakwazi ukusebenzisana neziteshi ze-KATP ezingatholakali kumanyikwe kuphela, kodwa nasezindongeni zemithambo yegazi, okwandisa ubungozi be-pathology yazo. I-glimepiride yezidakamizwa isebenza kuphela kuma-pancreas, ngakho-ke kuvunyelwe kwabanesifo sikashukela nge-angiopathy nesifo senhliziyo.
4. Imiyalo ikhombisa ikhono le-Glimepiride lokunciphisa ukumelana ne-insulin, ukwandisa ukwakheka kwe-glycogen, kanye nokukhiqizwa kwe-glucose. Lesi senzo sibuthakathaka kakhulu kune-metformin, kodwa singcono kune-PSM yonke.
5. Umuthi usebenza ngokushesha kune-analogues, ukukhethwa komthamo kanye nokuzuzwa kwesinxephezelo sikashukela kuthatha isikhathi esincane.
6. Amacwecwe we-Glimepiride avuselela zombili izigaba zokufihlwa kwe-insulin, ngenxa yalokho, anciphisa ngokushesha i-glycemia ngemuva kokudla. Izidakamizwa ezindala zisebenza ngokuyinhloko esigabeni 2.

Umthamo

Umthamo owamukelwa ngokuvamile we-glimepiride, abakhiqizi abanamathela kuwo, ngu-1, 2, 3, 4 mg wento esebenzayo kwithebhulethi. Ungakhetha inani elifanele lomuthi ngokunemba okuphezulu, uma kunesidingo, umthamo kulula ukuwuguqula. Njengomthetho, ithebhulethi ifakwe engcupheni, ekuvumela ukuthi uyihlukanise ngesigamu.

Umphumela wehlisela ushukela umuthi ukhuphuka ngasikhathi sinye ngokwanda komthamo osuka ku-1 uye ku-8 mg. Ngokusho kwesifo sikashukela, iningi labantu lidinga kuphela i-4 mg noma ngaphansi kwe-glimepiride ukuze sinxephezele isifo sikashukela. Imithamo emikhulu inokwenzeka ezigulini ezinesifo sikashukela esibolile kanye nokumelana kanzima ne-insulin. Kufanele zinciphe kancane kancane njengoba isimo sizinza - ukuthuthukisa ukuzwela kwe-insulin, ukunciphisa umzimba, kanye nokushintsha kwendlela yokuphila.

Ukwehla okulindelekile kwe-glycemia (amanani aphakathi ngokwesifundo):

Imininingwane evela emiyalweni ekulandelana kokukhetha umthamo owuthandayo:

1. Umthamo wokuqala ngu-1 mg. Ngokuvamile kwanele kwabanesifo sikashukela abane-glucose ephakeme kancane, kanye nasezigulini ezihluleke ngokwezinso. Izifo zesibindi azithinti usayizi wedosi.
2. Inani lamathebulethi liyakhuphuka kuze kufinyeleleke okuhloswe ngalo ushukela. Ukugwema i-hypoglycemia, umthamo wanda kancane kancane, ngezikhathi zamasonto ama-2. Okwamanje, izilinganiso ezivame kakhulu ze-glycemia ziyadingeka kunokwejwayelekile.
3. Iphethini yokukhula kwe-dose: kufika ku-4 mg, engeza i-1 mg, ngemuva - 2 mg. Lapho ushukela usufinyelele okujwayelekile, yeka ukukhulisa inani lamathebulethi.
4. Umthamo omkhulu ovunyelwe yi-8 mg, uhlukaniswe ngemithamo eminingana: 2 kuya ku-4 mg noma 3; 3 no 2 mg.

Imiyalo enemininingwane yokusetshenziswa

Umphumela wethamo lomuthi kwenzeka ngemuva kwamahora cishe amabili ukusuka ekuphatheni kwawo. Ngalesi sikhathi, i-glycemia ingancipha kancane. Ngakho-ke, uma uphuza i-Glimepiride kanye ngosuku, inani elinjalo lizoba linye, uma uhlukanisa umthamo amahlandla ama-2, inani eliphakeme lizoba kabili, kodwa libe mnene. Ukwazi lesi sici sesidakamizwa, ungakhetha isikhathi sokwamukelwa. Kungcono ukuthi inani eliphakeme lesenzo liwela ngesikhathi ngemuva kokudla okugcwele okuqukethe ama-carbohydrate ahamba kancane, futhi akuhambisani nomsebenzi womzimba ohleliwe.

Ukungajwayelekile noma ukungondleki kahle, ukusebenza okuphezulu ngokudla okunganele kwama-carbohydrate, ukugula okungathí sina, ukuphazamiseka kwe-endocrine, ezinye izidakamizwa zandisa ingozi ye-hypoglycemia.

Ukusebenzisana kwezidakamizwa ngokuya ngemiyalo:

Izici zokuthatha izingane nabesifazane abakhulelwe

Lapho isetshenziswa ngesikhathi sokukhulelwa, umuthi i-Glimepiride ungena egazini le-fetus futhi ungadala i-hypoglycemia kuwo. Futhi, umuthi udlulela obisini lwebele, futhi ukusuka lapho kuya emgudwini wokugaya wengane. Ngesikhathi sokukhulelwa ne-HB, ukuthatha i-Glimepiride akuvunyelwe ngokuphelele. I-FDA (American Medicines Administration) ibeka i-Glimepiride njengesigaba C. Lokhu kusho ukuthi izifundo zezilwane ziveze ukuthi le nto inomthelela ongemuhle kuzingane.

I-Glimepiride ayinqunyelwe izingane, noma ngabe zitholakala zinesifo sikashukela sohlobo 2. Umuthi awuzange uphumelele ovivinyweni oludingekayo, umphumela wawo entweni ekhulayo awuzange ufundwe.

Uhlu lwemiphumela emibi

Umphumela omubi kakhulu we-Glimepiride yi-hypoglycemia. Ngokusho kokuhlolwa, ubungozi bayo bungaphansi kakhulu kwe-PSM enamandla kakhulu - glibenclamide. Amaconsi kashukela, okwaholela ekutheni alaliswe esibhedlela futhi adinge abalahla nge-glucose, ezigulini eziseGlimepiride - amayunithi angama-0,86 ngonyaka weminyaka eyi-1000. Uma kuqhathaniswa ne-glibenclamide, le nkomba ingaphansi izikhathi eziyizi-6.5. Inzuzo engabazeki yesidakamizwa yingozi engaphansi ye-hypoglycemia ngesikhathi sokuzivocavoca okusebenzayo noma isikhathi eside.

Eminye imiphumela emibi ye-glimepiride kusuka emiyalweni yokusebenzisa:

Kunomyalezo futhi mayelana nokutholakala kokukhubazeka kokukhubazeka kwe-hormone ye-antidiuretic. Le mphumela wecala isavivinywa, ngakho-ke ayifakiwe emiyalweni.

Kungaba khona i-overdose

Akunandaba ukuthi isidakamizwa i-Glimepiride sinesimanje futhi sinobumnene kangakanani, sisaqhubeka nokutholakala kwe-sulfonylurea, okusho ukuthi ukweqisa kwayo kuholela ku-hypoglycemia. Lo mphumela wecala usetshenziswe ngendlela yokusebenza komuthi, ungagwenywa kuphela ngokubheka imithamo ngokucophelela.

Umthetho wokuvimbela i-hypoglycemia emiyalweni esetshenziswayo: uma ngabe ithebhulethi ye-Glimepiride ilahlekile, noma kungekho qiniseko lokuthi umuthi udakiwe, umthamo akufanele unyuswe kumthamo olandelayo, noma ngabe kuphakama ushukela wegazi.

I-Hypoglycemia ingamiswa nge-glucose - ujusi omnandi, itiye noma ushukela. Akudingekile ukulinda izimpawu zomlingiswa, idatha eyanele ye-glycemic. Njengoba lesi sidakamizwa sisebenza cishe usuku, ushukela obuyiselwe kokujwayelekile usengancipha kaningi ufike ezinambeni eziyingozi. Sonke lesi sikhathi udinga ukuqapha i-glycemia, ungashiyi ushukela yedwa.

I-overdose eqinile yesikhathi esisodwa, ukusetshenziswa isikhathi eside kwemithamo ephezulu ye-glimepiride kusongela impilo. Esigulini esinesifo sikashukela, ukulahlekelwa ukwazi, ukuphazamiseka kwemizwa, i-hypoglycemic coma kungenzeka. Ezimweni ezinzima, amaconsi kashukela aphindaphindwe angahlala izinsuku ezimbalwa.

Ukwelashwa ngokweqile - i-gastric lavage, ama-drabents, ukubuyiselwa kwe-Normoglycemia ngokungenisa i-glucose emthanjeni.

Contraindication

Kwezinye izimo, ukuthatha umuthi i-Glimepiride kungaba yingozi empilweni:

• I-HS, iminyaka yezingane;
• ukukhulelwa, isifo sikashukela sokukhulelwa;
• ngezimo ezinzima zokwehluleka kwe-hepatic noma kwe-renal. Ukusetshenziswa kwamacwecwe e-glimepiride ezigulini zoku dialysis akufundwanga;
• ukuqinisekisile uhlobo 1 sikashukela. Uma kutholakala izinhlobo zesifo sikashukela ezithambile (Modi), i-latent), ukuqokwa kwe-drug glimepiride kungenzeka;
• izinkinga ezinzima zesifo sikashukela. I-Hypoglycemia kufanele iqedwe ngaphambi kokuthatha iphilisi elilandelayo. Kuzo zonke izinhlobo zikashukela com kanye ne-precom, noma imaphi amalungiselelo ethebhulethi akhanseliwe;
• uma onesifo sikashukela engalunganga kunoma yiziphi izithako zethebhulethi, ukusabela kwe-anaphylactic kungenzeka ngokusetshenziswa okuqhubekayo;
• ngenxa yokuthi ukwakheka kwamacwecwe kufaka i-lactose, ngeke kuthathwe yiziguli ezinenkinga yokuphilwa yifa lokutholwa kwayo.

Umyalo uncoma ukunakekelwa okukhethekile ekuqaleni kokwelashwa nge-glimepiride, esigabeni sokukhethwa komthamo, lapho ushintsha indlela odla ngayo noma yokuphila. I-Hyperglycemia ingaholela ekulimaleni, izifo ezithathelwanayo nokuvuvukala, ikakhulukazi lezo ezihambisana nomkhuhlane. Esikhathini sokutakula, ngokuphambene nalokho, i-hypoglycemia kungenzeka.

Izifo zokugaya ukudla zingashintsha umphumela wamathebulethi uma ukumunca kuphazamiseka. Ukuntuleka kokulimazeka kwe-glucose-6-phosphate dehydrogenase lapho uthatha umuthi i-Glimepiride kungakhula.

I-glimepiride analogues

Ama-analogues atholakalayo eRussia abhaliswe kwirejista yemithi:

Ngokusho kokubuyekezwa kwabanesifo sikashukela, ukufana okuphezulu kwe-Amaril yi-Glimepiride-Teva ne-Glimepiride ukukhiqizwa kwasekhaya. Ama-generator asele emakhemisi ayivelakancane.

I-Glimepiride noma i-Diabeteson - okungcono

Into esebenzayo eDiabeteson yi-gliclazide, isizukulwane se-PSM 2. Ithebhulethi inesakhiwo esikhethekile, esihlinzeka ngokugeleza kancane kancane komuthi ukuya egazini. Ngenxa yalokhu, Diabeteson MV mancane amathuba okuba ibangele i-hypoglycemia kune-gliclazide ejwayelekile. Kuyo yonke i-PSM etholakalayo, iyi-glyclazide ne-glimepiride eguqulwayo encoma abaphethe njenge-epheocrinologists njengephephe kunazo zonke. Banomphumela ofanayo wokwehlisa ushukela kumithamo yokuqhathanisa (1-6 mg ye-glimepiride, 30-120 mg ye-gliclazide). Imvamisa ye-hypoglycemia kulezi zidakamizwa nayo isiseduze.

UDiabeteson noGlepepiride banomehluko omncane. Okubaluleke kakhulu kuzo yile:

1. I-Glimepiride ibonakala ngesilinganiso esiphansi sokukhula kwe-insulin / ukwehla kweglucose - 0,03. E-Diabeteson, le nkomba ingu-0.07. Ngenxa yokuthi lapho uthatha amaphilisi we-glimepiride, i-insulin ikhiqizwa incane, abanesifo sikashukela banciphise isisindo, ukumelana ne-insulin kuyancipha, futhi amaseli we-beta asebenza isikhathi eside.
2. Kunemininingwane evela ezifundweni ezifakazela ukuthuthuka kwesimo seziguli ezine-pathologies yesistimu yenhliziyo ngemuva kokushintsha kusuka ku-Diabeteson kuya eGlepepide.
3. Ezigulini ezithatha i-metformin ene-glimepiride, ukufa kwabantu kuyinto ephansi kancane kunalezi zikashukela ezinikezwe ukwelashwa nge-gliclazide + metformin.

I-Glimepiride noma i-Amaryl - okungcono

I-Amaril isidakamizwa sokuqala esenziwe omunye wabaholi emakethe yezidakamizwa zesifo sikashukela, ukukhathazeka kweSanofi. Zonke izifundo ezishiwo ngenhla zenziwa ngokubamba iqhaza kwalo muthi.

Futhi, amalungiselelo we-glimepiride akhiqizwa ngaphansi kwamagama afanayo womkhiqizo yizinkampani ezinhlanu zaseRussia. Bangama-generics, noma ama-analogue, anokwakheka okufanayo noma okufanayo kakhulu. Zonke zingabizi kakhulu kune-Amaril. Umehluko ngentengo ubangelwa ukuthi le mishanguzo ayizange idlule zonke izivivinyo ezidingekayo ukubhalisa umuthi omusha. Inqubo yokwenza ama-generics yenziwe lula, kwanele ukuthi umenzi aqinisekise ukufana kwezibhebhe zamatafula akhe ku-Amaril yasekuqaleni. Izinga lokuhlanzwa, okutholwayo, ifomu lethebhulethi lingahluka.

Ngaphandle kokuthi ukubuyekezwa ku-Amaril kanye ne-Russian Glimepirides kuyafana, kukhona abanesifo sikashukela abathanda izidakamizwa zangempela. Uma kukhona izinsolo zokuthi i-generic ingasebenza kabi, kungcono ukuthenga i-Amaril, ngoba ukuthembela ekwelashweni elibekiwe kubaluleke kakhulu. Umphumela we-placebo uthinta ngamunye wethu futhi unomthelela oqondile enhlalakahleni yethu.

Izindleko nokugcinwa

Intengo yephakeji ye-Glimepiride, umthamo ongu-4 mg:

Ama-analogues ashibhile kakhulu akhiqizwa uSamara Ozone noProdproject baseSt. Zombili lezi zinkampani zithenga izinto zokwelapha ezinkampanini zemithi zaseNdiya.

Impilo yamashalofu yabakhiqizi abahlukahlukene iyahlukahluka futhi yiminyaka emi-2 noma emi-3. Izidingo zokushisa kokugcina ziyefana - azikho ngaphezu kwama-25 degrees.

Ukubuyekezwa kwesifo sikashukela