I-Combogliz Prolong - ikhambi lesizukulwane esisha sikashukela

Ukuhlanganiswa kwe-metformin ne-DPP4 inhibitors (glyptins) kuqashelwa ngabaphethwe yi-endocrinologists njengabanengqondo kakhulu kwabanesifo sikashukela sohlobo 2. Into efundwe kakhulu evela esigabeni sama-gliptins yi-saxagliptin. Inhlanganisela ye-saxagliptin ene-metformin elungiswe kuthebhulethi eyodwa yaqala ukuthengiswa ngo-2013 ngaphansi kwegama elithi Combogliz Prolong.

Izakhi ezisebenzayo ekwakhekeni kwazo zinomphumela ohambelana nawo: zinciphisa ukumelana kwe-insulin futhi zengeza ukwakheka kwe-insulin. Ngaphezu kwalokho, umuthi ukhombisile ukuphepha kwenhliziyo nemithambo yegazi, empeleni akubangeli i-hypoglycemia, akunikele ekuzuzeni isisindo. Ama-algorithms wesifo sashukela wasekhaya ancoma ukuthatha i-Combogliz Prolong yeziguli ezinesifo se-insulin. Nge-hemoglobin ye-glycated ngenhla kwe-9%, ingabekwa ngokushesha ngemuva kokutholwa kwesifo sikashukela.

Indlela yokwenza isenzo se-comboglize

ICombogliz Prolong isidakamizwa saseMelika, amalungelo aso ezinkampanini iBristol Myers no-Astra Zeneka. Amathebhulethi anezinketho ezintathu zomthamo, okwenza ukuthi ukwazi ukukhetha inani elifanele le-metformin ne-saxagliptin, kuya ngezimpawu zesifo:

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%

• I-1000 mg + 2,5 mg ilungele abanesifo sikashukela abane-high insulin ukumelana, ukukhuluphala, umsebenzi ophansi wezimoto;
• I-1000 mg + 5 mg iyindlela evamile yeziguli ezinesifo sikashukela esinokuncipha kokuhlanganiswa kwe-insulin kanye nesisindo ngokweqile;
• I-500 + 5 mg isetshenziswa ekuqaleni kokwelashwa nge-Combogliz Prolong, ingasetjenziswa ngokuqhubekayo ngokuqinile kokuphikisana ne-insulin, isisindo somzimba esijwayelekile.

Lapho ubheka ukufana kweComboglyz nezakhi zayo, i-metformin ne-saxagliptin, kwavela ukuthi akukho mehluko ema-pharmacokinetics emishanguzweni, ukuhlanganiswa kwezinto ezimbili kwithebhulethi elilodwa akunazisi izakhiwo zanoma iyiphi yazo, umphumela wesifo sikashukela uyefana.

Ngasikhathi sinye, ukuhlanganiswa kwezidakamizwa okungaguquki kubhekwa njengokusebenza kangcono kunokuthatha izidakamizwa ezifanayo ngokwahlukana. Lokhu kungenxa yokwanda kokunamathela ekwelashweni, leli gama lisho ukuhambisana nayo yonke imiyalo kadokotela. Ezigulini ezingalapheki, ezinjengesifo sikashukela i-mellitus, ngokwesiko liphansi: iziguli ziyakhohlwa ukuthatha elinye iphilisi, noma zimane ziyeke ukuthatha omunye umuthi obekiwe. Ucwaningo lukhombisa ukuthi indlela elula yokwelashwa esetshenziselwa ngayo ukwedlula yonke, udokotela angayifeza kangcono. Ushintsho olusuka ku-metformin ne-saxagliptin ngokwehlukana ukuya eCombogliz Prolong likuvumela ukuthi uphinde unciphise i-hemoglobin ye-glycated ngo-0.53%.

I-Metformin

Iminyaka eminingi, yi-metformin enconyelwa izinhlangano ezinesifo sikashukela ukuba ichazwe kwasekuqaleni. Lokhu kungenxa yokuthi i-metformin isebenza ngokuyimbangela enkulu ye-hyperglycemia kuhlobo 2 sikashukela - ukumelana ne-insulin. Ngokwemiyalo, ukunciphisa kwe-glycemia kushukela kwenzeka ngenxa:

• ukucindezelwa kokukhiqizwa kwe-glucose emzimbeni (gluconeogenesis, ngezinga elincane - glycogenolysis);
• ukubambezela ukumuncwa koshukela emgodini wokugaya ukudla;
• khuphula ukusebenza kwe-insulin kwezicubu, ikakhulukazi izicubu.

Ukusebenza kwezidakamizwa ezinciphisa ushukela kuvame ukuhlolwa ngokudonsa kwe-hemoglobin ye-glycated lapho ithathwa. Okwe-metformin, le nkomba iphezulu impela - 1-2%. Umuthi awuthathi hlangana nesisindo; ngaphezu kweminyaka eyi-10 yokuphatha, ukwanda okuphakathi kweziguli ezinesifo sikashukela kwakuyi-1 kg, okuncane kakhulu kunokwelashwa nge-insulin kanye nokutholakala kwe-sulfonylurea.

Ngeshwa, ukwelashwa nge-metformin akwenzeki ngaso sonke isikhathi ngenxa yemiphumela yaso emibi - ukungakhululeki esiswini, isifo sohudo, ukugula kwasekuseni. Ukwenza ngcono ukubekezelela umuthi, kwaqala ukukhishwa ngesimo samathebulethi ngokukhishwa okuguquliwe (okunwetshiwe). Yi-metformin enjalo equkethe ku-Comboglize Prolong. Ithebhulethi inesakhiwo esikhethekile: into esebenzayo ibekwe kumatrix emunca amanzi. Ngemuva kokuphathwa, i-matrix iphenduka ijeli, okuholela ekuthini ukugeleza kokufana kwe-metformin kuye kusuka egazini. Ukusebenza kokunciphisa ushukela kudonsa isikhathi eside ngale ndlela kuze kube ngamahora angama-24, ngakho-ke imiyalo yokusebenzisa incoma ukuthatha amaphilisi kanye ngosuku.

I-Saxagliptin

Le ngxenye yeComboglize Prolong ibhekele ukuthuthukisa ukwakheka kwe-insulin. Indlela yokusebenza ye-saxagliptin ingukuvinjwa kwe-enzyme DPP-4, indima okuwukuqhekeka kwama-incretins. Ama-incretin akhiqizwa nge-glycemia eyandayo futhi ashukumise ukwanda ekukhiqizweni kwe-insulin endulin. Uma wehlisa umphumela we-DPP-4, ama-incretin azosebenza isikhathi eside, ukuhlanganiswa kwe-insulin kuzonyuka, ushukela wegazi uzokwehla.

Inzuzo yesidakamizwa ubudlelwano be-glucose egazini nokukhiqizwa kwe-insulin. Ama-Derivatives we-sulfonylurea awanabo ubudlelwano obunjalo. Noma imithamo ephezulu, i-saxagliptin ayikwazi ukunweba impilo yama -retretin izikhathi ezingaphezu kwezingu-2, ngakho-ke umphumela wayo wokunciphisa ushukela ukhawulelwe ngesikhathi futhi empeleni akubangeli i-hypoglycemia. Akukho ukwehla okuyingozi okukodwa kwe-glucose ngesikhathi sokusetshenziswa kwayo kubhalwe phansi. Isimo sokucophelela se-saxagliptin kumaseli e-beta akhiqiza i-insulin sivumela ukwandisa umsebenzi waso futhi sibambezele ukuqokwa kokulashwa kwe-insulin, okungenakugwemeka ku-mellitus yesifo sikashukela.

Zombili i-metformin ne-saxacgliptin zehlisa ukungena kwe-glucose kusuka emgudwini wamathumbu ungene emikhunjini. Ngokusho kwesifo sikashukela, zombili lezi zidakamizwa zinciphisa isifiso sokudla futhi zikhuphula amandla okugcwala, ngakho-ke i-Combogliz Prolong yisinqumo esihle kunazo zonke kwiziguli ezinesisindo ngokweqile, ngokungafani nezinhlanganisela ezidumile ze-metformin nge-sulfonylurea.

Ukuphela kokudonswa kwe-saxagliptin yintengo yayo, okuyi-oda lesilinganiso esiphakeme kunamalungiselelo ashibhile we-sulfonylurea.

Izakhi ezisizayo

Ngaphezu kwezinto ezisebenzayo, amaphilisi we-Combogliz Prolong nawo aqukethe izinto ezengeziwe ezihlinzekela ukukhiqiza futhi zinikeze ukubanjwa okungapheli kwe-metformin. Njengengxenye yangaphakathi, noma i-matrix, i-magnesium stearate, hypromellose, carmellose. Izibhebhe zinamagobolondo amathathu e-Opadrai, aqukethe i-talc, titanium oxide, macrogol. Ingqimba ephezulu iqukethe udayi - i-iron oxide.

Imithamo ehlukene ihlukile ngombala: 2,5 + 1000 mg ophuzi, 5 + 500 beige, 5 + 1000 pink. Kwithebhulethi ngalinye, umthamo ofanele usetshenziswa ngopende oluhlaza okwesibhakabhaka.

Izakhi ezisizayo zidonswa ndawonye nezindunduma zesisindo esithambile, kungathatha uhlobo lwethebhulethi. Azisekho ezinye izinto ezisebenzayo kulesi sisindo.

Impilo yeshelufu yeComboglize Prolong yiminyaka emi-3. Imfuneko yomkhiqizi kuphela yezimo zokugcina isitoreji ingukushisa okufika kuma-30 degrees.

Intengo yokufaka isuka kuma-ruble angama-3150 kuya kwangama-3900. kuya ngenani lamathebulethi wepakethe (ama-28 noma ama-56 ama-pcs.) nomthamo.

Imithetho yokuphuza umuthi

Umthamo wansuku zonke onconywayo we-saxagliptin wabanesifo sikashukela abaningi ngu-5 mg. Umthamo omncane we-2,5 mg ubekelwe ukwehluleka kwezinso nge-GFR ngaphansi kwama-50, kanye nalapho uthatha imishanguzo ethile ye-antifungal, antibacterial and antiretroviral ekhulisa ukugcwala kwe-saxagliptin egazini.

Umthamo we-metformin ukhethwa ngokuhlukile ngokuya ngezinga lokumelana ne-insulin. Engxenyeni yokuqala yenyanga, iziguli ezinesifo sikashukela ziphuza ithebhulethi engu-1 equkethe ama-5 + 500 mg.

Ekuqaleni kokwelashwa, ubungozi bemiphumela emibi ye-metformin ephezulu kakhulu. Ukuze wehlise, umuthi uthathwa ngokuqinile nokudla, mhlawumbe kusihlwa. Uma i-metformin ibekezelelwa kahle, ngemuva kwamasonto ama-2, umthamo wayo unyuswa waba ngu-1000 mg. I-Saxagliptin idakiwe emthweni ofanayo. Uma kuba nomuzwa ongathandeki emgudwini wokugaya ukudla, ukwanda komthamo kufanele kuhlehliswe futhi isikhathi esithe xaxa kufanele sinikezwe emzimbeni ukuze sijwayele umuthi. Uma i-glycemia ivamile, i-Combogliz Prolong ingathathwa kumthamo ofanayo iminyaka eminingana ngaphandle kokulahleka kokusebenza.

Umthamo omkhulu ovunyelwe we-Comboglize ngu-5 + 2000 mg. Inikezwa ngamathebhulethi amabili we-2,5 + 1000 mg, adakwa ngasikhathi sinye. Uma i-2000 mg ye-metformin yesifo sikashukela ayanele, enye i-1000 mg ingathathwa ngokuhlukile, ngokungcono ifomu elide lesikhathi eside (i-Glucofage Long kanye ne-analogues: IForom Long, Metformin MV, njll.).

Ukuqinisekisa isenzo esifanayo sezinto ezisebenzayo, umuthi udakiwe cishe ngasikhathi sinye. Ukuze ulondoloze izakhiwo ezikhona zamathebulethi azikwazi ukuchobozeka.

Ungayithatha kanjani indawo yeCombogliz Prolong

IGenerikhi eCombogliz Prolong ayikho futhi ngeke ivele maduze, ngoba ilungelo lobunikazi lisahlanganiswa nomuthi. Ama-analogues eqembu yi-linagliptin gliptins (inhlanganisela ne-metformin yenziwa ngaphansi kophawu lwentengiso lwaseGentadueto), i-vildagliptin (isidakamizwa seGalvus Met sokuhlanganisa), i-sitagliptin (i-Velmetia, i-Yanumet) Umphumela wabo kushukela wesifo sikashukela usondelene ne-saxagliptin, kepha izinto ziyahlukahluka kumithamo, i-pharmacokinetics, contraindication, ngakho-ke ukuguqulelwa kumuthi omusha kumele kuvunyelwane nodokotela.

Ungagcina kanjani ekuthengeni kwe-Combogliz Prolong:

1. "Qoqa" Ukwanda kweCombogliz kusuka ku-Onglisa nakuMetformin. U-Onglisa - umuthi womenzi ofanayo, uqukethe i-2,5 noma 5 mg ye-saxagliptin. Intengo yayo ama-ruble ayi-1800. amaphilisi angu-30 we-5 mg. Ukuze ukwazi ukuphinda ngokuphelele ukwakhiwa kweCombogliz Prolong, noma iyiphi i-metformin ende ifakwa ku-Ongliz, kuzobiza ama-ruble angama-250-750 ngenyanga.
2. Cela udokotela wakho ukuthi akunikeze incwadi yamahhala ye-saxagliptin. Umuthi kungenzeka ungatholakali kuzo zonke izifunda, kepha inani labo liyanda minyaka yonke. Inkomba yokuqokwa kwe-saxagliptin - i-hypoglycemia ejwayelekile noma enzima kwi-sulfonylurea. Njengoba umuthi ungenawo ama-generics ashibhile, ikhemisi lizokunikeza noma amaphilisi asekuqaleni eCombogliz Prolong, noma i-metformin ne-Onglizu.
3. Uma u-oda umuthi ekhemisi eliku-inthanethi futhi uzikhethele kusuka lapho kukhishwa khona, ungonga cishe i-10% yezindleko zawo.

Ukushintshela kokutholakala kwe-sulfonylurea kungathandeki, ngoba kungadala i-hypoglycemia. Uma kungenye enye indlela, kungcono ukuthatha i-glimepiride ephephe kakhulu ne-gliclazide. Ama-analoggues wezidakamizwa Combogliz ngalezi zinto - i-Amaril M, Glimecomb.

Izinkomba zokusetshenziswa

Ngokusho kwemiyalo, amaphilisi we-Combogliz Prolong anqunyelwa isifo sikashukela sohlobo 2, uma ukulungiswa komsoco nokuzivocavoca umzimba kunganciphisi ngokwanele i-glycemia. Njengoba kunikezwe izindleko eziphakeme zomuthi, isilinganiso saso sinciphile. Ngokusho kwe-endocrinologists, banquma umuthi kulezi zimo ezilandelayo:

1. Uma isiguli sinciphise i-insulin synthesis, futhi ukuthatha i-sulfonylurea kuyabhalwa.
2. Ngobungozi obukhulu be-hypoglycemia: asebekhulile, abanesifo sikashukela abanezifo ezihambisanayo kanye nemikhawulo yokudla, iziguli ezinamazinga aphezulu omzimba, eziqashwe emsebenzini ezidinga ukunakwa ngokweqile.
3. Iziguli ezinesifo sikashukela ezingasebenzisi njalo izincomo zikadokotela zingakhohlwa ukuphuza iphilisi noma ukudla ngesikhathi.
4. Isifo sikashukela nge-neuropathy esisule izimpawu ze-hypoglycemia.
5. Uma isiguli sikashukela silwa ngamandla akhe onke ukugwema ukushintshela ku-insulin. Kukholelwa ukuthi i-sulfonylurea ingasheshisa ukubhujiswa kwamaseli e-beta. Ayikho imininingwane enjalo mayelana ne-sacasagliptin.

Contraindication

Uhlu lwe-contraindication emiyalweni ye-Combogliz Prolong banzi kakhulu, njenganoma yimuphi umuthi wokuhlanganisa:

Imiphumela emibi

ISaxagliptin ikhuphula kancane amathuba okuba ikhanda (ngo-1.5%), i-sinusitis, ukugabha (1%), ubuhlungu besisu (1,9%), i-gastroenteritis (1.4%), ukusabela komzimba (1.1%).

Emiphumeleni emibi efana ne-metformin, isicanucanu kanye nokuhlanza kwabonwa lapho kuthathwa amaphilisi e-Combogliz Prolong. Imvamisa yabo ingaphezulu kuka-5%.

I-overdose ye-saxagliptin ayinabungozi futhi ibangela ukudakwa. Ukweqisa umthamo we-metformin kungayilimaza kakhulu impilo. Ingxenye yesithathu yeziguli zesifo sikashukela ezithathe ngaphezu kwe-50 g ye-metformin yaqala ukuthuthukisa i-lactic acidosis.

Ngenkathi uthatha i-Metformin Prolong, ezinye izidakamizwa zingaguqula umphumela wazo we-hypoglycemic. Ukuqashelwa ikakhulukazi kufanele kukhokhwe kumithi elwa namagciwane, izidakamizwa ezihlaselayo, ama-antihypertensive, ama-antidepressants, uhlu lwabo oluphelele luqukethwe kwimiyalo. Lapho usebenzisa i-antifungal ketoconazole ne-itraconazole, ama-antibioticcacithromycin ne-telithromycin, i-antidepressant nefazodone, izidakamizwa ezilwa negciwane le-HIV ngosuku, kuvunyelwe kuphela u-2,5 mg we-saxagliptin.

Ukubuyekezwa mayelana ne-Comboglize