Lesi sifo namuhla sithinta 9% yabantu emhlabeni. Izinkampani ezenza amakhambi kanye nezinhlelo zokunakekelwa kwempilo zamazwe aholayo emhlabeni zitshala izigidigidi zamadola, futhi isifo sikashukela sihamba ngokuzulazula emhlabeni, siba mncane, siba nolaka ngokwengeziwe.
Lo bhubhane uthatha isilinganiso obekulindelekile: ngonyaka ka-2020, kubikwa ukuthi iziguli ezinesigamu sesigidi ezinesifo sikashukela sohlobo lwe-2, futhi odokotela abafundanga ukusilawula ngempumelelo lesi sifo.
Uma ngesifo sikashukela sohlobo 1, esithinta ngaphansi kwe-10% yabo bonke abantu abanesifo sikashukela, yonke into ilula: ukunciphisa ukugcwala kwe-glucose egazini ngokujova nge-insulin (akukho okunye okunganikezwa lapho) futhi konke kuzolunga (namuhla, ezigulini ezinjengalezi, basungule futhi ipancake eyindala ), ke ngesifo sikashukela sohlobo 2, ubuchwepheshe obuphezulu abusebenzi.
Ngokufanekisela, isifo sikashukela sohlobo 2, ushukela kwathiwa yisitha esikhulu, sigcwalisa imakethe ngemithi yokwehlisa ushukela. Ukwelashwa kwabanesifo sikashukela ngosizo lwamaphiramidi okwelapha kuyaqina, lapho omunye umuthi usetshenziselwa umuthi owodwa, khona-ke kuhlanganiswa umuthi wesithathu kule nkimbinkimbi kuze kufike isikhathi se-insulin.
Eminyakeni engama-20 edlule, odokotela bebelokhu belwa noshukela, kepha umphumela ungaphansi kwe-zero, ngoba imiphumela emibi nezinkinga zezidakamizwa zivame kakhulu ukusebenza kwabo, ikakhulukazi uma ungalandeli umthamo, ungabheki ukuthi umuthi ungowani futhi ungubani.
Enye yalezi zitho okugxilwe kuzo inhliziyo nemithambo yegazi. Kufakazelwa ukuthi ukwelashwa ngokweqile kwesifo sikashukela kunikeza umphumela ophambene futhi kuholele ekufeni kwemithambo. Ushukela umaka nje kuphela isifo sikashukela sohlobo 2; lesi sifo sisuselwa ku-metabolic syndrome.
Umuthi wesizukulwane esisha u-Onglisa, okhiqizwe ososayensi baseBrithani nabase-Italy, awugcinanga ngokulwa nesifo sikashukela kuphela, kodwa futhi nekhono le-inhliziyo. Imithi yochungechunge lwama-incretin, kubandakanya i-Onglisa, iyintuthuko yakamuva emkhakheni we-diabetesology. Basebenzela ukwehlisa isifiso sokudla kanye nokwehla kwesisindo - esinye sezizathu eziphambili zokwakhiwa kwesifo sikashukela sohlobo 2.
Ngaphezu kwalokho, ama-incretinomimetics awavuseleli i-hypoglycemia, asiza ukunciphisa umfutho wegazi, futhi avikele namaseli we-pancreatic. Intengo ephezulu kanye nokuntuleka kwesipiliyoni somtholampilo ngenxa yesikhathi esifushane sokusetshenziswa kwezidakamizwa kungahle kubangelwe ukungathandeki kwe-Onglisa, kepha futhi lokhu kuyindaba yesikhathi.
Ukwakheka nefomu lokukhululwa
Ithebhulethi ngalinye le-Onglisa, isithombe salo esivezwe kulesi sigaba, liqukethe i-2,5 noma 5 mg ye-saxagliptin hydrochloride egobolondweni. Ifomula lalethwa ngababizi: i-cellulose, i-lactose monohydrate, i-croscarmellose sodium, i-magnesium stearate ne-Opadray dyes (emhlophe, ephuzi nohlaza okwesibhakabhaka ngamaphilisi we-2,5 mg futhi omhlophe, opinki nohlaza okwesibhakabhaka ngomthamo we-5 mg).
Umuthi ungakhonjwa ngesimo (amaphilisi e-biconvex nge-tint ephuzi futhi umaka u-2,5 / 4214 bese upinki ngokuqoshwa kwe-5/4215). Umbhalo ugcotshwa ohlangothini ngalunye ngoyinki oluhlaza okwesibhakabhaka.
Ungathenga umuthi onikezwe umuthi. Ngamathebhulethi we-Ongliz, intengo ayiveli esigabeni sesabelomali: kuma-30 ama-pcs. I-5 mg eMoscow udinga ukukhokha ama-ruble ayi-1700. Umenzi unqume impilo yeshelufu yemithi kungakapheli iminyaka emithathu. Izimo zokugcina zomuthi zijwayelekile.
Izici ze-Pharmacological
Isithako esiyinhloko se-Onglisa yi-saxagliptin. Kungakapheli usuku ngemuva kokungena emgodini wokugaya ukudla, kuvimbela umsebenzi we-DPP-4 peptide. Lapho uthintana ne-glucose, ukucindezelwa kwe-enzyme ngokumangazayo (izikhathi ezi-2-3) kuthuthukisa ukugcinwa kwe-glucagon-like peptide-1 (GLP-1) ne-insulinotropic polypeptide (HIP) ye-glucose.
Ngasikhathi sinye, izinga le-glucagon kumaseli e-b liyancipha, umsebenzi wamaseli we-b obhekene nokukhiqizwa kwe-insulin yendabuko uyanda. Ngenxa yalokhu, izinkomba zokuzila nokudla kwe-postprandial glycemia kuncishiswa kakhulu.
Ukuphepha kanye nokusebenza kahle kwalo muthi kwafundwa ezivivinyweni ezi-6, lapho amavolontiya angama-4148 anesifo sohlobo 2 ahlanganyela. Bonke ababambiqhaza bakhombise ukuguquguquka okuhle kwe-hemoglobin ye-glycated, ushukela wendlala kanye ne-glycemia ngemuva komthwalo we-carbohydrate. Abahlanganyeli bebodwa abangazange bafeze i-100% glycemic control babekwa eminye imishanguzo - i-thiazolidinediones, metformin, glibenclamide.
Iziguli ezisebenzisa ezinye izidakamizwa ze-antidiabetes ziyakhombisa imiphumela efanayo. Isisindo sabo bonke ababambe iqhaza kulolo hlolo luzinzile.
Lapho kunqunywe iSaxagliptin
Isifo sikashukela esinesifo sohlobo 2 i-Ongliz enqunyiwe:
- Njenge-monotherapy, ehlanganiswe nokuguqulwa kwendlela yokuphila;
- Ngokuhlanganiswa, ngokungezwa kwenketho yangaphambilini nge-metformin, uma i-monotherapy inganikeli ukulawula okuphelele kwe-glycemia;
- Kanye nokutholakala kochungechunge lwe-sulfanylurea ne-thiazolidinediones, uma ukuhlanganiswa kwangaphambilini bekungasebenzi ngokwanele.
Uphathiswe okabani kuye u-Onglisa
Njengoba i-saxagliptin iyisikhuthazi esinamandla esithuthukisa umsebenzi wamaseli we-b futhi sinqande ukusebenza kwamaseli e-b, singasetshenziswa ngokulinganiselwa okuthile, ikakhulukazi, umuthi awukhonjisiwe:
- Omama abakhulelwe futhi abancelile;
- Ebuntwaneni;
- Isifo sikashukela esinesifo sohlobo 1;
- Ngokuhlukahluka okuxhomekeke ku-insulin kohlobo 2 sikashukela;
- Ethintwa yisifo sikashukela sikashukela;
- Uma isiguli singabekezeleli i-galactose;
- Nge-hypersensitivity kwizithako zefomula.
Lapho ukhetha irejimeni yokwelashwa, udokotela akagxili kuphela ku-contraindication efakwe ohlwini, kodwa futhi nasekuvumelaneni ne-saxagliptin yezidakamizwa ezithathwa yisifo sikashukela ezifweni ezihlangene. Ngakho-ke, yonke izidakamizwa ezidalwa yisifo sikashukela ngokufana, udokotela kumele aziswe ngesikhathi esifanele.
Iziphakamiso zokusetshenziswa
Udokotela unquma umthamo womuthi ngamunye, ebheka imiphumela yokuhlolwa, iminyaka, isigaba sesifo, ukusabela komzimba ngakunye. Ku-Onglisa, imiyalelo yokusebenzisa incoma ukuthatha amaphilisi ngomlomo, ngaphandle kokuboshelwa ngesikhathi sokudla. Umthamo ojwayelekile womuthi ngu-5 mg / ngosuku.
Ekuqaleni kwenkambo yokwelashwa, irejimeni ejwayelekile ibukeka kanjena:
- I-Saksagliptin - 5 mg / usuku .;
- I-Metformin - 500 mg / ngosuku.
Ngemuva kwezinsuku eziyishumi nanhlanu, umphumela wokwelapha wohlobo olukhethiwe uyahlolwa futhi, uma kunesidingo, isilinganiso se-metformin siyalungiswa, sigcina izinga le-Onglisa lingashintshiwe.
Uma isikhathi sokuphuza umuthi sishoda, sithathwa ngomthamo ojwayelekile ngethuba lokuqala. Awukwazi ukuphinda okujwayelekile, ngoba umzimba udinga isikhathi sokukucubungula.
Uma kunomlando wesifo sezinso esimnene, asikho isidingo sethamo. Ngefomu elinganiselayo nelinzima, okujwayelekile kuncishiswa izikhathi ezi-2 - 2,5 mg / ngosuku. (isikhathi esisodwa).
Ngesikhathi se-hemodialysis, ithebhulethi idakwa ekugcineni kwenqubo. Umphumela we-Onglisa ezigulini ezikwi-peritoneal dialysis awuzange ufundwe. Ngaphambi kokunquma umuthi futhi kuyo yonke inkambo, kuyadingeka ukuhlola ngezikhathi ezithile ukusebenza kwezinso.
Nge-pathologies ye-hepatic, umuthi unqunywe kumthamo ojwayelekile we-5 mg / ngosuku. Kwabanesifo sikashukela sobudala obuvuthiwe, i-dose titration ayidingeki, kepha isimo sezinso kumele sibhekwe.
Umthamo wama -retretins unqanyulwa ekwelashweni okuyinkimbinkimbi ngama-inhibitors:
- Atazanavir;
- I-Ketoconazole;
- Igraconazole;
- INelfinavir;
- Clarithromycin;
- I-Ritonavir;
- I-Saquinavir;
- Indinavir;
- I-Telithromycin.
Akunamininingwane esemthethweni ngokululeka kokusebenzisa lo muthi kwabesifazane abakhulelwe nezingane ezingaphansi kweminyaka engu-18, ngenxa yalokho kukhethwa izichazi zalesi sigaba sabanesifo sikashukela.
Imiphumela engathandeki kanye ne-overdose
Izidakamizwa zeqembu le-incretin lesizukulwane sakamuva kungenye ephephe kakhulu. Ngazo zonke izincomo zikadokotela, u-Ongliz ubekezelelwa ngokujwayelekile ngabanoshukela abaningi.
Kwezinye izimo, okulandelayo kuyaphawulwa:
- Ukuphazamiseka kwe-dyspeptic;
- Ubuhlungu bekhanda;
- I-pancreatitis
- Izifo zamapheshana wokuphefumula;
- Izifo ze-urogenital zesimo esithathelwanayo.
Uma kuvela ezinye zezimpawu noma okunye ukungakhululeki okungajwayelekile, kufanele uyeke ukusebenzisa lo muthi bese uthintana nodokotela wakho.
Ngenhloso yesayensi, lo muthi wanikezwa amavolontiya okwedlula ngendlela evamile izikhathi ezingama-80. Izimpawu zokudakwa azilungiswa. I-saxagliptin eyeqile ingasuswa kusetshenziswa i-hemodialysis.
Izincomo ezingeziwe
ISaxagliptin ayinqunyelwe kwirejimeni kathathu lapho imijovo ye-insulin ihlanganiswa ne-metformin ne-thiazolidinediones, ngoba imiphumela yokusebenzisana ayifundiswanga. Ukulawulwa kwezinso kwenziwa kuzo zonke izigaba zokwelashwa nge-Onglisa, kepha ngesimo esincane, umthamo awushintshiwe, kwezinye izimo uyanqanyulwa.
I-Saxagliptin maqondana nemiphumela ye-hypoglycemic iphephile ngokuphelele, kepha uma kuhlanganiswa nezidakamizwa ze-sulfonylurea kungavusa izimo ze-hypoglycemic. Ngakho-ke, ngokuphathwa okuyinkimbinkimbi, ukunikezwa kwemithamo yengozi ekugcineni kwendlela yokunciphisa kuyimpoqo.
Uma kwenzeka kungabekezelelwa izidakamizwa zochungechunge lwama-incretin - i-DPP-4 inhibitors, i-Ongliza nayo ayinqunyelwe, ngoba kwezinye izimo ukusabela okungelona iqiniso kuqoshwe kusuka ekuqhekekeni kwesikhumba okujwayelekile kuye ekuqhumeni kwe-anaphylactic ne-angioedema, kudinga ukuhoxiswa ngokushesha kwemithi.
Njengoba umuthi uqukethe i-lactose, ayibekelwanga abanesifo sikashukela ngokubekezelela komuntu ngamunye, ukuntuleka kwe-lactose, i-glucose-galactose malabsorption.
Ehlelweni lokuqapha abanesifo sikashukela ngemuva kokwelashwa no-Onglisa, kuye kwaba nezimo zokuthuthuka kwe-pancreatitis e-acute. Lapho unquma inkambo ye-saxagliptin, isiguli kufanele saziswe ngesimpawu esibonakalayo: Ubuhlungu obungapheli nobunzima e-epigastrium.
Uma kunokungakhululeki esiswini, kufanele uyeke ukuthatha lo muthi futhi ubike udokotela wakho ngokuxebuka. Imiphumela ingeyesikhashana futhi iguqukele emuva, idlulela ngokwayo ngemuva kokuyeka umuthi.
Ezimweni ezingasebenzi kahle ezinempilo ngesimo esilinganiselwe nesinzima, ukubalwa kokuthathwa komthamo owodwa. Ezimweni ezinzima, i-Onglizu isetshenziswa ngokuqapha; esigabeni esibulalayo, lapho isiguli singekho ngaphandle kwe-hemodialysis, ungasebenzisi nhlobo. Ukuqashwa kwesimo sezinso ezimweni ezinjalo kwenziwa ngaphambi kokuqala kwenkambo yokwelashwa futhi njalo ezinyangeni eziyisithupha kusetshenziswa i-Ogliza njalo.
Ukuhlangenwe nakho ekwelashweni kwabanesifo sikashukela esekhulile (kusuka eminyakeni engama-75) akwanele, ngakho-ke, lesi sigaba seziguli sidinga ukunakwa okwengeziwe.
Imiphumela yethonya le-Onglisa ekhonweni lokulawula ukuthutha noma izindlela eziyinkimbinkimbi asishicilelwe, ngakho-ke, abanesifo sikashukela kufanele baphuze lesi sidakamizwa ngokucophelela, ikakhulukazi ngoba isiyezi senzeka phakathi kwemiphumela emibi. Ukunakwa okukhethekile ezimeni ezinjalo kuyadingeka ezigulini ezisebenzisa i-Onglisa ekwelashweni okuyinkimbinkimbi, ngoba ezinye izidakamizwa ze-antidiabetic zingavusa i-hypoglycemia.
Isipiliyoni sokusebenzisa umuthi wezinkinga zenhliziyo sibonisa ukuthi lesi sidakamizwa sijwayelekile ukushaya kwenhliziyo. E-Melika, ngisho nangomkhawulo ophezulu weshukela ejwayelekile, udokotela ubeka abantu abanesifo sikashukela nge-arrhythmia Onglizu ukuthuthukisa ama-glycemic indices futhi ubuyisele izinga lokushaya kwenhliziyo.
Ukusebenzisana kwezidakamizwa ne-Onglisa ne-analogues
Ngokuhambisana nedatha yocwaningo lwesayensi, imiphumela yokuxhumana kwe-Onglisa nezinye izinto ngesikhathi sokwelashwa okuyinkimbinkimbi akubalwa njengokubalulekile ngokomtholampilo.
Umthelela ekusebenzeni kahle kokulashwa kokusetshenziswa kotshwala, ugwayi, izidlo ezahlukahlukene, amakhambi we-homeopathic awukasungulwa.
Kwifomu lethebhulethi, ochungechungeni lwe-incretin, kanye no-Onglisa, uGalvus noJanuvia bayakhululwa esibayeni sesirinji - uBaetu noViktoza.
Izilinganiso zochwepheshe nezomsebenzisi
Kumaforamu anokwethenjwa mayelana nomuthi u-Ongliza, ukubuyekezwa kuyahlaba umxhwele, mhlawumbe okuwukuphela kokuphansi kwentengo ehambelana nekhwalithi yaseYurophu.
Ngeshwa, izifo, njengokuguga, aziguquki futhi azinakugwenywa, ngoba impilo, njengoba uyazi, ayinakuthengwa, futhi uhlobo lwesifo sikashukela 2 alubizwa ngephutha ngokuthi ithikithi lendlela eyodwa.
Kepha ama-pancreas kwisifo sikashukela esinesifo sohlobo lwe-2 awagcini ndawo, anendawo yokubeka kabusha imisebenzi yayo, futhi ayiqede njengengasebenzi (kusukela ekubukeni kokugcwala kwe-insulin) ngaphambi kwesikhathi.
Ngaphambi kokukhulula u-Ongliza emakethe, unjiniyela usebenzise imali eyizigidigidi hhayi nje ukufakazela ukungabikhona kwemiphumela emibi, kodwa futhi nokuqinisekisa ukusebenza kwayo. Uma umuthi uzosiza kuphela ukubambezeleka kwezinkinga iminyaka eyi-10 ukuya kwengama-20, noma ngenxa yalesi sikhathi esigcwele (ngaphandle kokuhlaselwa yinhliziyo, imizwa, ubugebengu, ukungaboni, ukungabi namandla, ukungasebenzi kahle kwempilo), kufanele unake kakhulu.
Ukuphawula ngamathuba we-Onglisa kanye nemiphumela yezidakamizwa zesifo sikashukela empilweni ye-endocrinologist Shmul Levit, inhloko. Isikhungo Sikashukela, bheka ividiyo:
