Isifo sikashukela yindawo ekhuthele kwezokwelapha. Eminyakeni yamuva nje, kuye kwakhiqizwa izidakamizwa eziningi ezintsha ezisiza ukuphathwa kukashukela wohlobo 2. Ukuvela kwesayensi kule minyaka eyishumi edlule kubizwa ngokuthi yi-incretin mimetics, okwehlisa i-glycated hemoglobin nge-1%. Kulokhu, isisindo somzimba sikashukela siyancipha futhi kancane kancane; izidakamizwa ezikhuphukayo azibangeli imiphumela ebuhlungu njenge-hypoglycemia.
Zonke lezi zici (ukungathathi hlangothi ngokwesisindo somzimba, ukungatholakali kwemiphumela emibi kakhulu, ukusebenza kahle okuphezulu kanye nentengo engabizi) zisebenza nasekwelapheni kwendabuko yesifo sikashukela iMetformin, ebilokhu ithatha isikhundla esiphambili ekwelashweni kwesifo sikashukela sohlobo 2 kwesigamu seminyaka.
I-Combogliz Prolong ehlanganisiwe yaseMelika ihlanganisa izinzuzo ze-metformin ne-incretinomimetics, futhi ifomu lesikhathi eside linikezela kalula ukusetshenziswa nokuphepha okwengeziwe.
Izici ze-Pharmacological zomuthi
ICombogliz Prolong iyinhlanganisela ehleliwe ye-saxagliptin ne-metformin, enikeza odokotela kanye nabanesifo sikashukela ngamathuba amasha wokulawula iphrofayili yabo ye-glycemic.
I-Saxagliptin
ISaxagliptin imele izidakamizwa ze-incretin. Amathumbu akhiqizwa amathumbu lapho ama-carbohydrate engena kuwo. Kunezinhlobo ezi-2 zama-hormone wemvelo: I-GLP-1 (i-glucagon-like peptide) ne-HIP (glucose-insulinotropic polypeptide).
Ukungena egazini, bona abangama-70% bavuselela ukukhiqizwa kwe-insulin endulini ngamaseli β-abhekele le nqubo.
Ngokufana, ama-incretins avimbela ukwakheka kwe-glucagon futhi vimbela ukukhishwa kokuqukethwe esiswini, kwakha umphumela wokugcwaliseka okwengeziwe.
Kusungulwe ukuthi kubantu abanesifo sikashukela abanesifo sohlobo 2, ukukhiqizwa kwama-insretin endo native kuphansi ngenxa yokuthi ama-hormone abhujiswa kalula yi-enzyme DPP-4 (dipeptidyl peptidase). Ama-agonists akhulayo avimbela umsebenzi we-DPP-4, ngenkathi egcina ukusebenza kwama-incretin endo native. I-analogues eyakhiwe ye-GLP-1 ayinazwela kule enzyme enolaka.
I-Saxagliptin ayigcini nje ngokunweba impilo yama -retretin, kodwa futhi inomthelela ekukhuleni kwamanani abo ngaphakathi kwesimo sempilo (isilinganiso sezikhathi ezi-2). Ukuthatha i-incretinomimetics kunciphisa izinkomba zokudla okusheshayo kanye ne-postprandial glycemia. Lezi zici zomuthi zingaziqeda izimo ze-hypoglycemic.
I-Metformin
I-antihyperglycemic drug metformin, okuwukuphela koyimele weqembu le-Biguanide, ayithinti ama-b-cell, ngakho-ke, ayigqugquzeli ukuvikelwa kwe-insulin futhi ayigcwali ama-pancreas.
Ulawula ukuguquguquka kwe-basal glycemia ngokuvimbela ukukhishwa kwe-glycogen esibindini ngama-30%. I-Metformin ivimba ukumunwa kwama-molecule eglue esiswini, ithuthukisa ukuzwela kwama-cell receptors kune-insulin yawo. Ngokusheshisa ukuhanjiswa kwe-glucose emisipha, kwandisa izindleko zamandla wezidingo zomzimba futhi kwehlise inani lokuguqulwa koshukela olungachazwanga lube ngamafutha.
I-Metformin ngokukhishwa okuguquliwe inenzuzo eyengeziwe - ubuncane bemiphumela emibi evela emgodini wesisu, ukuqina kwesisindo. Ijusi ye-gastric engabonakali, ulwelwesi luqhibilika ngokushesha, ikepisi ligxibilika futhi limbozwe ngejeli. Ngenxa yalesi matrix we-gel, umuthi udedelwa ngendlela efanayo usuku lonke, uhlinzeka ngemibandela yokufakelwa okuphezulu.
Ukuhlanganiswa kwe-incretinomimetic ene-metformin kwaqashelwa odokotela njengokwenanoma yisiphi isigaba sokulawulwa kwesifo sikashukela sohlobo 2. Ngaphezu kokulula kokuthola kanye nokwethembeka kwesineke kulelo hlobo lokwelashwa, umbandela oyinhloko wukusebenza kahle okuphezulu nokuphepha okufakazelwe. Kwabashukela abanesifo sikashukela abakhulu, lesi yisinqumo esihle kunazo zonke, ngoba umuthi awunagalelo ekuzuzeni isisindo, ukukhula kokwehluleka kwenhliziyo, i-pancreatitis, ne-oncology.
Khipha ifomu nokwakheka kwesikhathi kweKombiglyze
Inkampani yemithi yaseMelika iBristol-Myers squibb ikhiqiza umuthi we-antidiabetic ngendlela yamathebulethi anemibala enamakhono aguquliwe.
I-capsule ngayinye iqukethe i-500 noma i-1,000 mg yezithako ezisebenzayo zeMetformin kanye ne-2,5 noma 5 mg ye-Saxagliptin. Ngaphezu kwezithako eziyisisekelo, ukwakheka kuhlanganiswa nama-filler: i-magnesium stearate, sodium carmellose, hypromellose. Umbala wegobolondo ungaba ophuzi, opinki noma o-beige, kuya ngomthamo. Amaphilisi ahlanganiswe kumaseli we-aluminium foil blister cell. Ibhokisi lekhadibhodi lingaqukatha amapuleti anjalo angama-4-8.
Khipha umuthi kadokotela. Kwi-Combogliz Yandisa intengo incike kumthamo: i-1000 mg + 5 mg (amaphilisi angama-28) - ukuya kuma-ruble angama-3250 .; I-1000 mg + 2,5 mg (amaphilisi angama-56 ngephakethe ngalinye) - ukuya kuma-ruble angama-3130.
Impilo yeshalofu yemithi ayisekho iminyaka emi-3. Umuthi ophelelwe yisikhathi kumele ulahlwe. Umuthi awudingi izimo ezikhethekile zokugcinwa.
Combogliz Prolong: Imiyalo esetshenzisiwe
Udokotela ukhetha uhlelo lokuphatha kanye nomthamo ngamunye, kucatshangelwa izinkomba ze-glucometer, impilo ejwayelekile, iminyaka yesifo sikashukela, ukusabela komuntu mathupha ezibhebheni. Ngokuvamile, imiyalo inikeza izincomo ezinjalo.
Umuthi owenziwa isikhathi eside uvame ukuthathwa 1 r. / Day. ngasikhathi sinye.
Phuza ithebhulethi ekuseni noma kusihlwa, ngaphandle kokugaya. Ngezindlela zokukhululwa eziguquliwe, ubuqotho begobolondo budlala indima ekhethekile.
Umthamo uwumuntu ngamunye, njenge-monotherapy yokuqala kungaba yithebhulethi eyi-1 (500 mg ye-metformin + 2,5 mg ye-saxagliptin), uma ukulawulwa okuphelele kwe-glycemic kungatholakali, umthamo wenyuselwa kumathebhulethi ama-2 (1000 mg we-metformin + 5 mg we-saxagliptin).
Ngokusetshenziswa kanyekanye kwemithi yokwelapha izifo ezihlangene, imiphumela yokusebenzisana kwabo kufanele ibhekwe. Ikakhulu, ngokuphathwa kanyekanye kwama-inhibitors we-CYP3A4 / 5 isoenzymes (Indinavir, Ketoconazole, Nefazodon, Itraconazole, Atazanavir), umthamo omncane we-saxagliptin unqunyelwe - 2,5 mg.
Imithi esekelwe kwi-metformin enomthelela wesikhathi eside wemiphumela engathandeki ngendlela yokuphazamiseka kwengqondo i-dyspeptic incane kakhulu kune-analogues ngokukhishwa okusheshayo. Ukuze umzimba uguqukele ezimeni ezintsha, akunabuhlungu ngokuphelele indlela yokugaya, i-derm titration kufanele yenziwe kancane kancane, njalo emavikini ama-2.
Noma iluphi ushintsho lwendlela yokuphila kufanele lubhekwe lapho kulungiswa imvelo yomuthi, ngakho-ke kubalulekile ukwazisa udokotela ngabo ngesikhathi esifanele.
Analogs Kombiglyce Prolong
Kwi-Combogliz Prolong, i-analogue enesethi efanayo yezithako ezisebenzayo kungenzeka kube yi-Comboglis XR, ekhiqizwa e-Italy nase-UK. Intengo ye-analogue isuka kuma-ruble ayi-1650. (Amaphilisi angu-28 we-1000 mg we-metformin no-2,5 mg we-saxagliptin).
Imiphumela yokwelapha ehlanganisiwe ye-Avandamet, Yanumet, Glimecomb, GalvusMet neBagomet plus inomphumela ofanayo wokwelapha.
Nikeza izidakamizwa ngokuya ngesakhi esisodwa esisebenzayo njengeGlyformin Prolong, Glucofage, Metadiene, Sofamet, Diaformin Od, Ongliza, Matospanin, Metfogamma, Siofora.
Uboniswa ngubani umuthi
Ukulondolozwa kwe-Combogliz kunqunyelwe uhlobo 2 lwesifo sikashukela ukuze kulungiswe ukulawulwa kwe-glycemic njengokungezwa kokudla okuphansi kwe-carb kanye nokuzivocavoca okwanele ngokomzimba, uma ukuguqulwa kwendlela yokuphila kungazange kukhiqize imiphumela efunwayo kanye nokuhlanganiswa kwe-saxagliptin ene-metformin kufanelekile esigulini.
Ukuphulwa okuphelele nokuhlobene
Ngisho nomuthi onokuphepha okuphezulu, okuyiCombogliz Prolong, awunqunyelwe ukungabekezelelani komuntu ngamunye kanye ne-hypersensitivity kwizithako zefomula.
- Umuthi awukhonjiswa komama abakhulelwe futhi abakhulelwe (badluliselwa okwesikhashana kwi-insulin), ngenxa yokuntuleka kwesisekelo sobufakazi esanele ngokusebenza kwawo, awubekelwe izingane.
- Umuthi awulungele abanesifo sikashukela abanesifo sohlobo 1.
- Ekungasebenzi kahle kwezinso, kanye nemibandela ebacasulayo, umuthi nawo awubekiwe.
- Ungasebenzisi umuthi ukwelapha iziguli ngama-pathologies abangela ukulamba kwe-oksijini kwezicubu.
- Nge-ketoacidosis (ifomu lesifo sikashukela) elinenhlaka noma engenakunga, umuthi awuthathwa okwesikhashana.
- Amaphilisi akhanselwa ngesikhathi sokusebenza, ngokulimala kanzima, ukusha okukhulu. Ukuhlolwa kwe-X-ray ngezimpawu eziqukethe iodine kwisifo sikashukela kungazilimaza izinso, ngakho-ke kubuye kuguqulwe kuyi-insulin. Sekukonke, ukwelashwa kwe-insulin kuboniswa emahoreni angama-48 ngaphambili namahora angama-48 ngemuva kwezinqubo, ikakhulukazi, konke kuncike esimweni sezinso nasenhlalakahleni isiguli.
- Ama-pathologies wesibindi, i-lactic acidosis kanye nokuxhomekeka kotshwala nakho kuluhlu lwe-contraindication. Awukwazi ukunquma umuthi ezigulini ezinokubekezelelwa kofuzo.
Ukubhekisisa ikakhulukazi kufanele kunikezwe kwabanesifo sikashukela sobudala obuvuthiwe, ikakhulukazi ukungondleki, i-pancreatitis kanye nokuzivocavoca okwanele okungavusa i-hypoglycemia.
Imiphumela engathandeki engafuneki kanye ne-overdose
ISaksagliptin enamazinga ahlukahlukene wamathuba iyakwazi ukudala izimo:
- I-Sinusitis
- Migraines
- Ubuhlungu besisu;
- Ukuqhafaza;
- Izifo ze-Urinaryape;
- Ukuphazamiseka kwesigqi sokuhamba kwamathumbu;
- I-Thrombocytopenia;
- Nasopharyngitis;
- I-Hypoglycemia;
- I-Gastroenteritis;
- Ukuvuvukala ebusweni;
- I-pancreatitis
- I-Urticaria.
Ucwaningo lwelabhorethri lukhombise ukwehla kokufakwa kwe-vithamini B12 ngokusebenzisa umuthi isikhathi eside, kanye nokwehla kwenani lama-lymphocyte. Amacala we-overdose awashadi, kuvame ukwenzeka ngokusetshenziswa kwe-saxagliptin isikhathi eside. Umuthi awubangeli ukudakwa, ngokweqile komuthi, i-hemodialysis iyasebenza. Ngokuhambisana, ukwelashwa okubonakalayo kuyenziwa.
I-overdose ye-metformin ivame kakhulu, ubunzima obuyingozi kakhulu yi-lactic acidosis.. Ungasibona isimo ngezimpawu ezilandelayo:
- Ukwehlukaniswa;
- Ukuphefumula;
- Ubuhlungu besisu;
- Umfutho wegazi ophansi;
- I-Hypothermia;
- Ukuqina kwemisipha;
- Ukuphazamiseka kwesigqi senhliziyo.
Esimweni esinzima, ukwazi ukungasebenzi kahle, ukuhoxa, ukucaciswa komzimba nokukhubazeka kukhula. Isisulu sidinga ukulashwa ngokuphuthumayo esibhedlela, ngaphandle kokuthola ukunakekelwa okwanele kwezokwelashwa, angafa. I-metformin eyeqile nayo isuswa yi-hemodialysis, kubalulekile ukuthi ucabangele ukuthi imvume ye-creatinine ifinyelela ku-170 ml / min.
Lapho umuntu onesifo sikashukela egcwaliseka ngokunembile konke ukunconywa kukadokotela, unciphisa ingozi yokushayisana okukhulu. Endabeni yeCombogliz ende, akunzima ukulandela uhlelo lokuphuza umuthi.
Izinketho zokuxhumana neminye imithi
Lapho wenza inqubo yokwelashwa ye-Combogliz Prolong, kubalulekile ukuxwayisa i-endocrinologist mayelana nayo yonke imishanguzo edalwa yisifo sikashukela ukwelapha izifo ezilinganayo. Abanye babo bayakwazi ukuthuthukisa amandla anciphisa ushukela eComboglize, abanye bevimbela umsebenzi wawo.
Ngomqondo ojwayelekile, ungazulazula etafuleni.
I-Saxagliptin | I-Metformin |
Ukuthuthuka komphumela we-Hyperglycemic | |
| I-Rifampicin, i-Pioglitazone, iMagnesium ne-Aluminium Hydroxides / Simethicone | I-GCS, i-diuretics, i-nicotinic acid ama-hormone egilo, i-isoniazid, ama-sympathomimetics, ama-phenothiazines, ama-estrogens, ama-phenytoin, ama-calcium blockers |
Nikeza izimo ze-hypoglycemic | |
| I-Amprenavir, i-Diltiazem, i-Erythromycin, i-Fluconazole, i-Aprepitant, i-Verapamil, ijusi lamagilebhisi, i-Ketoconazole, izidakamizwa ze-sulfonylurea, i-Glibenclamide, i-Ketoconazole, i-isoenzymes CYP3A 4/5, Famotidine | Ama-cationic agents, iFurosemide, imithi esekwe ethanol, iNifedipine |
I-Amprenavir, i-Diltiazem, i-Erythromycin, i-Fluconazole, i-Aprepitant, i-Verapamil, ijusi lamagilebhisi, i-Ketoconazole, izidakamizwa ze-sulfonylurea, i-Glibenclamide, i-Ketoconazole, i-isoenzymes CYP3A 4/5, Famotidine
Ama-cationic agents, iFurosemide, imithi esekwe ethanol, iNifedipine
Kuyacaca ukuthi izivivinyo zokuzihlola kanye nokuzelapha ngemithi ye-Combogliz Prolong zingaba nemiphumela emibi yezempilo.
Ukwanda Kwe-Combogliz: ukubukeza kwabanesifo sikashukela
Odokotela ababheka ukusebenza ngempumelelo kwale ndlela yokwelashwa nge-Combogliz Prolong baqaphela ukuhluka kwayo, futhi abanesifo sikashukela abanakho ukungabaza emandleni ayo.
Ukuphathwa ngokuphelele kwesifo sikashukela kudinga indlela ehlanganisiwe: umsoco ophansi we-carb, ukuqapha nsuku zonke ukufundwa kwe-glucometer, ukusebenza ngokomzimba okwanele nokusekelwa kwezokwelapha. Kule nhlanganisela kuphela ongabheka umphumela we-100% we-Combogliz Prolong.
Kule vidiyo, uprofesa-endocrinologist u-A.S. Ametov ukhuluma ngemigomo yesimanje yokulawulwa kwesifo sikashukela sohlobo 2.
