Wonke umuntu weshumi ohlala kule planethi (nakwezinye izifunda zase China - umzuzwana ngamunye) uyagula noma usengozini yokuba nesifo sikashukela. Izimbangela eziholayo zokufa (i-myocardial infarction ne-oncology) zivame ukuba yisifo sikashukela, kungaba sobala noma samuva.
Ukulwa nalolu bhubhane lwekhulu lama-21, sekukhiqizwe amakhulukhulu ezinhlobo zemithi - yomibili indabuko, enobufakazi obuqinile, futhi inobuhlakani, idinga isiqinisekiso sokusebenza ngempumelelo. Phakathi kwemithi edume kakhulu yesifo sikashukela yiGlucovans yenkampani yase-Austrian Nycomed Austria GmbH.
Izici ezijwayelekile zomuthi
Ukwakheka kwe-ejenti ye-hypoglycemic ehlangene kufaka izithako ezimbili ezisebenzayo: Metformin neGlibenclamide. Isilinganiso sabo kumakhompiyutha siyahluka:
| Umthamo mg | glibenclamide, mg | metformin mg |
| 2,5 /500 | 2,5 | 500 |
| 5/500 | 5 | 500 |
Emithini, kukhona nababizi: i-croscarmellose sodium, i-magnesium stearate, cellulose, povidone K 30.
Umuthi ukhishwa ngendlela yamathebulethi. Igobolondo le-capsule lingaba ophuzi noma owolintshi. Enguqulo yokuqala, inombolo "5" ibhalwe ohlangothini olungaphambili, kwesibili - "2,5".
Izici ze-Pharmacological
I-Metformin imele isigaba se-biagudins. Injongo yayo eyinhloko ukunciphisa i-glucose ye-basal ne-postprandial egazini. Le nto ayikukhiqizi ukukhiqizwa kwe-insulin endulin, ngakho-ke ayivusi i-hypoglycemia. Izindlela eziyinhloko zomthelela wayo:
- Ukunciphisa ukwakheka kwe-glycogen esibindini ngokuvimbela izinqubo ze-gluconeogeneis;
- Ukuqedwa "kobumpumputhe" bama-peripheral hormone receptors;
- Ukwanda kokusetshenziswa nokusetshenziswa kwe-glucose kumaseli;
- Ukuvinjwa kokufakwa kweglue.
I-Metformin futhi ithinta ngokuqinile imetabolism ye-lipid: izinga le-triglycerol ne-cholesterol "embi" lehlisiwe kakhulu.
I-Glibenclamide imele isigaba sesibili sezidakamizwa ze-sulfonylurea. I-compound isiza ukwenza i-glycemia ihlale ngokwejwayelekile ngenxa yokuvuswa kwama-β-cell abhekene nokukhiqizwa kwe-insulin uqobo.
Indlela yokusebenza yezakhi zefomula ihlukile, kepha bagcwalisa ngempumelelo amandla we-hypoglycemic ngayinye, okwenza umphumela we-synergistic. Ngokusetshenziswa okuhlukile, umthamo womuthi ngamunye ngemiphumela efanayo uzoba mkhulu kakhulu.
Amandla we-Pharmacokinetic
I-Glibenclamide lapho igxilwe emgodini wokugaya imunwa yi-95%. Njengengxenye yesidakamizwa i-Glucovans ® is micronized. Inani lokuphakama egazini lifinyelelwa ngemuva kwamahora ama-4, umthamo wokusabalalisa kwento ufinyelela kumalitha ayi-10. I-Glibenclamide ibopha amaprotheni ngo-99%. I-metabolism yezidakamizwa yenziwa esibindini, lapho iguqulwa ibe ngama-inert metabolites amabili. Zikhipha umzimba ezinsweni (zize zifike kuma-40%) nangendlela yokuhambisa umzimba (zifike kuma-60%). Inqubo yesigamu sempilo isuka emahoreni angama-4-11.
Lapho ihanjiswa ngomlomo, i-metformin idonswa ngokuphelele, umuthi ufinyelela ekugxileni kwawo okuphezulu egazini ngemuva kwamahora amabili nesigamu. Ngaphandle kwezinguquko ezinkulu, u-20-30% wengxenye udlula amathumbu. I-bioavailability ye-metformin ingama-50-60%. Ezicutshini, umuthi ubhebhetheka cishe manjalo futhi awubophele amaprotheni egazi nakancane. Umuthi cishe awunakubangelwa yi-metabolism, iningi lawo likhishwa yizinso. Ukuphila kwesigamu kuthatha amahora ayisithupha nesigamu.
Ezindleleni ezingapheli zezinso, imvume ye-creatinine iyancishiswa. I-T1 / 2 yisitho esilelisiwe siyabambezeleka, umuthi uqongelela egazini. I-Glucovans bioavailability ifana naleya naleyo fomu ngayinye yomthamo. Ukudla akuphazamisi ipharamitha le, kepha izinga lokufakwa kwe-glibenclamide ngokufana nokudla lizoba ngaphezulu.
Uboniswa ngubani lo muthi
Le yinkimbinkimbi yenzelwe ukwelapha isifo sikashukela sohlobo 2. Kunqunyiwe uma ukuguqulwa kwendlela yokuphila nokwelashwa okwedlule nge-metformin noma eminye imishanguzo kungaholelanga kumphumela olindelekile.
Isidakamizwa sinconywa kwabanesifo sikashukela ngokunxeshezelwa ushukela okugcwele ukuze basebenzise irejimenti yangaphambi kokwelashwa ngemithi emibili ehlukile - iMetformin nabamele isigaba se-sulfonylurea.
Ungasifaka kanjani isicelo
Ngokuya ngezici zomtholampilo zezifo zesifo sikashukela esithile, i-endocrinologist iba nohlelo lomuntu siqu. Encwadini ezinconywayo zomenzi, kuvezwa izindinganiso ezijwayelekile zomuthi wokuqalisa: ikhompiyutha eyodwa yanoma yiluphi uhlobo lwamaGlucovans.
Uma umthamo okhethiwe ungasinxephezeli ngokuphelele i-glycemia ngesikhathi sokuguqulwa kwendlela yokuphila, ungayilungisa, kepha hhayi ngaphambi kwamaviki ama-2, ama-5 mg we-glibenclamide + 500 mg ye-metformin nsuku zonke.
Lapho uthatha indawo yokwelashwa eyinkimbinkimbi yangaphambilini nge-Glucovans, umthamo wokuqala kufanele ulingane nesilinganiso semihla ngemihla se-glibenclamide noma eminye imishanguzo evela eqenjini le-sulfonylurea, kanye ne-metformin, eyayinqunywe esigabeni sangaphambi kokwelashwa.
Ngokuhambisana nokufundwa kwe-glucometer ngemuva kwamasonto amabili, ungaguqula umthamo wama-glucovans.
Isibalo esiphezulu samathebhulethi angahle anqunywe kwesifo sikashukela yizicucu ezi-4 kumthamo we-5 mg / 500 mg noma izingcezu ezi-6 zeGlucovans®, efakwe ku-2,5 mg / 500 mg.
Indlela yokufaka isicelo izoncika ohlelweni olukhethwe udokotela. Kumathebhulethi we-2.5 mg / 500 mg no-5 mg / 500 mg kunezincomo ezijwayelekile.
- Uma kubekwe ithebhulethi / usuku olungu-1, kudakwa ekuseni ngokudla;
- Lapho isilinganiso sansuku zonke singamacwecwe ama-2 noma ama-4, asatshalaliswa ekuseni nakusihlwa, egcina izikhathi ezifanayo zesikhathi;
- Uma kunconyiwe, thatha amaphilisi angama-3.5 noma ayi-6 / usuku. kumthamo we-2,5 mg / 500 mg, badakwa ngesidlo sasekuseni, ngesikhathi sasemini nakusihlwa;
- Ngomthamo we-5 mg / 500 mg, kubekwa amaphilisi ama-3 / ngosuku. futhi uwahambise kuma-reception ama-3: isidlo sasekuseni, isidlo sasemini nesidlo sakusihlwa
Kubaluleke kakhulu ukubamba amaphilisi ngokudla okwanele. Ukuthatha ama-Glucovans esiswini esingenalutho kungadala i-hypoglycemia.
Kwabanesifo sikashukela sobudala obuvuthiwe, lapho bahlanganisa i-algorithm yokwelashwa, bagxila ekusebenzeni kwezinso.
Umthamo wokuqala kunoma yisiphi isimo awudluli ithebhulethi engu-2,5 mg / 500 mg. Kulokhu, isimo sezinso kumele sibhekwe njalo.
Ayikho imininingwane ethembekile ngomthelela weGlucovans® ezinganeni, ukusebenza kwayo nokuphepha, ngakho-ke, ukusetshenziswa kwayo akunconyelwanga izingane.
Izici zokwelashwa kweGlucovans
Lapho usebenzisa umuthi, kubalulekile ukubheka ushukela wakho ngokuhlelekile esiswini esingenalutho, kanye namahora ama-2 ngemuva kokudla. Ngokufanelekile, kuyadingeka ukuqopha ukufundwa kwe-glucometer kudayari 5 r. / Usuku.
I-Lactic acidosis
I-complication iyivelakancane, kepha imbi kangangokuba wonke umuntu onesifo sikashukela kufanele azi ngayo. Uma kungekho ukunakekelwa okuphuthumayo kwezokwelashwa, ohlukunyezwayo angafa. Isimo esiyingozi sivela ngokuqalwa kwe-metformin. Ukweqiwa okungajwayelekile kwayo kuhlotshaniswa nokwehluleka kwezinso, ngakho-ke, ne-pyelonephritis nezinye izifo ezingalapheki futhi ezinamandla ze-renal, umuthi kufanele uthathwe ngokuqapha.
Ezinye izici zobungozi zibandakanya ukulawulwa okungaphelele kwesifo sikashukela sohlobo 2, i-ketosis, ukuzila ukudla isikhathi eside noma ukungondleki kahle okuhleliwe, ukusetshenziswa kabi kotshwala nokuqina kwesibindi.
Ingozi ye-lactic acidosis inyuka ngama-izicubu omsipha, ukuphazamiseka kwe-dyspeptic, ubuhlungu esifundeni se-epigastric, ubuthakathaka obukhulu.
Uma kungekho ukulaliswa esibhedlela okuphuthumayo, ukushoda kwe-acidotic yokuphefumula, ukushoda kwe-oksijini, i-hypothermia, ukuthuthukiswa komthambo.
I-Hypoglycemia
IGlibenclamide ikhona kwifomula yeGlucovans ®, okusho ukuthi amathuba we-hypoglycemia uma usebenzisa amaphilisi awanakuvinjwa. I-serial tit titration izosiza ukugwema ushintsho olungazelelwe kushukela we-plasma. Kubalulekile ukwazisa isiguli ngokudla okufika ngesikhathi, ngoba isidlo sasebusuku sekwedlule noma isidlo sasekuseni esiningi ngaphandle kwama-carbohydrate, isidlo sakusihlwa esingalindelekile singavusa i-hypoglycemia. Ngemithwalo ekhulayo yemisipha (ukuqeqeshwa kakhulu kwemidlalo, ukusebenza kanzima ngokomzimba), ngemuva komkhosi omningi, ukudla kwe-hypocaloric noma ukusetshenziswa kwezidakamizwa eziyinkimbinkimbi zezifo zemithi, kungenzeka ukuthi i-hypoglycemia iphezulu kakhulu.
Ukuphendula okubucayi okuvezwa yilesi simo ngesimo sokujuluka kokujuluka, ukuhlaselwa ukwethuka, ukukhuphuka kokujuluka, ukuphazamiseka kwesigqi senhliziyo, umfutho wegazi, isifo senhliziyo.
Uma i-hypoglycemia ikhula kancane kancane, isifo senhliziyo asihlali njalo sikhula, ikakhulukazi ngokuhlinzwa kwe-neuropathy noma ngokufana ne-β-blockers, reserpine, clonidine, guanethidine.
Ezinye izinkomba ze-hypoglycemia zifaka:
- Isifiso esingalawulwa;
- Ubuhlungu bekhanda;
- Ukuqhafaza;
- Ukwehlukaniswa;
- Izinga eliphansi lokulala;
- Ubunqunu;
- Ubulukhuni
- Ukuphazamiseka;
- Ukuvinjwa;
- Ukulimazeka kokubonakalayo;
- Izinkinga zokukhuluma;
- I-Tremor;
- Ukulahleka kokuxhumana;
- Ukuhluza
- Ukushaya kwenhliziyo kancane;
- Iyahluleka.
Ukukhetha ngokucophelela kwemithi, ukubalwa kwesilinganiso esifanele, nokwazisa iziguli ngemiphumela okungenzeka kuyizici ezibalulekile zokuvimbela. Uma onesifo sikashukela esivele enamakhambi we-hypoglycemia, kufanelekile ukuthi ubuyekeze uhlobo lonyango olwelaphekayo.
I-Pathology yesibindi nezinso
Izici ze-pharmacodynamic ne-pharmacokinetic zabantu abanesifo sikashukela abanokuphazamiseka okusebenzayo kwezinso nezinso zibhekana nezinguquko ezinkulu. I-Hypoglycemia kwezifo ezingamahlalakhona isikhathi eside futhi idinga ukwelashwa okwanele.
I-glycemia engazinzi
Uma kunesidingo, ukwelashwa okulondolozayo noma ngesinye isizathu esibangela ukubola kweshukela, isiguli sidluliselwa okwesikhashana ku-insulin. Izimpawu ze-hyperglycemia zingaba ukuchama kaningi, ukoma okungapheli, ukozela, ubuthakathaka, isikhumba esomile semikhawulo engezansi ngenxa yokujikeleza kahle kwezempilo. Ezinsukwini ezimbili ngaphambi kokuhlinzwa noma ukujova emithanjeni esezingeni eliphakeme ezifundweni ze-X-ray, iGlucovans® ikhanseliwe, ukwelashwa kuqale phansi kungakapheli izinsuku ezimbili ngemuva kokuhlinzwa nezinqubo zokuhlola ukusebenza okwanele kwezinso.
Izinkinga zezinso
Izinso zibamba iqhaza ngokuqinile ekuhoxisweni kwe-metformin, ngakho-ke, ngaphambi kokuqala kwenkambo futhi ngokuhlelekile lapho usebenzisa umuthi, imvume ye-creatinine kufanele ihlolwe. Isifo sikashukela esinezinso ezinempilo kufanele sihlolwe okungenani i-1 r. / Year, kubantu asebekhulile ngeminyaka, kanye neziguli ezinikezwe imvume ye-creatinine emkhawulweni ophezulu ojwayelekile - 2-4 r. / Year.
Ukungasebenzi kahle kwe-renal kubonwa ezigulini ezinomfutho ophakeme ezithatha ama-diuretics nama-NSAIDs, ngakho-ke lesi sigaba sabashukela kufanele sinikezwe ukunakwa okukhethekile.
Izinyathelo ezingeziwe
Ngezifo zamapheshana wokuphefumula noma izifo zohlelo lwe-genitourinary lwesifo esithathelwanayo, abanesifo sikashukela kufanele batshele i-endocrinologist yabo ngezinkinga.
Imiphumela emibi
Imvamisa yemiphumela engathandeki evela ekusetshenzisweni kweGlucovans ilinganiselwa ngokwesilinganiso esikhethekile se-WHO:
- Kaningi: ≥ 0.1;
- Imvamisa: ≥ 0.01, <0.1;
- Ngokujwayelekile: ≥ 0.001, <0.01;
- Kancane: ≥ 0.0001, <0.001;
- Akuvamile kakhulu: <0.0001.
Amacala angawodwa awahlaziywa yilezi zinqubo.
| Yiluphi uhlangothi loshintsho | Izinhlobo Zokwephulwa | Imvamisa |
| Izinqubo ze-Metabolic | I-Hypoglycemia; I-renal nesikhumba se-porphyria; I-Lactic acidosis Ukufakwa okwenziwa ngaphandle kwe-Vitamin B12 | kuyaqabukela kakhulu akuvamile |
| Ucwaningo lwelebhu | Ukukhula kwe-urea ne-creatinine ku-plasma; I-Hyponatremia | Okuvamile |
| Ukugeleza kwegazi | I-Leukopenia ne-thrombocytopenia; I-hememic anemia, i-pancytopenia, i-agranulocytosis, i-aplasia | akuvamile kakhulu |
| CNS | ukunambitheka kokushintsha | kaningi |
| Umbono | ukunciphisa ukubonakala ngenxa ye-hypoglycemia | ekuqaleni kwenkambo |
| Amapheshana wesisu | ukukhubazeka kwe-dyspeptic, ubuhlungu endaweni ye-epigastric, ukuntuleka kwesifiso sokudla | ekuqaleni kwenkambo |
| Isikhumba | Ukulunywa, i-urticaria, imichilo yama-maculopapular; IVasculitis, isikhumba, i-erythema | kuyaqabukela kuyaqabukela |
| Ukungavikeleki | ukwethuka kwe-anaphylactic | kuyaqabukela |
Kwesinye isikhathi i-hepatitis namanye ama-hepatic pathologies akhula, adinga ukwelashwa okukhethekile kanye nokuqedwa kwama-Glucovans.
Imiphumela Yokusebenzelana Kwezidakamizwa
Umuntu onesifo sikashukela uphoqelekile ukuthi atshele udokotela ngayo yonke imishanguzo ethathiwe ukuze anake amakhono ayo lapho ehlanganisa i-algorithm yokudla nangesikhathi esifanele ukubona izimpawu zemiphumela engathandeki.
- Okufakiwe: IMinazole ene-glibenclamide (khombisa i-hypoglycemia), izidakamizwa ze-metformin nezidakamizwa eziqukethe iodine (ama-Glucovans akhanseliwe ngemuva kwamahora angama-48).
Izinketho ezinconyiwe: imishanguzo yekilasi le-sulfonylurea kanye notshwala (ingozi yesifo sikashukela), i-phenylbutazone ene-glibenclamide (khuphula amandla e-hypoglycemic yemithi), i-bosentan ene-glibenclamide (ingozi ye-hepatoxic umphumela), i-metformin notshwala (amathuba we-lactic acidosis).
- Inhlanganisela nama-Glucovans asetshenziswe ngokucophelela: I-Chlorpromazine (inhibits insulin secretion), glucocorticosteroids (ketosis), danazol (hyperglycemia), diuretics (hyperglycemia, lactic acidosis), i-ACE inhibitors (hypoglycemia).
Izimpawu zokusebenzisa ngokweqile kanye nokuphikisana
I-overdose iyingozi nge-hypoglycemia yobunzima obahlukahlukene. Ngefomu emnene, izimpawu nazo zingasuswa ngocezu kashukela, kube nezimpawu ezibucayi zokulaliswa esibhedlela kuyadingeka, ngoba kunosongo lwe-lactic acidosis nekhotha, ikakhulukazi nge-hypoglycemia ende. Nodokotela, udinga ukulungisa umthamo futhi uhambise ekudleni.
Contraindication:
- I-Hypersensitivity yezithako eziyisisekelo kanye nababizi;
- Uhlobo 1 sikashukela;
- I-Ketoacidosis, ikhesa kanye nesimo sayo sangaphambilini;
- Ama-dysfunctions ama-renal (imvume ye-creatinine - aze afike ku-60 ml / min);
- Izimo ezidala izifo, ukwethuka, ukomisa;
- Ama-Pathologies abangela izicubu zomzimba;
- Izifo zenhliziyo nezokuphefumula;
- Ukungasebenzi kahle kwe-Hepatic;
- Ukukhulelwa nokuncelisa ibele
- Ukwelashwa okungathi sína;
- Ukusetshenziswa okufanayo kwe-miconazole;
- Utshwala;
- I-Lactic acidosis (umlando);
- Ukungondleki okungapheli
Izimo nezimo zokugcina
Amacwecwe ahlanganiswe emabhulini. Ebhokisini ngalinye - amapuleti ama-2. Incwadi "M" igxishwe emaphaketheni - ukuvikela izidakamizwa. Thengisa umuthi onikezwe umuthi.
E-Glucovans, intengo eketheni likhemisi incike esifundeni, uhlobo lwamakhemisi nomthamo. Ngokwesilinganiso, iphakethe le-2,5 mg / 500 mg lingathengwa ngama-ruble angama-220., 5 mg / 500 mg - kuma-ruble angama-320.
Gcina umuthi ezimweni zasekamelweni ngaphandle kokutholwa yizingane. Impilo yeshelf iyiminyaka emithathu.
Ama-Glucovans: imibono odokotela nabasebenzisi
Mayelana nama-Glucovans, kubuyekezwa izilinganiso zikashukela. Abantu beminyaka yobudala abavuthiwe bakhuluma ngokusetshenziswa okulula: ungakhumbuli ukuthi ngiphuza yiphi ipilisi nokuthi ngiyikhohliwe yiphi. Kwabanye, umuthi usuphenduke enye indlela ephumelelayo ye-insulin, ngoba akekho othanda imijovo. Abanye bakhala ngokuba nesiyezi, ubuhlungu besisu, isifiso sokudla njalo.
Odokotela emazwaneni baphawula ukuthi imiphumela emibi esezingeni lokuqala lokwelashwa nge-Glucovans ijwayelekile. Ngokuhamba kwesikhathi, umzimba uguquguquka. Akufanele wesabe i-insulin, kwesinye isikhathi kuyindlela yesikhashana ephoqelekile. Kunoma ikuphi, ukukhetha kwezidakamizwa kuhlale kunekhono lodokotela. Abaningi bayakuqaphela ukutholakala kwalo muthi, yize umsuka wawo unegunya.
