UGalvus ngumenzeli we-hypoglycemic enzelwe ukulawula i-glycemia ngohlobo 2 sikashukela. Isakhi esisebenzayo somuthi yi-vildagliptin. Umuthi ukhishwa ngendlela yamathebulethi. Bobabili odokotela nabanesifo sikashukela bathole impendulo enhle evela kuGalvus.
Ilawula ngamandla amandla we-insulin ne-glucagon. I-European Antidiabetesic Association ithi iGalvus ekwi-monotherapy kuyelulekwa ukuthi isetshenziswe kuphela uma i-metformin ihlinzekelwe esigulini. Kwabashukela abancike e-insulin abanesifo sohlobo 2, uGalvus usiza ukunciphisa inani lama-poplites kanye nenani le-insulin.
Izici ze-Pharmacological
Ama-hormone abizwa ngama-hormone athunyelwa ngamathumbu lapho izakhi zingena kuwo. Lawa ma-hormone yi-insulinotropic, enza ukuba secretion kwe-insulin, ngoba ukukhiqizwa kwawo kungama-60% ngenxa yemiphumela yama-insretin. Le nto yatholakala ngo-1960, lapho befunda ukuthola ukuthi ngabe i-insulin igcwele kangakanani kuyi-plasma.
IGlucan-like peptide-1 (GLP-1) ingenye edume kakhulu, ngoba ukuhlushwa kwayo kuncishiswe kakhulu kuhlobo 2 sikashukela. Lokhu kuholele esigabeni esisha sezidakamizwa ezikhulisa okuqukethwe ama-hormone anjalo kungaba ngomjovo we-analogue yokwenziwa ye-GLP-1, njengeBaeta noma iVictoza, noma ngezindlela zomlomo ezinjengeGalvus noma i-analogue Januvia. Ama-Dhib-4 ama-inhibitors awakhuphi kuphela ama-hormone womabili, kodwa futhi avimbele ukonakaliswa kwawo.
Ngubani ofanele uGalvus
Kwabashukela abanesifo sohlobo lwesibili, umuthi ungasetshenziswa:
- Ukuze uthole i-monotherapy, ihambisana nokudla okuphansi kwe-carb nemithwalo yemisipha eyanele;
- Ekwelashweni okuyinkimbinkimbi ngokuhambisana ne-metformin, uma imiphumela etholakala kwekhambi elilodwa inganele;
- Njengolunye uhlobo lwemithi efana ne-Galvus efana ne-metformin ne-vildagliptin;
- Njengokwengezwa kwamanye ama-hypoglycemic agents, uma ngabe izindlela zokwelashwa zangaphambilini azisebenzi;
- Njengokwelashwa okuphindwe kathathu nge-insulin ne-metformin, uma ukudla, ukuzivocavoca ne-insulin ene-metformin bekungasebenzi ngokwanele.
Imiyalo yokusebenzisa
Umthamo unqunywa yi-endocrinologist ngawodwana, kucatshangelwa isigaba sesifo kanye nesimo sempilo esijwayelekile sesifo sikashukela. Ukusetshenziswa kwamathebulethi akuxhunyiwe ekudleni kwasekuseni, into esemqoka ukuphuza umuthi ngamanzi anele. Lapho kwenzeka kube nemiphumela engalindelekanga yephephisi lesisu, kungcono ukusebenzisa umuthi ngokudla.
Uma uhlobo 2 lukashukela lufakiwe, uGalvus angabelwa ngokushesha. Akunandaba noma irejimeni yokwelashwa (eyinkimbinkimbi noma ye-monotherapy), amaphilisi athathwa ngenani lama-50-100g / ngosuku. Isilinganiso esiphakeme kakhulu (i-100 mg / ngosuku) sithathwa ngezigaba ezinzima zesifo sikashukela. Ngesikhathi sokulashwa, kanye namanye ama-hypoglycemic agents, kunikezwa ama-100 mg / ngosuku.
Ingxenye engama-50 g / ngosuku. kuthathwe kanye, imvamisa ekuseni, umthamo we-100 mg kufanele uhlukaniswe ngemithamo emi-2 - ngokulinganayo, ekuseni nakusihlwa kusihlwa. Uma ukwamukelwa kweGalvus kuphuthelwe, iphilisi kufanele liphuzwe nganoma yisiphi isikhathi, kodwa imingcele ejwayelekile kufanele ibonwe.
Uma nge-monotherapy ungathatha i-100 mg / ngosuku, bese usebenzisa ukwelashwa okuyinkimbinkimbi, uqale nge-50 mg / ngosuku, ngokwesibonelo, nge-metformin: 50 mg / 500 mg, 50 mg / 850 mg, 50 mg / 100 mg.
Ngokunxeshezelwa kwesifo sikashukela okungapheleli, enye i-hypoglycemic drug (i-metformin, i-insulin, i-sulfonylurea derivatives, njll.) Ibekiwe ngokungeziwe.
Uma izinso sikashukela nesibindi sekuvele kusebenza ngokwephula, umthamo omkhulu wehliselwa ku-50 mg / ngosuku., Njengoba iGalvus ikhishwa yizinso, okwenza umthwalo owengeziwe ohlelweni lwe-excretory.
Izimpawu ze-overdose
Uma inqubo yansuku zonke ingeqi i-200 mg / ngosuku, ama-Galvus diabetesics adluliswa ngaphandle kwemiphumela. I-overdose enezimpawu ezifanele ibonwa lapho idliwa ngokweqile kwe-400 mg / ngosuku. I-Myalgia (ubuhlungu bemisipha) ibonakaliswa kaningi, inciphise kakhulu - i-paresthesia (ngendlela emnene ne-transistor), ukuvuvukala, umkhuhlane, izinga le-lipase lenyuka ngokuphindwe kabili njenge-VGN.
Uma okwejwayelekile kweGalvus kungaphezu kokuphindwe kathathu (600 mg / ngosuku), kunengozi yokuvuvukala kwemilenze, i-paresthesia kanye nokwanda kwezinga le-ALT, CPK, myoglobin ne-C-reactive protein. Yonke imiphumela yokuhlola, njengezimpawu, iyanyamalala lapho iGalvus ikhanseliwe.
UGalvus: ama-analogues
Ngokusho kwengxenye esebenzayo, le mithi iVildaglympin neGalvus Met izofana neGalvus, noJanuvia no-Onglisa bahambisane ngokusho kwekhodi ye-ATX-4. Ucwaningo lwezidakamizwa nokubuyekezwa kweziguli kukhombisile ukuthi le mishanguzo iyashintshana ngokuphelele.
Imicimbi Emibi
Ukusetshenziswa kwesikhathi eside kweGalvus kungahle kuhambisane nemiphumela emibi:
- Ubuhlungu bekhanda nokulahleka kokuxhumana;
- Ukuqina kwezingalo nemilenze;
- Ukuphazamiseka kwe-dyspeptic;
- I-peeling, iziqubu kanye nokuqhuma kwesikhumba kwemvelaphi yomzimba;
- Ukwephulwa kwesigqi sokunyakaza kwamathumbu;
- Ukuzivikela kokuzivikela
- Ukuqhekeka nokusebenza ngokweqile;
- IHepatitis, i-pancreatitis nezinye izifo zesibindi namanyikwe;
- Izilonda nokudumba.
Ubani uGalvus ophikisiwe
Ukuxhumana ngokusetshenziswa kweGalvus kuzoba yizifo nezifo eziningi.
- Ukungabekezelelani komuntu ngamunye ezingxenyeni zezidakamizwa, ukusabela komzimba;
- Ukungasebenzi kohlelo lwe-renal ne-excretory;
- Izimo ezidala ukungasebenzi kahle kwezinso (umkhuhlane, ukutheleleka, isihlalo somsindo, ukugabha);
- Izifo zenhliziyo nemithambo yegazi;
- Izinkinga zokuphefumula;
- I-ketoacidosis yesifo sikashukela, ikoma, nokhokho, lapho isifo sikashukela sihunyushwa ngokuthi i-insulin;
- I-Lactic acidosis, ukungezelelwa okuthe xaxa kwe-lactic acid;
- Ukukhulelwa nokukhulelwa;
- Uhlobo 1 sikashukela;
- Ukuhlukumezeka okuhleliwe noma ubuthi botshwala;
- Ukudla okuqinile kakhulu nokuqukethwe kwekhalori kwe-1000 Kcal / ngosuku;
- Imikhawulo yeminyaka: kuze kube seminyakeni engu-18 yobudala, i-metabolite ayinqunyelwe, ngemuva kweminyaka engama-60 - ngokuqapha;
- Ngaphambi kokuhlinzwa (izinsuku ezi-2 ngaphambi nangemva kwalokho), ngaphambi kosuku lokungeniswa kwama-ejenti wokuqhathanisa noma ukuhlolwa kwe-radiographic;
- Enye ye-contraindication enkulu ye-Galvus yi-lactic acidosis, ngakho-ke, ngokuhluleka kwesibindi noma ukuqina kwezinso, umuthi awunqunyelwe.
Ku-diabetesics yobudala obuvuthiwe, umlutha we-metformin kungenzeka, lokhu kukhulisa iphesenti lezinkinga, ngakho-ke uGalvus unqunyelwe ngaphansi kokuqashwa okuqinile kwezokwelapha.
Izici zokwelashwa kweGalvus zemikhakha ethile yesifo sikashukela
Akukho datha ethembekile mayelana nomphumela wesidakamizwa empilweni kamama kanye neye-fetus, ngakho-ke, ngesikhathi sokukhulelwa akunqunyelwe. Ukugcwala kwenani likashukela kowesifazane okhulelwe kwandisa ingozi yokuba nezifo zokuzala futhi nokufa kwengane. Esikhathini sikashukela kwabesifazane abakhulelwe, i-glycemia imvamisa i-insulin.
Ucwaningo luye lwabonisa ukuthi noma umthamo kaGalvus, odlula okwejwayelekile izikhathi ezingama-200, awuzange udale ushintsho lwe-pathological esimweni sempilo sowesifazane okhulelwe noma se-fetus. Umphumela ofanayo wabhalwa ngokusetshenziswa kwe-metformin neGalvus ngesilinganiso se-10: 1.
Umbuzo wokuthi kungenzeka ukungena kwe-metabolite ukungena obisini lwebele kungazange kufundwe, ngakho-ke, ngokuncelisa ibele, uGalvus naye akabekiwe.
Umuzwa wokwelashwa kweGalvus wezingane ezinesifo sikashukela ngohlobo lwe-2 lesi sifo (inani leziguli ezinjalo landa ngokushesha namuhla), ikakhulukazi, isilinganiso sokusebenza kwayo nemiphumela emibi, asifundwanga ngokwanele.
Ngakho-ke, i-incretin yohlobo lwesifo sikashukela esinqunyelwe isuka eminyakeni eyi-18.
Izazi zesifo sikashukela sobudala obuvuthiwe (ngemuva kweminyaka engama-60) kufanele zilawule ngokuqinile umthamo weGalvus namapharamitha awo abalulekile, ukuze kuthi uma uzizwa kabi, wazise udokotela ngokushesha. Kulesi sikhathi, ubungozi bezinkinga nemiphumela engathandeki luyanda, njengoba umphumela wokulutha ubangelwa.
Izincomo ezikhethekile
Abantu abanesifo sikashukela kumele baziswe ngayo yonke imiphumela engaba khona yokwelashwa okusha kuye.
UGalvus ngumenzeli wokulwa nesifo sikashukela, kepha akuyona i-analogue ye-insulin. Ngakho-ke, ukusetshenziswa kwayo kudinga ukubhekwa njalo kokusebenza kwesibindi. Lokhu kungabuye kuchazwe iqiniso lokuthi isakhi esiyinhloko se-Galvus sithuthukisa umsebenzi wama-aminotransferases. Ngaphandle, lokhu akuvezwanga kwizimpawu ezithile, kepha izinguquko esimweni sokusebenza kwesibindi kuze kube sekukhulisweni kwehepatitis azinakugwenywa. Kunoma ikuphi, amavolontiya aneswekile eqenjini lokulawula akhombisile umphumela onjalo. Ngezimpawu zokuqala ze-pancreatitis acute (ubuhlungu besisu esibuhlungu obuqhubekayo), umuthi kufanele ukhanselwe ngokushesha. Ngisho nangemva kokubuyiselwa kwempilo yesibindi, uGalvus akasabekiwe futhi.
Ama-diabetesics ancike kwe-Galvus insulin anesifo sohlobo 2 anqunywa kuphela ngokuhambisana namalungiselelo e-insulin.
Ukucindezelwa kaningi kanye nokulayishwa ngokweqile kwemizwa kunciphisa kakhulu ukusebenza kwe-Galvus. Ngokusho kwabanesifo sikashukela, imvamisa imizimba yabo ihlangana ngokulahleka kokuhlangana kanye nenausea. Ngakho-ke, ukushayela imoto noma ukwenza umsebenzi oyingozi ezimweni ezinjalo akunconywa.
Ngaphambi kokuhlolwa kwanoma yiluphi uhlobo, uGalvus nezimpawu zalo kumiswa izinsuku ezimbili. Ama-ejenti ahlukile asetshenziswa ekuhlonzeni imvamisa aqukethe iodine. Ukuxhumana ne-vildagliptin, kwakha umthwalo owengeziwe esibindini nakuhlelo lwe-excretory. Ngokuphikisana nesizinda sokuwohloka ekusebenzeni kwabo, i-lactic acidosis kungenzeka.
Isigaba sokuqala sokwehluleka kwenhliziyo (ukuhlukaniswa kwe-NYHA) ngemithwalo ejwayelekile yemisipha akudingi ukulungiswa kwamthamo kweGalvus. Isigaba sesibili sihilela ukunciphisa umsebenzi we-izicubu ukuvimbela ukushesha komoya, ubuthakathaka, kanye ne-tachycardia, ngoba esimweni sokuthula akukho zifo ezifanayo ezirekhodiwe.
Ukugwema ingozi ye-hypoglycemia, kanye nokwelashwa okuhlangene namalungiselelo we-sulfonylurea, kukhethwa ubuncane bokusebenza komthamo omncane.
Imiphumela Yokusebenzelana Kwezidakamizwa
Ezokwelapha eziyinkimbinkimbi ngokungezwa kwe-metformin, glibenclamide, pioglitazone, i-ramipril, i-amlodipine, i-digoxin, i-valsartan, i-simvastatin, i-warfarin kuya kwe-Galvus, akukho mphumela obalulekile emtholampilo owembuliwe kusukela ekusebenzisaneni kwabo.
Ukuphathwa okuhlanganayo ngama-thiazides, glucocorticosteroids, ama-sympathomimetics, ama-hormone e-thyroid anciphisa amandla we-hypoglycemic we-vildagliptin.
Ama-inhibitors e-eniotensin-aguqulayo enzyme ngokusetshenziswa okuhambisanayo andisa ingozi ye-angioedema.
IGalvus enezimpawu ezinje ayikhanswanga, ngoba i-edema idlula yona.
Umuthi awushintshi isilinganiso se-metabolic nokusetshenziswa okufanayo kwe-enzymes CYP3A4, CYP1A2, CYP2C8, CYP3A5, CYP2C9, CYP2C19, CYP2D6, CYP2E1.
Imithetho yokugcina
Kwinethiwekhi yamakhemikhali, uGalvus uthengiswa ngomuthi. Zingahlukaniswa ngomkhawulo ohlanganisiwe nokumakwa kwezinhlangothi ezimbili: izifinyezo FB ne-NVR. Epuletini kungaba amaphilisi ayi-7 noma ayi-14 ka-50 mg. Ekufakweni kwamakhadibhodi kukhona kusuka ku-2 kuya kweziyishumi nambili.
Umuthi ugcinwa ezimweni zokushisa uze ufike ku-30 ° C endaweni emnyama, ngaphandle kokutholwa yizingane. Impilo yeShelf kaGalvus ifinyelela eminyakeni emi-3. Amaphilisi aphelelwe yisikhathi kumele alahlwe.
Ukubuyekezwa kodokotela neziguli
Lo menzeli we-hypoglycemic womlomo uvame ukunikezwa kuqala kwabanesifo sikashukela ngokushesha ngemuva kokuxilongwa. Ngakho-ke, ekubuyekezweni kwizithangami ezinezihloko kunemibuzo eminingi kune-endocrinologist kunezimpendulo.
Ephawula ngemibiko enjalo, odokotela bayabona ukuthi isifo sikashukela yisifo esenzeka impilo yonke. Akekho uGalvus, nanoma yimuphi omunye umenzeli wesifo sikashukela ongalungisa imitha yeglucose ngokwejwayelekile. Isimo sempilo sikashukela siwohloka njalo, isilinganiso sezinguquko ezingezinhle ngqo sincike kubungako bokuthola ushukela. Alikho iphilisi eliyisimangaliso labanesifo sikashukela. Ukulungiswa kokudla okwenziwe ngomsoco kuphela, ukulungiswa kabusha kwendlela yonke yokuphila nge -ondlo yesondlo kunganciphisa ukuthuthukiswa kwezinkinga futhi kugcinwe nekhwalithi yempilo nesifo sikashukela ezingeni elijwayelekile.
Akubona bonke abahola impesheni abanokufinyelela kuGalvus ngentengo yama-ruble angama-800. ama-28 ama-pcs., abaningi bafuna ukumfaka esikhundleni, yize uJanuvia (ama-ruble ayi-1400) noma u-Onglisa (ama-ruble ayi-1700) nawo engahambisani nawo wonke umuntu. Futhi labo abaqhubeka nokusebenzisa baqaphela ukuthi kancane kancane ushukela uqala ukuphuma ekuphathweni futhi ukusebenza ngempumelelo kokwelashwa kuyancipha.
