Imiyalo ye-Amaril yezidakamizwa esetshenziswayo inika ukuhlolwa njengomuthi wesizukulwane esisha semithi yokulwa nesifo sikashukela sohlobo 2. Enye yezinto ezethembisa kakhulu namuhla kwakunguGlibenclamide-HB-419 eqenjini le-sulfonylurea. Abantu abangaphezu kwesigamu sabanesifo sikashukela sohlobo lwesibili bakubonile lokho.
Izici ze-pharmacological zomuthi
I-Amaryl isidakamizwa se-hypoglycemic esisiza ukulawula ushukela we-plasma. Isithako esisebenzayo somuthi yi-glimepiride. Njengomanduleli wayo, iGlibenclamide, i-Amaril nayo ivela eqenjini le-sulfonylurea, elithuthukisa ukufakwa kwe-insulin kusuka kumaseli we-b amasikebhe we-pancreatic aseLangerhans.
Ukufeza umphumela ohlosiwe, bavimba isiteshi se-potassium se-ATP ngokuzwela okwengeziwe. Lapho i-sulfonylurea ibopha kuma-receptors akhiwe kulwelwesi lwe-b-cell, umsebenzi wesigaba se-K-AT uyashintsha. Ukuvinjwa kweziteshi ze-calcium ngokwanda kwesilinganiso se-ATP / ADP ku-cytoplasm kuthuthukisa i-membolane depolarization. Lokhu kunomthelela ekukhulisweni kwezindlela ezi-calcium futhi zikhuphule ukuqina kwe-cytosolic calcium.
Umphumela wokukhuthazeka okunjalo kwe-exocytosis yamagilebhisi asezinhlwini, okuyinkqubo yokuphuma kwenhlanganisela kokuphakathi kwangaphakathi ngamangqamuzana, kuzoba ukukhululwa kwe-insulin egazini.
I-Glimepiride imele isizukulwane sesithathu se-sulfonylureas. Ishukumisa ukukhishwa kwe-hormone ye-pancreatic ngokushesha, futhi ithuthukise ukuzwela kwe-insulin kwamaseli wamaprotheni kanye ne-lipid.
Izicubu zomzimba zithuthukisa i-glucose kakhulu zisebenzisa amaprotheni okuhambisa avela kulwelwesi lweseli. Ngohlobo lukashukela oluzimele lwe-insulin, ukuguqulwa koshukela lube izicubu kuncipha. I-Glimepiride ikhuthaza ukukhuphuka kwevolumu yamaprotheni okuhambisa futhi ithuthukise nomsebenzi wayo. Umphumela onamandla we-pancreatic usiza ukwehlisa ukumelana ne-insulin (insensitivity) kwi-hormone.
I-Amaryl ivimbela ukwakheka kwe-glucogen ngesibindi ngenxa yokwanda kwenani le-fructose-2,6-bisphosphate ene-antiaggregant (inhibition of thrombus ukwakheka), antiatherogenic (ukwehla kwezinkomba ze-cholesterol "embi") kanye ne-antioxidant (ukuvuselelwa, ukulwa nokuguga). Izinqubo ze-oxidation ziyancipha ngenxa yokwanda kokuqukethwe kwe-endo native b-tocopherol kanye nomsebenzi wama-enzymes we-antioxidant.
I-Pharmacokinetics yesidakamizwa
Ngokwakheka kwe-Amaril, isakhi esiyinhloko esisebenzayo yi-glimepiride eqenjini le-sulfonylurea. I-Povidone, i-lactose monohydrate, i-magnesium stearate, i-microcrystalline cellulose nodayi u-E172, i-E132 isetshenziswa njengama-filler.
I-Amaryl icubungula ama-enzyme wesibindi u-100%, ngakho-ke nokusetshenziswa isikhathi eside kwesidakamizwa akusongeli ukunqwabelana ngokweqile kwezitho zayo nezicubu. Njengomphumela wokucutshungulwa, kwakheka izinto ezimbili ze-glipemiride: hydroxymetabolite kanye ne-carboxymethabolite. I-metabolite yokuqala inikezwe izakhiwo zamakhemikhali ezinikeza umphumela ozinzile we-hypoglycemic.
Egazini, okuqukethwe okuphezulu kwengxenye esebenzayo kubhekwa ngemuva kwamahora amabili nesigamu. Ukuba ne-bioavailability ngokuphelele, umuthi awubeki umkhawulo sikashukela ekukhetheni imikhiqizo yokudla "awuthatha" umuthi. Ukutholwa ngandlela zonke kuzoba yi-100%.
Ukuthuthuka okubalulekile kuma-indices we-glycemic kubhekwa ngisho nezinkinga zokusebenza nesibindi, ikakhulukazi, ebudaleni (nangaphezulu kweminyaka engama-65) kanye nokwehluleka kwesibindi, ukuqina kwengxenye esebenzayo kuyinto evamile.
Ungayisebenzisa kanjani i-Amaryl
Umuthi ukhiqizwa ngendlela yamathebulethi e-oval enomugqa ohlukanisayo, okuvumela ukuthi uhlukanise kalula umthamo ube ngama-halves. Umbala wezibhebhe uncike kumthamo: 1 mg we-glimepiride - igobolondo elipinki, 2 mg - luhlaza okotshani, 3 mg - ophuzi.
Lo mklamo awuzange ukhethwe ngengozi: uma amaphilisi angahlukaniswa ngombala, lokhu kunciphisa ubungozi bokusebenzisa ngokweqile ngengozi, ikakhulukazi ezigulini esezikhulile.
Amacwecwe ahlanganiswe emabhulini angama-15 ama-pcs. Ibhokisi ngalinye lingaba namapuleti amabili ukusuka kwayi-6.
Izici zokusebenzisa i-Amaril:
- Ithebhulethi (noma ingxenye yalo) ligwinyiwe lonke, lihlanzwa ngamanzi okungenani i-150 ml. Ngokushesha ngemuva kokuphuza umuthi, udinga ukudla.
- I-endocrinologist ikhetha irejimeni yokwelashwa ngokuya ngemiphumela yokuhlaziywa koketshezi lwebhayoloji.
- Qala inkambo ngemithamo emincane ye-Amaril. Uma ingxenye ye-1 mg ngemuva kwesikhathi esithile ingakhombisi umphumela ohleliwe, isilinganiso siyenyuka.
- Umthamo ulungiswa kancane kancane, kungakapheli amasonto ayi-1-2, ukuze umzimba ube nesikhathi sokujwayela izimo ezintsha. Nsuku zonke, ungakhuphula izinga nge-1 mg. Umthamo omkhulu wesidakamizwa yi-6 mg / ngosuku. Umkhawulo ngamunye ubekwa udokotela.
- Kuyadingeka ukulungisa okujwayelekile ngokushintshwa kwesisindo sikashukela noma umthamo wemithwalo yemisipha, kanye nengozi ye-hypoglycemia (ngendlala, ukungondleki, ukusetshenziswa kabi kotshwala, izinkinga zezinso nezesibindi).
- Isikhathi sokusebenzisa nomthamo kuzoncika kusigqi sokuphila kanye nezimpawu zokusebenzisa umzimba. Imvamisa, ukuphathwa okukodwa kwe-Amaril kunqunywa ngosuku ngokuhlanganiswa okuphoqelekile nokudla. Uma ibhulakufesi ligcwele, ungaphuza iphilisi ekuseni, uma lingokomfanekiso - kungcono ukuhlanganisa ukwamukela nelebhulakufesi.
- I-overdose isongela nge-hypoglycemia, lapho ushukela osentabeni wehla uye ku-3.5 mol / L noma ngaphansi. Isimo sihlala isikhathi eside impela: kusuka emahoreni ayi-12 kuye ezinsukwini ezi-3.
Amathebulethi e-Amaryl (kwiphakethe lezingcezu ezingama-30) athengiswa ngentengo:
- 260 rub - 1 mg ngamunye;
- 500 rub - 2 mg ngamunye;
- 770 rub. - 3 mg ngamunye;
- I-1020 rub. - 4 mg ngamunye.
Ungathola amaphakheji wezingcezu zamathebhulethi angama-60, 90,120.
Okunye ukuhambisana kwezidakamizwa
Abantu abanesifo sikashukela, ikakhulukazi “abanokuhlangenwe nakho”, njengomthetho, banezixhaxha zezinkinga ezihlangene: umfutho wegazi, izinkinga zenhliziyo nezemithambo, ukuphazamiseka kwe-metabolic, izinso kanye nesibindi. Ngale kit, akufanele uthathe kuphela izidakamizwa ezinciphisa ushukela.
Ngokuvimbela ukungahambi kahle kwemithambo yegazi nenhliziyo, kudalwa izidakamizwa ezinama-aspirin. I-Amaryl iyikhipha kwizakhi zamaprotheni, kepha izinga layo esegazini aliguquki. Umphumela jikelele wokusetshenziswa okuyinkimbinkimbi ungathuthuka.
umsebenzi Enhanced Amare kwalokho yayo insulin, Allopurinu, coumarin okunye, Ama-anabolic steroid, guanethidine, chloramphenicol, fluoxetine, fenfluramine, pentoxifylline, Feniramidolu, fibric nemikhiqizo acid, Phenylbutazone, miconazole, azapropazone, probenecid, quinolones, oxyphenbutazone, salicylates, tetracycline, sulfinpyrazone, I-Tritocqualin ne-sulfonamides.
I-Amaril inciphisa amandla okungeza i-Epinephrine, glucocorticosteroids Diazoxide, ama-laxatives, i-Glucagon, i-barbiturates, i-Acetazolamide, i-saluretics, i-thiazide diuretics, i-nicotinic acid, i-Phenytoin, i-Phenothiazine, i-Rifampicin, i-Chlorpromazine, ne-progestin.
I-Amaryl plus histamine H2 receptor blockers, i-reserpine ne-clonidine unikeza umphumela ongalindelekile namaconsi ku-glucometer kunoma iyiphi indlela. Umphumela ofanayo unikeza ukuphuza utshwala ne-Amaril.
Umuthi awuthinti umsebenzi we-ACE inhibitors (Ramipril) kanye nama-anticoagulant agents (Warfarin) nganoma iyiphi indlela.
Ukuvumelana kwe-Hypoglycemic
Uma noma yisiphi isidakamizwa se-hypoglycemic kumele sithathelwe indawo yi-Amaril, kuthathwa umthamo omncane (1 mg), ngisho noma ngabe isiguli sithola umuthi owedlule kwithomu elikhulu kunawo wonke. Okokuqala, ukusabela kwesitho sikashukela kubhekelwe amasonto amabili, bese umthamo ulungiswa.
Uma i-ejenti elwa nama-antidiabetic ene-high half-life isetshenziswa ngaphambi kwe-Amaril ukugwema ukuthuthukiswa kwe-hypoglycemia, kufanele kube nesikhashana ezinsukwini ezimbalwa ngemuva kokukhanselwa.
Uma umuntu onesifo sikashukela ekwazile ukugcina amandla e-pancreas ukukhiqiza awakhe ama-hormone, khona-ke imijovo ye-insulin ingakwazi ukuthatha u-100% esikhundleni se-Amaryl. Inkambo ibuye iqale nge-1 mg / ngosuku.
Lapho uhlelo lwesinxephezelo sikashukela seMetformin ushukela lungavumeli ukuphathwa ngokuphelele kwesifo sikashukela, kungangezwa i-1 mg ye-Amaril. Uma imiphumela ingagculisi, imvelo ivuselelwa kancane kancane ibe ngu-6 mg / ngosuku.
Uma uhlelo lwe-Amaril + Metformin aluphilelelanga lokho okulindelwe, luthathelwa indawo yi-Insulin, ngenkathi kugcinwa inqubo ye-Amaril. Imijovo ye-insulin nayo iqala ngomthamo omncane. Uma izinkomba ze-glucometer zingakhuthazi, khuphula inani le-Insulin. Ukusetshenziswa okufanayo kwezidakamizwa kusathandeka, ngoba kukuvumela ukuthi unciphise ukungena kwama-40% ngo-40 uma kuqhathaniswa nokwelashwa kwe-hormone okuhlanzekile.
Ngaphezu kwe-Amaril, i-endocrinologist futhi inezinketho zokuthola i-analogues: Amaperid, Glemaz, Diapyrid, Diameprid, Glimepiride, Diagliside, Reclide, Amix, Glibamide, Gllepid, Glayri, Panmicron, Glibenclamide, Gligenclad, Glliblik Dim UGlimaril, Glyclazide, Manil, Maninil, Glimed, Glioral, u-Olior, Glynez, Glyrid, Gluktam, Glypomar, Glyrenorm, Diabeteson, Diabresid.
Okwenzelwe lona, futhi kunganconywa ukuthi ngubani umuthi
Umuthi wenzelwa ukwelapha isifo sikashukela sohlobo 2. Kusetshenziswa kokubili nge-monotherapy nasekwelapheni okuyinkimbinkimbi ngokuhambisana neMetformin noma ne-Insulin.
Ingxenye esebenzayo ye-Amaril inqoba isithiyo se-placenta, futhi umuthi nawo udlula ubisi lwebele. Ngenxa yalesi sizathu, ayifaneleki ukuthi omama abakhulelwe nabancelayo. Uma owesifazane efuna ukuba ngumama, ngisho nangaphambi kokukhulelwa kwengane, kufanele adluliselwe emijozweni we-insulin ngaphandle kwe-Amaril. Isikhathi sokuphaka, ukuqokwa okunjalo kuyagcinwa, uma noma kunjalo kunesidingo sokwelashwa ne-Amaril, ukuncelisa kuyamiswa.
Ukusetshenziswa kwezidakamizwa ekhefini likashukela kanye nesimo esandulele ukoma akwamukeleki. Ezimweni ezinzima zesifo sikashukela (njenge-ketoacidosis), i-Amaryl ayifakiwe. Umuthi futhi awulungele abanesifo sikashukela ngohlobo lokuqala lwesifo.
Ngokuphazamiseka okusebenzayo kwezinso nezinso, i-Amaril ayisebenzi, i-Amaril ayikhonjisiwe nge-hemodialysis kanye nesifo sikashukela, nokuthiya ukungabekezelelani komuntu ngamunye ne-glipemiride noma ezinye izidakamizwa zesigaba se-sulfonamide nesigaba sulfonylurea.
Nge-intestinal paresis noma ukuvinjwa kwamathumbu, ukufakwa kwezidakamizwa kuyaphazamiseka, ngakho-ke i-Amaril ayichazi lezo zinkinga ngesikhathi sokugcwala. Zidinga ukushintshela ku-insulin nokulimala okuningi, ukuhlinzwa, ukugula okushisa okuphezulu, ukusha okukhulu.
I-Amaril ingahle ihambisane nokusabela kwe-hypoglycemic. Kwesinye isikhathi iziguli zikhononda ngesiyezi, ezinye ziba zimbi kakhulu izinga lokulala, kuba novalo, ukujuluka ngokweqile, nokuphazamiseka kwengqondo. Esikhathini sikashukela, kuba khona njalo kwendlala engalawulwa, ukuphazamiseka kwengqondo, ukungakhululeki endaweni yesibindi. Ukungasebenzi kahle kwesigqi senhliziyo, ukuqubuka esikhunjeni. Ukugeleza kwegazi kwesinye isikhathi kuya kuba kubi.
Imiphumela yokweqisa kwemithi
Ukusetshenziswa isikhathi eside kwalo muthi, kanye nehaba ngokweqile, kungavusa i-hypoglycemia, okuyizimpawu zazo ezichazwe esigabeni esedlule.
Umuntu onesifo sikashukela kufanele abe nenothi yemiyalo enencazelo emfushane yokugula kwakhe nokuthile okuvela kuma-carbohydrate asheshayo (uswidi, amakhukhi). Ijusi noma itiye elimnandi nalo kufanelekile, kuphela ngaphandle kwama-sweeteners wokufakelwa. Ezimweni ezimbi kakhulu, isiguli kufanele siphuthunyiswe esibhedlela ngokuphuthumayo ngenxa yokuphathwa kolwelwesi kanye nokuphathwa kwama-drabents (i-carbon eyenziwe yasebenza, njll.).
Imiphumela emibi
Ezimweni ezingavamile, ukusetshenziswa kwe-Amaril kuhambisana nemiphumela emibi ngendlela yokulahleka kwesikhashana kombono, izinkinga ngohlelo lokujikeleza, ukuphazamiseka kwe-metabolic, ukuphazamiseka kwesisu.
Phakathi kokujwayelekile:
- I-Glycemic syndrome, ebonakala ngokuphelelwa amandla, ukuwohloka kokuhlushwa, ukulahleka kombono, ukuqina kokuqina, indlala engalawulwa, ukujuluka ngokweqile.
- Ukwahluka kwezinkomba zeshukela, okuvusa ukonakala kokubonakalayo.
- Ukuphazamiseka kwengqondo kwe-dyspeptic, ukwephula isigqi sokuduka, kunyamalale lapho umuthi uhoxiswa.
- Ukwehla kobunzima obuhlukahlukene (ukuqunjelwa isikhumba, ukulunywa, okhalweni, i-vasculitis engalawuleki, ukushaqeka kwe-anaphylactic, umfutho wegazi ophansi kanye nokushoda komoya).
Ukuthatha i-Amaril kuthinta kabi ijubane lokuphendula kwe-psychomotor - ukushayela imoto, kanye nomsebenzi odinga ukunakwa, ikakhulukazi esigabeni sokuqala sokwelashwa, akuhambelani nokwelashwa kwe-Amaril.
Imibono yodokotela nabanesifo sikashukela nge-Amaril
Ukubuyekezwa kwabaphethwe yi-endocrinologists abahlangana nsuku zonke nakho konke ukubonakaliswa kwalesi sifo okuyisona inhloso enkulu, ngoba banethuba lokutadisha ukusabela kweziguli kulo muthi ukuthola iziphetho ngokusebenza kwaso.
Ngokusho kodokotela, ngohlobo lokwelashwa olwenziwe kahle, i-Amaril isiza ukuguqula indices ze-glycemic ngokushesha ngokushesha. Abantu abanesifo sikashukela abaphuza lo muthi banezikhalazo ze-hypoglycemia lapho umthamo ungakhethi kahle. Futhi nokho, mayelana nomuthi i-Amaril, ukubuyekezwa kweziguli kunethemba elihle impela.
Ukudla okuphansi kwe-carb, ukusebenza komzimba okukhishwa, ukulawulwa kwesisindo kunomthelela omkhulu ekusebenzeni kokwelashwa kwe-Amaril. Isifo sikashukela kufanele sazise i-endocrinologist ngesikhathi ngemiphumela emibi, izimpawu ze-hypo- ne-hyperglycemia ezikhula ne-Amaril.
Ukwelashwa kufaka nokuziqapha njalo kwezinkomba zikashukela nokuqapha imisebenzi yesibindi, ukuhlolwa kwelabhoratri, ikakhulukazi ukuhlolwa kwe-glycated hemoglobin, namuhla okubhekwa njengeyona nhloso enkulu yokuhlola isimo sesiguli esinesifo sikashukela. Lokhu kuzosiza ukukhomba izinga lokumelana ne-Amaril ngokulungiswa kwerejimeni yokwelashwa.
Ungafunda ngezici ezingeziwe ze-Amaril kusukela kuvidiyo.
