Kusetshenziswa imishanguzo ehlukene ngokuya ngohlobo lwesifo sikashukela.
Ngohlobo 1, ama-insulin anqunyelwe, futhi ohlobo 2, ikakhulukazi amalungiselelo wethebhulethi.
Izidakamizwa ezinciphisa ushukela zifaka amaGlucovans.
Imininingwane ejwayelekile mayelana nomuthi
Ifomula leMetformin
I-Glucovans (glucovance) - umuthi oyinkimbinkimbi onomphumela we-hypoglycemic. Ubumfihlo bayo yinhlanganisela yezingxenye ezimbili ezisebenzayo zamaqembu e-pharmacological ehlukile e-metformin ne-glibenclamide. Le nhlanganisela ithuthukisa umphumela.
I-Glibenclamide imele isizukulwane sesibili se-sulfonylurea derivatives. Yaziwa njengesidakamizwa esisebenza kakhulu kuleli qembu.
I-Metformin ithathwa njengesidakamizwa sohlu lokuqala, esisetshenziswa lapho kungekho khona umphumela wokwelashwa kokudla. Umuthi, uma uqhathanisa ne-glibenclamide, unobungozi obuphansi be-hypoglycemia. Ukuhlanganiswa kwalezi zinto ezimbili kukuvumela ukuthi uzuze umphumela obonakalayo futhi ukhuphule ukusebenza kwezokwelapha.
Isenzo somuthi kungenxa yezakhi ezi-2 ezisebenzayo - glibenclamide / metformin. Njengokwengezwa, kusetshenziswa i-magnesium stearate, i-povidone K30, i-MCC, i-sodium ye-croscarmone.
Kutholakala kwifomu lethebhulethi kwimithamo emibili: 2,5 mg (glibenclamide) +500 mg (metformin) no-5 mg (glibenclamide) +500 mg (metformin).
Isenzo se-Pharmacological
Ifomula yeGlibenclamide
I-Glibenclamide - uvimba iziteshi ze-potassium futhi uvuse amaseli we-pancreatic. Ngenxa yalokhu, secretion ye-hormone iyakhuphuka, ingena egazini nasemthanjeni wegazi.
Ukusebenza kokukhuthaza kokuqothuka kwama-hormone kuncike kumthamo othathwe. Yehlisa ushukela kuzo zombili iziguli ezinesifo sikashukela nabantu abanempilo.
I-Metformin - kuvimbela ukwakheka kwe-glucose esibindini, kwandisa ukuzwela kwezicubu kuyi-hormone, kuvimbela ukufakwa kweglucose egazini.
Ngokungafani ne-glibenclamide, ayivuseleli ukuhlanganiswa kwe-insulin. Ngaphezu kwalokho, inomphumela omuhle kuphrofayili ye-lipid - i-cholesterol ephelele, i-LDL, i-triglycerides. Ayilinciphisi izinga lokuqala loshukela kubantu abanempilo.
I-Pharmacokinetics
I-Glibenclamide igxilwe ngentshiseko kungakhathalekile ukuthathwa kokudla. Ngemuva kwamahora angama-2,5, ukuhlangana kwawo okuphezulu egazini kufinyelelwa, ngemuva kwamahora angama-8 kunciphisa kancane kancane. Ukuphila kwengxenye kungamahora ayi-10, kanti ukuqedwa ngokuphelele yizinsuku ezingama-2-3. Cishe iklanyelwe ngokuphelele esibindini. Umuthi ukhishwa kumchamo ne-bile. Ukuhlanganiswa kwamaprotheni e-plasma awudluli kuma-98%.
Ngemuva kokuphathwa ngomlomo, i-metformin icishe ifakwe ngokuphelele. Ukudla kuthinta ukumuncwa kwe-metformin. Ngemuva kwamahora angama-2,5, inani lokuphakama kwento lifinyelelwa; liphansi egazini kuneplasma yegazi. Ayenzelwe umzimba futhi ishiya ingashintshiwe. Ukuqedwa kwesigamu sempilo kungamahora ayi-6.2. Kukhishwa ikakhulu ngomchamo. Ukuxhumana ngamaprotheni akubalulekile.
I-bioavailability yesidakamizwa iyafana nokudla okuhlukile kwesithako ngasinye esisebenzayo.
Izinkomba kanye ne-contraindication
Phakathi kwezinkomba zokuthatha amaphilisi weGlucovans:
- Thayipha isifo sikashukela esingu-2 ngokungatholakali kokusebenza kokulashwa kokudla, imisebenzi yomzimba;
- Thayipha isifo sikashukela esingu-2 lapho ungekho khona umphumela ngesikhathi sokwenza i-monotherapy nge-Metformin ne-Glibenclamide;
- lapho uthatha indawo yokwelashwa ezigulini ezinezinga elilawulwayo le-glycemia.
Ukuxhumana okusetshenziswayo yile:
- Uhlobo 1 isifo sikashukela;
- hypersensitivity to sulfonylureas, metformin;
- hypersensitivity kwezinye izingxenye zomuthi;
- ukungasebenzi kwezinso;
- ukukhulelwa / ukukhulelwa;
- isifo sikashukela sikashukela;
- ukungenelela kokuhlinzwa;
- i-lactic acidosis;
- ukudakwa kotshwala;
- Ukudla kwe-hypocaloric;
- iminyaka yezingane;
- ukwehluleka kwenhliziyo;
- ukwehluleka ukuphefumula;
- izifo ezithathelwanayo ezinzima;
- ukushaya kwenhliziyo;
- i-porphyria;
- umsebenzi wezinso ongonakalisiwe.
Imiyalo yokusebenzisa
Umthamo usethwa ngudokotela, kucatshangelwa izinga le-glycemia nezimpawu zomuntu siqu zomzimba. Ngokwesilinganiso, inqubo ejwayelekile yokwelashwa ingahle ihambisane nalokho ebekiwe. Ukuqala kokwelashwa kukodwa ngosuku. Ukuvimbela i-hypoglycemia, akufanele yedlule umthamo osungulwe we-metformin ne-glibenclamide ngokwehlukana. Ukwanda, uma kunesidingo, kwenziwa njalo emavikini amabili noma ngaphezulu.
Ezimweni zokudluliselwa kusuka kwesidakamizwa siye eGlucovans, ukwelashwa kubekiwe kucatshangelwa imithamo yangaphambilini yengxenye ngayinye esebenzayo. Isilinganiso sansuku zonke esisungulwe yiyunithi ezi-4 zama-5 + 500 mg noma ama-6 amayunithi ayi-2,5 + 500 mg.
Amacwecwe asetshenziswa ngokuhlangana nokudla. Ukugwema amazinga amancane kashukela egazini, yenza isidlo sibe ngaphezulu kuma-carbohydrate njalo lapho uthatha umuthi.
Ividiyo evela kuDkt Malysheva:
Iziguli ezikhethekile
Umuthi awuchaziwe ngesikhathi sokuhlela nangesikhathi sokukhulelwa. Ezimweni ezinjalo, isiguli sidluliselwa ku-insulin. Lapho uhlela ukukhulelwa, kufanele wazise udokotela wakho. Ngenxa yokuntuleka kwemininingwane yocwaningo, nge-lactation, ama-Glucovans awasetshenziswa.
Iziguli esezikhulile (> iminyaka engama-60 ubudala) azihlinzeki ngemithi ebekiwe. Abantu abasebenza kanzima ngokomzimba futhi abanconywa ukuthi baphuze lo muthi. Lokhu kuhlotshaniswa nobungozi obukhulu be-lactic acidosis. Nge-anemia ye-megoblastic, kufanele kukhunjulwe ukuthi umuthi unciphisa ukumuncwa kwe-B 12.
Imiyalo ekhethekile
Sebenzisa ngokuqapha ezifweni ze-gland yegilo, izimo ze-febrile, ukungasebenzi kahle kwe-adrenal. Awukho umuthi obekelwe izingane. Ama-Glucovans awavunyelwe ukuhlanganiswa notshwala.
Ukwelashwa kufanele kuhambisane nenqubo yokulinganisa ushukela ngaphambi / ngemuva kokudla. Kunconywa futhi ukuhlola okuhlushwa i-creatinine. Uma kwenzeka umsebenzi we-renal ophazamisekile kubantu asebekhulile, ukuqapha kwenziwa kathathu ngonyaka. Ngokusebenza okujwayelekile kwezitho, kwanele ukuhlaziya kanye ngonyaka.
Amahora angama-48 ngaphambi / ngemuva kokuhlinzwa, umuthi ukhanseliwe. Emahoreni angama-48 ngaphambi / ngemuva kokuhlolwa kwe-X-ray ngento ye-radiopaque, i-Glucovans ayisetshenziswa.
Abantu abanokuhluleka kwenhliziyo banengozi eyandayo yokuthola ukuhluleka kwezinso ne-hypoxia. Kunconywa ukuqapha okuqinile kokusebenza kwenhliziyo nezinso.
Umphumela wecala nokusebenzisa ngokweqile
Phakathi kwemiphumela emibi ngesikhathi sokudla kuyabonakala:
- okuvame kakhulu yi-hypoglycemia;
- i-lactic acidosis, i-ketoacidosis;
- ukwephula ukunambitheka;
- i-thrombocytopenia, i-leukopenia;
- ukukhuphuka kwe-creatinine ne-urea egazini;
- ukuntuleka kokudla kanye nezinye iziphazamiso zomgudu wesisu;
- i-urticaria nokulunywa kwesikhumba;
- ukonakala ekusebenzeni kwesibindi;
- i-hepatitis;
- i-hyponatremia;
- i-vasculitis, i-erythema, i-dermatitis;
- ukuphazamiseka okubukwayo kwesimo sesikhashana.
Uma kwenzeka okweqisa kwe-Glucovans, i-hypoglycemia ingaqhamuka ngenxa yokuba khona kwe-glibenclamide. Ukuthatha u-20 g we-glucose kusiza ukumisa amaphaphu okuwozeleka okulinganiselayo. Ngaphezu kwalokho, ukulungiswa komthamo kuyenziwa, ukudla kuyabuyekezwa. I-hypoglycemia enkulu idinga ukunakekelwa okuphuthumayo nokungeniswa esibhedlela. Ukweqisa okubalulekile kungaholela ku-ketoacidosis ngenxa yokuba khona kwe-metformin. Isimo esifanayo selashwa esibhedlela. Indlela ephumelela kunazo zonke yi-hemodialysis.
Ukuxhumana neminye imithi
Musa ukuhlanganisa umuthi ne-phenylbutazone noma i-danazole. Uma kunesidingo, isiguli siqapha kakhulu ukusebenza. Ama-inhibitors e-ACE anciphisa ushukela. Ukunyuka - i-corticosteroids, i-chlorpromazine.
IGlibenclamide ayinconywa ukuhlanganiswa ne-miconazole - ukusebenzisana okunjalo kukhulisa ubungozi be-hypoglycemia. Ukuqinisa isenzo sento kungenzeka ngenkathi uthatha i-Fluconazole, ama-anabolic steroid, ama-clofibrate, ama-antidepressants, ama-sulfalamides, ama-hormone abesilisa, okususelwa ku-coumarin, ama-cytostatics. Ama-hormone abesifazane, ama-hormone egilo, i-glucagon, ama-barbiturates, ama-diuretics, ama-sympathomimetics, ama-corticosteroids anciphisa umphumela we-glibenclamide.
Ngokuphathwa kanyekanye kwe-metformin ene-diuretics, amathuba okuthuthuka kwe-lactic acidosis ayanda. Izinto zeRadiopaque uma zithathwa ndawonye zingavusa ukwehluleka kwezinso. Ungavumeli ukusetshenziswa kotshwala kuphela, kepha nezidakamizwa nokuqukethwe kwako.
Imininingwane eyengeziwe, ama-analogues
Intengo yesidakamizwa amaGlukovans ngama-ruble angama-270. Akudingi izimo ezithile zesitoreji. Ikhishwe ngumbhalo. Impilo yeshelf iyiminyaka emithathu.
Ukukhiqiza - Merck Sante, eFrance.
Ama-analogue aphelele (izakhi ezisebenzayo ziyahlangana) yiGlybomet, Glybofor, Duotrol, Glunored.
Kukhona ezinye izinhlanganisela zezinto ezisebenzayo (i-metformin ne-glycoslide) - I-Dianorm-M, i-metformin ne-glipizide - i-Dibizid-M, i-metformin ne-glimeperide - i-Amaryl-M, Douglimax.
Ukuphindisela esikhundleni kungaba izidakamizwa ngento eyodwa esebenzayo. I-Glucofage, iBagomet, iGlycomet, Insufort, Meglifort (metformin). I-Glibomet, Maninil (glibenclamide).
Umbono wesifo sikashukela
Ukubuyekezwa kweziguli kukhombisa ukusebenza kwe-Glucovans futhi ngentengo eyamukelekayo. Kuyaziwa nokuthi ukulinganisa ushukela ngenkathi uthatha umuthi kufanele kwenzeke kaningi.
Kuqala wathatha uGlucophage, ngemuva kokuthi enikezwe amaGlucovans. Udokotela wanquma ukuthi kuzophumelela kakhudlwana. Lesi sidakamizwa sehlisa ushukela kangcono. Kuphela manje kufanele sithathe izilinganiso kaningi ukuvikela i-hypoglycemia. Udokotela wangazisa ngalokhu. Umehluko phakathi kweGlucovans neGlucophage: umuthi wokuqala uqukethe i-glibenclamide ne-metformin, kanti owesibili uqukethe kuphela i-metformin.
USalamatina Svetlana, oneminyaka engama-49 ubudala, iNovosibirsk
Sekuphele iminyaka engu-7 ngihlaselwa yisifo sikashukela. Muva nje ngichithwe umuthi wokuhlanganisa iGlucovans. Ngokushesha izinzuzo: ukusebenza kahle, ukusetshenziswa kalula, ukuphepha. Intengo nayo ayikuluma - ngoba emaphaketheni enginikeza wona angama-265 r kuphela, anele ngesigamu senyanga. Ukushoda phakathi kokushiyeka: kukhona ukuphambana, kepha angisiyena owlesi sigaba.
U-Lidia Borisovna, oneminyaka engama-56, Yekaterinburg
Umuthi obekelwe umama, unesifo sikashukela. UTakes Glucovans cishe iminyaka emi-2, uzizwa kahle, ngimbona ekhuthele futhi ejabule. Ekuqaleni, umama waba nesisu esidabukisayo - isicanucanu nokulahlekelwa yinhliziyo, ngemuva kwenyanga konke kuhambile. Ngaphetha ngokuthi umuthi uyasebenza futhi usiza kahle.
USergeeva Tamara, oneminyaka engama-33 ubudala, u-Ulyanovsk
Ngithathe iManinil ngaphambili, ushukela ugcinwe cishe ngo-7.2. Washintshela kwabakwaGlucovans, ngesonto ushukela wehle waya ku-5.3. Ngihlanganisa ukwelashwa nokuzivocavoca umzimba kanye nokudla okukhethwe ngokukhethekile. Ngilinganisa ushukela kaningi futhi angizivumeli izimo ezeqile. Kuyadingeka ukushintshela kumuthi kuphela ngemuva kokubonana nodokotela, ubone imithamo echazwe ngokucacile.
U-Alexander Savelyev, oneminyaka engama-38, eSt
