Baqale bakhuluma ngento ye-Metformin ngo-1922, bachaza isenzo sayo esiyinhloko nezinye ezisolwa ngo-1929, baqala ukuthandwa kakhulu ngemuva kuka-1950. Kusukela kulowomzuzu, ososayensi baqala ukukhombisa intshisakalo ekhulayo ku-metformin njenge-ejenti ekwehlisa ushukela engathinti inhliziyo nemithambo yegazi.
Ngemuva kokutadisha ngokucophelela nokuqhathanisa nezinye izidakamizwa zaleli qembu, kwanqunywa eCanada ngonyaka wama-70 onesifo sikashukela sohlobo 2, futhi eMelika savunyelwa kuphela ngonyaka we-1994, lapho savunywa yi-FDA.
Okuqukethwe yi-athikili
- 1 Yini i-Metformin
- 2 Ukwakheka nefomu lokukhululwa
- Izakhiwo ezingama-3
- 4 Izinkomba kanye ne-contraindication
- 5 Ungayithatha kanjani iMetformin
- I-6 Metformin ngesikhathi sokukhulelwa nokukhulelwa
- 7 Imiphumela emibi nokusetshenziswa ngokweqile
- 8 Imiyalo ekhethekile
- Imiphumela 9 yezifundo ezisemthethweni
- Ukubuka konke izidakamizwa zokuncipha kwesisindo kanye nokwelashwa kwesifo sikashukela sohlobo 2
- I-10.1 Analogs of metformin
- Ukubuyekezwa kokunciphisa umzimba kanye nesifo sikashukela
Yini i-Metformin
Ngokwesakhiwo samakhemikhali, i-metformin ingummeleli oyinhloko wenqwaba yama-Biguanides. Umuthi wokuqala olapha ekwelapheni isifo sikashukela sohlobo 2, uthathwa njenge-ejenti ethandwa kakhulu kwe-hypoglycemic emazweni amaningi omhlaba. Ngokungafani namanye amaqembu ama-ejenti omlomo, kungcono ukubamba isisindo endaweni noma kusiza ukwehlisa. Futhi, i-metformin kwesinye isikhathi isetshenziselwa ukwehla kwesisindo (ukwelashwa kokukhuluphala) kubantu abangenaso isifo sikashukela, yize yayingahloswanga lokhu ekuqaleni.
Umphumela wayo ekunciphiseni isisindo kungenxa yezindlela eziningana:
- izinga le-cholesterol "embi" liyancishiswa;
- ukumunca ushukela olula emgodini wokugaya ukudla kuyancishiswa;
- ukwakheka kwe-glycogen kuvinjelwe;
- ukucubungula ushukela kushesha kakhulu.
Ukwakheka nefomu lokukhululwa
Yonke i-metformin ekhona iyatholakala kumaphilisi ajwayelekile ahlanganisiwe wefilimu noma wokuqina, anciphisa imvamisa yokuphatha. Ukuqanjwa kufaka i-metformin hydrochloride kumthamo we-500, 750, 850 noma we-1000 mg.
Izici ze-Pharmacological
Umuthi ungumenzeli wuchungechunge we-Biguanide. Ukuhluka kwayo ukuthi ayikhulisi ukwakheka kwe-insulin yayo. Ngaphezu kwalokho, akuwathinti amazinga kashukela kubantu abanempilo. I-Metformin iyakwazi ukukhulisa ukuzwela kwe-insulin kwama-receptors akhethekile, ivimbela ukufakwa kwe-glucose emgodini we-gastrointestinal futhi yehlise inani layo egazini ngokuvimbela ukuguqulwa kwesibindi.
Ngaphezu kwalokho, i-metformin inomphumela omuhle kuma-metabolism wamafutha: yehlisa i-cholesterol, i-lipoproteins ephansi kanye ne-triglycerides, futhi ngasikhathi sinye ikhulisa okuqukethwe kwama-lipoproteins aphezulu. Ngesikhathi sokulashwa, isisindo somzimba kungenzeka ukuthi singashintshiwe (futhi okuwumphumela omuhle), noma sincipha kancane.
Ukuqoqwa okukhulu kwento kutholakala cishe amahora angama-2,5 ngemuva kwesicelo. Isigamu sempilo singamahora ayi-7. Uma kwenzeka umsebenzi wezinso ongasebenzi kahle, ubungozi bokubuqoqeka emzimbeni bukhuphuka, obugcwele izinkinga.
Izinkomba kanye ne-contraindication
I-Metformin inqunyelwe iziguli ezinesifo sikashukela sohlobo 2 sikashukela esimweni lapho ukulungiswa kokudla okunempilo kanye nokuba khona kwezemidlalo kungalethi imiphumela ebilindelwe. Ingasetshenziswa njengomuthi okuwukuphela kwawo wokulwa nesifo sikashukela ezinganeni ezineminyaka eyi-10 ubudala kanye nabantu abadala, noma njengesijobelelo se-insulin. Abantu abadala bangayihlanganisa namanye amaphilisi we-hypoglycemic.
Umuthi unokuphikisana okuningi:
- Ukungezwani komzimba kokuthile okusebenzayo noma yisiphi isakhi.
- Awukwazi ukukuthatha ngesikhathi sokudla okuqinile uma kudla okungaphansi kwe-kcal ayi-1000 ngosuku.
- Ukukhulelwa
- Ukwehluleka kwenhliziyo okukhulu, ukumelana kabi kwe-myocardial, izinkinga zokuphefumula kulesi sizinda.
- Umsebenzi wezinso ongasebenzi kahle. Lokhu kufaka nokuphazamiseka ekulinganiselweni kwamanzi, ukushaqeka, izifo ezithathelwanayo ezinzima ezingaholela ekwehlulekeni kwezinso.
- Ukungenelela okukhulu kakhulu kokuhlinzwa nokulimala.
- I-ketoacidosis yesifo sikashukela, i-thoroma ne-coma.
- Ukwephulwa kwesibindi, utshwala, ubuthi obukhulu ngeziphuzo ezinamandla.
- Ukuqongelelwa kwe-lactic acid emithanjeni yamathambo, isikhumba nobuchopho, obubizwa nge-lactic acidosis.
I-Metformin akufanele ithathwe ngabantu asebekhulile abanokuzivocavoca okusindayo ngokomzimba - lokhu kungenxa yokuvela kungenzeka kwe-lactic acidosis. Abesifazane abancelisa ibele kufanele futhi baqaphele futhi baphuze umuthi kuphela njengoba kuvunyelwene nodokotela, kodwa ikakhulukazi bavame ukuqeda ukukhipha isisu ukuze bangalimazi umntwana.
Ungayithatha kanjani i-metformin
Ngokuvamile kubangela imiphumela emibi evela emgodini wesisu, ukuthuthukisa ukubekezelelana, kunconyelwa ukwandisa umthamo kancane bese ubachoboza.
Uhlobo lokwamukelwa kwabadala njengomuthi kuphela wokulashwa noma ngokuhlangana namanye amaphilisi okwehlisa ushukela:
- Umuthi udakwa ngesikhathi sokudla noma ngemuva kokudla. Imvamisa, umthamo wokuqala ngu-500-850 mg ngosuku, uhlukaniswe ngemithamo eminingana. Ukunyuka kwayo kuhlobene ngqo nezinga le-glucose egazini.
- Umthamo wokulondolozwa ngu-1500-2000 mg ngosuku, uhlukaniswe ngemithamo engu-2-3 yokuphucula ukusabela kwephephabhuku lesisu kulo muthi.
- Umthamo ophelele wansuku zonke akufanele ube ngaphezu kwama-3000 mg.
Inhlanganisela ne-insulin:
- Umthamo wokuqala we-metformin ubuye 500-850 mg izikhathi ezingama-2-3 ngosuku, inani le-insulin likhethiwe ngokuhlukile kushukela wegazi.
Izingane ezineminyaka eyi-10 ubudala zichazwa njenge-metformin 500-850 mg kanye ngosuku ngemuva kokudla. Ukulungiswa kwe-dose kungenzeka ngemuva kokusetshenziswa kwesidakamizwa emavikini amabili. Umthamo ophelele akufanele udlule ku-2000 mg ngosuku, uhlukaniswe ngemithamo engu-2-3.
Kunefomu elide lamathebulethi ongaliphuza kanye ngosuku. Imithamo ikhethiwe futhi yanda ngawodwana, umuthi usetshenziswa kuleli cala, imvamisa ngemuva kwesidlo sakusihlwa.
I-Metformin ngesikhathi sokukhulelwa nokuqunjelwa
Kwakungekho zifundo ezigcwele emibusweni. Ukuqashwa okulinganiselwe kukhombisa ukuthi akukho okuphambuka okutholakele ezinganeni ezingakazalwa, ngenkathi owesifazane okhulelwe ephuza lesi sidakamizwa. Kepha imfundo esemthethweni ilibeka ngembaba elokuthi umama okhulelwe kufanele azise udokotela ozobhekana naye ngesimo sakhe, abese ecabanga ngokudluliselwa kwakhe kumalungiselelo e-insulin, uma kunesidingo.
Kuyafakazelwa ukuthi into le ikhishwa kanye nobisi lwebele, kepha imiphumela emibi ezinganeni ayikabonwa. Ngaphandle kwalokhu, ayinakuthathwa ngesikhathi sokuqunjelwa, kungakuhle kakhulu ukukuqedela ukuze kungazibangeli izinkinga ezingalindelekile enganeni.
Imiphumela emibi kanye ne-overdose
Imvamisa, ngenkathi uphuza umuthi, uhlelo lokugaya luyahlupheka: izithambisi ezikhululekile, isicanucanu, ukuhlanza ukuvela, ukunambitheka kwezinguquko zokudla, kanye nokudla kungadamba. Imvamisa, lezi zimpawu ziyaphenduka - zivela ekuqaleni kokwelashwa futhi zinyamalale njengoba zivele.
Ezinye izinkinga ezingenzeka:
- Isikhumba: ukulunywa, ukuqunjelwa, amabala abomvu.
- I-Metabolism: i-lactic acidosis engavamile kakhulu. Ngokusebenzisa isikhathi eside umuthi, ukumuncwa kwe-B kwesinye isikhathi kuyalimaza.12.
- Isibindi: ukwephulwa kwamapharamitha welebhu, i-hepatitis. Izinguquko ziyaguqulwa futhi ziyadlula ngemuva kokukhanselwa.
Esimweni lapho imiphumela emibi ingaphazamisi impilo ngokuvamile, umuthi uyaqhubeka ngaphandle kwezinguquko. Uma kwenzeka imiphumela engachazwanga emiyalweni esemthethweni, kuyadingeka ukwazisa udokotela ohambayo ngabo futhi ulandele imiyalo yayo eminye.
I-overdose ye-metformin yenzeka kuphela lapho umthamo othathwe uphakeme kaningana kunomuthi wansuku zonke. Imvamisa kubonakaliswa yi-lactic acidosis - uhlelo lwezinzwa oluphakathi lucindezelekile, ukuphefumula, ukuphazamiseka kwenhliziyo kanye noxinzelelo lwe-extretory system. Kulokhu, ukungena esibhedlela ngokushesha!
Imiyalo ekhethekile
Ukuhlinzwa.I-Metformin kufanele ikhanseliwe ezinsukwini ezimbili ngaphambi kokuhlinzwa okuhleliwe futhi kuqokwe kungakapheli izinsuku ezimbili emva kwazo uma umsebenzi wezinso ugcinwa.
I-Lactic acidosis. Kuyinkinga enkulu impela, futhi kunezici ezikhomba ubungozi bokuthi kwenzeke. Lokhu kufaka phakathi:
- ukwehluleka okunzima kwezinso;
- izimo lapho kungenakwenzeka ukulawula izinga le-glucose egazini;
- ukuthola inani elikhulu le-ketone emzimbeni;
- isiteleka sendlala;
- Izinkinga ezinkulu zesibindi;
- uphuzo oludakayo.
Ngokuphikisana nesizinda sokuthatha i-metformin, utshwala kufanele bushiywe namalungiselelo angaqukatha i-ethanol (ama-tincture, izixazululo, njll.)
Umsebenzi wezinso. Ukuqashelwa ikakhulukazi kufanele kusetshenziswe ngabantu asebekhulile abathi futhi basebenzise izidakamizwa ezingama-antihypertensive, ze-diuretic nezingelona i-steroidal futhi banezinkinga zezinso.
Eminye imithi engadala imiphumela engafuneki ngasikhathi sinye:
- danazole;
- i-chlorpromazine;
- I-β2-adrenomimetics ngendlela yemijovo;
- i-nifedipine;
- digoxin;
- i-ranitidine;
- vancomycin.
Ngokuqondene nokusetshenziswa kwazo, kufanele uxwayise udokotela kusengaphambili.
Izingane ezivela eminyakeni eyi-10. Ukuxilongwa kumele kusungulwe ngaphambi kokuqokwa kwe-metformin. Ucwaningo selufakazile ukuthi aluthinti ukuthomba nokukhula. Kepha ukulawula ngalezi zinhlaka kufanele kube kubucayi, ikakhulukazi eneminyaka eyi-10-12.
Okunye Ukuze ulahlekelwe isisindo, kunconywa ukulandela indlela yokudla ukuze ukudla okwenziwa ama-carbohydrate kufane usuku lonke. Usuku okudingeka udle ngalo lungaphansi kuka-1000 kcal. Ukufa yindlala akuvunyelwe!
Imiphumela Yokucwaninga Esemthethweni
Olunye uvivinyo olubalulekile lomtholampilo olubizwa ngokuthi yiBritish Prospential Diabetes Study (UKPDS) lwenziwa kubantu abanesifo sikashukela sohlobo 2 ababekhuluphele futhi abathatha i-metformin. Imiphumela:
- ukufa kwabantu kusuka kuhlobo 2 lwesifo sikashukela kuncishiswe ngama-42%;
- ingozi encishisiwe yezinkinga ze-vascular - 32%;
- ubungozi bokwehliswa kwe-myocardial kwehliswa ngo-39%, unhlangothi - 41%;
- Ukufa okuphelele kuncishiswa ngama-36%.
Ucwaningo olusanda kwenziwa, i-Diabetes Prevention Programme, lwenziwa ngomuthi waseFrance wokuqala, iGlucofage. Ngemuva kwakhe, kwenziwa isiphetho esilandelayo:
- ukwehla noma ukuvimba ukuthuthukiswa kwesifo sikashukela kubantu abane-carbohydrate metabolism ephazamisekile ngama-31% kwaphawulwa.
Ukubuka konke kwezidakamizwa zokunciphisa umzimba kanye nokwelashwa kwesifo sikashukela sohlobo 2
Izimpawu ezivame kakhulu futhi ezinhle kakhulu yilezi: iGlucophage (umuthi waseFrance wokuqala), iMetformin eyenziwe nguGideon Richter noSiofor. Umehluko phakathi kwabo awumkhulu kakhulu, into esebenzayo ayifani, izakhi ezisizayo kuphela ezingaba ngokuhlukile ezithinta ukukhishwa nokufakwa komuthi uqobo emzimbeni.
Izidakamizwa ezidumile ezinomuthi osebenzayo "metformin", izindleko zincike kumthamo:
Igama lokuhweba | Umkhiqizi | Intengo, hlikihla |
| I-Glucophage | Merck Sante, eFrance | Kusuka ku-163 kuya ku-310 |
| Metformin Richter | UGideon Richter-Rus, eRussia | Kusuka ku-207 kuya ku-270 |
| Siofor | Berlin Chemie, eJalimane | 258 kuye ku-467 |
Ama-analog we-Metformin
Ezinye izidakamizwa zokunciphisa isisindo kanye nokwelashwa kohlobo 2 sikashukela:
| Isihloko | Into esebenzayo | Iqembu le-Pharmacotherapeutic |
| I-Lycumia | I-Lixisenatide | Izidakamizwa ezinciphisa ushukela (uhlobo 2 ukwelashwa kwesifo sikashukela) |
| I-Forsyga | I-Dapaliflozin | |
| I-Novonorm | I-Repaglinide | |
| Victoza | ILiraglutide | |
| IGoldline | ISibutramine | Izilawuli zokudla (ukwelashwa kokukhuluphala) |
| I-Xenical, Orsoten | I-Orlistat | Kusho ukwelashwa kokukhuluphala |
Ukubuyekezwa kokunciphisa umzimba kanye nesifo sikashukela
Inna, oneminyaka engama-39: Nginamakhilogremu angeziwe kanye nohlobo lweshukela 2. Udokotela unqume i-metformin wathi nayo iyasiza ekwehliseni isisindo. Ekuqaleni angizange ngiyikholelwe, ngoba ngisho nokudla nokuzivocavoca okhethekile akuzange kusize. Kepha njengoba umuthi wawungowokuqala unesifo sikashukela, nganquma ukuwuphuza noma kunjalo, ngalandela izincomo ezedlule zokudla okunempilo. Ngamangala kakhulu lapho inyanga kamuva ngibona izinamba zesikali zingaphansi kokujwayelekile.
U-Ivan, oneminyaka engama-28: Kuyo yonke impilo yami bengikhuluphele: ushukela ujwayelekile, ezemidlalo zikhona, ngigcina ukudla - akukho okusebenzayo. Ngazama imishanguzo ehlukahlukene yokunciphisa umzimba, kufaka ne-metformin. Ngaphezu kokugayeka, angitholanga lutho, isisindo sakhula ngokufana ngaphandle kwakhe. Kungenzeka ukuthi uthathe ngaphandle kadokotela futhi wakhetha umthamo ongalungile.
I-Metformin iyithuluzi elikhethekile lokunciphisa isisindo nokulwa nesifo sikashukela sohlobo 2, ungazithatheli ngokwakho. Ngaphezu kwalokho, usatshalaliswa ngomuthi, onquma umthamo owuthandayo kanye nemvamisa yokwamukelwa. Ukuzelapha kungaba yingozi empilweni yakho!
