Allunan Glibenclamide: umarnin don amfani

Oral hypoglycemic kwayoyi. Abubuwan da suka samo asali na sulfonylureas.

Lambar ATX: A10VB01.

Glibenclamide yana rage taro glucose a cikin jini. Anaruwar yawan ƙwayar insulin plasma da raguwar matakin glucose yana faruwa a hankali. Da kyau yana rinjayar matakai na rayuwa. Ayyukan yana haɓaka sa'o'i 2 bayan gudanarwa, ya kai mafi girma bayan sa'o'i 7-8 kuma yana ɗaukar awoyi 8-12.

Yin hulɗa tare da wasu kwayoyi

Yana haɓaka sakamakon maganin rashin daidaituwa.
Manyan acidifying na ciki (ammonium chloride, alli na chloride, ascorbic acid a cikin manyan allurai) suna inganta tasirin glibenclamide.

Antifungal tsari nufin (azole Kalam), fluoroquinolones, tetracyclines, chloramphenicol, H2-blockers, beta-blockers, ACE hanawa, nonsteroidal antiinflammatory kwayoyi, monoamine oxidase hanawa, clofibrate, bezafibrate, probenecid, acetaminophen, ethionamide, anabolic steroids, pentoxifylline, allopurmnol , cyclophosphamide, reserpine, sulfonamides, insulin suna ba da gudummawa ga ci gaban hypoglycemia.
Barbiturates, phenothiazines, diazoxide, glucocorticoid da kwayoyin hodar iblis, estrogens, gestagens, glucagon, magungunan adrenomimetic, salhi lithium, abubuwan nicotinic acid, rifampicin da saluretics suna raunana tasirin hypoglycemic.

Contraindications

Glibenclamide yana cikin abubuwan da ke tafe:

mellitus-insulin-da ke fama da ciwon sukari (nau'in 1), gami da cikin yara da matasa,
mai ciwon sukari ketoacidosis,
precoma na sukari ko coma,
Cire koda
ilmin coma
mai girma game da koda ko gazawar hanta (ƙimar ƙirar creatinine kasa da 30 ml / min),
ƙonewa mai yawa
mai rauni mai yawa
m shisshigi
hanji na hanji,
paresis na ciki
malabsorption abinci tare da haɓakar cutar hawan jini,
leukopenia
individualara yawan haɓakar mutum ga miyagun ƙwayoyi, har da sauran magungunan sulfa da sulfonylureas,
ciki da lactation
shekaru har zuwa shekaru 14.

Matan da ke shirin yin juna biyu, da kuma haihuwar yara, ya kamata su canza zuwa insulin ko kuma su daina shayarwa gaba daya.

Sashi da gudanarwa

Ya kamata a wanke Glibenclamide tare da ruwa kaɗan. Likita ya ƙayyade kashi na farko da adadin ƙwayoyi don maganin kulawa don kowane mai haƙuri daban-daban, dangane da sakamakon bincike na matakan glucose a cikin fitsari da jini. Irin waɗannan umarnin ne don amfani Glibenclamide ke buƙata.

Maganin farko na maganin shine rabin kwamfutar hannu (2.5 MG) sau ɗaya a rana. Idan ya cancanta, ana iya ƙaruwa na yau da kullun ta hanyar saka idanu akai-akai game da tattarawar glucose a cikin jini. Ya kamata a aiwatar da karuwar kashi a hankali tare da tazara daga wasu ranaku da kashi 2.5, har sai an sami magani mai warkewa.

Matsakaicin adadin na iya zama allunan 3 a kowace rana (15 mg). Wuce wannan adadin baya inganta tasirin hypoglycemic.

Idan kashi ya kai allunan 2 a rana, to ana shan su a lokaci da safe kafin abinci. Idan kana buƙatar amfani da adadin ƙwayoyi, to, ya fi kyau a yi shi a allurai biyu, kuma rabon ya kamata ya zama 2: 1 (safe da maraice).

Ya kamata tsofaffi marasa lafiya su fara jiyya tare da rabi na rabi tare da karuwarsa tare da tazara tsakanin mako guda ba fiye da 2.5 mg kowace rana ba.

Idan nauyin jikin mutum ko salon rayuwar sa ya canza, dole a daidaita sashi. Hakanan, yakamata a yi gyara idan akwai abubuwanda zasu kara hadarin haɓakar hauhawar jini - ko hypoglycemia.

Tare da ƙarin yawan wannan magani, hypoglycemia ya fara. Alamomin ta:

ƙara yin gumi
damuwa
tachycardia da hauhawar jini, jin zafi a zuciya, arrhythmia,
ciwon kai
increasedarin abinci, ciwan ciki, tashin zuciya,
nutsuwa, rashin son zuciya,
tashin hankali da damuwa
mai da hankali taro,
ciki, rikicewar hankali,
paresis, rawar jiki,
canjin yanayin ji na ƙwarai
rashiwar halittar tsakiya.

A wasu halaye, a cikin bayyanar sa, hypoglycemia yana kama da bugun jini. Cowan ciki na iya haɓaka.

Yawan abinciki

Tare da m zuwa matsakaici na hypoglycemia, ana iya dakatar dashi ta hanyar haɗarin gaggawa na carbohydrates (yanka sukari, shayi mai zaki ko ruwan 'ya'yan itace). Sabili da haka, masu ciwon sukari ya kamata koyaushe suna ɗaukar 20 g na glucose (guda huɗu na sukari).

Masu zaki ba su da tasirin warkewa da cututtukan jini. Idan yanayin mai haƙuri yana da matukar damuwa, to lallai yana buƙatar asibiti. Tabbatar yin ƙoƙarin haifar da amai da kuma rubanya ruwa (ruwa ko lemun tsami tare da sodium sulfate da gawayi), da magungunan hypoglycemic.

Side sakamako

Daga gefen metabolism na iya zama:

hawan jini, yawanci ba dare ba rana, tare da:

ciwon kai
yunwa
tashin zuciya
tashin hankali na bacci
nasiha
damuwa
rawar jiki
rufin sanyi na ɗumi ɗumi,
samarin
rikicewar hankali
jin gajiya
matsalar magana da hangen nesa

Wasu lokuta wasu lokuta na iya zama rashin nutsuwa da coma, kazalika:

sensara nuna hankali ga barasa,
nauyi
dyslipidemia, tarin tsotse nama,
tare da yin amfani da tsawan lokaci, haɓakar hauhawar ƙwayar thyroid zai yiwu.

Daga tsarin narkewa:

tashin zuciya, amai,
nauyi, rashin jin daɗi da jin ciwon ciki,
ƙwannafi, ƙwannafi, zawo,
karuwa ko rage ci,
a cikin lokuta mafi wuya, aikin hanta na iya rikicewa, hepatitis, cholestatic jaundice, porphyria na iya haɓaka.

Daga tsarin hawan jini:

da wuya akwai mayuka ko na hancin ciki,
leukopenia
agranulocytosis,
kwankwantin
eosinophilia
thrombocytopenia.

erythema multiforme, daukar hoto ko exfoliative dermatitis da wuya ya haɓaka,
rashin lafiyan giciye don wakilai na thiazide, sulfonamides ko sulfonylureas na iya faruwa.

Sauran sakamako masu illa:

Rashin daidaituwa na maganin antidiuretic, tare da:

tsananin farin ciki
kumburi da fuska
hannaye da ankles
bacin rai
bari
katsewa
wawa
coma
rikicewar masauki (na lokaci).

Idan akwai wasu halayen da ba a so ko kuma wani abin mamaki a ciki, to ya kamata a nemi shawara tare da likitanku game da ƙarin magani tare da wannan magani, don yanzu dole ne a sake jinyar Glibenclamide.

Siffofin aikace-aikace

Dole ne likita koyaushe ya kasance da masaniya game da halayen haƙuri na baya ga magunguna a cikin wannan rukunin. Dole ne a yi amfani da Glibenclamide koyaushe kawai a allurai masu shawarar kuma a tsaftataccen lokacin lokaci. Wannan shine ainihin umarnin don amfani, kuma in ba haka ba ba a bada shawarar Glibenclamide.

Likita ya kayyade sashi, daidai rarraba kudin shiga yayin rana da lokacin amfani, gwargwadon tsarin aikin yau da kullum na mara lafiya.

Domin maganin ya haifar da ingantaccen glucose na jini, ya zama dole a bi abinci na musamman tare da shan maganin, yin motsa jiki da rage nauyin jiki, idan ya cancanta. Duk wannan ya zama umarnin don amfani.

Yakamata mai haƙuri ya yi ƙoƙarin iyakance lokacin cin rana da rage adadin abinci mai ƙima.

Gargaɗi da kurakurai a cikin shan miyagun ƙwayoyi

Wa'adin farko ya kamata koyaushe ya zama ta hanyar shawarar likita, ba za ku iya yin amfani da magani ba fiye da lokacin da aka ba da shawarar. Ya kamata a yi amfani da Glibenclamide da analogues tare da taka tsantsan idan akwai yiwuwar cututtukan ƙwayar cuta, adrenal insufficiency, buguwa, cututtukan thyroid (hauhawar jini ko hypothyroidism), idan akwai aiki na hanta mai rauni, haka kuma a cikin tsofaffi marasa lafiya.

Tare da monotherapy fiye da shekaru biyar, juriya na biyu na iya haɓaka.

Kulawar dakin gwaje-gwaje

Yayin yin jiyya tare da glibenclamide, kuna buƙatar kulawa da hankali a cikin jini (yayin da ake zaɓi kashi, wannan ya kamata a yi sau da yawa a mako), kazalika da matakin glycated haemoglobin (aƙalla sau ɗaya a kowane watanni uku), wurin da wannan yana da mahimmanci kuma glucose a cikin fitsari. Wannan zai sa ya yiwu a lura da juriya ko na farko game da wannan magani a cikin lokaci.

Hakanan ya kamata ku lura da yanayin da ke cikin jini (musamman abubuwan da ke cikin farin farin sel da platelet), da aikin hanta.

Rashin haɗarin hypoglycemia a farkon farawar magani

A farkon matakan jiyya, hadarin kamuwa da wannan yanayin yana ƙaruwa, musamman idan abinci ya tsallake ko kuma abincin da bai saba ba. Abubuwan da ke ba da gudummawa ga ci gaban hawan jini:

rashin iyawa ko rashin yarda da marasa lafiya, musamman tsofaffi, don yin aiki tare da likita da ɗaukar Glibenclamide ko misalinsa,
tamowa, rashin cin abinci na yau da kullun ko abinci,
rashin daidaituwa tsakanin cin abinci na carbohydrate da aikin jiki,
kurakurai a cikin abinci
shan giya, musamman idan akwai rashin abinci mai gina jiki,
mai aiki mai ɗaukar hoto,
mai tsanani hanta,
yawan shan magani
cututtukan da ba a daidaita su ba na tsarin endocrine wanda ke shafar metabolism na metabolism, kamar yadda yaduwar cututtukan jini, gami da cututtukan ƙwayar cuta da rashin daidaituwa, rashin aikin thyroid,
amfani da wasu magunguna lokaci guda.

Irin wannan kwayoyi a cikin sakamako:

gliclazide (Allunan 30mg),
gliclazide (80 MG kowace),
shine maxpharma,
diadeon
mai ciwon sukari MV,
glurenorm.

Glibenclamide yana cikin rukuni na wakilai na hypoglycemic don maganin magana. Yana da cakuduwar hanyar aiki, wacce ta ƙunshi ƙari-cikin farji da farji.

Pharmacokinetics

Bayan kulawa ta baka, hanzarin amfani da ƙwayar glibenclamide a cikin jijiyar ganye na faruwa. Gwaje-gwaje don cikin saki na vitro sun nuna cewa abu mai aiki Glibenclamide yana ƙaddamar da kusan kashi 63% na adadin kayan aiki a cikin mintina 15, 72% a cikin minti 60. A lokaci guda, cin abinci na iya haifar da raguwa a cikin ƙwayar jini a cikin jini idan aka kwatanta da amfani a kan komai a ciki. Hanyar glibenclamide tare da albumin a cikin jini na jini ya fi 98%. A cikin hanta, glibenclamide an kusan canza shi zuwa manyan metabolites biyu: 4-trans-hydroxy-glibenclamide da 3-cis-hydroxy-glibenclamide. Ana amfani da metabolites guda biyu daidai gwargwado ta hanjin kodan da hanta. Matsakaicin rabin rayuwar glibenclamide daga plasma jini shine awanni 1.5-3.5. Tsawon lokacin aikin, kodayake, bai yi daidai da rabin rai daga jini ba. A cikin marassa lafiyar marasa aikin hanta, an rage fitowar plasma. Tare da gazawar matsakaici na koda (ƙarancin keɓaɓɓen na 30 ml / min), ƙarar glibenclamide da manyan abubuwan metabolites biyu ba su canza ba, tare da gazawar haɓakar dan tayi mai yawa, tarawa mai yiwuwa ne.

Yadda ake amfani: sashi da hanya na jiyya

Yawan yana dogara ne da shekaru, tsananin girman cutar siga, maida hankali ga yawan glucose na jini da kuma awanni 2 bayan cin abinci. Matsakaicin matsakaita na yau da kullum ya tashi daga 2.5 zuwa 15 MG. Mitar gudanarwa sau 1-3 a rana don mintuna 20-30 kafin cin abinci. Allurar fiye da 15 mg / rana ba ta ƙara ɗaukar nauyi na sakamako na hypoglycemic ba. Maganin farko a cikin tsofaffi marasa lafiya shine 1 mg / rana.

Lokacin maye gurbin magunguna na hypoglycemic tare da irin wannan aikin, ana wajabta su bisa ga makircin da aka bayar a sama, kuma an soke maganin nan da nan. Lokacin canzawa daga biguanides, kashi na farko na yau da kullun shine 2.5 MG, idan ya cancanta, ana ƙara yawan adadin yau da kullun a kowace 5-6 na kwanaki ta 2.5 mg har sai an sami sakamako. In babu diyya a cikin makonni 4-6, ya zama dole yanke shawara game da hanyoyin haɗuwa.

Side effects

Hypoglycemia (take hakkin tsarin allurar rigakafi da rashin isasshen abinci), hauhawar nauyi, zazzabi, arthralgia, proteinuria, halayen rashin lafiyan (fatar fata, ƙaiƙayi), dyspepsia (tashin zuciya, zawo, jin motsin ciki a cikin ƙwayar zuciya), rikicewar jijiyoyin cuta (paresis, cuta mai raunin hankali) , hemopoiesis (hypoplastic ko hemolytic anemia, leukopenia, agranulocytosis, pancytopenia, eosinophilia, thrombocytopenia), rashin aiki na hanta (cholestasis), ƙarshen cutaneous porphyria, canje-canje a dandano, polyuria, hoto ensibilizatsiya, ciwon kai, gajiya, wani rauni, juwa.

Yawan damuwa Bayyanar cututtuka: rashin ƙarfi a cikin jiki (yunwar, zazzagewa, rauni mai ƙarfi, bugun zuciya, tashin hankali, damuwa, ciwon kai, tsananin rauni, rashin bacci, damuwa, rashin ƙarfi, haɓakar kumburi, magana mai rauni da hangen nesa, rashin iya magana).

Jiyya: idan mai haƙuri yana da hankali, ɗauki sukari a ciki, tare da asarar hankali - inject iv dextrose (iv bolus - 50% dextrose bayani, to jiko na 10% bayani), 1-2 mg glucagon s / c, i / m ko iv, diazoxide 30 mg iv na mintina 30, saka idanu kan yawan glucose a kowane mintuna 15, da kuma tantance pH, urea nitrogen, creatinine, da electrolytes a cikin jini. Bayan murmurewa, ya zama dole a bawa mai haƙuri abincin da ke da wadataccen abinci a cikin kwayoyi masu narkewa a ciki (don guje wa sake haɓakar ɗabi'a). Tare da cututtukan maɓallin cerebral edema, mannitol da dexamethasone.

Umarni na musamman

Wajibi ne a kula da matakin glucose a kai a kai cikin jini a kan komai a ciki kuma bayan cin abinci, abubuwan yau da kullun na abubuwan glucose a cikin jini da fitsari.

Dangane da abubuwan da suka shafi tiyata ko lalata cututtukan sukari, yiwuwar yin amfani da shirye-shiryen insulin.

Ya kamata a faɗakar da marasa lafiya game da haɗarin haɗarin hypoglycemia a cikin lokuta na shan ethanol (ciki har da haɓaka halayen disulfiram-kamar halayen ciki: zafin ciki, tashin zuciya, amai, ciwon kai), NSAIDs, da kuma matsananciyar yunwa.

Yayin jiyya, ba da shawarar zama a rana na dogon lokaci.

Daidaitawar magani ya zama dole don wuce gona da iri da motsin rai, canji a abinci.

Bayyanar bayyanar cututtuka na hypoglycemia za a iya rufe shi lokacin ɗaukar beta-blockers, clonidine, reserpine, guanethidine.

A lokacin jiyya, dole ne a kula sosai lokacin tuki motoci da shiga wasu ayyukan masu haɗari waɗanda ke buƙatar haɓakar jawo hankali da saurin halayen psychomotor.

Tambayoyi, amsoshi, sake dubawa game da magani Glibenclamide

Bayanin da aka bayar an yi shi ne don ƙwararrun likitoci da magunguna. Cikakken bayani game da magani yana kunshe ne a cikin umarnin da aka haɗe zuwa marufin da mai masana'anta. Babu wani bayani da aka sanya akan wannan ko wani shafin yanar gizon mu wanda zai iya canza matsayin roko na musamman ga kwararrun.

Yawan abin sama da ya kamata

Jiyya: allura ta ciki na 40 - 100 ml na maganin 20 na glucose na 20% da / ko (kuma a lokuta inda catheterization na jijiya ba zai yiwu ba) intramuscular ko allurar ciki na 1-2 ml na glucagon. Don rigakafin lalacewa bayan dawowar farkawa a cikin sa'o'i 24 zuwa 48 masu zuwa, ana ba da carbohydrates a baki (20 zuwa 30 carbohydrates nan da nan kuma kowane 2 zuwa 3 hours) ko kuma ana yin sa'a na glucose mai tsawo (5 zuwa 20%). Zai yuwu ku gudanar da glucagon 1 ml na intramuscularly 1 awanni 48 a kowane sa'o'i 48.Kulawa da sukari na yau da kullun na akalla sa'o'i 48 bayan ƙarshen mummunan yanayin hypoglycemic. A cikin yanayin inda, a gaban manya manyan maye (kamar yadda a lokuta suke da nufin kisan kai), asarar ƙwaƙwalwar ta ci gaba, ana ƙaruwa da haɓaka glucose 5-10%, yawan glucose da ke so a cikin jini ya zama kusan 200 mg / dl. Bayan mintina 20, sake hadewar maganin glucose kashi 40% zai yuwu. Idan hoto na asibiti ba ya canzawa, ya zama dole a nemi wasu dalilai na asarar hankali, ban da gudanar da aikin jiyya (cerebral edema) (dexamethasone, sorbitol), saka idanu sosai game da haƙuri da jiyya. A cikin mummunan guba, ana iya aiwatar da su tare da matakan da ke sama, da kuma matakan gaba ɗaya don kawar da guba (lalacewar ciki, shigar matsanancin ciki), da kuma rubutaccen aikin gawayi. Glibenclamide ba a cire shi ta hanyar hemodialysis ba.

Yanayin ajiya

Adana a zazzabi wanda bai wuce 25 ° C ba na isar da yara.

Sakin saki:
Glibenclamide - Allunan.
Allunan 30 a cikin kwantena.

Kwamfutar hannu 1Glibenclamide ya ƙunshi glibenclamide 5 MG.
Fitattun abubuwa: lactose monohydrate, sitacin dankalin turawa, sodium croscarmellose, povidone 25, magnesium stearate, colloidal silicon dioxide, indigo carmine E 132.