Magungunan Metamine: umarnin don amfani

Metformin shine biguanide tare da sakamako na antihyperglycemic. Yana rage duka matakan glucose na farko da matakin glucose bayan cin abinci a cikin jini na jini. Ba ya tayar da rufin insulin kuma baya haifar da tasirin hypoglycemic.

Metformin yana aiki ta hanyoyi uku:

yana haifar da raguwa ga samar da glucose a cikin hanta saboda hanawar gluconeogenesis da glycogenolysis,
yana inganta halayyar insulin ƙwayar tsoka ta hanyar inganta haɓakawa da kuma amfani da glucose na gefe
yana jinkirta ɗaukar glucose a cikin hanjin.

Metformin yana ƙarfafa mahaɗan glycogen kira ta hanyar aiki akan glycogen synthetases. Capacityara ƙarfin jigilar kayayyaki na nau'ikan jigilar ƙwayar ƙwayar membrane (GLUT).

Ko da kuwa tasirin sa akan matakan glucose na jini, metformin yana da tasirin gaske akan metabolism na lipid: yana rage yawan kuzari, karancin wadataccen lipoproteins da triglycerides.

Yayin gwaji na asibiti tare da yin amfani da metformin, nauyin jikin mai haƙuri ya kasance mai tsayayye ko an rage shi cikin ɗan lokaci. Baya ga shafar matakan glucose na jini, metformin yana da tasiri mai amfani akan metabolism na lipid. Lokacin da kake shan magani a allurai na warkewa a cikin karatun, matsakaici da na dogon lokacin karatun, an lura cewa metformin lowers matakan jimlar cholesterol, low lipoproteins da yawa na triglycerides.

Damuwa. Bayan ɗaukar metformin, lokacin isa zuwa mafi yawan maida hankali (T max) kusan awa 2.5. Rashin bioavailability na 500 MG ko allunan 800 MG shine kusan 50-60% a cikin masu sa kai masu lafiya. Bayan gudanarwar baka, sashin da ba'a tatsa ba kuma aka kebe shi a cikin feces 20-30%.

Bayan gudanar da baki, sha na metformin yana da wadar cikawa kuma ba ya cikawa.

Magungunan magungunan ƙwayoyin metformin suna ɗauka cewa ba layi bane. Lokacin amfani dashi a cikin abubuwan da aka bada shawarar metformin da allurai na allurar rigakafi, ana samun yawan kuzarin plasma a cikin awanni 24-48 kuma basu kai 1 /g / ml ba. A cikin gwaji na asibiti, matsakaicin matakan metformin plasma (C max) bai wuce 5 μg / ml ba har ma da iyakar allurai.

Tare da cin abinci na lokaci guda, sha na metformin yana raguwa kuma yana ɗan rage gudu.

Bayan shigowa da kashi 850 MG, raguwa a cikin mafi yawan maida hankalin plasma da kashi 40%, raguwa a cikin AUC da kashi 25%, sannan aka lura da karuwar mintuna 35 a lokacin don isa ga yawan plasma maida hankali ne. Ba a san mahimmancin asibiti na waɗannan canje-canje ba.

Rarraba. Tabbatar da furotin plasma bai zama sakaci ba. Metformin yana shiga cikin sel jini. Matsakaicin maida hankali a cikin jini yana ƙasa da matsakaicin maida hankali a cikin jini, kuma an kai shi bayan lokaci guda. Kwayoyin jini suna wakiltar ɗakin rarrabawa na biyu. Matsakaicin matsakaiciyar rarraba (Vd) ya tashi daga lita 63-276.

Tsarin rayuwa. Ana amfani da Metformin wanda baya canzawa a cikin fitsari. Ba'a sami metabolites a cikin mutane ba.

Kammalawa Enaladdamar da hukunci na metformin shine> 400 ml / min., Wannan yana nuna cewa metformin an keɓance saboda matattakakkiyar ɗaukakkiyar ruwa da kuma ɓoyewar tubular. Bayan ɗaukar kashi, rabin rayuwar kusan awa 6.5. Game da aiki na keɓaɓɓiyar aiki, ƙarar keɓaɓɓe yana raguwa gwargwadon karɓar ɗaukar hoto, sabili da haka kawarwar rabin rayuwa yana ƙaruwa, wanda ke haifar da haɓaka matakan plasma metformin.

Alamu don amfani

Nau'in nau'in ciwon sukari na 2 tare da rashin ingancin maganin abinci da motsa jiki, musamman a cikin marasa lafiya masu kiba

kamar yadda monotherapy ko maganin haɗin gwiwa a cikin haɗuwa tare da sauran wakilai na bakin jini ko a tare tare da insulin don lura da manya.
kamar yadda monotherapy ko magani tare da insulin don kula da yara kanana shekaru 10 da matasa.

Don rage rikicewar cututtukan sukari a cikin manya manya masu fama da ciwon sukari na 2 da nauyin kiba a matsayin magani na farko-tare da rashin ingancin maganin cutar abinci.

Hanyar aikace-aikace

Monotherapy ko magani a hade tare da sauran jami'in na baki hypoglycemic.

Yawanci, kashi na farko shine 500 MG ko 850 MG (methamine, allunan da aka sanya 500 MG ko 850 MG) sau 2-3 a rana yayin ko bayan abinci.

Bayan kwanaki 10-15, dole ne a daidaita sashi gwargwadon sakamakon ma'aunin matakan glucose a cikin jijiyoyin jini.

Rage hawa a kashi yana rage tasirin sakamako daga narkewa.

Lokacin yin jiyya tare da babban allurai (2000-3000 mg a kowace rana), yana yiwuwa a maye gurbin kowane allunan 2 na Metamin, 500 MG a 1 kwamfutar hannu na Metamin, 1000 MG.

Matsakaicin shawarar da aka ba da shawarar ita ce 3000 MG kowace rana, ya kasu kashi uku.

Game da canzawa daga wani maganin cututtukan fata, yana da mahimmanci a daina shan wannan magani kuma a tsara magungunan metformin kamar yadda aka bayyana a sama.

Hade jiki tare da insulin.

Don cimma nasarar sarrafa matakan glucose na jini, ana iya amfani da metformin da insulin azaman maganin haɗuwa.

Monotherapy ko magani a haɗe tare da insulin.

Ana amfani da magani na Metamin a cikin yara sama da shekaru 10 da matasa. Yawanci, kashi na farko shine 500 MG ko 850 MG na methamine 1 lokaci ɗaya a rana yayin ko bayan abinci. Bayan kwanaki 10-15, dole ne a daidaita sashi gwargwadon sakamakon ma'aunin matakan glucose a cikin jijiyoyin jini.

Rage hawa a kashi yana rage tasirin sakamako daga narkewa.

Matsakaicin mafi girman shawarar da aka bayar shine 2000 MG kowace rana, an kasu kashi biyu.

A cikin tsofaffi marasa lafiya, raguwa a cikin aikin koda yana yiwuwa, sabili da haka, dole ne a zaɓi kashi na metformin dangane da kimanta aikin aikin koda, wanda dole ne a yi shi akai-akai.

Marasa lafiya tare da na koda Za'a iya amfani da Metformin a cikin marasa lafiya tare da gazawar matsakaiciyar matsakaici, mataki Sha (keɓaɓɓen kwalliyar 45-59 ml / min ko GFR 45-59 ml / min / 1.73 m 2) kawai a cikin rashin sauran yanayin da zai iya ƙara haɗarin lactic acidosis, tare da daidaitaccen kashi na gyara: kashi na farko shine 500 MG ko 850 MG na metformin hydrochloride 1 lokaci a rana. Matsakaicin adadin shine 1000 MG kowace rana kuma ya kamata a raba shi zuwa allurai 2. Ya kamata a aiwatar da kulawa sosai akan aikin renal (kowane watanni 3-6).

Idan sharewar creatinine ko GFR ya ragu zuwa 2, bi da bi, metformin ya kamata a daina nan da nan.

Contraindications

Hypersensitivity zuwa metformin ko zuwa wani ɓangaren magungunan,
mai ciwon sukari ketoacidosis, ciwon suga,
renal gazawar matsakaici (mataki na IIIIb) da kuma mai rauni ko rashi aiki na na koda (keɓantaccen ɗaukar hoto 2),
mummunan yanayin da ke tattare da haɓakar haɓakar ƙwayar yara, kamar: ƙonewa, ƙwararrun cututtuka, girgiza
cututtukan da za su iya haifar da ci gaban hypoxia (musamman cututtukan cututtukan cututtukan fata ko rikicewar cututtukan cututtukan zuciya) sun lalata bugun zuciya, gazawar numfashi, rauni na baya bayan nan, girgiza
gazawar hanta, guba mai yawa, giya.

Yin hulɗa tare da wasu kwayoyi

Ba a bada shawarar haɗuwa da haɗin guiwa ba.

Barasa Muguwar giya tana da alaƙa da haɓakar haɗarin lactic acidosis, musamman a cikin lokuta na azumi ko bin abincin mai kalori, kazalika da gazawar hanta. A cikin lura da miyagun ƙwayoyi Methamine Ya kamata a guji barasa da kwayoyi masu ɗauke da giya.

Iodine-dauke da abubuwa masu aikin radiopaque. Gabatarwar abubuwa na furotin-aidin na iodine na iya haifar da gazawar renal kuma, sakamakon haka, tarin metformin da haɓakar haɗarin lactic acidosis.

Ga marasa lafiya tare da GFR> 60 ml / min / 1.73 m 2, metformin ya kamata a daina aiki kafin ko a lokacin binciken kuma bai kamata a sake farawa ba kafin sa'o'i 48 bayan binciken, kawai bayan sake nazarin aikin renal da kuma tabbatar da rashi na rashin ci gaba game da cutar ta ƙasa (duba dubawa) sashe "Siffofin aikace-aikace").

Marasa lafiya tare da gazawar matsakaiciyar matsakaici (GFR 45-60 ml / min / 1.73 m 2) yakamata su daina amfani da Metformin 48 sa'o'i kafin gudanarwar abubuwan da ke kunshe da sinadarin iodine kuma bai kamata a sake farawa ba kafin sa'o'i 48 bayan binciken, kawai bayan sake kimanta aikin aikin renal da kuma tabbatar da rashi na rashin lalacewa.

Ya kamata a yi amfani da haɗin haɗin hankali tare da taka tsantsan.

Magunguna waɗanda ke da tasirin gaske (GCS na tsarin tsari da aikin gida, sympathomimetics, chlorpromazine). Yana da mahimmanci don sarrafa matakin glucose a cikin jini sau da yawa, musamman a farkon jiyya. Lokacin da kuma bayan dakatar da irin wannan maganin haɗin gwiwa, ya zama dole don daidaita sashi na methamine a ƙarƙashin kulawar matakin glycemia.

ACE inhibitors na iya rage glucose jini. Idan ya cancanta, ya kamata a daidaita sashi na magunguna yayin aikin haɗin gwiwa.

Diuretics, musamman maɗauran diure, na iya haɓaka haɗarin lactic acidosis saboda raguwar yiwuwar aikin koda.

Siffofin aikace-aikace

Lactic acidosis abu ne mai wuya, amma rikitarwa na rayuwa mai wahala (ƙarancin mace-mace a cikin rashin magani na gaggawa), wanda zai iya faruwa sakamakon tarawar metformin. An bayar da rahoton lokuta na lactic acidosis a cikin marasa lafiya da ke fama da ciwon sukari na mellitus tare da gazawar koda ko kuma tabarbarewa cikin aikin renal.

Sauran abubuwan haɗari ya kamata a yi la'akari dasu don hana ci gaban lactic acidosis: mellitus mai ƙarancin iko, ketosis, tsawan azumi, yawan shan barasa, rashin hanta, ko kowane yanayin da ke haɗuwa da hypoxia (lalata ƙwaƙwalwar zuciya, matsanancin myocardial infarction).

Lactic acidosis na iya bayyana kamar jijiyoyin tsoka, ƙoshin ciki, zafin ciki da matsanancin asthenia. Marasa lafiya ya kamata sanar da likita nan da nan game da abin da ya faru na irin wannan halayen, musamman idan marasa lafiya sun amince da amfani da metformin a baya. A irin waɗannan halayen, ya zama dole a dakatar da amfani da metformin na ɗan lokaci har sai an tabbatar da yanayin. Ya kamata a sake farawa da maganin farfadowa na Metformin bayan kimanta fa'idodi / haɗarin haɗari a cikin yanayin mutum da kimanta aikin renal.

Binciko Lactic acidosis yana halin rashin ƙarfi na acidic na numfashi, zafi na ciki da hauhawar jini, ƙarin haɓakar ƙima yana yiwuwa. Manuniya na gwaji sun haɗa da raguwar dakin gwaje-gwaje a cikin pH na jini, karuwa a cikin taro na lactate a cikin ƙwayar jini sama da 5 mmol / l, karuwa a cikin tazara ta anion da kuma rabo na lactate / pyruvate. Game da lactic acidosis, ya zama dole a kwantar da majinyaci nan da nan. Dole ne likita ya gargadi marasa lafiya game da haɗarin ci gaba da alamu na lactic acidosis.

Rashin wahala. Tunda metformin ya cire kodan, ya zama dole a bincika ƙarar halittar (ana iya kiyasta ta matakin jini na ƙirar ƙwayar jini ta amfani da samfurin Cockcroft-Gault) ko GFR kafin farawa a kai a kai yayin kulawa da Metamine:

marasa lafiya da keɓaɓɓen aikin na ƙasa - aƙalla 1 lokaci a shekara,
don marasa lafiya tare da keɓancewar creatinine a ƙananan iyakance na al'ada da tsofaffi marasa lafiya - aƙalla sau 2-4 a shekara.

A cikin batun yayin ƙaddamar da creatinine 2), an hana yin amfani da metformin.

Rage aikin renal a cikin tsofaffi marasa lafiya ne na kowa da asymptomatic. Yakamata a yi taka tsantsan yayin da aikin keɓaɓɓe zai iya lalacewa, alal misali, a cikin yanayin bushewa ko a farkon jiyya tare da magungunan rigakafi, cututtukan diuretics, da kuma farkon farawa tare da NSAIDs.

Aikin Cardiac. Marasa lafiya tare da raunin zuciya suna da haɗarin haɓakar haɓakar hypoxia da gazawar koda. A cikin marasa lafiya da tsayayyen bugun zuciya, za a iya amfani da metformin tare da saka idanu na yau da kullun game da aikin zuciya da aikin koda. Metformin yana cikin contraindicated a cikin marasa lafiya da m da kuma m zuciya gazawar.

Iodine-dauke da kayan aikin rediyo. Gabatarwar wakilai na radiopaque don karatun rediyo na iya haifar da gazawar renal, kuma a sakamakon hakan yana haifar da tarin metformin da haɗarin haɗari na lactic acidosis. Marasa lafiya tare da GFR> 60 ml / min / 1.73 m 2, ya kamata a daina amfani da metformin kafin ko a lokacin binciken kuma bai kamata a sake farawa ba kafin sa'o'i 48 bayan binciken, kawai bayan sake nazarin aikin renal da kuma tabbatar da rashi rashin ci gaba na rashin ƙira ta ƙasa.

Marasa lafiya tare da gazawar matsakaiciyar matsakaici (GFR 45-60 ml / min / 1.73 m 2) yakamata su daina amfani da Metformin 48 sa'o'i kafin gudanarwar abubuwan da ke kunshe da sinadarin iodine kuma bai kamata a sake farawa ba kafin sa'o'i 48 bayan binciken, kawai bayan maimaita ƙididdigar aikin aikin renal da kuma tabbatar da rashi na rashin lalacewa.

Ayyukan tiyata. Wajibi ne a dakatar da amfani da Metamine 48 awanni kafin aikin tiyata da aka shirya, wanda aka gudanar a karkashin jijiyoyin, kashin baya ko maganin warwatse kuma ba za a sake farawa ba kafin sa'o'i 48 bayan aiki ko maido da abinci na abinci da kuma idan an inganta aikin na al'ada.

Yara. Kafin fara magani tare da metformin, dole ne a tabbatar da bayyanar cututtuka na nau'in ciwon sukari na 2. Ba'a gano sakamakon ci gaban metformin da balaga ba a cikin yara. Koyaya, babu bayanai game da tasirin metformin da na balaga tare da yin amfani da metformin na tsawon lokaci, sabili da haka, ana bada shawarar saka idanu akan waɗannan sigogi a cikin yaran da aka kula dasu tare da metformin, musamman lokacin balaga.

Yara masu shekaru 10 zuwa 12. Tasiri da amincin metformin a cikin marasa lafiya na wannan zamanin bai bambanta da wannan ba a cikin manyan yara da matasa.

Sauran matakan. Marasa lafiya suna buƙatar bin tsarin cin abinci, wadataccen abinci na carbohydrates a cikin kullun kuma saka idanu sigogi na dakin gwaje-gwaje. Yakamata mara lafiyar yakamata aci gaba da bin tsarin karancin kalori. Wajibi ne a sanya idanu a kai a kai wadanda suke nuna sinadarin metabolism.

Metformin monotherapy baya haifar da hypoglycemia, amma yakamata a yi taka tsantsan yayin amfani da metformin tare da insulin ko wasu wakilai na maganin hypoglycemic na baki (misali, sulfonylureas ko abubuwan asali na meglitinidam).

Wataƙila kasancewar gutsutsuren ƙwayar harsashi a cikin feces. Wannan al'ada ce kuma bata da mahimmancin asibiti.

Idan baka yarda da wasu sukari ba, nemi likita kafin ka sha wannan magani, saboda maganin yana dauke da lactose.

Yi amfani da lokacin daukar ciki ko lactation.

CikiCututtukan ciwon siga da ba a kulawa da su yayin daukar ciki (gestational or akai) yana kara hadarin kamuwa da cutar cututtukan cikin gida da mace-mace na haihuwa. Akwai iyakataccen bayanai game da amfani da metformin a cikin mata masu juna biyu waɗanda ba su nuna haɗarin haɗarin haɗarin rashin haihuwa ba. Karatuttukan haihuwa ba su bayyana wani mummunan tasiri kan ciki ba, ci gaba da tayi ko tayi, haihuwa da ci gaban haihuwa. Game da batun shirin daukar ciki, haka nan ma idan aka samu juna biyu, ana bada shawarar yin amfani da metformin don maganin cututtukan siga, da kuma insulin don kiyaye matakan glucose na jini kwata-kwata don al'ada, don rage hadarin kamuwa da cutar tayin.

Rashin shayarwa. Metformin an keɓe shi cikin madara, amma ba a sami sakamako ba illa a cikin jarirai / jarirai waɗanda ke shayar da mama. Koyaya, tunda babu isasshen bayanai game da amincin miyagun ƙwayoyi, ba a bada shawarar shayar da nono yayin maganin metformin ba. Dole ne a yanke shawarar dakatar da shayarwa ta la'akari da amfanin shayarwa da kuma haɗarin haɗarin sakamako ga jariri.

Haihuwa. Metformin baya shafar haihuwa da mace yayin amfani da allurai

600 MG / kg / rana, wanda kusan sau uku shine mafi girman adadin yau da kullun, wanda aka ba da shawarar don amfani a cikin mutane kuma ana lasafta shi gwargwadon sashin jikin mutum.

Thearfin yin tasiri akan ƙimar amsawa yayin tuki motocin ko wasu hanyoyin.

Metformin monotherapy ba ya tasiri da ƙimar amsawa lokacin tuki ko aiki tare da hanyoyin, tunda maganin ba ya haifar da hypoglycemia.

Koyaya, yakamata a yi taka tsantsan yayin amfani da metformin a hade tare da sauran wakilai na hypoglycemic (sulfonylureas, insulin, ko meglitidines) saboda haɗarin cutar hypoglycemia.

Ana amfani da maganin Mamin don magance yara masu shekaru 10.

Yawan abin sama da ya kamata

Lokacin amfani da miyagun ƙwayoyi a kashi na 85 g, ba a lura da ci gaban hypoglycemia ba. Koyaya, a wannan yanayin, an lura da ci gaban lactic acidosis. Game da haɓakar ci gaban lactic acidosis, dole ne a tsayar da magani tare da Metamine kuma mai haƙuri yana asibiti cikin gaggawa. Mafi girman gwargwado don cire lactate da metformin daga jiki shine hemodialysis.

M halayen

Rashin narkewar ƙwayar cuta da abinci mai gina jiki: lactic acidosis (duba sashe "Siffofin amfani").

Tare da tsawaita amfani da miyagun ƙwayoyi a cikin marasa lafiya tare da megaloblastic anemia, sha na bitamin B 12 na iya raguwa, wanda ke tattare da raguwa a matakin sa a cikin jijiyoyin jini. An ba da shawarar yin la'akari da irin wannan yiwuwar raunin bitamin B 12 idan mai haƙuri yana da cutar ƙin jini na megaloblastic.

Daga tsarin mai juyayi: ɗanɗanar damuwa.

Daga narkewa kamar jijiyoyi: tashin zuciya, amai, gudawa, ciwon ciki, rashin ci. Mafi sau da yawa, waɗannan sakamako masu illa suna faruwa a farkon jiyya kuma, a matsayin mai mulkin, yana ɓacewa lokaci ɗaya. Don hana faruwar sakamako masu illa daga narkewa, ana ba da shawarar a hankali ƙara yawan ƙwayar kuma amfani da miyagun ƙwayoyi sau 2-3 a rana lokacin ko bayan abinci.

Daga tsarin narkewa: alamomin aiki masu rauni na hanta ko hepatitis, wanda gaba ɗaya ya ɓace bayan katse metformin.

A wani ɓangaren fata da ƙananan ƙwayar fata: halayen ƙwayar fata, ciki har da kurji, erythema, pruritus, urticaria.