Gluconorm: umarnin don amfani: farashi da sake dubawa game da masu ciwon sukari game da magungunan masu ciwon sukari

Kwayar halittar endocrinologist tayi wani gwaji - yanayin cutar kansa. Weight yana girma koyaushe, rikicewar metabolism, da kyau, tafiya mai sukari (cututtukan hypoglycemic). A takaice, nishadi. Lokacin da kuka karya abinci, sukari ya tashi, da kyau, alamun da aka sani sun bayyana. Don farawa, don rage yawan ci, an umurce ni da wannan magani a abincin rana 1 lokaci ɗaya kowace rana don kwamfutar hannu 1, amma ko ta yaya babu wani sakamako, da kyau, kawai babu. Na je wurin wani likita, ya ba da umarnin Siofor 850, don ɗaukar kaina. Sakamakon da aka ji a ranar liyafar ta farko ya zama mafi sauƙi, da maraice Ina so in ci ƙasa da ƙasa. Bayan makonni 2 na jiyya, nauyin ya ragu da 1.5 kilogiram. Ee, kuma ina jin sauki.

Tuni shekara guda tun lokacin da aka gano ni da ciwon sukari na 2, bayan haka likita ya umurce ni da tsananin cin abinci da gluconorm. Mun dauki kashi na kusan wata daya, amma yanzu glucose baya tashi sama da 6-7. Abin tausayi kawai cewa dole ne a bi abincin. Kodayake lafiyar ta fi tsada, ba shakka.

Short Short

Miliyan 200 ... Yana da kyau a tuna da wannan adadi, saboda wannan shi ne daidai ƙididdigar yawan mutanen da ke fama da ciwon sukari a yau. Kuma bisa ga hasashen masana ilimin kimiyya (kuma ba mafi rashin damuwa ba), ta 2030 ya kamata muyi tsammanin karuwar wannan adadi aƙalla sau ɗaya da rabi. Abubuwa guda biyu masu mahimmancin cututtukan cututtukan jijiyoyi suna kwance a asalin cututtukan sukari: juriya insulin da ƙarancin ƙwayar cuta a cikin samar da insulin kwayoyin halitta. Don rage haɗarin yiwuwar rikicewar jijiyoyin jiki (makanta, bugun zuciya da bugun jini, yankan ƙafa), kuna buƙatar riƙe hannu koyaushe a kan bugun jini (ko kuma, a kan mita) don tabbatar da kula da matakan glucose na jini koyaushe. Dangane da wannan, ƙaruwar jiyya hanya ce ta asali a cikin lura da ciwon sukari. A matsayinka na mai mulkin, an fara maganin antidiabetic tare da monotherapy, wanda ke amfani da ko dai metformin ko sulfonylureas (glibenclamide glyclazide, glimepiride). Nan gaba, tare da tabbataccen lalacewa a cikin sigogin ƙirar ƙwayoyin cuta, ana fara haɗuwa da magunguna ko kuma a haɗa allurar insulin. Haka kuma: Tunda ana la'akari da cutar sankara a matsayin cuta mai ci gaba, har ma da nasarar farko na monotherapy, ba da daɗewa ba, za a buƙaci ƙarin ƙarin kayan aikin likitanci tare da raka'a ɗaya ko biyu na littafin duba maskovsky.

Mafi kyawun haɗin maganin antidiabetic a cikin aikin asibiti shine metformin + glibenclamide. Magungunan gluconorm ba wani abu bane face wannan ƙarfin jini mai ɗaukar nauyi biyu na cikin ƙasa. Metformin biguanide yana saukar da glukos din jini ta hanyar ragewa bakin kima don kwarewar insulin a cikin kasusuwa da inganta haɓakar glucose ta kyallen. Wannan abu yana hana shan carbohydrates a cikin narkewar abinci kuma ya cakuɗe da tsarin glucose ta hanta. Metformin kuma yana inganta hoton lipid na jini, yana rage matakin "mummunan" cholesterol. Glibenclamide, bi da bi, shine naman jikin sulfonylurea. Yana karfafa sakin insulin ta hanyar kara fahimtar yanayin β-sel da ke motsa jiki zuwa glucose da kuma darajar kusancin insulin tare da kwayoyin niyya.

Yawancin lokaci ana amfani da gluconorm don abinci a kashi ɗaya da aka yarda da likita (yana iya zama ɗaya a kowane yanayi). A bisa ga al'ada, sukan “fara” daga kwamfutar hannu ɗaya sannan sai su daidaita matakin kowane mako 1-2, suna yin la’akari da matakin glucose a cikin jini, alhali basu wuce ƙarancin yau da kullun na allunan 5 ba.

Pharmacology

Gluconorm ® wani hadadden haɗuwa ne na wakilai na jini guda biyu na ƙungiyoyin magunguna daban-daban: metformin da glibenclamide.

Metformin yana cikin rukunin biguanides kuma yana rage glucose mai ƙwaƙwalwa ta haɓaka ƙimar ƙwayar sel a cikin aikin insulin da haɓaka haɓakar glucose. Yana rage yawan carbohydrates a cikin narkewar abinci kuma yana hana gluconeogenesis a cikin hanta. Har ila yau, maganin yana da tasiri mai amfani akan bayanan lipid na jini, yana rage girman adadin cholesterol. LDL da triglycerides. Ba ya haifar da maganganun hypoglycemic.

Glibenclamide yana cikin rukuni na abubuwan da suka samo asali na sulfonylurea na ƙarni na biyu. Yana ƙarfafa insulin insulin ta hanyar rage ƙwanƙwasa ƙwanƙwasa ƙwayar panc-sel, haɓaka haɓakar insulin da ɗaurin ɗaukar nauyin ƙwaƙwalwa, yana haɓaka sakin insulin, yana inganta tasirin insulin akan ƙwayar tsoka da haɓakar hanta, kuma yana hana lipolysis a cikin tsopose nama. Ayyukan Manzanni a mataki na biyu na insulin ɓoyewar insulin.

Pharmacokinetics

Lokacin gudanar da shi, sha daga ƙwayar gastrointestinal shine kashi 48-84. Lokaci don isa C_max - 1-2 awanni V_d - Lita 9-10. Sadarwar tare da sunadaran plasma kashi 95%.

Yana da kusan metabolized a cikin hanta tare da samuwar metabolites guda biyu masu aiki, wanda ɗayan ya cire ta, ɗayan kuma hanjin hanji. T_1/2 - daga 3 zuwa 10-16 hours

Bayan gudanar da baki, yana narkewa daga jijiyar ciki gaba daya, an sami kashi 20-30% na kashi a cikin feces. Cikakken bayanin halitta daga 50 zuwa 60%. Tare da shigowa na lokaci daya, shakar metformin zai ragu kuma yana jinkirta. An rarraba shi da sauri a cikin nama, kusan ba a ɗaura shi ga furotin plasma ba.

Yana cikin metabolized sosai ga rauni sosai kuma kodan ya keɓe shi. T_1/2 kamar awa 9-12

Fom ɗin saki

Allunan da aka saka fim na farin fari ko kusan fararen launi, zagaye, biconvex, a hutu daga farin zuwa fari tare da farin launin toka.

Fitattun abubuwa: microcrystalline cellulose - 100 MG, sitaci masara - 20 MG, colloidal silicon dioxide - 20 MG, gelatin - 10 MG, glycerol - 10 MG, magnesium stearate - 7 MG, tsarkakakku talc - 15 MG, croscarmellose sodium - 30 MG, sitaci carboxymethyl sitaci - 18.3 mg, cellularphate - 2 MG, diethyl phthalate - 0.2 mg.

10 inji mai kwakwalwa. - blister (4) - fakitoci na kwali.
Guda 20. - blister (2) - fakitoci na kwali.

Ana amfani da miyagun ƙwayoyi a baki, tare da abinci. Adadin maganin yana maganin likita ne daban-daban ga kowane mara lafiya, gwargwadon matakin glucose na jini.

Yawancin lokaci kashi na farko shine 1 shafin. (400 MG / 2.5 MG) / rana. Kowane mako 1-2 bayan fara magani, ana gyara kashi na maganin yana dogara da matakin glucose na jini. Lokacin maye gurbin maganin haɗuwa na baya tare da metformin da glybeklamide, an tsara allunan 1-2. Gluconorm ya danganta da satin da ya gabata na kowane bangare.

Matsakaicin maganin yau da kullun shine Allunan 5.

Yawan abin sama da ya kamata

Yawan abin sha ko gaban haɗarin abubuwa na iya haifar da ci gaban lactic acidosis, kamar yadda Metforminum bangare ne na shiri. Lokacin da alamun cututtukan lactic acidosis suka bayyana (vomiting, zafi na ciki, rauni gaba ɗaya, ƙwayar tsoka), dole ne a daina shan magani. Lactic acidosis yanayi ne wanda ke buƙatar kulawa da lafiya na gaggawa, lura da lactic acidosis ya kamata a gudanar da shi a asibiti. Mafi kyawun magani shine maganin hemodialysis.

Doaryewar overdose na iya haifar da ci gaban hypoglycemia saboda kasancewar glibenclamide a cikin shirye-shiryen. Bayyanar cututtukan hypoglycemia: yunwar, gumi mai yawa, rauni, rauni, pallor na fata, paresthesia na bakin mucosa, rawar jiki, damuwa ta gaba daya, ciwon kai, matsanancin bacci, damuwa ta bacci, yanayin jin tsoro, rashin daidaituwa game da motsi, rikicewar jijiyoyin wucin gadi. Tare da ci gaban hypoglycemia, marasa lafiya na iya rasa ikon kamewa da sanin su.

Tare da hypoglycemia mai sauƙi ko matsakaici, ana ɗaukar dextrose (glucose) ko maganin sukari a baki. Game da cutar hypoglycemia mai tsanani (asarar hankali), ana aiwatar da maganin 40% na glucagon mafitsara (v / m, s / c) iv. Bayan ya dawo da hankali, dole ne a bai wa mara lafiya abinci mai wadataccen abinci a cikin carbohydrates don guje wa sake haɓakar cutar sankarar fata.

Haɗa kai

ACE inhibitors (captopril, enalapril), tsoffin ƙwayoyin Harkokin tarihin HAM suna haɓaka tasirin maganin ƙwaƙwalwar ƙwayar cuta₂masu karɓa (cimetidine), jami'ai na antifungal (miconazole, fluconazole), NSAIDs (phenylbutazone, azapropazone, oxyphenbutazone), fibrates (clofibrate, bezafibrat), magungunan rigakafin tarin fuka (ethionamide), salicytates, anticoagulant antagon, MAO, sulfonamides mai aiki da dogon lokaci, cyclophosphamide, chloramphenicol, fenfluramine, fluoxetine, guanethidine, pentoxifylline, tetracycline, theophylline, bloug secretion, bloerpine, bromocriptine, benawa, sitiri, da sauransu magungunan hypoglycemic (acarbose, biguanides, insulin), allopurinol.

Barbiturates, corticosteroids, adrenostimulants (epinephrine, clonidine), magungunan antiepileptik (phenytoin), jinkirin tashar alli mai laushi, inhibitors na carbonic anhydrase (acetazolamide), thiazide diuretics, chlortalidone, furosemide, diazanazide, triazene diazent , morphine, ritodrine, salbutamol, terbutaline, glucagon, rifampicin, iodine-mai dauke da kwayoyin hodar iblis, gishirin lithium, a cikin manyan allurai - nicotinic acid, chlorpromazine, maganin hana haihuwa da estrogens.

Magungunan acidifying acid (ammonium chloride, alli chloride, ascorbic acid a cikin manyan allurai) suna inganta sakamako ta hanyar rage darajar rarrabuwa da haɓaka reabsorption na glibenclamide.

Ethanol yana ƙaruwa da alama na lactic acidosis.

Metformin yana rage C_max da kuma T_1/2 furosemide ta hanyar 31% da 42.3%, bi da bi.

Furosemide yana ƙaruwa C_max metformin da kashi 22%.

Nifedipine yana ƙara sha, C_max yana rage jinkirin kawar da metformin.

Magungunan cationic (amiloride, digoxin, morphine, procainamide, quinidine, quinine, ranitidine, triamteren da vancomycin) waɗanda aka ɓoye a cikin tubules suna gasa don tsarin jigilar tubular kuma suna iya haɓaka C tare da tsawan magani_max 60% metformin.

Side effects

A wani bangare na metabolism: hypoglycemia mai yiwuwa ne.

Daga cututtukan hanji da hanta: da wuya - tashin zuciya, amai, ciwon ciki, asarar ci, "ƙarfe" dandano a bakin, a wasu yanayi - cholestatic jaundice, ƙara yawan aiki na enzymes hanta, hepatitis.

Daga tsarin hemopoietic: da wuya - leukopenia, thrombocytopenia, erythrocytopenia, da wuya - agranulocytosis, hemolytic ko megaloblastic anemia, pancytopenia.

Daga gefen tsarin juyayi na tsakiya: ciwon kai, dizziness, rauni, gajiya, da wuya - paresis, rikicewar hankali.

Allergic da immunopathological halayen: da wuya - urticaria, erythema, fata itching, zazzabi, arthralgia, proteinuria.

Abubuwan da ke tattare da cututtukan cututtukan fata: da wuya - ɗaukar hoto.

Daga gefen metabolism: lactic acidosis.

Sauran: amsawar m na rashin haƙuri bayan shan giya, wanda aka bayyana ta rikitarwa na jijiyoyin jini da gabobin jiki (disulfiram-like dauki: amai, jin zafi a fuska da babba jiki, tachycardia, dizziness, ciwon kai).

Type 2 ciwon sukari a cikin manya:

• tare da rashin ingancin maganin abinci, motsa jiki da kuma maganin da ya gabata tare da metformin ko glibenclamide,
• don maye gurbin maganin da ya gabata tare da kwayoyi guda biyu (metformin da glibenclamide) a cikin marasa lafiya tare da tsayayyen ingantaccen matakan glucose na jini.

Contraindications

• nau'in ciwon sukari guda 1
• fida mai fama da ciwon sukari,
• hawan jini,
• matsanancin cutar na koda,
• m yanayin da zai iya haifar da canji a cikin koda aiki (fitsari, mai tsanani kamuwa, girgiza),
• m ko cututtuka na kullum tare da hypoxia nama (zuciya ko na numfashi, rauni na baya bayan nan, gigicewa),
• gazawar hanta
• porfria
• amfani da miconazole,
• cututtuka masu rarrafe, manyan ayyukan tiyata, raunin da ya faru, ƙonewa mai yawa da sauran yanayin da ke buƙatar maganin insulin,
• na kullum mai shan barasa, m shan giya,
• lactic acidosis (gami da tarihi),
• Yi amfani da aƙalla awanni 48 kafin da a cikin awanni 48 bayan gudanar da karatun radioisotope ko raa-ray tare da gabatarwar iodine mai ɗauke da sigar matsakaici,
• biye da tsarin karancin kalori (kasa da adadin kuzari 1000 / rana),
• ciki
• lokacin shayarwa,
• hypersensitivity to metformin, glibenclamide ko wasu abubuwan da ake buƙata na sulfonylurea, da abubuwa masu taimako.

Ba'a ba da shawarar yin amfani da miyagun ƙwayoyi a cikin mutanen da suka haura shekaru 60 waɗanda ke yin aiki na zahiri, wanda ke da alaƙa da haɓakar haɗarin haɓakar lactic acidosis a cikinsu.

Tare da taka tsantsan: ciwo na febrile, karancin adrenal, hypofunction na kashin baya, cutar ta thyroid tare da aiki mai rauni.

Haihuwa da lactation

A lokacin daukar ciki, amfani da gluconorm ya saba. Lokacin da ake shirin yin ciki, da kuma lokacin da ake yin ciki yayin lokacin shan Gluconorm, yakamata a dakatar da miyagun ƙwayoyi kuma ya kamata a tsara maganin insulin.

Gluconorm ® yana cikin kwayar shayarwa, yayin da metformin ya shiga cikin madarar nono. A wannan yanayin, dole ne canzawa zuwa maganin insulin ko dakatar da shayarwa.

Umarni na musamman

Manyan hanyoyin tiyata da raunin da ya faru, konewa mai yawa, cututtuka masu yaduwa tare da cututtukan febrile na iya buƙatar dakatar da magani da kuma alƙawarin maganin insulin.

Wajibi ne a kula da matakin glucose a cikin jini akai-akai a cikin komai a ciki kuma bayan cin abinci.

Ya kamata a faɗakar da marasa lafiya game da haɗarin haɗarin hypoglycemia a cikin yanayin ethanol, NSAIDs, da kuma matsananciyar yunwa.

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

Yayin magani, ba da shawarar shan giya ba.

Awanni 48 kafin a yi tiyata ko a gudanar da wani abu wanda yake dauke da maganin fitsari a cikin aidin, ya kamata a dakatar da aikin gluconorm. An bada shawarar sake maganin gluconorm bayan awa 48.

Tasiri kan ikon tuka motoci da hanyoyin sarrafa abubuwa

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