Dianormet na miyagun ƙwayoyi: umarnin don amfani

Pharmacokinetics Dianormet (metformin -1 mai aiki mai narkewa -1.1 - dimethylbiguanide hydrochloride) wakili ne na hypoglycemic don sarrafa bakin mutum na rukunin biguanide. Yana rage glucose na jini a cikin marassa lafiya da masu ciwon suga. Magungunan yana haifar da sakamako ba tare da yin la'akari da ayyukan sirri ba. Ginshikai na mataki na Metformin ne saboda hanawa na sufuri da na numfashi sarkar electron mai rufi mitochondria da ta rage taro na kwayuka ATP da kunnawa da anaerobic glycolysis, inda glucose shiga daga extracellular sarari a cikin cell, da ragewa da depot na glycogen a cikin hanta, kuma Ya ƙãra samar da pyruvate da lactate a gabobin irin kamar hanji, hanta, da kuma a cikin tsoka da adipose nama.
Ayyukan Dianormet ya wuce zuwa:

• Gastrointestinal fili - yana hana shan glucose a cikin hanji, yana rage motsin ciki da hanji,
• hanta - yana hana gluconeogenesis da gudanawar glucose a cikin jini, yana inganta glycolysis anaerobic,
• nama na gefe - yana haɓaka ƙwayar nama a cikin jiki, wanda ya kasance sakamakon karuwar yanki na insulin na insulin (aiki a matakin mai karɓar insulin - karuwar lamba da kusancin masu karɓar, kazalika da hulɗa mai karɓar - kunnawa tsarin da ke jigilar glucose zuwa sel). A sakamakon haka, Dianormet ba ta motsa sakin insulin ta sel din islet din kayan da ke cikin kashin kansa ba, yana taimakawa kawar da cututtukan hyperinsulinemia, wanda shine ɗayan manyan abubuwan da ke haifar da ci gaba da rikicewar jijiyoyin jiki da nauyin nauyi a cikin nau'in ciwon sukari na II na mellitus.

Bugu da kari, Dianormet yana da ingantaccen sakamako na rayuwa akan:

• jini lipids - Yana rage matakin jimlar cholesterol ta 10-20% da gutsuttsuranta: LDL da VLDL, wanda ke da alaƙa da hana ƙoshinsu na biosynthesis a bangon hanji da haɓaka jijiyoyin jiki ta hanji. Yana ƙara HDL ta 10-20% kuma yana rage TG da 10-20% (koda kuwa haɓakarsu ta ƙaruwa da kashi 50%) ta hanyar hana iskar shaye shaye, rage ƙwayar insulin, da kuma hana shan glucose a cikin hanji,
• coagulation da tsarin fibrinolysis - yana rage yanayin hankalin platelet zuwa abubuwan haɗin kai, yana ƙarfafa fibrinolysis na endogenous ta hanyar ƙara yawan aiki na t-PA (ƙwaƙwalwar ƙwayar plasminogen), rage matakin PAI-1 (inhibitor plasminogen mai kunnawa nama) da rage matakin fibrinogen,
• jini bango - yana hana yaduwar ƙwayoyin tsoka mai santsi.

Additionalarin tasirin ma'amala da ƙwaƙwalwar ƙwayar cuta yana ƙaddara tasirinta mai kyau a cikin tsarin jijiyoyin jini, hanawa ci gaban cututtukan zuciya da hana rikice-rikice kamar hauhawar jini (hauhawar jijiya) da kuma cututtukan zuciya. A cikin marasa lafiya masu kiba, zai iya rage nauyin jiki, musamman a farkon jiyya.
Pharmacokinetics Ya kasance a cikin duodenum da ƙananan hanji. Bioavailability shine 50-60%. Magungunan ba su da alaƙa ga furotin na jini, cikin hanzari ana rarraba shi a cikin kyallen takarda daban-daban, yana tattara mafi yawan lokuta a cikin bangon gastrointestinal (ciki, duodenum da ƙananan hanji), hanta, tsokoki, ƙodan, hanjin hancin. Matsakaicin maida hankali a cikin aiki shine ana samun sa'o'i 2 bayan gudanarwa. Rabin-rayuwa shine awanni 1.5-6. Ba kamar phenformin, Dianormet ba a metabolized a cikin jiki ba. Magungunan ba a canzawa a cikin fitsari (kusan 90% a cikin awanni 12). A cikin tsofaffi marasa lafiya da kuma tare da nakasa aikin na renal, Pharmacokinetics na metformin yana canzawa sosai. Andididdigewa da izini na renal a cikin tsofaffi marasa lafiya an rage shi da 35-40%, a cikin marasa lafiya da matsakaici da kuma mummunan rauni na koda. - by 74-78%. Game da lalacewa aiki na renal, tarawa da miyagun ƙwayoyi yana yiwuwa.

Yin amfani da miyagun ƙwayoyi Dianormet

A ciki lokacin ko kai tsaye bayan abinci.
Dianormet 500: kashi na farko na 500 MG kowace rana. Ya kamata a ƙara yawan kashi a hankali don samun sakamako mafi kyau. Yawancin lokaci shan 500 MG (kwamfutar hannu 1) sau 2-3 a rana. Matsakaicin adadin yau da kullun shine 2500 MG.
Dianormet 850: kashi na farko na 850 mg / rana. Ya kamata a ƙara yawan kashi a hankali don samun sakamako mafi kyau. Yawancin lokaci shan 1 kwamfutar hannu sau 2-3 a rana. Matsakaicin adadin shine 2500 mg / rana.
Matsakaicin tasirin warkewa na iya haɓaka bayan kwanaki 10-14 na jiyya, sabili da haka bai kamata a ƙara yawan ƙwayar da sauri ba.
Lokacin amfani da Dianormet lokaci guda tare da insulin a cikin kwanakin farko na 4-6 na 6, ba a canza kashi na insulin ba, a nan gaba, ana rage yawan kashi na insulin (a 4 zuwa 4 na IU kwanaki da yawa).

Contraindications zuwa yin amfani da miyagun ƙwayoyi Dianormet

Hypersensitivity ga miyagun ƙwayoyi, ciwon sukari coma, metabolic acidosis, lactic acidosis, yanayin hypoxia (saboda hypoxemia, girgiza, da dai sauransu), na koda, gazawar hanta, gazawar jini tare da hypoxia nama, rashin ƙarfi na numfashi, gazawar numfashi, ƙonewa mai tsanani, ayyukan, cututtuka masu kamuwa da cuta. , amfani da aidin-dauke da abubuwa masu bambanci, giya, lokacin daukar ciki da lactation.

Sakamakon sakamako na miyagun ƙwayoyi Dianormet

Rage ci, ƙarar ƙarfe a bakin, tashin zuciya, amai, ciwon ciki, zawo. Ana samun raguwa cikin tsananin waɗannan abubuwan mamaki ta hanyar amfani da magani tare da abinci ko ta hanyar farawa da ƙananan allurai na yau da kullun. Idan abubuwan dyspeptic ba su wuce kansu ba na dogon lokaci, ya kamata a dakatar da maganin.
Yana da wuya sosai, ciwon kai da danshi, gajiya, halayen fata na fata.
Tare da tsawanta jiyya a lokuta masu saurin kamuwa da cuta, megaloblastic anemia na iya haɓaka saboda malamborption na bitamin B12 da folic acid. Lokacin amfani da miyagun ƙwayoyi, yana yiwuwa haɓaka lactic acidosis, abin da ya faru wanda aka sauƙaƙe ta hanyar hypoxia nama, renal, hanta ko gazawar bugun jini, gazawar jini, hypoxia na nama, cututtukan cututtukan fata da cututtukan oncological, hypovitaminosis, shan barasa, maganin sa barci, tsufa. A irin waɗannan halayen, an nuna alamar hemodialysis. A lokacin jiyya tare da Dianormet hade tare da abubuwan da ke haifar da maganin sulfonylurea da / ko insulin hypoglycemia na iya haɓaka, a cikin irin waɗannan halayen, daidaita sashi na magungunan da ake amfani da su ya zama dole.

Umarnin na musamman don amfanin Dianormet na miyagun ƙwayoyi

Yayin yin jiyya tare da Dianormet, ya kamata a sa ido kan matakan glucose a cikin jini da fitsari lokaci-lokaci. Idan ya cancanta, tiyata na tiyata, gabatarwar kwatankwacin cutar Dianormet na wani kankanin lokaci a soke. Shan giya yana kara haɗarin lactic acidosis a cikin maganin Dianormet. Tare da yin amfani da Dianormet tare da abubuwan da ake amfani da su na sulfonylurea da insulin, tare da isasshen abinci mai gina jiki, bayan gagarumar aikin motsa jiki ko kuma yanayin maye mai mahimmanci, yanayin hypoglycemic na iya haɓaka, wanda dole ne a la'akari lokacin tuki motocin da kuma aiki tare da ƙarancin haɗari.
Kafin da kuma lokacin jiyya tare da Dianormet, ya zama dole a lokaci-lokaci don saka idanu akan hanta da kuma alamun aikin koda. Tare da tsawanta yin amfani da miyagun ƙwayoyi, yakamata a gudanar da gwajin jini a cikin sau ɗaya a shekara, tunda ana iya ajiye metformin a cikin sel jini.

Mu'amala da Magunguna Dianormet

Dianormet yana aiki tare da abubuwan da suka samo asali na maganin sulfonylurea (glibenclamide, glipizide), insulin da acarbose. Amiloride, digoxin, quinidine, morphine, procainamide, triamteren, trimethoprim, cimetidine, ranitidine, famotidine, alluran tashoshi na alli (musamman nifedipine) hana fitowar tubular cikin kodan kuma yana iya kara yawan kwarin Dianormet a cikin jini. Furosemide yana ƙara maida hankali ga Dianormet a cikin jini, kuma Dianormet yana rage taro da rabin rayuwar furosemide.
Lokacin amfani da kwayoyi waɗanda zasu iya haifar da hypoglycemia (clofibrate, probenecid, propranalol, rifampicin, sulfonamides, salicylates), ana rage yawan adadin Dianormet.
Magunguna waɗanda zasu iya haifar da cututtukan hyperglycemia (maganin hana daukar ciki na estrogen-mai dauke da kwayoyi, corticosteroids, diuretics, isoniazid, acid nicotinic, phenytoin, chlorpromazine, hormones thyroid, sympathomimetics) na iya rage tasiri na Dianormet. Game da amfani da haɗe tare da waɗannan kwayoyi, ya kamata a kula da abubuwan da ke cikin glucose na jini kuma, idan ya cancanta, haɓaka mai dacewa a cikin kashi na Dianormet. Ethyl barasa yana kara haɗarin lactic acidosis. Colestyramine da guar suna rage jinkirin shan Dianormet, yana rage sakamako. Ya kamata a yi amfani da waɗannan kuɗin don awoyi da yawa bayan ɗaukar Dianormet. Magungunan yana inganta tasirin maganin anticoagulants na ƙungiyar coumarin.

Yawan shaye-shayen Dianormet, alamu da magani

Ko da gagarumar ƙwayar cuta yawanci yawanci ba ya haifar da ci gaban hypoglycemia, amma akwai barazanar lactic acidosis: haɓaka kiwon lafiya, rauni, rauni na tsoka, tashin zuciya, amai, gudawa, ciwon ciki, gazawar hanji. Jiyya na lactic acidosis - maganin hemodialysis.
Kwayar cutar m yawan abin sama da ya faru: amai, haske mara nauyi, bushe mucous membrane na baka kogo. Lokacin da waɗannan alamun suka bayyana, mai haƙuri ya kamata ya kasance ƙarƙashin kulawar likita. Jiyya mai nuna alama.
A cikin yawan yawan zafin jiki, raguwa ko hauhawar hauhawar jini, yara masu ɗorawa, ƙwararrakin ƙwaƙwalwa, tachy ko bradycardia, ischuria (saboda ƙwanƙwalwar ƙwayar mahaifa), ƙwanƙwasa hanji, hauhawar jini, hauhawar jijiyoyin jiki, hauhawar jijiyoyin jiki, gazawar numfashi, amai, damma Jiyya - cirewa na miyagun ƙwayoyi, lavage na ciki, maganin hemodialysis, farfadowa da pH na jini, kawar da hypoxia, maganin cututtukan anticonvulsant, kwantar da hankali na ayyukan jijiyoyin jini da tsarin numfashi.

Umarnin don amfani da Dianormet

Metformin 500 MG, 850 MG ko 100 MG.

Sauran kayan abinci: povidone, talc, magnesium stearate.

nau'in ciwon sukari na 2 wanda ba shi da insulin-insulin tare da maganin rashin cin nasara na abinci, musamman a cikin marasa lafiya da ke da kiba: kamar yadda monotherapy ko magani mai haɗuwa tare da sauran wakilai na bakin jini ko a hade tare da insulin don maganin manya, kamar monotherapy ko haɗuwa da maganin insulin don kula da yara daga shekara 10.

Rage ƙarancin rikicewar cututtukan cututtukan ƙwayar cuta a cikin marasa lafiyar manya da ke da nau'in ciwon sukari na 2 na 2 da masu kiba waɗanda suka yi amfani da metformin a matsayin magani na farko-tare da maganin rashin abinci.

Yadda ake amfani: sashi da hanya na jiyya

A ciki, yayin ko kai tsaye bayan cin abinci, don marasa lafiya da ke karɓar insulin, 1 g (Allunan 2) sau 2 a rana don kwanakin farko 3 ko 500 mg sau 3 a rana, sannan daga kwanaki 4 zuwa 14 - 1 g sau 3 a rana, bayan kwanaki 15 za a iya rage sashi yayin yin la'akari da abun da ke cikin glucose a cikin jini da fitsari. Kulawa na yau da kullun - 1-2 g.

Allunan shakatawa (850 MG) ana ɗaukar 1 safe da maraice. Matsakaicin adadin yau da kullun shine 3 g.

Tare da yin amfani da insulin a lokaci daya a cikin ƙarancin ƙasa da raka'a 40 / rana, tsarin kulawa na metformin iri ɗaya ne, yayin da za a iya rage yawan insulin a hankali (ta hanyar raka'a 4-8 a kowace rana). A cikin insulin fiye da raka'a 40 / rana, yin amfani da metformin da raguwa a cikin yawan insulin yana buƙatar kulawa sosai kuma ana gudanar dashi a asibiti.

Aikin magunguna

Biguanide, wakili na jini don maganin baka. A cikin marasa lafiya da ciwon sukari, yana rage maida hankali na glucose a cikin jini ta hanyar hana gluconeogenesis a cikin hanta, rage yawan glucose daga cikin hanji da haɓaka amfani da shi a cikin kyallen, Yana rage taro na TG, cholesterol da LDL (ƙaddara akan komai a ciki) a cikin ƙwayar jini kuma ba ya canza maida hankali na sauran jijiyoyi. Yanke ko rage karfin jiki.

Idan babu insulin a cikin jini, ba a bayyana tasirin warkewa ba. Hypoglycemic halayen ba sa. Haɓaka ƙwayoyin fibrinolytic na jini saboda hanawar mai hana mai hana ƙarfi motsa jini (plasminogen) nau'in nama.

Side effects

Daga tsarin narkewa: tashin zuciya, amai, '' ƙarfe '' ɗanɗano a cikin bakin, rage ci, dyspepsia, flatulence, ciki na ciki.

Daga gefen metabolism: a wasu yanayi - lactic acidosis (rauni, myalgia, rikicewar numfashi, tashin zuciya, raunin ciki, rashin lafiyar jiki, rage karfin jini, reflex bradyarrhythmia), tare da magani na dogon lokaci - hypovitaminosis B12 (malabsorption).

Daga gabobin hemopoietic: a wasu yanayi - megaloblastic anemia.

Allergic halayen: fatar fata.

Idan akwai wani sakamako na rashin illa, za a rage kashi ko a soke dan lokaci. Bayyanar cututtuka: lactic acidosis.

Haɗa kai

M rage Cmax da T1 / 2 na furosemide da 31 da 42.3%, bi da bi.

Mai jituwa tare da ethanol (lactic acidosis).

Yi amfani da hankali a hade tare da maganin rashin daidaituwa da sinetidine.

Abubuwan da suka samo asali na sulfonylureas, insulin, acarbose, MAO inhibitors, oxytetracycline, ACE inhibitors, clofibrate, cyclophosphamide da salicylates suna inganta sakamako.

Tare da yin amfani da lokaci guda tare da GCS, hana maganin hana haihuwa don gudanar da maganin baka, epinephrine, glucagon, hormones thyroid, abubuwan da ke haifar phenothiazine, magungunan thiazide, abubuwan nicotinic acid, raguwar tasirin hypoglycemic na metformin mai yiwuwa ne.

Furosemide yana ƙaruwa Cmax da 22%.

Nifedipine yana haɓaka sha, Cmax, yana rage jinkirin fita.

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