Amaril M

Pharmacodynamics
Glimepiride - wani abu mai aiki tare da aikin hypoglycemic lokacin da ake sarrafa shi ta baki, mai samo asali na sulfonylurea. Ana amfani dashi don nau'in ciwon sukari na II.
Glimepiride yana ƙarfafa ƙwayar insulin ta sel-cells-sel na ƙwanƙwasa, yana haɓaka sakin insulin. Kamar sauran abubuwan da ake amfani da su na sinadarin sulfonylurea, yana kara karfin sinadarin panc-sel da ke motsa jiki zuwa motsawar jiki na glucose. Bugu da kari, glimepiride, kamar sauran abubuwan da ake amfani da su na sulfonylurea, suna da tasirin da ake samu.
Sakin insulin
Sulfonylurea yana sarrafa ɓoye insulin ta hanyar rufe tashoshin potassium na ATP da ke kan membrane this-cell, wannan yana haifar da depolarization na membrane tantanin halitta, sakamakon abin da tashoshi masu ƙirar kalma ke buɗe kuma adadin mai ƙima yana shiga sel, wanda hakan yana ƙarfafa sakin insulin ta hanyar exocytosis.
Aikin karin magana
Extraarin tasirin karin shine don ƙara yawan ƙwayar ƙwayar mahaifa zuwa insulin kuma rage haɓakar insulin ta hanta. The jigilar glucose daga jini zuwa tsoka da tso adi nama yana faruwa ta hanyar sunadaran kwastomomi na musamman wanda aka keɓance akan membrane. Tsarin glucose ne a cikin waɗannan kyallen takarda wanda shine matakin da ke iyakance ƙimar yawan tasirin glucose. Glimepiride yana haɓaka yawan masu aiki da glucose mai aiki a cikin membrane na ƙwayar ƙwayar tsoka da mai mai, ta haka yana ƙarfafa haɓaka glucose.
Glimepiride yana ƙara yawan aikin phospholipase C, takamaiman don glycosyl phosphatidylinositol, kuma wannan yana da alaƙa da haɓakar lipogenesis da glycogenesis, waɗanda aka lura da su a cikin keɓaɓɓen mai da ƙwayoyin tsoka a ƙarƙashin tasirin wannan abu.
Glimepiride yana hana samuwar glucose a cikin hanta, yana kara yawan kwantar da hankali na fructose-2,6-diphosphate, wanda hakan ke hana gluconeogenesis.
Metformin
Metformin wani biguanide ne tare da sakamako na hypoglycemic, wanda ke bayyana kanta a cikin raguwa a duka matakan basal na glucose a cikin jini jini da kuma matakinsa a cikin jini na jini bayan cin abinci. Metformin baya motsa ƙwayar insulin kuma yana haifar da ci gaban hypoglycemia.
Metformin yana da matakai guda uku na aikin:

• yana rage haɓakar glucose ta hanta ta hana gluconeogenesis da glycogenolysis,
• A tsoka tsoka yana ƙaruwa da ƙwaƙwalwar insulin, yana inganta ɗaga sama da amfani da glucose,
• yana hana shan glucose a cikin hanji.

Metformin yana haɓaka haɗakar ƙwayar glycogen, yana tasiri glycogen synthase.
Metformin yana haɓaka ƙarfin jigilar kwastomomi masu jigilar glucose membrane (GLUT-1 da GLUT-4).
Ko da kuwa glucose na jini, metformin yana shafar metabolism na lipid. An nuna wannan lokacin amfani da miyagun ƙwayoyi a cikin allurai na warkewa yayin gwaji na matsakaici ko na tsawon lokaci na gwaji: metformin yana rage yawan matakan cholesterol, LDL da TG.
Pharmacokinetics
Glimepiride
Baƙon
Glimepiride yana da bioavailability na baki. Abinci baya tasiri sosai ga ɗaukar ruwa, kawai saurinsa yana ragu kaɗan. Matsakaicin mafi girman hankali a cikin jini plasma an kai shi kimanin awa 2.5 bayan maganin baka (akan matsakaici 0.3 μg / ml tare da maimaitawa a cikin kashi 4 na yau da kullun). Akwai dangantaka ta layi tsakanin yawan maganin, mafi girman maida hankali a cikin plasma da AUC.
Rarraba
A cikin glimepiride, akwai ƙaramin ƙarawar rarraba (kimanin 8.8 L), kusan daidai yake da girman rarraba albumin. Glimepiride yana da babban matsayi na ɗaurin garkuwar plasma (99%) da ƙarancin izini (kusan 48 ml / min).
A cikin dabbobi, glimepiride an keɓe shi a cikin madara, na iya shiga cikin mahaifa. Penetration ta hanyar BBB sakaci ne.
Biotransformation da kawar
Matsakaicin rabin rayuwar, wanda ya dogara da maida hankali a cikin jini na jini a karkashin yanayin maimaitawa na miyagun ƙwayoyi, ya kasance awanni 5-8. Bayan shan maganin a cikin allurai masu yawa, an lura da tsawan rabin rayuwar.
Bayan kashi ɗaya na glimepiride na radila, kashi 58% na maganin yana fitsari a cikin fitsari kuma kashi 35 cikin ɗari yana da ƙoshin fitsari. Ba canzawa, kayan da ke cikin fitsari ba a ƙaddara su ba. Tare da fitsari da feces, 2 metabolites an cire su, sakamakon metabolism a cikin hanta tare da halartar enzyme CYP 2C9: hydroxy da carboxy Kalam. Bayan gudanar na baka na glimepiride, m kawar rabin rayuwar wadannan metabolites kasance 3-6 hours da 5-6 hours, bi da bi.
Kwatancen ya nuna babu manyan bambance-bambance a cikin kantin magani bayan shan guda da yawa, bambancin sakamakon ga mutum ɗaya ya ragu sosai. Ba a lura da tarin yawa ba.
Magungunan magani na maza da mata, kuma a cikin nau'ikan shekaru daban-daban na marasa lafiya, iri ɗaya ne. Ga marassa lafiya da kekantaccen izinin bayyanainin, akwai yuwuwar karuwar yarda da raguwa a matsakaita yawan kwalliyar plasma na glimepiride, dalilin shine saurin kawar dashi da sauri saboda rashin dacewar garkuwar jini. Yawan rage metabolites biyu ta hanjin su ya ragu. Babu wani ƙarin haɗarin haɗarin ƙwayoyi a cikin irin waɗannan marasa lafiya.
A cikin marasa lafiya 5, ba tare da ciwon sukari ba, amma bayan tiyata akan ƙwayar bile, likitancin magunguna sun yi kama da waɗanda ke cikin mutane masu lafiya.
Metformin
Baƙon
Bayan gudanarwa na maganin metformin, lokacin isa ga mafi yawan maida hankalin plasma (tmax) shine awa 2.5. Cikakken bayanin bioavailability na metformin lokacin da aka gudanar dashi a kashi na 500 MG na magana don masu sa kai masu lafiya kusan 50-60%. Bayan gudanar da baka, ctionarfin da ba'a saka hannu a cikin feces shine 20-30%.
Shaƙar Metformin bayan gudanar da maganin magana yana da suttarwa kuma bai cika ba. Akwai shawarwari da cewa magunguna na ƙwaƙwalwar ƙwayar metformin shine layin layi. A lokutan da aka saba da tsarin gudanarwa na metformin, ana samun daidaiton ƙwaƙwalwar ƙwayar plasma bayan sa'o'i 24 zuwa 48 kuma bai wuce 1 μg / ml ba. A cikin gwaje-gwajen asibiti da aka sarrafa, Cmax metformin a cikin jini plasma bai wuce 4 μg / ml ba, har ma da mafi girman allurai.
Cin abinci yana rage digiri kuma ya ɗan ƙara tsawon lokacin ɗaukar metformin. Bayan shan kashi na 850 MG tare da abinci, raguwa a cikin plasma Cmax da 40%, raguwa a cikin AUC da 25%, kuma an lura da haɓaka tmax ta 35 min. Ba a san mahimmancin asibiti na irin waɗannan canje-canje ba.
Rarraba.
Tabbatar da furotin plasma bai zama sakaci ba. An rarraba Metformin a cikin sel jini. Cmax a cikin jini kasa da Cmax a cikin plasma kuma ana samunshi da misalin lokaci guda. Kwayoyin halittar jini ja sune wuraren saukarwa na sakandare. Matsakaicin darajar adadin rarraba rarraba daga lita 63-76.
Biotransformation da kawar.
Ana amfani da Metformin wanda baya canzawa a cikin fitsari. Bayyancen danyen metformin shine 400 ml / min, wanda ke nuna cewa metformin an cire shi ta hanyar dunƙule dunkulalliyar da tubular tobu. Bayan shigowa, ƙarshen rabin rayuwar rabi shine kusan awanni 6.5. Idan aikin nakal ɗin ya lalace, ƙaddamar da renal ya ragu daidai gwargwado ga ƙimar creatinine, sakamakon abin da rabin rabin rayuwa ya fi tsayi, wanda ke haifar da ƙaruwa cikin matakan metformin plasma.

Alamu don amfani da miyagun ƙwayoyi Amaryl m

A matsayin ƙari ga rage cin abinci da haɓaka aiki na jiki a cikin marasa lafiya da keɓaɓɓen ciwon sukari na II:

• a cikin yanayin yayin monotherapy tare da glimepiride ko metformin ba ya samar da matakin da ya dace na sarrafa glycemic,
• haɗakar amena tare da glimepiride da metformin.

Yin amfani da miyagun ƙwayoyi Amaryl m

An saita kashi na maganin antidiabetic akayi daban-daban dangane da sakamakon saka idanu akai-akai game da matakan glucose na jini. A matsayinka na mai mulki, ana bada shawara don fara jiyya tare da mafi ƙarancin tasiri kuma ƙara yawan ƙwayar magani dangane da matakin glucose a cikin jinin mai haƙuri.
Ana amfani da miyagun ƙwayoyi ta hanyar tsofaffi.
Ana shan miyagun ƙwayoyi sau 1 ko 2 a rana kafin ko lokacin abinci.
Dangane da batun canji daga haɗin glimepiride da metformin, an wajabta Amaril M, yana la'akari da allurai waɗanda mai haƙuri ya riga ya ɗauka.

Contraindications zuwa amfani da miyagun ƙwayoyi Amaryl m

- Type I diabetes mellitus, mai ciwon sukari mai ciwon sukari, precoa da ciwon sukari da coma, m ko na kullum acidosis na rayuwa.
- Hypersensitivity ga abubuwan da ke cikin miyagun ƙwayoyi, sulfonylurea, sulfonamides ko biguanides.
- Marasa lafiya da ke fama da rauni na hanta ko marasa lafiya waɗanda ke kan cutar sankara. Game da mummunan rauni na hanta da koda, yana da buƙatar canja wuri zuwa insulin don cimma daidaitaccen iko na matakan glucose na mai haƙuri.
- Lokacin daukar ciki da lactation.
- Marasa lafiya suna haɓaka haɓakar lactic acidosis, tarihin lactic acidosis, cutar koda ko aikin nakasa mai rauni (kamar yadda aka tabbatar da ƙaruwa a cikin matakan ƙwayoyin plasma creatinine na ≥1.5 mg / dL a cikin maza da ≥1.4 mg / dL a cikin mata ko rage yardawar creatinine), wanda yanayi zai iya haifar dashi sakamakon faduwar zuciya (gigice), matsanancin buguwar zuciya, da kuma cutar sikila.
- Marasa lafiya waɗanda aka ba su shirye-shiryen rigakafin cututtukan fida wanda ya ƙunshi aidin, tunda irin waɗannan magungunan na iya haifar da raunin ƙwayar cuta (ya kamata a dakatar da Amaril M na ɗan lokaci) (duba "Umarnin na Musamman").
- Cututtuka masu yawa, yanayi kafin da bayan tiyata, raunin raunin sosai.
- Yunwa na haƙuri, cachexia, hypofunction na pituitary ko glandar adrenal.
- Rashin aiki na hanta, mai rauni na rashin aiki da sauran yanayi waɗanda zasu iya kasancewa tare da faruwar haipoxemia, yawan shan barasa, gubar ciki, cututtukan hanji, gami da zawo da amai.
- Rashin bugun zuciya wanda ke buƙatar magani.
- Rage aikin na koda.
- Shekarun yara.

Sakamakon sakamako na miyagun ƙwayoyi Amaryl m

Glimepiride
Dangane da kwarewar amfani da miyagun ƙwayoyi na Amaril M da bayanai akan wasu hanyoyin da suka samo asali na sulfonylurea, wajibi ne don yin la’akari da yiwuwar waɗannan tasirin magungunan:
Hypoglycemia: tunda miyagun ƙwayoyi suna rage sukarin jini, wannan na iya haifar da ci gaban hypoglycemia, wanda, bisa gogewar ƙwarewar amfani da wasu abubuwan da ake buƙata na sulfonylurea, na iya ɗaukar dogon lokaci. Bayyanar cututtukan hypoglycemia sune: ciwon kai, matsananciyar yunwar ("ƙyamar wolf"), tashin zuciya, amai, rashin tausayi, nutsuwa, tashin hankali, tashin hankali, tashin hankali, tashin hankali, rashin damuwa, rikicewar magana, rashi magana, tashin hankali, rashin gani, rawar jiki, paresis, tashin hankali, tashin hankali, rashin taimako, nutsuwa, tashin zuciya, tashin zuciya da asarar hankali har zuwa ci gaban kwaro, sanyin numfashi da bradycardia. Bugu da kari, za a iya samun alamun adrenergic counter-regulation: profuse sweating, stickiness of skin, tachycardia, hauhawar jini (arterial pressure), ji na palpitations, farmaki na angina pectoris da cardiac arrhythmias. Gabatar da asibiti na mummunan rauni na hypoglycemia na iya kama da bugun jini. Duk waɗannan alamun kusan kusan suna ɓacewa bayan daidaituwa na yanayin glycemic.
Take hakkin gabobin hangen nesa: yayin jiyya (musamman a farkon), ana iya ganin raunin gani na hankali saboda canje-canje a matakan glucose na jini.
Take hakkin narkewa kamar fili: wani lokacin tashin zuciya, amai, jin nauyi ko jin cikakken ciki a yankin na ciki, ciwon ciki da zawo.
Take hakkin hanta da kuma biliary fili: a cikin wasu halaye, yana yiwuwa a ƙara yawan ayyukan enzymes na hanta da aikin lalata hanta (cholestasis da jaundice), da kuma hepatitis, wanda zai iya ci gaba zuwa gazawar hanta.
Daga tsarin jini: da wuya thrombocytopenia, da wuya kasasshen leukopenia, hemolytic anemia ko erythrocytopenia, granulocytopenia, agranulocytosis ko pancytopenia. Kulawa sosai game da yanayin mai haƙuri ya zama dole, tunda yayin jiyya tare da shirye-shiryen sulfonylurea akwai alamun rajistar cututtukan cututtukan ƙwayar cuta da cututtukan ƙwaƙwalwa na panlatopenia. Idan waɗannan abubuwan mamaki sun faru, ya kamata ku daina shan maganin kuma ku fara magani da ya dace.
Hypersensitivity: da wuya, rashin lafiyan ko maganganun cututtukan ƙwayar cuta, (alal misali, itching, urticaria, ko fitsari). Irin waɗannan halayen kusan kullun matsakaici ne, amma na iya samun ci gaba, tare da nessarancin numfashi da hauhawar jini, har zuwa rawar jiki. Idan amya ta faru, tuntuɓi likita kai tsaye.
Sauran: A lokuta da dama, ana iya lura da matsalar rashin lafiyar fitsari, daukar hoto da raguwar matakin sodium a cikin jini.
Metformin
Lactic acidosis: kalli "CIKIN LITTAFIN KARATU" da "GUDAWA".
Hypoglycemia.
Daga cikin jijiyoyin mahaifa: sau da yawa - zawo, tashin zuciya, amai, flatulence da anorexia. A cikin marasa lafiyar da suka karɓi maganin ƙwaƙwalwar ƙwayar cuta, waɗannan alamu sun faru kusan 30% fiye da sau da yawa a cikin marasa lafiya waɗanda suka dauki placebo, musamman a farkon jiyya. Wadannan alamomin ba su da yawa a zahiri kuma suna bacewa da kansu tare da ci gaba da magani. A wasu halaye, rage ƙarfin na ɗan lokaci na iya taimakawa. A lokacin gwaji na asibiti, an dakatar da maganin a cikin kusan 4% na marasa lafiya saboda halayen daga hanji.
Tun da bayyanar cututtuka na gastrointestinal fili a farkon jiyya sun kasance dogaro-da-kashi, ana iya rage alamun su ta hanyar ƙara yawan ƙwayoyi da shan magunguna yayin abinci.
Zawo gudawa da / ko amai na iya haifar da bushewa da bushewar azotemia, a cikin wannan halin, ya kamata a dakatar da maganin na ɗan lokaci.
Abinda ya faru na cututtukan gastrointestinal bayyanar cututtuka a cikin marasa lafiya da ke cikin yanayin kwanciyar hankali yayin ɗaukar Amaril M na iya zama ba a haɗa shi da amfani da miyagun ƙwayoyi ba, idan kasancewar cutar kuturta da lactic acidosis an cire shi.
Daga gabobin azanci: a farkon jiyya tare da miyagun ƙwayoyi, kusan 3% na marasa lafiya na iya yin gunaguni game da ɗanɗano mara dadi ko ƙarfe a cikin bakin, wanda, kamar yadda ya saba, ya ɓace akan nasa.
Fata halayen: mai yiwuwa abin da ya faru na kurji da sauran bayyanai. A irin waɗannan halayen, ya kamata a dakatar da maganin.
Daga tsarin jini: da wuya, anemia, leukocytopenia, ko thrombocytopenia. Kusan 9% na marasa lafiya waɗanda suka karbi maganin tafinototrapy tare da Amaril M da 6% na marasa lafiya waɗanda suka karbi magani tare da Amaril M ko sulfonylurea sun nuna raguwar asymptomatic a cikin plasma B12 (plasma folate bai ragu ba sosai). Duk da wannan, an rubuta megaloblastic anemia yayin shan miyagun ƙwayoyi, babu karuwa a cikin abin da ya faru na neuropathy da aka lura. Abubuwan da ke sama suna buƙatar saka idanu sosai kan matakin bitamin B12 a cikin jini (plasma) na jini ko ƙarin gudanarwa na bitamin B12 na lokaci-lokaci.
Daga hanta: A cikin mafi yawan lokuta mafi wahala, aikin hanta mai yiwuwa ne.
Duk lamurran da suka faru na halayen da suka biyo baya ko sauran halayen da suka dace da kai, ya kamata a sanar da likita nan da nan. Ba a lura da halayen da ba a sani ba game da wannan magani, ban da halayen da aka riga aka sani don glimepiride da metformin, ba a lura da su a lokacin gwaji na I ba da kuma gwaji na III na budewa.

Umarni na musamman don amfani da miyagun ƙwayoyi Amaryl m

Musamman matakan kiyayewa.
A cikin makon farko na magani tare da miyagun ƙwayoyi, saka idanu a hankali game da yanayin haƙuri yana da mahimmanci saboda karuwar haɗarin cututtukan jini. Hadarin hypoglycemia yana wanzu a cikin marasa lafiya masu zuwa ko a irin waɗannan yanayi:

• sha'awar ko rashin iya haƙuri don yin aiki tare da likita (musamman ma a cikin tsufa),
• rashin abinci mai gina jiki, rashin abinci mai gina jiki na yau da kullun,
• rashin daidaituwa tsakanin aiki na jiki da kuma yawan carbohydrate,
• canje-canje a abinci
• shan giya, musamman a hade tare da tsallake abinci,
• mai aiki mai ɗaukar hoto,
• mai lalata hanta,
• yawan shan magani
• wasu cututtukan da aka lalata na tsarin endocrin (lalata ƙwayar thyroid da adenohypophysial ko adrenocortical insufficiency) wanda ke shafar metabolism metabolism da hanawar hauhawar jini,
• Lokaci guda na amfani da wasu magunguna (duba sashe "hulɗa tare da sauran wakilai na warkewa da sauran nau'ikan hulɗa").

A cikin irin waɗannan halayen, ya zama dole a kula da matakin glucose na jini koyaushe, kuma mara lafiya ya kamata ya sanar da likitansa game da abubuwan da ke sama da kuma abubuwan da ke faruwa na hypoglycemia, idan sun faru. Idan akwai abubuwanda ke kara haɗarin hawan jini, kuna buƙatar daidaita sashin Amaril M ko kuma dukkan tsarin kulawa. Hakanan dole ne a aikata hakan idan akwai wani cuta ko canji a rayuwar mai haƙuri. Bayyanar cututtukan hypoglycemia wanda ke nuna adrenergic counterregulation na iya zama mai sauƙin ɗauka ko rashinsa gaba ɗaya a cikin yanayi yayin da hypoglycemia ya haɓaka a hankali: a cikin tsofaffi marasa lafiya, a cikin marasa lafiya da keɓaɓɓen neuropathy, ko a cikin waɗanda ke karɓar magani tare da ckers-adrenoreceptor blockers, clonidine, reserpine, guanethidine, ko wasu m
Janar hanyoyin kariya:

• Ingantaccen matakin glucose na jini yakamata a kiyaye ta lokaci guda biye da abinci da kuma yin motsa jiki, haka kuma, lokacin da ya cancanta, ta rage nauyin jiki da kuma ɗaukar Amaril M. a kai a kai. Alamomin asibiti na rashin isasshen raguwar glucose jini yana ƙaruwa sau urinary (polyuria) ), tsananin kishi, bushewar bushe da bushewar fata.
• Yakamata a sanar da mara lafiya game da fa'ida da kuma haɗarin da ke tattare da amfani da ƙwayar mara magani Milil M, da kuma mahimmancin bin abincin da motsa jiki na yau da kullun.
• A cikin mafi yawan lokuta, ana iya kawar da hypoglycemia da sauri ta hanyar shan carbohydrates nan da nan (glucose ko sukari, a cikin wani yanki na sukari, ruwan 'ya'yan itace tare da sukari ko shayi mai zaki). Don wannan, ya kamata mai haƙuri koyaushe a kawo aƙalla 20 g na sukari. Don guje wa rikice-rikice, mai haƙuri na iya buƙatar taimakon marasa izini. Abubuwan da ke sanya rai don keɓaɓɓen ƙwayar wucin gadi don maganin cututtukan cututtukan ƙwayar cuta ba su da tasiri.
• Daga gwaninta na amfani da wasu magunguna na sulfonylurea, an san cewa, duk da daidaituwar matakan warkewar da aka ɗauka, maimaitawar cututtukan jini zai yiwu. A wannan batun, mai haƙuri ya kamata ya kasance yana ƙarƙashin kulawa koyaushe. Mai tsananin rashin ƙarfi na buƙatar magani na gaggawa a ƙarƙashin kulawar likita, kuma a wasu yanayi, asibiti na mara haƙuri.
• Idan mai haƙuri ya sami kulawar likita daga wani likita (alal misali, yayin asibiti, haɗari, idan ya cancanta, nemi kulawar likita a ranar hutu), dole ne ya sanar da shi game da rashin lafiyarsa don ciwon sukari da kuma maganin da ya gabata.
• A cikin yanayi na musamman na damuwa (alal misali, tare da rauni, tiyata, wata cuta mai yaduwa tare da hauhawar jini), ana iya lalata matakan matakan glucose na jini, kuma yana iya zama dole a canja wurin mara lafiya na ɗan lokaci zuwa shirye-shiryen insulin don tabbatar da madaidaiciyar sarrafawa.
• A cikin jiyya tare da Amaril M, ana amfani da ƙananan allurai. Yayin kulawa tare da miyagun ƙwayoyi, ya zama dole don saka idanu akai-akai matakin glucose a cikin jini da fitsari. Bugu da ƙari, ana bada shawara don ƙayyade matakin gemocosylated haemoglobin. Hakanan wajibi ne don kimanta tasiri na jiyya, kuma idan ya kasa, ya zama dole don canja wurin haƙuri nan da nan zuwa wani maganin.
• A farkon jiyya, lokacin sauya sheka daga wannan magani zuwa wani ko tare da gudanarwa na marassa tsari na Amaril M, za a lura da raguwar kulawa da raunin da ya haifar da cutar ciwan-ciki ko hauhawar jini. Wannan na iya cutar da ƙarancin tuƙi mota ko aiki tare da wasu hanyoyin.
• Gudanar da aikin Renal: an san cewa Amaryl M yana daɗaɗɗan ƙwayoyin koda, sabili da haka, haɗarin tarawa na metformin da haɓakar lactic acidosis yana ƙaruwa gwargwadon ƙarfin cutar cututtukan koda. A wannan batun, marasa lafiya waɗanda matakan plasma creatinine suka wuce iyakar shekarun tsufa na yau da kullun bai kamata su sha wannan magani ba. Ga tsofaffi marassa lafiya, yin taka tsantsan mai yawa na kashi na Amaril M wajibi ne don ƙayyade mafi ƙarancin kashi wanda ke nuna tasirin glycemic da ya dace, tunda aikin koda ya ragu tare da shekaru. A cikin marasa lafiya tsofaffi, ya kamata a kula da aikin na koda a kai a kai, kuma wannan magani, kamar yadda ya saba, bai kamata a sanya shi cikin kaso mai tsoka ba.
• Yin amfani da wasu magunguna a lokaci guda wanda zai iya cutar da aikin kodan ko likitan magunguna na metformin: amfani da lokaci guda na kwayoyi waɗanda zasu iya shafar aikin kodan ko haifar da canje-canje masu yawa a cikin hemodynamics, ko kuma shafar magungunan magunguna na Amaryl M, magungunan da ke ɗauke da cations, Dole ne a yi amfani da shi da hankali, tun da ƙwayoyinsu ne suke yin su ta hanyar ɓoyewar ɓoyayyen.
• Nazarin X-ray tare da gudanarwar yanayin kwatankwacin jami'ai masu bambanci dauke da iodine (ciki, kwayar ciki, cholangiography, angiography da lissafin tomography (CT) ta amfani da wakilin bambanci): wakilan iodine-dauke da bambancin wakilan da aka tsara don gudanar da iv na iya haifar da mummunan lalacewa na ciki da haifar da ci gaba. lactic acidosis a cikin marasa lafiya suna shan Amaryl M (duba sashin "Contraindications"). Don haka, marasa lafiya waɗanda ke shirin irin wannan binciken ya kamata su daina amfani da Amaril M kafin, lokacin da kuma awanni 48 bayan aikin. A wannan yanayin, bai kamata a mayar da maganin ba har sai an yi bincike na biyu game da aikin koda.
• Yanayin cututtukan zuciya: rugujewar zuciya (gigicewa) na kowane tsararren cuta, mummunan rauni na zuciya, matsanancin myocardial infarction da sauran yanayi wanda hypoxemia na halayyar zai iya haɗuwa tare da bayyanar lactic acidosis, kuma yana iya haifar da cutar azotemia. Idan marasa lafiya da ke shan Amaryl M suna da irin wannan yanayin, ya kamata a dakatar da maganin nan da nan.
• Ayyukan tiyata: yayin duk wani aikin tiyata, ya zama dole don jinkirta magani na ɗan lokaci tare da ƙwayar (ban da ƙananan hanyoyin da ba sa buƙatar hani akan abinci da shan ruwa). Ba za a iya ci gaba da murmurewa ba har sai mai haƙuri ya fara ɗaukar abinci da kansa, kuma sakamakon binciken aikin aikin renal ba ya cikin iyaka.
• Amfani da barasa: tun da barasa yana haɓaka tasirin metformin akan metabolism na lactate, ya kamata a yi gargaɗi ga marasa lafiya game da wuce kima, guda ko shan barasa yayin shan Amaril M.
• Aikin hanta mai rauni: bai kamata a wajabta wa marasa lafiya da alamun asibiti ko alamun dakin yin aikin hanta mai rauni ba sakamakon haɗarin lactic acidosis.
• Matsayin Vitamin B12: yayin gwajin asibiti, wanda ya ɗauki tsawon makonni 29, kusan 7% na marasa lafiya waɗanda suka ɗauki Amaril M sun nuna raguwa a cikin matakan plasma B12, amma ba tare da alamu na asibiti ba. Wataƙila raguwar hakan ta faru ne sakamakon tasirin bitamin B12 - abubuwan da ke haifar da hadaddun ƙwayar cuta a cikin ƙwayar bitamin B12, wanda ba kasafai yake haɗuwa da cutar rashin jini ba kuma yana ɓoye da sauri lokacin da kuka dakatar da shan wannan magani ko lokacin da aka wajabta Vitamin B12.
  Wasu mutane (tare da rashin isasshen ci ko rage ƙarfin bitamin B12 ko alli) suna da dabi'ar rage matakan bitamin B12. Ga irin waɗannan marasa lafiya, yana iya zama da amfani a kai a kai, kowace shekara 2-3, ƙayyade matakin bitamin B12 a cikin jini.
• Canje-canje a cikin yanayin asibiti na mai haƙuri tare da mellitus na sukari wanda aka sarrafa a baya: abin da ya faru na karkatar da sigogi daga yanayin (alamun rashin daidaituwa) a cikin haƙuri tare da a baya an sami iko a kan hanyar ciwon sukari tare da metformin, yana buƙatar jarrabawa nan da nan don ware ketoacidosis da lactic acidosis . Wajibi ne a tantance taro na electrolytes da jikin ketone a cikin jini, matakin glucose na jini, sannan kuma, idan aka nuna, pH din jini, matakin lactate, pyruvate da metformin. A gaban kowane nau'i na acidosis, ya kamata a dakatar da gwamnatin Amaril M nan da nan kuma sauran matakan da suka wajaba don gyara farji ya kamata a fara.

Ya kamata a sanar da marasa lafiya game da fa'ida da kuma haɗarin da ke tattare da amfanin Amaril M, da kuma game da hanyoyin magani. Hakanan wajibi ne don sanar da mahimmancin cin abinci, motsa jiki na yau da kullun, kazalika da buƙatar kulawa da glucose na jini akai-akai, glycosylated haemoglobin, aikin koda, da kuma sigogin jini.
Marasa lafiya suna buƙatar yin bayanin menene haɗarin lactic acidosis, alamun cututtukan da ke tattare da shi da kuma abin da yanayi ke taimakawa bayyanuwa. Yakamata a shawarci marassa lafiya da su daina shan magungunan kuma a nemi likita kai tsaye idan alamun alamu kamar karuwar mita da zurfin numfashi, myalgia, zazzabi, amai, ko wasu alamomin da ba takamaiman bayyanar cututtuka sun faru. Idan mai haƙuri ya sami ƙarfi yayin ɗaukar kowane kashi na Amaril M, to, abin da ya faru na alamun cututtukan gastrointestinal marasa lafiya da aka lura a farkon farfaɗoyar magani ba shi da alaƙa da amfani da miyagun ƙwayoyi. Bayyanar bayyanar cututtukan gastrointestinal a cikin matakai na gaba na jiyya na iya lalacewa ta hanyar lactic acidosis ko wani mummunan ciwo.
Yawancin lokaci, metformin, wanda aka ɗauka shi kadai, ba ya haifar da hypoglycemia, kodayake abin da ya faru yana yiwuwa tare da yin amfani da metformin a lokaci ɗaya tare da abubuwan da aka samo na bakin sulfonylurea. Fara fara haɗin gwiwa, mai haƙuri yana buƙatar bayani game da haɗarin hauhawar jini, alamomin da ke tattare da shi da kuma abin da yanayi ke taimakawa bayyanuwa.
Yi amfani da shi a cikin tsofaffi marasa lafiya
An san cewa metformin yana fitar da kodan ne galibi ta kodan. Tun da hadarin haɓakawa da mummunan rauni ga Amaryl M a cikin marasa lafiya da ke fama da rauni na aiki sun fi girma, ana iya amfani da miyagun ƙwayoyi a cikin marasa lafiya tare da aikin na al'ada. Sakamakon gaskiyar cewa tare da shekaru, aikin koda ya ragu, a cikin tsofaffi ana amfani da metformin tare da taka tsantsan. Wajibi ne a zabi sashi mai kyau kuma a gudanar da bincike akai-akai game da aikin koda. Kamar yadda aka saba, tsofaffi marasa lafiya ba sa karuwar kashi na metformin zuwa matsakaicin.
Manuniyar dakin gwaje-gwaje
Sakamakon magani tare da yin amfani da kowane magungunan antidiabetic dole ne a sanya idanu a kai a kai don azumi glucose jini da kuma glycosylated haemoglobin. A yayin fitar da kashi na farko, alamar nuna inganci shine matakin glucose din jini. Koyaya, ƙididdigar haemoglobin suna da amfani wajen kimanta nasarorin kulawar cutar ta lokaci mai tsawo.
Hakanan wajibi ne don saka idanu akan lokaci-lokaci sigogi na jini (haemoglobin / hematocrit da tantance alamun jinin haila) da aikin koda (creatinine) aƙalla lokaci 1 a shekara. Lokacin amfani da metformin, megaloblastic anemia yana da wuya sosai, duk da haka, idan akwai tuhuma game da abin da ya faru, ya zama dole don ware rashi na bitamin B12.
Yi amfani da lokacin daukar ciki da lactation. Bai kamata a ɗauka Amaryl M a lokacin daukar ciki ba saboda haɗarin haɗarin kamuwa da jariri. Marasa lafiya da marasa lafiyar da ke shirin daukar ciki ya kamata su sanar da likita. Irin waɗannan marasa lafiya dole ne a canza su zuwa insulin.
Don gudun shigowar Amaril M tare da madara na mahaifiya a jikin jariri, bai kamata mata su sha shi yayin shayarwa ba. Idan ya cancanta, mai haƙuri ya kamata ya yi amfani da insulin ko kuma gaba ɗaya watsi da nono.
Carcinogenesis, mutagenesis, rage yawan haihuwa
An gudanar da bincike mai zurfi don nazarin cututtukan ƙwayar cutar a cikin berayen da beraye tare da jinkirin tsawon makonni 104 da sati 91, bi da bi. A wannan yanayin, an yi amfani da allurai har zuwa 900 mg / kg / rana da 1500 mg / kg / rana, bi da bi, bi da bi. Dukkanin allurai kusan sau uku sun wuce matsakaicin adadin yau da kullun, wanda aka ba da shawarar don amfani cikin ɗan adam kuma ana lasafta shi gwargwadon yanki na jikin mutum. Babu maza ko mata bera da suka nuna alamun cututtukan ƙwayar cuta na metformin. Hakanan, a cikin berayen maza, ba a gano yiwuwar cutar tumatir ba. Koyaya, a cikin berayen mata a allurai na 900 MG / kg / rana, an lura da karuwa akan abin da ya faru na polyps utromine polyps polyps.
Ba a gano alamun metformin mutagenicity a kowane ɗayan gwaje-gwaje ba: gwajin Ames (S. Typhi murium), gwajin maye gurbi (sel linzami na ƙwaƙwalwa), gwajin chromosome aberration (ɗan adam lymphocytes), da gwajin micronucleus. a cikin vivo (bargo na kashin kaji).
Metformin bai shafi yawan haihuwa tsakanin mace da mace a allurai wanda ya kai 600 mg / kg / rana ba, wato, a allurai wadanda suka ninka adadin yau da kullun da aka bada shawarar amfani dasu a jikin dan adam kuma ana kirgawa gwargwadon yanayin jikin mutum.
Yara. Ba a tabbatar da aminci da ingancin maganin a cikin yara ba.
Thearfin yin tasiri akan ƙimar amsawa lokacin tuki ko aiki tare da wasu hanyoyin.
Dole ne a faɗakar da mai haƙuri game da taka tsantsan yayin tuki motocin da kuma aiki tare da injuna.

Mu'amala da magunguna na Amaril M

Glimepiride
Idan mai haƙuri wanda ya ɗauki Amaryl M lokaci guda ya karɓi wasu magunguna ko ya dakatar da shan su, wannan na iya haifar da karuwa ko rashin raguwa a cikin tasirin hypoglycemic na glimepiride.Dangane da ƙwarewar yin amfani da Amaril M da sauran abubuwan da ake amfani da shi na jini, ya wajaba a yi la’akari da yuwuwar hulɗan da ke gaba da Amaril M da sauran ƙwayoyi.
Glimepiride yana metabolized ta enzyme CYP 2C9. An sani cewa metabolism dinsa yana shafar ta lokaci guda ta amfani da inducers (rifampicin) ko inhibitors (fluconazole) CYP 2C9.
Magunguna waɗanda ke haɓaka tasirin hypoglycemic.
Magungunan insulin ko na baka, maganin inshora, ACE inhibitors, alopurinol, steroids na anabolic, kwayoyin jima'i na maza, chloramphenicol, anticoagulants, waɗanda sune abubuwan ƙira na coumarin, cyclophosphamide, rashin biyayya, phenfluramine, pheniramidine, microfluoroethanolin, sunadirin kwalliya, sunadirin kwalliya paraaminosalicylic acid, pentoxifylline (lokacin da ake gudanar da aikin parenterally a cikin manyan allurai), phenylbutazone, probenicide, maganin rigakafi na kungiyar quinolone, salicylates, sulfinpyrazone, sulfonamide, tetra cyclins, tritokvalin, trofosfamide, azapropazone, oxyphenbutazone.
Magunguna waɗanda ke rage tasirin hypoglycemic.
Acetazolamide, barbiturates, corticosteroids, diazoxide, diuretics, epinephrine, glucagon, laxatives (tare da tsawan lokaci), nicotinic acid (a cikin manyan allurai), estrogens da progestogens, phenothiazine, phenytoin, rifampicin, hormones thyroid.
Magunguna waɗanda zasu iya haɓakawa da rage tasirin hypoglycemic.
Masu adawa da masu karɓar H2, clonidine da reserpine.
Masu hana of-adrenergic masu karɓar reduce-adrenergic masu karɓar haɓakar glucose, ta haka ne suke ƙara haɗarin hauhawar jini (saboda rikicewar rikicewar jiki).
Magunguna a ƙarƙashin tasiri wanda hanawa ko toshe alamun alamun adrenergic counterregulation na hypoglycemia an lura:
Magungunan Sympatholytic (clonidine, guanethidine da reserpine).
Dukansu guda ɗaya da mai amfani da giya na iya haɓaka ko rage tasirin cutar ta Amaril M. Amaril M na iya haɓakawa da rage tasirin abubuwan coumarin.
Metformin
Tare da yin amfani da lokaci ɗaya tare da wasu kwayoyi, lactic acidosis na iya haɓaka. Dole ne a kula da yanayin haƙuri a hankali idan aka yi amfani da lokaci ɗaya tare da kwayoyi masu zuwa: shirye-shiryen radipaque wanda ke ɗauke da aidin, ƙwayoyin rigakafi waɗanda ke da tasiri mai ƙarfi nephrotoxic (Gentamicin, da sauransu).
Tare da amfani da lokaci ɗaya tare da wasu kwayoyi, tasirin hypoglycemic na iya haɓaka da raguwa. Kulawa da haƙuri da kulawa da matakan glucose na jini suna da mahimmanci idan akwai amfani da lokaci ɗaya tare da kwayoyi masu zuwa:

• kwayoyi masu haɓaka sakamako: insulin, sulfonamides, sulfonylureas, steroids anabolic, guanethidine, salicylates (asfirin, da sauransu), blo-adrenoreceptor blockers (propranolol, da sauransu), MAO inhibitors,
• kwayoyi waɗanda ke rage tasirin: adrenaline, corticosteroids, hormones thyroid, estrogens, diuretics, pyrazinamide, isoniazid, acid nicotinic, phenothiazines.

Gliburide: yayin nazarin don nazarin hulɗa ta hanyar gudanar da lokaci guda na kulawa guda na nau'ikan masu ciwon sukari na II na sukari da metformin da glyburide, an gabatar da canje-canje a cikin kantin magunguna da magunguna na metformin. An sami raguwa a cikin AUC da Cmax) na glyburide, wanda yake yana da sauyi sosai. Sakamakon gaskiyar cewa an gudanar da kashi ɗaya tak a yayin binciken, kazalika saboda rashin daidaituwa tsakanin matakan glyburide a cikin ƙwayar jini da tasirin magungunansa, babu wani tabbaci cewa wannan hulɗa yana da mahimmanci na asibiti.
Furosemide: Yayin nazarin don nazarin hulɗa tsakanin metformin da furosemide ta hanyar gudanar da ɗayan guda ɗaya ga masu sa kai masu lafiya, an bayyane sarai cewa gudanar da waɗannan magunguna lokaci guda yana shafar sigogin maganin su. Furosemide ya ƙaru Cmax na metformin a cikin jini na plasma da kashi 22%, sannan kuma AUC - da kashi 15% ba tare da wani canje-canje masu mahimmanci ba game da rabuwa da ma'adinin metformin. Lokacin da aka yi amfani da metformin, Cmax da AUC na furosemide sun ragu da 31% da 12%, bi da bi, idan aka kwatanta da furosemide monotherapy, kuma ƙarshen ƙarshen rayuwar ya ragu da 32% ba tare da wasu manyan canje-canje a cikin ƙaddamar da kimar furosemide ba. Babu bayanai game da hulɗa da metformin da furosemide tare da amfani na tsawan lokaci.
Nifedipine: yayin nazarin don nazarin hulɗa tsakanin metformin da nifedipine ta hanyar gudanar da guda ɗaya ga masu sa kai masu lafiya, an nuna a sarari cewa gudanar da sinadarin nifedipine a lokaci guda yana ƙara Cmax da AUC na metformin a cikin jini na jini da kashi 20% da 9%, bi da bi, kuma yana ƙara yawan adadin ƙwayoyin da aka ƙwace tare da fitsari. Metformin kusan ba shi da tasiri a kan magunguna na nifedipine.
Shirye-shiryen cationic: shirye-shiryen cationic (amiloride, digoxin, morphine, procainamide, quinidine, quinine, ranitidine, triamteren, trimethoprim, vancomycin), waɗanda ƙwararrun yara ke kwance ta hanyar tubular ɓoyewa, ikon da ke iya ma'amala tare da metformin saboda gasa na tsarin motar tubular gama gari. An lura da wannan hulɗa tsakanin metformin da cimetidine lokacin da aka sarrafa shi a baki yayin nazarin don nazarin hulɗa tsakanin metformin da cimetidine ta hanyar guda ɗaya da sarrafa magunguna ga masu sa kai. Wadannan karatun sunyi nuni da karuwar kashi 60 cikin 100 na Cmax na metformin a cikin plasma, haka kuma karuwa da 40% a cikin AUC na metformin a cikin plasma. Yayin binciken tare da kashi ɗaya, ba a sami canje-canje ba a tsawon rayuwar rabin. Metformin baya tasiri kan magunguna na cimetidine. Duk da cewa irin waɗannan ma'amala suna da tsinkaye a zahiri (amma ban da cimetidine), ya wajaba a kula da marasa lafiya a hankali kuma a daidaita alluran metformin da (ko) maganin da ke hulɗa da shi, idan an cire magungunan cationic daga jiki ta hanyar ruɗani a cikin kusancin tubules na kodan.
Wasu: Wasu kwayoyi na iya haifar da karuwa a cikin glucose jini kuma suna iya haifar da asarar sarrafa glycemic. Wadannan kwayoyi sun hada da thiazide da sauran diuretics, corticosteroids, phenothiazines, hormones thyroid, estrogens, maganin hana haihuwa, phenytoin, nicotinic acid, sympathomimetics, allunan tashar alli da isoniazid. Lokacin da ake rubuta irin waɗannan magunguna ga mai haƙuri wanda ke shan metformin, ya zama dole a tsayar da kulawa da hankali don kiyaye matsayin da yakamata na sarrafa glycemic.
Yayin nazarin don nazarin hulɗa ta hanyar gudanar da guda ɗaya ga masu ba da agaji na lafiya, magungunan ƙwayoyin cuta na metformin da propranolol, da metformin da ibuprofen, ba su canza ba tare da amfani da lokaci guda.
Matsakaicin ɗaukar metformin zuwa ƙwayoyin plasma na jini ba shi da mahimmanci, wanda ke nufin ma'amalarsa da kwayoyi waɗanda ke da alaƙa da sunadarai na jini, irin su salicylates, sulfonylamides, chloramphenicol, probenecid, ba zai yuwu ba idan aka kwatanta da sulfonylurea, wanda ke da babban matakin ɗaure garkuwar jini na jini .
Metformin ba shi da kayan magani na farko ko na sakandare, wanda zai iya haifar da amfani da shi mara amfani da magani kamar magani na nishaɗi ko jaraba.

Doaukar hoto na Amaril M, alamu da magani

Tun da miyagun ƙwayoyi ya ƙunshi glimepiride, yawan shan jini zai iya haifar da raguwar glucose jini. Hypoglycemia ba tare da asarar sani ba da canje-canje na jijiyoyin jijiyoyi dole ne a kula dasu sosai tare da glucose na baki da kuma daidaita magunguna da (ko) abincin mai haƙuri. Mummunan lokuta na rashin lafiyar hypoglycemia, wanda ke haɗuwa da coma, huda da sauran alamun cututtukan jijiyoyi, ba su da ɗanɗano, amma yanayi ne na gaggawa da ke buƙatar asibiti mai haƙuri a cikin gaggawa. Idan an gano cutar rashin lafiyar hypoglycemic ko kuma akwai fargaba game da abin da ya faru, mai haƙuri yana buƙatar gudanar da aikin kwantar da hankali (40%) r / r glucose iv, sannan ya aiwatar da wani ci gaba na ƙananan glucose (10%) r-r glucose a cikin adadin wanda ke tabbatar da tsayayyen yanayi matakan sukari na jini sama da 100 mg / dl. Mai haƙuri yana buƙatar kulawa da kullun aƙalla awanni 24 zuwa 48, tunda bayan haɓaka yanayin mai haƙuri, hypoglycemia na iya sake komawa.
Saboda kasancewar metformin a cikin shiri, haɓakar lactic acidosis mai yiwuwa ne. Lokacin da metformin ya shiga ciki cikin adadin har zuwa 85 MG, ba a lura da cutar hypoglycemia ba. Metformin an cire shi ta hanyar dialysis (tare da sharewa har zuwa 170 ml / min kuma yana ƙarƙashin yanayin da ya dace). Sabili da haka, idan ana zargin yawan zubar da ruwa, hemodialysis zai iya zama da amfani don cire ƙwayar daga jikin mutum.