Galvus - umarnin don amfani, sake dubawa, analogs da nau'ikan sashi (allunan 50 mg, tare da metformin 50 500, 50 850, 50 1000 Met) na magani don maganin cututtukan type 2 na manya a cikin manya, yara da ciki.

A cikin wannan labarin, zaku iya karanta umarnin don amfani da miyagun ƙwayoyi Galvus. Yana ba da ra'ayi daga baƙi zuwa shafin - masu amfani da wannan magani, kazalika da ra'ayoyin kwararrun likitocin game da amfani da Galvus a cikin al'amuransu. Babban buƙatar shine a ƙara ra'ayoyin ku game da miyagun ƙwayoyi: maganin ya taimaka ko bai taimaka kawar da cutar ba, menene rikice-rikice da sakamako masu illa da aka lura, mai yiwuwa ba sanar da mai masana'anta ba a cikin bayanin. Galvus analogues a gaban isassun tsarin analogues. Amfani don maganin cututtukan type 2 na manya a cikin yara, yara, harda lokacin daukar ciki da lactation. Abun da magani.

Galvus - magani na baki hypoglycemic magani. Vildagliptin (abu mai aiki na miyagun ƙwayoyi Galvus) wakili ne na aji na masu motsa jiki na ƙwanƙwasa ƙwayar ƙwayar ƙwayar cuta, wanda aka zaɓi yana hana enzyme dipeptidyl-peptidase-4 (DPP-4). Mai saurin cikawa da cikakkiyar hana aiki na DPP-4 (fiye da 90%) yana haifar da karuwa a cikin tasoshin abinci na yau da kullun da abinci mai motsa jiki na nau'in 1 glucagon-kamar peptide (GLP-1) da glucose-polyulinptide-insulinotropic polypeptide (HIP) daga hanji zuwa cikin keɓaɓɓiyar keɓaɓɓu cikin yini.

Theara yawan haɗuwa da GLP-1 da HIP, vildagliptin suna haifar da karuwa a cikin ƙwayar ƙwayar beta ta pancreatic zuwa glucose, wanda ke haifar da haɓaka cikin insulin-dogara insulin glucose.

Lokacin amfani da vildagliptin a kashi 50-100 MG kowace rana a cikin marasa lafiya da ke fama da nau'in ciwon sukari na 2, ana lura da haɓaka aikin aikin reat-sel. Matsakaicin haɓaka aikin ƙwayoyin beta ya dogara da matakin lalacewarsu ta farko, don haka a cikin mutane ba sa shan wahala daga ciwon sukari mellitus (tare da matsakaicin matakan glucose na yau da kullun), vildagliptin baya motsa ƙwayar insulin kuma baya rage matakin glucose.

Ta hanyar ƙara yawan haɗuwa da GLP-1 na endogenous GLP-1, vildagliptin yana ƙara ƙwarewar ƙwayoyin α-sel zuwa glucose, wanda ke haifar da haɓakawa ga tsarin glucose na glucose. Decreasearin rage yawan glucagon ƙwayar abinci yayin abinci, bi da bi, yana haifar da raguwar juriya insulin.

Increaseara yawan haɓakar insulin / glucagon a kan yanayin hyperglycemia, saboda karuwa a cikin yawan ƙwayoyin cuta na GLP-1 da HIP, yana haifar da raguwar haɓakar glucose ta hanta duka a cikin lokacin prandial da bayan cin abinci, wanda ke haifar da raguwa da yawaitar glucose a cikin jini na jini.

Bugu da ƙari, a kan asalin amfani da vildagliptin, an lura da raguwa a cikin matakin lipids a cikin jini na jini, duk da haka, wannan tasiri ba shi da alaƙa da tasirinsa akan GLP-1 ko HIP da haɓakawa a cikin aikin ƙwayoyin beta na pancreatic.

An san cewa karuwa a GLP-1 na iya rage jinkirin motsa jiki, amma ba a lura da wannan tasirin ba tare da amfani da vildagliptin.

Galvus Met magani ne na baki wanda yake hade da maganin jiki. Abun da ke cikin miyagun ƙwayoyi Galvus Met ya haɗa da wakilai biyu na hypoglycemic tare da nau'ikan hanyoyin daban-daban: vildagliptin, mallakar ɓangare na dipeptidyl peptidase-4 inhibitors, da metformin (a cikin nau'in hydrochloride), wakilin aji na biguanides. Haɗin waɗannan abubuwan yana ba ku damar sarrafa yadda yakamata ku kula da yawan haɗuwar glucose a cikin jini a cikin marasa lafiya da masu ciwon sukari na 2 a cikin sa'o'i 24.

Abun ciki

Vildagliptin + magabata (Galvus).

Vildagliptin + Metformin hydrochloride + magabata (Galvus Met).

Pharmacokinetics

Lokacin da aka ɗauka akan komai a ciki, ana saka vildagliptin cikin sauri. Tare da shigo da abinci lokaci guda tare da abinci, yawan shan vildagliptin yana raguwa kaɗan, duk da haka, cin abinci ba ya shafar ƙimar sha da kuma AUC. An rarraba magungunan a ko'ina tsakanin plasma da sel jini. Biotransformation shine hanya ta farko ta excretion na vildagliptin. A jikin mutum, kashi 69% na maganin yana canzawa. Bayan shiga magungunan, kusan kashi 85% na kashi yana cirewa ne ta hanyar kodan kuma 15% ta hanjin hanji, koda na fitowar vildagliptin na canzawa shine 23%.

Jinsi, ma'aunin taro, da kabilanci ba su shafar magungunan likitanci na vildagliptin.

Ba a kafa tsarin magunguna na vildagliptin na yara da matasa a cikin shekaru 18 ba.

A bangon baya na cin abinci, da karancin digiri da yawan shan sinadarin metformin ya ragu. Magungunan a zahiri ba su ɗaukar nauyin sunadaran plasma, yayin da abubuwan da ake amfani da su na sulfonylurea ke ɗaure su sama da 90%. Metformin yana shiga cikin sel jini (mai yiwuwa ƙarfafa wannan tsari akan lokaci). Tare da gudanarwa guda ɗaya na gudanarwa ga masu sa kai na lafiya, metformin yana kwance da ƙodan baya canzawa. Ba a metabolized a cikin hanta (ba'a gano kwayoyin metabolites a cikin mutane ba) kuma ba'a fidda shi cikin bile ba. Lokacin da aka shiga cikin ciki, kusan kashi 90% na abubuwan da aka zubarwa ana keɓance su ta cikin kodan a cikin awanni 24 na farko.

Jinsi na marasa lafiya ba ya shafar magunguna na metformin.

Ba a kafa sifofin magunguna na metformin a cikin yara da matasa masu shekaru 18 ba.

Sakamakon abinci a kan pharmacokinetics na vildagliptin da metformin a cikin haɗin maganin miyagun ƙwayoyi Galvus Met bai bambanta da wannan lokacin shan magunguna daban.

Alamu

Type 2 ciwon sukari mellitus:

kamar yadda monotherapy a hade tare da tsarin abinci da motsa jiki,
a cikin marasa lafiya da ke karɓar maganin haɗin gwiwa tare da vildagliptin da metformin a cikin nau'ikan magunguna guda ɗaya (don Galvus Met),
a hade tare da metformin azaman farkon farawa na magani tare da isasshen ingancin maganin abinci da motsa jiki,
kamar yadda wani ɓangare na kayan haɗin haɗuwa biyu tare da metformin, abubuwan asali na sulfonylurea, thiazolidinedione ko tare da insulin cikin yanayin rashin ingancin maganin abinci, motsa jiki da monotherapy tare da waɗannan kwayoyi,
a matsayin wani ɓangare na ilmin haɗi sau uku: a hade tare da abubuwan da ake amfani da su na sulfonylurea da metformin a cikin marasa lafiyar da aka bi da su tare da abubuwan da suka samo asali na maganin sulfonylurea da metformin game da yanayin abinci da motsa jiki waɗanda kuma basu sami isasshen sarrafa glycemic ba,
a matsayin wani ɓangare na ilmin haɗi sau uku: a hade tare da insulin da metformin a cikin marasa lafiya waɗanda a baya sun karɓi insulin da metformin a kan yanayin abinci da motsa jiki kuma waɗanda ba su sami isasshen iko na glycemic ba.

Sakin Fom

Allunan 50 MG (Galvus).

Allunan da aka rufe 50 + 500 MG, 50 + 850 MG, 50 + 1000 MG (Galvus Met).

Umarnin don amfani da sashi

Ana ɗaukar Galvus ta baki ba tare da la'akari da cin abinci ba.

Ya kamata a zaɓi jigilar magunguna daban-daban dangane da tasiri da haƙuri.

Thewarin da aka ba da shawarar maganin a lokacin monotherapy ko kuma a matsayin ɓangaren maganin haɗin haɗakar abubuwa biyu tare da metformin, thiazolidinedione ko insulin (a hade tare da metformin ko ba tare da metformin ba) shine 50 MG ko 100 MG kowace rana. A cikin marasa lafiya da ke fama da cutar sukari mai nau'in 2 da ke karɓar magani tare da insulin, ana ba da shawarar Galvus a kashi 100 na MG kowace rana.

Thewarin da aka ba da shawarar magani na Galvus a matsayin wani ɓangare na maganin haɗin gwiwa sau uku (vildagliptin + sulfonylurea Kalam + metformin) shine 100 MG kowace rana.

Ya kamata a ba da kashi 50 na MG kowace rana a cikin kashi 1 na safe. Ya kamata a ba da allurar 100 a kowace rana sau 50 a rana da safe da maraice.

Lokacin amfani da shi azaman ɓangare na maganin haɗin haɗakar abubuwa biyu tare da abubuwan da suka samo asali na sulfonylurea, maganin da aka bada shawarar Galvus shine 50 MG 1 a kowace rana da safe. Lokacin da aka tsara shi a hade tare da abubuwan da suka samo asali na sulfonylurea, tasirin maganin maganin ƙwaƙwalwa a cikin kashi 100 MG kowace rana ya kasance daidai da hakan a kashi 50 na MG kowace rana. Tare da rashin isasshen sakamako na asibiti a kan asalin amfani da matsakaicin shawarar da aka bayar na yau da kullun na 100 MG, don mafi kyawun sarrafawa na glycemia, ƙarin takardar sayen magunguna na hypoglycemic mai yiwuwa ne: metformin, abubuwan da suka samo asali na sulfonylurea, thiazolidinedione ko insulin.

A cikin marasa lafiya da ke fama da rauni koda da aikin hepatic, ba a buƙatar daidaita sashi ba. A cikin marasa lafiya da ke da matsakaiciyar matsakaici ko mummunan rauni na aiki na renal (ciki har da muguwar ƙarancin ƙarancin ƙarancin koda a kan hemodialysis), ya kamata a yi amfani da miyagun ƙwayoyi a kashi 50 MG sau ɗaya a rana.

A cikin tsofaffi marasa lafiya (fiye da shekaru 65), ba a buƙatar gyaran tsarin maganin rage yawan maganin Galvus.

Tun da babu kwarewa game da amfani da miyagun ƙwayoyi a cikin yara da matasa a cikin shekaru 18, ba a ba da shawarar yin amfani da miyagun ƙwayoyi a cikin wannan rukuni na marasa lafiya.

Ana gudanar da maganin a baka. Dole ne a zaba tsarin magani na Galvus Met daban-daban dangane da tasiri da haƙuri. Lokacin amfani da Galvus Met, kada ku ƙeta yawan adadin shawarar da aka bayar na maganin yau da kullun na vildagliptin (100 MG).

Ya kamata a zaɓi kashi na farko na shawarar Galvus Met, yin la'akari da tsarin kulawa da mai haƙuri tare da vildagliptin da / ko metformin. Don rage tsananin tasirin sakamako daga tsarin narkewar abinci na metformin, ana ɗaukar Galvus Met tare da abinci.

Kashi na farko na Galvus Met tare da rashin tasiri na monotherapy tare da vildagliptin: ana iya farawa tare da Galvus Honey tare da kwamfutar hannu guda ɗaya tare da maganin 50 mg / 500 mg sau 2 a rana, kuma bayan kimanta tasirin warkewa, ana iya ƙara yawan kashi a hankali.

Yankin na farko na Galvus Met tare da rashin ingancin metformin monotherapy: dangane da adadin metformin da aka riga aka dauka, ana iya fara magani tare da Galvus Met tare da kwamfutar hannu guda ɗaya tare da maganin 50 mg / 500 mg, 50 mg / 850 mg ko 50 mg / 1000 mg sau 2 a rana.

Kashi na farko na Galvus Met a cikin marasa lafiya waɗanda a baya sun karɓi maganin haɗin gwiwa tare da vildagliptin da metformin kamar allunan dabam: dangane da allurai na vildagliptin ko metformin da aka riga aka ɗauka, jiyya tare da Galvus Met ya kamata a fara da kwamfutar hannu kamar yadda zai yiwu ga maganin da ke gudana 50 mg / 500 mg , 50 MG / 850 MG ko 50 MG / 1000 MG, kuma an sanya shi ta sakamako.

Kashi na farko na Galvus Met a matsayin magani na farko a cikin marasa lafiya da ke da nau'in ciwon sukari na 2 na rashin daidaituwa tare da ƙoshin lafiyar abinci da motsa jiki: azaman farawa, Galvus Met ya kamata a tsara shi a cikin kashi na farko na 50 mg / 500 mg sau ɗaya a rana kuma sannu a hankali bayan kimanta tasirin warkewa kashi biyu na kashi 50 a rana.

Harkokin haɗin gwiwa tare da Galvus Met tare da abubuwan da ake amfani da su na sulfonylurea ko insulin: ana lissafta kashi na Galvus Met daga kashi na vildagliptin 50 mg sau 2 a rana (100 MG kowace rana) da metformin a cikin kashi daidai yake da wanda aka ɗauke shi azaman magani ɗaya.

Yin amfani da Galvus Met an hana shi cikin marasa lafiya tare da gazawar renal ko lalacewar aikin renal.

Kodan ya fitar da kodan. Tun da marasa lafiya fiye da shekaru 65 sau da yawa suna da raguwa a cikin aikin renal, an wajabta Galvus Met a cikin wannan rukuni na marasa lafiya a cikin mafi ƙarancin kashi wanda ke tabbatar da daidaituwa na yawan glucose kawai bayan ƙaddara QC don tabbatar da aiki na al'ada na renal. Lokacin amfani da miyagun ƙwayoyi a cikin marasa lafiya waɗanda suka girmi shekaru 65, yana da Dole a kula da aikin koda yaushe.

Tunda ba a bincika aminci da tasiri na Galvus Met a cikin yara da matasa masu shekaru 18 ba, ba amfani da magungunan a cikin wannan rukuni na marasa lafiya.

Side sakamako

ciwon kai
tsananin farin ciki
rawar jiki
jin sanyi
tashin zuciya, amai,
mawakwalwa na ciki,
ciwon ciki
zawo, maƙarƙashiya,
rashin tsoro
hawan jini,
hyperhidrosis
gajiya
fata tayi
cututtukan mahaifa
itching
arthralgia
na gefe harshe,
hepatitis (ana iya juyawa akan dakatar da jiyya),
maganin cututtukan farji
karkatar da fata na fata,
blisters
rage sha na bitamin B12,
lactic acidosis
ƙarfe ɗanɗano a bakin.

Contraindications

gazawar renal ko rashin aiki na renal: tare da matakin ƙwayar ƙwaƙwalwa na ƙwaƙwalwar ƙwaƙwalwa fiye da 1.5 mg% (fiye da 135 μmol / l) ga maza da fiye da 1.4 mg% (fiye da 110 μmol / l) ga mata,
mummunan yanayin da ke tattare da haɓakar haɓakar ƙwayar yara: fitsari (tare da gudawa, amai), zazzabi, cututtukan da ke kara kamuwa da cuta, yanayin rashin ƙarfi a jiki (rawar jiki, mafitsara, cututtukan koda, cututtukan zuciya),
m da na kullum zuciya rashin cin nasara, m rauni na zuciya, rauni na zuciya da jijiyoyin jini (gigice),
gazawar numfashi
aikin hanta mai rauni,
m ko na kullum acidosis na rayuwa (ciki har da ketoacidosis mai ciwon sukari a hade tare da ko ba tare da coma ba). Ya kamata a gyara ketoacidosis na ciwon sukari ta hanyar insulin therapy,
lactic acidosis (gami da tarihi),
ba a sanya magani ba kwana biyu kafin tiyata, radioisotope, karatun x-ray tare da gabatarwar masu bambanci kuma cikin kwanaki 2 bayan an yi su,
ciki
lactation
nau'in ciwon sukari guda 1
na kullum barasa, guba mai guba,
biye da tsarin karancin kalori (kasa da 1000 kcal a rana),
yara 'yan ƙasa da shekara 18 (ba a kafa ingantaccen aiki da amincin amfani ba),
hypersensitivity to vildagliptin ko metformin ko duk wasu abubuwan haɗin maganin.

Tunda marasa lafiya da ke fama da rauni na hanta a wasu halaye, an lura da lactic acidosis, wanda tabbas yana ɗaya daga cikin tasirin sakamako na metformin, Galvus Met bai kamata a yi amfani da shi ba a cikin marasa lafiya da cututtukan hanta ko ƙarancin cututtukan cututtukan hepatic.

Tare da taka tsantsan, ana bada shawara don amfani da kwayoyi masu dauke da metformin a cikin marasa lafiya fiye da shekaru 60, da kuma lokacin yin babban aiki na zahiri saboda ƙaruwar lactic acidosis.

Haihuwa da lactation

Tun da mata masu juna biyu ba su da isasshen bayanai game da amfani da miyagun ƙwayoyi Galvus ko Galvus Met, amfani da miyagun ƙwayoyi a lokacin daukar ciki ya haɗu.

A yanayin rashin wadatar abinci na glucose a cikin mata masu juna biyu, akwai karuwar hadarin haɓakar asaran haihuwa, da kuma yawan cututtukan ƙananan yara da mace-mace. Don daidaita yawan ƙwayar glucose na jini yayin ɗaukar ciki, ana bada shawarar insulin monotherapy.

A cikin nazarin gwaji, lokacin da aka rubuta vildagliptin a allurai sau 200 sama da wanda aka ba da shawarar, magungunan bai haifar da nakasar haihuwa da farkon haɓaka tayin kuma ba ta yi tasirin teratogenic akan tayin ba. Lokacin da aka tsara vildagliptin a hade tare da metformin a cikin rabo na 1:10, babu kuma wani tasirin teratogenic akan tayin.

Tunda ba a san ko vildagliptin ko metformin ba a cikin madarar ɗan adam, amfani da miyagun ƙwayoyi Galvus yayin shayarwa yana shayarwa.

Yi amfani da yara

Contraindicated a cikin yara da matasa a kasa da shekara 18 (inganci da amincin amfani ba a kafa).

Yi amfani da shi a cikin tsofaffi marasa lafiya

Tare da taka tsantsan, ana bada shawara don amfani da kwayoyi waɗanda ke ɗauke da metformin a cikin marasa lafiya waɗanda suka girmi shekaru 60.

Umarni na musamman

A cikin marasa lafiya da ke karɓar insulin, Galvus ko Galvus Met ba za su iya maye gurbin insulin ba.

Tun lokacin da ake amfani da vildagliptin, an ƙara haɓakar ayyukan aminotransferases (yawanci ba tare da bayyanar cututtuka ba) an lura da ɗan lokaci fiye da ƙungiyar sarrafawa, kafin sanya magani Galvus ko Galvus Met, kazalika a kai a kai yayin kulawa tare da miyagun ƙwayoyi, ana bada shawara don ƙayyade sigogin biochemical na aikin hanta. Idan mai haƙuri yana da ƙarin aiki na aminotransferases, wannan binciken yakamata a tabbatar da shi ta hanyar binciken na biyu, sannan kuma a kai a kai ƙayyade sigogin ƙirar ƙwayar ƙwayar halittar hanta har sai sun daidaita. Idan wuce haddi na AST ko ayyukan ALT ya zama 3 ko fiye da hakan sama da VGN an tabbatar da shi ta hanyar maimaita binciken, ana bada shawara a soke maganin.

Lactic acidosis abu ne mai wuya amma mai rikitarwa yanayin rayuwa wanda ke faruwa tare da tara yawan metformin a jiki. Lactacidosis tare da amfani da metformin an lura da shi musamman a cikin marasa lafiya da ke fama da ciwon sukari mellitus tare da gazawar haɓaka ƙima. Hadarin kamuwa da cututtukan lactic acidosis ya ƙaru a cikin marasa lafiya waɗanda ke fama da rashin lafiya mai saurin kamuwa da cutar sankara, tare da ketoacidosis, matsananciyar yunwar, tsawaita shan giya, gazawar hanta da kuma cututtukan da ke haifar da ƙin jini.

Tare da haɓakar lactic acidosis, ƙarancin numfashi, ciwon ciki da hauhawar jini an lura, tare da coma. Manuniya na gwaje-gwaje masu zuwa suna da ƙimar bincike: raguwa a cikin pH na jini, taro mai lactate taro sama da 5 nmol / l, kazalika da karuwar tazara ta anionic da karuwar rabo na lactate / pyruvate. Idan ana zargin metabolic acidosis, ya kamata a dakatar da miyagun ƙwayoyi kuma mai haƙuri ya tafi asibiti nan da nan.

Tunda ƙananan ƙwayoyin metformin sun toshe kodan, haɗarin haɗinsa da haɓakar lactic acidosis yana da girma, mafi yawan aikin ƙarancin ke lalacewa. Lokacin amfani da miyagun ƙwayoyi, Galvus Met ya kamata yayi kimanta aikin na mutum a kai a kai, musamman a cikin yanayin da ke biyo baya wanda ke ba da gudummawa ga cin zarafin sa: yanayin farko na magani tare da magungunan antihypertensive, wakilai na hypoglycemic, ko NSAIDs. A matsayinka na doka, ya kamata a tantance aikin renal kafin a fara jiyya tare da Galvus Met, sannan aƙalla lokaci 1 a cikin shekara ga marasa lafiya waɗanda ke da aikin na ainihi na al'ada kuma aƙalla sau 2-4 a cikin shekara ga marasa lafiya tare da ƙwayoyin serum creatinine sama da VGN. A cikin marasa lafiya da ke cikin haɗarin rauni na aikin keɓaɓɓen aiki, ya kamata a sanya idanu sosai fiye da sau 2-4 a shekara. Idan alamun rashin aiki na renal ya bayyana, Galvus Met ya kamata a daina.

Lokacin gudanar da nazarin fasahar da ke buƙatar sarrafawar ƙwayar ciki na wakilin maganin bambancin maganin aidin, mai amfani da Galvus Met ya kamata a dakatar da shi na ɗan lokaci (sa'o'i 48 kafin kuma a cikin awanni 48 bayan binciken), tun da gudanarwar cikin kwayar iodine mai dauke da kayan aikin rediyo na iya haifar da mummunar barna a aikin koda da ƙara haɗarin cutar ci gaban lactic acidosis. Kuna iya sake komawa shan Galvus Met kawai bayan kimantawa na biyu na aikin koda.

A cikin rauni na zuciya da jijiyoyi (rawar jiki), gazawar zuciya mai rauni, raunin myocardial infarction da sauran halaye wadanda halin hypoxia ke nunawa, haɓakar lactic acidosis da kuma rashin haihuwa mai haɓaka mai yiwuwa ne. Idan yanayin da ke sama ya faru, ya kamata a dakatar da miyagun ƙwayoyi nan da nan.

Yayin ayyukan tiyata (ban da ƙananan ayyukan da ba su da alaƙa da iyakance yawan abinci da ruwa), Galvus Met ya kamata a daina. Kuna iya sake komawa shan maganin bayan mai haƙuri ya fara ɗaukar abinci da kansa kuma za a nuna cewa aikin ƙwayar sa ba ta da matsala.

An tabbatar da cewa ethanol (barasa) yana inganta tasirin metformin akan metabolism na lactate. Yakamata a gargadi marassa lafiya game da rashin halayen shaye-shaye yayin amfani da miyagun ƙwayoyi Galvus Met.

An gano cewa metformin a cikin kusan 7% na lokuta yana haifar da raguwar asymptomatic a cikin taro na bitamin B12. Irin wannan raguwa a cikin lambobin marasa galihu suna haifar da ci gaban anemia. A bayyane yake, bayan dakatar da metformin da / ko bitamin B12 sauyawa magani, taro taro na bitamin B12 da sauri al'ada. Marasa lafiya da ke karɓar Galvus Met, an ba da shawarar aƙalla 1 lokaci a shekara don gudanar da gwajin jini gaba ɗaya kuma idan an gano wani take hakkin, yanke dalilin su kuma ɗauki matakan da suka dace. A bayyane yake, wasu marasa lafiya (alal misali, marasa lafiya marasa isasshen ci ko malabsorption na bitamin B12 ko alli) suna da tsinkaye don rage yawan ƙwayar cutar ta bitamin B12. A irin waɗannan halayen, ana iya ba da shawarar don ƙayyade tara ƙwayar bitamin B12 aƙalla 1 lokaci a cikin shekaru 2-3.

Idan mai haƙuri tare da nau'in ciwon sukari na 2 na mellitus, wanda ya amsa wa kansa a baya, ya nuna alamun karuwa (canji a sigogi na dakin gwaje-gwaje ko bayyanar asibiti), kuma ba a bayyanar da alamun bayyanar ba, ya kamata a yi gwaje-gwaje nan da nan don gano ketoacidosis da / ko lactic acidosis. Idan aka tabbatar da acidosis a wani tsari ko wata, to ya kamata ka dakatar da Galvus Met kai tsaye kuma ka ɗauki matakan da suka dace.

Yawanci, a cikin marasa lafiya da ke karɓar Galvus Met kawai, ba a lura da cutar hypoglycemia ba, duk da haka, yana iya faruwa a kan tushen abinci mai kalori mai ƙaranci (lokacin da zafin jiki ba a rama adadin kuzari da abincin), ko kuma tushen amfani da barasa. Hypoglycemia yana iya yiwuwa a cikin tsofaffi, nakasasshe ko mara lafiya marasa lafiya, kazalika da tushen asalin cutar rashin ƙarfi, rashin ƙarfi ko maye. A cikin tsofaffi marasa lafiya da kuma a cikin marasa lafiya da ke karɓar beta-blockers, ganewar asali na hypoglycemia na iya zama da wahala.

Tare da damuwa (zazzabi, rauni, kamuwa da cuta, tiyata) wanda ya tashi a cikin mai haƙuri yana karɓar wakilai na hypoglycemic a cikin tsayayyar yanayi, raguwar ƙaƙƙarfan tasiri a ƙarshen ƙarshen na wani lokaci mai yiwuwa ne. A wannan yanayin, yana iya zama dole a soke Galvus Met kuma a tsara insulin. Kuna iya sake komawa magani tare da Galvus Met bayan ƙarshen lokacin tsananin.

Tasiri kan ikon tuka motoci da hanyoyin sarrafa abubuwa

Sakamakon magani Galvus ko Galvus Met akan ikon tuka motoci da aiki tare da kayan aikin ba'a yi binciken su ba. Tare da haɓaka dizzness a kan asalin amfani da miyagun ƙwayoyi, ya kamata mutum ya guji tuki motocin tare da aiki da hanyoyin.

Hulɗa da ƙwayoyi

Tare da yin amfani da vildagliptin na lokaci guda (100 MG 1 lokaci ɗaya kowace rana) da metformin (1000 mg 1 lokaci ɗaya kowace rana), ba'a lura da ma'amala mai mahimmanci ta hanyar magunguna tsakanin su ba. Ba tare da gwaji na asibiti ba, ko yayin amfani da asibiti na Galvus Met a cikin marasa lafiya da ke karɓar sauran magunguna masu haɗari da abubuwa, ba a gano ma'amala mara amfani ba.

Vildagliptin yana da ƙananan damar don hulɗa da miyagun ƙwayoyi. Tunda vildagliptin ba shine abubuwan cytochrome P450 isoenzymes ba, kuma ba sa hanawa ko haifar da waɗannan isoenzymes, hulɗarta tare da kwayoyi waɗanda ke canzawa, inhibitors, ko P450 inducers ba zai yiwu ba. Tare da yin amfani da vildagliptin na lokaci daya baya tasiri akan matakan metabolism na magunguna waɗanda suke maye gurbin enzymes: CYP1A2, CYP2C8, CYP2C9, CYP2C19, CYP2D6, CYP2E1 da CYP3A4 / 5.

Babu wata muhimmiyar hulɗar asibiti na vildagliptin tare da magungunan da aka fi amfani da su a cikin jiyya na cututtukan type 2 na mellitus (glibenclamide, pioglitazone, metformin) ko tare da madaidaicin kewayon warkewa (amlodipine, digoxin, ramipril, simvastatin, valsartan, warfarin).

Furosemide yana haɓaka Cmax da AUC na metformin, amma baya tasiri akan ƙididdigar ɗan ta. Metformin yana rage Cmax da AUC na furosemide kuma baya tasiri izinin sake fasalin su.

Nifedipine yana kara yawan sha, Cmax da AUC na metformin, ban da haka, yana kara fitar sha'awa cikin fitsari. Metformin a zahiri ba ya shafar sigogin magunguna na nifedipine.

Glibenclamide ba ya shafar tsarin ma'aunin magunguna / magunguna na metformin. Metformin gaba ɗaya yana rage Cmax da AUC na glibenclamide, amma girman tasirin yana bambanta sosai. A saboda wannan dalili, tabbatacce game da wannan hulɗa ya kasance ba a sani ba.

Abubuwan kula da kwayoyin, alal misali, amiloride, digoxin, morphine, procainamide, quinidine, quinine, ranitidine, triamteren, trimethoprim, vancomycin, da sauransu, da kodan ta hanyar ɓoyewar tubular, za a iya yin tunani tare da metformin, tunda suna gasa ga tsarin safarar tubule na kowa. Cimetidine yana ƙaruwa da yawan haɗuwa da metformin a cikin plasma / jini da ƙungiyar ta AUC da kashi 60% da 40%, bi da bi. Metformin baya tasiri ga tsarin magunguna na cimetidine.

Yakamata a yi taka tsantsan yayin amfani da Galvus Met tare da magunguna waɗanda ke shafar aikin koda ko rarraba metformin a cikin jiki.

Wasu kwayoyi na iya haifar da hyperglycemia da rage tasirin wakilai na hypoglycemic, irin waɗannan magungunan sun hada da thiazides da sauran diuretics, glucocorticosteroids (GCS), phenothiazines, shirye-shiryen hodar iblis, estrogens, maganin hana haihuwa, phenytoin, acid nicotinic, mai juyayi, da kuma alli. Lokacin rubuta irin waɗannan magunguna masu haɗuwa, ko kuma, musayar, idan an soke su, ana bada shawara don saka idanu sosai akan tasiri na metformin (tasirin hypoglycemic) kuma, idan ya cancanta, daidaita sashi na maganin.

Kada a bada shawarar yin amfani da gudaz din danazol a lokaci guda don guje wa tasirin karshen rayuwar. Idan jiyya tare da danazol ya zama dole kuma bayan dakatar da ƙarshen, ana buƙatar daidaita sashi na metformin a ƙarƙashin kula da matakin glucose.

Chlorpromazine lokacin da aka karɓa a cikin manyan allurai (100 MG kowace rana) yana ƙaruwa glycemia, yana rage ƙaddamar da insulin. A cikin maganin rigakafin ƙwayar cuta da kuma bayan dakatar da ƙarshen, ana buƙatar daidaita sashi a ƙarƙashin kula da matakan glucose.

Nazarin rediyo ta amfani da wakilai masu dauke da sinadarin iodine na iya haifar da ci gaban lactic acidosis a cikin marasa lafiya da ke fama da ciwon sukari mellitus tare da gazawar aikin koda.

An sanya shi azaman injections, beta2-sympathomimetics yana ƙaruwa glycemia saboda haɓakar masu karɓar beta2-adrenergic. A wannan yanayin, sarrafa glycemic wajibi ne. Idan ya cancanta, ana bada shawarar yin insulin.

Ta yin amfani da metformin lokaci guda tare da abubuwan da suka samo asali na sulfonylurea, insulin, acarbose, salicylates, haɓaka tasirin hypoglycemic mai yiwuwa ne.

Tun da amfani da metformin a cikin marasa lafiya tare da matsanancin maye na barasa yana kara haɗarin lactic acidosis (musamman yayin yunwar, ci, ko gazawar hanta), marasa lafiya ya kamata su guji shan barasa da kwayoyi masu ɗauke da ethanol (barasa) yayin jiyya tare da Galvus Met.

Analogs na miyagun ƙwayoyi Galvus

Tsarin analogues na mai aiki abu:

Analogs a cikin rukunin magunguna (wakilai na hypoglycemic):