Yadda ake ɗaukar Diagninid don ciwon sukari

Tabletaya daga cikin kwamfutar hannu ya ƙunshi:

Maimaita abu cikin 100% - 0,5 mg, 1 mg da 2 mg,

Poloxamer (nau'in 188) 3 mg, 3 mg ko 3 mg, meglumine 10 mg, 10 mg ko 13 mg, lactose monohydrate 47.8 mg, 47.55 mg ko 61.7 mg, microcrystalline cellulose 33.7 mg, 33, MG 45 mg ko 45 mg, polacryline potassium 4 mg, 4 mg ko 4 mg, colloidal silicon dioxide 0.5 mg, 0.5 mg ko 0.7 mg, magnesium stearate 0.5 mg, 0.5 mg ko 0.6 mg da bi.

Pharmacodynamics

Short-aiki na baka hypoglycemic magani. Yana ƙarfafa sakin insulin daga aiki a cikin ƙwayoyin beta na pancreas. Yana toshe tashoshi masu dogaro da ATP a cikin membranes na sel Kwayoyin ta hanyar kariyar sunadarai, wanda ke haifar da yankewar ƙwayoyin beta da buɗewar tashoshi na alli. Increasedarin yawan ions alli na calcium yana haifar da ɓoye insulin. A cikin marasa lafiya da nau'in ciwon sukari na 2 na mellitus, ana lura da insulinotropic martani ga abincin abinci a cikin mintina 30 bayan fitowar maganin. Wannan yana samar da raguwa a cikin tattarawar glucose a cikin jini yayin duk lokacin cin abinci. A wannan yanayin, yawan maida hankali a cikin plasma yana raguwa da sauri, kuma sa'o'i 4 bayan shan miyagun ƙwayoyi, an gano ƙaramin maida hankali ne a cikin plasma na marasa lafiya da nau'in ciwon sukari na 2. Lokacin amfani da repaglinide a cikin kewayon kashi daga 0.5 zuwa 4 MG, an lura da rage-yawan-dogara da ragewar haɗuwa a cikin glucose.

Pharmacokinetics

Lokacin da aka sha shi a baki, yawan shan ruwa daga ƙwayar jijiyoyin jiki suna da yawa. Lokacin da za a kai ga maida hankali shine sa'a 1. Matsakaicin bioavailability na fannoni shine kashi 63% (masu saurin magana shine 11%). Tunda titration na kashi na repaglinide ana aiwatar dashi gwargwadon mayar da martani ga warkasuwa, bambance banbance mai banbancin tasiri baya tasiri tasirin magani.

Volumearar watsawa - 30 l. Sadarwa tare da ƙwayoyin plasma - 98%.

An lalata shi gaba daya a cikin hanta ta hanyar bayyanar CYP3A4 zuwa metabolites marasa aiki.

An cire shi ta hanyar hanjin ciki, da kodan - 8% a cikin hanyar metabolites, ta cikin hanji - 1%. Rabin rayuwar shine 1 awa.

Yin amfani da maganin repaglinide a allurai na yau da kullun a cikin marassa lafiyar da ke fama da cutar hanta na iya haifar da maida hankali sosai da maganin farfadiya fiye da marasa lafiya da aikin hanta na yau da kullun. A wannan batun, amfani da maganin repaglinide an ba shi cikin marasa lafiya da rauni mai rauni, kuma a cikin marasa lafiya da ke fama da rauni na hepatic na laushi zuwa matsakaiciyar hanta ya kamata a yi amfani dashi da taka tsantsan. Matsakaicin tsakanin daidaitawa yakamata a kara zuwa mafi kimanta ƙimar amsawar da aka samu.

Yankin da ke ƙarƙashin lokacin ɗaukar lokaci (AUC) kuma mafi girman maida hankali a cikin plasma (C_max) iri ɗaya ne a cikin marasa lafiya da keɓaɓɓen aikin koda kuma a cikin marasa lafiya da ke fama da rauni na matsakaici ko matsin lamba. A cikin marasa lafiya da raunin rashin lafiyar koda, an lura da karuwa a cikin AUC da C_maxduk da haka, kawai mai rauni hulɗa tsakanin maida hankali ne game da repaglinide da yardawar Allah ya bayyana. Da alama marasa lafiya da ke fama da rauni na aiki koda babu buƙatar daidaita sigar farko. Koyaya, ƙarin kashi mai zuwa na gaba a cikin marasa lafiya da ke da nau'in ciwon sukari na 2 na ciwon sukari a haɗe tare da raunin ƙwayar cutar koda, wanda ke buƙatar hemodialysis, ya kamata a yi shi da taka tsantsan.

Diagninide: Manuniya

Nau'in ciwon sukari na 2 na ciwon sukari (tare da maganin rashin ingancin abinci, asarar nauyi da aiki na jiki) a cikin monotherapy ko a hade tare da metformin ko thiazolidinediones a cikin yanayi inda ba zai yiwu a sami ikon sarrafa glycemic mai gamsarwa tare da monotherapy tare da farfadowa ko metformin ko thiazolidinediones.

Diagninide: Contraindications

- Sanannen ruɓaɓɓen hankali don ramawa ko ga kowane ɓangaren magungunan,

- Type 1 ciwon sukari

- Ketoacidosis masu ciwon sukari, da kuma masu ciwon sukari,

- Cututtuka, manyan ayyukan tiyata da sauran halaye masu buƙatar insulin far,

- Lalacewar mummunan hanta,

- Wa'adin na lokaci daya na gemfibrozil (duba "hulɗa tare da wasu kwayoyi"),

- Rage karancin Lactase, rashin haƙuri a cikin lactose, glucose-galactose malabsorption,

- Cutar ciki da lactation,

- Shekarun yara har zuwa shekaru 18.

Ba a gudanar da nazarin asibiti a cikin marasa lafiya da ke ƙasa da shekara 18 da girmi 75 ba.

Tare da kulawa (buƙatar buƙatar kulawa da hankali) ya kamata a yi amfani da shi don aikin hanta mai rauni na digiri zuwa matsakaici na matsakaici, cututtukan febrile, lalacewa na koda, rashin shan giya, yanayin babban yanayin, rashin abinci mai gina jiki.

Haihuwa da lactation

Ba a gudanar da bincike kan amfani da maganin repaglinide a cikin mata masu juna biyu ba. Sabili da haka, amincin repaglinide a cikin mata masu ciki ba a yi nazari ba.

Lokacin shayarwa

Ba a gudanar da nazari kan amfani da maganin repaglinide a cikin mata yayin shayarwa ba. Idan ya zama dole ayi amfani da magani yayin shayarwa, ya kamata a daina shayar da jarirai.

Sashi da gudanarwa

Magungunan Diagnlinid ® an wajabta shi azaman daidai ne don maganin abinci da aiki na jiki don rage taro da glucose a cikin jini, ya kamata a gudanar da tsarinsa zuwa abinci.

Ana shan maganin a baki kafin manyan abinci 2, 3 ko 4 sau ɗaya a rana, yawanci mintina 15 kafin cin abinci, amma kuma ana iya ɗauka a cikin kewayon daga mintuna 30 kafin cin abinci zuwa daidai lokacin cin abinci.

An zaɓi kashi na miyagun ƙwayoyi daban-daban ga kowane mara lafiya, gwargwadon yawan glucose a cikin jini.

Maganin farko shine 0.5 MG / rana (idan mai haƙuri ya ɗauki wani magani na maganin hypoglycemic na baka - 1 mg). Ana aiwatar da gyaran fuska ne sau 1 a cikin mako ɗaya ko kuma 1 lokaci a cikin makonni 2 (yayin da ake mayar da hankali kan taro na glucose a cikin jini, a matsayin mai nuna amsa ga warkewa). Matsakaicin adadin guda ɗaya shine 4 MG. Matsakaicin kullun shine 16 MG.

Canja wurin marasa lafiya tare da jiyya tare da wasu magunguna na baka hypoglycemic Ana iya yin maganin ta farfadowa nan take. Koyaya, ainihin dangantakar tsakanin maganin repaglinide da kashi na sauran magunguna na hypoglycemic ba'a bayyana ba. Mafi girman shawarar farko na maganin repaglinide yayin canja shi daga wasu magungunan hypoglycemic shine 1 MG kafin babban abincin.

Ana iya ba da maganin farfadowa a hade tare da metformin ko thiazolidinediones dangane da rashin isasshen ikon glucose na jini akan monotherapy tare da metformin, thiazolidinediones ko repaglinide. A wannan yanayin, ana amfani da guda ɗin farko na repaglinide kamar yadda yake tare da monotherapy. Sannan aiwatar da gyaran fuska na kowane magani gwargwadon nasarar yawan glucose a cikin jini.

Groupsungiyoyin haƙuri na musamman

(duba sashen "Umarnin na Musamman").

Ba'a ba da shawarar yin amfani da maganin fansa ga mutanen da ke ƙasa da shekara 18 saboda ƙarancin isasshen bayanai kan amincinsa da tasirin sa a wannan rukuni na marasa lafiya.

Diagninide: Sakamakon Gashi

Sakamakon sakamako na yau da kullun shine hypoglycemia, mita wanda ya dogara, kamar yadda tare da kowane irin nau'in maganin ciwon sukari, a kan abubuwan mutum kamar halaye na cin abinci, kashi na miyagun ƙwayoyi, motsa jiki da damuwa.

Abubuwanda ke biyo baya sune halayen da aka lura tare da yin amfani da maganin repaglinide da sauran jami'ai na bakin jini. Dukkanin sakamako masu illa ana taruwa su gwargwadon yawan ci gaban, wanda aka ayyana shi azaman: sau da yawa (≥1 / 100 zuwa

Tare da yawan yawan zubar da ruwa, ƙwan jini na haɓaka.

Kwayar cutar yunwa, karuwar gumi, bugun zuciya, rawar jiki, tashin hankali, ciwon kai, rashin bacci, haushi, bacin rai, magana mai rauni da hangen nesa.

Lokacin amfani da maganin farfadowa a cikin marasa lafiya da ke da nau'in ciwon sukari na 2 na mako-mako a cikin ƙara yawan mako na 4 zuwa 20 MG sau 4 a rana (tare da kowane abinci), an lura da yawan abin da yake zubar da jini na makwanni 6, wanda aka nuna ta ƙaruwa sosai a cikin yawan ƙwayar glucose tare da haɓakar bayyanar cututtuka na cututtukan jini.

Game da bayyanar cututtuka na hypoglycemia, yakamata a ɗauki matakan da suka dace don ƙara yawan haɗuwa da glucose a cikin jini (ɗaukar dextrose ko abinci mai wadatar carbohydrates a ciki). A cikin babban rauni na hypoglycemia (asarar ƙwaƙwalwa, coma), ana sarrafa dextrose a cikin jijiya. Bayan murmurewa daga hankali - yawan cin abinci mai narkewa mai sauƙin narkewa (don kauce wa sake samun ci gaban hypoglycemia).

Haɗa kai

Dole ne a yi hulɗa da yiwuwar maganin repaglinide tare da kwayoyi waɗanda ke shafar metabolism din jini.

Hanyar narkewa, kuma ta haka ne tsinkaye na repaglinide, na iya canzawa a ƙarƙashin tasirin magungunan da ke tasiri, hanawa ko kunna enzymes daga rukuni na cytochrome P-450. Ya kamata a lura da kulawa ta musamman tare da gudanar da ayyukan CYP2C8 na lokaci daya tare da masu hana CYP3A4 tare da maimaituwa. Nazarin sun nuna cewa gudanarwar na Deferasirox na lokaci guda, wanda yake mai rauni mai hana CYP2C8 da CYP3A4, kuma repaglinide yana haifar da karuwa a cikin tasirin tsarin sakamako na repaglinide, tare da raguwa amma babban raguwa a cikin taro na jini. Tare da gudanarwa na lokaci guda na Deferasirox da Repaglinide, ya zama dole a yi la’akari da raguwa a cikin kashi na Repaglinide kuma a hankali kula da hankali da tasirin glucose a cikin jini.

Tare da yin amfani da clopidogrel lokaci guda, inhibitor na CYP2C8, da repaglinide, an lura da karuwa a cikin tsarin bayyanar cutar ta repaglinide da ƙara raguwa a cikin haɗuwar glucose jini. Idan ana amfani da repaglinide da clopidogrel lokaci guda, ya kamata a lura da saka idanu a kan yawan tattarawar glucose da lura da asibiti.

OATP1B1 anion jigilar furotin na inion (misali, cyclosporin) na iya haɓaka yawan aikin plasma repaglinide.

Wadannan kwayoyi masu zuwa na iya haɓaka da / ko tsawaita tasirin hypoglycemic na repaglinide:

Gemfibrozil, trimethoprim, rifampicin, clarithromycin, ketoconazole, itraconazole, cyclosporine, sauran magungunan hypoglycemic, monoamine oxidase inhibitors, wakilai masu hana beta-adrenergic tarewa, angiotensin suna canza enzyme inhibitors, steroidal steroid, nonroid

Beta-blockers na iya rufe alamun bayyanar cututtukan jini.

Gudanarwa na lokaci daya na cimetidine, nifedipine ko simvastatin (waɗanda suke canzawa na CYP3A4) tare da repaglinide ba ya da tasiri sosai a kan ma'aunin magunguna na repaglinide.

Repaglinide ba ya tasiri sosai game da kayyakin magani na digoxin, theophylline, ko warfarin lokacin da aka yi amfani da su ga masu sa kai. Don haka, babu buƙatar daidaita sashi na waɗannan magunguna idan aka haɗu da su tare da repaglinide.

Wadannan kwayoyi masu zuwa na iya raunana tasirin hypoglycemic na repaglinide:

Abubuwan hana haifuwa na baka, rifampicin, barbiturates, carbamazepine, thiazides, glucocorticosteroids, danazole, hodar iblis da kuma tausayawa.

Aikace-aikacen hadin gwiwa maganin hana haihuwa (ethinyl estradiol / levonorgestrel) ba ya haifar da babban canji a asibiti a cikin ɗakunan bioavailability na farfadowa, kodayake ana samun mafi girman maida hankali ne farkon. Repaglinide baya tasiri sosai a cikin bioavailability na levonorgestrel, amma tasirinsa akan bioavailability na estinio estradiol ba zai iya yanke hukunci ba.

Game da wannan, yayin alƙawarin ko soke magungunan da ke sama, marasa lafiya da ke karɓar maganin cutar ta kamata a sanya ido sosai don gano ainihin abubuwan da suka faru na sarrafa glycemic.

Umarni na musamman

Ana nuna Repaglinide don ƙarancin iko na glycemic da kuma juriyar bayyanar cututtuka na mellitus na sukari yayin maganin rage cin abinci, motsa jiki, da asarar nauyi.

Tun da repaglinide magani ne da ke motsa ƙwayar insulin, zai iya haifar da ƙwaƙwalwar ƙwayar cuta. Tare da haɗin gwiwa, haɗarin hauhawar jini yana ƙaruwa.

Manyan hanyoyin tiyata da raunin da ya faru, konewa mai yawa, cututtuka masu yaduwa tare da cututtukan febrile na iya buƙatar dakatar da magunguna na baka da maganin ɗan lokaci na maganin insulin.

Yana da Dole a sa ido a kai a kai yayin tattara yawan glucose a cikin jini akan komai a ciki kuma bayan cin abinci. Ya kamata a faɗakar da mai haƙuri game da haɗarin haɗarin hypoglycemia a cikin lokuta na shan barasa, NSAIDs, daidai lokacin azumi.

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

A cikin marasa lafiyar da ke fama da rashin abinci mai gina jiki, da kuma marasa lafiya da ke karɓar rashin abinci mai gina jiki, dole ne a kula da shi lokacin zaɓin kashi na farko da na kulawa, da kuma ƙayyadadden aikinsa, don guje wa hauhawar jini.

Groupsungiyoyin haƙuri na musamman

Zaɓin zaɓi a cikin marasa lafiya da keɓaɓɓen ciwon sukari na 2 a haɗe tare da aiki mai rashi mai rauni tare da taka tsantsan.

Gudanar da magunguna na al'ada na repaglinide a cikin marasa lafiya da ke fama da rauni na hanta zai iya haifar da mafi yawan maida hankali da ƙwayoyinta fiye da marasa lafiya da aikin hanta na al'ada. A wannan batun, an ba da izinin sake maganin repaglinide a cikin marasa lafiya da ke fama da rauni na hanta (duba sashin "Contraindications"), kuma a cikin marasa lafiya da ke fama da rauni na aikin taushi zuwa matsakaici na matsakaita na reni ya kamata a yi amfani da shi a hankali. Matsakaicin tsakanin daidaitawa yakamata a kara zuwa mafi kimanta ƙimar amsawar da aka samu.

Tasiri a kan ikon tuka motoci da aiki tare da kayan aiki

Thearfin marasa lafiya su mai da hankali kuma ana iya rage ƙarancin amsawar lokacin hypoglycemia da hyperglycemia, wanda zai iya zama haɗari a cikin yanayi inda wannan ikon yake musamman mahimmanci (alal misali, lokacin tuki motoci ko aiki tare da injuna da injuna). Ya kamata a shawarci marasa lafiya su dauki matakan hana ci gaban hypoglycemia da hyperglycemia yayin tuki motocin da kuma aiki da hanyoyin. Wannan yana da mahimmanci musamman ga marasa lafiya da basu da cikakkun alamu na abubuwan ci gaban haila ko tare da rikicewar yanayin yawan haila. A cikin waɗannan halayen, ya kamata a duba yiwuwar irin wannan aikin.

Manuniya da contraindications

Kamar sauran magunguna, Diclinid yana da alamomin kansa don amfani. Kamar yadda aka ambata a sama, an wajabta shi don buga masu ciwon sukari na II don daidaita sukarin jini. Bayarda cewa ayyukan da aka aiwatar a baya cikin tsarin abinci da wasanni basu bayar da tasirin warkewar da ake buƙata ba.

Ba za ku iya shan miyagun ƙwayoyi ba idan mai haƙuri yana da tabin hankali ga miyagun ƙwayoyi gaba ɗaya ko abubuwan haɗinsa, saboda wannan na iya haifar da rashin lafiyar rashin lafiyar mai saurin bambanta.

Ba a taɓa yin amfani da maganin don maganin ciwon sukari na mellitus na nau'in farko ba, tare da nau'in ciwon sukari na ketoacidosis, precomatosis, coma, aikin hanta mai rauni, rashi lactase, hankali ga lactose.

Jerin contraindications ba ƙarami bane kuma ya haɗa da halaye masu zuwa:

• Lokacin haihuwar, shayarwa.
• Shekarun yara, wato har zuwa shekaru 18.
• Ba za ku iya haɗa magungunan ba tare da gemfibrozil.
• Jinyar tiyata.
• Cututtukan cututtuka.
• Raunin raunin da yawa.

Contraindications da aka jera a sama cikakke ne. A takaice dai, ba a taba amfani da maganin ba idan suna da tarihin masu haƙuri. Tare da su, an kuma bambanta contraindications na dangi.

Wannan yana nufin cewa kafin rubuta magani, likita ya gwada yiwuwar sakamakon tasirin magani da haɗarin sakamako masu illa da sauran rikitarwa.

Lativearancin contraindications sun haɗa da cututtukan febrile, wani nau'in rashin lafiya na koda, rashin abinci mai gina jiki, yanayin rashin shan giya, da kuma mummunan yanayin haƙuri.

Magungunan ya wuce duk gwajin asibiti. Koyaya, binciken har zuwa shekaru 18 da sama da 75 ba a gudanar da su ba.

Wataƙila halayen da ba za a iya amfani da su ba daga amfani da miyagun ƙwayoyi

Binciken marasa lafiya ya lura cewa maganin yana da sauri yana taimakawa rage matakan sukari da haɓaka da zaman lafiya. Tare da wannan, yawancin magana game da tasirin sakamako waɗanda suka zama sakamakon amfani da miyagun ƙwayoyi.

Halin da ya fi dacewa da rikicewar yanayi shine yanayin rashin lafiyar. Abin takaici, yana da kusan wuya a hana rage raguwar sukari. Tun da wannan yanayin ya dogara da dalilai da yawa: sashi na maganin, abinci, aikin jiki, halin damuwa, neurosis, ji mai ƙarfi, da sauransu.

Sakamakon sakamako na iya faruwa a ɓangaren tafiyar matakai na rayuwa: kamar yadda aka riga aka fada, wannan shine farkon hypoglycemia. A matsayinka na mai mulkin, ya isa ya dauki karamin adadin carbohydrates don daidaita lafiyar mai haƙuri. Musamman a lokuta marasa wuya, ana buƙatar buƙatar likita na gaggawa.

Rashin maganin yana lura da wadannan sakamako masu illa:

1. A ɓangare na tsarin rigakafi: haɓaka halayen ƙwaƙwalwar ƙwaƙwalwa, misali vasculitis, halayen rashin lafiyan da ke tattare da bayyanar fata - kurji, itching, redness na fata.
2. Rushewar narkewar abinci da jijiyoyin jiki, jin zafi a ciki, hare-hare na tashin zuciya da amai.
3. Activityara ayyukan enzymes na hanta, aikin lalata hanta.

An lura cewa shan miyagun ƙwayoyi na iya haifar da tashin hankali na gani.

A matsayinka na mai mulkin, wannan alama ta ɗan gajeren lokaci ce, mai cin gashin kanta yayin aikin jiyya. Musamman a lokuta masu wuya, cire maganin zai iya zama dole.

Umarnin don amfani

Magungunan Diclinid ba panacea bane, ƙari ne ga aikin jiki da abinci mai ƙarancin carb ga masu ciwon sukari. A wannan yanayin ne kawai za'a iya samun sakamako na warkewa na magani.

An zabi sashi na miyagun ƙwayoyi koyaushe daban-daban. Babban ma'aunin sune alamun farko na sukarin jini. Lokacin zaɓin wani kashi, ana haɗuwa da cututtukan haɗin gwiwa da sauran abubuwan ƙari.

Jagorori don amfani sun ce ya kamata a ɗauki allunan kwata na awa ɗaya kafin babban abincin. Koyaya, zaku iya ɗaukar rabin sa'a kafin cin abinci.

Fasali na jiyya ta hanyar Diagninid:

• Matsakaicin ma'auni ga marasa lafiya waɗanda ba su taɓa shan kwayoyin ba don rage sukari jini a cikin nau'in ciwon sukari na 2 shine 0.5 mg.
• Idan mai haƙuri ya taɓa ɗaukar kowane wakili na hypoglycemic, to, maganin farko shine 1 MG.
• Kamar yadda ya cancanta, yana halatta don daidaita adadin maganin a sau ɗaya a kowace kwanaki 7-14.
• Da yake magana a kan matsakaici, bayan duk ƙaruwa, daidaitaccen kashi shine 4 MG na miyagun ƙwayoyi, wanda ya kasu kashi uku a kowace rana.
• Matsakaicin adadin ƙwayoyi shine 16 MG.

Idan mai haƙuri ya ɗauki wani wakili na hypoglycemic kuma yana buƙatar maye gurbinsa don kowane dalili na likita, to, ana aiwatar da canjin zuwa Diagninid ba tare da tsaka-tsaki ba. Tun da ba shi yiwuwa a tsayar da ainihin adadin kashi tsakanin magungunan guda biyu, amma kashi na farko bai wuce 1 MG ba.

Abubuwan da aka lissafa ana kiyaye su ba tare da la'akari da hanyar gudanar da maganin ba. Musamman, duka a cikin maganin monotherapy kuma a cikin hadaddun jiyya na nau'in ciwon sukari na 2 na ciwon sukari. Farashin ya kasance daga 200 rubles.

Analogs na Diaglinide, farashin da sake dubawa

Diaglinide yana da karancin analogues, kuma NovoNorm, da Repaglinide, ana maganarsu. Farashin NovoNorm ya bambanta daga 170 zuwa 250 rubles. Za'a iya siye magunguna a kantin magani ko kiosk na kantin magani, ya halatta a sayi magunguna akan Intanet.

An adana maganin a cikin wuri mai duhu, wanda ba a isa ga ƙananan yara. Rayuwar rayuwar shiryayye shine shekara biyu.

Bayan bincika da yawa sake dubawa na masu ciwon sukari, zamu iya yanke shawara cewa miyagun ƙwayoyi suna iya magance aikin sosai, yana taimakawa wajen daidaita sukari kuma yana kiyaye shi a matakin manufa. Koyaya, mai haƙuri ana buƙatar ƙoƙari a cikin tsarin abinci da aikin jiki.

Hakanan akwai sake dubawa marasa kyau, waɗanda ke haifar da mummunar rashin daidaituwa tare da shawarar maganin, da kurakurai a cikin abinci mai gina jiki.

Kuma me zaku iya fada game da wannan maganin? Shin kun ɗauki magungunan, kuma ta yaya suka yi aiki a yanayinku?