Umarnin amfani da allunan Amaryl

Tabletaya daga cikin kwamfutar hannu na Amarsh 1 MG ya ƙunshi: abu mai aiki: glimepiride - 1 MG,

magabata: lactose monohydrate, sitaci carboxymethyl sitaci (tun A), povidone 25000 (E1201), celclosese microcrystalline (E460), magnesium stearate (E470), baƙin ƙarfe oxide ja (E172).

Tabletaya daga cikin kwamfutar hannu na Amarsh 2 MG ya ƙunshi: abu mai aiki: glimepiride - 2 MG,

tsofaffi: lactose monohydrate, sitaci carboxymethyl sitaci (nau'in A), povidone 25000 (E1201), microcrystalline cellulose (E460), magnesium stearate (E470), launin farar baƙin ƙarfe launin ruwan sanyi (E172), daskararren carmin aluminum varnish (E132).

Tabletaya daga cikin kwamfutar hannu na Amarsh 3 MG ya ƙunshi: abu mai aiki: glimepiride - 3 MG.

tsofaffi: lactose monohydrate, sitaci carboxymethyl sitaci (nau'in A), povidone 25000 (E1201), microcrystalline cellulose (E460), magnesium stearate (E470), fenti baƙin ƙarfe (E172).

Tabletaya daga cikin kwamfutar hannu na Amarsh 4 MG ya ƙunshi: abu mai aiki: glimepiride - 4 MG.

tsofaffi: lactose monohydrate, sitaci carboxymethyl sitaci (nau'in A), povidone 25000 (E1201), microcrystalline cellulose, magnesium stearate (E460), indigo carmine aluminum varnish (E132).

Amarsh 1 MG: madaidaici, allunan ruwan hoda mai kauri a garesu tare da rarraba tsagi a garesu. Babban tambari: NMK / Sunan Brand. Alamar ƙasa: Sunan ƙasa / NMK.

Amarsh 2 MG: madaidaici, allunan kore masu kauri a garesu tare da rarraba tsagi a garesu. Babban tambari: NMM / Sunan Brand. Alamar ƙasa: Sunan ƙasa / NMM.

Amrsh 3 MG: madaidaici, allunan lebur a garesu na launi mai launin rawaya mai haske tare da tsagi mai tsada a ɓangarorin biyu. Babban tambari: NMN / Sunan Brand. Alamar ƙasa: Sunan ƙasa / NMN.

Amrsh 4 MG: madaidaici, allunan lebur a garesu na kwamfutar hannu shuɗi tare da tsagi biyu a ɓangarorin biyu. Babban tambari: NMO / Sunan Brand. Alama ƙasa: Sunan ƙasa / NMO.

Aikin magunguna

Glimepiride, abu mai aiki na Amaril, magani ne mai ƙwanƙwasa (saukar da sukari) don amfani da bakin - mai samo asali na sulfonylurea.

Glimepiride yana tayar da ɓoyewa da sakin insulin daga ƙwayoyin beta na pancreatic (sakamako na pancreatic), inganta haɓakar ƙwayar yanki (tsoka da mai) zuwa aikin insulin nasa (sakamako na extrapancreatic).

Abubuwan da ke cikin Sulfonylurea suna tsara asirin insulin ta hanyar rufe tashoshin potassium na ATP da ke dogara da ƙwayoyin cytoplasmic na ƙwayoyin beta na pancreatic. Rufe tashoshi na potassium, suna haifar da ɓarnar ƙwayoyin beta, wanda ke taimakawa buɗe tashoshin kalisiya da haɓaka kwararar mai a cikin sel. Glimepiride, tare da babban adadin canzawa, yana haɗuwa da ɓataccen tsari daga furotin beta-cell na motsi (molar taro 65 kD / SURX), wanda ke da alaƙa da tashoshin potassium na ATP, amma ya bambanta da hanyar da aka saba da asalin abubuwan da aka samo asali.

sulfonylureas (ƙwayar molar taro 140 kD / SUR1). . - X p>

Wannan tsari yana haifar da sakin insulin ta hanyar exocytosis, a wannan yanayin. - ingancin insulin da ke ɓoye ya fi ƙasa da na gargajiya tare da gargajiya. Leastarancin ƙarfafawa na glimepiride akan ɓoye insulin yana samar da ƙananan haɗarin cutar hypoglycemia.

Bugu da kari, an bayyana tasirin karin maganin cututtukan glimepiride (raguwa a cikin insulin juriya, karami sakamako akan tsarin zuciya, anti-atherogenic, anti-tarawa da tasirin antioxidant) wanda aka nuna, wanda shima yana da magungunan gargajiya na gargajiya na sulfonylurea, amma zuwa ga karancin yanayin.

Ingantaccen amfani da glucose daga jini ta hanyar kyallen hanji (tsoka da mai) yana faruwa ta amfani da furotin na jigilar abubuwa na musamman (GLUT1 da GLUT4) wanda ke cikin membranes cell. Jigilar glucose cikin waɗannan kyallen takarda a cikin nau'in ciwon sukari na 2 mataki ne na iyakancewa mai sauri cikin amfani da glucose. Glimepiride yana ƙaruwa da sauri da kuma yawan abubuwan da ke ɗaukar kwayoyin glucose (GLUT1 da GLUT4), wanda ke haifar da ƙaruwa a cikin haɓaka glucose ta kyallen da ke kewaye.

Glimepiride yana da raunin inhibitory mai rauni akan K_ATashoshin TF na katin ƙwaƙwalwar ajiya. Lokacin ɗaukar glimepiride, ana kiyaye ikon daidaitawar metabolism zuwa ischemia.

Glimepiride yana ƙaruwa da aikin glycosyl phosphatidylinositol-takamaiman phospholipase C, wanda maganin da ke haifar da lipogenesis da glycogenesis na iya daidaitawa cikin rabewar ƙwayar tsoka da ƙwayoyin mai.

Glimepiride yana hana samar da glucose a cikin hanta ta hanyar kara yawan abubuwan cikin jiki na fructose-2,6-bisphosphate, wanda hakan ke hana gluconeogenesis.

Glimepiride ya zama yana hana cyclooxygenase kuma yana jujjuyawar juyawar arachidonic acid zuwa thromboxane A2, wanda ke haɓaka haɗakar platelet, don haka aiwatar da tasirin maganin antithrombotic.

Glimepiride yana ba da gudummawa ga daidaituwar abubuwan lipid, rage matakin ƙaramin aldehyde a cikin jini, wanda ke haifar da raguwa mai mahimmanci a cikin ƙwayar ƙwayar lipid, wannan yana ba da gudummawa ga tasirin anti-atherogenic na miyagun ƙwayoyi. Glimepiride yana ƙara yawan to-tocopherol na endogenous a-tocopherol, aikin catalase, glutathione peroxidase da superoxide dismutase, wanda ke taimakawa rage tsananin matsalar damuwa na narkewar abu a jikin mai haƙuri, wanda ke kasancewa koyaushe a cikin nau'in ciwon sukari na 2 na ciwon sukari.

A cikin mutane masu lafiya, ƙarancin ingantaccen maganin magana na glimepiride shine kusan 0.6 mg. Sakamakon glimepiride ya dogara ne da kwayar cutar. Maganin ilimin halayyar jiki ga matsanancin motsa jiki da raguwa a cikin ɓoye insulin yayin da ake kula da glimepiride.

Babu bambance-bambance masu mahimmanci a cikin tasirin, dangane da ko an dauki miyagun ƙwayoyi minti 30 kafin abinci ko kuma nan da nan kafin abinci .. A cikin marasa lafiya da ke fama da cutar sankara, ana iya samun iko mai gamsarwa akan sa'o'i 24 ta hanyar ɗaukar kashi ɗaya na yau da kullun.

Duk da gaskiyar cewa glimepiride hydroxymetabolite ya haifar da ƙarami amma raguwa mai yawa a cikin kwantar da hankali na glucose jini a cikin marasa lafiya, wannan metabolite yana da alhakin kawai ƙaramin ɓangare na maganin gaba ɗaya.

Hade jiki tare da metformin

A cikin binciken asibiti, an tabbatar da cewa a cikin marasa lafiya tare da sakamako na rashin jin daɗi, duk da matsakaiciyar ƙarancin metformin, yin amfani da glimepiride lokaci guda tare da metformin yana samar da ingantaccen iko na rayuwa idan aka kwatanta da metotinrapy.

Hade jiki tare da insulin

Bayanai akan hadewar glimepiride tare da insulin suna da yawa. Marasa lafiya tare da sakamako marasa gamsuwa tare da mafi yawan allurai na glimepiride na iya farawa insulin lokaci guda. A cikin gwaji na asibiti guda biyu, magani hade yana ba da haɓaka haɓaka guda ɗaya kamar insulin monotherapy, duk da haka, a yanayin haɗakar maganin, an buƙaci ƙananan matakan insulin.

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Yara da matasa

An gudanar da gwaji na asibiti tare da sarrafawa mai aiki (glimepiride har zuwa 8 MG kowace rana ko metformin har zuwa 2,000 MG kowace rana) An gudanar da makonni 24 da suka gabata tare da yara 285 (shekaru 8-17) tare da nau'in ciwon sukari na 2. Dukkanin mahadi, glimepiride da metformin, sun nuna raguwa sosai a cikin HbAlc dangane da matakin farko na glimepiride -0.95 (a cikin serum 0, 41), metformin -1.39 (a cikin serum 0.40). Duk da wannan, glimepiride bai cika ka'idodin matsayin ba "mafi muni fiye da metformin", yana yin hukunci da matsakaicin canjin HbAlc dangane da alamomin farko. Bambanci ya kasance 0.44% a cikin goyon baya na metformin. Iyakar babba (1.05) amincewa 95%

tazara tsakanin banbancin ya zama mafi girman abin da aka iyakance na aƙalla iya aiki daidai da 0.3%,

Maganin Glimepiride bai bayyana ƙarin damuwa game da lafiyar yara ba idan aka kwatanta da na manya na marasa lafiya da ke fama da ciwon sukari na 2. Babu bayanai daga inganci na dogon lokaci da kuma binciken lafiya ga marasa lafiyar yara.

Pharmacokinetics

Lokacin da aka saka glimepiride bioavailability din sa ya cika. Cin abinci ba shi da tasiri a cikin sha, amma ban da raguwa sosai a cikin adadin sha. Tare da maimaita amfani da glimepiride a cikin maganin yau da kullun na 4 MG, mafi girman taro a cikin jijiyoyin jini (C_tah) an kai shi ne bayan kimanin sa'o'i 2.5 da adadinsu ya kai 309 ng / ml, akwai alaƙar layya tsakanin sashi da Stax, haka kuma tsakanin kashi da AUC (yankin da ke ƙarƙashin lokacin tattara lokaci).

Glimepiride yana da halin ƙaramin rashi mai rarraba (kimanin 8.8 L), kusan daidai yake da girman rarrabuwa na albumin, babban matakin ɗaure wa sunadaran plasma (sama da kashi 99%) da ƙarancin sharewa (kimanin 48 ml / min).

Biotpansformatssh da kuma cirewa

Bayan kashi daya na maganin glimepiride, 58% an fesa a cikin fitsari kuma 35% tare da feces. Ba'a gano abu mai canzawa a cikin fitsari ba. Bayanin rabin rayuwa a cikin kwarin plasma na miyagun ƙwayoyi a cikin magani wanda ya dace da tsarin allurai mai yawa shine 5-8 hours. Bayan ɗaukar manyan allurai, rabin rayuwar yana ƙaruwa kaɗan.

Ana gano metabolites biyu marasa aiki a cikin fitsari da feces, wanda aka samo shi sakamakon metabolism a cikin hanta, ɗayan ɗayan mai haɓakar hydroxy ne, ɗayan ɗayan kuma shi ne mai haɓakar carbon. Bayan shigowar glimepiride, rabin rabin rayuwar waɗannan metabolites shine 3-5 hours da 5-6 hours, bi da bi.

Glimepiride yana fita a cikin madara mai nono kuma ya haye shingen mahaifa. Magungunan suna shiga cikin talauci ta hanyar shinge-kwakwalwa.

Kwatanta guda ɗaya da mai yawa (sau ɗaya a rana) glimepiride gwamnatin ba ta bayyana mahimman bambance-bambance a cikin sigogin kantin magani ba, kuma an lura da bambance bambancinsu sosai tsakanin marassa lafiya daban-daban. Babu wani muhimmin tarin magunguna.

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Magunguna na Pharmacokinetic sunyi kama da juna a cikin marasa lafiya na mata da maza daban daban. A cikin marasa lafiya da ke fama da rauni na aiki na kasa da kasa (tare da karancin keɓaɓɓiyar izinin bayyana), akwai haɓaka ƙara haɓakar glimepiride da raguwa a matsakaiciyar ƙwaƙwalwarta a cikin ƙwayar jini, wanda shine mafi yawanci saboda saurin ƙwayar magunguna saboda ƙananan ƙuntatawa ga furotin. Saboda haka, a cikin wannan rukuni na marasa lafiya babu ƙarin haɗarin haɗarin ƙwayar cuta.

Gwajin da za a yi nazarin likitancin, aminci, da kuma haƙurin shanyewar ƙwayar 1 na glimepiride a cikin marasa lafiyar 30 (yara 4 masu shekaru 10-12 da yara 26 masu shekaru 12 zuwa 17) waɗanda ke fama da nau'in ciwon sukari na 2 sun nuna cewa matsakaicin AUCo -i_{kamar yadda}t, C_max da X analogueschny dabi'u waɗanda aka lura da su a cikin manya.

Contraindications

Kada ayi amfani da Glimepiride don:

• hypersensitivity to glimepiride ko ga wani ɓangaren ƙwayoyi marasa aiki, zuwa wasu abubuwan da suka samo asali na sulfonylurea ko zuwa magungunan sulfa (haɗarin maganganun tashin zuciya),

• ciwon sukari mai dogaro da insulin,

• ketoacidosis na masu fama da ciwon sukari, da kuma masu ciwon suga,

• tsananin rashin hanta,

• raunin ƙwayar cutar koda (ciki har da marasa lafiya akan cutar sankara),

• ciki da lactation.

Haihuwa da lactation

Glimepiride yana contraindicated a cikin mata masu juna biyu. Dangane da batun haihuwar da aka shirya ko a lokacin da aka fara samun juna biyu, yakamata a canza mace zuwa insulin therapy.

Tunda glimepiride, da alama, ya wuce cikin madara, bai kamata a wajabta mata ba lokacin shayarwa. A wannan yanayin, wajibi ne don canzawa zuwa ilimin insulin ko kuma dakatar da shayarwa.

Sashi da gudanarwa

An yi niyya don amfani da baka.

Dalili don cin nasarar sarrafa sukari shine ingantaccen tsarin abinci, motsa jiki na tsari, da sanya ido akai-akai game da jini da fitsari. Ba'a iya biyan diyya daga shawarar abinci ba ta hanyar allunan ko insulin.

Farkon kashi da zaɓin kashi

Yawan maganin glimepiride an tantance shi ta hanyar nazarin glucose a cikin jini da fitsari.

Maganin farko shine 1 MG na glimepiride kowace rana, idan a lokaci guda ana samun nasarar haɓaka metabolism - wannan yakamata a kiyaye yayin kulawa.

Don wasu magunguna na allurai, ana samun allunan a matakan da suka dace.

Idan ya cancanta, za a iya ƙara yawan ƙwayar yau da kullun a karkashin kulawa ta yau da kullun game da tattarawar glucose na jini (a cikin tsaka-tsaka na makonni 1-2) kuma a cikin tsari mai zuwa: 1 mg - 2 mg - 3 mg - 4 mg glimepiride kowace rana.

A kashi na glimepiride fiye da 4 MG a kowace rana take kaiwa zuwa kyakkyawan sakamako kawai a cikin lokuta na musamman. Matsakaicin da aka bayar da shawarar kullun shine 6 MG.

Lokaci da mitar shan magani na yau da kullun likita ne ya ƙaddara, yin la'akari da salon rayuwar mai haƙuri. A matsayinka na mai mulki, alƙawarin kashi na yau da kullun a cikin kashi 1 nan da nan kafin ko lokacin karin kumallo ko, idan kashi na yau da kullun ba

An kai shi nan da nan kafin ko lokacin cin abinci na farko. Ba a kawar da tsallake ƙwayar maganin ta hanyar gudanar da aikin da ya fi girma. Ana ɗaukar allunan Amaril gabaɗaya, ba tare da taunawa ba, tare da isasshen ruwan sha (kusan kofuna waɗanda 0.5). Yana da matukar mahimmanci kada a tsallake abinci bayan shan Amaril.

Yi amfani dashi a hade tare da metformin

Idan isasshen ƙarfi na taro na glucose a cikin jini a cikin marasa lafiya suna shan metformin, ana iya fara amfani da maganin haɗuwa tare da glimepiride. Yayinda yake riƙe da kashi na metformin a daidai matakin, jiyya tare da glimepiride yana farawa da mafi ƙarancin kashi, sannan ƙwayar sa a hankali yana ƙaruwa dangane da matakin da ake so na sarrafa glycemic, har zuwa matsakaicin adadin yau da kullun na 6 MG. Ya kamata a gudanar da aikin kwantar da hankali a karkashin kulawa ta fuskar lafiya.

Yi amfani da haɗin tare da insulin

A cikin yanayin inda ba zai yiwu a cimma daidaituwa game da tattarawar glucose na jini ba ta hanyar ɗaukar matsakaicin ƙwayar glimepiride a cikin monotherapy ko haɗuwa tare da matsakaicin ƙwayar metformin, haɗarin glimepiride tare da insulin yana yiwuwa. A wannan yanayin, kashi na ƙarshe na glimepiride da aka tsara ga mai haƙuri ya kasance ba a canzawa. A wannan yanayin, aikin insulin yana farawa da mafi ƙarancin kashi, tare da yiwuwar ƙarin ci gaba na hankali a yawan kashi na insulin a ƙarƙashin kulawar tattarawar glucose a cikin jini. Daidaita magani yana buƙatar kulawa da likita na tilas. Yayinda yake kula da kulawar glycemic na dogon lokaci, wannan haɗin maganin na iya rage buƙatun insulin zuwa 40%.

Canja wurin mai haƙuri daga wani magani na maganin hypoglycemic na baka zuwa glimepiride Babu takamaiman dangantaka tsakanin allurai na glimepiride da sauran magunguna na maganin hypoglycemic. Lokacin canja wurin daga irin waɗannan kwayoyi zuwa glimepiride, kashi na farko na yau da kullun ya kamata ya zama 1 MG (koda kuwa an canja mai haƙuri zuwa glimepiride tare da matsakaicin kashi na wani magani na bakin jini).Duk wani karuwa a cikin kashi na glimepiride ya kamata a aiwatar dashi a matakai, la'akari da amsar glimepiride daidai da shawarwarin da ke sama. Wajibi ne don la'akari da adadin da aka yi amfani da shi da tsawon lokacin sakamako na wakilin hypoglycemic da ya gabata. A wasu halaye, musamman lokacin shan magungunan hypoglycemic tare da tsawon rabin rai (alal misali, chlorpropamide), yana iya zama dole don ɗan lokaci (a cikin fewan kwanaki) dakatar da jiyya don guje wa sakamako mai ƙari wanda ke kara haɗarin cutar hypoglycemia.

Canza haƙuri daga insulin zuwa glimepiride

A cikin lokuta na musamman, idan marasa lafiya da ke da nau'in ciwon sukari na 2 na mellitus suka karɓi maganin insulin, to, tare da diyya da cutar kuma tare da aikin adana bayanan ƙwayoyin ƙwayoyin cuta na pancreatic, ana iya nuna su canja wuri zuwa glimepiride. Ya kamata a aiwatar da fassarar a karkashin kulawa ta lafiya. A wannan yanayin, canja wurin mai haƙuri zuwa glimepiride yana farawa da ƙaramin kashi na glimepiride na 1 MG.

Aikace-aikace don renal da hanta gazawar

Akwai isasshen bayani game da amfani da miyagun ƙwayoyi a cikin marasa lafiya da na koda da hepatic kasawa (duba sashi Contraindications).

Yara da matasa

Ba a samun bayanai game da amfani da glimepiride a cikin marasa lafiya da ke ƙasa da shekara 8 ba. Ga yara masu shekaru 8 zuwa 17, akwai ƙarancin bayanai game da amfani da glimepiride a cikin nau'in monotherapy (duba sashin magunguna da sashen Magunguna. Bayanan da suke akwai akan inganci da aminci basu isa ba don amfanin ƙwayar glimepiride a cikin ilimin yara, sabili da haka ba a bada shawarar yin amfani da irin wannan amfani ba.

Side sakamako

Bayanai game da mummunan halayen da aka haifar ta hanyar ɗaukar glimepiride da sauran abubuwan da ake buƙata na sulfonylurea an gabatar dasu a ƙasa yayin gwaji na asibiti. Ana rarraba halayen masu illa a cikin azuzuwan sassan tsarin kuma a harhada su saboda rage yawan aukuwar lamarin (sau da yawa:> 1/10, galibi:> 1/100, 1/1000, 1/10000,

Yawan damuwa

Bayan shigo da babban adadin glimepiride, haɓakar ƙwayar cuta yana yiwuwa, zai iya kasancewa daga sa'o'i 12 zuwa 72, wanda za'a iya maimaita shi bayan dawowar farko na maida hankali a cikin jini. Hawan jini ana iya dakatar da shi koda yaushe ta hanyar shan abinci na carbohydrates kai tsaye (glucose ko sukari, alal misali, a cikin wani yanki na sukari, ruwan 'ya'yan itace mai ɗanɗano ko shayi). A wannan batun, mai haƙuri koyaushe yakamata ya sami akalla g 20 na sukari (guda 4 na sukari). Masu zaki zazzabi basu da inganci a maganin cututtukan cututtukan zuciya. A mafi yawancin lokuta, ana bada shawarar saka idanu a asibiti. Jiyya ya haɗa da shigar da amai, shan ruwa (ruwa ko lemo tare da gawayi na aiki (adsorbent) da sodium sulfate (laxative)) Lokacin ɗaukar mai yawa na miyagun ƙwayoyi, ana nuna lavage ciki, biyo bayan gabatarwar gawayi da sodium sulfate. Hoton asibiti na tsananin zubar da jini na iya zama kama da hoto na asibiti na bugun jini, sabili da haka, yana buƙatar kulawa da gaggawa a ƙarƙashin kulawar likita, kuma a wasu yanayi da asibiti na mara lafiya. Idan anjima, gabatarwar glucose, idan ya cancanta Ta hanyar iv allurar 50 ml na maganin 40%, tare da jiko na mafita na 10% tare da saka idanu a hankali na yawan haɗuwa da glucose a cikin jini, ƙarin magani ya zama alama.

Kwayar cutar hypoglycemia na iya zama mai sauƙin cirewa ko kuma ba shi da cikakke a cikin tsofaffi marasa lafiya, a cikin marasa lafiya da ke fama da ciwon kai na nakasassu ko karbar magani na lokaci guda tare da p-adrenoblockers, clonidine, reserpine, guanethidine ko wasu wakilai masu juyayi.

Idan mai haƙuri da ke fama da ciwon sukari likitoci daban-daban suna kula da shi (alal misali, yayin zaman asibiti bayan wani haɗari, tare da ciwo a ƙarshen mako), dole ne ya sanar da su game da rashin lafiyarsa da kuma maganin da ya gabata.

A cikin kulawar hypoglycemia wanda ya samo asali sakamakon gudanarwar bazata na Amaril ta hannun jarirai ko yara, yakamata a kula da yawan maganin da ake kira dextrose (50 ml na maganin 40%) a hankali don guje wa haɗarin hawan jini. Dangane da wannan, ci gaba da cikakkiyar kulawa game da tattarawar glucose a cikin jini ya zama dole.

Yin hulɗa tare da wasu kwayoyi

Game da amfani da concomitant tare da glimepiride na wasu magunguna, duka raguwa da ba a so da kuma karuwa wanda ba a ke so ba a cikin tasirin hypoglycemic na glimepiride na iya faruwa. A wannan batun, ana iya ɗaukar wasu magunguna kawai tare da izinin (ko kamar yadda aka umurce) na likita.

Glimepiride yana metabolized ta hanyar cytochrome P4502C9, wanda yakamata ayi la'akari dashi lokacin amfani dashi lokaci guda tare da inducers (misali. Hatampicin) ko inhibitors (misali fluconazole).

A cikin hulɗar vivo da aka buga a cikin wallafe-wallafen yana nuna cewa fluconazole, ɗayan mafi girman abubuwan hanawa na CY32C9, yana ƙara AUC na glimepiride da kusan sau 2.

Dangane da gwaninta tare da glimepiride da sauran abubuwan da ake amfani da su na sulfonylurea, ya kamata a lura da mu'amala mai zuwa.

Za'a iya lura da karuwa a cikin tasirin hypoglycemic da yiwuwar haɓaka hypoglycemia wanda ke da alaƙa da wannan tare da amfani da glimepiride na lokaci guda tare da kwayoyi masu zuwa:

- phenylbutazone, azapropazone, oxyphenbutazone,

- insulin da sauran magunguna na rashin karfin jiki, irin su metformin,

- Salicylates da acid acid,

- steroids anabolic da kwayoyin jima'i na maza,

- chloramphenicol, wasu tsoffin abubuwan aiki na sulfonamides, tetracyclines, quinolones da clarithromycin,

- angiotensin tana canza masu haɓakar enzyme (ACE),

- fluoxetine, monoamine oxidase inhibitors (MAO),

- allopurinol, probenicide, sulfinpyrazone,

- cyclo-, tro- da ifosfamides,

- pentoxifylline (tare da gudanarwa a cikin babban allurai),

Ana iya lura da rauni na tasirin hypoglycemic da kuma haɗuwa da haɗuwa da haɗuwa da glucose a cikin jini tare da amfani da glimepiride na lokaci guda tare da kwayoyi masu zuwa:

- estrogens da progestogens,

- saluretics da thiazide diuretics,

- hormones thyroid, glucocorticosteroids

- epinephrine da sauran jami'ai masu juyayi,

- nicotinic acid (a cikin allurai) da abubuwan da ake amfani da shi na nicotinic acid,

- laxatives (tare da tsawan amfani da shi),

- glucagon, barbiturates da rifampicin,

Masu fafutuka N₂masu karɓa, clonidine da kuma reserpine suna iya haɓakawa da raunana tasirin hypoglycemic na glimepiride.

Karkashin tasirin wakilai na juyayi, kamar su beta-blockers, clonidine, guanethidine da reserpine, alamun adrenergic counterregulation a cikin martani ga hypoglycemia na iya raguwa ko ba ya nan.

A kan tushen ɗaukar maganin glimepiride, ana iya ƙaruwa ko raunin ayyukan da ke tattare da abubuwan da aka samo na coumarin.

Amfani guda ɗaya na giya ko na yau da kullun zai iya haɓakawa da raunana tasirin hypoglycemic na glimepiride.

Siffofin aikace-aikace

Ya kamata a dauki Glimepiride kai tsaye kafin ko lokacin abinci.

Idan ana ɗaukar abinci a tsaka-tsaki na tsaka-tsaki ko tsallake gaba ɗaya, mara lafiyar da ke karɓar maganin glimepiride zai iya haɓaka

yawan haila. Bayyanar alamun cututtukan hypoglycemia sun hada da: ciwon kai, matsananciyar yunwar, tashin zuciya, amai, jin gajiya, matsananciyar damuwa, tashin hankali, tashin hankali, tashin hankali, rashi, hankali da rashi, bacin rai, ruɗani, magana da hargitsi na gani, aphasia, rawar jiki, paresis , tashin hankali, damuwa, farin ciki, rashin taimako, asara na kamun kai, damuwa, rikicewar kwakwalwa, rudani da asarar hankali, gami da rashin lafiya, rashin numfashi, bradycardia. Bugu da kari, sakamakon sakamakon adrenergic na tsari, alamu irin su sanyi, gumi, damuwa, tachycardia, hauhawar jijiya, bugun zuciya, angina pectoris, da hargitsi na zuciya na iya faruwa.

Gabatarwar asibiti na tsananin raɗaɗi na iya zama kamar gabatarwar asibiti na bugun jini.

A kusan dukkanin lokuta, alamun za a iya sarrafa su ta hanzarta sarrafa tasirin hydrocarbons (sukari). Abun da ke sa kayan wucin gadi ba su da tasiri a lokaci guda.

Kamar yadda aka sani ne daga ƙwarewar amfani da wasu abubuwan da ake amfani da su na sulfonylurea, duk da nasarar yin amfani da hanyoyin gurɓatowar a farkon, za a iya sake haifar da ɗaukar jini.

Mai tsananin rauni ko tsawan jini, wanda kawai yake sarrafa shi na wani lokaci na sukari na yau da kullun, yana buƙatar kulawa ta gaggawa ko ma asibiti.

Abubuwan da ke ba da gudummawa ga ci gaban haɓakar haɓaka sun haɗa da:

- rashin damuwa ko (yawanci a tsufa) karancin ikon marasa lafiya don yin aiki tare da likita, lahani, abinci mai gina jiki, rashin tsallake abinci, azumi,

- canje-canje a cikin abincin da aka saba,

- rashin daidaituwa a tsakanin motsa jiki da kuma yawan ƙwayar carbohydrate,

- shan giya, musamman a hade tare da tsallake abinci,

- ba shi da aikin keɓaɓɓen, aikin lalata hanta,

- wasu cututtukan da ba a daidaita su ba na tsarin endocrine wanda ke shafar metabolism na metabolism, ko hypoglycemia na amsawa (alal misali, wasu abubuwan rashin daidaituwa na glandar thyroid, rashin isasshen abinci ko rashin isasshen ƙwayar cuta ta adrenal), amfani da wasu takaddun magunguna (duba hulɗa tare da wasu kwayoyi) )

Jiyya tare da glimepiride yana buƙatar saka idanu akai-akai na tattarawar glucose a cikin jini da fitsari. Bugu da ƙari, ana bada shawarar matakan glycosylated haemoglobin.

Hakanan, yayin jiyya tare da glimepiride, bincike na yau da kullum na aikin hanta da ƙididdige ƙwayoyin jini (musamman leukocytes da platelet) sun zama dole.

A cikin yanayin damuwa (alal misali, bayan hatsarori, ayyukan gaggawa, cututtukan febrile, da sauransu), za a iya nuna sauyawa ta ɗan lokaci zuwa insulin.

Babu wani ƙwarewa tare da glimepiride a cikin marasa lafiya da gazawar ƙwayar cuta mai girma ko a cikin marasa lafiya waɗanda ke buƙatar hemodialysis. Marasa lafiya da ke fama da matsalar koda ko hepatic kasawa ana nuna su canzawa zuwa insulin.

Jiyya tare da abubuwan da aka samo na sulfonylurea na iya haifar da cutar haemolytic a cikin marasa lafiya tare da raunin glucose-6-phosphate dehydrogenase. Tunda glimepiride na aji ne na abubuwan sulfonylurea, yakamata a yi amfani dashi da taka tsantsan a cikin marasa lafiya da rashi glucose-b-phosphate dehydrogenase. Bugu da ƙari, za a yi la'akari da zaɓuɓɓukan magani tare da madadin wakilai waɗanda basu da abubuwan asali na sulfonylurea.

Amaryl ya ƙunshi ƙwayoyin lactose monohydrate, don haka bai kamata a ɗauka a cikin marasa lafiya da rashin haƙuri na lactose, rashi lactase ko ƙarancin glucose-lactose.

Ba a gudanar da nazarin sakamakon tasirin glimepiride akan iya tuki motocin da abubuwa ba. Amsar mai haƙuri ko ikon yin hankali za a iya ragewa sakamakon haɓakar haɓaka ko ƙwararraki, ko, alal misali, saboda raunin gani. Waɗannan tasirin za su iya zama haɗari a cikin yanayi inda waɗannan damar ke da mahimmanci musamman (alal misali, lokacin tuki mota ko injina).

Yakamata a sanar da marassa lafiya game da bukatar yin taka-tsan-tsan don kauce wa hauhawar jini yayin tuki. Wannan yana da mahimmanci musamman ga marasa lafiya da cututtukan cututtukan hypoglycemia, ko marasa lafiya waɗanda basu da cikakkiyar cikakkiyar fahimta ko kuma rashin sanin alamun farko na hypoglycemia. A cikin waɗannan halayen, yakamata a bincika yiwuwar tuƙin motoci ko injin aiki.

Abun ciki da nau'i na saki

Ana samar da Amaryl a cikin allunan da ke dauke da mg na 1-4, wadanda aka cakuda su cikin guda 15 a cikin kowanne fatar baki. Packaya daga cikin fakitin na miyagun ƙwayoyi na iya haɗawa da fitsari 2, 4, 6 ko 8.

• Tabletaya daga cikin kwamfutar hannu na miyagun ƙwayoyi ya haɗa da abu mai aiki - glimepiride - 1-4 mg da abubuwan taimako: lactose monohydrate, povidone, sitaci carboxymethyl sitaci, microcrystalline cellulose, indigo carmine da magnesium stearate.

Rukunin Clinical da pharmacological: magani na baka hypoglycemic magani.

Umarnin don amfani

Dangane da umarnin don amfani, sashi na maganin Amaryl da Amaryl M shine likita ya tsara shi daban-daban ga kowane mara lafiya, gwargwadon yadda girman matakan sukari na mai haƙuri yake. Ya kamata a yi amfani da miyagun ƙwayoyi a cikin mafi ƙarancin isa don cimma ikon sarrafawa na rayuwa.

Umarnin don amfani da Amaril kuma ya ba da rahoton cewa lura yana buƙatar ƙaddara ta yau da kullun game da taro na glucose a cikin jini da kuma matakin glycosylated haemoglobin.

Ya kamata a kwashe allunan Amaryl duka, ba tare da taunawa ba, tare da isasshen adadin ruwa (kamar 1/2 kofin). Idan ya cancanta, za'a iya raba allunan magungunan Amaryl tare da haɗarin zuwa kashi biyu daidai.

• Maganin farko na Amaril shine 1 mg 1 lokaci / rana. Idan ya cancanta, za a iya ƙara yawan ƙwayar yau da kullun (a lokuta na 1-2 makonni) a karkashin kulawa na yau da kullum na glucose jini kuma a cikin tsari mai zuwa: 1 mg-2 mg-3 mg-4 mg-6 mg (-8 mg) kowace rana .
• A cikin marasa lafiya da nau'in sukari mai kyau guda 2 mai sarrafawa, yawanci yawanci yawanci shine 1-4 mg. Matsayi na yau da kullun fiye da 6 MG shine mafi inganci a cikin ƙaramin adadin marasa lafiya.

Take hakkin shan kwayoyi, alal misali, tsallakewa kashi na gaba, baya buƙatar yin hakan ta amfani da Amaril na gaba a cikin babbar siga.

Lokaci don ɗaukar allunan da rarraba allurai a duk tsawon rana likita ne ya ƙaddara. A lokaci guda, yana yin la’akari da salon rayuwar mai haƙuri (yawan motsa jiki, lokacin cin abinci, abincin). Ana tsara kowace rana a kashi 1, kai tsaye kafin cikakken karin kumallo. Idan ba a sha maganin yau da kullun ba, kafin farkon abincin farko. Yana da mahimmanci kar ku tsallake cin abinci bayan shan magani.

Yawancin lokaci ana yin maganin glimepiride na dogon lokaci.