Gluconorm: litaelo tsa tšebeliso: theko le litekolo tsa batho ba lefu la tsoekere ka lipilisi tsa lefu la tsoekere

The endocrinologist e ile ea etsa tlhahlobo ea mafu - boemo ba prediabetesic. Boima bo lula bo eketseha, mathata a metabolic, hantle, tsoekere ea tsoekere (syndrome ea hypoglycemic). Ka bokhutšoanyane, ho monate. Ha o pheha lijo, tsoekere e tsoha, hantle, matšoao a tsebahalang a hlaha. Ho qala pele, bakeng sa ho fokotsa takatso ea ka ea lijo, ke ile ka fuoa sehlahisoa sena ka nako ea lijo tsa motšehare 1 ka letsatsi bakeng sa tafole e le 'ngoe, empa ka tsela e itseng ha ho na phello, hantle feela. Ke ile ka ea ngakeng e 'ngoe, e laetsoeng Siofor 850, hore ke e nke. Tšusumetso e ileng ea ikutloa ka letsatsi la pele la kamohelo e ile ea e-ba bonolo, ka shoalane ke ne ke batla ho ja hanyane. Kamora libeke tse peli tsa kalafo, boima bo ile ba fokotseha ka 1.5 kg. Ho joalo, 'me ke ikutloa ke le betere.

E se e le selemo ho tloha ha ke ne ke fumanoa ke lefu la tsoekere la mofuta oa 2, 'me ka mor'a moo ngaka e ile ea mpha lijo tse matla tsa mmele le gluconorm. Re nkile lethal dose hoo e ka bang khoeli, empa joale glucose ha e phahame ka holimo ho 6-7. Ke kutloelo-bohloko feela hore lijo li tlameha ho lateloa. Leha bophelo bo botle bo theko e boima haholo, ho joalo.

Tlhaloso e khutšoane

Limilione tse 200 ... Ho bohlokoa ho hopola palo ena, hobane ke sona feela palo e hakanyetsoang ea batho ba nang le lefu la tsoekere kajeno. Mme ho latela lipakanyo tsa bo-ramahlale (mme eseng tse fanang ka tšepo ka ho fetesisa), ka 2030 re lokela ho lebella keketseho ea palo ena bonyane hanngoe le halofo. Motsong oa nts'etsopele ea lefu la tsoekere ke lintlha tse peli tsa bohlokoa tsa bohlokoa: ho hanyetsa insulin le ho haella ha manyeme ho hlahisoeng ha insulin. Ho fokotsa menyetla ea mathata a methapo ea methapo (ho foufala, ho nyekeloa ke pelo le stroke, ho khaoha leoto), ho hlokahala hore o lule o beha letsoho molekeng (ho fapana le moo, ho limithara) ho netefatsa ho lekola maemo a tsoekere ea mali. Mabapi le sena, matlafatso ea kalafo ke mokhoa oa mantlha kalafong ea lefu la tsoekere. Ha e le molao, kalafo ea antidiabetic e qala ka monotherapy, e sebelisang metformin kapa sulfonylureas (glibenclamide glyclazide, glimepiride). Nakong e tlang, ka ho senyeha ho hlakileng ha litekanyetso tsa biochemical, metsoako ea lithethefatsi e qala kapa liente tsa insulin li hokahane. Ntle le moo: Kaha lefu la tsoekere le nkuoa e le lefu le tsoetseng pele, leha e le katleho ea pele ea monotherapy, kapele, ho tla tlatsetsoa tlatsana ea meriana le karolo e le 'ngoe kapa tse peli tsa buka ea litšupiso ea Mashkovsky.

Motsoako o atileng haholo oa antidiabetes ho ts'ebetso ea bongaka ke metformin + glibenclamide. Gluconorm ea lithethefatsi ha e letho ho feta ligament ena e matla ea likarolo tse peli. Metformin biguanide e theola tsoekere ea mali ka ho theola monyako oa kutloisiso ea insulin liseleng tse poteletseng le ho ntlafatsa tsoekere ea glucose ka lisele. Ntho ena e thibela ho kenngoa ha lik'habohaedreite ka har'a tšilo ea lijo 'me e kena-kenana le tsoekere ea sebete ka sebete. Metformin e ntlafatsa le setšoantšo sa lipid tsa mali, e fokotsa boemo ba "cholesterol" e mpe ". Glibenclamide, le eena ke nama ea nama ea sulfonylurea. E susumetsa ho lokolloa ha insulin ka ho phahamisa kutloisiso ea "lisele" tsa "pancreatic" glucose le tekanyo ea ho tloaelana ha insulin ka lisele tsa sepheo.

Gluconorm hangata e sebelisoa bakeng sa lijo ka tekanyo eo ho lumellanoeng le ngaka ka eona (e ka ba motho ka mong maemong ka mong). Ka tloaelo, ba "qala" ho tsoa ho letlapa le le leng ebe ba beha lethal dose ka mor'a libeke tse ling le tse ling tse peli leihlo ho fihlela boemo ba tsoekere maling, leha bo sa fetele ka matla a letsatsi le letsatsi a matlapa a 5.

Thutela-litso

Gluconorm ® ke motsoako o tsitsitseng oa li-agent tse peli tsa molomo tsa hypoglycemic tsa lihlopha tse fapaneng tsa pharmacological: metformin le glibenclamide.

Metformin ke ea sehlopha sa "greatuanides" 'me e fokotsa tsoekere ea serum ka ho phahamisa kutloisiso ea lisele tsa thipa molemong oa ts'ebetso ea insulin le ho ntlafatsa ho ts'oaroa ha tsoekere. E fokotsa ho kenngoa ha lik'habohaedreite ka har'a tšilo ea lijo 'me e thibela gluconeogenesis ka har'a sebete. Motsoako ona o boetse o na le phello e molemo ho profid ea lipid ea mali, e theola boemo ba cholesterol e felletseng. LDL le triglycerides. Ha e bake karabelo ea hypoglycemic.

Glibenclamide ke ea sehlopha sa lihlahisoa tsa sulfonylurea tse tsoang molokong oa bobeli. E hlohlelletsa secretion ka ho theola monyako oa pancreatic β-cell glucose, e eketsa kutloisiso ea insulin le ho tlamahanya le eona liseleng tse lebisitsoeng, e eketsa ho tsoa ha insulin, ho ntlafatsa phello ea insulin metsong le tsoekere ea glucose, hape e thibela lipolysis ho lithane tsa adipose. E sebetsa mohatong oa bobeli oa insulin secretion.

Mofumahali

Ha e kenngoa, ho amoheloa ho tsoa ka mpeng ea gastrointestinal ke 48-84%. Nako ea ho fihla C_max - Lihora tse 1-2 V_d - lilithara tse 9-10. Puisano le liprotheine tsa plasma ke 95%.

Hoo e batla e na le metabolism e felletseng ka har'a sebete ka ho etsoa ka li-metabolite tse peli tse sa sebetseng, e 'ngoe e supuoa ke liphio, e' ngoe e le mala. T_1/2 - ho tloha lihora tse 3 ho isa ho 10-16

Kamora ho tsamaisoa ka molomo, e ananeloa ho tsoa pampiring ea mahlaba ka botlalo, 20-30% ea lethal dose e fumanoa ka har'a mantle. Boaoavailability e felletseng e tsoa ho 50 ho isa ho 60%. Ka ho kenella ka nako e tšoanang, ho kenngoa ha metformin hoa fokotseha ebe hoa lieha. E ajoa ka potlako ka har'a lithane, ka mokhoa o ha e tlamele liprotheine tsa plasma.

E tšelisoa ka tekanyo e fokolang haholo 'me e supe ke liphio. T_1/2 hoo e ka bang lihora tse 9-12

Fomu ea tokollo

Matlapa a koahetsoeng ka filimi a 'mala o mosoeu kapa o batlang o le mosoeu, ho pota, biconvex, nakong ea khefu ho tloha ho o mosoeu ho ea ho o mosoeu ka tint e putsoa.

Baeti: microcrystalline cellulose - 100 mg, starch ea poone - 20 mg, colloidal silicon dioxide - 20 mg, gelatin - 10 mg, glycerol - 10 mg, magnesium stearate - 7 mg, talcate e hloekisitsoeng - 15 mg, croscarmellose sodium - 30 mg, sodium carboxymethyl starch - 18,3 mg, cellacephate - 2 mg, diethyl phthalate - 0,2 mg.

Li-pcs tse 10. - marangrang (4) - lipakete tsa karete.
20 likhomphutha. - Mabokose (2) - lipakete tsa karete.

Setlhare se sebelisoa ka molomo, le lijo. Tekanyetso ea lithethefatsi e khethoa ke ngaka ka bonngoe ho mokuli ka mong, ho latela boemo ba tsoekere ea mali.

Hangata tekanyetso ea pele ke 1 tab. (400 mg / 2.5 mg) / letsatsi. Ka mor'a libeke tse ling le tse ling tse peli kamora ho qala kalafo, tekanyetso ea moriana e lokisoa ho latela boemo ba tsoekere ea mali. Ha u khutlisetsa kalafo ea motsoako e fetileng le metformin le glybeklamide, ho boleloa matlapa a 1-2. Gluconorm ho latela tekanyetso e fetileng ea karolo ka 'ngoe.

Sekhahla se phahameng sa letsatsi le letsatsi ke matlapa a 5.

Bongata

Ho fetella kapa ho ba teng ha maemo a kotsi ho ka baka nts'etsopele ea lactic acidosis, joalo ka Metforminum ke karolo ea boitokiso. Ha matšoao a lactic acidosis a hlaha (ho hlatsa, bohloko ba ka mpeng, bofokoli bo akaretsang, mesifa ea mokokotlo), o tlameha ho emisa ho sebelisa moriana. Lactic acidosis ke boemo bo hlokang tlhokomelo ea bongaka ea tšohanyetso, kalafo ea lactic acidosis e lokela ho etsoa sepetlele. Phekolo e sebetsang ka ho fetisisa ke hemodialysis.

Ho fetella le hona ho ka lebisa ho nts'etsopele ea hypoglycemia ka lebaka la boteng ba glibenclamide ha e ntse e hlophisoa. Matšoao a hypoglycemia: tlala, ho fufuleloa ho feteletseng, bofokoli, ho akheha ka letlalo, ho ruruha ha mucosa ea molomo, ho thothomela, ho tšoenyeha ho akaretsang, ho opeloa ke hlooho, ho otsela ha pelo, ho tšoha ha boroko, ho tšaba, ho hokahana ha metsamao, mathata a nakoana a methapo ea kutlo. Ha tsoelo-pele ea hypoglycemia e ntse e tsoela pele, bakuli ba ka 'na ba lahleheloa ke boitšoaro le ho hlaphoheloa kelellong.

Ka hypoglycemia e bonolo kapa e leka-lekaneng, dextrose (tsoekere) kapa tharollo ea tsoekere e nkuoa ka molomo. Maemong a hypoglycemia e matla (ho lahleheloa ke kelello), tharollo ea 40% dextrose (glucose) kapa glucagon e kenang kahare, v / m, s / c e tsamaisoa iv. Kamora ho hlaphoheloa kelellong, mokuli o lokela ho fuoa lijo tse nang le lik'habohaedreite ho qoba tsoelopele ea hypoglycemia.

Tšebelisano

Li-inhibitors tsa ACE (Captopril, enalapril), li-histamine H blockers li ntlafatsa phello ea hypoglycemic ea lithethefatsi₂li-receptors (cimetidine), li-antifungal agents (miconazole, fluconazole), NSAIDs (phenylbutazone, azapropazone, oxyphenbutazone), li-fibrate (clofibrate, bezafibrat), lithethefatsi tse felisang lefuba (ethionamide), salicytates, anticoagulant antagonists MAO, sulfonamides ea nako e telele, cyclophosphamide, chloramphenicol, fenfluramine, fluoxetine, guanethidine, pentoxifylline, tetracycline, theophylline, tubular secretion blockers, reserpine, bromocriptine, disopyramide, pyridoxine, ba bang lithethefatsi tsa hypoglycemic (acarbose, biguanides, insulin), allopurinol.

Barbiturates, corticosteroids, adrenostimulants (epinephrine, clonidine), lithethefatsi antiepileptic (phenytoin), butle-butle calcium Channel blockers, carbonic anhydrase inhibitors (acetazolamide), thiazide diuretics, chlortalidone, furosemide, diazanazide , morphine, ritodrine, salbutamol, terbutaline, tsoekere, rifampicin, lihomone tsa qoqotho tse nang le iodine, letsoai la lithium, litekanyetso tse phahameng - nicotinic acid, chlorpromazine, lithibela-pelehi tsa molomo le estrogens.

Litlhare tsa urine acidifying (ammonium chloride, calcium chloride, ascorbic acid ka tekanyetso e kholo) li matlafatsa sephetho ka ho fokotsa tekanyo ea ho ikarola le ho eketsa botjha ba glibenclamide.

Ethanol e eketsa menyetla ea lactic acidosis.

Metformin e fokotsa C_max le T_1/2 furosemide ka 31% le 42.3%, ka ho latellana.

Furosemide e eketsa C_max metformin ka 22%.

Nifedipine e eketsa ho monya, C_max e liehisa ho felisoa ha metformin.

Lithethefatsi tsa cationic (amiloride, digoxin, morphine, procainamide, quinidine, quinine, ranitidine, triamteren le vancomycin) tse fumanehang ka har'a marang-rang li qothisana le litsamaiso tsa tsamaiso ea methapo ebile li ka eketsa C ka kalafo ea nako e telele._max 60% metformin.

Litlamorao

Karolong ea metabolism ea carbohydrate: hypoglycemia e ka etsahala.

Ho tsoa mokokotlong oa mala le sebete: ka seoelo - ho nyekeloa, ho hlatsa, mpeng, ho felloa ke takatso ea lijo, tatso ea "metallic" molomong, maemong a mang - cholestatic jaundice, ts'ebetso e eketsehileng ea li-enzyme tsa sebete, hepatitis.

Ho tsoa ho sistimi ea hemopoietic: ka seoelo - leukopenia, thrombocytopenia, erythrocytopenia, ka seoelo - agranulocytosis, hemolytic kapa megaloblastic anemia, pancytopenia.

Ho tloha lehlakoreng la tsamaiso ea methapo e bohareng: ho opeloa ke hlooho, ho tsekela, ho fokola, ho tepella, ka seoelo - paresis, mathata a ho utloa bohloko.

Boitšoaro bo ho kula le ba immunopathological: ka seoelo - urticaria, erythema, ho hlohlona ha letlalo, feberu, arthralgia, proteinuria.

Boitšoaro ba methapo ea methapo: ka seoelo - photosensitivity.

Ho tloha ka lehlakoreng la metabolism: lactic acidosis.

Tse ling: ho itšunya-tšunya ha joala ho se mamellehe ka mor'a ho noa, ho bontšoa ke mathata a methapo ea mali le a ho hema (disulfiram-like reaction: ho hlatsa, ho utloa mocheso sefahlehong le 'mele o kaholimo, tachycardia, letsoalo, hlooho).

Type 2 lefu la tsoekere ho batho ba baholo:

• ka ho se sebetse hantle ha kalafo ea ho ja, ho ikoetlisa le kalafo e fetileng ka metformin kapa glibenclamide,
• ho khutlisa kalafo e fetileng ka lithethefatsi tse peli (metformin le glibenclamide) ho bakuli ba nang le maemo a tsoekere a mali a tsitsitseng le a laoloang hantle.

Contraindication

• mofuta oa 1 lefu la tsoekere
• lefu la tsoekere ketoacidosis, lefu la tsoekere, lefu la tsoekere,
• hypoglycemia,
• Ho senyeha ha real,
• maemo a hlobaetsang a ka lebisang phetohong ea ts'ebetso ea liphio (ho omella, ts'oaetso e matla, ho tsitsipana),
• mafu a hlobaetsang kapa a sa foleng a tsamaeang le tishu hypoxia (pelo kapa ho hloleha ho phefumoloha, infarction ea morao-rao ea myocardial, ts'oaro),
• ho hloleha ha sebete
• porphyria
• Tšebeliso e tšoanang ea miconazole,
• mafu a tšoaetsanoang, ts'ebetso e kholo ea ts'ebetso ea ho buoa, likotsi, ho chesa haholo le maemo a mang a hlokang kalafo ea insulin,
• tahi e sa foleng, botahoa bo bongata,
• lactic acidosis (ho kenyeletsoa le nalane),
• Sebelisa bonyane lihora tse 48 pele le ka hare ho lihora tse 48 kamora ho etsa lithuto tsa radioisotope kapa x-ray ka kenyelletso ea li-iodine tse nang le phapang e mahareng,
• ho khomarela lijo tse nang le khalori e tlase (ka tlase ho likhalori tse ka tlase ho 1000 / letsatsi),
• boimana
• nako ea ho anyesa,
• hypersensitivity ho metformin, glibenclamide kapa tse ling tse tsoang ho sulfonylurea, hammoho le lintho tse thusang.

Ha ho khothalletsoe ho sebelisa lithethefatsi ho batho ba lilemo tse fetang 60 ba etsang mosebetsi o boima oa 'mele, o amanang le kotsi e kholo ea ho ba le lactic acidosis ho bona.

Ka tlhokomeliso: febrile syndrome, adrenal insufficiency, hypofunction ea anterior pituitary, lefu la qoqotho le nang le ts'ebetso e sa sebetseng.

Bokhachane le pelehi

Nakong ea kemolo, tšebeliso ea gluconorm e hokahane. Ha u rera ho ima, hammoho le ketsahalong ea kemolo nakong ea ho nka Gluconorm, moriana o lokela ho khaotsa mme kalafo ea insulin e lokela ho fanoa.

Gluconorm ® e kopantsoe le letsoele, ha metformin e fetela lebeseng. Maemong ana, o tlameha ho fetoha kalafo ea insulin kapa ho emisa ho anyesa.

Litaelo tse khethehileng

Ho kenella ka matla ho kenelletseng le ho tsoa likotsi, ho cha haholo, mafu a tšoaetsanoang a nang le febrile syndrome ho ka hloka ho khaotsa lithethefatsi le ho khethoa ha kalafo ea insulin.

Hoa hlokahala hore kamehla u lekole boemo ba tsoekere maling maling ka mpeng e se nang letho le ka mor'a ho ja.

Bakuli ba lokela ho lemosoa ka kotsi e eketsehang ea hypoglycemia maemong a ethanol, NSAIDs, le tlala.

Phetoho ea tekanyetso ea hlokahala bakeng sa ho fetella hoa mmele le maikutlo, phetoho ea lijo.

Nakong ea kalafo, ha ho khothalletsoe ho nka joala.

Lihora tse 48 pele ho ts'ebetso ea bongaka kapa iv tsamaiso ea moemeli ea nang le iodineine e nang le iodineine, tsamaiso ea gluconorm e lokela ho emisoa. Phekolo ea gluconorm e khothalletsoa hore e qale hape ka mor'a lihora tse 48.

Tšusumetso ho bokhoni ba ho khanna makoloi le litsamaiso tsa taolo

Nakong ea kalafo, tlhokomelo e lokela ho nkuoa ha ho khannoa likoloi le ho etsa lintho tse ling tse ka bang kotsi tse hlokang ho tsepamisa mohopolo le ho potlakisa karabelo ea maikutlo haholo.