Litaelo tsa ho sebelisa matlapa a Amaryl

Letlapa le le leng la Amarsh 1 mg le na le ntho e sebetsang: glimepiride - 1 mg,

excipients: lactose monohydrate, sodium carboxymethyl starch (tun A), povidone 25000 (E1201), cellulose ya microcrystalline (E460), magnesium stearate (E470), dae e khubelu ea oxide e khubelu (E172).

Letlapa le le leng la Amarsh 2 mg le na le sehlahisoa se sebetsang: glimepiride - 2 mg,

Exipients: lactose monohydrate, sodium carboxymethyl starch (mofuta A), povidone 25000 (E1201), microcrystalline cellulose (E460), magnesium stearate (E470), dae e nang le tšepe ea oxide (E172), indigo carmine aluminium varnish (E132).

Letlapa le le leng la Amarsh 3 mg le na le ntho e sebetsang: glimepiride - 3 mg.

Excipients: lactose monohydrate, sodium carboxymethyl starch (mofuta A), povidone 25000 (E1201), microcrystalline cellulose (E460), magnesium stearate (E470), dae ya tshepe e tshehla (E172).

Letlapa le le leng la Amarsh 4 mg le na le ntho e sebetsang: glimepiride - 4 mg.

excipients: lactose monohydrate, sodium carboxymethyl starch (mofuta A), povidone 25000 (E1201), cellulose ea microcrystalline, magnesium stearate (E460), indigo carmine aluminium varnish (E132).

Amarsh 1 mg: Ho na le matlapa a pinki a sephara ka mahlakoreng ka bobeli a nang le groove e arolang mahlakore ka bobeli. Setempe se Phahameng: Lebitso la NMK / Brand. Setempe se ka tlase: Lebitso la Brand / NMK.

Amarsh 2 mg: Oblong, matlapa a tala a bataletseng ka mahlakoreng ka bobeli a nang le groove e arolang mahlakore ka bobeli. Setempe se Phahameng: Lebitso la NMM / Brand. Setempe se ka tlase: Lebitso la Brand / NMM.

Amarsh 3 mg: Oblong, matlapa a bataletseng ka mahlakoreng 'ohle a' mala o bobebe oa 'mala o mosehla o nang le karolo e arolang mahlakore ka bobeli. Setempe se Phahameng: Lebitso la NMN / Brand. Setempe se ka tlase: Lebitso la Brand / NMN.

Amarsh 4 mg: Oblong, matlapa a bataletseng ka mahlakoreng a mabeli a tafole e putsoa e nang le pokello e arolang mahlakore ka bobeli. Setempe se Phahameng: Lebitso la NMO / Brand. Setempe se ka tlase: Lebitso la Brand / NMO.

Ketso ea pharmacological

Glimepiride, ntho e sebetsang ea Amaril, ke setlhare sa hypoglycemic (tsoekere-e fokotsang tsoekere) bakeng sa tšebeliso ea molomo - ntho e tsoang ho sulfonylurea.

Glimepiride e matlafatsa secretion le ho lokolloa ha insulin lisele tsa beta tsa manyeme (pancreatic athari), e ntlafatsa kutloisiso ea lisele tsa mesifa (mesifa le mafura) ts'ebetsong ea eona ea insulin (phello ea extrapancreatic).

Li-derivatives tsa Sulfonylurea li laola secretion ea insulin ka ho koala liteishene tsa potasiamo tse itšetlehileng ka ATP tse fumanehang ka har'a membrane ea cytoplasmic ea lisele tsa pancreatic beta. Ho koala liteishene tsa potasiamo, li baka lisele tsa beta, tse thusang ho bula liteishene tsa khalsiamo le ho eketsa phallo ea khalsiamo liseleng. Glimepiride, e nang le sekhahla se phahameng sa ho kenella, e kopanya le ho senya ho tsoa ho protheine ea pancreatic beta-cell (molar boima 65 kD / SURX), e amanang le lits'ebetso tsa potasiamo tse ts'epahalang tsa ATP, empa e fapana le sebaka sa tloaelo se tlamang sa litheko tsa setso.

sulfonylureas (protein molar boima ba 140 kD / SUR1). . - X p>

Ts'ebetso ena e lebisa ho lokolloe ha insulin ka exocytosis, ho sena. - boleng ba insulin e patiloeng bo tlase haholo ha bo bapisoa le sulfonylureas ea setso. Tšusumetso e nyane haholo ea glimepiride ho secretion ea insulin e fana ka kotsi e tlase ea hypoglycemia.

Ntle le moo, litlamorao tse boletsoeng tsa extrapancreatic tsa glimepiride (ho fokotseha ha insulin ho hanyetsa, phello e nyane molemong oa tsamaiso ea pelo, anti-atherogenic, anti-aggregation le antioxidant), le tsona li na le litlamorao tsa setso tsa sulfonylurea, empa ka tekanyo e nyane haholo.

Ts'ebeliso e ntlafalitsoeng ea tsoekere e maling e tsoa maling ka mesifa le mesifa (mesifa le mafura) e etsahala ho sebelisoa liprotheine tse khethehileng tsa lipapatso (GLUT1 le GLUT4) tse fumanehang ka har'a li-membrane tsa sele. Ho tsamaisoa ha tsoekere ho linama tsena ke mofuta oa 2 lefu la tsoekere ke mohato o fokotsang sekhahla ts'ebetsong ea tsoekere. Glimepiride e potlakisa palo le ts'ebetso ea limolek'hule tse tsamaisang glucose (GLUT1 le GLUT4), tse lebisang keketseho ea tsoekere ea tsoekere ke lithane tsa peripheral.

Glimepiride e na le phello e fokolang ea thibelo ho K_ALitsela tsa TF tsa cardiomyocytee. Ha o nka glimepiride, bokhoni ba ho feto-fetoha ha metabolic ea myocardium ho ischemia boa bolokoa.

Glimepiride e eketsa ts'ebetso ea glycosyl phosphatidylinositol e ikhethang phospholipase C, eo lipogenis e kenyelitsoeng ke lithethefatsi le glycogeneis li ka kopanelang ho eona liseleng tse ka thoko tsa mesifa le mafura.

Glimepiride e sitisa tlhahiso ea tsoekere ka har'a sebete ka ho eketsa likhahla tsa protheine-2,6-bisphosphate, tseo ka lehlakoreng le leng li thibelang gluconeogeneis.

Glimepiride ka boikhethelo e thibela cycloo oxygenase 'me e fokotsa phetoho ea arachidonic acid ho thromboxane A2, e khothalletsang ho kopanngoa ha liplatrate, ka ho etsa joalo e hlahise phello ea antithrombotic.

Glimepiride e kenya letsoho ho thatafatseng litaba tsa lipid, e fokotsa boemo ba aldehyde bo fokolang maling, bo lebisang phokotsong e kholo ea lipid peroxidation, sena se kenya letsoho phello ea anti-atherogenic ea lithethefatsi. Glimepiride e eketsa boemo ba "a-tocopherol" e amanang le lefu la sethoathoa, ts'ebetso ea ho ba le lefu la kelello, glutathione peroxidase le superoxide dismutase, e thusang ho fokotsa botebo ba khatello ea methapo ea matla 'meleng oa mokuli, e lulang e le teng khafetsa ka mofuta oa lefu la tsoekere.

Bathong ba phetseng hantle, lethal dose e bonolo ea molomo ea glimepiride e ka bang 0,6 mg. Kameho ea glimepiride e itšetleha ka lethal dose hape e ka ikatisa. Karabelo ea 'mele ea ho ikoetlisa ka matla le ho fokotseha ha secretion ha u ntse u nka glimepiride e lula e le teng.

Ha ho na phapang e kholo litlamorao, ho latela hore na moriana o nooa metsotso e 30 pele ho lijo kapa hang-hang pele ho lijo. Ho bakuli ba nang le lefu la tsoekere, taolo e khotsofatsang ea metabolic e fetang lihora tse 24 e ka fumaneha ka ho nka tekanyetso e le 'ngoe ea letsatsi le letsatsi.

Le ha 'nete ea hore glimepiride hydroxymetabolite e bakile phokotso e nyane empa e kholo ea khatello ea tsoekere ea mali ho bakuli ba phetseng hantle, metabolite ena e ikarabella bakeng sa karolo e nyane feela ea phello e akaretsang ea lithethefatsi.

Motsoako oa motsoako o kopantsoeng le metformin

Phuputsong e 'ngoe ea kliniki, ho ile ha netefatsoa hore ho bakuli ba nang le liphetho tse sa khotsofatseng tsa kalafo, leha ho e-na le litekanyetso tse ngata tsa metformin, tšebeliso e tšoanang ea glimepiride e nang le metformin e fana ka taolo e ntle ea metabolic ha e bapisoa le metformin monotherapy.

Motsoako oa ho kopanya le insulin

Lintlha tse mabapi le motsoako oa glimepiride le insulin lia haella. Bakuli ba nang le kalafo e sa khotsofatseng ea kalafo e nang le litekanyetso tse ngata tsa glimepiride ba ka qala kalafo ea insulin ka nako e tšoanang. Litekong tse peli tsa kliniki, kalafo e kopaneng e ile ea fana ka ntlafatso e tšoanang ea metabolism joalo ka insulin monotherapy, leha ho le joalo, maemong a kalafo ea motswako, ho ne ho hlokahala litekanyetso tse tlase tsa insulin.

Lihlopha tse Khethehileng tsa Patent

Bana le bacha

Teko ea bongaka e nang le taolo e sebetsang (glimepiride ho fihlela ho 8 mg ka letsatsi kapa metformin ho fihlela ho 2 mg mg ka letsatsi) libeke tse 24 tse ileng tsa etsoa e ne e entsoe le bana ba 285 (ba lilemo tse 8 ho isa ho tse 17) ba nang le lefu la tsoekere la mofuta oa 2. Metsoako ka bobeli, glimepiride le metformin, e bontšitse ho fokotseha ho hoholo ho HbAlc mabapi le boemo ba pele ba glimepiride -0.95 (serum 0, 41), metformin -1.39 (serum 0.40). Ntle le sena, glimepiride ha e a ka ea fihlela maemo a "se sebe ho feta metformin", e ahlola ka phetoho e tloaelehileng ea HbAlc mabapi le letšoao la pele. Phapang e ne e le 0.44% molemong oa metformin. Meeli e Phahameng (1,05) 95% ea boitšepo

nako ea phapang e ne e phahame ho feta moeli o lumelloang oa bonyane katleho e lekanang le 0,3%,

Phekolo ea Glimepiride ha ea ka ea senola matšoenyeho a eketsehileng a polokeho ho bana ha a bapisoa le a bakuli ba baholo ba nang le lefu la tsoekere la mofuta oa 2. Ha ho na datha e tsoang ho liteko tsa nako e telele tsa ts'ebetso le polokeho ho bakuli ba bana.

Mofumahali

Ha a incheed glimepiride bioavailability ea eona e felletse. Ho ja ha ho na tšusumetso e kholo ho monyelleng, ntle le ho theoha butle ha sekhahla sa ho amoheloa. Ka tšebeliso ea khafetsa ea glimepiride ka tekanyetso ea 4 mg ea letsatsi le letsatsi, khatello e phahameng ka ho fetisisa serum ea mali (C_tlhokomeliso) e fihlelloa kamora lihora tse ka bang 2,5 mme e fihla ho 309 ng / ml, ho na le kamano pakeng tsa lethal dose le Stax, le pakeng tsa lethal dose le AUC (sebaka se tlasa khatello ea nako ea mahloriso).

Glimepiride e tšoauoa ka palo e tlase haholo ea phetiso (e ka bang 8.8 L), e batlang e lekana le bophahamo ba karolelano ea albin, tekanyo e phahameng ea ho tlama liprotheine tsa plasma (ho feta 99%) le tumello e tlase (hoo e ka bang 48 ml / min).

Biotpansformatssh le ho tlosoa

Kamora tekanyetso e le 'ngoe ea molomo ea glimepiride, 58% e hloelloa ka har'a moroto' me 35% e na le makhopho. Lintho tse sa fetoloang ka har'a moroto ha lia ka tsa fumanoa. Ho felisoa ha halofo ea bophelo maemong a plasma a moriana serum o tsamaellanang le regimen e ngata ea dosing ke lihora tse 5-8. Kamora ho nka tekanyetso e phahameng, halofo ea bophelo e eketseha hanyane.

Ho fumanoe li-metabolites tse peli tse sa sebetseng ka har'a moroto le makhopho, tse hlahisoang ka lebaka la metabolism sebeteng, e 'ngoe ea tsona e tsoa ho hydroxy,' me e 'ngoe e tsoa ho carboxy. Kamora ho kenella ha glimepiride, halofo ea bophelo ba metabolites tsena ke lihora tse 3-5 le lihora tse 5-6, ka ho latellana.

Glimepiride e hloekisoa lebeseng la matsoele mme e tšela sethopo sa placental. Setlhare se kenella hampe mothong oa mali le bokong.

Papiso ea glimepiride e le 'ngoe le e mengata (hang ka letsatsi) tsamaiso ea glimepiride ha ea ka ea senola phapang e kholo litekanyetsong tsa pharmacokinetic, mme phapang ea tsona e tlase haholo e ile ea bonoa pakeng tsa bakuli ba fapaneng. Ha ho na ts'ebetso e kholo ea lithethefatsi.

Lihlopha tse Khethehileng tsa Patent

Litekanyetso tsa Pharmacokinetic li tšoana ho bakuli ba bong bo fapaneng le ba lilemo tse fapaneng. Ho bakuli ba nang le ts'ebetso ea renal e holofetseng (e nang le tumello e tlase ea creatinine), ho ne ho na le tloaelo ea ho eketsa ho hlaka ha glimepiride le ho fokotseha ha likhahla tsa eona tse akaretsang serumong ea mali, e leng se ka etsahalang ka lebaka la tlhahiso ea meriana e potlakileng ka lebaka la ho tlama protheine e tlase. Kahoo, sehlopheng sena sa bakuli ha ho na kotsi e eketsehileng ea ho eketseha ha moriana.

Teko ea ho ithuta pharmacokinetics, polokeho, le mamello ea tekanyetso e le 'ngoe ea 1 mg ea glimepiride ho bakuli ba 30 ba bana (bana ba 4 ba lilemo li 10-12 le bana ba 26 ba lilemo li 12 - 17) ba nang le lefu la tsoekere la mofuta oa 2 ba bontšitse hore kakaretso ea AUCo -i_{joalo ka}t, C_max le X analoguechny litekanyetso tse shebiloeng pele ho batho ba baholo.

Contraindication

Glimepiride ha ea lokela ho sebelisoa bakeng sa:

• hypersensitivity ho glimepiride kapa ntho efe kapa efe e sa sebetseng ea lithethefatsi, ho tse ling tse tsoang ho sulfonylurea kapa lithethefatsi tsa sulfa (kotsi ea karabelo ea hypersensitivity),

• lefu la tsoekere le itšetlehileng ka lefu la tsoekere,

• lefu la tsoekere ketoacidosis, lefu la tsoekere le leta,

• ho hloka matla ha sebete,

• ho senyeheloa haholo ke renal (ho kenyeletsa le bakuli ba hemodialysis),

• ho ima le ho nyeka.

Bokhachane le pelehi

Glimepiride e kopantsoe le basali ba baimana. Tabeng ea kemolo e reriloeng kapa qalong ea kemaro, mosali o lokela ho fetisetsoa kalafo ea insulin.

Kaha glimepiride, kamoo ho hlakileng, e fetelang ka lebeseng la matsoele, ha ea lokela ho fuoa basali nakong ea pelehi. Maemong ana, ho hlokahala hore o fetole ho kalafo ea insulin kapa ho emisa matsoele.

Tekanyetso le tsamaiso

E etselitsoe tšebeliso ea molomo.

Motheo oa taolo e atlehileng ea lefu la tsoekere ke lijo tse nepahetseng, boikoetliso bo hlophisehileng, le ho lekola lipalo tsa mali le urine kamehla. Ho kheloha likhothaletso tsa lijo ho ka se lefelletsoe ke matlapa kapa insulin.

Khetlo ea pele le khetho

Tekanyetso ea glimepiride e khethoa ke tlhahlobo ea tsoekere maling le moriring.

Tekanyetso ea pele ke 1 mg ea glimepiride ka letsatsi, haeba ka nako e ts'oanang taolo ea metabolic e atlehileng e fumaneha - tekanyetso ena e lokela ho bolokoa nakong ea kalafo.

Bakeng sa mefuta e meng ea dosing, matlapa a fumaneha ka litekanyetso tse nepahetseng.

Ha ho hlokahala, tekanyetso ea letsatsi le letsatsi e ka eketsoa butle-butle tlasa tlhahlobo ea tsoekere maling maling ka nako le nako ka libeke tse 1-2 le ka tatellano e latelang: 1 mg - 2 mg - 3 mg - 4 mg glimepiride ka letsatsi.

Motsoako oa glimepiride o fetang 4 mg ka letsatsi o tlisa litlamorao tse ntle feela maemong a ikhethang. Tekanyo e phahameng e khothalletsoang letsatsi le letsatsi ke 6 mg.

Nako le khafetsa tsa ho nka tekanyetso ea letsatsi le letsatsi li khethoa ke ngaka, ho nahanela tsela ea bophelo ea mokuli. Ha e le molao, ho beoa ha tekanyetso ea letsatsi le letsatsi ka tekanyetso e le 'ngoe kapele kapa nakong ea lijo tsa hoseng tse monate kapa, haeba tekanyetso ea letsatsi le letsatsi e se eona

e nooa hang-hang pele kapa nakong ea lijo tse boima tsa pele. Ho siea ha moriana ha hoa lokela ho felisoa ke tsamaiso e latelang ea lethal dose e phahameng. Matlapa a Amaril a nkuoa a felletse, ntle le ho hlafuna, ka sekhahla se lekaneng sa metsi (hoo e ka bang likopi tse 0,5). Ho bohlokoa haholo hore u se ke oa tlola lijo ka mor'a ho nka Amaril.

Sebelisa hammoho le metformin

Ha ho sa lekana botsitso ba khatello ea tsoekere maling maling ho bakuli ba nkang metformin, kalafo e kopaneng le glimepiride e kanna ea qala. Ha a ntse a boloka tekanyetso ea metformin ka tekanyo e le 'ngoe, kalafo e nang le glimepiride e qala ka tekanyetso e fokolang,' me joale tekanyetso ea eona butle-butle e eketseha ho latela boemo bo lakatsehang ba taolo ea glycemic, ho fihlela tekanyo e phahameng ea letsatsi le letsatsi ea 6 mg. Phekolo ea ho kopanya e lokela ho etsoa ka tlasa tlhokomelo ea bongaka e haufi.

Sebelisa hammoho le insulin

Maemong moo ho ke keng ha khoneha ho fihlela tumellano ea tsoekere ea mali ka ho nka tekanyetso e phahameng ea glimepiride ho monotherapy kapa hammoho le lethal dose le leholo la metformin, motsoako oa glimepiride o nang le insulin oa khonahala. Tabeng ena, tekanyetso ea ho qetela ea glimepiride e fuoeng mokuli e lula e sa fetoha. Maemong ana, kalafo ea insulin e qala ka tekanyetso e fokolang, ka keketseho e tlang butle-butle ea lethal dose la insulin tlasa taolo ea khatello ea mali maling. Phekolo e kopaneng e hloka tlhokomelo e tlamang ea bongaka. Ha e ntse e boloka taolo ea glycemic ea nako e telele, kalafo ena e kopaneng e ka fokotsa tlhoko ea insulin ka 40%.

Phetisetso ea mokuli ho tsoa ho e 'ngoe ea lithethefatsi tsa molomo tsa hypoglycemic ho glimepiride Ha ho na kamano e nepahetseng pakeng tsa litekanyetso tsa glimepiride le litlhare tse ling tsa molomo tsa hypoglycemic. Ha ho fetisoa ho lithethefatsi tse joalo ho isa glimepiride, tekanyetso ea pele ea letsatsi ka leng e lokela ho ba 1 mg (le haeba mokuli a fetisetsoa glimepiride ka tekanyo e phahameng ea lithethefatsi tse ling tsa molomo tsa hypoglycemic).Keketseho efe kapa efe ea tekanyetso ea glimepiride e lokela ho etsoa ka mekhahlelo, ho nka karabelo ho glimepiride ho latela likhothaletso tse kaholimo. Hoa hlokahala ho ela hloko tekanyo e sebelisitsoeng le nako ea phello ea moemeli oa hypoglycemic ea nakong e fetileng. Maemong a mang, haholo-holo ha u sebelisa lithethefatsi tsa hypoglycemic ka nako e telele ea halofo ea bophelo (mohlala, chlorpropamide), ho ka hlokahala hore ka nakoana (ka mor'a matsatsi a 'maloa) u khaotse ho phekoloa ho qoba tšusumetso e eketsang kotsi ea hypoglycemia.

Phetisetso ea mokuli ho tsoa ho insulin ho ea glimepiride

Maemong a ikhethang, haeba bakuli ba nang le lefu la tsoekere la mofuta oa 2 ba amohela kalafo ea insulin, joale ka tefo ea lefu lena le ts'ebetso ea sephiri ea lisele tsa pancreatic beta, ba ka bontšoa phetisetso ea glimepiride. Mofetoleli o lokela ho etsoa tlas'a tlhokomelo e haufi ea bongaka. Maemong ana, phetisetso ea mokuli ho glimepiride e qala ka tekanyetso e fokolang ea glimepiride ea 1 mg.

Kopo ea ho se sebetse hantle ha masapo le sebete

Tlhahisoleseling e sa lekanyetsoang ea fumaneha ka tšebeliso ea lithethefatsi ho bakuli ba nang le a renal le hepatic insufficiency (bona karolo Contraindication).

Bana le bacha

Lintlha tse mabapi le tšebeliso ea glimepiride ho bakuli ba ka tlase ho lilemo tse 8 ha li fumanehe. Bakeng sa bana ba lilemo tse 8 ho isa ho 17, ho na le data e fokolang mabapi le ts'ebeliso ea glimepiride ka mokhoa oa monotherapy (bona karolo ea Pharmacokinetics le Pharmacodynamics). Lintlha tse fumanehang mabapi le katleho le polokeho ha li lekane bakeng sa ts'ebeliso ea glimepiride ho bana, ka hona ts'ebeliso e joalo ha e khothalletsoe.

Litla-morao

Lintlha tse mabapi le karabelo e mpe e bakoang ke ho nka glimepiride le tse ling tse tsoang sulfonylurea li hlahisoa ka tlase nakong ea liteko tsa bongaka. Liphetoho tse fapaneng li arotsoe ka mekhahlelo ea mekhahlelo ea litho mme e behiloe ka tatellano ea ho fokotseha hoa liketsahalo (hangata:> 1/10, khafetsa:> 1/100, 1/1000, 1/10000,

Bongata

Kamora ho kenella ka tekanyetso e kholo ea glimepiride, nts'etsopele ea hypoglycemia e ka etsahala, e nka lihora tse 12 ho isa ho tse 72, tse ka phetoang kamora ho khutlisetsoa ha khatello ea tsoekere maling. Hypoglycemia e kanna ea emisoa ka potlako ke takatso ea kapele ea lik'habohaedreite (tsoekere kapa tsoekere, ka mohlala, ka mokhoa oa sekhechana sa tsoekere, lero le monate la litholoana kapa tee). Tabeng ena, mokuli o lokela ho lula a na le bonyane 20 g ea tsoekere (likotoana tse 4 tsa tsoekere). Li-sweeteners ha li na thuso kalafong ea hypoglycemia. Maemong a mangata, ho khothalletsoa ho beha leihlo sepetlele. Phekolo e kenyelletsa ho hlatsa, ho ntsa metsi, metsi kapa Lemonade le mashala a ts'ebetso (adsorbent) le sodium sulfate (laxative) Ha u nka tekanyo e kholo ea lithethefatsi, ho hlahisoa ka sefuba ho lateloa ke ho hlahisoa ha charcoal e sebetsang le sodium ea sodium. setšoantšo sa tleliniki ea ho hlaseloa ke stroke, ka hona, se hloka kalafo e potlakileng tlasa tlhokomelo ea ngaka, le maemong a itseng le ho kena sepetlele ho mokuli. Hang ha ho khoneha, ho hlahisoa ha tsoekere ho hlokahala Ka mokhoa oa ho entoa ka iv bakeng sa 50 ml ea tharollo ea 40%, e lateloe ke ho kenngoa ha tharollo ea 10% ka ho lekola ka hloko tsoekere ea mali maling, kalafo e tsoelang pele e lokela ho ba matšoao.

Matšoao a hypoglycemia a ka lokisoa kapa a ba sieo ka ho felletseng ho bakuli ba tsofetseng, ho bakuli ba nang le bothata ba ho intša kapa ho fumana kalafo e tšoanang ka p-adrenoblockers, clonidine, reserpine, guanethidine kapa li-agents tse ling tse utloisang bohloko.

Haeba mokuli ea nang le lefu la tsoekere a phekoloa ke lingaka tse fapaneng (mohlala, nakong ea ho phomola sepetlele kamora kotsi, a kula ka beke), o lokela ho ba tsebisa ka bokuli ba hae le ka kalafo e fetileng.

Phekolo ea hypoglycemia e tsoetseng pele ka lebaka la tsamaiso e sa sebetseng ea Amaril ke masea kapa bana ba banyenyane, tekanyetso e boletsoeng ea dextrose (50 ml ea tharollo ea 40%) e lokela ho beoa leihlo ka hloko e le ho qoba hyperglycemia e kotsi. Ntlheng ena, ho hlokahala tlhahlobo e tsoelang pele le e phethahetseng ea khatello ea tsoekere maling.

Ho sebelisana le lithethefatsi tse ling

Tabeng ea tšebeliso e kopaneng le glimepiride ea lithethefatsi tse ling, ho fokotseha ho sa rateheng le keketseho e sa rateheng ea phello ea hypoglycemic ea glimepiride e ka hlaha. Ntlheng ena, lithethefatsi tse ling li ka nkuoa feela ka tumello (kapa joalo ka taelo ea ngaka).

Glimepiride e entsoe ka cytochrome P4502C9, e lokelang ho nahanoa ha e sebelisoa ka nako e ts'oanang le li-inducers (e.g. rifampicin) kapa inhibitors (e.g. fluconazole).

Litšebelisanong tsa vivo tse phatlalalitsoeng libukeng li bonts'a hore fluconazole, e 'ngoe ea lithibela-mafu tse matla ka ho fetisisa tsa CY32C9, e eketsa AUC ea glimepiride ka makhetlo a mabeli.

Ho latela boiphihlelo ka glimepiride le tse ling tse tsoang ho sulfonylurea, litšebelisano tse latelang li lokela ho hlokomeloa.

Keketseho ea phello ea hypoglycemic le kholo ea kholo ea hypoglycemia e amanang le sena e ka bonoa ka tšebeliso e tšoanang ea glimepiride le lithethefatsi tse latelang:

- phenylbutazone, azapropazone, oxyphenbutazone,

- insulin le lithethefatsi tse ling tsa hypoglycemic, joalo ka metformin,

- salicylates le aminosalicylic acid,

- Li-anabolic steroid le lihormone tsa banna tsa thobalano,

- chloramphenicol, sulfonamides e meng e telele, litšoelesa tsa tlhaho, Quinolones le clarithromycin,

- angiotensin e fetolang enzyme (ACE) inhibitors,

- fluoxetine, monoamine oxidase inhibitors (MAO),

- allopurinol, phenenosis, sulfinpyrazone,

- cyclo-, cy- and ifosfamides,

- pentoxifylline (ka tsamaiso ea batsoali ka tekanyetso e phahameng),

Ho fokola ha phello ea hypoglycemic le keketseho e amanang le khatello ea tsoekere maling ho ka bonoa ka tšebeliso e tšoanang ea glimepiride ka litlhare tse latelang:

- estrogens le progestogens,

- saluretics le thiazide diuretics,

- lihomone tsa qoqotho, glucocorticosteroids

- epinephrine le baemeli ba bang ba kutloelo-bohloko,

- nicotinic acid (litekanyetso tse phahameng) le tse tsoang ho nicotinic acid,

- Laxatives (ka tšebeliso e telele),

- glucagon, barbiturates le rifampicin,

Lithoko N₂li-receptors, clonidine le reserpine li khona ho ntlafatsa le ho fokolisa phello ea hypoglycemic ea glimepiride.

Tlas'a tšusumetso ea baemeli ba nang le kutloelo-bohloko, joalo ka beta-blockers, clonidine, guanethidine le reserpine, matšoao a ho hanyetsa ha adrenergic ha a arabela hypoglycemia a ka fokotsoa kapa a ba sieo.

Khahlano le semelo sa ho nka glimepiride, keketseho kapa ho fokola hoa ts'ebetso ea melemo ea coumarin e ka bonoa.

Tšebeliso e le 'ngoe ea joala kapa e sa foleng e ka matlafatsa le ho fokolisa phello ea hypoglycemic ea glimepiride.

Likarolo tsa ts'ebeliso

Glimepiride e lokela ho nkoa hang-hang pele ho lijo kapa nakong ea lijo.

Haeba lijo li nkuoa ka linako tse sa tsoeng kapa li sa thuoe ka ho felletseng, mokuli ea fumanang kalafo ea glimepiride a ka ba le

hypoglycemia Matšoao a ka bang teng a hypoglycemia a kenyelletsa: ho opeloa ke hlooho, tlala e matla, ho nyekeloa, ho hlatsa, ho ikutloa o khathetse, ho otsela, ho khathatseha boroko, ho tšoenyeha, ho ba mabifi, ho tsepamisa mohopolo, ho tsepamisa maikutlo le ho arabela, khatello ea maikutlo, pherekano, puo le pherekano ea pono, aphasia, thothomelo, paresis Ho ferekana ha maikutlo, ho tsekela, ho ikutloa u se na thuso, ho lahleheloa ke boitaolo, ho hlasimoloha kelello, mokokotlo oa kelello, pherekano le ho felloa ke letsoalo, ho kenyeletsa komisi, ho hema ka mokhoa o sa tsitsang, bradycardia. Ntle le moo, ka lebaka la ts'ebetso ea "adrenergic" ea ts'oaetso, matšoao a kang ho bata, ho fufuleloa ka sefuba, ho tšoenyeha, tachycardia, khatello ea methapo ea pelo, phallo ea pelo, ho senyeha hoa pelo le mathata a morethetho oa pelo.

Tlhahiso ea bongaka ea hypoglycemia e matla e kanna ea tšoana le tlhaiso ea bongaka ea stroke.

Hoo e batlang e le maemong ohle, matšoao a ka laoloa hang-hang ke tšebeliso ea hang-hang ea li-hydrocarbons (tsoekere). Li-monko o monate oa maiketsetso ha li sebetse ka nako e le 'ngoe.

Joalokaha ho tsejoa ho tsoa phihlelong ea ho sebelisa litlatsetso tse ling tsa sulfonylurea, leha ho bile le ts'ebeliso e atlehileng ea li-countermeasure qalong, hamorao hypoglycemia e ka boela ea hlaha.

Hypoglycemia e matla kapa e telele, e laoloang nakoana ka tsoekere e tloaelehileng, e hloka tlhokomelo ea bongaka kapele kapa esita le ho kena sepetlele.

Liphetoho tse hlahisang kholo ea hypoglycemia li kenyeletsa:

- ho tsilatsila kapa (hangata botsofaling) bokhoni bo sa lekaneng ba bakuli ba ho sebelisana le ngaka, ho fokola, phepo e sa lekanyetsoang, ho tlōla lijo, ho itima lijo,

- Liphetoho lijong tse tloaelehileng,

- ho leka-lekana pakeng tsa ts'ebetso ea 'mele le ho ja lijo tse matlafatsang tsa' mele,

- ho nwa jwala, haholoholo mmoho le ho tlola ja lijo,

- mosebetsi o sa sebetseng oa renal, o holofalitsoeng ke ho sebetsa ha sebete,

- mafu a mang a sa sebetseng a tsamaiso ea endocrine e amang metabolism ea carbohydrate, kapa hypoglycemia ea mohlala (mohlala, dysfunctions tse ling tsa tšoelesa ea qoqotho, ho se lekane kapa ho se lekane ha adrenal cortex), tšebeliso e tšoanang ea lithethefatsi tse ling (bona tšebelisano le lithethefatsi tse ling. )

Phekolo ka glimepiride e hloka ho lekola khafetsa khatello ea tsoekere maling le morong. Ntle le moo, ho kgothaletswa maemo a hemoglobin ea glycosylated.

Hape, nakong ea kalafo e nang le glimepiride, ho hlahlojoa ha ts'ebetso ea sebete le ho bala lisele tsa mali (haholo-holo leukocytes le liplatelete) hoa hlokahala.

Maemong a sithabetsang (mohlala, kamora kotsi, ts'ebetso ea tšohanyetso, ts'oaetso ea febrile, jj), ho ka bontšoa phetoho ea nakoana ho insulin.

Ha ho na boiphihlelo ba glimepiride ho bakuli ba nang le bothata bo matla ba ho lemala kapa ho bakuli ba hlokang hemodialysis. Bakuli ba nang le bothata bo matla ba renal kapa hepatic ba haelloa ke phetoho ho insulin.

Phekolo ka metsoako ea sulfonylurea e ka lebisa ho hemolytic anemia ho bakuli ba nang le khaello ea glucose-6-phosphate dehydrogenase. Kaha glimepiride ke ea sehlopha sa sulfonylurea derivatives, e lokela ho sebelisoa ka hloko ho bakuli ba nang le khaello ea glucose-b-phosphate dehydrogenase. Ntle le moo, likhetho tsa kalafo li lokela ho tsotelloa le lingaka tse ling tse se nang melemo ea sulfonylurea.

Amaryl e na le lactose monohydrate, ka hona ha ea lokela ho nkoa ho bakuli ba futsitseng lefu la lactose, khaello ea lactase kapa ho kenngoa ha glucose-lactose.

Boithuto ba phello ea glimepiride mabapi le bokhoni ba ho khanna makoloi le mekhoa ha e so ka e etsoa. Karabelo ea mokuli kapa matla a ho tsepamisa mohopolo li ka fokotsoa ka lebaka la nts'etsopele ea hypoglycemia kapa hyperglycemia, kapa, ka mohlala, ka lebaka la khaello ea pono. Litlamorao tsena li ka ba kotsi maemong ao bokhoni bona bo leng bohlokoa haholo (mohlala, ha u khanna koloi kapa mochine).

Bakuli ba lokela ho tsebisoa ka tlhokahalo ea mehato ea ho itlhokomela ho qoba hypoglycemia ha u ntse u khanna. Sena se bohlokoa haholo ho bakuli ba nang le liketsahalo tsa hypoglycemia khafetsa, kapa bakuli ba sa lekaneng kapa ba sa tsebeng letho ka matšoao a pele a hypoglycemia. Maemong ana, monyetla oa likoloi tsa ho khanna kapa mochini o sebetsang o lokela ho tsotelloa.

Sebopeho le mofuta oa tokollo

Amaryl e hlahisoa matlapeng a nang le 1-4 mg, e pakiloeng ka likotoana tse 15 ka blister e le 'ngoe. Pakete e le 'ngoe ea lithethefatsi e ka kenyelletsa marang-rang a 2, 4, 6 kapa 8.

• Letlapa le le leng la lithethefatsi le kenyelletsa ntho e sebetsang - glimepiride - 1-4 mg le likarolo tse thusang: lactose monohydrate, povidone, sodium carboxymethyl starch, cellulose ea microcrystalline, carmine ea indigo le furu ea magnesium.

Sehlopha sa Clinical le pharmacological: Setlhare sa hypoglycemic sa molomo.

Litaelo tsa ho sebelisoa

Ho latela litaelo tsa tšebeliso, litekanyetso tsa litokisetso tsa Amaryl le Amaryl M li laetsoe ke ngaka ka bonngoe ho mokuli ka mong, ho ipapisitse le boemo ba tsoekere ba mali ba mokuli bo phahameng hakae. Moriana o lokela ho sebelisoa ka tekanyetso e fokolang ho fihlela taolo ea metabolic e hlokahalang.

Litaelo tsa tšebeliso ea Amaril li boetse li tlaleha hore kalafo e hloka boikemisetso ba khafetsa ba khatello ea mali maling le boemo ba hemoglobin ea glycosylated.

Matlapa a Amaryl a lokela ho nkuoa a felletse, ntle le ho hlafuna, ka metsi a lekaneng (hoo e ka bang senoelo sa 1/2). Ha ho hlokahala, matlapa a lithethefatsi Amaryl a ka aroloa hammoho le likotsi ka likarolo tse peli tse lekanang.

• Tekanyetso ea pele ea Amaril ke 1 mg 1 nako / letsatsi. Ha ho hlokahala, tekanyetso ea letsatsi le letsatsi e ka eketsoa butle-butle (ka linako tse ling tsa libeke tse 1-2) ka tlasa tlhahlobo ea tsoekere ea mali le ka tatellano e latelang: 1 mg-2 mg-3 mg-4 mg-4 mg-6 mg (-8 mg) ka letsatsi .
• Bakeng sa bakuli ba nang le lefu la tsoekere la mofuta oa 2 le laoloang hantle, tekanyetso ea letsatsi le letsatsi hangata ke 1-4 mg. Pilisi ea letsatsi le letsatsi e fetang 6 mg e sebetsa hantle ho palo e fokolang feela ea bakuli.

Tlolo ea molao ea ho sebelisa lipilisi, mohlala, ho tlola tekanyetso e latelang, ha ho hlokehe hore e hlahisoe ke tšebeliso e latelang ea Amaril ka tekanyetso e phahameng.

Nako ea ho nka matlapa le ho ajoa ha litekanyetso ka letsatsi lohle e beoa ke ngaka. Ka nako e ts'oanang, ho nahanela bophelo ba mokuli (palo ea ho ikoetlisa ka 'mele, nako ea lijo, lijo). Tekanyetso ea letsatsi le letsatsi e beoa tekanyetso e le 'ngoe, kapele pele ho lijo tsa hoseng tse phethahetseng. Haeba tekanyetso ea letsatsi le letsatsi ha e so nkuoe, pele ho lijo tsa pele tse kholo. Ho bohlokoa hore u se ke oa tlola lijo ka mor'a ho sebelisa moriana.

Phekolo ea Glimepiride hangata e etsoa ka nako e telele.