Yuav kho tus mob Januvia mob ntshav qab zib li cas

Cov Tshuaj Hauv Tshuaj

Kev siv tshuaj hypoglycemicrau qhov ncauj tswj hwm, qhov muaj zog xaiv dipeptidyl peptidase-4 blocker. Nws txawv hauv cov qauv thiab ua los ntawm tshuaj insulin, biguanides, sulfonylurea derivatives, γ-receptor agonists, alpha-glycosidase blockers, analogues glucagon-zoo li peptide 1thiab amylinCov. Kev thaiv dipeptidyl peptidase-4, sitagliptinnce qib ntawm ob paub cov tshuaj hormones ntau ntxiv: insulinotropic qabzib-peptide peptide thiab glucagon-zoo li peptide 1.

Cov tshuaj hormones no tau zais cia hauv plab hnyuv, thiab lawv qib nce nyob rau hauv kev teb rau ib pluas noj. Kev tsis ntseeg Yog ib feem ntawm kev tswj hwm sab hauv metabolism hauvpiam thaj. Nrog ib txwm lossis nce ntshav ntxiv piam thajcov tshuaj hormones incretin txhawb nqa ua ketshuaj insulinthiab nws qhov zais ntawm cov txiav.

Glucagon-zoo li peptide 1 kuj tseem inhibits kev tso pa tawm ntau glucagon txiav Cov ntsiab lus txo glucagonthaum nce qib tshuaj insulin ua rau txo qis hauv synthesispiam thajmob siab, uas kawg ua rau lub cev tsis muaj zog txhauv.

Thaum tsis tshua muaj siab piam thajhauv plasma cov teebmeem saum toj no ntawm cov no cov tshuaj hormones incretinlos hais tshuaj insulin thiab kev tsuj ntawm kev zais kev zais glucagon tsis sau npe.Glucagon-zoo li peptide 1thiab insulinotropic qabzib-peptide peptidetsis cuam tshuam rau kev xaiv glucagonnyob rau hauv teb rau txoj kev loj hlob ntshav qog.

Sitagliptin inhibits hydrolysis incretinsenzyme dipeptidyl peptidase-4thiaj li ua kom cov ntshav ntau ntawm cov foos nquag glucagon-zoo li peptide 1thiab insulinotropic qabzib-peptide peptideCov. Txhawb cov ntsiab lus ntau ntxivincretins, sitagliptintsub kom cov piam thaj hauv qhov tso pa tawmtshuaj insulin thiab inhibits kev zais cia glucagonCov. Hauv cov neeg nrog ntshav qab zib hom 2nyob rau tom qab hyperglycemiacov khoom hloov no tshuaj insulin thiab glucagon ua rau muaj kev txo qis hauv kev xav glycated hemoglobin thiab kom tsawg piam thajhauv ntshav.

Hauv cov neeg nrog ntshav qab zib hom 2 noj ib qho qauv ntawm Januvia ua rau kev tsuj ntawm kev ua si enzymedipeptidyl peptidases-4thaum nruab hnub, uas ua rau muaj kev ncig ntau ntxiv hauv lub cev incretins(glucagon-zoo li peptide 1thiab insulinotropic qabzib-peptide peptide) 2-3 zaug, nce ntxiv tshuaj insulinthiab C peptide hauv ntshav, txo qis qib glucagon hauv cov ntshav, ua kom tsis muaj zog txhauvnyob rau ib plab khoob.

Cov Tshuaj Pharmacokinetics

Tom qab siv 100 mg ntawm cov tshuaj, sai nqus tau sau tseg sitagliptin nrog kev ua tiav ntawm cov ntsiab lus tseem ceeb tshaj plaws hauv cov ntshav tom qab 1-4 teev. Kev tsis raug cai ntawm kev tsis raug cai yog txog 87%. Kev siv ua ke ntawm cov roj ntsha tsis hloov pauv cov khw muag tshuaj sitagliptin.

Kev khi ntawm cov tshuaj nquag rau cov ntshav plasma nce mus txog 38%.

Tsuas yog ib feem me me ntawm cov tshuaj noj uas tau hloov pauv. 16% ntawm cov koob tshuaj yog tawm ua cov tshuaj metabolites. 6 metabolites paub sitagliptinuas tej zaum tsis muaj nws cov haujlwm. Thawj lub enzymes lub luag haujlwm rau cov metabolism sitagliptinyog CYP2C8 thiabCYP3A4.Txog li 79% ntawm cov tshuaj tau tawm hauv nws cov qauv qub nrog zis. Ib nrab-lub neej sitagliptin yog kwv yees li 12,5 teev.

Kev ntsuas rau siv

• Raws li ib feem ntawm kev kho mob sib xyaw ntshav qab zib hom 2 kom ua haujlwm tswj tau nruj txhauv txuam nrog PPAR-γ agonists lossis Metforminthaum lub cev ua si thiab kev noj haus ua ke nrog kev kho mob monotherapy nrog cov txhais tau hais saum toj no tsis tso cai rau koj los tswj glycemia.
• Monotherapy nrog cov tshuaj ua ib qho ntxiv rau kev siv lub cev thiab kev noj haus kom txhim kho glycemic tswj hauv cov neeg txom nyem ntshav qab zib hom 2.

Cov Yuav Tsum Tau Ua

• ntshav qab zib hom 1,
• cev xeeb tub thiab kev pub mis,
• mob ketoacidosis,
• kev tiv thaiv tsis haumrau lub Cheebtsam ntawm cov tshuaj,
• Nws tsis raug nquahu kom muab cov tshuaj rau cov neeg hnub nyoog qis dua 18 xyoo.

Nws raug nquahu kom muab tshuaj los ntawm kev ceev faj rau cov neeg mob uas tau mob los ntawm lub raum tsis ua hauj lwmCov. Ntawm raum tsis ua hauj lwm mob hnyav thiab hnyav, cov neeg mob nrog lub davhlau ya nyob twg ntawm qhov kev kov yeej no, xav tau hemodialysis Txoj kev txais tos hom yuav tsum tau kho.

Sab sij huam

• Kev cuam tshuam los ntawm kev ua pa: mob ntsws ua pa, nasopharyngitis.
• Kev cuam tshuam los ntawm kev ua si tshee: mob taub hau.
• Kev cuam tshuam los ntawm kev zom plab: mob plab zawv plabntuav, xeev siab.
• Kev cuam tshuam los ntawm musculoskeletal system: arthralgia.
• Kev cuam tshuam los ntawm tiv thaiv kab mob: ntshav qog.
• Kev Ntsuas Cov Ntaub Ntawv Tsis Zoo: Cov Ntsiab Lus Ntxiv uric acidkev poob qis me me hauv kev xav alkaline phosphatasence ntxiv hauv tus lej neutrophils.

Januvia, cov lus qhia rau kev siv (Txoj kev thiab ntau npaum li cas)

Cov lus qhia rau Januvia tsim kom pom zoo koob tshuaj ntawm cov tshuaj thaum siv hauv kev kho mob monotherapy lossis hauv kev sib xyaw nrog lwm cov tshuaj hauv 100 mg txhua hnub.

Cov tshuaj muaj cai tau noj tsuas yog ib qho zaub mov. Yog tias tus neeg mob tsis nco qab noj tshuaj, ces nws yuav tsum tau noj cov tshuaj no kom sai li sai tau. Nws yog txwv tsis pub noj ob zaug ntawm cov tshuaj.

Nrog ib tug kawm tiav me me lub raum tsis ua hauj lwmntau npaum li cas los kho tsis tas yuav ntau.

Ntsawv lub raum tsis ua hauj lwm qhov tshuaj yuav tsum yog 50 mg txhua hnub.

Nyob rau hauv loj lub raum tsis ua hauj lwm thiab hauv cov neeg mob nrog theem kawg raum tsis ua hauj lwmzoo li yog tsim nyog hemodialysis qhov ntau ntawm cov tshuaj yog 25 mg ib hnub ib zaug.

Noj ntau dhau

Cov cim ntawm kev txhaj tshuaj ntau dua: thaum noj ib koob ntawm 800 mg ntawm cov tshuaj, muaj kev hloov tsawg kawg nkaus tau pom txiav QTc.Cov kev tshawb fawb soj ntsuam ntawm kev noj cov tshuaj ntawm ib zaug dhau ntawm 800 mg rau ib hnub tsis tau ua.

Kev siv ntau dhau: kev kho plab zom mov, nqus tau enterosorbentssoj ntsuam ntawm cov cim tseem ceeb, kev txhawb nqa thiab tsos mob.

Nquag cov khoom tsis zoo lim ntshav.

Kev sib txuam

Tau nce me ntsis hauv qhov siab tshaj plaws tau muab sau tseg. Digoxin thaum sib qhia nrog sitagliptin.

Kuj tseem muaj qhov nce ntawm qhov nce hauv qhov siab tshaj plaws sitagliptin hauv cov neeg mob thaum siv nrog nrog Cyclosporine.

Cov lus qhia tshwj xeeb

Thaum qhov kev sim tshuaj ntawm cov tshuaj, qhov tshwm sim muaj ntau zaus ntshav qog thaum siv, nws zoo ib yam li thaum siv cov tshuaj placebo.

Them Cov Neeg Mob daim siab ua hauj lwm hloov pauv kev noj tshuaj tsis tas yuav tsum muaj.

Cov ntawv qhia txog Januvia: Galvus, Comboglize XR, Nesin, Ongliz, Trazent.

Koj yuav tsum tsis txhob thov cov tshuaj rau cov neeg tsis tau muaj 18 xyoo.

Kev Sib Sau thiab daim ntawv ntawm tso tawm

Cov tshuaj muaj nyob rau hauv daim ntawv ntawm cov ntsiav tshuaj. Lawv yog cov puag ncig, daj ntseg liab, lub teeb beige pom pom. Ntawm txhua cov ntsiav tshuaj muaj ib qho cim:

• "221" - yog tias qhov ntau npaum ntawm cov tshuaj nquag yog 25 mg,
• "112" - 50 mg,
• "277" - 100 mg.

Cov khoom siv tseem ceeb yog cov tshuaj sitagliptin (nws phosphate monohydrate).

Cov ntsiav tshuaj tau ntim rau hauv cov hlwv.

Cov teeb meem Pharmacological

Txhais tau tias "Januvia" yog hais txog ib pawg ntawm cov tshuaj hluavtaws hypoglycemic. Cov tshuaj yog ib qho incretin, ib qho inhibitor ntawm DPP-4. Nws nquag siv rau cov hom phiaj kho hauv kev kuaj mob ntshav qab zib hom II. Thaum noj nws, muaj qhov nce ntxiv nyob hauv kev ua kom ntau zuj zus, txhawb nqa lawv tus kheej. Pancreatic cells nce insulin synthesis. Nyob rau tib lub sijhawm, qhov zais cia ntawm glucagon yog suppressed - yog li ntawd, qib ntawm glycemia poob qis.

Nyob rau hauv lub xeev ib txwm, incretins yog tsim nyob rau hauv tib neeg txoj hnyuv, thaum noj lawv qib nce. Lawv muaj lub luag haujlwm rau kev txhawb cov txheej txheem ntawm cov tshuaj insulin.

Thaum noj cov tshuaj no, qhov siab ntawm glycated hemoglobin poob qis (qhov taw qhia uas txiav txim siab txog cov piam thaj hauv cov ntshav nyob rau lub hli dhau los), cov ntshav qabzib sai txo, lub cev qhov hnyav ntawm cov ntshav qab zib yog ib txwm muaj.

Cov tshuaj ua haujlwm yuav nqus rau 1-4 teev. Noj cov zaub mov rog tsis hloov pauv lub chaw muag tshuaj ntawm cov tshuaj. Yuav luag 79% ntawm cov tshuaj tsis txawv nrog cov zis.

Kev ntsuas rau siv

Endocrinologist tau sau tseg rau Januvia (ib yam tshuaj rau ntshav qab zib) ua ib qho txiaj ntsig ntxiv rau cov kev ua si tshwj xeeb thiab kev noj haus kom tswj tau glycemia hauv cov neeg mob ntshav qab zib hom 2. Kev kho mob tshuaj tua kab mob ua kom siv txoj kev kho Januvia thaum Metformin intolerance.

Xws li cov khoom siv rau kev kho mob sib xyaw, nws siv nrog nrog:

• "Metformin", yog tias siv cov cuab yeej no ua ke nrog kev tawm dag zog thiab kev noj haus tsis ua rau kom muaj txiaj ntsig,
• sulfonylurea kev npaj (Euglucon, Daonil, Diabeton, Amaril), muab tias lawv siv nrog kev txhim kho hauv kev ua neej tsis ua rau pom cov nyhuv, nrog Metformin tsis raug,
• PPARy antagonists (tshuaj TZD - thiazolidinediones): "Pioglitazone", "Rosiglitazone" thaum lawv siv yog qhov tsim nyog, tab sis tsis muab cov txiaj ntsig uas xav tau ua ke nrog kev thauj khoom thiab zaub mov noj.

Siv cov cuab yeej ua kev tivthaiv ntawm kev kho triple:

• kev sib xyaw nrog Metformin, sulfonylurea kev npaj, kev noj haus thiab kev tawm dag zog, yog tias qhov kev sib xyaw no tsis ua kom muaj peev xwm tswj tau glycemia,
• ua ke nrog Metformin thiab PPARy cov thaiv kev ua haujlwm, yog tias glycemic tswj hwm thaum lub sijhawm lawv noj mov, kev noj haus thiab kev tawm dag zog yog qhov tsis muaj txiaj ntsig.

Nws tseem tuaj yeem ua qhov kev txiav txim ntxiv rau cov ntshav qab zib thaum siv cov tshuaj insulin, tsis hais txog kev siv tshuaj Metformin, thaum ntsuas cov kev ntsuas tsis muab glycemic tswj.

Cov hau kev thov qauv

Cov kws kho mob sau ntawv rau Januvia tshuaj yuav tsum piav qhia tus qauv rau haus. Cov neeg mob feem ntau pom zoo rau cov ntsiav tshuaj nrog qhov kub siab ntawm 100 mg ntawm cov tshuaj nquag. Hauv kev txheeb xyuas ntawm kev mob raum qis, kev noj tshuaj 50 mg yog siv. Yog tias cov neeg mob tau mob lub raum tsis ua haujlwm, lawv yuav tsum muaj mob hemodialysis, ces 25 mg ntsiav tshuaj yog kws kho.

Hauv lub siab me mus rau lub siab tsis ua hauj lwm, tsis tas yuav hloov kho qhov tshuaj.

Yog tias cov tshuaj tau sau tseg ua kev sib txuam ntawm kev sib txuam, tom qab ntawd koj tuaj yeem txo qhov kev pheej hmoo ntawm hypoglycemia los ntawm kev txo qis ntawm cov tshuaj insulin lossis sulfonylurea.

Haus 1 ntsiav tshuaj ib hnub, tsis hais txog ntawm cov noj mov. Thaum hla lub koob tshuaj tom ntej, nws tsis tuaj yeem siv 2 ntsiav tshuaj hauv 1 hnub.

Daim ntawv teev cov contraindications

Ua ntej koj pib noj, koj yuav tsum nrhiav kom pom thaum koj tsis tuaj yeem siv cov tshuaj. Contraindications suav nrog:

• Yam I ntshav qab zib
• kev ua si tsis haum rau cov tshuaj uas tsim cov khoom lag luam,
• kev txhim kho rau cov ntshav qab zib ketoacidosis,
• lub sijhawm cev xeeb tub thiab lactation.

Cov txheej txheem tsis suav nrog thaum yau. Cov tshuaj tsis raug kuaj rau cov neeg mob hnub nyoog qis dua 18 xyoo.

Teeb meem tshwm sim tuaj

Cov kev tshuaj mob ntawm cov kws kho mob pom tias feem ntau cov neeg mob zam cov tshuaj zoo li nyias muaj nyias kev kho mob, lossis sib xyaw nrog lwm cov tshuaj.

Cov kev tshawb fawb pom tias tsis muaj kev sib raug zoo ntawm kev noj tshuaj thiab cov neeg mob zoo, tab sis cov teeb meem hauv qab no tshwm sim ntau dua nrog Januvia dua li siv cov placebo. Ntawm cov feem ntau muaj:

• kev tsim tawm ntawm nasopharyngitis thiab mob ntsws ua pa,
• dyspeptic mob
• ntshav qog.

Cov chaw kho mob muaj kev hloov pauv hauv qhov ntsuas pom, ECG tsis tau pom.

Yeeb tshuaj sib cuam tshuam

Nrog rau kev tswj hwm tib lub sij hawm ntawm cov tshuaj raws li sitagliptin thiab Digoxin, qhov kev txiav txim ntawm cov tom kawg nce ntxiv.

Thaum muab sib xyaw nrog Cyclosporine, cov concentration ntawm sitagliptin ntau dua.

Cov chaw muag tshuaj ntawm "Rosiglitazone", "Simvastatin", "Metformin", "Warfarin", thiab kev tiv thaiv qhov ncauj "Januvia" tsis cuam tshuam.

Tab sis thaum siv txoj kev kho ua ke, cov neeg mob yuav tsum ceeb toom rau qhov kev pheej hmoo ntawm kev mob ntshav qab zib ntshav qab zib.

Cov nqi ntawm cov nyiaj

Tsis yog txhua tus neeg pej xeem Lavxias muaj kev mob ntshav qab zib hom II tuaj yeem them yuav Januvia. Ib lub pob ntawm 28 ntsiav tshuaj ntawm 100 mg yuav raug nqi 1675 rubles. Qhov nyiaj tau hais tias tau txaus rau 4 lub lim tiam ntawm kev kho mob. Muab qhov tseeb tias kev noj tshuaj yuav tsum siv sijhawm ntev, rau ntau tus nqi ntau dhau.

Ua ke nrog kws kho mob, koj tuaj yeem xaiv qhov hloov pauv rau cov tshuaj uas tshwj tseg.

Tshaj tawm rau cov pab pawg tshwj xeeb ntawm cov neeg mob

Thaum kuaj pom, Januvia tshuaj tau muab rau cov neeg mob hnub nyoog 65 xyoos. Nws txoj kev ua tau zoo, tiv taus thiab kev nyab xeeb yog tib yam li hauv cov neeg mob uas muaj hnub nyoog 65 xyoos. Hauv qhov no, nws tau pom tias cov koob tshuaj tsis tas yuav tsum kho kom haum. Tab sis ua ntej sau ntawv yuav tsum tau kuaj xyuas lub cev ua haujlwm.

Hauv kev xyaum tshuaj, qhov tshuaj yeeb tshuaj tsis siv. Hauv qhov no, nws tsis pom zoo rau cov neeg mob hnub nyoog qis dua 18 xyoo.

Xaiv cov analogues

Ntau tus neeg mob uas tus kws kho mob sau Januvia sim nrhiav tshuaj analogues ntawm cov tshuaj. Tom qab tag nrho, nws tus nqi yog siab rau ntau yam. Tsis tas li, sitagliptin tsis yog panacea rau mob ntshav qab zib. Nws yog tshuaj ntxiv rau kev noj haus thiab kev tawm dag zog lub cev kom ntseeg tau tias ua tiav kev tswj mob ntshav qab zib hom II.

Yog tias koj tsom ntawm ATX 4 code, ces cov analogues ntawm cov cuab yeej yuav yog:

• "Onglisa" - cov tshuaj nquag saxagliptin,
• Galvus - vildagliptin,
• Galvus Met - vildagliptin, metformin,
• "Trazhenta" - linagliptin,
• "Combogliz Prolong" - metformin, saxagliptin,
• Nesina yog ib qho alogliptin.

Cov txheej txheem ntawm kev ua ntawm lub cev ntawm cov nyiaj no zoo ib yam. Lawv muaj kev cuam tshuam zoo rau kev ua haujlwm ntawm cov hlab ntsha hlab ntsha thiab hlab ntsha, tswj kev qab los noj mov.

Txoj cai nqe

Yog tias cov kev ua ntawm kev ua thiab kev ua haujlwm ntawm cov tshuaj uas suav tias yog analogues ntawm Januvia yog qhov qub, ntau tus neeg mob xaiv uas pheej yig dua. Yuav ntim tau 30 Galvus Met ntsiav tshuaj tuaj yeem muab nyiaj rau 1,487 rubles. Rau 28 ntsiav tshuaj tsim nyob rau hauv lub npe "Galvus" yuav tsum muab 841 rubles.

Tab sis cov cuab yeej "Onglisa" tseem kim dua: rau 30 ntsiav tshuaj koj yuav tsum tau them 1978 rubles. Tsis ntau nqi pheej yig thiab "Trazhenta": ib pob ntawm 30 ntsiav tshuaj hauv khw muag tshuaj raug nqi txog 1866 rubles.

Qhov uas kim tshaj plaws ntawm cov analogues nthuav tawm yog Combogliz Prolong rau 30 ntsiav tshuaj uas muaj 1 g ntawm metformin thiab 5 mg ntawm saxagliptin, 2863 rubles yuav tsum tau muab. Tab sis ntawm kev muag khoom muaj ib qho "Combogliz Prolong" uas muaj 1 g ntawm metformin thiab 2.5 mg ntawm saxagliptin. Rau 56 ntsiav tshuaj, tus mob ntshav qab zib tau them nyiaj txog 2,866 rubles.

Sib piv cov yam ntxwv ntawm cov tshuaj

Muab hais tias Galvus, ua los ntawm vildagliptin, yog 2 zaug pheej yig dua li Januvia, ntau tus neeg mob tau xav tias nws muaj peev xwm haus ib qho khoom pheej yig dua. Thaum noj cov tshuaj no, qhov kev txiav txim ntawm enzyme DPP-4 txhaws rau ib hnub. Yog li ntawd, nws txaus siv 1 ntsiav tshuaj nyob rau ib hnub. Nyob rau tib lub sijhawm, sijhawm ntev ntawm cov khoom tsim tawm los ntawm lub cev yog lengthened.

Yog tias tus neeg mob tau noj tshuaj rau 50 mg ntawm vildagliptin, ces nws yuav tsum noj ib hnub ib zaug thaum sawv ntxov. Ntawm kev noj tshuaj txhua hnub ntawm 100 mg, koj yuav tsum haus 50 mg ib hnub ob zaug. Qhov no txhais tau tias rau 28 hnub ntawm kev siv tshuaj, 2 ntim ntawm cov tshuaj xav tau.

"Januvia" lossis "Galvus": uas yog qhov zoo dua, nws nyuaj rau xam. Cov kev mob tshwm sim thaum noj cov tshuaj no muaj tsawg.Feem ntau, qhov ntau zaus ntawm kev tshwm sim ntawm cov kev tawm tsam yog yuav luag zoo tib yam li cov neeg mob noj cov placebo. Thaum siv cov teeb meem "Galvus" nrog kev ua haujlwm ntawm lub siab yuav tshwm sim. Tab sis tom qab kev ua tsis tiav ntawm kev kho, qhov xwm txheej ib txwm hloov.

Ob qho tshuaj tau tuaj yeem ua ke nrog kev nyab xeeb nrog lwm cov tshuaj tsim los txo cov kev ua kom muaj suab thaj hauv cov ntshav. Nrog lawv siv tsis tu ncua, tus nqi ntawm glycated hemoglobin toj ib xyoo txo ​​los ntawm 0.7-1.8%. Tus kws kho mob endocrinologist tau sau tseg nyiaj txiag nyob ntawm nws txoj kev paub dhau los nrog txhua yam tshuaj no.

Tus cwj pwm qub ntawm cov tshuaj "Ongliza." Nws cov kws kho mob tuaj yeem sau ntawv siv hloov "Galvus" lossis "Januvia". Tab sis tsis txhob hnov ​​qab tias tag nrho cov cuab yeej no pab tswj tau glycemia thaum tswj kev noj zaub mov zoo thiab ua txhawb lub cev qoj ib ce.

Tus neeg mob lub tswv yim

Tom qab ib hlis ntawm kev noj, cov ntshav qab zib tham txog qhov hloov ntawm lub xeev. Piv txwv li, cov neeg uas tus kws kho mob pom zoo kom noj Januvia hloov chaw mob ntshav qab zib sau tseg cov hauv qab no:

• kev them nyiaj yuav tsawg lus, kev nyeem ua qabzib nyob rau thaum sawv ntxov kuj ruaj khov,
• tom qab noj mov, qabzib concentration normalizes hauv lub sijhawm luv luv,
• tsis muaj mob ntawm kev txo qis hauv qab zib theem, nws cov kev kub siab, tsis hais qhov xwm txheej, tseem ruaj khov.

Yog lawm, txiav txim los ntawm kev txheeb xyuas cov neeg mob, ntau tus neeg tsis txaus siab rau tus nqi ntawm cov khoom. Qhov no yog hu ua kev cuam tshuam loj heev los ntawm tus mob ntshav qab zib. Tab sis hauv qee thaj tsam, cov neeg tswj kom tau txais qee feem nyiaj mob rau cov nqi ntshav qab zib tshuaj. Qhov no txo ​​qhov hnyav rau tsev neeg pob nyiaj.

Feem ntau xaiv cov kev cai no: lawv haus tshuaj thaum yav sawv ntxov. Tom qab tag nrho, cov khoom ua kom nquag plias yuav tsum them rov qab rau cov zaub mov uas nkag mus rau hauv lub hnub. Txawm hais tias cov kws kho mob tau hais tias lub sijhawm ntawm hnub tsis tseem ceeb. Qhov loj tshaj plaws yog kom haus cov ntsiav tshuaj txhua hnub yam tsis muaj qhov khoob nyob rau tib lub sijhawm. Qhov no yuav ua kom lub zog ntawm cov tshuaj hormones nyob rau tib theem.

Muaj tseeb, qee tus neeg mob ntshav qab zib tau hais tias tom qab ib pliag cov txiaj ntsig ntawm cov tshuaj txo qis. Qab zib surges rov pib dua. Qhov xwm txheej no tshwm sim nrog kev nce qib ntawm tus kabmob. Koj tuaj yeem sim qee cov kev them nyiaj rau qhov kev txo qis hauv kev xaiv los ntawm kev xaiv qhov kev ua haujlwm zoo tshaj plaws.

Thaum pib ntawm kev siv Januvia, nws yuav tsum to taub tias qhov no tsis yog qhov kev kho mob ywj pheej. Cov tshuaj yog siv los ua ib feem ntawm kev kho mob hauv kev sib xyaw ua ke nrog kev ua kom lub neej txawv txav. Nws yuav ua tau haujlwm tsuas yog thaum qhov nyiaj txaus rau cov tshuaj hormones nce zuj zus hauv lub cev.

Dosage daim ntawv thiab muaj pes tsawg leeg

Janucius incretomimetic, cov duab uas tau nthuav tawm hauv ntu no, yog tsim nyob rau hauv lub hauv paus ntawm sitagliptin, nthuav tawm hauv daim ntawv ntawm phosphate monohydrate. Siv rau hauv cov ntsiav tshuaj ntawm ntau cov tshuaj noj thiab chaw sau: magnesium, microcrystalline cellulose, sodium, calcium hydrogen phosphate.

Cov kws kho ntshav qab zib tuaj yeem sib txawv qhov ntau npaum li cas ntawm cov tshuaj hauv cov xim: nrog qhov koob tshuaj tsawg kawg nkaus - liab dawb, nrog qhov siab tshaj plaws - beige. Nyob ntawm qhov hnyav, cov ntsiav tshuaj tau cim: "221" - koob tshuaj 25 mg, "112" - 50 mg, "277" - 100 mg. Cov tshuaj tau ntim rau hauv cov hlwv pob. Yuav muaj ob peb lub hlwv nyob rau hauv txhua lub thawv.

Thaum lub ntsuas kub txog li 30 ° C, cov tshuaj tuaj yeem khaws cia hauv lub sijhawm lav (txog li ib xyoos).

Yuav ua li cas Januvia ua haujlwm

Cov tshuaj yeeb yaj kiab hypoglycemic nyob nrog pab pawg ntawm incretin mimetics uas inhibit DPP-4. Kev siv li niaj zaus ntawm Januvia tsub kom ntau ntxiv ntawm cov khoom plig, txhawb lawv cov kev ua ub no. Kev tsim cov tshuaj endogenous insulin nce, qhov sib txuas ntawm glucagon hauv lub siab yog suppressed.

Kev tswj hwm qhov ncauj txwv tsis pub cov piam thaj ntawm glucagon-zoo li peptide GLP-1, uas ua lub luag haujlwm zoo tshaj plaws hauv kev ua tiav ntawm kev paub txog cov piam thaj hauv insulin, thiab rov kho nws lub zog ntawm kev xav. Cov teeb txheej no ua rau muaj qhov hloov pauv ntawm glycemia.

Sitagliptin pab txo cov glycated hemoglobin, yoo suab thaj, thiab lub cev qhov hnyav. Txij ntawm lub plab zom mov, cov tshuaj tau nqus mus rau hauv cov hlab ntshav hauv 1-4 teev. Lub sijhawm ntawm kev noj thiab lub caloric tus nqi ntawm cov zaub mov tsis cuam tshuam rau pharmacokinetics ntawm qhov inhibitor.

Cov tshuaj no haum rau kev tswj hwm thaum lub sijhawm yooj yim: ua ntej, tom qab thiab thaum noj mov. Txog li 80% ntawm cov nquag ua hauj yog tawm los ntawm ob lub raum. Cov tshuaj yuav siv tau ob qho tib si nyob rau hauv monotherapy thiab nyob rau hauv txoj kev kho mob ntawm cov ntshav qab zib hom 2, tshwj xeeb tshaj yog nrog nce ntau ntawm hypoglycemic tawm tsam.

Hauv cov qauv txheej txheem, Januvia yog ntxiv los ntawm Metformin, kev noj zaub mov kom tsawg thiab ua rau lub cev qoj ib ce.

Koj tuaj yeem pom tus txheej txheem ntawm cov nyhuv ntawm cov tshuaj ntawm cov yees duab no:

Leej twg yuav qhia rau cov tshuaj

Januvia raug tshuaj rau hom 2 mob ntshav qab zib ntawm ntau theem ntawm kev tswj hwm tus kab mob.

Thaum ua ke nrog lwm cov tshuaj hypoglycemic, Januvia yog tshuaj:

• Ntxiv rau Metformin, yog tias kev hloov kho lub neej tsis coj cov kev cia siab tshwm sim,
• Ua ke nrog cov peev txheej ntawm sulfonylurea pab pawg - Euglucan, Daonil, Diabeton, Amaril, yog tias kev kho dhau los ua tsis tau zoo txaus lossis tus neeg mob tsis zam Metformin,
• Nyob rau hauv parallel nrog thiazolidinediones - Pioglitazan, Rosiglitazone, yog tias kev sib txuas ua ke yog tsim nyog.

Hauv kev kho peb zaug, Januvius ua ke:

• Nrog Metformin, sulfonylurea derivatives, noj zaub mov kom tsawg thiab ua kom ib ce muaj zog, yog tias tsis muaj Januvia tsis tuaj yeem ua tiav 100% glycemic tswj,
• Ib txhij nrog Metformin thiab thiazolidinediones, PPARy kev thaiv kev, yog tias lwm cov kev tswj xyuas kab mob kev noj qab haus huv tsis tau muaj txiaj ntsig txaus.

Nws yog qhov ua tau los siv Januvia ntxiv rau kev kho mob insulin yog tias cov tshuaj daws tau cov teeb meem ntawm kev tiv thaiv insulin.

Leej twg yuav tsum tsis txhob ua cov tshuaj sitagliptin

Nrog hom 1 ntshav qab zib thiab ua xua rau cov khoom xyaw ntawm mis, Januvia yog contraindicated. Tsis txhob xaj tshuaj rau:

1. Cov poj niam cev xeeb tub thiab lactating leej niam
2. Nrog cov ketoacidosis uas mob ntshav qab zib,
3. Hauv thaum yau.

Cov neeg mob nrog lub raum pathologies thaum sau ntawv rau Januvia yuav tsum tau muaj kev saib xyuas ntau ntxiv. Hauv cov ntawv loj, nws yog qhov zoo dua los xaiv analogues rau kev kho. Cov neeg mob rau ntawm hemodialysis tseem muaj kev saib xyuas tas mus li.

Yuav muaj teeb meem

Thaum muaj kev noj ntau dhau lawm, kev tiv thaiv tsis haum, tsis zoo rau kab mob kev kho mob, qhov tsis xav tau tshwm sim tuaj yeem ua rau muaj kev cuam tshuam ntau dua ntawm cov kab mob uas twb muaj lawm lossis kev tsim kho tshiab. Cov kev tshwm sim zoo li no tseem muaj peev xwm ua tau los ntawm kev sib cuam tshuam ntawm kev cuam tshuam ntawm cov tshuaj uas cov mob ntshav qab zib tau txais.

Ntawm cov teeb meem mob ntshav qab zib, muaj cov mob hnyav (mob ntshav qab zib ketoacidosis, precoma thiab glycemic coma) thiab mob ntev - mob hlwb, neuropathy, retinopathy, nephropathy, encephalopathy, etc. Retinopathy yog qhov ua rau dig muag ntawm cov neeg mob ntshav qab zib: hauv tebchaws Meskas, 24 txhiab tus neeg mob tshiab txhua xyoo. Nees ntshav yog qhov tseem ceeb ua rau lub raum khiav tsis zoo - 44% ntawm cov neeg mob ib xyoos twg, neuropathy yog qhov tseem ceeb uas tsis mob qhov ua rau mob siab tshaj plaws (60% ntawm cov neeg mob tshiab ib xyoos).

Yog tias tus kws kho mob cov lus pom zoo hais txog ntau npaum li cas thiab lub sijhawm pub nkag yog tsis ua raws, kev ua haujlwm dyspeptic thiab kev tso quav tso zis muaj peev xwm ua tau.

Ntawm lwm qhov kev mob tshwm sim, kev ua kom lub cev tsis muaj zog feem ntau tshwm sim, nrog rau cov hlab ntsws ua pa.

Hais txog cov tshuaj Januvia hauv kev txheeb xyuas, cov neeg mob ntshav qab zib yws yws mob taub hau thiab mob ntshav siab. Hauv kev tshuaj ntsuam xyuas, cov lej leukocyte yuav nce me ntsis, tab sis cov kws kho mob tsis suav tias theem no tseem ceeb. Kev ntseeg siab tsis pom kev sib txuas nrog cov tshuaj nrog kev txhim kho ntawm pancreatitis.

Nrog rau kev siv ntev ntawm sitagliptin, kev ua txhaum los ntawm ib sab ntawm lub plawv, cov hlab ntsha, thiab cov ntshav tsim tau. Tus mob ntshav qab zib yuav tsum tau qhia txog qhov yuav tsum tau mus ntsib kws kho mob yog tias muaj kev hloov pauv hauv ntshav siab lossis ntshav siab thaum noj Januvia.

Tsis muaj ib qho mob ntawm kev quav tshuaj rau hauv cov kev siv tshuaj; nrog kev hloov kho tsis txaus ntawm kev ua neej, tsuas yog nws cov txiaj ntsig tsawg yog ua tau.

Ntau tus neeg mob

Januvia yog cov tshuaj kho mob hnyav, thiab nruj me ntsis rau cov lus pom zoo ntawm tus neeg endocrinologist yog qhov tseem ceeb rau nws cov hauj lwm zoo. Kev pib nyab xeeb ntawm sitagliptin yog 80 mg.

Cov kev tshawb fawb txog qhov cuam tshuam ntawm kev haus luam yeeb ntau tau ua nrog kev nce kaum npaug hauv cov tshuaj no.

Yog hais tias kev mob hypoglycemic tsim, tus neeg yws yws mob taub hau, tsis muaj zog, mob plab tsis ua hauj lwm, thiab muaj lub dag zog zoo, nws yog qhov yuav tsum tau yaug lub plab thiab muab rau tus neeg mob lub zog npaj. Yuav muab cov kev qhia kho mob rau cov tsev kho mob ntshav qab zib.Cov rooj sib hais ntawm kev haus dej ntau dhau tau sau tseg tsis tshua muaj. Qhov no feem ntau cuam tshuam nrog ib tus neeg tsis kam txais lossis cov teebmeem ntawm lwm cov tshuaj siv hauv kev kho mob nyuaj.

Hemodialysis ntawm Januvia yog qhov tsis muaj txiaj ntsig. Rau 4 teev, thaum cov txheej txheem tau dhau mus, tom qab noj ib koob, tsuas yog 13% ntawm cov tshuaj tau tso tawm.

Lub peev xwm ntawm Januvia nrog txoj kev kho mob

Sitagliptin tsis inhibit qhov haujlwm ntawm Simvastatin, Warfarin, Metformin, Rosiglitazone. Januvia tuaj yeem siv los ntawm cov poj niam uas niaj hnub siv cov kev tiv thaiv kev tiv thaiv. Concurrent coj nrog Dioxin me ntsis pab txoj kev muaj peev xwm tom qab, tab sis cov kev hloov pauv no tsis tas yuav hloov kho koob.

Januvia tuaj yeem siv ua ke nrog cyclosporine lossis inhibitors (xws li ketoconazole). Cov nyhuv ntawm sitagliptin hauv cov rooj plaub no tsis yog qhov tseem ceeb thiab tsis hloov pauv qhov xwm txheej rau kev noj tshuaj.

Kev pom zoo rau kev siv

Rau Januvia cov tshuaj, cov lus qhia rau kev siv raug kos raws li kev nthuav dav txaus, thiab nws yuav tsum kawm ua ntej pib kev kho mob.

Yog tias lub sijhawm ntawm nkag mus hauv sijhawm tsis tiav, qhov tshuaj yuav tsum raug haus ntawm thawj zaug. Nyob rau tib lub sijhawm, ob npaug txoj cai yog qhov txaus ntshai, vim tias yuav tsum muaj ib lub sijhawm txhua hnub nyob nruab nrab ntawm cov koob tshuaj.

Tus txheej txheem koob tshuaj ntawm Januvia yog 100 mg / hnub. Nrog lub raum pathologies ntawm qhov mob sib khuav ntawm qhov hnyav mus rau mob hnyav, 50 mg / hnub yog kho tau.Yog tus kab mob loj zuj zus thiab mob hnyav ntxiv, cov cai tau hloov kho rau 25 mg / hnub. Yog tias cov tshuaj no tau siv ua ke nrog lwm cov tshuaj uas muaj suab thaj, kev noj tshuaj ntawm cov tshuaj insulin lossis cov ntsiav tshuaj yuav tsum raug txo kom tsis txhob mob hypoglycemia.

Yog tias tsim nyog, lim ntshav yog nqa tawm, thaum muab tshuaj rau qhov tsawg kawg nkausCov. Lub sijhawm ntawm tau txais Januvia tsis khi rau lub sijhawm ntawm txheej txheem. Hauv cov laus (txij li 65 xyoo), cov neeg mob ntshav qab zib tuaj yeem siv cov tshuaj yam tsis muaj kev txwv ntxiv, yog tias tseem muaj teeb meem ntxiv los ntawm lub raum. Hauv rooj plaub tom kawg, yuav tsum tau txhaj tshuaj kom haum.

Cov qauv ntawm Januvius

Qhov sib tw raws cov cim

Nqe txij li 90 rubles. Cov analogue yog pheej yig dua los ntawm 1305 rubles

Qhov sib tw raws cov cim

Nqe txij li 97 rubles. Cov analogue yog pheej yig dua rau 1298 rubles

Qhov sib tw raws cov cim

Nqe txij li 115 rub. Cov analogue yog pheej yig los ntawm 1280 rubles

Qhov sib tw raws cov cim

Tus nqi yog los ntawm 130 rubles. Cov analogue yog pheej yig dua los ntawm 1265 rubles

Qhov sib tw raws cov cim

Tus nqi yog los ntawm 273 rubles. Cov analogue yog pheej yig dua los ntawm 1122 rubles

Qhov sib tw raws cov cim

Tus nqi yog los ntawm 287 rubles. Cov analogue yog pheej yig dua los ntawm 1108 rubles

Qhov sib tw raws cov cim

Tus nqi yog los ntawm 288 rubles. Cov analogue yog pheej yig dua los ntawm 1107 rubles

Qhov sib tw raws cov cim

Tus nqi yog los ntawm 435 rubles. Cov analogue yog pheej yig los ntawm 960 rubles

Qhov sib tw raws cov cim

Tus nqi yog los ntawm 499 rubles. Cov analogue yog pheej yig dua los ntawm 896 rubles

Qhov sib tw raws cov cim

Tus nqi yog los ntawm 735 rubles. Cov analogue yog pheej yig dua los ntawm 660 rubles

Qhov sib tw raws cov cim

Nqe txij li 982 rubles. Cov analogue yog pheej yig dua los ntawm 413 rubles

Qhov sib tw raws cov cim

Nqe los ntawm 1060 rubles. Cov pev txig yog pheej yig dua los ntawm 335 rubles

Qhov sib tw raws cov cim

Tus nqi yog los ntawm 1301 rubles. Cov analogue yog pheej yig dua los ntawm 94 rubles

Qhov sib tw raws cov cim

Tus nqi yog los ntawm 1806 rubles. Cov analogue ntau kim ntawm 411 rubles

Qhov sib tw raws cov cim

Tus nqi yog los ntawm 2128 rubles. Cov analogue kim dua los ntawm 733 rubles

Qhov sib tw raws cov cim

Nqe los ntawm 2569 rubles. Cov analogue kim dua los ntawm 1174 rubles

Qhov sib tw raws cov cim

Tus nqi yog los ntawm 3396 rubles. Cov analogue ntau kim rau 2001 rubles

Qhov sib tw raws cov cim

Nqe los ntawm 4919 rubles. Cov analogue kim dua nyob ntawm 3524 rubles

Qhov sib tw raws cov cim

Nqe txij li 8880 rubles. Cov analogue muaj nqi ntau dua ntawm 7485 rubles

Cov lus qhia rau kev siv nrog Januvius

Kev sau npe :Lub npe Kev Lag Luam : JANUVIA / JANUVIA

Lub Npe Tsis Muaj Npe International : Sitagliptin

Dosage daim ntawv : zaj duab xis-coated ntsiav tshuaj

Muaj pes tsawg leeg :

1 lub koob ntim-cov ntsiav tshuaj muaj cov sitagliptin phosphate hydrate sib npaug rau 25 mg, 50 mg, 100 mg sitagliptin.
Cov muaj tswv yim: microcrystalline cellulose, calcium hydrogen phosphate tsis txaus, croscarmellose sodium, magnesium stearate, sodium stearyl fumarate.
Ntsiav tshuaj plhaub (Opadray® II: Paj yeeb 85 F97191 rau ib koob tshuaj 25 mg, Lub teeb beige 85 F 17498 rau qhov ntau npaum ntawm 50 mg, Beige 85 F 17438 rau haus 100 mg) muaj cov cawv polyvinyl, titanium dioxide, macrogol (polyethylene glycol) 3350, talc, hlau oxide daj, hlau oxide liab.

Kev piav qhia

Hloov cov roj teeb ua ke ntawm lub teeb xim xim nrog lub teeb beige tsis muaj zog, npog nrog lub plhaub zaj duab xis nrog lub ntsej muag "221" ntawm ib sab thiab du rau lwm yam.
50 mg ntsiav tshuaj:
Hloov biconvex ntsiav tshuaj ntawm lub teeb beige xim, coated nrog zaj duab xis plhaub nrog lub ntsej muag "112" ntawm ib sab thiab du ntawm lwm yam.
100 mg ntsiav tshuaj:
Hloov biconvex beige ntsiav tshuaj coated nrog zaj duab xis txheej nrog engraving "277" ntawm ib sab thiab du ntawm lwm yam.

Cov tshuaj pab pawg kho mob

Dipeptidyl peptidase inhibitor 4.

ATX code : A10VN01

Cov chaw muag tshuaj

Cov Tshuaj Hauv Tshuaj
JANUVIA (sitagliptin) yog qhov ncauj, qhov xaiv tau zoo heev ntawm cov enzyme dipeptidyl peptidase 4 (DPP-4), npaj kho rau hom 2 mob ntshav qab zib mellitus. Sitagliptin sib txawv hauv cov qauv tshuaj thiab cov tshuaj pharmacological los ntawm analogues ntawm glucagon-zoo li peptide-1 (GLP-1), insulin, sulfonylurea derivatives, biguanides, gamma receptor agonists ua kom los ntawm peroxisome proliferator (PPAR-γ), alpha-glycosidase inhibitors, analogs. Los ntawm inhibiting DPP-4, sitagliptin tsub kom qhov siab ntxiv ntawm ob qho kev paub cov tshuaj hormones ntawm tsev neeg incretin: GLP-1 thiab glucose-nyob insulinotropic peptide (HIP). Cov tshuaj hormones ntawm tsev neeg incretin yog zais cia hauv cov hnyuv nruab hnub, lawv qib nce nyob hauv kev teb rau kev ua zaub mov noj. Tus incretins yog ib feem ntawm cov txheej txheem kho mob sab hauv lub zog rau kev tswj hwm cov ntshav qabzib homeostasis. Thaum lub cev lossis cov ntshav nce ntxiv ntawm cov ntshav qabzib, cov tshuaj hormones ntawm tsev neeg muaj ntau ntxiv los ua rau muaj insulin synthesis ntau ntxiv, nrog rau nws qhov zais cia los ntawm pancreatic beta hlwb vim kev taw qhia rau intracellular mechanism cuam tshuam nrog cyclic AMP.
GLP-1 kuj tseem pab txhawb ntxiv kom muaj kev zais ntawm glucagon los ntawm alpha cell. Qhov kev txo qis hauv glucagon qhov siab tshaj tawm txog keeb kwm yav dhau los ntawm kev nce qib hauv insulin ua rau muaj kev txo qis ntshav qabzib ntau los ntawm lub siab, uas thaum kawg ua rau txo qis glycemia.
Thaum lub siab tsis zoo ntawm cov piam thaj hauv ntshav, cov txiaj ntsig tau teev ntawm incretins ntawm kev tso tawm insulin thiab ib qho kev txo qis hauv glucagon tso pa tsis pom. GLP-1 thiab HIP tsis cuam tshuam rau qhov glucagon tso tawm rau hauv kev teb rau hauv lub ntsej muag hypoglycemia. Nyob rau hauv cov kev mob tshwm sim hauv lub cev, kev ua si ntawm incretins raug txwv los ntawm enzyme DPP-4, uas tau nrawm hydrolyzes nce nrog kev tsim cov khoom tsis muaj zog.
Sitagliptin txwv tsis pub cov hydrolysis ntawm incretins los ntawm enzyme DPP-4, yog li ua kom cov ntshav ntau dua ntawm cov nquag cov ntaub ntawv ntawm GLP-1 thiab HIP. Los ntawm nce qib ntawm cov nce zuj zus, sitagliptin tsub kom cov piam thaj tso tawm cov kua dej thiab yuav pab txo qis kev tso zis ntawm glucagon. Hauv cov neeg mob uas muaj hom 2 mob ntshav qab zib mellitus nrog hyperglycemia, cov kev hloov pauv hauv kev zais ntawm insulin thiab glucagon ua rau qhov txo qis ntawm glycosylated hemoglobin НbА1С thiab txo qis hauv plasma concentration ntawm cov piam thaj, txiav txim siab ntawm lub plab tsis muaj zog thiab tom qab kev ntsuam xyuas mob.
Hauv cov neeg mob uas muaj hom 2 mob ntshav qab zib mellitus, noj ib koob ntawm YANUVIA ua rau inhibition ntawm cov kev ua ntawm DPP-4 enzyme rau 24 teev, uas ua rau muaj kev nce siab hauv qib ntawm circulating incretins GLP-1 thiab HIP los ntawm qhov tseem ceeb ntawm 2-3, kev nce hauv plasma concentration ntawm insulin thiab C- peptide, qhov kev txo qis hauv cov concentration ntawm glucagon nyob rau hauv cov ntshav ntshav, txo qis ntawm cov piam thaj, nrog rau kev txo qis glycemia tom qab cov piam thaj los yog zaub mov noj.

Cov Tshuaj Pharmacokinetics
Cov tshuaj pharmacokinetics ntawm sitagliptin tau pom ntau yam hauv cov neeg muaj kev noj qab haus huv thiab cov neeg mob ntshav qab zib hom 2. Hauv cov neeg muaj kev noj qab haus huv, tom qab qhov ncauj tswj hwm 100 mg ntawm sitagliptin, kev nqus tshuaj sai yog pom nrog lub siab tshaj plaws (Cmax) hauv thaj tsam li 1 mus rau 4 teev txij li lub sijhawm saib xyuas. Thaj chaw nyob hauv qhov chaw tsom-lub sijhawm nkhaus (AUC) nce raws qhov sib npaug ntawm cov koob tshuaj, thiab hauv kev noj qab haus huv yog 8.52 μMh / h thaum noj 100 mg ntawm qhov ncauj, Cmax yog 950 nM, thiab qhov nruab nrab ib nrab-lub neej yog 12.4 teev. Lub plasma AUC ntawm sitagliptin nce ntxiv kwv yees li 14% tom qab kev noj tshuaj ntxiv ntawm 100 mg ntawm tshuaj los ua kom tiav qhov sib luag ntawm lub xeev tom qab siv thawj zaug. Qhov sib txuam ntawm cov leeg- thiab cov ncauj lus sib txawv ua ke ntawm sitagliptin AUC tsis pom zoo.
Kev Tsis Txaus Siab
Qhov tsis ncaj ncees ntawm bioavailability ntawm sitagliptin yog kwv yees li 87%. Txij li thaum siv ua ke ntawm cov tshuaj YANUVIA thiab cov zaub mov muaj roj tsis muaj kev cuam tshuam rau cov tshuaj pharmacokinetics, cov tshuaj YANUVIA tuaj yeem yog tshuaj tsis hais cov pluas noj.
Kev xa Khoom
Qhov ntim nruab nrab ntawm kev faib tawm hauv qhov sib npaug tom qab ib koob ntawm 100 mg ntawm sitagliptin hauv cov neeg ua haujlwm noj qab haus huv zoo yog kwv yees li 198 L. Tus zauv seem ntawm sitagliptin uas khi rau cov ntshav muaj protein tsawg nyob ntawm 38%.
Kev zom zaub mov
Kwv yees li 79% ntawm cov sitagliptin yog cov tsis hloov pauv hauv cov zis.
Tsuas yog ib feem me me ntawm cov tshuaj tau txais hauv lub cev yog metabolized.
Tom qab tswj hwm ntawm 14C-daim ntawv lo ntawm sitagliptin sab hauv, kwv yees li 16% ntawm cov tshuaj yeeb yaj kiab raug tso tawm hauv daim ntawv ntawm nws cov tshuaj tiv thaiv. Kab ntawm 6 metabolites ntawm sitagliptin raug kuaj pom, tej zaum tsis muaj DPP-4 inhibitory kev ua si. Hauv cov kev tshawb fawb hauv vitro tau qhia tias thawj cov enzyme uas tau koom nrog hauv kev txwv metabolism ntawm sitagliptin yog CYP3A4 koom nrog CYP2C8.
Chaw Sau Ntawv
Tom qab 14C-daim ntawv lo sitagliptin tau muab rau qhov ncauj rau cov neeg ua haujlwm noj qab haus huv, kwv yees li 100% tshuaj tau raug tso tawm: 13% los ntawm txoj hnyuv, 87% los ntawm lub raum hauv ib lub lis piam tom qab noj cov tshuaj. Qhov kev tshem tawm nruab nrab ib nrab ntawm lub neej ntawm sitagliptin los ntawm kev tswj hwm qhov ncauj ntawm 100 mg yog kwv yees li 12.4 teev; kev tshem lub raum yog kwv yees li 350 ml / min.
Kev nthuav dav ntawm sitagliptin yog nqa tawm feem ntau los ntawm kev tawm los ntawm lub raum los ntawm kev ua haujlwm ntawm cov tubular muaj kev zais cia. Sitagliptin yog lub hauv paus rau qhov thauj cov organic anions ntawm hom thib peb ntawm tib neeg (hOAT-3), uas tej zaum yuav koom nrog hauv cov txheej txheem ntawm kev nthuav dav ntawm sitagliptin los ntawm lub raum. Clinically, kev koom tes ntawm hOAT-3 hauv kev thauj khoom ntawm sitagliptin tseem tsis tau kawm. Sitagliptin tseem yog ib lub zog p-glycoprotein, uas kuj yuav koom nrog kev tshem tawm ntawm sitagliptin. Txawm li cas los xij, cyclosporin, ib qho inhibitor ntawm p-glycoprotein, tsis txo qis kev tshem tawm ntawm sitagliptin.

Pharmacokinetics ntawm cov neeg mob ib leeg
Cov neeg mob raum tsis ua haujlwm
Kev tshawb nrhiav qhib ntawm cov tshuaj JANUVIA ntawm kev noj tshuaj ntawm 50 mg rau ib hnub tau tshawb nrhiav nws cov tshuaj pharmacokinetics hauv cov neeg mob uas muaj qhov txawv txav ntawm mob raum tsis ua haujlwm. Cov neeg mob suav nrog kev tshawb fawb tau muab faib ua pab pawg ntawm cov mob raum tsis ua hauj lwm (kev tshem tawm ntawm creatinine los ntawm 50 txog 80 ml / min), mob nruab nrab (creatinine tshem tawm los ntawm 30 txog 50 ml / min) thiab mob raum tsis zoo (creatinine tshem tawm tsawg dua 30 ml / min), thiab kuj yog cov neeg mob uas mob raum kawg uas yuav tsum tau lim ntshav.
Hauv cov neeg mob uas lub raum tsis ua haujlwm, tsis muaj kev hloov pauv tseem ceeb hauv plasma sitagliptin concentration piv nrog pawg tswj hwm ntawm cov neeg ua haujlwm noj qab haus huv.
Kev nce ob npaug ntawm sitagliptin AUC piv nrog pab pawg tswj tau pom nyob hauv cov neeg mob uas mob raum tsis txaus, kwv yees li ntawm plaub feem pua ​​ntawm AUC raug pom hauv cov neeg mob uas mob raum tsis zoo, thiab rau cov neeg mob raum mob raum thaum kawg piv nrog pawg tswj hwm. Sitagliptin tau raug tshem tawm me ntsis ntawm kev ncig los ntawm hemodialysis: tsuas yog 13.5% ntawm cov koob tshuaj tau raug tshem tawm ntawm lub cev thaum lub sijhawm 3-4 teev lim ntshav lim ntshav.
Yog li, txhawm rau kom ua tiav txoj kev kho kom zoo ntawm cov tshuaj hauv cov ntshav ntshav (zoo ib yam li cov neeg mob lub raum ua haujlwm) hauv cov neeg mob uas mob raum tsis txaus thiab mob raum tsis txaus, yuav tsum tau kho ntau npaum li cas (saib Dosage thiab Administration).
Cov neeg mob mob siab tsis ua haujlwm
Hauv cov neeg mob uas muaj lub siab tsis txaus (7-9 cov ntsiab lus ntawm Me-Pugh nplai), qhov nruab nrab ntawm AUC thiab Cmax ntawm sitagliptin nrog tib koob ntawm 100 mg nce ntxiv kwv yees 21% thiab 13%, feem. Yog li, ntau npaum hloov kho thaum mob me lossis mob siab daim siab tsis ua haujlwm.
Tsis muaj cov ntaub ntawv tshawb fawb txog kev siv cov sitagliptin hauv cov neeg mob uas tsis muaj peev xwm rau hepatic txaus (ntau dua li 9 ntsiab lus ntawm Cov Ntawv Qhia Me-Pugh). Txawm li cas los xij, vim tias qhov tseeb hais tias cov tshuaj feem ntau yog tawm los ntawm lub raum, ib qho yuav tsum tsis txhob cia siab tias muaj kev hloov pauv tseem ceeb hauv cov khw muag tshuaj ntawm sitagliptin hauv cov neeg mob uas muaj mob hnyav hnyav tsis txaus.
Cov neeg laus cov neeg mob
Lub hnub nyoog ntawm cov neeg mob tsis muaj kev cuam tshuam los ntawm kev kho mob tseem ceeb ntawm cov tshuaj pharmacokinetic ntawm sitagliptin. Piv nrog cov neeg mob hluas, cov neeg mob laus (65-80 xyoo) muaj qhov sitagliptin kwv yees li 19% siab dua. Tsis tas yuav tsum kho qhov koob tshuaj raws li lub hnub nyoog

Kev ntsuas rau siv

Kev Kho Mob Kho Mob
Cov tshuaj JANUVIA yog pom tias yog ib qho ntxiv rau kev noj haus thiab kev tawm dag zog los txhim kho glycemic tswj hauv cov neeg mob uas muaj ntshav qab zib hom 2. Kev sib xyaw ua ke
Cov tshuaj JANUVIA tseem qhia rau cov neeg mob uas muaj hom 2 mob ntshav qab zib mellitus los txhim kho glycemic tswj nrog metformin lossis PPARγ agonists (piv txwv, thiazolidinedione), thaum kev noj zaub mov zoo thiab kev ua si lub cev ua ke nrog kev kho mob monotherapy nrog rau cov tshuaj uas tsis teev cia tsis ua rau kev tswj glycemic txaus.

Cov Yuav Tsum Tau Ua

• ua kom lub cev tsis haum rau ib qho twg ntawm cov tshuaj,
  
• muaj menyuam hauv plab, pub niam mis,
  
• ntshav qab zib hom 1
  
• mob plab ketoacidosis.
  

Tsis hlauv
Dosage kev kho mob ntawm cov tshuaj JANUVIA yog yuav tsum tau nyob hauv cov neeg mob uas mob raum tsis txaus thiab mob raum, nrog rau cov neeg mob uas mob raum thaum kawg uas yuav tsum tau mob hemodialysis (saib Dosage thiab Administration).

Siv thaum cev xeeb tub thiab lactation

Tsis muaj kev tswj hwm tau soj ntsuam cov tshuaj YANUVIA hauv cov poj niam cev xeeb tub, yog li ntawd tsis muaj ntaub ntawv qhia txog kev nyab xeeb ntawm nws siv hauv cov poj niam cev xeeb tub. Cov tshuaj JANUVIA, zoo li lwm yam tshuaj rau qhov ncauj hypoglycemic, tsis pom zoo siv thaum cev xeeb tub. Tsis muaj ntaub ntawv hais txog kev pom zoo ntawm sitagliptin nrog rau mis. Yog li, cov tshuaj JANUVIA yuav tsum tsis txhob muab tshuaj rau lub sijhawm lactation.

Tsuas tshuaj thiab tswj hwm

Cov koob tshuaj pom zoo JANUVIA yog 100 mg ib hnub ib zaug li kev kho mob monotherapy lossis hauv kev sib xyaw nrog metformin lossis PPARγ agonist (piv txwv, thiazolidinedione).
JANUVIA tuaj yeem noj tsis hais tus noj mov.
Yog tias tus neeg mob tsis nco qab noj tshuaj JANUVIA, nws yuav tsum ua kom sai li sai tau tom qab tus neeg mob nco qab lub tshuaj tsis nco qab lawm. Tsis txhob pub tshaj ob npaug ntawm cov tshuaj JANUVIA.
Cov neeg mob raum tsis ua haujlwm
Cov neeg mob uas lub raum tsis ua haujlwm me me (ua kom tsis pom kev zoo ≥50 ml / min, kwv yees sib luag rau cov ntshav ntshav creatinine ≤1.7 mg / dL hauv cov txiv neej, ≤1.5 mg / dL hauv cov poj niam) tsis tas yuav kho cov tshuaj ntawm JANUVIA.
Rau cov neeg mob uas tsis tshua mob raum (qhov kev tsim ua kom zoo ≥30 ml / min, tab sis 1.7 mg / dl, tab sis ≤3 mg / dl hauv cov txiv neej,> 1.5 mg / dl, tab sis ≤2.5 mg / dl hauv cov poj niam ) qhov tshuaj ntawm JANUVIA yog 50 mg ib hnub ib zaug.
Rau cov neeg mob uas lub raum tsis ua haujlwm loj (kev tshem tawm ntawm 3 mg / dL hauv cov txiv neej,> 2,5 mg / dL hauv cov poj niam), nrog rau cov mob raum rov qab los uas yuav tsum muaj mob hemodialysis, koob tshuaj JANUVIA yog 25 mg ib hnub ib zaug. Cov tshuaj JANUVIA tuaj yeem siv tsis hais lub sijhawm ntawm cov txheej txheem hemodialysis.
Cov neeg mob mob siab tsis ua haujlwm
Tsis tas yuav txiav txim kho cov tshuaj JANUVIA yog yuav tsum muaj hauv cov neeg mob uas mob me lossis mob siab daim siab tsis ua hauj lwm. Cov tshuaj tsis tau kawm hauv cov neeg mob uas muaj lub siab ua haujlwm tsis zoo.
Cov neeg laus cov neeg mob
Tsis tas yuav kho qhov tshuaj ntawm JANUVIA yuav tsum yog nyob rau hauv cov neeg laus laus.

Cov tshuaj JANUVIA feem ntau zoo tiv thaiv ob qho tib si li monotherapy thiab hauv kev sib xyaw nrog lwm cov tshuaj hypoglycemic. Hauv kev sim tshuaj, tag nrho cov tshwm sim ntawm cov kev mob tshwm sim, nrog rau kev ncua ntev ntawm kev tshem tawm cov tshuaj vim muaj kev phiv tshuaj, zoo ib yam li cov placebo.
Cov xwm txheej tsis zoo uas tau tshwm sim yam tsis muaj kev sib raug zoo nrog kev siv tshuaj YANUVIA ntawm kev txhaj tshuaj ntawm 100 mg thiab 200 mg ib hnub, tab sis ntau zaus ntau dua nrog cov tshuaj placebo, nrog ntau zaus ≥3%: sab sauv ntawm txoj hlab ua pa (YANUVIA 100 mg - 6.8%, YANUVIA 200 mg - 6.1%, tso placebo - 6.7%), nasopharyngitis (YANUVIA 100 mg - 4.5%, YANUVIA 200 mg - 4.4%, placebo - 3.3%), mob taub hau (YANUVIA 100 mg - 3.6%, YANUVIA 200 mg - 3.9%, placebo - 3.6%), raws plab (YANUVIA 100 mg - 3.0%, YANUVIA 200 mg - 2.6%, placebo - 2.3%), arthralgia (YANUVIA 100 mg - 2.1%, YANUVIA 200 mg - 3.3%, placebo - 1.8%)
Lub sijhawm tag nrho cov kev mob hypoglycemia hauv cov neeg mob kho nrog YANUVIA zoo ib yam li cov tshuaj placebo (YANUVIA 100 mg - 1.2%, YANUVIA 200 mg - 0.9%, placebo - 0.9%).
Kev nquag tshwm sim ntawm qee qhov kev mob tshwm sim los ntawm txoj hnyuv mob thaum noj YANUVIA ntawm kev siv ob qho tib si zoo ib yam li cov tshuaj placebo, tshwj rau qhov tsis tshua pom muaj ntau zaus thaum noj YANUVIA ntawm koob tshuaj 200 mg rau ib hnub: mob plab (YANUVIA 100 mg - 2.3%, YANUVIA 200 mg - 1,3%, tso placebo - 2.1%), xeev siab (YANUVIA 100 mg - 1.4%, YANUVIA 200 mg - 2.9%, placebo - 0.6%), ntuav (YANUVIA 100 mg - 0.8%, YANUVIA 200 mg - 0.7%, tso placebo - 0.9%), mob plab zom mov (YANUVIA 100 mg - 3.0%, YANUVIA 200 mg - 2.6%, placebo - 2.3%).
Kev hloov pauv hauv tsev kho mob
Kev tsom xam ntawm cov kev tshawb fawb soj ntsuam cov tshuaj pom tias nce uric acid (kwv yees 0.2 mg / dl piv nrog cov placebo, qhov nruab nrab ntawm 5-5.5 mg / dl) hauv cov neeg mob tau txais tshuaj YANUVIA ntawm koob tshuaj 100 thiab 200 mg ib hnub. Tsis muaj cov kev mob gout li.
Muaj qhov txo qis me ntsis hauv kev ua kom zoo ntawm tag nrho cov alkaline phosphatase (kwv yees li 5 IU / L piv nrog cov placebo, qhov nruab nrab ntawm 56-62 IU / L), qee qhov cuam tshuam nrog me ntsis ntawm cov pob txha feem ntawm alkaline phosphatase.
Muaj qhov nce me ntsis ntawm cov leukocyte suav (kwv yees 200 / comparedl piv rau cov placebo, nruab nrab 6600 / μl), vim muaj qhov nce ntawm neutrophils. Qhov kev soj ntsuam no tau sau tseg rau hauv feem ntau, tab sis tsis yog tag nrho cov kev tshawb fawb.
Cov pauv hloov hauv chav ntsuas tsis pom tias yog tseem ceeb hauv chaw kho mob.
Thaum kho nrog YANUVIA, tsis muaj kev hloov hauv thaj chaw kho mob hauv cov phiajcim tseem ceeb thiab ECG (suav nrog lub sijhawm QTc).

Noj ntau dhau

Thaum lub sijhawm kuaj mob hauv cov neeg tuaj yeem noj qab haus huv, ib koob tshuaj 800 mg ntawm YANUVIA feem ntau tau pom zoo. Tsawg hloov me me hauv QTc ntu, uas tsis yog qhov tseem ceeb hauv tsev kho mob, tau sau tseg hauv ib txoj kev tshawb fawb ntawm cov tshuaj YANUVIA ntawm koob tshuaj 800 mg ib hnub. Qhov koob tshuaj ntau tshaj 800 mg toj ib hnub hauv tib neeg tsis tau kawm.
Yog tias muaj kev noj ntau dhau, nws yog ib qho tsim nyog yuav tsum pib ua tus qauv kev txhawb nqa: tshem tawm cov tshuaj tsis tuaj yeem los ntawm lub plab zom mov, soj ntsuam ntawm cov paib tseem ceeb, suav nrog ECG, nrog rau kev teem caij kho kev kho mob, yog tias tsim nyog.
Sitagliptin tsis zoo lim ntshav. Hauv cov kev tshawb fawb soj ntsuam, tsuas yog 13.5% ntawm cov koob tshuaj tau raug tshem tawm ntawm lub cev thaum lub sijhawm 3-4 teev lim piam ua haujlwm. Kev lim ntshav ntev yuav tsim tawm yog tsim nyog. Tsis muaj pov thawj qhia txog kev ua haujlwm ntawm peritoneal dialysis rau sitagliptin.

Kev cuam tshuam nrog lwm yam tshuaj

Hauv kev tshawb fawb txog kev cuam tshuam nrog lwm cov tshuaj, sitagliptin tsis muaj kev cuam tshuam loj rau lub pharmacokinetics ntawm cov tshuaj hauv qab no: metformin, rosiglitazone, glibenclamide, simvastatin, warfarin, qhov ncauj tawm tsam. Raws li cov ntaub ntawv no, sitagliptin tsis inhibit CYP isoenzymes CYP3A4, 2C8 lossis 2C9. Raws li cov ntaub ntawv hauv vitro, sitagliptin kuj tseem yuav tsis thaiv CYP2D6, 1A2, 2C19 lossis 2B6, thiab kuj tsis ntxias CYP3A4.
Muaj kev nce me ntsis hauv AUC (11%), ntxiv rau qhov nruab nrab Cmax (18%) ntawm digoxin thaum sib xyaw nrog sitagliptin. Qhov nce no tsis yog qhov tseem ceeb hauv tsev kho mob. Nws tsis pom zoo kom hloov cov koob tshuaj ntawm digoxin lossis tshuaj YANUVIA thaum siv ua ke.
Kev nce ntawm AUC thiab Cmax ntawm cov tshuaj YANUVIA tau sau tseg los ntawm 29% thiab 68%, feem ntau, hauv cov neeg mob nrog kev siv tshuaj ib zaug ntawm qhov ncauj ntawm 100 mg ntawm YANUVIA tshuaj thiab ib qho ncauj ntawm 600 mg ntawm cyclosporine, lub zog loj ntawm p-glycoprotein.
Cov kev pauv hloov uas pom muaj hauv cov qauv pharmacokinetic ntawm sitagliptin tsis suav tias yog kev kho mob tseem ceeb. Hloov cov koob tshuaj ntawm JANUVIA thaum ua ke nrog cyclosporine thiab lwm yam p-glycoprotein inhibitors (e.g. ketoconazole) tsis pom zoo.
Ib tug pej xeem-based pharmacokinetic tsom xam ntawm cov neeg mob thiab cov neeg ua haujlwm noj qab haus huv (N = 858) rau ntau yam tshuaj tsis sib haum (N = 83, kwv yees li ib nrab ntawm cov uas tau tawm los ntawm lub raum) tsis qhia txog qhov kev cuam tshuam los ntawm cov tshuaj no rau hauv pharmacokinetics ntawm sitagliptin.

Cov lus qhia tshwj xeeb

Kev ntshav siab
Hauv kev tshawb nrhiav kev kho mob ntawm cov tshuaj YANUVIA raws li monotherapy lossis ua ib feem ntawm kev sib xyaw ua ke nrog metformin lossis pioglitazone, qhov tshwm sim ntawm kev mob ntshav qab zib thaum siv cov tshuaj YANUVIA zoo ib yam li cov zaus ntawm hypoglycemia thaum siv cov placebo. Kev siv tshuaj sib xyaw ua ke JANUVIA hauv kev sib xyaw nrog cov tshuaj uas tuaj yeem ua rau mob ntshav qab zib, xws li insulin, sulfonylurea derivatives, tsis tau raug tshawb nrhiav.
Siv rau cov neeg laus.
Hauv kev sim tshuaj, qhov ua tau zoo thiab kev nyab xeeb ntawm cov tshuaj YANUVIA rau cov neeg laus (≥65 xyoo, 409 tus neeg mob) piv rau cov neeg mob hnub nyoog qis dua 65 xyoos.
Tsis tas yuav kho qhov npaum li cas los ntawm lub hnub nyoog. Cov neeg laus yog cov neeg lub raum tsis zoo. Raws li, ib yam li lwm pab pawg hnub nyoog, kev hloov tshuaj rau hauv cov neeg mob uas lub raum tsis ua haujlwm yog qhov tsim nyog (saib Dosage thiab Administration).

Cuam Tshuam rau kev muaj peev xwm tsav tsheb thiab ua haujlwm nrog tshuab .

Tsis muaj cov kev tshawb fawb tau tshawb fawb txog qhov tshwm sim ntawm cov tshuaj YANUVIA ntawm kev muaj peev xwm tsav tsheb.Txawm li cas los xij, qhov tsis zoo ntawm cov tshuaj JANUVIA ntawm kev muaj peev xwm tsav lub tsheb lossis cov twj siv tsis yooj yim tsis tau xav.

Daim ntawv tso tawm

Rau 14 ntsiav tshuaj hauv PVC / Al blister. 1, 2, 4, 6, lossis 7 lub hlwv muab tso rau hauv lub thawv ntawv thawv ntawv nrog rau cov lus qhia rau kev siv.

Cia rau cov neeg mob

Khaws ntawm qhov kub tsis tshaj li 30 ° C.
Khaws tsis ncav cuag ntawm cov menyuam yaus.

Hnub tas sij hawm

2 xyoos
Tsis txhob siv tom qab hnub tas sij hawm qhia ntawm pob.

Cov lus pom zoo tshwj xeeb

Yanuvia tuaj yeem muas tau hauv lub khw muag tshuaj network tsuas yog muaj ntawv sau tshuajCov. Kev mob hypoglycemia, raws li kev tshawb fawb, nrog kev kho hnyav tsis yog ib qho muaj ntau dua li siv cov placebo. Cov nyhuv ntawm lub cev ntawm Januvia tawm tsam keeb kwm ntawm kev tso siab ntawm cov tshuaj insulin tsis tau kawm, yog li cov neeg mob tsuas yog txwv nrog hypoglycemic tswj.

Qhov tshwm sim tsis zoo ntawm cov tshuaj ntawm lub peev xwm los tswj kev thauj lossis cov txheej txheem nyuaj tsis tau sau tseg, txij li cov kev ua haujlwm ntawm lub hauv nruab nrab cov hlab ntsha tsis cuam tshuam.

Hypersensitivity thaum noj Januvia tuaj yeem hais tawm tsis nco qab uas xav tau. Tus neeg mob lub ntsej muag o, ua pob ua pob ua paug tuaj. Hauv cov xwm txheej huab, Quincke's edema tau pom. Nrog rau cov tsos mob zoo li no, cov tshuaj raug nres tam sim ntawd thiab nrhiav kev pab kho mob.

Januvia hauv txoj kev kho nyuaj siv yog qhov tsis muaj qhov xav tau tom qab noj Metformin thiab kev hloov kho lub neej. Koj tseem tuaj yeem siv cov tshuaj thaum hloov mus rau insulin.

Tus neeg sawv cev hypoglycemic yog dab tsi?

Januvia tshuaj mob ntshav qab zib tau txais cov koob npe ntawm cov kws kho mob thiab cov neeg mob uas kuaj mob no.

Kev npaj ntsiav tshuaj muaj cov txiaj ntsig hypoglycemic hais thiab yog pawg ntawm DPP-4 inhibitors.

Kev siv cov tshuaj txhawb kev loj hlob ntawm lub zog nce ntxiv thiab txhawb lawv lub luag haujlwm. Thaum lub cev ua haujlwm ntawm lub cev, muaj zog ntau ntxiv hauv cov hnyuv, thiab lawv cov theem nce siab ntxiv tom qab noj mov.

Raws li kev txhim kho mob ntshav qab zib mellitus, ib qho tsis ua haujlwm tshwm sim hauv cov txheej txheem ntawm cov txheej txheem no, thiab vim li ntawd, cov kws kho mob tshwj xeeb ua tiav nws rov qab los ntawm kev kho mob rau cov neeg siv tshuaj Januvia.

Tus incretins yog lub luag haujlwm rau txhawb qhov tsim tawm ntawm cov tshuaj insulin los ntawm tus txiav ua ntshav.

Ntawm cov kev qhia tseem ceeb ntawm cov cuab yeej siv kho mob yog:

1. Kev tsis txaus siab ntawm glycated hemoglobin.
2. Kev tshem tawm cov cim ntawm hyperglycemia (suav nrog kev txo kev yoo mov ntshav qab zib).
3. Kev ua kom lub cev tsis hnyav.

Cov tshuaj muaj nyob hauv ntsiav tshuaj daim ntawv ntawm puag ncig, beige-kob coated ntsiav tshuaj.

Cov khoom siv tseem ceeb yog sitagliptin (mnn), raws li cov khoom siv pabcuam yog calcium calcium phosphate, microcrystalline cellulose, magnesium stearate, croscarmellose thiab sodium stearyl fumarate, uas kuj yog ib feem ntawm cov tshuaj. Lub teb chaws ntawm keeb kwm ntawm Januvia yog Netherlands, lub tuam txhab kev lag luam MERCK SHARP & DOHME.

Cov ntsiav tshuaj nrog cov nquag sib xyaw ntawm sitagliptin, raws li txoj cai, yog siv rau hauv rooj plaub:

• nyob rau hauv cov kev kho mob nyuaj kho kab mob xws li hom 2 mob ntshav qab zib mellitus, los ua kom cov ntshav qog nqaij hlav ntau nyob hauv kev sib xyaw nrog kev tawm tsam los yog metformin hydrochloride,
• raws li monotherapy nyob rau hauv kev tsim cov tshuaj insulin-ywj pheej ntawm cov ntshav qab zib mellitus hauv kev sib xyaw nrog kev siv tshuaj tsis yog tshuaj - kev kho kev noj haus thiab kev tawm dag zog.

Nws yuav tsum raug sau tseg tias txoj kev kho nyuaj yog siv cov tshuaj ntawm cov pawg hauv qab no:

1. Sitagliptin feem ntau siv ua ke nrog metformin (Siafor, Glucofage, Formmetin).
2. Nrog sulfonylurea derivatives (Diabeton lossis Amaryl).
3. Nrog rau cov tshuaj los ntawm pawg thiazolidinediones (Pioglitazole, Rosiglitazone).

Januvia ntsiav tshuaj, uas suav nrog sitagliptin, tau nrawm tom qab lawv tau noj thiab ncav cuag lawv qhov ntshav siab tshaj plaws tom qab plaub teev.

Qib ntawm lub cev tiag tiag bioavailability yog qhov loj heev thiab muaj li ntawm cuaj caum feem pua.

Cov lus qhia rau kev siv tshuaj

Kev lag luam kws tshuaj tau tsim cov qauv rau kev tsim cov khoom lag luam tshuaj muaj qhov sib txawv ntawm cov khoom tseem ceeb sib xyaw.

Kev txiav txim siab seb koob tshuaj twg zoo tshaj plaws rau tus neeg mob yog txiav txim los ntawm tus kws kho mob uas koom nrog.

Qhov kev xaiv ntawm ntau npaum li cas ntawm cov tshuaj yog nqa tawm tsuas yog tom qab kev soj ntsuam ntawm tus neeg mob.

Kev npaj cov ntsiav tshuaj tau nthuav tawm ntawm lub khw muag tshuaj hauv cov tshuaj hauv qab no:

• cov tshuaj muaj 25 mg ntawm cov tshuaj nquag,
• tus nqi ntawm cov khoom nquag yog 50 mg,
• Januvia 100 mg - ntsiav tshuaj nrog qhov siab tshaj plaws.

Cov lus qhia Januvia rau kev siv qhia qhov xav tau ntawm kev siv tshuaj uas siv cov qauv hauv qab no:

1. Cov ntsiav tshuaj tau noj ntawm qhov ncauj, ntxuav nrog cov kua tshuaj txaus, tsis hais qhov noj mov.
2. Cov koob tshuaj txhua hnub ntawm cov tshuaj yuav tsum yog ib puas milligrams ntawm lub nquag ua haujlwm.
3. Yog tias koj plam koob tshuaj ntxiv, tsis txhob muab ob npaug rau koob tshuaj ntawm kev siv txuas ntxiv.
4. Yog tias tus neeg mob lub raum lub raum ua haujlwm nrog kev ua haujlwm hauv nruab nrab uas tsis ua haujlwm, qhov koob tshuaj yuav tsum tau txo mus rau tsib caug milligrams. Nrog rau cov teeb meem mob raum tsis zoo, txoj kev tso cai pom zoo yuav tsum tsis pub ntau tshaj nees nkaum-tsib milligrams ntawm cov tshuaj nquag.

Kev siv cov sitagliptin tsuas yog tso cai los ntawm tus kws kho mob tshwj xeeb.

Thaum noj tshuaj ntau dhau, kev hloov pauv hauv QTc ntu tuaj yeem kuaj pom. Raws li kev kho mob, cov hau kev xws li mob plab zom mov, siv cov tshuaj enterosorbent thiab cov tsos mob kho tau siv.

Phiv thiab tuaj yeem tshwm sim tsis zoo

Januvia tshuaj muaj ntau yam tsis zoo tshuaj, tsis zoo li lwm yam qab zib-txo cov tshuaj.

Kev nquag ua haujlwm tau yooj yim zam lub cev, ua haujlwm yam tsis ua rau muaj kev phiv tshuaj.

Ntxiv mus, qee qhov, qee qhov tsis zoo los ntawm ntau yam plab hnyuv siab raum thiab lub nruab nrog cev.

Raws li txoj cai, zoo li qhov tsis zoo ploj tom qab tshem tawm yeeb tshuaj.

Cov kev phiv tshuaj tuaj yeem tshwm sim nyob rau ib feem ntawm txoj kev ua pa ntawm daim ntawv ntawm nasopharyngitis lossis mob sib kis ntawm txoj hlab pa.

Ntxiv rau, tus neeg mob yuav yws txog kev txhim kho ntawm cov txheej txheem xws li:

1. Mob taub hau heev.
2. Mob hauv plab, nrog los ntawm kev ua kis nrog rau xeev siab, ntuav, lossis raws plab.
3. Cov ua kom pom kev qog ntshav qab zib.
4. Raws li cov txiaj ntsig ntawm kev tsom xam, cov kev sib txawv hauv qab no tej zaum yuav tshwm sim - theem ntawm uric acid thiab neutrophils nce, qhov muaj zog ntawm alkaline phosphatase tsawg dua.

Tsis tas li ntawm cov kev tsis zoo tuaj yeem raug suav tias yog qhov nce ntawm kev nqhis dej, vim qhov ntawd tsis pom zoo rau tsav tsheb lossis nqa tawm cov haujlwm nrog cov txheej txheem uas yuav tsum muaj kev nce siab ntawm kev saib xyuas.

Kev tshuaj xyuas ntawm cov neeg siv khoom thiab cov kws kho mob

Ntawm ntau tus neeg mob uas tau siv cov tshuaj, tshuaj xyuas txog nws feem ntau yog qhov zoo.

Kev ntsuas qhov tsis zoo yog feem ntau cuam tshuam nrog kev ua txhaum cov lus qhia rau kev siv tshuaj.

Txog Januvia, kev txheeb xyuas pom tias cov tshuaj muaj ntau yam zoo.

Cov txiaj ntsig tseem ceeb tshaj plaws ntawm tus neeg sawv cev hypoglycemic, piv nrog rau lwm cov tshuaj muaj suab thaj, yog li hauv qab no:

• muaj qhov normalization ntawm qabzib nyob hauv cov ntshav, nyiaj yuav siv tsawg tus hue tsis muaj suab,
• tom qab noj mov, cov tshuaj ua sai sai, normalizing qib ntawm glycemia,
• ntshav qab zib ceases kom "spasmodic" nyob rau hauv cov xwm, tsis dauv los sis nce siab tsis pom.

Nws yuav tsum raug sau tseg tias raws li cov lus qhia rau kev siv tshuaj, cov ntsiav tshuaj tuaj yeem noj lub sijhawm twg los tau ntawm hnub, tsis hais txog kev noj zaub mov.

Tib lub sijhawm, cov neeg mob nyiam noj thaum sawv ntxov, hais tias nyob rau hauv txoj kev no ua kom ruaj khov thiab tshaj tawm yog pom, vim tias cov tshuaj yuav tsum tau them rau cov zaub mov uas tuaj txog thaum nruab hnub.

Lub tswv yim ntawm cov kws kho mob yog tias tsis muaj qhov sib txawv thaum noj tshuaj thiab txoj cai tseem ceeb yog ua raws li kev coj noj haus thiab tsis txhob plam daim ntawv thov tom ntej. Nws yog hom phiaj xwm no uas yuav ua rau kev kho kom muaj lub txiaj ntsig zoo.

Muaj qee kis, cov neeg mob ntshav qab zib tau tshaj tawm tias tom qab ib lub sijhawm, cov kev kho mob ntawm cov tshuaj pib poob qis thiab dhia hauv cov piam thaj hauv kev rov ua haujlwm. Cov xwm txheej no tau piav qhia los ntawm kev txhim kho ntxiv ntawm txheej txheem pathological.

Raws li cov neeg mob, lub ntsiab tsis zoo ntawm Januvia yog txoj cai tswj hwm tus nqi ntawm cov tshuaj.

Tus nqi ntawm ib cov tshuaj nrog qhov ntau kawg tsuas yog txawv ntawm 1,500 rau 1,700 rubles rau ib pob (28 ntsiav tshuaj).

Rau ntau tus neeg mob ntshav qab zib, tus nqi yuav dhau mus tsis tau, muab qhov tseeb tias tshuaj yuav tsum noj tsis tu ncua, thiab cov ntim khoom no txaus rau tsawg dua ib hlis.

Vim li ntawd, cov neeg mob pib nrhiav cov tshuaj hloov pauv uas pheej yig dua.

Hypoglycemic analogs

Januvia thiab analogues tuaj yeem yuav hauv khw muag tshuaj yog tias koj muaj ntawv kho mob uas kws kho mob sau los ntawm koj tus kws kho mob.

Niaj hnub no, cov chaw muag tshuaj Lavxias tsis tuaj yeem muab cov lus qhia ncaj qha nrog rau cov kev cuam tshuam tib yam rau lawv cov neeg siv khoom.

Yog tias peb piv cov cai ATX-4 los ntawm kev sib thooj, tom qab ntawd qee qhov analogues ntawm Januvia tuaj yeem ua cov tshuaj hloov chaw.

Onglisa yog ib tus neeg sawv cev hypoglycemic uas yog siv los ua kom cov ntshav cov ntshav qabzib ntau. Cov khoom siv tseem ceeb yog saxaglipin hauv kev noj tshuaj ntawm ob thiab ib nrab lossis tsib milligrams. Cov tshuaj muaj nyob hauv pawg ntawm DPP-4 inhibitors. Feem ntau siv los ua kev kho mob sib xyaw rau hauv kev sib xyaw nrog cov ntsiav tshuaj raws li metformin. Tus nqi ntawm cov tshuaj yog kwv yees li 1800 rubles.

Galvus Met - muaj ob lub ntsiab lus tseem ceeb - vildagliptin thiab metformin hydrochloride. Thawj yog tus neeg sawv cev ntawm chav kawm ntawm stimulators ntawm insular apparatus ntawm lub txiav thiab pab txhawm rau nce cov kev nkag siab ntawm beta hlwb mus rau cov khoom qab zib kom ntau li lawv tau puas.

Tib lub sijhawm, metformin hydrochloride inhibits cov txheej txheem ntawm gluconeogenesis, txhawb kev ua haujlwm glycolysis, uas ua rau kev txhim kho zoo dua ntawm cov piam thaj los ntawm cov hlwb thiab cov nqaij hauv lub cev. Ntxiv rau, muaj qhov txo qis hauv kev nqus ntawm cov piam thaj los ntawm cov hnyuv. Cov tshuaj tsis ua rau kev txhim kho hypoglycemia. Tus nqi ntawm xws li twj yog los ntawm 1300 txog 1500 rubles.

Galvus hauv nws cov txiaj ntsig zoo ib yam li Galves Met, tsuas yog tias nws tsuas muaj ib qho kev ua haujlwm nkaus xwb - vildagliptin. Tus nqi ntawm cov tshuaj yog los ntawm 800 rubles.

Sijhawm - cov ntsiav tshuaj tshuaj uas muaj cov nyhuv hypoglycemic. Lub hauv paus ua haujlwm tseem ceeb yog linagliptin. Lub ntsiab pharmacological tseem ceeb ntawm cov tshuaj suav nrog kev muaj peev xwm ua kom lub neej zoo ntawm qib glycemia, kev nce ntxiv hauv cov concentration ntawm incretins, nce ntxiv nyob rau hauv cov kua nplaum-tso cov pa tawm ntawm cov tshuaj insulin. Tus nqi ntawm Thauj Ib Ntus yog kwv yees li 1700 rubles.

Ib ntawm cov tshuaj yuav pab tiv thaiv kev ua kom lub ntsej muag kom huv siab thiab nres txoj kev loj hlob ntawm txoj kev tshiab, tsuas yog cov kws kho mob thiaj li tuaj yeem txiav txim siab. Nws tsis pom zoo kom hloov nws tus kheej los ntawm cov tshuaj kho mob los ntawm kws kho mob tshwj xeeb.

Cov tshuaj tiv thaiv hypoglycemic zoo tau piav qhia hauv cov yeeb yaj kiab hauv tsab xov xwm no.

Daim ntawv tso tawm

Cov tshuaj "Januvia" yog tsim nyob rau hauv daim ntawv ntawm cov ntsiav tshuaj. Lawv yog cov puag ncig, lub teeb liab dawb hauv cov xim nrog kov ntawm beige. Txhua ntsiav tshuaj muaj ib daim ntawv lo:

• "221" thaum ib pab ntawm cov tshuaj yog 25 mg,
• "112" thaum cov tshuaj yog 50 mg,
• "227" thaum ib pab cov khoom ntawm cov tshuaj yog 100 mg.

Cov ntsiav tshuaj tau ntim rau hauv daim phiaj nrog hlwb.

Tus nqi tshuaj

Tsis yog txhua tus neeg pej xeem Lavxias uas muaj mob ntshav qab zib hom 2 tuaj yeem mus yuav ntshav qab zib "Januvia" ntsiav tshuaj, tus nqi yuav siab. Rau pob rau 28 tsiav tshuaj ntawm 100 mg, tus nqi raug teeb tsa ntawm 1675 rubles.

Kev tsim kho hauv ntshav qab zib - tsuas yog haus txhua txhua hnub.

Cov naj npawb ntawm cov ntsiav tshuaj no yuav xaus tom qab 4 lub lim tiam ntawm kev kho. Tshaj tias cov tshuaj no tau noj rau ntev, tus nqi zoo li ntau tshaj li tsim nyog. Hauv kev sab laj nrog tus kws kho mob tuaj koom, kev xav txog kev npaj ntawm Januvia tau txiav txim siab.

Qhov sib xyaw ntawm cov ntsiav tshuaj

Ib qho tshuaj ntsiav ntawm Januvia mob ntshav qab zib tuaj yeem muaj 100, 50, thiab 25 mg ntawm sitagliptin.

Nws tseem muaj cov tshuaj pabcuam: calcium hydrogen phosphate, magnesium stearate, sodium stearyl fumarate.

Cov zaj yeeb yaj kiab sab nraud muaj cov roj polyvinyl cawv, titanium dioxide, hlau oxide daj, talc thiab oxide hlau liab.

Daim ntawv thov nta

Kev noj tshuaj yog muab tshuaj nrog tshuaj ntawm 0.1 g.

Yog tias Januvia ntsiav tshuaj siv ua ke nrog Metformin, tom qab ntawd qhov hloov pauv ntawm cov tshuaj tsis tas yuav tsum muaj.

Qhov ntau npaum li cas ntawm cov tshuaj mob ntshav qab zib Januvia tuaj yeem hloov pauv nkaus xwb thaum noj nrog insulin. Qhov no tseem ceeb ua rau kom tsis muaj kev pheej hmoo ntawm hypoglycemia.

Cov neeg mob laus tsis tas yuav hloov pauv ntawm Januvia rau ntshav qab zib. Tab sis koj yuav tsum them sai sai rau cov neeg uas muaj hnub nyoog 75 xyoos. Tsis muaj kev tshawb nrhiav tau ua nrog cov neeg mob ntawm lub hnub nyoog no.

Analogues ntawm cov tshuaj

Ntau cov tshuaj tab tom sim nrhiav cov analogues. Kuj tseem muaj cov yeeb yaj kiab ntawm Januvia, vim tias nws kim heev, thiab tsis yog txhua tus muaj peev xwm them taus cov tshuaj no. Ntxiv rau, sitagliptin tsis suav hais tias yog kev kho mob ntshav qab zib. Hauv kev npaj "Januvia", qhov kev qhia hais tias nws tau raug sau los ua daim ntawv thov rau kev noj zaub mov noj thiab ua kom lub cev, kom ua tiav kev soj ntsuam ntawm cov ntshav qab zib hom II.

Cov piv txwv ntawm Januvia yog:

Los ntawm hom nyhuv ntawm lub cev, cov tshuaj no zoo heev. Lawv favorably cuam tshuam lub leeg poob siab thiab hlab plawv, thiab tiv thaiv qhov tshwm sim ntawm tsis qab los tas li.

Thaum lub tshuab ntawm cov tshuaj yuav luag zoo li qub, tus nqi ntawm lawv tuaj yeem sib txawv. Thiab raws li lub hauv paus ntsiab lus no, cov neeg mob cia li xaiv cov tshuaj uas haum rau lawv. Nws tsis yooj yim los tsim qhov ua tau zoo dua "Galvus Met" lossis "Januvia", vim tias lawv tsis txawv ntawm nqe. Rau pob ntawv "Galvus Met", nyob qhov twg muaj 30 ntsiav tshuaj, tus nqi tau teeb tsa ntawm 1487 rubles.

Tab sis Yanuviya muaj cov analogues uas pheej yig dua, piv txwv li, Galvus, qhov twg 28 ntsiav tshuaj tuaj yeem yuav rau 841 rubles, uas, tau kawg, yog qhov pheej yig dua.

Thiab tus nqi ntawm Ongliza tseem siab tshaj li ntawm Januvia - tus neeg mob yuav them txog 1978 rubles rau pob khoom ntawm 30 tsiav tshuaj. "Trazhenta" tsis deb ntawm cov tshuaj dhau los - 30 ntsiav tshuaj raug nqi txog 1866 rubles.

Cov tshuaj kim tshaj plaws ntawm cov tshuaj tiv thaiv tau ntawm Januvia yog Combogliz Prolong, nyob rau hauv uas 30 ntsiav tshuaj raug nqi 2863 rubles. Tab sis muaj ntau yam xws li ntawm cov tshuaj no, qhov twg 56 ntsiav tshuaj muaj peev xwm yuav tau rau 2866 rubles.

Lub tswv yim ntawm cov kws kho mob

Hauv kev npaj Januvia, 100 mg, kev qhia hais tias cov ntsiav tshuaj tuaj yeem noj thaum nruab hnub, tsawg kawg hmo ntuj, tsis hais tus neeg mob nyiam noj li cas.

Cov kws kho mob ntseeg tias tsis muaj qhov sib txawv li cas tus neeg mob yuav noj tshuaj - thaum sawv ntxov lossis yav tsaus ntuj, qhov tseem ceeb tshaj plaws yog nws tsis nco qhov kev txais tos. Nws yog qhov xwm txheej no uas yuav ua rau cov tshuaj kho tau zoo.

Xyuas txog Januvia

Nrog cov kev nce qib ntawm cov ntshav qab zib hom 2 uas tsis muaj cov ntsiav tshuaj qab zib, qee leej tswj xyuas kom tsis txhob muaj cov piam thaj hauv tshuaj.

Nws kuj tseem ceeb kom pom koj cov tshuaj uas yuav pab tswj hwm koj tus mob mus ntev yam tsis muaj teeb meem ntxiv rau koj cov ntshav qab zib.

Thaum xaiv cov tshuaj hypoglycemic uas tsim nyog rau kev cuam tshuam ntawm cov ntshav qab zib, cov kws tshaj lij tau saib xyuas lub glycemic thiab tsis-glycemic tau. Hauv thawj qhov xwm txheej, qhov no yog qhov txo qis ntawm glycated hemoglobin, qhov kev pheej hmoo ntawm hypoglycemia, insulin secretion, thiab muaj kev nyab xeeb. Hauv qhov thib ob - kev hloov pauv ntawm lub cev lub cev, HF muaj kev pheej hmoo txaus ntshai, ua siab ntev, muaj kev nyab xeeb ntawm tus kheej, pheej yig, nqe, yooj yim siv.

Txog cov tshuaj Januvia kev xav zoo rau cov kws kho mob: Kev yoo mov glycemia yog ze rau qhov ib txwm, postprandial suab thaj thaum kev noj zaub mov tsis ntau tshaj qhov txwv tau, kev tso ntshav qab zib kom tsis pom, cov tshuaj muaj kev nyab xeeb thiab siv tau thiab ua tau raws li cov qauv. Tswv yim ntawm xibfwb A.S. Ametova, lub taub hau. Department of Endocrinology thiab Diabetology GBOU DPO RMAPO ntawm Ministry of Health ntawm Lavxias Lavxias, hais txog cov peev txheej ntawm sitagliptin, saib cov yeeb yaj kiab:

Kev tshuaj xyuas cov neeg mob noj Januvia tau sib xyaw.

A.I. Kuv tau nyob ntawm Metformin tau 3 xyoos tam sim no, tus kws kho mob tsis nyiam qhov kev sim zaum kawg, Kuv tau ntxiv Januvia ntxiv. Kuv tau haus ib ntsiav tshuaj rau ib lub hlis tam sim no. Tus kws kho mob tau hais tias koj tuaj yeem haus lub sijhawm twg los tau, tabsis kuv ib ce nyob kaj siab lug. Thiab cov tshuaj yuav tsum ua haujlwm, ua ntej txhua yam, thaum nruab hnub, thaum lub luag haujlwm ntawm lub cev yog siab tshaj plaws. Kuv tsis tau pom tias muaj cov tsos mob tshwm sim, thaum nws khaws qab zib.

T.O. Qhov kev sib cav tseem ceeb hauv kev sim rau kuv txoj kev noj qab haus huv yog tus nqi kho mob. Rau Januvia, tus nqi tsis yog qhov siv nyiaj ntau tshaj: Kuv tau yuav 28 ntsiav tshuaj ntawm 100 mg rau 1675 rubles. Qhov ntawd txaus rau kuv rau ib hlis. Cov tshuaj siv tau zoo, qab zib yog qhov qub, tab sis kuv xav yuav lwm yam tshuaj, yog li coj mus rau hauv tus account kuv cov nyiaj laus Kuv yuav nug tus kws kho mob kom hloov. Tej zaum ib tug neeg yuav qhia qhov pheej yig dua?

Kev sib piv yam ntxwv ntawm analogues ntawm Januvia

Yog tias peb piv cov tshuaj raws li ATX 4 code, tom qab ntawd es tsis txhob Januvia koj tuaj yeem xaiv analogues:

• Onglizu nrog cov tshuaj nquag saxagliptin,
• Galvus, tsim rau lub hauv paus ntawm vildagliptin,
• Galvus Met - vildagliptin txuam nrog metformin,
• Trazentu nrog lub zog tshuaj linagliptin,
• Combogliz Prolong - raws li metformin thiab saxagliptin,
• Nesinu nrog cov nquag ua hauj alogliptin.

Lub tshuab ntawm cawv ntawm cov tshuaj yog zoo ib yam: lawv suppress qab los noj mov, tsis inhibit nruab nrab lub paj hlwb thiab cov hlab plawv system. Yog tias koj piv cov analogues nrog Yanuvia ntawm tus nqi, ces koj tuaj yeem nrhiav pheej yig dua: rau 30 ntsiav tshuaj ntawm Galvus Meta nrog tib cov tshuaj, koj yuav tsum them 1,448 rubles, rau 28 daim ntawm Galvus - 841 rubles. Onlisa yuav raug nqi ntau dua: 1978 rubles rau 30 pcs. Hauv tib nqe nqe thiab Trazhenta: 1866 rubles. rau 30 ntsiav tshuaj. Qhov uas kim tshaj plaws nyob rau hauv cov npe no yuav yog Combogliz Prolong: 2863 rubles. rau 30 pcs.

Yog tias nws tsis muaj peev xwm ua tiav qhov tsawg kawg yog ib nrab nyiaj them rau cov tshuaj kim tiv thaiv kab mob siab, koj tuaj yeem xaiv qhov kev xaiv uas haum nrog koj tus kws kho mob.

Niaj hnub no, ntshav qab zib hom 2 tsis yog ib qho kev khuam siab rau tag nrho lub neej. Tus neeg mob ntshav qab zib tau nkag mus siv cov tshuaj tshiab ntawm ntau hom kev sib kis, cov khoom siv kho mob nqa khoom rau kev tswj hwm tshuaj thiab kev tshuaj xyuas tus kheej glycemia. Cov tsev kawm ntawv ntawm cov neeg mob ntshav qab zib tau tsim nyob hauv tsev kho mob thiab chaw tu neeg mob, thiab muaj txhua yam ntaub ntawv keeb kwm tseem ceeb hauv Is Taws Nem.

Yog Januvia cov tshuaj tshiab zam rau kev kho mob ntshav qab zib hom 2 lossis keeb kwm xav tau yam xav tau.