Vildagliptin - cov lus qhia, analogues thiab kev xyuas neeg mob

Vildagliptin yog ib hom tshuaj ntshav hypoglycemic uas tau siv hauv kev kho mob los kho cov ntshav qab zib tsis yog-insulin. Hauv tsab xov xwm peb yuav soj ntsuam vildagliptin - cov lus qhia rau kev siv.

Saib xyuas! Hauv kev faib tawm qhov ua rau-txoj hauv kev-kho-tshuaj (ATX), vildagliptin yog qhia los ntawm tus lej A10BH02. International Lub Npe Tsis Muaj Npe (INN): Vildagliptin.

Pharmacodynamics thiab pharmacokinetics: lus piav qhia

Vildagliptin yog ib qho tshuaj tiv thaiv dipeptidyl peptidase-4 (DPP-4) inhibitor. Lub enzyme inactivates ob (tseem hu ua incretins) gastrointestinal hormones - glucagon-zoo li peptide hom 1 (GP1T) thiab glucose-nyob insulinotropic polypeptide (GZIP). Ob qho tib si ua rau muaj kev tso tawm ntawm cov tshuaj insulin, uas tawm hauv kev teb rau kev noj zaub mov.

DPP-4 inhibitors nyob rau hauv hom 2 mob ntshav qab zib mellitus (T2DM) ua rau muaj kev tso tawm ntau ntxiv ntawm cov tshuaj insulin thiab txo cov nyhuv ntawm glucagon thiab, yog li, kom txo qis glycemia.

Vildagliptin tau nrawm nrawm tom qab kev tswj hwm qhov ncauj. Peak plasma concentration tau pom tom qab 1-2 teev. Bioavailability yog 85%. Vildagliptin yog metabolized los ntawm kwv yees li 2/3, thiab tas yog tas tsis hloov. Oxidation los ntawm cytochromes thiab glucuronidation ua si lub luag haujlwm me me hauv cov metabolism hauv cov tshuaj. Lub ntsiab metabolite tsis yog pharmacologically nquag. Cov tshuaj yog tshem tawm los ntawm 85% los ntawm kev tso zis thiab 15% los ntawm cov quav. Qhov kev tshem tawm ib nrab-lub neej ua los ntawm 2 mus rau 3 teev.

Kev taw qhia thiab contraindications

Vildagliptin tau raug sim nyob hauv ntau txog ntau txoj kev tshawb fawb hauv cov neeg muaj mob ntshav qab zib hom 2. HbA1c ntau zog hauv cov neeg mob li ntawm 7.5% mus rau 11%. Tag nrho cov kev tshawb fawb no ua ob zaug dig muag, thiab tseem tau kav 24 lub lis piam.

Peb qhov kev tshawb fawb los sib piv vildagliptin monotherapy (50 mg ob zaug ib hnub) nrog lwm cov tshuaj tiv thaiv kab mob. 760 tus neeg tau kho nrog vildagliptin lossis metformin (1000 mg / hnub) thaum xyoo. Hauv pawg vildagliptiptin, qhov nruab nrab ntawm HbA1c txo qis txog 1.0%, hauv pawg metformin - los ntawm 1.4%. Qhov sib txawv no tsis tau tso cai rau peb kom paub meej tias qhov kev xav thawj zaug tias vildagliptin tsis muaj txiaj ntsig tsawg dua li metformin. Ib nrab ntawm cov neeg mob tau ua raws li xyoo thib ob, thiab cov txiaj ntsig tau yuav luag zoo tib yam li tom qab thawj xyoo. Hauv kev tshawb nrhiav zaum ob, HbA1c raug txo qis 0.9% nrog vildagliptin thiab 1.3% nrog rosiglitazone (ib zaug 8 mg / hnub). Piv nrog acarbose (peb zaug ntawm 110 mg / hnub), qhov kev txo qis ntawm HbA1c raug pom zoo pom zoo muaj vildagliptin (1.4% tiv thaiv 1.3%).

Hauv 4 qhov kev tshawb nrhiav, cov neeg uas tsis txaus siab rau kev tswj glycemic nrog kev kho tus mob uas twb muaj lawm tau raug tshaj tawm vildagliptin lossis placebo. Thawj qhov kev tshawb fawb siv vildagliptin nrog metformin (≥1600 mg / hnub), zaum thib ob nrog pioglitazone (45 mg / hnub) lossis glimepiride (≥ 3 mg / hnub), thiab plaub nrog insulin (≥30E / hnub). Siv tag nrho 4 qhov sib xyaw ua ke ntawm vildagliptin, qhov txo qis HbA1c ntau dua tuaj yeem ua tiav. Hauv kev kawm txog sulfonylurea, qhov sib txawv ntawm ob koob ntawm vildagliptin (50,000 mcg ib hnub) tau tsawg dua li hais hauv kev kawm txog metformin thiab pioglitazone.

Lwm qhov kev tshawb fawb, 607 cov neeg mob uas tsis tau txais kev kho mob ntshav qab zib hom 2 tau muab faib ua plaub pawg: thawj zaug tau txais vildagliptin (ib puas mg / hnub), thib ob tau txais pioglitazone (peb caug mg / hnub), ob ntxiv tau txais vildaglitin thiab pioglitazo. Thaum noj tshuaj, HbA1c txo qis 0.7%, nrog pioglitazone los ntawm 0.9%, nrog rau qhov txo qis qis los ntawm 0.5%, thiab nrog koob tshuaj ntau dua los ntawm 1.9%. Txawm li cas los xij, kev sib xyaw ua ke siv nyob rau hauv txoj kev tshawb no tsis sib xws nrog thawj zaug kev kho mob ntshav qab zib 2 nbgf.

Tus incretins muaj luv heev ib nrab-lub neej thiab muaj kev puas tsuaj sai sai los ntawm enzyme. Muaj ntau yam kev sim nrog vildagliptin ob qho tib si hauv kev kho mob monotherapy thiab hauv kev sib xyaw nrog lwm cov kev kho mob kom zoo - metformin thiab glitazone.

Sab sij huam

Cov kev mob tshwm sim uas tshwm sim ntau dua nrog vildagliptin dua li nrog cov placebo yog kiv taub hau, mob taub hau, peripheral edema, cem quav, mob caj pas, thiab mob hlab pas. Kev mob ntshav qab zib tsawg tshwm sim rau qee leej.

Cov kev mob tshwm sim uas tau pom nyob hauv txhua qhov kev sim tshuaj ob qho tib si nrog kev kho mob monotherapy thiab hauv kev sib xyaw nrog lwm cov kev kho mob yog qhov nce ntawm qib uric acid hauv cov ntshav thiab txo qis me ntsis hauv theem ntawm cov ntshiab alkaline phosphatase.

Qib Transaminase tsis tshua nce siab. Txawm li cas los xij, cov kab mob hepatotoxic muaj ntau dua nrog qhov tshuaj txhua hnub ntawm ib puas mg. Txawm hais tias qhov ua kom mob plawv dhia tsis ua haujlwm tau tshwm sim hauv cov tsiaj tshawb fawb thaum siab tshaj ntawm vildagliptin, kev soj ntsuam hauv kev soj ntsuam tau pom tias qhov ntau zaus ntawm thawj-qib AV block yog siab dua thaum noj cov tshuaj.

Cov kev tshawb fawb tsiaj tau pom tias cov tshuaj yuav ua rau cov tawv nqaij mob khaus, nrog rau qhov ua kom tsis zoo ntawm lub raum. Hauv tib neeg, cov xwm txheej zoo li no feem ntau tsis tau tshwm sim. Txawm li cas los xij, Asmeskas Chaw Tswj Xyuas Khoom Noj thiab Tshuaj (FDA) tau txiav txim pom zoo kom txog thaum muaj kev nyab xeeb ntawm cov tshuaj tau raug pov thawj.

Tsuas tshuaj thiab tshaj

Vildagliptin muaj nyob rau hauv 50 mg ntsiav tshuaj. Cov tshuaj no tau pom zoo rau hauv tebchaws Russia los kho kev mob ntshav qab zib hom 2 hauv cov neeg laus. Qhov koob tshuaj txhua hnub yuav tsum tsis pub tshaj 50 mg. Ua ntej pib siv tshuaj kho, thiab tom qab ntawd txhua txhua peb lub hlis hauv thawj xyoo, qib ntawm transaminases yuav tsum tau saib xyuas.

Cov neeg mob nrog nephropathy (kev ua kom zoo rau lub cev hauv qab tsib caug ml / min), kev mob siab thiab muaj peev xwm hloov ntshav siab ntau (thaum qhov siab kawg ntawm cov cai tshaj li ntau tshaj 2.5 zaug) raug txwv tsis pub. Kev ceev faj tseem yuav tsum tau tawm hauv kev kho mob hauv lub plawv tsis ua hauj lwm (NYHA III thiab IV), vim vildagliptin tsis nkag siab zoo. Tsis muaj ntaub ntawv qhia txog kev siv thaum cev xeeb tub, lactation. Cov neeg mob hnub nyoog qis dua 16 xyoo tsis pom zoo siv cov tshuaj no.

Hauv xyoo 2013, ob txoj kev tshawb nrhiav tau txheeb pom tias muaj kev pheej hmoo ntau ntxiv ntawm kev mob caj dab thiab pancreatic cell metaplasia. Cov kev tshawb fawb tau tshaj tawm hauv cov ntawv xov xwm, ua rau FDA thiab European Medicines Agency thov kom muaj kev tshawb fawb ntxiv los kho kev pheej hmoo ntawm tus mob pancreatitis nrog kev siv tshuaj.

Kev sib txuam

Hauv kev sim tshuaj, kev cuam tshuam nrog lwm cov tshuaj tsis raug pom. Qhov ntxim nyiam ntawm kev sib cuam tshuam tsawg, vim hais tias vildagliptin tsis yog metabolized los ntawm superfamily ntawm cytochrome P450 thiab, yog li ntawd, tsis tiv thaiv qhov cuam tshuam ntawm metabolized los ntawm cytochrome P450 tshuaj. Cov tshuaj tuaj yeem cuam tshuam nrog lwm cov tshuaj tiv thaiv kab mob, thiazide diuretics, corticosteroids, kev npaj cov thyroid, thiab sympathomimetics.

Lub ntsiab analogues ntawm cov tshuaj.

Cov tswv yim ntawm tus kws kho mob thiab tus neeg mob.

Vildagliptin yog qhov tsim nyog rau qhov tsis muaj txiaj ntsig ntawm lwm txoj hauv kev kho - hloov pauv ntawm kev noj zaub mov noj, ua si lub cev lossis tsis teb rau metformin. Cov tshuaj muaj txiaj ntsig zoo txo ​​cov kev saib xyuas ntawm monosaccharides hauv cov hlab ntshav, tab sis nws tuaj yeem ua rau muaj kev phom sij loj, yog li kev kuaj mob tsis tu ncua.

Viktor Alexandrovich, tus kws kho ntshav qab zib

Metformin tau raug muab tshuaj, uas tsis pab thiab ua rau mob dyspepsia heev. Tom qab ntawd lawv hloov mus rau vildaglptin, uas txhim kho glycemia thiab txo cov tsos mob. Muaj qhov kev xav tias tom qab kev zom zaub mov zoo tuaj. Glycemia raug ntsuas tsis tu ncua - txhua yam yog qhov qub. Kuv tseem yuav coj nws mus ntxiv.

Nqe (hauv Lavxias Federation)

Tus nqi ntawm vildagliptin (50 mg / hnub) yog 1000 rubles toj ib hlis. Sitagliptin (100 mg / hnub), lwm qhov DPP-4 inhibitor, yuav luag ob npaug ntawm cov nqi thiab nqi 1800 rubles toj ib hlis, tab sis thaum tsis muaj qhov sib piv ncaj qha nws tsis paub meej tias ob tus neeg sawv cev no sib npaug ntawm cov koob tshuaj no. Kev kho nrog metformin lossis sulfonylureas, txawm tias qhov siab tshaj, nws yog tsawg dua 600 rubles hauv ib hlis.

Tswv yim! Ua ntej siv txhua txoj kev, koj yuav tsum sab laj tus kws tshaj lij txhawm rau txhawm rau zam kom tsis muaj teeb meem tshwm sim. Kev noj tshuaj rau tus kheej tuaj yeem tsim kev phom sij ntau dua li qhov zoo.

Kev tshuaj xyuas ntawm cov kws khomob txog galvus

Vildagliptin, i.e. Galvus yog ib qho tshuaj sim raws sijhawm thiab los ntawm kuv cov neeg mob. Cov hom phiaj kho mob ib leeg, tsis tshua muaj teeb meem ntshav qis, zoo heev thiab ua tiav sai sai. Tus nqi kuj tsis tuaj yeem tab sis zoo siab, yog li kuv nyiam xaiv "Galvus".

Siv ib hnub ob zaug.

Cov nyhuv zoo heev thaum noj thiab kev tswj zoo glycemic. Kuv tseem tsa cov laus - txhua yam tsis zoo!

Ib qho ntawm cov tshuaj feem ntau muaj nyob hauv Lavxias rau kev kho mob ntshav qab zib hom 2. Nws cov hauj lwm zoo thiab kev nyab xeeb yog ntsuas lub sijhawm. Nws tau txais txiaj ntsig zoo heev los ntawm cov neeg mob, txo cov ntshav qabzib ntau, thaum qhov kev pheej hmoo ntawm hypoglycemia yog tsawg heev. Nws tus nqi pheej yig yog qhov tseem ceeb, uas muaj kev txaus siab ntawm ob tus kws kho mob thiab cov neeg mob.

Vildagliptin ("Galvus") yog qhov tshuaj thib ob ntawm IDDP-4 pawg, tau sau npe nyob rau hauv Lavxias Kev Tshawb Fawb rau kev kho mob ntawm cov neeg mob ntshav qab zib hom 2, yog li qhov kev paub ntawm nws siv hauv peb lub teb chaws tau ntev heev. Galvus tau tsim nws tus kheej ua cov tshuaj muaj txiaj ntsig zoo thiab muaj kev nyab xeeb uas tau pom zoo los ntawm cov neeg mob, tsis pab txhawb rau qhov hnyav, thiab tseem muaj kev pheej hmoo tsawg nrog kev hais txog kev mob ntshav qab zib. Cov tshuaj no tuaj yeem siv los txo lub raum, uas ua rau tshwj xeeb hauv kev kho mob rau cov neeg laus laus uas muaj ntshav qab zib hom 2. Cov txiaj ntsig ntawm kev tshaj tawm preclinical thiab cov kev tshawb fawb qhia tias DPP-4 inhibitors (suav nrog Galvus) kuj yuav muaj peev xwm siv tsis tsuas yog tshuaj pleev ntshav tsis zoo, tab sis kuj yog kho nephroprotective.

Tus neeg mob Galvus tshuaj xyuas

Nws kuj txiav txim siab sau ib qho tshuaj xyuas txog cov tshuaj "Galvus". Hmoov tsis zoo, kev noj cov tshuaj no tau hloov lub xyoo ntawm kuv lub neej rau hauv ntuj txiag teb tsaus. Kuv muaj lub hauv caug gonarthrosis thiab txhua tus nkag siab nws nyuaj npaum li cas. Kuv yuav hais qhov tsis zoo yog thaum kuv txhais ceg mob. Thiab thaum twg qhov mob pib tsis yooj yim rau tib neeg, thaum nws tsis tuaj yeem mus pw, ncab lossis khoov koj ob txhais ceg, tig rau lwm sab, tsuas kov koj txhais ceg. Thaum nws zoo nkaus li tias hauv txhua qhov caviar muaj qhov sib tua thiab lawv tab tom tawg, ces lub siab xav tsuas yog kev tuag. Kuv muaj qhov pib ua kom mob siab heev, txawm tias cov kws kho mob xav tsis thoob thiab yog tias kuv hais tias nws tsis muaj peev xwm thev taus, ces qhov mob ntawd zoo li yuav tsis muaj peev xwm tiv thaiv. Qhov ntawd yog li cas kuv nyob txhua xyoo 2018 thiab lub neej ntuj ceeb tsheej no tau raug npaj rau kuv los ntawm Galvus. Yog li no, kuv xav ceeb toom rau cov uas muaj teeb meem txog pob qij txha lossis nqaj qaum, lossis nyuam qhuav pib mob lawv txhais ceg thiab nraub qaum. Yog vim li cas rau qhov no tej zaum yuav yog kev txais tos ntawm "Galvus", uas feem ntau ua rau mob arthralgia. Kuv tsum tsis noj thaum lub Ib Hlis 2, thiab kuv lub neej muaj kev zoo siab. Kuv yuav tsis hais tias txhais ceg tshiab tau loj tuaj lawm, tab sis kuv tuaj yeem ncab kuv ob txhais ceg hauv txaj, Kuv tuaj yeem kov cov leeg ntawm kuv ob txhais ceg yam tsis muaj kev mob siab, thiab qhov no twb yog kev zoo siab, tom qab qhov kev tsim txom no.

9 xyoo hom mob ntshav qab zib hom 2. Tus kws kho mob tau sau ntawv rau Siofor. Kuv haus nws 1 lub sijhawm, Kuv yuav luag muab nws - yog hnub phem hauv kuv lub neej! Rau lub hlis dhau los, tus kws kho mob qhia Galvus. Thaum xub thawj kuv zoo siab tias tsis muaj "Siofor effect", tab sis cov suab thaj ua rau tsis tau txo, tab sis muaj mob ntawm lub plab, zoo nkaus li cov zaub mov tsis mus ntxiv dua li lub plab thiab nteg muaj pob zeb, thiab tom qab ntawd mob taub hau txhua txhua hnub. Ncua tseg - lub taub hau tsis mob.

Thaum kuv tau hom mob ntshav qab zib hom 3 nyob rau 3 xyoos dhau los, lawv muab kuv tso rau hauv insulin tam sim ntawd thiab sau ntawv tias “Galvus”. Lawv tau hais tias koj yuav tsum haus yam tsawg 1 xyoos. Thaum kuv haus nws, qab zib khaws cia nyob li qub. Tab sis tom qab ntawd nws tau muag ntau rau kuv, thiab tom qab haus nws rau ib xyoos, Kuv tsum tsis yuav nws. Tam sim no cov piam thaj hauv siab tau loj. Thiab kuv tuaj yeem them yuav galvus, tab sis kuv ntshai ntawm nws qhov tsis zoo tshwm sim ntawm daim siab.

Kuv coj Galvus + Metformin rau ib hlis. Nws tsis hnov ​​mob heev. Tsis kam lees, nws ua neeg zoo dua. Kuv yuav so rau ib hlis thiab xav rov sim dua. Thiab cov piam thaj tshwm sim tau zoo thaum noj cov tshuaj no.

Xyoo thib ob Kuv coj galvus 50 mg nrog metformin 500 mg thaum sawv ntxov thiab yav tsaus ntuj. Thaum pib ntawm kev kho mob, cov ntsiav tshuaj nyob rau ntawm insulin raws li tus txheej txheem 10 + 10 + 8 units ntxiv rau ib qho ntev ib ntawm 8 qhov. Rau lub hlis tom qab, qab zib qab zib los ntawm 12 poob mus rau 4,5-5,5! Tam sim no cov ntsiav tshuaj nyob ruaj khov 5.5-5.8! Qhov hnyav hnyav tawm ntawm 114 mus rau 98 kg nrog nce li ntawm 178 cm H.E. Kuv tab tom suav rau hauv lub tshuab computer Calorie Calculator. Kuv qhia txhua tus! Hauv Is Taws Nem, koj tuaj yeem xaiv ib qho twg.

Niam muaj hom ntshav qab zib 2. Tus kws kho mob tau xub hais qhia Maninil, tab sis vim yog qee yam nws tsis haum nws niam, thiab cov piam thaj tsis tau tsawg thiab nws kev noj qab haus huv tsis zoo. Qhov tseeb yog tias kuv niam kuj tsis yog tag nrho lub plawv. Tom qab ntawd nws tau hloov los ntawm Galvus, qhov no yog qhov tshuaj zoo heev. Nws yooj yim heev rau nws - txawm tias ua ntej noj mov, txawm tias tom qab, thiab tsuas yog ib hnub ib zaug ntawm cov ntsiav tshuaj. Qab zib yog txo kom tsis txhob, tab sis maj mam, thaum niam zoo siab heev. Qhov tsuas yog qhov npau taws me ntsis yog tias nws cuam tshuam tsis zoo rau lub siab, tab sis rau nws txoj kev txhawb nqa, leej niam haus ntau yam tshuaj ntsuab, yog li txhua yam zoo.

Cov lus qhia luv luv

Cov tshuaj galvus (cov tshuaj vildagliptin) yog ib qhov tshuaj tiv thaiv hypoglycemic, los ntawm nws cov pharmacological kev ua, cuam tshuam nrog inhibitors ntawm tus enzyme dipeptidyl peptidase-4 (DPP-4) thiab siv los kho hom 2 mob ntshav qab zib mellitus. Nyob rau lub sijhawm tsis ntev los no, lub tswvyim ntawm cov tshuaj nyob rau hauv plab ua cov neeg tswj hwm ntawm insulin secretion tau nthuav dav. Cov feem ntau kawm txog biologically active yam nyob rau hauv qhov kev txiav txim zoo li tam sim no yog glucose-tiv thaiv insulinotropic polypeptide, sau ua HIP, thiab glucagon-zoo li peptide 1, luv luv li GLP-1. Pab pawg neeg lub npe ntawm cov tshuaj no yog incretins: plab hnyuv plab zais cia zais hauv kev teb rau kev noj zaub mov thiab ua kom muaj cov tshuaj insulin zais cia los ntawm β-hlwb ntawm cov txiav (qhov thiaj li hu ua "nce cov txiaj ntsig"). Tab sis hauv cov chaw muag tshuaj tsis muaj txoj hauv kev yooj yim: GLP-1 thiab GUIs tsis nyob ntev, uas tsis suav nrog kev siv lawv li tshuaj. Hauv qhov hais txog no, nws tau hais kom tsis txhob qhia qhov ntau zuj zus los ntawm sab nraud, tab sis kom sim khaws lub ntuj endogenous nce ntau li ntau tau, txwv qhov kev txiav txim ntawm cov enzyme uas ua rau lawv rhuav tshem, dipeptidyl peptidase-4 (DPP-4). Kev txwv tsis pub cov enzyme no ua rau muaj sia nyob ntev thiab cov haujlwm HIP thiab GLP-1, ua rau lawv cov ntshav nce ntxiv. Qhov no txhais tau hais tias cov tshuaj insulin / glucagon piv yog qib, cov tshuaj insulin tso tawm los ntawm pancreatic cells-hlwb yog kho, thaum lub zais ntawm glucagon ratio-hlwb yog suppressed. Tshaj tawm, qhov kev qhia ntawm tshooj lus, nws yuav tsum raug sau tseg tias DPP-4 cov tshuaj tiv thaiv kab mob yog ib pab pawg tshiab ntawm cov tshuaj hypoglycemic tsom feem ntau ntawm kev ua kom zoo rau lawv tus kheej nce.Ntxiv mus, raws li kev kwv yees ua ntej, cov tshuaj no muaj qhov ua tau zoo dua lwm cov tshuaj tiv thaiv kab mob ua ntej hais txog qhov ua tau zoo / kev nyab xeeb.

Kev sim, kev soj ntsuam thiab kev tshawb fawb tom qab muag tau lees tias lawv "ua haujlwm" hais txog kev ua kom cov tshuaj insulin endogenous ntau dua, txo qis cov qog glucagon, txwv kev tsim cov piam thaj hauv lub siab, thiab txo cov ntaub so ntswg tiv thaiv cov tshuaj insulin. Nws tsis tuaj yeem tsis lees paub tias DPP-4 inhibitors yog pab pawg muaj txiaj ntsig zoo rau kev kho mob ntshav qab zib hom 2. Qhov "digger" ntawm cov tshuaj no yog cov tshuaj galvus los ntawm cov tuam txhab lag luam thoob ntiaj teb Swiss Novartis. Hauv tebchaws Lavxias, cov tshuaj no tau pib siv hauv xyoo 2008 thiab hauv lub sijhawm luv luv tau txais tus cwj pwm tshaj plaws los ntawm tus kws tsim txoj cai endocrinologist, muaj ciam teb ntawm kev ua haujlwm zoo. Qhov twg, qhov dav dav, tsis yog qhov xav tsis thoob, muab cov ntawv pov thawj loj rau galvus. Hauv kev sim tshuaj, nyob rau hauv uas ntau dua 20 txhiab tus neeg tuaj yeem koom nrog, qhov kev ua haujlwm ntawm cov tshuaj tau pom zoo ob qho tib si hauv lub luag haujlwm ntawm kev kho mob monotherapy thiab hauv kev sib xyaw nrog lwm cov tshuaj tiv thaiv hypoglycemic (metformin, sulfonylurea derivatives, thiazolidinedione derivatives) thiab insulin. Ib qho ntawm qhov zoo ntawm galvus yog qhov ua tau ntawm nws siv nyob rau hauv cov neeg laus cov neeg mob kev txom nyem los ntawm tag nrho "pawg" ntawm ntau yam kab mob, suav nrog lub plawv thiab lub raum pathologies.

Ib qho ntawm ob peb plab hnyuv siab tsis haum rau galvus yog lub siab. Hauv qhov no, thaum nyob rau pharmacological chav kawm, nws yog ib qhov tsim nyog los saib xyuas lub hauv paus kev ua haujlwm ntawm lub siab, thiab ntawm thawj cov tsos mob daj ntseg, tam sim ntawd tso tseg kev kho mob tshuaj thiab tom qab tso galvus. Nrog rau cov ntshav qab zib hom 1, galvus tsis siv.

Galvus muaj nyob rau hauv cov ntsiav tshuaj. Qhov ntau npaum ntawm tshuaj yog xaiv los ntawm tus kws kho mob ib leeg zuj zus, koj tuaj yeem noj cov tshuaj tsis hais txog kev noj zaub mov.

Kws Tshuaj

Tshuaj qhov ncauj hypoglycemic. Vildagliptin - tus sawv cev ntawm chav kawm ntawm kev txhawb nqa ntawm cov twj tsis sib xws ntawm cov leeg nqaij ntawm cov txiav, xaiv yam tshuaj tiv thaiv qhov enzyme dipeptidyl peptidase-4 (DPP-4). Kev txwv ceev thiab ua tiav ntawm DPP-4 kev ua haujlwm (> 90%) ua rau muaj kev nce ntxiv hauv ob qho tib si hauv paus thiab zaub mov noj kom muaj kev zais ntawm hom 1 glucagon-zoo li peptide (GLP-1) thiab glucose-tiv thaiv insulinotropic polypeptide (HIP) los ntawm cov hnyuv mus rau hauv cov kab ke rau txhua hnub.

Ua rau ntau zog ntawm GLP-1 thiab HIP, vildagliptin ua rau muaj kev nkag siab ntau ntxiv ntawm cov pancreatic cells-hlwb rau cov piam thaj, uas ua rau muaj kev txhim kho hauv cov kua dej-npauj insulin secretion.

Thaum siv vildagliptin ntawm koob tshuaj 50-100 mg / hnub hauv cov neeg mob uas muaj hom 2 mob ntshav qab zib mellitus, qhov kev txhim kho ntawm kev ua haujlwm ntawm pancreatic cells-hlwb raug sau tseg. Qeb kev txhim kho ntawm kev ua haujlwm ntawm β-hlwb yog nyob ntawm qhov kev puas tsuaj ntawm lawv thawj zaug kev puas tsuaj, yog li nyob rau cov tib neeg tsis muaj ntshav qab zib mellitus (nrog ib qho kev sib xyaw ntawm cov piam thaj hauv ntshav plasma), vildagliptin tsis txhawb cov tshuaj insulin secretion thiab tsis txo cov piam thaj.

Los ntawm kev nce siab ntawm cov endogenous GLP-1, vildagliptin tsub kom lub hlwb α-hlwb rau cov kua nplaum ntev, uas ua rau muaj kev txhim kho hauv cov kua nplaum-raws li kev cai ntawm glucagon secretion. Kev txo qis hauv cov theem ntawm glucagon ntau dhau ntawm lub sijhawm noj mov, nyeg, ua rau muaj kev poob qis hauv insulin tsis kam.

Kev nce ntxiv ntawm qhov sib piv ntawm insulin / glucagon tiv thaiv keeb kwm ntawm hyperglycemia, vim qhov nce ntawm cov ntsiab lus ntawm GLP-1 thiab HIP, ua rau muaj cov suab thaj hauv cov ntshav ntau zuj zus los ntawm lub siab ob qho tib si hauv lub sijhawm prandial thiab tom qab noj mov, uas ua rau txo qis hauv cov concentration ntawm cov piam thaj hauv ntshav ntshav.

Tsis tas li ntawd, tawm tsam cov keeb kwm yav dhau los ntawm kev siv vildagliptin, qhov kev txo qis ntawm cov lipids hauv cov ntshav plasma raug sau tseg, txawm li cas los xij, cov nyhuv no tsis cuam tshuam nrog nws cov nyhuv ntawm GLP-1 lossis HIP thiab kev txhim kho ntawm kev ua haujlwm ntawm pancreatic cells-hlwb.

Nws paub txog tias kev nce hauv GLP-1 tuaj yeem qeeb plab zom mov, tab sis cov nyhuv no tsis pom nrog kev siv vildagliptin.

Thaum siv vildagliptin hauv 5795 cov neeg mob uas muaj mob ntshav qab zib hom 2 rau 12 txog 52 lub limtiam li monotherapy lossis kev sib xyaw nrog metformin, sulfonylurea derivatives, thiazolidinedione, lossis insulin, qhov tseem ceeb ntev ntev txo qis nyob rau hauv cov concentration ntawm glycated hemoglobin (HbA_1s) thiab yoo ntshav cov kua nplaum.

Thaum kev sib xyaw ntawm vildagliptin thiab metformin tau siv los ua kev kho mob thawj zaug rau cov neeg mob ntshav qab zib hom 2 ntshav qab zib, qhov tsawg-koob tshuaj HbA tau pom nyob rau 24 lub lis piam_1c thiab lub cev hnyav nyob rau hauv kev sib piv nrog monotherapy nrog cov tshuaj no. Cov neeg mob ntshav qab zib tsawg tsawg nyob rau ob pawg kho mob.

Hauv qhov kev tshawb fawb soj ntsuam, thaum thov vildagliptin ntawm koob tshuaj 50 mg 1 zaug / hnub rau 6 lub hlis hauv cov neeg mob uas muaj ntshav qab zib hom 2 sib xyaw ua ke nrog kev tsis zoo lub raum kev ua haujlwm ntawm hauj sim (GFR to30 txog 2) lossis hnyav (GFR 2) degree, qhov chaw kho mob tseem ceeb txo qis. Hba_1cpiv rau pab pawg placebo.

Hauv qhov kev tshawb fawb soj ntsuam, thaum thov vildagliptin ntawm koob tshuaj 50 mg 2 zaug / hnub nrog / tsis muaj metformin ua ke nrog cov tshuaj insulin (qhov nruab nrab ntawm 41 IU / hnub) hauv cov neeg mob uas muaj hom 2 mob ntshav qab zib mellitus, tau txo HbA tsawg dua_1c ntawm qhov xaus ntawm qhov xaus (-0.77%), nrog qhov pib ntsuas, ntawm nruab nrab, 8.8%. Qhov sib txawv nrog cov placebo (-0.72%) yog cov ntawv sau. Qhov tshwm sim ntawm cov ntshav qog nqaij hlav hauv cov pab pawg uas tau txais cov tshuaj tshawb tau yog piv rau qhov xwm txheej ntawm cov ntshav qab zib hauv cov placebo pab pawg. Hauv qhov kev tshawb fawb soj ntsuam siv vildagliptin ntawm koob tshuaj 50 mg 2 zaug / hnub ib txhij nrog metformin (≥1500 mg / hnub) ua ke nrog glimepiride (≥4 mg / hnub) hauv cov neeg mob hom 2 ntshav qab zib mellitus HbA_1c cov lus pom zoo tsawg dua 0.76% (qhov ntsuas pib, ntawm nruab nrab, 8.8%).

Cov Tshuaj Pharmacokinetics

Vildagliptin tau nrawm nrawm los ntawm kev noj nrog lub peev xwm txog ntawm 85%. Hauv kev kho mob koob tshuaj kom ntau, kev nce ntxiv hauv C_max vildagliptin nyob rau hauv ntshav thiab AUC yog yuav luag ncaj qha rau cov kev nce hauv koob tshuaj.

Tom qab kev noj haus rau ntawm lub plab khoob, lub sijhawm ncav C_max vildagliptin hauv ntshav ntshav yog 1 h 45 min. Nrog kev noj mov nrog rau kev noj mov nrog lub sij hawm, qhov nqus ntawm cov tshuaj txo qis me ntsis: ib qho zuj zus hauv C_max los ntawm 19% thiab nce ntxiv nyob rau hauv lub sijhawm kom ncav cuag nws mus txog 2 teev 30 feeb. Txawm li cas los xij, kev noj mov tsis cuam tshuam rau qib ntawm kev nqus thiab AUC.

Kev khi ntawm vildagliptin rau plasma protein yog tsawg (9.3%). Cov tshuaj no raug muab faib sib luag ntawm cov ntshav ntshav thiab ntshav liab. Vildagliptin kev faib tawm tshwm sim txawm tias yog extravascularly, V_ss tom qab iv tswj yog 71 litres.

Biotransformation yog qhov tseem ceeb ntawm kev zam ntawm vildagliptin. Hauv tib neeg lub cev, 69% ntawm cov tshuaj ntawm cov tshuaj yog hloov pauv. Lub ntsiab metabolite - LAY151 (57% ntawm qhov koob tshuaj) yog qhov tsis muaj tshuaj thiab yog ib yam khoom ntawm cov hydrolysis ntawm cov cyano tivthaiv. Txog 4% ntawm cov koob tshuaj ntawm cov tshuaj undergo amide hydrolysis.

Hauv kev sim tshuaj, qhov ua tau zoo ntawm DPP-4 ntawm kev hloov kho cov tshuaj hydrolysis. Vildagliptin tsis yog metabolized nrog kev koom tes ntawm CYP450 isoenzymes. Vildagliptin tsis yog lub cev pob, tsis tiv thaiv thiab tsis ntxias CYP450 isoenzymes.

Tom qab noj cov tshuaj hauv, kwv yees li 85% ntawm cov tshuaj yog txau tawm los ntawm lub raum thiab 15% los ntawm txoj hnyuv, kev tshem tawm cov ntshav tsis sib xws yog vildagliptin yog 23%. T_1/2 tom qab noj tau ntev li 3 teev, tsis hais noj ntau npaum li cas.

Pharmacokinetics hauv cov chaw kuaj mob tshwj xeeb

Tub los ntxhais, BMI, thiab haiv neeg tsis muaj kev cuam tshuam cov pharmacokinetics ntawm vildagliptin.

Hauv cov neeg mob uas muaj lub siab tsis ua haujlwm ntawm qhov mob me mus rau mob hnyav (6-10 cov ntsiab lus raws li kev faib menyuam yaus-Pugh), tom qab kev siv ib cov tshuaj, ib qho kev txo qis hauv bioavailability ntawm vildagliptin los ntawm 20% thiab 8%, feem. Hauv cov neeg mob uas lub siab ua rau lub siab ua txhaum loj (12 cov ntsiab lus raws li kev faib menyuam yaus-Pugh), kev siv lub cev ntawm vildagliptin nce ntxiv txog 22%. Kev nce lossis txo qis hauv qhov ntau ntawm bioavailability ntawm vildagliptin, tsis pub tshaj 30%, tsis yog qhov tseem ceeb hauv chaw kho mob. Tsis muaj kev sib txuam ntawm kev tsis ua haujlwm ntawm lub siab ua haujlwm tsis zoo thiab kev siv lub cev muaj peev xwm.

Hauv cov neeg mob uas lub raum lub raum tsis ua haujlwm, mob me, hnyav, lossis hnyav, vildagliptin tau nce 1.4, 1.7, thiab 2 zaug piv nrog cov neeg ua haujlwm noj qab haus huv zoo, feem. AUC ntawm metabolite LAY151 nce 1.6, 3.2 thiab 7.3 npaug, thiab cov metabolite BQS867 - 1.4, 2.7 thiab 7.3 npaug hauv cov neeg mob uas tsis muaj lub raum tsis ua haujlwm ntawm mob me, nruab nrab thiab hnyav, feem. Cov ntaub ntawv tsis tshua muaj tsawg hauv cov neeg mob uas mob raum tsis ua haujlwm (CRF) qhia tias qhov ntsuas ntawm pawg no zoo ib yam li cov neeg mob uas muaj mob raum tsis zoo. Qhov kev sib zog ntawm LAY151 metabolite hauv cov neeg mob nrog theem kawg CRF nce li 2-3 zaug piv nrog cov kev xav hauv cov neeg mob uas muaj mob raum tsis zoo. Kev tshem tawm cov vildagliptin lub sijhawm hemodialysis muaj kev txwv (4 teev tom qab ib koob yog 3% nrog lub sijhawm ntau tshaj 3-4 teev).

Qhov siab tshaj plaws hauv kev txav ntawm bioavailability ntawm cov tshuaj los ntawm 32% (nce hauv C_max 18%) hauv cov neeg mob laus dua 70 tsis yog qhov tseem ceeb hauv tsev kho mob thiab tsis cuam tshuam qhov inhibition ntawm DPP-4.

Cov teeb meem pharmacokinetic ntawm vildagliptin hauv cov menyuam yaus thiab cov neeg hluas hnub nyoog qis dua 18 xyoo tsis tau teeb tsa.

Daim ntawv tso tawm

Cov ntsiav tshuaj yog dawb mus rau lub teeb daj hauv xim, puag ncig, du, nrog beveled npoo, ntawm ib sab muaj kev tshaj xo ntawm "NVR", ntawm sab nraud - "FB".

Cov neeg siv tshwj xeeb: microcrystalline cellulose - 95.68 mg, anhydrous lactose - 47.82 mg, sodium carboxymethyl hmoov txhuv nplej siab - 4 mg, magnesium stearate - 2.5 mg.

7 Pcs - hlwv (2) - pob khoom los ntawm cardboard.
7 Pcs - hlwv (4) - pob khoom los ntawm cardboard.
7 Pcs - hlwv (8) - pob khoom los ntawm cardboard.
7 Pcs - hlwv (12) - pob khoom los ntawm cardboard.
14 pcs. - hlwv (2) - pob khoom los ntawm cardboard.
14 pcs. - hlwv (4) - pob khoom los ntawm cardboard.
14 pcs. - hlwv (8) - pob khoom los ntawm cardboard.
14 pcs. - hlwv (12) - pob khoom los ntawm cardboard.

Galvus noj ntawm qhov ncauj, tsis hais txog ntawm kev ua zaub mov.

Cov tshuaj ntau npaum li cas ntawm cov tshuaj yuav tsum tau xaiv ib tus zuj zus nyob ntawm qhov siv tau thiab ua siab ntev.

Qhov pom zoo koob tshuaj ntawm cov tshuaj thaum lub sij hawm monotherapy lossis ua ib feem ntawm ob qho kev sib xyaw ua ke nrog kev kho mob nrog metformin, thiazolidinedione lossis insulin (ua ke nrog metformin lossis tsis muaj metformin) yog 50 mg lossis 100 mg ib hnub. Hauv cov neeg mob uas muaj mob ntshav qab zib hom 2 ntau dua uas tau txais kev kho mob insulin, Galvus pom zoo ntawm koob tshuaj 100 mg / hnub.

Cov koob tshuaj pom zoo ntawm Galvus ua ib feem ntawm kev sib xyaw ua ke peb zaug (vildagliptin + sulfonylurea derivatives + metformin) yog 100 mg / hnub.

Ib koob tshuaj 50 mg / hnub yuav tsum noj 1 zaug thaum sawv ntxov. Qhov koob tshuaj 100 mg / hnub yuav tsum tau faib ua 2 koob tshuaj 50 mg thaum sawv ntxov thiab yav tsaus ntuj.

Yog tias koj tsis nco qab noj ib zaug, koob tshuaj ntxiv yuav tsum noj sai li sai tau, thaum koob tshuaj txhua hnub yuav tsum tsis pub tshaj.

Thaum siv raws li ib feem ntawm ob qho kev sib xyaw ua ke nrog kev kho nrog sulfonylurea derivatives, koob tshuaj pom zoo ntawm Galvus yog 50 mg 1 zaug / hnub thaum sawv ntxov. Thaum kws kho mob muab ua ke nrog sulfonylurea derivatives, cov txiaj ntsig ntawm kev siv tshuaj ntawm ib koob ntawm 100 mg / hnub tau zoo ib yam li cov koob tshuaj ntawm 50 mg / hnub. Nrog cov tshuaj tsis txaus ua haujlwm tiv thaiv keeb kwm yav dhau los ntawm kev siv qhov siab tshaj plaws pom zoo txhua hnub koob ntawm 100 mg, rau kev tswj hwm zoo dua ntawm glycemia, cov tshuaj ntxiv ntawm lwm cov tshuaj hypoglycemic yog ua tau: metformin, sulfonylurea derivatives, thiazolidinedione lossis insulin.

Cov neeg mob uas ua rau lub raum thiab lub cev tsis ua haujlwm hnyav me me tsis tas yuav tsum kho qhov ntau ntawm cov tshuaj no. Hauv cov neeg mob uas lub raum lub raum tsis ua haujlwm ntawm qhov kev ua kom qis thiab mob hnyav (suav nrog lub davhlau ya nyob twg ntawm kev mob raum tsis ua haujlwm ntawm kev mob hlwb), cov tshuaj yuav tsum siv ntawm ib koob ntawm 50 mg 1 zaug / hnub.

Hauv cov neeg mob laus (≥ 65 xyoo), yuav tsum tau kho ntawm ntau npaum li cas kev coj ntawm Galvus.

Txij li thaum tsis muaj kev paub hauv kev siv Galvus hauv cov menyuam yaus thiab cov tub ntxhais hluas hnub nyoog qis dua 18 xyoo, nws tsis pom zoo kom siv cov tshuaj hauv pawg no ntawm cov neeg mob.

Noj ntau dhau

Galvus muaj kev tiv thaiv zoo thaum muab rau ntawm ib koob li ntawm 200 mg / hnub.

Cov tsos mob: thaum siv cov tshuaj ntawm ib koob ntawm 400 mg / hnub, mob nqaij yuav pom, tsis tshua muaj - lub ntsws thiab lub cev hloov pauv sai sai, kub taub hau, o thiab qhov nce ntawm lipase concentration (2 zaug siab dua VGN). Nrog rau qhov nce ntawm koob Galvus mus rau 600 mg / hnub, kev txhim kho ntawm edema ntawm qhov kawg nrog paresthesias thiab kev nce ntxiv hauv qhov tob ntawm CPK, ALT, C-reactive protein thiab myoglobin yog tau. Tag nrho cov tsos mob ntawm kev haus ib ce thiab hloov cov kev hloov hauv chaw kuaj ploj tom qab tsis siv tshuaj.

Kev kho mob: tshem tawm cov tshuaj ntawm lub cev los ntawm kev lim ntshav yog qhov tsis zoo. Txawm li cas los xij, lub ntsiab hydrolytic metabolite ntawm vildagliptin (LAY151) tuaj yeem tshem tawm hauv lub cev los ntawm hemodialysis.

Cev xeeb tub thiab lactation

Tsis muaj cov ntaub ntawv txaus ntawm kev siv tshuaj Galvus hauv cov poj niam cev xeeb tub, thiab yog li ntawd cov tshuaj yuav tsum tsis txhob siv thaum cev xeeb tub.

Txij li nws tsis paub meej tias vildagliptin raug tawm hauv tib neeg cov kua mis, Galvus yuav tsum tsis txhob siv thaum lactation (pub mis niam).

Hauv kev sim tshuaj, thaum siv nyob rau hauv cov koob tshuaj 200 lub sijhawm siab dua qhov kev pom zoo, cov tshuaj tsis ua rau muaj qhov tsis taus thiab kev loj hlob ntawm menyuam thaum ntxov thiab tsis dhau cov teebmeem teratogenic.

Cov lus qhia tshwj xeeb

Txij li cov ntaub ntawv hais txog kev siv vildagliptin nyob rau hauv cov neeg mob uas muaj mob plawv tsis ua haujlwm ntawm chav kawm ua haujlwm III ua haujlwm raws li NYHA kev faib tawm (cov lus 1) yog qhov tsawg thiab tsis pub ua qhov kawg
xaus lus, nws raug nquahu kom siv Galvus nrog ceev faj hauv pawg ntawm cov neeg mob no.

Kev siv vildagliptin nyob rau hauv cov neeg mob uas mob plawv tsis ua haujlwm IV ua haujlwm rau chav kawm qib IV raws li NYHA kev faib tawm tsis pom zoo vim tias tsis muaj cov ntaub ntawv tshawb fawb txog kev siv vildagliptin hauv pawg neeg mob no.

Cov Lus 1. New York Kev Koom Tes ntawm Lub Xeev muaj nuj nqi ntawm Cov Neeg Mob Nrog Mob Hlwb Mob Hlwb Hlwb (li tau hloov kho), NYHA, 1964

Lub siab ua haujlwm tsis zoo

Txij li, hauv qee qhov tsis tshua muaj tshwm sim, kev siv vildagliptin qhia kev nce ntxiv ntawm aminotransferases (feem ntau tsis muaj kev kuaj mob), nws raug nquahu kom txiav txim siab cov biochemical cov kev ua haujlwm ntawm daim siab ua haujlwm ua ntej sau ntawv Galvus, zoo li tsis tu ncua thaum thawj xyoo ntawm kev kho mob nrog tshuaj (ib zaug txhua 3 lub hlis). Yog tias tus neeg mob tau ua haujlwm ntau ntxiv ntawm aminotransferases, qhov tshwm sim no yuav tsum tau lees paub los ntawm kev tshawb fawb zaum ob, thiab tom qab ntawd ua ntu zus txiav txim siab cov biochemical tsis ua haujlwm ntawm daim siab ua haujlwm kom txog thaum lawv ua haujlwm.Yog tias qhov kev ua haujlwm ntawm AST lossis ALT yog 3 zaug siab dua VGN (raws li kev lees paub los ntawm kev tshawb fawb ntxiv), nws raug nquahu kom thim cov tshuaj.

Nrog rau kev txhim kho jaundice lossis lwm cov cim ntawm lub siab ua haujlwm tsis zoo thaum lub sijhawm siv Galvus, kev kho tshuaj yuav tsum nres tam sim ntawd. Tom qab ua lub siab tsis ua hauj lwm qhov ntsuas, kev kho tshuaj tsis tuaj yeem rov ua dua.

Yog tias tsim nyog, insulin txoj kev kho Galvus tsuas yog siv ua ke nrog insulin. Cov tshuaj yuav tsum tsis txhob siv rau hauv cov neeg mob uas muaj hom 1 mob ntshav qab zib mellitus lossis rau kev kho mob ntshav qab zib ketoacidosis.

Cuam tshuam rau kev muaj peev xwm tsav tsheb thiab tswj cov tshuab

Qhov cuam tshuam ntawm cov tshuaj Galvus ntawm kev muaj peev xwm tsav tsheb thiab kev tswj cov tswv yim tsis tau teeb tsa. Nrog rau kev txhim kho kiv taub hau thaum kho nrog cov tshuaj, cov neeg mob yuav tsum tsis txhob tsav tsheb lossis ua haujlwm nrog cov txheej txheem.

Pharmacological kev txiav txim

Vildagliptin (Latin version - Vildagliptinum) yog nyob rau hauv chav kawm ntawm cov tshuaj uas txhawb cov islets ntawm Langerhans hauv cov leeg xoos thiab inhibit cov kev ua ntawm dipeptidyl peptidase-4. Cov nyhuv ntawm qhov enzyme no ua rau muaj kev puas tsuaj rau hom 1 glucagon-zoo li peptide (GLP-1) thiab glucose-nyob insulinotropic polypeptide (HIP).

Raws li qhov tshwm sim, qhov kev txiav txim ntawm dipeptidyl peptidase-4 yog suppressed los ntawm cov tshuaj yeeb dej caw, thiab kev tsim tawm ntawm GLP-1 thiab HIP yog txhim kho. Thaum lawv cov ntshav nce ntxiv, vildagliptin txhim kho qhov rhiab ntawm beta hlwb rau cov piam thaj, uas ua rau cov insulin ntau ntxiv. Qhov feem pua ​​ntawm qhov nce ntawm kev ua haujlwm ntawm beta hlwb yog ncaj qha nyob rau theem ntawm lawv qhov kev puas tsuaj. Yog li, hauv cov neeg muaj nuj nqi li qub ntawm cov piam thaj thaum siv tshuaj muaj vildagliptin, nws tsis cuam tshuam rau cov khoom noj suab thaj txo qis thiab, tau kawg, piam thaj.

Tsis tas li ntawd, thaum cov tshuaj tsub tawm cov ntsiab lus ntawm GLP-1, tib lub sijhawm, qabzib rhiab zuj zus hauv alpha hlwb. Xws li tus txheej txheem xav kom muaj kev nce siab ntxiv nyob rau hauv cov cai ntawm cov khoom ntawm hormone alpha hlwb, uas yog hu ua glucagon. Txo nws cov ntsiab lus ntau ntxiv thaum noj zaub mov noj yuav pab tshem tawm cov kev tiv thaiv cell mus rau insulin hormone.

Thaum qhov piv ntawm insulin thiab glucagon nce, uas yog txiav txim siab los ntawm tus nqi nce ntawm HIP thiab GLP-1, nyob rau hauv lub xeev hyperglycemic, qabzib hauv lub siab pib tsim tawm mus rau qhov tsawg dua, ob qho tib si thaum noj zaub mov noj thiab tom qab nws, uas ua rau txo qis cov piam thaj hauv ntshav ntshav ntawm cov ntshav qab zib.

Nws yuav tsum raug sau tseg tias, siv Vildagliptin, ntau npaum li cas ntawm cov lipids tsawg dua tom qab noj mov. Qhov kev nce ntawm cov ntsiab lus ntawm GLP-1 qee zaum ua rau lub qeeb hauv kev tso tawm ntawm lub plab, txawm hais tias tsis muaj qhov tshwm sim tau tshawb pom thaum lub sijhawm noj.

Ib txoj kev tshawb fawb tsis ntev los no uas muaj txog li 6,000 tus neeg mob ntev dua 52 lub limtiam tau ua pov thawj tias kev siv vildagliptin tuaj yeem txo cov piam thaj hauv lub plab thiab glycated hemoglobin (HbA1c) thaum siv cov tshuaj:

• raws li lub hauv paus ntawm kev siv tshuaj yaj yeeb,
• xyaw nrog metformin,
• txuam nrog sulfonylurea derivatives,
• ua ke nrog thiazolidinedione,

Cov kua nplaum hauv lub ntsej muag kuj txo qis nrog kev siv ua ke ntawm vildagliptin nrog cov kua dej.

Yuav ua li cas nrhiav tau vildagliptin

Cov lus qhia thawj zaug ntawm incretins tshwm sim ntau dua 100 xyoo dhau los, rov qab rau xyoo 1902. Cov quav tau cais tawm ntawm plab hnyuv thiab tau hu ua secretins. Tom qab ntawd lawv lub peev xwm los txhawb qhov kev tso tawm ntawm cov enzymes los ntawm kab mob ntshav ntswg tsim nyog rau kev zom cov zaub mov tau pom. Ob peb xyoos tom qab, muaj kev tawm tswv yim tias kev zais cia kuj tseem tuaj yeem cuam tshuam cov kev ua hauv hormonal ntawm cov qog. Nws tau muab tawm tias nyob rau hauv cov neeg mob glucosuria, thaum noj cov tshuaj ntxiv sai, cov piam thaj hauv cov zis muaj tsawg zuj zus, cov zis puas tsawg, thiab kev noj qab haus huv zoo tuaj.

Hauv xyoo 1932, qhov tshuaj hormones tau txais nws lub npe niaj hnub - glucose-tiv thaiv insulinotropic polypeptide (HIP). Nws muab tawm tias nws yog synthesized hauv cov hlwb ntawm mucosa ntawm duodenum thiab jejunum. Thaum xyoo 1983, 2 cov txiv kab ntxwv zoo li peptides (GLPs) tau raug cais tawm. Nws tau muab tawm tias GLP-1 ua rau cov kua dej hauv cov kua dej hauv cov lus teb rau cov piam thaj, thiab nws cov kev zais cia yog txo hauv cov ntshav qab zib.

Nkaus GLP-1:

• stimulates insulin tso rau hauv cov neeg mob ntshav qab zib,
• prolongs muaj cov khoom noj hauv lub plab,
• txo cov kev xav tau ntawm cov zaub mov, koom nrog poob,
• muaj lub txiaj ntsig zoo rau lub siab thiab cov hlab ntsha,
• txo cov khoom lag luam ntau lawm hauv glucagon hauv kev txiav - cov yam tshuaj uas lub zog ua rau cov ntshav dej tsis txaus siab.

Nws faib cov nce zuj zus ntxiv nrog cov enzyme DPP-4, uas yog tam sim no ntawm qhov endothelium ntawm cov hlab ntsha mus rau hauv lub plab hnyuv ntawm lub plab hnyuv, rau nws siv 2 feeb.

Kev siv tshuaj ntsuab ntawm cov kev tshawb pom no tau pib xyoo 1995 los ntawm lub tuam txhab kws kho mob Novartis. Cov kws tshawb fawb muaj peev xwm cais tawm cov tshuaj uas cuam tshuam rau kev ua haujlwm ntawm DPP-4 enzyme, uas yog vim li cas lub sijhawm ntawm GLP-1 thiab HIP nce los ntawm ntau lub sijhawm, thiab insulin synthesis tseem nce. Thawj cov tshuaj ruaj khov nrog rau xws li cov kev ua haujlwm uas tau dhau los ntawm kev kuaj xyuas kev nyab xeeb yog vildagliptin. Lub npe no tau nqus ntau cov ntaub ntawv: ntawm no yog chav kawm tshiab ntawm cov kab mob hypoglycemic "gliptin" thiab ib feem ntawm lub npe ntawm nws tus tsim Willhower, thiab qhov ntsuas qhov muaj peev xwm ntawm cov tshuaj txo glycemia "gly" thiab txawm hais tias "yog", los yog dipeptidylamino peptidase, lub enzyme DPP -4.

Kev txiav txim ntawm vildagliptin

Thaum pib ntawm lub hnub nyoog nce zuj zus hauv kev kho mob ntshav qab zib yog suav tias yog xyoo 2000, thaum tseem muaj peev xwm thaiv tau DPP-4 tau tshwm sim thawj zaug ntawm Congress ntawm Endocrinologist. Hauv lub sijhawm luv luv, vildagliptin tau nce qhov chaw muaj zog hauv cov qauv kev kho mob ntshav qab zib hauv ntau lub tebchaws hauv ntiaj teb. Hauv tebchaws Lavxias, cov tshuaj raug rau npe xyoo 2008. Tam sim no vildagliptin yog ib xyoos muaj nyob rau hauv cov npe ntawm cov tshuaj tseem ceeb.

Kev vam meej sai no yog vim muaj cov cim tshwj xeeb ntawm vildagliptin, uas tau lees paub los ntawm kev soj ntsuam ntau tshaj 130 qhov kev tshawb fawb thoob ntiaj teb.

Mob ntshav qab zib, cov tshuaj tso cai rau koj:

1. Txhim kho glycemic tswj. Vildagliptin hauv ib koob tshuaj 50 mg txhua hnub pab txo cov suab thaj tom qab noj mov yog kwv yees li 0.9 mmol / L. Glycated hemoglobin raug txo los ntawm qhov nruab nrab 1%.
2. Ua kom cov kua nplaum ntawm lub ntsej muag nrawm dua los ntawm kev txo cov kab mob siab. Ntau kawg postprandial glycemia txo los ntawm kwv yees li 0.6 mmol / L.
3. Yuav txo tau ntshav siab nyob nruab hnub thiab hmo ntuj hauv thawj rau lub hlis ntawm kev kho mob.
4. Txhim kho cov lipid metabolism feem ntau los ntawm kev txo cov tshuaj ntawm cov lipoproteins uas tsis muaj ntau. Cov kws tshawb fawb txiav txim siab qhov txiaj ntsig no ua ntxiv, tsis hais txog kev txhim kho cov nyiaj them ntshav qab zib kom them nyiaj.
5. Txo qhov hnyav thiab duav hauv cov neeg mob rog.
6. Vildagliptin yog tus cwj pwm ntawm kev zam zoo thiab kev nyab xeeb siab. Kev mob ntshav qab zib hauv lub sijhawm nws siv tsis tshua muaj: kev pheej hmoo yog 14 npaug qis dua thaum noj tshuaj sulfonylurea derivatives.
7. Cov tshuaj mus zoo nrog metformin. Hauv cov neeg mob noj cov tshuaj metformin, ntxiv ntawm 50 mg ntawm vildagliptin rau kev kho mob tuaj yeem txo qis GH los ntawm 0.7%, 100 mg los ntawm 1.1%.

Raws li cov lus qhia, kev nqis tes ntawm Galvus, lub npe lag luam tawm rau vildagliptin, ncaj qha nyob ntawm kev muaj peev xwm ntawm pancreatic beta hlwb thiab qib qabzib. Hauv thawj hom mob ntshav qab zib thiab hauv ntshav qab zib hom 2 nrog qhov feem pua ​​loj ntawm cov hlwb tawg, vildagliptin tsis muaj zog. Hauv cov neeg muaj kev noj qab haus huv thiab nyob rau hauv cov neeg mob ntshav qab zib nrog cov ntshav qabzib nyob, nws yuav tsis ua rau lub xeev hypoglycemic.

Tam sim no, vildagliptin thiab nws cov analogues raug suav hais tias yog cov tshuaj ntawm kab thib 2 tom qab metformin. Lawv tuaj yeem ua tiav hloov cov tam sim no feem ntau sulfonylurea derivatives, uas tseem txhim kho cov tshuaj insulin, tab sis muaj kev nyab xeeb tsawg dua.

Tshuaj nrog vildagliptin

Tag nrho cov cai rau vildagliptin yog txoj cai los ntawm Novartis, uas tau nqis peev ntau thiab nyiaj txiag hauv kev txhim kho thiab tua tawm cov tshuaj ntawm lub khw. Cov ntsiav tshuaj yog tsim nyob rau hauv Switzerland, Spain, Lub teb chaws Yelemees. Tsis ntev nws yuav npaj tua kab hauv Lavxias ntawm Novartis Neva cov ceg. Cov tshuaj yeeb tshuaj, uas yog vildagliptin nws tus kheej, tsuas muaj keeb kwm Swiss.

Vildagliptin muaj 2 Novartis khoom: Galvus thiab Galvus Met. Cov tshuaj nquag ntawm Galvus tsuas yog vildagliptin. Cov tshuaj muaj ib zaug tau tshuaj ntawm 50 mg.

Galvus Met yog kev sib xyaw ntawm metformin thiab vildagliptin hauv ib ntsiav tshuaj. Muaj cov tshuaj ntxiv rau: 50/500 (mg sildagliptin / mg metformin), 50/850, 50/100. Txoj kev xaiv no tso cai rau koj coj mus rau hauv tus yam ntxwv ntawm cov ntshav qab zib hauv ib tus neeg mob tshwj xeeb thiab xaiv txoj kev noj tshuaj uas yog.

Raws li cov neeg mob ntshav qab zib, noj Galvus thiab metformin hauv cov ntsiav tshuaj cais yog qhov pheej yig dua: tus nqi ntawm Galvus yog li 750 rubles, metformin (Glucofage) yog 120 rubles, Galvus Meta yog li 1600 rubles. Txawm li cas los xij, kev kho mob nrog cov sib xyaw ua ke Galvus Metom tau lees paub tias ua haujlwm zoo dua thiab yooj yim.

Galvus tsis muaj analogues nyob rau hauv Russia muaj vildagliptin, txij li cov tshuaj yeeb tshuaj yuav raug txwv. Tam sim no, nws yog txwv tsis pub tsuas yog tsim cov tshuaj nrog vildagliptin, tab sis kuj tseem txhim kho cov tshuaj yeeb nws tus kheej. Qhov kev ntsuas no tso cai rau cov khw tsim cov nqi ntawm cov kev tshawb fawb ntau qhov xav tau los sau npe rau ib yam tshuaj tshiab.

Kev ntsuas rau nkag

Vildagliptin tsuas yog qhia txog ntshav qab zib hom 2 xwb. Raws li cov lus qhia, ntsiav tshuaj tuaj yeem muab tshuaj:

1. Ntxiv rau metformin, yog tias nws cov koob tshuaj noj tsis zoo txaus los tswj ntshav qab zib.
2. Txhawm rau hloov sulfonylurea (PSM) kev npaj rau hauv cov neeg mob ntshav qab zib nrog rau kev pheej hmoo ntawm cov ntshav qab zib tsawg dua. Qhov laj thawj yuav yog hnub nyoog laus, muaj cov cwj pwm noj haus, kis las thiab lwm yam qoj ib ce, mob neuropathy, ua kom lub siab ua haujlwm tsis zoo thiab ua rau lub plab zom mov.
3. Tus mob ntshav qab zib uas muaj qhov tsis haum rau PSM pawg.
4. Hloov ntawm sulfonylurea, yog tias tus neeg mob nrhiav kom ncua sijhawm pib kho cov tshuaj insulin ntau li ntau tau.
5. Raws li kev kho mob monotherapy (tsuas yog vildagliptin), yog tias noj Metformin yog contraindicated lossis tsis tuaj yeem vim muaj kev phiv loj heev.

Txais tos ntawm vildagliptin yam tsis swb yog yuav tsum tau koom ua ke nrog kev noj haus ntshav qab zib thiab kev kawm lub cev. Muaj cov tshuaj insulin ntau heev vim kev ua haujlwm qis thiab kev tswj hwm kev noj haus tsis txaus rau lub cev muaj peev xwm dhau los ua qhov tsis txaus ntseeg ntawm kev ua tiav ntshav qab zib. Cov kev qhia tso cai rau koj los ua ke vildagliptin nrog metformin, PSM, glitazones, insulin.

Cov koob tshuaj pom zoo ntawm cov tshuaj yog 50 lossis 100 mg. Nws nyob ntawm ntau qhov mob ntshav qab zib. Cov tshuaj feem ntau cuam tshuam rau postprandial glycemia, yog li nws yuav tsum tau haus ib koob tshuaj 50 mg thaum sawv ntxov. 100 mg tau muab faib sib npaug rau kev txais tos thaum sawv ntxov thiab yav tsaus ntuj.

Nquag ua yam tsis xav tau

Qhov tseem ceeb tseem ceeb ntawm vildagliptin yog qhov tsawg tshwm sim ntawm cov kev mob tshwm sim thaum nws siv. Cov teeb meem tseem ceeb hauv cov neeg mob ntshav qab zib siv PSM thiab insulin yog hypoglycemia. Txawm hais tias qhov tseeb tias ntau zaus lawv dhau los ua ib daim ntawv me, cov kua qab zib poob yog qhov txaus ntshai rau cov hlab ntsha tsis zoo, yog li lawv sim kom zam ntau li ntau tau. Cov lus qhia rau kev siv paub tias kev pheej hmoo ntawm hypoglycemia thaum noj vildagliptin yog 0.3-0.5%. Rau kev sib piv, hauv pawg tswj hwm tsis txhob noj tshuaj, qhov kev pheej hmoo ntawm no yog ntawm 0.2%.

Kev nyab xeeb siab ntawm vildagliptin tseem qhia tau los ntawm qhov tseeb tias thaum lub sijhawm kawm, tsis muaj ntshav qab zib yuav tsum tau tshem tawm cov tshuaj vim nws cov kev mob tshwm sim, raws li muaj pov thawj los ntawm tib tus tsis pom zoo ntawm kev kho mob hauv cov pab pawg noj vildagliptin thiab placebo.

Tsawg dua 10% ntawm cov neeg mob yws yws me me, thiab tsawg dua 1% tau cem quav, mob taub hau, thiab o ntawm cov tshaj. Nws tau pom tias kev siv lub sijhawm ntev ntev ntawm vildagliptin tsis ua rau muaj kev nce ntxiv hauv lub zaus ntawm nws cov kev mob tshwm sim.

Tus kws kho mob ntawm Kev Tshawb Fawb Kev Kho Mob, Lub Taub Hau ntawm lub koom haum ntawm Diabetology - Tatyana Yakovleva

Kuv tau kawm mob ntshav qab zib tau ntau xyoo. Nws yog txaus ntshai thaum muaj coob tus neeg tuag, thiab haj yam ua rau neeg xiam vim ntshav qab zib.

Kuv maj nrawm los qhia txoj xov zoo - Endocrinological qhov chaw tshawb fawb ntawm Lavxias Academy ntawm Medical Science tau tswj hwm los tsim cov tshuaj uas kho cov ntshav qab zib kom meej. Thaum lub sijhawm, cov hauj lwm zoo ntawm cov tshuaj no tau nce mus txog 98%.

Lwm qhov xov xwm zoo: Lub Tsev Haujlwm Saib Xyuas Kev Noj Qab Haus Huv tau txais kev nyab xeeb qhov kev saws me nyuam ntawm cov haujlwm tshwj xeeb uas them rau cov nqi tshuaj ntau. Hauv Lavxias, neeg mob ntshav qab zib kom txog thaum lub Tsib Hlis 18 (suav nrog) tuaj yeem tau txais nws - Tsuas yog 147 rubles!

Raws li cov lus qhia, contraindications kom noj cov tshuaj tsuas yog hypersensitivity rau vildagliptin, me nyuam yaus, cev xeeb tub thiab lactation. Galvus muaj lactose ua ib lub koom haum pab, yog li ntawd, thaum nws tseem tsis haum, cov ntsiav tshuaj no yog txwv tsis pub. Galvus Met raug tso cai, vim tias tsis muaj lactose hauv nws cov muaj pes tsawg leeg.

Vildagliptin analogues

Tom qab vildagliptin, ntau ntau yam tshuaj tau pom tias tuaj yeem tiv thaiv DPP-4. Tag nrho cov ntawm lawv yog cov analogues:

• Saksagliptin, cov npe lag luam Onglisa, cov tsim tawm Astra Zeneka. Kev sib xyaw ntawm saxagliptin thiab metformin hu ua Combogliz,
• Sitagliptin muaj nyob hauv kev npaj ntawm Januvius los ntawm lub tuam txhab Merck, Xelevia los ntawm Berlin-Chemie. Sitagliptin nrog metformin - cov tshuaj yeeb tshuaj ntawm ob lub tshuaj tiv thaiv Janumet, cov lus sib piv ntawm Galvus Meta,
• Linagliptin muaj lub npe lag luam Trazhenta. Cov tshuaj yog lub hlwb ntawm lub tuam txhab German Beringer Ingelheim. Linagliptin ntxiv rau metformin hauv ib ntsiav tshuaj hu ua Gentadueto,
• Alogliptin yog ib qho muaj txiaj ntsig ntawm Vipidia ntsiav tshuaj, uas yog ua nyob rau hauv Asmeskas thiab Nyij Pooj los ntawm Takeda Pharmaceuticals. Kev sib xyaw ntawm alogliptin thiab metformin yog tsim nyob rau hauv cov cim lag luam Vipdomet,
• Gozogliptin tsuas yog qhov tshuaj nyob ib puag ncig ntawm vildagliptin. Nws yog npaj los tso Satereks LLC. Ib lub voj voog ntau lawm tag nrho, suav nrog cov tshuaj pharmacological, yuav tau nqa tawm hauv cheeb tsam Moscow. Raws li cov txiaj ntsig ntawm kev sim tshuaj, kev nyab xeeb thiab ua tau zoo ntawm gozogliptin tau ze rau vildagliptin.

Hauv cov khw muag tshuaj Lavxias, tam sim no koj tuaj yeem yuav Ongliza (tus nqi rau ib chav kawm txhua hli yog txog 1800 rubles), Combogliz (los ntawm 3200 rubles), Januvius (1500 rubles), Kselevia (1500 rubles), Yanumet (los ntawm 1800), Trazhentu ( 1700 rub.), Vipidia (los ntawm 900 rub.). Raws li tus naj npawb ntawm cov tshuaj xyuas, nws tuaj yeem sib cav tias feem ntau nrov ntawm cov analogues ntawm Galvus yog Januvius.

Cov kws kho mob tshuaj xyuas txog vildagliptin

Cov kws kho mob muab tus nqi vildagliptin ntau heev. Lawv hu rau qhov zoo ntawm cov tshuaj no lub cev muaj txiaj ntsig ntawm nws cov kev ua, kev kam rau siab, kev ua siab ntev ntawm cov nyhuv ntshav, tsis tshua muaj teeb meem ntawm lub qog ntshav qab zib, cov txiaj ntsig ntxiv hauv daim ntawv ntawm kev tiv thaiv kev txhim kho ntawm microangiopathy thiab txhim kho cov kev mob ntawm cov phab ntsa ntawm cov hlab ntsha loj.

Vildagliptin, tseeb, nce tus nqi kho mob, tab sis nyob rau qee kis (nquag muaj ntshav tsis txaus) tsis muaj qhov tsim nyog hloov rau nws. Cov nyhuv ntawm cov tshuaj yog suav tias yog sib npaug nrog metformin thiab PSM, sijhawm dhau mus, kev ntsuas kev noj haus cov carbohydrate txhim kho me ntsis.

Kuj nyeem qhov no:

• Glyclazide MV ntsiav tshuaj yog qhov nrov tshaj plaws tshuaj rau cov neeg mob ntshav qab zib.
• Dibicor ntsiav tshuaj - nws cov txiaj ntsig zoo li cas rau cov neeg mob ntshav qab zib (cov neeg tau txais kev pab)

Nco ntsoov kawm! Koj puas xav tias kev tswj hwm kev noj qab haus huv ntawm cov tshuaj thiab cov kua dej yog ib txoj kev los tswj cov piam thaj kom tswj? Tsis muaj tseeb! Koj tuaj yeem soj ntsuam qhov no koj tus kheej los ntawm kev pib siv nws. nyeem ntxiv >>

Vildagliptin yog dab tsi?

Thaum tshawb nrhiav cov tshuaj zoo tshaj plaws rau kev kho mob ntshav qab zib hom 2, cov kws tshawb fawb pom tau tias nws muaj peev xwm tswj hwm qhov concentration ntawm cov piam thaj hauv cov ntshav nrog kev pab los ntawm kev mob plab.

Lawv tau tsim tawm hauv cov lus teb rau cov zaub mov nkag mus rau lub plab thiab ua rau cov tshuaj lom ntawm cov tshuaj insulin hauv cov lus teb rau cov kua nplaum nyob hauv cov pob zaub mov. Ib qho ntawm cov tshuaj hormones no tau tshawb pom hauv 30s ntawm lub xyoo pua XX, nws tau cais tawm ntawm cov hnoos qeev ntawm cov hnyuv sab saud. Tshawb xyuas pom tias nws ua rau kev ua kom ntshav qis. Nws tau muab lub npe "incretin."

Lub sijhawm ntawm cov tseem ceeb tshiab cov tshuaj rau kev kho mob ntshav qab zib hom 2 pib tsuas yog xyoo 2000, thiab nws tau ua raws li vildagliptin. Novartis Pharma tau muab txoj hauv kev los ua lub npe chav kawm tshiab ntawm cov kab mob hypoglycemic hauv nws txoj hauv kev. Ntawd yog lawv tau txais lawv lub npe “glyptines”.

Txij xyoo 2000, ntau tshaj 135 cov kev tshawb fawb tau ua hauv ntau lub teb chaws uas tau ua pov thawj txog kev ua tau zoo thiab kev nyab xeeb ntawm vildagliptin. Nws tseem tau tshaj tawm tias nws cov tshuaj sib xyaw nrog metformin ua rau cov ntshav qog ntshav ntau zaus tsawg dua kev siv ua ke ntawm biguanides thiab glimepiride.

Hauv tebchaws Russia, thaum kawg xyoo 2008, thawj tus gliptin tau sau npe nyob rau hauv lub lag luam npe Galvus, thiab nws nkag mus rau hauv cov khw muag tshuaj hauv xyoo 2009. Tom qab ntawd, sib xyaw ua ke nrog metformin hu ua "Galvus Met" tau tshwm sim hauv khw muag tshuaj; nws muaj nyob hauv 3 pes tshuaj.

Tshuaj nrog Vildagliptin

Hauv Lavxias, tsuas yog 2 pob nyiaj tau sau npe, uas yog los ntawm no glyptin.

Lub npe lag luam, ntau npaum

Nqe, tshiav

Galvus 50 mg820 Galvus Met 50 + 10001 675 Galvus Met 50 + 5001 680 Galvus Met 50 + 8501 695

Hauv lwm lub tebchaws, muaj cov tshuaj hu ua Eucreas lossis yoojyim Vildagliptin.

Kev ntsuas rau siv

Tshuaj raws nws tau coj los kho mob ntshav qab zib hom 2. Nws yog qhov tseem ceeb heev uas yuav tsum sib xyaw nrog qhov kev qoj ib ce nrog kev tawm dag zog thiab kev noj zaub mov tshwj xeeb.

Hauv kev qhia ntau ntxiv, vildagliptin yog siv:

1. Raws li tsuas yog cov tshuaj nyob rau hauv kev kho mob hauv cov neeg muaj biguanide intolerance.
2. Hauv kev sib xyaw nrog metformin, thaum pluas noj thiab kis las tsis muaj zog.
3. Nrog rau kev kho ob zaug, nrog rau sulfonylurea derivatives, biguanides, thiazolidinediones lossis insulin, thaum monotherapy nrog cov tshuaj no, nrog rau kev tawm dag zog ib txwm muaj thiab kev noj haus, tsis muab cov nyhuv xav ua.
4. Ntxiv nrog rau kev kho, raws li ib qho kev kho mob thib peb: hauv kev sib xyaw nrog metformin thiab sulfonylurea derivatives, cov neeg mob uas twb tau siv cov tshuaj raws li lawv tau ua kis las thiab ua raws li kev noj haus, tab sis tsis tau txais glycemic tswj tau zoo.
5. Raws li ib qho tshuaj ntxiv, thaum ib tus neeg siv cov tshuaj insulin nrog metformin, thiab tawm tsam keeb kwm ntawm kev ua kis las thiab noj zaub mov kom raug, nws tsis tau txais cov phiaj xwm qhov tseem ceeb.

Cov kev thaiv tsis zoo thiab cov tshwm sim

Zoo li lwm txoj hauv kev ntawm hom ntshav qab zib hom 2, vildagliptin muaj qee yam kev mob thiab kab mob hauv cov npe ntawm contraindications, nyob rau hauv uas nkag tau ncaj qha txwv lossis tso cai nrog ceev faj.

Cov no suav nrog:

• tus kheej tsis kam rau ib qho ntawm cov khoom hauv cov lus sib xyaw,
• Yam 1 ntshav qab zib
• tsis muaj ib qho enzyme uas tsoo galactose, nws tsis txaus ntseeg,
• lub sijhawm cev xeeb tub thiab pub niam mis,
• cov me nyuam muaj hnub nyoog
• cov ntawv ua rau lub plawv tsis zoo thiab lub raum kev ua haujlwm,
• lactic acidosis,
• metabolic acidosis yog kev cuam tshuam ntawm acid-pib tshuav nyiaj li cas hauv lub cev.

Ceev faj kom paub zoo thaum kho vildagliptin nrog cov neeg paub txog:

• mob ntsws qhuav rau yav tas los (yav dhau los lossis tam sim no),
• qhov kawg theem ntawm mob raum thaum mob hemodialysis tau ua,
• III chav kawm ua haujlwm ntawm lub plawv tsis ua haujlwm.

Txawm hais tias vildagliptin muaj ntau qhov tshwm sim tsawg dua piv rau lwm cov kab mob hypoglycemic, lawv tseem nyob, tab sis lawv tsis muaj zog txaus qhia:

1. Mob leeg (NS): kiv taub hau, mob taub hau.
2. GIT: tsis tshua muaj, quav tsis taus.
3. Lub plawv mob: edema qee zaum tshwm sim ntawm caj npab lossis ceg.

Ua ke nrog metformin:

1. NS: kev tsis tuaj yeem nqa tes, kiv taub hau, mob taub hau.
2. Lub plab zom mov: xeev siab.

Cov kev mob tshwm sim tom qab tshaj tawm ntawm vildagliptin rau lub khw muag tshuaj:

• inflammatory nplooj siab kab mob
• khaus thiab ua pob rau daim tawv nqaij ua pob,
• pancreatitis
• qhov txhab ntawm daim tawv nqaij,
• mob lub pob qij txha thiab cov leeg.

Kev kawm tshawb fawb ntawm cov tshuaj

Qhov kev tshawb fawb loj tshaj plaws hauv kev xyaum kho mob (EDGE) yog qhov tshwj xeeb. Nws tau kawm los ntawm 46 txhiab tus neeg nrog CD-2 los ntawm 27 lub teb chaws ntawm lub ntiaj teb. Hauv chav kawm ntawm kev ua haujlwm thoob ntiaj teb, nws tau pom tias yuav tswj tau zoo npaum li cas thaum siv ncaj qha ib vildagliptin thiab nws cov kev sib xyaw nrog metformin.

Qhov nruab nrab glycated hemoglobin qib hauv txhua tus neeg yog ntawm 8.2%.

Lub hom phiaj ntawm kev soj ntsuam: ntsuam xyuas cov txiaj ntsig tau hauv kev sib piv nrog rau lwm pab pawg ntawm cov ntsiav tshuaj hypoglycemic.

Lub luag haujlwm tseem ceeb: txheeb xyuas dab tsi feem pua ​​ntawm cov neeg mob uas txo qis glycated hemoglobin (ntau dua 0.3%) yuav tsis muaj edema ntawm qhov kawg, qhov kev txhim kho ntawm cov qog ntshav qab zib, kev ua tsis tiav vim muaj kev phiv los ntawm txoj hnyuv hauv lub cev, qhov hnyav nce (ntau dua 5% ntawm thawj zaug) )

Ntsiab:

• kev ua tau zoo thiab kev nyab xeeb hauv cov hluas (tshaj 18 xyoo) thiab cov laus,
• yuav luag tsis muaj qhov hnyav hauv lub cev,
• tuaj yeem siv rau mob raum,
• cov hauj lwm tau raug pov thawj txawm tias kav ntev-CD-2,
• glucagon ntau lawm yog inhibited,
• pancreatic cells-hlwb ua haujlwm yog maximally fwm.

Qhov zoo thiab qhov tsis zoo ntawm kev siv

Vildagliptin - cov tshuaj ntawm ib chav kawm tshiab ntawm cov kab mob hypoglycemic. Nws muaj cov txiaj ntsig zoo ntawm lub cev, tsis zoo li cov tshuaj laus dua. Txawm hais tias thaum xub thawj nws tau muab tso rau hauv kab thib 2 ntawm lo lus kawg rau hom 2 mob ntshav qab zib, tab sis nyob rau xyoo tas los no nws nyob rau thawj kab ntawm cov tshuaj.

• yuav luag tsis muaj kev phiv los ntawm txoj hnyuv quav,
• vildagliptin tsis cuam tshuam rau qhov hnyav nce, tshwj xeeb tshaj yog ua ke nrog metformin,
• khaws cia lub luag haujlwm ntawm pancreatic cells-hlwb,
• tshem tawm cov tsis txaus ntseeg ntawm insulin thiab glucagon,
• tsub kom cov kev ua ntawm tib neeg cov tshuaj hormones ntawm lub plab ua haujlwm,
• txo txoj kev pheej hmoo ntawm hypoglycemia ntau zaus,
• lowers tus nqi ntawm glycated hemoglobin,
• ua nyob rau hauv daim ntawv ntawm cov ntsiav tshuaj,
• noj tsis ntau tshaj 2 zaug hauv ib hnub,
• daim ntawv thov tsis nyob ntawm qhov muaj lossis tsis muaj zaub mov hauv plab.

• yuav tsum tsis txhob coj cov menyuam yaus hnub nyoog qis dua 18 xyoo, laus thiab pojniam nyob hauv txoj haujlwm
• pub nkag mus yog raug txwv yog tias yav dhau los nws tau kuaj pom tias muaj tus mob pancreatitis,
• nqi.

Vildagliptin analogs

Nws tsis muaj kev piv txwv ncaj qha. Hauv tebchaws Russia, tsuas yog Galvus thiab Galvus Met tau sau npe ntawm nws lub hauv paus. Yog tias peb xav txog cov tshuaj zoo sib xws los ntawm tib pab pawg, peb tuaj yeem paub qhov txawv ntawm "Januvia", "Onglisa", "Trazhenta", "Vipidia".

Cov tshuaj phiv ntawm tag nrho cov tshuaj no sib txawv, tab sis lawv txhua tus puav leej yog gliptins. Hauv txhua tiam tshiab, muaj tsawg dua kev qhia tsis raug thiab cov txiaj ntsig zoo ntxiv.

Yog tias peb coj mus rau hauv pab pawg ntawm incretins, "Baeta" thiab "Saksenda" tuaj yeem raug suav hais tias yog cov analogues. Tab sis tsis zoo li gliptins, cov tshuaj no tsuas muaj nyob hauv daim ntawv ntawm txhaj tshuaj subcutaneous, uas muaj nws tus kheej cov kev txwv.

Txhua yam yog xaiv nruj me ntsis ntawm tus kheej, them sai sai rau contraindications, kev phiv, zoo, kev nyab xeeb, thiab cov kab mob uas ua rau muaj kev cuam tshuam cov hom mob ntshav qab zib hom 2.

Lavxias

Vildagliptin analogues uas ua los ntawm cov tuam txhab pharmacological niaj hnub suav nrog cov npe me - Diabefarm, Formmetin, Gliformin, Gliclazide, Glidiab, Glimecomb. Cov tshuaj ntxiv yog tsim tawm txawv teb chaws.

Vildagliptin tsis yog siv nws tus kheej hauv ib qho ntawm cov kev hloov pauv. Nws yog hloov los ntawm cov tshuaj uas zoo sib xws uas muaj lub luag haujlwm rau qhov pom ntawm qhov kev ua thiab qhov zoo ntawm kev sib kis hauv tib neeg lub cev.

Cov tshuaj yeeb dej caw tseem ceeb raug rho tawm hauv cov lus sib piv ntawm Vildagliptin:

• Metformin - Gliformin, Formmetin,
• Glyclazide - Diabefarm, Glidiab, Glyclazide,
• Glyclazide + Metformin - Glimecomb.

Tsuas yog ob yam tshuaj lom tau tshawb pom tias tiv thaiv cov piam thaj hauv siab ntau hauv lub cev. Yog tias txhua tus tsis sib haum nrog cais, cov tshuaj sib xyaw ua ke hauv kev kho mob sib xyaw (Glimecomb).

Ntawm tus nqi, cov tuam ntxhab Lavxias yog poob qis dua txawv teb chaws. Cov neeg ua haujlwm txawv teb chaws loj hlob nyob rau hauv tus nqi, muaj ntau dua 1000 rubles.

Formetin (119 rubles), Diabefarm (130 rubles), Glidiab (140 rubles) thiab Gliclazide (147 rubles) yog cov tshuaj pheej yig hauv tebchaws Lavxias. Gliformin tseem kim dua - 202 rubles. thaj tsam li 28 ntsiav tshuaj. Qhov tseem kim tshaj plaws yog Glimecomb - 440 rubles.

Nrau zoov

Cov tshuaj kho mob kom tshem tawm cov kev ua kom ntshav qab zib mellitus, tsim tawm hauv lwm lub teb chaws, tshwm sim hauv cov khoom loj dua li kev hloov pauv hauv tsev.

Cov tshuaj hauv qab no yog qhov txawv, uas muaj peev xwm tshem tawm qhov nce ntxiv ntawm cov piam thaj hauv cov ntshav ntawm tib neeg.

• Tebchaws Asmeskas - Trazhenta, Januvia, Combogliz Prolong, Nesina, Yanumet,
• Netherlands - Onglisa,
• Lub teb chaws Yelemees - Galvus Met, Glibomet,
• Fabkis - Amaril M, Glucovans,
• Ireland - Vipidia,
• Spain - Avandamet,
• Is Nrias teb - Gluconorm.

Cov tshuaj txawv teb chaws suav nrog Galvus, muaj Vildagliptin. Nws tso tawm yog teem rau hauv Switzerland. Cov lus txhais tsis tiav tsis tau.

Hauv kev sib pauv yog muaj cov tshuaj zoo ib yam, tab sis nrog sib txawv hauv lub ntsiab. Cov tshuaj yeeb dej caw ntawm ib qho khoom siv thiab kev tivthaiv ob qho:

• Linagliptin - Trazhenta,
• Sitagliptin - Onglisa,
• Saxagliptin - Januvius,
• Alogliptin benzoate - Vipidia, Nesina,
• Rosiglitazone + Metformin - Avandamet,
• Saksagliptin + Metformin - Comboglyz Prolong,
• Glibenclamide + Metformin - Gluconorm, Glucovans, Glibomet,
• Sitagliptin + Metformin - Yanumet,
• Glimepiride + Metformin - Amaril M.

Cov tshuaj txawv teb chaws muaj tus nqi siab dua. Yog li Gluconorm - 176 rubles, Avandamet - 210 rubles thiab Glukovans - 267 rubles yog pheej yig tshaj. Siab me ntsis hauv cov nqi - Glibomet thiab Glimecomb - 309 thiab 440 rubles. raws li.

Cov nqe hauv nruab nrab yog Amaril M (773 rubles). Tus nqi them los ntawm 1000 rubles. ua los ntawm cov tshuaj:

• Vipidia - 1239 rub.,
• Galvus Met - 1499 rub.,
• Onglisa - 1592 rubles.,
• Trazhenta - 1719 rub.,
• Januvia - 1965 rub.

Qhov uas kim tshaj plaws yog Combogliz Prolong (2941 rubles) thiab Yanumet (2825 rubles).

Yog li, Galvus, uas muaj cov tshuaj nquag Vildagliptin, tsis yog cov tshuaj uas kim tshaj plaws. Nws tau teev nyob hauv nruab nrab nqe qeb, coj mus rau hauv tag nrho cov tshuaj txawv teb chaws.

Victoria Sergeevna

“Kuv tau mob ntshav qab zib tau ntau xyoo, Kuv raug kuaj pom muaj tus kab mob kis (hom 2). Tus kws kho mob tau hais kom kuv coj Galvus, tab sis ntau npaum, uas yog qhov tsawg, uas tau nce ntxiv, tsis txo qis kuv qab zib, nws tsuas muaj qhov tsis zoo.

Ua xua tshwm tawm ntawm lub cev. Kuv tam sim ntawd hloov mus Galvus Met. Tsuas yog nrog nws ua rau kuv nyob kaj siab lug. "

Yaroslav Viktorovich

“Kuv nyuam qhuav muaj mob ntshav qab zib. Tam sim ntawv sau Galvus raws li Vildagliptin. Tab sis nws txo qis kuv qab zib qeeb heev los sis tsis ua haujlwm hlo li.

Kuv tig mus rau lub tsev muag tshuaj, qhov chaw uas lawv tau qhia kuv kom hloov nrog kev siv tshuaj Lavxias, tsis muaj qhov phem dua li lwm tus neeg txawv teb chaws - Gliformin. Tsuas yog tom qab noj nws ua kuv cov piam thaj poob. Tam sim no kuv thiaj li txais yuav nws xwb. "