Amaril tshuaj ntawm ib tiam tshiab

Amaryl ntsiav tshuaj rau ntshav qab zib hom 2: kawm txhua yam koj xav tau. Cov hauv qab no yog cov lus qhia kev qhia sau ua hom lus yooj yim. Tshuaj xyuas qhov ntsuas, contraindications, noj tshuaj, phiv, qhov piv ntawm cov txiaj ntsig thiab kev puas tsuaj rau lub cev. Nkag siab yuav ua li cas noj Amaril kom raug, tom qab pes tsawg teev tshuaj pib ua, nws puas sib xws nrog cawv. Hauv tsab xov xwm, qhov kev hais daws no tau muab piv nrog cov ntsiav tshuaj Diabeton, Glyukofazh thiab Yanumet. Cov npe no tseem raug muab them nyiaj tsawg ntawm cov khoom sib txig sib xyaw. Amaril tsis pheej yig hauv cov chaw muag tshuaj, tab sis nws yooj yim vim tias nws tau txaus los haus nws ib hnub ib zaug. Cov tshuaj tseem ceeb yog glimepiride.

Kho rau hom 2 ntshav qab zib Amaryl: cov ncauj lus ntxaws

Cov lus qhia rau kev siv

Noj tshuaj Amaryl, zoo li lwm yam tshuaj noj qab zib, koj yuav tsum ua raws kev noj haus.

Nyeem txog kev tiv thaiv thiab kev kho mob ntawm cov teeb meem:

Hauv qab no yog cov lus teb rau cov lus nug nquag nug los ntawm cov neeg mob ntshav qab zib hom 2.

Yuav noj Amaryl li cas: ua ntej noj mov lossis tom qab?

Amaryl tau noj ua ntej noj mov, kom nws muaj lub sijhawm los pib ua yeeb yam los ntawm lub sijhawm noj cov khoom noj yog assimilated. Raws li txoj cai, tus kws kho mob qhia cov ntshav qab zib kom noj cov tshuaj no ua ntej noj tshais. Thiab yog tias tus neeg mob feem ntau tsis tau noj tshais, ces noj ib ntsiav tshuaj ua ntej noj hmo. Cov tshuaj pleev ib ce uas muaj cov tshuaj glimepiride yuav tsum noj tib txoj kev.

Tsis txhob sim hla pluas mov tom qab noj Amaril. Nws yog ib qho tsim nyog yuav tau noj, txwv tsis pub cov tshuaj yuav txo cov ntshav qab zib ntau dhau thiab yuav ua. Qhov no yog ib qho mob hnyav uas tuaj yeem ua rau cov tsos mob sib txawv. Los ntawm kev poob siab thiab palpitations mus rau coma thiab tuag. Txoj kev pheej hmoo ntawm cov ntshav qog ntshav yog ib qhov laj thawj vim li cas nws tsis pom zoo kom noj glimepiride. Ntawm koj txoj kev pov tseg yog nyab xeeb thiab muaj txiaj ntsig zoo.

Cov tshuaj no puas haum nrog cawv?

Cov lus qhia rau kev siv Amaril ntsiav tshuaj yuav tsum tau kom cov neeg mob ntshav qab zib kom tsis txhob haus cawv haus lub sijhawm tag nrho ntawm kev kho nrog cov tshuaj no. Vim tias haus cawv ntau yuav ua rau muaj teeb meem ntshav qab zib thiab lub siab. Kev tsis haum ntawm cov tshuaj glimepiride nrog cawv yog qhov teeb meem loj. Vim tias nws yog hom tshuaj rau lub sijhawm ntev, kom paub lub neej ntev, thiab tsis yog rau lub sijhawm luv luv ntawm kev kho mob.

Tib lub sijhawm, cov neeg mob ntshav qab zib hom 2 uas tsis noj tshuaj uas tsis zoo thiab raug kho raws li nws, tsis txwv tsis pub haus dej cawv kom zoo li lawv muaj peev xwm. Nyeem cov ntsiab lus hauv tsab xov xwm “”. Koj tuaj yeem khaws cov piam thaj zoo kawg nkaus thiab qee zaum tso cai rau koj tus kheej haus khob lossis ob khob yam tsis muaj teeb meem rau kev noj qab haus huv.

Ntev npaum li cas tom qab nws pib noj?

Hmoov tsis zoo, tsis muaj ntaub ntawv qhia txog pes tsawg lub sijhawm tom qab noj Amaril pib ua. Cov ntshav qab zib cov ntshav yuav poob ntau li ntau tau tom qab 2-3 teev. Feem ntau cov yuav tshwm sim, cov nyhuv ntawm cov tshuaj pib ntau ua ntej lawm, tom qab 30-60 feeb. Yog li tsis txhob ncua sij hawm noj zaub mov kom tsis txhob muaj ntshav qab zib hauv lub cev tsis tshwm sim. Cov nyhuv ntawm txhua koob tshuaj glimepiride kav ntau tshaj ib hnub.

Nyeem txog cov khoom ntshav qab zib:

Qhov twg yog qhov zoo dua: Amaryl lossis Diabeton?

Ob leeg ntawm cov tshuaj no muaj nyob rau hauv. Nws yog qhov zoo uas yuav tau caiv txhob noj ..

Sim kom paub tus kws kho mob tus kws kho mob tau sau qhia rau Amaryl lossis Diabeton nrog cov khoom ntawm nplooj ntawv no. Thawj cov tshuaj, Ntshav qab zib, ua rau muaj neeg tuag coob ntawm cov neeg mob uas tau noj nws. Yog li ntawd, nws tau ntsiag to tshem tawm ntawm qhov muag. Tam sim no koj tuaj yeem yuav tsuas cov ntsiav tshuaj. Lawv ua ntau dua maj mam, tab sis lawv tseem tsim kev puas tsuaj.

Dab tsi yog qhov zoo rau haus: Amaryl lossis Glucophage?

Amaryl yog ib yam tshuaj tsis zoo .. - yog lwm yam teeb meem. Nov yog thawj cov tshuaj Metformin, ib feem tseem ceeb ntawm cov kauj ruam kev kho mob rau cov mob ntshav qab zib hom 2. - cov tshuaj tsis yog teeb meem, tab sis, theej siv tau ntau yam. Txog kev tswj ntshav qab zib kom tau zoo, koj yuav tsum xub pauv ua ntej. Kev noj qab haus huv kev noj qab haus huv yog ntxiv nrog kev siv tshuaj Glucofage, thiab, yog tias tsim nyog, muaj cov tshuaj insulin tsawg.

Kuv tuaj yeem coj Yanumet thiab Amaril tib lub sijhawm?

Amaryl thiab lwm cov ntsiav tshuaj muaj glimepiride yuav tsum tsis txhob noj rau cov laj thawj tau teev tseg saum toj no. Yanumet yog ib hom tshuaj sib xyaw ua ke uas muaj cov tshuaj metformin. Thaum lub sijhawm sau ntawv, nws kim heev thiab tsis muaj kev sib tw pheej yig. Hauv txoj ntsiab cai, koj tuaj yeem coj nws. Tab sis koj tuaj yeem sim hloov ntawm nws mus rau cov ntshiab metformin, qhov zoo tshaj plaws. Yog tias koj tswj hwm qhov ua tsis tau tswj kev mob ntshav qab zib, koj yuav txuag nyiaj ntau heev txhua hli.

Amaril analogues

Thaum lub sijhawm ntawm kev npaj tsab xov xwm los ntawm cov yeeb yaj kiab txawv teb, tsuas yog Glimepirid-Teva uas ua los ntawm Pliva Hrvatska, Croatia raug muag hauv khw muag tshuaj. Tib lub sijhawm, Amaril muaj ntau yam kev hloov pauv hauv Lavxias, uas yog qhov pheej yig dua li cov tshuaj qub.

Lavxias analogues ntawm Amaril

Txhua lub chaw tsim khoom tsim txhua txoj kev xaiv tshuaj rau glimepiride - 1, 2, 3 thiab 4 mg. Txheeb xyuas cov tshuaj thiab cov nqi hauv tsev muag tshuaj.

Tus thawj cov tshuaj Amaryl lossis cov khoom pheej yig: yuav ua li cas xaiv

Nyeem vim li cas Amaryl thiab nws cov analogues muaj kev phom sij vim li cas koj xav kom tsis kam coj lawv thiab qhov twg yog qhov zoo dua los hloov. Tus xaib ntawm lub vev xaib qhia txog qhov qub thiab ua kom nws ib txwm ruaj khov yam tsis tau yoo mov, noj tshuaj phem thiab kim, txhaj tshuaj loj ntawm cov tshuaj insulin.

Amaryl M: tshuaj ua ke

Amaryl M yog hom tshuaj ua ke rau hom ntshav qab zib hom 2. Nws muaj ob qho tshuaj uas muaj nyob hauv ib ntsiav tshuaj - glimepiride thiab. Raws li koj tau nyeem saum toj no, glimepiride yog qhov tsis zoo thiab nws zoo dua tsis txhob coj nws. Tab sis metformin tsis muaj teeb meem txhua, tab sis, theej heev pab tau rau tus mob ntshav qab zib. Cov tshuaj no txo ​​qis ntshav qab zib, tiv thaiv kab mob ntshav qab zib, pab kom yuag thiab lub neej ntev.

Daim ntawv tso tawm

Amaryl yog muag hauv ntsiav tshuaj daim ntawv. Xim nyob ntawm qhov ntau npaum ntawm cov tshuaj nquag:

• 1 mg glimepiride - liab dawb,
• 2 - ntsuab
• 3 - lub teeb daj
• 4– xiav.

Lawv txawv nyob rau hauv cov cim sau tseg rau ntawm cov ntsiav tshuaj.

Pharmacological kev txiav txim

Glimepiride muaj cov nyhuv hypoglycemic rau ntawm lub cev. Nws yog ib qho muab sib txuas ntawm peb tiam sulfonylurea.

Amaryl muaj cov ntsiab lus ncua ntev. Thaum cov ntsiav tshuaj siv, tus kws kho mob txiav lub siab, thiab beta-cells qhib kom ua haujlwm. Raws li qhov tshwm sim, insulin pib tawm ntawm lawv, cov tshuaj hormone nkag mus rau hauv cov hlab ntshav. Qhov no pab txo qis cov piam thaj tom qab noj mov.

Tib lub sijhawm, glimepiride muaj cov nyhuv ntxiv. Nws tsub kom rhiab ntawm cov leeg, cov nqaij rog ua rau cov insulin. Thaum siv cov tshuaj, cov tshuaj tiv thaiv kev phom sij, antiatherogenic, cov nyhuv antiplatelet yog pom.

Amaril txawv ntawm lwm cov sulfonylurea derivatives uas thaum nws siv, cov ntsiab lus ntawm tso tawm insulin yog qis dua thaum siv lwm cov tshuaj hypoglycemic. Vim qhov no, txoj kev pheej hmoo ntawm hypoglycemia muaj tsawg heev.

Ntxiv dag zog rau cov txheej txheem ntawm kev siv cov piam thaj nyob rau hauv cov leeg nqaij thiab cov nqaij rog ua tau vim tias muaj qhov tshwj xeeb thauj cov protein nyob hauv cov cell ua cov qog. Amaryl tsub kom lawv cov haujlwm ntau ntxiv.

Cov tshuaj yeeb yaj kiab tsis thaiv ATP-nkag siab poov tshuaj raws ntawm plauv nres myocytes. Lawv tseem muaj txoj hauv kev hloov kho rau cov mob ischemic.

Amaryl kev kho mob thaiv kev tsim cov kua nplaum los ntawm lub siab ua haujlwm. Cov txiaj ntsig tau taw qhia yog vim muaj cov ntsiab lus nce ntxiv ntawm fructose-2,6-biophosphate hauv hepatocytes. Qhov tshuaj no nres gluconeogenesis.

Cov tshuaj pab txhawm rau txhawm rau txhawm rau lub zog ntawm cyclooxygenase, kom txo cov txheej txheem ntawm kev hloov pauv ntawm thromboxane A2 los ntawm arachidonic acid. Vim tias qhov no, kev siv ntawm platelet aggregation tsawg dua. Hauv qab ntawm Amaril, qhov hnyav ntawm cov tshuaj tiv thaiv oxidative, uas tau pom hauv cov ntshav qab zib tsis yog-insulin, txo qis.

Sau tshuaj rau cov tshuaj glimepiride rau cov neeg mob uas muaj tus mob II, yog tias kev siv lub cev, kev noj haus tsis tso cai rau koj tswj qib qab zib.

Cov lus qhia rau kev siv qhia tau tias nws raug tso cai rau kev sib xyaw ua ke siv tshuaj Amaril nrog metformin, kev txhaj tshuaj insulin.

Dr. Bernstein pom zoo tias kev teem sijhawm rau cov neeg sawv cev hypoglycemic tsis yog qhov muaj tseeb, txawm tias muaj qhov qhia tau rau kev siv. Nws hais tias cov tshuaj muaj teeb meem, txhim kho cov teeb meem hauv lub cev hauv lub cev tsis ua haujlwm.Txhawm rau ua kom qhov xwm txheej tsis zoo, koj tuaj yeem siv tsis yog sulfonylurea derivatives, tab sis noj zaub mov ua ke nrog kev kho tshwj xeeb.

Cov Yuav Tsum Muaj

Amaril yuav tsum tsis txhob raug sau tseg rau cov neeg mob uas:

• insulin dependence
• ketoacidosis, mob ntshav qab zib tsis xeev,
• lub raum tsis ua haujlwm (suav nrog yog muaj mob xav tau hemodialysis),
• malfunctioning ntawm daim siab,
• tus tib neeg tsis kam txais lossis tso tshuaj lom rau glimepiride, excipients, lwm yam tshuaj ntawm sulfonylurea pawg,
• cov me nyuam muaj hnub nyoog.

Cov kws kho mob yuav tsum tsis txhob sau cov tshuaj rau cov neeg mob uas tsis zoo, noj zaub mov tsis xwm yeem, txwv cov calories kom tsawg, noj tsawg dua 1000 kcal. Contraindication yog ib qho ua txhaum ntawm cov txheej txheem ntawm kev nqus ntawm cov khoom noj los ntawm txoj hnyuv huam.

Sab sij huam

Thaum kho nrog Amaril, ntau yam tsis txaus siab tshwm sim tuaj yeem tsim kho, ib txoj kev los yog lwm qhov cuam tshuam kev ua haujlwm ntawm yuav luag txhua lub cev. Feem ntau, cov kev mob tshwm sim los ntawm cov qog ntshav qab zib, cov tsos mob uas tau hais tawm:, kev tshaib plab, xeev siab, ntuav,,, thiab ntau lwm cov tsos mob. Qee zaum cov kab mob hnyav hnyav ntawm kev txo ntshav qab zib zoo nkaus li mob stroke. Tom qab nws tshem tawm, pliaj tsis pom tsos mob kuj ploj tag.

Nyob rau theem pib ntawm kev kho mob, teeb meem nrog lub zeem muag, lub plab zom mov, thiab ntshav tsim tau tshwm sim. Nws kuj tseem muaj kev txhim kho, uas tuaj yeem tig mus rau hauv cov nyom. Yog li, yog tias cov tsos mob tsis txaus siab tshwm sim, koj yuav tsum sab laj nrog kws kho mob sai.

Cov lus qhia rau Amaryl (Txujci thiab ntau npaum li cas)

Cov ntsiav tshuaj yog npaj rau kev siv sab hauv tag nrho, yam tsis muaj ntxo thiab haus dej kom ntau.

Feem ntau, cov koob tshuaj yog txiav txim siab los ntawm kev saib xyuas cov piam thaj hauv cov ntshav. Rau kev kho mob, kev noj qab haus huv qis tshaj plaws yog qhov txiav txim siab, uas yuav pab ua kom tiav qhov kev tswj hwm kev hnyav tsim nyog

Cov lus qhia rau kev siv ntawm Amaril kuj tau tshaj tawm tias kev kho mob yuav tsum txiav txim siab tsis tu ncua ntawm kev saib xyuas cov piam thaj hauv cov ntshav thiab qib glycosylated hemoglobin.

Yog tias noj tshuaj tsis raug, nrog rau kev hla dhau koob tshuaj tom ntej, tsis pom zoo kom siv cov tshuaj ntxiv. Cov xwm txheej zoo li no yuav tsum muaj kev pom zoo ua ntej nrog tus kws kho mob uas koom nrog.

Thaum pib ntawm kev kho mob, cov neeg mob tau sau tshuaj rau txhua hnub yog 1 mg. Yog tias tsim nyog, cov koob tshuaj yog maj mam nce, ua kev soj ntsuam tas li ntawm ntshav qabzib concentration raws li cov txheej txheem: 1 mg - 2 mg - 3 mg - 4 mg - 6 mg - 8 mg. Kev siv tshuaj txhua hnub nyob hauv cov neeg mob uas tswj tau zoo yog 1-4 mg ntawm cov tshuaj nquag. Kev noj tshuaj txhua hnub ntawm 6 mg lossis ntau dua tsim cov kev cuam tshuam tsuas yog qee tus neeg mob tsawg.

Kev noj tshuaj rau txhua hnub rau cov tshuaj yog tsim los ntawm tus kws kho mob, vim nws yog qhov yuav tsum tau coj mus rau hauv tus account ntau yam, piv txwv li, lub sijhawm noj mov, qhov nyiaj ntawm lub cev ua si, thiab lwm yam.

Feem ntau, kev noj ib zaug ib hnub rau cov tshuaj yog kws kho, ua ntej noj tshais tag nrho lossis thawj pluas noj. Nws yog ib qho tseem ceeb uas tom qab noj cov ntsiav tshuaj tsis nco qab noj mov.

Nws paub txog tias kev txhim kho metabolic tswj tau cuam tshuam nrog kev nce insulin rhiab heev, thiab thaum kho, qhov xav tau glimepiride yuav poob. Koj tuaj yeem zam qhov kev txhim kho hypoglycemia los ntawm kev txo cov tshuaj noj kom tsis tu ncua lossis tsum tsis txhob noj Amaril.

Thaum lub sij hawm kho txheej txheem, tshuaj kho kom haum glimepiride tuaj yeem ua tau thaum:

• luj txo
• kev ua neej pauv
• kev tshwm sim ntawm lwm yam uas ua rau muaj kev pheej hmoo rau hypoglycemia lossis hyperglycemia.

Raws li txoj cai, Amaril kev kho mob yog nqa tawm ntev.

Noj ntau dhau

Nyob rau hauv cov kis ntawm mob hnyav overdose los yog lub caij nyoog siv ntau ntawm koob tshuaj glimepiride Mob ntshav qab zib heev, uas yuav ua tau kom tuag taus, tej zaum kuj yuav tshwm sim.

Yog tias pom muaj overdose, koj yuav tsum tau sab laj nrog kws kho mob sai.Kev ua ntshav qab zib kom nres yuav nres los ntawm kev noj carbohydrates, piv txwv li, piam thaj lossis ib qho me me ntawm cov khoom qab zib. Txog thaum cov tsos mob ntawm hypoglycemia raug tshem tawm tag, tus neeg mob yuav tsum tau ua tib zoo saib xyuas kev kho mob, vim tias qhov tsos mob tsis xav yuav rov ua haujlwm. Txoj kev kho ntxiv yog nyob ntawm cov tsos mob.

Kev sib txuam

Kev siv cov ntsiab lus ntawm glimepiride nrog qee cov tshuaj tuaj yeem ua rau kev loj hlob ntawm hypoglycemia, piv txwv li, nrogCov tshuaj insulin thiab lwm yam kab mob hypoglycemic, ACE inhibitors, tshuaj anabolic steroids thiab txiv neej nrog txiv neej cov tshuaj hormonesderivatives Coumarin, Cyclophosphamide, Dizopyramide, Fenfluramine, Feniramidol, Fibrates, Fluoxetine, Guanethidine, Ifosfamide, MAO inhibitors, para-aminosalicylic acid, Phenylbutazone, Azapropazone, Oksifenbutazonom, Salinamilamilam thiab lwm tus.

Txais tos , barbiturates , GKS , diazoxides , tshuaj kho mob , thiab lwm cov neeg muaj mob sympathomimetic, tshuaj noj plab (nrog rau siv ntev), (hauv kev siv tshuaj ntau), tshuaj estrogen thiab progestogens, phenothiazines, phenytoins, phom phom,iodine-muaj cov thyroid hormones ua rau lub cev tsis muaj zog ntawm cov nyhuv hypoglycemic, thiab raws li, nce qhov kev nce siab ntawm cov piam thaj hauv cov ntshav.

Yuav kom ntxiv dag zog lossis ua kom cov ntshav hypoglycemic ntawm glimepiride muaj peev xwm los thaiv H2-histamine receptors,, thiab beta-blockers.

Tso Tawm Cov Ntawv

Cov tshuaj muaj nyob hauv daim ntawv oval ntsiav tshuaj (1-4 mg). Ntawm ib sab ntawm cov ntsiav tshuaj yog nyeem inscription HD125. Hauv ib qho hlwv 15 daim. Cov blisters lawv tus kheej tau ntim rau hauv cov thawv ntawv thawv. Koj tuaj yeem yuav cov tshuaj hauv pob ntawm ob, plaub, rau, lossis yim lub hlwv. Cov ntsiav tshuaj muaj xim sib txawv: pinkish muaj 1 mg, ntsuab 2 mg, Amaryl 3 mg - txiv kab ntxwv hauv xim thiab Amaryl 4 mg - xiav ntsiav tshuaj daj ntseg.

Hauv ib ntsiav tshuaj:

• thib peb-tiam glimepiride - lub ntsiab lus tseem ceeb uas txo qis qabzib, cov tshuaj tawm los ntawm sulfamide,
• povidone - tshuaj lom neeg lub cev, enterosorbent,
• lactose nrog tus dej molecule (monohydrate),
• microcrystalline cellulose,
• sodium carboxymethyl hmoov txhuv nplej siab - zaub mov noj ntxiv, tsaj, tuab,
• indigo carmine yog cov zaub mov muaj xim nyab xeeb
• magnesium stearate (kho lub cev tiv thaiv antifoam).

Amaril yog yooj yim siv, koj tsuas yog xav noj tshuaj ntsiav ib zaug thaum sawv ntxov. Cov lus qhia rau kev siv, ntxiv rau tus nqi tau zoo txaus rau txhua tus neeg mob nrog tus kab mob endocrine no.

Kev Rov Ntsuam Xyuas Amaril

Ntau cov kev tshuaj xyuas ntawm cov neeg mob thiab cov kws kho mob tshwj xeeb qhia tias nyob rau hauv kev kho mob ntshav qab zib mellitus, txoj kev xaiv kom zoo ntawm kev noj tshuaj thiab cov txheej txheem tshuaj yog qhov tseem ceeb tshwj xeeb.

Ntxiv mus, kev tshuaj xyuas ntawm Amaril qhia tias cov tshuaj no tsis haum rau txhua tus mob ntshav qab zib. Kuj ntau, nyob rau theem pib ntawm kev kho, cov neeg mob muaj kev hloov pauv siab rau cov piam thaj hauv cov ntshav. Txawm li cas los xij, cov kws tshaj lij muaj kev cia siab tias nyob rau hauv cov xwm txheej zoo li no, txoj kev kho kom haum yog qhov tsim nyog nyob rau hauv kev coj ntawm kev nce thiab qhov no tsis yog txhua qhov kev ntsuas ntawm qhov tsis muaj peev xwm ntawm cov tshuaj.

Ntawm chav kawm, txhua qhov kev hloov pauv cuam tshuam nrog ob qho zuj zus thiab txo qis tshuaj yuav tsum tau ua nyob rau hauv kev saib xyuas los ntawm tus kws tshaj lij. Nws tau tsim tsa tias qhov tsis paub ntawv txais tos ntawm Amaril tuaj yeem ua rau muaj kev cuam tshuam kab mob.

Hnub tas sij hawm

Siv cov tshuaj yog tso cai rau 36 lub hlis txij li hnub tso tawm.

Qhov tsim nyog endocrinologist yuav tsum xaiv qhov hloov pauv txoj cai rau Amaryl. Nws tuaj yeem sau tshuaj ib qho analogue ua tau los ntawm cov khoom zoo tib yam, lossis xaiv cov tshuaj uas ua los ntawm lwm cov khoom siv.

Cov neeg mob tuaj yeem sau npe yuav hloov kho Lavxias, Diamerid, uas yog pheej yig. Rau 30 ntsiav tshuaj ntawm cov tshuaj uas ua rau lub hauv paus ntawm glimepiride, nrog cov tshuaj ntawm 1 mg hauv ib lub tsev muag tshuaj, cov neeg mob yuav them 179 p.Nrog txoj kev nkag ntawm qhov kev kub siab ntawm cov tshuaj nquag, tus nqi nce ntxiv. Rau diamerid hauv ib qho tshuaj 4 mg, 383 p.

Yog tias tsim nyog, hloov Amaryl nrog cov tshuaj Glimepiride, uas yog tsim los ntawm cov tuam txhab Lavxias teb sab Vertex. Cov ntsiav tshuaj uas hais qhia yog pheej yug. Rau ntim ntawm 30 pcs. 2 mg yuav tau them 191 p.

Tus nqi ntawm Glimepiride Canon, uas tsim los ntawm Canonfarm, kuj tseem qis dua. Tus nqi ntawm ib pob ntawm 30 ntsiav tshuaj ntawm 2 mg yog suav tias yog pheej yig, nws yog 154 p.

Yog tias glimepiride tsis qaug rau, cov neeg mob tau kho lwm yam tshuaj ntxiv raws ntawm metformin (Avandamet, Glimecomb, Metglib) lossis vildagliptin (Galvus). Lawv raug xaiv coj mus rau hauv tus account tus yam ntxwv ntawm tus neeg mob lub cev.

Cawv thiab Amaryl

Nws tsis tuaj yeem kwv yees ua ntej li cas haus cawv muaj cawv yuav cuam tshuam rau tus neeg uas siv tshuaj yaj yeeb raws li glimepiride. Cov cawv yuav ua rau lub cev tsis muaj zog lossis txhim kho hypoglycemic ntawm Amaril. Yog li, lawv tuaj yeem siv tsis tau tib lub sijhawm.

Kev siv tshuaj hypoglycemic nyob ntev. Vim tias qhov no, txoj cai txwv tsis pub haus cawv haus cawv ntau rau ib qho yuav dhau los ua teeb meem.

Muaj Cov Hloov Amaril Ntsiav Tshuaj Hloov

Ib qho ntawm cov pheej yig tshaj plaws ntawm cov Amaril hauv cov ntsiav tshuaj suav nrog:

Xav txog yuav ua li cas muaj txiaj ntsig yog cov analogues ntawm cov tshuaj Amaril.

Nws muaj tib lub zog tshuaj zoo ib yam li Amaryl. Kev ua rau txoj kev kho mob yog vim qhov ua kom pancreatic beta hlwb los ntawm cov tshuaj tsis muaj qabzib.

1. Lub sijhawm nruab nrab ntawm kev txais yuav tsum tsis pub dhau lub sijhawm teem sijhawm.
2. Cov teeb meem thaum noj tshuaj tsis tuaj yeem cuam tshuam los ntawm ib qho ntau dua cov kev xav ntawm cov tshuaj.
3. Tus neeg mob yuav tsum qhia nws tus kws kho mob txog kev siv tshuaj ntau ntxiv rau hauv cov tshuaj.
4. Kev loj hlob ntawm hypoglycemia tom qab cov thawj coj ntawm Diamerid hauv ib feem ntawm 1 mg / hnub, qhia tias kev noj zaub mov zaub mov yog qhov tsim nyog.

Tus nqi ntawm diamerid nyob ntawm 206 rubles. rau ib pob.

Cov tshuaj no nws muaj nws cov kev ua ntawm kev ua:

1. Cov tshuaj tiv thaiv hauv cov tshuaj ua kom muaj kev zais cia thiab tso cov tshuaj insulin los ntawm tus txiav ua kab mob.
2. Nce permeability ntawm peripheral cov ntaub so ntswg mus rau kev cuam tshuam ntawm insulin.

Noj, pib khaws ib feem ntawm cov tshuaj. Feem ntau, nws tau xaiv los ntawm kev soj ntsuam tas li ntawm cov ntsiab lus ntawm cov piam thaj hauv cov ntshav.

Muaj ntau txoj cai tswjfwm rau kev siv tshuaj kho tus mob no:

1. Thaum pib kho, kwv yees li 1 mg ntawm glimepiride raug kho, 1 zaug nyob rau ib hnub.
2. Thaum qhov kev kho tshwm sim tshwm sim, qhov no yog siv los txhawb.
3. Yog tias tsis muaj kev txhim kho, tom qab ntawd koj tuaj yeem maj mam nce cov tshuaj ntau ntxiv rau 4 mg / hnub.
4. Qhov ntau tshaj kev noj tshuaj yog 8 mg / hnub.

Qhov nruab nrab, tus nqi ntawm cov tshuaj zoo li ntawm 740-780 rubles rau ib pob.

Txhim kho cov ntshav qabzib ntau nyob rau hauv cov neeg mob uas muaj insulin-ywj pheej ntawm cov ntshav qab zib.

Nws muaj ntau yam teebmeem:

1. Kev mob siab.
2. Detoxifying.
3. Antisclerotic.
4. Kev tiv thaiv thiab kho dua tshiab.
5. Antioxidant.
6. Tshuaj tua kab mob.
7. Cholagogue thiab diuretic cuam tshuam.

Nws yog txiav txim los ntawm tus kws kho mob hauv kev noj tshuaj kom ua tiav:

1. Tso cai ua kom muaj cov kua nplaum ntev nyob rau hauv cov hlab ntshav thiab zis.
2. Siv rau kev tiv thaiv lub hom phiaj ntawm cov kab mob plawv.
3. Tau qhia rau kev siv los ntawm cov neeg mob uas muaj kab mob mus ntev ntawm daim siab, lub plab lossis plab hnyuv.

Thaum lub sijhawm noj tshuaj, ib qho yuav tsum ua raws nraim li cov koob tshuaj uas raug xaiv thiab kev ua neej. Hauv nruab nrab, Vijaysar tuaj yeem muas rau 282 rubles.

Muaj cov tshuaj Lavxias analogues ntawm cov tshuaj Amaril, uas kuj muaj txiaj ntsig zoo rau lawv txoj kev kho mob.

• Glimepiride Canon.
• Glimepiride.
• Glimecomb.
• Gliformin.
• Gliformin Prolong.

Cev xeeb tub, lactation

Yuav siv tsis tau lub sij hawm thaum xeeb tus me nyuam ntawm cev nqaij nruab deg, pub mis noj rau tus me nyuam yug tshiab, sulfonylurea derivatives yuav siv tsis tau. Hauv cov ntshav ntawm tus poj niam cev xeeb tub, cov kua nplaum nyob hauv lub cev yuav tsum tsis pub dhau. Tom qab tag nrho, hyperglycemia ua rau muaj kev pheej hmoo ntau ntxiv ntawm kev tsis ua haujlwm ntawm lub cev, ua rau cov menyuam mos tuag coob.

Cov poj niam cev xeeb tub tau pauv mus rau cov tshuaj insulin. Nws yog qhov ua tau kom tshem tawm qhov tshwm sim ntawm lub txim lom ntawm cov tshuaj rau tus menyuam hauv utero yog tias koj tso sulfonylurea nyob rau theem ntawm kev npaj lub tswv yim.

Thaum lub sijhawm lactation, Txoj kev kho Amaril yog txwv tsis pub. Cov tshuaj nquag kis mus rau niam mis, lub cev ntawm tus menyuam yug tshiab. Thaum pub niam mis, nws yog qhov tsim nyog kom tus poj niam hloov mus rau kev siv tshuaj insulin.

Pharmacological cov yam ntxwv ntawm cov tshuaj

Amaryl yog tshuaj hypoglycemic uas pab tswj ntshav qab zib hauv ntshav. Cov tshuaj nquag ua haujlwm ntawm cov tshuaj yog glimepiride. Zoo li nws ua ntej, Glibenclamide, Amaril kuj yog los ntawm pawg sulfonylurea, uas ua kom cov synthesis ntawm insulin los ntawm b hlwb ntawm lub pancreatic islets ntawm Langerhans.

Yuav kom ua tiav qhov txiaj ntsig uas tau npaj tseg, lawv thaiv ATP potassium channel nrog muaj lub siab tawv. Thaum sulfonylurea khi rau cov receptors nyob ntawm b-cell daim nyias nyias, cov haujlwm ntawm K-AT qib hloov. Kev thaiv ntawm cov calcium calcium uas muaj qhov nce ntxiv ntawm ATP / ADP piv rau hauv cytoplasm provokes depolarization ntawm daim nyias nyias. Qhov no pab tso cov calcium calcium txoj hauv kev thiab ua rau kom muaj cov calcium cytosolic ntxiv.

Qhov tshwm sim ntawm kev txhawb nqa ntawm exocytosis ntawm secretory granules, uas yog cov txheej txheem ntawm kev nthuav tawm los ntawm cov hlwb ntawm cov sib txuas rau hauv nruab nrab nruab nrab, yuav tso cov tshuaj insulin rau hauv cov ntshav.

Glimepiride yog tus sawv cev ntawm tiam 3 ntawm sulfonylureas. Nws stimulates tso tawm ntawm pancreatic hormone sai, txhim kho insulin rhiab heev ntawm protein thiab lipid hlwb.

Peripheral cov ntaub so ntswg metabolize cov piam thaj siv ntau dua los ntawm cov khoom siv thauj khoom thauj los ntawm cov kab mob cell. Nrog rau hom ntshav qab zib insulin-ywj siab, kev hloov pauv ntawm cov piam thaj rau hauv cov ntaub so ntswg yog qeeb. Glimepiride txhawb nqa kev nce hauv qhov ntim ntawm cov thauj cov protein thiab txhim kho lawv cov haujlwm. Xws li lub cev ua tau zoo ua rau lub cev pab txo qis cov insulin tsis kam (lub cev tsis raug) rau lub cev lawm.

Amaryl inhibits cov synthesis ntawm glucogen los ntawm lub siab vim muaj kev nce hauv ntim ntawm fructose-2,6-bisphosphate nrog antiaggregant (inhibition ntawm thrombus tsim), antiatherogenic (txo qis hauv qhov ntsuas ntawm "tsis zoo" cov cholesterol) thiab antioxidant (rov ua dua tshiab, tiv thaiv kev laus) cov peev xwm. Cov txheej txheem oxidation tau qeeb qeeb vim qhov nce ntawm cov ntsiab lus ntawm endogenous b-tocopherol thiab cov haujlwm ntawm cov antioxidant enzymes.

Txawm tias cov tshuaj me me ntawm Amaril ua rau txhim kho glucometer.

Pharmacokinetics ntawm cov tshuaj

Nyob rau hauv cov muaj pes tsawg leeg ntawm Amaril, lub ntsiab nquag tivthaiv yog glimepiride los ntawm sulfonylurea pab pawg. Povidone, lactose monohydrate, magnesium stearate, microcrystalline cellulose thiab dyes E172, E132 yog siv los ua cov tshuaj ntxaws.

Amaryl ua lub siab ua rau cov leeg mob 100%, yog li txawm tias siv sijhawm ntev ntawm cov tshuaj tsis cuam tshuam qhov kev txuam nrog ntawm nws tshaj hauv cov nruab nrog cev thiab cov nqaij. Raws li qhov tshwm sim los ntawm kev ua tiav, ob qho txuas ntxiv ntawm glipemiride yog tsim: hydroxymetabolite thiab carboxymethabolite. Thawj cov tshuaj metabolite yog muaj nrog lub zog pharmacological uas muab cov nyhuv hypoglycemic ruaj khov.

Hauv cov ntshav, cov ntsiab lus siab tshaj plaws ntawm cov nquag nquag tau pom tom qab ob thiab ib nrab teev. Possessing tsis txaus ntseeg tiag tiag, cov tshuaj tsis txwv tus mob ntshav qab zib hauv kev xaiv cov khoom noj cov khoom noj uas nws "seizes" cov tshuaj. Kev tshem tawm yuav yog nyob rau hauv txhua kis 100%.

Nws hloov tawm ntawm cov tshuaj yog qeeb heev, tus nqi tso tawm cov ntaub so ntswg thiab kua dej ntawm cov tshuaj (tshem tawm) yog 48 ml / min.Qhov kev tshem tawm ib nrab-lub neej yog los ntawm 5 txog 8 teev.

Kev txhim kho tseem ceeb hauv glycemic indices yog pom txawm tias muaj teeb meem ua haujlwm nrog lub siab, tshwj xeeb, hauv kev laus (ntau dua 65 xyoos) thiab nrog daim siab tsis ua hauj lwm, qhov tseem ceeb ntawm cov nquag muaj yeej.

Glimepiride Canon

Nws yog hom tshuaj ntshav hypoglycemic uas noj ntawm qhov ncauj. Nws cuam tshuam cov hlwb ntawm lub txiav thiab tso tawm insulin.

Cov tshuaj muaj ob peb yam tshwm sim:

1. Kev tawm ntawm thaj chaw hauv lub cev, uas ua rau muaj peev xwm ntawm cov ntaub so ntswg ntau ntxiv kom muaj cov tshuaj insulin.
2. Txo kev ua haujlwm ntawm cov tshuaj insulin hauv daim siab.
3. Txwv tsis pub cov piam thaj ntau lawm.

Thov ncauj. Ua ke nrog kev kho mob nrog cov tshuaj insulin yuav raug sau tseg, rau qhov tsis muaj ib qho txiaj ntsig kho. Txawm li cas los xij, thaum txiav txim qhov ntau npaum li cas, ib qho kev kuaj mob hauv lub cev ntawm cov piam thaj hauv cov ntshav khiav yog qhov tsim nyog. Kev kho feem ntau ntev. Kev kwv yees tus nqi ntawm 165 rubles.

Gliformin Prolong

Xaj rau ntshav qab zib hom 2 hauv cov neeg mob rog rog. Cov tshuaj yog siv ob qho tib si hauv monotherapy thiab hauv kev sib xyaw nrog lwm cov tshuaj.

Koj tuaj yeem coj nws tsis noj cov zaub mov. Cov koob tshuaj thiab ntau npaum li cas yog txiav txim siab raws li daim ntawv tshuaj ntau npaum li cas tau siv. Qhia tshuaj kom txog 3 zaug / hnub. Txhua 15 hnub koj yuav tsum tau hloov kho lub koob tshuaj.

Cov tshuaj yeeb yaj kiab uas txawv ntawm cov tshuaj, tus nqi

Amaril tseem muaj cov tshuaj yeeb yaj kiab (analogues), uas muaj cov nqi siab dua, tab sis kev lees paub ntxiv:

1. Avandaglim Cov. Nws muaj ob qhov tshuaj txuam, hu ua rosiglitazone maleate thiab glimepiride. Txhim kho glycemic tswj nyob rau hauv cov neeg mob uas muaj ntshav qab zib hom 2.
2. Avandamet. Cov tshuaj sib xyaw ua ke raws li rosiglitazone maleate thiab metformin hydrochloride. Txhim kho cov tshuaj insulin.
3. Bagomet Ntxiv. Qhov sib kis tau raws li kev sib xyaw ua ke ntawm ob qho tshuaj metformin thiab glibenclamide. Thawj qhov ua kom qis dua ntawm cov qib ntawm cov piam thaj hauv cov ntshav, inhibits qhov nqus ntawm carbohydrates thiab txo tus nqi ntawm gluconeogenesis. Metformin favorably cuam tshuam rau lipid muaj pes tsawg leeg ntawm cov ntshav, txo cov roj cholesterol thiab triglycerides hauv nws. Glibenclamide txo cov piam thaj hauv cov ntshav ntawm cov ntshav. Hais txog cov tshuaj pheej yig kom txo qis cov roj cholesterol - cov npe, cov nqi thiab tshuaj xyuas peb tau sau.
4. Bagomet Cov. Nws muaj ntau cov txiaj ntsig zoo:

• txo cov piam thaj nqus,
• Pab kom qis qis gluconeogenesis,
• kev siv cov peripheral qabzib ntau dua,
• nce lub peev xwm ntawm cov ntaub so ntswg rau kev cuam tshuam ntawm insulin.

Tus nqi nyob ntawm 68 rubles rau 101 rubles.

Kev qhia rau siv cov tshuaj Amaryl

Cov tshuaj nquag ua haujlwm raws li cov lus qhia hauv kev npaj Amaril yog glimepiride.

Cov tshuaj muaj qhov zoo:

1. Kev ua kom muaj zog insulin.
2. Ua kom muaj kev cuam tshuam ntau ntawm cov ntaub so ntswg mus rau insulin tsim los ntawm lub cev.
3. Tso tshuaj insulin.
4. Muaj cov haujlwm ua haujlwm ntxiv.
5. Lub peev xwm hloov kho myocardium rau ischemia tseem.
6. Antithrombotic kev txiav txim.

Cov tshuaj rau ntshav qab zib hom 2 tau siv. Hauv qhov no, tshuaj tuaj yeem siv ob qho tib si hauv monotherapy, thiab ua ke nrog lwm yam tshuaj.

Tsuas tshuaj thiab tswj hwm

Tus nqi ntawm Amaryl nyob ntawm 820 rubles rau 2300 rubles rau ib pob.

Thaum siv Amaril, nws yog ib qho tsim nyog yuav tsum ua raws li qee qhov kev cai:

1. Kev xaiv koob tshuaj yog nqa tawm los ntawm tus kws kho mob nkaus xwb. Qhov tshuaj thawj zaug yog 1 mg 1 zaug nyob rau ib hnub.
2. Cov koob tshuaj yuav tsum zoo ib yam li cov zaus ntawm cov tshuaj.
3. Cov ntsiav tshuaj yog nqos tag nrho yam tsis muaj ntxo.
4. Haus cov tshuaj nrog ib nrab ib liv dej.
5. Nws yog ib qho tseem ceeb heev kom tsis txhob noj mov.
6. Cov kev kho mob ntev.
7. Tej zaum yuav siv cov Amaril nrog metformin. Ntxiv mus, kev kho mob zoo li no yuav tsum tau ua nrog kev soj ntsuam mob ntau tshaj plaws.
8. Yog tias nws tsis tuaj yeem ua tiav qhov ib txwm ua tiav ntawm qib ntawm cov piam thaj hauv cov hlab ntshav los ntawm kev noj ib qho tshuaj uas siv tau ntawm Amaril, tom qab ntawd kev kho mob raws li kev sib xyaw ntawm glimepiride nrog insulin yog ua tau.
9. Hloov pauv ntawm tus neeg mob los ntawm cov tshuaj hypoglycemic rau Amaryl yog nqa nrog kev teem caij ntawm thawj zaug kev siv 1 mg.

Sab sij huam

Tsis tshua muaj tshwm sim, cov kev mob tshwm sim yuav tshwm sim nrog kev siv Amaril.

Lawv tshwm sim tom qab noj tshuaj:

• mob taub hau
• nkees feem ntau
• xeev siab
• ntxhoo
• tsaug zog ntxhov siab thiab ntxhov siab
• tsis meej pem nyob nco ntsoov
• cerebral spasms.
• xiam qhov yus tswj tus kheej.

• Feem ntau, cov kev hloov pauv hauv kev cuam tshuam ntawm kev ua haujlwm ntawm lub zeem muag tau sau tseg, uas tshwm sim los ntawm qhov kev hloov pauv hauv cov ntshav hauv cov ntshav hauv cov ntshav.

• ntuav
• zawv plab
• mob plab
• nce cov hauj lwm zoo ntawm daim siab enzymes,
• dajntoo.

Kev ua xua uas tsis haum (muaj peev xwm dhau los ntawm cov tsos mob ntawm qhov tsos mob):

• urticaria rau ntawm daim tawv nqaij,
• qhov khaus
• daim tawv nqaij ua pob.

Qee zaum, cov kev mob tshwm sim ntxiv tuaj yeem tshwm sim:

Txhawm rau tiv thaiv kev txhim kho kev mob tshwm sim tom qab siv tshuaj, koj yuav tsum sab laj tus kws kho mob ua ntej siv cov tshuaj.

Amaril tsis yog quav tshuaj. Tsis txhob sib xyaw cov tshuaj nrog cawv. Zoo, koj yuav tsum noj Amaryl tsuas yog tom qab sab laj nrog koj tus kws kho mob.

metformin, alogliptin 262 rub1750 UAH

Yuav siv Amaryl li cas

Ib qho tshuaj yog tsim nyob rau hauv daim ntawv ntawm oval ntsiav tshuaj nrog sib faib sawb, uas tso cai rau koj kom yooj yim cais qhov koob tshuaj nyob rau hauv halves. Cov xim ntawm cov ntsiav tshuaj nyob ntawm qhov tsuas tshuaj: 1 mg ntawm glimepiride - plhaub liab, 2 mg - greenish, 3 mg - daj.

Qhov kev tsim no tsis raug xaiv los ntawm lub caij nyoog: yog tias cov ntsiav tshuaj tuaj yeem pom qhov txawv txav ntawm cov xim, qhov no txo ​​txoj kev pheej hmoo ntawm kev noj ntau dhau, tshwj xeeb tshaj yog nyob rau cov neeg laus.

Cov ntsiav tshuaj tau ntim rau hauv cov hlwv ntawm 15 pcs. Txhua lub npov tuaj yeem muaj los ntawm 2 txog 6 li cov paib.

Cov yam ntxwv ntawm kev siv Amaril:

Amaryl ntsiav tshuaj (hauv ib pob ntawm 30 daim) muaj muag ntawm tus nqi ntawm:

• 260 rub - 1 mg txhua
• 500 rub - 2 mg,
• 770 rub - 3 mg txhua
• 1020 RUB. - 4 mg txhua.

Koj tuaj yeem nrhiav pob ntawm 60, 90,120 pieces ntawm ntsiav tshuaj.

Lub thawv Amaril tau tso rau hauv qhov chaw sov (txog li 30 degrees) tsis ntev tshaj peb xyoos. Cov khoom siv ua ntej yuav tsum tsis pub siv rau cov menyuam yaus.

Lwm yam tshuaj siv tau

Cov neeg mob ntshav qab zib, tshwj xeeb "nrog kev paub", raws li txoj cai, muaj tag nrho cov teeb meem sib xyaw ua ke: kub siab, mob plawv thiab ntshav, teeb meem metabolic, raum thiab lub siab pathologies. Nrog rau cov khoom siv no, koj yuav tsum tsis txhob siv cov tshuaj muaj suab thaj qis dua.

Rau kev tiv thaiv kev tsis txaus siab ntawm cov hlab ntsha thiab lub siab, cov tshuaj uas muaj aspirin yog tshuaj. Amaryl hloov chaw nws tawm hauv cov qauv protein, tab sis nws qib hauv cov ntshav tseem tsis tau hloov pauv. Cov txiaj ntsig ntawm kev siv niaj hnub tuaj yeem hloov kho.

Enhanced ua si AMARE nws ntxiv rau insulin, Allopurinu, coumarin derivatives, anabolic steroids, guanethidine, chloramphenicol, fluoxetine, fenfluramine, pentoxifylline, Feniramidolu, fibric acid derivatives, phenylbutazone, miconazole, azapropazone, probenecid, quinolones, oxyphenbutazone, salicylates, tetracycline, sulfinpyrazone, Tritocqualin thiab sulfonamides.

Amaril txo lub peev xwm ntxiv Epinephrine, glucocorticosteroids Diazoxide, laxatives, Glucagon, barbiturates, Acetazolamide, saluretics, thiazide diuretics, nicotinic acid, Phenytoin, Phenothiazine, Rifampicin, Chlorpromazine, thiab progestin, thiab ntsev.

Amaryl ntxiv rau histamine H2 receptor blockers, reserpine thiab clonidine muab qhov kev npaj txhij txog nrog rau dauv hauv glucometer hauv ib qho kev taw qhia. Cov txiaj ntsig zoo sib xws ua kom muaj cawv thiab Amaril ntau ntxiv.

Cov tshuaj tsis cuam tshuam rau cov kev ua ntawm ACE inhibitors (Ramipril) thiab cov tshuaj tiv thaiv anticoagulant (Warfarin) hauv txhua txoj kev.

Hypoglycemic Sib Piv

Yog tias ib qho tshuaj hypoglycemic yuav tsum tau hloov nrog Amaril, qhov kev siv tshuaj tsawg kawg nkaus (1 mg) tau sau tseg, txawm tias muaj xwm txheej tus neeg mob tau txais cov tshuaj dhau los hauv qhov ntau tshaj plaws. Ua ntej tshaj, qhov tshuaj tiv thaiv ntawm tus kab mob ntshav qab zib tau soj ntsuam ob lub lis piam, thiab tom qab ntawd ces cov tshuaj kho tau kho.

Yog tias tus neeg sawv cev tiv thaiv kab mob siab nrog lub siab ib nrab-lub neej tau siv ua ntej Amaril nyob rau hauv kev txiav txim kom tsis txhob muaj kev txhim kho ntawm lub qog ntshav qab zib, yuav tsum tau ncua sijhawm ob peb hnub tom qab tshem tawm.

Thaum tsoos cov piam thaj tso ib txwm Metformin tsis tso cai tswj ntshav qab zib kom puv, koj tuaj yeem noj tshuaj Amaril 1 mg ntxiv. Yog tias cov txiaj ntsig tsis txaus siab, cov txiaj ntsig maj mam hloov mus rau 6 mg / hnub.

Yog tias Amaril + Metformin cov txheej txheem tsis tau ua raws li qhov kev cia siab, nws raug hloov pauv nrog Insulin, thaum tswj kev ua raws li Amaril. Cov tshuaj insulin kuj tseem pib nrog kev txhaj tshuaj tsawg kawg nkaus. Yog tias cov ntsuas ntawm glucometer tsis tau txhawb nqa, ua kom cov Insulin ntau ntxiv. Kev sib txig nrog kev siv tshuaj yog tseem tau zoo, vim nws tso cai rau koj txo qis kev noj tshuaj hormone los ntawm 40% piv nrog kev kho tshuaj ntshiab tshuaj.

Ntxiv rau Amaril, tus kws kho mob endocrinologist tseem muaj kev xaiv rau cov analogues: Amaperid, Glemaz, Diapyrid, Diameprid, Glimepiride, Diagliside, Reclid, Amix, Glibamide, Gllepid, Glayri, Panmicron, Glibenclamide, Gligenclad, Glliblik Dimari, Dimari, Dimari, Dimari, Dimari, Dimari Glimaril, Glyclazide, Manil, Maninil, Glimed, Glioral, Olior, Glynez, Glirid, Gluktam, Glypomar, Glyurenorm, Diabeton, Diabresid.

Cov tshuaj tau txhim kho kev kho mob ntshav qab zib hom 2. Nws yog siv ob qho tib si nrog monotherapy thiab hauv txoj kev kho mob hauv kev sib txuam nrog Metformin lossis Insulin.

Cov tshuaj tivthaiv ntawm Amaril kov yeej cov nyom ntawm cov placenta, thiab cov tshuaj kuj dhau mus rau hauv niam mis. Vim li no, nws tsis haum rau leej niam cev xeeb tub thiab lactating. Yog tias tus poj niam xav ua niam, txawm tias ua ntej xeeb menyuam, nws yuav tsum pauv mus rau cov tshuaj insulin uas tsis muaj Amaril. Rau lub sijhawm pub mis, cov sijhawm tau teem sijhawm li no tau tshwj tseg, yog tias txawm li cas los xij yuav tsum muaj kev kho mob nrog Amaril, kev pub mis niam tau tso tseg.

Kev siv cov tshuaj nyob rau hauv ntshav qab zib coma thiab lub zwj ceeb ua ntej lub tsis nco qab yog tsis tsim nyog. Hauv kev mob hnyav rau ntshav qab zib (xws li ketoacidosis), Amaryl tsis ntxiv. Cov tshuaj tseem tsis haum rau cov neeg mob ntshav qab zib nrog thawj hom mob.

Nrog kev ua haujlwm tsis zoo ntawm lub raum thiab mob siab, Amaril tsis muaj txiaj ntsig, Amaril tsis qhia rau hemodialysis thiab ntshav qab zib, ntxiv rau rau ib tus neeg tsis kam lees rau glipemiride lossis lwm yam tshuaj ntawm sulfonamide thiab sulfonylurea chav kawm.

Nrog lub plab hnyuv paresis lossis mob plab hnyuv, kev nqus ntawm cov tshuaj yog cuam tshuam, yog li Amaril tsis hais txog teeb meem zoo li no thaum exacerbation. Lawv yuav tsum hloov mus rau cov tshuaj insulin thiab cov kev raug mob ntau, kev phais mob, mob kub, thiab kub hnyiab.

Amaril tej zaum yuav nrog los ntawm kev dhau mus hypoglycemic. Qee zaum cov neeg mob yws ntawm kiv taub hau, qee qhov ua rau tsis zoo ntawm kev pw tsaug zog, muaj kev ntxhov siab, tawm hws ntau dhau, thiab hais lus tsis meej. Ntawm cov ntshav qab zib, muaj ntau zaus ntawm kev tsis tuaj yeem tswj hwm kev tshaib plab, mob plab tsis haum, tsis xis nyob hauv lub siab. Ua tau malfunction ntawm lub plawv atherosclerosis, tawm pob rau ntawm daim tawv nqaij. Qee lub sij hawm cov ntshav ntws tawm ntau.

Lub sijhawm ntev ntawm kev siv tshuaj, nrog rau kev haus ib qho loj heev, tuaj yeem ua rau mob ntshav qab zib, cov tsos mob uas tau hais hauv seem yav dhau los.

Tus mob ntshav qab zib yuav tsum muaj daim ntawv qhia nrog qhov qhia qhov luv luv ntawm nws qhov mob thiab ib yam dab tsi los ntawm cov khoom noj ceev uas yog carbohydrates (khaub noom, khaub noom). Cov kua txiv qab zib lossis tshuaj yej kuj tsim nyog, tsuas yog tsis muaj cov khoom ua kua qab zib xwb.Thaum muaj mob hnyav, tus neeg mob yuav tsum tau mus pw hauv tsev kho mob kom sai vim tias mob plab thiab ua haujlwm rau lub zog (nqus cov pa roj carbon, thiab lwm yam).

Sab sij huam

Qee qhov tsis tshua muaj, kev siv Amaril nrog cov kev mob tshwm sim hauv cov qauv ntawm qhov tsis pom kev ib nrab, muaj teeb meem nrog cov ntshav ncig, cov roj ntsha tsis ua haujlwm, lub plab zom mov.

Ntawm cov feem ntau muaj:

Noj Amaril cuam tshuam loj heev rau kev ceev ntawm lub hlwb kev xav - tsav tsheb, nrog rau kev ua haujlwm xav tau kev saib xyuas, tshwj xeeb tshaj yog nyob rau theem pib ntawm kev kho, tsis sib haum nrog Amaril txoj kev kho.

Cov Cai Siv Tshuaj So

Nws yog tso rau ntawm lub hwj tshuaj.

Amaryl Ntau npaum li cas? Tus nqi nruab nrab hauv cov khw muag tshuaj yog nyob ntawm daim ntawv tso tawm:

• Amaryl ntsiav tshuaj 1 mg, 30 pcs. - los ntawm 262 rub.
• Amaryl ntsiav tshuaj 2 mg, 30 pcs. - los ntawm 498 rub.
• Amaryl ntsiav tshuaj 3 mg, 30 pcs. - los ntawm 770 rub.
• Amaryl ntsiav tshuaj 4 mg, 30 pcs. - txij li 1026 rub.

Cev xeeb tub thiab lactation

Amaryl yog contraindicated rau hauv lub cev xeeb tub. Kev xeeb menyuam hauv plab lossis thaum pib cev xeeb tub, tus pojniam yuav tsum pauv mus rau kev kho mob insulin.

Nws tau pom tias glimepiride ua tawm hauv cov kua mis. Thaum lub sijhawm pub mis, tus poj niam yuav tsum pauv mus rau cov kua dej lossis txwv tsis pub niam mis.

Cov lus qhia tshwj xeeb

Tus kws kho mob, thaum sau ntawv rau tus neeg mob Amaryl lossis Amaryl M, yuav tsum ceeb toom txog kev muaj peev xwm tshwm sim, thiab tseem ceeb tshaj plaws - txog kev tshwm sim ntawm kev mob ntshav qab zib hauv qhov xwm txheej uas tus neeg mob noj tshuaj, tab sis tsis nco qab noj mov. Hauv qhov no, tus neeg mob tau qhia kom ib txwm nqa khoom qab zib lossis qab zib hauv daim txhawm kom txhawm rau txhawm rau nce cov ntshav qab zib kom ntshav sai.

Ntxiv rau kev txheeb xyuas cov ntshav thiab ntshav qabzib nyob rau qib siab, Amaril thiab Amaril M kev kho kuj tseem tsom kwm saib ntshav muaj pes tsawg leeg thiab lub siab ua haujlwm ntxiv.

Thaum muaj kev ntxhov siab, nrog rau kev tso tawm adrenaline rau hauv cov ntshav, cov txiaj ntsig ntawm Amaril thiab Amaril M txo qis. Cov xwm txheej zoo li no tuaj yeem yog xwm txheej, kev tsis sib haum xeeb hauv tsev neeg lossis tom chaw ua haujlwm, kab mob nrog lub siab kub. Thaum zoo li no, kev hloov chaw ib ntus ntawm tus neeg mob mus rau kev insulin.

Yeeb tshuaj sib cuam tshuam

Kev siv cov tshuaj amaryl nrog insulin, lwm yam tshuaj rau cov ntshav qab zib, qee cov tshuaj tua kab mob (tetracyclines, sulfanilamides, clarithromycin), pentoxifylline ntau dua, fluoxetine, fluconazole, anabolic steroids, ACE inhibitors (captoprilprin, drilopril, erin, prilopril hypogens). Cov. Kev sib xyaw ntawm amaryl nrog barbiturates, laxatives, diuretics, koob tshuaj ntau ntawm nicotinic acid, thiab rifampicin yuav muaj cov txiaj ntsig rov qab.

Beta-blockers (carvedilol, atenolol, bisoprolol, metoprolol, thiab lwm yam), reserpine, clonidine, coumarin derivatives thiab cawv tuaj yeem nce thiab txo cov nyhuv hypoglycemic ntawm amaryl.

Amaril yog suav tias yog nrov ntawm cov neeg mob ntshav qab zib. Nws txoj kev txais tos tso cai rau cov neeg mob tuaj yeem tswj hwm lawv tus mob, txo qis qhov ntxim nyiam ntawm kev tsim hyperglycemia. Cov tshuaj uas kws kho mob muab rau noj rau cov neeg mob ntshav qab zib hom II xwb.

Cov tshuaj nquag ntawm Amaril yog glimepiride. Cov tshuaj ntawm cov ntsiav tshuaj tseem suav nrog cov khoom sib txuas. Lawv cov npe yuav nce raws qhov ntau npaum ntawm glimepiride. Ib qho sib xyaw ua ke ntawm cov tshuaj ntxiv hauv cov ntsiav tshuaj yog vim xim sib txawv.

INN (npe thoob ntiaj teb): glimepiride (npe Latin Glimepiride).

Amalil M1, M2 kuj tseem muag hauv khw muag tshuaj. Ntxiv rau glimepiride, cov tshuaj muaj pes tsawg leeg suav nrog metformin hauv qhov ntau npaum li 250 lossis 500 mg, feem. Cov tshuaj sib txuam no tej zaum yuav raug kho los ntawm tus kws kho mob endocrinologist nkaus xwb.

Sib txawv muaj pes tsawg leeg, tuaj yeem ua ke nyob rau hauv kev taw qhia thiab cov qauv ntawm daim ntawv thov

Txhawm rau kom ua ib daim ntawv teev cov khoom pheej yig ntawm cov tshuaj pheej yig, peb siv cov nqi uas yuav muab peb ntau tshaj 10,000 khw muag tshuaj thoob plaws hauv tebchaws Russia. Cov ntaub ntawv teev npe ntawm cov tshuaj thiab lawv cov analogues tau hloov kho tshiab txhua hnub, yog li cov ntaub ntawv muab rau ntawm peb lub vev xaib yog ib txwm hloov kho raws li niaj hnub no. Yog tias koj tsis tau pom ib qho analogue ntawm kev txaus siab rau koj, thov siv qhov kev tshawb nrhiav saum toj no thiab xaiv cov tshuaj ntawm kev txaus siab rau koj los ntawm cov npe. Ntawm nplooj ntawv ntawm txhua ntawm lawv koj yuav pom tag nrho cov kev xaiv ua tau rau cov qauv ntawm cov tshuaj xav tau, nrog rau tus nqi thiab chaw nyob ntawm cov khw muag tshuaj uas nws muaj.

Cov npe ntawm qhov ntsuas thiab contraindications rau kev txais neeg kawm

Amaryl muaj qhov taw qhia hauv qab no rau kev siv. Qhov loj tshaj plaws yog kev kho mob ntshav qab zib hom 2. Amaril tsim nyog rau cov neeg mob uas tsis xav tau kev txhaj tshuaj insulin, thiab rau cov neeg uas tau qhia insulin los txhim kho lawv qhov zoo.

Hauv kev kho mob ntshav qab zib, Amaryl ntsiav tshuaj tau sau tseg yog cov tshuaj tseem ceeb. Tab sis nrog kev tswj tsis tau txaus metabolic (tshwj xeeb yog tias tus neeg mob tau noj tshuaj ntau dua), Glimepiride noj nrog Metformin. Qhov no tuaj yeem txhim kho kev tswj cov metabolism. Hauv qhov no, cov txiaj ntsig tau zoo dua piv rau cov ua tiav nrog kev cais tawm ntawm cov tshuaj.

Cov txiaj ntsig zoo ua tiav los ntawm cov kev kho mob nyuaj siv Glimepiride thiab Metformin ua rau kev txhim kho ntawm cov tshuaj Amaryl M. Daim ntawv sau tshuaj tau muab rau cov tshuaj no yog tias kev kho mob ntshav qab zib mellitus nrog cov tshuaj nyuaj tsim nyog, uas yooj yim rau cov neeg mob.

Tshuaj Amaril uas txo qis cov ntshav qab zib tuaj yeem siv hauv cov neeg mob uas xav tau cov tshuaj insulin tsis tu ncua. Tib lub sijhawm, kev tswj kev zom zaub mov kuj tseem tuaj yeem txhim kho, tab sis qhov ntau npaum ntawm glimepiride raug pom zoo kom txo qis.

Zoo li txhua yam tshuaj, cov tshuaj tsis tuaj yeem pom tias muaj kev nyab xeeb kiag li. Amaril muaj contraindications, thiab lawv cov npe yog qhov loj heev.

Ua ntej tshaj plaws, nws raug nquahu kom ceev faj txog kev noj tshuaj thaum thawj theem ntawm kev kho mob: lub sijhawm no, tseem muaj kev pheej hmoo ntawm kev txo qis hauv qabzib. Yog tias dhau sijhawm dhau qhov kev pheej hmoo ntawm hypoglycemia tseem tshuav, nws raug nquahu kom hloov pauv kev kho mob lossis noj tshuaj ntawm Amaril. Koj yuav tsum ua tib zoo saib xyuas thiab muaj qee yam kabmob, kev ua neej tsis raug, kev noj zaub mov tsis txaus.

Cov kab mob nram qab no (lossis tej yam kev mob ntawm lub cev) yog lub ntsiab lus tseem ceeb rau kev teem caij ntawm Amaril:

1. Mob plab zas lossis yog poj koob yawm txwv.
2. Ketoacidosis.
3. Mob rau daim siab thiab mob raum.
4. Kev tsis nkag siab lossis txo qhov mob siab rau qhov tseem ceeb lossis ntxiv rau cov tshuaj.
5. Tsis tshua muaj kab mob yug (lactose intolerance, lactase deficiency, thiab lwm yam).
6. Cev xeeb tub Thaum npaj kev xeeb tub, yuav tsum hloov chaw kho mob. Tus neeg mob pauv mus rau kev txhaj tshuaj insulin, cov tshuaj tsis raug txwv.
7. Thaum pub niam mis, kev kho mob insulin txuas ntxiv. Yog hais tias rau ib qho laj thawj twg qhov kev kho mob no tsis haum, Amaril tau sau tseg rau tus neeg mob, tab sis nws raug nquahu kom tsum tsis txhob lactation.

Cov tshuaj tsis raug txwv rau kev kho mob ntshav qab zib hom I. Ib qho tseeb contraindication yog me nyuam lub hnub nyoog. Tsis muaj ntaub ntawv hais txog kev haus tshuaj rau menyuam yaus.

Yog li, rau kev kho mob ntshav qab zib hauv cov menyuam yaus, kev noj qab haus huv zoo dua ntawm cov tshuaj feem ntau yog kho.

Cov ntaub ntawv tshuaj ntxiv

Thaum sau ntawv yuav ntawm Amaril lossis Amaril M, tus kws kho mob yuav tsum tsis tsuas yog muab lus qhia txog kev siv tshuaj kom raug, tab sis kuj tseem ceeb toom txog kev mob tshwm sim. Kev saib xyuas tshwj xeeb yuav tsum tau them rau qhov kev pheej hmoo ntawm cov ntshav qog ntshav qab zib, uas tuaj yeem txhim kho yog tias tus neeg mob tsis nco qab noj tam sim ntawd tom qab noj Amaril. Txhawm rau kom tsis txhob mob hypoglycemia, nws zoo dua yog tias muaj ncuav qab zib lossis khoom qab zib nrog koj.

Ntxiv nrog rau qib piam thaj thiab piam thaj hauv kev tso zis, tus neeg mob yuav tsum kuaj xyuas lub raum thiab lub siab ua haujlwm tsis tu ncua.

Ib qho lus nug ntau yog seb nws puas tuaj yeem haus dej cawv thaum kho mob nrog Amaril. Nws yog tsim nyog kom nco ntsoov tias cawv feem ntau ua tsis tau zoo thaum kho tus mob ntshav qab zib thiab tsis sib xyaw nrog feem ntau cov tshuaj. Amaril kuj yog lawv li lawm. Qhov tshwm sim ntawm kev noj tshuaj thiab dej cawv tib lub sijhawm tuaj yeem tsis paub tseeb. Muaj qee kis, qhov kev ua haujlwm ntawm cov tshuaj tau nce siab dua, thiab hauv lwm qhov yog qhov txo qis. Yog li, thaum kho, koj yuav tsum tso tseg kev haus dej cawv thiab tshuaj yeeb muaj cawv.

Raws li rau kev sib cuam tshuam ntawm Amaril nrog lwm cov tshuaj, txhua yam ntawm no kuj yog nyob ntawm seb hom tshuaj. Noj qee yam tshuaj kho kom zoo dua ntawm kev ua haujlwm ntawm Amaril, lwm tus - txo qhov kev ua tau zoo. Daim ntawv ntawm ob qho tib si ntawd thiab lwm yam tshuaj muaj zog heev. Yog li, yog tias tsim nyog, noj lwm yam tshuaj, nws yog qhov yuav tsum tau qhia rau tus kws kho mob uas koom nrog txog kev kuaj mob thiab siv tshuaj dab tsi. Hauv qhov no, tus kws kho mob yuav tuaj yeem xaiv cov tshuaj uas yuav tsis muaj lub txiaj ntsig tseem ceeb ntawm kev ua haujlwm ntawm Amaril.

Yog tias muaj kev mob tshwm sim, koj yuav tsum tsis txhob noj cov tshuaj thiab sab laj nrog kws kho mob.

Kev tshuaj xyuas txog cov tshuaj

Thaum lub sijhawm siv Amaryl rau cov ntshav qab zib hom 2, kev tshuaj xyuas tau txais txiaj ntsig zoo los ntawm ntau cov neeg mob. Qhov no lees tias qhov tseeb uas nrog xaiv txoj kev xaiv tshuaj, cov tshuaj muaj txiaj ntsig zoo tua hyperglycemia.

Ntxiv rau qhov kev ua tau zoo, ntau tus neeg yuav khoom hu ua xim sib txawv ntawm cov ntsiav tshuaj kom zoo tshuaj - qhov no yuav pab kom tsis meej cov tshuaj nrog qhov sib txawv ntawm cov tshuaj glimepiride.

Cov kev tshuaj xyuas tau txais ntawm Amaril paub tseeb tsis tsuas nws cov hauj lwm zoo, tab sis kuj tseem pom cov kev mob tshwm sim hauv cov lus qhia rau Amaril.

Feem ntau, cov neeg mob noj cov tshuaj qhia cov cim ntawm lub qog ntshav qab zib:

1. Neeg tsis muaj zog.
2. Qhuas.
3. Kev ntxhov siab thoob plaws lub cev.
4. Kiv taub hau
5. Muaj ntau yam qab los noj mov.

Ntau zaus, raws li qhov tshwm sim, muaj kev phom sij ntawm kev poob qab. Yog li, cov neeg uas coj Amaril yuav tsum tau nqa cov khoom muaj piam thaj tas li (piv txwv li, khoom qab zib) nrog lawv, yog li, yog tias tsim nyog, lawv tuaj yeem nce lawv cov suab thaj sai thiab txhim kho lawv cov kev noj qab haus huv. Txawm li cas los xij, raws li kws kho mob, kev hloov pauv hauv thaj chaw qab zib tsis yog qhov qhia tau rau qhov tsis muaj txiaj ntsig ntawm cov tshuaj. Thaum cov tsos mob zoo li no, nws txaus los kho lub koob tshuaj.

Ib qho teeb meem tshwm sim rau cov neeg tsav tsheb uas tau yuam kom cov neeg mob hypoglycemic yog qhov muaj kev tsis zoo thaum tsav tsheb. Cov kev mob tshwm sim zoo sib xws yog qhia hauv cov lus qhia hauv cov npe ntawm cov kev mob tshwm sim. Qhov kev txo qis hauv cov tshuaj tiv thaiv tau piav qhia los ntawm cov nyhuv ntawm glimepiride ntawm lub paj hlwb.

Ntawm cov neeg mob ntshav qab zib laus, hauv kev txheeb xyuas ntawm Amaril, ntau tus sau tseg txog ib qho ntxiv tsis zoo: txawm hais tias qhov kev ua tau zoo uas Amaril txo qis qab zib, cov tshuaj rau ntshav qab zib yog kim heev, vim tias cov tshuaj muaj peev xwm raug nqi ntau dua li qee yam tshuaj noj, suav nrog Lavxias ntau lawm.

Nqe thiab analogues ntawm cov tshuaj

Koj tuaj yeem yuav Amaril nyob rau hauv cov chaw muag tshuaj hauv nroog tsis tu ncua, tab sis muaj ib lub caveat: nws tsis yog muag. Raws li rau ntau lwm cov tshuaj tiv thaiv kab mob, koj yuav tsum muab daim ntawv yuav tshuaj rau Amaryl noj.

Lwm lo lus nug nrov uas nyiam ntau tus mob ntshav qab zib yog Amaril raug nqi ntau npaum li cas. Tus nqi ntawm cov tshuaj hauv qhov no yuav yog nyob ntawm seb muaj pes tsawg ntawm cov ntsiav tshuaj hauv pob thiab qhov ntau npaum li cas ntawm cov tshuaj. Yog li, piv txwv li, ib pob ntawm cov tshuaj rau 30 ntsiav tshuaj tus nqi, nyob ntawm seb cov koob tshuaj, los ntawm 200 txog 850 rubles. Hauv qhov no, Amaril 1 mg raug tus nqi yog li ntawm 230-280 rubles, qhov ntim ntawm Amaril ntsiav tshuaj 2 mg - 450-560 rubles, 3 mg - rau 630-830 rubles. Cov ntsiav tshuaj uas kim tshaj plaws Amaril 4 mg 90 pcs. - lawv raug nqi qhov nruab nrab ntawm 870-1080 rubles.

Amaril M tuaj yeem muag rau 570-600 rubles. Nws yog ib qho tseem ceeb xav txog tias rau cov nqi zoo li no koj tuaj yeem yuav Amaril 2mg ntsiav tshuaj + 500 mg. Nws yog qhov nyuaj heev kom tau txais cov tshuaj qis dua (1 mg + 250), vim tias nws tau ntau tsawg los ntawm kws kho mob, thiab raws li, nws tsis tshua muaj muag.

Amaryl M kev qhia

LUS QHIA
ntawm kev siv cov tshuaj
AMARIL M

Daim ntawv tso tawm
Zaj duab xis-coated ntsiav tshuaj.

Pharmacological kev txiav txim
Amaryl® M yog cov tshuaj hypoglycemic ua ke, uas suav nrog glimepiride thiab metformin.
Cov chaw muag tshuaj ntawm glimepiride
Glimepiride, yog ib yam tshuaj lom ntawm Amaril® M, yog ib qhov tshuaj tiv thaiv hypoglycemic rau kev tswj hwm ntawm qhov ncauj, lub zog los ntawm sulfonylurea ntawm peb tiam.
Glimepiride stimulates qhov tso pa tawm thiab tso tawm ntawm insulin los ntawm pancreatic cells-hlwb (cov nyhuv pancreatic), txhim kho qhov rhiab ntawm peripheral cov ntaub so ntswg (nqaij thiab rog) rau qhov kev ua ntawm endogenous insulin (muaj txiaj ntsig ntxiv).
Ntxim rau insulin secretion
Cov lus qhia ntawm sulfonylureas nce insulin secretion los ntawm kaw ATP-dependant potassium cov chaw nyob hauv cytoplasmic membrane ntawm β-hlwb ntawm cov txiav.
Kaw cov calcium channels, lawv ua rau depolarization ntawm β-hlwb, uas yuav pab qhib cov calcium calcium thiab ua kom muaj kev ntws los ntawm cov calcium ntau ntxiv rau hauv cov cell. Glimepiride, nrog rau qhov hloov pauv siab, ua ke thiab tshem tawm ntawm cov protein (pancreatic protein-cell protein) (cov roj molecular 65 kD / SURX), uas cuam tshuam nrog ATP-tos cov potassium ntxiv, tab sis txawv ntawm qhov sib txuas ntawm cov pa sulfonylurea derivatives (protein nrog lub cev hnyav ntawm 140 kD / SUR1). Cov txheej txheem no ua rau muaj kev tso tawm ntawm cov tshuaj insulin los ntawm exocytosis, thaum tus nqi ntawm cov tshuaj insulin yog qhov tsawg dua li qhov kev txiav txim ntawm derivatives ntawm sulfonylurea ntawm lub cim thib ob (piv txwv, glibenclamide). Qhov tsawg tshaj plaws stimulating nyhuv ntawm glimepiride ntawm insulin secretion tseem ua rau muaj kev pheej hmoo qis ntawm hypoglycemia.
Extrapancreatic kev ua si
Zoo li tsoos sulfonylurea derivatives, tab sis rau ntau dua, glimepiride tau tshaj tawm cov teebmeem ntxiv (txo qis insulin tsis kam, antiatherogenic, antiplatelet thiab antioxidant teebmeem).Kev siv cov kua nplaum ntev los ntawm cov ntaub so ntswg (nqaij thiab rog) tshwm sim siv cov thauj tshwj xeeb (GLUT1 thiab GLUT4) nyob hauv cov cell ua ke. Qhov kev thauj khoom ntawm cov kua nplaum mus rau hauv cov nqaij no ntawm hom 2 ntshav qab zib yog qhov nrawm nrawm los ntawm kev siv cov piam thaj. Glimepiride nrawm dua rau tus naj npawb thiab cov haujlwm ntawm cov piam thaj thauj cov lwg me me (GLUT1 thiab GLUT4), ua rau muaj kev nce ntxiv hauv cov piam thaj los ntawm cov ntaub so ntswg.
Glimepiride muaj cov tshuaj ua rau lub zog tsis haum rau ATP-potassium ntxiv mus ntawm cardiomyocytes. Thaum noj glimepiride, lub peev xwm ntawm cov khoom noj hauv lub cev hloov kho ntawm myocardium rau ischemia yog tshwj tseg.
Glimepiride ua rau kom muaj phospholipase C ntau ntxiv, vim qhov kev sib txuam ntawm cov calcium hauv cov leeg nqaij thiab cov roj ntsha tsawg dua, ua rau muaj kev cuam tshuam ntawm cov kev ua ntawm protein kinase A, uas ua rau lub ntsej muag ua rau lub zog ntawm cov metabolism hauv qabzib.
Glimepiride inhibits kev tso tawm ntawm cov piam thaj los ntawm lub siab los ntawm kev muaj kev cia siab ntau ntawm fructose-2,6-bisphosphate, uas nyeg inhibits gluconeogenesis.
Glimepiride xaiv tau inhibits cyclooxygenase thiab txo qhov kev hloov pauv ntawm arachidonic acid rau thromboxane A2, qhov tseem ceeb endogenous platelet aggregation tau.
Glimepiride pab txo lipid cov ntsiab lus, txo lipid peroxidation, uas cuam tshuam nrog nws cov nyhuv tshuaj tiv thaiv atherogenic.
Glimepiride nce cov ntsiab lus ntawm endogenous to-tocopherol, qhov kev ua ntawm catalase, glutathione peroxidase thiab superoxide dismutase, uas pab txo qis qhov mob ntawm oxidative kev nyuab siab hauv tus neeg mob lub cev, uas yog ib txwm muaj nyob rau hauv lub cev ntawm cov neeg mob uas muaj ntshav qab zib hom 2.

Pharmacodynamics ntawm metformin
Metformin yog hom tshuaj hypoglycemic los ntawm pab pawg biguanide. Nws cov nyhuv ua rau ntshav qab zib yog qhov ua tau yog tias muaj zais ntawm cov tshuaj insulin (txawm hais tias txo qis) tswj. Metformin tsis cuam tshuam rau pancreatic cells-cov hlwb thiab tsis nce ntxiv insulin secretion. Hauv kev kho mob koob tshuaj, metformin tsis ua rau cov ntshav qab zib hauv tib neeg. Tus txheej txheem ntawm kev ua ntawm metformin tseem tsis tau to taub tag nrho. Nws ntseeg tias metformin tuaj yeem muaj peev xwm ua rau muaj qhov cuam tshuam los ntawm insulin lossis nws tuaj yeem nce ntxiv ntawm kev cuam tshuam ntawm insulin hauv peripheral receptor aav. Metformin ua rau cov nqaij mos rhiab ntau rau cov tshuaj insulin los ntawm kev ua kom cov insulin ntau ntxiv nyob rau hauv cov cell nyias nyias. Ntxiv rau, metformin inhibits gluconeogenesis nyob rau hauv daim siab, txo kev tsim cov roj ntsha dawb thiab ua kom muaj roj oxidation, thiab txo cov kev kub ntxhov ntawm triglycerides (TG), LDL thiab VLDL hauv cov ntshav. Metformin me ntsis txo qhov qab los noj mov thiab txo qhov nqus ntawm cov carbohydrates hauv txoj hnyuv. Nws txhim kho cov khoom fibrinolytic ntawm cov ntshav los ntawm inhibiting cov nqaij mos plasminogen activator inhibitor.
Cov Tshuaj Pharmacokinetics
Glimepiride
Xuas
Nrog kev rov qab haus ib zaug ntawm cov tshuaj hauv ib koob tshuaj txhua hnub ntawm 4 mg Cmax hauv cov ntshav dej tau tiav tom qab kwv yees li 2.5 teev thiab suav mus rau 309 ng / ml. Muaj txoj kab sib txuas ntawm qhov koob tshuaj thiab Cmax ntawm glimepiride hauv ntshav plasma, ntxiv rau nruab nrab ntawm cov koob thiab AUC. Thaum noj cov glimepiride nws qhov kev qhia tseeb txog kev noj qab haus huv tau ua tiav. Noj mov tsis muaj kev cuam tshuam loj ntawm kev nqus, nrog rau kev zam ntawm kev ua kom qeeb me ntsis hauv nws qhov ceev.
Kev xa Khoom
Glimepiride yog tus yam ntxwv tsawg kawg Vd (kwv yees li 8.8 L), kwv yees sib npaug ntawm Vd ntawm albumin, qhov siab ntawm kev sib khi rau cov ntshav plasma (ntau dua li 99%) thiab kev tshem tawm tsawg (li 48 ml / min).
Glimepiride ua haujlwm tawm hauv cov kua mis thiab hla tus qib placental. Glimepiride ua haujlwm tsis zoo rau BBB.
Kev sib piv ntawm ib qho thiab ntau yam (2 zaug / hnub) kev tswj hwm ntawm glimepiride tsis qhia tawm qhov sib txawv tseem ceeb hauv cov chaw muag tshuaj, thiab lawv cov kev hloov pauv hauv cov neeg mob sib txawv yog qhov tsis txaus ntseeg. Qhov tseem ceeb tsub zuj zuj ntawm glimepiride tsis tuaj.
Kev zom zaub mov
Glimepiride yog metabolized hauv lub siab nrog kev tsim ntawm ob lub cev ua kom muaj zog - hydroxylated thiab carboxylated derivatives, uas pom muaj nyob hauv cov zis thiab cov quav.
Chaw Sau Ntawv
T1 / 2 ntawm plasma qhov ntau ntawm cov tshuaj hauv ntshav dej, sib piv rau kev coj ua dua, yog kwv yees li 5-8 teevTom qab noj glimepiride hauv qib siab, T1 / 2 nce me ntsis.
Tom qab ib qho kev coj noj ntawm qhov ncauj, 58% ntawm glimepiride yog ua tawm los ntawm lub raum (hauv daim ntawv ntawm metabolites) thiab 35% los ntawm cov hnyuv. Tsis pom qhov kuaj pom tseeb hauv cov zis hauv lub cuab yeej.
Lub davhlau ya nyob twg T1 / 2 ntawm hydroxylated thiab carboxylated glimepiride metabolites yog 3-5 teev thiab 5-6 teev, feem.
Pharmacokinetics hauv cov chaw kuaj mob tshwj xeeb
Hauv cov neeg mob ntawm cov poj niam txiv neej sib txawv thiab pab pawg hnub nyoog sib txawv, cov tsis muaj tshuaj nyob hauv glimepiride zoo ib yam.
Hauv cov neeg mob uas lub raum tsis ua haujlwm (nrog CC tsawg), muaj qhov nyiam nce ntawm kev txhawm rau glimepiride thiab txo qis hauv nws qhov nruab nrab ntau ntawm cov ntshav, uas yog feem ntau vim yog sai dua ntawm glimepiride vim nws qis qis rau cov ntshav plasma protein. Yog li, hauv pawg no ntawm cov neeg mob tsis muaj kev pheej hmoo ntxiv los ntawm kev ua kom tiav ntawm glimepiride.
Metformin
Xuas
Tom qab cov neeg siv qhov ncauj, metformin yog nqus los ntawm cov hnyuv zom tag nrho. Kev tsis raug cai ntawm bioavailability yog 50-60%. Cmax hauv ntshav yog kwv yees li 2 μg / ml thiab ua tiav tom qab 2.5 teev. Nrog kev noj zaub mov ib txhij, kev nqus ntawm metformin poob qis thiab maj mam poob.
Kev faib khoom thiab cov metabolism
Metformin tau faib sai sai hauv cov ntaub so ntswg, kev xyaum ua haujlwm tsis khi rau cov ntshav protein. Nws yog metabolized mus rau ib tug kawm ntawv uas tsis muaj zog heev.
Chaw Sau Ntawv
T1 / 2 yog kwv yees li 6.5 teev .Txaus siab los ntawm lub raum. Kev tshem tawm hauv cov neeg ua hauj lwm pab noj qab haus huv yog 440 ml / min (4 zaug ntau dua KK), uas qhia tias muaj cov tubular ua kom zais ntshis ntawm metformin Pharmacokinetics hauv cov chaw kho mob tshwj xeeb Nrog lub raum tsis ua haujlwm, muaj kev pheej hmoo ntawm kev txuam tshuaj.
Pharmacokinetics ntawm Amaril® M nrog kev txhaj tshuaj ntau ntawm glimepiride thiab metformin
Cmax thiab AUC qhov tseem ceeb thaum noj cov tshuaj sib xyaw ua ke (cov tshuaj muaj glimepiride 2 mg + metformin 500 mg) ua tau raws li cov txheej txheem kev sib npaug thaum muab piv nrog cov ntsuas thaum siv tib qho kev sib xyaw ua ke (cais glimepiride ntsiav tshuaj 2 mg thiab metformin 500 ntsiav tshuaj) mg).
Tsis tas li ntawd, qhov koob tshuaj-koob tshuaj tiv thaiv nce hauv Cmax thiab AUC ntawm glimepiride tau qhia nrog qhov nce ntawm nws cov koob tshuaj hauv kev sib xyaw ua ke nrog cov tshuaj tiv thaiv tsis tu ncua los ntawm 1 mg rau 2 mg nrog ib koob tshuaj metformin (500 mg) hauv cov kev npaj no.
Tsis tas li ntawd, tsis muaj qhov sib txawv hauv kev nyab xeeb, suav nrog qhov profile ntawm qhov tsis tsim nyog, nruab nrab ntawm cov neeg mob noj Amaril M 1 mg + 500 mg thiab cov neeg mob noj Amaril M 2 mg + 500 mg.

Cov Khoom Qhia
Kev kho mob ntshav qab zib hom 2 (ntxiv rau kev noj haus, tawm dag zog thiab lub cev poob):
thaum glycemic tswj tsis tuaj yeem ua tiav nrog monotherapy nrog glimepiride lossis metformin,
thaum hloov kev sib xyaw ua ke nrog glimepiride thiab metformin nrog kev noj ib qho tshuaj sib txuam Amaril A M.

Cov Yuav Tsum Muaj
Yam 1 ntshav qab zib
ketoacidosis (nrog rau keeb kwm), mob ntshav qab zib tsis xeev thiab precoma,
mob acidosis mob ntev lossis mob nyhav,
daim siab ua haujlwm tsis zoo hauv lub siab (tsis muaj kev paub dhau los ntawm kev siv, kev kho mob insulin yog qhov tsim nyog los xyuas kom tswj tau glycemic txaus),
cov neeg mob hemodialysis (tsis muaj kev paub ntau)
lub raum tsis ua haujlwm thiab lub raum ua haujlwm tsis zoo (ntshav pliag creatinine concentration ≥1.5 mg / dL (135 μmol / L) hauv cov txiv neej thiab ≥1.2 mg / dL (110 μmol / L) hauv cov poj niam lossis txo qis hauv CK (muaj kev pheej hmoo ntawm lactic acidosis) thiab lwm cov kev mob tshwm sim los ntawm metformin)
mob uas ua rau lub raum khiav tsis zoo (lub cev qhuav dej, kis tau mob hnyav, poob siab, kev tswj hwm ntawm iodinated kev tsis sib haum) yog ua tau,
cov mob hnyav thiab mob nyhav uas tuaj yeem ua rau cov nqaij hypoxia (mob plawv lossis ua pa tsis ua haujlwm, mob hnyav thiab subocute myocardial infarction, poob siab),
ib qho kev hloov los tsim cov kab mob lactic acidosis, keeb kwm ntawm cov kab mob lactic acidosis,
cov xwm txheej ntxhov siab (mob hnyav, kub hnyiab, phais mob, mob hnyav nrog ua npaws, mob leeg tsis haum),
kev qaug zog, tshaib plab, ua raws li cov khoom noj uas muaj calorie tsawg (tsawg dua 1000 cal / hnub),
malabsorption ntawm cov zaub mov thiab cov tshuaj hauv cov hnyuv (nrog rau cov hnyuv hauv plab hnyuv, ua pa plab hnyuv, ua kom raws plab, ntuav),
cawv ntev, qaug cawv qaug cawv,
lactase deficiency, galactose intolerance, qabzib-galactose malabsorption,
kev xeeb tub, kev npaj cev xeeb tub,
lub sij hawm pub niam mis,
cov menyuam yaus thiab cov tub ntxhais hluas hnub nyoog qis dua 18 xyoo (kev paub tsis txaus los soj ntsuam),
muaj lub cev tsis haum rau lub tshuaj,
lub cev tsis haum rau sulfonylureas, sulfa tshuaj los yog biguanides.
Nrog kev ceev faj: hauv thawj lub lis piam ntawm kev kho mob nrog Amaril® M, qhov kev pheej hmoo ntawm kev mob ntshav qab zib nce zuj zus, uas yuav tsum tau saib xyuas tshwj xeeb. Nyob rau hauv kev mob uas qhov kev pheej hmoo ntawm kev mob ntshav qab zib yog nce (cov neeg mob tsis xav tau lossis tsis tuaj yeem koom tes nrog tus kws kho mob, feem ntau cov neeg laus laus, kev noj tsis zoo, noj zaub mov tsis xwm yeem, noj zaub mov noj, cov neeg mob uas tsis sib haum ntawm kev siv dag zog thiab kev noj zaub mov kom ntau, thaum hloov pauv) kev noj zaub mov, thaum haus dej haus uas muaj ethanol, tshwj xeeb tshaj yog nyob rau hauv kev sib xyaw nrog kev noj mov, nrog lub siab thiab lub raum ua haujlwm, nrog qee qhov tsis ua haujlwm ntawm endocrine, lawv raws li lub qog ua haujlwm lub qog ua rau lub cev, cov tshuaj hormones tsis ua haujlwm nyob rau hauv anterior pituitary thiab adrenal cortex, cuam tshuam rau cov metabolism hauv kev ua kom rog lossis ua haujlwm ntawm cov txheej txheem txhawm rau nce cov ntshav qabzib concentration thaum hypoglycemia, thaum txoj kev txhim kho ntawm cov kabmob sib kis thaum kho lossis hloov txoj kev ua neej (xws li cov neeg mob xav tau kev saib xyuas ntau ntxiv ntawm cov ntshav qabzib concentration thiab cov tsos mob ntawm cov ntshav qog ntshav qab zib, lawv yuav tsum tau txhaj koob tshuaj Amaril® M). Nrog kev siv qee cov tshuaj ib txhij. Hauv cov neeg mob laus (feem ntau lawv muaj qhov txo qis asymptomatic hauv lub raum ua haujlwm). Hauv cov xwm txheej uas lub raum kev ua haujlwm yuav phem dua ntxiv, xws li pib noj tshuaj tiv thaiv kabmob ntshav lossis tshuaj tua kab mob, nrog rau NSAIDs (muaj kev pheej hmoo ntawm lactic acidosis thiab lwm yam kev phiv tshuaj ntawm metformin). Thaum ua haujlwm hnyav lub cev (qhov kev pheej hmoo ntawm kev tsim mob lactic acidosis thaum noj metformin ntau ntxiv). Nrog rau kev ua kom tawg los yog tsis muaj cov tsos mob ntawm adrenergic antiglycemic txoj cai hauv kev teb rau kev txhim kho hypoglycemia (hauv cov neeg mob laus, nrog cov leeg mob hlwb los yog nrog kev kho mob nrog beta-blockers, clonidine, guanethidine thiab lwm yam sympatholytics, cov neeg mob xav tau kev saib xyuas ntau ntxiv ntawm cov ntshav qabzib) Cov. Thaum muaj cov piam thaj-6-phosphate dehydrogenase tsis muaj peev xwm (hauv cov neeg mob zoo li no, thaum noj sulfonylurea derivatives, hemolytic anemia yuav tshwm sim, yog li ntawd, kev siv lwm cov tshuaj hypoglycemic uas tsis yog sulfonylurea derivatives hauv cov neeg mob no yuav tsum tau xav).

Cev xeeb tub thiab lactation
Cov tshuaj no yog contraindicated hauv kev npaj cev xeeb tub.
Cov tshuaj yuav tsum tsis txhob noj thaum cev xeeb tub vim muaj qhov cuam tshuam tsis zoo ntawm kev loj hlob ntawm tus me nyuam hauv plab. Cov pojniam xeebtub thiab cov pojniam uas npaj yuav xeeb tub yuav tsum qhia lawv tus kws khomob.Thaum cev xeeb tub, cov poj niam muaj lub cev metabolism hauv lub cev tsis hnov ​​qab los ntawm kev noj zaub mov zoo thiab kev ua kom lub cev yuav tsum tau txais kev kho mob insulin.
Txhawm rau kom tsis txhob siv cov tshuaj nrog mis niam rau hauv tus menyuam lub cev, cov pojniam uas pub niam mis rau menyuam noj yuav tsum tsis txhob noj cov tshuaj no. Yog tias nws tsim nyog los ua cov kev kho mob hypoglycemic, tus neeg mob yuav tsum pauv mus rau kev kho mob insulin, txwv tsis pub nws yuav tsum tsis pub mis niam.

Cov lus qhia tshwj xeeb
Cov kab mob lactic acidosis
Cov kab mob lactic acidosis yog ib qho mob uas tsis tshua muaj tab sis mob hnyav (nrog kev tuag siab nyob rau qhov tsis muaj kev kho kom zoo) cov teeb meem metabolic uas tshwm sim vim kev txuam nrog metformin thaum kho. Cov kab mob ntawm cov kab mob lactic acidosis nrog metformin tau pom muaj feem ntau hauv cov neeg mob ntshav qab zib mellitus uas mob raum tsis ua haujlwm. Qhov tshwm sim ntawm cov kab mob lactic acid tuaj yeem thiab yuav tsum tau txo qis los ntawm kev txheeb xyuas qhov muaj lwm qhov kev pheej hmoo cuam tshuam rau cov kab mob lactic acidosis hauv cov neeg mob, xws li tswj ntshav qab zib mellitus, ketoacidosis, kev yoo mov ntev, haus dej haus ntau uas muaj ethanol, daim siab ua haujlwm rau lub siab, thiab tej yam kev mob nrog cov nqaij mos hypoxia.
Lactic acidosis yog tus cwj pwm mob los ntawm acidotic ua tsis taus pa, mob plab thiab hypothermia, nrog rau kev tsim kho tom qab. Kev kuaj pom kev kuaj ntshav yog ib qho kev nce siab ntawm lactate hauv cov ntshav (> 5 mmol / l), qhov pH ntawm cov ntshav tsawg dua, qhov kev ua txhaum ntawm cov dej-electrolyte tshuav nrog qhov nce ntawm qhov tsis txaus ntawm anions thiab piv ntawm lactate / pyruvate. Hauv qhov xwm txheej metformin ua rau cov kab mob lactic acidosis, ntshav plasma concentration ntawm metformin feem ntau yog 5 >g / ml. Yog tias xav tau cov kab mob lactic acidosis, metformin yuav tsum tsis ua haujlwm sai thiab tus neeg mob yuav tsum tau mus pw hauv tsev kho mob tam sim ntawd.
Qhov nquag qhia txog cov neeg muaj mob lactic acidosis hauv cov neeg mob noj cov tshuaj metformin muaj tsawg heev (li ntawm 0.03 mob / 1000 tus neeg mob-xyoo). Cov xwm ceeb toom feem ntau tau tshwm sim rau cov neeg mob ntshav qab zib mellitus uas mob raum tsis ua haujlwm, suav nrog nrog rau cov mob raum thiab cov raum hypoperfusion, feem ntau nyob rau hauv muaj ntau yam mob uas yuav tsum tau muaj kev kho mob thiab phais mob.
Kev phom sij ntawm cov kab mob lactic acid nce nrog rau qhov mob ua mob rau lub raum ua haujlwm thiab nrog lub hnub nyoog. Qhov ntxim nyiam ntawm lactic acidosis thaum noj cov tshuaj metformin tuaj yeem txo qis nrog kev soj ntsuam tas li ntawm kev ua haujlwm lub raum thiab kev siv tshuaj tsawg kawg ntawm metformin. Rau tib qho laj thawj, hauv kev mob cuam tshuam nrog hypoxemia los yog lub cev qhuav dej, nws yog ib qho tsim nyog kom tsis txhob noj Amaril® M.
Vim tias qhov ua rau lub siab ua haujlwm tsis zoo tuaj yeem txwv qhov tsis pom zoo ntawm lactate, kev siv Amaril® M yuav tsum zam rau cov neeg mob kuaj mob lossis kuaj pom tias muaj kab mob siab.
Ntxiv rau, kev tswj hwm ntawm Amaril® M yuav tsum tau txiav tawm ib ntus ua ntej xoo hluav taws xob nrog kev tshawb fawb hauv intravascular ntawm cov tshuaj iodine uas muaj cov tshuaj tiv thaiv kev cuam tshuam thiab ua ntej kev phais mob. Metformin yuav tsum tsis ua hauj lwm txuas ntxiv rau 48 xuaj moos ua ntej thiab 48 teev tom qab kev phais mob siv tshuaj loog dav dav.
Feem ntau cov kab mob lactic acidosis yuav tshwm sim zuj zus thiab pom los ntawm cov tsos mob tshwj xeeb, xws li kev noj qab haus huv tsis zoo, mob ntshav qab zib, ua pa tsis ua hauj lwm, nce tsaug zog thiab tsis meej tshwj xeeb mob plab. Nrog rau ntau cov kab mob acidosis, mob hypothermia, txo qis ntshav siab thiab tiv thaiv bradyarrhythmia muaj peev xwm ua tau. Tus neeg mob thiab tus kws kho mob koom yuav tsum paub tias cov tsos mob no tseem ceeb npaum li cas. Tus neeg mob yuav tsum qhia rau tus kws kho mob tam sim ntawd yog tias pom cov tsos mob tshwm sim.Txhawm rau kom paub tseeb txog kev kuaj mob ntawm cov kab mob lactic acidosis, nws yog qhov tsim nyog los txiav txim siab qhov concentration ntawm electrolytes thiab ketones hauv cov ntshav, cov concentration ntawm cov piam thaj hauv cov ntshav, pH ntawm cov ntshav, cov concentration ntawm lactate thiab metformin hauv cov ntshav. Kev yoo mov plasma plasma lactate concentration hauv kev ua kom cov ntshav sai sai, dhau qhov tsis txaus siab ntawm qhov ib txwm, tab sis qis dua 5 mmol / l hauv cov neeg mob noj metformin, tsis tas yuav qhia cov kab mob lactic acidosis, nws nce ntxiv tuaj yeem piav qhia los ntawm lwm cov txheej txheem, xws li tswj ntshav qab zib tsis zoo lossis rog rog, mob lub cev thauj khoom lossis cov cuab yeej tsis raug nyob rau hauv cov ntshav txhawm rau soj ntsuam.
Lub xub ntiag ntawm lactic acidosis nyob rau hauv tus neeg mob ntshav qab zib mellitus nrog metabolic acidosis thaum tsis muaj ketoacidosis (ketonuria thiab ketonemia) yuav tsum xav.
Cov kab mob lactic acidosis yog ib qho mob hnyav uas yuav tsum tau mus pw hauv tsev kho mob. Nyob rau hauv cov ntaub ntawv ntawm lactic acidosis, koj yuav tsum tam sim ntawd tsum tsis txhob noj Amaril® M thiab pib kev txhawb nqa dav dav. Metformin tshem tawm los ntawm cov ntshav siv hemodialysis nrog kev tshem tawm kom txog li ntawm 170 ml / min, yog li ntawd, nws raug nquahu, muab rau kom tsis muaj kev cuam tshuam hemodynamic, cuam tshuam sai rau hemodialysis kom tshem tawm cov tshuaj metformin thiab lactate. Cov kev ntsuas zoo li no feem ntau ua rau ploj sai ntawm cov tsos mob thiab rov qab.
Saib xyuas qhov ua tau zoo ntawm kev kho mob
Cov txiaj ntsig ntawm ib qho kev kho hypoglycemic yuav tsum tau saib xyuas txhua lub sijhawm los saib xyuas cov concentration ntawm cov piam thaj thiab glycosylated hemoglobin hauv cov ntshav. Lub hom phiaj ntawm kev kho mob yog ib txwm ua rau cov ntsuas no. Qhov concentration ntawm glycosylated hemoglobin tso cai rau kev soj ntsuam ntawm kev tswj glycemic.
Kev ntshav siab
Hauv thawj lub lim tiam ntawm kev kho mob, kev saib xyuas ceev faj yog qhov tsim nyog vim muaj kev pheej hmoo ntawm kev mob ntshav qab zib, tshwj xeeb nrog kev pheej hmoo ntawm nws txoj kev loj hlob (cov neeg mob tsis txaus siab lossis tsis ua raws li tus kws kho mob pom zoo, feem ntau cov neeg laus laus, noj zaub mov tsis zoo, noj zaub mov tsis xwm yeem, lossis zaub mov tsis zoo), nrog rau qhov tsis sib haum ntawm kev siv lub cev thiab kev noj haus carbohydrate, nrog rau kev hloov pauv ntawm kev noj zaub mov, nrog kev noj haus cawv, tshwj xeeb tshaj yog kev sib xyaw nrog kev noj mov, nrog lub raum tsis ua haujlwm, nrog rau qhov tsis zoo lub siab ua haujlwm, nrog qee qhov tsis raug teeb meem ntawm qhov endocrine system (piv txwv li, qee qhov kev ua haujlwm ntawm cov thyroid caj pas thiab cov tshuaj hormones tsis txaus nyob rau hauv anterior pituitary lossis adrenal cortex, thaum siv qee lwm yam tshuaj uas cuam tshuam rau cov metabolism metabolism.
Hauv cov xwm txheej zoo li no, yuav tsum tau saib xyuas kom ntshav qabzib ntau ntxiv. Tus neeg mob yuav tsum qhia tus kws kho mob txog cov kev pheej hmoo no thiab Cov tsos mob ntawm tus mob ntshav qab zib tsawg, yog tias muaj. Yog tias muaj kev pheej hmoo txaus rau cov ntshav siab ntshav qab zib, kev hloov kho cov tshuaj ntawm cov tshuaj no lossis txhua txoj kev kho mob yuav tsum tau ua. Cov hau kev no tau siv thaum muaj tus kab mob tshwm sim thaum kho lossis hloov pauv tus neeg mob lub neej. Cov tsos mob hypoglycemia, xav txog adrenergic antihypoglycemic cov kev cai hauv kev teb rau kev txhim kho hypoglycemia, tej zaum yuav muaj tsawg dua los yog tsis tuaj yeem yog tias hypoglycemia tsim kho maj mam, thiab nyob rau hauv cov neeg laus laus, nrog autonomic neuropathy lossis nrog kev kho mob nrog beta-blockers, clonidine, thiab lwm yam khuv xim.
Yuav luag txhua lub sijhawm, hypoglycemia tuaj yeem nres sai sai nrog kev noj sai ntawm carbohydrates (qabzib lossis qab zib, piv txwv li, ib qho qab zib, kua txiv txiv ntoo uas muaj suab thaj, tshuaj yej nrog qab zib). Rau lub hom phiaj no, tus neeg mob yuav tsum nqa tsawg kawg 20 g suab thaj. Tej zaum nws yuav xav tau kev pab los ntawm lwm tus kom zam dhau kev nyuaj. Kev hloov piam thaj yog qhov ua tsis tau zoo.
Los ntawm cov kev paub dhau los ntawm kev siv lwm yam tshuaj sulfonylurea, nws paub tias, txawm hais tias qhov pib siv tau los ntawm kev tiv thaiv tus cwj pwm, hypoglycemia tuaj yeem rov tshwm sim, yog li cov neeg mob yuav tsum nyob twj ywm nrog kev saib xyuas. Kev txhim kho ntawm cov ntshav qog ntshav hnyav yuav tsum tau txais kev kho mob sai thiab kev tswj hwm kev kho mob, qee kis, kev kho mob sab nrauv.
Kev qhia dav dav
Nws yog ib qho tsim nyog los tswj cov hom phiaj glycemia nrog kev pab cuam ntawm cov ntsuas: dhau los ua zaub mov noj thiab ua kom lub cev ua haujlwm, txo lub cev qhov hnyav, thiab yog tias tsim nyog, kev noj tshuaj tsis tu ncua ntawm cov tshuaj hypoglycemic. Cov neeg mob yuav tsum paub txog qhov tseem ceeb ntawm kev noj zaub mov kom ua tau zoo thiab ua kom tawm dag zog tas li.
Cov tsos mob hauv kev kho tsis txaus ntseeg cov ntshav glycemia suav nrog oliguria, nqhis dej, pathologically mob siab nqhis dej, daim tawv nqaij qhuav thiab lwm tus.
Yog tias tus neeg mob tau txais kev kho mob los ntawm kws kho mob tsis kho (piv txwv li, pw hauv tsev kho mob, kev sib tsoo, qhov xav tau mus ntsib kws kho mob ib hnub so), tus neeg mob yuav tsum qhia nws txog tus kab mob thiab kev kho ntshav qab zib.
Hauv cov xwm txheej ntxhov siab (piv txwv, raug mob, phais, tus kab mob kis nrog kub taub hau), tswj tau glycemic yuav tsis muaj zog, thiab kev hloov mus ib ntus rau kev kho tshuaj insulin tej zaum yuav tsum tau ua kom paub tseeb tias yuav tsum tau tswj kev noj haus.
Kev kuaj xyuas lub raum
Nws paub tias metformin tsuas yog tawm ntawm lub raum feem ntau. Nrog kev ua haujlwm tsis zoo hauv lub raum, qhov kev pheej hmoo ntawm kev txuam nrog metformin thiab kev txhim kho ntawm lactic acidosis nce. Thaum qhov kev ua kom cov ntshav creatinine tshaj li qhov muaj hnub nyoog siab ntawm qhov kev txwv, noj Amaryl® M tsis pom zoo. Rau cov neeg mob laus, ceev faj txog ib feem kaum ntawm koob tshuaj metformin yog qhov tsim nyog txhawm rau xaiv cov koob tshuaj tsawg kawg nkaus, txij li lub raum ua haujlwm poob qis nrog lub hnub nyoog. Cov raum ua haujlwm hauv cov neeg mob laus yuav tsum tau soj ntsuam txhua lub sijhawm thiab, raws li txoj cai, cov koob tshuaj metformin yuav tsum tsis txhob nce ntxiv rau nws qhov siab tshaj plaws txhua hnub.
Kev siv lwm cov tshuaj tsis haum yuav cuam tshuam rau lub raum kev ua haujlwm lossis kev tso tawm ntawm metformin, lossis ua rau muaj kev hloov pauv ntau ntawm cov ntshav.
Kev tshawb nrhiav xoo hluav taws xob nrog kev saib xyuas ntawm iodine-muaj cov tshuaj tiv thaiv tshuaj tiv thaiv (piv txwv li cov leeg mob urography, tso ntshav cholangiography, angiography thiab CT siv qhov nruab nrab nruab nrab): I / O-contrast iodine-muaj tshuaj uas npaj rau kev kuaj mob tuaj yeem ua rau mob raum tsis zoo, lawv siv yog txuam nrog kev tsim kho lactic acidosis hauv cov neeg mob noj cov tshuaj metformin. Yog tias qhov kev tshawb fawb no tau npaj tseg, Amaril® M yuav tsum raug muab tso tseg ua ntej txheej txheem thiab tsis rov ua dua li 48 teev tom qab kev kuaj mob .Amaril® kev kho mob tuaj yeem rov ua haujlwm tsuas yog tom qab soj ntsuam thiab tau txais cov kev ua haujlwm zoo li qub.
Cov mob uas ua tau hypoxia
Kev sib tsoo los yog poob siab ntawm ib qho keeb kwm, lub plawv tsis ua haujlwm, mob myocardial infarction, thiab lwm yam mob uas ua los ntawm cov nqaij mos hypoxemia thiab hypoxia kuj tuaj yeem ua rau lub raum tsis ua haujlwm thiab ua rau muaj kev pheej hmoo ntawm lactic acidosis. Yog tias cov neeg mob noj cov tshuaj no muaj cov xwm txheej zoo li no, lawv yuav tsum tsis txhob haus tshuaj ntxiv lawm.
Kev phais mob
Nrog rau kev npaj phais mob, yuav tsum tau txiav txoj kev kho nrog cov tshuaj no tsis pub dhau 48 teev (tshwj tsis yog cov txheej txheem me me uas tsis tas yuav txwv kev noj zaub mov thiab kua), kev kho mob tsis tuaj yeem rov ua dua kom txog thaum noj ntawm qhov ncauj rov qab thiab lub raum ua haujlwm tau lees paub qhov qub.
Cawv (dej qab zib muaj ethanol)
Ethanol raug paub los txhim kho cov nyhuv ntawm metformin ntawm lactate metabolism. Cov neeg mob yuav tsum tau ceev faj txog kev noj haus uas muaj ethanol thaum noj Amaril® M.
Lub siab ua haujlwm tsis zoo
Txij li thaum cov kab mob lactic acid tau cuam tshuam nrog lub siab ua haujlwm tsis zoo hauv qee kis, cov neeg mob kuaj mob lossis kuaj pom ntawm daim siab ua kom lub siab yuav tsum zam kom tsis txhob siv cov tshuaj no.
Hloov pauv mus rau lub chaw kho mob tus neeg mob uas muaj ntshav qab zib uas tau tswj dhau los
Tus neeg mob ntshav qab zib mellitus, yav dhau los ua tau zoo los ntawm kev siv cov tshuaj metformin, yuav tsum tau kuaj tam sim ntawd, tshwj xeeb tshaj yog muaj kab mob tsis meej thiab tsis paub tus kab mob, kom tsis suav nrog ketoacidosis thiab lactic acidosis. Txoj kev tshawb fawb yuav tsum muaj: kev txiav txim siab cov ntshav electrolytes thiab ketone lub cev, ntshav siab nyob hauv siab thiab, yog tias tsim nyog, ntshav pH, ntshav tsom ntawm lactate, pyruvate thiab metformin. Thaum muaj ib hom kev mob acidosis, Amaril® M yuav tsum tau txiav tawm tam sim ntawd thiab lwm yam tshuaj uas tau tswj hwm kom tswj tau glycemic.
Tus Neeg Mob Cov Ntaub Ntawv
Cov neeg mob yuav tsum tau txais kev ceeb toom txog cov kev pheej hmoo thiab cov txiaj ntsig ntawm cov tshuaj no, nrog rau cov kev xaiv kho lwm yam. Nws kuj tseem yuav tsum tau qhia meej meej txog qhov tseem ceeb ntawm kev ua raws li kev noj zaub mov zoo, ua haujlwm lub cev ua si thiab soj ntsuam cov teeb meem ntawm cov piam thaj hauv ntshav, glycosylated hemoglobin, lub raum ua haujlwm thiab hematological tsis tseem ceeb, nrog rau kev pheej hmoo ntawm kev txhim kho hypoglycemia, nws cov tsos mob thiab kev kho mob, nrog rau cov xwm txheej predisposing rau nws txoj kev loj hlob.
Cov concentration ntawm cov vitamins B12 hauv cov ntshav
Kev poob qis hauv kev cia siab ntawm cov vitamins B12 hauv cov dej hauv qab cov txheej txheem hauv qhov tsis muaj kev soj ntsuam tau pom nyob hauv kwv yees li ntawm 7% ntawm cov neeg mob noj Amaril® M, txawm li cas los xij, nws tsis tshua muaj kev mob ntshav siab thiab muaj kev thim rov qab thaum cov tshuaj no tau raug muab tso tseg lossis thaum noj tshuaj vitamin B12. Cov neeg mob uas tsis muaj txaus noj lossis tsis muaj kab mob txaus rau cov vitamin B12 feem ntau yog qhov tsawg dua cov vitamin B12 ntau. Rau cov neeg mob li no, tsis tu ncua, txhua 2-3 xyoo, kev txiav txim siab cov ntshav vitamin B12 ntau nyob rau hauv cov ntshav cov ntshav yuav pab tau.
Kuaj mob kev nyab xeeb kev tswj hwm
Hematological ciaj ciam (hemoglobin lossis hematocrit, ntshav liab rau cov ntshav liab) thiab lub raum kev ua haujlwm (cov ntshav siab creatinine concentration) yuav tsum tau saib xyuas tsawg kawg ib xyoos ib zaug hauv cov neeg mob uas lub cev tsis ua haujlwm zoo, thiab tsawg kawg 2-4 zaug hauv ib xyoo hauv cov neeg mob uas muaj creatinine concentration. hauv kev ntshiab ntawm VGN thiab hauv cov neeg laus laus. Yog tias tsim nyog, tus neeg mob tau pom tias tsim nyog kuaj thiab kho ntawm ib qho pom tseeb ntawm kev hloov pauv pathological. Txawm hais tias qhov tseeb tias kev txhim kho megaloblastic anemia tsis tshua pom muaj thaum noj cov tshuaj metformin, yog tias nws xav tias tsam, kev soj ntsuam yuav tsum tau ua kom tsis suav nrog kev tsis txaus cov vitamin B12.

Cuam tshuam rau kev muaj peev xwm tsav tsheb thiab lwm cov txheej txheem xav tau nce siab mloog
Tus neeg mob cov tshuaj tiv thaiv tus kab mob yuav ploj zuj zus vim qhov mob ntshav qab zib thiab hyperglycemia, tshwj xeeb tshaj yog thaum pib kho lossis tom qab hloov pauv kev kho, lossis nrog kev siv tshuaj tsis xwm yeem. Qhov no yuav cuam tshuam rau kev muaj peev xwm ntawm kev tsav tsheb thiab koom nrog hauv lwm yam kev phom sij.
Cov neeg mob yuav tsum tau ceeb toom txog qhov yuav tsum tau ceev faj thaum tsav tsheb, tshwj xeeb tshaj yog thaum muaj tus yam ntxwv yuag yuag dhau los thiab / lossis qhov txo qis ntawm qhov hnyav ntawm nws cov ua ntej.

Muaj pes tsawg leeg
1 ntsiav tshuaj muaj:
Cov tshuaj yeeb tshuaj: glimepiride micronized 2 mg, metformin hydrochloride 500 mg.
Cov kev zam: lactose monohydrate, sodium carboxymethyl hmoov txhuv nplej siab, povidone K30, microcrystalline cellulose, crospovidone, magnesium stearate.
Cov muaj pes tsawg leeg ntawm cov zaj duab xis membrane: hypromellose, macrogol 6000, titanium dioxide (E171), carnauba ciab.

Tsuas tshuaj thiab tswj hwm
Raws li txoj cai, koob tshuaj ntawm Amaril® M yog txiav txim los ntawm lub hom phiaj concentration ntawm cov piam thaj hauv tus neeg mob cov ntshav. Qhov tshuaj tiv thaiv qis qis txaus kom ua tiav qhov kev tswj hwm metabolic tsim nyog yuav tsum tau siv.
Thaum kho nrog Amaril® M, nws yog ib qho tsim nyog yuav tsum tau txiav txim siab tsis tu ncua cov concentration ntawm cov piam thaj hauv cov ntshav. Tsis tas li ntawd, kev soj ntsuam tas li ntawm qhov feem pua ​​ntawm glycosylated hemoglobin hauv cov ntshav tau pom zoo.
Qhov tsis zoo ntawm kev siv tshuaj, piv txwv li, hla kev siv tshuaj ntxiv, yuav tsum tsis txhob ntxiv los ntawm kev noj tshuaj ntxiv tom qab ntawm qhov siab dua.
Tus neeg mob cov kev coj ua thaum muaj qhov yuam kev thaum noj cov tshuaj (tshwj xeeb, thaum tsis txhaj koob tshuaj ntxiv lossis noj zaub mov noj), lossis cov xwm txheej uas tsis tuaj yeem siv tshuaj, yuav tsum tau tham ua ntej los ntawm tus neeg mob thiab tus kws kho mob.
Vim hais tias Txij li thaum kev tswj cov metabolic cuam tshuam nrog kev nce hauv cov nqaij hauv kev tiv thaiv insulin, qhov kev xav tau rau glimepiride tuaj yeem txo qis thaum kho nrog Amaril® M. Txhawm rau kom tsis txhob muaj kev txhim kho hypoglycemia, nws yog ib qho tsim nyog kom txo cov koob tshuaj lossis tsis noj tshuaj Amaril® M.
Amaryl® M yuav tsum noj 1 lossis 2 zaug / hnub nrog zaub mov noj.
Qhov siab tshaj plaws ntawm kev txhaj tshuaj metformin rau ib koob yog 1000 mg.
Qhov siab tshaj plaws niaj hnub noj tshuaj: rau glimepiride - 8 mg, rau metformin - 2000 mg.
Tsuas yog tsawg tus neeg mob muaj cov tshuaj zoo dua txhua hnub ntawm glimepiride ntau dua 6 mg.
Txhawm rau kom zam dhau kev txhim kho hypoglycemia, koob tshuaj pib ntawm Amaril® M yuav tsum tsis pub tshaj qhov niaj hnub noj ntawm glimepiride thiab metformin uas tus neeg mob tau noj. Thaum hloov mus rau cov neeg mob los ntawm kev noj ua ke los ntawm cov tib neeg npaj ntawm glimepiride thiab metformin rau Amaryl® M, nws cov koob tshuaj tau txiav txim siab raws li kev siv tshuaj tiv thaiv ntawm glimepiride thiab metformin raws li kev npaj cais. Yog tias nws tsim nyog txhawm rau nce koob tshuaj, koob tshuaj txhua hnub ntawm Amaryl® M yuav tsum tau titrated hauv nce ntxiv tsuas yog 1 ntsiav tshuaj ntawm Amaryl® M 1 mg + 250 mg lossis 1/2 ntsiav tshuaj ntawm Amaryl® M 2 mg + 500 mg.
Lub sijhawm kho: Amaril® M feem ntau kho rau lub sijhawm ntev.
Kev kawm txog kev nyab xeeb thiab ua haujlwm ntawm cov tshuaj hauv cov menyuam yaus uas muaj ntshav qab zib hom 2 tsis tau ua.
Nws paub tias metformin raug tso tawm feem ntau los ntawm lub raum, thiab txij li qhov kev pheej hmoo ntawm kev tsim muaj cov kev mob hnyav rau metformin hauv cov neeg mob uas lub raum tsis ua haujlwm zoo dua, nws tuaj yeem siv rau cov neeg mob uas lub raum tsis ua haujlwm. Vim yog qhov tseeb tias nrog lub hnub nyoog, lub raum ua haujlwm poob qis, hauv cov neeg mob laus metformin yuav tsum siv nrog ceev faj. Cov koob tshuaj yuav tsum tau ua tib zoo xaiv thiab ua tib zoo thiab kev saib xyuas ntawm lub raum kev ua haujlwm yuav tsum ua kom ntseeg tau.

Sab sij huam
Glimepiride + metformin
Kev siv ntawm kev sib xyaw ua ke ntawm glimepiride thiab metformin, ob qho tib si hauv kev sib koom ua ke pub dawb los ntawm cov tib neeg npaj tau ntawm glimepiride thiab metformin, thiab raws li kev npaj ua ke nrog cov koob tshuaj tiv thaiv glimepiride thiab metformin, cuam tshuam nrog tib cov yam ntxwv kev nyab xeeb raws li kev siv txhua ntawm cov tshuaj cais.
Glimepiride
Raws li kev paub dhau los ntawm kev kho mob nrog glimepiride thiab paub cov ntaub ntawv ntawm lwm cov sulfonylurea derivatives, kev txhim kho ntawm cov kev phiv tshuaj uas tau sau hauv qab yog ua tau.
Los ntawm ib sab ntawm cov metabolism thiab khoom noj khoom haus: kev txhim kho hypoglycemia yog ua tau, uas tuaj yeem tawm tsam. Cov tsos mob ntawm kev txhim kho hypoglycemia - mob taub hau, mob tshaib plab, xeev siab, ntuav, tsis muaj zog, qaug zog, pw tsaug zog, ntxhov siab, ntxhov siab, tsis tshua mloog siab, tsis meej pem thiab maj mam muaj lub siab xav, kev nyuaj siab, tsis meej pem, hais lus tsis meej, tsis meej pem, tsis pom kev, tshee tshee, paresis, hnov ​​qhov tsis txaus ntseeg, kiv taub hau, tsis paub pab, tsis tuaj yeem tswj tus kheej, delirium, cramps, tsaug zog thiab tsis nco qab mus txog txoj kev txhim kho tsis nco qab, ua tsis taus pa thiab bradycardia.Tsis tas li ntawd, kev txhim kho cov tsos mob ntawm adrenergic tiv thaiv glycemic txoj cai nyob rau hauv teb rau kev txhim kho hypoglycemia, xws li nce hws, nplaum ntawm daim tawv nqaij, nce kev ntxhov siab, tachycardia, ntshav nce siab, ib qho kev xav ntawm lub plawv dhia, angina pectoris thiab lub plawv kev ntxhov siab. Cov duab hauv chav saib xyuas txog qhov kev mob ntawm kev mob ntshav siab ntau ntawm lub cev yuav zoo ib yam li kev ua txhaum ntawm cov ntshav ncig ntawm lub hlwb. Cov tsos mob yuav luag txhua lub sijhawm tom qab kev tshem tawm ntawm hypoglycemia.
Los ntawm ob sab ntawm cov khoom hauv nruab nrog ntawm lub zeem muag: pom kev ib ntus, tshwj xeeb tshaj yog thaum pib kho, vim muaj kev hloov pauv hauv cov concentration ntawm cov piam thaj hauv cov ntshav. Yog vim li cas rau qhov tsis pom kev tsis pom kev zoo yog ib qho kev hloov mus ib ntus rau qhov o ntawm lub qhov muag, nyob ntawm qhov kev nyeem ntawm cov piam thaj hauv cov ntshav, thiab vim qhov no tau hloov pauv hauv lawv qhov ntsuas refractive.
Los ntawm lub plab zom mov: kev txhim kho lub plab ua haujlwm tshwm sim xws li xeev siab, ntuav, zoo nkaus li lub plab tag nrho, mob plab thiab raws plab.
Nyob rau ntawm daim siab thiab nplooj siab: kab mob siab, nce kev ua haujlwm ntawm daim siab enzymes thiab / lossis cholestasis thiab jaundice, uas tuaj yeem ua rau lub siab ua rau lub siab tsis ua haujlwm, tab sis yuav muaj kev txhim kho rov qab tom qab tshem tawm ntawm glimepiride.
Los ntawm cov kab mob hemopoietic: thrombocytopenia, qee kis - leukopenia lossis hemolytic anemia, erythrocytopenia, granulocytopenia, agranulocytosis lossis pancytopenia. Tom qab cov tshuaj tau nkag mus rau hauv kev ua lag luam, cov mob ntawm thrombocytopenia (nrog platelet suav tsawg dua 10,000 / μl) thiab thrombocytopenic purpura tau piav qhia.
Kev tiv thaiv kab mob hauv lub cev: ua xua lossis pseudo-ua xua (xws li, khaus, urticaria, lossis ua pob xua). Cov kev tshwm sim no yuav luag txhua zaus muaj mob me, tab sis tuaj yeem nkag mus rau hauv daim ntawv hnyav nrog ua tsis taus pa lossis txo qis ntshav siab, nce mus rau kev loj hlob ntawm anaphylactic kev poob siab. Thaum raug mob hnyav ntawm tus mob urticaria, tus kws kho mob yuav tsum tau qhia paub sai li sai tau. Kev phiv khaub thuas muaj peev xwm ua tau nrog lwm cov sulfonylurea derivatives, sulfonamides, lossis lwm yam zoo sib xws. Kev ua xua vasculitis.
Lwm yam: photosensitization, hyponatremia.
Metformin
Los ntawm sab ntawm cov metabolism: lactic acidosis.
Los ntawm cov txheej txheem hauv plab: kev mob plab zom mov (xeev siab, ntuav ua kom raws plab, mob plab, muaj roj ntxiv, ua pa thiab mob plab) - cov tshuaj tiv thaiv feem ntau nrog metformin monotherapy - yog kwv yees li 30% feem ntau dua li siv cov placebo, tshwj xeeb tshaj yog thaum xub thawj lub sij hawm ntawm kev kho mob. Cov tsos mob no feem ntau tsuas yog ib ntus xwb, nrog kev kho mob txuas ntxiv ntaws mus. Muaj qee kis, kev txo qhov txo tshuaj ib ntus tej zaum yuav pab tau. Vim tias qhov tseeb hais tias kev txhim kho ntawm lub plab zom mov thaum pib ntawm kev kho mob yog noj tshuaj, cov tsos mob no tuaj yeem txo qis los ntawm kev nce qib zuj zus thiab noj tshuaj nrog zaub mov. Txij thaum mob plab zawv heev thiab / lossis ntuav tuaj yeem ua rau lub cev qhuav dej thiab prerenal azotemia, thaum lawv tshwm sim, koj yuav tsum tso tseg ib ntus noj tshuaj Amaril® M. Qhov tsos mob tsis pom kev zoo rau cov neeg mob ntshav qab zib hom 2 mob ntshav qab zib, nrog lub xeev ruaj khov thaum noj Amaril ® M tuaj yeem cuam tshuam tsis tsuas yog kho nrog kev kho mob, tab sis kuj cuam tshuam nrog cov kab mob sib kis lossis kev loj hlob ntawm lactic acidosis.
Thaum pib kho nrog metformin, kwv yees li 3% ntawm cov neeg mob yuav hnov ​​qhov tsis kaj siab lossis xim hlau hauv qhov ncauj, uas feem ntau ploj mus tas li.
Ntawm ib feem ntawm daim siab thiab kab mob biliary: kev ntsuam xyuas lub siab ua haujlwm tsis zoo los yog mob rau daim siab, uas tau txais kev tsim kho rov qab thaum metformin tau txiav tawm. Nrog rau kev txhim kho ntawm cov saum toj no lossis lwm yam kev tsis haum siab, tus neeg mob yuav tsum qhia koj tus kws kho mob tam sim no. Txij li qee qhov tsis xav hnov ​​txog, xws li.hypoglycemia, lactic acidosis, hematologic ntshawv siab, kev ua xua nyhav thiab pseudo-ua xua thiab lub siab ua haujlwm tuaj yeem hem neeg mob lub neej, yog tias muaj kev cuam tshuam loj tuaj, tus neeg mob yuav tsum qhia nws tus kws kho mob tam sim ntawd txog qhov no thiab nres cov tshuaj ntxiv ua ntej tau txais lus qhia los ntawm kws kho mob.
Ntawm ib feem ntawm daim tawv nqaij thiab cov nqaij mos ua pob: erythema, khaus, pob.
Los ntawm cov kab mob hemopoietic: ua haujlwm ntshav, leukocytopenia lossis thrombocytopenia. Hauv cov neeg mob noj Metformin ntev ntev, feem ntau muaj qhov asymptomatic txo qis hauv kev ua kom muaj cov vitamins B12 hauv cov ntshav cov ntshav vim tias qhov txo qis hauv nws txoj hnyuv nqus. Yog tias tus neeg mob megaloblastic ua haujlwm tsis txaus, muaj peev xwm txo qhov nqus ntawm cov vitamin B12 cuam tshuam nrog kev siv tshuaj metformin yuav tsum txiav txim siab.

Yeeb tshuaj sib cuam tshuam
Kev cuam tshuam ntawm glimepiride nrog lwm yam tshuaj
Thaum tus neeg mob noj glimepiride raug kho lossis tso tseg tib lub sijhawm, lwm yam tshuaj muaj peev xwm ua tau, yam tsis xav tau muaj peev xwm ua tau: ntxiv dag zog lossis txo qis ntawm cov nyhuv hypoglycemic ntawm glimepiride. Raws li kev paub dhau los hauv chaw kho mob nrog glimepiride thiab lwm yam sulfonylureas, kev sib cuam tshuam tshuaj nyob hauv qab no yuav tsum raug txiav txim siab.
Nrog rau cov tshuaj uas yog inducers thiab inhibitors ntawm CYP2C9 isoenzyme: glimepiride yog metabolized nrog kev koom tes ntawm CYP2C9 isoenzyme. Nws cov metabolism yog cuam tshuam los ntawm kev siv lub zog sib luag ntawm cov CYP2C9 isoenzyme, piv txwv li, rifampicin (qhov kev pheej hmoo ntawm txo qis hypoglycemic effect ntawm glimepiride thaum siv nrog inducers ntawm CYP2C9 isoenzyme thiab nce qhov kev pheej hmoo ntawm hypoglycemia yog tias lawv raug tso tseg tsis muaj kev kho mob ntawm cov tshuaj tiv thaiv kab mob gl2 (C2). nce kev pheej hmoo ntawm hypoglycemia thiab phiv los ntawm glimepiride thaum noj tib lub sijhawm nrog inhibitors ntawm isoenzyme CYP2C9 thiab qhov kev pheej hmoo ntawm txo qis hauv nws lub qog ntshav qab zib cuam ​​tshuam thaum lawv raug muab tso tseg yam tsis muaj kev hloov kho ntawm glimepiride).
Nrog rau cov tshuaj uas txhim kho cov nyhuv hypoglycemic ntawm glimepiride: tshuaj insulin thiab hypoglycemic rau kev tswj hwm qhov ncauj, ACE inhibitors, anabolic steroids, txiv neej pw ua ke, chloramphenicol, indirect anticoagulants, coumarin derivatives, cyclophosphamide, disopyramide, phenfluramine fenamides, fenamides, MAO inhibitors, miconazole, fluconazole, aminosalicylic acid, pentoxifylline (koob tshuaj parenterally), phenylbutazone, azapropazone, oxyphenbutazone, probenecid, anti nthuav dav cov tshuaj quinolone derivatives, salicylates, sulfinpyrazone, clarithromycin, sulfa antimicrobials, tetracyclines, tritokvalin, trofosfamide: kev raug mob ntawm hypoglycemia, thaum lub sij hawm siv cov tshuaj nrog glimepiride thiab txoj kev pheej hmoo ntawm deterioration ntawm glycemic tswj nyob rau ntawm lawv tshem tawm tsis kho tshuaj ntawm glimepiride.
Nrog rau cov tshuaj uas ua rau cov ntshav hypoglycemic tsis muaj zog: acetazolamide, barbiturates, glucocorticosteroids, diazoxide, diuretics, epinephrine (adrenaline) lossis lwm yam sympathomimetics, glucagon, laxatives (siv sijhawm ntev), nicotinic acid (qib siab), estrogens, progestogens, phenothiazines, riphenit cov thyroid cov tshuaj hormones: qhov phom sij ntawm kev ua kom glycemic tswj thaum siv ua ke nrog cov tshuaj no thiab nce qhov kev pheej hmoo ntawm hypoglycemia yog tias lawv muab tso tseg tsis muaj kev kho mob ntawm glimepiride.
Nrog histamine H2 receptor blockers, beta-adrenergic blockers, clonidine, reserpine, guanethidine: nws muaj peev xwm nce lossis txo qis cov nyhuv hypoglycemic ntawm glimepiride. Yuav tsum tau ua tib zoo soj ntsuam cov ntshav qabzib hauv siab.Beta-blockers, clonidine, guanethidine thiab reserpine los ntawm kev thaiv qhov tsis haum ntawm cov leeg hlwb qhov kev xav nyob rau hauv kev teb rau hypoglycemia tuaj yeem ua rau kev txhim kho hypoglycemia pom ntau dua rau tus neeg mob thiab tus kws kho mob thiab yog li qhov kev pheej hmoo ntawm nws tshwm sim.
Nrog ethanol: mob siv ntev thiab ntev ntawm ethanol tuaj yeem tsis muaj kev cia siab yuav ua rau tsis muaj zog lossis txhim kho qhov hypoglycemic ntawm glimepiride.
Nrog cov anticoagulants tsis ncaj, coumarin derivatives: glimepiride tuaj yeem ob leeg txhim kho thiab txo cov txiaj ntsig ntawm kev tsis ncaj ntawm anticoagulants, coumarin derivatives.
Nrog cov kev faib tawm ntawm cov kua tsib cov kua qaub: lub log-phau ntawv khi rau glimepiride thiab txo qhov nqus ntawm glimepiride los ntawm cov hnyuv. Kev siv ntawm glimepiride, tsawg kawg 4 teev ua ntej kev noj ntawm cov leeg ua mob, ib qho kev cuam tshuam twg tsis pom. Yog li no, glimepiride yuav tsum tau noj tsawg kawg 4 teev ua ntej coj log log.

Kev cuam tshuam ntawm metformin nrog lwm cov tshuaj
Tsis pom zoo kev sib txuas ua ke
Nrog ethanol: nyob rau hauv cov cawv qaug cawv, muaj kev pheej hmoo ntawm kev tsim muaj cov kab mob lactic acidosis, tshwj xeeb tshaj yog muaj kev txav los yog noj zaub mov tsis txaus, muaj lub siab ua haujlwm. Tsis txhob haus cawv (ethanol) thiab tshuaj ethanol uas muaj tshuaj.
Nrog rau cov tshuaj tiv thaiv kab mob iodine: kev tswj hwm ntawm cov tshuaj tiv thaiv iodine uas muaj cov tshuaj tiv thaiv tsis zoo tuaj yeem ua rau lub raum tsis ua haujlwm, uas ua rau muaj kev txuam nrog metformin thiab muaj kev pheej hmoo ntxiv ntawm lactic acidosis. Metformin yuav tsum tsis ua haujlwm ntxiv ua ntej qhov kev tshawb fawb lossis thaum lub sijhawm kawm thiab yuav tsum tsis txhob ua dua tshiab nyob rau hauv 48 teev tom qab nws, rov pib dua ntawm metformin yog ua tau tsuas yog tom qab kev tshawb nrhiav thiab cov qub ntsuas ntawm lub raum kev ua haujlwm tau txais.
Nrog rau cov tshuaj tua kab mob nrog qhov tshaj tawm cov nyhuv nephrotoxic (gentamicin): muaj kev pheej hmoo ntawm cov kab mob lactic acidosis.
Kev sib xyaw ua ke ntawm cov tshuaj nrog metformin uas yuav tsum ceev faj
Nrog GCS (cov kab ke thiab rau hauv zos), beta2-adrenostimulants thiab diuretics nrog sab hauv hyperglycemic kev ua haujlwm: tus neeg mob yuav tsum paub txog qhov kev xav tau los mus soj ntsuam ntau dua thaum sawv ntxov cov ntshav qabzib hauv cov ntshav, tshwj xeeb tshaj yog thaum pib ntawm kev sib xyaw ua ke. Tej zaum nws yuav tsim nyog los kho lub koob tshuaj ntawm kev kho hypoglycemic thaum siv los yog tom qab txiav tawm cov tshuaj saum toj no.
Nrog ACE inhibitors: ACE inhibitors yuav txo cov ntshav qabzib. Kev siv tshuaj ntau dua ntawm kev kho ntshav kho lub qog tuaj yeem xav tau thaum siv lossis tom qab rho tawm ntawm ACE inhibitors.
Nrog rau cov tshuaj uas txhim kho cov nyhuv hypoglycemic ntawm metformin: insulin, sulfonylureas, anabolic steroids, guanethidine, salicylates (suav nrog acetylsalicylic acid), beta-blockers (suav nrog propranolol), MAO inhibitors: thaum siv cov tshuaj no ib txhij nrog metformin, ua tib zoo saib xyuas tus neeg mob thiab tswj kev saib xyuas cov ntshav qabzib hauv cov ntshav yog qhov tsim nyog, vim nws muaj peev xwm nce hypoglycemic effect ntawm metformin.
Nrog rau cov tshuaj uas ua rau cov ntshav hypoglycemic ua rau metformin: epinephrine, corticosteroids, cov thyroid hormones, estrogens, pyrazinamide, isoniazid, nicotinic acid, phenothiazines, thiazide diuretics thiab diuretics ntawm lwm pab pawg, qhov ncauj tiv thaiv kab mob, phenytoin, sympathomimetics, qeeb qeeb-thaiv cov tshuaj tiv thaiv: ntawm cov tshuaj no nrog metformin, ua tib zoo saib xyuas tus neeg mob thiab saib xyuas cov concentration ntawm cov piam thaj hauv cov ntshav yog qhov tsim nyog, vim tias ua tau kom tsis muaj zog ntawm cov nyhuv hypoglycemic.
Kev sib cuam tshuam rau hauv qhov kev txiav txim
Nrog furosemide: hauv kev tshawb fawb soj ntsuam txog kev sib cuam tshuam ntawm metformin thiab furosemide thaum noj ib zaug hauv cov neeg ua haujlwm noj qab haus huv, nws tau pom tias kev siv cov tshuaj no ib txhij cuam tshuam rau lawv cov pharmacokinetic. Furosemide nce Cmax ntawm metformin hauv ntshav ntshav los ntawm 22%, thiab AUC los ntawm 15% yam tsis muaj kev hloov pauv tseem ceeb hauv kev ua haujlwm ntawm lub raum ua kom tshem tawm ntawm metformin. Thaum siv nrog metformin, Cmax thiab AUC ntawm furosemide poob qis los ntawm 31% thiab 12%, feem, piv nrog furosemide monotherapy, thiab lub davhlau ya nyob twg T1 / 2 poob los ntawm 32% yam tsis muaj kev hloov tseem ceeb hauv lub raum kev ua kom huv ntawm furosemide. Cov ntaub ntawv ntawm kev sib cuam tshuam ntawm metformin thiab furosemide nrog kev siv ntev yog tsis muaj.
Nrog nifedipine: nyob rau hauv kev tshawb fawb soj ntsuam ntawm kev sib cuam tshuam ntawm metformin thiab nifedipine nrog tib koob hauv cov neeg tuaj yeem noj qab haus huv, nws tau qhia tias kev siv nifedipine tib lub sijhawm nce Cmax thiab AUC ntawm metformin hauv ntshav plasma los ntawm 20% thiab 9%, thiab, thiab tseem nce cov tshuaj metformin tawm hauv cov raum. Metformin muaj cov kev cuam tshuam tsawg kawg rau ntawm pharmacokinetics ntawm nifedipine.
Nrog rau cov tshuaj cationic (amiloride, dicogsin, morphine, procainamide, quinidine, quinine, ranitidine, triamteren, trimethoprim thiab vancomycin): cov tshuaj cationic tshem tawm los ntawm tubular secretion nyob rau hauv lub raum yog qhov ua tau zoo sib cuam tshuam nrog metformin uas yog qhov txiaj ntsig ntawm kev sib tw rau cov kev ua haujlwm ntawm cov tubular thauj. Qhov kev sib cuam tshuam ntawm metformin thiab qhov ncauj cimetidine tau pom nyob rau hauv cov neeg tuaj yeem noj qab haus huv hauv kev soj ntsuam kev sib raug zoo ntawm kev sib txuam ntawm metformin thiab cimetidine nrog ib qho thiab siv ntau, qhov twg muaj 60% nce rau hauv ntshav Cmax thiab tag nrho cov ntshav metformin concentration thiab 40% nce hauv ntshav thiab tag nrho cov metformin AUC. Nrog ib qho tshuaj kho ib qho, tsis muaj dab tsi hloov T1 / 2. Metformin tsis cuam tshuam dabtsi rau pharmacokinetics ntawm cimetidine. Txawm hais tias qhov kev sib txuam no tseem yog qhov tseem ceeb theoretical (tshwj tsis yog cimetidine), kev saib xyuas ntawm cov neeg mob yuav tsum tau ua kom zoo dua thiab cov kev hloov kho ntawm cov tshuaj metformin thiab / lossis cov tshuaj sib cuam tshuam nrog nws yuav tsum tau ua nyob rau hauv kev sib txig ua ke ntawm kev siv tshuaj cationic uas tawm ntawm lub cev los ntawm cov kab ke zais ntawm cov tub ntxhais ntawm lub raum.
Nrog propranolol, ibuprofen: hauv kev noj qab haus huv cov neeg tuaj pab hauv kev tshawb fawb txog ib koob tshuaj metformin thiab propranolol, zoo li metformin thiab ibuprofen, tsis muaj kev hloov pauv hauv lawv cov tsis muaj tshuaj.

Noj ntau dhau
Glimepiride noj overdose
Cov tsos mob: txij li Amaril® M muaj cov tshuaj glimepiride, ib qho kev noj ntau dhau (ob qho tib si mob thiab ntev ntev ntawm kev siv tshuaj hauv cov tshuaj siab) tuaj yeem ua rau mob ntshav qab zib ntshav hnyav.
Cov kev kho mob: kom sai li sai sai ntawm kev txhaj tshuaj ntawm glimepiride, koj yuav tsum qhia koj tus kws kho mob sai.
Ua ntej tus kws kho mob tuaj txog, tus neeg mob yuav tsum noj qab zib tam sim ntawd, yog tias ua tau, hauv daim ntawv dextrose (qabzib).
Cov neeg mob uas tau noj cov tshuaj glimepiride ua lub neej yuav tsum muaj plab zom mov thiab ua kom raug hluav ncaig. Qee zaum, raws li kev tiv thaiv kab mob, kev saib xyuas tsev kho mob yog qhov tsim nyog. Cov ntshav qog ntshav me me uas tsis muaj qhov tsis nco qab thiab ua rau cov leeg hlwb yuav tsum tau kho nrog qhov ncauj ntawm dextrose (qabzib) thiab kev kho mob ntawm Amaril® M thiab / lossis tus neeg mob noj zaub mov noj. Kev tshuaj xyuas kom zoo yuav tsum tau txuas ntxiv mus kom txog thaum tus kws kho mob paub tseeb tias tus neeg mob tsis muaj kev phom sij (nws yuav tsum tau ris lub siab tias qhov mob ntshav qab zib tsawg tuaj yeem tshwm sim ntxiv tom qab pib kho rau cov ntshav qabzib feem ntau hauv cov ntshav).
Cov kev noj tshuaj ntau dhau thiab qhov rov qab mob hypoglycemic nrog cov tsos mob xws li tsis nco qab lossis lwm tus mob loj ntawm cov mob paj hlwb yog cov mob tseem ceeb uas yuav tsum tau mus pw hauv tsev kho mob sai. Hauv lub xeev tsis nco qab ntawm tus neeg mob, kev qhia txog cov tshuaj muaj qabzib (dextrose) hauv / hauv dav hlau, piv txwv li, rau cov neeg laus pib nrog 40 ml ntawm 20% kev daws teeb meem ntawm qabzib (dextrose).
Lwm txoj hauv kev kho mob hauv cov neeg laus yog kev tswj hwm ntawm glucagon, piv txwv li ntawm koob tshuaj 0.5 txog 1 mg iv, s / c lossis i / m.
Tus neeg mob yog ua tib zoo saib rau tsawg kawg 24-48 teev, vim tiasTom qab pom tseeb tias cov chaw kho mob rov qab, cov qog ntshav qab zib yuav rov mob dua.
Txoj kev pheej hmoo ntawm rov tshwm sim ntawm cov ntshav qab zib hauv cov neeg mob hnyav nrog kev tiv thaiv ntev yuav nyob ntev rau ob peb hnub.
Thaum kho cov ntshav qog ntshav qab zib hauv cov menyuam yaus los ntawm kev tsis xwm yeem glimepiride, lawv yuav tsum ua tib zoo kho qhov tshuaj dextrose tau txais kev tswj xyuas tas li ntawm cov ntshav qabzib hauv siab, vim tias muaj peev xwm txhim kho kev txaus ntshai hyperglycemia.

Kev noj tshuaj ntau ntawm metformin
Cov tsos mob: nrog metformin hauv lub plab hauv qhov nyiaj txog li 85 g ntawm kev mob ntshav qab zib tsis tau pom. Ib qho kev haus ntau tshaj tawm lossis tus neeg mob cuam tshuam nrog kev tsim muaj cov kab mob lactic acidosis nrog Metformin tuaj yeem ua rau nce ntawm lactic acidosis.
Kev Kho Mob: lactic acidosis yog ib yam kev mob uas yuav tsum tau txais kev pabcuam thaum muaj xwm txheej ceev hauv tsev kho mob. Txoj hauv kev zoo tshaj plaws los tshem tawm lactate thiab metformin yog hemodialysis. Nrog zoo hemodynamics, metformin muaj peev xwm ua kom dhau los ntawm hemodialysis nrog kev tshem kom txog li 170 ml / min.

Cia rau cov neeg mob
Saib xyuas kom deb ntawm cov menyuam yaus ntawm qhov kub tsis txog 30 ° C.

Hnub tas sij hawm
3 xyoos Txhua yam lus tau hais tawm rau kev qhia tawm thiab tsis yog lub laj thawj ntawm kev kho tus kheej lossis hloov cov tshuaj.

Amaryl yog ib qho tshuaj uas pab txo cov ntshav qab zib.

Nws txoj kev txais tos pib thaum qhov tsis muaj cov tshuaj insulin tuaj yeem tsis tau them rov qab los ntawm lwm txoj hauv kev - cov kws kho mob tawm dag zog, kev kho mob ntawm pej xeem, tab sis tsis tsim nyog.

Noj cov tshuaj no muaj cov txiaj ntsig zoo rau kev mob ntawm cov neeg mob ntshav qab zib, uas tuaj yeem txhim kho lawv lub neej zoo.

Yog li no, Amaryl, cov tshuaj analogues uas tau tsim los ntawm ntau lub tuam txhab tshuaj, yog siv dav hauv kev kho mob ntawm kev cuam tshuam ntawm qhov tsis muaj cov tshuaj insulin hauv lub cev.

Amaryl thiab nws cov analogues tau qhia txog ntshav qab zib hom II.Cov tshuaj tiv thaiv tseem ceeb ntawm cov tshuaj yog glimepiride.

Qhov no koob thib 3 tiam tsim, tsim ntawm lub hauv paus ntawm sulfanylurea derivative, ua rau ntawm lub cev, maj mam txhawb nws cov b-hlwb, uas yog lub luag haujlwm rau kev tsim cov tshuaj insulin. Raws li nws cov cawv, cov txiav tau ua rau cov insulin ntau dua, thiab cov piam thaj hauv cov ntshav yuav tsawg zuj zus.