Amaril M: cov lus qhia rau kev siv thiab muaj pes tsawg leeg tshuaj

Kev piav qhia ntawm daim ntawv tshuaj

1 + 250 mg ntsiav tshuaj: oval, biconvex, them nrog zaj duab xis dawb sheath, sau nrog "HD125" ntawm ib sab.

2 + 500 mg ntsiav tshuaj: oval, biconvex, them nrog zaj duab xis dawb sheath, sau nrog "HD25" ntawm ib sab thiab nqis siab tshaj ntawm lwm yam.

Cov Tshuaj Hauv Tshuaj

Amaryl ® M yog cov tshuaj hypoglycemic ua ke, uas suav nrog glimepiride thiab metformin.

Glimepiride, yog ib yam tshuaj lom ntawm Amaril ® M, yog ib qhov tshuaj tiv thaiv hypoglycemic rau kev tswj hwm qhov ncauj, lub zog los ntawm peb tiam sulfonylurea.

Glimepiride stimulates qhov tso pa tawm thiab tso tawm ntawm insulin los ntawm pancreatic beta hlwb (cov nyhuv pacreatic), txhim kho qhov rhiab ntawm peripheral cov ntaub so ntswg (nqaij thiab rog) mus rau qhov kev ua ntawm endulinous insulin (ntxiv cov nyhuv ntxiv).

Ntxim rau insulin secretion

Cov khoom siv ntawm sulfonylureas nce insulin tso zis los ntawm kev kaw ATP-dependant potassium cov chaw nyob hauv cytoplasmic membrane ntawm lub pancreatic beta hlwb. Kaw cov poov tshuaj channel, lawv ua rau depolarization ntawm beta 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, sib xyaw thiab tshem tawm los ntawm cov protein (pancreatic beta-cell protein) (cov molecular phaus 65 kD / SURX), uas cuam tshuam nrog ATP-tos cov potassium ntxiv, tab sis txawv ntawm qhov chaw khi ntawm cov pa sulfonylurea derivatives (protein nrog cov molecular loj 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 cov kev ua ntawm kev coj ua (ib txwm siv) sulfonylurea derivatives (piv txwv li glibenclamide). Qhov tsawg tshaj plaws stimulating nyhuv ntawm glimepiride ntawm insulin secretion tseem ua rau muaj kev pheej hmoo qis ntawm hypoglycemia.

Zoo li tsoos sulfonylurea derivatives, tab sis rau ntau npaum li cas glimepiride tau tshaj tawm cov teebmeem ntxiv (txo qis hauv insulin tsis kam, antiatherogenic, antiplatelet thiab antioxidant teebmeem).

Kev siv cov kua nplaum ntawm cov ntshav los ntawm cov ntaub so ntswg (nqaij thiab rog) tshwm sim siv cov protein tshwj xeeb thauj (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), uas ua rau cov piam thaj nce ntxiv los ntawm cov ntaub so ntswg peripheral.

Glimepiride muaj cov tshuaj ua rau lub zog tsis txaus ntseeg ntawm ATP-dependant K + channels 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 nce rau kev ua haujlwm ntawm phospholipase C, nrog rau qhov twg lipogenesis thiab glycogenesis tuaj yeem sib txheeb rau cov nqaij ntshiv thiab rog hlwb.

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 alpha-tocopherol, qhov kev ua ntawm catalase, glutathione peroxidase thiab superoxide dismutase, uas pab txo qis qhov mob ntawm oxidative kev nyuab siab nyob rau hauv tus neeg mob lub cev, uas yog ib txwm muaj nyob hauv hom 2 ntshav qab zib mellitus.

Kev siv 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 muaj dab tsi cuam tshuam rau pancreatic beta hlwb thiab tsis nce insulin secretion; hauv kev siv tshuaj, nws tsis ua rau muaj ntshav qab zib hauv tib neeg.

Tus txheej txheem ntawm kev ua tsis tau to taub tag nrho. Nws ntseeg tias metformin tuaj yeem muaj peev xwm ua rau muaj qhov cuam tshuam los ntawm cov tshuaj insulin lossis nce cov teebmeem no hauv thaj chaw ib puag ncig receptor. Metformin tsub kom cov ntaub so ntswg hloov pauv tau rau cov kua dej los ntawm kev ua kom cov naj npawb ntawm insulin ntau dua nyob rau saum npoo ntawm cov cell. 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) thiab 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 kev tiv thaiv cov nqaij mos plasminogen activator inhibitor.

Cov Tshuaj Pharmacokinetics

Thaum noj hauv ib koob tshuaj txhua hnub ntawm 4 mg C_max hauv plasma txog li 2.5 teev tom qab kev tswj hwm ntawm qhov ncauj thiab yog 309 ng / ml, muaj txoj kab sib txuas ntawm koob tshuaj thiab C_max raws li zoo raws li nruab nrab ntawm koob tshuaj 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. Glimepiride yog tus cwj pwm los ntawm V qis heev_d (txog 8,8 L), kwv yees li qhov sib npaug ntawm qhov ntim ntawm albumin kev faib tawm, qib siab ntawm kev sib khi rau cov ntshav plasma (ntau dua li 99%) thiab kev tshem tawm tsawg (li 48 ml / min).

Tom qab ib qho tshuaj noj ntawm qhov ncauj glimepiride, 58% ntawm cov tshuaj tso tawm los ntawm lub raum (tsuas yog hauv cov tshuaj metabolites) thiab 35% los ntawm txoj hnyuv. T_1/2 nyob rau hauv cov ntshav ntau nyob rau hauv cov ntshav sib haum rau ntau lub koob tshuaj, nws yog 5-8 teev. Tom qab noj cov tshuaj hauv qhov siab kawg, ib qho elongation ntawm T raug pom_1/2 .

Hauv cov zis thiab cov quav, 2 lub cev tsis muaj zog ntawm lub cev tau pom tias tau tsim los ntawm cov metabolism hauv lub siab, ib qho yog hydroxy, thiab qhov thib ob yog lub plab carboxy derivative. Tom qab qhov ncauj tswj hwm ntawm glimepiride, lub davhlau ya nyob twg T_1/2 cov metabolites no tau 3-5 thiab 5-6 teev, ua ntu zus.

Glimepiride ua haujlwm tawm hauv cov kua mis thiab hla tus qib placental. Nws nkag mus rau qhov phem los ntawm BBB. Kev sib piv ntawm ib qho thiab ntau yam (2 zaug hauv ib hnub) kev tswj hwm ntawm glimepiride tsis qhia tawm qhov sib txawv tseem ceeb hauv cov chaw muag tshuaj, lawv qhov txawv ntawm cov neeg mob sib txawv. Qhov tseem ceeb tsub zuj zuj ntawm glimepiride tsis tuaj.

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 rau qhov tsis muaj creatinine tshem tawm), muaj qhov nyiam ua kom lub qhov txhaws ntau ntxiv thiab muaj qhov txo qis hauv nws cov ntsiab lus nruab nrab hauv cov ntshav, uas feem ntau yuav ua rau vim sai sai ntawm glimepiride vim nws qis dua 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.

Tom qab cov neeg siv qhov ncauj, metformin yog nqus los ntawm cov hnyuv zom tag nrho. Qhov tseeb txog kev noj qab haus huv ntawm metformin yog li 50-60%. C_max (kwv yees li 2 μg / ml lossis 15 μmol) hauv ntshav yog ua tiav tom qab 2.5 teev. Nrog kev noj zaub mov ib txhij, kev nqus ntawm metformin txo qis thiab maj mam poob.

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 thiab tawm los ntawm ob lub raum. Kev tshem tawm hauv cov ntsiab lus noj qab haus huv yog 440 ml / min (4 zaug ntau dua hauv creatinine), uas qhia tias muaj cov tubular muaj kev zais cia. Tom qab noj tau, lub davhlau ya nyob twg T_1/2 yog kwv yees li 6,5 teev. Nrog lub raum tsis ua hauj lwm, nws nce, muaj kev pheej hmoo ntawm kev txuam tshuaj.

Pharmacokinetics ntawm Amaril ® M nrog cov koob tshuaj tiv thaiv glimepiride thiab metformin tsau

C qhov tseem ceeb_max thiab AUC thaum noj cov tshuaj tiv thaiv sib xyaw ua ke (cov tshuaj muaj glimepiride 2 mg + metformin 500 mg) ua tau raws li cov txheej txheem kev sib npaug thaum sib piv nrog tib lub ntsuas thaum noj tib qho sib xyaw ua ke raws li kev npaj cais (glimepiride ntsiav tshuaj 2 mg thiab metformin 500 mg ntsiav tshuaj) Cov.

Ib qho ntxiv, qhov kev tshaj tawm cov tshuaj raws qib-C hauv C tau qhia._max thiab AUC ntawm glimepiride nrog rau kev nce ntxiv hauv nws cov koob tshuaj hauv kev sib xyaw ua ke nrog cov tshuaj tiv thaiv tsis tu ncua los ntawm 1 mus rau 2 mg nrog qhov tsis tu ncua cov tshuaj metformin (500 mg) hauv qhov sib xyaw ntawm cov tshuaj no.

Tsis tas li ntawd, tsis muaj qhov sib txawv ntawm kev nyab xeeb, suav nrog cov xwm txheej ntawm qhov tsis xav tau, 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 Lus Qhia Amaril ® M

Kev kho mob ntawm hom 2 mob ntshav qab zib mellitus (ntxiv rau kev noj haus, kev tawm dag zog thiab lub cev poob):

nyob rau hauv rooj plaub thaum glycemic tswj tsis tuaj yeem siv ua ke nrog kev noj haus, kev tawm dag zog, poob phaus thiab monotherapy nrog glimepiride lossis metformin,

thaum hloov cov kev sib txuas ua ke nrog glimepiride thiab metformin nrog ib qho tshuaj sib txuam.

Cov Yuav Tsum Muaj

ntshav qab zib hom 1

keeb kwm ntawm cov kab mob ntshav qab zib ketoacidosis, mob ketoacidosis, mob ntshav qab zib tsis xeev thiab precoma, mob hnyav los yog mob ntev ntawm metabolic acidosis,

cov tshuaj tiv thaiv hypersensitivity rau sulfonylurea derivatives, sulfonylamide npaj lossis biguanides, ntxiv rau ib qho twg ntawm qhov tsis zoo ntawm cov tshuaj,

lub siab ua haujlwm tsis zoo hauv lub siab (tsis muaj kev paub dhau los ntawm kev siv, xws li cov neeg mob xav tau kev kho mob insulin kom paub meej tias muaj kev tiv thaiv glycemic),

cov neeg mob hemodialysis (tsis muaj kev paub ntau)

lub raum ua kom tsis zoo thiab ua rau lub raum tsis ua haujlwm (ntshav siab los ntawm lub siab: ≥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 creatinine (nce ntxiv) kev pheej hmoo ntawm cov kab mob lactic acidosis thiab lwm yam phiv los ntawm metformin),

mob uas ua rau lub raum tsis ua hauj lwm zoo (ua kom lub cev qhuav dej, kis tau mob hnyav, poob siab, lub cev ntawm cov tshuaj iodine uas muaj cov tshuaj zoo sib xws, saib ntu “Cov Lus Qhia Tshwj Xeeb”),

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, kev phais mob, kev kis mob hnyav nrog ua npaws, mob plab)

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),

ua txhaum ntawm kev nqus ntawm cov khoom noj thiab cov tshuaj hauv cov hnyuv (nrog rau txoj hnyuv hauv plab hnyuv, mob plab hnyuv, 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 hauv kev tshawb nrhiav).

nyob rau hauv cov xwm txheej uas muaj kev pheej hmoo ntawm cov ntshav qab zib tsawg (cov neeg mob tsis txaus siab lossis tsis tuaj yeem (feem ntau cov neeg laus laus) koom tes nrog tus kws kho mob, kev noj zaub mov tsis zoo, kev noj zaub mov tsis xwm yeem, noj zaub mov, cov neeg mob tsis sib haum ntawm kev ua si lub cev thiab kev noj haus carbohydrate, hloov pauv kev noj zaub mov, thaum haus cov dej cawv uas muaj ethanol, tshwj xeeb tshaj yog ua ke nrog cov zaub mov hla, nrog lub siab thiab lub raum tsis ua haujlwm, nrog qee qhov tsis ua haujlwm ntawm endocrine tsis zoo, t xws li qee qhov ua haujlwm ntawm cov thyroid tsis txaus, cov tshuaj tiv thaiv kab mob hauv lub cev tsis ua haujlwm lossis kev ua haujlwm ntawm adrenal cortex, cuam tshuam rau cov metabolism hauv cov khoom noj lossis ua kom muaj cov txheej txheem txhawm rau nce cov ntshav qabzib concentration thaum lub cev tsis muaj ntshav, nrog kev txhim kho ntawm cov kabmob sib kis thaum kho lossis nrog rau kev hloov pauv hauv kev ua neej) () hauv cov neeg mob no, yuav tsum tau saib xyuas ntau dua ntawm cov ntshav qabzib hauv lub ntsej muag thiab cov tsos mob ntawm lub qog ntshav qab zib yog qhov tsim nyog, lawv yuav tsum tau txhaj koob tshuaj glimepiride lossis tag nrho hypoglide. kemicheskoy txoj kev kho)

nrog rau kev siv cov tshuaj ib txhij (saib "Kev Sib Hloov"),

nyob rau hauv cov neeg mob laus (feem ntau lawv muaj qhov txo qis hauv lub raum ua haujlwm), nyob rau hauv cov xwm txheej uas lub raum ua haujlwm tsis zoo, xws li pib noj tshuaj antihypertensive lossis diuretics, zoo li NSAIDs (muaj kev pheej hmoo ntawm lactic acidosis thiab lwm yam kev cuam tshuam ntawm metformin),

thaum ua cov haujlwm hnyav ntawm lub cev (qhov kev pheej hmoo ntawm kev lactic acidosis thaum noj metformin ntau ntxiv),

nrog kev txhim kho lossis tsis muaj cov tsos mob ntawm adrenergic antiglycemic kev tswj hwm hauv kev teb rau kev txhim kho hypoglycemia (hauv cov neeg mob laus, nrog neuropathy ntawm lub hlwb tsis nco qab lossis nrog kev kho mob nrog beta-blockers, clonidine, guanethidine thiab lwm yam mob siab xav) nyob rau hauv cov ntshav)

nrog kev tsis txaus cov piam thaj-6-phosphate dehydrogenase (hauv cov neeg mob zoo li no, thaum noj sulfonylurea derivatives, hemolytic anemia yuav tshwm sim, yog li ntawd, kev siv lwm cov tshuaj tiv thaiv hypoglycemic uas tsis yog sulfonylurea derivatives hauv cov neeg mob no yuav tsum xav txog).

Cev xeeb tub thiab lactation

Cev xeeb tub Contraindicated thaum cev xeeb tub vim muaj qhov cuam tshuam tsis zoo rau kev txhim kho intrauterine. 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 uas muaj cov metabolism hauv lub cev tsis txaus, noj zaub mov tsis xwm yeem thiab tawm dag zog yuav tsum tau txais tshuaj insulin.

Lactation. Txhawm rau kom tsis txhob noj tshuaj nrog niam mis hauv tus menyuam lub cev, cov pojniam uas pub niam mis rau menyuam noj yuav tsum tsis txhob noj cov tshuaj no. Yog tias tsim nyog, tus neeg mob yuav tsum pauv mus rau kev kho mob insulin lossis txwv tsis pub niam mis.

Sab sij huam

Raws li kev paub dhau los ntawm kev siv glimepiride thiab paub cov ntaub ntawv ntawm lwm cov sulfonylurea derivatives, kev txhim kho cov kev mob tshwm sim hauv qab no ntawm cov tshuaj yog ua tau.

Los ntawm sab ntawm cov metabolism thiab kev noj haus: kev txhim kho ntawm hypoglycemia, uas yuav tawm tsam (zoo li nrog lwm cov sulfonylurea derivatives).Cov tsos mob ntawm kev txhim kho hypoglycemia muaj xws li: mob taub hau, mob taub hau sai, xeev siab, ntuav, qaug zog, qaug zog, pw tsaug zog, ntxhov siab, ntxhov siab, tsis tshua mloog siab, tsis meej pem, ua rau lub hlwb khiav qeeb, nyuaj siab, tsis meej pem, hais lus tsis meej, tsis meej pem, tsis hnov ​​qab lub zeem muag, tshee hnyo, paresis, hnov ​​qhov muag rhiab heev, kiv taub hau, tsis paub pab, tsis tuaj yeem tswj tus kheej, ua kom zoo nkauj, mob plab, tsaug zog thiab tsis nco qab txog qhov tsis nco qab, ua pa nyuaj, bradycardia. Tsis tas li ntawd, cov cim ntawm kev txhim kho ntawm adrenergic cov tshuaj tiv thaiv rau cov ntshav qog ntshav qab zib yuav raug sau tseg: kev tawm hws, nce ntawm daim tawv nqaij, nce kev ntxhov siab, tachycardia, nce ntshav siab, kev hnov ​​ntawm lub plawv dhia, angina pectoris thiab arrhythmia. 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 zaus tom qab kev tshem tawm ntawm glycemia.

Los ntawm sab ntawm cov khoom ntawm lub zeem muag: pom kev tsis pom kev zoo (tshwj xeeb tshaj yog thaum pib kho vim muaj kev hloov pauv hauv cov concentration ntawm cov piam thaj hauv cov ntshav).

Los ntawm cov hnyuv: xeev siab, ntuav, tag nrho ntawm lub plab, mob plab thiab raws plab.

Nyob rau ib feem ntawm daim siab thiab kais plab: nce kev ua haujlwm ntawm daim siab enzymes thiab ua kom lub siab ua haujlwm tsis zoo (piv txwv li, cholestasis thiab jaundice), nrog rau mob siab, uas tuaj yeem ua rau lub siab ua haujlwm.

Los ntawm cov kab ke ntshav thiab cov kab mob lymphatic: thrombocytopenia, nyob rau qee kis - leukopenia, hemolytic anemia lossis erythrocytopenia, granulocytopenia, agranulocytosis lossis pancytopenia. Kev ua tib zoo saib xyuas tus neeg mob tus mob yog qhov tsim nyog, txij li cov neeg mob aplastic anemia thiab pancytopenia tau sau tseg thaum kho nrog sulfonylurea npaj. Yog tias cov tshwm sim no tshwm sim, cov tshuaj yuav tsum tau txiav thiab ntxiv kev kho tsim nyog pib.

Los ntawm lub nruab zog: kev ua xua lossis pseudo-ua xua kev ua xua (piv txwv, khaus, tawm pob, lossis ua pob xua). Cov kev tshwm sim zoo li no yuav luag tas mus li hauv ib daim ntawv me, tab sis tuaj yeem nkag mus rau hauv daim ntawv hnyav, nrog ua pa luv lossis poob qis hauv cov ntshav siab, nce mus rau qhov tshwm sim ntawm anaphylactic kev poob siab. Yog tias khaus qhov mob tshwm sim, sab laj nrog tus kws kho mob tam sim ntawd. Kev phiv khaub thuas muaj peev xwm ua tau nrog lwm cov sulfonylureas, sulfonamides lossis lwm yam zoo sib xws. Kev ua xua vasculitis.

Lwm yam: photosensitivity, hyponatremia.

Los ntawm sab ntawm cov metabolism thiab khoom noj khoom haus: lactic acidosis (saib. "Cov lus qhia tshwj xeeb"), mob ntshav qab zib.

Los ntawm cov hnyuv: zawv plab, xeev siab, mob plab, ntuav, tsim cov roj ntau ntxiv, tsis qab los noj mov - feem ntau cuam tshuam nrog tshuaj metformin monotherapy. Cov tsos mob no yuav luag 30% ntau dua rau cov neeg mob noj cov placebo, tshwj xeeb tshaj yog thaum pib kho. Cov tsos mob no feem ntau yog hloov dua tshiab thiab daws lawv tus kheej. Muaj qee kis, kev txo qhov txo tshuaj ib ntus tej zaum yuav pab tau. Thaum lub sij hawm tshawb fawb, metformin tau raug tshem tawm hauv yuav luag 4% ntawm cov neeg mob vim tias muaj kev phiv los ntawm txoj hnyuv plab.

Txij li thaum txoj kev loj hlob ntawm cov tsos mob los ntawm kev mob plab thaum pib ntawm kev kho mob yog koob tshuaj, lawv qhov kev tshwm sim tuaj yeem txo los ntawm maj mam nce cov koob tshuaj thiab noj tshuaj nrog zaub mov.

Txij li thaum zawv plab thiab / lossis ntuav tuaj yeem ua rau lub cev qhuav dej thiab lub raum tsis ua haujlwm, thaum lawv tshwm sim, cov tshuaj yuav tsum tau txiav ib pliag.

Thaum pib kho nrog metformin, kwv yees li 3% ntawm cov neeg mob yuav muaj kev tsis txaus siab nyob rau hauv lub qhov ncauj, uas feem ntau dhau ntawm nws tus kheej.

Ntawm daim tawv nqaij sab: erythema, khaus, pob.

Los ntawm cov kab ke ntshav thiab cov kab mob lymphatic: anemia, leukocytopenia, lossis thrombocytopenia. Kwv yees li ntawm 9% ntawm cov neeg mob uas tau txais kev kho mob monotherapy nrog Amaril ® M, thiab hauv 6% ntawm cov neeg mob uas tau txais kev kho mob nrog metformin lossis metformin / sulfonylurea, muaj kev txo qis asymptomatic hauv vitamin B ntau ntau₁₂ hauv cov ntshav ntshav (cov theem ntawm folic acid nyob rau hauv cov ntshav ntshav tsis tau txo qis). Dua li ntawm qhov no, tsuas yog kuaj ntshav megaloblastic uas tau sau tseg thaum noj Amaril ® M, thiab tsis muaj kev nce ntxiv hauv kev tshwm sim ntawm neuropathy. Yog li, yuav tsum tau saib xyuas cov qib B kom tsim nyog.₁₂ hauv cov ntshav ntshav (tej zaum yuav tsum tau muaj kev tswj hwm ib ntus ntawm cov tshuaj vitamin B₁₂).

Ntawm daim siab: ua rau lub siab ua haujlwm tsis zoo.

Txhua qhov kev tshwm sim ntawm cov kev phiv tshaj saud los yog lwm cov kev mob tshwm sim yuav tsum tau qhia rau tus kws kho mob sai. Vim qhov tseeb tias qee qhov kev xav tsis txaus ntseeg, incl. hypoglycemia, hematological ntshawv siab, kev tsis haum tshuaj hnyav thiab pseudo-ua xua thiab lub siab ua haujlwm tuaj yeem hem tus neeg mob lub neej, yog tias lawv txhim kho, tus neeg mob yuav tsum qhia tus kws kho mob tam sim ntawd thiab tsum tsis txhob siv tshuaj ntxiv ua ntej tau txais lus qhia los ntawm kws kho mob. Kev npaj tsis raug rau Amaryl ® M, tsuas yog zam ntawm qhov kev paub uas twb tau txais rau glimepiride thiab metformin, tsis pom nyob rau ntu I kev kuaj mob thiab theem III qhib kev sim.

Noj ua ke ntawm ob hom tshuaj no, ob qho tib si hauv kev sib koom ua ke pub dawb los ntawm kev sib cais npaj ntawm glimepiride thiab metformin, thiab ua cov tshuaj sib xyaw nrog cov tshuaj tiv thaiv glimepiride thiab metformin, cuam tshuam nrog tib cov kev nyab xeeb zoo li kev siv txhua ntawm cov tshuaj cais.

Kev sib txuam

Yog tias tus neeg mob uas noj tshuaj glimepiride raug kho lossis tso tseg tib lub sijhawm, lwm yam tshuaj muaj peev xwm ua tau ob qho txiaj ntsig tsis txaus siab thiab ua rau lub cev tsis muaj zog ntawm glimepiride. Raws li kev paub dhau los ntawm glimepiride thiab lwm yam sulfonylurea derivatives, kev sib cuam tshuam tshuaj nyob hauv qab no yuav tsum raug txiav txim siab.

Nrog rau cov tshuaj uas yog inducers lossis inhibitors ntawm CYP2C9

Glimepiride yog metabolized los ntawm cytochrome P450 CYP2C9. Nws paub tias nws cov metabolism tau cuam tshuam los ntawm kev siv CYP2C9 inducers tib lub sijhawm, piv txwv li rifampicin (qhov kev pheej hmoo ntawm txo qis hypoglycemic nyhuv ntawm glimepiride thaum siv ib txhij nrog CYP2C9 inducers thiab qhov kev pheej hmoo ntawm hypoglycemia yog tias CYP2C9 inducers raug muab tso tseg tsis muaj kev kho qhov tsis haum ntawm glimepiride), thiab kev txhim kho ntawm hypoglycemia thiab cov kev mob tshwm sim ntawm glimepiride thaum noj concomitantly nrog cov tshuaj no thiab qhov kev pheej hmoo ntawm txo qis hauv cov nyhuv hypoglycemic ntawm glimepiride nrog tsis muaj CYP2C9 inhibitors yam tsis muaj kev hloov kho ntawm glimepiride).

Nrog rau cov tshuaj uas txhim kho cov nyhuv hypoglycemic

Cov tshuaj insulin thiab qhov ncauj hypoglycemic, ACE inhibitors, allopurinol, anabolic steroids, txiv neej pw ua ke, chloramphenicol, coumarin anticoagulants, cyclophosphamide, disopyramide, phenfluramine, pheniramidol, fibrates, fluoxetine, azolinofluoromethanes, azolinofluorides (nrog rau cov kev tswj hwm hauv tsoomfwv hauv qib siab), phenylbutazone, probenecid, cov tshuaj tua kab mob ntawm cov pab pawg quinolone, salicylates, sulfinpyrazone, sulfonamide derivatives, tetracyclines, peb okvalin, trofosfamide, azapropazone, oxyphenbutazone.

Txoj kev pheej hmoo ntawm kev mob ntshav qab zib nce zuj zus nrog kev siv cov tshuaj ua ke nrog cov ntsiab lus saum toj no nrog glimepiride thiab qhov kev pheej hmoo ntawm kev tswj ntshav glycemic thaum lawv muab tso tseg tsis muaj kev kho mob ntawm glimepiride.

Nrog rau cov tshuaj uas txo cov nyhuv hypoglycemic

Acetazolamide, barbiturates, GCS, diazoxide, diuretics, epinephrine lossis sympathomimetics, glucagon, laxatives (nrog rau siv ntev), nicotinic acid (hauv kev txhaj tshuaj ntau), estrogens, progestogens, phenothiazines, phenytoin, rifampicin, thyroid hormones.

Txoj kev pheej hmoo ntawm kev ua tsis zoo glycemic tswj nrog kev siv sib xyaw ntawm glimepiride nrog rau cov tshuaj saum toj no thiab qhov kev pheej hmoo ntawm hypoglycemia yog tias lawv muab tso tseg tsis muaj kev kho mob ntawm glimepiride yog nce ntxiv.

Nrog rau cov tshuaj uas tuaj yeem ua ob qho tib si txhim kho thiab txo cov ntshav qis

Cov tshuaj tiv thaiv histamine H₂receptors, clonidine thiab reserpine.

Nrog rau kev siv tib lub sijhawm, ob qho tib si nce thiab txo qis hauv cov nyhuv hypoglycemic ntawm glimepiride yog ua tau. 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 tus neeg sawv cev sympatholytic

Lawv muaj peev xwm txo qis lossis thaiv qhov kev tsis haum ntawm cov kev mob siab ntsws nyob rau hauv kev teb rau hypoglycemia, uas tuaj yeem ua rau kev txhim kho ntawm hypoglycemia pom ntau dua rau tus neeg mob thiab tus kws kho mob thiab thiaj li ua rau muaj kev pheej hmoo tshwm sim.

Kev siv ntev thiab ntev ntawm ethanol tuaj yeem tsis muaj kev cia siab txog qhov ua kom tsis muaj zog lossis txhim kho kev muaj lub ntsej muag hypoglycemic ntawm glimepiride.

Nrog rau qhov tsis ncaj ntawm anticoagulants, coumarin derivatives

Glimepiride tuaj yeem ob leeg txhim kho thiab txo qhov tshwm sim ntawm qhov tsis ncaj ntawm anticoagulants, coumarin derivatives.

Hauv kev haus cawv ntau dhau, qhov kev pheej hmoo ntawm kev txhim kho cov kab mob lactic acidosis nce ntxiv, tshwj xeeb tshaj yog tias hla los sis noj zaub mov tsis txaus, muaj cov kab mob siab. Cawv (ethanol) thiab tshuaj uas muaj ethanol yuav tsum zam siv.

Nrog iodine-muaj cov tshuaj tiv thaiv sib xyaw

Kev tswj fwm ntawm cov tshuaj iodine uas muaj cov tshuaj tiv thaiv tsis zoo tuaj yeem ua rau lub raum tsis ua haujlwm, uas ua rau kev txuam nrog metformin thiab muaj kev pheej hmoo ntawm cov kab mob lactic acidosis. Metformin yuav tsum tsis ua haujlwm ntxiv ua ntej qhov kev kawm lossis thaum kawm thiab yuav tsum tsis txhob rov ua dua li ntawm 48 teev tom qab nws.

Nrog rau cov tshuaj tua kab mob nrog lub suab hais tawm nephrotoxic nyhuv (gentamicin)

Nce kev pheej hmoo ntawm cov kab mob lactic acidosis (saib "Cov lus qhia tshwj xeeb").

Kev sib xyaw ua ke ntawm cov tshuaj nrog metformin uas yuav tsum ceev faj

Nrog corticosteroids (muaj kab ke thiab rau hauv zos siv), beta₂-adrenostimulants thiab diuretics muaj sab hauv hyperglycemic kev ua si. Yuav tsum qhia rau tus neeg mob tias nws xav tau kev soj ntsuam ntau ntxiv thaum sawv ntxov ntawm cov ntshav qabzib nyob hauv cov ntshav, tshwj xeeb tshaj yog thaum pib ntawm txoj kev kho 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 tuaj yeem txo qhov kev nyeem zoo ntawm cov piam thaj hauv cov ntshav. Kev siv tshuaj ntau dua ntawm cov kev kho ntshav qab zib kom zoo thaum lub sijhawm 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 (acetylsalicylic acid, thiab lwm yam), beta-blockers (propranolol, thiab lwm yam), MAO inhibitors

Nyob rau hauv txoj kev ntawm kev siv ua ke nrog 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, txij li intensification ntawm hypoglycemic nyhuv ntawm glimepiride yog ua tau.

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 channel blockers.

Nyob rau hauv txoj kev ntawm kev siv ua ke nrog 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, txij li ua tau kom tsis muaj zog ntawm cov nyhuv hypoglycemic.

Kev sib cuam tshuam los txiav txim siab

Hauv kev tshawb fawb soj ntsuam ntawm kev sib cuam tshuam ntawm metformin thiab furosemide thaum noj ib zaug hauv cov neeg tuaj yeem noj qab haus huv, nws tau qhia tias kev siv cov tshuaj no ib txhij cuam tshuam rau lawv cov chaw muag tshuaj. Furosemide nce C_max metformin hauv plasma los ntawm 22%, thiab AUC - los ntawm 15% yam tsis muaj kev hloov pauv tseem ceeb hauv kev ua kom lub raum tshem tawm ntawm metformin. Thaum siv nrog metformin C_max thiab AUC ntawm furosemide poob qis los ntawm 31 thiab 12%, feem, piv nrog kev kho mob furosemide, thiab kev tshem tawm kawg ib nrab ntawm lub neej txo los ntawm 32% yam tsis muaj kev hloov pauv 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.

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 C_max thiab AUC ntawm metformin nyob rau hauv cov ntshav ntshav los ntawm 20 thiab 9%, feem, thiab kuj nce metformin ntau tawm hauv cov raum. Metformin muaj cov kev cuam tshuam tsawg kawg rau ntawm pharmacokinetics ntawm nifedipine.

Nrog rau cov tshuaj cationic (amiloride, digoxin, morphine, procainamide, quinidine, quinine, ranitidine, triamteren, trimethoprim thiab vancomycin)

Cov tshuaj Cationic ua rau cov tubular tso rau hauv lub raum yog qhov ua kom haum rau kev sib txuas lus nrog metformin uas yog qhov txiaj ntsig ntawm kev sib tw rau cov tubular thauj cov ib txwm muaj. Xws li 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 tshawb fawb txog kev sib cuam tshuam ntawm metformin thiab cimetidine nrog ib qho thiab siv ntau, qhov muaj 60% nce ntxiv rau qhov ntshav siab tshaj plaws thiab tag nrho cov ntsiab lus ntawm metformin hauv ntshav thiab nce 40% hauv ntshav thiab tag nrho AUC metformin. Nrog ib qho koob tshuaj, tsis muaj kev hloov pauv hauv ib nrab-lub neej. Metformin tsis cuam tshuam dabtsi rau pharmacokinetics ntawm cimetidine. Txawm hais tias qhov kev sib cuam tshuam ntawd yog qhov tseem ceeb theoretical (tshwj tsis yog cimetidine), kev saib xyuas ntawm cov neeg mob yuav tsum tau ua kom zoo thiab koob tshuaj metformin thiab / lossis cov tshuaj sib cuam tshuam nrog nws yuav tsum tau ua nyob rau hauv kev tswj hwm ua ke ntawm cov tshuaj cationic uas tawm ntawm lub cev los ntawm cov kab ke zais ntawm cov tub ntxhais ntawm lub raum.

Nrog propranolol, ibuprofen

Hauv cov neeg tuaj noj qab haus huv nyob rau hauv kev tshawb fawb txog kev siv ib qho tshuaj metformin thiab propranolol, nrog rau metformin thiab ibuprofen, tsis muaj kev hloov pauv hauv lawv cov chaw muag tshuaj.

Tsuas tshuaj thiab tswj hwm

Raws li txoj cai, koob tshuaj ntawm Amaril ® M yuav tsum txiav txim siab los ntawm lub hom phiaj concentration ntawm cov piam thaj hauv cov ntshav ntawm tus neeg mob. 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 qhov yuav tsum tau txiav txim siab tsis tu ncua cov kev ntsuas ntawm cov piam thaj hauv cov ntshav thiab zis. 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 rov qab txais ntxiv los ntawm kev noj tshuaj ntau 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.

Txij li kev txhim kho metabolic tswj yog txuam nrog kev muaj peev xwm ntau ntxiv rau insulin, kev xav tau 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 los txo cov koob tshuaj lossis tsis noj tshuaj Amaril ® M.

Cov tshuaj yuav tsum noj 1 lossis 2 zaug ib hnub thaum noj mov.

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 tsis txhob muaj kev txhim kho hypoglycemia, kev noj tshuaj thawj zaug ntawm Amaril ® M yuav tsum tsis pub tshaj qhov noj txhua hnub ntawm glimepiride thiab metformin uas tus neeg mob tau noj. Thaum hloov mus rau cov neeg mob los ntawm kev noj ua ke ntawm tus kheej npaj ntawm glimepiride thiab metformin rau Amaril ® M, nws cov koob tshuaj tau txiav txim siab raws li kev noj tshuaj glimepiride thiab metformin ua kev npaj cais.

Yog tias nws yog qhov yuav tsum tau nce qhov koob tshuaj, koob tshuaj txhua hnub ntawm Amaril ® M yuav tsum ua raws li kev nce qib ntawm tsuas yog 1 rooj. Amaril ® M 1 mg / 250 mg lossis 1/2 ntsiav tshuaj. Amaril ® M 2 mg / 500 mg.

Lub sijhawm kho. Feem ntau kho nrog Amaril ® M tau nqa tawm mus ntev.

Cov lus qhia tshwj xeeb

Cov kab mob lactic acidosis yog ib qho tsis tshua muaj tab sis muaj mob hnyav (nrog kev tuag siab nyob rau qhov tsis muaj kev kho kom zoo) cov teeb meem hauv lub cev kev zom zaub mov, 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 zoo. 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 mob ntshav kuaj ntshav yog qhov nce siab ntawm lactate hauv cov ntshav (> 5 mmol / l), cov ntshav pH txo qis, qhov kev ua txhaum ntawm cov dej-electrolyte sib npaug nrog kev nce hauv anion deficiency thiab qhov lactate / pyruvate piv. 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 nres tam sim ntawd 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 mob raum thiab mob raum hypoperfusion, feem ntau nyob rau hauv muaj ntau yam kab mob sib xyaw uas xav tau kev kho mob thiab phais mob.

Txoj kev pheej hmoo ntawm kev tsim cov kab mob lactic acidosis nce ntxiv nrog rau qhov mob ntawm 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 cov tshuaj no.

Raws li txoj cai, vim yog qhov tseeb tias lub siab ua haujlwm tsis zoo tuaj yeem txwv qhov tsis pom zoo ntawm lactate, kev siv cov tshuaj no yuav tsum raug zam rau cov neeg mob kuaj mob lossis kuaj pom ntawm daim siab mob siab.

Tsis tas li, cov tshuaj yuav tsum tau txiav ib ntus ua ntej ua kev tshawb nrhiav xoo hluav taws xob nrog kev saib xyuas intravascular ntawm iodine-muaj cov tshuaj tiv thaiv kab mob thiab ua ntej kev phais mob.

Feem ntau, cov kab mob lactic acid tau 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 hnyuv. 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 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 ntawm qhov tsis sib xws, 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 mellitus lossis rog rog, mob lub cev thau khoom los sis cov cuab yeej tsis raug thaum sim ntshav kuaj rau kev 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 acid yog ib yam mob uas yuav tsum tau mus ntsib tus kws khomob. Nyob rau hauv cov ntaub ntawv ntawm lactic acidosis, koj yuav tsum tam sim ntawd tsum tsis txhob noj cov tshuaj no thiab ua mus nrog kev txhawb nqa dav dav. Vim qhov tseeb tias metformin raug tshem tawm ntawm cov ntshav siv hemodialysis nrog kev tshem tawm txog li ntawm 170 ml / min, nws raug nquahu, muab rau kom tsis muaj hemodynamic cuam tshuam, sai 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.

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 kev noj tshuaj ntau dhau ntawm Amaril ® M, nrog qee cov tshuaj tsis haum xeeb ntawm qhov endocrine system (piv txwv li, qee qhov kev ua haujlwm ntawm cov thyroid tsis txaus thiab cov tshuaj hormones tsis ua haujlwm ntawm lub dawm pituitary lossis adrenal cortex, thaum siv qee lwm yam tshuaj uas cuam tshuam rau cov metabolism metabolism (saib "Kev cuam tshuam ").

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 ntawm tus mob ntshav qab zib tsawg, kev xav txog adrenergic antihypoglycemic txoj cai hauv kev teb rau kev txhim kho hypoglycemia (saib "Cov Kev Mob Rau Sab"), tej zaum yuav tsis tshua pom los yog tsis tuaj yeem yog tias hypoglycemia tsim kho maj mam, thiab nyob rau hauv cov neeg laus, nrog neuropathy ntawm lub hlwb tsis tuaj yeem lossis nrog tib lub sijhawm kev kho nrog beta-blockers, clonidine, guanethidine thiab lwm yam sympatholytics.

Yuav luag txhua lub sijhawm, hypoglycemia tuaj yeem nres sai sai nrog kev noj zaub mov sai sai (cov piam thaj lossis cov suab thaj, piv txwv li, ib qho qab zib, kua txiv txiv ntoo uas muaj suab thaj, tshuaj yej nrog piam thaj, thiab lwm yam). 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 nrog lwm cov tshuaj sulfonylurea, nws paub tias, txawm tias pib siv tau los ntawm kev ua kom zoo, kev ua kom tsis txhob qog ntshav yuav rov qab tshwm sim dua. Yog li, cov neeg mob yuav tsum tau saib xyuas kom zoo. Txoj kev loj hlob ntawm tus mob ntshav qab zib hnyav yuav tsum tau txais kev kho mob sai thiab kev tswj hwm kev kho mob, qee kis, kev kho mob hauv tsev.

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 kho los ntawm tus kws kho mob tsis yog kev kho mob (piv txwv li, pw hauv tsev kho mob, kev sib tsoo, qhov xav tau mus ntsib kws kho mob hnub so, thiab lwm yam), 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 ua tiav ntawm metformin thiab kev txhim kho ntawm lactic acidosis nce. Yog li no, thaum lub siab ntawm creatinine nyob rau hauv cov ntshav cov ntshav tau siab tshaj qhov muaj hnub nyoog sab saud ntawm tus cai, noj cov tshuaj no tsis pom zoo. Rau cov neeg mob laus, ceev faj ib ntus ntawm kev txhaj tshuaj metformin yog qhov tsim nyog txhawm rau xaiv cov koob tshuaj tsawg kawg, zoo li nrog lub hnub nyoog, lub raum ua haujlwm poob qis. 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 cov tshuaj iodine uas muaj cov tshuaj tiv thaiv kab mob sib piv (piv txwv li cov leeg mob urography, tso ntshav cholangiography, angiography thiab suav tomography (CT) siv tus neeg sawv cev tiv thaiv kab mob): kev sib piv cov tshuaj tiv thaiv uas muaj cov tshuaj iodine uas muaj lub tswv yim tshawb fawb tuaj yeem ua rau mob raum tsis zoo, lawv siv yog txuam nrog kev txhim kho ntawm cov kab mob lactic acidosis hauv cov neeg mob noj cov tshuaj metformin (saib. "Contraindications").

Yog li, yog tias nws tau npaj los ua qhov kev tshawb fawb no, Amaril-M yuav tsum tau muab tso tseg ua ntej txheej txheem thiab tsis rov ua dua li ntawm 48 teev tom qab kev kuaj mob. Koj tuaj yeem rov pib kho nrog cov tshuaj no tsuas yog tom qab soj ntsuam thiab tau txais cov kev ntsuas ntawm lub raum kev ua haujlwm.

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.

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. Yog li, cov neeg mob yuav tsum ceev faj txog kev haus cov cawv uas muaj cawv thaum noj cov tshuaj no.

Lub siab ua haujlwm tsis zoo

Txij li ntawm qee kis muaj mob lactic acidosis tau cuam tshuam nrog lub siab ua haujlwm tsis zoo, raws li txoj cai, cov neeg mob kuaj mob lossis kuaj pom ntawm daim siab ua rau 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. Nyob rau hauv muaj ib qho twg ntawm acidosis, cov tshuaj no yuav tsum tau muab 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.

Vitamin B Concentration₁₂ hauv cov ntshav

Kev txo qis Vitamin B₁₂ qis dua qhov kev cai nyob rau hauv cov ntshav cov ntshav 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 nrog thaum muaj cov tshuaj no tso tseg lossis thaum noj tshuaj vitamin B.₁₂ Nws tau hloov sai heev. Qee tus neeg (tsis muaj lossis nqus cov vitamin B₁₂) predisposed rau qhov kev txo qis hauv kev saib xyuas ntawm cov vitamins B₁₂Cov. Rau cov neeg mob zoo li no, tsis tu ncua, txhua 2-3 xyoo, kev txiav txim siab cov ntshav vitamin B ntau hauv ntshav cov ntshav yuav pab tau.₁₂.

Kuaj mob kev nyab xeeb kev tswj hwm

Hematological ciaj ciam (hemoglobin lossis hematocrit, erythrocyte suav) thiab lub raum muaj nuj nqi (ntshiab ncauj creatinine concentration) yuav tsum tau saib xyuas tsawg kawg ib xyoos ib zaug hauv cov neeg mob uas muaj lub raum zoo li qub, thiab tsawg kawg 2-4 zaug hauv ib xyoo hauv cov neeg mob uas muaj creatinine concentration. cov ntshav ntshav nyob rau hauv lub siab txwv ntawm ib txwm thiab nyob rau hauv cov neeg laus cov neeg mob. 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 hais tias kev txhim kho megaloblastic anemia tsis tshua pom thaum noj metformin, yog tias nws xav tias tsam, kev soj ntsuam yuav tsum tau ua kom tsis suav cov vitamin B tsis txaus₁₂.

Cuam tshuam rau lub peev xwm tsav tsheb lossis lwm yam txheej txheem. Tus neeg mob cov tshuaj tiv thaiv tus mob yuav qis dua vim qhov mob ntshav qab zib thiab hyperglycemia, tshwj xeeb tshaj yog thaum pib kho lossis tom qab hloov txoj kev kho, lossis nrog kev tswj hwm tshuaj tsis xwm yeem. Qhov no yuav cuam tshuam rau kev muaj peev xwm uas yuav tsum tau tsav tsheb thiab lwm yam txheej txheem. Cov neeg mob yuav tsum tau txais kev 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.

Cov nyhuv ntawm cov tshuaj rau ntawm tus neeg mob lub cev

Cov tshuaj glimepiride muaj nyob rau hauv cov tshuaj cuam tshuam rau cov ntaub so ntswg, koom nrog cov txheej txheem ntawm kev tswj cov khoom tsim los ntawm cov kua dej, thiab ua rau nws nkag mus rau hauv cov ntshav. Qhov kev nqus ntawm insulin hauv ntshav plasma pab txo qis cov piam thaj hauv lub cev ntawm tus neeg mob ntshav qab zib hom 2.

Ntxiv rau, glimepiride ua rau cov txheej txheem kev thauj cov calcium los ntawm ntshav ntshav mus rau hauv cov hlwb pancreatic. Tsis tas li ntawd, cov nyhuv inhibitory ntawm cov tshuaj nquag ntawm cov tshuaj ntawm kev tsim cov atherosclerotic plaques rau ntawm cov phab ntsa ntawm cov hlab ntsha ntawm cov ntshav ncig yog tsim los.

Metformin muaj nyob hauv cov tshuaj pab txo cov suab thaj hauv cov neeg mob lub cev. Qhov tshuaj tiv thaiv no txhim kho cov ntshav kev hauv daim siab thiab txhim kho kev hloov suab thaj los ntawm daim siab ua kua rau glucogen. Ib qho ntxiv, metformin muaj txiaj ntsig zoo rau kev nqus ntawm cov piam thaj los ntawm ntshav ntshav los ntawm cov leeg ntshav.

Kev siv ntawm Amaril M hauv ntshav qab zib hom 2 tso cai thaum lub sij hawm kho mob kom muaj kev cuam tshuam loj dua lub cev thaum siv tshuaj tsawg dua cov tshuaj.

Qhov tseeb no tsis muaj qhov tseem ceeb me me rau kev tswj hwm lub cev ib txwm ua haujlwm ntawm cov nruab nrog thiab cov nruab nrog cev.

Cov lus qhia rau kev siv tshuaj

Cov lus qhia rau kev siv tshuaj Amaryl m qhia meej meej tias cov tshuaj tau pom zoo rau kev siv nyob rau hauv muaj cov ntshav qab zib hom 2 hauv tus neeg mob.

Qhov ntau thiab tsawg ntawm cov tshuaj yog txiav txim siab nyob ntawm seb cov piam thaj hauv ntshav plasma. Nws raug nquahu, siv txoj kev sib xyaw ua ke xws li Amaril m, txhawm rau tshuaj lub sijhawm tsawg kawg ntawm cov tshuaj uas tsim nyog kom ua tiav cov txiaj ntsig zoo tshaj plaws kho tau.

Cov tshuaj yuav tsum tau noj 1-2 zaug thaum nruab hnub. Nws yog qhov zoo tshaj rau kev noj tshuaj nrog zaub mov.

Qhov ntau kawg ntawm cov tshuaj metformin hauv ib koob yuav tsum tsis pub tshaj 1000 mg, thiab glimepiride 4 mg.

Kev noj tshuaj txhua hnub ntawm cov tebchaw no yuav tsum tsis pub tshaj 2000 thiab 8 mg, ntsig txog.

Thaum siv cov tshuaj uas muaj 2 mg glimepiride thiab 500 mg metformin, cov tshuaj uas noj ib hnub yuav tsum tsis pub tshaj plaub.

Tus nqi ntawm cov tshuaj ib hnub twg tau muab faib ua ob zaug tshuaj ntawm ob lub tshuaj rau ib koob.

Thaum tus neeg mob hloov mus rau ntawm kev noj qee yam npaj muaj glimepiride thiab metformin los noj cov tshuaj Amaril sib xyaw, qhov kev siv tshuaj ntawm cov tshuaj thaum pib theem ntawm txoj kev kho yuav tsum yog qhov tsawg.

Qhov ntau npaum li cas ntawm cov tshuaj tiv thaiv raws li kev hloov pauv rau cov tshuaj sib xyaw ua ke raug kho kom haum raws li kev hloov pauv ntawm cov suab thaj hauv lub cev.

Txhawm rau nce cov tshuaj rau niaj hnub, yog tias tsim nyog, koj tuaj yeem siv cov tshuaj uas muaj 1 mg ntawm glimepiride thiab 250 mg ntawm metformin.

Kev kho nrog cov tshuaj no yog qhov ntev.

Txoj kev siv nrog rau tshuaj yeeb yog cov xwm txheej hauv qab no:

1. tus neeg mob muaj ntshav qab zib hom 1.
2. Qhov muaj ntshav qab zib ketoacidosis.
3. Txoj kev loj hlob hauv tus neeg mob lub cev ntawm kev mob ntshav qab zib tsis nco qab.
4. Lub xub ntiag ntawm cov mob hnyav nyob hauv kev ua haujlwm ntawm lub raum thiab mob siab.
5. Lub sijhawm ua haujlwm tiav thiab lub sijhawm lactation.
6. Lub xub ntiag ntawm tus kheej tsis kam rau lub hauv paus ntawm cov tshuaj.

Thaum siv Amaril M hauv tib neeg lub cev, cov kev mob tshwm sim hauv qab no tuaj yeem tsim:

• mob taub hau
• kev tsaug zog thiab pw tsaug zog,
• kev nyuaj siab mob
• hais lus tsis meej
• trembling hauv nqua
• kev puas tsuaj hauv kev ua haujlwm ntawm cov hlab plawv,
• xeev siab
• ntuav
• zawv plab
• Mob Kev Plab
• kev fab tshuaj tsis haum.

Yog tias muaj kev mob tshwm sim, koj yuav tsum sab laj nrog kws kho mob txog kev hloov kho tshuaj lossis tshem tawm yeeb tshuaj

Cov yam ntxwv ntawm kev siv ntawm cov tshuaj Amaryl M

Tus kws kho mob uas tuaj koom, taw kev rau tus neeg mob kom noj tshuaj raws li qhia, yog lub luag haujlwm ceeb toom txog qhov ua tau rau muaj kev phiv hauv lub cev. Qhov tseem ceeb thiab txaus ntshai ntawm cov kev mob tshwm sim yog hypoglycemia. Cov tsos mob ntawm tus mob hypoglycemia tshwm sim hauv tus neeg mob yog tias nws siv tshuaj tsis noj mov.

Txhawm rau kom tsis txhob muaj qhov tshwm sim hauv lub xeev hypoglycemic hauv lub cev, tus neeg mob yuav tsum ib txwm muaj khaub noom lossis qab zib hauv daim nrog nws. Tus kws kho mob yuav tsum piav qhia rau tus neeg mob kom meej meej txog dab tsi thawj cov tsos mob ntawm cov tsos mob hauv lub cev hypoglycemic hauv lub cev yog, vim tias tus neeg mob lub neej feem ntau nyob ntawm qhov no.

Tsis tas li ntawd, thaum kho cov ntshav qab zib mellitus ntawm yam thib ob, tus neeg mob yuav tsum kuaj xyuas cov ntshav qab zib cov ntshav ua ntu zus.

Tus neeg mob yuav tsum nco ntsoov tias qhov ua tau zoo ntawm cov tshuaj txo qis thaum muaj kev ntxhov siab tshwm sim, vim yog tso adrenaline rau hauv cov ntshav.

Cov xwm txheej zoo li no tuaj yeem yog xwm txheej, kev tsis sib haum xeeb ntawm kev ua haujlwm thiab hauv tus kheej lub neej thiab kab mob nrog los ntawm lub siab kub hauv lub cev.

Nqi, tshuaj xyuas txog cov tshuaj thiab nws cov analogues

Feem ntau, muaj kev txheeb xyuas qhov zoo txog kev siv cov tshuaj. Lub xub ntiag ntawm ntau qhov kev soj ntsuam zoo tuaj yeem ua pov thawj txog qhov muaj txiaj ntsig zoo ntawm cov tshuaj thaum siv tshuaj kho kom yog.

Cov neeg mob uas tawm lawv cov kev txheeb xyuas txog cov tshuaj feem ntau qhia tau tias ib qho kev mob tshwm sim los ntawm kev siv Amaril M yog txoj kev txhim kho hypoglycemia. Txhawm rau kom tsis txhob ua txhaum kev noj tshuaj thaum noj cov tshuaj, cov tuam txhab tsim khoom kom yooj yim ntawm cov neeg mob pleev xim sib txawv ntawm cov tshuaj hauv cov xim sib txawv, uas pab ua kom sib haum.

Tus nqi Amaril yog nyob ntawm cov khoom siv hauv nws ntawm cov tebchaw nquag.

Amaril m 2mg + 500mg muaj tus nqi nruab nrab ntawm kwv yees li 580 rubles.

Cov qauv ntawm cov tshuaj yog:

Tag nrho cov tshuaj no yog cov tshuaj analogues ntawm Amaril m hauv cov tshuaj tiv thaiv. Tus nqi ntawm analogues, raws li txoj cai, yog me ntsis qis dua li ntawm cov tshuaj thawj.

Hauv daim vis dis aus hauv tsab xov xwm no, koj tuaj yeem nrhiav cov ncauj lus qhia ntxaws txog cov tshuaj muaj suab thaj no.