Yanumet - cov lus qhia ua ntej rau siv

Cov tshuaj Yanumet yog kev sib txuas ntawm ob qhov tshuaj tiv thaiv hypoglycemic nrog muaj kev sib txuam (sib ntxiv) cov kev coj ua. Nws tau tsim kho kom zoo dua tswj glycemia hauv cov neeg mob kev txom nyem los ntawm hom II mob ntshav qab zib mellitusCov. Los ntawm cov xwm sitagliptinyog ib qho inhibitor dipeptidyl peptidases-4 (abbr. DPP-4), whereas metforminYog tus sawv cev chav kawm lojmuas.

Pharmacological kev txiav txim sitagliptinraws li inhibitor ntawm DPP-4 yog kev kho kom haum xeeb los ntawm kev ua kom zoo incretinsCov. Thaum inhibiting DPP-4, qhov kev kub siab ntawm 2 cov tshuaj hormones nquag ntawm tsev neeg no nce ntxiv. incretins: glucagon-zoo li peptide-1 (GLP-1),li qub piam thaj insulinotropic polypeptide (HIP) qabzibCov. Cov tshuaj hormones no yog ib feem ntawm cov kev tawm dag zog hauv lub cev evostasispiam thajCov. Yog Qib piam thajnyob rau hauv cov ntshav yog ib txwm los yog nce, ces cov saum toj no nce ntxiv ua rau kev nce hauv synthesis tshuaj insulin thiab nws txoj kev zais. Ntxiv rau, GLP-1 inhibits qhov kev faib nyiaj glucagon, uas inhibits lub synthesis ntawm piam thaj nyob rau hauv lub siab. Sitagliptinnyob rau hauv kev siv koob tshuaj tsis thaiv txoj kev ua si ntawm cov enzymes - dipeptidyl peptidases-8 thiab dipeptidyl peptidases-9.

Vim qhov ua siab ntev ntxiv rau piam thajhauv cov neeg mob nrog hom II mob ntshav qab zib mellitus txog metformin, txo qis qhov tsis tseem ceeb ntawm cov piam thaj hauv qab ntshav. Ntxiv rau, muaj qhov txo qis hauv kev ua ke piam thajnyob rau hauv lub siab (gluconeogenesis), kev nqus poob qis piam thajhauv txoj hnyuv, rhiab rau tshuaj insulinvim los ntawm kev ntes thiab siv ntawm cov lwg me me ntawm qabzib. Nws pharmacological mechanism ntawm kev ua yog txawv los ntawm lwm qhov ncauj hypoglycemic tus neeg sawv cev ntawm lwm cov chav kawm.

Kev ntsuas rau siv

Cov tshuaj Janumet yog pom tias yog ib qho kev ntxiv rau cov neeg ntawm kev siv lub cev thiab ua raws cov pluas nojpab txhawb kom zoo glycemic tswj hauv ntshav qab zib hom IICov. Kev kho mob tseem tuaj yeem nqa tawm hauv kev sib xyaw:

• nrog rau cov tshuaj uas cov tshuaj muaj yees sulfonylurea derivatives (kev sib xyaw ntawm 3 yam tshuaj)
• nrog PPAR agonists (piv txwv li, thiazolidinediones),
• nrog tshuaj insulin.

Cov Yuav Tsum Muaj

• hypersensitivity rau ib yam ntawm cov Cheebtsam ntawm Yanumet,
• mob hnyav uas tuaj yeem cuam tshuam rau lub raum kev ua haujlwm, xws li poob siab, lub cev qhuav dej, kis tau tus mob,
• mob / hom mob uas cov kab mob ua rau hypoxianqaij: lub plawv, ua pa tsis ua haujlwm, tsis ntev los no myocardial infarction,
• mob raum los sis mob hnyav, mob siab,
• mob haus dej cawv txaus qaug cawvlossis muaj mob zoo li quav cawv,
• yam kuv mob ntshav qab zib,
• mob los yog mob ntev metabolic acidosissuav nrog mob ketoacidosis,
• kev tshawb nrhiav hluav taws xob
• cev xeeb tub thiab lactation.

Cov lus qhia ntawm Yanumet (Txujci thiab ntau npaum li cas)

Janumet ntsiav tshuaj tau noj ob zaug ib hnub nrog zaub mov noj. Txhawm rau kom txo qis kev phiv los ntawm kev mob plab hnyuv, qhov koob tshuaj tau nce hauv qib. Cov tshuaj thawj zaug yog xaiv raws li theem tam sim no ntawm kev kho kev kho ntshav qab zib.

Cov lus qhia rau kev siv ntawm Yanumet qhia txog qhov siab tshaj plaws niaj hnub noj sitagliptin- 100 mg.

Saib xyuas! Cov tshuaj muab tshuaj ntawm cov tshuaj hypoglycemic Yanumet yuav tsum tau xaiv ib tus zuj zus, suav txog qhov kev kho mob tam sim no, nws cov hauj lwm zoo thiab tiv taus.

Noj ntau dhau

Thaum noj tshuaj ntau dhau ntawm Yanumet, nws raug pom zoo ua thawj coj ua cov qauv kev ntsuas: tshem tawm ntawm txoj hnyuv mus rau qhov seem ntawm cov tshuaj tsis siv tshuaj, saib xyuas cov cim tseem ceeb (ECG), tuav hemodialysis thiab muab tshuaj, yog tias tsim nyog, txoj kev kho tu.

Kev sib txuam

Tsis muaj ib qho kev tshawb fawb txog kev sib cuam tshuam ntawm kev sib cuam tshuam ntawm cov tshuaj Janumet, tab sis kev tshawb fawb txaus tau ua rau txhua tus muaj feem cuam tshuam - sitagliptinthiab metformin.

• Sitagliptinthaum sib tham nrog lwm cov tshuaj ua rau muaj kev nce ntxiv Auc, qhov siab tshaj plaws (C max) ntawm Digoxin, Januvia, Cyclosporintxawm li cas los xij, cov kev hloov pauv pharmacokinetic no tsis suav hais tias yog tseem ceeb hauv tsev kho mob.
• Ib koob tshuaj Furosemideua rau kom muaj kev nce ntxiv Nrog max metformin thiab Auchauv ntshav thiab ntshav kwv yees li 22% thiab 15%, feem, whereas Nrog max thiab AUC Furosemide poob qis.
• Tom qab noj Nifedipinence nrog max metforminlos ntawm 20% thiab AUC los ntawm 9%.

Daim ntawv noj tshuaj:

Cov lus sib xyaw ntawm lub plhaub rau ib qho tshuaj ntau npaum li 50 mg / 500 mg:
Opadry ® II Paj yeeb 85 F94203 (dej cawv polyvinyl, titanium dioxide E171, macrogol / polyethylene glycol 3350, talc, hlau oxide liab E172, hlau oxide dub E172),

Cov kab ke ntawm lub plhaub rau ib qho tshuaj ntau npaum li 50 mg / 850 mg:
Opadry ® II Paj yeeb 85 F94182 (dej cawv polyvinyl, titanium dioxide E171, macrogol / polyethylene glycol 3350, talc, hlau oxide liab E172, hlau oxide dub E172),

Cov kab ke ntawm lub plhaub rau kev noj tshuaj ntawm 50 mg / 1000 mg:
Opadry ® II Liab 85 F15464 (dej cawv polyvinyl, titanium dioxide E171, macrogol / polyethylene glycol 3350, talc, hlau oxide liab E172, hlau oxide dub E172).

Kev piav qhia

Janumet ntsiav tshuaj 50/500 mg: tshuaj ntsiav zoo li tus, biconvex, zaj duab xis-txheej, lub teeb xim liab, nrog cov ntawv sau "575" ntawm ib sab thiab du rau lwm sab.

Yanumet ntsiav tshuaj 50/850 mg: tshuaj ntsiav zoo li tus, biconvex, them nrog xim xaum zaj duab xis txheej, nrog cov ntawv sau "515" extruded ntawm ib sab thiab du rau sab nraud.

Yanumet ntsiav tshuaj 50/1000 mg: tshuaj ntsiav zoo li tus, biconvex, them nrog cov xaim zaj duab xis liab, nrog cov ntawv sau "577" extruded ntawm ib sab thiab du rau sab nraud.

Cov chaw muag tshuaj

Sitagliptin
Sitagliptin yog qhov ncauj ua rau nquag noj tshuaj enzyme inhibitor (DPP-4), uas yog siv rau kev kho mob hom II mob ntshav qab zib mellitus.
Cov teeb meem pharmacological ntawm DPP-4 inhibitors sib kho los ntawm kev ua kom nce ntawm incretins. Los ntawm inhibiting DPP-4, sitagliptin tsub kom qhov siab ntxiv ntawm ob txoj kev ua si nquag ntawm tsev neeg incretin: glucagon-zoo li peptide 1 (GLP-1) thiab glucose-tiv thaiv insulinotropic polypeptide (HIP).
Tus incretins yog ib feem ntawm cov txheej txheem kho mob sab hauv lub zog rau kev tswj hwm cov ntshav qabzib homeostasis. Nrog ib qho ntshav lossis ntshav nce ntxiv ntawm cov ntshav qabzib, GLP-1 thiab GUI nce cov tshuaj sib tov thiab tso kua ntshav tawm los ntawm pancreatic β-hlwb. GLP-1 kuj tseem ua rau cov kab mob ntshav qab zib tsis txaus los ntawm cov kab mob hlwb pan-hlwb, yog li txo cov synthesis ntawm cov piam thaj hauv lub siab. Qhov kev ua haujlwm ntawm qhov kev sib txawv no txawv ntawm qhov ntawm sulfonylurea derivatives, uas txhawb kev tso tawm ntawm insulin ntawm cov ntshav qabzib tsawg, uas ua rau kev txhim kho ntawm sulfonyl-hob ntshav hypoglycemia tsis yog hauv cov neeg mob uas muaj ntshav qab zib II mob ntshav qab zib mellitus, tab sis kuj yog cov neeg tuaj yeem noj qab haus huv. Ua tus xaiv thiab muaj kev cuam tshuam zoo ntawm DPP-4 enzyme, sitagliptin hauv kev kho kom zoo ntau tsis cuam tshuam cov kev ua haujlwm ntawm cov enzymes DPP-8 lossis DPP-9. Sitagliptin sib txawv hauv cov qauv tshuaj thiab cov tshuaj pharmacological los ntawm cov qauv sib piv ntawm GLP-1, insulin, sulfonylureas lossis mitiglinides, biguanides, γ-receptor agonists ua haujlwm los ntawm peroxisis proliferator (PPAR), α-glycosidase inhibitors thiab amylin analogues.

Metformin
Tus neeg sawv cev hypoglycemic nce nce ntxiv nyob hauv cov neeg mob ntshav qab zib hom II mob ntshav qab zib mellitus, txo qis qis qis thiab tom qab plasma ntshav qab zib ntau ntau. Nws cov tshuaj pharmacological ntawm kev ua txawv ntawm cov txheej txheem ntawm kev ua ntawm qhov ncauj tshuaj hypoglycemic ntawm lwm cov chav kawm.
Metformin txo cov synthesis ntawm cov piam thaj hauv lub siab, kev nqus ntawm cov piam thaj hauv cov hnyuv thiab nce insulin rhiab heev los ntawm kev txhim kho kev nkag siab thiab siv cov suab thaj.Tsis zoo li sulfonylurea derivatives, metformin tsis ua rau cov ntshav qog ntshav qab zib hauv cov neeg mob ntshav qab zib hom mellitus los yog hauv cov neeg ua haujlwm noj qab haus huv (tshwj tsis yog qee qhov xwm txheej, saib TSHUAJ TSHWJ XEEB) thiab tsis ua rau hyperinsulinemia. Thaum kho nrog metformin, insulin secretion tsis hloov, thaum lub sij hawm yoo insulin thiab cov ntshav ntshav insulin niaj hnub yuav poob qis.

Cov Tshuaj Pharmacokinetics

Mechanism ntawm kev ua
50 mg / 500 mg thiab 50 mg / 1000 mg sib xyaw ua ke ntawm cov tshuaj Yanumet (sitagliptin / metformin hydrochloride) yog cov sib npaug thaum sib cais ntawm cov tshuaj sitagliptin phosphate (Januvia) thiab metformin hydrochloride coj txawv.
Muab pov thawj pom kev sib luag ntawm cov ntsiav tshuaj nrog qhov tsawg kawg thiab qhov siab tshaj plaws ntawm kev siv tshuaj metformin, cov ntsiav tshuaj nrog cov tshuaj nruab nrab ntawm metformin ntawm 850 mg kuj tau pom los ntawm bioequivalence, muab tias cov tshuaj tiv thaiv ntawm cov tshuaj tau ua ke hauv ib ntsiav tshuaj.

Xuas
Sitagliptin. Qhov tsis txaus ntseeg txog kev yooj yim ntawm sitagliptin yog kwv yees li 87%. Txais tos ntawm sitagliptin ib txhij nrog cov khoom noj muaj roj tsis cuam tshuam rau pharmacokinetics ntawm cov tshuaj.

Metformin hydrochloride. Qhov tiag txog kev noj qab haus huv ntawm metformin hydrochloride thaum siv ntawm lub plab khoob ntawm koob tshuaj 500 mg yog 50-60%. Cov txiaj ntsig ntawm kev tshawb fawb ntawm ib qho kev txhaj tshuaj ntawm metformin hydrochloride ntsiav tshuaj hauv koob tshuaj los ntawm 500 mg rau 1500 mg thiab los ntawm 850 mg txog 2550 mg qhia qhov ua txhaum ntawm koob tshuaj sib npaug nrog nws nce, uas ntau dua vim txo qis dua kev nthuav dav. Kev siv yeeb tshuaj nrog kev noj zaub mov kom tsawg thiab tus nqi ntawm kev haus tshuaj metformin, raws li muaj pov thawj los ntawm Cmax nqis txog li 40%, txo AUC li ntawm 25%, thiab ncua 35-feeb kom txog thaum Tmax tiav tom qab ib koob 850 mg ntawm metformin tib lub sijhawm nrog zaub mov hauv kev sib piv nrog cov txiaj ntsig thaum noj cov tshuaj zoo sib xws ntawm cov tshuaj ntawm ib plab khoob.
Cov kab mob tseem ceeb hauv kev txo qis ntawm qhov tsis muaj pharmacokinetic tsis tau tsim.

Kev xa Khoom
Sitagliptin. Qhov ntim nruab nrab ntawm kev faib tawm hauv qhov sib npaug tom qab ib koob ntawm 100 mg ntawm sitagliptin hauv cov neeg ua haujlwm noj qab haus huv zoo yog kwv yees li 198 L. Tus zauv seem ntawm sitagliptin, uas khi rov qab rau cov ntshav plasma protein, kuj muaj tsawg (38%).

Metformin. Qhov faib tawm ntawm cov tshuaj metformin tom qab ib leeg noj ntawm qhov ncauj ntawm 850 mg ntau npaum li cas 654 ± 358 L. Metformin tsuas yog nyob hauv ib qho kev faib ua feem me me rau cov ntshav plasma protein, hauv kev sib piv ntawm sulfonylurea derivatives (txog 90%). Metformin yog ib feem thiab muab faib ua cov ntshav liab kom tsis tu ncua. Thaum siv metformin hauv cov koob tshuaj pom zoo, lub plasma concentration ntawm qhov sib npaug ntawm lub xeev (feem ntau raws li kev tshawb fawb tau tswj, Cmax ntawm cov tshuaj tsis ntau tshaj 5 μg / ml txawm tias tom qab noj ntau tshaj plaws ntawm cov tshuaj.

Kev zom zaub mov
Sitagliptin. Txog 79% ntawm sitagliptin yog tawm tsis hloov pauv hauv cov zis, kev hloov pauv hauv cov metabolism yog cov tsawg.
Tom qab 14 C-daim ntawv lo sitagliptin tau muab tshuaj rau qhov ncauj, txog 16% ntawm kev muab koob tshuaj tau tawm tas li cov tshuaj sitagliptin metabolites. Kev tsom me me ntawm 6 metabolites ntawm sitagliptin tau tshaj tawm tias tsis muaj ib qho cuam tshuam rau lub ntshav DPP-4 inhibitory kev ua si ntawm sitagliptin. Hauv kev tshawb fawb hauv vitro isoenzymes ntawm cytochrome system CYP 3A4 thiab CYP 2C8 tau txheeb los ua cov neeg tseem ceeb uas tau koom nrog kev zom cov metabolism ntawm sitagliptin.

Metformin. Tom qab siv ib zaug tshuaj metformin rau cov neeg pab dag zog noj qab haus huv, yuav luag tag nrho cov tshuaj tsis muaj nyob hauv cov zis. Tsis muaj kev hloov pauv hauv cov nplooj siab hauv lub siab thiab kev nthuav tawm nrog lub bile, thiab tsis muaj cov metabolites ntawm qhov tsis hloov pauv hauv metformin tau pom hauv tib neeg thaum ua tas.

Chaw Sau Ntawv
Sitagliptin.Tom qab noj 14 C-daim ntawv qhia sitagliptin sab hauv, yuav luag tag nrho cov tshuaj tso tawm yog tawm hauv lub cev tawm hauv ib lub lis piam, suav nrog 13% hauv lub plab zom mov thiab 87% hauv cov zis. T_1/2 sitagliptin nrog qhov ncauj tswj hwm ntawm 100 mg yog li 12.4 teev, kev ua kom lub plawv rov qab yog li 350 ml / min.
Kev zam ntawm sitagliptin yog nqa tawm feem ntau los ntawm kev ua haujlwm hauv lub raum los ntawm lub tshuab ntawm kev ua kom nquag plias. Sitagliptin yog lub cev hloov pauv ntawm cov neeg hloov pauv organic ntawm anions ntawm peb hom (hOAT-3), uas koom nrog kev tshem tawm ntawm sitagliptin los ntawm lub raum.
Cov kab mob tseem ceeb ntawm kev koom tes ntawm hOAT-3 hauv kev thauj khoom ntawm sitagliptin tseem tsis tau tsim. Kev koom tes ntawm p-glycoprotein nyob rau hauv kev tshem tawm raum tshem tawm ntawm sitagliptin (raws li lub cev) yog ua tau, txawm li cas los xij, qhov inhibitor ntawm p-glycoprotein cyclosporin tsis txo qhov kev tshem tawm ntawm kev ua haujlwm ntawm sitagliptin.

Metformin. Kev tshem tawm ntawm cov metformin ntau dua li cov neeg uas muaj creatinine tshem tawm los ntawm 3.5 zaug, qhia txog lub raum ua kom zoo li qhov tseem ceeb ntawm kev nthuav tawm. Kwv yees li 90% ntawm metformin raug tawm los ntawm lub raum thaum thawj 24 teev nrog lub plasma ib nrab tshem tawm tus nqi kwv yees li 6.2 teev. Hauv cov ntshav, tus nqi no nce ntxiv mus rau 17.6 teev, qhia txog kev tuaj yeem koom nrog cov ntshav liab ua lub peev xwm xa tawm.

Pharmacokinetics ntawm cov neeg mob ib leeg

Cov Neeg Mob Ntshav Qab Zib Hom II

Sitagliptin. Cov tshuaj pharmacokinetics ntawm sitagliptin hauv cov neeg mob ntshav qab zib hom II mob ntshav qab zib zoo ib yam li cov pharmacokinetics ntawm cov neeg ua haujlwm noj qab haus huv zoo.
Metformin. Nrog rau kev ua kom lub raum ua haujlwm, cov chaw muag tshuaj tom qab ib zaug thiab rov ua dua ntawm cov tshuaj metformin hauv cov neeg mob uas muaj ntshav qab zib hom 2 thiab cov neeg tuaj yeem noj qab haus huv zoo ib yam; kev sib txuam ntawm cov tshuaj thaum siv los kho cov tshuaj tsis tshwm sim.

Cov neeg mob uas lub raum tsis ua hauj lwm zoo

Janumet yuav tsum tsis txhob raug mob rau cov neeg mob uas tsis ua haujlwm lub raum (saib KEV KAWM QWJ).

Sitagliptin. Hauv cov neeg mob uas mob raum tsis txaus, kwv yees li ntawm 2 npaug ntawm AUC ntawm sitagliptin tau sau tseg, thiab hauv cov neeg mob uas muaj mob loj thiab davhlau ya nyob twg (ntawm hemodialysis), qhov nce ntawm AUC yog 4-npaug piv nrog cov kev tswj hwm hauv cov neeg ua haujlwm noj qab haus huv.

Metformin. Hauv cov neeg mob uas lub raum tsis zoo ua haujlwm T_1/2 cov tshuaj lengthens, thiab lub raum tshem tawm tsawg zuj zus hauv kev faib ua feem rau kev txo qis hauv creatinine kev tshem tawm.

Cov neeg mob uas muaj lub siab ua haujlwm tsis zoo

Sitagliptin. Hauv cov neeg mob uas muaj mob me me tsis txaus (7–9 cov ntsiab lus ntawm Child-Pugh nplai), cov nqi nruab nrab ntawm AUC thiab Cmax ntawm sitagliptin tom qab ib koob tshuaj 100 mg nce ntxiv txog 21 thiab 13%, piv, piv nrog cov neeg tuaj yeem noj qab haus huv. Qhov sib txawv no tsis yog qhov tseem ceeb.
Tsis muaj cov ntaub ntawv tshawb fawb txog kev siv cov sitagliptin hauv cov neeg mob uas tsis muaj peev xwm ua rau hepatic tsis txaus (> 9 cov ntsiab lus ntawm Child-Pugh scale). Txawm li cas los xij, raws li kev txiav txim siab feem ntau ntawm txoj kev quav tshuaj, qhov kev hloov pauv tseem ceeb ntawm pharmacokinetics ntawm sitagliptin hauv cov neeg mob uas muaj mob hepatic tsis txaus ntseeg tsis tau kwv yees.

Metformin. Ib txoj kev kawm ntawm cov pharmacokinetic ntsuas ntawm metformin hauv cov neeg mob uas tsis ua haujlwm siab tsis ua.

Cov neeg laus cov neeg mob

Cov hnub nyoog hloov pauv ntawm cov tshuaj pharmacokinetics ntawm cov tshuaj yog vim muaj qhov txo qis hauv kev tso zis ntawm lub raum.
Kev kho mob nrog Yanumet tsis yog qhia rau cov neeg mob hnub nyoog tshaj 80 xyoo, tsuas yog cov neeg tshwj xeeb uas muaj qib dab tsi ntawm kev tua neeg tsim muaj (saib TSHWJ XEEB LUS HAIS).

Muab thiab kev coj:

Yanumet feem ntau yog siv 2 zaug hauv ib hnub nrog zaub mov noj, nrog cov tshuaj tiv thaiv maj mam nce ntxiv los txo cov kev phiv los ntawm cov hnyuv, uas yog yam ntxwv ntawm metformin.

Noj cov lus pom zoo

Thawj koob tshuaj ntawm cov tshuaj yog nyob ntawm qhov kev kho hypoglycemic tsis tu ncua. Yanumet noj 2 zaug hauv ib hnub nrog zaub mov.

Cov koob tshuaj pom zoo thawj zaug ntawm Yanumet rau cov neeg mob uas tsis tau ua tiav kev tswj hwm nrog metformin monotherapy yuav tsum tau muab ib hnub uas pom zoo ntawm sitagliptin 100 mg, uas yog, 50 mg ntawm sitagliptin 2 zaug hauv ib hnub ntxiv rau qhov tshuaj tiv thaiv tam sim no ntawm metformin.

Cov koob tshuaj pom zoo thawj zaug ntawm Yanumet rau cov neeg mob uas tsis tau ua tiav kev tswj txaus nrog monotherapy nrog sitagliptin yog 50 mg sitagliptin / 500 mg metformin hydrochloride 2 zaug hauv ib hnub. Hauv lub neej yav tom ntej, cov koob tshuaj yuav raug nce ntxiv rau 50 mg ntawm sitagliptin / 1000 mg ntawm metformin hydrochloride 2 zaug hauv ib hnub.

Rau cov neeg mob uas siv cov tshuaj hloov haum ntawm sitagliptin vim yog lub raum khiav tsis zoo, kev kho mob nrog Janumet yog contraindicated.

Rau cov neeg mob noj ua ke ntawm sitagliptin thiab metformin

Thaum hloov los ntawm kev kho mob ua ke nrog sitagliptin thiab metformin, thawj zaug koob tshuaj yuav yog qhov sib npaug nrog cov koob tshuaj uas lawv siv sitagliptin thiab metformin.

Rau cov neeg mob noj ob ntawm peb yam tshuaj hypoglycemic - sitagliptin, metformin lossis sulfonylurea derivative

Thawj qhov kev pom zoo ntawm cov tshuaj Janumet yuav tsum tau muab tshuaj rau kev kho tshuaj txhua hnub ntawm sitagliptin 100 mg (50 mg sitagliptin 2 zaug hauv ib hnub).
Thawj koob tshuaj metformin yog txiav txim siab los ntawm glycemic tswj ntsuas thiab qhov tam sim no (yog tias tus neeg mob noj cov tshuaj no) koob tshuaj metformin. Kev nce ntxiv ntawm cov tshuaj metformin yuav tsum maj mam ua kom tsawg dua qhov txo cov kev mob tshwm sim los ntawm txoj hnyuv plab hnyuv.

Rau cov neeg mob noj sulfonylurea derivatives, nws yuav pom zoo kom txo qhov tam sim no kom txo qhov pheej hmoo ntawm sulfonyl-hog hypoglycemia.

Rau cov neeg mob noj ob ntawm peb yam tshuaj hypoglycemic - sitagliptin, metformin, lossis PPAR-γ agonist (piv txwv, thiazolidinediones)

Thawj qhov kev pom zoo ntawm cov tshuaj yuav tsum tau muab kev kho tshuaj txhua hnub ntawm sitagliptin 100 mg (50 mg sitagliptin 2 zaug hauv ib hnub). Thawj koob tshuaj metformin yog txiav txim siab los ntawm glycemic tswj ntsuas thiab qhov tam sim no (yog tias tus neeg mob noj cov tshuaj no) koob tshuaj metformin. Kev nce ntxiv ntawm cov tshuaj metformin yuav tsum maj mam ua kom tsawg dua qhov txo cov kev mob tshwm sim los ntawm txoj hnyuv plab hnyuv.

Rau cov neeg mob noj ob ntawm peb qhov tshuaj hypoglycemic - sitagliptin, metformin lossis insulin

Thawj qhov kev pom zoo ntawm cov tshuaj Janumet yuav tsum tau muab tshuaj rau kev kho tshuaj txhua hnub ntawm sitagliptin 100 mg (50 mg sitagliptin 2 zaug hauv ib hnub). Thawj koob tshuaj metformin yog txiav txim siab los ntawm glycemic tswj ntsuas thiab qhov tam sim no (yog tias tus neeg mob noj cov tshuaj no) koob tshuaj metformin. Kev nce ntxiv ntawm cov tshuaj metformin yuav tsum maj mam ua kom tsawg dua qhov txo cov kev mob tshwm sim los ntawm txoj hnyuv plab hnyuv. Rau cov neeg mob uas tau siv lossis pib siv tshuaj insulin, kev noj tshuaj insulin qis dua yuav raug txo kom txo qis kev pheej hmoo ntawm hypoglycemia.

Kev kawm tshwj xeeb ntawm kev nyab xeeb thiab kev ua haujlwm ntawm kev hloov pauv los ntawm kev kho mob nrog lwm cov tshuaj hypoglycemic mus rau kev kho mob nrog cov tshuaj sib xyaw ua ke Yanumet tsis tau nqa tawm.
Txhua qhov hloov pauv ntawm kev kho mob ntawm hom II mob ntshav qab zib mellitus yuav tsum tau ua nrog ceev faj thiab muaj kev tswj hwm, suav txog kev hloov pauv ntawm theem kev tswj hwm ntawm glycemic.

Sab sij huam

Ua ke kev kho mob nrog sitagliptin thiab metformin

Pib kev kho

Hauv 24-lub lim tiam placebo-tswj kev tshawb nrhiav qhov tseeb ntawm kev pib ua ke nrog kev kho mob nrog sitagliptin thiab metformin (sitagliptin 50 mg + metformin 500 mg lossis 1000 mg 1000 2 zaug hauv ib hnub) hauv cov tshuaj sib xyaw ua ke piv nrog cov tshuaj monotherapy pawg metformin (500 mg lossis 1000 mg × 2 ib zaug ib hnub), sitagliptin (100 mg ib hnub ib zaug) lossis placebo, cov kev mob tshwm sim hauv qab no nrog kev noj cov tshuaj tau pom, pom nrog ntau zaus ntawm ≥ 1% hauv pawg kho mob sib xyaw thiab ntau dua nyob hauv pawg placebo: raws plab (sitagliptin + metform n - 3.5%, metformin - 3.3%, sitagliptin - 0.0%, tso placebo - 1.1%), xeev siab (1.6%, 2.5%, 0.0% thiab 0.6%), dyspepsia (1.3%, 1.1%, 0.0% thiab 0.0%), flatulence (1.3%, 0.5%>, 0.0%> thiab 0.0%). ntuav (1.1%, 0.3%), 0.0% thiab 0.0%>) mob taub hau (1.3%, 1.1%, 0.6% thiab 0.0%) thiab mob ntshav qab zib (1.1) %, 0.5%>, 0.6%) thiab 0.0%).

Ntxiv sitagliptin rau cov tshuaj metformin kho tam sim no

Hauv 24-lub lis piam, kev kawm tshuaj placebo, nrog ntxiv ntawm sitagliptin ntawm koob tshuaj 100 mg / hnub rau kev kho mob tam sim no nrog metformin, tsuas yog qhov tshwm sim cuam tshuam nrog kev noj tshuaj tau pom nrog ntau zaus ≥1%> hauv pawg kho mob nrog sitagliptin thiab ntau dua li ntau dua hauv cov tshuaj placebo. , muaj xeev siab (sitagliptin + metformin - 1.1%, placebo + metformin - 0.4%).

Kev mob ntshav qab zib thiab kev phiv tshuaj los ntawm lub plab zom mov

Hauv kev soj ntsuam cov tshuaj placebo ntawm kev kho mob ua ke nrog sitagliptin thiab metformin, qhov tshwm sim ntawm kev mob ntshav qab zib (tsis hais txog ntawm kev sib luag) hauv cov pab pawg sib xyaw ua ke tau muab piv rau qhov muaj ntau zaus hauv cov kev kho mob ntawm metformia ua ke nrog placebo (1.3-1.6% thiab 2.1 % feem). Qhov ntau zaus los ntawm kev saib xyuas qhov tshwm sim tsis zoo los ntawm kev mob plab (tsis hais txog qhov ua rau kev sib raug zoo) hauv kev sib koom ua ke ntawm kev kho mob ntawm sitagliptia thiab metformia tau muab piv rau qhov muaj ntau zaus nyob rau hauv cov mob metformia monotherapy pawg: raws plab (sitagliptin + metformin - 7.5%. Metformin - 7,7%). xeev siab (4.8%, 5.5%). ntuav (2.1%. 0.5%). mob plab (3.0%, 3.8%).

Hauv txhua qhov kev tshawb fawb, qhov tshwm sim tsis zoo nyob rau hauv daim ntawv ntawm cov ntshav khov (hypoglycemia) tau sau tseg los ntawm txhua daim ntawv tshaj tawm ntawm cov kws kho mob pom tias muaj cov ntshav qog ntshav qab zib, kev ntsuas ntxiv ntawm cov concentration ntawm cov piam thaj hauv cov ntshav tsis tas yuav tsum.

Ua ke nrog kev kho mob nrog sitagliptin, metformin thiab sulfonylurea derivative

Hauv 24-lub lis piam, kev kawm tshuaj placebo siv sitagliptin ntawm koob tshuaj 100 mg / hnub tiv thaiv keeb kwm ntawm kev kho mob tam sim no nrog glimepiride ntawm koob tshuaj ≥4 mg / hnub thiab metformia hauv koob tshuaj ≥ 1500 mg / hnub, cov tshuaj tiv thaiv kab mob hauv qab no tau pom nrog cov tshuaj, pom nrog nrog ntau zaus ntawm ≥1% hauv pawg kho mob nrog sitagliptia thiab ntau dua li ntawm pawg placebo: hypoglycemia (sitagliptin -13.8%, placebo -0.9%), cem quav (1.7% thiab 0.0%), metformia ua ke nrog placebo (1, 3-1.6% thiab 2.1% feem). Qhov ntau zaus los ntawm kev saib xyuas qhov tshwm sim tsis zoo los ntawm kev mob plab (tsis hais txog qhov ua rau kev sib raug zoo) hauv kev sib koom ua ke ntawm kev kho mob ntawm sitagliptia thiab metformia tau muab piv rau qhov muaj ntau zaus nyob rau hauv cov mob metformia monotherapy pawg: raws plab (sitagliptin + metformin - 7.5%. Metformin - 7,7%). xeev siab (4.8%, 5.5%). ntuav (2.1%. 0.5%). mob plab (3.0%, 3.8%).

Hauv txhua qhov kev tshawb fawb, qhov tshwm sim tsis zoo nyob rau hauv daim ntawv ntawm cov ntshav khov (hypoglycemia) tau sau tseg los ntawm txhua daim ntawv tshaj tawm ntawm cov kws kho mob pom tias muaj cov ntshav qog ntshav qab zib, kev ntsuas ntxiv ntawm cov concentration ntawm cov piam thaj hauv cov ntshav tsis tas yuav tsum.

Ua ke nrog kev kho mob nrog sitagliptin, metformia, thiab sulfonylurea derivatives

Hauv 24-lub lis piam, kev kawm tshuaj placebo siv sitagliptin ntawm koob tshuaj 100 mg / hnub tiv thaiv keeb kwm ntawm kev kho mob tam sim no nrog glimepiride ntawm koob tshuaj ≥4 mg / hnub thiab metformia hauv koob tshuaj ≥ 1500 mg / hnub, cov tshuaj tiv thaiv kab mob hauv qab no tau pom nrog cov tshuaj, pom nrog zaus ntawm ≥ 1% hauv pawg kho mob nrog sitagliptin thiab ntau dua li ntau dua hauv cov pawg placebo: hypoglycemia (sitagliptin -13.8%, placebo -0.9%), cem quav (1.7% thiab 0.0%).

Ua ke nrog kev kho mob nrog sitagliptin, metformin thiab PPAR-γ agonist

Raws li kev tshawb pom cov tshuaj placebo siv sitagliptin ntawm koob tshuaj 100 mg / hnub tiv thaiv keeb kwm yav dhau los ntawm kev kho mob tam sim no nrog rosiglitazone thiab metformin nyob rau ntawm 18 lub lim tiam ntawm kev kho mob, cov kev mob tshwm sim hauv qab no cuam tshuam nrog cov tshuaj tau pom, pom nrog ntau zaus ntawm ≥1% hauv pawg kho mob nrog sitagliptin thiab ntau dua, dua li hauv cov pawg placebo: mob taub hau (sitagliptin - 2.4%, placebo - 0.0%), raws plab (1.8%, 1.1%), xeev siab (1.2%, 1.1%), hypoglycemia (1.2%, 0.0%), ntuav (1.2%. 0.0%). Nyob rau ntawm lub lim tiam 54 ntawm kev kho ua ke, cov kev mob tshwm sim hauv qab no cuam tshuam nrog cov tshuaj tau pom, muaj ntau zaus ntawm> 1% hauv pawg kho mob nrog sitagliptin thiab ntau dua li ntau dua hauv cov pawg placebo: mob taub hau (sitagliptin -2.4%, placebo - 0.0% ), mob qog ntshav qog (2.4%, 0.0%), muaj mob ua pa rau sab saud (1.8%, 0.0%), xeev siab (1.2%, 1.1%), hnoos (1.2%) , 0.0%), mob fungal ntawm daim tawv nqaij (1.2%, 0.0%), peripheral edema (1.2%, 0.0%), ntuav (1.2%, 0.0%).

Ua ke kev kho mob nrog sitagliptin, metformin thiab insulin

Hauv 24-lub lis piam, cov tshuaj placebo kawm siv sitagliptin ntawm koob tshuaj 100 mg / hnub tiv thaiv keeb kwm ntawm kev siv tshuaj tam sim no nrog metformin ntawm koob tshuaj ≥1500 mg / hnub thiab cov koob tshuaj insulin tas li tsuas yog muaj qhov tshwm sim cuam tshuam nrog kev noj tshuaj thiab pom nrog ntau zaus ntawm> 1% hauv pawg kho mob nrog sitagliitin thiab ntau dua li ntau dua hauv cov pawg placebo yog hypoglycemia (sitagliptin - 10.9%, placebo - 5.2%).

Lwm qhov kev tshawb nrhiav 24-lub lim tiam, hauv cov neeg mob tau txais sitagliptin ua kev kho mob rau cov tshuaj insulin (nrog lossis tsis muaj metformin), tsuas pom qhov tshwm sim tsis zoo uas tau pom nrog ntau zaus ≥1% hauv pawg kho mob nrog sitagliptin thiab metformin. thiab ntau dua li ntawm cov placebo thiab metformin pawg, muaj ntuav (sitagliptin thiab metformin -1,1%, cov placebo thiab metformin - 0.4%).

Kev mob caj dab

Hauv qhov kev ntsuam xyuas dav dav ntawm 19 ob lub qhov muag tsis pom nyob rau hauv kev kuaj mob ntawm kev siv cov sitagliptin (ntawm 100 koob tshuaj / hnub) lossis cov tshuaj tiv thaiv kev tiv thaiv (nquag lossis cov placebo), teev ntawm kev txhim kho ntawm tus mob pancreatitis yog 0.1 kis rau 100 tus neeg mob-xyoo ntawm kev kho mob hauv txhua pawg (saib ntu. "Cov lus qhia tshwj xeeb. Kab mob hauv Pancreatitis").

Tsis muaj qhov sib txawv hauv tsev kho mob hauv cov cim tseem ceeb lossis ECG (suav nrog lub sijhawm QTc ntu) raug pom nrog kev kho ua ke nrog sitagliitin thiab metformin.

Kev phiv tshuaj tsis zoo vim kev siv cov sitagliptin

Cov neeg mob tsis tau ntsib kev phiv tshuaj vim tias sitagliptin, qhov ntau yog ≥1%.

Kev phiv tshuaj tiv thaiv vim yog siv cov metformin

Cov kev mob tshwm sim hauv pawg metformin hauv> 5% ntawm cov neeg mob thiab ntau dua li cov pab pawg placebo yog raws plab, tons ntawm sab qab teb / ntuav, mob plab, asthenia, dyspepsia, mob plab thiab mob taub hau.

Kev soj ntsuam tom qab cuv npe tas

Thaum lub sijhawm sau npe tom qab tshuaj xyuas kev siv ntawm cov tshuaj Janumet lossis sitagliptin. suav nrog nws qhov muaj pes tsawg leeg, hauv kev kho mob hlwb thiab / lossis kev sib txuam nrog kev kho mob nrog lwm tus neeg hypoglycemic, muaj cov xwm txheej tsis zoo ntxiv tau pom.

Vim tias cov ntaub ntawv no tau txais los ntawm cov neeg tsis paub meej txog qhov loj me, qhov kev paub ntau heev thiab qhov cuam tshuam ntawm cov xwm txheej tsis zoo no nrog kev kho tsis tuaj yeem txiav txim siab. Cov no suav nrog: kev ua kom tsis haum lub siab, suav nrog anaphylaxis: angioneurotic edema: tawv nqaij ua pob: urticaria: tawv nqaij vasculitis: exfoliative daim tawv nqaij mob, nrog rau Stevens-Johnson syndrome, mob mob ua rau muaj mob, nrog rau kev mob hemorrhagic thiab necrotic nrog rau kev ua kom mob thiab tsis ua raws li txoj cai: ua rau mob raum tsis ua haujlwm suav nrog mob raum tsis ua haujlwm (qee lub sijhawm lim ntshav yuav tsum muaj), mob hlab pas siab, txhaws ntswg, cem quav: ntuav, mob taub hau: mob caj dab: myalgia, nqaj mob, mob nraub qaum.

Kev hloov pauv hauv tsev kho mob

Sitagliptin
Kev ntsuas ntawm qhov ntsuas ntawm cov ntsuas hauv cov pawg kho mob nrog sitagliptip thiab metformin tau sib piv nrog cov zaus hauv cov pawg kho mob nrog cov placebo thiab metformin. Feem ntau, tab sis tsis yog txhua qhov kev sim pom tau nce me ntsis ntawm cov qe ntshav dawb (kwv yees 200 / comparedl piv nrog cov placebo, cov ntsiab lus nruab nrab thaum pib kho 6600 / μl). vim muaj qhov nce ntxiv hauv tus lej neutrophils. Qhov kev hloov pauv no tsis yog qhov tseem ceeb hauv tsev kho mob.

Metformin
Hauv kev tswj xyuas cov kev tshawb fawb soj ntsuam ntawm metformin kav ntev li 29 lub lim tiam, ib qho kev txo qis ntawm qhov ib txwm muaj ntawm ciaiocobalamin (vitamin B₁₂) rau cov nuj nqis tsis xws luag hauv cov ntshav ntshav kwv yees li 7% ntawm cov neeg mob, tsis muaj kev kuaj mob. Qhov zoo li txo qis vim kev xaiv malabsorption ntawm vitamin B₁₂ (piv txwv li, kev ua txhaum ntawm kev tsim ntawm ib txoj hauv kev nrog lub tsev fuabtais sab hauv tsim nyog rau qhov nqus ntawm cov vitamin B₁₂ )tsis tshua muaj neeg ua rau kev txhim kho ntshav tsis txaus thiab kho tau yooj yim los ntawm kev tshem tawm tshuaj metformin lossis kev noj cov tshuaj vitamin B ntxiv.₁₂ (saib hauv tshooj "Cov Lus Qhia Tshwj Xeeb. Metformin").

Cov lus qhia tshwj xeeb

Kev mob caj dab

Hauv lub sijhawm sau npe tom qab kev soj ntsuam, tau txais xov xwm txog kev txhim kho ntawm tus mob ua paug, nrog rau hemorrhagic lossis necrotic nrog rau kev ua rau tuag taus thiab tsis mob, rau cov neeg mob noj sitagliitin (saib ntu "Cov Kev Phiv Tom Qab Kev Sau Npe").

Txij li cov xov no tau txais kev yeem los ntawm cov pejxeem uas tsis paub tseeb, nws tsis tuaj yeem ntseeg tau kwv yees ntau npaum li cas ntawm cov xov xwm no lossis tsim kom muaj kev sib raug zoo nrog lub sijhawm siv tshuaj. Cov neeg mob yuav tsum tau qhia txog cov yam ntxwv ntawm tus yam ntxwv ntawm tus mob pancreatitis: mob hnyav, mob plab heev. Soj ntsuam qhov tseeb ntawm pancreatitis ploj tom qab tsis mus kev ntawm sitagliptin. Yog hais tias xav tias tsam tus mob pancreatitis, nws yog ib qho tsim nyog yuav tsum tsis txhob noj tshuaj Janumet thiab lwm yam tshuaj txaus ntshai.

Kev kuaj xyuas lub raum

Qhov zoo tshaj txoj hauv kev rau tshem tawm metformin thiab sitagliptin yog mob raum. Txoj kev pheej hmoo ntawm kev txuam nrog metformin thiab kev txhim kho ntawm cov kab mob lactic acidosis nce rau hauv kev faib ua feem ntawm qhov tsis ua haujlwm ntawm lub raum, vim li no, cov tshuaj Janumet yuav tsum tsis txhob raug rau cov neeg mob uas muaj cov ntshav tsim muaj peev txheej siab dua li ib puag ncig lub hnub nyoog ntawm ib txwm. Hauv cov neeg mob neeg laus, vim tias lub hnub nyoog ntsig txog txo qis hauv lub raum kev ua haujlwm, ib qho yuav tsum siv zog ua kom tiav cov glycemic tswj kev noj qab haus huv tsawg kawg ntawm Yanumet. Hauv cov neeg laus laus, tshwj xeeb cov laus tshaj 80 xyoo. ib txwm soj ntsuam hmo ntuj muaj nuj nqi. Ua ntej pib kev kho mob nrog Yanumet, ntxiv rau tsawg kawg ib xyoos ib zaug tom qab pib kev kho mob, nrog kev pab los ntawm kev kuaj mob uas tsim nyog, kev ua haujlwm ntawm lub raum ib txwm muaj tseeb. Nrog txoj kev muaj peev xwm ntawm kev txhim kho lub raum ua haujlwm, lub raum kev ua haujlwm soj ntsuam tau nqa tawm ntau dua, thiab thaum nws kuaj pom, cov tshuaj Janumet tau muab tso tseg.

Kev tsim cov ntshav qog ntshav nrog kev siv ua ke nrog sulfonylureas lossis insulin

Ib yam li lwm yam kab mob hypoglycemic, kev tiv thaiv hypoglycemia tau raug soj ntsuam nrog kev siv sitagliptin thiab metformin nrog rau cov tshuaj insulin lossis sulfonylurea derivatives (saib ntu "phiv"). Txhawm rau txo cov kev pheej hmoo ntawm kev tsim muaj sulfonyl-ntxias los yog tsim cov tshuaj insulin los ua kom txo qis, qhov koob tshuaj sulfonylurea derivative lossis insulin yuav tsum raug txo qis (saib ntu "Dosage thiab Administration").

Sitagliptin

Kev tsim cov ntshav qog ntshav nrog kev siv ua ke nrog sulfonylureas lossis insulin

Hauv kev tshawb fawb soj ntsuam ntawm sitagliptin, ob qho tib si hauv monotherapy thiab hauv kev sib xyaw nrog cov tshuaj uas tsis ua rau kev txhim kho hypoglycemia (uas yog, metformin lossis PPARγ agonists - thiazolidinediones). qhov tshwm sim ntawm cov ntshav qog nqaij hlav hauv cov pab pawg ntawm cov neeg mob noj cov tshuaj sitagliptin. tau nyob ze rau qhov zaus hauv cov pab pawg neeg mob tau noj cov placebo.

Ib yam li lwm yam kab mob hypoglycemic, kev tiv thaiv hypoglycemia tau raug soj ntsuam nrog kev siv sitagliptin tib lub sijhawm sib xyaw nrog insulin lossis sulfonylurea derivatives (saib ntu "Cov Kev Phiv"). Txhawm rau txo cov kev pheej hmoo ntawm kev tsim muaj sulfonyl-ntxias los yog tsim cov tshuaj insulin los ua kom txo qis, qhov koob tshuaj sulfonylurea derivative lossis insulin yuav tsum raug txo qis (saib ntu "Dosage thiab Administration").

Kev ua haujlwm tsis haum siab

Thaum lub sijhawm sau npe tom qab kev saib xyuas ntawm kev siv cov tshuaj Yanumet lossis sitagliptin, uas yog ib feem ntawm nws, hauv kev kho mob monotherapy thiab / lossis kev sib xyaw nrog kev kho mob nrog lwm tus neeg mob hypoglycemic, kev tiv thaiv tus cwj pwm tsis nco qab tau raug kuaj tau. Cov kev cuam tshuam no suav nrog anaphylaxis, angioedema, exfoliative kab mob ntawm daim tawv nqaij, suav nrog Stevens-Johnson syndrome.Vim tias cov ntaub ntawv no tau txais los ntawm cov neeg tsis paub meej txog qhov loj me, kev paub ntau zaus thiab kev sib raug zoo nrog txoj kev kho ntawm cov kev tsis zoo no tsis tuaj yeem txiav txim siab. Cov kev cuam tshuam no tau tshwm sim hauv thawj 3 lub hlis tom qab pib kho nrog sitagliptin. qee qhov tau pom tshwm sim tom qab noj thawj koob ntawm cov tshuaj. Yog tias kev txhim kho ntawm kev tiv thaiv tsis haum lub siab, nws yog qhov tsim nyog kom tsum tsis txhob noj cov tshuaj Janumet, tshuaj xyuas lwm qhov laj thawj ntawm kev txhim kho ntawm qhov tshwm sim tsis tsim nyog thiab sau tawm lwm txoj kev kho lipid-txo qis (saib ntu "Kev Pom Tsis Zoo" thiab "Cov Kev Phom Sij Tom Qab Kev Sau Npe").

Metformin

Lactic acidosis

Lactoapidosis yog ib qho mob uas tsis tshua muaj tab sis mob hnyav uas tshwm sim vim qhov kev txuam nrog metformin thaum kho mob nrog Yanumet. Kev tuag ntawm cov kab mob lactic acidosis mus txog kwv yees li 50%. Kev loj hlob ntawm cov kab mob lactic acid tuaj yeem tshwm sim tiv thaiv keeb kwm ntawm qee tus kab mob somatic, tshwj xeeb, mob ntshav qab zib mellitus lossis lwm yam kab mob pathological, nrog mob hyioperfusion thiab hypoxemia ntawm cov ntaub so ntswg thiab kabmob. Lactic acidosis yog tus cwj pwm los ntawm kev nce siab ntawm lactate hauv cov ntshav ntshav (> 5 mmol / l). txo cov ntshav pH, electrolyte cuam tshuam nrog kev nce hauv anion interval, nce ntxiv ntawm qhov feem ntawm lactate / pyruvate. Yog tias cov metformin yog qhov ua rau acidosis, nws cov ntshav plasma feem ntau yog> 5 μg / ml. Raws li cov lus ceeb toom, cov kab mob lactic acidosis hauv kev kho mob nrog metformin tsim muaj qhov tsis tshua muaj heev (hauv thaj tsam li 0.03 rau ib tus neeg mob 1000 xyoo. Nrog rau kev tuag ntawm kwv yees li 0.015 kis rau 1000 tus neeg mob xyoo). Txog 20,000 tus neeg mob-xyoo kev siv tshuaj metformin kho, tsis muaj cov mob ntawm cov kab mob lactic acidosis tau qhia hauv kev kuaj mob.

Cov neeg muaj mob feem ntau tau tshwm sim rau cov neeg mob ntshav qab zib mellitus nrog rau lub raum tsis ua haujlwm loj, nrog rau lub raum mob ntshav siab thiab lub raum hypoperfusion, feem ntau ua ke nrog concomitant ntau somatic / phais kab mob thiab polypharmacy.

Txoj kev pheej hmoo ntawm kev tsim mob lactic acidosis hauv cov neeg mob uas muaj lub plawv tsis ua haujlwm ntev, yuav tsum tau hloov kho cov tshuaj tseem ceeb, tshwj xeeb tshaj yog nrog kev tsis txaus siab ntawm lub plawv tsis haum / lub siab tsis ua haujlwm hauv cov mob siab, nrog kev mob siab hypoperfusion thiab hypoxemia, tau nce ntau. Txoj kev pheej hmoo ntawm kev tsim cov kab mob lactic acid nce nyob rau hauv kev faib ua feem ntawm kev tsis ua haujlwm ntawm lub raum thiab cov neeg mob lub hnub nyoog, yog li ntawd, kev soj ntsuam kom zoo rau lub raum kev ua haujlwm, nrog rau kev siv tshuaj tsawg kawg ntawm metformin, tuaj yeem txo qhov kev pheej hmoo ntawm lactic acidosis. Ua tib zoo saib xyuas kev ua haujlwm ntawm lub raum yog qhov tshwj xeeb tshaj yog nyob rau hauv kev kho mob ntawm cov neeg laus, thiab cov neeg mob hnub nyoog laus dua 80 xyoo tau kho nrog metformin tsuas yog tom qab paub meej txog kev ua haujlwm lub raum txaus thiab cov txiaj ntsig ntawm kev soj ntsuam ntawm kev tsim creatinine, txij li cov neeg mob no muaj kev pheej hmoo ntau dua ntawm kev mob lactic acidosis. Tsis tas li ntawd, nyob rau hauv ib qho xwm txheej twg los nrog kev txhim kho hypoxemia, lub cev qhuav dej lossis sepsis, metformin yuav tsum tau tshem tawm tam sim ntawd.

Muab hais tias nrog lub siab ua haujlwm tsis zoo, kev ua haujlwm ntawm lactate yog qhov txo qis, metformin yuav tsum tsis txhob raug rau cov neeg mob uas kuaj mob lossis kuaj pom ntawm daim siab mob. Thaum lub sij hawm kho nrog megformin, kev haus cawv yuav tsum txwv, txij li cawv cawv potentiates cov nyhuv ntawm metformin ntawm lactate metabolism. Ib qho ntxiv, kev kho mob nrog metformin ib pliag txuas ib ntus thaum lub sijhawm tshawb nrhiav kev xoo hluav taws xob thiab kev phais mob. Qhov pib ntawm lactic acidosis feem ntau nyuaj nrhiav tau, thiab nws tseem nrog cov tsos mob tshwj xeeb nkaus xwb, xws li malaise, myalgia. mob ntsws ua pa nyuaj, tsaug zog ntau dua tuaj, thiab cov tsos mob tsis txaus ntseeg.Nrog kev mob siab rau ntawm chav kawm ntawm cov kab mob lactic acidosis, mob ntshav qab zib, mob ntshav qis, thiab tiv thaiv bradyarrhythmia tuaj yeem koom nrog cov tsos mob aforementioned. Tus kws kho mob thiab tus neeg mob yuav tsum paub txog qhov tseem ceeb ntawm cov tsos mob zoo li no, thiab tus neeg mob yuav tsum qhia tus kws kho mob tam sim ntawd ntawm lawv qhov tsos. Kev kho mob nrog metformin raug muab tso tseg kom txog thaum qhov xwm txheej ntshiab. Plasma ntau ntawm electrolytes, ketones, ntshav qabzib tau txiav txim siab, ntxiv rau (raws li qhia) pH tus nqi ntawm cov ntshav, cov concentration ntawm lactate. Qee zaum cov ntshav ntsiab lus ntawm metformin kuj tseem yuav pab tau. Tom qab tus neeg mob tau siv los kho qhov zoo tshaj plaws ntawm cov tshuaj metformin, mob plab nyhuv cov yam ntxwv ntawm kev pib kho mob yuav tsum ploj mus. Yog tias cov tsos mob tshwm sim, tom qab ntawd lawv yog. feem ntau yuav yog lub cim ntawm kev tsim cov kab mob lactic acidosis lossis lwm tus kabmob hnyav.

Yog tias, thaum lub sijhawm kho nrog metformin, qhov kev cia siab ntawm lactate hauv cov ntshav plasma ntau dua qhov txwv tsis pub tshaj, tsis tshuav ntau dua 5 mmol / l, qhov no tsis yog pathognomonic rau lactic acidosis thiab vim yog kev mob tsis zoo xws li ntshav qab zib mellitus lossis rog rog, lossis kev ua haujlwm ntau dhau los, lossis kev tshaj lij ntsuas ntsuas yuam kev. Hauv txhua tus neeg mob uas mob ntshav qab zib mellitus thiab metabolic acidosis tsis muaj kev paub txog ketoacidosis (ketonuria thiab ketoemia), muaj kev pheej hmoo ntawm lactic acidosis.

Lactic acidosis yog ib tus mob uas yuav tsum tau siv tshuaj khomob xwm txheej nyob hauv tsev kho mob. Metformin kev kho mob raug tso tseg thiab qhov tsim nyog ntawm kev saib xyuas kev kho mob yog nqa tawm tam sim ntawd. Txij li metformin tau tshawb xyuas ntawm qhov ceev ntawm 170 ml / min nyob rau hauv kev mob ntawm hemodynamics zoo, hemodialysis sai tau pom zoo kom kho sai acidosis thiab tshem tawm cov tshuaj metformin. Cov kev ntsuas no feem ntau ua rau muaj kev ploj sai sai ntawm txhua tus tsos mob ntawm cov kab mob lactic acidosis thiab kho kom rov qab zoo dua ntawm tus neeg mob (saib ntu "Contraindications").

Kev ntshav siab

Nyob rau hauv ib txwm mob, nrog metformin monotherapy, hypoglycemia tsis txhim kho, tab sis nws txoj kev loj hlob muaj peev xwm tiv thaiv keeb kwm ntawm kev tshaib plab, tom qab lub cev tseem ceeb tsis muaj kev cuam tshuam tom ntej ntawm cov calories hlawv, thaum noj lwm yam tshuaj hypoglycemic (sulfonylurea derivatives thiab insulin) lossis dej cawv. Txhawm rau ntau dua, kev txhim kho hypoglycemia cuam tshuam rau cov laus, cov neeg ua haujlwm tsis muaj zog lossis ua rau cov neeg mob, cov neeg mob uas quav cawv, cov neeg mob adrenal lossis qias neeg tsis txaus. Kev mob ntshav qab zib yog ib qho nyuaj rau nco txog cov neeg laus thiab cov neeg mob uas siv cov beta-blockers.

Ntsuas kev kho mob

Cov tshuaj kws kho mob ua rau muaj kev cuam tshuam tsis zoo rau lub raum kev ua haujlwm lossis kev faib tawm tshuaj metformin. Kev siv cov tshuaj ib txhij uas cuam tshuam rau lub raum kev ua haujlwm, hemodynamics lossis kev faib tawm cov tshuaj metformin (xws li cov tshuaj cationic uas tso tawm hauv lub cev los ntawm tubular cov pa) yuav tsum tau sau tseg nrog kev ceev faj (saib Ntu “Kev cuam tshuam nrog lwm cov tshuaj. Metformin”).

Kev tshawb nrhiav radiological nrog kev saib xyuas ntawm cov tshuaj iodine uas muaj cov tshuaj tiv thaiv kab mob sib piv (piv txwv li, cov leeg urogram, tso ntshav cholangiography, angiography, suav tomography nrog kev saib xyuas lub cev ntawm cov tshuaj tiv thaiv kev cuam tshuam).

Kev tswj fwm ntawm cov tshuaj iodine uas muaj cov tshuaj tiv thaiv kab mob cuam tshuam nrog kev txhim kho ntawm cov kab mob lactic acidosis hauv cov neeg mob noj cov tshuaj metformin thiab tuaj yeem ua rau mob raum tsis zoo (saib ntu "Contraindications"). Yog li, cov neeg mob uas tau teem sijhawm rau txoj kev kawm no yuav tsum tsum tsis pub noj tshuaj Janumet li 48 teev ua ntej thiab nyob hauv 48 teev tom qab kev tshawb fawb. Kev rov pib kho mob yog tso cai tau tsuas yog tom qab kuaj pom tseeb ntawm lub raum li qub.

Tej yam kev mob hypoxic

Vascular kev sib tsoo (poob siab) ntawm txhua txoj kev etiology, mob plawv tsis ua haujlwm, mob myocardial infarction thiab lwm yam mob nrog rau kev txhim kho hypoxemia. tuaj yeem ua rau kev txhim kho ntawm cov kab mob lactic acidosis thiab mob raum. Yog tias cov xwm txheej tau teev tseg hauv tus neeg mob lub sijhawm kho nrog Yanumet. noj cov tshuaj yuav tsum tau nres tam sim ntawd. Cov kev cuam tshuam txog kev phais mob Kev siv cov tshuaj Janumet yuav tsum tsis ua rau lub sijhawm txiav tawm ntawm kev phais mob (tshwj tsis yog muaj kev sib cais me me uas tsis tas yuav txwv txoj kev haus dej haus cawv thiab kev tshaib plab) thiab kom txog thaum noj mov ib txwm rov qab, muab kev kuaj pom tseeb ntawm kev ua haujlwm raum rov qab.

Haus cawv

Cawv cawv potentiates cov nyhuv ntawm metformin rau ntawm cov metabolism ntawm cov kab mob lactic acid. Tus neeg mob yuav tsum tau ceeb toom txog kev phom sij ntawm kev haus cawv (ib qho tshuaj ntau ntau lossis ib txwm haus me me) thaum lub sijhawm kho mob nrog Yanumet.

Lub siab ua haujlwm tsis zoo

Txij li thaum muaj kev paub txog mob lactic acidosis hauv cov neeg mob uas lub siab tsis ua haujlwm, nws tsis pom zoo kom muab tshuaj Janumet rau cov neeg mob uas kuaj mob lossis kuaj pom ntawm daim siab mob.

Qhov concentration ntawm cyanocobalamin (vitamin B₁₂) hauv ntshav ntshav

Hauv cov kev tshawb fawb soj ntsuam ntawm cov tshuaj metformin kav ntev li 29 lub lis piam, 7% ntawm cov neeg mob tau pom tias qhov qis ntawm kev pib ua rau muaj cyanocobalamin (vitamin B₁₂) nyob rau hauv cov ntshav plasma yam tsis muaj kev txhim kho kev soj ntsuam cov tsos mob ua kom tsis muaj zog. Kev txo qis zoo ib yam yog vim xaiv malabsorption ntawm vitamin B₁₂ (hu ua, kev ua txhaum ntawm kev tsim cov txheej txheem nrog lub hauv tsev fuabtais ntawm qhov tseem ceeb. tsim nyog rau kev nqus ntawm cov vitamin B thiab), tsis tshua muaj txiaj ntsig ua rau muaj kev txhim kho kev mob ntshav siab thiab yog kho tau yooj yim los ntawm kev tshem tawm cov tshuaj metformin lossis kev noj ntxiv ntawm vitamin B thiab. Thaum kho nrog Yanumet, nws raug nquahu kom kuaj xyuas cov ntshav hematological tsis txhua xyoo, thiab txhua yam kev hloov pauv uas tau tshwm sim yuav tsum kawm thiab kho. Cov Neeg Mob Vitamin B Tsis Txaus₁₂ (vim tias txo qis kev nqus lossis nqus cov vitamin B₁₂ los yog calcium) nws raug nquahu kom txiav txim siab ntshav plasma cov vitamin B₁₂ ntawm cov sijhawm ntawm 2-3 xyoo.

Hloov pauv mus kawm kev mob nkeeg ntawm cov neeg mob uas tswj tau tus mob ntshav qab zib hom 2 kom txaus

Yog tias kuaj ntshav tsis haum lossis chaw kuaj mob tus kabmob (tshwj xeeb yog ib qho mob uas tsis tuaj yeem pom meej meej) pom nyob rau ntawm tus neeg mob uas muaj tus kabmob 2 ntshav qab zib mellitus thaum kho mob nrog Yanumet, ketoacidosis lossis lactic acidosis yuav tsum tau muab tshem tawm tam sim ntawd. Kev ntsuas kev ntsuas ntawm tus neeg mob yuav tsum muaj kev kuaj ntshav rau electrolytes thiab kston. qhov ua hauj lwm zoo ntawm cov piam thaj hauv cov ntshav, nrog rau (raws li kev taw qhia) pH ntawm cov ntshav, ntshav ntau ntawm lactate, pyruvate thiab metformin. Nrog rau kev loj hlob ntawm acidosis ntawm tej etiology, koj yuav tsum tam sim ntawd tsum tsis txhob noj cov tshuaj Janumet thiab ntsuas kev tsim nyog los kho acidosis.

Poob ntawm glycemic tswj

Hauv qhov xwm txheej ntawm lub cev kev nyuaj siab (hyperthermia, mob, mob lossis phais) nyob rau hauv tus neeg mob nrog kev paub yav dhau los ua ntej glycemic tswj, ib ntus poob ntawm glycemic tswj yog ua tau. Nyob rau hauv cov sijhawm zoo li no, kev hloov ib ntus ntawm cov tshuaj Janumet nrog kev kho tshuaj insulin yog qhov zoo, thiab tom qab daws qhov mob tshwm sim, tus neeg mob tuaj yeem rov pib kho dua.

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

Tsis muaj kev tshawb nrhiav tau tshawb nrhiav qhov tshwm sim ntawm cov tshuaj Janumet ntawm kev muaj peev xwm tsav tsheb thiab ua haujlwm nrog cov txheej txheem. Txawm li cas los xij, cov xwm txheej ntawm kiv taub hau thiab tsaug zog pom nrog sitagliptin yuav tsum raug txiav txim siab.

Tsis tas li ntawd, cov neeg mob yuav tsum paub txog kev pheej hmoo ntawm hypoglycemia nrog rau kev siv cov tshuaj Janumet ib txhij nrog kev sib xyaw ntawm sulfoylurea lossis insulin.

Chaw tsim tshuaj paus:

Pob:
Merck Sharp thiab Dome B.V., Netherlands
Merck Sharp & Dohme B.V., lub Netherlands
Waarderweg 39, 2031 BN Haarlem, Tebchaws Netherlands
lossis
Frosst Iberica S.A., Spain Frosst Iberica, S.A. Ntawm Kev Tsis Txaus Siab,
140 Alcala de Henares (Madrid), 28805 Spain
lossis
Qhib Cov Cuab Yeej Sib Koom Tes Tshuaj Lag Luam Tshuaj thiab Tshuaj Ua Ke Ua Ke AKRIKHIN (AKRIKHIN OJSC)
142450, cheeb tsam Moscow, Noginsky koog tsev kawm ntawv, lub nroog ntawm Staraya Kupavna, ul. Kirova, 29.

Tshaj tawm kev tswj hwm zoo:
Merck Sharp thiab Dome B.V., Netherlands
Merck Sharp & Dohme B.V., lub Netherlands Waarderweg 39,
2031 BN Haarlem, Tebchaws Netherlands lossis

Qhib Cov Cuab Yeej Sib Koom Tes Tshuaj Lag Luam Tshuaj thiab Tshuaj Ua Ke Ua Ke AKRIKHIN (AKRIKHIN OJSC)
142450, cheeb tsam Moscow, Noginsky koog tsev kawm ntawv, lub nroog ntawm Staraya Kupavna, ul. Kirova, 29.

Yanumet ntsiav tshuaj ua haujlwm li cas

Tom qab kuaj pom tus kab mob ntshav qab zib, kev txiav txim siab ntawm txoj kev kho mob tsim nyog yog ua raws li kev soj ntsuam rau glycated hemoglobin. Yog tias qhov ntsuas no qis dua 9%, tus neeg mob yuav tsum tsuas yog ib qho tshuaj, metformin, txhawm rau ua kom glycemia li qub. Nws yog qhov tshwj xeeb tshaj yog nyob rau hauv cov neeg mob uas muaj qhov hnyav thiab tsis tshua muaj kev ntxhov siab. Yog tias glycated hemoglobin ntau dua, ib yam tshuaj nyob rau hauv feem ntau tsis txaus, yog li ntawd, kev sib txuas ua ke yog kho rau cov neeg mob ntshav qab zib, ib cov tshuaj ntshav qab zib los ntawm lwm pab pawg yog ntxiv rau metformin. Nws muaj peev xwm coj ob qho tshuaj sib xyaw ua ke hauv ib ntsiav tshuaj. Cov piv txwv ntawm cov tshuaj no yog Glibomet (metformin nrog glibenclamide), Galvus Met (nrog vildagliptin), Janumet (nrog sitagliptin) thiab lawv cov tshuaj noj.

Thaum xaiv qhov zoo tshaj plaws ua ke, cov kev phiv uas tag nrho cov tshuaj tiv thaiv kab mob tseem ceeb yog qhov tseem ceeb. Cov tsim tawm ntawm sulfonylureas thiab cov tshuaj insulin ua rau muaj kev pheej hmoo ntawm hypoglycemia, txhawb qhov hnyav nce, PSM nrawm nrawm qhov ua kom tiav ntawm cov qe hlwb. Rau feem ntau cov neeg mob, kev sib xyaw ntawm metformin nrog DPP4 inhibitors (gliptins) lossis incretin mimetics yuav muaj kuab. Ob leeg ntawm cov pab pawg no nce insulin synthes tsis muaj kev cuam tshuam cov beta hlwb thiab tsis tas yuav ua rau cov ntshav qog ntshav qab zib.

Tus sitagliptin uas muaj nyob hauv Janumet tshuaj yog thawj zaug ntawm gliptins. Tam sim no nws yog tus neeg sawv cev tshaj plaws hauv chav kawm no. Cov tshuaj ua kom ntev li ntawm lub neej ntawm incretins - cov tshuaj hormones tshwj xeeb uas tsim tawm hauv kev teb rau kev nce ntxiv hauv cov piam thaj thiab txhawb kev tso tawm ntawm insulin mus rau hauv cov hlab ntshav. Raws li nws ua haujlwm hauv ntshav qab zib, insulin hluavtaws ua kom muaj zog txog li 2 zaug. Qhov tsis txaus ntseeg kom zoo dua ntawm Yanumet yog tias nws tsuas ua nrog ntshav qab zib kom ntau. Thaum cov tshuaj glycemia yog ib txwm, muaj zog zuj zus tsis tsim, insulin tsis nkag mus rau hauv cov hlab ntshav, yog li, hypoglycemia tsis tshwm sim.

Cov nyhuv tseem ceeb ntawm metformin, qhov tshuaj thib ob ntawm cov tshuaj Janumet, yog ib qho kev txo qis hauv insulin tsis kam. Ua tsaug rau qhov no, kua nplaum zoo dua nkag mus rau cov ntaub so ntswg, tso ntshav tawm cov ntshav. Cov txiaj ntsig ntxiv tab sis tseem ceeb yog qhov txo qis hauv kev coj los ua ke ntawm cov piam thaj hauv lub siab, thiab maj mam poob ntawm kev nqus ntawm cov piam thaj los ntawm cov khoom noj. Metformin tsis cuam tshuam dab tsi rau pancreatic muaj nuj nqi, yog li ntawd, tsis ua rau kom ntshav qog.

Raws li kws kho mob, kev sib koom ua ke nrog metformin thiab sitagliptin txo glycated hemoglobin los ntawm qhov nruab nrab ntawm 1.7%. Tus mob ntshav qab zib tsawg yog compensated, qhov zoo txo ​​ntawm glycated hemoglobin muab Janumet. Nrog rau qhov kub siab> 11, qhov nruab nrab qis yog 3.6%.

Cov lus qhia rau kev teem caij

Cov tshuaj Yanumet yog siv los txo cov piam thaj tsuas yog mob ntshav qab zib hom 2 xwb. Daim ntawv qhia tshuaj tsis thim qhov kev noj haus yav dhau los thiab kev kawm paub lub cev, vim tias tsis yog ib hom tshuaj kho mob muaj peev xwm kov yeej cov tshuaj insulin siab, tshem tawm cov piam thaj ntau hauv cov ntshav.

Cov lus qhia rau kev siv tso cai rau koj kom sib xyaw ua ke cov tshuaj Yanumet nrog metformin (Glucofage thiab analogues), yog tias koj xav nce nws ntau npaum li cas, nrog rau sulfonylurea, glitazones, insulin.

Yanumet tshwj xeeb tshaj yog qhia rau cov neeg mob uas tsis xav ua raws li kws kho mob cov lus pom zoo. Qhov sib xyaw ua ke ntawm ob qho tshuaj hauv ib ntsiav tshuaj tsis yog whim ntawm lub chaw tsim khoom, tab sis ib txoj kev los txhim kho glycemic tswj.Tsuas sau tshuaj kom zoo yog qhov tsis txaus, koj xav tau cov ntshav qab zib kom coj lawv hauv kev coj ua, qhov ntawd yog, cog lus rau kev kho mob. Txog cov kab mob thiab ntshav qab zib, suav nrog, qhov kev cog lus no tseem ceeb heev. Raws li kev tshuaj xyuas cov neeg mob, nws pom tias 30-90% ntawm cov neeg mob tau txais kev pom zoo. Cov khoom ntau dua uas tus kws kho mob tau hais tseg, thiab ntau dua cov ntsiav tshuaj koj yuav tsum tau noj nyob rau hauv ib hnub, qhov siab dua qhov kev pom zoo uas yuav tsum tau ua raws. Cov tshuaj sib xyaw nrog ntau cov tshuaj xyaw yog ib txoj hauv kev zoo los txhawm rau ua raws li kev kho mob, thiab yog li ntawd txhim kho kev noj qab haus huv ntawm cov neeg mob.

Tsuas tshuaj thiab muab ntau npaum

Cov tshuaj Yanumet yog tsim los ntawm Merck, lub Netherlands. Tam sim no ntau lawm tau pib raws lub tuam txhab Lavxias teb sab Akrikhin. Cov tshuaj nyeg thiab txawv teb muaj qhov zoo sib xws, yauv mus ua tib zoo tswjhwm. Cov ntsiav tshuaj muaj lub ntsej muag zoo nkauj, npog nrog ib zaj duab xis ua qauv. Rau qhov yooj yim ntawm kev siv, lawv tau pleev xim rau hauv ntau yam xim nyob ntawm qhov tsuas tshuaj.

Muaj kev xaiv:

Yanumet Long yog cov tshuaj tshiab kiag li, hauv Lavxias Lavxias nws tau sau npe hauv xyoo 2017. Cov lus sib xyaw ntawm Yanumet thiab Yanumet Ntev yog qhov zoo ib yam, lawv tsuas yog sib txawv hauv cov qauv ntawm cov ntsiav tshuaj. Kev siv yuav tsum noj ob zaug ib hnub, vim tias cov tshuaj metformin siv tau tsis ntev tshaj 12 teev. Hauv Yanumet, Ntev Metformin raug tso tawm hloov kho qeeb dua, yog li koj tuaj yeem haus nws ib zaug ib hnub yam tsis poob zoo.

Metformin tau pom los ntawm kev cuam tshuam ntau heev ntawm cov kev tshwm sim hauv cov hnyuv. Metformin Ntev pab txhim kho kev zam rau cov tshuaj, txo qis cov raws plab thiab lwm cov kev mob tshwm sim los ntawm ntau tshaj 2 zaug. Kev txiav txim los ntawm kev txheeb xyuas, qhov ntau kawg tsuas noj, Yanumet thiab Yanumet Ntev muab kwv yees li qhov hnyav sib npaug. Txwv tsis pub, Yanumet Ntev yeej, nws muab cov kev tswj zoo glycemic, zoo dua txo cov tshuaj insulin kuj thiab cov roj (cholesterol).

Lub txee lub neej ntawm Yanumet 50/500 yog 2 xyoos, kev siv tshuaj loj - 3 xyoos. Cov tshuaj no raug muag raws li cov tshuaj ntawm endocrinologist. Kwv yees tus nqi hauv cov khw muag tshuaj:

Cov lus qhia rau kev siv

Cov tshuaj pom zoo cov lus qhia rau cov ntshav qab zib mellitus:

1. Cov tshuaj zoo ntawm cov tshuaj sitagliptin yog 100 mg, lossis 2 ntsiav tshuaj.
2. Cov koob tshuaj ntawm metformin raug xaiv raws li theem ntawm qhov rhiab heev rau insulin thiab thev taus ntawm cov tshuaj no. Txo txoj kev pheej hmoo ntawm qhov tsis zoo uas tsis txaus siab ntawm kev noj tshuaj, lub koob tshuaj tau nce qeeb zuj zus, ntawm 500 mg. Ua ntej, lawv haus Yanumet 50/500 ib hnub ob zaug. Yog tias cov piam thaj hauv ntshav tsis tau txo qis txaus, tom qab ib lossis ob lub lis piam, ntau npaum li cas ntxiv tau ntxiv rau 2 ntsiav tshuaj ntawm 50/1000 mg.
3. Yog hais tias cov tshuaj Janumet tau ntxiv rau sulfonylurea derivatives los yog insulin, nws yog ib qho tsim nyog yuav tsum nce nws cov koob tshuaj nrog kev tiv thaiv huab txaus kom tsis txhob qhaj ntshav qab zib.
4. Qhov nyiaj pab ntau tshaj ntawm Yanumet yog 2 ntsiav tshuaj. 50/1000 mg.

Txhawm rau txhim kho kev zam rau cov tshuaj, cov ntsiav tshuaj noj thaum tib lub sijhawm ua khoom noj. Kev tshuaj xyuas cov neeg mob ntshav qab zib hais tias cov khoom noj txom ncauj rau lub hom phiaj no yuav tsis ua haujlwm, nws yog qhov zoo dua los ua ke cov tshuaj nrog cov pluas noj uas muaj cov protein thiab qeeb carbohydrates. Ob txais khoom xa tawm kom faib nruab nrab ntawm lawv ua 12 teev ib zaug.

Ceev faj thaum noj tshuaj:

1. Cov tshuaj yeeb dej caw uas tsim los ua kom Yanumet yog feem ntau tawm hauv cov zis. Nrog kev ua haujlwm tsis zoo hauv lub raum, qhov kev pheej hmoo ntawm metformin nce ntxiv nrog kev txhim kho tom qab ntawm lactic acidosis. Txhawm rau zam qhov kev cuam tshuam no, nws yuav tsum tau tshuaj xyuas lub raum ua ntej sau cov tshuaj. Nyob rau yav tom ntej, kev ntsuam xyuas tau dhau los txhua xyoo. Yog tias cov creatinine siab dua li ib txwm muaj, cov tshuaj yuav raug muab tso tseg.Cov neeg mob ntshav qab zib yog cov yam ntxwv cuam tshuam txog lub hnub nyoog hloov raum tsis zoo ntawm lub raum ua haujlwm, yog li ntawd, lawv tau pom zoo kom siv tsawg tshaj li ntawm Yanumet.
2. Tom qab sau npe ntawm cov tshuaj, muaj kev soj ntsuam cov neeg muaj mob ua paug rau tus neeg mob ntshav qab zib noj Yanumet, yog li cov neeg tsim khoom ceeb toom txog kev pheej hmoo uas twb muaj lawm hauv cov lus qhia rau kev siv. Nws tsis tuaj yeem tsim kom muaj ntau zaus ntawm cov kev mob tshwm sim no, vim qhov kev tsis txaus ntseeg no tsis tau sau cia hauv pawg tswj hwm, tab sis nws tuaj yeem suav tias nws muaj tsawg kawg. Cov tsos mob ntawm tus mob pancreatitis: mob hnyav hauv plab sab sauv, muab rau sab laug, ntuav.
3. Yog tias cov tshuaj Yanumet tau noj ua ke nrog gliclazide, glimepiride, glibenclamide thiab lwm yam PSM, hypoglycemia yog ua tau. Thaum nws tshwm sim, qhov koob tshuaj ntawm Yanumet tshuav tsis hloov, qhov tshuaj ntawm PSM raug txo qis.
4. Txoj cawv cawv lub peev xwm yumum tsis zoo. Metformin hauv kev haus cawv thiab mob ntev mus ntev tuaj yeem ua rau lactic acidosis. Tsis tas li, haus dej cawv haus ntau ntxiv rau kev txhim kho ntshav qab zib muaj teeb meem thiab ua rau nws cov nyiaj raug mob.
5. Kev ntxhov siab hauv lub cev (vim tias muaj kev mob nyhav, kub hnyiab, kub siab dhau, kis tus kab mob, mob nyhav, phais mob) tuaj yeem ua rau cov ntshav qab zib nce siab. Thaum lub sijhawm rov qab los, kev qhia tau hais kom hloov mus rau ib qho tshuaj insulin ib ntus, thiab tom qab ntawd rov qab mus rau kev kho mob dhau los.
6. Cov kev qhia tso cai rau tsav tsheb, ua haujlwm nrog cov txheej txheem rau cov neeg mob ntshav qab zib noj Yanumet. Raws li kev tshuaj xyuas, cov tshuaj tuaj yeem ua rau mob taub hau me me thiab kiv taub hau, yog li thaum pib ntawm nws txoj kev tswj hwm koj yuav tsum tau ua tib zoo saib xyuas koj tus mob.

Sab sij huam tshuaj

Feem ntau, kev tiv taus ntawm cov tshuaj no yog ntaus nqi zoo. Kev phiv tshuaj tuaj yeem ua rau cov tshuaj metformin nkaus xwb. Kev phiv tshuaj nrog kev kho mob nrog sitagliptin tau pom ntau npaum li nrog cov placebo.

Raws li cov ntaub ntawv tau muab rau hauv cov lus qhia rau cov ntsiav tshuaj, cov kab mob tshwm sim dhau los tsis tshaj 5%:

• raws plab - 3.5%,
• xeev siab - 1.6%
• mob, mob hnyav hauv plab - 1.3%,
• ntau dhau cov roj tsim - 1.3%,
• mob taub hau - 1.3%,
• ntuav - 1.1%
• cov ntshav qab zib tsawg - 1.1%.

Tsis tas li thaum lub sijhawm tshawb fawb thiab nyob hauv lub sijhawm sau npe tom qab, cov kws kho mob ntshav qab zib pom:

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

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

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

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

• kev ua xua, suav nrog cov ntawv loj,
• mob txhaj thuv tas
• lub raum tsis ua hauj lwm zoo,
• cov kab mob ua pa
• cem quav
• mob hauv qhov sib koom tes, nraub qaum, nqua.

Feem ntau yuav, Yanumet tsis muaj feem xyuam nrog cov kev ua txhaum no, tab sis cov chaw tsim khoom tseem suav lawv hauv cov lus qhia. Feem ntau, qhov zaus ntawm cov kev mob tshwm sim no hauv cov neeg mob ntshav qab zib ntawm Yanumet tsis txawv ntawm pawg tswj hwm uas tsis tau txais cov tshuaj no.

Tsis tshua muaj tshwm sim, tab sis muaj kev ua txhaum tiag tiag uas tuaj yeem tshwm sim thaum noj Janumet thiab lwm cov ntsiav tshuaj nrog metformin yog lactic acidosis. Qhov no yog qhov nyuaj los kho cov mob ntshav qab zib tsis txaus - cov npe ntawm cov mob ntshav qab zib. Raws li cov chaw tsim khoom, nws qhov ntau zaus yog 0.03 cov nyom ntawm 1000 tus neeg-xyoo. Kwv yees li 50% ntawm cov neeg mob ntshav qab zib yuav cawm tsis tau. Qhov ua kom mob ntawm cov kab mob lactic acid tuaj yeem ua rau dhau li ntawm cov koob tshuaj Yanumet, tshwj xeeb tshaj yog ua ke nrog kev cuam tshuam cov ntsiab lus: raum, mob plawv, mob siab thiab ua pa tsis ua hauj lwm, haus dej cawv, tshaib plab.

Pharmacological kev txiav txim

Cov tshuaj Janumet yog kev sib xyaw ntawm ob qhov tshuaj tiv thaiv hypoglycemic nrog kev ua kom tiav (ua kom tiav) cov txheej txheem ntawm kev ua, tsim los txhim kho glycemic tswj nyob rau hauv cov neeg mob ntshav qab zib hom 2: sitagliptin, ib qho tshuaj tiv thaiv ntawm dipeptidyl peptidase-4 (DPP-4) enzyme, thiab metformin, tus sawv cev ntawm chav kawm biguanide.

Sitagliptin yog qhov ncauj ua kom nquag plias, xaiv DPP-4 ntau heev rau kev kho mob ntshav qab zib hom 2. Cov teeb meem pharmacological ntawm chav kawm ntawm cov tshuaj inhibitors ntawm DPP-4 yog kho kom haum xeeb los ntawm kev ua kom muaj zog ntawm incretins. Los ntawm inhibiting DPP-4, sitagliptin tsub kom qhov siab ntxiv ntawm ob txoj kev ua si nquag ntawm tsev neeg incretin: glucagon-zoo li peptide 1 (GLP-1) thiab glucose-tiv thaiv insulinotropic polypeptide (HIP). Tus incretins yog ib feem ntawm cov txheej txheem kho mob sab hauv lub zog rau kev tswj hwm cov ntshav qabzib homeostasis. Thaum cov ntshav qabzib feem ntau yog nce siab ntshav qabzib, GLP-1 thiab GUIs nce cov khoom cua thiab tso kua ntshav tawm los ntawm cov roj ntsha pancreatic beta hlwb. GLP-1 tseem tseem ceeb kev tsis txaus siab ntawm glucagon los ntawm pancreatic alpha cells, yog li txo cov synthesis ntawm cov piam thaj hauv lub siab. Qhov kev ua haujlwm ntawm qhov kev sib txawv no txawv ntawm cov txheej txheem ntawm kev ua ntawm sulfonylurea derivatives, uas txhawb kev tso tawm ntawm insulin txawm tias muaj ntshav qabzib ntau ntau, uas yog fraught nrog txoj kev loj hlob ntawm sulfonyl-hog hypoglycemia tsis yog hauv cov neeg mob uas muaj hom 2 mob ntshav qab zib mellitus, tab sis kuj nyob rau hauv cov neeg noj qab haus huv. Ua tus xaiv thiab muaj kev cuam tshuam zoo ntawm DPP-4 enzyme, sitagliptin hauv kev kho kom zoo ntau tsis cuam tshuam cov kev ua haujlwm ntawm cov enzymes DPP-8 lossis DPP-9. Sitagliptin sib txawv hauv cov qauv tshuaj thiab cov tshuaj pharmacological los ntawm analogues ntawm GLP-1, insulin, sulfonylurea derivatives lossis meglitinides, biguanides, gamma receptor agonists ua kom los ntawm peroxis proliferator (PPARy), alpha-glycosidase inhibitors thiab amylin analogues.

Metformin yog ib hom tshuaj hypoglycemic uas ua rau muaj cov ntshav qabzib ntau nyob rau hauv cov neeg mob ntshav qab zib hom 2, txo cov ntshav qabzib thiab postprandial ntshav qabzib. Nws cov tshuaj pharmacological ntawm kev ua txawv ntawm cov txheej txheem ntawm kev ua ntawm qhov ncauj tshuaj hypoglycemic ntawm lwm cov chav kawm. Metformin txo cov suab thaj nyob hauv lub siab, txo qis plab hnyuv tawm, thiab nce insulin rhiab heev los ntawm kev coj thiab siv cov piam thaj

Yanumet tau qhia ua ib qho kev sib ntxiv rau kev noj haus thiab kev tawm dag zog kom txhim kho glycemic tswj nyob rau hauv cov neeg mob hom II mob ntshav qab zib mellitus uas tsis tau ua tiav kev tswj hwm zoo rau cov keeb kwm yav dhau los ntawm monotherapy nrog metformin lossis sitagliptin, lossis tom qab tsis ua tiav txoj kev kho nrog ob yam tshuaj. Yanumet yog qhia ua ke nrog sulfonylurea derivatives (kev sib xyaw ntawm peb cov tshuaj) ua ib qho kev sib ntxiv rau kev noj haus thiab kev tawm dag zog kom txhim kho glycemic tswj nyob rau hauv cov neeg mob ntshav qab zib hom II uas tsis ua tiav kev tswj hwm txaus tom qab kho nrog ob ntawm peb qho tshuaj no: metformin, sitagliptin lossis derivatives sulfonylureas. Janumet yog qhia ua ke nrog PPAR-? Agonists (piv txwv, thiazolidinediones) ntxiv rau kev noj haus thiab kev tawm dag zog kom txhim kho glycemic tswj nyob rau hauv cov neeg mob ntshav qab zib hom II uas tsis ua tiav kev tswj txaus tom qab kho nrog ob ntawm peb qho tshuaj no: metformin, sitagliptin, lossis PPAR-β agonist. Yanumet tau qhia rau cov neeg mob uas muaj ntshav qab zib hom II mellitus (kev sib xyaw ntawm peb cov tshuaj) ua ib qho kev sib ntxiv rau kev noj haus thiab kev tawm dag zog kom txhim kho glycemic tswj nyob rau hauv kev sib xyaw nrog insulin.

Cev xeeb tub thiab lactation

Tsis muaj cov kev tshawb fawb txaus los ntawm cov tshuaj Yanumet lossis nws cov khoom siv hauv cov poj niam cev xeeb tub, yog li ntawd, tsis muaj ntaub ntawv qhia txog kev nyab xeeb ntawm nws siv hauv cov poj niam cev xeeb tub.Cov tshuaj Janumet, zoo li lwm yam tshuaj rau qhov ncauj hypoglycemic, tsis pom zoo rau siv thaum cev xeeb tub. Muaj tsis muaj kev sim tshuaj rau kev sib xyaw ua ke ntawm cov tshuaj Yanumet los ntsuas nws cov nyhuv ntawm kev ua me nyuam. Tsuas yog cov ntaub ntawv muaj los ntawm kev tshawb fawb ntawm sitagliptin thiab metformin yog nthuav tawm.

Tso tawm daim ntawv thiab muaj pes tsawg leeg

Yanumet muaj nyob rau hauv cov qauv ntawm cov yeeb yaj kiab-cov ntsiav tshuaj: oval, biconvex, hauv peb koob (metformin / sitagliptin): 500 mg / 50 mg - nrog lub teeb xim zaj duab xis txheej, ntawm ib sab tau sau "575", 850 mg / 50 mg - nrog rau cov xim zaj duab xis txheej, kos duab "515" ntawm ib sab, 1000 mg / 50 mg - nrog xim liab-xim av xim txheej, "577" engraving ntawm ib sab, qhov tseem ceeb yog los ntawm yuav luag dawb rau dawb (raws li 14 pcs. Hauv cov hlwv, hauv daim duab qhwv ib pob ntawm 1, 2, 4, 6 lossis 7 blisters).

1 ntsiav tshuaj muaj:

• cov khoom xyaw nquag: metformin hydrochloride - 500 mg, 850 mg lossis 1000 mg, sitagliptin phosphate monohydrate - 64.25 mg, uas yog sib npaug rau cov ntsiab lus ntawm 50 mg ntawm sitagliptin,
• ntu ntu: sodium stearyl fumarate, microcrystalline cellulose, sodium lauryl sulfate, povidone,
• muaj pes tsawg leeg ntawm lub plhaub: ntsiav tshuaj ntawm koob 500 mg / 50 mg (lub teeb liab) - Opadry II Paj yeeb, 85 F 94203, ntawm koob tshuaj 850 mg / 50 mg (liab) - Opadray II Paj yeeb, 85 F 94182, ntawm koob tshuaj 1000 mg / 50 mg (xim av liab) - Opadry II Liab, 85 F 15464, cov khoom sib xyaw ntawm cov khauj khaum ntawm txhua cov ntsiav tshuaj suav nrog: cawv polyvinyl, macrogol-3350, titanium dioxide (E171), liab hlau oxide (E172), dub hlau oxide (E172) ), talc.

Cov Tshuaj Pharmacokinetics

Kev siv ntawm Yanumet nyob rau hauv koob tshuaj 500 mg / 50 mg, 850 mg / 50 mg thiab 1000 mg / 50 mg yog bioequivalent sib cais tswj hwm ntawm cov koob tshuaj tsim nyog ntawm metformin thiab sitagliptin.

Kev tsis txaus siab txog kev noj qab haus huv: sitagliptin - kwv yees li 87%, metformin (thaum noj ntawm 500 mg rau ntawm lub plab khoob) - 50-60%. Tus pharmacokinetics ntawm sitagliptin thaum noj nrog cov rog cov zaub mov tsis hloov pauv. Qhov sai thiab ntau npaum li cas ntawm kev nqus metformin thaum noj nrog zaub mov yog txo. Cov kab mob tseem ceeb ntawm kev nce sij hawm kom ncav cuag thiab qis dua qhov siab tshaj plaws ntshav plasma concentration (C_max) metformin tsis raug ntsia.

Plasma protein khi: sitagliptin - 38%, metformin - ua ib qho me me.

Ib feem ntawm metformin yog muab faib tawm ib ntus hauv cov qe ntshav liab, ntshav plasma concentration ntawm qhov sib npaug ntawm lub xeev tawm tsam keeb kwm ntawm cov tshuaj pom zoo ntau npaum li cas tau mus txog tom qab 24–48 teev thiab feem ntau tsawg dua 0.001 mg / ml.

Cytochrome P isoenzymes koom nrog kev zom me me ntawm sitagliptin.₄₅₀ CYP3A4 thiab CYP2C8. Kev hloov pauv hauv cov metabolism ntawm sitagliptin yog qhov tsawg heev, kwv yees li 79% ntawm cov koob tshuaj noj tau tawm ntawm cov raum tsis hloov.

Metformin raug tawm hauv ob lub raum tsis hloov hlo li yuav luag tiav (90%) hauv 24 teev.

Ib nrab-lub neej (T_1/2) Sitagliptin yog kwv yees li 12.4 teev, lub raum ntxuav yog li 350 ml / min.

Kev tsis pom qhov quav ntawm sitagliptin feem ntau yog ua los ntawm cov tubular ua kom tsis zais.

T_1/2 metformin los ntawm ntshav ntshav rau kwv yees li 6.2 teev, los ntawm ntshav - 17.6 teev. Nws txoj hauv kev tseem ceeb ntawm kev nthuav tawm los ntawm ob lub raum ua rau 3.5-npaug hauv kev kho lub raum uas tau txiav txim siab tshaj li qhov kev ua neeg tsim muaj cov nyom (CC).

Cumulation ntawm metformin tiv thaiv keeb kwm yav dhau los ntawm kev siv tshuaj kho tsis tshwm sim.

Hauv cov neeg mob uas muaj qhov txawv txav ntawm qhov tsis ua haujlwm ntawm lub raum, lub sijhawm ib nrab ntawm lub neej ntawm Yanumet yog lengthened, tag nrho cov kev xav (AUC) ntawm sitagliptin hauv cov ntshav ntshav nce ntxiv. Koj tuaj yeem siv tsis tau cov tshuaj rau kev ua haujlwm ntawm lub raum.

Nrog tus neeg kawm qib nruab nrab (7–9 cov ntsiab lus ntawm Child-Pugh nplai) ntawm daim siab tsis ua haujlwm, ib koob tshuaj sitagliptin ntawm koob tshuaj 100 mg ua rau muaj kev nce ntxiv hauv nws cov txiaj ntsig nruab nrab C._max los ntawm 13%, AUC - los ntawm 21%. Tsis muaj cov ntaub ntawv tshawb fawb txog cov kev paub hauv kev siv tshuaj nyob hauv cov mob loj (ntau tshaj 9 ntsiab lus ntawm Child-Pugh scale) ntawm lub siab ua haujlwm.

Tus tub los ntxhais, haiv neeg, lossis qhov hnyav ntawm tus neeg mob tsis cuam tshuam rau qhov txiav txim pharmacokinetic ntawm cov yam muaj sia.

Cov neeg laus muaj lub sijhawm rub tus mob T_1/2 thiab nce C_max Cov. Cov kev hloov pauv no cuam tshuam nrog kev txo lub hnub nyoog ntawm kev rov ua lub ntsej muag ua kom rov ua haujlwm.Thaum muaj hnub nyoog tshaj 80 xyoo, kho mob nrog Yanumet tsuas yog ua tau rau cov neeg mob uas lub raum tsis ua haujlwm zoo thiab CC.

Cov kev tshawb fawb txog kev ua haujlwm zoo thiab kev nyab xeeb ntawm kev siv tshuaj hauv cov menyuam yaus tseem tsis tau ua.

Yeeb tshuaj sib cuam tshuam

Kev tswj hwm ib txhij ntawm ntau cov koob tshuaj sitagliptin (50 mg ob zaug ib hnub) thiab metformin (1000 mg ob zaug ib hnub) tsis ua rau lub chaw kho mob muaj kev hloov pauv ntau hauv cov chaw muag tshuaj ntawm cov tshuaj hauv cov neeg mob ntshav qab zib hom 2.

Cov kev tshawb fawb ntawm kev sib cuam tshuam ntawm Yanumet nrog lwm cov tshuaj tsis tau ua. Yog li no, thaum sau ntawv kho cov tshuaj concomitant, ib qho yuav tsum tau ua los ntawm cov txiaj ntsig ntawm kev tshawb fawb zoo sib xws ua nyias rau ntawm sitagliptin thiab metformin.

Nrog tib lub sijhawm siv ntawm sitagliptin:

• rosiglitazone, glibenclamide, simvastatin, warfarin, qhov ncauj qhov kev tiv thaiv: tsis muaj kev hloov tseem ceeb hauv lawv cov pharmacokinetics tshwm sim, sitagliptin tsis txwv tsis pub isoenzymes ntawm cytochrome P system₄₅₀ CYP3A4, CYP2C8, CYP2C9, tsis txwv qhov isoenzymes CYP1A2, CYP2D6, CYP2B6, CYP2C19, tsis yog qhov tsis txaus siab CYP3A4,
• fibrates, statins, ezetimibe (hypocholesterolemic agents), clopidogrel, antihypertensive tshuaj, suav nrog angiotensin II receptor antagonists, angiotensin hloov mus rau enzyme inhibitors, beta-adrenergic thaiv cov kab mob, hydrochlorothiazide, qeeb calcium calcium blockers, tsis-tshuaj steroidal, cellulose, tshuaj los tiv thaiv. (fluoxetine, sertraline, bupropion), proton twj tso kua mis inhibitors (omeprazole, lansoprazole), antihistamines (cetirizine), sildenafil: tsis cuam tshuam rau lub teeb taws akokinetiku sitagliptin,
• digoxin, cyclosporine: thaj chaw kho mob nce ntxiv lawv cov txiaj ntsig ntawm AUC thiab C_max.

Nrog kev siv thooj txhij ntawm metformin:

• glyburide: tsis ua rau muaj kev sib txuam tseem ceeb hauv chaw tshuaj,
• furosemide: hloov nws cov pharmacokinetic tsis, nce tus nqi ntawm C_max metformin los ntawm 22%, AUC hauv tag nrho cov ntshav - los ntawm 15%, qhov pom tseeb ntawm cov tshuaj tsis hloov pauv ntau,
• nifedipine: ua rau lub zog nqus ntxiv, plasma concentration thiab ntau npaum li cas ntawm metformin ua tawm los ntawm ob lub raum,
• cov neeg sawv cev cationic - morphine, amiloride, digoxin, procainamide, quinine, quinidine, trimethoprim, vancomycin, ranitidine, triamteren: lawv tuaj yeem sib tw rau kev siv cov hlaus tub ceev thauj khoom,
• phenothiazines, diuretics, glucocorticosteroids, thyroid npaj, tshuaj tiv thaiv qhov ncauj, estrogens, nicotinic acid, phenytoin, sympathomimetics, isoniazid, qeeb calcium calcium blockers: muaj hyperglycemic muaj peev xwm, tuaj yeem cuam tshuam kev tswj glycemic, nws yog qhov yuav tsum tau ua tib zoo saib xyuas glycemic,
• cov tshuaj uas nquag khi rau cov ntshav plasma, xws li salicylates, sulfonamides, chloramphenicol, probenecid: tsis cuam tshuam nrog metformin.

Cov lus piv txwv ntawm Yanumet yog: Yanumet Ntev, Velmetia, Amaril M, Glibomet, Glukovans, Gluconorm, Avandamet, Galvus Met, Douglimaks, Tripride.

Kev txheeb xyuas txog Yanumet

Kev txheeb xyuas txog Yanumet yog qhov zoo. Cov neeg mob thiab cov kws kho mob taw qhia txog qhov ua tau zoo ntawm kev siv tshuaj thiab cov xeeb ceem ntawm nws yog qhov zoo ntxiv rau kev noj haus thiab kev ua si hauv kev kho mob ntshav qab zib hom 2. Kev kho mob hlwb thiab kev sib koom ua ke, suav nrog Yanumet, muab cov tshuaj glycemic ruaj khov thiab tsis muaj kev cuam tshuam los ntawm kev mob tshwm sim hauv chaw kho mob.

Cov kws kho mob tau qhia txog kev ceev faj rau cov npe ntawm cov lus sib tshooj rau kev noj cov tshuaj Yanumet thiab ua raws nraim li txhua tus kws kho mob cov lus pom zoo.

Qhov tsis zoo yog tag nrho cov ntaus nqi rau tus nqi ntau ntawm cov tshuaj, muab qhov xav tau rau nws txoj kev noj haus tas li.

Yanumet: muaj pes tsawg leeg thiab nta

Qhov ua cov nquag ua hauv mis yog metformin hydrochloride. Cov tshuaj tau ntim hauv 500 mg, 850 mg lossis 1000 mg hauv 1 ntsiav tshuaj.Sitagliptin pabcuam ntawm cov tshuaj yog qhov tseem ceeb, hauv ib tsiav tshuaj nws yuav yog 50 mg ntawm txhua koob ntawm metformin. Muaj cov zam rau hauv cov mis uas tsis muaj kev txaus siab nyob rau hauv cov nqe lus ntawm cov tshuaj muaj peev xwm.

Elongated convex capsules yog kev tiv thaiv los ntawm fakes nrog cov ntawv sau "575", "515" lossis "577", nyob ntawm qhov ntau npaum. Txhua pob ntawv cardboard muaj ob lossis plaub daim phiaj ntawm 14 daim. Daim ntawv yuav tshuaj yog muab faib tawm.

Lub thawv kuj tseem qhia txog lub txee lub neej ntawm cov tshuaj - 2 xyoo. Cov tshuaj uas tas sij hawm yuav tsum tau muab pov tseg. Qhov xav tau rau qhov chaw cia khoom yog tus qauv: ib qho chaw qhuav nkag tsis tau rau hauv lub hnub thiab cov menyuam yaus nrog lub ntsuas kub txog li 25 degrees.

Pharmacological tau

Yanumet yog qhov kev xav ua ke ntawm ob txoj kev kho mob uas muaj piam thaj nrog kev ua kom tiav (sib ntxiv rau lwm tus) cov yam ntxwv: metformin hydrochloride, uas yog ib pawg ntawm lojuanides, thiab sitagliptin, ib qho inhibitor ntawm DPP-4.

Synagliptin

Cov khoom siv yog npaj rau kev siv qhov ncauj. Cov txheej txheem ntawm kev ua ntawm sitagliptin yog ua raws li kev ua kom muaj zog ntau zuj zus. Thaum DPP-4 raug txwv, qib ntawm GLP-1 thiab HIP peptides, uas tswj cov ntshav qabzib homeostasis, nce ntxiv. Yog tias nws qhov kev ua tau zoo dua, incretins ua kom lub zog tsim cov kua dej siv cov β-hlwb. GLP-1 tseem ua rau kev txhim kho cov glucagon los ntawm α-cov roj ntsha hauv lub siab. Qhov kev txiav txim siab zoo li no tsis zoo ib yam nrog lub hauv paus ntsiab lus ntawm cov tshuaj sulfonylurea (SM) chav kawm tshuaj uas ua kom cov tshuaj insulin ntau ntxiv rau txhua qib ntawm cov piam thaj.

Cov kev ua si zoo li no tuaj yeem ua rau cov ntshav qog ntshav qab zib tsis yog nyob rau hauv cov ntshav qab zib xwb, tab sis kuj yog hauv cov neeg ua haujlwm noj qab haus huv.

DPP-4 enzyme inhibitor nyob rau hauv cov koob tshuaj pom zoo tsis thaiv qhov ua haujlwm ntawm PPP-8 lossis PPP-9 enzymes. Hauv chaw muag tshuaj, sitagliptin tsis zoo ib yam li nws cov tshuaj ntxiv: GLP-1, insulin, SM derivatives, meglitinide, biguanides, α-glycosidase inhibitors, γ-receptor agonists, amylin.

Ua tsaug rau metformin, kev ua kom cov ntshav qab zib ntau hauv cov ntshav qab zib hom 2 nce: lawv qhov kev xav tsawg dua (ob qho tib si postprandial thiab hauv paus), insulin tsis kam. Qhov kev txiav txim siab ntawm cov tshuaj muaj txiaj ntsig yog txawv ntawm cov ntsiab cai ntawm kev ua haujlwm ntawm kev hloov pauv kho cov ntshav qab zib. Txwv tsis pub cov khoom tsim cov glucogen los ntawm lub siab, metformin txo qis nws nqus los ntawm cov hnyuv phab ntsa, txo cov tshuaj insulin tsis kam, ua kom muaj kev cuam tshuam peripheral.

Tsis zoo li SM npaj, metformin tsis ua rau mob ntshav qab zib thiab mob ntshav qab zib tsis muaj ntshav qab zib rau cov neeg mob ntshav qab zib uas muaj hom 2, tsis nyob hauv pawg tswj hwm. Thaum kho nrog metformin, insulin ntau lawm tseem nyob rau tib theem, tab sis nws qhov kev yoo mov thiab cov qib txhua hnub nyiam.

Xuas

Lub bioavailability ntawm sitagliptin yog 87%. Kev siv ntawm cov khoom noj muaj roj ntau ntau thiab cov khoom noj muaj lub cev tsis muaj txiaj ntsig tsis muaj kev cuam tshuam rau tus nqi ntawm kev nqus. Qib siab tshaj plaws ntawm cov tshuaj nyob hauv cov hlab ntshav yog tsau 1-4 teev tom qab nqus los ntawm kev mob hauv txoj hnyuv.

Lub bioavailability ntawm metformin ntawm ib plab khoob yog li 60% ntawm koob tshuaj 500 mg. Nrog ib qho hno ntawm koob tshuaj loj (txog 2550 mg), lub hauv paus ntsiab lus ntawm kev sib luag, vim kev nqus qis, tau ua txhaum. Metformin los ua haujlwm tom qab ob thiab ib nrab teev. Nws qib mus txog 60%. Qhov kawg ntawm metformin yog tsau tom qab ib hnub lossis ob hnub. Thaum noj mov, cov ua haujlwm ntawm cov tshuaj tsawg dua.

Kev xa Khoom

Qhov ntim ntawm kev faib tawm ntawm synagliptin nrog kev siv nrog 1 mg ntawm pawg pab pawg tswj hwm ntawm cov koom hauv kev sim yog 198 l. Cov qib ntawm khi rau cov ntshav protein yog sib txawv me - 38%.

Hauv cov kev sim uas zoo sib xws nrog metformin, pawg tswj hwm tau muab cov tshuaj rau hauv qhov ntau npaum li 850 mg, qhov faib tawm tib lub sijhawm tau kwv yees li thaj tsam li ntawm 506 litres.

Thaum muab piv nrog cov tshuaj ntawm cov chav kawm SM, metformin qhov tseeb tsis khi rau cov protein, ib ntus ib feem me me ntawm nws nyob hauv cov ntshav liab.

Yog tias koj noj cov tshuaj hauv cov txheej txheem ntau npaum, kev pom zoo (Xaus

Txog li 80% ntawm cov tshuaj raug tawm los ntawm ob lub raum, metformin tsis yog cov tshuaj tiv thaiv hauv lub cev, hauv pawg tswj yuav luag tag nrho cov seem tshuav hauv nws daim ntawv qub rau ib hnub. Tus kab mob siab Hepatic thiab ua rau hauv cov kiav txhab tag yog qhaj. Sinagliptin raug tso tawm zoo ib yam (txog li 79%) nrog cov metabolism hauv qhov tsawg. Thaum muaj teeb meem lub raum, cov koob tshuaj Yanumet yuav tsum tau qhia meej. Nrog tus kab mob siab

Rau leej twg nws yog muaj thiab rau leej twg nws tsis pom

Cov tshuaj yog tsim los tswj hom ntshav qab zib 2. Nws tau sau tseg hauv qee kis tshwj xeeb.

1. Raws li ib qho ntxiv rau kev hloov kho hauv lub neej txhawm rau txhim kho glycemic profile ntawm cov ntshav qab zib, yog tias monotherapy nrog metformin tsis muab 100% qhov tshwm sim.
2. Yanumet siv nyob rau hauv kev kho mob nyuaj ua ke nrog tshuaj ntsuab ntawm SM yog tias kev xaiv "metformin + tshuaj ntawm pawg SM + kev noj cov zaub mov qis thiab cov leeg nqaij" tsis zoo txaus.
3. Cov tshuaj sib xyaw ua ke, yog tias tsim nyog, nrog gamma receptor agonists.
4. Yog tias cov tshuaj insulin tsis ua tiav cov nyiaj qab zib, Yanumet raug kho nyob rau tib lub sijhawm.

Cov txheej txheem tsis haum hauv cov lus qhia yog raws li nram no:

• Kev ua yauv tsis haum rau cov khoom xyaw,
• Coma (uas yog ntshav qab zib)
• Lub raum pathology,
• Kis tau cov kab mob
• Txhaj tshuaj nrog tshuaj iodine (iv),
• Poob siab mob
• Cov kab mob uas ua rau cov pa oxygen tsis txaus nyob rau hauv cov ntaub so ntswg,
• Mob plab zom mov, lom, haus dej cawv,
• Kev pub niam mis
• Yam 1 ntshav qab zib.

Sab sij huam

Ua ntej siv, koj yuav tsum kawm cov npe ntawm cov kev mob tshwm sim thiab cov tsos mob txhawm rau qhia rau tus kws kho mob kom raws sijhawm txog lub cev qhov tshuaj tiv thaiv kom kho cov kev kho mob kom zoo. Ntawm cov feem ntau tsis yuav tshwm sim:

• Kev hnoos hnoos
• Dyspeptic mob
• Mob taub hau ib yam li mob taub hau,
• Plab mov
• Kab mob sib kis
• Tsis nqhuag zoo
• Exacerbation ntawm pancreatitis thiab lwm yam pathologies ntawm lub txiav,
• O,
• Kev poob phaus, tsis nco qab,
• Cov kab mob pwm nyob rau ntawm daim tawv nqaij.

Qhov tshwm sim ntawm cov kev mob tshwm sim tuaj yeem kwv yees nyob rau WHO:

• Ntau heev (> 1 / 0,1),
• Feem ntau (> 0.001, 0.001, Yuav thov li cas

Cov lus sau ua ntej "tau ntsib" nyob rau hauv lub npe ntawm cov tshuaj qhia tau tias muaj cov metformin hauv nws cov muaj pes tsawg leeg, tab sis cov tshuaj no tau coj ib yam nkaus li thaum muab tshuaj Januvia, cov tshuaj raws li sitagliptin tsis muaj metformin.

Tus kws kho mob suav qhov ntau npaum li cas, thiab noj tshuaj thaum sawv ntxov thiab yav tsaus ntuj nrog zaub mov.

Hauv qee qhov xwm txheej, ib qho yuav tsum ua tib zoo saib xyuas thaum kho nrog Janumet.

1. Mob ncauj mob taub hau. Sitagliptin muaj peev xwm txhim kho nws cov tsos mob. Tus kws kho mob yuav tsum ceeb toom rau tus neeg mob: yog tias muaj mob hauv plab lossis sab xis hypochondrium, koj yuav tsum tsum tsis txhob noj tshuaj ntxiv.
2. Cov kab mob lactic acidosis. Qhov mob hnyav thiab tsis yog li no tsuas yog txaus ntshai nrog kev phom sij, thiab cov kev kho mob cuam tshuam thaum cov tsos mob tshwm sim. Nws tuaj yeem lees paub los ntawm kev ua pa luv, mob epigastric, ua daus no, hloov ntshav sib xyaw, nqaij pob txha tsis meej, asthenia, thiab lub plab zom mov ua rau lub cev tsis ua haujlwm.
3. Kev ntshav siab. Nyob rau hauv cov xwm txheej paub, tawm tsam keeb kwm ntawm Yanumet, nws tsis txhim kho. Nws tuaj yeem tsim kev npau taws los ntawm kev tawm dag zog ntau dhau, kev noj zaub mov kom tsawg (li 1000 kcal / hnub) khoom noj khoom haus, teeb meem nrog rau lub qog adrenal thiab lub caj pas pituitary, cawv, thiab siv β-blockers. Tsub qhov muaj feem ntau ntawm cov ntshav qog ntshav qab zib nyob rau hauv cov kev kho mob txuas nrog insulin.
4. Cov hlwv pathology. Kev pheej hmoo ntawm kev tsim mob lactic acidosis nce ntxiv nrog rau mob raum, yog li nws yog qhov tseem ceeb los saib xyuas creatinine. Qhov no yog qhov tseeb tshwj xeeb tshaj yog rau cov ntshav qab zib ntawm lub hnub nyoog paub tab, txij li lub raum tsis zoo hauv lawv tuaj yeem yog asymptomatic.
5. Kev ua haujlwm tsis zoo. Yog hais tias lub cev muaj kev tsis haum nrog cov kev tshwm sim ua xua, cov tshuaj raug muab tso tseg.
6. Kev phais mob. Yog tias tus mob ntshav qab zib muaj kev npaj ua haujlwm, ob hnub ua ntej nws, Janument tau muab tso tseg thiab tus neeg mob pauv mus rau insulin.
7. Iodine-muaj cov khoom lag luam.Yog tias tus neeg sawv cev raws tshuaj iodine yog qhia nrog Yanumet, qhov no tuaj yeem ua rau mob raum.

Cov nyhuv ntawm Yanumet rau cov poj niam cev xeeb tub tau kawm tsuas yog rau cov neeg sawv cev ntawm lub ntiaj teb tsiaj. Hauv cov pojniam cev xeeb tub, kev loj hlob ntawm tus menyuam tsis tau sau nrog Metformin. Tab sis cov kev txiav txim siab no tsis txaus ntseeg tau muab tshuaj rau cov poj niam cev xeeb tub. Hloov mus rau cov tshuaj insulin nyob rau theem kev npaj ntawm cev xeeb tub.

Metformin kuj dhau mus rau hauv niam cov kua mis, yog li ntawd, rau lub sijhawm ntawm lactation, Yanumet tsis muaj kev cai hais.

Metformin tsis cuam tshuam rau kev tsav tsheb lossis cov txheej txheem tsis yooj yim, thiab synagliptin tuaj yeem ua rau qaug zog thiab qaug zog, yog li ntawd, Januvia tsis siv yog tias muaj kev cuam tshuam sai thiab kev xav tau siab yog xav tau.

Qhov teeb meem ntawm kev overdose

Txhawm rau zam dhau kev tshaj tawm ntawm metformin, koj tuaj yeem siv tsis tas siv ntxiv rau Yanumet. Kev noj tshuaj ntau dhau yog txaus ntshai nrog cov kab mob lactic acidosis, tshwj xeeb tshaj yog nrog cov tshuaj tshaj ntawm metformin. Thaum cov tsos mob ntawm kev noj ntau dua tshwm sim, kev kho mob tshwm sim uas siv los ua kom tsis haum.

Vim li cas txhim kho Metformin complexes nrog Yanuvia, Galvus, Onglyza, Glybyuryd, yog tias koj tuaj yeem siv tib cov cuab yeej hauv cov kev kho mob sib cais sib cais? Cov kev sim pom tau hais tias nrog rau txhua txoj kev tswj hwm rau tus mob ntshav qab zib hom 2, Metformin yog tam sim no (txawm tias hloov mus rau insulin). Ntxiv mus, thaum siv ob qho tshuaj yeeb dej cawv nrog cov txheej txheem sib txawv ntawm kev nqis tes ua, cov txiaj ntsig ntawm cov tshuaj nce ntxiv thiab koj tuaj yeem ua nrog cov tshuaj noj nrog cov tshuaj noj qis dua.

Nws tsuas yog ib qho tseem ceeb los tswj cov koob tshuaj ntawm cov tshuaj metformin hauv pob (500 mg, 850 mg lossis 1000 mg) txhawm rau kom zam dhau cov tsos mob ntau dhau. Rau cov neeg mob uas tsis nco qab haus txhua hom tshuaj noj raws sijhawm, sijhawm zoo yuav txhua yam lawv xav tau nyob rau ib lub sijhawm yog qhov txiaj ntsig zoo uas cuam tshuam loj rau kev nyab xeeb thiab cov txiaj ntsig ntawm kev kho mob.

Kev ntsuas thiab tus nqi

Yanumet yog cov tshuaj muaj nqi ntau: qhov nruab nrab, tus nqi hauv cov khw muag tshuaj muaj txiaj ntsig los ntawm ob thiab ib nrab txog peb txhiab rubles rau ib lub thawv nrog 1-7 cov paib (14 ntsiav tshuaj hauv ib lub hlwv). Lawv tsim cov tshuaj qub hauv Spain, Switzerland, Tebchaws Netherlands, Tebchaws Asmeskas, Puerto Rico. Ntawm cov analogues, tsuas yog Velmetia yog kiag li haum nyob rau hauv muaj pes tsawg leeg. Qhov kev ua tau zoo thiab kev cai ntawm cov tshuaj ATC zoo sib xws:

Glibomet suav nrog metformin thiab glibenclamide, uas muab nws nrog lub peev xwm hypoglycemic thiab hypolipidemic. Kev qhia rau kev siv zoo ib yam li cov lus pom zoo rau Yanumet. Douglimax ua raws li metformin thiab glimepiride. Tus txheej txheem ntawm kev sib kis thiab ntsuas tau zoo ib yam li Yanumet. Tripride muaj cov glimepiride thiab pioglitazone, uas muaj cov nyhuv tshuaj tua kab mob thiab cov cim zoo sib xws. Avandamet, uas yog kev sib xyaw ntawm metformin + rosiglitazone, kuj tseem muaj cov yam ntxwv hypoglycemic.

Yog Yanumet tsis haum

Cov laj thawj ntawm kev hloov cov tshuaj tuaj yeem sib txawv: rau qee yam, cov tshuaj tsuas yog tsis pab ua kom tau qib siab, rau lwm tus nws ua rau muaj kev mob tshwm sim tsis tu ncua lossis tsuas yog nws tsis tuaj yeem them taus.

Thaum kev siv cov tshuaj tsis tuaj yeem ua rau tag nrho cov dej qab zib, nws raug hloov los ntawm cov tshuaj insulin. Lwm cov ntsiav tshuaj hauv qhov no tsis tau muaj txiaj ntsig. Yuav luag txhua zaus, los ntawm kev kho cov tshuaj tiv thaiv kev ntxhov siab, kev ua haujlwm txiav, thiab ua tiav hom kab mob ntshav qab zib hom 2 tau dhau mus rau hom ntshav qab zib hom 1.

Txawm tias cov ntsiav tshuaj niaj hnub no yuav ua rau tsis muaj txiaj ntsig yog tias koj tsis quav ntsej cov lus pom zoo ntawm tus neeg endocrinologist rau cov khoom noj uas tsis muaj carb thiab cov khoom siv thauj khoom.

Cov kev mob tshwm sim feem ntau npau taws los ntawm metformin, sitagliptin tsis muaj kev phom sij hauv qhov no. Raws li nws cov peev txheej ntawm cov tshuaj, Metformin yog cov tshuaj tshwj xeeb, ua ntej koj nrhiav kev hloov rau nws, nws tsim nyog los ua qhov kev mob siab tshaj plaws kom yoog tau. Dyspeptic cuam tshuam yuav dhau sij hawm, thiab metformin yuav ua kom qab zib li qub tsis muaj kev rhuav tshem cov txiav thiab lub raum.Tsawg qhov tsis tsim nyog tau txais yog muab los ntawm kev noj Janumet tsis ua ntej lossis tom qab noj mov, tab sis thaum noj mov.

Txhawm rau txuag nyiaj, koj tuaj yeem hloov Janumet lossis Januvia nkaus xwb nrog cov ntshiab metformin. Hauv cov khw muag tshuaj, nws yog qhov zoo dua los xaiv cov Glukofage lossis Siofor cov cim lag luam hloov chaw ntawm cov tuam ntxhab.

Tus mob ntshav qab zib thiab kws kho mob txog Yanumet

Hais txog cov tshuaj Janumet, kev tshuaj xyuas ntawm cov kws kho mob yog qhov sawv daws pom. Cov kws kho mob hais tias: ib qho tseem ceeb ntawm nws cov khoom siv (tshwj xeeb yog sitagliptin) yog qhov lawv tsis ua rau cov ntshav qog ntshav qab zib. Yog tias koj tsis ua txhaum txhaum txoj cai tswjfwm uas tau hais tseg thiab ua raws li cov lus pom zoo ntawm khoom noj khoom haus thiab kev kawm paub lub cev, cov ntsuas ntawm qhov ntsuas yuav tsawg tsawg. Yog tias muaj qhov tsis xis nyob hauv lub caij nyoog (epigastrium) thiab lwm qhov tsis zoo, qhov tsim nyog yuav tsum faib cov koob tshuaj txhua hnub ua 2 koob tshuaj txhawm rau kom txo qis lub nra ntawm lub cev. Tom qab hloov kho dua tshiab, koj tuaj yeem rov qab mus rau tsoomfwv yav dhau los, yog tias cov piam thaj ntau dua li cov txiaj ntsig pom, kev kho raws li cov kws kho mob tau pom zoo.

Txog Yanumet, tus neeg mob tshuaj xyuas yog qhov muaj kev sib cav, vim tias tus kab mob hauv txhua tus neeg tau nce mus txawv. Feem ntau ntawm cov neeg mob cov neeg laus yws txog cov kev mob tshwm sim, vim tias ob lub raum, thiab lub cev tag nrho, twb muaj qhov cuam tshuam nrog cov kab mob sib kis.

Endocrinologist muaj cov lus tshaj tawm nrov: "Kev ua si nawv thiab khoom noj yog koob tshuaj tiv thaiv ntshav qab zib." Txhua tus neeg uas tshawb nrhiav cov ntsiav tshuaj zoo kawg nkaus, thiab ntseeg hais tias cov tshuaj tshiab, lwm daim ntawv tshaj tawm lossis tshuaj ntsuab yuav kho cov ntshav qab zib mus tas li tsis muaj dag zog ntau, yuav tsum nco ntsoov nws ntau zaus.

Yuav ua li cas coj, chav kawm ntawm kev tswj hwm thiab ntau npaum li cas

Kev noj tshuaj ntau dua ntawm cov tshuaj Yanumet yuav tsum tau xaiv ib tus zuj zus, raws li kev kho tam sim no, kev ua haujlwm thiab kev tuaj yeem, tab sis tsis tshaj qhov siab tshaj qhov pom zoo txhua hnub koob tshuaj sitagliptin 100 mg. Cov tshuaj Yanumet feem ntau tau siv 2 zaug hauv ib hnub nrog zaub mov noj, nrog cov tshuaj tiv thaiv kab mob nce ntxiv, txhawm rau txo cov kev mob tshwm sim los ntawm lub plab zom mov (GIT), cov yam ntxwv ntawm metformin. Thawj qhov hno ntawm cov tshuaj Janumet nyob ntawm kev kho hypoglycemic tam sim no.

Cov lus qhia tshwj xeeb

Siv nyob rau hauv tus neeg laus Yanumet: txij li txoj kev tseem ceeb ntawm kev tshem tawm sitagliptin thiab metformin yog lub raum, thiab txij li lub sijhawm ua haujlwm ntawm lub raum poob qis nrog lub hnub nyoog, qhov kev ceev faj rau sau tseg cov tshuaj Yanumet nce hauv kev faib ua feem rau cov hnub nyoog. Cov neeg laus tau txais kev xaiv koob tshuaj thiab saib xyuas lub raum kev ua haujlwm tas li.