Pioglitazone (Pioglitazone)

Cov tshuaj yog tsim nyob rau hauv daim ntawv ntawm ntsiav tshuaj: los ntawm yuav luag dawb mus dawb, puag ncig, 15 mg - biconvex, engraved ntawm ib sab ntawm "15", 30 mg - tiaj, nrog ib tug bevel, engraved ntawm ib sab ntawm "30" (10 pcs. hauv cov hlwv, 1, 3 lossis 5 hlwv thiab cov lus qhia rau kev siv Pioglara rau hauv daim duab los qhia).

1 ntsiav tshuaj muaj:

• cov tshuaj nquag: pioglitazone hydrochloride - 16.53 lossis 33.07 mg, uas yog sib piv rau pioglitazone hauv tus nqi 15 thiab 30 mg, ntsig txog
• cov khoom siv ntxiv: calcium carboxymethyl cellulose, magnesium stearate, hydroxypropyl cellulose (tsis muaj viscosity), lactose, dej lim.

Cov Tshuaj Hauv Tshuaj

Pioglitazone yog lub qhov ncauj hypoglycemic tus neeg sawv cev, ib qho kev sib txuas ntawm thiazolidinedione series, xaiv kev ua kom muaj zog the receptors ua haujlwm los ntawm cov peroxisome proliferator (PPARγ). PPARγ cov chaw txais tau nyob hauv cov nqaij hauv cov nqaij uas muaj qhov tseem ceeb tshaj ntawm cov txheej txheem ntawm kev ua haujlwm ntawm insulin (cov leeg pob txha, cov leeg nqaij thiab daim siab). Kev zam txim ntawm PPARγ nuclear receptors ua rau hloov cov ntawv sib hloov ntawm ntau cov caj ces muaj qhov nkag siab txog insulin thiab koom tes hauv kev tswj ntshav qabzib thiab lipid metabolism. Pioglitazone muab qhov txo qis hauv insulin tsis kam, vim qhov kev noj ntawm insulin-nce ntxiv nyob rau hauv qab, ntau dhau ntawm cov piam thaj thiab nws tso tawm los ntawm lub siab txo. Cov tshuaj nquag pab txo qis triglycerides, nce qhov siab ntawm cov lipoproteins ntau ntom (HDL) thiab cov roj cholesterol. Pioglar tsis txhawb kev tsim cov tshuaj insulin, tsis zoo li sulfonylurea derivatives.

Cov Tshuaj Pharmacokinetics

Tom qab kev tswj hwm ntawm qhov ncauj, qhov siab nqus ntawm pioglitazone tau pom, hauv cov ntshav ntshav cov tshuaj ua haujlwm tau pom tom qab 30 feeb, qhov siab tshaj plaws (C_max) tau tiav tom qab 2 teev, thiab tom qab noj mov - tom qab 3-4 teev. Tus neeg sawv cev yuav luag tag nrho khi rau cov ntshav plasma - los ntawm 99%, qhov ntim ntawm faib (V_d) yog 0.22–1.04 l / kg. Pioglitazone muaj feem cuam tshuam los ntawm hydroxylation thiab oxidation, cov metabolites tsim los ntawm biotransformation ntawm cov tshuaj nquag tseem hloov ib nrab hloov mus rau sulfate / glucuronide conjugates.

Derivatives ntawm pioglitazone hydroxide (metabolites M-II thiab M-IV) thiab keto-derivative pioglitazone (metabolite M-III) muaj cov haujlwm pharmacological. Hauv kev ua tiav ntawm hepatic metabolism ntawm cov tshuaj, lub luag haujlwm tseem ceeb yog koom nrog isoenzymes ntawm cytochrome P450 - CYP3A4 thiab CYP2C8. Txhawm rau kom tsawg dua, ntau lwm yam isoenzymes tseem koom nrog hauv cov metabolism hauv cov tshuaj, feem ntau suav nrog isoenzyme CYP1A1 tshwj xeeb ntxiv.

Kev siv txhua hnub ntawm Pioglar hauv plasma, qhov kev nkag siab ntawm tag nrho pioglitazone (pioglitazone nrog cov tshuaj metabolites) tau mus txog tom qab 24 teev. Cov tshuaj ruaj ruaj nyob ruaj ruaj (C_ss) hauv cov ntshav ntawm ob qho tag nrho pioglitazone thiab pioglitazone yog pom tom qab 7 hnub.

Cov tshuaj tawm yog tas nrog cov kua tsib hauv daim ntawv uas tsis hloov pauv thiab hauv daim ntawv ntawm kev hloov pauv, tshem tawm nrog quav. 15-30% yog tawm los ntawm lub raum nyob rau hauv daim ntawv ntawm metabolites thiab lawv conjugates. Ib nrab-lub neej (T_½) pioglitazone thiab tag nrho pioglitazone yog 3-7 teev thiab 16-24 teev, raws li.

Kev ntsuas rau siv

Pioglar raug pom zoo rau siv nyob rau hauv hom 2 mob ntshav qab zib mellitus (raws li kev kho mob monotherapy lossis hauv kev sib xyaw nrog metformin, insulin lossis sulfonylurea derivatives nyob rau hauv cov teeb meem no thaum kev tawm dag zog, kev noj zaub mov noj thiab kev kho mob monotherapy nrog ib qho ntawm cov tshuaj tiv thaiv kab mob saum toj kawg nkaus tsis pub kom ua tiav glycemic tswj).

Cov Yuav Tsum Muaj

• Qeb III - IV lub plawv tsis ua haujlwm, raws li kev faib tawm ntawm New York Koom Haum Kev Tshawb Fawb (NYHA),
• ketoacidosis, yam 1 mob ntshav qab zib mellitus,
• muaj teeb meem loj hauv lub siab tsis ua haujlwm, nce kev ua haujlwm ntawm daim siab enzymes ntau dua 2.5 npaug ntawm qhov tsis pub dhau lub siab (VGN),
• macrohematuria tsis paub keeb kwm,
• zais zis mob hlwb (suav nrog keeb kwm)
• hnub nyoog txog 18 xyoo
• cev xeeb tub thiab lactation,
• piam thaj-galactose malabsorption, lactase deficiency, galactose intolerance,
• muaj qhov tsis haum xeeb rau ib qho twg ntawm cov yeeb tshuaj.

Tus Txheeb Ze (Pioglar ntsiav tshuaj yuav tsum tau siv nrog huab ceev faj):

• lub plawv tsis ua hauj lwm
• anemia
• edematous mob siab
• kev ua haujlwm ntawm lub siab.

Pioglar, cov lus qhia rau kev siv: txoj kev thiab ntau npaum li cas

Pioglar ntsiav tshuaj yog noj ntawm qhov ncauj 1 zaug hauv ib hnub, tsis hais lub sijhawm noj mov.

Thaum coj cov tshuaj monotherapy, nws raug nquahu kom noj cov tshuaj hauv 15-30 mg, qhov koob tshuaj ntau tshaj txhua hnub yog 45 mg.

Hauv kev sib koom ua ke nrog kev siv tshuaj metformin lossis sulfonylurea derivatives, pioglitazone yuav tsum tau siv nyob rau hauv kev pib ua rau 15 lossis 30 mg; yog tias hypoglycemia tshwm sim, cov koob tshuaj metformin lossis sulfonylurea kev npaj yuav tsum raug txo kom tsawg.

Nrog rau kev siv Pioglar nrog kev siv tshuaj insulin, kev pib noj txhua hnub ntawm pioglitazone yuav tsum yog 15-30 mg, qhov tshuaj ntawm cov insulin tsis pub hloov lossis txo qis dua 10-25% yog tias tus neeg mob qhia txog hypoglycemia lossis ntshav ntshav ntshav siab poob qis rau ib qib tsis tshaj 100 mg / dl.

Sab sij huam

• cov kab mob ua pa: sinusitis, pharyngitis,
• cov hlab ntsha hauv lub cev thiab cov plab hnyuv siab ntsws: hnov ​​mob taub hau, kiv taub hau, pw tsis tsaug zog, mob ntshav qab zib, pom kev tsis sib haum xeeb (feem ntau tshwm sim thaum pib kho thiab muaj feem nrog kev hloov ntshav hauv ntshav qab zib, ib yam li lwm yam tshuaj tiv thaiv kab mob ntshav qab zib),
• hematopoietic system: ntshav khov,
• metabolism: hypoglycemia, rog rog,
• lub plab zom mov: plab,
• mob qog lossis mob qog: mob qog ua hlav, cov cim ntawm kev txhim kho uas yuav nquag tso zis, mob macrohematuria, mob lub sijhawm tso zis, mob plab lossis hauv plab lumbar (qhov tshwm sim ntawm cov kev tsis zoo no yuav tsum ceeb toom rau tus kws kho mob uas tau koom nrog),
• cov leeg ua haujlwm: myalgia, arthralgia,
• cov kev ntsuas hauv lub zog: nce kev ua haujlwm ntawm alanine aminotransferase (ALT) thiab creatine phosphokinase, txo qis hemoglobin ntau ntau thiab txo qis ntawm hematocrit (feem ntau yog kho mob tsis tseem ceeb, tej zaum yuav yog vim muaj kev nce hauv plasma ntau thiab tsis qhia txog kev txhim kho ntawm lwm qhov kev mob ntshav ntshav loj).

Nrog rau kev kho mob ntev dua 1 xyoos, hauv 6-9% ntawm tus neeg mob, qhov tsos ntawm qhov tsos mob me / mob qis, feem ntau tsis tas yuav tshem tawm Pioglar, tuaj yeem sau cia hauv cov neeg mob.

Thaum kho, qee zaum, qhov tshwm sim ntawm lub plawv nres yog tau.

Cov lus qhia tshwj xeeb

Hauv cov neeg mob uas muaj lub zog anovulatory nyob rau lub sijhawm premenopausal thiab insulin tsis kam ua kev kho mob nrog pioglitazone, kev rov qab los ovulation tuaj yeem sau tseg. Vim tias muaj qhov cuam tshuam ntau ntxiv ntawm cov neeg mob no rau insulin thaum tsis muaj kev siv tshuaj tiv thaiv kom muaj txiaj ntsig, qhov kev pheej hmoo ntawm cev xeeb tub yuav nce ntxiv. Yog tias cev xeeb tub tshwm sim thaum kho lossis tus neeg mob tab tom npaj lub cev xeeb tub, pioglitazone yuav tsum tsis ua ntxiv.

Raws li cov txiaj ntsig ntawm kev tshawb fawb preclinical, thiazolidinediones, suav nrog pioglitazone, ua rau muaj kev nce plasma ntau ntxiv thiab kev txhim kho ntawm myocardial hypertrophy, vim ua ntej thauj khoom. Hauv kev sim kho mob hauv cov neeg mob hauv chav kawm III thiab IV lub plawv tsis ua haujlwm (NYHA) tsis koom nrog, tsis muaj qhov nce ntxiv ntawm qhov tshwm sim tsis zoo ntawm cov hlab plawv, nyob ntawm qhov nce ntawm plasma ntim (mob plawv tsis txaus).

Cov txiaj ntsig ntawm kev tswj xyuas cov kab mob sib kis, nrog rau cov ntaub ntawv muaj kabmob sib kis, qhia tias muaj kev ua phem ntxiv ntawm kev hem thawj tias mob zais zis hauv cov neeg mob ntshav qab zib uas tau noj cov tshuaj pioglitazone hauv kev noj qab haus huv txhua hnub ntev. Txawm li cas los xij, muaj ntawm cov ntaub ntawv no tsis suav nrog qhov ua tau ntawm lub zais zis mob cancer thaum lub sij hawm luv luv kev kho nrog cov tshuaj. Cov xwm txheej hauv qab no tuaj yeem cuam tshuam nrog kev pheej hmoo ua mob zais zis: kev laus laus, kev haus luam yeeb (suav txog yav dhau los), kev siv tshuaj kho mob (suav nrog kev siv cyclophosphamide), kev kho hluav taws xob ntawm lub plab mob hauv plab, thiab qee qhov kev ua haujlwm txaus ntshai. Ua ntej pib ntawm chav kawm ntawm txoj kev kho, kev tshawb fawb macroscopic yuav tsum tsim kom muaj ib qho macrohematuria. Nws yog ib qho tsim nyog yuav tsum tau qhia tus kws kho mob tam sim ntawd txog tag nrho cov tsos mob ntawm dysuria thiab ib qho kev loj hlob ntawm cov tsos mob tshwm sim los ntawm mob txeeb zig thiab / lossis zais zis.

Nrog lub siab ua haujlwm tsis zoo

Thaum kho, nws pom zoo kom soj ntsuam kom tsis txhob muaj cov kab mob siab zoo hauv cov ntshav hauv cov ntshav. Hauv txhua tus neeg mob, ua ntej pib kho nrog pioglitazone, txhua 2 lub hlis nyob rau thawj xyoo ntawm tau txais Pioglar thiab tsis tseg nyob rau xyoo tom qab ntawm kev kho, nws yog qhov yuav tsum tau txiav txim siab txog theem ntawm ALT. Nws tseem yuav tsum tau ntsuas qhov kev ua haujlwm hauv lub siab thaum cov tsos mob tshwm sim uas tuaj yeem ua rau pom kev ua haujlwm siab, xws li mob plab, xeev siab, ntuav, tsis nco qab, qaug zog, tso zis tsaus nti. Yog tias tus mob daj ntseg tshwm sim, tsum tsis txhob noj Pioglar.

Kev siv cov tshuaj tiv thaiv hypoglycemic yog contraindicated rau hauv cov neeg mob uas muaj lub siab ua haujlwm lossis tiv thaiv keeb kwm yav dhau los ntawm qhov nce ntawm ALT cov cim ntau tshaj li 2.5 npaug VGN.

Nrog nce me ntsis ntawm ALT qib (1-2.5 lub sijhawm siab dua li qub) ua ntej chav kawm lossis thaum kho, kev soj ntsuam yuav tsum tsim kom muaj qhov ua rau ua txhaum cai no. Pib los yog txuas ntxiv kev kho mob nrog Pioglar nyob rau hauv kev pom muaj qhov kev nce qib hauv kev ua haujlwm ntawm daim siab enzymes nrog kev ceev faj, ua qhov kev soj ntsuam ntau dua ntawm lawv cov haujlwm.

Nyob rau hauv rooj plaub thaum qhov kev nce ntawm kev ua ntawm hepatic transaminases tau pom los ntawm ntau dua 2.5 zaug piv nrog VGN, nws yog qhov yuav tsum tau soj ntsuam kom tsis tu ncua qib ntawm cov enzymes, kom txog rau thaum cov ntsuas qis qis mus rau qhov qub lossis pib rau thawj. Yog tias qib ALT stably tshaj li qhov muaj nuj nqis ntau dua los ntawm ntau tshaj 3 zaug lossis jaundice pom, kev siv pioglitazone yuav tsum tso tseg.

Siv rau lub sijhawm qub

Hauv cov neeg laus, ua ntej thiab thaum kho, vim qhov kev phem ntawm kev hem thawj ntawm pob txha lov, kab mob ntawm cov hlab plawv thiab zais zis ntawm cov neeg mob ntawm cov neeg mob hnub nyoog no, kev ntsuas tshwj xeeb tshaj plaws ntawm cov txiaj ntsig thiab kev phom sij ntawm kev kho mob nrog Pioglar yuav tsum tau ua.

Yeeb tshuaj sib cuam tshuam

• qhov ncauj tsis pub muaj qhov ncauj - cov kev tshawb fawb pharmacokinetic ntawm kev siv cov tshuaj thiab cov pioglitazone tsis tau ua tiav, txawm li cas los xij, kev siv lwm cov thiazolidinediones ua ke nrog kev tiv thaiv qhov ncauj, uas suav nrog cov tshuaj tiv thaiv ethinyl estradiol / norethindrone, ua rau muaj kev txo qis hauv plasma theem ntawm ob qho tshuaj hormones los ntawm 30%, uas tuaj yeem ua rau muaj kev cuam tshuam tsis muaj zog ntawm cov tshuaj tiv thaiv. Kev sib xyaw ua ke no yuav tsum tau ceev faj
• warfarin, digoxin, metformin, glipizide - tsis muaj ib yam dab tsi pauv hauv pharmacokinetics ntawm pioglitazone,
• ketoconazole - pioglitazone metabolism feem ntau yog tshuaj tiv thaiv, raws li kev tshawb fawb hauv vitro, nrog kev sib xyaw no nws yog ib qho tsim nyog yuav tau ua tib zoo saib xyuas cov concentration ntawm cov ntshav piam thaj,
• lwm cov tshuaj tiv thaiv kab mob hauv qhov ncauj: tsis muaj ntaub ntawv qhia txog kev siv pioglitazone hauv kev sib xyaw nrog peb zaug nrog cov tshuaj no.

Cov Lus Cog Tseg ntawm Pioglar yog: Astrozone, Diab-norm, Piouno, Amalvia, Diaglitazone, Piogli.

Pioglar tshuaj xyuas

Raws li kev txheeb xyuas, Pioglar yog ib tus neeg sawv cev hypoglycemic zoo siv rau kev kho mob hom 2 mob ntshav qab zib mellitus, ob qho tib si thaum kho mob monotherapy thiab hauv kev sib xyaw nrog lwm tus kab mob hypoglycemic, suav nrog insulin. Cov neeg mob nco ntsoov tias cov tshuaj txhim kho cov piam thaj hauv kev tswj hwm thiab nce qhov kev tawm tsam ntawm cov hlwb rau insulin, tab sis txhua tus pom zoo siv Pioglar tsuas yog qhia los ntawm kws kho mob.

Qhov tsis zoo ntawm Pioglar suav nrog kev nyob ntawm contraindications thiab kev txhim kho cov kev mob tshwm sim, tshwj xeeb hauv kev nce hauv lub cev hnyav, mob taub hau, flatulence.

Tus nqi ntawm Pioglar hauv cov chaw muag tshuaj

Tsis muaj ntaub ntawv txaus ntseeg ntawm tus nqi Pioglar, vim tias tam sim no cov tshuaj tsis raug muag hauv cov chaw muag tshuaj.

Kev Kawm Ntawv: Thawj Moscow State Medical University muaj npe tom qab I.M. Sechenov, tshwj xeeb "Tshuaj General".

Cov ntaub ntawv hais txog cov tshuaj raug muab dav dav, muab rau kev qhia tawm thiab tsis hloov chaw cov lus qhia. Kev siv tshuaj rau tus kheej yog qhov txaus ntshai rau kev noj qab haus huv!

Tib neeg cov ntshav "khiav" los ntawm cov hlab ntsha hauv qab qhov siab, thiab yog tias nws txoj kev ncaj ncees tau ua txhaum, nws tuaj yeem tua txog 10 meters.

Tib neeg cov pob txha yog plaub zaug muaj zog dua li cov pob zeb.

Yog tias koj lub siab ua haujlwm, kev tuag yuav tshwm sim hauv ib hnub.

Ntau tshaj $ 500 lab tau ib xyoo yog siv rau cov tshuaj tiv thaiv ua xua nkaus xwb nyob hauv Tebchaws Meskas. Koj puas tseem ntseeg tias txoj hauv kev uas thaum kawg kov yeej kev ua xua yuav pom?

Muaj ntau cov kev kho mob nthuav tawm heev, xws li kev siv khoom tsis nco qab ntawm cov khoom. Hauv plab ntawm ib tus neeg mob uas tau mob los ntawm tus txiv neej no, 2500 cov khoom txawv teb chaws tau pom.

Hauv 5% ntawm cov neeg mob, antidepressant clomipramine ua rau lub orgasm.

Nrog kev mus saib xyuas lub txaj tanning, txoj kev pheej hmoo ntawm kev mob qog tawv nqaij yuav nce 60%.

Thaum txham, peb lub cev ua haujlwm tsis tiav. Txawm lub plawv nres.

Yog tias koj luag nyav tsuas yog ob zaug ib hnub, koj tuaj yeem txo cov ntshav siab thiab txo qhov kev pheej hmoo ntawm lub plawv thiab mob nkees.

Raws li kev txheeb cais, nyob rau hnub Monday, kev pheej hmoo ntawm nraub qaum nce ntxiv li 25%, thiab kev pheej hmoo ntawm mob plawv - los ntawm 33%. Kom ceev faj.

Raws li kev tshawb fawb los ntawm WHO, kev sib tham ib nrab hnub nyob rau ntawm lub xov tooj ntawm tes tau qhov feem ntau ntawm kev txhim kho lub hlwb lub hlwb los ntawm 40%.

Muaj 74 xyoo nyob hauv tebchaws Australian yawg James Harrison tau los ua neeg muab ntshav li 1,000 zaus. Nws muaj ib hom ntshav uas tsis tshua muaj, cov tshuaj tiv thaiv uas pab cov menyuam mos liab uas muaj ntshav tsawg txaus kom ciaj sia taus. Yog li, Australian thiaj cawm tau ntau txog ob lab tus menyuam.

Txhua tus neeg muaj tsis tsuas yog nyias tus ntiv tes, tab sis kuj hais lus.

Nws tau siv los ua yawning enriches lub cev nrog oxygen. Txawm li cas los xij, qhov kev pom no tau nthuav dav. Cov kws tshawb fawb tau ua pov thawj tias yawning, ib tus neeg ua kom lub hlwb txias thiab txhim kho kev ua haujlwm.

Qhov ua kom pom kev vibrator ua ntej nyob rau xyoo 19th. Nws ua haujlwm ntawm lub tshuab tso hluav taws xob thiab nws tau npaj kho qhov mob poj niam.

Thawj nthwv dej ntawm paj yog tuaj txog qhov kawg, tab sis cov ntoo tawg paj yuav hloov los ntawm cov nyom los pib thaum lub Rau Hli, uas yuav cuam tshuam rau cov neeg tsis haum tshuaj.

Kws Tshuaj

Xaiv yam tshuaj rau cov hluav taws xob nuclear gamma receptors ua haujlwm los ntawm cov kev txhawb nqa peroxisome (gamma PPAR). Nws hloov kho qhov hloov pauv ntawm cov noob caj dab uas nkag siab txog insulin thiab koom nrog kev tswj cov piam thaj thiab lipid metabolism hauv adipose, cov leeg nqaij thiab lub siab. Nws tsis txhawb kev loj hlob ntawm insulin, Txawm li cas los xij, nws tseem nquag ua haujlwm thaum muaj cov kua dej-kua hluavtaws ua haujlwm ntawm cov txiav ua ntej txiav txim siab. Txo cov insulin tsis kam ntawm peripheral cov ntaub so ntswg thiab daim siab, nce kev noj ntawm insulin-txo cov piam thaj, txo cov zis ntawm cov piam thaj los ntawm daim siab, txo cov ntshav qis, insulin thiab glycosylated hemoglobin hauv cov ntshav. Hauv cov neeg mob uas muaj cov lipid metabolism tsis ua hauj lwm, nws txo qis triglycerides thiab nce HDL yam tsis hloov LDL thiab tag nrho cov cholesterol.

Hauv kev sim tshuaj, nws tsis muaj carcinogenic thiab mutagenic teebmeem. Thaum muab rau cov poj niam thiab txiv neej nas txog 40 mg / kg / hnub, pioglitazone (txog 9 zaug siab dua MPDC, hais txog 1 m 2 ntawm lub cev saum npoo), tsis muaj kev cuam tshuam ntawm kev muaj menyuam hauv lub cev.

Pom hauv ntshav 30 min tom qab kev tswj hwm ntawm ncauj, C_max ua tiav tom qab 2 teev. Kev noj haus qeeb qeeb nqus (C_max sau tseg tom qab 3-4 teev), tab sis tsis cuam tshuam rau nws qhov tiav. Nws khi rau cov ntshav plasma protein, feem ntau nrog albumin, los ntawm ntau dua 99%. Qhov nruab nrab ntawm cov khoom faib yog 0.63 l / kg. Kev siab nyob rau hauv cov ntshav txuas ntxiv mus 24 teev tom qab siv ib koob. T_1/2 yog 3-7 teev (pioglitazone) thiab 16–24 teev (cov khoom ua kom muaj zog). Nws yog metabolized hauv daim siab nrog kev koom tes ntawm cytochrome P450 nrog kev tsim ntawm ob lub cev nquag, ib feem txuas nrog glucuronic thiab sulfuric acids. Nws yog tawm hauv cov kua tsib tsis tau hloov pauv thiab hauv daim ntawv ntawm kev ua kom muaj zog, tawm hauv lub cev nrog quav thiab tso zis (15-30%). Kev tshem av yog 5-7 l / h.

Kev sib txuam

Cov qub txeeg qub teg los ntawm sulfonamides, metformin thiab insulin potentiate (ob leeg) hypoglycemia. Muaj peev xwm ua kom tsis muaj zog ntawm kev ua tau zoo ntawm kev tiv thaiv qhov ncauj.

Pharmacokinetic cov kev tshawb fawb txog kev siv cov tshuaj pioglitazone thiab kev tiv thaiv qhov ncauj tsis tau ua. Kev siv ntawm lwm cov thiazolidinediones ua ke nrog kev tiv thaiv kab mob hauv qhov ncauj uas muaj ethinyl estradiol lossis norethindrone tau nrog 30% txo rau qhov kev cia siab ntawm ob qho tshuaj hormones hauv plasma, uas tuaj yeem ua rau txo qis qhov tshwm sim muaj txiaj ntsig. Yog li, kev ceev faj yuav tsum tau siv rau kev siv ntau ntawm pioglitazone thiab tshuaj tiv thaiv qhov ncauj.

Kev sib cuam tshuam nrog CYP2C8 Inductors

Inducers ntawm CYP2C8 isoenzyme ntawm cytochrome P450 (e.g. rifampicin) tuaj yeem txo pioglitazone AUC. Yog li, thaum pib lossis thaum txiav tawm kev kho mob nrog CYP2C8 inducers, kev kho kom haum ntawm pioglitazone yuav tsim nyog.

Ceev faj txog cov tshuaj Pioglitazone

Nrog kev ceev faj, cov neeg mob uas muaj edema thiab muaj kev nce qib ntawm kev nce siab hauv daim siab yog raug sau tseg. Kev txhim kho ntawm hypoglycemia thaum lub sij hawm ua ke txoj kev kho mob xav tau kom txo qis ntawm koob tshuaj concomitant sulfonamides lossis insulin. Tawm tsam keeb kwm yav dhau los ntawm lub raum tsis ua haujlwm, kev hloov kho tshuaj tsis tas yuav tsum tau. Yog tias mob daj ntseg, kev kho mob tso tseg. Hauv cov neeg mob uas tsis rov ua haujlwm hauv lub sijhawm premenopausal, kev nkag mus kawm tuaj yeem ua rau ovulation thiab nce qhov kev pheej hmoo ntawm cev xeeb tub (kev tiv thaiv tsim nyog yog tsim nyog).

Txoj kev pheej hmoo ntawm kev mob khees xaws.

Kev siv cov pioglitazone rau ntau dua 1 xyoo yuav cuam tshuam nrog kev pheej hmoo ntawm kev tsim mob qog ntshav.

Thaum muab tshuaj pioglitazone, cov neeg mob yuav tsum coj mus rau hauv qhov kev pheej hmoo ntawm kev mob kheesxaws ntawm lub zais zis thiab zam kom tsis txhob xaj nws rau cov neeg mob qog nqaij hlav, nrog rau hauv tsev neeg zaj keeb kwm.
Cov ntaub ntawv kev nyab xeeb no rau pioglitazone yog ua raws cov kev tshawb pom ntawm ob txoj kev tshawb nrhiav yav dhau los hauv cov neeg mob ntau dua 40 nrog kev kuaj mob ntshav qab zib mellitus.
Hauv kaum-xyoo soj ntsuam pawg neeg sib koom ua ke (Lub Ib Hlis 1997 - Plaub Hlis 2008) hauv Asmeskas, ntau dua 193 txhiab tus neeg mob tau suav nrog. Kev tshuaj xyuas nruab nrab ntawm cov ntaub ntawv los ntawm qhov kev kawm no qhia tau tias hnub nyoog, tub los ntxhais, haus luam yeeb, noj lwm yam tshuaj rau ntshav qab zib thiab lwm yam feem ntau tsis muaj kev cuam tshuam loj ntxiv ntawm kev pheej hmoo ntawm kev muaj mob qog ntshav hauv cov neeg mob noj pioglitazone piv rau cov neeg mob uas tsis tau thov (qhov tsis sib xws piv LOSSIS = 1.2, 95% kev ntseeg siab ib sij CI = 0.9-1.5). Txawm li cas los xij, kev kho mob mus ntev nrog pioglitazone (ntau dua 12 lub hlis) tau cuam tshuam nrog 40% nce ntawm kev muaj mob qog ntshav (OS = 1.4, 95% CI = 1.03-2.0).
Cov txiaj ntsig ntawm kev rov qab kawm ua ke nyob rau Fabkis (2006-2009), uas suav nrog kwv yees li 1.5 lab tus neeg mob ntshav qab zib, tau qhia txog kev muaj mob qog nqaij hlav cancer ntxiv nrog rau pioglitazone dhau 28 mg (OS = 1.75, 95 % CI = 1.22-2.5) thiab thaum noj ntau dua 1 xyoos (OS = 1.34, 95% CI = 1.02-1.75), ntxiv mus, txiv neej muaj kev pheej hmoo siab tshaj poj niam (OS = 1.28, 95% CI = 1.09-1.51).
Raws li cov ntaub ntawv los ntawm cov kev tshawb fawb no, kev siv tshuaj pioglitazone raug tshem tawm hauv Fabkis, thiab hauv Tebchaws Yelemees nws tau pom zoo kom tsis txhob pib kho pioglitazone hauv cov neeg mob tshiab.
Cov neeg mob yuav tsum qhia txog cov cim qhia zais zis, xws li hematuria, tso zis, mob lub sijhawm tso zis, mob lub nraub qaum lossis qis dua hauv plab.

Cov kev npaj niaj hnub glitazone

Ntawm tag nrho cov tshuaj nyob rau hauv khw, tsuas yog pioglitazone (Aktos, Diab-norm, Pioglar) thiab rosiglitazone (Roglit) tam sim no muag.

Lwm yam tshuaj tau raug rho tawm vim muaj kev phiv los ntawm kev kho.

Thiazolidinedione npaj

Troglitazone (Rezulin) yog cov tshuaj ntawm thawj tiam ntawm pab pawg no. Nws tau rov qab los ntawm qhov muag, vim nws cov nyhuv cuam tshuam tsis zoo rau daim siab.

Rosiglitazone (Avandia) yog hom tshuaj thib peb hauv pab pawg no. Nws tsis kam siv hauv xyoo 2010 (txwv tsis pub nyob hauv European Union) tom qab tau muaj pov thawj tias nws ua rau muaj kev pheej hmoo ntawm cov kab mob plawv.

Tus txheej txheem ntawm kev ua ntawm pioglitazone

Qhov kev ua ntawm pioglitazone yog txuas rau lub tshwj xeeb PPAR-gamma receptor, uas yog nyob rau hauv lub cell nucleus. Yog li, cov tshuaj cuam tshuam rau kev ua haujlwm ntawm cov hlwb cuam tshuam nrog kev ua haujlwm ntawm cov piam thaj. Lub siab, nyob rau hauv nws lub hwj chim, ua rau nws muaj tsawg dua. Tib lub sijhawm, cov ntaub so ntswg rhiab rau insulin ntau dua.

Qhov no muaj tseeb tshwj xeeb tshaj yog rau cov rog, leeg thiab cov qog hlwb. Thiab tom qab ntawd, muaj ib qho kev txo qis ntawm cov ntshav plasma cov ntshav qabzib thiab qhov ua tiav ntawm kev xav txog kev muab tso tawm tom qab.

Daim ntawv thov nyhuv

Tsis tas li ntawd, nws tau raug pov thawj tias cov tshuaj muaj qee cov txiaj ntsig zoo ntxiv:

• Lowers ntshav siab
• Cuam tshuam rau theem ntawm cov roj (txhaws qhov nce ntawm "cov roj (cholesterol)" zoo, uas yog, HDL, thiab tsis nce "cov roj (cholesterol) phem" - LDL),
• Nws inhibits qhov tsim thiab loj hlob ntawm atherosclerosis,
• Txo txo ​​txoj kev pheej hmoo mob plawv (piv txwv li, mob plawv nres, mob stroke).

Rau leej twg pioglitazone yog kws kho

Pioglitazone tuaj yeem siv los ua ib qho yeeb tshuaj, i.e. tshuaj mob hlwb. Tsis tas li, yog tias koj muaj hom 2 mob ntshav qab zib mellitus, koj cov kev hloov pauv hauv kev ua neej tsis muab cov txiaj ntsig kev cia siab thiab muaj contraindications rau metformin, nws qhov tsis ua siab ntev thiab muaj kev phiv

Kev siv ntawm pioglitazone yog ua tau nrog kev sib xyaw nrog lwm cov tshuaj tiv thaiv kab mob (piv txwv li, acarbose) thiab metformin yog tias lwm cov kev coj ua tsis coj ua tiav

Pioglitazone tseem tuaj yeem siv nrog cov kua dej insulin, tshwj xeeb tshaj yog rau cov tib neeg uas lawv lub cev cuam tshuam rau metformin tsis zoo.

Yuav ua li cas noj pioglitazone

Cov tshuaj yuav tsum noj ib hnub ib zaug, hais ntawm ncauj, thaum lub sijhawm lav. Qhov no tuaj yeem ua tau ob qho ua ntej thiab tom qab noj mov, vim tias cov zaub mov tsis cuam tshuam rau kev nqus ntawm cov tshuaj. Kev kho mob feem ntau yog pib nrog qhov qis dua. Hauv qhov xwm txheej uas qhov tshwm sim ntawm kev kho tsis zoo, nws tuaj yeem maj mam dhau los.

Qhov ua tau zoo ntawm cov tshuaj pom nyob rau hauv rooj plaub uas yuav tsum tau kho mob ntshav qab zib hom 2, tab sis siv tsis tau metformin, kev kho mob monotherapy nrog rau ib qho tshuaj tsis raug tso cai.

Ntxiv rau qhov tseeb tias pioglitazone txo qis postprandial glycemia, ntshav qabzib thiab khov kho glycated hemoglobin, nws kuj tseem muaj cov txiaj ntsig zoo ntxiv ntawm cov ntshav siab thiab ntshav cov roj. Tsis tas li ntawd, nws tsis ua kev tsis haum.

Sab sij huam

Cov kev phiv uas yuav tshwm sim nrog kev kho pioglitazone suav nrog:

• Cov dej ntau ntxiv hauv lub cev (tshwj xeeb tshaj yog thaum siv nrog insulin)
• Kev nce pob txha tsis zoo, uas yog fraught nrog kev raug mob ntau ntxiv,
• Cov kab mob sib kis ntau dua
• Qhov hnyav nce.
• Thab thab.
• Daim siab ua hauj lwm.

Kev noj tshuaj yuav ua rau muaj kev pheej hmoo ntawm macular edema (thawj tus tsos mob tej zaum yuav ua kom tsis zoo rau lub qhov muag pom, uas yuav tsum tau ceeb toom sai rau tus kws kho mob ntsej muag) thiab qhov kev pheej hmoo ntawm kev mob qog nqaij hlav.

Cov tshuaj no tsis ua rau kom mob ntshav qab zib, tab sis muaj kev pheej hmoo ntawm nws qhov tshwm sim thaum siv nrog cov tshuaj los ntawm cov tshuaj insulin lossis sulfonylurea.

Tsuas tshuaj thiab tswj hwm

Pioglitazone (Aktos, Diab-norm, Pioglar) noj ntawm qhov ncauj, 1 zaug hauv ib hnub, tsis hais txog ntawm cov khoom noj. Thawj koob tshuaj yog 15-30 mg, qhov tshuaj ntau tshaj txhua hnub yog 45 mg, thiab qhov siab tshaj plaws hauv kev sib xyaw ua ke yog 30 mg / hnub.

Rosiglitazone (Avandia, Roglite) noj qhov ncauj 1-2 zaug nyob rau ib hnub, tsis hais txog ntawm cov khoom noj. Thawj koob tshuaj yog 4 mg / hnub, qhov siab tshaj plaws txhua hnub yog 8 mg, thiab qhov siab tshaj plaws hauv kev sib xyaw ua ke yog 4 mg / hnub.

Cov lus qhia rau kev siv tshuaj

Kev tswj hwm ntawm cov tshuaj tsuas yog qhia tsuas yog tom qab sab laj nrog tus kws kho mob uas tuaj koom, uas sau ntawv tshuaj kom raug, coj mus rau hauv tus account tus yam ntxwv ntawm tus neeg mob. Txheeb tus kheej ntawm kev siv cov tshuaj Pioglitazone, cov lus qhia rau cov tshuaj yuav tsum ua tib zoo kawm kom tsis txhob muaj kev cuam tshuam.

Cov tshuaj tau qhia rau kev siv yog tias thawj zaug tau pib yog li ntawm 15 txog 30 mg, thiab qhov siab tshaj plaws (hauv ib hnub) yog 45 mg. Yog tias koj muab cov tshuaj ua ke nrog lwm cov tshuaj, cov tshuaj yuav tsum tsis pub ntau tshaj 30 mg. Pioglitazone yog qhia txog kev siv ib hnub ib zaug.

Thaum kho, koj yuav tsum txuas ntxiv ua raws kev noj haus thiab tawm dag zog. Nws yog ib qho tseem ceeb heev uas yuav tau kuaj xyuas hemoglobin qib hauv cov ntshav.

Pioglitazone yog qhia nrog kev saib xyuas tshwj xeeb rau cov neeg mob uas muaj kev o, thiab lub siab muaj cov enzymes ntau ntxiv. Nrog rau kev txhim kho ntawm hypoglycemia thaum lub sij hawm ua ke txoj kev kho yuav tsum muaj kev txo qis hauv cov tshuaj cov tshuaj insulin lossis sulfonamides. Yog hais tias tus neeg mob qaij muaj mob daj ntseg, muaj kev cuam tshuam tsis zoo rau lub cev tuaj yeem tawm, yog li kev kho mob yuav tsum tau nres. Cov neeg mob uas muaj lub cev ntas khaub thuas anovulatory thaum lub sijhawm premenopausal yog qhov muaj feem yuav xeeb tub, yog li ntawd kev tiv thaiv yuav tsum siv.

Ntau yam tshuaj uas siv hauv ntshav qab zib tau ntev ntev tsis ntev rau cov tshuaj insulin.

Cov Tsev Muag Tshuaj niaj hnub no muaj ntau yam cuab yeej los pab txo cov piam thaj hauv ntshav qab zib hom 2. Ib feem tseem ceeb ntawm lawv yog cov ua ke, raws li Pioglitazone (Pioglitazone).

Kev Sau ua ke, daim foos tso tawm

Cov tshuaj mus rau hauv muag ntim hauv cov thawv ntawv uas muaj 3 los yog 10 daim paib, muaj ib lub kaum os ntsiav tshuaj puag ncig thiab xim dawb. Cov tshuaj tiv thaiv hnyav kuj yuav muaj nyob hauv lawv ntawm 15, 30 lossis 45 mg.

Lub hauv paus tshuaj ntawm cov tshuaj yog pioglitazone hydrochloride, uas txo qhov rhiab ntawm daim siab thiab cov ntaub so ntswg mus rau qhov kev ua ntawm cov tshuaj, vim tias kev siv cov piam thaj nce ntxiv, thiab nws cov khoom hauv lub siab txo qis.

Ntxiv nrog rau qhov loj, ntsiav tshuaj muaj cov khoom siv ntxiv:

• lactose monohydrate,
• magnesium stearate,
• hydroxypropyl cellulose,
• calcium carboxymethyl cellulose.

Pharmacological kev txiav txim

Pioglitazone yog hais txog cov tshuaj hypoglycemic hauv qhov ncauj raws li thiazolidindine. Cov tshuaj txuam nrog tswj hwm cov ntshav piam thaj thiab lipid metabolism. Txo cov kev tsis kam ntawm cov ntaub so ntswg ntawm lub cev thiab daim siab rau insulin, nws ua rau kev nce ntxiv hauv kev siv nyiaj ntawm insulin-nyob rau hauv cov piam thaj thiab txo nws cov pa tawm los ntawm daim siab.

Txawm li cas los xij, nws tsis nthuav tawm ntxiv kev txhawb nqa ntawm β-hlwb ntawm cov txiav, uas txuag lawv los ntawm kev laus sai. Cov nyhuv ntawm cov tshuaj hauv cov ntshav qab zib hom 2 ua rau txo qis ntshav hauv cov piam thaj thiab glycosylated hemoglobin. Cov khoom lag luam tuaj yeem siv ib leeg los yog ua ke nrog lwm cov kua qab zib.

Kev siv cov tshuaj pab ua kom cov lipid metabolism zoo li qub, ua rau muaj qhov txo qis ntawm TG ntau ntau thiab nce HDL yam tsis cuam tshuam rau tag nrho cov roj (cholesterol) thiab LDL.

Kev taw qhia thiab contraindications

Pioglitazone raug pom zoo ua txoj hauv kev los tswj hom ntshav qab zib 2. Nws tuaj yeem siv los ua ib qho yeeb tshuaj, zoo li xws li nws tau feem ntau kho rau cov neeg mob ntshav qab zib uas rog dhau los lossis rau leej twg Metformin yog contraindicated.

Ntau yam ntxiv, cov tshuaj yog siv nyob rau hauv txoj kev kho nyob rau hauv cov nram no:

• ob chav sib xyaw nrog cov tshuaj metformin lossis sulfonylurea,
• triple ua ke nrog ob pawg ntawm cov tshuaj

Raws li contraindications yog:

• ntau rhiab rau ib qho tshuaj ntawm cov tshuaj,
• keeb kwm ntawm cov hlab plawv pathologies,
• mob siab ua rau daim siab,
• ntshav qab zib hom 1
• mob ketoacidosis,
• muaj mob cancer
• lub xub ntiag ntawm macroscopic hematuria ntawm keeb kwm tsis paub tseeb.

Hauv cov rooj plaub no, cov tshuaj hloov nrog analogues muaj kev sib txawv thiab kev ua haujlwm ntawm kev ua.

Cov Neeg Mob Tshwj Xeeb thiab Cov Lus Qhia

Rau cov neeg laus, tsis muaj cov tshuaj tshwj xeeb yuav tsum tau ua. Nws kuj pib nrog qhov tsawg kawg nkaus, nce zuj zus.

Thaum cev xeeb tub, cov tshuaj tsis raug tso cai rau siv, nws cov nyhuv ntawm tus me nyuam hauv plab tsis nkag siab, yog li nws nyuaj rau twv seb qhov yuav tshwm sim. Thaum lub sijhawm pub mis, yog tias tus poj niam xav siv cov tshuaj no, nws yuav tsum tsis kam pub mis rau menyuam noj.

Cov neeg mob uas muaj cov kab mob ntawm lub plawv thiab cov hlab ntshav siv cov koob tshuaj tsawg kawg nkaus, thaum nws yog qhov yuav tsum tau saib xyuas kev mob ntawm cov teeb meem kabmob thaum lub sijhawm saib xyuas Pioglitazone.

Noj Pioglitazone tuaj yeem ua rau muaj kev pheej hmoo ntawm kev mob kheesxaws ntawm zais zis 0,06 feem pua, uas tus kws kho mob yuav tsum ceeb toom rau tus neeg mob thiab qhia txo lwm yam kev pheej hmoo.

Rau cov neeg mob uas muaj lub siab tsis ua haujlwm, cov tshuaj yog contraindicated, thiab nrog mob hnyav, siv nrog ceev faj yog ua tau. Hauv qhov no, nws yog ib qho tsim nyog los tswj cov theem ntawm daim siab enzymes, yog tias lawv tshaj qhov kev tswj hwm peb zaug, tshuaj yuav raug muab tso tseg.

Video hais txog kev cuam tshuam ntawm cov tshuaj mob ntshav qab zib rau hauv lub cev:

Npaj cov haujlwm zoo sib xws

Pioglitazone cov lus qhia tau sib piv rau tom khw muaj ntau yam tshuaj yeeb dej caw.

Cov cuab yeej muaj cov sib xws muaj xws li:

• Indian tshuaj Pioglar,
• Lavxias analogues ntawm Diaglitazone, Astrozone, Diab-Norm,
• Irish ntsiav tshuaj Actos,
• Tus yawg Croatian tshuaj Amalvia,
• Pioglite
• Piouno thiab lwm tus.

Tag nrho cov tshuaj no yog koom nrog cov pab pawg ntawm glitazone npaj, uas kuj suav nrog troglitazone thiab rosiglitazone, uas muaj cov txheej txheem zoo sib xws, tab sis txawv hauv cov qauv tshuaj, yog li lawv tuaj yeem siv thaum pioglitazone raug tso tseg los ntawm lub cev. Lawv kuj muaj lawv tus kheej zoo thiab tsis zoo, uas tuaj yeem nrhiav tau hauv cov lus qhia rau cov tshuaj.

Tsis tas li, cov analogues muaj qhov sib txawv uas twb muaj lawm tuaj yeem siv ua ib qho analogues: Glucofage, Siofor, Bagomet, NovoFormin.

Nws yog tsim nyog sau cia tias kev tshuaj xyuas ntawm cov neeg mob uas siv Pioglitazone thiab nws cov generics txawv me ntsis. Yog li, hauv kev sib piv rau cov tshuaj nws tus kheej, cov neeg mob teb feem ntau zoo, tau txais qhov tsawg kawg ntawm kev phiv.

Kev txais ntawm cov tshuaj analogues feem ntau yog nrog cov kev coj tsis zoo, xws li nce phaus, edema, qog hemoglobin qib.

Raws li kev xyaum qhia, cov tshuaj tiag tiag ua rau txo qis qis cov piam thaj thiab tuaj yeem siv tau rau hauv kev kho mob ntshav qab zib hom 2. Txawm li cas los xij, nws yog ib qho tseem ceeb kom xaiv txoj cai tshuaj thiab ntau npaum li cas.

Tus nqi tiag tiag

Txij li cov cuab yeej tuaj yeem tsim nyob hauv ntau lub npe, nyob ntawm tus tsim khoom lag luam, nws tus nqi sib txawv. Yuav Pioglitazone hauv cov chaw muag tshuaj nyob hauv nws daim ntawv ntshiab yog qhov muaj teeb meem, nws tau nqis tes ua cov tshuaj nrog lwm lub npe.Nws pom nyob rau hauv lub npe Pioglitazone Khoom Siv, tus nqi uas nyob rau hauv qhov ntau npaum ntawm 45 mg yog los ntawm 2 txhiab rubles.

Lub samoglar yuav raug nqi 600 thiab ob peb rubles rau 30 ntsiav tshuaj nrog tshuaj ntawm 15 mg thiab me ntsis kim dua li ntau txhiab rau ib tus nqi nrog cov tshuaj ntawm 30 mg.

Tus nqi ntawm Aktos, nyob rau hauv cov lus qhia ntawm uas tib cov tshuaj nquag raug tshuaj, yog feem ntawm 800 thiab 3000 rubles.

Amalvia yuav raug nqi 900 rubles rau ib qhov tshuaj ntawm 30 mg, thiab Diaglitazone - los ntawm 300 rubles rau qhov ntau npaum ntawm 15 mg.

Kev nce qib tshuaj niaj hnub ua rau nws ua tiav kom ua tiav cov txiaj ntsig zoo hauv kev saib xyuas thiab kho cov ntshav qab zib kom qis. Kev siv cov tshuaj niaj hnub tuaj yeem ua tiav qhov no sai thiab muaj txiaj ntsig, txawm tias lawv tsis yog tsis muaj qhov tsis zoo, uas koj yuav tsum paub txog ua ntej koj pib noj cov tshuaj.