Metformin: dab tsi yog tau sau tseg, cov lus qhia, cov kev mob tshwm sim

Mob ntshav qab zib mellitus tau muab faib ua ob hom. Ntshav Qab Zib Hom 1 hu ua insulin-vam khom. Nrog hom mob no, kev sib txuas ntawm cov enzyme tshwj xeeb hauv cov txiav ua kab mob, insulin, uas zom cov piam thaj, yog qhov tsis taus. Ntshav qab zib Hom 2 hu ua non-insulin dependant. Nrog rau cov ntshav qab zib hom no, kev ua haujlwm hauv lub cev ua rau lub siab tsis muaj qhov tsis zoo, txawm li cas los xij, muaj qhov txo qis ntawm cov tshuaj insulin nyob rau hauv cov ntaub so ntswg feem ntau ntawm lub cev, thiab cov piam thaj hauv cov nqaij hauv lub siab tseem nce ntxiv.

Cov neeg feem ntau mob tus mob ntshav qab zib hom 2 nyob rau lub hnub nyoog laus, tab sis tsis ntev los no cov ntshav qab zib tau dhau los pom tias "yau dua". Cov laj thawj rau qhov no yog kev ua neej nyob sedentary, kev nyuaj siab, ntxiv rau cov zaub mov ceev thiab kev noj haus tsis zoo. Lub caij no, ntshav qab zib yog ib qho txaus ntshai heev, uas qhov tsis muaj cov kev qhia sab nraud loj heev ua rau muaj kev pheej hmoo mob ntshav siab thaum ntxov thiab mob hlab ntsha tawg, ntshav thiab ntshav vau. Yog li, cov kws tshawb nrhiav tau nrhiav ntev ntev rau cov tshuaj uas yuav pab txo qis cov ntshav qab zib thiab tib lub sij hawm yuav tsis ua mob rau lub cev.

Qhia txog ntawm cov tshuaj

Los ntawm cov txheej txheem tshuaj lom neeg, metformin hais txog biguanides, derivatives ntawm guanidine. Hauv kev coj ua, guanidine pom nyob hauv qee cov nroj tsuag, piv txwv li, nyob rau hauv kev siv tshuaj tua tshis, uas tau siv los kho mob ntshav qab zib txij thaum Hnub nyoog Nruab Nrab. Txawm li cas los xij, cov tshuaj ntshiab guanidine muaj kuab lom rau lub siab.

Metformin tau muab tso ua ke raws li guanidine rov qab rau hauv 20s ntawm lub xyoo pua xeem. Txawm tias tom qab ntawd, nws tau paub txog nws cov khoom hauv hypoglycemic, tab sis lub sijhawm ntawd, vim yog zam rau cov tshuaj insulin, cov tshuaj tau hnov qab rau qee lub sijhawm. Tsuas yog txij li xyoo 1950, thaum nws pom tseeb tias kev kho mob insulin rau tus mob ntshav qab zib hom 2 muaj ntau yam tsis zoo, cov tshuaj pib siv los ua tus neeg sawv cev tiv thaiv kab mob thiab tom qab lub sijhawm luv luv tau txais kev lees paub vim nws cov hauj lwm zoo, kev nyab xeeb thiab muaj tsawg ntawm cov kev mob tshwm sim thiab contraindications.

Niaj hnub no, metformin tau suav hais tias yog cov tshuaj tshaj plaws hauv lub ntiaj teb. Nws muaj npe hauv WHO Cov Tshuaj Tseem Ceeb. Nws tau ntseeg tau tsim tias kev siv cov tshuaj metformin tsis tu ncua tuaj yeem txo qhov kev pheej hmoo ntawm kev tuag los ntawm kab mob ntawm cov hlab plawv los ntawm ntshav qab zib. Cov kev tshawb fawb pom tau tias hauv cov neeg rog thiab hom 2 mob ntshav qab zib, kev kho mob nrog metformin yog 30% ntau dua kev kho mob nrog insulin thiab lwm yam tshuaj tiv thaiv kab mob, thiab 40% zoo dua kev kho mob nrog kev noj zaub mov noj ib leeg. Piv nrog rau lwm cov tshuaj tiv thaiv kab mob, cov tshuaj muaj tsawg phiv, nrog kev kho mob monotherapy nws xyaum tsis ua rau muaj kev mob ntshav qis, nws tsis tshua muaj kev phom sij txaus ntshai - lactic acidosis (mob ntshav nrog lactic acid).

Metformin belongs rau cov chav kawm ntawm cov tshuaj uas npaj rau kev kho mob ntshav qab zib hom 2. Tom qab noj cov tshuaj Metformin, nws txo cov ntsiab lus ntawm cov piam thaj hauv cov ntshav, qib ntawm glycosylated hemoglobin thiab ua rau lub cev muaj cov ntshav siab dua. Cov tshuaj tsis muaj cov khoom carcinogenic, tsis cuam tshuam rau kev muaj menyuam.

Tus txheej txheem ntawm kev kho mob ntawm metformin yog ntau yam. Ua ntej tshaj plaws, nws txo qis tsim kom muaj cov piam thaj hauv daim siab ua haujlwm. Hauv hom 2 Ntshav Qab Zib, ntau lawm cov piam thaj hauv lub siab yog ntau zaus dua li ib txwm. Metformin txo qhov ntsuas no los ntawm ib feem peb. Qhov kev ua no tau piav qhia los ntawm kev ua haujlwm los ntawm metformin ntawm qee yam ua rau daim siab, uas ua lub luag haujlwm tseem ceeb hauv cov metabolism hauv cov piam thaj thiab cov rog.

Txawm li cas los xij, qhov kev coj ua uas metformin txo cov piam thaj hauv cov ntshav tsis yog txwv rau txwv kev tsim cov piam thaj hauv lub siab. Metformin tseem muaj cov kev coj tshwm sim hauv lub cev:

txhim kho cov txheej txheem metabolic,
txo qhov nqus ntawm cov piam thaj los ntawm cov hnyuv,
txhim kho kev siv cov kua nplaum nyob rau hauv cov ntaub so ntswg peripheral,
nce cov nqaij mos rhiab rau insulin,
muaj cov nyhuv fibrinolytic.

Thaum tsis muaj cov tshuaj insulin nyob rau hauv cov ntshav, cov tshuaj tsis qhia nws qhov kev ua haujlwm hypoglycemic. Tsis zoo li ntau lwm cov tshuaj tiv thaiv kab mob, metformin tsis ua rau muaj kev phom sij txaus ntshai - lactic acidosis. Tsis tas li ntawd, nws tsis cuam tshuam rau kev tsim cov tshuaj insulin los ntawm cov hlwb ntawm tus txiav. Tsis tas li, cov tshuaj muaj peev xwm txo qis cov roj "tsis zoo" - ntshav qab zib tsawg lipoproteins thiab triglycerides (tsis txo cov roj "zoo" - lipoproteins ntau), txo cov roj ua kom muaj roj ntau ntau thiab ua kom cov roj dawb. Qhov tseem ceeb, cov metformin qib muaj peev xwm ntawm cov tshuaj insulin los txhawb kev tsim cov rog nqaij, yog li cov tshuaj muaj peev xwm txo qis lossis txhim kho lub cev qhov hnyav. Cov cuab yeej kawg ntawm metformin yog vim li cas cov tshuaj no feem ntau siv los ntawm cov uas xav kom poob phaus.

Nws kuj tseem yuav tsum tau sau tseg txog qhov muaj txiaj ntsig zoo uas cov tshuaj muaj rau lub plawv hlab plawv. Metformin ntxiv dag zog rau cov leeg ntawm cov hlab ntshav cov hlab ntshav, tiv thaiv kev txhim kho mob ntshav qab zib.

Cov Tshuaj Pharmacokinetics

Hauv cov ntsiav tshuaj, metformin yog nthuav tawm ua hydrochloride. Nws yog cov tsis muaj kob tsis muaj hluav taws xob zom cov hmoov, zoo heev soluble hauv dej.

Metformin yog hom tshuaj uas siv tshuaj qeeb. Feem ntau, qhov tshwm sim zoo ntawm kev noj nws yuav pib tshwm tom qab 1-2 hnub. Lub sijhawm no, muaj kev sib luag ntawm cov tshuaj hauv cov ntshav, nce mus txog 1 μg / ml. Hauv qhov no, qhov siab tshaj plaws ntawm cov tshuaj hauv cov ntshav tuaj yeem pom nws twb muaj 2.5 teev tom qab kev coj noj coj ua. Cov tshuaj tsis muaj zog khi rau cov qe ntshav. Ib nrab-lub neej yog 9-12 teev .Nws yog tsuas yog hloov los ntawm lub raum tsis hloov.

Cov neeg uas lub raum tsis ua hauj lwm zoo yuav muaj kev txuam nrog cov tshuaj hauv lub cev.

Qhov tseem ceeb qhia rau kev siv tshuaj Metformin yog hom ntshav qab zib 2. Ntxiv mus, tus kab mob no yuav tsum tsis txhob muaj teeb meem los ntawm ketoacidosis. Nws yog qhov zoo tshaj plaws los mus muab tshuaj rau cov neeg mob uas tsis tau txais kev pab los ntawm cov zaub mov tsis zoo, thiab rau cov neeg mob rog. Hauv qee kis, cov tshuaj muaj peev xwm siv nrog kev siv tshuaj insulin. Tsis tas li, cov tshuaj muaj peev xwm qee zaum sau tseg rau mob ntshav qab zib hauv kev xeeb tub (mob ntshav qab zib los ntawm kev muaj menyuam hauv plab).

Cov tshuaj kuj tseem tuaj yeem siv yog tias tus neeg tau hnov mob insulin tsis ua haujlwm, tab sis cov ntshav qabzib cov ntshav tsis dhau cov txiaj ntsig tseem ceeb. Tus mob no yog hu ua mob ntshav qab zib. Txawm li cas los xij, cov kws tshaj lij feem ntau nyob hauv qhov tseeb tias qhov xwm txheej no, kev tawm dag zog thiab kev noj zaub mov kom zoo dua, thiab cov tshuaj tiv thaiv kab mob nrog cov ntshav qab zib ua tsis tau zoo.

Tsis tas li ntawd, cov tshuaj tuaj yeem raug teem rau qee lwm yam kabmob, piv txwv li, nrog polycystic zes qe menyuam, tsis yog cawv cawv daim siab pathologies, kev ua tiav thaum ntxov. Cov kab mob no tau sib koom tes los ntawm qhov tseeb tias nrog lawv muaj insensitivity ntawm cov ntaub so ntswg rau insulin. Txawm li cas los xij, qhov ua tau zoo ntawm metformin hauv cov kab mob no tseem tsis tau muaj pov thawj nyob rau hauv cov ntshav qab zib ib yam. Qee zaum cov tshuaj kuj tseem siv rau qhov poob phaus, txawm hais tias cov tshuaj tshwj xeeb hais txog kev siv tshuaj metformin nrog cov neeg tsis ntseeg, tshwj xeeb tshaj yog tias nws tsis yog hais txog cov neeg muaj kab mob nyhav dhau los.

Daim ntawv tso tawm

Cov tshuaj muaj rau cov tshuaj uas muaj tshuaj ntau npaum li 500 thiab 1000 mg. Kuj tseem muaj cov ntsiav tshuaj ua haujlwm ntev nrog cov tshuaj 850 mg, txheej nrog cov tshuaj pleev xim tshwj xeeb.

Cov yam ntxwv tseem ceeb ntawm metformin uas muaj cov tib cov tshuaj yeeb yam muaj xws li cov neeg sawv cev ntawm Fabkis Glucofage. Cov tshuaj no yog suav tias yog thawj, thiab lwm yam tshuaj nrog metformin, tsim los ntawm ntau lub tuam txhab tshuaj thoob ntiaj teb - generics. Cov tshuaj no tau muab faib hauv lub tsev muag tshuaj yam tsis muaj daim ntawv yuav tshuaj.

Cov Yuav Tsum Muaj

Cov tshuaj muaj ib tug xov tooj ntawm contraindications:

cov qauv mob hnyav hauv lub plawv, ua pa thiab lub raum tsis ua haujlwm,
lub siab ua tsis taus haujlwm,
mob myocardial infarction,
cov kev huam yuaj ntawm cerebrovascular,
mob ketoacidosis,
mob ntshav qab zib coma thiab precoma,
lactic acidosis (nrog rau keeb kwm ntawm)
kab mob thiab kev mob uas muaj kev pheej hmoo ntawm lub raum ua tsis zoo,
lub cev qhuav dej
mob hnyav (feem ntau bronchopulmonary thiab lub raum),
hypoxia
poob siab
sepsis
kev phais hnyav ua haujlwm (hauv qhov no, kev siv tshuaj insulin yog qhia),
haus cawv ntev ntev los yog cawv dej cawv (muaj kev pheej hmoo ntawm cov mob lactic acidosis),
kev kuaj mob nrog kev qhia txog ntawm iodine-muaj tshuaj (ob hnub ua ntej txheej txheem thiab ob hnub tom qab),
hypocaloric noj tshuaj (tsawg dua 1000 Kcal tauj ib hnub),
theem siab ntawm creatinine hauv cov ntshav (135 μmol / l hauv cov txiv neej thiab 115 μmol / l hauv cov poj niam),
Ntshav qab zib mob ko taw
npaws.

Nrog kev ceev faj, cov tshuaj yuav tsum yog cov kws kho mob rau cov neeg laus thiab cov neeg ua haujlwm lub cev hnyav (vim tias muaj kev pheej hmoo ntawm cov kab mob lactic acidosis).

Cov tshuaj tsis pom zoo rau cov neeg mob uas muaj hnub nyoog qis dua 18 xyoo, thaum cev xeeb tub thiab lactation, nrog rau kev mob siab ntxiv rau cov tshuaj. Muaj qee kis, nws muaj peev xwm siv cov tshuaj no thaum cev xeeb tub thiab menyuam yaus (ntau dua 10 xyoo) nyob hauv kev saib xyuas ntawm tus kws kho mob nruj.

Cov lus qhia tshwj xeeb

Yog tias kev kho mob txuas ntxiv, tom qab ntawd lub raum ua haujlwm yuav tsum tau saib xyuas. Tsawg kawg yog ob zaug hauv ib xyoos, nws yog ib qhov tsim nyog yuav tau kuaj xyuas lub ntsiab ntawm lactic acid hauv cov ntshav. Yog tias mob nqaij ntshiv, tam sim ntawd tshawb xyuas qhov concentration ntawm lactic acid.

Tsis tas li, 2-4 zaug hauv ib xyoos yuav tsum kuaj xyuas lub raum kev ua haujlwm (qib creatinine hauv cov ntshav). Qhov no muaj tseeb tshwj xeeb ntawm cov neeg laus.

Nrog rau cov tshuaj tua kab mob, cov tshuaj tsis cuam tshuam rau lub hauv nruab nrab cov hlab hlwb, yog li nws muaj peev xwm siv cov tshuaj hauv cov neeg tsav tsheb thiab ua haujlwm uas yuav tsum muaj kev kub siab.

Sab sij huam

Cov kev phiv loj thaum noj cov tshuaj metformin yog txuam nrog kev mob txoj hnyuv. Ntau zaus thaum noj tshuaj, muaj qhov tshwm sim xws li mob plab, xeev siab, ntuav, raws plab, pom muaj teeb meem. Txhawm rau zam qhov no, cov ntsiav tshuaj yuav tsum tau noj thaum lub sijhawm lossis tom qab noj mov tas. Nws tseem muaj peev xwm ua tau qhov tsos ntawm cov xim hlau hauv lub qhov ncauj, tsis muaj qhov tsis qab los noj mov, tawv nqaij ua pob.

Txhua qhov kev cuam tshuam saum toj no tsis muaj kev hem thawj. Lawv feem ntau tshwm sim thaum pib ntawm txoj kev kho thiab kis lawv tus kheej. Txhawm rau kom zam kev tsis txaus siab tshwm sim cuam tshuam nrog lub plab zom mov, antispasmodics lossis antacids tuaj yeem nqa mus.

Tsis tshua muaj, cov tshuaj tuaj yeem ua rau cov kab mob lactic acidosis, megaloblastic anemia, hypoglycemia, txo qis hauv kev tsim cov thyroid hormones thiab testosterone nyob rau hauv cov txiv neej. Kev mob ntshav qab zib feem ntau tshwm sim yog tias qee yam tshuaj tiv thaiv kev mob ntshav siab, piv txwv li, sulfonylureas, noj nrog tshuaj metformin. Nrog kev siv ntev, cov tshuaj tuaj yeem ua rau cov vitamin B12 tsis txaus.

Hypoglycemic teebmeem tsis raug cais tawm thaum noj NSAIDs, ACE inhibitors thiab MAO, beta-blockers, cyclophosphamide. Thaum noj GCS, epinephrine, sympathomimetics, diuretics, cov thyroid hormones, glucagon, estrogens, calcium antagonists, nicotinic acid, ntawm qhov tsis sib thooj, cov nyhuv ntawm cov tshuaj txo qis.

Cov tshuaj muaj tshuaj iodine tuaj yeem ua rau lub raum tsis ua haujlwm thiab ua rau muaj kev mob siab ntau ntxiv. Yog tias xav paub tias cov mob lactic acidosis, yuav tsum tau mus pw hauv tsev kho mob sai.

Cov lus qhia rau kev siv

Raws li txoj cai, thaum pib kho mob, cov tshuaj yuav tsum siv 0.5-1 g ib hnub ib zaug. Qhov tsuas tshuaj no yuav tsum tau ua raws li peb hnub. Txij li 4 mus rau 14 hnub nws yog qhov tsim nyog yuav tau noj cov tshuaj metformin 1 g peb zaug ib hnub. Yog tias cov piam thaj nyob hauv cov qib qis dua, qhov koob tshuaj yuav raug txo kom tsawg. Raws li kev saib xyuas txij nkawm, cov tshuaj metformin yuav tsum noj ntawm 1500-2000 mg rau ib hnub. Nyob rau hauv rooj plaub ntawm kev siv tshuaj ntev (850 mg), nws yog ib qho tsim nyog yuav tsum noj cov tshuaj 1 ntsiav tshuaj ib hnub ob zaug - thaum sawv ntxov thiab yav tsaus ntuj.

Qhov siab tshaj plaws yog 3 g (6 ntsiav tshuaj ntawm tshuaj, 500 mg rau ib hnub) ib hnub. Hauv cov neeg laus, ua kom lub raum tsis zoo yog qhov ua tau, yog li ntawd, qhov siab tshaj plaws txhua hnub koob yuav tsum tsis pub tshaj 1000 mg (2 ntsiav tshuaj ntawm 500 mg tshuaj ib zaug). Lawv kuj yuav tsum tsis txhob cuam tshuam kev kho mob nrog rau yeeb tshuaj, nyob rau hauv rooj plaub twg lawv yuav tsum ceeb toom rau tus kws kho mob.

Nws yog qhov zoo tshaj rau noj cov ntsiav tshuaj tam sim ntawd tom qab noj mov nrog dej ntau. Kev noj cov tshuaj ncaj qha nrog zaub mov tuaj yeem txo nws txoj kev nqus hauv cov ntshav. Qhov koob tshuaj txhua hnub yog pom zoo kom muab faib ua 2-3 koob.

Kev noj tshuaj ntau npaum li cas thaum siv ua ke nrog cov tshuaj insulin (ntawm koob tshuaj insulin tsawg dua 40 units / hnub) feem ntau yog qhov tsis xws li tsis muaj tshuaj insulin. Hauv thawj hnub ntawm kev noj cov tshuaj metformin, cov koob tshuaj insulin yuav tsum tsis raug txo kom tsawg. Tom qab, qhov koob tshuaj insulin tuaj yeem txo qis. Tus txheej txheem no yuav tsum tau ua nrog kev saib xyuas ntawm tus kws kho mob.

Noj ntau dhau

Metformin yog ib cov tshuaj uas muaj kev nyab xeeb thiab txawm tias nws cov koob tshuaj loj (yog tias tsis muaj kev cuam tshuam nrog tshuaj), raws li txoj cai, tsis ua rau muaj kev phom sij txo qis hauv cov ntshav qab zib. Txawm li cas los xij, nrog kev noj ntau dhau, muaj lwm qhov, tsis muaj tsawg dua qhov txaus ntshai - qhov nce ntawm cov tshuaj lactic acid hauv cov ntshav, uas yog hu ua lactic acidosis. Cov tsos mob ntawm tus kab mob lactic acid yog qhov mob ntawm lub plab thiab cov leeg, hloov hauv lub cev kub, ua rau tsis nco qab. Qhov kev cuam tshuam no thaum tsis muaj kev kho mob tuaj yeem ua rau tuag taus vim qhov tshwm sim ntawm txoj kev rov qab. Yog li ntawd, nyob rau hauv qhov kev tshwm sim uas rau qee qhov laj thawj kev tshaj tawm ntawm cov tshuaj tau tshwm sim, tus neeg mob yuav tsum tau coj mus rau tus kws kho mob. Nyob rau hauv cov ntaub ntawv ntawm overdose, kev kho mob yam ntxwv yog ua. Kev tshem tawm cov tshuaj ntawm cov ntshav siv hemodialysis yog tseem ua haujlwm zoo.

Nqe thiab mechanism ntawm kev txiav txim ntawm cov tshuaj

Metformin yog ib qhov ncauj tshuaj hypoglycemic los ntawm pab pawg biguanide. Tus nqi tshuaj yog dab tsi? Hauv khw muag tshuaj, tus nqi nruab nrab ntawm Metformin yog 120-200 rubles. Ib pob muaj 30 ntsiav tshuaj.

Cov tshuaj tiv thaiv tseem ceeb ntawm cov tshuaj yog metformin hydrochloride. Kuj tseem muaj cov khoom xyaw pabcuam, xws li E171, propylene glycol, talc, hypromellose, silicon dioxide, magnesium stearate, pob kws nplej, povidone.

Yog li dab tsi yog cov nyhuv pharmacological ntawm metformin? Yog tias koj ntseeg tias cov lus qhia rau kev siv tshuaj, tom qab ntawd nws cov khoom siv coj los ua yog ua hauv qab no:

Tshem tawm cov tshuaj insulin tsis kam. Qhov no yog qhov tseem ceeb heev, vim tias ntau tus neeg mob ntshav qab zib muaj peev xwm tiv taus qhov cuam tshuam ntawm insulin. Qhov no yog fraught nrog txoj kev loj hlob ntawm hyperglycemic coma thiab lwm yam loj pathologies.
Pab ua kom qeeb kev nqus ntawm cov piam thaj ntawm txoj hnyuv. Vim tias qhov no, tus neeg mob tsis muaj lub ntsej muag zoo hauv cov ntshav qab zib. Kev txiav txim siab kom raug qhov tseeb ntawm Metformin, qib piam thaj yuav ruaj khov. Tab sis muaj flip sab rau cov kis. Metformin hydrochloride xyaw nrog kev siv tshuaj insulin tuaj yeem ua rau kev txhim kho hypoglycemic coma. Yog vim li ntawd nrog kev siv cov tshuaj ib txhij no thiab kev siv tshuaj insulin, kev hloov kho ntau dua yuav tsim nyog.
Nws inhibits gluconeogenesis nyob rau hauv daim siab. Txoj kev no muaj nyob hauv qhov hloov cov piam thaj, uas lub cev tau txais los ntawm lwm txoj hauv kev siv hluav taws xob.Vim tias ncua sij hawm tsim cov piam thaj los ntawm lactic acid, qab zib ntxiv thiab lwm yam kev mob ntshav qab zib tuaj yeem zam dhau.
Txo qhov qab los noj mov. Ntau zaus, yam ntshav qab zib hom 2 yog qhov txiaj ntsig ntawm kev rog dhau. Tias yog vim li cas, tawm tsam keeb kwm ntawm kev noj zaub mov noj, tus neeg mob raug nquahu kom siv cov tshuaj tiv thaiv kab mob. Metformin muaj qhov tsis xws leej twg, vim nws pab tsis tsuas tswj cov ntshav qab zib kom tsis txhob muaj kab mob ntshav qab zib, tab sis kuj tseem nce cov txiaj ntsig ntawm kev noj zaub mov noj los ntawm 20-50%.
Kuaj ntshav muaj roj. Thaum siv Metformin, qhov txo qis hauv qib ntawm triglycerides thiab qis lipoproteins tsawg tau pom.

Metformin hydrochloride kuj inhibits cov txheej txheem ntawm peroxidation cov rog. Nov yog hom kev tiv thaiv mob qog noj ntshav.

Cov lus qhia thiab cov lus qhia rau siv Metformin

Lub sijhawm twg yog qhov siv ntawm Metformin tsim nyog? Yog tias koj ntseeg tias cov lus qhia rau kev siv, cov tshuaj yuav siv tau rau hauv kev kho mob ntshav qab zib hom 2.

Ntxiv mus, cov ntsiav tshuaj tuaj yeem raug siv los kho kev kho mob lossis tshuaj ua ke nrog lwm tus neeg mob hypoglycemic. Lwm qhov kev kho mob tau siv dav hauv qee qhov kev pabcuam kev noj zaub mov pab tsis muaj ntshav qab zib.

Nws yog tsim nyog teev cia tias qhov ntsuas ntawm kev siv Metformin tsis yog tas rau qhov no. Cov tshuaj yog siv dav hauv kev kho mob ntshav qab zib thiab cleropolicystosis ntawm zes qe menyuam. Ntawm cov kev ntsuas rau kev siv, metabolic syndrome thiab rog rog kuj yog qhov txawv txav, nrog kev txhim kho ntawm insulin tsis kam.

Yuav xaiv cov tshuaj Metformin ntau npaum li cas? Cov koob tshuaj txhua hnub ntawm Metformin tuaj yeem xaiv tshwj tsis yog qee tus. Hauv qhov no, tus kws kho mob yuav tsum paub txog cov ntaub ntawv keeb kwm, vim tias tus neeg sawv cev hypoglycemic no muaj ntau yam kev tiv thaiv kev siv.

Kuv xav nco ntsoov tias Metformin muaj nyob hauv ntau koob. Nws tuaj yeem yog 1000, 850, 500, 750 mg. Ntxiv mus, muaj kev sib txuam tshuaj rau ntshav qab zib, uas muaj kwv yees li 400 mg ntawm metformin hydrochloride.

Yog li, yog dab tsi ntau npaum noj tau? Thawj koob tshuaj ntawm Metformin yog 500 mg, thiab qhov ntau zaus ntawm kev tswj hwm yog 2-3 zaug hauv ib hnub. Koj yuav tsum tau noj tshuaj tam sim ntawd tom qab noj mov.

Tom qab ob peb lub lim piam ntawm kev kho mob, qhov tshuaj yuav tuaj yeem hloov kho. Txhua yam yuav yog nyob ntawm cov ntshav qab zib. Glycemia pom zoo kom ntsuas txhua hnub ntawm lub plab khoob. Rau cov laj thawj no, nws yog qhov zoo tshaj plaws los siv ntsej muag.

Metformin siv sijhawm ntev npaum li cas? Nws tsis muaj peev xwm los teb cov lus nug no. Thaum xaiv qhov ntev ntawm kev kho mob, tus yam ntxwv ntawm ib tus neeg yuav raug coj mus rau hauv tus lej, tshwj xeeb, ntshav qabzib qib, qhov hnyav thiab hnub nyoog. Txoj kev kho mob tuaj yeem siv 15 hnub, 21 hnub lossis "dhau" hauv ib hlis.

Qhov tshuaj ntau tshaj plaws ntawm Metformin yog 2000 mg rau ib hnub. Nws yuav tsum raug sau tseg tias nrog kev siv tshuaj insulin ib txhij, qhov koob tshuaj yuav tsum raug txo kom 500-850 mg ib hnub twg.

Sab Tshuaj Los Ntawm Metformin

Qhov tshwm sim tshwm sim los ntawm Metformin yog dab tsi? Muaj qhov zoo li no yog qhov tseem ceeb txaus ntshai ntawm cov kab mob hypoglycemic, tshwj xeeb hauv Metformin. Dab tsi nws muaj?

Qhov tseeb yog tias muaj yam mob ntshav qab zib hom 2, tus neeg mob yuav tsum soj ntsuam cov khoom noj tsis muaj calorie kom ntau, thiab tshwj xeeb tshaj yog cov nyiaj carbohydrates hauv nws. Yog tias tus mob ntshav qab zib siv hypoglycemic cov neeg sawv cev, thiab zaum ntawm cov zaub mov nruj, ces qhov ntxim nyiam ntawm kev txhim kho hypoglycemia yog qhov ntau heev - txo qis hauv cov ntshav qabzib.

Ntawm cov kev phiv los ntawm Metformin kuj tuaj yeem hais qhov txawv:

Ua txhaum ntawm cov hom hematopoietic. Thaum siv cov Metformin, kev muaj peev xwm ntawm thrombocytopenia, leukocytopenia, erythrocytopenia, granulocytopenia, hemolytic anemia, pancytopenia tsis tuaj yeem tswj hwm tau. Tab sis nws yuav tsum raug sau tseg tias txhua yam kev cuam tshuam no yog qhov thim rov qab, thiab lawv daws lawv tus kheej tom qab cov tshuaj tau thim tawm.
Ua tsis txaus siab nyob rau hauv daim siab. Lawv pom tias yog kev loj hlob ntawm daim siab ua haujlwm thiab mob siab. Tab sis tom qab nws tsis kam Metformin, cov teeb meem no daws tau lawv tus kheej. Qhov no muaj tseeb los ntawm kev tshuaj xyuas ntawm kws kho mob thiab cov neeg mob.
Saj tsis cuam tshuam. Qhov kev tsis zoo no tshwm sim ntau zaus. Qhov tseem ceeb ntawm cov tshuab rau kev txhim kho ntawm saj tsis hnov qab hauv qab ntawm metformin hydrochloride tsis paub meej.
Cov tawv nqaij ua pob, erythema, urticaria.
Lactic acidosis. Qhov kev tsis txaus ntseeg no txaus ntshai heev. Nws feem ntau loj hlob yog tias kev xaiv cov tshuaj tsis yog, lossis yog tias tus mob ntshav qab zib tau haus cawv thaum lub sijhawm kho.
Kev ua txhaum nyob rau hauv kev ua haujlwm ntawm txoj hnyuv. Hom mob no tshwm sim ntau zaus, raws li muaj pov thawj los ntawm kev kuaj xyuas neeg mob. Cov teeb meem hauv lub plab zom mov tau tshwm sim los ntawm kev ua kom ntuav, ntuav, lub ntsej muag hlau hauv lub qhov ncauj, thiab tsis qab los noj mov. Tab sis hauv kev ncaj ncees, nws tsim nyog sau cia tias cov kev mob no feem ntau tshwm sim hauv thawj theem ntawm txoj kev kho, thiab tom qab ntawd daws lawv tus kheej.
Txo tsawg dua kev nqus ntawm cov vitamin B12.
General tsis muaj zog.
Qog ntshav qab zib tsis tsaug zog.

Thaum cov teeb meem saum toj no tshwm sim, nws raug nquahu kom siv rau pawg pawg analogues ntawm Metformin thiab yauv mus kuaj mob.

Kev Sib Tham Yeeb Tshuaj Metformin

Metformin txo cov ntshav qabzib. Tab sis thaum sib cuam tshuam nrog qee yam tshuaj, cov tshuaj no ua kom zoo dua, lossis rov ua dua, txo nws cov nyhuv hypoglycemic.

Qhov no tuaj yeem ua rau tsis muaj kev cuam tshuam. Kuv tam sim ntawd xav nco ntsoov tias cov nyhuv hypoglycemic yog qhov muaj txiaj ntsig zoo thaum ua ke nrog Metformin nrog sulfonylurea derivatives. Hauv qhov no, yuav tsum tau txhaj tshuaj.

Cov hauv qab no tuaj yeem ua rau kom muaj txiaj ntsig hypoglycemic ntawm Metformin:

Acarbose.
Cov tshuaj nonsteroidal anti-inflammatory.
Monoamine oxidase inhibitors.
Oxytetracycline.
Angiotensin-hloov ua enzyme inhibitors.
Cyclophosphamide.
Derivatives ntawm clofibrate.
Beta blockers.

Corticosteroids, diuretics, analogues ntawm samostanin txo qis kev ua haujlwm ntawm kev kho ntshav qab zib nrog Metformin. Nws tseem tau sau cia tias cov nyhuv hypoglycemic tsawg dua nrog kev siv glucagon, thyroid hormones tib lub sijhawm, estrogens, nicotinic acid, calcium antagonists thiab isoniazids.

Nws tseem yuav tsum tau nco ntsoov hais tias cimeteredin, thaum sib tham nrog Metformin, ua rau kom muaj kev pheej hmoo ntawm kev tsim mob lactic acidosis.

Cov tshuaj twg siv tau nrog rau metformin?

Hauv kev kho mob ntshav qab zib mellitus, ib yam tshuaj xws li Januvia feem ntau tau sau tseg nyob hauv kev sib xyaw nrog Metformin. Nws tus nqi yog 1300-1500 rubles. Lub hauv paus ua haujlwm tseem ceeb ntawm cov tshuaj yog sitagliptin.

Cov tshuaj no inhibits DPP-4, thiab nce qhov kev sib txuam ntawm GLP-1 thiab HIP. Cov tshuaj hormones ntawm tsev neeg incretin yog zais cia hauv cov hnyuv rau ib hnub, tom qab ntawd lawv qib nce tom qab noj mov.

Tus incretins yog ib qho kev sib koom ua ke ntawm lub cev kev txheeb ze rau kev tswj hwm ntshav qab zib hauv tsev. Nrog kev nce hauv cov ntshav qab zib kom tsawg, cov tshuaj hormones los ntawm tsev neeg no ua rau muaj kev nce ntxiv hauv cov tshuaj insulin thiab nws txoj kev tso tawm los ntawm cov qe ntshav.

Yuav noj cov tshuaj li cas? Qhov tshuaj pib yog 100 mg 1 zaug nyob rau ib hnub. Tab sis xaiv cov koob tshuaj kom zoo tshaj plaws, ntxiv, yuav tsum yog tus kws kho mob mus koom. Kev kho raug tso cai, tshwj xeeb tshaj yog yog tias Januvia siv nrog nrog Metformin.

Cov kev txwv tsis pub siv Januvia:

Yam 1 ntshav qab zib.
Kev fab tshuaj rau cov ntawv pov thawj cov tshuaj.
Ntshav qab zib ketoacidosis.
Lub sijhawm ntawm cev xeeb tub thiab lactation.
Cov me nyuam lub hnub nyoog.
Nrog ceev faj nyob rau hauv daim siab tsis ua hauj lwm. Nrog rau kev ua kom muaj kab mob ntshav siab kev tsis haum tshuaj, kev noj tshuaj txo qis yuav tsim nyog. Qhov no yog pov thawj los ntawm cov ntaub ntawv tshawb fawb, thiab kev tshuaj xyuas cov kws paub txog endocrinologist.

Cov tshuaj puas muaj kev phiv? Yog kawg, lawv muaj ib qho chaw nyob. Tab sis Januvia feem ntau ua rau muaj teeb meem thaum qhov ntau dua rau 200 mg. Thaum tswj hwm cov koob tshuaj qis, qhov ntxim nyiam ntawm kev phiv yog qhov tsawg heev.

Raws li cov lus qhia, thaum noj tshuaj, muaj teeb meem xws li mob ntsws, mob nasopharyngitis, mob taub hau, raws plab, xeev siab, ntuav, mob pob txha.

Tsis tas li, qhov yuav ua rau muaj kev fab tshuaj tiv thaiv kev tsis haum thiab tsis tuaj yeem txo tus mob ntshav qab zib tau.

Cov tsiaj ntawv zoo tshaj ntawm Metformin

Qhov zoo tshaj plaws ntawm Metformin yog Avandia. Tus neeg sawv cev hypoglycemic no nws kim heev - 5000-5500 rubles. Ib pob muaj 28 ntsiav tshuaj.

Cov tshuaj tivthaiv kev ua haujlwm ntawm cov tshuaj yog rosiglitazone. Avandia yog siv rau hauv kev kho mob ntawm ntshav qab zib hom 2. Ntxiv mus, nws tuaj yeem siv txuas nrog Metformin, thiab tuaj yeem siv cais.

Yuav ua li cas xaiv lub sijhawm ntawm kev noj tshuaj? Nws yuav tsum tau hais tam sim ntawd koj tuaj yeem noj cov tshuaj ua ntej lossis tom qab noj mov. Thawj koob tshuaj yog 4 mg ib hnub nyob rau hauv 1-2 koob tshuaj. Tom qab 6-8 lub lis piam, cov koob tshuaj tuaj yeem tau nce ntxiv ob zaug. Ib qho kev nce ntxiv yog tsim yog thaum 4 mg ib txwm li ntawm cov ntshav qab zib tsis pom.

Cov kev txwv tsis pub siv rau qhov tshuaj:

Yam 1 ntshav qab zib.
Kev tsis haum tshuaj rau cov feem ntawm cov tshuaj.
Lub sijhawm lactation.
Cov menyuam yaus lub hnub nyoog (txog 18 xyoo).
Cev xeeb tub
Mob lub plawv heev lossis lub raum tsis ua haujlwm.

Thaum siv Avandia, cov teeb meem cuam tshuam los ntawm cov nruab nrog ntawm cov pa ntawm txoj hlab ntsws lossis hlab plawv tuaj yeem tau.

Kuj tseem muaj qhov ua kom lub cev hnyav ntxiv. Cov lus qhia tseem sau tseg tias txoj kev kho mob tuaj yeem ua rau mob ntshav tsis txaus, ua haujlwm ntawm lub siab thiab mob hypercholesterolemia. Tab sis kev kuaj mob rau cov neeg mob qhia tau hais tias kev kho kom zoo yog qhov ua tau zoo. Daim vis dis aus hauv tsab xov xwm no yuav tham txog Metformin ua haujlwm li cas.

Kev ntsuas rau siv

Hom Ntshav Qab Zib II mellitus (non-insulin-dependant) nrog kev kho kev noj haus tsis muaj txiaj ntsig, tshwj xeeb yog cov neeg mob rog:

- Raws li kev kho mob monotherapy lossis kev sib txuas ua ke hauv kev sib txuas nrog lwm tus neeg lub qhov ncauj hypoglycemic los yog hauv kev txuam nrog insulin rau kev kho mob ntawm cov neeg laus.

- Raws li monotherapy lossis kev sib txuas nrog kev kho mob nrog tshuaj insulin rau kev kho mob ntawm cov menyuam yaus hnub nyoog ntau dua 10 xyoo.

Tsuas tshuaj thiab tswj hwm

Kev kho kab mob ntshav siab los yog kev kho mob sib xyaw ua ke nrog lwm tus neeg sawv cev rau qhov ncauj ntshav qog.

Cov neeg laus Feem ntau, cov tshuaj thawj zaug yog 500 mg lossis 850 mg ntawm metformin 2-3 zaug hauv ib hnub thaum lossis tom qab noj mov. Tom qab 10-15 hnub ntawm kev kho mob, lub koob tshuaj yuav tsum tau kho raws li cov txiaj ntsig ntawm kev ntsuas ntawm ntshav dej qabzib qib. Kev nce ntxiv hauv koob yuav pab txo cov kev phiv los ntawm cov hnyuv.

Qhov kev xav tau ntau tshaj plaws yog 3000 mg rau ib hnub, muab faib ua 3 koob.

Hauv kev kho cov tshuaj siab, Metformin yog siv hauv qhov ntau npaum ntawm 1000 mg.

Yog tias muaj kev hloov pauv rau kev kho nrog Metformin, nws yog ib qho tsim nyog yuav tsum tsis txhob noj lwm tus neeg sawv cev tiv thaiv kab mob.

Kev kho kev sib xyaw ua ke nrog kev siv tshuaj insulin.

Txhawm rau kom ua tau zoo tswj cov ntshav qabzib kom ntau, metformin thiab insulin tuaj yeem siv los ua kev kho ua ke. Feem ntau, thawj zaug koob tshuaj yog 500 mg lossis 850 mg ntawm metformin 2-3 zaug hauv ib hnub, thaum koob tshuaj insulin raug xaiv raws li cov txiaj ntsig ntsuas ntshav ntshav.

Kev kho mob nkees lossis kev kho mob ua ke nrog kev siv tshuaj insulin.

Cov menyuam. Metformin yog tshuaj rau cov menyuam muaj hnub nyoog tshaj 10 xyoo. Feem ntau, cov tshuaj thawj zaug yog 500 mg lossis 850 mg ntawm metformin 1 zaug hauv ib hnub hauv lub sijhawm lossis tom qab noj mov. Tom qab 10-15 hnub ntawm kev kho mob, lub koob tshuaj yuav tsum tau kho raws li cov txiaj ntsig ntawm kev ntsuas ntawm ntshav dej qabzib qib.

Kev nce ntxiv hauv koob yuav pab txo cov kev phiv los ntawm cov hnyuv.

Qhov siab tshaj plaws kev pom zoo yog 2000 mg rau ib hnub, muab faib ua 2-3 koob.

Hauv cov neeg laus cov neeg mob lub raum tsis ua haujlwm, yog li ntawd, cov koob tshuaj metformin yuav tsum raug xaiv raws li kev ntsuas ntawm lub raum kev ua haujlwm, uas yuav tsum tau ua tsis tu ncua.

Kev cuam tshuam nrog lwm yam tshuaj

Tsis sib haum nrog ethanol, voj diuretics, iodine-muaj radiopaque tus neeg sawv cev, vim tias nws nce kev pheej hmoo ntawm cov kab mob lactic acidosis, tshwj xeeb tshaj yog nyob rau hauv kis ntawm kev tshaib plab lossis noj zaub mov tsis muaj calorie ntau. Lub sijhawm siv cov tshuaj metformin, haus dej cawv thiab muaj cawv muaj cawv yuav tsum zam. Thaum ua kev ntsuam xyuas xoo hluav taws xob, cov tshuaj yuav tsum tso tseg tsis pub dhau 48 teev thiab tsis rov ua dua tshiab tsis pub dhau 2 hnub tom qab kev kawm.

Siv nrog ceev faj nyob rau hauv ua ke nrog indirect anticoagulants thiab cimetidine. Sulfonylurea derivatives, insulin, acarbose, monoamine oxidase inhibitors (MAOs), oxytetracycline, angiotensin hloov enzyme (ACE) inhibitors, clofibrate, cyclophosphamide thiab salicylates txhim kho cov nyhuv ntawm metformin.

Nrog rau kev siv ua ke nrog glucocorticosteroids, sib xyaw ua ke ntawm qhov ncauj, epinephrine, glucagon, cov thyroid hormones, derivatives ntawm phenothiazine, nicotinic acid, thiazide diuretics, txo qis hauv cov nyhuv ntawm metformin yog ua tau.

Nifedipine nce ntxiv kev nqus, C_maxslows hauv excretion.

Cationic tshuaj (amiloride, digoxin, morphine, procainamide, quinidine, quinine, ranitidine, triamteren, thiab vancomycin) sib tw rau tubular thauj cov tshuab thiab, nrog kev kho mob ntev, tuaj yeem nce C_max los ntawm 60%.

Kev tiv thaiv kev nyab xeeb

Cov kab mob lactic acidosis yog qhov tsis tshua pom tab sis muaj mob hnyav ntawm metabolic uas tuaj yeem tshwm sim los ntawm kev ua kom tiav ntawm metformin hydrochloride. Cov neeg muaj mob uas hais tau lactic acidosis hauv cov neeg mob ntshav qab zib mellitus thiab mob raum tsis ua haujlwm zoo. Cov teeb meem phom sij rau cov kab mob lactic acidosis: ua haujlwm tsis zoo rau cov ntshav qab zib mellitus, ketosis, kev yoo mov ntev, kev haus cawv ntau dhau, kab mob siab, lossis lwm yam kev mob cuam tshuam nrog hypoxia.

Lactic acidosis yog tus cwj pwm mob nqaij ntshiv, mob caj dab acidic ua tsis taus pa, mob plab thiab mob hypothermia, kev txhim kho ntxiv ntawm kev tsis nco qab yog ua tau. Kuaj cov cim ntawm kev txhim kho ntawm cov kab mob lactic acidosis yog kev nce ntxiv ntawm cov ntshav lactate ntau dua 5 mmol / l, txo ntshav pH tawm tsam cuam tshuam nrog electrolyte cuam tshuam, thiab nce ntxiv ntawm lactate / pyruvate piv. Yog tias xav tau cov kab mob lactic acidosis, nws tsim nyog tsum tsis txhob siv cov tshuaj thiab ua rau pw hauv tsev kho mob sai.

Tsis hlauvCov. Txij li cov metformin raug ntuav tawm los ntawm lub raum, ua ntej thiab thaum kho nrog Metformin, cov ntshav creatinine qib yuav tsum tau kuaj xyuas, tshwj xeeb tshaj yog nyob rau cov neeg mob uas tsis muaj peev xwm ua lub raum thiab hauv cov neeg laus. Kev ceev faj yuav tsum tau siv rau thaum muaj kev rov qab ua haujlwm tsis zoo, piv txwv li, thaum pib kho nrog antihypertensive tshuaj, diuretics, thiab thaum pib ntawm NSAID txoj kev kho.

Cov tshuaj tiv thaiv radiopaque muaj IodineCov. Thaum ua qhov kev tshawb fawb radiological siv cov tshuaj radiopaque, nws yog ib qho tsim nyog yuav tsum tsis txhob siv cov tshuaj metformin 48 teev ua ntej kev tshawb fawb thiab tsis rov pib dua 48 teev tom qab kev kuaj mob radiological thiab ntsuas kev ua haujlwm lub raum.

Kev phais mobCov. Nws yog ib qho tsim nyog yuav tsum tso tseg kev siv cov tshuaj metformin 48 teev ua ntej txoj kev npaj phais mob, thiab tsis rov pib dua 48 teev tom qab kev ua haujlwm thiab kev ntsuas ntawm lub raum kev ua haujlwm.

Cov menyuam. Raws li cov txiaj ntsig ntawm kev tshawb fawb soj ntsuam, cov txiaj ntsig ntawm metformin ntawm kev loj hlob thiab kev muaj nkauj hauv cov menyuam yaus tsis qhia tawm. Txawm li cas los xij, tsis muaj cov ntaub ntawv qhia txog cov txiaj ntsig ntawm metformin ntawm kev loj hlob thiab kev muaj nkauj nrog kev siv lub sijhawm ntev ntawm metformin, yog li ntawd, nws yuav tsum siv cov tshuaj nrog kev saib xyuas tshwj xeeb hauv cov menyuam thaum pub dawb, tshwj xeeb tshaj yog thaum hnub nyoog 10 txog 12 xyoos.

Cov neeg mob yuav tsum ua raws kev noj haus thiab soj ntsuam kev kuaj ntshav kuaj ntshav. Nrog rau kev siv ua ke ntawm metformin nrog insulin lossis sulfonylurea derivatives, ib qho kev nce ntawm hypoglycemic effect yog tau.

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

Thaum cov tshuaj sib xyaw ua ke nrog lwm cov tshuaj hypoglycemic (sulfonylurea derivatives, insulin), kev mob hypoglycemic yuav pib txhim kho qhov uas tsav tsheb thiab lwm yam kev muaj feem phom sij uas xav tau kev nce siab thiab ceev ntawm psychomotor cov kev cuam tshuam tsis zoo.

Siv thaum cev xeeb tub thiab lactation

Cov tshuaj yog contraindicated rau kev siv thaum cev xeeb tub thiab thaum pub mis.

Thaum npaj lossis pib cev xeeb tub, metformin yuav tsum tsis txhob ua haujlwm ntxiv thiab kho insulin raws li kws kho mob hais. Tus neeg mob yuav tsum tau ceeb toom txog qhov yuav tsum tau qhia rau tus kws kho mob thaum cev xeeb tub. Leej niam thiab tus menyuam yuav tsum saib xyuas.

Kuj tsis paub meej tias metformin ua rau kua mis tawm los. Yog tias tsim nyog, siv cov tshuaj thaum lactation yuav tsum tsis txhob pub mis niam.

Cov txheej txheem ntawm kev ua ntawm metformin

Metformin ua kom muaj kev tso tawm ntawm hepatic enzyme AMP-activated protein kinase (AMPK), uas yog lub luag haujlwm rau cov metabolism hauv qabzib thiab rog. Xav kom ua AMPK rau inhibitory nyhuv ntawm metformin ntawm gluconeogenesis nyob rau hauv daim siab.

Ntxiv nrog rau qhov kev txwv ntawm cov txheej txheem ntawm gluconeogenesis hauv lub siab metformin ntau ntxiv cov nqaij ua rau lub cev tsis txaus siab rau insulin, nce peripheral qabzib kev txhim kho, ua rau muaj roj fatty acids oxidation, thaum txo cov piam thaj nqus ntawm cov hnyuv.

Txhawm rau nws yooj yim dua, tom qab ntawd tom qab cov zaub mov nrog cov ntsiab lus ntawm carbohydrates nkag mus rau hauv lub cev, pancreatic insulin pib muab zais kom tswj cov ntshav qab zib kom tsis pub dhau. Cov khoom noj carbohydrates hauv cov zaub mov tau zom rau hauv cov hnyuv thiab tig mus rau hauv qabzib, uas nkag mus rau cov hlab ntshav. Nrog kev pab ntawm cov tshuaj insulin, nws tau xa mus rau hauv lub hlwb thiab ua rau muaj zog.

Lub siab thiab cov leeg muaj peev xwm khaws cov piam thaj ntau dhau, thiab kuj yooj yim tso nws mus rau hauv cov hlab ntshav yog tias tsim nyog (piv txwv, nrog lub qog ntshav qab zib, nrog kev tawm dag zog ntawm lub cev). Tsis tas li ntawd, lub siab tuaj yeem khaws cov piam thaj los ntawm lwm cov as-ham, piv txwv li, los ntawm cov rog thiab cov amino acids (tuam tsev cov protein).

Qhov ua tau zoo tshaj plaws ntawm metformin yog qhov cuam tshuam (txwv) ntawm kev tsim cov piam thaj los ntawm lub siab, uas yog ib txwm muaj rau ntshav qab zib hom 2.

Lwm cov nyhuv ntawm cov tshuaj yog qhia hauv kev ncua sij hawm nqus cov piam thaj hauv cov hnyuv, uas tso cai rau koj kom muaj cov ntshav qabzib hauv cov ntshav qab zib tom qab noj mov (tom qab ntshav qab zib), ntxiv rau qhov ua rau cov neeg muaj peev xwm xav tau cov insulin (cov hlwb lub hlwb pib teb sai dua rau insulin, uas tso tawm thaum lub sijhawm ua piam thaj).

Replica ntawm Dr. R. Bernstein ntawm metformin: "Metformin ua kom tsawg muaj qee yam ntxiv zoo - nws txo cov neeg mob qog nqaij hlav cancer thiab txhawb kev noj qab nyob zoo ghrelin kev tshaib kev nqhis, yog li txo qhov nyiam ntawm kev noj qab haus huv. Txawm li cas los xij, hauv kuv kev paub, tsis yog txhua yam yeeb yaj kiab ntawm metformin ua tau zoo ib yam. Kuv ib txwm sau ntawv rau Glucophage, txawm hais tias nws yuav kim dua li nws tau siv nyiaj ntau tshaj ntawm nws cov khub "(Diabetes Soluton, 4 tsab. P. 249).

Yuav ceev npaum li cas metformin?

Tom qab kev tswj hwm ntawm qhov ncauj, cov ntsiav tshuaj metformin yog nqus rau hauv txoj hnyuv plab. Qhov kev nqis tes ua ntawm cov tshuaj nquag pib 2.5 teev tom qab kev coj thiab tom qab 9-12 teev ua tiav tawm los ntawm ob lub raum. Metformin tuaj yeem muaj ntau ntxiv hauv daim siab, raum, thiab cov leeg.

Metforminum feem ntau yog kho thaum pib kho. ob rau peb zaug txhua hnub ua ntej lossis tom qab noj mov, 500-850 mg. Tom qab kawm tiav 10-15 hnub, nws cov txiaj ntsig ntawm ntshav qab zib tau raug tshuaj xyuas thiab, yog tias tsim nyog, qhov koob tshuaj tau nce ntxiv nyob hauv kev saib xyuas ntawm kws kho mob. Metformin koob tshuaj tuaj yeem nce ntxiv txog 3000 mgCov. ib hnub, muab faib ua 3 koob tshuaj sib npaug.

Yog tias cov piam thaj hauv ntshav tsis poob mus rau qhov qub, ces cov lus nug ntawm kev teem sijhawm ntawm kev kho mob sib xyaw ua ke yog txiav txim siab. Ua ke npaj ntawm metformin muaj nyob rau hauv Lavxias thiab Ukrainian lag luam, cov no suav nrog: Pioglitazone, Vildagliptin, Sitagliptin, Saksagliptin thiab Glibenclamide. Nws tseem tuaj yeem tau sau ntawv kho mob sib xyaw nrog kev siv tshuaj insulin.

Ntev-ntev metformin thiab nws cov qauv

Txhawm rau kom tshem tawm txoj hnyuv plab thiab txhim kho lub neej kev pab ntawm cov neeg mob, Fabkis tau tsim kho ntev metformin ua yeeb yamCov. Glucophage Ntev - cov tshuaj nrog ncua ncua kev nqus ntawm cov tshuaj nquag, uas yuav tau noj tsuas yog 1 ib hnub ib zaug. Qhov txheej txheem no tiv thaiv kev txais tos ntawm cov pob zeb siab tshaj plaws hauv kev ua kom tau cov tshuaj metformin hauv cov ntshav, muaj cov txiaj ntsig zoo rau kev ua siab ntev ntawm metformin thiab txo qhov tshwm sim ntawm cov teeb meem zom zaub mov.

Qhov nqus ntawm metformin ntev ntev tshwm sim nyob rau hauv cov hnyuv sab saud. Cov kws tshawb fawb tau tsim cov txheej txheem gel diffusion system GelShield ("txheej hauv qhov ncauj"), uas pab metformin maj mam thiab kom tus tawm ntawm cov ntsiav tshuaj daim ntawv.

Metformin cov lus piv txwv

Tus thawj cov tshuaj yog Fabkis Ntsia hauv qabCov. Muaj ntau ntau yam siv tshuaj tiv thaiv (ua kom sib luag) ntawm metformin. Cov no suav nrog cov tshuaj Lavxias Gliformin, Novoformin, Formmetin thiab Metformin Richter, German Metfogamma thiab Siofor, Croatian Formin Pliva, Argentinean Bagomet, Israeli Metformin-Teva, Slovak Metformin Zentiva.

Ntev ntev metformin analogs thiab lawv cov nqi

Metformin cuam tshuam li cas rau daim siab thiab ob lub raum?

Metformin tuaj yeem muaj cov kev mob tshwm sim rau daim siab thiab lub raum, yog li ntawd, nws raug txwv tsis pub nqa mus rau cov neeg mob uas muaj cov kab mob mus ntev (nrog lub raum tsis ua haujlwm ntev, mob siab, mob ntsws, thiab lwm yam).

Metformin yuav tsum zam rau cov neeg mob qog mob ntshav liab. cov nyhuv ntawm cov tshuaj tshwm sim ncaj qha rau hauv daim siab thiab tuaj yeem ua rau muaj kev hloov pauv hauv nws lossis ua rau mob ntshav qabzib heev, thaiv qhov synthesis ntawm gluconeogenesis. Tej zaum qhov tsim los ntawm kev rog hauv lub siab.

Txawm li cas los xij, hauv qee kis, metformin nyiam cov kab mob siab, yog li daim siab mob thaum noj cov tshuaj no yuav tsum tau ua tib zoo saib xyuas.

Hauv daim siab mob siab ntev, metformin yuav tsum raug tso tseg, vim hais tias mob rau daim siab ua rau muaj mob loj ntxiv. Hauv qhov no, nws raug nquahu kom siv mus rau kev kho mob insulin, raws li cov tshuaj insulin nkag ncaj qha rau hauv cov ntshav, hla lub siab, lossis muab tshuaj kho nrog sulfonylureas.

Cov kev mob tshwm sim los ntawm metformin rau lub siab ua kom lub cev noj qab haus huv tsis tau pom tseeb.

Koj tuaj yeem nyeem ntxiv ntawm peb lub vev xaib. txog kev noj tshuaj metformin rau mob raum.

Tshuaj metformin cuam tshuam li cas rau cov poj niam cev xeeb tub uas mob ntshav qab zib gestational?

Kev muab cov tshuaj metformin rau cov poj niam cev xeeb tub tsis yog qhov tseeb sib kis; Txawm li cas los xij Cov tshuaj insulin feem ntau kho rau mob ntshav qab zib gestational. Qhov no tau piav qhia los ntawm cov lus tsis sib haum ntawm kev kawm txog qhov cuam tshuam ntawm metformin rau cov neeg mob cev xeeb tub.

Ib txoj kev tshawb nrhiav hauv Tebchaws Asmeskas tau pom tias metformin muaj kev nyab xeeb thaum cev xeeb tub. Cov poj niam muaj ntshav qab zib tsis tsaug zog uas siv tshuaj metformin tau hnyav dua thaum cev xeeb tub dua li cov neeg mob siv tshuaj insulin. Cov menyuam yaus yug los ntawm cov poj niam uas tau txais cov tshuaj metformin muaj qis dua ntawm cov rog visceral, uas ua rau lawv tsis muaj peev xwm tiv thaiv cov tshuaj insulin tsawg dua nyob rau yav tom ntej.

Hauv kev sim tsiaj, tsis muaj qhov tshwm sim zoo ntawm metformin ntawm kev txhim kho me nyuam hauv plab.

Dua li qhov no, hauv qee lub tebchaws, metformin tsis pom zoo siv los ntawm cov poj niam cev xeeb tub. Piv txwv li, hauv Tebchaws Yelemees, cov tshuaj ntawm cov tshuaj no thaum cev xeeb tub thiab cov ntshav qab zib hauv lub cev yog qhov raug txwv, thiab cov neeg mob uas xav noj nws yuav txhua yam kev pheej hmoo thiab them rau nws tus kheej. Raws li cov kws kho mob German, metformin tuaj yeem muaj kev phom sij rau tus me nyuam hauv plab thiab tsim nws cov yeeb yaj kiab tiv thaiv cov tshuaj tiv thaiv insulin.

Nrog rau kev ua mis, metformin yuav tsum tau muab pov tseg.vim nws hla mus rau hauv niam cov kua mis. Kev kho mob nrog metformin thaum pub niam mis yuav tsum tsis ua ntxiv.

Metformin cuam tshuam li cas rau cov zes qe menyuam li cas?

Metformin feem ntau siv rau kev kho mob ntshav qab zib hom 2, tab sis nws kuj tseem raug txhaj rau polycystic ovary syndrome (PCOS) vim muaj kev sib raug zoo ntawm cov kab mob no, vim tias polycystic ovary syndrome feem ntau cuam tshuam nrog insulin kuj.

Cov kev sim tshuaj sim ua tiav nyob rau xyoo 2006-2007 xaus lus tias qhov ua tau ntawm metformin rau polycystic ovary tsis zoo dua cov nyhuv placebo, thiab metformin ua ke nrog clomiphene tsis zoo dua li clomiphene ib leeg.

Hauv tebchaws Askiv, kev siv tshuaj metformin yog thawj txoj kev kho rau polycystic ovary syndrome tsis pom zoo. Lub hom phiaj ntawm clomiphene yog pom tias yog kev pom zoo thiab xav tau kev hloov pauv ntawm kev ua neej, tsis hais kev siv tshuaj kho mob, tseem ceeb.

Metformin rau poj niam ntxiv lawm tshob

Tus nab npawb ntawm cov kev tshawb fawb soj ntsuam tau pom tias qhov ua tau zoo ntawm metformin hauv kev muaj menyuam muaj peev xwm ntxiv, nrog rau clomiphene. Metformin yuav tsum tau siv tshuaj ntxiv ua ob yog tias kho nrog clomiphene tau pom tias tsis muaj txiaj ntsig.

Lwm txoj kev tshawb nrhiav pom zoo metformin yam tsis muaj kev tshwj tseg yog qhov kev xaiv kho mob thawj zaug, vim nws muaj cov txiaj ntsig zoo tsis yog rau kev kho mob nkaus xwb, tab sis kuj tseem cuam tshuam rau insulin tsis kam, hirsutism thiab rog rog, uas feem ntau pom nrog PCOS.

Mob ntshav qab zib thiab metformin

Cov tshuaj Metformin tuaj yeem ua rau mob ntshav qab zib (cov neeg muaj kev pheej hmoo los ntawm kev mob ntshav qab zib hom 2), uas txo lawv txoj kev pheej hmoo ntawm kev kis tus kab mob no, txawm hais tias kev tawm dag zog lub cev thiab kev noj zaub mov nrog kev txwv tsis pub muaj carbohydrates yog qhov zoo dua rau lub hom phiaj no.

Hauv Tebchaws Meskas, ib txoj kev tshawb nrhiav tau ua raws li ib pawg uas tau muab cov tshuaj metformin, thiab lwm tus tau mus ua kis las thiab ua raws kev noj haus. Raws li qhov tshwm sim, qhov tshwm sim ntawm cov ntshav qab zib hauv cov pab pawg muaj kev noj qab haus huv yog 31% tsawg dua ntawm cov neeg mob ntshav qab zib noj cov tshuaj metformin.

Nov yog qhov lawv sau txog kev mob ntshav qab zib thiab cov tshuaj metformin nyob rau hauv ib qho kev tshawb fawb tshawb fawb tau tshaj tawm PubMed - Lus Askiv cov lus ntawm cov ntaub ntawv kho mob thiab kev lom neeg (PMC4498279):

"Cov neeg muaj ntshav qab zib hauv lub siab, tsis mob ntshav qab zib, yuav muaj kev pheej hmoo rau kev mob ntshav qab zib hom 2, lub npe" ntshav qab zib. " mob ntshav qab zib feem ntau siv rau ciam teb theem yoo cov piam thaj hauv cov ntshav plasma (qhov ua rau cov piam thaj ceev) thiab / lossis mus rau theem ntawm cov piam thaj hauv cov ntshav ntshav tau muab 2 teev tom qab lub qhov ncauj ntsuas cov ntshav qab zib nrog 75 g. qab zib (tsis hnov lus qab zib zoo). Hauv tebchaws Asmeskas, txawm tias qib theem qis tshaj ntawm glycated hemoglobin (HbA1c) tau pom tias yog mob ntshav qab zib.
Cov neeg uas mob ntshav qab zib muaj kev pheej hmoo ntau ntxiv ntawm microvascular puas tsuaj thiab kev txhim kho macrovascular nyuaj ntxiv.zoo ib yam li lub sijhawm ntev mob ntshav qab zib. Txhawm rau ncua lossis thim rov qab qhov kev vam meej ntawm qhov txo qis hauv insulin rhiab thiab kev puas tsuaj ntawm β-tes haujlwm yog tus yuam sij rau kev ua tiav kev tiv thaiv ntawm cov ntshav qab zib hom 2.

Ntau yam kev ntsuas tau tsim los ntawm kev poob phaus: kev kho mob tshuaj (metformin, thiazolidinediones, acarbose, txhaj tshuaj ntawm cov tshuaj insalal thiab noj tshuaj rau qhov kev poob phaus), nrog rau kev phais mob bariatric. Cov kev ntsuas no yog tsim los txo qis cov mob ntshav qab zib hom 2 hauv cov neeg mob ntshav qab zib, txawm hais tias cov txiaj ntsig zoo tsis yog ib txwm ua tiav.

Metformin txhim kho qhov kev ua ntawm insulin hauv daim siab thiab cov leeg pob txhathiab nws cov txiaj ntsig ntawm kev ncua lossis tiv thaiv qhov pib ntawm ntshav qab zib tau ua pov thawj hauv ntau qhov loj, npaj tau zoo, sim kev sim,

suav nrog kev pab tiv thaiv mob ntshav qab zib. Kaum xyoo ntawm kev siv kho mob tau pom tias metformin feem ntau ua rau pom zoo thiab nyab xeeb. "

Kuv tuaj yeem coj Metformin rau qhov kev poob phaus? Tshawb nrhiav tau

Raws li kev tshawb fawb, metformin tuaj yeem pab qee tus neeg poob ceeb thawj. Txawm li cas los xij nws tseem tsis meej npaum li cas metformin ua rau cov neeg poob phaus.

Ib txoj kev xav yog tias metformin txo qhov qab los, ua rau poob phaus. Txawm hais tias metformin pab ua kom poob phaus, cov tshuaj no tsis yog ncaj qha rau lub hom phiaj no.

Raws li kev tshawb fawb ncua ntev (saib: PubMed, PMCID: PMC3308305), poob phaus los ntawm kev siv cov metformin ntau tshwm sim maj mam dhau los, dhau ib mus rau ob xyoos. Tus naj npawb ntawm cov phaus poob lawm tseem muaj qhov sib txawv ntawm cov neeg sib txawv thiab muaj feem xyuam nrog ntau lwm yam - nrog rau kev coj ua ntawm lub cev, nrog cov naj npawb ntawm cov calories noj txhua hnub, nrog txoj kev ntawm lub neej. Raws li cov txiaj ntsig ntawm txoj kev tshawb no, cov ncauj lus, ntawm qhov nruab nrab, poob ntawm 1.8 mus rau 3.1 kg tom qab ob lossis ntau xyoo ntawm kev noj cov tshuaj metformin. Piv nrog rau lwm txoj hauv kev poob phaus (noj cov zaub mov uas tsis muaj carb ntau, ua kom lub cev nyhav, yoo mov), qhov no ua tau ntau tshaj qhov tshwm sim.

Kev tswj hwm kev xav ntawm cov tshuaj yam tsis tau saib lwm yam ntawm kev ua neej noj qab haus huv tsis zoo ua rau poob phaus. Cov neeg uas ua raws li kev noj qab haus huv kev tawm dag zog thiab kev tawm dag zog thaum noj cov tshuaj metformin yuav ua rau poob ntau dua. Qhov no yog vim qhov tseeb tias metformin nce qhov feem ntau ntawm kev hlawv cov calories thaum ua exercise. Yog tias koj tsis koom nrog kev ncaws pob, ces tej zaum koj yuav tsis muaj qhov zoo no.

Ib qho ntxiv, ib qho kev poob phaus yuav ua txuas ntxiv ntev li koj tau noj tshuaj. Qhov no txhais tau tias yog tias koj tsum tsis noj cov tshuaj metformin, muaj ntau qhov muaj feem yuav rov qab mus rau qhov qub. Thiab txawm tias thaum koj tseem noj tshuaj, koj tuaj yeem pib maj mam nce phaus. Hauv lwm lo lus metformin tsis yog "ntsiav tshuaj zoo" rau qhov poob ceeb thawj tawm tsam qhov kev cia siab ntawm qee tus neeg. Nyeem ntxiv txog qhov no hauv peb cov khoom siv: Kev siv cov metformin rau cov kev poob phaus: kev tshuaj xyuas, kev kawm, cov lus qhia

Puas siv tshuaj metformin rau menyuam?

Kev lees txais ntawm metformin los ntawm cov menyuam yaus thiab cov tub ntxhais hluas muaj hnub nyoog ntau dua kaum xyoo yog tso cai - qhov no tau muaj tseeb los ntawm ntau cov kev tshawb fawb soj ntsuam. Lawv tsis qhia meej txog kev mob tshwm sim muaj feem nrog kev loj hlob ntawm tus menyuam, tab sis kev kho yuav tsum tau ua nyob rau hauv kev saib xyuas ntawm kws kho mob.

Metformin txo qhov tsim tawm ntawm cov piam thaj hauv cov qog (gluconeogenesis) thiab nce rhiab heev ntawm cov ntaub so ntswg lub cev mus rau insulin.
Txawm hais tias kev ua lag luam siab nyob rau hauv cov tshuaj hauv ntiaj teb, cov tshuab ntawm nws cov kev coj ua tsis tau to taub tag nrho, thiab ntau txoj kev tshawb fawb sib tawm tsam ib leeg.
Noj cov tshuaj metformin ntau dua 10% ntawm cov neeg mob ua rau muaj teeb meem hnyuv. Txhawm rau daws qhov teeb meem no, lub sijhawm ntev-ua yeeb yam metformin tau tsim (qhov qub yog Glucofage Ntev), uas ua rau txo qis qhov nqus ntawm cov tshuaj nquag thiab ua rau nws cov nyhuv ntawm lub plab ntau dua.
Metformin yuav tsum tsis txhob noj rau daim siab mob siab (mob siab siab, mob ntsws) thiab ob lub raum (mob raum tsis ua haujlwm, mob nephritis).
Ua ke nrog kev haus cawv, metformin tuaj yeem ua rau cov kab mob tuag taus lactic acidosis, yog li nws txwv tsis pub nws haus cawv thiab thaum haus cawv ntau.
Kev siv ntev ntawm metformin ua rau tsis muaj cov vitamin B12, yog li nws raug nquahu kom noj cov tshuaj vitamin ntxiv no.
Metformin tsis pom zoo rau cev xeeb tub thiab ntshav qab zib hauv lub cev, thiab rau kev pub niam mis, thiab nws nkag rau hauv cov mis.
Metformin tsis yog "ntsiav tshuaj zoo" rau qhov poob phaus.Kev poob ceeb thawj yog qhov zoo dua los ntawm kev ua raws li kev noj zaub mov zoo (suav nrog kev txwv tsis pub muaj cov ua carbohydrates) nrog rau kev ua si.

Qhov chaw:

Petunina N.A., Kuzina I.A. Ntev ntev metformin analogs // Koom nrog kws kho mob. 2012. Tsis muaj 3.
Puas yog metformin ua rau cov kab mob lactic acidosis? / Cochrane cov kev rov saib xyuas lub cev: cov ntsiab lus tseem ceeb // Xov xwm ntawm cov tshuaj thiab chaw muag tshuaj. 2011. No. 11-12.
Kev Nyab Xeeb Ntev Ntev, Ruaj, thiab Nyhav txuam nrog Metformin hauv Txoj Haujlwm Kev Tiv Thaiv Ntshav Qab Zib Cov Kev Kawm Tau Los Ntawm Kev Mob Ntshav Qab Zib // Kev Tu Ntshav Qab Zib. Xyoo 2012 Lub Plaub Hlis, 35 (4): 731-737. PMCID: PMC3308305.