Galvus - cov lus qhia rau kev siv, tshuaj xyuas, sib piv thiab ntau npaum li cas (cov ntsiav tshuaj 50 mg, nrog metformin 50 500, 50 850, 50 1000 Met) ntawm cov tshuaj rau kev kho mob ntshav qab zib hom 2 hauv cov neeg laus, menyuam yaus thiab cev xeeb tub

Hauv tsab xov xwm no, koj tuaj yeem nyeem cov lus qhia rau kev siv tshuaj yaj yeeb GalvusCov. Muab tswv yim los ntawm cov neeg tuaj saib rau ntawm thaj chaw - cov neeg tau txais kev pab ntawm cov tshuaj no, nrog rau kev xav ntawm cov kws kho mob tshwj xeeb txog kev siv Galvus hauv lawv cov kev coj ua. Qhov kev thov loj yog nquag ntxiv kev tshuaj xyuas koj ntawm cov tshuaj: cov tshuaj tau pab lossis tsis pab ua kom tshem tawm ntawm tus kabmob, muaj dab tsi tshwm sim thiab cov kev mob tshwm sim, tejzaum nws tsis tshaj tawm los ntawm tus tsim khoom hauv cov lus piav qhia. Galvus analogues nyob rau hauv muaj cov qauv txheej txheem qauv. Siv rau kev kho mob ntshav qab zib hom 2 rau cov neeg laus, menyuam yaus, nrog rau lub sijhawm cev xeeb tub thiab lactation. Cov tshuaj muaj pes tsawg leeg.

Galvus - cov tshuaj qhov ncauj hypoglycemic. Vildagliptin (cov tshuaj nquag ntawm Galvus) yog tus sawv cev ntawm chav kawm ntawm stimulators ntawm insular apparatus ntawm lub txiav, xaiv ntawm qhov ua kom haum rau cov enzyme dipeptidyl peptidase-4 (DPP-4). Kev txwv ceev thiab ua tiav ntawm DPP-4 kev ua haujlwm (ntau dua 90%) ua rau muaj kev nce ntxiv ntawm ob qho tib si hauv paus thiab zaub mov tso tawm cov pa ntawm hom 1 glucagon-zoo li peptide (GLP-1) thiab glucose-tiv thaiv insulinotropic polypeptide (HIP) los ntawm cov hnyuv mus rau hauv cov kab ke rau txhua hnub.

Ua rau ntau zog ntawm GLP-1 thiab HIP, vildagliptin ua rau muaj kev cuam tshuam ntau ntxiv ntawm cov hlwb ntawm pancreatic beta hlwb rau cov piam thaj, uas ua rau muaj kev txhim kho hauv cov kua dej-insulin secretion.

Thaum siv vildagliptin ntawm koob tshuaj 50-100 mg ib hnub rau cov neeg mob uas muaj hom 2 mob ntshav qab zib mellitus, qhov kev txhim kho ntawm kev ua haujlwm ntawm pancreatic cells-hlwb yog sau tseg. Qeb kev txhim kho ntawm kev ua haujlwm ntawm beta hlwb nyob ntawm qib ntawm lawv thawj zaug kev puas tsuaj, yog li nyob rau hauv cov tib neeg tsis raug kev mob ntshav qab zib mellitus (muaj ib qho ntshav ntshav qabzib feem ntau), vildagliptin tsis txhawb cov tshuaj insulin secretion thiab tsis txo cov ntshav qabzib.

Los ntawm kev nce siab ntawm cov endogenous GLP-1, vildagliptin tsub kom lub hlwb α-hlwb rau cov kua nplaum ntev, uas ua rau muaj kev txhim kho hauv cov kua nplaum-raws li kev cai ntawm glucagon secretion. Kev txo qis hauv cov theem ntawm glucagon ntau dhau ntawm lub sijhawm noj mov, nyeg, ua rau muaj kev poob qis hauv insulin tsis kam.

Kev nce ntxiv ntawm qhov sib piv ntawm insulin / glucagon tiv thaiv keeb kwm ntawm hyperglycemia, vim qhov nce ntawm cov ntsiab lus ntawm GLP-1 thiab HIP, ua rau muaj cov suab thaj hauv cov ntshav ntau zuj zus los ntawm lub siab ob qho tib si hauv lub sijhawm prandial thiab tom qab noj mov, uas ua rau txo qis hauv cov concentration ntawm cov piam thaj hauv ntshav ntshav.

Tsis tas li ntawd, tawm tsam cov keeb kwm yav dhau los ntawm kev siv vildagliptin, qhov kev txo qis ntawm cov lipids hauv cov ntshav plasma raug sau tseg, txawm li cas los xij, cov nyhuv no tsis cuam tshuam nrog nws cov nyhuv ntawm GLP-1 lossis HIP thiab kev txhim kho nyob rau hauv kev ua haujlwm ntawm pancreatic beta hlwb.

Nws paub txog tias kev nce hauv GLP-1 tuaj yeem qeeb plab zom mov, tab sis cov nyhuv no tsis pom nrog kev siv vildagliptin.

Galvus Met yog qhov sib xyaw tshuaj tiv thaiv qhov ncauj hypoglycemic. Cov sib xyaw ua ke ntawm cov tshuaj Galvus Met suav nrog ob tus kab mob hypoglycemic nrog cov txheej txheem sib txawv ntawm kev ua: vildagliptin, zwm rau hauv chav kawm ntawm dipeptidyl peptidase-4 inhibitors, thiab metformin (hauv daim ntawv ntawm hydrochloride), tus sawv cev ntawm chav kawm ntawm biguanides. Kev sib xyaw ua ke ntawm cov khoom no tso cai rau koj kom tswj tau cov ntshav qabzib ntau hauv cov ntshav hauv cov neeg mob ntshav qab zib hom 2 hauv 24 teev.

Muaj pes tsawg leeg

Vildagliptin + excipients (Galvus).

Vildagliptin + Metformin hydrochloride + excipients (Galvus Met).

Cov Tshuaj Pharmacokinetics

Thaum noj rau ntawm lub plab tas, vildagliptin yuav nqus nrawm. Nrog kev sib xyaw ua ke nrog cov khoom noj, tus nqi ntawm nqus ntawm vildagliptin txo qis me ntsis, txawm li cas los xij, kev noj zaub mov tsis cuam tshuam rau qib ntawm kev nqus thiab AUC. Cov tshuaj no tau faib tawm ncaj nruab nrab ntawm cov ntshav thiab cov ntshav liab. Biotransformation yog qhov tseem ceeb ntawm kev zam ntawm vildagliptin. Hauv tib neeg lub cev, 69% ntawm cov tshuaj ntawm cov tshuaj yog hloov pauv. Tom qab noj cov tshuaj, kwv yees li 85% ntawm cov koob tshuaj yog ua rau lub raum thiab 15% dhau los ntawm txoj hnyuv, lub raum ua rau tsis muaj qhov hloov pauv vildagliptin yog 23%.

Tus poj niam txiv neej, lub cev ua haujlwm ntawm lub cev, thiab haiv neeg tsis muaj kev cuam tshuam cov pharmacokinetics ntawm vildagliptin.

Cov teeb meem pharmacokinetic ntawm vildagliptin hauv cov menyuam yaus thiab cov neeg hluas hnub nyoog qis dua 18 xyoo tsis tau teeb tsa.

Tawm tsam ntawm keeb kwm yav dhau los ntawm kev noj, qhov degree thiab tus nqi ntawm nqus ntawm metformin yog qee qhov txo qis. Cov tshuaj yeeb yaj kiab tsis khi rau cov protein plasma, thaum sulfonylurea derivatives khi rau lawv ntau dua 90%. Metformin nkag mus rau cov ntshav liab (tej zaum yuav ntxiv dag zog rau txoj kev no dhau mus). Nrog rau txoj kev tswj hwm ib leeg rau cov neeg ua haujlwm noj qab haus huv, metformin raug ntuav tawm los ntawm lub raum tsis hloov. Nws tsis muaj tshuaj lom nyob hauv lub siab (tsis muaj cov metabolites tau raug tshawb pom hauv tib neeg) thiab nws tsis raug tso tawm hauv cov kua tsib. Thaum noj, kwv yees li 90% ntawm qhov tshuaj uas tau nqus tau yog tawm hauv lub raum thaum thawj 24 teev.

Tus tub los ntxhais ntawm cov neeg mob tsis cuam tshuam rau pharmacokinetics ntawm metformin.

Cov yam ntxwv ntawm cov tshuaj metformin hauv cov menyuam yaus thiab cov tub ntxhais hluas hnub nyoog qis dua 18 xyoo tsis tau tsim.

Cov nyhuv ntawm cov zaub mov ntawm pharmacokinetics ntawm vildagliptin thiab metformin hauv tshuaj muaj pes tsawg leeg Galvus Met tsis txawv ntawm qhov ntawd thaum noj ob qho tshuaj sib cais.

Cov Khoom Qhia

Yam 2 Ntshav Qab Zib Hom:

raws li monotherapy nyob rau hauv ua ke nrog kev noj haus kev tawm dag zog thiab kev tawm dag zog,
hauv cov neeg mob yav tas los tau txais kev kho ua ke nrog vildagliptin thiab metformin ua ib hom tshuaj (rau Galvus Met),
nrog rau cov tshuaj metformin uas yog kev pib siv tshuaj kho mob nrog kev tsis muaj txiaj ntsig ntawm kev noj zaub mov zoo thiab tawm dag zog,
ua ib feem ntawm ob qho kev sib xyaw ua ke nrog kev kho mob nrog metformin, sulfonylurea derivatives, thiazolidinedione lossis nrog insulin thaum tsis muaj kev noj haus zoo rau kev kho mob, kev tawm dag zog thiab monotherapy nrog cov tshuaj no,
raws li ib feem ntawm txoj kev kho ua ke peb zaug: hauv kev sib xyaw nrog sulfonylurea derivatives thiab metformin hauv cov neeg mob yav tas los kho nrog sulfonylurea derivatives thiab metformin tiv thaiv keeb kwm ntawm kev noj haus thiab kev tawm dag zog thiab uas tsis tau ua tiav glycemic tswj,
ua ib feem ntawm txoj kev kho ua ke peb zaug: ua ke nrog insulin thiab metformin hauv cov neeg mob uas tau txais insulin thiab metformin yav dhau los ntawm kev noj haus thiab kev tawm dag zog thiab tus uas tsis ua tiav glycemic tswj tau zoo.

Tso Tawm Cov Ntawv

Ntsiav tshuaj 50 mg (Galvus).

Coated ntsiav tshuaj 50 + 500 mg, 50 + 850 mg, 50 + 1000 mg (Galvus Met).

Cov lus qhia rau kev siv thiab ntau npaum li cas

Galvus noj ntawm qhov ncauj tsis hais txog kev noj zaub mov.

Cov tshuaj ntau npaum li cas ntawm cov tshuaj yuav tsum tau xaiv ib tus zuj zus nyob ntawm qhov siv tau thiab ua siab ntev.

Qhov pom zoo koob tshuaj ntawm cov tshuaj thaum lub sij hawm monotherapy lossis ua ib feem ntawm ob qho kev sib xyaw ua ke nrog kev kho mob nrog metformin, thiazolidinedione lossis insulin (ua ke nrog metformin lossis tsis muaj metformin) yog 50 mg lossis 100 mg ib hnub. Hauv cov neeg mob uas muaj mob ntshav qab zib hom 2 ntau dua tau txais kev kho mob nrog insulin, Galvus pom zoo ntawm koob tshuaj 100 mg rau ib hnub.

Qhov pom zoo koob tshuaj Galvus ua ib feem ntawm kev sib xyaw ua ke peb zaug (vildagliptin + sulfonylurea derivatives + metformin) yog 100 mg rau ib hnub.

Ib koob tshuaj ntawm 50 mg rau ib hnub yuav tsum tau muab sau tseg 1 lub tshuaj thaum sawv ntxov. Qhov koob tshuaj 100 mg rau ib hnub yuav tsum tau noj 50 mg 2 zaug hauv ib hnub thaum sawv ntxov thiab yav tsaus ntuj.

Thaum siv raws li ib feem ntawm ob qho kev sib xyaw ua ke nrog kev kho nrog sulfonylurea derivatives, koob tshuaj pom zoo ntawm Galvus yog 50 mg 1 zaug hauv ib hnub thaum sawv ntxov. Thaum muaj kev sib xyaw nrog sulfonylurea derivatives, qhov ua tau ntawm kev siv tshuaj ntawm ib koob ntawm 100 mg rau ib hnub yog zoo ib yam li cov koob tshuaj ntawm 50 mg rau ib hnub. Nrog cov tshuaj tsis txaus ua haujlwm tiv thaiv keeb kwm yav dhau los ntawm kev siv qhov siab tshaj plaws pom zoo txhua hnub koob ntawm 100 mg, rau kev tswj hwm zoo dua ntawm glycemia, cov tshuaj ntxiv ntawm lwm cov tshuaj tiv thaiv ntshav qab zib yog qhov ua tau: metformin, sulfonylurea derivatives, thiazolidinedione lossis insulin.

Hauv cov neeg mob uas tsis muaj teeb meem lub raum thiab lub siab mob lub siab, kev hloov kho ntau yam tsis tas yuav tsum muaj. Hauv cov neeg mob uas muaj mob qog lossis mob hnyav lub raum ua haujlwm (suav nrog cov davhlau ya nyob twg ntawm kev mob raum tsis ua haujlwm ntawm kev mob hlwb), cov tshuaj yuav tsum tau siv ntawm koob tshuaj 50 mg ib hnub ib zaug.

Hauv cov neeg mob laus (ntau dua 65 xyoos), yuav tsum tau kho ntawm Galvus dosage regimen tsis yog qhov yuav tsum tau ua.

Txij li thaum tsis muaj kev paub hauv kev siv tshuaj nyob hauv menyuam yaus thiab tub ntxhais hluas hnub nyoog qis dua 18 xyoo, nws tsis pom zoo kom siv cov tshuaj hauv pawg no ntawm cov neeg mob.

Cov tshuaj yog muab ntawm qhov ncauj. Qhov ntau npaum ntawm qhov tshuaj ntawm Galvus Met yuav tsum tau xaiv ib tus zuj zus nyob ntawm seb qhov ua tau zoo thiab kev tiv taus. Thaum siv Galvus Met, tsis txhob siab tshaj qhov pom zoo tshaj plaws txhua hnub koob tshuaj vildagliptin (100 mg).

Cov koob tshuaj pom zoo thawj zaug ntawm Galvus Met yuav tsum tau xaiv, coj mus rau hauv tus lej ntawm tus neeg mob cov txheej txheem kho nrog vildagliptin thiab / lossis metformin. Txo kom txo qhov txaus ntshai tshwm sim los ntawm cov hnyuv hauv lub cev ntawm metformin, Galvus Met noj nrog zaub mov.

Thawj koob tshuaj Galvus ntsib nrog qhov tsis muaj txiaj ntsig ntawm kev kho mob monotherapy nrog vildagliptin: kev kho mob nrog Galvus zib ntab tuaj yeem pib nrog ib ntsiav tshuaj nrog kev noj tshuaj ntawm 50 mg / 500 mg 2 zaug hauv ib hnub, thiab tom qab tshuaj xyuas cov txiaj ntsig kho, qhov koob tshuaj yuav tau nce ntxiv.

Thawj koob tshuaj Galvus Met nrog qhov tsis muaj txiaj ntsig ntawm kev siv tshuaj metformin monotherapy: nyob ntawm koob tshuaj metformin uas twb tau noj lawm, kev kho nrog Galvus Met tuaj yeem pib nrog ib ntsiav tshuaj nrog ntau npaum ntawm 50 mg / 500 mg, 50 mg / 850 mg lossis 50 mg / 1000 mg 2 zaug hauv ib hnub.

Thawj koob tshuaj Galvus Met hauv cov neeg mob uas yav tas los tau txais kev kho mob sib xyaw nrog vildagliptin thiab metformin ua cov ntsiav tshuaj txawv: nyob ntawm koob tshuaj vildagliptin lossis metformin uas twb tau noj lawm, kev kho nrog Galvus Met yuav tsum tau pib nrog ib ntsiav tshuaj ze li sai tau rau txoj kev kho mob 50 mg / 500 mg , 50 mg / 850 mg lossis 50 mg / 1000 mg, thiab titrated los ntawm cov nyhuv.

Thawj koob tshuaj Galvus Met ua thawj qhov kev kho mob rau cov neeg mob ntshav qab zib hom 2 mob ntshav qab zib muaj txiaj ntsig tsis txaus ntawm kev noj zaub mov noj thiab qoj ib ce: raws li kev pib kho, Galvus Met yuav tsum tau kho nyob rau hauv thawj koob tshuaj 50 mg / 500 mg ib hnub ib zaug thiab maj mam tom qab tshuaj xyuas cov txiaj ntsig kho titrate ib koob tshuaj txog li 50 mg / 100 mg 2 zaug ib hnub.

Kev sib xyaw ua ke nrog Galvus Met ua ke nrog sulfonylurea derivatives lossis insulin: koob tshuaj Galvus Met yog suav los ntawm koob tshuaj vildagliptin 50 mg 2 zaug hauv ib hnub (100 mg rau ib hnub) thiab metformin hauv ib koob sib npaug uas tau siv yav tas los ua ib hom tshuaj.

Kev siv Galvus Met yog contraindicated rau hauv cov neeg mob uas lub raum tsis ua haujlwm lossis lub raum tsis ua haujlwm.

Metformin raug ntuav tawm los ntawm ob lub raum. Txij li cov neeg mob uas muaj hnub nyoog 65 xyoos feem ntau muaj qhov ua kom lub raum khiav qis dua, Galvus Met tau raug tshaj tawm nyob rau hauv pawg no ntawm cov neeg mob hauv qhov tsawg kawg nkaus uas ua rau muaj cov ntshav qabzib hauv lub cev tsuas yog tom qab txiav txim QC kom paub meej tias lub raum ua haujlwm li qub. Thaum siv cov tshuaj hauv cov neeg mob uas muaj hnub nyoog 65 xyoos, nws yuav tsum tau soj ntsuam lub raum tsis tu ncua.

Txij li thaum muaj kev nyab xeeb thiab ua haujlwm ntawm Galvus Met hauv cov menyuam yaus thiab cov tub ntxhais hluas hnub nyoog qis dua 18 xyoo tsis tau kawm, kev siv cov tshuaj yog contraindicated hauv pawg neeg mob no.

Sab sij huam

mob taub hau
kiv taub hau
tshee hnyo
ua daus no
xeev siab, ntuav,
gastroesophageal reflux,
mob plab
raws plab, cem quav,
flatulence
ntshav qab zib,
hyperhidrosis
nkees
daim tawv nqaij ua pob
urticaria
khaus
arthralgia,
peripheral edema,
kab mob siab (thim rov qab thaum tsis kho kev kho),
pancreatitis
laus laus ntawm daim tawv nqaij,
hlwv
txo qis nqus ntawm cov vitamins B12,
lactic acidosis
nws yog xim hlau ci hauv qhov ncauj.

Cov Yuav Tsum Muaj

lub raum tsis ua hauj lwm los yog lub raum tsis zoo: muaj cov ntshav creatinine ntau dua 1.5 mg% (ntau dua 135 μmol / l) rau cov txiv neej thiab ntau dua 1.4 mg% (ntau dua 110 μmol / l) rau cov poj niam,
muaj mob hnyav nrog kev pheej hmoo ntawm kev tsim muaj lub raum ua haujlwm: lub cev qhuav dej (nrog rau mob raws plab, ntuav), kub taub hau, mob hnyav kis, mob ntawm hypoxia (poob siab, sepsis, mob raum, kab mob ntsws).
mob plawv thiab mob plawv tsis ua haujlwm, mob myocardial infarction, mob plawv tsis txaus (poob siab),
ua pa tsis ua hauj lwm
lub siab ua tsis taus haujlwm,
mob hnyav lossis mob ntsws metabolic acidosis (suav nrog ketoacidosis uas mob ntshav qab zib ua ke nrog lossis tsis nco qab lawm). Tus kab mob ntshav qab zib ketoacidosis yuav tsum kho tus mob insulin kho,
lactic acidosis (suav nrog keeb kwm),
cov tshuaj tsis tau siv 2 hnub ua ntej kev phais mob, radioisotope, kev tshawb nrhiav xoo hluav taws xob nrog kev qhia ntawm cov tshuaj tiv thaiv kab mob thiab tsis pub dhau 2 hnub tom qab lawv tau ua,
cev xeeb tub
kev pub mis
ntshav qab zib hom 1
haus cawv qaug cawv, qaug cawv lom,
ua raws li kev noj zaub mov kom tsis txhob muaj calories ntau tsawg (tsawg dua 1000 kcal ib hnub),
cov me nyuam qis dua 18 xyoo (qhov ua tau zoo thiab kev nyab xeeb ntawm kev siv tsis tau tsim),
ua kom lub cev tsis haum rau vildagliptin lossis metformin lossis lwm yam tshuaj.

Txij li cov neeg mob uas muaj lub siab ua haujlwm tsis txaus nyob hauv qee kis, lactic acidosis raug sau tseg, uas tej zaum yog ib qho kev phiv tshuaj ntawm metformin, Galvus Met yuav tsum tsis txhob siv rau cov neeg mob siab lossis mob siab rau hepatic biochemical.

Nrog kev ceev faj, nws raug nquahu kom siv cov tshuaj muaj metformin hauv cov neeg mob hnub nyoog tshaj 60 xyoo, zoo li thaum ua haujlwm lub cev hnyav vim qhov muaj feem yuav ua mob lactic acidosis.

Cev xeeb tub thiab lactation

Txij li cov poj niam cev xeeb tub tsis muaj cov ntaub ntawv txaus rau kev siv tshuaj Galvus lossis Galvus Met, kev siv cov tshuaj thaum cev xeeb tub yog contraindicated.

Thaum muaj teeb meem cov piam thaj hauv kev xeeb tub hauv cov poj niam cev xeeb tub, muaj qhov muaj feem yuav ua mob txhawm rau txhawm rau lub cev, nrog rau lub cev tsis muaj hlwb thiab lub neej kev tuag. Yuav ua kom cov ntshav qabzib hauv lub siab thaum lub cev xeeb tub, insulin monotherapy yog kev pom zoo.

Hauv kev sim tshuaj, thaum sau ntawv rau vildagliptin hauv koob tshuaj 200 zaug siab dua qhov kev pom zoo, cov tshuaj tsis ua rau lub cev tsis muaj zog thiab kev txhim kho thaum ntxov ntawm lub cev thiab tsis ua qhov cuam tshuam teratogenic rau tus me nyuam hauv plab. Thaum sau tshuaj rau vildagliptin hauv kev sib xyaw nrog metformin hauv qhov sib piv ntawm 1:10, kuj tsis muaj teratogenic effect ntawm tus me nyuam hauv plab.

Txij li nws tsis paub meej tias vildagliptin lossis metformin raug tawm hauv tib neeg cov kua mis, kev siv cov tshuaj Galvus thaum lub sijhawm pub mis niam yog contraindicated.

Siv rau menyuam yaus

Contraindicated rau cov menyuam yaus thiab cov neeg hluas hnub nyoog qis dua 18 xyoo (qhov ua tau zoo thiab kev nyab xeeb ntawm kev siv tsis tau tsim).

Siv rau cov neeg mob laus

Nrog kev ceev faj, nws raug nquahu kom siv cov tshuaj muaj metformin hauv cov neeg mob laus dua 60 xyoo.

Cov lus qhia tshwj xeeb

Hauv cov neeg mob uas tau txais insulin, Galvus lossis Galvus Met tsis tuaj yeem hloov cov insulin.

Txij li thaum siv vildagliptin, ib qho kev nce ntxiv hauv kev ua si ntawm aminotransferases (feem ntau tsis muaj kev kho mob hauv cov chaw kho mob) tau sau tseg qee yam ntau dua li pawg tswj hwm, ua ntej sau cov tshuaj Galvus lossis Galvus Met, ntxiv rau lub sijhawm ua haujlwm nrog cov tshuaj, nws raug nquahu kom txiav txim siab biochemical tsis ua haujlwm ntawm daim siab ua haujlwm. Yog tias tus neeg mob tau ua haujlwm ntau ntxiv ntawm aminotransferases, qhov txiaj ntsig no yuav tsum tau lees paub los ntawm kev tshawb fawb zaum ob, thiab tom qab ntawd ua ntu zus txiav txim siab cov biochemical tsis ua haujlwm ntawm daim siab ua haujlwm kom txog thaum lawv ua haujlwm. Yog tias qhov dhau ntawm AST lossis ALT kev ua haujlwm yog 3 lossis ntau dua lub sijhawm ntau dua li VGN tau lees paub los ntawm kev tshawb fawb tshawb, nws raug nquahu kom thim cov tshuaj.

Cov kab mob lactic acidosis yog ib qho mob uas tsis tshua pom tshwm sim ntau tab sis hnyav uas tshwm sim nrog kev txuam nrog metformin hauv lub cev. Lactacidosis nrog rau kev siv cov tshuaj metformin tau raug soj ntsuam feem ntau hauv cov neeg mob ntshav qab zib mellitus uas muaj mob raum tsis zoo. Txoj kev pheej hmoo ntawm kev tsim mob lactic acidosis tau nce ntxiv hauv cov neeg mob uas tsis muaj peev xwm kho tau tus mob ntshav qab zib mellitus, nrog ketoacidosis, kev tshaib plab ntev ntev, haus dej cawv ntau, ua rau lub siab ua haujlwm thiab kab mob uas ua rau hypoxia.

Nrog rau kev txhim kho ntawm cov kab mob lactic acidosis, ua pa luv, mob plab thiab hypothermia tau sau tseg, ua raws li rov qab. Qhov ntsuas pom hauv qab no muaj cov kev kuaj mob: qhov txo qis hauv cov ntshav pH, ntshav dej lactate siab siab tshaj 5 nmol / l, nrog rau qhov muaj zog ntau dua anionic thiab qhov nce ntawm lactate / pyruvate. Yog tias xav tias tsam tus kab mob metabolic acidosis, cov tshuaj yuav tsum tsis ua ntxiv thiab tus neeg mob pw hauv tsev kho mob tam sim ntawd.

Txij li metformin feem ntau ua rau lub raum tawm, qhov kev pheej hmoo ntawm nws ntau zuj zus thiab kev loj hlob ntawm cov kab mob lactic acid yog siab dua, ntau lub raum tsis ua haujlwm. Thaum siv tshuaj, Galvus Met yuav tsum soj ntsuam lub raum kev ua haujlwm tsis tu ncua, tshwj xeeb tshaj yog nyob rau cov xwm txheej hauv qab no uas ua rau nws ua txhaum: thawj theem pib ntawm kev kho mob nrog cov tshuaj tiv thaiv kab mob, hypoglycemic agents, lossis NSAIDs Raws li txoj cai, lub raum kev ua haujlwm yuav tsum raug txheeb xyuas ua ntej pib kho nrog Galvus Met, thiab tom qab ntawd tsawg kawg 1 zaug nyob rau ib xyoos rau cov neeg mob uas lub raum muaj nuj nqi thiab tsawg kawg 2-4 zaug hauv ib xyoos rau cov neeg mob uas muaj cov ntshav creatinine saum VGN. Hauv cov neeg mob uas muaj kev pheej hmoo siab ntawm lub raum tsis ua haujlwm, nws yuav tsum tau soj ntsuam ntau dua 2-4 zaug hauv ib lub xyoo. Yog tias pom tias lub raum ua tsis muaj zog tshwm sim, Galvus Met yuav tsum tsis ua mus ntxiv.

Thaum nqa tawm cov kev tshawb nrhiav xoo hluav taws xob uas yuav tsum muaj kev tswj hwm intravascular ntawm iodine-muaj cov radiopaque sib piv cov neeg sawv cev, Galvus Met yuav tsum tau txiav tawm ib ntus (48 teev ua ntej, zoo li tsis pub dhau 48 teev tom qab kev tshawb fawb), txij li intravascular tswj hwm ntawm iodine-muaj radiopaque cov neeg sawv cev tuaj yeem ua rau lub cev tsis zoo hauv lub raum kev ua haujlwm thiab ua rau muaj kev pheej hmoo. kev loj hlob ntawm cov kab mob lactic acidosis. Koj tuaj yeem rov pib noj Galvus Met tsuas yog tom qab kev ntsuas thib ob ntawm lub raum ua haujlwm.

Hauv cov mob plawv tsis ua haujlwm (poob siab), mob plawv tsis ua haujlwm, mob myocardial infarction thiab lwm yam mob uas pom los ntawm hypoxia, kev txhim kho ntawm cov kab mob lactic acidosis thiab prerenal mob raum tsis ua haujlwm tau. Yog tias cov xwm txheej saum toj no tshwm sim, cov tshuaj yuav tsum tau txiav tam sim ntawd.

Thaum muaj kev cuam tshuam txog kev phais mob (tshwj tsis yog muaj kev ua haujlwm me me uas tsis cuam tshuam txog kev txwv kev noj zaub mov thiab kua dej), Galvus Met yuav tsum tsis ua mus ntxiv. Koj tuaj yeem rov qab noj cov tshuaj tom qab tus neeg mob pib noj zaub mov ntawm nws tus kheej thiab nws yuav pom tias nws lub raum tsis ua haujlwm.

Nws tau tsim tsa uas muaj cawv cawv (cawv) ua rau cov nyhuv ntawm metformin ntawm lactate metabolism. Cov neeg mob yuav tsum tau ceeb toom txog qhov tsis muaj cai ntawm kev haus cawv thaum lub sijhawm siv cov tshuaj Galvus Met.

Nws tau pom tias metformin hauv kwv yees li 7% ntawm cov neeg mob ua rau txo qis asymptomatic hauv cov ntshiab vitamin B12 cov ntsiab lus. Xws li qhov kev txo qis hauv qhov tsis tshua muaj neeg mob ua rau kev loj hlob ntawm lub cev tsis muaj ntshav. Pom meej, tom qab kev ncua ntawm metformin thiab / lossis vitamin B12 hloov kev kho, qhov kev ntsuas ntshav ntawm vitamin B12 sai sai ib txwm muaj. Cov neeg mob tau txais Galvus Met, nws raug pom zoo tsawg kawg 1 zaug hauv ib lub xyoo los ua qhov kev kuaj ntshav dav dav thiab yog tias muaj ib qho kev ua txhaum cai tshawb nrhiav, txiav txim siab lawv qhov ua rau thiab ntsuas kev tsim nyog. Thaj, qee tus neeg mob (piv txwv li, cov neeg mob uas muaj qhov tsis txaus noj lossis malabsorption ntawm cov vitamin B12 lossis calcium) muaj qhov xav ua kom txo qis ntshav ntau ntawm cov vitamin B12. Hauv cov xwm txheej zoo li no, nws tuaj yeem pom zoo kom txiav txim siab cov ntshav ntau ntawm cov vitamin B12 tsawg kawg 1 zaug hauv 2-3 xyoos.

Yog tias tus neeg mob uas muaj mob ntshav qab zib hom 2, uas yav dhau los teb rau txoj kev kho, qhia pom qhov tsis zoo (muaj kev hloov hauv chav kuaj lossis lub chaw kuaj mob), thiab cov tsos mob tsis tau hais meej, kev kuaj yuav tsum tau ua tam sim ntawd kom paub ketoacidosis thiab / lossis lactic acidosis. Yog hais tias acidosis nyob rau hauv ib daim ntawv lossis lwm qhov muaj tseeb, koj yuav tsum tso tseg Galvus Met tam sim ntawd thiab ntsuas kev tsim nyog.

Feem ntau, hauv cov neeg mob uas tau txais tsuas yog Galvus Met, kev mob ntshav qab zib tsis pom, txawm li cas los xij, nws tuaj yeem tshwm sim tiv thaiv keeb kwm ntawm cov zaub mov uas tsis muaj calorie (thaum lub cev ua si tsis tau them nyiaj los ntawm cov ntsiab lus hauv calorie ntawm cov zaub mov), lossis tiv thaiv keeb kwm yav dhau los ntawm kev haus cawv. Kev mob ntshav siab yog feem ntau rau cov neeg laus, debilitated lossis depleted cov neeg mob, nrog rau kev tiv thaiv ntawm cov keeb kwm yav dhau los ntawm hypopituitarism, adrenal tsis txaus los yog haus dej cawv. Hauv cov neeg mob laus thiab cov neeg mob uas tau txais beta-blockers, kev kuaj mob ntawm cov qog ntshav qab zib tuaj yeem nyuaj.

Nrog rau kev ntxhov siab (kub cev, mob, mob, phais) uas tshwm sim hauv tus neeg mob tau txais hypoglycemic cov neeg sawv cev hauv qhov chaw ruaj khov, qhov kev poob qis ntawm cov txiaj ntsig ntawm qhov kawg rau qee lub sijhawm yog ua tau. Hauv qhov no, nws yuav tsim nyog kom lawb tawm Galvus Met thiab muab cov tshuaj insulin. Koj tuaj yeem rov pib kho nrog Galvus Met tom qab xaus lub sijhawm mob.

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

Qhov cuam tshuam ntawm cov tshuaj Galvus lossis Galvus Met ntawm kev muaj peev xwm tsav tsheb thiab ua haujlwm nrog cov txheej txheem tsis tau kawm. Nrog rau kev txhim kho kiv taub hau tiv thaiv keeb kwm yav dhau los ntawm kev siv tshuaj, ib qho yuav tsum tsis kam tsav tsheb thiab ua haujlwm nrog cov txheej txheem.

Yeeb tshuaj sib cuam tshuam

Nrog rau kev siv vildagliptin (100 mg 1 zaug nyob rau ib hnub) thiab metformin (1000 mg 1 zaug hauv ib hnub), tsis muaj ib qho tseem ceeb ntawm cov chaw muag tshuaj sib txawv ntawm lawv tau sau tseg. Tsis yog nyob rau hauv chav kawm ntawm kev sim tshuaj, lossis thaum lub sijhawm saib xyuas kev siv dav dav ntawm Galvus Met hauv cov neeg mob tau txais lwm cov tshuaj thiab cov tshuaj yeeb dej caw, ib qho kev sib tham tsis tau xav txog tsis pom.

Vildagliptin muaj qhov tsis tshua zoo rau kev sib txuam tshuaj. Txij li thaum vildagliptin tsis yog lub zog ntawm cytochrome P450 isoenzymes, tsis yog nws inhibit lossis ntxias cov isoenzymes no, nws cov kev cuam tshuam nrog cov tshuaj uas yog substrates, inhibitors, lossis P450 inducers tsis zoo li. Nrog rau kev siv vildagliptin ib txhij tsis cuam tshuam rau qhov tshuaj ntawm cov tshuaj uas hloov cov enzymes: CYP1A2, CYP2C8, CYP2C9, CYP2C19, CYP2D6, CYP2E1 thiab CYP3A4 / 5.

Tsis muaj kev sib cuam tshuam hauv chaw kho mob tseem ceeb ntawm vildagliptin nrog cov tshuaj feem ntau siv hauv kev kho mob hom 2 mob ntshav qab zib mellitus (glibenclamide, pioglitazone, metformin) lossis nrog nqaim kev kho mob (amlodipine, digoxin, ramipril, simvastatin, valsartan, warfarin).

Furosemide nce Cmax thiab AUC ntawm metformin, tab sis tsis cuam tshuam rau nws lub raum kev ua haujlwm. Metformin txo cov Cmax thiab AUC ntawm furosemide thiab tsis cuam tshuam rau nws txoj kev ua haujlwm hauv lub raum.

Nifedipine nce ntxiv kev nqus, Cmax thiab AUC ntawm metformin, ntxiv rau, nws tsub kom nws cov zis tawm hauv cov zis. Metformin kev coj ua tsis cuam tshuam rau qhov kev txiav txim ntawm nifedipine.

Glibenclamide tsis cuam tshuam rau qhov kwv yees pharmacokinetic / pharmacodynamic ntawm metformin. Metformin feem ntau txo Cmax thiab AUC ntawm glibenclamide, tab sis qhov ntau ntawm cov nyhuv txawv heev. Vim li no, qhov tseem ceeb kho mob ntawm qhov kev sib txuam no tseem tsis meej.

Organic cations, piv txwv li, amiloride, digoxin, morphine, procainamide, quinidine, quinine, ranitidine, triamteren, trimethoprim, vancomycin, thiab lwm tus, raug zam los ntawm lub raum los ntawm tubular secretion, tuaj yeem sib cuam tshuam nrog metformin, txij li thaum lawv sib tw rau cov leeg tub hlab ntsha kev thauj khoom. Cimetidine nce ntxiv ob qho tib si ntawm cov metformin hauv plasma / ntshav thiab nws cov AUC los ntawm 60% thiab 40%, feem. Metformin tsis cuam tshuam rau qhov kev siv pharmacokinetic ntawm cimetidine.

Ceev faj yuav tsum tau siv thaum siv Galvus Met nrog rau cov tshuaj uas cuam tshuam rau lub raum kev ua haujlwm lossis kev faib tawm ntawm metformin hauv lub cev.

Qee cov tshuaj muaj peev xwm ua rau hyperglycemia thiab txo qis kev ua haujlwm ntawm hypoglycemic tus neeg sawv cev, cov tshuaj no suav nrog thiazides thiab lwm cov tshuaj diuretics, glucocorticosteroids (GCS), phenothiazines, thyroid hormone npaj, estrogens, tshuaj tiv thaiv qhov ncauj, phenytoin, nicotinic acid, sympathomimetics, thiab calcium antagonists. Thaum sau tshuaj rau cov tshuaj tsis sib xws, lossis, hloov dua siab tshiab, yog tias lawv raug tso tseg, nws raug nquahu kom ua tib zoo saib xyuas qhov ua tau zoo ntawm metformin (nws cov nyhuv ntshav qab zib) thiab, yog tias tsim nyog, kho cov koob tshuaj.

Kev siv tib lub sijhawm sib xyaw ntawm danazol tsis pom zoo nyob rau hauv kev txiav txim kom tsis txhob muaj cov nyhuv hyperglycemic ntawm tom kawg. Yog tias kev kho mob nrog danazol yog qhov tsim nyog thiab tom qab txiav tawm qhov kawg, kev kho tshuaj metformin yuav tsum ua raws li kev tswj xyuas qib siab.

Chlorpromazine thaum noj ntau dua (100 mg ib hnub twg) nce glycemia, txo qis kev tawm ntawm insulin. Hauv kev kho tshuaj tiv thaiv tshuaj tiv thaiv thiab tom qab siv ceev xwmphem qhov kawg, kev hloov kho koob tshuaj yuav tsum muaj kev tswj hwm nyob hauv qib siab.

Kev tshawb nrhiav hluav taws xob uas siv cov tshuaj iodine-radiopaque tuaj yeem ua rau lactic acidosis hauv cov neeg mob ntshav qab zib mellitus nrog lub raum tsis ua haujlwm.

Muab tso rau hauv kev txhaj tshuaj, beta2-sympathomimetics nce glycemia vim qhov kev txhawb nqa ntawm beta2-adrenergic receptors. Hauv qhov no, glycemic tswj yog tsim nyog. Yog tias tsim nyog, insulin raug pom zoo.

Nrog tib lub sijhawm siv cov metformin nrog sulfonylurea derivatives, insulin, acarbose, salicylates, nce ntxiv ntawm cov nyhuv hypoglycemic yog ua tau.

Txij li thaum siv cov metformin rau cov neeg mob haus cawv ntau ua rau muaj kev phom sij lactic acid (tshwj xeeb tshaj yog lub sijhawm tshaib plab, qaug zog, lossis lub siab tsis ua haujlwm), cov neeg mob yuav tsum tsis txhob haus cawv thiab tshuaj muaj cawv (cawv) thaum kho nrog Galvus Met.

Cov tshuaj ntawm cov tshuaj Galvus

Cov qauv ntawm cov qauv ua haujlwm:

Cov tshuaj hauv cov pawg pharmacological (hypoglycemic agents):