17 November, 2024
    Kev khomob thiab kev tiv thaiv

    Invocana® (100 mg) Canagliflozin

    Dosage daim ntawv - cov yeeb yaj kiab-xim ntsiav tshuaj: tshuaj ntsiav zoo li tus kabmob, ntawm ib sab kos nrog "CFZ", tus ntoo khaub lig-tshooj tseem yuav luag dawb lossis dawb, ntau npaum 100 mg - daj, nrog engraving "100" ntawm lwm sab, ntau npaum 300 mg - yuav luag dawb lossis dawb, sau nrog "300" nyob rau sab nraud (hauv daim npav ntoo ntawm 1, 3, 9 lossis 10 hlwv ntawm 10 ntsiav tshuaj thiab cov lus qhia rau kev siv Invokany).

    Composition 1 ntsiav tshuaj:

    • cov tshuaj nquag: canagliflozin - 100 lossis 300 mg (hauv qhov ua tau ntawm canagliflozin hemihydrate - 102 lossis 306 mg, feem),
    • Cov khoom siv pabcuam (100/300 mg): microcrystalline cellulose - 39.26 / 117.78 mg, croscarmellose sodium - 12/36 mg, anhydrous lactose - 39.26 / 117.78 mg, magnesium stearate - 1.48 / 4, 44 mg, hyprolose - 6/18 mg,
    • zaj duab xis txheej: ntau npaum li 100 mg - Opadry II 85F92209 zas xim daj (qee qhov dej cawv polyvinyl cawv - 40%, macrogol 3350 - 20.2%, titanium dioxide - 24.25%, talc - 14.8%, daj oxide ntawm hlau - 0, 75%) - 8 mg, 300 mg dosage - Opadry II 85F18422 dawb zas xim (qee qhov dej cawv polyvinyl cawv - 40%, macrogol 3350 - 20.2%, titanium dioxide - 25%, talc - 14.8%) - 18 mg.

    Cov Tshuaj Hauv Tshuaj

    Nws tau tsim tsa hais tias tawm tsam cov keeb kwm ntawm ntshav qab zib mellitus muaj qhov muaj zog ntawm lub raum rov qab ntxiv ntawm cov piam thaj, uas tuaj yeem ua rau muaj kev nce ntxiv hauv cov ntshav qabzib. Rau feem ntau ntawm cov rov ua kom qabzib los ntawm cov kua nplaum los ntawm tubule lumen, SGLT2 (hom 2 sodium glucose cotransporter), uas tau hais tawm hauv qhov tseeb ntawm lub raum tubules, yog lub luag haujlwm.

    Kanagliflosin - cov tshuaj nquag ntawm Invokana - yog ib qho ntawm cov inhibitors ntawm SGLT2. Thaum SGLT2 yog tshuaj tiv thaiv, muaj ib qho kev txo qis hauv cov ntshav qabzib reabsorption thiab qhov txo qis hauv BCP (lub raum pib rau cov piam thaj), uas yuav pab kom cov ntshav qabzib ntau dhau los ntawm lub raum, uas ua rau cov ntshav plasma glucose concentration nyob rau hauv cov ntshav siv cov tshuaj insulin-ywj siab rau hauv cov neeg mob uas muaj ntshav qab zib 2 mellitus. Tsis tas li, vim muaj kev nce ntxiv ntawm cov ntshav qabzib los ntawm lub raum los ntawm kev tiv thaiv ntawm SGLT2, kev txhim kho ntawm osmotic diuresis tau sau tseg, cov nyhuv diuretic pab txo systolic siab. Tsis tas li ntawd, tawm tsam cov keeb kwm yav dhau los ntawm nce ntxiv ntawm cov piam thaj los ntawm ob lub raum, muaj qhov ua kom poob phaus thiab vim li ntawd, txoj kev poob phaus.

    Thaum ua kev tshawb fawb theem III, kev siv koob tshuaj ntawm 300 mg ntawm Invokana ua ntej noj mov ua rau muaj kev tawm suab ntau ntxiv rau hauv qab postprandial nce ntxiv nyob rau hauv cov piam thaj ntau dua li thaum noj ib koob ntawm 100 mg. Muab cov kev hloov pauv ntau dhau los ntawm cov khoom hauv lub plab hnyuv ua ntej nws nqus, cov nyhuv no yuav cuam tshuam nrog kev cuam tshuam hauv zos hauv kev siv cov hnyuv xa mus rau SGLT1 (canagliflozin yog qhov tshuaj tiv thaiv ntawm cov haujlwm qis SGLT1). Hauv kev kawm siv cov canagliflozin, tsis muaj qabzib malabsorption tsis raug kuaj.

    Tom qab ib qho / ntau qhov ncauj tswj hwm ntawm canagliflozin thaum lub sijhawm kuaj mob hauv cov neeg mob uas muaj ntshav qab zib hom 2 ntshav qab zib, qhov kev txiav txim siab-txo qis hauv lub raum pib rau cov piam thaj thiab ib qho kev nce ntxiv los ntawm cov kua nplaum los ntawm lub raum tau sau tseg. Rau cov piam thaj, tus nqi pib ntawm lub raum pib yog kwv yees li 13 mmol / L, qhov siab tshaj plaws nyob rau qhov nruab nrab txhua hnub lub zog ntawm cov piam thaj yog pom nrog 300 mg ntawm canagliflozin 1 zaug hauv ib hnub thiab yog 4-5 mmol / L. Qhov no qhia tau tias nws muaj kev pheej hmoo ntawm hypoglycemia thaum siv tshuaj kho.

    Thaum siv rau 16 hnub, 100-300 mg ntawm canagliflozin ib zaug ib hnub nyob rau hauv cov neeg mob uas muaj hom 2 mob ntshav qab zib mellitus, muaj qhov txo qis qis rau lub raum nyob rau cov piam thaj thiab ib qho kev nce ntxiv ntawm cov kua nplaum los ntawm lub raum. Hauv qhov no, txo qis ntshav plasma cov piam thaj hauv cov ntshav tau tshwm sim koob tshuaj-nyob rau thawj hnub ntawm txoj kev kho thiab muaj kev nyiam rau yav tom ntej ntawm lub plab khoob thiab tom qab noj mov.

    Ib koob tshuaj 300 mg ntawm Advocana ua ntej cov zaub mov sib xyaw ua rau muaj kev ncua sij hawm ntawm qhov nqus ntawm cov piam thaj hauv qhov hnyuv thiab txo qis postprandial glycemia los ntawm kev ua haujlwm ntxiv thiab lub raum.

    Thaum ua qhov kev tshawb fawb nrog 60 tus neeg tuaj yeem noj qab haus huv, nws tau pom tias noj ib koob tshuaj 300 thiab 1200 mg (4 zaug siab dua qhov kho tau ntau tshaj plaws) tsis ua rau muaj kev hloov pauv tseem ceeb hauv QTc. Qhov siab tshaj plaws ntshav plasma concentration ntawm canagliflozin hauv cov ntshav thaum ua ntawv thov ntawm 1200 mg tshaj qhov tias tom qab ib daim ntawv thov ntawm 300 mg, kwv yees li 1,4 zaug.

    Kev siv cov canagliflozin raws li kev kho mob monotherapy lossis ua ib feem ntawm kev sib xyaw ua ke (nrog kev siv ntawm 1-2 lub qhov ncauj hypoglycemic tus neeg sawv cev), piv nrog placebo, qhov nruab nrab ua rau muaj kev hloov pauv sai ntawm glycemia los ntawm theem pib ntawm –1.2 txog –1.9 mmol / l thiab los ntawm –1.9 txog –2.4 mmol / l nrog 100 thiab 300 mg, ntsig txog. Cov nyhuv no tau ze rau qhov siab tshaj plaws tom qab thawj hnub ntawm txoj kev kho thiab tau mob siab thoob plaws hauv lub sijhawm kho.

    Peb kuj tau kawm txog kev siv canagliflozin raws li kev kho mob monotherapy lossis ua ib feem ntawm kev sib koom ua ke kev kho mob (siv 1-2 lub qhov ncauj hypoglycemic tus neeg sawv cev) rau ntsuas postprandial glycemia tom qab qabzib kam rau ua tiv thaiv ib tus qauv noj tshais ua ke. Txoj kev kho, hauv kev sib piv nrog qib pib, ua rau muaj qhov nruab nrab txo qis ntawm qib postprandial glycemia hauv kev sib raug zoo rau cov placebo los ntawm –1.5 txog –2.7 mmol / L thiab txij li –2.1 txog –3.5 mmol / L thaum noj 100 thiab 300 mg, ntsig txog, uas cuam tshuam nrog txo qis hauv cov piam thaj ua ntej noj mov thiab txo qis rau cov ntshav hloov hauv qib postprandial glycemia.

    Raws li kev tshawb fawb hauv cov neeg mob uas muaj hom 2 mob ntshav qab zib mellitus, kev siv canagliflozin txhim kho txoj haujlwm ntawm beta hlwb (raws li tus qauv ntawm homeostasis hauv kev sib raug zoo nrog kev ua haujlwm ntawm beta hlwb) thiab tus nqi ntawm cov tshuaj insulin secretion (raws li kev kuaj ntshav qabzib nrog kev noj tshais).

    Cov Tshuaj Pharmacokinetics

    Hauv cov ntsiab lus noj qab haus huv, cov kws kho mob ntawm canagliflozin zoo ib yam li cov tshuaj pharmacokinetic ntawm cov tshuaj hauv cov neeg mob ntshav qab zib hom 2. Tom qab ib leeg ntawm qhov ncauj ntawm 100 thiab 300 mg ntawm Invokana los ntawm cov neeg ua haujlwm noj qab haus huv, canagliflozin tau nrawm nrawm, Tmax (lub sijhawm kom mus txog qhov siab tshaj plaws ntawm ib yam khoom) hauv ntshav yog li ntawm 1-2 teev. Ntshav Cmax (qhov siab tshaj plaws ntawm cov tshuaj) thiab AUC (thaj chaw hauv qab nkhaus "kev xav - lub sijhawm") nce sib npaug nrog kev siv cov canagliflozin ntau ntawm koob 50-300 mg. Thaj finite T1/2 (ib nrab-lub neej) thaum siv 100 thiab 300 mg ntawm canagliflozin yog 10.6 thiab 13.1 teev, raws li. Lub xeev kev sib luag yog mus txog 4-5 hnub tom qab pib kev kho mob.

    Lub pharmacokinetics ntawm canagliflozin tsis nyob ntawm lub sijhawm; tom qab siv tas, kev txuam nrog cov khoom hauv plasma nce mus txog 36%.

    Qhov nruab nrab txog kev txiav txim siab nruab nrab ntawm canagliflozin yog li ntawm 65%. Kev siv cov khoom noj nrog cov rog hauv cov rog tsis muaj kev cuam tshuam cov pharmacokinetics ntawm canagliflozin, yog li Invokana tuaj yeem siv nrog lossis tsis noj mov. Txawm li cas los xij, muab lub peev xwm ntawm canagliflozin kom txo tau qhov nce ntxiv ntawm postprandial glycemia vim maj mam nqus ntawm cov piam thaj hauv txoj hnyuv, nws pom zoo kom noj ua ntej noj mov thawj zaug.

    Hauv cov neeg muaj kev noj qab haus huv, tom qab tso ib leeg txoj hlab ntshav, nruab nrab Vd (kev faib khoom ntim) ntawm canagliflozin hauv kev sib npaug yog 119 L, uas yog pov thawj ntawm kev faib ntau hauv cov ntaub so ntswg. Cov tshuaj khi rau cov ntshav plasma protein, feem ntau nrog albumin, rau ntau qhov loj (ntawm qib 99%). Kev sib txuas lus nrog cov protein tsis nyob ntawm qhov ntshav plasma concentration ntawm canagliflozin. Tawm tsam keeb kwm yav dhau los ntawm raum / nplooj siab tsis ua hauj lwm, kev sib raug zoo nrog cov protein ntshav tsis hloov pauv.

    Txoj hauv kev tseem ceeb ntawm canagliflozin metabolism yog O-glucuronidation. Cov txheej txheem feem ntau tshwm sim nrog kev koom tes ntawm UGT1A9 thiab UGT2I34 nrog kev tsim ntawm ob qhov tsis muaj zog O-glucuronide metabolites. Hauv tib neeg, lub oxidative (SURZA4-mediated) metabolism ntawm canagliflozin yog qhov tsawg (kwv yees 7%).

    Tom qab cov neeg siv tshuaj noj ntawm qhov ncauj ntawm 14 C-canagliflozin los ntawm cov neeg ua haujlwm noj qab haus huv, 3.2, 7 thiab 41.5% ntawm kev muab tshuaj rau radioactive hauv daim ntawv ntawm O-glucuronide metabolite, hydroxylated metabolite thiab canagliflozin, ntsig txog, raug kuaj hauv cov quav. Kev nkag mus hauv lub cev yog qhov tseem ceeb.

    Kwv yees li 33% ntawm lub koob tshuaj tiv thaiv kab mob hauv dej muaj nyob hauv cov zis, feem ntau yog siv O-glucuronide metabolites (30.5%). Tsawg dua li 1% ntawm koob tshuaj yog tawm los ntawm lub raum hauv daim ntawv ntawm cov tshuaj tsis hloov pauv. Thaum siv 100 thiab 300 mg ntawm canagliflozin, kev tshem tshuaj raum yog nyob rau thaj tsam ntawm 1.3-1.55 ml / min.

    Canagliflozin yog ib cov tshuaj uas muaj qhov kev tshem tawm tsawg, tom qab kev coj ncaj qha rau hauv cov neeg noj qab haus huv, qhov nruab nrab ntawm qhov kev tshem tawm yog kwv yees li 192 ml / min.

    Kev siv cov canagliflozin nyob rau hauv lub raum ua tsis zoo, qhov xaus ntawm lub raum tsis ua hauj lwm zoo, nrog rau cov neeg mob rau kev lim ntshav, tsis pom zoo, vim nws tsis xav tias cov tshuaj yuav pab tau zoo hauv pawg neeg mob no. Thaum lub caij lim ntshav, tsawg kawg tshem tawm ntawm canagliflozin yog tau sau tseg.

    Hauv cov tsos mob me me mus rau hepatic tsis txaus, kev kho kom haum ntawm Invokana tsis yuav tsum tau ua. Cov neeg mob uas muaj mob rau daim siab hnyav (ntawm Child-Pugh scale-class C) tsis tau sau tseg rau hauv cov tshuaj, vim tsis muaj kev soj ntsuam hauv chaw kho mob nrog nws siv hauv pawg neeg mob no.

    Cov ntu tsis haum ntawm canagliflozin hauv cov menyuam yaus tsis tau kawm.

    Tso npe, cov lus qhia rau siv: hom thiab ntau npaum li cas

    Cov tshuaj ntsiav Invokan yuav tsum noj ntawm qhov ncauj, nyiam dua ua ntej noj tshais, 1 zaug hauv ib hnub.

    Qhov pom zoo kom noj txhua hnub yog 100 lossis 300 mg.

    Yog tias Invokana tau siv los ua lub zog rau cov tshuaj insulin lossis cov neeg sawv cev uas ua kom nws txoj kev tso pa tawm (tshwj xeeb, sulfonylurea derivatives), txhawm rau txo cov kev pheej hmoo ntawm hypoglycemia, cov tshuaj no tuaj yeem raug sau nyob rau hauv qis dua.

    Canagliflozin muaj cov nyhuv diuretic. Cov neeg mob kho nrog diuretics, thiab cov neeg uas lub raum tsis zoo ua haujlwm ntawm qhov mob nyav (nrog kev kho lub siab ntawm 30 mus rau 60 ml / min / 1.73 m 2) thiab hauv cov neeg mob uas laus dua 75 xyoo, kev txhim kho feem ntau ntawm cov kev mob tshwm sim uas cuam tshuam nrog nrog ib qho kev txo qis hauv cov ntim hauv intravascular (piv txwv li ntawm txoj hlab ntshav / orthostatic hypotension, postural kiv taub hau). Pab pawg neeg mob no tau pom zoo kom pib kho nrog ib koob tshuaj 100 mg ib hnub twg. Cov neeg mob uas muaj cov tsos mob ntawm hypovolemia ua ntej pib kho nrog canagliflozin raug pom zoo kom kho tus mob no. Yog tias qhov koob tshuaj 100 mg tau zoo siab rau thiab kev tswj hwm ntxiv ntawm glycemia yog qhov xav tau, nws raug nquahu kom nce qhov koob tshuaj kom txog 300 mg.

    Yog tias koj tsis nco qab noj tshuaj ntxiv ntawm Invokana, koj yuav tsum noj sai li sai tau, tab sis koj yuav tsum tsis txhob noj ob zaug nyob hauv ib hnub.

    Sab sij huam

    Cov teebmeem tsis pom kev zoo thaum lub sijhawm kuaj mob (tshuaj kho mob thiab siv ua ke nrog metformin, sulfonylurea derivatives thiab metformin, nrog rau metformin thiab pioglitazone) nrog rau zaus ntawm ≥ 2% (systematized nyob ntawm qhov nquag ntawm tshwm sim raws li kev faib tawm hauv qab no: ntau zaus - ≥ 1/10, feem ntau - ≥ 1/100 thiab 2), nrog rau tawm tsam keeb kwm ntawm kev siv ua ke nrog voj diuretics saum toj no. Thaum ua qhov kev tshawb fawb txog cov kev pheej hmoo ntawm cov hlab plawv, qhov ntau zaus ntawm cov kev tsis haum loj uas cuam tshuam nrog txo qis ntawm cov ntim hauv intravascular tsis nce ntxiv nrog kev siv Invokana. Cov xwm txheej tsis zoo no ua rau cov neeg xav hloov txoj kev kho tsis txaus ntseeg.

    Kev txhim kho ntawm hypoglycemia thaum kho nrog Invocana ntxiv rau cov tshuaj insulin lossis sulfonylurea derivatives tau tshaj tawm ntau dua, uas yog muaj raws li qhov kev cia siab ntawm qhov nce ntawm hypoglycemia nyob rau hauv rooj plaub uas cov tshuaj uas tsis siv nrog kev txhim kho ntawm tus mob no tau ntxiv rau cov tshuaj insulin lossis tshuaj uas txhim kho nws qhov kev zais.

    Hauv 4.4% ntawm cov neeg mob tau txais 100 mg ntawm canagliflozin, hauv 7% ntawm cov neeg mob tau txais 300 mg ntawm canagliflozin, thiab hauv 4.8% ntawm cov neeg mob placebo, muaj kev nce ntxiv ntawm cov poov tshuaj poov tshuaj concentration (> 5.4 mEq / L thiab siab dua qhov pib siab los ntawm 15%). Cov neeg mob uas lub raum lub raum tsis ua haujlwm ntawm kev mob hnyav qee zaus pom muaj kev nce siab ntau ntxiv ntawm cov poov tshuaj poov tshuaj (feem ntau hauv pawg neeg mob no muaj kev nce siab ntau ntxiv, thiab / lossis lawv tau txais ntau cov tshuaj uas txo cov excretion ntawm potassium - potassium-sparing diuretics thiab angiotensin-hloov enzyme inhibitors). Feem ntau, qhov kev ua txhaum no yog tshwm sim nyob rau hauv qhov thiab tsis tas yuav muaj kev kho tshwj xeeb.

    Hauv thawj 6 lub lis piam ntawm kev kho, ib qho me me (30%) tau pom, piv nrog thawj qib pom nyob rau txhua theem ntawm kev kho, ntau npaum li 2 thiab 4.1% thaum siv 100 thiab 300 mg ntawm canagliflozin, ntsig txog, thaum siv cov placebo - 2.1%. Feem ntau qhov kev tsis zoo no tau hloov mus rau qhov xwm txheej, thiab los ntawm qhov kawg ntawm kev tshawb fawb nws tau sau tseg nyob hauv tus neeg mob tsawg dua. Raws li kev soj ntsuam ua ke ntawm cov neeg mob uas muaj mob hnyav ntawm lub raum tsis ua haujlwm, qhov feem pua ​​ntawm cov neeg mob uas muaj qhov txawv txav ntawm cov kab mob glomerular (> 30%), piv nrog qib pib pom nyob rau txhua ntu ntawm kev kho, yog 9.3 thiab 12.2% thaum siv 100 thiab 300 mg ntawm canagliflozin, ntsig txog, thaum siv cov placebo - 4.9%. Cov kev hloov hauv chav sim tom qab siv ceev xwm txheej ntawm Invokany muaj qhov zoo los yog rov qab mus rau lawv qhov tseem ceeb.

    Ntawm keeb kwm ntawm kev kho canagliflozin, qhov tshuaj tiv thaiv kab mob nce ntxiv nyob rau hauv cov concentration ntawm LDL (tsis tshua muaj lipoproteins tsawg) tau pom. Cov kev hloov pauv nruab nrab hauv qhov ntsuas no ua feem pua ​​ntawm qhov pib siab, piv nrog cov placebo, yog 0.11 mmol / L (4.5%) thiab 0.21 mmol / L (8%) thaum siv 100 thiab 300 mg ntawm canagliflozin, ntsig txog. Qhov nruab nrab thaum pib qhov LDL concentration qhov tseem ceeb nrog 100 thiab 300 mg ntawm canagliflozin thiab cov placebo yog 2.76, 2.7 thiab 2.83 mmol / L, feem.

    Qhov kev nqus ntawm 100 thiab 300 mg ntawm canagliflozin ua rau muaj kev nce siab me ntsis ntawm qhov nruab nrab feem ntau pauv hauv hemoglobin concentration (3.5 thiab 3.8%, feem), piv nrog txo qis me ntsis hauv cov pab pawg ntawm cov neeg mob uas tau siv cov placebo (1.1%). Kev nce piv rau qhov nce ntawm qhov nruab nrab feem pua ​​ntawm cov neeg mob ntshav liab thiab hematocrit tau sau tseg. Hauv feem ntau cov neeg mob, hemoglobin concentration nce (> 20 g / l), qhov kev cuam tshuam no tau pom nyob rau hauv 6% ntawm cov neeg mob tau 100 mg ntawm canagliflozin, thiab hauv 5.5% ntawm cov neeg mob tau txais 300 mg ntawm canagliflozin, zoo li hauv 1% ntawm cov neeg mob placebo-kho. Feem ntau ntawm cov nuj nqis tsis tau mus dhau txoj cai.

    Kev siv 100 thiab 300 mg ntawm canagliflozin ua rau muaj qhov nruab nrab txo qis hauv qhov nruab nrab ntawm kev mob siab ntawm uric acid (los ntawm 10.1 thiab 10.6%, feem), piv nrog cov placebo, kev siv uas pom qhov nce ntawm qhov nruab nrab concentration los ntawm 1.9% ntawm thawj zaug. Cov kev tsis zoo no tau tshwm sim ntau kawg nkaus los yog ze rau qhov kawg ntawm qhov thib rau lub lim tiam ntawm kev kho thiab tau mob siab rau thoob plaws hauv kev siv Invokana. Kuj pom muaj cov neeg tso zis uric acid nyob rau hauv cov zis zoo dua ntxiv. Raws li kev soj ntsuam los ntawm kev sib tham ua ke ntawm kev siv canagliflozin hauv cov koob tshuaj pom zoo, qhov tshwm sim ntawm nephrolithiasis tsis tau nce ntxiv.

    Noj ntau dhau

    Cov kab mob ntawm overdose Invokana tsis paub. Cov neeg noj qab haus huv noj cov tshuaj canagliflozin ib zaug, ncav cuag 1600 mg, thiab cov neeg mob uas muaj ntshav qab zib hom mob ntshav qab zib mellitus - 600 mg ib hnub hauv 2 faib koob tshuaj rau 12 lub lis piam feem ntau tau txais kev tiv thaiv zoo.

    Kev Kho Mob: nws yog qhov qhia tau hais tias qhov kev txhawb nqa ib txwm muaj, piv txwv li, tshem tawm ib qho khoom tsis txaus tawm los ntawm txoj hnyuv plab, kev soj ntsuam kev soj ntsuam thiab kho kev kho mob, suav nrog tus neeg mob lub chaw kuaj mob.

    Thaum lub caij plaub teev roj, canagliflozin tseem tsis tau tawm los. Kev siv tshuaj tua kab mob peritoneal dialysis, cov tshuaj tsis xav tias yuav ua kom tawm tau.

    Cov lus qhia tshwj xeeb

    Kev siv ntawm Invokana hauv cov neeg mob uas muaj hom 1 mob ntshav qab zib mellitus tsis tau kawm, yog li ntawd, nws cov sijhawm teem rau cov neeg mob nyob rau hauv pawg no yog contraindicated.

    Raws li cov txiaj ntsig ntawm kev tshawb fawb pharmacological ntawm kev nyab xeeb, tshuaj lom ntawm kev rov ua dua, genotoxicity, ontogenetic thiab kev muaj me nyuam toxicity, Invokana tsis ua rau muaj kev phom sij tshwj xeeb rau tib neeg.

    Cov nyhuv ntawm canagliflozin ntawm tib neeg kev muaj peev xwm tsis tau kawm. Hauv kev tshawb nrhiav tsiaj, tsis muaj kev cuam tshuam ntawm kev muaj menyuam yaus tau pom.

    Nws tau pom tias canagliflozin thaum siv los ua kev kho mob lossis ntxiv nrog rau cov tshuaj hypoglycemic, uas tsis nrog los ntawm kev txhim kho ntawm hypoglycemia, tsis tshua coj mus rau hypoglycemia. Nws tau tsim tsa hais tias insulin thiab hypoglycemic cov neeg sawv cev uas txhim kho nws cov kev zais cia ua rau muaj qhov tshwm sim ntawm kev mob ntshav qab zib. Nrog Invoquana txoj kev kho, ntxiv rau cov tshuaj zoo li no, qhov kev pheej hmoo ntawm hypoglycemia, piv nrog cov placebo, yog siab dua. Yog li, txhawm rau txo qhov ua tau ntawm kev txo qis ntshav qab zib, nws raug nquahu kom txo cov koob tshuaj insulin lossis ua kom nws txoj kev zais ntshis.

    Canagliflozin, vim yog nce ntxiv ntawm cov kua nplaum los ntawm lub raum, muaj cov diuretic nyhuv thiab ua rau osmotic diuresis, uas tuaj yeem ua rau txo qis hauv cov ntshav hauv lub cev. Hauv kev tshawb fawb soj ntsuam ntawm canagliflozin, kev nce ntxiv ntawm cov zaus cov kev phiv tshuaj uas cuam tshuam nrog qhov kev cuam tshuam no tau pom ntau nyob rau thawj peb lub hlis ntawm kev kho nrog 300 mg ntawm Invocana. Cov neeg mob uas ntxim rau cov kev phiv tshuaj uas cuam tshuam nrog kev txo qis hauv cov hlab ntim ntau ntxiv suav nrog cov neeg mob uas laus dua 75 xyoo, cov neeg mob tau txais lub voj diuretics, thiab cov neeg mob tsis zoo lub raum ua haujlwm ntawm mob hnyav.

    Cov kev mob tshwm sim ntawm qhov kev txo qis hauv cov ntim hauv nruab nrog cev yuav tsum ceeb toom rau tus kws kho mob. Feem ntau qhov no ua rau muaj kev tshem tawm ntawm Invokany. Nrog kev siv txuas ntawm canagliflozin, kev txhim kho ntawm kev coj ntawm cov tshuaj tiv thaiv kabmob (nrog rau cov diuretics) feem ntau xav tau. Ua ntej txoj kev kho mob, cov neeg mob uas txo qis hauv cov ntshav ntim yuav tsum kho cov mob no.

    Cov kev tshawb fawb soj ntsuam tau tshaj tawm tias muaj neeg coob leej ntau tus neeg tsis txaus siab (suav nrog vulvovaginal fungal mob thiab vulvovaginitis) hauv cov poj niam uas tau txais canagliflozin piv nrog cov pab pawg placebo. Cov neeg mob uas muaj keeb kwm mob candidiasis vulvovaginitis muaj feem ntau yuav tsim tus kab mob no. Ntawm cov poj niam kho nrog canagliflozin, 2.3% ntawm lawv qhia kev loj hlob ntawm ntau tshaj ib ntu kev kis tus kab mob. Feem ntau cov kev puas tsuaj no tau tsim tawm thaum thawj plaub lub hlis ntawm kev kho mob nrog Invocana. Cov tshuaj tsis tau ncua tseg vim yog vim muaj neeg mob tsis txaus siab txog qhov mob tawg ntawm 0.7% ntawm txhua tus neeg mob. Hauv cov kev tshawb fawb soj ntsuam, cov hauj lwm zoo ntawm kev kho mob hauv qhov ncauj lossis hauv zos los ntawm tus kws kho mob lossis nqa tawm ntawm nws tus kheej ntawm keeb kwm ntawm kev tswj hwm txuas ntxiv ntawm canagliflozin tau sau tseg.

    Candidiasis balanoposthitis lossis balanitis tau pom ntau dua hauv cov neeg mob uas tau txais Invokana hauv cov koob tshuaj pom zoo, piv nrog cov tshuaj placebo. Ua ntej tshaj plaws, cov kab mob no tau tsim hauv cov txiv neej uas tsis yauv ua kevcai txiav, thiab ntau zaus - hauv cov neeg mob uas muaj keeb kwm muaj mob hnyav. Thaum kho, 0.9% ntawm cov neeg mob tau muaj ntau dua li ib ntu kev kis tus kab mob. Hauv 0.5% ntawm txhua kis, canagliflozin raug tshem tawm vim tias yog candida balanoposthitis lossis balanitis. Hauv kev sim tshuaj, kev kis kab mob yog kho tau feem ntau los ntawm cov tshuaj tua kab mob hauv zos los ntawm kws kho mob lossis nqa lawv tus kheej, yam tsis tas yuav tshem tawm Invokana. Muaj cov ntaub ntawv hais txog cov mob tsis tshua muaj mob phimosis, qee zaum yuav tau phais qhov kev phais mob.

    Thaum ua kev tshawb nrhiav txog cov kev mob plawv hauv 4327 cov neeg mob uas paub tseeb hais tias yog cov kab mob plawv lossis muaj kev pheej hmoo hauv cov hlab plawv, qhov tshwm sim ntawm cov pob txha pob txha yog 16.3, 16.4, thiab 10.8 rau 1000 tus neeg mob-xyoo ntawm kev siv Invokana ntawm koob tshuaj 100 thiab 300 mg thiab hauv cov pab pawg tso nrog, ntsig txog. Qhov tsis txaus ntawm kev saib tsis taus ntawm pob txha lov tshwm sim thaum thawj 26 lub lim tiam ntawm kev kho mob.

    Hauv kev tshuaj ntsuam xyuas ua ke ntawm lwm txoj kev tshawb fawb ntawm cov tshuaj, uas suav txog 5800 cov neeg mob ntshav qab zib mellitus los ntawm cov pej xeem, nrog Invocana kho nyob rau hauv koob tshuaj 100 thiab 300 mg thiab hauv cov placebo pawg, qhov tshwm sim ntawm pob txha pob txha yog 10.8, 12 thiab 14.1 rau 1000 tus neeg mob xyoo ntsig txog.

    Thaum lub sijhawm 104 lub lim tiam ntawm txoj kev kho, cov tshuaj tsis cuam tshuam loj heev rau cov pob txha ntxhia.

    Kev cuam tshuam rau kev muaj peev xwm tsav tsheb thiab cov txheej txheem nyuaj

    Thaum tsav tsheb, nws yog ib qho tsim nyog yuav tsum coj mus rau qhov kev pheej hmoo ntawm lub qog ntshav qab zib nyob rau hauv cov ntaub ntawv ntawm kev siv Invokana ntxiv rau cov tshuaj insulin lossis cov tshuaj uas ua kom nws txoj kev zais, qhov kev pheej hmoo ntawm qhov tsis xav tau cuam tshuam nrog kev txo qis hauv lub ntim ntshav (suav nrog kev qaug zog tom qab), thiab txo qis lub peev xwm tsav tsheb nrog kev txhim kho tsis xav kev tawm tsam.

    Cev xeeb tub thiab lactation

    Kev siv cov canagliflozin hauv cov poj niam cev xeeb tub tsis tau raug kuaj xyuas. Hauv cov kev tshawb fawb tsiaj, tsis muaj cov kev qhia ncaj qha los yog tsis ncaj rau kev ua rau muaj kev muaj me nyuam tau tsim. Txawm li cas los xij, Invocana tsis raug hais kom ua thaum cev xeeb tub.

    Raws li muaj cov tshuaj pharmacodynamic / toxicological cov ntaub ntawv tau thaum lub sijhawm kev tshawb nrhiav, canagliflozin hla mus rau niam mis. Hauv qhov no, thaum pub niam mis, siv cov tshuaj invokany yog contraindicated.

    Thaum tsis ua haujlwm lub raum

    Invokan ntsiav tshuaj rau lub raum tsis ua haujlwm yog contraindicated.

    Hauv cov kab mob ntshav qab zib ketoacidosis, thaum kawg kev mob raum tsis ua haujlwm thiab hauv cov neeg mob rau kev lim ntshav, kev siv Invokana yuav tsis muaj txiaj ntsig, yog li, nws lub hom phiaj hauv pawg neeg mob no tsis tsim nyog.

    Yeeb tshuaj sib cuam tshuam

    Kanagliflozin hauv kev coj noj coj ua ntawm tib neeg hepatocytes tsis ntxias cov lus qhia ntawm CYP450 system isoenzymes (ZA4, 2C9, 2C19, 1A2 thiab 2B6). Nws kuj, raws li kev kuaj sim siv tib neeg lub siab microsomes, tsis inhibit cytochrome P isoenzymes450 (IA2, 2A6, 2C19, 2E1 lossis 2B6) thiab tsis muaj zog tiv thaiv CYP2B6, CYP2C8, CYP3A4, CYP2C9. Canagliflozin yog lub zog nruab nrab ntawm UGT2B4 thiab UGTIA9 cov enzymes uas metabolize tshuaj, thiab cov tshuaj thauj neeg P-gp (P-glycoprotein) thiab MRP2. Canagliflozin yog ib qho ntawm qhov ua kom tsis muaj zog ntawm P-gp. Cov khoom undergoes oxidative metabolism tsawg. Yog li no, cov chaw kho mob tseem ceeb ntawm lwm cov tshuaj los ntawm cytochrome P system tsis zoo li450 nyob rau pharmacokinetics ntawm canagliflozin.

    Raws li cov ntaub ntawv soj ntsuam, nws tuaj yeem suav tias qhov tshwm sim ntawm kev sib txuam tseem ceeb nrog cov tshuaj noj hauv kev sib xyaw nrog Invocana yog tsawg.

    Nrog rau kev siv ua ke nrog rifampicin, kis ntawm canagliflozin thiab, vim li ntawd, nws cov hauj lwm tau txo. Yog tias nws yuav tsum tau siv ib txhij nrog rifampicin thiab lwm yam inducers ntawm UGT tsev neeg ntawm cov enzymes thiab cov tshuaj nqa tshuaj (suav nrog phenytoin, phenobarbital, ritonavir) hauv cov neeg mob tau txais 100 mg ntawm canagliflozin, nws yog qhov tsim nyog los tswj kev xav ntawm glycated hemoglobin НbA1sCov. Yog tias xav tau glycemic tswj ntxiv, xav txog kev nce qib ntawm canagliflozin rau 300 mg.

    Hauv cov kev tshawb fawb soj ntsuam, canagliflozin tsis muaj kev cuam tshuam loj heev rau cov qauv pharmacokinetic ntawm metformin, qhov ncauj tiv thaiv kab mob (ethinyl estradiol thiab levonorgestrel), simvastatin, glibenclamide, warfarin lossis paracetamol.

    Canagliflozin thaum ua ke nrog digoxin me ntsis cuam tshuam nws cov ntshav plasma concentration, uas yuav tsum muaj kev soj ntsuam kom zoo.

    Cov yeeb yaj kiab ntawm Invokany yog Forsyga, Jardins.

    Dosage daim ntawv

    100 mg thiab 300 mg zaj duab xis-ntsiav tshuaj

    Hauv 1 lub ntsiav tshuaj, zaj duab xis-coated 100 mg muaj:

    102 mg ntawm canagliflozin hemihydrate yog sib npaug rau 100 mg ntawm canagliflozin.

    Excipients (tub ntxhais): microcrystalline cellulose, anhydrous lactose, croscarmellose sodium, hydroxypropyl cellulose, magnesium stearate.

    Excipients (plhaub): Opadry II 85F92209 daj: polyvinyl cawv, ib nrab hydrolyzed, titanium dioxide (E171), macrogol / polyethylene glycol 3350, talc, hlau oxide daj (E172).

    Hauv ib qho 300 mg zaj duab xis-ntsiav tshuaj muaj:

    306 mg ntawm canagliflozin hemihydrate yog sib npaug rau 300 mg ntawm canagliflozin.

    Excipients (tub ntxhais): microcrystalline lactose anhydrous cellulose, croscarmellose sodium, hydroxypropyl cellulose, magnesium stearate.

    Excipients (plhaub): Opadry II 85F18422 dawb: cawv

    polyvinyl, qee cov hydrolyzed, titanium dioxide (E171), macrogol / polyethylene glycol 3350, talc.

    Rau qhov ntau npaum ntawm 100 mg: ntsiav tshuaj, zaj duab xis-coated xim daj, tshuaj ntsiav zoo li tus duab, engraved nrog "CFZ" ntawm ib sab thiab "100" ntawm lwm yam.

    Rau qhov ntau npaum ntawm 300 mg: zaj duab xis-ntsiav tshuaj los ntawm dawb mus rau yuav luag dawb, tshuaj ntsiav zoo li tus, txho nrog "CFZ" ntawm ib sab thiab "300" ntawm lwm yam.

    Cov chaw muag tshuaj

    Cov Tshuaj Pharmacokinetics

    Cov kws kho mob ntawm canagliflozin hauv cov neeg muaj kev noj qab haus huv zoo ib yam li cov pharmacokinetics ntawm canagliflozin hauv cov neeg mob ntshav qab zib hom 2. Tom qab kev noj tshuaj ib qhov ncauj ntawm 100 mg thiab 300 mg los ntawm cov neeg ua haujlwm noj qab haus huv, canagliflozin nrawm nrawm, qhov siab tshaj plaws ntshav ntshav (nruab nrab Tmax) tau tiav 1-2 teev tom qab koob tshuaj. cov tshuaj. Qhov ntshav siab tshaj plaws ntawm Cmax thiab AUC ntawm canagliflozin ntau ntxiv nrog kev siv cov koob tshuaj ntawm 50 mg rau 300 mg. Pom meej kawg ib nrab-lub neej (t1 / 2) (qhia raws li iation qauv kev sib txawv) yog 10.6 ± 2.13 teev thiab 13.1 ± 3.28 teev thaum siv tshuaj 100 mg thiab 300 mg, ntsig txog. Qhov sib luag siab zoo tau ncav cuag 4-5 hnub tom qab pib txoj kev kho canagliflozin ntawm koob tshuaj 100-300 mg ib hnub ib zaug.

    Lub pharmacokinetics ntawm canagliflozin tsis nyob ntawm lub sijhawm. Kev sib txuam ntawm cov tshuaj hauv plasma ncav cuag 36% tom qab kev rov ua dua.

    Xuas

    Qhov nruab nrab txog kev txiav txim siab nruab nrab ntawm canagliflozin yog kwv yees li 65%. Noj cov zaub mov muaj roj ntau hauv lub cev tsis muaj kev cuam tshuam cov pharmacokinetics ntawm canagliflosin, yog li canagliflosin tuaj yeem noj nrog lossis tsis noj mov. Txawm li cas los xij, ua tib zoo xav txog kev muaj peev xwm ntawm canagliflozin los txo cov kev hloov pauv hauv postprandial glycemia vim tias kev qeeb ntawm kev nqus ntawm cov piam thaj hauv txoj hnyuv, nws raug nquahu kom noj canagliflozin ua ntej noj mov thawj zaug.

    Kev xa Khoom

    Qhov nruab nrab siab tshaj plaws ntawm canagliflozin hauv kev sib npaug tom qab ib leeg ntawm cov leeg ntshav ntawm cov tib neeg noj qab haus huv yog 119 l, uas qhia tau hais tias muaj kev faib tawm ntau hauv cov ntaub so ntswg. Canagliflosin lom zem ntau cuam tshuam nrog cov protein plasma (99%), feem ntau yog nrog albumin. Kev cog lus tiv thaiv protein yog ywj siab ntawm ntshav concentration ntawm canagliflozin. Plasma protein khi tsis hloov pauv ntau hauv cov neeg mob raum lossis mob rau daim siab.

    Kev zom zaub mov

    Txoj hauv kev tseem ceeb ntawm metabolic excretion ntawm canagliflozin yog O-glucuronidation, uas tau ua los ntawm UGT1A9 thiab UGT2B4 ntau rau ob qho tsis muaj zog O-glucuronide metabolites. Cov metabolism hauv ntawm canagliflozin sib kho los ntawm CYP3A4 (oxidative metabolism) hauv tib neeg yog qhov tsis lees paub (kwv yees li 7%).

    Hauv kev tshawb fawb hauvvitro canagliflozin tsis tiv thaiv qhov kev tawm tsam ntawm cytochrome P450 system CYP1A2, CYP2A6, CYP2C19, CYP2D6 lossis CYP2E1, CYP2B6, CYP2C8, CYP2C9 thiab tsis paub CYP1A2, CYP2 Clinically tseem ceeb ua rau lub siab ntawm CYP3A4 hauvvivo tsis tau pom (saib Tshooj "Kev sib tshuam tshuaj").

    Chaw Sau Ntawv

    Tom qab ib qho kev tswj hwm ntawm qhov ncauj ntawm 14C canagliflozin hauv cov neeg tuaj yeem noj qab haus huv, 41.5%. 7.0% thiab 3.2% ntawm cov koob tshuaj uas lees txais tau raug tso nrog quav hauv daim ntawv canagliflozin, hydroxylated metabolite thiab O-glucuronide metabolite, feem. Enterohepatic recirculation ntawm canagliflozin yog qhov tsis lees paub.

    Kwv yees li 33% feem pua ​​ntawm cov tshuaj kua hluav taws xob tau lees tawm hauv cov zis, feem ntau yog siv O-glucuronide metabolites (30.5%). Tsawg dua li 1% ntawm kev noj tshuaj tau muab tshem tawm uas tsis pauv li canagliflozin hauv cov zis. Lub raum tshem tawm ntawm canagliflozin thaum siv nyob rau hauv koob tshuaj 100 mg thiab 300 mg thaj tsam li ntawm 1.30 ml / min txog 1.55 ml / min.

    Canagliflozin yog ib qho khoom siv nrog kev tshem tawm tsawg tsawg, thaum nruab nrab qhov nruab nrab ntawm kev tshem tawm hauv cov neeg tuaj yeem noj qab haus huv tom qab kev tso dej tawm yog li 192 ml / min.

    Cov pab pawg neeg tshwj xeeb

    Cov neeg mob uas lub raum tsis ua hauj lwm zoo

    Hauv kev qhib ib qho kev tshawb nrhiav ib zaug, cov pharmacokinetics ntawm canagliflozin tau kawm thaum thov ntawm 200 koob tshuaj rau cov neeg mob uas lub raum tsis ua haujlwm ntawm qhov sib txawv (raws li kev faib tawm raws qib ntawm kev tsim cov tshuaj tawm tswv yim los ntawm cov mis Cockcroft-Gault) piv nrog cov neeg noj qab haus huv. Txoj kev tshawb no koom nrog 8 cov neeg mob uas lub raum lub cev rov ua haujlwm (creatinine tshem tawm ≥ 80 ml / min), 8 tus neeg mob raum tsis ua haujlwm me me (creatinine tshem tawm 50 ml / min -10% thiab ≤12%

    Hauv kev tshawb nrhiav nrog cov neeg mob uas muaj qhov theem qis HbA1c> 10% thiab ≤ 12% thaum siv canagliflozin raws li kev kho mob monotherapy, qhov txo qis hauv HbA1c qhov tseem ceeb piv rau lub hauv paus (tsis muaj kev kho cov placebo) los ntawm -2.13% thiab -2.56% rau canagliflozin hauv koob tshuaj ntawm 100 mg thiab 300 mg, ntsig txog.

    Lub Koom Haum European rau Kev Tshuaj Ntsuam Xyuas Qhov Zoo ntawm Cov Tshuaj tso cai muaj txoj cai tsis muab cov txiaj ntsig ntawm kev tshawb fawb ntawm cov tshuaj Invocana® nyob rau txhua pawg neeg ntawm cov menyuam yaus uas muaj ntshav qab zib hom 2 (cov ntaub ntawv hais txog kev siv hauv cov menyuam yaus raug nthuav tawm hauv nqe "Txoj Kev Siv thiab Koob Tshuaj").

    Kev ntsuas rau siv

    Txhim kho glycemic tswj hauv kev kho mob hom 2 mob ntshav qab zib rau cov neeg mob laus:

    - rau cov kev noj haus uas tsis zoo thiab kev tawm dag zog lub cev tsis muab glycemic tswj tau txaus thiab kev siv cov metformin yog suav tias yog qhov tsis tsim nyog lossis cuam tshuam.

    - raws li ib qho khoom siv ntxiv nrog rau lwm cov tshuaj ua kom ntshav qab zib, nrog rau cov insulin, thaum lawv, ua ke nrog kev noj zaub mov zoo thiab ua haujlwm lub cev, tsis muaj kev tswj glycemic txaus.

    Tsuas tshuaj thiab tswj hwm

    Invocana® yuav tsum noj qhov ncauj ib hnub ib zaug, nyiam dua ua ntej noj mov thawj zaug.

    Cov neeg muaj hnub nyoog (≥ 18 xyoo)

    Qhov pom zoo kom pib koob Invocan® yog 100 mg ib hnub ib zaug. Cov neeg mob uas zam 100 mg ntawm cov tshuaj zoo ib hnub ib zaug rau tus neeg uas kwv yees tus nqi glomerular pom (rSCF) ≥ 60 ml / min. / 1.73 m2 lossis creatinine tshem tawm (CrCl) ≥ 60 ml / min., Thiab leej twg xav tau kev nruj dua ntshav qabzib tswj, koob tshuaj yuav raug nce ntxiv rau 300 mg ib hnub ib zaug (saib hauv tshooj "Cov lus qhia tshwj xeeb").

    Nws yog ib qho tsim nyog yuav tau soj ntsuam qhov nce ntxiv ntawm cov tshuaj rau cov neeg mob hnub nyoog ≥ 75 xyoo, cov neeg mob uas muaj kab mob ntawm cov hlab plawv, lossis lwm tus neeg mob rau tus neeg mob thawj zaug mob los ntawm kev noj Invokana® yog qhov muaj pheej hmoo (saib ntu "Cov Lus Qhia Tshwj Xeeb"). Rau cov neeg mob uas lub cev qhuav dej, pom zoo kom kho tus mob no ua ntej noj tshuaj Invokana® (saib nqe lus "Cov lus qhia tshwj xeeb").

    Thaum siv cov tshuaj Invokana® los ua cov tshuaj rau cov tshuaj insulin lossis cov tshuaj tiv thaiv cov tshuaj tiv thaiv kab mob (piv txwv li, sulfonylurea kev npaj), txhawm rau txo kev pheej hmoo ntawm hypoglycemia, kev siv tshuaj qis ntawm cov tshuaj saum toj no yuav raug txiav txim siab (saib ntu "Kev Sib Cuam Tshuam Tshuaj" thiab "Cov Kev Phom Ntawm Sab") Cov.

    Cov neeg laus cov neeg mob ≥ 65 xyoo

    Kev ua haujlwm hauv lub raum thiab qhov kev pheej hmoo ntawm lub cev qhuav dej yuav tsum tau suav rau hauv (saib "Cov Lus Qhia Tshwj Xeeb").

    Cov neeg mob raum tsis ua haujlwm

    Rau cov neeg mob eGFR ntawm 60 ml / min / 1.73 m2 txog 30%) txhua lub sijhawm thaum kho yog 9.3%, 12.2% thiab 4.9% ntawm cov uas noj 100 mg, 300 mg canagliflozin thiab cov placebo, ntsig txog. Thaum kawg ntawm txoj kev tshawb no, qhov kev txo qis hauv tus nqi no tau pom nyob hauv 3.0% ntawm cov neeg mob uas tau noj 100 mg ntawm canagliflozin, 4.0% ntawm cov uas noj 300 mg, thiab 3.3% ntawm cov placebo (saib Ntu "Cov Lus Qhia Tshwj Xeeb").

    Cov tshuaj sib cuam tshuam

    Canagliflozin tuaj yeem txhim kho cov nyhuv ntawm diuretics, zoo li ua rau muaj kev pheej hmoo ntawm lub cev qhuav dej thiab mob hypotension (saib ntu "Cov lus qhia tshwj xeeb").

    Kev tsim cov tshuaj insulin thiab insulin secretion

    Kev tsim tshuaj insulin thiab tshuaj insulin secretion, xws li sulfonylureas, tuaj yeem ua rau mob ntshav qab zib tsawg.

    Yog li, txhawm rau txo cov ntshav qog ntshav qab zib, nws yog ib qho tsim nyog yuav tau txo qhov koob tshuaj insulin lossis kev txhawb zog ntawm insulin secretion thaum siv ua ke nrog canagliflozin (saib ntu "Dosage thiab Administration" thiab "Side Effects").

    Cawv lwm cov tshuaj ntawm canagliflozin

    Kev zom zaub mov ntawm canagliflozin yog feem ntau vim yog kev sib txuas nrog glucuronides, kev sib kho los ntawm UDP-glucuronyl transferase 1A9 (UGT1A9) thiab 2B4 (UGT2B4). Canagliflozin yog nqa los ntawm P-glycoprotein (P-gp) thiab cov protein tiv thaiv mob cancer mis (BCRP).

    Enzyme Inductors (xws li St. John's Wort) Hypericumperforatum, rifampicin, barbiturates, phenytoin, carbamazepine, ritonavir, efavirenz) tuaj yeem ua rau txo qis dua rau canagliflozin. Tom qab tib lub sijhawm siv canagliflozin thiab rifampicin (ib qho inducer ntawm ntau cov neeg thauj khoom nquag thiab cov enzymes koom nrog tshuaj metabolism), qhov txo qis ntawm cov kab ke ntawm canagliflozin los ntawm 51% thiab 28% (thaj chaw nkhaus, AUC) thiab qhov siab tshaj (concentration) (Cmax). Xws li ib qho kev txo qis tuaj yeem ua rau txo qis ntawm qhov txiaj ntsig ntawm canagliflozin.

    Yog tias nws yog ib qho tsim nyog yuav tsum tau siv ib lub inducer ntawm cov UDP enzymes thiab thauj cov protein thiab canagliflozin, nws yog qhov tsim nyog los tswj qib qabzib kom soj ntsuam cov lus teb rau canagliflozin. Yog tias nws yuav tsum tau siv qhov inducer ntawm cov UDF enzymes ua ke nrog canagliflozin, qhov koob tshuaj tau nce rau 300 mg ib hnub ib zaug, yog tias muaj kev zam zoo los ntawm cov neeg mob 100 mg ntawm canagliflozin ib zaug ib hnub, lawv tus nqi rSCF yog ≥ 60 ml / min. / 1,73 m2 los yog CrCl ≥ 60 ml / min., thiab lawv xav tau kev tswj ntxiv ntawm cov piam thaj hauv ntshav. Rau cov neeg mob uas muaj eGFR ntawm 45 ml / min / 1.73 m2 lossis tsawg dua 60 ml / min / 1.73 m2 lossis CrCl ntawm 45 ml / min. thiab tsawg dua 60 ml / min., thiab uas siv 100 mg ntawm canagliflozin, thiab tseem yauv ua kev kho mob nrog UDF-enzyme stimulator, thiab leej twg xav tau tswj ntshav qabzib ntxiv, lwm hom kev kho yuav tsum raug txiav txim siab kom txo cov ntshav qabzib (saib ntu "Dosage thiab administration" thiab "Cov lus qhia tshwj xeeb").

    Cholestyramine tuaj yeem txo qis qis canagliflozin ntau. Canagliflozin yuav tsum noj tsawg kawg ib teev ua ntej lossis 4-6 teev tom qab siv cov kua tsib tsib ntu ua kom tsawg li qhov cuam tshuam ntawm lawv qhov kev nqus.

    Kev tshawb fawb los ntawm kev sib piv tau qhia tias metformin, hydrochlorothiazide, tshuaj tiv thaiv qhov ncauj (ethinyl estradiol thiab levonorgestrol), cyclosporine thiab / lossis probenecid tsis cuam tshuam rau pharmacokinetics ntawm canagliflozin.

    Cov nyhuv ntawm canagliflozin ntawm lwm cov tshuaj

    Digoxin: kev siv ib txhij ntawm canagliflozin ntawm koob tshuaj 300 mg ib zaug ib hnub rau 7 hnub nrog kev siv 0.5 mg ntawm digoxin ua raws kev siv tshuaj 0.25 mg rau ib hnub rau 6 hnub ua rau muaj kev nce ntxiv hauv AUC ntawm digoxin los ntawm 20% thiab nce Cmax los ntawm 36 %%, tej zaum vim yog los ntawm inhibition of P-gp. Canagliflozin tau pom tias inhibit P-gp hauvvitroCov. Cov neeg mob noj digoxin thiab lwm yam kev mob plawv glycosides (piv txwv li, digitoxin) yuav tsum tau kuaj xyuas kom haum.

    Dabigatran: kev siv ua ke ntawm canagliflozin (qhov tsis muaj zog P-gp inhibitor) thiab dabigatran etexilate (P-gp substrate) tsis tau kawm. Txij li thaum lub siab ntawm dabigatran tuaj yeem nce hauv muaj cov canagliflozin, nrog rau kev siv ua keigatran thiab canagliflozin tib lub sijhawm, nws yog ib qhov tsim nyog los soj ntsuam tus neeg mob (kom tshem tawm cov cim los ntshav lossis ntshav liab).

    Simvastatin: kev siv ua ke ntawm 300 mg ntawm canagliflozin ib zaug ib hnub rau 6 hnub thiab ib daim ntawv thov ntawm 40 mg ntawm simvastatin (substrate CYP3A4) ua rau muaj kev nce ntxiv hauv AUC ntawm simvastatin los ntawm 12% thiab nce rau Cmax los ntawm 9%, thiab ntxiv rau AUC ntawm simvastatin acid los ntawm 18% thiab nce Cmax ntawm simvast acid los ntawm 26%. Xws li nce hauv simvastatin thiab simvastatin acid ntau tsis suav hais tias yog kev kho mob tseem ceeb.

    Kev txwv tsis pub muaj cov kab mob qog mis tiv thaiv kab mob cancer mis (BCRP) nyob rau hauv kev cuam tshuam ntawm canagliflozin nyob rau hauv txoj hnyuv tsis tuaj yeem tswj tau, thiab yog li nws muaj peev xwm nce qhov kev nce siab ntawm cov tshuaj thauj los ntawm BCRP, piv txwv li, qee yam statins, xws li rosuvastatin thiab qee cov tshuaj anticancer.

    Hauv kev kawm txog kev sib cuam tshuam ntawm canagliflozin hauv kev muaj peev xwm sib npaug, tsis muaj kev cuam tshuam los ntawm lub chaw muag tshuaj ntawm metformin, tshuaj tiv thaiv qhov ncauj (ethinyl estradiol thiab levonorgestrol), glibenclamide, paracetamol, hydrochlorothiazide thiab warfarin.

    Kev sib cuam tshuam rau yeeb tshuaj / cuam tshuam rau kev sim tau

    Kev suav ntawm 1,5-AG

    Kev nce ntxiv tso zis tawm thaum siv canagliflozin tuaj yeem ua rau kev tsim cov qib tsis txaus ntseeg ntawm 1,5-anhydroglucite (1,5-AH), vim qhov kev tshawb nrhiav 1,5-AH poob lawv qhov kev cia siab rau kev soj ntsuam kev tswj glycemic. Hauv qhov no, qhov kev txiav txim siab ntau ntau ntawm 1,5-AH yuav tsum tsis txhob siv los ua qauv rau kev ntsuas ntsuas glycemia tswj nyob rau hauv cov neeg mob tau txais Invokana®. Yog xav paub cov ntaub ntawv ntxaws ntxiv, nws raug nquahu kom tiv toj cov tuam ntxhab ntawm cov tshuab ntsuas kom paub txiav txim 1,5-AH.

    Chaw tsim tshuaj paus

    Janssen-Ortho LLC, Gurabo, Puerto Rico

    Pob Ntawv

    Janssen-Silag S.p.A., Ltalis

    Tus tswv ntawm daim ntawv pov thawj rau npe:

    Johnson & Johnson LLC, Russia.

    Chaw nyob ntawm lub koom haum lees txais kev thov nyiaj los ntawm cov neeg siv khoom ntawm cov khoom lag luam zoo (cov khoom lag luam) thiab lub luag haujlwm rau kev tso npe tom qab kev soj ntsuam kev nyab xeeb tshuaj nyob hauv thaj chaw ntawm koom pheej ntawm Kazakhstan

    Ncau ceg ntawm LLC Johnson & Johnson hauv koom pheej ntawm Kazakhstan

    050040, Almaty, st. Timiryazev, 42, pavilion No. 23 "A"

    Invokana (canagliflozin): cov lus qhia, tshuaj xyuas

    Tshuaj invokana yog qhov tsim nyog rau kev kho mob ntshav qab zib hom 2 rau cov neeg laus. Txoj kev kho yuav tsum muaj kev sib xyaw nrog kev noj zaub mov nruj, nrog rau kev tawm dag zog ib txwm.

    Glycemia yuav tau txais txiaj ntsig zoo dua ua tsaug rau kev kho mob monotherapy, nrog rau kev kho mob ua ke nrog lwm tus neeg mob hypoglycemic.

    Cov txheej txheem sib txuas thiab cov yam ntxwv ntawm kev siv

    Cov tshuaj Invokana tsis tuaj yeem siv rau hauv cov xwm txheej zoo li no:

    • cov tshuaj tiv thaiv hypersensitivity rau canagliflozin lossis lwm yam khoom uas tau siv los ua tus pab,
    • ntshav qab zib hom 1
    • mob ketoacidosis,
    • mob raum tsis ua haujlwm
    • mob siab mob siab,
    • cev xeeb tub thiab lactation,
    • cov me nyuam hnub nyoog qis dua 18 xyoo

    Thaum cev xeeb tub thiab kev pub niam mis, kev tshawb fawb ntawm lub cev lub cev teb rau tshuaj tau tsis tau ua. Hauv kev sim tsiaj, nws tsis pom tias canagliflozin muaj qhov tsis ncaj lossis teebmeem lom rau lub cev yug menyuam.

    Txawm li cas los xij, txawm li cas los xij, kev siv cov tshuaj los ntawm cov poj niam thaum lub sijhawm no ntawm lawv lub neej yog qhov tsis tau pom zoo, vim tias lub ntsiab tseem ceeb muaj peev xwm nkag mus rau cov kua mis thiab tus nqi ntawm cov kev kho mob ntawd yuav tsis ncaj.

    Tso cov ntaub ntawv thiab cov nyob ua ke

    Qhov sib xyaw ntawm cov ntsiav tshuaj muaj xws li canagliflozin hemihydrate nyob rau hauv ib qho nyiaj npaum li 100-300 mg ntawm canagliflozin. Txoj kev sib xyaw ua ke ntawm cov ntu pabcuam suav nrog cov tshuaj uas kho cov qauv ntawm cov ntsiav tshuaj thiab pab txhawb kev faib khoom ntawm cov tshuaj nquag hauv lub cev.

    Muaj nyob rau hauv daim ntawv ntawm ntsiav tshuaj ntawm 100 lossis 300 mg, zaj duab xis-coated nrog ib tug daj zas. Txhua lub ntsiav tshuaj muaj qhov phom sij ua rau tawg.

    Pharmacological kev txiav txim

    Nws muaj cov nyhuv hypoglycemic. Canagliflozin yog hom 2 sodium glucose cotransporter inhibitor. Tom qab ib koob tshuaj, cov tshuaj tsub kom muaj qhov tsis pom qabzib ntau dhau ntawm ob lub raum, uas yuav pab txo nws cov ntshav hauv cov ntshav. Cov tshuaj yog siv los kho cov mob ntshav qab zib tsis yog insulin. Tsis nce ntxiv insulin secretion.

    Cov tshuaj yog siv los kho cov mob ntshav qab zib tsis yog insulin.

    Nce diuresis, uas tseem ua rau cov ntshav qab zib kom tsawg. Cov kev tshawb fawb soj ntsuam qhia tias kev siv tshuaj txhua hnub txo qis lub ntsej muag ntawm lub ntsej muag thiab ua rau nws nyob tas mus li. Kev siv cov tshuaj canagliflozin txo cov glycemia tom qab noj zaub mov. Kev kho sai sai kom tshem tawm cov piam thaj nyob rau hauv cov hnyuv.

    Hauv kev tshawb nrhiav, nws tau ua pov thawj tias kev siv Invokana los ua kev kho tus mob monotherapy lossis ua ib qho txuas rau kev kho mob nrog lwm cov tshuaj hypoglycemic, piv nrog cov placebo, pab txo glycemia ua ntej noj mov los ntawm 1.9-2.4 mmol ib liter.

    Kev siv tshuaj noj pab txo glycemia tom qab sim ua siab zoo lossis ua tshais xyaw ua ke. Kev siv cov canagliflozin txo cov ntshav qabzib los ntawm 2.1-3.5 mmol ib liter. Hauv qhov no, cov tshuaj yuav pab txhim kho lub xeev ntawm beta hlwb hauv cov txiav thiab nce lawv cov lej.

    Los ntawm cov kab mob zis

    Tej zaum qhov ua txhaum cai ntawm kev ua haujlwm tsis zoo ntawm lub raum hauv daim ntawv ntawm nquag tso zis thiab tso kua ntau ntawm cov dej. Tus neeg mob haus dej haus dej haus cawv hauv qhov dej hloov pauv, thiab nws pib siv cov kua dej ntau. Yuav tsum tau yaum kom hnyav ntxiv, qhia tias tsis muaj zis nyob rau hauv lub zais zis.

    Tej zaum qhov ua txhaum cai ntawm kev ua haujlwm tsis zoo ntawm lub raum hauv daim ntawv ntawm nquag tso zis thiab tso kua ntau ntawm cov dej.

    Ntawm ib sab ntawm daim siab thiab cov hnyuv

    Tsis ua rau lub siab puas tsuaj thiab hloov pauv hauv cov haujlwm ntawm daim siab enzymes.

    Qee qhov xwm txheej, nws ua rau pom qhov tshwm sim ntawm kev tsis haum ntawm daim tawv nqaij ua pob lossis ua tawv nqaij.

    Qee qhov xwm txheej, nws ua rau pom qhov tshwm sim ntawm kev tsis haum ntawm daim tawv nqaij ua pob.

    Siv thaum cev xeeb tub thiab lactation

    Lub hom phiaj ntawm cov tshuaj no thaum lub caij xeeb tub thiab kev pub mis niam tsis pom. Txawm hais tias kev tshawb fawb tsiaj tsis pom muaj kev cuam tshuam tsis zoo ntawm cov tshuaj ntawm cov menyuam hauv plab, cov kws kho mob poj niam thiab cov kws kho mob tsis pom zoo kom siv cov ntsiav tshuaj thaum coj tus menyuam.

    Kev siv tshuaj kho mob kuj tseem raug txwv tsis pub siv lub sijhawm lactation, vim tias cov tshuaj ua kom lub cev muaj peev xwm nkag mus rau hauv niam mis thiab ua rau lub cev ntawm tus menyuam mos.

    Kev siv tshuaj kho mob kuj tseem raug txwv tsis pub siv lub sijhawm lactation, vim tias cov tshuaj ua kom lub cev muaj peev xwm nkag mus rau hauv niam mis thiab ua rau lub cev ntawm tus menyuam mos. Cov nyhuv ntawm cov tshuaj nyob rau fertility tsis tau kawm.

    Kev cuam tshuam nrog lwm yam tshuaj

    Cov tshuaj hloov me ntsis hloov qhov kev nkag siab ntawm digoxin hauv cov ntshav ntshav. Cov neeg noj cov tshuaj no yuav tsum tau ceev faj tshwj xeeb thiab hloov cov tshuaj kom ncav sijhawm.

    Tej zaum me ntsis hloov kev nqus thiab kev zom zaub mov ntawm Levonorgestrel, Glibenclamide, Hydrochlorothiazide, Metformin, Paracetamol.

    Cov neeg mob tshwj xeeb

    Raws li twb tau sau tseg, cov menyuam ntawm Invokan tsis pom zoo siv vim tias qhov tseeb tias qhov ua tau zoo thiab kev nyab xeeb ntawm kev kho mob zoo li no tsis tau tsim.

    Hauv lub hnub nyoog laus, cov koob tshuaj thawj zaug yuav yog 100 mg ib zaug. Yog tias kev thev taus yog qhov txaus siab, tom qab ntawd cov neeg mob yuav tsum hloov mus rau ib koob tshuaj txog 300 ml, tab sis yuav raug tswj ntxiv ntawm glycemia.

    Yog tias tsis muaj zog hauv lub raum, tsis tas yuav tsum kho qhov ntim ntawm cov tshuaj.

    Yog tias muaj qhov tsis zoo ntawm lub raum kev ua haujlwm (mob hnyav ntawm qhov hnyav), tus kws kho mob yuav pom zoo kom siv cov tshuaj Invokana hauv thawj zaug ntawm 100 mg rau ib hnub. Nrog kev sib nkag siab tsim nyog thiab kev tswj hwm ntxiv ntawm cov ntshav qab zib hauv lub cev, cov neeg mob yuav raug hloov mus rau ib koob ntawm 300 mg ntawm canagliflozin. Nws yog ib qho tseem ceeb uas tswj tau qab zib. siv lub cuab yeej los ntsuas nws. Tab sis dab tsi yog qhov zoo tshaj plaws glucometer los siv, peb tsab xov xwm ntawm lub vev xaib yuav qhia.

    Cov tshuaj yog contraindicated rau kev siv los ntawm pab pawg ntawm cov neeg mob nyob rau hauv uas cov neeg kawm tiav ntawm lub raum tsis ua haujlwm loj. Yog hais tias cov theem ntawm chav kawm ntawm lub raum tsis ua haujlwm yog lub davhlau ya nyob twg, ces hauv qhov xwm txheej no kev siv canagliflozin yuav tsis muaj txiaj ntsig. Tib txoj cai no yuav siv rau cov neeg mob uas ib txwm rov lim ntshav.

    Sab sij huam tshuaj

    Cov kev tshawb fawb kho mob tshwj xeeb tau tshawb xyuas los sau cov ntaub ntawv qhia txog kev phiv tshuaj los ntawm kev siv tshuaj. Cov ntaub ntawv tau txais yog systematized nyob ntawm txhua qhov hloov khoom nruab nrog thiab ntau zaus tshwm sim.

    Nws yuav tsum tsom rau cov kev tsis zoo uas tshwm sim ntau tshaj plaws ntawm kev siv canagliflozin:

    • teeb meem lub plab zom mov (cem quav, nqhis dej, qhov ncauj qhuav),
    • kev ua txhaum ntawm lub raum thiab mob tso zis (urosepsis, kab mob kis ntawm lub tso zis, polyuria, pollakiuria, peremptory yaum kom tso zis),
    • teeb meem los ntawm qog thiab cov qog ntawm qhov chaw mos (balanitis, balanoposthitis, mob rau hauv lub paum, mob vulvovaginal candidiasis).

    Cov kev mob tshwm sim no rau lub cev yog ua raws li kev kho mob, nrog rau kev kho mob uas cov tshuaj tau ntxiv nrog pioglitazone, nrog rau sulfonylurea.

    Tsis tas li ntawd, qhov tshwm sim tsis zoo ntawm tus neeg mob nrog hom 2 mob ntshav qab zib mellitus suav nrog cov uas tau tsim nyob rau hauv cov kev sim tshuaj placebo ntawm canagliflozin nrog ntau zaus tsawg dua 2 feem pua. Peb tab tom hais txog cov kev tsis txaus siab uas cuam tshuam nrog qhov txo qis hauv lub ntim hauv nruab nrog cev, nrog rau urticaria thiab tawm pob rau ntawm daim tawv nqaij. Nws yuav tsum raug sau tseg tias cov tawv nqaij tshwm sim hauv lawv tus kheej nrog ntshav qab zib tsis yog qhov tsis yooj yim.

    Cov tsos mob tseem ceeb ntawm kev siv ntau tshaj ntawm cov tshuaj

    Hauv kev xyaum kho mob, kom txog rau hnub, qhov xwm txheej ntawm kev noj ntau ntawm canagliflozin tseem tsis tau sau cia. Txawm hais tias cov koob tshuaj ib zaug twg uas tau ncav 1600 mg nyob rau hauv cov neeg noj qab haus huv thiab 300 mg ib hnub (rau 12 lub lis piam) hauv cov neeg mob ntshav qab zib hom 2 tau zam rau ib txwm.

    Yog tias qhov tseeb ntawm kev siv ntau tshaj ntawm cov tshuaj tshwm sim, ces tus nqi ntawm qhov teeb meem yog ua raws li cov qauv kev txhawb nqa.

    Ib txoj hauv kev los kho kev noj ntau dhau yuav yog qhov kev tshem tawm ntawm cov khoom seem ntawm tus neeg mob txoj hnyuv, nrog rau kev nqis tes ua mus rau kev soj ntsuam thiab kev kho mob tsis tu ncua, suav txog qhov xwm txheej tam sim no.

    Kanagliflosin tsis tuaj yeem raug tshem tawm thaum lub sijhawm 4 teev. Hauv kev pom ntawm qhov no, tsis muaj lub laj thawj hais tias cov tshuaj yeeb yaj kiab yuav dhau los ntawm txoj kev tawm ntawm peritoneal dialysis.

    Cov lus piav qhia dav dav thiab cov lus qhia txog kev siv tshuaj Invokana

    Qhov tshuaj pleev ntshav hypoglycemic no muaj nyob rau hauv daim ntawv ntawm ntom ntom coated nrog lub plhaub daj daj, uas yog npaj rau kev tswj hwm qhov ncauj hauv ib chav kawm tag nrho. Cov neeg mob tuaj yeem siv cov tshuaj ntawm Invokan los ua tus neeg kho mob ywj siab, lossis ua ib feem ntawm txoj kev kho kom ncaj ncees hauv kev sib xyaw nrog kev tswj hwm ntawm insulin.

    Cov nquag ua haujlwm ntawm Invocan yog canagliflozin hemihydrate, uas yog lub luag haujlwm rau kev mloog zoo ntawm cov piam thaj hauv cov ntshav. Nws lub hom phiaj rau tus neeg mob yog tsim nyog rau cov ntshav qab zib hom 2. Tab sis nrog tus kab mob no ntawm thawj hom mob no, kev teem caij yog nruj me ntsis. Cov khoom hauv hluavtaws hauv cov tshuaj lom neeg ntawm Invocan yog cov khoom lag luam nkag mus rau hauv cov kab ke hauv lub cev, ua kom lub siab tawg, thiab tawm hauv ob lub raum hauv zis.

    Invokana tsis pom zoo rau kev siv los ntawm cov poj niam thaum cev xeeb tub thiab lactation. Kev txwv txiav mob kuj siv rau kev nthuav tawm hauv qab no:

    • hypersensitivity rau active tshuaj,
    • mob ketoacidosis,
    • muaj hnub nyoog txog 18 xyoo,
    • nyuab raum tsis ua hauj lwm,
    • lub plawv tsis ua hauj lwm
    • mob siab hnyav ua haujlwm.

    Nyias, nws tsim nyog hais txog qhov kev txwv hais txog cov neeg mob cev xeeb tub thiab cov niam cev xeeb tub. Cov kev tshawb fawb soj ntsuam ntawm cov khoom lag luam tshuaj Invokana rau cov pab pawg ntawm cov neeg mob tsis tau ua, yog li cov kws kho mob tau ceev faj txog qhov kev teem caij no tsuas yog tawm ntawm qhov tsis lees paub. Yog tias kev kho mob yog qhov tsim nyog, tsis muaj kev txwv cais raws li cov lus qhia ntawm Invokan, nws tsuas yog tias tus neeg mob yuav tsum tau ua tib zoo saib xyuas hauv lub sijhawm ntawm cov kev kho lossis cov txheej txheem prophylactic. Qhov txiaj ntsig rau tus me nyuam hauv plab yuav tsum siab dua qhov muaj feem cuam tshuam rau txoj kev txhim kho intrauterine - tsuas yog hauv qhov no qhov kev teem caij tau ua haujlwm zoo.

    Cov tshuaj yoog raws imperceptibly hauv lub cev, tab sis thaum pib ntawm kev txuag txoj kev kho tuaj yeem ua rau muaj kev mob tshwm sim. Ntau zaus nws yog ib qho kev tsis haum tshuaj nyob rau hauv daim ntawv ntawm hemorrhagic pob thiab khaus heev ntawm daim tawv nqaij, cov tsos mob ntawm dyspepsia thiab xeev siab. Hauv qhov no, kev tswj hwm qhov ncauj ntawm Invocan yuav tsum tsis ua mus ntxiv, ua ke nrog tus kws tshaj lij, xaiv ib qho analogue, hloov tus neeg sawv cev kho. Kev siv ntau tshaj yog qhov txaus ntshai rau tus neeg mob, vim tias lawv xav tau kev kho mob sai sai.

    Txoj kev thov, txhua hnub kev noj tshuaj ntawm cov tshuaj Invokana

    Kev noj tshuaj txhua hnub Invokana yog 100 mg lossis 300 mg ntawm canagliflozin hemihydrate, uas tau qhia ib hnub ib zaug. Kev tswj hwm ntawm qhov ncauj rau cov neeg mob hnub nyoog tshaj 18 xyoo yog qhia ua ntej noj tshais - tshwj rau ntawm lub plab khoob. Ua ke nrog cov tshuaj insulin, cov tshuaj txhua hnub yuav tsum tau kho ib tus zuj zus kom cais tawm thiab txo qis kev pheej hmoo ntawm kev mob ntshav qab zib.

    Yog tias tus neeg mob tsis nco qab noj ib qho tshuaj, ces nws yuav tsum haus ib qho tshuaj ntsiav ntawm thawj lub cim nco ntawm txoj cai. Yog tias paub txog ntawm kev txhaj tshuaj ib zaug tuaj txog hnub ob xwb, noj ob zaug tshuaj rau qhov ncauj yog nruj me ntsis. Yog tias cov tshuaj raug txwv rau cov menyuam yaus, cov hluas lossis cov laus so txog 75 xyoo, nws yog ib qho tseem ceeb kom txo cov tshuaj txhua hnub rau 100 mg.

    Txij li thaum cov tshuaj muaj qhov cuam tshuam ncaj qha rau cov tshuaj lom neeg cov ntshav, nws tsis yooj yim sua kom kaw cov txheej txheem ntawm cov txheej txheem txhua hnub ntawm Invokan. Txwv tsis pub, tus neeg mob xav kom mob plab zom mov los ntawm kev ntuav cuav, kev noj ntxiv ntawm sorbents, cov tsos mob kho mob nruj me ntsis rau kev kho mob.

    Cov tshuaj ntawm cov tshuaj Invokana

    Cov tshuaj tshwj xeeb tsis tsim nyog rau txhua tus neeg mob, thiab cov npe ntawm cov kev mob tshwm sim hauv cov lus qhia ib zaug ntxiv ua pov thawj qhov kev phom sij ntawm xws li kev teem sij hawm nrog kev ua txhaum cov lus qhia kho mob tsis tu ncua. Muaj kev xav tau ntawm kev yuav cov analogues, uas cov tshuaj hauv qab no tau pov thawj lawv tus kheej zoo:

    Xyuas txog cov tshuaj Invokana

    Cov tshuaj tshwj xeeb yog nrov ntawm cov neeg mob uas mob ntshav qab zib hom 2. Txhua tus neeg sau rau ntawm kev sib tham txog kev kho mob hais txog qhov ua tau zoo ntawm Invokan, thaum nco ntsoov ua rau muaj kev poob siab ntawm cov nqi poob siab. Tus nqi ntawm cov tshuaj yog siab, kwv yees li 1,500 rubles, nyob ntawm lub nroog ntawm kev yuav khoom thiab kev ntaus nqi ntawm lub tsev muag tshuaj. Cov neeg uas txawm li ntawd los ua qhov kev ua lag luam tau txaus siab rau qhov kev kawm, vim tias cov piam thaj hauv ntshav tau nyob ntev li ib hlis.

    Cov neeg mob ntshav qab zib mellitus tshaj tawm tias Invokan cov khoom kho mob tsis tuaj yeem lav tsis tau rov ua tiav, txawm li cas los xij, pom tias muaj kev txhim kho nyob rau hauv cov mob "ntshav qab zib" pom tseeb. Tus nab npawb ntawm cov tsos mob tsis zoo ploj, piv txwv li, cov qog ua kom qhuav thiab ua rau lub siab nqhis dej tas li, thiab tus neeg mob rov xav tias nws tus kheej yog tus neeg muaj lub siab xav. Coob tus neeg mob ntshav qab zib piav qhia tus mob thaum khaus daim tawv thiab dhau ntawm lub ntsej muag ploj tag.

    Cov lus tsis zoo txog Invokana pom nyob hauv lawv cov haiv neeg tsawg, thiab hauv cov ntsiab lus ntawm kev sib tham kho mob lawv tsuas yog them tus nqi siab ntawm cov tshuaj no, qhov muaj tsis nyob hauv txhua qhov chaw muag tshuaj ntawm lub nroog. Feem ntau, cov tshuaj yog qhov zoo, vim tias nws pab ua rau tus neeg muaj ntshav qab zib mob ntshav qab zib kom tswj ntshav qab zib, kom tsis txhob muaj qhov mob tsis txaus, ua rau muaj mob ntshav qab zib thiab ua rau mob ntshav qab zib.

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