Cov lus qhia rau kev siv Amaryl ntsiav tshuaj

Ib ntsiav tshuaj ntawm Amarsh 1 mg muaj: cov tshuaj nquag: glimepiride - 1 mg,

muaj kev zam: lactose monohydrate, sodium carboxymethyl hmoov txhuv nplej siab (tun A), povidone 25000 (E1201), microcrystalline cellulose (E460), magnesium stearate (E470), hlau oxide liab zas (E172).

Ib ntsiav tshuaj ntawm Amarsh 2 mg muaj: cov tshuaj nquag: glimepiride - 2 mg,

kev zam: lactose monohydrate, sodium carboxymethyl hmoov txhuv nplej siab (hom A), povidone 25000 (E1201), microcrystalline cellulose (E460), magnesium stearate (E470), daj hlau oxide zas xim (E172), indigo carmine txhuas kua roj vanish (E132).

Ib ntsiav tshuaj ntawm Amarsh 3 mg muaj: cov tshuaj nquag: glimepiride - 3 mg.

kev zam: lactose monohydrate, sodium carboxymethyl hmoov txhuv nplej siab (hom A), povidone 25000 (E1201), microcrystalline cellulose (E460), magnesium stearate (E470), xim daj hlau daj (E172).

Ib ntsiav tshuaj ntawm Amarsh 4 mg muaj: cov tshuaj nquag: glimepiride - 4 mg.

kev zam: lactose monohydrate, sodium carboxymethyl hmoov txhuv nplej siab (hom A), povidone 25000 (E1201), microcrystalline cellulose, magnesium stearate (E460), indigo carmine txhuas cov kua roj vanish (E132).

Amarsh 1 mg: Ntev ntev, lub ntsiav tshuaj xim ntsuab ntawm ob sab nrog cov zuaj sib faib ntawm ob sab. Sab saum toj Cov Ntaus: NMK / Hom Lub Npe. Hauv qab khov: Hom Lub Npe / NMK.

Amarsh 2 mg: Oblong, tiaj ntsuab ntsiav tshuaj ntawm ob sab nrog tus zawj faib rau ob sab. Sab saum toj Cov Ntaus: NMM / Hom Lub Npe. Hauv qab cov thwj cim: Hom Lub Npe / NMM.

Amarsh 3 mg: Lub sijhawm ntev, lub ntsiav tshuaj tiaj tiaj ntawm ob sab ntawm lub teeb xim daj nrog lub ntsej muag sib faib ntawm ob sab. Sab saum toj Cov Ntaus: NMN / Hom Lub Npe. Hauv qab khov: Hom Lub Npe / NMN.

Amarsh 4 mg: Oblong, ntsiav tshuaj tiaj tiaj ntawm ob sab ntawm xiav ntsiav tshuaj nrog cov kab sib faib ntawm ob sab. Sab saum toj Cov Ntaus: NMO / Hom Lub Npe. Hauv qab khov: Hom Lub Npe / NMO.

Pharmacological kev txiav txim

Glimepiride, yam tshuaj tseem ceeb ntawm Amaril, yog qhov tshuaj hypoglycemic (suab thaj-txo qis) rau kev siv qhov ncauj - sulfonylurea derivative.

Glimepiride stimulates qhov tso pa tawm thiab tso tawm ntawm insulin los ntawm beta hlwb ntawm cov txiav (txiav nyhuv), txhim kho qhov rhiab ntawm peripheral cov ntaub so ntswg (nqaij thiab rog) mus rau qhov kev ua ntawm nws tus kheej insulin (cov txiaj ntsig ntxiv).

Sulfonylurea derivatives tswj cov tshuaj insulin kom sib xyaw tau los ntawm kev kaw ATP-cov tub ntxhais hluas cov tshuaj potassium nyob hauv cytoplasmic membrane ntawm cov roj ntsha pancreatic beta hlwb. Kaw cov poov tshuaj channel, lawv ua rau depolarization ntawm beta hlwb, uas yuav pab qhib cov calcium calcium thiab ua kom muaj kev ntws los ntawm cov calcium ntau ntxiv rau hauv cov cell. Glimepiride, nrog rau qhov hloov pauv siab, sib txuas thiab tshem tawm ntawm cov protein (pancreatic beta-cell protein) (hniav puas loj 65 kD / SURX), uas cuam tshuam nrog ATP-nyob ntawm thaj chaw potassium, tab sis txawv los ntawm qhov chaw khi ntawm cov ib txwm muaj.

sulfonylureas (protein molar loj 140 kD / SUR1). Cov. - X p

Txoj kev no ua rau cov tshuaj insulin los ntawm exocytosis, hauv qhov no. - qhov ua tau zoo ntawm cov tshuaj insulin tseem ceeb tsawg dua nrog cov tshuaj sulfonylureas. Qhov tsawg tshaj plaws yam tshwm sim ntawm glimepiride ntawm insulin secretion muab qhov ua kom tsawg dua ntawm kev txo qis.

Tsis tas li ntawd, tshaj tawm cov teebmeem ntxiv ntawm glimepiride (txo qis ntawm insulin tsis kam, muaj kev cuam tshuam tsawg dua rau cov hlab plawv, tiv thaiv atherogenic, tiv thaiv kev sib xyaw thiab cov tshuaj tiv thaiv antioxidant) tau qhia, uas kuj muaj cov tshuaj sulfonylurea derivatives, tab sis rau ntau qhov tsawg.

Kev siv cov ntshav qabzib ntau dhau ntawm cov ntshav los ntawm cov ntaub so ntswg (nqaij thiab rog) tshwm sim siv cov thauj tshwj xeeb (GLUT1 thiab GLUT4) nyob hauv cov cell ua ke. Qhov kev thauj khoom ntawm cov kua nplaum mus rau hauv cov nqaij hauv ntshav qab zib hom 2 yog qhov yuav tau txav nrawm rau kev siv cov piam thaj. Glimepiride nrawm dua rau tus naj npawb thiab kev ua haujlwm ntawm cov piam thaj thauj cov lwg me me (GLUT1 thiab GLUT4), uas ua rau cov piam thaj nce ntxiv los ntawm cov ntaub so ntswg peripheral.

Glimepiride muaj cov tshuaj ua tsis muaj zog tiv thaiv tsis zoo rau K_ATF raws ntawm cardiomyocytes. Thaum noj glimepiride, lub peev xwm ntawm cov khoom noj hauv lub cev hloov kho ntawm myocardium rau ischemia yog tshwj tseg.

Glimepiride tsub kom cov kev ua haujlwm ntawm glycosyl phosphatidylinositol-phospholipase C, uas cov tshuaj ua rau lipogenesis thiab glycogenesis tuaj yeem sib txheeb rau cov nqaij ntshiv thiab rog hlwb.

Glimepiride inhibits qabzib ntau lawm hauv lub siab los ntawm kev ua rau muaj ntau yam ntawm fructose-2,6-bisphosphate, uas nyeg inhibits gluconeogenesis.

Glimepiride xaiv tau inhibits cyclooxygenase thiab txo qhov kev hloov pauv ntawm arachidonic acid rau thromboxane A2, uas txhawb cov platelet sib xyaw, thiaj li ua rau cov txiaj ntsig antithrombotic.

Glimepiride ua rau lub cev hloov kho lipid cov ntsiab lus, txo cov theem ntawm cov aldehyde me me hauv cov ntshav, uas ua rau txo qis tseem ceeb ntawm lipid peroxidation, qhov no ua rau muaj kev tiv thaiv atherogenic ntawm cov tshuaj. Glimepiride nce qib ntawm endogenous a-tocopherol, qhov kev ua ntawm catalase, glutathione peroxidase thiab superoxide dismutase, uas pab txo qis ntawm qhov mob oxidative kev nyuaj siab hauv tus neeg mob lub cev, uas yog ib txwm muaj nyob hauv hom 2 ntshav qab zib mellitus.

Hauv cov neeg muaj kev noj qab haus huv, qhov tshuaj tsawg kawg hauv qhov ncauj ntawm glimepiride yog kwv yees li 0.6 mg. Cov nyhuv ntawm glimepiride yog koob tshuaj thiab rov ua dua tshiab. Lub cev muaj zog teb rau lub cev hnyav dhau los thiab txo qis cov tshuaj insulin thaum noj glimepiride yog kev tswj hwm.

Tsis muaj qhov sib txawv ntawm cov nyhuv, nyob ntawm seb cov tshuaj noj 30 feeb ua ntej noj mov lossis tam sim ntawd ua ntej noj mov. Hauv cov neeg mob ntshav qab zib, kev txaus siab rau kev tswj lub cev zom zaub mov hauv 24 teev tuaj yeem ua tiav los ntawm kev noj ib koob tshuaj txhua hnub.

Txawm hais tias qhov tseeb tias glimepiride hydroxymetabolite ua rau me me tab sis tseem ceeb txo cov ntshav qabzib hauv cov neeg mob noj qab haus huv, cov metabolite no tsuas yog ib qho me me ntawm qhov cuam tshuam tag nrho ntawm cov tshuaj.

Kev sib xyaw ua ke nrog metformin

Hauv ib txoj kev tshawb nrhiav, nws tau ua pov thawj tias hauv cov neeg mob uas tsis txaus siab txog kev kho mob, txawm hais tias muaj ntau npaum li cas ntawm metformin, kev siv tib lub sij hawm ntawm glimepiride nrog metformin muab cov kev tswj zoo dua ntxiv piv nrog metformin monotherapy.

Kev sib xyaw ua ke nrog cov tshuaj insulin

Cov ntaub ntawv ntawm kev sib xyaw ntawm glimepiride nrog insulin yog tsis muaj. Cov neeg mob uas tsis tau txais kev pab kho tau zoo tshaj plaws nrog qhov siab tshaj plaws ntawm glimepiride tuaj yeem pib kho insulin ib txhij. Hauv ob qhov kev sim tshuaj, kev sib xyaw ua ke tau muab tib txoj kev txhim kho metabolic zoo li insulin monotherapy, txawm li cas los xij, ntawm kev sib txuam, kev siv tshuaj insulin tsawg dua.

Cov Pab Pawg Tshwj Xeeb Patent

Menyuam yaus thiab tub ntxhais hluas

Ib qho kev sim hauv tsev kho mob nrog kev tswj hwm (glimepiride txog 8 mg rau ib hnub lossis metformin txog 2,000 mg ib hnub) ntev kawg 24 lub lis piam tau ua nrog 285 cov menyuam (hnub nyoog 8-17 xyoo) uas muaj ntshav qab zib hom 2. Ob lub tebchaw, glimepiride thiab metformin, qhia tau tias HbAlc txo qis thaum pib ntawm glimepiride -0.95 (hauv ntshiab 0, 41), metformin -1.39 (hauv ntshiab 0.40). Dua li ntawm qhov no, glimepiride tsis tau ua tiav cov qauv ntawm cov xwm txheej "tsis muaj qhov phem dua li metformin", txiav txim los ntawm kev hloov pauv nruab nrab hauv HbAlc nrog rau qhov ntsuas pib. Qhov txawv yog 0.44% nyob rau hauv kev pom zoo ntawm metformin. Kev txwv qis (1.05) 95% kev ntseeg siab

qhov nruab nrab ntawm qhov sib txawv yog siab dua qhov pom zoo tso cai tsawg kawg qhov kev ua haujlwm sib luag nrog 0.3%,

Kev kho mob Glimepiride tsis qhia txog kev txhawj xeeb ntxiv rau kev nyab xeeb rau menyuam yaus piv nrog rau cov neeg mob laus neeg mob ntshav qab zib hom 2. Tsis muaj cov ntaub ntawv los ntawm kev ua kom ntev thiab kev nyab xeeb kev tshawb fawb rau cov neeg mob paum.

Cov Tshuaj Pharmacokinetics

Thaum noj cov glimepiride nws txoj kev noj qab haus huv tau ua tiav. Noj mov tsis muaj lub zog tseem ceeb ntawm kev nqus, nrog rau kev zam ntawm qhov ua kom qeeb me ntsis hauv qhov nqus tus nqi. Nrog kev siv tas li ntawm glimepiride nyob rau hauv ib koob tshuaj txhua hnub ntawm 4 mg, qhov siab tshaj plaws nyob rau hauv cov ntshav ntshav (C_tah) tau mus txog tom qab li 2.5 teev thiab suav txog 309 ng / ml, muaj qhov sib txuam ntawm qhov koob tshuaj thiab Stax, nrog rau nruab nrab ntawm cov koob tshuaj thiab AUC (thaj chaw hauv qab qhov ntsuas-lub sijhawm nkhaus).

Glimepiride yog tus yam ntxwv los ntawm kev faib tsawg heev (li 8.8 L), kwv yees li qhov sib npaug ntawm qhov ntim ntawm albumin, qhov siab siab ntawm kev khi rau cov ntshav plasma protein (ntau dua li 99%) thiab qhov tsawg tsawg (kwv yees li 48 ml / min).

Biotpansformatssh thiab tshem tawm

Tom qab ib qho tshuaj glimepiride noj ntawm qhov ncauj, 58% yog tawm hauv cov zis thiab 35% nrog quav. Cov tshuaj tsis raug hloov nyob rau hauv cov zis tsis tau kuaj pom. Kev tshem tawm ib nrab-lub neej ntawm ntshav ntau ntawm cov tshuaj hauv cov ntshav coj mus rau ntau qhov kev noj tshuaj ntau yog 5-8 teev. Tom qab noj cov koob tshuaj siab, ib nrab-lub neej yog me ntsis nce.

Ob qhov kev tiv thaiv tsis ua haujlwm tau kuaj pom nyob hauv cov zis thiab cov quav, uas tsim los ntawm cov metabolism hauv lub siab, ib qho yog hydroxy derivative, thiab lwm qhov yog carboxy derivative. Tom qab noj ntawm glimepiride, lub davhlau ya nyob twg ib nrab-lub neej ntawm cov metabolites yog 3-5 teev thiab 5-6 teev, feem.

Glimepiride ua haujlwm tawm hauv cov kua mis thiab hla tus qib placental. Cov tshuaj nkag mus tsis zoo los ntawm cov ntshav-lub hlwb teeb meem.

Kev sib piv ntawm ib qho thiab ntau yam (ib zaug ib hnub) kev tswj hwm glimepiride tsis qhia tawm qhov sib txawv tseem ceeb hauv cov chaw muag tshuaj, thiab lawv cov kev hloov pauv tau tsawg pom ntawm cov neeg mob sib txawv. Tsis muaj qhov tseem ceeb zuj zus ntawm cov tshuaj.

Cov Pab Pawg Tshwj Xeeb Patent

Pharmacokinetic cov cim muaj qhov zoo sib xws hauv cov neeg mob sib txawv thiab pawg hnub nyoog sib txawv. Hauv cov neeg mob uas tsis muaj lub raum lub hlwb (nrog rau qhov tsis muaj creatinine tsawg), muaj qhov nyiam ua kom lub qhov txhaws ntau ntxiv thiab txo qis hauv nws cov ntsiab lus nruab nrab hauv cov ntshav cov ntshav, uas feem ntau yuav yog vim sai dua cov tshuaj vim nws qis dua rau cov protein. Yog li, hauv pawg no ntawm tus neeg mob tsis muaj kev pheej hmoo ntxiv los khaws cov tshuaj.

Ib qho kev sim los kawm cov tshuaj pharmacokinetics, kev nyab xeeb, thiab kev tiv thaiv siab ntawm ib koob tshuaj 1 mg ntawm glimepiride hauv 30 cov neeg mob (4 cov menyuam hnub nyoog 10-12 xyoo thiab 26 cov menyuam hnub nyoog 12-17 xyoo) uas raug los ntawm hom 2 mob ntshav qab zib qhia tias nruab nrab AUCo -i_lit, C_max thiab X lub analogueschny qhov tseem ceeb tau pom yav dhau los hauv cov neeg laus.

Cov Yuav Tsum Tau Ua

Glimepiride yuav tsum tsis txhob siv rau:

• Ua rau lub ntsej muag tsis haum ntawm glimepiride lossis rau ib qho tshuaj tsis haum ntawm cov tshuaj, mus rau lwm yam sulfonylurea derivatives los yog rau cov tshuaj sulfa (muaj kev phom sij rau qhov tsis haum lub siab),

• mob ntshav qab zib insulin-tiv thaiv kev mob ntshav qab zib,

• ketoacidosis uas mob ntshav qab zib, mob ntshav qab zib thiab ua rau tsis nco qab,

• mob rau daim siab mob siab,

• Kev mob raum (nrog rau cov neeg mob hemodialysis),

• cev xeeb tub thiab lactation.

Cev xeeb tub thiab lactation

Glimepiride yog sib xyaw rau cov poj niam cev xeeb tub. Kev xeeb menyuam hauv plab lossis thaum pib cev xeeb tub, tus pojniam yuav tsum pauv mus rau kev kho mob insulin.

Txij li thaum glimepiride, pom meej, hla mus rau hauv niam cov kua mis, nws yuav tsum tsis txhob raug rau cov poj niam thaum lactation. Hauv qhov no, nws yog ib qho tsim nyog yuav tsum hloov mus rau kev siv tshuaj insulin lossis txwv kom tsis pub niam mis.

Tsuas tshuaj thiab tswj hwm

Npaj rau kev siv lub qhov ncauj.

Lub hauv paus rau kev ua tiav cov ntshav qab zib kom tau zoo yog kev noj haus kom zoo, kev tawm dag zog kom zoo, thiab kev saib xyuas ntshav thiab zis mus tas li. Kev tsis pom zoo los ntawm cov lus qhia txog kev noj zaub mov tsis tuaj yeem them nyiaj los ntawm cov ntsiav tshuaj lossis insulin.

Pib xaiv koob thiab koob tshuaj

Kev noj tshuaj ntawm glimepiride yog txiav txim siab los ntawm kev soj ntsuam ntawm cov piam thaj hauv cov ntshav thiab zis.

Thawj koob tshuaj yog 1 mg ntawm glimepiride ib hnub, yog tias tib lub sij hawm ua tiav cov kev tswj mob metabolic tiav - qhov tshuaj no yuav tsum tswj tau thaum kho.

Txog lwm txoj kev noj tshuaj ntau dua, cov ntsiav tshuaj muaj nyob hauv cov tshuaj noj kom tsim nyog.

Yog tias tsim nyog, qhov kev noj tshuaj txhua hnub tuaj yeem nce ntxiv nyob rau hauv kev saib xyuas tas li ntawm kev saib xyuas ntawm cov kua nplaum hauv cov ntshav (nrog ntu 1-2 lub lis piam) thiab hauv cov txheej txheem hauv qab no: 1 mg - 2 mg - 3 mg - 4 mg glimepiride ib hnub.

Qhov kev txhaj tshuaj ntawm glimepiride tshaj li 4 mg ib hnub twg ua rau muaj txiaj ntsig zoo tsuas yog nyob hauv kis tshwj xeeb. Qhov siab tshaj plaws pom zoo rau kev noj tshuaj txhua hnub yog 6 mg.

Lub sijhawm thiab ntau zaus ntawm kev noj cov tshuaj ib hnub twg tau txiav txim los ntawm tus kws kho mob, xam rau hauv tus neeg mob txoj kev ua neej. Raws li txoj cai, kev teem caij noj ib koob tshuaj txhua hnub hauv 1 koob tshuaj tam sim ua ntej lossis thaum noj tshais lossis los yog, yog tias noj tshuaj txhua hnub tsis yog

tau noj tam sim ntawd ua ntej lossis thaum thawj pluas mov hnyav. Kev tshem tawm ntawm cov tshuaj yuav tsum tsis raug tshem tawm los ntawm kev tswj hwm tom qab ntawm qhov siab dua. Amaril ntsiav tshuaj noj tag nrho, yam tsis ntxo, nrog cov kua txaus (li 0.5 khob). Nws yog ib qho tseem ceeb heev kom tsis txhob pluas noj tom qab noj Amaril.

Siv ua ke nrog metformin

Thaum tsis tshua muaj kev ruaj khov ntawm kev saib xyuas cov piam thaj hauv cov ntshav hauv cov neeg mob noj cov tshuaj metformin, kev kho nrog qhov muag nrog glimepiride yuav tau pib. Thaum tswj hwm cov koob tshuaj metformin nyob rau tib theem, kev kho mob nrog glimepiride pib nrog qhov txhaj tshuaj tsawg kawg, thiab tom qab ntawd nws cov koob tshuaj yuav nce ntxiv nyob ntawm qhov xav tau ntawm glycemic tswj, nce mus txog qhov siab tshaj plaws txhua hnub koob tshuaj 6 mg. Kev sib xyaw ua ke yuav tsum tau ua nyob rau hauv kev saib xyuas mob nkeeg zoo.

Siv ua ke nrog cov tshuaj insulin

Hauv qhov xwm txheej uas tsis muaj peev xwm ua tiav qhov ua kom cov ntshav qabzib hauv siab los ntawm kev noj ntau tshaj plaws ntawm glimepiride hauv kev kho mob monotherapy lossis hauv kev sib xyaw nrog qhov ntau kawg ntawm metformin, kev sib xyaw ntawm glimepiride nrog insulin yog ua tau. Hauv qhov no, koob tshuaj kawg ntawm glimepiride qhia rau tus neeg mob tseem tsis hloov pauv. Hauv qhov no, kev kho tshuaj insulin pib nrog qhov txhaj tshuaj tsawg kawg, nrog kev muaj peev xwm nce zuj zus ntxiv ntawm koob tshuaj insulin nyob rau hauv kev tswj hwm qhov kev tswj hwm ntawm cov piam thaj hauv cov ntshav. Kev kho mob sib xyaw ua ke yuav tsum muaj kev saib xyuas mob nkeeg uas yuav tsum tau ua. Thaum tswj kev tiv thaiv glycemic ncua ntev, qhov kev sib xyaw ua ke no tuaj yeem txo cov tshuaj insulin ntau dua li 40%.

Hloov pauv ntawm tus neeg mob los ntawm lwm qhov ncauj tshuaj hypoglycemic rau glimepiride Tsis muaj kev sib txheeb ntawm cov koob tshuaj glimepiride thiab lwm cov tshuaj hypoglycemic hauv qhov ncauj. Thaum hloov pauv los ntawm cov tshuaj no rau glimepiride, qhov pib ntawm thawj hnub ntawm qhov kawg yuav tsum yog 1 mg (txawm tias tus neeg mob hloov mus rau glimepiride nrog qhov siab tshaj plaws ntawm lwm qhov ncauj tshuaj hypoglycemic).Ib qho kev nce ntxiv ntawm qhov koob tshuaj glimepiride yuav tsum tau ua nyob rau theem, suav txog cov lus teb rau glimepiride raws li cov lus pom zoo saum toj no. Nws yog ib qho tsim nyog yuav tsum coj mus rau hauv cov tshuaj uas tau siv thiab lub sijhawm ntawm cov nyhuv ntawm cov tshuaj tiv thaiv hypoglycemic dhau los. Muaj qee kis, tshwj xeeb tshaj yog thaum noj tshuaj hypoglycemic nrog lub sijhawm ntev ib nrab-lub neej (piv txwv, chlorpropamide), nws yuav tsim nyog mus ib ntus (tsis pub dhau ob peb hnub) tsum kho kom tsis txhob muaj qhov cuam tshuam ntxiv uas ua rau muaj kev pheej hmoo ntawm hypoglycemia.

Hloov chaw ntawm tus neeg mob los ntawm insulin mus rau glimepiride

Muaj qee kis, yog tias cov neeg mob uas muaj mob ntshav qab zib hom 2 tau txais kev kho mob insulin, tom qab ntawd nrog kev them nyiaj ntawm tus kabmob thiab nrog cov kev khaws cia tsis pub lwm tus ua haujlwm ntawm pancreatic beta hlwb, lawv tuaj yeem pom hloov mus rau glimepiride. Cov txhais lus yuav tsum tau ua nyob rau hauv kev saib xyuas mob nkeeg. Hauv qhov no, hloov chaw ntawm tus neeg mob mus rau glimepiride pib nrog kev txhaj tshuaj tsawg kawg ntawm glimepiride ntawm 1 mg.

Daim ntawv thov rau lub raum thiab lub siab ua haujlwm

Cov ntaub ntawv tsis txaus muaj nyob rau ntawm kev siv tshuaj hauv cov neeg mob uas mob raum thiab mob siab tsis txaus (saib Ntu Kev Tiv Thaiv).

Menyuam yaus thiab tub ntxhais hluas

Cov ntaub ntawv hais txog kev siv glimepiride hauv cov neeg mob qis dua 8 xyoo tsis muaj. Rau cov menyuam yaus hnub nyoog 8 txog 17 xyoo, muaj qee cov ntaub ntawv hais txog kev siv glimepiride hauv kev kho mob monotherapy (saib Pharmacokinetics thiab Pharmacodynamics ntu). Cov ntaub ntawv muaj nyob ntawm kev ua tau zoo thiab kev nyab xeeb tsis txaus rau kev siv glimepiride hauv kev kho mob hauv pob txha, thiab yog li ntawd kev siv zoo li no tsis raug pom zoo.

Sab sij huam

Cov ntaub ntawv hais txog kev phiv tshuaj los ntawm kev noj glimepiride thiab lwm yam sulfonylurea derivatives muaj qhia hauv qab no thaum sim tshuaj. Cov kev tsis zoo tshwm sim yog muab faib rau hauv cov chav kawm ntawm cov nruab nrog cev thiab sib koom ua ke kom txo qis tsawg zaus (feem ntau:> 1/10, feem ntau:> 1/100, 1/1000, 1/10000,

Noj ntau dhau

Tom qab noj ib qho loj ntawm glimepiride, txoj kev loj hlob ntawm lub qog ntshav qab zib muaj peev xwm ua tau, kav ntev mus txog 12 txog 72 teev, uas tuaj yeem rov ua dua tom qab pib kho dua ntawm kev mloog zoo ntawm cov piam thaj hauv cov ntshav. Kev mob ntshav qab zib tuaj yeem ua rau tas mus li yuav tsum nres sai sai los ntawm kev noj zaubmov sai (qabzib lossis qab zib, piv txwv, hauv daim ntawv ntawm cov piam thaj, kua txiv qab zib lossis kua txiv). Hauv qhov no, tus neeg mob yuav tsum tau muaj tsawg kawg 20 g piam thaj (4 daim piam thaj). Cov khoom qab zib yog qhov tsis muaj txiaj ntsig hauv kev kho mob ntawm hypoglycemia. Feem ntau, kev saib xyuas hauv tsev kho mob yog qhov pom zoo. Kev kho mob suav nrog kev ua kom lub cev ntuav, haus dej (dej los yog kua txiv qaub nrog lub nplaim hluavtaws (adsorbent) thiab sodium sulfate (laxative). Thaum noj ntau ntawm cov tshuaj, pais plab lav yog qhia, tom qab kev qhia ntawm lub tshuab ua pa thiab sodium sulfate. kev soj ntsuam daim duab ntawm mob stroke, yog li ntawd, nws xav tau kev kho mob sai raws li kev saib xyuas ntawm tus kws kho mob, thiab hauv qee qhov xwm txheej thiab tsev kho mob ntawm tus neeg mob.Yog li sai tau, kev qhia ntawm cov kua nplaum, yog tias tsim nyog Hauv daim ntawv ntawm iv txhaj tshuaj ntawm 50 ml ntawm 40% kev daws, tom qab ntawd infusion ntawm 10% kev daws nrog ceev faj xyuas ntawm cov concentration ntawm cov piam thaj hauv cov ntshav, kev kho mob ntxiv yuav tsum yog cov tsos mob.

Cov tsos mob ntawm tus mob ntshav qab zib tsawg yuav ua tau zoo lossis tsis tuaj kiag li hauv cov neeg mob laus, hauv cov neeg mob uas muaj lub hlwb tsis zoo lossis tau txais kev kho mob ib txhij nrog p-adrenoblockers, clonidine, reserpine, guanethidine lossis lwm tus neeg mob sympatholytic.

Yog tias ib tug neeg mob uas mob ntshav qab zib tau txais kev kho mob los ntawm cov kws kho mob sib txawv (piv txwv li, thaum nyob hauv tsev kho mob tom qab muaj xwm txheej, nrog rau mob thaum hnub so), nws yuav tsum qhia lawv txog nws tus mob thiab txog kev kho mob dhau los.

Hauv kev kho mob ntawm lub qog ntshav ntshav uas tsim los ntawm kev tswj hwm kev sib tsoo ntawm Amaril los ntawm cov menyuam mos lossis menyuam yaus, cov tshuaj uas tau hais tseg ntawm dextrose (50 ml ntawm 40% kev daws teeb meem) yuav tsum tau ua tib zoo saib xyuas txhawm rau kom tsis txhob muaj kev phom sij hyperglycemia. Hauv qhov no, kev saib xyuas tas li thiab ua kom zoo ntawm kev saib xyuas cov kua nplaum hauv cov ntshav yog tsim nyog.

Kev cuam tshuam nrog lwm yam tshuaj

Cov kev siv concomitant nrog glimepiride ntawm lwm yam tshuaj, ob qho tib si qhov tsis xav tau txo qis thiab qhov tsis xav tau nce nyob rau hauv cov nyhuv hypoglycemic ntawm glimepiride tuaj yeem tshwm sim. Hauv no hais txog, lwm yam tshuaj muaj peev xwm tau tsuas yog kev tso cai (lossis raws li qhia) ntawm tus kws kho mob.

Glimepiride yog metabolized los ntawm cytochrome P4502C9, uas yuav tsum tau txiav txim siab thaum siv ib txhij nrog cov inducers (piv txwv li rifampicin) lossis tshuaj tiv thaiv kab mob (xws li fluconazole).

Hauv kev sib txuam vivo luam tawm nyob rau hauv cov ntaub ntawv qhia tau tias fluconazole, ib qho ntawm cov muaj zog tshaj plaws ntawm CY32C9, nce AUC ntawm glimepiride txog li 2 zaug.

Raws li kev paub dhau los ntawm glimepiride thiab lwm yam sulfonylurea derivatives, kev cuam tshuam hauv qab no yuav tsum raug sau tseg.

Kev nce ntawm hypoglycemic cov nyhuv thiab kev txhim kho tau ntawm hypoglycemia cuam tshuam nrog qhov no tuaj yeem raug soj ntsuam nrog kev siv tib lub sij hawm ntawm glimepiride nrog cov tshuaj hauv qab no:

- phenylbutazone, azapropazone, oxyphenbutazone,

- Tshuaj insulin thiab lwm yam tshuaj hypoglycemic, xws li metformin,

- salicylates thiab aminosalicylic acid,

- anabolic steroids thiab txiv neej poj niam txiv neej cov tshuaj hormones,

- chloramphenicol, qee qhov ua yeeb yam ntev ntev sulfonamides, tetracyclines, quinolones thiab clarithromycin,

- angiotensin hloov mus rau enzyme (ACE) inhibitors,

- fluoxetine, monoamine oxidase inhibitors (MAO),

- allopurinol, probenicide, sulfinpyrazone,

- cyclo-, tro- thiab ifosfamides,

- pentoxifylline (nrog rau cov kev tswj hwm hauv tsoomfwv hauv qib siab),

Kev ua kom lub cev tsis muaj zog ntawm lub ntsej muag ntshav thiab ua rau muaj kev nce siab ntxiv hauv cov concentration ntawm cov piam thaj hauv cov ntshav tuaj yeem pom nrog kev siv tib lub sij hawm ntawm glimepiride nrog rau cov tshuaj hauv qab no:

- estrogens thiab progestogens,

- saluretics thiab thiazide diuretics,

- cov thyroid hormones, glucocorticosteroids

- epinephrine thiab lwm cov neeg ua mob sympathomimetic,

- nicotinic acid (hauv kev txhaj tshuaj ntau) thiab derivatives ntawm nicotinic acid,

- laxatives (nrog rau siv ntev),

- glucagon, barbiturates thiab rifampicin,

Cov Thaiv Khoom N₂receptors, clonidine thiab reserpine muaj peev xwm txhim kho ob qho tib si thiab ua kom cov nyhuv tsis muaj zog ntawm glimepiride.

Hauv qab ntawm cov neeg mob sympatholytic, xws li beta-blockers, clonidine, guanethidine thiab reserpine, cov cim ntawm adrenergic counterregulation nyob rau hauv teb rau hypoglycemia tej zaum yuav raug txo lossis ploj.

Tawm tsam keeb kwm yav dhau los ntawm kev noj glimepiride, ib qho kev nce los yog qaug zog ntawm kev nqis tes ua ntawm coumarin derivatives tuaj yeem pom.

Kev haus cawv ib leeg lossis mob ntev tuaj yeem ua rau ob leeg txhim kho thiab tsis muaj zog ntawm cov nyhuv hypoglycemic ntawm glimepiride.

Daim ntawv thov nta

Glimepiride yuav tsum tau noj tam sim ua ntej lossis thaum noj mov.

Yog tias noj zaub mov tsis tu ncua los hla mus tas li, tus neeg mob tau txais kev kho glimepiride yuav tshwm sim

ntshav qog. Cov tsos mob tshwm sim ntawm tus mob ntshav qab zib yog: mob taub hau, tshaib plab, xeev siab, ntuav, nkees, nkees nkees, pw tsaug zog, ntxhov siab, ntxhov siab, tsis pom kev, mob siab thiab tawm tsam, kev nyuaj siab, tsis meej pem, hais lus thiab pom lub siab tsis sib haum, dhuav, tshee tseeg, paresis , kev ntxhov siab txawv txav, kiv taub hau, zoo li tsis paub pab, poob siab rau tus kheej, tsis nco qab lawm, txhaws qias, tsis meej pem thiab tsis nco qab, suav tsis nco qab, ua pa nyuaj, bradycardia. Tsis tas li ntawd, raws li qhov kev tawm tswv yim adrenergic mechanism, cov tsos mob xws li mob khaub thuas, clammy hws, ntxhov siab vim, tachycardia, hlab ntsha tawg, lub plawv dhia, lub plawv dhia, lub ntsws angina pectoris, thiab lub plawv tsis zoo tuaj yeem tshwm sim.

Cov kev nthuav tawm ntawm cov neeg mob ntshav qab zib siab ntau yuav zoo ib yam li kev nthuav qhia los ntawm cov neeg mob stroke.

Yuav luag txhua qhov teeb meem, cov tsos mob tuaj yeem tswj hwm los ntawm kev noj sai ntawm hydrocarbons (qab zib). Cov khoom cua cuav yog qhov tsis muaj txiaj ntsig tib lub sijhawm.

Raws li tau paub los ntawm cov kev paub ntawm kev siv lwm yam sulfonylurea derivatives, txawm hais tias muaj kev vam meej siv cov kev ntsuas qhov pib thaum pib, tom qab ntawd hypoglycemia tuaj yeem rov tshwm sim.

Mob ntshav qab zib heev los yog ntau heev, uas tsuas yog tswj ntshav qab zib ib ntus, yuav tsum tau mus kuaj mob tam sim ntawd lossis mus pw hauv tsev kho mob.

Qhov tseem ceeb uas ua rau muaj kev txhim kho hypoglycemia suav nrog:

- kev thim rov qab lossis feem ntau (thaum muaj hnub nyoog laus) tsis muaj peev xwm ntawm cov neeg mob koom tes nrog tus kws kho mob, muaj cov khoom noj tsis xwm yeem, noj zaub mov tsis xwm yeem, tsis noj mov, yoo mov

- hloov pauv noj li qub,

- tsis txaus ntawm kev qoj ib ce thiab kev ua kom yuag,

- haus dej haus cawv, tshwj xeeb tshaj yog ua ke nrog yauv noj mov,

- Lub raum khiav tsis zoo, mob hnyav lub siab ua haujlwm,

- qee cov kab mob tsis haum xeeb ntawm cov kab mob endocrine uas cuam tshuam rau cov metabolism hauv kev ua kom yuag, lossis cov lus qhuab qhia hypoglycemia (piv txwv, qee qhov kev ua haujlwm ntawm cov thyroid caj pas, lub caj pas tsis txaus lossis tsis txaus ntawm adrenal cortex), concomitant siv qee yam tshuaj ntxiv (saib Kev cuam tshuam nrog lwm cov tshuaj )

Kev kho mob nrog glimepiride xav tau kev soj ntsuam tsis tu ncua ntawm cov concentration ntawm cov piam thaj hauv cov ntshav thiab zis. Ntxiv rau, glycosylated hemoglobin qib raug pom zoo.

Tsis tas li, thaum kho nrog glimepiride, kev kuaj xyuas lub siab ua haujlwm tas li thiab suav cov ntshav (tshwj xeeb yog leukocytes thiab platelets) yog qhov tsim nyog.

Hauv cov xwm txheej ntxhov siab (piv txwv, tom qab muaj xwm txheej, kev ua haujlwm thaum muaj xwm ceev, kab mob febrile, thiab lwm yam), kev hloov mus ib ntus rau insulin kuj qhia tau.

Tsis muaj kev paub nrog glimepiride nyob rau hauv cov neeg mob uas mob raum tsis zoo lossis hauv cov neeg mob uas xav tau hemodialysis. Cov neeg mob uas mob raum lossis siab tsis txaus ua rau pom cov ntshav pauv mus rau insulin.

Kev kho nrog sulfonylurea derivatives tuaj yeem ua rau hemolytic anemia nyob rau hauv cov neeg mob uas muaj piam thaj-6-phosphate dehydrogenase tsis txaus. Txij li thaum glimepiride nyob rau hauv chav kawm sulfonylurea derivatives, nws yuav tsum siv nrog ceev faj hauv cov neeg mob uas muaj piam thaj-b-phosphate dehydrogenase tsis txaus. Ntxiv rau, cov kev kho mob yuav tsum tau txiav txim siab nrog lwm tus neeg sawv cev uas tsis muaj sulfonylurea derivatives.

Amaryl muaj cov lactose monohydrate, yog li nws yuav tsum tsis txhob siv rau cov neeg mob uas tsis muaj mob lactose, lactase tsis txaus lossis tsis hnov ​​qab cov ntshav-lactose.

Kev kawm txog cov txiaj ntsig ntawm glimepiride ntawm kev muaj peev xwm tsav tsheb thiab cov tshuab tseem tsis tau ua. Tus neeg mob cov lus teb lossis kev muaj peev xwm mloog zoo tuaj yeem txo qis vim qhov tshwm sim ntawm kev txhim kho hypoglycemia lossis hyperglycemia, lossis, piv txwv li, vim qhov muag tsis pom kev. Cov teebmeem no tuaj yeem ua rau txaus ntshai nyob rau hauv qhov xwm txheej uas cov peev xwm no muaj qhov tseem ceeb tshwj xeeb (piv txwv, thaum tsav tsheb lossis tshuab).

Cov neeg mob yuav tsum paub txog kev ceev faj kom tsis txhob mob ntshav qab zib thaum tsav tsheb. Qhov no yog qhov tseem ceeb tshwj xeeb tshaj yog rau cov neeg mob uas muaj ntau lub sijhawm tsis muaj ntshav qab zib, lossis cov neeg mob tsis txaus lossis tsis paub txog thaum ntxov qhia tias tus mob hypoglycemia. Hauv cov xwm txheej no, qhov tsim nyog ntawm kev tsav tsheb los yog siv tshuab ua haujlwm yuav tsum tau txiav txim siab.

Kev Sib Sau thiab daim ntawv ntawm kev tso tawm

Amaryl yog tsim tawm hauv cov ntsiav tshuaj muaj 1-4 mg, uas tau ntim hauv 15 daim ib lub hlwv. Ib pob ntawm cov tshuaj yuav muaj xws li 2, 4, 6 lossis 8 lub hlwv.

• Ib ntsiav tshuaj ntawm cov tshuaj suav nrog cov tshuaj nquag - glimepiride - 1-4 mg thiab ntu sib xyaw: lactose monohydrate, povidone, sodium carboxymethyl hmoov txhuv nplej siab, microcrystalline cellulose, indigo carmine thiab magnesium stearate.

Cov chaw soj ntsuam thiab kws tshuaj: qhov ncauj tshuaj hypoglycemic.

Cov lus qhia rau kev siv

Raws li cov lus qhia rau kev siv, ntau npaum li cas ntawm Amaryl thiab Amaryl M cov tshuaj tau npaj los ntawm tus kws kho mob tshwj xeeb rau txhua tus neeg mob, nyob ntawm seb cov ntshav qab zib cov ntshav siab npaum li cas ntawm tus neeg mob. Cov tshuaj yuav tsum tau siv nyob rau hauv qhov tsawg kawg nkaus kom txaus kom ua tiav qhov kev tswj hwm kev hnyav tsim nyog.

Cov lus qhia rau kev siv ntawm Amaril kuj tau tshaj tawm tias kev kho mob yuav tsum txiav txim siab tsis tu ncua ntawm kev saib xyuas cov piam thaj hauv cov ntshav thiab qib glycosylated hemoglobin.

Amaryl ntsiav tshuaj yuav tsum noj kom tag nrho, tsis txhob ntxo, nrog cov kua txaus (li 1/2 khob). Yog tias tsim nyog, cov ntsiav tshuaj ntawm cov tshuaj Amaryl tuaj yeem muab faib raws cov kev pheej hmoo ua ob seem sib luag.

• Thawj koob tshuaj ntawm Amaril yog 1 mg 1 zaug / hnub. Yog tias tsim nyog, koob tshuaj txhua hnub tuaj yeem hloov zuj zus (ntu sijhawm li ntawm 1-2 lub lis piam) raws li kev saib xyuas ntshav qabzib tas li thiab raws li cov cai hauv qab no: 1 mg-2 mg-3 mg-4 mg-6 mg (-8 mg) ib hnub Cov.
• Hauv cov neeg mob uas muaj hom mob ntshav qab zib hom 2, tshuaj txhua hnub feem ntau yog 1-4 mg. Kev noj tshuaj txhua hnub ntau dua 6 mg yuav zoo dua hauv qee tus neeg tsawg xwb.

Kev ua txhaum ntawm kev noj tshuaj, piv txwv, hla cov koob tshuaj tom ntej, tsis tas yuav tsum ua los ntawm kev siv tshuaj Amaril tom qab ntau dua.

Lub sijhawm rau noj cov ntsiav tshuaj thiab faib cov koob tshuaj thoob plaws hnub ntawd yog txiav txim los ntawm tus kws kho mob. Tib lub sijhawm, nws yuav siv mus rau hauv tus neeg mob txoj kev ua neej (tus nqi ntawm lub cev, lub sijhawm noj mov, kev noj haus). Qhov muab tshuaj rau txhua hnub yog muab rau hauv 1 koob tshuaj, tam sim ntawd ua ntej noj tshais. Yog tias qhov koob tshuaj txhua hnub tsis tau noj, ua ntej thawj pluas noj. Nws yog ib qho tseem ceeb kom tsis txhob noj ib pluas mov tom qab siv cov tshuaj.

Glimepiride txoj kev kho yog feem ntau nqa tawm mus ntev.