Kev sib xyaw ntawm metformin thiab DPP4 inhibitors (glyptins) raug lees paub los ntawm endocrinologist yog qhov muaj kuab tshaj plaws rau tus mob ntshav qab zib hom 2. Cov khoom siv feem ntau tau kawm los ntawm chav kawm ntawm gliptins yog saxagliptin. Kev sib xyaw ntawm saxagliptin nrog metformin tsau hauv ib ntsiav tshuaj mus rau muag nyob rau xyoo 2013 raws li lub npe Combogliz Prolong.
Cov nquag nyob hauv nws cov muaj pes tsawg leeg muaj qhov ua kom tiav: lawv txo insulin tsis kam thiab txhim kho cov tshuaj insulin. Ntxiv mus, cov tshuaj muaj pov thawj kev nyab xeeb rau lub plawv thiab cov hlab ntshav, kev xyaum tsis ua rau kev mob ntshav qab zib, tsis pab txhawb rau qhov hnyav. Cov kab mob ntshav qab zib kho hauv tsev pom zoo kev pom zoo kom siv Combogliz Prolong rau cov neeg mob uas tsis txaus insulin. Nrog glycated hemoglobin saum toj no 9%, nws tuaj yeem kho mob tom qab kuaj pom ntshav qab zib.
Tus txheej txheem ntawm kev ua ntawm comboglize
Combogliz Prolong yog ib hom tshuaj siv tshuaj Asmeskas, cov cai ntawm nws yog rau cov tuam txhab Bristol Myers thiab Astra Zeneka. Cov ntsiav tshuaj muaj 3 ntau txoj kev xaiv, uas ua rau nws xaiv tau cov nqi ntawm metformin thiab saxagliptin, nyob ntawm seb tus yam ntxwv ntawm tus kabmob:
Mob ntshav qab zib thiab siab surges yuav yog ib yam dhau los
- Li qub ntawm qab zib -95%
- Kev tshem tawm ntawm cov hlab ntsha thrombosis - 70%
- Ntaus tau ntawm lub plawv dhia muaj zog -90%
- Kev tshem tawm ntshav siab - 92%
- Qhov nce hauv lub zog nruab hnub, txhim kho pw tsaug zog thaum hmo ntuj -97%
- 1000 mg + 2.5 mg yog qhov tsim nyog rau cov neeg mob ntshav qab zib nrog kev muaj peev xwm tiv thaiv insulin, kev rog, kev ua kom lub cev tsis tshua muaj zog;
- 1000 mg + 5 mg yog qhov kev xaiv dav dav rau cov neeg mob ntshav qab zib nrog kev txo qis cov tshuaj lom neeg thiab ua rau lub cev hnyav ntxiv me ntsis;
- 500 + 5 mg yog siv thaum pib kho nrog Combogliz Prolong, tuaj yeem siv txuas ntxiv nrog rau cov tshuaj insulin tsis kam, lub cev qhov hnyav.
Thaum kuaj xyuas qhov sib npaug ntawm Comboglyz thiab nws cov khoom sib xyaw, metformin thiab saxagliptin, nws tau muab tawm tias tsis muaj kev sib txawv hauv cov khw muag tshuaj ntawm cov tshuaj, kev sib xyaw ntawm ob yam tshuaj hauv ib ntsiav tshuaj tsis ua tsis zoo cov yam ntxwv ntawm ib qho twg, cov nyhuv ntawm ntshav qab zib zoo ib yam.
Nyob rau tib lub sijhawm, cov tshuaj sib txuam ua ke tau pom tias muaj txiaj ntsig zoo dua li noj tib cov tshuaj sib cais. Qhov no yog vim muaj qhov nce ntxiv ntawm qhov yuav ua raws li kev kho, lo lus txhais tau tias ua tau raws li txhua tus kws kho mob cov tshuaj. Hauv cov kab mob mus ntev, xws li mob ntshav qab zib mellitus, nws yog ib txwm muaj qis: cov neeg mob tsis nco qab noj lwm lub tshuaj, lossis lawv cia li tso tseg tsis noj ib qho tshuaj uas tau hais tseg. Kev tshawb fawb pom tias qhov kev kho mob yooj yim dua, ua rau tus kws kho mob muaj peev xwm ua tiav. Txoj kev hloov ntawm metformin thiab saxagliptin cais mus rau Combogliz Prolong tso cai rau koj txuas ntxiv txo glycated hemoglobin los ntawm 0.53%.
Metformin
Tau ntau xyoo, nws yog metformin uas tau pom zoo los ntawm cov koom haum mob ntshav qab zib yuav tsum tau sau tseg rau hauv thawj qhov chaw. Qhov no yog vim qhov tseeb tias metformin ua rau qhov tseem ceeb ntawm hyperglycemia hauv hom 2 ntshav qab zib - insulin tsis kam. Raws li cov lus qhia, txo qis glycemia hauv ntshav qab zib tshwm sim vim:
- kev tiv thaiv cov piam thaj ntau ntau hauv lub cev (gluconeogenesis, kom tsawg dua - glycogenolysis);
- ua rau kom nqus cov nqus ntawm cov hnyuv hauv lub plab zom mov;
- nce kev ua haujlwm ntawm cov kua dej hauv cov ntaub so ntswg, tshwj xeeb tshaj yog cov leeg.
Qhov ua tau zoo ntawm kev txo qis ntshav qab zib cov tshuaj feem ntau yog ntsuas los ntawm kev poob hauv glycated hemoglobin thaum lawv noj. Rau metformin, qhov ntsuas no tseem heev - 1-2%. Cov tshuaj yog qhov nruab nrab nrog rau qhov hnyav; dhau 10 xyoo ntawm kev tswj hwm, qhov nce nruab nrab ntawm cov neeg mob ntshav qab zib yog 1 kg, uas tsawg dua nrog kev kho nrog insulin thiab sulfonylurea derivatives.
Hmoov tsis zoo, kev kho mob nrog metformin tsis yog ib txwm ua tau vim nws cov kev mob tshwm sim - lub plab tsis xis nyob, raws plab, mob sawv ntxov. Txhawm rau txhawm rau txhim kho qhov ua siab ntev ntawm cov tshuaj, nws tau pib tso rau hauv daim ntawv ntawm cov ntsiav tshuaj nrog hloov kho (txuas ntxiv) tso. Nws yog cov metformin uas tau muaj nyob hauv Comboglize Prolong. Cov ntsiav tshuaj muaj tus qauv tshwj xeeb: cov tshuaj nquag tso rau hauv lub txhoj uas nqus dej. Tom qab kev tswj hwm, lub matrix hloov mus rau hauv ib lub gel, uas ua rau kom muaj kev ncua sijhawm tsis xws luag ntawm metformin los ntawm nws mus rau hauv cov ntshav. Kev txo qis qab zib cov txiaj ntsig yog ncua ntev hauv txoj hauv kev no txog 24 teev, yog li cov lus qhia rau kev siv pom zoo kom noj cov ntsiav tshuaj ib hnub ib zaug.
Saxagliptin
Cov khoom sib xyaw ntawm Comboglize Prolong yog lub luag haujlwm rau kev txhim kho insulin synthesis. Tus txheej txheem ntawm kev ua ntawm saxagliptin yog qhov kev txwv tsis pub rau lub enzyme DPP-4, lub luag haujlwm ntawm qhov twg yog qhov tawg ntawm incretins. Tus incretins yog tsim tawm nrog nce glycemia thiab txhawb kev nce siab hauv kev tsim cov tshuaj insulin endogenous. Yog tias koj ua kom qeeb ntawm cov nyhuv ntawm DPP-4, incretins yuav ua haujlwm ntev dua, insulin synthesis yuav nce siab, ntshav qabzib yuav poob qis.
Qhov kom zoo ntawm cov tshuaj yog kev sib raug zoo ntawm cov piam thaj mus rau hauv cov ntshav thiab cov kua dej los tsim tawm. Derivatives ntawm sulfonylurea tsis muaj kev sib raug zoo li ntawd. Txawm hais tias siv tshuaj ntau dua, saxagliptin tsis tuaj yeem txuas lub neej ntawm incretins ntau dua 2 zaug, yog li nws cov ntshav qab zib cov txiaj ntsig tsawg tsawg hauv lub sijhawm thiab kev coj ua tsis ua rau mob ntshav qab zib. Tsis yog ib qho txaus ntshai txo cov piam thaj thaum lub sijhawm nws siv tau raug kaw tseg. Tus cwj pwm ceev faj ntawm saxagliptin rau beta hlwb tsim cov tshuaj insulin tso cai ntev lawv cov kev ua haujlwm thiab ncua sijhawm teem sijhawm kho cov tshuaj insulin, uas yog kev tsis pom qab rau hauv cov ntshav qab zib mellitus.
Ob qho metformin thiab saxacgliptin qeeb rau kev nkag mus ntawm cov kua nplaum los ntawm lub plab hnyuv mus rau hauv cov hlab ntsha. Raws li cov neeg mob ntshav qab zib, ob qho tshuaj yuav txo qhov qab los noj mov thiab ua kom muaj kev txaus siab, yog li Combogliz Prolong yog qhov kev xaiv zoo tshaj plaws rau cov neeg mob uas muaj qhov hnyav dhau los, hauv kev sib piv rau cov tshuaj sib xyaw ua ke ntawm metformin nrog sulfonylurea.
Tsuas yog drawback ntawm saxagliptin yog nws tus nqi, uas yog ib qho kev txiav txim ntawm qhov ntau dua li pheej yig sulfonylurea npaj.
Ntu Cheebtsam
Ntxiv rau cov tshuaj yeeb dej caw, Combogliz Prolong ntsiav tshuaj tseem muaj cov khoom ntxiv uas pab txhawb kev tsim khoom thiab muab lub sijhawm ntev ntawm metformin. Ua ib feem ntawm sab hauv, lossis matrix, magnesium stearate, hypromellose, carmellose. Cov tshuaj muaj peb lub plhaub taum Opadrai, uas muaj li ntawm talc, titanium oxide, macrogol. Sab saum toj txheej muaj zas - hlau oxide.
Cov tshuaj sib txawv sib txawv hauv cov xim: 2.5 + 1000 mg daj, 5 + 500 beige, 5 + 1000 paj yeeb. Rau txhua lub ntsiav tshuaj, tsim nyog qhov tshuaj yog thov pleev xim xiav.
Ntu cov khoom xyaw tau tawm ua ke nrog cov quav hauv daim ntawv ntawm lub ntsej muag, nws tuaj yeem nqa daim ntawv ntsiav tshuaj. Hauv cov pawg no tsis muaj ntau yam nyob hauv lub zog.
Lub txee lub neej ntawm Comboglize Prolong yog 3 xyoos. Cov neeg tsim khoom lag luam tsuas xav tau kev tswj tuav cia yog qhov kub txog li 30 degrees.
Tus nqi ntawm kev ntim khoom yog ntawm 3150 txog 3900 rubles. nyob ntawm seb muaj pes tsawg ntawm cov tshuaj hauv ib pob (28 lossis 56 pcs.) thiab ntau npaum li cas.
Cov kev cai rau kev noj cov tshuaj
Qhov pom zoo kom zoo txhua hnub ntawm saxagliptin rau cov neeg mob ntshav qab zib feem ntau yog 5 mg. Ib koob tshuaj me dua ntawm 2.5 mg yog kho rau lub raum ua haujlwm nrog GFR tsawg dua 50, zoo li thaum noj qee yam tshuaj tua kab mob, tshuaj tua kab mob thiab tshuaj ua kom nce siab ntawm saxagliptin hauv cov ntshav.
Kev noj cov tshuaj metformin raug xaiv ib tus zuj zus raws li qib ntawm cov tshuaj insulin. Rau thawj ib nrab ntawm lub hlis, cov neeg mob ntshav qab zib haus 1 ntsiav tshuaj muaj 5 + 500 mg.
Thaum pib ntawm kev kho, qhov kev pheej hmoo ntawm phiv ntawm metformin yog qhov siab tshwj xeeb. Txhawm rau txo lawv, cov tshuaj yuav tsum nruj me ntsis nrog cov zaub mov, nyiam dua thaum yav tsaus ntuj. Yog tias cov tshuaj metformin muaj kev tiv thaiv zoo, tom qab 2 lub lis piam, nws cov koob tshuaj tau nce mus txog 1000 mg. Saxagliptin yog qaug cawv ntawm tib yam tshuaj. Yog tias muaj qhov tsis zoo nyob hauv txoj hnyuv, qhov kev muab tshuaj yuav tsum tau muab ncua thiab muab sij hawm ntxiv rau lub cev kom tau siv cov tshuaj. Yog tias glycemia yog qhov qub, Combogliz Prolong tuaj yeem siv rau tib lub sij hawm ntau xyoo yam uas tsis tas yuav poob qhov kev ua hauj lwm zoo.
Qhov siab tshaj uas tau tso cai ntawm Comboglize yog 5 + 2000 mg. Nws yog muab los ntawm 2 ntsiav tshuaj ntawm 2.5 + 1000 mg, lawv haus cawv tib lub sijhawm. Yog tias 2000 mg ntawm metformin rau cov ntshav qab zib tsis txaus, lwm 1000 mg tuaj yeem noj nyias, zoo dua rau tib daim ntawv ntev (Glucofage Ntev thiab analogues: Formin Ntev, Metformin MV, thiab lwm yam).
Txhawm rau kom ntseeg tau yam tsis ua haujlwm ntawm cov nquag, cov tshuaj tau qaug rau tib lub sijhawm. Txhawm rau khaws cia ntev lub zog ntawm cov ntsiav tshuaj tsis tuaj yeem tsoo.
Yuav hloov hloov Combogliz Prolong li cas
Generics hauv Combogliz Prolong tsis tuaj kawm ntawv thiab yuav tsis tshwm sim rau yav tom ntej, vim tias patent tseem muaj tshuaj los ntawm cov tshuaj. Pab pawg neeg analogues yog linagliptin gliptins (kev sib xyaw nrog metformin yog tsim los hauv cov khoom lag luam Gentadueto), vildagliptin (Galvus Met ua ke nrog tshuaj), sitagliptin (Velmetia, Yanumet). Lawv cov txiaj ntsig nyob rau hauv cov ntshav qab zib mellitus yog ze rau saxagliptin, tab sis cov tshuaj sib txawv ntawm qhov ntau thiab tsawg, pharmacokinetics, contraindications, yog li kev hloov mus rau cov tshuaj tshiab yuav tsum pom zoo nrog kws kho mob.
Yuav ua li cas tuaj yeem txuag khaws ntawm kev yuav ntawm Combogliz Prolong:
- "Sau" Combogliz Prolong los ntawm Onglisa thiab Metformin. Onglisa - cov tshuaj ntawm tib cov chaw tsim tshuaj, muaj 2.5 lossis 5 mg ntawm saxagliptin. Nws tus nqi yog 1800 rubles. rau 30 ntsiav tshuaj ntawm 5 mg. Txhawm rau kom ua tiav cov lus sib xyaw ntawm Combogliz Prolong, ib qho tshuaj tiv thaiv ntev ntev ntxiv rau Ongliz, nws yuav raug nqi 250-750 rubles ib hlis.
- Nug koj tus kws kho mob txog tshuaj pub dawb rau saxagliptin. Cov tshuaj yuav tseem tsis tau muaj nyob hauv txhua thaj chaw, tab sis lawv cov lej tau nce txhua xyoo. Kev taw qhia rau kev teem caij ntawm saxagliptin - ua rau lub cev tsis muaj ntshav lossis ntshav ntau heev ntawm sulfonylurea. Vim tias cov tshuaj tsis muaj cov tshuaj ua kom pheej yig, lub tsev muag tshuaj yuav muab koj li qub Combogliz Prolong ntsiav tshuaj, lossis metformin thiab Onglizu.
- Yog tias koj xaj cov tshuaj hauv khw muag tshuaj online thiab khaws nws tus kheej los ntawm qhov teeb meem, koj tuaj yeem txuag tau li 10% ntawm nws cov nqi.
Hloov mus rau sulfonylurea derivatives yog qhov tsis xav tau, vim tias lawv tuaj yeem ua rau mob ntshav qab zib. Yog tias tsis muaj lwm txoj kev xaiv, nws yog qhov zoo uas yuav tau coj qhov kev nyab xeeb ntawm glimepiride thiab gliclazide. Analogues ntawm cov tshuaj Combogliz nrog cov tshuaj no - Amaril M, Glimecomb.
Kev ntsuas rau siv
Raws li cov lus qhia, Combogliz Prolong ntsiav tshuaj tau tawm rau cov ntshav qab zib hom 2, yog tias kev kho cov zaub mov thiab kev ua haujlwm lub cev tsis txaus txo cov glycemia. Muab tus nqi siab ntawm cov tshuaj, nws qhov kev txiav txim siab yog me ntsis kom nqaim dua. Raws li endocrinologist, lawv muab tshuaj rau hauv cov teebmeem hauv qab no:
- Yog hais tias tus neeg mob tau txo qis tshuaj insulin, thiab noj sulfonylurea yog contraindicated.
- Nrog rau kev pheej hmoo siab ntawm cov ntshav qog ntshav ntshav: cov neeg laus, cov ntshav qab zib nrog cov kab mob sib xyaw ua ke thiab kev txwv kev noj zaub mov, cov neeg mob uas muaj lub siab ntawm kev tawm dag zog, ua haujlwm ntawm kev ua haujlwm uas yuav tsum tau mob siab rau.
- Cov neeg mob ntshav qab zib uas ib txwm tsis ua raws li kws kho mob cov lus qhia yuav tsis nco qab noj tshuaj lossis noj mov raws sijhawm.
- Tus neeg mob ntshav qab zib nrog neuropathy uas tau tshem cov tsos mob ntawm cov qog ntshav qab zib.
- Yog tias tus neeg mob ntshav qab zib mob siab siv nws lub dag zog kom tsis txhob hloov mus rau insulin. Nws ntseeg tias sulfonylurea tuaj yeem ua kom sai ntawm kev rhuav tshem cov beta hlwb. Tsis muaj cov ntaub ntawv zoo li no hais txog sacasagliptin.
Cov Yuav Tsum Muaj
Daim ntawv ntawm contraindications hauv cov lus qhia rau Combogliz Prolong yog qhov dav heev, zoo li hauv kev siv tshuaj:
| Pom kev sib deev | Cov Ntaub Ntawv Ntxiv |
| Kev ua haujlwm tsis haum rau cov Cheebtsam ntawm lub ntsiav tshuaj. | Feem ntau nws yog intolerance rau metformin. Me me kev phiv nyob rau hauv lub plab zom mov tsis yog contraindication. Cov tshuaj tiv thaiv anaphylactic yam saxagliptin muaj tsawg dua. |
| 1 yam mob ntshav qab zib. | Kev siv saxagliptin yog txwv tsis pub vim muaj qhov ploj lossis qhov tshwm sim sai ntawm cov qe ntshav hauv cov ntshav qab zib. |
| Cev xeeb tub, HB, mob ntshav qab zib menyuam yaus ntawm txhua yam. | Tsis muaj cov kev tshawb fawb pom tseeb txog kev nyab xeeb ntawm cov tshuaj. |
| Mob raum. | Ob qhov sib xyaw ntawm Combogliz raug tso tawm los ntawm lub raum, nrog lub raum tsis ua hauj lwm, cov tshuaj muaj ntau ntxiv nyob rau hauv cov ntshav, thiab ib qho kev sib txuam ntau dhau. |
| Kev pheej hmoo siab raum tsis ua haujlwm. | Qhov ua rau yuav poob siab, myocardial infarction, lub cev qhuav dej, kis mob hnyav nrog kub taub hau. |
| Cov xwm txheej uas yuav tsum siv tshuaj insulin. | Mob hnyav cov ntshav qab zib, kev phais mob, raug mob hnyav. |
| Kev Hypoxia | Nce kev pheej hmoo ntawm cov kab mob lactic acidosis. Nws yog soj ntsuam nrog ua pa thiab lub plawv tsis ua hauj lwm, anemia. |
| Cawv kev quav cawv, ob leeg tib si thiab ntev. | Ua rau qeeb tus nqi ntawm kev hloov pauv ntawm lactate mus rau cov piam thaj hauv daim siab, txhawb cov lactic acidosis. |
Sab sij huam
Saxagliptin me ntsis ua rau muaj kev pheej hmoo mob taub hau (los ntawm 1.5%), mob ntsws, ntuav (1%), mob plab (1.9%), mob ncauj plab (1.4%), kev tsis haum tshuaj (1.1%).
Ntawm cov kev mob tshwm sim los ntawm cov yam ntxwv ntawm metformin, xeev siab thiab ntuav tau pom thaum noj Combogliz Prolong ntsiav tshuaj. Lawv qhov ntau yog ntau dua 5%.
Kev siv tshuaj ntau dhau ntawm saxagliptin tsis txaus ntshai thiab ua rau qaug cawv. Tshaj dhau cov koob tshuaj metformin tuaj yeem cuam tshuam loj rau kev noj qab haus huv. Ib feem peb ntawm cov neeg mob ntshav qab zib uas tau noj ntau dua 50 g ntawm metformin ib zaug pib tsim cov mob lactic acidosis.
Thaum siv Metformin Prolong, qee cov tshuaj yuav hloov nws cov nyhuv hypoglycemic. Kev saib xyuas tshwj xeeb yuav tsum tau them rau cov tshuaj tua kab mob, tshuaj tua kab mob, tshuaj tiv thaiv hormonal thiab antihypertensive, tshuaj tiv thaiv kev ntxhov siab, lawv cov npe tag nrho muaj nyob hauv cov lus qhia. Thaum siv cov tshuaj tua kab mob ketoconazole thiab itraconazole, tshuaj tua kab mob clarithromycin thiab telithromycin, tshuaj tiv thaiv nefazodone, tshuaj tiv thaiv HIV rau ib hnub, tsuas pub 2,5 mg ntawm saxagliptin tau tso cai.
