Thiazolidinediones yog ib pawg tshuaj tiv thaiv kab mob hauv lub qhov ncauj tshiab. Ib yam li biguanides, lawv tsis tshaj tawm ntawm lub txiav, txhawb kev tsim cov tshuaj insulin endogenous, tab sis tsuas yog txo qhov tsis kam ntawm cov cell mus rau lub cev.
Ntxiv nrog rau kev loj hlob ntawm glycemia, cov tshuaj kuj tseem txhim kho cov lipid spectrum: qhov kev mloog ntawm HDL nce ntxiv, qib triglycerol tsawg. Txij li thaum cov nyhuv ntawm cov tshuaj yog raws kev txhawb nqa ntawm kev hloov cov noob, cov txiaj ntsig zoo ntawm kev kho mob tuaj yeem xav tau hauv 2-3 lub hlis. Hauv kev sim tshuaj, kev kho mob hlwb nrog thiazolidinediones txo glycated hemoglobin txog 2%.
Cov tshuaj ntawm cov pab pawg no tau zoo ua ke nrog lwm cov tshuaj tiv thaiv kab mob - metformin, insulin, sulfonylurea derivatives. Kev sib xyaw nrog metformin yog ua tau vim muaj cov txheej txheem sib txawv ntawm cov yeeb yam: biguanides inhibit glucogenesis, thiab thiazolidinediones nce qabzib kev siv.
Lawv kuj tsis ua kom cov nyhuv hypoglycemic nrog monotherapy, tab sis, zoo li metformin, hauv txoj kev kho nyuaj nrog hypoglycemic tshuaj tuaj yeem ua rau muaj kev cuam tshuam zoo li no.
Raws li cov tshuaj uas ua rau muaj qhov rhiab ntxiv ntawm receptors rau insulin, thiazolidinediones yog ib qho tshuaj zoo tshaj plaws rau kev tswj hwm tus mob ntshav qab zib hom 2. Qhov kev tiv thaiv tau zoo tom qab noj cov tshuaj kav ntev txog 8 lub hlis tom qab kawg ntawm txoj haujlwm.
Muaj kev kwv yees hais tias cov tshuaj ntawm cov hauv chav kawm no tuaj yeem kho qhov kev mob caj ces ntawm tus mob metabolic syndrome, ncua kev nce qib ntawm tus mob ntshav qab zib hom 2 kom txog thaum ua tiav kev kov yeej tus kab mob.
Ntawm thiazolidinediones, koob thib 2 tiam Aktos ntawm lub tuam txhab pharmacological "Eli Lilly" (Tebchaws USA) tau sau npe ntawm Lavxias khw hnub no. Nws siv nws qhib txoj kev tshiab tshiab tsis tsuas yog nyob rau hauv diabetology, tab sis kuj hauv cardiology, qhov twg cov tshuaj siv los tiv thaiv pathologies ntawm lub plawv thiab cov hlab ntsha, feem ntau vim yog cov tshuaj tiv thaiv insulin.
Dosage daim ntawv thiab cov qauv ntawm Pioglitazone
Qhov tseem ceeb ntawm cov tshuaj yog pioglitazone hydrochloride. Hauv ib ntsiav tshuaj, nws cov nyiaj nyob ntawm qhov koob tshuaj - 15 lossis 30 mg. Cov tshuaj sib xyaw ua ke hauv kev tsim qauv yog ntxiv nrog lactose monohydrate, hydroxypropyl cellulose, calcium carboxymethyl cellulose, magnesium stearate.
Thawj cov ntsiav tshuaj dawb tuaj yeem txheeb xyuas los ntawm cov duab puab convex thiab kos "15" lossis "30".
Hauv ib lub phaj 10 ntsiav tshuaj, hauv ib lub thawv - 3-10 cov phiaj xwm zoo li no. Lub txee lub neej ntawm cov tshuaj yog 2 xyoos. Rau pioglitazone, tus nqi tsis yog tsuas yog nyob ntawm qhov ntau npaum li cas ntawm cov tshuaj, tab sis kuj rau cov chaw tsim tshuaj paus: 30 ntsiav tshuaj ntawm Indian Pioglar 30 mg txhua tus tuaj yeem yuav rau 1083 rubles, 28 ntsiav tshuaj ntawm Irish Actos 30 mg txhua - rau 3000 rubles.
Cov yam ntxwv ntawm Pharmacological
Pioglitazone yog qhov ncauj tshuaj hypoglycemic ntawm thiazolidinedione chav kawm. Cov dej num ntawm cov tshuaj cuam tshuam nrog muaj cov tshuaj insulin: txo qis qhov pib ntawm qhov rhiab ntawm daim siab thiab cov nqaij ua rau lub cev, nws nce tus nqi ntawm cov piam thaj thiab txo nws cov kev tsim tawm hauv lub siab. Piv nrog rau cov tshuaj sulfonylurea, pioglitazone tsis txhawb lub hlwb b lub luag haujlwm rau insulin ntau lawm thiab tsis nrawm rau lawv cov laus thiab necrosis.
Kev txo qis hauv cov tshuaj insulin hauv hom 2 ntshav qab zib pab ua rau cov glycemic profile thiab glycated hemoglobin muaj nuj nqis. Nrog cov kev mob plab zom mov, cov tshuaj ua rau muaj qhov nce siab hauv HDL ntau ntau thiab txo qis hauv triglycerol ntau ntxiv. Cov ntsiab lus ntawm cov roj (cholesterol) tag nrho thiab LDL tseem tsis hloov.
Thaum nws nkag mus rau hauv lub zom zaub mov, cov yeeb tshuaj nquag nquag nqus, nce mus txog qhov muaj nuj nqis hauv cov ntshav tom qab 2 teev nrog kev siv nyiaj bioavailability ntawm 80%. Ib qho kev nce ntau ntawm cov tshuaj nyob rau hauv cov ntshav tau sau tseg rau qhov ntau npaum li cas ntawm 2 txog 60 mg. Cov txiaj ntsig ruaj khov yog tiav tom qab noj cov ntsiav tshuaj hauv thawj 4-7 hnub.
Kev siv ntau zaus tsis ua rau kev txuam ntawm cov tshuaj. Qhov nqus dej tsis yog nyob ntawm lub sijhawm tau txais khoom noj.
Pioglitazone raug tshem tawm nrog quav quav (55%) thiab tso zis (45%). Cov tshuaj, uas yog nyob rau hauv qhov hloov pauv tsis txawv, muaj lub neej ib nrab ntawm 5-6 teev, rau nws cov metabolites, 16-23 teev.
Lub hnub nyoog uas muaj ntshav qab zib tsis cuam tshuam rau lub khw muag tshuaj ntawm cov tshuaj. Nrog lub raum ua haujlwm tsis zoo, cov ntsiab lus ntawm glitazone thiab nws cov metabolites yuav qis dua, tab sis kev ua kom huv yuav zoo ib yam, yog li cov tshuaj ntawm cov tshuaj dawb yog tswj.
Nrog rau daim siab ua haujlwm, txhua theem ntawm cov tshuaj nyob rau hauv cov ntshav yog qhov xwm yeem, nrog qhov nce ntawm cov khoom faib tawm, qhov tshem tawm yuav txo qis, thiab qhov feem me me ntawm cov tshuaj pub dawb yuav nce ntxiv.
Kev ntsuas rau siv
Pioglitazone yog siv los tswj cov ntshav qab zib hom 2 ob qho tib si raws li kev kho mob monotherapy thiab hauv txoj kev kho mob, yog tias kev hloov kho hauv lub neej (kev noj zaub mov tsis muaj carbohydrate, ua kom lub cev txaus, tswj kev xav hauv lub xeev) tsis tau them tag nrho rau cov mob glycemia.
Hauv cov kev kho mob nyuaj, dual lub cev nrog tshuaj metformin yog siv (tshwj xeeb tshaj yog rau kev rog), yog tias monotherapy nrog metformin hauv kev kho tshuaj tsis muab 100% glycemic tswj. Thaum contraindications rau metformin, pioglitazone nrog cov tshuaj sulfonylurea, yog tias siv cov tom kawg hauv kev kho mob monotherapy tsis muab cov txiaj ntsig xav tau.
Kev sib txuas ntawm pioglitazone thiab hauv triple kev sib txuas nrog metformin thiab sulfonylurea kev npaj yog ua tau, tshwj xeeb tshaj yog rau cov neeg mob rog, yog tias cov phiaj xwm dhau los tsis muab glycemic profile ib txwm.
Cov ntsiav tshuaj kuj tseem tsim nyog rau cov tshuaj insulin-tiv thaiv ntshav qab zib hom 2, yog tias cov tshuaj insulin tsis txaus tswj ntshav qab zib, thiab metformin yog sib kis lossis tsis pom zoo los ntawm tus neeg mob.
Cov Yuav Tsum Muaj
Ntxiv nrog rau qhov ua kom tsis haum xeeb rau qhov sib xyaw ntawm cov mis, pioglitazone tsis pom zoo:
- Cov neeg mob uas muaj hom 1;
- Nrog cov ketoacidosis uas mob ntshav qab zib;
- Cov neeg mob mob rau daim siab ua rau lub siab ua haujlwm siab;
- Yog hais tias nyob rau hauv anamnesis - mob pathologies ntawm kos duab. Kuv - IV NYHA;
- Nrog macroscopic hematuria ntawm tsis paub meej etiology;
- Cov mob ntshav qab zib nrog oncology (mob zais zis).
Yeeb Tshuaj Sib Raug
Cov kev siv ua ke ntawm pioglitazone nrog digoxin, warfarin, fenprocoumone thiab metformin tsis hloov pauv ntawm lawv lub peev xwm pharmacological. Tsis muaj kev cuam tshuam cov tshuaj pharmacokinetics thiab kev siv ntawm glitazone nrog sulfonylurea derivatives.
Cov kev tshawb fawb txog kev cuam tshuam ntawm pioglitazone nrog kev tiv thaiv qhov ncauj, calcium channel blockers, cyclosporine, thiab HMCA-CoA reductase inhibitors tsis tau qhia txog cov kev hloov pauv hauv lawv tus yam ntxwv.
Qhov kev siv ntau tshaj tawm ntawm pioglitazone thiab gemfibrozil provokes qhov nce ntawm AUC ntawm glitazone, uas ua rau cov sij hawm-siab tsis tos, los ntawm 3 zaug. Cov xwm txheej zoo li no yuav ua rau muaj feem ntau qhov tshwm sim ntawm qhov tsis pom kev xav ntau-cuam tshuam, vim li ntawd, ntau npaum li cas ntawm pioglitazone yuav tsum tau kho thaum ua ke nrog tshuaj tiv thaiv.
Tus nqi ntawm pioglitazone yog nce ntxiv thaum rifampicin siv los ua ke. Saib xyuas glycemia yog qhov yuav tsum tau.
Kev pom zoo rau kev siv Pioglitazonum
Pioglitazone cov lus qhia rau kev siv pom zoo tias cov neeg mob ntshav qab zib siv 1 p. / Hnub. Cov ntsiav tshuaj nqos tau tag nrho nrog dej, tus kws kho mob xaiv cov koob tshuaj coj mus rau hauv kev kho mob yav dhau los, hnub nyoog, theem ntawm tus kab mob, concomitant pathologies, lub cev tawm tsam.
Nrog cov kev kho mob nyuaj nrog cov tshuaj insulin, cov koob tshuaj ntawm tom kawg tau kho raws li kev nyeem ntawm glucometer thiab kev noj haus cov yam ntxwv.
Rau cov neeg laus ntshav qab zib, tsis tas yuav hloov pauv qhov ntau npaum, lawv pib nrog qis qis, nce qeeb zuj zus, tshwj xeeb nrog kev sib koom ua ke - qhov no yooj yim yoog thiab txo cov haujlwm ntawm cov kev mob tshwm sim.
Nrog lub raum tsis ua haujlwm (qhov ua kom lub qhov txhab pom zoo ntau dua 4 ml / min.), Glitazone raug kho raws li ib txwm muaj, nws tsis yog qhia rau cov neeg mob hemodialysis, ntxiv rau lub siab ua haujlwm.
Cov lus pom zoo ntxiv
Kev ua tau zoo ntawm kev xaiv cov tshuaj ntsuam xyuas tau raug tshuaj txhua 3 lub hlis siv glycated hemoglobin assays. Yog tias tsis muaj qhov tshwm sim txaus, tsum tsis txhob noj cov tshuaj. Lub sijhawm siv ntev ntawm pioglitazone nqa ib qho kev pheej hmoo, yog li, tus kws kho mob yuav tsum saib xyuas kev nyab xeeb ntawm cov tshuaj.
Cov tshuaj muaj peev xwm tuav cov dej hauv lub cev thiab ua rau kom lub siab tsis ua haujlwm. Yog tias tus mob ntshav qab zib muaj kev pheej hmoo txaus ua rau tus neeg laus, mob plawv nres lossis mob plawv, pib qhov yuav tsum yog tsawg heev.
Kev suav nrog yog tau nrog qhov zoo puab. Hom kab mob ntshav qab zib no xav tau kev soj ntsuam lawv li kev noj qab haus huv (hnyav, o, mob tshwm sim ntawm kab mob plawv), tshwj xeeb yog cov qis qis hauv diastolic.
Kev saib xyuas tshwj xeeb thaum sau daim ntawv noj tshuaj yuav tsum tau muab rau cov neeg mob ntshav qab zib ntawm lub hnub nyoog (txij li 75 xyoo), vim tias tsis muaj ib qho kev paub dhau los ntawm kev siv yeeb tshuaj rau pawg no. Nrog kev sib xyaw ntawm pioglitazone nrog insulin, mob pathologies yuav ua kom zoo dua. Thaum muaj hnub nyoog no, kev pheej hmoo ntawm mob qog nqaij hlav, pob txha lov muaj ntau ntxiv, yog li thaum sau ntawv yuav tshuaj, nws yog qhov tsim nyog los soj ntsuam cov txiaj ntsig tiag thiab muaj kev phom sij.
Cov chaw soj ntsuam tshawb pom tseeb hais tias yuav muaj mob kheesxaws ntau ntxiv tom qab noj pioglitzone. Txawm hais tias muaj kev pheej hmoo tsawg (0.06% piv rau 0.02% hauv pawg tswj hwm), txhua yam cuam tshuam kev mob qog nqaij hlav (haus luam yeeb, tsim kev puas tsuaj, pelvic irradiation, hnub nyoog) yuav tsum tau ntsuas.
Ua ntej kev teem caij tshuaj, mob siab rau daim siab. Nrog rau kev nce ntxiv hauv ALT los ntawm 2.5 zaug thiab nrog mob siab tsis ua haujlwm, cov tshuaj yog contraindicated. Nrog mob hnyav ntawm daim siab pathologies, pioglitazone noj nrog ceev faj.
Nrog cov tsos mob ntawm tus kab mob siab (mob ntshav tsis txaus, mob epigastric, mob tsis nco qab, nkees nkees tas li), daim siab daim siab yog soj ntsuam. Tshaj dhau qhov kev cai los ntawm 3 zaug, ntxiv rau cov tsos mob hauv daim siab, yuav tsum yog ib qho laj thawj ntawm kev tshem tawm cov tshuaj.
Nrog rau txo qis hauv insulin tsis kam, qhov kev faib tawm ntawm cov rog tshwm sim: visceral tsawg zuj zus, thiab ntxiv-mob plab. Yog tias qhov hnyav nce ntxiv yog txuam nrog edema, nws yog qhov tseem ceeb los tswj lub plawv ua haujlwm thiab kev noj zaub mov kom muaj calorie.
Vim tias cov ntshav nce ntau ntxiv, hemoglobin tuaj yeem txo qis li ntawm 4%. Cov kev hloov zoo sib xws tau pom thaum noj lwm cov tshuaj tiv thaiv kab mob (rau metformin - 3-4%, sulfonylurea npaj - 1-2%).
Hauv kev sib xyaw ua ke ob zaug thiab peb zaug nrog pioglitazone, insulin thiab sulfonylurea series, kev pheej hmoo ntawm hypoglycemia nce. Nrog rau cov kev kho nyuaj, kev ua kom tiav lub sijhawm kawg ntawm lub koob tshuaj yog qhov tseem ceeb.
Thiazolidinediones tuaj yeem pab ua kom pom kev hnov lus thiab o. Thaum hu rau tus kws kho mob ophthalmologist, nws yog ib qho tseem ceeb uas yuav tsum xav txog qhov muaj peev xwm ntawm macular edema nrog pioglitazone. Muaj kev pheej hmoo ntawm pob txha tawg.
Vim tias lub hauv paus tsis txaus ntseeg tau muaj txiaj ntsig thiab kev nyab xeeb txog kev xeeb tub thiab lactation, cov poj niam tsis tau sau cia polyglitazone rau lub sijhawm no. Cov tshuaj muaj contraindicated rau hauv thaum yau.
Thaum tsav tsheb los yog cov txheej txheem nyuaj, tseem muaj kev phiv tom qab siv glitazone yuav tsum tau txiav txim siab.
Noj ntau dhau thiab tsis zoo lub siab
Nrog kev kho mob hlwb thiab hauv cov txheej txheem nyuaj, qhov tsis txaus siab tau muab sau cia:
- Macular edema, qhov muag tsis pom;
- Mob Kev Plab
- Hypersthesia, mob taub hau;
- Kev kis mob ntawm cov kab mob ua pa, mob ntsws thiab pharyngitis;
- Kev fab tshuaj, anaphylaxis, kev tiv thaiv tsis qab, mob hlwb;
- Txo tsis zoo ntawm kev pw tsaug zog;
- Cov qog ntawm ntau qhov: polyps, hlwv, mob cancer;
- Kev poob thiab mob ntawm qhov kawg;
- Kev tso quav tso tsis haum;
- Erectile kawg ua haujlwm;
Kev noj ntshav qab zib, kev noj haus tsis zoo;- Hypesthesia, ua tsis tiav kev sib koom tes;
- Vertigo;
- Qhov hnyav nce thiab ALT kev loj hlob;
- Glucosuria, proteinuria.
Kev noj ntshav qab zib, kev noj haus tsis zoo;Cov kev tshawb fawb soj ntsuam qhov kev nyab xeeb ntawm ib koob ntawm 120 mg, uas cov neeg ua haujlwm pab dawb noj 4 hnub, thiab tom qab ntawd lwm 7 hnub ntawm 180 mg. Tsis muaj pom cov tsos mob overdose tau pom.
Kev mob ntshav qab zib yog ua tau nrog ib txoj kev nyuaj nrog cov tshuaj insulin thiab sulfonylurea. Kev kho yog mob thiab pab txhawb.
Pioglitazone - analogues
Hauv Asmeskas kev ua lag luam ntawm cov tshuaj tua kab mob, yog ib qhov loj tshaj plaws hauv ntiaj teb, pioglitazone occupies ntu ntu piv rau metformin. Thaum contraindications los yog ua siab ntev tsis zoo ntawm pioglitazone, nws tuaj yeem hloov los ntawm Avandia lossis Roglit - analogues raws rosiglitazone - ib cov tshuaj ntawm tib chav kawm ntawm thiazolidinediones, txawm li cas los xij, kev kwv yees ntev mus rau cov pab pawg no tau ploj lawm.
Txo cov tshuaj lom insulin thiab biguanides. Hauv qhov no, pyoglizatone tuaj yeem hloov los ntawm Glucophage, Siofor, Bagomet, NovoFormin thiab lwm yam tshuaj uas muaj metformin.
Los ntawm cov peev nyiaj ntu ntawm cov tshuaj hypoglycemic, Lavxias analogues yog cov nrov: Diab-norm, Diaglitazone, Astrozone. Vim tias daim ntawv teev cov khoom tseem ceeb ntawm cov lus qhia sib kis, cov lej uas nce nrog kev kho mob nyuaj, ib qho yuav tsum tau ceev faj nrog kev xaiv ntawm cov analogues.
Kev Ntsuas Cov Neeg Siv Khoom
Txog pioglitazone, kev txheeb xyuas tus mob ntshav qab zib yog sib xyaw. Cov neeg uas tau noj cov tshuaj qub pom tias muaj txiaj ntsig zoo thiab qhov tsawg kawg ntawm kev phiv.
Qhov xaus yog qhov tsis sib xws: cov tshuaj tiag tiag txo qib glycemia, glycated hemoglobin thiab txawm tias xav tau cov tshuaj insulin (tshwj xeeb nrog kev kho mob nyuaj). Tab sis nws tsis haum rau txhua tus, yog li koj yuav tsum tsis txhob sim nrog kev noj qab haus huv, tau txais cov tshuaj ntawm cov lus qhia ntawm cov phooj ywg. Tsuas yog tus kws kho mob tshwj xeeb muaj peev xwm txiav txim siab txog qhov ua tau ntawm kev kho mob thiab kev daws teeb meem rau txais pioglitazone.
Koj tuaj yeem kawm paub ntau ntxiv txog kev siv thiazolidinediones hauv kev siv tshuaj los ntawm cov yeeb yaj kiab:
