Cov tshuaj sulfonylurea rau cov tshuaj uas pab tswj ntshav qab zib hom 2 yog ib chav kawm ntawm cov tshuaj ntshav tsis qab zib. Thiab, txawm tias qhov tseeb hais tias cov tshuaj ntawm ib tiam tshiab raws li glimepiride (xws li Amaryl) twb tau tsim, tus txiv neej qub zoo Maninil (glibenclamide hauv nws cov lus sib xyaw) tsis tau poob nws qhov tseeb. Cov kev tshawb fawb tsis ntev los no tau qhia cov yam ntxwv tshiab ntawm cov tshuaj classic.
Antidiabetic ntsiav tshuaj ntawm sulfonylurea pab pawg ntawm cov tshuaj txhawb kev ua si pancreatic thiab tsis yog txhua tus neeg mob ntshav qab zib nrog hom 2 yog qhov haum, yog li koj yuav tsum nkag siab zoo txog lawv cov yam ntxwv.
Maninil - daim ntawv tso tawm
Manilin, daim duab uas tau muab nthuav tawm hauv ntu no, muaj cov ntsiab lus tseem ceeb los tiv thaiv glibenclamide thiab chaw sau:
- Methyl hydroxyethyl cellulose;
- Lactose Monohydrate;
- Cov qos yaj ywm hmoov txhuv nplej siab;
- Magnesium stearate;
- Silicon dioxide;
- Dye Ponceau 4R.
Txheeb xyuas cov khoom lag luam ntawm German chaw tsim tshuaj lag luam Berlin-Chemie (Menarini Group) los ntawm cov tsos yog yooj yim: cov ntsiav tshuaj nrog lub pob khawm pinkish muaj cov chamfer thiab txoj kab sib cais ntawm ib sab. Nyob ntawm seb ntau npaum li cas, ib ntsiav tshuaj yuav ntim tau li ntawm 3.5-5 mg ntawm lub ntsiab kev ua tau tshuaj.
Hauv cov khw muag tshuaj lub khw muag tshuaj, tuaj yeem yuav tshuaj nrog rau cov ntawv yuav tshuaj noj. Hauv Maninil, tus nqi yog peev nyiaj ntau - ntawm 140 txog 185 rubles. Cov tshuaj tsis tas yuav muaj cov xwm txheej tshwj xeeb rau kev cia, tab sis kev nkag ntawm cov menyuam yaus thiab kev tshav ntuj ncaj qha yuav tsum tau txwv. Lub txee lub neej ntawm cov ntsiav tshuaj yog 3 xyoos, cov tshuaj tas sij hawm yog raug pov tseg.
Pharmacological tau
Lub luag haujlwm tseem ceeb ntawm glibenclamide yog kev tsa ntawm β-hlwb ntawm cov islets ntawm Langerhans, lub luag haujlwm tsim khoom ntawm lawv tus kheej insulin. Activity-kev ua haujlwm ntawm tes tau ncaj qha mus rau theem ntawm glycemia thiab nws ib puag ncig. Tom qab siv, cov ntsiav tshuaj tau nqus nrawm ntawm cov hnyuv phab ntsa. Tus nqi ntawm kev nqus ntawm qhov ntim ntawm cov ntsiab lus ntawm lub plab thiab lub sijhawm nws sau nrog zaub mov tsis cuam tshuam. Nrog plasma protein, cov tshuaj nkag mus rau hauv kev sib cuag los ntawm 98%. Lub ncov ntawm nws qib hauv cov ntshav cov ntshav tau pom nyob tom qab 2 thiab ib nrab teev thiab nce mus txog ntawm 100 ng / ml. Ib nrab-lub neej yog li 2 teev, thaum noj ib os - 7 teev. Ua raws li kev saib xyuas kab mob ntawm tus kab mob, hauv cov neeg mob ntshav qab zib lub sijhawm no tuaj yeem yog 8 lossis 10 teev.
Cov tshuaj yog metabolized feem ntau hauv daim siab, hloov pauv nrog kev pab ntawm cov tsis muaj pathocytes rau ob hom metabolites: 3-cis-hydroxy-glibenclamide thiab 4-trans-hydroxy-glibenclamide.
Nws tau raug sim hais tias cov khoom noj metabolites tsis ua rau kev mob ntshav hauv lub ntsej muag, tshem tawm los ntawm lub raum thiab cov kua tsib los ntawm lub cev tag nrho hauv 2-3 hnub.
Yog tias lub siab ua tsis tau zoo, cov tshuaj raug khaws cia hauv cov ntshav ntev dua. Nrog pathologies ntawm ob lub raum nrog zis, nws tau tshem tawm nrog kev ncua, lub sijhawm ntawm uas nyob ntawm qhov mob hnyav ntawm kev ua haujlwm tsis txaus ntseeg ntawm lub cev.
Tshwj xeeb, nrog cov mob me mus rau qib hauv lub raum kev ua haujlwm, lub zog tsis ruaj khov. Nrog creatinine tshem tawm ≤30 ml / min, tus nqi ntawm kev tshem tawm cov metabolites txo, feem nce cov theem ntawm cov tshuaj hauv cov ntshav. Cov xwm txheej zoo sib xws rau Maninil xav tau ib feem kaum ntawm cov tshuaj lossis tshem tawm (feem ntau hauv cov xwm txheej zoo li no, cov tshuaj insulin hauv qab daus).
Leej twg yog Maninil rau?
Cov tshuaj yog tsim los tswj hom mob ntshav qab zib hom 2 (uas tsis yog-insulin-yam ua qauv). Cov ntsiav tshuaj tau muab rau cov neeg mob ntshav qab zib nyob rau hauv tas li ntawd, nyob rau hauv qhov tsis tau npaj ua tiav tom qab hloov txoj kev ua neej (noj cov zaub mov qis, ua kom lub cev tsim nyog, kho qhov hnyav dhau, tswj kev xav hauv lub xeev, ua raws li kev pw tsaug zog thiab so).
Tus kws kho mob endocrinologist muab tshuaj, suav kev kho mob mus rau hauv tus account noj haus, lub hnub nyoog neeg mob, theem ntawm tus kabmob, concomitant pathologies, kev noj qab nyob zoo thiab lub cev kev teb rau cov tshuaj. Cov koob tshuaj yog txiav txim siab raws li glycemic profile ntawm tus neeg mob.
Qhov pib txhaj tshuaj yog ib txwm muaj raws li qhov tsawg kawg - ib nrab ib ntsiav tshuaj hnyav 5 mg lossis 3.5 mg ib hnub. Kev saib xyuas tshwj xeeb hauv kev kho mob koob tshuaj yog muab rau cov neeg mob asthenic nrog kev noj zaub mov rau lub cev, nyob hauv keeb kwm ntawm qhov muaj kev tawm tsam ntshav qab zib, nrog rau cov neeg koom nrog kev ua haujlwm hnyav lub cev. Thawj lub limtiam ntawm glycemic tswj txhua hnub yog xav tau. Kev noj tshuaj titration yog ua raws li cov lus tim khawv ntawm lub ntsuas ntsuas thiab kev txiav txim siab ntawm tus kws kho mob.
Txoj kev kho mob ntawm Maninil yog kwv yees li 15 mg / hnub, uas yog 3 ntsiav tshuaj ntawm 5 mg lossis 5 ntsiav tshuaj ntawm 3.5 mg.
Thaum Maninil hloov lwm cov tshuaj rau hypoglycemic, lawv raug coj los ntawm kev pib siv. Tom qab tshem tawm cov kev siv tshuaj yav dhau los, cov lus qhia glucometer thiab cov txiaj ntsig ntawm kev txheeb xyuas cov zis ntawm lub keeb kwm yav dhau los, tsis muaj tshuaj yeeb tshuaj, tau hais meej. Kev tawm tsam ntawm lub cev yog tshawb xyuas los ntawm qhov muaj pes tsawg kawg - 0.5 ntsiav tshuaj ntawm 3.5 lossis 5 mg. Ua raws li kev noj haus thiab lwm yam mob ntawm lub neej noj qab nyob zoo yog qhov yuav tsum tau ua. Txhawm rau kom tsis txhob muaj kev phiv, qhov koob tshuaj ntawm cov tshuaj tshiab tau nce zuj zus. Tus mob ntshav qab zib yuav tsum qhia rau tus kws kho mob uas tau mus kawm txog txhua yam hloov pauv hauv kev noj qab haus huv.
Kev pom zoo rau kev siv
Maninil pom zoo kom siv nws thaum sawv ntxov, ua ntej noj tshais, ntxuav koj cov koob tshuaj ntawm cov ntsiav tshuaj nrog ib khob dej dawb. Thaum qhov kev cai ntau tshaj 2 pcs / hnub, nws muab faib ua 2 koob tshuaj hauv qhov sib piv ntawm 2: 1. Yuav kom tau txais qhov kho mob siab tshaj plaws, nws raug nquahu kom noj cov tshuaj nyob rau tib lub sijhawm.
Sab sij huam
Raws li cov lus pom zoo los ntawm WHO, lub sijhawm dhau los ntawm kev cuam tshuam tsis zoo los ntawm cov tshuaj raug soj ntsuam rau ntawm qhov ntsuas tshwj xeeb:
- Ntau zaus - los ntawm 10%;
- Feem ntau - txij li 1 txog 10%;
- Qee zaum - los ntawm 0.1 txog 1%;
- Tsis tshua muaj, los ntawm 0.01% rau 0.1%;
- Tsis tshua muaj heev - txog 0.01% lossis cov neeg mob tsis tau sau cia txhua.
Cov xwm txheej ntawm qhov xwm txheej tsis zoo ntawm kev noj Maninil yog yooj yim kawm hauv lub rooj.
| Tshuab thiab kabmob | Hom ntawm txim | Qhov tshwm sim |
| Kev zom zaub mov | hypoglycemic tawm tsam, rog | feem ntau |
| Lub zeem muag | kev tab kaum ntawm kev pab thiab kev xav | tsis tshua muaj neeg pom |
| Kev kho mob txoj hnyuv | Mob plab zom mov tsis haum, hloov pauv ntawm lub cev ntawm lub plab | qee zaum |
| Lub siab | nce nyob rau theem (ib qho me ntsis dhau ntawm) ntawm alkaline phosphatase thiab transaminases | tsis tshua muaj |
| Cov tawv nqaij thiab txheej subcutaneous | dermatitis-zoo li ua pob raws nrog khaus | tsis tshua muaj |
| Tej ntshav ntws | txo cov ntshav txhaws hauv ntshav; erythrocyte txo qis nrog cov qe ntshav dawb | tsis tshua muaj |
| Lwm yam kabmob | Cov nyhuv tsis tseem ceeb ntawm diuretics, proteinuria ib ntus, sodium tsis txaus | tsis tshua muaj neeg pom |
Kev puas siab puas ntsoog feem ntau pom thaum lub sijhawm hloov mus rau tshuaj thiab ploj mus ntawm lawv tus kheej, tsis muaj kev cuam tshuam kev kho mob. Dyspeptic cuam tshuam nyob rau hauv daim ntawv ntawm xeev siab, ntuav, raws plab tsis tas yuav hloov cov tshuaj thiab kuj ploj nthawv lub sij hawm.
Yog tias muaj hyperergic yam kev tsis haum rau glibenclamide, muaj kev pheej hmoo ntawm cholestasis intracranial nrog rau cov kev mob hnyav ua rau daim ntawv ua rau lub siab ua haujlwm tsis zoo.
Cov tawv nqaij ua xua feem ntau yog qhov thim rov qab, tab sis, qee zaus muaj peev xwm ua rau muaj kev poob siab uas yuav tsim teeb meem rau lub neej cov ntshav qab zib.
Los ntawm Maninil, kev ua xua thiab lwm yam kev phiv tuaj yeem pom los ntawm ua daus no, kub taub hau, cov tsos mob daj ntseg, thiab kuaj cov protein nyob hauv kev kuaj zis. Hauv txhua qhov xwm txheej, kev sab laj ntawm tus kws kho mob uas xav tau yog qhov tseem ceeb.
Hauv qee kis, kev txo qis hauv txhua cov ntshav cov ntshav tau muab sau tseg tam sim ntawd. Thaum cov tshuaj raug muab tso tseg, qhov xwm txheej tsis dhau nthawv. Kev phiv khaub thuas muaj peev xwm ua tau nrog lwm cov tshuaj uas ua rau mob hypersensitivity hauv tus neeg mob. Hauv tshwj xeeb, zas xim E124, uas yog siv rau hauv kev tsim tshuaj, yog qhov muaj zog fab tsis haum.
Maninil - contraindications
Cov tshuaj tsis yog siv rau qhov ua kom txo qis mus rau qhov sib xyaw ntawm cov mis. Thiab, nws tsis pom tias:
- Rau kev ua xua rau diuretics thiab ib qho tshuaj sulfonylurea-based, sulfonylamide npaj, probenecid;
- Tus mob ntshav qab zib nrog hom ntshav qab zib hom 1, nrog atrophy ntawm β-hlwb;
- Yog tias tus neeg mob ua rau mob metabolic acidosis, mob ntshav qab zib tsis zoo;
- Cov poj niam cev xeeb tub thiab lactating;
- Cov neeg mob uas muaj mob rau daim siab thiab lub raum ua tsis tiav (qib 3);
- Rau cov neeg quav cawv thiab tsim txom cawv (hem hem thawj ntawm hypoglycemia).
Nrog kev haus dej cawv ua rau lub ntsej muag, qhov ua kom lub ntsej muag ntawm glibenclamide zoo tuaj, thiab lub xeev ntawm intoxication npog cov tsos mob ntawm tab tom yuav muaj kev puas tsuaj.
Nrog lub plab ua haujlwm, kev raug mob hnyav, kub nyhiab, noj cov tshuaj antidiabetic yog txwv tsis pub. Lawv hloov mus ib ntus nrog cov tshuaj insulin, uas tso cai rau koj kom yooj yim thiab ceev kho cov ntsiab lus ntawm cov suab thaj hauv cov ntshav.
Tsis muaj kev txwv tsis pub rau kev tsav tsheb thiab lwm yam khoom siv rau lub sijhawm ua kev kho mob nrog Maninil. Tab sis kev mob ntshav qab zib tsawg tuaj yeem cuam tshuam kev xav thiab kev xav, tshwj xeeb hauv kev sib koom ua ke nrog kev noj qab zib. Yog li, cov qib ntawm kev pheej hmoo rau txhua tus mob ntshav qab zib yuav tsum ntsuas nws tus kheej.
Qhia Txog Kev Sib Koom Tes Nrog Tshuaj
Nrog rau cov kev kho mob ua ke nrog glibenclamide thiab clonidine, thiab ntxiv rau β-adrenergic blockers, reserpine, guanethidine, cov tsos mob ntawm kev mob ntshav qab zib tsis muaj qhov ntsej muag thiab tsis pub ua kom tsis nco qab txog ntshav qab zib tsis nco qab yuav raug lees paub.
Kev siv cov tshuaj pleev plab tas li uas ua rau qhov quav tsis zoo yuav txo qhov glucometer thiab qhov muaj feem yuav ua rau tus mob ntshav qab zib tsawg.
Ua kom muaj peev xwm ntawm glibenclamide txog kev tawm tsam hypoglycemic, koj tuaj yeem siv cov tshuaj tua kab mob tib yam li cov tshuaj insulin, ACE inhibitors, txo qis cov ntsiav tshuaj, tshuaj raws li txiv neej cov tshuaj hormones, tshuaj steroid, antidepressants, β-blockers, clofibrate, tshuaj raws quinolone, coumarin, phenamine, disaminophen miconazole, PASK, pentoxifylline, perhexylin, pyrazolone, probenecid, salicylates, sulfonamidamide tshuaj, tshuaj tua kab mob ntawm chav kawm tetracycline, tritokvalin, cytost lub suab qw.
Nws inhibits qhov kev ua ntawm cov tshuaj, ua rau cov neeg muaj mob hyperglycemic, tib lub sijhawm siv ntawm acetazolamides, β-adrenergic thaiv cov tshuaj, diazoxide, glucagon, barbiturates, diuretics, tubazide, glucocorticosteroids, phenothiazine chav kawm tshuaj, phenytoin, nicotinates, cov tshuaj tua kab mob phom, gazimomonet pawg, tshuaj gorimomonet lub qog ua haujlwm.
Coumarin pab pawg tshuaj, ranitidine, pais plab H2 receptor antagonists, pentamidine, reserpine ua kev tsis txaus ntseeg, ua yeeb yam xws li catalysts lossis inhibitors ntawm glibenclamide kev ua si.
Pab nrog overdose
Kev noj tshuaj ntau dua ntawm glibenclamide (ob qho tib si hauv cov qauv mob thiab kev ua kom tsis txaus siab) muab cov ntshav qog ntshav siab - muaj qhov cuam tshuam ntev, mob hnyav thiab ua rau tuag taus ntawm tus neeg raug mob. Cov kab mob kev soj ntsuam ntawm kev tawm tsam hypoglycemic, txhua tus mob ntshav qab zib yuav tsum paub kom raug:
- Kev tswj tsis tau tshaib plab;
- Tshaj tawm ntawm caj npab thiab ceg;
- Tachycardia;
- Nce kev ntxhov siab;
- Tawv tawv nqaij thiab qog ua kua.
Qee lub sij hawm muaj kev cuam tshuam ib ntus ntawm kev nco qab, paresthesia. Yog hais tias tus neeg raug tsim txom tsis tau muab kev pab kho mob thaum muaj xwm txheej ceev, nws poob rau hauv lub ntsej muag hypoglycemic precoma thiab coma, uas yog neeg tuag taus.
Kev kuaj pom ntawm cov kev rau txim tom qab ntawd yog pib ntawm kev sau cov ntaub ntawv hais txog tus raug mob los ntawm cov txheeb ze paub txog cov tshuaj uas tus kab mob ntshav qab zib thiab nws muaj feem cuam noj. Ib lub chaw kuaj sim ua haujlwm.
Kev kuaj xyuas ntawm tus neeg raug mob tso cai rau koj soj ntsuam cov xwm txheej ntawm daim tawv nqaij (txias, txias, ntub). Qhov kub ntawv yuav zoo li qub lossis qis dua. Ua raws li qhov mob hnyav ntawm kev tawm tsam, cov leeg pob txha ntawm lub tonic lossis clonic yam, tsis kho raws kev cai, thiab pom tus mob chua leeg.
Yog tias tus neeg mob tseem nco qab, nws tuaj yeem haus dej qab zib qab zib nrog cov piam thaj tsis tu ncua, noj tej zaub mov sai (qab zib, khaub noom). Yog tias tus mob tseem tsis hloov, cov ntshav qab zib tau pw hauv tsev kho mob.
Nrog rau kev tsis nco qab nyob hauv tsev kho mob, ib qho 40% piam thaj tov (40 ml) yog muab rau iv. Raws li kev saib xyuas ntawm kev sim hauv chaw sim, kev kho txoj kev lis ntshav nrog kev pab ntawm molecular phaus lub cev hnyav yog kho tau.
Muaj cov neeg paub txog tus mob hypoglycemic ncua ntev thiab ncua sij hawm chua leeg, npau taws los ntawm cov peev txheej ntawm glibenclamide. Cov xwm txheej zoo li no yuav tsum tau soj ntsuam cov neeg raug tsim txom hauv tsev kho mob li 10 hnub lossis ntau dua hnub nrog kev tshuaj xyuas glycemia thiab kho cov tsos mob kom zoo.
Yog tias tus neeg tau noj tshuaj ntxiv ib zaug thiab huam yuaj, nws txaus los yaug lub plab, muab tus neeg nqus thiab ib khob dej qab zib lossis kua txiv.
Analogues ntawm cov tshuaj
Nrog tib yam tshuaj sib xyaw ua ke hauv Glibenclamide, Glibenclamide thiab Glibamide tuaj yeem hloov Maninyl. Kev taw qhia, contraindications, phiv yog zoo tib yam. Raws li ATX code ntawm qib 4 rau Maninil, Glidiab, Glyclazide, Diabeton, Glurenorm, uas muaj cov kev kho mob zoo ib yam, tuaj yeem yog analogues.
Cov lus pom zoo ntxiv
Rau cov neeg mob paub tab, cov neeg uas muaj zaub mov noj tsis txaus, asthenics, mob ntshav qab zib nrog lub siab thiab lub raum pathologies, qhov pib ntawm Maninil yog txo qis rau qhov tsawg kawg vim qhov kev pheej hmoo ntawm hypoglycemia. Yog hais tias tus mob ntshav qab zib tau hloov pauv, kev ua neej, kev kho mob kuj tseem tau tshuaj xyuas.
Kev saib xyuas tshwj xeeb yog tseev kom muaj los ntawm cov neeg mob senile dementia, kev puas siab puas ntsws thiab lwm yam mob uas cuam tshuam txoj kev sib cuag tag nrho ntawm tus neeg mob nrog kws kho mob. Kev kuaj hauv chav kuaj ntawm cov neeg mob no yuav tsum ua kom ntau li ntau tau. Txheeb xyuas txhua qhov tshwj xeeb ntawm cov nyhuv ntawm cov tshuaj ntawm lub cev, lawv tau qhia txog cov tshuaj analogues nrog kev tso tawm sai sai ntawm cov tshuaj yeeb dej caw.
Yog tias tus mob ntshav qab zib tsis nqus tshuaj metformin, nws tau raug muab tshuaj kho mob glitazone xws li rosiglitazone lossis pioglitazone. Nrog rau cov kev ntsuas uas tsim nyog, Maninil ntsiav tshuaj kuj tseem ntxiv nrog lwm cov tshuaj tiv thaiv kab mob ntshav nrog tshuaj sib txawv ntawm kev ua. Guarem lossis Acarbose, uas, zoo li Maninil, txhawb nqa lub txiav, tsis siv hauv kev kho mob nyuaj.
Kev siv lub sijhawm ntev ntawm glibenclamide depletes β-hlwb, ua rau necrosis, thiab txhim kho qhov tsis zoo rau Maninil. Txhawm rau pab txhawb nqa tus txiav, ntshav qab zib tau pauv mus rau insulin (tag nrho lossis ib feem, nyob ntawm seb qhov degree ntawm lawv atrophy).
Kev ntsuas kev ntsuas tshuaj los ntawm cov kws kho mob thiab cov ntshav qab zib
Txog Maninil cov tshuaj xyuas tau sib xyaw. Cov kws kho mob cim nws raws li ib txwm noj tshuaj hypoglycemic nrog cov pov thawj ua tau zoo hauv kev ua haujlwm thiab kev nyab xeeb. Tus mob ntshav qab zib tsis txaus siab rau ib qho ntxiv yuav luag lees paub qhov hnyav nce thiab lwm cov kev mob tshwm sim, tab sis nws yog qhov tsawg kawg nkaus rau kev ntsuam xyuas lub peev xwm ntawm cov tshuaj raws li cov txiaj ntsig ntawm ib tus neeg mob.
Cov lus pom zoo ntawm lub xaib no yog kev hloov kho ntawm cov lus qhia ntawm nom tswv, npaj rau kev paub dav dav, thiab tsis yog rau kev siv tus kheej. Qhov xaiv ntawm cov tshuaj thiab kev npaj ntawm txheej txheem kev kho mob yog tsuas yog ua lub luag haujlwm ntawm tus kws kho mob.
