Txhua tus neeg nyob hauv lub ntiaj teb (thiab nyob rau qee thaj tsam ntawm Suav teb - txhua thib ob) muaj mob lossis muaj pheej hmoo yuav muaj ntshav qab zib. Cov hau kev tseem ceeb ntawm kev ploj tuag (myocardial infarction thiab oncology) feem ntau muaj ntshav qab zib, txawm tias tsis meej lossis tsis pom dab tsi.
Yuav kom tawm tsam kev sib kis ntawm tiam 21 no, ntau pua hom tshuaj tau tsim kho - ob qho tib si ib txwm, nrog cov pov thawj ruaj khov, thiab muaj tswv yim tshiab, xav tau kev pom zoo ntawm cov hauj lwm zoo. Ntawm cov tshuaj tiv thaiv kab mob nrov tshaj plaws yog Glucovans ntawm lub tuam txhab Austrian Nycomed Austria GmbH.
Cov yam ntxwv dav dav ntawm cov tshuaj
Cov tshuaj sib xyaw ua ke ntawm tus neeg sawv cev nrog tus kabmob hypoglycemic suav nrog ob yam khoom xyaw: Metformin thiab Glibenclamide. Lawv piv nyob rau hauv tsiav tshuaj sib txawv:
| Tsuas tshuaj mg | glibenclamide, mg | metformin mg |
| 2,5 /500 | 2,5 | 500 |
| 5/500 | 5 | 500 |
Hauv cov tshuaj, tseem muaj tus tshaj lij: croscarmellose sodium, magnesium stearate, cellulose, povidone K 30.
Cov tshuaj yog tso tawm hauv cov qauv hauv cov ntsiav tshuaj. Lub plhaw tshuaj ntsiav tej zaum yuav daj lossis txiv kab ntxwv. Hauv thawj version, tus naj npawb "5" tau sau rau ntawm sab xub ntiag, hauv ob - "2.5".
Cov yam ntxwv ntawm Pharmacological
Metformin yog tus sawv cev ntawm chav kawm ntawm biagudins. Nws lub hom phiaj tseem ceeb yog txhawm rau txo qhov kev kub siab ntawm basal thiab postprandial glucose hauv cov ntshav. Cov tshuaj tsis txhawb tus tsim tshuaj ntawm endulinous insulin, yog li ntawd nws tsis ua kom tsis muaj ntshav qab zib. Cov tswv yim tseem ceeb ntawm nws qhov kev cuam tshuam:
- Txo kev coj ua ke ntawm glycogen hauv daim siab los ntawm inhibiting gluconeogenesis cov txheej txheem;
- Kev tshem tawm ntawm "kev dig muag" ntawm peripheral hormone receptors;
- Kev siv ntau ntxiv thiab siv cov piam thaj hauv cov hlwb;
- Kev txwv tsis pub muaj cov kua nplaum nqus.
Metformin tseem ua cuam tshuam rau cov lipid metabolism: cov qib roj triglycerol thiab cov "roj" kom roj tsawg.
Glibenclamide yog tus neeg sawv cev ntawm cov kawm qib ob tiam sulfonylurea ntawm cov tshuaj. Cov lus sib txuas pab ua rau qhov qub glycemia vim qhov kev tsim kho ntawm β-hlwb lub luag haujlwm rau kev tsim cov tshuaj insulin.
Lub tshuab ntawm kev ua ntawm cov Cheebtsam ntawm cov qauv tsis sib txawv, tab sis lawv ua tiav cov peev txheej hypoglycemic ntawm txhua tus, tsim cov nyhuv synergistic. Nrog rau kev siv cais, kev muab tshuaj ntawm txhua cov tshuaj rau qhov tshwm sim zoo sib xws yuav ua rau ntau dua.
Muaj peev xwm ntawm Pharmacokinetic
Glibenclamide thaum noj hauv lub plab zom tau yog nqus los ntawm 95%. Raws li ib feem ntawm cov tshuaj Glucovans® nws yog micronized. Qhov siab tshaj plaws nyob rau hauv cov ntshav tau mus txog tom qab 4 teev, qhov ntim ntawm kev faib tawm cov khoom muaj txog li 10 liv. Glibenclamide khi rau cov nqaijrog los ntawm 99%. Cov tshuaj noj tshuaj metabolism hauv lub siab ua haujlwm, qhov twg nws hloov mus ua ob lub cev tsis muaj zog. Lawv tawm hauv lub cev los ntawm lub raum (nce txog 40%) thiab dhau los ntawm cov khoom sib faib (txog li 60%). Tus txheej txheem ib nrab ntawm lub neej nyob ntawm 4-11 teev.
Thaum muab tshuaj ntawm qhov ncauj, metformin yog nqus tag, cov tshuaj mus txog nws cov kev xav ntau hauv cov ntshav tom qab ob thiab ib nrab teev. Yog tias tsis muaj kev hloov loj, 20-30% ntawm cov tivthaiv excretes txoj hnyuv. Lub peev txheej ntawm metformin yog 50-60%. Hauv cov ntaub so ntswg, cov tshuaj kis tau yuav luag tam sim ntawd thiab tsis khi rau cov ntshav protein txhua. Cov tshuaj yuav luag tsis raug rau cov metabolism, feem ntau nws raug nteg tawm los ntawm lub raum. Ib nrab-lub neej yuav siv li 6 thiab ib nrab teev.
Hauv cov kab mob raum ntev ntev, kev kho mob creatinine yog txo. T1 / 2 los ntawm lub hom phiaj hloov khoom nruab nrog cev tau qeeb, cov tshuaj tau khaws tseg rau hauv cov ntshav. Glucovans bioavailability zoo ib yam li txhua yam ntawm cov tib neeg cov ntawv ntau npaum cov tshuaj. Kev noj haus tsis cuam tshuam rau qhov no, tab sis tus nqi ntawm kev nqus ntawm glibenclamide nyob rau hauv parallel nrog zaub mov yuav siab dua.
Leej twg thiaj pom cov tshuaj noj
Cov txheej txheem tsim los kho hom 2 ntshav qab zib. Nws tau sau tseg yog tias kev hloov kho hauv lub neej thiab kev kho yav dhau los nrog metformin lossis lwm yam tshuaj tsis ua rau tshwm sim tuaj.
Cov tshuaj tau pom zoo rau cov neeg mob ntshav qab zib nrog tag nrho cov nyiaj qab zib los hloov cov kev kho mob yav dhau los nrog ob yam tshuaj cais - Metformin thiab cov neeg sawv cev ntawm cov chav kawm sulfonylurea.
Yuav thov li cas
Ua raws li kev kho mob thaj chaw ntawm chav kawm ntawm tus kab mob ntawm qee qhov mob ntshav qab zib, tus endocrinologist tau tsim kho tus kheej. Hauv cov lus pom zoo ntawm cov khw muag khoom, cov qauv txheej txheem rau kev pib siv tshuaj yog nthuav tawm: ib qho tshuaj ntsiav ntawm ib hom Glucovans.
Yog tias cov koob tshuaj uas tau xaiv tsis tau them rov qab rau glycemia thaum hloov txoj kev ua neej, koj tuaj yeem hloov kho, tab sis tsis ntxov dua tom qab 2 lub lis piam, 5 mg ntawm glibenclamide + 500 mg ntawm metformin txhua hnub.
Thaum hloov cov kev kho ua ntej dhau los ua ke nrog Glucovans, qhov pib siv yuav tsum yog sib npaug ntawm cov kev coj ua niaj hnub ntawm glibenclamide lossis cov tshuaj zoo sib xws los ntawm sulfonylurea pab pawg, nrog rau cov metformin, uas tau raug kho nyob rau theem dhau los ntawm kev kho mob.
Ua raws li kev nyeem ntawv ntawm glucometer tom qab 2 lub lis piam, koj tuaj yeem hloov kho ntau npaum li cas ntawm glucovans.
Qhov ntau kawg ntawm cov ntsiav tshuaj uas tuaj yeem kho rau cov ntshav qab zib yog 4 daim ntawm ib qho kev noj tshuaj ntawm 5 mg / 500 mg lossis 6 daim Glucovans®, ntim hauv 2.5 mg / 500 mg.
Txoj kev ntawm daim ntawv thov yuav nyob ntawm lub txheej txheem xaiv los ntawm kws kho mob. Rau cov ntsiav tshuaj ntawm 2.5 mg / 500 mg thiab 5 mg / 500 mg muaj cov lus pom zoo qauv.
- Yog tias 1 ntsiav tshuaj / hnub tau sau tseg, nws yuav qaug cawv thaum sawv ntxov nrog zaub mov;
- Thaum lub sijhawm txhua hnub yog 2 lossis 4 ntsiav tshuaj, lawv muab faib rau thaum sawv ntxov thiab yav tsaus ntuj, tswj kev cuam tshuam tib lub sijhawm;
- Yog tias pom zoo, noj 3,5 lossis 6 ntsiav tshuaj / hnub. ntawm qhov ntau npaum ntawm 2.5 mg / 500 mg, lawv yuav haus cawv nrog pluas tshais, thaum noj su thiab noj hmo;
- Ntawm kev noj tshuaj ntawm 5 mg / 500 mg, 3 ntsiav tshuaj / hnub tau kho. thiab faib lawv rau hauv 3 txais tos: rau pluas tshais, noj su thiab noj hmo.
Nws yog qhov tseem ceeb heev uas yuav tsum khaws cov ntsiav tshuaj nrog cov zaub mov txaus. Noj Glucovans rau ntawm ib plab khoob tuaj yeem ua rau lub qog ntshav qab zib.
Rau cov neeg mob ntshav qab zib ntawm lub hnub nyoog tiav, thaum suav sau cov tshuaj kho mob, lawv tsom mus rau kev ua haujlwm ntawm lub raum.
Cov tshuaj pib rau hauv ib rooj plaub twg tsis pub tshaj 1 ntsiav tshuaj ntawm 2.5 mg / 500 mg. Hauv qhov no, qhov xwm txheej ntawm lub raum yuav tsum tau kuaj xyuas tas li.
Tsis muaj cov ntaub ntawv muaj txiaj ntsig ntawm cov txiaj ntsig ntawm Glucovans® rau cov menyuam yaus, nws cov hauj lwm zoo thiab kev nyab xeeb, yog li ntawd, nws siv tsis pom zoo rau cov menyuam hluas.
Cov yam ntxwv ntawm Kev Kho Mob Glucovans
Thaum siv cov tshuaj, nws yog ib qho tseem ceeb kom kuaj xyuas koj cov piam thaj kom huv ntawm lub plab, thiab 2 teev tom qab noj mov. Qhov tsim nyog, nws yog qhov yuav tsum tau sau cov ntawv nyeem ntawm glucometer hauv phau ntawv sau hnub 5 r. / Hnub.
Lactic acidosis
Qhov tshwm sim tsawg tsawg, tab sis, mob hnyav heev uas txhua tus mob ntshav qab zib yuav tsum paub txog nws. Thaum tsis muaj kev kho mob sai, tus neeg mob yuav tuag. Ib qho phom sij muaj tshwm sim nrog kev ua kom tiav ntawm metformin. Kev tsis pom qhov tseeb ntawm nws yog cuam tshuam nrog raum tsis ua haujlwm, yog li ntawd, nrog pyelonephritis thiab lwm yam mob raum thiab mob sai, cov tshuaj yuav tsum tau ua nrog ceev faj.
Lwm yam kev pheej hmoo muaj xws li kev tswj tsis tau tus kabmob ntshav qab zib 2, ketosis, kev yoo mov lossis lub cev yuag yuag, kev haus dej cawv, thiab lub siab ua haujlwm tsis zoo.
Txoj kev pheej hmoo ntawm cov kab mob lactic acid nce nrog cov leeg mob, mob plab tsis ua hauj lwm, mob nyob hauv thaj av epigastric, muaj zog tsis muaj zog.
Thaum tsis tas mus pw hauv tsev kho mob sai sai, acidotic ua tsis taus pa, oxygen tsis muaj zog, ua kom lub cev puas tsuaj, lub cev ntaj ntsug.
Kev ntshav siab
Glibenclamide muaj nyob rau hauv hom tshuaj Glucovans which, txhais tau tias qhov zoo li yuav muaj ntshav siab thaum siv cov ntsiav tshuaj tsis tuaj yeem txiav txim siab tau. Txoj kev txhaj ib koob tshuaj rau lub cev yuav pab kom tsis txhob hloov pauv hauv cov ntshav piam thaj ntshav ntau. Nws yog ib qho tseem ceeb uas yuav tau qhia rau tus neeg mob txog cov khoom noj txom ncauj kom raws sij hawm, txij li yav tsaus ntuj los noj lossis tshais ntau dhau uas tsis muaj carbohydrates, ib pluas hmo uas tsis tseem ceeb yuav ua rau mob ntshav qab zib tsawg. Nrog cov leeg mob nce ntxiv (kev kawm ua kis las, ua haujlwm lub zog ua haujlwm hnyav), tom qab noj mov ntau, noj mov hypocaloric lossis siv cov tshuaj tiv thaiv kab mob hauv lub cev, txoj kev pheej hmoo ntawm hypoglycemia yog qhov ntau heev.
Cov tshuaj tiv thaiv uas ua rau kom tus mob no ua rau muaj kev tawm hws, kev tawm tsam ntau dua, tawm hws ntau ntxiv, lub plawv dhia ceev tsis zoo, ntshav siab, mob plawv.
Yog tias hypoglycemia ua rau muaj zog zuj zus ntxiv, mob plawv tsis tuaj yeem tsim kho, tshwj xeeb tshaj yog mob neuropathy lossis kev kho mob sib luag nrog β-blockers, reserpine, clonidine, guanethidine.
Lwm cov tsos mob ntawm tus qog ntshav qab zib muaj xws li:
- Paub tswj tus kheej tsis qab los;
- Mob taub hau;
- Ntuav;
- Puas;
- Kev tsis zoo ntawm kev pw tsaug zog;
- Kev tsis zoo nkauj;
- Txhoj puab heev
- Qhov cuam tshuam;
- Cov Kev Txwv Tshuaj;
- Pom kev tsis zoo;
- Hais lus tsis meej;
- Lub Nruab Siab;
- Poob kev sib koom tes;
- Tawg
- Lub plawv dhia qeeb;
- Tsaus muag.
Txoj kev xaiv tshuaj noj kom zoo, kev siv tshuaj rau lub sijhawm yog, thiab qhia rau cov neeg mob txog qhov yuav tshwm sim yog qhov tseem ceeb rau kev tiv thaiv. Yog tias tus mob ntshav qab zib tau mob ntshav qab zib tas los, nws tsim nyog kho qhov qhia tshuaj kom rov zoo.
Pathology ntawm lub siab thiab lub raum
Cov chaw muag tshuaj thiab pharmacokinetic ntawm cov neeg mob ntshav qab zib nrog kev ua haujlwm tsis zoo ntawm lub raum thiab lub siab ua rau muaj qhov hloov pauv ntau. Kev mob ntshav qab zib tsawg nyob rau hauv cov kab mob mus ntev yog xav tau ntev thiab yuav tsum tau muaj kev kho kom zoo.
Tsis khov tsis khov glycemia
Yog tias tsim nyog, kev kho kom zoo lossis lwm yam laj thawj uas ua rau mob ntshav qab zib tsis txaus, tus neeg mob hloov mus rau insulin ib ntus. Cov tsos mob ntawm tus mob hyperglycemia tuaj yeem tso zis ntau zaus, nqhis dej tas li, nkees nkees, tsis muaj zog, tawv nqaij ntawm daim tawv qis vim tias kev ncig tsis zoo. Ob hnub ua ntej kev phais lossis kev txhaj tshuaj rau txoj leeg ntawm qhov sib piv rau kev tshawb nrhiav xoo hluav taws xob, Glucovans® raug muab tso tseg, kev kho mob rov pib dua tsis pub dhau ob hnub tom qab kev ua haujlwm thiab kev kuaj mob nrog cov raum ua haujlwm txaus.
Teeb meem raum
Lub raum koom rau hauv qhov kev tshem tawm ntawm metformin, yog li ntawd, ua ntej pib ua haujlwm thiab kev kaw lus kom zoo thaum siv cov tshuaj, kev tsim muaj peev xwm tshem tawm yuav tsum kuaj xyuas. Cov neeg mob ntshav qab zib nrog lub raum zoo yuav tsum raug kuaj tsawg kawg 1 r. / Xyoo, rau cov neeg muaj hnub nyoog paub tab, nrog rau cov neeg mob uas muaj creatinine tshem ntawm qhov tsis pub tshaj ntawm ib txwm - 2-4 r / xyoo.
Cov raum tsis ua haujlwm tau pom nyob rau hauv cov neeg mob ntshav siab noj tshuaj diuretics thiab NSAIDs, yog li cov kab mob ntshav qab zib no yuav tsum tau muab tshwj xeeb.
Ntxiv kev ntsuas
Txog rau tus mob ua pa ntawm cov pa lossis cov kab mob ntawm cov genitourinary system ntawm ib qho kev sib kis, cov ntshav qab zib yuav tsum qhia lawv tus kws kho mob endocrinologist txog cov teeb meem.
Sab sij huam
Cov zaus ntawm qhov tsis xav tau uas tau txais los ntawm kev siv Glucovans raug kwv yees raws li qhov tshwj xeeb WHO teev:
- Ntau zaus: ≥ 0.1;
- Feem ntau: ≥ 0.01, <0.1;
- Tawm tsam: ≥ 0.001, <0.01;
- Tsis tshua muaj: ≥ 0.0001, <0.001;
- Tsis tshua muaj heev: <0.0001.
Cov xwm txheej cais yuav tsis raug soj ntsuam los ntawm cov qauv no.
| Sab twg ntawm kev hloov pauv | Hom Kev Ua Phem | Zaus |
| Kev paub kev zom zaub mov | Kev Hypoglycemia; Renal thiab tawv nqaij plooj (porphyria); Lactic acidosis Worsening nqus cov vitamin B12 | tsis tshua pom muaj qhov ua tau |
| Kev tshawb fawb kuaj | Kev loj hlob ntawm urea thiab creatinine hauv ntshav; Kev Hyponatremia | Tsis tshua muaj neeg pom |
| Tej ntshav ntws | Leukopenia thiab thrombocytopenia; Hemolytic anemia, pancytopenia, agranulocytosis, aplasia | tsawg tsawg |
| CNS | saj hloov | feem ntau |
| Lub zeem muag | tsis pom kev zoo vim kev txo qis | thaum pib ntawm qhov pib |
| Kev kho mob txoj hnyuv | Mob plab zom mov tsis haum, mob hauv thaj tsam epigastric, tsis muaj qab los noj mov | thaum pib ntawm qhov pib |
| Tawv | Khaus, urticaria, maculopapular ua pob; Vasculitis, dermatitis, erythema | tsis tshua muaj tsis tshua muaj neeg pom |
| Kev tiv thaiv kab mob | anaphylactic poob siab | tsis tshua muaj neeg pom |
Qee zaum cov kab mob siab thiab lwm cov kab mob hepatic pathologies txhim kho, xav tau kev kho mob tshwj xeeb thiab tshem tawm Glucovans.
Qhia Txog Kev Sib Koom Tes Nrog Tshuaj
Tus kws kho mob ntshav qab zib tau qhia rau tus kws kho mob txog txhua yam tshuaj kho mob txhawm rau coj lawv lub peev xwm mus rau hauv kev suav thaum sau cov txheej txheem ua kom tsawg thiab ua kom raws sijhawm kom paub txog cov cim tsis muaj kev cuam tshuam.
- Contraindicated: Minazole nrog glibenclamide (ua rau lub cev tsis muaj ntshav qab zib), metformin thiab iodine muaj tshuaj (Glucovans tso tseg tom qab 48 teev).
Cov kev xaiv pom zoo: sulfonylurea chav kawm tshuaj thiab dej cawv (muaj kev phom sij rau mob ntshav qab zib tsis ua hauj lwm), phenylbutazone nrog glibenclamide (nce hypoglycemic muaj peev xwm ntawm cov tshuaj), bosentan nrog glibenclamide (kev pheej hmoo ntawm cov nyhuv hepatoxic), metformin thiab cawv (muaj peev xwm ntawm lactic acidosis).
- Kev sib xyaw nrog Glucovans tau siv kom zoo: Chlorpromazine (inhibits insulin secretion), glucocorticosteroids (ketosis), danazol (hyperglycemia), diuretics (hyperglycemia, lactic acidosis), ACE inhibitors (hypoglycemia).
Cov cim qhia kev haus tshuaj ntau dhau thiab contraindications
Kev overdose yog txaus ntshai nrog hypoglycemia ntawm qhov sib txawv heev. Nrog rau daim ntawv me, cov tsos mob kuj tuaj yeem raug tshem tawm nrog ib qho qab zib, nrog cov tsos mob hnyav dua li tsev kho mob yog tsim nyog, vim tias muaj kev hem thawj ntawm cov kab mob lactic acidosis thiab rov qab zoo li qub, tshwj xeeb tshaj yog muaj ntshav qab zib ntev. Nrog rau tus kws kho mob, koj yuav tsum kho cov koob tshuaj thiab tswj kev noj haus.
Cov Tshuaj Tiv Thaiv:
- Hypersensitivity rau cov khoom xyaw yooj yim thiab excipients;
- Ntshav Qab Zib Hom 1;
- Ketoacidosis, coma thiab nws qhov mob ua ntej;
- Kev tsis ua haujlwm raum (creatinine tshem tawm - txog 60 ml / min);
- Cov xwm txheej ua rau muaj kab mob sib kis, poob siab, lub cev qhuav dej;
- Cov pathologies uas ua rau cov leeg hypoxia;
- Kab mob hauv lub plawv thiab mob ntsws;
- Tus Kab Mob Siab Hepatic;
- Cev xeeb tub thiab pub niam mis
- Kev phais mob hnyav;
- Txhawb kev siv miconazole;
- Kev quav cawv;
- Lactic acidosis (keeb kwm);
- Muaj khoom noj khoom haus muaj tsis tu ncua ntev ntev
Tus nqi thiab chaw cia khoom
Cov ntsiav tshuaj tau ntim rau hauv cov hlwv. Hauv txhua lub thawv - 2 daim phiaj. Daim ntawv "M" yog lo rau lub ntim - tiv thaiv kev dag. Muag ib yam tshuaj kho mob kom yuav.
Ntawm Glucovans, tus nqi hauv cov khw muag tshuaj muaj raws li cheeb tsam, hom tshuaj thiab ntau npaum li cas. Qhov nruab nrab, ib pob ntawm 2.5 mg / 500 mg tuaj yeem yuav rau 220 rubles., 5 mg / 500 mg - rau 320 rubles.
Khaws cov tshuaj hauv chav rau mob yam tsis muaj menyuam nkag. Txee lub neej yog 3 xyoos.
Glucovans: kev xav ntawm kws kho mob thiab cov neeg siv
Txog Glucovans, kev txheeb xyuas tus mob ntshav qab zib yog sib xyaw. Cov neeg ntawm lub hnub nyoog paub tab tham txog kev siv yooj yim: tsis txhob nco qab kuv haus cov tshuaj twg thiab qhov twg kuv tsis hnov qab. Rau qee qhov, cov tshuaj tau dhau los ua ib txoj hauv kev zoo rau cov tshuaj insulin, vim tias tsis muaj leej twg nyiam txhaj tshuaj. Qee tus yws yws txog kiv taub hau, mob plab, tsis qab los.
Cov kws kho mob hauv cov lus tau sau tseg tias cov kev mob tshwm sim thaum thawj theem ntawm kev kho nrog Glucovans yog qhov ib txwm ua. Lub sijhawm dhau mus, lub cev yoog. Koj yuav tsum tsis txhob ntshai cov tshuaj insulin, qee zaum nws yog kev ntsuas lub zog ib ntus. Nyob rau hauv txhua rooj plaub, kev xaiv cov tshuaj yeej ib txwm nyob hauv kev txawj ntawm tus kws kho mob. Ntau tus sau tseg tias muaj cov tshuaj, txawm hais tias nws muaj cai keeb kwm.
