Glibenclamide: ka wehewehe ʻana o ka lāʻau lapaʻau, nā loiloi a me nā ʻōlelo aʻoaʻo

Nā lāʻau lapaʻau waha ʻole. Nā hua palapala o nā sulfonylureas.

IU code ATX: A10VB01.

Hoʻololi ʻo Glibenclamide i ke kahe o ka glucose i loko o ke koko. ʻO ka hoʻonui ʻana o ka neʻe o ka plasma ʻaila a me kahi hoʻohaʻahaʻa i ka pae o ka glucose e hele lohi. Loaʻa kaʻoluʻolu pili mau metabolic kaʻina. Hoʻomohala ka hana i nā hola 2 ma hope o ka hoʻokele ʻana, hiki i ka lōʻihi ma hope o 7-8 mau hola a lōʻihi i ka hola 8-12.

Hoʻopili pū me nā lāʻau ʻē aʻe

Hoʻonui i ka hopena o nā anticoagulants kūpaʻa.
Ka hoʻohuihui huehue i ka paʻakai (ammonium chloride, calcium chloride, ascorbic acid ma nā wai he nui) hoʻonui i ka hopena o ka glibenclamide.

Antifungal systemic ano (AZ nā mea loaʻa), fluoroquinolones, tetracyclines, chloramphenicol, h2-blockers, Hoʻokolohua-blockers, ACE nā mea kūpale, nonsteroidal antiinflammatory ai ', monoamine oxidase nā mea kūpale, clofibrate, bezafibrate, probenecid, acetaminophen, ethionamide, anabolic steroid, pentoxifylline, allopurmnol , cyclophosphamide, reserpine, sulfonamides, hāʻawi i ka insulin i ka hoʻomohala ʻana o ka hypoglycemia.
ʻO nā Barbiturates, phenothiazines, diazoxide, glucocorticoid a me nā hormone thyroid, estrogens, gestagens, glucagon, nā lāʻau lapaʻau adrenomimetic, salith lithium, derivatives acid nicotinic, rifampicin a me saluretics e hoʻonāwaliwali i ka hopena hypoglycemic.

Nā Hoʻohui

ʻO Glibenclamide ua hoʻohaunaele ʻia i loko o kēia mau hihia:

• ʻO mellitus ka pakanika o ka insulin (type 1), me nā keiki a me nā ʻōpio,
• maʻi maʻamau ketoacidosis,
• maʻi maʻi precoma or coma,
• Hōʻalo i ka pancreas
• pāpale pākole,
• pilikia hōʻeha a i ʻole hōʻino ole o ka lau (ʻoi aku ka waiwai o ka hana ma mua o 30 ml / min),
• pālahalā nui
• nā hōʻeha ʻeha nui
• hoʻōki kūloko
• ālai ʻole,
• paresis o ka ʻōpū
• lawe malakalorption o ka meaʻai me ka hoʻomohala ʻana o ka hypoglycemia,
• leukopenia
• hoʻonui ka ulu ʻana o kēlā me kēia lāʻau i ka lāʻau, a me nā lālani sulfa a me ka sulfonylureas,
• hapai a lactation
• makahiki a hiki i ka 14 makahiki.

ʻO ka wahine e hoʻolālā ana i ka hāpai ʻana, ʻoiai hoʻi i ka hānau ʻana i kahi keiki, pono e hoʻololi i ka insulin a i ʻole hoʻopau i nā ʻōpū.

ʻLoe a me ke kākele

Pono e holoi ʻia ʻo Glibenclamide me kahi liʻiliʻi o ka wai. Hoʻoholo ka kauka i ka hopena mua a me ka nui o ka lāʻau no ka mālama mālama ʻana no kēlā me kēia maʻi pākahi, ma muli o nā hopena o ka nānā ʻana i ka pae o ka glucose i ka urine a me ke koko. Kahi ia mau ʻōlelo kuhikuhi no ka hoʻohana ʻana o Glibenclamide e koi ai.

ʻO ka hapai mua o ka lāʻau lapaʻau he hapalua papa iʻa (2.5 mg) hoʻokahi i ka lā. Inā pono, hiki ke hoʻonui ʻia ka pākopona i kēlā me kēia lā ma ka nānā ʻana i ka neʻe ʻana o ka glucose i ke koko. ʻO ka hoʻonui ʻia e lawe ʻia ʻana me kahi lohi o kekahi mau lā e 2.5 mg, a hiki i ka hopena hopena.

ʻO ka nui loa ka ʻai ʻana he 3 papa i kēlā me kēia lā (15 mg). ʻAʻole i hoʻonui i kēia helu e hoʻoikaika i ka hopena hypoglycemic.

Aia a make ka pā i nā papa papa he 2 i kēlā me kēia lā, a laila e lawe ʻia lākou i ka manawa o ke kakahiaka ma mua o ka papaʻaina. Inā makemake ʻoe e hoʻohana i kahi nui o ka lāʻau lapaʻau, a laila ʻoi aku ka maikaʻi ma ka hana ʻana ma ʻelua mau kala, a ʻo ke ʻano o ka pākēnē 2: 1 (kakahiaka a me ke ahiahi).

Pono nā poʻe maʻi maʻi e hoʻomaka i ka mālama ʻana me ka hapa hapalua e ukali ʻia e ka hoʻonui me ka awelika o hoʻokahi pule ma mua o 2.5 mg i kēlā me kēia lā.

Inā loli paha ke kino o ke kanaka a i ʻole ka loli ʻana o ka nohona, pono ke hoʻoponopono ʻia i ka lāʻau. Eia kekahi, pono e alakaʻi i ka hoʻoponopono ʻana inā aia kekahi mau mea e hoʻonui ai i ka hiki ke hoʻomohala ʻana i ka maʻi hyper-or hypoglycemia.

Me kahi overdose o kēia lāʻau lapaʻau, hoʻomaka ka hypoglycemia. ʻO kāna mau hōʻailona:

1. hoʻonui hoʻonui ʻia
2. hopohopo
3. tachycardia a hoʻonui i ke koko, ke ʻeha ma ka naʻau, arrhythmia,
4. lie kanikela
5. hoonui
6. keokeo, āpau,
7. hoāmi a me ka hopohopo
8. lēʻo ke kauā,
9. nā manaʻo kaumaha
10. paresis, tremor,
11. hoʻololi ka hoʻololi
12. kapihewa o ka ʻenehana kūmole.

I kekahi mau hihia, i kona mau hōʻike ʻana, ua like ka hypoglycemia me kahi hōʻeha. E ulu paha kahi coma.

ʻO ka hoʻomaʻemaʻe overdose

Me kahi awelika o ka hypoglycemia maʻalahi, hiki ke pani ʻia e kahi huakaʻi pōpilikia o ka nui o nā kalapona (puna kīwē, ʻona momona a i ʻole ka wai huaʻai). No laila, e hoʻomau mau ʻia nā mea maʻi i nā 20 g o ka glucose (ʻehā mau kihi o ke kō).

ʻAʻole loaʻa i nā mea momona kahi hopena therapeutic me hypoglycemia. Inā koʻikoʻi ke kūlana o ka mea maʻi, a laila pono ʻo ia i ka haukapila. E hoʻāʻo e hoʻokau i ka hoʻopuʻi a kuhikuhi i nā wai (wai a lemon paha me ka sodium sulfate a me ka carbon activated), a me nā lāʻau hypoglycemic hāmeʻa.

Loaʻa ka hopena

Mai ka ʻaoʻao o ka metabolism hiki:

hypoglycemia, pinepine nocturnal, i hui pū ʻia e:

• lie kanikela
• pololi
• ninini
• hiamoe a hiamoe ʻole
• mo na po
• hopohopo
• ka haʻalulu
• ʻhiu o ka ʻū
• tachycardia
• pupule hopohopo
• mālie
• nā mālamalama ʻōlelo a me ka ʻike

I kekahi manawa he hewa paha a me ka coma, a pēlā pū kekahi:

1. mahuahua
2. loaʻa ka paona
3. dyslipidemia, hōʻiliʻili i ka kiko adipose,
4. me ka hoʻohana ʻana i ka manawa lōʻihi, hiki i ka hiki ʻana o ke kūkulu ʻana i ka hypofunction o ka mālama thyroid.

Mai ka pūnaehana hana ʻana:

• paila, mamaila,
• kaumaha, ʻeha a me kahi ʻeha o ka ʻōpū,
• ʻolipiko nui, nā ʻōpū, ʻōpala,
• hoʻonui a hoʻohaʻahaʻa paha i ka makemake,
• i nā hanana pinepine, hiki ke hoʻopilikia ʻia ka hana o ka ʻōpū, hepatitis, jaundice cholestatic, porphyria i hiki ke ulu.

Mai ka ʻōnaehana hemopoietic:

1. luhi loa paha may he aplastic a hemolytic anemia wale nō,
2. leukopenia
3. huokupaʻa,
4. pancytopenia
5. eosinophilia
6. thrombocytopenia.

• erythema multiforme, photosensitivity a exfoliative dermatitis pinepine i ulu,
• cross-allergy i nā mālamalama like-thiazide, sulfonamides a sulfonylureas hiki paha i kahi.

ʻO nā hopena ʻē aʻe:

Loaʻa kahi hemahema o ka hormone antidiuretic, i ukali ʻia e:

• āhāhuʻe
• ka ʻōpū o ka maka
• lima a me nā ʻeke
• manaʻo ʻino
• lethargy
• nahoa
• ʻaihue
• koma
• noho huakaʻi (transient).

Inā loaʻa kahi hopena kūpono ʻole a i ʻole nā ​​ʻano ʻokoʻa koʻikoʻi, a laila e pono ʻoe e kamaʻilio pū me kāu kauka e pili ana i ka mālama hou ʻana me kēia lāʻau lapaʻau, i ka manawa, e hōʻemi ʻia ʻo Glibenclamide.

Nā hiʻohiʻona noi

Pono ke kauka e ʻike mau i nā hopena o ka mea maʻi i nā lāʻau lapaʻau i kēia hui. Pono e hoʻohana ʻia ʻo Glibenclamide wale nō i nā dosis i kau ʻia ai a i ka manawa kikoʻī o ka lā. ʻO kēia nā kuhikuhi kūpono no ka hoʻohana ʻana, a inā ʻaʻole i ʻōlelo ʻia ʻo Glibenclamide.

E hoʻoholo ka kauka i ka dosage, ka hāʻawi kūpono o ka komo ʻana i ka lā a me ka manawa o ka hoʻohana ʻana, e pili ana i ka hoʻoponopono o ka mea maʻi i kēlā me kēia lā.

I mea e hoʻohana ai ka lāʻau lapaʻau i alakaʻi i ke kūlohelohe o ke koko, pono pono e hahai i kekahi meaʻai kūikawā me ka lawe ʻana i ka lāʻau lapaʻau, hana i ka hoʻomaʻamaʻa kino a hōʻemi i ke paona kino, inā pono. Pono kēia mau mea i kuhikuhi i ka hoʻohana ʻia.

Pono ka mea maʻi e hoʻokaʻawale i ka manawa i hoʻopau ʻia i ka lā a hōʻemi i ka nui o nā meaʻai momona.

ʻO nā mālama a me nā hemahema i ka lawe ʻana i ka lāʻau

Pono mua ka hana mua ʻana ma mua o ke kūkā ʻana a ke kauka, ʻaʻole hiki iā ʻoe ke hoʻohana i ka lāʻau lapaʻau ma mua o ka manawa i ʻōlelo ʻia. Pono e hoʻohana ʻia ka Glibenclamide a me nā analogue me ka mālama aka o ka febrile syndrome, ka adrenal insufficiency, alkoholism, maʻi thyroid (hyper- or hypothyroidism), i kahi mea hoʻopunipuni ka hana o ka puʻuwai, a me nā mea maʻi.

Me ka monotherapy no nā makahiki ʻelima, e ulu paha ka pale kū.

Ka nānā ʻana o ka lawena ʻana

I ka wā o ka mālama ʻana me ka glibenclamide, pono ʻoe e kiaʻi mau i ka neʻe i ke koko (ʻoiai ke koho ʻia nei ke ʻano, hana ʻia kēia mau manawa i ka hebedoma), me ke ʻano o ka gogemobly gogek (me ka liʻiliʻi loa i kēlā me kēia mau mahina), ka wahi me kēia mea nui a me ka glucose i loko o ka pūpū. ʻO kēia ka mea e hiki ai ke hoʻomaopopo i ka pale mua a i ʻole paha ke kū'ē i kēia lāʻau lapaʻau i ka manawa.

Pono ʻoe e nānā i ke kūlana o ke koko peripheral (ʻoi aku hoʻi i ka ʻike o nā kaila koko keʻokeʻo a me nā platelets), a me ka hana pūpū.

ʻO ka hopena o ka hypoglycemia i ka hoʻomaka ʻana o ka lāʻau lapaʻau

Ma nā hoʻomaka mua o ka mālama ʻana, hoʻonui ʻia ka hopena o ka hoʻomohala ʻana i kēia ʻano, inā paha inā i kīkī ʻia nā pāʻina ʻai a i ʻole nā ​​hui ʻole. Hoʻokomo ka poʻe i ka hoʻomohala ʻana o ka hypoglycemia:

1. ka ʻāpono ʻole a i ʻole makemake ʻole i nā maʻi, ʻoi aku ka poʻe kahiko, e hana pū pū me kahi kauka a lawe i Glibenclamide a i nā ʻiliʻenehana,
2. pono ʻole ke kīnā ʻole, nā lau ʻai ʻāpono a i ʻole nā ​​meaʻai ʻole.
3. ka hoʻemi ʻana ma waena o ka hana kālai a me ka hana kino,
4. mau hewa i ka papaʻai
5. inu wai ʻona, keu inā loaʻa ka pōʻino,
6. huakaʻi renal function,
7. Kanaka hele hewa,
8. ʻOke lāʻau
9. nā maʻi uncompensated o ka ʻōnaehana endocrine e pili ana i ka metabolism, ke kālai ʻia ʻana o ka hypoglycemia, me ka maʻi pituitary a me ka adrenocortical insufficiency, hana i ka hopena thyroid.
10. ka hana like ʻana o kekahi mau lāʻauʻokoʻa.

Nā hopena like ʻole i ka hopena:

• gliclazide (30 mau papa),
• gliclazide (80 mg kēlā me kēia),
• lihilihi
• diadeon
• Aliʻi Honu,
• ʻūmūlū.

ʻO Glibenclamide ka hui o nā hui hypoglycemic no ka hoʻokūkū waha. Loaʻa iā ia kahi papa hana o ka hana a ka mea, i ka nui o ka pancreatic a me ka hopena pancreatic.

Lapaʻau lāʻau

Ma hope o ka lawelawe waha, ua puka a me ka hana paʻa o ka glibenclamide i loko o ka wahi lāʻau. I nā hōʻike hōʻike vitro hōʻike i hōʻike ʻia e hoʻokuʻu ʻia e Glibenclamide o ka mea hana i ka manawa o 63% o ka nui o ka waiwai i loko o 15 mau minuke, ʻo 72% i loko o 60 mau minuke. I ka manawa like, hiki i ka ʻai ke alakaʻi i ka emi ʻana o kona kao i loko o ke koko ka hoʻohālikelike ʻia me ka hoʻohana ʻana ma kahi ʻōpū ʻole. ʻO ka paa ʻana o ka glibenclamide me albumin i loko o ke koko heʻoi aku ma mua o 98%. I ka ate, ua hoʻololi like ka glibenclamide i ʻelua mau metabolites nui: 4-trans-hydroxy-glibenclamide a me 3-cis-hydroxy-glibenclamide. Hoʻololi ʻia nā lua o nā metabolites i ka like me ka lolo a me ka puʻuwai. ʻO ka hapalua hapalua o nā glibenclamide mai nā kaila koko he 1.5-3.5 hola. ʻO ka lōʻihi o ka hana, ʻaʻole ia e pili i ka hapalua-ola mai ke kō koko. I nā poʻe maʻi me ka hana paʻa ʻeha, ua hoʻemi ʻia ka excretion plasma. Me ka maikaʻi ʻole o ka pana ʻole (hōʻoki i ka hana ʻana me 30 ml / min), ʻaʻole i loli ka excretion o glibenclamide a me nā mea nui a ʻelua, me ka loaʻa ʻole o ka pilikia ʻole, a hiki i ka cumulation.

Pehea e hoʻohana ai: dosis a me ke ʻano o ka mālama ʻana

Loko ka nui o ka laʻana, paʻakikī o ka papa maʻi o ka maʻi maʻi, ka ʻike ʻana o ka hookeai i ke koko glucose a me 2 mau hola ma hope o ka ʻai ʻana. ʻO ka awelika o kēlā me kēia lā maʻamau mai 2.5 a 15 mg. ʻO ka pinepine o ka hoʻokele 1-3 manawa i ka lā no 20-30 mau minuke ma mua o ka ʻai ʻana. ʻAʻole hoʻonui nā wai o ka oi aku ma mua o 15 mg / lā i ka nui o ka hopena hypoglycemic. ʻO ka maʻi mua ma nā mea maʻi maʻi he 1 mg / lā.

Ke hoʻololi nei i nā lāʻau lapaʻaka hypoglycemic me kahi ʻano hana like, hoʻohālikelike ʻia lākou e like me ke ʻano i hāʻawi ʻia ma luna, a hoʻopau koke ʻia ka lāʻau lapaʻau ma mua. Ke hoʻololi nei mai biguanides, ʻo ka hopena mua o kēlā me kēia lā he 2.5 mg, inā pono, hoʻonui ʻia ka nui o kēlā me kēia lā i nā lā 5-6 e 2.5 mg a hiki i ka loaʻa ʻana o ka uku. I ka loaʻa ʻole o ka uku i loko o nā hebedoma 4-6, pono ia e hoʻoholo i ka lāʻau hoʻohui.

Nā hopena hopena

ʻO ka hypoglycemia (i ka laʻe hewa ʻana a me ka ʻai ʻole), ka nui o ka momona, ke kuni, ka arthralgia, ka proteinuria, ka maʻi kūloko (ke ʻano o ka ʻili, ka puhaka), dyspepsia (keha, ka maʻi palu, kahi manaʻo kaumaha i ka epigastrium), ka maʻi neurological (paresis, hōʻino ka naʻau) , hemopoiesis (hypoplastic a hemolytic anemia, leukopenia, agranulocytosis, pancytopenia, eosinophilia, thrombocytopenia), hana hana aho ka pehu (cholestasis), poli cutaneous hope, loli i ka ʻono, polyuria, kiʻi ensibilizatsiya, headache, luhi, nawaliwali, pōniuniu.

Ke keu. Nā hōʻailona: hypoglycemia (pōloli, hoʻoheheʻe, nāwaliwali koʻikoʻi, palpitations, tremors, hopohopo, hōʻeha, hōʻeha, insomnia, irritability, palupalu, cerebral edema, wahaheʻe e haʻi aku ana i ka ʻike a me ka ʻike, ʻike makaʻa ʻole), hypoglycemic coma.

Mea hoʻōla: inā ʻike ka mea maʻi, lawe i ke kō i loko, me ka nalowale o ka ʻike - inject iv dextrose (iv bolus - 50% kūwāwaʻa dextrose, a laila infusion o 10% hopena), 1-2 mg glucagon s / c, i / m a i ʻole iv, diazoxide 30 mg iv no 30 mau minuke, ka nānā ʻana i ka hoʻoliʻi glucose i kēlā me kēia 15 mau minuke, me ka hoʻoholo ʻana i ka pH, urea ʻūkū, nā mea hana a me nā electrolyte i loko o ke koko. Ma hope o ka ʻike hou ʻana, pono e hāʻawi i ka mea ʻai i ka mea maʻi i ka momona hoʻokaʻawale ʻia (i mea e pale ʻole ai ka hana hou o ka hypoglycemia). Me ka edema cerebral, mannitol a me dexamethasone.

Nā ʻōlelo kikoʻī

Pono e kiaʻi pinepine i ka pae o ka glucose i loko o ke koko ma kahi ʻōpū ʻole a ma hope o ka ʻai ʻana, ke kuapo o kēlā me kēia lā o ka waihona o ka glucose i loko o ke koko a me ka paʻi.

Ma ka hihia o nā mea ʻokiʻoki a i ʻole decompensation o ka maʻi kō, e noʻonoʻo pono ai i ka hoʻohana ʻana i ka hoʻomākaukau ʻana i ka insulin.

Hoʻomaʻamaʻa ʻia nā mea maʻi e pili ana i ka hoʻonui nui o ka hypoglycemia i nā hihia o ka intanol intake (me ka hoʻomohala ʻana o nā ʻano leʻina o disulfiram: ʻo ka ʻeha o ka pūpū, ka luaʻi, ka luaʻi, ka ʻeha), nā NSAID, a me ka pōloli.

I ka wā o ka mālamaʻana, ʻaʻole ia e ʻōlelo ʻia e noho i ka lā no ka lōʻihi.

Pono kahi hoʻoponopono hoʻoponopono ʻia no ke ʻano kūlohelohe a me ke kaumaha, kahi hoʻololi i ka ʻai.

Hōʻike ʻia nā hōʻike maʻi o ka hypoglycemia i ka wā e lawe ai i nā beta-blockers, clonidine, reserpine, guanethidine.

I ka wā o ka mālama ʻana, pono e mālama ʻia i ka wā e alakaʻi ana i nā kaʻa a komo i nā hana ʻē aʻe ʻē aʻe e koi ai i ka nui o ka neʻe ʻana a me ka wikiwiki o ka hopena psychomotor.

Nā nīnau, nā pane, nā loiloi e pili ana i ka lāʻau lapaʻau Glibenclamide

ʻO ka ʻikepili i hāʻawi ʻia e hana no nā lāʻau lapaʻau a me nā lāʻau lapaʻau. Aia nā ʻike e pili ana i ka lāʻau lapaʻau e pili ana i nā ʻōlelo i hoʻopili ʻia e ka mea hoʻopiʻi e ka mea hana. ʻAʻohe ʻikepili i hoʻopili ʻia ma kēia a ʻole kekahi ʻaoʻao o ka pūnaewele a mākou e hiki ke lawelawe ma kahi kūʻokoʻa no ka hoʻopiʻi pilikino i ka loea.

Ke keu

Therapy: ʻo ka intravenous injection o 40-100 ml o kahi 20% hopena glucose a me / a i ʻole (a i nā hihia a ʻaʻole hiki ke kuhi ʻia ka catheterization o ka vein) intramuscular a i ʻole subcutaneous injine o 1-2 ml o glucagon. No ka pale ʻana i ka hoʻi hou ʻana ma hope o ka hoʻihoʻi ʻana i ka ʻike, hāʻawi ʻia nā mau pūkala i ka ʻōlelo maʻamau (20-30 mau kākela i ka wā maʻamau a i kēlā me kēia 2 i 3 mau hola) i nā hola 24 a hiki i ka 48 hola, a i ʻole ka lōʻihi o ka infusion glucose (5 a 20%). Hiki ke lawelawe i ka intramuscularly 1 ml glucagon i kēlā me kēia hola 48 i kēlā me kēia mau hola 48.ʻO ka mālama pinepineʻana i ke kō koko koko no ka liʻiliʻi 48 mau hola ma hope o ka pau ʻana o kahi kūlana hypoglycemic koʻikoʻi. Ma nā hihia i ʻike ʻia ai ka piʻi ʻana o ka ʻōpū ma ka hanu (ʻoiai, me ka nui o nā manaʻo suicidal), ke hoʻomau ʻia ka nalowale o ka ʻike ʻana, kahi infusion e hoʻolōʻihi ʻia ana ka nui o ka 5-10%, e lawe ʻia ka makemake makemake o ka glucose i loko o ke koko ma kahi o 200 mg / dl. Ma hope o 20 mau minuke, hiki ke hoʻonui hou ʻia he hopena iki glucose 40%. Inā ʻaʻole e loli ka kiʻi o ka lāʻau lapaʻau, pono ia e nānā i nā kumu ʻē aʻe o ka nalowale o ka ʻike, ʻo ka hoʻohui ʻana i ka lāʻau lapaʻau no ka cerebral edema (dexamethasone, sorbitol), ka nānā pono ʻana o ka mea maʻi a me nā maʻi. I ka lāʻau o ka pakanā, hiki ke lawe ʻia iā lākou me nā hana o luna, a me nā hana maʻamau e hoʻoneʻe i ka ʻāʻā (ka gastric lavage, hoʻoulu i ka luaʻi), a me ke kau pū kekahi i ka ulana i hoʻōla ʻia. ʻAʻole i hoʻopā ʻia ʻo Glibenclamide e ka hemodialysis.

Nā kūlana mālama

E kūʻai ma ke ʻano wela i ka 25 ° C mai kahi hiki i nā keiki.

Kuhi puka:
Glibenclamide - nā papa.
30 papa i nā pahu.

1 papaʻO Glibenclamide mau ka glibenclamide 5 mg.
Nā mea kūʻokoʻa: lactose monohydrate, kālai kalaka, ka sodium croscarmellose, povidone 25, magnesium stearate, colloidal silicon dioxide, indigo carmine E 132.