ʻO ka lāʻau lapaʻau hou antidiabetic ʻo Metformin Teva

No ka mālamaʻana i nā hui pū, ua hoʻohana maikaʻi kā mākou mea heluhelu iā DiabeNot. Ke ʻike nei i ka kaulana o kēia huahana, ua hoʻoholo mākou e hāʻawi iā i kou makemake.

Manaʻo kekahi mau maʻi hānai ʻaʻole lākou i lawe i ka metformin. Akā ʻaʻole naʻe kēia, ʻo ka hapa hapalua o kēia mau mea maʻi e mālama pū ʻia me nā lāʻau lapaʻau e pili ana i ka metformin hydrochloride mai nā lā mua ma hope o ke ʻano o ka maʻi maʻamau o ka maʻi type 2, inā ʻaʻole ka hopena o ka noho ʻana e lawe mai i nā hopena i makemake ʻia. Hoʻonohonoho ʻia nā papa i ke ʻano o ka hoʻokūkū me ka non-proprietary international name metformin i kekahi mau kūlana (metabolic syndrome, pale ʻana i nā kūlana cardiovascular a me ka oncology), akā, i kekahi kūlana, hiki ke kūʻai wale ʻia lākou ma ka lāʻau lapaʻau.

Inā loaʻa ʻoe i ka metformin ma ke ʻano, koho iā Metformin Teva. ʻO kēia analogue kūpono o ka Pelekane o nā Glucophage kumu mua e hoʻokō i nā koi āpau o nā lāʻau antidiabetic kiʻekiʻe kiʻekiʻe.

ʻO Metformin Teva a me kāna hoa mua

ʻOihana kūʻiʻo Israeli huahana TEVA Pharmaceutical Industries, Ltd. ma ke kaona ʻo Petah Tikva (a me nā keʻena lunamanaʻo ma Polani, Italia a me nā ʻāina ʻē aʻe) e hana ana i nā mea laulā e pili ana i ka waiwai like (me ka metformin hydrochloride), me nā maʻi like (500, 850 a me 1000 mg), me ka like o ka kao a me ka nui o ka excretion. ka hana ikaika, e like me ka lāʻau Farani. Hoʻohālikelike nā kūlana hana a me nā pono hana i ka neʻe ʻana i nā hana i nā ʻenehana i hana i ka metformin kumu.

ʻO ke ʻano o ka hoʻohana ʻana i ka hoʻomākaukau o ka waha a me ka mea hoʻohālike.

ʻO ka Metformin Teva he liʻiliʻi: povidone, magnesium stearate a talc.

ʻOi loa aku ka maʻalahi o Generative Metformin Teva: ʻo ka pauna o ka Glucofage kumu kūʻai 330 mau rubles, kahi pahu like like o kahi ʻano - 169 rubles. Ma loko hiki iā ʻoe ke loaʻa i nā kīmaha me ke keʻokeʻo a i ʻole ka oval (ma muli o ke ʻano lāʻau) nā papa me ka laina hoʻokaʻawale a me nā kaha kahakaha. E maile ke kahua o, me ka ʻole o ka pōʻino a me nā haumia. Loaʻa ka Metformin-MV-Teva i loko o kahi waihona o 500 mg me nā hiki lōʻihi. ʻO ka ola mahele o nā papa he 2.5-3 mau makahiki, ʻaʻole pono ka lāʻau lapaʻau i nā kūlana kūikawā no ka mālama.

Lapaʻau lāʻau

ʻO ka mea hana nui o ka lāʻau ka metformin hydrochloride, kahi hui o nā derivatives biguanide e hoʻomāneʻoniʻoni i nā indly glycemic o ka wikiwiki a me ke kōpila postprandial. ʻO ke ʻano o nā hana o ka lāʻau lapaʻau he mau huakaʻi.

1. Ke pale nei ka lāʻau lapaʻau i ka hana ʻana o ka glycogen i loko o ka ate ma ka pale ʻana i nā kaʻina hana o ka gluconeogenesis me glycogenolysis,
2. Hoʻomaʻamaʻa ka lāʻau lapaʻau i ka pale ʻana o nā uaua i ka insulin, hoʻomaikaʻi i ka hoʻonui ʻana a me ka hana ʻana o ka glucose i nā uaua,
3. Hōʻemi ka mea i ka nui o ke kaʻe o ka glucose i nā pā o ka ʻōpū.

Hoʻokomo ʻo Biguanide i ka hana o ka glycogen endogenous.

Hoʻokuʻu ʻia ka mea hiki i nā ʻōnaehana holomua glucose i ka membrane kelepona.

Ua hoʻokolohua ʻia me nā hakahaka therapeutic o ka lāʻau e hoʻomaikaʻi ai i ka hoʻopili ʻana o ka lipid mea o ke koko: hoʻemi i ka hapa nui o nā kolamu, triglycerol a me nā lipid kūloko haʻahaʻa.

Lapaʻau lāʻau

1. Hoʻopau ʻO ka pae kiʻekiʻe loa o ka T o ka lāʻau me ka bioavailability piha loa a hiki i 60% ka hoʻopaʻa ʻia he 2 mau hola ma hope o ke komo ʻana i ka ʻao gastrointestinal. Me nā regimens lapaʻau maʻamau, ʻo ka hōʻuluʻulu mau ʻana o ka lāʻau i loko o ke koko e nānā ʻia ma hope o hoʻokahi lā a i ʻelua paha, a i nā helu 1 μg / ml. ʻO ka lawe ʻana i ka lāʻau lapaʻau me ka meaʻai e hoʻohaʻahaʻa i ke kahe o ka metabolite.
2. Kahele. ʻAʻole hiki i ka mea hoʻokomo loa i ka hoʻopili ʻia me nā protein; ʻike ʻia kona mau ala i loko o nā kōnela koko wale nō. ʻO V D (ka lahilahi hoʻopuka kikowaena) ʻaʻole iʻoi aku i ka 276 lita. ʻAʻole ʻike ʻia nā mea maʻamau i loko o ke kino.
3. Leʻaleʻa. Hōʻike nā hōʻike o ka hepatic clearance o metformin (mai i 400 ml / min.) Hōʻike e hoʻihoʻi ʻia kona hōʻemi ʻia e ka filtration glomerular. ʻO ka hapalua o ka ola i ka manawa hope o ka excretion he 6.5 mau hola. Me nā dysfunctions renal, hemo ka clearance, hoʻonāukiuki kēia i ka hōʻiliʻili o ka metformin i ke koko. Aia a 30% o ka lāʻau i hoʻokaʻawale ai i loko o nā pua i kona ʻano kumu.

ʻO Metformin Teva kahi lāʻau lapaʻau mua loa; ua kuhikuhi ʻia no nā pākeke a me nā keiki ma mua o 10 mau makahiki o ka hoʻokele ʻana i nā ʻano maʻi type 2 i nā manawa āpau o ka hoʻomohala ʻana i ka maʻi.

Hoʻomaopopo ʻia ka lāʻau lapaʻau inā he loli ola (haʻahaʻa-kaʻai ʻai, ka hana kūlohelohe, ka mālama ʻana i ka manaʻo o ka naʻau) ʻaʻole kāohi i ka glycemia.

Ua kūpono kēia lāʻau lapaʻau no ka monotherapy a no ka mālama maʻi paʻakikī, ʻoiai ua hui pū ʻia ka metformin me ka insulin a me nā lāʻau lapaʻau ʻanoma antidiabetic e like me kahi ʻano o ka hana ma mua o biguanides.

Nā Hoʻohui

Hoʻopili i nā mea kikoʻī o kēlā me kēia mea o nā ʻano lāʻau, ʻaʻole i kuhikuhi ʻia ka lāʻau lapaʻau.

• Me ka ketoacidosis maʻi maʻi, coma, precoma,
• ʻO nā mea maʻi me nā ʻolihi kūwili (CC ma lalo o 60 ml / min.),
• ʻO nā mea maʻi i ka pīhoihoi, me ka dehydration, nā maʻi koʻikoʻi o kahi ʻano maʻi,
• Inā hoʻonāukiuki ʻia nā maʻi (ke aʻalolo a i ʻole kekahi) kaumaha i ka pololi o ka oxygen.
• I ka wā e noiʻi ana i ka hoʻohana ʻana i nā hōʻailona hoʻohālikelike iodine.
• Me nā hana hemo o ka ate, me ka hoʻohuihui ʻawaʻawa (ikaika a koʻikoʻi paha).

Ma muli o ka nele o nā hōʻike pono o ka palekana, ua mālama ʻia ʻo Metformin Teva i nā wahine hāpai, nā kahu hānai, a me nā keiki ma lalo o 10 makahiki.

Ke kaʻa ʻole nei i nā kaʻa a me nā hana paʻakikī no ka maʻi maʻi maʻi i ka wā e mālama ai me ka Metformin Teva, ʻaʻole cont conticated inā e lawe lākou i ka lāʻau lapaʻau e like me monotherapy. Me ka hoʻomaʻamaʻa paʻakikī, pono e noʻonoʻo i nā pono o nā lāʻau ʻē aʻe.

Nā manaʻo e hoʻohana

Manaʻo ka lāʻau Metformin Teva e lawe iā ia me he piha me ka wai piha. Hiki ke loaʻa ka hopena kiʻekiʻe ma ka hoʻohana ʻana i nā papa ma mua o ka pāʻina a i ka wā e ʻai ʻia ai. Koho ke kauka i ka hoʻoponopono dosage a me ka dosage i ke ʻano o ka manawa o ka maʻi, nā pathologies concomitant, ʻo ia ka makahiki o ka maʻi maʻi, ka hopena kū hoʻokahi i ka lāʻau lapaʻau.

Me ka monotherapy ʻana a i ʻole ka hōʻola paʻakikī, ʻaʻole iʻoi aku ka nui o ka hoʻomaka ʻana ma mua o nā pālaha 1. / 2-3r. / Lā. Hiki ke hoʻoponopono ʻia i ke ʻano ma hope o nā hebedoma 2, i ka wā e hiki ai iā ʻoe ke loiloi i ka maikaʻi o ka pau ʻana. ʻO ke hoʻonui hoʻonui i ka lohi e kōkua i ke kino e ola i ka manawa o ka hoʻololi ʻana me nā hopena kūpono ʻole. ʻO ka helu marginal o ka lāʻau lapaʻau no kēia 'o nā maʻi maʻi he 3 g / lā. me ka hoʻohana 'ana

Ke hoʻololi nei i nā kikowaena hypoglycemic me kahi lāʻau lapaʻau, alakaʻi ʻia lākou e ka hoʻoponopono lāʻau mua. No ka lohi ʻana i nā huahana, pono paha e hoʻomaha iki i ka hoʻololi ʻana i kahi papa hana hou.

Me ka hui pū ʻana me nā papa me ka inikini insulin, hoʻomaka ka metformin e lawe ʻia me ka liʻiliʻi liʻiliʻi (500 mg / 2-3 r / lā.).

Koho ʻia ka nui o ka insulin e like me ka meaʻai a me ke glucometer.

ʻO ka maʻi Diabetics

Ma nā maʻi maʻi "mākaukau", nawaliwali nā mākaukau o nā keiki, no laila, i ke koho ʻana i kahi hoʻoponopono lapaʻau, pono ke mālama ʻia ko lākou kūlana a nānā pono ʻia nā mea ʻike.

ʻO nā keiki me ka maʻi hānai ma mua o 10 mau makahiki i kau ʻia e 500 mg / lā. Lawe ka papa papa i hoʻokahi manawa, i ke ahiahi, i ka wā pāʻina piha. Hiki ke hoʻopau ʻia nā kaha titration ma hope o 2 mau pule. ʻO ka palena kiʻekiʻe loa no kēia māhele ʻo 2000 mg / lā, i hoʻohele ʻia ma luna o 3 pākēneka.

Nā hopena ʻaoʻao a me ka overdose

ʻO ka Metformin Teva kekahi o nā lāʻau lapaʻau antidiabetic palekana loa. Ua hōʻoia ʻia kēia mau ʻike ʻia e nā haʻawina he nui a he mau makahiki o ka hoʻomaʻamaʻa ʻana i nā makahiki he nui. I ka wā o ka hoʻololi, ua hoʻopiʻi ka 30% o nā maʻi maʻi i ka maʻi dyspeptic: nuala, luaʻi, huina a me ke kala mai ka manawa a ka manawa, hoʻemi ʻia ka makemake, pau ka pāʻina i kēlā me kēia papa.

Hōʻalo ka minamina i ka hopena me ka hōʻeha a me ka wā ke kau nei nā hōʻailona. ʻO kahi hiʻohiʻona o ka Metformin Teva kahi liʻiliʻi o nā mea hoʻohui i nā mana. ʻO ka pinepine ka mea nāna e hoʻonāukiuki i nā hopena maikaʻi ʻole.

ʻOiai ka hoʻonui ʻana o 10 mau pā i ka pomo therapeutic no nā hana hoʻokolohua ʻaʻole i hoʻonāukiuki i ka hypoglycemia. Ma kahi o ka hōʻailona o ka lactic acidosis i nānā. Hoʻihoʻi i nā hana o ke kino e pili ana i ka maʻi infusion a me ka hemodialysis.

ʻO nā waiwai Pharmacological

ʻO ka Metformin hydrochloride kahi lāʻau antidiabetic o ka hui o nā derivatives biguanide, kahi e hoʻemi ana i ka neʻe o ka glucose i loko o ke koko koko ma o ka ʻōpū ʻole a ma hope o ka ʻai.

ʻO ka metformin hydrochloride ʻekolu mau lāʻau hoʻomehana antidiabetic.

1. Hoʻemi i ka hana o ka glucose i loko o ke akea ma ke kāohi ʻana i ka glucoseoneogenesis a me ka glycogenolysis.

2. Hoʻonui i ke kūlike o ka insulin sensor, e hoʻonui ai i ka uptake a me ka hoʻohana ʻana i ka glucose i nā kiko peripheral.

3. Hoʻemi i ka loaʻaʻana o ka glucose i loko o nā mea palupalu.

Hoʻomoe ka Metformin hydrochloride i ka syntact glycogen intracellular, hoʻonui i ka hiki ke kahe o nā ʻano o nā ʻōnaehana o nā halihali i lawe i ka glucose ma o ke membrane, e hoʻopilikia maikaʻi i ka hana lipid metabolism. Ua hōʻike ʻia ua metformin i loko o ka hopena therapeutic i hōʻemi ʻia o ka nui o ka kolamu, haʻahaʻa lipoproteins haʻahaʻa a me triglycerides.

Ua hōʻike ʻia me Metformin, noho paʻa ke kino o ka mea maʻi a hoʻemi ʻia paha ia.

Kapehu. Ma hope o ka lawe ʻana i ka metformin, ʻo ka manawa e hiki ai i ka lōʻihi loa o ke kaila (T _max ) aia ma kahi o 2.5 mau hola. ʻO ka bioavailability o nā papa 500 mg kahi ma kahi o 50-60%. Ma hope o ka lawelawe ʻana i ka waha, ʻo ka hapa nui i unuhi ʻia a hoʻopiʻi ʻia i loko o nā feces he 20-30%.

Ma hope o ka lawelawe waha, ua lawa ke ʻano o ka hoʻopili ʻana o ka metformin.

ʻO nā pharmacokinetics o ke kōpili o ka metformin i manaʻo ʻia ʻaʻole ia e laina. I ka manawa e hoʻohana ʻia ai i ka pona ʻāpono o nā metformin a me nā regimens dosing, hoʻokō ʻia nā loko o ka plasma paʻa i loko o nā hola 24-48 a emi mai ka 1 μg / ml. Ua hōʻikeʻia e hiki i nā kiʻekiʻe metformin plasma (C _max ) ʻaʻole iʻoi aku ma 5 μg / ml a me ka nui loa o ka nui.

Me kahi pāʻina like, hoʻoliʻiliʻi ka emi ʻana o ka metformin a kahaha ka lohi i lalo.

Ma hope o ka nānā ʻana i kahi paona o 850 mg, ua emi iho kahi hōʻemi i ka nui o ka plasma kiʻekiʻe ma o 40%, a me ka emi ʻana o AUC ma o 25%, a me ka hoʻonui ʻana o 35 mau minuke i ka manawa e hiki ai ke piʻi ʻana o ka plasma kiʻekiʻe. ʻAʻole maopopo ka ʻike koʻikoʻi o kēia mau hoʻololi.

Kahele. Hoʻopili iki nā Metformin i nā protein plasma. Hoʻopili ʻia ʻo Metformin i loko o nā kōlepa koko. Ka haʻahaʻa loa i ka nui o ke koko ma lalo o ke ana ka nui o ke kaila o ke koko, a loaʻa ma hope o ka manawa like. ʻO nā papa koko ʻokoʻa ka mea i koho ʻia i kahi keʻena hoʻoilina lua. ʻO ka nui nui o ka hoʻolaha (V _{e d} ) he 63-276 lita.

Hāpai. Hoʻopili ʻia ʻo Metformin i loko o ka urine. ʻAʻole i loaʻa ka metabolites ma nā kānaka.

Hoʻohālikelike Hoʻopili ka Renal i ka metformin - ʻoi aku ma mua o 400 ml / min. Hōʻike kēia i ka metformin e hoʻopili ʻia ma muli o ka filtration glomerular a me ka hilo huna tubular. Ma hope o ka hoʻokele ʻana, ʻo ka hoʻopau ʻana o ka hapalua-ola he 6,5 mau hola. I ka hihia o ka hana renal impaired, hoʻomaʻemaʻe ka hoʻomaʻamaʻa ʻana o ka renal i ka hoʻohālikelike me ka clearance creatinine, i pili pū me kēia, hoʻonui ka hapalua-ola. Ke alakaʻi nei kēia i kahi hoʻonui i ke kahe o ka metformin i plasma koko.

ʻO ka maʻi diabetes mellitus Type II me ka hoʻopono ʻole o ka mālama ʻana i ka papa ʻaina a me ka hoʻoponopono regimen, ʻoi aku hoʻi i nā mea maʻi me ka momona nui

• ʻoiai he monotherapy a i ʻole hui pū ʻana i hui pū me nā ʻaole hypoglycemic waha a i hui pū ʻia paha me ka insulin no ka mālama ʻana i nā pākeke.
• like monotherapy a hui pū paha me ka insulin no ka mālama ʻana i nā keiki mai 10 mau makahiki a ʻo nā ʻōpio.

ʻO ka hōʻemi i nā hoʻopiʻi maʻi diabetes i nā maʻi pākeke me nā maʻi diabetes II II o ka mellitus a me ke kau momona ka mea nāna i hoʻohana i ka metformin e like me ka lālani mua o ka maʻi me ka lapaʻau ʻana me ka maʻi ʻole.

Hoʻopili me nā lāʻau lapaʻau a me nā ʻano ʻē aʻe ʻē aʻe

ʻAkohola . ^ E Ha yM. Ka pili ʻana i ka ʻeha hoʻohuihui huehue e pili pū me ka nui o ka loaʻa o ka acidosis lactic, ʻoi aku ka pilikia o ka wikiwiki a i ʻole ke kau ʻana ma kahi haʻahaʻa o ka lālama, me ka puʻuwai pū kekahi. Ke mālama ʻia nei me ka metformin, pono ke pale aku i ka wai a me ka lāʻau lapaʻau e pono ai ka waiʻona.

Iodine-mea waiwai radiopaque. ʻO ka hoʻohana nui ʻana i nā mea i loaʻa i ka radiodika iodine e loaʻa i ka hiki ʻole o ka hana a me ka hopena, hoʻopiʻi o ka metformin a me ka hoʻonui nui ʻana o ka acidact lactic.

No ka poʻe maʻi me GFR (glomerular filtration rate)> 60 ml / min / 1,73 m 2, pono e hoʻohana ʻia ka hoʻohana ʻana i ka metformin ma mua a i ʻole ke kau ʻana o ka haʻawina a ʻaʻole hoʻi e hoʻihoʻi hou ma mua o ka mau hola 48 ma hope o ka noi ʻana, ma hope wale o ka loiloi ʻana i ka hana o ka lāiwi a me ka hōʻoia i ka hala ʻole o ka holomua. nā hana maʻemaʻe o ka pūpū.

ʻO nā mea maʻi me ka hiki ʻole o ka renal moderate (GFR 45-60 ml / min / 1.73 m 2) pono e hooki i ka hoʻohana ʻana i ka Metformin 48 mau hola ma mua o ka hoʻokō ʻana i nā mea i pili ai ka iodine e loaʻa ʻole i kahi mau hola ma mua o 48 mau hola ma hope o ke aʻo ʻana, ma hope wale nō o ka loiloi ʻana i ka hana renal a me ka hōʻoia ʻana o ka hana ʻole o ka hoʻāla hou ʻana.

Pono e hoʻopili ʻia nā hui me ka mālama.

ʻO nā lāʻau lapaʻau i loaʻa i kahi hopena hyperglycemic (GCS o ka ʻōnaehana o ka ʻōnaehana a me ke kūloko, sympathomimetics) . ^ E Ha yM. Pono e kāohi i ka pae o ka glucose i ke koko pinepine pinepine, ma mua hoʻi o ka hoʻomaka ʻana o ka mālama. I ka manawa a ma hope o ka pau ʻana o ia ʻano hui, pono ia e hoʻoponopono i ka nui o ka metformin.

Hoʻopuka i nā mea hoʻohiwahiwa, ʻo ia hoʻi diuretics loop, hoʻonui paha i ka loli o ka lactic acidosis ma muli o kahi hiki ke hoʻemi ʻia i ka hana o ka maʻi.

Nā hiʻohiʻona noi

Lactic acidosis. Laminu i ka hanana ana ka lactic acid, akā he mea pōʻino me ka hoʻopiʻi metabola (ʻo ka make nui o ka make nui ma ka haʻalele ʻole o ka mālama maʻi), hiki ke hele mai ma muli o ka hoʻopiʻi o ka metformin. ʻO nā hihia o ka acidact lactic i hōʻike ʻia i nā mea maʻi me ka maʻi mellitus me ka maikaʻi ʻole o ka renal a i ʻole kahi koi koʻikoʻi i ka hana ʻoi. Pono e mālama ʻia nā hana āpau i kahi hana ʻole ʻole o ka renal, no ka laʻana, me ka hōʻeha ʻana o ka maʻi (hōʻeha a hoʻomāhuʻi ʻia paha), a i ka hoʻomaka ʻana o ka mālama ʻana me nā lāʻau antihypertensive, diuretics, a i ka hoʻomaka ʻana o ka hopena NSAID. I ka hoʻomakaʻana o kēia mau exacerbations, pono e pani iki ka hana ʻana i ka metformin.

ʻO nā kumuhana ʻē aʻe i hiki ke kōkua i ka ulu ʻana o ka hoʻōla lactic e pono ke noʻonoʻo ʻia: ke kālai ʻia ʻana o ka maʻi mellitus maʻi maʻamau, ketosis, hoʻoku wā lōʻihi, ʻawaʻawa wai, hōʻemi ʻole ʻia a i ʻole kekahi ʻano e pili ana i ka hypoxia (decompensated heart failed, ʻonuka myocardial infarction)

Hiki i ka acidactact lactic ke hōʻike mai he kani lūlū, indigestion, ʻeha o ka ʻōpū a me nā asthenia koʻikoʻi. Hoʻomaopopo koke nā poʻe maʻi i ke kauka e pili ana i ka hiki ʻana o nā ʻano hoʻohālikelike, ʻoi aku paha inā i hoʻomanawanui mua nā mea maʻi i ka hoʻohana ʻana i ka metformin. I ia mau hihia, he mea pono e hoʻokaʻawale i ka hoʻohana ʻana i ka metformin a laila e wehewehe ʻia ke kūlana. Pono ke hoʻomau i ka ʻoihana Metformin ma hope o ka loiloi ʻana i ka pānaʻi hana / hopena i loko o nā hihia pilikino a me ka loiloi i ka hana pūlima.

Nā huapau Hōʻike ʻia ka acidact lactic i ka waika o ka hanu, nā ʻeha o ka ʻōpū a me ka hypothermia, hiki ke hoʻomohala hou.Nā hōʻailona diagnostic e pili ana i ka emi ʻana o ka laboratori i ka pH koko, kahi hoʻonui i ke kahe o ka lactate i loko o ka serum koko ma luna o 5 mmol / l, kahi hoʻonui i ka pā anion a me ka ratio o ka lactate / pyruvate. I ka hihia o ka hoʻomohalaʻana o ka acidosis lactic, pono ia e hoʻokipa koke i ka mea maʻi (e ʻike i ka ʻāpana "Overdose"). Pono ke kauka i ka poʻe maʻi e pili ana i ka hiki ʻana o ka hoʻomohala ʻana a me nā hōʻailona o ka acidosis lactic.

ʻO Renal hiki ʻole. No ka mea ua hoʻopili ʻia ka metformin e nā keiki, pono ia e nānā i ka clearance creatinine (hiki ke kuhi ʻia ana e ka pae o ka creatinine i loko o ke koko koko me ka hoʻohana ʻana i ka rumi ʻo Cockcroft-Gault) a i ʻole GFR ma mua o ka hoʻomaka a maʻamau mau i ka wā o ka metformin lapaʻau:

• nā mea maʻi me ka hana maʻamau maʻamau - ma kahi o ka manawa 1 ma ka makahiki.
• i nā mea maʻi me ka hōʻoki ʻana ma lalo o ka palena o nā mea maʻi maʻamau a me nā mākua - ma kahi o 2-4 mau manawa i ka makahiki.

I ka hihia inā hana ʻo cleinine clearance 2), ua hui ʻia nā metformin (e ʻike. "Contraindications").

Hoʻemi ʻia ka hana renal i nā poʻe maʻi maʻi hele pinepine a he asymptomatic. Pono e mālama ʻia i ka mālama ʻana i nā hihia me ka hopena o ka renal, no ka laʻana, i ka hopena o ka hoʻomehana, a i ka hoʻomaka ʻana o ka mālama ʻana me nā lāʻau antihypertensive, diuretics, a i ka hoʻomaka ʻana o ka maʻi me nā NSAID. I ia mau hihia, ua ʻōlelo ʻia hoʻi e nānā i nā hana ʻoi aku ma mua o ka hoʻomaka ʻana i ka mālama ʻana me ka metformin.

Hola Cardiac. ʻO ka maʻi me ka puʻuwai puʻuwai e kiʻekiʻe aʻe ka hopena o ka ulu ʻana o ka hypoxia a me ka pani ʻole ʻana i ka renal. I nā maʻi me ka puʻuwai ulu kūpaʻa paʻa, hiki ke hoʻohana ʻia me ka metformin me ka mālama pinepine ʻana o ka cardiac a me ka hana renal. Ua hoʻohālikelike ʻia ka metformin ma nā maʻi me nā maʻi puʻuwai a me ke kūpaʻa ʻole.

ʻO nā mea hoʻopihapiha Iodine. ʻO ka hana maʻalahi i nā aihana radiopaque no nā haʻawina radiological hiki ke alakaʻi i ka hiki ʻole o ka renal, a ma ke kumu, i ka hoʻohui ʻana o ka metformin a me ka hoʻonui nui ʻana o ka hoʻomoʻakai lactic acidosis. No ka poʻe maʻi me GFR> 60 ml / min / 1.73 m 2, pono e hoʻokaʻawale ʻia ka hoʻohana ʻana i ka metformin ma mua a i ʻole ke kau ʻana a ʻike ʻia ma mua o 48 mau hola ma hope o ka hoʻopaʻa ʻana, aia wale nō ma hope o ka loiloi ʻana i ka hana renal a hōʻoia i ka hala ʻana o ka hana hou ʻole. . ^ E Ha yM.

ʻO nā mea maʻi me ka hiki ʻole o ka renal moderate (GFR 45-60 ml / min / 1.73 m 2) pono e hooki i ka hoʻohana ʻana i ka Metformin 48 mau hola ma mua o ka hoʻokō ʻana i nā mea i pili ai ka iodine e loaʻa ʻole i kahi mau hola ma mua o 48 mau hola ma hope o ke aʻo ʻana, ma hope wale nō o ka loiloi ʻana i ka hana renal a me ke hōʻoia nei o ka hala ʻana o ka maʻi haki hou (ʻike i ka "Hoʻohui ʻana i nā lāʻau lapaʻau a me nā ʻano ʻē aʻe".

Hoʻopuka ʻana i nā mea hanu. Pono e hoʻōki i ka hoʻohana ʻana o ka metformin 48 mau hola ma mua o ke komo ʻana o ka lāʻau lapaʻau i hoʻolālā ʻia, ka mea i hana ʻia ma lalo o ka hanana, spinal a i ʻole aestestia a noho hou ma mua o 48 mau hola ma hope o ka hana a hoʻihoʻi hou i ka mālama waha a i ʻole ke kūpaʻa ʻia ka hana maʻamau.

E na keiki. Ma mua o ka hoʻomaka ʻana i ka mālama ʻana me ka metformin, pono ke hōʻoia i ka hōʻoia ʻana o ka maʻi mellitus o ke ʻano II mellitus. Wahi a nā hopena o nā noi, ʻaʻole i hōʻike ʻia kahi hopena o ka metformin no ka ulu ʻana a me ka wā ʻōpiopio i nā keiki. Eia nō naʻe, ʻaʻohe ʻikepili i ka hopena o ka ulu ʻana i ka metformin ulu a me ka wā ʻōpiopio me ka hoʻohana ʻana i ka metformin, no laila, mālama pono ka nānā ʻana i kēia mau ʻatikala i nā keiki i mālama ʻia me ka metformin, ʻoiai i ka wā ʻōpiopio.

Na keiki he 10 a 12 paha makahiki. Wahi a nā hopena o nā haʻawina o nā kamaliʻi 15 a hiki i ka 12 mau makahiki, ʻaʻole i ʻokoʻa ka maikaʻi a me ka palekana o ka metformin ma kēia pūʻulu o nā maʻi i ka ʻokoʻa i nā keiki ʻōpio a me nā ʻōpio. Pono ke ʻano o ka lāʻau lapaʻau me ka mālama ʻana i nā keiki i ka makahiki 10 a 12 paha.

ʻO nā hana ʻē aʻe. Pono ka poʻe maʻi e hahai i kahi papaʻai, ka kaila o nā pulupulu 'āpau i ke ao holoʻokoʻa. Pono nā poʻe maʻi kaumaha e hoʻomau ma muli o kahi papa haʻahaʻa haʻahaʻa. Pono e kiaʻi pinepine i nā ʻōnaehana o ka hana o ka hoʻoliʻiliʻi o nā maʻi maʻi.

ʻAʻole ke kumu o ka metformin monotherapy e hana i ka hypoglycemia, akā, pono e mālama ʻia i ka wā e hoʻohana ana i ka metformin me ka insulin a i ʻole nā ​​mea maʻi hypoglycemic waha (me ka hoʻohālike, ka sulfonylureas a i nā derenin meglitinidam).

Hoʻohana i ka wā hāpai a lactation.

Kahawai ʻO ka hoʻomoʻa ʻole ʻana i ka maʻi maʻi ma ka wā hāpai (gestational a i ʻole ka hoʻomau) e hoʻonui i ka pilikia o ka hoʻomohala ʻana i nā maʻi malia a me ke ʻano make. Aia nā palena waiwai ma ka hoʻohana ʻana i ka metformin no nā wahine hāpai, ʻaʻole i hōʻike i ka nui o ke kuʻuna o ka anomalies congenital.

Haumakua. Hoʻopili ʻia ʻo Metformin i ka waiū umauma, akā ʻaʻole ʻike ʻia nā hopena kūpono i nā pēpē / keiki hou i maʻi hānai ʻia. Eia naʻe, no ka mea, ʻaʻole i lawa nā hōʻike e pili ana i ka palekana o ka lāʻau, ʻaʻole pono ka hānai o ka umauma i ka wā o ka metformin therapy. ʻO ka hoʻoholo e pani ai i ka hōʻuluʻulu ʻana e pono e mālama i nā pono o ka umauma a me ka hiki o nā hopena kūpono no nā ʻaoʻao kūpono loa i ka pēpē.

Pūnaewele . ^ E Ha yM. ʻAʻole i pili ʻo Metformin i ka ulu holoholona ʻana i ka wā i hoʻohana ʻia ai i nā dosis o 600 mg / kg / lā, ua kokoke loa kēlā me 3 mau manawa i ko ka nui o ka nui o nā lā i hāpai ʻia e ke kanaka e pili ana i ka pae kino kino.

ʻO ka hiki ke alakaʻi i ka hopena i ka wā e lawe ana i nā kaʻa a i ʻole nā ​​hana ʻē aʻe.

ʻAʻole pili ka metformin monotherapy i ka hopena o ka hopena i ka wā e holo a hana paha me nā hana ʻē aʻe, no ka mea ʻaʻole i hoʻonā ka lāʻau i ka hypoglycemia.

ʻLoe a me ke kākele

Monotherapy a hui pū paha hui e hui pū me nā mea hana waha hypoglycemic waha.

ʻO ka maʻamau, ʻo ka dosis mua he 500 mg (pili ma ke ʻano kūpono) a i ʻole 850 mg o ka metformin hydrochloride 2-3 mau manawa o ka lā i ka wā a ma hope o ka ʻaina.

Ma hope o nā lā 10-15, pono ke hoʻoponopono ʻia ke ʻano e like me nā hopena o ke ana o ka pae o ka glucose i ka serum koko.

Holoi ka piʻi ʻana o ka hopena hoʻemi i nā hopena ʻaoʻao mai ka digestive tract.

ʻO ka nui loa e hōʻike ʻia ai he 3000 mg i kēlā me kēia lā (e kau ma ke ʻano he kūpono, e māhele ʻia iā 3 pūpeka.

Ma ka hihia o kahi loli mai kahi lāʻau lapaʻau hou antidiabetic, pono ke kāpae i ka lawe ʻana i kēia lāʻau lapaʻau a kuhikuhi i ka metformin, e like me ka mea i hōʻike ʻia ma luna nei.

Hoʻohui hui me ka insulin .

E hoʻokō ʻoi aku ka maikaʻi o nā kaila glucose, hiki ke hoʻohana i ka metformin a me ka insulin e like me ka hui pū ʻana.

Hoʻololi a hui pū paha me nā insulin.

Hoʻohana ʻia ka Metformin hydrochloride i nā keiki mai 10 mau makahiki o nā makahiki a ʻo nā ʻōpio. ʻO ka maʻamau, ʻo ka dosis mua he 500 mg (pili ma kahi kūpono kūpono) a i ʻole 850 mg o ka metformin hydrochloride 1 mau manawa i kēlā me kēia lā a ma hope o ka ʻai. Ma hope o nā lā 10-15, pono ke hoʻoponopono ʻia ke ʻano e like me nā hopena o ke ana o ka pae o ka glucose i ka serum koko.

Holoi ka piʻi ʻana o ka hopena hoʻemi i nā hopena ʻaoʻao mai ka digestive tract.

ʻO ka dosis kiʻekiʻe loa e hōʻike ʻia ana ʻo 2000 mg i kēlā me kēia lā, mahele ʻia i 2-3 pona.

I nā maʻi maʻi maʻi hiki ke koho ʻia kahi emi ʻana o ka hana hula, no laila, pono ke koho ʻia ka huina o ka metformin e pili ana i kahi loiloi o ka hana ʻana, pono ke hana pinepine ʻia (e ʻike i ka ʻāpana "Hōʻike o ka hoʻohana").

ʻO nā maʻi me ka hala ʻole ʻole. Hiki ke hoʻohana i ka Metformin i nā maʻi me ka hiki ʻole ke hoʻololi 'ana i ka papalula, kahi hope Sha (cleanine clearance 45-59 ml / min a i ʻole GFR 45-59 ml / min / 1.73 m 2) wale nō i ka ʻole o nā kūlana ʻē aʻe e hoʻonui ai i ka hōʻeha o ka acidact lactic, me ka hoʻoponopono hoʻoponopono hou ʻia: ʻo ka nui o ka hana mua he 500 mg a i ʻole 850 mg o ka metformin hydrochloride 1 manawa i kēlā me kēia lā. ʻO ka nui maʻa loa he 1000 mg i kēlā me kēia lā a pono e hoʻokaʻawale i 2 mau pona. E mālama pono i ka mālama ʻana i nā hana hā (ʻo kēlā me kēia mahina 3-6).

Inā hōʻea ke kuhi creinine a i ʻole GFR i ka 2, i kēlā me kēia, pono e hoʻokaʻawale ka metformin.

Hoʻohana ʻia ʻo Metformin e mālama i nā keiki mai 10 mau makahiki aku.

Nā hopena maikaʻiʻole

ʻO nā hopena hoʻopiʻi pinepine pinepine ʻia, i ka hoʻomaka ʻana o ka mālama ʻana, ka nisa, ka luaʻi, ke ʻōpū ʻana o ka ʻōpū, ʻeha o ka ʻōpū, ka nele o kaʻai.

Mai ka palaki kuʻekuʻe: nā pilikia o ke kūnaehana ʻana, e like me ka nausea, ka luaʻi, ka nele o ka makemake, ka ʻōpū, ka ʻeha o ka ʻōpū. ʻO ka pinepine, ʻo kēia mau hopena ʻaoʻao e hoʻomaka i ka hoʻomaka ʻana o ka mālama ʻana, a ma ke ʻano he kānāwai, e kau pono ma luna o lākou.

Mai ka ʻaoʻao o ka metabolism: lactic acidosis.

Me ka hoʻohana mau ʻana i ka lāʻau lapaʻau, hiki i ke emi ʻana o ka hoʻōla ʻana o ka vitamin B ₁₂ , kahi i hala ʻia me ka hoʻēmi ʻana o kona pae ma ka serum koko. A manaʻo ʻia no ke ʻano he kumu like ʻole o ka hypovitaminosis B. ₁₂ inā he mea maʻi ka maʻi megaloblastic.

Mai ka ʻōnaehana hoʻonāukiuki: lau kuhi hewa.

Mai ka pūnaehana hana ʻana: ʻO ka hoʻemi ʻana i ka hana o ka pepeka a i ʻole hepatitis paha, e nalo ana ma hope o ka hoʻokuʻu ʻana o ka metformin.

Ma ka ʻāpana o ka ʻili a me ka kiko. nā hopena ʻili, ʻo ia ka erythema, pruritus, urticaria.

ʻO ka loiloi mea hoʻohana no ka lāʻau lapaʻau

ʻAʻohe manaʻo maikaʻi ʻole e pili ana i ka Metformin Teva. Hoʻomaopopo ka Diabetics i kona loaʻa, ka pono a me ka palekana, ʻaʻole i haʻahaʻa i nā kumukūʻai kūʻai nui.

He alakaʻi ʻo ka hui multinational ʻo Teva Pharmaceutical Industries Ltd i ke alakaʻi ʻana i ka ʻoihana kūʻai honua: i ka makahiki i hala wale nō, ʻoi aku ka loaʻa ʻana o kāna waiwai nui ma mua o ka $ 22 biliona. Na ke kōkō kuleana ke kuleana o nā mākeke 80 nona ka mea i loaʻa i kāna huahana. No 20 mau makahiki ua hana ʻo ia me ka mea hana Lūkini, e hāʻawi ana iā lākou ma kahi o 300 mau ʻano o kāna huahana.

Mai ka makahiki 2014, ua hana ka mea kanu i Yaroslavl e loaʻa ai nā papa he 2 bilona i kēlā me kēia makahiki no Russia a me nā ʻāina ʻē. Ua wehe ʻia ka ʻoihana ʻo Teva LLC ma ke ʻano o ka hoʻokō o kāna hoʻolālā waiwai ʻenehana.