Ke ʻano lāʻau Xelevia: kuhikuhi i ka hoʻohana > He hoʻomaʻemaʻe a me ke pale aku

Loaʻa i nā papa pani kiʻi ʻia. ʻO nā papa ʻāpana poli, ma ka ʻaoʻao o ka membrane kiʻi ma ke ʻaoʻao kahi i kahakaha ʻia "277", ma ka ʻaoʻao ʻē aku holoʻokoʻa lākou.

ʻO ka papa hana nui o ka sitagliptin phosphate monohydrate i loko o kahi waihona o 128.5 mg. Nā kumuwaiwai hou: cellulose microcrystalline, calcium hydrogen phosphate, sodium croscarmellose, magnesium stearate, magnesium stearyl fumarate. ʻO ka uhi ʻana o ka kiʻi ʻoniʻoni he polyvinyl alkohol, titanium dioxide, polyethylene glycol, talc, ka melemele a me ka ulaula pōpilikia.

Loaʻa ka lāʻau lapaʻau i nā palaka no nā papa he 14. I loko o kahi kīʻaha kāleka he 2 mau blisters a me nā kuhikuhi no ka hoʻohana.

Ma hea a pehea e hoʻokomo ai i ka insulin i ka diabetes mellitus - heluhelu i kēia ʻatikala.

Ka hana lāʻau lapaʻau

Hoʻolālā no ka mālamaʻana i ka maʻi maʻi i ka lua. Kuhi ʻia ka hana o ka hana i ka pale ʻana o ka enzyme DPP-4. Hoʻololi ka mea ikaika i ka hana mai ka insulin a me nā mea antiglycemic e hiki ai. Ke hoʻonui nei ke kukuna o ka testosterone-dependantine e hoʻonui ʻia i ka glucose.

ʻO kahi pale i kahi o ka huna i ka hopena o ka glucagon e nā sela pancreatic. Hāʻawi kēia i ka hōʻemi o ka hoʻohuihui o ka glucose i ka palupalu, e hoʻoneʻe i nā hōʻailona o ka hypoglycemia. Kuhi ka hana o sitagliptin e kāohi i ka hydrolysis o ka pancreatic enzyme. Hoʻemi ʻia ka mea huna Glucagon, ma laila e hoʻoulu ai i ka hoʻokuʻu ʻana o insulin. I kēia hihia, ua loaʻa ka glycosylated insulin index a me ka hoʻoneʻe ʻana o ka maʻi glucose i ke koko.

Hoʻolālā ʻia ʻo Xelevia e mālama i ka maʻi maʻamau ʻo 2.

Lapaʻau lāʻau

Ma hope o ka lawe ʻana i ka paila i loko, ua hoʻihoʻi koke ka mea hana mai ke aihue. Eʻai ana i ka ʻai. Hoʻoholo ʻia kona ʻano kiʻekiʻe loa i ke koko ma hope o kekahi mau hola. He kiʻekiʻe ke Bioavailability, akā he haʻahaʻa ka hiki ke hoʻopaʻa ʻia i nā kāpena protein. Hoʻopilikia wale ka mea hoʻokūkū i ka palupalu. Hoʻohālikelike ʻia ka lāʻau mai ke kino me ka urine ma ka kānalua renal a ʻelua i loli a ma ke ʻano o nā metabolites maʻamau.

Nā hōʻailona no ka hoʻohana ʻana

Nui kekahi mau hōʻike pololei no ka hoʻohana ʻana i kēia lāʻau lapaʻau.

monotherapy e hoʻomaikaʻi i ka metabolly glycemic i nā mea maʻi me ka maʻi diabetes type 2,
hoʻomaka i ka hopena paʻakikī me ka metformin type 2 diabetes pathology,
hana ma ke ʻano maʻi maʻi type 2, ke ʻano o ka meaʻai a me ka hoʻōla ʻana.
hoʻohui puke insulin
e hoʻomaikaʻi i ka mana glycemic i ka hui ʻana me nā derivatives sulfonylurea,
hui pū ʻana o nā maʻi maʻi o ka lua o ke ʻano me thiazolidinediones.

Nā Hoʻohui

ʻO nā contraindications hoʻohana i ka hoʻohana ʻana o ka lāʻau lapaʻau, i hōʻike ʻia i nā ʻōkuhi no ka hoʻohana ʻana, nā:

hypersensitivity i nā māhele o ka lāʻau lapaʻau,
hapai a lactation
makahiki i 18 makahiki
maʻi maʻamau ketoacidosis,
maʻi diabetes type 1
hana koʻikoʻi kahi keiki.

Hoʻohana ʻia ʻo Xelevia i ka mālama ʻana i ka maʻi maʻamau ʻo 2, i ʻole hana i ka meaʻai a me ka hana.

Me ka mālama nui, ua kuhikuhi ʻia ʻo Xelevia i nā poʻe me ka hōʻeha ʻole a me ke kaulike, a me nā maʻi i loaʻa i ka mōʻaukala o ka pancreatitis.

Pehea e lawe ai iā Xelevia?

ʻO ka hapa a me ka lōʻihi o ka mālama ʻana ke hilinaʻi pololei nei i ka paʻakikī o ke kūlana.

Ke lawe nei i ka monotherapy, ua lawe ʻia ka lāʻau lapaʻau i kahi ma mua o kēlā me kēia lā no 100 mg i ka lā. Hoʻomaopopo ka ʻano like like i ka wā e hoʻohana ʻia ai ka lāʻau lapaʻau me ka metformin, insulin a me sulfonylureas. Ke lawe nei i ka therapy paʻakikī, e noʻonoʻo e hoʻemi i ka hopena o ka insulin i lawe ʻia e pale i ka hoʻomohala ʻana o ka hypoglycemia.

Mai lawe i kahi pualikoa ʻelua o ka lāʻau i ka lā hoʻokahi. Me kahi loli koʻikoʻi i ka olakino ākea, pono ai ke hoʻoponopono ʻia. I kekahi mau hihia, ua mālama ʻia nā hapalua a i ʻole nā hapaha paha, he nui ka hopena placebo. Hoʻololi paha ka ʻōlelo i kēlā me kēia lā i ka hōʻike ʻana i nā hōʻike haki o nā maʻi a me ka pono o ka hoʻohana ʻana i kēia lāʻau.

Nā hopena hopena o Xelevia

Ke lawe nei ʻo Xelevia, hiki mai paha nā hopena like ʻole:

nā hopena kūlohelohe
lilo ka momona
constipation
nahoa
tachycardia
ʻōpala
aloha
hikiʻole ke hoʻopiliʻike.

I nā hihia loaʻa pinepine, hiki i ka exacerbation o hemorrhoids. Hoʻomaʻamaʻa ka hoʻomaʻamaʻa. I nā kūlana koʻikoʻi, ua hele pū ʻia me nā mea hoʻokūkū, hana ʻia nā hemodialysis.

Hoʻohana i ka wā kahiko

Basically, ʻaʻole pono ka poʻe maʻi maʻi e hoʻoponopono i ka hoʻoponopono ʻia. Akā inā inoino ke kūlana a ʻole ka hāʻawi ʻana mai ka hopena i nā hopena i manaʻo ʻia, a laila maikaʻi ke kāpae i ka lawe ʻana i nā ʻāpana a hoʻoponopono paha i ka dosage i ke emi ʻana.

ʻAʻole pono nā maʻi ʻōpio i nā hoʻoponopono hoʻoponopono o Xelevia.

Hoʻohana i ka wā hāpai a me ka lactation

ʻAʻohe data kūpono i ka hopena o ka hana ikaika ma ka kuʻi. No laila, pāpā ʻia ka hoʻohana ʻana i kēia lāʻau i ka wā gestation.

ʻOiai inā ʻaʻohe data e hilinaʻi nei i ka mea i hala ka lāʻau i ka waiū umauma, ʻoi aku ka maikaʻi o ka haʻalele ʻana i ka umauma inā pono nā ʻano o ia ʻano maʻi.

Ke noi no ka hana renal impaired

E hilinaʻi ʻia ka lāʻau hoʻōla o ka lāʻau lapaʻau me ka mahele o ka mea hiki. ʻO ke kiʻekiʻe kahi kiʻekiʻe, ʻo ka haʻahaʻa o ka lāʻau i kauoha ʻia. I ka hihia no ka lawa o ka hana ʻole, hiki ke hoʻoponopono ʻia i ka lāʻau mua ma 50 mg i kēlā me kēia lā. Inā hāʻawi ka mālama i ka hopena therapeutic i makemake ʻia, pono ʻoe e kāpae i ka lāʻau lapaʻau.

Ke noi no ka hana lawelawe lēʻaleʻa

Me kahi ʻoluʻolu o nā pilikia ʻole, ʻaʻole pono ke hoʻoponopono ʻia. ʻO ka dosis i kēlā me kēia lā i kēia hihia he 100 mg. ʻO kahi hana nui wale nō o ka palupalu o ka kō, ʻaʻole e mālama ʻia ka lāʻau lapaʻau me kēia lāʻau lapaʻau.

Me ka loaʻa ʻana o ka nui o ka pūpū, ʻaʻole i kuhikuhi ʻia ʻo Xelevia.

ʻOi loa o Xelevia

ʻAʻole kūpono nā hihia o ka overdose. Hiki i kahi moku'āina make kino hiki ke hele wale i ka wā e lawe ai i ka pākaʻi hoʻokahi ma kahi o 800 mg. I kēia hihia, hoʻonui nui nā hōʻailona o ka hopena ʻaoʻao.

Hoʻokomo ʻia i ka mālama ʻana i ka gastage lavage, kahi detoxification a me ka mālama pono ʻana i ka mālama maʻi. Hiki ke wehe i nā toxins i ke kino e hoʻohana ana i ka dialysis lōʻihi, no ka mea hemodialysis maʻamau e kū pono wale i nā hihia maʻalahi o ka overdose.

Hoʻopili pū me nā lāʻau ʻē aʻe

Hiki ke hoʻohui ʻia ka lāʻau lapaʻau me ka metformin, warfarin, kekahi mau mea hoʻokūkū waha. ʻAʻole loli i ka pharmacokinetics o ka mea ikaika me ka hui pū ʻia me nā mea paʻa me ka ACE inhibitors, nā antiplatelet agents, nā lipid-kaila haʻahaʻa, beta-blockers a me nā konupuna saluran kalepa.

Hoʻopili pū kekahi me nā lāʻau anti-inflammatory non-steroidal, antidepressants, antihistamines, proton pump inhibitors a me kekahi mau lāʻau lapaʻau e hoʻopau ai i ka erectile dysfunction.

Ke hui pū nei me Digoxin a me Cyclosporine, e nānā iki kahi liʻiliʻi o ke kaohi o ka mea ikaika i ka plasma koko.

Hoʻolaha ka waipuna

ʻAʻole hiki iā ʻoe ke lawe i kēia lāʻau lapaʻau me ka waiʻona. Hoʻemi ʻia ka hopena o ka lāʻau lapaʻau, a mahuahua wale nā hōʻailona dyspeptic.

He loaʻa i kēia lāʻau lapaʻau ka nui o nā mea hoʻohālikelike e like me ia ma nā ʻōlelo o ke ʻano ikaika a me ka hopena i loaʻa ai iā ia. Ka mea maʻamau ma waena o lākou:

Pauin,
Sitagliptin phosphate monohydrate,
Hoavius
Yasitara.

Mea hana

ʻOihana hana: Berlin-Chemie, Kelemānia.

E mālama iā Xelevia mai nā kamaliʻi.

Mikhail, 42 makahiki, ʻo Bryansk

Ua ʻōlelo ke kauka e lawe iā Xelevia ma ke ʻano nui. Ma hope o hoʻokahi mahina o ka hoʻohana ʻana, hoʻonui iki aʻe ka huki ʻaʻa, ma mua o loko o 5, ʻae i kēia manawa i ka 6-6.5. Ua loli pū ka hopena o ke kino i ka hana kūlohelohe. Ma mua, ma hope o ka hele ʻana a i ke pāʻani ʻana i ke kō, ua hāʻule nui ke kō, a me ka mea, ʻoi loa ka mea kuhikuhi i ka 3. I ka wā e lawe ana iā Xelevia, maʻa kō ke kōpaʻa ma hope o ka hoʻomaʻamaʻa ʻana, lohi, a hoʻi ia i ka maʻamau. Ua hoʻomaka ʻo ia e maikaʻi. No laila uaʻike wau i ka lāʻau lapaʻau.

Alina, 38 makahiki, Smolensk

ʻAe wau iā Xelevia i mea kōkua i ka insulin. Ua maʻi wau me ka maʻi maʻi no nā makahiki he nui a ua hoʻāʻo kā lākou i nā lāʻau lapaʻau a me nā hui pū ʻana. Makemake wau i kēia a loa. ʻO ka lāʻau lapaʻau wale nō e pane wale i ke kō kiʻekiʻe. Inā e hoʻohaʻahaʻa i kēia manawa, a laila ʻaʻole e ʻā ke lāʻau i ka lāʻau. E hana mālie. ʻAʻohe spakes i ke kō i loko o ke ao. Aia ma kahi kūpono kūpono, ʻaʻole i wehewehe ʻia i nā kuhikuhi i ka hoʻohana ʻana: hoʻololi i ka meaʻai. Hoʻemi ʻia ka ʻeleʻele e ka hapalua. He maikaʻi kēia.

Mark, 54 mau makahiki, Irkutsk

Loaʻa koke ka lāʻau iā ʻoe. Ma mua o kēlā, lawe ʻo ia iā Januvia. Ma hope ona, ʻaʻole maikaʻi. Ma hope o kekahi mau mahina i ka lawe ai iā Xelevia, ʻaʻole wale ka nui o ke kō i hoʻōla ʻia, akā ke olakino pū kekahi. ʻIke wau i ke ʻano o ka ikaika loa, ʻaʻohe pono e kīleʻaleʻa mau. Ua aneane poina wau i ke ʻano o ka hypoglycemia. ʻAʻole palau ka Sugar, pulu ia a kū mālie a lūlū, me kahi e pane maikaʻi ai ke kino.

E hoʻokuʻu i ke ʻano a me ka ʻano

ʻO ke ʻano hua ʻōlelo o Xelevia nā papa i uhi ʻia i nā kiʻi ʻoniʻoni: beige, biconvex, kahi pōʻai, ʻūwī ma kekahi ʻaoʻao, i ke kiʻi ʻana i ka "277" (i ka pahu pahu pahu 2 i nā blisters he 14 papa i kēlā me kēia) a me nā kauoha no ka hoʻohana ʻana iā Xelevia.

Helu 1 papa:

mea waiwai: sitagliptin fosfat monohala - 128.5 mg (e pili ana i nā ʻike o sitagliptin - 100 mg),
ʻO nā mea kōkua: ʻo ka sodium stearyl fumarate - 12 mg, magnesium stearate - 4 mg, sodium croscarmellose - 8 mg, calcium univined hydrogen phosphate - 123.8 mg, microcrystalline cellulose - 123.8 mg,
palauo kiʻi: Opadry II beige 85F17438 ulaula pōpoki hao (E 172) - 0.37%, hao kekeila hao (E 172) - 3.07%, talc - 14.8%, polyethylene glycol (macrogol 3350) - 20.2% ʻO ka titanium dioxide (E 171) - 21.56%, polyvinyl waiʻona - 40% - 16 mg.

Lapaʻau lāʻau

ʻO Xelevia kahi mea mālama paʻa koho maikaʻi loa o ka DPP-4, ka mea i hana i ka wā e lawe ʻia ai ka ʻōlelo maʻamau a no ka mālama ʻana i ka maʻi mellitus type 2.

ʻO ka waiwai ikaika o Xelevia (sitagliptin) mai nā analogue o ke glucagon like-peptide-1 (GLP-1) a me nā amylin, nā inhibitor α-glucosidase, on-receptor agonists e hoʻāla ʻia e ka proliferator peroxisome (PPAR-γ), insulin, sulfonylurea derivatives a me nā konanuan a me ka hana lāʻau lapaʻau. Ma ka hoʻokaʻawale ʻana iā DPP-4, hoʻonui ka sitagliptin i ka hoʻoneʻe ʻana o ʻelua mau huaʻai o ka ʻohana singʻokinen - GLP-1 a me ka glucose-e hilinaʻi i ka insulinotropic polypeptide (HIP).

Hoʻokaʻa ʻia nā Hormone o kēia ʻohana i loko o ka ʻōpū i 24 mau hola, ma ke ʻano he komo ʻana i ka meaʻai, piʻi ka nui. ʻO ka incretins he ʻāpana o ka pūnaehana physiological kūloko no ka hoʻoponopono o ka homeostasis glucose. E pale aku i ka hoʻoneʻe o ka glucose koko maʻamau a hoʻokiʻekiʻe paha, ua kōkua nā hormones o ka ʻohana tendetin i ka hoʻonui ʻana i ka synthesis o ka insulin a me kāna neʻe ʻana e ka pancreatic β-cells ma ka hōʻailona ʻana i ka hana ʻenehana intracellular pili i ka cyclic adenosine monophosphate (AMP).

Pēlā nō hoʻi, hoʻomaʻemaʻe ʻo GLP-1 i ka hoʻonui ʻia ʻana o ka mea huna o ka glucagon e ka pancreatic α-cell. ʻO ka emi ʻana o ke kaʻe o ka glucoseagon me ka piʻi ʻana o ka insulin e alakaʻi i ka emi ʻana o ka hana glucose i ka ʻāʻī, kahi i hala ai ke kahuli i ka glycemia. ʻOkoʻa kahi ʻano hana o kēlā me kēia hana i kū mai ai i nā derivatives sulfonylurea, ka mea, me ka haʻahaʻa haʻahaʻa o ke koko, e hoʻowalewale i ka hoʻokuʻu ʻia ʻana o ka insulin. Hāʻawi kēia i ka ʻike o ka hypoglycemia sulfone-hoʻohuihui wale nō, ʻaʻole wale i nā mea maʻi me ka diabetes mellitus type 2, akā naʻe i nā mea olakino.

Ma ka hoʻohaʻahaʻa haʻahaʻa o ka glucose i ke koko, ʻaʻole ʻike ʻia nā hopena o ka nui o nā hua i loko o kahi e hoʻemi ana i ka huna ʻana i ka huna me ka ʻaihue a me ka hoʻokuʻu ʻana o insulin. ʻAʻole pili ʻo HIP a me GLP-1 pili i ka hoʻokuʻu ʻana o glucagon ma ka pane ʻana i ka hypoglycemia. Hoʻohālikelike ʻia ka hana o ka incretins ma lalo o nā kūlana physiological e ka DPP-4 ene, me ka hoʻololi koke iā lākou me ke ʻano o nā huahana hiki ʻole. Mālama ʻo Sitagliptin i kēia kaʻina hana, ma muli o ke ʻano o ka hoʻohui ʻana o ka plasma o nā hana ikaika o HIP a me GLP-1 hoʻonui.

I ka hoʻonui ʻana i nā kiko o ka puke, ua hoʻonui ʻo Xelevia i ka hoʻokuʻu ʻana i ka glucose i ka insulin a kōkua i ka hoʻohaʻahaʻa ʻana i ka hana huna o ka glucagon. I nā mea maʻi me ka diabetes mellitus type 2 me ka hyperglycemia, kēlā mau loli i ka ʻalilo ʻana o ka glucagon a me ka insulin e lawelawe ai i ka hoʻemi ʻana i ka ʻaila o glycated hemoglobin HbA _1C a me ka emi ʻana o ka glucose i loko o ke koko koko, i hoʻoholo ʻia ma kahi ʻōpū ʻole a ma hope o ka hoʻāʻo ʻana i ka kaumaha.

ʻO ka lawe ʻana i hoʻokahi pākahi o Xelevia i ke ʻano mellitus type 2 e alakaʻi i ka pale ʻana i ka hana o ka enzyme DPP-4 no 24 mau hola, ka mea e lawelawe ana e hoʻemi i ka kūʻai glucose, a me ka hoʻōla ʻana o ka glucose a i ʻole ka ʻai, hoʻoliʻi i ka plasma glucoseagon kiʻekiʻe, hoʻonui i ka plasma o ka insulin a me C- ʻo ka peptide, ke hoʻonui ʻana i ka manaʻo o ka neʻe i ka vitelini i hōʻea i luna o GLP-1 a me ISU i 2 a i 3 mau manawa paha.

ʻO Renal hiki ʻole

Ua wehe ʻia kahi noi noi o sitagliptin i loko o kēlā me kēia lā o 50 mg e hoʻopaʻa ʻia i ka pharmacokinetics no nā ʻano like ʻole o ka nui o ka pohō ʻole o ka pilikia ʻole. Ua hoʻokaʻawale ʻia nā mea manawaleʻa i loko o ka hoʻopaʻa ʻana i kēia mau pūʻulu:

nā mea maʻi me ka maikaʻi ʻoi aku ka maikaʻi ʻole: ka hana ʻana i hana (CC) 50-80 ml i 1 min,
nā mea maʻi me ka hikiʻole ke kūlohelohe kaulike: CC 30-50 ml no 1 min,
nā mea maʻi me ka hikiʻole o ka pilikia haki: CC 9 point) i haʻalele. Akā, ʻo ka mea, ua kūʻai mua ʻia ka waiwai e nā keiki, ʻaʻole pono e manaʻo kekahi i kahi loli nui i kona mau pharmacokinetics i kēlā mau kūlana.

Mamua

ʻAʻole i loaʻa i nā makahiki o nā mea maʻi ka hopena koʻikoʻi ma luna o ke ana o ka parakola pharmacokinetic o ka lāʻau. Hoʻohālikelike me nā mea ʻōpiopio ʻōpio, ʻoi aku ka kiʻekiʻe o ka sitagliptin i loko o nā ʻelemakule (ʻo 65 a 80 mau makahiki makahiki) ke kiʻekiʻe nei ma kahi o 19%. Wahi a ka makahiki, ʻaʻole i lawe ʻia ka hoʻoponopono ʻana o Xelevia.

Xelevia, nā ʻōlelo e hoʻohana ai: ke ʻano a me ke ʻano

Lawe ʻia nā papa liʻiliʻi, me ka ʻole o ka meaʻai. ʻO ka ʻōlelo paʻa o ka lāʻau lapaʻau ʻia he 1 papa (100 mg) hoʻokahi i ka lā. Hoʻohana ʻia ʻo Xelevia ma ka monotherapy, ma ka manawa like me nā derivatives metformin / sulfonylurea / PPAR-agonists, a i ʻole metformin a me nā derivatives o ka metformin / metformin a me PPAR-γ / insulin agonists (me ka ʻole a me ka metformin).

ʻO ka nui o ka pauku i nā lāʻau i hoʻohana ʻia i ka wā like me Xelevia i koho ʻia ma ke ʻano i ʻōlelo ʻia no kēia mau lāʻau.

E kūlike i ka mea pili i ka hoʻōla hui ʻia me Xelevia me ka insulin a i ʻole ka hopena sulfonylurea, ʻoi ʻia e hōʻemi i nā ʻōlelo kuʻuna o ka insulin a me nā derivatives o ka sulfonylurea e hōʻemi i ka hopena o ka insulin-induced or sulfone-induced hypoglycemia.

Ke hoʻolei nei i nā paila, e kipa ʻia e lawe iā lākou i ka manawa kūpono ma hope o ka hoʻomanaʻo ʻana i ka mea maʻi i ka pau i hala. Pono e hāpai i ka noʻonoʻo o ka hoʻohana ʻana ʻelua o ka lāʻau i ka lā like ma ka lā hoʻokahi.

ʻO ka hoʻoponopono ʻana i ka paukū hoʻokā ʻia no ka hiki ʻole o ka renal rula (CC ≥ 50 ml no 1 min, kahi kūpono e pili ana i ka serum creatinine concentration per 1.5 mg no 1 dL i nā wahine a me ka ≤ 1.7 mg no 1 dL i nā kāne) ʻaʻole pono.

I nā maʻi me ka hōʻeha a me ka maikaʻi ʻole o ka renal nui, koi ʻia ka hoʻoponopono ʻana o ka sitagliptin.No ka mea ʻaʻohe ʻokoʻa ka pilikia ma nā papa o Xelevia a ʻaʻole i hoʻokuʻu ʻia lākou ma ke ʻano o 25 a 50 mg (akā wale nō ma ke ʻano he 100 mg), ʻaʻole hiki ke ʻano e hōʻoiaʻiʻo i ka hoʻoponopono palena ʻāina i kēlā mau maʻi. Ma kēia pili ʻana, ʻaʻole i kuhikuhi ʻia ka lāʻau i loko o kēia ʻano o nā mea maʻi.

ʻO ka hoʻohana ʻana o ka sitagliptin e pili ana i ke kua o ka pilikia o ka renal e pono ai kahi loiloi o ka hana ʻoka ma mua o ka hoʻomaka ʻana i ka maʻi a me nā manawa maʻamau i ka hoʻohana ʻana.

I nā hōʻoluʻolu a me nā degere maʻalahi o ka palaleka o ke kō, a me ka poʻe maʻi maʻi maʻi, ʻaʻole i hoʻoponopono ʻia ka nui o ka lāʻau. ʻO ka hoʻohana ʻana o Xelevia e kūʻē i kahi wī o ka nui o ka hikiʻole o ka nui ma ka ʻike ʻole ʻia.

Hoʻohui hui inamua me ka metformin

Ua mālama ʻia kahi haʻawina hoʻonaninani ka papa hana 24-wiki ma ka hoʻomaka ʻana e hoʻomaʻamaʻa ʻia o ka sitagliptin i loko o kēlā me kēia lā o 100 mg a me ka metformin i loko o kēlā me kēia lā no 1000 he 2000 mg (50 mg o sitagliptin + 500 a me 1000 mg o metformin 2 mau manawa i ka lā). Wahi a ka ʻikepili i loaʻa, ʻo nā hanana ʻino i pili ʻia me ka lawe ʻana i ka lāʻau lapaʻau i ʻike pinepine ʻia (me ka pinepine o ≥ 1%) i ka hui e loaʻa ana ka sitagliptin + metformin ma mua o ka metformin monotherapy. ʻO ka ulu ʻana o nā hopena ʻaoʻao i nā hui o sitagliptin + metformin a me ka metformin ma monotherapy ʻo kēlā me kēia:

kāʻeha - 3.5 a me 3.3%,
uila - 1.1 a 0.3%,
hōʻeha - 1.3 a 1.1%,
dyspepsia - 1,3 a me 1.1%,
hypoglycemia - 1.1 a me 0.5%,
kikowaʻo - 1,3 a me 0.5%.

Hoʻohana waiwai me nā derivatives o ka sulfonylurea a i ʻole nā dermona sulfonylurea a me ka metformin

I loko o kahi hōʻike 24-wiki plebo control o ka hoʻohana like ʻana o ka 100 mg o sitagliptin i kēlā me kēia lā me ka glimepiride a i ʻole glimepiride a me ka metformin, he pinepine (me ka piʻi o ≥ 1%) hoʻomōhala o ka hypoglycemia i nānā ʻia me ka hui e loaʻa ana i ka placebo me ka glimepiride a i ʻole glimepiride a me metformin. ʻO ka pinepine o kona hoʻomohala ʻana he 9.5 / 0.9%, kēlā

Hoʻohui hui mua me PPAR-γ agonists

Ke hana nei i kahi hōʻike 24-pule o ka hopena hui mua me ka sitagliptin i loko o kēlā me kēia lā he 100 mg a me ka pioglitazone i loko o kēlā me kēia lā he 30 mg i ka hui e loaʻa ana i sitagliptin i hui pū, ua ʻike pinepine ʻia nā hopena ʻehā (me ka maʻamau o ≥ 1%) ma ka hui e loaʻa ana ka pioglitazone ma monotherapy . ^ E Ha yM. ʻO ka loaʻa ʻana o nā hanana pōʻino i loko o nā hui o sitagliptin + pioglitazone a me pioglitazone ma monotherapy ʻo (kēlā):

hōʻailona hypoglycemia: 0.4 a me 0.8%,
ka hoʻohaʻahaʻa ʻana o ka asymptomatic i ke kaila o ka glucose o ke koko: 1.1 a me 0%.

Hoʻohui hui me nā metformin a me nā agarist o PPAR-y

Ua hana ʻia kahi haʻawina hoʻokele pletebo me ka hoʻohana ʻana i 100 mg o ka sitagliptin i kēlā me kēia lā me ka rosiglitazone a me ka metformin me ke komo ʻana o nā hui ʻelua - nā mea maʻi e loaʻa pū ana me ka lāʻau lapaʻau haʻawina, a me nā poʻe e loaʻa pū ana me ka pletebo. Wahi a ka ʻike i loaʻa, ʻike pinepine ʻia nā lono (me ka pinepine o ≥ 1%) ma ka hui e loaʻa ana kahi sitagliptin ma mua o ka hui e loaʻa ana i ka placebo.

I ka wiki 18 o ka nānā ʻana i kēia mau hui, ua hōʻike ʻia nā hopena o ka ʻaoʻao me ka nalo i kēia:

holoau - 1.2 a 0%,
hōʻeha - 2.4 a me 0%,
hypoglycemia - 1.2 a 0%,
kanalua - 1.2 a 1.1%,
kāʻeha - 1,8 a 1,1%.

I ka wiki he 54 o ka nānā ʻana i kēia mau pūʻulu, ua ʻike ʻia kekahi helu nui e pili ana i kēia mau ʻano:

peripheral edema - 1.2 a 0%,
hōʻeha - 2.4 a me 0%,
kanalua - 1.2 a 1.1%,
fungal maʻi o ka ʻili - 1.2 a 0%,
huhū - 1,2 a 0%
hypoglycemia - 2,4 a me 0%,
nā maʻi ʻeha puhi kū loa - 1.8 a 0%,
maiuka - 1.2 a 0%.

Hoʻohui hui me ka insulin

I loko o kahi hōʻike no 24 wiki he plebo ka hoʻomohala like i ka hoʻohana ʻana o 100 mg o ka sitagliptin i kēlā me kēia lā a me kahi mau neʻe o ka insulin (a i ʻole a me ka metformin), ʻike pinepine ʻia nā hopena ʻehā (me ka nui o ≥ 1%) i ka hui e loaʻa ana i kahi sitagliptin i hui pū me ka insulin (me ka ʻole a me ka metformin paha. ) ma mua o ka hui placebo me ka insulin (a i ʻole me ka metformin). ʻO ka ulu ʻana o nā hanana pōʻino i kēlā

headache - 1,2 / 0%,
ʻaiila - 1.2 / 0.3%,
hypoglycemia - 9.6 / 5.3%.

ʻO kekahi noiʻi 24-pule, kahi i hoʻohana ai ʻo sitagliptin i mea hana hou no ka ʻomo ʻana o ka insulin (me ka ʻole a me ke metformin paha), ʻaʻole i hōʻike i kahi ʻano ʻino pili i ka lawe ʻana i ka lāʻau lapaʻau.

ʻO ka pancreatitis

ʻO kahi loiloi maʻamau holoʻokoʻa o ka 19 ʻelua makapō, hoʻokolohua lāʻau lapaʻau manuahi o ka hoʻohana ʻana o sitagliptin i loko o kēlā me kēia lā he 100 mg a i ka lāʻau lapaʻau kūpono e pili ana (hoʻoikaika a placebo paha) i ʻike ʻia ka ulu ʻana o ka pancreatitis aʻae ʻole i hoʻopaʻa ʻia he 0.1 hihia no 100 mau makahiki maʻi o ka maʻi i kēlā me kēia hui.

ʻO nā hemahema nui o nā maʻi i nā hōʻailona koʻikoʻi a i ʻole electrocardiograms, me ka lōʻihi o ka manawa QTc, ʻaʻole i nānā ʻia me sitagliptin.

Ka Hōʻona Manaʻo ʻO Sitagliptin Cardiovascular Safety Review (TECOS)

Hoʻokomo ʻo TECOS i nā maʻi 7332 i loaʻa he 100 mg o ka sitagliptin i kēlā me kēia lā (a 50 mg i kēlā me kēia lā inā ʻike ʻia ka pae palena palapala glomerular he ≥ 30 a me 2), a me 7339 nā mea maʻi e loaʻa ana i ka placebo i ka nui o ka lehulehu o nā poʻe i hāʻawi ʻia. hānai

Hoʻokomo ʻia ka lāʻau lapaʻau a i ʻole placebo i ka hana maʻamau e like me nā kūlana kaulike i nā manawa no ke koho ʻana i ke kiʻekiʻe o ka HbA_1C a me ka kāohi o nā mea e pili ana i ka maʻi cardiovascular. Loaʻa ka nui o 2004 mau maʻi mai ka makahiki 75 o nā mea i ʻike ʻia, a he 970 i loaʻa iā sitagliptin, a he 1034 i loaʻa iā pletebo. ʻO ka loli nui o nā hopena koʻikoʻi i nā hui ʻelua i like. ʻO kahi loiloi o nā hoʻopiʻi e pili ana me ka maʻi mellitus, i hōʻike mua ʻia no ka nānā ʻana, hōʻike ʻia i ka hopena o ka hopena maikaʻi loa ma waena o nā hui i ka wā e lawe ai i ka sitagliptin / plasebo, me ka hana o ka renal impaired (1.4 / 1.5%) a me ka maʻi (18. 4 / 17,7%). ʻO ka ʻaoʻao hopena ka hopena i nā mea maʻi me 75 mau makahiki a ʻoi aku ka mea like me ka lehulehu.

ʻO ka nui o ka helu o ka episekole o ka hypoglycemia koʻikoʻi i ka heluna o nā mea maʻi i kuhikuhi ʻia "therapy-to-treat" therapy a ʻo ka mea i loaʻa i ka sulfonylurea a me / a me ke ʻano maʻi insulin i ka wā e lawe ai i ka sitagliptin / placebo he 2.7 / 2.5%, kēlā. Eia kekahi, i nā mea maʻi i lawe ʻole i ka sulfonylurea a me / a i ʻole ka hoʻomākaukau ʻana i ka insulin, ʻo kēia kaomi o ka 1 / 0.7%, kēlā. I ka wā o ka hoʻokolohua, ʻo ka loaʻa ʻana o nā hihia i hoʻopaʻa ʻia i ka pancreatitis i ka wā e lawe ai i ka lāʻau lapaʻau / plasebo he 0.3 / 0.2%, a me nā neoplasms malignant - 3.7 / 4%, kēlā me kēia.

Nā mea nānā mai ka hoʻopaʻa inoa ʻana

ʻO ka nānā kau ʻana i ka hoʻopaʻa inoa ʻana o ka hoʻohana ʻana i ka sitagliptin i monotherapy a / a i ʻole me ka hoʻohui pū me nā lāʻau hypoglycemic ʻē aʻe i hōʻike ʻia nā hopena ʻē aʻe. Ma muli o ka loaʻa ʻana o kēia mau ʻike mai ka heluna nui o ka helu i helu ʻole ʻia, ʻaʻole hiki ke hoʻokū ʻia ka lōʻihi a me ka pilina me ke ʻano o nā hanana.

E pili ana kēia:

angioedema,
hypersensitivity mauʻano, me ka anaphylaxis,
pruritus / hāpau, urticaria, pemphigoid, vasculitis ka ʻili, nā puʻuwai kulit exfoliative, pū me nā maʻi Stevens-Johnson,
ʻo ka pancreatitis waha, me nā ʻano hemorrhagic a me ke ʻano necrotic me / ʻaʻohe hopena o ka mea make,
hana aho ʻole paʻa, ʻo ia hoʻi me ka maikaʻi ʻole o ka renal (i kekahi mau hihia, ua koi ʻia ʻo ka dialysis)
nā maʻi ʻeha hanu kiʻekiʻe
nasopharyngitis,
pua nani, kahiki
lie kanikela
aripaka, myalgia,
ʻeha i nā lālā, hope.

ʻO nā loli makahiki

Ma ka nui o nā noiʻi hauoli, he liʻiliʻi iki ka nui o ka helu leukocyte i nā poʻe maʻi e loaʻa ana i kahi sitagliptin (100 mg i kēlā me kēia lā) hoʻohālikelike ʻia me ka hui plasebo (200 μl ma ka awelika, ma ka hoʻomaka ʻana o ka hōʻike ʻana i ka hōʻailona he 6600 μl), ma muli o ka hoʻonui ʻana o ka nui o nā neutrophils.

Ua ʻike iki ka hoʻonui iki ʻana o ka waikawa uric (ma ka 0.2 mg no 1 dl) me ka 100 a me 200 mg o ka sitagliptin i kēlā me kēia lā i hoʻohālikelike ʻia me ka placebo. Ma mua o ka hoʻomaka ʻana o ka hōʻola, ʻo ka nui awelika o ka 5-5.5 mg no 1 dL. ʻAʻole i hōʻike ʻia nā hihia o ka gout.

Aia hoʻi i loaʻa ka emi o ka phosphatase alkaline āpau i ka hui e loaʻa ana i ka lāʻau, ke hoʻohālikelike ʻia me ka hui plasebo (kokoke i ka 5 IU i ka 1 lita, ma ka awelika, ma mua o ka hoʻomaka ʻana o ka lapaʻau, ʻo ka ʻāʻī o 56 i ka 62 IU i ka 1 lita) ka mea i hui ʻia kaomi ʻana i ka hana o nā iwi me ka hoʻōla.

ʻAʻole mau manaʻo i nā loli i loko o nā ʻina ʻana o nā ʻoihana.

Hypoglycemia

Wahi a nā nānā kulekele, ʻo ka ulu ʻana o ka hypoglycemia i ka wā monotherapy me sitagliptin a i ʻole ka hoʻāʻo ʻana me ka lāʻau lapaʻau ʻaʻole e hoʻolilo i kēia ʻano pathological (pioglitazone, metformin) i like me kēlā me ka hui pletebo. E like me nā lāʻau lapaʻau hypoglycemic ʻē aʻe, i hele mai ka hypoglycemia i ka wā o ke alakaʻi ʻana o Xelevia i hui pū me nā derogative sulfonylurea a i ʻole insulin. No ka hōʻemi i ka hopena o ka hypoglycemia sulfon-induced, ua hōʻemi ʻia ka nui o ka derivative o ka sulfonylurea.

Therapy i nā mea maʻi maʻi

ʻO ka palekana a me ka hana pono o Xelevia ma nā hoʻokolohua lapaʻau i nā mea maʻi ma waena o nā mea maʻi (409 mau mea maʻi) ma luna o 65 mau makahiki he hoʻohālikelike ʻia i ka poʻe i hui pū ʻia ʻana ma lalo o ka 65 mau makahiki. Ma kēia mea, pono ke hoʻoponopono ʻana i ka hoʻoponopono ʻia dosage e pili ana i ka makahiki o ka mea maʻi. Pono e noʻonoʻo ʻia ka poʻe maʻi ma mua o ka hopena o ka pilikia ʻole. No laila, ma mua o ka hikiʻole o nā hana renal i kēia ʻoihana o kēia makahiki, e like me kekahi o nā ʻano ʻē aʻe, e hoʻoponopono ʻia ka nui o ka sitagliptin.

Ma ke aʻo ʻana o TECOS, loaʻa nā mea hana ma ka sitagliptin i kēlā me kēia lā he 100 mg (a i 50 mg i kēlā me kēia lā me ka ʻike mua o ka pōkole kānalua filtration helu ≥ 30 a me 2) a i kahi placebo. Ua hoʻohui ʻia lākou i ka hana maʻi maʻamau e like me nā kūlana kaulike o ka nūhou no ka hoʻoholo ʻana i nā pae HbA kikoʻī._1C a me ka kāohi o nā mea e pili ana i ka maʻi cardiovascular. I ka hopena o ka awelika haʻawina (3 mau makahiki) i nā mea maʻi me ka maʻi maʻi type 2, ke lawe ʻana i ka lāʻau lapaʻau i ka hoʻohui ʻana i ke ʻano maʻamau no ka hoʻonui ʻana o ka hoʻokipa ma muli o ka loaʻa ʻana o ka puʻuwai (a i ka hopena hoʻokaumaha - 1, 95% huakaʻi hilinaʻi - mai 0.83 a i 1,2, p = 0.98 no nā ʻokoʻa i ke alapine i ka hopena) a i ʻole ka hopena i nā hopena maikaʻi loa mai ka pūnaehana cardiovascular (ʻoi aku ka pilikia - 0.98, 95% interval hilinaʻi - mai 0.89 a 1.08, p CYP 2C8, CYP 2C9 a me CYP 3 A 4. E like me ka ʻike i vitro , ʻaʻole ia e pale i ka CYP 1A2, CYP 2B6, CYP 2C19 a me CYP 2 D 6 isoenzymes a ʻaʻole e hoʻoulu iā CYP 3 A 4 isoenzyme.

Me ka hoʻohana like ʻana o ka metformin me sitagliptin, he mau loli nui i ka lāʻau pharmacokinetic o ka lua i ʻike ʻia i nā mea maʻi me ka maʻi diabetes mellitus type 2.

ʻO ka ʻike i loaʻa mai kahi helu pharmacokinetic analisa o nā poʻe maʻi me ka maʻi diabetes type 2 i hōʻike ʻia ʻaʻole i loaʻa ka hopena koʻikoʻi o ka maʻi i ka pharmacokinetics o ka lāʻau. Ma kēia loiloi loiloi i nā lāʻau lapaʻau i hōʻike pinepine ʻia no ka maʻi type 2, e like me kēia:

β-blockers
lipid-hoʻemi haʻahaʻa (e like me ezetimibe, hoʻohālikelike, statins),
antidepressants (e like me sertraline, fluoxetine, bupropion),
nā hui antiplatelet (e.g. clopidogrel),
antihistamines (e.g. cetirizine),
nā lāʻau lapaʻau no ka mālama ʻana o ka holoʻokoʻa erectile (e. G. sildenafil),
ole-anti antiidal maʻi anti-inflammatory (e like me celecoxib, diclofenac, naproxen),
proton pump inhibitors (e like me lansoprazole, omeprazole),
nā lāʻau antihypertensive (e like me ka hydrochlorothiazide, nā lewa hāpana palupalu kalaka, angiotensin II mea i hoʻohālikelike ai i nā anagonists, ʻo ka angiotensin e hoʻohuli ai i nā inhibitor enzyme)

ʻO kahi hoʻonui liʻiliʻi i ka AUC a me C _m_ah digoxin (ma 11 a 18%, kekahi) i hoʻomaopopo pū me kona hoʻohana ʻana me ka sitagliptin. ʻAʻole i manaʻo ʻia kēia hoʻonui e nui koʻikoʻi. Me ka hui pū ʻana, ʻaʻole ʻōlelo ʻia nā loli lōkō.

He hoʻonui AUC a me C _m_ah Ua mālama ʻia ʻo Sitagliptin (29 a 68%, nika) i ka wā e hoʻohana ai iā ia ma ke ʻano he 100 mg o ka hui pū me ka wai pānaʻi hoʻokahi o cyclosporine (kahi mea hoʻomakeʻa pū o P-glycoprotein) no ka hoʻokō waha i ka maʻi ma kahi o 600 mg. ʻO nā mea i ʻike ʻia i loko o nā hiʻohiʻona pharmacokinetic o ka lāʻau ʻaʻole manaʻo i manaʻo nui he maʻi koʻikoʻi. Ke hoʻohana nei i kahi hui me ka cyclosporine a i ʻole kekahi P-glycoprotein inhibitor (no ka laʻana, ka ketoconazole), ʻaʻole pono ke hoʻololi i ka maʻi o Xelevia.

Wahi a ka loiloi pharmacokinetic o nā poʻe maʻi a me nā mea hana olakino olakino (N = 858) no ka nui o nā lāʻau lapaʻau concomitant (N = 83, aneane hapalua ia mau mea i hoʻoiho ʻia e nā keiki), ʻaʻole nā hopena koʻikoʻi nā maʻi i ka pharmacokinetics o sitagliptin.

ʻO nā inoa o Xelevia nā Yasitara, Sitagliptin phosphate monohydrate, Januvia.

Nā hōʻailona a me nā contraindications

Ke kuhikuhi nei no ka hoʻohana ʻana o "Xelevia" i:

ka hoʻemi ʻana o ka naʻau o ka maʻi maʻi i ka hypoglycemia ma lalo o ka mana o ka neuropathy a i ʻole nā pilikia olakino ʻē aʻe,
predisposition i popo o hypoglycemia i ka pō,
elemakule
ka pono no ka hoʻonui ʻana i ka makaʻeu ke kaomi ʻana a hana paha me nā mīkini paʻakikī.
Hoʻokomo pinepine i ka hypoglycemia aʻo ka lawe ʻana i ka sulfonylurea.

Ma mua o lawe ia, he mea nui loa ia e familiarize iā ʻoe iho me nā contraindications. E pili ana kēia:

hanau ana he keiki, lactation,
maʻi diabetes type 1
diabetes ketoacidosis, ma lalo o 18 makahiki,
renal hiki ʻole i ke ʻano ʻeha a paʻakikī paha.

Ma muli o ka nele o nā haʻawina hoʻokele e pili ana i ka pono a me ka palekana o ka lāʻau lapaʻau no nā wahine hāpai, ʻaʻole i ʻōlelo ʻia ʻo Xelevia no ka hoʻohana ʻana i ka wā hāpai. Eia nō naʻe, ʻo ka hiki ʻana o nā hana ʻā a me ka umauma umauma i hoʻopaʻa ʻia, no laila, me ka lactation, ua contraindicated.

ʻO ka dosis a me ka wīwī

ʻO ka paipai ʻia o ka lāʻau no 100 mg 1 mau lā i ka lā. Lawe ʻia ia ma ke ʻano he lāʻau nui a i ʻole me ka mea hoʻohui me ka metformin a i nā mea ola paha me nā ʻano mea ikaika ʻē aʻe. ʻO ka lawe ʻana i ka lāʻau lapaʻau, ʻaʻohe pili i ka meaʻai. ʻO ka hewa o "Xelevia" a me nā lāʻau lapaʻau hou, ua hoʻokumu ʻia ko lākou kūlike e ka neʻe ʻana i nā kauka e mālama ana i nā ʻōlelo manaʻo o ke aʻo.

Inā nalowale ʻoe i kahi paila, manaʻo ʻia e lawe koke ʻoe i ka manawa like a pau ke hoʻomanaʻo ʻana o ke kanaka iā ia. I hoʻokahi lā pāpā ʻia ʻo ia e lawe pālua ʻia i ka ʻelua o ka lāʻau.

Ma nā hoʻokolohua lapaʻau i loko o nā limahana olakino, ua hōʻemi ʻia ka lāʻau lapaʻau ma kahi kiʻekiʻe loa o 800 mg no ka maʻi maʻi. ʻAʻole ʻike nui nā loli liʻiliʻi. ʻAʻole i aʻo ʻia nā dosages ma luna o 800 mg. ʻO nā hopena ʻino loa inā lawe ʻia ka 400 mg o "Xelevia" no nā wiki he 4 ʻaʻole i ʻike ʻia.

Akā inā inā i loaʻa kahi overdose no kekahi kumu, ua maikaʻi ka mea maʻi, a laila pono ka hoʻonohonoho o kēlā mau hanana.

ka wehe ʻana i ka lāʻau paʻa ʻole mai ka gastrointestinal tract,
ka nānā ʻana o nā hōʻailona, ʻo ka mālama ʻana i ka hana o ka naʻau ma o ka ECG,
e hoʻokō nei i ka mālama mālama ʻia.

ʻO ka sitagliptin hāmeʻa ikaika e lei palau. ʻO 13.5% wale nō ka excreted i ka hola 4 o ka hana o ke kaʻina hana. Ua koho ʻia ʻo ia ma ke ʻano he hope loa.

ʻO ke ala nui e hoʻokaʻawale i kahi mea o ka lāʻau mai ke kino ma o ka excretion kidney. No nā mea maʻi me nā ala like ʻole o ka pūpū, ua hoʻonohonoho ʻia ka nui, akā inā ma nā hōʻailona o nā pilikia i loko o nā pūpū, ua hoʻemi ʻia ia:

hōʻeha paʻakikī a paʻakikī paha
papa hana o ka pilikia ʻole i ka kūleʻa ʻana.

Hoʻohālikelike

No ke ʻano o ke ʻano o ka lāʻau a me nā loiloi e pili ana i ia mea, hiki iā mākou ke manaʻo e kūpono a he hopena maikaʻi loa i ka mālama pono o nā maʻi. ʻO kahi lanakila kūpono ʻole ma ka aneane holoʻokoʻa loa i nā hopena o ke kino. ʻAno maoli, ʻaʻole e hiki i kahi kanaka ke koho i ka dosage, a ʻoi aku hoʻi ke hui pū me kahi lāʻau hou, me ka hōʻino ʻole ʻia i kona olakino. No ka hana i kēia, pono ʻoe e hoʻokaʻawale i ka endocrinologist, a mai lawe ʻole i ka lāʻau lapaʻau ponoʻī.

Ka hoʻonohonoho ʻana a me ke ʻano o ka hoʻokuʻu ʻana

Papa - 1 papa:

ʻO ka waiwai koʻikoʻi: sitagliptin phosphate monohydrate - 128.5 mg, e pili ana i nā kiko o ka sitagliptin - 100 mg,
Nā mea hoʻihoʻi: nā cellulose microcrystalline - 123.8 mg, kalepona kalima hydrogen phosphate - 123.8 mg, sodium croscarmellose - 8 mg, magnesium stearate - 4 mg, sodium stearyl fumarate - 12 mg,
ka hui sheath: opadry II beige, 85F17438 - 16 mg (polyvinyl alkohol - 40%, titanium dioxide (E171) - 21.56%, macrogol 3350 (polyethylene glycol) - 20.2%, talc - 14.8%, kaio hao kaila (E172) - 3.07% , ka ʻioʻula hāleʻa (E172) - 0.37%).

14 ʻōpō. - nā kāmele (2) - nā kīʻaha o ke kāleka.

ʻO nā papa, i hoʻohui ʻia me ka pūpū kiʻi beige, ua puni, biconvex, me ka kahakaha "277" ma kekahi ʻaoʻao a alualu i ka ʻaoʻao.

ʻO ka lāʻau lapaʻau Xelevia (sitagliptin) he hana maʻa mau loa, he koho paʻa loa o ka enzyme dipeptidyl peptidase-4 (DPP-4), i manaʻo ʻia no ka mālamaʻana i ka mellitus type type 2. Lā ʻo Sitagliptin ʻokoʻa i ka hana kemika a me nā hana farmacological mai nā analogues o ke kīmona-like peptide-1 (GLP-1), insulin, derivatives sulfonylurea, biguanides, agonists receptor gamma i hoʻāla ʻia e peroxisome proliferator (PPAR-γ), alpha-glucosidase inhibitors, mau amylin analogues. Ma ka hoʻokaʻawale ʻana i DPP-4, hoʻonui ka sitagliptin i ka hoʻoneʻe ʻana o ʻelua mau huaʻai o ka ʻohana incretin: GLP-1 a me ka glucose-e hilinaʻi i ka insulinotropic polypeptide (HIP). Hoʻokomo ʻia nā haʻalulu o ka ʻohana pakanui i loko o ka ʻōpū i ka lā, ua hoʻonui ʻia ko lākou hoʻouka ʻana i ka pane ʻana i ka ʻai ʻana o ka meaʻai. ʻO ka incretins he ʻāpana o ka pūnaehana physiological kūloko no ka hoʻoponopono o ka homeostasis glucose. I ka hoʻonaninani ʻana i ka hoʻoliʻiliʻi o ka hoʻonaninani koko a hoʻonaninani paha, ua kōkua nā ʻano o ka ʻohana incretin i ka hoʻonui ʻana i ka synthesis o ka insulin, a me kona nūhi ʻia ʻana e nā cell beta pancreatic ma muli o ka hōʻailona ʻana i ka hana intracellular e pili ana me ka cyclic adenosine monophosphate (AMP).

Kōkua hoʻi ka GLP-1 i ka hoʻopiʻi ʻana i ka hoʻonui ʻia ʻana o ka mea huna o ka glucagon e nā cell alpha pancreatic. ʻO ka emi ʻana o ke kaʻe o ka glucoseagon e kū'ē i ka wā e hoʻonui ai i ka hoʻemi ʻana i ka insulin e kōkua i ka hoʻohaʻahaʻa ʻana i ka hana glucose e ka ʻāʻohi, kahi e hiki ai ke kahaki i ka glycemia. ʻOkoʻa kahi ʻano hana o kēlā me kēia hana o ka hana o ka derony o ka sulfonylurea, ka mea e hoʻoulu ai i ka hoʻokuʻu ʻana i ka insulin a hiki i ka haʻahaʻa ʻana o ka glucose i loko o ke koko, i mea hoʻopiʻi ʻia me ka hoʻomohala i nā hypoglycemia sulfone ʻaʻole wale nō i nā mea maʻi me ka diabetes mellitus type 2, akā pū nō hoʻi i nā mea olakino.

Ma ka hoʻohaʻahaʻa haʻahaʻa o ka glucose i ke koko, ʻaʻole ʻike ʻia nā hopena o ka nui o nā huaole i ka hoʻokuʻu ʻia ʻana o ka insulin a me kahi hoʻohaʻahaʻa i ka huna ʻana o nā ʻaihue glucagon. ʻAʻole pā ʻo GLP-1 a me HIP i ka hoʻokuʻu ʻana o glucagon i ke pane ʻana i ka hypoglycemia. Ma lalo o nā kūlana physiological, ka palena o ka hana o ka incretins e kaupalena ʻia e ka DPP-4 ene, kahi wikiwiki e hoʻoulu hou ana i nā incretins me ka hoʻokumu ʻana o nā huahana ikaika.

Mālama ʻo Sitagliptin i ka hydrolysis o incretins e ka enzyme DPP-4, me laila e hoʻonui ai i nā kaila o ka plasma o nā hana ikaika o GLP-1 a me HIP. Ma ka hoʻonui ʻana i ka pānoke o ka incretins, e hoʻonui ai ka sitagliptin i ka hoʻokuʻu ʻana i ka glucose o ka glucose a kōkua i ka hoʻēmi ʻana i ka hana huna o glucagon. I ka poʻe maʻi me ka diabetes mellitus type 2 me ka hyperglycemia, ua loli kēia mau hoʻololi i ka huna ʻana o ka insulin a me ka glucagon i ka emi ʻana o ka ʻike o glycosylated hemoglobin HbA1C a me ka hoʻohaʻahaʻa ʻana i ka kukuna plasma o glucose, i hoʻoholo ʻia ma ka ʻōpū ʻole a ma hope o ka hoʻāʻo ʻana.

I ka poʻe maʻi me ka maʻi diabetes mellitus type 2, e lawe ana i hoʻokahi maʻa o Xelevia i ka pale ʻana i ka hana o ka enzyme DPP-4 no 24 mau hola, ke alakaʻi nei i ka hoʻonui ʻana o ka pīpī i hoʻohui ʻia o GLP-1 a me HIP e ke kumu o ka 2-3, he hoʻonui i ka kukū plasma o ka insulin a me C ʻO ka peptide, kahi e hoʻemi ai i ka hoʻāʻo o ka glucagon i loko o ke kaila koko, kahi i hoʻohaʻahaʻa i ka glucose wikiwiki, a me ka hōʻemi ʻana i ka glycemia ma hope o ka ukana o ka glucose a i ʻole ka lawe ʻana i ka meaʻai.

Ua hōʻike piha ʻia ka pharmacokinetics o sitagliptin i nā poʻe olakino olakino a me nā mea maʻi me ka maʻi diabetes type 2. I nā poʻe olakino olakino, ma hope o ka lawelawe waha ʻana o 100 mg o sitagliptin, mālama koke ʻia ka lāʻau i ka minamina loa (Cmax) i ka pae mai 1 a 4 mau hola mai ka manawa o ka hoʻokele. ʻO ka mahele ma lalo o ka pihi pākeke paʻa mau manawa (AUC) hoʻonui i ka hapa like i ka nui a me nā kumumanaʻo he 8.52 μmol / L * hola i ka wā e lawe ai i ka 100 mg a ka waha, Cmax he 950 nmol / L. Ua hoʻonui ʻia ka plasma AUC o ka sitagliptin e pili ana i ka 14% ma hope o ka hopena hou o 100 mg o ka lāʻau lapaʻau e hoʻokō i kahi kāʻei kūpeʻe ma hope o ka lawe ʻana i ka hopena mua. The intra- and intersubject varie coefficient of sitagliptin AUC i palewa.

ʻO ka bioavailability pololei o sitagliptin ma kahi o 87%. No ka loaʻa ʻana o ka ʻai me ka sitagliptin a me nā meaʻai momona, ʻaʻohe hopena o ka pharmacokinetics, hiki ke kuhikuhi ʻia ka lāʻau lapaʻau Xelevia ma kahi o ka ʻai.

ʻO ka nui o ka laha ʻana i ka hoʻohālikelike ma hope o hoʻokahi pā manawa o 100 mg o ka sitagliptin i loko o nā limahana olakino e like me 198 l. ʻO ka haʻahaʻa sitagliptin e hoʻopili ai i nā protein plasma he haʻahaʻa loa i ka 38%.

Ma kahi o 79% o sitagliptin e hoʻopiʻi ʻia e nā ʻōpū. Hoʻokomo wale nā mea liʻiliʻi o ka lāʻau i loaʻa i ke kino.

Ma hope o ka hoʻomoe ʻana o kahi sitagliptin hōʻailona 14C i loko, ma kahi o 16% o ka sitagliptin radioaktif a hoʻāliʻi ʻia e like me nā metabolites. Loaʻa nā maile o 6 mau metabolites o sitagliptin, ʻaʻole paha i loaʻa i ka hana inhibitory DPP-4. Ua hōʻike ʻia nā haʻawina vitro i nā isoenzymes mua i komo i ka metabolism palena o ka sitagliptin he CYP3A4 a me CYP2C8.

Ma hope o ka hoʻomōhala ʻana o ka sitagliptin 14C-inoa i loko o nā mea ʻalohiona olakino, ma kahi o 100% o ka sitagliptin i lawelawe ʻia e hoʻopau ʻia: 13% ma loko o nā ʻōpū, 87% e nā pēpē i loko o hoʻokahi pule ma hope o ka lawe ʻana i ka lāʻau. ʻO ka hoʻopau ʻana o ka hapalua o ka noho ʻana o ka sitagliptin ma o ke kaona waha o 100 mg ka mea ma kahi o 12,4 hola; ʻo ka hoʻomaʻemaʻe kino paha ma kahi o 330 ml / min.

Lawe ʻia ka ʻeka o ka sitagliptin ma o ke aʻoki ʻana e nā ʻōpū ma o ke kumu o ka hana ʻana o ka puna tubular. ʻO Sitagliptin kahi papahele no ka transporter o nā anions kanaka kūlohelohe o ke kolu o ke ʻano (hOAT-3), kahi i komo ʻia ma ka ʻā o ka sitagliptin e nā keiki. Huli, ʻo ke komo ʻana o ka hOAT-3 i ka lawe ʻana i sitagliptin ʻaʻole i aʻo ʻia. ʻO Sitagliptin kahi substrate o ka p-glycoprotein, hiki ke komo pū me ka excretion o sitagliptin e nā keiki. Eia naʻe, ʻo cyclosporin, kahi mea pale i ka p-glycoprotein, ʻaʻole i hōʻemi i ka hoʻomaʻemaʻe o ka hana a ka sitagliptin.

Pharmacokinetics i loko o nā hui hoʻomanawanui pilikino:

ʻO nā mea maʻi me ka pani ʻole ʻana:

Ua wehe ʻia kahi noi noi o sitagliptin ma kahi o 50 mg o kēlā me kēia lā e aʻo ai i kāna pharmacokinetics i nā mea maʻi me nā ʻano like ʻole o ka hopena o ka hopena o ka renal ʻole. ʻO nā mea maʻi i komo i ka noiʻi ua māhele ʻia i nā pūʻulu o nā mea maʻi me ka hina ʻole ʻoi (ʻo ka hana ʻana mai i hana ʻia mai ka 50 a 80 ml / min), me ke ʻano (clearanine clearance mai 30 a 50 ml / min) a me ka maikaʻi o ke kūleʻa renal maikaʻi ʻole (hana i hana ma lalo o 30 ml / min) , pū me ke ʻaneʻanaka me ke kaha o ke kūleʻa o ka pilikia e koi ai i ka dialysis.

I ka poʻe maʻi me ka hiki ʻole o ka pale renal, ʻaʻohe i ka nui o ka loli i ka nui o ka pilina o ka sitagliptin i hoʻohālikelike ʻia me ka hui o nā mea hana ola olakino.

Ka nui o ka hoʻonui ʻana ma ka sitagliptin AUC i hoʻohālikelike ʻia me ka hui mana i ʻike ʻia i nā poʻe maʻi me ka hōʻoki ʻole ʻia o ka pilikia, ma kahi kokoke i ʻehā mau makahiki i ʻike ʻia i ka poʻe maʻi me ka hōʻeha o ka papaleka, a me ka poʻe maʻi me ka pau ʻole o ka hanaliki o ke kuʻuna o ka hana ʻole i hoʻohālikelike ʻia me ka hui o ka hui. Ua huke iki ʻia ʻo Sitagliptin e ka hemodialysis: ʻo 13.5% wale nō ka paʻu i hoʻoneʻe ʻia mai ke kino i ka wā o ka hālāwai dialysis 3-4 hola.

Pēlā, i mea e hoʻokō ai i kahi konsultant therapeutic o sitagliptin i loko o ke koko koko (e like me ia i nā mea maʻi me ka hana maʻamau maʻamau) i nā mea maʻi me ke hōʻemi a maikaʻi ʻole o ka pale ʻana, pono ke hoʻoponopono ʻia.

ʻO nā maʻi me ka palaualohiʻi:

I nā mea maʻi me ka maʻi hepatic haʻahaʻa (7-9 mau poina ma ka pēpē Child-Pugh), ʻo ka awelika ʻo AUC a me Cmax o sitagliptin me kahi pākahi o ka 100 mg hoʻonui e ka nui ma kahi o 21% a 13%, alahi. No laila, ʻaʻole pono ka hoʻoponopono ʻana o ka maʻi hoʻoneʻe no ka maʻi maʻalahi i ka pehu.

ʻAʻohe data lapaʻau e pili ana i ka hoʻohana ʻana o sitagliptin i nā mea maʻi me ka maʻi hepatic koʻikoʻi (ʻoi aku ma mua o 9 mau hola ma ka ʻōpiopio o nā keiki-Pugh). Eia nō naʻe, ma muli o ka sitagliptin e hoʻopili maoli ʻia e nā ʻōpū, ʻaʻole pono e manaʻo kekahi i kahi hoʻololi nui o ka pharmacokinetics o sitagliptin i nā mea maʻi me ka maʻi hepatic koʻikoʻi.

ʻAʻole i loaʻa i nā makahiki o nā mea maʻi ka hopena koʻikoʻi i ka parola o ka pharmacokinetic o sitagliptin. Hoʻohālikelike me nā mea maʻi ʻōpio, ʻo nā maʻi maʻi maʻi (65-80 mau makahiki) he sitagliptin kaʻo ʻana o ka nui o 19% kiʻekiʻe. ʻAʻole koi ke hoʻoponopono ʻana ma muli o ka makahiki.

ʻO ka lāʻau lapaʻau hypoglycemic oral.

Loaʻa nā ʻaoʻao ma Xelevia

Ua hoʻopaʻa ʻoluʻolu maikaʻi ʻia ka Sitagliptin i ka monotherapy a me ka hoʻohui pū me nā lāʻau lapaʻau hypoglycemic ʻē aʻe. I nā hoʻokolohua lāʻau lapaʻau, ʻo ka nui o ka loaʻa ʻana o nā hanana hōʻino, a me ke kaila o ka hōʻa ʻia ʻana o ka lāʻau ma muli o nā hanana ʻino, like ka poʻe me ka placebo.

Wahi a 4 mau haʻawina ʻonaʻelima ka hoʻomehana (mau ka 18-24 mau pule) o ka sitagliptin i kēlā me kēia lā he 100-200 mg e like me ka mono- a i hui pū ʻia ai me metformin a pioglitazone paha, ʻaʻohe ʻano hopena pili i pili i ka lāʻau lapaʻau e nānā ana, ʻo ka ʻoi aku ka nui o ka 1% i ka hui ahonui. lawe ʻia sitagliptin. Ua hoʻohālikelike ka ka palekana palekana o kēlā me kēia lā he 200 mg i ka lōlū palekana ma kahi maʻi o kēlā me kēia lā o 100 mg.

ʻO ka hōʻike ʻana o nā ʻikepili i loaʻa i ka wā o ka hōʻike ma luna o nā hōʻike maʻi i hōʻike ʻia, ʻo ka nui o ka ulu o ka hypoglycemia i nā poʻe maʻi e lawe ana i ka sitagliptin e like me ka placebo (sitagliptin 100 mg-1.2%, sitagliptin 200 mg-0.9%, placebo - 0,9%). ʻO ke alapine o nā hanana ʻino i nānā ʻia i ka wā e lawe ai i ka sitagliptin ma nā iniha ʻelua like me ke ʻano o ka placebo (koe wale nō ke ʻano o ka manawa pinepine o ka pualikoa e lawe ana i ka sitagliptin ma kahi o ka 200 mg o kēlā me kēia lā): ka ʻeha o ka ʻōpū (sitagliptin 100 mg - 2 , 3%, sitagliptin 200 mg - 1,3%, plasebo - 2,1%), keue (1,4%, 2,9%, 0.6%), huʻi (0.8%, 0.7% , 0,9%) nā huaʻeha (diarrhea, 3.0%, 2.6%, 2,3%).

I nā haʻawina a pau, ʻaʻole i koi ʻia nā hopena ʻino loa i ke ʻano o ka hypoglycemia ma ke kumu o nā hōʻike a pau i hōʻike ʻia i nā hōʻailona o ka hypoglycemia, ʻaʻole i koi ʻia ka hoʻonaninani kūlohelohe o ka glucose koko.

Hoʻomaka ka hui pū ʻana me metformin:

I loko o kahi he 24 he pule, aʻo ka papa hana plasebo control control o ka hui pū ʻana me ka sitagliptin i loko o kēlā me kēia lā o 100 mg a metformin i loko o kēlā me kēia lā o 1000 mg a 2000 mg (sitagliptin 50 mg + metformin 500 mg a i ʻole 1000 mg x 2 mau manawa i ka lā) i loko o ka hui hui hui. Hoʻohālikelike ʻia me ka hui monotherapy metformin, ua ʻike ʻia nā hanana ʻino e hiki mai ana:

Nā hopena pili hewa e pili ana i ka lawe ʻana i ka lāʻau lapaʻau i nānā ʻia me ka pinepine o & gt1% i loko o ka pūʻulu mālama sitagliptin a ʻoi aku ka pinepine ma ka hui ʻoihana metformin ma monotherapy: ʻeha (sitagliptin + metformin - 3,5%, metformin - 3.3%), dyspepsia (1, 3%, 1.1%), kuini (1.3%, 1.1%), flatulence (1.3%, 0,5%), hypoglycemia (1.1%, 0.5%), huʻi (1.1%, 0.3%).

Hoʻohui a me nā derivatives o ka olonylurea a i ʻole ka derpona sulfonylurea a me ka metformin:

I loko o kahi hōʻike 24-wiki plebo control o ka hui hui ʻana me ka sitagliptin (i kēlā me kēia lā o 100 mg) a me glimepiride a glimepiride a metformin, ʻike ʻia nā hanana ʻino e pili ana i ka hui o ka lāʻau noiʻi hoʻohālikelike i ka hui o nā mea maʻi e lawe ana i ka placebo a me ka glimepiride a me ka glimepiride a me ka metformin:

ʻO nā hopena ʻino e pili ana me ka lawe ʻana i ka lāʻau lapaʻau i nānā ʻia me ka pinepine o & gt1% i ka hui lapaʻau me ka sitagliptin a ʻoi aku ka pinepine i loko o ka hui hoʻohui me ka pletebo: hypoglycemia (sitagliptin - 9,5%, pletebo - 0.9%).

Hoʻohui hui mua me PPAR-γ agonists:

I loko o kahi hōʻike 24 wiki o ka hoʻomaka ʻana i ka hoʻoulu ʻia me ka sitagliptin i loko o kēlā me kēia lā o 100 mg a me ka pioglitazone i loko o kēlā me kēia lā he 30 mg, ua ʻike ʻia nā hanana ʻino e like me ka hui ʻoi ʻana me ka monogloplo pioglitazone:

ʻO nā hopena ʻino e pili ana me ka lawe ʻana i ka lāʻau lapaʻau i nānā ʻia me ka pinepine o & gt1% i ka hui o ka sitagliptin lapaʻau a ʻoi aku ka pinepine ma ka hui ʻoi ʻana o ka pioglitazone ma ka monotherapy: ka hoʻoliʻelima asymptomatic i ka hoʻoliʻi glucose o ke koko (sitagliptin + pioglitazone - 1.1%, pioglitazone - 0.0%) hōʻailona hypoglycemia (0.4%, 0.8%).

E hui pū me nā agarist o PPAR-y a me ka metformin:

Wahi a kahi haʻawina hoʻokele plasebo i ka mālama ʻana i ka sitagliptin (i kēlā me kēia lā o 100 mg) e hui pū me ka rosiglitazone a me ka metformin i ke ʻano lāʻau lapaʻau lāʻau, ʻike ʻia nā hanana ʻino e pili ana i ka hoʻohālikelike ʻana me ka hui o nā poʻe maʻi e lawe ana i ka placebo srosiglitazone a me ka metformin:

I ka wiki 18 o ka nānā ʻana:

ʻO nā hopena ʻino e pili ana me ka lawe ʻana i ka lāʻau lapaʻau i nānā ʻia me ka pinepine o & gt1% i ka hui lapaʻau me ka sitagliptin a ʻoi aku ka pinepine ma loko o ka hui hoʻohui me ka plasebo: ʻeha (sitagliptin - 2.4%, pletebo - 0,0%), huehue (1.8 %, 1.1%), keue (1,2%, 1.1%), hypoglycemia (1,2%, 0,0%), huʻu (1.2%, 0,0%).

I nā wiki he 54 o ka nānā ʻana:

ʻO nā hopena ʻino e pili ana me ka lawe ʻana i ka lāʻau lapaʻau i nānā ʻia me ka pinepine o & gt1% i ka hui lapaʻau me ka sitagliptin a ʻoi aku ka pinepine ma loko o ka hui hoʻohui me ka plasebo: ʻeha (sitagliptin - 2.4%, pletebo - 0.0%), hypoglycemia (2.4 %, 0,0%), nā maʻi hōʻeha hanu kiʻekiʻe (1,8%, 0,0%), hōʻeha (1,2%, 1.1%), huhū (1,2%, 0,0%), maʻi maʻi o ka ʻili (1,2%, 0,0%), peremaʻi peripheral (1.2%, 0,0%), huʻu (1,2%, 0,0%).

Hoʻohui me ka insulin:

I loko o kahi hōʻike 24-wiki plebo control control o ka hui pū ʻana me ka sitagliptin (i kahi lā i kēlā me kēia lā he 100 mg) a me ka pā mau ʻana o ka insulin (me a i ʻole metformin) i ka pūʻulu lāʻau lapaʻau ʻano hoʻohālikelike ʻia me ka hui o nā mea maʻi e lawe ana i ka placebo a me ka insulin (me ka ʻole o ka metformin). e pili ana i nā hanana ʻino:

Hōʻalo ʻia ka hopena me ka lawe ʻana i ka lāʻau lapaʻau i ʻike ʻia me ka pinepine o & gt1% i ka hui hoʻōla sitagliptin a ʻoi aku ka nui o ka hui ʻo ka insulin lapaʻau (me a i ʻole metformin): hypoglycemia (sitagliptin + insulin (me a i ʻole metformin) - 9,6%, placebo + insulin (me ka ʻole o ka metformin) - 5.3%), maʻi (1,2%, 0.3%), hōʻeha (1.2%, 0,0%).

Ma kahi haʻawina hou he 24 mau wiki, kahi i loaʻa ai i nā mea maʻi ka sitagliptin i hui hou no ka ʻomo ʻana o ka insulin (me a ʻole i loaʻa ka metformin), ʻaʻohe hopena ʻino e pili ana i ka lawe ʻana i ka lāʻau me ka maʻamau o & gt1% i ka hui lapaʻau o sitagliptin (ma kahi o 100 mg mg ), a he oi aku ma mua o ka pūʻulu plasebo.

Ma ka loiloi laulā o ka 19 ʻelua nā mana lāʻau lapaʻau manuahi no ka hoʻohana ʻana o sitagliptin i loko o kēlā me kēia lā o 100 mg a i ʻole ka hopena e pili ana i ka lāʻau lapaʻau (ikaika a placebo paha), i ka hōʻeha ʻana o ka maʻi pancreatitis kūmole ʻo 0.1 ka hapa i kēlā me kēia 100 mau makahiki maʻi o ka mālama ʻana i kēlā me kēia hui.

ʻAʻole i ʻike hewa ʻia nā maʻi koʻikoʻi i nā hōʻailona koʻikoʻi a i ʻole ECG (me ka lōʻihi o ke ana o ka QTc interval) i nānā ʻia ma ka wā o ka mālama ʻana me sitagliptin.

ʻO Sitagliptin Cardiovascular Safety Assessment Study (TECOS):

ʻO ka noiʻi ʻana i ka palekana cardiovascular safety o sitagliptin (TECOS) i hoʻopili i ka poʻe maʻi 7332 i lawe i ka sitagliptin 100 mg i kēlā me kēia lā (a 50 mg i kēlā me kēia lā inā he baslation e pili ana ka pae filtration pae (eGFR) e & gt30 a me lt50 ml / min / 1. 73 m), a me nā maʻi 7339 e lawe nei i ka placebo i ka lehulehu nui o nā mea maʻi i kuhikuhi i ka mālama ʻia. Hoʻohui ʻia ka lāʻau aʻo (sitagliptin a i placebo paha) i ke ʻano maʻamau e like me nā kūlana kūloko o ke aupuni no ka koho ʻana i ke kiʻekiʻe o ka pae o ka HbA1C a me ka kaohi o nā mea palena pilikia cardiovascular. Ua loaʻa i ka noiʻi ka nui o nā maʻi 2004 ma ka makahiki 75 a keu aku (970 ua lawe i sitagliptin a he 1034 i lawe i kahi placebo). ʻO ka nui nui o nā hanana kūʻē koʻikoʻi i nā mea maʻi e lawe ana i ka sitagliptin i like me ka nui o nā mea maʻi e lawe ana i ka placebo. ʻO ka loiloi o nā hoʻopiʻi mua i ʻike ʻia me ka maʻi maʻi i hōʻike ʻia kahi hoʻohālikelike o nā hanana ʻino ma waena o nā hui, ʻo ka maʻi (18,4% i nā mea maʻi e lawe ana i kahi sitagliptin a me 17,7% i nā mea maʻi e lawe nei i ka plasebo) a me ka hana ʻole o ka renal functioning ( ʻO 1.4% i nā mea maʻi e lawe ana i ka sitagliptin a me 1,5% i nā maʻi e lawe ana i ka placebo). ʻO ke kōmike o nā hanana ʻino i ka poʻe maʻi me 75 mau makahiki a ʻoi aku ka mea like like no ia no ka lehulehu.

I ka heluna o nā poʻe maʻi i kuhikuhi i ka mālama ʻia ("manao-e mālama ʻia"), i waena o ka poʻe i loaʻa i mua ke hoʻoponopono i ka insulin a me / a i ʻole sulfonylureas, he mea nui ka hypoglycemia koʻikoʻi he 2.7% i nā mea maʻi e lawe ana i ka sitagliptin, a me 2. 5% i nā mea maʻi e lawe ana i ka placebo. Ma waena o nā mea maʻi i loaʻa ʻole i ka insulin a me / a i ʻole ka sulfonylurea, ʻo ka hihia o ka hypoglycemia koʻikoʻi he 1.0% i nā mea maʻi e lawe ana i ka sitagliptin a me 0.7% i nā mea maʻi e lawe nei i ka placebo. ʻO ka pohō o nā hihia pancreatitis-hōʻoia ʻia ʻo 0.3% i nā mea maʻi e lawe ana i ka sitagliptin a me 0.2% i nā mea maʻi e lawe nei i ka placebo. ʻO ka pohā o nā hihia i hoʻopaʻa ʻia i ke kanulau na neoplasms malignant he 3.7% i nā mea maʻi e lawe ana i ka sitagliptin a me 4.0% i nā mea maʻi e lawe nei i ka placebo.

I ka wā o ka nānā ʻana i ka hoʻopaʻa inoa ʻana o ka hoʻohana ʻana i ka sitagliptin i loko o ka monotherapy a / a i ʻole hui pū ʻana me nā ʻaina hypoglycemic ʻē aʻe, ua ʻike ʻia nā hanana keu ʻē aʻe. Mai ka loaʻa ʻana o kēia mau ʻike mai ka lehulehu ka nui o ka nui o ka nui, ʻaʻole hiki ke hoʻoholo ʻia ka pinepine a me nā kumu kumu me ka mālama ʻana i kēia mau hanana ʻino. E pili ana kēia:

ʻO ka hopena o ka maʻi o ka hypersensitivity, me ka anaphylaxis, angioedema, rash, urticaria, vasculitis maʻa, nā maʻi ʻili exfoliative, me ka maʻi o ka maʻi Stevens-Johnson, ka pancreatitis nui, e komo pū ana me ka hemorrhagic a me ka necrotic me kahi hopena momona a me ka lethal o ka hopena, hana ʻole ʻia i ʻole, a me ke ʻano o ka māla pono ka nele (dialysis i kekahi manawa), nā ʻōpū hanu o luna loa, nasopharyngitis, constipation, holo a me ke poʻo, ʻeha, arthralgia, myalgia, ʻeha ʻeha, ʻeha hope, ʻeha, pemphigoid.

ʻO nā hoʻololi i loko o nā hōʻailona ʻōkuhi:

Hoʻohālikelike i ke alaula o nā ʻenekekeko ʻōmālua i nā pūʻulu lapaʻau o sitagliptin (i kahi la i kēlā me kēia lā o 100 mg) ka hoʻohālikelike ʻia me ka pinepine o nā pūʻulu plasebo. Ma ka hapa nui, akā ʻaʻole i nā hoʻokolohua āpau, he liʻiliʻi iki ka nui o ka helu leukocyte (ma kahi o 200 / μl i hoʻohālikelike ʻia me ka placebo, ʻo ka ʻike maʻamau ma ka hoʻomaka ʻana o ka mālama maʻi ʻo 6600 / μl), ma muli o ka hoʻonui ʻana o ka nui o nā neutrophils.

ʻO ka loiloi o ka hōʻike hōʻike lāʻau lapaʻau i ka lāʻau e hōʻike nei i ka liʻiliʻi o ka piʻi ʻana o ka waikū uric (ma kahi o 0.2 mg / dl hoʻohālikelike ʻia i ka placebo, ʻo ka makeʻe o ka paʻila ma mua o 5-5.5 mg / dl) i nā mea maʻi e loaʻa ana ka sitagliptin ma kahi o ka 100 a me 200 mg mg lā. ʻAʻohe hihia i ka hoʻomohala pū. Aia ka emi iki o ka hoʻoliʻina ʻana o ka momona alkatine e pili ana i ka hapalua (ma kahi o 5 IU / L i hoʻohālikelike ʻia me ka placebo, ʻo ka ʻolololi ka mea ma mua o ka hoʻōla ʻana ma ka 56-62 IU / L), ka mea i hoʻopili ʻia me ka hoʻokaʻawale iki ʻana i ka hapa iwi o ka alkatine phosphatase.

ʻAʻole i manaʻo ʻia nā loli i loko o nā ʻāpana kaulike.

Ma nā haʻawina e pili ana i ka hoʻopili ʻana me nā lāʻau lapaʻau ʻē aʻe, ʻaʻole i loaʻa i kahi koʻikoʻi nui ka sitagliptin i ka pharmacokinetics o nā lāʻau lapaʻau penei: metformin, rosiglitazone, glibenclamide, simvastatin, warfarin, contraceptives waha. Hoʻokumu ʻia ma kēia mau ʻike, ʻaʻole ka pale ʻo sitagliptin i ka CYP3A4, 2C8, a i ʻole 2C9 isoenzymes. Hoʻokumu ʻia i ka ʻike vitro, ʻaʻole hoʻi i ka sitagliptin ka mea e pale ai i ka CYP2D6, 1A2, 2C19 a me 2B6 isoenzymes a ʻaʻole i hoʻonāukiuki i ka isoenzyme CYP3A4. ʻO ka hana hoʻomohala hou ʻana o ka metformin i hui pū me ka sitagliptin ʻaʻole i hoʻopilikia nui ʻo ka nui o ka parekela pharmacokinetic o sitagliptin i nā mea maʻi me ka diabetes mellitus type 2.

Wahi a ka loiloi pharmacokinetic o ka poʻe maʻi me ka diabetes type type 2 mellitus, ʻaʻole i loaʻa i ka hopena koʻikoʻi nā maʻi i ka pharmacokinetics o sitagliptin. Ka loiloi i ka noiʻi ʻana i kekahi mau o nā lāʻau lapaʻau maʻamau i hoʻohana pinepine ʻia e nā mea maʻi me ka diabetes mellitus type 2, e hui pū ana me: nā lipid-kaila haʻalulu (statins, fibrates, ezetimibe), nā ʻoniʻoni antiplatelet (clopidogrel), nā lāʻau antihypertensive (ACE inhibitors, angiotensin II receptor antagonists, beta-blockers, blockers "Lōlō" kīwaha kalepa, hydrochlorothiazide), nā lāʻau lapaʻau anti-inflammatory (naproxen, diclofenac, celecoxib), antidepressants (bupropion, fluoxetine, sertraline), antihistamines (cetiri zine), nā mea hoʻomakeke proton (omeprazole, lansoprazole) a me nā mea kanu no ka mālama ʻana i ka ʻeha erectile (sildenafil).

Aia i ke hoʻonui liʻiliʻi o AUC (11%), a me ka awelika Cmax (18%) o ka digoxin i hui pū ʻia me sitagliptin. ʻAʻole i manaʻo ʻia kēia hoʻonui e nui koʻikoʻi. ʻAʻole ia e kuhikuhi i ka hoʻololi ʻana i ka wai o ka digoxin a i ʻole sitagliptin i ka wā i hoʻohana pū ʻia ai.

ʻO ka hoʻonui ʻana o ka AUC a me Cmax o sitagliptin i ʻike ʻia e 29% a me 68%, pākahi, i nā mea maʻi me ka hoʻohana pū ʻana i kahi pā o hoʻokahi waha o 100 mg o sitagliptin a me kahi pākahi waha he 600 mg o cyclosporin, kahi paʻa o ka p-glycoprotein. ʻO nā loli i ʻike ʻia i nā hiʻohiʻona pharmacokinetic o sitagliptin ʻaʻole i manaʻo nui ʻia he koʻikoʻi koʻikoʻi. ʻAʻole ke kāhea ʻia ka hoʻololi ʻana i ka maʻi o Xelevia i ka wā i hui pū ʻia ai me ka cyclosporine a me nā p-glycoprotein inhibitors (e.g. ketoconazole).

Kahi ʻano lapaʻau e pili ana i ka maʻi ma waena o nā poʻe maʻi a me nā mea hana olakino olakino (N = 858) no ka nui o ka lāʻau lapaʻau concomitant (N = 83, ma kahi o ka hapalua o ia mau mea e ka poʻe maʻi) ʻaʻole i hōʻike i nā hopena koʻikoʻi o nā maʻi o kēia mau mea ma ka pharmacokinetics o sitagliptin.

Xelevia dosage

ʻO Xelevia i ʻōlelo ʻia ʻia ʻo 100 mg hoʻokahi mau lā i kēlā me kēia lā e like me ka monotherapy, a i ʻole me ka hui ʻana me nā metformin, a i ʻole derony paha o sulfonylurea, a i ʻole PPAR-γ agonists (thiazolidinediones), a i ʻole insulin (me a i ʻole metformin), a i hui pū me ka metformin a he huaʻai sulfonylurea, a metformin a me PPAR-γ agonists.

Lawe ʻia ʻo Xelevia me ka nānā ʻole i ka mea ʻai. ʻO ka nui o ka pauku waiwai o ka metformin, sulfonylurea derivatives a me PPAR-γ agonists e pono e koho i nā kaila i ʻōlelo ʻia no kēia mau lāʻau.

Ke hoʻohui nei i Xelevia me ka derivatives sulfonylurea a i ʻole me ka insulin, pono ia e hōʻemi i ka lāʻau lapaʻau i ʻōlelo ʻia ai ka hopena o ka sulfonylurea a i ka derivative insulin e hōʻemi i ka hopena o ka hoʻomohala ʻana i ka hopena o ka sulfone-induced a insulin-induced hypoglycemia.

Inā pau ka mea hoʻomanawanui i ka lawe ʻana i ka lāʻau Xelevia, pono e lawe ʻia ka lāʻau i ka wā hiki ke hoʻomanaʻo ma hope o ka hoʻomanaʻo ʻana i ka lāʻau lapaʻau i hala.

ʻAʻole hiki ke ʻoluʻolu ʻia ka lawe ʻia ʻana o ʻelua papau o Xelevia ma ka lā like.

ʻO nā mea maʻi me ka pani ʻole ʻana:

ʻO ka poʻe maʻi me ka haʻalulu māmā emoole (cleince clearance (CC) & gt50 ml / min, kahi kokoke i kahi serum creatinine concentrations o & lt1.7 mg / dl i nā kāne a me & lt1.5 mg / dl i nā wahine) ʻaʻole koi i ka hoʻoponopono hoʻoponopono o Xelevia.

Ma muli o ka pono o ka hoʻoponopono ʻana i ka hapa o ka sitagliptin i nā mea maʻi me ka maʻi hakahaka hou a i ʻole ka hopena o ka maʻi, ʻaʻole i hōʻike ʻia ka hoʻohana ʻana o Xelevia i kēia ʻano o nā maʻi (ʻo ka haʻalele ʻana o nā pilikia i kahi papa 100 mg a me ka hala ʻole o 25 mg a 50 mg dosages ʻaʻole i ʻae ʻia no ke kaʻi ʻana o ka dosage i ka poʻe maʻi me ka renal. nele o ka hōʻeha a me ka kaumaha nui).

Ma muli o ka pono o ka hoʻoponopono hoʻoponopono ʻana, ʻo ia ka mea e nānā ai i nā mea maʻi me ka nānā ʻole i ka hana papalela e nānā i ka hana ʻoi a ma mua o ka hoʻomaka ʻana o ka mālama ʻana me sitagliptin a me kēlā manawa i ka wā e mālama ai.

ʻO nā maʻi me ka palaualohiʻi:

ʻAʻohe hoʻoponopono hoʻoponopono o Xelevia e koi ʻia i nā mea maʻi me ka hōʻemi i ka maʻi hepatic hōʻemi. ʻAʻole i aʻo ʻia ka lāʻau lapaʻau i nā maʻi me ka hōʻeha paʻakikī o ka naʻau.

ʻAʻole koi kekahi hoʻoponopono hoʻoponopono o Xelevia i nā maʻi maʻi maʻi.

I ka wā o nā hoʻokolohua lapaʻau i nā mea hana olakino olakino, kahi pākahi ʻo 800 mg o sitagliptin i ʻema ʻia i ka maʻamau. ʻO ka hoʻololi iki ʻana i ka palena o QTc, ʻaʻole i manaʻo ʻia he nui koʻikoʻi, ua nānā ʻia i loko o kekahi o nā noiʻi o sitagliptin i kahi maʻi o 800 mg i kēlā me kēia lā. ʻAʻole i aʻo ʻia kahi make ma kahi o 800 mg i kēlā me kēia lā.

Ma ka hoʻomaka mua o nā hoʻokolohua lapaʻau, ʻike ʻia nā helu he nui o nā ʻano meakē e pili ana i ka mālama ʻana me ka sitagliptin i ʻike ʻia i ka wā e lawe ai i ka lāʻau lapaʻau i loko o kēlā me kēia lā a hiki i ka 400 mg no 28 mau lā.

Ma ka hihia o ka overdose, pono ia e hoʻomaka i nā hana kākoʻo kākoʻo: ka hoʻohemo ʻana i ka lāʻau paʻa ʻole mai ka gastrointestinal tract, ka nānā ʻana i nā hōʻailona koʻikoʻi, me ka ECG, me ka koho ʻana o ka mālama mālama, inā pono.

Hoʻololi maikaʻi ʻole ʻia ka sitagliptin. I nā haʻawina loea, ʻo ka 13.5% wale nō ka nui o ka hopena i lawe ʻia mai ke kino ma ka manawa o ka hola 3-4 dialysis. Hiki ke kuhikuhi ʻia ka dialysis wā lōʻihi inā pono. ʻAʻohe mea hōʻike i ka hopena o ka dialysis peritoneal no sitagliptin.

ʻO ke ala nui o ka excretion o sitagliptin mai ke kino he ren excretion. No ka hoʻokō ʻana i nā kukuna like like like me i nā poʻe maʻi me ka hana excretory maʻamau o nā pēpē, nā mea maʻi me ka maʻi maʻalahi o ka pūpū māmā, a me nā mea maʻi me ka hopena o ke ake ʻole a pau e koi ana i ka hemodialysis a i ka dialysis peritoneal, koi ʻia ka hoʻoponopono ʻana o Xelevia . ^ E Ha yM.

Ua hōʻike ʻia nā manaʻo e pili ana i ka hoʻomohala ʻana i ka pancreatitis akui, me ka hemorrhagic a i ka necrotic me ka hopena o ka mea momona a me ka mea ʻole-momona, ma nā mea maʻi e lawe ana i sitagliptin. Pono e hoʻomaopopo ʻia nā mea maʻi e pili ana i nā hōʻailona ʻano o ka maʻi pancreatitis maʻa: mau, ka hōʻeha ʻeha. Hōʻike ʻia nā maʻi haukapila o ka pancreatitis ma hope o ka hoʻokuʻu ʻana o sitagliptin. I ka hihia o ka maʻi pancreatitis, pono e hoʻōki i ka lawe ʻana iā Xelevia a me nā mea hōʻeha kūpono ʻē aʻe.

Wahi a nā hoʻokolohua lapaʻau o sitagliptin, ʻo ka ulu ʻana o ka hypoglycemia i ka wā monotherapy a i ʻole hui pū ʻana me nā lāʻau lapaʻau ʻaʻole i kumu i ka hypoglycemia (metformin, pioglitazone) i hoʻohālikelike ʻia me ka manaʻo o ka hypoglycemia ma ka hui pletebo. E like me nā lāʻau lapaʻau hypoglycemic ʻē aʻe, ua nānāʻia ka hypoglycemia me sitagliptin i hui pū ʻia me nā deroli o ka insulin a i ʻole ka hopena sulfonylurea. I mea e hōʻemi ai i ka hopena o ka uluʻana o ka hypoglycemia sulfone-induced, e hoʻemi ʻia ka nui o ka pilina o sulfonylurea.

Hoʻohana i ka poʻeʻelemakule:

Ma nā haʻawina loiloi, ʻo ka maikaʻi a me ka palekana o sitagliptin i nā maʻi maʻi makua (6565 mau makahiki he 40, nā mea maʻi 409) i hoʻohālikelike ʻia i nā mea maʻi ma lalo iho o 65 mau makahiki. ʻAʻole koi ʻia ka hoʻoponopono ʻana ma ke ʻano e pili ana i ka makahiki. Hiki i nā maʻi maʻi makua ke hoʻomohala i ka hiki ʻole o ka renal. Wahi a ia, e like me nā hui ʻē aʻe, pono ia ka hoʻoponopono ʻana i ka wai maʻi i nā mea maʻi me ka maikaʻi ʻole o ka renal.

ʻO Sitagliptin Cardiovascular Safety Assessment Study (TECOS):

E hoʻokuʻu i ke ʻano, ka hoʻonohonoho ʻana a me ka pōpoki

Hana ʻia ia i ke ʻano o ka beige, nā papa biconvex i kahi kiʻi ʻoniʻoni. Kūkulu:

sitagliptin phosphate monohydrate (100 mg sitagliptin),
kalima
mikuleka
sodium stearyl fumarate
sodium polio
paʻahau magnesium.

Hoʻopili ʻia nā papa he 14 i kahi pōpō (2 ma kahi pahu.

Hoʻohui nūhou

ʻAʻole i loaʻa he hopena koʻikoʻi no nā maʻi ʻē aʻe i ka maikaʻi o Xelevia. No laila, ʻaʻole koi kēia kūlana i kahi loli i kā lākou dosis. ʻO nā mea i koe, he sulfonylurea a me ka insulin.

ʻAʻole pili ka sitagliptin i ka hopena o nā lāʻau lapaʻau hou. ʻAʻole i loaʻa kahi kamaʻilio koʻikoʻi ma ka hana o ka hui pū ʻana me nā mea hana ʻē aʻe.

Eia naʻe, i mea e pale ai i ka pilikia o ke olakino, i ka manawa e kuhikuhi ai i ka mālama ʻana, pono e hōʻike ʻia kekahi loea e pili ana i ka lawe ʻana i nā lāʻau ʻē aʻe.

Nā ʻōlelo kikoʻī

I mea e pale ai i ka hypoglycemia, ʻoi ʻia ka hoʻēmi ʻana i ka lāʻau i lawe ʻia ʻia i loko o kekahi lāʻau lapaʻau hypoglycemic hou i ka hui pū ʻana.

He mea nui ia no nā poʻe ʻōpio ma mua o 65 e nānā i ke kūlana o nā keiki, ʻoiai ʻoi aku ka paʻakikī o kēia ʻōpū i nā ʻōpiopio. Loaʻa nā mea maʻi i ka hypoglycemia i ka wā o ka hoʻohālikelike ʻana me nā lāʻau like ʻole.

ʻAʻohe hopena i ka ʻōnaehana cardiovascular.

ʻAʻole pili ka mea ikaika i ka hiki ke lawe i kahi mīkini a hana paha me nā hana. Akā, i ka hui hoʻohui, hiki i kēia hopena hopena. No laila, i kēia hihia, ʻoi aku ka maikaʻi o ka haʻalele i ka hoʻokele.

Hoʻokuʻu ʻia ma nā kau wale nō i kau inoa!

Hoʻohālikelike me nā kikowaena

Hoavius. ʻO ka lāʻau lapaʻau e pili ana i ka sitagliptin. Hoʻopuka i ka hui "Merck Sharp", nā Netherlands. ʻO ke kumukūʻai no ka pauka he 1600 rubles a kiʻekiʻe aʻe. ʻO ka hana i hāʻawi ʻia e ka mea like me ka Xelevia. ʻO ia he mimetin mimetic, e pili ana i ke kō koko koko a hoʻēmi hou i ka momona o kahi maʻi maʻi. No laila, hāʻawi pinepine ʻia i nā poʻe me ka luhi i ka maʻi ʻaoʻao. Na nā minuses - ke kumukūʻai. ʻO kēia kahi kikoʻī piha.

Yasitara. Nā papa me nā sitagliptin i ka hoʻonohonoho. ʻO ka ʻoihana hana ʻo Pharmasintez, Rusia. Kahi kuʻina o ke ʻano o ka lāʻau, he hopena like ia a me kahi hoʻonohonoho o nā contraindications.ʻO ke kumukūʻai maʻamau no kēia māhele. ʻOi aku ka maʻalahi ma ke kuhikuhi ʻana i ka mālama ʻana, no ka mea, he mau ʻekolu ʻekolu o ka papa hana - 25, 50 a me 100 mg o sitagliptin. Akā naʻe pāpā ʻia no nā wahine hāpai a me nā keiki. I waena o nā minus - he kumu pinepine ia i ka hypoglycemia.

Vipidia. He ʻōmole ogé hoʻonākiuki, akā loaʻa ka apogliptin. Loaʻa i ke ʻano o nā papa o 12.5 a me 25 mg. Kumukūʻai - mai 800 a 1150 mau rubles, hilinaʻi i ka nui. Hana ʻia e Takeda GmbH, Iapana. Hoʻohālike kāna hana, akā ʻoi aku ka maikaʻi o ka maikaʻi. Mai kuhikuhi i nā keiki a me nā wahine hāpai i ka nele o nā ʻike noiʻi. Contraindications maʻamau a me kahi papa inoa o nā hopena hopena.

Invokana. Nā papa papa ʻōlelo Canagliflozin. Hoʻopuka i ka hui Italia Janssen-Silag. Ua kiʻekiʻe ke kumukūʻai: mai 2600 mau rubles i 100 mau ʻāpana. Hoʻohana ʻia ia i ka mālamaʻana o ka maʻi diabetes me ka hana ʻole o ka metformin a me ka meaʻai. Eia naʻe, pono e hui pū ʻia ka lāʻau me kahi papa i koho ʻia e ke kauka. Nā maʻi nā contraindications.

Galvus Met. ʻO kēia kahi hopena hoʻomehana i ka maʻi maʻi maʻi, inā ʻaʻole lawa ka hopena o hoʻokahi mea. Hoʻohui ʻia o ka metformin a me vildagliptin. Hana ʻia nā papa e ka hui Swiss Novartis. Kumukūʻai - mai 1500 mau rubles a i luna. He lōʻihi ka hopena, e pili ana i 24 mau hola. ʻAʻole hiki ke hoʻohana i nā mālama o nā keiki, nā wahine hāpai a me nā lactating. I nā mākua, ua hoʻohana nui me ka mālama. ʻAʻole kūpono e like me kahi mea hou o ka insulin.

Trazenta. Ke loaʻa nei kēia lāʻau lapaʻau linagliptin, ʻo ia hoʻi kahi mea pale o DPP-4. No laila, ua like kona ʻano me Xelevia. A ʻoi aku ka maikaʻi ma loko o nā ʻōpū, ʻo ia hoʻi, ʻohi ʻia ka luhi i nā ʻōpū. Hiki ke hoʻohui pū me nā mea ola ʻē aʻe. Ua like nā ʻano kīnā e hoʻokae ʻia. Nui nō kekahi hopena ʻaoʻao. U kumukūʻai - mai 1500 rubles. Hoʻopuka i ka hui "Beringer Ingelheim Pharma" ma Kelemānia a me nā USA.

Ke hoʻololi nei i kekahi lāʻau lapaʻau e hana wale ʻia e ke kauka. ʻAʻole hiki ke nānā ʻia ka lāʻau lapaʻau iho!

Ma keʻano holoʻokoʻa, ʻōlelo maikaʻi ka poʻe me ka maʻi maʻi e pili ana i kēia lāʻau lapaʻau. Kahi ʻia kona kūlana kiʻekiʻe a me ka maʻalahi o ka hoʻokipa ʻana. No kekahi, ʻaʻole kūpono kēia hoʻoponopono.

Valery: "Ma mua wau e lawe iā Galvus, makemake nui wau. Akā ʻae lākou i ka hāʻawi ʻana iā ia i mau pōmaikaʻi ma koʻu haukapila, a ʻōlelo mai ke kauka iaʻu e hoʻololi i Xelevia. ʻAʻole au i ʻike i ka ʻokoʻa. Hana lākou i kahi ʻano like, e like me ka wehewehe a ke kauka. He maʻamau ke gula, ʻaʻole wau e nānā i nā leaka. I ka wā mālama, ʻaʻole i "hopena hopena". Ua mahalo wau i kēia lāʻau lapaʻau. "

Alla: "Hoʻohui hou ke kauka ʻo Xelevia i ka insulin, no ka mea ʻaʻole i hoʻokō mau ka mea i ka mua i ka mālama ʻana i ke kō i loko o nā maʻamau maʻamau. Ma hope o ka hōʻemi ʻana i kahi hapaha i kona nui, ua hoʻomaka wau e ʻike i ka hopena ma kahi piha. ʻAʻole pono nā mākaukau, he maikaʻi nā hoʻokolohua, a me ke kūlana olakino olakino. ʻIke pū aku au ua makemake liʻiliʻi wau e ʻai liʻiliʻi. Ua wehewehe ke kauka e like me nā hana āpau o kēia ʻano. Ka, inā hoʻohui ʻia. ”