Thiazolidinediones sabon rukuni ne na magungunan baka na maganin antidiabetic. Kamar biguanides, ba sa cika yawan fitsari, suna haɓaka samar da sinadarai masu ɗorewa, sai dai su rage juriya da ƙwayoyin.
Bugu da ƙari ga al'ada na al'ada na glycemia, kwayoyi kuma suna inganta bakan: yawan taro na HDL yana ƙaruwa, matakin triglycerol yana raguwa. Tunda tasirin kwayoyi ya dogara ne akan haɓakar kwayar halitta, ana iya tsammanin sakamako mafi kyau daga jiyya a cikin watanni 2-3. A cikin gwaji na asibiti, monotherapy tare da thiazolidinediones sun rage glycated haemoglobin zuwa 2%.
Magunguna na wannan rukunin suna haɗuwa daidai tare da sauran ma'aikatan antidiabetic - metformin, insulin, abubuwan samo asali na sulfonylurea. Haɗuwa tare da metformin mai yiwuwa ne saboda wata hanya ta daban: biguanides yana hana glucogenesis, kuma thiazolidinediones yana ƙara yawan amfani da glucose.
Hakanan basu tsokani tasirin hypoglycemic tare da monotherapy, amma, kamar metformin, a cikin hadaddun farji tare da magungunan hypoglycemic na iya haifar da irin wannan sakamako.
Kamar yadda kwayoyi masu haɓaka hankalin masu karɓa zuwa insulin, thiazolidinediones suna daga cikin magungunan da ke bayar da himma don gudanar da ciwon sukari na 2. Tasirin rigakafin bayan shan maganin ya kai har watanni 8 bayan ƙarshen karatun.
Akwai hango cewa magungunan wannan aji na iya gyara lahanin ƙwayar cuta ta cutar sankara, ta jinkirta ci gaba da ciwon sukari na 2 har sai an sami nasara akan cutar.
Daga cikin thiazolidinediones, ana amfani da maganin karni na 2 na Aktos na kamfanin harhada magunguna "Eli Lilly" (Amurka) an yi rajista a kasuwar Rasha a yau. Amfani da shi yana buɗe sababbin damar ba kawai a cikin diabetology ba, har ma a cikin zuciya, inda ake amfani da maganin don hana cututtukan zuciya da jijiyoyin jini, galibi saboda juriya na insulin.
Sashi tsari da abun da ke ciki na Pioglitazone
Babban kayan maganin shine pioglitazone hydrochloride. A cikin kwamfutar hannu ɗaya, adadinta ya dogara da kashi - 15 ko 30 MG. Kwayar aiki mai aiki a cikin tsari an haɗu da shi tare da lactose monohydrate, hydroxypropyl cellulose, alli carboxymethyl cellulose, magnesium stearate.
Za a iya gano allunan fari na asali ta hanyar convex zagaye da kuma zane "15" ko "30".
A cikin farantin karfe 10 allunan, a cikin akwati - 3-10 irin faranti. Rayuwar shiryayye na miyagun ƙwayoyi shine shekaru 2. Don pioglitazone, farashin ya dogara ne ba kawai a kan sashi na miyagun ƙwayoyi ba, har ma a kan masana'antar ƙirar ƙasa: 30 Allunan 30 na Indian Pioglar 30 MG kowane za'a iya sayan don 1083 rubles, allunan 28 na Irish Actos 30 MG kowane - don 3000 rubles.
Halayen magunguna
Pioglitazone magani ne na baki wanda ya shafi aji na thiazolidinedione. Ayyukan miyagun ƙwayoyi suna da alaƙa tare da kasancewar insulin: rage ƙarancin hankali na hanta da kyallen takarda zuwa hormone, yana ƙara farashin glucose da rage haɓakawa a cikin hanta. Idan aka kwatanta da magungunan sulfonylurea, pioglitazone baya motsa kwayoyin b wadanda ke da alhakin samarda insulin kuma baya hanzarta tsufa da cutar kwayan da suke yi.
Rage juriya a cikin insulin juriya a cikin nau'in 2 na ciwon sukari yana taimakawa wajen daidaita bayanan martaba na glycemic da glycated hemoglobin. Tare da rikice-rikice na rayuwa, miyagun ƙwayoyi suna ba da gudummawa ga haɓaka matakan HDL da raguwa a cikin matakan triglycerol. Abun da ke cikin jimlar cholesterol da LDL ya kasance ba su canzawa.
Lokacin da ya shiga cikin narkewa, ƙwayar tana cikin ƙwaƙwalwa sosai, yana isa ƙimar iyaka a cikin jini bayan sa'o'i 2 tare da bioavailability na 80%. An karu da haɓaka gwargwadon ƙwayar cuta a cikin jini don sashi daga 2 zuwa 60 MG. Ana samun sakamako mai tabbaci bayan ɗaukar allunan a cikin kwanakin 4-7 na farko.
Yin amfani da maimaitawa baya tsokanar ƙwayar magunguna. Yawan shayewar ba ya dogara da lokacin karɓar abinci mai gina jiki.
Ana cire Pioglitazone tare da feces (55%) da fitsari (45%). Magungunan, wanda aka watsa ta hanyar da ba ta canzawa, yana da rabin rayuwa na 5-6 hours, don metabolites, 16-23 hours.
Shekarun masu ciwon sukari ba ya shafar magungunan magunguna. Tare da dysfunctions na koda, abun ciki na glitazone da metabolites zai zama ƙasa, amma sharewar zai zama daidai, don haka ana kiyaye taro na magani kyauta.
Tare da gazawar hanta, matakin gaba ɗaya na miyagun ƙwayoyi a cikin jini na yau da kullun ne, tare da karuwa a cikin rarraba rarraba, za a rage sharewar abubuwa, kuma za'a ƙara ƙaruwa na magungunan kyauta.
Alamu don amfani
Ana amfani da Pioglitazone don sarrafa nau'in ciwon sukari na 2 duka biyu a matsayin maganin monotherapy kuma a cikin hadaddun magani, idan gyare-gyare na rayuwa (ƙarancin abinci mai narkewa, ƙayyadadden aikin motsa jiki, kula da yanayin motsin rai) ba su rama cikakkiyar cutar glycemia ba.
A cikin hadadden jiyya, ana amfani da dual tare da metformin (musamman don kiba), idan monotherapy tare da metformin a cikin maganin warkewa bai samar da 100% na sarrafa glycemic ba. Game da contraindications don metformin, pioglitazone an haɗe shi da magungunan sulfonylurea, idan amfani da ƙarshen na monotherapy bai ba da sakamakon da ake so ba.
Haɗin pioglitazone kuma a cikin abubuwan haɗari sau uku tare da shirye-shiryen metformin da shirye-shiryen sulfonylurea mai yiwuwa ne, musamman ga masu fama da kiba, idan ƙididdigar da ta gabata ba ta ba da bayanin martaba na al'ada ba.
Allunan kuma sun dace da nau'in ciwon sukari da ke dogaro da sukari na 2, idan allurar insulin bata iya sarrafa sukari yadda yakamata, kuma metformin yana haɓaka ko mara haƙuri.
Contraindications
Baya ga rashin hankali ga abubuwan da ke cikin tsari, pioglitazone ba da shawarar ba:
- Marasa lafiya da nau'in cuta ta 1;
- Tare da ketoacidosis mai ciwon sukari;
- Marasa lafiya tare da tsananin dysfunctions hanta;
- Idan a cikin anamnesis - cututtukan zuciya na zane-zane. I - IV NYHA;
- Tare da herosuria macroscopic na rashin ilimin etiology;
- Masu fama da cutar siga tare da oncology (cancer na mafitsara).
Abun Harkokin Magunguna
Haɗewar yin amfani da pioglitazone tare da digoxin, warfarin, fenprocoumone da metformin ba su canza ikon magungunan su ba. Ba ya tasiri kan magunguna da kuma amfani da glitazone tare da abubuwan da aka samo asali na sulfonylurea.
Karatun game da hulɗa da pioglitazone tare da hana hana haihuwa, allurar tashar alli, cyclosporine da masu hana ƙananan HMCA-CoA ba su bayyana canji a halayen su ba.
Amfani da jigon pioglitazone da gemfibrozil suna haifar da karuwa a cikin AUC na glitazone, wanda ke nuna mahimmancin lokacin tattara-lokaci, sau 3. Irin wannan halin yana ƙara yawan damar bayyanar tasirin sakamako wanda ba a ke so ba, saboda haka, ya kamata a daidaita sashin pioglitazone yayin haɗa shi da inhibitor.
Yawan adadin pioglitazone yana ƙaruwa lokacin da aka yi amfani da rifampicin tare. Kulawa da cutar ta glycemia na wajaba.
Yabo don amfani da Pioglitazonum
Dokokin Pioglitazone don amfani suna bada shawarar cewa masu ciwon sukari suna amfani da p / Rana. Ana cin kwamfutar hannu duka tare da ruwa, likita ya zaɓi sashin shan la'akari da maganin da ya gabata, shekaru, matakin cutar, rikicewar cututtukan jiki, halayen jiki.
Tare da kulawa mai rikitarwa tare da insulin, ana daidaita sashi na ƙarshen bisa ga karatun kwalliyar glucoeter da kayan abinci.
Ga tsofaffi masu ciwon sukari, babu buƙatar canza sashi, suna farawa da mai ƙanƙan da kai, haɓaka a hankali, musamman tare da tsare-tsaren haɗin gwiwa - wannan yana sauƙaƙe daidaitawa da rage ayyukan sakamako masu illa.
Tare da dysfunctions na koda (ƙirar creatinine mafi girma fiye da 4 ml / min.), An tsara Glitazone kamar yadda aka saba, ba a nuna shi ga marasa lafiya na hemodialysis ba, har ma da gazawar hanta.
Recommendationsarin shawarwari
Ana kimantawa mahimmancin tsarin zaɓaɓɓen kowane watanni 3 ta amfani da glycated assymal hemoglobin. Idan babu cikakkiyar amsawa, dakatar da shan maganin. Yin amfani da pioglitazone na dogon lokaci yana ɗaukar haɗarin, saboda haka, likitan yakamata ya kula da bayanan amincin miyagun ƙwayoyi.
A miyagun ƙwayoyi zai iya riƙe ruwa a cikin jikin mutum kuma ya lalata yanayin cikin bugun zuciya. Idan mai ciwon sukari yana da abubuwan haɗari a cikin yanayin girma, bugun zuciya ko cututtukan zuciya na zuciya, farawa ya kamata ya zama kaɗan.
Titration mai yiwuwa ne tare da ingantaccen kuzari. Wannan rukuni na masu ciwon sukari suna buƙatar saka idanu na yau da kullun game da yanayin lafiyar su (nauyi, kumburi, alamun cututtukan zuciya), musamman tare da ƙarancin diastolic reserve.
Musamman kulawa lokacin rubuta magani ya kamata a bai wa masu ciwon sukari na balaga (daga shekara 75), tunda babu ƙwarewa game da amfani da miyagun ƙwayoyi don wannan rukuni. Tare da haɗuwa da pioglitazone tare da insulin, ana iya inganta cibiyoyin cututtukan zuciya. A wannan zamanin, haɗarin ciwon kansa, karaya yana ƙaruwa, don haka lokacin da ake rubuta magani, ya zama dole don kimanta ainihin fa'idodi da cutarwar da take fuskanta.
Gwajin asibiti yana tabbatar da saurin kamuwa da cutar kansa na mahaifa bayan cinikin pioglitzone. Duk da ƙananan haɗarin (0.06% a kan 0.02% a cikin ƙungiyar kulawa), duk abubuwan da ke haifar da cutar kansa (shan sigari, samarwa mai cutarwa, ƙwayar cutar ƙwalƙwalwar ƙwayar cuta, tsufa) ya kamata a kimanta.
Kafin saduwa da miyagun ƙwayoyi, ana bincika enzymes hanta. Tare da karuwa a cikin AlT ta hanyar sau 2.5 kuma tare da gazawar hanta mai ƙarfi, ƙwaƙwalwar ƙwaƙwalwar ƙwaƙwalwa ta hana. Tare da matsakaicin zafin cutar hanta, ana ɗaukar pioglitazone tare da taka tsantsan.
Tare da alamun bayyanar cututtuka na hepatic (rikicewar dyspeptik, raunin epigastric, anorexia, gajiya koyaushe), ana bincika enzymes hanta. Wuce ƙa'idar ta sau 3, da kuma bayyanar hepatitis, ya zama dalilin janye magunguna.
Tare da raguwa a cikin juriya na insulin, sake rarraba kitsen mai yana faruwa: visceral yana raguwa, da ƙari-ciki yana ƙaruwa. Idan yawan nauyi yana da alaƙa da edema, yana da mahimmanci don sarrafa aikin zuciya da kuma yawan adadin kuzari.
Sakamakon ƙaruwar jini, haemoglobin na iya raguwa da matsakaicin 4%. Ana lura da irin waɗannan canje-canje yayin ɗaukar wasu magungunan antidiabetic (don metformin - 3-4%, shirye-shiryen sulfonylurea - 1-2%).
A cikin haɗuwa sau biyu da sau uku tare da pioglitazone, insulin da jerin sulfonylurea, haɗarin hypoglycemia yana ƙaruwa. Tare da rikicewar jiyya, tsarin tit na lokaci yana da mahimmanci.
Thiazolidinediones na iya ba da gudummawa ga gurbataccen hangen nesa da kumburi. Lokacin da ake tuntuɓar likitan likitan ido, yana da muhimmanci a yi la’akari da yiwuwar rashin lafiyar macular edema tare da pioglitazone. Akwai haɗarin fashewar kasusuwa.
Saboda ƙarancin shaidar tabbaci don tasiri da aminci dangane da juna biyu da shayarwa, ba a sanya mata polyglitazone yayin waɗannan lokutan. An sanya maganin a cikin yara.
Lokacin tuki motoci ko ƙananan kayan aiki, yiwuwar sakamako masu illa bayan amfani da glitazone.
Yawan abin sha da yawa kuma mara amfani
Tare da monotherapy kuma a cikin tsarin tsararru, an rubuta abubuwan da ba a so:
- Harshen macular, raunin gani;
- Cutar amai da gudawa
- Hypersthesia, ciwon kai;
- Cututtuka na tsarin numfashi, sinusitis da pharyngitis;
- Allergy, anaphylaxis, hypersensitivity, angioedema;
- Rage ingancin bacci;
- Tumbin ire-iren yanayi: polyps, cysts, cancer;
- Fuskar fasowa da jin zafi a cikin naɓar;
- Rashin rikicewar rudani;
- Rashin daidaituwa;
Hypoglycemia, ci da ba a sarrafawa ba;- Hypesthesia, rashin daidaituwa ta hanyar aiki;
- Vertigo;
- Rage nauyi da haɓakar ALT;
- Glucosuria, furotin.
Hypoglycemia, ci da ba a sarrafawa ba;Nazarin sun gwada lafiyar lafiyar kashi na 120 MG, wanda masu sa kai suka ɗauki kwanaki 4, sannan kuma sauran kwanaki 7 a 180 MG. Ba a sami alamun cutar yawan jini ba.
Yanayin hypoglycemic yana yiwuwa tare da hadaddun tsari tare da shirye-shiryen insulin da sulfonylurea. Farfesa yana alamu da taimako.
Pioglitazone - analogues
A cikin kasuwannin Amurka na maganin rigakafi, ɗayan mafi girma a duniya, pioglitazone ya mamaye wani ɓangaren da yake daidai da metformin. Tare da contraindications ko haƙuri mara kyau, ana iya maye gurbin pioglitazone ta Avandia ko Roglit - analogues dangane da rosiglitazone - magani ne na aji ɗaya na thiazolidinediones, duk da haka, tsinkaya na dogon lokaci a cikin wannan rukunin yana da ban takaici.
Rage juriya insulin da biguanides. A wannan yanayin, pyoglizatone za'a iya maye gurbin ta Glucophage, Siofor, Bagomet, NovoFormin da sauran magunguna na tushen metformin.
Daga ɓangaren kasafin kuɗi na magungunan hypoglycemic, analogues na Rasha sun shahara: Diab-norm, Diaglitazone, Astrozone. Sakamakon ingantaccen jerin contraindications, adadin wanda ke ƙaruwa tare da rikicewar jiyya, dole ne mutum yayi hankali da zaɓin analogues.
Kimantawa na Abokin Ciniki
Game da pioglitazone, sake dubawa game da masu ciwon sukari suna hade. Wadanda suka sha magungunan asali suna lura da inganci sosai da ƙarancin sakamako.
Conclusionarshen ba shi da tushe: magani da gaske yana rage matakin cutar glycemia, haemoglobin da ke motsa jiki har ma da buƙatar insulin (musamman tare da magani mai rikitarwa). Amma bai dace da kowa ba, don haka bai kamata kuyi gwaji tare da lafiya ba, ku samo magunguna akan shawarar abokai. Awararren masani ne kaɗai ke da ikon yanke shawara game da yiwuwar wannan farjin da algorithm don karɓar pioglitazone.
Kuna iya ƙarin koyo game da amfani da thiazolidinediones a cikin aikin asibiti daga bidiyon:
