Метформин МВ Таблетки, 60 шт, 500 мг, для взрослых, пролонгированного действия

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Повышает чувствительность периферических рецепторов к инсулину и утилизацию глюкозы клетками. Снижает выработку глюкозы печенью за счет ингибирования глюконеогенеза и гликогенолиза. Задерживает всасывание глюкозы в кишечнике."}},{"type":"paragraph","data":{"text":"Метформин стимулирует синтез гликогена воздействуя на гликогенсинтазу."}},{"type":"paragraph","data":{"text":"Увеличивает транспортную емкость всех типов мембранных переносчиков глюкозы. На фоне приема метформина масса тела пациента либо остается стабильной либо умеренно снижается. Метформин оказывает благоприятный эффект на метаболизм липидов: снижает концентрацию общего холестерина липопротеинов низкой плотности и триглицеридов."}},{"type":"header","data":{"text":"Фармакокинетика:","level":3}},{"type":"paragraph","data":{"text":"Всасывание"}},{"type":"paragraph","data":{"text":"После перорального приема препарата в форме таблетки с пролонгированным высвобождением всасывание метформина замедлено по сравнению с таблеткой с обычным высвобождением метформина. Время достижения максимальной концентрации в плазме крови (ТС\u003csub\u003em\u003c/sub\u003e\u003csub\u003eах\u003c/sub\u003e)после однократного приема внутрь 1таблетки с пролонгированным высвобождением в дозе 1000 мг составляет 5-7 часов (в диапазоне от 4 до 12 часов). В то же время ТС\u003csub\u003em\u003c/sub\u003e\u003csub\u003eах\u003c/sub\u003e для таблетки с обычным высвобождением составляет 25 час."}},{"type":"paragraph","data":{"text":"В равновесном состоянии идентичном равновесному состоянию метформина с обычным высвобождением максимальная концентрация (С\u003csub\u003em\u003c/sub\u003e\u003csub\u003eах\u003c/sub\u003e) и площадь под кривой \"концентрация-время\" (AUC) увеличиваются непропорционально принимаемой дозе. После однократного приема внутрь 2000 мг метформина в форме таблеток с пролонгированным высвобождением AUC аналогична наблюдаемой после приема 1000 мг метформина в форме таблеток с обычным высвобождением два раза в сутки. Внутрииндивидуальная вариабельность С\u003csub\u003em\u003c/sub\u003e\u003csub\u003eах\u003c/sub\u003e и AUC после приема метформина в форме таблеток с пролонгированным высвобождением аналогична наблюдаемой после приема метформина в форме таблеток с обычным высвобождением."}},{"type":"paragraph","data":{"text":"Всасывание метформина из таблеток с пролонгированным высвобождением не изменяется в зависимости от состава принимаемой пищи. Не наблюдается кумуляции при многократном приеме до 2000 мг метформина в форме таблеток с пролонгированным высвобождением."}},{"type":"paragraph","data":{"text":"Распределение"}},{"type":"paragraph","data":{"text":"Связь с белками плазмы незначительна. С\u003csub\u003em\u003c/sub\u003e\u003csub\u003eах\u003c/sub\u003e в крови ниже С\u003csub\u003em\u003c/sub\u003e\u003csub\u003eах\u003c/sub\u003e в плазме и достигается примерно через такое же время. Средний объем распределения (V\u003csub\u003ed\u003c/sub\u003e) колеблется в диапазоне 63-276 л."}},{"type":"paragraph","data":{"text":"Метаболизм"}},{"type":"paragraph","data":{"text":"Метаболитов у человека не обнаружено."}},{"type":"paragraph","data":{"text":"Выведение"}},{"type":"paragraph","data":{"text":"Метформин выводится в неизмененном виде почками. Почечный клиренс метформина составляет > 400 мл/мин что указывает что метформин выводится за счет клубочковой фильтрации и канальцевой секреции. После перорального приема период полувыведения составляет около 65 час."}},{"type":"paragraph","data":{"text":"При нарушении функции почек клиренс метформина снижается пропорционально клиренсу креатинина увеличивается период полувыведения что может приводить к увеличению концентрации метформина в плазме крови."}}]},{"id":8,"name":"Показания к применению","slug":"indications","body":[{"type":"paragraph","data":{"text":"Сахарный диабет 2 типа у взрослых особенно у пациентов с ожирением при неэффективности диетотерапии и физических нагрузок:"}},{"type":"paragraph","data":{"text":"- в качестве монотерапии:"}},{"type":"paragraph","data":{"text":"- в сочетании с другими пероральными гипогликемическими средствами или с инсулином."}}]},{"id":9,"name":"Противопоказания","slug":"contraindications","body":[{"type":"paragraph","data":{"text":"- Повышенная чувствительность к метформину или к любому вспомогательному веществу;"}},{"type":"paragraph","data":{"text":"- диабетический кетоацидоз диабетическая прекома кома;"}},{"type":"paragraph","data":{"text":"- почечная недостаточность или нарушение функции почек (клиренс креатинина менее 45 мл/мин);"}},{"type":"paragraph","data":{"text":"- острые состояния протекающие с риском развития нарушения функции почек: дегидратация (при хронической или тяжелой диарее многократных приступах рвоты) тяжелые инфекционные заболевания (например инфекции дыхательных путей инфекции мочевыводящих путей) шок;"}},{"type":"paragraph","data":{"text":"- клинически выраженные проявления острых или хронических заболеваний которые могут приводить к развитию тканевой гипоксии (в том числе острая сердечная недостаточность хроническая сердечная недостаточность с нестабильными показателями гемодинамики дыхательная недостаточность острый инфаркт миокарда);"}},{"type":"paragraph","data":{"text":"- обширные хирургические операции и травмы когда показано проведение инсулинотерапии (см. раздел \"Особые указания\");"}},{"type":"paragraph","data":{"text":"- печеночная недостаточность нарушение функции печени;"}},{"type":"paragraph","data":{"text":"- хронический алкоголизм острое отравление алкоголем;"}},{"type":"paragraph","data":{"text":"- беременность;"}},{"type":"paragraph","data":{"text":"- лактоацидоз (в т.ч. и в анамнезе);"}},{"type":"paragraph","data":{"text":"- применение в течение менее 48 ч до и в течение 48 ч после проведения радиоизотопных или рентгенологических исследований с введением йодсодержащего контрастного вещества (например внутривенная урография ангиография) (см. раздел \"Взаимодействие с другими лекарственными средствами\");"}},{"type":"paragraph","data":{"text":"- соблюдение гипокалорийной диеты (менее 1000 ккал/сут);"}},{"type":"paragraph","data":{"text":"- детский возраст до 18 лет в связи с отсутствием данных по применению."}}]},{"id":10,"name":"С осторожностью","slug":"cautions","body":[{"type":"paragraph","data":{"text":"Применять препарат:"}},{"type":"paragraph","data":{"text":"- у пациентов старше 60 лет выполняющих тяжелую физическую работу что связано с повышенным риском развития у них лактоацидоза;"}},{"type":"paragraph","data":{"text":"- у пациентов с почечной недостаточностью (клиренс креатинина 45-59 мл/мин);"}},{"type":"paragraph","data":{"text":"- в период грудного вскармливания."}}]},{"id":11,"name":"Применение при беременности и в период грудного вскармливания","slug":"pregnancy_warnings","body":[{"type":"paragraph","data":{"text":"Декомпенсированный сахарный диабет во время беременности связан с повышенным риском возникновения врожденных пороков и перинатальной смертности."}},{"type":"paragraph","data":{"text":"Ограниченное количество данных свидетельствует о том что прием метформина у беременных женщин не увеличивает риск развития врожденных пороков у детей."}},{"type":"paragraph","data":{"text":"При планировании беременности а также в случае наступления беременности на фоне приема метформина препарат следует отменить и назначить инсулинотерапию. Необходимо поддерживать концентрацию глюкозы в крови на уровне наиболее близком к норме для снижения риска возникновения пороков развития плода."}},{"type":"paragraph","data":{"text":"Метформин проникает в грудное молоко. Побочные эффекты у новорожденных при грудном вскармливании на фоне приема метформина не наблюдались. Однако в связи с ограниченным количеством данных применение препарата в период грудного вскармливания не рекомендовано. Решение о прекращении грудного вскармливания должно быть принято с учетом пользы от грудного вскармливания и потенциального риска возникновения побочных эффектов у ребенка."}}]},{"id":12,"name":"Способ применения и дозы","slug":"dosage","body":[{"type":"paragraph","data":{"text":"Препарат Метформин МВ принимают внутрь. Таблетки проглатывают целиком не разжевывая запивая достаточным количеством жидкости. 1 раз в день во время ужина. Доза препарата Метформин МВ подбирается врачом индивидуально для каждого пациента на основании результатов измерения концентрации глюкозы в крови."}},{"type":"paragraph","data":{"text":"Монотерапия и комбинированная терапия в сочетании с другими гипогликемическими средствами"}},{"type":"paragraph","data":{"text":"- Для пациентов не принимавших метформин рекомендуемой начальной дозой препарата Метформин МВ является 500 мг 750 мг или 850 мг один раз в сутки во время ужина."}},{"type":"paragraph","data":{"text":"- Через каждые 10-15 дней рекомендуется корректировать дозу на основании результатов измерения концентрации глюкозы в крови. Медленное увеличение дозы способствует снижению побочных эффектов со стороны желудочно-кишечного тракта."}},{"type":"paragraph","data":{"text":"- Для пациентов уже получающих лечение метформином начальная доза препарата Метформин МВ должна быть эквивалентна суточной дозе таблеток с обычным высвобождением."}},{"type":"paragraph","data":{"text":"- Пациентам принимающим метформин в форме таблеток с обычным высвобождением в дозе превышающей 2000 мг не рекомендован переход на препарат Метформин МВ."}},{"type":"paragraph","data":{"text":"- В случае планирования перехода с другого гипогликемического средства необходимо прекратить прием другого средства. Подбор дозы метформина осуществляют начиная с назначения препарата Метформин МВ 500 мг 750 мг или 850 мг с возможным последующим переходом на препарат Метформин МВ 1000 мг."}},{"type":"paragraph","data":{"text":"Комбинация с инсулином"}},{"type":"paragraph","data":{"text":"Для достижения лучшего контроля концентрации глюкозы в крови метформин и инсулин можно применять в виде комбинированной терапии. Обычная начальная доза препарата Метформин МВ составляет одну таблетку 500 мг 750 мг или 850 мг 1 раз в сутки во время ужина в то время как дозу инсулина подбирают па основании результатов измерения концентрации глюкозы в крови. Далее возможен переход на препарат Метформин МВ 1000 мг."}},{"type":"paragraph","data":{"text":"Суточная доза"}},{"type":"paragraph","data":{"text":"Максимальная рекомендованная доза препарата Метформин МВ:"}},{"type":"paragraph","data":{"text":"1) 4 таблетки 500 мг в сутки (2000 мг);"}},{"type":"paragraph","data":{"text":"2) 2 таблетки 750 мг в сутки (1500 мг);"}},{"type":"paragraph","data":{"text":"3) 2 таблетки 850 мг в сутки (1700 мг);"}},{"type":"paragraph","data":{"text":"4) 2 таблетки 1000 мг в сутки (2000 мг)."}},{"type":"paragraph","data":{"text":"Если адекватный гликемический контроль не достигается доза препарата Метформин МВ может быть увеличена до максимальной суточной."}},{"type":"paragraph","data":{"text":"Для уменьшения побочных эффектов со стороны желудочно-кишечного тракта суточную дозу препарата можно разделить на 2 приема."}},{"type":"paragraph","data":{"text":"Если при приеме максимальной рекомендованной дозы 1 раз в день во время ужина не удается достичь адекватного контроля концентрации глюкозы в крови тогда максимальная доза может быть разделена на два приема:"}},{"type":"paragraph","data":{"text":"- 2 таблетки во время завтрака и 2 таблетки во время ужина для дозировки 500 мг;"}},{"type":"paragraph","data":{"text":"- 1 таблетка во время завтрака и 1 таблетка во время ужина для дозировки 1000 мг. Если адекватный контроль концентрации глюкозы в крови не достигается при приеме максимальных рекомендованных доз метформина в форме таблеток с пролонгированным высвобождением возможен переход на метформин в виде таблеток с обычным высвобождением с максимальной суточной дозой 3000 мг."}},{"type":"paragraph","data":{"text":"Пациенты с почечной недостаточностью"}},{"type":"paragraph","data":{"text":"Метформин может применяться у пациентов с почечной недостаточностью средней степени тяжести (клиренс креатинина 45-59 мл/мин) только в случае отсутствия состояний которые могут увеличивать риск развития лактоацидоза. Начальная доза составляет 500 мг 750 мг или 850 мг 1 раз в сутки. Максимальная доза составляет 1000 мг в сутки. Функция почек должна тщательно контролироваться каждые 3-6 месяцев. Если клиренс креатинина ниже 45 мл/мин прием препарата должен быть немедленно прекращен (см. раздел \"Противопоказания\")."}},{"type":"paragraph","data":{"text":"Пациенты пожилого возраста"}},{"type":"paragraph","data":{"text":"Пожилым пациентам дозу метформина корректируют на основании оценки функции почек которую необходимо проводить регулярно не менее 2 раз в год (см. раздел \"Особые указания\")."}},{"type":"paragraph","data":{"text":"Продолжительность курса лечения"}},{"type":"paragraph","data":{"text":"Метформин МВ следует принимать ежедневно без перерыва. В случае прекращения лечения пациент должен сообщить об этом врачу."}},{"type":"paragraph","data":{"text":"Пропуск дозы"}},{"type":"paragraph","data":{"text":"В случае пропуска приема очередной дозы пациенту следует принять следующую дозу в обычное время. Не следует принимать двойную дозу препарата Метформин МВ."}}]},{"id":13,"name":"Побочное действие","slug":"side_effects","body":[{"type":"paragraph","data":{"text":"Частота побочных эффектов препарата расценивается следующим образом: очень часто: ≥ 1/10: часто: ≥ 1/100 < 1/10: нечасто: ≥ 1/1000 < 1/100; редко: ≥ 1/10 000 < 1/1000; очень редко: < 1/10 000."}},{"type":"paragraph","data":{"text":"Нарушения со стороны обмена веществ и питания: очень редко - лактоацидоз (см. раздел \"Особые указания\")."}},{"type":"paragraph","data":{"text":"При длительном приеме метформина может наблюдаться снижение всасывания витамина В\u003csub\u003e12\u003c/sub\u003e. При обнаружении мегалобластной анемии необходимо учитывать возможность такой этиологии."}},{"type":"paragraph","data":{"text":"Нарушения со стороны нервной системы: часто - нарушение вкуса (металлический привкус во рту)."}},{"type":"paragraph","data":{"text":"Нарушения со стороны желудочно-кишечного тракта: очень часто - тошнота рвота диарея боли в животе и отсутствие аппетита."}},{"type":"paragraph","data":{"text":"Наиболее часто они возникают в начальный период лечения и в большинстве случаев спонтанно проходят. Для предотвращения симптомов рекомендуется принимать метформин во время приема пищи. Медленное увеличение дозы может улучшить желудочно-кишечную переносимость."}},{"type":"paragraph","data":{"text":"Нарушения со стороны печени и желчевыводящих путей: очень редко - нарушение показателей функции печени и гепатит; после отмены метформина эти нежелательные явления полностью исчезают."}},{"type":"paragraph","data":{"text":"Нарушения со стороны кожи и подкожных тканей: очень редко - кожные реакции такие как эритема (покраснение кожи) зуд крапивница."}},{"type":"paragraph","data":{"text":"Если любые из указанных в инструкции побочных эффектов усугубляются или были замечены любые другие побочные эффекты не указанные в инструкции необходимо сообщить об этом врачу."}}]},{"id":14,"name":"Передозировка","slug":"overdose","body":[{"type":"paragraph","data":{"text":"При применении метформина в дозе 85 г (в 425 раза превышающей максимальную суточную дозу) развития гипогликемии не наблюдалось. Однако в этом случае наблюдалось развитие лактоацидоза. Значительная передозировка или сопряженные факторы риска могут привести к развитию лактоацидоза (см. раздел \"Особые указания\"). Лечение: в случае появления признаков лактоацидоза лечение препаратом необходимо прекратить пациента срочно госпитализировать и определив концентрацию лактата уточнить диагноз. Наиболее эффективным мероприятием по выведению из организма лактата и метформина является гемодиализ. Проводят также симптоматическое лечение."}}]},{"id":15,"name":"Взаимодействие с другими лекарственными средствами","slug":"drugs_interaction","body":[{"type":"paragraph","data":{"text":"Противопоказанные комбинации"}},{"type":"paragraph","data":{"text":"Йодсодержащие рентгеноконтрастные средства: на фоне функциональной почечной недостаточности у пациентов с сахарным диабетом радиологическое исследование с применением йодсодержащих рентгеноконтрастных средств может вызывать развитие лактоацидоза. Лечение препаратом Метформин МВ необходимо отменить в зависимости от функции почек за 48 ч до или на время рентгенологического исследования с применением йодсодержащих рентгеноконтрастных средств и возобновлять не ранее 48 ч после при условии что в ходе обследования функция почек была признана нормальной."}},{"type":"paragraph","data":{"text":"Не рекомендуемые комбинации"}},{"type":"paragraph","data":{"text":"Алкоголь: при острой алкогольной интоксикации увеличивается риск развития лактоацидоза особенно в случае:"}},{"type":"paragraph","data":{"text":"- недостаточного питания соблюдения низкокалорийной диеты;"}},{"type":"paragraph","data":{"text":"- печеночной недостаточности."}},{"type":"paragraph","data":{"text":"Во время приема препарата следует избегать приема алкоголя и лекарственных средств содержащих этанол."}},{"type":"paragraph","data":{"text":"Комбинации требующие осторожности"}},{"type":"paragraph","data":{"text":"Лекарственные средства с непрямым гипергликемическим действием (например глюкокортикостероиды (ГКС) и тетракозактид (системного и местного действия) бета\u003csub\u003e2\u003c/sub\u003e-адреномимегики даназол хлорпромазин при приеме в больших дозах (100 мг в день) и диуретики: может потребоваться более частый контроль концентрации глюкозы в крови особенно в начале лечения. При необходимости доза препарата Метформин МВ может быть скорректирована в процессе лечения и после его прекращения исходя из концентрации глюкозы в крови."}},{"type":"paragraph","data":{"text":"Диуретики: одновременный прием \"петлевых\" диуретиков может привести к развитию лактоацидоза из-за возможной функциональной почечной недостаточности."}},{"type":"paragraph","data":{"text":"При одновременном применении препарата Метформин МВ с производными сульфонилмочевины инсулином акарбозой салицилатами возможно развитие гипогликемии."}},{"type":"paragraph","data":{"text":"Нифедипин повышает абсорбцию и С\u003csub\u003em\u003c/sub\u003e\u003csub\u003eах\u003c/sub\u003e метформина."}},{"type":"paragraph","data":{"text":"Катионные лекарственные средства (амилорид дигоксин морфин прокаинамид хинидин хинин ранитидин триамтерен триметоприм и Ванкомицин) секретирующиеся в почечных канальцах конкурируют с метформином за канальцевые транспортные системы и могут приводить к увеличению его С\u003csub\u003em\u003c/sub\u003e\u003csub\u003eах\u003c/sub\u003e."}},{"type":"paragraph","data":{"text":"Колесевелам при одновременном применении с метформином в форме таблеток е пролонгированным высвобождением увеличивает концентрацию метформина в плазме крови (увеличение AUC без значительного увеличения С\u003csub\u003em\u003c/sub\u003e\u003csub\u003eах\u003c/sub\u003e)."}}]},{"id":16,"name":"Особые указания","slug":"","body":[{"type":"paragraph","data":{"text":"Лактоацидоз"}},{"type":"paragraph","data":{"text":"Лактоацидоз является редким но серьезным осложнением (высокая смертность при отсутствии неотложного лечения) которое может возникнуть из-за кумуляции метформина. Случаи лактоацидоза при приеме метформина возникали в основном у пациентов с сахарным диабетом с выраженной почечной недостаточностью."}},{"type":"paragraph","data":{"text":"Следует учитывать и другие сопряженные факторы риска такие как декомпенсированный сахарный диабет кетоз продолжительное голодание алкоголизм печеночная недостаточность и любое состояние связанное с выраженной гипоксией. Это может помочь снизить частоту случаев возникновения лактоацидоза."}},{"type":"paragraph","data":{"text":"Следует учитывать риск развития лактоацидоза при появлении неспецифических признаков таких как мышечные судороги сопровождающиеся диспепсическими расстройствами болью в животе и выраженной астенией."}},{"type":"paragraph","data":{"text":"Лактоацидоз характеризуется сильным недомоганием с общей слабостью ацидотической одышкой рвотой болью в животе мышечными судорогами и гипотермией с последующей комой. Диагностическими лабораторными показателями являются снижение pH крови (менее 725) концентрация лактата в плазме крови свыше 5 ммоль/л повышенные анионный промежуток и отношение лактат/пируват. При подозрении на лактоацидоз необходимо прекратить прием препарата и немедленно обратиться к врачу."}},{"type":"paragraph","data":{"text":"Хирургические операции"}},{"type":"paragraph","data":{"text":"Применение метформина должно быть прекращено за 48 ч до проведения плановых хирургических операций и может быть продолжено не ранее чем через 48 ч после при условии что в ходе обследования почечная функция была признана нормальной."}},{"type":"paragraph","data":{"text":"Функция почек"}},{"type":"paragraph","data":{"text":"Поскольку метформин выводится почками перед началом лечения и регулярно в последующем необходимо определять клиренс креатинина: не реже одного раза в год у пациентов с нормальной функцией почек и 2-4 раза в год у пожилых пациентов а также у пациентов с клиренсом креатинина на нижней границе нормы."}},{"type":"paragraph","data":{"text":"В случае клиренса креатинина менее 45 мл/мин применение препарата противопоказано. Следует проявлять особую осторожность при возможном нарушении функций почек у пожилых пациентов при одновременном применении диуретиков или нестероидных противовоспалительных препаратов."}},{"type":"paragraph","data":{"text":"Сердечная недостаточность"}},{"type":"paragraph","data":{"text":"Пациенты с сердечной недостаточностью имеют более высокий риск развития гипоксии и почечной недостаточности. Пациентам с хронической сердечной недостаточностью следует регулярно проводить мониторинг сердечной функции и функции почек во время приема метформина. Прием метформина при острой сердечной недостаточности и хронической сердечной недостаточности с нестабильными показателями гемодинамики противопоказан."}},{"type":"paragraph","data":{"text":"Другие меры предосторожности"}},{"type":"paragraph","data":{"text":"- Пациентам рекомендуется продолжать соблюдать диету с равномерным потреблением углеводов в течение дня. Пациентам с избыточной массой тела рекомендуется продолжать соблюдать гипокалорийную диету (но не менее 1000 ккал/сут). Также пациентам следует регулярно делать физические упражнения."}},{"type":"paragraph","data":{"text":"- Пациенты должны информировать врача о каком-либо проводимом лечении и любых инфекционных заболеваниях таких как простуда инфекции дыхательных путей или инфекции мочевыводящих путей."}},{"type":"paragraph","data":{"text":"- Рекомендуется регулярно проводить стандартные лабораторные анализы для контроля сахарного диабета."}},{"type":"paragraph","data":{"text":"- Метформин при монотерапии не вызывает гипогликемию однако рекомендуется проявлять осторожность при его применении в комбинации с инсулином или другими пероральными гипогликемическими средствами (например производными сульфонилмочевины или репаглинидом и др.). Симптомами гипогликемии являются слабость головная боль головокружение повышенное потоотделение учащенное сердцебиение нарушение зрения или нарушение концентрации внимания."}},{"type":"paragraph","data":{"text":"- Необходимо предупредить пациента что неактивные компоненты препарата Метформин МВ могут выделяться в неизмененном виде через кишечник что не влияет на терапевтическую активность препарата."}}]},{"id":17,"name":"Влияние на способность управлять автомобилем и движущимися механизмами","slug":"","body":[{"type":"paragraph","data":{"text":"Монотерапия препаратом Метформин МВ не вызывает гипогликемии поэтому не влияет на способность управлять транспортными средствами и механизмами."}},{"type":"paragraph","data":{"text":"Тем не менее возможно развитие гипогликемии при применении метформина в сочетании с другими гипогликемическими препаратами (производные сульфонилмочевины инсулин репаглинид и др.). При появлении симптомов гипогликемии не следует управлять транспортными средствами и механизмами."}}]},{"id":18,"name":"Форма выпуска","slug":"","body":[{"type":"paragraph","data":{"text":"Таблетки с пролонгированным высвобождением 500 мг"}}]},{"id":19,"name":"Условия хранения","slug":"storage","body":[{"type":"paragraph","data":{"text":"В защищенном от света месте при температуре нс выше 25 °С."}},{"type":"paragraph","data":{"text":"Хранить в недоступном для детей месте."}}]},{"id":20,"name":"Срок годности","slug":"expiry_date","body":[{"type":"paragraph","data":{"text":"3 года."}},{"type":"paragraph","data":{"text":"Не применять по истечении срока годности."}}]},{"id":21,"name":"Условия отпуска","slug":"release_condition","body":[{"type":"paragraph","data":{"text":"По рецепту"}}]},{"id":22,"name":"Производитель","slug":"","body":[{"type":"paragraph","data":{"text":"Общество с ограниченной ответственностью \"Изварино Фарма\" "}}]},{"id":23,"name":"Организация, принимающая претензии потребителей","body":[{"type":"paragraph","data":{"text":"ООО \"Изварино Фарма\""}}]}],"source":null},"description_toggle":false,"short_description":"Метформин - бигуанид с гипогликемическим действием снижающий как базальную так и постпрандиальную концентрацию глюкозы в плазме крови lie стимулирует секрецию инсулина и в связи с этим нс вызывает гипогликемии. Повышает чувствительность периферических рецепторов к инсулину и утилизацию глюкозы клетками. Снижает выработку глюкозы печенью за счет ингибирования глюконеогенеза и гликогенолиза. Задерживает всасывание глюкозы в кишечнике. Метформин стимулирует синтез гликогена воздействуя на гликогенсинтазу. Увеличивает транспортную емкость всех типов мембранных переносчиков глюкозы. На фоне приема метформина масса тела пациента либо остается стабильной либо умеренно снижается. Метформин оказывает благоприятный эффект на метаболизм липидов: снижает концентрацию общего холестерина липопротеинов низкой плотности и триглицеридов. Всасывание После перорального приема препарата в форме таблетки с пролонгированным высвобождением всасывание метформина замедлено по сравнению с таблеткой с обычным высвобождением метформина. Время достижения максимальной концентрации в плазме крови (ТСmах)после однократного приема внутрь 1таблетки с пролонгированным высвобождением в дозе 1000 мг составляет 5-7 часов (в диапазоне от 4 до 12 часов). В то же время ТСmахдля таблетки с обычным высвобождением составляет 25 час. В равновесном состоянии идентичном равновесному состоянию метформина с обычным высвобождением максимальная концентрация (Сmах) и площадь под кривой \"концентрация-время\" (AUC) увеличиваются непропорционально принимаемой дозе. После однократного приема внутрь 2000 мг метформина в форме таблеток с пролонгированным высвобождением AUC аналогична наблюдаемой после приема 1000 мг метформина в форме таблеток с обычным высвобождением два раза в сутки. Внутрииндивидуальная вариабельность Сmахи AUC после приема метформина в форме таблеток с пролонгированным высвобождением аналогична наблюдаемой после приема метформина в форме таблеток с обычным высвобождением. Всасывание метформина из таблеток с пролонгированным высвобождением не изменяется в зависимости от состава принимаемой пищи. Не наблюдается кумуляции при многократном приеме до 2000 мг метформина в форме таблеток с пролонгированным высвобождением. Распределение Связь с белками плазмы незначительна. Сmахв крови ниже Сmахв плазме и достигается примерно через такое же время. Средний объем распределения (Vd) колеблется в диапазоне 63-276 л. Метаболизм Метаболитов у человека не обнаружено. Выведение Метформин выводится в неизмененном виде почками. Почечный клиренс метформина составляет \u003e 400 мл/мин что указывает что метформин выводится за счет клубочковой фильтрации и канальцевой секреции. После перорального приема период полувыведения составляет около 65 час. При нарушении функции почек клиренс метформина снижается пропорционально клиренсу креатинина увеличивается период полувыведения что может приводить к увеличению концентрации метформина в плазме крови.","substance":[{"id":480,"title":"Метформин","title_latin":"Metforminum","slug":"metformin_480"}],"branding":null,"valid_for_quick_buy":false,"is_available_to_delivery":false,"comments":null,"image_alt":"Метформин МВ - фото упаковки","image_share":{"isTouch":{"default":"https://vseapteki.ru/cropping/thumbnails/101/80429/share_default/"},"isFromTablet":{"default":"https://vseapteki.ru/cropping/thumbnails/101/80429/share_default/"}},"diseases":[],"other_packages":[],"other_product_forms":[],"related_products":{"title":"Аналоги","type":"analogs","products":[{"id":103246,"title":"Глюкофаж","subtitle":{"full":"Таблетки, 30 шт, 1000 мг","short":"Таблетки, 30 шт, 1000 мг","package":"30 шт, 1000 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