Метформин - пероральное гипогликемическое средство из группы... Инструкция
Показания к применению
— сахарный диабет 2 типа у взрослых (особенно у пациентов с ожирением) при неэффективности диеты и физических нагрузок в качестве монотерапии или в комбинации с другими пероральными гипогликемическими средствами или инсулином.
Противопоказания
Повышенная чувствительность к метформину или к любому вспомогательному веществу препарата
Метформин - пероральное гипогликемическое средство из группы бигуанидов. У больных сахарным диабетом снижает концентрацию глюкозы в крови путем угнетения глюконеогенеза в печени, уменьшения всасывания глюкозы из ЖКТ и повышения ее утилизации в тканях за счет повышения их чувствительности к инсулину (преимущественно поперечно-полосатой мускулатуры, в меньшей степени - жировой ткани). Не стимулирует секрецию инсулина, гипогликемических реакций не вызывает. Оказывает влияние на липидный обмен - снижает концентрацию в сыворотке крови триглицеридов, холестерина и липопротеинов низкой плотности. Стимулирует внутриклеточный гликогенез, активируя гликогенсинтазу.
Показания к применению
— сахарный диабет 2 типа у взрослых (особенно у пациентов с ожирением) при неэффективности диеты и физических нагрузок в качестве монотерапии или в комбинации с другими пероральными гипогликемическими средствами или инсулином.
Противопоказания
Повышенная чувствительность к метформину или к любому вспомогательному веществу препарата
Почечная недостаточность или нарушение функции почек (КК менее 60 мл/мин)
Острые состояния, протекающие с риском развития нарушений функции почек
Дегидратация (при диарее, рвоте), лихорадка, тяжелые инфекционные заболевания
Состояния гипоксии (шок, сепсис, почечные инфекции, бронхолегочные заболевания)
Клинически выраженные проявления острых и хронических заболеваний, которые могут приводить к развитию тканевой гипоксии (в том числе, сердечная или дыхательная недостаточность, острый инфаркт миокарда)
Обширные хирургические операции и травмы, когда показано проведение инсулинотерапии
Печеночная недостаточность, нарушение функции печени
Применение в течение не менее 48 ч до и в течение 48 ч после проведения радиоизотопных или рентгенологических исследований с введением йодсодержащего контрастного вещества
Период не менее 48 ч до и в течение 48 ч после хирургических вмешательств под общим наркозом, спинномозговой или перидуральной анестезией
С осторожностью: у лиц старше 60 лет, выполняющих тяжелую физическую работу (повышенная опасность развития лактоацидоза).
Применение при беременности и в период грудного вскармливания
Препарат противопоказан к применению при беременности и в период грудного вскармливания.; При планировании или наступлении беременности Метформин-Тева следует отменить и назначить инсулинотерапию. Пациентку следует предупредить о необходимости поставить в известность врача в случае наступления беременности. За матерью и ребенком следует установить наблюдение.; Неизвестно, выделяется ли метформин с грудным молоком. При необходимости применения препарата в период лактации следует прекратить грудное вскармливание.
Способ применения и дозы
Внутрь, во время или непосредственно после еды.; Монотерапия и комбинированная терапия с другими пероральными гипогликемическими; средствами; Начальная доза: 500-1000 мг 1 раз в сутки вечером. Через 7-15 дней при отсутствии неблагоприятных эффектов со стороны ЖКТ назначают по 500-1000 мг 2 раза в сутки утром и вечером. Возможно дальнейшее постепенное увеличение дозы в зависимости от концентрации глюкозы в крови.; Поддерживающая доза: 1500-2000 мг/сут. Для уменьшения побочных явлений со стороны ЖКТ дозу следует разделить на 2-3 приема. Максимальная доза: 3000 мг/сут в 3 приема. Медленное увеличение дозы может способствовать улучшению желудочно-кишечной переносимости препарата.; Пациенты, принимающие метформин в дозах 2000-3000 мг/сут, могут быть переведены на прием дозы 1000 мг. Максимальная рекомендованная доза: 3000 мг/сут в 3 приема. При переходе на терапию с другого гипогликемического средства следует прекратить прием другого средства и начать прием препарата Метформин-Тева в дозе, указанной выше.; Комбинации с инсулином; Препарат Метформин-Тева и инсулин можно применять в виде комбинированной терапии для достижения лучшего гликемического контроля.; Препарат Метформин-Тева назначается в обычной начальной дозе 500 мг или 850 мг 2-3 раза в сутки. Дозу инсулина подбирают на основании результатов измерения глюкозы крови. Через 10-15 дней дозу корректируют в зависимости от концентрации глюкозы в крови. Максимальная доза метформина при комбинированном лечении: 2 г/сут в 2-3 приема.; У пожилых пациентов суточная доза не должна превышать 1000 мг/сут.
Побочное действие
Побочные эффекты классифицированы в соответствии со следующей частотой: очень часто - не менее 10%; часто - не менее 1%, но менее 10%; нечасто - не менее 0.1%, но менее 1%; редко - не менее 0.01%, но менее 0.1%; очень редко - менее 0.01%, включая единичные случаи.; Со стороны центральной нервной системы: часто - нарушение вкуса (металлический привкус во рту).; Со стороны пищеварительной системы: очень часто - тошнота, рвота, боли в животе, отсутствие аппетита, возникающие в начальный период лечения и в большинстве случаев спонтанно проходящие; единичные случаи - нарушение показателей функции печени или гепатит, полностью исчезающие после отмены препарата.; Аллергические реакции: очень редко - эритема, кожный зуд, сыпь.; Со стороны обмена веществ: очень часто - лактоацидоз (требует отмены препарата).; Прочие: очень редко - при длительном применении развивается гиповитаминоз B12.
Передозировка
Симптомы; При применении метформина в дозе 85 г не наблюдалось гипогликемии, однако отмечалось развитие лактоацидоза. Ранними симптомами лактоацидоза являются тошнота, рвота, диарея, снижение температуры тела, боли в животе, боли в мышцах, в дальнейшем может отмечаться учащение дыхания, головокружение, нарушение сознания и развитие комы.; Лечение; В случае появления признаков лактоацидоза лечение препаратом необходимо немедленно прекратить, больного срочно госпитализировать и, определив концентрацию лактата, уточнить диагноз. Наиболее эффективным мероприятием по выведению из организма лактата и метформина является гемодиализ. Проводят также симптоматическое лечение.
Особые указания
В период лечения препаратом Метформин-Тева необходимо регулярно контролировать концентрацию глюкозы в крови натощак и после еды.; Пациента следует предупредить о необходимости прекратить прием препарата и обратиться к врачу при появлении рвоты, болей в животе, мышечных болей, общей слабости и сильного недомогания. Данные симптомы могут быть признаком начинающегося лактоацидоза. Препарат Метформин-Тева следует отменить за 48 ч до и в течение 48 ч после проведения рентгенологического исследования (в т.ч. урографии, внутривенной ангиографии) с применением рентгеноконтрастных средств.; Препарат Метформин-Тева следует отменить за 48 ч до и в течение 48 ч после хирургических вмешательств под общим наркозом, спинномозговой или перидуралыюй анестезией. Поскольку метформин выводится почками, перед началом лечения и регулярно в последующем следует определять КК: у пациентов с сохраненной функцией почек 1 раз в год, у пациентов с пониженным КК и у пожилых пациентов 2-4 раза в год.; Особую осторожность следует проявлять при нарушении функции почек, например, в начальный период терапии антигипертензивными средствами, диуретиками, НПВП.; Следует проинформировать пациента о необходимости обращения к врачу-при появлении симптомов бронхолегочной инфекции или инфекционного заболевания мочеполовых органов. На фоне применения препарата Метформин-Тева следует воздерживаться от приема алкоголя, в связи с повышенным риском развития гипогликемии и дисульфирамоподобного эффекта. Гиповитаминоз B12 при приеме препарата Метформин-Тева обусловлен нарушением всасывания витамина B12 и имеет обратимый характер. При отмене препарата Метформин-Тева признаки гиповитаминоза B12 быстро исчезают.; Влияние на способность к вождению автотранспорта и управлению механизмами; Монотерапия препаратом Метформин-Тева не вызывает гипогликемии и поэтому не влияет на способность управлять автомобилем и работать с механизмами. При применении препарата Метформин-Тева с другими гипогликемическими средствами (производными сульфонилмочевины, инсулином и т.д.) возможно развитие гипогликемических состояний, при которых ухудшается способность к вождению автотранспорта и занятию другими потенциально опасными видами деятельности, требующими повышенного внимания и быстрых психомоторных реакций.
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У больных сахарным диабетом снижает концентрацию глюкозы в крови путем угнетения глюконеогенеза в печени, уменьшения всасывания глюкозы из ЖКТ и повышения ее утилизации в тканях за счет повышения их чувствительности к инсулину (преимущественно поперечно-полосатой мускулатуры, в меньшей степени - жировой ткани). Не стимулирует секрецию инсулина, гипогликемических реакций не вызывает. Оказывает влияние на липидный обмен - снижает концентрацию в сыворотке крови триглицеридов, холестерина и липопротеинов низкой плотности. Стимулирует внутриклеточный гликогенез, активируя гликогенсинтазу."}}]},{"id":3,"name":"Показания к применению","slug":"indications","displayInMenu":true,"body":[{"type":"paragraph","data":{"text":"— сахарный диабет 2 типа у взрослых (особенно у пациентов с ожирением) при неэффективности диеты и физических нагрузок в качестве монотерапии или в комбинации с другими пероральными гипогликемическими средствами или инсулином."}}]},{"id":4,"name":"Противопоказания","slug":"contraindications","displayInMenu":true,"body":[{"type":"list","data":{"style":"unordered","items":["Повышенная чувствительность к метформину или к любому вспомогательному веществу препарата","Диабетический кетоацидоз, диабетическая прекома, кома","Почечная недостаточность или нарушение функции почек (КК менее 60 мл/мин)","Острые состояния, протекающие с риском развития нарушений функции почек","Дегидратация (при диарее, рвоте), лихорадка, тяжелые инфекционные заболевания","Состояния гипоксии (шок, сепсис, почечные инфекции, бронхолегочные заболевания)","Клинически выраженные проявления острых и хронических заболеваний, которые могут приводить к развитию тканевой гипоксии (в том числе, сердечная или дыхательная недостаточность, острый инфаркт миокарда)","Обширные хирургические операции и травмы, когда показано проведение инсулинотерапии","Печеночная недостаточность, нарушение функции печени","Хронический алкоголизм, острое отравление алкоголем","Лактоацидоз (в т.ч. в анамнезе)","Применение в течение не менее 48 ч до и в течение 48 ч после проведения радиоизотопных или рентгенологических исследований с введением йодсодержащего контрастного вещества","Период не менее 48 ч до и в течение 48 ч после хирургических вмешательств под общим наркозом, спинномозговой или перидуральной анестезией","Соблюдение гипокалорийной диеты (менее 1000 ккал/сут)","Детский возраст до 18 лет"]}},{"type":"paragraph","data":{"text":"С осторожностью: у лиц старше 60 лет, выполняющих тяжелую физическую работу (повышенная опасность развития лактоацидоза)."}}]},{"id":5,"name":"Применение при беременности и в период грудного вскармливания","slug":"pregnancy_warnings","displayInMenu":true,"body":[{"type":"paragraph","data":{"text":"Препарат противопоказан к применению при беременности и в период грудного вскармливания.; При планировании или наступлении беременности Метформин-Тева следует отменить и назначить инсулинотерапию. Пациентку следует предупредить о необходимости поставить в известность врача в случае наступления беременности. За матерью и ребенком следует установить наблюдение.; Неизвестно, выделяется ли метформин с грудным молоком. При необходимости применения препарата в период лактации следует прекратить грудное вскармливание."}}]},{"id":6,"name":"Способ применения и дозы","slug":"dosage","displayInMenu":true,"body":[{"type":"paragraph","data":{"text":"Внутрь, во время или непосредственно после еды.; Монотерапия и комбинированная терапия с другими пероральными гипогликемическими; средствами; Начальная доза: 500-1000 мг 1 раз в сутки вечером. Через 7-15 дней при отсутствии неблагоприятных эффектов со стороны ЖКТ назначают по 500-1000 мг 2 раза в сутки утром и вечером. Возможно дальнейшее постепенное увеличение дозы в зависимости от концентрации глюкозы в крови.; Поддерживающая доза: 1500-2000 мг/сут. Для уменьшения побочных явлений со стороны ЖКТ дозу следует разделить на 2-3 приема. Максимальная доза: 3000 мг/сут в 3 приема. Медленное увеличение дозы может способствовать улучшению желудочно-кишечной переносимости препарата.; Пациенты, принимающие метформин в дозах 2000-3000 мг/сут, могут быть переведены на прием дозы 1000 мг. Максимальная рекомендованная доза: 3000 мг/сут в 3 приема. При переходе на терапию с другого гипогликемического средства следует прекратить прием другого средства и начать прием препарата Метформин-Тева в дозе, указанной выше.; Комбинации с инсулином; Препарат Метформин-Тева и инсулин можно применять в виде комбинированной терапии для достижения лучшего гликемического контроля.; Препарат Метформин-Тева назначается в обычной начальной дозе 500 мг или 850 мг 2-3 раза в сутки. Дозу инсулина подбирают на основании результатов измерения глюкозы крови. Через 10-15 дней дозу корректируют в зависимости от концентрации глюкозы в крови. Максимальная доза метформина при комбинированном лечении: 2 г/сут в 2-3 приема.; У пожилых пациентов суточная доза не должна превышать 1000 мг/сут."}}]},{"id":7,"name":"Побочное действие","slug":"side_effects","displayInMenu":true,"body":[{"type":"paragraph","data":{"text":"Побочные эффекты классифицированы в соответствии со следующей частотой: очень часто - не менее 10%; часто - не менее 1%, но менее 10%; нечасто - не менее 0.1%, но менее 1%; редко - не менее 0.01%, но менее 0.1%; очень редко - менее 0.01%, включая единичные случаи.; Со стороны центральной нервной системы: часто - нарушение вкуса (металлический привкус во рту).; Со стороны пищеварительной системы: очень часто - тошнота, рвота, боли в животе, отсутствие аппетита, возникающие в начальный период лечения и в большинстве случаев спонтанно проходящие; единичные случаи - нарушение показателей функции печени или гепатит, полностью исчезающие после отмены препарата.; Аллергические реакции: очень редко - эритема, кожный зуд, сыпь.; Со стороны обмена веществ: очень часто - лактоацидоз (требует отмены препарата).; Прочие: очень редко - при длительном применении развивается гиповитаминоз B12."}}]},{"id":8,"name":"Передозировка","slug":"overdose","displayInMenu":true,"body":[{"type":"paragraph","data":{"text":"Симптомы; При применении метформина в дозе 85 г не наблюдалось гипогликемии, однако отмечалось развитие лактоацидоза. Ранними симптомами лактоацидоза являются тошнота, рвота, диарея, снижение температуры тела, боли в животе, боли в мышцах, в дальнейшем может отмечаться учащение дыхания, головокружение, нарушение сознания и развитие комы.; Лечение; В случае появления признаков лактоацидоза лечение препаратом необходимо немедленно прекратить, больного 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":9,"name":"Особые указания","slug":"cautions","displayInMenu":true,"body":[{"type":"paragraph","data":{"text":"В период лечения препаратом Метформин-Тева необходимо регулярно контролировать концентрацию глюкозы в крови натощак и после еды.; Пациента следует предупредить о необходимости прекратить прием препарата и обратиться к врачу при появлении рвоты, болей в животе, мышечных болей, общей слабости и сильного недомогания. Данные симптомы могут быть признаком начинающегося лактоацидоза. Препарат Метформин-Тева следует отменить за 48 ч до и в течение 48 ч после проведения рентгенологического исследования (в т.ч. урографии, внутривенной ангиографии) с применением рентгеноконтрастных средств.; Препарат Метформин-Тева следует отменить за 48 ч до и в течение 48 ч после хирургических вмешательств под общим наркозом, спинномозговой или перидуралыюй анестезией. Поскольку метформин выводится почками, перед началом лечения и регулярно в последующем следует определять КК: у пациентов с сохраненной функцией почек 1 раз в год, у пациентов с пониженным КК и у пожилых пациентов 2-4 раза в год.; Особую осторожность следует проявлять при нарушении функции почек, например, в начальный период терапии антигипертензивными средствами, диуретиками, НПВП.; Следует проинформировать пациента о необходимости обращения к врачу-при появлении симптомов бронхолегочной инфекции или инфекционного заболевания мочеполовых органов. На фоне применения препарата Метформин-Тева следует воздерживаться от приема алкоголя, в связи с повышенным риском развития гипогликемии и дисульфирамоподобного эффекта. Гиповитаминоз B12 при приеме препарата Метформин-Тева обусловлен нарушением всасывания витамина B12 и имеет обратимый характер. При отмене препарата Метформин-Тева признаки гиповитаминоза B12 быстро исчезают.; Влияние на способность к вождению автотранспорта и управлению механизмами; Монотерапия препаратом Метформин-Тева не вызывает гипогликемии и поэтому не влияет на способность управлять автомобилем и работать с механизмами. При применении препарата Метформин-Тева с другими гипогликемическими средствами (производными сульфонилмочевины, инсулином и т.д.) возможно развитие гипогликемических состояний, при которых ухудшается способность к вождению автотранспорта и занятию другими потенциально опасными видами деятельности, требующими повышенного внимания и быстрых психомоторных реакций."}}]}],"source":{"title":"36.6","url":"https://366.ru"}},"description_toggle":false,"short_description":"Метформин - пероральное гипогликемическое средство из группы бигуанидов. У больных сахарным диабетом снижает концентрацию глюкозы в крови путем угнетения глюконеогенеза в печени, уменьшения всасывания глюкозы из ЖКТ и повышения ее утилизации в тканях за счет повышения их чувствительности к инсулину (преимущественно поперечно-полосатой мускулатуры, в меньшей степени - жировой ткани). Не стимулирует секрецию инсулина, гипогликемических реакций не вызывает. 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