Сахарный диабет 2 типа у взрослых при неэффективности диетотерапии.
Противопоказания
Сахарный диабет 1 типа, кетоацидоз, диабетическая прекома и кома, тяжелые нарушения микроциркуляции, инфекционные заболевания, выраженные нарушения функции почек и/или печени. Повышенная чувствительность к производным сульфонилмочевины и сульфаниламидным препаратам. Не применяют при проведении серьезных хирургических вмешательств.
Пероральное гипогликемическое средство, производное сульфонилмочевины II поколения. Стимулирует секрецию инсулина β-клетками поджелудочной железы, увеличивает высвобождение инсулина. Действует главным образом во время второй стадии секреции инсулина. Повышает чувствительность периферических тканей к инсулину и степень его связывания с клетками-мишенями. Оказывает гиполипидемическое действие, снижает тромбогенные свойства крови.
Показания к применению
Сахарный диабет 2 типа у взрослых при неэффективности диетотерапии.
Противопоказания
Сахарный диабет 1 типа, кетоацидоз, диабетическая прекома и кома, тяжелые нарушения микроциркуляции, инфекционные заболевания, выраженные нарушения функции почек и/или печени. Повышенная чувствительность к производным сульфонилмочевины и сульфаниламидным препаратам. Не применяют при проведении серьезных хирургических вмешательств.
Способ применения и дозы
Дозу устанавливают индивидуально, в зависимости от возраста, степени тяжести диабета, уровня гликемии натощак и через 2 ч после еды.Средняя доза составляет 2.5-15 мг/сут, частота приема - 1-3 раза/сут. Принимают за 20-30 мин до еды. В дозах более 15 мг/сут используется в редких случаях и не вызывает существенного усиления гипогликемического эффекта. Для пожилых пациентов начальная доза составляет 1 мг/сут.При переходе с бигуанидов начальная доза глибенкламида составляет 2.5 мг/сут. Бигуаниды следует отменить, а доза глибенкламида при необходимости может быть повышена на 2.5 мг каждые 5-6 дней до компенсации нарушений углеводного обмена. При отсутствии компенсации в течение 4-6 недель необходимо планировать комбинированную терапию глибенкламидом и бигуанидами.
Побочное действие
Со стороны эндокринной системы: гипогликемия вплоть до комы (вероятность ее развития повышается при нарушении режима дозирования и неадекватной диете). Аллергические реакции: кожная сыпь, зуд.Со стороны пищеварительной системы: тошнота, диарея, чувство тяжести в области эпигастрия; редко - нарушения функции печени, холестаз. Со стороны ЦНС и периферической нервной системы: редко - парезы, нарушения чувствительности, головная боль, усталость, слабость, головокружение.Со стороны системы кроветворения: редко - нарушения кроветворения вплоть до развития панцитопении.Дерматологические реакции: редко - фотосенсибилизация.
Взаимодействие с другими лекарственными средствами
Усиление гипогликемического действия глибенкламида возможно при одновременном применении бета-адреноблокаторов, анаболических средств, аллопуринола, циметидина, клофибрата, циклофосфамида, изобарина, ингибиторов МАО, сульфонамидов длительного действия, салицилатов, хлорамфеникола, тетрациклинов, этанолсодержащих препаратов.Ослабление действия глибенкламида и развитие гипергликемии возможно при одновременном применении барбитуратов, хлорпромазина, фенотиазинов, фенитоина, диазоксида, ацетазоламида, глюкокортикоидов, симпатомиметических средств, глюкагона, индометацина, высоких доз никотинатов, контрацептивов для приема внутрь и эстрогенов, салуретиков, гормонов щитовидной железы, солей лития, высоких доз слабительных средств.
Особые указания
С осторожностью применяют у пациентов с патологией печени и почек (в т.ч. в анамнезе), а также при лихорадочных состояниях, нарушениях функции надпочечников, щитовидной железы, при хроническом алкоголизме.Во время терапии необходим регулярный контроль содержания глюкозы в крови и суточной экскреции глюкозы с мочой.При развитии гипогликемии, если пациент находится в сознании, глюкозу (или раствор сахара) назначают внутрь. При потере сознания вводят глюкозу в/в или глюкагон п/к, в/м или в/в. После восстановления сознания необходимо дать больному пищу, богатую углеводами, во избежание повторного развития гипогликемии.Пациентам, принимающим глибенкламид, следует воздерживаться от приема алкоголя. В случае употребления алкоголя возможно развитие дисульфирамоподобных реакций, а также выраженной гипогликемии.
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