19.09.2020

Diabeton, metformin or maninil: which is better? The difference between maninil and diabeton Maninil tablets instructions for use metformin

Tablets for lowering blood sugar - Diabeton. Description and comparison with other drugs.

Diabetes mellitus is an extremely serious disease, it can be called a modern “plague”. Patients face an acute question - what is better to choose from effective available drugs - Maninil or Diabeton? Are there analogues of Diabeton and Metformin?

The number of people affected by this disease is increasing every year. The risk of developing diabetes is significantly increased when a person's lifestyle is associated with the influence of undesirable factors - addictions, lack of sleep, unbalanced nutrition or pancreatic pathologies.

With a diagnosis of diabetes, a person can live a full life if they follow a diet and exercise. However, you still have to use the pills. Doctors often prescribe drugs such as Diabeton and Maninil at the beginning of the development of the disease. Which of these drugs is best for a particular patient, the doctor will be able to determine after the examination.

The indication for the use of this drug is diabetes mellitus (only type 2). Tablets promote the production of insulin and increase tissue sensitivity, as well as reduce the amount of cholesterol and the time indicator (from eating to insulin release). If the kidneys suffer against the background of the underlying disease, the tablets help to lower the level of protein in the urine.

Despite the pronounced effectiveness, the medicine also has contraindications:

Dysfunction of the liver, kidneys
Type 1 diabetes
Coma and pre-coma state
Pronounced sensitivity of the body to sulfanilamide drugs, sulfonylurea.

When making a diagnosis, the doctor prescribes certain exercises, but if they do not help keep the pathology under control, they prescribe medications. The gliclazide component in the composition of the drug helps to increase the amount of insulin produced, that is, it stimulates the work of pancreatic cells.

Reviews of the results of admission from patients are mostly positive. There is a significant decrease in blood glucose. It should be noted that the chance of developing a hypoglycemic process is small - less than 7%.

How to take Diabeton for diabetes? The medicine is convenient to use, because it is required to take it only 1 time per day. Therefore, most patients do not seek to stop taking the drug, but continue to use it for many years. The medicine can provoke a slight weight gain, which usually does not affect the general state of health.

Doctors often choose a medicine for type 2 diabetes - Diabeton because of its ease of use and good tolerability in patients. Many diabetics recognize that it is hard to live on a strict diet and with constant physical activity. And just take 1 tablet a day is very easy.

A significant minus of the remedy is the destructive effect on the beta cells of the pancreas, leading to their death. As a result, the pathology can develop into type 1, more severe. The risk group includes people with a thin physique. The severe stage of the disease usually manifests itself over a period of 2 to 8 years. According to an extensive international study, the drug reduces sugar, but does not affect mortality rates. Before prescribing Diabeton for diabetes, doctors often tend to try drugs based on metformin (for example, Siofor).

Description of Maninila

The indication for the use of the drug is type 2 diabetes mellitus. Its action is aimed at reducing the amount of sugar in the blood. The drug has a beneficial effect on the beta cells of the pancreas, stimulating their work, and also increases the sensitivity of insulin receptors. There are also contraindications:

Extirpation of the pancreas
Type 1 diabetes
Pathological processes in the kidneys, liver
Negative reaction of the body to the components of the drug
Postoperative rehabilitation
Pregnancy, lactation
Bowel obstruction

There are many side effects:

Likely to develop hypoglycemia
Nausea, vomiting
Skin rashes
Icteria and hepatitis
Joint pain
Fever

According to experts, Maninil causes severe damage to the body due to side effects. If we consider Diabeton, its harmfulness is significantly lower.

Metformin

The drug is prescribed for the treatment of patients with type 2 diabetes mellitus. Metformin differs from other similar drugs in its effect, which prevents the development of hyperglycemia. This effect is due to the fact that Metformin lowers glucose not by increasing insulin levels. How does Metformin work? The process begins in the liver, where glucose production is suppressed. At the same time, tissue sensitivity to insulin increases. The liver and muscles begin to absorb sugar much better, and the process of glucose absorption in the intestinal section, on the contrary, proceeds more slowly.

Metformin copes with two tasks - it allows you to control the amount of sugar and prevents blood clots. Thus, the probability of developing pathology of the heart and blood vessels is reduced by 50%. Metformin is often prescribed for overweight and obese patients.

Using Metformin, patients sometimes complain of digestive disorders - diarrhea or dyspepsia. Usually these phenomena stop within a few days. To avoid side effects, you should start using the minimum dosage.

Tablets are recommended to be used after the evening meal, or before going to bed. The medicine should be washed down with a sufficient amount of liquid - tea, water. Only 1 tablet is taken daily. Diabeton or Metformin - which is better to take? If there are no special indications, you can start treatment with the second remedy, in the absence or weakening of the effect, switch to the first.

Preparations Siofor and Glucofage

Metmorphine is the main active ingredient in these drugs. To understand which one is better, one should turn to the pharmacological action.

Siofor has the following effects:

Tissue sensitivity of many organs to insulin increases
Slows down the absorption of sugar from the digestive system
The amount of glucose in the blood decreases
Weight loss and appetite suppression

Diabeton or Siofor - what is better to take? It is impossible to say for sure, the drugs are equally effective and the attending physician should make the choice.

Glucophage also has many advantages:

Normalization of the amount of glucose in the blood
Quality control of glycemia
Reducing the patient's body weight by normalizing protein and fat metabolism
Complications in the underlying disease occur much less frequently compared to other means.

It is possible to take this medicine and other medicines at the same time. Diabeton or Glucophage - which is better to take? Both drugs are good for people with normal or overweight. When choosing, you can focus on the price of the product and the recommendations of the doctor.

Glucovans is a product based on 2 active ingredients. Unlike the drugs Siofor and Glucofage, Glyukovans contains not only metmorphine, but also glibenclamide. The active ingredients of the drug Glucovans affect organs and tissues in different ways, but at the same time they are able to enhance each other's therapeutic effects. Glucovans can be used to start therapy when diet and exercise fail. What is better to take - Glucovans or Diabeton. If possible, at the initial stage of the disease, it is advisable to choose Glucovans.

Amaril

Amaryl is another common drug that is indicated for type 2 diabetes. The active ingredient in Amaryl tablets is glimepiride. The drug Amaryl has no analogues. When using this remedy, some side effects are noted - visual impairment, excessive decrease in sugar levels, digestive disorders. You should start taking Amaryl tablets with a dose of 1 mg (this is one tablet). That is, if the dose needs to be increased, one tablet per day is no longer enough. If you figure out what is better to take - the drug Amaryl or Diabeton, the answer will not be unambiguous. Each of these medications may work better or worse for a particular patient.

When choosing tablets for diabetes - Diabeton, Maninil and any other means, you should rely on the opinion of the attending physician, evaluate financial capabilities and individual characteristics of the body. You can start therapy with more inexpensive and gentle means. If the drug is not suitable, a wide range of effective medicines will always allow a replacement.

2 types are - diet, optimal exercise and hypoglycemic therapy, with one or more hypoglycemic tablets. The modern doctor is armed with several groups of hypoglycemic pills that affect various links in the occurrence and existence of diabetes. A combination of different groups of drugs is possible, but not drugs of the same group. The first group includes hypoglycemic pills that increase the release of insulin in the blood,- these are sulfonylurea drugs and prandial glycemic regulators (glinides). The second group includes drugs that increase the sensitivity of tissues to insulin,- they are boguanids. Preparations of the third group reduce absorption in the intestine. Fourth group drugs-sensitizers- glitazones, which also increase the sensitivity of peripheral tissues to insulin.

Sulfonylureas

Stimulate insulin secretion due to the ability to bind to the beta cell receptor. The drugs in this group include glibenclamide (maninil, including micronized forms 1.75 and 3.5), amaryl, diabeton, glurenorm and glibenez.

Maninil

The bioavailability of the non-micronized form of glibenclamide (maninil 5 mg) is 70%, and its concentration in the blood reaches a maximum 4-6 hours after administration. The half-life (t 1/2) is 10 -12 hours, and the hypoglycemic effect persists for 24 hours. It is excreted from the body by the kidneys (65%) and intestines (35%). Treatment with maninil is recommended to start with 2.5 mg in the morning. If necessary, the dose is increased at weekly intervals by 2.5 mg until compensation is achieved. The daily dose can vary from 2.5 to 20 mg (usually 10-15 mg) and is administered in 2 divided doses. The sometimes used 3-fold intake is not justified in terms of increasing the effectiveness of the drug. Usually the ratio of morning and evening doses is 1:1. The drug is recommended to be taken within 30 minutes. before meals.

The micronized forms that have appeared in recent years (maninil 1.75 and 3.5 mg) are characterized by 100% bioavailability and greater efficiency when used in a smaller single and daily dose, they also provide a complete release of the active substance within 5 minutes. after dissolution and rapid absorption. The maximum concentration is provided after 1.7 hours (1.75 mg) and 2.5 hours (3.5 mg), i.e. at the peak of the increase in sugar after eating. This leads to a decrease in the risk of hypoglycemia between meals, which, no doubt, is relevant for elderly patients. The duration of the hypoglycemic effect of micronized forms is 24 hours. Due to the 100% bioavailability of glibenclamide, the daily requirement for the drug is 30-40% lower compared to the usual form. When ensuring adequate secretion of insulin during the day, this helps to reduce the risk of hypoglycemic conditions. The maximum dose of micronized glibenclamide is 14 mg/day. The average therapeutic dose is 3.75-10 mg. The drug is taken 2 times a day.

Amaril

Glimepiride (Amaryl 1/2/3/4 mg; Glemaz 4 mg) stimulates insulin secretion. However, it has a number of specific features due to the unique structure of the molecule. Due to its unique structure, it binds to the beta cell receptor faster and breaks this connection even faster. These properties contribute to the insulin-sparing effect of glimepiride. The drug does not block the decrease in insulin secretion during exercise, and therefore significantly reduces the risk of hypoglycemic reactions. In addition to stimulating insulin secretion, glimepiride also reduces insulin resistance in peripheral tissues. With prolonged use of the drug, a decrease in body weight of patients is noted. Because the drug is excreted from the body not only with urine, but also with bile, it can be prescribed for moderate or mild renal failure. The duration of action of glimepiride is 24 hours. A single use of the drug (in the morning before breakfast), which provides its necessary concentration during the day, reduces the likelihood of skipping the medication. At the beginning of treatment, 1 mg of glimepiride is prescribed, if necessary, the daily dose of the drug can be increased to a maximum of 8 mg. However, a decrease in fasting blood glucose is achieved only after 1-2 weeks. therapy, in this regard, dose changes should be carried out only after a minimum period of treatment. The dose increase is carried out with regular monitoring of blood sugar levels and gradually, at intervals of 1-2 weeks. in the following order: 1 mg / 2 mg / 3 mg / 4 mg / 6 mg / 8 mg.

Gliclazide

(Diabeton 80 mg, diabeton MB 30 mg; glidiab 30 mg). In addition to the hypoglycemic effect, it has a positive effect on microcirculation, the hemostasis system, some hematological parameters and blood rheological properties, which is extremely important for patients with diabetes. Recently, a new modified-release form of gliclazide, diabeton MB 30 mg, has been predominantly used. This form of the drug was created in order to ensure the release of the active active substance in accordance with fluctuations in the level of glycemia in patients with type 2 diabetes during the day. When interacting with gastrointestinal juice, the hydrophilic matrix of the tablet forms a gel, which leads to a gradual release of the drug. The maximum concentration of the drug is observed in the daytime, at night there is a gradual decrease. Its bioavailability is almost 100%, which allows you to reduce the daily dose to 30-120 mg. And t1/2 is 17 hours. Diabeton MB is taken once a day in the morning. Restoration of the first phase of insulin secretion improves glycemic control after meals and helps to reduce the delayed increase in insulin levels, which leads to a decrease in the frequency of hypoglycemia. Patients taking Diabeton MB do not experience weight gain. All these qualities of the drug allow it to be used in the elderly. Due to the high selectivity for beta-cell receptors, Diabeton MB does not adversely affect the state of the heart. The drug is excreted through the kidneys and gastrointestinal tract.

Gliquidone

(Glurenorm 30 mg). A drug from the sulfonylurea group, the appointment of which is possible for people with moderately severe kidney disease. 95% of the received dose of the drug is excreted through the gastrointestinal tract and only 5% through the kidneys, so the use of this drug is possible even at the initial stage of chronic renal failure, subject to adequate glycemic control.

It should be noted that, compared with other drugs, gliquidone is shorter-acting, so the frequency of administration can be increased up to 3 times a day. The short-term effect of the drug allows correcting hyperglycemia without the risk of developing prolonged hypoglycemia. Glurenorm can be recommended as a "drug of choice" for the treatment of type 2 diabetes with diabetic nephropathy. At the same time, numerous studies have shown the insufficient effectiveness of glurenorm monotherapy.

Glipizide

(Glibenez 5 mg). Currently, it is represented by two main forms: traditional and prolonged (glibenez retard, or GITS: gastrointestinal therapeutic system). Unlike the traditional form, glibenez retard comes from the tablet into the gastrointestinal tract gradually and constantly. The drug has an osmotically active core surrounded by a membrane semi-permeable to water. The tablet core is divided into two layers: an "active" layer containing the drug, and a layer containing inert components with osmolar activity. The membrane surrounding the tablet is permeable to water, but not to the drug or osmotic acceptor. Water from the intestinal tract enters the tablet, increasing the pressure in the osmotic layer, which “squeezes out” the active part of the drug from the central zone. This leads to the release of the drug through the smallest holes formed by the laser in the outer membrane of the tablet. The initial dose of the traditional form of glibenez is 2.5-5 mg, the maximum daily dose is 20 mg. The duration of the drug is 12-24 hours, so it is prescribed 2 times a day before meals. After taking the drug of prolonged action, its concentration in plasma reaches a maximum after 6-12 hours. Effective plasma concentration is maintained for 24 hours, which reduces the number of doses of the drug to 1 time per day. This improves the quality of life of patients, sets up patients for treatment. Glibenez-retard tablets should be swallowed whole, they should not be chewed, divided into parts or broken. In the absence of effect, it is gradually increased to 180 mg in 3 divided doses.

Prandial glycemic regulators (glinides)

Glinides(meglitinides) - stimulate the secretion of insulin by pancreatic beta cells. Glinides bind to their own specific receptor (molecular weight 36 kD), which is part of the ATP-dependent K+ channel. This allows the drugs to be quickly absorbed and quickly excreted from the body. Due to the rapid normalization of the level of stimulated insulin after taking these drugs, the risk of hypoglycemic conditions in between meals is minimized.

Repaglinide (novonorm 0.5/1/2 mg) is currently used in Russia. Repaglinide does not stimulate insulin secretion by beta cells in the absence of glucose in the medium, but at a glucose concentration above 5 mmol / l it is more active than sulfonylurea preparations. Another feature of the drug is the speed of its action. The drug is rapidly absorbed, the onset of action occurs within 5-10 minutes, which allows the patient to take it immediately before meals. The action reaches a maximum in about 30-50 minutes. Insulin levels return to baseline 3 hours after taking the drug, which mimics normal insulin secretion during meals and reduces the likelihood of hypoglycemia in between meals. The excretion of repaglinide and its metabolites is carried out mainly through the gastrointestinal tract (94%), and therefore its use is possible in individuals with a moderate degree of kidney damage. Due to the short half-life, the risk of hypoglycemic conditions almost completely disappears. Dosage - from 0.5 mg to 4 mg before main meals (usually 3-4 times a day). Thus, the drug allows the patient a more flexible approach to the issue of compliance with the diet. In case of skipping a meal (for example, lunch), the drug is also skipped. The maximum dose is 16 mg / day.

Biguanides:

Metformin

(500/850/1000 mg glucophage, metfogamma, siofor, formin). It is the only biguanide recommended for the pharmacotherapy of patients with type 2 diabetes.

The effect of metformin on glycemia can be assessed as antihyperglycemic rather than hypoglycemic, because. the process of reducing glycemia when using this drug is not directly related to an increase in the content of endogenous insulin in the blood. This effect of metformin is due to the following main mechanisms:

Suppression of the formation of glucose in the liver in the liver;

Increased insulin sensitivity and improved glucose uptake in the liver, muscle and adipose tissue;

Slowing down the absorption of glucose in the intestine.

Along with this, metformin has a vasoprotective, lipid-lowering and anti-atherogenic effect; has a positive effect on the hemostasis system and blood rheology, has the ability to inhibit platelet aggregation and reduce the risk of blood clots. Thus, it not only effectively controls the level of glycemia, but also affects numerous risk factors for cardiovascular diseases that are present in most patients with type 2 diabetes. Metformin is the drug of choice in the treatment of patients with type 2 diabetes with overweight or 90% of all diabetic patients.

In 1998, the UKPDS clinical study showed that, unlike other PSSPs (glibenclamide, chlorpropamide, insulin), metformin led to a 32% reduction in the risk of vascular complications of diabetes by 32%, diabetes-related mortality by 42%, and overall mortality. - by 36%, myocardial infarction - by 39%, stroke - by 41%. In addition, the use of metformin reduced the number of angina attacks.

Among the side effects, it should also be noted diarrhea and other dyspeptic phenomena, which are observed in almost 20% of patients, but disappear on their own after a few days. These complications can be avoided by prescribing the minimum dose of the drug (500 mg).

The initial dose of the drug is 500 mg at the last meal (after dinner or at bedtime with a glass of water / tea). If necessary, the dose is gradually increased to 2000 mg / day: 850-1000 mg x 2 times a day. The drug is taken during or after a meal. The effect of prescribing the drug is estimated at 7-10 days from the start of administration. Unlike the usual, the retard form of metformin (bagomet 850 mg) is prescribed once a day.

Insulin sensitizers

Thiazolidinediones(pioglitazone, rosiglitazone) reduce insulin resistance of peripheral tissues. Without stimulating insulin secretion, thiazolidinediones stimulate the synthesis of insulin-sensitive proteins (enzymes) involved in glucose metabolism through special receptors in the cell. As a result of the action of this group of drugs, insulin sensitivity is increased, as it were, “from inside the cell”, as a result of which they received their second name - “insulin sensitizers”. An important clinical effect of the action of thiazolidinediones is the improvement of the lipid profile (the level of HDL increases, the content of triglycerides decreases). Against the background of their use, the severity of microalbuminuria decreases, blood pressure moderately decreases. It takes up to 2-3 months to get the maximum effect from therapy. Currently, in Russia, from the group of insulin sensitizers, the drug rosiglitazone (avandia 4/8 mg) is used. The bioavailability of the drug is 99%. Apply Avandia 1-2 times a day. The daily dose is 4-8 mg (8 mg once in the morning or 4 mg x 2 times a day). Inactivation of the drug occurs in the liver, excreted mainly in the bile. Side effects include swelling and weight gain. With an increase in ALT by 3 or more times compared to normal values, the drug is canceled. Glitazones are contraindicated in patients with chronic heart failure class III and IV.

Alpha-glucosidase inhibitors

Alpha-glucosidase inhibitors (acarbose, glucobay 50/100 mg), which are pseudotetrasaccharides, competitively inhibit intestinal enzymes (alpha-glucosidase) involved in the breakdown of di-, oligo- and polysaccharides. As a result, the digestibility of carbohydrates from food and the flow of glucose into the blood slows down. The drug does not have a stimulating effect on the pancreas, therefore, with acarbose monotherapy, the risk of developing hypoglycemia, especially at night, is excluded. However, with combination therapy, a hypoglycemic reaction may occur. In this case, it must be remembered that in order to stop hypoglycemia, it is necessary to take drugs or products containing glucose (grape juice, glucose tablets), but not ordinary sugar, which will be ineffective. Side effects stem from the mechanism of action of the drug. The development of flatulence and diarrhea depends on the ratio of various types of carbohydrates in the patient's diet. So, with a predominance of starch in the diet, intestinal reactions develop 6 hours later than with a large amount of sucrose. Therefore, the patient should be informed that the occurrence of side effects contributes mainly to the deviation from the recommended diet.

Contraindications for the appointment of acarbose are diseases of the gastrointestinal tract (hernias of various localization, ulcerative colitis, as well as chronic intestinal diseases), occurring with severe disorders of digestion and absorption, acute and chronic hepatitis, pancreatitis, colitis.

The initial dose of acarbose is 50 mg once at bedtime. In case of good tolerability of the drug and the absence of side effects, the dose of the drug can be increased to 300-600 mg / day. (100-200 mg x 3 times a day with meals).

Literature:

Journal Medical Council №2 2007. M.B.ANTSIFEROV, MD, Professor, A.K.

Maninil is designed to control type 2 diabetes (non-insulin dependent form).

Tablets are prescribed to diabetics in addition in the absence of the planned effect after lifestyle modification (low-carbohydrate diet, adequate physical activity, excess weight correction, emotional state control, sleep and rest regimen).

The endocrinologist prescribes the medicine, calculating the treatment regimen taking into account the diet, the age of the patient, the stage of the disease, comorbidities, general well-being and the body's response to the drug. The exact dosage of the drug is determined based on the glycemic profile of the patient.

Clinical and pharmacological group

Oral hypoglycemic drug.

Terms of dispensing from pharmacies

Released by prescription.

Prices

How much does Maninil cost? The average price in pharmacies is at the level of 175 rubles.

Release form and composition

"Maninil" is available in the form of round tablets of pink or pale pink color, packaged in medical glass bottles of 120 pieces each or in cardboard packs (one blister contains 20 tablets). Depending on the content of the active substance, three forms of the drug are distinguished:

"Maninil 1.75" (1.75 mg of glibenclamide);
"Maninil 3.5" (3.5 mg of glibenclamide);
"Maninil 5" (5 mg glibenclamide).

Lactose in the form of monohydrate is used as auxiliary ingredients in the manufacture of the drug, so patients with lactase deficiency should take the drug with caution. The composition of the tablets also contains: potato starch, talc, gelatin, silicon dioxide. The pink color is achieved by adding food additive E124, which is a food coloring.

Pharmacological effect

The active substance of the drug belongs to the category of sulfonylurea derivatives. It has a hypoglycemic effect, making it convenient to use for the treatment of diabetes. Glibenclamide binds to the beta cells of the pancreas, thereby increasing insulin production in the body.

In addition, when taking these pills, insulin sensitivity increases. This contributes to the faster uptake of glucose by muscle tissues. A very important feature of Glibenclamide is its ability to slow down lipolysis, which avoids the development of atherosclerosis. Also, this drug prevents the formation of blood clots. Assimilation of Glibenclamide comes from the digestive tract. This substance begins to act after about 2 hours. The drug actively binds to the proteins contained in the blood plasma. Metabolism is carried out in the liver, with the formation of two metabolites, which are considered inactive. One of them is excreted by the kidneys, the other is eliminated along with the bile.

To remove half of the substance contained in the body, it takes from 3 to 16 hours (this depends on the individual characteristics of the patient). The duration of the effect of the drug is at least 20 hours, while its effect is characterized by softness and physiology.

Indications for use

The drug is prescribed in cases where additional measures, such as moderate exercise, a diet low in sugar, weight loss do not affect the level of glucose in the blood, leading it to normal physiological parameters.

The medicine Maninil for diabetes is indicated for use.

Contraindications

The drug should not be prescribed in the following situations:

Leukopenia;
Diabetic coma and precoma, diabetic ketoacidosis;
Condition after removal of the pancreas;
Paresis of the stomach, intestinal obstruction;
Deficiency of glucose-6-phosphate dehydrogenase;
Pregnancy and the period of breastfeeding (lactation);
Severe liver and kidney failure (with creatinine clearance less than 30 ml per minute);
Hereditary lactose intolerance, lactase deficiency or lactose and glucose malabsorption syndrome;
Age up to 18 years (the effectiveness and safety of using Maninil in this age group of patients have not been studied);
Hypersensitivity to the components of the drug, as well as to other sulfonylurea derivatives, sulfonamides, probenecid, diuretic (diuretic) drugs containing a sulfonamide group in the molecule (due to the possibility of developing cross-reactions);
Decompensation of carbohydrate metabolism in infectious diseases, injuries, burns, or after major surgical operations, when insulin therapy is indicated.

Maninil should be taken with caution in patients with acute alcohol intoxication, chronic alcoholism, febrile syndrome, thyroid diseases (with impaired function), hypofunction of the adrenal cortex or anterior pituitary gland, as well as in patients over 70 years old (due to the risk of hypoglycemia).

Use during pregnancy and lactation

The drug should not be prescribed to patients during breastfeeding and pregnancy.

In the event that pregnancy occurs during therapy, the drug is canceled.

Dosage and method of application

The instructions for use indicate that the dose of the drug Maninil depends on the age, severity of the course of diabetes mellitus, the concentration of glucose in the blood on an empty stomach and 2 hours after a meal.

Maninil should be taken before meals, without chewing and with a small amount of liquid. Daily doses of the drug, up to 2 tablets, should usually be taken 1 time / day - in the morning, immediately before breakfast. Higher doses are divided into morning and evening intake.

The initial dose of the drug Maninil 1.75 is 1-2 tab. (1.75-3.5 mg) 1 time / day. With insufficient effectiveness, under the supervision of a physician, the dose of the drug is gradually increased until the daily dose necessary to stabilize carbohydrate metabolism is reached. Dose increases should be made at intervals of several days to 1 week, until the required therapeutic dose is reached, which should not exceed the maximum. The maximum daily dose of Maninil 1.75 is 6 tab. (10.5 mg).

If the daily dose of glibenclamide exceeds 3 tab. the drug Maninil 1.75, it is recommended to use the drug Maninil 3.5.

The transition from other hypoglycemic drugs to Maninil 1.75 should be started under the supervision of a physician with 1-2 tab. the drug Maninil 1.75 per day (1.75-3.5 mg), gradually increasing the dose to the required therapeutic.

The initial dose of the drug Maninil 3.5 is 1/2-1 tab. (1.75-3 mg) 1 time / day. With insufficient effectiveness, under the supervision of a physician, the dose of the drug is gradually increased until the daily dose necessary to stabilize carbohydrate metabolism is reached. Dose increases should be made at intervals of several days to 1 week, until the required therapeutic dose is reached, which should not exceed the maximum. The maximum daily dose of the drug Maninil 3.5 is 3 tab. (10.5 mg).

The transition from other hypoglycemic drugs to Maninil 3.5 should be started under medical supervision with 1/2-1 tab. the drug Maninil 3.5 per day (1.75-3.5 mg), gradually increasing the dose to the required therapeutic.

Initial dose of Maninil 5 is 1/2-1 tab. (2.5-5 mg) 1 time / day. With insufficient effectiveness, under the supervision of a physician, the dose of the drug is gradually increased until the daily dose necessary to stabilize carbohydrate metabolism is reached. Dose increases should be made at intervals of several days to 1 week, until the required therapeutic dose is reached, which should not exceed the maximum. The maximum daily dose of Maninil 5 is 3 tab. (15 mg).

The transition from other hypoglycemic drugs to Maninil 5 should be started under the supervision of a physician with 1/2-1 tab. the drug Maninil 5 per day (2.5-5 mg), gradually increasing the dose to the required therapeutic one.

In elderly patients, debilitated patients, malnourished patients, in patients with severely impaired renal or hepatic function, the initial and maintenance dose of Maninil should be reduced due to the risk of hypoglycemia.

If you miss one dose of the drug, the next tablet should be taken at the usual time, while taking a higher dose is not allowed.

Side effects

According to patient reviews, Maninil may have side effects, such as:

Hepatitis, intrahepatic cholestasis, temporary increase in liver enzymes (from the biliary tract and liver).
Nausea, belching, feeling of heaviness in the stomach, abdominal pain, vomiting, metallic taste in the mouth, diarrhea (from the digestive system);
Hyperthermia, hunger, drowsiness, tachycardia, weakness, impaired coordination of movements, headache, skin moisture, tremor, fear, general anxiety, transient neurological disorders, weight gain (metabolism).
Thrombocytopenia, pancytopenia, agranulocytosis, leukopenia, hemolytic anemia, erythropenia (from the hematopoietic system).
Itching, petechiae, urticaria, photosensitivity, allergic vasculitis, purpura, anaphylactic shock, generalized allergic reactions accompanied by fever, skin rash, proteinuria, arthralgia and jaundice (from the immune system).

In addition, Maninil can cause increased diuresis, visual disturbances, accommodation disorders, hyponatremia, transient proteinuria, cross-allergy to probenecis, sulfonamides, sulfonylurea derivatives and diuretic drugs containing a sulfonamide group in the molecule.

Overdose

Symptoms of an overdose of the drug are manifested in the form of hypoglycemia, hunger, hyperthermia, tachycardia, drowsiness, weakness, moisture of the skin, impaired coordination of movements, tremor, general anxiety, fear, headache, transient neurological disorders (for example, visual and speech disorders, manifestations of paresis or paralysis or altered perception of sensations). With the progression of hypoglycemia, the patient may lose self-control and consciousness, the development of hypoglycemic coma.

To eliminate the symptoms of an overdose and with mild hypoglycemia, the patient should ingest a piece of sugar, food or drinks with a high sugar content (jam, honey, a glass of sweet tea). In case of loss of consciousness, it is necessary to inject intravenous glucose - 40-80 ml of a 40% dextrose (glucose) solution, then infusion of a 5-10% dextrose solution. Then you can additionally enter 1 mg of glucagon in / in, / m or s / c. If the patient does not regain consciousness, then this measure can be repeated; further intensive care may be required.

special instructions

Before you start using the drug, read the special instructions:

During treatment, prolonged exposure to the sun is not recommended.
Prolonged abstinence from food intake, insufficient supply of carbohydrates, intense physical activity, diarrhea or vomiting are the risk of developing hypoglycemia.
During treatment with Maninil, it is necessary to strictly follow the doctor's recommendations for diet and self-monitoring of blood glucose concentration.
In elderly patients, the risk of developing hypoglycemia is slightly higher, therefore, more careful selection of the dose of the drug and regular monitoring of fasting and postprandial blood glucose concentrations, especially at the beginning of treatment, are necessary.
Simultaneous use of drugs that have an effect on the central nervous system, lowering blood pressure (including beta-blockers), as well as peripheral neuropathy, can mask the symptoms of hypoglycemia.
Major surgical interventions and injuries, extensive burns, infectious diseases with a febrile syndrome may require the abolition of oral hypoglycemic drugs and the appointment of insulin.
Alcohol can provoke the development of hypoglycemia, as well as the development of a disulfiram-like reaction (nausea, vomiting, abdominal pain, a feeling of heat in the skin of the face and upper body, tachycardia, dizziness, headache), so you should refrain from drinking alcohol during treatment with Maninil.

drug interaction

When using the drug, it is necessary to take into account the interaction with other drugs:

Urine acidifying agents (ammonium chloride, calcium chloride) enhance the effect of Maninil by reducing the degree of its dissociation and increasing its reabsorption.
Pentamidine in isolated cases can cause a strong decrease or increase in the concentration of glucose in the blood.
H2-receptor antagonists can, on the one hand, weaken and, on the other hand, enhance the hypoglycemic effect of the drug Maninil.
With simultaneous use with the drug Maninil, the effect of coumarin derivatives may increase or decrease.
Along with an increase in the hypoglycemic effect, beta-blockers, clonidine, guanethidine and reserpine, as well as drugs with a central mechanism of action, can reduce the feeling of precursors of symptoms of hypoglycemia.
The hypoglycemic effect of the drug Maninil may decrease with the simultaneous use of barbiturates, isoniazid, diazoxide, GCS, glucagon, nicotinates (in high doses), phenytoin, phenothiazines, rifampicin, thiazide diuretics, acetazolamide, oral contraceptives and estrogens, thyroid hormone preparations, sympathomimetic agents, blockers of slow calcium channels, lithium salts.

An increase in the hypoglycemic effect of the drug Maninil is possible when taken simultaneously with ACE inhibitors, anabolic agents and male sex hormones, other oral hypoglycemic agents (for example, acarbose, biguanides) and insulin, azapropazone, NSAIDs, beta-blockers, quinolone derivatives, chloramphenicol, clofibrate and its analogues, coumarin derivatives, disopyramide, fenfluramine, antifungal drugs (miconazole, fluconazole), fluoxetine, MAO inhibitors, PAS, pentoxifylline (in high doses for parenteral administration), perhexilin, pyrazolone derivatives, phosphamides (for example, cyclophosphamide, ifosfamide, trophosfamide) , probenecid, salicylates, sulfonamides, tetracyclines and tritoqualin.

The use of drugs Maninil and Diabeton effectively relieves hyperglycemia, which develops as a result of the progression of type 2 diabetes mellitus. Both drugs have advantages and disadvantages. When choosing a drug, the doctor takes into account many factors: the degree of development of the disease, the causes of its occurrence, the individual characteristics of the body, side effects.

It also includes:

lactose monohydrate;
gelatin;
talc;
magnesium stearate;
potato starch;
dye.

Release form - flat-cylindrical tablets, which in the amount of 120 pieces are in colorless glass bottles placed in a cardboard box.

The effect of the drug on the body is that beta cells activate the production of insulin. This happens in the cells of the pancreas after a person has eaten, resulting in a decrease in the level of glycemia in the blood. The therapeutic effect lasts for a day. The drug is absorbed quickly and almost completely. Its highest concentration after application is reached after 2.5 hours.

The main component is able to fully bind to plasma proteins. Metabolism of the active substance occurs in the cells of the liver tissues, with the formation of 2 inactive metabolites. The output of one is carried out together with bile, and the second - with urine.

Maninil is indicated for type 2 diabetes. In addition, the drug can be used simultaneously with other antidiabetic agents, except for sulfonylurea derivatives and glinides.

Contraindications are as follows:

type 1 diabetes;
intestinal obstruction, paresis of the stomach;
severe renal and hepatic insufficiency;
after surgery to remove the pancreas;
diabetic ketoacidosis;
diabetic precoma and coma;
leukopenia;
lack of glucose-6-phosphate dehydrogenase;
decompensation of carbohydrate metabolism in case of burns, injuries, infectious diseases or after surgery with prescribed insulin therapy;
age up to 18 years;
pregnancy and lactation;
individual intolerance to the components of the drug.

With caution, Maninil should be taken by patients who have acute alcohol intoxication, febrile syndrome, chronic alcoholism, thyroid diseases with impaired function, hyperfunction of the anterior pituitary gland or adrenal cortex, patients whose age is over 70 years.

Taking the drug may be accompanied by the development of side effects from:

digestive: nausea, vomiting, heaviness in the stomach, diarrhea, metallic taste in the mouth, abdominal pain;
hematopoietic: thrombocytopenia, leukopenia, erythropenia, agranulocytosis, pancytopenia, hemolytic anemia;
immune: urticaria, itching, purpura, petechiae, increased photosensitivity, allergic reactions accompanied by proteinuria, jaundice, fever, skin rashes, arthralgia, allergic vasculitis, anaphylactic shock;
metabolism: hypoglycemia, which is manifested by tremor, hunger, drowsiness, tachycardia, hyperthermia, headache, general anxiety, impaired coordination of movements, skin moisture, a feeling of fear;
liver and biliary tract: hepatitis, intrahepatic cholestasis.

In addition, after taking the drug, vision may be impaired, diuresis may increase, transient proteinuria and hyponatremia may develop. Using Maninil, you must strictly follow the doctor's instructions, following a diet and controlling blood glucose levels.

The manufacturer of the drug is Berlin-Chemie AG, Germany.

Maninil's analogs:

Glibenclamide.
Glybamid.
Glidanil.

Characteristics of Diabeton

Diabeton is a hypoglycemic agent with a modified release. The main component is gliclazide. The composition also includes: calcium hydrogen phosphate dihydrate, hypromellose, maltodextrin, magnesium stearate. The product is available in the form of oval biconvex tablets and capsules.

The drug is intended for diabetics suffering from type 2 diabetes. Thanks to its use in the body, the work of pancreatic beta cells is enhanced, which increases the production of insulin.

Diabeton has a beneficial effect on the permeability of the walls of blood vessels, improving or normalizing their condition.

The components of the drug reduce the amount of cholesterol in the blood, which reduces the risk of atherosclerosis and microthrombosis. The process of blood microcirculation is normalized and the development of diabetic nephropathy is prevented. The drug is excreted along with urine.

The effect on the body of the drug is as follows:

normalizes sugar levels;
reduces weight;
prevents the formation of blood clots;
restores insulin production.

Indications for the use of Diabeton are as follows:

type 2 diabetes;
for prophylactic purposes in case of circulatory disorders.

The drug is used together with other antidiabetic agents in the complex treatment of diabetes mellitus.

Main contraindications:

type 1 diabetes;
sharing with Danazol, Phenylbutazone or Miconazole;
severe renal or hepatic failure;
diabetic precoma and coma;
diabetic ketoacidosis;
pregnancy and lactation;
age up to 18 years;
individual intolerance to glucose, galactose, lactose, as well as the components of the drug.

Relative contraindications include:

alcoholism;
hypothyroidism;
pituitary or adrenal insufficiency;
severe cardiovascular disease;
elderly age;
liver or kidney failure;
long-term treatment with glucocorticosteroids;
insufficiency of glucose-6-phosphate dehydrogenase.

Complications include the development of hypoglycemia. Its symptoms include headache, nausea, agitation, reduced concentration, increased fatigue, vomiting, shallow breathing, confusion, loss of self-control, depression, slow reaction.

In addition, irritability, dizziness, a sense of helplessness, aphasia, impaired vision and speech, bradycardia, convulsions, weakness, loss of consciousness, which may be accompanied by the development of coma, can be noted.

Side effects include adrenergic reactions: arrhythmia, angina pectoris, increased blood pressure, anxiety, tachycardia, increased sweating.

The work of the digestive system may be disrupted and nausea, vomiting, abdominal pain, diarrhea, constipation may occur. On the part of the hematopoietic organs and the lymphatic system, hematological disorders are observed: anemia, granulocytopenia, thrombocytopenia, leukopenia. Skin itching, urticaria, rash, bullous reactions, maculopapular rash, Quincke's edema, erythema are possible. On the part of the organs of vision, transient visual disturbances may develop.

What is the difference

Maninil is contraindicated in overweight people, because. leads to an increase in weight. The drugs have different manufacturers and composition.

What is cheaper

The average price of Maninil is 131 rubles, and Diabeton is 281 rubles.

Which is better - Maninil or Diabeton

Choosing which is better - Maninil or Diabeton, the doctor evaluates the individual characteristics of the patient's body after examination and determining the level of glucose in the blood. It necessarily takes into account the results of tests, existing diseases and contraindications.

With diabetes

With this disease, doctors often prescribe Diabeton, which reduces the risk of developing micro- and macrovascular complications of diabetes due to the hemovascular effect. This allows you to extend the life of the patient and improve its quality.

Only a doctor deals with the appointment of antidiabetic drugs, the selection causes difficulties due to side effects and contraindications.

Hypoglycemic agents, such as and, differ in the mechanism of action and the strength of the hypoglycemic effect.

This is due to the different composition of drugs, consider their features and differences.

Compound

Metformin is a biguanide substance that effectively lowers blood glucose by inhibiting its absorption in the liver.

Maninil includes the substance glibenclamide, a second-generation sulfonylurea derivative with a hypoglycemic effect. Medicines are produced only in tablets with different doses of active ingredients.

pharmachologic effect

Metformin works by inhibiting gluconeogenesis. The substance activates a special enzyme in the liver that prevents further entry of glucose into the blood. The drug inhibits the conversion of fatty acids and promotes their oxidation, inhibits the absorption of sugar in the intestine.

Compared with other hypoglycemic agents, the agent is most effective in the prevention of development. With systematic use, the drug prevents weight gain, and if observed, it helps to reduce it.

Metformin tablets

The drug inhibits the development of insulin resistance and facilitates the penetration of glucose into human tissues. With insufficient insulin in the blood, the substance practically does not show hypoglycemic properties.

Maninil stimulates insulin production by closing potassium channels in beta cells. The content of potassium ions increases, which gives a signal to the pancreas to synthesize new insulin.

During treatment with glibenclamide (Maninil), blood sugar control is necessary, the strength of the drug depends on the dose used. When taken simultaneously with biguanide, the risk of development increases significantly, so the dose of glibenclamide is reduced.

The drug is able to increase the metabolic response to, reduces the risk of development and mortality. The mechanism of action is not related to the amount of glucose in the blood, so the drug works even with normoglycemia.

Indications

Metformin is prescribed as a hypoglycemic agent mainly for.

Metformin, Maninil should not be used in cases of:

lactation;
and kidneys;
appearances;
hypersensitivity.

Glibenclamide can be used with caution in alcoholism, which is an absolute limitation for biguanide.

In addition, Metformin is canceled 2 days before and after the x-ray if there was an introduction of iodinated contrast.

Maninil or Amaril

is a hypoglycemic agent based on third generation sulfonylurea derivatives. Contains the active ingredient - glimepiride. The principle of action is to stimulate the release of endogenous insulin by the pancreas.

Amaryl tablets

Unlike Maninil, Amaryl has an additional effect - the drug inhibits gluconeogenesis. The hypoglycemic effect of Amaryl is more pronounced and lasts at least 24 hours.

Maninil and Amaryl should not be prescribed for insulin-dependent diabetes. When selecting the dose of Amaryl and subsequent therapy, blood sugar readings must be taken into account, since there is the possibility of hypoglycemia.

Negative manifestations from the use of drugs and contraindications practically do not differ. An exception is the more pronounced disorders of the digestive tract in Amaryl, which is associated with the process of suppression of gluconeogenesis by the drug.