Clopidogrel - ntuziaka maka iji mbadamba ihe, ihe ngosipụta, usoro nke ime ihe, nsonaazụ na ọnụahịa

Nkọwa nke metụtara 28.01.2015

• Aha Latin: Clop>

Mbadamba ọgwụ ọgwụ Clopidogrel gụnyere 75 mg nke otu ihe na-arụ ọrụ n'ụdị hydrosulfate.

Ihe ndi ozo: prosalv, lactose monohydrate, silloon silicon dioxide, ssumum croscarmellose, sodium fumarate.

Ihe mejupụtara shell: pink opadray II (hypromellose, lactose monohydrate, titanium dioxide, carmine, odo iron oxide, macrogol), silicone emulsion.

Mpempe mwepụta

Mbadamba ụrọ agba agba pink bụ biconvex n'ụdị, na-acha ọcha-edo edo na mpaghara.

• Mbadamba iri na anọ kwa otu, ngwugwu 1 ma ọ bụ 2 na mpempe akwụkwọ.
• Mpempe akwụkwọ 7 ma ọ bụ 10 kwa otu, ngwugwu 1, 2, 3 ma ọ bụ 4 na ngwugwu mpempe akwụkwọ.
• 7 ma ọ bụ mbadamba 10 na nchapu; blister 1, 2, 3 ma ọ bụ 4 na otu mpempe akwụkwọ.
• Mpempe akwụkwọ 14 ma ọ bụ 28 n'ime karama polymer, karama 1 na mpempe akwụkwọ.
• Mpempe akwụkwọ 14 ma ọ bụ 28 na polymer nwere ike, 1 nwere ike na ngwugwu mpempe akwụkwọ.

Pharmacodynamics na pharmacokinetics

Ọgwụ ahụ na-emechi nchịkọta platelet ma na -ebelata njiri nke adenosine diphosphate (ADP) na ndị na-anabata platelet, ma belata ike ịgbalite ndị na-anabata glycoprotein n'okpuru ọrụ adenosine diphosphate. Ọgwụ ahụ na-ebelata njikọ nke platelet, nke ndị na - emegide ya na - akpata ya, na - egbochi ADDI ya na ADP wepụtara. Mkpụrụ ọgwụ ọgwụ ahụ jikọtara ya na platelet ADP ndị na-anabata ya, mgbe nke ahụ, platelet na-efunyụọ anya na mkpali ADP.

Mmetụta nke igbochi nchịkọta platelet na-apụta awa abụọ mgbe usoro nke mbụ gasịrị. Ogo nke mkpokọta nke aggregment na-abawanye n'ime 4-7 ụbọchị wee rute kachasị elu na njedebe nke oge a. N'okwu a, nrị kwa ụbọchị kwesịrị ịbụ 50-100 mg kwa ụbọchị. Ọ bụrụ na mmebi vaskụla atherosclerotic dị, mgbe ahụ ị takingụ ọgwụ ahụ na-egbochi ọganihu nke ọrịa ahụ.

Mgbe ị theụsịrị ọgwụ ahụ n'ime obere oge na-etinye obi gị dum na eriri afọ. Bionweta ndu ọgwụ a bụ 50%; nri nri anaghị emetụta ọkwa a. Metabolism nke ọgwụ na-eme na imeju. Na plasma ọbara, a na-eru ogo kachasị elu otu elekere mgbe ị .ụsịrị ọgwụ. Oge iwepu ọkara ndụ bụ awa asatọ, akụrụ weputara ya na eriri afọ ya.

Ntụziaka pụrụ iche

Ejiri ọgwụ a jikọtara ya na mkpa ọ dị ịchekwa ọnọdụ onye ọrịa oge niile. Ihe ndị a kapịrị ọnụ igosipụta dị:

1. N'ime ndị ọrịa afọ ndụ karịrị afọ 75, ekwesịrị ịkwụsị iwu nke mmụba mbụ.
2. N'ime usoro ọgwụgwọ, ịkwesịrị ịgbaso ngosipụta nke sistemụ hemostatic, iji nyochaa ọnọdụ nke imeju na-arụ ọrụ.
3. Jiri nlezianya mee ihe na ndị ọrịa nwere oke ọbara ọgbụgba n'ihi mmerụ ahụ ma ọ bụ ihe ndị ọzọ.
4. Ọnụnọ nke ọrịa metụtara ọbara ọgbụgba, a ga-eburu n'uche na ọgwụ ahụ na-agbatị oge ọbara ọgbụgba.
5. Mgbe ị na-anya ụgbọala, rịba ama na clopidogrel nwere ike ibute ọgbụgba.

N’oge ime ime

Ruo ugbu a, enweghi ọmụmụ ihe omimi zuru oke na nyocha nyocha na nsonso nke clopidogrel na-atụrụ ime ma etolite n’afọ nwa ebu n’afọ. Maka nke a, a naghị enye ọgwụ a ọgwụ n’oge afọ ime. Onweghi ihe akaebe banyere ogwu a na-abanye na mmiri ara ure, ya mere, adighi atụ aro ị Cụ Clopidogrel n'oge a na-enye nwa ara.

Ihe ngosi maka ojiji

Mgbochi nke ihe omume atherothrombotic na ndị ọrịa mgbe ọrịa myocardial infarction (site na ụbọchị ole na ole ruo ụbọchị 35), ọrịa ischemic (site na ụbọchị 7 ruo ọnwa 6) ma ọ bụ ndị nwere ọrịa mgbaasị na-akpata ọrịa.

Mgbochi nke ihe ndị atherothrombotic (yana njikọta na acetylsalicylic acid) na ndị ọrịa nwere nnukwu ọrịa obi:

- na - eweliteghi ngalaba ST (enweghi ike angina pectoris ma obu infarction myocardial na - enweghi ebili mmiri), tinyere ndi oria ndi nwere nsogbu site na ogwugwo obi.

- site na ịrị elu nke ngalaba ST (nnukwu myocardial infarction) na ọgwụgwọ ọgwụ yana enwere ike thrombolysis.

Ihe ngbanwe

- nnukwu ọbara ọgbụgba (dịka ọmụmaatụ, ọbara ọgbụgba na ọnya ọgbụgba).

- Inwelata lactose e ketara eketa, ụkọ lactase na glucose-galactose malabsorption,

- ụmụaka na ndị ntorobịa erubeghị afọ 18 (echebeghị nchekwa na arụmọrụ),

- Hypersensitivity na clopidogrel ma ọ bụ ihe ọ bụla nke ọgwụ ọgwụ.

- odida imeju na - erughi ala, nke enwere ike ikwupụta ọbara na - agbapụta (mmachi ahụike dị ụkọ)

- ọdịda akụrụngwa (ahụmịhe akụrụngwa)

- ọrịa nke enwere nguzogide na mmepe nke igba obara (ma eriri afọ ma obu intraocular),

- ochichi nke na - egbochi steroidal anti-inflammatory ọgwụ ndị na - abụghị steroidal nhọrọ COX-2 na-egbochi,

- iji ya mee ihe nke oge agha, heparin, glycoprotein IIb / IIIa inhibitors,

Etu esi eji: usoro onunu ogwu na usoro ọgwụgwọ

Ndị okenye na ndị ọrịa agadi na-arụ ọrụ nkịtị nke CYP2C19 isoenzyme

Ekwesịrị iji okwu Clopidogrel-SZ were ọnụ, n'agbanyeghị nri oriri.

Ọrịa infịction na-arịa myocardial infarction, ọrịa ọnya afọ ischemic, yana ọrịa ọrịa mgbali ọgụ gbasara ọrịa

A na-a drugụ ọgwụ ahụ na 75 mg 1 oge / ụbọchị.

N'ime ndị ọrịa nwere myocardial infarction (MI), enwere ike ịmalite ọgwụgwọ site na ụbọchị mbụ ruo ụbọchị 35th nke MI, na ndị ọrịa nwere ọrịa ischemic (II), site na ụbọchị 7 ruo ọnwa 6 mgbe MI gasịrị.

Nnukwu akwara na-arịa ọrịa na-enweghị nkwụchi elu ST (akwụghị ọtọ angina, infarction myocardial na-enweghị ebili mmiri Q).

Ọgwụgwọ na Clopidogrel-SZ kwesịrị ibido site na otu ntụtụ nke 300 mg, wee gaa n'ihu na 75 mg 1 oge / ụbọchị (yana yana Acetylsalicylic acid dị ka onye na-ahụ maka antiplatelet na usoro nke 75-325 mg / ụbọchị). Ebe obu na iji acetylsalicylic acid na onunu ogwu di elu nwere ihe jikotara ya na nsogbu obara, otiti acetylsalicylic acid di na ngosi a ekwesighi gafere 100 mg. Mmetụta ọgwụgwọ kachasị bụ ọnwa nke atọ emere. Usoro ọgwụgwọ ya dị ka afọ 1.

Ọrịa coronary syndrome na ST nkeze elu (nnukwu myocardial infarction na nnukwu ngalaba ST)

Edebere Clopidogrel na 75 mg 1 oge / ụbọchị yana otu mkpụrụ ọgwụ mbụ na mbido mkpokọta yana Acetylsalicylic acid dị ka onye na-ahụ maka antiplatelet na thrombolytics (ma ọ bụ na-enweghị thrombolytics). A na-amalite ọgwụgwọ njikọta ozugbo enwere ike mgbe mmalite nke mgbaàmà ma na-aga n’ihu ma ọ dịkarịa ala izu anọ. N'ime ndị ọrịa karịrị afọ 75, a ga-amalite ịgwọ Clopidogrel-SZ n’ebighi ịkwụ ụgwọ.

Ndị ọrịa nwere Mbelata CYP2C19 Isoenzyme Ọrịa

Na-eme ka ike gwụ metabolism site na iji CYP2C19 isoenzyme nwere ike ibute mbelata na mmetụta antiplatelet nke clopidogrel. Usoro ezigbo usoro ọgwụgwọ maka ndị ọrịa nwere metabolism na-esighi ike site na iji CYP2C19 isoenzyme amabeghị.

Omume ọgwụ

Onye na-ahụ maka ihe mgbochi. Clopidogrel bụ prodrug, otu n'ime metabolites na - arụ ọrụ nke bụ ihe na - egbochi mkpokọta platelet. Onye na-arụ ọrụ clopidogrel metabolite ahọrọ na-egbochi ikechikọta adenosine diphosphate (ADP) na P2Y12 platelet na ADP nke na-emegharị ọnụ nke usoro GPIIb / IIIa, na-eduga na iwelata nchịkọta platelet. N'ihi nnabata a na-atụgharịghị agbanwe, platelet na-adịgide na mkpali ADP ruo oge ndụ ha niile (ihe dịka 7-10 ụbọchị), na mweghachi nke ọrụ platelet nkịtị na-eme na ọsọ ọsọ kwekọrọ na ọkwa mgbapụta platelet. Nchịkọta nke platelet kpatara site na ndị agonist na-abụghị ADP na-egbochikwa mmụba platelet na-abawanye site na ADP wepụtara. N'ihi na nguzobe nke metabolite na-arụ ọrụ na-eme site na iji P450 isoenzymes, ụfọdụ n'ime ha nwere ike ịdị iche na polymorphism ma ọ bụ ọgwụ ndị ọzọ ga-egbochi ya; ọ bụghị ndị ọrịa niile nwere ike ịnwe mkpanaka platelet zuru ezu.

Nsonaazụ

Site na sistemụ etiti na akụkụ ọfụma: nke na - adịghị ala ala - isi ọwụwa, dizziness na paresthesia, ọ na - adịkarịghị - vertigo, ọ na - adịkarị obere - mmebi nke sensations ụtọ.

N’akụkụ nke usoro akwara obi: ọria adịkarịsịrị - vasculitis, mbelata ọbara mgbali elu, ọbara ọgbụgba ọbara, ọnya afọ (njikọ, n’anụ na retina), hematoma, imi, na-agba ọbara site na akụkụ okuku ume, ọbara ọgbụgba, ọbara ọgbụgba azụ. nsonaazụ, ọbara na akwara na nkwonkwo, hematuria.

Site na usoro iku ume: enwerekarịkarị - bronchospasm, pneumonitis interstitial.

Site na usoro nri: oge ​​- afọ ọsịsa, ọnya afọ, dyspepsia, na-adịghị ala ala - ọnya afọ na duodenal ọnya afọ, gastritis, vomiting, ọgbụgbọ, afọ ntachi, flatulence, adịkarịghị - pancreatitis, colitis (gụnyere ọnya afọ ma ọ bụ lymphocytic colitis), stomatitis, oke imeju okpu, ịba ọcha n'anya.

Site na sistemụ urinary: ọ dịkarịsịrị ike - glomerulonephritis.

Site na sisọmu ọbara: na - adịghị egbu oge - ịgbatị oge ọbara ọgbụgba.

Site na sistemu hemopoietic: ugboro ugboro - thrombocytopenia, leukopenia, neutropenia na eosinophilia, nke adịkarịghị - thrombocytopenic thrombohemolytic purpura, thrombocytopenia siri ike (platelet na-erughị ma ọ bụ hara nha 30 × 109 / l), agranulocytosisia, granulocytopenia, granulocytopenia, granulocytopia

N’akụkụ anụ ahụ na akwara dị n’ime ala: adịghị ala ala - ọnya akpụkpọ ahụ na itching, ọ na - adịkarịghị - angioedema, urticaria, erythematous rash (jikọtara ya na clopidogrel ma ọ bụ acetylsalicylic acid), dịkarịsịrị ike - bulmat dermatitis (erythema multiforme, Stevens-Johnson syndrome, toxic, toxic) ), eczema na lichen planus.

Site na usoro mọzụlụ: dịkarịsịrị ike - ogbu na nkwonkwo, ọrịa ogbu na nkwonkwo, myalgia.

Na akụkụ nke sistem: ọ dịkarịghị - mmeghachi omume anaphylactoid, ọrịa ọbara.

Mmekorita

Oge nchịkwa nke oge a na clopidogrel nwere ike ime ka ọbara ọgbụgba dịkwuo ike, yabụ akwadoghị ojiji nke njikọ a.

Ojiji nke IIb / IIIa na-egbochi ihe na njikọta na clopidogrel chọrọ ịkpachara anya maka ndị ọrịa nwere oke ọbara ọgbụgba (ya na mmerụ ahụ na ntinye aka ma ọ bụ ọnọdụ ndị ọzọ).

Acetylsalicylic acid anaghị agbanwe mmetụta nke clopidogrel, nke na-egbochi nchịkọta ADP na-akpata, mana clopidogrel na-eme ka mmetụta nke acetylsalicylic acid pụta na nchịkọta platelet na-eweta. Ka o sina dị, ojiji nke Acetylsalicylic acid na clopidogrel dị ka onye na - ahụ maka ọgwụ antipyretic nke 500 mg ugboro abụọ / otu maka ụbọchị 1 emeghị ka mmụba dị ukwuu na oge ọbara ọgbụgba nke nchịkwa clopidogrel kpatara. N'agbata clopidogrel na acetylsalicylic acid, enwere ike ịmekọrịta ọgwụ ọgwụ, nke na-eduga n'ịba ụba nke ọbara ọgbụgba. Ya mere, n'iji ha, n'otu oge, ekwesịrị ịkpachara anya, ọ bụ ezie na n'ọmụmụ ihe banyere ụlọ ọgwụ, ndị ọrịa natara ọgwụgwọ ọgwụ na clopidogrel na acetylsalicylic acid ruo otu afọ.

Dika ihe omumu nke ulo ogwu gosiputara na ndi oru afọ ofufo mara mma, mgbe ha na-ewere clopidogrel, odighi mkpa igbanwe onodu heparin na mmetụta anticoagulant ya agbanweghi. Ojiji nke heparin emegharịghị ịgbanwe ihe mgbochi antipidogrel. N'agbata clopidogrel na heparin, enwere ike ịmekọrịta ọgwụ ọgwụ, nke nwere ike ịbawanye ohere nke ọbara ọgbụgba, yabụ n'otu oge ị ofụ ọgwụ ndị a chọrọ ịkpachara anya.

Ntụziaka maka ojiji

A na-eji Clopidogrel mee ndị okenye okenye 1 oge kwa ụbọchị (tupu nri ehihie, mgbe nri ehihie), n'agbanyeghị nri. Ekwesighi igodo mbadamba ihe. Na-a plentyụ nnukwu mmiri (opekata mpe 70 ml). Gwọ ọgwụ akwadoro ka ọgwụ ahụ bụ 75 mg kwa ụbọchị (otu mbadamba).

Ofzọ nke itinye n'ọrụ maka ọrịa obi ọria: ndị okenye nọ na ngalaba ọrịa obi n'okpuru nlekọta ahụike ka etinyere 300 mg nke clopidogrel. Na-esote, a na-aga n'ihu na usoro ọgwụgwọ na usoro mmezi nke 75 mg, karịa mgbe ọ na-ejikọ ya na acetylsalicylic acid na usoro onwa si 0.075 ruo 0.325 g.

Dị Mkpa! Iji zere ọbara ọgbụgba, were ihe karịrị 100 mg nke acetylsalicylic acid.

Amabeghị oge ọ ga-anabata mbanye. Theụ ọgwụ ahụ na-aga n'ihu ruo mgbe ọnọdụ onye ọrịa laghachiri na nkịtị na uche dọkịta na-aga ya.

Treatmentzọ a ga-esi gwọọ ya n'oge ọrịa obi ọgụ: usoro nke clopidogrel bụ 75 mg kwa ụbọchị, gụnyere ọgwụ mbido mbụ nke 300 mg yana ọgwụ acetylsalicylic acid na ọgwụ thrombolytic.

Dị Mkpa! Ọ dị mkpa ka ndị ọrịa gbachara afọ iri asaa na ise ịhapụ iwere ọgwụ ọgwụ.

Ogologo oge nke regimen bụ opekata mpe otu ọnwa.

N'ihe banyere nhichapụ, ihe ndị a ga-eme:

1. Ọ bụrụ na-ahapụ ihe karịrị elekere iri na abụọ tupu ị takingụ ọgwụ ọzọ, drinkụọ ọgwụ ahụ ozugbo.
2. Ọ bụrụ na tupu itinye ọgwụ ọzọ maka clopidogrel erughị awa iri na abụọ - were usoro ị na-esote n'oge kwesịrị ekwesị (emekwala ka usoro ahụ dị ukwuu).

A machibidoro ya ịhapụ iji onwe ya na oge nkwụsịtụ iji Clopidogrel, ebe ọnọdụ onye ọrịa ahụ nwere ike ịkawanye njọ, ịmaliteghachi ọrịa na-akpata ọrịa nwere ike ịmalite.

Dodoụbiga ya ókè

Iji Irishal nke clopidogrel dị oke elu nwere ike ibute nsonaazụ ndị a:

• ọbara ọgbụgba
• mmụba nke ọbara ọgbụgba.

Treatmentụbiga ọgwụ ike ókè bụ ihe mgbaàmà. Nke kachasị dị irè bụ mmịnye ọgwụ nke dabere na platelet.

Mmanya na-aba n'anya

N'ihe banyere ị alcoholụ mmanya, ohere nke iwe na afọ na-abawanye, n'ihi ọbara ọgbụgba nwere ike ịmalite. Ya mere, ekwesiri ịwepu ngwakọta nke clopidogrel na mmanya n'ihi oke ndakọrịta.

Companieslọ ọrụ ọgwụ na-emepụta ọgwụ ndị dị ka Clopidogrel:

• Agrel,
• Gridoklein,
• Atherocard,
• Avix,
• Clopidogrel nke ndị nrụpụta dịgasị iche - Izvarino, Tatkhimpharmpreparaty, Canon Pharma, Severnaya Zvezda (SZ), Biocom (ihe atụ nke Russia nke Clopidogrel), Teva, Gideon Richter, Ratiopharm, Zentiva,
• Atrogrel
• Cardogrel
• Diloxol
• Sylt,
• Afọ Iju,
• Deplatt
• Noclot,
• Clopact,
• Clorelo
• Clopix
• Clopidal
• Lodigrel
• Orogrel
• Thromborel,
• Ebe ebe
• Lopirel
• Plavix,
• Reodar,
• Osimiri,
• Ejiri m plagiari
• Osimiri,
• Platogril
• Pingel
• Reomax
• Gburugburu,
• Clopidex
• Plavigrel
• Flamogrel.

Ọgwụ ndị a niile enweghị ọdịiche dị na nhazi na usoro nke ihe eji arụ ọrụ. Ihe dị iche bụ naanị na ndị nrụpụta na ọnụahịa.

Mlọ ọgwụ

Ibepu ulo Mgbe otu ugboro ugboro ma ọ bụ ugboro ugboro nchịkwa nke onunu nke 75 mg kwa ụbọchị, clopidogrel na-abanye ngwa ngwa. Nkezi ọnụnọ kachasị nke plasma nke ihe dịkarịsịrị mkpa (ihe dịka 2.2-2.5 ng / ml mgbe otu mkpụrụ ọgwụ 75 mg) hụrụ ihe dịka nkeji iri anọ na ise mgbe nchịkwa gachara.Dabere na metabolites clopidogrel na-egosipụta na mmamịrị, mmịpụta dịkarịa ala 50%.

Nkesa. Clopidogrel na isi (adịghị arụ ọrụ) na - agagharị metabolite na - agbagha na - egbochi protein ndị dị na plasma n'imevitro (98 na 94%, n'otu n'otu). Ihe nkekọ a bụ afọ ojuju. n'imevitro karia otutu uzo lebara anya.

Metabolism. Clopidogrel na-agbakọ ngwa ngwa n'imeju. Navitro na n'imevivo clopidogrel bụ metabolized n'ụzọ abụọ: otu bụ nke esterases na-edugharị ma na-eduga hydrolysis na arụ ọrụ nke carbonxylic acid (85% nke metabolites na-agagharị n'ọbara), nke ọzọ (15%) na-agbagha site n'ọtụtụ cytochromes P450. Nke mbu, clopidogrel bụ metabolized ka onye na-etiti metabolite, 2-oxo-clopidogrel. Metabolism nke na-esochi bụ metabolism dị n'etiti 2-oxo-clopidogrel na-eduga na nguzobe nke metabolite na-arụ ọrụ, usoro nke thiol nke clopidogrel. Navitro okporo ụzọ metabolic a bụ CYP3A4, CYP2C19, CYP1A2 na CYP2B6 bụ onye ogbugbo ya. Ọrụ metabolite na-arụ ọrụ nke dịpụrụ adịpụ n'imevitro ngwa ngwa na adabeghị, ọ na-abata na ndị na-anabata platelet, si otú a na-egbochi nchịkọta platelet.

Na_max metabolite na-arụ ọrụ ji okpukpu abụọ dị elu karịa otu ugboro nke njikwa mmiri nke 300 mg nke clopidogrel karịa mgbe ụbọchị anọ nke usoro mmezi nke 75 mg. Na_max hụrụ na oge 30-60 mgbe ị afterụsịrị ọgwụ.

Mwepu. Ihe dị ka 50% nke ọgwụ a na-apụ apụ na mmamịrị na ihe dịka 46% nwere ọrịa n'ime awa 120 mgbe nchịkwa gasịrị. Mgbe otu ọgwụ jiri 75 mg, mkpochapụ ọkara ndụ nke clopidogrel bụ awa 6. Ọkara ndụ nke metabolite na-ekesa bụ elekere asatọ gachara mgbe otu ndọghachiri otu ugboro.

Pharmacogenetics. CYP2C19 na-etinye aka na nguzobe nke metabolite na-arụ ọrụ na metabolite dị n'etiti, 2-oxo-clopidogrel. Pharmacokinetics na antiplatelet na-arụ ọrụ nke metabolite na-arụ ọrụ nke clopidogrel dịka a tụrụ ya na ule nchịkọta platelet. buvivo, dịgasị iche dabere na ụdị mkpụrụ osisi CYP2C19.

CYP2C19 * 1 allele kwekọrọ na metabolism zuru oke na-arụ ọrụ, ebe CYP2C19 * 2 na CYP2C19 * 3 alleles abụghị arụ ọrụ. Ndekọ ihe niile CYP2C19 * 2 na CYP2C19 * 3 maka ọtụtụ alleles nwere obere ọrụ na-acha ọcha (85%) na Asians (99%) enweghị oke metabolism. Allezọ ndị ọzọ na-adịghị arụ ma ọ bụ belata ọrụ gụnyere, n'etiti ndị ọzọ, CYP2C19 * 4, * 5, * 6, * 7 na * 8. Ndị ọrịa nwere ọrụ metabolic dị ala bụ ndị na-ebu ụzọ arụ ọrụ abụọ. Dabere na data e bipụtara, ugboro ole nke genotype nwere ọrụ metabolic dị ala nke CYP2C19 bụ ihe dịka 2% n'ọsọ Caucasoid, 4% n'ọsọ Negroid na 14% n'ọsọ Mongoloid.

Olu nke ihe omumu ihe omumu ezughi iji choputa ihe di iche na ihe ndi ozo diri ndi oria enweghi oke nkpokota clopidogrel.

Alrụ ọrụ na-arụ ọrụ na ụlọ. Mkpokọta nke isi iyi metabolite na plasma ọbara mgbe ị na-ewere 75 mg nke clopidogrel kwa ụbọchị dị ala na ndị ọrịa nwere ọrịa akụrụ siri ike (mwepụ nke creatinine site na 5 ruo 15 ml / min) ma e jiri ya tụnyere ndị ọrịa nke klọpịpine ya bụ 30-60 ml / min na mmadụ iche iche. N'otu oge ahụ, e belatara mmetụta inhibitory na nchịkọta ADP na-akpata platelet na ndị ọrịa nwere ọrịa akụrụ siri ike (25%) ma e jiri ya tụnyere otu mmetụta ahụ n’otu ndị siri ike, ọbara ọgbụgba ahụ toro ogologo oge ahụ dịka n’etiti ndị ahụ gbasiri ike. mg clopidogrel kwa ụbọchị. Na mgbakwunye, nnabata ụlọ ọgwụ dị mma n’ebe ndị ọrịa niile nọ.

Ọrụ imeju na-arụ ọrụ. N'ime ndị ọrịa nwere nnukwu ọrịa ịba ọcha n'anya, mgbe ha na-a aụ ọgwụ kwa ụbọchị nke 75 ml nke clopidogrel ruo ụbọchị 10, mmachi ADP na-akpata mkpokọta platelet dị ka nke ahụ na ndị mmadụ nwere ahụ ike. Mmụba ahụ pụtara n'oge ọbara ọgbụgba bụ otu ihe ahụ n'otu abụọ ahụ.

Ọsọ. Otutu nke CYP2C19 bụ ihe ebumnuche, nke na-ebute metabolism na-adịghị mma nke metụtara CYP2C19, dịgasị iche site na agbụrụ ma ọ bụ agbụrụ. Naanị data pere mpe maka ndị bi na Eshia dị na akwụkwọ ahụ iji tụta mkpa ọgwụgwọ CYP a si na CGP pụta maka nsonaazụ clinical.

Ime na lactation

Ihe omumu banyere uto nke clopidogrel n’ime ime na anumanu egosiputaghi ihe ojoo n’acho ime, imu nwa n’afọ imu nwa, imu ime na imu imu nwa.

Ara. Amabeghị ma clopidogrel na-abanye na mmiri ara ara mmadụ. Nnyocha ụmụ anụmanụ achọpụtala na ọgwụ ahụ na-abanye na mmiri ara ara. Dịka ịdọ aka na ntị, a ga-akwụsị ịhapụ inye ụmụaka ara n'oge a na-agwọ clopidogrel.

Ebe ọ bụ na a na-ahụkarị ọgwụ ọgwụ ara na mmiri ara, yana maka ohere nke ịmalite ibute ọrịa ọjọọ na ụmụ a na-enye nwa ara, a ga-eme mkpebi mkpebi ịkwụsị ma ọ bụ kwụsị inye ya ara, maka mkpa ịgwọ ọrịa clopidogrel na nne na-enye nwa ara.

Ọrụ omumu. N'ime ọmụmụ anụmanụ, clopidogrel emetụtaghị ọrụ omumu.

Usoro onunu ogwu na nhazi

A na-ezube Clopidogrel maka nchịkwa ọnụ otu ugboro n'ụbọchị, n'agbanyeghị nri oriri.

Doses

Ndi okenye na ndi okenye

Ọgwụ a na-eme kwa ụbọchị bụ 75 mg n'ọnụ otu ugboro n'ụbọchị.

Ọrịa coronary Acute:

- nnukwu akwara ozi na-enweghị nkwaliteST(angina na-ejighi n'akaAjụjụ): Ekwesịrị ịmalite usoro ọgwụgwọ nke Clopidogrel site na otu iko 300 mg, wee gaa n’ihu site na iji 75 mg otu ugboro kwa ụbọchị (ya na acetylsalicylic acid na dose 75-325 mg kwa ụbọchị). A naghị atụ aro ka ọ gafere oke nke acetylsalicylic acid nke 100 mg, ebe ọ bụ na a na-ejikọ ọnụ ọgụgụ dị elu nke ASA na ohere ọbara ọgbụgba hiri nne. Ekebeghị ezigbo oge ọgwụgwọ ọ bụla. Data ikpe nyocha nke ụlọ ọgwụ na-akwado iji usoro ahụ maka ọnwa iri na abụọ, a na-ahụkwa uru kachasị na mgbe ọnwa 3 gachara.

- nnukwu myocardial infarction yana mpaghara eluST: A na-enye clopidogrel otu ugboro kwa ụbọchị na dose nke 75 mg site na iji mbido mbido 300 mg na acetylsalicylic acid yana yana ma ọ bụ na - enweghị thrombolytics ndị ọzọ. Maka ndị ọrịa karịrị afọ 75, ekwesịrị ịgwọ ọrịa clopidogrel na-ejighi otu ntụtụ. A na-amalite ọgwụgwọ njikọta ozugbo enwere ike mgbe mmalite nke mgbaàmà ma na-aga n’ihu ma ọ dịkarịa ala izu anọ. Enweghi uru nke ijikọtara clopidogrel na ASA mgbe izu anọ gacabeghị na nke a.

Atrial fibrillation: 75 mg clopidogrel otu ugboro n'ụbọchị. Nenye ASA (75-100 mg / day) ma gaa n’ihu ijikọ ya na clopidogrel.

Bụrụ na skipping dose:

- erughi awa iri na abụọ mgbe oge nchịkwa a na-ejikarị: ọ dị mkpa ị theụ ọgwụ ahụ ozugbo, a ga-ewere ọgwụ ọzọ na oge a kara aka,

- Ihe kariri awa iri na abuo ka oge nnabata a ghaburu: ekwesiri doseaara ogwu ozo n’oge enyere, n’etinyeghi ya ozo.

Childrenmụaka na ndị nọ n'afọ iri na ụma

E guzobebeghị nchekwa na nrụpụta ọrụ nke clopidogrel n'ime ụmụaka ọrịa.

Ndị ọrịa nwere ọrụ mgbazinye nsogbu

Ahụmịhe nke ịgwọ ndị ọrịa nwere ọrụ mgbazinye nsogbu dị obere.

Ndị ọrịa nwere ọria imeju

Ahụmịhe nke ịgwọ ndị ọrịa nwere ọrịa imeju na-adịghị ala ala ebe enwere ike ịmịchapụ ọbara dị obere.

Nchedo nchekwa

Ọbara ọgbụgba na nsonaazụ hematologic

Ọ bụrụ na ọrịa egosipụtara n'oge ọgwụgwọ na-egosi mmepe nke ọbara ọgbụgba na nsonaazụ akụkụ ọbara, ekwesịrị ilebara ọbara ozugbo. N'ihi ịba ụba nke ọbara ọgbụgba, ọ kwesịrị ịkpachara anya mgbe nhazi nke clopidogrel na warfarin.

Ekwesịrị iji Clopidogrel jiri nlezianya mee ihe na ndị ọrịa nọ n'ihe ize ndụ nke ọbara ọgbụgba nke metụtara trauma, ịwa ahụ ma ọ bụ ọnọdụ ndị ọzọ, yana n'ihe njikọ nke clopidogrel na acetylsalicylic acid, ọgwụ mgbochi mkpali na-abụghị steroid, gụnyere ndị na-egbochi COX-2 inhibitors, heparin, glycoprotein inhibitors. IIb / IIIa, nhọrọ serotonin reuptake inhibitors (SSRIs) ma ọ bụ ọgwụ ndị ọzọ metụtara n'ihe ize ndụ ọbara ọgbụgba, dika pentoxifylline. Achọrọ nlezianya nlele nke ngosipụta nke akara ọbara ọgbụgba, gụnyere ọbara ọgbụgba dị mkpirikpi, chọrọ izu ndị mbụ ọgwụgwọ yana / ma ọ bụ usoro mmerụ ahụ ma ọ bụ ịwa ahụ. Agaghị atụkọta ojiji maka clopidogrel na ọgwụ anticoagulants, ebe ọ bụ na ngwakọta dị otú ahụ nwere ike ime ka ọbara ọgbụgba dịkwuo ike.

N'ihe banyere usoro ịwa ahụ, ọ bụrụ na achọghị ka ọ bụrụ nke na-adịghị mma, a ga-akwụsị usoro ọgwụgwọ ya na clopidogrel ụbọchị asaa tupu ịwa ahụ. Ọ dị mkpa ịgwa dọkịta na ndị dọkịta na-abịa ọrụ banyere ị theụ ọgwụ ahụ ma ọ bụrụ na a ga-awa onye ọrịa ahụ ma ọ bụ ọ bụrụ na dọkịta depụtara onye ọrịa ahụ ọgwụ ọhụrụ.

Ekwesịrị iji Clopidogrel jiri nlezianya mee ihe n'ebe ndị ọrịa nọ n'ihe ize ndụ nke ọbara ọgbụgba (karịsịa eriri afọ na akwara). Mgbe ị na-ewere clopidogrel, jiri ịkpachara anya na-eji ọgwụ ndị nwere ike ibute ọrịa nke eriri afọ (dịka ọmụmaatụ, acetylsalicylic acid na NSAIDs).

Should kwesịrị ịmara na ebe ọ bụ na ịkwụsị ọbara ọgbụgba mgbe ị na-ewere clopidogrel (naanị ya ma ọ bụ na njikọ yana ASA) chọrọ oge ka ukwuu, ị ga-eme ka dọkịta gị mara banyere ọnọdụ ọ bụla na-adịghị ahụkebe (n'ọnọdụ nke ọnọdụ yana / ma ọ bụ oge).

Thrombotic Thrombocytopenic Purpura (TTP)

Ọnọdụ nke thrombotic thrombocytopenic purpura (TTP) mgbe ekpesịrị clopidogrel. Ihe ama ama nke a bụ nke thrombocytopenia na microemiopathic haemolytic anaemia tinyere yana mgbaàmà akwara ozi, arụ ọrụ ezumike, ma ọ bụ ahụ ọkụ. Mmepe nke TTP nwere ike bụrụ ihe na - egbu ndụ yana ọ nwere ike ịchọ ihe ngwa ngwa, gụnyere plasmapheresis.

A kọwo ọnọdụ nke mmepe nke hemophilia enwetara mgbe ewerechara clopidogrel. N'ihe banyere mmụba egosipụtara na mpaghara nke akụkụ ọkara ahụ dịpụrụ adịpụ nke ọbara na-agba ma ọ bụ na-enweghị ọbara ọbara, a ga-atụle ohere o nwere ịmalite ịba ọcha n'anya. Ekwesịrị ilebara ndị ọrịa nwere nkwenye siri ike nke hemophilia enwetara ma lekọta ha anya, a ga-akwụsị ịgwọ ọrịa clopidogrel.

N'ihi data ezughi ezu, ekwesighi ịkọwa clopidogrel n'ime ụbọchị 7 mbụ tupu ọrịa ọgbụgba na-akpata isi.

N'ime ndị ọrịa na-arụ ọrụ metabolic dị ala nke CYP2C19, clopidogrel na usoro onunu ogwu a na-atụ aro na-enye obere nke ọrụ metabolite na-arụ ọrụ nke clopidogrel ma nwee mmetụta antiplatelet dị ala. Ndị ọrịa nwere obere ọrụ metabolic na-arịa nnukwu ọrịa ma ọ bụ ndị na-arịa ọrịa na-emetụta akwara ma na-anata ọgwụgwọ clopidogrel na usoro a tụrụ aro nwere ike ịnọ n'ihe ize ndụ dị elu nke ịmalite ọrịa obi karịa ndị ọrịa nwere ọrụ arụmọrụ nkịtị nke CYP2C19.

Ebe ọ bụ na CYP2C19 mejupụtara clopidogrel ka ọ bụrụ metabolite na-arụ ọrụ, ọ na-atụ anya na ọgwụ ndị na-egbochi ọrụ enzyme a ga-eduga na mbelata ọgwụ ndị na-arụ ọrụ nke clopidogrel. Emebeghị ka amuta ihe banyere ulo ogwu a. Uzo abuo nke ihe ndi CYP2C19 inhibitors kwesiri ijufu.

Achọrọ nlezianya na ndị ọrịa na-eji ọgwụ Clopidogrel na-anakọ ọnụ - dochie anya CYP2C8 isoenzyme.

Ọrụ nrụgide

Onye ọrịa ahụ kwesịrị inwe akụkọ ntanetị nke hypersensitivity na thienopyridines ndị ọzọ (dịka ticlopidine, prasugrel), ebe enwere okwu ikpe ama ama nke nrụrụ ọgbụgba na ọgbụgba. A ga-elezi ndị ọrịa nwere akụkọ gbasara ịdị na-arịa ọrịa ọgbụgba mmiri ndị ọzọ anya n'oge ọgwụgwọ maka akara nke hypersensitivity na clopidogrel. Thienopyridines nwere ike iduga mmepe nke mmeghachi omume nfụkasị nke ịdị nhịahụ dịgasị iche, dịka ọnya ọgbụgba, ọnya Quincke, ma ọ bụ mmeghachi mmeghachi omume hematological, dịka thrombocytopenia na neutropenia. Ndị ọrịa nwere akụkọ mmeghachi omume nfụkasị na / ma ọ bụ mmeghachi omume hematological na otu thienopyridine nwere ike ịnwe ohere dị elu nke ịmalite otu ihe ma ọ bụ mmeghachi omume ọzọ na thienopyridine.

Ihe mejupụtara ọgwụ ahụ gụnyere nsị karmuazin (E-122), nke nwere ike ibute mmeghachi ahụ nfụkasị.

Alrụ ọrụ na-arụ ọrụ na ụlọ

Ahụmahụ ọgwụgwọ na clopidogrel n'ime ndị ọrịa nwere ọrụ mgbazinye nsogbu dị ụkọ. Ekwesịrị iji ọgwụ ahụ mee ihe na ndị ọrịa dị otú ahụ nwere ịkpachara anya.

Ọrụ imeju na-arụ ọrụ

Ekwesịrị iji Clopidogrel jiri nlezianya mee ihe na ndị ọrịa nwere ọrụ imeju na-adịghị agbagha agbagha, nke nwere ike ibute ọrịa hemorrhagic diathesis.

Mmetụta ikike ịkwọ ụgbọala na usoro ndị ọzọ nwere ike ibute nsogbu. Clopidogrel anaghị emetụta ma ọ bụ nwee obere mmetụta na ịkwọ ụgbọala na usoro ndị ọzọ.