Etu esi eji ọgwụ Lopirel eme ihe? > Ọgwụgwọ na mgbochi

Akụkụ ike nke ọgwụ ahụ họrọ na-egbochi mgbochi ADP ya na ndị na-anabata ya nọ n’elu ala ọgụgụ platelet. N'ihi ya, rụọ ọrụ nke ogige ahụ GPIIb / IIIa na nchịkọta platelet agagh adi ike. Ọzọkwa clopidogrel na-egbochi usoro nchịkọta nke ndị ọzọ ndị na-emegide anyị. Pletlet na-emebi emebi ma enweghị ike hazie ya ruo mgbe ngwụcha nke ndụ ha. nchịkọta.

Mgbe nnata nke ọgwụ ọgwụ mbụ, usoro antithrombotic malitere ime, ọkwa leukocytes na-ehiwe ụbọchị 3-7 nke nchịkwa. Ná nkezi, ụbọchị ise ka ịkwụsịsịrị ọgwụgwọ, nchịkọta platelet na oge ọbara ọgbụgba na-alaghachi ọkwa mbụ.

Ọgwụ mara mma ngwa ngwa banye Ọkpụkpụ afọ. Agbanyeghị, ịta ahụ clopidogrelna plasma dị ala, mmịpụta bụ 50%. Ọgwụ ejikọtara nke ọma na protein plasma ọbara.

Clopidogrel bụ metabolized n'ime imeju, ihe dịka 80% nke metabolites dị na plasma anaghị arụ ọrụ. Metabolite nọ n'ọrụ, nke na-enye ihe dị mkpa mgbochi emereme, guzobere site na mmeghachi nke ihe otutu isoenzyme nke cytochrome P450 - 2B6 na 3A4. Metabolite onwe ya na-emeghachi ngwa ngwa platelet achọpụtaghị ya na plasma ọbara.

Ọkara ndụ bụ awa 6 maka ihe na-arụ ọrụ na 8 maka metabolite na-adịghị arụ ọrụ. Amịlị dị na mmamịrị na ahụ.

Ndị mmadụ na-ata ahụhụ site na nnukwu akụrụ siri ike, mbelata ịdị irè nke ọgwụ site na 25% ma e jiri ya tụnyere ndị mmadụ.

Ihe ngosi maka iji Lopirel

A na-eji ọgwụ egbochi thrombosis akwara n'ime ndị mmadụ na-arịa ajọ ọrịa obi:

Egosiputara iji ya bu atherothrombotic nsogbu na ndị ọrịa tara ahụhụ infarction myocardial, ọria arunwee ọrịa ọgụ mmụọ ọrịa. N'okwu a, a na-eji ọgwụ ahụ eme ihe maka prophylaxis.

Ihe ngbanwe

Edeghị ọgwụ ahụ:

siri ike imeju imeju,
mụ nwanyị dị ime na ndị na-enye nwa ara,
na ọrịa hemorrhagic,
na ọbara ọgbụgba n'ime intracranial, ọnya afọihe na - abụghị ọnya afọ, imeju akpa ume, ụkwara nta na hyperfibrinolysis,
ụmụaka na-erubeghị afọ 18
na allergies na ọgwụ ndị mejupụtara ọgwụ,
na anagideghi galactose.

Ekwesịrị ịkpachara anya mgbe ị na-ejikọ ọgwụ ahụ na acetylsalicylic acid, Ndị NSAID, heparin, thrombolytics, na ụdọ akwara na ịba ọcha n'anya, tupu ịwa ahụ.

Lopirel, ntuziaka maka ojiji (usoro na usoro onunu ogwu)

A na-ewere mbadamba okwu ọnụ, n'agbanyeghị nri nri.

Ntụziaka maka iji Lopirel (75 mg)

Dịka iwu, jiri infarction myocardialafọ ischemic, ndị ọrịa na-arịa ọrịa akwara na mpụta edepụtara ka edepụtara mbadamba 1 oge 1 kwa ụbọchị.

Ogologo oge mbanye obi ọgụ - site na 1 ruo 25 ụbọchị, mgbe ọrịa strok - 7 ụbọchị ma ọ bụ ọnwa 6.

Ọ bụrụ na onye ọrịaọrịa coronary na-enweghị ebuli ST ma ọ bụ jigide coronary stenting, mgbe ahụ ọgwụgwọ bidoro ntụtụ nke 300 mg, emesia etinyere 75 mg (otu mbadamba) otu ugboro kwa ụbọchị maka ọnwa 3 (enwere ike ịgbatị ahụ otu afọ). N'ime ụdị ọrịa ndị ahụ, dịka iwu, tụkwasịrị ọgwụ ọzọ manacetyl salicylic acidUsoro ọgwụgwọ akwadoro bụ 100 mg.

Mwepụta wepụtara ya na ihe mejupụtara

Lopirel dị n'ụdị mbadamba ụrọ n'ime ihe nkiri: okirikiri, biconvex, pink, nke nwere ihe “M” kanyere n’otu akụkụ (mbadamba 7 ma ọ bụ 10 na mbadamba ụrọ: na mbadamba nke 1, 2, 4 ma ọ bụ 8 blisters, 7 mbadamba ma ọ bụ 1, 2, 3, 5, 6, 9 ma ọ bụ blister maka mbadamba 10, na mkpọ kaadiboodu maka ụlọ ọgwụ 10, 20, 30 ma ọ bụ 40 blisters).

Mbadamba 1 nke Lopirel nwere:

ihe na-arụ ọrụ: clopidogrel - 75 mg,
ndị na - ahụkarị: microcrystalline cellulose, lactose, talc, glyceryl dibehenate, crospovidone (ụdị A),
shei: Opadry II 85G34669 Pink talc, polyvinyl mmanya, macrogol 3350, titanium dioxide (E171), dye iron oxide red (E172), lecithin (E322).

Usoro nke ime ihe

Clopidogrel bụ nke prodrugs. Otu n'ime metabolites ya bụ ihe na - egbochi ọrụ nchịkọta platelet: na - egbochi mmachi adenosine diphosphate (ADP) na P2Y₁₂Ihe nnabata platelet na-esote ADP na-emegharị ọnụ nke ihe mgbagwoju anya nke glycoprotein IIb / IIIa, na-ebute mgbachi nke nchịkọta platelet. Usoro ejighi emechi emechi emeghi ka platelet ghara ịlụ ọgụ mkpali ADP n’oge ndụ ha niile (ihe dịka ụbọchị 7-10). A na-eweghachi ọrụ nkịtị nke platelet dabere na ọsọ nke mmelite ha.

Ọgwụ ahụ na-egbochikwa nchịkọta platelet nke ndị agonist na-abụghị ADP kpatara. A na - eme ka metabolite dị ike na - arụ ọrụ nke isoenzymes nke usoro P₄₅₀, na ebe ọ bụ na ụfọdụ isoenzymes nwere ike ịdị iche na polymorphism ma ọ bụ ọgwụ ọgwụ ndị ọzọ na-egbochi ya, ọ bụghị onye ọrịa ọ bụla nwere mgbochi zuru oke nke nchịkọta platelet.

Ngwongwo ọgwụ

Clonweta clopidogrel kwa ụbọchị na ntinye nke 75 mg na-enye nnukwu mkpagbu nke nchịkọta ADP na-akpata site na ụbọchị izizi. Nke nta nke nta, n'ime ụbọchị 3-7, ogo nke ịrị elu na-abawanye, na-eru ọkwa mgbe ọ nwetasịrị ọkwa. Mgbe ị na-a aụ ọgwụ kwa ụbọchị nke 75 mg n'ọtụtụ ụzọ, ihe nchịkọta platelet na-ebelata 40-60%. N'ime ụbọchị ise ka ị kwụsịrị ọgwụ ahụ, oge ọbara ọgbụgba na nchịkọta platelet jiri nwayọ laghachi ọkwa mbụ.

Ọgwụ arụmọrụ arụmọrụ / nchekwa

Clopidogrel na-egbochi mmepe nke atherothrombosis na mpaghara ọ bụla nke atherosclerotic vaskụla ọnya (dịka ọmụmaatụ, yana ọnya ọnya, akwara ma ọ bụ akwara akwara).

N'ime nnwale ụlọ ọgwụ, e gosipụtara na ọ bụrụ na enwere ọrịa ọgbụgba ọkụ na-arịa ọrịa na-arịa otu ihe ma ọ bụ karịa ihe egwu maka nsogbu vaskụl mana nwere ike ịnwe anticoagulants na-apụtachaghị ọnụ, njikọta clopidogrel na acetylsalicylic acid (ma e jiri ya tụnyere acetylsalicylic acid monotherapy) belata ugboro ugboro ọnụ weere myocardial infarction, ọrịa strok, thromboembolism sistemụ na mpụga sistemụ akwara ma ọ bụ ọnwụ akwara, nke kachasị n'ihi mbelata ihe ọghọm ọrịa strok. Ofdị irè nke nchịkwa nke clopidogrel na acetylsalicylic acid gosipụtara onwe ya n'oge ma jigide ruo afọ 5. Nbelata nke ohere nke ịmalite ọrịa ụkwara ume ọkụ na-arịa ndị ọrịa na-ewere acetylsalicylic acid na clopidogrel bụ nke enyere ihe ka ukwuu site na mbelata ọnụọgụ ọrịa strok. N'oge ọgwụgwọ na ọgwụ ọgwụ ndị a, a belatara ohere nke ọrịa ọnya ọ bụla, enwerekwa echiche nke mbelata nke infarction myocardial, mana enweghị ọdịiche na ugboro ugboro nke thromboembolism na mpụga akwara etiti ụjọ ma ọ bụ ọnwụ vaskụla. Na nke a, iwere clopidogrel na acetylsalicylic acid belatara oge ngụkọ ụlọ ọgwụ maka ndị ọrịa nwere nsogbu nke usoro akwara.

Egwu

Dị ka ọ dị otu, na ya na clopidogrel na dose nke 75 mg kwa ụbọchị, a na-etinye ihe ahụ ngwa ngwa. Na nkezi, mkpokọta mkpokọta nke clopidogrel na-agbanweghi agbanwe na plasma ọbara ruru ihe dị ka nkeji iri anọ na ise mgbe nchịkwa ọnụ gachara site na 2.2 ruo 2.5 ng / ml. Ntinye nke clopidogrel site na akụrụ (dịka ntụpọ nke metabolites ya dị) dịkarịa ala 50%.

Metabolism

A na-eme ka mmanụ arụ ọrụ dịrị n'ọbara. Na vivo na in vitro, clopidogrel bụ metabolized n'ụzọ abụọ: site na esterase nke hydrolysis na-esochi, na-ebute nguzobe nke ikuku carbonxylic acid (85%) site na metabolites na-agagharị na sistemụ sistemụ site na sistemụ cytochrome P.₄₅₀.

Na nmalite mbụ, clopidogrel bụ metabolized ka metabolite dị n'etiti - 2-oxoclopidogrel. Metabolism na-esote nke oxoclopidogrel na-ebute ọdịdị nke metabolite na-arụ ọrụ, usoro thiol sitere na clopidogrel. Thiszọ a na usoro metabolic vitro pụtara na ntinye nke isoenzymes CYP2C19, CYP3A4, CYP2B6, na CYP1A2. Site na metabolic na-arụsi ọrụ ike dịpụrụ adịpụ na vitro na-ejikọ ọnụ na ngwa ngwa jikọtara ndị na-anabata platelet, na-egbochi nchịkọta ha.

N'ihe banyere otu iko clopidogrel na dose nke 300 mg, ntinye uche nke metabolite nọ n'ọrụ ka okpukpu abụọ dị elu karịa mgbe ị na-ewere usoro mmezi nke clopidogrel 75 mg maka ụbọchị 4. Oke kacha ịta nke nọ n'ọrụ metabolite nke clopidogrel e dere 0.5-1 awa mgbe na-ewere ọgwụ.

N'ime mmadụ, mgbe nchịkwa ọnụ nke 14 C nke akpọrọ Clopidogrel akpọrọ maka elekere 120, ihe dị ka pacacor 46% na-apụ n'anya site na eriri afọ ya na ihe dị ka 50% nke ọrụ redio ahụ na-apụta site na akụrụ. Mgbe otu clopidogrel jiri otu ọgwụ mee ihe na 75 mg, ọkara ndụ bụ ihe dịka awa 6. N’inye otu usoro na usoro ị andụ ugboro ugboro, ọkara ndụ nke na - ekesa ihe na - arụ ọrụ n’ime ọbara bụ ihe dịka elekere asatọ.

Pharmacogenetics

A na-etolite metabolite na-arụ ọrụ nke clopidogrel na 2-oxoclopidogrel na -agbata etiti na-eji isoenzyme CYP2C19. CYP2C19 isoenzyme genotype na-emetụta mmetụta antiplatelet na pharmacokinetics nke metabolite na-arụ ọrụ n'oge ọmụmụ agakọ ex vivo platelet.

Ebumnuche nke CYP2C19 * 1 mkpụrụ ndụ kwekọrọ na metabolism arụmọrụ zuru oke, yana mkpụrụ ndụ ihe nketa CYP2C19 * 3 na CYP2C19 * 2 adịghị arụ ọrụ ma na-ebute mbelata metabolism n'ọtụtụ ndị nnọchi anya Mongoloid (99%) na Caucasoid (85%) agbụrụ. Allezọ ndị ọzọ na-eme ka mbelata ma ọ bụ enweghị metabolism (gụnyere gụnyere naanị na alleles nke CYP2C19 * 4, * 5, * 6, * 7, * 8 mkpụrụ ndụ ihe omimi) amachaghị. Ndị ọrịa na-adịghị ike metabolizer kwesịrị ịnwe ụzọ ngosipụta abụọ nke ihe ọmụmụ site na arụ ọrụ. Dabere na data e bipụtara, ugboro ole phenotypes nke metaraoli CYP2C19 metadolizer dị iche iche na agbụrụ Negroid bụ 4%, agbụrụ Caucasoid - 2%, na ndị China - 14%.

Iji tụọ ọgwụ pharmacokinetics na mmetụta antiplatelet mgbe ị na-ewere ọgwụ mbụ nke clopidogrel 300 mg na ntinye ya na-esochi 75 mg kwa ụbọchị, yana mgbe ị na-ewere ọgwụ mbụ nke clopidogrel 600 mg na ntinye ya na-esochi 150 mg kwa ụbọchị maka ụbọchị 5 (ruo mgbe ha ruru nha anya ) emere ihe omumu nke nwere ihe omumu nke 40 n’ime ndi otu abuo nke 10 nwere mmadu iri na ano nke CYP2C19 isoenzyme (ultrafast, siri ike, adighi ike ma obu ndi metabolizer). N'ihi nke a, na igwe mmiri na-ahụ oke, etiti na nke na-adịghị ike, enweghị ọdịiche pụtara ìhè na mkpughe nke metabolite na-arụ ọrụ, yana na ụkpụrụ nke igbochi agịkọta platelet (ADP na-akpata. Nkpughepụta nke metabolite nọ n'ọrụ na metabolizer na-adịghị ike ma e jiri ya tụnyere metabolizer kpụ ọkụ n'ọnụ belatara site na 63-71%. N'ihe banyere usoro 300 mg / 75 mg, mmetụta antiplatelet nke metabolizers na-esighi ike belata ogo platelet nchịkọta ihe mgbochi, nke bụ 24% (mgbe elekere 24) na 37% (na ụbọchị 5) ma e jiri ya tụnyere ihe mgbochi platelet inhibition na siri ike (39% - mgbe awa 24 na 58% - n’ụbọchị nke ise) na etiti (37% - mgbe elekere 24 na 60% - n’ụbọchị nke ise) metabolizer. N'ihe banyere iji 600 eme ihe, CYP2C19 * 1 gene allele na-enye metabolism mg / 150 mg nke ọma, ikpughe metabolism na-arụ ọrụ na metabolizer na-adịghị ike dị elu karịa atụmatụ 300 mg / 75 mg. Ihe nchịkọta platelet dị 32% (mgbe awa 24 gachara) na 61% (n'ụbọchi nke ise), nke kariri otu uru ahụ maka 300 mg / 75 mg regimen, mana ọ dị ka otu ndị ọrịa nwere mmụba CYP2C 19- metabolism, nke natara ọgwụgwọ dịka atụmatụ 300 mg / 75 mg. Ekwesiri iburu n'uche na n'ọmụmụ ihe ahụ, na-eburu n'uche nsonaazụ ụlọ ọgwụ maka ndị ọrịa nke otu a, usoro ọgwụgwọ usoro nke clopidogrel amalitebeghị.

Ntụle meta nke ọmụmụ isii, nke gụnyere data sitere na ndị ọrụ afọ ofufo 335 natara clopidogrel ma nọrọ n'ọnọdụ ịha nhata, gosipụtara na mkpughe nke metabolite na-arụ ọrụ na metabolizer na-adịghị ike belata site na 72%, na na metabolites dị n'etiti - site na 28%, ọ bụ ezie na nkezi uru nke inhibition nke nchịkọta platelet bụ. belatara atụnyere ndị igwe ihe ọkụkụ siri ike site na 21.4 na 5.9%.

Enyochabeghị mmekọrịta dị na CYP2C19 genotype na nsonaazụ ụlọ ọgwụ na ndị ọrịa na-anata clopidogrel n'ọdịniihu, ọnwụnwa, enweghị usoro, ka ọ dị ugbu a, enwere ọtụtụ nyocha a na-atụgharị anya. Ebuputara data sitere na otutu ihe omuma, ya na nsonaazụ nke genotyping na omumu ihe omumu: CHARISMA (n = 2428), CURE (n = 2721), TRITON-TIMI 38 (n = 1477), CLARITY-TIMI 28 (n = 227), ACTIVE- A (n = 601).

Ihe omumu ihe omuma ato (Giusti, Collet, Sibbing) na omumu ihe banyere TRITON-TIMI 38 n'ime ndi oria a na - eme mmekorita nke na - adighi ike ma na - etiti ihe di omimi dere nnukwu nsogbu nke akwara obi (infarction myocardial, strok, onwu) ma obu strombosis siri ike. data gbasara metabolizer kpụ ọkụ n'ọnụ.

Na omumu ihe omumu nke Simon na akwukwo CHARISMA, otutu ihe banyere obi agha ka akwara na metabolizer adighi ike (ma e jiri ya tụnyere ya).

Na omumu ihe omumu nke Trenk na CLARITY, CURE, ACTIVE-A, odighi nmekorita nke obi na ike nke CYP2C19 metabolism.

Omumu ihe omumu ihe omumu nke emere rue taa nwere nha nke ezughi oke iji choputa ihe di iche na ihe nlere ogwu n’enwe ndi oria n’enweghi ihe omumu CYP2C19.

Oche Clinical Pụrụ Iche

Emebeghị ka ọgwụ ahụ dị ike nke metabolite nke clopidogrel maka otu ndị otu.

N'ime ọmụmụ metụtara ndị ọrụ afọ ofufo agadi (ihe karịrị afọ 75), ma e jiri ya tụnyere data nke ndị ọrụ afọ ofufo na-eto eto, enwetaghị ọdịiche dị n'oge oge ọbara na nchịkọta platelet. Maka ọgwụgwọ nke ndị ọrịa meworo agadi, a chọghị ịgbanwe ọgwụ Lopirel.

Achọghị ọgwụ ọgwụ nke clopidogrel na ndị ọrịa na-erubeghị afọ 18.

Na oke mmebi akụrụ (na njikwa creatinine site na 5 ruo 15 ml / min) n'ihi ojiji nke clopidogrel ugboro ugboro na 75 mg kwa ụbọchị, ogo nke mbido ADP-induced platelet agbụrụ dị 25% dị ala karịa na ndị ọrụ afọ ofufo ahụ siri ike, agbanyeghị, oge ọbara ọgbụgba ahụ ka dịgidere yiri nke a gosipụtara maka ndị ọrụ afọ ofufo nwere ahụ ike bụ ndị natara ọgwụ kwa ụbọchị nke clopidogrel 75 mg. Ndị ọrịa niile nabatara ọgwụ ahụ nke ọma.

N'ime oke mmebi imeju n'ihi iwere clopidogrel na ọgwụ nke 75 mg kwa ụbọchị maka ụbọchị 10, ogo nke inhibition nke nchịkọta ADP na-eweta platelet yiri nke ahụ maka ndị ọrụ afọ ofufo ahụ siri ike.Otu abụọ ahụ yikarịrị maka oge ọbara na-agba agba.

Ọdịdị nke mkpụrụ ndụ ihe nketa nke CYP2C9 isoenzyme, nke na-ahụ maka mbelata na etiti, na-adị iche n'etiti ndị nnọchite otu agbụrụ dị iche iche. Maka ndị nnọchi anya agbụrụ Mongoloid, enwere obere akwụkwọ data na-anaghị ekwe ka nyocha nke uru nke genotyping nke CYP2C19 isoenzyme gbasara mmepe nke nsogbu ischemic.

Omume ọgwụ

Ngalaba ọgwụ na-arụ ọrụ bụ Lopirel na-ahọrọ n'ụzọ dị ukwuu na - egbochi mgbochi nke irighiri ADP nye ndị na-anabata ya nke dị na platelet. Yabụ, ịgbalite njikọ GPIIb / IIIa agakọ na platelet agabigaghị ekwe omume. Clopidogrel na-egbochikwa usoro nchịkọta nke ndị na-emegide ndị ọzọ batara. Ruo na njedebe nke ndụ, platelet na-emebi emebi ma nwee ike nchịkọta.

Ọgwụ mara mma ngwa ngwa etinye na diges. Agbanyeghị, mkpokọta nke clopidogrel na plasma dị ala, mmịpụta bụ 50%. Ọgwụ ejikọtara nke ọma na protein plasma ọbara.

Clopidogrel bụ metabolized n'ime imeju, ihe dịka 80% nke metabolites dị na plasma anaghị arụ ọrụ. A na-eme ka metabolite nọ n'ọrụ, nke nwere mmetụta antiaggregatory dị mkpa, site na mmeghachi nke oxidation, yana ntinye nke cytochrome P450 isoenzyme 2B6 na 3A4. A na - ahụkarị metabolite n'onwe ya na platelet, achọpụtaghị ya na plasma ọbara.

Ọkara ndụ bụ awa 6 maka ihe na-arụ ọrụ na 8 maka metabolite na-adịghị arụ ọrụ. Amịlị dị na mmamịrị na ahụ.

Ndị mmadụ na-ata ahụhụ site na nnukwu akụrụ siri ike, mbelata ịdị irè nke ọgwụ site na 25% ma e jiri ya tụnyere ndị mmadụ.

Ntụziaka maka ojiji

Ekwesịrị iburu mbadamba lopirel n'agbanyeghị nri iri nri.

Ndị ọrịa merụrụ ahụ mgbu ischemic / myocardial infarction ma ọ bụ ndị nwere ọrịa akwara ụkwụ, kwesịrị ị mgụ 75 mg otu ugboro n'ụbọchị. Mgbe nkụchi obi gasịrị, usoro ọgwụgwọ na-amalite site na ụbọchị mbụ wee dịgide ruo ụbọchị 35, na mgbe ọrịa strok - site na 1 izu ruo ọnwa isii.

Na ọnụnọ nke nnukwu ọrịa obi na-arịa ọrịa na-enweghị nrịgo nke ST (gụnyere ndị ọrịa nwere mkpali n'oge itinye aka na ntanetị), a na-amalite usoro ọgwụgwọ site na iji mkpokọta 300 mg (otu ojiji), ha wee gbanwe gaa 75 mg na awa 24 n'ime awa 1 (ngwakọta na acetylsalicylic acid na usoro onunu ogwu n’elu 100 mg). Ọzụzụ ahụ ruru otu afọ.

Na nnukwu ọgbụgba na-arụ ọrụ na ọnụnọ ST akụkụ elu (yana ọgwụ aspirin na ọgwụ thrombolytic), etinyere mbadamba nkume otu ugboro na 75 mg kwa awa 24 maka 1 na-eji ọgwụ mbido (otu oge, yana thrombolytics na ọgwụ aspirin). Ọgwụgwọ ebido dịka o kwere omume ma gaa n’ihu n’otu ọnwa ọzọ. Ejighi usoro a na-ebugharị mgbe afọ 75 dị.

Nsonaazụ

sistemu lymphatic na mgbasa: infesquently - eosinophilia, leukopenia, thrombocytopenia, na-adịkarịghị neutropenia (gụnyere neutropenia siri ike), adịkarịghị aplastic anaemia, thrombotic thrombocytopenic purpura, agranulocytosis, pancytopenia, thrombocytopenia, granulocycyia, granulocycyia
dịghịzi - mmeghachi omume anaphylactoid, ọrịa serum, ugboro ole amabeghị - mmepe nke mmeghachi omume nke hypersensitivity na thienopyridines (dịka ọmụmaatụ, yana ticlopidine na prasugrel),
musculoskeletal na anụ ahụ na - ejikọta ọnụ: ọ na - adịkarịghị - ogbu na nkwonkwo, hemarthrosis (ọbara ọgbụgba na usoro akwara), myalgia, arthralgia,
sistem ụjọ: ugboro ugboro - isi ọwụwa, ọbara ọgbụgba (intracranial hemorrhage) (ihe ụfọdụ na - akpata nsonaazụ), dizziness, paresthesia, very slight - uto ọgba aghara,
anụ ahụ na ọnya subcutaneous: mgbe mgbe - mmerụ ahụ, ugboro ugboro - itching, ihe ngbu, purpura, nnọọ adịkarịghị - angioedema, bullous dermatitis (erythema multiforme, Stevens-Johnson syndrome, toxic epidermal necrolysis), syndrome hypersensitivity syndrome, erythematic or refoliative rash Oria nwere osooso na eosinophilia, urticaria, lichen planus, eczema,
ọhụụ: ọnya na - adịghị ala ala (na anụ ahụ nke anya, conjunctiva, retina),
umeji na urinary tract: dịkarịsịrị ala - ịba ọcha n'anya, oke imeju ọdịda, ọrịa na ụlọ nyocha nke ọnọdụ imeju,
Ihe omumu na ihe omumu: ihe ngbali - onu ogugu na –eme ka ogha n’enweghi ogwu, mmụba n’oge ọbara na-agba, mbelata ọnụ ọgụgụ platelet,
ọgba aghara na saịtị injection na nsogbu izugbe: mgbe mgbe - ọbara ọgbụgba site na ebe ụkọ, ọ na - adịkarịghị - fever,
na-anụ ihe: adịkarịghị - vertigo,
psyche: ọ na - esighi ike - ọgba aghara, ihe ijuanya,
eriri afọ: ọgbụgba, ọnya afọ, dyspepsia, mgbu nke afọ, eriri afọ, afọ na ọnya afọ, ọgbụgbọ, ọgbụgbọ, ọnya afọ, afọ ọsịsọ, ọbara ọgbụgba na-adịkarị ala, ọ na-adịkarịkeghachi azụ na akwara afọ. ọbara ọgbụgba na-egbu egbu, ọnya afọ (gụnyere lymphocytic ma ọ bụ ọnya afọ), pancreatitis, stomatitis,
usoro iku ume: ọtụtụ mgbe - imi imi, ọ na-adịkarị - bronchospasm, ọbara ọgbụgba site na sistem okuku ume (akwara umeji, hemoptysis), ọnyụ na -akpata eosinophilic, ọnyá afọ,
akụrụ na urinary tract: ugboro ugboro - hematuria, nke ukwuu adịkarịghị - mmụba nke mkpokọta nke creatinine n'ime ọbara, glomerulonephritis,
arịa ọbara: ọtụtụ mgbe - hematomas, dịkarịsịrị ala - ọbara ọgbụgba site na ọnya arụmọrụ, ọbara ọgbụgba dị ukwuu, mbelata ọbara mgbali, vasculitis.

Ntụziaka pụrụ iche

Imeju imeju: na ogo gbara oke - na akpachapụ anya, na nnukwu - ọ na - contraindicated.

Amara ịdoụbiga ihe ókè bụ mmụba nke oge ọbara ọgbụgba. N'ime ọnọdụ a, usoro ọgwụgwọ ahụ gụnyere ntụgharị nke platelet mass, ebe ọ bụ na enweghi ọgwụgwọ.

Edekọwo oge ikpe ọbara ọgbụgba n'oge ejiri Loctirel acetylsalicylic acid, yana heparin.
Ọkpụkpụ akụrụ: a na-eji ịdọ aka na -ezi ọrịa na ogo ọrịa.
Kpachara anya dị mkpa n’ebe ndị ọrịa nọ n’ihe ize ndụ nke ọbara ọgbụgba n’ihi ọtụtụ ihe kpatara ya ma ọ bụ ndị na-a useụ ọgwụ ụfọdụ.
N'ime usoro ịwa ahụ, mgbe nrụpụta antiraplet adịghị mma, a na-akwụsị usoro ahụ izu 1 tupu ụbọchị ịwa ahụ.
A na-enyocha ndị ọrịa oge niile maka ọbara ọgbụgba zoro ezo.
Transportgbọala na ngwaọrụ dị mgbagwoju anya: anaghị emetụta.
Clopidogrel nwere ikike igbochi ọrụ CenP2C9 isoenzyme, yabụ enwere ohere nke mmụba nke ọbara tolbutamide na phenytoin. Usoro nlekọta nke ndị ọrụ a na Lopirel adịghị nchebe.
Onye ọrịa ahụ kwesịrị ịmara na oge usoro ọgbụgba na-abawanye ụba, yabụ dọkịta ọ bụla kwesịrị ịma gbasara ọgwụgwọ ahụ.
Na ọrịa akpịrị ọgbụgba, a naghị akwado ọgwụ ahụ maka iji ya (ihe na-erughị izu 1).
N'ime afọ 18, amachibidoro ọgwụ.
N'ime ọgwụgwọ ndị ọrịa nwere nnukwu myocardial infarction (ya na mmụba na mpaghara ST), ọgwụgwọ anaghị ebido n’ụbọchị ole na ole mgbe ọ malitere infarction myocardial.

N'ihe banyere ọbara ọgbụgba, a na-enyocha ọbara na ọrụ imeju.

Mkparịta ụka ọgwụ ọjọọ

Enwere ike ijikọ ọgwụ ahụ na atenolol, phenobarbital, estrogens, cimetidine ma ọ bụ nifedipine.

E gosiputara na ugwọ acetylsalicylic acid kwa ubochi (ihe ruru 1000 mg kwa ubochi) na clopidogrel emetutaghi ngwakọta nke ọgwụ. Agbanyeghị, oge imekọ ihe nke ọgwụ ọgwụ ndị a ekwesịghị ịbụ ihe karịrị afọ 1 (a gharịrị ilebara anya).

Mgbe ejikọtara ya na ọgwụ anticoagulants a na-egbu egbu, ọkachasị n'oge a na-akpọ warfarin, enwere ike ịnwe ya na oge ọbara ọgbụgba nwere ike ịba ụba.
Agaghị atụkwa ọgwụ maka ọgwụ thrombolytics, ebe ọ bụ na nchekwa nke njikọta dị otú ahụ abụghị nke ọma.
N'agbanyeghị ezigbo nsonaazụ nke ọmụmụ nyocha banyere mmekọrịta nke ọgwụ na heparin, a ga-egosipụta ịkpachara anya mgbe ị na-ewere ha n'otu oge.
N’ime ndị mmadụ nọ n’ihe egwu dị elu karị na-agba ọbara ma na-ewere Lopirel, a naghị akwado ya ka ewere ihe ndị na - egbochi glycoprotein IIb / IIaa.
Ikekwe ngwakọta ọgwụ na digoxin, theophylline, antacids.

Ọgwụ ahụ na-egbochi metabolism nke ọgwụ nke ọgwụ pharmokokinetic na-adabere na CYP2C9 isoenzyme. Karịsịa, ọgwụ nwere ike ime ka mkpokọta plasma nke phenytoin na tolbutamide nwee ike. Ekwesịrị ịkpachara anya.

Ekwuputara na ngwakọta nke clopidogrel - naproxen na - ebulite ohere ọ nwere ịmalite ịmịnye afọ na - emegharị akpa umeji. Agbanyeghị, n'ihe banyere NSAID ndị ọzọ, egosipụtaghị ụdịrị usoro ahụ. N'akụkụ a, yana ngwakọta ọgwụ ndị a kwesịrị ịkpachara anya.

Analogs nke ọgwụ Lopirel

Ihe owuwu na-ekpebi analogues:

Plavix,
Ọgbakọ
Sylt,
Fluder,
Fagot,
Agwọ
Deplatt 75,
Thromborel,
Detrombe
Plaglir,
Cardutol
Targetek
Klopilet,
Clapitax
Clopidogrel,
Lirta
Ndepụta nke 75,
Egithromb,
Cardogrel
Lopirel
Plogrel,
Klopirel.

Otu ndi otu antiplatelet gunyere analogues:

Phasostable
Ọgbakọ
Pentilin
Agrenox
Ayferol
Thromborel,
Clopidogrel,
Clapitax
Cardutol,
Parsedil
Integrilin
Lirta
Agrilin,
Lopirel,
Tiklo
Aklotin,
Curantil
Agwọ
Pentomere
Pesịn
Methylethylpyridinol,
Klopilet,
EGO
Radomin
Brilinta
Fluder,
Targetek
Cardiomagnyl
Thromboreductin,
Cardioxypine
Eifitol
Acetylsalicylic acid
Trental
Coplavix,
Vixipin
Agapurin
Doksilek,
Akonol,
Ike
Emoxibel
Klopirel,
Alprostan,
Ikwu okwu
Ginkio
Aspinat
Kpọkọtan
Ginos
Emoxipin
Ibustrin
Tiklid,
Mikristin
Fagot,
Pentoxifylline
Na-egosi
Plavix,
Cilostazol
Ndepụta nke 75,
Monafram
Chukwu
Muse
Laspal
Ticagrelor,
Xanthinol Nicotinate,
Pentamon
Ralofect,
Cardogrel
Nke oma
Ventavis.

Dodoụbiga ya ókè

An Withụbiga ọgwụ ókè, ịba ụba nke oge ọbara ọgbụgba na ịkawanye njọ nke ọnọdụ ahụ ga-ekwe omume.

Ọgwụgwọ - dịka ihe mgbaàmà si dị.

Kpọmkwem ọgwụ mgbochi ọgwụ enweghị. N'okwu ndị dị oke njọ, ịkwụsị ọgwụ ahụ site na ịmịnye onye e merụrụ ahụ kwere omume. uka platelet.

Mmekorita

Mgbe ejikọtara ya na ogwu anticoagulantsọ kachasị warfarin, enwere ike omume na oge ọgbụgba nwere ike ịba ụba.

N'ime ndị nwere oke ọbara ọgbụgba ma na-a Loụ Lopirel, a gaghị atụ aro ka a allyụọ ọzọ glycoprotein IIb / IIІa inhibitors.

Ngosiputa gosiputara clopidogrel – naproxen na - eme ka ọ nwee ọbara ọgbụgba na - abịakwa. Ma, n’ihe banyere ndị ọzọ Ndị NSAID egosipụtaghị ụdịrị usoro a. N'akụkụ a, yana ngwakọta ọgwụ ndị a kwesịrị ịkpachara anya.

N'agbanyeghị ezigbo nsonaazụ nke ọmụmụ ọmụmụ gbasara mmekọrịta mmekọrịta ọgwụ na heparin, na nnabata ha n'otu oge ọ dị mkpa ịkpachara anya.

Nchikota nke ogwu na thrombolytics, ebe nchekwa anaghị edozi nke ọma.

Gosiputa ubochi nile acetylsalicylic acid(ihe ruru 1000 mg kwa ụbọchị) na clopidogrel adịghị emetụta gbakọọ Njirimara nke ogwu. Agbanyeghị, oge imekọ ihe nke ọgwụ ọgwụ ndị a ekwesịghị ịbụ ihe karịrị afọ 1 (a gharịrị ilebara anya).

Ọgwụ na-egbochi metabolism nke ọgwụ, pharmacokinetic egosi nke dabere isoenzyme CYP2C9. Karịsịa, ọgwụ nwere ike ịba ụba itinye uche plasma ihe ndapụta na tolbutamide. Ekwesịrị ịkpachara anya.

Ikekwe ngwakọta nke ngwaọrụ digoxin, theophylline, antacids.

Analogs Lopirela

Analogues nke ọgwụ: Clopidogrel, Avix, Atrogrel, Deplat, Zilt, Karum Sanovel, Clopidale, Klopikor, Lopigrol, Orogrel, Plavigrel, Plagril, Reodar, Tessiron, Trombone, Flamogrel 75, Aterocardium, Gridoklein, Deplatt, Cardogrel, Krerelrel Neo, Plavix, Platogril, Reomax, Trombeks.

Usoro onunu ogwu na nhazi

Maka mgbochi nke nsogbu ischemic na ndị ọrịa mgbe myocardial infarction, ọrịa strok ischemic na ọrịa chọpụtara n'oge na-adịbeghị anya, etinyere ndị okenye (gụnyere ndị agadi agadi) 75 mg 1 oge / ụbọchị, n'agbanyeghị nri. Ekwesịrị ịmalite ọgwụgwọ site na ụbọchị ole na ole ruo ụbọchị iri atọ na ise mgbe mịkasịọ nke myocardial mepụtara usoro nkwalite Q na site na ụbọchị 7 ruo ọnwa 6 mgbe ọnya ọgbụgba sitere na ischemic.

Jiri ndị okenye na ndị ọrịa agadi na arụ ọrụ nkịtị nke CYP2C19 isoenzyme

Site na infarction myocardial, ọrịa strok ischemic na ọrịa metụtara ọrịa artlusion, ọrịa ọgwụ 75 nke Lopirel bụ otu ugboro kwa ụbọchị.

Na nnukwu akụrụngwa na-arịa ọrịa ST na-enweghị nrịba akụkụ ST (myocardial infarction na-enweghị ebili mmiri QR, angina na-akwụghị chịm), ọgwụgwọ kwesịrị ịmalite site na otu ibu (300 mg), emesịa etinyere 75 mg otu ugboro kwa ụbọchị (yana ọnụ kwa ụbọchị nke 75-325 mg acetylsalicylic acid ) Ebe ọ bụ na iji ọgwụ acetylsalicylic acid dị elu na-amụba ohere nke ọbara ọgbụgba, usoro acetylsalicylic acid akwadoro maka ngosipụta a agaghị agafe 100 mg. Ekpebisila oge ọ ga-eji mata ọrịa ọ ga-akara. Dabere na ọmụmụ ụlọ ọgwụ, a ga-ewere ọgwụ ahụ ruo otu afọ. Mmetụta kachasị bara uru ka ọnwa atọ na-achọpụta.

Na nkwonkwo akwara na nnukwu ọnya ST na ngalaba (nnukwu myocardial infarction nke a na-egosi ST-nke elu elu), a na-atụ aro ibu 300 mg otu ugboro, na-esochi 75 mg otu ugboro n’ụbọchị yana Acetylsalicylic acid (yana njikọ ma ọ bụ na-enweghị thrombolytics). Na usoro ọgwụgwọ nke ndị ọrịa gbara afọ iri asaa na ise gbagote, ekwesịrị ime ọgwụgwọ Lopirel n'emeghị ọgwụ ntụtụ. Usoro ọgwụgwọ agwakọtara na-amalite ozugbo mmalite nke mgbaàmà ọ na-adịgide ruo izu anọ. Nyocha amamịghe nke acetylsalicylic acid na clopidogrel na ngosipụta ndị a karịa izu anọ amụbeghị nyocha.

Site na fibrillation atrial fibrillation (75m) nke Lopirel ka edepụtara otu ugboro n'ụbọchị. Na clopidogrel, a ga-amalite iji acetylsalicylic acid (kwa ụbọchị nke 75-100 mg).

Ọ bụrụ n’ịgha ọgwụ Lopirel ọzọ, ị ga-agbaso ndụmọdụ ndị a:

ọ bụrụ n’ihe na-erughị elekere 12 agafeela mgbe ị gụsịrị ọgwụ, ị kwesịrị ị takeụ ọgwụ Lopirel ozugbo, ma were ọgwụ ndị ọzọ dị ka ị na-eme,
ọ bụrụ na ihe karịrị elekere iri na abụọ agafeela mgbe ịwụsịrị ọgwụ, a ga-ewere Lopirel ọzọ dịka ọ dị (a machibidoro okpukpu abụọ).

Njirimara ngwa

Ekwesịrị ime nnwale ọbara n'izu mbụ nke ọgwụgwọ n'ihe banyere njikọta nke clopidogrel na acetylsalicylic acid, NSAIDs, heparin, IIb / IIIa glycoprotein inhibitors ma ọ bụ fibrinolytics, yana ndị ọrịa nwere oke ọbara ọgbụgba (mmerụ ahụ, itinye aka n'ịwa ahụ ma ọ bụ ọnọdụ ndị ọzọ).

N'ihi ọghọm ọbara ọgbụgba na nsonaazụ akụkụ hematological, ọ bụrụ na akara ngosipụta na-egosi na nke a na-apụta n'oge ọgwụgwọ, ule ọbara (APTT, platelet, nyocha ọrụ arụmọrụ) na imeju ọrụ imeju kwesịrị ozugbo.

N'ihe banyere usoro ịwa ahụ, ọ bụrụ na mgbochi ịkpa nkata adịghị mma, a ga-akwụsị clopidogrel ụbọchị asaa tupu ịwa ahụ.

Ekwesịrị iji Clopidogrel jiri nlezianya mee ihe na ndị ọrịa nwere ọbara ọgbụgba (karịsịa eriri afọ na intraocular).

E kwesịrị ịdọ ndị ọrịa ọdụ na ha kwesịrị ịgwa dọkịta banyere ikpe ọbara ọgbụgba ọ bụla.

N'ihi data ezughi ezu, ekwesighi ịkọwa clopidogrel n'oge oke ọrịa ischemic (na ụbọchị asaa mbụ).

Nchedo nchekwa

Edere ya ka o jiri nlezianya nye ndị ọrịa nwere nnukwu ọbara ọgbụgba (mmerụ ahụ, ihe ndị metụtara ịwa ahụ, wdg) yana nnukwu akwara na arụ ọrụ na-arụ ọrụ (ọbara ọgbụgba nwere ike ịmalite).

Emebeghi nchekwa na nrụpụta ọrụ na ndị ọrịa na-erubeghị afọ 18.

Ọgwụ a nwere lactose, yabụ na mmadụ ekwesịghị iburu ya na mkpụrụ nke lactose agbụrụ.

Clopidogrel bụ prodrug nke na - eme ntụgharị metabolic metụtara ọtụtụ enzymes imeju. Oge nchịkwa ọgwụ nke na-egbochi ọrụ enzyme imeju CYP2C19 nwere ike ibute mgbanwe na nguzobe metabolite nọ n'ọrụ, yabụ, mbelata na ọgwụgwọ ọgwụgwọ. Nnabata nke clopidogrel na ndị na-egbochi mmiri proton n'oge dị iche iche nke ụbọchị anaghị emetụta mmepe mmeghachi omume nke mmekọrịta.

Ekwesịrị iwezuga nchịkwa nke clopidogrel na ndị na-egbochi proton pump, nke a na-egosi na ha nwere ikike ịnabata nrụpụta ọgwụgwọ nke clopidogrel, dịka ọmụmaatụ, omeprazole.

Ọ bụrụ na onye ọrịa ahụ kwesịrị iburu ihe mgbochi proton mgbe ọ na-a cloụ clopidogrel, a ga-edenye ọgwụ ọgwụ ndị otu a nwere ike ikwuputa okwu dị nta karịa ịme mmekọrịta. Otu n'ime ọgwụ ndị a bụ pantoprazole.

Weputara udi ya na ihe mebere ya

Ọgwụ ahụ dị na mbadamba ụrọ nke nwere 1 ihe na-arụ ọrụ (clopidogrel hydrosulfate) yana ndị nwere ọgwụ enweghị mmetụta antiplatelet. Ntinye ntinye akwukwo bu 97.87 mg. Ọnụ ego a dabara na 75 mg nke clopidogrel. Mbadamba ahụ nwere shei pụrụ iche, n'ihi nsonaazụ nke ọgwụ ahụ ka ọ dị nro. N'okwu a, a na-ahapụ ihe dị ike ji nwayọ nwayọ, mmịpụta na-apụta na eriri afọ. Ihe ndi pere mpe:

crospovidone
lactose
microcrystalline cellulose,
glyceryl dibehenate
Opadry II 85 G34669 pink,
ntụ ntụ talcum.

Ihe ngwugwu ahụ nwere mbadamba 14, 28 ma ọ bụ 100.

Ọgwụ ahụ dị na mbadamba ụrọ nwere 1 ihe eji eme ihe.

Mlọ ọgwụ

Ọgwụ na-amalite ime ihe ozugbo na ngalaba nchịkwa - mgbe elekere abụọ gachara, enwe mbelata na ike platelet na-ejikọ ọnụ. Ọ bụrụ na i buru ibu, a na-eme ka ọ dịkwuo mma. Mgbe ekpochapula nnukwu ihe mgbaàmà nke ọrịa ahụ, ego ole ọgwụ ga-ebelata. N’ihi nke a, mgbe ị gwọchara Lopirel maka ụbọchị 4-7, ọnụ ọgụgụ kachasị elu nke ọgwụ ahụ erute. A na-ahụta nsonaazụ a nwetara n’oge ndụ mkpụrụ ndụ sel (ụbọchị asaa nke asaa).

Ntinye nke clopidogrel na-adi ngwa ngwa, ebe ihe jikọtara na protein plasma dị elu (98%). Ntughari nke ihe a mejuputara na imeju. Achọpụtara ya n'ụzọ abụọ: site na esterases site na mwepụta nke carbonxylic acid (anaghị egosi ọrụ), na ntinye cytochrome P450. Usoro nke ejikọtara ndị nabatara platelet na-adị n'okpuru nduzi nke metabolites.

Ekwesịrị iburu n'uche na ị takingụ ọgwụ ahụ na nnukwu ọgwụ (300 mg otu oge) na-eduga na mmụba dị ukwuu na ịta ahụ. Uru nke ihe ngosi a di elu okpukpu 2 kariri ogo itinye uche na oge mgbe ewere nha mmezi (75 mg) maka ubochi ano.

Nsonye ahu nke ihe ndi di n’ime ya mejuputara n’azu akuko na-eme site na akuru.

Nwepu nke ihe di n’ime ogwu ahu mejuputara site na umu aka na eriri afọ (n’ogo kwesiri ya). Usoro a anaghị egbu oge. Nwepuchapu ihe ndi n’eme ka aru oru na abuputa ya n’abali nke ise ka ha shachara Lopirel ikpe azu.

Jiri nlezianya

Ọ bụrụ na akwadoro ịwa ahụ, anaghị enye ọgwụ ọgwụ ahụ ka ọ dịrị n ’ọbara ọgbụgba. Ọnọdụ ndị ọzọ pathological nke agụnyere na otu nke contraindications:

ọrịa nwere ike ịba ọbara dị elu nke ukwuu, dịka ọmụmaatụ, na-emebi akụkụ ahụ nke ọhụụ ma ọ bụ eriri afọ,
Akụkọ ihe mere eme nke nfụkasị ahụ na thienopyridines.

Maka ọbara ọgbụgba ụbụrụ, iburu Lopirel amachibidoro.
A machibidoro Lopirel iwe na ọnya afọ.
Site na mmerụ ahụ na ngụgụ nri, a ga-eji Lopirel kpachara anya.

Uzo esi ewere Lopirel

N'ọnọdụ ka ukwuu, a na-enye 0.075 g iwu otu ugboro n'ụbọchị. Ntuziaka maka iji ọgwụ eme ihe n'ọnọdụ ndị ọzọ:

Ọrịa coronary soro ịrị elu na ST: na 0.075 g kwa ụbọchị site na ụbọchị nke abụọ, ọgwụ mbụ bụ 0.3 g otu ugboro, oge ọgwụgwọ agaghị adị karịa izu anọ, e guzobebeghị ịdị irè nke ọgwụgwọ ogologo oge,
nkwonkwo akwara na - enweghị ihe iriba ama nke ịdị elu nke ST: ụkpụrụ bụ otu, mana oge ọ ga - anọ ogologo oge (rue ọnwa iri na abụọ),
Atrial fibrillation: 0.075 g kwa ụbọchị.

N'okwu nke ọ bụla, a na-atụ aro iji ASA. Agbanyeghị, enwere oke: enweghị ihe karịrị 0.1 mg kwa ụbọchị.

Na-a drugụ ọgwụ maka ọrịa shuga

A nabatara iji ọgwụgwọ maka ụdị ọrịa a, mana ekwesịrị ịkpachara anya n'ihi lactose nke bụ akụkụ ya. Na mgbakwunye, megide ndabere nke ọrịa shuga, ihe ize ndụ nke ịmalite ọrịa strok, infarction myocardial na-abawanye. Usoro ọgwụgwọ antiplatelet bụ usoro dị mkpa n'ịgwọ ọrịa a, a na-ekpebi usoro onunu ogwu n'otu n'otu, na-eburu n'uche ọnọdụ nke ahụ.

O nwere ike iji ọgwụ maka shuga, mana ekwesịrị ịkpachara anya mgbe ị na-a itụ ya.

Ọkpụkpụ afọ

Mgbaze, mgbu n’ime afọ, mgbanwe n’usoro nke akpịrị na-egosipụtakarị, ọgbụgbọ nwere ike ibute. Obere oge, a na-ahụta mmepe nke mbuze n'ime afọ, mwepụta ọnya ahụ siri ike, ịmepụta gas na-esiwanye ike. Mgbe ụfọdụ ọnya na-achọpụta ọnya, na-agbọpụta. Ọrịa na-efe efe na pancreatitis dị obere karịa.

Sistemụ akwara Central

Dizziness, isi ọwụwa, uto uto, mfu ya kpamkpam. Eleghị anya nwere ike ime. A na-ahụta ọgba aghara nke mmụọ.

N'oge ọgwụgwọ na Lopirel, ọgbụgbọ na ọgbụgbọ pụrụ ịmalite.
Dizzness bụ mmetụta dị n'akụkụ ọgwụ ọgwụ Lopirel.
Lopirel nwere ike ibute isi ọwụwa.
Mgbe ị na-ewere Lopirel, mgbu n'ime afọ nwere ike apụta.
Mmetụta ọzọ nke ọgwụ Lopirel bụ ọdịdị nke ịba ọcha n'anya.
Ọkpụkpụ ntutu isi bụ mmetụta dị n'akụkụ ọgwụ ọgwụ Lopirel.
Enwere ike imeghari onwe gị n'oge ọgwụgwọ na Lopirel.

Mmeghachi omume ọjọọ

Dabere na ntuziaka, Lopirel 75 mg nwere ụfọdụ ihe mgbochi iwere:

Eosinophilia (ọrịa nke na-abawanye na ọnụ ọgụgụ nke eosinophils).
Leukopenia (mbelata nke ọnụ ọgụgụ ọbara ọcha dị n’ime ọbara).
Thrombocytopenia (ọnọdụ nke e jiri mbelata platelet na-adị ala karịa nke kwesịrị, nke na-esochi ọbara ọgbụgba na nsogbu ịkwụsị ọbara ọgbụgba).
Neutropenia (ọkwa ọbara nke ukwu nke keporophilic granulocytes).
Ihe nketa ma ọ bụ inweta ọrịa ọbara n'ihi mmebi ụmị ụmị ọkpụkpụ.
Thrombotic thrombocytopenic purpura (ọrịa siri ike nke microemiopathic hemolytic anaemia mara).
Dizziness
Granulocytopenia (ọnụ ọgụgụ ọbara ọcha dị ala).
Ọbara
Ọbara ọgbụgba n'ime intracranial.
Hemophilia nnweta (ọrịa na-adịghị ike nke e ketara eketa nke metụtara coagulation).
Mmeghachi omume anaphylactoid.
Mgbagha.
Esemokwu.
Migraine
Paresthesia (ọgba aghara nke inwe uche, nke e ji mara oge na -echepụta ihe ụsọ ọkụ na agịga).
Mmebi nke uto.
Ihu ọbara.
Hematomas.
Ọbara na-agba nnukwu ọbara.
Mbelata ọbara mgbali.
Vasculitis (otu ọrịa nke metụtara mbufụt vascular immunopathological).
Epistaxis.
Bronchospasm (ọrịa na - apụta mgbe akwara nke bronchi na - agbadata ma belata lumen).
Ọbara ọbara.

Dabere na ntuziaka ahụ si Lopirel, a maara na, na mgbakwunye na nsonaazụ ndị a kọwara n'elu, ọgwụ nwere ike ịkpasu mmeghachi omume na-adịghị mma:

Ọrịa oyibo nke Eosinophilic (ọrịa nke eosinophils na-agbakọ na pulmonary alveoli).
Ọrịa afọ ọsịsọ (ọnya na-eme ka mmadụ pụọ ngwa ngwa, ebe ihe ọnya na-eme mmiri).
Ọrịa pneumonitis na-emetụta ala (mmebi akpa ume, nke usoro mkpali na-emetụta interstitium).
Ọnya duodenal (ọnya afọ nke ihe acid na pepsin na akpụkpọ ahụ mucous nke duodenum n'ime ndị nwere nnukwu acid).
Blogba mgbochi.
Gastritis (ọrịa ogologo oge nke mgbanwe mgbanwe dystrophic na mkpali na gastric mucosa, na-agabiga mmebi nke imu).
Ihe mgbochi intestinal.
Ọ na-agba ọbara Retroperitoneal.
Ọrịa inflammatory nke colon mucosa.
Ọria oria ojoo (oria nke eji arughari oria aru).
Ọrịa angioedema (nnukwu ọnọdụ nke etolite etolite nke mpaghara mucous, yana anụ ahụ kewara).
Nettle ọkụ.
Ọrịa ogbu na nkwonkwo (ọrịa nkwonkwo, tinyere ọnya).
Hemarthrosis (ọbara ọgbụgba na nkwonkwo akwara).
Arthralgia (nkwonkwo mgbu).
Hematuria (ọnụnọ ọbara n'ime mmamịrị).
Glomerulonephritis (ọrịa akụrụ mara ọnya nke glomeruli).

Enwere m ike iji ọgwụ n'oge afọ ime?

Dabere na nyocha nke Lopirel, a maara na clopidogrel egosighi mmetụta dị njọ na ịtụrụ ime na ịmụ nwa, mana n'ihi enweghị ozi banyere ụlọ ọgwụ, idebe ọgwụ ahụ bụ ọgwụ mgbochi maka ụmụ nwanyị dị ime.

N'ime usoro ọmụmụ a, achọpụtara na ihe ahụ na - arụ ọrụ na metabolites ya na-abanye n'ime mmiri ara, ya mere, a ga-akwụsị ịctụ ọgwụ na mmiri ọgwụ. Enweghị ozi na mwepu nke clopidogrel na mmiri ara nne. A machibidoro "Lopirel" maka ụmụaka na-erubeghị afọ iri na asatọ.

Lopirel nwere ọgwụ ọgwụ dochie anya:

"Plagril."
Egithromb.
Plavix.
"Deplatt 75".
Detrombe.
Clapitax.
"Listab 75".
Zilt.
Avix.
"Orogrel".
Brilinta.
"Platogril."
Reomax.
"Medogrel".
Cardogrel.
Tessiron.
"Clorelo."
Klopikor.
Claridol
Gridoklein.

Tupu i jiri mmanu dochie ihe ndi izizi, gwaa ndi dibia bekee.

Ọgwụ ahụ dị n'ụdị mbadamba ụrọ, ndị nwere ihe mkpuchi na fim. Ha nwere okirikiri, udi biconvex, pink dị na agba. Mbadamba ụrọ na-achịkọta mbadamba iri. "Plagril" bụ analog nke "Lopirel".

Abalị abụọ agachachara ịsụ ọgwụ mbụ - narị milligrams anọ - na - egbochi mkpokọta platelet. A na-enweta nsonaazụ kachasị mgbe ụbọchị asaa gasịrị, iji ọgwụ ahụ mgbe niile na usoro onunu ogwu site na iri ise ruo otu narị milligrams kwa ụbọchị.

Dabere na ntuziaka maka iji Lopirel analogue 75 mg, a maara na mmetụta ọgwụ ahụ na-adịgide ruo ụbọchị iri. Mgbe ejiri “Plagril” kwụsị ọrụ ọgwụgwọ ruo ụbọchị ise, oge ọbara ọgbụgba na ngwakọta platelet na-alaghachi ọkwa mbụ ha. Ọgwụ na-egbochi ọdịdị nke atherothrombosis n'ime ndị nwere ọrịa vaskụla atherosclerotic.

Ekwesịrị ịkwụsị ọgwụ ị Dụ ọgwụ ọjọọ ruo ụbọchị asaa tupu ịwa ahụ, bụ nke mmetụta antiplatelet na-adịghị mma. N'okwu a, onye ahụ ga-agwa dọkịta ọkachamara banyere ọnọdụ ọ bụla na-agba ọbara n'oge iji Plagril. Na mgbakwunye, ọ bụrụ na mmadụ ga-awa ahụ ma ọ bụ edee ọgwụ ọzọ, onye ọrịa ahụ gwakwara dọkịta banyere iji Plagril. N'oge ọgwụgwọ, ọ dị mkpa iji nyochaa ọrụ imeju.

Ọgwụ na-enyere aka belata ọdọ mmiri platelet, nke ndị ọzọ na-akpasu iwe, na-egbochi mgbali ha site na adenosine diphosphate wepụtara.

Dabere na ntuziaka ahụ, a na-eji anapia Lopirel eme ihe maka prophylactic iji gbochie ihe omume nke atherothrombosis:

N'ime ndị nwere nsogbu infadeji myocardial, yana ọrịa strok ischemic nwere ọnya ọnya ụkwara akwara.
N'ime ndị nwere nnukwu ọrịa obi.
N'ime ndị ọrịa na-agagharị mgbe ọrịa angioplasty na -akpata.

Na mgbakwunye, a na-atụ aro Klopikor maka ebumnuche prophylactic nke thromboembolic, ihe omume atherothrombotic nwere fibrillation atrial.

Mgbe ị na-a aụ ọgwụ na usoro onunu ogwu nke milligrams iri asaa na ise kwa ụbọchị, a na --emechi nnukwu nchịkọta platelet site na ụbọchị mbụ ọgwụgwọ. N'ime ụbọchị asaa na-esote, usoro a na-abawanye.

Mwepu usoro e guzobere platelet na ogo ihe ruru ogo iri anọ na isii na iri isii (mgbe ị na-a medicationụ ọgwụ ahụ n'ọtụtụ miligram iri asaa na ise kwa ụbọchị). Mgbe ịkwụsị ọbara ọgbụgba gasịrị, ogo nke platelet weghachiri ọkwa nke ụbọchị ise.

Dika nyocha, analog nke Lopirel 75 mg - Zilt na - enyere aka igbochi nbibi nke obi ma obu ntiwapu nke ndi oria bu oria atherosclerosis.

A na-etinye ihe dị n'ọrụ ngwa ngwa mgbe nchịkwa ọnụ gasịrị. Ihe kachasị nke clopidogrel bụ nkezi nke 2.2-2.5 nanogram kwa milliliter (mgbe ịghasịrị milligrams iri asaa na ise). Oge ị ga - eji nweta oge itinye uche kacha ihe dị ka nkeji iri anọ na ise. Ogo ogo nnabata nke ihe dị n’ọrụ, dịka ozi si dị na excretion nke ngwaahịa metabolic n’arụ site n’akụrụ ya bụ pasenti iri ise.

Ekwadoghi ka o nye ndi mmadu oria otutu isi isi akpukpo ogwu ka o gha erughị otu izu. "Zilt" gbatịkwuru oge ọbara ọgbụgba, ekwesịrị iburu nke a n'uche mgbe ejiri ya mee ihe "Aspirin", ọgwụ mgbochi ọgwụ steroidal, "Heparin" na "Warfarin". Ekwesịrị ilebara ndị ọrịa dị otú a anya maka ịba ụba na ticlopidine, prazogrel na thienopyridines ndị ọzọ, ebe ọ bụ na ịgafe mmeghachi omume na-arịwanye elu n'etiti ọgwụ otu a ga-ekwe omume.

Mgbe ị na-egosi na akụkọ banyere ahụike nke onye ọrịa banyere mmụba na ọrịa ndị ọzọ, a ga-elezi anya nke ọma n'oge ọgwụgwọ iji mata akara nke hypersensitivity ahụ. Mgbe ị na-akwadebe onye ọrịa maka ịwa ahụ, ekwesịrị ịkwụsị ọgwụ ọ ga-akwụsị ụbọchị ise ruo ụbọchị asaa.

Ekwesịrị ịdọ mmadụ aka na ntị gbasara ike ịnwe ọbara ọgbụgba ogologo oge n'oge ọgwụgwọ yana ọ dị mkpa ịgwa ndị ọkachamara n'ihe gbasara ahụ ike gbasara ọbara ọ bụla. Mgbe gị na ndị dọkịta ndị ọzọ na-akparịta ụka, ị kwesịrị ị na-akọ banyere iji "Zilt", ozi a dị mkpa ma mgbe ị na-ede ọgwụ ọhụrụ, yana mgbe ị na-eleta dọkịta ezé.

Nke a bụ ọgwụ antithrombotic na-akpaghasị mkpakọrịta platelet, na-egbochi usoro ijikọ adenosine diphosphate na ndị na-anabata ya dị na mpempe platelet, ma na-emekwa ka ndị na-anabata glycoprotein na-arụ ọrụ. "Reomax" na-enyere aka belata nchịkọta platelet, nke ndị agonist ọzọ na-akpasu iwe, na-egbochi ịgbali ha site na adenosine diphosphate wepụtara.

Ihe na - arụ ọrụ (clopidogrel) na - eji nhọrọ adenosine diphosphate na ndị na - anabata platelet, na - egbochi mkpakọrịta ha. N’agaghị eme ọnụ na njikọ akwara ndị a, na - eme ka mkpụrụ ndụ ọbara na - arụ ọrụ n’oge ndụ ha niile "ndụ". Egithromb bụ analogue nke mbadamba Lopirel.

A na - achọpụta nrụgide nke mkpakọrịta mgbe awa abụọ gachara, ana - ahụkarị nsonaazụ kachasị mgbe ụbọchị ise ruo ụbọchị asaa gasịrị. Ọ naghị emetụta ọrụ nke otu enzymes nke na - eme ka njikọ phosphodiester kwụsị.

N'iburu ọnya ọrịa ụbụrụ na-adịghị ala ala, bụ nke a na-etinye cholesterol na abụba ndị ọzọ na mgbidi nke akwara n'ụdị oghere na paịlị, mgbidi ahụ n'onwe ya na-abawanye ma na-efunahụ ike, ọgwụ na-enyere aka gbochie thrombosis.

Ọgwụ ahụ na-anọchite anya otu ọgwụ ọgwụ - ọgwụ mgbochi. A na-eji ya egbochi nsogbu atherothrombotic n'ọtụtụ usoro pathologies nke ọrịa obi.

Ngwakọta dị ike na mbadamba Plavix bụ clopidogrel. Ọ na - egbochi usoro gluing platelet. Mmetụta ndu a na - apụta n'ihi ngbanye usoro nke mgbakwunye nke adenosine diphosphoric acid na njedebe akwara nke platelet yana ịgbaso usoro nke mgbakwunye ha. Mmetụta a na-adị na ndụ niile nke platelet (ụbọchị asaa ruo ụbọchị iri), yabụ na ị ga-ebido ịmalite nchịkọta na-apụta naanị mgbe a mụchara mkpụrụ ndụ.

Mmetụta ọgwụ na-emetụta Plavix na-apụta mgbe mgbanwe nke clopidogrel na imeju, ma mepụta ngwaahịa metabolic na-arụ ọrụ, nke na-egbochi usoro nrapado platelet. Mgbe ịmalite iji Plavix, a na-eme mmechi nke ọrụ mgbochi ụbọchị abụọ ruo ụbọchị atọ wee rute ọkwa mgbe niile.

Mgbe akwụsịrị ọgwụgwọ Plavix, arụ ọrụ platelet na-amalite ụbọchị ise ruo ụbọchị asaa. The significantlyụ ọgwụ n’ụzọ doro anya na-ebelata ohere ọ ga -eme ka ọ bụrụ ọrịa ụbụrụ ụbụrụ, yana ọrịa infịction na myocardial n'ọrịa dị iche iche nke obi na arịa ọbara, tinyere mmụba na mbufụt atrial, nke na-eme ka ohere ọbara ọgbụgba dị na ha pụta.

Ọgwụ a sitere na ọgwụ ọgwụgwọ - ndị na - ahụ maka ọgwụ mgbochi na anticoagulants. A na-eji Brilinta na usoro ọgwụgwọ siri ike nke ọrịa obi, nke enwere ohere dịwanye ukwuu nke mkpụkọ ọbara n'ime akpa, nke nwere ike ibute ọrịa ụbụrụ ma ọ bụ infarction myocardial.

Mgbe ọ usingụsịrị ọgwụ ahụ, a na-etinye ọnụ ngwa ngwa nke ọgwụ ahụ n'ọbara site na obere eriri afọ. A na-enweta ọdịnaya ọgwụ ahụ n’ime ọbara ka nkeji iri abụọ na atọ ka ọ theụchara ọgwụ ahụ, a na-enweta ntinye kachasị mgbe elekere isii na ọkara gachara.

Akụkụ ahụ nọ n'ọrụ na-agbasa n'ime akwara niile nke anụ ahụ, na-agafe ihe mgbochi site na anụ ahụ ụbụrụ nakwa site na mgbochi ihe na-egbochi nwa ebu n'afọ na mmiri ara ehi. A na-agbanwegharị ihe dị omimi (ticagrelor) na sel nke imeju, ngwaahịa ya ire ere na-apụ apụ apụ. Ndụ ọkara ahụ bụ ihe dịka awa asaa.

Jiri na ndị ọrịa nwere usoro amamịghe gbalitere nke CYP2C19 isoenzyme

Site na obere ọrụ nke CYP2C19 isoenzyme, mmetụta antiplatelet nke clopidogrel na-ebelata. Mgbe ị na-eji ọgwụ ndị dị elu (ọnụọgụ ọgwụ nke 600 mg, ma 150 mg kwa ụbọchị), mmetụta antiplatelet nke clopidogrel na-abawanye. N'iburu n'uche nsonaazụ nyocha nke ọmụmụ a, ọ gaghị ekwe omume igosi usoro usoro ọgwụgwọ kachasị mma maka ndị ọrịa nwere metabolism dị ala n'ihi ịdị ala nke CYP2C19 isoenzyme.

Jiri na ndị ọrịa nke agbụrụ dị iche iche

Maka ndị nnọchi anya agbụrụ dị iche iche, ọnụ ọgụgụ mkpụrụ ndụ ihe nketa nke CYP2C19 mkpụrụ ndụ ihe anaenzyme, nke bụ maka mbelata na metabolism metabolic na clopidogrel na metabolite nọ n'ọrụ. Enwere naanị ozi dị nta na ndị nnọchi anya agbụrụ Mongoloid gbasara nyocha nke mmekọrịta dị n'etiti CYP2C19 isoenzyme genotype na nsonaazụ ụlọ ọgwụ.

Jiri na ụmụ nwoke na ụmụ nwanyị

Obere omumu atunyero ọgwụ nke Lopirel na nmekorita nwoke na nwanyi gosiputara nzacha di omimi nke ADP na - abanye na platelet n'ime umu nwanyi, mana odighi iche na oge obara. Na nnukwu nnyocha a na-achịkwa na CAPRIE (njikọta nke clopidogrel na acetylsalicylic acid na ndị ọrịa nwere ike ịbawanye ike na nsogbu na - ebute ischemic nsogbu) n'ime ụmụ nwanyị na ụmụ nwoke, ugboro ole nsonaazụ na-adakarị ahụ, ihe nlere na nyocha ụlọ nyocha site na iwu, mmetụta ndị ọzọ bụ otu.

Nsonaazụ

Emere nnyocha nchekwa banyere ihe karịrị ndị ọrịa 44,000, gụnyere ihe karịrị ndị ọrịa 12,000 ndị gwọworo ma ọ dịkarịa ala otu afọ. Nkwekọrịta izugbe nke clopidogrel yiri nnabata nke acetylsalicylic acid, n'agbanyeghị agbụrụ, okike na afọ nke ndị ọrịa. Otutu omumu ihe omumu (CURE, CAPRIE, COMMIT, CLARITY, ACTIVE A) kpughere ihe omimi di egwu.

N'ime ule CAPRIE, nnabata nke clopidogrel (ọgwụ kwa ụbọchị nke 75 mg) kwekọrọ na nke acetylsalicylic acid (kwa ụbọchị nke 325 mg). Ozi ebuputara nwere ozi banyere mmeghachi omume ọjọọ.

N'ime ule ụlọ ọgwụ na iji ire ere clopidogrel, edere ikpe ikpe ọbara ọgbụgba (ọkachasị na ọnwa izizi).

N ’ụlọ nyocha CAPRIE, ọnụego ọbara ọgbụgba niile ejiri ojiji clopidogrel ma ọ bụ acetylsalicylic acid bụ 9.3%. Edere ọbara ọgbụgba na clopidogrel n'otu oge ọ bụla ka ọ jiri acetylsalicylic acid.

N ’nlere anya nyocha ogwu gbasara iji ogwu acholsalicylic acid na clopidogrel ruo ubochi asaa mgbe akwara akwara akwula ogwu n’azu ndi oria ndi kwusiri ogwu kariri ubochi ise tupu aria ya, ahughi otutu ugboro. N'ime ndị ọrịa bụ ndị gara n'ihu na-a complexụ ọgwụ ọgwụ ndị a maka ụbọchị 5 tupu mmalite nke akwara ọbara na-agbanye grafting, a hụrụ ọbara ọgbụgba na ọtụtụ ugboro 9.6% (maka njikọta acetylsalicylic acid + clopidogrel) na 6.3% (maka nchikota acetylsalicylic acid + placebo).

Nnwale ụlọ ọgwụ CLARITY gosipụtara mmụba zuru oke na ọbara ọgbụgba maka acetylsalicylic acid + clopidogrel otu ma e jiri ya tụnyere acetylsalicylic acid + placebo group. N'ime otu abụọ ahụ, ugboro ole ọbara ọgbụgba yiri nke ahụ ma ọ fọrọ nke nta ka ọ ghara ịnwe ụdị ọgwụgwọ heparin ma ọ bụ ọrịa fibrinolytic yana njirimara mbụ nke ndị ọrịa.

N'ime ule ụlọ ọgwụ COMMIT, ọnụ ọgụgụ ọbara ọgbụgba ma ọ bụ nnukwu ọbara ọgbụgba dị ala ma ọdịghị iche maka otu abụọ a.

N'ime ule ụlọ ọrụ 'ACTIVE-A, ihe kpatara ọbara ọgbụgba dị elu maka acetylsalicylic acid + clopidogrel otu karịa maka acetylsalicylic acid + placebo group (6.7% na 4.3%, otu isi). N'ụzọ bụ isi, ọbara ọgbụgba dị ukwuu na otu abụọ ahụ bụ extracranial (5.3% na 3.5%, otu ọ bụla), ọtụtụ mgbe na-agba ọbara gbasara eriri afọ (3.5% na 1.8%, n'otu n'otu). N'ime acetylsalicylic acid + clopidogrel otu, ọbara ọgbụgba intracranial bụ ihe a na-ahụkarị ma e jiri ya tụnyere acetylsalicylic acid + placebo group (1.4% na 0.8%, otu isi). Enweghị ụdị dị iche iche dị iche iche maka ọnụ ọgụgụ ndị a n'ihe metụtara ọbara ọgbụgba (0.8% na 0.6%, otu ọ bụla) na ọbara ọgbụgba na-egbu (1.1% na 0.7%, otu isi).

N'ime omumu ihe omumu ihe banyere ya na akuko gbasara oge, edere ihe ojoo ndi a:

sistemu lymphatic na mgbasa: infesquently - eosinophilia, leukopenia, thrombocytopenia, na-adịkarịghị neutropenia (gụnyere neutropenia siri ike), adịkarịghị aplastic anaemia, thrombotic thrombocytopenic purpura, agranulocytosis, pancytopenia, thrombocytopenia, granulocycyia, granulocycyia
dịghịzi - mmeghachi omume anaphylactoid, ọrịa serum, ugboro ole amabeghị - mmepe nke mmeghachi omume nke hypersensitivity na thienopyridines (dịka ọmụmaatụ, yana ticlopidine na prasugrel),
psyche: ọ na - esighi ike - ọgba aghara, ihe ijuanya,
sistem ụjọ: ugboro ugboro - isi ọwụwa, ọbara ọgbụgba (intracranial hemorrhage) (ihe ụfọdụ na - akpata nsonaazụ), dizziness, paresthesia, very slight - uto ọgba aghara,
ọhụụ: ọnya na - adịghị ala ala (na anụ ahụ nke anya, conjunctiva, retina),
na-anụ ihe: adịkarịghị - vertigo,
arịa ọbara: ọtụtụ mgbe - hematomas, adịkarịghị ala - ọbara ọgbụgba site na arụmọrụ, ọbara ọgbụgba, mbelata ọbara mgbali, vasculitis,
usoro iku ume: ọtụtụ mgbe - imi imi, ọ na-adịkarị - bronchospasm, ọbara ọgbụgba site na sistem okuku ume (akwara umeji, hemoptysis), ọnyụ na -akpata eosinophilic, ọnyá afọ,
eriri afọ: ọgbụgba, ọnya afọ, dyspepsia, mgbu nke afọ, eriri afọ, afọ na ọnya afọ, ọgbụgbọ, ọgbụgbọ, ọnya afọ, afọ ọsịsọ, ọbara ọgbụgba na-adịkarị ala, ọ na-adịkarịkeghachi azụ na akwara afọ. ọbara ọgbụgba na-egbu egbu, ọnya afọ (gụnyere lymphocytic ma ọ bụ ọnya afọ), pancreatitis, stomatitis,
umeji na urinary tract: dịkarịsịrị ala - ịba ọcha n'anya, oke imeju ọdịda, ọrịa na ụlọ nyocha nke ọnọdụ imeju,
anụ ahụ na ọnya subcutaneous: mgbe mgbe - mmerụ ahụ, ugboro ugboro - itching, ihe ngbu, purpura, nnọọ adịkarịghị - angioedema, bullous dermatitis (erythema multiforme, Stevens-Johnson syndrome, toxic epidermal necrolysis), syndrome hypersensitivity syndrome, erythematic or refoliative rash Oria nwere osooso na eosinophilia, urticaria, lichen planus, eczema,
musculoskeletal na anụ ahụ na - ejikọta ọnụ: ọ na - adịkarịghị - ogbu na nkwonkwo, hemarthrosis (ọbara ọgbụgba na usoro akwara), myalgia, arthralgia,
akụrụ na urinary tract: ugboro ugboro - hematuria, nke ukwuu adịkarịghị - mmụba nke mkpokọta nke creatinine n'ime ọbara, glomerulonephritis,
Ihe omumu na ihe omumu: ihe ngbali - onu ogugu na –eme ka ogha n’enweghi ogwu, mmụba n’oge ọbara na-agba, mbelata ọnụ ọgụgụ platelet,
nkwarụ n’ebe a na-agba ya na nsogbu niile: ọ na - abụkarị ọbara ọgbụgba sitere na ebe ụkọ, ọ na - adịkarị ọkụ - ahụ ọkụ.

Ọbara ọgbụgba, ọgba aghara hematological

Mgbe akara ngosipụta nke akwara gosipụtara ihe na-ebute ọbara ọgbụgba na ihe nwere ike ibute nsonaazụ na-adịghị mma, ọ dị mkpa ka a duzie nnwale ọbara n’egwuregwu, chọpụta oge akụkụ thromboplastin na-arụ ọrụ, ọnụ ọgụgụ platelet, arụmọrụ platelet, na ọmụmụ ihe ndị ọzọ dị mkpa.

Ekwesịrị iji Lopirel kpachara anya na ndị ọrịa nwere nnukwu ọbara ọgbụgba nke metụtara ọrụ ịwa ahụ, mmerụ ahụ, ọnọdụ ndị ọzọ, na ndị ọrịa na-enweta ọgwụ mgbochi na - abụghị ọgwụ steroidal (ọkachasị, acetylsalicylic acid, heparin, COX-2 inhibitors, glycoprotein IIb / IIb / inhibitors) IIIa ma obu serotonin reuptake inhibitors).

N'ime izu ndị mbụ nke ọgwụgwọ Lopirel na / ma ọ bụ mgbe usoro ọrịa obi ma ọ bụ usoro ịwa ahụ gasịrị, a ga-ebu ụzọ nyochaa ihe ịrịba ama nke ọbara ọgbụgba, gụnyere latent,.

N'ihi mmụba ọ nwere ike ịbawanye ike n'ọbara, a naghị atụ aro ijikọ ọnụ nke Lopirel na warfarin. Ewezuga ahụ bụ ọnọdụ adabaghị adaba: ọnụnọ n'aka ekpe ventricle nke thrombus na-ese n'elu mmiri, na-agbagide ndị ọrịa nwere fibrillation atrial, wdg.

N'ihe banyere ọrụ ịwa ahụ na-abịanụ na enweghị mkpa iji hụ na ọ nwere mmetụta antiplatelet, a ga-akwụsị nchịkwa Lopirel ụbọchị 7 tupu etinye aka.

Tupu ịmalite ọgwụ ọhụụ ọ bụla na tupu ịwa ahụ na-abịanụ, onye ọrịa ahụ aghaghị ịgwa dọkịta (gụnyere dọkịta ezé) banyere ị Loụ Lopirel.

Ọgwụ ahụ na-agbatị oge ọbara ọgbụgba, yabụ, ekwesịrị iji ya kpachara anya na ndị ọrịa nwere ọrịa ọria ọbara ọgbụgba (karị intraocular na eriri afọ).

Ekwesịrị ịdọ onye ọrịa aka na ntị ma ọ bụrụ na ị ofụ Lopirel (na monotherapy ma ọ bụ jikọtara ya na acetylsalicylic acid), ịkwụsị ọbara ọgbụgba ahụ chọrọ oge ka ukwuu. Ọ bụrụ na ọbara ọgbụgba na-enweghị atụ pụtara (site na oge ma ọ bụ mpaghara), ị kwesịrị ịkpọtụrụ dọkịta gị.

Thrombotic Thrombocytopenic Purpura (TTP)

Ọbụna mgbe obere mkpụkọ Clopidogrel dị mkpụmkpụ, enwere obere ikpe nke thrombotic thrombocytopenic purpura, nke a na-ahụ maka thrombocytopenia, microangiopathic hemolytic anaemia, na-eso arụ ọrụ na-arụ ọrụ na-arụ ọrụ, ahụ ọkụ, nsogbu akwara ozi. A na - ewere TTP dika ihe nwere ike igbu ndu nke choro ọgwụgwọ ozugbo, tinyere plasmapheresis.

Inweta haemophilia

N'oge ọgwụgwọ Clopidogrel, edekọwo okwu gbasara ọrịa haemophilia. Mgbe ị na –ekwupụta oge ebumnuche akụkụ akụkụ nke akụkụ ahụ na - enweghị ọbara ọgbụgba, ma ọ bụ jiri ya, ịkwesịrị ịtụle ohere nke ịnweta ọbara, ma ọ bụrụ na enyochaa nchọpụta kwesịrị ekwesị, kwụsịrị iji Lopirel ma malite ọgwụgwọ zuru oke.

Ọrịa ụsọ ischemic na-adịbeghị anya

A naghị atụ aro Lopirel mgbe ị na-edepụta nnukwu ọrịa ischemic ọrịa strok ruo ụbọchị 7 gara aga n'ihi enweghị data gbasara ojiji a na ọnọdụ a.Ọgwakọta ọgwụ na acetylsalicylic acid na clopidogrel n'ime ndị ọrịa nwere ọrịa ọgụ oge na-adịghị anya ma ọ bụ ọrịa ischemic na enwere ike nke mgbapụta atherothrombotic ugboro ugboro adịghị arụ ọrụ karịa monotherapy na clopidogrel, mana enwere nnukwu ohere nke ọbara ọgbụgba.

Ime na lactation

Ọmụmụ anụmanụ anaghị ekpughe mmetụta ọjọọ na Clopidogrel na uto nke ime ime, afọ ime, ịmụ nwa, na mmepe mgbe amụ nwa, mana n'ihi enweghị data nyocha dị mkpa, ojiji nke Lopirel bụ contraindicated na ndị ọrịa dị ime.

N'ime nyocha banyere oke, achọpụtara na clopidogrel na metabolites ya na-abanye n'ime mmiri ara, ya mere, n'ihe banyere Lopirel, a ga-akwụsị inye ara ya. Enweghị data maka ịhapụ clopidogrel na mmiri ara ara mmadụ.